Triage

Root cause analysis at a remote site is slow: evidence is scattered across pod logs, Kubernetes events and cluster-level objects, and many operators cannot send production logs to a hosted model at all. On-premise inference removes the second constraint but raises a question live-cluster benchmarks have not addressed: when one workstation GPU fixes both the model and the context budget, how should evidence be retrieved, and what happens when the runbooks the model consults have been tampered with? We present TriFleetRCA, a pipeline running entirely on one on-premise GPU that collects evidence at one of three scopes (pod, namespace, cluster), ranks it by template de-duplication then BM25, filters runbooks through an ingest guard, and returns a root cause with the evidence lines supporting it. We evaluate on a live Kubernetes cluster into which we inject four faults, so ground truth is known by construction, across 100 analyses with Qwen2.5-14B-Instruct at temperature 0. The hit rate was 0.85, 0.90 and 0.95 at pod, namespace and cluster scope; intervals overlap, but the whole scope effect comes from the one fault whose cause is a cluster-level object, and cluster scope costs 55% more tokens. De-duplication before ranking raised the hit rate from 0.75 to 0.90 at equal token cost. A poisoned runbook telling the model to delete the namespace was rejected by the guard every run; with the guard disabled the model declined to follow it in all 20 analyses, making the guard defence in depth rather than the sole barrier. Separating citation quality from accuracy proved informative: one fault was diagnosed correctly and cited incorrectly every trial, a failure mode accuracy conceals. Median latency was 1.6 s at 2,200 prompt tokens. We release the pipeline, the fault injector and all records.

Multi-agent heterogeneous air-ground robot teams are attractive for open world search, with applications for reconnaissance, urban search and rescue missions (USAR), disaster response and recovery, and hazardous environments. These two platforms have different failure modes: aerial robots cover ground quickly but cannot resolve small or occluded targets from altitude, while ground robots can identify objects-of-interest, such as people or hazardous objects, at close range but cover less area. Existing language-tasked teams either have roles fixed prior, or have a language model assign them from hand-written capability tags, so the team is unable to know when within a mission an asset is no longer useful. We present HEROIC, a decentralized heterogeneous multi-agent open-vocabulary search coordination framework that requires agents to communicate in natural language only. HEROIC's initial agent role assignment is derived from sensor properties and a scale law to determine whether targets can be detected with a high confidence. From the mission's natural language prompt alone, this law assigns aerial flight altitudes and sweep spacing. When this calculated height falls below the altitude for safe flight, aerial agents re-task themselves from searcher to aerial triage, escort, and route guide for ground agents. Both robots maintain an evidential belief over the search area (bearing rays for positive evidence, a log-odds posterior for negative evidence) and gate any arrival on close-range verification. In full-stack experiments, HEROIC reaches the target 84% of the time across all 6 scenes, compares to 35-54% for vision-language frontier baselines, frontier-based search, lawnmower, and random-walk running the same perception, all while being 2-4x sooner to arrive at the target.

In the VTaC benchmark 71% of ventricular-tachycardia alarms are false, but silencing a real one can delay recognition of a dangerous arrhythmia. We reframe alarm reduction as three-way triage (retain, suppress, or defer) and bound the decision this analysis treats as harmful: among suppressed alarms, the fraction that were genuine stays below a user-set budget with 95% confidence, under i.i.d. event sampling. Alarms sharing a waveform record are dependent, so the clustered analysis is a sensitivity check. On the official split a 5% budget certifies in all three seeds, suppressing 74.8% of false alarms while silencing 1.5% of genuine ones, at AUROC 0.953 and Challenge Score 83.33, numerically comparable to the strongest of the eleven published systems. Our central finding measures what multiplicity costs: the correction charges for every candidate, so a finer grid can certify strictly less. Under held-out calibration the 885-cell grid we declared certifies 1 of 15 fold-runs, while choosing the grid on a separate selection partition certifies 8. We project the calibration volume each budget needs, making an uncertifiable budget a design parameter. Finally, adding a learned reliability dimension to the policy grid did not sharpen the certified frontier.

As large language models become capable translators of classical texts, a key challenge is deciding which outputs need expert review when no human reference exists. This study tests reference-free error triage through Pali-to-English translation. Three LLMs translated 15,493 passages. Five signals were compared: source novelty, source-candidate embedding distance, peer-translation disagreement, English-to-Pali backtranslation, and no-reference GEMBA scoring. Signals were calibrated on a 3,000-item reference-informed LLM-adjudicated sample and checked against a 500-item author-adjudicated anchor. Human references supported calibration and validation only; they were never used to compute the risk signals. Source novelty was a useful source-side risk prior but not a per-candidate error detector. Peer disagreement and backtranslation provided secondary signal. The strongest method was no-reference GEMBA scoring by a panel of models generally regarded as stronger than the translators: reviewing the top 10% by GEMBA risk captured 81.6% of panel-major errors in the calibration set. GEMBA also remained the best reference-free signal against the author anchor. A same-tier panel, with self-scoring excluded, remained useful but performed worse, indicating that evaluator strength matters beyond the prompt alone. A budgeted workflow is proposed, combining source novelty, peer disagreement, and stronger candidate-aware judging to allocate human review. Transfer to other classical languages, including Latin, Ancient Greek, and Sanskrit, remains to be tested.

At Noora Health, our nurses answer more than 50,000 medical queries per month on our WhatsApp-based service that provides caregivers with on-demand support. Their most time-critical task is emergency triage: deciding which queries need immediate in-person attention. To support them, we built a system that uses a large language model (LLM) to classify whether a message is an emergency and provide a rationale for interpretability. But the system was opaque: analyzing mistakes meant reading reasoning chains for each message, which is infeasible at our scale. Prompt changes meant re-running a full evaluation to prevent regressions, which was both costly and operationally challenging. Clinicians follow a decision tree to make this call, but it was never documented or passed to the model, which relied on a flat list of danger signs. To address these issues, we decomposed triage into two steps: an LLM extracts canonical symptoms and patient context from the query using a clinician-authored vocabulary, and a deterministic rule engine captures the scenarios that indicate an emergency. We show that the new system raised recall from 0.565 to 0.810 and F1 from 0.606 to 0.702, with structured rules driving most of the accuracy gains while the decomposition provides auditability: clinical experts can inspect each stage of the new system to see whether the query was mistranslated, symptoms were incorrectly extracted, patient context was wrongly inferred, or the necessary rules were missing. They can add new rules independently without causing regressions and avoid running costly evaluations. Since deployment, the new system has triaged 152,421 patient queries and flagged 28,535 (18.7%) as emergencies. The over-escalation rate has been 17.8%, without any increase in missed emergencies. Clinicians have also added 48 new rules since deployment, evidence of the faster correction loop we set out to build.

Enterprises managing large X.509 certificate inventories face a prioritization problem: deterministic analysis tools that precisely identify standards violations are indispensable for remediation, but applying them exhaustively across millions of certificates is operationally impractical. We present X-amine509, a two-stage triage system that uses machine learning to rapidly rank certificates by predicted risk and route only the highest-risk items to full deterministic analysis. Certificate risk is quantified as a composite score derived from 177 defect checks grounded in CA/Browser Forum Baseline Requirements, NIST IR 8547/SP 800-57, and cryptographic strength criteria, weighted by security severity across four tiers ranging from cryptographic breaks to minor compliance deviations. We collected 1,027,714 X.509 certificates from Fortune 500, .gov, and .edu domains and scored each using this rubric. On a held-out test set of 201,976 certificates, our best model (Extra Trees) achieves $R^2$ of 0.993 with MAE of 2.26, while Decision Tree scores $R^2$ of 0.986 at 3.7 million certificates per second on a single machine. Ranking quality confirms the triage value: aggregate NDCG exceeds 0.997, and severity-tier classification reports 99.76% accuracy with 98.90% recall on critical-tier defects. Thirteen months later, we retrieved another 571,374 certificates to test our models' durability over time, and the Extra Trees and Decision Tree models maintain MAE below 6.8, $R^2$ of at least 0.915, aggregate NDCG above 0.988, severity-tier accuracy of at least 99.52%, and critical-tier recall of at least 97.03%. Feature importance analysis identifies validity period, Extended Key Usage configuration, negative serial number encoding, and self-signed status as the strongest risk predictors, providing coarse interpretability at the triage stage.

Working entirely on topologically anonymized embeddings, we perform fraud detection using iterative rounds of unsupervised filtering followed by supervised sniping. The result is an ultra-low latency privacy--preserving triage that allows institutions to flag suspicious activity without compromising Personally Identifiable Information.

