A knowledge-guided agentic framework for mitigating patient-context ambiguity in health queries

Patients often submit short, underspecified queries to healthcare chatbots that lack the patient-specific information needed to determine an appropriate response. Although these queries may be linguistically clear, they can support multiple plausible answers depending on undisclosed factors such as symptoms, diagnoses, medications, allergies, or dietary restrictions. A language model answering such a query directly may therefore rely on unsupported assumptions about the patient. We introduce a knowledge-guided agentic framework for mitigating patient-context ambiguity before final response generation. The framework operates between the patient and an otherwise unchanged downstream language model. It interprets the initial query, uses a task-specific knowledge graph to construct a set of plausible hypotheses, identifies the missing patient-context variables needed to distinguish among them, and asks targeted follow-up questions. The original query and the acquired context are then combined into a clarified prompt for the downstream model. We evaluated the framework across five language models using two controlled ambiguity-mitigation benchmarks: diagnosis retrieval from 1,034 symptom queries with clinically relevant evidence systematically masked, and dietary-safety classification from 487 queries with decisive health context omitted. The framework was compared with direct answering of the underspecified query and with rephrasing the same query without acquiring new patient information. In diagnosis retrieval, it increased overall exact Top-1 accuracy by at least 57.1 percentage points and selective exact Recall@5 by at least 77.7 percentage points across the five evaluated models compared with direct prompting. In dietary-safety classification, it improved accuracy across all five models and achieved the highest Matthews correlation coefficient for four...

When Clean Signals Are Not Enough: Detecting Structural Ambiguity for Safe Wearable Stress Classification

Wearable stress classifiers can achieve strong average performance while failing completely for a particular individual. On WESAD, a Random Forest reaches 93.0% mean accuracy yet yields F1 = 0 for Subject 14, whose cross-signal coupling weakens near stress onset. We call this structural ambiguity: individually plausible physiological channels form an inter-signal pattern that is poorly supported by the person's non-stress reference. We introduce the Individual Conformal Coupling Monitor (ICCM), a lightweight and transparent pre-inference monitor that quantifies subject-specific coupling divergence and routes each window to classify, defer, or abstain without retraining the downstream classifier. Across WESAD (N = 15) and Stress-Predict (N = 35), full-cohort Pearson associations between ambiguity and accuracy are negative (r = -0.607, p = 0.016; r = -0.412, p = 0.014). Robustness analyses temper this finding: rank correlations are not significant, and the WESAD association disappears when Subject 14 is removed. ICCM changes false-positive counts from 29 to 27 and 94 to 92, although neither paired change is significant. It withholds 3 of Subject 14's 21 stress windows but does not repair the missed-stress failure. These results position ICCM as an interpretable signal of unsupported physiology and individual failure, rather than a stand-alone safety guarantee.

CoPlan: A Trustworthy Co-Intelligence Interface for Care Planning through Role-Based Contestable Argument Graphs

AI-supported care planning can help clinicians, patients, caregivers, and care teams coordinate complex decisions across clinical, functional, psychosocial, and environmental needs. However, many AI systems present recommendations as fixed outputs, limiting stakeholders' ability to inspect, challenge, and revise plans when they conflict with clinical judgment, patient values, or real-world feasibility. We present CoPlan - a Co-Intelligent and Contestable Interface for Human-AI Care Planning. CoPlan uses a multi-agent workflow in which specialized AI agents generate candidate interventions and supporting or challenging arguments, while human care planners can accept, reject, modify, or add arguments before final plan generation. Through this design, CoPlan combines co-intelligence, in which humans and AI agents contribute complementary expertise, with contestability, where recommendations remain open to inspection, revision, and justification. We demonstrate CoPlan in an aging-in-place care planning scenario. The system supports adaptive care team recruitment, role-based argument review, final care plan generation, and practical follow-up through scheduling agents. This work contributes a contestable care planning interface and a design framing for trustworthy human-AI care planning that preserves human agency and clinical accountability.

