Daily Papers

Application of deep learning on histopathological whole slide images (WSIs) holds promise of improving diagnostic efficiency and reproducibility but is largely dependent on the ability to write computer code or purchase commercial solutions. We present a code-free pipeline utilizing free-to-use, open-source software (QuPath, DeepMIB, and FastPathology) for creating and deploying deep learning-based segmentation models for computational pathology. We demonstrate the pipeline on a use case of separating epithelium from stroma in colonic mucosa. A dataset of 251 annotated WSIs, comprising 140 hematoxylin-eosin (HE)-stained and 111 CD3 immunostained colon biopsy WSIs, were developed through active learning using the pipeline. On a hold-out test set of 36 HE and 21 CD3-stained WSIs a mean intersection over union score of 96.6% and 95.3% was achieved on epithelium segmentation. We demonstrate pathologist-level segmentation accuracy and clinical acceptable runtime performance and show that pathologists without programming experience can create near state-of-the-art segmentation solutions for histopathological WSIs using only free-to-use software. The study further demonstrates the strength of open-source solutions in its ability to create generalizable, open pipelines, of which trained models and predictions can seamlessly be exported in open formats and thereby used in external solutions. All scripts, trained models, a video tutorial, and the full dataset of 251 WSIs with ~31k epithelium annotations are made openly available at https://github.com/andreped/NoCodeSeg to accelerate research in the field.

Large Language Models (LLMs) have seen great advance in both academia and industry, and their popularity results in numerous open-source frameworks and techniques in accelerating LLM pre-training, fine-tuning, and inference. Training and deploying LLMs are expensive as it requires considerable computing resources and memory, hence many efficient approaches have been developed for improving system pipelines as well as operators. However, the runtime performance can vary significantly across hardware and software stacks, which makes it difficult to choose the best configuration. In this work, we aim to benchmark the performance from both macro and micro perspectives. First, we benchmark the end-to-end performance of pre-training, fine-tuning, and serving LLMs in different sizes , i.e., 7, 13, and 70 billion parameters (7B, 13B, and 70B) on three 8-GPU platforms with and without individual optimization techniques, including ZeRO, quantization, recomputation, FlashAttention. Then, we dive deeper to provide a detailed runtime analysis of the sub-modules, including computing and communication operators in LLMs. For end users, our benchmark and findings help better understand different optimization techniques, training and inference frameworks, together with hardware platforms in choosing configurations for deploying LLMs. For researchers, our in-depth module-wise analyses discover potential opportunities for future work to further optimize the runtime performance of LLMs.

Multimodal large language models (MLLMs) have made significant strides, yet they face challenges in the medical domain due to limited specialized knowledge. While recent medical MLLMs demonstrate strong performance in lab settings, they often struggle in real-world applications, highlighting a substantial gap between research and practice. In this paper, we seek to address this gap at various stages of the end-to-end learning pipeline, including data collection, model fine-tuning, and evaluation. At the data collection stage, we introduce SemiHVision, a dataset that combines human annotations with automated augmentation techniques to improve both medical knowledge representation and diagnostic reasoning. For model fine-tuning, we trained PMC-Cambrian-8B-AN over 2400 H100 GPU hours, resulting in performance that surpasses public medical models like HuatuoGPT-Vision-34B (79.0% vs. 66.7%) and private general models like Claude3-Opus (55.7%) on traditional benchmarks such as SLAKE and VQA-RAD. In the evaluation phase, we observed that traditional benchmarks cannot accurately reflect realistic clinical task capabilities. To overcome this limitation and provide more targeted guidance for model evaluation, we introduce the JAMA Clinical Challenge, a novel benchmark specifically designed to evaluate diagnostic reasoning. On this benchmark, PMC-Cambrian-AN achieves state-of-the-art performance with a GPT-4 score of 1.29, significantly outperforming HuatuoGPT-Vision-34B (1.13) and Claude3-Opus (1.17), demonstrating its superior diagnostic reasoning abilities.

The rapid development of Large Language Models (LLMs) for healthcare applications has spurred calls for holistic evaluation beyond frequently-cited benchmarks like USMLE, to better reflect real-world performance. While real-world assessments are valuable indicators of utility, they often lag behind the pace of LLM evolution, likely rendering findings obsolete upon deployment. This temporal disconnect necessitates a comprehensive upfront evaluation that can guide model selection for specific clinical applications. We introduce MEDIC, a framework assessing LLMs across five critical dimensions of clinical competence: medical reasoning, ethics and bias, data and language understanding, in-context learning, and clinical safety. MEDIC features a novel cross-examination framework quantifying LLM performance across areas like coverage and hallucination detection, without requiring reference outputs. We apply MEDIC to evaluate LLMs on medical question-answering, safety, summarization, note generation, and other tasks. Our results show performance disparities across model sizes, baseline vs medically finetuned models, and have implications on model selection for applications requiring specific model strengths, such as low hallucination or lower cost of inference. MEDIC's multifaceted evaluation reveals these performance trade-offs, bridging the gap between theoretical capabilities and practical implementation in healthcare settings, ensuring that the most promising models are identified and adapted for diverse healthcare applications.

This technical report introduces a Named Clinical Entity Recognition Benchmark for evaluating language models in healthcare, addressing the crucial natural language processing (NLP) task of extracting structured information from clinical narratives to support applications like automated coding, clinical trial cohort identification, and clinical decision support. The leaderboard provides a standardized platform for assessing diverse language models, including encoder and decoder architectures, on their ability to identify and classify clinical entities across multiple medical domains. A curated collection of openly available clinical datasets is utilized, encompassing entities such as diseases, symptoms, medications, procedures, and laboratory measurements. Importantly, these entities are standardized according to the Observational Medical Outcomes Partnership (OMOP) Common Data Model, ensuring consistency and interoperability across different healthcare systems and datasets, and a comprehensive evaluation of model performance. Performance of models is primarily assessed using the F1-score, and it is complemented by various assessment modes to provide comprehensive insights into model performance. The report also includes a brief analysis of models evaluated to date, highlighting observed trends and limitations. By establishing this benchmarking framework, the leaderboard aims to promote transparency, facilitate comparative analyses, and drive innovation in clinical entity recognition tasks, addressing the need for robust evaluation methods in healthcare NLP.

Large Language Models (LLMs) are widely adopted for assisting in software development tasks, yet their performance evaluations have narrowly focused on the functional correctness of generated code. Human programmers, however, require LLM-generated code to be not only correct but also optimally efficient. We propose PerfCodeGen, a training-free framework that enhances the performance of LLM-generated code by incorporating feedback based on runtime during test case execution into the self-refinement iterations. With PerfCodeGen, we achieve speedups for a significantly higher proportion of problems compared to using the base LLM with sophisticated prompting techniques. Applied to open language models like Phi-3-mini, PerfCodeGen achieves runtime efficiency comparable to prompting powerful closed models like GPT-4. We achieve state-of-the-art runtime efficiency on benchmarks such as HumanEval, MBPP, and APPS, frequently surpassing the ground truth reference solutions with PerfCodeGen using GPT-3.5 and GPT-4. Additionally, we demonstrate the effectiveness of our approach in enhancing code quality across a range of open LLMs of varying sizes including Phi-3-mini, Llama 3 8B, Mixtral 8x7B, Command R, and Llama 3 70B.

Large language models (LLMs) can potentially democratize access to medical knowledge. While many efforts have been made to harness and improve LLMs' medical knowledge and reasoning capacities, the resulting models are either closed-source (e.g., PaLM, GPT-4) or limited in scale (<= 13B parameters), which restricts their abilities. In this work, we improve access to large-scale medical LLMs by releasing MEDITRON: a suite of open-source LLMs with 7B and 70B parameters adapted to the medical domain. MEDITRON builds on Llama-2 (through our adaptation of Nvidia's Megatron-LM distributed trainer), and extends pretraining on a comprehensively curated medical corpus, including selected PubMed articles, abstracts, and internationally-recognized medical guidelines. Evaluations using four major medical benchmarks show significant performance gains over several state-of-the-art baselines before and after task-specific finetuning. Overall, MEDITRON achieves a 6% absolute performance gain over the best public baseline in its parameter class and 3% over the strongest baseline we finetuned from Llama-2. Compared to closed-source LLMs, MEDITRON-70B outperforms GPT-3.5 and Med-PaLM and is within 5% of GPT-4 and 10% of Med-PaLM-2. We release our code for curating the medical pretraining corpus and the MEDITRON model weights to drive open-source development of more capable medical LLMs.

Large-language models have recently demonstrated impressive zero-shot capabilities in a variety of natural language tasks such as summarization, dialogue generation, and question-answering. Despite many promising applications in clinical medicine, adoption of these models in real-world settings has been largely limited by their tendency to generate incorrect and sometimes even toxic statements. In this study, we develop Almanac, a large language model framework augmented with retrieval capabilities for medical guideline and treatment recommendations. Performance on a novel dataset of clinical scenarios (n = 130) evaluated by a panel of 5 board-certified and resident physicians demonstrates significant increases in factuality (mean of 18% at p-value < 0.05) across all specialties, with improvements in completeness and safety. Our results demonstrate the potential for large language models to be effective tools in the clinical decision-making process, while also emphasizing the importance of careful testing and deployment to mitigate their shortcomings.

Africa has a very low doctor-to-patient ratio. At very busy clinics, doctors could see 30+ patients per day -- a heavy patient burden compared with developed countries -- but productivity tools such as clinical automatic speech recognition (ASR) are lacking for these overworked clinicians. However, clinical ASR is mature, even ubiquitous, in developed nations, and clinician-reported performance of commercial clinical ASR systems is generally satisfactory. Furthermore, the recent performance of general domain ASR is approaching human accuracy. However, several gaps exist. Several publications have highlighted racial bias with speech-to-text algorithms and performance on minority accents lags significantly. To our knowledge, there is no publicly available research or benchmark on accented African clinical ASR, and speech data is non-existent for the majority of African accents. We release AfriSpeech, 200hrs of Pan-African English speech, 67,577 clips from 2,463 unique speakers across 120 indigenous accents from 13 countries for clinical and general domain ASR, a benchmark test set, with publicly available pre-trained models with SOTA performance on the AfriSpeech benchmark.

Evaluation of large language models (LLMs) for code has primarily relied on static benchmarks, including HumanEval (Chen et al., 2021), which measure the ability of LLMs to generate complete code that passes unit tests. As LLMs are increasingly used as programmer assistants, we study whether gains on existing benchmarks translate to gains in programmer productivity when coding with LLMs, including time spent coding. In addition to static benchmarks, we investigate the utility of preference metrics that might be used as proxies to measure LLM helpfulness, such as code acceptance or copy rates. To do so, we introduce RealHumanEval, a web interface to measure the ability of LLMs to assist programmers, through either autocomplete or chat support. We conducted a user study (N=213) using RealHumanEval in which users interacted with six LLMs of varying base model performance. Despite static benchmarks not incorporating humans-in-the-loop, we find that improvements in benchmark performance lead to increased programmer productivity; however gaps in benchmark versus human performance are not proportional -- a trend that holds across both forms of LLM support. In contrast, we find that programmer preferences do not correlate with their actual performance, motivating the need for better, human-centric proxy signals. We also open-source RealHumanEval to enable human-centric evaluation of new models and the study data to facilitate efforts to improve code models.

Background: Recent advancements in large language models (LLMs) offer potential benefits in healthcare, particularly in processing extensive patient records. However, existing benchmarks do not fully assess LLMs' capability in handling real-world, lengthy clinical data. Methods: We present the LongHealth benchmark, comprising 20 detailed fictional patient cases across various diseases, with each case containing 5,090 to 6,754 words. The benchmark challenges LLMs with 400 multiple-choice questions in three categories: information extraction, negation, and sorting, challenging LLMs to extract and interpret information from large clinical documents. Results: We evaluated nine open-source LLMs with a minimum of 16,000 tokens and also included OpenAI's proprietary and cost-efficient GPT-3.5 Turbo for comparison. The highest accuracy was observed for Mixtral-8x7B-Instruct-v0.1, particularly in tasks focused on information retrieval from single and multiple patient documents. However, all models struggled significantly in tasks requiring the identification of missing information, highlighting a critical area for improvement in clinical data interpretation. Conclusion: While LLMs show considerable potential for processing long clinical documents, their current accuracy levels are insufficient for reliable clinical use, especially in scenarios requiring the identification of missing information. The LongHealth benchmark provides a more realistic assessment of LLMs in a healthcare setting and highlights the need for further model refinement for safe and effective clinical application. We make the benchmark and evaluation code publicly available.

Large language models (LLMs) power many state-of-the-art systems in natural language processing. However, these models are extremely computationally expensive, even at inference time, raising the natural question: when is the extra cost of deploying a larger model worth the anticipated boost in capabilities? Better understanding this tradeoff fundamentally could benefit from an inference efficiency metric that is both (i) easily comparable across models from different providers, and (ii) representative of the true cost of running queries in an isolated performance environment. Unfortunately, access to LLMs today is largely restricted to black-box text generation APIs and raw runtimes measured through this interface do not satisfy these desiderata: model providers can apply various software and hardware optimizations orthogonal to the model, and models served on shared infrastructure are susceptible to performance contention. To circumvent these problems, we propose a new metric for comparing inference efficiency across models. This metric puts models on equal footing as though they were served (i) on uniform hardware and software, and (ii) without performance contention. We call this metric the idealized runtime, and we propose a methodology to efficiently estimate this metric for autoregressive Transformer models. We also propose cost-aware variants that incorporate the number of accelerators needed to serve the model. Using these metrics, we compare ten state-of-the-art LLMs to provide the first analysis of inference efficiency-capability tradeoffs; we make several observations from this analysis, including the fact that the superior inference runtime performance of certain APIs is often a byproduct of optimizations within the API rather than the underlying model. Our methodology also facilitates the efficient comparison of different software and hardware stacks.

