Daily Papers

The discovery of "jailbreaks" to bypass safety filters of Large Language Models (LLMs) and harmful responses have encouraged the community to implement safety measures. One major safety measure is to proactively test the LLMs with jailbreaks prior to the release. Therefore, such testing will require a method that can generate jailbreaks massively and efficiently. In this paper, we follow a novel yet intuitive strategy to generate jailbreaks in the style of the human generation. We propose a role-playing system that assigns four different roles to the user LLMs to collaborate on new jailbreaks. Furthermore, we collect existing jailbreaks and split them into different independent characteristics using clustering frequency and semantic patterns sentence by sentence. We organize these characteristics into a knowledge graph, making them more accessible and easier to retrieve. Our system of different roles will leverage this knowledge graph to generate new jailbreaks, which have proved effective in inducing LLMs to generate unethical or guideline-violating responses. In addition, we also pioneer a setting in our system that will automatically follow the government-issued guidelines to generate jailbreaks to test whether LLMs follow the guidelines accordingly. We refer to our system as GUARD (Guideline Upholding through Adaptive Role-play Diagnostics). We have empirically validated the effectiveness of GUARD on three cutting-edge open-sourced LLMs (Vicuna-13B, LongChat-7B, and Llama-2-7B), as well as a widely-utilized commercial LLM (ChatGPT). Moreover, our work extends to the realm of vision language models (MiniGPT-v2 and Gemini Vision Pro), showcasing GUARD's versatility and contributing valuable insights for the development of safer, more reliable LLM-based applications across diverse modalities.

The National Comprehensive Cancer Network (NCCN) provides evidence-based guidelines for cancer treatment. Translating complex patient presentations into guideline-compliant treatment recommendations is time-intensive, requires specialized expertise, and is prone to error. Advances in large language model (LLM) capabilities promise to reduce the time required to generate treatment recommendations and improve accuracy. We present an LLM agent-based approach to automatically generate guideline-concordant treatment trajectories for patients with non-small cell lung cancer (NSCLC). Our contributions are threefold. First, we construct a novel longitudinal dataset of 121 cases of NSCLC patients that includes clinical encounters, diagnostic results, and medical histories, each expertly annotated with the corresponding NCCN guideline trajectories by board-certified oncologists. Second, we demonstrate that existing LLMs possess domain-specific knowledge that enables high-quality proxy benchmark generation for both model development and evaluation, achieving strong correlation (Spearman coefficient r=0.88, RMSE = 0.08) with expert-annotated benchmarks. Third, we develop a hybrid approach combining expensive human annotations with model consistency information to create both the agent framework that predicts the relevant guidelines for a patient, as well as a meta-classifier that verifies prediction accuracy with calibrated confidence scores for treatment recommendations (AUROC=0.800), a critical capability for communicating the accuracy of outputs, custom-tailoring tradeoffs in performance, and supporting regulatory compliance. This work establishes a framework for clinically viable LLM-based guideline adherence systems that balance accuracy, interpretability, and regulatory requirements while reducing annotation costs, providing a scalable pathway toward automated clinical decision support.

Sepsis management in the ICU requires sequential treatment decisions under rapidly evolving patient physiology. Although large language models (LLMs) encode broad clinical knowledge and can reason over guidelines, they are not inherently grounded in action-conditioned patient dynamics. We introduce SepsisAgent, a world model-augmented LLM agent for sepsis treatment recommendation. SepsisAgent uses a learned Clinical World Model to simulate patient responses under candidate fluid--vasopressor interventions, and follows a propose--simulate--refine workflow before committing to a prescription. We first show that world-model access alone yields inconsistent LLM decision performance, motivating agent-specific training. We then train SepsisAgent through a three-stage curriculum: patient-dynamics supervised fine-tuning, propose--simulate--refine behavior cloning, and world-model-based agentic reinforcement learning. On MIMIC-IV sepsis trajectories, SepsisAgent outperforms all traditional RL and LLM-based baselines in off-policy value while achieving the best safety profile under guideline adherence and unsafe-action metrics. Further analysis shows that repeated interaction with the Clinical World Model enables the agent to learn regularities in patient evolution, which remain useful even when simulator access is removed.

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

The rise of Large Language Models (LLMs) has streamlined frontend interface creation through tools like Vercel's V0, yet surfaced challenges in design quality (e.g., accessibility, and usability). Current solutions, often limited by their focus, generalisability, or data dependency, fall short in addressing these complexities. Moreover, none of them examine the quality of LLM-generated UI design. In this work, we introduce DesignRepair, a novel dual-stream design guideline-aware system to examine and repair the UI design quality issues from both code aspect and rendered page aspect. We utilised the mature and popular Material Design as our knowledge base to guide this process. Specifically, we first constructed a comprehensive knowledge base encoding Google's Material Design principles into low-level component knowledge base and high-level system design knowledge base. After that, DesignRepair employs a LLM for the extraction of key components and utilizes the Playwright tool for precise page analysis, aligning these with the established knowledge bases. Finally, we integrate Retrieval-Augmented Generation with state-of-the-art LLMs like GPT-4 to holistically refine and repair frontend code through a strategic divide and conquer approach. Our extensive evaluations validated the efficacy and utility of our approach, demonstrating significant enhancements in adherence to design guidelines, accessibility, and user experience metrics.

