Automating Expert-Level Medical Reasoning Evaluation of Large Language Models

As large language models (LLMs) become increasingly integrated into clinical decision-making, ensuring transparent and trustworthy reasoning is essential. However, existing evaluation strategies of LLMs' medical reasoning capability either suffer from unsatisfactory assessment or poor scalability, and a rigorous benchmark remains lacking. To address this, we introduce MedThink-Bench, a benchmark designed for rigorous, explainable, and scalable assessment of LLMs' medical reasoning. MedThink-Bench comprises 500 challenging questions across ten medical domains, each annotated with expert-crafted step-by-step rationales. Building on this, we propose LLM-w-Ref, a novel evaluation framework that leverages fine-grained rationales and LLM-as-a-Judge mechanisms to assess intermediate reasoning with expert-level fidelity while maintaining scalability. Experiments show that LLM-w-Ref exhibits a strong positive correlation with expert judgments. Benchmarking twelve state-of-the-art LLMs, we find that smaller models (e.g., MedGemma-27B) can surpass larger proprietary counterparts (e.g., OpenAI-o3). Overall, MedThink-Bench offers a foundational tool for evaluating LLMs' medical reasoning, advancing their safe and responsible deployment in clinical practice.

Give Me FP32 or Give Me Death? Challenges and Solutions for Reproducible Reasoning

Large Language Models (LLMs) are now integral across various domains and have demonstrated impressive performance. Progress, however, rests on the premise that benchmark scores are both accurate and reproducible. We demonstrate that the reproducibility of LLM performance is fragile: changing system configuration such as evaluation batch size, GPU count, and GPU version can introduce significant difference in the generated responses. This issue is especially pronounced in reasoning models, where minor rounding differences in early tokens can cascade into divergent chains of thought, ultimately affecting accuracy. For instance, under bfloat16 precision with greedy decoding, a reasoning model like DeepSeek-R1-Distill-Qwen-7B can exhibit up to 9% variation in accuracy and 9,000 tokens difference in response length due to differences in GPU count, type, and evaluation batch size. We trace the root cause of this variability to the non-associative nature of floating-point arithmetic under limited numerical precision. This work presents the first systematic investigation into how numerical precision affects reproducibility in LLM inference. Through carefully controlled experiments across various hardware, software, and precision settings, we quantify when and how model outputs diverge. Our analysis reveals that floating-point precision -- while critical for reproducibility -- is often neglected in evaluation practices. Inspired by this, we develop a lightweight inference pipeline, dubbed LayerCast, that stores weights in 16-bit precision but performs all computations in FP32, balancing memory efficiency with numerical stability. Code is available at https://github.com/nanomaoli/llm_reproducibility.

Are LLMs Reliable Translators of Logical Reasoning Across Lexically Diversified Contexts?

Neuro-symbolic approaches combining large language models (LLMs) with solvers excels in logical reasoning problems need long reasoning chains. In this paradigm, LLMs serve as translators, converting natural language reasoning problems into formal logic formulas. Then reliable symbolic solvers return correct solutions. Despite their success, we find that LLMs, as translators, struggle to handle lexical diversification, a common linguistic phenomenon, indicating that LLMs as logic translators are unreliable in real-world scenarios. Moreover, existing logical reasoning benchmarks lack lexical diversity, failing to challenge LLMs' ability to translate such text and thus obscuring this issue. In this work, we propose SCALe, a benchmark designed to address this significant gap through **logic-invariant lexical diversification**. By using LLMs to transform original benchmark datasets into lexically diversified but logically equivalent versions, we evaluate LLMs' ability to consistently map diverse expressions to uniform logical symbols on these new datasets. Experiments using SCALe further confirm that current LLMs exhibit deficiencies in this capability. Building directly on the deficiencies identified through our benchmark, we propose a new method, MenTaL, to address this limitation. This method guides LLMs to first construct a table unifying diverse expressions before performing translation. Applying MenTaL through in-context learning and supervised fine-tuning (SFT) significantly improves the performance of LLM translators on lexically diversified text. Our code is now available at https://github.com/wufeiwuwoshihua/LexicalDiver.

