Location Not Found: Exposing Implicit Local and Global Biases in Multilingual LLMs

Multilingual large language models (LLMs) have minimized the fluency gap between languages. This advancement, however, exposes models to the risk of biased behavior, as knowledge and norms may propagate across languages. In this work, we aim to quantify models' inter- and intra-lingual biases, via their ability to answer locale-ambiguous questions. To this end, we present LocQA, a test set containing 2,156 questions in 12 languages, referring to various locale-dependent facts such as laws, dates, and measurements. The questions do not contain indications of the locales they relate to, other than the querying language itself. LLMs' responses to LocQA locale-ambiguous questions thus reveal models' implicit priors. We used LocQA to evaluate 32 models, and detected two types of structural biases. Inter-lingually, we show a global bias towards answers relevant to the US-locale, even when models are asked in languages other than English. Moreover, we discovered that this global bias is exacerbated in models that underwent instruction tuning, compared to their base counterparts. Intra-lingually, we show that when multiple locales are relevant for the same language, models act as demographic probability engines, prioritizing locales with larger populations. Taken together, insights from LocQA may help in shaping LLMs' desired local behavior, and in quantifying the impact of various training phases on different kinds of biases.

MedGemma 1.5 Technical Report

We introduce MedGemma 1.5 4B, the latest model in the MedGemma collection. MedGemma 1.5 expands on MedGemma 1 by integrating additional capabilities: high-dimensional medical imaging (CT/MRI volumes and histopathology whole slide images), anatomical localization via bounding boxes, multi-timepoint chest X-ray analysis, and improved medical document understanding (lab reports, electronic health records). We detail the innovations required to enable these modalities within a single architecture, including new training data, long-context 3D volume slicing, and whole-slide pathology sampling. Compared to MedGemma 1 4B, MedGemma 1.5 4B demonstrates significant gains in these new areas, improving 3D MRI condition classification accuracy by 11% and 3D CT condition classification by 3% (absolute improvements). In whole slide pathology imaging, MedGemma 1.5 4B achieves a 47% macro F1 gain. Additionally, it improves anatomical localization with a 35% increase in Intersection over Union on chest X-rays and achieves a 4% macro accuracy for longitudinal (multi-timepoint) chest x-ray analysis. Beyond its improved multimodal performance over MedGemma 1, MedGemma 1.5 improves on text-based clinical knowledge and reasoning, improving by 5% on MedQA accuracy and 22% on EHRQA accuracy. It also achieves an average of 18% macro F1 on 4 different lab report information extraction datasets (EHR Datasets 2, 3, 4, and Mendeley Clinical Laboratory Test Reports). Taken together, MedGemma 1.5 serves as a robust, open resource for the community, designed as an improved foundation on which developers can create the next generation of medical AI systems. Resources and tutorials for building upon MedGemma 1.5 can be found at https://goo.gle/MedGemma.

A prospective clinical feasibility study of a conversational diagnostic AI in an ambulatory primary care clinic

Large language model (LLM)-based AI systems have shown promise for patient-facing diagnostic and management conversations in simulated settings. Translating these systems into clinical practice requires assessment in real-world workflows with rigorous safety oversight. We report a prospective, single-arm feasibility study of an LLM-based conversational AI, the Articulate Medical Intelligence Explorer (AMIE), conducting clinical history taking and presentation of potential diagnoses for patients to discuss with their provider at urgent care appointments at a leading academic medical center. 100 adult patients completed an AMIE text-chat interaction up to 5 days before their appointment. We sought to assess the conversational safety and quality, patient and clinician experience, and clinical reasoning capabilities compared to primary care providers (PCPs). Human safety supervisors monitored all patient-AMIE interactions in real time and did not need to intervene to stop any consultations based on pre-defined criteria. Patients reported high satisfaction and their attitudes towards AI improved after interacting with AMIE (p < 0.001). PCPs found AMIE's output useful with a positive impact on preparedness. AMIE's differential diagnosis (DDx) included the final diagnosis, per chart review 8 weeks post-encounter, in 90% of cases, with 75% top-3 accuracy. Blinded assessment of AMIE and PCP DDx and management (Mx) plans suggested similar overall DDx and Mx plan quality, without significant differences for DDx (p = 0.6) and appropriateness and safety of Mx (p = 0.1 and 1.0, respectively). PCPs outperformed AMIE in the practicality (p = 0.003) and cost effectiveness (p = 0.004) of Mx. While further research is needed, this study demonstrates the initial feasibility, safety, and user acceptance of conversational AI in a real-world setting, representing crucial steps towards clinical translation.

