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Sep 17

Towards Robust Foundation Models for Digital Pathology

Biomedical Foundation Models (FMs) are rapidly transforming AI-enabled healthcare research and entering clinical validation. However, their susceptibility to learning non-biological technical features -- including variations in surgical/endoscopic techniques, laboratory procedures, and scanner hardware -- poses risks for clinical deployment. We present the first systematic investigation of pathology FM robustness to non-biological features. Our work (i) introduces measures to quantify FM robustness, (ii) demonstrates the consequences of limited robustness, and (iii) proposes a framework for FM robustification to mitigate these issues. Specifically, we developed PathoROB, a robustness benchmark with three novel metrics, including the robustness index, and four datasets covering 28 biological classes from 34 medical centers. Our experiments reveal robustness deficits across all 20 evaluated FMs, and substantial robustness differences between them. We found that non-robust FM representations can cause major diagnostic downstream errors and clinical blunders that prevent safe clinical adoption. Using more robust FMs and post-hoc robustification considerably reduced (but did not yet eliminate) the risk of such errors. This work establishes that robustness evaluation is essential for validating pathology FMs before clinical adoption and demonstrates that future FM development must integrate robustness as a core design principle. PathoROB provides a blueprint for assessing robustness across biomedical domains, guiding FM improvement efforts towards more robust, representative, and clinically deployable AI systems that prioritize biological information over technical artifacts.

  • 12 authors
·
Jul 22, 2025

UltraVR: A Diagnostic Ultra-Resolution Image-VQA Benchmark for Evidence-Grounded Reasoning

Vision-language models (VLMs) excel on visual question answering and multimodal reasoning benchmarks. Yet their capability on ultra-resolution images - where critical evidence is tiny, subtle, spatially distant, or distributed - remains unclear. Existing evaluations largely report final-answer accuracy, offering limited insight into whether models acquire and integrate the necessary visual evidence. We introduce UltraVR, a diagnostic benchmark for evidence-grounded visual reasoning over ultra-resolution images. UltraVR spans four high-value scenarios: CCTV surveillance, remote sensing (RS), whole-slide image (WSI) pathology, and industrial anomaly detection (AD). These domains pose complementary challenges: fine-grained object grounding in crowded CCTV scenes, long-range spatial comparison in RS, multi-scale evidence navigation in WSI, and subtle irregularity detection in repetitive industrial layouts. Beyond standard QA triples, each instance includes a structured ground-truth chain of thought with step-level questions, intermediate answers, and reasoning labels. These labels decompose reasoning into evidence grounding, local perception, quantification, evidence integration, and decision inference, enabling process-level diagnosis over black-box scoring. Using UltraVR, we evaluate frontier VLMs and show that current models remain far from reliable on ultra-resolution reasoning. Importantly, the structured annotations allow us to localize failures across the visual-to-decision pipeline: errors concentrate in evidence grounding and local perception, while downstream inference often recovers when intermediate visual facts are supplied. These findings demonstrate UltraVR as a diagnostic testbed for measuring not only whether VLMs answer correctly, but where their ultra-resolution reasoning process breaks.

  • 9 authors
·
Jun 3

DR.BENCH: Diagnostic Reasoning Benchmark for Clinical Natural Language Processing

The meaningful use of electronic health records (EHR) continues to progress in the digital era with clinical decision support systems augmented by artificial intelligence. A priority in improving provider experience is to overcome information overload and reduce the cognitive burden so fewer medical errors and cognitive biases are introduced during patient care. One major type of medical error is diagnostic error due to systematic or predictable errors in judgment that rely on heuristics. The potential for clinical natural language processing (cNLP) to model diagnostic reasoning in humans with forward reasoning from data to diagnosis and potentially reduce the cognitive burden and medical error has not been investigated. Existing tasks to advance the science in cNLP have largely focused on information extraction and named entity recognition through classification tasks. We introduce a novel suite of tasks coined as Diagnostic Reasoning Benchmarks, DR.BENCH, as a new benchmark for developing and evaluating cNLP models with clinical diagnostic reasoning ability. The suite includes six tasks from ten publicly available datasets addressing clinical text understanding, medical knowledge reasoning, and diagnosis generation. DR.BENCH is the first clinical suite of tasks designed to be a natural language generation framework to evaluate pre-trained language models. Experiments with state-of-the-art pre-trained generative language models using large general domain models and models that were continually trained on a medical corpus demonstrate opportunities for improvement when evaluated in DR. BENCH. We share DR. BENCH as a publicly available GitLab repository with a systematic approach to load and evaluate models for the cNLP community.

  • 7 authors
·
Sep 29, 2022

LLM Judges Verify Presence, Not Absence: Omission Blindness in AI Clinical Notes and What Recovers It

Ambient AI scribes draft clinical notes, and published audits find their dominant error is omission: information the encounter established that the note fails to record. The standard check is an LLM judge: a second model reads the note against the transcript and flags problems. We ask whether judges detect omissions. Public corpora cannot supply the answer key: their clinician reference notes and transcripts are materially discrepant. Our benchmark has 500 single-error note pairs from audited fact sheets, 298 with a named fact certainly absent and 202 added-or-altered controls. Across eight judge designs, paired discrimination (the flawed note below its clean twin, 0.5 a coin flip) reads 0.79-0.94 on added or altered content and 0.50-0.63 on omissions. On single notes, no design flags omissions reliably more often than perfect notes. Wording changes, voting and GEPA prompt optimisation move the operating point without creating usable detection. Restructuring the task recovers it: list the facts the transcript establishes, then check the note for each. Two methods reach it independently and trade off: a per-fact pipeline, and a GEPA-evolved prompt doing the same in one call. The pipeline's flags name the missing fact and its severity at 2.7% false alarms. The single call detects more (36.9% against 24.6%, p=0.002) at 6.2% false alarms and a tenth of the cost per note. A physician author validated 70 items and, where the two routes disagree, sided with the pipeline on 10 of 10 (p=0.002). A second clinician, not an author, graded the severity rubric blind and agrees to within a grade. On real vendor notes from a companion census no benchmark threshold transfers, but the re-calibrated single call detects more than the best of the eight at half its false-alarm rate. Omissions whose fact is restated elsewhere defeat both routes. We release the benchmark, prompts and judgements.

  • 4 authors
·
Aug 30

Interpretable Failure Analysis in Multi-Agent Reinforcement Learning Systems

Multi-Agent Reinforcement Learning (MARL) is increasingly deployed in safety-critical domains, yet methods for interpretable failure detection and attribution remain underdeveloped. We introduce a two-stage gradient-based framework that provides interpretable diagnostics for three critical failure analysis tasks: (1) detecting the true initial failure source (Patient-0); (2) validating why non-attacked agents may be flagged first due to domino effects; and (3) tracing how failures propagate through learned coordination pathways. Stage 1 performs interpretable per-agent failure detection via Taylor-remainder analysis of policy-gradient costs, declaring an initial Patient-0 candidate at the first threshold crossing. Stage 2 provides validation through geometric analysis of critic derivatives-first-order sensitivity and directional second-order curvature aggregated over causal windows to construct interpretable contagion graphs. This approach explains "downstream-first" detection anomalies by revealing pathways that amplify upstream deviations. Evaluated across 500 episodes in Simple Spread (3 and 5 agents) and 100 episodes in StarCraft II using MADDPG and HATRPO, our method achieves 88.2-99.4% Patient-0 detection accuracy while providing interpretable geometric evidence for detection decisions. By moving beyond black-box detection to interpretable gradient-level forensics, this framework offers practical tools for diagnosing cascading failures in safety-critical MARL systems.

  • 4 authors
·
Feb 8

VeriLLMed: Interactive Visual Debugging of Medical Large Language Models with Knowledge Graphs

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.

  • 10 authors
·
Apr 24

SigmaMedStat: Temporal Signal Modeling for ICU False Alarm Reduction

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

  • 1 authors
·
May 27

Exploring Multimodal Large Language Models for Radiology Report Error-checking

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from two real-world radiology datasets (MIMIC-CXR and IU-Xray), with 1,000 subsampled reports each. A subset of original reports was modified to contain synthetic errors by introducing various type of mistakes. The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. LLaVA (Large Language and Visual Assistant) variant models, including our instruction-tuned model, were used for the evaluation. Additionally, a domain expert evaluation was conducted on a small test set. At the SIMPLE level, the LLaVA v1.5 model outperformed other publicly available models. Instruction tuning significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU-Xray data, respectively. The model also surpassed the domain experts accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. This study marks a promising step toward utilizing multi-modal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans. Nevertheless, future work is needed to improve the model ability to identify the types of inconsistency.

