Daily Papers

High-fidelity simulations and complex inverse problems, such as detector modeling and unfolding, are computationally intensive bottlenecks across subatomic physics, yet essential for accurate physical interpretation. While Conditional Flow Matching (CFM) offers a robust acceleration approach, we demonstrate its standard training loss is fundamentally misleading. Specifically, utilizing a Jefferson Lab Nuclear Physics (NP) kinematic dataset (γp to ρ^0 p to π^+π^- p), we expose that CFM loss plateaus prematurely, obscuring ongoing physical refinement. To verify this disconnect is a dataset-agnostic pathology, we introduce ScatterPrism, an efficient generative surrogate evaluated against both the NP data and synthetic stress tests modeling challenging 1D distribution topologies. Coupling these benchmarks, we establish that physics-informed metrics continue improving long after standard loss converges. Consequently, we propose a multi-metric diagnostic protocol to ensure true kinematic fidelity without data memorization. Driven by NP challenges relevant to the forthcoming Electron-Ion Collider (EIC), this unified machinery has strong potential to extend to High-Energy Physics (HEP) applications, such as jet modeling. Furthermore, the framework holds promise for broader domains requiring rigorous generative reliability, including medical imaging, astrophysics, and quantitative finance.

Clinical diagnosis is critical in medical practice, typically requiring a continuous and evolving process that includes primary diagnosis, differential diagnosis, and final diagnosis. However, most existing clinical diagnostic tasks are single-step processes, which does not align with the complex multi-step diagnostic procedures found in real-world clinical settings. In this paper, we propose a multi-step diagnostic task and annotate a clinical diagnostic dataset (MSDiagnosis). This dataset includes primary diagnosis, differential diagnosis, and final diagnosis questions. Additionally, we propose a novel and effective framework. This framework combines forward inference, backward inference, reflection, and refinement, enabling the LLM to self-evaluate and adjust its diagnostic results. To assess the effectiveness of our proposed method, we design and conduct extensive experiments. The experimental results demonstrate the effectiveness of the proposed method. We also provide a comprehensive experimental analysis and suggest future research directions for this task.

Recent text-to-video (T2V) technology advancements, as demonstrated by models such as Gen2, Pika, and Sora, have significantly broadened its applicability and popularity. Despite these strides, evaluating these models poses substantial challenges. Primarily, due to the limitations inherent in automatic metrics, manual evaluation is often considered a superior method for assessing T2V generation. However, existing manual evaluation protocols face reproducibility, reliability, and practicality issues. To address these challenges, this paper introduces the Text-to-Video Human Evaluation (T2VHE) protocol, a comprehensive and standardized protocol for T2V models. The T2VHE protocol includes well-defined metrics, thorough annotator training, and an effective dynamic evaluation module. Experimental results demonstrate that this protocol not only ensures high-quality annotations but can also reduce evaluation costs by nearly 50%. We will open-source the entire setup of the T2VHE protocol, including the complete protocol workflow, the dynamic evaluation component details, and the annotation interface code. This will help communities establish more sophisticated human assessment protocols.

Selective Classification, wherein models can reject low-confidence predictions, promises reliable translation of machine-learning based classification systems to real-world scenarios such as clinical diagnostics. While current evaluation of these systems typically assumes fixed working points based on pre-defined rejection thresholds, methodological progress requires benchmarking the general performance of systems akin to the AUROC in standard classification. In this work, we define 5 requirements for multi-threshold metrics in selective classification regarding task alignment, interpretability, and flexibility, and show how current approaches fail to meet them. We propose the Area under the Generalized Risk Coverage curve (AUGRC), which meets all requirements and can be directly interpreted as the average risk of undetected failures. We empirically demonstrate the relevance of AUGRC on a comprehensive benchmark spanning 6 data sets and 13 confidence scoring functions. We find that the proposed metric substantially changes metric rankings on 5 out of the 6 data sets.

Diagnosing 802.11 packet captures requires expert protocol knowledge, is slow, inconsistent across engineers, and unscalable. LLM-based approaches sound plausible but fabricate protocol events absent from captures (especially truncated traces), produce uncalibrated confidence scores, and suffer evaluation bias when golden references are co-produced by the model under test. We introduce PROBE (Protocol Reasoning Over evidence-Based Ensembles), a multi-stage pipeline addressing all three failures. It integrates (i) deterministic PCAP-to-text normalization with frame-level verifiability, (ii) multi-run, multi-candidate ensembles with optional cross-model second opinion and progressive obfuscation, (iii) a verdict-aware evidence framework treating absence of failure evidence as contributing evidence, and (iv) a fully deterministic composite reliability score from evidence validity, run-to-run stability, and cross-model agreement without LLM self-assessment. On 87 enterprise Wi-Fi captures (104 capture-reviewer pairs), single-pass LLM analysis raises weighted evidence F1 from 0.871 (expert baseline) to 0.912 but misses critical frames in 35% of cases. Naive ensemble voting drops below baseline (0.842) as majority voting amplifies conservative verdicts: 50% of confirmed failures are misclassified as 'no issue' or 'insufficient evidence.' Adding evidence-grounded reconciliation achieves 0.957 F1, a 96% auto-accept rate, and a worst-case floor above 0.70. LLM self-reported confidence clusters at 0.95 regardless of difficulty (71% report exactly 0.95), confirming it is uninformative. We also introduce a model-agnostic evaluation framework using per-field assertion matching, eliminating circular bias from model-co-produced golden references.

Traditional metrics for Medical Report Generation (MRG) predominantly rely on surface-level n-gram overlap, which fails to capture clinical factual accuracy and often overlooks catastrophic diagnostic errors. We address this fundamental limitation by proposing AtomiMed, a universal, modality-agnostic evaluation framework that decomposes complex medical narratives into a standardized, multi-level hierarchy of Atomic Clinical Facts, encompassing Disease-level entities and Attribute-level descriptors, including location, morphology, and severity. By implementing an Agentic Cross-Verification loop between ground-truth and predicted reports, AtomiMed simulates a multi-radiologist peer-review process to verify clinical consistency, thus enabling the decoupled assessment of diagnostic detection and descriptive accuracy. To facilitate standardized evaluation, we introduce MRGEvalKit, an open-source toolkit for automated hierarchical extraction, and curate OmniMRG-Bench, a comprehensive multi-modal benchmark covering X-ray, CT, MRI, and Ultrasound. Extensive experiments on multiple expert-annotated reader studies demonstrate that AtomiMed achieves significantly higher correlation with human radiologist judgment compared to traditional and model-based metrics. Our code are release at https://github.com/Venn2336/MRGEvalkit

The evaluation of generative models for natural image tasks has been extensively studied. Similar protocols and metrics are used in cases with unique particularities, such as Handwriting Generation, even if they might not be completely appropriate. In this work, we introduce three measures tailored for HTG evaluation, HTG_{HTR} , HTG_{style} , and HTG_{OOV} , and argue that they are more expedient to evaluate the quality of generated handwritten images. The metrics rely on the recognition error/accuracy of Handwriting Text Recognition and Writer Identification models and emphasize writing style, textual content, and diversity as the main aspects that adhere to the content of handwritten images. We conduct comprehensive experiments on the IAM handwriting database, showcasing that widely used metrics such as FID fail to properly quantify the diversity and the practical utility of generated handwriting samples. Our findings show that our metrics are richer in information and underscore the necessity of standardized evaluation protocols in HTG. The proposed metrics provide a more robust and informative protocol for assessing HTG quality, contributing to improved performance in HTR. Code for the evaluation protocol is available at: https://github.com/koninik/HTG_evaluation.

Large-scale AI training is now fundamentally a distributed systems problem, and hardware failures have become routine operating conditions rather than rare exceptions. Public operational evidence from production training clusters, however, remains scarce. This technical report presents an empirical analysis of a 63-node NVIDIA B200 production cluster (504 GPUs), using 55 days of Prometheus time-series data and 73 days of operational logs covering 224 multi-node training sessions. The cluster operates within a cross-organizational environment in which five parties (SKT, Upstage, Lablup, NVIDIA Korea, and VAST Data) share a unified monitoring pipeline. This arrangement enabled joint diagnosis of a 60-node-scale storage I/O bottleneck that did not appear at 2-4-node scale, a production-scale phenomenon no single team could isolate alone. Drawing on a months-long pre-training campaign, we perform three quantitative analyses yielding four findings. First, statistical analysis over 751 Prometheus metrics and 10 XID-identified GPU failures achieves a 10/10 detection rate (2/10 pre-XID) at ~0.84 false positives per day. No single metric is consistently dominant across failure types, motivating a multi-signal detection strategy. Second, profiling 523 checkpoint events along the GPU VRAM to NFS path attributes the "bandwidth paradox" (1.4-10.4% utilization of 200 Gbps RoCE) to saturation of the 128-slot NFS RPC layer. Third, multi-node failure response shows concentrated exclusions (top 3 of 63 nodes account for >50% of all exclusions) and an auto-retry chain success rate of 33.3% over 12 chains (73 attempts), 2.7x the 12.5% manual recovery rate; the median retry interval is 11 min (IQR 10-11). All analyses are grounded in production infrastructure providing session-level workload management, GPU-centric scheduling, and unified observability.

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

This paper presents our team's participation in the MEDIQA-ClinicalNLP2024 shared task B. We present a novel approach to diagnosing clinical dermatology cases by integrating large multimodal models, specifically leveraging the capabilities of GPT-4V under a retriever and a re-ranker framework. Our investigation reveals that GPT-4V, when used as a retrieval agent, can accurately retrieve the correct skin condition 85% of the time using dermatological images and brief patient histories. Additionally, we empirically show that Naive Chain-of-Thought (CoT) works well for retrieval while Medical Guidelines Grounded CoT is required for accurate dermatological diagnosis. Further, we introduce a Multi-Agent Conversation (MAC) framework and show its superior performance and potential over the best CoT strategy. The experiments suggest that using naive CoT for retrieval and multi-agent conversation for critique-based diagnosis, GPT-4V can lead to an early and accurate diagnosis of dermatological conditions. The implications of this work extend to improving diagnostic workflows, supporting dermatological education, and enhancing patient care by providing a scalable, accessible, and accurate diagnostic tool.

The field of medical diagnosis has undergone a significant transformation with the advent of large language models (LLMs), yet the challenges of interpretability within these models remain largely unaddressed. This study introduces Chain-of-Diagnosis (CoD) to enhance the interpretability of LLM-based medical diagnostics. CoD transforms the diagnostic process into a diagnostic chain that mirrors a physician's thought process, providing a transparent reasoning pathway. Additionally, CoD outputs the disease confidence distribution to ensure transparency in decision-making. This interpretability makes model diagnostics controllable and aids in identifying critical symptoms for inquiry through the entropy reduction of confidences. With CoD, we developed DiagnosisGPT, capable of diagnosing 9604 diseases. Experimental results demonstrate that DiagnosisGPT outperforms other LLMs on diagnostic benchmarks. Moreover, DiagnosisGPT provides interpretability while ensuring controllability in diagnostic rigor.

The Model Context Protocol (MCP), introduced by Anthropic in November 2024, defines a standardized interface for connecting large language models (LLMs) to external tools, data sources, and services. Within months of release, hundreds of community-built MCP servers appeared on GitHub, but no software-maintenance literature has yet described how the ecosystem is being structured in production. This industry experience paper catalogues five recurring MCP server architectural patterns observed across an enumerated corpus of fifteen independently developed servers (five production servers from the ANSYR voice AI platform plus ten public servers from the official MCP registry): Resource Gateway, Tool Orchestrator, Stateful Session Server, Proxy Aggregator, and Domain-Specific Adapter. Each pattern is described in the structured form of Gamma et al.: context, problem, solution, and consequences. We also document four anti-patterns and a set of cross-cutting concerns around authentication, versioning, and observability. The quantitative evaluation contributes three measurements: inter-rater reliability of the taxonomy across two independent LLM raters on 54 held-out servers (Cohen's kappa = 0.76), which also localizes three pattern-boundary ambiguities; transport overhead measured end-to-end on loopback and modeled for cross-host paths; and a tool-count study showing tool-selection accuracy drops below 90% between 10 and 15 tools per context for Claude Haiku 4.5 and between 20 and 30 tools for Sonnet 4. Code, corpus, and prompts are released as a replication package.

LLM confidence signals are used for abstention, routing, and safety-critical decisions. No standard practice exists for checking whether a confidence signal carries item-level information before building on it. We transfer the validity screening principle from clinical personality assessment (PAI, MMPI-3) as a portable protocol for benchmark-based LLM confidence data. The protocol specifies three core indices (L, Fp, RBS), a structural indicator (TRIN), and an item-sensitivity statistic, computed from a single 2x2 contingency table. A three-tier classification system (Invalid, Indeterminate, Valid) draws on four clinical traditions. Validated on 20 frontier LLMs across 524 items, four models are classified Invalid, two Indeterminate. Valid-profile models show mean r = .18 (15/16 significant). Invalid-profile models show mean r = -.20 (d = 2.48). Cross-benchmark validation on 18 models using MMLU with verbalized confidence and on external data from Yang et al. (2024) confirms the screen transfers across benchmarks and probe formats. All data and code: https://github.com/synthiumjp/validity-scaling-llm

Integrating Large Language Models (LLMs) in healthcare diagnosis demands systematic frameworks that can handle complex medical scenarios while maintaining specialized expertise. We present KG4Diagnosis, a novel hierarchical multi-agent framework that combines LLMs with automated knowledge graph construction, encompassing 362 common diseases across medical specialties. Our framework mirrors real-world medical systems through a two-tier architecture: a general practitioner (GP) agent for initial assessment and triage, coordinating with specialized agents for in-depth diagnosis in specific domains. The core innovation lies in our end-to-end knowledge graph generation methodology, incorporating: (1) semantic-driven entity and relation extraction optimized for medical terminology, (2) multi-dimensional decision relationship reconstruction from unstructured medical texts, and (3) human-guided reasoning for knowledge expansion. KG4Diagnosis serves as an extensible foundation for specialized medical diagnosis systems, with capabilities to incorporate new diseases and medical knowledge. The framework's modular design enables seamless integration of domain-specific enhancements, making it valuable for developing targeted medical diagnosis systems. We provide architectural guidelines and protocols to facilitate adoption across medical contexts.

Anomaly detection methods can be very useful in identifying unusual or interesting patterns in data. A recently proposed conditional anomaly detection framework extends anomaly detection to the problem of identifying anomalous patterns on a subset of attributes in the data. The anomaly always depends (is conditioned) on the value of remaining attributes. The work presented in this paper focuses on instance-based methods for detecting conditional anomalies. The methods rely on the distance metric to identify examples in the dataset that are most critical for detecting the anomaly. We investigate various metrics and metric learning methods to optimize the performance of the instance-based anomaly detection methods. We show the benefits of the instance-based methods on two real-world detection problems: detection of unusual admission decisions for patients with the community-acquired pneumonia and detection of unusual orders of an HPF4 test that is used to confirm Heparin induced thrombocytopenia - a life-threatening condition caused by the Heparin therapy.