Analytical framework for predicting General Matrix Multiplication (GEMM) performance on modern GPUs, focusing on runtime, power consumption, and energy efficiency. Our study employs two approaches: a custom-implemented tiled matrix multiplication kernel for fundamental analysis, and NVIDIA's CUTLASS library for comprehensive performance data collection across advanced configurations. Using the NVIDIA RTX 4070 as our experimental platform, we developed a Random Forest-based prediction model with multi-output regression capability. Through analysis of both naive tiled matrix multiplication with varying tile sizes (1 to 32) and 16,128 CUTLASS GEMM operations across diverse configurations, we identified critical performance patterns related to matrix dimensions, thread block configurations, and memory access patterns. Our framework achieved exceptional accuracy with an R^2 score of 0.98 for runtime prediction (mean error 15.57%) and 0.78 for power prediction (median error 5.42%). The system successfully predicts performance across matrix sizes, demonstrating robust scaling behavior. Our results show that optimal tile size selection can improve performance by up to 3.2x while reducing power consumption by 22% compared to baseline configurations. Analysis of shared memory utilization and SM occupancy reveals that tile sizes of 16x16 achieve the best balance between parallelism and resource usage. The implementation of our framework, including prediction models and analysis tools, is available as an open-source project at GPPerf [https://github.com/pavlyhalim/GPPerf].

Clinical trial matching is the task of identifying trials for which patients may be potentially eligible. Typically, this task is labor-intensive and requires detailed verification of patient electronic health records (EHRs) against the stringent inclusion and exclusion criteria of clinical trials. This process is manual, time-intensive, and challenging to scale up, resulting in many patients missing out on potential therapeutic options. Recent advancements in Large Language Models (LLMs) have made automating patient-trial matching possible, as shown in multiple concurrent research studies. However, the current approaches are confined to constrained, often synthetic datasets that do not adequately mirror the complexities encountered in real-world medical data. In this study, we present the first, end-to-end large-scale empirical evaluation of clinical trial matching using real-world EHRs. Our study showcases the capability of LLMs to accurately match patients with appropriate clinical trials. We perform experiments with proprietary LLMs, including GPT-4 and GPT-3.5, as well as our custom fine-tuned model called OncoLLM and show that OncoLLM, despite its significantly smaller size, not only outperforms GPT-3.5 but also matches the performance of qualified medical doctors. All experiments were carried out on real-world EHRs that include clinical notes and available clinical trials from a single cancer center in the United States.

Large language models for code (i.e., code LLMs) have shown strong code understanding and generation capabilities. To evaluate the capabilities of code LLMs in various aspects, many benchmarks have been proposed (e.g., HumanEval and ClassEval). Code reasoning is one of the most essential abilities of code LLMs, but existing benchmarks for code reasoning are not sufficient. Typically, they focus on predicting the input and output of a program, ignoring the evaluation of the intermediate behavior during program execution, as well as the logical consistency (e.g., the model should not give the correct output if the prediction of execution path is wrong) when performing the reasoning. To address these problems, in this paper, we propose a framework, namely REval, for evaluating code reasoning abilities and consistency of code LLMs with program execution. We utilize existing code benchmarks and adapt them to new benchmarks within our framework. A large-scale empirical study is conducted and most LLMs show unsatisfactory performance on both Runtime Behavior Reasoning (i.e., an average accuracy of 44.4%) and Incremental Consistency Evaluation (i.e., an average IC score of 10.3). Evaluation results of current code LLMs reflect the urgent need for the community to strengthen the code reasoning capability of code LLMs. Our code, data, and \newname leaderboard are available at https://r-eval.github.io.

How can we test AI performance? This question seems trivial, but it isn't. Standard benchmarks often have problems such as in-distribution and small-size test sets, oversimplified metrics, unfair comparisons, and short-term outcome pressure. As a consequence, good performance on standard benchmarks does not guarantee success in real-world scenarios. To address these problems, we present Touchstone, a large-scale collaborative segmentation benchmark of 9 types of abdominal organs. This benchmark is based on 5,195 training CT scans from 76 hospitals around the world and 5,903 testing CT scans from 11 additional hospitals. This diverse test set enhances the statistical significance of benchmark results and rigorously evaluates AI algorithms across various out-of-distribution scenarios. We invited 14 inventors of 19 AI algorithms to train their algorithms, while our team, as a third party, independently evaluated these algorithms on three test sets. In addition, we also evaluated pre-existing AI frameworks--which, differing from algorithms, are more flexible and can support different algorithms--including MONAI from NVIDIA, nnU-Net from DKFZ, and numerous other open-source frameworks. We are committed to expanding this benchmark to encourage more innovation of AI algorithms for the medical domain.

Foundation Models (FMs) trained on Electronic Health Records (EHRs) have achieved state-of-the-art results on numerous clinical prediction tasks. However, most existing EHR FMs have context windows of <1k tokens. This prevents them from modeling full patient EHRs which can exceed 10k's of events. Recent advancements in subquadratic long-context architectures (e.g., Mamba) offer a promising solution. However, their application to EHR data has not been well-studied. We address this gap by presenting the first systematic evaluation of the effect of context length on modeling EHR data. We find that longer context models improve predictive performance -- our Mamba-based model surpasses the prior state-of-the-art on 9/14 tasks on the EHRSHOT prediction benchmark. For clinical applications, however, model performance alone is insufficient -- robustness to the unique properties of EHR is crucial. Thus, we also evaluate models across three previously underexplored properties of EHR data: (1) the prevalence of "copy-forwarded" diagnoses which creates artificial repetition of tokens within EHR sequences; (2) the irregular time intervals between EHR events which can lead to a wide range of timespans within a context window; and (3) the natural increase in disease complexity over time which makes later tokens in the EHR harder to predict than earlier ones. Stratifying our EHRSHOT results, we find that higher levels of each property correlate negatively with model performance, but that longer context models are more robust to more extreme levels of these properties. Our work highlights the potential for using long-context architectures to model EHR data, and offers a case study for identifying new challenges in modeling sequential data motivated by domains outside of natural language. We release our models and code at: https://github.com/som-shahlab/long_context_clues

Large Language Models (LLMs) hold great promise to revolutionize current clinical systems for their superior capacities on medical text processing tasks and medical licensing exams. Meanwhile, traditional ML models such as SVM and XGBoost have still been mainly adopted in clinical prediction tasks. An emerging question is Can LLMs beat traditional ML models in clinical prediction? Thus, we build a new benchmark ClinicalBench to comprehensively study the clinical predictive modeling capacities of both general-purpose and medical LLMs, and compare them with traditional ML models. ClinicalBench embraces three common clinical prediction tasks, two databases, 14 general-purpose LLMs, 8 medical LLMs, and 11 traditional ML models. Through extensive empirical investigation, we discover that both general-purpose and medical LLMs, even with different model scales, diverse prompting or fine-tuning strategies, still cannot beat traditional ML models in clinical prediction yet, shedding light on their potential deficiency in clinical reasoning and decision-making. We call for caution when practitioners adopt LLMs in clinical applications. ClinicalBench can be utilized to bridge the gap between LLMs' development for healthcare and real-world clinical practice.

Large language models (LLMs) hold great promise in summarizing medical evidence. Most recent studies focus on the application of proprietary LLMs. Using proprietary LLMs introduces multiple risk factors, including a lack of transparency and vendor dependency. While open-source LLMs allow better transparency and customization, their performance falls short compared to proprietary ones. In this study, we investigated to what extent fine-tuning open-source LLMs can further improve their performance in summarizing medical evidence. Utilizing a benchmark dataset, MedReview, consisting of 8,161 pairs of systematic reviews and summaries, we fine-tuned three broadly-used, open-sourced LLMs, namely PRIMERA, LongT5, and Llama-2. Overall, the fine-tuned LLMs obtained an increase of 9.89 in ROUGE-L (95% confidence interval: 8.94-10.81), 13.21 in METEOR score (95% confidence interval: 12.05-14.37), and 15.82 in CHRF score (95% confidence interval: 13.89-16.44). The performance of fine-tuned LongT5 is close to GPT-3.5 with zero-shot settings. Furthermore, smaller fine-tuned models sometimes even demonstrated superior performance compared to larger zero-shot models. The above trends of improvement were also manifested in both human and GPT4-simulated evaluations. Our results can be applied to guide model selection for tasks demanding particular domain knowledge, such as medical evidence summarization.

Healthcare systems continuously generate vast amounts of electronic health records (EHRs), commonly stored in the Fast Healthcare Interoperability Resources (FHIR) standard. Despite the wealth of information in these records, their complexity and volume make it difficult for users to retrieve and interpret crucial health insights. Recent advances in Large Language Models (LLMs) offer a solution, enabling semantic question answering (QA) over medical data, allowing users to interact with their health records more effectively. However, ensuring privacy and compliance requires edge and private deployments of LLMs. This paper proposes a novel approach to semantic QA over EHRs by first identifying the most relevant FHIR resources for a user query (Task1) and subsequently answering the query based on these resources (Task2). We explore the performance of privately hosted, fine-tuned LLMs, evaluating them against benchmark models such as GPT-4 and GPT-4o. Our results demonstrate that fine-tuned LLMs, while 250x smaller in size, outperform GPT-4 family models by 0.55% in F1 score on Task1 and 42% on Meteor Task in Task2. Additionally, we examine advanced aspects of LLM usage, including sequential fine-tuning, model self-evaluation (narcissistic evaluation), and the impact of training data size on performance. The models and datasets are available here: https://huggingface.co/genloop

The integration of Artificial Intelligence (AI), especially Large Language Models (LLMs), into the clinical diagnosis process offers significant potential to improve the efficiency and accessibility of medical care. While LLMs have shown some promise in the medical domain, their application in clinical diagnosis remains underexplored, especially in real-world clinical practice, where highly sophisticated, patient-specific decisions need to be made. Current evaluations of LLMs in this field are often narrow in scope, focusing on specific diseases or specialties and employing simplified diagnostic tasks. To bridge this gap, we introduce CliBench, a novel benchmark developed from the MIMIC IV dataset, offering a comprehensive and realistic assessment of LLMs' capabilities in clinical diagnosis. This benchmark not only covers diagnoses from a diverse range of medical cases across various specialties but also incorporates tasks of clinical significance: treatment procedure identification, lab test ordering and medication prescriptions. Supported by structured output ontologies, CliBench enables a precise and multi-granular evaluation, offering an in-depth understanding of LLM's capability on diverse clinical tasks of desired granularity. We conduct a zero-shot evaluation of leading LLMs to assess their proficiency in clinical decision-making. Our preliminary results shed light on the potential and limitations of current LLMs in clinical settings, providing valuable insights for future advancements in LLM-powered healthcare.

In recent years, researchers have proposed numerous benchmarks to evaluate the impressive coding capabilities of large language models (LLMs). However, existing benchmarks primarily focus on assessing the correctness of code generated by LLMs, while neglecting other critical dimensions that also significantly impact code quality. Therefore, this paper proposes the RACE benchmark, which comprehensively evaluates the quality of code generated by LLMs across 4 dimensions: Readability, mAintainability, Correctness, and Efficiency. Specifically, considering the demand-dependent nature of dimensions beyond correctness, we design various types of user requirements for each dimension to assess the model's ability to generate correct code that also meets user demands. We evaluate 18 representative LLMs on RACE and find that: 1) the current LLMs' ability to generate high-quality code on demand does not yet meet the requirements of software development; 2) readability serves as a critical indicator of the overall quality of generated code; 3) most LLMs exhibit an inherent preference for specific coding style. These findings can help researchers gain a deeper understanding of the coding capabilities of current LLMs and shed light on future directions for model improvement.

Multimodal/vision language models (VLMs) are increasingly being deployed in healthcare settings worldwide, necessitating robust benchmarks to ensure their safety, efficacy, and fairness. Multiple-choice question and answer (QA) datasets derived from national medical examinations have long served as valuable evaluation tools, but existing datasets are largely text-only and available in a limited subset of languages and countries. To address these challenges, we present WorldMedQA-V, an updated multilingual, multimodal benchmarking dataset designed to evaluate VLMs in healthcare. WorldMedQA-V includes 568 labeled multiple-choice QAs paired with 568 medical images from four countries (Brazil, Israel, Japan, and Spain), covering original languages and validated English translations by native clinicians, respectively. Baseline performance for common open- and closed-source models are provided in the local language and English translations, and with and without images provided to the model. The WorldMedQA-V benchmark aims to better match AI systems to the diverse healthcare environments in which they are deployed, fostering more equitable, effective, and representative applications.

Clinical trials are fundamental in developing new drugs, medical devices, and treatments. However, they are often time-consuming and have low success rates. Although there have been initial attempts to create large language models (LLMs) for clinical trial design and patient-trial matching, these models remain task-specific and not adaptable to diverse clinical trial tasks. To address this challenge, we propose a clinical trial foundation model named Panacea, designed to handle multiple tasks, including trial search, trial summarization, trial design, and patient-trial matching. We also assemble a large-scale dataset, named TrialAlign, of 793,279 trial documents and 1,113,207 trial-related scientific papers, to infuse clinical knowledge into the model by pre-training. We further curate TrialInstruct, which has 200,866 of instruction data for fine-tuning. These resources enable Panacea to be widely applicable for a range of clinical trial tasks based on user requirements. We evaluated Panacea on a new benchmark, named TrialPanorama, which covers eight clinical trial tasks. Our method performed the best on seven of the eight tasks compared to six cutting-edge generic or medicine-specific LLMs. Specifically, Panacea showed great potential to collaborate with human experts in crafting the design of eligibility criteria, study arms, and outcome measures, in multi-round conversations. In addition, Panacea achieved 14.42% improvement in patient-trial matching, 41.78% to 52.02% improvement in trial search, and consistently ranked at the top for five aspects of trial summarization. Our approach demonstrates the effectiveness of Panacea in clinical trials and establishes a comprehensive resource, including training data, model, and benchmark, for developing clinical trial foundation models, paving the path for AI-based clinical trial development.

