A Framework for Feature Discovery in Intracranial Pressure Monitoring Data Using Neural Network Attention

We present a novel framework for analyzing intracranial pressure monitoring data by applying interpretability principles. Intracranial pressure monitoring data was collected from 60 patients at Johns Hopkins. The data was segmented into individual cardiac cycles. A convolutional neural network was trained to classify each cardiac cycle into one of seven body positions. Neural network attention was extracted and was used to identify regions of interest in the waveform. Further directions for exploration are identified. This framework provides an extensible method to further understand the physiological and clinical underpinnings of the intracranial pressure waveform, which could lead to better diagnostic capabilities for intracranial pressure monitoring.

An interpretable data-driven approach to optimizing clinical fall risk assessment

In this study, we aim to better align fall risk prediction from the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) with additional clinically meaningful measures via a data-driven modelling approach. We conducted a retrospective cohort analysis of 54,209 inpatient admissions from three Johns Hopkins Health System hospitals between March 2022 and October 2023. A total of 20,208 admissions were included as high fall risk encounters, and 13,941 were included as low fall risk encounters. To incorporate clinical knowledge and maintain interpretability, we employed constrained score optimization (CSO) models to reweight the JHFRAT scoring weights, while preserving its additive structure and clinical thresholds. Recalibration refers to adjusting item weights so that the resulting score can order encounters more consistently by the study's risk labels, and without changing the tool's form factor or deployment workflow. The model demonstrated significant improvements in predictive performance over the current JHFRAT (CSO AUC-ROC=0.91, JHFRAT AUC-ROC=0.86). This performance improvement translates to protecting an additional 35 high-risk patients per week across the Johns Hopkins Health System. The constrained score optimization models performed similarly with and without the EHR variables. Although the benchmark black-box model (XGBoost), improves upon the performance metrics of the knowledge-based constrained logistic regression (AUC-ROC=0.94), the CSO demonstrates more robustness to variations in risk labeling. This evidence-based approach provides a robust foundation for health systems to systematically enhance inpatient fall prevention protocols and patient safety using data-driven optimization techniques, contributing to improved risk assessment and resource allocation in healthcare settings.

From Visual Perception to Deep Empathy: An Automated Assessment Framework for House-Tree-Person Drawings Using Multimodal LLMs and Multi-Agent Collaboration

Background: The House-Tree-Person (HTP) drawing test, introduced by John Buck in 1948, remains a widely used projective technique in clinical psychology. However, it has long faced challenges such as heterogeneous scoring standards, reliance on examiners subjective experience, and a lack of a unified quantitative coding system. Results: Quantitative experiments showed that the mean semantic similarity between Multimodal Large Language Model (MLLM) interpretations and human expert interpretations was approximately 0.75 (standard deviation about 0.05). In structurally oriented expert data sets, this similarity rose to 0.85, indicating expert-level baseline comprehension. Qualitative analyses demonstrated that the multi-agent system, by integrating social-psychological perspectives and destigmatizing narratives, effectively corrected visual hallucinations and produced psychological reports with high ecological validity and internal coherence. Conclusions: The findings confirm the potential of multimodal large models as standardized tools for projective assessment. The proposed multi-agent framework, by dividing roles, decouples feature recognition from psychological inference and offers a new paradigm for digital mental-health services. Keywords: House-Tree-Person test; multimodal large language model; multi-agent collaboration; cosine similarity; computational psychology; artificial intelligence

Auditing Significance, Metric Choice, and Demographic Fairness in Medical AI Challenges

Open challenges have become the de facto standard for comparative ranking of medical AI methods. Despite their importance, medical AI leaderboards exhibit three persistent limitations: (1) score gaps are rarely tested for statistical significance, so rank stability is unknown; (2) single averaged metrics are applied to every organ, hiding clinically important boundary errors; (3) performance across intersecting demographics is seldom reported, masking fairness and equity gaps. We introduce RankInsight, an open-source toolkit that seeks to address these limitations. RankInsight (1) computes pair-wise significance maps that show the nnU-Net family outperforms Vision-Language and MONAI submissions with high statistical certainty; (2) recomputes leaderboards with organ-appropriate metrics, reversing the order of the top four models when Dice is replaced by NSD for tubular structures; and (3) audits intersectional fairness, revealing that more than half of the MONAI-based entries have the largest gender-race discrepancy on our proprietary Johns Hopkins Hospital dataset. The RankInsight toolkit is publicly released and can be directly applied to past, ongoing, and future challenges. It enables organizers and participants to publish rankings that are statistically sound, clinically meaningful, and demographically fair.

