Daily Papers

In psychotherapy, therapeutic outcome assessment, or treatment outcome evaluation, is essential for enhancing mental health care by systematically evaluating therapeutic processes and outcomes. Existing large language model approaches often focus on therapist-centered, single-session evaluations, neglecting the client's subjective experience and longitudinal progress across multiple sessions. To address these limitations, we propose IPAEval, a client-Informed Psychological Assessment-based Evaluation framework that automates treatment outcome evaluations from the client's perspective using clinical interviews. IPAEval integrates cross-session client-contextual assessment and session-focused client-dynamics assessment to provide a comprehensive understanding of therapeutic progress. Experiments on our newly developed TheraPhase dataset demonstrate that IPAEval effectively tracks symptom severity and treatment outcomes over multiple sessions, outperforming previous single-session models and validating the benefits of items-aware reasoning mechanisms.

Process Reward Models (PRMs) aim to improve multi-step reasoning in Large Language Models (LLMs) by supervising intermediate steps and identifying errors. However, building effective PRMs remains challenging due to the lack of scalable, high-quality annotations. Existing approaches rely on costly human labeling, LLM-based self-evaluation that is prone to hallucination, or Monte Carlo (MC) estimation, which infers step quality solely from rollout outcomes and often introduces noisy, misaligned supervision due to credit misattribution. These issues result in three core limitations: noisy rewards, low factual fidelity, and misalignment with step-level reasoning objectives. To address these challenges, we introduce GroundedPRM, a tree-guided and fidelity-aware framework for automatic process supervision. To reduce reward noise and enable fine-grained credit assignment, we construct structured reasoning paths via Monte Carlo Tree Search (MCTS). To eliminate hallucinated supervision, we validate each intermediate step using an external tool, providing execution-grounded correctness signals. To combine both step-level validation and global outcome assessment, we design a hybrid reward aggregation mechanism that fuses tool-based verification with MCTS-derived feedback. Finally, we format the reward signal into a rationale-enhanced, generative structure to promote interpretability and compatibility with instruction-tuned LLMs. GroundedPRM is trained on only 40K automatically labeled samples, amounting to just 10% of the data used by the best-performing PRM trained with auto-labeled supervision. Nevertheless, it achieves up to a 26% relative improvement in average performance on ProcessBench. When used for reward-guided greedy search, GroundedPRM outperforms even PRMs trained with human-labeled supervision, offering a scalable and verifiable path toward high-quality process-level reasoning.

Integration of Vision-Language Models (VLMs) in surgical intelligence is hindered by hallucinations, domain knowledge gaps, and limited understanding of task interdependencies within surgical scenes, undermining clinical reliability. While recent VLMs demonstrate strong general reasoning and thinking capabilities, they still lack the domain expertise and task-awareness required for precise surgical scene interpretation. Although Chain-of-Thought (CoT) can structure reasoning more effectively, current approaches rely on self-generated CoT steps, which often exacerbate inherent domain gaps and hallucinations. To overcome this, we present SurgRAW, a CoT-driven multi-agent framework that delivers transparent, interpretable insights for most tasks in robotic-assisted surgery. By employing specialized CoT prompts across five tasks: instrument recognition, action recognition, action prediction, patient data extraction, and outcome assessment, SurgRAW mitigates hallucinations through structured, domain-aware reasoning. Retrieval-Augmented Generation (RAG) is also integrated to external medical knowledge to bridge domain gaps and improve response reliability. Most importantly, a hierarchical agentic system ensures that CoT-embedded VLM agents collaborate effectively while understanding task interdependencies, with a panel discussion mechanism promotes logical consistency. To evaluate our method, we introduce SurgCoTBench, the first reasoning-based dataset with structured frame-level annotations. With comprehensive experiments, we demonstrate the effectiveness of proposed SurgRAW with 29.32% accuracy improvement over baseline VLMs on 12 robotic procedures, achieving the state-of-the-art performance and advancing explainable, trustworthy, and autonomous surgical assistance.

Process Reward Models (PRMs) emerge as a promising approach for process supervision in mathematical reasoning of Large Language Models (LLMs), which aim to identify and mitigate intermediate errors in the reasoning processes. However, the development of effective PRMs faces significant challenges, particularly in data annotation and evaluation methodologies. In this paper, through extensive experiments, we demonstrate that commonly used Monte Carlo (MC) estimation-based data synthesis for PRMs typically yields inferior performance and generalization compared to LLM-as-a-judge and human annotation methods. MC estimation relies on completion models to evaluate current-step correctness, leading to inaccurate step verification. Furthermore, we identify potential biases in conventional Best-of-N (BoN) evaluation strategies for PRMs: (1) The unreliable policy models generate responses with correct answers but flawed processes, leading to a misalignment between the evaluation criteria of BoN and the PRM objectives of process verification. (2) The tolerance of PRMs of such responses leads to inflated BoN scores. (3) Existing PRMs have a significant proportion of minimum scores concentrated on the final answer steps, revealing the shift from process to outcome-based assessment in BoN Optimized PRMs. To address these challenges, we develop a consensus filtering mechanism that effectively integrates MC estimation with LLM-as-a-judge and advocates a more comprehensive evaluation framework that combines response-level and step-level metrics. Based on the mechanisms, we significantly improve both model performance and data efficiency in the BoN evaluation and the step-wise error identification task. Finally, we release a new state-of-the-art PRM that outperforms existing open-source alternatives and provides practical guidelines for future research in building process supervision models.

Large Language Models (LLMs) increasingly rely on external tools such as search engines to solve complex agentic tasks that require reasoning and external knowledge retrieval. Recently, reinforcement learning with verifiable rewards (RLVR) has demonstrated its effectiveness in advancing capabilities of LLMs by rewarding the final answers via outcome rewards. While straightforward to supervise, outcome rewards only provide sparse signals and delayed feedback, which limits their effectiveness on long trajectories. Process rewards address this by evaluating intermediate steps, providing fine-grained supervision and encouraging grounded problem solving. However, it is notoriously hard to annotate step-wise labels, especially in non-verifiable process without "golden" answers. Furthermore, step-wise judgment requires the balance between local quality with contribution to the final outcome, as optimizing towards higher process reward may not always align with better final outcomes. To address the above challenges, we introduce Principle Process Reward (PPR), an RL approach that unifies principled step-level assessment and outcome verification. We train a principle-based reward model to improve the transparency and reliability of process evaluation, and further introduce a Reward Normalization (ReNorm) strategy to calibrate outcome and process rewards. Experiment results show that PPR achieves state-of-the-art performance across a wide range of benchmarks, demonstrating its impressive robustness and generalization. Our code and model collection is available in this link.

Forecasting is an important task in many domains, such as technology and economics. However existing forecasting benchmarks largely lack comprehensive confidence assessment, focus on limited question types, and often consist of artificial questions that do not align with real-world human forecasting needs. To address these gaps, we introduce FOReCAst (Future Outcome Reasoning and Confidence Assessment), a benchmark that evaluates models' ability to make predictions and their confidence in them. FOReCAst spans diverse forecasting scenarios involving Boolean questions, timeframe prediction, and quantity estimation, enabling a comprehensive evaluation of both prediction accuracy and confidence calibration for real-world applications.

Large language models (LLMs) have achieved significant progress in solving complex reasoning tasks by Reinforcement Learning with Verifiable Rewards (RLVR). This advancement is also inseparable from the oversight automated by reliable verifiers. However, current outcome-based verifiers (OVs) are unable to inspect the unreliable intermediate steps in the long reasoning chains of thought (CoTs). Meanwhile, current process-based verifiers (PVs) have difficulties in reliably detecting errors in the complex long CoTs, limited by the scarcity of high-quality annotations due to the prohibitive costs of human annotations. Therefore, we propose the Outcome-based Process Verifier (OPV), which verifies the rationale process of summarized outcomes from long CoTs to achieve both accurate and efficient verification and enable large-scale annotation. To empower the proposed verifier, we adopt an iterative active learning framework with expert annotations to progressively improve the verification capability of OPV with fewer annotation costs. Specifically, in each iteration, the most uncertain cases of the current best OPV are annotated and then subsequently used to train a new OPV through Rejection Fine-Tuning (RFT) and RLVR for the next round. Extensive experiments demonstrate OPV's superior performance and broad applicability. It achieves new state-of-the-art results on our held-out OPV-Bench, outperforming much larger open-source models such as Qwen3-Max-Preview with an F1 score of 83.1 compared to 76.3. Furthermore, OPV effectively detects false positives within synthetic dataset, closely align with expert assessment. When collaborating with policy models, OPV consistently yields performance gains, e.g., raising the accuracy of DeepSeek-R1-Distill-Qwen-32B from 55.2% to 73.3% on AIME2025 as the compute budget scales.

Large Language Models (LLMs) have shown exceptional capabilities in Natural Language Processing (NLP) across diverse domains. However, their application in specialized tasks such as Legal Judgment Prediction (LJP) for low-resource languages like Arabic remains underexplored. In this work, we address this gap by developing an Arabic LJP dataset, collected and preprocessed from Saudi commercial court judgments. We benchmark state-of-the-art open-source LLMs, including LLaMA-3.2-3B and LLaMA-3.1-8B, under varying configurations such as zero-shot, one-shot, and fine-tuning using QLoRA. Additionally, we used a comprehensive evaluation framework combining quantitative metrics (BLEU and ROUGE) and qualitative assessments (Coherence, legal language, clarity). Our results demonstrate that fine-tuned smaller models achieve comparable performance to larger models in task-specific contexts while offering significant resource efficiency. Furthermore, we investigate the effects of prompt engineering and fine-tuning on model outputs, providing insights into performance variability and instruction sensitivity. By making the dataset, implementation code, and models publicly available, we establish a robust foundation for future research in Arabic legal NLP.

In legal NLP, Case Outcome Classification (COC) must not only be accurate but also trustworthy and explainable. Existing work in explainable COC has been limited to annotations by a single expert. However, it is well-known that lawyers may disagree in their assessment of case facts. We hence collect a novel dataset RAVE: Rationale Variation in ECHR1, which is obtained from two experts in the domain of international human rights law, for whom we observe weak agreement. We study their disagreements and build a two-level task-independent taxonomy, supplemented with COC-specific subcategories. To our knowledge, this is the first work in the legal NLP that focuses on human label variation. We quantitatively assess different taxonomy categories and find that disagreements mainly stem from underspecification of the legal context, which poses challenges given the typically limited granularity and noise in COC metadata. We further assess the explainablility of SOTA COC models on RAVE and observe limited agreement between models and experts. Overall, our case study reveals hitherto underappreciated complexities in creating benchmark datasets in legal NLP that revolve around identifying aspects of a case's facts supposedly relevant to its outcome.

Clinical monitoring of metastatic disease to the brain can be a laborious and time-consuming process, especially in cases involving multiple metastases when the assessment is performed manually. The Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) guideline, which utilizes the unidimensional longest diameter, is commonly used in clinical and research settings to evaluate response to therapy in patients with brain metastases. However, accurate volumetric assessment of the lesion and surrounding peri-lesional edema holds significant importance in clinical decision-making and can greatly enhance outcome prediction. The unique challenge in performing segmentations of brain metastases lies in their common occurrence as small lesions. Detection and segmentation of lesions that are smaller than 10 mm in size has not demonstrated high accuracy in prior publications. The brain metastases challenge sets itself apart from previously conducted MICCAI challenges on glioma segmentation due to the significant variability in lesion size. Unlike gliomas, which tend to be larger on presentation scans, brain metastases exhibit a wide range of sizes and tend to include small lesions. We hope that the BraTS-METS dataset and challenge will advance the field of automated brain metastasis detection and segmentation.

This study evaluates Artificial Intelligence (AI) agents for Dhumbal, a culturally significant multiplayer card game with imperfect information, through a systematic comparison of rule-based, search-based, and learning-based strategies. We formalize Dhumbal's mechanics and implement diverse agents, including heuristic approaches (Aggressive, Conservative, Balanced, Opportunistic), search-based methods such as Monte Carlo Tree Search (MCTS) and Information Set Monte Carlo Tree Search (ISMCTS), and reinforcement learning approaches including Deep Q-Network (DQN) and Proximal Policy Optimization (PPO), and a random baseline. Evaluation involves within-category tournaments followed by a cross-category championship. Performance is measured via win rate, economic outcome, Jhyap success, cards discarded per round, risk assessment, and decision efficiency. Statistical significance is assessed using Welch's t-test with Bonferroni correction, effect sizes via Cohen's d, and 95% confidence intervals (CI). Across 1024 simulated rounds, the rule-based Aggressive agent achieves the highest win rate (88.3%, 95% CI: [86.3, 90.3]), outperforming ISMCTS (9.0%) and PPO (1.5%) through effective exploitation of Jhyap declarations. The study contributes a reproducible AI framework, insights into heuristic efficacy under partial information, and open-source code, thereby advancing AI research and supporting digital preservation of cultural games.

We introduce an approach aimed at enhancing the reasoning capabilities of Large Language Models (LLMs) through an iterative preference learning process inspired by the successful strategy employed by AlphaZero. Our work leverages Monte Carlo Tree Search (MCTS) to iteratively collect preference data, utilizing its look-ahead ability to break down instance-level rewards into more granular step-level signals. To enhance consistency in intermediate steps, we combine outcome validation and stepwise self-evaluation, continually updating the quality assessment of newly generated data. The proposed algorithm employs Direct Preference Optimization (DPO) to update the LLM policy using this newly generated step-level preference data. Theoretical analysis reveals the importance of using on-policy sampled data for successful self-improving. Extensive evaluations on various arithmetic and commonsense reasoning tasks demonstrate remarkable performance improvements over existing models. For instance, our approach outperforms the Mistral-7B Supervised Fine-Tuning (SFT) baseline on GSM8K, MATH, and ARC-C, with substantial increases in accuracy to 81.8% (+5.9%), 34.7% (+5.8%), and 76.4% (+15.8%), respectively. Additionally, our research delves into the training and inference compute tradeoff, providing insights into how our method effectively maximizes performance gains. Our code is publicly available at https://github.com/YuxiXie/MCTS-DPO.