Adaptive Arena-based Contestable Argumentative Network-of-Experts for Open-Ended Care Plan Coordination

Care plan coordination demands synthesizing heterogeneous clinical, functional, and psychosocial information across multiple professional disciplines, where monolithic LLM pipelines cannot perform in a transparent or safe manner. We present CANOE (Contestable Argumentative Network-of-Experts), a multi-agent neuro-symbolic framework that addresses these limitations through five modules: complexity assessment, adaptive team recruitment, role-based argumentative computation via an Arena-based Quantitative Bipolar Argumentation Framework (A-QBAF), human-in-the-loop contestation, and care-plan synthesis. Role-specialized agents generate supporting and attacking arguments for candidate interventions; conflicts are resolved through arena-based clash resolution before acceptability scores propagate across the argumentation graph. Care planners may accept, reject, edit, or add arguments, and the framework will deterministically recompute the final plan. Evaluation on Discharge Me! and MedicalRAG using ROUGE-L, AlignScore, MEDCON F1, FKGL, and LLM-as-a-judge shows that medically fine-tuned models achieve the strongest clinical correctness and safety, while CANOE's argumentative structure provides faithful explanation and human contestability.

Self-Evolving Human-Centered Framework for Explainable Depression Symptom Annotation

Annotation quality is a major bottleneck in building reliable and explainable artificial intelligence (XAI) systems for mental health research. In depression-related datasets, labels are often assigned without structured evidence, symptom-level justification, or traceable alignment with the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), limiting both transparency and downstream model interpretability. We propose a self-evolving, expert-in-the-loop annotation framework for Major Depressive Disorder (MDD) that combines large language model (LLM)-assisted labeling with expert verification. The framework is intended to support the construction of explainable, DSM-5-TR-aligned datasets rather than to perform clinical diagnosis. It operates in three stages: candidate evidence selection from textual records, criterion-level DSM-5-TR analysis, and case-level synthesis that produces label-level diagnostic and severity annotations. A dual-memory architecture, composed of Example Memory and Reflection Memory, is designed to internalize expert feedback and iteratively improve future annotations without retraining. We describe this mechanism and leave its evaluation across multiple feedback cycles to future work. In addition to final labels, the framework exports clinical evidence, reasoning traces, and edit histories, enabling comprehensive auditability. In a pilot study using expert-reviewed samples, the proposed approach improves annotation consistency and explainability while reducing manual revision effort.

Anatomically-conditioned Latent Diffusion Model for Data-Efficient Few-Shot Cross-Domain 3D Glioma MRI Synthesis

Accurate classification of diffuse gliomas is often hindered by domain shifts across centers and a lack of large, annotated datasets. We propose the Anatomically-conditioned Latent Diffusion Model (ALDM), a novel framework for data-efficient, few-shot 3D volumetric MRI synthesis. ALDM utilizes a two-stage approach: a 3D variational autoencoder learns anatomical priors from a data-rich source domain, while a conditional latent diffusion model, guided by tumor masks via a ControlNet, generates structurally coherent volumes for a data-scarce target domain. Evaluated in an extreme few-shot setting with only 16 target images, ALDM outperformed GAN and hybrid baselines, achieving a superior Frechet Inception Distance (FID) of 85.40 and a downstream classification AUC of 0.987. Qualitative results confirm that the model preserves sharp pathology boundaries and cross-modal consistency, with visual fidelity improving progressively during training. By capturing essential diagnostic features, ALDM provides a robust tool for clinical data augmentation in low-resource settings. Our implementation is available at https://github.com/Analytics-Everywhere-Lab/anatomically-conditioned-LDM.

T2D-Bench: Evidence-Gated Evaluation of LLM Outputs for Type 2 Diabetes Using a Multi-Layer Clinical-Lifestyle Knowledge Graph

Large language models (LLMs) can produce clinically fluent recommendations for type 2 diabetes while failing to satisfy guideline constraints or explicitly justify lifestyle-related glycemic claims. We present T2D-Bench, a reproducible benchmark and evidence-gated evaluation framework for testing whether LLM outputs satisfy explicit, graph-checkable evidence requirements. T2D-Bench is built on a multi-layer clinical-lifestyle knowledge graph that combines a biomedical spine (UMLS, DrugBank, SIDER), computable ADA Standards of Care rules, and lifestyle knowledge connected through a mechanistic bridge to glycemic laboratory effects. Across 100 structured vignettes spanning diagnosis, medication safety, and adversarial lifestyle conflicts, baseline outputs failed benchmark-defined evidence-path checks in 35% of cases for GPT-4o-mini and 33% for GPT-4o. The evidence gate detects unsupported omissions and uses constrained revision to bring outputs into verifier-level compliance with benchmark-defined evidence requirements. These results show that computable evidence constraints can make unsupported clinical omissions explicit, measurable, and correctable in diabetes-focused LLM outputs.

