What Is Missing in Surgical Risk Stratification and Outcome Prediction: A Scoping Review of End-to-End Machine Learning Approaches

Postoperative adverse events, including mortality and morbidity, remain a major global burden, many of which are preventable through early identification of high-risk patients and targeted perioperative care. Accurate risk stratification is therefore essential. With the growing availability of large-scale electronic health records (EHRs), machine learning (ML) provides a data-driven approach to model complex clinical patterns. However, existing studies vary widely in design, and methodological practices remain fragmented. This scoping review characterizes ML pipelines for surgical risk stratification and outcome prediction using EHR data. We reviewed 190 studies covering the ML workflow, including data preprocessing, algorithm selection, model evaluation, and explainability. Most studies relied on single-center private datasets with limited data modalities, while the scarcity of open-access surgical datasets constrained reproducibility and generalizability. Reporting of key preprocessing steps, including missing data handling, feature selection, and class imbalance, was often incomplete. Conventional ML models and simple neural networks predominated, whereas deep learning and multimodal approaches remained uncommon. Benchmark datasets and standardized evaluation protocols were largely absent, hindering cross-study comparisons. Only about one-third of studies incorporated explainability methods. This review identifies methodological gaps limiting clinically robust postoperative ML tools and provides a structured reference to support more rigorous, reproducible, and clinically meaningful ML development for perioperative care.

Semantic-Anchored Evidential Fusion for Domain-Robust Whole-Slide Survival Analysis

Whole-slide images (WSIs) are widely used for computational cancer prognosis. However, most existing methods primarily focus on in-domain performance and fail to generalize across clinical centers. This limitation stems from their reliance on pixel-derived representations that are highly susceptible to domain-specific artifacts caused by staining protocols and scanner hardware. We hypothesize that high-level pathology semantics, such as tumor grade and micro-environmental architecture, provide a domain-invariant semantic representation that mirrors the robust diagnostic logic of human pathologists. Therefore, we propose a Semantic-Anchored Evidential Fusion Survival (SAEFS) framework, where SAEFS derives semantic anchors from WSIs via Visual Question Answering (VQA), employs a dual-stream WSI evidence extraction architecture, uses Dirichlet-based Subjective Logic to model uncertainty, and fuses semantic and visual evidence through a cautious conjunction rule to avoid overconfident fusion from correlated sources. Trained exclusively on one source domain and evaluated zero-shot across four unseen domains, SAEFS consistently outperforms state-of-the-art models both in prediction accuracy and reliability, improving the average C-index by 10.2%. Quantitative analyses further show that VQA-derived semantic features exhibit significantly lower cross-center divergence than pixel-derived features, highlighting their robustness for cross-center clinical applications.

Evidential Fusion Network for Multimodal Survival Prediction under Missing Modalities

Recent multimodal survival prediction models have demonstrated strong predictive performance by leveraging complementary information across modalities. However, such models generally assume data completeness and exhibit limited robustness toward missing modalities, which are frequently encountered in real-world clinical settings. We propose the Evidential Missing Modality Survival Fusion (EMMS) model for multimodal survival prediction under missing modalities. EMMS offers a straightforward, computationally effective approach to survival analysis without requiring a generative phase for missing data. By employing Dempster-Shafer theory and Gaussian Random Fuzzy Numbers for multimodal decision fusion, it considers both aleatoric and epistemic uncertainty alongside modality reliability for fusion. Moreover, the model treats missing modalities as vacuous evidence, preventing interference with available inputs and naturally reflecting increased uncertainty and calibrated predictions. Extensive experiments on four cancer datasets demonstrate state-of-the-art performance while providing calibrated and interpretable uncertainty estimates under incomplete multimodal observations, without introducing additional computational overhead.

