GUIDE: Reinforcement Learning for Behavioral Action Support in Type 1 Diabetes

Type 1 Diabetes (T1D) management requires continuous adjustment of insulin and lifestyle behaviors to maintain blood glucose within a safe target range. Although automated insulin delivery (AID) systems have improved glycemic outcomes, many patients still fail to achieve recommended clinical targets, warranting new approaches to improve glucose control in patients with T1D. While reinforcement learning (RL) has been utilized as a promising approach, current RL-based methods focus primarily on insulin-only treatment and do not provide behavioral recommendations for glucose control. To address this gap, we propose GUIDE, an RL-based decision-support framework designed to complement AID technologies by providing behavioral recommendations to prevent abnormal glucose events. GUIDE generates structured actions defined by intervention type, magnitude, and timing, including bolus insulin administration and carbohydrate intake events. GUIDE integrates a patient-specific glucose level predictor trained on real-world continuous glucose monitoring data and supports both offline and online RL algorithms within a unified environment. We evaluate both off-policy and on-policy methods across 25 individuals with T1D using standardized glycemic metrics. Among the evaluated approaches, the CQL-BC algorithm demonstrates the highest average time-in-range, reaching 85.49% while maintaining low hypoglycemia exposures. Behavioral similarity analysis further indicates that the learned CQL-BC policy preserves key structural characteristics of patient action patterns, achieving a mean cosine similarity of 0.87 $\pm$ 0.09 across subjects. These findings suggest that conservative offline RL with a structured behavioral action space can provide clinically meaningful and behaviorally plausible decision support for personalized diabetes management.

When AI Gets it Wong: Reliability and Risk in AI-Assisted Medication Decision Systems

Artificial intelligence (AI) systems are increasingly integrated into healthcare and pharmacy workflows, supporting tasks such as medication recommendations, dosage determination, and drug interaction detection. While these systems often demonstrate strong performance under standard evaluation metrics, their reliability in real-world decision-making remains insufficiently understood. In high-risk domains such as medication management, even a single incorrect recommendation can result in severe patient harm. This paper examines the reliability of AI-assisted medication systems by focusing on system failures and their potential clinical consequences. Rather than evaluating performance solely through aggregate metrics, this work shifts attention towards how errors occur and what happens when AI systems produce incorrect outputs. Through a series of controlled, simulated scenarios involving drug interactions and dosage decisions, we analyse different types of system failures, including missed interactions, incorrect risk flagging, and inappropriate dosage recommendations. The findings highlight that AI errors in medication-related contexts can lead to adverse drug reactions, ineffective treatment, or delayed care, particularly when systems are used without sufficient human oversight. Furthermore, the paper discusses the risks of over-reliance on AI recommendations and the challenges posed by limited transparency in decision-making processes. This work contributes a reliability-focused perspective on AI evaluation in healthcare, emphasising the importance of understanding failure behavior and real-world impact. It highlights the need to complement traditional performance metrics with risk-aware evaluation approaches, particularly in safety-critical domains such as pharmacy practice.

ShapE-GRPO: Shapley-Enhanced Reward Allocation for Multi-Candidate LLM Training

In user-agent interaction scenarios such as recommendation, brainstorming, and code suggestion, Large Language Models (LLMs) often generate sets of candidate recommendations where the objective is to maximize the collective utility of the entire set rather than individual candidates independently. However, existing reinforcement learning post-training paradigms, such as Group Relative Policy Optimization (GRPO), typically assign the same set-level scalar reward to every candidate in the set. This leads to noisy training signals where poor candidates free-ride on the high reward produced by a single strong peer, resulting in suboptimal exploration. To address this, we propose Shapley-Enhanced GRPO (ShapE-GRPO). By leveraging the permutation-invariant nature of set-level utility, we derive a Shapley-enhanced formulation from cooperative game theory to decompose set-level rewards into granular, candidate-specific signals. We show that our formulation preserves the fundamental axioms of the Shapley value while remaining computationally efficient with polynomial-time complexity. Empirically, ShapE-GRPO consistently outperforms standard GRPO across diverse datasets with accelerated convergence during training.

