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Jul 22

Context Clues: Evaluating Long Context Models for Clinical Prediction Tasks on EHRs

Foundation Models (FMs) trained on Electronic Health Records (EHRs) have achieved state-of-the-art results on numerous clinical prediction tasks. However, most existing EHR FMs have context windows of <1k tokens. This prevents them from modeling full patient EHRs which can exceed 10k's of events. Recent advancements in subquadratic long-context architectures (e.g., Mamba) offer a promising solution. However, their application to EHR data has not been well-studied. We address this gap by presenting the first systematic evaluation of the effect of context length on modeling EHR data. We find that longer context models improve predictive performance -- our Mamba-based model surpasses the prior state-of-the-art on 9/14 tasks on the EHRSHOT prediction benchmark. For clinical applications, however, model performance alone is insufficient -- robustness to the unique properties of EHR is crucial. Thus, we also evaluate models across three previously underexplored properties of EHR data: (1) the prevalence of "copy-forwarded" diagnoses which creates artificial repetition of tokens within EHR sequences; (2) the irregular time intervals between EHR events which can lead to a wide range of timespans within a context window; and (3) the natural increase in disease complexity over time which makes later tokens in the EHR harder to predict than earlier ones. Stratifying our EHRSHOT results, we find that higher levels of each property correlate negatively with model performance, but that longer context models are more robust to more extreme levels of these properties. Our work highlights the potential for using long-context architectures to model EHR data, and offers a case study for identifying new challenges in modeling sequential data motivated by domains outside of natural language. We release our models and code at: https://github.com/som-shahlab/long_context_clues

  • 8 authors
·
Dec 9, 2024

LongHealth: A Question Answering Benchmark with Long Clinical Documents

Background: Recent advancements in large language models (LLMs) offer potential benefits in healthcare, particularly in processing extensive patient records. However, existing benchmarks do not fully assess LLMs' capability in handling real-world, lengthy clinical data. Methods: We present the LongHealth benchmark, comprising 20 detailed fictional patient cases across various diseases, with each case containing 5,090 to 6,754 words. The benchmark challenges LLMs with 400 multiple-choice questions in three categories: information extraction, negation, and sorting, challenging LLMs to extract and interpret information from large clinical documents. Results: We evaluated nine open-source LLMs with a minimum of 16,000 tokens and also included OpenAI's proprietary and cost-efficient GPT-3.5 Turbo for comparison. The highest accuracy was observed for Mixtral-8x7B-Instruct-v0.1, particularly in tasks focused on information retrieval from single and multiple patient documents. However, all models struggled significantly in tasks requiring the identification of missing information, highlighting a critical area for improvement in clinical data interpretation. Conclusion: While LLMs show considerable potential for processing long clinical documents, their current accuracy levels are insufficient for reliable clinical use, especially in scenarios requiring the identification of missing information. The LongHealth benchmark provides a more realistic assessment of LLMs in a healthcare setting and highlights the need for further model refinement for safe and effective clinical application. We make the benchmark and evaluation code publicly available.

  • 10 authors
·
Jan 25, 2024

LLM Output Drift: Cross-Provider Validation & Mitigation for Financial Workflows

Financial institutions deploy Large Language Models (LLMs) for reconciliations, regulatory reporting, and client communications, but nondeterministic outputs (output drift) undermine auditability and trust. We quantify drift across five model architectures (7B-120B parameters) on regulated financial tasks, revealing a stark inverse relationship: smaller models (Granite-3-8B, Qwen2.5-7B) achieve 100% output consistency at T=0.0, while GPT-OSS-120B exhibits only 12.5% consistency (95% CI: 3.5-36.0%) regardless of configuration (p<0.0001, Fisher's exact test). This finding challenges conventional assumptions that larger models are universally superior for production deployment. Our contributions include: (i) a finance-calibrated deterministic test harness combining greedy decoding (T=0.0), fixed seeds, and SEC 10-K structure-aware retrieval ordering; (ii) task-specific invariant checking for RAG, JSON, and SQL outputs using finance-calibrated materiality thresholds (plus or minus 5%) and SEC citation validation; (iii) a three-tier model classification system enabling risk-appropriate deployment decisions; and (iv) an audit-ready attestation system with dual-provider validation. We evaluated five models (Qwen2.5-7B via Ollama, Granite-3-8B via IBM watsonx.ai, Llama-3.3-70B, Mistral-Medium-2505, and GPT-OSS-120B) across three regulated financial tasks. Across 480 runs (n=16 per condition), structured tasks (SQL) remain stable even at T=0.2, while RAG tasks show drift (25-75%), revealing task-dependent sensitivity. Cross-provider validation confirms deterministic behavior transfers between local and cloud deployments. We map our framework to Financial Stability Board (FSB), Bank for International Settlements (BIS), and Commodity Futures Trading Commission (CFTC) requirements, demonstrating practical pathways for compliance-ready AI deployments.

  • 2 authors
·
Nov 10, 2025

LongBench: A Bilingual, Multitask Benchmark for Long Context Understanding

Although large language models (LLMs) demonstrate impressive performance for many language tasks, most of them can only handle texts a few thousand tokens long, limiting their applications on longer sequence inputs, such as books, reports, and codebases. Recent works have proposed methods to improve LLMs' long context capabilities by extending context windows and more sophisticated memory mechanisms. However, comprehensive benchmarks tailored for evaluating long context understanding are lacking. In this paper, we introduce LongBench, the first bilingual, multi-task benchmark for long context understanding, enabling a more rigorous evaluation of long context understanding. LongBench comprises 21 datasets across 6 task categories in both English and Chinese, with an average length of 6,711 words (English) and 13,386 characters (Chinese). These tasks cover key long-text application areas including single-doc QA, multi-doc QA, summarization, few-shot learning, synthetic tasks, and code completion. All datasets in LongBench are standardized into a unified format, allowing for effortless automatic evaluation of LLMs. Upon comprehensive evaluation of 8 LLMs on LongBench, we find that: (1) Commercial model (GPT-3.5-Turbo-16k) outperforms other open-sourced models, but still struggles on longer contexts. (2) Scaled position embedding and fine-tuning on longer sequences lead to substantial improvement on long context understanding. (3) Context compression technique such as retrieval brings improvement for model with weak ability on long contexts, but the performance still lags behind models that have strong long context understanding capability. The code and datasets are available at https://github.com/THUDM/LongBench.

  • 13 authors
·
Aug 28, 2023

Clinical-Longformer and Clinical-BigBird: Transformers for long clinical sequences

Transformers-based models, such as BERT, have dramatically improved the performance for various natural language processing tasks. The clinical knowledge enriched model, namely ClinicalBERT, also achieved state-of-the-art results when performed on clinical named entity recognition and natural language inference tasks. One of the core limitations of these transformers is the substantial memory consumption due to their full self-attention mechanism. To overcome this, long sequence transformer models, e.g. Longformer and BigBird, were proposed with the idea of sparse attention mechanism to reduce the memory usage from quadratic to the sequence length to a linear scale. These models extended the maximum input sequence length from 512 to 4096, which enhanced the ability of modeling long-term dependency and consequently achieved optimal results in a variety of tasks. Inspired by the success of these long sequence transformer models, we introduce two ___domain enriched language models, namely Clinical-Longformer and Clinical-BigBird, which are pre-trained from large-scale clinical corpora. We evaluate both pre-trained models using 10 baseline tasks including named entity recognition, question answering, and document classification tasks. The results demonstrate that Clinical-Longformer and Clinical-BigBird consistently and significantly outperform ClinicalBERT as well as other short-sequence transformers in all downstream tasks. We have made our source code available at [https://github.com/luoyuanlab/Clinical-Longformer] the pre-trained models available for public download at: [https://huggingface.co/yikuan8/Clinical-Longformer].