  • 10 authors
·
Dec 20, 2023

Automated SSIM Regression for Detection and Quantification of Motion Artefacts in Brain MR Images

Motion artefacts in magnetic resonance brain images can have a strong impact on diagnostic confidence. The assessment of MR image quality is fundamental before proceeding with the clinical diagnosis. Motion artefacts can alter the delineation of structures such as the brain, lesions or tumours and may require a repeat scan. Otherwise, an inaccurate (e.g. correct pathology but wrong severity) or incorrect diagnosis (e.g. wrong pathology) may occur. "Image quality assessment" as a fast, automated step right after scanning can assist in deciding if the acquired images are diagnostically sufficient. An automated image quality assessment based on the structural similarity index (SSIM) regression through a residual neural network is proposed in this work. Additionally, a classification into different groups - by subdividing with SSIM ranges - is evaluated. Importantly, this method predicts SSIM values of an input image in the absence of a reference ground truth image. The networks were able to detect motion artefacts, and the best performance for the regression and classification task has always been achieved with ResNet-18 with contrast augmentation. The mean and standard deviation of residuals' distribution were mu=-0.0009 and sigma=0.0139, respectively. Whilst for the classification task in 3, 5 and 10 classes, the best accuracies were 97, 95 and 89\%, respectively. The results show that the proposed method could be a tool for supporting neuro-radiologists and radiographers in evaluating image quality quickly.

  • 7 authors
·
Jun 14, 2022

Position: Early-Stage Quality Assurance in Annotation Pipelines Is More Cost-Effective Than Late-Stage Validation

This position paper argues that the machine learning community should prioritize early-stage quality assurance in annotation pipelines over the prevailing practice of late-stage validation. Data quality bottlenecks increasingly limit foundation model improvement, yet quality assurance research focuses almost exclusively on validation methods rather than validation timing. When validation occurs, not merely what methods are employed, fundamentally determines both error rates and annotation costs. This temporal neglect is puzzling given the well-established "shift-left" principle from software engineering, where empirical studies demonstrate 4--100x cost multipliers for defects detected in later stages (Boehm, 1981; Shull et al., 2002). Annotation pipelines exhibit analogous dynamics: errors caught before annotation begins cost a fraction of those discovered after review cycles complete. We propose a taxonomy of three QA trigger points, namely pre-annotation (T0), post-annotation (T1), and post-review (T2), that decompose annotation workflows into discrete validation opportunities. A parametric error-propagation model formalizes when timing affects final error rates versus only economics, making timing a measurable design variable rather than a configuration afterthought. A survey of 47 recent papers reveals that only 4% report when validation occurs, a striking gap given timing's demonstrated impact in adjacent fields. Without explicit attention to QA timing, the community risks optimizing validation methods while ignoring the structural variable that may matter most. Acting on this position requires three steps: researchers should report QA timing configurations alongside validation methods; annotation platforms should expose timing as a first-class parameter; and the community should run controlled experiments that measure stage-specific detection rates directly.

  • 11 authors
·
May 14

AEGIS: Assay-Aware Protocol Validation and Runtime Monitoring for Open-Source Liquid Handling Robots

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

  • 4 authors
·
Jul 16

One note in three: a verified census of three deployed AI scribes, and the instrument that counted it

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

  • 4 authors
·
Aug 30

MedVista3D: Vision-Language Modeling for Reducing Diagnostic Errors in 3D CT Disease Detection, Understanding and Reporting

Radiologic diagnostic errors-under-reading errors, inattentional blindness, and communication failures-remain prevalent in clinical practice. These issues often stem from missed localized abnormalities, limited global context, and variability in report language. These challenges are amplified in 3D imaging, where clinicians must examine hundreds of slices per scan. Addressing them requires systems with precise localized detection, global volume-level reasoning, and semantically consistent natural language reporting. However, existing 3D vision-language models are unable to meet all three needs jointly, lacking local-global understanding for spatial reasoning and struggling with the variability and noise of uncurated radiology reports. We present MedVista3D, a multi-scale semantic-enriched vision-language pretraining framework for 3D CT analysis. To enable joint disease detection and holistic interpretation, MedVista3D performs local and global image-text alignment for fine-grained representation learning within full-volume context. To address report variability, we apply language model rewrites and introduce a Radiology Semantic Matching Bank for semantics-aware alignment. MedVista3D achieves state-of-the-art performance on zero-shot disease classification, report retrieval, and medical visual question answering, while transferring well to organ segmentation and prognosis prediction. Code and datasets will be released.

  • 6 authors
·
Sep 3, 2025 2

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

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

  • 7 authors
·
Dec 26, 2024

Excess Separability: Nuisance-Controlled Residual-Stream Probing for Benchmark Contamination Detection

Benchmark contamination is diagnosed with n-gram overlap, likelihood-based membership inference, or canary strings, and each needs something usually unavailable: the training corpus, a well-chosen test statistic, or foresight at release. A recent alternative reads it off a linear probe on internal activations. We show the natural way to do this does not work, specify one that survives measurement, then find that the correction making it work carries more variance than the null it is tested against. The protocol reports a zero-sum contrast on the depth profile of probe accuracy, recentred on a level-matched placebo baseline, tested against a label-permutation null, with the reference set twice the size of the suspect set. Each choice replaces a simpler alternative we rejected on measurement. Reporting the level of excess separability rather than its shape makes the false positive rate track the size of the analyst's own control set, 0.03 to 0.99 under a true null. Contrasting against a flat depth profile rejects a true null 0.72 of the time when surface decodability rises with depth, and loses all power when it falls. On real transformers the protocol fails a test the simulations did not pose. The recentring subtracts an estimate, and the permutation null holds it fixed. Re-estimated across split seeds on four audits of contaminated checkpoints, its standard deviation is 1.30 to 1.56 times the null's own in every arm: what is subtracted to remove a bias is more variable than what it corrects. The one nominally significant result, p = 0.0075, becomes 0.0745 once that variance is propagated, and no verdict is issued. The simulations missed this because their surface key is the covariate driving item variation; on real text it is a proxy, and degrading key quality in simulation reproduces it. We add a companion measurement and a widened null. No arm shows contamination.

  • 1 authors
·
Aug 15

Dynamic Bidirectional Pattern Memory: A Production-Scale Empirical Characterisation of Inference-Time Gating in Clinical NLP

We study inference-time pattern-memory gating in a production-scale clinical natural language processing (NLP) pipeline. The pipeline pairs a generator (Llama-3.3 70B) proposing extractions with a verifier (MMed-Llama-3.1 70B) accepting or rejecting them, over 167,034 PMC-Patients narratives, and adds a lightweight memory that learns at deployment which extractions to filter, so the verifier need not re-examine candidates already seen to fail. We report four findings. First, learning filtering rules directly from the verifier's rejections failed at full scale: the relation-extraction filter stayed empty despite 785,797 logged rejections, because they were spread too thinly across too many distinct forms to accumulate. Second, a simpler rule using a fixed clinical ontology produced the same filtering without the verifier, capturing 49,734 ontology-violating relations on a held-out 5,000-patient set. Third, of five versions of the question-answering filter, four failed for distinct, instructive reasons; the fifth succeeded by checking whether a patient's extracted entities support the question asked, and where it applies was 1.84 times likelier to flag an answer the verifier would reject than one it would accept. Fourth, one pattern held across all five: a filter is selective only when it tests the same evidence the verifier weighs, not when it imitates the verifier's output. Together these give a transferable result for any generator-verifier pipeline: the most natural memory design can fail silently at scale, and whether a pre-generation gate is selective is decided before any engineering effort, by whether its signal probes the question the verifier itself answers. Throughout, the system flags suspect extractions rather than deleting them, so every decision stays visible for clinical review. All code and test artefacts are released openly.

  • 2 authors
·
Jun 30

Computer Aided Detection for Pulmonary Embolism Challenge (CAD-PE)

Rationale: Computer aided detection (CAD) algorithms for Pulmonary Embolism (PE) algorithms have been shown to increase radiologists' sensitivity with a small increase in specificity. However, CAD for PE has not been adopted into clinical practice, likely because of the high number of false positives current CAD software produces. Objective: To generate a database of annotated computed tomography pulmonary angiographies, use it to compare the sensitivity and false positive rate of current algorithms and to develop new methods that improve such metrics. Methods: 91 Computed tomography pulmonary angiography scans were annotated by at least one radiologist by segmenting all pulmonary emboli visible on the study. 20 annotated CTPAs were open to the public in the form of a medical image analysis challenge. 20 more were kept for evaluation purposes. 51 were made available post-challenge. 8 submissions, 6 of them novel, were evaluated on the 20 evaluation CTPAs. Performance was measured as per embolus sensitivity vs. false positives per scan curve. Results: The best algorithms achieved a per-embolus sensitivity of 75% at 2 false positives per scan (fps) or of 70% at 1 fps, outperforming the state of the art. Deep learning approaches outperformed traditional machine learning ones, and their performance improved with the number of training cases. Significance: Through this work and challenge we have improved the state-of-the art of computer aided detection algorithms for pulmonary embolism. An open database and an evaluation benchmark for such algorithms have been generated, easing the development of further improvements. Implications on clinical practice will need further research.

