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AI-Enhanced Social Robotic Versus Computer-Based Virtual Patients for Clinical Reasoning Training in Medical Education: Observational Crossover Cohort Study

Background: Virtual patient (VP) simulations can be used to practice clinical reasoning (CR) in controlled learning environments. Traditional computer-based VP platforms often lack the authenticity and interactivity required for effective CR training. Artificial intelligence (AI)–enhanced social robotic VPs can enhance realism and engagement; however, quantitative evidence comparing them with conventional VP platforms remains limited. Objective: We compared medical students’ experience of an AI-enhanced social robotic versus a conventional computer-based VP platform regarding the extent to which the design characteristics of the respective platform facilitate CR skill training. Methods: This observational crossover cohort study involved 178 sixth-semester medical students at Karolinska Institutet, Stockholm, Sweden (response rate: 42.3%; 178 of 421 invited students; Spring 2024-Spring 2025), who experienced both a large language model–enhanced social robotic VP platform supporting dialogue (social artificial intelligence–enhanced robotic interface [SARI]) and a conventional computer-based VP platform (virtual interactive case [VIC]) during their clinical rotation within rheumatology. Platform order was determined by clinical rotation scheduling. VP design was evaluated using a validated questionnaire across 5 domains: authenticity, professional approach, coaching quality, learning effects, and overall judgment. Students’ CR training preferences were assessed using categorical responses and a Visual Analogue Scale, where a lower score favored SARI and a score of 5 indicated equal preference between platforms. Results: SARI outperformed VIC across all 5 VP design domains. Students rated SARI higher for authenticity (median 4.0, IQR 3.5-4.5 vs 3.0, IQR 2.5-3.5; P<.001 professional approach iqr vs>P<.001 coaching quality iqr vs>P<.001 learning effect iqr vs>P<.001 and overall judgment vs iqr>P<.001 students strongly preferred sari for cr training vs odds ratio ci>P<.001 with visual analogue scale scores confirming this preference iqr>P<.001 preferences were consistent across most subgroups prior vp experience and platform order in the difference was not significant that is students with vs or ci>P=.11) and students first introduced to VIC (55% vs 45%; OR 1.5; 95% CI 0.7-2.9; P=.33). Conclusions: Our findings provide the first quantitative evidence that AI-enhanced social robotic VPs offer superior design characteristics than conventional computer-based platforms for CR training in medical education. These results support the use of AI-driven social robots for VP simulations to better prepare medical students for real clinical encounters, and warrant future research on objective CR skill outcomes and long-term transfer to clinical practice. Unlike previous qualitative studies examining each platform separately, this study provides the first quantitative comparison of design characteristics between AI-enhanced social robotic and conventional computer-based VPs.
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Harnessing Single-Cell RNA-Seq for Computational Drug Repurposing in Cancer Immunotherapy

Pharmaceuticals (Basel). 2025 Nov 20;18(11):1769. doi: 10.3390/ph18111769.

ABSTRACT

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and show notable success in some cancer types such as non-small cell lung cancer, melanoma and colorectal cancers, while they demonstrate relatively low response rate in others, such as esophageal cancers. Due to the heterogeneous nature of the tumor microenvironment and patient-to-patient variability, there remains a need to improve ICI response rates. Combining ICIs with therapies that can overcome resistance is a promising strategy. Compared to de novo drug development, drug repurposing offers a faster and more cost-effective approach to identifying such combination candidates. A variety of computational drug repurposing tools leverage genomics and/or transcriptomic data. As single-cell RNA sequencing (scRNA-seq) technology becomes available, it enables precise targeting of cancer-driving cellular components. In this review, we highlight current computational drug repurposing tools utilizing scRNA-seq data and demonstrate the application of two such tools, scDrug and scDrugPrio, on an esophageal squamous cell carcinoma dataset to identify potential drug candidates for combination with ICI therapy to enhance treatment response. scDrug focuses on predicting tumor cell-specific cytotoxicity, while scDrugPrio prioritizes drugs by reversing gene signatures associated with ICI non-responsiveness across diverse tumor microenvironment cell types. Together, this review underscores the importance of a multi-faceted approach in computational drug repurposing and highlights its potential for identifying drugs that enhance ICI treatment. Future work can expand the application of these strategies to multi-omics and spatial transcriptomics datasets, as well as personalized patient samples, to further refine drug repurposing involving ICI therapy.

PMID:41305010 | PMC:PMC12655618 | DOI:10.3390/ph18111769

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Monitoring of circulating tumor DNA allows early detection of disease relapse in patients with operable breast cancer

Mol Oncol. 2025 Nov 27. doi: 10.1002/1878-0261.70170. Online ahead of print.

