AgentDrift: Unsafe Recommendation Drift Under Tool Corruption Hidden by Ranking Metrics in LLM Agents

Tool-augmented LLM agents increasingly serve as multi-turn advisors in high-stakes domains, yet their evaluation relies on ranking-quality metrics that measure what is recommended but not whether it is safe for the user. We introduce a paired-trajectory protocol that replays real financial dialogues under clean and contaminated tool-output conditions across seven LLMs (7B to frontier) and decomposes divergence into information-channel and memory-channel mechanisms. Across the seven models tested, we consistently observe the evaluation-blindness pattern: recommendation quality is largely preserved under contamination (utility preservation ratio approximately 1.0) while risk-inappropriate products appear in 65-93% of turns, a systematic safety failure poorly reflected by standard NDCG. Safety violations are predominantly information-channel-driven, emerge at the first contaminated turn, and persist without self-correction over 23-step trajectories; no agent across 1,563 contaminated turns explicitly questions tool-data reliability. Even narrative-only corruption (biased headlines, no numerical manipulation) induces significant drift while completely evading consistency monitors. A safety-penalized NDCG variant (sNDCG) reduces preservation ratios to 0.51-0.74, indicating that much of the evaluation gap becomes visible once safety is explicitly measured. These results motivate considering trajectory-level safety monitoring, beyond single-turn quality, for deployed multi-turn agents in high-stakes settings.

VLM2Rec: Resolving Modality Collapse in Vision-Language Model Embedders for Multimodal Sequential Recommendation

Sequential Recommendation (SR) in multimodal settings typically relies on small frozen pretrained encoders, which limits semantic capacity and prevents Collaborative Filtering (CF) signals from being fully integrated into item representations. Inspired by the recent success of Large Language Models (LLMs) as high-capacity embedders, we investigate the use of Vision-Language Models (VLMs) as CF-aware multimodal encoders for SR. However, we find that standard contrastive supervised fine-tuning (SFT), which adapts VLMs for embedding generation and injects CF signals, can amplify its inherent modality collapse. In this state, optimization is dominated by a single modality while the other degrades, ultimately undermining recommendation accuracy. To address this, we propose VLM2Rec, a VLM embedder-based framework for multimodal sequential recommendation designed to ensure balanced modality utilization. Specifically, we introduce Weak-modality Penalized Contrastive Learning to rectify gradient imbalance during optimization and Cross-Modal Relational Topology Regularization to preserve geometric consistency between modalities. Extensive experiments demonstrate that VLM2Rec consistently outperforms state-of-the-art baselines in both accuracy and robustness across diverse scenarios.

Proactive Knowledge Inquiry in Doctor-Patient Dialogue: Stateful Extraction, Belief Updating, and Path-Aware Action Planning

Most automated electronic medical record (EMR) pipelines remain output-oriented: they transcribe, extract, and summarize after the consultation, but they do not explicitly model what is already known, what is still missing, which uncertainty matters most, or what question or recommendation should come next. We formulate doctor-patient dialogue as a proactive knowledge-inquiry problem under partial observability. The proposed framework combines stateful extraction, sequential belief updating, gap-aware state modeling, hybrid retrieval over objectified medical knowledge, and a POMDP-lite action planner. Instead of treating the EMR as the only target artifact, the framework treats documentation as the structured projection of an ongoing inquiry loop. To make the formulation concrete, we report a controlled pilot evaluation on ten standardized multi-turn dialogues together with a 300-query retrieval benchmark aggregated across dialogues. On this pilot protocol, the full framework reaches 83.3% coverage, 80.0% risk recall, 81.4% structural completeness, and lower redundancy than the chunk-only and template-heavy interactive baselines. These pilot results do not establish clinical generalization; rather, they suggest that proactive inquiry may be methodologically interesting under tightly controlled conditions and can be viewed as a conceptually appealing formulation worth further investigation for dialogue-based EMR generation. This work should be read as a pilot concept demonstration under a controlled simulated setting rather than as evidence of clinical deployment readiness. No implication of clinical deployment readiness, clinical safety, or real-world clinical utility should be inferred from this pilot protocol.

