Daily Papers

The proliferation of Large Language Models (LLMs) has established LLM routing as a standard service delivery mechanism, where users select models based on cost, Quality of Service (QoS), among other things. However, optimal pricing in LLM routing platforms requires precise modeling for dynamic service markets, and solving this problem in real time at scale is computationally intractable. In this paper, we propose \PriLLM, a novel practical and scalable solution for real-time dynamic pricing in competitive LLM routing. \PriLLM models the service market as a Stackelberg game, where providers set prices and users select services based on multiple criteria. To capture real-world market dynamics, we incorporate both objective factors (\eg~cost, QoS) and subjective user preferences into the model. For scalability, we employ a deep aggregation network to learn provider abstraction that preserve user-side equilibrium behavior across pricing strategies. Moreover, \PriLLM offers interpretability by explaining its pricing decisions. Empirical evaluation on real-world data shows that \PriLLM achieves over 95\% of the optimal profit while only requiring less than 5\% of the optimal solution's computation time.

A significant barrier to progress in data-driven approaches to building dialog systems is the lack of high quality, goal-oriented conversational data. To help satisfy this elementary requirement, we introduce the initial release of the Taskmaster-1 dataset which includes 13,215 task-based dialogs comprising six domains. Two procedures were used to create this collection, each with unique advantages. The first involves a two-person, spoken "Wizard of Oz" (WOz) approach in which trained agents and crowdsourced workers interact to complete the task while the second is "self-dialog" in which crowdsourced workers write the entire dialog themselves. We do not restrict the workers to detailed scripts or to a small knowledge base and hence we observe that our dataset contains more realistic and diverse conversations in comparison to existing datasets. We offer several baseline models including state of the art neural seq2seq architectures with benchmark performance as well as qualitative human evaluations. Dialogs are labeled with API calls and arguments, a simple and cost effective approach which avoids the requirement of complex annotation schema. The layer of abstraction between the dialog model and the service provider API allows for a given model to interact with multiple services that provide similar functionally. Finally, the dataset will evoke interest in written vs. spoken language, discourse patterns, error handling and other linguistic phenomena related to dialog system research, development and design.

Model-driven engineering (MDE) provides abstraction and analytical rigour, but industrial adoption in many domains has been limited by the cost of developing and maintaining models. Large language models (LLMs) can help shift this cost balance by supporting direct generation of models from natural-language (NL) descriptions. For domain-specific languages (DSLs), however, LLM-generated models may be less accurate than LLM-generated code in mainstream languages such as Python, due to the latter's dominance in LLM training corpora. We investigate this issue in mathematical optimization, with AMPL, a DSL with established industrial use. We introduce EXEOS, an LLM-based approach that derives AMPL models and Python code from NL problem descriptions and iteratively refines them with solver feedback. Using a public optimization dataset and real-world supply-chain cases from our industrial partner Kinaxis, we evaluate generated AMPL models against Python code in terms of executability and correctness. An ablation study with two LLM families shows that AMPL is competitive with, and sometimes better than, Python, and that our design choices in EXEOS improve the quality of generated specifications.

A faithful and interpretable explanation of an AI model's behavior and internal structure is a high-level explanation that is human-intelligible but also consistent with the known, but often opaque low-level causal details of the model. We argue that the theory of causal abstraction provides the mathematical foundations for the desired kinds of model explanations. In causal abstraction analysis, we use interventions on model-internal states to rigorously assess whether an interpretable high-level causal model is a faithful description of an AI model. Our contributions in this area are: (1) We generalize causal abstraction to cyclic causal structures and typed high-level variables. (2) We show how multi-source interchange interventions can be used to conduct causal abstraction analyses. (3) We define a notion of approximate causal abstraction that allows us to assess the degree to which a high-level causal model is a causal abstraction of a lower-level one. (4) We prove constructive causal abstraction can be decomposed into three operations we refer to as marginalization, variable-merge, and value-merge. (5) We formalize the XAI methods of LIME, causal effect estimation, causal mediation analysis, iterated nullspace projection, and circuit-based explanations as special cases of causal abstraction analysis.

This work explores hypernetworks: an approach of using a one network, also known as a hypernetwork, to generate the weights for another network. Hypernetworks provide an abstraction that is similar to what is found in nature: the relationship between a genotype - the hypernetwork - and a phenotype - the main network. Though they are also reminiscent of HyperNEAT in evolution, our hypernetworks are trained end-to-end with backpropagation and thus are usually faster. The focus of this work is to make hypernetworks useful for deep convolutional networks and long recurrent networks, where hypernetworks can be viewed as relaxed form of weight-sharing across layers. Our main result is that hypernetworks can generate non-shared weights for LSTM and achieve near state-of-the-art results on a variety of sequence modelling tasks including character-level language modelling, handwriting generation and neural machine translation, challenging the weight-sharing paradigm for recurrent networks. Our results also show that hypernetworks applied to convolutional networks still achieve respectable results for image recognition tasks compared to state-of-the-art baseline models while requiring fewer learnable parameters.

Visual programming languages (VPLs) provide coding without typing texts. VPL makes coding easy to programmers with automatically adding usually used some code structure. Beginners in coding have generally two main challenges; transforming ideas into logical expressions and syntax errors. Syntax errors are impossible with VPLs because of there is no forgotten parentheses and semicolons. VPLs provide to focus on algorithm for programmers. VPL is a new trend for educational robotic environments. In this study, Robot Operating System (ROS) compatible web based visual programming system has been developed for evarobot. ROS provides libraries and tools to help software developers create robot applications. It provides hardware abstraction, device drivers, libraries, visualizers, message-passing, package management, and more. Blockly has been used as VPL for the study and to generate / use blocks (commucation, sensing etc.). Some applications were generated like teleoperation, SLAM and wander etc. In this system, communication between server and client is supported by rosbridge package. Web page connected to ROS which runs on server using roslibjs library. Rosbridge provides a JSON API to ROS functionality for non-ROS programs.