  • 5 authors
·
Jan 27, 2022

Learning Energy-Based Models by Cooperative Diffusion Recovery Likelihood

Training energy-based models (EBMs) on high-dimensional data can be both challenging and time-consuming, and there exists a noticeable gap in sample quality between EBMs and other generative frameworks like GANs and diffusion models. To close this gap, inspired by the recent efforts of learning EBMs by maximizing diffusion recovery likelihood (DRL), we propose cooperative diffusion recovery likelihood (CDRL), an effective approach to tractably learn and sample from a series of EBMs defined on increasingly noisy versions of a dataset, paired with an initializer model for each EBM. At each noise level, the two models are jointly estimated within a cooperative training framework: samples from the initializer serve as starting points that are refined by a few MCMC sampling steps from the EBM. The EBM is then optimized by maximizing recovery likelihood, while the initializer model is optimized by learning from the difference between the refined samples and the initial samples. In addition, we made several practical designs for EBM training to further improve the sample quality. Combining these advances, our approach significantly boost the generation performance compared to existing EBM methods on CIFAR-10 and ImageNet datasets. We also demonstrate the effectiveness of our models for several downstream tasks, including classifier-free guided generation, compositional generation, image inpainting and out-of-distribution detection.

  • 4 authors
·
Sep 10, 2023

LongProc: Benchmarking Long-Context Language Models on Long Procedural Generation

Existing benchmarks for evaluating long-context language models (LCLMs) primarily focus on long-context recall, requiring models to produce short responses based on a few critical snippets while processing thousands of irrelevant tokens. We introduce LongProc (Long Procedural Generation), a new benchmark that requires both the integration of highly dispersed information and long-form generation. LongProc consists of six diverse procedural generation tasks, such as extracting structured information from HTML pages into a TSV format and executing complex search procedures to create travel plans. These tasks challenge LCLMs by testing their ability to follow detailed procedural instructions, synthesize and reason over dispersed information, and generate structured, long-form outputs (up to 8K tokens). Furthermore, as these tasks adhere to deterministic procedures and yield structured outputs, they enable reliable rule-based evaluation. We evaluate 17 LCLMs on LongProc across three difficulty levels, with maximum numbers of output tokens set at 500, 2K, and 8K. Notably, while all tested models claim a context window size above 32K tokens, open-weight models typically falter on 2K-token tasks, and closed-source models like GPT-4o show significant degradation on 8K-token tasks. Further analysis reveals that LCLMs struggle to maintain long-range coherence in long-form generations. These findings highlight critical limitations in current LCLMs and suggest substantial room for improvement. Data and code available at: https://princeton-pli.github.io/LongProc

  • 8 authors
·
Jan 9, 2025

LongGenBench: Long-context Generation Benchmark

Current long-context benchmarks primarily focus on retrieval-based tests, requiring Large Language Models (LLMs) to locate specific information within extensive input contexts, such as the needle-in-a-haystack (NIAH) benchmark. Long-context generation refers to the ability of a language model to generate coherent and contextually accurate text that spans across lengthy passages or documents. While recent studies show strong performance on NIAH and other retrieval-based long-context benchmarks, there is a significant lack of benchmarks for evaluating long-context generation capabilities. To bridge this gap and offer a comprehensive assessment, we introduce a synthetic benchmark, LongGenBench, which allows for flexible configurations of customized generation context lengths. LongGenBench advances beyond traditional benchmarks by redesigning the format of questions and necessitating that LLMs respond with a single, cohesive long-context answer. Upon extensive evaluation using LongGenBench, we observe that: (1) both API accessed and open source models exhibit performance degradation in long-context generation scenarios, ranging from 1.2% to 47.1%; (2) different series of LLMs exhibit varying trends of performance degradation, with the Gemini-1.5-Flash model showing the least degradation among API accessed models, and the Qwen2 series exhibiting the least degradation in LongGenBench among open source models.

  • 4 authors
·
Oct 5, 2024 3

The Patient is not a Moving Document: A World Model Training Paradigm for Longitudinal EHR

Large language models (LLMs) trained with next-word-prediction have achieved success as clinical foundation models. Representations from these language backbones yield strong linear probe performance across biomedical tasks, suggesting that patient semantics emerge from next-token prediction at scale. However, this paradigm treats patients as a document to be summarized rather than a dynamical system to be simulated; a patient's trajectory emerges from their state evolving under interventions and time, requiring models that simulate dynamics rather than predict tokens. To address this, we introduce SMB-Structure, a world model for structured EHR that grounds a joint-embedding prediction architecture (JEPA) with next-token prediction (SFT). SFT grounds our model to reconstruct future patient states in token space, while JEPA predicts those futures in latent space from the initial patient representation alone, forcing trajectory dynamics to be encoded before the next state is observed. We validate across two large-scale cohorts: Memorial Sloan Kettering (23,319 oncology patients; 323,000+ patient-years) and INSPECT (19,402 pulmonary embolism patients). Using a linear probe evaluated at multiple points along the disease trajectory, we demonstrate that our training paradigm learns embeddings that capture disease dynamics not recoverable by autoregressive baselines, enabling SMB-Structure to achieve competitive performance on complex tasks characterized by high patient heterogeneity. Model weights are available at https://huggingface.co/standardmodelbio/SMB-v1-1.7B-Structure.

  • 8 authors
·
Jan 29

RePrompT: Recurrent Prompt Tuning for Integrating Structured EHR Encoders with Large Language Models

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.

  • 5 authors
·
Apr 19

ExpertLongBench: Benchmarking Language Models on Expert-Level Long-Form Generation Tasks with Structured Checklists

This paper introduces ExpertLongBench, an expert-level benchmark containing 11 tasks from 9 domains that reflect realistic expert workflows and applications. Beyond question answering, the application-driven tasks in ExpertLongBench demand long-form outputs that can exceed 5,000 tokens and strict adherence to ___domain-specific requirements. Notably, each task in ExpertLongBench includes a rubric, designed or validated by ___domain experts, to specify task requirements and guide output evaluation. Furthermore, we propose CLEAR, an evaluation framework that supports accurate evaluation of long-form model outputs in our benchmark. To achieve fine-grained, expert-aligned evaluation, CLEAR derives checklists from both model outputs and references by extracting information corresponding to items in the task-specific rubric. Checklist items for model outputs are then compared with corresponding items for reference outputs to assess their correctness, enabling grounded evaluation. We benchmark 11 large language models (LLMs) and analyze components in CLEAR, showing that (1) existing LLMs, with the top performer achieving only a 26.8% F1 score, require significant improvement for expert-level tasks; (2) models can generate content corresponding to the required aspects, though often not accurately; and (3) accurate checklist extraction and comparison in CLEAR can be achieved by open-weight models for more scalable and low-cost usage.

  • 17 authors
·
Jun 1, 2025 2

BiomedSQL: Text-to-SQL for Scientific Reasoning on Biomedical Knowledge Bases

Biomedical researchers increasingly rely on large-scale structured databases for complex analytical tasks. However, current text-to-SQL systems often struggle to map qualitative scientific questions into executable SQL, particularly when implicit ___domain reasoning is required. We introduce BiomedSQL, the first benchmark explicitly designed to evaluate scientific reasoning in text-to-SQL generation over a real-world biomedical knowledge base. BiomedSQL comprises 68,000 question/SQL query/answer triples grounded in a harmonized BigQuery knowledge base that integrates gene-disease associations, causal inference from omics data, and drug approval records. Each question requires models to infer ___domain-specific criteria, such as genome-wide significance thresholds, effect directionality, or trial phase filtering, rather than rely on syntactic translation alone. We evaluate a range of open- and closed-source LLMs across prompting strategies and interaction paradigms. Our results reveal a substantial performance gap: GPT-o3-mini achieves 59.0% execution accuracy, while our custom multi-step agent, BMSQL, reaches 62.6%, both well below the expert baseline of 90.0%. BiomedSQL provides a new foundation for advancing text-to-SQL systems capable of supporting scientific discovery through robust reasoning over structured biomedical knowledge bases. Our dataset is publicly available at https://huggingface.co/datasets/NIH-CARD/BiomedSQL, and our code is open-source at https://github.com/NIH-CARD/biomedsql.

  • 11 authors
·
May 23, 2025 2

L-CiteEval: Do Long-Context Models Truly Leverage Context for Responding?

