Daily Papers

Large language models (LLMs) offer a promising pre-screening tool, improving early disease detection and providing enhanced healthcare access for underprivileged communities. The early diagnosis of various diseases continues to be a significant challenge in healthcare, primarily due to the nonspecific nature of early symptoms, the shortage of expert medical practitioners, and the need for prolonged clinical evaluations, all of which can delay treatment and adversely affect patient outcomes. With impressive accuracy in prediction across a range of diseases, LLMs have the potential to revolutionize clinical pre-screening and decision-making for various medical conditions. In this work, we study the diagnostic capability of LLMs for Rheumatoid Arthritis (RA) with real world patients data. Patient data was collected alongside diagnoses from medical experts, and the performance of LLMs was evaluated in comparison to expert diagnoses for RA disease prediction. We notice an interesting pattern in disease diagnosis and find an unexpected misalignment between prediction and explanation. We conduct a series of multi-round analyses using different LLM agents. The best-performing model accurately predicts rheumatoid arthritis (RA) diseases approximately 95\% of the time. However, when medical experts evaluated the reasoning generated by the model, they found that nearly 68\% of the reasoning was incorrect. This study highlights a clear misalignment between LLMs high prediction accuracy and its flawed reasoning, raising important questions about relying on LLM explanations in clinical settings. LLMs provide incorrect reasoning to arrive at the correct answer for RA disease diagnosis.

Traditional Chinese medicine (TCM) plays a vital role in health protection and disease treatment, but its practical application requires extensive medical knowledge and clinical experience. Existing TCM Large Language Models (LLMs) exhibit critical limitations of uncomprehensive medical consultation and diagnoses, and inaccurate syndrome differentiation-based treatment. To address these issues, this study establishes JingFang (JF): a novel TCM Large Language Model that demonstrates the expert-level capability of medical diagnosis and syndrome differentiation-based treatment. We innovate a Multi-agent Dynamic Collaborative Chain-of-Thought Mechanism (MDCCTM) for medical consultation, enabling JF with effective and accurate diagnostic ability. In addition, a Syndrome Agent and a Dual-Stage Retrieval Scheme (DSRS) are developed to significantly enhance the capacity of JF for disease treatment based on syndrome differentiation. JingFang not only facilitates the application of LLMs but also promotes the effective practice of TCM in human health protection and disease treatment.

Multimodal in-context learning (ICL) remains underexplored despite significant potential for domains such as medicine. Clinicians routinely encounter diverse, specialized tasks requiring adaptation from limited examples, such as drawing insights from a few relevant prior cases or considering a constrained set of differential diagnoses. While multimodal large language models (MLLMs) have shown advances in medical visual question answering (VQA), their ability to learn multimodal tasks from context is largely unknown. We introduce SMMILE, the first expert-driven multimodal ICL benchmark for medical tasks. Eleven medical experts curated problems, each including a multimodal query and multimodal in-context examples as task demonstrations. SMMILE encompasses 111 problems (517 question-image-answer triplets) covering 6 medical specialties and 13 imaging modalities. We further introduce SMMILE++, an augmented variant with 1038 permuted problems. A comprehensive evaluation of 15 MLLMs demonstrates that most models exhibit moderate to poor multimodal ICL ability in medical tasks. In open-ended evaluations, ICL contributes only 8% average improvement over zero-shot on SMMILE and 9.4% on SMMILE++. We observe a susceptibility for irrelevant in-context examples: even a single noisy or irrelevant example can degrade performance by up to 9.5%. Moreover, example ordering exhibits a recency bias, i.e., placing the most relevant example last can lead to substantial performance improvements by up to 71%. Our findings highlight critical limitations and biases in current MLLMs when learning multimodal medical tasks from context.

Large language models (LLMs) have demonstrated impressive capabilities in disease diagnosis. However, their effectiveness in identifying rarer diseases, which are inherently more challenging to diagnose, remains an open question. Rare disease performance is critical with the increasing use of LLMs in healthcare settings. This is especially true if a primary care physician needs to make a rarer prognosis from only a patient conversation so that they can take the appropriate next step. To that end, several clinical decision support systems are designed to support providers in rare disease identification. Yet their utility is limited due to their lack of knowledge of common disorders and difficulty of use. In this paper, we propose RareScale to combine the knowledge LLMs with expert systems. We use jointly use an expert system and LLM to simulate rare disease chats. This data is used to train a rare disease candidate predictor model. Candidates from this smaller model are then used as additional inputs to black-box LLM to make the final differential diagnosis. Thus, RareScale allows for a balance between rare and common diagnoses. We present results on over 575 rare diseases, beginning with Abdominal Actinomycosis and ending with Wilson's Disease. Our approach significantly improves the baseline performance of black-box LLMs by over 17% in Top-5 accuracy. We also find that our candidate generation performance is high (e.g. 88.8% on gpt-4o generated chats).

Artificial intelligence (AI) has demonstrated significant potential in ECG analysis and cardiovascular disease assessment. Recently, foundation models have played a remarkable role in advancing medical AI. The development of an ECG foundation model holds the promise of elevating AI-ECG research to new heights. However, building such a model faces several challenges, including insufficient database sample sizes and inadequate generalization across multiple domains. Additionally, there is a notable performance gap between single-lead and multi-lead ECG analyses. We introduced an ECG Foundation Model (ECGFounder), a general-purpose model that leverages real-world ECG annotations from cardiology experts to broaden the diagnostic capabilities of ECG analysis. ECGFounder was trained on over 10 million ECGs with 150 label categories from the Harvard-Emory ECG Database, enabling comprehensive cardiovascular disease diagnosis through ECG analysis. The model is designed to be both an effective out-of-the-box solution, and a to be fine-tunable for downstream tasks, maximizing usability. Importantly, we extended its application to lower rank ECGs, and arbitrary single-lead ECGs in particular. ECGFounder is applicable to supporting various downstream tasks in mobile monitoring scenarios. Experimental results demonstrate that ECGFounder achieves expert-level performance on internal validation sets, with AUROC exceeding 0.95 for eighty diagnoses. It also shows strong classification performance and generalization across various diagnoses on external validation sets. When fine-tuned, ECGFounder outperforms baseline models in demographic analysis, clinical event detection, and cross-modality cardiac rhythm diagnosis. The trained model and data will be publicly released upon publication through the bdsp.io. Our code is available at https://github.com/bdsp-core/ECGFounder

Recent studies have shown promising results in the detection of Mild Cognitive Impairment (MCI) using easily accessible Electroencephalogram (EEG) data which would help administer early and effective treatment for dementia patients. However, the reliability and practicality of such systems remains unclear. In this work, we investigate the potential limitations and challenges in developing a robust MCI detection method using two contrasting datasets: 1) CAUEEG, collected and annotated by expert neurologists in controlled settings and 2) GENEEG, a new dataset collected and annotated in general practice clinics, a setting where routine MCI diagnoses are typically made. We find that training on small datasets, as is done by most previous works, tends to produce high variance models that make overconfident predictions, and are unreliable in practice. Additionally, distribution shifts between datasets make cross-domain generalization challenging. Finally, we show that MCI detection using EEG may suffer from fundamental limitations because of the overlapping nature of feature distributions with control groups. We call for more effort in high-quality data collection in actionable settings (like general practice clinics) to make progress towards this salient goal of non-invasive MCI detection.

Decision-makers are often experts of their domain and take actions based on their domain knowledge. Doctors, for instance, may prescribe treatments by predicting the likely outcome of each available treatment. Actions of an expert thus naturally encode part of their domain knowledge, and can help make inferences within the same domain: Knowing doctors try to prescribe the best treatment for their patients, we can tell treatments prescribed more frequently are likely to be more effective. Yet in machine learning, the fact that most decision-makers are experts is often overlooked, and "expertise" is seldom leveraged as an inductive bias. This is especially true for the literature on treatment effect estimation, where often the only assumption made about actions is that of overlap. In this paper, we argue that expertise - particularly the type of expertise the decision-makers of a domain are likely to have - can be informative in designing and selecting methods for treatment effect estimation. We formally define two types of expertise, predictive and prognostic, and demonstrate empirically that: (i) the prominent type of expertise in a domain significantly influences the performance of different methods in treatment effect estimation, and (ii) it is possible to predict the type of expertise present in a dataset, which can provide a quantitative basis for model selection.

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

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

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.

As the field of artificial intelligence progresses, assistive technologies are becoming more widely used across all industries. The healthcare industry is no different, with numerous studies being done to develop assistive tools for healthcare professionals. Automatic diagnostic systems are one such beneficial tool that can assist with a variety of tasks, including collecting patient information, analyzing test results, and diagnosing patients. However, the idea of developing systems that can provide a differential diagnosis has been largely overlooked in most of these research studies. In this study, we propose a transformer-based approach for providing differential diagnoses based on a patient's age, sex, medical history, and symptoms. We use the DDXPlus dataset, which provides differential diagnosis information for patients based on 49 disease types. Firstly, we propose a method to process the tabular patient data from the dataset and engineer them into patient reports to make them suitable for our research. In addition, we introduce two data modification modules to diversify the training data and consequently improve the robustness of the models. We approach the task as a multi-label classification problem and conduct extensive experiments using four transformer models. All the models displayed promising results by achieving over 97% F1 score on the held-out test set. Moreover, we design additional behavioral tests to get a broader understanding of the models. In particular, for one of our test cases, we prepared a custom test set of 100 samples with the assistance of a doctor. The results on the custom set showed that our proposed data modification modules improved the model's generalization capabilities. We hope our findings will provide future researchers with valuable insights and inspire them to develop reliable systems for automatic differential diagnosis.

At the heart of medicine lies the physician-patient dialogue, where skillful history-taking paves the way for accurate diagnosis, effective management, and enduring trust. Artificial Intelligence (AI) systems capable of diagnostic dialogue could increase accessibility, consistency, and quality of care. However, approximating clinicians' expertise is an outstanding grand challenge. Here, we introduce AMIE (Articulate Medical Intelligence Explorer), a Large Language Model (LLM) based AI system optimized for diagnostic dialogue. AMIE uses a novel self-play based simulated environment with automated feedback mechanisms for scaling learning across diverse disease conditions, specialties, and contexts. We designed a framework for evaluating clinically-meaningful axes of performance including history-taking, diagnostic accuracy, management reasoning, communication skills, and empathy. We compared AMIE's performance to that of primary care physicians (PCPs) in a randomized, double-blind crossover study of text-based consultations with validated patient actors in the style of an Objective Structured Clinical Examination (OSCE). The study included 149 case scenarios from clinical providers in Canada, the UK, and India, 20 PCPs for comparison with AMIE, and evaluations by specialist physicians and patient actors. AMIE demonstrated greater diagnostic accuracy and superior performance on 28 of 32 axes according to specialist physicians and 24 of 26 axes according to patient actors. Our research has several limitations and should be interpreted with appropriate caution. Clinicians were limited to unfamiliar synchronous text-chat which permits large-scale LLM-patient interactions but is not representative of usual clinical practice. While further research is required before AMIE could be translated to real-world settings, the results represent a milestone towards conversational diagnostic AI.

Identifying, tracking, and predicting wound heal-stage progression is a fundamental task towards proper diagnosis, effective treatment, facilitating healing, and reducing pain. Traditionally, a medical expert might observe a wound to determine the current healing state and recommend treatment. However, sourcing experts who can produce such a diagnosis solely from visual indicators can be difficult, time-consuming and expensive. In addition, lesions may take several weeks to undergo the healing process, demanding resources to monitor and diagnose continually. Automating this task can be challenging; datasets that follow wound progression from onset to maturation are small, rare, and often collected without computer vision in mind. To tackle these challenges, we introduce a self-supervised learning scheme composed of (a) learning embeddings of wound's temporal dynamics, (b) clustering for automatic stage discovery, and (c) fine-tuned classification. The proposed self-supervised and flexible learning framework is biologically inspired and trained on a small dataset with zero human labeling. The HealNet framework achieved high pre-text and downstream classification accuracy; when evaluated on held-out test data, HealNet achieved 97.7% pre-text accuracy and 90.62% heal-stage classification accuracy.

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

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

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

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.

Diabetic retinopathy (DR) is a growing health problem worldwide and is a leading cause of visual impairment and blindness, especially among working people aged 20-65. Its incidence is increasing along with the number of diabetes cases, and it is more common in developed countries than in developing countries. Recent research in the field of diabetic retinopathy diagnosis is using advanced technologies, such as analysis of images obtained by ophthalmoscopy. Automatic methods for analyzing eye images based on neural networks, deep learning and image analysis algorithms can improve the efficiency of diagnosis. This paper describes an automatic DR diagnosis method that includes processing and analysis of ophthalmoscopic images of the eye. It uses morphological algorithms to identify the optic disc and lesions characteristic of DR, such as microaneurysms, hemorrhages and exudates. Automated DR diagnosis has the potential to improve the efficiency of early detection of this disease and contribute to reducing the number of cases of diabetes-related visual impairment. The final step was to create an application with a graphical user interface that allowed retinal images taken at cooperating ophthalmology offices to be uploaded to the server. These images were then analyzed using a developed algorithm to make a diagnosis.