We introduce Meta Agents Research Environments (ARE), a research platform for scalable creation of environments, integration of synthetic or real applications, and execution of agentic orchestrations. ARE provides simple abstractions to build complex and diverse environments, each with their own rules, tools, content, and verifiers, helping to bridge the gap between model development and real-world deployment. We also propose Gaia2, a benchmark built in ARE and designed to measure general agent capabilities. Beyond search and execution, Gaia2 requires agents to handle ambiguities and noise, adapt to dynamic environments, collaborate with other agents, and operate under temporal constraints. Unlike prior benchmarks, Gaia2 runs asynchronously, surfacing new failure modes that are invisible in static settings. Our experiments show that no system dominates across the intelligence spectrum: stronger reasoning often comes at the cost of efficiency, and budget scaling curves plateau, highlighting the need for new architectures and adaptive compute strategies. Perhaps more importantly, ARE abstractions enable continuous extension of Gaia2 to other environments, empowering the community to rapidly create new benchmarks tailored to their domains. In AI's second half, progress increasingly depends on defining meaningful tasks and robust evaluations to drive frontier capabilities forward.

Recent advances in large language models (LLMs) and autonomous agents have enabled systems capable of performing complex tasks across domains such as human-computer interaction, planning, and web navigation. However, many existing frameworks struggle in real-world or resource-constrained environments due to their reliance on cloud-based computation, limited robustness in dynamic contexts, and lack of persistent autonomy and environmental awareness. We present Amico, a modular, event-driven framework for building autonomous agents optimized for embedded systems. Written in Rust for safety and performance, Amico supports reactive, persistent agents that operate efficiently across embedded platforms and browser environments via WebAssembly. It provides clean abstractions for event handling, state management, behavior execution, and integration with reasoning modules. Amico delivers a unified infrastructure for constructing resilient, interactive agents suitable for deployment in settings with limited compute and intermittent connectivity.

With the ever-increasing volumes of the Earth observation data present in the archives of large programmes such as Copernicus, there is a growing need for efficient vector representations of the underlying raw data. The approach of extracting feature representations from pretrained deep neural networks is a powerful approach that can provide semantic abstractions of the input data. However, the way this is done for imagery archives containing geospatial data has not yet been defined. In this work, an extension is proposed to an existing community project, Major TOM, focused on the provision and standardization of open and free AI-ready datasets for Earth observation. Furthermore, four global and dense embedding datasets are released openly and for free along with the publication of this manuscript, resulting in the most comprehensive global open dataset of geospatial visual embeddings in terms of covered Earth's surface.

KonfAI is a modular, extensible, and fully configurable deep learning framework specifically designed for medical imaging tasks. It enables users to define complete training, inference, and evaluation workflows through structured YAML configuration files, without modifying the underlying code. This declarative approach enhances reproducibility, transparency, and experimental traceability while reducing development time. Beyond the capabilities of standard pipelines, KonfAI provides native abstractions for advanced strategies including patch-based learning, test-time augmentation, model ensembling, and direct access to intermediate feature representations for deep supervision. It also supports complex multi-model training setups such as generative adversarial architectures. Thanks to its modular and extensible architecture, KonfAI can easily accommodate custom models, loss functions, and data processing components. The framework has been successfully applied to segmentation, registration, and image synthesis tasks, and has contributed to top-ranking results in several international medical imaging challenges. KonfAI is open source and available at https://github.com/vboussot/KonfAI{https://github.com/vboussot/KonfAI}.

On the way to Exascale, programmers face the increasing challenge of having to support multiple hardware architectures from the same code base. At the same time, portability of code and performance are increasingly difficult to achieve as hardware architectures are becoming more and more diverse. Today's heterogeneous systems often include two or more completely distinct and incompatible hardware execution models, such as GPGPU's, SIMD vector units, and general purpose cores which conventionally have to be programmed using separate tool chains representing non-overlapping programming models. The recent revival of interest in the industry and the wider community for the C++ language has spurred a remarkable amount of standardization proposals and technical specifications in the arena of concurrency and parallelism. This recently includes an increasing amount of discussion around the need for a uniform, higher-level abstraction and programming model for parallelism in the C++ standard targeting heterogeneous and distributed computing. Such an abstraction should perfectly blend with existing, already standardized language and library features, but should also be generic enough to support future hardware developments. In this paper, we present the results from developing such a higher-level programming abstraction for parallelism in C++ which aims at enabling code and performance portability over a wide range of architectures and for various types of parallelism. We present and compare performance data obtained from running the well-known STREAM benchmark ported to our higher level C++ abstraction with the corresponding results from running it natively. We show that our abstractions enable performance at least as good as the comparable base-line benchmarks while providing a uniform programming API on all compared target architectures.

Abstraction is a core tenet of human cognition and communication. When composing natural language instructions, humans naturally evoke abstraction to convey complex procedures in an efficient and concise way. Yet, interpreting and grounding abstraction expressed in NL has not yet been systematically studied in NLP, with no accepted benchmarks specifically eliciting abstraction in NL. In this work, we set the foundation for a systematic study of processing and grounding abstraction in NLP. First, we deliver a novel abstraction elicitation method and present Hexagons, a 2D instruction-following game. Using Hexagons we collected over 4k naturally-occurring visually-grounded instructions rich with diverse types of abstractions. From these data, we derive an instruction-to-execution task and assess different types of neural models. Our results show that contemporary models and modeling practices are substantially inferior to human performance, and that models' performance is inversely correlated with the level of abstraction, showing less satisfying performance on higher levels of abstraction. These findings are consistent across models and setups, confirming that abstraction is a challenging phenomenon deserving further attention and study in NLP/AI research.