WAXAL: A Large-Scale Multilingual African Language Speech Corpus

The advancement of speech technology has predominantly favored high-resource languages, creating a significant digital divide for speakers of most Sub-Saharan African languages. To address this gap, we introduce WAXAL, a large-scale, openly accessible speech dataset for 21 languages representing over 100 million speakers. The collection consists of two main components: an Automated Speech Recognition (ASR) dataset containing approximately 1,250 hours of transcribed, natural speech from a diverse range of speakers, and a Text-to-Speech (TTS) dataset with over 180 hours of high-quality, single-speaker recordings reading phonetically balanced scripts. This paper details our methodology for data collection, annotation, and quality control, which involved partnerships with four African academic and community organizations. We provide a detailed statistical overview of the dataset and discuss its potential limitations and ethical considerations. The WAXAL datasets are released at https://huggingface.co/datasets/google/WaxalNLP under the permissive CC-BY-4.0 license to catalyze research, enable the development of inclusive technologies, and serve as a vital resource for the digital preservation of these languages.

The FACTS Leaderboard: A Comprehensive Benchmark for Large Language Model Factuality

We introduce The FACTS Leaderboard, an online leaderboard suite and associated set of benchmarks that comprehensively evaluates the ability of language models to generate factually accurate text across diverse scenarios. The suite provides a holistic measure of factuality by aggregating the performance of models on four distinct sub-leaderboards: (1) FACTS Multimodal, which measures the factuality of responses to image-based questions; (2) FACTS Parametric, which assesses models' world knowledge by answering closed-book factoid questions from internal parameters; (3) FACTS Search, which evaluates factuality in information-seeking scenarios, where the model must use a search API; and (4) FACTS Grounding (v2), which evaluates whether long-form responses are grounded in provided documents, featuring significantly improved judge models. Each sub-leaderboard employs automated judge models to score model responses, and the final suite score is an average of the four components, designed to provide a robust and balanced assessment of a model's overall factuality. The FACTS Leaderboard Suite will be actively maintained, containing both public and private splits to allow for external participation while guarding its integrity. It can be found at https://www.kaggle.com/benchmarks/google/facts .

Advancing Conversational Diagnostic AI with Multimodal Reasoning

Large Language Models (LLMs) have demonstrated great potential for conducting diagnostic conversations but evaluation has been largely limited to language-only interactions, deviating from the real-world requirements of remote care delivery. Instant messaging platforms permit clinicians and patients to upload and discuss multimodal medical artifacts seamlessly in medical consultation, but the ability of LLMs to reason over such data while preserving other attributes of competent diagnostic conversation remains unknown. Here we advance the conversational diagnosis and management performance of the Articulate Medical Intelligence Explorer (AMIE) through a new capability to gather and interpret multimodal data, and reason about this precisely during consultations. Leveraging Gemini 2.0 Flash, our system implements a state-aware dialogue framework, where conversation flow is dynamically controlled by intermediate model outputs reflecting patient states and evolving diagnoses. Follow-up questions are strategically directed by uncertainty in such patient states, leading to a more structured multimodal history-taking process that emulates experienced clinicians. We compared AMIE to primary care physicians (PCPs) in a randomized, blinded, OSCE-style study of chat-based consultations with patient actors. We constructed 105 evaluation scenarios using artifacts like smartphone skin photos, ECGs, and PDFs of clinical documents across diverse conditions and demographics. Our rubric assessed multimodal capabilities and other clinically meaningful axes like history-taking, diagnostic accuracy, management reasoning, communication, and empathy. Specialist evaluation showed AMIE to be superior to PCPs on 7/9 multimodal and 29/32 non-multimodal axes (including diagnostic accuracy). The results show clear progress in multimodal conversational diagnostic AI, but real-world translation needs further research.

LLM-based Text Simplification and its Effect on User Comprehension and Cognitive Load

Information on the web, such as scientific publications and Wikipedia, often surpasses users' reading level. To help address this, we used a self-refinement approach to develop a LLM capability for minimally lossy text simplification. To validate our approach, we conducted a randomized study involving 4563 participants and 31 texts spanning 6 broad subject areas: PubMed (biomedical scientific articles), biology, law, finance, literature/philosophy, and aerospace/computer science. Participants were randomized to viewing original or simplified texts in a subject area, and answered multiple-choice questions (MCQs) that tested their comprehension of the text. The participants were also asked to provide qualitative feedback such as task difficulty. Our results indicate that participants who read the simplified text answered more MCQs correctly than their counterparts who read the original text (3.9% absolute increase, p<0.05). This gain was most striking with PubMed (14.6%), while more moderate gains were observed for finance (5.5%), aerospace/computer science (3.8%) domains, and legal (3.5%). Notably, the results were robust to whether participants could refer back to the text while answering MCQs. The absolute accuracy decreased by up to ~9% for both original and simplified setups where participants could not refer back to the text, but the ~4% overall improvement persisted. Finally, participants' self-reported perceived ease based on a simplified NASA Task Load Index was greater for those who read the simplified text (absolute change on a 5-point scale 0.33, p<0.05). This randomized study, involving an order of magnitude more participants than prior works, demonstrates the potential of LLMs to make complex information easier to understand. Our work aims to enable a broader audience to better learn and make use of expert knowledge available on the web, improving information accessibility.