Although large visual-language models (LVLMs) have demonstrated strong performance in multimodal tasks, errors may occasionally arise due to biases during the reasoning process. Recently, reward models (RMs) have become increasingly pivotal in the reasoning process. Specifically, process RMs evaluate each reasoning step, outcome RMs focus on the assessment of reasoning results, and critique RMs perform error analysis on the entire reasoning process, followed by corrections. However, existing benchmarks for vision-language RMs (VLRMs) typically assess only a single aspect of their capabilities (e.g., distinguishing between two answers), thus limiting the all-round evaluation and restricting the development of RMs in the visual-language domain. To address this gap, we propose a comprehensive and challenging benchmark, dubbed as VLRMBench, encompassing 12,634 questions. VLRMBench is constructed based on three distinct types of datasets, covering mathematical reasoning, hallucination understanding, and multi-image understanding. We design 12 tasks across three major categories, focusing on evaluating VLRMs in the aspects of process understanding, outcome judgment, and critique generation. Extensive experiments are conducted on 21 open-source models and 5 advanced closed-source models, highlighting the challenges posed by VLRMBench. For instance, in the `Forecasting Future', a binary classification task, the advanced GPT-4o achieves only a 76.0% accuracy. Additionally, we perform comprehensive analytical studies, offering valuable insights for the future development of VLRMs. We anticipate that VLRMBench will serve as a pivotal benchmark in advancing VLRMs. Code and datasets will be available at https://github.com/JCruan519/VLRMBench.

Outcome-Based Education (OBE) emphasizes the development of specific competencies through student-centered learning. In this study, we reviewed the importance of OBE and implemented transformer-based models, particularly DistilBERT, to analyze an NLP dataset that includes student feedback. Our objective is to assess and improve educational outcomes. Our approach is better than other machine learning models because it uses the transformer's deep understanding of language context to classify sentiment better, giving better results across a wider range of matrices. Our work directly contributes to OBE's goal of achieving measurable outcomes by facilitating the identification of patterns in student learning experiences. We have also applied LIME (local interpretable model-agnostic explanations) to make sure that model predictions are clear. This gives us understandable information about how key terms affect sentiment. Our findings indicate that the combination of transformer models and LIME explanations results in a strong and straightforward framework for analyzing student feedback. This aligns more closely with the principles of OBE and ensures the improvement of educational practices through data-driven insights.

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.

Large Language Models (LLMs) are increasingly deployed in real-world applications that demand complex reasoning. To track progress, robust benchmarks are required to evaluate their capabilities beyond superficial pattern recognition. However, current LLM reasoning benchmarks often face challenges such as insufficient interpretability, performance saturation or data contamination. To address these challenges, we introduce GAMEBoT, a gaming arena designed for rigorous and transparent assessment of LLM reasoning capabilities. GAMEBoT decomposes complex reasoning in games into predefined modular subproblems. This decomposition allows us to design a suite of Chain-of-Thought (CoT) prompts that leverage domain knowledge to guide LLMs in addressing these subproblems before action selection. Furthermore, we develop a suite of rule-based algorithms to generate ground truth for these subproblems, enabling rigorous validation of the LLMs' intermediate reasoning steps. This approach facilitates evaluation of both the quality of final actions and the accuracy of the underlying reasoning process. GAMEBoT also naturally alleviates the risk of data contamination through dynamic games and head-to-head LLM competitions. We benchmark 17 prominent LLMs across eight games, encompassing various strategic abilities and game characteristics. Our results suggest that GAMEBoT presents a significant challenge, even when LLMs are provided with detailed CoT prompts. Project page: https://visual-ai.github.io/gamebot

This study investigates GPT-4's assessment of its performance in healthcare applications. A simple prompting technique was used to prompt the LLM with questions taken from the United States Medical Licensing Examination (USMLE) questionnaire and it was tasked to evaluate its confidence score before posing the question and after asking the question. The questionnaire was categorized into two groups-questions with feedback (WF) and questions with no feedback(NF) post-question. The model was asked to provide absolute and relative confidence scores before and after each question. The experimental findings were analyzed using statistical tools to study the variability of confidence in WF and NF groups. Additionally, a sequential analysis was conducted to observe the performance variation for the WF and NF groups. Results indicate that feedback influences relative confidence but doesn't consistently increase or decrease it. Understanding the performance of LLM is paramount in exploring its utility in sensitive areas like healthcare. This study contributes to the ongoing discourse on the reliability of AI, particularly of LLMs like GPT-4, within healthcare, offering insights into how feedback mechanisms might be optimized to enhance AI-assisted medical education and decision support.

We present the findings of "The Alzheimer's Disease Prediction Of Longitudinal Evolution" (TADPOLE) Challenge, which compared the performance of 92 algorithms from 33 international teams at predicting the future trajectory of 219 individuals at risk of Alzheimer's disease. Challenge participants were required to make a prediction, for each month of a 5-year future time period, of three key outcomes: clinical diagnosis, Alzheimer's Disease Assessment Scale Cognitive Subdomain (ADAS-Cog13), and total volume of the ventricles. The methods used by challenge participants included multivariate linear regression, machine learning methods such as support vector machines and deep neural networks, as well as disease progression models. No single submission was best at predicting all three outcomes. For clinical diagnosis and ventricle volume prediction, the best algorithms strongly outperform simple baselines in predictive ability. However, for ADAS-Cog13 no single submitted prediction method was significantly better than random guesswork. Two ensemble methods based on taking the mean and median over all predictions, obtained top scores on almost all tasks. Better than average performance at diagnosis prediction was generally associated with the additional inclusion of features from cerebrospinal fluid (CSF) samples and diffusion tensor imaging (DTI). On the other hand, better performance at ventricle volume prediction was associated with inclusion of summary statistics, such as the slope or maxima/minima of biomarkers. TADPOLE's unique results suggest that current prediction algorithms provide sufficient accuracy to exploit biomarkers related to clinical diagnosis and ventricle volume, for cohort refinement in clinical trials for Alzheimer's disease. However, results call into question the usage of cognitive test scores for patient selection and as a primary endpoint in clinical trials.

There have been multiple calls for investments in the development of AI standards that both preserve the transformative potential and minimize the risks of AI. The goals of AI standards, particularly with respect to AI data, performance, and governance, are to promote innovation and public trust in systems that use AI. However, there is a lack of a formal or shared method to measure the impact of these standardization activities on the goals of innovation and trust. This concept paper proposes an analytical approach that could inform the evaluation of the impact of AI standards. The proposed approach could be used to measure, assess, and eventually evaluate the extent to which AI standards achieve their stated goals, since most Standards Development Organizationss do not track the impact of their standards once completed. It is intended to stimulate discussions with a wide variety of stakeholders, including academia and the standards community, about the potential for the approach to evaluate the effectiveness, utility, and relative value of AI standards. The document draws on successful and well-tested evaluation frameworks, tools, and metrics that are used for monitoring and assessing the effect of programmatic interventions in other domains to describe a possible approach. It begins by describing the context within which an evaluation would be designed, and then introduces a standard evaluation framework. These sections are followed by a description of what outputs and outcomes might result from the adoption and implementation of AI standards and the process whereby those AI standards are developed . Subsequent sections provide an overview of how the effectiveness of AI standards might be assessed and a conclusion.

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.

In Brazil, all legal professionals must demonstrate their knowledge of the law and its application by passing the OAB exams, the national bar exams. The OAB exams therefore provide an excellent benchmark for the performance of legal information systems since passing the exam would arguably signal that the system has acquired capacity of legal reasoning comparable to that of a human lawyer. This article describes the construction of a new data set and some preliminary experiments on it, treating the problem of finding the justification for the answers to questions. The results provide a baseline performance measure against which to evaluate future improvements. We discuss the reasons to the poor performance and propose next steps.

This paper shows how LLMs (Large Language Models) may be used to estimate a summary of the emotional state associated with piece of text. The summary of emotional state is a dictionary of words used to describe emotion together with the probability of the word appearing after a prompt comprising the original text and an emotion eliciting tail. Through emotion analysis of Amazon product reviews we demonstrate emotion descriptors can be mapped into a PCA type space. It was hoped that text descriptions of actions to improve a current text described state could also be elicited through a tail prompt. Experiment seemed to indicate that this is not straightforward to make work. This failure put our hoped for selection of action via choosing the best predict ed outcome via comparing emotional responses out of reach for the moment.

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

Background: Rapid advancements in natural language processing have led to the development of large language models with the potential to revolutionize mental health care. These models have shown promise in assisting clinicians and providing support to individuals experiencing various psychological challenges. Objective: This study aims to compare the performance of two large language models, GPT-4 and Chat-GPT, in responding to a set of 18 psychological prompts, to assess their potential applicability in mental health care settings. Methods: A blind methodology was employed, with a clinical psychologist evaluating the models' responses without knowledge of their origins. The prompts encompassed a diverse range of mental health topics, including depression, anxiety, and trauma, to ensure a comprehensive assessment. Results: The results demonstrated a significant difference in performance between the two models (p > 0.05). GPT-4 achieved an average rating of 8.29 out of 10, while Chat-GPT received an average rating of 6.52. The clinical psychologist's evaluation suggested that GPT-4 was more effective at generating clinically relevant and empathetic responses, thereby providing better support and guidance to potential users. Conclusions: This study contributes to the growing body of literature on the applicability of large language models in mental health care settings. The findings underscore the importance of continued research and development in the field to optimize these models for clinical use. Further investigation is necessary to understand the specific factors underlying the performance differences between the two models and to explore their generalizability across various populations and mental health conditions.

The integration of artificial intelligence (AI) in educational measurement has revolutionized assessment methods, enabling automated scoring, rapid content analysis, and personalized feedback through machine learning and natural language processing. These advancements provide timely, consistent feedback and valuable insights into student performance, thereby enhancing the assessment experience. However, the deployment of AI in education also raises significant ethical concerns regarding validity, reliability, transparency, fairness, and equity. Issues such as algorithmic bias and the opacity of AI decision-making processes pose risks of perpetuating inequalities and affecting assessment outcomes. Responding to these concerns, various stakeholders, including educators, policymakers, and organizations, have developed guidelines to ensure ethical AI use in education. The National Council of Measurement in Education's Special Interest Group on AI in Measurement and Education (AIME) also focuses on establishing ethical standards and advancing research in this area. In this paper, a diverse group of AIME members examines the ethical implications of AI-powered tools in educational measurement, explores significant challenges such as automation bias and environmental impact, and proposes solutions to ensure AI's responsible and effective use in education.

Automatic summary assessment is useful for both machine-generated and human-produced summaries. Automatically evaluating the summary text given the document enables, for example, summary generation system development and detection of inappropriate summaries. Summary assessment can be run in a number of modes: ranking summary generation systems; ranking summaries of a particular document; and estimating the quality of a document-summary pair on an absolute scale. Existing datasets with annotation for summary assessment are usually based on news summarization datasets such as CNN/DailyMail or XSum. In this work, we describe a new dataset, the podcast summary assessment corpus, a collection of podcast summaries that were evaluated by human experts at TREC2020. Compared to existing summary assessment data, this dataset has two unique aspects: (i) long-input, speech podcast based, documents; and (ii) an opportunity to detect inappropriate reference summaries in podcast corpus. First, we examine existing assessment methods, including model-free and model-based methods, and provide benchmark results for this long-input summary assessment dataset. Second, with the aim of filtering reference summary-document pairings for training, we apply summary assessment for data selection. The experimental results on these two aspects provide interesting insights on the summary assessment and generation tasks. The podcast summary assessment data is available.

Urban assessments often compress diverse needs into single scores, which can obscure minority perspectives. We present a community-centered study in Montreal (n=35; wheelchair users, seniors, LGBTQIA2+ residents, and immigrants). Participants rated 20 streets (accessibility, inclusivity, aesthetics, practicality) and ranked 7 images on 12 interview-elicited criteria. Disagreement patterns were systematic in our sample: wheelchair users diverged most on accessibility and practicality; LGBTQIA2+ participants emphasized inclusion and liveliness; seniors prioritized security. Group discussion reduced information gaps but not value conflicts; ratings conveyed intensity, while rankings forced trade-offs. We then formalize negotiative alignment, a transparent, budget-aware bargaining procedure, and pilot it with role-played stakeholder agents plus a neutral mediator. Relative to the best base design under the same public rubric, the negotiated package increased total utility (21.10 to 24.55), raised the worst-group utility (3.20 to 3.90), improved twentieth percentile satisfaction (0.86 to 1.00; min-max normalized within the scenario), and reduced inequality (Gini 0.036 to 0.025). Treating disagreement as signal and reporting worst-group outcomes alongside totals may help planners and AI practitioners surface trade-offs and preserve minority priorities while maintaining efficiency.

The global cost of drug discovery and development exceeds $200 billion annually. The main results of drug discovery and development are the outcomes of clinical trials, which directly influence the regulatory approval of new drug candidates and ultimately affect patient outcomes. Despite their significance, large-scale, high-quality clinical trial outcome data are not readily available to the public. Suppose a large clinical trial outcome dataset is provided; machine learning researchers can potentially develop accurate prediction models using past trials and outcome labels, which could help prioritize and optimize therapeutic programs, ultimately benefiting patients. This paper introduces Clinical Trial Outcome (CTO) dataset, the largest trial outcome dataset with around 479K clinical trials, aggregating outcomes from multiple sources of weakly supervised labels, minimizing the noise from individual sources, and eliminating the need for human annotation. These sources include large language model (LLM) decisions on trial-related documents, news headline sentiments, stock prices of trial sponsors, trial linkages across phases, and other signals such as patient dropout rates and adverse events. CTO's labels show unprecedented agreement with supervised clinical trial outcome labels from test split of the supervised TOP dataset, with a 91 F1.