Ensuring alignment, which refers to making models behave in accordance with human intentions [1,2], has become a critical task before deploying large language models (LLMs) in real-world applications. For instance, OpenAI devoted six months to iteratively aligning GPT-4 before its release [3]. However, a major challenge faced by practitioners is the lack of clear guidance on evaluating whether LLM outputs align with social norms, values, and regulations. This obstacle hinders systematic iteration and deployment of LLMs. To address this issue, this paper presents a comprehensive survey of key dimensions that are crucial to consider when assessing LLM trustworthiness. The survey covers seven major categories of LLM trustworthiness: reliability, safety, fairness, resistance to misuse, explainability and reasoning, adherence to social norms, and robustness. Each major category is further divided into several sub-categories, resulting in a total of 29 sub-categories. Additionally, a subset of 8 sub-categories is selected for further investigation, where corresponding measurement studies are designed and conducted on several widely-used LLMs. The measurement results indicate that, in general, more aligned models tend to perform better in terms of overall trustworthiness. However, the effectiveness of alignment varies across the different trustworthiness categories considered. This highlights the importance of conducting more fine-grained analyses, testing, and making continuous improvements on LLM alignment. By shedding light on these key dimensions of LLM trustworthiness, this paper aims to provide valuable insights and guidance to practitioners in the field. Understanding and addressing these concerns will be crucial in achieving reliable and ethically sound deployment of LLMs in various applications.

We propose Self-Control, a novel method utilizing suffix gradients to control the behavior of large language models (LLMs) without explicit human annotations. Given a guideline expressed in suffix string and the model's self-assessment of adherence, Self-Control computes the gradient of this self-judgment concerning the model's hidden states, directly influencing the auto-regressive generation process towards desired behaviors. To enhance efficiency, we introduce Self-Control_{prefix}, a compact module that encapsulates the learned representations from suffix gradients into a Prefix Controller, facilitating inference-time control for various LLM behaviors. Our experiments demonstrate Self-Control's efficacy across multiple domains, including emotional modulation, ensuring harmlessness, and enhancing complex reasoning. Especially, Self-Control_{prefix} enables a plug-and-play control and jointly controls multiple attributes, improving model outputs without altering model parameters or increasing inference-time costs.

This paper shows that alignment methods can achieve superior adherence to guardrails compared to instruction fine-tuning alone in conversational agents, also known as bots, within predefined guidelines or 'guardrails'. It examines traditional training approaches such as instruction fine-tuning and the recent advancements in direct alignment methods like Identity Preference Optimization (IPO), and Kahneman-Tversky Optimization (KTO). The effectiveness of alignment techniques both pre and post-instruction tuning is highlighted, illustrating their potential to optimize conversational bots in domains that require strict adherence to specified rules, such as customer care.

Adherence to prescribed treatments is crucial for individuals with chronic conditions to avoid costly or adverse health outcomes. For certain patient groups, intensive lifestyle interventions are vital for enhancing medication adherence. Accurate forecasting of treatment adherence can open pathways to developing an on-demand intervention tool, enabling timely and personalized support. With the increasing popularity of smartphones and wearables, it is now easier than ever to develop and deploy smart activity monitoring systems. However, effective forecasting systems for treatment adherence based on wearable sensors are still not widely available. We close this gap by proposing Adherence Forecasting and Intervention with Machine Intelligence (AIMI). AIMI is a knowledge-guided adherence forecasting system that leverages smartphone sensors and previous medication history to estimate the likelihood of forgetting to take a prescribed medication. A user study was conducted with 27 participants who took daily medications to manage their cardiovascular diseases. We designed and developed CNN and LSTM-based forecasting models with various combinations of input features and found that LSTM models can forecast medication adherence with an accuracy of 0.932 and an F-1 score of 0.936. Moreover, through a series of ablation studies involving convolutional and recurrent neural network architectures, we demonstrate that leveraging known knowledge about future and personalized training enhances the accuracy of medication adherence forecasting. Code available: https://github.com/ab9mamun/AIMI.

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

Large Language Models (LLMs) exhibit impressive capabilities but also present risks such as biased content generation and privacy issues. One of the current alignment techniques includes principle-driven integration, but it faces challenges arising from the imprecision of manually crafted rules and inadequate risk perception in models without safety training. To address these, we introduce Guide-Align, a two-stage approach. Initially, a safety-trained model identifies potential risks and formulates specific guidelines for various inputs, establishing a comprehensive library of guidelines and a model for input-guidelines retrieval. Subsequently, the retrieval model correlates new inputs with relevant guidelines, which guide LLMs in response generation to ensure safe and high-quality outputs, thereby aligning with human values. An additional optional stage involves fine-tuning a model with well-aligned datasets generated through the process implemented in the second stage. Our method customizes guidelines to accommodate diverse inputs, thereby enhancing the fine-grainedness and comprehensiveness of the guideline library. Furthermore, it incorporates safety expertise from a safety-trained LLM through a lightweight retrieval model. We evaluate our approach on three benchmarks, demonstrating significant improvements in LLM security and quality. Notably, our fine-tuned model, Labrador, even at 13 billion parameters, outperforms GPT-3.5-turbo and surpasses GPT-4 in alignment capabilities.

Large Language Models (LLMs) have great potential in the field of health care, yet they face great challenges in adapting to rapidly evolving medical knowledge. This can lead to outdated or contradictory treatment suggestions. This study investigated how LLMs respond to evolving clinical guidelines, focusing on concept drift and internal inconsistencies. We developed the DriftMedQA benchmark to simulate guideline evolution and assessed the temporal reliability of various LLMs. Our evaluation of seven state-of-the-art models across 4,290 scenarios demonstrated difficulties in rejecting outdated recommendations and frequently endorsing conflicting guidance. Additionally, we explored two mitigation strategies: Retrieval-Augmented Generation and preference fine-tuning via Direct Preference Optimization. While each method improved model performance, their combination led to the most consistent and reliable results. These findings underscore the need to improve LLM robustness to temporal shifts to ensure more dependable applications in clinical practice.

