Daily Papers

Modern embodied agents achieve impressive success rates, yet their actual instruction-following ability is far weaker than these numbers suggest. We trace this illusion to a structural property we term low scene entropy: when a visual scene admits only one valid task, language becomes redundant and a policy can score highly while barely using it. We introduce RoboFollow, a diagnostic benchmark with three principles: (1) High Scene Entropy: each training scene supports multiple kinematically distinct task branches, making vision alone insufficient and forcing reliance on language. (2) Hierarchical Diagnostic Protocol: a four-level protocol (L0--L3) progressively perturbs visual layout and semantics, probing whether equivalent instructions yield consistent behavior and distinct ones yield discriminable behavior across spatial relations, attributes, trajectory constraints, and logic. (3) Confound-Controlled Diagnosis: we simplify interaction objects, restrict actions to the trained repertoire and report stage-wise Intent and Execution scores, isolating comprehension from motor execution. Evaluation of nine VLA and WAM policies shows that strong L0 performance, where attained, does not reliably transfer to L1--L3 under our fine-tuning setup. Representative mitigations, including stronger VLM backbones, QA co-training, LangForce, and Classifier-Free Guidance, all fail to close this gap. RoboFollow exposes genuine instruction following as a critical, overlooked bottleneck. Code and dataset are available at https://github.com/AutoLab-SAI-SJTU/RoboFollow and https://huggingface.co/datasets/AutoLab-SJTU/robofollow-data.

Gaussian-corrupted sentence embeddings have no direct linguistic interpretation, yet continuous diffusion language models can generate fluent text from them. We study this puzzle through Embedded Language Flows (ELF) and identify a decoder-basin mechanism: our evidence suggests that denoising becomes reliable when trajectories reach regions where the native decoder can read stable tokens. We introduce a diagnostic protocol for denoisability, semantic recoverability, order sensitivity, decoder compatibility, and trajectory reliability. It exposes failures hidden by scalar metrics: low mean-squared error can discard linguistic content, low perplexity can reflect low-entropy collapse, and clean latent reconstruction can coexist with a narrow decoder basin. A decoder-margin bound explains why token recovery depends on margin and local decoder sensitivity, not latent error alone. Auditing public ELF checkpoints reveals an interface phase diagram: early predictions are weakly readable, mid-trajectory disagreement marks a competition region, and late predictions enter a high-margin decoder basin. Once inside, token realization is surprisingly simple on generated ELF states: frozen T5 (Text-to-Text Transfer Transformer) token-embedding lookup recovers 93--96% of native decoder decisions, and a single linear readout reaches 97.9% agreement at 32k samples, leaving an approx1.1--1.2 perplexity gap in a structured residual tail. Under conservative held-out gates, a margin rule exits roughly 17--28% earlier in denoising steps under an explicit diagnostic monitor. Boundary checks on LangFlow, BitstreamDiffusion, and the Continuous Latent Diffusion Language Model (Cola-DLM) show that the same interface questions remain meaningful when the state object and decoder change. Continuous and latent diffusion language models should therefore be evaluated as representation-decoder systems.

Persistent AI assistants, such as OpenClaw, accumulate large collections of related memories over long-term interactions. As these memories grow, they may reinforce one another, diverge across contexts, or directly conflict, making correct assistance depend on memory relations rather than isolated recall. Existing long-term memory benchmarks rarely probe how agents preserve and utilize such relations during downstream tasks. To address this gap, we introduce SubtleMemory, a benchmark for fine-grained relational memory discrimination in long-running AI agents. SubtleMemory constructs relation-controlled latent semantic artifacts whose variants instantiate complementary, nuanced, or contradictory relations, and embeds them into realistic user-agent histories, requiring agents to recover distributed relational structures during later queries and instructions. The benchmark contains 1,522 evaluation instances over 10 long histories, grounded in 1,090 relation-controlled memory-variant sets and spanning user-related and non-user-related queries. Evaluating six standalone memory systems, two Claw-style agents with native memory modules, and three Claw-style agents with plugin memory modules, we find that current systems remain weak on fine-grained relational memory discrimination. We further introduce diagnostic protocols that reveal distinct capability profiles across memory preservation, retrieval, and downstream reasoning stages.

Long-context LLM agents must access the right evidence from large environments and use it faithfully. However, the popular Needle-in-a-Haystack (NIAH) evaluation mostly measures benign span localization. The needle is near-unique, and the haystack is largely irrelevant. We introduce EverMemBench-S (EMB-S), an adversarial NIAH-style benchmark built on a 326M-token MemoryBank. While the full MemoryBank spans 326M tokens for retrieval-based (RAG) evaluation, we evaluate native long-context models only at scales that fit within each model's context window (up to 1M tokens in this work) to ensure a fair comparison. EMB-S pairs queries with collision-tested near-miss hard negatives and gold evidence sets spanning one or more documents, validated via human screening and LLM verification. We also propose a decoupled diagnostic protocol that reports evidence access (document-ID localization) separately from end-to-end QA quality under full-context prompting. This enables consistent diagnosis for both native long-context prompting and retrieval pipelines. Across a reference-corpus ladder from domain-isolated 64K contexts to a globally shared 326M-token environment, we observe a clear reality gap. Systems that saturate benign NIAH degrade sharply in evidence access under semantic interference. These results indicate that semantic discrimination, not context length alone, is the dominant bottleneck for long-context memory at scale.

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

Joint-embedding predictive architectures (JEPAs) for world modeling train an encoder so a predictor maps a current embedding and action to the next frame's embedding, always from a single rendered frame. This has a structural blind spot: a renderer without motion blur draws a scene from configuration alone, so a single-frame embedding carries no velocity information, for any encoder, including the official released LeWM weights. We confirm this on official checkpoints across four real benchmarks (PushT, Reacher, Cube, TwoRoom): every linear velocity probe sits at or below chance while position probes reach R^2 about 0.95. We introduce RateIdent, a three-stage diagnostic protocol, and TI-JEPA, a lightweight fix splitting the latent into a pose code and an explicit finite-difference motion code, predicted jointly. Across three physically grounded environments, TI-JEPA gives a significant, seed-robust gain on a stop-at-goal planning task over a matched-memory baseline, e.g. 55% lower final distance on Pendulum (p=3.2x10^-10) and 64% on CartPole (p=5.1x10^-15). We reproduce this at official ViT-Tiny plus AdaLN-transformer scale, then push the same recipe onto real dm_control Reacher photographs trained from scratch, where TI-JEPA's branch separation exceeds the memory-having baseline's by roughly 38x, the paper's largest margin. Against a same-footprint recurrent RSSM-style predictor, TI-JEPA matches or beats its rollout accuracy on two of three environments, stays separately probeable for pose and motion, and wins outright on the most coupled one. A checkable formal argument and six evaluated environments show single-frame targets are the wrong object to predict when velocity matters, and a small, interpretable structural change fixes it with no privileged supervision. Code, checkpoints, and the project page are linked below the title.

When a large language model fails a reasoning task, it is often assumed to lack the underlying capability. However, this conflates a genuine absence of reasoning with a late-stage output bottleneck. We observe a consistent readout gap across diverse reasoning benchmarks: hidden-state probes successfully decode correct answers even when native sequence scoring completely collapses due to structural biases. To test whether instance-specific logic survives this collapse, we introduce a diagnostic protocol using a minimal, target-label-free additive correction. Fitting just two parameters on as few as 25 unlabeled examples recovers 9--34 accuracy points for Qwen3.5 models, transferring successfully to OLMo-2-1B and Llama-3.1-8B. Crucially, these recovered decisions persist on hard instances unresolved by simple lexical overlap and significantly exceed count-preserving permutation baselines. Our results show that many apparent zero-shot reasoning deficits are expression failures masking intact internal logic, urging a narrower interpretation of benchmark evaluations.

Recent 4D LiDAR language models aim to reason about objects and their evolving spatial relationships. Yet, in our evaluation, always selecting the same option nearly matches the multiple-choice accuracy of two B4DL-derived configurations. We introduce LiDAR-Hallu, a geometry-referenced benchmark and diagnostic protocol with 10,000 questions across 150 nuScenes scenes. It covers object existence, ego-relative position, distance ordering, relative motion, and temporal localization, with explicit rules for selecting objects, comparing times, and determining reference answers. Our protocol combines fixed-answer and candidate-content controls, cross-scene pairs with identical prompts but opposite reference answers, and relation-specific recall. Analysis of 100,000 recorded responses reveals failures hidden by aggregate accuracy. Candidate duration alone makes temporal answers predictable without observing LiDAR. On paired questions, the models frequently give the same answer to scenes requiring opposite answers. Relation-specific analysis further shows that both configurations miss every positive lateral-motion case across all tested conditions. Temporal-shuffle contrastive decoding provides little net improvement, as repairs are largely offset by new errors and the main failures persist. These results show that evaluating spatio-temporal reasoning requires testing whether models distinguish the queried physical relationships, rather than relying on individual-answer accuracy alone. The source code, checkpoints, and data are released at https://github.com/Awesome4D/4DMLLM_Hallucination_Bench.

Sparse-view Computed Tomography (CT) reconstructs images from a limited number of X-ray projections to reduce radiation and scanning time, which is an ill-posed inverse problem. Existing methods achieve high-fidelity reconstructions but overfit to a fixed acquisition setup, failing to generalize well across sampling rates. For example, convolutional neural networks (CNNs) use the same kernels across resolutions, leading to artifacts when data resolution changes. This is a critical limitation in clinical practice, where acquisition sampling settings vary across organs and diagnostic protocols. We propose Computed Tomography neural Operator (CTO), the first neural operator (NO) framework for CT reconstruction. CTO extends learning from fixed discretized grids to continuous function space, enabling a single model to generalize across measurement sampling rates without retraining. We also propose new NO architectural designs for CT: (i) a dual-domain NO architecture in both sinogram and image spaces, capturing complementary spatial-frequency information, and (ii) rotation-equivariant DIScrete-COntinuous convolutions (DISCO) that exploit the rotational structure inherent in tomographic acquisition. Empirically, CTO outperforms CNNs (> 3.4dB PSNR gain) and other baselines in multi-resolution settings across multiple CT datasets. Compared to state-of-the-art diffusion methods, CTO has 500x faster inference with an average 3dB gain. CTO further demonstrates strong out-of-distribution robustness, maintaining gains under cross-dataset transfer and noisy sinogram conditions. Ablation studies also validate each design choice. CTO establishes neural operators as a principled and practical paradigm for flexible, discretization-agnostic CT reconstruction. Our code is available at https://github.com/neuraloperator/sparse_ct.

Deep equilibrium models promise input-adaptive implicit computation: harder problems should demand more solver iterations, and the solved equilibrium should encode the result of genuine iterative inference. We report a cautionary study of a port-Hamiltonian DEQ with a learned initialization on two reasoning tasks -- ProofWriter entailment over frozen DeBERTa embeddings and a BFS-verified graph-reachability benchmark -- in which the implicit computation is a silent no-op. Across tasks, seeds, and controlled ablation arms, the solved equilibrium equals the solver's start point to numerical precision, and bypassing the solver entirely changes test accuracy by +0.00 percentage points in 18 of 19 training runs. Controlled interventions falsify the tempting explanation: removing the anchoring term reproduces every result, and retraining with noise-decoupled starts yields a solver that converges to the noisy start while the decoder learns to ignore it. The single escaping run diverges instead (|h^{*}-z_0|=171), producing a co-adapted noise channel whose removal improves accuracy. Iteration counts are uncorrelated with ground-truth difficulty (r=0.009), and the full apparatus never outperforms a two-layer MLP on either task. We trace the mechanism to gradient starvation along two distinct routes, show that the standard zeroing ablation is confounded and gives wildly seed-dependent answers where the correct substitution test gives a stable zero, and distill a four-test diagnostic protocol for auditing claimed implicit computation. All experiments run on a single free Colab GPU; code, raw logs, and analysis scripts are released.

Despite the success of deep learning, training deep networks in biologically plausible and hardware-efficient ways remains an open challenge. Feedback alignment (FA) methods address this by replacing backpropagation's symmetric backward weights with fixed random matrices, but their effectiveness depends critically on whether they can be accurately evaluated. The standard evaluation relies on two quantities: task accuracy and cosine similarity between the method's credit signal and the backpropagation gradient. We show that this reporting pair is insufficient by identifying two independent failure modes, both silent under current reporting: (1) measurement degeneracy, where the BP reference gradient collapses to the numerical floor in terminal-LayerNorm residual architectures, rendering cosine uninterpretable; and (2) aggregation collapse, where the aggregate cosine masks layerwise heterogeneity that concentrates credit at one end of the network. To address these limitations, we propose a diagnostic evaluation protocol based on three checks -- scale stability, reference validity, and depth utility -- together with per-layer rather than aggregate cosine reporting. Across multiple architectures and methods, the standard reporting pair gives no signal of failure in any audited case, while our protocol identifies all failures with wide calibration margins. The two failure modes are causally independent: a per-block scale penalty alleviates Mode 1 (residual scale explosion driving reference collapse) without affecting Mode 2 (cosine ranking that contradicts every functional metric we measured). Identifying these silent failures prevents researchers from building on non-functional credit assignment and provides actionable guidance for developing FA methods that genuinely train deep layers.

