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Simulating Clinical AI Assistance using Multimodal LLMs: A Case Study in Diabetic Retinopathy

arXiv.org Artificial Intelligence

Diabetic retinopathy (DR) is a leading cause of blindness worldwide, and AI systems can expand access to fundus photography screening. Current FDA-cleared systems primarily provide binary referral outputs, where this minimal output may limit clinical trust and utility. Yet, determining the most effective output format to enhance clinician-AI performance is an empirical challenge that is difficult to assess at scale. We evaluated multimodal large language models (MLLMs) for DR detection and their ability to simulate clinical AI assistance across different output types. Two models were tested on IDRiD and Messidor-2: GPT-4o, a general-purpose MLLM, and MedGemma, an open-source medical model. Experiments included: (1) baseline evaluation, (2) simulated AI assistance with synthetic predictions, and (3) actual AI-to-AI collaboration where GPT-4o incorporated MedGemma outputs. MedGemma outperformed GPT-4o at baseline, achieving higher sensitivity and AUROC, while GPT-4o showed near-perfect specificity but low sensitivity. Both models adjusted predictions based on simulated AI inputs, but GPT-4o's performance collapsed with incorrect ones, whereas MedGemma remained more stable. In actual collaboration, GPT-4o achieved strong results when guided by MedGemma's descriptive outputs, even without direct image access (AUROC up to 0.96). These findings suggest MLLMs may improve DR screening pipelines and serve as scalable simulators for studying clinical AI assistance across varying output configurations. Open, lightweight models such as MedGemma may be especially valuable in low-resource settings, while descriptive outputs could enhance explainability and clinician trust in clinical workflows.


Podcasts as a Medium for Participation in Collective Action: A Case Study of Black Lives Matter

arXiv.org Artificial Intelligence

We study how participation in collective action is articulated in podcast discussions, using the Black Lives Matter (BLM) movement as a case study. While research on collective action discourse has primarily focused on text-based content, this study takes a first step toward analyzing audio formats by using podcast transcripts. Using the Structured Podcast Research Corpus (SPoRC), we investigated spoken language expressions of participation in collective action, categorized as problem-solution, call-to-action, intention, and execution. We identified podcast episodes discussing racial justice after important BLM-related events in May and June of 2020, and extracted participatory statements using a layered framework adapted from prior work on social media. We examined the emotional dimensions of these statements, detecting eight key emotions and their association with varying stages of activism. We found that emotional profiles vary by stage, with different positive emotions standing out during calls-to-action, intention, and execution. We detected negative associations between collective action and negative emotions, contrary to theoretical expectations. Our work contributes to a better understanding of how activism is expressed in spoken digital discourse and how emotional framing may depend on the format of the discussion.


The Few-shot Dilemma: Over-prompting Large Language Models

arXiv.org Artificial Intelligence

Abstract--Over-prompting, a phenomenon where excessive examples in prompts lead to diminished performance in Large Language Models (LLMs), challenges the conventional wisdom about in-context few-shot learning. T o investigate this few-shot dilemma, we outline a prompting framework that leverages three standard few-shot selection methods - random sampling, semantic embedding, and TF-IDF vectors - and evaluate these methods across multiple LLMs, including GPT -4o, GPT -3.5-turbo, DeepSeek-V3, Gemma-3, LLaMA-3.1, Our experimental results reveal that incorporating excessive domain-specific examples into prompts can paradoxically degrade performance in certain LLMs, which contradicts the prior empirical conclusion that more relevant few-shot examples universally benefit LLMs. Given the trend of LLM-assisted software engineering and requirement analysis, we experiment with two real-world software requirement classification datasets. By gradually increasing the number of TF-IDF-selected and stratified few-shot examples, we identify their optimal quantity for each LLM. This combined approach achieves superior performance with fewer examples, avoiding the over-prompting problem, thus surpassing the state-of-the-art by 1% in classifying functional and non-functional requirements. Instruction-tuned LLMs have demonstrated exceptional language understanding and knowledge inference capabilities [12].


