Same Patient, Different Words, Different Diagnosis? Evaluating Semantic Stability in Clinical LLMs

Large Language Models (LLMs) are increasingly used in clinical applications. However, their behavior remains highly sensitive to subtle linguistic variations, such as rephrasing or syntactic variation. This sensitivity poses risks in safety-critical healthcare settings, where semantically equivalent inputs should produce consistent predictions. However, a key challenge is to ensure that prompt variations truly preserve clinical meaning, as embedding-based similarity metrics often fail to capture distinctions involving negation, temporality, or severity. To address this limitation, we propose a semantic verification framework based on Natural Language Inference (NLI) to filter meaning-preserving prompt variations, which are further refined using an LLM-as-a-judge and audited by a clinical expert. In addition, we introduce three metrics to quantify model sensitivity: MeaningPreserving Variation Sensitivity (MVS), confidence variation (ΔC), and Worst-Case Instability (WCI). We evaluate 16 open-source general-purpose (GP) and medical LLMs within the same model families and parameter scales, using reformulated prompts derived from the DiagnosisQA and MedQA datasets. Our results demonstrate that robustness differences between domain-specific (DS) models are mixed and highly model-dependent, i.e., domain specialization does not consistently improve or reduce robustness to meaning-preserving prompt reformulations. Several DS models rank among the most robust (when compared with GP counterparts), and strong GP baselines remain competitive as well.

RAPTOR+: A Visually Grounded Vision-Language Framework to Improve Clinical Trust and Auditability in Automated Cancer Referral Processing

Urgent suspected colorectal cancer (CRC) referrals create operational bottlenecks because semi-structured clinical documents often require manual review and transcription. The original RAPTOR system used Large Language Models for structured extraction but relied on a separate OCR stage, making it vulnerable to handwriting, layout variation, and loss of visual evidence linkage. We present RAPTOR+, a multimodal extension that uses Vision-Language Models (VLMs) for end-to-end referral understanding. We evaluate fine-tuned VLMs, commercial and open-source zero-shot VLMs, and the original OCR-based pipeline on 223 clinically curated CRC urgent referral forms. We also introduce a grounding-aware evaluation framework that measures both extraction accuracy and evidence localisation. Results show a clear grounding gap in zero-shot models. Gemini 2.5 Flash achieved 92.6% Reading Accuracy but only 1.2% Strict Safety. In contrast, fine-tuned Qwen3-VL-8B achieved 96.1% Reading Accuracy and 60.6% Strict Safety, substantially improving verifiable evidence grounding. These findings show that task-specific fine-tuning is essential for reliable, auditable clinical document understanding. RAPTOR+ enables extracted referral decisions to be linked to visual evidence, supporting safer and more efficient cancer referral triage.

PathWISE: Multi-Agent Cancer Pathway Triaging Ontology Learning from Clinical Flowcharts

Clinical pathways are disseminated as visual flowcharts where spatial topology, arrow direction, colour coding, and font weight encode critical triage logic that remains inaccessible to computational systems. We present PathWISE, a five-phase pipeline combining four LLM-based agents with a deterministic depth-first search auditor and a Java compiler critic, transforming these non-computable artefacts into validated, executable HL7 Clinical Quality Language (CQL) libraries deployable as FHIR CDS Hooks services. Purpose-built agents extract flowchart structure into a typed directed graph, perform deterministic path enumeration, conduct a structured semantic audit of every node's computability, generate terminology-constrained CQL definitions verified by the official Java CQL-to-ELM compiler, and produce routing logic covering 100% of enumerated patient journeys. Demonstrated across five UK NHS cancer pathways (colorectal, lung, skin, upper GI, and breast), PathWISE audits up to 183 nodes (182 under the Hybrid configuration), identifies 544 structured governance findings across four issue categories, achieves 100% syntactic compilation success, with UNCOMPUTABLE nodes receiving false placeholders that preserve compilability while surfacing governance gaps for clinical review, and produces zero hallucinated terminology codes for dictionary-covered concepts. Critically, PathWISE confines non-deterministic LLM inference to knowledge extraction while deterministic graph mathematics and a standard compiler underpin every verification step.

Mining Subscenario Refactoring Opportunities in Behaviour-Driven Software Test Suites: ML Classifiers and LLM-Judge Baselines

