Improving large language models (LLMs) for electronic health record (EHR) reasoning is essential for enabling accurate and generalizable clinical predictions. While LLMs excel at medical text understanding, they underperform on EHR-based prediction tasks due to challenges in modeling temporally structured, high-dimensional data. Existing approaches often rely on hybrid paradigms, where LLMs serve merely as frozen prior retrievers while downstream deep learning (DL) models handle prediction, failing to improve the LLM’s intrinsic reasoning capacity and inheriting the generalization limitations of DL models. To this end, we propose EAG-RL, a novel two-stage training framework designed to intrinsically enhance LLMs’ EHR reasoning ability through expert attention guidance, where expert EHR models refer to task-specific DL models trained on EHR data. Concretely, EAG-RL first constructs high-quality, stepwise reasoning trajectories using expert-guided Monte Carlo Tree Search to effectively initialize the LLM’s policy. Then, EAG-RL further optimizes the policy via reinforcement learning by aligning the LLM’s attention with clinically salient features identified by expert EHR models. Extensive experiments on two real-world EHR datasets show that EAG-RL improves the intrinsic EHR reasoning ability of LLMs by an average of 14.62%, while also enhancing robustness to feature perturbations and generalization to unseen clinical domains. These results demonstrate the practical potential of EAG-RL for real-world deployment in clinical prediction tasks.

Hongxin Ding, Baixiang Huang, Yue Fang, Weibin Liao, Xinke Jiang, Jinyang Zhang, Yinghao Zhu, Zheng Li, Liantao Ma, Junfeng Zhao, Yasha Wang. Proceedings of the 64th Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers). 2026.

Xichen Zhang, Ziyi He, Yinghao Zhu, Sitong Wu, Shaozuo Yu, Meng Chu, Wenhu Zhang, Haoru Tan, Jiaya Jia. Proceedings of the 64th Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers). 2026.

Clinician skepticism toward opaque AI hinders adoption in high-stakes healthcare. We present AICare, an interactive and interpretable AI copilot for collaborative clinical decision-making. By analyzing longitudinal electronic health records, AICare grounds dynamic risk predictions in scrutable visualizations and LLM-driven diagnostic recommendations. Through a within-subjects counterbalanced study with 16 clinicians across nephrology and obstetrics, we comprehensively evaluated AICare using objective measures (task completion time and error rate), subjective assessments (NASA-TLX, SUS, and confidence ratings), and semi-structured interviews. Our findings indicate AICare’s reduced cognitive workload. Beyond performance metrics, qualitative analysis reveals that trust is actively constructed through verification, with interaction strategies diverging by expertise: junior clinicians used the system as cognitive scaffolding to structure their analysis, while experts engaged in adversarial verification to challenge the AI’s logic. This work offers design implications for creating AI systems that function as transparent partners, accommodating diverse reasoning styles to augment rather than replace clinical judgment.

Text-to-Image (T2I) diffusion models have achieved remarkable success in image generation. Despite their progress, challenges remain in both prompt-following ability, image quality and lack of high-quality datasets, which are essential for refining these models. As acquiring labeled data is costly, we introduce AGFSync, a framework that enhances T2I diffusion models through Direct Preference Optimization (DPO) in a fully AI-driven approach. AGFSync utilizes Vision-Language Models (VLM) to assess image quality across style, coherence, and aesthetics, generating feedback data within an AI-driven loop. By applying AGFSync to leading T2I models such as SD v1.4, v1.5, and SDXL-base, our extensive experiments on the TIFA dataset demonstrate notable improvements in VQA scores, aesthetic evaluations, and performance on the HPS v2 benchmark, consistently outperforming the base models. AGFSync's method of refining T2I diffusion models paves the way for scalable alignment techniques.