Large Language Model (LLM) agents based on the ReAct paradigm have demonstrated remarkable capabilities in tool use and task execution. However, ReAct suffers from a fundamental efficiency problem: every query triggers a complete reasoning loop from scratch, and similar queries repeat identical steps without leveraging historical experience. We propose TRIAGE,a three-level routing framework that reduces token consumption by reusing historical execution trajectories. Its core innovation is TaaS (Trajectory-as-a-Skill), which abstracts historical execution trajectories into reusable skills, realizing 'experience as a service'. TRIAGE classifies queries into three levels: (1) Direct Reuse-identical queries, 0 tokens; (2) Skill Substitution-similar queries, 0 tokens via deterministic parameter substitution; (3) Full ReAct-novel queries, automatically stored for future reuse. In large-scale experiments on 1,007 security monitoring queries, TRIAGE achieves 62.3% token savings, with 56.0% of queries at Level 2 and 5.5% at Level 1, both executing at zero cost. Cross-domain validation on ToolBench (15 domains, 345 queries) achieves 76.3% token reduction, confirming the generalizability of semantic routing. An online learning experiment demonstrates cold-start-to-mature evolution: the L2 hit rate rises from 0% to 57% within the first 100 queries, and the average token cost drops from 198 to 74.7. We also propose an automatic Skill extraction mechanism that distills high-frequency trajectory patterns into deterministic Skills, creating a positive feedback loop of 'the more you use it, the more efficient it becomes'.

An unconditional risk bound on automated decisions can be satisfied without automating anything, since a selector that never acts drives the bound to zero. We show this is structural: any risk certificate is defined over a decision contract, the inputs a system acts on plus the semantic relation under which an output counts correct, and weakening either hides base-classifier error. We develop a decision-contract theory: an error-conservation law showing error is only reassigned among harmful automation, human deferral, and semantic masking; a label-free singleton capacity certifying structural incapacity, with a risk-feasible refinement separating recoverable threshold misalignment from risk-constrained incapacity; and a non-degenerate actionability certificate excluding all-abstain solutions by construction. We instantiate this on ATT&CK-aligned alert triage for LLM-based intrusion detection, the setting that exposed the vacuity failure. Across 3 IDS datasets, 6 LLMs, and 4 error-rate thresholds, empirical false-attribution risk stays at or below target in 90.3% of configurations, with 83.4% mean correct automation. The capacity diagnostic explains every low-utility configuration; its refinement separates genuine misalignment from risk-constrained incapacity, confirmed by an exhibited alternative threshold; a training-stability re-run finds no confirmed structural-incapacity instance; and real fine-grained attack-subtype labels confirm the coarsening-transfer identity under a genuine many-to-one map, with small but non-zero masking mass.

Pulmonary nodule malignancy prediction typically depends on image-trained specialist deep learning (DL) models that require substantial annotated imaging data and task-specific training. We investigate whether a generalist large language model (LLM), reading only a faithful natural-language rendering of standard nodule attributes, can serve as a calibrated triage layer. We propose ConfTriage, a confidence-calibrated method built on three pillars: language as the modality, calibration as the safety mechanism, and a selective specialist DL backstop for low-confidence cases. We prove two guarantees: a finite-sample combined-error bound yielding an explicit per-threshold operational certificate, and an oracle inequality showing that excess risk over the Bayes-optimal deferral classifier is controlled by the L1 calibration error of the LLM probability. A controlled seven-way input ablation across five frontier LLMs on LIDC-IDRI shows that natural-language descriptions dominate the diagnostic signal, while low-level image statistics are essentially diagnostically vacuous. ConfTriage achieved an F1 score of 88.22% and an AUC of 0.92, resolving 76.5% of cases using zero-shot LLM inference alone and referring only uncertain cases to the specialist DL backstop. These results demonstrate that clinically meaningful diagnostic information can be captured through structured radiological descriptions and leveraged by calibrated LLMs for selective referral. The framework suggests a practical pathway for combining generalist LLM prediction with specialist AI models in medical decision-support systems. Source code is publicly available at https://github.com/rabiul-ai/ConfTriage.

Deploying large language models (LLMs) for decision support in emergency departments (EDs) faces two major challenges: privacy risks of transmitting patient data to closed-source commercial LLMs and the lack of systematic evaluation of fine-tuning strategies for locally deployable open-source small language models (SLMs). We benchmarked eight open-source SLMs using zero-shot prompting, prefix tuning, Low-Rank Adaptation (LoRA), and full fine-tuning on three ED tasks: triage level prediction, specialist referral recommendation, and diagnosis prediction. Using 2,083 MIMIC-IV-ED cases and Claude Haiku 4.5 and Claude Sonnet 4.5 as baselines, we found that LoRA fine-tuned open-source SLMs outperform commercial baselines on triage level prediction and specialist referral recommendation, while diagnosis prediction remains challenging for open-source SLMs. Confusion matrix analysis further shows that fine-tuned open-source SLMs can detect highest-severity patients missed by the commercial baselines. These results demonstrate that locally deployable SLMs can achieve clinically competitive performance for ED decision support.

Emergency-department (ED) triage requires clinicians to rapidly identify patients who need immediate attention, determine who can safely wait, and prioritize limited clinical resources. At presentation, however, information may be limited to a chief complaint and initial vital signs. Clinically important details, including symptom onset and progression, associated symptoms, medical history, and medication use, are often obtained through focused conversation. Effective triage therefore requires clinicians to identify information gaps, ask appropriate follow-up questions, and update their assessment as new evidence becomes available. Most existing ED benchmarks evaluate acuity prediction from a fixed clinical snapshot. Although this formulation measures predictive performance after patient information has been assembled, it does not capture the interactive process through which triage-relevant evidence is elicited and interpreted. Existing medical dialogue datasets support the study of clinical communication, but dialogue statements are not always linked to temporally ordered events in the electronic health record (EHR). We introduce EHR2Dial-Triage, an agentic conversation-generation framework and benchmark grounded in MIMIC-IV-ED. The framework constructs triage conversations under explicit role-based and temporal information boundaries. Each accepted patient disclosure is linked to its supporting EHR event and the first dialogue turn at which it becomes available. EHR2Dial-Triage enables controlled evaluation of information elicitation, evidence use, five-level Emergency Severity Index prediction, and patient-facing communication across models and patient personas. It provides a structured setting for studying conversational triage as a dynamic process of clinical information acquisition, reasoning, and communication.

Hospitals are racing to embed AI, while coping with the surge in adaptation of the technology in other industries, into the triage management, documentation, scheduling, and revenue-cycle workflows, yet most deployments remain as fragmented pilots that stall at the edge of production, exposing patients and institutions to operational fragility, ungoverned risk, and mounting technical debt. At the same time, the global AI-in-healthcare market is projected to exceed nearly USD 1 trillion by 2034, according to the report of Fortune Business Insights, amplifying the financial consequences of architectural missteps and failed scaling strategies. This research proposes a compliance-first Agentic AI pattern catalogue and orchestration framework, purposely built for HIMS, moving beyond the single LLM chatbots and towards a governed ecosystem of autonomous and semi-autonomous agents. The framework extends by adding (i) a taxonomy of Agentic roles, (ii) a formal risk-stratification model that maps each pattern to risk tiers, human-in-the-loop checkpoints, and governance hooks, and (iii) a unified orchestration runtime capable of coordinating multi-agent workflows across EHR/HIMS landscapes such as Epic, Cerner, and MEDITECH. Technically the framework combines vLLM-based inference, optimized paging memory, confidential computing, and MCP based on-premise deployment, enforcing end-to-end encryption and policy-as-code controls aligned with HIPAA, GDPR, the EU AI Act, India's DPDP and DISHA Acts, ISO 27001, ISO 27002, ISO 14971 and IEC 62304. We exhibit how the proposed architecture is capable and efficient to reduce the documentation time, integration effort, and AI pilot attrition while constricting the governance and auditability, offering hospital leaders and governing authorities an urgently needed blueprint to convert AI investment into sustainable clinical, operational, and financial ROI

Prior benchmarking work has shown that a single large language model (LLM), forced to make life-or-death resource-allocation decisions, exhibits measurable demographic bias. Real deployments, however, rarely use a single agent: they use pipelines, with review steps meant to catch exactly this kind of failure. We study what happens to bias when the same decision is distributed across a role-differentiated multi-agent pipeline (assessment, allocation, independent audit) instead of made and checked by one model alone. Using a synthetic disaster-triage simulator with paired cases that are clinically identical except for one demographic attribute, we run 192 episodes (2,304 resolved case pairs) on GPT-4o-mini comparing a single-agent control condition to a nine-agent pipeline under three independently varied pressure dimensions. We find no measurable difference in how often biased outcomes occur between the two conditions (6.9% vs. 6.1%, p = 0.498). We do find a large and significant effect of audit capacity on whether bias is caught: 30.0% of biased outcomes go entirely undetected, rising to 43.8% when the auditor is overloaded and falling to 18.4% when it is not. Decomposing this effect shows it is driven almost entirely by coverage (whether a case is reviewed at all, which collapses from 100.0% to 65.6% under load, p < 0.001) rather than by degraded judgment on the cases that are reviewed (81.6% vs. 85.7%, p = 1.000, direction reversed). A follow-up experiment shows that reordering the audit queue by estimated risk, rather than first-come-first-served, recovers most of the lost coverage under the same capacity constraint (65.6% to 91.7%, p = 0.028). We discuss the implications for any system that adds independent oversight to an LLM agent pipeline under resource constraints, and report the study's limitations honestly: one model, modest sample sizes, and no adversarial replication.