Omni-modal assistants must remember not only what users say, but also what they show and convey. Existing long-term memory benchmarks are mostly text-and-image or report a single end-to-end score, so they cannot locate whether evidence is lost when it is represented, retrieved, delivered, or read. We introduce MOSAIC, a benchmark of 923 questions over persona-grounded histories of 11-24 sessions spanning text, image, video, and audio. MOSAIC constructs targeted spatial, temporal, and prosodic signals rather than decorative media, with the strongest causal validation for spatial information and selector-level validation for annotated prosody, and pairs them with a matched diagnostic protocol that freezes the question, reader, prompt, and budget while intervening on representation, retrieval, and delivery. Matched decomposition shows that representation loss is modality-dependent, residual reading dominates even under gold evidence, and abstention remains weak on these controls: strong answerable scores coexist with failures to refuse. MOSAIC thus turns omni-modal memory evaluation from a leaderboard into a diagnosis of write, retrieve, deliver, and read failures.

Precise tracking of the jaw kinematics is crucial for diagnosing various musculoskeletal and neuromuscular diseases affecting the masticatory system and for advancing rehabilitative devices such as jaw exoskeletons, a hardly explored research field, to treat these disorders. We introduce an open-source, low-cost, precise, non-invasive, and biocompatible jaw tracking system based on optical motion capture technology to address the need for accessible and adaptable research tools. The system encompasses a complete pipeline from data acquisition, processing, and kinematic analysis to filtering, visualization, and data storage. We evaluated its performance and feasibility in experiments with four participants executing various jaw movements. The system demonstrated reliable kinematic tracking with an estimated precision of (182 pm 47) {mu}m and (0.126 pm 0.034) {deg}. Therefore, the open-source nature of the system and its utility comparable to commercial systems make it suitable for many research and development contexts, especially for applications such as the integration and design of jaw exoskeletons and customized diagnostic protocols. The complete system is available at GitHub with the aim of promoting innovation in temporomandibular disorders research and jaw assistive technology.

Decision trees can make vision-language model (VLM) classification interpretable by replacing a single prediction with a sequence of root-to-leaf questions. However, the accuracy cost of this greedy, non-backtracking procedure remains unclear. We introduce MYOPIA, a benchmark comprising four LLM-generated, human-refined decision trees for GTSRB, MNIST, CIFAR-10, and MSCOCO, together with matched prompts, diagnostic protocols, and an evaluation harness. Across GPT-4o, Qwen-VL Max, and LLaMA-3.2 11B Vision, tree traversal underperforms zero-shot prompting in all 12 dataset--model pairs; paired bootstrap analyses consistently favor zero-shot. Our diagnostics characterize interacting failure modes associated with this gap. Models often recall tree-encoded class attributes more accurately than they ground the same attributes in images: the mean label--image accuracy gaps are 9.5, 13.8, and 12.6 points for GPT-4o, Qwen-VL Max, and LLaMA, respectively. Incorrect local decisions then irreversibly exclude the correct class, while answer extraction introduces additional model-dependent loss. A node-level audit of the four trees finds that split entropy is weakly but consistently associated with lower node accuracy, whereas depth, branching factor, and within-node grounding differences are less stable. MYOPIA therefore provides a framework for diagnosing hierarchical visual classification and motivates testing tree designs that prioritize perceptual answerability and recovery from early errors. Code is available at https://github.com/islammesabah/VLM_Classification.

Navigation Instruction Generation (NIG) aims to produce step-by-step natural language instructions for navigation guidance. Existing studies primarily treat NIG as an auxiliary task for vision-andlanguage navigation (VLN), focusing on data augmentation or multi-task learning. However, generating navigation instructions from compact environmental priors requires meticulous spatial reasoning, especially when the target route does not simply follow the demonstrated tour, and remains challenging for current multimodal models. In this work, we introduce VideoNIG, a goal-oriented video-grounded NIG task that generates navigation instructions from ego-centric tour videos, an initial observation, and a textual or visual goal, without relying on intermediate representations such as graphs and maps. We instantiate VideoNIG in a controlled simulator benchmark with 60K tour videos across continuous indoor environments and 37K multimodal prompts with progressive difficulty levels. We further introduce a diagnostic evaluation protocol that combines text similarity, choice-based spatial consistency tests, and downstream navigation execution. To address this task, we propose a two-stage Curriculum Learning framework that decomposes the learning into foundational motion perception and long-horizon navigation reasoning. Specifically, we first employ Action Warmup for spatial action-view alignment, followed by Complexity Progression using trajectories with increasing exploratory difficulty. Extensive experiments show that existing MLLMs struggle with VideoNIG, while our approach significantly improves instruction quality across complementary diagnostic metrics. Finally, integrating VideoNIG-generated instructions with a VLN agent demonstrates the executability of this task formulation for end-to-end navigation.

Structured semantic parsing is typically judged by whether the correct category is assigned, which leaves value recovery and instance-level associations unexamined: a system may recognize an event yet bind an argument to the wrong instance, or identify an intent yet supply an incorrect slot value. We present USP, a cross-family semantic contract that represents categories, fields, values, and instance associations through a common interface for named-entity recognition, relation extraction, event extraction, and intent-slot parsing. The contract is paired with five diagnostic matching views---category agreement, field recognition, field-value pairing, instance-bound assignment, and complete-instance recovery---that ask distinct questions about the same output. Using this contract, we normalize 61 datasets into a unified corpus with shared schemas, prompts, and matching rules, and compare six models on a fixed test subset. Our fine-tuned Xing4.0-29B-Intent attains 57.70 task-balanced Field-Value Micro-F1 (equally weighted across the four task families) and ranks first in every family and on all five views; its margin over the strongest alternative widens from 2.93 points for category matching to 20.73 points for complete-instance matching. This widening gap shows that category agreement alone understates structural deficits. USP thus offers the community a shared representation, a normalized 61-dataset corpus, and a diagnostic evaluation protocol that make structural agreement measurable and comparable across extraction and intent-slot tasks.

Video-language models and video agents can produce hallucinations that conflict with spatiotemporal evidence. Existing benchmarks mainly evaluate model hallucinations, and heterogeneous mechanisms make detector reliability difficult to compare. We introduce VidHalLoc, a benchmark that evaluates hallucination detection methods under a unified diagnostic evaluation protocol using 2,000 adversarial hallucination samples across Video Question Answering and Video Captioning tasks, spanning Ontology and Dynamic hallucination categories. To construct VidHalLoc efficiently, we introduce VideoHALO, a Harness Engineering-informed multi-agent workflow that decomposes data construction into four executable stages supported by a memory system and a communication protocol. Evaluation of fifteen methods reveals that the four dedicated detectors peak at an Overall accuracy of only 34.63%, indicating limited reliability across video hallucination types [Dataset Repository: https://huggingface.co/datasets/wesfggfd/VidHalLoc].

We introduce PRISM-Bench, a benchmark of puzzle-based visual challenges designed to evaluate not only whether models can solve problems, but how their reasoning unfolds. Unlike prior evaluations that measure only final-answer accuracy, PRISM-Bench introduces a diagnostic task: given a visual puzzle and a step-by-step chain-of-thought (CoT) containing exactly one error, models must identify the first incorrect step. This setting enables fine-grained assessment of logical consistency, error detection, and visual reasoning. The puzzles in PRISM-Bench require multi-step symbolic, geometric, and analogical reasoning, resisting shortcuts based on superficial pattern matching. Evaluations across state-of-the-art MLLMs reveal a persistent gap between fluent generation and faithful reasoning: models that produce plausible CoTs often fail to locate simple logical faults. By disentangling answer generation from reasoning verification, PRISM-Bench offers a sharper lens on multimodal reasoning competence and underscores the need for diagnostic evaluation protocols in the development of trustworthy MLLMs.

Historical Arabic manuscript transcription is not only a recognition problem. A usable scholarly system must cope with shifting hands and layouts, preserve uncertain readings, distinguish visual evidence from linguistic plausibility, and record the researcher's final decision. We present Phoenix, a 4.99-million-parameter CNN-BiLSTM-CTC recognizer, and Athar, an evidence-aware review workflow built around it. Phoenix is adapted across archival, Maghrebi, and historical manuscript domains using document-aware replay, an expanded 81-symbol codec, and forgetting guards that reject checkpoints that improve a new domain at unacceptable cost to previous domains. In a pre-specified held-out comparison against the preceding checkpoint, frozen before evaluation and scored with greedy decoding and raw references, Phoenix reduced CER from 22.12% to 17.86% on 10,594 Agapet lines and from 17.72% to 11.84% on 11,684 Omar lines, while regressing from 10.39% to 10.72% on 164 TariMa lines. Across the two large held-out sets, character-weighted CER fell from 19.98% to 14.93%, a 25.3% relative error reduction. A separate same-protocol development diagnostic found the lowest CER for Phoenix on four of four comparable domains (9.59% unweighted macro CER). An N-best diagnostic revealed a 2.15-point oracle gap between beam decoding and Oracle@25, while neural text rerankers, consensus MBR, CTC-posterior quality estimation, and local pre-CTC hidden-state quality estimation recovered less than 4% of this gap. Athar therefore preserves the visual reading, exposes bounded alternatives, uses local language models conservatively, retrieves source parallels with unique, ambiguous, or abstain states, and exports auditable TEI and PAGE-XML records. The results support evaluating manuscript HTR as auditable evidence management rather than silent text replacement.

The evaluation of generated reports remains a critical challenge in Computed Tomography (CT) report generation, due to the large volume of text, the diversity and complexity of findings, and the presence of fine-grained, disease-oriented attributes. Conventional evaluation metrics offer only coarse measures of lexical overlap or entity matching and fail to reflect the granular diagnostic accuracy required for clinical use. To address this gap, we propose CT-FineBench, a benchmark built from CT-RATE and Merlin to evaluate the fine-grained factual consistency of CT reports, constructed from CT-RATE and Merlin. Our benchmark is constructed through a meticulous, Question-Answering (QA) based process: first, we identify and structure key, finding-specific clinical attributes (like location, size, margin). Second, we systematically transform these attributes into a QA dataset, where questions probe for specific clinical details grounded in gold-standard reports. The evaluation protocol for CT-FineBench involves using this QA dataset to query a machine-generated report and scoring the correctness of the answers. This allows for a comprehensive, interpretable, and clinically-relevant assessment, moving beyond superficial lexical overlap to pinpoint specific clinical errors. Experiments show that CT-FineBench correlates better with expert clinical assessment and is substantially more sensitive to fine-grained factual errors than prior metrics.

Semantic-ID (SID) tokenizers are increasingly reused as standalone artifacts in generative recommendation: an exported item-to-code mapping becomes the address space that a later sequence generator must use. These mappings rarely come with a common inspection interface, so coverage gaps, full-code aliasing, behaviorally weak prefixes, tail compression, and prefix fan-out are often found only after downstream training. We present SIDInspector, a mapping-first diagnostic resource for SID tokenizer artifacts. SIDInspector defines a small adapter contract over item mappings, metadata, interactions, and optional generator traces; validates the contract; and reports mapping-level probes for utilization, aliasing, neighborhood alignment, popularity allocation, and structural cost, with hooks for temporal churn and generator traces. SIDInspector characterizes exported mappings independently of downstream leaderboard scores. The release covers four tokenizer lines: GRID-style RQ-KMeans under two capacity settings and a bounded ReSID/GAOQ export in a same-item Musical protocol, plus released LETTER and LC-Rec item-index artifacts. In that protocol, D2 aliasing falls from 0.977 to 0.779 under added GRID-style capacity and to 0.000 for ReSID/GAOQ, while D3 remains below a deterministic category-prefix control (0.055-0.154 versus 0.447). SIDInspector exposes capacity, addressability, and behavioral prefix alignment as distinct artifact properties before method-level evaluation. Additional domain checks show the same diagnostic distinction. Bounded fixed-reranker probes connect prefix alignment to candidate exposure, while final ranking quality remains a downstream model question.

Recent video generation models (VGMs) have made substantial progress in visual fidelity, yet their ability to follow long, compositional instructions remains insufficiently evaluated. Existing evaluation protocols often rely on prompts that are short and semantically shallow, with limited atomic constraints and weak spatio-temporal dependencies. They also frequently depend on costly human evaluation or handcrafted vision pipelines, while providing little diagnostic insight into which instruction constraints succeed or fail. To address this gap, we propose VGIF-Score, a highly automated and interpretable framework for evaluating instruction following in video generation. VGIF-Score consists of two complementary components: an objective completion branch that parses prompts into a Spatio-Temporal Directed Acyclic Graph (ST-DAG) and performs dependency-aware QA with short-circuit diagnostics, and a subjective satisfaction branch that uses instruction-conditioned AutoRubric to assess cinematography, visual purity, motion smoothness, and physics adherence. Together, these components produce a unified score that captures both objective completion and perceptual satisfaction. We instantiate this framework on VGIF-Bench, a benchmark of 223 long, structurally entangled prompts paired with approximately 4.3K fine-grained evaluation items. Experiments on 14 proprietary and open-source VGMs across more than 3K generated videos show that VGIF-Score provides reliable, interpretable, and diagnostically useful evaluation of video generation instruction following. The code will be available at https://github.com/PRIS-CV/VGIF-SCORE.

Electrocardiography (ECG) serves as an indispensable diagnostic tool in clinical practice, yet existing multimodal large language models (MLLMs) remain unreliable for ECG interpretation, often producing plausible but clinically incorrect analyses. To address this, we propose ECG-R1, the first reasoning MLLM designed for reliable ECG interpretation via three innovations. First, we construct the interpretation corpus using Protocol-Guided Instruction Data Generation, grounding interpretation in measurable ECG features and monograph-defined quantitative thresholds and diagnostic logic. Second, we present a modality-decoupled architecture with Interleaved Modality Dropout to improve robustness and cross-modal consistency when either the ECG signal or ECG image is missing. Third, we present Reinforcement Learning with ECG Diagnostic Evidence Rewards to strengthen evidence-grounded ECG interpretation. Additionally, we systematically evaluate the ECG interpretation capabilities of proprietary, open-source, and medical MLLMs, and provide the first quantitative evidence that severe hallucinations are widespread, suggesting that the public should not directly trust these outputs without independent verification. Code and data are publicly available at https://github.com/PKUDigitalHealth/ECG-R1{here}, and an online platform can be accessed at http://ai.heartvoice.com.cn/ECG-R1/{here}.