This study presents a comprehensive analysis and comparison of two predominant fine-tuning methodologies - full-parameter fine-tuning and parameter-efficient tuning - within the context of medical Large Language Models (LLMs). We developed and refined a series of LLMs, based on the Llama-2 architecture, specifically designed to enhance medical knowledge retrieval, reasoning, and question-answering capabilities. Our experiments systematically evaluate the effectiveness of these tuning strategies across various well-known medical benchmarks. Notably, our medical LLM Med42 showed an accuracy level of 72% on the US Medical Licensing Examination (USMLE) datasets, setting a new standard in performance for openly available medical LLMs. Through this comparative analysis, we aim to identify the most effective and efficient method for fine-tuning LLMs in the medical domain, thereby contributing significantly to the advancement of AI-driven healthcare applications.

Clinical trial matching is a key process in health delivery and discovery. In practice, it is plagued by overwhelming unstructured data and unscalable manual processing. In this paper, we conduct a systematic study on scaling clinical trial matching using large language models (LLMs), with oncology as the focus area. Our study is grounded in a clinical trial matching system currently in test deployment at a large U.S. health network. Initial findings are promising: out of box, cutting-edge LLMs, such as GPT-4, can already structure elaborate eligibility criteria of clinical trials and extract complex matching logic (e.g., nested AND/OR/NOT). While still far from perfect, LLMs substantially outperform prior strong baselines and may serve as a preliminary solution to help triage patient-trial candidates with humans in the loop. Our study also reveals a few significant growth areas for applying LLMs to end-to-end clinical trial matching, such as context limitation and accuracy, especially in structuring patient information from longitudinal medical records.

A key strength of managed runtimes over hardware is the ability to gain detailed insight into the dynamic execution of programs with instrumentation. Analyses such as code coverage, execution frequency, tracing, and debugging, are all made easier in a virtual setting. As a portable, low-level bytecode, WebAssembly offers inexpensive in-process sandboxing with high performance. Yet to date, Wasm engines have not offered much insight into executing programs, supporting at best bytecode-level stepping and basic source maps, but no instrumentation capabilities. In this paper, we show the first non-intrusive dynamic instrumentation system for WebAssembly in the open-source Wizard Research Engine. Our innovative design offers a flexible, complete hierarchy of instrumentation primitives that support building high-level, complex analyses in terms of low-level, programmable probes. In contrast to emulation or machine code instrumentation, injecting probes at the bytecode level increases expressiveness and vastly simplifies the implementation by reusing the engine's JIT compiler, interpreter, and deoptimization mechanism rather than building new ones. Wizard supports both dynamic instrumentation insertion and removal while providing consistency guarantees, which is key to composing multiple analyses without interference. We detail a fully-featured implementation in a high-performance multi-tier Wasm engine, show novel optimizations specifically designed to minimize instrumentation overhead, and evaluate performance characteristics under load from various analyses. This design is well-suited for production engine adoption as probes can be implemented to have no impact on production performance when not in use.

Deep convolutional neural networks (CNNs) are the current state-of-the-art for digital analysis of histopathological images. The large size of whole-slide microscopy images (WSIs) requires advanced memory handling to read, display and process these images. There are several open-source platforms for working with WSIs, but few support deployment of CNN models. These applications use third-party solutions for inference, making them less user-friendly and unsuitable for high-performance image analysis. To make deployment of CNNs user-friendly and feasible on low-end machines, we have developed a new platform, FastPathology, using the FAST framework and C++. It minimizes memory usage for reading and processing WSIs, deployment of CNN models, and real-time interactive visualization of results. Runtime experiments were conducted on four different use cases, using different architectures, inference engines, hardware configurations and operating systems. Memory usage for reading, visualizing, zooming and panning a WSI were measured, using FastPathology and three existing platforms. FastPathology performed similarly in terms of memory to the other C++ based application, while using considerably less than the two Java-based platforms. The choice of neural network model, inference engine, hardware and processors influenced runtime considerably. Thus, FastPathology includes all steps needed for efficient visualization and processing of WSIs in a single application, including inference of CNNs with real-time display of the results. Source code, binary releases and test data can be found online on GitHub at https://github.com/SINTEFMedtek/FAST-Pathology/.

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from two real-world radiology datasets (MIMIC-CXR and IU-Xray), with 1,000 subsampled reports each. A subset of original reports was modified to contain synthetic errors by introducing various type of mistakes. The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. LLaVA (Large Language and Visual Assistant) variant models, including our instruction-tuned model, were used for the evaluation. Additionally, a domain expert evaluation was conducted on a small test set. At the SIMPLE level, the LLaVA v1.5 model outperformed other publicly available models. Instruction tuning significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU-Xray data, respectively. The model also surpassed the domain experts accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. This study marks a promising step toward utilizing multi-modal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans. Nevertheless, future work is needed to improve the model ability to identify the types of inconsistency.

Large language models (LLMs) have shown potential in biomedical applications, leading to efforts to fine-tune them on domain-specific data. However, the effectiveness of this approach remains unclear. This study evaluates the performance of biomedically fine-tuned LLMs against their general-purpose counterparts on a variety of clinical tasks. We evaluated their performance on clinical case challenges from the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA) and on several clinical tasks (e.g., information extraction, document summarization, and clinical coding). Using benchmarks specifically chosen to be likely outside the fine-tuning datasets of biomedical models, we found that biomedical LLMs mostly perform inferior to their general-purpose counterparts, especially on tasks not focused on medical knowledge. While larger models showed similar performance on case tasks (e.g., OpenBioLLM-70B: 66.4% vs. Llama-3-70B-Instruct: 65% on JAMA cases), smaller biomedical models showed more pronounced underperformance (e.g., OpenBioLLM-8B: 30% vs. Llama-3-8B-Instruct: 64.3% on NEJM cases). Similar trends were observed across the CLUE (Clinical Language Understanding Evaluation) benchmark tasks, with general-purpose models often performing better on text generation, question answering, and coding tasks. Our results suggest that fine-tuning LLMs to biomedical data may not provide the expected benefits and may potentially lead to reduced performance, challenging prevailing assumptions about domain-specific adaptation of LLMs and highlighting the need for more rigorous evaluation frameworks in healthcare AI. Alternative approaches, such as retrieval-augmented generation, may be more effective in enhancing the biomedical capabilities of LLMs without compromising their general knowledge.

Although large language models (LLMs) have been assessed for general medical knowledge using medical licensing exams, their ability to effectively support clinical decision-making tasks, such as selecting and using medical calculators, remains uncertain. Here, we evaluate the capability of both medical trainees and LLMs to recommend medical calculators in response to various multiple-choice clinical scenarios such as risk stratification, prognosis, and disease diagnosis. We assessed eight LLMs, including open-source, proprietary, and domain-specific models, with 1,009 question-answer pairs across 35 clinical calculators and measured human performance on a subset of 100 questions. While the highest-performing LLM, GPT-4o, provided an answer accuracy of 74.3% (CI: 71.5-76.9%), human annotators, on average, outperformed LLMs with an accuracy of 79.5% (CI: 73.5-85.0%). With error analysis showing that the highest-performing LLMs continue to make mistakes in comprehension (56.6%) and calculator knowledge (8.1%), our findings emphasize that humans continue to surpass LLMs on complex clinical tasks such as calculator recommendation.

Building upon our previous investigations of O1 replication (Part 1: Journey Learning [Qin et al., 2024] and Part 2: Distillation [Huang et al., 2024]), this work explores the potential of inference-time scaling in large language models (LLMs) for medical reasoning tasks, ranging from diagnostic decision-making to treatment planning. Through extensive experiments on medical benchmarks of varying complexity (MedQA, Medbullets, and JAMA Clinical Challenges), our investigation reveals several key insights: (1) Increasing inference time does lead to improved performance. With a modest training set of 500 samples, our model yields substantial performance improvements of 6%-11%. (2) Task complexity directly correlates with the required length of reasoning chains, confirming the necessity of extended thought processes for challenging problems. (3) The differential diagnoses generated by our model adhere to the principles of the hypothetico-deductive method, producing a list of potential conditions that may explain a patient's symptoms and systematically narrowing these possibilities by evaluating the evidence. These findings demonstrate the promising synergy between inference-time scaling and journey learning in advancing LLMs' real-world clinical reasoning capabilities.

We introduce MURA, a large dataset of musculoskeletal radiographs containing 40,561 images from 14,863 studies, where each study is manually labeled by radiologists as either normal or abnormal. To evaluate models robustly and to get an estimate of radiologist performance, we collect additional labels from six board-certified Stanford radiologists on the test set, consisting of 207 musculoskeletal studies. On this test set, the majority vote of a group of three radiologists serves as gold standard. We train a 169-layer DenseNet baseline model to detect and localize abnormalities. Our model achieves an AUROC of 0.929, with an operating point of 0.815 sensitivity and 0.887 specificity. We compare our model and radiologists on the Cohen's kappa statistic, which expresses the agreement of our model and of each radiologist with the gold standard. Model performance is comparable to the best radiologist performance in detecting abnormalities on finger and wrist studies. However, model performance is lower than best radiologist performance in detecting abnormalities on elbow, forearm, hand, humerus, and shoulder studies. We believe that the task is a good challenge for future research. To encourage advances, we have made our dataset freely available at https://stanfordmlgroup.github.io/competitions/mura .

Large Vision-Language Models (LVLMs) are capable of handling diverse data types such as imaging, text, and physiological signals, and can be applied in various fields. In the medical field, LVLMs have a high potential to offer substantial assistance for diagnosis and treatment. Before that, it is crucial to develop benchmarks to evaluate LVLMs' effectiveness in various medical applications. Current benchmarks are often built upon specific academic literature, mainly focusing on a single domain, and lacking varying perceptual granularities. Thus, they face specific challenges, including limited clinical relevance, incomplete evaluations, and insufficient guidance for interactive LVLMs. To address these limitations, we developed the GMAI-MMBench, the most comprehensive general medical AI benchmark with well-categorized data structure and multi-perceptual granularity to date. It is constructed from 285 datasets across 39 medical image modalities, 18 clinical-related tasks, 18 departments, and 4 perceptual granularities in a Visual Question Answering (VQA) format. Additionally, we implemented a lexical tree structure that allows users to customize evaluation tasks, accommodating various assessment needs and substantially supporting medical AI research and applications. We evaluated 50 LVLMs, and the results show that even the advanced GPT-4o only achieves an accuracy of 52%, indicating significant room for improvement. Moreover, we identified five key insufficiencies in current cutting-edge LVLMs that need to be addressed to advance the development of better medical applications. We believe that GMAI-MMBench will stimulate the community to build the next generation of LVLMs toward GMAI. Project Page: https://uni-medical.github.io/GMAI-MMBench.github.io/

Hospital information systems (HIS) have become an essential part of healthcare institutions and now incorporate prescribing support software. Prescription support software allows for structured information capture, which improves the safety, appropriateness and efficiency of prescriptions and reduces the number of adverse drug events (ADEs). However, such a system increases the amount of time physicians spend at a computer entering information instead of providing medical care. In addition, any new visiting clinician must learn to manage complex interfaces since each HIS has its own interfaces. In this paper, we present a natural language interface for e-prescribing software in the form of a spoken dialogue system accessible on a smartphone. This system allows prescribers to record their prescriptions verbally, a form of interaction closer to their usual practice. The system extracts the formal representation of the prescription ready to be checked by the prescribing software and uses the dialogue to request mandatory information, correct errors or warn of particular situations. Since, to the best of our knowledge, there is no existing voice-based prescription dialogue system, we present the system developed in a low-resource environment, focusing on dialogue modeling, semantic extraction and data augmentation. The system was evaluated in the wild with 55 participants. This evaluation showed that our system has an average prescription time of 66.15 seconds for physicians and 35.64 seconds for other experts, and a task success rate of 76\% for physicians and 72\% for other experts. All evaluation data were recorded and annotated to form PxCorpus, the first spoken drug prescription corpus that has been made fully available to the community (https://doi.org/10.5281/zenodo.6524162).

Commercial large language models (LLMs), like OpenAI's GPT-4 powering ChatGPT and Anthropic's Claude 3 Opus, have dominated natural language processing (NLP) benchmarks across different domains. New competing Open-Source alternatives like Mixtral 8x7B or Llama 3 have emerged and seem to be closing the gap while often offering higher throughput and being less costly to use. Open-Source LLMs can also be self-hosted, which makes them interesting for enterprise and clinical use cases where sensitive data should not be processed by third parties. We participated in the 12th BioASQ challenge, which is a retrieval augmented generation (RAG) setting, and explored the performance of current GPT models Claude 3 Opus, GPT-3.5-turbo and Mixtral 8x7b with in-context learning (zero-shot, few-shot) and QLoRa fine-tuning. We also explored how additional relevant knowledge from Wikipedia added to the context-window of the LLM might improve their performance. Mixtral 8x7b was competitive in the 10-shot setting, both with and without fine-tuning, but failed to produce usable results in the zero-shot setting. QLoRa fine-tuning and Wikipedia context did not lead to measurable performance gains. Our results indicate that the performance gap between commercial and open-source models in RAG setups exists mainly in the zero-shot setting and can be closed by simply collecting few-shot examples for domain-specific use cases. The code needed to rerun these experiments is available through GitHub.

