Daily Papers

Longitudinal clinical notes contain rich evidence of how patients evolve over time, but converting this signal into training supervision for clinical prediction remains challenging. We extend Foresight Learning to clinical prediction by converting time-ordered MIMIC-III notes into examples consisting of past patient context, a natural-language question about a possible future event, and a label resolved from later documentation. This process yields 6,900 prediction examples from 702 admissions across medications, procedures, organ support, microbiology, and mortality. A small LoRA adapter trained on these examples improves over the prompted base model, reducing expected calibration error from 0.1269 to 0.0398 and Brier score from 0.199 to 0.145, while slightly outperforming GPT-5 point estimates on held-out questions. The approach enables reusable clinical prediction supervision from longitudinal notes without hand-engineered structured features or endpoint-specific classifiers.

The advancement of natural language processing (NLP) systems in healthcare hinges on language model ability to interpret the intricate information contained within clinical notes. This process often requires integrating information from various time points in a patient's medical history. However, most earlier clinical language models were pretrained with a context length limited to roughly one clinical document. In this study, We introduce ClinicalMamba, a specialized version of the Mamba language model, pretrained on a vast corpus of longitudinal clinical notes to address the unique linguistic characteristics and information processing needs of the medical domain. ClinicalMamba, with 130 million and 2.8 billion parameters, demonstrates a superior performance in modeling clinical language across extended text lengths compared to Mamba and clinical Llama. With few-shot learning, ClinicalMamba achieves notable benchmarks in speed and accuracy, outperforming existing clinical language models and general domain large models like GPT-4 in longitudinal clinical notes information extraction tasks.

Synthetic data is increasingly used to enable the development and evaluation of AI systems in domains where access to real-world data is restricted. In healthcare, clinical documentation presents particular challenges due to its sensitivity. This work introduces a synthetic clinical notes pipeline and dataset designed to support the development of clinical AI tools while avoiding the privacy risks associated with real patient data. The dataset is generated using a modular pipeline that combines structured patient generation, semi-structured patient journey simulation, and unstructured clinical note generation using large language models. The pipeline is designed to prioritise internal consistency across longitudinal patient records, while also capturing variation in writing style, note structure, and clinical detail. Additional mechanisms, including LLM-based validation and augmentation steps, are used to improve faithfulness, realism, and diversity of the generated notes. We release a dataset of 70 synthetic patients, each associated with 20-50 clinical notes spanning a full hospital journey. The dataset is provided at multiple levels of validation, enabling users to balance realism and scalability depending on their use case. This dataset supports the development, testing, and evaluation of clinical AI systems, including summarisation tools, coding models, and decision support systems, without reliance on real patient data.

Specialist epilepsy expertise is scarce in resource-constrained settings, making LLM-based decision support attractive for frontline clinicians managing longitudinal treatment. Such systems must adapt to local prescribing practice and know when to defer. We study this problem in Ugandan pediatric epilepsy care, predicting anti-seizure medication regimens from longitudinal unstructured clinic notes. Standard prompting achieves non-trivial agreement with physician prescriptions, but neurologist review shows that many errors reflect distribution-miscalibrated prescribing defaults rather than failures to parse the local record. We introduce MANANA, a non-parametric prompt-learning framework that learns local prescribing guidance from a small patient-level training set. MANANA converts observed prescription errors into auditable prompt memories, instantiated in single-agent and multi-agent variants, and improves over classical ML models, direct LLM prompting, and prompt-optimization baselines across two independently collected Ugandan cohorts. We further propose Bayesian prompt averaging, which converts the learned prompt trajectory into prescription likelihoods and an uncertainty-based deferral signal. On the independently collected held-out cohort, this improves visit-level top-3 prescription accuracy by 4-8 percentage points over prompt-optimization baselines and enables selective prediction: the system can auto-handle the most confident half of cases at 95% precision, or the most confident quarter at 99% precision, while deferring lower-confidence cases for specialist review.

While Large Language Models (LLMs) have shown strong performance on clinical text understanding, they struggle with longitudinal prediction tasks such as dementia prognosis, which require reasoning over complex, non-monotonic symptom trajectories across multiple visits. Standard supervised training lacks explicit annotations for symptom evolution, while direct Reinforcement Learning (RL) is hindered by sparse binary rewards. To address this challenge, we introduce Dementia-R1, an RL-based framework for longitudinal dementia prognosis from unstructured clinical notes. Our approach adopts a Cold-Start RL strategy that pre-trains the model to predict verifiable clinical indices extracted from patient histories, enhancing the capability to reason about disease progression before determining the final clinical status. Extensive experiments demonstrate that Dementia-R1 achieves an F1 score of 77.03% on real-world unstructured clinical datasets. Notably, on the ADNI benchmark, our 7B model rivals GPT-4o, effectively capturing fluctuating cognitive trajectories. Code is available at https://anonymous.4open.science/r/dementiar1-CDB5

Objective: Using natural language processing (NLP) to find sentences that state treatment plans in a clinical note, would automate plan extraction and would further enable their use in tools that help providers and care managers. However, as in the most NLP tasks on clinical text, creating gold standard to train and test NLP models is tedious and expensive. Fortuitously, sometimes but not always clinical notes contain sections with a heading that identifies the section as a plan. Leveraging contents of such labeled sections as a noisy training data, we assessed accuracy of NLP models trained with the data. Methods: We used common variations of plan headings and rule-based heuristics to find plan sections with headings in clinical notes, and we extracted sentences from them and formed a noisy training data of plan sentences. We trained Support Vector Machine (SVM) and Convolutional Neural Network (CNN) models with the data. We measured accuracy of the trained models on the noisy dataset using ten-fold cross validation and separately on a set-aside manually annotated dataset. Results: About 13% of 117,730 clinical notes contained treatment plans sections with recognizable headings in the 1001 longitudinal patient records that were obtained from Cleveland Clinic under an IRB approval. We were able to extract and create a noisy training data of 13,492 plan sentences from the clinical notes. CNN achieved best F measures, 0.91 and 0.97 in the cross-validation and set-aside evaluation experiments respectively. SVM slightly underperformed with F measures of 0.89 and 0.96 in the same experiments. Conclusion: Our study showed that the training supervised learning models using noisy plan sentences was effective in identifying them in all clinical notes. More broadly, sections with informal headings in clinical notes can be a good source for generating effective training data.

Electronic Health Records (EHRs) contain rich, longitudinal patient information across structured (e.g., labs, vitals, and imaging) and unstructured (e.g., clinical notes) modalities. While deep learning models such as RNNs and Transformers have advanced single- and multimodal EHR analysis, existing methods often optimize for specific downstream tasks and overlook the creation of generalizable patient representations that can be reused across multiple tasks. To address this gap, we propose CAAT-EHR, a novel Cross-Attentional Autoregressive Transformer architecture that produces task-agnostic, longitudinal embeddings of multimodal EHR data. In CAAT-EHR, self-attention layers capture temporal dependencies within each modality, while cross-attention layers fuse information across modalities to model complex interrelationships. During pre-training, an autoregressive decoder predicts future time steps from the fused embeddings, enforcing temporal consistency and enriching the encoder output. Once trained, the encoder alone generates versatile multimodal EHR embeddings that can be applied directly to a variety of predictive tasks. CAAT-EHR demonstrates significant improvements on benchmark EHR datasets for mortality prediction, ICU length-of-stay estimation, and Alzheimer's disease diagnosis prediction. Models using EHR embeddings generated by CAAT-EHR outperform models trained on raw EHR data in eleven out of twelve comparisons for F1 score and AUC across all three downstream tasks. Ablation studies confirm the critical roles of cross-modality fusion and autoregressive refinement. Overall, CAAT-EHR provides a unified framework for learning generalizable, temporally consistent multimodal EHR representations that support more reliable clinical decision support systems.

Electronic Health Records (EHRs) hold immense potential for advancing healthcare, offering rich, longitudinal data that combines structured information with valuable insights from unstructured clinical notes. However, the unstructured nature of clinical text poses significant challenges for secondary applications. Traditional methods for structuring EHR free-text data, such as rule-based systems and multi-stage pipelines, are often limited by their time-consuming configurations and inability to adapt across clinical notes from diverse healthcare settings. Few systems provide a comprehensive attribute extraction for terminologies. While giant large language models (LLMs) like GPT-4 and LLaMA 405B excel at structuring tasks, they are slow, costly, and impractical for large-scale use. To overcome these limitations, we introduce GENIE, a Generative Note Information Extraction system that leverages LLMs to streamline the structuring of unstructured clinical text into usable data with standardized format. GENIE processes entire paragraphs in a single pass, extracting entities, assertion statuses, locations, modifiers, values, and purposes with high accuracy. Its unified, end-to-end approach simplifies workflows, reduces errors, and eliminates the need for extensive manual intervention. Using a robust data preparation pipeline and fine-tuned small scale LLMs, GENIE achieves competitive performance across multiple information extraction tasks, outperforming traditional tools like cTAKES and MetaMap and can handle extra attributes to be extracted. GENIE strongly enhances real-world applicability and scalability in healthcare systems. By open-sourcing the model and test data, we aim to encourage collaboration and drive further advancements in EHR structurization.

Longitudinal information in radiology reports refers to the sequential tracking of findings across multiple examinations over time, which is crucial for monitoring disease progression and guiding clinical decisions. Many recent automated radiology report generation methods are designed to capture longitudinal information; however, validating their performance is challenging. There is no proper tool to consistently label temporal changes in both ground-truth and model-generated texts for meaningful comparisons. Large language models (LLMs) offer a promising annotation alternative, as they are capable of capturing nuanced linguistic patterns and semantic similarities without extensive manual intervention. They also adapt well to new contexts. In this study, we therefore propose an LLM-based pipeline to automatically annotate longitudinal information in radiology reports. The pipeline first identifies sentences containing relevant information and then extracts the progression of diseases. We evaluate and compare five mainstream LLMs on these two tasks using 500 manually annotated reports. Considering both efficiency and performance, Qwen2.5-32B was subsequently selected and used to annotate another 95,169 reports from the public MIMIC-CXR dataset. Our Qwen2.5-32B-annotated dataset provided us with a standardized benchmark for evaluating report generation models. Using this new benchmark, we assessed seven state-of-the-art report generation models. Our LLM-based annotation method outperforms existing annotation solutions, achieving 11.3\% and 5.3\% higher F1-scores for longitudinal information detection and disease tracking, respectively. The source code is available at https://github.com/wxinyi1996/Standardizing-Longitudinal-Chest-X-ray-Report-Evaluation-via-Large-Language-Model-Annotation.git.

Recent advances in large language models have led to renewed interest in natural language processing in healthcare using the free text of clinical notes. One distinguishing characteristic of clinical notes is their long time span over multiple long documents. The unique structure of clinical notes creates a new design choice: when the context length for a language model predictor is limited, which part of clinical notes should we choose as the input? Existing studies either choose the inputs with domain knowledge or simply truncate them. We propose a framework to analyze the sections with high predictive power. Using MIMIC-III, we show that: 1) predictive power distribution is different between nursing notes and discharge notes and 2) combining different types of notes could improve performance when the context length is large. Our findings suggest that a carefully selected sampling function could enable more efficient information extraction from clinical notes.

A longitudinal web crawl is a sequence of partial samples of an evolving URL population. Pairwise containment between two crawls is the standard probe; under a simple urn model of the crawl -- each round samples a fraction of the URLs and replaces a fraction -- it recovers two interpretable rates, per-round survival α and coverage c, but treats the population as uniform and consumes one pair at a time. In this work, we define a formal language for talking about a crawl. We extend this analysis with the discovery curve U(s, T), the cumulative URL footprint over a sliding window of T crawls starting at s, which under the same urn model is also a closed-form function of (α, c). Containment and the discovery curve are then two projections of one process: independent fits agree on (α, c) when the urn is homogeneous, so any disagreement is itself a measurement. Applied to Common Crawl (2020--2025, domain granularity) and to the German Academic Web (GAW, URL granularity), the two projections disagree on both archives, and a two-component urn with a persistent core fraction κ alongside shell parameters (α_partial, c_partial) reconciles the disagreement. A residual on c_partial remains, signaling that the shell itself is not homogeneous; κ is recorded as the scalar entry point to a rank-resolved generalization, which is left to follow-up work. web archive \and crawl coverage \and discovery curve \and urn model \and two-component model \and URL lifetime

The discharge summary is a one of critical documents in the patient journey, encompassing all events experienced during hospitalization, including multiple visits, medications, tests, surgery/procedures, and admissions/discharge. Providing a summary of the patient's progress is crucial, as it significantly influences future care and planning. Consequently, clinicians face the laborious and resource-intensive task of manually collecting, organizing, and combining all the necessary data for a discharge summary. Therefore, we propose "NOTE", which stands for "Notable generation Of patient Text summaries through an Efficient approach based on direct preference optimization". NOTE is based on Medical Information Mart for Intensive Care- III dataset and summarizes a single hospitalization of a patient. Patient events are sequentially combined and used to generate a discharge summary for each hospitalization. In the present circumstances, large language models' application programming interfaces (LLMs' APIs) are widely available, but importing and exporting medical data presents significant challenges due to privacy protection policies in healthcare institutions. Moreover, to ensure optimal performance, it is essential to implement a lightweight model for internal server or program within the hospital. Therefore, we utilized DPO and parameter efficient fine tuning (PEFT) techniques to apply a fine-tuning method that guarantees superior performance. To demonstrate the practical application of the developed NOTE, we provide a webpage-based demonstration software. In the future, we will aim to deploy the software available for actual use by clinicians in hospital. NOTE can be utilized to generate various summaries not only discharge summaries but also throughout a patient's journey, thereby alleviating the labor-intensive workload of clinicians and aiming for increased efficiency.

Longitudinal observational data are often subject to informative missingness. For example, in healthcare research using electronic health records, covariates and outcomes are measured only when patients interact with the healthcare system. Whether these data are observed usually depends on the unobserved variable values themselves, introducing a common form of data missing not at random. We develop identification and estimation methods for the effects of longitudinal modified treatment policies under a self-censoring model which explicitly models this dependence. We consider effects of treatments that can be modified only at measurement times (e.g., interactions with the heathcare system). We study two settings: one in which the observed history suffices for treatment confounding control, and another in which confounder control requires covariate values that were not measured at missed visits. In both settings, we combine longitudinal causal identification with shadow-variable conditional moment restrictions to obtain recursive identification formulas for the counterfactual outcome mean. We derive gradients of the pathwise derivatives and second-order remainder expansions, and use these results to construct estimators that accommodate machine learning for nuisance-function estimation. Under suitable product-rate conditions and cross-fitting, the estimators are asymptotically linear and permit root-n inference, including simultaneous inference across outcome times. We also describe conditional-moment learning and ensemble approaches for estimating the nuisance functions required by our approach, together with a pool-and-smooth strategy that borrows information across sparsely measured outcomes.

Iterative RAG for multi-hop question answering faces challenges with lengthy contexts and the buildup of irrelevant information. This hinders a model's capacity to process and reason over retrieved content and limits performance. While recent methods focus on compressing retrieved information, they are either restricted to single-round RAG, require finetuning or lack scalability in iterative RAG. To address these challenges, we propose Notes Writing, a method that generates concise and relevant notes from retrieved documents at each step, thereby reducing noise and retaining only essential information. This indirectly increases the effective context length of Large Language Models (LLMs), enabling them to reason and plan more effectively while processing larger volumes of input text. Notes Writing is framework agnostic and can be integrated with different iterative RAG methods. We demonstrate its effectiveness with three iterative RAG methods, across two models and four evaluation datasets. Notes writing yields an average improvement of 15.6 percentage points overall, with minimal increase in output tokens.