Conversational memory changes during use, so endpoint question answering alone cannot establish how a persistent state accumulates, ages, or incorporates revisions. We introduce LSREP, a Longitudinal State-Replay Evaluation Protocol combining ordered replay, explicit lifecycle schedules, repeated probes, evolving reference answers, and mechanism-fidelity checks. Its architectural case study is ICE v2, a local-first memory middleware with typed stores, retrieval fusion, and dynamic context budgets. The private, single-user instantiation contains 1,985 turns, 219 distinct probes, and 1,211 probe-checkpoint observations across 52 checkpoints. On three ordinary-density datasets, ICE v2 has a near-zero mean quality difference from vector-RAG while selecting 32% fewer fragments but using 6.6% more estimated prompt tokens. A fourth, dense dataset exposes catastrophic failures of the unbudgeted baseline. The fidelity audit limits attribution: procedural retrieval is defective, several mechanisms are unexercised, and graph utility is not established. In a complementary matched public diagnostic, ICE v2 loses decisively to pure vector-RAG on LongMemEval: 50.8% versus 72.8% in the evidence-only oracle and 43.0% versus 69.5% in full-S. Paired differences are -22.0 points (95% CI [-26.6, -17.4]) and -26.5 ([-31.3, -21.8]). Conservative abstention accompanies severe multi-session and temporal failures. ICE uses less context in this diagnostic, establishing a quality-cost trade-off rather than superior efficiency. Together, replay, fidelity auditing, and public endpoint testing expose distinct failure modes that neither architectural descriptions nor aggregate scores identify alone.

Large language model agents are increasingly connected to scientific software, yet it remains unclear when tool access makes scientific computation more reliable rather than merely more complex. We introduce PHREEQC-MCQ-200, a benchmark for evaluating tool-augmented agents on deterministic aqueous-geochemistry simulations. The benchmark contains 200 multiple-choice questions derived from 21 validated PHREEQC scenarios, requiring agents to construct simulator inputs, execute PHREEQC, inspect structured outputs, and commit to final answers. Across multiple frontier and mid-tier model families, simulator access substantially improves aggregate accuracy, confirming that grounded execution is necessary for many scientific-computation tasks. However, the gains are not monotonic: tool-augmented agents also lose items they answered correctly without tools, revealing regressions that average accuracy alone hides. We further show that output-access protocol matters. A table-of-contents interface can reduce token cost while preserving or improving accuracy for stronger models, but it degrades performance for mid-tier models that cannot reliably navigate structured simulator outputs. PHREEQC-MCQ-200 therefore frames scientific tool use as an end-to-end diagnostic problem rather than a simple tool-calling capability. We argue that evaluations of scientific agents should report not only accuracy, but also item-level retention, output-access sensitivity, trajectory failures, and where the computation chain breaks.

Multimodal large language models (MLLMs) are increasingly used as OCR systems in document and knowledge-processing pipelines, but their ability to faithfully read real handwriting remains underexplored. Existing OCR benchmarks focus largely on printed text or clean single-line inputs, leaving limited coverage of realistic handwritten OCR scenarios such as multilingual handwriting, writer errors, and structurally complex mathematical expressions. We introduce OmniHandwritingOCR, a diagnostic benchmark for evaluating MLLMs and OCR systems on handwritten OCR. It covers handwritten text recognition and handwritten mathematical expression recognition across six subtasks and twelve subsets, totaling 77.57K labeled images from public datasets and newly collected student writings. A key component is a difficulty-stratified multi-line formula corpus designed to test robustness under increasing structural complexity. We evaluate thirteen open- and closed-source systems with five complementary metrics under a unified protocol. Results show that current systems remain far from faithful transcription: performance drops sharply on complex multi-line formulas, model rankings vary across language and formula settings, and several generative models hallucinate plausible but visually unsupported corrections. OmniHandwritingOCR provides a challenging testbed for diagnosing language, content, structural, and visual-grounding failure modes of multimodal models in handwritten OCR scenarios.

Large language models (LLMs) hold significant potential for mental health support, capable of generating empathetic responses and simulating therapeutic conversations. However, existing LLM-based approaches often lack the clinical grounding necessary for real-world psychological counseling, particularly in explicit diagnostic reasoning aligned with standards like the DSM/ICD and incorporating diverse therapeutic modalities beyond basic empathy or single strategies. To address these critical limitations, we propose PsyLLM, the first large language model designed to systematically integrate both diagnostic and therapeutic reasoning for mental health counseling. To develop the PsyLLM, we propose a novel automated data synthesis pipeline. This pipeline processes real-world mental health posts, generates multi-turn dialogue structures, and leverages LLMs guided by international diagnostic standards (e.g., DSM/ICD) and multiple therapeutic frameworks (e.g., CBT, ACT, psychodynamic) to simulate detailed clinical reasoning processes. Rigorous multi-dimensional filtering ensures the generation of high-quality, clinically aligned dialogue data. In addition, we introduce a new benchmark and evaluation protocol, assessing counseling quality across four key dimensions: comprehensiveness, professionalism, authenticity, and safety. Our experiments demonstrate that PsyLLM significantly outperforms state-of-the-art baseline models on this benchmark.

LeWorldModel trains a latent world model with a prediction loss and a single anti-collapse regulariser, and reports approximately 87% of goals reached on TwoRoom, its simplest diagnostic environment. We reproduce that result by independent reimplementation on roughly $25 of rented compute, with all evaluation on one laptop CPU. We reach 94.0% at the repository's evaluation goal offset, against 84.0% for the authors' own released checkpoint measured under our protocol on identical episodes, and we reproduce the reported representation result directly (position probe Pearson r = 0.9988 against a reported 0.996). Reaching that point required four conventions that determine the outcome and appear in no released configuration file: dense action gathering across a frameskip block, a programmatically-set action-encoder width, ImageNet pixel normalisation, and action z-scoring. A reproducer following the released configurations alone obtains a model whose predictor cannot converge. The evaluation protocol is itself contested by the released material. The paper's appendix and the repository's configuration specify different goal offsets and step budgets; on the authors' own weights these yield 14.0% and 84.0%, and only the configuration's values reproduce the reported figure. On fifty identical episodes, changing nothing but how the goal is constructed moves that checkpoint from 84.0% to 8.0%. Two findings generalise. One-step prediction accuracy does not predict long-horizon planning success: across three checkpoints spanning a sevenfold range in prediction error, including the authors' own, it orders short-horizon success monotonically and fails to order long-horizon success at all. And a batch normalisation layer inflated our reported validation loss by up to a factor of 300, concealing a training loss that was flat throughout.

While Large Language Models (LLMs) have demonstrated high proficiency on English-centric medical examinations, their performance often declines when faced with non-English languages and multimodal diagnostic tasks. This study protocol describes the development of EuropeMedQA, the first comprehensive, multilingual, and multimodal medical examination dataset sourced from official regulatory exams in Italy, France, Spain, and Portugal. Following FAIR data principles and SPIRIT-AI guidelines, we describe a rigorous curation process and an automated translation pipeline for comparative analysis. We evaluate contemporary multimodal LLMs using a zero-shot, strictly constrained prompting strategy to assess cross-lingual transfer and visual reasoning. EuropeMedQA aims to provide a contamination-resistant benchmark that reflects the complexity of European clinical practices and fosters the development of more generalizable medical AI.

Decision models support routing, guardrails, and output verification in LLM systems. However, item accuracy alone cannot establish whether models make correct decisions across controlled variations or assign reliable confidence to their predictions. We introduce DecisionPivot, a diagnostic benchmark comprising 48 tasks and 40,033 items across seven decision roles. Its core track contains 7,800 items from 13 generated task families, organized into contrast groups with computed answers verified by independently implemented solvers. The complementary reference track contains 32,233 items from 35 public test sets, preserving their original evaluation metrics. We evaluate 40 decision models and 14 general models using documented, model-specific protocols, assessing item and contrast-group accuracy, probability ordering, calibration, and empirical selective coverage. Our results reveal substantial differences obscured by aggregate scores: two 27B models separated by only 2.6 points on the reference track achieve contrast-group accuracies of 70.1% and 44.2%. Across 2,400 binary contrast pairs, Perplexity Decider correctly ranks the positive member above the negative member in 92.3% of pairs but answers both members correctly in only 74.1%, exposing a gap between probability ordering and decision correctness. Models with similar item accuracy also differ in the reliability of their high-confidence predictions. On a separate 1,296-item subset, GLM-5.3 achieves 93.5\% contrast-group accuracy at a higher reasoning setting, compared with 81.5% at its lowest effort. By linking errors to pivotal details and difficulty levels, DecisionPivot provides fine-grained diagnostics of decision failures that aggregate evaluation alone cannot reveal.

When researchers ask whether two transformer layers are "equivalent" for compression, they often conflate distinct tests. Replacement asks whether one layer's map can substitute for another's in place; interchange asks whether two layers approximately commute when their positions are swapped. Both are output-grounded swap-KL probes, but they need not agree: on pretrained transformers the protocol gap can change which layers look safe to prune by several-fold under the same evaluator, especially when replacement distances are high. We measure both protocols across checkpoints and architectures. On a Pythia training trajectory (410M and 1.4B), the replacement-interchange gap grows from initialization to convergence. Under one matched WikiText-2 contract at 8B scale, Qwen3-8B enters a divergent regime: interchange-guided removal is several-fold safer than replacement-guided at the same layer budgets, while Llama-3.1-8B ties the two protocols for pruning cost even though interchange KL is lower, showing metric gaps need not map one-to-one to removal. Before layer removal or merging, score both swap-KLs on the target checkpoint; the diagnostic requires only unlabeled forward passes.

Recent advances in Large Vision-Language Models (LVLMs) have shown strong potential for multi-modal radiological reasoning, particularly in tasks like diagnostic visual question answering (VQA) and radiology report generation. However, most existing approaches for 3D CT analysis largely rely on static, single-pass inference. In practice, clinical interpretation is a dynamic, tool-mediated workflow where radiologists iteratively review slices and use measurement, radiomics, and segmentation tools to refine findings. To bridge this gap, we propose CT-Flow, an agentic framework designed for interoperable volumetric interpretation. By leveraging the Model Context Protocol (MCP), CT-Flow shifts from closed-box inference to an open, tool-aware paradigm. We curate CT-FlowBench, the first large-scale instruction-tuning benchmark tailored for 3D CT tool-use and multi-step reasoning. Built upon this, CT-Flow functions as a clinical orchestrator capable of decomposing complex natural language queries into automated tool-use sequences. Experimental evaluations on CT-FlowBench and standard 3D VQA datasets demonstrate that CT-Flow achieves state-of-the-art performance, surpassing baseline models by 41% in diagnostic accuracy and achieving a 95% success rate in autonomous tool invocation. This work provides a scalable foundation for integrating autonomous, agentic intelligence into real-world clinical radiology.

Digital healthcare infrastructure is crucial for global medical service delivery. Egypt faces EHR adoption barriers: only 314 hospitals had such systems as of Oct 2024. This limits data management and decision-making. This project introduces an EHR system for Egypt's Universal Health Insurance and healthcare ecosystem. It simplifies data management by centralizing medical histories with a scalable micro-services architecture and polyglot persistence for real-time access and provider communication. Clinical workflows are enhanced via patient examination and history tracking. The system uses the Llama3-OpenBioLLM-70B model to generate summaries of medical histories, provide chatbot features, and generate AI-based medical reports, enabling efficient searches during consultations. A Vision Transformer (ViT) aids in pneumonia classification. Evaluations show the AI excels in capturing details (high recall) but needs improvement in concise narratives. With optimization (retrieval-augmented generation, local data fine-tuning, interoperability protocols), this AI-driven EHR could enhance diagnostic support, decision-making, and healthcare delivery in Egypt.

Jaguar re-identification (re-ID) from citizen-science imagery can look strong on standard retrieval metrics while still relying on the wrong evidence, such as background context or silhouette shape, instead of the coat pattern that defines identity. We introduce a diagnostic framework for wildlife re-ID with two axes: a leakage-controlled context ratio, background/foreground, computed from inpainted background-only versus foreground-only images, and a laterality diagnostic based on cross-flank retrieval and mirror self-similarity. To make these diagnostics measurable, we curate a Pantanal jaguar benchmark with per-pixel segmentation masks and an identity-balanced evaluation protocol. We then use representative mitigation families, ArcFace fine-tuning, anti-symmetry regularization, and Lorentz hyperbolic embeddings, as case studies under the same evaluation lens. The goal is not only to ask which model ranks best, but also what visual evidence it uses to do so.