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.

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

Generalist vision language models (VLMs) have made significant strides in computer vision, but they fall short in specialized fields like healthcare, where expert knowledge is essential. In traditional computer vision tasks, creative or approximate answers may be acceptable, but in healthcare, precision is paramount.Current large multimodal models like Gemini and GPT-4o are insufficient for medical tasks due to their reliance on memorized internet knowledge rather than the nuanced expertise required in healthcare. VLMs are usually trained in three stages: vision pre-training, vision-language pre-training, and instruction fine-tuning (IFT). IFT has been typically applied using a mixture of generic and healthcare data. In contrast, we propose that for medical VLMs, a fourth stage of specialized IFT is necessary, which focuses on medical data and includes information from domain expert models. Domain expert models developed for medical use are crucial because they are specifically trained for certain clinical tasks, e.g. to detect tumors and classify abnormalities through segmentation and classification, which learn fine-grained features of medical data-features that are often too intricate for a VLM to capture effectively especially in radiology. This paper introduces a new framework, VILA-M3, for medical VLMs that utilizes domain knowledge via expert models. Through our experiments, we show an improved state-of-the-art (SOTA) performance with an average improvement of ~9% over the prior SOTA model Med-Gemini and ~6% over models trained on the specific tasks. Our approach emphasizes the importance of domain expertise in creating precise, reliable VLMs for medical applications.

Large language models have demonstrated remarkable proficiency in long and complex reasoning tasks. However, they frequently exhibit a problematic reliance on familiar reasoning patterns, a phenomenon we term reasoning rigidity. Despite explicit instructions from users, these models often override clearly stated conditions and default to habitual reasoning trajectories, leading to incorrect conclusions. This behavior presents significant challenges, particularly in domains such as mathematics and logic puzzle, where precise adherence to specified constraints is critical. To systematically investigate reasoning rigidity, a behavior largely unexplored in prior work, we introduce a expert-curated diagnostic set, . Our dataset includes specially modified variants of existing mathematical benchmarks, namely AIME and MATH500, as well as well-known puzzles deliberately redesigned to require deviation from familiar reasoning strategies. Using this dataset, we identify recurring contamination patterns that occur when models default to ingrained reasoning. Specifically, we categorize this contamination into three distinctive modes: (i) Interpretation Overload, (ii) Input Distrust, and (iii) Partial Instruction Attention, each causing models to ignore or distort provided instructions. We publicly release our diagnostic set to facilitate future research on mitigating reasoning rigidity in language models.

Expert interpretation of anatomical images of the human brain is the central part of neuro-radiology. Several machine learning-based techniques have been proposed to assist in the analysis process. However, the ML models typically need to be trained to perform a specific task, e.g., brain tumour segmentation or classification. Not only do the corresponding training data require laborious manual annotations, but a wide variety of abnormalities can be present in a human brain MRI - even more than one simultaneously, which renders representation of all possible anomalies very challenging. Hence, a possible solution is an unsupervised anomaly detection (UAD) system that can learn a data distribution from an unlabelled dataset of healthy subjects and then be applied to detect out of distribution samples. Such a technique can then be used to detect anomalies - lesions or abnormalities, for example, brain tumours, without explicitly training the model for that specific pathology. Several Variational Autoencoder (VAE) based techniques have been proposed in the past for this task. Even though they perform very well on controlled artificially simulated anomalies, many of them perform poorly while detecting anomalies in clinical data. This research proposes a compact version of the "context-encoding" VAE (ceVAE) model, combined with pre and post-processing steps, creating a UAD pipeline (StRegA), which is more robust on clinical data, and shows its applicability in detecting anomalies such as tumours in brain MRIs. The proposed pipeline achieved a Dice score of 0.642pm0.101 while detecting tumours in T2w images of the BraTS dataset and 0.859pm0.112 while detecting artificially induced anomalies, while the best performing baseline achieved 0.522pm0.135 and 0.783pm0.111, respectively.

Automated diagnosis prediction from medical images is a valuable resource to support clinical decision-making. However, such systems usually need to be trained on large amounts of annotated data, which often is scarce in the medical domain. Zero-shot methods address this challenge by allowing a flexible adaption to new settings with different clinical findings without relying on labeled data. Further, to integrate automated diagnosis in the clinical workflow, methods should be transparent and explainable, increasing medical professionals' trust and facilitating correctness verification. In this work, we introduce Xplainer, a novel framework for explainable zero-shot diagnosis in the clinical setting. Xplainer adapts the classification-by-description approach of contrastive vision-language models to the multi-label medical diagnosis task. Specifically, instead of directly predicting a diagnosis, we prompt the model to classify the existence of descriptive observations, which a radiologist would look for on an X-Ray scan, and use the descriptor probabilities to estimate the likelihood of a diagnosis. Our model is explainable by design, as the final diagnosis prediction is directly based on the prediction of the underlying descriptors. We evaluate Xplainer on two chest X-ray datasets, CheXpert and ChestX-ray14, and demonstrate its effectiveness in improving the performance and explainability of zero-shot diagnosis. Our results suggest that Xplainer provides a more detailed understanding of the decision-making process and can be a valuable tool for clinical diagnosis.

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

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

There has been a rapidly growing interest in Automatic Symptom Detection (ASD) and Automatic Diagnosis (AD) systems in the machine learning research literature, aiming to assist doctors in telemedicine services. These systems are designed to interact with patients, collect evidence about their symptoms and relevant antecedents, and possibly make predictions about the underlying diseases. Doctors would review the interactions, including the evidence and the predictions, collect if necessary additional information from patients, before deciding on next steps. Despite recent progress in this area, an important piece of doctors' interactions with patients is missing in the design of these systems, namely the differential diagnosis. Its absence is largely due to the lack of datasets that include such information for models to train on. In this work, we present a large-scale synthetic dataset of roughly 1.3 million patients that includes a differential diagnosis, along with the ground truth pathology, symptoms and antecedents for each patient. Unlike existing datasets which only contain binary symptoms and antecedents, this dataset also contains categorical and multi-choice symptoms and antecedents useful for efficient data collection. Moreover, some symptoms are organized in a hierarchy, making it possible to design systems able to interact with patients in a logical way. As a proof-of-concept, we extend two existing AD and ASD systems to incorporate the differential diagnosis, and provide empirical evidence that using differentials as training signals is essential for the efficiency of such systems or for helping doctors better understand the reasoning of those systems.

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

The differential diagnosis of neurodegenerative dementias is a challenging clinical task, mainly because of the overlap in symptom presentation and the similarity of patterns observed in structural neuroimaging. To improve diagnostic efficiency and accuracy, deep learning-based methods such as Convolutional Neural Networks and Vision Transformers have been proposed for the automatic classification of brain MRIs. However, despite their strong predictive performance, these models find limited clinical utility due to their opaque decision making. In this work, we propose a framework that integrates two core components to enhance diagnostic transparency. First, we introduce a modular pipeline for converting 3D T1-weighted brain MRIs into textual radiology reports. Second, we explore the potential of modern Large Language Models (LLMs) to assist clinicians in the differential diagnosis between Frontotemporal dementia subtypes, Alzheimer's disease, and normal aging based on the generated reports. To bridge the gap between predictive accuracy and explainability, we employ reinforcement learning to incentivize diagnostic reasoning in LLMs. Without requiring supervised reasoning traces or distillation from larger models, our approach enables the emergence of structured diagnostic rationales grounded in neuroimaging findings. Unlike post-hoc explainability methods that retrospectively justify model decisions, our framework generates diagnostic rationales as part of the inference process-producing causally grounded explanations that inform and guide the model's decision-making process. In doing so, our framework matches the diagnostic performance of existing deep learning methods while offering rationales that support its diagnostic conclusions.

Explaining Artificial Intelligence (AI) decisions is a major challenge nowadays in AI, in particular when applied to sensitive scenarios like medicine and law. However, the need to explain the rationale behind decisions is a main issue also for human-based deliberation as it is important to justify why a certain decision has been taken. Resident medical doctors for instance are required not only to provide a (possibly correct) diagnosis, but also to explain how they reached a certain conclusion. Developing new tools to aid residents to train their explanation skills is therefore a central objective of AI in education. In this paper, we follow this direction, and we present, to the best of our knowledge, the first multilingual dataset for Medical Question Answering where correct and incorrect diagnoses for a clinical case are enriched with a natural language explanation written by doctors. These explanations have been manually annotated with argument components (i.e., premise, claim) and argument relations (i.e., attack, support), resulting in the Multilingual CasiMedicos-Arg dataset which consists of 558 clinical cases in four languages (English, Spanish, French, Italian) with explanations, where we annotated 5021 claims, 2313 premises, 2431 support relations, and 1106 attack relations. We conclude by showing how competitive baselines perform over this challenging dataset for the argument mining task.

The integration of Computer-Assisted Diagnosis (CAD) with Large Language Models (LLMs) holds great potential in clinical applications, specifically in the roles of virtual family doctors and clinic assistants. However, current works in this field are plagued by limitations, specifically a restricted scope of applicable image domains and the provision of unreliable medical advice. This restricts their overall processing capabilities. Furthermore, the mismatch in writing style between LLMs and radiologists undermines their practical usefulness. To tackle these challenges, we introduce ChatCAD+, which is designed to be universal and reliable. It is capable of handling medical images from diverse domains and leveraging up-to-date information from reputable medical websites to provide reliable medical advice. Additionally, it incorporates a template retrieval system that improves report generation performance via exemplar reports. This approach ensures greater consistency with the expertise of human professionals. The source code is available at https://github.com/zhaozh10/ChatCAD.

Clinical diagnosis of the eye is performed over multifarious data modalities including scalar clinical labels, vectorized biomarkers, two-dimensional fundus images, and three-dimensional Optical Coherence Tomography (OCT) scans. Clinical practitioners use all available data modalities for diagnosing and treating eye diseases like Diabetic Retinopathy (DR) or Diabetic Macular Edema (DME). Enabling usage of machine learning algorithms within the ophthalmic medical domain requires research into the relationships and interactions between all relevant data over a treatment period. Existing datasets are limited in that they neither provide data nor consider the explicit relationship modeling between the data modalities. In this paper, we introduce the Ophthalmic Labels for Investigating Visual Eye Semantics (OLIVES) dataset that addresses the above limitation. This is the first OCT and near-IR fundus dataset that includes clinical labels, biomarker labels, disease labels, and time-series patient treatment information from associated clinical trials. The dataset consists of 1268 near-IR fundus images each with at least 49 OCT scans, and 16 biomarkers, along with 4 clinical labels and a disease diagnosis of DR or DME. In total, there are 96 eyes' data averaged over a period of at least two years with each eye treated for an average of 66 weeks and 7 injections. We benchmark the utility of OLIVES dataset for ophthalmic data as well as provide benchmarks and concrete research directions for core and emerging machine learning paradigms within medical image analysis.

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

Generalist foundation models such as GPT-4 have displayed surprising capabilities in a wide variety of domains and tasks. Yet, there is a prevalent assumption that they cannot match specialist capabilities of fine-tuned models. For example, most explorations to date on medical competency benchmarks have leveraged domain-specific training, as exemplified by efforts on BioGPT and Med-PaLM. We build on a prior study of GPT-4's capabilities on medical challenge benchmarks in the absence of special training. Rather than using simple prompting to highlight the model's out-of-the-box capabilities, we perform a systematic exploration of prompt engineering. We find that prompting innovation can unlock deeper specialist capabilities and show that GPT-4 easily tops prior leading results for medical benchmarks. The prompting methods we explore are general purpose, and make no specific use of domain expertise, removing the need for expert-curated content. Our experimental design carefully controls for overfitting during the prompt engineering process. We introduce Medprompt, based on a composition of several prompting strategies. With Medprompt, GPT-4 achieves state-of-the-art results on all nine of the benchmark datasets in the MultiMedQA suite. The method outperforms leading specialist models such as Med-PaLM 2 by a significant margin with an order of magnitude fewer calls to the model. Steering GPT-4 with Medprompt achieves a 27% reduction in error rate on the MedQA dataset over the best methods to date achieved with specialist models and surpasses a score of 90% for the first time. Beyond medical problems, we show the power of Medprompt to generalize to other domains and provide evidence for the broad applicability of the approach via studies of the strategy on exams in electrical engineering, machine learning, philosophy, accounting, law, nursing, and clinical psychology.

Depression is a global burden and one of the most challenging mental health conditions to control. Experts can detect its severity early using the Beck Depression Inventory (BDI) questionnaire, administer appropriate medication to patients, and impede its progression. Due to the fear of potential stigmatization, many patients turn to social media platforms like Reddit for advice and assistance at various stages of their journey. This research extracts text from Reddit to facilitate the diagnostic process. It employs a proposed labeling approach to categorize the text and subsequently fine-tunes the Longformer model. The model's performance is compared against baseline models, including Naive Bayes, Random Forest, Support Vector Machines, and Gradient Boosting. Our findings reveal that the Longformer model outperforms the baseline models in both English (48%) and Luganda (45%) languages on a custom-made dataset.