Retrieval-Augmented Generation (RAG) is a promising approach for mitigating the hallucination of large language models (LLMs). However, existing research lacks rigorous evaluation of the impact of retrieval-augmented generation on different large language models, which make it challenging to identify the potential bottlenecks in the capabilities of RAG for different LLMs. In this paper, we systematically investigate the impact of Retrieval-Augmented Generation on large language models. We analyze the performance of different large language models in 4 fundamental abilities required for RAG, including noise robustness, negative rejection, information integration, and counterfactual robustness. To this end, we establish Retrieval-Augmented Generation Benchmark (RGB), a new corpus for RAG evaluation in both English and Chinese. RGB divides the instances within the benchmark into 4 separate testbeds based on the aforementioned fundamental abilities required to resolve the case. Then we evaluate 6 representative LLMs on RGB to diagnose the challenges of current LLMs when applying RAG. Evaluation reveals that while LLMs exhibit a certain degree of noise robustness, they still struggle significantly in terms of negative rejection, information integration, and dealing with false information. The aforementioned assessment outcomes indicate that there is still a considerable journey ahead to effectively apply RAG to LLMs.

In recent years, advancements in Natural Language Processing (NLP) techniques have revolutionized the field of accessibility and exclusivity of testing, particularly for visually impaired students (VIS). CBT has shown in years back its relevance in terms of administering exams electronically, making the test process easier, providing quicker and more accurate results, and offering greater flexibility and accessibility for candidates. Yet, its relevance was not felt by the visually impaired students as they cannot access printed documents. Hence, in this paper, we present an NLP-driven Computer-Based Test guide for visually impaired students. It employs a speech technology pre-trained methods to provide real-time assistance and support to visually impaired students. The system utilizes NLP technologies to convert the text-based questions and the associated options in a machine-readable format. Subsequently, the speech technology pre-trained model processes the converted text enabling the VIS to comprehend and analyze the content. Furthermore, we validated that this pre-trained model is not perverse by testing for accuracy using sample audio datasets labels (A, B, C, D, E, F, G) to compare with the voice recordings obtained from 20 VIS which is been predicted by the system to attain values for precision, recall, and F1-scores. These metrics are used to assess the performance of the pre-trained model and have indicated that it is proficient enough to give its better performance to the evaluated system. The methodology adopted for this system is Object Oriented Analysis and Design Methodology (OOADM) where Objects are discussed and built by modeling real-world instances.

In response to the pressing need for advanced clinical problem-solving tools in healthcare, we introduce BooksMed, a novel framework based on a Large Language Model (LLM). BooksMed uniquely emulates human cognitive processes to deliver evidence-based and reliable responses, utilizing the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework to effectively quantify evidence strength. For clinical decision-making to be appropriately assessed, an evaluation metric that is clinically aligned and validated is required. As a solution, we present ExpertMedQA, a multispecialty clinical benchmark comprised of open-ended, expert-level clinical questions, and validated by a diverse group of medical professionals. By demanding an in-depth understanding and critical appraisal of up-to-date clinical literature, ExpertMedQA rigorously evaluates LLM performance. BooksMed outperforms existing state-of-the-art models Med-PaLM 2, Almanac, and ChatGPT in a variety of medical scenarios. Therefore, a framework that mimics human cognitive stages could be a useful tool for providing reliable and evidence-based responses to clinical inquiries.

Introduction: Recently, the effectiveness of Large Language Models (LLMs) has increased rapidly, allowing them to be used in a great number of applications. However, the risks posed by the generation of false information through LLMs significantly limit their applications in sensitive areas such as healthcare, highlighting the necessity for rigorous validations to determine their utility and reliability. To date, no study has extensively compared the performance of LLMs on Polish medical examinations across a broad spectrum of specialties on a very large dataset. Objectives: This study evaluated the performance of three Generative Pretrained Transformer (GPT) models on the Polish Board Certification Exam (Pa\'nstwowy Egzamin Specjalizacyjny, PES) dataset, which consists of 297 tests. Methods: We developed a software program to download and process PES exams and tested the performance of GPT models using OpenAI Application Programming Interface. Results: Our findings reveal that GPT-3.5 did not pass any of the analyzed exams. In contrast, the GPT-4 models demonstrated the capability to pass the majority of the exams evaluated, with the most recent model, gpt-4-0125, successfully passing 222 (75%) of them. The performance of the GPT models varied significantly, displaying excellence in exams related to certain specialties while completely failing others. Conclusions: The significant progress and impressive performance of LLM models hold great promise for the increased application of AI in the field of medicine in Poland. For instance, this advancement could lead to the development of AI-based medical assistants for healthcare professionals, enhancing the efficiency and accuracy of medical services.

Representation engineering methods have recently shown promise for enabling efficient steering of model behavior. However, evaluation pipelines for these methods have primarily relied on subjective demonstrations, instead of quantitative, objective metrics. We aim to take a step towards addressing this issue by advocating for four properties missing from current evaluations: (i) contexts sufficiently similar to downstream tasks should be used for assessing intervention quality; (ii) model likelihoods should be accounted for; (iii) evaluations should allow for standardized comparisons across different target behaviors; and (iv) baseline comparisons should be offered. We introduce an evaluation pipeline grounded in these criteria, offering both a quantitative and visual analysis of how effectively a given method works. We use this pipeline to evaluate two representation engineering methods on how effectively they can steer behaviors such as truthfulness and corrigibility, finding that some interventions are less effective than previously reported.

Problem: Effective patient-centered communication is a core competency for physicians. However, both seasoned providers and medical trainees report decreased confidence in leading conversations on sensitive topics such as goals of care or end-of-life discussions. The significant administrative burden and the resources required to provide dedicated training in leading difficult conversations has been a long-standing problem in medical education. Approach: In this work, we present a novel educational tool designed to facilitate interactive, real-time simulations of difficult conversations in a video-based format through the use of multimodal generative artificial intelligence (AI). Leveraging recent advances in language modeling, computer vision, and generative audio, this tool creates realistic, interactive scenarios with avatars, or "synthetic patients." These synthetic patients interact with users throughout various stages of medical care using a custom-built video chat application, offering learners the chance to practice conversations with patients from diverse belief systems, personalities, and ethnic backgrounds. Outcomes: While the development of this platform demanded substantial upfront investment in labor, it offers a highly-realistic simulation experience with minimal financial investment. For medical trainees, this educational tool can be implemented within programs to simulate patient-provider conversations and can be incorporated into existing palliative care curriculum to provide a scalable, high-fidelity simulation environment for mastering difficult conversations. Next Steps: Future developments will explore enhancing the authenticity of these encounters by working with patients to incorporate their histories and personalities, as well as employing the use of AI-generated evaluations to offer immediate, constructive feedback to learners post-simulation.

In recent years, there have been significant breakthroughs in the field of natural language processing, particularly with the development of large language models (LLMs). These LLMs have showcased remarkable capabilities on various benchmarks. In the healthcare field, the exact role LLMs and other future AI models will play remains unclear. There is a potential for these models in the future to be used as part of adaptive physician training, medical co-pilot applications, and digital patient interaction scenarios. The ability of AI models to participate in medical training and patient care will depend in part on their mastery of the knowledge content of specific medical fields. This study investigated the medical knowledge capability of LLMs, specifically in the context of internal medicine subspecialty multiple-choice test-taking ability. We compared the performance of several open-source LLMs (Koala 7B, Falcon 7B, Stable-Vicuna 13B, and Orca Mini 13B), to GPT-4 and Claude 2 on multiple-choice questions in the field of Nephrology. Nephrology was chosen as an example of a particularly conceptually complex subspecialty field within internal medicine. The study was conducted to evaluate the ability of LLM models to provide correct answers to nephSAP (Nephrology Self-Assessment Program) multiple-choice questions. The overall success of open-sourced LLMs in answering the 858 nephSAP multiple-choice questions correctly was 17.1% - 25.5%. In contrast, Claude 2 answered 54.4% of the questions correctly, whereas GPT-4 achieved a score of 73.3%. We show that current widely used open-sourced LLMs do poorly in their ability for zero-shot reasoning when compared to GPT-4 and Claude 2. The findings of this study potentially have significant implications for the future of subspecialty medical training and patient care.

Text-based open-ended questions in academic formative and summative assessments help students become deep learners and prepare them to understand concepts for a subsequent conceptual assessment. However, grading text-based questions, especially in large courses, is tedious and time-consuming for instructors. Text processing models continue progressing with the rapid development of Artificial Intelligence (AI) tools and Natural Language Processing (NLP) algorithms. Especially after breakthroughs in Large Language Models (LLM), there is immense potential to automate rapid assessment and feedback of text-based responses in education. This systematic review adopts a scientific and reproducible literature search strategy based on the PRISMA process using explicit inclusion and exclusion criteria to study text-based automatic assessment systems in post-secondary education, screening 838 papers and synthesizing 93 studies. To understand how text-based automatic assessment systems have been developed and applied in education in recent years, three research questions are considered. All included studies are summarized and categorized according to a proposed comprehensive framework, including the input and output of the system, research motivation, and research outcomes, aiming to answer the research questions accordingly. Additionally, the typical studies of automated assessment systems, research methods, and application domains in these studies are investigated and summarized. This systematic review provides an overview of recent educational applications of text-based assessment systems for understanding the latest AI/NLP developments assisting in text-based assessments in higher education. Findings will particularly benefit researchers and educators incorporating LLMs such as ChatGPT into their educational activities.

One of the most concrete measures to take towards meaningful AI accountability is to consequentially assess and report the systems' performance and impact. However, the practical nature of the "AI audit" ecosystem is muddled and imprecise, making it difficult to work through various concepts and map out the stakeholders involved in the practice. First, we taxonomize current AI audit practices as completed by regulators, law firms, civil society, journalism, academia, consulting agencies. Next, we assess the impact of audits done by stakeholders within each domain. We find that only a subset of AI audit studies translate to desired accountability outcomes. We thus assess and isolate practices necessary for effective AI audit results, articulating the observed connections between AI audit design, methodology and institutional context on its effectiveness as a meaningful mechanism for accountability.

To assess the effectiveness of any medical intervention, researchers must conduct a time-intensive and highly manual literature review. NLP systems can help to automate or assist in parts of this expensive process. In support of this goal, we release MS^2 (Multi-Document Summarization of Medical Studies), a dataset of over 470k documents and 20k summaries derived from the scientific literature. This dataset facilitates the development of systems that can assess and aggregate contradictory evidence across multiple studies, and is the first large-scale, publicly available multi-document summarization dataset in the biomedical domain. We experiment with a summarization system based on BART, with promising early results. We formulate our summarization inputs and targets in both free text and structured forms and modify a recently proposed metric to assess the quality of our system's generated summaries. Data and models are available at https://github.com/allenai/ms2

Laboratory test results are an important and generally high dimensional component of a patient's Electronic Health Record (EHR). We train embedding representations (via Word2Vec and GloVe) for LOINC codes of laboratory tests from the EHRs of about 80,000 patients at a cancer center. To include information about lab test outcomes, we also train embeddings on the concatenation of a LOINC code with a symbol indicating normality or abnormality of the result. We observe several clinically meaningful similarities among LOINC embeddings trained over our data. For the embeddings of the concatenation of LOINCs with abnormality codes, we evaluate the performance for mortality prediction tasks and the ability to preserve ordinality properties: i.e. a lab test with normal outcome should be more similar to an abnormal one than to the a very abnormal one.

Glioblastomas are the most aggressive type of glioma, having a 5-year survival rate of 6.9%. Treatment typically involves surgery, followed by radiotherapy and chemotherapy, and frequent magnetic resonance imaging (MRI) scans to monitor disease progression. To assess treatment response, radiologists use the Response Assessment in Neuro-Oncology (RANO) criteria to categorize the tumor into one of four labels based on imaging and clinical features: complete response, partial response, stable disease, and progressive disease. This assessment is very complex and time-consuming. Since deep learning (DL) has been widely used to tackle classification problems, this work aimed to implement the first DL pipeline for the classification of RANO criteria based on two consecutive MRI acquisitions. The models were trained and tested on the open dataset LUMIERE. Five approaches were tested: 1) subtraction of input images, 2) different combinations of modalities, 3) different model architectures, 4) different pretraining tasks, and 5) adding clinical data. The pipeline that achieved the best performance used a Densenet264 considering only T1-weighted, T2-weighted, and Fluid Attenuated Inversion Recovery (FLAIR) images as input without any pretraining. A median Balanced Accuracy of 50.96% was achieved. Additionally, explainability methods were applied. Using Saliency Maps, the tumor region was often successfully highlighted. In contrast, Grad-CAM typically failed to highlight the tumor region, with some exceptions observed in the Complete Response and Progressive Disease classes, where it effectively identified the tumor region. These results set a benchmark for future studies on glioblastoma treatment response assessment based on the RANO criteria while emphasizing the heterogeneity of factors that might play a role when assessing the tumor's response to treatment.

Automated Essay Score (AES) is proven to be one of the cutting-edge technologies. Scoring techniques are used for various purposes. Reliable scores are calculated based on influential variables. Such variables can be computed by different methods based on the domain. The research is concentrated on the user's understanding of a given topic. The analysis is based on a scoring index by using Large Language Models. The user can then compare and contrast the understanding of a topic that they recently learned. The results are then contributed towards learning analytics and progression is made for enhancing the learning ability. In this research, the focus is on summarizing a PDF document and gauging a user's understanding of its content. The process involves utilizing a Langchain tool to summarize the PDF and extract the essential information. By employing this technique, the research aims to determine how well the user comprehends the summarized content.

The emergence of ChatGPT has generated much speculation in the press about its potential to disrupt social and economic systems. Its astonishing language ability has aroused strong curiosity among scholars about its performance in different domains. There have been many studies evaluating the ability of ChatGPT and GPT-4 in different tasks and disciplines. However, a comprehensive review summarizing the collective assessment findings is lacking. The objective of this survey is to thoroughly analyze prior assessments of ChatGPT and GPT-4, focusing on its language and reasoning abilities, scientific knowledge, and ethical considerations. Furthermore, an examination of the existing evaluation methods is conducted, offering several recommendations for future research in evaluating large language models.