Tracking depression from multi-session counseling dialogues requires estimating both current symptom severity and how it changes across sessions. Yet progress on this task is constrained by the scarcity of longitudinal counseling data with standardized session-level depression labels. Existing resources typically provide either multi-session conversations without depression labels or labeled interviews in a single session. Building such a benchmark poses three challenges: maintaining longitudinal consistency and diversity, grounding symptom progression in empirical patterns, and expressing controlled depression states naturally without exposing target labels. To address these challenges, we introduce LongCounsel-8, a benchmark suite of three independently generated datasets totaling 7,749 five-session counseling trajectories, grounded in real-world client profiles, depression trajectories, symptom compositions, and counseling patterns. We combine profile-grounded simulation, empirically informed state construction, and indirect behavioral realization to address these challenges. Across the benchmark, simulated self-reports closely recover the controlled states, supporting label fidelity. Experiments on existing depression tracking methods reveal three key findings: (1) lower single-session score error does not guarantee accurate identification of trend, i.e., improvement or worsening; (2) existing methods are consistently less reliable on worsening trajectories; and (3) additional session history may reduce the accuracy of trend prediction. Together, these findings establish LongCounsel-8 as a foundation for advancing depression assessment from static, single-session prediction toward reliable longitudinal tracking of mental-health change.

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

Large language model (LLM) agents extend generative models with reasoning, tool use, and persistent memory, thereby enabling the automation of complex tasks. In healthcare, such systems could support documentation, care coordination, and clinical decision making. Their reliable deployment in hospitals, however, remains constrained by safety risks, limited transparency, and inadequate mechanisms for handling longitudinal clinical context. Here we propose an architecture that adapts LLM agents to hospital environments. The design comprises four components: a restricted execution environment inspired by multi-user operating systems, a document-centric interaction model linking patient and clinician agents, a page-indexed memory architecture for longitudinal context management, and a curated library of composable medical skills. Implemented on top of OpenClaw, an open-source agent orchestration framework, this design provides the basis for an Agentic Operating System for Hospitals: a computing layer for coordinating clinical workflows while preserving safety, transparency, and auditability. To evaluate the memory component, we introduce manifest-guided retrieval for hierarchical navigation of longitudinal patient records. In a benchmark derived from the MIMIC-IV dataset (v2.2) comprising 100 de-identified patient records and 300 clinical queries stratified across three difficulty tiers (100 per tier), manifest-guided retrieval matched a metadata-filtered RAG baseline on overall recall (0.877 versus 0.876) while achieving 2.2x higher precision (0.779 versus 0.352) and retrieving fewer documents; on tier-3 longitudinal queries, manifest recall was 21% higher (0.846 versus 0.701), confirming that LLM-guided hierarchical navigation is most valuable when queries span multiple care episodes. These results outline a practical path toward hospital-scale agentic infrastructure.

Longitudinal analysis has great potential to reveal developmental trajectories and monitor disease progression in medical imaging. This process relies on consistent and robust joint 4D segmentation. Traditional techniques are dependent on the similarity of images over time and the use of subject-specific priors to reduce random variation and improve the robustness and sensitivity of the overall longitudinal analysis. This is however slow and computationally intensive as subject-specific templates need to be rebuilt every time. The focus of this work to accelerate this analysis with the use of deep learning. The proposed approach is based on deep CNNs and incorporates semantic segmentation and provides a longitudinal relationship for the same subject. The proposed approach is based on deep CNNs and incorporates semantic segmentation and provides a longitudinal relationship for the same subject. The state of art using 3D patches as inputs to modified Unet provides results around {0.91 pm 0.5} Dice and using multi-view atlas in CNNs provide around the same results. In this work, different models are explored, each offers better accuracy and fast results while increasing the segmentation quality. These methods are evaluated on 135 scans from the EADC-ADNI Harmonized Hippocampus Protocol. Proposed CNN based segmentation approaches demonstrate how 2D segmentation using prior slices can provide similar results to 3D segmentation while maintaining good continuity in the 3D dimension and improved speed. Just using 2D modified sagittal slices provide us a better Dice and longitudinal analysis for a given subject. For the ADNI dataset, using the simple UNet CNN technique gives us {0.84 pm 0.5} and while using modified CNN techniques on the same input yields {0.89 pm 0.5}. Rate of atrophy and RMS error are calculated for several test cases using various methods and analyzed.

Brain tissue segmentation is essential for neuroscience and clinical studies. However, segmentation on longitudinal data is challenging due to dynamic brain changes across the lifespan. Previous researches mainly focus on self-supervision with regularizations and will lose longitudinal generalization when fine-tuning on a specific age group. In this paper, we propose a dual meta-learning paradigm to learn longitudinally consistent representations and persist when fine-tuning. Specifically, we learn a plug-and-play feature extractor to extract longitudinal-consistent anatomical representations by meta-feature learning and a well-initialized task head for fine-tuning by meta-initialization learning. Besides, two class-aware regularizations are proposed to encourage longitudinal consistency. Experimental results on the iSeg2019 and ADNI datasets demonstrate the effectiveness of our method. Our code is available at https://github.com/ladderlab-xjtu/DuMeta.

These notes are loosely based on lectures given at the CERN Winter School on Supergravity, Strings and Gauge theories, February 2009 and at the IPM String School in Tehran, April 2009. I have focused on a few concrete topics and also on addressing questions that have arisen repeatedly. Background condensed matter physics material is included as motivation and easy reference for the high energy physics community. The discussion of holographic techniques progresses from equilibrium, to transport and to superconductivity.

This lecture note is intended to prepare early-year master's and PhD students in data science or a related discipline with foundational ideas in machine learning. It starts with basic ideas in modern machine learning with classification as a main target task. These basic ideas include loss formulation, backpropagation, stochastic gradient descent, generalization, model selection as well as fundamental blocks of artificial neural networks. Based on these basic ideas, the lecture note explores in depth the probablistic approach to unsupervised learning, covering directed latent variable models, product of experts, generative adversarial networks and autoregressive models. Finally, the note ends by covering a diverse set of further topics, such as reinforcement learning, ensemble methods and meta-learning. After reading this lecture note, a student should be ready to embark on studying and researching more advanced topics in machine learning and more broadly artificial intelligence.

The adoption of Large Language Models (LLMs) in scientific writing promises efficiency but risks introducing informational entropy. While "hallucinated papers" are a known artifact, the systematic degradation of valid citation chains remains unquantified. We conducted a forensic audit of 50 recent survey papers in Artificial Intelligence (N=5,514 citations) published between September 2024 and January 2026. We utilized a hybrid verification pipeline combining DOI resolution, Crossref metadata analysis, Semantic Scholar queries, and fuzzy text matching to distinguish between formatting errors ("Sloppiness") and verifiable non-existence ("Phantoms). We detect a persistent 17.0% Phantom Rate -- citations that cannot be resolved to any digital object despite aggressive forensic recovery. Diagnostic categorization reveals three distinct failure modes: pure hallucinations (5.1%), hallucinated identifiers with valid titles (16.4%), and parsing-induced matching failures (78.5%). Longitudinal analysis reveals a flat trend (+0.07 pp/month), suggesting that high-entropy citation practices have stabilized as an endemic feature of the field. The scientific citation graph in AI survey literature exhibits "link rot" at scale. This suggests a mechanism where AI tools act as "lazy research assistants," retrieving correct titles but hallucinating metadata, thereby severing the digital chain of custody required for reproducible science.

Researchers are usually interested in examining the impact of covariates when separating heterogeneous samples into latent classes that are more homogeneous. The majority of theoretical and empirical studies with such aims have focused on identifying covariates as predictors of class membership in the structural equation modeling framework. In other words, the covariates only indirectly affect the sample heterogeneity. However, the covariates' influence on between-individual differences can also be direct. This article presents a mixture model that investigates covariates to explain within-cluster and between-cluster heterogeneity simultaneously, known as a mixture-of-experts (MoE) model. This study aims to extend the MoE framework to investigate heterogeneity in nonlinear trajectories: to identify latent classes, covariates as predictors to clusters, and covariates that explain within-cluster differences in change patterns over time. Our simulation studies demonstrate that the proposed model generally estimates the parameters unbiasedly, precisely and exhibits appropriate empirical coverage for a nominal 95% confidence interval. This study also proposes implementing structural equation model forests to shrink the covariate space of the proposed mixture model. We illustrate how to select covariates and construct the proposed model with longitudinal mathematics achievement data. Additionally, we demonstrate that the proposed mixture model can be further extended in the structural equation modeling framework by allowing the covariates that have direct effects to be time-varying.

Longitudinal treatment decisions require predicting potential outcomes under future treatment sequences in the presence of time-varying confounding, heterogeneous patient dynamics, and limited domain-specific data. Existing longitudinal causal estimators typically train a new model for each cohort or simulator. We introduce Causal Longitudinal Prior-Fitted Networks (CausalLongPFN), a prior-fitted in-context predictor for longitudinal causal prediction. The model is pretrained entirely on synthetic episodes sampled from a broad prior over temporal structural causal models, exposing it to treatment-confounder feedback, latent heterogeneity, nonlinear state evolution, delayed effects, and cumulative treatment responses. At test time, CausalLongPFN is frozen: it conditions on support trajectories, a query history, and a proposed future treatment sequence, and returns a predictive distribution over future outcomes without gradient updates or propensity-model fitting. Multi-step predictions are obtained by recursively applying the one-step predictor under the specified treatment sequence. We evaluate on branchable cancer, HIV, and warfarin benchmarks with ground-truth counterfactual labels, and on factual-only rolling-origin prediction in MIMIC-III ICU trajectories. CausalLongPFN is competitive with domain-trained longitudinal baselines on counterfactual benchmarks and performs strongly on factual MIMIC-III prediction, suggesting that broad synthetic causal pretraining can provide a useful frozen alternative when repeated domain-specific training is costly or impractical.

Under a unified operational definition, we define LLM memory as a persistent state written during pretraining, finetuning, or inference that can later be addressed and that stably influences outputs. We propose a four-part taxonomy (parametric, contextual, external, procedural/episodic) and a memory quadruple (location, persistence, write/access path, controllability). We link mechanism, evaluation, and governance via the chain write -> read -> inhibit/update. To avoid distorted comparisons across heterogeneous setups, we adopt a three-setting protocol (parametric only, offline retrieval, online retrieval) that decouples capability from information availability on the same data and timeline. On this basis we build a layered evaluation: parametric (closed-book recall, edit differential, memorization/privacy), contextual (position curves and the mid-sequence drop), external (answer correctness vs snippet attribution/faithfulness), and procedural/episodic (cross-session consistency and timeline replay, E MARS+). The framework integrates temporal governance and leakage auditing (freshness hits, outdated answers, refusal slices) and uncertainty reporting via inter-rater agreement plus paired tests with multiple-comparison correction. For updating and forgetting, we present DMM Gov: coordinating DAPT/TAPT, PEFT, model editing (ROME, MEND, MEMIT, SERAC), and RAG to form an auditable loop covering admission thresholds, rollout, monitoring, rollback, and change audits, with specs for timeliness, conflict handling, and long-horizon consistency. Finally, we give four testable propositions: minimum identifiability; a minimal evaluation card; causally constrained editing with verifiable forgetting; and when retrieval with small-window replay outperforms ultra-long-context reading. This yields a reproducible, comparable, and governable coordinate system for research and deployment.

Human organs constantly undergo anatomical changes due to a complex mix of short-term (e.g., heartbeat) and long-term (e.g., aging) factors. Evidently, prior knowledge of these factors will be beneficial when modeling their future state, i.e., via image generation. However, most of the medical image generation tasks only rely on the input from a single image, thus ignoring the sequential dependency even when longitudinal data is available. Sequence-aware deep generative models, where model input is a sequence of ordered and timestamped images, are still underexplored in the medical imaging domain that is featured by several unique challenges: 1) Sequences with various lengths; 2) Missing data or frame, and 3) High dimensionality. To this end, we propose a sequence-aware diffusion model (SADM) for the generation of longitudinal medical images. Recently, diffusion models have shown promising results in high-fidelity image generation. Our method extends this new technique by introducing a sequence-aware transformer as the conditional module in a diffusion model. The novel design enables learning longitudinal dependency even with missing data during training and allows autoregressive generation of a sequence of images during inference. Our extensive experiments on 3D longitudinal medical images demonstrate the effectiveness of SADM compared with baselines and alternative methods. The code is available at https://github.com/ubc-tea/SADM-Longitudinal-Medical-Image-Generation.

Video has become a popular media form for information sharing and consumption. However, taking notes while watching a video requires significant time and effort. To address this, we propose a novel interactive system, NoTeeline, for taking real-time, personalized notes. NoTeeline lets users quickly jot down keypoints (micronotes), which are automatically expanded into full-fledged notes that capture the content of the user's micronotes and are consistent with the user's writing style. In a within-subjects study (N=12), we found that NoTeeline helps users create high-quality notes that capture the essence of their micronotes with a higher factual correctness (93.2%) while accurately reflecting their writing style. While using NoTeeline, participants experienced significantly reduced mental effort, captured satisfactory notes while writing 47% less text, and completed notetaking with 43.9% less time compared to a manual notetaking baseline.

In medical imaging, the clinical value of Computed Tomography (CT) lies not only in depicting current disease status, but crucially in enabling longitudinal comparison of serial scans to determine disease evolution, a process that underpins response assessment, recurrence detection, and ongoing patient management. Yet, despite this central role of temporal comparison in clinical decision-making, existing medical foundation models remain largely confined to single-study understanding, leaving temporally grounded cross-examination insufficiently addressed. To address this gap, we study longitudinal imaging difference reporting, a task in which a model takes two temporally separated scans from the same patient and generates a clinically meaningful report describing interval changes between them. We introduce CT-ΔBench, a dedicated benchmark for this task with patient-level splitting to prevent information leakage. To better evaluate this task beyond surface-level text similarity, we further develop change-aware metrics specifically designed to capture clinically meaningful longitudinal changes, and conduct an independent physician validation to assess the reliability of the synthesized references and event extraction pipeline. We also compare direct paired-CT reasoning with an indirect two-stage pipeline that first generates single-timepoint reports and then performs textual differencing. Finally, we propose DeltaMed, a baseline model for direct paired-CT difference reporting, and train it on the benchmark training set. Together, these contributions lay the groundwork for temporally aware medical foundation models that better reflect real-world longitudinal clinical reasoning.

Co-citation structure is widely assumed to provide stable retrieval signal in legal information systems. We test this assumption longitudinally by constructing UA-StatuteRetrieval, a benchmark that measures co-citation predictability across 20 annual snapshots (2007-2026) of 396 million codex citations from 101 million Ukrainian court decisions. Using a leave-one-out protocol over the full bipartite citation graph, we find that Adamic-Adar MRR declines 33% on a fixed set of articles (from 0.43 to 0.29) and 47% under a train/test temporal split (from 0.51 to 0.27) confirming genuine temporal decay rather than compositional shift or evaluation artifact. The decay is non-uniform: criminal procedure maintains stable co-citation patterns (MRR ~0.40), while civil law degrades from 0.35 to 0.15, coinciding with the 2017 judicial reform. Hub articles (>100K citations) resist decay, but mid-frequency articles (1K-10K) -- the practical retrieval frontier lose half their predictability. A BM25 text baseline decays even faster (31%), and embedding drift analysis with E5-large reveals a 4.3% semantic shift in how articles are cited, providing a mechanistic explanation for the observed decay. The benchmark is released at https://huggingface.co/datasets/overthelex/ua-statute-retrieval.

