Smoking has severe health consequences, and secondhand smoke (SHS) exposure among children increases the risk of sudden infant death syndrome, chronic respiratory diseases, such as asthma, and lung cancer in adulthood. For many parents, pediatricians are the primary source of interaction with the healthcare system. Nevertheless, in pediatric settings, appropriate tobacco treatments are rarely, if ever, provided to parents who smoke. To best address tobacco use among parents, it is ideal to develop scalable solutions that are coordinated across health systems, community partners, and national services within pediatric settings. We describe our experience developing and implementing a parent tobacco treatment platform (PTTP) within a pediatric institution that leverages multiple international standards to support interoperability, with the overarching goal of providing a model for how such work can be approached. The clinical decision support (CDS) system includes clinician- and patient-facing components, connects parents to three different treatment options (nicotine replacement therapy, text-based counseling, and telephonic counseling), and incorporates three international standards (Fast Healthcare Interoperability Resources [FHIR], SMART on FHIR, and CDS Hooks). FHIR is used across all components. SMART on FHIR is limited to the clinician-facing tool, and CDS Hooks is used in the patient-facing portion. While healthcare interoperability standards supported a significant portion of the overall system, non-standard technologies and enhancements of existing standards were also required. Further, no connections with community partners could use existing interoperability standards. Over one year, the CDS was used in 194,946 visits, identified 7,847 parents who smoke, and connected 2,954 parents to 6,320 distinct treatment services, a significant improvement compared to prior efforts. Our project demonstrates that building CDS systems using international standards, such as SMART on FHIR, FHIR, and CDS Hooks, is possible, but challenges remain. Limits in the CDS Hooks standard to support common workflows and a lack of communication standards used by 3rd parties outside the healthcare system represent areas for future work. To support these requirements, additional EHR-specific records and communication mechanisms were required.

Background: The COVID-19 pandemic has intensified mental health issues globally, highlighting the urgent need for remote mental health monitoring. Digital phenotyping using smart devices has emerged as a promising approach, but it remains unclear which features are essential for predicting depression and anxiety. Objective: This systematic review aimed to identify the types of features collected through smart packages—integrated systems combining smartphones with wearable devices such as Actiwatches, smartbands, and smartwatches—and to determine which features should be considered essential for mental health monitoring based on the type of device used. Methods: A systematic review was conducted. Searches were performed across Web of Science, PubMed, and Scopus on February 5, 2025. Inclusion criteria comprised quantitative studies involving adults (≥19 years) using smart devices to predict depression or anxiety based on passive data collection. Studies focusing solely on smartphones or qualitative designs were excluded. Risk of bias was assessed using the Mixed Methods Appraisal Tool and Quality Criteria Checklist. Data were synthesized descriptively, and the relative contribution of each feature was further assessed by calculating coverage (proportion of studies using a feature) and importance among used (proportion identifying it as important when used). These metrics were visualized in quadrant-based scatter plots to identify consistently important features across devices. Results: From 1,382 records, 22 studies across 11 countries were included. The overall synthesis identified a core feature package—accelerometer (ACC), steps, Heart Rate (HR), and sleep. Device-specific analyses revealed further nuances: In Actiwatch studies, ACC and activity were consistently important, but sleep features were rarely examined. In smartbands, HR, steps, sleep, and phone usage were essential, while Global Positioning System (GPS), Electrodermal Activity (EDA), and skin temperature (TEMP) showed high importance when used, suggesting opportunities for broader adoption. In smartwatch studies, sleep and HR emerged as core features, whereas steps and ACC were widely used but often not identified as important. Conclusions: This systematic review identified a core feature package comprising ACC, steps, HR, and sleep that consistently contributes to mood disorder prediction across devices. At the same time, device-specific differences were observed: Actiwatch studies mainly emphasized ACC and activity but underutilized sleep features; smartbands highlighted HR, steps, sleep, and phone usage, with EDA, TEMP, and GPS showing additional promise; and smartwatches most reliably leveraged sleep and HR, while steps and ACC were widely used yet less effective. These findings suggest that while a shared core set of features exists, optimizing digital phenotyping requires tailoring feature selection to the characteristics of each device type. To advance this field, improving data accessibility, particularly in smartwatch ecosystems, and adopting standardized reporting frameworks will be essential to enhance comparability, reproducibility, and future meta-analytic integration. Clinical Trial: Open Science Framework https://osf.io/nz7k8

Nature Medicine, Published online: 05 November 2025; doi:10.1038/s41591-025-03982-3

Pretrained using 335,645 whole-slide images, a foundation model is developed to provide representations for slide- and patient-level tasks. It is capable of performing clinical tasks and generating reports even in data-scarce scenarios, such as rare cancer diagnosis and survival prediction, without requiring further fine-tuning.