  • 20 authors
·
Mar 30, 2020

Prior Audit-Repair Context Shifts LLM Verifier Thresholds Toward Leniency

Automated checking pipelines increasingly place one language model as the checker and another (or the same one) as the fixer. We ask whether that wiring changes what the checker reports. Measuring false alarms on human-verified-correct ProcessBench traces with the present task held byte-identical, we find that a completed audit -> repair episode already in the model's context lowers false alarms in 15 of 15 model x wording combinations, by 2.8 to 11.5 percentage points against a length-matched non-audit control, a 9 to 25% reduction relative to that control. The direction contradicts what the accumulated-message literature predicts: an episode whose audit reported an error lowers false alarms further still, at all five wordings on the model where that manipulation lands cleanly, though a negativity asymmetry predicts more flagging. Decomposing the episode finds repair content and audit verdict complementary: different components carry the effect on different model families. Signal-detection analysis locates the change in the threshold rather than in discrimination -- the criterion moves in 15 of 15 combinations and survives correction in 13 while d' survives in none, though the d' test is half as sensitive by construction -- and a hand audit of 50 false alarms finds 82% simply wrong, so at this operating point the shift need not be harmful. With reasoning enabled the effect keeps its relative size on both models tested, and the threshold reading holds there too.

  • 2 authors
·
Aug 16 2

SurvBench: A Standardised Preprocessing Pipeline for Multi-Modal Electronic Health Record Survival Analysis

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

  • 2 authors
·
May 11

MedObvious: Exposing the Medical Moravec's Paradox in VLMs via Clinical Triage

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

  • 8 authors
·
Mar 23

CausalFlow: Causal Attribution and Counterfactual Repair for LLM Agent Failures

Large language model (LLM) agents frequently fail on multi-step tasks involving reasoning, tool use, and environment interaction. While such failures are typically logged or retried heuristically, they contain structured signals about where execution broke down. We introduce CausalFlow, an interventional framework that converts failed agent traces into minimal counterfactual repairs and reusable supervision. CausalFlow models execution traces as sequential chains of dependent steps and computes Causal Responsibility Scores(CRS) via step-level counterfactual intervention to identify failure-inducing steps. For these steps, we generate minimally edited repairs that flip the final outcome to success, producing validated contrastive pairs of the form (wrong step, corrected step). CausalFlow supports two complementary uses: targeted test-time repair that recovers from failures with minimal behavioral drift, and training-time supervision suitable for offline preference optimization or reward modeling. Across four benchmarks spanning mathematical reasoning, code generation, question answering, and medical browsing, CausalFlow converts failed executions into validated minimal repairs with high minimality and causal-consensus scores, and demonstrates that causal attribution is necessary for reliable improvement across diverse agent tasks, outperforming heuristic refinement in complex retrieval settings while producing more localized repairs throughout. These results demonstrate that interventional analysis over structured execution traces provides a principled and scalable mechanism for transforming agent failures into reliability gains and learning-ready supervision.

  • 5 authors
·
May 24

Root-Cause Attribution Is a Search Problem: Continual Search for Long-Horizon Agent Failures

The increasing deployment of AI agents in long-horizon tasks yields massive execution logs. Diagnosing failures within these records is crucial for reliability, as it transforms outcome-level signals into actionable interventions. The sheer scale of the data renders human review impractical, driving the need for automated root-cause attribution (RCA). However, automated RCA methods using LLMs suffer from low diagnostic accuracy, especially as execution traces grow larger. They struggle because relevant information is often sparse, distributed across distant actions, and disconnected from the visible failure, reducing root-cause attribution to a massive search problem. Existing RCA methods typically rely on one-shot LLM judgments to diagnose failures from execution traces. While effective for shorter trajectories, these judges tend to settle on a plausible diagnosis early, leaving critical evidence in longer traces unexamined. We introduce Continual Search, an iterative framework that nudges the judge, over successive turns, to keep searching for unresolved diagnostic evidence. We evaluate Continual Search across four existing RCA benchmarks. Recognizing the lack of massive execution traces in current benchmarks, we introduce MegaRCA-Mix to evaluate RCA at scale. MegaRCA-Mix provides a challenging testbed of 50 human-annotated failure trials spanning long-horizon, execution-heavy tasks. Across multiple benchmark suites and model families, Continual Search consistently improves attribution performance. On MegaRCA-Mix, for example, it improves GPT-5.5's F1 score by more than 40\%, from 0.349 to 0.498. More interestingly, within the same model family, lower-tier models can even surpass their higher-tier counterparts, demonstrating that effective search supersedes raw model scale.

ScaleAI Scale AI
·
Sep 10 2

Evaluation data contamination in LLMs: how do we measure it and (when) does it matter?

Hampering the interpretation of benchmark scores, evaluation data contamination has become a growing concern in the evaluation of LLMs, and an active area of research studies its effects. While evaluation data contamination is easily understood intuitively, it is surprisingly difficult to define precisely which samples should be considered contaminated and, consequently, how it impacts benchmark scores. We propose that these questions should be addressed together and that contamination metrics can be assessed based on whether models benefit from the examples they mark contaminated. We propose a novel analysis method called ConTAM, and show with a large scale survey of existing and novel n-gram based contamination metrics across 13 benchmarks and 7 models from 2 different families that ConTAM can be used to better understand evaluation data contamination and its effects. We find that contamination may have a much larger effect than reported in recent LLM releases and benefits models differently at different scales. We also find that considering only the longest contaminated substring provides a better signal than considering a union of all contaminated substrings, and that doing model and benchmark specific threshold analysis greatly increases the specificity of the results. Lastly, we investigate the impact of hyperparameter choices, finding that, among other things, both using larger values of n and disregarding matches that are infrequent in the pre-training data lead to many false negatives. With ConTAM, we provide a method to empirically ground evaluation data contamination metrics in downstream effects. With our exploration, we shed light on how evaluation data contamination can impact LLMs and provide insight into the considerations important when doing contamination analysis. We end our paper by discussing these in more detail and providing concrete suggestions for future work.

  • 7 authors
·
Nov 6, 2024

Conformal Segmentation in Industrial Surface Defect Detection with Statistical Guarantees

In industrial settings, surface defects on steel can significantly compromise its service life and elevate potential safety risks. Traditional defect detection methods predominantly rely on manual inspection, which suffers from low efficiency and high costs. Although automated defect detection approaches based on Convolutional Neural Networks(e.g., Mask R-CNN) have advanced rapidly, their reliability remains challenged due to data annotation uncertainties during deep model training and overfitting issues. These limitations may lead to detection deviations when processing the given new test samples, rendering automated detection processes unreliable. To address this challenge, we first evaluate the detection model's practical performance through calibration data that satisfies the independent and identically distributed (i.i.d) condition with test data. Specifically, we define a loss function for each calibration sample to quantify detection error rates, such as the complement of recall rate and false discovery rate. Subsequently, we derive a statistically rigorous threshold based on a user-defined risk level to identify high-probability defective pixels in test images, thereby constructing prediction sets (e.g., defect regions). This methodology ensures that the expected error rate (mean error rate) on the test set remains strictly bounced by the predefined risk level. Additionally, we observe a negative correlation between the average prediction set size and the risk level on the test set, establishing a statistically rigorous metric for assessing detection model uncertainty. Furthermore, our study demonstrates robust and efficient control over the expected test set error rate across varying calibration-to-test partitioning ratios, validating the method's adaptability and operational effectiveness.

  • 2 authors
·
Apr 23, 2025

Agent Mesh: Reliability Primitives for Non-Idempotent Agent Delegation - Identity Adequacy and Evidence Adequacy

Autonomous agents increasingly perform bounded software tasks under an orchestrator that retries, resumes, and budgets them. The machinery such orchestrators reach for is the service mesh's: retry, timeout, and error-rate circuit breaking. We report a failure study of a production agentic software-delivery platform over 147 numbered incidents spanning 81 runs, each with a measured cost and, in most cases, a mutation proof reproducing the failure. All three assumptions those primitives rest on are violated in practice, and we quantify the consequences: a loop of fifty-four consecutive successful tool calls no error-rate breaker could see; a progress signal constant by construction, guaranteeing a false trip on the third repair round and driving one run from six of six components to three; twenty-one events accumulated across six invocations of one delegation, making a correct, idempotent component unwinnable; a misrouted failure that woke five components for a two-component fault, leaving three bystanders regressing working code; and twelve incidents in which the enforcement layer blocked correct work, the most expensive costing 107 agent turns and zero accepted writes. We find one cross-cutting cause and its dual. Identity adequacy: in five separate subsystems an identity that failed to discriminate produced a confident wrong answer, and two of them derived the corrective rule independently. Evidence adequacy: a reliability decision may be taken only on evidence capable of moving, attributable to what it measures, and deterministic under identical conditions. From the findings we derive seven reliability primitives whose enforcement unit is the delegation rather than the message, and specify the controlled evaluation the study motivates but does not constitute.