Towards Conversational AI for Disease Management

While large language models (LLMs) have shown promise in diagnostic dialogue, their capabilities for effective management reasoning - including disease progression, therapeutic response, and safe medication prescription - remain under-explored. We advance the previously demonstrated diagnostic capabilities of the Articulate Medical Intelligence Explorer (AMIE) through a new LLM-based agentic system optimised for clinical management and dialogue, incorporating reasoning over the evolution of disease and multiple patient visit encounters, response to therapy, and professional competence in medication prescription. To ground its reasoning in authoritative clinical knowledge, AMIE leverages Gemini's long-context capabilities, combining in-context retrieval with structured reasoning to align its output with relevant and up-to-date clinical practice guidelines and drug formularies. In a randomized, blinded virtual Objective Structured Clinical Examination (OSCE) study, AMIE was compared to 21 primary care physicians (PCPs) across 100 multi-visit case scenarios designed to reflect UK NICE Guidance and BMJ Best Practice guidelines. AMIE was non-inferior to PCPs in management reasoning as assessed by specialist physicians and scored better in both preciseness of treatments and investigations, and in its alignment with and grounding of management plans in clinical guidelines. To benchmark medication reasoning, we developed RxQA, a multiple-choice question benchmark derived from two national drug formularies (US, UK) and validated by board-certified pharmacists. While AMIE and PCPs both benefited from the ability to access external drug information, AMIE outperformed PCPs on higher difficulty questions. While further research would be needed before real-world translation, AMIE's strong performance across evaluations marks a significant step towards conversational AI as a tool in disease management.

ECLeKTic: a Novel Challenge Set for Evaluation of Cross-Lingual Knowledge Transfer

To achieve equitable performance across languages, multilingual large language models (LLMs) must be able to abstract knowledge beyond the language in which it was acquired. However, the current literature lacks reliable ways to measure LLMs' capability of cross-lingual knowledge transfer. To that end, we present ECLeKTic, a multilingual closed-book QA (CBQA) dataset that Evaluates Cross-Lingual Knowledge Transfer in a simple, black-box manner. We detected information with uneven coverage across languages by controlling for presence and absence of Wikipedia articles in 12 languages. We generated knowledge-seeking questions in a source language, for which the answer appears in a relevant Wikipedia article and translated them to all other 11 languages, for which the respective Wikipedias lack equivalent articles. Assuming that Wikipedia reflects the prominent knowledge in the LLM's training data, to solve ECLeKTic's CBQA task the model is required to transfer knowledge between languages. Experimenting with 8 LLMs, we show that SOTA models struggle to effectively share knowledge across, languages even if they can predict the answer well for queries in the same language the knowledge was acquired in.

CoCa-CXR: Contrastive Captioners Learn Strong Temporal Structures for Chest X-Ray Vision-Language Understanding

Vision-language models have proven to be of great benefit for medical image analysis since they learn rich semantics from both images and reports. Prior efforts have focused on better alignment of image and text representations to enhance image understanding. However, though explicit reference to a prior image is common in Chest X-Ray (CXR) reports, aligning progression descriptions with the semantics differences in image pairs remains under-explored. In this work, we propose two components to address this issue. (1) A CXR report processing pipeline to extract temporal structure. It processes reports with a large language model (LLM) to separate the description and comparison contexts, and extracts fine-grained annotations from reports. (2) A contrastive captioner model for CXR, namely CoCa-CXR, to learn how to both describe images and their temporal progressions. CoCa-CXR incorporates a novel regional cross-attention module to identify local differences between paired CXR images. Extensive experiments show the superiority of CoCa-CXR on both progression analysis and report generation compared to previous methods. Notably, on MS-CXR-T progression classification, CoCa-CXR obtains 65.0% average testing accuracy on five pulmonary conditions, outperforming the previous state-of-the-art (SOTA) model BioViL-T by 4.8%. It also achieves a RadGraph F1 of 24.2% on MIMIC-CXR, which is comparable to the Med-Gemini foundation model.