Optimizing scientific software is a difficult task because codebases are often large and complex, and performance can depend upon several factors including the algorithm, its implementation, and hardware among others. Causes of poor performance can originate from disparate sources and be difficult to diagnose. Recent years have seen a multitude of work that use large language models (LLMs) to assist in software development tasks. However, these tools are trained to model the distribution of code as text, and are not specifically designed to understand performance aspects of code. In this work, we introduce a reinforcement learning based methodology to align the outputs of code LLMs with performance. This allows us to build upon the current code modeling capabilities of LLMs and extend them to generate better performing code. We demonstrate that our fine-tuned model improves the expected speedup of generated code over base models for a set of benchmark tasks from 0.9 to 1.6 for serial code and 1.9 to 4.5 for OpenMP code.

Current Large Language Models (LLMs) benchmarks are often based on open-ended or close-ended QA evaluations, avoiding the requirement of human labor. Close-ended measurements evaluate the factuality of responses but lack expressiveness. Open-ended capture the model's capacity to produce discourse responses but are harder to assess for correctness. These two approaches are commonly used, either independently or together, though their relationship remains poorly understood. This work is focused on the healthcare domain, where both factuality and discourse matter greatly. It introduces a comprehensive, multi-axis suite for healthcare LLM evaluation, exploring correlations between open and close benchmarks and metrics. Findings include blind spots and overlaps in current methodologies. As an updated sanity check, we release a new medical benchmark--CareQA--, with both open and closed variants. Finally, we propose a novel metric for open-ended evaluations --Relaxed Perplexity-- to mitigate the identified limitations.

BACKGROUND: Radiology reports are typically written in a free-text format, making clinical information difficult to extract and use. Recently the adoption of structured reporting (SR) has been recommended by various medical societies thanks to the advantages it offers, e.g. standardization, completeness and information retrieval. We propose a pipeline to extract information from free-text radiology reports, that fits with the items of the reference SR registry proposed by a national society of interventional and medical radiology, focusing on CT staging of patients with lymphoma. METHODS: Our work aims to leverage the potential of Natural Language Processing (NLP) and Transformer-based models to deal with automatic SR registry filling. With the availability of 174 radiology reports, we investigate a rule-free generative Question Answering approach based on a domain-specific version of T5 (IT5). Two strategies (batch-truncation and ex-post combination) are implemented to comply with the model's context length limitations. Performance is evaluated in terms of strict accuracy, F1, and format accuracy, and compared with the widely used GPT-3.5 Large Language Model. A 5-point Likert scale questionnaire is used to collect human-expert feedback on the similarity between medical annotations and generated answers. RESULTS: The combination of fine-tuning and batch splitting allows IT5 to achieve notable results; it performs on par with GPT-3.5 albeit its size being a thousand times smaller in terms of parameters. Human-based assessment scores show a high correlation (Spearman's correlation coefficients>0.88, p-values<0.001) with AI performance metrics (F1) and confirm the superior ability of LLMs (i.e., GPT-3.5, 175B of parameters) in generating plausible human-like statements.

Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like responses across diverse contexts and adapting to novel tasks following human instructions. Their potential application spans a broad range of medical tasks, such as clinical documentation, matching patients to clinical trials, and answering medical questions. In this primer paper, we propose an actionable guideline to help healthcare professionals more efficiently utilize LLMs in their work, along with a set of best practices. This approach consists of several main phases, including formulating the task, choosing LLMs, prompt engineering, fine-tuning, and deployment. We start with the discussion of critical considerations in identifying healthcare tasks that align with the core capabilities of LLMs and selecting models based on the selected task and data, performance requirements, and model interface. We then review the strategies, such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized medical tasks. Deployment considerations, including regulatory compliance, ethical guidelines, and continuous monitoring for fairness and bias, are also discussed. By providing a structured step-by-step methodology, this tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.

The scaling laws and extraordinary performance of large foundation models motivate the development and utilization of such models in biomedicine. However, despite early promising results on some biomedical benchmarks, there are still major challenges that need to be addressed before these models can be used in real-world clinics. Frontier general-domain models such as GPT-4V still have significant performance gaps in multimodal biomedical applications. More importantly, less-acknowledged pragmatic issues, including accessibility, model cost, and tedious manual evaluation make it hard for clinicians to use state-of-the-art large models directly on private patient data. Here, we explore training open-source small multimodal models (SMMs) to bridge competency gaps for unmet clinical needs in radiology. To maximize data efficiency, we adopt a modular approach by incorporating state-of-the-art pre-trained models for image and text modalities, and focusing on training a lightweight adapter to ground each modality to the text embedding space, as exemplified by LLaVA-Med. For training, we assemble a large dataset of over 697 thousand radiology image-text pairs. For evaluation, we propose CheXprompt, a GPT-4-based metric for factuality evaluation, and demonstrate its parity with expert evaluation. For best practice, we conduct a systematic ablation study on various choices in data engineering and multimodal training. The resulting LlaVA-Rad (7B) model attains state-of-the-art results on standard radiology tasks such as report generation and cross-modal retrieval, even outperforming much larger models such as GPT-4V and Med-PaLM M (84B). The inference of LlaVA-Rad is fast and can be performed on a single V100 GPU in private settings, offering a promising state-of-the-art tool for real-world clinical applications.

Run-time steering strategies like Medprompt are valuable for guiding large language models (LLMs) to top performance on challenging tasks. Medprompt demonstrates that a general LLM can be focused to deliver state-of-the-art performance on specialized domains like medicine by using a prompt to elicit a run-time strategy involving chain of thought reasoning and ensembling. OpenAI's o1-preview model represents a new paradigm, where a model is designed to do run-time reasoning before generating final responses. We seek to understand the behavior of o1-preview on a diverse set of medical challenge problem benchmarks. Following on the Medprompt study with GPT-4, we systematically evaluate the o1-preview model across various medical benchmarks. Notably, even without prompting techniques, o1-preview largely outperforms the GPT-4 series with Medprompt. We further systematically study the efficacy of classic prompt engineering strategies, as represented by Medprompt, within the new paradigm of reasoning models. We found that few-shot prompting hinders o1's performance, suggesting that in-context learning may no longer be an effective steering approach for reasoning-native models. While ensembling remains viable, it is resource-intensive and requires careful cost-performance optimization. Our cost and accuracy analysis across run-time strategies reveals a Pareto frontier, with GPT-4o representing a more affordable option and o1-preview achieving state-of-the-art performance at higher cost. Although o1-preview offers top performance, GPT-4o with steering strategies like Medprompt retains value in specific contexts. Moreover, we note that the o1-preview model has reached near-saturation on many existing medical benchmarks, underscoring the need for new, challenging benchmarks. We close with reflections on general directions for inference-time computation with LLMs.

The entry of large language models (LLMs) into research and commercial spaces has led to a trend of ever-larger models, with initial promises of generalisability, followed by a widespread desire to downsize and create specialised models without the need for complete fine-tuning, using Parameter Efficient Fine-tuning (PEFT) methods. We present an investigation into the suitability of different PEFT methods to clinical decision-making tasks, across a range of model sizes, including extremely small models with as few as 25 million parameters. Our analysis shows that the performance of most PEFT approaches varies significantly from one task to another, with the exception of LoRA, which maintains relatively high performance across all model sizes and tasks, typically approaching or matching full fine-tuned performance. The effectiveness of PEFT methods in the clinical domain is evident, particularly for specialised models which can operate on low-cost, in-house computing infrastructure. The advantages of these models, in terms of speed and reduced training costs, dramatically outweighs any performance gain from large foundation LLMs. Furthermore, we highlight how domain-specific pre-training interacts with PEFT methods and model size, and discuss how these factors interplay to provide the best efficiency-performance trade-off. Full code available at: tbd.

Medical applications of machine learning (ML) have experienced a surge in popularity in recent years. The intensive care unit (ICU) is a natural habitat for ML given the abundance of available data from electronic health records. Models have been proposed to address numerous ICU prediction tasks like the early detection of complications. While authors frequently report state-of-the-art performance, it is challenging to verify claims of superiority. Datasets and code are not always published, and cohort definitions, preprocessing pipelines, and training setups are difficult to reproduce. This work introduces Yet Another ICU Benchmark (YAIB), a modular framework that allows researchers to define reproducible and comparable clinical ML experiments; we offer an end-to-end solution from cohort definition to model evaluation. The framework natively supports most open-access ICU datasets (MIMIC III/IV, eICU, HiRID, AUMCdb) and is easily adaptable to future ICU datasets. Combined with a transparent preprocessing pipeline and extensible training code for multiple ML and deep learning models, YAIB enables unified model development. Our benchmark comes with five predefined established prediction tasks (mortality, acute kidney injury, sepsis, kidney function, and length of stay) developed in collaboration with clinicians. Adding further tasks is straightforward by design. Using YAIB, we demonstrate that the choice of dataset, cohort definition, and preprocessing have a major impact on the prediction performance - often more so than model class - indicating an urgent need for YAIB as a holistic benchmarking tool. We provide our work to the clinical ML community to accelerate method development and enable real-world clinical implementations. Software Repository: https://github.com/rvandewater/YAIB.

LLMs have become increasingly capable at accomplishing a range of specialized-tasks and can be utilized to expand equitable access to medical knowledge. Most medical LLMs have involved extensive fine-tuning, leveraging specialized medical data and significant, thus costly, amounts of computational power. Many of the top performing LLMs are proprietary and their access is limited to very few research groups. However, open-source (OS) models represent a key area of growth for medical LLMs due to significant improvements in performance and an inherent ability to provide the transparency and compliance required in healthcare. We present OpenMedLM, a prompting platform which delivers state-of-the-art (SOTA) performance for OS LLMs on medical benchmarks. We evaluated a range of OS foundation LLMs (7B-70B) on four medical benchmarks (MedQA, MedMCQA, PubMedQA, MMLU medical-subset). We employed a series of prompting strategies, including zero-shot, few-shot, chain-of-thought (random selection and kNN selection), and ensemble/self-consistency voting. We found that OpenMedLM delivers OS SOTA results on three common medical LLM benchmarks, surpassing the previous best performing OS models that leveraged computationally costly extensive fine-tuning. The model delivers a 72.6% accuracy on the MedQA benchmark, outperforming the previous SOTA by 2.4%, and achieves 81.7% accuracy on the MMLU medical-subset, establishing itself as the first OS LLM to surpass 80% accuracy on this benchmark. Our results highlight medical-specific emergent properties in OS LLMs which have not yet been documented to date elsewhere, and showcase the benefits of further leveraging prompt engineering to improve the performance of accessible LLMs for medical applications.

We present Eir Thai Medical LLM, a large language model with 8 billion parameters, specifically designed to enhance the accuracy of handling medical tasks in the Thai language. This model focuses on providing clear and easy-to-understand answers for both healthcare professionals and patients, thereby improving the efficiency of diagnosis and treatment processes. Human evaluation was conducted to ensure that the model adheres to care standards and provides unbiased answers. To prioritize data security, the model is deployed within the hospital's internal network, ensuring both high security and faster processing speeds. The internal API connection is secured with encryption and strict authentication measures to prevent data leaks and unauthorized access. We evaluated several open-source large language models with 8 billion parameters on four medical benchmarks: MedQA, MedMCQA, PubMedQA, and the medical subset of MMLU. The best-performing baselines were used to develop Eir Thai Medical LLM. Our evaluation employed multiple questioning strategies, including zero-shot, few-shot, chain-of-thought reasoning, and ensemble/self-consistency voting methods. Our model outperformed commercially available Thai-language large language models by more than 10%. In addition, we developed enhanced model testing tailored for clinical use in Thai across 18 clinical tasks, where our model exceeded GPT-4o performance by more than 11%

We evaluate AI-assisted generative capabilities on fundamental numerical kernels in high-performance computing (HPC), including AXPY, GEMV, GEMM, SpMV, Jacobi Stencil, and CG. We test the generated kernel codes for a variety of language-supported programming models, including (1) C++ (e.g., OpenMP [including offload], OpenACC, Kokkos, SyCL, CUDA, and HIP), (2) Fortran (e.g., OpenMP [including offload] and OpenACC), (3) Python (e.g., numba, Numba, cuPy, and pyCUDA), and (4) Julia (e.g., Threads, CUDA.jl, AMDGPU.jl, and KernelAbstractions.jl). We use the GitHub Copilot capabilities powered by OpenAI Codex available in Visual Studio Code as of April 2023 to generate a vast amount of implementations given simple <kernel> + <programming model> + <optional hints> prompt variants. To quantify and compare the results, we propose a proficiency metric around the initial 10 suggestions given for each prompt. Results suggest that the OpenAI Codex outputs for C++ correlate with the adoption and maturity of programming models. For example, OpenMP and CUDA score really high, whereas HIP is still lacking. We found that prompts from either a targeted language such as Fortran or the more general-purpose Python can benefit from adding code keywords, while Julia prompts perform acceptably well for its mature programming models (e.g., Threads and CUDA.jl). We expect for these benchmarks to provide a point of reference for each programming model's community. Overall, understanding the convergence of large language models, AI, and HPC is crucial due to its rapidly evolving nature and how it is redefining human-computer interactions.

