Daily Papers

This study investigates the metacognitive capabilities of Large Language Models relative to human metacognition in the context of the International Coaching Federation ICF mimicking exam, a situational judgment test related to coaching competencies. Using a mixed method approach, we assessed the metacognitive performance, including sensitivity, accuracy in probabilistic predictions, and bias, of human participants and five advanced LLMs (GPT-4, Claude-3-Opus 3, Mistral Large, Llama 3, and Gemini 1.5 Pro). The results indicate that LLMs outperformed humans across all metacognitive metrics, particularly in terms of reduced overconfidence, compared to humans. However, both LLMs and humans showed less adaptability in ambiguous scenarios, adhering closely to predefined decision frameworks. The study suggests that Generative AI can effectively engage in human-like metacognitive processing without conscious awareness. Implications of the study are discussed in relation to development of AI simulators that scaffold cognitive and metacognitive aspects of mastering coaching competencies. More broadly, implications of these results are discussed in relation to development of metacognitive modules that lead towards more autonomous and intuitive AI systems.

Recently, In-context Learning (ICL) has become a significant inference paradigm in Large Multimodal Models (LMMs), utilizing a few in-context demonstrations (ICDs) to prompt LMMs for new tasks. However, the synergistic effects in multimodal data increase the sensitivity of ICL performance to the configurations of ICDs, stimulating the need for a more stable and general mapping function. Mathematically, in Transformer-based models, ICDs act as ``shift vectors'' added to the hidden states of query tokens. Inspired by this, we introduce Mimic In-Context Learning (MimIC) to learn stable and generalizable shift effects from ICDs. Specifically, compared with some previous shift vector-based methods, MimIC more strictly approximates the shift effects by integrating lightweight learnable modules into LMMs with four key enhancements: 1) inserting shift vectors after attention layers, 2) assigning a shift vector to each attention head, 3) making shift magnitude query-dependent, and 4) employing a layer-wise alignment loss. Extensive experiments on two LMMs (Idefics-9b and Idefics2-8b-base) across three multimodal tasks (VQAv2, OK-VQA, Captioning) demonstrate that MimIC outperforms existing shift vector-based methods. The code is available at https://github.com/Kamichanw/MimIC.

Idiopathic pulmonary fibrosis (IPF) is a progressive disease that irreversibly transforms lung tissue into rigid fibrotic structures, leading to debilitating symptoms such as shortness of breath and chronic fatigue. The heterogeneity and complexity of this disease, particularly regarding its severity and progression rate, have made predicting its future course a complex and challenging task. Besides, traditional diagnostic methods based on clinical evaluations and imaging have limitations in capturing the disease's complexity. Using the Kaggle Pulmonary Fibrosis Progression dataset, which includes computed tomography images, and clinical information, the model predicts changes in forced vital capacity (FVC), a key progression indicator. Our method uses a proposed context-aware sequential-parallel hybrid transformer model and clinical information enrichment for its prediction. The proposed method achieved a Laplace Log-Likelihood score of -6.508, outperforming prior methods and demonstrating superior predictive capabilities. These results highlight the potential of advanced deep learning techniques to provide more accurate and timely predictions, offering a transformative approach to the diagnosis and management of IPF, with implications for improved patient outcomes and therapeutic advancements.

Foundation models rely on large-scale web-crawled datasets, which frequently contain noisy data, biases, and irrelevant content. Existing data selection techniques typically use human heuristics, downstream evaluation datasets, or specialized scoring models, and can overlook samples' utility in the training process. Instead, we propose a new approach, Mimic Score, a data quality metric that uses a pretrained reference model as a guide to assess the usefulness of data samples for training a new model. It relies on the alignment between the gradient of the new model parameters and the vector pointing toward the reference model in weight space. Samples that misalign with this direction are considered low-value and can be filtered out. Motivated by the Mimic score, we develop Grad-Mimic, a data selection framework that identifies and prioritizes useful samples, automating the selection process to create effective filters. Empirically, using Mimic scores to guide model training results in consistent performance gains across six image datasets and enhances the performance of CLIP models. Moreover, Mimic scores and their associated filters improve upon existing filtering methods and offer accurate estimation of dataset quality.

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

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

Supervised Fine-Tuning (SFT) is used to specialize model behavior by training weights to produce intended target responses for queries. In contrast, In-Context Learning (ICL) adapts models during inference with instructions or demonstrations in the prompt. ICL can offer better generalizability and more calibrated responses compared to SFT in data scarce settings, at the cost of more inference compute. In this work, we ask the question: Can ICL's internal computations be used to improve the qualities of SFT? We first show that ICL and SFT produce distinct activation patterns, indicating that the two methods achieve adaptation through different functional mechanisms. Motivated by this observation and to use ICL's rich functionality, we introduce ICL Activation Alignment (IA2), a self-distillation technique which aims to replicate ICL's activation patterns in SFT models and incentivizes ICL-like internal reasoning. Performing IA2 as a priming step before SFT significantly improves the accuracy and calibration of model outputs, as shown by our extensive empirical results on 12 popular benchmarks and 2 model families. This finding is not only practically useful, but also offers a conceptual window into the inner mechanics of model adaptation.