Qualitative research faces a critical reliability challenge: traditional inter-rater agreement methods require multiple human coders, are time-intensive, and often yield moderate consistency. We present a multi-perspective validation framework for LLM-based thematic analysis that combines ensemble validation with dual reliability metrics: Cohen's Kappa (κ) for inter-rater agreement and cosine similarity for semantic consistency. Our framework enables configurable analysis parameters (1-6 seeds, temperature 0.0-2.0), supports custom prompt structures with variable substitution, and provides consensus theme extraction across any JSON format. As proof-of-concept, we evaluate three leading LLMs (Gemini 2.5 Pro, GPT-4o, Claude 3.5 Sonnet) on a psychedelic art therapy interview transcript, conducting six independent runs per model. Results demonstrate Gemini achieves highest reliability (κ= 0.907, cosine=95.3%), followed by GPT-4o (κ= 0.853, cosine=92.6%) and Claude (κ= 0.842, cosine=92.1%). All three models achieve a high agreement (κ> 0.80), validating the multi-run ensemble approach. The framework successfully extracts consensus themes across runs, with Gemini identifying 6 consensus themes (50-83% consistency), GPT-4o identifying 5 themes, and Claude 4 themes. Our open-source implementation provides researchers with transparent reliability metrics, flexible configuration, and structure-agnostic consensus extraction, establishing methodological foundations for reliable AI-assisted qualitative research.

Clinical diagnosis is a highly specialized discipline requiring both domain expertise and strict adherence to rigorous guidelines. While current AI-driven medical research predominantly focuses on knowledge graphs or natural text pretraining paradigms to incorporate medical knowledge, these approaches primarily rely on implicitly encoded knowledge within model parameters, neglecting task-specific knowledge required by diverse downstream tasks. To address this limitation, we propose Retrieval-Augmented Diagnosis (RAD), a novel framework that explicitly injects external knowledge into multimodal models directly on downstream tasks. Specifically, RAD operates through three key mechanisms: retrieval and refinement of disease-centered knowledge from multiple medical sources, a guideline-enhanced contrastive loss that constrains the latent distance between multi-modal features and guideline knowledge, and the dual transformer decoder that employs guidelines as queries to steer cross-modal fusion, aligning the models with clinical diagnostic workflows from guideline acquisition to feature extraction and decision-making. Moreover, recognizing the lack of quantitative evaluation of interpretability for multimodal diagnostic models, we introduce a set of criteria to assess the interpretability from both image and text perspectives. Extensive evaluations across four datasets with different anatomies demonstrate RAD's generalizability, achieving state-of-the-art performance. Furthermore, RAD enables the model to concentrate more precisely on abnormal regions and critical indicators, ensuring evidence-based, trustworthy diagnosis. Our code is available at https://github.com/tdlhl/RAD.

The potential of Multimodal Large Language Models (MLLMs) in domain of medical imaging raise the demands of systematic and rigorous evaluation frameworks that are aligned with the real-world medical imaging practice. Existing practices that report single or coarse-grained metrics are lack the granularity required for specialized clinical support and fail to assess the reliability of reasoning mechanisms. To address this, we propose a paradigm shift toward multidimensional, fine-grained and in-depth evaluation. Based on a two-stage systematic construction pipeline designed for this paradigm, we instantiate it with MedRCube. We benchmark 33 MLLMs, Lingshu-32B achieve top-tier performance. Crucially, MedRCube exposes a series of pronounced insights inaccessible under prior evaluation settings. Furthermore, we introduce a credibility evaluation subset to quantify reasoning credibility, uncover a highly significant positive association between shortcut behavior and diagnostic task performance, raising concerns for clinically trustworthy deployment. The resources of this work can be found at https://github.com/F1mc/MedRCube.

LLM judges are used to reduce the need for costly human labor in evaluating open-ended text generation. However, the reliability of these judges depends critically on their alignment with human raters -- a property that itself depends on costly human annotations. In this work, we develop a method (Metric Match) for estimating correlation-based reliability metrics of LLM judges from limited annotations. Metric Match selects a subset of samples for human annotation such that the subset matches the population reliability metric with respect to acquired synthetic labels. We empirically show that Metric Match achieves a win-rate of 0.838 against random subset selection across four different correlation metrics and 15 datasets, with an 18.7% decrease in average estimation error and reduces annotation needs by 32.5%. We provide a cost model and highlight a medical case study where our method saves $1,041.67 compared to random selection for expert annotation. Further, we shift our task from reliability estimation to reliability classification of whether a given judge is above a deployment threshold, outperforming random selection with Metric Match. All project code is publicly available, and we additionally provide an installable package for ease of use.

Surgical phase recognition is a basic component for different context-aware applications in computer- and robot-assisted surgery. In recent years, several methods for automatic surgical phase recognition have been proposed, showing promising results. However, a meaningful comparison of these methods is difficult due to differences in the evaluation process and incomplete reporting of evaluation details. In particular, the details of metric computation can vary widely between different studies. To raise awareness of potential inconsistencies, this paper summarizes common deviations in the evaluation of phase recognition algorithms on the Cholec80 benchmark. In addition, a structured overview of previously reported evaluation results on Cholec80 is provided, taking known differences in evaluation protocols into account. Greater attention to evaluation details could help achieve more consistent and comparable results on the surgical phase recognition task, leading to more reliable conclusions about advancements in the field and, finally, translation into clinical practice.

Real-world clinical diagnosis is a complex process in which the doctor is required to obtain information from both interaction with the patient and conducting medical exams. Additionally, the doctor needs to adapt to different patient personas, as well as noisy and incomplete information that can happen at any time during the process. However, existing benchmarks for medical LLMs and methods for automatic diagnosis largely simplify this process by reducing it to single-turn question answering, noise-free conversations, or sequential exam making, etc., ignoring the interactive and uncertain nature of clinical diagnosis. In this paper, we aim to address this gap by formalizing clinical diagnosis as a Partially Observable Markov Decision Process (POMDP) with three action types: questioning the patient, ordering medical exams as tool calls, and issuing a diagnosis. We also introduce a systematic noise model comprising seven patient noise types and three exam noise types. Using our proposed environment, we train an effective diagnosis agent, MedExAgent, through a two-stage pipeline that first performs supervised finetuning on synthetic conversations structured after the Calgary-Cambridge model for clinical interviews, and then applies DAPO to optimize a composite reward capturing diagnostic accuracy, tool call quality, and exam cost including financial cost and patient discomfort. Through extensive experiments and ablation studies, we demonstrate that MedExAgent achieves diagnostic performance comparable to larger models while maintaining cost-efficient examination strategies.

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

Radiology report generation (RRG) is commonly formulated as a single-path generation task, where a multimodal large language model (MLLM) produces one decoded report as the final output. While recent progress has largely been driven by scaling training data, model capacity, and retrieval mechanisms, improving report quality at inference time remains underexplored. In this work, we observe that fixed radiology MLLMs often generate clinically stronger reports elsewhere in their candidate pool than the one selected by default decoding, suggesting that inference-time decision making remains an overlooked bottleneck. To address this, we propose Clinical Consensus Selection (CCS), a decoder-agnostic inference-time selection framework that samples multiple candidate reports and selects the one with the highest clinical consensus across the rollout pool. CCS unifies text-based utilities with a radiology-adapted utility computed by an image--report-trained multimodal embedder, which measures candidate agreement beyond surface-level textual similarity. Across three datasets and multiple radiology MLLMs, CCS consistently improves inference-time performance over single-path decoding and generic Best-of-N baselines, with particularly clear gains on clinical metrics. Further analysis shows that image-grounded utility forms a selection axis distinct from textual consensus and that substantial headroom remains for improving RRG at inference time.

We study whether demonstration-curation metrics that detect defective training episodes also improve the downstream behavior-cloning policy that trains on the curated data. On a contact-rich LIBERO pick-and-place benchmark with a controlled structural defect (early gripper release during the carry phase), we find that the two quantities are sharply decoupled. The metric with the highest defect-detection AUROC (0.804) produces the worst curated policy (13.3% task success), while a metric with a substantially lower AUROC (0.638) produces a policy that nearly matches the oracle trained on ground-truth clean data (90.0% vs. 93.3%). We further show that five of the seven metrics we evaluate exploit episode length as a trivial proxy for the defect label, a confound that inflates reported AUROCs to near-perfect values and disappears once episode length is controlled. Across all conditions, the contaminated baseline succeeds on only 3.3% of rollouts, and the two best curation methods close this to within 3 percentage points of the 93.3% oracle ceiling. Our results argue that curation methods should be evaluated by the policy they produce, not the defects they flag, and that any curation benchmark must control for episode length before reporting detection accuracy. We release the testbed, all metric implementations, and the evaluation pipeline.

The Model Context Protocol (MCP) is rapidly becoming the standard interface for Large Language Models (LLMs) to discover and invoke external tools. However, existing evaluations often fail to capture the complexity of real-world scenarios, relying on restricted toolsets, simplistic workflows, or subjective LLM-as-a-judge metrics. We introduce MCP-Atlas, a large-scale benchmark for evaluating tool-use competency, comprising 36 real MCP servers and 220 tools. It includes 1,000 tasks designed to assess tool-use competency in realistic, multi-step workflows. Tasks use natural language prompts that avoid naming specific tools or servers, requiring agents to identify and orchestrate 3-6 tool calls across multiple servers. We score tasks using a claims-based rubric that awards partial credit based on the factual claims satisfied in the model's final answer, complemented by internal diagnostics on tool discovery, parameterization, syntax, error recovery, and efficiency. Evaluation results on frontier models reveal that top models achieve pass rates exceeding 50%, with primary failures arising from inadequate tool usage and task understanding. We release the task schema, containerized harness, and a 500-task public subset of the benchmark dataset to facilitate reproducible comparisons and advance the development of robust, tool-augmented agents.

We introduce a Cascaded Diffusion Model (Cas-DM) that improves a Denoising Diffusion Probabilistic Model (DDPM) by effectively incorporating additional metric functions in training. Metric functions such as the LPIPS loss have been proven highly effective in consistency models derived from the score matching. However, for the diffusion counterparts, the methodology and efficacy of adding extra metric functions remain unclear. One major challenge is the mismatch between the noise predicted by a DDPM at each step and the desired clean image that the metric function works well on. To address this problem, we propose Cas-DM, a network architecture that cascades two network modules to effectively apply metric functions to the diffusion model training. The first module, similar to a standard DDPM, learns to predict the added noise and is unaffected by the metric function. The second cascaded module learns to predict the clean image, thereby facilitating the metric function computation. Experiment results show that the proposed diffusion model backbone enables the effective use of the LPIPS loss, leading to state-of-the-art image quality (FID, sFID, IS) on various established benchmarks.

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.

For safety, medical AI systems undergo thorough evaluations before deployment, validating their predictions against a ground truth which is assumed to be fixed and certain. However, this ground truth is often curated in the form of differential diagnoses. While a single differential diagnosis reflects the uncertainty in one expert assessment, multiple experts introduce another layer of uncertainty through disagreement. Both forms of uncertainty are ignored in standard evaluation which aggregates these differential diagnoses to a single label. In this paper, we show that ignoring uncertainty leads to overly optimistic estimates of model performance, therefore underestimating risk associated with particular diagnostic decisions. To this end, we propose a statistical aggregation approach, where we infer a distribution on probabilities of underlying medical condition candidates themselves, based on observed annotations. This formulation naturally accounts for the potential disagreements between different experts, as well as uncertainty stemming from individual differential diagnoses, capturing the entire ground truth uncertainty. Our approach boils down to generating multiple samples of medical condition probabilities, then evaluating and averaging performance metrics based on these sampled probabilities. In skin condition classification, we find that a large portion of the dataset exhibits significant ground truth uncertainty and standard evaluation severely over-estimates performance without providing uncertainty estimates. In contrast, our framework provides uncertainty estimates on common metrics of interest such as top-k accuracy and average overlap, showing that performance can change multiple percentage points. We conclude that, while assuming a crisp ground truth can be acceptable for many AI applications, a more nuanced evaluation protocol should be utilized in medical diagnosis.

Given a set of dissimilarity measurements amongst data points, determining what metric representation is most "consistent" with the input measurements or the metric that best captures the relevant geometric features of the data is a key step in many machine learning algorithms. Existing methods are restricted to specific kinds of metrics or small problem sizes because of the large number of metric constraints in such problems. In this paper, we provide an active set algorithm, Project and Forget, that uses Bregman projections, to solve metric constrained problems with many (possibly exponentially) inequality constraints. We provide a theoretical analysis of Project and Forget and prove that our algorithm converges to the global optimal solution and that the L_2 distance of the current iterate to the optimal solution decays asymptotically at an exponential rate. We demonstrate that using our method we can solve large problem instances of three types of metric constrained problems: general weight correlation clustering, metric nearness, and metric learning; in each case, out-performing the state of the art methods with respect to CPU times and problem sizes.

Artificial intelligence has advanced in Medical Visual Question Answering (Med-VQA), but prevalent research tends to focus on the accuracy of the answers, often overlooking the reasoning paths and interpretability, which are crucial in clinical settings. Besides, current Med-VQA algorithms, typically reliant on singular models, lack the robustness needed for real-world medical diagnostics which usually require collaborative expert evaluation. To address these shortcomings, this paper presents MedCoT, a novel hierarchical expert verification reasoning chain method designed to enhance interpretability and accuracy in biomedical imaging inquiries. MedCoT is predicated on two principles: The necessity for explicit reasoning paths in Med-VQA and the requirement for multi-expert review to formulate accurate conclusions. The methodology involves an Initial Specialist proposing diagnostic rationales, followed by a Follow-up Specialist who validates these rationales, and finally, a consensus is reached through a vote among a sparse Mixture of Experts within the locally deployed Diagnostic Specialist, which then provides the definitive diagnosis. Experimental evaluations on four standard Med-VQA datasets demonstrate that MedCoT surpasses existing state-of-the-art approaches, providing significant improvements in performance and interpretability.

The Model Context Protocol (MCP) defines a schema bound execution model for agent-tool interaction, enabling modular computer vision workflows without retraining. To our knowledge, this is the first protocol level, deployment scale audit of MCP in vision systems, identifying systemic weaknesses in schema semantics, interoperability, and runtime coordination. We analyze 91 publicly registered vision centric MCP servers, annotated along nine dimensions of compositional fidelity, and develop an executable benchmark with validators to detect and categorize protocol violations. The audit reveals high prevalence of schema format divergence, missing runtime schema validation, undeclared coordinate conventions, and reliance on untracked bridging scripts. Validator based testing quantifies these failures, with schema format checks flagging misalignments in 78.0 percent of systems, coordinate convention checks detecting spatial reference errors in 24.6 percent, and memory scope checks issuing an average of 33.8 warnings per 100 executions. Security probes show that dynamic and multi agent workflows exhibit elevated risks of privilege escalation and untyped tool connections. The proposed benchmark and validator suite, implemented in a controlled testbed and to be released on GitHub, establishes a reproducible framework for measuring and improving the reliability and security of compositional vision workflows.