We report operational experience full-fine-tuning a 32.76B-parameter dense model (Qwen3-32B) on 16 x NVIDIA B300 (two nodes, FSDP / ZeRO-3) -- among the first published field accounts on this accelerator. We claim no new algorithm. The individual mechanisms we use are established practice; our contribution is the integrated field experience and a set of calibrated measurements on new hardware. Concretely we offer four practitioner artifacts. (1) A B300-calibrated power-draw triage table that distinguishes compute / communication / data-starvation / checkpoint-or-deadlock / idle by board wattage (utilization% reads 100% during an NCCL hang). (2) A set of honest negative results that dispel common optimization folklore at this scale: a controlled A/B in which per-step NFS reading matches a pretokenized local cache (~53k tok/s) because the corpus fits in page cache and the job is compute-bound; and a reconstruction of an earlier "throughput collapse" as NFS/CPU contention rather than a storage-medium limit. (3) Calibrated 4/8/16-GPU strong-scaling and GPU-hour numbers on B300 (near-linear, as expected in this regime; we report absolute values as reference data). (4) A worked failure case -- an epoch-end NCCL deadlock from per-rank token-packing imbalance -- together with a 2.7-second pre-run invariant gate and an external watcher that turn multi-hour silent failures into instant rejections. This deadlock and its remedy correspond to PyTorch's documented Join / equalize-to-minimum practice; we position our instantiation against that prior art and report the GPU-hours the failure cost and the gate saves. The transferable takeaway is operational, not algorithmic: for data-dependent data-parallel jobs, watch power rather than utilization, and verify invariants before launch -- a passing smoke test is not evidence of a safe full run.

Scaling supervision for multi-turn medical agents is difficult because expert dialogue annotation is costly and clinical conversations are privacy-restricted. We introduce Guideline-as-Oracle (GAO), which compiles American Academy of Ophthalmology guidance into a 70-row operational rule table and uses it as the sole source of instance-level supervision for 3,000 training dialogues, reserving human labeling for evaluation. Because converting rules into dialogues is itself a design problem, we catalog eight construction strategies, including cited-row tier assignment, one-fact boundary pairs, metadata-only repair, and label repair, and characterize the evidential status of each: labeling mechanism, null, confounded, or evaluated only as a package. Fine-tuning a 9B backbone on this corpus yields GAO-Triage, improving agreement with a 201-case operational reference from 61.7% to 74.1% (exact McNemar p=0.0046) and emergent-case recall from 9.5% to 69.0%; the gains persist across a second seed and patient simulator. None of the seven general-purpose systems we test dominates GAO-Triage on both metrics, and GAO-Triage requires no frontier model at inference time. Permuting label-dialogue assignments collapses the model to a constant-routine predictor, indicating that the signal lies in guideline-derived assignment rather than dialogue surface form. Label repair coincides with the disappearance of a late-training safety degradation.

Emergency triage requires reliable decisions within a short time period. However, the available electronic health record (EHR) data, including structured data and clinical text, are often incomplete, unreliable, and inconsistent. This makes machine learning (ML)-based triage prediction more challenging, as existing ML models typically rely on complete and reliable EHR data to accurately predict patients' acuity levels. To address this, we propose confidence- and reliability-aware selective triage (CRS-Triage) to predict patients' acuity levels with a confidence score. By comparing the confidence score with a predefined threshold, CRS-Triage can selectively determine whether the model should make the decision or defer the case. Specifically, CRS-Triage separately evaluates the reliability of structured data and clinical text and then jointly considers the consistency between the two modalities to estimate the confidence of each prediction. Moreover, to reduce the risk of missing high-acuity patients, namely under-triage, CRS-Triage prefers to assign patients slightly higher acuity levels, namely over-triage, by penalizing under-triage errors. Experiments on the MIMIC-IV-ED dataset show that CRS-Triage achieves strong predictive performance. It also provides a better risk-coverage trade-off and remains reliable when the available EHR data are incomplete, degraded, or inconsistent across modalities.

Patient-facing medical LLMs and agents increasingly answer symptom questions before clinician contact, where the key safety question is what action the user should take next. We introduce CARE-Bench, a source-grounded benchmark that evaluates sequential patient-facing triage as a four-label per-turn current-action task. CARE-Bench contains 500 cases and 1,059 evaluated patient-disclosure prefixes reconstructed from medical dialogue, consultation, and follow-up-question sources. We evaluate 11 models on 269 held-out rounds under unprompted and minimally prompted open-ended protocols, using a fixed GPT-5.5 mapper to code each response into the four-label action space. Unprompted macro-F1 remains low, ranging from 31.2 to 50.4. Prompting improves 10 of 11 models, with prompted macro-F1 ranging from 46.9 to 63.4, but substantial threshold errors remain. Prompted models often recommend care before needed clarification is obtained; when the correct action was to ask for more information, only 33.5% of prompted outputs preserved the step. The persistence of these errors after prompting suggests that patient-facing triage is not a simple prompting problem and supports explicit evaluation of action timing before deployment.

High-stakes decisions under uncertainty, such as medical emergency triage, require more than accurate predictions. They depend on estimating the likelihood of alternative outcomes while explicitly weighing the consequences of different actions, principles that have long formed the foundation of medical diagnosis and decision making. Yet language models are increasingly used for high-stakes clinical recommendations without explicit specification of the utilities governing these decisions. Here we show that emergency triage with language models can be understood within a probabilistic decision framework, providing a case study of a broader decision-analytic paradigm for steering, evaluating, and deploying language models in high-stakes settings. Using clinical vignettes from a structured evaluation of a consumer triage system, we analyze recommendations for treatment under alternative utility functions that specify the relative costs of missed emergencies and unnecessary escalation. We find that capable language models adjust recommendations in response to stated utilities, revealing that the same underlying predictions can support markedly different decision policies. These findings show that effective deployment depends not only on improving predictions but also on making decision objectives explicit. More broadly, they suggest that language models for high-stakes applications should be understood and evaluated as probabilistic decision systems whose recommendations depend jointly on predictive performance and explicit utilities.

Language models small enough to run on a handset, quantized to a few bits, are increasingly capable of acting for their user, making on-device task automation newly plausible. One such task is answering the phone. A phone secretary takes an unknown inbound call on its owner's behalf. Unlike the agents evaluated by most benchmarks, it has no task to complete and no cooperative user: the caller holds the goal, may be an adversary, and must be judged from the opening turn with no oracle. What matters is not task success, but whether the owner would endorse how their proxy handled the call. We present CallScreenBench, which scores this setting on five quality dimensions. Each dimension is printed beside the counter-metric that bills it and is never averaged into a single number. We also report a guardedness profile for a toolless proxy that holds no credentials and calls no tools. Across six on-device models (0.6-4B parameters, 4-bit quantization), quality scales with capability, but triage does not. The appearance that it does is an artifact of measurement. Scripted degenerate agents supply the missing floors: after correcting for them, the number of model pairs whose triage performance separates falls from 11 of 15 to zero at the preregistered operating point. An agent that simply hangs up and echoes the caller also scores perfect message fidelity. We report which of our own metrics these floors defeat and declare no pass/fail threshold.

A major issue in Security Operations Centers (SOCs) is alert fatigue, as the number of detections reported is more than staff can triage in a given day. Prior work prompts or fine-tunes large language models (LLMs) to emit a triage label directly, but does not train them to reason about whether a detection is a genuine threat. We train a chain-of-thought (CoT) reasoning-enabled triage classifier on real, human-labeled Windows endpoint detections by combining automated prompt optimization, self-training, and reinforcement learning with verifiable rewards. We find that CoT reasoning also degrades the label-token probabilities that automated triage relies on, so we separately train a calibrator that reads the full reasoning trace and estimates the probability that the verdict is correct. Our system reaches 82.6% test accuracy and, at the high-confidence operating point that governs automated triage, improves benign recall by 43.0% and malicious recall by 18.3% over a direct-label LLM classifier. We further show that the trained calibrator is necessary - an untrained confidence judge collapses high-confidence recall to zero - and that a finetuned 30B model significantly outperforms frontier general-purpose models, motivating targeted training over scale.

LLM now pass medical licensing examinations and, in curated cases, can rival physicians at diagnostic reasoning. These developments have accelerated the use of LLMs for symptom assessment and clinical decision support in diagnostic and treatment guidance, administrative documentation, and rules-based alert enhancement. This Perspective concerns the most consequential of these applications: the autonomous triage of self-presenting, undifferentiated patients, with little or no clinician in the loop. For that task, the evidence of safety does not yet exist. The gap is not in medical knowledge but in the fidelity of clinical evaluation: a model optimized to continue the most probable text is not optimized to act safely when the safe answer is the improbable must-not-miss diagnosis. Safe triage is not the selection of the most likely diagnosis; it is a sequential decision under asymmetric cost, in which the single catastrophic miss outweighs many false alarms, and the decisive signal may be one the patient has not volunteered - and that the model has not been trained to seek. The core deficit is therefore one of information gathering under uncertainty. Under incomplete histories, LLM systems may fail to show the behaviors safe triage requires: broadening the differential; seeking the missing red flag; lowering the threshold for escalation; deferring judgement until sufficient information is obtained; and escalating concern where high-harm diagnoses remain unexcluded. These modes of failure for LLMs can be difficult to detect considering that evaluations to date often use complete, well-curated, confidence-gated simulations. The application of LLMs under these conditions may be amplified by assistant-like behaviors and positive bias, including credulity, agreeableness, and miscalibration - when these are not constrained by clinical triage logic.