  • 3 authors
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Aug 25

Evaluation Blindness: How Silent Measurement Failures Corrupt AI Systems from Training to Deployment

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

  • 1 authors
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Aug 2

Susceptibility of Large Language Models to User-Driven Factors in Medical Queries

Large language models (LLMs) are increasingly used in healthcare, but their reliability is heavily influenced by user-driven factors such as question phrasing and the completeness of clinical information. In this study, we examined how misinformation framing, source authority, model persona, and omission of key clinical details affect the diagnostic accuracy and reliability of LLM outputs. We conducted two experiments: one introducing misleading external opinions with varying assertiveness (perturbation test), and another removing specific categories of patient information (ablation test). Using public datasets (MedQA and Medbullets), we evaluated proprietary models (GPT-4o, Claude 3.5 Sonnet, Claude 3.5 Haiku, Gemini 1.5 Pro, Gemini 1.5 Flash) and open-source models (LLaMA 3 8B, LLaMA 3 Med42 8B, DeepSeek R1 8B). All models were vulnerable to user-driven misinformation, with proprietary models especially affected by definitive and authoritative language. Assertive tone had the greatest negative impact on accuracy. In the ablation test, omitting physical exam findings and lab results caused the most significant performance drop. Although proprietary models had higher baseline accuracy, their performance declined sharply under misinformation. These results highlight the need for well-structured prompts and complete clinical context. Users should avoid authoritative framing of misinformation and provide full clinical details, especially for complex cases.

  • 7 authors
·
Mar 26, 2025

Medical Reasoning in LLMs: An In-Depth Analysis of DeepSeek R1

Integrating large language models (LLMs) like DeepSeek R1 into healthcare requires rigorous evaluation of their reasoning alignment with clinical expertise. This study assesses DeepSeek R1's medical reasoning against expert patterns using 100 MedQA clinical cases. The model achieved 93% diagnostic accuracy, demonstrating systematic clinical judgment through differential diagnosis, guideline-based treatment selection, and integration of patient-specific factors. However, error analysis of seven incorrect cases revealed persistent limitations: anchoring bias, challenges reconciling conflicting data, insufficient exploration of alternatives, overthinking, knowledge gaps, and premature prioritization of definitive treatment over intermediate care. Crucially, reasoning length correlated with accuracy - shorter responses (<5,000 characters) were more reliable, suggesting extended explanations may signal uncertainty or rationalization of errors. While DeepSeek R1 exhibits foundational clinical reasoning capabilities, recurring flaws highlight critical areas for refinement, including bias mitigation, knowledge updates, and structured reasoning frameworks. These findings underscore LLMs' potential to augment medical decision-making through artificial reasoning but emphasize the need for domain-specific validation, interpretability safeguards, and confidence metrics (e.g., response length thresholds) to ensure reliability in real-world applications.

  • 3 authors
·
Mar 27, 2025

Auditing Demonstration Curation Metrics: Action-Only Scorers Fail on the Structural Defects That Degrade Imitation Policies

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.

  • 1 authors
·
Jun 3

Pervasive Label Errors in Test Sets Destabilize Machine Learning Benchmarks

We identify label errors in the test sets of 10 of the most commonly-used computer vision, natural language, and audio datasets, and subsequently study the potential for these label errors to affect benchmark results. Errors in test sets are numerous and widespread: we estimate an average of at least 3.3% errors across the 10 datasets, where for example label errors comprise at least 6% of the ImageNet validation set. Putative label errors are identified using confident learning algorithms and then human-validated via crowdsourcing (51% of the algorithmically-flagged candidates are indeed erroneously labeled, on average across the datasets). Traditionally, machine learning practitioners choose which model to deploy based on test accuracy - our findings advise caution here, proposing that judging models over correctly labeled test sets may be more useful, especially for noisy real-world datasets. Surprisingly, we find that lower capacity models may be practically more useful than higher capacity models in real-world datasets with high proportions of erroneously labeled data. For example, on ImageNet with corrected labels: ResNet-18 outperforms ResNet-50 if the prevalence of originally mislabeled test examples increases by just 6%. On CIFAR-10 with corrected labels: VGG-11 outperforms VGG-19 if the prevalence of originally mislabeled test examples increases by just 5%. Test set errors across the 10 datasets can be viewed at https://labelerrors.com and all label errors can be reproduced by https://github.com/cleanlab/label-errors.

  • 3 authors
·
Mar 26, 2021

CSTRL: Context-Driven Sequential Transfer Learning for Abstractive Radiology Report Summarization

A radiology report comprises several sections, including the Findings and Impression of the diagnosis. Automatically generating the Impression from the Findings is crucial for reducing radiologists' workload and improving diagnostic accuracy. Pretrained models that excel in common abstractive summarization problems encounter challenges when applied to specialized medical domains largely due to the complex terminology and the necessity for accurate clinical context. Such tasks in medical domains demand extracting core information, avoiding context shifts, and maintaining proper flow. Misuse of medical terms can lead to drastic clinical errors. To address these issues, we introduce a sequential transfer learning that ensures key content extraction and coherent summarization. Sequential transfer learning often faces challenges like initial parameter decay and knowledge loss, which we resolve with the Fisher matrix regularization. Using MIMIC-CXR and Open-I datasets, our model, CSTRL - Context-driven Sequential TRansfer Learning - achieved state-of-the-art performance, showing 56.2% improvement in BLEU-1, 40.5% in BLEU-2, 84.3% in BLEU-3, 28.9% in ROUGE-1, 41.0% in ROUGE-2 and 26.5% in ROGUE-3 score over benchmark studies. We also analyze factual consistency scores while preserving the medical context. Our code is publicly available at https://github.com/fahmidahossain/Report_Summarization.

  • 6 authors
·
Feb 21, 2025

Yet Another ICU Benchmark: A Flexible Multi-Center Framework for Clinical ML

Medical applications of machine learning (ML) have experienced a surge in popularity in recent years. The intensive care unit (ICU) is a natural habitat for ML given the abundance of available data from electronic health records. Models have been proposed to address numerous ICU prediction tasks like the early detection of complications. While authors frequently report state-of-the-art performance, it is challenging to verify claims of superiority. Datasets and code are not always published, and cohort definitions, preprocessing pipelines, and training setups are difficult to reproduce. This work introduces Yet Another ICU Benchmark (YAIB), a modular framework that allows researchers to define reproducible and comparable clinical ML experiments; we offer an end-to-end solution from cohort definition to model evaluation. The framework natively supports most open-access ICU datasets (MIMIC III/IV, eICU, HiRID, AUMCdb) and is easily adaptable to future ICU datasets. Combined with a transparent preprocessing pipeline and extensible training code for multiple ML and deep learning models, YAIB enables unified model development. Our benchmark comes with five predefined established prediction tasks (mortality, acute kidney injury, sepsis, kidney function, and length of stay) developed in collaboration with clinicians. Adding further tasks is straightforward by design. Using YAIB, we demonstrate that the choice of dataset, cohort definition, and preprocessing have a major impact on the prediction performance - often more so than model class - indicating an urgent need for YAIB as a holistic benchmarking tool. We provide our work to the clinical ML community to accelerate method development and enable real-world clinical implementations. Software Repository: https://github.com/rvandewater/YAIB.

  • 6 authors
·
Jun 8, 2023

IndustryBench: Probing the Industrial Knowledge Boundaries of LLMs

In industrial procurement, an LLM answer is useful only if it survives a standards check: recommended material must match operating condition, every parameter must respect a regulated threshold, and no procedure may contradict a safety clause. Partial correctness can mask safety-critical contradictions that aggregate LLM benchmarks rarely capture. We introduce IndustryBench, a 2,049-item benchmark for industrial procurement QA in Chinese, grounded in Chinese national standards (GB/T) and structured industrial product records, organized by seven capability dimensions, ten industry categories, and panel-derived difficulty tiers, with item-aligned English, Russian, and Vietnamese renderings. Our construction pipeline rejects 70.3% of LLM-generated candidates at a search-based external-verification stage, calibrating how unreliable industrial QA remains after LLM-only filtering.Our evaluation decouples raw correctness, scored by a Qwen3-Max judge validated at κ_w = 0.798 against a domain expert, from a separate safety-violation (SV) check against source texts. Across 17 models in Chinese and an 8-model intersection over four languages, we find: (i) the best system reaches only 2.083 on the 0--3 rubric, leaving substantial headroom; (ii) Standards & Terminology is the most persistent capability weakness and survives item-aligned translation; (iii) extended reasoning lowers safety-adjusted scores for 12 of 13 models, primarily by introducing unsupported safety-critical details into longer final answers; and (iv) safety-violation rates reshuffle the leaderboard -- GPT-5.4 climbs from rank 6 to rank 3 after SV adjustment, while Kimi-k2.5-1T-A32B drops seven positions.Industrial LLM evaluation therefore requires source-grounded, safety-aware diagnosis rather than aggregate accuracy. We release IndustryBench with all prompts, scoring scripts, and dataset documentation.