Large Language Models (LLMs) have shown remarkable capabilities as AI agents. However, existing methods for enhancing LLM-agent abilities often lack a focus on data quality, leading to inefficiencies and suboptimal results in both fine-tuning and prompt engineering. To address this issue, we introduce EDGE, a novel approach for identifying informative samples without needing golden answers. We propose the Guideline Effectiveness (GE) metric, which selects challenging samples by measuring the impact of human-provided guidelines in multi-turn interaction tasks. A low GE score indicates that the human expertise required for a sample is missing from the guideline, making the sample more informative. By selecting samples with low GE scores, we can improve the efficiency and outcomes of both prompt engineering and fine-tuning processes for LLMs. Extensive experiments validate the performance of our method. Our method achieves competitive results on the HotpotQA and WebShop and datasets, requiring 75\% and 50\% less data, respectively, while outperforming existing methods. We also provide a fresh perspective on the data quality of LLM-agent fine-tuning.

Large language models (LLMs) are typically aligned to a universal set of safety and usage principles intended for broad public acceptability. Yet, real-world applications of LLMs often take place within organizational ecosystems shaped by distinctive corporate policies, regulatory requirements, use cases, brand guidelines, and ethical commitments. This reality highlights the need for rigorous and comprehensive evaluation of LLMs with pluralistic alignment goals, an alignment paradigm that emphasizes adaptability to diverse user values and needs. In this work, we present PLURALISTIC BEHAVIOR SUITE (PBSUITE), a dynamic evaluation suite designed to systematically assess LLMs' capacity to adhere to pluralistic alignment specifications in multi-turn, interactive conversations. PBSUITE consists of (1) a diverse dataset of 300 realistic LLM behavioral policies, grounded in 30 industries; and (2) a dynamic evaluation framework for stress-testing model compliance with custom behavioral specifications under adversarial conditions. Using PBSUITE, We find that leading open- and closed-source LLMs maintain robust adherence to behavioral policies in single-turn settings (less than 4% failure rates), but their compliance weakens substantially in multi-turn adversarial interactions (up to 84% failure rates). These findings highlight that existing model alignment and safety moderation methods fall short in coherently enforcing pluralistic behavioral policies in real-world LLM interactions. Our work contributes both the dataset and analytical framework to support future research toward robust and context-aware pluralistic alignment techniques.

Large Language Models, particularly decoder-only generative models such as GPT, are increasingly used to automate Software Engineering tasks. These models are primarily guided through natural language prompts, making prompt engineering a critical factor in system performance and behavior. Despite their growing role in SE research, prompt-related decisions are rarely documented in a systematic or transparent manner, hindering reproducibility and comparability across studies. To address this gap, we conducted a two-phase empirical study. First, we analyzed nearly 300 papers published at the top-3 SE conferences since 2022 to assess how prompt design, testing, and optimization are currently reported. Second, we surveyed 105 program committee members from these conferences to capture their expectations for prompt reporting in LLM-driven research. Based on the findings, we derived a structured guideline that distinguishes essential, desirable, and exceptional reporting elements. Our results reveal significant misalignment between current practices and reviewer expectations, particularly regarding version disclosure, prompt justification, and threats to validity. We present our guideline as a step toward improving transparency, reproducibility, and methodological rigor in LLM-based SE research.

Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like responses across diverse contexts and adapting to novel tasks following human instructions. Their potential application spans a broad range of medical tasks, such as clinical documentation, matching patients to clinical trials, and answering medical questions. In this primer paper, we propose an actionable guideline to help healthcare professionals more efficiently utilize LLMs in their work, along with a set of best practices. This approach consists of several main phases, including formulating the task, choosing LLMs, prompt engineering, fine-tuning, and deployment. We start with the discussion of critical considerations in identifying healthcare tasks that align with the core capabilities of LLMs and selecting models based on the selected task and data, performance requirements, and model interface. We then review the strategies, such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized medical tasks. Deployment considerations, including regulatory compliance, ethical guidelines, and continuous monitoring for fairness and bias, are also discussed. By providing a structured step-by-step methodology, this tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.

This study quantifies the association between non-adherence to antipsychotic medications and adverse outcomes in individuals with schizophrenia. We frame the problem using survival analysis, focusing on the time to the earliest of several adverse events (early death, involuntary hospitalization, jail booking). We extend standard causal inference methods (T-learner, S-learner, nearest neighbor matching) to utilize various survival models to estimate individual and average treatment effects, where treatment corresponds to medication non-adherence. Analyses are repeated using different amounts of longitudinal information (3, 6, 9, and 12 months). Using data from Allegheny County in western Pennsylvania, we find strong evidence that non-adherence advances adverse outcomes by approximately 1 to 4 months. Ablation studies confirm that county-provided risk scores adjust for key confounders, as their removal amplifies the estimated effects. Subgroup analyses by medication formulation (injectable vs. oral) and medication type consistently show that non-adherence is associated with earlier adverse events. These findings highlight the clinical importance of adherence in delaying psychiatric crises and show that integrating survival analysis with causal inference tools can yield policy-relevant insights. We caution that although we apply causal inference, we only make associative claims and discuss assumptions needed for causal interpretation.