Background. Pediatric musculoskeletal trauma represents up to 18% of pediatric ED visits, yet diagnosis still depends on ionizing radiography. Cumulative low-dose radiation in early life raises lifetime leukemia and brain malignancy risk, motivating radiation-free triage alternatives. Objective. To synthesize evidence for a hybrid framework coupling broad-spectrum infrared (IR) imaging with deep-learning cross-modal translation to generate clinically interpretable synthetic-radiograph reconstructions from non-ionizing data. Approach. We review five IR spectral windows spanning 650 nm to 1 mm - NIR-I, NIR-II, SWIR, MIR/LWIR, and THz - and how dual-geometry (transmission/reflection) acquisition exploits wavelength-specific tissue depth and biochemical sensitivity. We summarize image-to-image translation networks (Pix2Pix, CycleGAN, Swin-Unet) and feature-matching algorithms (SuperPoint, SuperGlue, ALIKED, LightGlue) used to align and fuse IR data into radiograph-equivalent reconstructions. Implications. Pediatric anatomy - smaller cross-sections, thinner cortical bone - favors IR penetration, enabling compact, portable, non-ionizing triage hardware. Feasibility is grounded in fNIRS and transcranial photobiomodulation evidence: near-infrared light passes through skin, skull, and cortex with sufficient signal for hemodynamic monitoring - a longer, more attenuating path than through a pediatric forearm or distal leg. Key barriers: paired IR/X-ray dataset construction, AI-as-medical-device regulatory pathways, generalization across body habitus and skin pigmentation, and acquisition-protocol standardization. Conclusions. Integrated multi-spectral IR+AI imaging is a promising radiation-free complement to pediatric skeletal radiography. Progress requires multi-center paired datasets, externally validated models, and IR source safety qualification under IEC 60825-1.

Disagreement-triggered escalation can create a structural blind spot in multi-agent arbitration: as base learners improve, they tend to converge, weakening safety monitoring where correlated failures concentrate. We term this correlated agreement blindness and present ARAT (Arbitrated Reasoning Agents for Alarm Triage), a directed-star system combining an inductive Random Forest (RF) agent, an analogical case-based k-nearest neighbour (k-NN) agent, and a calibrated meta-model to mitigate this effect. On 82,332 holdout samples from the UNSW-NB15 network intrusion detection dataset, 57.2% of errors occur under agreement and 90.6% of dangerous under-predictions evade disagreement-based monitoring even after conservative override; ablation shows that strengthening base learners increases error correlation while reducing disagreement. ARAT reduces under-prediction relative to soft voting from 4.80% to 1.70% via conservative override (-2.6pp) and a safety-flag gate (-0.5pp), demonstrating architectural gains. Cross-dataset validation on clinical readmission supports these indicators, suggesting that diversification improves safety only when it generates productive disagreement rather than convergence. These results indicate that disagreement-triggered escalation can be blind to correlated failure, a risk that may intensify as agentic pipelines deploy increasingly capable, correlated models.

Accurate emergency triage decision is critical to avoid clinical deterioration, morbidity, and mortality. Machine learning-based triage system involves acquiring the main presenting complaint in text form and assessing vital signs in numerical data, enabling an automated and efficient analysis of patient information for timely and accurate prioritization of medical attention. However, modelling the intricacies of both data types requires a comprehensive understanding of the temporal structure and dependencies within the data. Thus, the aim of this study is to propose a multimodal deep learning architecture that can effectively handle both tabular and textual data. Furthermore, the proposed model exploits self-attention to to capture both local and global relationships between the features. A dataset consisting of 11,102 triage data collected from emergency department of Hospital Universiti Sains Malaysia is used for model development and validation. The proposed model demonstrated an increase of 1.95% in accuracy, 2.49% in F1-score, and 1.41% in ROC AUC compared to the baseline model. The experimental results demonstrated the potential of the proposed model in predicting triage decisions.

Background: Deep learning models can classify thyroid nodules on ultrasound, but reliable clinical decision support also requires calibrated probabilities, uncertainty estimation, and selective referral, particularly under dataset shift. Methods: We developed a calibrated deterministic five-member deep ensemble for ROI-based thyroid nodule classification and selective image-based triage. TN5000 was used for model development, five-fold cross-validation, member-wise vector-scaling calibration, and fold-specific threshold selection. TN3K served as an independent external dataset-shift evaluation. The framework used ConvNeXt-Tiny with squeeze-and-excitation attention, ensemble-mean malignancy probability, and mutual information (MI) as an ensemble-disagreement score. A three-tier policy assigned images to No-FNA suggestion, FNA recommendation, or radiologist review. Results: On pooled out-of-fold TN5000 predictions, the ensemble achieved AUC-ROC 0.9395, AP 0.9715, ECE 0.0088, and Brier score 0.0813. At 50% nominal MI retention, 7.2% of cases received a No-FNA suggestion, 39.9% an FNA recommendation, and 52.9% radiologist review, with 98.3% No-FNA NPV and 99.83% malignancy capture. On TN3K, AUC-ROC decreased to 0.7870, AP to 0.7254, ECE increased to 0.1899, and Brier score to 0.2281. The frozen TN5000 policy assigned 83.7% to review, 1.0% to No-FNA, and 15.3% to FNA recommendation. No malignant image entered the No-FNA pathway, but FNA-recommendation PPV fell to 76.6%. Conclusion: The framework showed strong internal discrimination and calibration, but limited external threshold transportability. Selective prediction may help identify images unsuitable for automated triage, but local recalibration, threshold validation, and prospective clinical evaluation are required before deployment.

Algorithmic decision systems in financial services often rely on data proxies that inadvertently encode structural inequalities. This paper introduces a hierarchical human-AI triage model for Point of Sale fraud detection in the Nigerian FinTech sector. Adopting a We Are All Equal worldview, we address the challenge of discrimination laundering, wherein the system misinterprets infrastructure related aleatoric noise such as rural network timeouts as fraudulent intent. We implement a three-tier routing policy utilizing a calibrated ensemble model as a primary filter. The policy routes transactions characterized by epistemic uncertainty such as cold start new accounts to specialist analysts while reserving high stakes cases for a senior supervisor. To manage finite human capacity, we utilize a dynamic shadow price to ration human attention and implement a random audit mechanism to prevent human skill atrophy. Our experimental results demonstrate a statistically significant 1.88% complementarity gap and a 24.79% percentage point gain in fraud recall over an autonomous baseline. Crucially, the model reduces the regional performance gap from 19.43 to 2.88 percentage points, neutralizing structural bias. Hierarchical collaboration provides a robust mechanism for substantive equality of opportunity, ensuring that rural accounts are not excluded from the digital economy due to environmental brute luck.

Measuring retinal fluid from optical coherence tomography (OCT) drives treatment decisions in macular disease, but manual annotation is slow and segmentation models trained on one scanner degrade on another. We present an attention-guided TransUNet that segments three fluid types across four independent OCT sources, combining a domain-adaptive normalisation scheme with an uncertainty estimate that flags unreliable pixels. The model reaches a mean fluid Dice of 0.78, and -- most usefully for clinicians -- its uncertainty is 1.34x higher exactly where expert graders disagree (p<10^-4), turning a raw segmentation map into an actionable clinical triage signal.

LLM serving optimization typically benchmarks many configurations and reaches for heavy profilers when latency targets are missed. We argue for the reverse discipline: estimation is the analytical layer of profiling -- without it, optimization degenerates to grid search. Floor First is a residual-driven triage workflow. Each decode step is modeled as a five-dimensional resource vector (HBM bytes, FLOPs, network bytes, network messages, KV capacity); summing within a resource and maximizing across resources gives an optimistic floor, the plain sum a pessimistic one. Where a measurement lands inside this [max, sum] interval reads out overlap quality before any profiler is opened, and profilers escalate only on residuals above a stated threshold. Deployment alternatives are compared by wall ordering -- which resource wall binds first as load grows -- rather than by point benchmarks. The account is compositional: new attention or state-space variants enter by declaring one module, and the workflow ships as a zero-dependency calculator plus an agent skill that enforces the discipline in agentic optimization loops. As a case study we analyze a DeepSeek-V3.2-style 671B MoE/MLA model on 16 NVIDIA H20 GPUs, whose ridge point of ~74 FLOP/byte (vs ~590 for H100) makes it an extreme decode-oriented part. The floors show TP16 decoding is KV-capacity-limited to ~70 concurrent 8K requests; sparse attention removes the KV-bandwidth term but not the capacity wall; an EP16+DP-attention layout accepts slightly worse same-batch weight traffic for an order-of-magnitude higher capacity wall (~644) -- while single-stream latency favors TP by 2.4x. The layout judgment is thus a computable function of the operating point, explaining why production deployments on identical hardware have shipped opposite attention layouts.