Why Has Predicting Downstream Capabilities of Frontier AI Models with Scale Remained Elusive?

Predictable behavior from scaling advanced AI systems is an extremely desirable property. Although a well-established literature exists on how pretraining performance scales, the literature on how particular downstream capabilities scale is significantly muddier. In this work, we take a step back and ask: why has predicting specific downstream capabilities with scale remained elusive? While many factors are certainly responsible, we identify a new factor that makes modeling scaling behavior on widely used multiple-choice question-answering benchmarks challenging. Using five model families and twelve well-established multiple-choice benchmarks, we show that downstream performance is computed from negative log likelihoods via a sequence of transformations that progressively degrade the statistical relationship between performance and scale. We then reveal the mechanism causing this degradation: downstream metrics require comparing the correct choice against a small number of specific incorrect choices, meaning accurately predicting downstream capabilities requires predicting not just how probability mass concentrates on the correct choice with scale, but also how probability mass fluctuates on specific incorrect choices with scale. We empirically study how probability mass on the correct choice co-varies with probability mass on incorrect choices with increasing compute, suggesting that scaling laws for incorrect choices might be achievable. Our work also explains why pretraining scaling laws are commonly regarded as more predictable than downstream capabilities and contributes towards establishing scaling-predictable evaluations of frontier AI models.

  • 9 authors
·
Jun 6, 2024

MedRECT: A Medical Reasoning Benchmark for Error Correction in Clinical Texts

Large language models (LLMs) show increasing promise in medical applications, but their ability to detect and correct errors in clinical texts -- a prerequisite for safe deployment -- remains under-evaluated, particularly beyond English. We introduce MedRECT, a cross-lingual benchmark (Japanese/English) that formulates medical error handling as three subtasks: error detection, error localization (sentence extraction), and error correction. MedRECT is built with a scalable, automated pipeline from the Japanese Medical Licensing Examinations (JMLE) and a curated English counterpart, yielding MedRECT-ja (663 texts) and MedRECT-en (458 texts) with comparable error/no-error balance. We evaluate 9 contemporary LLMs spanning proprietary, open-weight, and reasoning families. Key findings: (i) reasoning models substantially outperform standard architectures, with up to 13.5% relative improvement in error detection and 51.0% in sentence extraction; (ii) cross-lingual evaluation reveals 5-10% performance gaps from English to Japanese, with smaller disparities for reasoning models; (iii) targeted LoRA fine-tuning yields asymmetric improvements in error correction performance (Japanese: +0.078, English: +0.168) while preserving reasoning capabilities; and (iv) our fine-tuned model exceeds human expert performance on structured medical error correction tasks. To our knowledge, MedRECT is the first comprehensive cross-lingual benchmark for medical error correction, providing a reproducible framework and resources for developing safer medical LLMs across languages.

  • 3 authors
·
Nov 1, 2025

MedCaseReasoning: Evaluating and learning diagnostic reasoning from clinical case reports

Doctors and patients alike increasingly use Large Language Models (LLMs) to diagnose clinical cases. However, unlike domains such as math or coding, where correctness can be objectively defined by the final answer, medical diagnosis requires both the outcome and the reasoning process to be accurate. Currently, widely used medical benchmarks like MedQA and MMLU assess only accuracy in the final answer, overlooking the quality and faithfulness of the clinical reasoning process. To address this limitation, we introduce MedCaseReasoning, the first open-access dataset for evaluating LLMs on their ability to align with clinician-authored diagnostic reasoning. The dataset includes 14,489 diagnostic question-and-answer cases, each paired with detailed reasoning statements derived from open-access medical case reports. We evaluate state-of-the-art reasoning LLMs on MedCaseReasoning and find significant shortcomings in their diagnoses and reasoning: for instance, the top-performing open-source model, DeepSeek-R1, achieves only 48% 10-shot diagnostic accuracy and mentions only 64% of the clinician reasoning statements (recall). However, we demonstrate that fine-tuning LLMs on the reasoning traces derived from MedCaseReasoning significantly improves diagnostic accuracy and clinical reasoning recall by an average relative gain of 29% and 41%, respectively. The open-source dataset, code, and models are available at https://github.com/kevinwu23/Stanford-MedCaseReasoning.

  • 10 authors
·
May 16, 2025 2

Correlation Is Not Enough: Embedding Human Metadata for Individual Causal Discovery

Ask a pretrained biomedical language model whether "cortisol 28 ug/dL" and "stock-market volatility" are related, and it returns a cosine similarity of 0.83 on a scale where 1.0 means identical. The two share no mechanism. This is not a corner case: every off-the-shelf biomedical encoder we tested (BioBERT, PubMedBERT, BioM-ELECTRA) scores unrelated cross-domain pairs between 0.76 and 0.92 when the answer should be near zero. Accuracy on cross-domain discrimination is 0%. Retrieval systems survive this, because a language model downstream filters the noise. A Large Behavioural Model (LBM), a foundation model whose subject is a person rather than a sentence, does not: it reasons over a graph of a user's life and treats embedding proximity as evidence that two events are causally linked. False proximity writes a false causal edge, and everything downstream inherits the error. Here, embedding geometry is not a tuning knob; it is correctness. We report the fix. A contrastive pass over 72,034 pairs raises PubMedBERT BIOSSES correlation from 0.633 to 0.828 and within-vs-across-domain separation from 1.05x to 1.63x. A second pass, BODHI, mines hard negatives from edges absent in a biomedical knowledge graph and lifts separation to 2.30x and the discrimination gap to +0.392, at a 4.5% BIOSSES cost. On an Intel Xeon 6737P with AMX, OpenVINO cuts single-query latency from 1367 ms to 10 ms (133x) and reaches 555 sentences/sec. One finding contradicts standard advice: FP16 beats INT8 on this silicon at every serving batch size, and we explain why. The same model on a no-AMX Ice Lake instance runs 13-27x slower. We release the benchmark suite, training corpora, the BODHI generator, and the OpenVINO scripts.

  • 3 authors
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Jun 7

Diagnosis Before Recovery: Turning Agent Failures into Selective Self-Correction

Self-correction is particularly useful when a failure constrains the next repair. Coding agents benefit from this property because compilers, tests, and execution traces turn many failures into typed recovery signals, but broad language-agent tasks often expose only a coarse task failure. This creates a tension for generic recovery playbooks: they broaden the agent's context precisely when the system needs a narrower repair interface, mixing incompatible signals for invalid actions, missing procedures, and strict-format errors. Our insight is that development-set failures can recover part of the missing diagnostic substrate by deciding which recovery interventions are admissible before test-time correction. We propose DARC, a diagnosis-guided recovery harness that profiles task-family failure modes, prunes mismatched interventions from a shared recovery library, and freezes a verifier-selected success-cost policy for deployment. This causal order makes correction selective: the harness first determines what kind of failure can be repaired, then decides how much recovery evidence to spend. In ALFWorld, AppWorld, and XBRL Finance, the same protocol yields an action-validity harness, a procedural-recovery fallback, and a format-precision retrieval policy; in each evaluated setting it improves average task performance over base agents and broad playbooks while reducing environment steps or retrieval budget. Our experiments show that failures need not trigger uniformly more context: DARC turns self-correction from prompt expansion into recovery-interface design. DARC provides a practical route toward more reliable agents in domains where compiler-like feedback is absent: making failures actionable before making contexts larger.