Clinical diagnosis prediction models, when provided with a patient's medical history, aim to detect potential diseases early, facilitating timely intervention and improving prognostic outcomes. However, the inherent scarcity of patient data and large disease candidate space often pose challenges in developing satisfactory models for this intricate task. The exploration of leveraging Large Language Models (LLMs) for encapsulating clinical decision processes has been limited. We introduce MERA, a clinical diagnosis prediction model that bridges pertaining natural language knowledge with medical practice. We apply hierarchical contrastive learning on a disease candidate ranking list to alleviate the large decision space issue. With concept memorization through fine-tuning, we bridge the natural language clinical knowledge with medical codes. Experimental results on MIMIC-III and IV datasets show that MERA achieves the state-of-the-art diagnosis prediction performance and dramatically elevates the diagnosis prediction capabilities of generative LMs.

Diffusion models have emerged as mainstream framework in visual generation. Building upon this success, the integration of Mixture of Experts (MoE) methods has shown promise in enhancing model scalability and performance. In this paper, we introduce Race-DiT, a novel MoE model for diffusion transformers with a flexible routing strategy, Expert Race. By allowing tokens and experts to compete together and select the top candidates, the model learns to dynamically assign experts to critical tokens. Additionally, we propose per-layer regularization to address challenges in shallow layer learning, and router similarity loss to prevent mode collapse, ensuring better expert utilization. Extensive experiments on ImageNet validate the effectiveness of our approach, showcasing significant performance gains while promising scaling properties.

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

Mixture-of-Experts (MoE) model architecture has emerged as a promising solution for scaling transformer models efficiently, offering sparse activation that reduces computational costs while increasing model capacity. However, as MoE models scale, they need to be distributed across GPU devices, thus face critical performance bottlenecks due to their large memory footprint. Expert parallelism distributes experts across GPUs, however, faces key challenges including an unbalanced token routing and expert activation, resulting in communication tail latency and processing inefficiencies. While existing solutions address some of these issues, they fail to resolve the dual challenges of load imbalance and communication skew. The imbalance in token processing load across experts causes uneven processing times on different GPUs, while communication skew between GPUs leads to unbalanced inter-GPU data transfers. These factors degrade the performance of MoE models by increasing tail latency and reducing overall throughput. To address these limitations, we propose an Integer Linear Programming (ILP) formulation to optimize expert placement by jointly considering token load, communication, and computation costs. We exploit the property that there is a token routing dependency across layers, where tokens routed to a specific expert in one layer are likely to be routed to a limited set of experts in the subsequent layer. Our solution, MoETuner, offers an optimal expert-to-GPU assignment that minimizes inter-GPU token routing costs and balances token processing across devices, thereby reducing tail latency and end-to-end execution time. Experimental results demonstrate 9.3% and 17.5% of end-to-end speedups for single-node and multi-node inference respectively, showcasing the potential of our ILP-based optimization for offering expert parallel solutions for next-generation MoEs.

The training and fine-tuning of large language models (LLMs) often involve diverse textual data from multiple sources, which poses challenges due to conflicting gradient directions, hindering optimization and specialization. These challenges can undermine model generalization across tasks, resulting in reduced downstream performance. Recent research suggests that fine-tuning LLMs on carefully selected, task-specific subsets of data can match or even surpass the performance of using the entire dataset. Building on these insights, we propose the Ensembles of Low-Rank Expert Adapters (ELREA) framework to improve the model's capability to handle diverse tasks. ELREA clusters the training instructions based on their gradient directions, representing different areas of expertise and thereby reducing conflicts during optimization. Expert adapters are then trained on these clusters, utilizing the low-rank adaptation (LoRA) technique to ensure training efficiency and model scalability. During inference, ELREA combines predictions from the most relevant expert adapters based on the input data's gradient similarity to the training clusters, ensuring optimal adapter selection for each task. Experiments show that our method outperforms baseline LoRA adapters trained on the full dataset and other ensemble approaches with similar training and inference complexity across a range of domain-specific tasks.

Expert parallelism has been introduced as a strategy to distribute the computational workload of sparsely-gated mixture-of-experts (MoE) models across multiple computing devices, facilitating the execution of these increasingly large-scale models. However, the All-to-All communication intrinsic to expert parallelism constitutes a significant overhead, diminishing the MoE models' efficiency. Current optimization approaches offer some relief, yet they are constrained by the sequential interdependence of communication and computation operations. To address this limitation, we present a novel shortcut-connected MoE architecture with overlapping parallel strategy, designated as ScMoE, which effectively decouples communication from its conventional sequence, allowing for a substantial overlap of 70% to 100% with computation. When compared with the prevalent top-2 MoE architecture, ScMoE demonstrates training speed improvements of 30% and 11%, and inference improvements of 40% and 15%, in our PCIe and NVLink hardware environments, respectively, where communication constitutes 60% and 15% of the total MoE time consumption. On the other hand, extensive experiments and theoretical analyses indicate that ScMoE not only achieves comparable but in some instances surpasses the model quality of existing approaches in vision and language tasks.

Large Language Models have achieved remarkable success across various natural language processing tasks, yet their high computational cost during inference remains a major bottleneck. This paper introduces Sparse Expert Activation Pruning (SEAP), a training-free pruning method that selectively retains task-relevant parameters to reduce inference overhead. Inspired by the clustering patterns of hidden states and activations in LLMs, SEAP identifies task-specific expert activation patterns and prunes the model while preserving task performance and enhancing computational efficiency. Experimental results demonstrate that SEAP significantly reduces computational overhead while maintaining competitive accuracy. Notably, at 50% pruning, SEAP surpasses both WandA and FLAP by over 20%, and at 20% pruning, it incurs only a 2.2% performance drop compared to the dense model. These findings highlight SEAP's scalability and effectiveness, making it a promising approach for optimizing large-scale LLMs.

In the era of large language models, Mixture-of-Experts (MoE) is a promising architecture for managing computational costs when scaling up model parameters. However, conventional MoE architectures like GShard, which activate the top-K out of N experts, face challenges in ensuring expert specialization, i.e. each expert acquires non-overlapping and focused knowledge. In response, we propose the DeepSeekMoE architecture towards ultimate expert specialization. It involves two principal strategies: (1) finely segmenting the experts into mN ones and activating mK from them, allowing for a more flexible combination of activated experts; (2) isolating K_s experts as shared ones, aiming at capturing common knowledge and mitigating redundancy in routed experts. Starting from a modest scale with 2B parameters, we demonstrate that DeepSeekMoE 2B achieves comparable performance with GShard 2.9B, which has 1.5 times the expert parameters and computation. In addition, DeepSeekMoE 2B nearly approaches the performance of its dense counterpart with the same number of total parameters, which set the upper bound of MoE models. Subsequently, we scale up DeepSeekMoE to 16B parameters and show that it achieves comparable performance with LLaMA2 7B, with only about 40% of computations. Further, our preliminary efforts to scale up DeepSeekMoE to 145B parameters consistently validate its substantial advantages over the GShard architecture, and show its performance comparable with DeepSeek 67B, using only 28.5% (maybe even 18.2%) of computations.

Cinematography, the fundamental visual language of film, is essential for conveying narrative, emotion, and aesthetic quality. While recent Vision-Language Models (VLMs) demonstrate strong general visual understanding, their proficiency in comprehending the nuanced cinematic grammar embedded within individual shots remains largely unexplored and lacks robust evaluation. This critical gap limits both fine-grained visual comprehension and the precision of AI-assisted video generation. To address this, we introduce ShotBench, a comprehensive benchmark specifically designed for cinematic language understanding. It features over 3.5k expert-annotated QA pairs from images and video clips, meticulously curated from over 200 acclaimed (predominantly Oscar-nominated) films and spanning eight key cinematography dimensions. Our evaluation of 24 leading VLMs on ShotBench reveals their substantial limitations: even the top-performing model achieves less than 60% average accuracy, particularly struggling with fine-grained visual cues and complex spatial reasoning. To catalyze advancement in this domain, we construct ShotQA, a large-scale multimodal dataset comprising approximately 70k cinematic QA pairs. Leveraging ShotQA, we develop ShotVL through supervised fine-tuning and Group Relative Policy Optimization. ShotVL significantly outperforms all existing open-source and proprietary models on ShotBench, establishing new state-of-the-art performance. We open-source our models, data, and code to foster rapid progress in this crucial area of AI-driven cinematic understanding and generation.

Large Language Models (LLMs) have shown tremendous potential as agents, excelling at tasks that require multiple rounds of reasoning and interactions. Rejection Sampling Fine-Tuning (RFT) has emerged as an effective method for finetuning LLMs as agents: it first imitates expert-generated successful trajectories and further improves agentic skills through iterative fine-tuning on successful, self-generated trajectories. However, since the expert (e.g., GPT-4) succeeds primarily on simpler subtasks and RFT inherently favors simpler scenarios, many complex subtasks remain unsolved and persistently out-of-distribution (OOD). Upon investigating these challenging subtasks, we discovered that previously failed expert trajectories can often provide valuable guidance, e.g., plans and key actions, that can significantly improve agent exploration efficiency and acquisition of critical skills. Motivated by these observations, we propose Exploring Expert Failures (EEF), which identifies beneficial actions from failed expert trajectories and integrates them into the training dataset. Potentially harmful actions are meticulously excluded to prevent contamination of the model learning process. By leveraging the beneficial actions in expert failures, EEF successfully solves some previously unsolvable subtasks and improves agent tuning performance. Remarkably, our approach achieved a 62\% win rate in WebShop, outperforming RFT (53. 6\%) and GPT-4 (35. 6\%), and to the best of our knowledge, setting a new state-of-the-art as the first method to surpass a score of 0.81 in WebShop and exceed 81 in SciWorld.

We present Multi-expert Prompting, a novel enhancement of ExpertPrompting (Xu et al., 2023), designed to improve the large language model (LLM) generation. Specifically, it guides an LLM to fulfill an input instruction by simulating multiple experts, aggregating their responses, and selecting the best among individual and aggregated responses. This process is performed in a single chain of thoughts through our seven carefully designed subtasks derived from the Nominal Group Technique (Ven and Delbecq, 1974), a well-established decision-making framework. Our evaluations demonstrate that Multi-expert Prompting significantly outperforms ExpertPrompting and comparable baselines in enhancing the truthfulness, factuality, informativeness, and usefulness of responses while reducing toxicity and hurtfulness. It further achieves state-of-the-art truthfulness by outperforming the best baseline by 8.69% with ChatGPT. Multi-expert Prompting is efficient, explainable, and highly adaptable to diverse scenarios, eliminating the need for manual prompt construction.

Recent artificial intelligence (AI) systems have reached milestones in "grand challenges" ranging from Go to protein-folding. The capability to retrieve medical knowledge, reason over it, and answer medical questions comparably to physicians has long been viewed as one such grand challenge. Large language models (LLMs) have catalyzed significant progress in medical question answering; Med-PaLM was the first model to exceed a "passing" score in US Medical Licensing Examination (USMLE) style questions with a score of 67.2% on the MedQA dataset. However, this and other prior work suggested significant room for improvement, especially when models' answers were compared to clinicians' answers. Here we present Med-PaLM 2, which bridges these gaps by leveraging a combination of base LLM improvements (PaLM 2), medical domain finetuning, and prompting strategies including a novel ensemble refinement approach. Med-PaLM 2 scored up to 86.5% on the MedQA dataset, improving upon Med-PaLM by over 19% and setting a new state-of-the-art. We also observed performance approaching or exceeding state-of-the-art across MedMCQA, PubMedQA, and MMLU clinical topics datasets. We performed detailed human evaluations on long-form questions along multiple axes relevant to clinical applications. In pairwise comparative ranking of 1066 consumer medical questions, physicians preferred Med-PaLM 2 answers to those produced by physicians on eight of nine axes pertaining to clinical utility (p < 0.001). We also observed significant improvements compared to Med-PaLM on every evaluation axis (p < 0.001) on newly introduced datasets of 240 long-form "adversarial" questions to probe LLM limitations. While further studies are necessary to validate the efficacy of these models in real-world settings, these results highlight rapid progress towards physician-level performance in medical question answering.

Combining pre-trained expert models offers substantial potential for scalable multimodal reasoning, but building a unified framework remains challenging due to the increasing diversity of input modalities and task complexity. For instance, medical diagnosis requires precise reasoning over structured clinical tables, while financial forecasting depends on interpreting plot-based data to make informed predictions. To tackle this challenge, we introduce MEXA, a training-free framework that performs modality- and task-aware aggregation of multiple expert models to enable effective multimodal reasoning across diverse and distinct domains. MEXA dynamically selects expert models based on the input modality and the task-specific reasoning demands (i.e., skills). Each expert model, specialized in a modality task pair, generates interpretable textual reasoning outputs. MEXA then aggregates and reasons over these outputs using a Large Reasoning Model (LRM) to produce the final answer. This modular design allows flexible and transparent multimodal reasoning across diverse domains without additional training overhead. We extensively evaluate our approach on diverse multimodal benchmarks, including Video Reasoning, Audio Reasoning, 3D Understanding, and Medical QA. MEXA consistently delivers performance improvements over strong multimodal baselines, highlighting the effectiveness and broad applicability of our expert-driven selection and aggregation in diverse multimodal reasoning tasks.