Background: Large language models (LLMs) are trained to follow directions, but this introduces a vulnerability to blindly comply with user requests even if they generate wrong information. In medicine, this could accelerate the generation of misinformation that impacts human well-being. Objectives/Methods: We analyzed compliance to requests to generate misleading content about medications in settings where models know the request is illogical. We investigated whether in-context directions and instruction-tuning of LLMs to prioritize logical reasoning over compliance reduced misinformation risk. Results: While all frontier LLMs complied with misinformation requests, both prompt-based and parameter-based approaches can improve the detection of logic flaws in requests and prevent the dissemination of medical misinformation. Conclusion: Shifting LLMs to prioritize logic over compliance could reduce risks of exploitation for medical misinformation.

We introduce the Agent GPA (Goal-Plan-Action) framework: an evaluation paradigm based on an agent's operational loop of setting goals, devising plans, and executing actions. The framework includes five evaluation metrics: Goal Fulfillment, Logical Consistency, Execution Efficiency, Plan Quality, and Plan Adherence. Logical Consistency checks that an agent's actions are consistent with its prior actions. Execution Efficiency checks whether the agent executes in the most efficient way to achieve its goal. Plan Quality checks whether an agent's plans are aligned with its goals; Plan Adherence checks if an agent's actions are aligned with its plan; and Goal Fulfillment checks that agent's final outcomes match the stated goals. Our experimental results on two benchmark datasets - the public TRAIL/GAIA dataset and an internal dataset for a production-grade data agent - show that this framework (a) provides a systematic way to cover a broad range of agent failures, including all agent errors on the TRAIL/GAIA benchmark dataset; (b) supports LLM-judges that exhibit strong agreement with human annotation, covering 80% to over 95% errors; and (c) localizes errors with 86% agreement to enable targeted improvement of agent performance.

With the growing reliance on artificial intelligence (AI) for many different applications, the sharing of code, data, and models is important to ensure the replicability and democratization of scientific knowledge. Many high-profile academic publishing venues expect code and models to be submitted and released with papers. Furthermore, developers often want to release these assets to encourage development of technology that leverages their frameworks and services. A number of organizations have expressed concerns about the inappropriate or irresponsible use of AI and have proposed ethical guidelines around the application of such systems. While such guidelines can help set norms and shape policy, they are not easily enforceable. In this paper, we advocate the use of licensing to enable legally enforceable behavioral use conditions on software and code and provide several case studies that demonstrate the feasibility of behavioral use licensing. We envision how licensing may be implemented in accordance with existing responsible AI guidelines.

With the introduction of ChatGPT, Large Language Models (LLMs) have received enormous attention in healthcare. Despite their potential benefits, researchers have underscored various ethical implications. While individual instances have drawn much attention, the debate lacks a systematic overview of practical applications currently researched and ethical issues connected to them. Against this background, this work aims to map the ethical landscape surrounding the current stage of deployment of LLMs in medicine and healthcare. Electronic databases and preprint servers were queried using a comprehensive search strategy. Studies were screened and extracted following a modified rapid review approach. Methodological quality was assessed using a hybrid approach. For 53 records, a meta-aggregative synthesis was performed. Four fields of applications emerged and testify to a vivid exploration phase. Advantages of using LLMs are attributed to their capacity in data analysis, personalized information provisioning, support in decision-making, mitigating information loss and enhancing information accessibility. However, we also identifies recurrent ethical concerns connected to fairness, bias, non-maleficence, transparency, and privacy. A distinctive concern is the tendency to produce harmful misinformation or convincingly but inaccurate content. A recurrent plea for ethical guidance and human oversight is evident. Given the variety of use cases, it is suggested that the ethical guidance debate be reframed to focus on defining what constitutes acceptable human oversight across the spectrum of applications. This involves considering diverse settings, varying potentials for harm, and different acceptable thresholds for performance and certainty in healthcare. In addition, a critical inquiry is necessary to determine the extent to which the current experimental use of LLMs is necessary and justified.

Large language models (LLMs) have shown impressive capabilities in natural language processing tasks, including dialogue generation. This research aims to conduct a novel comparative analysis of two prominent techniques, fine-tuning with LoRA (Low-Rank Adaptation) and the Retrieval-Augmented Generation (RAG) framework, in the context of doctor-patient chat conversations with multiple datasets of mixed medical domains. The analysis involves three state-of-the-art models: Llama-2, GPT, and the LSTM model. Employing real-world doctor-patient dialogues, we comprehensively evaluate the performance of models, assessing key metrics such as language quality (perplexity, BLEU score), factual accuracy (fact-checking against medical knowledge bases), adherence to medical guidelines, and overall human judgments (coherence, empathy, safety). The findings provide insights into the strengths and limitations of each approach, shedding light on their suitability for healthcare applications. Furthermore, the research investigates the robustness of the models in handling diverse patient queries, ranging from general health inquiries to specific medical conditions. The impact of domain-specific knowledge integration is also explored, highlighting the potential for enhancing LLM performance through targeted data augmentation and retrieval strategies.