Long-context models (LCMs) have made remarkable strides in recent years, offering users great convenience for handling tasks that involve long context, such as document summarization. As the community increasingly prioritizes the faithfulness of generated results, merely ensuring the accuracy of LCM outputs is insufficient, as it is quite challenging for humans to verify the results from the extremely lengthy context. Yet, although some efforts have been made to assess whether LCMs respond truly based on the context, these works either are limited to specific tasks or heavily rely on external evaluation resources like GPT-4.In this work, we introduce L-CiteEval, a comprehensive multi-task benchmark for long-context understanding with citations, aiming to evaluate both the understanding capability and faithfulness of LCMs. L-CiteEval covers 11 tasks from diverse domains, spanning context lengths from 8K to 48K, and provides a fully automated evaluation suite. Through testing with 11 cutting-edge closed-source and open-source LCMs, we find that although these models show minor differences in their generated results, open-source models substantially trail behind their closed-source counterparts in terms of citation accuracy and recall. This suggests that current open-source LCMs are prone to responding based on their inherent knowledge rather than the given context, posing a significant risk to the user experience in practical applications. We also evaluate the RAG approach and observe that RAG can significantly improve the faithfulness of LCMs, albeit with a slight decrease in the generation quality. Furthermore, we discover a correlation between the attention mechanisms of LCMs and the citation generation process.

  • 6 authors
·
Oct 2, 2024 3

LongRM: Revealing and Unlocking the Context Boundary of Reward Modeling

Reward model (RM) plays a pivotal role in aligning large language model (LLM) with human preferences. As real-world applications increasingly involve long history trajectories, e.g., LLM agent, it becomes indispensable to evaluate whether a model's responses are not only high-quality but also grounded in and consistent with the provided context. Yet, current RMs remain confined to short-context settings and primarily focus on response-level attributes (e.g., safety or helpfulness), while largely neglecting the critical dimension of long context-response consistency. In this work, we introduce Long-RewardBench, a benchmark specifically designed for long-context RM evaluation, featuring both Pairwise Comparison and Best-of-N tasks. Our preliminary study reveals that even state-of-the-art generative RMs exhibit significant fragility in long-context scenarios, failing to maintain context-aware preference judgments. Motivated by the analysis of failure patterns observed in model outputs, we propose a general multi-stage training strategy that effectively scales arbitrary models into robust Long-context RMs (LongRMs). Experiments show that our approach not only substantially improves performance on long-context evaluation but also preserves strong short-context capability. Notably, our 8B LongRM outperforms much larger 70B-scale baselines and matches the performance of the proprietary Gemini 2.5 Pro model.

SUDA Soochow University
·
Oct 8, 2025 2

Long-tailed Medical Diagnosis with Relation-aware Representation Learning and Iterative Classifier Calibration

Recently computer-aided diagnosis has demonstrated promising performance, effectively alleviating the workload of clinicians. However, the inherent sample imbalance among different diseases leads algorithms biased to the majority categories, leading to poor performance for rare categories. Existing works formulated this challenge as a long-tailed problem and attempted to tackle it by decoupling the feature representation and classification. Yet, due to the imbalanced distribution and limited samples from tail classes, these works are prone to biased representation learning and insufficient classifier calibration. To tackle these problems, we propose a new Long-tailed Medical Diagnosis (LMD) framework for balanced medical image classification on long-tailed datasets. In the initial stage, we develop a Relation-aware Representation Learning (RRL) scheme to boost the representation ability by encouraging the encoder to capture intrinsic semantic features through different data augmentations. In the subsequent stage, we propose an Iterative Classifier Calibration (ICC) scheme to calibrate the classifier iteratively. This is achieved by generating a large number of balanced virtual features and fine-tuning the encoder using an Expectation-Maximization manner. The proposed ICC compensates for minority categories to facilitate unbiased classifier optimization while maintaining the diagnostic knowledge in majority classes. Comprehensive experiments on three public long-tailed medical datasets demonstrate that our LMD framework significantly surpasses state-of-the-art approaches. The source code can be accessed at https://github.com/peterlipan/LMD.

  • 5 authors
·
Feb 5, 2025

A Comprehensive Survey on Long Context Language Modeling

Efficient processing of long contexts has been a persistent pursuit in Natural Language Processing. With the growing number of long documents, dialogues, and other textual data, it is important to develop Long Context Language Models (LCLMs) that can process and analyze extensive inputs in an effective and efficient way. In this paper, we present a comprehensive survey on recent advances in long-context modeling for large language models. Our survey is structured around three key aspects: how to obtain effective and efficient LCLMs, how to train and deploy LCLMs efficiently, and how to evaluate and analyze LCLMs comprehensively. For the first aspect, we discuss data strategies, architectural designs, and workflow approaches oriented with long context processing. For the second aspect, we provide a detailed examination of the infrastructure required for LCLM training and inference. For the third aspect, we present evaluation paradigms for long-context comprehension and long-form generation, as well as behavioral analysis and mechanism interpretability of LCLMs. Beyond these three key aspects, we thoroughly explore the diverse application scenarios where existing LCLMs have been deployed and outline promising future development directions. This survey provides an up-to-date review of the literature on long-context LLMs, which we wish to serve as a valuable resource for both researchers and engineers. An associated GitHub repository collecting the latest papers and repos is available at: https://github.com/LCLM-Horizon/A-Comprehensive-Survey-For-Long-Context-Language-Modeling{\color[RGB]{175,36,67}{LCLM-Horizon}}.

  • 37 authors
·
Mar 20, 2025 2

Financial Risk Assessment via Long-term Payment Behavior Sequence Folding

Online inclusive financial services encounter significant financial risks due to their expansive user base and low default costs. By real-world practice, we reveal that utilizing longer-term user payment behaviors can enhance models' ability to forecast financial risks. However, learning long behavior sequences is non-trivial for deep sequential models. Additionally, the diverse fields of payment behaviors carry rich information, requiring thorough exploitation. These factors collectively complicate the task of long-term user behavior modeling. To tackle these challenges, we propose a Long-term Payment Behavior Sequence Folding method, referred to as LBSF. In LBSF, payment behavior sequences are folded based on merchants, using the merchant field as an intrinsic grouping criterion, which enables informative parallelism without reliance on external knowledge. Meanwhile, we maximize the utility of payment details through a multi-field behavior encoding mechanism. Subsequently, behavior aggregation at the merchant level followed by relational learning across merchants facilitates comprehensive user financial representation. We evaluate LBSF on the financial risk assessment task using a large-scale real-world dataset. The results demonstrate that folding long behavior sequences based on internal behavioral cues effectively models long-term patterns and changes, thereby generating more accurate user financial profiles for practical applications.

  • 7 authors
·
Nov 22, 2024

Autoformer: Decomposition Transformers with Auto-Correlation for Long-Term Series Forecasting

Extending the forecasting time is a critical demand for real applications, such as extreme weather early warning and long-term energy consumption planning. This paper studies the long-term forecasting problem of time series. Prior Transformer-based models adopt various self-attention mechanisms to discover the long-range dependencies. However, intricate temporal patterns of the long-term future prohibit the model from finding reliable dependencies. Also, Transformers have to adopt the sparse versions of point-wise self-attentions for long series efficiency, resulting in the information utilization bottleneck. Going beyond Transformers, we design Autoformer as a novel decomposition architecture with an Auto-Correlation mechanism. We break with the pre-processing convention of series decomposition and renovate it as a basic inner block of deep models. This design empowers Autoformer with progressive decomposition capacities for complex time series. Further, inspired by the stochastic process theory, we design the Auto-Correlation mechanism based on the series periodicity, which conducts the dependencies discovery and representation aggregation at the sub-series level. Auto-Correlation outperforms self-attention in both efficiency and accuracy. In long-term forecasting, Autoformer yields state-of-the-art accuracy, with a 38% relative improvement on six benchmarks, covering five practical applications: energy, traffic, economics, weather and disease. Code is available at this repository: https://github.com/thuml/Autoformer.