Large Language Models (LLMs) have shown the potential to significantly contribute to patient care, diagnostics, and administrative processes. Emerging biomedical LLMs address healthcare-specific challenges, including privacy demands and computational constraints. However, evaluation of these models has primarily been limited to non-clinical tasks, which do not reflect the complexity of practical clinical applications. Additionally, there has been no thorough comparison between biomedical and general-domain LLMs for clinical tasks. To fill this gap, we present the Clinical Language Understanding Evaluation (CLUE), a benchmark tailored to evaluate LLMs on real-world clinical tasks. CLUE includes two novel datasets derived from MIMIC IV discharge letters and four existing tasks designed to test the practical applicability of LLMs in healthcare settings. Our evaluation covers several biomedical and general domain LLMs, providing insights into their clinical performance and applicability. CLUE represents a step towards a standardized approach to evaluating and developing LLMs in healthcare to align future model development with the real-world needs of clinical application. We publish our evaluation and data generation scripts: https://github.com/dadaamin/CLUE

Medical benchmark datasets significantly contribute to developing Large Language Models (LLMs) for medical knowledge extraction, diagnosis, summarization, and other uses. Yet, current benchmarks are mainly derived from exam questions given to medical students or cases described in the medical literature, lacking the complexity of real-world patient cases that deviate from classic textbook abstractions. These include rare diseases, uncommon presentations of common diseases, and unexpected treatment responses. Here, we construct Clinically Uncommon Patient Cases and Diagnosis Dataset (CUPCase) based on 3,562 real-world case reports from BMC, including diagnoses in open-ended textual format and as multiple-choice options with distractors. Using this dataset, we evaluate the ability of state-of-the-art LLMs, including both general-purpose and Clinical LLMs, to identify and correctly diagnose a patient case, and test models' performance when only partial information about cases is available. Our findings show that general-purpose GPT-4o attains the best performance in both the multiple-choice task (average accuracy of 87.9%) and the open-ended task (BERTScore F1 of 0.764), outperforming several LLMs with a focus on the medical domain such as Meditron-70B and MedLM-Large. Moreover, GPT-4o was able to maintain 87% and 88% of its performance with only the first 20% of tokens of the case presentation in multiple-choice and free text, respectively, highlighting the potential of LLMs to aid in early diagnosis in real-world cases. CUPCase expands our ability to evaluate LLMs for clinical decision support in an open and reproducible manner.

Large Language Models (LLMs) and multi-agent systems have shown impressive capabilities in natural language tasks but face challenges in clinical trial applications, primarily due to limited access to external knowledge. Recognizing the potential of advanced clinical trial tools that aggregate and predict based on the latest medical data, we propose an integrated solution to enhance their accessibility and utility. We introduce Clinical Agent System (ClinicalAgent), a clinical multi-agent system designed for clinical trial tasks, leveraging GPT-4, multi-agent architectures, LEAST-TO-MOST, and ReAct reasoning technology. This integration not only boosts LLM performance in clinical contexts but also introduces novel functionalities. The proposed method achieves competitive predictive performance in clinical trial outcome prediction (0.7908 PR-AUC), obtaining a 0.3326 improvement over the standard prompt Method. Publicly available code can be found at https://anonymous.4open.science/r/ClinicalAgent-6671.

Code generation has largely improved development efficiency in the era of large language models (LLMs). With the ability to follow instructions, current LLMs can be prompted to generate code solutions given detailed descriptions in natural language. Many research efforts are being devoted to improving the correctness of LLM-generated code, and many benchmarks are proposed to evaluate the correctness comprehensively. Despite the focus on correctness, the time efficiency of LLM-generated code solutions is under-explored. Current correctness benchmarks are not suitable for time efficiency evaluation since their test cases cannot well distinguish the time efficiency of different code solutions. Besides, the current execution time measurement is not stable and comprehensive, threatening the validity of the time efficiency evaluation. To address the challenges in the time efficiency evaluation of code generation, we propose COFFE, a code generation benchmark for evaluating the time efficiency of LLM-generated code solutions. COFFE contains 398 and 358 problems for function-level and file-level code generation, respectively. To improve the distinguishability, we design a novel stressful test case generation approach with contracts and two new formats of test cases to improve the accuracy of generation. For the time evaluation metric, we propose efficienct@k based on CPU instruction count to ensure a stable and solid comparison between different solutions. We evaluate 14 popular LLMs on COFFE and identify four findings. Based on the findings, we draw some implications for LLM researchers and software practitioners to facilitate future research and usage of LLMs in code generation.

With the advent of large language models (LLMs) like GPT-3, a natural question is the extent to which these models can be utilized for source code optimization. This paper presents methodologically stringent case studies applied to well-known open source python libraries pillow and numpy. We find that contemporary LLM ChatGPT-4 (state September and October 2023) is surprisingly adept at optimizing energy and compute efficiency. However, this is only the case in interactive use, with a human expert in the loop. Aware of experimenter bias, we document our qualitative approach in detail, and provide transcript and source code. We start by providing a detailed description of our approach in conversing with the LLM to optimize the _getextrema function in the pillow library, and a quantitative evaluation of the performance improvement. To demonstrate qualitative replicability, we report further attempts on another locus in the pillow library, and one code locus in the numpy library, to demonstrate generalization within and beyond a library. In all attempts, the performance improvement is significant (factor up to 38). We have also not omitted reporting of failed attempts (there were none). We conclude that LLMs are a promising tool for code optimization in open source libraries, but that the human expert in the loop is essential for success. Nonetheless, we were surprised by how few iterations were required to achieve substantial performance improvements that were not obvious to the expert in the loop. We would like bring attention to the qualitative nature of this study, more robust quantitative studies would need to introduce a layer of selecting experts in a representative sample -- we invite the community to collaborate.

Automatic and consistent meningioma segmentation in T1-weighted MRI volumes and corresponding volumetric assessment is of use for diagnosis, treatment planning, and tumor growth evaluation. In this paper, we optimized the segmentation and processing speed performances using a large number of both surgically treated meningiomas and untreated meningiomas followed at the outpatient clinic. We studied two different 3D neural network architectures: (i) a simple encoder-decoder similar to a 3D U-Net, and (ii) a lightweight multi-scale architecture (PLS-Net). In addition, we studied the impact of different training schemes. For the validation studies, we used 698 T1-weighted MR volumes from St. Olav University Hospital, Trondheim, Norway. The models were evaluated in terms of detection accuracy, segmentation accuracy and training/inference speed. While both architectures reached a similar Dice score of 70% on average, the PLS-Net was more accurate with an F1-score of up to 88%. The highest accuracy was achieved for the largest meningiomas. Speed-wise, the PLS-Net architecture tended to converge in about 50 hours while 130 hours were necessary for U-Net. Inference with PLS-Net takes less than a second on GPU and about 15 seconds on CPU. Overall, with the use of mixed precision training, it was possible to train competitive segmentation models in a relatively short amount of time using the lightweight PLS-Net architecture. In the future, the focus should be brought toward the segmentation of small meningiomas (less than 2ml) to improve clinical relevance for automatic and early diagnosis as well as speed of growth estimates.

Patient recruitment is challenging for clinical trials. We introduce TrialGPT, an end-to-end framework for zero-shot patient-to-trial matching with large language models. TrialGPT comprises three modules: it first performs large-scale filtering to retrieve candidate trials (TrialGPT-Retrieval); then predicts criterion-level patient eligibility (TrialGPT-Matching); and finally generates trial-level scores (TrialGPT-Ranking). We evaluate TrialGPT on three cohorts of 183 synthetic patients with over 75,000 trial annotations. TrialGPT-Retrieval can recall over 90% of relevant trials using less than 6% of the initial collection. Manual evaluations on 1,015 patient-criterion pairs show that TrialGPT-Matching achieves an accuracy of 87.3% with faithful explanations, close to the expert performance. The TrialGPT-Ranking scores are highly correlated with human judgments and outperform the best-competing models by 43.8% in ranking and excluding trials. Furthermore, our user study reveals that TrialGPT can reduce the screening time by 42.6% in patient recruitment. Overall, these results have demonstrated promising opportunities for patient-to-trial matching with TrialGPT.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

On the way to Exascale, programmers face the increasing challenge of having to support multiple hardware architectures from the same code base. At the same time, portability of code and performance are increasingly difficult to achieve as hardware architectures are becoming more and more diverse. Today's heterogeneous systems often include two or more completely distinct and incompatible hardware execution models, such as GPGPU's, SIMD vector units, and general purpose cores which conventionally have to be programmed using separate tool chains representing non-overlapping programming models. The recent revival of interest in the industry and the wider community for the C++ language has spurred a remarkable amount of standardization proposals and technical specifications in the arena of concurrency and parallelism. This recently includes an increasing amount of discussion around the need for a uniform, higher-level abstraction and programming model for parallelism in the C++ standard targeting heterogeneous and distributed computing. Such an abstraction should perfectly blend with existing, already standardized language and library features, but should also be generic enough to support future hardware developments. In this paper, we present the results from developing such a higher-level programming abstraction for parallelism in C++ which aims at enabling code and performance portability over a wide range of architectures and for various types of parallelism. We present and compare performance data obtained from running the well-known STREAM benchmark ported to our higher level C++ abstraction with the corresponding results from running it natively. We show that our abstractions enable performance at least as good as the comparable base-line benchmarks while providing a uniform programming API on all compared target architectures.

This research tests the role of Large Language Models (LLMs) as formal second opinion tools in professional decision-making, particularly focusing on complex medical cases where even experienced physicians seek peer consultation. The work analyzed 183 challenging medical cases from Medscape over a 20-month period, testing multiple LLMs' performance against crowd-sourced physician responses. A key finding was the high overall score possible in the latest foundational models (>80% accuracy compared to consensus opinion), which exceeds most human metrics reported on the same clinical cases (450 pages of patient profiles, test results). The study rates the LLMs' performance disparity between straightforward cases (>81% accuracy) and complex scenarios (43% accuracy), particularly in these cases generating substantial debate among human physicians. The research demonstrates that LLMs may be valuable as generators of comprehensive differential diagnoses rather than as primary diagnostic tools, potentially helping to counter cognitive biases in clinical decision-making, reduce cognitive loads, and thus remove some sources of medical error. The inclusion of a second comparative legal dataset (Supreme Court cases, N=21) provides added empirical context to the AI use to foster second opinions, though these legal challenges proved considerably easier for LLMs to analyze. In addition to the original contributions of empirical evidence for LLM accuracy, the research aggregated a novel benchmark for others to score highly contested question and answer reliability between both LLMs and disagreeing human practitioners. These results suggest that the optimal deployment of LLMs in professional settings may differ substantially from current approaches that emphasize automation of routine tasks.

We present CRUXEval (Code Reasoning, Understanding, and eXecution Evaluation), a benchmark consisting of 800 Python functions (3-13 lines). Each function comes with an input-output pair, leading to two natural tasks: input prediction and output prediction. First, we propose a generic recipe for generating our execution benchmark which can be used to create future variation of the benchmark. Second, we evaluate twenty code models on our benchmark and discover that many recent high-scoring models on HumanEval do not show the same improvements on our benchmark. Third, we show that simple CoT and fine-tuning schemes can improve performance on our benchmark but remain far from solving it. The best setup, GPT-4 with chain of thought (CoT), achieves a pass@1 of 75% and 81% on input and output prediction, respectively. In contrast, Code Llama 34B achieves a pass@1 of 50% and 46% on input and output prediction, highlighting the gap between open and closed source models. As no model is close to acing CRUXEval, we provide examples of consistent GPT-4 failures on simple programs as a lens into its code reasoning capabilities and areas for improvement.

In the evolving landscape of large language models (LLMs) tailored for software engineering, the need for benchmarks that accurately reflect real-world development scenarios is paramount. Current benchmarks are either too simplistic or fail to capture the multi-tasking nature of software development. To address this, we introduce CoderUJB, a new benchmark designed to evaluate LLMs across diverse Java programming tasks that are executable and reflective of actual development scenarios, acknowledging Java's prevalence in real-world software production. CoderUJB comprises 2,239 programming questions derived from 17 real open-source Java projects and spans five practical programming tasks. Our empirical study on this benchmark investigates the coding abilities of various open-source and closed-source LLMs, examining the effects of continued pre-training in specific programming languages code and instruction fine-tuning on their performance. The findings indicate that while LLMs exhibit strong potential, challenges remain, particularly in non-functional code generation (e.g., test generation and defect detection). Importantly, our results advise caution in the specific programming languages continued pre-training and instruction fine-tuning, as these techniques could hinder model performance on certain tasks, suggesting the need for more nuanced strategies. CoderUJB thus marks a significant step towards more realistic evaluations of programming capabilities in LLMs, and our study provides valuable insights for the future development of these models in software engineering.

As opposed to evaluating computation and logic-based reasoning, current benchmarks for evaluating large language models (LLMs) in medicine are primarily focused on question-answering involving domain knowledge and descriptive reasoning. While such qualitative capabilities are vital to medical diagnosis, in real-world scenarios, doctors frequently use clinical calculators that follow quantitative equations and rule-based reasoning paradigms for evidence-based decision support. To this end, we propose MedCalc-Bench, a first-of-its-kind dataset focused on evaluating the medical calculation capability of LLMs. MedCalc-Bench contains an evaluation set of over 1000 manually reviewed instances from 55 different medical calculation tasks. Each instance in MedCalc-Bench consists of a patient note, a question requesting to compute a specific medical value, a ground truth answer, and a step-by-step explanation showing how the answer is obtained. While our evaluation results show the potential of LLMs in this area, none of them are effective enough for clinical settings. Common issues include extracting the incorrect entities, not using the correct equation or rules for a calculation task, or incorrectly performing the arithmetic for the computation. We hope our study highlights the quantitative knowledge and reasoning gaps in LLMs within medical settings, encouraging future improvements of LLMs for various clinical calculation tasks.