Artificial intelligence holds great promise for expanding access to expert medical knowledge and reasoning. However, most evaluations of language models rely on static vignettes and multiple-choice questions that fail to reflect the complexity and nuance of evidence-based medicine in real-world settings. In clinical practice, physicians iteratively formulate and revise diagnostic hypotheses, adapting each subsequent question and test to what they've just learned, and weigh the evolving evidence before committing to a final diagnosis. To emulate this iterative process, we introduce the Sequential Diagnosis Benchmark, which transforms 304 diagnostically challenging New England Journal of Medicine clinicopathological conference (NEJM-CPC) cases into stepwise diagnostic encounters. A physician or AI begins with a short case abstract and must iteratively request additional details from a gatekeeper model that reveals findings only when explicitly queried. Performance is assessed not just by diagnostic accuracy but also by the cost of physician visits and tests performed. We also present the MAI Diagnostic Orchestrator (MAI-DxO), a model-agnostic orchestrator that simulates a panel of physicians, proposes likely differential diagnoses and strategically selects high-value, cost-effective tests. When paired with OpenAI's o3 model, MAI-DxO achieves 80% diagnostic accuracy--four times higher than the 20% average of generalist physicians. MAI-DxO also reduces diagnostic costs by 20% compared to physicians, and 70% compared to off-the-shelf o3. When configured for maximum accuracy, MAI-DxO achieves 85.5% accuracy. These performance gains with MAI-DxO generalize across models from the OpenAI, Gemini, Claude, Grok, DeepSeek, and Llama families. We highlight how AI systems, when guided to think iteratively and act judiciously, can advance diagnostic precision and cost-effectiveness in clinical care.

While Multi-Agent Systems (MAS) show potential for complex clinical decision support, the field remains hindered by architectural fragmentation and the lack of standardized multimodal integration. Current medical MAS research suffers from non-uniform data ingestion pipelines, inconsistent visual-reasoning evaluation, and a lack of cross-specialty benchmarking. To address these challenges, we present MedMASLab, a unified framework and benchmarking platform for multimodal medical multi-agent systems. MedMASLab introduces: (1) A standardized multimodal agent communication protocol that enables seamless integration of 11 heterogeneous MAS architectures across 24 medical modalities. (2) An automated clinical reasoning evaluator, a zero-shot semantic evaluation paradigm that overcomes the limitations of lexical string-matching by leveraging large vision-language models to verify diagnostic logic and visual grounding. (3) The most extensive benchmark to date, spanning 11 organ systems and 473 diseases, standardizing data from 11 clinical benchmarks. Our systematic evaluation reveals a critical domain-specific performance gap: while MAS improves reasoning depth, current architectures exhibit significant fragility when transitioning between specialized medical sub-domains. We provide a rigorous ablation of interaction mechanisms and cost-performance trade-offs, establishing a new technical baseline for future autonomous clinical systems. The source code and data is publicly available at: https://github.com/NUS-Project/MedMASLab/

Recent advances in medical multi-modal models focus on specialized image analysis like dermatology, pathology, or radiology. However, they do not fully capture the complexity of real-world clinical diagnostics, which involve heterogeneous inputs and require ongoing contextual understanding during patient-physician interactions. To bridge this gap, we introduce PulseMind, a new family of multi-modal diagnostic models that integrates a systematically curated dataset, a comprehensive evaluation benchmark, and a tailored training framework. Specifically, we first construct a diagnostic dataset, MediScope, which comprises 98,000 real-world multi-turn consultations and 601,500 medical images, spanning over 10 major clinical departments and more than 200 sub-specialties. Then, to better reflect the requirements of real-world clinical diagnosis, we develop the PulseMind Benchmark, a multi-turn diagnostic consultation benchmark with a four-dimensional evaluation protocol comprising proactiveness, accuracy, usefulness, and language quality. Finally, we design a training framework tailored for multi-modal clinical diagnostics, centered around a core component named Comparison-based Reinforcement Policy Optimization (CRPO). Compared to absolute score rewards, CRPO uses relative preference signals from multi-dimensional com-parisons to provide stable and human-aligned training guidance. Extensive experiments demonstrate that PulseMind achieves competitive performance on both the diagnostic consultation benchmark and public medical benchmarks.

Visible-light cameras can capture subtle physiological biomarkers without physical contact with the subject. We present the Multi-Site Physiological Monitoring (MSPM) dataset, which is the first dataset collected to support the study of simultaneous camera-based vital signs estimation from multiple locations on the body. MSPM enables research on remote photoplethysmography (rPPG), respiration rate, and pulse transit time (PTT); it contains ground-truth measurements of pulse oximetry (at multiple body locations) and blood pressure using contacting sensors. We provide thorough experiments demonstrating the suitability of MSPM to support research on rPPG, respiration rate, and PTT. Cross-dataset rPPG experiments reveal that MSPM is a challenging yet high quality dataset, with intra-dataset pulse rate mean absolute error (MAE) below 4 beats per minute (BPM), and cross-dataset pulse rate MAE below 2 BPM in certain cases. Respiration experiments find a MAE of 1.09 breaths per minute by extracting motion features from the chest. PTT experiments find that across the pairs of different body sites, there is high correlation between remote PTT and contact-measured PTT, which facilitates the possibility for future camera-based PTT research.

Large Multimodal Models (LMMs) have shown remarkable progress in the field of medical Visual Question Answering (Med-VQA), achieving high accuracy on existing benchmarks. However, their reliability under robust evaluation is questionable. This study reveals that state-of-the-art models, when subjected to simple probing evaluation, perform worse than random guessing on medical diagnosis questions. To address this critical evaluation problem, we introduce the Probing Evaluation for Medical Diagnosis (ProbMed) dataset to rigorously assess LMM performance in medical imaging through probing evaluation and procedural diagnosis. Particularly, probing evaluation features pairing original questions with negation questions with hallucinated attributes, while procedural diagnosis requires reasoning across various diagnostic dimensions for each image, including modality recognition, organ identification, clinical findings, abnormalities, and positional grounding. Our evaluation reveals that top-performing models like GPT-4V and Gemini Pro perform worse than random guessing on specialized diagnostic questions, indicating significant limitations in handling fine-grained medical inquiries. Besides, models like LLaVA-Med struggle even with more general questions, and results from CheXagent demonstrate the transferability of expertise across different modalities of the same organ, showing that specialized domain knowledge is still crucial for improving performance. This study underscores the urgent need for more robust evaluation to ensure the reliability of LMMs in critical fields like medical diagnosis, and current LMMs are still far from applicable to those fields.

Devising indicative evaluation metrics for the image generation task remains an open problem. The most widely used metric for measuring the similarity between real and generated images has been the Fr\'echet Inception Distance (FID) score. Because it does not differentiate the fidelity and diversity aspects of the generated images, recent papers have introduced variants of precision and recall metrics to diagnose those properties separately. In this paper, we show that even the latest version of the precision and recall metrics are not reliable yet. For example, they fail to detect the match between two identical distributions, they are not robust against outliers, and the evaluation hyperparameters are selected arbitrarily. We propose density and coverage metrics that solve the above issues. We analytically and experimentally show that density and coverage provide more interpretable and reliable signals for practitioners than the existing metrics. Code: https://github.com/clovaai/generative-evaluation-prdc.

Medical domain automated text generation is an active area of research and development; however, evaluating the clinical quality of generated reports remains a challenge, especially in instances where domain-specific metrics are lacking, e.g. histopathology. We propose HARE (Histopathology Automated Report Evaluation), a novel entity and relation centric framework, composed of a benchmark dataset, a named entity recognition (NER) model, a relation extraction (RE) model, and a novel metric, which prioritizes clinically relevant content by aligning critical histopathology entities and relations between reference and generated reports. To develop the HARE benchmark, we annotated 813 de-identified clinical diagnostic histopathology reports and 652 histopathology reports from The Cancer Genome Atlas (TCGA) with domain-specific entities and relations. We fine-tuned GatorTronS, a domain-adapted language model to develop HARE-NER and HARE-RE which achieved the highest overall F1-score (0.915) among the tested models. The proposed HARE metric outperformed traditional metrics including ROUGE and Meteor, as well as radiology metrics such as RadGraph-XL, with the highest correlation and the best regression to expert evaluations (higher than the second best method, GREEN, a large language model based radiology report evaluator, by Pearson r = 0.168, Spearman ρ= 0.161, Kendall τ= 0.123, R^2 = 0.176, RMSE = 0.018). We release HARE, datasets, and the models at https://github.com/knowlab/HARE to foster advancements in histopathology report generation, providing a robust framework for improving the quality of reports.

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

Developing reliable AI systems to assist human clinicians in multi-modal medical diagnosis has long been a key objective for researchers. Recently, Multi-modal Large Language Models (MLLMs) have gained significant attention and achieved success across various domains. With strong reasoning capabilities and the ability to perform diverse tasks based on user instructions, they hold great potential for enhancing medical diagnosis. However, directly applying MLLMs to the medical domain still presents challenges. They lack detailed perception of visual inputs, limiting their ability to perform quantitative image analysis, which is crucial for medical diagnostics. Additionally, MLLMs often exhibit hallucinations and inconsistencies in reasoning, whereas clinical diagnoses must adhere strictly to established criteria. To address these challenges, we propose MedAgent-Pro, an evidence-based reasoning agentic system designed to achieve reliable, explainable, and precise medical diagnoses. This is accomplished through a hierarchical workflow: at the task level, knowledge-based reasoning generate reliable diagnostic plans for specific diseases following retrieved clinical criteria. While at the case level, multiple tool agents process multi-modal inputs, analyze different indicators according to the plan, and provide a final diagnosis based on both quantitative and qualitative evidence. Comprehensive experiments on both 2D and 3D medical diagnosis tasks demonstrate the superiority and effectiveness of MedAgent-Pro, while case studies further highlight its reliability and interpretability. The code is available at https://github.com/jinlab-imvr/MedAgent-Pro.

Several Deep Learning (DL) methods have recently been proposed for an automated identification of kidney stones during an ureteroscopy to enable rapid therapeutic decisions. Even if these DL approaches led to promising results, they are mainly appropriate for kidney stone types for which numerous labelled data are available. However, only few labelled images are available for some rare kidney stone types. This contribution exploits Deep Metric Learning (DML) methods i) to handle such classes with few samples, ii) to generalize well to out of distribution samples, and iii) to cope better with new classes which are added to the database. The proposed Guided Deep Metric Learning approach is based on a novel architecture which was designed to learn data representations in an improved way. The solution was inspired by Few-Shot Learning (FSL) and makes use of a teacher-student approach. The teacher model (GEMINI) generates a reduced hypothesis space based on prior knowledge from the labeled data, and is used it as a guide to a student model (i.e., ResNet50) through a Knowledge Distillation scheme. Extensive tests were first performed on two datasets separately used for the recognition, namely a set of images acquired for the surfaces of the kidney stone fragments, and a set of images of the fragment sections. The proposed DML-approach improved the identification accuracy by 10% and 12% in comparison to DL-methods and other DML-approaches, respectively. Moreover, model embeddings from the two dataset types were merged in an organized way through a multi-view scheme to simultaneously exploit the information of surface and section fragments. Test with the resulting mixed model improves the identification accuracy by at least 3% and up to 30% with respect to DL-models and shallow machine learning methods, respectively.

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

The rapid development of the AI agent communication protocols, including the Model Context Protocol (MCP), Agent2Agent (A2A), Agora, and Agent Network Protocol (ANP), is reshaping how AI agents communicate with tools, services, and each other. While these protocols support scalable multi-agent interaction and cross-organizational interoperability, their security principles remain understudied, and standardized threat modeling is limited; no protocol-centric risk assessment framework has been established yet. This paper presents a systematic security analysis of four emerging AI agent communication protocols. First, we develop a structured threat modeling analysis that examines protocol architectures, trust assumptions, interaction patterns, and lifecycle behaviors to identify protocol-specific and cross-protocol risk surfaces. Second, we introduce a qualitative risk assessment framework that identifies twelve protocol-level risks and evaluates security posture across the creation, operation, and update phases through systematic assessment of likelihood, impact, and overall protocol risk, with implications for secure deployment and future standardization. Third, we provide a measurement-driven case study on MCP that formalizes the risk of missing mandatory validation/attestation for executable components as a falsifiable security claim by quantifying wrong-provider tool execution under multi-server composition across representative resolver policies. Collectively, our results highlight key design-induced risk surfaces and provide actionable guidance for secure deployment and future standardization of agent communication ecosystems.

Predictive artificial intelligence (AI) offers an opportunity to improve clinical practice and patient outcomes, but risks perpetuating biases if fairness is inadequately addressed. However, the definition of "fairness" remains unclear. We conducted a scoping review to identify and critically appraise fairness metrics for clinical predictive AI. We defined a "fairness metric" as a measure quantifying whether a model discriminates (societally) against individuals or groups defined by sensitive attributes. We searched five databases (2014-2024), screening 820 records, to include 41 studies, and extracted 62 fairness metrics. Metrics were classified by performance-dependency, model output level, and base performance metric, revealing a fragmented landscape with limited clinical validation and overreliance on threshold-dependent measures. Eighteen metrics were explicitly developed for healthcare, including only one clinical utility metric. Our findings highlight conceptual challenges in defining and quantifying fairness and identify gaps in uncertainty quantification, intersectionality, and real-world applicability. Future work should prioritise clinically meaningful metrics.

Checkpoint merging is a technique for combining multiple model snapshots into a single superior model, potentially reducing training time for large language models. This paper explores checkpoint merging in the context of parameter-efficient fine-tuning (PEFT), where only small adapter modules (e.g. LoRA) are trained. We propose Metrics-Weighted Averaging (MWA), a simple yet effective method to merge model checkpoints by weighting their parameters according to performance metrics. In particular, we investigate weighting by training loss and by training steps, under the intuition that lower-loss or later-step checkpoints are more valuable. We introduce a formula with a penalty factor to adjust weight distribution, requiring only one hyperparameter regardless of the number of checkpoints. Experiments on three fine-tuning tasks (mathematical reasoning, preference alignment, and general instruction tuning) show that MWA consistently produces merged models that outperform the naive uniform average of checkpoints. Notably, loss-weighted merging often yields the best results, delivering up to 5% higher task accuracy than the baseline uniform merge and even surpassing the final individual checkpoint's performance. These findings validate checkpoint merging for PEFT and demonstrate that a metric-driven weighting heuristic can efficiently boost model performance with minimal computational overhead.

Knowledge Graph (KG) plays a crucial role in Medical Report Generation (MRG) because it reveals the relations among diseases and thus can be utilized to guide the generation process. However, constructing a comprehensive KG is labor-intensive and its applications on the MRG process are under-explored. In this study, we establish a complete KG on chest X-ray imaging that includes 137 types of diseases and abnormalities. Based on this KG, we find that the current MRG data sets exhibit a long-tailed problem in disease distribution. To mitigate this problem, we introduce a novel augmentation strategy that enhances the representation of disease types in the tail-end of the distribution. We further design a two-stage MRG approach, where a classifier is first trained to detect whether the input images exhibit any abnormalities. The classified images are then independently fed into two transformer-based generators, namely, ``disease-specific generator" and ``disease-free generator" to generate the corresponding reports. To enhance the clinical evaluation of whether the generated reports correctly describe the diseases appearing in the input image, we propose diverse sensitivity (DS), a new metric that checks whether generated diseases match ground truth and measures the diversity of all generated diseases. Results show that the proposed two-stage generation framework and augmentation strategies improve DS by a considerable margin, indicating a notable reduction in the long-tailed problem associated with under-represented diseases.