Nature, Published online: 05 November 2025; doi:10.1038/s41586-025-09716-2

The Fair Human-Centric Image Benchmark (FHIBE, pronounced ‘Feebee’)—an image dataset that implements best practices for consent, privacy, compensation, safety, diversity and utility—can be used responsibly as a fairness evaluation dataset for many human-centric computer vision applications.

arXiv:2511.01935v1 Announce Type: cross Abstract: The determination of sample size in qualitative research has traditionally relied on the subjective and often ambiguous principle of data saturation, which can lead to inconsistencies and threaten methodological rigor. This study introduces a new, systematic model based on machine learning (ML) to make this process more objective. Utilizing a dataset derived from five fundamental qualitative research approaches - namely, Case Study, Grounded Theory, Phenomenology, Narrative Research, and Ethnographic Research - we developed an ensemble learning model. Ten critical parameters, including research scope, information power, and researcher competence, were evaluated using an ordinal scale and used as input features. After thorough preprocessing and outlier removal, multiple ML algorithms were trained and compared. The K-Nearest Neighbors (KNN), Gradient Boosting (GB), Random Forest (RF), XGBoost, and Decision Tree (DT) algorithms showed the highest explanatory power (Test R2 ~ 0.85), effectively modeling the complex, non-linear relationships involved in qualitative sampling decisions. Feature importance analysis confirmed the vital roles of research design type and information power, providing quantitative validation of key theoretical assumptions in qualitative methodology. The study concludes by proposing a conceptual framework for a web-based computational application designed to serve as a decision support system for qualitative researchers, journal reviewers, and thesis advisors. This model represents a significant step toward standardizing sample size justification, enhancing transparency, and strengthening the epistemological foundation of qualitative inquiry through evidence-based, systematic decision-making.

arXiv:2511.02531v1 Announce Type: cross Abstract: Healthcare artificial intelligence systems routinely fail when deployed across institutions, with documented performance drops and perpetuation of discriminatory patterns embedded in historical data. This brittleness stems, in part, from learning statistical associations rather than causal mechanisms. Causal graph neural networks address this triple crisis of distribution shift, discrimination, and inscrutability by combining graph-based representations of biomedical data with causal inference principles to learn invariant mechanisms rather than spurious correlations. This Review examines methodological foundations spanning structural causal models, disentangled causal representation learning, and techniques for interventional prediction and counterfactual reasoning on graphs. We analyse applications demonstrating clinical value across psychiatric diagnosis through brain network analysis, cancer subtyping via multi-omics causal integration, continuous physiological monitoring with mechanistic interpretation, and drug recommendation correcting prescription bias. These advances establish foundations for patient-specific Causal Digital Twins, enabling in silico clinical experimentation, with integration of large language models for hypothesis generation and causal graph neural networks for mechanistic validation. Substantial barriers remain, including computational requirements precluding real-time deployment, validation challenges demanding multi-modal evidence triangulation beyond cross-validation, and risks of causal-washing where methods employ causal terminology without rigorous evidentiary support. We propose tiered frameworks distinguishing causally-inspired architectures from causally-validated discoveries and identify critical research priorities making causal rather than purely associational claims.

arXiv:2511.02752v1 Announce Type: cross Abstract: Artificial intelligence (AI) is diffusing globally at unprecedented speed, but adoption remains uneven. Frontier Large Language Models (LLMs) are known to perform poorly on low-resource languages due to data scarcity. We hypothesize that this performance deficit reduces the utility of AI, thereby slowing adoption in Low-Resource Language Countries (LRLCs). To test this, we use a weighted regression model to isolate the language effect from socioeconomic and demographic factors, finding that LRLCs have a share of AI users that is approximately 20% lower relative to their baseline. These results indicate that linguistic accessibility is a significant, independent barrier to equitable AI diffusion.