Recent work has shown that asking language models to generate reasoning steps improves performance on many reasoning tasks. When moving beyond prompting, this raises the question of how we should supervise such models: outcome-based approaches which supervise the final result, or process-based approaches which supervise the reasoning process itself? Differences between these approaches might naturally be expected not just in final-answer errors but also in reasoning errors, which can be difficult to detect and are problematic in many real-world domains such as education. We run the first comprehensive comparison between process- and outcome-based approaches trained on a natural language task, GSM8K. We find that pure outcome-based supervision produces similar final-answer error rates with less label supervision. However, for correct reasoning steps we find it necessary to use process-based supervision or supervision from learned reward models that emulate process-based feedback. In total, we improve the previous best results from 16.8% to 12.7% final-answer error and 14.0% to 3.4% reasoning error among final-answer-correct solutions.

Personalized treatment effect estimates are often of interest in high-stakes applications -- thus, before deploying a model estimating such effects in practice, one needs to be sure that the best candidate from the ever-growing machine learning toolbox for this task was chosen. Unfortunately, due to the absence of counterfactual information in practice, it is usually not possible to rely on standard validation metrics for doing so, leading to a well-known model selection dilemma in the treatment effect estimation literature. While some solutions have recently been investigated, systematic understanding of the strengths and weaknesses of different model selection criteria is still lacking. In this paper, instead of attempting to declare a global `winner', we therefore empirically investigate success- and failure modes of different selection criteria. We highlight that there is a complex interplay between selection strategies, candidate estimators and the data used for comparing them, and provide interesting insights into the relative (dis)advantages of different criteria alongside desiderata for the design of further illuminating empirical studies in this context.

This paper presents CG-Eval, the first comprehensive evaluation of the generation capabilities of large Chinese language models across a wide range of academic disciplines. The models' performance was assessed based on their ability to generate accurate and relevant responses to different types of questions in six disciplines, namely, Science and Engineering, Humanities and Social Sciences, Mathematical Calculations, Medical Practitioner Qualification Examination, Judicial Examination, and Certified Public Accountant Examination. This paper also presents Gscore, a composite index derived from the weighted sum of multiple metrics to measure the quality of model's generation against a reference. The test data and test results can be found at http://cgeval.besteasy.com/.

Background: General-purpose large language models that utilize both text and images have not been evaluated on a diverse array of challenging medical cases. Methods: Using 934 cases from the NEJM Image Challenge published between 2005 and 2023, we evaluated the accuracy of the recently released Generative Pre-trained Transformer 4 with Vision model (GPT-4V) compared to human respondents overall and stratified by question difficulty, image type, and skin tone. We further conducted a physician evaluation of GPT-4V on 69 NEJM clinicopathological conferences (CPCs). Analyses were conducted for models utilizing text alone, images alone, and both text and images. Results: GPT-4V achieved an overall accuracy of 61% (95% CI, 58 to 64%) compared to 49% (95% CI, 49 to 50%) for humans. GPT-4V outperformed humans at all levels of difficulty and disagreement, skin tones, and image types; the exception was radiographic images, where performance was equivalent between GPT-4V and human respondents. Longer, more informative captions were associated with improved performance for GPT-4V but similar performance for human respondents. GPT-4V included the correct diagnosis in its differential for 80% (95% CI, 68 to 88%) of CPCs when using text alone, compared to 58% (95% CI, 45 to 70%) of CPCs when using both images and text. Conclusions: GPT-4V outperformed human respondents on challenging medical cases and was able to synthesize information from both images and text, but performance deteriorated when images were added to highly informative text. Overall, our results suggest that multimodal AI models may be useful in medical diagnostic reasoning but that their accuracy may depend heavily on context.

We present an empirical evaluation of various outputs generated by nine of the most widely-available large language models (LLMs). Our analysis is done with off-the-shelf, readily-available tools. We find a correlation between percentage of memorized text, percentage of unique text, and overall output quality, when measured with respect to output pathologies such as counterfactual and logically-flawed statements, and general failures like not staying on topic. Overall, 80.0% of the outputs evaluated contained memorized data, but outputs containing the most memorized content were also more likely to be considered of high quality. We discuss and evaluate mitigation strategies, showing that, in the models evaluated, the rate of memorized text being output is reduced. We conclude with a discussion on potential implications around what it means to learn, to memorize, and to evaluate quality text.

Clinical trials or studies oftentimes require long-term and/or costly follow-up of participants to evaluate a novel treatment/drug/vaccine. There has been increasing interest in the past few decades in using short-term surrogate outcomes as a replacement of the primary outcome i.e., in using the surrogate outcome, which can potentially be observed sooner, to make inference about the treatment effect on the long-term primary outcome. Very few of the available statistical methods to evaluate a surrogate are applicable to settings where both the surrogate and the primary outcome are time-to-event outcomes subject to censoring. Methods that can handle this setting tend to require parametric assumptions or be limited to assessing only the restricted mean survival time. In this paper, we propose a non-parametric approach to evaluate a censored surrogate outcome, such as time to progression, when the primary outcome is also a censored time-to-event outcome, such as time to death, and the treatment effect of interest is the difference in overall survival. Specifically, we define the proportion of the treatment effect on the primary outcome that is explained (PTE) by the censored surrogate outcome in this context, and estimate this proportion by defining and deriving an optimal transformation of the surrogate information. Our approach provides the added advantage of relaxed assumptions to guarantee that the true PTE is within (0,1), along with being model-free. Finite sample performance of our estimators are illustrated via extensive simulation studies and a real data application examining progression-free survival as a surrogate for overall survival for patients with metastatic colorectal cancer.

Documentation burden is a major contributor to clinician burnout, which is rising nationally and is an urgent threat to our ability to care for patients. Artificial intelligence (AI) chatbots, such as ChatGPT, could reduce clinician burden by assisting with documentation. Although many hospitals are actively integrating such systems into electronic medical record systems, AI chatbots utility and impact on clinical decision-making have not been studied for this intended use. We are the first to examine the utility of large language models in assisting clinicians draft responses to patient questions. In our two-stage cross-sectional study, 6 oncologists responded to 100 realistic synthetic cancer patient scenarios and portal messages developed to reflect common medical situations, first manually, then with AI assistance. We find AI-assisted responses were longer, less readable, but provided acceptable drafts without edits 58% of time. AI assistance improved efficiency 77% of time, with low harm risk (82% safe). However, 7.7% unedited AI responses could severely harm. In 31% cases, physicians thought AI drafts were human-written. AI assistance led to more patient education recommendations, fewer clinical actions than manual responses. Results show promise for AI to improve clinician efficiency and patient care through assisting documentation, if used judiciously. Monitoring model outputs and human-AI interaction remains crucial for safe implementation.

The rapid increase of computed tomography (CT) scans and their time-consuming manual analysis have created an urgent need for robust automated analysis techniques in clinical settings. These aim to assist radiologists and help them managing their growing workload. Existing methods typically generate entire reports directly from 3D CT images, without explicitly focusing on observed abnormalities. This unguided approach often results in repetitive content or incomplete reports, failing to prioritize anomaly-specific descriptions. We propose a new anomaly-guided report generation model, which first predicts abnormalities and then generates targeted descriptions for each. Evaluation on a public dataset demonstrates significant improvements in report quality and clinical relevance. We extend our work by conducting an ablation study to demonstrate its effectiveness.

With the advent of LLMs, various tasks across the natural language processing domain have been transformed. However, their application in predictive tasks remains less researched. This study compares large language models, including GatorTron-Base (trained on clinical data), Llama 8B, and Mistral 7B, against models like BioBERT, DocBERT, BioClinicalBERT, Word2Vec, and Doc2Vec, setting benchmarks for predicting Shock in critically ill patients. Timely prediction of shock can enable early interventions, thus improving patient outcomes. Text data from 17,294 ICU stays of patients in the MIMIC III database were scored for length of stay > 24 hours and shock index (SI) > 0.7 to yield 355 and 87 patients with normal and abnormal SI-index, respectively. Both focal and cross-entropy losses were used during finetuning to address class imbalances. Our findings indicate that while GatorTron Base achieved the highest weighted recall of 80.5%, the overall performance metrics were comparable between SLMs and LLMs. This suggests that LLMs are not inherently superior to SLMs in predicting future clinical events despite their strong performance on text-based tasks. To achieve meaningful clinical outcomes, future efforts in training LLMs should prioritize developing models capable of predicting clinical trajectories rather than focusing on simpler tasks such as named entity recognition or phenotyping.

Objective: Question answering (QA) systems have the potential to improve the quality of clinical care by providing health professionals with the latest and most relevant evidence. However, QA systems have not been widely adopted. This systematic review aims to characterize current medical QA systems, assess their suitability for healthcare, and identify areas of improvement. Materials and methods: We searched PubMed, IEEE Xplore, ACM Digital Library, ACL Anthology and forward and backward citations on 7th February 2023. We included peer-reviewed journal and conference papers describing the design and evaluation of biomedical QA systems. Two reviewers screened titles, abstracts, and full-text articles. We conducted a narrative synthesis and risk of bias assessment for each study. We assessed the utility of biomedical QA systems. Results: We included 79 studies and identified themes, including question realism, answer reliability, answer utility, clinical specialism, systems, usability, and evaluation methods. Clinicians' questions used to train and evaluate QA systems were restricted to certain sources, types and complexity levels. No system communicated confidence levels in the answers or sources. Many studies suffered from high risks of bias and applicability concerns. Only 8 studies completely satisfied any criterion for clinical utility, and only 7 reported user evaluations. Most systems were built with limited input from clinicians. Discussion: While machine learning methods have led to increased accuracy, most studies imperfectly reflected real-world healthcare information needs. Key research priorities include developing more realistic healthcare QA datasets and considering the reliability of answer sources, rather than merely focusing on accuracy.

Current approaches to building general-purpose AI systems tend to produce systems with both beneficial and harmful capabilities. Further progress in AI development could lead to capabilities that pose extreme risks, such as offensive cyber capabilities or strong manipulation skills. We explain why model evaluation is critical for addressing extreme risks. Developers must be able to identify dangerous capabilities (through "dangerous capability evaluations") and the propensity of models to apply their capabilities for harm (through "alignment evaluations"). These evaluations will become critical for keeping policymakers and other stakeholders informed, and for making responsible decisions about model training, deployment, and security.

Global rates of mental health concerns are rising and there is increasing realization that existing models of mental healthcare will not adequately expand to meet the demand. With the emergence of large language models (LLMs) has come great optimism regarding their promise to create novel, large-scale solutions to support mental health. Despite their nascence, LLMs have already been applied to mental health-related tasks. In this review, we summarize the extant literature on efforts to use LLMs to provide mental health education, assessment, and intervention and highlight key opportunities for positive impact in each area. We then highlight risks associated with LLMs application to mental health and encourage adoption of strategies to mitigate these risks. The urgent need for mental health support must be balanced with responsible development, testing, and deployment of mental health LLMs. Especially critical is ensuring that mental health LLMs are fine-tuned for mental health, enhance mental health equity, adhere to ethical standards, and that people, including those with lived experience with mental health concerns, are involved in all stages from development through deployment. Prioritizing these efforts will minimize potential harms to mental health and maximize the likelihood that LLMs will positively impact mental health globally.

Large language models (LLMs) have demonstrated remarkable capabilities in natural language understanding and generation across various domains, including medicine. We present a comprehensive evaluation of GPT-4, a state-of-the-art LLM, on medical competency examinations and benchmark datasets. GPT-4 is a general-purpose model that is not specialized for medical problems through training or engineered to solve clinical tasks. Our analysis covers two sets of official practice materials for the USMLE, a three-step examination program used to assess clinical competency and grant licensure in the United States. We also evaluate performance on the MultiMedQA suite of benchmark datasets. Beyond measuring model performance, experiments were conducted to investigate the influence of test questions containing both text and images on model performance, probe for memorization of content during training, and study probability calibration, which is of critical importance in high-stakes applications like medicine. Our results show that GPT-4, without any specialized prompt crafting, exceeds the passing score on USMLE by over 20 points and outperforms earlier general-purpose models (GPT-3.5) as well as models specifically fine-tuned on medical knowledge (Med-PaLM, a prompt-tuned version of Flan-PaLM 540B). In addition, GPT-4 is significantly better calibrated than GPT-3.5, demonstrating a much-improved ability to predict the likelihood that its answers are correct. We also explore the behavior of the model qualitatively through a case study that shows the ability of GPT-4 to explain medical reasoning, personalize explanations to students, and interactively craft new counterfactual scenarios around a medical case. Implications of the findings are discussed for potential uses of GPT-4 in medical education, assessment, and clinical practice, with appropriate attention to challenges of accuracy and safety.

The ability to measure and track the speed and trajectory of a community's post-disaster recovery is essential to inform resource allocation and prioritization. The current survey-based approaches to examining community recovery, however, have significant lags and put the burden of data collection on affected people. Also, the existing literature lacks quantitative measures for important milestones to inform the assessment of recovery trajectory. Recognizing these gaps, this study uses location-based data related to visitation patterns and credit card transactions to specify critical recovery milestones related to population activity recovery. Using data from 2017 Hurricane Harvey in Harris County (Texas), the study specifies four critical post-disaster recovery milestones and calculates quantitative measurements of the length of time between the end of a hazard event and when the spatial areas (census tracts) reached these milestones based on fluctuations in visits to essential and non-essential facilities, and essential and non-essential credit card transactions. Accordingly, an integrated recovery metric is created for an overall measurement of each spatial area's recovery progression. Exploratory statistical analyses were conducted to examine whether variations in community recovery progression in achieving the critical milestones is correlated to its flood status, socioeconomic characteristics, and demographic composition. Finally, the extent of spatial inequality is examined. The results show the presence of moderate spatial inequality in population activity recovery in Hurricane Harvey, based upon which the inequality of recovery is measured. Results of this study can benefit post-disaster recovery resource allocation as well as improve community resilience towards future natural hazards.