Longitudinal modelling of Alzheimer's disease progression is clinically useful only if it can describe not just the most likely next diagnosis, but how a patient may evolve over time and how reliable that forecast is. Most deep learning approaches reduce this problem to single-step classification, treating cognitively normal, mild cognitive impairment, and dementia as flat categories while providing limited insight into how uncertainty accumulates across future visits. We propose a probabilistic framework that combines ordinal diagnosis prediction, multi-horizon trajectory generation, and decomposed uncertainty estimation. A Temporal Fusion Transformer encoder is adapted with a CORAL ordinal output layer, asymmetric loss weighting, and converter oversampling to respect disease-stage ordering and improve sensitivity to MCI-to-dementia transitions. Conditioned on the learned patient-context representation, an autoregressive Mixture Density Network generates five-year probabilistic trajectories for diagnosis state, CDR Sum of Boxes, MMSE orientation, and hippocampal volume. On ADNI, the model outperforms linear, recurrent, and transformer baselines for next-visit diagnosis prediction, with the strongest gains on MCI-versus-dementia discrimination. Generated trajectories achieve near-nominal 90% credible interval coverage, widening uncertainty across the forecast horizon, and biomarker dynamics consistent with expected Alzheimer's disease progression. We further separate aleatoric from epistemic uncertainty using analytic mixture variance and a five-member bootstrap ensemble, which provides the strongest encoder diversity and output-level epistemic signal. Epistemic uncertainty is higher for rare progression archetypes, MCI and dementia patients, and under external evaluation on OASIS-3, where it increases alongside prediction error.

Writing clinical notes and documenting medical exams is a critical task for healthcare professionals, serving as a vital component of patient care documentation. However, manually writing these notes is time-consuming and can impact the amount of time clinicians can spend on direct patient interaction and other tasks. Consequently, the development of automated clinical note generation systems has emerged as a clinically meaningful area of research within AI for health. In this paper, we present three key contributions to the field of clinical note generation using large language models (LLMs). First, we introduce CliniKnote, a comprehensive dataset consisting of 1,200 complex doctor-patient conversations paired with their full clinical notes. This dataset, created and curated by medical experts with the help of modern neural networks, provides a valuable resource for training and evaluating models in clinical note generation tasks. Second, we propose the K-SOAP (Keyword, Subjective, Objective, Assessment, and Plan) note format, which enhances traditional SOAP~podder2023soap (Subjective, Objective, Assessment, and Plan) notes by adding a keyword section at the top, allowing for quick identification of essential information. Third, we develop an automatic pipeline to generate K-SOAP notes from doctor-patient conversations and benchmark various modern LLMs using various metrics. Our results demonstrate significant improvements in efficiency and performance compared to standard LLM finetuning methods.

A crucial step within secondary analysis of electronic health records (EHRs) is to identify the patient cohort under investigation. While EHRs contain medical billing codes that aim to represent the conditions and treatments patients may have, much of the information is only present in the patient notes. Therefore, it is critical to develop robust algorithms to infer patients' conditions and treatments from their written notes. In this paper, we introduce a dataset for patient phenotyping, a task that is defined as the identification of whether a patient has a given medical condition (also referred to as clinical indication or phenotype) based on their patient note. Nursing Progress Notes and Discharge Summaries from the Intensive Care Unit of a large tertiary care hospital were manually annotated for the presence of several high-context phenotypes relevant to treatment and risk of re-hospitalization. This dataset contains 1102 Discharge Summaries and 1000 Nursing Progress Notes. Each Discharge Summary and Progress Note has been annotated by at least two expert human annotators (one clinical researcher and one resident physician). Annotated phenotypes include treatment non-adherence, chronic pain, advanced/metastatic cancer, as well as 10 other phenotypes. This dataset can be utilized for academic and industrial research in medicine and computer science, particularly within the field of medical natural language processing.

Objective: We develop a deep learning framework based on the pre-trained Bidirectional Encoder Representations from Transformers (BERT) model using unstructured clinical notes from electronic health records (EHRs) to predict the risk of disease progression from Mild Cognitive Impairment (MCI) to Alzheimer's Disease (AD). Materials and Methods: We identified 3657 patients diagnosed with MCI together with their progress notes from Northwestern Medicine Enterprise Data Warehouse (NMEDW) between 2000-2020. The progress notes no later than the first MCI diagnosis were used for the prediction. We first preprocessed the notes by deidentification, cleaning and splitting, and then pretrained a BERT model for AD (AD-BERT) based on the publicly available Bio+Clinical BERT on the preprocessed notes. The embeddings of all the sections of a patient's notes processed by AD-BERT were combined by MaxPooling to compute the probability of MCI-to-AD progression. For replication, we conducted a similar set of experiments on 2563 MCI patients identified at Weill Cornell Medicine (WCM) during the same timeframe. Results: Compared with the 7 baseline models, the AD-BERT model achieved the best performance on both datasets, with Area Under receiver operating characteristic Curve (AUC) of 0.8170 and F1 score of 0.4178 on NMEDW dataset and AUC of 0.8830 and F1 score of 0.6836 on WCM dataset. Conclusion: We developed a deep learning framework using BERT models which provide an effective solution for prediction of MCI-to-AD progression using clinical note analysis.

Large Language Models (LLMs) have shown strong promise for mining Electronic Health Records (EHRs) by reasoning over longitudinal clinical information to capture context-rich patient trajectories. However, leveraging LLMs for structured EHRs (e.g., standardized diagnosis and medication codes) presents two key challenges. First, translating time-stamped EHR sequences into plain text can obscure both temporal structure and code identities, weakening the ability to capture code co-occurrence and longitudinal regularities. Second, unlike cohort-trained predictive models that learn a shared, task-aligned representation space across patients, LLMs are often applied in a case-isolated inference setting where each patient is processed independently without leveraging population-level patterns. To address these challenges, we introduce RePrompT, a time-aware LLM framework that integrates structured EHR encoders through prompt tuning, without modifying underlying architectures. Specifically, RePrompT recurrently incorporates latent states from prior visits to preserve longitudinal information, and injects population-level information through trainable prompt tokens derived from a cohort-trained, task-aligned EHR encoder. Experiments on MIMIC-III and MIMIC-IV demonstrate that RePrompT consistently outperforms both EHR-based and LLM-based baselines across multiple clinical prediction tasks.

Note-taking is a critical practice for capturing, organizing, and reflecting on information in both academic and professional settings. The recent success of large language models has accelerated the development of AI-assisted tools, yet existing solutions often struggle with efficiency. We present NoteBar, an AI-assisted note-taking tool that leverages persona information and efficient language models to automatically organize notes into multiple categories and better support user workflows. To support research and evaluation in this space, we further introduce a novel persona-conditioned dataset of 3,173 notes and 8,494 annotated concepts across 16 MBTI personas, offering both diversity and semantic richness for downstream tasks. Finally, we demonstrate that NoteBar can be deployed in a practical and cost-effective manner, enabling interactive use without reliance on heavy infrastructure. Together, NoteBar and its accompanying dataset provide a scalable and extensible foundation for advancing AI-assisted personal knowledge management.

Score-informed note separation seeks to extract the performed waveform of all individual notes, often from a polyphonic recording. Existing deep learning systems generally only target instrument-level stems. We present, to our knowledge, the first deep learning approach to score-informed note separation, NoteSep. NoteSep extracts the queried notes by applying an extraction stage model, NoteGrab, once per note. Conditioned on pitch, onset, and offset, NoteGrab separates harmonic and percussive components in two U-Nets linked by bidirectional cross-attention; selective harmonic gating suppresses lower-octave interference while preserving percussive attacks. Finally, a joint separation stage applies Adaptive Set Ownership (ASO) to compare concurrent NoteGrab estimates and reallocate mixture energy. We curate SCNS-Train (25,729 mixtures and 743,920 targets) for training and SCNS-Eval (16 instruments, disjoint scores and libraries) for evaluation. On SCNS-Eval, NoteSep reaches a median SI-SDR of 7.39~dB, compared with 2.49~dB for our strongest baseline. See the demo page at https://benschou.com/notesep.

Clinical LLM assistants must reason over multi-visit patient trajectories, yet whether the compact history representations used to scale them---retrieval, structured timelines, LLM summaries, agentic memory---preserve the longitudinal signal clinical reasoning needs has not been measured. We introduce ClinTraceBench: 385 MIMIC-IV-derived verified dialogues with event-ID provenance, a nine-task taxonomy (T1--T9), and L0--L4 deterministic + L5 human-audit validation (98.92\% agreement). We evaluate eight history representation strategies---a no-context floor, last-visit-only, full-context, BGE-M3 dense-retrieval, two compression schemes, and two agentic-memory systems (Mem0, A-Mem)---across four backbones (DeepSeek-V3, GPT-4o-mini, Haiku~4.5, Sonnet~4.6) on 6{,}271 questions: 32 cells, 200{,}672 predictions. Four findings: (SP4) a controlled T3 injection probe isolates compression-induced relation loss---with the attribution sentence present before construction, Mem0, A-Mem and llm-summary still recover only 0--5.3\% of the injected positives; (SP1) compressed strategies pay an aggregation tax on multi-visit trends and cross-patient comparisons; (SP2) the blind-to-full gap spans +29.8~pp (GPT-4o-mini) to +62.7~pp (Haiku); (SP3) abstention scales non-monotonically with context length. On the Pareto frontier Haiku dominates Sonnet under full-context (\25.76 vs. 106.21), inverting the ``biggest backbone wins'' heuristic.

Identifying patient cohorts is fundamental to numerous healthcare tasks, including clinical trial recruitment and retrospective studies. Current cohort retrieval methods in healthcare organizations rely on automated queries of structured data combined with manual curation, which are time-consuming, labor-intensive, and often yield low-quality results. Recent advancements in large language models (LLMs) and information retrieval (IR) offer promising avenues to revolutionize these systems. Major challenges include managing extensive eligibility criteria and handling the longitudinal nature of unstructured Electronic Medical Records (EMRs) while ensuring that the solution remains cost-effective for real-world application. This paper introduces a new task, Automatic Cohort Retrieval (ACR), and evaluates the performance of LLMs and commercial, domain-specific neuro-symbolic approaches. We provide a benchmark task, a query dataset, an EMR dataset, and an evaluation framework. Our findings underscore the necessity for efficient, high-quality ACR systems capable of longitudinal reasoning across extensive patient databases.

Clinical notes contain information about patients that goes beyond structured data like lab values and medications. However, clinical notes have been underused relative to structured data, because notes are high-dimensional and sparse. This work develops and evaluates representations of clinical notes using bidirectional transformers (ClinicalBERT). ClinicalBERT uncovers high-quality relationships between medical concepts as judged by humans. ClinicalBert outperforms baselines on 30-day hospital readmission prediction using both discharge summaries and the first few days of notes in the intensive care unit. Code and model parameters are available.

Linear attention promises the efficiency needed for long-context language modelling, yet its fixed-size recurrent state must simultaneously support ongoing computation and preserve information from an ever-growing history. This coupling has reinforced a prevailing view that the state's memory capacity defines the model's long-context capability. We challenge this presumed ceiling: recurrent computation need not bear the full burden of long-term storage. We introduce NoteBank, a sparse episodic memory that archives selected text before future queries are known, uses the backbone's native features for writing and addressing, and reads retrieved evidence through its native forward computation via replay. This training-free, plug-and-play interface requires no external embedding model, separately trained retriever, or separate neural reader. At one million tokens, it raises Gated DeltaNet's mean accuracy across six RULER retrieval tasks from 1.7% to 70.3%, with no observed significant retrieval degradation from 4K to 1M tokens. This recovery adds leqslant0.025% to analytical FLOPs, with persistent context storage approximately 1/2,600 that of a Transformer's full MHA KV cache at matched width, depth, and precision. Experiments extend from three 1.3B recurrent backbones to Mamba-2-8B and post-trained Qwen3.5-9B, demonstrating gains on LongBench v1/v2 and MemoryAgentBench. Together, these results show that sparse evidence storage and native replay can substantially expand the long-context capability of pretrained linear attention models while retaining the efficiency of recurrent computation.

In clinical practice, patients often undergo multiple imaging examinations over successive visits, yielding longitudinal data. Modeling such temporal information is crucial for reliable assessment of disease progression and treatment response. However, despite the rapid advancement of multimodal large language models (MLLMs), longitudinal medical visual reasoning remains largely underexplored. To fill this gap, we propose LoMeVQA, a comprehensive benchmark consisting of 206K longitudinal visual question answering (VQA) pairs for temporal medical image analysis. LoMeVQA covers five tasks: progress classification, progress description, progress report generation, differential region grounding, and differential region description. To construct the dataset, we develop an automated pipeline that (1) organizes patient records chronologically, (2) extracts clinically meaningful entities via a medical knowledge graph, and (3) models their temporal evolution to guide large language models in generating high-quality longitudinal VQA pairs. Extensive evaluations demonstrate that both general-purpose and medical-domain MLLMs perform poorly on LoMeVQA, revealing substantial limitations in temporal reasoning. To address these limitations, we introduce MedLong-8B, which achieves state-of-the-art performance across all tasks. Beyond benchmarking, we conduct detailed analyses that uncover key failure modes and shed light on how to improve longitudinal medical visual reasoning. Our data is available at: https://github.com/pepperbubble/LoMeVQA

Large Language Models (LLMs) have emerged as a new paradigm for recommendation by converting interacted item history into language modeling. However, constrained by the limited context length of LLMs, existing approaches have to truncate item history in the prompt, focusing only on recent interactions and sacrificing the ability to model long-term history. To enable LLMs to model long histories, we pursue a concise embedding representation for items and sessions. In the LLM embedding space, we construct an item's embedding by aggregating its textual token embeddings; similarly, we construct a session's embedding by aggregating its item embeddings. While efficient, this way poses two challenges since it ignores the temporal significance of user interactions and LLMs do not natively interpret our custom embeddings. To overcome these, we propose PatchRec, a multi-grained patch training method consisting of two stages: (1) Patch Pre-training, which familiarizes LLMs with aggregated embeddings -- patches, and (2) Patch Fine-tuning, which enables LLMs to capture time-aware significance in interaction history. Extensive experiments show that PatchRec effectively models longer behavior histories with improved efficiency. This work facilitates the practical use of LLMs for modeling long behavior histories. Codes are available at https://github.com/ljy0ustc/PatchRec.

Recent research has demonstrated the capability of behavior signals captured by smartphones and wearables for longitudinal behavior modeling. However, there is a lack of a comprehensive public dataset that serves as an open testbed for fair comparison among algorithms. Moreover, prior studies mainly evaluate algorithms using data from a single population within a short period, without measuring the cross-dataset generalizability of these algorithms. We present the first multi-year passive sensing datasets, containing over 700 user-years and 497 unique users' data collected from mobile and wearable sensors, together with a wide range of well-being metrics. Our datasets can support multiple cross-dataset evaluations of behavior modeling algorithms' generalizability across different users and years. As a starting point, we provide the benchmark results of 18 algorithms on the task of depression detection. Our results indicate that both prior depression detection algorithms and domain generalization techniques show potential but need further research to achieve adequate cross-dataset generalizability. We envision our multi-year datasets can support the ML community in developing generalizable longitudinal behavior modeling algorithms.