Question the Questions: Auditing Representation in Online Deliberative Processes

A central feature of many deliberative processes, such as citizens' assemblies and deliberative polls, is the opportunity for participants to engage directly with experts. While participants are typically invited to propose questions for expert panels, only a limited number can be selected due to time constraints. This raises the challenge of how to choose a small set of questions that best represent the interests of all participants. We introduce an auditing framework for measuring the level of representation provided by a slate of questions, based on the social choice concept known as justified representation (JR). We present the first algorithms for auditing JR in the general utility setting, with our most efficient algorithm achieving a runtime of $O(mn\log n)$, where $n$ is the number of participants and $m$ is the number of proposed questions. We apply our auditing methods to historical deliberations, comparing the representativeness of (a) the actual questions posed to the expert panel (chosen by a moderator), (b) participants' questions chosen via integer linear programming, (c) summary questions generated by large language models (LLMs). Our results highlight both the promise and current limitations of LLMs in supporting deliberative processes. By integrating our methods into an online deliberation platform that has been used for over hundreds of deliberations across more than 50 countries, we make it easy for practitioners to audit and improve representation in future deliberations.

Jr. AI Scientist and Its Risk Report: Autonomous Scientific Exploration from a Baseline Paper

Understanding the current capabilities and risks of AI Scientist systems is essential for ensuring trustworthy and sustainable AI-driven scientific progress while preserving the integrity of the academic ecosystem. To this end, we develop Jr. AI Scientist, a state-of-the-art autonomous AI scientist system that mimics the core research workflow of a novice student researcher: Given the baseline paper from the human mentor, it analyzes its limitations, formulates novel hypotheses for improvement, validates them through rigorous experimentation, and writes a paper with the results. Unlike previous approaches that assume full automation or operate on small-scale code, Jr. AI Scientist follows a well-defined research workflow and leverages modern coding agents to handle complex, multi-file implementations, leading to scientifically valuable contributions. For evaluation, we conducted automated assessments using AI Reviewers, author-led evaluations, and submissions to Agents4Science, a venue dedicated to AI-driven scientific contributions. The findings demonstrate that Jr. AI Scientist generates papers receiving higher review scores than existing fully automated systems. Nevertheless, we identify important limitations from both the author evaluation and the Agents4Science reviews, indicating the potential risks of directly applying current AI Scientist systems and key challenges for future research. Finally, we comprehensively report various risks identified during development. We hope these insights will deepen understanding of current progress and risks in AI Scientist development.

Optimizing Clinical Fall Risk Prediction: A Data-Driven Integration of EHR Variables with the Johns Hopkins Fall Risk Assessment Tool

In this study we aim to better align fall risk prediction from the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) with additional clinically meaningful measures via a data-driven modelling approach. We conducted a retrospective analysis of 54,209 inpatient admissions from three Johns Hopkins Health System hospitals between March 2022 and October 2023. A total of 20,208 admissions were included as high fall risk encounters, and 13,941 were included as low fall risk encounters. To incorporate clinical knowledge and maintain interpretability, we employed constrained score optimization (CSO) models on JHFRAT assessment data and additional electronic health record (EHR) variables. The model demonstrated significant improvements in predictive performance over the current JHFRAT (CSO AUC-ROC=0.91, JHFRAT AUC-ROC=0.86). The constrained score optimization models performed similarly with and without the EHR variables. Although the benchmark black-box model (XGBoost), improves upon the performance metrics of the knowledge-based constrained logistic regression (AUC-ROC=0.94), the CSO demonstrates more robustness to variations in risk labelling. This evidence-based approach provides a robust foundation for health systems to systematically enhance inpatient fall prevention protocols and patient safety using data-driven optimization techniques, contributing to improved risk assessment and resource allocation in healthcare settings.