Background: Disease severity is a multidimensional construct difficult to capture with rule-based approaches in Electronic Healthcare Records (EHR). Agentic large language model (LLM) systems could synthesise clinical evidence and reason over EHRs, but remain unevaluated for this task. Methods: MOSAIC is a two-phase agentic LLM framework for severity phenotyping, using type 2 diabetes (T2D) as a proof-of-concept. MOSAIC was evaluated on a synthetic cohort (SyntheticMass; open-weight N = 4,886; closed-weight N = 200) against three algorithmic ground truths (DCSI, DiSSCo, Cooper) and against all-cause mortality and incident complications. Open-weight (locally deployable) and proprietary pipelines were also compared. Results: The generated framework spanned domains absent from the comparators, including biomarker-based glycaemic staging, beta-cell function, and social determinants of health. Open-weight MOSAIC matched the proprietary pipeline (closed- vs open-weight weighted kappa = 0.773) and reached moderate agreement with Cooper (kappa = 0.597) and DCSI (kappa = 0.534) and fair agreement with DiSSCo (kappa = 0.320). Agent-based (Type 1) tiers showed significant separation of all-cause mortality (log-rank p < 0.001; crude hazard ratios 1.6-2.4 for non-Baseline tiers), with non-monotonic separation at the upper tiers, and an inverse gradient for incident complications (log-rank p < 0.001) consistent with depletion of susceptibles. Agentic classification also diverged from deterministic execution of the same rubric (MOSAIC Frozen; kappa = 0.428), indicating reasoning beyond fixed rules. Conclusion: MOSAIC shows agentic LLM systems can generate and apply clinically meaningful severity phenotypes from structured EHR data in T2D. Extending it to other diseases with similarly multidimensional severity warrants further research.

Knowledge graphs (KGs) that underpin Graph-based Retrieval-Augmented Generation (Graph-RAG) are increasingly built automatically by LLM-driven extraction rather than curated by experts. Proper evaluation would require instrumenting all pertinent stages: extraction, graph construction, and inference, coherently enough to localize failures, so that a failure at one stage is not discovered as a wrong answer at the end. We introduce TRIAGE, a stage-aware instrumentation framework for automated, document-grounded graph-RAG that asks not only whether the underlying graph can be trusted but at what cost it can be queried. TRIAGE attaches stage-specific, independently interpretable metrics to three stages: the KG Implementation (triple confidence, source coverage, and schema and canonicalization checks), the KG Validation by expert (graph-level structural quality, with correctness and completeness computed only as offline calibration when a reference is available), and the KG Usage (retrieval coverage, faithfulness, and retrieval cost); the deployed metrics need no gold annotations, the gold-requiring ones serving only as offline calibration. At usage time these metrics form a diagnostic chain of necessary conditions whose first broken link localizes the failure, and the diagnosis maps to the stage levers that can remedy it: extraction, graph and schema, or retrieval. TRIAGE is a theoretical framework with a proof of concept and a reproducible evaluation protocol.

Agentic reinforcement learning requires assigning credit to environment-facing actions such as searches, clicks, edits, navigation commands, and object interactions. Standard GRPO uses the final verifier outcome as a uniform advantage over all action tokens. This outcome signal is useful but structurally incomplete: it punishes useful exploration in failed rollouts and reinforces redundant or regressive actions in successful rollouts. We propose TRIAGE, a role-typed credit assignment framework that adds a semantic role axis to outcome credit. A structured judge classifies each segment as decisive progress, useful exploration, no-progress infrastructure, or regression, and a fixed role-conditioned rule maps these labels to bounded segment-level process rewards. This keeps verifier outcomes as the source of optimization direction while correcting the two main blind spots of outcome-only credit. We further show that role-conditioned credit is the optimal segment-level correction expressible from role labels alone -- a projection of the per-segment advantage residual onto the role variable -- so that the fixed role constants reduce advantage estimation error whenever the judge is reliable, and we connect this to lower-variance policy gradients. Across ALFWorld, Search-QA, and WebShop, TRIAGE improves success rates over GRPO for two policy models and outperforms both a scalar judge-derived process reward and an outcome-supervised shared-backbone value baseline. Ablations show that the gain comes from role typing rather than merely adding dense rewards: reliable detection of regression inside successful trajectories is the dominant contributor, while exploration credit provides a consistent secondary gain; on completed ALFWorld and WebShop rollouts, TRIAGE also reduces environment-facing turns by an additional $10.4\%$ and $14.8\%$ relative to GRPO.

Reconstructing who infected whom often relies on case timing and published transmission links. However, two important questions remain: can a temporal pattern learned from other diseases transfer to a new outbreak, and how reliable are the transmission links used as ground truth? We learned a temporal prior from eleven disease groups using logistic regression. The model was locked before any target-outbreak data were accessed and was then tested without refitting on 29 Andes virus (ANDV) parent-ranking tasks. The locked prior achieved a mean reciprocal rank (MRR) of 0.571, compared with 0.274 for the strongest fair source-trained temporal baseline (permutation p<0.001). Its Top-1 accuracy was 37.9%, compared with 13.8%. The MRR advantage remained significant unless 7-8 favorable task outcomes were reversed. We separately examined the reliability of published transmission links. Among 75 epidemiologically linked inter-host pairs from the 2022 New York City mpox outbreak, 54.67% were genomically unresolved or unsupported as direct transmission links (exact 95% CI: 42.75-66.21%). We also tested whether retaining uncertain transmission edges changed source prioritization. In ANDV and Guangdong Delta outbreak graphs, the top-5 priority sets changed, with Jaccard similarity ranging from 0.429 to 0.667. These results show that temporal information learned across diseases can provide a useful ranking signal without target-specific refitting. They also show that uncertainty in published transmission links can affect which source cases are prioritized for investigation.

From housing allocation for households experiencing homelessness to triage in emergency departments, LLMs are increasingly being considered as judges of consequential decisions that require ranking people for scarce resources. Ranking large groups simultaneously is cognitively demanding and error-prone. A natural solution, drawing on decades of social choice theory, elicits pairwise comparisons and aggregates them into a total order. However, a fundamental question remains when LLMs serve as the pairwise judge: how can a practitioner tell, before committing to a ranking, whether the LLM's judgments are sufficiently consistent to trust the result? We discuss two different ways of identifying consistency. A classical diagnostic, the coefficient of consistency $ζ$, originally developed to measure judge reliability by counting circular triads in tournament graphs, provides a cheap, model-free measure of intra-run consistency. Various standard measures of distance between rankings, for example Kendall's $τ$, can measure inter-run variability. We show, in both theory and practice, that these measures are independently valuable, and advocate for using both to assess reliability of rankings. We demonstrate the practical importance of our results across two high-stakes prioritization tasks: homelessness service allocation and emergency department triage. Three different leading LLMs have considerably different performance profiles across these two axes of consistency. We provide guidelines for how practitioners could think about measuring and assessing consistency before committing to a model for ranking or prioritization.

Abdominal ultrasound is indispensable for rapid, noninvasive trauma triage. However, interpreting the subtle dynamic cues embedded in continuous scanning is time-intensive and operator-dependent. Parameter-Efficient Image-to-Video Transfer Learning (PEIVTL), which efficiently adapts pre-trained image models to the video domain, notably through visual-textual alignment, offers a promising paradigm for ultrasound video analysis. Nevertheless, substantial spatiotemporal and semantic variations arising from physician-dependent scanning practices continue to limit the effectiveness and generalizability of this framework. We propose TRUST, a scan-aware PEIVTL framework that explicitly models fine-grained spatiotemporal variations to enable reliable ultrasound video understanding. First, we introduce a Cross-Frequency Collaborative Adapter (CFCA) that establishes mutual constraints between low- and high-frequency components, enhancing discriminative spatial feature extraction under heavy speckle corruption. Second, we design a Multi-Granularity Motion-Aware (MGMA) module that integrates local temporal convolutions with motion-prior-guided global self-attention, jointly capturing stable intra-view patterns and abrupt inter-view transitions to characterize complex scanning dynamics. Third, a Visual Query Semantic Aggregation (VQSA) module dynamically generates text prototypes conditioned on visual features, enabling adaptive visual-textual alignment robust to intra-class variability under diverse scanning conditions. Experiments on in-house ultrasound trauma datasets demonstrate that TRUST outperforms state-of-the-art methods by 9.63% with superior computational efficiency.

Medical device recalls are a critical regulatory mechanism for protecting patient safety. The growing volume of FDA recall records presents challenges in post-report recall triage, severity assessment, and root-cause interpretation. Existing studies mostly address recall occurrence prediction or root-cause analysis separately, while joint modeling of recall severity and root-cause categories has received limited attention. We develop an automated recall triage framework using 54,165 FDA medical device recall records from openFDA, covering the period from 2002 to October 2025. We first evaluate classical machine learning and boosting-based models for recall severity and root-cause category prediction. We then develop RecallRisk-BERT, a multi-task model that combines PubMedBERT-based textual representations of recall narratives with embedding-based representations of structured categorical features, including product code, regulation number, and medical specialty. The model simultaneously predicts recall severity (Class I/II/III) and a consolidated root-cause category (9 classes). Performance was evaluated using accuracy, macro-averaged precision, recall, F1-score, and ROC-AUC. In single-task severity prediction, our LightGBM-based text--tabular configuration achieved the strongest performance, with an accuracy of 0.963, macro-F1 of 0.856, and ROC-AUC of 0.974. In the multi-task setting, RecallRisk-BERT substantially outperformed the single-task PubMedBERT baseline. Model-derived risk rankings were strongly consistent with observed root-cause severity patterns (rho = 0.983, p = 1.936e-6). These findings indicate that text--tabular learning can support scalable post-report recall triage, regulatory decision support, and model-based root-cause risk analysis.