ABSTRACT

Breast cancer is known for late recurrences, yet current follow-up lacks radiological or blood-based monitoring for systemic relapse. This study evaluated circulating tumor DNA (ctDNA) monitoring for early detection of systemic relapse after curative treatment. In this case-control study of 70 patients with operable breast cancer (35 with relapse and 35 without relapse), blood samples were collected every 6-12 months during a median 8.3-year follow-up. ctDNA was analyzed by targeted DNA sequencing using Oncomine™ Breast cfDNA Research Assay v2, and results were compared to genetic analysis of tumor and metastasis biopsies. ctDNA was detected at relapse in 19 of 35 (54%) patients with disease relapse and preceded clinical or radiological relapse detection in 17, with a median lead time of 10.3 months. In 13 (68%) patients, there was concordance with tumor mutations, and in seven patients, there was also concordance with metastasis. Among the relapse-free patients, seven were ctDNA-positive postsurgery, and only one of them had a match among the tumor variants. These findings suggest serial ctDNA analysis may enable earlier detection of systemic relapse in patients with operable breast cancer.

PMID:41307327 | DOI:10.1002/1878-0261.70170

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Harnessing Single-Cell RNA-Seq for Computational Drug Repurposing in Cancer Immunotherapy

Pharmaceuticals (Basel). 2025 Nov 20;18(11):1769. doi: 10.3390/ph18111769.

ABSTRACT

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and show notable success in some cancer types such as non-small cell lung cancer, melanoma and colorectal cancers, while they demonstrate relatively low response rate in others, such as esophageal cancers. Due to the heterogeneous nature of the tumor microenvironment and patient-to-patient variability, there remains a need to improve ICI response rates. Combining ICIs with therapies that can overcome resistance is a promising strategy. Compared to de novo drug development, drug repurposing offers a faster and more cost-effective approach to identifying such combination candidates. A variety of computational drug repurposing tools leverage genomics and/or transcriptomic data. As single-cell RNA sequencing (scRNA-seq) technology becomes available, it enables precise targeting of cancer-driving cellular components. In this review, we highlight current computational drug repurposing tools utilizing scRNA-seq data and demonstrate the application of two such tools, scDrug and scDrugPrio, on an esophageal squamous cell carcinoma dataset to identify potential drug candidates for combination with ICI therapy to enhance treatment response. scDrug focuses on predicting tumor cell-specific cytotoxicity, while scDrugPrio prioritizes drugs by reversing gene signatures associated with ICI non-responsiveness across diverse tumor microenvironment cell types. Together, this review underscores the importance of a multi-faceted approach in computational drug repurposing and highlights its potential for identifying drugs that enhance ICI treatment. Future work can expand the application of these strategies to multi-omics and spatial transcriptomics datasets, as well as personalized patient samples, to further refine drug repurposing involving ICI therapy.

PMID:41305010 | DOI:10.3390/ph18111769

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Cognitive bias in LLM reasoning compromises interpretation of clinical oncology notes

arXiv:2511.20680v1 Announce Type: cross Abstract: Despite high performance on clinical benchmarks, large language models may reach correct conclusions through faulty reasoning, a failure mode with safety implications for oncology decision support that is not captured by accuracy-based evaluation. In this two-cohort retrospective study, we developed a hierarchical taxonomy of reasoning errors from GPT-4 chain-of-thought responses to real oncology notes and tested its clinical relevance. Using breast and pancreatic cancer notes from the CORAL dataset, we annotated 600 reasoning traces to define a three-tier taxonomy mapping computational failures to cognitive bias frameworks. We validated the taxonomy on 822 responses from prostate cancer consult notes spanning localized through metastatic disease, simulating extraction, analysis, and clinical recommendation tasks. Reasoning errors occurred in 23 percent of interpretations and dominated overall errors, with confirmation bias and anchoring bias most common. Reasoning failures were associated with guideline-discordant and potentially harmful recommendations, particularly in advanced disease management. Automated evaluators using state-of-the-art language models detected error presence but could not reliably classify subtypes. These findings show that large language models may provide fluent but clinically unsafe recommendations when reasoning is flawed. The taxonomy provides a generalizable framework for evaluating and improving reasoning fidelity before clinical deployment.
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Rigor in AI: Doing Rigorous AI Work Requires a Broader, Responsible AI-Informed Conception of Rigor

