#01Oct 26, 2026
cs.AI
Beyond Physical Illness: Can Clinical Narratives Reveal Emerging Mental Health Risks in Chronically Ill Patients?
Sudeshna Jana, Siddhartha Laha, Manjira Sinha and 2 more
Mental-health risks such as depression, dementia, and suicidal ideation can emerge during hospitalization among chronically ill patients and may worsen without timely recognition and intervention. However, most existing mental health studies focus on patients with established psychiatric conditions rather than patients hospitalized primarily for physical illness. In this work, we investigate whether latent mental-health risk in chronically ill patients can be inferred from longitudinal clinical narratives. We construct a weakly supervised cohort around 4,000 patients from MIMIC-III using mental-health evidence extracted from discharge summaries. A hierarchical state-space framework derives mental-health representations from day-wise clinical narratives and models their temporal evolution for risk estimation throughout hospitalization. Preliminary results demonstrate improved binary risk prediction using the proposed representations and show distinct model derived risk trajectories between risk and no-risk cohorts, providing a foundation for studying emerging mental-health risks in chronically ill patients.
#02Oct 26, 2026
cs.AI
Patient-specific rubric-based evaluation of large language models across longitudinal cancer care
Wei-Wei Zhang, Pengkai Wang, Yan Li and 13 more
Large language models (LLMs) show promise in specialty medicine, yet existing evaluations largely focus on isolated clinical encounters rather than tracking how clinical responsibilities evolve across a longitudinal care pathway. Here we introduce NPC-RubricBench, a phase-aware benchmark for evaluating multistage clinical reasoning across the cancer care continuum, using nasopharyngeal carcinoma as a defined disease context. Curated from longitudinal records of 405 patients across two cancer centers, the benchmark comprises 941 patient-phase units across six sequential care phases and 17,688 patient-specific atomic criteria spanning five evaluation dimensions, with each assessment strictly restricted to decision-time clinical evidence. Evaluating 30 general-purpose and medical LLMs revealed that strong diagnostic performance does not carry over to downstream care. We evaluated 30 general-purpose and medical LLMs, showing that high diagnostic performance did not translate into improved downstream care. Instead, the dominant failure modes reversed across phases. Explicit decision errors dominated anatomical staging at 48.2%, whereas decision omissions dominated initial work-up and post-treatment follow-up at 33.4% and 30.4%, respectively. In the evaluated model set, medically adapted models showed higher omission rates than general-purpose models. Moreover, varying query granularity exposes a critical specification trade-off: broad open-ended requests degrade Decision Quality across all 30 models, while more detailed, checklist-like prompts raise Decision Quality but reduce Evidence Faithfulness and Safety Adherence. Furthermore, NPC-RubricBench demonstrates that static diagnostic benchmarks are insufficient to ensure consistent clinical reliability over time, highlighting the importance of phase-adaptive safeguards in multistage medical AI.
#03Oct 26, 2026
cs.CL
Learning When to Commit: Schedule Distillation for Fast Diffusion Language Models
Aidar Myrzakhan, Zhiqiang Shen
Diffusion large language models (dLLMs) can generate multiple tokens in parallel, but often require many decoding rounds to complete a response. Efficient generation depends not only on which tokens are easy to predict, but also on how committing to them helps predict the remaining positions. A highly predictable token may provide little useful context, while revealing a less predictable token can help several other positions become predictable sooner. We propose dSpark, a new schedule distillation-based framework for learning when to commit tokens for faster diffusion language generation. To achieve this, we construct unmasking schedules that prioritize tokens whose reveal makes other positions easier to predict, reducing uncertainty earlier in decoding. We then distill these schedules into the model to enable faster parallel sampling, with a KL-divergence regularizer to help preserve generation quality. We extensively evaluate our approach across mathematical reasoning and code generation tasks. On GSM8K, our method achieves remarkable 10.12$\times$ and 5.12$\times$ speedups over the various baselines on LLaDA-8B-Instruct and Dream-7B-Instruct, respectively, while maintaining superior task performance. Our code is available at https://github.com/VILA-Lab/dSpark.
#04Oct 26, 2026
cs.CR
I-HITL: Inalienable Human-in-the-Loop
Samuel Breckenridge, Dani Vilardell, Wenhao Wang and 2 more
Human oversight is a pillar of AI safety. It is often exercised by a human in the loop (HITL) who approves critical actions taken by an AI agent. AI agents' increasing ability to bypass guardrails, though, raises the question of how to enforce HITL robustly. We introduce the concept of inalienable human-in-the-loop (I-HITL). An I-HITL protocol ensures that an agent can initiate an action only with explicit human approval, even when the human interacts with a system (e.g., a local agentic harness) compromised by the agent. A strong I-HITL protocol additionally ensures such approval even when an adversarial human attempts to delegate approvals to an agent. To motivate I-HITL, we report on experiments with a popular agentic wallet platform in which raising an agent's spending cap requires HITL approval via emailed one-time passcodes (OTPs). Given access to the user's email and a task blocked by the cap, we find that ten different frontier models will often autonomously raise the cap, harvesting OTPs to bypass a HITL guardrail and surfacing other vulnerabilities. We formally define I-HITL using the concept of communication topologies and prove necessary and sufficient conditions for its realization. We show that an I-HITL protocol requires a trusted entity - a trusted computing device (or equivalent) - and characterize which such devices can and cannot realize an I-HITL protocol. We present a prototype I-HITL system called Countersign that can plug into and strengthen existing HITL systems using off-the-shelf consumer mobile devices.
#05Oct 26, 2026
cs.LG
Multi-Objective Reinforcement Learning Using Routed Ensembles and Trajectory Attribution
Zhenshuo Zhang, Ruoxuan Xiong, Hongyang R. Zhang
Multi-objective reinforcement learning is a fundamental problem for modern AI, with applications spanning post-training, reasoning models, and robotic control. A central challenge is to learn policies that balance competing objectives, such as helpfulness versus honesty in safety and alignment, or speed versus energy in robotics. The optimal policy can vary sharply with objective-weighting combinations, and the extent of this variation depends crucially on the degree of conflict among objectives, making per-preference policy learning sample-inefficient. In this paper, we introduce objective-conflict coefficients and derive near-optimal regret bounds for online settings using this measure, thereby quantifying the impact of misalignment on learning efficiency. Then, we design routed ensemble policy learning, an algorithm that maintains a small set of basis policies and dynamically routes trajectories to the policy with the highest potential reward. Finally, we consider trajectory selection as another approach to mitigate objective conflict, and design a kernel surrogate trajectory attribution algorithm that estimates how feedback signals from a set of trajectories influence policy learning on other trajectories. The kernel can capture nonlinear interactions such as synergy and antagonism between trajectories. We evaluate our approach across diverse environments and benchmarks: routed ensembles improve average performance by 4.3% over baselines for online environments from Meta-World and MO-Gymnasium, and kernel surrogate attribution improves correlation with leave-one-out analysis over existing baselines by 50%. When applied to trajectory selection, kernel-based attribution yields a 27% improvement in reward over baseline attribution methods.