SC-LoRA: Balancing Efficient Fine-tuning and Knowledge Preservation via Subspace-Constrained LoRA

Parameter-Efficient Fine-Tuning (PEFT) methods, particularly Low-Rank Adaptation (LoRA), are indispensable for efficiently customizing Large Language Models (LLMs). However, vanilla LoRA suffers from slow convergence speed and knowledge forgetting problems. Recent studies have leveraged the power of designed LoRA initialization, to enhance the fine-tuning efficiency, or to preserve knowledge in the pre-trained LLM. However, none of these works can address the two cases at the same time. To this end, we introduce Subspace-Constrained LoRA (SC-LoRA), a novel LoRA initialization framework engineered to navigate the trade-off between efficient fine-tuning and knowledge preservation. We achieve this by constraining the output of trainable LoRA adapters in a low-rank subspace, where the context information of fine-tuning data is most preserved while the context information of preserved knowledge is least retained, in a balanced way. Such constraint enables the trainable weights to primarily focus on the main features of fine-tuning data while avoiding damaging the preserved knowledge features. We provide theoretical analysis on our method, and conduct extensive experiments including safety preservation and world knowledge preservation, on various downstream tasks. In our experiments, SC-LoRA succeeds in delivering superior fine-tuning performance while markedly diminishing knowledge forgetting, surpassing contemporary LoRA initialization methods.

Multimodal Forecasting of Sparse Intraoperative Hypotension Events Powered by Language Model

Intraoperative hypotension (IOH) frequently occurs under general anesthesia and is strongly linked to adverse outcomes such as myocardial injury and increased mortality. Despite its significance, IOH prediction is hindered by event sparsity and the challenge of integrating static and dynamic data across diverse patients. In this paper, we propose \textbf{IOHFuseLM}, a multimodal language model framework. To accurately identify and differentiate sparse hypotensive events, we leverage a two-stage training strategy. The first stage involves domain adaptive pretraining on IOH physiological time series augmented through diffusion methods, thereby enhancing the model sensitivity to patterns associated with hypotension. Subsequently, task fine-tuning is performed on the original clinical dataset to further enhance the ability to distinguish normotensive from hypotensive states. To enable multimodal fusion for each patient, we align structured clinical descriptions with the corresponding physiological time series at the token level. Such alignment enables the model to capture individualized temporal patterns alongside their corresponding clinical semantics. In addition, we convert static patient attributes into structured text to enrich personalized information. Experimental evaluations on two intraoperative datasets demonstrate that IOHFuseLM outperforms established baselines in accurately identifying IOH events, highlighting its applicability in clinical decision support scenarios. Our code is publicly available to promote reproducibility at https://github.com/zjt-gpu/IOHFuseLM.

An Outlook on the Opportunities and Challenges of Multi-Agent AI Systems

Multi-agent AI systems (MAS) offer a promising framework for distributed intelligence, enabling collaborative reasoning, planning, and decision-making across autonomous agents. This paper provides a systematic outlook on the current opportunities and challenges of MAS, drawing insights from recent advances in large language models (LLMs), federated optimization, and human-AI interaction. We formalize key concepts including agent topology, coordination protocols, and shared objectives, and identify major risks such as dependency, misalignment, and vulnerabilities arising from training data overlap. Through a biologically inspired simulation and comprehensive theoretical framing, we highlight critical pathways for developing robust, scalable, and secure MAS in real-world settings.