Solving expert-level multimodal tasks is a key milestone towards general intelligence. As the capabilities of multimodal large language models (MLLMs) continue to improve, evaluation of such advanced multimodal intelligence becomes necessary yet challenging. In this work, we introduce ProBench, a benchmark of open-ended user queries that require professional expertise and advanced reasoning. ProBench consists of 4,000 high-quality samples independently submitted by professionals based on their daily productivity demands. It spans across 10 fields and 56 sub-fields, including science, arts, humanities, coding, mathematics, and creative writing. Experimentally, we evaluate and compare 24 latest models using MLLM-as-a-Judge. Our results reveal that although the best open-source models rival the proprietary ones, ProBench presents significant challenges in visual perception, textual understanding, domain knowledge and advanced reasoning, thus providing valuable directions for future multimodal AI research efforts.

Sparse expert models are a thirty-year old concept re-emerging as a popular architecture in deep learning. This class of architecture encompasses Mixture-of-Experts, Switch Transformers, Routing Networks, BASE layers, and others, all with the unifying idea that each example is acted on by a subset of the parameters. By doing so, the degree of sparsity decouples the parameter count from the compute per example allowing for extremely large, but efficient models. The resulting models have demonstrated significant improvements across diverse domains such as natural language processing, computer vision, and speech recognition. We review the concept of sparse expert models, provide a basic description of the common algorithms, contextualize the advances in the deep learning era, and conclude by highlighting areas for future work.

Large language models are typically trained densely: all parameters are updated with respect to all inputs. This requires synchronization of billions of parameters across thousands of GPUs. We introduce a simple but effective method to asynchronously train large, sparse language models on arbitrary text corpora. Our method clusters a corpus into sets of related documents, trains a separate expert language model on each cluster, and combines them in a sparse ensemble for inference. This approach generalizes embarrassingly parallel training by automatically discovering the domains for each expert, and eliminates nearly all the communication overhead of existing sparse language models. Our technique outperforms dense baselines on multiple corpora and few-shot tasks, and our analysis shows that specializing experts to meaningful clusters is key to these gains. Performance also improves with the number of experts and size of training data, suggesting this is a highly efficient and accessible approach to training large language models.

Recently, Large Language Models (LLMs) with Mixture of Experts (MoE) layers have gained significant attention. Currently, state-of-the-art LLMs utilize this architecture. There is a substantial amount of research on how to train such models and how to select hyperparameters for this architecture. However, there is a lack of studies focusing on post-evaluation analysis of MoE layer properties. In this paper, we take a first step toward closing this gap by evaluating expert contributions on the quiz-based MMLU benchmark. We show that most experts were never activated during inference on this benchmark. Additionally, the output distribution of gating networks is much closer to uniform than sparse. Finally, we demonstrate that the average performance of some experts within the same layer varies significantly.

As language models are adapted by a more sophisticated and diverse set of users, the importance of guaranteeing that they provide factually correct information supported by verifiable sources is critical across fields of study & professions. This is especially the case for high-stakes fields, such as medicine and law, where the risk of propagating false information is high and can lead to undesirable societal consequences. Previous work studying factuality and attribution has not focused on analyzing these characteristics of language model outputs in domain-specific scenarios. In this work, we present an evaluation study analyzing various axes of factuality and attribution provided in responses from a few systems, by bringing domain experts in the loop. Specifically, we first collect expert-curated questions from 484 participants across 32 fields of study, and then ask the same experts to evaluate generated responses to their own questions. We also ask experts to revise answers produced by language models, which leads to ExpertQA, a high-quality long-form QA dataset with 2177 questions spanning 32 fields, along with verified answers and attributions for claims in the answers.

With the emergence of Mixture-of-Experts (MoE), the efficient scaling of model size has accelerated the development of large language models in recent years. However, their high memory requirements prevent their use in resource-constrained environments. While knowledge distillation (KD) has been a proven method for model compression, its application to MoE teacher models remains underexplored. Through our investigation, we discover that non-activated experts in MoE models possess valuable knowledge that benefits student models. We further demonstrate that existing KD methods are not optimal for compressing MoE models, as they fail to leverage this knowledge effectively. To address this, we propose two intuitive MoE-specific KD methods for the first time: Knowledge Augmentation (KA) and Student-Aware Router (SAR), both designed to effectively extract knowledge from all experts. Specifically, KA augments knowledge by sampling experts multiple times, while SAR uses all experts and adjusts the expert weights through router training to provide optimal knowledge. Extensive experiments show that our methods outperform conventional KD methods, demonstrating their effectiveness for MoE teacher models.

Large Language Models (LLMs) have demonstrated impressive performance across various tasks, and their application in edge scenarios has attracted significant attention. However, sparse-activated Mixture-of-Experts (MoE) models, which are well suited for edge scenarios, have received relatively little attention due to their high memory demands. Offload-based methods have been proposed to address this challenge, but they face difficulties with expert prediction. Inaccurate expert predictions can result in prolonged inference delays. To promote the application of MoE models in edge scenarios, we propose Fate, an offloading system designed for MoE models to enable efficient inference in resource-constrained environments. The key insight behind Fate is that gate inputs from adjacent layers can be effectively used for expert prefetching, achieving high prediction accuracy without additional GPU overhead. Furthermore, Fate employs a shallow-favoring expert caching strategy that increases the expert hit rate to 99\%. Additionally, Fate integrates tailored quantization strategies for cache optimization and IO efficiency. Experimental results show that, compared to Load on Demand and Expert Activation Path-based method, Fate achieves up to 4.5x and 1.9x speedups in prefill speed and up to 4.1x and 2.2x speedups in decoding speed, respectively, while maintaining inference quality. Moreover, Fate's performance improvements are scalable across different memory budgets.

Since the emergence of the Large Language Model (LLM), LLM has been widely used in fields such as writing, translating, and searching. However, there is still great potential for LLM-based methods in handling complex tasks such as decision-making in the StarCraft II environment. To address problems such as lack of relevant knowledge and poor control over subtasks of varying importance, we propose a Hierarchical Expert Prompt (HEP) for LLM. Our method improves the understanding of game situations through expert-level tactical knowledge, improving the processing quality of tasks of varying importance through a hierarchical framework. Our approach defeated the highest level (Elite) standard built-in agent in TextStarCraft II for the first time and consistently outperformed the baseline method in other difficulties. Our experiments suggest that the proposed method is a practical solution for tackling complex decision-making challenges. The replay video can be viewed on https://www.bilibili.com/video/BV1uz42187EF and https://youtu.be/dO3PshWLV5M, and our codes have been open-sourced on https://github.com/luchang1113/HEP-LLM-play-StarCraftII.

Image-goal navigation aims to steer an agent towards the goal location specified by an image. Most prior methods tackle this task by learning a navigation policy, which extracts visual features of goal and observation images, compares their similarity and predicts actions. However, if the agent is in a different room from the goal image, it's extremely challenging to identify their similarity and infer the likely goal location, which may result in the agent wandering around. Intuitively, when humans carry out this task, they may roughly compare the current observation with the goal image, having an approximate concept of whether they are in the same room before executing the actions. Inspired by this intuition, we try to imitate human behaviour and propose a Room Expert Guided Image-Goal Navigation model (REGNav) to equip the agent with the ability to analyze whether goal and observation images are taken in the same room. Specifically, we first pre-train a room expert with an unsupervised learning technique on the self-collected unlabelled room images. The expert can extract the hidden room style information of goal and observation images and predict their relationship about whether they belong to the same room. In addition, two different fusion approaches are explored to efficiently guide the agent navigation with the room relation knowledge. Extensive experiments show that our REGNav surpasses prior state-of-the-art works on three popular benchmarks.

Recent advancements in large language model (LLM) unlearning have shown remarkable success in removing unwanted data-model influences while preserving the model's utility for legitimate knowledge. However, despite these strides, sparse Mixture-of-Experts (MoE) LLMs--a key subset of the LLM family--have received little attention and remain largely unexplored in the context of unlearning. As MoE LLMs are celebrated for their exceptional performance and highly efficient inference processes, we ask: How can unlearning be performed effectively and efficiently on MoE LLMs? And will traditional unlearning methods be applicable to MoE architectures? Our pilot study shows that the dynamic routing nature of MoE LLMs introduces unique challenges, leading to substantial utility drops when existing unlearning methods are applied. Specifically, unlearning disrupts the router's expert selection, causing significant selection shift from the most unlearning target-related experts to irrelevant ones. As a result, more experts than necessary are affected, leading to excessive forgetting and loss of control over which knowledge is erased. To address this, we propose a novel single-expert unlearning framework, referred to as UOE, for MoE LLMs. Through expert attribution, unlearning is concentrated on the most actively engaged expert for the specified knowledge. Concurrently, an anchor loss is applied to the router to stabilize the active state of this targeted expert, ensuring focused and controlled unlearning that preserves model utility. The proposed UOE framework is also compatible with various unlearning algorithms. Extensive experiments demonstrate that UOE enhances both forget quality up to 5% and model utility by 35% on MoE LLMs across various benchmarks, LLM architectures, while only unlearning 0.06% of the model parameters.

Large Language Models (LLMs) have emerged as powerful tools in mathematical theorem proving, particularly when utilizing formal languages such as LEAN. The major learning paradigm is expert iteration, which necessitates a pre-defined dataset comprising numerous mathematical problems. In this process, LLMs attempt to prove problems within the dataset and iteratively refine their capabilities through self-training on the proofs they discover. We propose to use large scale LEAN problem datasets Lean-workbook for expert iteration with more than 20,000 CPU days. During expert iteration, we found log-linear trends between solved problem amount with proof length and CPU usage. We train a critic model to select relatively easy problems for policy models to make trials and guide the model to search for deeper proofs. InternLM2.5-StepProver achieves open-source state-of-the-art on MiniF2F, Lean-Workbook-Plus, ProofNet, and Putnam benchmarks. Specifically, it achieves a pass of 65.9% on the MiniF2F-test and proves (or disproves) 17.0% of problems in Lean-Workbook-Plus which shows a significant improvement compared to only 9.5% of problems proved when Lean-Workbook-Plus was released. We open-source our models and searched proofs at https://github.com/InternLM/InternLM-Math and https://huggingface.co/datasets/internlm/Lean-Workbook.

We propose a novel approach to enhancing the performance and efficiency of large language models (LLMs) by combining domain prompt routing with domain-specialized models. We introduce a system that utilizes a BERT-based router to direct incoming prompts to the most appropriate domain expert model. These expert models are specifically tuned for domains such as health, mathematics and science. Our research demonstrates that this approach can significantly outperform general-purpose models of comparable size, leading to a superior performance-to-cost ratio across various benchmarks. The implications of this study suggest a potential paradigm shift in LLM development and deployment. Rather than focusing solely on creating increasingly large, general-purpose models, the future of AI may lie in developing ecosystems of smaller, highly specialized models coupled with sophisticated routing systems. This approach could lead to more efficient resource utilization, reduced computational costs, and superior overall performance.

With the growing prominence of the Mixture of Experts (MoE) architecture in developing large-scale foundation models, we investigate the Hierarchical Mixture of Experts (HMoE), a specialized variant of MoE that excels in handling complex inputs and improving performance on targeted tasks. Our analysis highlights the advantages of using the Laplace gating function over the traditional Softmax gating within the HMoE frameworks. We theoretically demonstrate that applying the Laplace gating function at both levels of the HMoE model helps eliminate undesirable parameter interactions caused by the Softmax gating and, therefore, accelerates the expert convergence as well as enhances the expert specialization. Empirical validation across diverse scenarios supports these theoretical claims. This includes large-scale multimodal tasks, image classification, and latent domain discovery and prediction tasks, where our modified HMoE models show great performance improvements compared to the conventional HMoE models.

Text-to-SQL technology has become crucial for translating natural language into SQL queries in various industries, enabling non-technical users to perform complex data operations. The need for accurate evaluation methods has increased as these systems have grown more sophisticated. However, we found that the Execution Accuracy (EX), the most promising evaluation metric, still shows a substantial portion of false positives and negatives compared to human evaluation. Thus, this paper introduces FLEX (False-Less EXecution), a novel approach to evaluating text-to-SQL systems using large language models (LLMs) to emulate human expert-level evaluation of SQL queries. Our method shows significantly higher agreement with human expert judgments, improving Cohen's kappa from 61 to 78.17. Re-evaluating top-performing models on the Spider and BIRD benchmarks using FLEX reveals substantial shifts in performance rankings, with an average performance decrease of 3.15 due to false positive corrections and an increase of 6.07 from addressing false negatives. This work contributes to a more accurate and nuanced evaluation of text-to-SQL systems, potentially reshaping our understanding of state-of-the-art performance in this field.