arXiv:2511.02805v1 Announce Type: cross Abstract: Typical search agents concatenate the entire interaction history into the LLM context, preserving information integrity but producing long, noisy contexts, resulting in high computation and memory costs. In contrast, using only the current turn avoids this overhead but discards essential information. This trade-off limits the scalability of search agents. To address this challenge, we propose MemSearcher, an agent workflow that iteratively maintains a compact memory and combines the current turn with it. At each turn, MemSearcher fuses the user's question with the memory to generate reasoning traces, perform search actions, and update memory to retain only information essential for solving the task. This design stabilizes context length across multi-turn interactions, improving efficiency without sacrificing accuracy. To optimize this workflow, we introduce multi-context GRPO, an end-to-end RL framework that jointly optimize reasoning, search strategies, and memory management of MemSearcher Agents. Specifically, multi-context GRPO samples groups of trajectories under different contexts and propagates trajectory-level advantages across all conversations within them. Trained on the same dataset as Search-R1, MemSearcher achieves significant improvements over strong baselines on seven public benchmarks: +11% on Qwen2.5-3B-Instruct and +12% on Qwen2.5-7B-Instruct relative average gains. Notably, the 3B-based MemSearcher even outperforms 7B-based baselines, demonstrating that striking a balance between information integrity and efficiency yields both higher accuracy and lower computational overhead. The code and models will be publicly available at https://github.com/icip-cas/MemSearcher

arXiv:2510.09801v2 Announce Type: replace Abstract: LLM-powered agents are both a promising new technology and a source of complexity, where choices about models, tools, and prompting can affect their usefulness. While numerous benchmarks measure agent accuracy across domains, they mostly assume full automation, failing to represent the collaborative nature of real-world use cases. In this paper, we make two major steps towards the rigorous assessment of human-agent interactions. First, we propose PULSE, a framework for more efficient human-centric evaluation of agent designs, which comprises collecting user feedback, training an ML model to predict user satisfaction, and computing results by combining human satisfaction ratings with model-generated pseudo-labels. Second, we deploy the framework on a large-scale web platform built around the open-source software agent OpenHands, collecting in-the-wild usage data across over 15k users. We conduct case studies around how three agent design decisions -- choice of LLM backbone, planning strategy, and memory mechanisms -- impact developer satisfaction rates, yielding practical insights for software agent design. We also show how our framework can lead to more robust conclusions about agent design, reducing confidence intervals by 40% compared to a standard A/B test. Finally, we find substantial discrepancies between in-the-wild results and benchmark performance (e.g., the anti-correlation between results comparing claude-sonnet-4 and gpt-5), underscoring the limitations of benchmark-driven evaluation. Our findings provide guidance for evaluations of LLM agents with humans and identify opportunities for better agent designs.

arXiv:2504.04365v5 Announce Type: replace-cross Abstract: The performance of large language models (LLMs) depends on how they are prompted, with choices spanning both the high-level prompting pattern (e.g., Zero-Shot, CoT, ReAct, ReWOO) and the specific prompt content (instructions and few-shot demonstrations). Manually tuning this combination is tedious, error-prone, and specific to a given LLM and task. Therefore, this paper proposes AutoPDL, an automated approach to discovering good LLM agent configurations. Our approach frames this as a structured AutoML problem over a combinatorial space of agentic and non-agentic prompting patterns and demonstrations, using successive halving to efficiently navigate this space. We introduce a library implementing common prompting patterns using the PDL prompt programming language. AutoPDL solutions are human-readable, editable, and executable PDL programs that use this library. This approach also enables source-to-source optimization, allowing human-in-the-loop refinement and reuse. Evaluations across three tasks and seven LLMs (ranging from 3B to 70B parameters) show consistent accuracy gains ($9.21\pm15.46$ percentage points), up to 67.5pp, and reveal that selected prompting strategies vary across models and tasks.

Nature, Published online: 05 November 2025; doi:10.1038/d41586-025-03540-4

Scientists are developing antibodies to track the evolution of these viruses and better treat infections.