  • 4 authors
·
Jun 24, 2021

EHRMamba: Towards Generalizable and Scalable Foundation Models for Electronic Health Records

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

  • 4 authors
·
May 23, 2024

MemMamba: Rethinking Memory Patterns in State Space Model

With the explosive growth of data, long-sequence modeling has become increasingly important in tasks such as natural language processing and bioinformatics. However, existing methods face inherent trade-offs between efficiency and memory. Recurrent neural networks suffer from gradient vanishing and explosion, making them hard to scale. Transformers can model global dependencies but are constrained by quadratic complexity. Recently, selective state-space models such as Mamba have demonstrated high efficiency with O(n) time and O(1) recurrent inference, yet their long-range memory decays exponentially. In this work, we conduct mathematical derivations and information-theoretic analysis to systematically uncover the memory decay mechanism of Mamba, answering a fundamental question: what is the nature of Mamba's long-range memory and how does it retain information? To quantify key information loss, we further introduce horizontal-vertical memory fidelity metrics that capture degradation both within and across layers. Inspired by how humans distill and retain salient information when reading long documents, we propose MemMamba, a novel architectural framework that integrates state summarization mechanism together with cross-layer and cross-token attention, which alleviates long-range forgetting while preserving linear complexity. MemMamba achieves significant improvements over existing Mamba variants and Transformers on long-sequence benchmarks such as PG19 and Passkey Retrieval, while delivering a 48% speedup in inference efficiency. Both theoretical analysis and empirical results demonstrate that MemMamba achieves a breakthrough in the complexity-memory trade-off, offering a new paradigm for ultra-long sequence modeling.

  • 5 authors
·
Sep 28, 2025 3

A Survey on Medical Large Language Models: Technology, Application, Trustworthiness, and Future Directions

With the advent of Large Language Models (LLMs), medical artificial intelligence (AI) has experienced substantial technological progress and paradigm shifts, highlighting the potential of LLMs to streamline healthcare delivery and improve patient outcomes. Considering this rapid technical progress, in this survey, we trace the recent advances of Medical Large Language Models (Med-LLMs), including the background, key findings, and mainstream techniques, especially for the evolution from general-purpose models to medical-specialized applications. Firstly, we delve into the foundational technology of Med-LLMs, indicating how general models can be progressively adapted and refined for the complicated medical tasks. Secondly, the wide-ranging applications of Med-LLMs are investigated across various healthcare domains, as well as an up-to-date review of existing Med-LLMs. The transformative impact of these models on daily medical practice is evident through their ability to assist clinicians, educators, and patients. Recognizing the importance of responsible innovation, we discuss the challenges associated with ensuring fairness, accountability, privacy, and robustness. Ethical considerations, rigorous evaluation methodologies, and the establishment of regulatory frameworks are crucial for building trustworthiness in the real-world system. We emphasize the need for ongoing scrutiny and development to maintain high standards of safety and reliability. Finally, we anticipate possible future trajectories for Med-LLMs, identifying key avenues for prudent expansion. By consolidating these insights, our review aims to provide professionals and researchers with a thorough understanding of the strengths and limitations of Med-LLMs, fostering a balanced and ethical approach to their integration into the healthcare ecosystem.

  • 9 authors
·
Jun 5, 2024

OLAPH: Improving Factuality in Biomedical Long-form Question Answering

In the medical ___domain, numerous scenarios necessitate the long-form generation ability of large language models (LLMs). Specifically, when addressing patients' questions, it is essential that the model's response conveys factual claims, highlighting the need for an automated method to evaluate those claims. Thus, we introduce MedLFQA, a benchmark dataset reconstructed using long-form question-answering datasets related to the biomedical ___domain. We use MedLFQA to facilitate the automatic evaluations of factuality. We also propose OLAPH, a simple and novel framework that enables the improvement of factuality through automatic evaluations. The OLAPH framework iteratively trains LLMs to mitigate hallucinations using sampling predictions and preference optimization. In other words, we iteratively set the highest-scoring response as a preferred response derived from sampling predictions and train LLMs to align with the preferred response that improves factuality. We highlight that, even on evaluation metrics not used during training, LLMs trained with our OLAPH framework demonstrate significant performance improvement in factuality. Our findings reveal that a 7B LLM trained with our OLAPH framework can provide long answers comparable to the medical experts' answers in terms of factuality. We believe that our work could shed light on gauging the long-text generation ability of LLMs in the medical ___domain. Our code and datasets are available at https://github.com/dmis-lab/OLAPH}{https://github.com/dmis-lab/OLAPH.

  • 5 authors
·
May 21, 2024

Holistic Reasoning with Long-Context LMs: A Benchmark for Database Operations on Massive Textual Data

The rapid increase in textual information means we need more efficient methods to sift through, organize, and understand it all. While retrieval-augmented generation (RAG) models excel in accessing information from large document collections, they struggle with complex tasks that require aggregation and reasoning over information spanning across multiple documents--what we call holistic reasoning. Long-context language models (LCLMs) have great potential for managing large-scale documents, but their holistic reasoning capabilities remain unclear. In this work, we introduce HoloBench, a novel framework that brings database reasoning operations into text-based contexts, making it easier to systematically evaluate how LCLMs handle holistic reasoning across large documents. Our approach adjusts key factors such as context length, information density, distribution of information, and query complexity to evaluate LCLMs comprehensively. Our experiments show that the amount of information in the context has a bigger influence on LCLM performance than the actual context length. Furthermore, the complexity of queries affects performance more than the amount of information, particularly for different types of queries. Interestingly, queries that involve finding maximum or minimum values are easier for LCLMs and are less affected by context length, even though they pose challenges for RAG systems. However, tasks requiring the aggregation of multiple pieces of information show a noticeable drop in accuracy as context length increases. Additionally, we find that while grouping relevant information generally improves performance, the optimal positioning varies across models. Our findings surface both the advancements and the ongoing challenges in achieving a holistic understanding of long contexts.

  • 3 authors
·
Oct 15, 2024

AI in Investment Analysis: LLMs for Equity Stock Ratings

Investment Analysis is a cornerstone of the Financial Services industry. The rapid integration of advanced machine learning techniques, particularly Large Language Models (LLMs), offers opportunities to enhance the equity rating process. This paper explores the application of LLMs to generate multi-horizon stock ratings by ingesting diverse datasets. Traditional stock rating methods rely heavily on the expertise of financial analysts, and face several challenges such as data overload, inconsistencies in filings, and delayed reactions to market events. Our study addresses these issues by leveraging LLMs to improve the accuracy and consistency of stock ratings. Additionally, we assess the efficacy of using different data modalities with LLMs for the financial ___domain. We utilize varied datasets comprising fundamental financial, market, and news data from January 2022 to June 2024, along with GPT-4-32k (v0613) (with a training cutoff in Sep. 2021 to prevent information leakage). Our results show that our benchmark method outperforms traditional stock rating methods when assessed by forward returns, specially when incorporating financial fundamentals. While integrating news data improves short-term performance, substituting detailed news summaries with sentiment scores reduces token use without loss of performance. In many cases, omitting news data entirely enhances performance by reducing bias. Our research shows that LLMs can be leveraged to effectively utilize large amounts of multimodal financial data, as showcased by their effectiveness at the stock rating prediction task. Our work provides a reproducible and efficient framework for generating accurate stock ratings, serving as a cost-effective alternative to traditional methods. Future work will extend to longer timeframes, incorporate diverse data, and utilize newer models for enhanced insights.

  • 4 authors
·
Oct 30, 2024

TabEBM: A Tabular Data Augmentation Method with Distinct Class-Specific Energy-Based Models

Data collection is often difficult in critical fields such as medicine, physics, and chemistry. As a result, classification methods usually perform poorly with these small datasets, leading to weak predictive performance. Increasing the training set with additional synthetic data, similar to data augmentation in images, is commonly believed to improve downstream classification performance. However, current tabular generative methods that learn either the joint distribution p(x, y) or the class-conditional distribution p(x mid y) often overfit on small datasets, resulting in poor-quality synthetic data, usually worsening classification performance compared to using real data alone. To solve these challenges, we introduce TabEBM, a novel class-conditional generative method using Energy-Based Models (EBMs). Unlike existing methods that use a shared model to approximate all class-conditional densities, our key innovation is to create distinct EBM generative models for each class, each modelling its class-specific data distribution individually. This approach creates robust energy landscapes, even in ambiguous class distributions. Our experiments show that TabEBM generates synthetic data with higher quality and better statistical fidelity than existing methods. When used for data augmentation, our synthetic data consistently improves the classification performance across diverse datasets of various sizes, especially small ones. Code is available at https://github.com/andreimargeloiu/TabEBM.