Background: Agent skills are increasingly deployed as modular, reusable capability units in AI agent systems. Medical research agent skills require safeguards beyond general-purpose evaluation, including scientific integrity, methodological validity, reproducibility, and boundary safety. This study developed and preliminarily evaluated a domain-specific audit framework for medical research agent skills, with a focus on reliability against expert review. Methods: We developed MedSkillAudit (skill-auditor@1.0), a layered framework assessing skill release readiness before deployment. We evaluated 75 skills across five medical research categories (15 per category). Two experts independently assigned a quality score (0-100), an ordinal release disposition (Production Ready / Limited Release / Beta Only / Reject), and a high-risk failure flag. System-expert agreement was quantified using ICC(2,1) and linearly weighted Cohen's kappa, benchmarked against the human inter-rater baseline. Results: The mean consensus quality score was 72.4 (SD = 13.0); 57.3% of skills fell below the Limited Release threshold. MedSkillAudit achieved ICC(2,1) = 0.449 (95% CI: 0.250-0.610), exceeding the human inter-rater ICC of 0.300. System-consensus score divergence (SD = 9.5) was smaller than inter-expert divergence (SD = 12.4), with no directional bias (Wilcoxon p = 0.613). Protocol Design showed the strongest category-level agreement (ICC = 0.551); Academic Writing showed a negative ICC (-0.567), reflecting a structural rubric-expert mismatch. Conclusions: Domain-specific pre-deployment audit may provide a practical foundation for governing medical research agent skills, complementing general-purpose quality checks with structured audit workflows tailored to scientific use cases.

The rapid progress of multimodal large language models (MLLMs) has led to increasing interest in agent-based systems. While most prior work in medical imaging concentrates on automating routine clinical workflows, we study an underexplored yet clinically significant setting: distinguishing visually hard-to-separate diseases in a zero-shot setting. We benchmark representative agents on two imaging-only proxy diagnostic tasks, (1) melanoma vs. atypical nevus and (2) pulmonary edema vs. pneumonia, where visual features are highly confounded despite substantial differences in clinical management. We introduce a multi-agent framework based on contrastive adjudication. Experimental results show improved diagnostic performance (an 11-percentage-point gain in accuracy on dermoscopy data) and reduced unsupported claims on qualitative samples, although overall performance remains insufficient for clinical deployment. We acknowledge the inherent uncertainty in human annotations and the absence of clinical context, which further limit the translation to real-world settings. Within this controlled setting, this pilot study provides preliminary insights into zero-shot agent performance in visually confounded scenarios.

In this work, we introduce MedAgentSim, an open-source simulated clinical environment with doctor, patient, and measurement agents designed to evaluate and enhance LLM performance in dynamic diagnostic settings. Unlike prior approaches, our framework requires doctor agents to actively engage with patients through multi-turn conversations, requesting relevant medical examinations (e.g., temperature, blood pressure, ECG) and imaging results (e.g., MRI, X-ray) from a measurement agent to mimic the real-world diagnostic process. Additionally, we incorporate self improvement mechanisms that allow models to iteratively refine their diagnostic strategies. We enhance LLM performance in our simulated setting by integrating multi-agent discussions, chain-of-thought reasoning, and experience-based knowledge retrieval, facilitating progressive learning as doctor agents interact with more patients. We also introduce an evaluation benchmark for assessing the LLM's ability to engage in dynamic, context-aware diagnostic interactions. While MedAgentSim is fully automated, it also supports a user-controlled mode, enabling human interaction with either the doctor or patient agent. Comprehensive evaluations in various simulated diagnostic scenarios demonstrate the effectiveness of our approach. Our code, simulation tool, and benchmark are available at https://medagentsim.netlify.app/.

MRI is an indispensable clinical tool, offering a rich variety of tissue contrasts to support broad diagnostic and research applications. Clinical exams routinely acquire multiple structural sequences that provide complementary information for differential diagnosis, while research protocols often incorporate advanced functional, diffusion, spectroscopic, and relaxometry sequences to capture multidimensional insights into tissue structure and composition. However, these capabilities come at the cost of prolonged scan times, which reduce patient throughput, increase susceptibility to motion artifacts, and may require trade-offs in image quality or diagnostic scope. Over the last two decades, advances in image reconstruction algorithms--alongside improvements in hardware and pulse sequence design--have made it possible to accelerate acquisitions while preserving diagnostic quality. Central to this progress is the ability to incorporate prior information to regularize the solutions to the reconstruction problem. In this tutorial, we overview the basics of MRI reconstruction and highlight state-of-the-art approaches, beginning with classical methods that rely on explicit hand-crafted priors, and then turning to deep learning methods that leverage a combination of learned and crafted priors to further push the performance envelope. We also explore the translational aspects and eventual clinical implications of these methods. We conclude by discussing future directions to address remaining challenges in MRI reconstruction. The tutorial is accompanied by a Python toolbox (https://github.com/tutorial-MRI-recon/tutorial) to demonstrate select methods discussed in the article.

Digital Forensics and Incident Response (DFIR) involves analyzing digital evidence to support legal investigations. Large Language Models (LLMs) offer new opportunities in DFIR tasks such as log analysis and memory forensics, but their susceptibility to errors and hallucinations raises concerns in high-stakes contexts. Despite growing interest, there is no comprehensive benchmark to evaluate LLMs across both theoretical and practical DFIR domains. To address this gap, we present DFIR-Metric, a benchmark with three components: (1) Knowledge Assessment: a set of 700 expert-reviewed multiple-choice questions sourced from industry-standard certifications and official documentation; (2) Realistic Forensic Challenges: 150 CTF-style tasks testing multi-step reasoning and evidence correlation; and (3) Practical Analysis: 500 disk and memory forensics cases from the NIST Computer Forensics Tool Testing Program (CFTT). We evaluated 14 LLMs using DFIR-Metric, analyzing both their accuracy and consistency across trials. We also introduce a new metric, the Task Understanding Score (TUS), designed to more effectively evaluate models in scenarios where they achieve near-zero accuracy. This benchmark offers a rigorous, reproducible foundation for advancing AI in digital forensics. All scripts, artifacts, and results are available on the project website at https://github.com/DFIR-Metric.

The 7-point checklist (7PCL) is a widely used diagnostic tool in dermoscopy for identifying malignant melanoma by assigning point values to seven specific attributes. However, the traditional 7PCL is limited to distinguishing between malignant melanoma and melanocytic Nevi, and falls short in scenarios where multiple skin diseases with appearances similar to melanoma coexist. To address this limitation, we propose a novel diagnostic framework that integrates a clinical knowledge-based topological graph (CKTG) with a gradient diagnostic strategy featuring a data-driven weighting system (GD-DDW). The CKTG captures both the internal and external relationships among the 7PCL attributes, while the GD-DDW emulates dermatologists' diagnostic processes, prioritizing visual observation before making predictions. Additionally, we introduce a multimodal feature extraction approach leveraging a dual-attention mechanism to enhance feature extraction through cross-modal interaction and unimodal collaboration. This method incorporates meta-information to uncover interactions between clinical data and image features, ensuring more accurate and robust predictions. Our approach, evaluated on the EDRA dataset, achieved an average AUC of 88.6%, demonstrating superior performance in melanoma detection and feature prediction. This integrated system provides data-driven benchmarks for clinicians, significantly enhancing the precision of melanoma diagnosis.

Surgical resection remains the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC), and eligibility depends on accurate assessment of vascular invasion (VI), i.e., tumor extension into adjacent critical vessels. Despite its importance for preoperative staging and surgical planning, computational VI assessment remains underexplored. Two major challenges are the lack of public datasets and the diagnostic ambiguity at the tumor-vessel interface, which leads to substantial inter-rater variability even among expert radiologists. To address these limitations, we introduce the CURVAS-PDACVI Dataset and Challenge, an open benchmark for uncertainty-aware AI in PDAC staging based on a densely annotated dataset with five independent expert annotations per scan. We also propose a multi-metric evaluation framework that extends beyond spatial overlap to include probabilistic calibration and VI assessment. Evaluation of six state-of-the-art methods shows that strong global volumetric overlap does not necessarily translate into reliable performance at clinically critical tumor-vessel interfaces. In particular, methods optimized for binary segmentation perform competitively on average overlap metrics, but often degrade in high-complexity cases with low expert consensus, either collapsing in volume or overextending at uncertain boundaries. In contrast, methods that model inter-rater disagreement produce better calibrated probabilistic maps and show greater robustness in these ambiguous cases. The benchmark highlights the limitations of volumetric accuracy as a proxy for localized surgical utility, motivating uncertainty-aware probabilistic models for preoperative decision-making.

This paper presents a Patherea, a framework for point-based cell detection and classification that provides a complete solution for developing and evaluating state-of-the-art approaches. We introduce a large-scale dataset collected to directly replicate a clinical workflow for Ki-67 proliferation index estimation and use it to develop an efficient point-based approach that directly predicts point-based predictions, without the need for intermediate representations. The proposed approach effectively utilizes point proposal candidates with the hybrid Hungarian matching strategy and a flexible architecture that enables the usage of various backbones and (pre)training strategies. We report state-of-the-art results on existing public datasets - Lizard, BRCA-M2C, BCData, and the newly proposed Patherea dataset. We show that the performance on existing public datasets is saturated and that the newly proposed Patherea dataset represents a significantly harder challenge for the recently proposed approaches. We also demonstrate the effectiveness of recently proposed pathology foundational models that our proposed approach can natively utilize and benefit from. We also revisit the evaluation protocol that is used in the broader field of cell detection and classification and identify the erroneous calculation of performance metrics. Patherea provides a benchmarking utility that addresses the identified issues and enables a fair comparison of different approaches. The dataset and the code will be publicly released upon acceptance.

Large language model agents now act on codebases, browsers, operating systems, calendars, files, and tool ecosystems, but the benchmarks used to evaluate them are fragmented: each emphasizes a different unit of measurement (final task success, tool-call validity, repeated-pass consistency, trajectory safety, or attack robustness). A line of 2024-2025 work has converged on the diagnosis that a single accuracy column is no longer the right unit of comparison for deployable agents. AgentAtlas extends this line of work with four components: (i) a six-state control-decision taxonomy (Act / Ask / Refuse / Stop / Confirm / Recover); (ii) a nine-category trajectory-failure taxonomy with two orthogonal hierarchical labels (primary_error_source, impact); (iii) a taxonomy-aware vs. taxonomy-blind methodology that measures how much of a model's apparent capability comes from the supervision in the prompt; and (iv) a benchmark-coverage audit mapping fifteen agent benchmarks against six behavioral axes. To demonstrate the methodology we run a small fixed eight-model set (1,342 generated items, four frontier closed and four open-weight) under both prompt modes. Removing the explicit label menu drops every model's trajectory accuracy by 14-40 pp to a tight 0.54-0.62 floor regardless of family, and no single model wins on all three of control accuracy, trajectory diagnosis, and tool-context utility retention. We treat the synthetic run as a measurement-protocol demonstration, not a benchmark release.

Machine Translation (MT) evaluation metrics assess translation quality automatically. Recently, researchers have employed MT metrics for various new use cases, such as data filtering and translation re-ranking. However, most MT metrics return assessments as scalar scores that are difficult to interpret, posing a challenge to making informed design choices. Moreover, MT metrics' capabilities have historically been evaluated using correlation with human judgment, which, despite its efficacy, falls short of providing intuitive insights into metric performance, especially in terms of new metric use cases. To address these issues, we introduce an interpretable evaluation framework for MT metrics. Within this framework, we evaluate metrics in two scenarios that serve as proxies for the data filtering and translation re-ranking use cases. Furthermore, by measuring the performance of MT metrics using Precision, Recall, and F-score, we offer clearer insights into their capabilities than correlation with human judgments. Finally, we raise concerns regarding the reliability of manually curated data following the Direct Assessments+Scalar Quality Metrics (DA+SQM) guidelines, reporting a notably low agreement with Multidimensional Quality Metrics (MQM) annotations.

Deploying models on target domain data subject to distribution shift requires adaptation. Test-time training (TTT) emerges as a solution to this adaptation under a realistic scenario where access to full source domain data is not available and instant inference on target domain is required. Despite many efforts into TTT, there is a confusion over the experimental settings, thus leading to unfair comparisons. In this work, we first revisit TTT assumptions and categorize TTT protocols by two key factors. Among the multiple protocols, we adopt a realistic sequential test-time training (sTTT) protocol, under which we further develop a test-time anchored clustering (TTAC) approach to enable stronger test-time feature learning. TTAC discovers clusters in both source and target domain and match the target clusters to the source ones to improve generalization. Pseudo label filtering and iterative updating are developed to improve the effectiveness and efficiency of anchored clustering. We demonstrate that under all TTT protocols TTAC consistently outperforms the state-of-the-art methods on six TTT datasets. We hope this work will provide a fair benchmarking of TTT methods and future research should be compared within respective protocols. A demo code is available at https://github.com/Gorilla-Lab-SCUT/TTAC.

Recent advancements in Large Language Models (LLMs) have demonstrated significant promise in clinical diagnosis. However, current models struggle to emulate the iterative, diagnostic hypothesis-driven reasoning of real clinical scenarios. Specifically, current LLMs suffer from three critical limitations: (1) generating hallucinated medical content due to weak grounding in verified knowledge, (2) asking redundant or inefficient questions rather than discriminative ones that hinder diagnostic progress, and (3) losing coherence over multi-turn dialogues, leading to contradictory or inconsistent conclusions. To address these challenges, we propose MedKGI, a diagnostic framework grounded in clinical practices. MedKGI integrates a medical knowledge graph (KG) to constrain reasoning to validated medical ontologies, selects questions based on information gain to maximize diagnostic efficiency, and adopts an OSCE-format structured state to maintain consistent evidence tracking across turns. Experiments on clinical benchmarks show that MedKGI outperforms strong LLM baselines in both diagnostic accuracy and inquiry efficiency, improving dialogue efficiency by 30% on average while maintaining state-of-the-art accuracy.

The emergence of groundbreaking large language models capable of performing complex reasoning tasks holds significant promise for addressing various scientific challenges, including those arising in complex clinical scenarios. To enable their safe and effective deployment in real-world healthcare settings, it is urgently necessary to benchmark the diagnostic capabilities of current models systematically. Given the limitations of existing medical benchmarks in evaluating advanced diagnostic reasoning, we present DiagnosisArena, a comprehensive and challenging benchmark designed to rigorously assess professional-level diagnostic competence. DiagnosisArena consists of 1,113 pairs of segmented patient cases and corresponding diagnoses, spanning 28 medical specialties, deriving from clinical case reports published in 10 top-tier medical journals. The benchmark is developed through a meticulous construction pipeline, involving multiple rounds of screening and review by both AI systems and human experts, with thorough checks conducted to prevent data leakage. Our study reveals that even the most advanced reasoning models, o3-mini, o1, and DeepSeek-R1, achieve only 45.82%, 31.09%, and 17.79% accuracy, respectively. This finding highlights a significant generalization bottleneck in current large language models when faced with clinical diagnostic reasoning challenges. Through DiagnosisArena, we aim to drive further advancements in AIs diagnostic reasoning capabilities, enabling more effective solutions for real-world clinical diagnostic challenges. We provide the benchmark and evaluation tools for further research and development https://github.com/SPIRAL-MED/DiagnosisArena.

Failure attribution is essential for diagnosing and improving multi-agent systems (MAS), yet existing benchmarks and methods largely assume a single deterministic root cause for each failure. In practice, MAS failures often admit multiple plausible attributions due to complex inter-agent dependencies and ambiguous execution trajectories. We revisit MAS failure attribution from a multi-perspective standpoint and propose multi-perspective failure attribution, a practical paradigm that explicitly accounts for attribution ambiguity. To support this setting, we introduce MP-Bench, the first benchmark designed for multi-perspective failure attribution in MAS, along with a new evaluation protocol tailored to this paradigm. Through extensive experiments, we find that prior conclusions suggesting LLMs struggle with failure attribution are largely driven by limitations in existing benchmark designs. Our results highlight the necessity of multi-perspective benchmarks and evaluation protocols for realistic and reliable MAS debugging.