Aligning Multimodal Sequential Recommendations via Robust Direct Preference Optimization with Sparse MoE

Preference-based alignment objectives have been widely adopted, from RLHF-style pairwise learning in large language models to emerging applications in recommender systems. Yet, existing work rarely examines how Direct Preference Optimization (DPO) behaves under implicit feedback, where unobserved items are not reliable negatives. We conduct systematic experiments on multimodal sequential recommendation to compare common negative-selection strategies and their interaction with DPO training. Our central finding is that a simple modification, replacing deterministic hard negatives with stochastic sampling from a dynamic top-K candidate pool, consistently improves ranking performance. We attribute its effectiveness to two factors: (1) reducing erroneous suppressive gradients caused by false negatives, and (2) retaining informative hard signals while smoothing optimization via controlled stochasticity. With an optional sparse Mixture-of-Experts encoder for efficient capacity scaling, RoDPO achieves up to 5.25% NDCG@5 on three Amazon benchmarks, with nearly unchanged inference cost.

GISTBench: Evaluating LLM User Understanding via Evidence-Based Interest Verification

We introduce GISTBench, a benchmark for evaluating Large Language Models' (LLMs) ability to understand users from their interaction histories in recommendation systems. Unlike traditional RecSys benchmarks that focus on item prediction accuracy, our benchmark evaluates how well LLMs can extract and verify user interests from engagement data. We propose two novel metric families: Interest Groundedness (IG), decomposed into precision and recall components to separately penalize hallucinated interest categories and reward coverage, and Interest Specificity (IS), which assesses the distinctiveness of verified LLM-predicted user profiles. We release a synthetic dataset constructed on real user interactions on a global short-form video platform. Our dataset contains both implicit and explicit engagement signals and rich textual descriptions. We validate our dataset fidelity against user surveys, and evaluate eight open-weight LLMs spanning 7B to 120B parameters. Our findings reveal performance bottlenecks in current LLMs, particularly their limited ability to accurately count and attribute engagement signals across heterogeneous interaction types.

AI-Mediated Explainable Regulation for Justice

Present practice of deciding on regulation faces numerous problems that make adopted regulations static, unexplained, unduly influenced by powerful interest groups, and stained with a perception of illegitimacy. These well-known problems with the regulatory process can lead to injustice and have substantial negative effects on society and democracy. We discuss a new approach that utilizes distributed artificial intelligence (AI) to make a regulatory recommendation that is explainable and adaptable by design. We outline the main components of a system that can implement this approach and show how it would resolve the problems with the present regulatory system. This approach models and reasons about stakeholder preferences with separate preference models, while it aggregates these preferences in a value sensitive way. Such recommendations can be updated due to changes in facts or in values and are inherently explainable. We suggest how stakeholders can make their preferences known to the system and how they can verify whether they were properly considered in the regulatory decision. The resulting system promises to support regulatory justice, legitimacy, and compliance.

Drift-Aware Continual Tokenization for Generative Recommendation

Generative recommendation commonly adopts a two-stage pipeline in which a learnable tokenizer maps items to discrete token sequences (i.e. identifiers) and an autoregressive generative recommender model (GRM) performs prediction based on these identifiers. Recent tokenizers further incorporate collaborative signals so that items with similar user-behavior patterns receive similar codes, substantially improving recommendation quality. However, real-world environments evolve continuously: new items cause identifier collision and shifts, while new interactions induce collaborative drift in existing items (e.g., changing co-occurrence patterns and popularity). Fully retraining both tokenizer and GRM is often prohibitively expensive, yet naively fine-tuning the tokenizer can alter token sequences for the majority of existing items, undermining the GRM's learned token-embedding alignment. To balance plasticity and stability for collaborative tokenizers, we propose DACT, a Drift-Aware Continual Tokenization framework with two stages: (i) tokenizer fine-tuning, augmented with a jointly trained Collaborative Drift Identification Module (CDIM) that outputs item-level drift confidence and enables differentiated optimization for drifting and stationary items; and (ii) hierarchical code reassignment using a relaxed-to-strict strategy to update token sequences while limiting unnecessary changes. Experiments on three real-world datasets with two representative GRMs show that DACT consistently achieves better performance than baselines, demonstrating effective adaptation to collaborative evolution with reduced disruption to prior knowledge. Our implementation is publicly available at https://github.com/HomesAmaranta/DACT for reproducibility.