Security concerns related to Large Language Models (LLMs) have been extensively explored; however, the safety implications for Multimodal Large Language Models (MLLMs), particularly in medical contexts (MedMLLMs), remain inadequately addressed. This paper investigates the security vulnerabilities of MedMLLMs, focusing on their deployment in clinical environments where the accuracy and relevance of question-and-answer interactions are crucial for addressing complex medical challenges. We introduce and redefine two attack types: mismatched malicious attack (2M-attack) and optimized mismatched malicious attack (O2M-attack), by integrating existing clinical data with atypical natural phenomena. Using the comprehensive 3MAD dataset that we developed, which spans a diverse range of medical imaging modalities and adverse medical scenarios, we performed an in-depth analysis and proposed the MCM optimization method. This approach significantly improves the attack success rate against MedMLLMs. Our evaluations, which include white-box attacks on LLaVA-Med and transfer (black-box) attacks on four other SOTA models, reveal that even MedMLLMs designed with advanced security mechanisms remain vulnerable to breaches. This study highlights the critical need for robust security measures to enhance the safety and reliability of open-source MedMLLMs, especially in light of the potential impact of jailbreak attacks and other malicious exploits in clinical applications. Warning: Medical jailbreaking may generate content that includes unverified diagnoses and treatment recommendations. Always consult professional medical advice.

Machine learning for electronic health records (EHR) is advancing rapidly and already underpins risk stratification, readmission and mortality prediction, and decision support, yet reliable translation still stalls on fragmented data pipelines, inconsistent medical-code handling, and hard-to-reproduce eval-uation-barriers that especially hinder R-centric clinical teams. Despite impressive methodological gains in temporal modeling, attention mechanisms, and strong classical baselines, most turnkey toolchains live in Python; as a result, many healthcare researchers and clinical data scientists working in R lack a single, integrated path from raw multi-table EHR to calibrated, auditable models. We address this gap with RHealth, an open-source, R-native toolkit that plays the role of an end-to-end conductor: from data harmonization and medical-code normal-ization to task specification, model training, and standardized reporting. Concretely, RHealth provides adapters for widely used public datasets (e.g., MIMIC-III/IV, eICU), utilities to traverse and map ICD-9/10 and CCS codes, task templates for common outcomes (mortality, 30-day readmission, length of stay), and a modeling stack that-at this development stage-supports standard recurrent baselines (e.g., RNN) and offers an extensible interface for user-defined architectures under active development, all evaluated with reproducible splits, AUROC/AUPRC, and cali-bration diagnostics. By packaging the full pipeline-from data to evaluation granularity-into modular, composable components, RHealth lowers the entry barrier for R users, reduces “glue code,” and promotes transparent, people-centric experimentation that can also serve as a trustworthy upstream substrate for LLM-enabled applications. To our knowledge, it is among the first comprehensive, integrated deep-learning toolkits for EHR in the R ecosystem. The code and documentation will be released after the double-blind review process.

Large Language Models (LLMs) have demonstrated remarkable capabilities in code editing, substantially enhancing software development productivity. However, the inherent complexity of code editing tasks forces existing approaches to rely on LLMs’ autoregressive end-to-end generation, where decoding speed plays a critical role in efficiency. While inference acceleration techniques like speculative decoding are applied to improve the decoding efficiency, these methods fail to account for the unique characteristics of code editing tasks, where changes are typically localized and existing code segments are reused. To address this limitation, we propose EfficientEdit, a novel method that improves LLM-based code editing efficiency through two key mechanisms based on speculative decoding: (1) effective reuse of original code segments while identifying potential edit locations, and (2) efficient generation of edit content via high-quality drafts from edit-oriented draft models and a dynamic verification mechanism that balances quality and acceleration. Experimental results show that EfficientEdit can achieve up to 10.38× and 13.09× speedup compared to standard autoregressive decoding in CanItEdit and CodeIF-Bench, respectively, outperforming state-of-the-art inference acceleration approaches by up to 90.6%. The code and data are available at https://github.com/zhu-zhu-ding/EfficientEdit.

Analyzing the health status of patients based on Electronic Health Records (EHR) is a fundamental research problem in medical informatics. The presence of extensive missing values in EHR makes it challenging for deep neural networks (DNNs) to directly model the patient's health status. Existing DNNs training protocols, including Impute-then-Regress Procedure and Jointly Optimizing of Impute-n-Regress Procedure, require the additional imputation models to reconstruction missing values. However, Impute-then-Regress Procedure introduces the risk of injecting imputed, non-real data into downstream clinical prediction tasks, resulting in power loss, biased estimation, and poorly performing models, while Jointly Optimizing of Impute-n-Regress Procedure is also difficult to generalize due to the complex optimization space and demanding data requirements. Inspired by the recent advanced literature of learnable prompt in the fields of NLP and CV, in this work, we rethought the necessity of the imputation model in downstream clinical tasks, and proposed Learnable Prompt as Pseudo-Imputation (PAI) as a new training protocol to assist EHR analysis. PAI no longer introduces any imputed data but constructs a learnable prompt to model the implicit preferences of the downstream model for missing values, resulting in a significant performance improvement for all state-of-the-arts EHR analysis models on four real-world datasets across two clinical prediction tasks. Further experimental analysis indicates that PAI exhibits higher robustness in situations of data insufficiency and high missing rates. More importantly, as a plug-and-play protocol, PAI can be easily integrated into any existing or even imperceptible future EHR analysis models. The code of this work is deployed publicly available at https://github.com/MrBlankness/PAI to help the research community reproduce the results and assist the EHR analysis tasks.