The integration of Large Language Models (LLMs) into healthcare promises to transform medical diagnostics, research, and patient care. Yet, the progression of medical LLMs faces obstacles such as complex training requirements, rigorous evaluation demands, and the dominance of proprietary models that restrict academic exploration. Transparent, comprehensive access to LLM resources is essential for advancing the field, fostering reproducibility, and encouraging innovation in healthcare AI. We present Hippocrates, an open-source LLM framework specifically developed for the medical domain. In stark contrast to previous efforts, it offers unrestricted access to its training datasets, codebase, checkpoints, and evaluation protocols. This open approach is designed to stimulate collaborative research, allowing the community to build upon, refine, and rigorously evaluate medical LLMs within a transparent ecosystem. Also, we introduce Hippo, a family of 7B models tailored for the medical domain, fine-tuned from Mistral and LLaMA2 through continual pre-training, instruction tuning, and reinforcement learning from human and AI feedback. Our models outperform existing open medical LLMs models by a large-margin, even surpassing models with 70B parameters. Through Hippocrates, we aspire to unlock the full potential of LLMs not just to advance medical knowledge and patient care but also to democratize the benefits of AI research in healthcare, making them available across the globe.

Causal abstraction is a promising theoretical framework for explainable artificial intelligence that defines when an interpretable high-level causal model is a faithful simplification of a low-level deep learning system. However, existing causal abstraction methods have two major limitations: they require a brute-force search over alignments between the high-level model and the low-level one, and they presuppose that variables in the high-level model will align with disjoint sets of neurons in the low-level one. In this paper, we present distributed alignment search (DAS), which overcomes these limitations. In DAS, we find the alignment between high-level and low-level models using gradient descent rather than conducting a brute-force search, and we allow individual neurons to play multiple distinct roles by analyzing representations in non-standard bases-distributed representations. Our experiments show that DAS can discover internal structure that prior approaches miss. Overall, DAS removes previous obstacles to conducting causal abstraction analyses and allows us to find conceptual structure in trained neural nets.

Medical care follows complex clinical pathways that extend beyond isolated physician-patient encounters, emphasizing decision-making and transitions between different stages. Current benchmarks focusing on static exams or isolated dialogues inadequately evaluate large language models (LLMs) in dynamic clinical scenarios. We introduce CP-Env, a controllable agentic hospital environment designed to evaluate LLMs across end-to-end clinical pathways. CP-Env simulates a hospital ecosystem with patient and physician agents, constructing scenarios ranging from triage and specialist consultation to diagnostic testing and multidisciplinary team meetings for agent interaction. Following real hospital adaptive flow of healthcare, it enables branching, long-horizon task execution. We propose a three-tiered evaluation framework encompassing Clinical Efficacy, Process Competency, and Professional Ethics. Results reveal that most models struggle with pathway complexity, exhibiting hallucinations and losing critical diagnostic details. Interestingly, excessive reasoning steps can sometimes prove counterproductive, while top models tend to exhibit reduced tool dependency through internalized knowledge. CP-Env advances medical AI agents development through comprehensive end-to-end clinical evaluation. We provide the benchmark and evaluation tools for further research and development at https://github.com/SPIRAL-MED/CP_ENV.

Electronic health records (EHRs) contain vast amounts of complex data, but harmonizing and processing this information remains a challenging and costly task requiring significant clinical expertise. While large language models (LLMs) have shown promise in various healthcare applications, their potential for abstracting medical concepts from EHRs remains largely unexplored. We introduce EHRmonize, a framework leveraging LLMs to abstract medical concepts from EHR data. Our study uses medication data from two real-world EHR databases to evaluate five LLMs on two free-text extraction and six binary classification tasks across various prompting strategies. GPT-4o's with 10-shot prompting achieved the highest performance in all tasks, accompanied by Claude-3.5-Sonnet in a subset of tasks. GPT-4o achieved an accuracy of 97% in identifying generic route names, 82% for generic drug names, and 100% in performing binary classification of antibiotics. While EHRmonize significantly enhances efficiency, reducing annotation time by an estimated 60%, we emphasize that clinician oversight remains essential. Our framework, available as a Python package, offers a promising tool to assist clinicians in EHR data abstraction, potentially accelerating healthcare research and improving data harmonization processes.

Hospitals and healthcare systems rely on operational decisions that determine patient flow, cost, and quality of care. Despite strong performance on medical knowledge and conversational benchmarks, foundation models trained on general text may lack the specialized knowledge required for these operational decisions. We introduce Lang1, a family of models (100M-7B parameters) pretrained on a specialized corpus blending 80B clinical tokens from NYU Langone Health's EHRs and 627B tokens from the internet. To rigorously evaluate Lang1 in real-world settings, we developed the REalistic Medical Evaluation (ReMedE), a benchmark derived from 668,331 EHR notes that evaluates five critical tasks: 30-day readmission prediction, 30-day mortality prediction, length of stay, comorbidity coding, and predicting insurance claims denial. In zero-shot settings, both general-purpose and specialized models underperform on four of five tasks (36.6%-71.7% AUROC), with mortality prediction being an exception. After finetuning, Lang1-1B outperforms finetuned generalist models up to 70x larger and zero-shot models up to 671x larger, improving AUROC by 3.64%-6.75% and 1.66%-23.66% respectively. We also observed cross-task scaling with joint finetuning on multiple tasks leading to improvement on other tasks. Lang1-1B effectively transfers to out-of-distribution settings, including other clinical tasks and an external health system. Our findings suggest that predictive capabilities for hospital operations require explicit supervised finetuning, and that this finetuning process is made more efficient by in-domain pretraining on EHR. Our findings support the emerging view that specialized LLMs can compete with generalist models in specialized tasks, and show that effective healthcare systems AI requires the combination of in-domain pretraining, supervised finetuning, and real-world evaluation beyond proxy benchmarks.

We introduce OpenTinker, an infrastructure for reinforcement learning (RL) of large language model (LLM) agents built around a separation of concerns across algorithm design, execution, and agent-environment interaction. Rather than relying on monolithic, end-to-end RL pipelines, OpenTinker decomposes agentic learning systems into lightweight, composable components with clearly defined abstraction boundaries. Users specify agents, environments, and interaction protocols, while inference and training are delegated to a managed execution runtime. OpenTinker introduces a centralized scheduler for managing training and inference workloads, including LoRA-based and full-parameter RL, supervised fine-tuning, and inference, over shared resources. We further discuss design principles for extending OpenTinker to multi-agent training. Finally, we present a set of RL use cases that demonstrate the effectiveness of the framework in practical agentic learning scenarios.