  • 9 authors
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Aug 11

Real-Time Detection and Repair of LLM Agent Failures

LLM agents fail mid-episode -- they loop, cascade tool errors, drift off goal, fabricate results, or silently absorb corrupted content -- and the standard remedy, judging every step with a second LLM, costs more than the agent itself. We ask how much detection is achievable from observable step telemetry alone, using monitors costing microseconds per step and trained only on healthy runs. On 2,823 committed agent episodes across three frameworks, three local models (qwen2.5 7b/3b, llama3.1 8b) and a commercial API (gemini-2.5-flash), a one-class echo-state-network ensemble with CUSUM alarms detects 0.71 of failures at a 5% false-alarm budget (AUROC 0.872). Its advantage over a memoryless baseline is a monotone function of post-onset horizon (+0.09 at <=3 steps, +0.40 at >=9), predicting its own failure region out of sample on AFTraj-2K. Ranking transfers with no retraining to two corpora from other groups (AFTraj-2K 0.745, ATBench 0.779). Monitors carry two burdens: a per-deployment healthy null (they do not transfer -- AUROC 0.527 cold against 0.885 recalibrated) and a residual false-alarm rate. We add a layer carrying neither: deterministic verification, which recomputes a run's stated total from the tool results it actually received and confirms every required call was made. Head-to-head it catches 60% of failures (96% with the coverage check) at 0 of 63 false positives against the monitor's 54% at 17%, transfers unchanged to llama3.1:8b (110 of 110 at 0 of 10), and trips on 0 of 1825 healthy episodes. Detection is then closed into repair: each flagged run is rolled back and re-run live, recovering 45% of failures against a 16% resampling control (p=0.0005) and lifting task success from 52% to 73% for about one extra model call per run. The system runs at ~200 microseconds per step, three orders of magnitude below a judge call. Code, traces and results are released.

  • 1 authors
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Aug 2

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

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

  • 6 authors
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Mar 2

LLM Context Conditioning and PWP Prompting for Multimodal Validation of Chemical Formulas

Identifying subtle technical errors within complex scientific and technical documents, especially those requiring multimodal interpretation (e.g., formulas in images), presents a significant hurdle for Large Language Models (LLMs) whose inherent error-correction tendencies can mask inaccuracies. This exploratory proof-of-concept (PoC) study investigates structured LLM context conditioning, informed by Persistent Workflow Prompting (PWP) principles, as a methodological strategy to modulate this LLM behavior at inference time. The approach is designed to enhance the reliability of readily available, general-purpose LLMs (specifically Gemini 2.5 Pro and ChatGPT Plus o3) for precise validation tasks, crucially relying only on their standard chat interfaces without API access or model modifications. To explore this methodology, we focused on validating chemical formulas within a single, complex test paper with known textual and image-based errors. Several prompting strategies were evaluated: while basic prompts proved unreliable, an approach adapting PWP structures to rigorously condition the LLM's analytical mindset appeared to improve textual error identification with both models. Notably, this method also guided Gemini 2.5 Pro to repeatedly identify a subtle image-based formula error previously overlooked during manual review, a task where ChatGPT Plus o3 failed in our tests. These preliminary findings highlight specific LLM operational modes that impede detail-oriented validation and suggest that PWP-informed context conditioning offers a promising and highly accessible technique for developing more robust LLM-driven analytical workflows, particularly for tasks requiring meticulous error detection in scientific and technical documents. Extensive validation beyond this limited PoC is necessary to ascertain broader applicability.

  • 1 authors
·
May 18, 2025 2

QualityFM: a Multimodal Physiological Signal Foundation Model with Self-Distillation for Signal Quality Challenges in Critically Ill Patients

Photoplethysmogram (PPG) and electrocardiogram (ECG) are commonly recorded in intesive care unit (ICU) and operating room (OR). However, the high incidence of poor, incomplete, and inconsistent signal quality, can lead to false alarms or diagnostic inaccuracies. The methods explored so far suffer from limited generalizability, reliance on extensive labeled data, and poor cross-task transferability. To overcome these challenges, we introduce QualityFM, a novel multimodal foundation model for these physiological signals, designed to acquire a general-purpose understanding of signal quality. Our model is pre-trained on an large-scale dataset comprising over 21 million 30-second waveforms and 179,757 hours of data. Our approach involves a dual-track architecture that processes paired physiological signals of differing quality, leveraging a self-distillation strategy where an encoder for high-quality signals is used to guide the training of an encoder for low-quality signals. To efficiently handle long sequential signals and capture essential local quasi-periodic patterns, we integrate a windowed sparse attention mechanism within our Transformer-based model. Furthermore, a composite loss function, which combines direct distillation loss on encoder outputs with indirect reconstruction loss based on power and phase spectra, ensures the preservation of frequency-domain characteristics of the signals. We pre-train three models with varying parameter counts (9.6 M to 319 M) and demonstrate their efficacy and practical value through transfer learning on three distinct clinical tasks: false alarm of ventricular tachycardia detection, the identification of atrial fibrillation and the estimation of arterial blood pressure (ABP) from PPG and ECG signals.

  • 3 authors
·
Sep 8, 2025

Anatomical Foundation Models for Brain MRIs

Deep Learning (DL) in neuroimaging has become increasingly relevant for detecting neurological conditions and neurodegenerative disorders. One of the most predominant biomarkers in neuroimaging is represented by brain age, which has been shown to be a good indicator for different conditions, such as Alzheimer's Disease. Using brain age for weakly supervised pre-training of DL models in transfer learning settings has also recently shown promising results, especially when dealing with data scarcity of different conditions. On the other hand, anatomical information of brain MRIs (e.g. cortical thickness) can provide important information for learning good representations that can be transferred to many downstream tasks. In this work, we propose AnatCL, an anatomical foundation model for brain MRIs that i.) leverages anatomical information in a weakly contrastive learning approach, and ii.) achieves state-of-the-art performances across many different downstream tasks. To validate our approach we consider 12 different downstream tasks for the diagnosis of different conditions such as Alzheimer's Disease, autism spectrum disorder, and schizophrenia. Furthermore, we also target the prediction of 10 different clinical assessment scores using structural MRI data. Our findings show that incorporating anatomical information during pre-training leads to more robust and generalizable representations. Pre-trained models can be found at: https://github.com/EIDOSLAB/AnatCL.

  • 4 authors
·
Aug 7, 2024

SCI: A Metacognitive Control for Signal Dynamics

Modern deep learning systems are typically deployed as open-loop function approximators: they map inputs to outputs in a single pass, without regulating how much computation or explanatory effort is spent on a given case. In safety-critical settings, this is brittle: easy and ambiguous inputs receive identical processing, and uncertainty is only read off retrospectively from raw probabilities. We introduce the Surgical Cognitive Interpreter (SCI), a lightweight closed-loop metacognitive control layer that wraps an existing stochastic model and turns prediction into an iterative process. SCI monitors a scalar interpretive state SP(t), here instantiated as a normalized entropy-based confidence signal, and adaptively decides whether to stop, continue sampling, or abstain. The goal is not to improve accuracy per se, but to regulate interpretive error ΔSP and expose a safety signal that tracks when the underlying model is likely to fail. We instantiate SCI around Monte Carlo dropout classifiers in three domains: vision (MNIST digits), medical time series (MIT-BIH arrhythmia), and industrial condition monitoring (rolling-element bearings). In all cases, the controller allocates more inference steps to misclassified inputs than to correct ones (up to about 3-4x on MNIST and bearings, and 1.4x on MIT-BIH). The resulting ΔSP acts as a usable safety signal for detecting misclassifications (AUROC 0.63 on MNIST, 0.70 on MIT-BIH, 0.86 on bearings). Code and reproducibility: https://github.com/vishal-1344/sci

  • 1 authors
·
Nov 15, 2025

IryoNLP at MEDIQA-CORR 2024: Tackling the Medical Error Detection & Correction Task On the Shoulders of Medical Agents

In natural language processing applied to the clinical domain, utilizing large language models has emerged as a promising avenue for error detection and correction on clinical notes, a knowledge-intensive task for which annotated data is scarce. This paper presents MedReAct'N'MedReFlex, which leverages a suite of four LLM-based medical agents. The MedReAct agent initiates the process by observing, analyzing, and taking action, generating trajectories to guide the search to target a potential error in the clinical notes. Subsequently, the MedEval agent employs five evaluators to assess the targeted error and the proposed correction. In cases where MedReAct's actions prove insufficient, the MedReFlex agent intervenes, engaging in reflective analysis and proposing alternative strategies. Finally, the MedFinalParser agent formats the final output, preserving the original style while ensuring the integrity of the error correction process. One core component of our method is our RAG pipeline based on our ClinicalCorp corpora. Among other well-known sources containing clinical guidelines and information, we preprocess and release the open-source MedWiki dataset for clinical RAG application. Our results demonstrate the central role of our RAG approach with ClinicalCorp leveraged through the MedReAct'N'MedReFlex framework. It achieved the ninth rank on the MEDIQA-CORR 2024 final leaderboard.

  • 1 authors
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Apr 23, 2024

Sequential Diagnosis with Language Models

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.