As the general capabilities of artificial intelligence (AI) agents continue to evolve, their ability to learn to master multiple complex tasks through experience remains a key challenge. Current LLM agents, particularly those based on proprietary language models, typically rely on prompts to incorporate knowledge about the target tasks. This approach does not allow the agent to internalize this information and instead relies on ever-expanding prompts to sustain its functionality in diverse scenarios. This resembles a system of notes used by a person affected by anterograde amnesia, the inability to form new memories. In this paper, we propose a novel method to train AI agents to incorporate knowledge and skills for multiple tasks without the need for either cumbersome note systems or prior high-quality demonstration data. Our approach employs an iterative process where the agent collects new experiences, receives corrective feedback from humans in the form of hints, and integrates this feedback into its weights via a context distillation training procedure. We demonstrate the efficacy of our approach by implementing it in a Llama-3-based agent that, after only a few rounds of feedback, outperforms advanced models GPT-4o and DeepSeek-V3 in tasksets requiring correct sequencing of information retrieval, tool use, and question answering.

Conversational memory changes during use, so endpoint question answering alone cannot establish how a persistent state accumulates, ages, or incorporates revisions. We introduce LSREP, a Longitudinal State-Replay Evaluation Protocol combining ordered replay, explicit lifecycle schedules, repeated probes, evolving reference answers, and mechanism-fidelity checks. Its architectural case study is ICE v2, a local-first memory middleware with typed stores, retrieval fusion, and dynamic context budgets. The private, single-user instantiation contains 1,985 turns, 219 distinct probes, and 1,211 probe-checkpoint observations across 52 checkpoints. On three ordinary-density datasets, ICE v2 has a near-zero mean quality difference from vector-RAG while selecting 32% fewer fragments but using 6.6% more estimated prompt tokens. A fourth, dense dataset exposes catastrophic failures of the unbudgeted baseline. The fidelity audit limits attribution: procedural retrieval is defective, several mechanisms are unexercised, and graph utility is not established. In a complementary matched public diagnostic, ICE v2 loses decisively to pure vector-RAG on LongMemEval: 50.8% versus 72.8% in the evidence-only oracle and 43.0% versus 69.5% in full-S. Paired differences are -22.0 points (95% CI [-26.6, -17.4]) and -26.5 ([-31.3, -21.8]). Conservative abstention accompanies severe multi-session and temporal failures. ICE uses less context in this diagnostic, establishing a quality-cost trade-off rather than superior efficiency. Together, replay, fidelity auditing, and public endpoint testing expose distinct failure modes that neither architectural descriptions nor aggregate scores identify alone.

Long-term memory lets an LLM assistant use a history it can no longer reread, and most memory systems build it by rewriting conversations into facts, graphs or typed memories at write time. We argue that the work of memory divides, as thinking does, into two systems. Most of it is fast System 1 work: many small, independent yes/no judgments about records, such as whether a record is needed or no longer current, which a decision model makes by the dozen in a third of a second. Only a little is slow System 2 work: writing a few search queries, naming what the reply needs and composing the answer, which an LLM does well but slowly. We present Mnemon, a memory agent built on this division. It keeps conversations as raw, dated records; an LLM (System 2) plans searches over them, a decision model, Jev (System 1), judges what the searches return, and rules with explicit budgets turn the judgments into a small View for an unchanged answering model. A background pass consolidates each record once into topic timelines, value histories and standing instructions linked to the records, so that questions about a whole conversation reach evidence their own searches miss. Because nothing is decided about a record when it is written, the same agent can read any store that returns dated records. With gpt-4.1-mini answering, as in a public re-evaluation of 14 systems, Mnemon scores 91.7% on LoCoMo, the highest among them, and 83.8% on LongMemEval-S, from under 4k tokens of context per question, with the lowest effective cost index on LoCoMo. With a reasoning model answering, it reaches 92.2% on LoCoMo and 94.4% on LongMemEval-S, the latter on par with the best published results. From 100K to 10M tokens of history on BEAM, its cost per question grows by a factor of 1.11. On the same records, Jev separates gold evidence better than two LLMs and is 3-11 times faster.

Community Notes, the crowd-sourced misinformation governance system on X (formerly Twitter), allows users to flag misleading posts, attach contextual notes, and rate the notes' helpfulness. However, our empirical analysis of 30.8K health-related notes reveals substantial latency, with a median delay of 17.6 hours before notes receive a helpfulness status. To improve responsiveness during real-world misinformation surges, we propose CrowdNotes+, a unified LLM-based framework that augments Community Notes for faster and more reliable health misinformation governance. CrowdNotes+ integrates two modes: (1) evidence-grounded note augmentation and (2) utility-guided note automation, supported by a hierarchical three-stage evaluation of relevance, correctness, and helpfulness. We instantiate the framework with HealthNotes, a benchmark of 1.2K health notes annotated for helpfulness, and a fine-tuned helpfulness judge. Our analysis first uncovers a key loophole in current crowd-sourced governance: voters frequently conflate stylistic fluency with factual accuracy. Addressing this via our hierarchical evaluation, experiments across 15 representative LLMs demonstrate that CrowdNotes+ significantly outperforms human contributors in note correctness, helpfulness, and evidence utility.

Knowledge-intensive language tasks require NLP systems to both provide the correct answer and retrieve supporting evidence for it in a given corpus. Autoregressive language models are emerging as the de-facto standard for generating answers, with newer and more powerful systems emerging at an astonishing pace. In this paper we argue that all this (and future) progress can be directly applied to the retrieval problem with minimal intervention to the models' architecture. Previous work has explored ways to partition the search space into hierarchical structures and retrieve documents by autoregressively generating their unique identifier. In this work we propose an alternative that doesn't force any structure in the search space: using all ngrams in a passage as its possible identifiers. This setup allows us to use an autoregressive model to generate and score distinctive ngrams, that are then mapped to full passages through an efficient data structure. Empirically, we show this not only outperforms prior autoregressive approaches but also leads to an average improvement of at least 10 points over more established retrieval solutions for passage-level retrieval on the KILT benchmark, establishing new state-of-the-art downstream performance on some datasets, while using a considerably lighter memory footprint than competing systems. Code and pre-trained models at https://github.com/facebookresearch/SEAL.

Scientific paper recommendation is typically evaluated as static ranking over a fixed candidate set, yet real scientific reading unfolds as a daily, longitudinal process in which interests shift and feedback accumulates. We introduce PaperFlow, a framework that organizes it into three coupled stages: Profiling, which constructs and maintains a structured, inspectable scholarly profile from heterogeneous cold-start evidence; Recommending, which ranks each date-specific paper stream through multi-signal aggregation under a fixed display budget; and Adapting, which updates user state from semantically distinct feedback signals and models interest drift across days. We further define a longitudinal user-day benchmark that fixes users, dates, candidate pools, visible inputs, and hidden simulated relevance labels under a shared temporal information boundary. The benchmark contains 24 simulated research users, 50 daily paper streams, 1,200 user-day episodes, 20,727 unique papers, and 497,448 episode-paper records. We additionally specify a blind human-evaluation protocol to validate alignment between automatic metrics and expert judgments. Experiments against five scientific recommendation baselines show that PaperFlow achieves the strongest oracle-based ranking, the highest behavioral alignment with simulated reading selections, and the best blind human-evaluation score.

Large language models (LLMs) have become popular writing tools among students and may expand access to high-quality feedback for students with less access to traditional writing support. At the same time, LLMs may standardize student voice or invite overreliance. This study examines how adoption of LLM-assisted writing varies across socioeconomic groups and how it relates to outcomes in a high-stakes context: U.S. college admissions. We analyze a de-identified longitudinal dataset of applications to a selective university from 2020 to 2024 (N = 81,663). Estimating LLM use using a distribution-based detector trained on synthetic and historical essays, we tracked how student writing changed as LLM use proliferated, how adoption differed by socioeconomic status (SES), and whether potential benefits translated equitably into admissions outcomes. Using fee-waiver status as a proxy for SES, we observe post-2023 convergence in surface-level linguistic features, with the largest changes in fee-waived and rejected applicants. Estimated LLM use rose sharply in 2024 across all groups, with disproportionately larger increases among lower SES applicants, consistent with an access hypothesis in which LLMs substitute for scarce writing support. However, increased estimated LLM use was more strongly associated with declines in predicted admission probability for lower SES applicants than for higher SES applicants, even after controlling for academic credentials and stylometric features. These findings raise concerns about equity and the validity of essay-based evaluation in an era of AI-assisted writing and provide the first large-scale longitudinal evidence linking LLM adoption, linguistic change, and evaluative outcomes in college admissions.

Many people aim for change, but not everyone succeeds. While there are a number of social psychology theories that propose motivation-related characteristics of those who persist with change, few computational studies have explored the motivational stage of personal change. In this paper, we investigate a new dataset consisting of the writings of people who manifest intention to change, some of whom persist while others do not. Using a variety of linguistic analysis techniques, we first examine the writing patterns that distinguish the two groups of people. Persistent people tend to reference more topics related to long-term self-improvement and use a more complicated writing style. Drawing on these consistent differences, we build a classifier that can reliably identify the people more likely to persist, based on their language. Our experiments provide new insights into the motivation-related behavior of people who persist with their intention to change.

Many psychological experiments have subjects repeat a task to gain the statistical precision required to test quantitative theories of psychological performance. In such experiments, time-on-task can have sizable effects on performance, changing the psychological processes under investigation. Most research has either ignored these changes, treating the underlying process as static, or sacrificed some psychological content of the models for statistical simplicity. We use particle Markov chain Monte-Carlo methods to study psychologically plausible time-varying changes in model parameters. Using data from three highly-cited experiments we find strong evidence in favor of a hidden Markov switching process as an explanation of time-varying effects. This embodies the psychological assumption of "regime switching", with subjects alternating between different cognitive states representing different modes of decision-making. The switching model explains key long- and short-term dynamic effects in the data. The central idea of our approach can be applied quite generally to quantitative psychological theories, beyond the models and data sets that we investigate.

Long-running LLM agents compress past interactions into persistent memories that may be reused as premises for later tasks. This creates a distinct derivation problem: whether the memory actually follows from what the interaction history supports. Relevant evidence may be scattered across earlier interactions, while compression can introduce relations or event status that the history never established. A valid memory may therefore appear unsupported because its citations omit relevant evidence, while individually supported facts may be composed into a stronger statement the history never established. We characterize this problem through three coupled requirements: (1) Evidence scope; (2) Compositional validity; (3) Admission reliability. We therefore ask whether the interaction history available at write time supports what enters persistent memory. We introduce DerivAudit, a framework for auditing whether a memory is actually supported by the history available when it was written. The audit separates three questions: whether supporting evidence lies beyond writer-provided citations, whether the composed memory introduces unsupported meaning, and how write-time admission decisions affect later memory use. Across two natural memory corpora, audits using broader pre-write history recover support for nearly 60% of memories that appear unsupported from citations alone, while 17-21% remain unsupported after expansion. Yet broader evidence does not by itself make admission reliable: unsupported memories are still frequently admitted across verification models, and evidence expansion alone worsens it on two backbones.

The performance of speaker verification systems is adversely affected by speaker aging. However, due to challenges in data collection, particularly the lack of sustained and large-scale longitudinal data for individuals, research on speaker aging remains difficult. In this paper, we present VoxAging, a large-scale longitudinal dataset collected from 293 speakers (226 English speakers and 67 Mandarin speakers) over several years, with the longest time span reaching 17 years (approximately 900 weeks). For each speaker, the data were recorded at weekly intervals. We studied the phenomenon of speaker aging and its effects on advanced speaker verification systems, analyzed individual speaker aging processes, and explored the impact of factors such as age group and gender on speaker aging research.

Current LLM benchmarks focus on evaluating models' memory of facts and semantic relations, primarily assessing semantic aspects of long-term memory. However, in humans, long-term memory also includes episodic memory, which links memories to their contexts, such as the time and place they occurred. The ability to contextualize memories is crucial for many cognitive tasks and everyday functions. This form of memory has not been evaluated in LLMs with existing benchmarks. To address the gap in evaluating memory in LLMs, we introduce Sequence Order Recall Tasks (SORT), which we adapt from tasks used to study episodic memory in cognitive psychology. SORT requires LLMs to recall the correct order of text segments, and provides a general framework that is both easily extendable and does not require any additional annotations. We present an initial evaluation dataset, Book-SORT, comprising 36k pairs of segments extracted from 9 books recently added to the public domain. Based on a human experiment with 155 participants, we show that humans can recall sequence order based on long-term memory of a book. We find that models can perform the task with high accuracy when relevant text is given in-context during the SORT evaluation. However, when presented with the book text only during training, LLMs' performance on SORT falls short. By allowing to evaluate more aspects of memory, we believe that SORT will aid in the emerging development of memory-augmented models.

The growing availability of longitudinal Magnetic Resonance Imaging (MRI) datasets has facilitated Artificial Intelligence (AI)-driven modeling of disease progression, making it possible to predict future medical scans for individual patients. However, despite significant advancements in AI, current methods continue to face challenges including achieving patient-specific individualization, ensuring spatiotemporal consistency, efficiently utilizing longitudinal data, and managing the substantial memory demands of 3D scans. To address these challenges, we propose Brain Latent Progression (BrLP), a novel spatiotemporal model designed to predict individual-level disease progression in 3D brain MRIs. The key contributions in BrLP are fourfold: (i) it operates in a small latent space, mitigating the computational challenges posed by high-dimensional imaging data; (ii) it explicitly integrates subject metadata to enhance the individualization of predictions; (iii) it incorporates prior knowledge of disease dynamics through an auxiliary model, facilitating the integration of longitudinal data; and (iv) it introduces the Latent Average Stabilization (LAS) algorithm, which (a) enforces spatiotemporal consistency in the predicted progression at inference time and (b) allows us to derive a measure of the uncertainty for the prediction at the global and voxel level. We train and evaluate BrLP on 11,730 T1-weighted (T1w) brain MRIs from 2,805 subjects and validate its generalizability on an external test set comprising 2,257 MRIs from 962 subjects. Our experiments compare BrLP-generated MRI scans with real follow-up MRIs, demonstrating state-of-the-art accuracy compared to existing methods. The code is publicly available at: https://github.com/LemuelPuglisi/BrLP.

Prior work on a social web highlighter located individuality in selection -- which documents a person chooses to highlight -- but measured it cross-sectionally. We ask the temporal question: is a reader's selection signature a trait or a state? We freeze each reader's first six months of highlighting as a profile and track its own-vs-other advantage on their later selections at growing gaps (to 24+ months), with negatives drawn from the same calendar era -- so supply drift cannot masquerade as personal drift -- at a coarse global level and at a fine level whose negatives and controls come from the reader's own interest neighborhood; the anchor cell reproduces the prior cross-sectional level (+0.188 vs +0.169), validating the harness. Four results. Within the same users, the fine-layer advantage shows no statistically detectable paired decline at any horizon (6-12 month retention R = 1.00 [0.85, 1.18], n = 212; the farthest bin is compatible with a modest decline; the only contrast whose interval excludes zero is the coarse layer at 12-24 months, about 13%). The signal is not reducible to repeated domains (~90% survives excluding all profile sources). Within-person drift is slow (a recent-half profile beats the old half by +0.042). Prospectively, personal profiles -- even one built from a reader's earliest documents, median 20 months before evaluation -- rank their next reads at roughly 3x the AP of every simple non-personal prior tested. We use "trait" operationally (a stable signature under continued engagement); the scope is heavy, long-tenured readers of one platform, and exposure is not separable from choice.