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.

We present a training system, which can provably defend significantly larger neural networks than previously possible, including ResNet-34 and DenseNet-100. Our approach is based on differentiable abstract interpretation and introduces two novel concepts: (i) abstract layers for fine-tuning the precision and scalability of the abstraction, (ii) a flexible domain specific language (DSL) for describing training objectives that combine abstract and concrete losses with arbitrary specifications. Our training method is implemented in the DiffAI system.

For clinical data integration and healthcare services, the HL7 FHIR standard has established itself as a desirable format for interoperability between complex health data. Previous attempts at automating the translation from free-form clinical notes into structured FHIR resources rely on modular, rule-based systems or LLMs with instruction tuning and constrained decoding. Since they frequently suffer from limited generalizability and structural inconformity, we propose an end-to-end framework powered by LLM agents, code execution, and healthcare terminology database tools to address these issues. Our solution, called Infherno, is designed to adhere to the FHIR document schema and competes well with a human baseline in predicting FHIR resources from unstructured text. The implementation features a front end for custom and synthetic data and both local and proprietary models, supporting clinical data integration processes and interoperability across institutions.

Abstraction ability is crucial in human intelligence, which can also benefit various tasks in NLP study. Existing work shows that LLMs are deficient in abstract ability, and how to improve it remains unexplored. In this work, we design the framework AbsInstruct to enhance LLMs' abstraction ability through instruction tuning. The framework builds instructions with in-depth explanations to assist LLMs in capturing the underlying rationale of abstraction. Meanwhile, we introduce a plausibility estimator to select instructions that are more consistent with the abstraction knowledge of LLMs to be aligned. Then, our framework combines abstraction instructions with general-purpose ones to build a hybrid dataset. Extensive experiments and analyses demonstrate that our framework can considerably enhance LLMs' abstraction ability with strong generalization performance while maintaining their general instruction-following abilities.

The advent of foundation models (FMs) as an emerging suite of AI techniques has struck a wave of opportunities in computational healthcare. The interactive nature of these models, guided by pre-training data and human instructions, has ignited a data-centric AI paradigm that emphasizes better data characterization, quality, and scale. In healthcare AI, obtaining and processing high-quality clinical data records has been a longstanding challenge, ranging from data quantity, annotation, patient privacy, and ethics. In this survey, we investigate a wide range of data-centric approaches in the FM era (from model pre-training to inference) towards improving the healthcare workflow. We discuss key perspectives in AI security, assessment, and alignment with human values. Finally, we offer a promising outlook of FM-based analytics to enhance the performance of patient outcome and clinical workflow in the evolving landscape of healthcare and medicine. We provide an up-to-date list of healthcare-related foundation models and datasets at https://github.com/Yunkun-Zhang/Data-Centric-FM-Healthcare .

Large-scale clinical databases offer opportunities for medical research, but their complexity creates barriers to effective use. The Medical Information Mart for Intensive Care (MIMIC-IV), one of the world's largest open-source electronic health record databases, traditionally requires both SQL proficiency and clinical domain expertise. We introduce M3, a system that enables natural language querying of MIMIC-IV data through the Model Context Protocol. With a single command, M3 retrieves MIMIC-IV from PhysioNet, launches a local SQLite instance or connects to hosted BigQuery, and allows researchers to pose clinical questions in plain English. We evaluated M3 using one hundred questions from the EHRSQL 2024 benchmark with two language models: the proprietary Claude Sonnet 4 achieved 94% accuracy, while the open-source gpt-oss-20B (deployable locally on consumer hardware) achieved 93% accuracy. Both models translate natural language into SQL, execute queries against MIMIC-IV, and return structured results alongside the underlying query for verification. Error analysis revealed that most failures stemmed from complex temporal reasoning or ambiguous question phrasing rather than fundamental architectural limitations. The comparable performance of a smaller open-source model demonstrates that privacy-preserving local deployment is viable for sensitive clinical data analysis. M3 lowers technical barriers to critical care data analysis while maintaining security through OAuth2 authentication, query validation, and comprehensive audit logging.

Transformers have significantly advanced the modeling of Electronic Health Records (EHR), yet their deployment in real-world healthcare is limited by several key challenges. Firstly, the quadratic computational cost and insufficient context length of these models pose significant obstacles for hospitals in processing the extensive medical histories typical in EHR data. Additionally, existing models employ separate finetuning for each clinical task, complicating maintenance in healthcare environments. Moreover, these models focus exclusively on either clinical prediction or EHR forecasting, lacking the flexibility to perform well across both. To overcome these limitations, we introduce EHRMamba, a robust foundation model built on the Mamba architecture. EHRMamba can process sequences up to four times longer than previous models due to its linear computational cost. We also introduce a novel approach to Multitask Prompted Finetuning (MTF) for EHR data, which enables EHRMamba to simultaneously learn multiple clinical tasks in a single finetuning phase, significantly enhancing deployment and cross-task generalization. Furthermore, our model leverages the HL7 FHIR data standard to simplify integration into existing hospital systems. Alongside EHRMamba, we open-source Odyssey, a toolkit designed to support the development and deployment of EHR foundation models, with an emphasis on data standardization and interpretability. Our evaluations on the MIMIC-IV dataset demonstrate that EHRMamba advances state-of-the-art performance across 6 major clinical tasks and excels in EHR forecasting, marking a significant leap forward in the field.

The concept of causal abstraction got recently popularised to demystify the opaque decision-making processes of machine learning models; in short, a neural network can be abstracted as a higher-level algorithm if there exists a function which allows us to map between them. Notably, most interpretability papers implement these maps as linear functions, motivated by the linear representation hypothesis: the idea that features are encoded linearly in a model's representations. However, this linearity constraint is not required by the definition of causal abstraction. In this work, we critically examine the concept of causal abstraction by considering arbitrarily powerful alignment maps. In particular, we prove that under reasonable assumptions, any neural network can be mapped to any algorithm, rendering this unrestricted notion of causal abstraction trivial and uninformative. We complement these theoretical findings with empirical evidence, demonstrating that it is possible to perfectly map models to algorithms even when these models are incapable of solving the actual task; e.g., on an experiment using randomly initialised language models, our alignment maps reach 100% interchange-intervention accuracy on the indirect object identification task. This raises the non-linear representation dilemma: if we lift the linearity constraint imposed to alignment maps in causal abstraction analyses, we are left with no principled way to balance the inherent trade-off between these maps' complexity and accuracy. Together, these results suggest an answer to our title's question: causal abstraction is not enough for mechanistic interpretability, as it becomes vacuous without assumptions about how models encode information. Studying the connection between this information-encoding assumption and causal abstraction should lead to exciting future work.