Medical Lay Language Generation (MLLG) plays a vital role in improving the accessibility of complex scientific content for broader audiences. Recent literature to MLLG commonly employ parameter-efficient fine-tuning methods such as Low-Rank Adaptation (LoRA) to fine-tuning large language models (LLMs) using paired expert-lay language datasets. However, LoRA struggles with the challenges posed by multi-source heterogeneous MLLG datasets. Specifically, through a series of exploratory experiments, we reveal that standard LoRA fail to meet the requirement for semantic fidelity and diverse lay-style generation in MLLG task. To address these limitations, we propose Magical, an asymmetric LoRA architecture tailored for MLLG under heterogeneous data scenarios. Magical employs a shared matrix A for abstractive summarization, along with multiple isolated matrices B for diverse lay-style generation. To preserve semantic fidelity during the lay language generation process, Magical introduces a Semantic Invariance Constraint to mitigate semantic subspace shifts on matrix A. Furthermore, to better adapt to diverse lay-style generation, Magical incorporates the Recommendation-guided Switch, an externally interface to prompt the LLM to switch between different matrices B. Experimental results on three real-world lay language generation datasets demonstrate that Magical consistently outperforms prompt-based methods, vanilla LoRA, and its recent variants, while also reducing trainable parameters by 31.66%. Our code is publicly available at https://github.com/tianlwang/Magical.git.

The rapid advancement of Large Language Models (LLMs) has stimulated interest in multi-agent collaboration for addressing complex medical tasks. However, the practical advantages of multi-agent collaboration approaches remain insufficiently understood. Existing evaluations often lack generalizability, failing to cover diverse tasks reflective of real-world clinical practice, and frequently omit rigorous comparisons against both single-LLM-based and established conventional methods. To address this critical gap, we introduce MedAgentBoard, a comprehensive benchmark for the systematic evaluation of multi-agent collaboration, single-LLM, and conventional approaches. MedAgentBoard encompasses four diverse medical task categories: (1) medical (visual) question answering, (2) lay summary generation, (3) structured Electronic Health Record (EHR) predictive modeling, and (4) clinical workflow automation, across text, medical images, and structured EHR data. Our extensive experiments reveal a nuanced landscape: while multi-agent collaboration demonstrates benefits in specific scenarios, such as enhancing task completeness in clinical workflow automation, it does not consistently outperform advanced single LLMs (e.g., in textual medical QA) or, critically, specialized conventional methods that generally maintain better performance in tasks like medical VQA and EHR-based prediction. MedAgentBoard offers a vital resource and actionable insights, emphasizing the necessity of a task-specific, evidence-based approach to selecting and developing AI solutions in medicine. It underscores that the inherent complexity and overhead of multi-agent collaboration must be carefully weighed against tangible performance gains. All code, datasets, detailed prompts, and experimental results are open-sourced at this link.

Recent studies have indicated that Large Language Models (LLMs) harbor an inherent understanding of truthfulness, yet often fail to consistently express it and generate false statements. This gap between ''knowing'' and ''telling'' poses a challenge for ensuring the truthfulness of generated content. Inspired by recent work on the practice of encoding human-interpretable concepts linearly within large language models, we treat truthfulness as a specially linearly encoded concept within LLMs, and introduce Adaptive Activation Steering (ACT), a tuning-free method that adaptively shifts LLM's activations in the ''truthful'' direction during inference. ACT addresses diverse categories of hallucinations by utilizing diverse truthfulness-related steering vectors and adjusting the steering intensity adaptively. Applied as an add-on across various models, ACT significantly improves truthfulness in LLaMA (↑142%), LLaMA2 (↑24%), Alpaca (↑36%), Vicuna (↑28%), LLaMA2-Chat (↑19%), and LLaMA3(↑34%). Furthermore, we verify ACT's scalability across larger models (13B, 33B, 65B), underscoring the adaptability of ACT to large-scale language models. Our code is available at https://github.com/tianlwang/ACT.