Current approaches to AI compliance treat conformity as a binary, audit-time verdict rather than a continuous, measurable property of production systems. We argue that this compliance fiction is structurally ill-suited to the requirements of the EU AI Act, which demands ongoing human oversight and the detection of emergent behavioural drift in deployed systems. We introduce governance from metrics, a principle whereby regulatory compliance is derived as a continuous signal from runtime observability rather than from static assessments. Building on this principle, we present govllm, an open-source framework implementing a governance-driven routing architecture in which model selection is determined by accumulated compliance scores rather than by latency or cost alone. Central to our approach is a panel of regulatory judges - LLM evaluators specialised per criterion (EU AI Act, GDPR, ANSSI, accessibility) - whose inter-judge disagreement we reframe not as noise but as a regulatory uncertainty signal warranting human arbitration. We validate this approach through a ground truth corpus of 49 annotated prompt/response pairs across five regulatory criteria, evaluated by four small language models (SLMs, 1.7B-7B parameters) running fully on-premise. Agreement rates range from 51.5% (mistral:7b) to 69.1% (phi4-mini), with no single model dominating across all criteria - empirically motivating the Profile-as-jury design. We further document three structural failure modes in small regulatory judges and a judge-specific position bias that degrades agreement by up to 25 percentage points across three question-order conditions (original, reversed, permuted). govllm is released as open-source software to support reproducible AI governance research.

Deploying Large Language Models (LLMs) for regulatory compliance demands rigorous traceability via comprehensive citations across multi-tiered authority structures. Unlike traditional multi-hop or legal QA, this task requires structured procedural lookups and evidence-set closure rather than entity resolution or case-law reasoning. Existing RAG systems struggle here due to flattened citation edges, fragmented retrieval expansions, and fragile post-hoc attribution. We formalize Regulatory Compliance QA with RegOps-Bench, a novel benchmark featuring an Operational Knowledge Graph derived from complex national R\&D regulations. To address these bottlenecks, we propose RefWalk, a unified framework driven by a shared topic anchor. RefWalk traverses cross-document citations, fuses multi-view candidates via max-based aggregation, and enforces per-rule attribution to explicitly map claims to sources. We establish a strong baseline with substantial improvements in retrieval recall and citation accuracy. Finally, a contrastive evaluation on a U.S. health compliance dataset (HIPAA) reveals that existing systems exhibit saturation on flat-structure rules, underscoring the need for RegOps-Bench. Our code is available at https://github.com/yeongjoonJu/RefWalk.

With the advent of Large Language Models (LLMs), medical artificial intelligence (AI) has experienced substantial technological progress and paradigm shifts, highlighting the potential of LLMs to streamline healthcare delivery and improve patient outcomes. Considering this rapid technical progress, in this survey, we trace the recent advances of Medical Large Language Models (Med-LLMs), including the background, key findings, and mainstream techniques, especially for the evolution from general-purpose models to medical-specialized applications. Firstly, we delve into the foundational technology of Med-LLMs, indicating how general models can be progressively adapted and refined for the complicated medical tasks. Secondly, the wide-ranging applications of Med-LLMs are investigated across various healthcare domains, as well as an up-to-date review of existing Med-LLMs. The transformative impact of these models on daily medical practice is evident through their ability to assist clinicians, educators, and patients. Recognizing the importance of responsible innovation, we discuss the challenges associated with ensuring fairness, accountability, privacy, and robustness. Ethical considerations, rigorous evaluation methodologies, and the establishment of regulatory frameworks are crucial for building trustworthiness in the real-world system. We emphasize the need for ongoing scrutiny and development to maintain high standards of safety and reliability. Finally, we anticipate possible future trajectories for Med-LLMs, identifying key avenues for prudent expansion. By consolidating these insights, our review aims to provide professionals and researchers with a thorough understanding of the strengths and limitations of Med-LLMs, fostering a balanced and ethical approach to their integration into the healthcare ecosystem.

Although large language models (LLMs) demonstrate expert-level medical knowledge, aligning their open-ended outputs with fine-grained clinician preferences remains challenging. Existing methods often rely on coarse objectives or unreliable automated judges that are weakly grounded in professional guidelines. We propose a two-stage framework to address this gap. First, we introduce HealthRubrics, a dataset of 7,034 physician-verified preference examples in which clinicians refine LLM-drafted rubrics to meet rigorous medical standards. Second, we distill these rubrics into HealthPrinciples: 119 broadly reusable, clinically grounded principles organized by clinical dimensions, enabling scalable supervision beyond manual annotation. We use HealthPrinciples for (1) offline alignment by synthesizing rubrics for unlabeled queries and (2) an inference-time tool for guided self-revision. A 30B parameter model that activates only 3B parameters at inference trained with our framework achieves 33.4% on HealthBench-Hard, outperforming much larger models including Deepseek-R1 and o3, establishing a resource-efficient baseline for clinical alignment.

The recommendation of medication is a vital aspect of intelligent healthcare systems, as it involves prescribing the most suitable drugs based on a patient's specific health needs. Unfortunately, many sophisticated models currently in use tend to overlook the nuanced semantics of medical data, while only relying heavily on identities. Furthermore, these models face significant challenges in handling cases involving patients who are visiting the hospital for the first time, as they lack prior prescription histories to draw upon. To tackle these issues, we harness the powerful semantic comprehension and input-agnostic characteristics of Large Language Models (LLMs). Our research aims to transform existing medication recommendation methodologies using LLMs. In this paper, we introduce a novel approach called Large Language Model Distilling Medication Recommendation (LEADER). We begin by creating appropriate prompt templates that enable LLMs to suggest medications effectively. However, the straightforward integration of LLMs into recommender systems leads to an out-of-corpus issue specific to drugs. We handle it by adapting the LLMs with a novel output layer and a refined tuning loss function. Although LLM-based models exhibit remarkable capabilities, they are plagued by high computational costs during inference, which is impractical for the healthcare sector. To mitigate this, we have developed a feature-level knowledge distillation technique, which transfers the LLM's proficiency to a more compact model. Extensive experiments conducted on two real-world datasets, MIMIC-III and MIMIC-IV, demonstrate that our proposed model not only delivers effective results but also is efficient. To ease the reproducibility of our experiments, we release the implementation code online.

