Augmenting Clinical Decision-Making with an Interactive and Interpretable AI Copilot: A Real-World User Study with Clinicians in Nephrology and Obstetrics

Clinician skepticism toward opaque AI hinders adoption in high-stakes healthcare. We present AICare, an interactive and interpretable AI copilot for collaborative clinical decision-making. By analyzing longitudinal electronic health records, AICare grounds dynamic risk predictions in scrutable visualizations and LLM-driven diagnostic recommendations. Through a within-subjects counterbalanced study with 16 clinicians across nephrology and obstetrics, we comprehensively evaluated AICare using objective measures (task completion time and error rate), subjective assessments (NASA-TLX, SUS, and confidence ratings), and semi-structured interviews. Our findings indicate AICare's reduced cognitive workload. Beyond performance metrics, qualitative analysis reveals that trust is actively constructed through verification, with interaction strategies diverging by expertise: junior clinicians used the system as cognitive scaffolding to structure their analysis, while experts engaged in adversarial verification to challenge the AI's logic. This work offers design implications for creating AI systems that function as transparent partners, accommodating diverse reasoning styles to augment rather than replace clinical judgment.

RecGOAT: Graph Optimal Adaptive Transport for LLM-Enhanced Multimodal Recommendation with Dual Semantic Alignment

Multimodal recommendation systems typically integrates user behavior with multimodal data from items, thereby capturing more accurate user preferences. Concurrently, with the rise of large models (LMs), multimodal recommendation is increasingly leveraging their strengths in semantic understanding and contextual reasoning. However, LM representations are inherently optimized for general semantic tasks, while recommendation models rely heavily on sparse user/item unique identity (ID) features. Existing works overlook the fundamental representational divergence between large models and recommendation systems, resulting in incompatible multimodal representations and suboptimal recommendation performance. To bridge this gap, we propose RecGOAT, a novel yet simple dual semantic alignment framework for LLM-enhanced multimodal recommendation, which offers theoretically guaranteed alignment capability. RecGOAT first employs graph attention networks to enrich collaborative semantics by modeling item-item, user-item, and user-user relationships, leveraging user/item LM representations and interaction history. Furthermore, we design a dual-granularity progressive multimodality-ID alignment framework, which achieves instance-level and distribution-level semantic alignment via cross-modal contrastive learning (CMCL) and optimal adaptive transport (OAT), respectively. Theoretically, we demonstrate that the unified representations derived from our alignment framework exhibit superior semantic consistency and comprehensiveness. Extensive experiments on three public benchmarks show that our RecGOAT achieves state-of-the-art performance, empirically validating our theoretical insights. Additionally, the deployment on a large-scale online advertising platform confirms the model's effectiveness and scalability in industrial recommendation scenarios. Code available at https://github.com/6lyc/RecGOAT-LLM4Rec.

Towards Sample-Efficient and Stable Reinforcement Learning for LLM-based Recommendation

While Long Chain-of-Thought (Long CoT) reasoning has shown promise in Large Language Models (LLMs), its adoption for enhancing recommendation quality is growing rapidly. In this work, we critically examine this trend and argue that Long CoT is inherently ill-suited for the sequential recommendation domain. We attribute this misalignment to two primary factors: excessive inference latency and the lack of explicit cognitive reasoning patterns in user behavioral data. Driven by these observations, we propose pivoting away from the CoT structure to directly leverage its underlying mechanism: Reinforcement Learning (RL), to explore the item space. However, applying RL directly faces significant obstacles, notably low sample efficiency-where most actions fail to provide learning signals-and training instability. To overcome these limitations, we propose RISER, a novel Reinforced Item Space Exploration framework for Recommendation. RISER is designed to transform non-learnable trajectories into effective pairwise preference data for optimization. Furthermore, it incorporates specific strategies to ensure stability, including the prevention of redundant rollouts and the constraint of token-level update magnitudes. Extensive experiments on three real-world datasets show that RISER significantly outperforms competitive baselines, establishing a robust paradigm for RL-enhanced LLM recommendation. Our code will be available at https://anonymous.4open.science/r/RISER/.