Background: Electronic Health Records hold detailed longitudinal information about each patient's health status and general clinical history, a large portion of which is stored within the unstructured text. Existing approaches focus mostly on structured data and a subset of single-domain outcomes. We explore how temporal modelling of patients from free text and structured data, using deep generative transformers can be used to forecast a wide range of future disorders, substances, procedures or findings. Methods: We present Foresight, a novel transformer-based pipeline that uses named entity recognition and linking tools to convert document text into structured, coded concepts, followed by providing probabilistic forecasts for future medical events such as disorders, substances, procedures and findings. We processed the entire free-text portion from three different hospital datasets totalling 811336 patients covering both physical and mental health. Findings: On tests in two UK hospitals (King's College Hospital, South London and Maudsley) and the US MIMIC-III dataset precision@10 0.68, 0.76 and 0.88 was achieved for forecasting the next disorder in a patient timeline, while precision@10 of 0.80, 0.81 and 0.91 was achieved for forecasting the next biomedical concept. Foresight was also validated on 34 synthetic patient timelines by five clinicians and achieved relevancy of 97% for the top forecasted candidate disorder. As a generative model, it can forecast follow-on biomedical concepts for as many steps as required. Interpretation: Foresight is a general-purpose model for biomedical concept modelling that can be used for real-world risk forecasting, virtual trials and clinical research to study the progression of disorders, simulate interventions and counterfactuals, and educational purposes.

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

Forecasting the future anatomy of slow-evolving neurodegenerative diseases could enable earlier, more targeted intervention and improve clinical trial design, but it remains challenging because true progression signals are subtle in longitudinal MRI. In this low-signal regime, transferring modern generative sequence models directly is unreliable: training is dominated by stable baseline anatomy and confounded by dense, sample-specific nuisance variation. We first provide a theoretical analysis that explains these failures through two modes. Identity collapse occurs when optimization is driven toward reproducing the current anatomy, which prevents the model from learning faint temporal change. The continuous interpolation trap arises when standard smooth networks cannot separate localized biological drift from pervasive noise, which leads to spurious changes that diffuse across the volume. To address both issues, we propose Latent Drift, a progressive generative framework that learns change in a compressed semantic representation rather than synthesizing full-resolution anatomy. This design removes pixel-level identity from the prediction target and concentrates model capacity on progression-relevant dynamics. We further apply Finite Scalar Quantization to the learned change representation, which suppresses small, high-frequency nuisance fluctuations while preserving consistent structural drift. Experiments on longitudinal 3D brain MRI show that Latent Drift improves patient-specific neuro-forecasting over diffusion and autoregressive transformer baselines across generative fidelity and clinically relevant evaluation metrics. Project page: https://cutepkq.github.io/latent-drift{https://cutepkq.github.io/latent-drift}.

Longitudinal health agents must reason across multi-source trajectories that combine continuous device streams, sparse clinical exams, and episodic life events - yet evaluating them is hard: real-world data cannot be released at scale, and temporally grounded attribution questions seldom admit definitive answers without structured ground truth. We present ESL-Bench, an event-driven synthesis framework and benchmark providing 100 synthetic users, each with a 1-5 year trajectory comprising a health profile, a multi-phase narrative plan, daily device measurements, periodic exam records, and an event log with explicit per-indicator impact parameters. Each indicator follows a baseline stochastic process driven by discrete events with sigmoid-onset, exponential-decay kernels under saturation and projection constraints; a hybrid pipeline delegates sparse semantic artifacts to LLM-based planning and dense indicator dynamics to algorithmic simulation with hard physiological bounds. Users are each paired with 100 evaluation queries across five dimensions - Lookup, Trend, Comparison, Anomaly, Explanation - stratified into Easy, Medium, and Hard tiers, with all ground-truth answers programmatically computable from the recorded event-indicator relationships. Evaluating 13 methods spanning LLMs with tools, DB-native agents, and memory-augmented RAG, we find that DB agents (48-58%) substantially outperform memory RAG baselines (30-38%), with the gap concentrated on Comparison and Explanation queries where multi-hop reasoning and evidence attribution are required.

Automated radiology report generation offers an effective solution to alleviate radiologists' workload. However, most existing methods focus primarily on single or fixed-view images to model current disease conditions, which limits diagnostic accuracy and overlooks disease progression. Although some approaches utilize longitudinal data to track disease progression, they still rely on single images to analyze current visits. To address these issues, we propose enhanced contrastive learning with Multi-view Longitudinal data to facilitate chest X-ray Report Generation, named MLRG. Specifically, we introduce a multi-view longitudinal contrastive learning method that integrates spatial information from current multi-view images and temporal information from longitudinal data. This method also utilizes the inherent spatiotemporal information of radiology reports to supervise the pre-training of visual and textual representations. Subsequently, we present a tokenized absence encoding technique to flexibly handle missing patient-specific prior knowledge, allowing the model to produce more accurate radiology reports based on available prior knowledge. Extensive experiments on MIMIC-CXR, MIMIC-ABN, and Two-view CXR datasets demonstrate that our MLRG outperforms recent state-of-the-art methods, achieving a 2.3% BLEU-4 improvement on MIMIC-CXR, a 5.5% F1 score improvement on MIMIC-ABN, and a 2.7% F1 RadGraph improvement on Two-view CXR.

We propose a computationally efficient inferential procedure for longitudinal function-on-function regression. The method follows a marginal three-step approach: (1) fit massive pointwise longitudinal scalar-on-function regression models, (2) smooth the resulting estimates along the bivariate functional domain, and (3) compute confidence bands using either an analytic approach for Gaussian data or a cluster bootstrap for Gaussian or non-Gaussian data. Simulation studies demonstrate that the proposed method achieves accurate estimation and valid inference, while substantially reducing computational burden compared to existing approaches. Methods are motivated by a physical activity intervention trial in older adults where high-dimensional wearable data were collected longitudinally across multiple visits. Our applications reveal significant increases in physical activity in the morning using interpersonal intervention strategies, but not intrapersonal strategies. The proposed methods are implemented in an R package.

Objective: Data unavailability has been one of the biggest barriers in clinical natural language processing. This paper is aimed at providing a large-scale and publicly available patient note dataset, named PMC-Patients, with relevant articles and similar patients annotations. The ultimate goal of PMC-Patients is to facilitate the development of retrieval-based clinical decision support systems. Materials and Methods: To collect PMC-Patients, we extract patient notes from case reports in PubMed Central by recognizing certain section patterns. Patient-article relevance and patient-patient similarity are annotated by citation relationships in PubMed. In addition, we perform three tasks with PMC-Patients to demonstrate its utility in providing clinical decision support for a given patient, including (1) classifying whether another patient is similar, (2) retrieving similar patients in PMC-Patients, and (3) retrieving relevant articles in PubMed. Results: We collect and release PMC-Patients under the CC BY-NC-SA license, which becomes the largest publicly available patient note dataset so far. PMC-Patients contains 167k patient notes that are annotated with 3.1M relevant articles and 293k similar patients. Qualitative and quantitative analyses reveal the high quality and richness of our dataset. Experiments show that classifying the similarity of patient pairs is relatively easy, but it is hard to retrieve similar patients or relevant articles for a given patient from a large set of candidates. Conclusion: We present PMC-Patients, a large-scale dataset of patient notes with high quality, easy access, diverse conditions, and rich annotations. The proposed dataset can also serve as a hard benchmark for evaluating retrieval-based clinical decision support systems.

In recent years, large language models have shown substantial potential in psychological support tasks. However, existing psychological counseling data mostly rely on single-turn question answering or short multi-turn dialogues, making it difficult to characterize how college students' psychological distress accumulates, interacts, and gradually evolves over long periods within campus life events. To address this issue, this paper proposes Psy-Chronicle, a structured data-generation framework for synthesizing long-horizon campus psychological counseling dialogues. We generate a semester-spanning temporal stress event graph to model the chronological order and evolutionary dependencies among campus stress events. Through interactive simulation between a student agent and a counselor agent, together with a structured memory integration mechanism, Psy-Chronicle generates long-horizon dialogues with continuity across counseling sessions. Based on Psy-Chronicle, we construct and open-source CPCD, a Chinese long-horizon dialogue dataset for college psychological counseling, containing 100 student profiles, 90,000 counseling dialogues. We further build CPCD-Bench to evaluate models' long-horizon campus counseling capabilities from three dimensions: session-level response, long-horizon memory recall, and temporal-causal reasoning. Experimental results show that CPCD effectively improves session-level response generation and long-horizon memory recall for models with the same base architecture. Meanwhile, improvements in temporal-causal reasoning remain limited, indicating that event-chain organization and causal explanation are key challenges in long-horizon psychological counseling modeling. The related code and data are available at: https://github.com/EdwinUSTB/Psy-Chronicle

Large language models (LLMs) are entering legal workflows, yet we lack a jurisdiction-specific framework to assess their baseline competence therein. We use India's public legal examinations as a transparent proxy. Our multi-year benchmark assembles objective screens from top national and state exams and evaluates open and frontier LLMs under real-world exam conditions. To probe beyond multiple-choice questions, we also include a lawyer-graded, paired-blinded study of long-form answers from the Supreme Court's Advocate-on-Record exam. This is, to our knowledge, the first exam-grounded, India-specific yardstick for LLM court-readiness released with datasets and protocols. Our work shows that while frontier systems consistently clear historical cutoffs and often match or exceed recent top-scorer bands on objective exams, none surpasses the human topper on long-form reasoning. Grader notes converge on three reliability failure modes: procedural or format compliance, authority or citation discipline, and forum-appropriate voice and structure. These findings delineate where LLMs can assist (checks, cross-statute consistency, statute and precedent lookups) and where human leadership remains essential: forum-specific drafting and filing, procedural and relief strategy, reconciling authorities and exceptions, and ethical, accountable judgment.

We present eCream-MedCorpus, a new and unique large-scale dataset of clinical notes produced in Emergency Departments of Italian hospitals. The corpus, in its current version, is composed of approximately 4 million clinical notes fully anonymized, covering diverse phases of patient care during the stay in the emergency department. In addition, a subset of about six thousand notes has been manually annotated by clinical experts through a structured Case Report Form (CRF) containing 132 items relevant for two patient situations in emergency departments, dyspnea and loss of consciousness. Items may assume numerical values (e.g., for blood saturation), categorical (e.g., for level of consciousness ), binary (e.g., for presence of traumas), and mixed value types. The annotation process involved multiple clinicians and underwent iterative revision to resolve ambiguities in item formulation, resulting in a richly structured (although high imbalanced) resource. The dataset aims to fill a relevant gap of data able to support both the development and the use of Large Language Models in concrete medical applications. We describe the data collection protocol, the on-site anonymisation pipeline, corpus statistics, and the annotation scheme. Finally, we propose CRF-filling as a novel structured information extraction benchmark, and provide zero-shot baseline resulting from Gemma-27B and MedGemma-27B. To the best of our knowledge, eCream-MedCorpus is the largest freely available dataset of clinical notes existing for the Italian language.

Summarization of clinical narratives is a long-standing research problem. Here, we introduce the task of hospital-course summarization. Given the documentation authored throughout a patient's hospitalization, generate a paragraph that tells the story of the patient admission. We construct an English, text-to-text dataset of 109,000 hospitalizations (2M source notes) and their corresponding summary proxy: the clinician-authored "Brief Hospital Course" paragraph written as part of a discharge note. Exploratory analyses reveal that the BHC paragraphs are highly abstractive with some long extracted fragments; are concise yet comprehensive; differ in style and content organization from the source notes; exhibit minimal lexical cohesion; and represent silver-standard references. Our analysis identifies multiple implications for modeling this complex, multi-document summarization task.

Long-term memory has become increasingly important for LLM agents that operate across extended interactions and evolving task contexts. Recent memory systems have made past experiences more persistent, compact, and retrievable, but retrieval alone does not ensure that a memory provides valid evidence for the current query. When experiences are compressed into reusable fragments, memories from different situations may appear equally relevant if they involve recurring entities or user states. We refer to this failure as context collapse: memories lose the surrounding context needed to judge whether they provide valid evidence for the current query. To address this problem, we propose Contextual Reinstatement for Agentic Memory (RaMem), a framework that turns retrieved memory fragments into contextually verifiable evidence. RaMem operates through four coordinated stages: (i) evidence anchoring grounds each memory in its original episodic conditions, especially event time, mention time, session span, and participants; (ii) recall condition induction derives the evidence conditions implied by the query; (iii) validity-aware retrieval uses these conditions to prioritize context-compatible memories while retaining content-relevant candidates as fallback evidence; and (iv) context-preserved synthesis keeps the selected memories' structured context available to the generator. Experiments on long-term memory benchmarks show that RaMem consistently improves performance over strong memory baselines, with average F1 gains of more than 10% across several backbones.

Recent incidents involving LLMs used for mental-health support reveal a critical evaluation gap: surface-level safety scores do not capture how models behave across realistic, emotionally sensitive interactions over time. Existing benchmarks measure knowledge, safety, or static response quality, but miss whether LLM interactions help users keep reflecting, coping, and making decisions themselves. We formalize this missing dimension as COGNITIVE ATROPHY, a process-level behavioural measure in AI-mediated mental-health support distinct from safety and helpfulness. To measure it, we introduce COGNITIVE ATROPHY BENCH, a clinically grounded benchmark built from 1,576 fully human-generated counseling conversations, 15,680 turns, and 42,230 responses from five LLMs. Three clinical and neuropsychology experts developed a 20-attribute schema spanning user context, response behaviour, and global risk flags; six trained clinical reviewers applied it with span-grounded evidence, producing 5,324 reviewer judgments. We further introduce the User-Input Risk Index (UIRI), the Cognitive Atrophy Risk Index (ARI), and trajectory summaries. Across five LLMs, models show a consistent moderate-to-high level of atrophy-aligned behaviour across single and multi-turn settings. While models generally respond to overt safety cues, they adapt less reliably when users seek solutions or decisions. The dominant recurring patterns are directive advice, problem-solving, recommendation responses, topic shifts, and forms of validation that may reinforce dependence rather than reflection. Our work makes COGNITIVE ATROPHY measurable and provides a foundation for auditing model behaviour in sensitive LLM conversations.

Long-term memory remains a structural weakness of AI agents. The dominant approach, retrieval-augmented generation (RAG), relies on embedding-based similarity search, which is opaque by construction, difficult to audit, and bounded by the theoretical limits of vector representations. We present the Memory-Orchestrated Semantic System (MOSS), an agentic memory architecture in which the agent drives retrieval over a structured relational database. MOSS is model-agnostic, storage-agnostic, and API-agnostic: it runs on any relational engine, connects to any LLM provider (or to deterministic non-LLM processes), and deploys on any infrastructure, local or cloud. Its retrieval execution is symbolic and reproducible (once a query is formulated, no LLM participates in the retrieval loop) and every step of the system, from indexing to answer formulation, is logged and inspectable, making MOSS auditable by construction. Rather than imposing an external ontology, MOSS derives its conceptual vocabulary from the corpus itself. We report on a longitudinal deployment unique in the agentic-memory literature: a year of continuous production over an individual scholar's working corpus--a conversational corpus reaching back to October 2024 (some 44 million tokens, retroactively indexed) comprising 110,183 segments, alongside 163,494 catalogued documents, 569 inductively derived concepts, 322,662 concept annotations, and eleven metadata graphs totaling approximately five million relations--across four successive infrastructure generations. While the present case is that of a single researcher, the architecture is in no way specific to one person: it serves a team, an institution, or any entity that accumulates knowledge over time. We argue that auditable, sovereign, structurally unbounded memory is a precondition for AI agents intended to accompany a person or an organization over years rather than sessions.