Efficient Cold-Start Recommendation via BPE Token-Level Embedding Initialization with LLM

arXiv.org Artificial Intelligence

The cold-start issue is the challenge when we talk about recommender systems, especially in the case when we do not have the past interaction data of new users or new items. Content-based features or hybrid solutions are common as conventional solutions, but they can only work in a sparse metadata environment with shallow patterns. In this paper, the efficient cold-start recommendation strategy is presented, which is based on the sub word-level representations by applying Byte Pair Encoding (BPE) tokenization and pre-trained Large Language Model (LLM) embedding in the initialization procedure. We obtain fine-grained token-level vectors that are aligned with the BPE vocabulary as opposed to using coarse-grained sentence embeddings. Together, these token embeddings can be used as dense semantic priors on unseen entities, making immediate recommendation performance possible without user-item interaction history. Our mechanism can be compared to collaborative filtering systems and tested over benchmark datasets with stringent cold-start assumptions. Experimental findings show that the given BPE-LLM method achieves higher Recall@k, NDCG@k, and Hit Rate measurements compared to the standard baseline and displays the same capability of sufficient computational performance. Furthermore, we demonstrate that using subword-aware embeddings yields better generalizability and is more interpretable, especially within a multilingual and sparse input setting. The practical application of token-level semantic initialization as a lightweight, but nevertheless effective extension to modern recommender systems in the zero-shot setting is indicated within this work.


FinSearchComp: Towards a Realistic, Expert-Level Evaluation of Financial Search and Reasoning

arXiv.org Artificial Intelligence

Search has emerged as core infrastructure for LLM-based agents and is widely viewed as critical on the path toward more general intelligence. Finance is a particularly demanding proving ground: analysts routinely conduct complex, multi-step searches over time-sensitive, domain-specific data, making it ideal for assessing both search proficiency and knowledge-grounded reasoning. Yet no existing open financial datasets evaluate data searching capability of end-to-end agents, largely because constructing realistic, complicated tasks requires deep financial expertise and time-sensitive data is hard to evaluate. We present FinSearchComp, the first fully open-source agent benchmark for realistic, open-domain financial search and reasoning. FinSearchComp comprises three tasks -- Time-Sensitive Data Fetching, Simple Historical Lookup, and Complex Historical Investigation -- closely reproduce real-world financial analyst workflows. To ensure difficulty and reliability, we engage 70 professional financial experts for annotation and implement a rigorous multi-stage quality-assurance pipeline. The benchmark includes 635 questions spanning global and Greater China markets, and we evaluate 21 models (products) on it. Grok 4 (web) tops the global subset, approaching expert-level accuracy. DouBao (web) leads on the Greater China subset. Experimental analyses show that equipping agents with web search and financial plugins substantially improves results on FinSearchComp, and the country origin of models and tools impact performance significantly.By aligning with realistic analyst tasks and providing end-to-end evaluation, FinSearchComp offers a professional, high-difficulty testbed for complex financial search and reasoning.


LLM Hallucination Detection: A Fast Fourier Transform Method Based on Hidden Layer Temporal Signals

arXiv.org Artificial Intelligence

Hallucination remains a critical barrier for deploying large language models (LLMs) in reliability-sensitive applications. Existing detection methods largely fall into two categories: factuality checking, which is fundamentally constrained by external knowledge coverage, and static hidden-state analysis, that fails to capture deviations in reasoning dynamics. As a result, their effectiveness and robustness remain limited. We propose HSAD (Hidden Signal Analysis-based Detection), a novel hallucination detection framework that models the temporal dynamics of hidden representations during autoregressive generation. HSAD constructs hidden-layer signals by sampling activations across layers, applies Fast Fourier Transform (FFT) to obtain frequency-domain representations, and extracts the strongest non-DC frequency component as spectral features. Furthermore, by leveraging the autoregressive nature of LLMs, HSAD identifies optimal observation points for effective and reliable detection. Across multiple benchmarks, including TruthfulQA, HSAD achieves over 10 percentage points improvement compared to prior state-of-the-art methods. By integrating reasoning-process modeling with frequency-domain analysis, HSAD establishes a new paradigm for robust hallucination detection in LLMs.


Reasoning with Preference Constraints: A Benchmark for Language Models in Many-to-One Matching Markets

arXiv.org Artificial Intelligence

Recent advances in reasoning with large language models (LLMs) have demonstrated strong performance on complex mathematical tasks, including combinatorial optimization. Techniques such as Chain-of-Thought and In-Context Learning have further enhanced this capability, making LLMs both powerful and accessible tools for a wide range of users, including non-experts. However, applying LLMs to matching problems, which require reasoning under preferential and structural constraints, remains underexplored. To address this gap, we introduce a novel benchmark of 369 instances of the College Admission Problem, a canonical example of a matching problem with preferences, to evaluate LLMs across key dimensions: feasibility, stability, and optimality. We employ this benchmark to assess the performance of several open-weight LLMs. Our results first reveal that while LLMs can satisfy certain constraints, they struggle to meet all evaluation criteria consistently. They also show that reasoning LLMs, like QwQ and GPT-oss, significantly outperform traditional models such as Llama, Qwen or Mistral, defined here as models used without any dedicated reasoning mechanisms. Moreover, we observed that LLMs reacted differently to the various prompting strategies tested, which include Chain-of-Thought, In-Context Learning and role-based prompting, with no prompt consistently offering the best performance. Finally, we report the performances from iterative prompting with auto-generated feedback and show that they are not monotonic; they can peak early and then significantly decline in later attempts. Overall, this work offers a new perspective on model reasoning performance and the effectiveness of prompting strategies in combinatorial optimization problems with preferential constraints.