Recent advances in large language models (LLMs) have brought impressive performance across diverse tasks; however, shortcomings remain in logical reasoning, including inconsistencies under linguistic variation. To improve the reasoning capacity of LLMs, we must be able to accurately measure their reasoning capacity. Current benchmarks primarily report single accuracy numbers on selected reasoning tasks. Such a performance-based evaluation methodology says little about a model's generalization capacity in reasoning. To address this limitation, we argue for a different evaluation paradigm, called competence-based evaluation (CBE), which tests whether models reliably apply the same competence across a family of problems. A parameterized generator scales complexity while keeping the required competence fixed, and matched answer-preserving presentations test correctness beyond one formulation. We instantiate CBE on elementary ordering tasks, scaling input size while varying presentations of the same ordering rule. Across six GPT and Qwen models, performance is reasonably good over bounded complexity ranges, but even strong models fail the competence condition across the tested family. Chain-of-thought and GRPO extend strong performance without resolving all tested failures; supervised LoRA shows little held-out transfer. CBE provides diagnostic profiles and an evaluation protocol that can grow with future models.

While auditing a perturbation-based OOD detector on a document benchmark, we recorded an AUROC of 0.326 -- well below the 0.5 chance level. The cause is a benchmark leak: the designated "OOD" class is one the model was trained on, so its examples sit inside the in-distribution fit set and the detector is penalized for correctly ranking them as familiar. Deleting the class and retraining 35 models across two domains raises the score to 0.911. We distill the contamination into a leak fingerprint -- near-perfect supervised decodability (AUROC approximately 1) coupled with unsupervised detection collapsed below 0.65 -- and validate it on a controlled battery of 52 settings (20 leaked, 32 clean) across ResNet-50 and ViT-B/16 on CIFAR-10/100, achieving sensitivity 18/20 and specificity 31/32 in embedding space; the matched fit-set-exclusion controls are perfect at 20/20. An in-the-wild audit of 24 standard near/far OOD benchmark pairs fires on exactly one (the intrinsically hard CIFAR-100 vs CIFAR-10 pair) and on no far-OOD pair, confirming specificity and that standard cross-dataset construction is clean. Under the corrected protocol, perturbation signals are decodable but not detectable: a supervised reader recovers the OOD signal (AUROC 0.87-1.00) while no unsupervised detector does, and the perturbation method does not improve on plain Mahalanobis distance. We provide a theoretical account of why and, for transparency, retract an earlier circular correlation. The contributions are a corrected protocol and a validated leak diagnostic, not a new OOD method.

This paper introduces the task of analytical question answering over large, semi-structured document collections. We present MuDABench, a benchmark for multi-document analytical QA, where questions require extracting and synthesizing information across numerous documents to perform quantitative analysis. Unlike existing multi-document QA benchmarks that typically require information from only a few documents with limited cross-document reasoning, MuDABench demands extensive inter-document analysis and aggregation. Constructed via distant supervision by leveraging document-level metadata and annotated financial databases, MuDABench comprises over 80,000 pages and 332 analytical QA instances. We also propose an evaluation protocol that measures final answer accuracy and uses intermediate-fact coverage as an auxiliary diagnostic signal for the reasoning process. Experiments reveal that standard RAG systems, which treat all documents as a flat retrieval pool, perform poorly. To address these limitations, we propose a multi-agent workflow that orchestrates planning, extraction, and code generation modules. While this approach substantially improves both process and outcome metrics, a significant gap remains compared to human expert performance. Our analysis identifies two primary bottlenecks: single-document information extraction accuracy and insufficient domain-specific knowledge in current systems. MuDABench is available at https://github.com/Zhanli-Li/MuDABench.

Test-Time Scaling (TTS) improves LLM reasoning by exploring multiple candidate responses and then operating over this set to find the best output. A tacit premise behind TTS is that sufficiently diverse candidate pools enhance reliability. In this work, we show that this assumption in TTS introduces a previously unrecognized failure mode. When candidate diversity is curtailed, even by a modest amount, TTS becomes much more likely to produce unsafe outputs. We present a reference-guided diversity reduction protocol (RefDiv) that serves as a diagnostic attack to stress test TTS pipelines. Through extensive experiments across open-source models (e.g. Qwen3, Mistral, Llama3.1, Gemma3) and two widely used TTS strategies (Monte Carlo Tree Search and Best-of-N), constraining diversity consistently signifies the rate at which TTS produces unsafe results. The effect is often stronger than that produced by prompts directly with high adversarial intent scores. This observed phenomenon also transfers across TTS strategies and to closed-source models (e.g. OpenAI o3-mini and Gemini-2.5-Pro), thus indicating that this is a general and extant property of TTS rather than a model-specific artifact. Additionally, we find that numerous widely used safety guardrail classifiers (e.g. Llama-Guard), are unable to flag the adversarial input prompts generated by RefDiv, demonstrating that existing defenses offer limited protection against this diversity-driven failure mode.

While Multimodal Large Language Models (MLLMs) excel on benchmarks, their processing paradigm differs from the human ability to integrate visual information. Unlike humans who naturally bridge details and high-level concepts, models tend to treat these elements in isolation. Prevailing evaluation protocols often decouple low-level perception from high-level reasoning, overlooking their semantic and causal dependencies, which yields non-diagnostic results and obscures performance bottlenecks. We present VCU-Bridge, a framework that operationalizes a human-like hierarchy of visual connotation understanding: multi-level reasoning that advances from foundational perception through semantic bridging to abstract connotation, with an explicit evidence-to-inference trace from concrete cues to abstract conclusions. Building on this framework, we construct HVCU-Bench, a benchmark for hierarchical visual connotation understanding with explicit, level-wise diagnostics. Comprehensive experiments demonstrate a consistent decline in performance as reasoning progresses to higher levels. We further develop a data generation pipeline for instruction tuning guided by Monte Carlo Tree Search (MCTS) and show that strengthening low-level capabilities yields measurable gains at higher levels. Interestingly, it not only improves on HVCU-Bench but also brings benefits on general benchmarks (average +2.53%), especially with substantial gains on MMStar (+7.26%), demonstrating the significance of the hierarchical thinking pattern and its effectiveness in enhancing MLLM capabilities. The project page is at https://vcu-bridge.github.io .

Electroencephalography foundation models (EEG-FMs) have advanced brain signal analysis, but the lack of standardized evaluation benchmarks impedes model comparison and scientific progress. Current evaluations rely on inconsistent protocols that render cross-model comparisons unreliable, while a lack of diagnostic analyses obscures the internal mechanisms driving transfer efficiency and scaling behaviors. To address this, we introduce EEG-FM-Bench, a unified system for the standardized evaluation of EEG-FMs. The benchmark integrates 14 datasets across 10 paradigms and incorporates diverse experimental settings, including multiple fine-tuning strategies, task organizations, and classifier configurations, supported by tools for gradient and representation analysis. Our experiments and analysis reveal several critical insights: (1) multi-task learning acts as a critical regularizer to mitigate overfitting in data-scarce EEG contexts; (2) pre-training efficiency is currently limited by gradient conflicts between reconstruction objectives and downstream tasks; (3) model scaling deviates from typical laws, as compact architectures with domain-specific inductive biases consistently outperform significantly larger models. This benchmark enables fair comparison and reproducible analysis, shifting the field from fragmented results to interpretable advances. Code is available at https://github.com/xw1216/EEG-FM-Bench.

The escalating complexity of modern software imposes an unsustainable operational burden on Site Reliability Engineering (SRE) teams, demanding AI-driven automation that can emulate expert diagnostic reasoning. Existing solutions, from traditional AI methods to general-purpose multi-agent systems, fall short: they either lack deep causal reasoning or are not tailored for the specialized, investigative workflows unique to SRE. To address this gap, we present OpenDerisk, a specialized, open-source multi-agent framework architected for SRE. OpenDerisk integrates a diagnostic-native collaboration model, a pluggable reasoning engine, a knowledge engine, and a standardized protocol (MCP) to enable specialist agents to collectively solve complex, multi-domain problems. Our comprehensive evaluation demonstrates that OpenDerisk significantly outperforms state-of-the-art baselines in both accuracy and efficiency. This effectiveness is validated by its large-scale production deployment at Ant Group, where it serves over 3,000 daily users across diverse scenarios, confirming its industrial-grade scalability and practical impact. OpenDerisk is open source and available at https://github.com/derisk-ai/OpenDerisk/

The integration of visual understanding and generation into unified multimodal models represents a significant stride toward general-purpose AI. However, a fundamental question remains unanswered by existing benchmarks: does this architectural unification actually enable synergetic interaction between the constituent capabilities? Existing evaluation paradigms, which primarily assess understanding and generation in isolation, are insufficient for determining whether a unified model can leverage its understanding to enhance its generation, or use generative simulation to facilitate deeper comprehension. To address this critical gap, we introduce RealUnify, a benchmark specifically designed to evaluate bidirectional capability synergy. RealUnify comprises 1,000 meticulously human-annotated instances spanning 10 categories and 32 subtasks. It is structured around two core axes: 1) Understanding Enhances Generation, which requires reasoning (e.g., commonsense, logic) to guide image generation, and 2) Generation Enhances Understanding, which necessitates mental simulation or reconstruction (e.g., of transformed or disordered visual inputs) to solve reasoning tasks. A key contribution is our dual-evaluation protocol, which combines direct end-to-end assessment with a diagnostic stepwise evaluation that decomposes tasks into distinct understanding and generation phases. This protocol allows us to precisely discern whether performance bottlenecks stem from deficiencies in core abilities or from a failure to integrate them. Through large-scale evaluations of 12 leading unified models and 6 specialized baselines, we find that current unified models still struggle to achieve effective synergy, indicating that architectural unification alone is insufficient. These results highlight the need for new training strategies and inductive biases to fully unlock the potential of unified modeling.

Despite recent advances in unified multimodal models for multi-reference image generation, existing benchmarks remain organized around predefined task types (e.g., "subject composition"), which are ill-suited to this combinatorial setting and lead to fragmented coverage, uncontrolled complexity, and little diagnostic value. Recognizing that diverse multi-reference tasks share a common set of atomic operations, we adopt a capability-oriented perspective and formalize four operators: Anchor (f), Disentangle (g), Apply (oplus), and Compose (C). Any multi-reference prompt can then be represented as a compositional formula over these operators, whose structural complexity is quantified by the number of operator slots. Building on this formulation, we construct TRACE-Bench, comprising approximately 1,600 evaluation cases across slot counts 1--8, built from 631 formula templates and around 4,000 reference images spanning diverse artistic styles and real-world subjects. The formula structure directly drives an operator-aligned evaluation protocol for per-capability scoring and a diagnostic tree analysis for recursive failure localization. Evaluating 9 leading models reveals insights invisible to holistic scoring: the primary bottleneck lies in disentanglement (g) and attribute binding (oplus) rather than scene-level composition (C), with even the best model scoring only 0.74 on attribute fidelity. Project page: https://amuseum-whr.github.io/TraceBench

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

Image generation models now produce high-quality static images, yet their ability to represent how a visual world changes over time remains poorly understood. Practical workflows such as storyboarding, step-by-step illustration, reference-guided editing, and video previsualization require models to preserve identities, objects, spatial relations, and causal order across multiple visual states. Existing evaluations largely measure single-image correctness, compositional alignment, or video quality, leaving open whether an image model can coherently imagine a temporally ordered process. We introduce ImageTime, a diagnostic benchmark that uses spatiotemporal consistency as a behavioral probe of visual world modeling in image generation. Given an action instruction, and optionally a reference image specifying the initial state, a model must generate one image containing four ordered key states: initial state, action onset, transition state, and final state. This four-keyframe protocol is more temporally demanding than single-image generation while avoiding the confounds of dense video dynamics. ImageTime organizes tasks with a progressive capability hierarchy and decomposes each scenario into stage-wise state predicates, cross-frame temporal constraints, and forbidden causal violations. GPT-5.5 scores all generated images under a structured VLM-as-judge protocol, producing interpretable capability scores, diagnostic subscores, and failure labels. Through multi-family benchmarking, ImageTime reveals where current image generation systems succeed, fail, and drift when asked to maintain coherent visual world states over time.

End-to-end speech large language models ((LLMs)) extend the capabilities of text-based models to directly process and generate audio tokens. However, this often leads to a decline in reasoning and generation performance compared to text input, a phenomenon referred to as intelligence degradation. To systematically evaluate this gap, we propose S2SBench, a benchmark designed to quantify performance degradation in Speech LLMs. It includes diagnostic datasets targeting sentence continuation and commonsense reasoning under audio input. We further introduce a pairwise evaluation protocol based on perplexity differences between plausible and implausible samples to measure degradation relative to text input. We apply S2SBench to analyze the training process of Baichuan-Audio, which further demonstrates the benchmark's effectiveness. All datasets and evaluation code are available at https://github.com/undobug/S2SBench.

Current AI-assisted skin image diagnosis has achieved dermatologist-level performance in classifying skin cancer, driven by rapid advancements in deep learning architectures. However, unlike traditional vision tasks, skin images in general present unique challenges due to the limited availability of well-annotated datasets, complex variations in conditions, and the necessity for detailed interpretations to ensure patient safety. Previous segmentation methods have sought to reduce image noise and enhance diagnostic performance, but these techniques require fine-grained, pixel-level ground truth masks for training. In contrast, with the rise of foundation models, the Segment Anything Model (SAM) has been introduced to facilitate promptable segmentation, enabling the automation of the segmentation process with simple yet effective prompts. Efforts applying SAM predominantly focus on dermatoscopy images, which present more easily identifiable lesion boundaries than clinical photos taken with smartphones. This limitation constrains the practicality of these approaches to real-world applications. To overcome the challenges posed by noisy clinical photos acquired via non-standardized protocols and to improve diagnostic accessibility, we propose a novel Cross-Attentive Fusion framework for interpretable skin lesion diagnosis. Our method leverages SAM to generate visual concepts for skin diseases using prompts, integrating local visual concepts with global image features to enhance model performance. Extensive evaluation on two skin disease datasets demonstrates our proposed method's effectiveness on lesion diagnosis and interpretability.