arXiv:2511.01445v1 Announce Type: new Abstract: Global healthcare systems face critical challenges from increasing patient volumes and limited consultation times, with primary care visits averaging under 5 minutes in many countries. While pre-consultation processes encompassing triage and structured history-taking offer potential solutions, they remain limited by passive interaction paradigms and context management challenges in existing AI systems. This study introduces a hierarchical multi-agent framework that transforms passive medical AI systems into proactive inquiry agents through autonomous task orchestration. We developed an eight-agent architecture with centralized control mechanisms that decomposes pre-consultation into four primary tasks: Triage ($T_1$), History of Present Illness collection ($T_2$), Past History collection ($T_3$), and Chief Complaint generation ($T_4$), with $T_1$--$T_3$ further divided into 13 domain-specific subtasks. Evaluated on 1,372 validated electronic health records from a Chinese medical platform across multiple foundation models (GPT-OSS 20B, Qwen3-8B, Phi4-14B), the framework achieved 87.0% accuracy for primary department triage and 80.5% for secondary department classification, with task completion rates reaching 98.2% using agent-driven scheduling versus 93.1% with sequential processing. Clinical quality scores from 18 physicians averaged 4.56 for Chief Complaints, 4.48 for History of Present Illness, and 4.69 for Past History on a 5-point scale, with consultations completed within 12.7 rounds for $T_2$ and 16.9 rounds for $T_3$. The model-agnostic architecture maintained high performance across different foundation models while preserving data privacy through local deployment, demonstrating the potential for autonomous AI systems to enhance pre-consultation efficiency and quality in clinical settings.

arXiv:2511.00094v1 Announce Type: cross Abstract: Robotic systems have become integral to smart environments, enabling applications ranging from urban surveillance and automated agriculture to industrial automation. However, their effective operation in dynamic settings - such as smart cities and precision farming - is challenged by continuously evolving topographies and environmental conditions. Traditional control systems often struggle to adapt quickly, leading to inefficiencies or operational failures. To address this limitation, we propose a novel framework for autonomous and dynamic reconfiguration of robotic controllers using Digital Twin technology. Our approach leverages a virtual replica of the robot's operational environment to simulate and optimize movement trajectories in response to real-world changes. By recalculating paths and control parameters in the Digital Twin and deploying the updated code to the physical robot, our method ensures rapid and reliable adaptation without manual intervention. This work advances the integration of Digital Twins in robotics, offering a scalable solution for enhancing autonomy in smart, dynamic environments.

arXiv:2511.00209v1 Announce Type: cross Abstract: Diffusion models have emerged as a leading framework in generative modeling, showing significant potential to accelerate and transform the traditionally slow and costly process of drug discovery. This review provides a systematic comparison of their application in designing two principal therapeutic modalities: small molecules and therapeutic peptides. We analyze how a unified framework of iterative denoising is adapted to the distinct molecular representations, chemical spaces, and design objectives of each modality. For small molecules, these models excel at structure-based design, generating novel, pocket-fitting ligands with desired physicochemical properties, yet face the critical hurdle of ensuring chemical synthesizability. Conversely, for therapeutic peptides, the focus shifts to generating functional sequences and designing de novo structures, where the primary challenges are achieving biological stability against proteolysis, ensuring proper folding, and minimizing immunogenicity. Despite these distinct challenges, both domains face shared hurdles: the need for more accurate scoring functions, the scarcity of high-quality experimental data, and the crucial requirement for experimental validation. We conclude that the full potential of diffusion models will be unlocked by bridging these modality-specific gaps and integrating them into automated, closed-loop Design-Build-Test-Learn (DBTL) platforms, thereby shifting the paradigm from chemical exploration to the targeted creation of novel therapeutics.

arXiv:2511.00588v1 Announce Type: cross Abstract: Large language models (LLMs) offer transformative potential for clinical decision support in spine surgery but pose significant risks through hallucinations, which are factually inconsistent or contextually misaligned outputs that may compromise patient safety. This study introduces a clinician-centered framework to quantify hallucination risks by evaluating diagnostic precision, recommendation quality, reasoning robustness, output coherence, and knowledge alignment. We assessed six leading LLMs across 30 expert-validated spinal cases. DeepSeek-R1 demonstrated superior overall performance (total score: 86.03 $\pm$ 2.08), particularly in high-stakes domains such as trauma and infection. A critical finding reveals that reasoning-enhanced model variants did not uniformly outperform standard counterparts: Claude-3.7-Sonnet's extended thinking mode underperformed relative to its standard version (80.79 $\pm$ 1.83 vs. 81.56 $\pm$ 1.92), indicating extended chain-of-thought reasoning alone is insufficient for clinical reliability. Multidimensional stress-testing exposed model-specific vulnerabilities, with recommendation quality degrading by 7.4% under amplified complexity. This decline contrasted with marginal improvements in rationality (+2.0%), readability (+1.7%) and diagnosis (+4.7%), highlighting a concerning divergence between perceived coherence and actionable guidance. Our findings advocate integrating interpretability mechanisms (e.g., reasoning chain visualization) into clinical workflows and establish a safety-aware validation framework for surgical LLM deployment.