Public Profile Matters: A Scalable Integrated Approach to Recommend Citations in the Wild

Proper citation of relevant literature is essential for contextualising and validating scientific contributions. While current citation recommendation systems leverage local and global textual information, they often overlook the nuances of the human citation behaviour. Recent methods that incorporate such patterns improve performance but incur high computational costs and introduce systematic biases into downstream rerankers. To address this, we propose Profiler, a lightweight, non-learnable module that captures human citation patterns efficiently and without bias, significantly enhancing candidate retrieval. Furthermore, we identify a critical limitation in current evaluation protocol: the systems are assessed in a transductive setting, which fails to reflect real-world scenarios. We introduce a rigorous Inductive evaluation setting that enforces strict temporal constraints, simulating the recommendation of citations for newly authored papers in the wild. Finally, we present DAVINCI, a novel reranking model that integrates profiler-derived confidence priors with semantic information via an adaptive vector-gating mechanism. Our system achieves new state-of-the-art results across multiple benchmark datasets, demonstrating superior efficiency and generalisability.

PACE-RAG: Patient-Aware Contextual and Evidence-based Policy RAG for Clinical Drug Recommendation

Drug recommendation requires a deep understanding of individual patient context, especially for complex conditions like Parkinson's disease. While LLMs possess broad medical knowledge, they fail to capture the subtle nuances of actual prescribing patterns. Existing RAG methods also struggle with these complexities because guideline-based retrieval remains too generic and similar-patient retrieval often replicates majority patterns without accounting for the unique clinical nuances of individual patients. To bridge this gap, we propose PACE-RAG (Patient-Aware Contextual and Evidence-based Policy RAG), a novel framework designed to synthesize individual patient context with the prescribing tendencies of similar cases. By analyzing treatment patterns tailored to specific clinical signals, PACE-RAG identifies optimal prescriptions and generates an explainable clinical summary. Evaluated on a Parkinson's cohort and the MIMIC-IV benchmark using Llama-3.1-8B and Qwen3-8B, PACE-RAG achieved state-of-the-art performance, reaching F1 scores of 80.84% and 47.22%, respectively. These results validate PACE-RAG as a robust, clinically grounded solution for personalized decision support. Our code is available at: https://github.com/ChaeYoungHuh/PACE-RAG.

Deployment and Evaluation of an EHR-integrated, Large Language Model-Powered Tool to Triage Surgical Patients

Surgical co-management (SCM) is an evidence-based model in which hospitalists jointly manage medically complex perioperative patients alongside surgical teams. Despite its clinical and financial value, SCM is limited by the need to manually identify eligible patients. To determine whether SCM triage can be automated, we conducted a prospective, unblinded study at Stanford Health Care in which an LLM-based, electronic health record (EHR)-integrated triage tool (SCM Navigator) provided SCM recommendations followed by physician review. Using pre-operative documentation, structured data, and clinical criteria for perioperative morbidity, SCM Navigator categorized patients as appropriate, not appropriate, or possibly appropriate for SCM. Faculty indicated their clinical judgment and provided free-text feedback when they disagreed. Sensitivity, specificity, positive predictive value, and negative predictive value were measured using physician determinations as a reference. Free-text reasons were thematically categorized, and manual chart review was conducted on all false-negative cases and 30 randomly selected cases from the largest false-positive category. Since deployment, 6,193 cases have been triaged, of which 1,582 (23%) were recommended for hospitalist consultation. SCM Navigator displayed high sensitivity (0.94, 95% CI 0.91-0.96) and moderate specificity (0.74, 95% CI 0.71-0.77). Post-hoc chart review suggested most discrepancies reflect modifiable gaps in clinical criteria, institutional workflow, or physician practice variability rather than LLM misclassification, which accounted for 2 of 19 (11%) false-negative cases. These findings demonstrate that an LLM-powered, EHR-integrated, human-in-the-loop AI system can accurately and safely triage surgical patients for SCM, and that AI-enabled screening tools can augment and potentially automate time-intensive clinical workflows.

Learning Evolving Preferences: A Federated Continual Framework for User-Centric Recommendation

User-centric recommendation has become essential for delivering personalized services, as it enables systems to adapt to users' evolving behaviors while respecting their long-term preferences and privacy constraints. Although federated learning offers a promising alternative to centralized training, existing approaches largely overlook user behavior dynamics, leading to temporal forgetting and weakened collaborative personalization. In this work, we propose FCUCR, a federated continual recommendation framework designed to support long-term personalization in a privacy-preserving manner. To address temporal forgetting, we introduce a time-aware self-distillation strategy that implicitly retains historical preferences during local model updates. To tackle collaborative personalization under heterogeneous user data, we design an inter-user prototype transfer mechanism that enriches each client's representation using knowledge from similar users while preserving individual decision logic. Extensive experiments on four public benchmarks demonstrate the superior effectiveness of our approach, along with strong compatibility and practical applicability. Code is available.