Foundation models (FMs) trained on electronic health records (EHRs) have shown strong performance on a range of clinical prediction tasks. However, adapting these models to local health systems remains challenging due to limited data availability and resource constraints. In this study, we investigated what these models learn and evaluated the transferability of an FM trained on MIMIC-IV to an institutional EHR dataset at the University of Chicago Medical Center. We assessed their ability to identify outlier patients and examined representation-space patient trajectories in relation to future clinical outcomes. We also evaluated the performance of supervised fine-tuned classifiers on both source and target datasets. Our findings offer insights into the adaptability of FMs across different healthcare systems, highlight considerations for their effective implementation, and provide an empirical analysis of the underlying factors that contribute to their predictive performance.

Reasoning requires going beyond pattern matching or memorization of solutions to identify and implement "algorithmic procedures" that can be used to deduce answers to hard problems. Doing so requires realizing the most relevant primitives, intermediate results, or shared procedures, and building upon them. While RL post-training on long chains of thought ultimately aims to uncover this kind of algorithmic behavior, most reasoning traces learned by large models fail to consistently capture or reuse procedures, instead drifting into verbose and degenerate exploration. To address more effective reasoning, we introduce reasoning abstractions: concise natural language descriptions of procedural and factual knowledge that guide the model toward learning successful reasoning. We train models to be capable of proposing multiple abstractions given a problem, followed by RL that incentivizes building a solution while using the information provided by these abstractions. This results in a two-player RL training paradigm, abbreviated as RLAD, that jointly trains an abstraction generator and a solution generator. This setup effectively enables structured exploration, decouples learning signals of abstraction proposal and solution generation, and improves generalization to harder problems. We also show that allocating more test-time compute to generating abstractions is more beneficial for performance than generating more solutions at large test budgets, illustrating the role of abstractions in guiding meaningful exploration.

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

The emergence of advanced reasoning capabilities in Large Language Models (LLMs) marks a transformative development in healthcare applications. Beyond merely expanding functional capabilities, these reasoning mechanisms enhance decision transparency and explainability-critical requirements in medical contexts. This survey examines the transformation of medical LLMs from basic information retrieval tools to sophisticated clinical reasoning systems capable of supporting complex healthcare decisions. We provide a thorough analysis of the enabling technological foundations, with a particular focus on specialized prompting techniques like Chain-of-Thought and recent breakthroughs in Reinforcement Learning exemplified by DeepSeek-R1. Our investigation evaluates purpose-built medical frameworks while also examining emerging paradigms such as multi-agent collaborative systems and innovative prompting architectures. The survey critically assesses current evaluation methodologies for medical validation and addresses persistent challenges in field interpretation limitations, bias mitigation strategies, patient safety frameworks, and integration of multimodal clinical data. Through this survey, we seek to establish a roadmap for developing reliable LLMs that can serve as effective partners in clinical practice and medical research.

Despite the proven effectiveness of Transformer neural networks across multiple domains, their performance with Electronic Health Records (EHR) can be nuanced. The unique, multidimensional sequential nature of EHR data can sometimes make even simple linear models with carefully engineered features more competitive. Thus, the advantages of Transformers, such as efficient transfer learning and improved scalability are not always fully exploited in EHR applications. Addressing these challenges, we introduce SANSformer, an attention-free sequential model designed with specific inductive biases to cater for the unique characteristics of EHR data. In this work, we aim to forecast the demand for healthcare services, by predicting the number of patient visits to healthcare facilities. The challenge amplifies when dealing with divergent patient subgroups, like those with rare diseases, which are characterized by unique health trajectories and are typically smaller in size. To address this, we employ a self-supervised pretraining strategy, Generative Summary Pretraining (GSP), which predicts future summary statistics based on past health records of a patient. Our models are pretrained on a health registry of nearly one million patients, then fine-tuned for specific subgroup prediction tasks, showcasing the potential to handle the multifaceted nature of EHR data. In evaluation, SANSformer consistently surpasses robust EHR baselines, with our GSP pretraining method notably amplifying model performance, particularly within smaller patient subgroups. Our results illuminate the promising potential of tailored attention-free models and self-supervised pretraining in refining healthcare utilization predictions across various patient demographics.

We develop Polaris, the first safety-focused LLM constellation for real-time patient-AI healthcare conversations. Unlike prior LLM works in healthcare focusing on tasks like question answering, our work specifically focuses on long multi-turn voice conversations. Our one-trillion parameter constellation system is composed of several multibillion parameter LLMs as co-operative agents: a stateful primary agent that focuses on driving an engaging conversation and several specialist support agents focused on healthcare tasks performed by nurses to increase safety and reduce hallucinations. We develop a sophisticated training protocol for iterative co-training of the agents that optimize for diverse objectives. We train our models on proprietary data, clinical care plans, healthcare regulatory documents, medical manuals, and other medical reasoning documents. We align our models to speak like medical professionals, using organic healthcare conversations and simulated ones between patient actors and experienced nurses. This allows our system to express unique capabilities such as rapport building, trust building, empathy and bedside manner. Finally, we present the first comprehensive clinician evaluation of an LLM system for healthcare. We recruited over 1100 U.S. licensed nurses and over 130 U.S. licensed physicians to perform end-to-end conversational evaluations of our system by posing as patients and rating the system on several measures. We demonstrate Polaris performs on par with human nurses on aggregate across dimensions such as medical safety, clinical readiness, conversational quality, and bedside manner. Additionally, we conduct a challenging task-based evaluation of the individual specialist support agents, where we demonstrate our LLM agents significantly outperform a much larger general-purpose LLM (GPT-4) as well as from its own medium-size class (LLaMA-2 70B).