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

Interrogating the evolution of biological changes at early stages of life requires longitudinal profiling of molecules, such as DNA methylation, which can be challenging with children. We introduce a probabilistic and longitudinal machine learning framework based on multi-mean Gaussian processes (GPs), accounting for individual and gene correlations across time. This method provides future predictions of DNA methylation status at different individual ages while accounting for uncertainty. Our model is trained on a birth cohort of children with methylation profiled at ages 0-4, and we demonstrated that the status of methylation sites for each child can be accurately predicted at ages 5-7. We show that methylation profiles predicted by multi-mean GPs can be used to estimate other phenotypes, such as epigenetic age, and enable comparison to other health measures of interest. This approach encourages epigenetic studies to move towards longitudinal design for investigating epigenetic changes during development, ageing and disease progression.

Emotional states, as indicators of affect, are pivotal to overall health, making their accurate prediction before onset crucial. Current studies are primarily centered on immediate short-term affect detection using data from wearable and mobile devices. These studies typically focus on objective sensory measures, often neglecting other forms of self-reported information like diaries and notes. In this paper, we propose a multimodal deep learning model for affect status forecasting. This model combines a transformer encoder with a pre-trained language model, facilitating the integrated analysis of objective metrics and self-reported diaries. To validate our model, we conduct a longitudinal study, enrolling college students and monitoring them over a year, to collect an extensive dataset including physiological, environmental, sleep, metabolic, and physical activity parameters, alongside open-ended textual diaries provided by the participants. Our results demonstrate that the proposed model achieves predictive accuracy of 82.50% for positive affect and 82.76% for negative affect, a full week in advance. The effectiveness of our model is further elevated by its explainability.

Following each patient visit, physicians draft long semi-structured clinical summaries called SOAP notes. While invaluable to clinicians and researchers, creating digital SOAP notes is burdensome, contributing to physician burnout. In this paper, we introduce the first complete pipelines to leverage deep summarization models to generate these notes based on transcripts of conversations between physicians and patients. After exploring a spectrum of methods across the extractive-abstractive spectrum, we propose Cluster2Sent, an algorithm that (i) extracts important utterances relevant to each summary section; (ii) clusters together related utterances; and then (iii) generates one summary sentence per cluster. Cluster2Sent outperforms its purely abstractive counterpart by 8 ROUGE-1 points, and produces significantly more factual and coherent sentences as assessed by expert human evaluators. For reproducibility, we demonstrate similar benefits on the publicly available AMI dataset. Our results speak to the benefits of structuring summaries into sections and annotating supporting evidence when constructing summarization corpora.

Exam-style accuracy does not establish whether large language models (LLMs) reason well over clinical records. We define clinical reasoning as integrating and updating evidence across time and sources to form, revise and justify a patient's problem representation and a defensible plan. This structured narrative review maps three literatures: medical education assessment instruments, clinical LLM benchmarks published from 2023 onwards, and general-domain methods for evaluating long-form generation. We examine six dimensions: problem representation, temporal synthesis, differential and management reasoning, counterfactual reasoning, calibrated uncertainty, and reasoning faithfulness. Preprints are included and flagged. No single instrument covers all six dimensions. Problem representation and differential or management reasoning are reasonably covered, although reliability varies by instrument and setting. TIMER-Eval targets temporal synthesis, and ER-Reason assesses sequential diagnostic belief updating. Dedicated uncertainty and counterfactual evaluations are emerging, but their applicability to longitudinal free-text reasoning remains limited. Factual completeness is well theorised in general-domain evaluation, with early clinical evidence of important omissions. Faithfulness remains the weakest dimension, with one identified clinical causal-ablation study on multiple-choice questions. Existing tools should be combined through binary rubric items, separate completeness and correctness scores, case-specific importance weighting with non-compensable safety caps, temporal order-consistency checks, and chance-corrected reliability reporting. Further design work is needed for calibrated uncertainty, counterfactual reasoning and faithfulness over longitudinal free-text records. This review provides a design rationale, not a validated instrument.

The rise of deep learning technologies has quickly advanced many fields, including that of generative music systems. There exist a number of systems that allow for the generation of good sounding short snippets, yet, these generated snippets often lack an overarching, longer-term structure. In this work, we propose CM-HRNN: a conditional melody generation model based on a hierarchical recurrent neural network. This model allows us to generate melodies with long-term structures based on given chord accompaniments. We also propose a novel, concise event-based representation to encode musical lead sheets while retaining the notes' relative position within the bar with respect to the musical meter. With this new data representation, the proposed architecture can simultaneously model the rhythmic, as well as the pitch structures in an effective way. Melodies generated by the proposed model were extensively evaluated in quantitative experiments as well as a user study to ensure the musical quality of the output as well as to evaluate if they contain repeating patterns. We also compared the system with the state-of-the-art AttentionRNN. This comparison shows that melodies generated by CM-HRNN contain more repeated patterns (i.e., higher compression ratio) and a lower tonal tension (i.e., more tonally concise). Results from our listening test indicate that CM-HRNN outperforms AttentionRNN in terms of long-term structure and overall rating.

The rising global prevalence of mental health conditions, together with longstanding barriers in traditional healthcare, such as limited resources, high cost, stigma, and privacy concerns, has created an urgent need for accessible and scalable support. Large Language Models (LLMs) have emerged as a transformative technology with strong potential to democratize mental health support through advanced natural language understanding and generation. However, the rapidly expanding, fragmented body of work in this area lacks a coherent evolutionary narrative, making it difficult to contextualize current progress and identify future directions. This survey addresses this gap by organizing and analyzing the literature around a central thesis: the role of LLMs in mental health is evolving through three distinct, increasingly sophisticated phases. We trace this trajectory from Phase I, in which LLMs act primarily as passive Information Tools and Pattern Recognizers for assessment; through Phase II, where they function as Empathetic Conversationalists for in-the-moment, stateless interactions; to the current frontier, Phase III, which seeks Longitudinal, Personalized Companions implemented as stateful cognitive agents. To support this framework, we systematically review core technologies, agent architectures (Profile, Memory, Reasoning, and Planning), and the critical infrastructure of datasets and benchmarks, highlighting how their evolution underpins this developmental path. Viewing the field through this developmental lens, we provide a comprehensive synthesis of existing work, an insightful narrative of its trajectory, and a clear roadmap for future innovation in responsible, effective, and human-centered AI for mental healthcare. A curated collection of the resources reviewed in this survey is available at our project repository: https://github.com/Emo-gml/Awesome-Mental-Health-LLMs.

Chest Xray imaging is a widely used diagnostic tool in modern medicine, and its high utilization creates substantial workloads for radiologists. To alleviate this burden, vision language models are increasingly applied to automate Chest Xray radiology report generation (CXRRRG), aiming for clinically accurate descriptions while reducing manual effort. Conventional approaches, however, typically rely on single images, failing to capture the longitudinal context necessary for producing clinically faithful comparison statements. Recently, growing attention has been directed toward incorporating longitudinal data into CXR RRG, enabling models to leverage historical studies in ways that mirror radiologists diagnostic workflows. Nevertheless, existing surveys primarily address single image CXRRRG and offer limited guidance for longitudinal settings, leaving researchers without a systematic framework for model design. To address this gap, this survey provides the first comprehensive review of longitudinal radiology report generation (LRRG). Specifically, we examine dataset construction strategies, report generation architectures alongside longitudinally tailored designs, and evaluation protocols encompassing both longitudinal specific measures and widely used benchmarks. We further summarize LRRG methods performance, alongside analyses of different ablation studies, which collectively highlight the critical role of longitudinal information and architectural design choices in improving model performance. Finally, we summarize five major limitations of current research and outline promising directions for future development, aiming to lay a foundation for advancing this emerging field.

Clinical notes in Electronic Health Records (EHR) present rich documented information of patients to inference phenotype for disease diagnosis and study patient characteristics for cohort selection. Unsupervised user embedding aims to encode patients into fixed-length vectors without human supervisions. Medical concepts extracted from the clinical notes contain rich connections between patients and their clinical categories. However, existing unsupervised approaches of user embeddings from clinical notes do not explicitly incorporate medical concepts. In this study, we propose a concept-aware unsupervised user embedding that jointly leverages text documents and medical concepts from two clinical corpora, MIMIC-III and Diabetes. We evaluate user embeddings on both extrinsic and intrinsic tasks, including phenotype classification, in-hospital mortality prediction, patient retrieval, and patient relatedness. Experiments on the two clinical corpora show our approach exceeds unsupervised baselines, and incorporating medical concepts can significantly improve the baseline performance.

LLM-based simulated clients are increasingly used to train novice counselors, evaluate LLM therapists, and generate synthetic data. However, current simulators produce overly cooperative clients that disclose too readily, accept therapeutic reframes without resistance, and resolve core issues within a single session. We trace these issues to profiles that lack causal depth and behavioral mechanisms that treat all content as equally accessible. We present PatientAct, a framework for client simulation grounded in established clinical theories. Our profiles integrate the 5Ps clinical case formulation, providing causal depth without tying the design to any single therapeutic modality. During simulation, profiles include a dynamic memory layer in which items carry trust thresholds (e.g., symptoms are available early, whereas formative memories require a sustained therapeutic alliance). At each turn, the client's emotional reaction and behavior are modeled before generating a response. If the therapist approaches gated content, PatientAct expresses resistance in terms of quantity, content, and style rather than defaulting to cooperation or a single resistance pattern. We evaluate our framework on 40 clinical situations and demonstrate that it generates diverse profiles with high clinical plausibility. Moreover, PatientAct significantly outperforms the baselines, yielding substantial gains in resistance quality and behavioral realism. Our code and data will be publicly available via github.com/Sahandfer/PatientHub.

Large language models (LLMs) are increasingly relied upon to support ambient documentation and clinical reasoning. Here we examine the impact of a failure mode shared between these two applications by assessing their sensitivity to information incidental to the patient encounter. In 576 patient-clinician dialogues, we found that frontier models inserted small-talk exchanges into 35% of notes, while mean quality scores changed by at most 0.20 points on five-point scales. In 3.7% of frontier notes, models misattributed the asides or used them clinically. In 57 mock recorded consultations, background speech from a separate patient encounter at -10 dB leaked into 48.2% of transcripts, with contamination detected in 5.3% of downstream notes generated by four open-weight models. We propose a dual encoding hypothesis of clinical reasoning and distraction in LLMs, with preliminary evidence that LLM components associated with disruption by incidental information also support clinical reasoning. These findings support evaluating resistance to incidental information before clinical use, with safeguards that prevent contamination while preserving clinical reasoning.

Many empirical studies of labor market questions rely on estimating relatively simple predictive models using small, carefully constructed longitudinal survey datasets based on hand-engineered features. Large Language Models (LLMs), trained on massive datasets, encode vast quantities of world knowledge and can be used for the next job prediction problem. However, while an off-the-shelf LLM produces plausible career trajectories when prompted, the probability with which an LLM predicts a particular job transition conditional on career history will not, in general, align with the true conditional probability in a given population. Recently, Vafa et al. (2024) introduced a transformer-based "foundation model", CAREER, trained using a large, unrepresentative resume dataset, that predicts transitions between jobs; it further demonstrated how transfer learning techniques can be used to leverage the foundation model to build better predictive models of both transitions and wages that reflect conditional transition probabilities found in nationally representative survey datasets. This paper considers an alternative where the fine-tuning of the CAREER foundation model is replaced by fine-tuning LLMs. For the task of next job prediction, we demonstrate that models trained with our approach outperform several alternatives in terms of predictive performance on the survey data, including traditional econometric models, CAREER, and LLMs with in-context learning, even though the LLM can in principle predict job titles that are not allowed in the survey data. Further, we show that our fine-tuned LLM-based models' predictions are more representative of the career trajectories of various workforce subpopulations than off-the-shelf LLM models and CAREER. We conduct experiments and analyses that highlight the sources of the gains in the performance of our models for representative predictions.

Community-based fact-checking can reduce the spread of annotated misleading posts, but whether it produces lasting behavioral change among corrected authors remains unclear. Here, we conduct a large-scale quasi-experimental study of the Community Notes system on X (formerly Twitter), tracking four weeks of activity before and after note display for 19,854 accounts and 57,935 corrections (noted posts and matched controls), covering 11,909,591 original posts. Difference-in-Differences estimates show that note display is followed by an average 2.9% increase in corrected accounts' original-post activity. This aggregate conceals two divergent trajectories. Accounts corrected only once reduce their activity by 2.4% and subsequently publish less toxic and less misleading content. Repeatedly corrected accounts, which constitute 28.6% of corrected accounts but produce 73.4% of fact-checked posts, instead increase their activity by 4.4% after their first correction and show no detectable response to later ones. They exhibit no comparable content improvement, and instead publish more highly misleading posts, cite lower-quality domains, and post more political content. Community notes can thus constrain individual misleading posts without durably improving the behavior of the accounts most responsible for them, indicating that correcting content and changing its producers are distinct objectives for platform design.

The impact of person-job fit on job satisfaction and performance is widely acknowledged, which highlights the importance of providing workers with next steps at the right time in their career. This task of predicting the next step in a career is known as career path prediction, and has diverse applications such as turnover prevention and internal job mobility. Existing methods to career path prediction rely on large amounts of private career history data to model the interactions between job titles and companies. We propose leveraging the unexplored textual descriptions that are part of work experience sections in resumes. We introduce a structured dataset of 2,164 anonymized career histories, annotated with ESCO occupation labels. Based on this dataset, we present a novel representation learning approach, CareerBERT, specifically designed for work history data. We develop a skill-based model and a text-based model for career path prediction, which achieve 35.24% and 39.61% recall@10 respectively on our dataset. Finally, we show that both approaches are complementary as a hybrid approach achieves the strongest result with 43.01% recall@10.

Large language models (LLMs) offer a scalable approach to social simulation, but their credibility depends on how agents are constructed. Existing methods can partially reproduce population-level patterns, yet often fail to capture human-like diversity. Our analysis shows that static-profile agents exhibit stronger demographic separation and within-group compression than humans, a pattern consistent with identity essentialism: demographic labels can encourage models to treat group-average tendencies as individual traits, homogenizing responses within groups. We argue that this limitation arises from two related factors: sparse, static agent representations and the limited ability of prompt-only memory to persistently integrate experience. Inspired by complementary memory systems, we propose LifeMem, a longitudinal memory framework that combines structured life-event retrieval with agent-specific parametric memory for experience integration. Experiments on Add Health and Understanding Society with three LLMs show that LifeMem improves alignment with human data in terms of response distributions, overall and within-group diversity, and patterns of within-person response change across life stages. These findings highlight the value of longitudinal life-event memory for constructing more faithful and dynamically evolving social agents.

The development of large language models tailored for handling patients' clinical notes is often hindered by the limited accessibility and usability of these notes due to strict privacy regulations. To address these challenges, we first create synthetic large-scale clinical notes using publicly available case reports extracted from biomedical literature. We then use these synthetic notes to train our specialized clinical large language model, Asclepius. While Asclepius is trained on synthetic data, we assess its potential performance in real-world applications by evaluating it using real clinical notes. We benchmark Asclepius against several other large language models, including GPT-3.5-turbo and other open-source alternatives. To further validate our approach using synthetic notes, we also compare Asclepius with its variants trained on real clinical notes. Our findings convincingly demonstrate that synthetic clinical notes can serve as viable substitutes for real ones when constructing high-performing clinical language models. This conclusion is supported by detailed evaluations conducted by both GPT-4 and medical professionals. All resources including weights, codes, and data used in the development of Asclepius are made publicly accessible for future research.