Progress in genomic foundation models is difficult to assess due to fragmented benchmarks, incompatible evaluation protocols, and task-specific reporting. As a result, claims of superiority or generality across models are often not directly comparable. We introduce GENEB, a large-scale diagnostic benchmark that evaluates frozen representations from 40 genomic foundation models across 100 tasks spanning 13 functional categories under a unified probing-based protocol, including few-shot regimes. GENEB enables controlled comparison across model scale, architecture, tokenization, and pretraining data while explicitly exposing task-level trade-offs. Our analysis shows that aggregate leaderboards are unstable: model rankings vary sharply across task categories, scale provides only modest and inconsistent gains, and architectural and pretraining alignment frequently outweigh parameter count. These results highlight limitations of current evaluation practices and position GENEB as a reference framework for principled comparison and category-aware model selection in genomic machine learning.

Time series are central to modern data mining applications, from industrial telemetry and server metrics to finance and physiology, yet time-series self-supervised learning often depends on view and augmentation choices that encode domain-specific invariances. We study how an SSL recipe behaves when its method-specific configuration is reused unchanged after the pretraining signal family changes, framing this as a fixed-recipe stress test rather than a comparison against optimally tuned methods. We introduce Latent Euclidean Next-Embedding Prediction Architecture (LeNEPA), a no-augmentation next-latent-token objective with a causal backbone. LeNEPA replaces the stop-gradient/EMA stabilization used by vanilla NEPA with SIGReg-based isotropy regularization and computes the predictive loss in a lightweight projected space that is discarded for evaluation. We compare LeNEPA with an ECG-tuned JEPA recipe under a fixed-horizon frozen-probe protocol on PTB-XL and Diag, a synthetic diagnostic corpus generated with Aionoscope. Both methods are retrained independently on each dataset while keeping their method-specific recipes unchanged. In this protocol, the ECG-tuned JEPA recipe is strong in-domain on PTB-XL but weaker when reused unchanged on Diag, whereas LeNEPA preserves useful frozen-probe gains on both datasets. Learning curves suggest faster early representation acquisition: LeNEPA reaches 80% of its final AUROC/AUPRC gain after 2--5k updates, compared with 5--10k updates for the faster JEPA readout. As a separate external frozen-encoder check, a CauKer-pretrained LeNEPA variant reaches 77.65% mean UCR-128 Random-Forest accuracy in a single-seed, best-checkpoint run, within 1.16 points of Mantis and within 0.24 points of MOMENT (77.89%). Overall, the results support no-augmentation latent prediction as a useful candidate recipe for low-retuning time-series SSL.

Cognitive diagnosis (CD) is a fundamental task in intelligent education that profiles learner proficiency over knowledge concepts. In real-world learning platforms, newly added items continually introduce previously unseen concepts, necessitating dynamic expansion of the underlying concept space. Yet existing incremental CD models assume a fixed concept space, allowing gradients from new items to overwrite historical pathways and induce catastrophic forgetting. More critically, these methods rely solely on soft constraints to preserve historical diagnoses. Such constraints may fail to satisfy the requirement of diagnostic invariance after incremental updates, a requirement known as psychometric consistency in cognitive diagnosis. Therefore, we propose CLEAN (Continual Learning with Expandable and Architecturally Isolated Networks), a novel incremental CD framework supporting concept-space expansion while providing structural guarantees for pointwise invariance of historical diagnoses. Specifically, CLEAN first introduces a strict topological bipartition protocol, freezes historical diagnostic functions and applies deterministic orthogonal column masking to sever gradient interference. Second, to accommodate concept expansion, expandable full-rank branches with micro-variance initialization are deployed to learn novel concepts. Finally, to verify that this architectural design achieves invariance by construction, we formalize Representation Drift (RD) to quantify the perturbation of historical traits. Extensive experiments on three large-scale educational datasets demonstrate that CLEAN achieves zero RD, preserving old-item metrics identically to static anchors through architectural isolation while remaining competitive with or superior to strong continual-learning baselines on new items.

LLM-based agents for machine learning engineering (MLE) predominantly rely on tree search, a form of gradient-free optimization that uses scalar validation scores to rank candidates. As LLM reasoning capabilities improve, exhaustive enumeration becomes increasingly inefficient compared to directed updates, analogous to how accurate gradients enable efficient descent over random search. We introduce Gome, an MLE agent that operationalizes gradient-based optimization. Gome maps structured diagnostic reasoning to gradient computation, success memory to momentum, and multi-trace execution to distributed optimization. Under a closed-world protocol that isolates architectural effects from external knowledge, Gome achieves a state-of-the-art 35.1\% any-medal rate on MLE-Bench with a restricted 12-hour budget on a single V100 GPU. Scaling experiments across 10 models reveal a critical crossover: with weaker models, tree search retains advantages by compensating for unreliable reasoning through exhaustive exploration; as reasoning capability strengthens, gradient-based optimization progressively outperforms, with the gap widening at frontier-tier models. Given the rapid advancement of reasoning-oriented LLMs, this positions gradient-based optimization as an increasingly favorable paradigm. We release our codebase and GPT-5 traces at https://github.com/microsoft/RD-Agent.

Continuous diffusion language models lag behind autoregressive transformers, partly because diffusion is applied in spaces poorly suited to language denoising and token recovery. We propose DiHAL, a geometry-guided diffusion-transformer hybrid that asks where diffusion should enter a pretrained transformer. DiHAL scores layers with geometry-based proxies, selects a diffusion-friendly hidden-state interface, and replaces the lower transformer prefix with a diffusion bridge while retaining the upper layers and original LM head. By reconstructing the selected-layer hidden state rather than tokens, DiHAL avoids direct continuous-to-discrete recovery. Experiments on 8B-scale backbones show that the geometry score predicts effective shallow insertion layers under a fixed bridge-training protocol and that hidden-state recovery improves over continuous diffusion baselines in a diagnostic comparison matching the diffusion/recovery training budget. These results suggest that hidden-state geometry helps identify where diffusion-based replacement is feasible inside pretrained language models.

Long-horizon failure in world models is conventionally attributed to compounding error, a generic framing that does not distinguish what kind of error compounds. We propose a kinematic-vs-dynamic reframing: world models tend to imagine kinematically rather than dynamically. We operationalize this as the imagined Kinematic-Consistency Error, a per-step diagnostic that measures how far a rollout departs from a closed-form kinematic null, paired with a perturbation protocol that tests whether iKCE responds when physical conditions cross a regime boundary. We instantiate the diagnostic on a released DreamerV3 checkpoint trained on DMC walker-walk, where imagined iKCE runs roughly two orders of magnitude above that of matched real-physics rollouts. Across a friction sweep that crosses the gait-collapse boundary, the model's iKCE stays statistically flat even as the trained policy's reward collapses through the same range, providing the kinematic-not-dynamic signature. The diagnostic distinguishes kinematic from dynamic imagination at horizons longer than the embodiment's gait period.

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

Vision-language models (VLMs) read an image and produce text in a single forward pass, whereas radiologists typically inspect an image several times and consult the literature before writing a report. We introduce GAZE (Grounded Agentic Zero-shot Evaluation), a framework that lets a medical VLM work in this iterative way by calling viewer-level tools (zoom, windowing, contrast, edge detection) and two retrieval tools backed by the U.S. National Library of Medicine (PubMed for medical literature, Open-i for radiological images), with structured outputs validated against a schema and full tool-call traces recorded for auditability. On NOVA, a benchmark of 906 brain MRI cases covering 281 rare neurological conditions, GAZE reaches 58.2 mean average precision (mAP) at intersection-over-union (IoU) 0.3 for lesion localisation and 34.9% Top-1 diagnostic accuracy under a joint protocol that scores captioning, diagnosis, and localisation from the image alone, without task-specific fine-tuning. Before any tool is used, structured prompting and schema-validated outputs already improve over the published Gemini 2.0 Flash baseline (20.2 to 29.4 mAP@0.3), so framework design is itself an experimental variable. Tool use helps rare pathologies disproportionately: the fraction of cases with IoU > 0.3 rises from 17% to 58% for diagnoses with three or fewer examples versus 25% to 68% for common conditions (geq10 cases), with gains tracking engagement (Gemini 3 Flash: Cohen's d = 0.79, 11.8 tool calls per case; Gemini 2.0 Flash: tools used in 8.2% of cases, no significant benefit). Retrieval ablations additionally reveal a model-dependent trade-off in which gains in diagnosis can coincide with losses in localisation, reinforcing the case for joint evaluation of diagnosis, localisation, and captioning in medical VLMs.

Genomic foundation models are increasingly reused as frozen feature extractors for downstream sequence prediction, offering a compute-efficient alternative to full fine-tuning. However, it remains unclear when biological information encoded by these models is accessible without task-specific adaptation. We present a representation-accessibility analysis of frozen genomic language models across regulatory, epigenetic, promoter, splice-site, and variant-effect prediction tasks. We evaluate DNABERT-2, Nucleotide Transformer, HyenaDNA, GENERATOR-v2, and Omni-DNA under unified frozen-probing protocols, while separating diagnostic readout analyses from validation-selected checks. Our results reveal a consistent task-dependent pattern: frozen probes recover 95-100 % of fine-tuned performance on promoter tasks, but average splice-site recovery drops to 60-88 %. Frozen embeddings are also competitive on broad Genomic Benchmark tasks such as coding-region and species-discrimination classification, but show larger gaps on some regulatory and OCR tasks. Layer-wise probing, in-silico mutagenesis, variant-effect prediction, and embedding geometry show that local biological signal is partially present in frozen representations, but is not always accessible through final pooled embeddings.

Medical Multimodal Large Language Models (Med-MLLMs) require egocentric clinical intent understanding for real-world deployment, yet existing benchmarks fail to evaluate this critical capability. To address these challenges, we introduce MedGaze-Bench, the first benchmark leveraging clinician gaze as a Cognitive Cursor to assess intent understanding across surgery, emergency simulation, and diagnostic interpretation. Our benchmark addresses three fundamental challenges: visual homogeneity of anatomical structures, strict temporal-causal dependencies in clinical workflows, and implicit adherence to safety protocols. We propose a Three-Dimensional Clinical Intent Framework evaluating: (1) Spatial Intent: discriminating precise targets amid visual noise, (2) Temporal Intent: inferring causal rationale through retrospective and prospective reasoning, and (3) Standard Intent: verifying protocol compliance through safety checks. Beyond accuracy metrics, we introduce Trap QA mechanisms to stress-test clinical reliability by penalizing hallucinations and cognitive sycophancy. Experiments reveal current MLLMs struggle with egocentric intent due to over-reliance on global features, leading to fabricated observations and uncritical acceptance of invalid instructions.

Recent advances in agentic Large Language Models (LLMs) have positioned them as generalist planners capable of reasoning and acting across diverse tasks. However, existing agent benchmarks largely focus on symbolic or weakly grounded environments, leaving their performance in physics-constrained real-world domains underexplored. We introduce AstroReason-Bench, a comprehensive benchmark for evaluating agentic planning in Space Planning Problems (SPP), a family of high-stakes problems with heterogeneous objectives, strict physical constraints, and long-horizon decision-making. AstroReason-Bench integrates multiple scheduling regimes, including ground station communication and agile Earth observation, and provides a unified agent-oriented interaction protocol. Evaluating on a range of state-of-the-art open- and closed-source agentic LLM systems, we find that current agents substantially underperform specialized solvers, highlighting key limitations of generalist planning under realistic constraints. AstroReason-Bench offers a challenging and diagnostic testbed for future agentic research.

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

Diagnostic consultation is an online sequential decision-making process in which clinicians gather evidence through patient interaction until a diagnosis is sufficiently supported. Automating this process requires adaptive inquiry and interpretable decisions. Bayesian networks offer a natural foundation by updating diagnostic posteriors as evidence accumulates, but their use in open-ended consultation raises two challenges: linking diagnostic hypotheses to potential inquiries and translating evolving posteriors into consultation decisions. We introduce AutoDisym, an automated pipeline that integrates diagnostic knowledge with heterogeneous diagnosis-labeled clinical narratives to construct a Disorder--Symptom Bayesian Network (DSBN). Building on the DSBN, we propose ConsultMind, an uncertainty-aware framework that updates disorder posteriors after each response and uses posterior uncertainty to guide inquiry and diagnosis. We evaluate both methods across psychiatry, respiratory medicine, fever clinics, and three public datasets. The results show that AutoDisym can automatically construct high-quality DSBNs and that ConsultMind consistently improves diagnostic performance and explanation soundness. For example, AutoDisym achieves macro-averaged F1 scores of 81.37 for canonical symptoms and 72.19 for manifestations using GPT-5.6-Sol. ConsultMind improves Top-1 and Top-3 diagnostic accuracy by up to 22.15 and 37.89 percentage points, respectively. Physician evaluation further shows that ConsultMind improves the quality of ranking explanations, differential diagnoses, and diagnosis rationales across LLMs of different scales. This work offers a promising approach to automatic diagnostic consultation.

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

The deployment of Large Language Models (LLMs) for structuring clinical data is critically hindered by their tendency to hallucinate facts and their inability to follow domain-specific rules. To address this, we introduce MedPAO, a novel agentic framework that ensures accuracy and verifiable reasoning by grounding its operation in established clinical protocols such as the ABCDEF protocol for CXR analysis. MedPAO decomposes the report structuring task into a transparent process managed by a Plan-Act-Observe (PAO) loop and specialized tools. This protocol-driven method provides a verifiable alternative to opaque, monolithic models. The efficacy of our approach is demonstrated through rigorous evaluation: MedPAO achieves an F1-score of 0.96 on the critical sub-task of concept categorization. Notably, expert radiologists and clinicians rated the final structured outputs with an average score of 4.52 out of 5, indicating a level of reliability that surpasses baseline approaches relying solely on LLM-based foundation models. The code is available at: https://github.com/MiRL-IITM/medpao-agent

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

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.