This study explores the potential of large language models (LLMs) for identifying and examining intertextual relationships within biblical, Koine Greek texts. By evaluating the performance of LLMs on various intertextuality scenarios the study demonstrates that these models can detect direct quotations, allusions, and echoes between texts. The LLM's ability to generate novel intertextual observations and connections highlights its potential to uncover new insights. However, the model also struggles with long query passages and the inclusion of false intertextual dependences, emphasizing the importance of expert evaluation. The expert-in-the-loop methodology presented offers a scalable approach for intertextual research into the complex web of intertextuality within and beyond the biblical corpus.

We investigate efficient methods for training Large Language Models (LLMs) to possess capabilities in multiple specialized domains, such as coding, math reasoning and world knowledge. Our method, named Branch-Train-MiX (BTX), starts from a seed model, which is branched to train experts in embarrassingly parallel fashion with high throughput and reduced communication cost. After individual experts are asynchronously trained, BTX brings together their feedforward parameters as experts in Mixture-of-Expert (MoE) layers and averages the remaining parameters, followed by an MoE-finetuning stage to learn token-level routing. BTX generalizes two special cases, the Branch-Train-Merge method, which does not have the MoE finetuning stage to learn routing, and sparse upcycling, which omits the stage of training experts asynchronously. Compared to alternative approaches, BTX achieves the best accuracy-efficiency tradeoff.

Parameter-efficient fine-tuning (PEFT) is crucial for customizing Large Language Models (LLMs) with constrained resources. Although there have been various PEFT methods for dense-architecture LLMs, PEFT for sparse-architecture LLMs is still underexplored. In this work, we study the PEFT method for LLMs with the Mixture-of-Experts (MoE) architecture and the contents of this work are mainly threefold: (1) We investigate the dispersion degree of the activated experts in customized tasks, and found that the routing distribution for a specific task tends to be highly concentrated, while the distribution of activated experts varies significantly across different tasks. (2) We propose Expert-Specialized Fine-Tuning, or ESFT, which tunes the experts most relevant to downstream tasks while freezing the other experts and modules; experimental results demonstrate that our method not only improves the tuning efficiency, but also matches or even surpasses the performance of full-parameter fine-tuning. (3) We further analyze the impact of the MoE architecture on expert-specialized fine-tuning. We find that MoE models with finer-grained experts are more advantageous in selecting the combination of experts that are most relevant to downstream tasks, thereby enhancing both the training efficiency and effectiveness.

We introduce CogVLM, a powerful open-source visual language foundation model. Different from the popular shallow alignment method which maps image features into the input space of language model, CogVLM bridges the gap between the frozen pretrained language model and image encoder by a trainable visual expert module in the attention and FFN layers. As a result, CogVLM enables deep fusion of vision language features without sacrificing any performance on NLP tasks. CogVLM-17B achieves state-of-the-art performance on 10 classic cross-modal benchmarks, including NoCaps, Flicker30k captioning, RefCOCO, RefCOCO+, RefCOCOg, Visual7W, GQA, ScienceQA, VizWiz VQA and TDIUC, and ranks the 2nd on VQAv2, OKVQA, TextVQA, COCO captioning, etc., surpassing or matching PaLI-X 55B. Codes and checkpoints are available at https://github.com/THUDM/CogVLM.

The complementary potential of Large Language Models (LLM) assumes off-the-shelf LLMs have heterogeneous expertise in a wide range of domains and tasks so that an ensemble of LLMs can achieve consistently better performance. Existing ensemble methods for LLMs mainly focus on reward model ranking of outputs, leading to significant computation overhead. To combat this issue, we revisit the complementary potential of LLMs and further elaborate it by mining latent expertise with off-the-shelf reward models. We propose Zooter, a reward-guided routing method distilling rewards on training queries to train a routing function, which can precisely distribute each query to the LLM with expertise about it. We also integrate a tag-based label enhancement to mitigate noise from uncertainty when using rewards as silver supervision. Zooter shows computation efficiency in inference as it introduces only a minor computation overhead of a routing function compared with reward model ranking methods. We evaluate Zooter on a comprehensive benchmark collection with 26 subsets on different domains and tasks. Zooter outperforms the best single model on average and ranks first on 44% of tasks, even surpassing multiple reward model ranking methods.

Current large vision-language models (VLMs) often encounter challenges such as insufficient capabilities of a single visual component and excessively long visual tokens. These issues can limit the model's effectiveness in accurately interpreting complex visual information and over-lengthy contextual information. Addressing these challenges is crucial for enhancing the performance and applicability of VLMs. This paper proposes the use of ensemble experts technique to synergizes the capabilities of individual visual encoders, including those skilled in image-text matching, OCR, image segmentation, etc. This technique introduces a fusion network to unify the processing of outputs from different visual experts, while bridging the gap between image encoders and pre-trained LLMs. In addition, we explore different positional encoding schemes to alleviate the waste of positional encoding caused by lengthy image feature sequences, effectively addressing the issue of position overflow and length limitations. For instance, in our implementation, this technique significantly reduces the positional occupancy in models like SAM, from a substantial 4096 to a more efficient and manageable 64 or even down to 1. Experimental results demonstrate that VLMs with multiple experts exhibit consistently superior performance over isolated visual encoders and mark a significant performance boost as more experts are integrated. We have open-sourced the training code used in this report. All of these resources can be found on our project website.

Sparsely-activated Mixture-of-experts (MoE) models allow the number of parameters to greatly increase while keeping the amount of computation for a given token or a given sample unchanged. However, a poor expert routing strategy (e.g. one resulting in load imbalance) can cause certain experts to be under-trained, leading to an expert being under or over-specialized. Prior work allocates a fixed number of experts to each token using a top-k function regardless of the relative importance of different tokens. To address this, we propose a heterogeneous mixture-of-experts employing an expert choice method. Instead of letting tokens select the top-k experts, we have experts selecting the top-k tokens. As a result, each token can be routed to a variable number of experts and each expert can have a fixed bucket size. We systematically study pre-training speedups using the same computational resources of the Switch Transformer top-1 and GShard top-2 gating of prior work and find that our method improves training convergence time by more than 2x. For the same computational cost, our method demonstrates higher performance in fine-tuning 11 selected tasks in the GLUE and SuperGLUE benchmarks. For a smaller activation cost, our method outperforms the T5 dense model in 7 out of the 11 tasks.

A pivotal advancement in the progress of large language models (LLMs) is the emergence of the Mixture-of-Experts (MoE) LLMs. Compared to traditional LLMs, MoE LLMs can achieve higher performance with fewer parameters, but it is still hard to deploy them due to their immense parameter sizes. Different from previous weight pruning methods that rely on specifically designed hardware, this paper mainly aims to enhance the deployment efficiency of MoE LLMs by introducing plug-and-play expert-level sparsification techniques. Specifically, we propose, for the first time to our best knowledge, post-training approaches for task-agnostic and task-specific expert pruning and skipping of MoE LLMs, tailored to improve deployment efficiency while maintaining model performance across a wide range of tasks. Extensive experiments show that our proposed methods can simultaneously reduce model sizes and increase the inference speed, while maintaining satisfactory performance. Data and code will be available at https://github.com/Lucky-Lance/Expert_Sparsity.

Recently, large language model (LLM) based artificial intelligence (AI) systems have demonstrated remarkable capabilities in natural language understanding and generation. However, these models face a significant challenge when it comes to sensitive applications, such as reasoning over medical knowledge and answering medical questions in a physician-like manner. Prior studies attempted to overcome this challenge by increasing the model size (>100B) to learn more general medical knowledge, while there is still room for improvement in LLMs with smaller-scale model sizes (<100B). In this work, we start from a pre-trained general LLM model (AntGLM-10B) and fine-tune it from a medical beginner towards a medical expert (called AntGLM-Med-10B), which leverages a 3-stage optimization procedure, i.e., general medical knowledge injection, medical domain instruction tuning, and specific medical task adaptation. Our contributions are threefold: (1) We specifically investigate how to adapt a pre-trained general LLM in medical domain, especially for a specific medical task. (2) We collect and construct large-scale medical datasets for each stage of the optimization process. These datasets encompass various data types and tasks, such as question-answering, medical reasoning, multi-choice questions, and medical conversations. (3) Specifically for multi-choice questions in the medical domain, we propose a novel Verification-of-Choice approach for prompting engineering, which significantly enhances the reasoning ability of LLMs. Remarkably, by combining the above approaches, our AntGLM-Med-10B model can outperform the most of LLMs on PubMedQA, including both general and medical LLMs, even when these LLMs have larger model size.

The emergence of large multimodal models has unlocked remarkable potential in AI, particularly in pathology. However, the lack of specialized, high-quality benchmark impeded their development and precise evaluation. To address this, we introduce PathMMU, the largest and highest-quality expert-validated pathology benchmark for LMMs. It comprises 33,573 multimodal multi-choice questions and 21,599 images from various sources, and an explanation for the correct answer accompanies each question. The construction of PathMMU capitalizes on the robust capabilities of GPT-4V, utilizing approximately 30,000 gathered image-caption pairs to generate Q\&As. Significantly, to maximize PathMMU's authority, we invite six pathologists to scrutinize each question under strict standards in PathMMU's validation and test sets, while simultaneously setting an expert-level performance benchmark for PathMMU. We conduct extensive evaluations, including zero-shot assessments of 14 open-sourced and three closed-sourced LMMs and their robustness to image corruption. We also fine-tune representative LMMs to assess their adaptability to PathMMU. The empirical findings indicate that advanced LMMs struggle with the challenging PathMMU benchmark, with the top-performing LMM, GPT-4V, achieving only a 51.7\% zero-shot performance, significantly lower than the 71.4\% demonstrated by human pathologists. After fine-tuning, even open-sourced LMMs can surpass GPT-4V with a performance of over 60\%, but still fall short of the expertise shown by pathologists. We hope that the PathMMU will offer valuable insights and foster the development of more specialized, next-generation LLMs for pathology.

This paper presents MoE-Infinity, a cost-efficient mixture-of-expert (MoE) serving system that realizes activation-aware expert offloading. MoE-Infinity features sequence-level expert activation tracing, a new approach adept at identifying sparse activations and capturing the temporal locality of MoE inference. By analyzing these traces, MoE-Infinity performs novel activation-aware expert prefetching and caching, substantially reducing the latency overheads usually associated with offloading experts for improved cost performance. Extensive experiments in a cluster show that MoE-Infinity outperforms numerous existing systems and approaches, reducing latency by 4 - 20X and decreasing deployment costs by over 8X for various MoEs. MoE-Infinity's source code is publicly available at https://github.com/TorchMoE/MoE-Infinity

Sparsely-gated Mixture of Expert (MoE), an emerging deep model architecture, has demonstrated a great promise to enable high-accuracy and ultra-efficient model inference. Despite the growing popularity of MoE, little work investigated its potential to advance convolutional neural networks (CNNs), especially in the plane of adversarial robustness. Since the lack of robustness has become one of the main hurdles for CNNs, in this paper we ask: How to adversarially robustify a CNN-based MoE model? Can we robustly train it like an ordinary CNN model? Our pilot study shows that the conventional adversarial training (AT) mechanism (developed for vanilla CNNs) no longer remains effective to robustify an MoE-CNN. To better understand this phenomenon, we dissect the robustness of an MoE-CNN into two dimensions: Robustness of routers (i.e., gating functions to select data-specific experts) and robustness of experts (i.e., the router-guided pathways defined by the subnetworks of the backbone CNN). Our analyses show that routers and experts are hard to adapt to each other in the vanilla AT. Thus, we propose a new router-expert alternating Adversarial training framework for MoE, termed AdvMoE. The effectiveness of our proposal is justified across 4 commonly-used CNN model architectures over 4 benchmark datasets. We find that AdvMoE achieves 1% ~ 4% adversarial robustness improvement over the original dense CNN, and enjoys the efficiency merit of sparsity-gated MoE, leading to more than 50% inference cost reduction. Codes are available at https://github.com/OPTML-Group/Robust-MoE-CNN.

Sparsely-gated Mixture of Expert (MoE) layers have been recently successfully applied for scaling large transformers, especially for language modeling tasks. An intriguing side effect of sparse MoE layers is that they convey inherent interpretability to a model via natural expert specialization. In this work, we apply sparse MoE layers to CNNs for computer vision tasks and analyze the resulting effect on model interpretability. To stabilize MoE training, we present both soft and hard constraint-based approaches. With hard constraints, the weights of certain experts are allowed to become zero, while soft constraints balance the contribution of experts with an additional auxiliary loss. As a result, soft constraints handle expert utilization better and support the expert specialization process, while hard constraints maintain more generalized experts and increase overall model performance. Our findings demonstrate that experts can implicitly focus on individual sub-domains of the input space. For example, experts trained for CIFAR-100 image classification specialize in recognizing different domains such as flowers or animals without previous data clustering. Experiments with RetinaNet and the COCO dataset further indicate that object detection experts can also specialize in detecting objects of distinct sizes.