Using Large Language Models (LLMs) for relevance assessments offers promising opportunities to improve Information Retrieval (IR), Natural Language Processing (NLP), and related fields. Indeed, LLMs hold the promise of allowing IR experimenters to build evaluation collections with a fraction of the manual human labor currently required. This could help with fresh topics on which there is still limited knowledge and could mitigate the challenges of evaluating ranking systems in low-resource scenarios, where it is challenging to find human annotators. Given the fast-paced recent developments in the domain, many questions concerning LLMs as assessors are yet to be answered. Among the aspects that require further investigation, we can list the impact of various components in a relevance judgment generation pipeline, such as the prompt used or the LLM chosen. This paper benchmarks and reports on the results of a large-scale automatic relevance judgment evaluation, the LLMJudge challenge at SIGIR 2024, where different relevance assessment approaches were proposed. In detail, we release and benchmark 42 LLM-generated labels of the TREC 2023 Deep Learning track relevance judgments produced by eight international teams who participated in the challenge. Given their diverse nature, these automatically generated relevance judgments can help the community not only investigate systematic biases caused by LLMs but also explore the effectiveness of ensemble models, analyze the trade-offs between different models and human assessors, and advance methodologies for improving automated evaluation techniques. The released resource is available at the following link: https://llm4eval.github.io/LLMJudge-benchmark/

A law practitioner has to go through numerous lengthy legal case proceedings for their practices of various categories, such as land dispute, corruption, etc. Hence, it is important to summarize these documents, and ensure that summaries contain phrases with intent matching the category of the case. To the best of our knowledge, there is no evaluation metric that evaluates a summary based on its intent. We propose an automated intent-based summarization metric, which shows a better agreement with human evaluation as compared to other automated metrics like BLEU, ROUGE-L etc. in terms of human satisfaction. We also curate a dataset by annotating intent phrases in legal documents, and show a proof of concept as to how this system can be automated. Additionally, all the code and data to generate reproducible results is available on Github.

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.

There has been considerable recent interest in scoring properties on the basis of eviction risk. The success of methods for eviction prediction is typically evaluated using different measures of predictive accuracy. However, the underlying goal of such prediction is to direct appropriate assistance to households that may be at greater risk so they remain stably housed. Thus, we must ask the question of how useful such predictions are in targeting outreach efforts - informing action. In this paper, we investigate this question using a novel dataset that matches information on properties, evictions, and owners. We perform an eviction prediction task to produce risk scores and then use these risk scores to plan targeted outreach policies. We show that the risk scores are, in fact, useful, enabling a theoretical team of caseworkers to reach more eviction-prone properties in the same amount of time, compared to outreach policies that are either neighborhood-based or focus on buildings with a recent history of evictions. We also discuss the importance of neighborhood and ownership features in both risk prediction and targeted outreach.

We report the development of GPT-4, a large-scale, multimodal model which can accept image and text inputs and produce text outputs. While less capable than humans in many real-world scenarios, GPT-4 exhibits human-level performance on various professional and academic benchmarks, including passing a simulated bar exam with a score around the top 10% of test takers. GPT-4 is a Transformer-based model pre-trained to predict the next token in a document. The post-training alignment process results in improved performance on measures of factuality and adherence to desired behavior. A core component of this project was developing infrastructure and optimization methods that behave predictably across a wide range of scales. This allowed us to accurately predict some aspects of GPT-4's performance based on models trained with no more than 1/1,000th the compute of GPT-4.

Perception of toxicity evolves over time and often differs between geographies and cultural backgrounds. Similarly, black-box commercially available APIs for detecting toxicity, such as the Perspective API, are not static, but frequently retrained to address any unattended weaknesses and biases. We evaluate the implications of these changes on the reproducibility of findings that compare the relative merits of models and methods that aim to curb toxicity. Our findings suggest that research that relied on inherited automatic toxicity scores to compare models and techniques may have resulted in inaccurate findings. Rescoring all models from HELM, a widely respected living benchmark, for toxicity with the recent version of the API led to a different ranking of widely used foundation models. We suggest caution in applying apples-to-apples comparisons between studies and lay recommendations for a more structured approach to evaluating toxicity over time. Code and data are available at https://github.com/for-ai/black-box-api-challenges.

Objective: BCI (Brain-Computer Interface) technology operates in three modes: online, offline, and pseudo-online. In the online mode, real-time EEG data is constantly analyzed. In offline mode, the signal is acquired and processed afterwards. The pseudo-online mode processes collected data as if they were received in real-time. The main difference is that the offline mode often analyzes the whole data, while the online and pseudo-online modes only analyze data in short time windows. Offline analysis is usually done with asynchronous BCIs, which restricts analysis to predefined time windows. Asynchronous BCI, compatible with online and pseudo-online modes, allows flexible mental activity duration. Offline processing tends to be more accurate, while online analysis is better for therapeutic applications. Pseudo-online implementation approximates online processing without real-time constraints. Many BCI studies being offline introduce biases compared to real-life scenarios, impacting classification algorithm performance. Approach: The objective of this research paper is therefore to extend the current MOABB framework, operating in offline mode, so as to allow a comparison of different algorithms in a pseudo-online setting with the use of a technology based on overlapping sliding windows. To do this will require the introduction of a idle state event in the dataset that takes into account all different possibilities that are not task thinking. To validate the performance of the algorithms we will use the normalized Matthews Correlation Coefficient (nMCC) and the Information Transfer Rate (ITR). Main results: We analyzed the state-of-the-art algorithms of the last 15 years over several Motor Imagery (MI) datasets composed by several subjects, showing the differences between the two approaches from a statistical point of view. Significance: The ability to analyze the performance of different algorithms in offline and pseudo-online modes will allow the BCI community to obtain more accurate and comprehensive reports regarding the performance of classification algorithms.

This research article highlights the potential of AI-powered chatbots in education and presents the results of using ChatGPT, a large language model, to complete the Vietnamese National High School Graduation Examination (VNHSGE). The study dataset included 30 essays in the literature test case and 1,700 multiple-choice questions designed for other subjects. The results showed that ChatGPT was able to pass the examination with an average score of 6-7, demonstrating the technology's potential to revolutionize the educational landscape. The analysis of ChatGPT performance revealed its proficiency in a range of subjects, including mathematics, English, physics, chemistry, biology, history, geography, civic education, and literature, which suggests its potential to provide effective support for learners. However, further research is needed to assess ChatGPT performance on more complex exam questions and its potential to support learners in different contexts. As technology continues to evolve and improve, we can expect to see the use of AI tools like ChatGPT become increasingly common in educational settings, ultimately enhancing the educational experience for both students and educators.

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

This article details the advances made to a system that uses artificial intelligence to identify alarming student responses. This system is built into our assessment platform to assess whether a student's response indicates they are a threat to themselves or others. Such responses may include details concerning threats of violence, severe depression, suicide risks, and descriptions of abuse. Driven by advances in natural language processing, the latest model is a fine-tuned language model trained on a large corpus consisting of student responses and supplementary texts. We demonstrate that the use of a language model delivers a substantial improvement in accuracy over the previous iterations of this system.

This paper reports on the second "Throughput" phase of the Tracking Machine Learning (TrackML) challenge on the Codalab platform. As in the first "Accuracy" phase, the participants had to solve a difficult experimental problem linked to tracking accurately the trajectory of particles as e.g. created at the Large Hadron Collider (LHC): given O(10^5) points, the participants had to connect them into O(10^4) individual groups that represent the particle trajectories which are approximated helical. While in the first phase only the accuracy mattered, the goal of this second phase was a compromise between the accuracy and the speed of inference. Both were measured on the Codalab platform where the participants had to upload their software. The best three participants had solutions with good accuracy and speed an order of magnitude faster than the state of the art when the challenge was designed. Although the core algorithms were less diverse than in the first phase, a diversity of techniques have been used and are described in this paper. The performance of the algorithms are analysed in depth and lessons derived.

The large language model (LLM)-as-judge paradigm has been used to meet the demand for a cheap, reliable, and fast evaluation of model outputs during AI system development and post-deployment monitoring. While judge models -- LLMs finetuned to specialize in assessing and critiquing model outputs -- have been touted as general purpose evaluators, they are typically evaluated only on non-contextual scenarios, such as instruction following. The omission of contextual settings -- those where external information is used as context to generate an output -- is surprising given the increasing prevalence of retrieval-augmented generation (RAG) and summarization use cases. Contextual assessment is uniquely challenging, as evaluation often depends on practitioner priorities, leading to conditional evaluation criteria (e.g., comparing responses based on factuality and then considering completeness if they are equally factual). To address the gap, we propose ContextualJudgeBench, a judge benchmark with 2,000 challenging response pairs across eight splits inspired by real-world contextual evaluation scenarios. We build our benchmark with a multi-pronged data construction pipeline that leverages both existing human annotations and model-based perturbations. Our comprehensive study across 11 judge models and 9 general purpose models, reveals that the contextual information and its assessment criteria present a significant challenge to even state-of-the-art models. For example, OpenAI's o1, the best-performing model, barely reaches 55% consistent accuracy.

With the widespread availability of LLMs since the release of ChatGPT and increased public scrutiny, commercial model development appears to have focused their efforts on 'safety' training concerning legal liabilities at the expense of social impact evaluation. This mimics a similar trend which we could observe for search engine autocompletion some years prior. We draw on scholarship from NLP and search engine auditing and present a novel evaluation task in the style of autocompletion prompts to assess stereotyping in LLMs. We assess LLMs by using four metrics, namely refusal rates, toxicity, sentiment and regard, with and without safety system prompts. Our findings indicate an improvement to stereotyping outputs with the system prompt, but overall a lack of attention by LLMs under study to certain harms classified as toxic, particularly for prompts about peoples/ethnicities and sexual orientation. Mentions of intersectional identities trigger a disproportionate amount of stereotyping. Finally, we discuss the implications of these findings about stereotyping harms in light of the coming intermingling of LLMs and search and the choice of stereotyping mitigation policy to adopt. We address model builders, academics, NLP practitioners and policy makers, calling for accountability and awareness concerning stereotyping harms, be it for training data curation, leader board design and usage, or social impact measurement.

In this report, we introduce NICE (New frontiers for zero-shot Image Captioning Evaluation) project and share the results and outcomes of 2023 challenge. This project is designed to challenge the computer vision community to develop robust image captioning models that advance the state-of-the-art both in terms of accuracy and fairness. Through the challenge, the image captioning models were tested using a new evaluation dataset that includes a large variety of visual concepts from many domains. There was no specific training data provided for the challenge, and therefore the challenge entries were required to adapt to new types of image descriptions that had not been seen during training. This report includes information on the newly proposed NICE dataset, evaluation methods, challenge results, and technical details of top-ranking entries. We expect that the outcomes of the challenge will contribute to the improvement of AI models on various vision-language tasks.

In medical applications, deep learning methods are built to automate diagnostic tasks. However, a clinically relevant question that practitioners usually face, is how to predict the future trajectory of a disease (prognosis). Current methods for such a problem often require domain knowledge, and are complicated to apply. In this paper, we formulate the prognosis prediction problem as a one-to-many forecasting problem from multimodal data. Inspired by a clinical decision-making process with two agents -- a radiologist and a general practitioner, we model a prognosis prediction problem with two transformer-based components that share information between each other. The first block in this model aims to analyze the imaging data, and the second block leverages the internal representations of the first one as inputs, also fusing them with auxiliary patient data. We show the effectiveness of our method in predicting the development of structural knee osteoarthritis changes over time. Our results show that the proposed method outperforms the state-of-the-art baselines in terms of various performance metrics. In addition, we empirically show that the existence of the multi-agent transformers with depths of 2 is sufficient to achieve good performances. Our code is publicly available at https://github.com/MIPT-Oulu/CLIMAT.

Despite advancements in rehabilitation protocols, clinical assessment of upper extremity (UE) function after stroke largely remains subjective, relying heavily on therapist observation and coarse scoring systems. This subjectivity limits the sensitivity of assessments to detect subtle motor improvements, which are critical for personalized rehabilitation planning. Recent progress in computer vision offers promising avenues for enabling objective, quantitative, and scalable assessment of UE motor function. Among standardized tests, the Box and Block Test (BBT) is widely utilized for measuring gross manual dexterity and tracking stroke recovery, providing a structured setting that lends itself well to computational analysis. However, existing datasets targeting stroke rehabilitation primarily focus on daily living activities and often fail to capture clinically structured assessments such as block transfer tasks. Furthermore, many available datasets include a mixture of healthy and stroke-affected individuals, limiting their specificity and clinical utility. To address these critical gaps, we introduce StrokeVision-Bench, the first-ever dedicated dataset of stroke patients performing clinically structured block transfer tasks. StrokeVision-Bench comprises 1,000 annotated videos categorized into four clinically meaningful action classes, with each sample represented in two modalities: raw video frames and 2D skeletal keypoints. We benchmark several state-of-the-art video action recognition and skeleton-based action classification methods to establish performance baselines for this domain and facilitate future research in automated stroke rehabilitation assessment.

Nearly all jurisdictions in the United States require a professional license exam, commonly referred to as "the Bar Exam," as a precondition for law practice. To even sit for the exam, most jurisdictions require that an applicant completes at least seven years of post-secondary education, including three years at an accredited law school. In addition, most test-takers also undergo weeks to months of further, exam-specific preparation. Despite this significant investment of time and capital, approximately one in five test-takers still score under the rate required to pass the exam on their first try. In the face of a complex task that requires such depth of knowledge, what, then, should we expect of the state of the art in "AI?" In this research, we document our experimental evaluation of the performance of OpenAI's `text-davinci-003` model, often-referred to as GPT-3.5, on the multistate multiple choice (MBE) section of the exam. While we find no benefit in fine-tuning over GPT-3.5's zero-shot performance at the scale of our training data, we do find that hyperparameter optimization and prompt engineering positively impacted GPT-3.5's zero-shot performance. For best prompt and parameters, GPT-3.5 achieves a headline correct rate of 50.3% on a complete NCBE MBE practice exam, significantly in excess of the 25% baseline guessing rate, and performs at a passing rate for both Evidence and Torts. GPT-3.5's ranking of responses is also highly-correlated with correctness; its top two and top three choices are correct 71% and 88% of the time, respectively, indicating very strong non-entailment performance. While our ability to interpret these results is limited by nascent scientific understanding of LLMs and the proprietary nature of GPT, we believe that these results strongly suggest that an LLM will pass the MBE component of the Bar Exam in the near future.