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

Coronavirus disease 2019 (Covid-19) is highly contagious with limited treatment options. Early and accurate diagnosis of Covid-19 is crucial in reducing the spread of the disease and its accompanied mortality. Currently, detection by reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard of outpatient and inpatient detection of Covid-19. RT-PCR is a rapid method, however, its accuracy in detection is only ~70-75%. Another approved strategy is computed tomography (CT) imaging. CT imaging has a much higher sensitivity of ~80-98%, but similar accuracy of 70%. To enhance the accuracy of CT imaging detection, we developed an open-source set of algorithms called CovidCTNet that successfully differentiates Covid-19 from community-acquired pneumonia (CAP) and other lung diseases. CovidCTNet increases the accuracy of CT imaging detection to 90% compared to radiologists (70%). The model is designed to work with heterogeneous and small sample sizes independent of the CT imaging hardware. In order to facilitate the detection of Covid-19 globally and assist radiologists and physicians in the screening process, we are releasing all algorithms and parametric details in an open-source format. Open-source sharing of our CovidCTNet enables developers to rapidly improve and optimize services, while preserving user privacy and data ownership.

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

The controversy of computed tomography (CT) use in COVID-19 screening is associated with ambiguous characteristics of chest CT as a diagnostic test. The reported values of CT sensitivity and specificity calculated using RT-PCR as a reference standard vary widely. The objective of this study was to reevaluate the diagnostic and prognostic value of CT using an alternative approach. This study included 973 symptomatic COVID-19 patients aged 42 pm 17 years, 56% females. We reviewed the disease dynamics between the initial and follow-up CT studies using a "CT0-4" grading system. Sensitivity and specificity were calculated as conditional probabilities that a patient's condition would improve or deteriorate relative to the initial CT study results. For the calculation of negative (NPV) and positive (PPV) predictive values, we estimated the COVID-19 prevalence in Moscow. We used several ARIMA and EST models with different parameters to fit the data on total cases of COVID-19 from March 6, 2020, to July 20, 2020, and forecast the incidence. The "CT0-4" grading scale demonstrated low sensitivity (28%) but high specificity (95%). The best statistical model for describing the pandemic in Moscow was ETS with multiplicative trend, error, and season type. According to our calculations, with the predicted prevalence of 2.1%, the values of NPV and PPV would be 98% and 10%, correspondingly. We associate the low sensitivity and PPV values with the small sample size of the patients with severe symptoms and non-optimal methodological setup for measuring these specific characteristics. The "CT0-4" grading scale was highly specific and predictive for identifying admissions to hospitals of COVID-19 patients. Despite the ambiguous accuracy, chest CT proved to be an effective practical tool for patient management during the pandemic, provided that the necessary infrastructure and human resources are available.

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

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.

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

Reality may establish that an outcome occurred without identifying which evolving procedure produced it or why. This distinction matters in production ML systems whose code, configuration, and artifacts change while external feedback accumulates. We examine it in a human-directed, agent-engineered quantitative trading system, using oracle to mean an external source of realized outcomes rather than a complete correctness specification. Across one year, the account gained and outperformed a broad market index, while annual alpha was not statistically distinguishable from zero under the main retrospective specification. Retrospectively selected subperiods include adverse relative performance and conditional candidate-level weakness under declared approximate references. Engineering records document changes during the episode, and complete recommendation-to-runtime binding is unavailable. The archive does not establish a common frozen instance or a unique cause. The case motivates an outcome--diagnosis gap: outcome evidence, evaluated-object identity, and causal explanation support distinct claims. We distinguish frozen instances, pre-specified adaptive procedures, and ad-hoc development; organize archive-relative claim identifiability and an evidence hierarchy; and propose a prospective production-binding protocol. An illustrative compatible-history example shows how factual binding can resolve a recommendation's referent without supplying its counterfactual effect. The protocol is proposed rather than prospectively validated. External feedback constrains outcome claims, while provenance and additional identification structure determine the resolution of diagnosis.

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

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

Randomized controlled trials (RCTs) are the benchmark for causal inference, yet field implementation can deviate. We here present a remote audit - a design-based, preregistrable diagnostic that uses only pre-treatment satellite imagery to test whether assignment is independent of local conditions. The conditional randomization test of the remote audit evaluates whether treatment assignment is more predictable from pre-treatment satellite features than expected under the experiment's registered mechanism, providing a finite-sample valid, design-based diagnostic that requires no parametric assumptions. The procedure is finite-sample valid, honors blocks and clusters, and controls multiplicity across image models and resolutions via a max-statistic. We illustrate with two RCTs: Uganda's Youth Opportunities Program, where the audit corroborates randomization and flags selection and missing-data risks; and a school-based trial in Bangladesh, where assignment is highly predictable from pre-treatment features relative to the stated design, consistent with independent concerns about irregularities. Remote audits complement balance tests, lower early-stage costs, and enable rapid design checks when baseline surveys are expensive or infeasible.

Medical vision-language model (VLM) evaluation is sensitive to workflow design, prompting strategy, and benchmark construction, yet most studies treat these factors in isolation. We introduce a reliability stress test for chest X-ray interpretation built on two balanced datasets (a private report-backed set and a curated MIMIC subset). Three medical VLMs (CheXagent, MedGemma-4B, and MedGemma-27B) are evaluated across three prompt styles and two workflows (single-VLM and multi-agent), producing 36 configurations. We show that exact-match accuracy alone can overstate the effectiveness of conservative models that default to "Normal" predictions. Diagnostic reliability also depends heavily on model family and scale: multi-agent reasoning helps some configurations but hurts others. Building on these observations, we propose a decision-time routing framework that selectively escalates to multi-agent inference only when beneficial, improving the cost-quality trade-off over fixed workflows. Our results highlight the need for evaluation protocols that jointly consider prompt sensitivity, failure-mode diversity, and workflow choice before clinical deployment.

Diagnosing lung cancer typically involves physicians identifying lung nodules in Computed tomography (CT) scans and generating diagnostic reports based on their morphological features and medical expertise. Although advancements have been made in using multimodal large language models for analyzing lung CT scans, challenges remain in accurately describing nodule morphology and incorporating medical expertise. These limitations affect the reliability and effectiveness of these models in clinical settings. Collaborative multi-agent systems offer a promising strategy for achieving a balance between generality and precision in medical applications, yet their potential in pathology has not been thoroughly explored. To bridge these gaps, we introduce LungNoduleAgent, an innovative collaborative multi-agent system specifically designed for analyzing lung CT scans. LungNoduleAgent streamlines the diagnostic process into sequential components, improving precision in describing nodules and grading malignancy through three primary modules. The first module, the Nodule Spotter, coordinates clinical detection models to accurately identify nodules. The second module, the Radiologist, integrates localized image description techniques to produce comprehensive CT reports. Finally, the Doctor Agent System performs malignancy reasoning by using images and CT reports, supported by a pathology knowledge base and a multi-agent system framework. Extensive testing on two private datasets and the public LIDC-IDRI dataset indicates that LungNoduleAgent surpasses mainstream vision-language models, agent systems, and advanced expert models. These results highlight the importance of region-level semantic alignment and multi-agent collaboration in diagnosing nodules. LungNoduleAgent stands out as a promising foundational tool for supporting clinical analyses of lung nodules.

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

When asked to describe a medical image that was never attached, frontier vision-language models do not abstain: they confabulate a diagnosis. We show that this confabulation is not random. It is structured by who the patient is said to be. Across chest X-ray, brain MRI, and dermatology, Claude Opus-4.7, GPT-5.4, and Gemini-3.1-Pro are each queried with only a demographic descriptor and no image, and changing the descriptor systematically shifts the diagnosis returned. Claude concentrates sharply: a 65-year-old white man asking about a skin mole receives Melanoma in nearly every response, and a 32-year-old Black woman asking about her chest X-ray receives a Sarcoidosis diagnosis whose reasoning reads "suspected, based on demographics and classic pattern.'' GPT-5.4's effect is broader, fabricating across every demographic cell we test, most conspicuously naming Sarcoidosis for young Black patients on chest X-ray. Two structural findings sharpen the problem. A hedged regime appears in which the prose acknowledges the missing image while the structured diagnosis field nevertheless names a disease, a dissociation invisible to prose-only audits. And Claude's dermatology effect collapses entirely when 'skin mole' is swapped for 'skin lesion' while GPT-5.4's is preserved, indicating that mirage is a family of distinct failure modes rather than a single phenomenon. Trustworthy VLM deployment in clinical pipelines requires auditing the structured output channel directly, and probe-word sensitivity should be treated as a first-class evaluation dimension

Clinical diagnosis is inherently sequential: clinicians escalate from cheap to costly tests only when additional evidence is expected to resolve diagnostic uncertainty. We present ActiveMedAgent, a framework that brings this cost-aware sequential logic to multimodal medical AI. Given a frozen, API-accessed vision-language model, ActiveMedAgent tracks probability distributions over candidate diagnoses and scores each acquisition by its per-step diagnostic utility minus cost. A lightweight MLP controller is then trained offline on these scored trajectories, learning when to request additional evidence and when to commit. Across three commonly used benchmarks, trajectory-based policy learning consistently outperforms both unguided acquisition and full-modality baselines. Notably, we identify an information overload effect. In 175 cases, the agent produces a correct diagnosis with fewer channels while the full-modality baseline fails, showing that learning what to omit can be as important as learning what to acquire.

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

Coronavirus disease (COVID-19) is a pandemic disease, which has already caused thousands of causalities and infected several millions of people worldwide. Any technological tool enabling rapid screening of the COVID-19 infection with high accuracy can be crucially helpful to healthcare professionals. The main clinical tool currently in use for the diagnosis of COVID-19 is the Reverse transcription polymerase chain reaction (RT-PCR), which is expensive, less-sensitive and requires specialized medical personnel. X-ray imaging is an easily accessible tool that can be an excellent alternative in the COVID-19 diagnosis. This research was taken to investigate the utility of artificial intelligence (AI) in the rapid and accurate detection of COVID-19 from chest X-ray images. The aim of this paper is to propose a robust technique for automatic detection of COVID-19 pneumonia from digital chest X-ray images applying pre-trained deep-learning algorithms while maximizing the detection accuracy. A public database was created by the authors combining several public databases and also by collecting images from recently published articles. The database contains a mixture of 423 COVID-19, 1485 viral pneumonia, and 1579 normal chest X-ray images. Transfer learning technique was used with the help of image augmentation to train and validate several pre-trained deep Convolutional Neural Networks (CNNs). The networks were trained to classify two different schemes: i) normal and COVID-19 pneumonia; ii) normal, viral and COVID-19 pneumonia with and without image augmentation. The classification accuracy, precision, sensitivity, and specificity for both the schemes were 99.7%, 99.7%, 99.7% and 99.55% and 97.9%, 97.95%, 97.9%, and 98.8%, respectively.

Healthcare agents must transform longitudinal clinical evidence into reliable actions through heterogeneous tools and stateful workflows, conditions under which model-centric systems may lose context, misuse tools, fail to verify consequential transitions, or cross authorization boundaries. Existing medical-agent benchmarks primarily emphasize terminal task outcomes, making it difficult to determine whether execution failures arise from the agent model, the runtime harness, or their interaction. We present the Medical Harness Protocol, an outcome-preserving framework that independently evaluates seven healthcare-specific process dimensions: Care Action Fulfillment, Clinical Resource Competence, Patient-Evidence Alignment, Clinical Workflow Continuity, Clinical Auditability, Closed-Loop Verification, and Clinical Conduct Boundaries. A normalized intervention trace further tracks whether runtime support is available, activated, delivered, adopted by the agent, and propagated into subsequent behavior. We instantiate the protocol as MedHarnessBench, comprising 342 executable tasks across FHIR/EHR operations, healthcare-administration interfaces, and multimodal clinical tools. Across more than 16,000 controlled task executions, MedHarness yields broad improvements in terminal task success, intermediate subtask completion, and healthcare-specific process quality. We further evaluate MedHarness against multiple general-purpose harnesses and use controlled single-fault perturbations to verify the sensitivity and discrimination of the seven-dimensional evaluation. These results demonstrate that healthcare-specific runtime support can substantially improve both task completion and execution quality, while revealing failures that terminal outcomes alone cannot capture. Code and resources are available at https://github.com/Tomry1114/Awesome-Agent-Harness-for-Healthcare.

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

Online medical consultation (OMC) restricts doctors to gathering patient information solely through inquiries, making the already complex sequential decision-making process of diagnosis even more challenging. Recently, the rapid advancement of large language models has demonstrated a significant potential to transform OMC. However, most studies have primarily focused on improving diagnostic accuracy under conditions of relatively sufficient information, while paying limited attention to the "inquiry" phase of the consultation process. This lack of focus has left the relationship between "inquiry" and "diagnosis" insufficiently explored. In this paper, we first extract real patient interaction strategies from authentic doctor-patient conversations and use these strategies to guide the training of a patient simulator that closely mirrors real-world behavior. By inputting medical records into our patient simulator to simulate patient responses, we conduct extensive experiments to explore the relationship between "inquiry" and "diagnosis" in the consultation process. Experimental results demonstrate that inquiry and diagnosis adhere to the Liebig's law: poor inquiry quality limits the effectiveness of diagnosis, regardless of diagnostic capability, and vice versa. Furthermore, the experiments reveal significant differences in the inquiry performance of various models. To investigate this phenomenon, we categorize the inquiry process into four types: (1) chief complaint inquiry; (2) specification of known symptoms; (3) inquiry about accompanying symptoms; and (4) gathering family or medical history. We analyze the distribution of inquiries across the four types for different models to explore the reasons behind their significant performance differences. We plan to open-source the weights and related code of our patient simulator at https://github.com/LIO-H-ZEN/PatientSimulator.