We introduce SoftTiger, a clinical large language model (CLaM) designed as a foundation model for healthcare workflows. The narrative and unstructured nature of clinical notes is a major obstacle for healthcare intelligentization. We address a critical problem of structuring clinical notes into clinical data, according to international interoperability standards. We collect and annotate data for three subtasks, namely, international patient summary, clinical impression and medical encounter. We then supervised fine-tuned a state-of-the-art LLM using public and credentialed clinical data. The training is orchestrated in a way that the target model can first support basic clinical tasks such as abbreviation expansion and temporal information extraction, and then learn to perform more complex downstream clinical tasks. Moreover, we address several modeling challenges in the healthcare context, e.g., extra long context window. Our blind pairwise evaluation shows that SoftTiger outperforms other popular open-source models and GPT-3.5, comparable to Gemini-pro, with a mild gap from GPT-4. We believe that LLMs may become a step-stone towards healthcare digitalization and democratization. Therefore, we publicly release SoftTiger models at scales of 13 billion and 70 billion parameters, as well as datasets and code for our innovative scalable evaluation, hopefully, making a significant contribution to the healthcare industry.

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.

Large language models (LLMs) integrated into agent-driven workflows hold immense promise for healthcare, yet a significant gap exists between their potential and practical implementation within clinical settings. To address this, we present a practitioner-oriented field manual for deploying generative agents that use electronic health record (EHR) data. This guide is informed by our experience deploying the "irAE-Agent", an automated system to detect immune-related adverse events from clinical notes at Mass General Brigham, and by structured interviews with 21 clinicians, engineers, and informatics leaders involved in the project. Our analysis reveals a critical misalignment in clinical AI development: less than 20% of our effort was dedicated to prompt engineering and model development, while over 80% was consumed by the sociotechnical work of implementation. We distill this effort into five "heavy lifts": data integration, model validation, ensuring economic value, managing system drift, and governance. By providing actionable solutions for each of these challenges, this field manual shifts the focus from algorithmic development to the essential infrastructure and implementation work required to bridge the "valley of death" and successfully translate generative AI from pilot projects into routine clinical care.

Although Foundation Models (FMs), such as GPT-4, are increasingly used in domains like finance and software engineering, reliance on textual interfaces limits these models' real-world interaction. To address this, FM providers introduced tool calling-triggering a proliferation of frameworks with distinct tool interfaces. In late 2024, Anthropic introduced the Model Context Protocol (MCP) to standardize this tool ecosystem, which has become the de facto standard with over eight million weekly SDK downloads. Despite its adoption, MCP's AI-driven, non-deterministic control flow introduces new risks to sustainability, security, and maintainability, warranting closer examination. Towards this end, we present the first large-scale empirical study of MCP servers. Using state-of-the-art health metrics and a hybrid analysis pipeline, combining a general-purpose static analysis tool with an MCP-specific scanner, we evaluate 1,899 open-source MCP servers to assess their health, security, and maintainability. Despite MCP servers demonstrating strong health metrics, we identify eight distinct vulnerabilities - only three overlapping with traditional software vulnerabilities. Additionally, 7.2% of servers contain general vulnerabilities and 5.5% exhibit MCP-specific tool poisoning. Regarding maintainability, while 66% exhibit code smells, 14.4% contain nine bug patterns overlapping with traditional open-source software projects. These findings highlight the need for MCP-specific vulnerability detection techniques while reaffirming the value of traditional analysis and refactoring practices.

When applying offline reinforcement learning (RL) in healthcare scenarios, the out-of-distribution (OOD) issues pose significant risks, as inappropriate generalization beyond clinical expertise can result in potentially harmful recommendations. While existing methods like conservative Q-learning (CQL) attempt to address the OOD issue, their effectiveness is limited by only constraining action selection by suppressing uncertain actions. This action-only regularization imitates clinician actions that prioritize short-term rewards, but it fails to regulate downstream state trajectories, thereby limiting the discovery of improved long-term treatment strategies. To safely improve policy beyond clinician recommendations while ensuring that state-action trajectories remain in-distribution, we propose Offline Guarded Safe Reinforcement Learning (OGSRL), a theoretically grounded model-based offline RL framework. OGSRL introduces a novel dual constraint mechanism for improving policy with reliability and safety. First, the OOD guardian is established to specify clinically validated regions for safe policy exploration. By constraining optimization within these regions, it enables the reliable exploration of treatment strategies that outperform clinician behavior by leveraging the full patient state history, without drifting into unsupported state-action trajectories. Second, we introduce a safety cost constraint that encodes medical knowledge about physiological safety boundaries, providing domain-specific safeguards even in areas where training data might contain potentially unsafe interventions. Notably, we provide theoretical guarantees on safety and near-optimality: policies that satisfy these constraints remain in safe and reliable regions and achieve performance close to the best possible policy supported by the data.

The successes of foundation models such as ChatGPT and AlphaFold have spurred significant interest in building similar models for electronic medical records (EMRs) to improve patient care and hospital operations. However, recent hype has obscured critical gaps in our understanding of these models' capabilities. We review over 80 foundation models trained on non-imaging EMR data (i.e. clinical text and/or structured data) and create a taxonomy delineating their architectures, training data, and potential use cases. We find that most models are trained on small, narrowly-scoped clinical datasets (e.g. MIMIC-III) or broad, public biomedical corpora (e.g. PubMed) and are evaluated on tasks that do not provide meaningful insights on their usefulness to health systems. In light of these findings, we propose an improved evaluation framework for measuring the benefits of clinical foundation models that is more closely grounded to metrics that matter in healthcare.