Context. Behaviour-Driven Development (BDD) software test suites accumulate duplicated step subsequences. Three published refactoring patterns are available (within-file Background, within-repo reusable-scenario invocation, cross-organisational shared higher-level step), but no prior work automates which recurring subsequences are worth extracting or which mechanism applies. Objective. Rank recurring step subsequences ("slices") by refactoring suitability (extraction-worthy), pre-map each to one of the three patterns, and quantify prevalence across the public BDD ecosystem. Method. Every contiguous L-step window (L in [2, 18]) in a 339-repository / 276-upstream-owner Gherkin corpus is keyed by paraphrase-robust cluster identifiers and counted under three scopes. Sentence-BERT (SBERT) / Uniform Manifold Approximation and Projection (UMAP) / Hierarchical Density-Based Clustering (HDBSCAN) recovers paraphrase-equivalent slices. Three authors label a stratified 200-slice pool against a written rubric. An eXtreme Gradient Boosting (XGBoost) extraction-worthy classifier trained under 5-fold cross-validation is compared with a tuned rule baseline and two open-weight Large Language Model (LLM) judges. Results. The miner produces 5,382,249 slices collapsing to 692,020 recurring patterns. Three-author Fleiss' kappa = 0.56 (extraction-worthy) and 0.79 (mechanism). The classifier reaches out-of-fold F1 = 0.891 (95% CI [0.852, 0.927]), outperforming both the rule baseline (F1 = 0.836, p = 0.017) and the better LLM judge (F1 = 0.728, p < 1e-4). 75.0%, 59.5%, and 11.7% of scenarios carry a within-file Background, within-repo reusable-scenario, or cross-organisational shared-step candidate. Conclusion. Paraphrase-robust subscenario discovery yields a corpus-wide census of BDD refactoring opportunities; pipeline, classifier predictions, labelled pool, and rubric are released under Apache-2.0.

Large Language Models for Agentic NetOps and AIOps: Architectures, Evaluation, and Safety

Large language models are increasingly being used to support network operations (NetOps) and artificial intelligence for IT operations (AIOps), including incident investigation, root-cause analysis, configuration synthesis, and limited self-healing. In both NetOps and AIOps, this shift is changing how tasks are managed. Agent-based operations work as workflows, from gathering evidence to taking action, following permissions, policies, and checks, and providing rollback options when necessary. This is crucial because operational decisions can have instant impacts. To make the argument concrete, we organise the relevant literature around the hierarchy of autonomy, tool scope, evidence traces, and assurance contracts. These contracts define what an agent may observe, propose, and execute. They also define the checks that must pass before any action is allowed. A consistent pattern appears across work on telemetry query recommendation, diagnosis, root-cause analysis, configuration synthesis, change planning, and limited self-healing. Operational reliability does not come chiefly from the model itself. It depends on the machinery around the model. We also argue that evaluation should go beyond static question answering. Agentic NetOps and AIOps systems require workflow-centred evaluation, including trace quality, bounded tool use, safe proposal generation, replay in sandboxed environments, and canary trials with rollback-aware scoring. Without these measures, a system may appear robust yet remain too fragile. Finally, we examine security, privacy, and governance risks that become acute when agents sit close to operational control surfaces. Taken together, the survey concludes that progress in intelligent NetOps and AIOps will depend on treating autonomy as a constrained operational control problem, whose outputs must be reliable, auditable, and securely deployable.

Finding Duplicates in 1.1M BDD Steps: cukereuse, a Paraphrase-Robust Static Detector for Cucumber and Gherkin

Behaviour-Driven Development (BDD) suites accumulate step-text duplication whose maintenance cost is established in prior work. Existing detection techniques require running the tests (Binamungu et al., 2018-2023) or are confined to a single organisation (Irshad et al., 2020-2022), leaving a gap: a purely static, paraphrase-robust, step-level detector usable on any repository. We fill the gap with cukereuse, an open-source Python CLI combining exact hashing, Levenshtein ratio, and sentence-transformer embeddings in a layered pipeline, released alongside an empirical corpus of 347 public GitHub repositories, 23,667 parsed .feature files, and 1,113,616 Gherkin steps. The step-weighted exact-duplicate rate is 80.2 %; the median-repository rate is 58.6 % (Spearman rho = 0.51 with size). The top hybrid cluster groups 20.7k occurrences across 2.2k files. Against 1,020 pairs manually labelled by the three authors under a released rubric (inter-annotator Fleiss' kappa = 0.84 on a 60-pair overlap), we report precision, recall, and F1 with bootstrap 95 % CIs under two protocols: the primary rubric and a score-free second-pass relabelling. The strongest honest pair-level number is near-exact at F1 = 0.822 on score-free labels; the primary-rubric semantic F1 = 0.906 is inflated by a stratification artefact that pins recall at 1.000. Lexical baselines (SourcererCC-style, NiCad-style) reach primary F1 = 0.761 and 0.799. The paper also presents a CDN-structured critique of Gherkin (Cognitive Dimensions of Notations); eight of fourteen dimensions are rated problematic or unsupported. The tool, corpus, labelled pairs, rubric, and pipeline are released under permissive licences.