  • 4 authors
·
Sep 24, 2024 1

BizFinBench.v2: A Unified Dual-Mode Bilingual Benchmark for Expert-Level Financial Capability Alignment

Large language models have undergone rapid evolution, emerging as a pivotal technology for intelligence in financial operations. However, existing benchmarks are often constrained by pitfalls such as reliance on simulated or general-purpose samples and a focus on singular, offline static scenarios. Consequently, they fail to align with the requirements for authenticity and real-time responsiveness in financial services, leading to a significant discrepancy between benchmark performance and actual operational efficacy. To address this, we introduce BizFinBench.v2, the first large-scale evaluation benchmark grounded in authentic business data from both Chinese and U.S. equity markets, integrating online assessment. We performed clustering analysis on authentic user queries from financial platforms, resulting in eight fundamental tasks and two online tasks across four core business scenarios, totaling 29,578 expert-level Q&A pairs. Experimental results demonstrate that ChatGPT-5 achieves a prominent 61.5% accuracy in main tasks, though a substantial gap relative to financial experts persists; in online tasks, DeepSeek-R1 outperforms all other commercial LLMs. Error analysis further identifies the specific capability deficiencies of existing models within practical financial business contexts. BizFinBench.v2 transcends the limitations of current benchmarks, achieving a business-level deconstruction of LLM financial capabilities and providing a precise basis for evaluating efficacy in the widespread deployment of LLMs within the financial ___domain. The data and code are available at https://github.com/HiThink-Research/BizFinBench.v2.

RCP-Merging: Merging Long Chain-of-Thought Models with Domain-Specific Models by Considering Reasoning Capability as Prior

Large Language Models (LLMs) with long chain-of-thought (CoT) capability, termed Reasoning Models, demonstrate superior intricate problem-solving abilities through multi-step long CoT reasoning. To create a dual-capability model with long CoT capability and ___domain-specific knowledge without substantial computational and data costs, model merging emerges as a highly resource-efficient method. However, significant challenges lie in merging ___domain-specific LLMs with long CoT ones since nowadays merging methods suffer from reasoning capability degradation, even gibberish output and output collapse. To overcome this, we introduce RCP-Merging: Merging Long Chain-of-Thought Models with Domain-Specific Models by Considering Reasoning Capability as Prior, a novel merging framework designed to integrate ___domain-specific LLMs with long CoT capability, meanwhile maintaining model performance in the original ___domain. Treating reasoning model weights as foundational prior, our method utilizes a reasoning capability indicator to preserve core long CoT capability model weights while selectively merging essential ___domain-specific weights. We conducted extensive experiments on Qwen2.5-7B, Llama3.1-8B, and Qwen2.5-1.5B models in BioMedicine and Finance domains. Our results show that RCP-Merging successfully merges a reasoning model with ___domain-specific ones, improving ___domain task performance by 9.5% and 9.2% over state-of-the-art methods, without significantly harming the original long CoT reasoning capability.

  • 5 authors
·
Aug 5, 2025

MLB: A Scenario-Driven Benchmark for Evaluating Large Language Models in Clinical Applications

The proliferation of Large Language Models (LLMs) presents transformative potential for healthcare, yet practical deployment is hindered by the absence of frameworks that assess real-world clinical utility. Existing benchmarks test static knowledge, failing to capture the dynamic, application-oriented capabilities required in clinical practice. To bridge this gap, we introduce a Medical LLM Benchmark MLB, a comprehensive benchmark evaluating LLMs on both foundational knowledge and scenario-based reasoning. MLB is structured around five core dimensions: Medical Knowledge (MedKQA), Safety and Ethics (MedSE), Medical Record Understanding (MedRU), Smart Services (SmartServ), and Smart Healthcare (SmartCare). The benchmark integrates 22 datasets (17 newly curated) from diverse Chinese clinical sources, covering 64 clinical specialties. Its design features a rigorous curation pipeline involving 300 licensed physicians. Besides, we provide a scalable evaluation methodology, centered on a specialized judge model trained via Supervised Fine-Tuning (SFT) on expert annotations. Our comprehensive evaluation of 10 leading models reveals a critical translational gap: while the top-ranked model, Kimi-K2-Instruct (77.3% accuracy overall), excels in structured tasks like information extraction (87.8% accuracy in MedRU), performance plummets in patient-facing scenarios (61.3% in SmartServ). Moreover, the exceptional safety score (90.6% in MedSE) of the much smaller Baichuan-M2-32B highlights that targeted training is equally critical. Our specialized judge model, trained via SFT on a 19k expert-annotated medical dataset, achieves 92.1% accuracy, an F1-score of 94.37%, and a Cohen's Kappa of 81.3% for human-AI consistency, validating a reproducible and expert-aligned evaluation protocol. MLB thus provides a rigorous framework to guide the development of clinically viable LLMs.

  • 23 authors
·
Jan 7

MedKGent: A Large Language Model Agent Framework for Constructing Temporally Evolving Medical Knowledge Graph

The rapid expansion of medical literature presents growing challenges for structuring and integrating ___domain knowledge at scale. Knowledge Graphs (KGs) offer a promising solution by enabling efficient retrieval, automated reasoning, and knowledge discovery. However, current KG construction methods often rely on supervised pipelines with limited generalizability or naively aggregate outputs from Large Language Models (LLMs), treating biomedical corpora as static and ignoring the temporal dynamics and contextual uncertainty of evolving knowledge. To address these limitations, we introduce MedKGent, a LLM agent framework for constructing temporally evolving medical KGs. Leveraging over 10 million PubMed abstracts published between 1975 and 2023, we simulate the emergence of biomedical knowledge via a fine-grained daily time series. MedKGent incrementally builds the KG in a day-by-day manner using two specialized agents powered by the Qwen2.5-32B-Instruct model. The Extractor Agent identifies knowledge triples and assigns confidence scores via sampling-based estimation, which are used to filter low-confidence extractions and inform downstream processing. The Constructor Agent incrementally integrates the retained triples into a temporally evolving graph, guided by confidence scores and timestamps to reinforce recurring knowledge and resolve conflicts. The resulting KG contains 156,275 entities and 2,971,384 relational triples. Quality assessments by two SOTA LLMs and three ___domain experts demonstrate an accuracy approaching 90%, with strong inter-rater agreement. To evaluate downstream utility, we conduct RAG across seven medical question answering benchmarks using five leading LLMs, consistently observing significant improvements over non-augmented baselines. Case studies further demonstrate the KG's value in literature-based drug repurposing via confidence-aware causal inference.

  • 13 authors
·
Aug 17, 2025

Long-context LLMs Struggle with Long In-context Learning

Large Language Models (LLMs) have made significant strides in handling long sequences exceeding 32K tokens. However, their performance evaluation has largely been confined to metrics like perplexity and synthetic tasks, which may not fully capture their abilities in more nuanced, real-world scenarios. This study introduces a specialized benchmark (LIConBench) focusing on long in-context learning within the realm of extreme-label classification. We meticulously selected six datasets with a label range spanning 28 to 174 classes covering different input (few-shot demonstration) length from 2K to 50K. Our benchmark requires LLMs to comprehend the entire input to recognize the massive label spaces to make correct prediction. We evaluate 13 long-context LLMs on our benchmarks. We find that the long-context LLMs perform relatively well under the token length of 20K and the performance benefits from utilizing the long context window. However, after the context window exceeds 20K, most LLMs except GPT-4 will dip dramatically. This suggests a notable gap in current LLM capabilities for processing and understanding long, context-rich sequences. Further analysis revealed a tendency among models to favor predictions for labels presented towards the end at the sequence. Their ability to reason over multiple pieces in the long sequence is yet to be improved. Our study reveals that long context understanding and reasoning is still a challenging task for the existing LLMs. We believe LIConBench could serve as a more realistic evaluation for the future long context LLMs.