arXiv:2506.14652v2 Announce Type: replace-cross Abstract: In AI research and practice, rigor remains largely understood in terms of methodological rigor -- such as whether mathematical, statistical, or computational methods are correctly applied. We argue that this narrow conception of rigor has contributed to the concerns raised by the responsible AI community, including overblown claims about the capabilities of AI systems. Our position is that a broader conception of what rigorous AI research and practice should entail is needed. We believe such a conception -- in addition to a more expansive understanding of (1) methodological rigor -- should include aspects related to (2) what background knowledge informs what to work on (epistemic rigor); (3) how disciplinary, community, or personal norms, standards, or beliefs influence the work (normative rigor); (4) how clearly articulated the theoretical constructs under use are (conceptual rigor); (5) what is reported and how (reporting rigor); and (6) how well-supported the inferences from existing evidence are (interpretative rigor). In doing so, we also provide useful language and a framework for much-needed dialogue about the AI community's work by researchers, policymakers, journalists, and other stakeholders.
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Smart spatial omics (S2-omics) optimizes region of interest selection to capture molecular heterogeneity in diverse tissues

Nat Cell Biol. 2025 Nov 26. doi: 10.1038/s41556-025-01811-w. Online ahead of print.

ABSTRACT

Spatial omics technologies have transformed biomedical research by enabling high-resolution molecular profiling while preserving the native tissue architecture. These advances provide unprecedented insights into tissue structure and function. However, the high cost and time-intensive nature of spatial omics experiments necessitate careful experimental design, particularly in selecting regions of interest (ROIs) from large tissue sections. Currently, ROI selection is performed manually, which introduces subjectivity, inconsistency and a lack of reproducibility. Previous studies have shown strong correlations between spatial molecular patterns and histological features, suggesting that readily available and cost-effective histology images can be leveraged to guide spatial omics experiments. Here we present Smart Spatial omics (S2-omics), an end-to-end workflow that automatically selects ROIs from histology images with the goal of maximizing molecular information content in the ROIs. Through comprehensive evaluations across multiple spatial omics platforms and tissue types, we demonstrate that S2-omics enables systematic and reproducible ROI selection and enhances the robustness and impact of downstream biological discovery.

PMID:41298871 | DOI:10.1038/s41556-025-01811-w

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scGALA advances graph link prediction-based cell alignment for comprehensive data integration and harmonization

Nat Commun. 2025 Nov 26. doi: 10.1038/s41467-025-66644-5. Online ahead of print.

ABSTRACT

Single-cell technologies have transformed our understanding of cellular heterogeneity through multimodal data acquisition. However, robust cell alignment remains a major challenge for data integration and harmonization, including batch correction, label transfer, and multi-omics integration. Many existing methods constrain alignment based on rigid feature-wise distance metrics, limiting their ability to capture accurate cell correspondence across diverse cell populations and conditions. We introduce scGALA, a graph-based learning framework that redefines cell alignment by combining graph attention networks with a score-driven, task-independent optimization strategy. scGALA constructs enriched graphs of cell-cell relationships by integrating gene expression profiles with auxiliary information, such as spatial coordinates, and iteratively refines alignment via self-supervised graph link prediction, where a deep neural network is trained to identify and reinforce high-confidence correspondences across datasets. In extensive benchmarks, scGALA identifies over 25 percent more high-confidence alignments without compromising accuracy. By improving the core step of cell alignment, scGALA serves as a versatile enhancer for a wide range of single-cell data integration tasks.

PMID:41298467 | DOI:10.1038/s41467-025-66644-5

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Information content as a health system screening tool for rare diseases

npj Digital Medicine, Published online: 25 November 2025; doi:10.1038/s41746-025-02096-x

Information content as a health system screening tool for rare diseases
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Human Experts' Evaluation of Generative AI for Contextualizing STEAM Education in the Global South

arXiv:2511.19482v2 Announce Type: replace-cross Abstract: This study investigates how human experts evaluate the capacity of Generative AI (GenAI) to contextualize STEAM education in the Global South, with a focus on Ghana. Using a convergent mixed-methods design, four STEAM specialists assessed GenAI-generated lesson plans created with a customized Culturally Responsive Lesson Planner (CRLP) and compared them to standardized lesson plans from the Ghana National Council for Curriculum and Assessment (NaCCA). Quantitative ratings were based on a validated 25-item Culturally Responsive Pedagogy Rubric measuring bias awareness, cultural representation, contextual relevance, linguistic responsiveness, and teacher agency. Qualitative reflections provided additional insight into how GenAI handles cultural and pedagogical appropriateness. Findings show that GenAI, when paired with the CRLP tool, can support contextualized STEAM instruction by linking abstract curriculum standards to learners' cultural knowledge, community practices, and everyday experiences. Experts rated GenAI-assisted lessons as more culturally grounded and pedagogically responsive than NaCCA plans, integrating Indigenous knowledge, bilingual elements, and locally relevant examples. However, GenAI struggled to represent Ghana's cultural pluralism, often offering surface-level references to language, history, and identity. These weaknesses were most evident in Mathematics and Computing, where cultural nuance was limited. The results highlight the need for continued teacher mediation, community involvement, and culturally attuned refinement of AI outputs. Future work should include classroom trials, expanded expert participation, and model fine-tuning using Indigenous language corpora to strengthen cultural fidelity in Global South contexts.
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Precision Oncology: Current Landscape, Emerging Trends, Challenges, and Future Perspectives