  • 15 authors
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Jun 27, 2025

Diagnosis-Driven Automatic Repair for Agentic Workflow via Symbolic Inference

Platform-orchestrated agentic workflows have become a popular paradigm for developing LLM-based applications. However, their reliability remains a major challenge due to the uncertainty of LLM outputs, complex inter-node dependencies, and heterogeneous tool interactions. Existing agentic workflow optimization and agent enhancement methods primarily rely on trajectory-level feedback. Without explicitly identifying the underlying failure root causes, their resulting repair plans are often insufficiently targeted. We propose FlowFixer, a diagnosis-driven automated repair framework for agentic workflows. FlowFixer first transforms workflow executions into unified symbolic traces and performs symbolic inference to derive executable behavioral specifications that capture node correctness, temporal dependencies, and causal relationships. Based on specification verification, it conducts failure attribution and root cause analysis, and then generates targeted repair patches. To reduce verification costs, FlowFixer further employs a multi-dimensional pre-execution assessment to filter infeasible repairs before dynamic verification. We evaluate FlowFixer on workflow failures collected from three popular development platforms: Dify, Coze and n8n. Results show that FlowFixer achieves a repair success rate of 71.3%, outperforming state-of-the-art baselines by 11.9% to 27.6%. It also improves failure attribution accuracy by 4.8% to 33.1% and root cause analysis accuracy by 15.3% to 38.8%. This work offers a new perspective on reliable diagnosis and repair of agentic workflows through symbolic modeling and inference.

  • 8 authors
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Jul 2

Improving Clinical Document Understanding on COVID-19 Research with Spark NLP

Following the global COVID-19 pandemic, the number of scientific papers studying the virus has grown massively, leading to increased interest in automated literate review. We present a clinical text mining system that improves on previous efforts in three ways. First, it can recognize over 100 different entity types including social determinants of health, anatomy, risk factors, and adverse events in addition to other commonly used clinical and biomedical entities. Second, the text processing pipeline includes assertion status detection, to distinguish between clinical facts that are present, absent, conditional, or about someone other than the patient. Third, the deep learning models used are more accurate than previously available, leveraging an integrated pipeline of state-of-the-art pretrained named entity recognition models, and improving on the previous best performing benchmarks for assertion status detection. We illustrate extracting trends and insights, e.g. most frequent disorders and symptoms, and most common vital signs and EKG findings, from the COVID-19 Open Research Dataset (CORD-19). The system is built using the Spark NLP library which natively supports scaling to use distributed clusters, leveraging GPUs, configurable and reusable NLP pipelines, healthcare specific embeddings, and the ability to train models to support new entity types or human languages with no code changes.

  • 2 authors
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Dec 6, 2020

DiagnosticIQ: A Benchmark for LLM-Based Industrial Maintenance Action Recommendation from Symbolic Rules

Monitoring complex industrial assets relies on engineer-authored symbolic rules that trigger based on sensor conditions and prompt technicians to perform corrective actions. The bottleneck is not detection but response: translating rules into maintenance steps requires asset-specific knowledge gained through years of practice. We investigate whether LLMs can serve as decision support for this rule-to-action step and introduce , a benchmark of 6{,}690 expert-validated multiple-choice questions from 118 rule-action pairs across 16 asset types. We contribute (i) a symbolic-to-MCQA pipeline normalizing rules to Disjunctive Normal Form with embedding-based distractor sampling, (ii) five variants probing distinct failure modes (Pro, Pert, Verbose, Aug, Rationale), and (iii) a benchmark of 29 LLMs and 4 embedding baselines. A human evaluation (9 practitioners, mean 45.0\%) confirms requires specialist knowledge beyond operational experience. Three findings stand out. The frontier has closed: the top three LLMs lie within one Macro point, with Bradley-Terry Elo placing claude-opus-4-6 30 points above the next model. Yet \,Pro exposes brittleness, with every model losing 13--60\% relative accuracy under distractor expansion. \,Aug exposes pattern-matching: under condition inversion, frontier models still select the original answer 49--63\% of the time. The deployment bottleneck is not capability but calibration: frontier models handle template-style fault detection but break under structural perturbation.

ibm IBM
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May 8 2

Toxicity Assessment in Preclinical Histopathology via Class-Aware Mahalanobis Distance for Known and Novel Anomalies

Drug-induced toxicity is a leading cause of preclinical and early-clinical failure, making early detection critical. Histopathology is the gold standard for toxicity assessment but relies on expert pathologists, creating a bottleneck for large-scale screening. We introduce an AI-based anomaly detection framework for whole-slide images (WSIs) of rodent liver that identifies healthy tissue and known pathologies (anomalies) and flags samples without training data as out-of-distribution (OOD). We evaluate OOD detection on two held-out categories: apoptosis (single-cell, near-OOD) and staining/processing artifacts (heterogeneous, far-OOD). We build a novel pixelwise-annotated dataset and fine-tune a pre-trained Vision Transformer (DINOv2) via Low-Rank Adaptation (LoRA) for segmentation, then use the Mahalanobis distance for OOD detection with class-specific thresholds. Optimizing the false positive rate subject to a predefined constraint on the false negative rate yields only 0.16% of pathological tissue classified as healthy and 0.35% of healthy tissue classified as pathological. Our false negative rate does not penalise cross-type errors, reflecting the safety-first objective of never overlooking a lesion; under the stricter correct-class criterion our method assigns 93.93% of ID and 89.38% of OOD findings to their own class. The study demonstrates technical feasibility of pixel-level anomaly detection for mouse liver histopathology, indicating possible applications in improving preclinical workflows and drug development efficiency.

  • 6 authors
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Jun 29

AutoMedBench: Towards Medical AutoResearch with Agentic AI Models

Autonomous agents are increasingly expected to support end-to-end medical-AI research workflows, moving beyond isolated prediction tasks or short-form clinical question answering. However, existing medical agent benchmarks primarily evaluate final outputs, providing limited visibility into agent behavior within the research process. To address this gap, we present AutoMedBench, a workflow-aware benchmark for autonomous medical-AI research across diverse medical imaging and multimodal inference tasks, organizing agent execution into a unified five-stage workflow (S1-S5): Plan, Setup, Validate, Inference, and Submit. It comprises long-horizon tasks with each run averaging 33 agent turns, spanning five research tracks: segmentation, image enhancement, visual question answering (VQA), report generation, and lesion detection. Each task is evaluated under two difficulty tiers, Lite and Standard, which use the same data and metrics but differ in the amount of task-brief scaffolding, and each run is scored using both final task performance and S1-S5 stage scores, enabling stage-level analysis from the initial task brief to the final submitted artifact. Across thousands of recorded runs, stage-level scoring reveals that Validate is the weakest workflow stage on average, whereas Setup is the strongest, suggesting that current agents are better at making pipelines executable than at verifying their reliability. Post-run error analysis further shows that verification and submission failures dominate tagged errors, accounting for 37.7% and 38.1% of fired codes respectively, whereas task-understanding errors are rare at 0.9%, and runs with one fired error code have a 48% lower overall score than runs with no error code on average.

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

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

  • 6 authors
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Mar 14, 2023

Rethinking Benchmark and Contamination for Language Models with Rephrased Samples

Large language models are increasingly trained on all the data ever produced by humans. Many have raised concerns about the trustworthiness of public benchmarks due to potential contamination in pre-training or fine-tuning datasets. While most data decontamination efforts apply string matching (e.g., n-gram overlap) to remove benchmark data, we show that these methods are insufficient, and simple variations of test data (e.g., paraphrasing, translation) can easily bypass these decontamination measures. Furthermore, we demonstrate that if such variation of test data is not eliminated, a 13B model can easily overfit a test benchmark and achieve drastically high performance, on par with GPT-4. We validate such observations in widely used benchmarks such as MMLU, GSK8k, and HumanEval. To address this growing risk, we propose a stronger LLM-based decontamination method and apply it to widely used pre-training and fine-tuning datasets, revealing significant previously unknown test overlap. For example, in pre-training sets such as RedPajama-Data-1T and StarCoder-Data, we identified that 8-18\% of the HumanEval benchmark overlaps. Interestingly, we also find such contamination in synthetic dataset generated by GPT-3.5/4, suggesting a potential risk of unintentional contamination. We urge the community to adopt stronger decontamination approaches when using public benchmarks. Moreover, we call for the community to actively develop fresh one-time exams to evaluate models accurately. Our decontamination tool is publicly available at https://github.com/lm-sys/llm-decontaminator.