Large Language Models (LLMs) are fluent but prone to hallucinations, producing answers that appear plausible yet are unsupported by available evidence. This failure is especially problematic in high-stakes domains where decisions must be justified by verifiable information. We introduce EvidenceRL, a reinforcement learning framework that enforces evidence adherence during training. EvidenceRL scores candidate responses for grounding (entailment with retrieved evidence and context) and correctness (agreement with reference answers) and optimizes the generator using Group Relative Policy Optimization (GRPO). We evaluate across two high-stakes domains, cardiac diagnosis and legal reasoning, where EvidenceRL consistently improves evidence grounding and faithfulness without sacrificing task accuracy. On cardiac diagnosis, F1@3 increases from 37.0 to 54.5 on Llama-3.2-3B while grounding (G_{max}@3) rises from 47.6 to 78.2; hallucinations drop nearly 5times and evidence-supported diagnoses increase from 31.8\% to 61.6\%. On legal reasoning, EvidenceRL raises Faithfulness from 32.8\% to 67.6\% on Llama-3.1-8B, demonstrating consistent behavioral change across domains. Our code is open-sourced at https://github.com/Wizaaard/EvidenceRL.git.

People increasingly seek personal advice from large language models (LLMs), yet whether humans follow their advice, and its consequences for their well-being, remains unknown. In a longitudinal randomised controlled trial with a representative UK sample (N = 2,302), 75% of participants who had a 20-minute discussion with GPT-4o about health, careers or relationships subsequently reported following its advice. Based on autograder evaluations of chat transcripts, LLM advice rarely violated safety best practice. When queried 2-3 weeks later, participants who had interacted with personalised AI (with access to detailed user information) followed its advice more often in the real world and reported higher well-being than those advised by non-personalised AI. However, while receiving personal advice from AI temporarily reduced well-being, no differential long-term effects compared to a control emerged. Our results suggest that humans readily follow LLM advice about personal issues but doing so shows no additional well-being benefit over casual conversations.

The development of Artificial Intelligence (AI), including AI in Science (AIS), should be done following the principles of responsible AI. Progress in responsible AI is often quantified through evaluation metrics, yet there has been less work on assessing the robustness and reliability of the metrics themselves. We reflect on prior work that examines the robustness of fairness metrics for recommender systems as a type of AI application and summarise their key takeaways into a set of non-exhaustive guidelines for developing reliable metrics of responsible AI. Our guidelines apply to a broad spectrum of AI applications, including AIS.

While large language models (LLMs) have shown promise in diagnostic dialogue, their capabilities for effective management reasoning - including disease progression, therapeutic response, and safe medication prescription - remain under-explored. We advance the previously demonstrated diagnostic capabilities of the Articulate Medical Intelligence Explorer (AMIE) through a new LLM-based agentic system optimised for clinical management and dialogue, incorporating reasoning over the evolution of disease and multiple patient visit encounters, response to therapy, and professional competence in medication prescription. To ground its reasoning in authoritative clinical knowledge, AMIE leverages Gemini's long-context capabilities, combining in-context retrieval with structured reasoning to align its output with relevant and up-to-date clinical practice guidelines and drug formularies. In a randomized, blinded virtual Objective Structured Clinical Examination (OSCE) study, AMIE was compared to 21 primary care physicians (PCPs) across 100 multi-visit case scenarios designed to reflect UK NICE Guidance and BMJ Best Practice guidelines. AMIE was non-inferior to PCPs in management reasoning as assessed by specialist physicians and scored better in both preciseness of treatments and investigations, and in its alignment with and grounding of management plans in clinical guidelines. To benchmark medication reasoning, we developed RxQA, a multiple-choice question benchmark derived from two national drug formularies (US, UK) and validated by board-certified pharmacists. While AMIE and PCPs both benefited from the ability to access external drug information, AMIE outperformed PCPs on higher difficulty questions. While further research would be needed before real-world translation, AMIE's strong performance across evaluations marks a significant step towards conversational AI as a tool in disease management.

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

Large language models (LLMs) are increasingly used in clinical and care settings. This exploratory study investigates whether LLMs exhibit sycophantic behavior - adapting their responses to social expectation signals rather than maintaining professional quality - in the context of dementia care. Five prompts with systematically increasing confirmatory and authority-related framing (P1 neutral to P5 authority-signaled implementation support) were submitted to four LLMs (GPT-5, Claude Sonnet 4.6, Gemini 3.1 Pro, Mistral Large), each repeated five times (N = 100 responses). Responses were evaluated using an LLM-as-a-Judge methodology against seven nursing-ethical quality criteria (K1-K7) and a tone scale (0-3). All models showed significant negative Spearman correlations between prompt level and response quality (rho ranging from -0.543 to -0.734, all p < 0.01). Mistral Large exhibited the most pronounced effect (rho = -0.734), with mean scores dropping from 6.0/7 at P1 to 0.2/7 at P5. The findings suggest that LLMs pose context-sensitive risks in high-stakes care environments and that prompt framing significantly shapes response quality - a dimension that has received insufficient attention in healthcare AI deployment.