The Model Context Protocol (MCP) standardizes how AI agents discover and invoke external tools, with over 10,000 active servers and 97 million monthly SDK downloads as of early 2026. Yet MCP does not yet standardize how agents safely operate those tools at production scale. Three protocol-level primitives remain missing: identity propagation, adaptive tool budgeting, and structured error semantics. This paper identifies these gaps through field lessons from an enterprise deployment of an AI agent platform integrated with a major cloud provider's MCP servers (client name redacted). We propose three mechanisms to fill them: (1) the Context-Aware Broker Protocol (CABP), which extends JSON-RPC with identity-scoped request routing via a six-stage broker pipeline; (2) Adaptive Timeout Budget Allocation (ATBA), which frames sequential tool invocation as a budget allocation problem over heterogeneous latency distributions; and (3) the Structured Error Recovery Framework (SERF), which provides machine-readable failure semantics that enable deterministic agent self-correction. We organize production failure modes into five design dimensions (server contracts, user context, timeouts, errors, and observability), document concrete failure vignettes, and present a production readiness checklist. All three algorithms are formalized as testable hypotheses with reproducible experimental methodology. Field observations demonstrate that while MCP provides a solid protocol foundation, reliable agent tool integration requires infrastructure-level mechanisms that the specification does not yet address.

Laboratory workflows in pharmaceutical and biomedical research encode substantial tacit knowledge -- expert judgment about failure conditions, decision branching logic, and contextual dependencies -- that remains inaccessible to protocol documents, sensor streams, and existing biomedical ontologies. We present a repeatable structured expert elicitation methodology and federated Semantic Knowledge Graph (SKG) architecture for capturing and querying this knowledge, demonstrated through deployment at the Biochemical and Cellular Pharmacology Department of Genentech. Knowledge is elicited via the Protocol Intelligence Co-pilot, a purpose-built AI interview agent that applies structured elicitation lenses to surface tacit procedural knowledge with expert-assigned confidence scores, producing graph representations across three tiers: program-level decision milestones, assay protocol knowledge, and physical execution infrastructure. Separately constructed subgraphs, exemplified by immunoassay (ELISA), quantitative mass spectrometry (LC-MS/PRM), and laboratory automation, are aligned through a shared upper ontology and queried as a single federated graph. Evaluation demonstrates seven query types structurally unavailable from any individual data source, including a cross-subgraph traversal that identifies automation-masked silent failures -- conditions where execution logs report success while scientific validity is compromised. Critically, the MASKED_BY graph relationship encodes a class of laboratory risk invisible to current informatics platforms -- the structural gap that prevents existing systems from reasoning about scientific validity. This architecture provides the semantic world model that AI laboratory agents currently lack: a queryable representation of where workflows fail silently, where human judgment is irreplaceable, and which execution assets mask rather than detect failure.

Multimodal large language models (MLLMs) have advanced clinical tasks for common conditions, but their performance on rare diseases remains largely untested. In rare-disease scenarios, clinicians often lack prior clinical knowledge, forcing them to rely strictly on case-level evidence for clinical judgments. Existing benchmarks predominantly evaluate common-condition, single-image settings, leaving multimodal and multi-image evidence integration under rare-disease data scarcity systematically unevaluated. We introduce MMRareBench, to our knowledge the first rare-disease benchmark jointly evaluating multimodal and multi-image clinical capability across four workflow-aligned tracks: diagnosis, treatment planning, cross-image evidence alignment, and examination suggestion. The benchmark comprises 1,756 question-answer pairs with 7,958 associated medical images curated from PMC case reports, with Orphanet-anchored ontology alignment, track-specific leakage control, evidence-grounded annotations, and a two-level evaluation protocol. A systematic evaluation of 23 MLLMs reveals fragmented capability profiles and universally low treatment-planning performance, with medical-domain models trailing general-purpose MLLMs substantially on multi-image tracks despite competitive diagnostic scores. These patterns are consistent with a capacity dilution effect: medical fine-tuning can narrow the diagnostic gap but may erode the compositional multi-image capability that rare-disease evidence integration demands.

Background: Clinical documentation represents a significant burden for healthcare providers, with physicians spending up to 2 hours daily on administrative tasks. Recent advances in large language models (LLMs) offer promising solutions, but privacy concerns and computational requirements limit their adoption in healthcare settings. Objective: To develop and evaluate a privacy-preserving, on-device medical transcription system using a fine-tuned Llama 3.2 1B model capable of generating structured medical notes from medical transcriptions while maintaining complete data sovereignty entirely in the browser. Methods: We fine-tuned a Llama 3.2 1B model using Parameter-Efficient Fine-Tuning (PEFT) with LoRA on 1,500 synthetic medical transcription-to-structured note pairs. The model was evaluated against the base Llama 3.2 1B on two datasets: 100 endocrinology transcripts and 140 modified ACI benchmark cases. Evaluation employed both statistical metrics (ROUGE, BERTScore, BLEURT) and LLM-as-judge assessments across multiple clinical quality dimensions. Results: The fine-tuned OnDevice model demonstrated substantial improvements over the base model. On the ACI benchmark, ROUGE-1 scores increased from 0.346 to 0.496, while BERTScore F1 improved from 0.832 to 0.866. Clinical quality assessments showed marked reduction in major hallucinations (from 85 to 35 cases) and enhanced factual correctness (2.81 to 3.54 on 5-point scale). Similar improvements were observed on the internal evaluation dataset, with composite scores increasing from 3.13 to 4.43 (+41.5%). Conclusions: Fine-tuning compact LLMs for medical transcription yields clinically meaningful improvements while enabling complete on-device browser deployment. This approach addresses key barriers to AI adoption in healthcare: privacy preservation, cost reduction, and accessibility for resource-constrained environments.

Medical diagnostic applications require models that can process multimodal medical inputs (images, patient histories, lab results) and generate diverse outputs including both textual reports and visual content (annotations, segmentation masks, and images). Despite this need, existing medical AI systems disrupt this unified process: medical image understanding models interpret images but cannot generate visual outputs, while medical image generation models synthesize images but cannot provide textual explanations. This leads to gaps in data representation, feature integration, and task-level multimodal capabilities. To this end, we propose a multi-level framework that draws inspiration from diagnostic workflows through the Observation-Knowledge-Analysis (OKA) paradigm. Specifically, at the observation level, we construct UniMed-5M, a dataset comprising over 5.6M samples that reformat diverse unimodal data into multimodal pairs for foundational observation. At the knowledge level, we propose Progressive Curriculum Learning that systematically introduces medical multimodal knowledge. At the analysis level, we introduce UniMedVL, the first medical unified multimodal model for the simultaneous analysis of image understanding and generation tasks within a single architecture. UniMedVL achieves superior performance on five medical image understanding benchmarks, while matching specialized models in generation quality across eight medical imaging modalities. Crucially, our unified architecture enables bidirectional knowledge sharing: generation tasks enhance visual understanding features, demonstrating that integrating traditionally separate capabilities within a single medical framework unlocks improvements across diverse medical vision-language tasks. Code is available at https://github.com/uni-medical/UniMedVL.

Current medical language models, adapted from large language models (LLMs), typically predict ICD code-based diagnosis from electronic health records (EHRs) because these labels are readily available. However, ICD codes do not capture the nuanced, context-rich reasoning clinicians use for diagnosis. Clinicians synthesize diverse patient data and reference clinical practice guidelines (CPGs) to make evidence-based decisions. This misalignment limits the clinical utility of existing models. We introduce GARMLE-G, a Generation-Augmented Retrieval framework that grounds medical language model outputs in authoritative CPGs. Unlike conventional Retrieval-Augmented Generation based approaches, GARMLE-G enables hallucination-free outputs by directly retrieving authoritative guideline content without relying on model-generated text. It (1) integrates LLM predictions with EHR data to create semantically rich queries, (2) retrieves relevant CPG knowledge snippets via embedding similarity, and (3) fuses guideline content with model output to generate clinically aligned recommendations. A prototype system for hypertension diagnosis was developed and evaluated on multiple metrics, demonstrating superior retrieval precision, semantic relevance, and clinical guideline adherence compared to RAG-based baselines, while maintaining a lightweight architecture suitable for localized healthcare deployment. This work provides a scalable, low-cost, and hallucination-free method for grounding medical language models in evidence-based clinical practice, with strong potential for broader clinical deployment.

In addition to generating data and annotations, devising sensible data splitting strategies and evaluation metrics is essential for the creation of a benchmark dataset. This practice ensures consensus on the usage of the data, homogeneous assessment, and uniform comparison of research methods on the dataset. This study focuses on CholecT50, which is a 50 video surgical dataset that formalizes surgical activities as triplets of <instrument, verb, target>. In this paper, we introduce the standard splits for the CholecT50 and CholecT45 datasets and show how they compare with existing use of the dataset. CholecT45 is the first public release of 45 videos of CholecT50 dataset. We also develop a metrics library, ivtmetrics, for model evaluation on surgical triplets. Furthermore, we conduct a benchmark study by reproducing baseline methods in the most predominantly used deep learning frameworks (PyTorch and TensorFlow) to evaluate them using the proposed data splits and metrics and release them publicly to support future research. The proposed data splits and evaluation metrics will enable global tracking of research progress on the dataset and facilitate optimal model selection for further deployment.

metric-learn is an open source Python package implementing supervised and weakly-supervised distance metric learning algorithms. As part of scikit-learn-contrib, it provides a unified interface compatible with scikit-learn which allows to easily perform cross-validation, model selection, and pipelining with other machine learning estimators. metric-learn is thoroughly tested and available on PyPi under the MIT licence.

Positron emission tomography/computed tomography (PET/CT) is essential in oncology, yet the rapid expansion of scanners has outpaced the availability of trained specialists, making automated PET/CT report generation (PETRG) increasingly important for reducing clinical workload. Compared with structural imaging (e.g., X-ray, CT, and MRI), functional PET poses distinct challenges: metabolic patterns vary with tracer physiology, and whole-body 3D contextual information is required rather than local-region interpretation. To advance PETRG, we propose PETRG-3D, an end-to-end 3D dual-branch framework that separately encodes PET and CT volumes and incorporates style-adaptive prompts to mitigate inter-hospital variability in reporting practices. We construct PETRG-Lym, a multi-center lymphoma dataset collected from four hospitals (824 reports w/ 245,509 paired PET/CT slices), and construct AutoPET-RG-Lym, a publicly accessible PETRG benchmark derived from open imaging data but equipped with new expert-written, clinically validated reports (135 cases). To assess clinical utility, we introduce PETRG-Score, a lymphoma-specific evaluation protocol that jointly measures metabolic and structural findings across curated anatomical regions. Experiments show that PETRG-3D substantially outperforms existing methods on both natural language metrics (e.g., +31.49\% ROUGE-L) and clinical efficacy metrics (e.g., +8.18\% PET-All), highlighting the benefits of volumetric dual-modality modeling and style-aware prompting. Overall, this work establishes a foundation for future PET/CT-specific models emphasizing disease-aware reasoning and clinically reliable evaluation. Codes, models, and AutoPET-RG-Lym will be released.

The deployment of modern network applications is increasing the network size and traffic volumes at an unprecedented pace. Storing network-related information (e.g., traffic traces) is key to enable efficient network management. However, this task is becoming more challenging due to the ever-increasing data transmission rates and traffic volumes. In this paper, we present a novel method for network traffic compression that exploits spatial and temporal patterns naturally present in network traffic. We consider a realistic scenario where traffic measurements are performed at multiple links of a network topology using tools like SNMP or NetFlow. Such measurements can be seen as multiple time series that exhibit spatial and temporal correlations induced by the network topology, routing or user behavior. Our method leverages graph learning methods to effectively exploit both types of correlations for traffic compression. The experimental results show that our solution is able to outperform GZIP, the de facto traffic compression method, improving by 50\%-65\% the compression ratio on three real-world networks.

Progress in remote PhotoPlethysmoGraphy (rPPG) is limited by the critical issues of existing publicly available datasets: small size, privacy concerns with facial videos, and lack of diversity in conditions. The paper introduces a novel comprehensive large-scale multi-view video dataset for rPPG and health biomarkers estimation. Our dataset comprises 3600 synchronized video recordings from 600 subjects, captured under varied conditions (resting and post-exercise) using multiple consumer-grade cameras at different angles. To enable multimodal analysis of physiological states, each recording is paired with a 100 Hz PPG signal and extended health metrics, such as electrocardiogram, arterial blood pressure, biomarkers, temperature, oxygen saturation, respiratory rate, and stress level. Using this data, we train an efficient rPPG model and compare its quality with existing approaches in cross-dataset scenarios. The public release of our dataset and model should significantly speed up the progress in the development of AI medical assistants.

Predictive multiplicity refers to the phenomenon in which classification tasks may admit multiple competing models that achieve almost-equally-optimal performance, yet generate conflicting outputs for individual samples. This presents significant concerns, as it can potentially result in systemic exclusion, inexplicable discrimination, and unfairness in practical applications. Measuring and mitigating predictive multiplicity, however, is computationally challenging due to the need to explore all such almost-equally-optimal models, known as the Rashomon set, in potentially huge hypothesis spaces. To address this challenge, we propose a novel framework that utilizes dropout techniques for exploring models in the Rashomon set. We provide rigorous theoretical derivations to connect the dropout parameters to properties of the Rashomon set, and empirically evaluate our framework through extensive experimentation. Numerical results show that our technique consistently outperforms baselines in terms of the effectiveness of predictive multiplicity metric estimation, with runtime speedup up to 20times sim 5000times. With efficient Rashomon set exploration and metric estimation, mitigation of predictive multiplicity is then achieved through dropout ensemble and model selection.

Pingmark defines a universal textual protocol for expressing spatial context through a minimal symbol: !@. Rather than embedding coordinates or using proprietary map links, Pingmark introduces a semantic trigger that compliant client applications interpret to generate a standardized resolver link of the form https://pingmark.me/lat/lon/[timestamp]. This allows location expression to function like existing textual conventions - @ for identity or # for topics - but for physical space. The protocol requires no user registration, relies on open mapping technologies, and protects privacy by generating location data ephemerally and locally. This paper presents the motivation, syntax, and design of the Pingmark Protocol Specification (PPS v0.1), its reference resolver implementation, and the long-term goal of establishing Pingmark as an open Internet standard for spatial mentions.

Few-shot learning is a challenging area of research that aims to learn new concepts with only a few labeled samples of data. Recent works based on metric-learning approaches leverage the meta-learning approach, which is encompassed by episodic tasks that make use a support (training) and query set (test) with the objective of learning a similarity comparison metric between those sets. Due to the lack of data, the learning process of the embedding network becomes an important part of the few-shot task. Previous works have addressed this problem using metric learning approaches, but the properties of the underlying latent space and the separability of the difference classes on it was not entirely enforced. In this work, we propose two different loss functions which consider the importance of the embedding vectors by looking at the intra-class and inter-class distance between the few data. The first loss function is the Proto-Triplet Loss, which is based on the original triplet loss with the modifications needed to better work on few-shot scenarios. The second loss function, which we dub ICNN loss is based on an inter and intra class nearest neighbors score, which help us to assess the quality of embeddings obtained from the trained network. Our results, obtained from a extensive experimental setup show a significant improvement in accuracy in the miniImagenNet benchmark compared to other metric-based few-shot learning methods by a margin of 2%, demonstrating the capability of these loss functions to allow the network to generalize better to previously unseen classes. In our experiments, we demonstrate competitive generalization capabilities to other domains, such as the Caltech CUB, Dogs and Cars datasets compared with the state of the art.