  • 5 authors
·
Apr 2, 2024 4

Training Long-Context Vision-Language Models Effectively with Generalization Beyond 128K Context

Long-context modeling is becoming a core capability of modern large vision-language models (LVLMs), enabling sustained context management across long-document understanding, video analysis, and multi-turn tool use in agentic workflows. Yet practical training recipes remain insufficiently explored, particularly for designing and balancing long-context data mixtures. In this work, we present a systematic study of long-context continued pre-training for LVLMs, extending a 7B model from 32K to 128K context with extensive ablations on long-document data. We first show that long-document VQA is substantially more effective than OCR transcription. Building on this observation, our ablations further yield three key findings: i) for sequence-length distribution, balanced data outperforms target-length-focused data (e.g., 128K), suggesting that long-context ability requires generalizable key-information retrieval across various lengths and positions; ii) retrieval remains the primary bottleneck, favoring retrieval-heavy mixtures with modest reasoning data for task diversity; and iii) pure long-document VQA largely preserves short-context capabilities, suggesting that instruction-formatted long data reduces the need for short-data mixing. Based on these findings, we introduce MMProLong, obtained by long-context continued pre-training from Qwen2.5-VL-7B with only a 5B-token budget. MMProLong improves long-document VQA scores by 7.1% and maintains strong performance at 256K and 512K contexts beyond its 128K training window, without additional training. It further generalizes to webpage-based multimodal needle retrieval, long-context vision-text compression, and long-video understanding without task-specific supervision. Overall, our study establishes a practical LongPT recipe and an empirical foundation for advancing long-context vision-language models.

Right Prediction, Wrong Reasoning: Uncovering LLM Misalignment in RA Disease Diagnosis

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

  • 7 authors
·
Apr 9, 2025

What is Wrong with Perplexity for Long-context Language Modeling?

Handling long-context inputs is crucial for large language models (LLMs) in tasks such as extended conversations, document summarization, and many-shot in-context learning. While recent approaches have extended the context windows of LLMs and employed perplexity (PPL) as a standard evaluation metric, PPL has proven unreliable for assessing long-context capabilities. The underlying cause of this limitation has remained unclear. In this work, we provide a comprehensive explanation for this issue. We find that PPL overlooks key tokens, which are essential for long-context understanding, by averaging across all tokens and thereby obscuring the true performance of models in long-context scenarios. To address this, we propose LongPPL, a novel metric that focuses on key tokens by employing a long-short context contrastive method to identify them. Our experiments demonstrate that LongPPL strongly correlates with performance on various long-context benchmarks (e.g., Pearson correlation of -0.96), significantly outperforming traditional PPL in predictive accuracy. Additionally, we introduce LongCE (Long-context Cross-Entropy) loss, a re-weighting strategy for fine-tuning that prioritizes key tokens, leading to consistent improvements across diverse benchmarks. In summary, these contributions offer deeper insights into the limitations of PPL and present effective solutions for accurately evaluating and enhancing the long-context capabilities of LLMs. Code is available at https://github.com/PKU-ML/LongPPL.

  • 8 authors
·
Jul 26, 2025

CN-Buzz2Portfolio: A Chinese-Market Dataset and Benchmark for LLM-Based Macro and Sector Asset Allocation from Daily Trending Financial News

Large Language Models (LLMs) are rapidly transitioning from static Natural Language Processing (NLP) tasks including sentiment analysis and event extraction to acting as dynamic decision-making agents in complex financial environments. However, the evolution of LLMs into autonomous financial agents faces a significant dilemma in evaluation paradigms. Direct live trading is irreproducible and prone to outcome bias by confounding luck with skill, whereas existing static benchmarks are often confined to entity-level stock picking and ignore broader market attention. To facilitate the rigorous analysis of these challenges, we introduce CN-Buzz2Portfolio, a reproducible benchmark grounded in the Chinese market that maps daily trending news to macro and sector asset allocation. Spanning a rolling horizon from 2024 to mid-2025, our dataset simulates a realistic public attention stream, requiring agents to distill investment logic from high-exposure narratives instead of pre-filtered entity news. We propose a Tri-Stage CPA Agent Workflow involving Compression, Perception, and Allocation to evaluate LLMs on broad asset classes such as Exchange Traded Funds (ETFs) rather than individual stocks, thereby reducing idiosyncratic volatility. Extensive experiments on nine LLMs reveal significant disparities in how models translate macro-level narratives into portfolio weights. This work provides new insights into the alignment between general reasoning and financial decision-making, and all data, codes, and experiments are released to promote sustainable financial agent research.

  • 6 authors
·
Mar 17

Evidence Inference 2.0: More Data, Better Models

How do we most effectively treat a disease or condition? Ideally, we could consult a database of evidence gleaned from clinical trials to answer such questions. Unfortunately, no such database exists; clinical trial results are instead disseminated primarily via lengthy natural language articles. Perusing all such articles would be prohibitively time-consuming for healthcare practitioners; they instead tend to depend on manually compiled systematic reviews of medical literature to inform care. NLP may speed this process up, and eventually facilitate immediate consult of published evidence. The Evidence Inference dataset was recently released to facilitate research toward this end. This task entails inferring the comparative performance of two treatments, with respect to a given outcome, from a particular article (describing a clinical trial) and identifying supporting evidence. For instance: Does this article report that chemotherapy performed better than surgery for five-year survival rates of operable cancers? In this paper, we collect additional annotations to expand the Evidence Inference dataset by 25\%, provide stronger baseline models, systematically inspect the errors that these make, and probe dataset quality. We also release an abstract only (as opposed to full-texts) version of the task for rapid model prototyping. The updated corpus, documentation, and code for new baselines and evaluations are available at http://evidence-inference.ebm-nlp.com/.

  • 5 authors
·
May 8, 2020

Beyond the Needle's Illusion: Decoupled Evaluation of Evidence Access and Use under Semantic Interference at 326M-Token Scale

Long-context LLM agents must access the right evidence from large environments and use it faithfully. However, the popular Needle-in-a-Haystack (NIAH) evaluation mostly measures benign span localization. The needle is near-unique, and the haystack is largely irrelevant. We introduce EverMemBench-S (EMB-S), an adversarial NIAH-style benchmark built on a 326M-token MemoryBank. While the full MemoryBank spans 326M tokens for retrieval-based (RAG) evaluation, we evaluate native long-context models only at scales that fit within each model's context window (up to 1M tokens in this work) to ensure a fair comparison. EMB-S pairs queries with collision-tested near-miss hard negatives and gold evidence sets spanning one or more documents, validated via human screening and LLM verification. We also propose a decoupled diagnostic protocol that reports evidence access (document-ID localization) separately from end-to-end QA quality under full-context prompting. This enables consistent diagnosis for both native long-context prompting and retrieval pipelines. Across a reference-corpus ladder from ___domain-isolated 64K contexts to a globally shared 326M-token environment, we observe a clear reality gap. Systems that saturate benign NIAH degrade sharply in evidence access under semantic interference. These results indicate that semantic discrimination, not context length alone, is the dominant bottleneck for long-context memory at scale.

  • 9 authors
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Jan 28

Rethinking Retrieval-Augmented Generation for Medicine: A Large-Scale, Systematic Expert Evaluation and Practical Insights

Large language models (LLMs) are transforming the landscape of medicine, yet two fundamental challenges persist: keeping up with rapidly evolving medical knowledge and providing verifiable, evidence-grounded reasoning. Retrieval-augmented generation (RAG) has been widely adopted to address these limitations by supplementing model outputs with retrieved evidence. However, whether RAG reliably achieves these goals remains unclear. Here, we present the most comprehensive expert evaluation of RAG in medicine to date. Eighteen medical experts contributed a total of 80,502 annotations, assessing 800 model outputs generated by GPT-4o and Llama-3.1-8B across 200 real-world patient and USMLE-style queries. We systematically decomposed the RAG pipeline into three components: (i) evidence retrieval (relevance of retrieved passages), (ii) evidence selection (accuracy of evidence usage), and (iii) response generation (factuality and completeness of outputs). Contrary to expectation, standard RAG often degraded performance: only 22% of top-16 passages were relevant, evidence selection remained weak (precision 41-43%, recall 27-49%), and factuality and completeness dropped by up to 6% and 5%, respectively, compared with non-RAG variants. Retrieval and evidence selection remain key failure points for the model, contributing to the overall performance drop. We further show that simple yet effective strategies, including evidence filtering and query reformulation, substantially mitigate these issues, improving performance on MedMCQA and MedXpertQA by up to 12% and 8.2%, respectively. These findings call for re-examining RAG's role in medicine and highlight the importance of stage-aware evaluation and deliberate system design for reliable medical LLM applications.