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

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

COVID-19 (coronavirus disease 2019) pandemic caused by SARS-CoV-2 has led to a treacherous and devastating catastrophe for humanity. At the time of writing, no specific antivirus drugs or vaccines are recommended to control infection transmission and spread. The current diagnosis of COVID-19 is done by Reverse-Transcription Polymer Chain Reaction (RT-PCR) testing. However, this method is expensive, time-consuming, and not easily available in straitened regions. An interpretable and COVID-19 diagnosis AI framework is devised and developed based on the cough sounds features and symptoms metadata to overcome these limitations. The proposed framework's performance was evaluated using a medical dataset containing Symptoms and Demographic data of 30000 audio segments, 328 cough sounds from 150 patients with four cough classes ( COVID-19, Asthma, Bronchitis, and Healthy). Experiments' results show that the model captures the better and robust feature embedding to distinguish between COVID-19 patient coughs and several types of non-COVID-19 coughs with higher specificity and accuracy of 95.04 pm 0.18% and 96.83pm 0.18% respectively, all the while maintaining interpretability.

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

Incidental findings in CT scans, though often benign, can have significant clinical implications and should be reported following established guidelines. Traditional manual inspection by radiologists is time-consuming and variable. This paper proposes a novel framework that leverages large language models (LLMs) and foundational vision-language models (VLMs) in a plan-and-execute agentic approach to improve the efficiency and precision of incidental findings detection, classification, and reporting for abdominal CT scans. Given medical guidelines for abdominal organs, the process of managing incidental findings is automated through a planner-executor framework. The planner, based on LLM, generates Python scripts using predefined base functions, while the executor runs these scripts to perform the necessary checks and detections, via VLMs, segmentation models, and image processing subroutines. We demonstrate the effectiveness of our approach through experiments on a CT abdominal benchmark for three organs, in a fully automatic end-to-end manner. Our results show that the proposed framework outperforms existing pure VLM-based approaches in terms of accuracy and efficiency.

Retinal imaging has emerged as a powerful, non-invasive modality for detecting and quantifying biomarkers of systemic diseases-ranging from diabetes and hypertension to Alzheimer's disease and cardiovascular disorders but current insights remain dispersed across platforms and specialties. Recent technological advances in optical coherence tomography (OCT/OCTA) and adaptive optics (AO) now deliver ultra-high-resolution scans (down to 5 {\mu}m ) with superior contrast and spatial integration, allowing early identification of microvascular abnormalities and neurodegenerative changes. At the same time, AI-driven and machine learning (ML) algorithms have revolutionized the analysis of large-scale retinal datasets, increasing sensitivity and specificity; for example, deep learning models achieve > 90 \% sensitivity for diabetic retinopathy and AUC = 0.89 for the prediction of cardiovascular risk from fundus photographs. The proliferation of mobile health technologies and telemedicine platforms further extends access, reduces costs, and facilitates community-based screening and longitudinal monitoring. Despite these breakthroughs, translation into routine practice is hindered by heterogeneous imaging protocols, limited external validation of AI models, and integration challenges within clinical workflows. In this review, we systematically synthesize the latest OCT/OCT and AO developments, AI/ML approaches, and mHealth/Tele-ophthalmology initiatives and quantify their diagnostic performance across disease domains. Finally, we propose a roadmap for multicenter protocol standardization, prospective validation trials, and seamless incorporation of retinal screening into primary and specialty care pathways-paving the way for precision prevention, early intervention, and ongoing treatment of life-threatening systemic diseases.

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

A Mamba state-space model trained only for next-step prediction appears to recover Granger-causal structure through a simple readout S = |W_{out} W_{in}|, with early experiments suggesting the phenomenon generalized across architectures and benefited from interventional data at p < 10^{-5}. We package the protocol used to test that claim -- standardized synthetic generators (VAR/Lorenz/CauseMe-style), three intervention semantics (do(X=c), soft-noise, random-forcing), edge-provenance cards on three real datasets, and size-matched control arms -- as a reusable falsification benchmark, and walk the claim through it in five stages. The method-level claim does not survive: (i) a plain linear bottleneck does as well or better; (ii) tuned Lasso beats the bottleneck on synthetic CauseMe-style benchmarks, and on Lorenz-96 (the only real benchmark with unambiguous ground truth) classical PCMCI and Granger lead a tight cluster in which the bottleneck trails; (iii) the headline intervention advantage is roughly 60% a sample-size confound, and the residual disappears under standard do(X=c) interventions, surviving only under a non-standard random-forcing scheme; (iv) even that residual reproduces, with a larger effect, in classical bivariate Granger -- the effect is method-agnostic. What survives is a narrow characterization result; the benchmark is the lasting artifact, and each stage above is one of its control arms.

Our interest is in the design of software systems involving a human-expert interacting -- using natural language -- with a large language model (LLM) on data analysis tasks. For complex problems, it is possible that LLMs can harness human expertise and creativity to find solutions that were otherwise elusive. On one level, this interaction takes place through multiple turns of prompts from the human and responses from the LLM. Here we investigate a more structured approach based on an abstract protocol described in [3] for interaction between agents. The protocol is motivated by a notion of "two-way intelligibility" and is modelled by a pair of communicating finite-state machines. We provide an implementation of the protocol, and provide empirical evidence of using the implementation to mediate interactions between an LLM and a human-agent in two areas of scientific interest (radiology and drug design). We conduct controlled experiments with a human proxy (a database), and uncontrolled experiments with human subjects. The results provide evidence in support of the protocol's capability of capturing one- and two-way intelligibility in human-LLM interaction; and for the utility of two-way intelligibility in the design of human-machine systems. Our code is available at https://github.com/karannb/interact.

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

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

Background: The positive predictive value (PPV) of large language model (LLM)-based proofreading for radiology reports is limited due to the low error prevalence. Purpose: To assess whether a three-pass LLM framework enhances PPV and reduces operational costs compared with baseline approaches. Materials and Methods: A retrospective analysis was performed on 1,000 consecutive radiology reports (250 each: radiography, ultrasonography, CT, MRI) from the MIMIC-III database. Two external datasets (CheXpert and Open-i) were validation sets. Three LLM frameworks were tested: (1) single-prompt detector; (2) extractor plus detector; and (3) extractor, detector, and false-positive verifier. Precision was measured by PPV and absolute true positive rate (aTPR). Efficiency was calculated from model inference charges and reviewer remuneration. Statistical significance was tested using cluster bootstrap, exact McNemar tests, and Holm-Bonferroni correction. Results: Framework PPV increased from 0.063 (95% CI, 0.036-0.101, Framework 1) to 0.079 (0.049-0.118, Framework 2), and significantly to 0.159 (0.090-0.252, Framework 3; P<.001 vs. baselines). aTPR remained stable (0.012-0.014; P>=.84). Operational costs per 1,000 reports dropped to USD 5.58 (Framework 3) from USD 9.72 (Framework 1) and USD 6.85 (Framework 2), reflecting reductions of 42.6% and 18.5%, respectively. Human-reviewed reports decreased from 192 to 88. External validation supported Framework 3's superior PPV (CheXpert 0.133, Open-i 0.105) and stable aTPR (0.007). Conclusion: A three-pass LLM framework significantly enhanced PPV and reduced operational costs, maintaining detection performance, providing an effective strategy for AI-assisted radiology report quality assurance.

Purpose: Surgical performance depends not only on surgeons' technical skills but also on team communication within and across the different professional groups present during the operation. Therefore, automatically identifying team communication in the OR is crucial for patient safety and advances in the development of computer-assisted surgical workflow analysis and intra-operative support systems. To take the first step, we propose a new task of detecting communication briefings involving all OR team members, i.e. the team Time-out and the StOP?-protocol, by localizing their start and end times in video recordings of surgical operations. Methods: We generate an OR dataset of real surgeries, called Team-OR, with more than one hundred hours of surgical videos captured by the multi-view camera system in the OR. The dataset contains temporal annotations of 33 Time-out and 22 StOP?-protocol activities in total. We then propose a novel group activity detection approach, where we encode both scene context and action features, and use an efficient neural network model to output the results. Results: The experimental results on the Team-OR dataset show that our approach outperforms existing state-of-the-art temporal action detection approaches. It also demonstrates the lack of research on group activities in the OR, proving the significance of our dataset. Conclusion: We investigate the Team Time-Out and the StOP?-protocol in the OR, by presenting the first OR dataset with temporal annotations of group activities protocols, and introducing a novel group activity detection approach that outperforms existing approaches. Code is available at https://github.com/CAMMA-public/Team-OR.

Pathology vision-language models (VLMs) have shown strong visual perception ability, but their robustness in the language domain remains poorly characterized. Existing pathology VLM benchmarks largely rely on canonical closed-set prompts or perturb only generic templates, treating language as a fixed evaluation component rather than a variable axis of model behavior. In clinical practice, however, diagnostic language varies across reports, institutions, and candidate diagnoses. We introduce PathLang, a language-centered and clinically grounded zero-shot benchmark. PathLang holds the underlying slides, ground-truth labels, and image-text evaluation direction fixed while systematically varying only the diagnostic language, so that performance differences reflect how a diagnosis is phrased rather than what is imaged. The language variation follows how pathologists actually rephrase diagnoses (terminology, specificity, and reporting style), and all prompts and candidate pools are validated by six board-certified pathologists. PathLang covers four task families: (1) zero-shot classification with image-text alignment analysis, (2) cross-modal retrieval, (3) paraphrase robustness, including semantic-equivalence paraphrases, length and reporting-style variation, and prompt ensembling, and (4) open-vocabulary diagnosis retrieval over four candidate pools with distinct forms of semantic competition. Across nine VLMs and five public datasets spanning four organs, we find that performance is highly sensitive to clinically equivalent paraphrases, varies substantially across forms of semantic competition, and that image-text alignment quality does not necessarily translate into inter-class separability. We release the prompt corpus, candidate pools, pre-computed text embeddings, and evaluation code at https://anonymous.4open.science/r/PathLang.

Autonomous computational pathology (ACP) converts high-level pathology analysis goals into executable, traceable and clinically bounded workflows. Realizing this capability requires adapting general agentic harness systems to pathology-specific tasks, tools, evidence standards and clinical claim boundaries. We contribute ACP-Bench, a framework that adapts existing harness systems from computational pathology support toward ACP workflow capability. ACP-Bench evaluates 41 pathology workflow tasks, including 24 biomarker, 7 morphology and 10 prognosis tasks spanning 6 body-system groups and 9 endpoint families. The benchmark evaluates 9 models and 3 harness groups (Claude Code, Codex and Open Code), yielding 369 complete trajectories. ACP-Bench evaluates each trajectory across workflow execution, diagnostic performance and clinical-boundary alignment, combining expert-adjudicated process audits, diagnostic assessment and pathologist-validated safety review. Across evaluated systems, workflow initiation, task interpretation and diagnostic reporting were more mature than tool-bound execution, result binding and reflective workflow revision, and formal end-to-end completion remained rare. ACP-Bench provides a reusable standard for auditing whether agentic systems can operationalize pathology workflows before claims of reliable clinical autonomy.

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

Most clinical benchmarks evaluate language models (LMs) on diagnosis using complete case descriptions. In clinical practice, however, patients present information in different ways, and clinicians must obtain relevant history and determine which examinations are needed before reaching a diagnosis. Diagnostic accuracy alone therefore cannot establish whether an agent gathered essential information or conducted an appropriate clinical assessment. Furthermore, existing benchmarks lack professional clinicians' verification. To address this gap, we introduce KlinikeBench, a benchmark of 333 clinician-authored tasks, each providing an isolated sandbox environment with a virtual patient, clinical tools, and task-specific success criteria. More than 35 clinicians contributed to case authoring and benchmark evaluation. In an empirical study, clinicians gave simulated dialogues higher mean quality ratings than reference conversations, which is adapted from real conversation. In each task, an LM has a fixed budget of turns to communicate with the patient, ask about relevant history, request examinations, follow action constraints, and record a final diagnosis. We score these steps separately as well as together. Across 31 models and seven model families, the best-performing models (e.g., GPT-6-astra and Claude Opus 5) succeed on less than 30% of tasks, even though their diagnosis accuracy reaches 90.7%. Some models benefit from talking with the patient; others diagnose well from a complete chart but perform much worse in conversation. Overall, KlinikeBench provides a testbed for evaluating the full clinical encounter and reveals a substantial gap between diagnostic accuracy and performance in interactive clinical assessment.