Mixture-of-Expert (MoE) presents a strong potential in enlarging the size of language model to trillions of parameters. However, training trillion-scale MoE requires algorithm and system co-design for a well-tuned high performance distributed training system. Unfortunately, the only existing platform that meets the requirements strongly depends on Google's hardware (TPU) and software (Mesh Tensorflow) stack, and is not open and available to the public, especially GPU and PyTorch communities. In this paper, we present FastMoE, a distributed MoE training system based on PyTorch with common accelerators. The system provides a hierarchical interface for both flexible model design and easy adaption to different applications, such as Transformer-XL and Megatron-LM. Different from direct implementation of MoE models using PyTorch, the training speed is highly optimized in FastMoE by sophisticated high-performance acceleration skills. The system supports placing different experts on multiple GPUs across multiple nodes, enabling enlarging the number of experts linearly against the number of GPUs. The source of FastMoE is available at https://github.com/laekov/fastmoe under Apache-2 license.

The ability to customize a trained Deep Neural Network (DNN) locally using user-specific data may greatly enhance user experiences, reduce development costs, and protect user's privacy. In this work, we propose to incorporate a novel Mixture of Experts (MOE) approach to accomplish this goal. This architecture comprises of a Global Expert (GE), a Local Expert (LE) and a Gating Network (GN). The GE is a trained DNN developed on a large training dataset representative of many potential users. After deployment on an embedded edge device, GE will be subject to customized, user-specific data (e.g., accent in speech) and its performance may suffer. This problem may be alleviated by training a local DNN (the local expert, LE) on a small size customized training data to correct the errors made by GE. A gating network then will be trained to determine whether an incoming data should be handled by GE or LE. Since the customized dataset is in general very small, the cost of training LE and GN would be much lower than that of re-training of GE. The training of LE and GN thus can be performed at local device, properly protecting the privacy of customized training data. In this work, we developed a prototype MOE architecture for handwritten alphanumeric character recognition task. We use EMNIST as the generic dataset, LeNet5 as GE, and handwritings of 10 users as the customized dataset. We show that with the LE and GN, the classification accuracy is significantly enhanced over the customized dataset with almost no degradation of accuracy over the generic dataset. In terms of energy and network size, the overhead of LE and GN is around 2.5% compared to those of GE.

In large language models like the Generative Pre-trained Transformer, the Mixture of Experts paradigm has emerged as a powerful technique for enhancing model expressiveness and accuracy. However, deploying GPT MoE models for parallel inference on distributed systems presents significant challenges, primarily due to the extensive Alltoall communication required for expert routing and aggregation. This communication bottleneck exacerbates the already complex computational landscape, hindering the efficient utilization of high-performance computing resources. In this paper, we propose a lightweight optimization technique called ExFlow, to largely accelerate the inference of these MoE models. We take a new perspective on alleviating the communication overhead by exploiting the inter-layer expert affinity. Unlike previous methods, our solution can be directly applied to pre-trained MoE models without any fine-tuning or accuracy degradation. By proposing a context-coherent expert parallelism on distributed systems, our design only uses one Alltoall communication to deliver the same functionality while previous methods all require two Alltoalls. By carefully examining the conditional probability in tokens' routing across multiple layers, we proved that pre-trained GPT MoE models implicitly exhibit a strong inter-layer expert affinity. We then design an efficient integer programming model to capture such features and show that by properly placing the experts on corresponding GPUs, we can reduce up to 67% cross-GPU routing latency. Our solution beats the cutting-edge MoE implementations with experts from 8 to 64, with up to 2.2x improvement in inference throughput. We further provide a detailed study of how the model implicitly acquires this expert affinity at the very early training stage and how this affinity evolves and stabilizes during training.

Evaluating the accuracy of outputs generated by Large Language Models (LLMs) is especially important in the climate science and policy domain. We introduce the Expert Confidence in Climate Statements (ClimateX) dataset, a novel, curated, expert-labeled dataset consisting of 8094 climate statements collected from the latest Intergovernmental Panel on Climate Change (IPCC) reports, labeled with their associated confidence levels. Using this dataset, we show that recent LLMs can classify human expert confidence in climate-related statements, especially in a few-shot learning setting, but with limited (up to 47%) accuracy. Overall, models exhibit consistent and significant over-confidence on low and medium confidence statements. We highlight implications of our results for climate communication, LLMs evaluation strategies, and the use of LLMs in information retrieval systems.

Mixture-of-Experts (MoE) is a neural network architecture that adds sparsely activated expert blocks to a base model, increasing the number of parameters without impacting computational costs. However, current distributed deep learning frameworks are limited in their ability to train high-quality MoE models with large base models. In this work, we present DeepSpeed-TED, a novel, three-dimensional, hybrid parallel algorithm that combines data, tensor, and expert parallelism to enable the training of MoE models with 4 to 8x larger base models than the current state-of-the-art. We also describe memory optimizations in the optimizer step, and communication optimizations that eliminate unnecessary data movement. We implement our approach in DeepSpeed and achieve speedups of 26% over a baseline (i.e. without our communication optimizations) when training a 40 billion parameter MoE model (6.7 billion base model with 16 experts) on 128 V100 GPUs.

Mixture-of-Experts (MoE) models have gained popularity in achieving state-of-the-art performance in a wide range of tasks in computer vision and natural language processing. They effectively expand the model capacity while incurring a minimal increase in computation cost during training. However, deploying such models for inference is difficult due to their large size and complex communication pattern. In this work, we provide a characterization of two MoE workloads, namely Language Modeling (LM) and Machine Translation (MT) and identify their sources of inefficiencies at deployment. We propose three optimization techniques to mitigate sources of inefficiencies, namely (1) Dynamic gating, (2) Expert Buffering, and (3) Expert load balancing. We show that dynamic gating improves maximum throughput by 6.21-11.23times for LM, 5.75-10.98times for MT Encoder and 2.58-5.71times for MT Decoder. It also reduces memory usage by up to 1.36times for LM and up to 1.1times for MT. We further propose Expert Buffering, a new caching mechanism that only keeps hot, active experts in GPU memory while buffering the rest in CPU memory. This reduces static memory allocation by up to 1.47times. We finally propose a load balancing methodology that provides additional scalability to the workload.

Sparsely Mixture of Experts (MoE) has received great interest due to its promising scaling capability with affordable computational overhead. MoE converts dense layers into sparse experts, and utilizes a gated routing network to make experts conditionally activated. However, as the number of experts grows, MoE with outrageous parameters suffers from overfitting and sparse data allocation. Such problems are especially severe on tasks with limited data, thus hindering the progress for MoE models to improve performance by scaling up. In this work, we propose Mixture of Expert Clusters - a general approach to enable expert layers to learn more diverse and appropriate knowledge by imposing variance-based constraints on the routing stage. We further propose a cluster-level expert dropout strategy specifically designed for the expert cluster structure. Our experiments reveal that MoEC could improve performance on machine translation and natural language understanding tasks, and raise the performance upper bound for scaling up experts under limited data. We also verify that MoEC plays a positive role in mitigating overfitting and sparse data allocation.

The sparse Mixture-of-Experts (MoE) model is powerful for large-scale pre-training and has achieved promising results due to its model capacity. However, with trillions of parameters, MoE is hard to be deployed on cloud or mobile environment. The inference of MoE requires expert parallelism, which is not hardware-friendly and communication expensive. Especially for resource-limited downstream tasks, such sparse structure has to sacrifice a lot of computing efficiency for limited performance gains. In this work, we observe most experts contribute scarcely little to the MoE fine-tuning and inference. We further propose a general method to progressively drop the non-professional experts for the target downstream task, which preserves the benefits of MoE while reducing the MoE model into one single-expert dense model. Our experiments reveal that the fine-tuned single-expert model could preserve 99.3% benefits from MoE across six different types of tasks while enjoying 2x inference speed with free communication cost.

Despite recent advancements in language models (LMs), their application to dialogue management (DM) problems and ability to carry on rich conversations remain a challenge. We use reinforcement learning (RL) to develop a dialogue agent that avoids being short-sighted (outputting generic utterances) and maximizes overall user satisfaction. Most existing RL approaches to DM train the agent at the word-level, and thus, have to deal with a combinatorially complex action space even for a medium-size vocabulary. As a result, they struggle to produce a successful and engaging dialogue even if they are warm-started with a pre-trained LM. To address this issue, we develop a RL-based DM using a novel mixture of expert language model (MoE-LM) that consists of (i) a LM capable of learning diverse semantics for conversation histories, (ii) a number of {\em specialized} LMs (or experts) capable of generating utterances corresponding to a particular attribute or personality, and (iii) a RL-based DM that performs dialogue planning with the utterances generated by the experts. Our MoE approach provides greater flexibility to generate sensible utterances with different intents and allows RL to focus on conversational-level DM. We compare it with SOTA baselines on open-domain dialogues and demonstrate its effectiveness both in terms of the diversity and sensibility of the generated utterances and the overall DM performance.

Mixture-of-Experts (MoE) models can achieve promising results with outrageous large amount of parameters but constant computation cost, and thus it has become a trend in model scaling. Still it is a mystery how MoE layers bring quality gains by leveraging the parameters with sparse activation. In this work, we investigate several key factors in sparse expert models. We observe that load imbalance may not be a significant problem affecting model quality, contrary to the perspectives of recent studies, while the number of sparsely activated experts k and expert capacity C in top-k routing can significantly make a difference in this context. Furthermore, we take a step forward to propose a simple method called expert prototyping that splits experts into different prototypes and applies k top-1 routing. This strategy improves the model quality but maintains constant computational costs, and our further exploration on extremely large-scale models reflects that it is more effective in training larger models. We push the model scale to over 1 trillion parameters and implement it on solely 480 NVIDIA V100-32GB GPUs, in comparison with the recent SOTAs on 2048 TPU cores. The proposed giant model achieves substantial speedup in convergence over the same-size baseline.

In this work, we investigate the problem of lip-syncing a talking face video of an arbitrary identity to match a target speech segment. Current works excel at producing accurate lip movements on a static image or videos of specific people seen during the training phase. However, they fail to accurately morph the lip movements of arbitrary identities in dynamic, unconstrained talking face videos, resulting in significant parts of the video being out-of-sync with the new audio. We identify key reasons pertaining to this and hence resolve them by learning from a powerful lip-sync discriminator. Next, we propose new, rigorous evaluation benchmarks and metrics to accurately measure lip synchronization in unconstrained videos. Extensive quantitative evaluations on our challenging benchmarks show that the lip-sync accuracy of the videos generated by our Wav2Lip model is almost as good as real synced videos. We provide a demo video clearly showing the substantial impact of our Wav2Lip model and evaluation benchmarks on our website: cvit.iiit.ac.in/research/projects/cvit-projects/a-lip-sync-expert-is-all-you-need-for-speech-to-lip-generation-in-the-wild. The code and models are released at this GitHub repository: github.com/Rudrabha/Wav2Lip. You can also try out the interactive demo at this link: bhaasha.iiit.ac.in/lipsync.

The absence of explicitly tailored, accessible annotated datasets for educational purposes presents a notable obstacle for NLP tasks in languages with limited resources.This study initially explores the feasibility of using machine translation (MT) to convert an existing dataset into a Tigrinya dataset in SQuAD format. As a result, we present TIGQA, an expert annotated educational dataset consisting of 2.68K question-answer pairs covering 122 diverse topics such as climate, water, and traffic. These pairs are from 537 context paragraphs in publicly accessible Tigrinya and Biology books. Through comprehensive analyses, we demonstrate that the TIGQA dataset requires skills beyond simple word matching, requiring both single-sentence and multiple-sentence inference abilities. We conduct experiments using state-of-the art MRC methods, marking the first exploration of such models on TIGQA. Additionally, we estimate human performance on the dataset and juxtapose it with the results obtained from pretrained models.The notable disparities between human performance and best model performance underscore the potential for further enhancements to TIGQA through continued research. Our dataset is freely accessible via the provided link to encourage the research community to address the challenges in the Tigrinya MRC.

Mixture-of-Expert (MoE) based large language models (LLMs), such as the recent Mixtral and DeepSeek-MoE, have shown great promise in scaling model size without suffering from the quadratic growth of training cost of dense transformers. Like dense models, training MoEs requires answering the same question: given a training budget, what is the optimal allocation on the model size and number of tokens? We study the scaling law of MoE-based LLMs regarding the relations between the model performance, model size, dataset size, and the expert degree. Echoing previous research studying MoE in different contexts, we observe the diminishing return of increasing the number of experts, but this seems to suggest we should scale the number of experts until saturation, as the training cost would remain constant, which is problematic during inference time. We propose to amend the scaling law of MoE by introducing inference efficiency as another metric besides the validation loss. We find that MoEs with a few (4/8) experts are the most serving efficient solution under the same performance, but costs 2.5-3.5x more in training. On the other hand, training a (16/32) expert MoE much smaller (70-85%) than the loss-optimal solution, but with a larger training dataset is a promising setup under a training budget.

