arXiv:2601.09072v1 Announce Type: new Abstract: Developing safe, effective, and practically useful clinical prediction models (CPMs) traditionally requires iterative collaboration between clinical experts, data scientists, and informaticists. This process refines the often small but critical details of the model building process, such as which features/patients to include and how clinical categories should be defined. However, this traditional collaboration process is extremely time- and resource-intensive, resulting in only a small fraction of CPMs reaching clinical practice. This challenge intensifies when teams attempt to incorporate unstructured clinical notes, which can contain an enormous number of concepts. To address this challenge, we introduce HACHI, an iterative human-in-the-loop framework that uses AI agents to accelerate the development of fully interpretable CPMs by enabling the exploration of concepts in clinical notes. HACHI alternates between (i) an AI agent rapidly exploring and evaluating candidate concepts in clinical notes and (ii) clinical and domain experts providing feedback to improve the CPM learning process. HACHI defines concepts as simple yes-no questions that are used in linear models, allowing the clinical AI team to transparently review, refine, and validate the CPM learned in each round. In two real-world prediction tasks (acute kidney injury and traumatic brain injury), HACHI outperforms existing approaches, surfaces new clinically relevant concepts not included in commonly-used CPMs, and improves model generalizability across clinical sites and time periods. Furthermore, HACHI reveals the critical role of the clinical AI team, such as directing the AI agent to explore concepts that it had not previously considered, adjusting the granularity of concepts it considers, changing the objective function to better align with the clinical objectives, and identifying issues of data bias and leakage.

npj Digital Medicine, Published online: 10 December 2025; doi:10.1038/s41746-025-02119-7

Potential for Algorithmic Bias in Clinical Decision Instrument Development

arXiv:2505.23856v2 Announce Type: replace-cross Abstract: The emerging capabilities of large language models (LLMs) have sparked concerns about their immediate potential for harmful misuse. The core approach to mitigate these concerns is the detection of harmful queries to the model. Current detection approaches are fallible, and are particularly susceptible to attacks that exploit mismatched generalization of model capabilities (e.g., prompts in low-resource languages or prompts provided in non-text modalities such as image and audio). To tackle this challenge, we propose Omniguard, an approach for detecting harmful prompts across languages and modalities. Our approach (i) identifies internal representations of an LLM/MLLM that are aligned across languages or modalities and then (ii) uses them to build a language-agnostic or modality-agnostic classifier for detecting harmful prompts. Omniguard improves harmful prompt classification accuracy by 11.57\% over the strongest baseline in a multilingual setting, by 20.44\% for image-based prompts, and sets a new SOTA for audio-based prompts. By repurposing embeddings computed during generation, Omniguard is also very efficient ($\approx\!120 \times$ faster than the next fastest baseline). Code and data are available at: https://github.com/vsahil/OmniGuard.