The scholarly publishing ecosystem faces a dual crisis of unmanageable submission volumes and unregulated AI, creating an urgent need for new governance models to safeguard scientific integrity. The traditional human-only peer review regime lacks a scalable, objective benchmark, making editorial processes opaque and difficult to audit. Here we investigate a deterministic simulation framework that provides the first stable, evidence-based standard for evaluating AI-generated peer review reports. Analyzing 352 peer-review simulation reports, we identify consistent system state indicators that demonstrate its reliability. First, the system is able to simulate calibrated editorial judgment, with 'Revise' decisions consistently forming the majority outcome (>50%) across all disciplines, while 'Reject' rates dynamically adapt to field-specific norms, rising to 45% in Health Sciences. Second, it maintains unwavering procedural integrity, enforcing a stable 29% evidence-anchoring compliance rate that remains invariant across diverse review tasks and scientific domains. These findings demonstrate a system that is predictably rule-bound, mitigating the stochasticity of generative AI. For the scientific community, this provides a transparent tool to ensure fairness; for publishing strategists, it offers a scalable instrument for auditing workflows, managing integrity risks, and implementing evidence-based governance. The framework repositions AI as an essential component of institutional accountability, providing the critical infrastructure to maintain trust in scholarly communication.

Policy compliance assessment is a fundamental task of evaluating whether an input case strictly complies with a set of human-defined rules, more generally known as policies. In practice, human experts follow a systematic, step-by-step process to identify violations with respect to specific stipulations outlined in the policy. However, such documentation of gold-standard, expert-level reasoning processes is costly to acquire. In this paper, we introduce Policy Reasoning Traces (PRT), a form of specialized generated reasoning chains that serve as a reasoning bridge to improve an LLM's policy compliance assessment capabilities. Our empirical evaluations demonstrate that the use of PRTs for both inference-time and training-time scenarios significantly enhances the performance of open-weight and commercial models, setting a new state-of-the-art for HIPAA and GDPR policies. Beyond accuracy gains, we also highlight how PRTs can improve an LLM's ability to accurately cite policy clauses, as well as influence compliance decisions through their high utilization from the raw chains of thought.

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

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

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

As large language models are deployed in high-stakes enterprise applications, from healthcare to finance, ensuring adherence to organization-specific policies has become essential. Yet existing safety evaluations focus exclusively on universal harms. We present COMPASS (Company/Organization Policy Alignment Assessment), the first systematic framework for evaluating whether LLMs comply with organizational allowlist and denylist policies. We apply COMPASS to eight diverse industry scenarios, generating and validating 5,920 queries that test both routine compliance and adversarial robustness through strategically designed edge cases. Evaluating seven state-of-the-art models, we uncover a fundamental asymmetry: models reliably handle legitimate requests (>95% accuracy) but catastrophically fail at enforcing prohibitions, refusing only 13-40% of adversarial denylist violations. These results demonstrate that current LLMs lack the robustness required for policy-critical deployments, establishing COMPASS as an essential evaluation framework for organizational AI safety.

Understanding causal narratives communicated in clinical notes can help make strides towards personalized healthcare. Extracted causal information from clinical notes can be combined with structured EHR data such as patients' demographics, diagnoses, and medications. This will enhance healthcare providers' ability to identify aspects of a patient's story communicated in the clinical notes and help make more informed decisions. In this work, we propose annotation guidelines, develop an annotated corpus and provide baseline scores to identify types and direction of causal relations between a pair of biomedical concepts in clinical notes; communicated implicitly or explicitly, identified either in a single sentence or across multiple sentences. We annotate a total of 2714 de-identified examples sampled from the 2018 n2c2 shared task dataset and train four different language model based architectures. Annotation based on our guidelines achieved a high inter-annotator agreement i.e. Fleiss' kappa (kappa) score of 0.72, and our model for identification of causal relations achieved a macro F1 score of 0.56 on the test data. The high inter-annotator agreement for clinical text shows the quality of our annotation guidelines while the provided baseline F1 score sets the direction for future research towards understanding narratives in clinical texts.

Machine learning (ML) approaches have demonstrated promising results in a wide range of healthcare applications. Data plays a crucial role in developing ML-based healthcare systems that directly affect people's lives. Many of the ethical issues surrounding the use of ML in healthcare stem from structural inequalities underlying the way we collect, use, and handle data. Developing guidelines to improve documentation practices regarding the creation, use, and maintenance of ML healthcare datasets is therefore of critical importance. In this work, we introduce Healthsheet, a contextualized adaptation of the original datasheet questionnaire ~gebru2018datasheets for health-specific applications. Through a series of semi-structured interviews, we adapt the datasheets for healthcare data documentation. As part of the Healthsheet development process and to understand the obstacles researchers face in creating datasheets, we worked with three publicly-available healthcare datasets as our case studies, each with different types of structured data: Electronic health Records (EHR), clinical trial study data, and smartphone-based performance outcome measures. Our findings from the interviewee study and case studies show 1) that datasheets should be contextualized for healthcare, 2) that despite incentives to adopt accountability practices such as datasheets, there is a lack of consistency in the broader use of these practices 3) how the ML for health community views datasheets and particularly Healthsheets as diagnostic tool to surface the limitations and strength of datasets and 4) the relative importance of different fields in the datasheet to healthcare concerns.

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

Instruction-tuned large language models (LLMs) excel at many tasks, and will even provide explanations for their behavior. Since these models are directly accessible to the public, there is a risk that convincing and wrong explanations can lead to unsupported confidence in LLMs. Therefore, interpretability-faithfulness of self-explanations is an important consideration for AI Safety. Assessing the interpretability-faithfulness of these explanations, termed self-explanations, is challenging as the models are too complex for humans to annotate what is a correct explanation. To address this, we propose employing self-consistency checks as a measure of faithfulness. For example, if an LLM says a set of words is important for making a prediction, then it should not be able to make the same prediction without these words. While self-consistency checks are a common approach to faithfulness, they have not previously been applied to LLM's self-explanations. We apply self-consistency checks to three types of self-explanations: counterfactuals, importance measures, and redactions. Our work demonstrate that faithfulness is both task and model dependent, e.g., for sentiment classification, counterfactual explanations are more faithful for Llama2, importance measures for Mistral, and redaction for Falcon 40B. Finally, our findings are robust to prompt-variations.