Despite their popularity in non-English NLP, multilingual language models often underperform monolingual ones due to inter-language competition for model parameters. We propose Cross-lingual Expert Language Models (X-ELM), which mitigate this competition by independently training language models on subsets of the multilingual corpus. This process specializes X-ELMs to different languages while remaining effective as a multilingual ensemble. Our experiments show that when given the same compute budget, X-ELM outperforms jointly trained multilingual models across all considered languages and that these gains transfer to downstream tasks. X-ELM provides additional benefits over performance improvements: new experts can be iteratively added, adapting X-ELM to new languages without catastrophic forgetting. Furthermore, training is asynchronous, reducing the hardware requirements for multilingual training and democratizing multilingual modeling.

While text style transfer has many applications across natural language processing, the core premise of transferring from a single source style is unrealistic in a real-world setting. In this work, we focus on arbitrary style transfer: rewriting a text from an arbitrary, unknown style to a target style. We propose STEER: Unified Style Transfer with Expert Reinforcement, a unified frame-work developed to overcome the challenge of limited parallel data for style transfer. STEER involves automatically generating a corpus of style-transfer pairs using a product of experts during decoding. The generated offline data is then used to pre-train an initial policy before switching to online, off-policy reinforcement learning for further improvements via fine-grained reward signals. STEER is unified and can transfer to multiple target styles from an arbitrary, unknown source style, making it particularly flexible and efficient. Experimental results on a challenging dataset with text from a diverse set of styles demonstrate state-of-the-art results compared to competitive baselines. Remarkably, STEER outperforms the 175B parameter instruction-tuned GPT-3 on overall style transfer quality, despite being 226 times smaller in size. We also show STEER is robust, maintaining its style transfer capabilities on out-of-domain data, and surpassing nearly all baselines across various styles. The success of our method highlights the potential of RL algorithms when augmented with controllable decoding to overcome the challenge of limited data supervision.

The application of deep learning to nursing procedure activity understanding has the potential to greatly enhance the quality and safety of nurse-patient interactions. By utilizing the technique, we can facilitate training and education, improve quality control, and enable operational compliance monitoring. However, the development of automatic recognition systems in this field is currently hindered by the scarcity of appropriately labeled datasets. The existing video datasets pose several limitations: 1) these datasets are small-scale in size to support comprehensive investigations of nursing activity; 2) they primarily focus on single procedures, lacking expert-level annotations for various nursing procedures and action steps; and 3) they lack temporally localized annotations, which prevents the effective localization of targeted actions within longer video sequences. To mitigate these limitations, we propose NurViD, a large video dataset with expert-level annotation for nursing procedure activity understanding. NurViD consists of over 1.5k videos totaling 144 hours, making it approximately four times longer than the existing largest nursing activity datasets. Notably, it encompasses 51 distinct nursing procedures and 177 action steps, providing a much more comprehensive coverage compared to existing datasets that primarily focus on limited procedures. To evaluate the efficacy of current deep learning methods on nursing activity understanding, we establish three benchmarks on NurViD: procedure recognition on untrimmed videos, procedure and action recognition on trimmed videos, and action detection. Our benchmark and code will be available at https://github.com/minghu0830/NurViD-benchmark.

The emergence of Large Language Models (LLMs), such as ChatGPT, has revolutionized general natural language preprocessing (NLP) tasks. However, their expertise in the financial domain lacks a comprehensive evaluation. To assess the ability of LLMs to solve financial NLP tasks, we present FinLMEval, a framework for Financial Language Model Evaluation, comprising nine datasets designed to evaluate the performance of language models. This study compares the performance of encoder-only language models and the decoder-only language models. Our findings reveal that while some decoder-only LLMs demonstrate notable performance across most financial tasks via zero-shot prompting, they generally lag behind the fine-tuned expert models, especially when dealing with proprietary datasets. We hope this study provides foundation evaluations for continuing efforts to build more advanced LLMs in the financial domain.

This paper introduces a new IncidentAI dataset for safety prevention. Different from prior corpora that usually contain a single task, our dataset comprises three tasks: named entity recognition, cause-effect extraction, and information retrieval. The dataset is annotated by domain experts who have at least six years of practical experience as high-pressure gas conservation managers. We validate the contribution of the dataset in the scenario of safety prevention. Preliminary results on the three tasks show that NLP techniques are beneficial for analyzing incident reports to prevent future failures. The dataset facilitates future research in NLP and incident management communities. The access to the dataset is also provided (the IncidentAI dataset is available at: https://github.com/Cinnamon/incident-ai-dataset).

Scaling high-quality tutoring remains a major challenge in education. Due to growing demand, many platforms employ novice tutors who, unlike experienced educators, struggle to address student mistakes and thus fail to seize prime learning opportunities. Our work explores the potential of large language models (LLMs) to close the novice-expert knowledge gap in remediating math mistakes. We contribute Bridge, a method that uses cognitive task analysis to translate an expert's latent thought process into a decision-making model for remediation. This involves an expert identifying (A) the student's error, (B) a remediation strategy, and (C) their intention before generating a response. We construct a dataset of 700 real tutoring conversations, annotated by experts with their decisions. We evaluate state-of-the-art LLMs on our dataset and find that the expert's decision-making model is critical for LLMs to close the gap: responses from GPT4 with expert decisions (e.g., "simplify the problem") are +76% more preferred than without. Additionally, context-sensitive decisions are critical to closing pedagogical gaps: random decisions decrease GPT4's response quality by -97% than expert decisions. Our work shows the potential of embedding expert thought processes in LLM generations to enhance their capability to bridge novice-expert knowledge gaps. Our dataset and code can be found at: https://github.com/rosewang2008/bridge.

Training a large and state-of-the-art machine learning model typically necessitates the use of large-scale datasets, which, in turn, makes the training and parameter-tuning process expensive and time-consuming. Some researchers opt to distil information from real-world datasets into tiny and compact synthetic datasets while maintaining their ability to train a well-performing model, hence proposing a data-efficient method known as Dataset Distillation (DD). Despite recent progress in this field, existing methods still underperform and cannot effectively replace large datasets. In this paper, unlike previous methods that focus solely on improving the efficacy of student distillation, we are the first to recognize the important interplay between expert and student. We argue the significant impact of expert smoothness when employing more potent expert trajectories in subsequent dataset distillation. Based on this, we introduce the integration of clipping loss and gradient penalty to regulate the rate of parameter changes in expert trajectories. Furthermore, in response to the sensitivity exhibited towards randomly initialized variables during distillation, we propose representative initialization for synthetic dataset and balanced inner-loop loss. Finally, we present two enhancement strategies, namely intermediate matching loss and weight perturbation, to mitigate the potential occurrence of cumulative errors. We conduct extensive experiments on datasets of different scales, sizes, and resolutions. The results demonstrate that the proposed method significantly outperforms prior methods.

Foundation vision-language models are currently transforming computer vision, and are on the rise in medical imaging fueled by their very promising generalization capabilities. However, the initial attempts to transfer this new paradigm to medical imaging have shown less impressive performances than those observed in other domains, due to the significant domain shift and the complex, expert domain knowledge inherent to medical-imaging tasks. Motivated by the need for domain-expert foundation models, we present FLAIR, a pre-trained vision-language model for universal retinal fundus image understanding. To this end, we compiled 37 open-access, mostly categorical fundus imaging datasets from various sources, with up to 97 different target conditions and 284,660 images. We integrate the expert's domain knowledge in the form of descriptive textual prompts, during both pre-training and zero-shot inference, enhancing the less-informative categorical supervision of the data. Such a textual expert's knowledge, which we compiled from the relevant clinical literature and community standards, describes the fine-grained features of the pathologies as well as the hierarchies and dependencies between them. We report comprehensive evaluations, which illustrate the benefit of integrating expert knowledge and the strong generalization capabilities of FLAIR under difficult scenarios with domain shifts or unseen categories. When adapted with a lightweight linear probe, FLAIR outperforms fully-trained, dataset-focused models, more so in the few-shot regimes. Interestingly, FLAIR outperforms by a large margin more generalist, larger-scale image-language models, which emphasizes the potential of embedding experts' domain knowledge and the limitations of generalist models in medical imaging.

We assessed the performance of commercial Large Language Models (LLMs) GPT-3.5-Turbo and GPT-4 on tasks from the 2023 BioASQ challenge. In Task 11b Phase B, which is focused on answer generation, both models demonstrated competitive abilities with leading systems. Remarkably, they achieved this with simple zero-shot learning, grounded with relevant snippets. Even without relevant snippets, their performance was decent, though not on par with the best systems. Interestingly, the older and cheaper GPT-3.5-Turbo system was able to compete with GPT-4 in the grounded Q&A setting on factoid and list answers. In Task 11b Phase A, focusing on retrieval, query expansion through zero-shot learning improved performance, but the models fell short compared to other systems. The code needed to rerun these experiments is available through GitHub.

Reading comprehension of legal text can be a particularly challenging task due to the length and complexity of legal clauses and a shortage of expert-annotated datasets. To address this challenge, we introduce the Merger Agreement Understanding Dataset (MAUD), an expert-annotated reading comprehension dataset based on the American Bar Association's 2021 Public Target Deal Points Study, with over 39,000 examples and over 47,000 total annotations. Our fine-tuned Transformer baselines show promising results, with models performing well above random on most questions. However, on a large subset of questions, there is still room for significant improvement. As the only expert-annotated merger agreement dataset, MAUD is valuable as a benchmark for both the legal profession and the NLP community.

While coreference resolution typically involves various linguistic challenges, recent models are based on a single pairwise scorer for all types of pairs. We present LingMess, a new coreference model that defines different categories of coreference cases and optimize multiple pairwise scorers, where each scorer learns a specific set of linguistic challenges. Our model substantially improves pairwise scores for most categories and outperforms cluster-level performance on Ontonotes and 5 additional datasets. Our model is available in https://github.com/shon-otmazgin/lingmess-coref

The recent explosion of question answering (QA) datasets and models has increased the interest in the generalization of models across multiple domains and formats by either training on multiple datasets or by combining multiple models. Despite the promising results of multi-dataset models, some domains or QA formats may require specific architectures, and thus the adaptability of these models might be limited. In addition, current approaches for combining models disregard cues such as question-answer compatibility. In this work, we propose to combine expert agents with a novel, flexible, and training-efficient architecture that considers questions, answer predictions, and answer-prediction confidence scores to select the best answer among a list of answer candidates. Through quantitative and qualitative experiments we show that our model i) creates a collaboration between agents that outperforms previous multi-agent and multi-dataset approaches in both in-domain and out-of-domain scenarios, ii) is highly data-efficient to train, and iii) can be adapted to any QA format. We release our code and a dataset of answer predictions from expert agents for 16 QA datasets to foster future developments of multi-agent systems on https://github.com/UKPLab/MetaQA.

Due to the severity of the social media offensive and hateful comments in Brazil, and the lack of research in Portuguese, this paper provides the first large-scale expert annotated corpus of Brazilian Instagram comments for hate speech and offensive language detection. The HateBR corpus was collected from the comment section of Brazilian politicians' accounts on Instagram and manually annotated by specialists, reaching a high inter-annotator agreement. The corpus consists of 7,000 documents annotated according to three different layers: a binary classification (offensive versus non-offensive comments), offensiveness-level classification (highly, moderately, and slightly offensive), and nine hate speech groups (xenophobia, racism, homophobia, sexism, religious intolerance, partyism, apology for the dictatorship, antisemitism, and fatphobia). We also implemented baseline experiments for offensive language and hate speech detection and compared them with a literature baseline. Results show that the baseline experiments on our corpus outperform the current state-of-the-art for the Portuguese language.

Many specialized domains remain untouched by deep learning, as large labeled datasets require expensive expert annotators. We address this bottleneck within the legal domain by introducing the Contract Understanding Atticus Dataset (CUAD), a new dataset for legal contract review. CUAD was created with dozens of legal experts from The Atticus Project and consists of over 13,000 annotations. The task is to highlight salient portions of a contract that are important for a human to review. We find that Transformer models have nascent performance, but that this performance is strongly influenced by model design and training dataset size. Despite these promising results, there is still substantial room for improvement. As one of the only large, specialized NLP benchmarks annotated by experts, CUAD can serve as a challenging research benchmark for the broader NLP community.

The use of deep neural models for diagnosis prediction from clinical text has shown promising results. However, in clinical practice such models must not only be accurate, but provide doctors with interpretable and helpful results. We introduce ProtoPatient, a novel method based on prototypical networks and label-wise attention with both of these abilities. ProtoPatient makes predictions based on parts of the text that are similar to prototypical patients - providing justifications that doctors understand. We evaluate the model on two publicly available clinical datasets and show that it outperforms existing baselines. Quantitative and qualitative evaluations with medical doctors further demonstrate that the model provides valuable explanations for clinical decision support.