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

Introduction. Generative Artificial Intelligence, particularly large language models (LLMs), offers transformative potential for Health Economics and Outcomes Research (HEOR). However, evaluating the quality, transparency, and rigor of LLM-assisted research lacks standardized guidance. This article introduces the ELEVATE AI LLMs framework and checklist, designed to support researchers and reviewers in assessing LLM use in HEOR. Methods. The ELEVATE AI LLMs framework was developed through a targeted review of existing guidelines and evaluation frameworks. The framework comprises ten evaluation domains, including model characteristics, accuracy, comprehensiveness, and fairness. The accompanying checklist operationalizes the framework. To validate the framework, we applied it to two published studies, demonstrating its usability across different HEOR tasks. Results. The ELEVATE AI LLMs framework provides a comprehensive structure for evaluating LLM-assisted research, while the checklist facilitates practical application. Validation of the framework and checklist on studies of systematic literature reviews and health economic modeling highlighted their ability to identify strengths and gaps in reporting. Limitations. While the ELEVATE AI LLMs framework provides robust guidance, its broader generalizability and applicability to diverse HEOR tasks require further empirical testing. Additionally, several metrics adapted from computer science need further validation in HEOR contexts. Conclusion. The ELEVATE AI LLMs framework and checklist fill a critical gap in HEOR by offering structured guidance for evaluating LLM-assisted research. By promoting transparency, accuracy, and reproducibility, they aim to standardize and improve the integration of LLMs into HEOR, ensuring their outputs meet the field's rigorous standards.

Social media has become a valuable resource for the study of suicidal ideation and the assessment of suicide risk. Among social media platforms, Reddit has emerged as the most promising one due to its anonymity and its focus on topic-based communities (subreddits) that can be indicative of someone's state of mind or interest regarding mental health disorders such as r/SuicideWatch, r/Anxiety, r/depression. A challenge for previous work on suicide risk assessment has been the small amount of labeled data. We propose an empirical investigation into several classes of weakly-supervised approaches, and show that using pseudo-labeling based on related issues around mental health (e.g., anxiety, depression) helps improve model performance for suicide risk assessment.

Differential diagnosis is crucial for medicine as it helps healthcare providers systematically distinguish between conditions that share similar symptoms. This study assesses the impact of lab test results on differential diagnoses (DDx) made by large language models (LLMs). Clinical vignettes from 50 case reports from PubMed Central were created incorporating patient demographics, symptoms, and lab results. Five LLMs GPT-4, GPT-3.5, Llama-2-70b, Claude-2, and Mixtral-8x7B were tested to generate Top 10, Top 5, and Top 1 DDx with and without lab data. A comprehensive evaluation involving GPT-4, a knowledge graph, and clinicians was conducted. GPT-4 performed best, achieving 55% accuracy for Top 1 diagnoses and 60% for Top 10 with lab data, with lenient accuracy up to 80%. Lab results significantly improved accuracy, with GPT-4 and Mixtral excelling, though exact match rates were low. Lab tests, including liver function, metabolic/toxicology panels, and serology/immune tests, were generally interpreted correctly by LLMs for differential diagnosis.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare seven public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting regime for medical question-answering (QA) tasks. For instance, across the tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 12.1% of cases, reach a (statistical) tie in 49.8% of cases, and are significantly worse than their base models in the remaining 38.2% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

We present a radiology-specific multimodal model for the task for generating radiological reports from chest X-rays (CXRs). Our work builds on the idea that large language model(s) can be equipped with multimodal capabilities through alignment with pre-trained vision encoders. On natural images, this has been shown to allow multimodal models to gain image understanding and description capabilities. Our proposed model (MAIRA-1) leverages a CXR-specific image encoder in conjunction with a fine-tuned large language model based on Vicuna-7B, and text-based data augmentation, to produce reports with state-of-the-art quality. In particular, MAIRA-1 significantly improves on the radiologist-aligned RadCliQ metric and across all lexical metrics considered. Manual review of model outputs demonstrates promising fluency and accuracy of generated reports while uncovering failure modes not captured by existing evaluation practices. More information and resources can be found on the project website: https://aka.ms/maira.

KT developed a Responsible AI (RAI) assessment methodology and risk mitigation technologies to ensure the safety and reliability of AI services. By analyzing the Basic Act on AI implementation and global AI governance trends, we established a unique approach for regulatory compliance and systematically identify and manage all potential risk factors from AI development to operation. We present a reliable assessment methodology that systematically verifies model safety and robustness based on KT's AI risk taxonomy tailored to the domestic environment. We also provide practical tools for managing and mitigating identified AI risks. With the release of this report, we also release proprietary Guardrail : SafetyGuard that blocks harmful responses from AI models in real-time, supporting the enhancement of safety in the domestic AI development ecosystem. We also believe these research outcomes provide valuable insights for organizations seeking to develop Responsible AI.

Unstructured clinical notes contain essential patient information but are challenging for physicians to search and interpret efficiently. Although large language models (LLMs) have shown promise in question answering (QA), most existing systems lack transparency, usability, and alignment with clinical workflows. This work introduces an interactive QA system that enables physicians to query clinical notes via text or voice and receive extractive answers highlighted directly in the note for traceability. The system was built using OpenAI models with zero-shot prompting and evaluated across multiple metrics, including exact string match, word overlap, SentenceTransformer similarity, and BERTScore. Results show that while exact match scores ranged from 47 to 62 percent, semantic similarity scores exceeded 87 percent, indicating strong contextual alignment even when wording varied. To assess usability, the system was also evaluated using simulated clinical personas. Seven diverse physician and nurse personas interacted with the system across scenario-based tasks and provided structured feedback. The evaluations highlighted strengths in intuitive design and answer accessibility, alongside opportunities for enhancing explanation clarity.

Researchers and developers increasingly rely on toxicity scoring to moderate generative language model outputs, in settings such as customer service, information retrieval, and content generation. However, toxicity scoring may render pertinent information inaccessible, rigidify or "value-lock" cultural norms, and prevent language reclamation processes, particularly for marginalized people. In this work, we extend the concept of algorithmic recourse to generative language models: we provide users a novel mechanism to achieve their desired prediction by dynamically setting thresholds for toxicity filtering. Users thereby exercise increased agency relative to interactions with the baseline system. A pilot study (n = 30) supports the potential of our proposed recourse mechanism, indicating improvements in usability compared to fixed-threshold toxicity-filtering of model outputs. Future work should explore the intersection of toxicity scoring, model controllability, user agency, and language reclamation processes -- particularly with regard to the bias that many communities encounter when interacting with generative language models.

An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.

The effectiveness of feedback in enhancing learning outcomes is well documented within Educational Data Mining (EDM). Various prior research has explored methodologies to enhance the effectiveness of feedback. Recent developments in Large Language Models (LLMs) have extended their utility in enhancing automated feedback systems. This study aims to explore the potential of LLMs in facilitating automated feedback in math education. We examine the effectiveness of LLMs in evaluating student responses by comparing 3 different models: Llama, SBERT-Canberra, and GPT4 model. The evaluation requires the model to provide both a quantitative score and qualitative feedback on the student's responses to open-ended math problems. We employ Mistral, a version of Llama catered to math, and fine-tune this model for evaluating student responses by leveraging a dataset of student responses and teacher-written feedback for middle-school math problems. A similar approach was taken for training the SBERT model as well, while the GPT4 model used a zero-shot learning approach. We evaluate the model's performance in scoring accuracy and the quality of feedback by utilizing judgments from 2 teachers. The teachers utilized a shared rubric in assessing the accuracy and relevance of the generated feedback. We conduct both quantitative and qualitative analyses of the model performance. By offering a detailed comparison of these methods, this study aims to further the ongoing development of automated feedback systems and outlines potential future directions for leveraging generative LLMs to create more personalized learning experiences.

Access to the right evidence does not guarantee that large language models (LLMs) will reason with it correctly. This gap between retrieval and reasoning is especially concerning in clinical settings, where outputs must align with structured protocols. We study this gap using Written Exposure Therapy (WET) guidelines as a testbed. In evaluating model responses to curated clinician-vetted questions, we find that errors persist even when authoritative passages are provided. To address this, we propose an evaluation framework that measures accuracy, consistency, and fidelity of reasoning. Our results highlight both the potential and the risks: retrieval-augmented generation (RAG) can constrain outputs, but safe deployment requires assessing reasoning as rigorously as retrieval.

Purpose: In radiology, large language models (LLMs), including ChatGPT, have recently gained attention, and their utility is being rapidly evaluated. However, concerns have emerged regarding their reliability in clinical applications due to limitations such as hallucinations and insufficient referencing. To address these issues, we focus on the latest technology, retrieval-augmented generation (RAG), which enables LLMs to reference reliable external knowledge (REK). Specifically, this study examines the utility and reliability of a recently released RAG-equipped LLM (RAG-LLM), NotebookLM, for staging lung cancer. Materials and methods: We summarized the current lung cancer staging guideline in Japan and provided this as REK to NotebookLM. We then tasked NotebookLM with staging 100 fictional lung cancer cases based on CT findings and evaluated its accuracy. For comparison, we performed the same task using a gold-standard LLM, GPT-4 Omni (GPT-4o), both with and without the REK. Results: NotebookLM achieved 86% diagnostic accuracy in the lung cancer staging experiment, outperforming GPT-4o, which recorded 39% accuracy with the REK and 25% without it. Moreover, NotebookLM demonstrated 95% accuracy in searching reference locations within the REK. Conclusion: NotebookLM successfully performed lung cancer staging by utilizing the REK, demonstrating superior performance compared to GPT-4o. Additionally, it provided highly accurate reference locations within the REK, allowing radiologists to efficiently evaluate the reliability of NotebookLM's responses and detect possible hallucinations. Overall, this study highlights the potential of NotebookLM, a RAG-LLM, in image diagnosis.

Recent research on large language models (LLMs) has primarily focused on their adaptation and application in specialized domains. The application of LLMs in the medical field is mainly concentrated on tasks such as the automation of medical report generation, summarization, diagnostic reasoning, and question-and-answer interactions between doctors and patients. The challenge of becoming a good teacher is more formidable than that of becoming a good student, and this study pioneers the application of LLMs in the field of medical education. In this work, we investigate the extent to which LLMs can generate medical qualification exam questions and corresponding answers based on few-shot prompts. Utilizing a real-world Chinese dataset of elderly chronic diseases, we tasked the LLMs with generating open-ended questions and answers based on a subset of sampled admission reports across eight widely used LLMs, including ERNIE 4, ChatGLM 4, Doubao, Hunyuan, Spark 4, Qwen, Llama 3, and Mistral. Furthermore, we engaged medical experts to manually evaluate these open-ended questions and answers across multiple dimensions. The study found that LLMs, after using few-shot prompts, can effectively mimic real-world medical qualification exam questions, whereas there is room for improvement in the correctness, evidence-based statements, and professionalism of the generated answers. Moreover, LLMs also demonstrate a decent level of ability to correct and rectify reference answers. Given the immense potential of artificial intelligence in the medical field, the task of generating questions and answers for medical qualification exams aimed at medical students, interns and residents can be a significant focus of future research.

Assessment and evaluation have long been critical challenges in artificial intelligence (AI) and natural language processing (NLP). However, traditional methods, whether matching-based or embedding-based, often fall short of judging subtle attributes and delivering satisfactory results. Recent advancements in Large Language Models (LLMs) inspire the "LLM-as-a-judge" paradigm, where LLMs are leveraged to perform scoring, ranking, or selection across various tasks and applications. This paper provides a comprehensive survey of LLM-based judgment and assessment, offering an in-depth overview to advance this emerging field. We begin by giving detailed definitions from both input and output perspectives. Then we introduce a comprehensive taxonomy to explore LLM-as-a-judge from three dimensions: what to judge, how to judge and where to judge. Finally, we compile benchmarks for evaluating LLM-as-a-judge and highlight key challenges and promising directions, aiming to provide valuable insights and inspire future research in this promising research area. Paper list and more resources about LLM-as-a-judge can be found at https://github.com/llm-as-a-judge/Awesome-LLM-as-a-judge and https://llm-as-a-judge.github.io.

This study investigates the consistency of feedback ratings generated by OpenAI's GPT-4, a state-of-the-art artificial intelligence language model, across multiple iterations, time spans and stylistic variations. The model rated responses to tasks within the Higher Education (HE) subject domain of macroeconomics in terms of their content and style. Statistical analysis was conducted in order to learn more about the interrater reliability, consistency of the ratings across iterations and the correlation between ratings in terms of content and style. The results revealed a high interrater reliability with ICC scores ranging between 0.94 and 0.99 for different timespans, suggesting that GPT-4 is capable of generating consistent ratings across repetitions with a clear prompt. Style and content ratings show a high correlation of 0.87. When applying a non-adequate style the average content ratings remained constant, while style ratings decreased, which indicates that the large language model (LLM) effectively distinguishes between these two criteria during evaluation. The prompt used in this study is furthermore presented and explained. Further research is necessary to assess the robustness and reliability of AI models in various use cases.

Ranking and scoring are ubiquitous. We consider the setting in which an institution, called a ranker, evaluates a set of individuals based on demographic, behavioral or other characteristics. The final output is a ranking that represents the relative quality of the individuals. While automatic and therefore seemingly objective, rankers can, and often do, discriminate against individuals and systematically disadvantage members of protected groups. This warrants a careful study of the fairness of a ranking scheme. In this paper we propose fairness measures for ranked outputs. We develop a data generation procedure that allows us to systematically control the degree of unfairness in the output, and study the behavior of our measures on these datasets. We then apply our proposed measures to several real datasets, and demonstrate cases of unfairness. Finally, we show preliminary results of incorporating our ranked fairness measures into an optimization framework, and show potential for improving fairness of ranked outputs while maintaining accuracy.

Predicting case outcomes is useful but still an extremely hard task for attorneys and other Law professionals. It is not easy to search case information to extract valuable information as this requires dealing with huge data sets and their complexity. For instance, the complexity of Brazil legal system along with the high litigation rates makes this problem even harder. This paper introduces an approach for predicting Brazilian court decisions which is also able to predict whether the decision will be unanimous. We developed a working prototype which performs 79% of accuracy (F1-score) on a data set composed of 4,043 cases from a Brazilian court. To our knowledge, this is the first study to forecast judge decisions in Brazil.