Cells. 2025 Nov 17;14(22):1804. doi: 10.3390/cells14221804.

ABSTRACT

Precision oncology is broadly defined as cancer prevention, diagnosis, and treatment specifically tailored to the patient based on his/her genetics and molecular profile. In simple terms, the goal of precision medicine is to deliver the right cancer treatment to the right patient, at the right dose, at the right time. Precision oncology is the most studied and widely applied subarea of precision medicine. Now, precision oncology has expanded to include modern technology (big data, single-cell spatial multiomics, molecular imaging, liquid biopsy, CRISPR gene editing, stem cells, organoids), a deeper understanding of cancer biology (driver cancer genes, single nucleotide polymorphism, cancer initiation, intratumor heterogeneity, tumor microenvironment ecosystem, pan-cancer), cancer stratification (subtyping of traditionally defined cancer types and pan-cancer re-classification based on shared properties across traditionally defined cancer types), clinical applications (cancer prevention, early detection, diagnosis, targeted therapy, minimal residual disease monitoring, managing drug resistance), lifestyle changes (physical activity, smoking, alcohol consumption, sunscreen), cost management, public policy, and more. Despite being the most developed area in precision medicine, precision oncology is still in its early stages and faces multiple challenges that need to be overcome for its successful implementation. In this review, we examine the history, development, and future directions of precision oncology by focusing on emerging technology, novel concepts and principles, molecular cancer stratification, and clinical applications.

PMID:41294857 | PMC:PMC12651332 | DOI:10.3390/cells14221804

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Hybrid Neuro-Symbolic Models for Ethical AI in Risk-Sensitive Domains

arXiv:2511.17644v1 Announce Type: new Abstract: Artificial intelligence deployed in risk-sensitive domains such as healthcare, finance, and security must not only achieve predictive accuracy but also ensure transparency, ethical alignment, and compliance with regulatory expectations. Hybrid neuro symbolic models combine the pattern-recognition strengths of neural networks with the interpretability and logical rigor of symbolic reasoning, making them well-suited for these contexts. This paper surveys hybrid architectures, ethical design considerations, and deployment patterns that balance accuracy with accountability. We highlight techniques for integrating knowledge graphs with deep inference, embedding fairness-aware rules, and generating human-readable explanations. Through case studies in healthcare decision support, financial risk management, and autonomous infrastructure, we show how hybrid systems can deliver reliable and auditable AI. Finally, we outline evaluation protocols and future directions for scaling neuro symbolic frameworks in complex, high stakes environments.
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Leveraging Evidence-Guided LLMs to Enhance Trustworthy Depression Diagnosis

arXiv:2511.17947v1 Announce Type: new Abstract: Large language models (LLMs) show promise in automating clinical diagnosis, yet their non-transparent decision-making and limited alignment with diagnostic standards hinder trust and clinical adoption. We address this challenge by proposing a two-stage diagnostic framework that enhances transparency, trustworthiness, and reliability. First, we introduce Evidence-Guided Diagnostic Reasoning (EGDR), which guides LLMs to generate structured diagnostic hypotheses by interleaving evidence extraction with logical reasoning grounded in DSM-5 criteria. Second, we propose a Diagnosis Confidence Scoring (DCS) module that evaluates the factual accuracy and logical consistency of generated diagnoses through two interpretable metrics: the Knowledge Attribution Score (KAS) and the Logic Consistency Score (LCS). Evaluated on the D4 dataset with pseudo-labels, EGDR outperforms direct in-context prompting and Chain-of-Thought (CoT) across five LLMs. For instance, on OpenBioLLM, EGDR improves accuracy from 0.31 (Direct) to 0.76 and increases DCS from 0.50 to 0.67. On MedLlama, DCS rises from 0.58 (CoT) to 0.77. Overall, EGDR yields up to +45% accuracy and +36% DCS gains over baseline methods, offering a clinically grounded, interpretable foundation for trustworthy AI-assisted diagnosis.
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Cross-Disciplinary Knowledge Retrieval and Synthesis: A Compound AI Architecture for Scientific Discovery

