Retrieval-Augmented Guardrails for AI-Drafted Patient-Portal Messages: Error Taxonomy Construction and Large-Scale Evaluation

Asynchronous patient-clinician messaging via EHR portals is a growing source of clinician workload, prompting interest in large language models (LLMs) to assist with draft responses. However, LLM outputs may contain clinical inaccuracies, omissions, or tone mismatches, making robust evaluation essential. Our contributions are threefold: (1) we introduce a clinically grounded error ontology comprising 5 domains and 59 granular error codes, developed through inductive coding and expert adjudication; (2) we develop a retrieval-augmented evaluation pipeline (RAEC) that leverages semantically similar historical message-response pairs to improve judgment quality; and (3) we provide a two-stage prompting architecture using DSPy to enable scalable, interpretable, and hierarchical error detection. Our approach assesses the quality of drafts both in isolation and with reference to similar past message-response pairs retrieved from institutional archives. Using a two-stage DSPy pipeline, we compared baseline and reference-enhanced evaluations on over 1,500 patient messages. Retrieval context improved error identification in domains such as clinical completeness and workflow appropriateness. Human validation on 100 messages demonstrated superior agreement (concordance = 50% vs. 33%) and performance (F1 = 0.500 vs. 0.256) of context-enhanced labels vs. baseline, supporting the use of our RAEC pipeline as AI guardrails for patient messaging.

Automated Sperm Morphology Analysis Based on Instance-Aware Part Segmentation

Traditional sperm morphology analysis is based on tedious manual annotation. Automated morphology analysis of a high number of sperm requires accurate segmentation of each sperm part and quantitative morphology evaluation. State-of-the-art instance-aware part segmentation networks follow a "detect-then-segment" paradigm. However, due to sperm's slim shape, their segmentation suffers from large context loss and feature distortion due to bounding box cropping and resizing during ROI Align. Moreover, morphology measurement of sperm tail is demanding because of the long and curved shape and its uneven width. This paper presents automated techniques to measure sperm morphology parameters automatically and quantitatively. A novel attention-based instance-aware part segmentation network is designed to reconstruct lost contexts outside bounding boxes and to fix distorted features, by refining preliminary segmented masks through merging features extracted by feature pyramid network. An automated centerline-based tail morphology measurement method is also proposed, in which an outlier filtering method and endpoint detection algorithm are designed to accurately reconstruct tail endpoints. Experimental results demonstrate that the proposed network outperformed the state-of-the-art top-down RP-R-CNN by 9.2% [AP]_vol^p, and the proposed automated tail morphology measurement method achieved high measurement accuracies of 95.34%,96.39%,91.2% for length, width and curvature, respectively.

Data-Driven Simulator for Mechanical Circulatory Support with Domain Adversarial Neural Process

Mechanical Circulatory Support (MCS) devices, implemented as a probabilistic deep sequence model. Existing mechanical simulators for MCS rely on oversimplifying assumptions and are insensitive to patient-specific behavior, limiting their applicability to real-world treatment scenarios. To address these shortcomings, our model Domain Adversarial Neural Process (DANP) employs a neural process architecture, allowing it to capture the probabilistic relationship between MCS pump levels and aortic pressure measurements with uncertainty. We use domain adversarial training to combine simulation data with real-world observations, resulting in a more realistic and diverse representation of potential outcomes. Empirical results with an improvement of 19% in non-stationary trend prediction establish DANP as an effective tool for clinicians to understand and make informed decisions regarding MCS patient treatment.