Image copy detection (ICD) aims to determine whether a query image is an edited copy of any image from a reference set. Currently, there are very limited public benchmarks for ICD, while all overlook a critical challenge in real-world applications, i.e., the distraction from hard negative queries. Specifically, some queries are not edited copies but are inherently similar to some reference images. These hard negative queries are easily false recognized as edited copies, significantly compromising the ICD accuracy. This observation motivates us to build the first ICD benchmark featuring this characteristic. Based on existing ICD datasets, this paper constructs a new dataset by additionally adding 100, 000 and 24, 252 hard negative pairs into the training and test set, respectively. Moreover, this paper further reveals a unique difficulty for solving the hard negative problem in ICD, i.e., there is a fundamental conflict between current metric learning and ICD. This conflict is: the metric learning adopts symmetric distance while the edited copy is an asymmetric (unidirectional) process, e.g., a partial crop is close to its holistic reference image and is an edited copy, while the latter cannot be the edited copy of the former (in spite the distance is equally small). This insight results in an Asymmetrical-Similarity Learning (ASL) method, which allows the similarity in two directions (the query <-> the reference image) to be different from each other. Experimental results show that ASL outperforms state-of-the-art methods by a clear margin, confirming that solving the symmetric-asymmetric conflict is critical for ICD. The NDEC dataset and code are available at https://github.com/WangWenhao0716/ASL.

Conventional task-specific electrocardiogram (ECG) analysis models require large annotated datasets to train. Foundation models mitigate this burden by leveraging self-supervised pretraining; however, the scarcity of open-weight ECG foundation models hinders adoption and cross-study comparability. We present ECG-FM, an open foundation model for ECG analysis, and conduct a study using a dataset of 1.5 million ECGs. ECG-FM is a transformer-based model pretrained using a hybrid contrastive and generative self-supervised learning approach. Our downstream tasks include predicting reduced left ventricular ejection fraction (LVEF) and ECG interpretation labels, where we release a benchmark task on the MIMIC-IV-ECG dataset. We affirm that ECG-FM is robust, label-efficient, and functionally discriminative by showcasing data scaling experiments, performing a latent space analysis, and generating saliency maps. ECG-FM markedly outperforms task-specific models in the small-to-medium-scale data regime and demonstrates cross-dataset generalizability, achieving high AUROC on many clinically salient labels such as atrial fibrillation (0.996) and LVEF<=40% (0.929). We release our code, model weights, and benchmark task at https://github.com/bowang-lab/ECG-FM/.

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

This study aims to explore the implementation of Natural Language Processing (NLP) and machine learning (ML) techniques to automate the coding of medical letters with visualised explainability and light-weighted local computer settings. Currently in clinical settings, coding is a manual process that involves assigning codes to each condition, procedure, and medication in a patient's paperwork (e.g., 56265001 heart disease using SNOMED CT code). There are preliminary research on automatic coding in this field using state-of-the-art ML models; however, due to the complexity and size of the models, the real-world deployment is not achieved. To further facilitate the possibility of automatic coding practice, we explore some solutions in a local computer setting; in addition, we explore the function of explainability for transparency of AI models. We used the publicly available MIMIC-III database and the HAN/HLAN network models for ICD code prediction purposes. We also experimented with the mapping between ICD and SNOMED CT knowledge bases. In our experiments, the models provided useful information for 97.98\% of codes. The result of this investigation can shed some light on implementing automatic clinical coding in practice, such as in hospital settings, on the local computers used by clinicians , project page https://github.com/Glenj01/Medical-Coding.

The applicability of current lesion segmentation models for chest X-rays (CXRs) has been limited both by a small number of target labels and the reliance on long, detailed expert-level text inputs, creating a barrier to practical use. To address these limitations, we introduce a new paradigm: instruction-guided lesion segmentation (ILS), which is designed to segment diverse lesion types based on simple, user-friendly instructions. Under this paradigm, we construct MIMIC-ILS, the first large-scale instruction-answer dataset for CXR lesion segmentation, using our fully automated multimodal pipeline that generates annotations from chest X-ray images and their corresponding reports. MIMIC-ILS contains 1.1M instruction-answer pairs derived from 192K images and 91K unique segmentation masks, covering seven major lesion types. To empirically demonstrate its utility, we introduce ROSALIA, a vision-language model fine-tuned on MIMIC-ILS. ROSALIA can segment diverse lesions and provide textual explanations in response to user instructions. The model achieves high segmentation and textual accuracy in our newly proposed task, highlighting the effectiveness of our pipeline and the value of MIMIC-ILS as a foundational resource for pixel-level CXR lesion grounding.