Longitudinal multimodal data, including electronic health records (EHR) and sequential chest X-rays (CXRs), is critical for modeling disease progression, yet remains underutilized due to two key challenges: (1) redundancy in consecutive CXR sequences, where static anatomical regions dominate over clinically-meaningful dynamics, and (2) temporal misalignment between sparse, irregular imaging and continuous EHR data. We introduce DiPro, a novel framework that addresses these challenges through region-aware disentanglement and multi-timescale alignment. First, we disentangle static (anatomy) and dynamic (pathology progression) features in sequential CXRs, prioritizing disease-relevant changes. Second, we hierarchically align these static and dynamic CXR features with asynchronous EHR data via local (pairwise interval-level) and global (full-sequence) synchronization to model coherent progression pathways. Extensive experiments on the MIMIC dataset demonstrate that DiPro could effectively extract temporal clinical dynamics and achieve state-of-the-art performance on both disease progression identification and general ICU prediction tasks.

Digitized musical heritage collections offer new opportunities to examine how stylistic traditions change over historical time, but computational analyses often reduce musical works to static classifications or similarity scores. This article proposes a representation-to-dynamics framework for studying cross-cultural harmonic change in Western art music. Starting from symbolic chord sequences, we derive contextual chord embeddings, project work-level representations into a shared harmonic space, and reconstruct country-level trajectories through temporally causal Kalman filtering. These trajectories are then modeled with DeGroot and Friedkin--Johnsen dynamics, yielding interpretable influence-like networks and estimates of stylistic anchoring. We apply the framework to a curated corpus of 480 dated works from 1875 to 1940 across Russia, France, Germany, Austria, and a heterogeneous ''Others'' group. Models fitted on 1875--1925 are evaluated through recursive forecasts for 1930--1940, testing whether the estimated dependency structure remains informative across a potentially changing historical and stylistic regime. The estimated trajectories and influence patterns are broadly consistent with established music-historical accounts of late Romantic and early modernist exchange, including the close relationship between German and Austrian traditions and historically plausible cross-currents between Russian and French traditions. PCA-variance-weighted estimation provides modest improvements while preserving a single interpretable influence network. Rather than treating the estimated matrices as direct causal evidence, the framework offers a reproducible quantitative layer for cultural heritage research, complementing archival and musicological interpretation.

Long-term memory is crucial for agents in specialized web environments, where success depends on recalling interface affordances, state dynamics, workflows, and recurring failure modes. However, existing memory benchmarks for agents mostly focus on user histories, short traces, or downstream task success, leaving open how to directly evaluate whether memory systems effectively internalize environment-specific experience. To address this gap, we introduce LongMemEval-V2 (LME-V2), a benchmark for evaluating whether memory systems can help agents acquire the experience needed to become knowledgeable colleagues in customized environments. LME-V2 contains 451 manually curated questions covering five core memory abilities for web agents: static state recall, dynamic state tracking, workflow knowledge, environment gotchas, and premise awareness. Questions are paired with history trajectories containing up to 500 trajectories and 115M tokens. We use a context gathering formulation: memory systems consume history trajectories and return compact evidence for downstream question answering. We propose a suite of two memory methods: AgentRunbook-R, an efficient RAG-based memory with knowledge pools for raw state observations, events, and strategy notes, and AgentRunbook-C, which stores trajectories as files and invokes a coding agent to gather evidence in an augmented sandbox. Experiments show that AgentRunbook-C achieves the best performance with 72.5% average accuracy, outperforming the strongest RAG baseline (48.5%) and the off-the-shelf coding agent baseline (69.3%). Despite the strong performance gains, coding agent based methods have high latency costs. While AgentRunbook-C advances the accuracy-latency Pareto frontier, substantial room for improvement remains. Together, these results establish LME-V2 as a challenging testbed for developing long-term memory systems for environment experience.

We here summarize our experience running a challenge with open data for musical genre recognition. Those notes motivate the task and the challenge design, show some statistics about the submissions, and present the results.

Understanding whether and to what extent large language models (LLMs) have memorised training data has important implications for the reliability of their output and the privacy of their training data. In order to cleanly measure and disentangle memorisation from other phenomena (e.g. in-context learning), we create an experimental framework that is based on repeatedly exposing LLMs to random strings. Our framework allows us to better understand the dynamics, i.e., the behaviour of the model, when repeatedly exposing it to random strings. Using our framework, we make several striking observations: (a) we find consistent phases of the dynamics across families of models (Pythia, Phi and Llama2), (b) we identify factors that make some strings easier to memorise than others, and (c) we identify the role of local prefixes and global context in memorisation. We also show that sequential exposition to different random strings has a significant effect on memorisation. Our results, often surprising, have significant downstream implications in the study and usage of LLMs.

Accurate segmentation of Multiple Sclerosis (MS) lesions in longitudinal MRI scans is crucial for monitoring disease progression and treatment efficacy. Although changes across time are taken into account when assessing images in clinical practice, most existing deep learning methods treat scans from different timepoints separately. Among studies utilizing longitudinal images, a simple channel-wise concatenation is the primary albeit suboptimal method employed to integrate timepoints. We introduce a novel approach that explicitly incorporates temporal differences between baseline and follow-up scans through a unique architectural inductive bias called Difference Weighting Block. It merges features from two timepoints, emphasizing changes between scans. We achieve superior scores in lesion segmentation (Dice Score, Hausdorff distance) as well as lesion detection (lesion-level F_1 score) as compared to state-of-the-art longitudinal and single timepoint models across two datasets. Our code is made publicly available at www.github.com/MIC-DKFZ/Longitudinal-Difference-Weighting.

Chest X-Ray (CXR) report generation is a promising approach to improving the efficiency of CXR interpretation. However, a significant increase in diagnostic accuracy is required before that can be realised. Motivated by this, we propose a framework that is more inline with a radiologist's workflow by considering longitudinal data. Here, the decoder is additionally conditioned on the report from the subject's previous imaging study via a prompt. We also propose a new reward for reinforcement learning based on CXR-BERT, which computes the similarity between reports. We conduct experiments on the MIMIC-CXR dataset. The results indicate that longitudinal data improves CXR report generation. CXR-BERT is also shown to be a promising alternative to the current state-of-the-art reward based on RadGraph. This investigation indicates that longitudinal CXR report generation can offer a substantial increase in diagnostic accuracy. Our Hugging Face model is available at: https://huggingface.co/aehrc/cxrmate and code is available at: https://github.com/aehrc/cxrmate.

Continuity of care is crucial to ensuring positive health outcomes for patients discharged from an inpatient hospital setting, and improved information sharing can help. To share information, caregivers write discharge notes containing action items to share with patients and their future caregivers, but these action items are easily lost due to the lengthiness of the documents. In this work, we describe our creation of a dataset of clinical action items annotated over MIMIC-III, the largest publicly available dataset of real clinical notes. This dataset, which we call CLIP, is annotated by physicians and covers 718 documents representing 100K sentences. We describe the task of extracting the action items from these documents as multi-aspect extractive summarization, with each aspect representing a type of action to be taken. We evaluate several machine learning models on this task, and show that the best models exploit in-domain language model pre-training on 59K unannotated documents, and incorporate context from neighboring sentences. We also propose an approach to pre-training data selection that allows us to explore the trade-off between size and domain-specificity of pre-training datasets for this task.

Clinical notes contain rich data, which is unexploited in predictive modeling compared to structured data. In this work, we developed a new text representation Clinical XLNet for clinical notes which also leverages the temporal information of the sequence of the notes. We evaluated our models on prolonged mechanical ventilation prediction problem and our experiments demonstrated that Clinical XLNet outperforms the best baselines consistently.

Spoken conversational systems must recover information from prior interactions (i.e., memory), yet relevant information in speech extends beyond what was said to who said it, how it was spoken, and what was audible, information that exists only in the audio signal and cannot be recovered from a transcript. Beyond what to remember, memory also demands diverse operations: retrieving a single fact, integrating evidence across turns, tracking an evolving state. Real interactions further unfold across sessions, meaning information accumulates across distinct episodes rather than a single continuous recording. Existing benchmarks fall short on all three dimensions: they focus primarily on lexical content, adopt limited and ad hoc memory operations, and treat memory as a single-session problem. We argue that principled memory evaluation requires jointly characterizing the acoustic evidence to be retained and the operations applied to it, and introduce a taxonomy along these two axes. Building on this taxonomy, we present VoxMem: 3,196 evaluation instances over 34,743 spoken sessions (177 hours) crossing four acoustic evidence types (speech semantics, speaker identity, paralinguistic cues, environmental sound) with four memory operations (information extraction, multi-session reasoning, temporal tracking, and answer refusal), grounded in multi-session histories and stratified across context budgets from 8K to 64K tokens. Evaluating 15 LALMs, no model exceeds 40% at 32K. Models retain what was said far better than who said it, how, or what was audible, a gap that widens for complex operations, grows with history length, and manifests as qualitatively distinct failure modes across evidence types. VoxMem aims to provide a foundation to measure and drive progress on the full scope of spoken conversational memory.

A widely held hypothesis for why generative recommendation (GR) models outperform conventional item ID-based models is that they generalize better. However, there is few systematic way to verify this hypothesis beyond a superficial comparison of overall performance. To address this gap, we categorize each data instance based on the specific capability required for a correct prediction: either memorization (reusing item transition patterns observed during training) or generalization (composing known patterns to predict unseen item transitions). Extensive experiments show that GR models perform better on instances that require generalization, whereas item ID-based models perform better when memorization is more important. To explain this divergence, we shift the analysis from the item level to the token level and show that what appears to be item-level generalization often reduces to token-level memorization for GR models. Finally, we show that the two paradigms are complementary. We propose a simple memorization-aware indicator that adaptively combines them on a per-instance basis, leading to improved overall recommendation performance.

Music generation has generally been focused on either creating scores or interpreting them. We discuss differences between these two problems and propose that, in fact, it may be valuable to work in the space of direct it performance generation: jointly predicting the notes it and it also their expressive timing and dynamics. We consider the significance and qualities of the data set needed for this. Having identified both a problem domain and characteristics of an appropriate data set, we show an LSTM-based recurrent network model that subjectively performs quite well on this task. Critically, we provide generated examples. We also include feedback from professional composers and musicians about some of these examples.

A common expectation is that career productivity peaks rather early and then gradually declines with seniority. But whether this holds true is still an open question. Here we investigate the productivity trajectories of almost 8,500 scientists from over fifty disciplines using methods from time series analysis, dimensionality reduction, and network science, showing that there exist six universal productivity patterns in research. Based on clusters of productivity trajectories and network representations where researchers with similar productivity patterns are connected, we identify constant, u-shaped, decreasing, periodic-like, increasing, and canonical productivity patterns, with the latter two describing almost three-fourths of researchers. In fact, we find that canonical curves are the most prevalent, but contrary to expectations, productivity peaks occur much more frequently around mid-career rather than early. These results outline the boundaries of possible career paths in science and caution against the adoption of stereotypes in tenure and funding decisions.

Understanding memorisation in language models has practical and societal implications, e.g., studying models' training dynamics or preventing copyright infringements. Prior work defines memorisation as the causal effect of training with an instance on the model's ability to predict that instance. This definition relies on a counterfactual: the ability to observe what would have happened had the model not seen that instance. Existing methods struggle to provide computationally efficient and accurate estimates of this counterfactual. Further, they often estimate memorisation for a model architecture rather than for a specific model instance. This paper fills an important gap in the literature, proposing a new, principled, and efficient method to estimate memorisation based on the difference-in-differences design from econometrics. Using this method, we characterise a model's memorisation profile--its memorisation trends across training--by only observing its behaviour on a small set of instances throughout training. In experiments with the Pythia model suite, we find that memorisation (i) is stronger and more persistent in larger models, (ii) is determined by data order and learning rate, and (iii) has stable trends across model sizes, thus making memorisation in larger models predictable from smaller ones.

As AI companions increasingly mediate repeated social interaction, users may rely on a stable role and shared history, yet locally acceptable replies do not ensure that either persists. We study two observable long-horizon failures: 'persona collapse', the loss of a deployed role, boundaries, values, or style, and 'behavioral drift', the gradual or recurrent erosion of those properties. We introduce ANCHOR, a controlled synthetic audit that separately measures persona enactment and trajectory recall. The study contains 2,008 conversations spanning 27 personas, nine interaction schedules, three generated memory settings, and four evaluated models. The Identity Probe combines a sealed 102-item questionnaire with turn-level judgments, while the Trajectory Probe scores 110 calibrated counterfactual questions from 35 conversation banks. Our results show that no evaluated model and configuration reliably preserves either dimensions: trajectory accuracy averages only 44.4%, user-state recall remains near four-option chance, and no tested context condition or memory consistently resolves these failures. Questionnaire retention also varies by model and persona facet, disagrees with turn-level behavior, and is sensitive to evaluator choice. These results indicate that current systems do not yet reliably support long-horizon companion continuity and that audits must distinguish persona enactment, trajectory recall, evaluator provenance, and deployment context rather than collapse them into a single trust or stability score.

The widespread use of LLM-based writing assistance has raised an interesting question about the homogenization of English. As LLMs tend to revise texts toward mainstream English conventions reflected in their training data, the subtle fingerprints that reflect an author's native language (L1) may be gradually disappearing. This study investigates this phenomenon by analyzing native language identification (NLI) performance on academic abstracts. To this end, we construct two NLI datasets of academic abstracts extracted from arXiv and the ACL Anthology that covers eight native language groups across three time periods: pre-neural network (NN), pre-LLM, and post-LLM. We then evaluate NLI performance for each era using NLI classifiers obtained by fine-tuning LLMs. The results reveal a consistent decline in NLI performance over time. Notably, however, the decline is more pronounced from the pre-NN era to the pre-LLM era than from the pre-LLM era to the post-LLM era. This suggests that although academic English appears to have become increasingly homogenized in the LLM era, this homogenization did not suddenly emerge with the advent of LLMs; rather, it has progressed gradually since the emergence of neural approaches to language processing. Furthermore, a rewriting experiment using recent LLMs shows a larger NLI performance drop than the progression across eras alone, suggesting that increased LLM use may lead to further homogenization in the future.

Memorization, or the tendency of large language models (LLMs) to output entire sequences from their training data verbatim, is a key concern for safely deploying language models. In particular, it is vital to minimize a model's memorization of sensitive datapoints such as those containing personal identifiable information (PII). The prevalence of such undesirable memorization can pose issues for model trainers, and may even require discarding an otherwise functional model. We therefore seek to predict which sequences will be memorized before a large model's full train-time by extrapolating the memorization behavior of lower-compute trial runs. We measure memorization of the Pythia model suite and plot scaling laws for forecasting memorization, allowing us to provide equi-compute recommendations to maximize the reliability (recall) of such predictions. We additionally provide further novel discoveries on the distribution of memorization scores across models and data. We release all code and data necessary to reproduce the results in this paper at https://github.com/EleutherAI/pythia

Physicians spend significant time documenting clinical encounters, a burden that contributes to professional burnout. To address this, robust automation tools for medical documentation are crucial. We introduce MedSynth -- a novel dataset of synthetic medical dialogues and notes designed to advance the Dialogue-to-Note (Dial-2-Note) and Note-to-Dialogue (Note-2-Dial) tasks. Informed by an extensive analysis of disease distributions, this dataset includes over 10,000 dialogue-note pairs covering over 2000 ICD-10 codes. We demonstrate that our dataset markedly enhances the performance of models in generating medical notes from dialogues, and dialogues from medical notes. The dataset provides a valuable resource in a field where open-access, privacy-compliant, and diverse training data are scarce. Code is available at https://github.com/ahmadrezarm/MedSynth/tree/main and the dataset is available at https://huggingface.co/datasets/Ahmad0067/MedSynth.