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

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

As large language models (LLMs) become primary sources of health information for millions, their accuracy in women's health remains critically unexamined. We introduce the Women's Health Benchmark (WHB), the first benchmark evaluating LLM performance specifically in women's health. Our benchmark comprises 96 rigorously validated model stumps covering five medical specialties (obstetrics and gynecology, emergency medicine, primary care, oncology, and neurology), three query types (patient query, clinician query, and evidence/policy query), and eight error types (dosage/medication errors, missing critical information, outdated guidelines/treatment recommendations, incorrect treatment advice, incorrect factual information, missing/incorrect differential diagnosis, missed urgency, and inappropriate recommendations). We evaluated 13 state-of-the-art LLMs and revealed alarming gaps: current models show approximately 60\% failure rates on the women's health benchmark, with performance varying dramatically across specialties and error types. Notably, models universally struggle with "missed urgency" indicators, while newer models like GPT-5 show significant improvements in avoiding inappropriate recommendations. Our findings underscore that AI chatbots are not yet fully able of providing reliable advice in women's health.

Finding relevant literature underpins the practice of evidence-based medicine. From 2014 to 2016, TREC conducted a clinical decision support track, wherein participants were tasked with finding articles relevant to clinical questions posed by physicians. In total, 87 teams have participated over the past three years, generating 395 runs. During this period, each team has trialled a variety of methods. While there was significant overlap in the methods employed by different teams, the results were varied. Due to the diversity of the platforms used, the results arising from the different techniques are not directly comparable, reducing the ability to build on previous work. By using a stable platform, we have been able to compare different document and query processing techniques, allowing us to experiment with different search parameters. We have used our system to reproduce leading teams runs, and compare the results obtained. By benchmarking our indexing and search techniques, we can statistically test a variety of hypotheses, paving the way for further research.

Large-language models have recently demonstrated impressive zero-shot capabilities in a variety of natural language tasks such as summarization, dialogue generation, and question-answering. Despite many promising applications in clinical medicine, adoption of these models in real-world settings has been largely limited by their tendency to generate incorrect and sometimes even toxic statements. In this study, we develop Almanac, a large language model framework augmented with retrieval capabilities for medical guideline and treatment recommendations. Performance on a novel dataset of clinical scenarios (n = 130) evaluated by a panel of 5 board-certified and resident physicians demonstrates significant increases in factuality (mean of 18% at p-value < 0.05) across all specialties, with improvements in completeness and safety. Our results demonstrate the potential for large language models to be effective tools in the clinical decision-making process, while also emphasizing the importance of careful testing and deployment to mitigate their shortcomings.

Corruption studies, the primary tool for evaluating chain-of-thought (CoT) faithfulness, identify which chain positions are "computationally important" by measuring accuracy when steps are replaced with errors. We identify a systematic confound: for chains with explicit terminal answer statements, the dominant format in standard benchmarks, corruption studies detect where the answer text appears, not where computation occurs. A within-dataset format ablation provides the key evidence: on standard GSM8K chains ending with "the answer is X," removing only the answer statement, preserving all reasoning, collapses suffix sensitivity ~19x at 3B (N=300, p=0.022). Conflicting-answer experiments quantify the causal mechanism: at 7B, CC accuracy drops to near-zero (<=0.02) across five architecture families; the followed-wrong rate spans 0.63-1.00 at 3B-7B and attenuates at larger scales (0.300 at Phi-4-14B, ~0.01 at 32B). A within-stable 7B replication (9.3x attenuation, N=76, p=7.8e-3; Qwen3-8B N=299, p=0.004) provides converging evidence, and the pattern replicates on MATH (DeepSeek-R1-7B: 10.9x suffix-survival recovery). On chains without answer suffixes the same protocol identifies the prefix as load-bearing (Delta=-0.77, p<10^-12). Generation-time probes confirm a dissociation: the answer is not early-determined during generation (early commitment <5%), yet at consumption time model outputs systematically follow the explicit answer text. The format-determination effect persists through 14B (8.5x ratio, p=0.001) and converges toward zero at 32B. We propose a three-prerequisite protocol (question-only control, format characterization, all-position sweep) as a minimum standard for corruption-based faithfulness studies.

Global healthcare providers are exploring use of large language models (LLMs) to provide medical advice to the public. LLMs now achieve nearly perfect scores on medical licensing exams, but this does not necessarily translate to accurate performance in real-world settings. We tested if LLMs can assist members of the public in identifying underlying conditions and choosing a course of action (disposition) in ten medical scenarios in a controlled study with 1,298 participants. Participants were randomly assigned to receive assistance from an LLM (GPT-4o, Llama 3, Command R+) or a source of their choice (control). Tested alone, LLMs complete the scenarios accurately, correctly identifying conditions in 94.9% of cases and disposition in 56.3% on average. However, participants using the same LLMs identified relevant conditions in less than 34.5% of cases and disposition in less than 44.2%, both no better than the control group. We identify user interactions as a challenge to the deployment of LLMs for medical advice. Standard benchmarks for medical knowledge and simulated patient interactions do not predict the failures we find with human participants. Moving forward, we recommend systematic human user testing to evaluate interactive capabilities prior to public deployments in healthcare.