The emerging trend of advancing generalist artificial intelligence, such as GPTv4 and Gemini, has reshaped the landscape of research (academia and industry) in machine learning and many other research areas. However, domain-specific applications of such foundation models (e.g., in medicine) remain untouched or often at their very early stages. It will require an individual set of transfer learning and model adaptation techniques by further expanding and injecting these models with domain knowledge and data. The development of such technologies could be largely accelerated if the bundle of data, algorithms, and pre-trained foundation models were gathered together and open-sourced in an organized manner. In this work, we present OpenMEDLab, an open-source platform for multi-modality foundation models. It encapsulates not only solutions of pioneering attempts in prompting and fine-tuning large language and vision models for frontline clinical and bioinformatic applications but also building domain-specific foundation models with large-scale multi-modal medical data. Importantly, it opens access to a group of pre-trained foundation models for various medical image modalities, clinical text, protein engineering, etc. Inspiring and competitive results are also demonstrated for each collected approach and model in a variety of benchmarks for downstream tasks. We welcome researchers in the field of medical artificial intelligence to continuously contribute cutting-edge methods and models to OpenMEDLab, which can be accessed via https://github.com/openmedlab.

While large language models (LLMs) are increasingly being used for program synthesis, they lack the global view needed to develop useful abstractions; they generally predict programs one at a time, often repeating the same functionality. Generating redundant code from scratch is both inefficient and error-prone. To address this, we propose Refactoring for Generalizable Abstraction Learning (ReGAL), a gradient-free method for learning a library of reusable functions via code refactorization, i.e. restructuring code without changing its execution output. ReGAL learns from a small set of existing programs, iteratively verifying and refining its abstractions via execution. We find that the shared function libraries discovered by ReGAL make programs easier to predict across diverse domains. On three datasets (LOGO graphics generation, Date reasoning, and TextCraft, a Minecraft-based text game), both open-source and proprietary LLMs improve in accuracy when predicting programs with ReGAL functions. For CodeLlama-13B, ReGAL results in absolute accuracy increases of 11.5% on graphics, 26.1% on date understanding, and 8.1% on TextCraft, outperforming GPT-3.5 in two of three domains. Our analysis reveals ReGAL's abstractions encapsulate frequently-used subroutines as well as environment dynamics.

Medical Imaging (MI) datasets are fundamental to artificial intelligence in healthcare. The accuracy, robustness, and fairness of diagnostic algorithms depend on the data (and its quality) used to train and evaluate the models. MI datasets used to be proprietary, but have become increasingly available to the public, including on community-contributed platforms (CCPs) like Kaggle or HuggingFace. While open data is important to enhance the redistribution of data's public value, we find that the current CCP governance model fails to uphold the quality needed and recommended practices for sharing, documenting, and evaluating datasets. In this paper, we conduct an analysis of publicly available machine learning datasets on CCPs, discussing datasets' context, and identifying limitations and gaps in the current CCP landscape. We highlight differences between MI and computer vision datasets, particularly in the potentially harmful downstream effects from poor adoption of recommended dataset management practices. We compare the analyzed datasets across several dimensions, including data sharing, data documentation, and maintenance. We find vague licenses, lack of persistent identifiers and storage, duplicates, and missing metadata, with differences between the platforms. Our research contributes to efforts in responsible data curation and AI algorithms for healthcare.

The utilization of large language models (LLMs) in the Healthcare domain has generated both excitement and concern due to their ability to effectively respond to freetext queries with certain professional knowledge. This survey outlines the capabilities of the currently developed LLMs for Healthcare and explicates their development process, with the aim of providing an overview of the development roadmap from traditional Pretrained Language Models (PLMs) to LLMs. Specifically, we first explore the potential of LLMs to enhance the efficiency and effectiveness of various Healthcare applications highlighting both the strengths and limitations. Secondly, we conduct a comparison between the previous PLMs and the latest LLMs, as well as comparing various LLMs with each other. Then we summarize related Healthcare training data, training methods, optimization strategies, and usage. Finally, the unique concerns associated with deploying LLMs in Healthcare settings are investigated, particularly regarding fairness, accountability, transparency and ethics. Our survey provide a comprehensive investigation from perspectives of both computer science and Healthcare specialty. Besides the discussion about Healthcare concerns, we supports the computer science community by compiling a collection of open source resources, such as accessible datasets, the latest methodologies, code implementations, and evaluation benchmarks in the Github. Summarily, we contend that a significant paradigm shift is underway, transitioning from PLMs to LLMs. This shift encompasses a move from discriminative AI approaches to generative AI approaches, as well as a shift from model-centered methodologies to datacentered methodologies.

In this study, we provide solutions to two practical yet overlooked scenarios in federated learning for electronic health records (EHRs): firstly, we introduce EHRFL, a framework that facilitates federated learning across healthcare institutions with distinct medical coding systems and database schemas using text-based linearization of EHRs. Secondly, we focus on a scenario where a single healthcare institution initiates federated learning to build a model tailored for itself, in which the number of clients must be optimized in order to reduce expenses incurred by the host. For selecting participating clients, we present a novel precision-based method, leveraging data latents to identify suitable participants for the institution. Our empirical results show that EHRFL effectively enables federated learning across hospitals with different EHR systems. Furthermore, our results demonstrate the efficacy of our precision-based method in selecting reduced number of participating clients without compromising model performance, resulting in lower operational costs when constructing institution-specific models. We believe this work lays a foundation for the broader adoption of federated learning on EHRs.

Agents are rapidly advancing in automating digital work, but enterprises face a harder challenge: moving beyond prototypes to deployed systems that deliver measurable business value. This path is complicated by fragmented frameworks, slow development, and the absence of standardized evaluation practices. Generalist agents have emerged as a promising direction, excelling on academic benchmarks and offering flexibility across task types, applications, and modalities. Yet, evidence of their use in production enterprise settings remains limited. This paper reports IBM's experience developing and piloting the Computer Using Generalist Agent (CUGA), which has been open-sourced for the community (https://github.com/cuga-project/cuga-agent). CUGA adopts a hierarchical planner--executor architecture with strong analytical foundations, achieving state-of-the-art performance on AppWorld and WebArena. Beyond benchmarks, it was evaluated in a pilot within the Business-Process-Outsourcing talent acquisition domain, addressing enterprise requirements for scalability, auditability, safety, and governance. To support assessment, we introduce BPO-TA, a 26-task benchmark spanning 13 analytics endpoints. In preliminary evaluations, CUGA approached the accuracy of specialized agents while indicating potential for reducing development time and cost. Our contribution is twofold: presenting early evidence of generalist agents operating at enterprise scale, and distilling technical and organizational lessons from this initial pilot. We outline requirements and next steps for advancing research-grade architectures like CUGA into robust, enterprise-ready systems.