arXiv:2511.01775v1 Announce Type: cross Abstract: Foundation models in video generation are demonstrating remarkable capabilities as potential world models for simulating the physical world. However, their application in high-stakes domains like surgery, which demand deep, specialized causal knowledge rather than general physical rules, remains a critical unexplored gap. To systematically address this challenge, we present SurgVeo, the first expert-curated benchmark for video generation model evaluation in surgery, and the Surgical Plausibility Pyramid (SPP), a novel, four-tiered framework tailored to assess model outputs from basic appearance to complex surgical strategy. On the basis of the SurgVeo benchmark, we task the advanced Veo-3 model with a zero-shot prediction task on surgical clips from laparoscopic and neurosurgical procedures. A panel of four board-certified surgeons evaluates the generated videos according to the SPP. Our results reveal a distinct "plausibility gap": while Veo-3 achieves exceptional Visual Perceptual Plausibility, it fails critically at higher levels of the SPP, including Instrument Operation Plausibility, Environment Feedback Plausibility, and Surgical Intent Plausibility. This work provides the first quantitative evidence of the chasm between visually convincing mimicry and causal understanding in surgical AI. Our findings from SurgVeo and the SPP establish a crucial foundation and roadmap for developing future models capable of navigating the complexities of specialized, real-world healthcare domains.

arXiv:2510.19755v3 Announce Type: replace-cross Abstract: Diffusion Models have become a cornerstone of modern generative AI for their exceptional generation quality and controllability. However, their inherent \textit{multi-step iterations} and \textit{complex backbone networks} lead to prohibitive computational overhead and generation latency, forming a major bottleneck for real-time applications. Although existing acceleration techniques have made progress, they still face challenges such as limited applicability, high training costs, or quality degradation. Against this backdrop, \textbf{Diffusion Caching} offers a promising training-free, architecture-agnostic, and efficient inference paradigm. Its core mechanism identifies and reuses intrinsic computational redundancies in the diffusion process. By enabling feature-level cross-step reuse and inter-layer scheduling, it reduces computation without modifying model parameters. This paper systematically reviews the theoretical foundations and evolution of Diffusion Caching and proposes a unified framework for its classification and analysis. Through comparative analysis of representative methods, we show that Diffusion Caching evolves from \textit{static reuse} to \textit{dynamic prediction}. This trend enhances caching flexibility across diverse tasks and enables integration with other acceleration techniques such as sampling optimization and model distillation, paving the way for a unified, efficient inference framework for future multimodal and interactive applications. We argue that this paradigm will become a key enabler of real-time and efficient generative AI, injecting new vitality into both theory and practice of \textit{Efficient Generative Intelligence}.

Generative artificial intelligence (GenAI) enables the production of coherent and contextually relevant text by processing large-scale linguistic datasets. Tools such as ChatGPT, Gemini, Claude, and LLaMA are increasingly integrated into medical education, assisting students with a range of tasks, including clinical reasoning, literature review, scientific writing, and formative assessment. Although these tools offer significant advantages in terms of productivity, personalization, and cognitive support, their impact on critical thinking—a cornerstone of medical education—remains uncertain. The aim of this viewpoint paper is to critically assess the influence of GenAI on critical thinking within medical training, examining both its potential to enhance cognitive skills and the risks it poses to cognitive autonomy. Users have reported increased efficiency and improved linguistic output; however, concerns have also been raised regarding the risk of cognitive overreliance. Current evidence presents a mixed picture, indicating both improvements in learner engagement and potential drawbacks such as passivity or susceptibility to misinformation. Without curricular integration that prioritizes ethical use, prompt engineering, and critical evaluation, GenAI may compromise the cognitive autonomy of medical students. Conversely, when thoughtfully embedded into pedagogical frameworks, these tools can act as cognitive enhancers—supporting, rather than replacing, clinical reasoning. Medical education must adapt to ensure that future physicians engage with GenAI in a critical, ethical, and context-aware manner, especially in complex decision-making scenarios. This transformation demands not only technological fluency but also reflective practice and sustained oversight by faculty and academic institutions.