Brief hospital course (BHC) summaries are common clinical documents generated by summarizing clinical notes. While large language models (LLMs) depict remarkable capabilities in automating real-world tasks, their capabilities for healthcare applications such as BHC synthesis have not been shown. To enable the adaptation of LLMs for BHC synthesis, we introduce a novel benchmark consisting of a pre-processed dataset extracted from MIMIC-IV notes, encapsulating clinical note, and brief hospital course (BHC) pairs. We assess the performance of two general-purpose LLMs and three healthcare-adapted LLMs to improve BHC synthesis from clinical notes. Using clinical notes as input for generating BHCs, we apply prompting-based (using in-context learning) and fine-tuning-based adaptation strategies to three open-source LLMs (Clinical-T5-Large, Llama2-13B, FLAN-UL2) and two proprietary LLMs (GPT-3.5, GPT-4). We quantitatively evaluate the performance of these LLMs across varying context-length inputs using conventional natural language similarity metrics. We further perform a qualitative study where five diverse clinicians blindly compare clinician-written BHCs and two LLM-generated BHCs for 30 samples across metrics of comprehensiveness, conciseness, factual correctness, and fluency. Overall, we present a new benchmark and pre-processed dataset for using LLMs in BHC synthesis from clinical notes. We observe high-quality summarization performance for both in-context proprietary and fine-tuned open-source LLMs using both quantitative metrics and a qualitative clinical reader study. We propose our work as a benchmark to motivate future works to adapt and assess the performance of LLMs in BHC synthesis.

Brain MRI interpretation is a longitudinal clinical reasoning problem: radiologists compare serial studies, integrate information across MRI sequences, localize findings within volumetric anatomy, and translate this evidence into report-grounded assessments. Existing medical VQA and 3D imaging benchmarks capture important parts of this workflow, but often evaluate brain MRI through isolated images, static volumes, or ungrounded report-style answers, thereby obscuring failures in the evidence chain that support clinical validity. We introduce BrainTRACE, a report-grounded benchmark for evaluating whether vision-language models can trace the evidence structure required for longitudinal brain MRI interpretation. BrainTRACE contains 7,273 scored VQA instances derived from 1,778 longitudinal patients, 7,299 MRI studies, and approximately 29k co-registered 3D MRI sequence volumes. The benchmark is organized by five levels of clinical reasoning, from acquisition recognition to case-level synthesis, and by evidence demands covering longitudinal comparison, report-grounded references, multi-sequence integration, and volumetric spatial evidence. BrainTRACE supports rendered inputs compatible with standard VLM interfaces, a 3D-evidence condition, and a decomposed case-reasoning track that audits six steps in a longitudinal evidence chain. Evaluation of 20 VLM configurations shows that current systems can identify isolated visual cues but rarely compose them into grounded longitudinal interpretations. We release the benchmark specification, evaluation lists, scoring implementation, scoring rubrics, and audit-record format to support reproducible progress in brain MRI VLM evaluation.

Transformers owe much of their strong long-context retrieval capability to a token-level memory that grows with context length. This flexibility, however, incurs a quadratic computation complexity during training and a key--value cache that grows linearly during autoregressive inference. Recurrent alternatives offer efficient decoding by compressing the entire history into a fixed-size state, but often underperform on recall-intensive tasks since earlier associations usually get overwritten by subsequent updates, and only the most recent contextual information is retained. In this paper, we introduce Memory-Anchor Routing across Context History (MARCH), a network architecture that effectively scales state-space models beyond a fixed-size dimension, while maintaining computational efficiency over long-sequences. MARCH periodically caches cumulative recurrent-state checkpoints as state anchors and associates each anchor with a compact, content-conditioned anchor key. This lets MARCH maintain a memory bank, which can grow as context length increases, providing a controllable trade-off between historical resolution and memory cost. At each token, MARCH produces an anchor query to attend all causally available state anchors, and the output is calculated as an attention-style aggregation over all historical anchors along the current state. We show that after standard pretraining, MARCH consistently outperforms multiple linear attention variants across commonsense reasoning, LongBench, and in-context retrieval. These results demonstrate that content-routed state caching substantially strengthens recurrent long-range memory while preserving its native computation path.

Advances in large language models (LLMs) provide new opportunities in healthcare for improved patient care, clinical decision-making, and enhancement of physician and administrator workflows. However, the potential of these models importantly depends on their ability to generalize effectively across clinical environments and populations, a challenge often underestimated in early development. To better understand reasons for these challenges and inform mitigation approaches, we evaluated ClinicLLM, an LLM trained on [HOSPITAL]'s clinical notes, analyzing its performance on 30-day all-cause readmission prediction focusing on variability across hospitals and patient characteristics. We found poorer generalization particularly in hospitals with fewer samples, among patients with government and unspecified insurance, the elderly, and those with high comorbidities. To understand reasons for lack of generalization, we investigated sample sizes for fine-tuning, note content (number of words per note), patient characteristics (comorbidity level, age, insurance type, borough), and health system aspects (hospital, all-cause 30-day readmission, and mortality rates). We used descriptive statistics and supervised classification to identify features. We found that, along with sample size, patient age, number of comorbidities, and the number of words in notes are all important factors related to generalization. Finally, we compared local fine-tuning (hospital specific), instance-based augmented fine-tuning and cluster-based fine-tuning for improving generalization. Among these, local fine-tuning proved most effective, increasing AUC by 0.25% to 11.74% (most helpful in settings with limited data). Overall, this study provides new insights for enhancing the deployment of large language models in the societally important domain of healthcare, and improving their performance for broader populations.

Memorization in language models is typically treated as a homogenous phenomenon, neglecting the specifics of the memorized data. We instead model memorization as the effect of a set of complex factors that describe each sample and relate it to the model and corpus. To build intuition around these factors, we break memorization down into a taxonomy: recitation of highly duplicated sequences, reconstruction of inherently predictable sequences, and recollection of sequences that are neither. We demonstrate the usefulness of our taxonomy by using it to construct a predictive model for memorization. By analyzing dependencies and inspecting the weights of the predictive model, we find that different factors influence the likelihood of memorization differently depending on the taxonomic category.

Large Language Models (LLMs) frequently memorize long sequences verbatim, often with serious legal and privacy implications. Much prior work has studied such verbatim memorization using observational data. To complement such work, we develop a framework to study verbatim memorization in a controlled setting by continuing pre-training from Pythia checkpoints with injected sequences. We find that (1) non-trivial amounts of repetition are necessary for verbatim memorization to happen; (2) later (and presumably better) checkpoints are more likely to verbatim memorize sequences, even for out-of-distribution sequences; (3) the generation of memorized sequences is triggered by distributed model states that encode high-level features and makes important use of general language modeling capabilities. Guided by these insights, we develop stress tests to evaluate unlearning methods and find they often fail to remove the verbatim memorized information, while also degrading the LM. Overall, these findings challenge the hypothesis that verbatim memorization stems from specific model weights or mechanisms. Rather, verbatim memorization is intertwined with the LM's general capabilities and thus will be very difficult to isolate and suppress without degrading model quality.

Large language models have been shown to struggle with limited context memory and multi-step reasoning. We propose a simple method for solving both of these problems by allowing the model to take Self-Notes. Unlike recent scratchpad approaches, the model can deviate from the input context at any time to explicitly think. This allows the model to recall information and perform reasoning on the fly as it reads the context, thus extending its memory and enabling multi-step reasoning. Our experiments on multiple tasks demonstrate that our method can successfully generalize to longer and more complicated instances from their training setup by taking Self-Notes at inference time.

Cognitive dynamics are pivotal to advance human understanding of the world. Recent advancements in large language models (LLMs) reveal their potential for cognitive simulation. However, these LLM-based cognitive studies primarily focus on static modeling, overlooking the dynamic nature of cognition. To bridge this gap, we propose the concept of the cognitive dynamics of LLMs and present a corresponding task with the inspiration of longitudinal studies. Towards the task, we develop CogBench, a novel benchmark to assess the cognitive dynamics of LLMs and validate it through participant surveys. We also design two evaluation metrics for CogBench, including Authenticity and Rationality. Recognizing the inherent static nature of LLMs, we introduce CogGPT for the task, which features an innovative iterative cognitive mechanism aimed at enhancing lifelong cognitive dynamics. Empirical results demonstrate the superiority of CogGPT over existing methods, particularly in its ability to facilitate role-specific cognitive dynamics under continuous information flows.

Self-attention gives LLMs fine-grained, query-dependent access to context, but dense token interactions incur quadratic prefill cost and a key--value cache growing with context length. Research thus spans explicit-memory compression, sparse access, recurrent state construction, structured state dynamics, and heterogeneous mechanism composition. This survey analyzes these developments as model-internal contextual memory. We introduce a five-dimensional lens---Memory Representation, Memory Update, Access, Readout, and Integration---describing what is represented, how it changes, what is query-eligible, how it is read, and how readouts form outputs. This lens compares overlapping research lines without imposing one computational model. We reconstruct mechanism-level developments and architectural adoption using 59 release-level records from 14 major model lineages and 11 high-performing open-weight endpoints. First, explicit-memory and recurrent-state methods retain distinct interfaces but increasingly control overlapping memory functions. Second, heterogeneous architectures increasingly coordinate across network depth: layer-wise composition distributes complementary memory processing across representational stages, while cross-layer reuse carries selected memory and routing artifacts forward. Depth thus becomes a dimension along which contextual memory is constructed and managed. Third, these developments motivate a stateful multidimensional memory-routing hypothesis: persistent memory is organized across temporal scope, network depth, substrate type, and representation granularity, while coordinated Sparse Write and Sparse Read determine what is maintained and what contributes to each query. Overall, efficient sequence architecture design increasingly concerns the organization, lifecycle, and selective use of contextual memory rather than an isolated Attention operator.

Formulating a quantum theory of gravity lies at the heart of fundamental theoretical physics. This collection of lecture notes encompasses a selection of topics that were covered in six mini-courses at the Nordita PhD school "Towards Quantum Gravity". The scope was to provide a coherent picture, from its foundation to forefront research, emphasizing connections between different areas. The lectures begin with perturbative quantum gravity and effective field theory. Subsequently, two ultraviolet-complete approaches are presented: asymptotically safe gravity and string theory. Finally, elements of quantum effects in black hole spacetimes are discussed.

Human aging is marked by a steady rise in the risk of dying with age-a process demographers call senescence. Over the past century, life expectancy has risen dramatically, but is this because we are aging slower, or simply starting it later? Vaupel hypothesizes that the pace at which individuals age may be constant, with gains in longevity coming from the delayed onset of senescence rather than its slowing down. We test this idea using a new framework that decomposes the pace of senescence into three components: a biological baseline, a long-term trend, and the cumulative impact of period shocks. Applying this to cohort mortality data above age 80 from 12 countries, we find that once period shocks are accounted for, there is no statistical evidence of a long-term trend, consistent with Vaupel's hypothesis. Analyses using lower starting ages yield the same qualitative conclusion. Rather than indicating a change in the process that drives senescence, these variations are consistent with echoes of shared historical events. These results suggest that while longevity has shifted, the rhythm of human aging may be conserved.

Skin carcinoma is the most prevalent form of cancer globally, accounting for over $8 billion in annual healthcare expenditures. In clinical settings, physicians document patient visits using detailed SOAP (Subjective, Objective, Assessment, and Plan) notes. However, manually generating these notes is labor-intensive and contributes to clinician burnout. In this work, we propose a weakly supervised multimodal framework to generate clinically structured SOAP notes from limited inputs, including lesion images and sparse clinical text. Our approach reduces reliance on manual annotations, enabling scalable, clinically grounded documentation while alleviating clinician burden and reducing the need for large annotated data. Our method achieves performance comparable to GPT-4o, Claude, and DeepSeek Janus Pro across key clinical relevance metrics. To evaluate clinical quality, we introduce two novel metrics MedConceptEval and Clinical Coherence Score (CCS) which assess semantic alignment with expert medical concepts and input features, respectively.

We introduce a novel Longitudinal Focused Attention Meditation Electroencephalography (L-FAME) dataset and an accompanying benchmark, designed to foster research into the neural effects of various meditation practices and the evolution of these effects over a six-week training period. The dataset contains EEG recordings and psychological assessments from 74 healthy college participants, collected at two distinct time points: pre-intervention and post-intervention. Participants were randomly assigned to one of three distinct meditation groups: two mantra-based techniques (SA-TA-NA-MA and Hare Krishna) and one Breath Focus practice. Leveraging this unique longitudinal and comparative dataset, we propose a benchmark suite comprising three distinct classification tasks: (1) cognitive state decoding to distinguish between resting and meditation states, (2) fine-grained classification of the specific meditation techniques, and (3) cross-session adaptation to evaluate model generalization across the longitudinal time gap. We provide comprehensive baseline results for these tasks utilizing a range of classical machine learning algorithms and deep learning architectures. The complete dataset, preprocessing pipelines, and benchmark evaluation code will be publicly released, offering a valuable resource and a standardized framework for the development and comparison of new analytical methods in computational meditation research and EEG-based machine learning. The dataset is available at https://huggingface.co/datasets/L-FAME-Dataset-Benchmark/L-FAME

Clinical notes contain personally identifiable information (PII), restricting reuse for research and medical AI, especially when data cannot leave an institution. We developed MedDeID, an on-premises framework combining in-house annotation and synthetic-note generation with model training, inference, pseudonymisation and evaluation. On an independently annotated, adjudicated 300-note Dutch hospital benchmark, a hospital-trained compact transformer detected 98.9% of identifying text while redacting 0.24% of text outside annotated identifiers; a synthetic-only counterpart detected 96.1%. On 100 primary-care notes, the synthetic-trained model achieved higher recall than the hospital-trained model (90.3% versus 87.0%) and greater robustness to identifier-format perturbations. An English instantiation trained without real text detected 99.7% and 98.9% of annotated identifier characters on two external synthetic benchmarks. These results demonstrate transfer of the workflow to another language, but not clinical English performance. MedDeID provides a route to locally governed de-identification using real or synthetic training data.

Ambient AI scribes draft clinical notes under the reassurance that a clinician signs every note. We audited three commercial AI scribes on the same 142 consultations: 565 notes from recorded UK primary-care and US ambulatory encounters plus authored scenarios. Twelve discovery passes proposed 13,678 candidate errors; the 5,898 clearing an importance filter went to an adversarial panel of two models from different families, each told to refute what it could, and 618 survived. One note in three (31.3% [27.0, 35.6]) carries a verified failure, concentrated in allergy and medication information, invented patient identity, and history written up as examination on telephone consultations that can contain none. No product was given a patient record; setting aside the two classes a record would have prefilled, invented identity and dates, the rate is 24.8% [20.8, 29.0]. One failure mode did not fit our scheme, drawn from published scribe-error taxonomies: a treatment the clinician retracts, recorded as delivered care. Two clinicians adjudicated blind, disjoint samples: a physician author upheld 20 of 21 findings (95.2% [77.3, 99.2]) and an independent clinician, not an author, 12 of 12 ([75.8, 100]); both judged every sampled refusal genuine. A failure rate depends on the instrument as much as the scribes. With model, evidence and settings fixed, the review instruction alone moves the share of candidates verified from 9.3% to 79.0%, and the reviewing family moves it too: alone at that instruction the gentler flags 54.8% of notes against 27.8%. Between 28% and 97% of sampled notes carry a failure depending on the standard. Published audits disagree among themselves by a margin instrument differences alone can produce: omission is 54-86% of their errors against our 23.1%. We release all 618 findings with transcript-side evidence, every prompt and model version, and the re-runnable pipeline.