Let the Agent Steer: Closed-Loop Ranking Optimization via Influence Exchange

Recommendation ranking is fundamentally an influence allocation problem: a sorting formula distributes ranking influence among competing factors, and the business outcome depends on finding the optimal "exchange rates" among them. However, offline proxy metrics systematically misjudge how influence reallocation translates to online impact, with asymmetric bias across metrics that a single calibration factor cannot correct. We present Sortify, the first fully autonomous LLM-driven ranking optimization agent deployed in a large-scale production recommendation system. The agent reframes ranking optimization as continuous influence exchange, closing the full loop from diagnosis to parameter deployment without human intervention. It addresses structural problems through three mechanisms: (1) a dual-channel framework grounded in Savage's Subjective Expected Utility (SEU) that decouples offline-online transfer correction (Belief channel) from constraint penalty adjustment (Preference channel); (2) an LLM meta-controller operating on framework-level parameters rather than low-level search variables; (3) a persistent Memory DB with 7 relational tables for cross-round learning. Its core metric, Influence Share, provides a decomposable measure where all factor contributions sum to exactly 100%. Sortify has been deployed across two markets. In Country A, the agent pushed GMV from -3.6% to +9.2% within 7 rounds with peak orders reaching +12.5%. In Country B, a cold-start deployment achieved +4.15% GMV/UU and +3.58% Ads Revenue in a 7-day A/B test, leading to full production rollout.

Cold-Starts in Generative Recommendation: A Reproducibility Study

Cold-start recommendation remains a central challenge in dynamic, open-world platforms, requiring models to recommend for newly registered users (user cold-start) and to recommend newly introduced items to existing users (item cold-start) under sparse or missing interaction signals. Recent generative recommenders built on pre-trained language models (PLMs) are often expected to mitigate cold-start by using item semantic information (e.g., titles and descriptions) and test-time conditioning on limited user context. However, cold-start is rarely treated as a primary evaluation setting in existing studies, and reported gains are difficult to interpret because key design choices, such as model scale, identifier design, and training strategy, are frequently changed together. In this work, we present a systematic reproducibility study of generative recommendation under a unified suite of cold-start protocols.

Unsupervised 4D Flow MRI Velocity Enhancement and Unwrapping Using Divergence-Free Neural Networks

This work introduces an unsupervised Divergence and Aliasing-Free neural network (DAF-FlowNet) for 4D Flow Magnetic Resonance Imaging (4D Flow MRI) that jointly enhances noisy velocity fields and corrects phase wrapping artifacts. DAF-FlowNet parameterizes velocities as the curl of a vector potential, enforcing mass conservation by construction and avoiding explicit divergence-penalty tuning. A cosine data-consistency loss enables simultaneous denoising and unwrapping from wrapped phase images. On synthetic aortic 4D Flow MRI generated from computational fluid dynamics, DAF-FlowNet achieved lower errors than existing techniques (up to 11% lower velocity normalized root mean square error, 11% lower directional error, and 44% lower divergence relative to the best-performing alternative across noise levels), with robustness to moderate segmentation perturbations. For unwrapping, at peak velocity/velocity-encoding ratios of 1.4 and 2.1, DAF-FlowNet achieved 0.18% and 5.2% residual wrapped voxels, representing reductions of 72% and 18% relative to the best alternative method, respectively. In scenarios with both noise and aliasing, the proposed single-stage formulation outperformed a state-of-the-art sequential pipeline (up to 15% lower velocity normalized root mean square error, 11% lower directional error, and 28% lower divergence). Across 10 hypertrophic cardiomyopathy patient datasets, DAF-FlowNet preserved fine-scale flow features, corrected aliased regions, and improved internal flow consistency, as indicated by reduced inter-plane flow bias in aortic and pulmonary mass-conservation analyses recommended by the 4D Flow MRI consensus guidelines. These results support DAF-FlowNet as a framework that unifies velocity enhancement and phase unwrapping to improve the reliability of cardiovascular 4D Flow MRI.