Safe and trustworthy use of Large Language Models (LLM) in the processing of healthcare documents and scientific papers could substantially help clinicians, scientists and policymakers in overcoming information overload and focusing on the most relevant information at a given moment. Retrieval Augmented Generation (RAG) is a promising method to leverage the potential of LLMs while enhancing the accuracy of their outcomes. This report assesses the potentials and shortcomings of such approaches in the automatic knowledge synthesis of different types of documents in the health domain. To this end, it describes: (1) an internally developed proof of concept pipeline that employs state-of-the-art practices to deliver safe and trustable analysis for healthcare documents and scientific papers called RAGEv (Retrieval Augmented Generation Evaluation); (2) a set of evaluation tools for LLM-based document retrieval and generation; (3) a benchmark dataset to verify the accuracy and veracity of the results called RAGEv-Bench. It concludes that careful implementations of RAG techniques could minimize most of the common problems in the use of LLMs for document processing in the health domain, obtaining very high scores both on short yes/no answers and long answers. There is a high potential for incorporating it into the day-to-day work of policy support tasks, but additional efforts are required to obtain a consistent and trustworthy tool.

Abstention Ability (AA) is a critical aspect of Large Language Model (LLM) reliability, referring to an LLM's capability to withhold responses when uncertain or lacking a definitive answer, without compromising performance. Although previous studies have attempted to improve AA, they lack a standardised evaluation method and remain unsuitable for black-box models where token prediction probabilities are inaccessible. This makes comparative analysis challenging, especially for state-of-the-art closed-source commercial LLMs. This paper bridges this gap by introducing a black-box evaluation approach and a new dataset, Abstain-QA, crafted to rigorously assess AA across varied question types (answerable and unanswerable), domains (well-represented and under-represented), and task types (fact centric and reasoning). We also propose a new confusion matrix, the ''Answerable-Unanswerable Confusion Matrix'' (AUCM) which serves as the basis for evaluating AA, by offering a structured and precise approach for assessment. Finally, we explore the impact of three prompting strategies-Strict Prompting, Verbal Confidence Thresholding, and Chain-of-Thought (CoT)-on improving AA. Our results indicate that even powerful models like GPT-4, Mixtral 8x22b encounter difficulties with abstention; however, strategic approaches such as Strict prompting and CoT can enhance this capability.

Medical large language models (LLMs) research often makes bold claims, from encoding clinical knowledge to reasoning like a physician. These claims are usually backed by evaluation on competitive benchmarks; a tradition inherited from mainstream machine learning. But how do we separate real progress from a leaderboard flex? Medical LLM benchmarks, much like those in other fields, are arbitrarily constructed using medical licensing exam questions. For these benchmarks to truly measure progress, they must accurately capture the real-world tasks they aim to represent. In this position paper, we argue that medical LLM benchmarks should (and indeed can) be empirically evaluated for their construct validity. In the psychological testing literature, "construct validity" refers to the ability of a test to measure an underlying "construct", that is the actual conceptual target of evaluation. By drawing an analogy between LLM benchmarks and psychological tests, we explain how frameworks from this field can provide empirical foundations for validating benchmarks. To put these ideas into practice, we use real-world clinical data in proof-of-concept experiments to evaluate popular medical LLM benchmarks and report significant gaps in their construct validity. Finally, we outline a vision for a new ecosystem of medical LLM evaluation centered around the creation of valid benchmarks.

Knee osteoarthritis (OA) is one of the highest disability factors in the world. This musculoskeletal disorder is assessed from clinical symptoms, and typically confirmed via radiographic assessment. This visual assessment done by a radiologist requires experience, and suffers from moderate to high inter-observer variability. The recent literature has shown that deep learning methods can reliably perform the OA severity assessment according to the gold standard Kellgren-Lawrence (KL) grading system. However, these methods require large amounts of labeled data, which are costly to obtain. In this study, we propose the Semixup algorithm, a semi-supervised learning (SSL) approach to leverage unlabeled data. Semixup relies on consistency regularization using in- and out-of-manifold samples, together with interpolated consistency. On an independent test set, our method significantly outperformed other state-of-the-art SSL methods in most cases. Finally, when compared to a well-tuned fully supervised baseline that yielded a balanced accuracy (BA) of 70.9pm0.8% on the test set, Semixup had comparable performance -- BA of 71pm0.8% (p=0.368) while requiring 6 times less labeled data. These results show that our proposed SSL method allows building fully automatic OA severity assessment tools with datasets that are available outside research settings.

How do we most effectively treat a disease or condition? Ideally, we could consult a database of evidence gleaned from clinical trials to answer such questions. Unfortunately, no such database exists; clinical trial results are instead disseminated primarily via lengthy natural language articles. Perusing all such articles would be prohibitively time-consuming for healthcare practitioners; they instead tend to depend on manually compiled systematic reviews of medical literature to inform care. NLP may speed this process up, and eventually facilitate immediate consult of published evidence. The Evidence Inference dataset was recently released to facilitate research toward this end. This task entails inferring the comparative performance of two treatments, with respect to a given outcome, from a particular article (describing a clinical trial) and identifying supporting evidence. For instance: Does this article report that chemotherapy performed better than surgery for five-year survival rates of operable cancers? In this paper, we collect additional annotations to expand the Evidence Inference dataset by 25\%, provide stronger baseline models, systematically inspect the errors that these make, and probe dataset quality. We also release an abstract only (as opposed to full-texts) version of the task for rapid model prototyping. The updated corpus, documentation, and code for new baselines and evaluations are available at http://evidence-inference.ebm-nlp.com/.

Prompting large language models (LLMs) to evaluate generated text, known as LLM-as-a-judge, has become a standard evaluation approach in natural language generation (NLG), but is primarily used as a quantitative tool, i.e. with numerical scores as main outputs. In this work, we propose LLM-as-a-qualitative-judge, an LLM-based evaluation approach with the main output being a structured report of common issue types in the NLG system outputs. Our approach is targeted at providing developers with meaningful insights on what improvements can be done to a given NLG system and consists of two main steps, namely open-ended per-instance issue analysis and clustering of the discovered issues using an intuitive cumulative algorithm. We also introduce a strategy for evaluating the proposed approach, coupled with ~300 annotations of issues in instances from 12 NLG datasets. Our results show that LLM-as-a-qualitative-judge correctly recognizes instance-specific issues in 2/3 cases and is capable of producing error type reports resembling the reports composed by human annotators. Our code and data are publicly available at https://github.com/tunde-ajayi/llm-as-a-qualitative-judge.

We present a framework for the automated measurement of responsible AI (RAI) metrics for large language models (LLMs) and associated products and services. Our framework for automatically measuring harms from LLMs builds on existing technical and sociotechnical expertise and leverages the capabilities of state-of-the-art LLMs, such as GPT-4. We use this framework to run through several case studies investigating how different LLMs may violate a range of RAI-related principles. The framework may be employed alongside domain-specific sociotechnical expertise to create measurements for new harm areas in the future. By implementing this framework, we aim to enable more advanced harm measurement efforts and further the responsible use of LLMs.

Global comparisons of wellbeing increasingly rely on survey questions that ask respondents to evaluate their lives, most commonly in the form of "life satisfaction" and "Cantril ladder" items. These measures underpin international rankings such as the World Happiness Report and inform policy initiatives worldwide, yet their comparability has not been established with contemporary global data. Using the Gallup World Poll, Global Flourishing Study, and World Values Survey, I show that the two question formats yield divergent distributions, rankings, and response patterns that vary across countries and surveys, defying simple explanations. To explore differences in respondents' cognitive interpretations, I compare regression coefficients from the Global Flourishing Study, analyzing how each question wording relates to life circumstances. While international rankings of wellbeing are unstable, the scientific study of the determinants of life evaluations appears more robust. Together, the findings underscore the need for a renewed research agenda on critical limitations to cross-country comparability of wellbeing.

A significant body of recent research in the field of Learning Analytics has focused on leveraging machine learning approaches for predicting at-risk students in order to initiate timely interventions and thereby elevate retention and completion rates. The overarching feature of the majority of these research studies has been on the science of prediction only. The component of predictive analytics concerned with interpreting the internals of the models and explaining their predictions for individual cases to stakeholders has largely been neglected. Additionally, works that attempt to employ data-driven prescriptive analytics to automatically generate evidence-based remedial advice for at-risk learners are in their infancy. eXplainable AI is a field that has recently emerged providing cutting-edge tools which support transparent predictive analytics and techniques for generating tailored advice for at-risk students. This study proposes a novel framework that unifies both transparent machine learning as well as techniques for enabling prescriptive analytics, while integrating the latest advances in large language models. This work practically demonstrates the proposed framework using predictive models for identifying at-risk learners of programme non-completion. The study then further demonstrates how predictive modelling can be augmented with prescriptive analytics on two case studies in order to generate human-readable prescriptive feedback for those who are at risk using ChatGPT.

Large language models (LLMs) have shown remarkable progress in encoding clinical knowledge and responding to complex medical queries with appropriate clinical reasoning. However, their applicability in subspecialist or complex medical settings remains underexplored. In this work, we probe the performance of AMIE, a research conversational diagnostic AI system, in the subspecialist domain of breast oncology care without specific fine-tuning to this challenging domain. To perform this evaluation, we curated a set of 50 synthetic breast cancer vignettes representing a range of treatment-naive and treatment-refractory cases and mirroring the key information available to a multidisciplinary tumor board for decision-making (openly released with this work). We developed a detailed clinical rubric for evaluating management plans, including axes such as the quality of case summarization, safety of the proposed care plan, and recommendations for chemotherapy, radiotherapy, surgery and hormonal therapy. To improve performance, we enhanced AMIE with the inference-time ability to perform web search retrieval to gather relevant and up-to-date clinical knowledge and refine its responses with a multi-stage self-critique pipeline. We compare response quality of AMIE with internal medicine trainees, oncology fellows, and general oncology attendings under both automated and specialist clinician evaluations. In our evaluations, AMIE outperformed trainees and fellows demonstrating the potential of the system in this challenging and important domain. We further demonstrate through qualitative examples, how systems such as AMIE might facilitate conversational interactions to assist clinicians in their decision making. However, AMIE's performance was overall inferior to attending oncologists suggesting that further research is needed prior to consideration of prospective uses.

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.

Automatically summarizing patients' main problems from daily progress notes using natural language processing methods helps to battle against information and cognitive overload in hospital settings and potentially assists providers with computerized diagnostic decision support. Problem list summarization requires a model to understand, abstract, and generate clinical documentation. In this work, we propose a new NLP task that aims to generate a list of problems in a patient's daily care plan using input from the provider's progress notes during hospitalization. We investigate the performance of T5 and BART, two state-of-the-art seq2seq transformer architectures, in solving this problem. We provide a corpus built on top of progress notes from publicly available electronic health record progress notes in the Medical Information Mart for Intensive Care (MIMIC)-III. T5 and BART are trained on general domain text, and we experiment with a data augmentation method and a domain adaptation pre-training method to increase exposure to medical vocabulary and knowledge. Evaluation methods include ROUGE, BERTScore, cosine similarity on sentence embedding, and F-score on medical concepts. Results show that T5 with domain adaptive pre-training achieves significant performance gains compared to a rule-based system and general domain pre-trained language models, indicating a promising direction for tackling the problem summarization task.

The global economy is increasingly dependent on knowledge workers to meet the needs of public and private organizations. While there is no single definition of knowledge work, organizations and industry groups still attempt to measure individuals' capability to engage in it. The most comprehensive assessment of capability readiness for professional knowledge workers is the Uniform CPA Examination developed by the American Institute of Certified Public Accountants (AICPA). In this paper, we experimentally evaluate OpenAI's `text-davinci-003` and prior versions of GPT on both a sample Regulation (REG) exam and an assessment of over 200 multiple-choice questions based on the AICPA Blueprints for legal, financial, accounting, technology, and ethical tasks. First, we find that `text-davinci-003` achieves a correct rate of 14.4% on a sample REG exam section, significantly underperforming human capabilities on quantitative reasoning in zero-shot prompts. Second, `text-davinci-003` appears to be approaching human-level performance on the Remembering & Understanding and Application skill levels in the Exam absent calculation. For best prompt and parameters, the model answers 57.6% of questions correctly, significantly better than the 25% guessing rate, and its top two answers are correct 82.1% of the time, indicating strong non-entailment. Finally, we find that recent generations of GPT-3 demonstrate material improvements on this assessment, rising from 30% for `text-davinci-001` to 57% for `text-davinci-003`. These findings strongly suggest that large language models have the potential to transform the quality and efficiency of future knowledge work.

Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting 35% of extremely low birth weight infants. Defined by oxygen dependence at 36 weeks postmenstrual age, it causes lifelong respiratory complications. However, preventive interventions carry severe risks, including neurodevelopmental impairment, ventilator-induced lung injury, and systemic complications. Therefore, early BPD prognosis and prediction of BPD outcome is crucial to avoid unnecessary toxicity in low risk infants. Admission radiographs of extremely preterm infants are routinely acquired within 24h of life and could serve as a non-invasive prognostic tool. In this work, we developed and investigated a deep learning approach using chest X-rays from 163 extremely low-birth-weight infants (leq32 weeks gestation, 401-999g) obtained within 24 hours of birth. We fine-tuned a ResNet-50 pretrained specifically on adult chest radiographs, employing progressive layer freezing with discriminative learning rates to prevent overfitting and evaluated a CutMix augmentation and linear probing. For moderate/severe BPD outcome prediction, our best performing model with progressive freezing, linear probing and CutMix achieved an AUROC of 0.78 pm 0.10, balanced accuracy of 0.69 pm 0.10, and an F1-score of 0.67 pm 0.11. In-domain pre-training significantly outperformed ImageNet initialization (p = 0.031) which confirms domain-specific pretraining to be important for BPD outcome prediction. Routine IRDS grades showed limited prognostic value (AUROC 0.57 pm 0.11), confirming the need of learned markers. Our approach demonstrates that domain-specific pretraining enables accurate BPD prediction from routine day-1 radiographs. Through progressive freezing and linear probing, the method remains computationally feasible for site-level implementation and future federated learning deployments.