Empowering LLMs with Parameterized Skills for Adversarial Long-Horizon Planning

arXiv.org Artificial Intelligence

Recent advancements in Large Language Models(LLMs) have led to the development of LLM-based AI agents. A key challenge is the creation of agents that can effectively ground themselves in complex, adversarial long-horizon environments. Existing methods mainly focus on (1) using LLMs as policies to interact with the environment through generating low-level feasible actions, and (2) utilizing LLMs to generate high-level tasks or language guides to stimulate action generation. However, the former struggles to generate reliable actions, while the latter relies heavily on expert experience to translate high-level tasks into specific action sequences. To address these challenges, we introduce the Plan with Language, Act with Parameter (PLAP) planning framework that facilitates the grounding of LLM-based agents in long-horizon environments. The PLAP method comprises three key components: (1) a skill library containing environment-specific parameterized skills, (2) a skill planner powered by LLMs, and (3) a skill executor converting the parameterized skills into executable action sequences. We implement PLAP in MicroRTS, a long-horizon real-time strategy game that provides an unfamiliar and challenging environment for LLMs. The experimental results demonstrate the effectiveness of PLAP. In particular, GPT-4o-driven PLAP in a zero-shot setting outperforms 80% of baseline agents, and Qwen2-72B-driven PLAP, with carefully crafted few-shot examples, surpasses the top-tier scripted agent, CoacAI. Additionally, we design comprehensive evaluation metrics and test 6 closed-source and 2 open-source LLMs within the PLAP framework, ultimately releasing an LLM leaderboard ranking long-horizon skill planning ability. Our code is available at https://github.com/AI-Research-TeamX/PLAP.


Shaping Explanations: Semantic Reward Modeling with Encoder-Only Transformers for GRPO

arXiv.org Artificial Intelligence

While Large Language Models (LLMs) excel at generating human-like text, aligning their outputs with complex, qualitative goals like pedagogical soundness remains a significant challenge. Standard reinforcement learning techniques often rely on slow and expensive LLM-as-a-judge evaluations or on brittle, keyword-based metrics like ROUGE, which fail to capture the semantic essence of a high-quality explanation. In this work, we introduce a novel approach to reward shaping within the Group Relative Policy Optimisation (GRPO) framework. Our central contribution is the use of a small, efficient encoder-only transformer as a semantic reward model. This model provides a dense, semantically rich reward signal based on the cosine similarity between a generated explanation and a ground-truth reference, guiding the policy towards explanations that are not just factually correct but also structurally and conceptually aligned with expert reasoning. We apply this method to the task of training a model for the Italian medical-school entrance examinations, following standard domain-adaptive continued pre-training (CPT) and supervised fine-tuning (SFT). Our results demonstrate that GRPO with our proposed semantic reward significantly improves explanation faithfulness and clarity over a strong SFT baseline, showcasing the power of using lightweight encoder models for nuanced reward shaping in complex generation tasks


When Inverse Data Outperforms: Exploring the Pitfalls of Mixed Data in Multi-Stage Fine-Tuning

arXiv.org Artificial Intelligence

Existing work has shown that o1-level performance can be achieved with limited data distillation, but most existing methods focus on unidirectional supervised fine-tuning (SFT), overlooking the intricate interplay between diverse reasoning patterns. In this paper, we construct r1k, a high-quality reverse reasoning dataset derived by inverting 1,000 forward examples from s1k, and examine how SFT and Direct Preference Optimization (DPO) affect alignment under bidirectional reasoning objectives. SFT on r1k yields a 1.6%--6.8% accuracy improvement over s1k across evaluated benchmarks. However, naively mixing forward and reverse data during SFT weakens the directional distinction. Although DPO can partially recover this distinction, it also suppresses less preferred reasoning paths by shifting the probability mass toward irrelevant outputs. These findings suggest that mixed reasoning data introduce conflicting supervision signals, underscoring the need for robust and direction-aware alignment strategies.