Action-Free Offline-to-Online RL via Discretised State Policies

Most existing offline RL methods presume the availability of action labels within the dataset, but in many practical scenarios, actions may be missing due to privacy, storage, or sensor limitations. We formalise the setting of action-free offline-to-online RL, where agents must learn from datasets consisting solely of $(s,r,s')$ tuples and later leverage this knowledge during online interaction. To address this challenge, we propose learning state policies that recommend desirable next-state transitions rather than actions. Our contributions are twofold. First, we introduce a simple yet novel state discretisation transformation and propose Offline State-Only DecQN (\algo), a value-based algorithm designed to pre-train state policies from action-free data. \algo{} integrates the transformation to scale efficiently to high-dimensional problems while avoiding instability and overfitting associated with continuous state prediction. Second, we propose a novel mechanism for guided online learning that leverages these pre-trained state policies to accelerate the learning of online agents. Together, these components establish a scalable and practical framework for leveraging action-free datasets to accelerate online RL. Empirical results across diverse benchmarks demonstrate that our approach improves convergence speed and asymptotic performance, while analyses reveal that discretisation and regularisation are critical to its effectiveness.

Uncertainty and Fairness Awareness in LLM-Based Recommendation Systems

Large language models (LLMs) enable powerful zero-shot recommendations by leveraging broad contextual knowledge, yet predictive uncertainty and embedded biases threaten reliability and fairness. This paper studies how uncertainty and fairness evaluations affect the accuracy, consistency, and trustworthiness of LLM-generated recommendations. We introduce a benchmark of curated metrics and a dataset annotated for eight demographic attributes (31 categorical values) across two domains: movies and music. Through in-depth case studies, we quantify predictive uncertainty (via entropy) and demonstrate that Google DeepMind's Gemini 1.5 Flash exhibits systematic unfairness for certain sensitive attributes; measured similarity-based gaps are SNSR at 0.1363 and SNSV at 0.0507. These disparities persist under prompt perturbations such as typographical errors and multilingual inputs. We further integrate personality-aware fairness into the RecLLM evaluation pipeline to reveal personality-linked bias patterns and expose trade-offs between personalization and group fairness. We propose a novel uncertainty-aware evaluation methodology for RecLLMs, present empirical insights from deep uncertainty case studies, and introduce a personality profile-informed fairness benchmark that advances explainability and equity in LLM recommendations. Together, these contributions establish a foundation for safer, more interpretable RecLLMs and motivate future work on multi-model benchmarks and adaptive calibration for trustworthy deployment.

SWGCN: Synergy Weighted Graph Convolutional Network for Multi-Behavior Recommendation

Multi-behavior recommendation paradigms have emerged to capture diverse user activities, forecasting primary conversions (e.g., purchases) by leveraging secondary signals like browsing history. However, current graph-based methods often overlook cross-behavioral synergistic signals and fine-grained intensity of individual actions. Motivated by the need to overcome these shortcomings, we introduce Synergy Weighted Graph Convolutional Network (SWGCN). SWGCN introduces two novel components: a Target Preference Weigher, which adaptively assigns weights to user-item interactions within each behavior, and a Synergy Alignment Task, which guides its training by leveraging an Auxiliary Preference Valuator. This task prioritizes interactions from synergistic signals that more accurately reflect user preferences. The performance of our model is rigorously evaluated through comprehensive tests on three open-source datasets, specifically Taobao, IJCAI, and Beibei. On the Taobao dataset, SWGCN yields relative gains of 112.49% and 156.36% in terms of Hit Ratio (HR) and Normalized Discounted Cumulative Gain (NDCG), respectively. It also yields consistent gains on IJCAI and Beibei, confirming its robustness and generalizability across various datasets. Our implementation is open-sourced and can be accessed via https://github.com/FangdChen/SWGCN.

BEAR: Towards Beam-Search-Aware Optimization for Recommendation with Large Language Models

Recent years have witnessed a rapid surge in research leveraging Large Language Models (LLMs) for recommendation. These methods typically employ supervised fine-tuning (SFT) to adapt LLMs to recommendation scenarios, and utilize beam search during inference to efficiently retrieve $B$ top-ranked recommended items. However, we identify a critical training-inference inconsistency: while SFT optimizes the overall probability of positive items, it does not guarantee that such items will be retrieved by beam search even if they possess high overall probabilities. Due to the greedy pruning mechanism, beam search can prematurely discard a positive item once its prefix probability is insufficient. To address this inconsistency, we propose BEAR (Beam-SEarch-Aware Regularization), a novel fine-tuning objective that explicitly accounts for beam search behavior during training. Rather than directly simulating beam search for each instance during training, which is computationally prohibitive, BEAR enforces a relaxed necessary condition: each token in a positive item must rank within the top-$B$ candidate tokens at each decoding step. This objective effectively mitigates the risk of incorrect pruning while incurring negligible computational overhead compared to standard SFT. Extensive experiments across four real-world datasets demonstrate that BEAR significantly outperforms strong baselines. Code will be released upon acceptance.