MLLM-HWSI: A Multimodal Large Language Model for Hierarchical Whole Slide Image Understanding

Whole Slide Images (WSIs) exhibit hierarchical structure, where diagnostic information emerges from cellular morphology, regional tissue organization, and global context. Existing Computational Pathology (CPath) Multimodal Large Language Models (MLLMs) typically compress an entire WSI into a single embedding, which hinders fine-grained grounding and ignores how pathologists synthesize evidence across different scales. We introduce \textbf{MLLM-HWSI}, a Hierarchical WSI-level MLLM that aligns visual features with pathology language at four distinct scales, cell as word, patch as phrase, region as sentence, and WSI as paragraph to support interpretable evidence-grounded reasoning. MLLM-HWSI decomposes each WSI into multi-scale embeddings with scale-specific projectors and jointly enforces (i) a hierarchical contrastive objective and (ii) a cross-scale consistency loss, preserving semantic coherence from cells to the WSI. We compute diagnostically relevant patches and aggregate segmented cell embeddings into a compact cellular token per-patch using a lightweight \textit{Cell-Cell Attention Fusion (CCAF)} transformer. The projected multi-scale tokens are fused with text tokens and fed to an instruction-tuned LLM for open-ended reasoning, VQA, report, and caption generation tasks. Trained in three stages, MLLM-HWSI achieves new SOTA results on 13 WSI-level benchmarks across six CPath tasks. By aligning language with multi-scale visual evidence, MLLM-HWSI provides accurate, interpretable outputs that mirror diagnostic workflows and advance holistic WSI understanding. Code is available at: \href{https://github.com/BasitAlawode/HWSI-MLLM}{GitHub}.

MedObvious: Exposing the Medical Moravec's Paradox in VLMs via Clinical Triage

Vision Language Models (VLMs) are increasingly used for tasks like medical report generation and visual question answering. However, fluent diagnostic text does not guarantee safe visual understanding. In clinical practice, interpretation begins with pre-diagnostic sanity checks: verifying that the input is valid to read (correct modality and anatomy, plausible viewpoint and orientation, and no obvious integrity violations). Existing benchmarks largely assume this step is solved, and therefore miss a critical failure mode: a model can produce plausible narratives even when the input is inconsistent or invalid. We introduce MedObvious, a 1,880-task benchmark that isolates input validation as a set-level consistency capability over small multi-panel image sets: the model must identify whether any panel violates expected coherence. MedObvious spans five progressive tiers, from basic orientation/modality mismatches to clinically motivated anatomy/viewpoint verification and triage-style cues, and includes five evaluation formats to test robustness across interfaces. Evaluating 17 different VLMs, we find that sanity checking remains unreliable: several models hallucinate anomalies on normal (negative-control) inputs, performance degrades when scaling to larger image sets, and measured accuracy varies substantially between multiple-choice and open-ended settings. These results show that pre-diagnostic verification remains unsolved for medical VLMs and should be treated as a distinct, safety-critical capability before deployment.

AURORA: Adaptive Unified Representation for Robust Ultrasound Analysis

Ultrasound images vary widely across scanners, operators, and anatomical targets, which often causes models trained in one setting to generalize poorly to new hospitals and clinical conditions. The Foundation Model Challenge for Ultrasound Image Analysis (FMC-UIA) reflects this difficulty by requiring a single model to handle multiple tasks, including segmentation, detection, classification, and landmark regression across diverse organs and datasets. We propose a unified multi-task framework based on a transformer visual encoder from the Qwen3-VL family. Intermediate token features are projected into spatial feature maps and fused using a lightweight multi-scale feature pyramid, enabling both pixel-level predictions and global reasoning within a shared representation. Each task is handled by a small task-specific prediction head, while training uses task-aware sampling and selective loss balancing to manage heterogeneous supervision and reduce task imbalance. Our method is designed to be simple to optimize and adaptable across a wide range of ultrasound analysis tasks. The performance improved from 67% to 85% on the validation set and achieved an average score of 81.84% on the official test set across all tasks. The code is publicly available at: https://github.com/saitejalekkala33/FMCUIA-ISBI.git

An Ensemble Learning Approach towards Waste Segmentation in Cluttered Environment

Environmental pollution is a critical global issue, with recycling emerging as one of the most viable solutions. This study focuses on waste segregation, a crucial step in recycling processes to obtain raw material. Recent advancements in computer vision have significantly contributed to waste classification and recognition. In waste segregation, segmentation masks are essential for robots to accurately localize and pick objects from conveyor belts. The complexity of real-world waste environments, characterized by deformed items without specific patterns and overlapping objects, further complicates waste segmentation tasks. This paper proposes an Ensemble Learning approach to improve segmentation accuracy by combining high performing segmentation models, U-Net and FPN, using a weighted average method. U-Net excels in capturing fine details and boundaries in segmentation tasks, while FPN effectively handles scale variation and context in complex environments, and their combined masks result in more precise predictions. The dataset used closely mimics real-life waste scenarios, and preprocessing techniques were applied to enhance feature learning for deep learning segmentation models. The ensemble model, referred to as EL-4, achieved an IoU value of 0.8306, an improvement over U-Net's 0.8065, and reduced Dice loss to 0.09019 from FPN's 0.1183. This study could contribute to the efficiency of waste sorting at Material Recovery Facility, facilitating better raw material acquisition for recycling with minimal human intervention and enhancing the overall throughput.