  • 5 authors
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Nov 8, 2023 1

DeCon: Detecting Incorrect Assertions via Postconditions Generated by a Large Language Model

Recently, given the docstring for the target problem and the target function signature, large language models (LLMs) have been used not only to generate source code, but also to generate test cases, consisting of test inputs and assertions (e.g., in the form of checking an actual output against the expected output). However, as shown by our empirical study on assertions generated by four LLMs for the HumanEval benchmark, over 62% of the generated assertions are incorrect (i.e., failed on the ground-truth problem solution). To detect incorrect assertions (given the docstring and the target function signature along with a sample of example inputs and outputs), in this paper, we propose a new approach named DeCon to effectively detect incorrect assertions via LLM-generated postconditions for the target problem (a postcondition is a predicate that must always be true just after the execution of the ground-truth problem solution). Our approach requires a small set of I/O examples (i.e., a sample of example inputs and outputs) for the target problem (e.g., the I/O examples included in the docstring for a target problem in HumanEval). We use the given I/O examples to filter out those LLM-generated postconditions that are violated by at least one given I/O example. We then use the remaining postconditions to detect incorrect assertions as those assertions that violate at least one remaining postcondition. Experimental results show that DeCon can detect averagely more than 64% (63% and 65.5% detected by GPT-3.5 and GPT-4, respectively) incorrect assertions generated by four state-of-the-art LLMs, and DeCon can also improve the effectiveness of these LLMs in code generation by 4% in terms of Pass@1. In addition, although DeCon might filter out correct assertions, the fault-finding ability of the remaining correct assertions decreases only slightly.

  • 11 authors
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Jan 5, 2025

An Empirical Study of Flaky Tests in Python

Tests that cause spurious failures without any code changes, i.e., flaky tests, hamper regression testing, increase maintenance costs, may shadow real bugs, and decrease trust in tests. While the prevalence and importance of flakiness is well established, prior research focused on Java projects, thus raising the question of how the findings generalize. In order to provide a better understanding of the role of flakiness in software development beyond Java, we empirically study the prevalence, causes, and degree of flakiness within software written in Python, one of the currently most popular programming languages. For this, we sampled 22352 open source projects from the popular PyPI package index, and analyzed their 876186 test cases for flakiness. Our investigation suggests that flakiness is equally prevalent in Python as it is in Java. The reasons, however, are different: Order dependency is a much more dominant problem in Python, causing 59% of the 7571 flaky tests in our dataset. Another 28% were caused by test infrastructure problems, which represent a previously undocumented cause of flakiness. The remaining 13% can mostly be attributed to the use of network and randomness APIs by the projects, which is indicative of the type of software commonly written in Python. Our data also suggests that finding flaky tests requires more runs than are often done in the literature: A 95% confidence that a passing test case is not flaky on average would require 170 reruns.

  • 4 authors
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Jan 22, 2021

LiveMedBench: A Contamination-Free Medical Benchmark for LLMs with Automated Rubric Evaluation

The deployment of Large Language Models (LLMs) in high-stakes clinical settings demands rigorous and reliable evaluation. However, existing medical benchmarks remain static, suffering from two critical limitations: (1) data contamination, where test sets inadvertently leak into training corpora, leading to inflated performance estimates; and (2) temporal misalignment, failing to capture the rapid evolution of medical knowledge. Furthermore, current evaluation metrics for open-ended clinical reasoning often rely on either shallow lexical overlap (e.g., ROUGE) or subjective LLM-as-a-Judge scoring, both inadequate for verifying clinical correctness. To bridge these gaps, we introduce LiveMedBench, a continuously updated, contamination-free, and rubric-based benchmark that weekly harvests real-world clinical cases from online medical communities, ensuring strict temporal separation from model training data. We propose a Multi-Agent Clinical Curation Framework that filters raw data noise and validates clinical integrity against evidence-based medical principles. For evaluation, we develop an Automated Rubric-based Evaluation Framework that decomposes physician responses into granular, case-specific criteria, achieving substantially stronger alignment with expert physicians than LLM-as-a-Judge. To date, LiveMedBench comprises 2,756 real-world cases spanning 38 medical specialties and multiple languages, paired with 16,702 unique evaluation criteria. Extensive evaluation of 38 LLMs reveals that even the best-performing model achieves only 39.2%, and 84% of models exhibit performance degradation on post-cutoff cases, confirming pervasive data contamination risks. Error analysis further identifies contextual application-not factual knowledge-as the dominant bottleneck, with 35-48% of failures stemming from the inability to tailor medical knowledge to patient-specific constraints.

  • 7 authors
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Feb 10 2

Expert-level validation of AI-generated medical text with scalable language models

With the growing use of language models (LMs) in clinical environments, there is an immediate need to evaluate the accuracy and safety of LM-generated medical text. Currently, such evaluation relies solely on manual physician review. However, detecting errors in LM-generated text is challenging because 1) manual review is costly and 2) expert-composed reference outputs are often unavailable in real-world settings. While the "LM-as-judge" paradigm (a LM evaluating another LM) offers scalable evaluation, even frontier LMs can miss subtle but clinically significant errors. To address these challenges, we propose MedVAL, a self-supervised framework that leverages synthetic data to train evaluator LMs to assess whether LM-generated medical outputs are factually consistent with inputs, without requiring physician labels or reference outputs. To evaluate LM performance, we introduce MedVAL-Bench, a dataset containing 840 outputs annotated by physicians, following a physician-defined taxonomy of risk levels and error categories. Across 6 diverse medical tasks and 10 state-of-the-art LMs spanning open-source, proprietary, and medically adapted models, MedVAL fine-tuning significantly improves (p < 0.001) alignment with physicians on both seen and unseen tasks, increasing average F1 scores from 66% to 83%, with per-sample safety classification scores up to 86%. MedVAL improves the performance of even the best-performing proprietary LM (GPT-4o) by 8%. To support a scalable, risk-aware pathway towards clinical integration, we open-source the 1) codebase ( https://github.com/StanfordMIMI/MedVAL ), 2) MedVAL-Bench ( https://huggingface.co/datasets/stanfordmimi/MedVAL-Bench ), and 3) MedVAL-4B ( https://huggingface.co/stanfordmimi/MedVAL-4B ), the best-performing open-source LM. Our research provides the first evidence of LMs approaching expert-level validation ability for medical text.

  • 27 authors
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Jul 3, 2025

Time Travel in LLMs: Tracing Data Contamination in Large Language Models

Data contamination, i.e., the presence of test data from downstream tasks in the training data of large language models (LLMs), is a potential major issue in measuring LLMs' real effectiveness on other tasks. We propose a straightforward yet effective method for identifying data contamination within LLMs. At its core, our approach starts by identifying potential contamination at the instance level; using this information, our approach then assesses wider contamination at the partition level. To estimate contamination of individual instances, we employ "guided instruction:" a prompt consisting of the dataset name, partition type, and the random-length initial segment of a reference instance, asking the LLM to complete it. An instance is flagged as contaminated if the LLM's output either exactly or nearly matches the latter segment of the reference. To understand if an entire partition is contaminated, we propose two ideas. The first idea marks a dataset partition as contaminated if the average overlap score with the reference instances (as measured by ROUGE-L or BLEURT) is statistically significantly better with the completions from guided instruction compared to a "general instruction" that does not include the dataset and partition name. The second idea marks a dataset partition as contaminated if a classifier based on GPT-4 with few-shot in-context learning prompt marks multiple generated completions as exact/near-exact matches of the corresponding reference instances. Our best method achieves an accuracy between 92% and 100% in detecting if an LLM is contaminated with seven datasets, containing train and test/validation partitions, when contrasted with manual evaluation by human experts. Further, our findings indicate that GPT-4 is contaminated with AG News, WNLI, and XSum datasets.

  • 2 authors
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Aug 16, 2023

The Specification as Quality Gate: Three Hypotheses on AI-Assisted Code Review

The dominant industry response to AI-generated code quality problems is to deploy AI reviewers. This paper argues that this response is structurally circular when executable specifications are absent: without an external reference, both the generating agent and the reviewing agent reason from the same artefact, share the same training distribution, and exhibit correlated failures. The review checks code against itself, not against intent. Three hypotheses are developed. First, that correlated errors in homogeneous LLM pipelines echo rather than cancel, a claim supported by convergent empirical evidence from multiple 2025-2026 studies and by three small contrived experiments reported here. The first two experiments are same-family (Claude reviewing Claude-generated code); the third extends to a cross-family panel of four models from three families. All use a planted bug corpus rather than a natural defect sample; they are directional evidence, not a controlled demonstration. Second, that executable specifications perform a domain transition in the Cynefin sense, converting enabling constraints into governing constraints and moving the problem from the complex domain to the complicated domain, a transition that AI makes economically viable at scale. Third, that the defect classes lying outside the reach of executable specifications form a well-defined residual, which is the legitimate and bounded target for AI review. The combined argument implies an architecture: specifications first, deterministic verification pipeline second, AI review only for the structural and architectural residual. This is not a claim that AI review is valueless. It is a claim about what it is actually for, and about what happens when it is deployed without the foundation that makes it non-circular.

  • 1 authors
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Mar 25