Beyond Semantics: An Evidential Reasoning-Aware Multi-View Learning Framework for Trustworthy Mental Health Prediction

Automated mental health prediction using textual data has shown promising results with deep learning and large language models. However, deploying these models in high-stakes real-world settings remains challenging, as existing approaches largely rely on semantic representations and often produce overconfident predictions under ambiguous, noisy, or shifted data. Moreover, most methods lack reliable uncertainty estimation, undermining trust in risk-sensitive mental health applications. To address these limitations, we formulate the task as a multi-view learning problem that integrates semantic information from encoder-only models with higher-level reasoning information from decoder-only models, where reasoning-aware representations and uncertainty modeling are obtained in a trustworthy manner. To ensure reliable fusion, we adopt an evidential learning framework based on Subjective Logic to explicitly model uncertainty and introduce an evidential fusion strategy that balances complementary views while discounting unreliable evidence. Benchmarking on three real-world datasets, Dreaddit, SDCNL, and DepSeverity, reports accuracies of 0.835, 0.731, and 0.751, respectively, demonstrating its potential for reliable mental health prediction. Additional experiments on robustness to noise and case studies for interpretability confirm that our proposed framework not only improves predictive performance but also provides trustworthy uncertainty estimates and human-understandable reasoning signals, making it suitable for risk-sensitive applications in mental health assessment.

Detecting LLM-Generated Spam Reviews by Integrating Language Model Embeddings and Graph Neural Network

The rise of large language models (LLMs) has enabled the generation of highly persuasive spam reviews that closely mimic human writing. These reviews pose significant challenges for existing detection systems and threaten the credibility of online platforms. In this work, we first create three realistic LLM-generated spam review datasets using three distinct LLMs, each guided by product metadata and genuine reference reviews. Evaluations by GPT-4.1 confirm the high persuasion and deceptive potential of these reviews. To address this threat, we propose FraudSquad, a hybrid detection model that integrates text embeddings from a pre-trained language model with a gated graph transformer for spam node classification. FraudSquad captures both semantic and behavioral signals without relying on manual feature engineering or massive training resources. Experiments show that FraudSquad outperforms state-of-the-art baselines by up to 44.22% in precision and 43.01% in recall on three LLM-generated datasets, while also achieving promising results on two human-written spam datasets. Furthermore, FraudSquad maintains a modest model size and requires minimal labeled training data, making it a practical solution for real-world applications. Our contributions include new synthetic datasets, a practical detection framework, and empirical evidence highlighting the urgency of adapting spam detection to the LLM era. Our code and datasets are available at: https://anonymous.4open.science/r/FraudSquad-5389/.

A Foundation Model for Chest X-ray Interpretation with Grounded Reasoning via Online Reinforcement Learning

Medical foundation models (FMs) have shown tremendous promise amid the rapid advancements in artificial intelligence (AI) technologies. However, current medical FMs typically generate answers in a black-box manner, lacking transparent reasoning processes and locally grounded interpretability, which hinders their practical clinical deployments. To this end, we introduce DeepMedix-R1, a holistic medical FM for chest X-ray (CXR) interpretation. It leverages a sequential training pipeline: initially fine-tuned on curated CXR instruction data to equip with fundamental CXR interpretation capabilities, then exposed to high-quality synthetic reasoning samples to enable cold-start reasoning, and finally refined via online reinforcement learning to enhance both grounded reasoning quality and generation performance. Thus, the model produces both an answer and reasoning steps tied to the image's local regions for each query. Quantitative evaluation demonstrates substantial improvements in report generation (e.g., 14.54% and 31.32% over LLaVA-Rad and MedGemma) and visual question answering (e.g., 57.75% and 23.06% over MedGemma and CheXagent) tasks. To facilitate robust assessment, we propose Report Arena, a benchmarking framework using advanced language models to evaluate answer quality, further highlighting the superiority of DeepMedix-R1. Expert review of generated reasoning steps reveals greater interpretability and clinical plausibility compared to the established Qwen2.5-VL-7B model (0.7416 vs. 0.2584 overall preference). Collectively, our work advances medical FM development toward holistic, transparent, and clinically actionable modeling for CXR interpretation.

Self-supervised Quantized Representation for Seamlessly Integrating Knowledge Graphs with Large Language Models

Due to the presence of the natural gap between Knowledge Graph (KG) structures and the natural language, the effective integration of holistic structural information of KGs with Large Language Models (LLMs) has emerged as a significant question. To this end, we propose a two-stage framework to learn and apply quantized codes for each entity, aiming for the seamless integration of KGs with LLMs. Firstly, a self-supervised quantized representation (SSQR) method is proposed to compress both KG structural and semantic knowledge into discrete codes (\ie, tokens) that align the format of language sentences. We further design KG instruction-following data by viewing these learned codes as features to directly input to LLMs, thereby achieving seamless integration. The experiment results demonstrate that SSQR outperforms existing unsupervised quantized methods, producing more distinguishable codes. Further, the fine-tuned LLaMA2 and LLaMA3.1 also have superior performance on KG link prediction and triple classification tasks, utilizing only 16 tokens per entity instead of thousands in conventional prompting methods.