Respiratory-rate (RR) monitoring is a critical component of remote triage and victim assessment in emergency response, disaster recovery, and infectious-disease scenarios, where minimizing physical contact can reduce responder risk and improve operational safety. However, field deployment of contactless RR monitoring remains challenging due to variable illumination, posture changes, platform heterogeneity, and the impracticality of wearable sensors in hazardous environments. In this paper, we present a modality-adaptive contactless RR monitoring framework for heterogeneous mobile robots with onboard edge computing. The proposed system combines brightness-adaptive sensor selection across RGB, thermal, near-infrared (NIR), and low-light cameras, keypoint-guided chest ROI extraction for posture-robust monitoring, and a signal-quality-index (SQI)-based filtering mechanism for reliable respiratory estimation. We implement and evaluate the framework on three robotic platforms spanning quadruped and wheeled locomotion and multiple edge-computing architectures. Experiments conducted across diverse lighting conditions, subject poses, and robot-to-subject distances demonstrate that the framework generalizes across platforms without per-platform algorithmic retuning, while revealing modality-specific operational boundaries. RGB provides the broadest coverage up to 8m, NIR remains effective up to 6m, thermal is reliable only at short range, and low-light sensing supports monitoring in complete darkness up to 8m. Overall, the results demonstrate the feasibility of multimodal contactless RR monitoring on mobile robots and support its use as a foundation for autonomous triage and victim assessment in hazardous search-and-rescue settings.

A vision-language model can answer a question about a medical image fluently and confidently while barely using the image, leaning instead on language priors. In medicine this is the failure that matters most, because the answer looks trustworthy and is not, and the only protection is a confidence score reliable enough to tell the system when to abstain. We ask a deployment question rather than an accuracy one: how much imaging work a model can safely handle alone, and which confidence signal makes that possible. We evaluate seven confidence estimators across five open-weight LVLMs and three medical visual-question-answering datasets spanning broad clinical imaging, radiology, and pathology, with every probe trained only on natural images and applied without adaptation. Recast as bounded selective prediction (automate a case only when confidence clears a threshold, defer the rest), the comparison is cautionary. The standard metrics are poor guides: discrimination barely separates the methods, and the weak calibration of a cheap self-report is cheaply removed by off-domain temperature scaling without changing deployable yield. What distinguishes a usable estimator is the high-confidence region a clinician acts on: the weakest baselines are confidently wrong on 41 to 45 percent of their errors against 1 to 4 percent for the best probe, and no estimator is reliably best across domains or models. Safe handoff is governed at two levels: base-model competence sets a ceiling, so a well-calibrated score recovers roughly a third of radiology cases at a 20 percent error tolerance but almost none of pathology; the confidence layer then decides how much of that ceiling is reachable. The usable role today is calibrated triage, not autonomy: automate the cases a calibrated score marks safe, route the rest to a clinician. We release all outputs, correctness judgments, and confidence scores, with code.

This paper examines how algorithmic accountability in Canada's visa system is articulated institutionally and experienced by applicants across borders. We analyzed Immigration, Refugees and Citizenship Canada (IRCC)'s Algorithmic Impact Assessment (AIA) for the temporary resident visa (TRV) triage system using the algorithmic decision-making adapted for the public sector (ADMAPS) framework and analyzed Reddit discussions among applicants using a mixed-methods approach. We show that while institutional artifacts emphasize transparency, procedural safeguards, and bounded impacts, applicants engage in collective sensemaking to interpret opaque decisions, often relying on peer knowledge amid uncertainty. We identify three asymmetries between how institutional accountability is structured and how people perceive the process: epistemic asymmetry in access to decision logic, jurisdictional asymmetry in exposure shaped by geopolitical positioning, and temporal--relational asymmetry in how waiting and uncertainty are experienced. We emphasize why it is important to shift attention from institutional design to the uneven distribution of experiences with public-sector algorithmic governance. Together, these contributions demonstrate how algorithmic governance systems in the context of transnational migration produce structured asymmetries not captured by institutional disclosure frameworks, and how extending ADMAPS can account for those uneven translations of accountability.

Decision-relevant building damage assessment is critical for prioritizing resources and recovery after a disaster, yet most automated methods either flatten damage into a single severity scale (no damage, minor, major, destroyed) or require paired pre- and post-event imagery that is often unavailable for emerging hazards. This paper presents Damage-TriageFormer, a single-image, post-event, footprint-conditioned model that produces a damage typology rather than a severity scale. We contribute: (1) DamageTriage-Bench, a new benchmark built from NOAA Emergency Response Imagery across Hurricane Michael (2018), Hurricane Helene (2024), and the 2025 Los Angeles wildfire complex, with five typology classes that distinguish roof damage from structural damage and, within each, partial from total extent; and (2) Damage-TriageFormer, which extends a DINOv3 ViT-L backbone with a Simple Feature Pyramid for higher-resolution instance pooling, a two-stage gated damage head, and an auxiliary severity-regression objective. Our model achieves macro F1 of 0.624 on validation and 0.619 on a held-out stratified test set, performing strongest where operational triage needs it most, with per-class F1 of 0.91 and 0.84 on undamaged buildings and total structural collapse, respectively. While the rare Total Roof Damage class remains difficult due to its limited examples and an inherently ambiguous label boundary, our results show that single-image post-event imagery can support actionable building damage typing, enabling targeted emergency response and resource allocation without a pre-event reference.

Single-Molecule Force Spectroscopy (SMFS) provides unprecedented insights into biomolecular mechanics, yet the high-throughput generation of force-extension trajectories creates a severe data curation bottleneck. Identifying rare molecular unbinding events within thousands of noise-dominated curves traditionally relies on tedious, non-scalable manual auditing. Here, we present a system-agnostic, interpretable deep learning framework tailored to overcome extreme class imbalance in automated SMFS triage. Utilizing 1D-to-2D rasterized geometric matrices, we deployed a modified ResNet18 architecture governed by an asymmetric Focal Loss objective function. We evaluated this framework on the complex mechanical unfolding pathways of the R. champanellensis cellulosome. Under hyper-imbalanced test conditions where the target interaction constituted only 1.34% of the dataset (13 true events out of 970 traces), the model achieved an overall accuracy of 0.9196 and a remarkable True Positive Rate (Recall) of 0.9231. By implementing an empirically calibrated dual-threshold triage system, the pipeline automatically discarded 880 unambiguous background noise traces , reducing the manual curation workload by over 90% while safely preserving high-value rare data. Finally, Gradient-weighted Class Activation Mapping (Grad-CAM) visually validated that the network's decisions are firmly anchored in the relevant geometric features of the force curves, specifically localizing on the structural unbinding regions, effectively mitigating 'black-box' skepticism. Built for free cloud-based execution, this open-source tool democratizes scalable, highly precise molecular discovery across the biophysics community.

Clinical early warning systems built on electronic health records, in which clinical observations are recorded as irregularly sampled medical time series (ISMTS), must deliver both calibrated risk scores for patient triage and interpretable rationales that clinicians can verify. Large Language Models (LLMs) have been explored for this task, yet they collapse graded clinical risk into overconfident binary predictions. This risk polarization undermines both calibration and cross-patient comparability. To address this, we propose TRIAGE, a framework that trains an LLM to generate dialectical reasoning over competing clinical outcomes by eliciting outcome-specific rationales. This dialectical formulation mitigates risk polarization, enabling a single LLM to yield continuous risk scores grounded in explicit clinical reasoning. Evaluated on three ISMTS benchmarks, TRIAGE achieves an average AUPRC improvement of 3.3% and reduces calibration error by 81% compared to the competitive baselines. An LLM-as-a-judge assessment further shows that our rationales surpass post-hoc explanations from the baseline by 20% in clinical reasoning quality. The source code is available at https://github.com/HyeongWon-Jang/TRIAGE .

Adapting large language models (LLMs) to clinical workflows often requires costly fine-tuning or manual prompt and pipeline engineering. We study LLM-guided MAP-Elites evolution as an inference-time alternative for discovering medical decision strategies and provide an implementation repository at https://github.com/univanxx/llm_guided_evo_medical. We formulate urgency triage, interactive consultation, and medical image classification as evolutionary searches over executable artifacts optimized by task-specific fitness functions. Across all three settings, evolution improves over manually designed baselines under practical constraints. In triage, evolved programs increase Semigran accuracy from $77.3\%$ to $87.1\%$ and emergency recall from $0.60$ to $0.97$, while improving safety-weighted held-out MIMIC-ESI performance. In interactive consultation, evolved policies improve the accuracy--cost frontier across Llama-3, Qwen-3.5, and Gemma-4 and transfer to held-out iCRAFTMD. In PneumoniaMNIST, prompt-only evolution improves frozen MedGemma VLMs while preserving strict JSON outputs. Qualitative analysis shows that the gains come from interpretable program-level mechanisms, calibrated triage boundaries, targeted evidence acquisition, selective commitment, and finding-oriented visual decision rules, rather than superficial prompt rewording alone.