  • 27 authors
·
Nov 10, 2025

Long-Context Inference with Retrieval-Augmented Speculative Decoding

The emergence of long-context large language models (LLMs) offers a promising alternative to traditional retrieval-augmented generation (RAG) for processing extensive documents. However, the computational overhead of long-context inference, particularly in managing key-value (KV) caches, presents significant efficiency challenges. While Speculative Decoding (SD) traditionally accelerates inference using smaller draft models, its effectiveness diminishes substantially in long-context scenarios due to memory-bound KV cache operations. We present Retrieval-Augmented Speculative Decoding (RAPID), which leverages RAG for both accelerating and enhancing generation quality in long-context inference. RAPID introduces the RAG drafter-a draft LLM operating on shortened retrieval contexts-to speculate on the generation of long-context target LLMs. Our approach enables a new paradigm where same-scale or even larger LLMs can serve as RAG drafters while maintaining computational efficiency. To fully leverage the potentially superior capabilities from stronger RAG drafters, we develop an inference-time knowledge transfer dynamic that enriches the target distribution by RAG. Extensive experiments on the LLaMA-3.1 and Qwen2.5 backbones demonstrate that RAPID effectively integrates the strengths of both approaches, achieving significant performance improvements (e.g., from 39.33 to 42.83 on InfiniteBench for LLaMA-3.1-8B) with more than 2x speedups. Our analyses reveal that RAPID achieves robust acceleration beyond 32K context length and demonstrates superior generation quality in real-world applications.

  • 5 authors
·
Feb 27, 2025

Closing the gap between open-source and commercial large language models for medical evidence summarization

Large language models (LLMs) hold great promise in summarizing medical evidence. Most recent studies focus on the application of proprietary LLMs. Using proprietary LLMs introduces multiple risk factors, including a lack of transparency and vendor dependency. While open-source LLMs allow better transparency and customization, their performance falls short compared to proprietary ones. In this study, we investigated to what extent fine-tuning open-source LLMs can further improve their performance in summarizing medical evidence. Utilizing a benchmark dataset, MedReview, consisting of 8,161 pairs of systematic reviews and summaries, we fine-tuned three broadly-used, open-sourced LLMs, namely PRIMERA, LongT5, and Llama-2. Overall, the fine-tuned LLMs obtained an increase of 9.89 in ROUGE-L (95% confidence interval: 8.94-10.81), 13.21 in METEOR score (95% confidence interval: 12.05-14.37), and 15.82 in CHRF score (95% confidence interval: 13.89-16.44). The performance of fine-tuned LongT5 is close to GPT-3.5 with zero-shot settings. Furthermore, smaller fine-tuned models sometimes even demonstrated superior performance compared to larger zero-shot models. The above trends of improvement were also manifested in both human and GPT4-simulated evaluations. Our results can be applied to guide model selection for tasks demanding particular ___domain knowledge, such as medical evidence summarization.

  • 14 authors
·
Jul 25, 2024

Energy-Based Concept Bottleneck Models: Unifying Prediction, Concept Intervention, and Probabilistic Interpretations

Existing methods, such as concept bottleneck models (CBMs), have been successful in providing concept-based interpretations for black-box deep learning models. They typically work by predicting concepts given the input and then predicting the final class label given the predicted concepts. However, (1) they often fail to capture the high-order, nonlinear interaction between concepts, e.g., correcting a predicted concept (e.g., "yellow breast") does not help correct highly correlated concepts (e.g., "yellow belly"), leading to suboptimal final accuracy; (2) they cannot naturally quantify the complex conditional dependencies between different concepts and class labels (e.g., for an image with the class label "Kentucky Warbler" and a concept "black bill", what is the probability that the model correctly predicts another concept "black crown"), therefore failing to provide deeper insight into how a black-box model works. In response to these limitations, we propose Energy-based Concept Bottleneck Models (ECBMs). Our ECBMs use a set of neural networks to define the joint energy of candidate (input, concept, class) tuples. With such a unified interface, prediction, concept correction, and conditional dependency quantification are then represented as conditional probabilities, which are generated by composing different energy functions. Our ECBMs address both limitations of existing CBMs, providing higher accuracy and richer concept interpretations. Empirical results show that our approach outperforms the state-of-the-art on real-world datasets.

  • 5 authors
·
Jan 25, 2024

PhysicianBench: Evaluating LLM Agents in Real-World EHR Environments

We introduce PhysicianBench, a benchmark for evaluating LLM agents on physician tasks grounded in real clinical setting within electronic health record (EHR) environments. Existing medical agent benchmarks primarily focus on static knowledge recall, single-step atomic actions, or action intent without verifiable execution against the environment. As a result, they fail to capture the long-horizon, composite workflows that characterize real clinical systems. PhysicianBench comprises 100 long-horizon tasks adapted from real consultation cases between primary care and subspecialty physicians, with each task independently reviewed by a separate panel of physicians. Tasks are instantiated in an EHR environment with real patient records and accessed through the same standard APIs used by commercial EHR vendors. Tasks span 21 specialties (e.g., cardiology, endocrinology, oncology, psychiatry) and diverse workflow types (e.g., diagnosis interpretation, medication prescribing, treatment planning), requiring an average of 27 tool calls per task. Solving each task requires retrieving data across encounters, reasoning over heterogeneous clinical information, executing consequential clinical actions, and producing clinical documentation. Each task is decomposed into structured checkpoints (670 in total across the benchmark) capturing distinct stages of completion graded by task-specific scripts with execution-grounded verification. Across 13 proprietary and open-source LLM agents, the best-performing model achieves only 46% success rate (pass@1), while open-source models reach at most 19%, revealing a substantial gap between current agent capabilities and the demands of real-world clinical workflows. PhysicianBench provides a realistic and execution-grounded benchmark for measuring progress toward autonomous clinical agents.

LongWriter: Unleashing 10,000+ Word Generation from Long Context LLMs

Current long context large language models (LLMs) can process inputs up to 100,000 tokens, yet struggle to generate outputs exceeding even a modest length of 2,000 words. Through controlled experiments, we find that the model's effective generation length is inherently bounded by the sample it has seen during supervised fine-tuning (SFT). In other words, their output limitation is due to the scarcity of long-output examples in existing SFT datasets. To address this, we introduce AgentWrite, an agent-based pipeline that decomposes ultra-long generation tasks into subtasks, enabling off-the-shelf LLMs to generate coherent outputs exceeding 20,000 words. Leveraging AgentWrite, we construct LongWriter-6k, a dataset containing 6,000 SFT data with output lengths ranging from 2k to 32k words. By incorporating this dataset into model training, we successfully scale the output length of existing models to over 10,000 words while maintaining output quality. We also develop LongBench-Write, a comprehensive benchmark for evaluating ultra-long generation capabilities. Our 9B parameter model, further improved through DPO, achieves state-of-the-art performance on this benchmark, surpassing even much larger proprietary models. In general, our work demonstrates that existing long context LLM already possesses the potential for a larger output window--all you need is data with extended output during model alignment to unlock this capability. Our code & models are at: https://github.com/THUDM/LongWriter.

  • 9 authors
·
Aug 13, 2024 6

MedAgentBench: A Realistic Virtual EHR Environment to Benchmark Medical LLM Agents

Recent large language models (LLMs) have demonstrated significant advancements, particularly in their ability to serve as agents thereby surpassing their traditional role as chatbots. These agents can leverage their planning and tool utilization capabilities to address tasks specified at a high level. However, a standardized dataset to benchmark the agent capabilities of LLMs in medical applications is currently lacking, making the evaluation of LLMs on complex tasks in interactive healthcare environments challenging. To address this gap, we introduce MedAgentBench, a broad evaluation suite designed to assess the agent capabilities of large language models within medical records contexts. MedAgentBench encompasses 300 patient-specific clinically-derived tasks from 10 categories written by human physicians, realistic profiles of 100 patients with over 700,000 data elements, a FHIR-compliant interactive environment, and an accompanying codebase. The environment uses the standard APIs and communication infrastructure used in modern EMR systems, so it can be easily migrated into live EMR systems. MedAgentBench presents an unsaturated agent-oriented benchmark that current state-of-the-art LLMs exhibit some ability to succeed at. The best model (Claude 3.5 Sonnet v2) achieves a success rate of 69.67%. However, there is still substantial space for improvement which gives the community a next direction to optimize. Furthermore, there is significant variation in performance across task categories. MedAgentBench establishes this and is publicly available at https://github.com/stanfordmlgroup/MedAgentBench , offering a valuable framework for model developers to track progress and drive continuous improvements in the agent capabilities of large language models within the medical ___domain.