AI research agents combine prior knowledge, public sources, and experimental feedback to produce useful results. The Discovery Certification Protocol (DCP) turns claims about these results into executable recovery and feedback tests. Gate 1 validates useful improvement on sealed evaluation. Gate 2 gives matched agents the registered starting information and observed Web content while withholding the target research history. Every valid method reaching the numerical target supplies a recovery witness and triggers the Core veto. DCP Core requires adequate controls, zero observed recoveries, and a finite-sample bound on recovery in one fresh registered episode. Optional Gate 3 measures the average effect of truthful feedback relative to a specified neutral policy from a shared checkpoint. DCP Evidence adds this effect after independent null calibration and a registered effect margin. Two controlled audits exercise the complete protocol in SQLite optimization and virtual catalyst control under different models. Each produced zero recoveries in 96 episodes, with an upper bound of 0.0468. Each paired study yielded 30 truthful recoveries and zero neutral recoveries, with passing 60-pair null studies. Additional cases exercise Core, recovered, and audit-incomplete decisions. A deterministic, LLM-free verifier reproduces the decisions from frozen evidence. DCP provides a common evidence language for useful outcomes, alternative routes, and feedback effects across AI research.

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.

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

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

Traditionally, AI research in medical diagnosis has largely centered on image analysis. While this has led to notable advancements, the absence of patient-reported symptoms continues to hinder diagnostic accuracy. To address this, we propose a Pre-Consultation Dialogue Framework (PCDF) that mimics real-world diagnostic procedures, where doctors iteratively query patients before reaching a conclusion. Specifically, we simulate diagnostic dialogues between two vision-language models (VLMs): a DocVLM, which generates follow-up questions based on the image and dialogue history, and a PatientVLM, which responds using a symptom profile derived from the ground-truth diagnosis. We additionally conducted a small-scale clinical validation of the synthetic symptoms generated by our framework, with licensed clinicians confirming their clinical relevance, symptom coverage, and overall realism. These findings indicate that the resulting DocVLM-PatientVLM interactions form coherent, multi-turn consultations paired with images and diagnoses, which we then use to fine-tune the DocVLM. This dialogue-based supervision leads to substantial gains over image-only training, highlighting the value of realistic symptom elicitation for diagnosis.

Lung cancer is the deadliest type of cancer worldwide and late detection is the major factor for the low survival rate of patients. Low dose computed tomography has been suggested as a potential screening tool but manual screening is costly, time-consuming and prone to variability. This has fueled the development of automatic methods for the detection, segmentation and characterisation of pulmonary nodules but its application to clinical routine is challenging. In this study, a new database for the development and testing of pulmonary nodule computer-aided strategies is presented which intends to complement current databases by giving additional focus to radiologist variability and local clinical reality. State-of-the-art nodule detection, segmentation and characterization methods are tested and compared to manual annotations as well as collaborative strategies combining multiple radiologists and radiologists and computer-aided systems. It is shown that state-of-the-art methodologies can determine a patient's follow-up recommendation as accurately as a radiologist, though the nodule detection method used shows decreased performance in this database.

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

Evaluating an agent's planning ability remains challenging for open-domain tasks, where verifying procedures through execution is often impractical. Existing evaluations typically assess only the final plan and do not distinguish procedural errors such as missing, incorrect, or misordered actions. We introduce STEPBENCH, a benchmark of 6,885 verified procedures crawled from wikiHow across 81 open-domain categories. From each procedure, we derive 5 diagnostic tasks: four with deterministic answers involving withheld, incorrect, or shuffled steps, and one requiring next-step generation. We additionally evaluate full-plan generation to examine how diagnostic performance correlates with end-to-end plan validity. Using the same procedures across tasks lets us directly compare different planning capabilities. For generation, STEPEVAL identifies critical failures that prevent goal completion. Across 14 configurations of 12 models, we find substantial differences across planning capabilities, with step ordering proving the most difficult: the strongest model correctly orders only 63.0% of procedures, dropping to 33.1% for those with nine or more steps. Incorrect-step detection also predicts judged plan validity across models, suggesting a lower-cost alternative for evaluating generation quality. On STEPBENCH-Val, comprising 214 procedures published in 2026, comprehension scores and rankings remain stable, suggesting limited influence from memorisation.

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

Providing high quality explanations for AI predictions based on machine learning is a challenging and complex task. To work well it requires, among other factors: selecting a proper level of generality/specificity of the explanation; considering assumptions about the familiarity of the explanation beneficiary with the AI task under consideration; referring to specific elements that have contributed to the decision; making use of additional knowledge (e.g. expert evidence) which might not be part of the prediction process; and providing evidence supporting negative hypothesis. Finally, the system needs to formulate the explanation in a clearly interpretable, and possibly convincing, way. Given these considerations, ANTIDOTE fosters an integrated vision of explainable AI, where low-level characteristics of the deep learning process are combined with higher level schemes proper of the human argumentation capacity. ANTIDOTE will exploit cross-disciplinary competences in deep learning and argumentation to support a broader and innovative view of explainable AI, where the need for high-quality explanations for clinical cases deliberation is critical. As a first result of the project, we publish the Antidote CasiMedicos dataset to facilitate research on explainable AI in general, and argumentation in the medical domain in particular.

Following clinical decision pathways (CDPs) defined by clinical practice guidelines is essential for safe and reliable medical decision-making. However, existing medical large language model (LLM) benchmarks mainly evaluate final-answer accuracy, providing limited evaluation of models' ability to adhere to guidelines. To address this gap, we introduce MEGA-CDP, a benchmark for evaluating whether medical LLMs can generate guideline-adherent CDPs using provided guidelines as references. MEGA-CDP is constructed from 2,274 English and Chinese clinical practice guidelines through a guideline-to-case pipeline, yielding 42,353 clinical cases with explicit reference CDPs. It supports both single-turn vignette and multi-turn interactive settings, and introduces a CDP-oriented evaluation framework for measuring pathway consistency. Experiments on 16 representative LLMs show that reliable clinical decision support remains challenging for current models, demonstrating the need for CDP-oriented evaluation and the value of MEGA-CDP for advancing guideline adherence in medical LLMs.

Vision-language models used for decisions in histopathology rarely return calibrated probabilities over the candidates a user cares about. Decision-native models write a question and a candidate set chosen at run time into the input and return a normalised distribution from a small decision head in one forward pass. We build PathJev-P, a decision-native model for histopathology: MedGemma-1.5-4B with LoRA adapters and a decision head, trained on 40,000 patch states from three public collections whose expert labels are turned into typed questions with organ-specific candidate sets and a "none of these" option. In a comparison over 3 seeds with an analysis plan fixed before testing, on test sets without documented overlap with the training data of the backbone, PathJev-P is more accurate than a generative model trained with the same backbone, data and selection rule, the zero-shot pathology model CONCH and a general medical decision model (balanced accuracy 0.541 against 0.492, 0.345 and 0.213); its advantage over the generative model comes from two organs absent from training. The calibration advantage depends on how the generative model's probabilities are read out. With the summed candidate log-likelihood used in previous work, PathJev-P has the lower calibration error (ECE 0.204 against 0.279); with a length-normalised read-out of the same generative model, examined post hoc, the two have similar mean calibration error (0.201) and the generative model is better calibrated on the unseen organs, where PathJev-P remains over-confident. A supervised linear probe on a pathology foundation model is better calibrated in every setting. In a qualitative whole-slide demonstration, PathJev-P labels unsupervised tissue clusters with abstention and separates carcinoma from other tissue while running the model on a fraction of the tiles.

Psychiatric consultation requires agents to elicit discriminative evidence, map uncertain narratives to diagnostic criteria, and decide when evidence suffices. Existing dialogue and retrieval-augmented systems condition policies on raw histories or appended passages, leaving observed evidence, missing checks, differentials, and support reliability entangled. We introduce MIND, a criteria-grounded evidence-state decision interface. At each turn, MIND constructs a typed state containing observed evidence, unresolved criterion checks, active differentials, criterion-linked supports, and reliability metadata. A training-split Psychiatric Reasoning Bank supplies gated supports, turning retrieval into state construction rather than prompt injection. The same state conditions action selection, process rewards, information-gain scoring, and trajectory rectification. Under EMR-grounded simulator protocols, MIND improves accuracy by 8.8 and 7.3 points over strong inference-only, RAG, and RL baselines, with gains transferring to public MDD-5k dialogues. Matched interventions attribute these gains to the shared state rather than prompt length, retrieval text, or formatting. MIND targets screening-level decision support, not autonomous diagnosis. Code is available at https://github.com/Lingxi-mental-health/MIND.Å

Clinical AI development has traditionally followed a collaborative paradigm that depends on close interaction between clinicians and specialized AI teams. This paradigm imposes a practical challenge: clinicians must repeatedly communicate and refine their requirements with AI developers before those requirements can be translated into executable model development. This iterative process is time-consuming, and even after repeated discussion, misalignment may still exist because the two sides do not fully share each other's expertise. However, autonomous coding agents may change this paradigm, raising the possibility that clinicians could develop clinical AI models independently through natural-language interaction alone. In this study, we present such an autonomous prototype for clinician-driven clinical AI development. We evaluated the system on five clinical tasks spanning dermoscopic lesion classification, melanoma-versus-nevus triage, wrist-fracture detection (including a weakly supervised variant with only 5% bounding-box annotations), and debiased pneumothorax classification on chest radiographs. Across these settings, the system consistently developed models from clinician requests and achieved promising performance. Notably, in a debiased pneumothorax classification task on chest radiographs, where chest drains can act as a major confounder, the system successfully mitigated shortcut learning and nearly halved the model's reliance on chest drains. These findings provide proof of concept that autonomous coding agents may help shift clinical AI development toward a more clinician-driven paradigm, reducing the communication overhead and dependence on specialized AI developers. Although further validation and robustness assessment are needed, this study suggests a promising path toward making clinical AI development more accessible.

The rapid advancement of large-scale vision-language models has showcased remarkable capabilities across various tasks. However, the lack of extensive and high-quality image-text data in medicine has greatly hindered the development of large-scale medical vision-language models. In this work, we present a diagnosis-guided bootstrapping strategy that exploits both image and label information to construct vision-language datasets. Based on the constructed dataset, we developed MedDr, a generalist foundation model for healthcare capable of handling diverse medical data modalities, including radiology, pathology, dermatology, retinography, and endoscopy. Moreover, during inference, we propose a simple but effective retrieval-augmented medical diagnosis strategy, which enhances the model's generalization ability. Extensive experiments on visual question answering, medical report generation, and medical image diagnosis demonstrate the superiority of our method.

Retrieval-based factuality evaluation, where LLM-generated claims are verified against evidence from authoritative medical corpora, has become the dominant paradigm for scalable hallucination detection in high-stakes clinical settings. Despite the urgency of reliable and transparent medical fact verification, most systems measure performance with aggregate metrics like F1, which obscure where and why failures occur. Existing RAG diagnostics require gold answers or annotated gold evidence, neither of which exists in this regime. We introduce two comprehensive taxonomies, grounded in a case study on the open-ended MedExpert dataset and 3 closed-ended datasets, decomposing failures into retrieval-stage errors along five quality dimensions, and verifier-reasoning errors into six consecutive steps. We adapt an automatic pattern induction pipeline using LLM-as-Judge to label evidence quality and classify verifier reasoning errors at scale, and then stress-test our findings across 4 retrieval methods and 6 frontier verifier models. Our analysis reveals that scaling model size, adding reasoning effort, expanding to authoritative web sources, and applying medical fine-tuning do not resolve these failure modes, demonstrating that they represent fundamental limitations of the retrieve-then-verify paradigm in open-ended medical settings rather than artifacts of outdated systems. We release our code and data at https://anonymous.4open.science/r/Medical_RAG_eval-4AB5 for the full reproducibility of our results.

Controlling the COVID-19 pandemic largely hinges upon the existence of fast, safe, and highly-available diagnostic tools. Ultrasound, in contrast to CT or X-Ray, has many practical advantages and can serve as a globally-applicable first-line examination technique. We provide the largest publicly available lung ultrasound (US) dataset for COVID-19 consisting of 106 videos from three classes (COVID-19, bacterial pneumonia, and healthy controls); curated and approved by medical experts. On this dataset, we perform an in-depth study of the value of deep learning methods for differential diagnosis of COVID-19. We propose a frame-based convolutional neural network that correctly classifies COVID-19 US videos with a sensitivity of 0.98+-0.04 and a specificity of 0.91+-08 (frame-based sensitivity 0.93+-0.05, specificity 0.87+-0.07). We further employ class activation maps for the spatio-temporal localization of pulmonary biomarkers, which we subsequently validate for human-in-the-loop scenarios in a blindfolded study with medical experts. Aiming for scalability and robustness, we perform ablation studies comparing mobile-friendly, frame- and video-based architectures and show reliability of the best model by aleatoric and epistemic uncertainty estimates. We hope to pave the road for a community effort toward an accessible, efficient and interpretable screening method and we have started to work on a clinical validation of the proposed method. Data and code are publicly available.

Building upon our previous investigations of O1 replication (Part 1: Journey Learning [Qin et al., 2024] and Part 2: Distillation [Huang et al., 2024]), this work explores the potential of inference-time scaling in large language models (LLMs) for medical reasoning tasks, ranging from diagnostic decision-making to treatment planning. Through extensive experiments on medical benchmarks of varying complexity (MedQA, Medbullets, and JAMA Clinical Challenges), our investigation reveals several key insights: (1) Increasing inference time does lead to improved performance. With a modest training set of 500 samples, our model yields substantial performance improvements of 6%-11%. (2) Task complexity directly correlates with the required length of reasoning chains, confirming the necessity of extended thought processes for challenging problems. (3) The differential diagnoses generated by our model adhere to the principles of the hypothetico-deductive method, producing a list of potential conditions that may explain a patient's symptoms and systematically narrowing these possibilities by evaluating the evidence. These findings demonstrate the promising synergy between inference-time scaling and journey learning in advancing LLMs' real-world clinical reasoning capabilities.