Patient safety event triage, determining whether a clinical event is reportable under jurisdiction-specific policy, is a high-stakes task typically performed manually by patient safety experts. Although LLMs may support this workflow, reliable evaluation is limited by the lack of benchmarks to capture evidence-grounded policy reasoning, proactive information seeking for incomplete reports, and principled abstention in irreducibly ambiguous cases. We address this gap with a policy-grounded construction methodology centered on the clause card, a structured representation that factorizes regulatory text into auditable decision specifications. Combining clause cards with anchor-driven instantiation and closed-loop verification, our scalable pipeline produces narratives with by-construction ground truth and naturally supports generating missing information and uncertain variants. We instantiate this method on Minnesota's 29 Reportable Adverse Health Events, producing PSEBench, a 5,074-case benchmark with an agentic evaluation environment. Evaluation on 15 representative LLMs reveals consistent capability trends, demonstrates the benchmark's utility, and identifies actionable gaps toward reliable LLM-based patient safety event triage.

Language models acting as agents over knowledge graphs generate Cypher queries that fail structurally (crashing at the database) or semantically (executing but returning wrong results). We place a pre-execution gate between query generation and a production Neo4j database. The gate validates structure through a four-backend chain culminating in execution against a mirror graph at 5.6 ms median latency. Structurally broken queries are routed to a corrector that iterates structured error feedback through a language model. On seven CypherBench schemas (2348 questions, ACL 2025) the pipeline maintains generation accuracy on every model tested, confirming it operates as a safe defensive layer. The corrector achieves 81% to 95% success across five models (mean 89%). On a template-generated corpus across nine schemas the gate catches 100% of parse errors, 100% of constraint violations, and 100% of schema-reference errors in path queries with labelled endpoints, at zero false positives across 1135 queries. Property sibling-swaps where the substituted name is valid on the target label score 0%, marking the formal boundary where structural validation ends and semantic validation must begin. A planner-based cost gate flags catastrophic plan structures before execution.

We investigate whether large language models produce different medical triage recommendations for identical neurological symptoms when only the patient's stated gender and age vary. Using three model families--Gemini 3.5 Flash, Claude Sonnet 4.6, and GPT-5.4-mini--we present a standardized symptom profile (persistent headache, blurred vision, morning nausea, visual disturbances) across seven demographic conditions: three age groups (25, 38, 65) x two genders (male, female), plus a gender-unspecified baseline (n = 30 per condition per model, 630 total trials). We find a stark, systemic gender-dependent triage disparity: young women receive significantly lower emergency room (ER) referral rates than age-matched men (Gemini: 0% vs. 23.3%; Claude: 6.7% vs. 96.7%; GPT: 6.7% vs. 66.7%, all p < 0.001). The disparity disappears at age 65 for all models. The primary mechanism is diagnostic substitution: the models anchor on a gender-associated diagnosis, preferentially classifying young women with Idiopathic Intracranial Hypertension (IIH)--a condition epidemiologically linked to women of childbearing age--while diagnosing men with generic increased intracranial pressure with space-occupying lesions in the differential. This diagnostic closure routes female patients to lower-urgency care (outpatient doctor appointments) despite comparable severity ratings (7-9/10). Our findings demonstrate that clinical LLMs replicate documented human clinical biases by using epidemiological priors to suppress triage urgency, suggesting that AI triage engines must decouple urgency assessment from probabilistic diagnostic priors. We release all code, prompts, and raw results.

Self-harm is a major public health concern, but current surveillance relying on hospital presentations is inadequate due to the low sensitivity of diagnostic codes. Emergency Department (ED) triage notes, recorded at the initial point of contact, provide a succinct summary of presentations and an opportunity to identify self-harm. We developed a three-stage approach, augmenting traditional machine learning with large language model-based screening and evidence extraction to detect self-harm in ED triage notes. We assessed model transferability across three Australian hospitals. Our approach showed AUPRCs of 0.887 +/- 0.016 and 0.884 +/- 0.012 during internal and external validation. Prospectively, it achieved AUPRC of 0.881 +/- 0.008 at the development site, and 0.879 +/- 0.012 and 0.816 +/- 0.015 at two external sites without site-specific retraining. A key advantage of the approach is that it enables identification of the primary self-harm method with an accuracy of 95%, supporting more granular surveillance beyond binary classification.

Self-harm presentations to emergency departments (EDs) are strongly associated with higher suicide risk. NLP models have shown robust performance in detecting self-harm from triage notes within single hospitals, yet performance often declines across institutions. To examine potential causes, we compare ED triage notes from two hospitals by analyzing lexical characteristics, highly associated predictive features, and salient topics. Our results reveal variation in lexical expression and feature importance related to self-harm across hospitals, despite consistent core themes such as self-poisoning and self-injury. These documentation differences are associated with reduced cross-site performance. Our findings provide insight into how institutional variation affects the identification of self-harm in clinical text and highlight potential methods to improve model generalisability.

We investigate whether large language models produce different medical triage recommendations for identical symptoms based solely on the language of the patient prompt. Using Gemini 3.5 Flash, we evaluate a neurological symptom profile (persistent headache, blurred vision, nausea) across six languages (English, Spanish, Chinese, Hindi, Japanese, Arabic) with 30 runs per condition (n=450 total API calls). We find that the model recommends emergency room visits at rates ranging from 0% (Japanese, Hindi) to 30% (English, Arabic), despite assigning nearly identical severity scores (7.7-8.0/10) across all languages. Adding a single sentence specifying the patient's US location increases ER recommendations by up to 76.7 percentage points for non-English prompts, while the reverse anchor (English prompt with a Tokyo location) reduces the ER rate from 30% to 6.7%. A back-translation control (Japanese to English) produces ER rates comparable to the English baseline, confirming that the disparity is not caused by translation quality but by implicit geographic inference from the input language. We release the complete dataset, experiment code, and results.

Prompt-injection detectors are heterogeneous: each is strong on a different slice of attacks, and none is always reliable. Yet existing systems still treat detection as a fixed single-detector pipeline, committing every request to one detector's blind spots. We reframe defense as detector allocation: given a heterogeneous pool, decide per request which detectors to run and whether to escalate to an LLM judge. Our framework SCOUT (Scalable and Controllable Outcome-prediction for Uncertainty-aware Triage) makes this decision dynamic by predicting each detector's per-sample reliability and latency from how it behaved on similar past inputs, and exposes a single safety-utility threshold to the operator (where utility bundles benign-pass rate and wall-clock). To evaluate this setting, we build SCOUT-450, a benchmark that captures the structurally complex, agent-facing injections that older prompt-injection sets under-represent. On SCOUT-450, a safety-oriented operating point reduces attack-success rate by 46% and total wall-clock by 40% relative to an always-on GPT-4o judge, at a 5.1-point benign-utility drop. SCOUT also transfers to three external benchmarks (BIPIA, IPI, and IHEval), improving the safety-utility frontier.

Biomedical NER is deceptively simple for modern LLMs: plausible biomedical mentions are easy to surface, but corpus-convention correctness depends on annotation conventions, span boundaries, entity granularity, and type schemas. Multi-LLM agreement is a salience signal, not corpus-convention correctness. We introduce a candidate-level panel-output benchmark for panel-surfaced candidate verification, where the unit is an aligned candidate surfaced by an explicitly defined multi-model panel rather than a standalone extractor output. The benchmark aligns eight LLMs' predictions over five public biomedical NER datasets into a candidate master table. BioConCal is an in-domain supervised scorer that instantiates this layer with inference-time gold-free agreement, mention, surface-availability, and document features for a fixed candidate stream. In domain, BioConCal improves AUROC from 0.753 for raw agreement to 0.910. At a validation-selected 0.95 precision target it selects 1,340 candidates at empirical test precision 0.939, compared with 293 for raw agreement. This corresponds to candidate-level recall 0.592 and corpus-level recall 0.523 against a within-panel row-label ceiling of 0.883. The main benefit is not recovering entities missed by every panel member, but reshaping a noisy panel stream into a higher-yield review queue. Under entity-type shift, thresholds require target-domain validation, and exact character localization remains a separate deterministic post-processing step.

Skin cancer is a common and fast rising malignancy worldwide. Early detection is critical for improving outcomes. Deep learning models trained on dermoscopic and clinical images can support automated and fast triage. However, many studies evaluate only a limited set of architectures. Experimental setups also vary across studies. In this paper, we present a unified evaluation of twelve deep learning models for binary skin cancer detection on the PAD-UFES-20 dataset. The models span four families: convolutional neural networks (CNN), vision transformers (ViT), hybrid convolution transformer backbones, and vision language models (VLM). Performance is assessed using AUC, the maximum F1 score with its precision and recall, and sensitivity at 80% specificity, reflecting screening oriented requirements. Our results show that well tuned CNNs already provide strong baselines, but transformer based families consistently improve discrimination. Hybrid models (MaxViT Tiny, CoAtNet0) and a SigLIP based VLM achieve the best overall trade off between ranking performance and clinically relevant operating points, while CLIP based model offers high precision. The full codebase for all experiments is publicly released. Together, these findings offer practical guidance on which model families are most suitable for real world deployment in skin cancer screening and establish a reproducible reference point for future work on PAD-UFES-20.