Leveraging LLMs For Turkish Skill Extraction

Skill extraction is a critical component of modern recruitment systems, enabling efficient job matching, personalized recommendations, and labor market analysis. Despite Türkiye's significant role in the global workforce, Turkish, a morphologically complex language, lacks both a skill taxonomy and a dedicated skill extraction dataset, resulting in underexplored research in skill extraction for Turkish. This article seeks the answers to three research questions: 1) How can skill extraction be effectively performed for this language, in light of its low resource nature? 2)~What is the most promising model? 3) What is the impact of different Large Language Models (LLMs) and prompting strategies on skill extraction (i.e., dynamic vs. static few-shot samples, varying context information, and encouraging causal reasoning)? The article introduces the first Turkish skill extraction dataset and performance evaluations of automated skill extraction using LLMs. The manually annotated dataset contains 4,819 labeled skill spans from 327 job postings across different occupation areas. The use of LLM outperforms supervised sequence labeling when used in an end-to-end pipeline, aligning extracted spans with standardized skills in the ESCO taxonomy more effectively. The best-performing configuration, utilizing Claude Sonnet 3.7 with dynamic few-shot prompting for skill identification, embedding-based retrieval, and LLM-based reranking for skill linking, achieves an end-to-end performance of 0.56, positioning Turkish alongside similar studies in other languages, which are few in the literature. Our findings suggest that LLMs can improve skill extraction performance in low-resource settings, and we hope that our work will accelerate similar research on skill extraction for underrepresented languages.

User-Adaptive Meta-Learning for Cold-Start Medication Recommendation with Uncertainty Filtering

Large-scale Electronic Health Record (EHR) databases have become indispensable in supporting clinical decision-making through data-driven treatment recommendations. However, existing medication recommender methods often struggle with a user (i.e., patient) cold-start problem, where recommendations for new patients are usually unreliable due to the lack of sufficient prescription history for patient profiling. While prior studies have utilized medical knowledge graphs to connect medication concepts through pharmacological or chemical relationships, these methods primarily focus on mitigating the item cold-start issue and fall short in providing personalized recommendations that adapt to individual patient characteristics. Meta-learning has shown promise in handling new users with sparse interactions in recommender systems. However, its application to EHRs remains underexplored due to the unique sequential structure of EHR data. To tackle these challenges, we propose MetaDrug, a multi-level, uncertainty-aware meta-learning framework designed to address the patient cold-start problem in medication recommendation. MetaDrug proposes a novel two-level meta-adaptation mechanism, including self-adaptation, which adapts the model to new patients using their own medical events as support sets to capture temporal dependencies; and peer-adaptation, which adapts the model using similar visits from peer patients to enrich new patient representations. Meanwhile, to further improve meta-adaptation outcomes, we introduce an uncertainty quantification module that ranks the support visits and filters out the unrelated information for adaptation consistency. We evaluate our approach on the MIMIC-III and Acute Kidney Injury (AKI) datasets. Experimental results on both datasets demonstrate that MetaDrug consistently outperforms state-of-the-art medication recommendation methods on cold-start patients.

Metric Hub: A metric library and practical selection workflow for use-case-driven data quality assessment in medical AI

Machine learning (ML) in medicine has transitioned from research to concrete applications aimed at supporting several medical purposes like therapy selection, monitoring and treatment. Acceptance and effective adoption by clinicians and patients, as well as regulatory approval, require evidence of trustworthiness. A major factor for the development of trustworthy AI is the quantification of data quality for AI model training and testing. We have recently proposed the METRIC-framework for systematically evaluating the suitability (fit-for-purpose) of data for medical ML for a given task. Here, we operationalize this theoretical framework by introducing a collection of data quality metrics - the metric library - for practically measuring data quality dimensions. For each metric, we provide a metric card with the most important information, including definition, applicability, examples, pitfalls and recommendations, to support the understanding and implementation of these metrics. Furthermore, we discuss strategies and provide decision trees for choosing an appropriate set of data quality metrics from the metric library given specific use cases. We demonstrate the impact of our approach exemplarily on the PTB-XL ECG-dataset. This is a first step to enable fit-for-purpose evaluation of training and test data in practice as the base for establishing trustworthy AI in medicine.