Deploying Semantic ID-based Generative Retrieval for Large-Scale Podcast Discovery at Spotify

Podcast listening is often grounded in a set of favorite shows, while listener intent can evolve over time. This combination of stable preferences and changing intent motivates recommendation approaches that support both familiarity and exploration. Traditional recommender systems typically emphasize long-term interaction patterns, and are less explicitly designed to incorporate rich contextual signals or flexible, intent-aware discovery objectives. In this setting, models that can jointly reason over semantics, context, and user state offer a promising direction. Large Language Models (LLMs) provide strong semantic reasoning and contextual conditioning for discovery-oriented recommendation, but deploying them in production introduces challenges in catalog grounding, user-level personalization, and latency-critical serving. We address these challenges with GLIDE, a production-scale generative recommender for podcast discovery at Spotify. GLIDE formulates recommendation as an instruction-following task over a discretized catalog using Semantic IDs, enabling grounded generation over a large inventory. The model conditions on recent listening history and lightweight user context, while injecting long-term user embeddings as soft prompts to capture stable preferences under strict inference constraints. We evaluate GLIDE using offline retrieval metrics, human judgments, and LLM-based evaluation, and validate its impact through large-scale online A/B testing. Across experiments involving millions of users, GLIDE increases non-habitual podcast streaming on Spotify home surface by up to 5.4% and new-show discovery by up to 14.3%, while meeting production cost and latency constraints.

A Unified Language Model for Large Scale Search, Recommendation, and Reasoning

LLMs are increasingly applied to recommendation, retrieval, and reasoning, yet deploying a single end-to-end model that can jointly support these behaviors over large, heterogeneous catalogs remains challenging. Such systems must generate unambiguous references to real items, handle multiple entity types, and operate under strict latency and reliability constraints requirements that are difficult to satisfy with text-only generation. While tool-augmented recommender systems address parts of this problem, they introduce orchestration complexity and limit end-to-end optimization. We view this setting as an instance of a broader research problem: how to adapt LLMs to reason jointly over multiple-domain entities, users, and language in a fully self-contained manner. To this end, we introduce NEO, a framework that adapts a pre-trained decoder-only LLM into a tool-free, catalog-grounded generator. NEO represents items as SIDs and trains a single model to interleave natural language and typed item identifiers within a shared sequence. Text prompts control the task, target entity type, and output format (IDs, text, or mixed), while constrained decoding guarantees catalog-valid item generation without restricting free-form text. We refer to this instruction-conditioned controllability as language-steerability. We treat SIDs as a distinct modality and study design choices for integrating discrete entity representations into LLMs via staged alignment and instruction tuning. We evaluate NEO at scale on a real-world catalog of over 10M items across multiple media types and discovery tasks, including recommendation, search, and user understanding. In offline experiments, NEO consistently outperforms strong task-specific baselines and exhibits cross-task transfer, demonstrating a practical path toward consolidating large-scale discovery capabilities into a single language-steerable generative model.

Characterizing Delusional Spirals through Human-LLM Chat Logs

As large language models (LLMs) have proliferated, disturbing anecdotal reports of negative psychological effects, such as delusions, self-harm, and ``AI psychosis,'' have emerged in global media and legal discourse. However, it remains unclear how users and chatbots interact over the course of lengthy delusional ``spirals,'' limiting our ability to understand and mitigate the harm. In our work, we analyze logs of conversations with LLM chatbots from 19 users who report having experienced psychological harms from chatbot use. Many of our participants come from a support group for such chatbot users. We also include chat logs from participants covered by media outlets in widely-distributed stories about chatbot-reinforced delusions. In contrast to prior work that speculates on potential AI harms to mental health, to our knowledge we present the first in-depth study of such high-profile and veridically harmful cases. We develop an inventory of 28 codes and apply it to the $391,562$ messages in the logs. Codes include whether a user demonstrates delusional thinking (15.5% of user messages), a user expresses suicidal thoughts (69 validated user messages), or a chatbot misrepresents itself as sentient (21.2% of chatbot messages). We analyze the co-occurrence of message codes. We find, for example, that messages that declare romantic interest and messages where the chatbot describes itself as sentient occur much more often in longer conversations, suggesting that these topics could promote or result from user over-engagement and that safeguards in these areas may degrade in multi-turn settings. We conclude with concrete recommendations for how policymakers, LLM chatbot developers, and users can use our inventory and conversation analysis tool to understand and mitigate harm from LLM chatbots. Warning: This paper discusses self-harm, trauma, and violence.