Large Language Models (LLMs) have shown remarkable performance across various tasks, yet significant disparities remain for non-English languages, and especially native African languages. This paper addresses these disparities by creating approximately 1 million human-translated words of new benchmark data in 8 low-resource African languages, covering a population of over 160 million speakers of: Amharic, Bambara, Igbo, Sepedi (Northern Sotho), Shona, Sesotho (Southern Sotho), Setswana, and Tsonga. Our benchmarks are translations of Winogrande and three sections of MMLU: college medicine, clinical knowledge, and virology. Using the translated benchmarks, we report previously unknown performance gaps between state-of-the-art (SOTA) LLMs in English and African languages. Finally, using results from over 400 fine-tuned models, we explore several methods to reduce the LLM performance gap, including high-quality dataset fine-tuning (using an LLM-as-an-Annotator), cross-lingual transfer, and cultural appropriateness adjustments. Key findings include average mono-lingual improvements of 5.6% with fine-tuning (with 5.4% average mono-lingual improvements when using high-quality data over low-quality data), 2.9% average gains from cross-lingual transfer, and a 3.0% out-of-the-box performance boost on culturally appropriate questions. The publicly available benchmarks, translations, and code from this study support further research and development aimed at creating more inclusive and effective language technologies.

Social determinants of health (SDoH) have an important impact on patient outcomes but are incompletely collected from the electronic health records (EHR). This study researched the ability of large language models to extract SDoH from free text in EHRs, where they are most commonly documented, and explored the role of synthetic clinical text for improving the extraction of these scarcely documented, yet extremely valuable, clinical data. 800 patient notes were annotated for SDoH categories, and several transformer-based models were evaluated. The study also experimented with synthetic data generation and assessed for algorithmic bias. Our best-performing models were fine-tuned Flan-T5 XL (macro-F1 0.71) for any SDoH, and Flan-T5 XXL (macro-F1 0.70). The benefit of augmenting fine-tuning with synthetic data varied across model architecture and size, with smaller Flan-T5 models (base and large) showing the greatest improvements in performance (delta F1 +0.12 to +0.23). Model performance was similar on the in-hospital system dataset but worse on the MIMIC-III dataset. Our best-performing fine-tuned models outperformed zero- and few-shot performance of ChatGPT-family models for both tasks. These fine-tuned models were less likely than ChatGPT to change their prediction when race/ethnicity and gender descriptors were added to the text, suggesting less algorithmic bias (p<0.05). At the patient-level, our models identified 93.8% of patients with adverse SDoH, while ICD-10 codes captured 2.0%. Our method can effectively extracted SDoH information from clinic notes, performing better compare to GPT zero- and few-shot settings. These models could enhance real-world evidence on SDoH and aid in identifying patients needing social support.

Code benchmarks such as HumanEval are widely adopted to evaluate the capabilities of Large Language Models (LLMs), providing insights into their strengths and weaknesses. However, current benchmarks primarily exercise LLMs' capability on common coding tasks (e.g., bubble sort, greatest common divisor), leaving domain-specific coding tasks (e.g., computation, system, cryptography) unexplored. To fill this gap, we propose a multi-domain code benchmark, DOMAINEVAL, designed to evaluate LLMs' coding capabilities thoroughly. Our pipeline works in a fully automated manner, enabling a push-bottom construction from code repositories into formatted subjects under study. Interesting findings are observed by evaluating 12 representative LLMs against DOMAINEVAL. We notice that LLMs are generally good at computation tasks while falling short on cryptography and system coding tasks. The performance gap can be as much as 68.94% (80.94% - 12.0%) in some LLMs. We also observe that generating more samples can increase the overall performance of LLMs, while the domain bias may even increase. The contributions of this study include a code generation benchmark dataset DOMAINEVAL, encompassing six popular domains, a fully automated pipeline for constructing code benchmarks, and an identification of the limitations of LLMs in code generation tasks based on their performance on DOMAINEVAL, providing directions for future research improvements. The leaderboard is available at https://domaineval.github.io/.

There is a lack of benchmarks for evaluating large language models (LLMs) in long-form medical question answering (QA). Most existing medical QA evaluation benchmarks focus on automatic metrics and multiple-choice questions. While valuable, these benchmarks fail to fully capture or assess the complexities of real-world clinical applications where LLMs are being deployed. Furthermore, existing studies on evaluating long-form answer generation in medical QA are primarily closed-source, lacking access to human medical expert annotations, which makes it difficult to reproduce results and enhance existing baselines. In this work, we introduce a new publicly available benchmark featuring real-world consumer medical questions with long-form answer evaluations annotated by medical doctors. We performed pairwise comparisons of responses from various open and closed-source medical and general-purpose LLMs based on criteria such as correctness, helpfulness, harmfulness, and bias. Additionally, we performed a comprehensive LLM-as-a-judge analysis to study the alignment between human judgments and LLMs. Our preliminary results highlight the strong potential of open LLMs in medical QA compared to leading closed models. Code & Data: https://github.com/lavita-ai/medical-eval-sphere

Objective: We investigate whether deep learning techniques for natural language processing (NLP) can be used efficiently for patient phenotyping. Patient phenotyping is a classification task for determining whether a patient has a medical condition, and is a crucial part of secondary analysis of healthcare data. We assess the performance of deep learning algorithms and compare them with classical NLP approaches. Materials and Methods: We compare convolutional neural networks (CNNs), n-gram models, and approaches based on cTAKES that extract pre-defined medical concepts from clinical notes and use them to predict patient phenotypes. The performance is tested on 10 different phenotyping tasks using 1,610 discharge summaries extracted from the MIMIC-III database. Results: CNNs outperform other phenotyping algorithms in all 10 tasks. The average F1-score of our model is 76 (PPV of 83, and sensitivity of 71) with our model having an F1-score up to 37 points higher than alternative approaches. We additionally assess the interpretability of our model by presenting a method that extracts the most salient phrases for a particular prediction. Conclusion: We show that NLP methods based on deep learning improve the performance of patient phenotyping. Our CNN-based algorithm automatically learns the phrases associated with each patient phenotype. As such, it reduces the annotation complexity for clinical domain experts, who are normally required to develop task-specific annotation rules and identify relevant phrases. Our method performs well in terms of both performance and interpretability, which indicates that deep learning is an effective approach to patient phenotyping based on clinicians' notes.

Large Language Models (LLMs) are gaining popularity among software engineers. A crucial aspect of developing effective code generation LLMs is to evaluate these models using a robust benchmark. Evaluation benchmarks with quality issues can provide a false sense of performance. In this work, we conduct the first-of-its-kind study of the quality of prompts within benchmarks used to compare the performance of different code generation models. To conduct this study, we analyzed 3,566 prompts from 9 code generation benchmarks to identify quality issues in them. We also investigated whether fixing the identified quality issues in the benchmarks' prompts affects a model's performance. We also studied memorization issues of the evaluation dataset, which can put into question a benchmark's trustworthiness. We found that code generation evaluation benchmarks mainly focused on Python and coding exercises and had very limited contextual dependencies to challenge the model. These datasets and the developers' prompts suffer from quality issues like spelling and grammatical errors, unclear sentences to express developers' intent, and not using proper documentation style. Fixing all these issues in the benchmarks can lead to a better performance for Python code generation, but not a significant improvement was observed for Java code generation. We also found evidence that GPT-3.5-Turbo and CodeGen-2.5 models may have data contamination issues.

Brief hospital course (BHC) summaries are common clinical documents generated by summarizing clinical notes. While large language models (LLMs) depict remarkable capabilities in automating real-world tasks, their capabilities for healthcare applications such as BHC synthesis have not been shown. To enable the adaptation of LLMs for BHC synthesis, we introduce a novel benchmark consisting of a pre-processed dataset extracted from MIMIC-IV notes, encapsulating clinical note, and brief hospital course (BHC) pairs. We assess the performance of two general-purpose LLMs and three healthcare-adapted LLMs to improve BHC synthesis from clinical notes. Using clinical notes as input for generating BHCs, we apply prompting-based (using in-context learning) and fine-tuning-based adaptation strategies to three open-source LLMs (Clinical-T5-Large, Llama2-13B, FLAN-UL2) and two proprietary LLMs (GPT-3.5, GPT-4). We quantitatively evaluate the performance of these LLMs across varying context-length inputs using conventional natural language similarity metrics. We further perform a qualitative study where five diverse clinicians blindly compare clinician-written BHCs and two LLM-generated BHCs for 30 samples across metrics of comprehensiveness, conciseness, factual correctness, and fluency. Overall, we present a new benchmark and pre-processed dataset for using LLMs in BHC synthesis from clinical notes. We observe high-quality summarization performance for both in-context proprietary and fine-tuned open-source LLMs using both quantitative metrics and a qualitative clinical reader study. We propose our work as a benchmark to motivate future works to adapt and assess the performance of LLMs in BHC synthesis.

Code large language models (codeLLMs) have made significant strides in code generation. Most previous code-related benchmarks, which consist of various programming exercises along with the corresponding test cases, are used as a common measure to evaluate the performance and capabilities of code LLMs. However, the current code LLMs focus on synthesizing the correct code snippet, ignoring the alignment with human preferences, where the query should be sampled from the practical application scenarios and the model-generated responses should satisfy the human preference. To bridge the gap between the model-generated response and human preference, we present a rigorous human-curated benchmark CodeArena to emulate the complexity and diversity of real-world coding tasks, where 397 high-quality samples spanning 40 categories and 44 programming languages, carefully curated from user queries. Further, we propose a diverse synthetic instruction corpus SynCode-Instruct (nearly 20B tokens) by scaling instructions from the website to verify the effectiveness of the large-scale synthetic instruction fine-tuning, where Qwen2.5-SynCoder totally trained on synthetic instruction data can achieve top-tier performance of open-source code LLMs. The results find performance differences between execution-based benchmarks and CodeArena. Our systematic experiments of CodeArena on 40+ LLMs reveal a notable performance gap between open SOTA code LLMs (e.g. Qwen2.5-Coder) and proprietary LLMs (e.g., OpenAI o1), underscoring the importance of the human preference alignment.\url{https://codearenaeval.github.io/ }

LLMs have become the go-to choice for code generation tasks, with an exponential increase in the training, development, and usage of LLMs specifically for code generation. To evaluate the ability of LLMs on code, both academic and industry practitioners rely on popular handcrafted benchmarks. However, prior benchmarks contain only a very limited set of problems, both in quantity and variety. Further, due to popularity and age, many benchmarks are prone to data leakage where example solutions can be readily found on the web and thus potentially in training data. Such limitations inevitably lead us to inquire: Is the leaderboard performance on existing benchmarks reliable and comprehensive enough to measure the program synthesis ability of LLMs? To address this, we introduce EvoEval -- a program synthesis benchmark suite created by evolving existing benchmarks into different targeted domains for a comprehensive evaluation of LLM coding abilities. Our study on 51 LLMs shows that compared to the high performance obtained on standard benchmarks like HumanEval, there is a significant drop in performance (on average 39.4%) when using EvoEval. Additionally, the decrease in performance can range from 19.6% to 47.7%, leading to drastic ranking changes amongst LLMs and showing potential overfitting of existing benchmarks. Furthermore, we showcase various insights, including the brittleness of instruction-following models when encountering rewording or subtle changes as well as the importance of learning problem composition and decomposition. EvoEval not only provides comprehensive benchmarks, but can be used to further evolve arbitrary problems to keep up with advances and the ever-changing landscape of LLMs for code. We have open-sourced our benchmarks, tools, and complete LLM generations at https://github.com/evo-eval/evoeval

Estimating the overall user experience (UX) on a device is a common challenge faced by manufacturers. Today, device makers primarily rely on microbenchmark scores, such as Geekbench, that stress test specific hardware components, such as CPU or RAM, but do not satisfactorily capture consumer workloads. System designers often rely on domain-specific heuristics and extensive testing of prototypes to reach a desired UX goal, and yet there is often a mismatch between the manufacturers' performance claims and the consumers' experience. We present our initial results on predicting real-life experience on laptops from their hardware specifications. We target web applications that run on Chromebooks (ChromeOS laptops) for a simple and fair aggregation of experience across applications and workloads. On 54 laptops, we track 9 UX metrics on common end-user workloads: web browsing, video playback and audio/video calls. We focus on a subset of high-level metrics exposed by the Chrome browser, that are part of the Web Vitals initiative for judging the UX on web applications. With a dataset of 100K UX data points, we train gradient boosted regression trees that predict the metric values from device specifications. Across our 9 metrics, we note a mean R^2 score (goodness-of-fit on our dataset) of 97.8% and a mean MAAPE (percentage error in prediction on unseen data) of 10.1%.

Several studies showed that Large Language Models (LLMs) can answer medical questions correctly, even outperforming the average human score in some medical exams. However, to our knowledge, no study has been conducted to assess the ability of language models to validate existing or generated medical text for correctness and consistency. In this paper, we introduce MEDEC (https://github.com/abachaa/MEDEC), the first publicly available benchmark for medical error detection and correction in clinical notes, covering five types of errors (Diagnosis, Management, Treatment, Pharmacotherapy, and Causal Organism). MEDEC consists of 3,848 clinical texts, including 488 clinical notes from three US hospital systems that were not previously seen by any LLM. The dataset has been used for the MEDIQA-CORR shared task to evaluate seventeen participating systems [Ben Abacha et al., 2024]. In this paper, we describe the data creation methods and we evaluate recent LLMs (e.g., o1-preview, GPT-4, Claude 3.5 Sonnet, and Gemini 2.0 Flash) for the tasks of detecting and correcting medical errors requiring both medical knowledge and reasoning capabilities. We also conducted a comparative study where two medical doctors performed the same task on the MEDEC test set. The results showed that MEDEC is a sufficiently challenging benchmark to assess the ability of models to validate existing or generated notes and to correct medical errors. We also found that although recent LLMs have a good performance in error detection and correction, they are still outperformed by medical doctors in these tasks. We discuss the potential factors behind this gap, the insights from our experiments, the limitations of current evaluation metrics, and share potential pointers for future research.