Does Mixture-of-Experts Actually Help Inference on Consumer and Edge Hardware? An Empirical Study

Mixture-of-Experts (MoE) language models are often described as ideal for resource-constrained inference. Each token activates only a small subset of experts, so the per-token compute cost, in floating-point operations (FLOPs), resembles that of a much smaller dense model. Whether that FLOP advantage survives in practice is far less clear. We ask whether MoE models actually run faster and cheaper than comparable dense models on consumer-grade and edge hardware. We benchmark OLMoE-1B-7B (1.3 B active of 6.9 B total) against three dense baselines on an Apple M2 Pro and an NVIDIA Jetson Orin Nano 8 GB through \texttt{llama.cpp}, measuring throughput, memory, and on-device energy. The answer is device-dependent: OLMoE's active-parameter advantage is only partly realised on the laptop (~10% behind the same-active Llama-3.2-1B) and erodes on the edge device (~31% behind, at 2.1$\times$ the energy per token, with peak memory at the 8 GB ceiling). Patching \texttt{llama.cpp} to time the decode graph node-by-node shows routing accounts for under 9% of MoE-block compute on the cleaner edge backend, so the gap reflects total-parameter memory footprint, expert dispatch, and KV-cache pressure rather than routing. The implication is that on bandwidth-bound edge hardware, inference cost tracks total parameters, not active ones, and sparse activation does not buy back what the device is constrained on. These findings are bounded to one MoE model at this parameter scale and two devices, and we release the full measurement harness and per-run data.

Beyond AHI: An Interpretable Causal-Discovery-Guided Framework for Sleep Recovery in Connected Health

Objective sleep assessment relies on polysomnography (PSG), yet clinical impact is often better reflected in patient-reported outcomes (PROs) such as sleepiness and fatigue. Existing summary indices, including the Apnea-Hypopnea Index (AHI), provide limited insight into the multidomain physiology underlying functional recovery. We propose an interpretable, causal-discovery--guided framework for deriving a hierarchical Sleep Recovery Score (SRS) from multimodal PSG. Using two large population cohorts (MESA: n=1540; MrOS: n=825), we apply directed acyclic graph (DAG) learning to identify candidate physiological drivers spanning respiratory burden, hypoxic burden, sleep fragmentation, sleep architecture, and autonomic regulation. Although derived from clinical PSG, these domains map naturally to sensing streams increasingly available in connected health technologies, including wearable ECG, oximetry, and sleep-stage estimation devices. To preserve mechanistic plausibility, we introduce a two-stage screening process that combines physiology-based constraints with constrained LLM-assisted auditing to identify and remove structural confounders and construct-overlapping variables. Across cohorts, these five domains emerge as recurrent physiological domains associated with recovery, and the resulting SRS shows up to 2.5$\times$ stronger alignment with perceived recovery than AHI. By linking multimodal sleep physiology to patient-centered outcomes through an interpretable, bias-aware, and domain structured framework, this work provides a practical foundation for recovery modeling across both clinical sleep studies and emerging smart and connected health settings.

Consensus-based Agentic Large Language Model Framework for Harmonized Tariff Schedule Code Classification

Accurate Harmonized Tariff Schedule (HTS) code classification is essential for customs clearance, duty assessment, trade statistics, and regulatory compliance in maritime logistics. However, exact HTS classification remains challenging because product descriptions are often short, incomplete, or ambiguous, while correct classification depends on hierarchical tariff structures, legal notes, and jurisdiction-specific rules. This paper proposes an agentic large language model (LLM) framework for Canadian 10-digit HTS code classification in smart-port and maritime logistics environments. The framework integrates multi-agent information retrieval, semantic retrieval over official tariff documents, evidence-grounded reasoning, consensus-based validation, element-wise voting across hierarchical code components, confidence estimation, and human-in-the-loop escalation. We evaluate the framework on a private dataset of 3,300 domain-expert-labeled product records collected from logistics and delivery contexts. Experimental results show that exact 10-digit classification remains difficult even for advanced LLMs, with performance decreasing from coarse chapter-level prediction to fine-grained tariff and statistical suffix assignment. These findings demonstrate the need for evidence-grounded, uncertainty-aware, and human-centered classification workflows rather than fully autonomous single-step prediction. The proposed framework supports more interpretable, accountable, and compliance-oriented HTS classification for maritime logistics and smart-port operations. Our code is available at https://github.com/Analytics-Everywhere-Lab/hts.