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

With the increasing availability of structured and unstructured data and the swift progress of analytical techniques, Artificial Intelligence (AI) is bringing a revolution to the healthcare industry. With the increasingly indispensable role of AI in healthcare, there are growing concerns over the lack of transparency and explainability in addition to potential bias encountered by predictions of the model. This is where Explainable Artificial Intelligence (XAI) comes into the picture. XAI increases the trust placed in an AI system by medical practitioners as well as AI researchers, and thus, eventually, leads to an increasingly widespread deployment of AI in healthcare. In this paper, we present different interpretability techniques. The aim is to enlighten practitioners on the understandability and interpretability of explainable AI systems using a variety of techniques available which can be very advantageous in the health-care domain. Medical diagnosis model is responsible for human life and we need to be confident enough to treat a patient as instructed by a black-box model. Our paper contains examples based on the heart disease dataset and elucidates on how the explainability techniques should be preferred to create trustworthiness while using AI systems in healthcare.

Speech patterns have been identified as potential diagnostic markers for neuropsychiatric conditions. However, most studies only compare a single clinical group to healthy controls, whereas clinical practice often requires differentiating between multiple potential diagnoses (multiclass settings). To address this, we assembled a dataset of repeated recordings from 420 participants (67 with major depressive disorder, 106 with schizophrenia and 46 with autism, as well as matched controls), and tested the performance of a range of conventional machine learning models and advanced Transformer models on both binary and multiclass classification, based on voice and text features. While binary models performed comparably to previous research (F1 scores between 0.54-0.75 for autism spectrum disorder, ASD; 0.67-0.92 for major depressive disorder, MDD; and 0.71-0.83 for schizophrenia); when differentiating between multiple diagnostic groups performance decreased markedly (F1 scores between 0.35-0.44 for ASD, 0.57-0.75 for MDD, 0.15-0.66 for schizophrenia, and 0.38-0.52 macro F1). Combining voice and text-based models yielded increased performance, suggesting that they capture complementary diagnostic information. Our results indicate that models trained on binary classification may learn to rely on markers of generic differences between clinical and non-clinical populations, or markers of clinical features that overlap across conditions, rather than identifying markers specific to individual conditions. We provide recommendations for future research in the field, suggesting increased focus on developing larger transdiagnostic datasets that include more fine-grained clinical features, and that can support the development of models that better capture the complexity of neuropsychiatric conditions and naturalistic diagnostic assessment.

Depression has proven to be a significant public health issue, profoundly affecting the psychological well-being of individuals. If it remains undiagnosed, depression can lead to severe health issues, which can manifest physically and even lead to suicide. Generally, Diagnosing depression or any other mental disorder involves conducting semi-structured interviews alongside supplementary questionnaires, including variants of the Patient Health Questionnaire (PHQ) by Clinicians and mental health professionals. This approach places significant reliance on the experience and judgment of trained physicians, making the diagnosis susceptible to personal biases. Given that the underlying mechanisms causing depression are still being actively researched, physicians often face challenges in diagnosing and treating the condition, particularly in its early stages of clinical presentation. Recently, significant strides have been made in Artificial neural computing to solve problems involving text, image, and speech in various domains. Our analysis has aimed to leverage these state-of-the-art (SOTA) models in our experiments to achieve optimal outcomes leveraging multiple modalities. The experiments were performed on the Extended Distress Analysis Interview Corpus Wizard of Oz dataset (E-DAIC) corpus presented in the Audio/Visual Emotion Challenge (AVEC) 2019 Challenge. The proposed solutions demonstrate better results achieved by Proprietary and Open-source Large Language Models (LLMs), which achieved a Root Mean Square Error (RMSE) score of 3.98 on Textual Modality, beating the AVEC 2019 challenge baseline results and current SOTA regression analysis architectures. Additionally, the proposed solution achieved an accuracy of 71.43% in the classification task. The paper also includes a novel audio-visual multi-modal network that predicts PHQ-8 scores with an RMSE of 6.51.

Breast cancer is a major cause of cancer death among women, emphasising the importance of early detection for improved treatment outcomes and quality of life. Mammography, the primary diagnostic imaging test, poses challenges due to the high variability and patterns in mammograms. Double reading of mammograms is recommended in many screening programs to improve diagnostic accuracy but increases radiologists' workload. Researchers explore Machine Learning models to support expert decision-making. Stand-alone models have shown comparable or superior performance to radiologists, but some studies note decreased sensitivity with multiple datasets, indicating the need for high generalisation and robustness models. This work devises MammoDG, a novel deep-learning framework for generalisable and reliable analysis of cross-domain multi-center mammography data. MammoDG leverages multi-view mammograms and a novel contrastive mechanism to enhance generalisation capabilities. Extensive validation demonstrates MammoDG's superiority, highlighting the critical importance of domain generalisation for trustworthy mammography analysis in imaging protocol variations.

In clinical radiology reports, doctors capture important information about the patient's health status. They convey their observations from raw medical imaging data about the inner structures of a patient. As such, formulating reports requires medical experts to possess wide-ranging knowledge about anatomical regions with their normal, healthy appearance as well as the ability to recognize abnormalities. This explicit grasp on both the patient's anatomy and their appearance is missing in current medical image-processing systems as annotations are especially difficult to gather. This renders the models to be narrow experts e.g. for identifying specific diseases. In this work, we recover this missing link by adding human anatomy into the mix and enable the association of content in medical reports to their occurrence in associated imagery (medical phrase grounding). To exploit anatomical structures in this scenario, we present a sophisticated automatic pipeline to gather and integrate human bodily structures from computed tomography datasets, which we incorporate in our PAXRay: A Projected dataset for the segmentation of Anatomical structures in X-Ray data. Our evaluation shows that methods that take advantage of anatomical information benefit heavily in visually grounding radiologists' findings, as our anatomical segmentations allow for up to absolute 50% better grounding results on the OpenI dataset as compared to commonly used region proposals. The PAXRay dataset is available at https://constantinseibold.github.io/paxray/.

Skin conditions affect an estimated 1.9 billion people worldwide. A shortage of dermatologists causes long wait times and leads patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in referral errors, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories). The DLS distinguishes between 26 skin conditions that represent roughly 80% of the volume of skin conditions seen in primary care. The DLS was developed and validated using de-identified cases from a teledermatology practice serving 17 clinical sites via a temporal split: the first 14,021 cases for development and the last 3,756 cases for validation. On the validation set, where a panel of three board-certified dermatologists defined the reference standard for every case, the DLS achieved 0.71 and 0.93 top-1 and top-3 accuracies respectively. For a random subset of the validation set (n=963 cases), 18 clinicians reviewed the cases for comparison. On this subset, the DLS achieved a 0.67 top-1 accuracy, non-inferior to board-certified dermatologists (0.63, p<0.001), and higher than primary care physicians (PCPs, 0.45) and nurse practitioners (NPs, 0.41). The top-3 accuracy showed a similar trend: 0.90 DLS, 0.75 dermatologists, 0.60 PCPs, and 0.55 NPs. These results highlight the potential of the DLS to augment general practitioners to accurately diagnose skin conditions by suggesting differential diagnoses that may not have been considered. Future work will be needed to prospectively assess the clinical impact of using this tool in actual clinical workflows.

Generalist Large Language Models (LLMs), such as GPT-4, have shown considerable promise in various domains, including medical diagnosis. Rare diseases, affecting approximately 300 million people worldwide, often have unsatisfactory clinical diagnosis rates primarily due to a lack of experienced physicians and the complexity of differentiating among many rare diseases. In this context, recent news such as "ChatGPT correctly diagnosed a 4-year-old's rare disease after 17 doctors failed" underscore LLMs' potential, yet underexplored, role in clinically diagnosing rare diseases. To bridge this research gap, we introduce RareBench, a pioneering benchmark designed to systematically evaluate the capabilities of LLMs on 4 critical dimensions within the realm of rare diseases. Meanwhile, we have compiled the largest open-source dataset on rare disease patients, establishing a benchmark for future studies in this domain. To facilitate differential diagnosis of rare diseases, we develop a dynamic few-shot prompt methodology, leveraging a comprehensive rare disease knowledge graph synthesized from multiple knowledge bases, significantly enhancing LLMs' diagnostic performance. Moreover, we present an exhaustive comparative study of GPT-4's diagnostic capabilities against those of specialist physicians. Our experimental findings underscore the promising potential of integrating LLMs into the clinical diagnostic process for rare diseases. This paves the way for exciting possibilities in future advancements in this field.

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

Rare diseases collectively affect over 300 million individuals worldwide, yet timely and accurate diagnosis remains a pervasive challenge. This is largely due to their clinical heterogeneity, low individual prevalence, and the limited familiarity most clinicians have with rare conditions. Here, we introduce DeepRare, the first rare disease diagnosis agentic system powered by a large language model (LLM), capable of processing heterogeneous clinical inputs. The system generates ranked diagnostic hypotheses for rare diseases, each accompanied by a transparent chain of reasoning that links intermediate analytic steps to verifiable medical evidence. DeepRare comprises three key components: a central host with a long-term memory module; specialized agent servers responsible for domain-specific analytical tasks integrating over 40 specialized tools and web-scale, up-to-date medical knowledge sources, ensuring access to the most current clinical information. This modular and scalable design enables complex diagnostic reasoning while maintaining traceability and adaptability. We evaluate DeepRare on eight datasets. The system demonstrates exceptional diagnostic performance among 2,919 diseases, achieving 100% accuracy for 1013 diseases. In HPO-based evaluations, DeepRare significantly outperforms other 15 methods, like traditional bioinformatics diagnostic tools, LLMs, and other agentic systems, achieving an average Recall@1 score of 57.18% and surpassing the second-best method (Reasoning LLM) by a substantial margin of 23.79 percentage points. For multi-modal input scenarios, DeepRare achieves 70.60% at Recall@1 compared to Exomiser's 53.20% in 109 cases. Manual verification of reasoning chains by clinical experts achieves 95.40% agreements. Furthermore, the DeepRare system has been implemented as a user-friendly web application http://raredx.cn/doctor.

Large language models (LLMs), particularly those with reasoning capabilities, have rapidly advanced in recent years, demonstrating significant potential across a wide range of applications. However, their deployment in healthcare, especially in disease reasoning tasks, is hindered by the challenge of acquiring expert-level cognitive data. In this paper, we introduce Citrus, a medical language model that bridges the gap between clinical expertise and AI reasoning by emulating the cognitive processes of medical experts. The model is trained on a large corpus of simulated expert disease reasoning data, synthesized using a novel approach that accurately captures the decision-making pathways of clinicians. This approach enables Citrus to better simulate the complex reasoning processes involved in diagnosing and treating medical conditions.To further address the lack of publicly available datasets for medical reasoning tasks, we release the last-stage training data, including a custom-built medical diagnostic dialogue dataset. This open-source contribution aims to support further research and development in the field. Evaluations using authoritative benchmarks such as MedQA, covering tasks in medical reasoning and language understanding, show that Citrus achieves superior performance compared to other models of similar size. These results highlight Citrus potential to significantly enhance medical decision support systems, providing a more accurate and efficient tool for clinical decision-making.

Medical question-answering (QA) is a critical task for evaluating how effectively large language models (LLMs) encode clinical knowledge and assessing their potential applications in medicine. Despite showing promise on multiple-choice tests, LLMs frequently struggle with open-ended medical questions, producing responses with dangerous hallucinations or lacking comprehensive coverage of critical aspects. Existing approaches attempt to address these challenges through domain-specific fine-tuning, but this proves resource-intensive and difficult to scale across models. To improve the comprehensiveness and factuality of medical responses, we propose a novel approach utilizing structured medical reasoning. Our method guides LLMs through an seven-step cognitive process inspired by clinical diagnosis, enabling more accurate and complete answers without additional training. Experiments on the MedLFQA benchmark demonstrate that our approach achieves the highest Factuality Score of 85.8, surpassing fine-tuned models. Notably, this improvement transfers to smaller models, highlighting the method's efficiency and scalability. Our code and datasets are available.

Recent advances in vision language models (VLMs) have enabled broad progress in the general medical field. However, pathology still remains a more challenging subdomain, with current pathology specific VLMs exhibiting limitations in both diagnostic accuracy and reasoning plausibility. Such shortcomings are largely attributable to the nature of current pathology datasets, which are primarily composed of image description pairs that lack the depth and structured diagnostic paradigms employed by real world pathologists. In this study, we leverage pathology textbooks and real world pathology experts to construct high-quality, reasoning-oriented datasets. Building on this, we introduce Patho-R1, a multimodal RL-based pathology Reasoner, trained through a three-stage pipeline: (1) continued pretraining on 3.5 million image-text pairs for knowledge infusion; (2) supervised fine-tuning on 500k high-quality Chain-of-Thought samples for reasoning incentivizing; (3) reinforcement learning using Group Relative Policy Optimization and Decoupled Clip and Dynamic sAmpling Policy Optimization strategies for multimodal reasoning quality refinement. To further assess the alignment quality of our dataset, we propose PathoCLIP, trained on the same figure-caption corpus used for continued pretraining. Comprehensive experimental results demonstrate that both PathoCLIP and Patho-R1 achieve robust performance across a wide range of pathology-related tasks, including zero-shot classification, cross-modal retrieval, Visual Question Answering, and Multiple Choice Question. Our project is available at the Patho-R1 repository: https://github.com/Wenchuan-Zhang/Patho-R1.