Large language models (LLMs) have demonstrated impressive capabilities in disease diagnosis. However, their effectiveness in identifying rarer diseases, which are inherently more challenging to diagnose, remains an open question. Rare disease performance is critical with the increasing use of LLMs in healthcare settings. This is especially true if a primary care physician needs to make a rarer prognosis from only a patient conversation so that they can take the appropriate next step. To that end, several clinical decision support systems are designed to support providers in rare disease identification. Yet their utility is limited due to their lack of knowledge of common disorders and difficulty of use. In this paper, we propose RareScale to combine the knowledge LLMs with expert systems. We use jointly use an expert system and LLM to simulate rare disease chats. This data is used to train a rare disease candidate predictor model. Candidates from this smaller model are then used as additional inputs to black-box LLM to make the final differential diagnosis. Thus, RareScale allows for a balance between rare and common diagnoses. We present results on over 575 rare diseases, beginning with Abdominal Actinomycosis and ending with Wilson's Disease. Our approach significantly improves the baseline performance of black-box LLMs by over 17% in Top-5 accuracy. We also find that our candidate generation performance is high (e.g. 88.8% on gpt-4o generated chats).

Solving the inverse problem is the key step in evaluating the capacity of a physical model to describe real phenomena. In medical image computing, it aligns with the classical theme of image-based model personalization. Traditionally, a solution to the problem is obtained by performing either sampling or variational inference based methods. Both approaches aim to identify a set of free physical model parameters that results in a simulation best matching an empirical observation. When applied to brain tumor modeling, one of the instances of image-based model personalization in medical image computing, the overarching drawback of the methods is the time complexity for finding such a set. In a clinical setting with limited time between imaging and diagnosis or even intervention, this time complexity may prove critical. As the history of quantitative science is the history of compression, we align in this paper with the historical tendency and propose a method compressing complex traditional strategies for solving an inverse problem into a simple database query task. We evaluated different ways of performing the database query task assessing the trade-off between accuracy and execution time. On the exemplary task of brain tumor growth modeling, we prove that the proposed method achieves one order speed-up compared to existing approaches for solving the inverse problem. The resulting compute time offers critical means for relying on more complex and, hence, realistic models, for integrating image preprocessing and inverse modeling even deeper, or for implementing the current model into a clinical workflow.

In natural language processing applied to the clinical domain, utilizing large language models has emerged as a promising avenue for error detection and correction on clinical notes, a knowledge-intensive task for which annotated data is scarce. This paper presents MedReAct'N'MedReFlex, which leverages a suite of four LLM-based medical agents. The MedReAct agent initiates the process by observing, analyzing, and taking action, generating trajectories to guide the search to target a potential error in the clinical notes. Subsequently, the MedEval agent employs five evaluators to assess the targeted error and the proposed correction. In cases where MedReAct's actions prove insufficient, the MedReFlex agent intervenes, engaging in reflective analysis and proposing alternative strategies. Finally, the MedFinalParser agent formats the final output, preserving the original style while ensuring the integrity of the error correction process. One core component of our method is our RAG pipeline based on our ClinicalCorp corpora. Among other well-known sources containing clinical guidelines and information, we preprocess and release the open-source MedWiki dataset for clinical RAG application. Our results demonstrate the central role of our RAG approach with ClinicalCorp leveraged through the MedReAct'N'MedReFlex framework. It achieved the ninth rank on the MEDIQA-CORR 2024 final leaderboard.

Purpose: In radiology, large language models (LLMs), including ChatGPT, have recently gained attention, and their utility is being rapidly evaluated. However, concerns have emerged regarding their reliability in clinical applications due to limitations such as hallucinations and insufficient referencing. To address these issues, we focus on the latest technology, retrieval-augmented generation (RAG), which enables LLMs to reference reliable external knowledge (REK). Specifically, this study examines the utility and reliability of a recently released RAG-equipped LLM (RAG-LLM), NotebookLM, for staging lung cancer. Materials and methods: We summarized the current lung cancer staging guideline in Japan and provided this as REK to NotebookLM. We then tasked NotebookLM with staging 100 fictional lung cancer cases based on CT findings and evaluated its accuracy. For comparison, we performed the same task using a gold-standard LLM, GPT-4 Omni (GPT-4o), both with and without the REK. Results: NotebookLM achieved 86% diagnostic accuracy in the lung cancer staging experiment, outperforming GPT-4o, which recorded 39% accuracy with the REK and 25% without it. Moreover, NotebookLM demonstrated 95% accuracy in searching reference locations within the REK. Conclusion: NotebookLM successfully performed lung cancer staging by utilizing the REK, demonstrating superior performance compared to GPT-4o. Additionally, it provided highly accurate reference locations within the REK, allowing radiologists to efficiently evaluate the reliability of NotebookLM's responses and detect possible hallucinations. Overall, this study highlights the potential of NotebookLM, a RAG-LLM, in image diagnosis.

Recent advancements in Large Language Models (LLMs) have demonstrated their potential in delivering accurate answers to questions about world knowledge. Despite this, existing benchmarks for evaluating LLMs in healthcare predominantly focus on medical doctors, leaving other critical healthcare professions underrepresented. To fill this research gap, we introduce the Examinations for Medical Personnel in Chinese (EMPEC), a pioneering large-scale healthcare knowledge benchmark in traditional Chinese. EMPEC consists of 157,803 exam questions across 124 subjects and 20 healthcare professions, including underrepresented occupations like Optometrists and Audiologists. Each question is tagged with its release time and source, ensuring relevance and authenticity. We conducted extensive experiments on 17 LLMs, including proprietary, open-source models, general domain models and medical specific models, evaluating their performance under various settings. Our findings reveal that while leading models like GPT-4 achieve over 75\% accuracy, they still struggle with specialized fields and alternative medicine. Surprisingly, general-purpose LLMs outperformed medical-specific models, and incorporating EMPEC's training data significantly enhanced performance. Additionally, the results on questions released after the models' training cutoff date were consistent with overall performance trends, suggesting that the models' performance on the test set can predict their effectiveness in addressing unseen healthcare-related queries. The transition from traditional to simplified Chinese characters had a negligible impact on model performance, indicating robust linguistic versatility. Our study underscores the importance of expanding benchmarks to cover a broader range of healthcare professions to better assess the applicability of LLMs in real-world healthcare scenarios.

We introduce WebApp1K, a practical code-generation benchmark to measure LLM ability to develop web apps. This benchmark aims to calibrate LLM output and aid the models to progressively improve code correctness and functionality. The benchmark is lightweight and easy to run. We present the initial version of WebApp1K, and share our findings of running the benchmark against the latest frontier LLMs. First, open source LLMs deliver impressive performance, closely trailing behind GPT-4o and Claude 3.5. Second, model size has strong correlation with code correctness. Third, no prompting techniques have been found to lift performance either universally to all models, or significantly to a single model.

Recent advancements in large language models (LLMs) have greatly improved code generation, specifically at the function level. For instance, GPT-4 has achieved an 88.4% pass rate on HumanEval. However, this draws into question the adequacy of existing benchmarks in thoroughly assessing function-level code generation capabilities. Our study analyzed two common benchmarks, HumanEval and MBPP, and found that these might not thoroughly evaluate LLMs' code generation capacities due to limitations in quality, difficulty, and granularity. To resolve this, we introduce the Mostly Hard Python Problems (MHPP) dataset, consisting of 140 unique human-curated problems. By focusing on the combination of natural language and code reasoning, MHPP gauges LLMs' abilities to comprehend specifications and restrictions, engage in multi-step reasoning, and apply coding knowledge effectively. Initial evaluations of 22 LLMs using MHPP showed many high-performing models on HumanEval failed to achieve similar success on MHPP. Moreover, MHPP highlighted various previously undiscovered limitations within various LLMs, leading us to believe that it could pave the way for a better understanding of LLMs' capabilities and limitations. Dataset and code are available at https://github.com/SparksofAGI/MHPP.

Large Language Models (LLMs) have shown impressive performance on existing medical question-answering benchmarks. This high performance makes it increasingly difficult to meaningfully evaluate and differentiate advanced methods. We present MedAgentsBench, a benchmark that focuses on challenging medical questions requiring multi-step clinical reasoning, diagnosis formulation, and treatment planning-scenarios where current models still struggle despite their strong performance on standard tests. Drawing from seven established medical datasets, our benchmark addresses three key limitations in existing evaluations: (1) the prevalence of straightforward questions where even base models achieve high performance, (2) inconsistent sampling and evaluation protocols across studies, and (3) lack of systematic analysis of the interplay between performance, cost, and inference time. Through experiments with various base models and reasoning methods, we demonstrate that the latest thinking models, DeepSeek R1 and OpenAI o3, exhibit exceptional performance in complex medical reasoning tasks. Additionally, advanced search-based agent methods offer promising performance-to-cost ratios compared to traditional approaches. Our analysis reveals substantial performance gaps between model families on complex questions and identifies optimal model selections for different computational constraints. Our benchmark and evaluation framework are publicly available at https://github.com/gersteinlab/medagents-benchmark.

Training algorithms, broadly construed, are an essential part of every deep learning pipeline. Training algorithm improvements that speed up training across a wide variety of workloads (e.g., better update rules, tuning protocols, learning rate schedules, or data selection schemes) could save time, save computational resources, and lead to better, more accurate, models. Unfortunately, as a community, we are currently unable to reliably identify training algorithm improvements, or even determine the state-of-the-art training algorithm. In this work, using concrete experiments, we argue that real progress in speeding up training requires new benchmarks that resolve three basic challenges faced by empirical comparisons of training algorithms: (1) how to decide when training is complete and precisely measure training time, (2) how to handle the sensitivity of measurements to exact workload details, and (3) how to fairly compare algorithms that require hyperparameter tuning. In order to address these challenges, we introduce a new, competitive, time-to-result benchmark using multiple workloads running on fixed hardware, the AlgoPerf: Training Algorithms benchmark. Our benchmark includes a set of workload variants that make it possible to detect benchmark submissions that are more robust to workload changes than current widely-used methods. Finally, we evaluate baseline submissions constructed using various optimizers that represent current practice, as well as other optimizers that have recently received attention in the literature. These baseline results collectively demonstrate the feasibility of our benchmark, show that non-trivial gaps between methods exist, and set a provisional state-of-the-art for future benchmark submissions to try and surpass.

Clinical monitoring of metastatic disease to the brain can be a laborious and time-consuming process, especially in cases involving multiple metastases when the assessment is performed manually. The Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) guideline, which utilizes the unidimensional longest diameter, is commonly used in clinical and research settings to evaluate response to therapy in patients with brain metastases. However, accurate volumetric assessment of the lesion and surrounding peri-lesional edema holds significant importance in clinical decision-making and can greatly enhance outcome prediction. The unique challenge in performing segmentations of brain metastases lies in their common occurrence as small lesions. Detection and segmentation of lesions that are smaller than 10 mm in size has not demonstrated high accuracy in prior publications. The brain metastases challenge sets itself apart from previously conducted MICCAI challenges on glioma segmentation due to the significant variability in lesion size. Unlike gliomas, which tend to be larger on presentation scans, brain metastases exhibit a wide range of sizes and tend to include small lesions. We hope that the BraTS-METS dataset and challenge will advance the field of automated brain metastasis detection and segmentation.

In this study, we present a novel dataset for training machine learning models translating between OpenMP Fortran and C++ code. To ensure reliability and applicability, the dataset is created from a range of representative open-source OpenMP benchmarks. It is also refined using a meticulous code similarity test. The effectiveness of our dataset is assessed using both quantitative (CodeBLEU) and qualitative (human evaluation) methods. We showcase how this dataset significantly elevates the translation competencies of large language models (LLMs). Specifically, models without prior coding knowledge experienced a boost of times~5.1 in their CodeBLEU scores, while models with some coding familiarity saw an impressive times~9.9-fold increase. The best fine-tuned model using our dataset outperforms GPT-4. It is also reaching human-level accuracy. This work underscores the immense potential of our dataset in propelling advancements in the domain of code translation for high-performance computing. The dataset is accessible at https://github.com/bin123apple/Fortran-CPP-HPC-code-translation-dataset{OpenMP-Fortran-CPP-Translation}.

Speech patterns have been identified as potential diagnostic markers for neuropsychiatric conditions. However, most studies only compare a single clinical group to healthy controls, whereas clinical practice often requires differentiating between multiple potential diagnoses (multiclass settings). To address this, we assembled a dataset of repeated recordings from 420 participants (67 with major depressive disorder, 106 with schizophrenia and 46 with autism, as well as matched controls), and tested the performance of a range of conventional machine learning models and advanced Transformer models on both binary and multiclass classification, based on voice and text features. While binary models performed comparably to previous research (F1 scores between 0.54-0.75 for autism spectrum disorder, ASD; 0.67-0.92 for major depressive disorder, MDD; and 0.71-0.83 for schizophrenia); when differentiating between multiple diagnostic groups performance decreased markedly (F1 scores between 0.35-0.44 for ASD, 0.57-0.75 for MDD, 0.15-0.66 for schizophrenia, and 0.38-0.52 macro F1). Combining voice and text-based models yielded increased performance, suggesting that they capture complementary diagnostic information. Our results indicate that models trained on binary classification may learn to rely on markers of generic differences between clinical and non-clinical populations, or markers of clinical features that overlap across conditions, rather than identifying markers specific to individual conditions. We provide recommendations for future research in the field, suggesting increased focus on developing larger transdiagnostic datasets that include more fine-grained clinical features, and that can support the development of models that better capture the complexity of neuropsychiatric conditions and naturalistic diagnostic assessment.