  • 7 authors
·
Jan 24, 2025

When Cases Get Rare: A Retrieval Benchmark for Off-Guideline Clinical Question Answering

Across medical specialties, clinical practice is anchored in evidence-based guidelines that codify best studied diagnostic and treatment pathways. These pathways routinely fall short for the long tail of real-world care not covered by guidelines. Most medical large language models (LLMs), however, are trained to encode common, guideline-focused medical knowledge in their parameters. Current evaluations test models primarily on recalling and reasoning with this memorized content, often in multiple-choice settings. Given the fundamental importance of evidence-based reasoning in medicine, it is neither feasible nor reliable to depend on memorization in practice. To address this gap, we introduce OGCaReBench, a free-form retrieval-focused benchmark aimed at evaluating LLMs at answering clinical questions that require going beyond typical guidelines. Extracted from published medical case reports and validated by medical experts, OGCaReBench contains long-form clinical questions requiring free-text answers, providing a systematic framework for assessing open-ended medical reasoning in rare, case-based scenarios. Our experiments reveal that even the best-performing baseline (GPT-5.2) correctly answers only 56% of our benchmark with specialized models only reaching 42%. Augmenting models with retrieved medical articles improves this performance to up to 82% (using GPT-5.2) highlighting the importance of evidence-grounding for real-world medical reasoning tasks. This work thus establishes a foundation for benchmarking and advancing both general-purpose and medical LLMs to produce reliable answers in challenging clinical contexts.

  • 14 authors
·
May 19

StockBench: Can LLM Agents Trade Stocks Profitably In Real-world Markets?

Large language models (LLMs) have recently demonstrated strong capabilities as autonomous agents, showing promise in reasoning, tool use, and sequential decision-making. While prior benchmarks have evaluated LLM agents in domains such as software engineering and scientific discovery, the finance ___domain remains underexplored, despite its direct relevance to economic value and high-stakes decision-making. Existing financial benchmarks primarily test static knowledge through question answering, but they fall short of capturing the dynamic and iterative nature of trading. To address this gap, we introduce StockBench, a contamination-free benchmark designed to evaluate LLM agents in realistic, multi-month stock trading environments. Agents receive daily market signals -- including prices, fundamentals, and news -- and must make sequential buy, sell, or hold decisions. Performance is assessed using financial metrics such as cumulative return, maximum drawdown, and the Sortino ratio. Our evaluation of state-of-the-art proprietary (e.g., GPT-5, Claude-4) and open-weight (e.g., Qwen3, Kimi-K2, GLM-4.5) models shows that while most LLM agents struggle to outperform the simple buy-and-hold baseline, several models demonstrate the potential to deliver higher returns and manage risk more effectively. These findings highlight both the challenges and opportunities in developing LLM-powered financial agents, showing that excelling at static financial knowledge tasks does not necessarily translate into successful trading strategies. We release StockBench as an open-source resource to support reproducibility and advance future research in this ___domain.

  • 7 authors
·
Oct 2, 2025 4

LLMs Can Easily Learn to Reason from Demonstrations Structure, not content, is what matters!

Large reasoning models (LRMs) tackle complex reasoning problems by following long chain-of-thoughts (Long CoT) that incorporate reflection, backtracking, and self-validation. However, the training techniques and data requirements to elicit Long CoT remain poorly understood. In this work, we find that a Large Language model (LLM) can effectively learn Long CoT reasoning through data-efficient supervised fine-tuning (SFT) and parameter-efficient low-rank adaptation (LoRA). With just 17k long CoT training samples, the Qwen2.5-32B-Instruct model achieves significant improvements on a wide range of math and coding benchmarks, including 56.7% (+40.0%) on AIME 2024 and 57.0% (+8.1%) on LiveCodeBench, competitive to the proprietary o1-preview model's score of 44.6% and 59.1%. More importantly, we find that the structure of Long CoT is critical to the learning process, whereas the content of individual reasoning steps has minimal impact. Perturbations affecting content, such as training on incorrect samples or removing reasoning keywords, have little impact on performance. In contrast, structural modifications that disrupt logical consistency in the Long CoT, such as shuffling or deleting reasoning steps, significantly degrade accuracy. For example, a model trained on Long CoT samples with incorrect answers still achieves only 3.2% lower accuracy compared to training with fully correct samples. These insights deepen our understanding of how to elicit reasoning capabilities in LLMs and highlight key considerations for efficiently training the next generation of reasoning models. This is the academic paper of our previous released Sky-T1-32B-Preview model. Codes are available at https://github.com/NovaSky-AI/SkyThought.

  • 9 authors
·
Feb 11, 2025 2

Biomedical Large Languages Models Seem not to be Superior to Generalist Models on Unseen Medical Data

Large language models (LLMs) have shown potential in biomedical applications, leading to efforts to fine-tune them on ___domain-specific data. However, the effectiveness of this approach remains unclear. This study evaluates the performance of biomedically fine-tuned LLMs against their general-purpose counterparts on a variety of clinical tasks. We evaluated their performance on clinical case challenges from the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA) and on several clinical tasks (e.g., information extraction, document summarization, and clinical coding). Using benchmarks specifically chosen to be likely outside the fine-tuning datasets of biomedical models, we found that biomedical LLMs mostly perform inferior to their general-purpose counterparts, especially on tasks not focused on medical knowledge. While larger models showed similar performance on case tasks (e.g., OpenBioLLM-70B: 66.4% vs. Llama-3-70B-Instruct: 65% on JAMA cases), smaller biomedical models showed more pronounced underperformance (e.g., OpenBioLLM-8B: 30% vs. Llama-3-8B-Instruct: 64.3% on NEJM cases). Similar trends were observed across the CLUE (Clinical Language Understanding Evaluation) benchmark tasks, with general-purpose models often performing better on text generation, question answering, and coding tasks. Our results suggest that fine-tuning LLMs to biomedical data may not provide the expected benefits and may potentially lead to reduced performance, challenging prevailing assumptions about ___domain-specific adaptation of LLMs and highlighting the need for more rigorous evaluation frameworks in healthcare AI. Alternative approaches, such as retrieval-augmented generation, may be more effective in enhancing the biomedical capabilities of LLMs without compromising their general knowledge.

  • 11 authors
·
Aug 25, 2024

Causal Longitudinal Prior-Fitted Networks for Counterfactual Outcome Prediction

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.

  • 5 authors
·
Jun 3

EpiCurveBench: Evaluating VLMs on Epidemic Curve Digitization

Chart-to-data extraction with vision-language models (VLMs) is increasingly evaluated on benchmarks that show diminishing headroom (frontier VLMs exceed 89% on ChartQA) and with metrics that treat extracted points as unordered key-value pairs, ignoring the temporal structure of time series and penalizing small alignment shifts as catastrophic failures. We address both gaps with EpiCurveBench, a benchmark of 1,000 real-world epidemic curve images curated from diverse public-health sources, and EpiCurveSimilarity (ECS), an evaluation metric that aligns predicted and ground-truth series via dynamic programming, tolerating local temporal shifts and gaps while penalizing them proportionally. Evaluating six methods--three frontier closed VLMs, one open VLM, and two specialized chart-extraction systems--we find the strongest model reaches only 52.3% ECS, and that ECS spreads the four general-purpose VLMs over a 25-point range where key-value metrics (RMS, SCRM) compress them into a 5-point band. We further validate ECS against four downstream epidemiological summary statistics, finding that higher ECS predicts smaller errors in total counts, peak timing, and peak magnitude, and higher growth-rate fidelity; across all four, ECS correlates 1.5--3.6 times more strongly than Dynamic Time Warping, which lacks a gap penalty and therefore cannot distinguish a truncated prediction from a temporally faithful one. EpiCurveBench targets a high-impact public-health application--unlocking decades of outbreak data trapped in published figures--but the benchmark and metric apply directly to any structured time-series chart-extraction setting.

  • 2 authors
·
May 25

Hippocrates: An Open-Source Framework for Advancing Large Language Models in Healthcare

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

  • 7 authors
·
Apr 25, 2024