We present the Consilium Protocol, a Byzantine Fault Tolerance-derived architecture for structured multi-model AI deliberation that treats inter-model disagreement as epistemic signal rather than error. The protocol assigns engineered cognitive personas to language models -- separating what a model is from how it reasons -- and introduces an In-Sample/Out-of-Sample validation framework adapted from quantitative finance to distinguish training-data consensus from empirically grounded conclusions. Across 1,478 deliberation sessions spanning 32 topics in 10 domain categories, we demonstrate that (1) the cognitive persona, not the underlying model, determines epistemic behavior: free edge-inference models costing 0.0002 USD per batch produced comparable analytical output to frontier models costing 10.69 USD; (2) RLHF alignment training creates measurable, domain-specific epistemic blind spots -- contested policy topics exhibit 12.3 percentage points less adversarial challenge than settled science topics, and AI safety topics show asymmetric bias (Δ=11.6%) where models challenge claims that AI is dangerous far more vigorously than claims that AI risk is overstated; (3) the protocol exhibits no directional bias of its own (immigration Δ=2.3%, renewables Δ=1.2%); and (4) out-of-sample evidence retrieval validated 239 claims with 100% evidence retrieval and surfaced 167 blind-spot discoveries invisible to training-data deliberation. Run-to-run reproducibility across randomized modeltimespersona assignments averages pm2.2% standard deviation. Total cost for the complete battery including all overhead: 217 USD. We release the protocol specification under MIT license to enable independent verification.

Despite being widely used to support clinical care, general-purpose large multimodal models (LMMs) have generally shown poor or inconclusive performance in medical image interpretation, particularly in pathology, where gigapixel images are used. However, prior studies have used either low-resolution thumbnails or random patches, which likely underestimated model performance. Here, we ask whether LMMs can be adapted to reason coherently and accurately in the evaluation of such images. In this study, we introduce Gigapixel Image Agent for Navigating Tissue (GIANT), the first framework that allows LMMs to iteratively navigate whole-slide images (WSIs) like a pathologist. Accompanying GIANT, we release MultiPathQA, a new benchmark, which comprises 934 WSI-level questions, encompassing five clinically-relevant tasks ranging from cancer diagnosis to open-ended reasoning. MultiPathQA also includes 128 questions, authored by two professional pathologists, requiring direct slide interpretation. Using MultiPathQA, we show that our simple agentic system substantially outperforms conventional patch- and thumbnail-based baselines, approaching or surpassing the performance of specialized models trained on millions of images. For example, on pathologist-authored questions, GPT-5 with GIANT achieves 62.5% accuracy, outperforming specialist pathology models such as TITAN (43.8%) and SlideChat (37.5%). Our findings reveal the strengths and limitations of current foundation models and ground future development of LMMs for expert reasoning in pathology.

Chest X-ray plays a central role in thoracic diagnosis, and its interpretation inherently requires multi-step, evidence-grounded reasoning. However, large vision-language models (LVLMs) often generate plausible responses that are not faithfully grounded in diagnostic evidence and provide limited visual evidence for verification, while also requiring costly retraining to support new diagnostic tasks, limiting their reliability and adaptability in clinical settings. To address these limitations, we present CXReasonAgent, a diagnostic agent that integrates a large language model (LLM) with clinically grounded diagnostic tools to perform evidence-grounded diagnostic reasoning using image-derived diagnostic and visual evidence. To evaluate these capabilities, we introduce CXReasonDial, a multi-turn dialogue benchmark with 1,946 dialogues across 12 diagnostic tasks, and show that CXReasonAgent produces faithfully grounded responses, enabling more reliable and verifiable diagnostic reasoning than LVLMs. These findings highlight the importance of integrating clinically grounded diagnostic tools, particularly in safety-critical clinical settings.

Metadata are general characteristics of the data in a well-curated and condensed format, and have been proven to be useful for decision making, knowledge discovery, and also heterogeneous data organization of biobank. Among all data types in the biobank, pathology is the key component of the biobank and also serves as the gold standard of diagnosis. To maximize the utility of biobank and allow the rapid progress of biomedical science, it is essential to organize the data with well-populated pathology metadata. However, manual annotation of such information is tedious and time-consuming. In the study, we develop a multimodal multitask learning framework to predict four major slide-level metadata of pathology images. The framework learns generalizable representations across tissue slides, pathology reports, and case-level structured data. We demonstrate improved performance across all four tasks with the proposed method compared to a single modal single task baseline on two test sets, one external test set from a distinct data source (TCGA) and one internal held-out test set (TTH). In the test sets, the performance improvements on the averaged area under receiver operating characteristic curve across the four tasks are 16.48% and 9.05% on TCGA and TTH, respectively. Such pathology metadata prediction system may be adopted to mitigate the effort of expert annotation and ultimately accelerate the data-driven research by better utilization of the pathology biobank.

High-quality Machine Translation (MT) evaluation relies heavily on human judgments. Comprehensive error classification methods, such as Multidimensional Quality Metrics (MQM), are expensive as they are time-consuming and can only be done by experts, whose availability may be limited especially for low-resource languages. On the other hand, just assigning overall scores, like Direct Assessment (DA), is simpler and faster and can be done by translators of any level, but is less reliable. In this paper, we introduce Error Span Annotation (ESA), a human evaluation protocol which combines the continuous rating of DA with the high-level error severity span marking of MQM. We validate ESA by comparing it to MQM and DA for 12 MT systems and one human reference translation (English to German) from WMT23. The results show that ESA offers faster and cheaper annotations than MQM at the same quality level, without the requirement of expensive MQM experts.

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

While Minimum Bayes Risk (MBR) decoding using metrics such as COMET or MetricX has outperformed traditional decoding methods such as greedy or beam search, it introduces a challenge we refer to as metric bias. As MBR decoding aims to produce translations that score highly according to a specific utility metric, this very process makes it impossible to use the same metric for both decoding and evaluation, as improvements might simply be due to reward hacking rather than reflecting real quality improvements. In this work we find that compared to human ratings, neural metrics not only overestimate the quality of MBR decoding when the same metric is used as the utility metric, but they also overestimate the quality of MBR/QE decoding with other neural utility metrics as well. We also show that the metric bias issue can be mitigated by using an ensemble of utility metrics during MBR decoding: human evaluations show that MBR decoding using an ensemble of utility metrics outperforms a single utility metric.

Automatic medical report generation (MRG) is of great research value as it has the potential to relieve radiologists from the heavy burden of report writing. Despite recent advancements, accurate MRG remains challenging due to the need for precise clinical understanding and the identification of clinical findings. Moreover, the imbalanced distribution of diseases makes the challenge even more pronounced, as rare diseases are underrepresented in training data, making their diagnostic performance unreliable. To address these challenges, we propose diagnosis-driven prompts for medical report generation (PromptMRG), a novel framework that aims to improve the diagnostic accuracy of MRG with the guidance of diagnosis-aware prompts. Specifically, PromptMRG is based on encoder-decoder architecture with an extra disease classification branch. When generating reports, the diagnostic results from the classification branch are converted into token prompts to explicitly guide the generation process. To further improve the diagnostic accuracy, we design cross-modal feature enhancement, which retrieves similar reports from the database to assist the diagnosis of a query image by leveraging the knowledge from a pre-trained CLIP. Moreover, the disease imbalanced issue is addressed by applying an adaptive logit-adjusted loss to the classification branch based on the individual learning status of each disease, which overcomes the barrier of text decoder's inability to manipulate disease distributions. Experiments on two MRG benchmarks show the effectiveness of the proposed method, where it obtains state-of-the-art clinical efficacy performance on both datasets.

Imaging markers of cerebral small vessel disease provide valuable information on brain health, but their manual assessment is time-consuming and hampered by substantial intra- and interrater variability. Automated rating may benefit biomedical research, as well as clinical assessment, but diagnostic reliability of existing algorithms is unknown. Here, we present the results of the VAscular Lesions DetectiOn and Segmentation (Where is VALDO?) challenge that was run as a satellite event at the international conference on Medical Image Computing and Computer Aided Intervention (MICCAI) 2021. This challenge aimed to promote the development of methods for automated detection and segmentation of small and sparse imaging markers of cerebral small vessel disease, namely enlarged perivascular spaces (EPVS) (Task 1), cerebral microbleeds (Task 2) and lacunes of presumed vascular origin (Task 3) while leveraging weak and noisy labels. Overall, 12 teams participated in the challenge proposing solutions for one or more tasks (4 for Task 1 - EPVS, 9 for Task 2 - Microbleeds and 6 for Task 3 - Lacunes). Multi-cohort data was used in both training and evaluation. Results showed a large variability in performance both across teams and across tasks, with promising results notably for Task 1 - EPVS and Task 2 - Microbleeds and not practically useful results yet for Task 3 - Lacunes. It also highlighted the performance inconsistency across cases that may deter use at an individual level, while still proving useful at a population level.

As Large Language Models (LLMs) evolve from passive text generators to active reasoning agents capable of tool interaction, the Model Context Protocol (MCP) has emerged as a standardized framework for dynamic tool discovery and orchestration. Despite widespread industry adoption, existing evaluation methodologies fail to adequately assess tool utilization capabilities within this new paradigm. This paper introduces MCP-RADAR, the first comprehensive benchmark specifically designed to evaluate LLM performance in the MCP framework through a novel five-dimensional approach measuring: answer accuracy, tool selection efficiency, computational resource efficiency, parameter construction accuracy, and execution speed. Unlike conventional benchmarks that rely on subjective human evaluations or binary success metrics, MCP-RADAR employs objective, quantifiable measurements across multiple task domains including software engineering, mathematical reasoning, and general problem-solving. Our evaluations of leading commercial and open-source LLMs reveal distinctive capability profiles with significant trade-offs between accuracy, efficiency, and speed, challenging traditional single-metric performance rankings. Besides, we provide valuable guidance for developers to optimize their tools for maximum model compatibility and effectiveness. While focused on MCP due to its standardized approach, our methodology remains applicable across all LLM agent tool integration frameworks, providing valuable insights for both LLM developers and tool creators to optimize the entire LLM-tool interaction ecosystem. The implementation, configurations, and datasets used in our evaluation are publicly available at https://anonymous.4open.science/r/MCPRadar-B143.

Clinical decision support systems (CDSS) require scrutable, auditable pipelines that enable rigorous, reproducible validation. Yet current LLM-based CDSS remain largely opaque. Most "open" models are open-weight only, releasing parameters while withholding the data provenance, curation procedures, and generation pipelines that determine model behavior. Fully Open (FO) models, which expose the complete training stack end-to-end, do not currently exist in medicine. We introduce Fully Open Meditron, the first fully open pipeline for building LLM-CDSS, comprising a clinician-audited training corpus, a reproducible data construction and training framework, and a use-aligned evaluation protocol. The corpus unifies eight public medical QA datasets into a normalized conversational format and expands coverage with three clinician-vetted synthetic extensions: exam-style QA, guideline-grounded QA derived from 46,469 clinical practice guidelines, and clinical vignettes. The pipeline enforces system-wide decontamination, gold-label resampling of teacher generations, and end-to-end validation by a four-physician panel. We evaluate using an LLM-as-a-judge protocol over expert-written clinical vignettes, calibrated against 204 human raters. We apply the recipe to five FO base models (Apertus-70B/8B-Instruct, OLMo-2-32B-SFT, EuroLLM-22B/9B-Instruct). All MeditronFO variants are preferred over their bases. Apertus-70B-MeditronFO improves +6.6 points over its base (47.2% to 53.8%) on aggregate medical benchmarks, establishing a new FO SoTA. Gemma-3-27B-MeditronFO is preferred over MedGemma in 58.6% of LLM-as-a-judge comparisons and outperforms it on HealthBench (58% vs 55.9%). These results show that fully open pipelines can achieve state-of-the-art domain-specific performance without sacrificing auditability or reproducibility.

Biological protocols are fundamental to reproducible and safe life science research. While LLMs excel on general tasks, their systematic evaluation on these highly specialized, accuracy-critical, and inherently procedural texts remains limited. In this work, we present BioProBench, the first large-scale, integrated multi-task benchmark for biological protocol understanding and reasoning. While limited benchmarks have touched upon specific aspects like protocol QA, BioProBench provides a comprehensive suite of five core tasks: Protocol Question Answering, Step Ordering, Error Correction, Protocol Generation, and Protocol Reasoning, enabling a holistic evaluation of LLMs on procedural biological texts. Built upon 27K original protocols, it yields nearly 556K high-quality structured instances. We evaluate 12 mainstream open/closed-source LLMs on BioProBench. Experimental results reveal that while top models preform well on surface understanding tasks, struggle significantly with deep reasoning and structured generation tasks like ordering and generation. Furthermore, model comparisons reveal diverse performance: certain open-source models approach closed-source levels on some tasks, yet bio-specific small models lag behind general LLMs, indicating limitations on complex procedural content. Overall, our findings underscore that procedural reasoning within biological protocols represents a significant challenge for current LLMs. BioProBench serves as a standardized framework to diagnose these specific limitations and guide the development of AI systems better equipped for safely automating complex scientific procedures. The code and data are available at: https://github.com/YuyangSunshine/bioprotocolbench and https://huggingface.co/datasets/GreatCaptainNemo/BioProBench.

Longitudinal chest X-ray (CXR) interpretation requires reasoning over disease evolution across multiple patient visits, yet most existing medical VQA benchmarks focus on single images or short-horizon image pairs. We introduce MI-CXR, a benchmark for standardized evaluation of Multi-Interval longitudinal reasoning over multi-visit CXR sequences, without requiring free-form report generation or additional clinical context. MI-CXR comprises five-way multiple-choice questions over five-visit patient timelines and instantiates three complementary task families: Temporal Event Localization, Interval-wise Change Reasoning, and Global Trajectory Summarization, which assess clinically grounded visual reasoning over time. Evaluating 14 state-of-the-art vision-language models (VLMs) shows low overall performance, with an average accuracy of 29.3%, only modestly above random guessing. Using stage-wise diagnostic probing, we find that models often produce locally plausible interval descriptions but fail to enforce temporal constraints or compose evidence into globally consistent decisions over the full timeline. These findings reveal key limitations of current VLMs and establish MI-CXR as a principled benchmark for longitudinal medical reasoning. The benchmark is available at https://github.com/AIDASLab/MI-CXR

The integration of Large Language Models (LLMs) with Internet-of-Things (IoT) systems faces significant challenges in hardware heterogeneity and control complexity. The Model Context Protocol (MCP) emerges as a critical enabler, providing standardized communication between LLMs and physical devices. We propose IoT-MCP, a novel framework that implements MCP through edge-deployed servers to bridge LLMs and IoT ecosystems. To support rigorous evaluation, we introduce IoT-MCP Bench, the first benchmark containing 114 Basic Tasks (e.g., ``What is the current temperature?'') and 1,140 Complex Tasks (e.g., ``I feel so hot, do you have any ideas?'') for IoT-enabled LLMs. Experimental validation across 22 sensor types and 6 microcontroller units demonstrates IoT-MCP's 100% task success rate to generate tool calls that fully meet expectations and obtain completely accurate results, 205ms average response time, and 74KB peak memory footprint. This work delivers both an open-source integration framework (https://github.com/Duke-CEI-Center/IoT-MCP-Servers) and a standardized evaluation methodology for LLM-IoT systems.