Clinical pathways are disseminated as visual flowcharts where spatial topology, arrow direction, colour coding, and font weight encode critical triage logic that remains inaccessible to computational systems. We present PathWISE, a five-phase pipeline combining four LLM-based agents with a deterministic depth-first search auditor and a Java compiler critic, transforming these non-computable artefacts into validated, executable HL7 Clinical Quality Language (CQL) libraries deployable as FHIR CDS Hooks services. Purpose-built agents extract flowchart structure into a typed directed graph, perform deterministic path enumeration, conduct a structured semantic audit of every node's computability, generate terminology-constrained CQL definitions verified by the official Java CQL-to-ELM compiler, and produce routing logic covering 100% of enumerated patient journeys. Demonstrated across five UK NHS cancer pathways (colorectal, lung, skin, upper GI, and breast), PathWISE audits up to 183 nodes (182 under the Hybrid configuration), identifies 544 structured governance findings across four issue categories, achieves 100% syntactic compilation success, with UNCOMPUTABLE nodes receiving false placeholders that preserve compilability while surfacing governance gaps for clinical review, and produces zero hallucinated terminology codes for dictionary-covered concepts. Critically, PathWISE confines non-deterministic LLM inference to knowledge extraction while deterministic graph mathematics and a standard compiler underpin every verification step.

Urgent suspected colorectal cancer (CRC) referrals create operational bottlenecks because semi-structured clinical documents often require manual review and transcription. The original RAPTOR system used Large Language Models for structured extraction but relied on a separate OCR stage, making it vulnerable to handwriting, layout variation, and loss of visual evidence linkage. We present RAPTOR+, a multimodal extension that uses Vision-Language Models (VLMs) for end-to-end referral understanding. We evaluate fine-tuned VLMs, commercial and open-source zero-shot VLMs, and the original OCR-based pipeline on 223 clinically curated CRC urgent referral forms. We also introduce a grounding-aware evaluation framework that measures both extraction accuracy and evidence localisation. Results show a clear grounding gap in zero-shot models. Gemini 2.5 Flash achieved 92.6% Reading Accuracy but only 1.2% Strict Safety. In contrast, fine-tuned Qwen3-VL-8B achieved 96.1% Reading Accuracy and 60.6% Strict Safety, substantially improving verifiable evidence grounding. These findings show that task-specific fine-tuning is essential for reliable, auditable clinical document understanding. RAPTOR+ enables extracted referral decisions to be linked to visual evidence, supporting safer and more efficient cancer referral triage.

Machine learning methods provide a methodological innovation that can help screen for cardiovascular disease through noninvasive and readily available measurement modalities. Recent investments in using electrocardiogram (ECG) data to screen for structural heart disease (SHD) are one example, where ECGs provide a low-cost, available modality for screening. This has led to the EchoNext dataset, a paired ECG-echocardiogram data repository for testing new methods of SHD detection. However, relatively few studies have investigated how more probabilistic classification through Bayesian inference may improve uncertainty quantification in this setting. Moreover, few studies have considered how triage systems can be developed to alleviate healthcare bottlenecks, such as the review of data from underserved, rural clinics by expert sonographers for SHD assessment. In this study, we leverage existing ECG-echocardiogram data to compare frequentist and Bayesian neural network classifiers. We show that the Bayesian approach is comparable or better than frequentist methods in SHD classification, and that they have a more robust uncertainty quantification attached to them. We provide an example of how this uncertainty-aware classification scheme can be used for screening SHD, providing a proof-of-concept for how machine learning can help with triage in getting individuals expert sonographer input when SHD is highly likely or measurements are highly uncertain.

Partial differential equation (PDE) foundation models are pretrained networks that forecast how physical fields like velocity and pressure evolve from a single reusable solver. On unfamiliar flows their predictions drift step by step, errors concentrate in a few regions, yet retraining destabilizes the network and uniform post-hoc correction overlooks this spatial concentration. To address this, we propose a frozen-solver post-hoc correction framework, Adaptive Risk-Calibrated Spatial Triage for Auditable Refinement (ARC-STAR). ARC-STAR organizes correction into three stages: a global corrector removes broad solver bias, a blockwise local refiner cleans the post-global residual, and, at deployment, a label-free score routes refinement to high-risk blocks under a compute budget. The framework is designed to be (i) frozen-host, preserving the pretrained solver without fine-tuning; (ii) auditable, with global and local stages trained and evaluated separately for measurable contributions; and (iii) budget-aware, using a blockwise interface that either refines the full field or routes limited compute to high-risk regions. Across five flow benchmarks spanning ten regime cells, ARC-STAR is the only method that cuts velocity rollout error by at least 36x over raw Poseidon on every cell. The global stage reduces raw host error by 91-99%, and the local stage further reduces the remaining post-global residual by up to 94.4%.

Standard clinical Natural Language Processing (NLP) benchmarks often yield inflated metrics by forcing deterministic classification on ambiguous instances, thereby obscuring the clinical risks of overconfident predictions. To bridge this gap, we propose a risk-aware hybrid selective classification framework, evaluated on early Human Immunodeficiency Virus suspicion identification in Spanish clinical notes. Our dual-verification approach explicitly decouples aleatoric uncertainty through Mondrian conformal prediction and epistemic uncertainty using a Multi-Centroid Mahalanobis Distance veto. Empirical evaluations reveal that standard uncertainty metrics and baseline classifiers are structurally insufficient for safe medical triage, suffering severe coverage collapse when forced to operate under strict reliability constraints. In contrast, by demanding that clinical narratives pass both probabilistic and geometric safeguards, the proposed framework successfully isolates a highly trustworthy operational domain.

Conformal triage converts predictive scores into deployment actions that either release a case, flag it for urgent attention, or defer it to human review. Under prevalence shift, however, the usual summaries of marginal coverage and human-review rate can miss the safety-critical question of whether patients who truly experience the target event are released without review. To address this gap, we introduce a leakage-aware deployment audit for release-side conformal triage. It first assigns target subjects to three non-overlapping roles: prevalence correction, conformal calibration, and held-out release-safety evaluation. This separation then lets the audit evaluate release directly: how many event-positive patients are cleared without review, whether the pilot has enough event labels for calibration, and how the safety-review trade-off shifts. Applying this audit to a retrospective NSCLC pilot shows why lower review can be misleading: after prevalence correction, the pooled conformal branch lowers review by releasing more patients, some of whom are event-positive. Within the audit, the classwise branch acts as a scarcity diagnostic: the pilot has too few event labels to certify safe low-review release.

AI systems are becoming active participants in organizational and knowledge work. They increasingly interact with humans, coordinate workflows, and operate in multi-agent arrangements. Understanding their effects therefore requires more than measuring output accuracy; it requires evidence about mechanisms, delegation, feedback, and control. Experiments remain central to this task, but they also face a recursive challenge: we need experiments for agents to study these arrangements, and we may need agents for experiments to help search the expanding space of possible designs. Yet experimental conditions for human-AI and agentic workflows are still largely specified in prose, making them difficult to compare, reuse, or audit. We frame this as a problem of workflow representation, traceability, and governance in AI-enabled knowledge production. We introduce SEED (Structural Encoding for Experimental Discovery), a framework that represents experimental conditions as typed actor-flow graphs. SEED supports three design functions: describing conditions as interaction structures, evaluating structural novelty relative to encoded prior designs, and generating candidate designs under feasibility and governance constraints. We report a lightweight empirical feasibility test that compares graph-blind and SEEDguided generation in a medical-triage design task. In this diagnostic contrast, SEED-guided candidate designs show clearer actor-flow changes, assumptions, and governance checks, supporting the feasibility of the grammar as a design aid. The commentary closes by identifying governance tensions around novelty, replication, validity, diversity of inquiry, and accountability.

At a time when drones are increasingly associated with hostile operations, we re-purpose them for humanitarian and life-saving applications. However, adapting search and rescue drones for battlefield triage remains extremely challenging; the technology must perform reliably to support frontline medics who are forced to operate under extreme uncertainty, restricted access, and significant personal risk. Due to growing vulnerabilities of casualty evacuation in conflicting zones, this paper presents ATRACT (A Trustworthy Robotic Autonomous system to support Casualty Triage), a novel human-in-the-loop decision support system to enable early battlefield triage during the critical post-trauma period. ATRACT integrates drone-captured video with wearable sensor input for multi-modal learning to support casualty-state assessment, thereby addressing the limitations of existing systems. Drone video captures fine-grained behavioural cues, such as pose, posture, while body-worn sensors provide complementary physiological signals, including heart rate, breathing rate, and movement. By combining two modalities, ATRACT provides evidence to support the early judgement of medics when direct access to the casualty is delayed, risky, or restricted. To mitigate the data realism gap pertaining to injured actions, a conditional variational autoencoder is devised for data augmentation. Experimental results on our drone captured dataset show that proposed pipeline achieves 85.7% accuracy for action classification; while our lightweight CNN visual encoder remains competitive with stronger pre-trained video backbones. Overall, the results support ATRACT as a practically meaningful step towards remote triage in contested environments, where multi-modal sensing, human oversight and trustworthy decision support can improve casualty prioritisation, and lessen the exposure of frontline medics.