EsurvFusion: An evidential multimodal survival fusion model based on Gaussian random fuzzy numbers

Multimodal survival analysis aims to combine heterogeneous data sources (e.g., clinical, imaging, text, genomics) to improve the prediction quality of survival outcomes. However, this task is particularly challenging due to high heterogeneity and noise across data sources, which vary in structure, distribution, and context. Additionally, the ground truth is often censored (uncertain) due to incomplete follow-up data. In this paper, we propose a novel evidential multimodal survival fusion model, EsurvFusion, designed to combine multimodal data at the decision level through an evidence-based decision fusion layer that jointly addresses both data and model uncertainty while incorporating modality-level reliability. Specifically, EsurvFusion first models unimodal data with newly introduced Gaussian random fuzzy numbers, producing unimodal survival predictions along with corresponding aleatoric and epistemic uncertainties. It then estimates modality-level reliability through a reliability discounting layer to correct the misleading impact of noisy data modalities. Finally, a multimodal evidence-based fusion layer is introduced to combine the discounted predictions to form a unified, interpretable multimodal survival analysis model, revealing each modality's influence based on the learned reliability coefficients. This is the first work that studies multimodal survival analysis with both uncertainty and reliability. Extensive experiments on four multimodal survival datasets demonstrate the effectiveness of our model in handling high heterogeneity data, establishing new state-of-the-art on several benchmarks.

Evidential time-to-event prediction model with well-calibrated uncertainty estimation

Time-to-event analysis, or Survival analysis, provides valuable insights into clinical prognosis and treatment recommendations. However, this task is typically more challenging than other regression tasks due to the censored observations. Moreover, concerns regarding the reliability of predictions persist among clinicians, mainly attributed to the absence of confidence assessment, robustness, and calibration of prediction. To address those challenges, we introduce an evidential regression model designed especially for time-to-event prediction tasks, with which the most plausible event time, is directly quantified by aggregated Gaussian random fuzzy numbers (GRFNs). The GRFNs are a newly introduced family of random fuzzy subsets of the real line that generalizes both Gaussian random variables and Gaussian possibility distributions. Different from conventional methods that construct models based on strict data distribution, e.g., proportional hazard function, our model only assumes the event time is encoded in a real line GFRN without any strict distribution assumption, therefore offering more flexibility in complex data scenarios. Furthermore, the epistemic and aleatory uncertainty regarding the event time is quantified within the aggregated GRFN as well. Our model can, therefore, provide more detailed clinical decision-making guidance with two more degrees of information. The model is fit by minimizing a generalized negative log-likelihood function that accounts for data censoring based on uncertainty evidence reasoning. Experimental results on simulated datasets with varying data distributions and censoring scenarios, as well as on real-world datasets across diverse clinical settings and tasks, demonstrate that our model achieves both accurate and reliable performance, outperforming state-of-the-art methods.

Camouflaged_Object_Tracking__A_Benchmark

Visual tracking has seen remarkable advancements, largely driven by the availability of large-scale training datasets that have enabled the development of highly accurate and robust algorithms. While significant progress has been made in tracking general objects, research on more challenging scenarios, such as tracking camouflaged objects, remains limited. Camouflaged objects, which blend seamlessly with their surroundings or other objects, present unique challenges for detection and tracking in complex environments. This challenge is particularly critical in applications such as military, security, agriculture, and marine monitoring, where precise tracking of camouflaged objects is essential. To address this gap, we introduce the Camouflaged Object Tracking Dataset (COTD), a specialized benchmark designed specifically for evaluating camouflaged object tracking methods. The COTD dataset comprises 200 sequences and approximately 80,000 frames, each annotated with detailed bounding boxes. Our evaluation of 20 existing tracking algorithms reveals significant deficiencies in their performance with camouflaged objects. To address these issues, we propose a novel tracking framework, HiPTrack-MLS, which demonstrates promising results in improving tracking performance for camouflaged objects. COTD and code are avialable at https://github.com/openat25/HIPTrack-MLS.