arXiv:2511.18298v1 Announce Type: new Abstract: The exponential growth of scientific knowledge has created significant barriers to cross-disciplinary knowledge discovery, synthesis and research collaboration. In response to this challenge, we present BioSage, a novel compound AI architecture that integrates LLMs with RAG, orchestrated specialized agents and tools to enable discoveries across AI, data science, biomedical, and biosecurity domains. Our system features several specialized agents including the retrieval agent with query planning and response synthesis that enable knowledge retrieval across domains with citation-backed responses, cross-disciplinary translation agents that align specialized terminology and methodologies, and reasoning agents that synthesize domain-specific insights with transparency, traceability and usability. We demonstrate the effectiveness of our BioSage system through a rigorous evaluation on scientific benchmarks (LitQA2, GPQA, WMDP, HLE-Bio) and introduce a new cross-modal benchmark for biology and AI, showing that our BioSage agents outperform vanilla and RAG approaches by 13\%-21\% powered by Llama 3.1. 70B and GPT-4o models. We perform causal investigations into compound AI system behavior and report significant performance improvements by adding RAG and agents over the vanilla models. Unlike other systems, our solution is driven by user-centric design principles and orchestrates specialized user-agent interaction workflows supporting scientific activities including but not limited to summarization, research debate and brainstorming. Our ongoing work focuses on multimodal retrieval and reasoning over charts, tables, and structured scientific data, along with developing comprehensive multimodal benchmarks for cross-disciplinary discovery. Our compound AI solution demonstrates significant potential for accelerating scientific advancement by reducing barriers between traditionally siloed domains.
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Predicting Healthcare Provider Engagement in SMS Campaigns

arXiv:2511.17658v1 Announce Type: cross Abstract: As digital communication grows in importance when connecting with healthcare providers, traditional behavioral and content message features are imbued with renewed significance. If one is to meaningfully connect with them, it is crucial to understand what drives them to engage and respond. In this study, the authors analyzed several million text messages sent through the Impiricus platform to learn which factors influenced whether or not a doctor clicked on a link in a message. Several key insights came to light through the use of logistic regression, random forest, and neural network models, the details of which the authors discuss in this paper.
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Toward explainable AI approaches for breast imaging: adapting foundation models to diverse populations

arXiv:2511.17828v1 Announce Type: cross Abstract: Foundation models hold promise for specialized medical imaging tasks, though their effectiveness in breast imaging remains underexplored. This study leverages BiomedCLIP as a foundation model to address challenges in model generalization. BiomedCLIP was adapted for automated BI-RADS breast density classification using multi-modality mammographic data (synthesized 2D images, digital mammography, and digital breast tomosynthesis). Using 96,995 images, we compared single-modality (s2D only) and multi-modality training approaches, addressing class imbalance through weighted contrastive learning. Both approaches achieved similar accuracy (multi-modality: 0.74, single-modality: 0.73), with the multi-modality model offering broader applicability across different imaging modalities and higher AUC values consistently above 0.84 across BI-RADS categories. External validation on the RSNA and EMBED datasets showed strong generalization capabilities (AUC range: 0.80-0.93). GradCAM visualizations confirmed consistent and clinically relevant attention patterns, highlighting the models interpretability and robustness. This research underscores the potential of foundation models for breast imaging applications, paving the way for future extensions for diagnostic tasks.
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Reinforcement Learning for Portfolio Optimization with a Financial Goal and Defined Time Horizons

arXiv:2511.18076v1 Announce Type: cross Abstract: This research proposes an enhancement to the innovative portfolio optimization approach using the G-Learning algorithm, combined with parametric optimization via the GIRL algorithm (G-learning approach to the setting of Inverse Reinforcement Learning) as presented by. The goal is to maximize portfolio value by a target date while minimizing the investor's periodic contributions. Our model operates in a highly volatile market with a well-diversified portfolio, ensuring a low-risk level for the investor, and leverages reinforcement learning to dynamically adjust portfolio positions over time. Results show that we improved the Sharpe Ratio from 0.42, as suggested by recent studies using the same approach, to a value of 0.483 a notable achievement in highly volatile markets with diversified portfolios. The comparison between G-Learning and GIRL reveals that while GIRL optimizes the reward function parameters (e.g., lambda = 0.0012 compared to 0.002), its impact on portfolio performance remains marginal. This suggests that reinforcement learning methods, like G-Learning, already enable robust optimization. This research contributes to the growing development of reinforcement learning applications in financial decision-making, demonstrating that probabilistic learning algorithms can effectively align portfolio management strategies with investor needs.
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