Large Language Models (LLMs) have shown promise in accelerating the scientific research pipeline. A key capability for this process is the ability to generate novel research ideas, and prior studies have found settings in which LLM-generated research ideas were judged as more novel than human-expert ideas. However, a good idea should not simply appear to be novel, it should also result in better research after being executed. To test whether AI-generated ideas lead to better research outcomes, we conduct an execution study by recruiting 43 expert researchers to execute randomly-assigned ideas, either written by experts or generated by an LLM. Each expert spent over 100 hours implementing the idea and wrote a 4-page short paper to document the experiments. All the executed projects are then reviewed blindly by expert NLP researchers. Comparing the review scores of the same ideas before and after execution, the scores of the LLM-generated ideas decrease significantly more than expert-written ideas on all evaluation metrics (novelty, excitement, effectiveness, and overall; p < 0.05), closing the gap between LLM and human ideas observed at the ideation stage. When comparing the aggregated review scores from the execution study, we even observe that for many metrics there is a flip in rankings where human ideas score higher than LLM ideas. This ideation-execution gap highlights the limitations of current LLMs in generating truly effective research ideas and the challenge of evaluating research ideas in the absence of execution outcomes.

We describe recent research on the use of actual causality in the definition of responsibility scores as explanations for query answers in databases, and for outcomes from classification models in machine learning. In the case of databases, useful connections with database repairs are illustrated and exploited. Repairs are also used to give a quantitative measure of the consistency of a database. For classification models, the responsibility score is properly extended and illustrated. The efficient computation of Shap-score is also analyzed and discussed. The emphasis is placed on work done by the author and collaborators.

Recent developments in Generative Artificial Intelligence (GenAI) have created significant uncertainty in education, particularly in terms of assessment practices. Against this backdrop, we present an updated version of the AI Assessment Scale (AIAS), a framework with two fundamental purposes: to facilitate open dialogue between educators and students about appropriate GenAI use and to support educators in redesigning assessments in an era of expanding AI capabilities. Grounded in social constructivist principles and designed with assessment validity in mind, the AIAS provides a structured yet flexible approach that can be adapted across different educational contexts. Building on implementation feedback from global adoption across both the K-12 and higher education contexts, this revision represents a significant change from the original AIAS. Among these changes is a new visual guide that moves beyond the original traffic light system and utilises a neutral colour palette that avoids implied hierarchies between the levels. The scale maintains five distinct levels of GenAI integration in assessment, from "No AI" to "AI Exploration", but has been refined to better reflect rapidly advancing technological capabilities and emerging pedagogical needs. This paper presents the theoretical foundations of the revised framework, provides detailed implementation guidance through practical vignettes, and discusses its limitations and future directions. As GenAI capabilities continue to expand, particularly in multimodal content generation, the AIAS offers a starting point for reimagining assessment design in an era of disruptive technologies.

We present the system description for our submission towards the Key Point Analysis Shared Task at ArgMining 2021. Track 1 of the shared task requires participants to develop methods to predict the match score between each pair of arguments and keypoints, provided they belong to the same topic under the same stance. We leveraged existing state of the art pre-trained language models along with incorporating additional data and features extracted from the inputs (topics, key points, and arguments) to improve performance. We were able to achieve mAP strict and mAP relaxed score of 0.872 and 0.966 respectively in the evaluation phase, securing 5th place on the leaderboard. In the post evaluation phase, we achieved a mAP strict and mAP relaxed score of 0.921 and 0.982 respectively. All the codes to generate reproducible results on our models are available on Github.

When evaluating large language models (LLMs) with multiple-choice question answering (MCQA), it is common to end the prompt with the string "Answer:" to facilitate automated answer extraction via next-token probabilities. However, there is no consensus on how to tokenize the space following the colon, often overlooked as a trivial choice. In this paper, we uncover accuracy differences of up to 11% due to this (seemingly irrelevant) tokenization variation as well as reshuffled model rankings, raising concerns about the reliability of LLM comparisons in prior work. Surprisingly, we are able to recommend one specific strategy -- tokenizing the space together with the answer letter -- as we observe consistent and statistically significant performance improvements. Additionally, it improves model calibration, enhancing the reliability of the model's confidence estimates. Our findings underscore the importance of careful evaluation design and highlight the need for standardized, transparent evaluation protocols to ensure reliable and comparable results.

Multiple choice benchmarks have long been the workhorse of language model evaluation because grading multiple choice is objective and easy to automate. However, we show multiple choice questions from popular benchmarks can often be answered without even seeing the question. These shortcuts arise from a fundamental limitation of discriminative evaluation not shared by evaluations of the model's free-form, generative answers. Until recently, there appeared to be no viable, scalable alternative to multiple choice--but, we show that this has changed. We consider generative evaluation via what we call answer matching: Give the candidate model the question without the options, have it generate a free-form response, then use a modern language model with the reference answer to determine if the response matches the reference. To compare the validity of different evaluation strategies, we annotate MMLU-Pro and GPQA-Diamond to obtain human grading data, and measure the agreement of each evaluation approach. We find answer matching using recent models--even small ones--achieves near-perfect agreement, in the range of inter-annotator agreement. In contrast, both multiple choice evaluation and using LLM-as-a-judge without reference answers aligns poorly with human grading. Improving evaluations via answer matching is not merely a conceptual concern: the rankings of several models change significantly when evaluating their free-form responses with answer matching. In light of these findings, we discuss how to move the evaluation ecosystem from multiple choice to answer matching.

Purpose: To evaluate the performance of an automated deep learning method in detecting ascites and subsequently quantifying its volume in patients with liver cirrhosis and ovarian cancer. Materials and Methods: This retrospective study included contrast-enhanced and non-contrast abdominal-pelvic CT scans of patients with cirrhotic ascites and patients with ovarian cancer from two institutions, National Institutes of Health (NIH) and University of Wisconsin (UofW). The model, trained on The Cancer Genome Atlas Ovarian Cancer dataset (mean age, 60 years +/- 11 [s.d.]; 143 female), was tested on two internal (NIH-LC and NIH-OV) and one external dataset (UofW-LC). Its performance was measured by the Dice coefficient, standard deviations, and 95% confidence intervals, focusing on ascites volume in the peritoneal cavity. Results: On NIH-LC (25 patients; mean age, 59 years +/- 14 [s.d.]; 14 male) and NIH-OV (166 patients; mean age, 65 years +/- 9 [s.d.]; all female), the model achieved Dice scores of 0.855 +/- 0.061 (CI: 0.831-0.878) and 0.826 +/- 0.153 (CI: 0.764-0.887), with median volume estimation errors of 19.6% (IQR: 13.2-29.0) and 5.3% (IQR: 2.4-9.7) respectively. On UofW-LC (124 patients; mean age, 46 years +/- 12 [s.d.]; 73 female), the model had a Dice score of 0.830 +/- 0.107 (CI: 0.798-0.863) and median volume estimation error of 9.7% (IQR: 4.5-15.1). The model showed strong agreement with expert assessments, with r^2 values of 0.79, 0.98, and 0.97 across the test sets. Conclusion: The proposed deep learning method performed well in segmenting and quantifying the volume of ascites in concordance with expert radiologist assessments.

This study investigates the efficacy of large language models (LLMs) as tools for grading master-level student essays. Utilizing a sample of 60 essays in political science, the study compares the accuracy of grades suggested by the GPT-4 model with those awarded by university teachers. Results indicate that while GPT-4 aligns with human grading standards on mean scores, it exhibits a risk-averse grading pattern and its interrater reliability with human raters is low. Furthermore, modifications in the grading instructions (prompt engineering) do not significantly alter AI performance, suggesting that GPT-4 primarily assesses generic essay characteristics such as language quality rather than adapting to nuanced grading criteria. These findings contribute to the understanding of AI's potential and limitations in higher education, highlighting the need for further development to enhance its adaptability and sensitivity to specific educational assessment requirements.

Benchmarking is seen as critical to assessing progress in NLP. However, creating a benchmark involves many design decisions (e.g., which datasets to include, which metrics to use) that often rely on tacit, untested assumptions about what the benchmark is intended to measure or is actually measuring. There is currently no principled way of analyzing these decisions and how they impact the validity of the benchmark's measurements. To address this gap, we draw on evidence-centered design in educational assessments and propose Evidence-Centered Benchmark Design (ECBD), a framework which formalizes the benchmark design process into five modules. ECBD specifies the role each module plays in helping practitioners collect evidence about capabilities of interest. Specifically, each module requires benchmark designers to describe, justify, and support benchmark design choices -- e.g., clearly specifying the capabilities the benchmark aims to measure or how evidence about those capabilities is collected from model responses. To demonstrate the use of ECBD, we conduct case studies with three benchmarks: BoolQ, SuperGLUE, and HELM. Our analysis reveals common trends in benchmark design and documentation that could threaten the validity of benchmarks' measurements.

Evaluation benchmarks are the cornerstone of measuring capabilities of large language models (LLMs), as well as driving progress in said capabilities. Originally designed to make claims about capabilities (or lack thereof) in fully pretrained models, evaluation benchmarks are now also extensively used to decide between various training choices. Despite this widespread usage, we rarely quantify the variance in our evaluation benchmarks, which dictates whether differences in performance are meaningful. Here, we define and measure a range of metrics geared towards measuring variance in evaluation benchmarks, including seed variance across initialisations, and monotonicity during training. By studying a large number of models -- both openly available and pretrained from scratch -- we provide empirical estimates for a variety of variance metrics, with considerations and recommendations for practitioners. We also evaluate the utility and tradeoffs of continuous versus discrete performance measures and explore options for better understanding and reducing this variance. We find that simple changes, such as framing choice tasks (like MMLU) as completion tasks, can often reduce variance for smaller scale (sim7B) models, while more involved methods inspired from human testing literature (such as item analysis and item response theory) struggle to meaningfully reduce variance. Overall, our work provides insights into variance in evaluation benchmarks, suggests LM-specific techniques to reduce variance, and more generally encourages practitioners to carefully factor in variance when comparing models.

We present BLANC, a new approach to the automatic estimation of document summary quality. Our goal is to measure the functional performance of a summary with an objective, reproducible, and fully automated method. Our approach achieves this by measuring the performance boost gained by a pre-trained language model with access to a document summary while carrying out its language understanding task on the document's text. We present evidence that BLANC scores have as good correlation with human evaluations as do the ROUGE family of summary quality measurements. And unlike ROUGE, the BLANC method does not require human-written reference summaries, allowing for fully human-free summary quality estimation.

Ensuring the accuracy of responses provided by large language models (LLMs) is crucial, particularly in clinical settings where incorrect information may directly impact patient health. To address this challenge, we construct K-QA, a dataset containing 1,212 patient questions originating from real-world conversations held on K Health (an AI-driven clinical platform). We employ a panel of in-house physicians to answer and manually decompose a subset of K-QA into self-contained statements. Additionally, we formulate two NLI-based evaluation metrics approximating recall and precision: (1) comprehensiveness, measuring the percentage of essential clinical information in the generated answer and (2) hallucination rate, measuring the number of statements from the physician-curated response contradicted by the LLM answer. Finally, we use K-QA along with these metrics to evaluate several state-of-the-art models, as well as the effect of in-context learning and medically-oriented augmented retrieval schemes developed by the authors. Our findings indicate that in-context learning improves the comprehensiveness of the models, and augmented retrieval is effective in reducing hallucinations. We make K-QA available to to the community to spur research into medically accurate NLP applications.

In recent years, large language models have greatly improved in their ability to perform complex multi-step reasoning. However, even state-of-the-art models still regularly produce logical mistakes. To train more reliable models, we can turn either to outcome supervision, which provides feedback for a final result, or process supervision, which provides feedback for each intermediate reasoning step. Given the importance of training reliable models, and given the high cost of human feedback, it is important to carefully compare the both methods. Recent work has already begun this comparison, but many questions still remain. We conduct our own investigation, finding that process supervision significantly outperforms outcome supervision for training models to solve problems from the challenging MATH dataset. Our process-supervised model solves 78% of problems from a representative subset of the MATH test set. Additionally, we show that active learning significantly improves the efficacy of process supervision. To support related research, we also release PRM800K, the complete dataset of 800,000 step-level human feedback labels used to train our best reward model.

Learning disorders are neurological conditions that affect the brain's ability to interconnect communication areas. Dyslexic students experience problems with reading, memorizing, and exposing concepts; however the magnitude of these can be mitigated through both therapies and the creation of compensatory mechanisms. Several efforts have been made to mitigate these issues, leading to the creation of digital resources for students with specific learning disorders attending primary and secondary education levels. Conversely, a standard approach is still missed in higher education. The VRAIlexia project has been created to tackle this issue by proposing two different tools: a mobile application integrating virtual reality (VR) to collect data quickly and easily, and an artificial intelligencebased software (AI) to analyze the collected data for customizing the supporting methodology for each student. The first one has been created and is being distributed among dyslexic students in Higher Education Institutions, for the conduction of specific psychological and psychometric tests. The second tool applies specific artificial intelligence algorithms to the data gathered via the application and other surveys. These AI techniques have allowed us to identify the most relevant difficulties faced by the students' cohort. Our different models have obtained around 90\% mean accuracy for predicting the support tools and learning strategies.

This article reports the results of a study examining the ability of legal and non-legal Large Language Models to perform legal analysis using the Issue-Rule-Application-Conclusion framework. LLMs were tested on legal reasoning tasks involving rule analysis and analogical reasoning. The results show that LLMs can conduct basic IRAC analysis, but are limited by brief responses lacking detail, an inability to commit to answers, false confidence, and hallucinations. The study compares legal and nonlegal LLMs, identifies shortcomings, and explores traits that may hinder their ability to think like a lawyer. It also discusses the implications for legal education and practice, highlighting the need for critical thinking skills in future lawyers and the potential pitfalls of overreliance on artificial intelligence AI resulting in a loss of logic, reasoning, and critical thinking skills.