Generative AI (GenAI) has reshaped software system design by introducing foundation models as pre-trained subsystems that redefine architectures and operations. The emerging challenge is no longer model fine-tuning but context engineering-how systems capture, structure, and govern external knowledge, memory, tools, and human input to enable trustworthy reasoning. Existing practices such as prompt engineering, retrieval-augmented generation (RAG), and tool integration remain fragmented, producing transient artefacts that limit traceability and accountability. This paper proposes a file-system abstraction for context engineering, inspired by the Unix notion that 'everything is a file'. The abstraction offers a persistent, governed infrastructure for managing heterogeneous context artefacts through uniform mounting, metadata, and access control. Implemented within the open-source AIGNE framework, the architecture realises a verifiable context-engineering pipeline, comprising the Context Constructor, Loader, and Evaluator, that assembles, delivers, and validates context under token constraints. As GenAI becomes an active collaborator in decision support, humans play a central role as curators, verifiers, and co-reasoners. The proposed architecture establishes a reusable foundation for accountable and human-centred AI co-work, demonstrated through two exemplars: an agent with memory and an MCP-based GitHub assistant. The implementation within the AIGNE framework demonstrates how the architecture can be operationalised in developer and industrial settings, supporting verifiable, maintainable, and industry-ready GenAI systems.

Clinical predictive models often rely on patients' electronic health records (EHR), but integrating medical knowledge to enhance predictions and decision-making is challenging. This is because personalized predictions require personalized knowledge graphs (KGs), which are difficult to generate from patient EHR data. To address this, we propose GraphCare, an open-world framework that uses external KGs to improve EHR-based predictions. Our method extracts knowledge from large language models (LLMs) and external biomedical KGs to build patient-specific KGs, which are then used to train our proposed Bi-attention AugmenTed (BAT) graph neural network (GNN) for healthcare predictions. On two public datasets, MIMIC-III and MIMIC-IV, GraphCare surpasses baselines in four vital healthcare prediction tasks: mortality, readmission, length of stay (LOS), and drug recommendation. On MIMIC-III, it boosts AUROC by 17.6\% and 6.6\% for mortality and readmission, and F1-score by 7.9\% and 10.8\% for LOS and drug recommendation, respectively. Notably, GraphCare demonstrates a substantial edge in scenarios with limited data availability. Our findings highlight the potential of using external KGs in healthcare prediction tasks and demonstrate the promise of GraphCare in generating personalized KGs for promoting personalized medicine.

In this work we present Ludwig, a flexible, extensible and easy to use toolbox which allows users to train deep learning models and use them for obtaining predictions without writing code. Ludwig implements a novel approach to deep learning model building based on two main abstractions: data types and declarative configuration files. The data type abstraction allows for easier code and sub-model reuse, and the standardized interfaces imposed by this abstraction allow for encapsulation and make the code easy to extend. Declarative model definition configuration files enable inexperienced users to obtain effective models and increase the productivity of expert users. Alongside these two innovations, Ludwig introduces a general modularized deep learning architecture called Encoder-Combiner-Decoder that can be instantiated to perform a vast amount of machine learning tasks. These innovations make it possible for engineers, scientists from other fields and, in general, a much broader audience to adopt deep learning models for their tasks, concretely helping in its democratization.

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

The integration of Large Language Models (LLMs) into healthcare demands a safety paradigm rooted in primum non nocere. However, current alignment techniques rely on generic definitions of harm that fail to capture context-dependent violations, such as administrative fraud and clinical discrimination. To address this, we introduce Medical Malice: a dataset of 214,219 adversarial prompts calibrated to the regulatory and ethical complexities of the Brazilian Unified Health System (SUS). Crucially, the dataset includes the reasoning behind each violation, enabling models to internalize ethical boundaries rather than merely memorizing a fixed set of refusals. Using an unaligned agent (Grok-4) within a persona-driven pipeline, we synthesized high-fidelity threats across seven taxonomies, ranging from procurement manipulation and queue-jumping to obstetric violence. We discuss the ethical design of releasing these "vulnerability signatures" to correct the information asymmetry between malicious actors and AI developers. Ultimately, this work advocates for a shift from universal to context-aware safety, providing the necessary resources to immunize healthcare AI against the nuanced, systemic threats inherent to high-stakes medical environments -- vulnerabilities that represent the paramount risk to patient safety and the successful integration of AI in healthcare systems.

Real-world clinical decision-making grapples with integrating information from diverse data modalities, including medical text, 2D/3D images, and video, leading to inefficiencies and potential diagnostic oversights. While generalist vision-language models (VLMs) offer promise, their medical development faces challenges of opaque pipelines, data scarcity, and architectural inflexibility. Here we present Hulu-Med, a transparent medical VLM that unifies understanding across all these modalities. Built upon a unified patch-based vision encoder and an LLM decoder, Hulu-Med was progressively trained on 16.7 million (M) samples to scale from 2D to 3D and video comprehension. The medical-aware token reduction enables efficient training, requiring only 4,000 to 40,000 GPU hours for 7B to 32B parameter variants. Extensive evaluation across 30 benchmarks exhibits state-of-the-art performance, surpassing leading open-source models and competing with proprietary systems in tasks spanning visual question-answering, medical report generation, and complex reasoning in multilingual and rare disease scenarios. By open-sourcing our complete pipeline, we establish that high-performance medical VLM can be achieved transparently, providing a foundational tool for accessible and impactful clinical AI. Code is released on https://github.com/ZJUI-AI4H/Hulu-Med{https://github.com/ZJUI-AI4H/Hulu-Med}.