We introduce the Information-Estimation Metric (IEM), a novel form of distance function derived from an underlying continuous probability density over a domain of signals. The IEM is rooted in a fundamental relationship between information theory and estimation theory, which links the log-probability of a signal with the errors of an optimal denoiser, applied to noisy observations of the signal. In particular, the IEM between a pair of signals is obtained by comparing their denoising error vectors over a range of noise amplitudes. Geometrically, this amounts to comparing the score vector fields of the blurred density around the signals over a range of blur levels. We prove that the IEM is a valid global distance metric and derive a closed-form expression for its local second-order approximation, which yields a Riemannian metric. For Gaussian-distributed signals, the IEM coincides with the Mahalanobis distance. But for more complex distributions, it adapts, both locally and globally, to the geometry of the distribution. In practice, the IEM can be computed using a learned denoiser (analogous to generative diffusion models) and solving a one-dimensional integral. To demonstrate the value of our framework, we learn an IEM on the ImageNet database. Experiments show that this IEM is competitive with or outperforms state-of-the-art supervised image quality metrics in predicting human perceptual judgments.

General-purpose Large Vision-Language Models (LVLMs), despite their massive scale, often falter in dermatology due to "diffuse attention" - the inability to disentangle subtle pathological lesions from background noise. In this paper, we challenge the assumption that parameter scaling is the only path to medical precision. We introduce SkinFlow, a framework that treats diagnosis as an optimization of visual information transmission efficiency. Our approach utilizes a Virtual-Width Dynamic Vision Encoder (DVE) to "unfold" complex pathological manifolds without physical parameter expansion, coupled with a two-stage Reinforcement Learning strategy. This strategy sequentially aligns explicit medical descriptions (Stage I) and reconstructs implicit diagnostic textures (Stage II) within a constrained semantic space. Furthermore, we propose a clinically grounded evaluation protocol that prioritizes diagnostic safety and hierarchical relevance over rigid label matching. Empirical results are compelling: our 7B model establishes a new state-of-the-art on the Fitzpatrick17k benchmark, achieving a +12.06% gain in Top-1 accuracy and a +28.57% boost in Top-6 accuracy over the massive general-purpose models (e.g., Qwen3VL-235B and GPT-5.2). These findings demonstrate that optimizing geometric capacity and information flow yields superior diagnostic reasoning compared to raw parameter scaling.

The open radio access network (O-RAN), with its disaggregated and open architecture, is poised to meet the demands of the next generation of wireless communication. However, to unlock the full potentials of O-RAN, real-time network modeling and optimization are essential. A promising solution for such requirement is the use of network digital twin (NDT). NDT provides a comprehensive view of a network, covering both physical and logical components, including infrastructure, protocols, and algorithms. NDT, as a real-time virtual representation of O-RAN facilitates a variety of operations, such as emulations, test, optimization, monitoring, and analysis of a new configuration in a risk-free environment, without requiring them to be implemented in real network. Such capability enables the vendors and network operators for a faster adoption of new solutions with frequent updates, while ensuring the resiliency of the existing services via planning ahead under various "what-if" scenarios. In this paper, we first describe what exactly NDT means in the context of O-RAN, as well as its key enablers. We then describe the NDT application within the O-RAN in both prior and post-deployment. Finally, we provide two practical uses cases, namely network energy efficiency and traffic steering, where the NDT can be leveraged effectively.

Accurate and interpretable multi-disease diagnosis remains a critical challenge in medical research, particularly when leveraging heterogeneous multimodal medical data. Current approaches often rely on single-modal data, limiting their ability to comprehensively understand complex diseases. To address this, we propose MedTVT-R1, a novel Multimodal Large Language Model (MLLM) framework designed to integrate clinical multimodal data for reasoning and diagnosing multiple diseases. We construct MedTVT-QA, a curated instruction dataset that provides question-answer pairs for physiological-level interpretations and disease-level diagnoses with a Chain of Evidence approach. MedTVT-R1 incorporates a modality perception layer to capture inter-modal dependencies and adaptively weight modality contributions. Additionally, we employ Group Relative Policy Optimization (GRPO)-based Reinforcement Fine-Tuning with a Jaccard Reward function to enhance diagnostic reasoning. Experimental results demonstrate MedTVT-R1's superiority in multimodal feature utilization and multi-disease diagnosis, offering significant potential for clinical applications such as diagnostic report generation and comorbidity reasoning. The dataset and code are available at https://github.com/keke-nice/MedTVT-R1.

Diagnosing a whole-slide image is an interactive, multi-stage process involving changes in magnification and movement between fields. Although recent pathology foundation models are strong, practical agentic systems that decide what field to examine next, adjust magnification, and deliver explainable diagnoses are still lacking. The blocker is data: scalable, clinically aligned supervision of expert viewing behavior that is tacit and experience-based, not written in textbooks or online, and therefore absent from large language model training. We introduce the AI Session Recorder, which works with standard WSI viewers to unobtrusively record routine navigation and convert the viewer logs into standardized behavioral commands (inspect or peek at discrete magnifications) and bounding boxes. A lightweight human-in-the-loop review turns AI-drafted rationales into the Pathology-CoT dataset, a form of paired "where to look" and "why it matters" supervision produced at roughly six times lower labeling time. Using this behavioral data, we build Pathologist-o3, a two-stage agent that first proposes regions of interest and then performs behavior-guided reasoning. On gastrointestinal lymph-node metastasis detection, it achieved 84.5% precision, 100.0% recall, and 75.4% accuracy, exceeding the state-of-the-art OpenAI o3 model and generalizing across backbones. To our knowledge, this constitutes one of the first behavior-grounded agentic systems in pathology. Turning everyday viewer logs into scalable, expert-validated supervision, our framework makes agentic pathology practical and establishes a path to human-aligned, upgradeable clinical AI.

We introduce Metric-Fair Prompting, a fairness-aware prompting framework that guides large language models (LLMs) to make decisions under metric-fairness constraints. In the application of multiple-choice medical question answering, each {(question, option)} pair is treated as a binary instance with label +1 (correct) or -1 (incorrect). To promote {individual fairness}~--~treating similar instances similarly~--~we compute question similarity using NLP embeddings and solve items in joint pairs of similar questions rather than in isolation. The prompt enforces a global decision protocol: extract decisive clinical features, map each \((question, option)\) to a score f(x) that acts as confidence, and impose a Lipschitz-style constraint so that similar inputs receive similar scores and, hence, consistent outputs. Evaluated on the {MedQA (US)} benchmark, Metric-Fair Prompting is shown to improve performance over standard single-item prompting, demonstrating that fairness-guided, confidence-oriented reasoning can enhance LLM accuracy on high-stakes clinical multiple-choice questions.

Radiological imaging is central to diagnosis, treatment planning, and clinical decision-making. Vision-language foundation models have spurred interest in automated radiology report generation (RRG), but safe deployment requires reliable clinical evaluation of generated reports. Existing metrics often rely on surface-level similarity or behave as black boxes, lacking interpretability. We introduce ICARE (Interpretable and Clinically-grounded Agent-based Report Evaluation), an interpretable evaluation framework leveraging large language model agents and dynamic multiple-choice question answering (MCQA). Two agents, each with either the ground-truth or generated report, generate clinically meaningful questions and quiz each other. Agreement on answers captures preservation and consistency of findings, serving as interpretable proxies for clinical precision and recall. By linking scores to question-answer pairs, ICARE enables transparent, and interpretable assessment. Clinician studies show ICARE aligns significantly more with expert judgment than prior metrics. Perturbation analyses confirm sensitivity to clinical content and reproducibility, while model comparisons reveal interpretable error patterns.

Pancreatic ductal adenocarcinoma (PDAC) segmentation on contrast-enhanced CT is inherently ambiguous: inter-rater disagreement among experts reflects genuine uncertainty rather than annotation noise. Standard deep learning approaches assume a single ground truth, producing probabilistic outputs that can be poorly calibrated and difficult to interpret under such ambiguity. We present TwinTrack, a framework that addresses this gap through post-hoc calibration of ensemble segmentation probabilities to the empirical mean human response (MHR) -the fraction of expert annotators labeling a voxel as tumor. Calibrated probabilities are thus directly interpretable as the expected proportion of annotators assigning the tumor label, explicitly modeling inter-rater disagreement. The proposed post-hoc calibration procedure is simple and requires only a small multi-rater calibration set. It consistently improves calibration metrics over standard approaches when evaluated on the MICCAI 2025 CURVAS-PDACVI multi-rater benchmark.

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.

Face reconstruction and tracking is a building block of numerous applications in AR/VR, human-machine interaction, as well as medical applications. Most of these applications rely on a metrically correct prediction of the shape, especially, when the reconstructed subject is put into a metrical context (i.e., when there is a reference object of known size). A metrical reconstruction is also needed for any application that measures distances and dimensions of the subject (e.g., to virtually fit a glasses frame). State-of-the-art methods for face reconstruction from a single image are trained on large 2D image datasets in a self-supervised fashion. However, due to the nature of a perspective projection they are not able to reconstruct the actual face dimensions, and even predicting the average human face outperforms some of these methods in a metrical sense. To learn the actual shape of a face, we argue for a supervised training scheme. Since there exists no large-scale 3D dataset for this task, we annotated and unified small- and medium-scale databases. The resulting unified dataset is still a medium-scale dataset with more than 2k identities and training purely on it would lead to overfitting. To this end, we take advantage of a face recognition network pretrained on a large-scale 2D image dataset, which provides distinct features for different faces and is robust to expression, illumination, and camera changes. Using these features, we train our face shape estimator in a supervised fashion, inheriting the robustness and generalization of the face recognition network. Our method, which we call MICA (MetrIC fAce), outperforms the state-of-the-art reconstruction methods by a large margin, both on current non-metric benchmarks as well as on our metric benchmarks (15% and 24% lower average error on NoW, respectively).

Metric-induced discrete flow matching (MI-DFM) exploits token-latent geometry for discrete generation, but its practical use is limited by two issues: heuristic schedulers requiring hyperparameter search, and finite-step path-tracking error from its first-order continuous-time Markov chain (CTMC) solver. We address both issues. First, we derive a kinetic-optimal scheduler for prescribed scalar-parameterized probability paths, and instantiate it for MI-DFM as a training-free numerical schedule that traverses the path at constant Fisher-Rao speed. Second, we introduce a finite-step moment correction that adjusts the jump probability while preserving the CTMC jump destination distribution. We validate the resulting method, GibbsTTS, on codec-based zero-shot text-to-speech (TTS). Under controlled comparisons with a unified architecture and large-scale dataset, GibbsTTS achieves the best objective naturalness and is preferred in subjective evaluations over masked discrete generative baselines. Additionally, in comparison with the evaluated state-of-the-art TTS systems, GibbsTTS shows strong speaker similarity, achieving the highest similarity on three of four test sets and ranking second on the fourth. Project page: https://ydqmkkx.github.io/GibbsTTSProject

AI-agent guardrails are memoryless: each message is judged in isolation, so an adversary who spreads a single attack across dozens of sessions slips past every session-bound detector because only the aggregate carries the payload. We make three contributions to cross-session threat detection. (1) Dataset. CSTM-Bench is 26 executable attack taxonomies classified by kill-chain stage and cross-session operation (accumulate, compose, launder, inject_on_reader), each bound to one of seven identity anchors that ground-truth "violation" as a policy predicate, plus matched Benign-pristine and Benign-hard confounders. Released on Hugging Face as intrinsec-ai/cstm-bench with two 54-scenario splits: dilution (compositional) and cross_session (12 isolation-invisible scenarios produced by a closed-loop rewriter that softens surface phrasing while preserving cross-session artefacts). (2) Measurement. Framing cross-session detection as an information bottleneck to a downstream correlator LLM, we find that a session-bound judge and a Full-Log Correlator concatenating every prompt into one long-context call both lose roughly half their attack recall moving from dilution to cross_session, well inside any frontier context window. Scope: 54 scenarios per shard, one correlator family (Anthropic Claude), no prompt optimisation; we release it to motivate larger, multi-provider datasets. (3) Algorithm and metric. A bounded-memory Coreset Memory Reader retaining highest-signal fragments at K=50 is the only reader whose recall survives both shards. Because ranker reshuffles break KV-cache prefix reuse, we promote CSR_prefix (ordered prefix stability, LLM-free) to a first-class metric and fuse it with detection into CSTM = 0.7 F_1(CSDA@action, precision) + 0.3 CSR_prefix, benchmarking rankers on a single Pareto of recall versus serving stability.

Imitation-learning policies inherit the quality of the demonstrations they are trained on, and a growing set of curation metrics promise to score and filter low-quality demonstrations automatically. These metrics are each validated on different data with different protocols, so it is unclear which of them actually identify the demonstrations that harm a policy. We build a controlled testbed in which demonstration defects are injected with known type, and audit seven curation metrics along two axes: how well each separates defective from clean demonstrations, and whether training a behavior-cloning policy on each metric's curated subset improves task success. We study two defect regimes. Subtle perturbations (correlated action noise, tremor, truncation) are detectable by multivariate outlier scoring and, once removed, recover the full downstream gap. Structural errors, where the demonstration executes a wrong action at a key moment, are invisible to every action-only metric we test, and two of them are inverted: they score defective demonstrations as higher quality and, used for curation, tend to leave the policy at or below the uncurated baseline rather than above it. Only metrics that examine the state trajectory detect structural errors, and even the best of them recovers just a third of the downstream gap. High detection accuracy does not guarantee downstream improvement. We release the testbed and all curation implementations.

Early detection of gastric cancer, a leading cause of cancer-related mortality worldwide, remains hampered by the limitations of current diagnostic technologies, leading to high rates of misdiagnosis and missed diagnoses. To address these challenges, we propose an integrated system that synergizes advanced hardware and software technologies to balance speed-accuracy. Our study introduces the One Class Twin Cross Learning (OCT-X) algorithm. Leveraging a novel fast double-threshold grid search strategy (FDT-GS) and a patch-based deep fully convolutional network, OCT-X maximizes diagnostic accuracy through real-time data processing and seamless lesion surveillance. The hardware component includes an all-in-one point-of-care testing (POCT) device with high-resolution imaging sensors, real-time data processing, and wireless connectivity, facilitated by the NI CompactDAQ and LabVIEW software. Our integrated system achieved an unprecedented diagnostic accuracy of 99.70%, significantly outperforming existing models by up to 4.47%, and demonstrated a 10% improvement in multirate adaptability. These findings underscore the potential of OCT-X as well as the integrated system in clinical diagnostics, offering a path toward more accurate, efficient, and less invasive early gastric cancer detection. Future research will explore broader applications, further advancing oncological diagnostics. Code is available at https://github.com/liu37972/Multirate-Location-on-OCT-X-Learning.git.