We introduce ColaCare, a framework that enhances Electronic Health Record (EHR) modeling through multi-agent collaboration driven by Large Language Models (LLMs). Our approach seamlessly integrates domain-specific expert models with LLMs to bridge the gap between structured EHR data and text-based reasoning. Inspired by the Multidisciplinary Team (MDT) approach used in clinical settings, ColaCare employs two types of agents: DoctorAgents and a MetaAgent, which collaboratively analyze patient data. Expert models process and generate predictions from numerical EHR data, while LLM agents produce reasoning references and decision-making reports within the MDT-driven collaborative consultation framework. The MetaAgent orchestrates the discussion, facilitating consultations and evidence-based debates among DoctorAgents, simulating diverse expertise in clinical decision-making. We additionally incorporate the Merck Manual of Diagnosis and Therapy (MSD) medical guideline within a retrieval-augmented generation (RAG) module for medical evidence support, addressing the challenge of knowledge currency. Extensive experiments conducted on three EHR datasets demonstrate ColaCare's superior performance in clinical mortality outcome and readmission prediction tasks, underscoring its potential to revolutionize clinical decision support systems and advance personalized precision medicine. All code, case studies and a questionnaire are available at the project website: https://colacare.netlify.app.

The integration of multimodal Electronic Health Records (EHR) data has significantly advanced clinical predictive capabilities. Existing models, which utilize clinical notes and multivariate time-series EHR data, often fall short of incorporating the necessary medical context for accurate clinical tasks, while previous approaches with knowledge graphs (KGs) primarily focus on structured knowledge extraction. In response, we propose EMERGE, a Retrieval-Augmented Generation (RAG) driven framework to enhance multimodal EHR predictive modeling. We extract entities from both time-series data and clinical notes by prompting Large Language Models (LLMs) and align them with professional PrimeKG, ensuring consistency. In addition to triplet relationships, we incorporate entities' definitions and descriptions for richer semantics. The extracted knowledge is then used to generate task-relevant summaries of patients' health statuses. Finally, we fuse the summary with other modalities using an adaptive multimodal fusion network with cross-attention. Extensive experiments on the MIMIC-III and MIMIC-IV datasets' in-hospital mortality and 30-day readmission tasks demonstrate the superior performance of the EMERGE framework over baseline models. Comprehensive ablation studies and analysis highlight the efficacy of each designed module and robustness to data sparsity. EMERGE contributes to refining the utilization of multimodal EHR data in healthcare, bridging the gap with nuanced medical contexts essential for informed clinical predictions. We have publicly released the code at https://github.com/yhzhu99/EMERGE.

Electronic Health Records (EHRs) provide valuable patient data but often suffer from sparsity issue, posing significant challenges in predictive modeling. Conventional imputation methods inadequately distinguish between real and imputed data, leading to potential inaccuracies of patient representations. To address these issues, we introduce PRISM, a framework that indirectly imputes data through prototype representations of similar patients, thus ensuring denser and more accurate embeddings. PRISM also includes a feature confidence learner module, which evaluates the reliability of each feature considering missing statuses. Additionally, it incorporates a new patient similarity metric that accounts for feature confidence, avoiding overreliance on imprecise imputed values. Our extensive experiments on the MIMIC-III, MIMIC-IV, PhysioNet Challenge 2012, eICU datasets demonstrate PRISM's superior performance in predicting in-hospital mortality and 30-day readmission tasks, showcasing its effectiveness in handling EHR data sparsity. For the sake of reproducibility and further research, we have publicly released the code at https://github.com/yhzhu99/PRISM.