The Dragon Hatchling: The Missing Link between the Transformer and Models of the Brain

The relationship between computing systems and the brain has served as motivation for pioneering theoreticians since John von Neumann and Alan Turing. Uniform, scale-free biological networks, such as the brain, have powerful properties, including generalizing over time, which is the main barrier for Machine Learning on the path to Universal Reasoning Models. We introduce `Dragon Hatchling' (BDH), a new Large Language Model architecture based on a scale-free biologically inspired network of \$n\$ locally-interacting neuron particles. BDH couples strong theoretical foundations and inherent interpretability without sacrificing Transformer-like performance. BDH is a practical, performant state-of-the-art attention-based state space sequence learning architecture. In addition to being a graph model, BDH admits a GPU-friendly formulation. It exhibits Transformer-like scaling laws: empirically BDH rivals GPT2 performance on language and translation tasks, at the same number of parameters (10M to 1B), for the same training data. BDH can be represented as a brain model. The working memory of BDH during inference entirely relies on synaptic plasticity with Hebbian learning using spiking neurons. We confirm empirically that specific, individual synapses strengthen connection whenever BDH hears or reasons about a specific concept while processing language inputs. The neuron interaction network of BDH is a graph of high modularity with heavy-tailed degree distribution. The BDH model is biologically plausible, explaining one possible mechanism which human neurons could use to achieve speech. BDH is designed for interpretability. Activation vectors of BDH are sparse and positive. We demonstrate monosemanticity in BDH on language tasks. Interpretability of state, which goes beyond interpretability of neurons and model parameters, is an inherent feature of the BDH architecture.

Evaluating Compositional Approaches for Focus and Sentiment Analysis

This paper summarizes the results of evaluating a compositional approach for Focus Analysis (FA) in Linguistics and Sentiment Analysis (SA) in Natural Language Processing (NLP). While quantitative evaluations of compositional and non-compositional approaches in SA exist in NLP, similar quantitative evaluations are very rare in FA in Linguistics that deal with linguistic expressions representing focus or emphasis such as "it was John who left". We fill this gap in research by arguing that compositional rules in SA also apply to FA because FA and SA are closely related meaning that SA is part of FA. Our compositional approach in SA exploits basic syntactic rules such as rules of modification, coordination, and negation represented in the formalism of Universal Dependencies (UDs) in English and applied to words representing sentiments from sentiment dictionaries. Some of the advantages of our compositional analysis method for SA in contrast to non-compositional analysis methods are interpretability and explainability. We test the accuracy of our compositional approach and compare it with a non-compositional approach VADER that uses simple heuristic rules to deal with negation, coordination and modification. In contrast to previous related work that evaluates compositionality in SA on long reviews, this study uses more appropriate datasets to evaluate compositionality. In addition, we generalize the results of compositional approaches in SA to compositional approaches in FA.

Dataset and Benchmark for Enhancing Critical Retained Foreign Object Detection

Critical retained foreign objects (RFOs), including surgical instruments like sponges and needles, pose serious patient safety risks and carry significant financial and legal implications for healthcare institutions. Detecting critical RFOs using artificial intelligence remains challenging due to their rarity and the limited availability of chest X-ray datasets that specifically feature critical RFOs cases. Existing datasets only contain non-critical RFOs, like necklace or zipper, further limiting their utility for developing clinically impactful detection algorithms. To address these limitations, we introduce "Hopkins RFOs Bench", the first and largest dataset of its kind, containing 144 chest X-ray images of critical RFO cases collected over 18 years from the Johns Hopkins Health System. Using this dataset, we benchmark several state-of-the-art object detection models, highlighting the need for enhanced detection methodologies for critical RFO cases. Recognizing data scarcity challenges, we further explore image synthetic methods to bridge this gap. We evaluate two advanced synthetic image methods, DeepDRR-RFO, a physics-based method, and RoentGen-RFO, a diffusion-based method, for creating realistic radiographs featuring critical RFOs. Our comprehensive analysis identifies the strengths and limitations of each synthetic method, providing insights into effectively utilizing synthetic data to enhance model training. The Hopkins RFOs Bench and our findings significantly advance the development of reliable, generalizable AI-driven solutions for detecting critical RFOs in clinical chest X-rays.