Positron emission tomography (PET) is a cornerstone of modern oncologic and neurologic imaging, distinguished by its unique ability to illuminate dynamic metabolic processes that transcend the anatomical focus of traditional imaging technologies. Radiology reports are essential for clinical decision making, yet their manual creation is labor-intensive and time-consuming. Recent advancements of vision-language models (VLMs) have shown strong potential in medical applications, presenting a promising avenue for automating report generation. However, existing applications of VLMs in the medical domain have predominantly focused on structural imaging modalities, while the unique characteristics of molecular PET imaging have largely been overlooked. To bridge the gap, we introduce PET2Rep, a large-scale comprehensive benchmark for evaluation of general and medical VLMs for radiology report generation for PET images. PET2Rep stands out as the first dedicated dataset for PET report generation with metabolic information, uniquely capturing whole-body image-report pairs that cover dozens of organs to fill the critical gap in existing benchmarks and mirror real-world clinical comprehensiveness. In addition to widely recognized natural language generation metrics, we introduce a series of clinical efficiency metrics to evaluate the quality of radiotracer uptake pattern description in key organs in generated reports. We conduct a head-to-head comparison of 30 cutting-edge general-purpose and medical-specialized VLMs. The results show that the current state-of-the-art VLMs perform poorly on PET report generation task, falling considerably short of fulfilling practical needs. Moreover, we identify several key insufficiency that need to be addressed to advance the development in medical applications.

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.

Clinical diagnostic workups typically follow a modality escalation pathway: after initial clinical evaluation, clinicians begin with routine structural imaging (e.g., MRI), selectively add sequences such as FLAIR or T2 to refine the differential, and reserve molecular imaging (e.g., amyloid-PET) for cases that remain uncertain after standard evaluation. Consequently, patients are observed with heterogeneous and often incomplete modality subsets. However, most current AI models assume fixed data modalities as the model inputs. In this paper, we present BrainAnytime, a unified pretraining framework pretrained on 34,899 3D brain scans from five datasets that support brain image analysis under arbitrary modality availability spanning multi-sequence MRI and amyloid-PET. A single model accepts whatever imaging is available, from a lone T1 scan to a full multimodal workup. Pretraining learns structural-molecular correspondences between MRI and PET via cross-modal distillation (RCMD) and prioritizes disease-vulnerable anatomy via atlas-guided curriculum masking (PACM), all within a shared 3D masked autoencoder (Multi-MAE3D). Across four downstream tasks and five clinically motivated modality settings, BrainAnytime largely outperforms modality-specific models, missing-modality baselines, and large-scale brain MRI pretrained foundation models on most modality settings. Notably, it surpasses the strongest missing-modality baselines with relative improvements of 6.2% and 7.0% in average accuracy on CN vs. AD and CN vs. MCI classification, respectively. Code is available at https://github.com/SDH-Lab/BrainAnytime.

Annually, at the Conference of Machine Translation (WMT), the Metrics Shared Task organizers conduct the meta-evaluation of Machine Translation (MT) metrics, ranking them according to their correlation with human judgments. Their results guide researchers toward enhancing the next generation of metrics and MT systems. With the recent introduction of neural metrics, the field has witnessed notable advancements. Nevertheless, the inherent opacity of these metrics has posed substantial challenges to the meta-evaluation process. This work highlights two issues with the meta-evaluation framework currently employed in WMT, and assesses their impact on the metrics rankings. To do this, we introduce the concept of sentinel metrics, which are designed explicitly to scrutinize the meta-evaluation process's accuracy, robustness, and fairness. By employing sentinel metrics, we aim to validate our findings, and shed light on and monitor the potential biases or inconsistencies in the rankings. We discover that the present meta-evaluation framework favors two categories of metrics: i) those explicitly trained to mimic human quality assessments, and ii) continuous metrics. Finally, we raise concerns regarding the evaluation capabilities of state-of-the-art metrics, emphasizing that they might be basing their assessments on spurious correlations found in their training data.

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 .

Clinical image interpretation is inherently multi-step and tool-centric: clinicians iteratively combine visual evidence with patient context, quantify findings, and refine their decisions through a sequence of specialized procedures. While LLM-based agents promise to orchestrate such heterogeneous medical tools, existing systems treat tool sets and invocation strategies as static after deployment. This design is brittle under real-world domain shifts, across tasks, and evolving diagnostic requirements, where predefined tool chains frequently degrade and demand costly manual re-design. We propose MACRO, a self-evolving, experience-augmented medical agent that shifts from static tool composition to experience-driven tool discovery. From verified execution trajectories, the agent autonomously identifies recurring effective multi-step tool sequences, synthesizes them into reusable composite tools, and registers these as new high-level primitives that continuously expand its behavioral repertoire. A lightweight image-feature memory grounds tool selection in a visual-clinical context, while a GRPO-like training loop reinforces reliable invocation of discovered composites, enabling closed-loop self-improvement with minimal supervision. Extensive experiments across diverse medical imaging datasets and tasks demonstrate that autonomous composite tool discovery consistently improves multi-step orchestration accuracy and cross-domain generalization over strong baselines and recent state-of-the-art agentic methods, bridging the gap between brittle static tool use and adaptive, context-aware clinical AI assistance. Code will be available upon acceptance.

The scaling laws and extraordinary performance of large foundation models motivate the development and utilization of such models in biomedicine. However, despite early promising results on some biomedical benchmarks, there are still major challenges that need to be addressed before these models can be used in real-world clinics. Frontier general-domain models such as GPT-4V still have significant performance gaps in multimodal biomedical applications. More importantly, less-acknowledged pragmatic issues, including accessibility, model cost, and tedious manual evaluation make it hard for clinicians to use state-of-the-art large models directly on private patient data. Here, we explore training open-source small multimodal models (SMMs) to bridge competency gaps for unmet clinical needs in radiology. To maximize data efficiency, we adopt a modular approach by incorporating state-of-the-art pre-trained models for image and text modalities, and focusing on training a lightweight adapter to ground each modality to the text embedding space, as exemplified by LLaVA-Med. For training, we assemble a large dataset of over 697 thousand radiology image-text pairs. For evaluation, we propose CheXprompt, a GPT-4-based metric for factuality evaluation, and demonstrate its parity with expert evaluation. For best practice, we conduct a systematic ablation study on various choices in data engineering and multimodal training. The resulting LlaVA-Rad (7B) model attains state-of-the-art results on standard radiology tasks such as report generation and cross-modal retrieval, even outperforming much larger models such as GPT-4V and Med-PaLM M (84B). The inference of LlaVA-Rad is fast and can be performed on a single V100 GPU in private settings, offering a promising state-of-the-art tool for real-world clinical applications.

As large-scale multi-agent systems evolve, the communication protocol layer has become a critical yet under-evaluated factor shaping performance and reliability. Despite the existence of diverse protocols (A2A, ACP, ANP, Agora, etc.), selection is often intuition-driven and lacks standardized guidance. We introduce ProtocolBench, a benchmark that systematically compares agent protocols along four measurable axes: task success, end-to-end latency, message or byte overhead, and robustness under failures. On ProtocolBench, protocol choice significantly influences system behavior. In the Streaming Queue scenario, overall completion time varies by up to 36.5% across protocols, and mean end-to-end latency differs by 3.48 s. Under Fail-Storm Recovery, resilience also differs consistently across protocols. Beyond evaluation, we present ProtocolRouter, a learnable protocol router that selects per-scenario (or per-module) protocols from requirement and runtime signals. ProtocolRouter reduces Fail-Storm recovery time by up to 18.1% versus the best single-protocol baseline, and achieves scenario-specific gains such as higher success in GAIA. We also release ProtocolRouterBench to standardize protocol evaluation and improve reliability at scale.

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.

Despite Retrieval-Augmented Generation (RAG) has shown promising capability in leveraging external knowledge, a comprehensive evaluation of RAG systems is still challenging due to the modular nature of RAG, evaluation of long-form responses and reliability of measurements. In this paper, we propose a fine-grained evaluation framework, RAGChecker, that incorporates a suite of diagnostic metrics for both the retrieval and generation modules. Meta evaluation verifies that RAGChecker has significantly better correlations with human judgments than other evaluation metrics. Using RAGChecker, we evaluate 8 RAG systems and conduct an in-depth analysis of their performance, revealing insightful patterns and trade-offs in the design choices of RAG architectures. The metrics of RAGChecker can guide researchers and practitioners in developing more effective RAG systems.

Artificial intelligence has significantly advanced healthcare, particularly through large language models (LLMs) that excel in medical question answering benchmarks. However, their real-world clinical application remains limited due to the complexities of doctor-patient interactions. To address this, we introduce AI Hospital, a multi-agent framework simulating dynamic medical interactions between Doctor as player and NPCs including Patient, Examiner, Chief Physician. This setup allows for realistic assessments of LLMs in clinical scenarios. We develop the Multi-View Medical Evaluation (MVME) benchmark, utilizing high-quality Chinese medical records and NPCs to evaluate LLMs' performance in symptom collection, examination recommendations, and diagnoses. Additionally, a dispute resolution collaborative mechanism is proposed to enhance diagnostic accuracy through iterative discussions. Despite improvements, current LLMs exhibit significant performance gaps in multi-turn interactions compared to one-step approaches. Our findings highlight the need for further research to bridge these gaps and improve LLMs' clinical diagnostic capabilities. Our data, code, and experimental results are all open-sourced at https://github.com/LibertFan/AI_Hospital.

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).

As the performance of large language models (LLMs) continues to advance, their adoption is expanding across a wide range of domains, including the medical field. The integration of LLMs into medical applications raises critical safety concerns, particularly due to their use by users with diverse roles, e.g. patients and clinicians, and the potential for model's outputs to directly affect human health. Despite the domain-specific capabilities of medical LLMs, prior safety evaluations have largely focused only on general safety benchmarks. In this paper, we introduce a safety evaluation protocol tailored to the medical domain in both patient user and clinician user perspectives, alongside general safety assessments and quantitatively analyze the safety of medical LLMs. We bridge a gap in the literature by building the PatientSafetyBench containing 466 samples over 5 critical categories to measure safety from the perspective of the patient. We apply our red-teaming protocols on the MediPhi model collection as a case study. To our knowledge, this is the first work to define safety evaluation criteria for medical LLMs through targeted red-teaming taking three different points of view - patient, clinician, and general user - establishing a foundation for safer deployment in medical domains.

Acute poly-substance intoxication requires rapid, life-saving decisions under substantial uncertainty, as clinicians must rely on incomplete ingestion details and nonspecific symptoms. Effective diagnostic reasoning in this chaotic environment requires fusing unstructured, non-medical narratives (e.g. paramedic scene descriptions and unreliable patient self-reports or known histories), with structured medical data like vital signs. While Large Language Models (LLMs) show potential for processing such heterogeneous inputs, they struggle in this setting, often underperforming simple baselines that rely solely on patient histories. To address this, we present DeToxR (Decision-support for Toxicology with Reasoning), the first adaptation of Reinforcement Learning (RL) to emergency toxicology. We design a robust data-fusion engine for multi-label prediction across 14 substance classes based on an LLM finetuned with Group Relative Policy Optimization (GRPO). We optimize the model's reasoning directly using a clinical performance reward. By formulating a multi-label agreement metric as the reward signal, the model is explicitly penalized for missing co-ingested substances and hallucinating absent poisons. Our model significantly outperforms its unadapted base LLM counterpart and supervised baselines. Furthermore, in a clinical validation study, the model indicates a clinical advantage by outperforming an expert toxicologist in identifying the correct poisons (Micro-F1: 0.644 vs. 0.473). These results demonstrate the potential of RL-aligned LLMs to synthesize unstructured pre-clinical narratives and structured medical data for decision support in high-stakes environments.

Multi-agent systems (MAS) are critical for automating complex tasks, yet their practical deployment is severely hampered by the challenge of failure attribution. Current diagnostic tools, which rely on statistical correlations, are fundamentally inadequate; on challenging benchmarks like Who\&When, state-of-the-art methods achieve less than 15\% accuracy in locating the root-cause step of a failure. To address this critical gap, we introduce the first failure attribution framework for MAS grounded in multi-granularity causal inference. Our approach makes two key technical contributions: (1) a performance causal inversion principle, which correctly models performance dependencies by reversing the data flow in execution logs, combined with Shapley values to accurately assign agent-level blame; (2) a novel causal discovery algorithm, CDC-MAS, that robustly identifies critical failure steps by tackling the non-stationary nature of MAS interaction data. The framework's attribution results directly fuel an automated optimization loop, generating targeted suggestions whose efficacy is validated via counterfactual simulations. Evaluations on the Who\&When and TRAIL benchmarks demonstrate a significant leap in performance. Our method achieves up to 36.2\% step-level accuracy. Crucially, the generated optimizations boost overall task success rates by an average of 22.4\%. This work provides a principled and effective solution for debugging complex agent interactions, paving the way for more reliable and interpretable multi-agent systems.

Although Foundation Models (FMs), such as GPT-4, are increasingly used in domains like finance and software engineering, reliance on textual interfaces limits these models' real-world interaction. To address this, FM providers introduced tool calling-triggering a proliferation of frameworks with distinct tool interfaces. In late 2024, Anthropic introduced the Model Context Protocol (MCP) to standardize this tool ecosystem, which has become the de facto standard with over eight million weekly SDK downloads. Despite its adoption, MCP's AI-driven, non-deterministic control flow introduces new risks to sustainability, security, and maintainability, warranting closer examination. Towards this end, we present the first large-scale empirical study of MCP servers. Using state-of-the-art health metrics and a hybrid analysis pipeline, combining a general-purpose static analysis tool with an MCP-specific scanner, we evaluate 1,899 open-source MCP servers to assess their health, security, and maintainability. Despite MCP servers demonstrating strong health metrics, we identify eight distinct vulnerabilities - only three overlapping with traditional software vulnerabilities. Additionally, 7.2% of servers contain general vulnerabilities and 5.5% exhibit MCP-specific tool poisoning. Regarding maintainability, while 66% exhibit code smells, 14.4% contain nine bug patterns overlapping with traditional open-source software projects. These findings highlight the need for MCP-specific vulnerability detection techniques while reaffirming the value of traditional analysis and refactoring practices.

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

This paper presents a comprehensive evaluation of GPT-4V's capabilities across diverse medical imaging tasks, including Radiology Report Generation, Medical Visual Question Answering (VQA), and Visual Grounding. While prior efforts have explored GPT-4V's performance in medical image analysis, to the best of our knowledge, our study represents the first quantitative evaluation on publicly available benchmarks. Our findings highlight GPT-4V's potential in generating descriptive reports for chest X-ray images, particularly when guided by well-structured prompts. Meanwhile, its performance on the MIMIC-CXR dataset benchmark reveals areas for improvement in certain evaluation metrics, such as CIDEr. In the domain of Medical VQA, GPT-4V demonstrates proficiency in distinguishing between question types but falls short of the VQA-RAD benchmark in terms of accuracy. Furthermore, our analysis finds the limitations of conventional evaluation metrics like the BLEU scores, advocating for the development of more semantically robust assessment methods. In the field of Visual Grounding, GPT-4V exhibits preliminary promise in recognizing bounding boxes, but its precision is lacking, especially in identifying specific medical organs and signs. Our evaluation underscores the significant potential of GPT-4V in the medical imaging domain, while also emphasizing the need for targeted refinements to fully unlock its capabilities.