Multimodal electronic health record (EHR) data are widely used in clinical applications. Conventional methods usually assume that each sample (patient) is associated with the unified observed modalities, and all modalities are available for each sample. However, missing modality caused by various clinical and social reasons is a common issue in real-world clinical scenarios. Existing methods mostly rely on solving a generative model that learns a mapping from the latent space to the original input space, which is an unstable ill-posed inverse problem. To relieve the underdetermined system, we propose a model solving a direct problem, dubbed learning with Missing Modalities in Multimodal healthcare data (M3Care). M3Care is an end-to-end model compensating the missing information of the patients with missing modalities to perform clinical analysis. Instead of generating raw missing data, M3Care imputes the task-related information of the missing modalities in the latent space by the auxiliary information from each patient's similar neighbors, measured by a task-guided modality-adaptive similarity metric, and thence conducts the clinical tasks. The task-guided modality-adaptive similarity metric utilizes the uncensored modalities of the patient and the other patients who also have the same uncensored modalities to find similar patients. Experiments on real-world datasets show that M3Care outperforms the state-of-the-art baselines. Moreover, the findings discovered by M3Care are consistent with experts and medical knowledge, demonstrating the capability and the potential of providing useful insights and explanations.

In datacenter networks, bandwidth-demanding elephant flows without deadline and delay-sensitive mice flows with strict deadline coexist. They compete with each other for limited network resources, and the effective scheduling of such mix-flows is extremely challenging. We propose a deep reinforcement learning with private link approach (DRL-PLink), which combines the software-defined network and deep reinforcement learning (DRL) to schedule mix-flows. DRL-PLink divides the link bandwidth and establishes some corresponding private-links for different types of flows to isolate them such that the competition among different types of flows can decrease accordingly. DRL is used to adaptively and intelligently allocate bandwidth resources for these private-links. Furthermore, to improve the scheduling policy, DRL-PLink introduces the novel clipped double Q-learning, exploration with noise, and prioritized experience replay technology for DDPG to address function approximation error, to induce lager and more randomness for exploration, as well as more effective and efficient experience replay in DRL respectively. The experiment results under actual datacenter network workloads (including Web search and data mining workload) indicate that DRL-PLink can effectively schedule mix-flows at a small system overhead. Compared with ECMP, pFabric, and Karuna, the average flow completion time of DRL-PLink decreased by 77.79%, 65.61%, and 23.34% respectively, when the deadline meet rate is increased by 16.27%, 0.02%, and 0.836% respectively. Additionally, DRL-PLink can also well achieve load balance between paths.

A variety of network states can better help network operators to manage the whole network. However, the existing network measurement schemes still exhibit some drawbacks, such as excessive bandwidth overhead caused by running packet-level measurement, lack of coverage of variety measurement granularities, and occupying several switch’s memory. This paper presents the FullSight based on the programmable data plane, which provides fine multiple granularities measurement. Based on the programmability of data plane, this paper proposes an intelligent measurement mechanism that can adaptively adjust the measurement frequency according to the network state to greatly reduce the bandwidth overhead of measuring while ensuring a certain measurement accuracy and acceptable processing overhead. Also, the Rotating Memory scheme is proposed to reduce occupying memory of switch when achieving a variety of fine-grained measurements. The simulation results demonstrate the effectiveness of FullSight in terms of the bandwidth overhead reduction, the memory overhead reduction, full coverage of a variety of fine-grained network states. Compared with Netsight, FullSight only suffers from 0. 1% bandwidth overhead which is two orders of magnitude lower than Netsight, and FullSight has taken up no more than 0. 001% memory overhead for different measurement tasks.

In software-defined datacenter networks, there are bandwidth-demanding elephant flows without deadline and delay-sensitive mice flows with strict deadline. They compete with each other for limited network resources, and how to effectively schedule such mix-flow is a huge challenge. We propose DRL-PLink (deep reinforcement learning with private link) that combines software-defined network and deep reinforcement learning (DRL) to schedule mix-flow. It divides the link bandwidth and establishes some corresponding private links for different types of flows respectively to isolate them. DRL is used to adaptively allocate bandwidth resources for these private links. Furthermore, DRL-PLink introduces Clipped Double Q-learning and parameter exploration NoisyNet technology to improve the scheduling policy for overestimated value estimates and action exploration problems in DRL. The simulation results show that DRL-PLink can effectively schedule mix-flow. Compared with ECMP and pFabric, the average flow completion time of DRL-PLink has decreased by 68.87% and 52.18% respectively. At the same time, it maintains a high deadline meet rate (>96.6%) close to pFabric and Karuna very much.