Longer Context, Deeper Thinking: Uncovering the Role of Long-Context Ability in Reasoning

Recent language models exhibit strong reasoning capabilities, yet the influence of long-context capacity on reasoning remains underexplored. In this work, we hypothesize that current limitations in reasoning stem, in part, from insufficient long-context capacity, motivated by empirical observations such as (1) higher context window length often leads to stronger reasoning performance, and (2) failed reasoning cases resemble failed long-context cases. To test this hypothesis, we examine whether enhancing a model's long-context ability before Supervised Fine-Tuning (SFT) leads to improved reasoning performance. Specifically, we compared models with identical architectures and fine-tuning data but varying levels of long-context capacity. Our results reveal a consistent trend: models with stronger long-context capacity achieve significantly higher accuracy on reasoning benchmarks after SFT. Notably, these gains persist even on tasks with short input lengths, indicating that long-context training offers generalizable benefits for reasoning performance. These findings suggest that long-context modeling is not just essential for processing lengthy inputs, but also serves as a critical foundation for reasoning. We advocate for treating long-context capacity as a first-class objective in the design of future language models.

am-ELO: A Stable Framework for Arena-based LLM Evaluation

Arena-based evaluation is a fundamental yet significant evaluation paradigm for modern AI models, especially large language models (LLMs). Existing framework based on ELO rating system suffers from the inevitable instability problem due to ranking inconsistency and the lack of attention to the varying abilities of annotators. In this paper, we introduce a novel stable arena framework to address these issues by enhancing the ELO Rating System. Specifically, we replace the iterative update method with a Maximum Likelihood Estimation (MLE) approach, m-ELO, and provide theoretical proof of the consistency and stability of the MLE approach for model ranking. Additionally, we proposed the am-ELO, which modify the Elo Rating's probability function to incorporate annotator abilities, enabling the simultaneous estimation of model scores and annotator reliability. Experiments demonstrate that this method ensures stability, proving that this framework offers a more robust, accurate, and stable evaluation method for LLMs.

Sensitivity Meets Sparsity: The Impact of Extremely Sparse Parameter Patterns on Theory-of-Mind of Large Language Models

This paper investigates the emergence of Theory-of-Mind (ToM) capabilities in large language models (LLMs) from a mechanistic perspective, focusing on the role of extremely sparse parameter patterns. We introduce a novel method to identify ToM-sensitive parameters and reveal that perturbing as little as 0.001% of these parameters significantly degrades ToM performance while also impairing contextual localization and language understanding. To understand this effect, we analyze their interaction with core architectural components of LLMs. Our findings demonstrate that these sensitive parameters are closely linked to the positional encoding module, particularly in models using Rotary Position Embedding (RoPE), where perturbations disrupt dominant-frequency activations critical for contextual processing. Furthermore, we show that perturbing ToM-sensitive parameters affects LLM's attention mechanism by modulating the angle between queries and keys under positional encoding. These insights provide a deeper understanding of how LLMs acquire social reasoning abilities, bridging AI interpretability with cognitive science. Our results have implications for enhancing model alignment, mitigating biases, and improving AI systems designed for human interaction.

EPEE: Towards Efficient and Effective Foundation Models in Biomedicine

Foundation models, including language models, e.g., GPT, and vision models, e.g., CLIP, have significantly advanced numerous biomedical tasks. Despite these advancements, the high inference latency and the "overthinking" issues in model inference impair the efficiency and effectiveness of foundation models, thus limiting their application in real-time clinical settings. To address these challenges, we proposed EPEE (Entropy- and Patience-based Early Exiting), a novel hybrid strategy designed to improve the inference efficiency of foundation models. The core idea was to leverage the strengths of entropy-based and patience-based early exiting methods to overcome their respective weaknesses. To evaluate EPEE, we conducted experiments on three core biomedical tasks-classification, relation extraction, and event extraction-using four foundation models (BERT, ALBERT, GPT-2, and ViT) across twelve datasets, including clinical notes and medical images. The results showed that EPEE significantly reduced inference time while maintaining or improving accuracy, demonstrating its adaptability to diverse datasets and tasks. EPEE addressed critical barriers to deploying foundation models in healthcare by balancing efficiency and effectiveness. It potentially provided a practical solution for real-time clinical decision-making with foundation models, supporting reliable and efficient workflows.