Large Language Models (LLMs) have demonstrated remarkable performance on coding related tasks, particularly on assisting humans in programming and facilitating programming automation. However, existing benchmarks for evaluating the code understanding and generation capacities of LLMs suffer from severe limitations. First, most benchmarks are deficient as they focus on a narrow range of popular programming languages and specific tasks, whereas the real-world software development scenarios show dire need to implement systems with multilingual programming environments to satisfy diverse requirements. Practical programming practices also strongly expect multi-task settings for testing coding capabilities of LLMs comprehensively and robustly. Second, most benchmarks also fail to consider the actual executability and the consistency of execution results of the generated code. To bridge these gaps between existing benchmarks and expectations from practical applications, we introduce CodeScope, an execution-based, multilingual, multi-task, multi-dimensional evaluation benchmark for comprehensively gauging LLM capabilities on coding tasks. CodeScope covers 43 programming languages and 8 coding tasks. It evaluates the coding performance of LLMs from three dimensions (perspectives): difficulty, efficiency, and length. To facilitate execution-based evaluations of code generation, we develop MultiCodeEngine, an automated code execution engine that supports 14 programming languages. Finally, we systematically evaluate and analyze 8 mainstream LLMs on CodeScope tasks and demonstrate the superior breadth and challenges of CodeScope for evaluating LLMs on code understanding and generation tasks compared to other benchmarks. The CodeScope benchmark and datasets are publicly available at https://github.com/WeixiangYAN/CodeScope.

Healthcare monitoring is crucial for early detection, timely intervention, and the ongoing management of health conditions, ultimately improving individuals' quality of life. Recent research shows that Large Language Models (LLMs) have demonstrated impressive performance in supporting healthcare tasks. However, existing LLM-based healthcare solutions typically rely on cloud-based systems, which raise privacy concerns and increase the risk of personal information leakage. As a result, there is growing interest in running these models locally on devices like mobile phones and wearables to protect users' privacy. Small Language Models (SLMs) are potential candidates to solve privacy and computational issues, as they are more efficient and better suited for local deployment. However, the performance of SLMs in healthcare domains has not yet been investigated. This paper examines the capability of SLMs to accurately analyze health data, such as steps, calories, sleep minutes, and other vital statistics, to assess an individual's health status. Our results show that, TinyLlama, which has 1.1 billion parameters, utilizes 4.31 GB memory, and has 0.48s latency, showing the best performance compared other four state-of-the-art (SOTA) SLMs on various healthcare applications. Our results indicate that SLMs could potentially be deployed on wearable or mobile devices for real-time health monitoring, providing a practical solution for efficient and privacy-preserving healthcare.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare ten public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting and supervised fine-tuning regimes for medical question-answering (QA). For instance, across all tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 22.7% of cases, reach a (statistical) tie in 36.8% of cases, and are significantly worse than their base models in the remaining 40.5% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately in zero-/few-shot prompting; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Meanwhile, we find that after fine-tuning on specific QA tasks, medical LLMs can show performance improvements, but the benefits do not carry over to tasks based on clinical notes. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

In this study, we present MedS-Bench, a comprehensive benchmark designed to evaluate the performance of large language models (LLMs) in clinical contexts. Unlike existing benchmarks that focus on multiple-choice question answering, MedS-Bench spans 11 high-level clinical tasks, including clinical report summarization, treatment recommendations, diagnosis, named entity recognition, and medical concept explanation, among others. We evaluated six leading LLMs, e.g., MEDITRON, Mistral, InternLM 2, Llama 3, GPT-4, and Claude-3.5 using few-shot prompting, and found that even the most sophisticated models struggle with these complex tasks. To address these limitations, we developed MedS-Ins, a large-scale instruction tuning dataset for medicine. MedS-Ins comprises 58 medically oriented language corpora, totaling 13.5 million samples across 122 tasks. To demonstrate the dataset's utility, we conducted a proof-of-concept experiment by performing instruction tuning on a lightweight, open-source medical language model. The resulting model, MMedIns-Llama 3, significantly outperformed existing models across nearly all clinical tasks. To promote further advancements in the application of LLMs to clinical challenges, we have made the MedS-Ins dataset fully accessible and invite the research community to contribute to its expansion.Additionally, we have launched a dynamic leaderboard for MedS-Bench, which we plan to regularly update the test set to track progress and enhance the adaptation of general LLMs to the medical domain. Leaderboard: https://henrychur.github.io/MedS-Bench/. Github: https://github.com/MAGIC-AI4Med/MedS-Ins.

Program synthesis has been long studied with recent approaches focused on directly using the power of Large Language Models (LLMs) to generate code. Programming benchmarks, with curated synthesis problems and test-cases, are used to measure the performance of various LLMs on code synthesis. However, these test-cases can be limited in both quantity and quality for fully assessing the functional correctness of the generated code. Such limitation in the existing benchmarks begs the following question: In the era of LLMs, is the code generated really correct? To answer this, we propose EvalPlus -- a code synthesis evaluation framework to rigorously benchmark the functional correctness of LLM-synthesized code. EvalPlus augments a given evaluation dataset with large amounts of test-cases newly produced by an automatic test input generator, powered by both LLM- and mutation-based strategies. While EvalPlus is general, we extend the test-cases of the popular HumanEval benchmark by 80x to build HumanEval+. Our extensive evaluation across 26 popular LLMs (e.g., GPT-4 and ChatGPT) demonstrates that HumanEval+ is able to catch significant amounts of previously undetected wrong code synthesized by LLMs, reducing the pass@k by up-to 19.3-28.9%. We also surprisingly found that test insufficiency can lead to mis-ranking. For example, both WizardCoder-CodeLlama and Phind-CodeLlama now outperform ChatGPT on HumanEval+, while none of them could on HumanEval. Our work not only indicates that prior popular code synthesis evaluation results do not accurately reflect the true performance of LLMs for code synthesis, but also opens up a new direction to improve such programming benchmarks through automated testing. We have open-sourced our tools, enhanced datasets as well as all LLM-generated code at https://github.com/evalplus/evalplus to facilitate and accelerate future LLM-for-code research.

Accelerating MRI scans is one of the principal outstanding problems in the MRI research community. Towards this goal, we hosted the second fastMRI competition targeted towards reconstructing MR images with subsampled k-space data. We provided participants with data from 7,299 clinical brain scans (de-identified via a HIPAA-compliant procedure by NYU Langone Health), holding back the fully-sampled data from 894 of these scans for challenge evaluation purposes. In contrast to the 2019 challenge, we focused our radiologist evaluations on pathological assessment in brain images. We also debuted a new Transfer track that required participants to submit models evaluated on MRI scanners from outside the training set. We received 19 submissions from eight different groups. Results showed one team scoring best in both SSIM scores and qualitative radiologist evaluations. We also performed analysis on alternative metrics to mitigate the effects of background noise and collected feedback from the participants to inform future challenges. Lastly, we identify common failure modes across the submissions, highlighting areas of need for future research in the MRI reconstruction community.

To generate evidence regarding the safety and efficacy of artificial intelligence (AI) enabled medical devices, AI models need to be evaluated on a diverse population of patient cases, some of which may not be readily available. We propose an evaluation approach for testing medical imaging AI models that relies on in silico imaging pipelines in which stochastic digital models of human anatomy (in object space) with and without pathology are imaged using a digital replica imaging acquisition system to generate realistic synthetic image datasets. Here, we release M-SYNTH, a dataset of cohorts with four breast fibroglandular density distributions imaged at different exposure levels using Monte Carlo x-ray simulations with the publicly available Virtual Imaging Clinical Trial for Regulatory Evaluation (VICTRE) toolkit. We utilize the synthetic dataset to analyze AI model performance and find that model performance decreases with increasing breast density and increases with higher mass density, as expected. As exposure levels decrease, AI model performance drops with the highest performance achieved at exposure levels lower than the nominal recommended dose for the breast type.

Recent advances in generative models, including large language models (LLMs), vision language models (VLMs), and diffusion models, have accelerated the field of natural language and image processing in medicine and marked a significant paradigm shift in how biomedical models can be developed and deployed. While these models are highly adaptable to new tasks, scaling and evaluating their usage presents new challenges not addressed in previous frameworks. In particular, the ability of these models to produce useful outputs with little to no specialized training data ("zero-" or "few-shot" approaches), as well as the open-ended nature of their outputs, necessitate the development of new guidelines for robust reporting of clinical generative model research. In response to gaps in standards and best practices for the development of clinical AI tools identified by US Executive Order 141103 and several emerging national networks for clinical AI evaluation, we begin to formalize some of these guidelines by building on the original MI-CLAIM checklist. The new checklist, MI-CLAIM-GEN (Table 1), aims to address differences in training, evaluation, interpretability, and reproducibility of new generative models compared to non-generative ("predictive") AI models. This MI-CLAIM-GEN checklist also seeks to clarify cohort selection reporting with unstructured clinical data and adds additional items on alignment with ethical standards for clinical AI research.

Large language models (LLMs) have manifested strong ability to generate codes for productive activities. However, current benchmarks for code synthesis, such as HumanEval, MBPP, and DS-1000, are predominantly oriented towards introductory tasks on algorithm and data science, insufficiently satisfying challenging requirements prevalent in real-world coding. To fill this gap, we propose NaturalCodeBench (NCB), a challenging code benchmark designed to mirror the complexity and variety of scenarios in real coding tasks. NCB comprises 402 high-quality problems in Python and Java, meticulously selected from natural user queries from online coding services, covering 6 different domains. Noting the extraordinary difficulty in creating testing cases for real-world queries, we also introduce a semi-automated pipeline to enhance the efficiency of test case construction. Comparing with manual solutions, it achieves an efficiency increase of more than 4 times. Our systematic experiments on 39 LLMs find that performance gaps on NCB between models with close HumanEval scores could still be significant, indicating a lack of focus on practical code synthesis scenarios or over-specified optimization on HumanEval. On the other hand, even the best-performing GPT-4 is still far from satisfying on NCB. The evaluation toolkit and development set are available at https://github.com/THUDM/NaturalCodeBench.

Large Language Models (LLMs) are consistently improving at increasingly realistic software engineering (SE) tasks. In real-world software stacks, significant SE effort is spent developing foundational system software like the Linux kernel. Unlike application-level software, a systems codebase like Linux is multilingual (low-level C/Assembly/Bash/Rust); gigantic (>20 million lines); critical (impacting billions of devices worldwide), and highly concurrent (involving complex multi-threading). To evaluate if ML models are useful while developing such large-scale systems-level software, we introduce kGym (a platform) and kBench (a dataset). The kGym platform provides a SE environment for large-scale experiments on the Linux kernel, including compiling and running kernels in parallel across several virtual machines, detecting operations and crashes, inspecting logs, and querying and patching the code base. We use kGym to facilitate evaluation on kBench, a crash resolution benchmark drawn from real-world Linux kernel bugs. An example bug in kBench contains crashing stack traces, a bug-reproducer file, a developer-written fix, and other associated data. To understand current performance, we conduct baseline experiments by prompting LLMs to resolve Linux kernel crashes. Our initial evaluations reveal that the best performing LLM achieves 0.72% and 5.38% in the unassisted and assisted (i.e., buggy files disclosed to the model) settings, respectively. These results highlight the need for further research to enhance model performance in SE tasks. Improving performance on kBench requires models to master new learning skills, including understanding the cause of crashes and repairing faults, writing memory-safe and hardware-aware code, and understanding concurrency. As a result, this work opens up multiple avenues of research at the intersection of machine learning and systems software.

In this study, we investigated the ability of the large language model (LLM) to enhance healthcare data interoperability. We leveraged the LLM to convert clinical texts into their corresponding FHIR resources. Our experiments, conducted on 3,671 snippets of clinical text, demonstrated that the LLM not only streamlines the multi-step natural language processing and human calibration processes but also achieves an exceptional accuracy rate of over 90% in exact matches when compared to human annotations.

The rapid progress in Large Language Models (LLMs) has prompted the creation of numerous benchmarks to evaluate their capabilities.This study focuses on the Comprehensive Medical Benchmark in Chinese (CMB), showcasing how dataset diversity and distribution in supervised fine-tuning (SFT) may enhance LLM performance.Remarkably, We successfully trained a smaller base model to achieve scores comparable to larger models, indicating that a diverse and well-distributed dataset can optimize performance regardless of model size.This study suggests that even smaller models may reach high performance levels with carefully curated and varied datasets.By integrating a wide range of instructional content, our approach addresses potential issues such as data quality inconsistencies. Our results imply that a broader spectrum of training data may enhance a model's ability to generalize and perform effectively across different medical scenarios, highlighting the importance of dataset quality and diversity in fine-tuning processes.

We present the findings of "The Alzheimer's Disease Prediction Of Longitudinal Evolution" (TADPOLE) Challenge, which compared the performance of 92 algorithms from 33 international teams at predicting the future trajectory of 219 individuals at risk of Alzheimer's disease. Challenge participants were required to make a prediction, for each month of a 5-year future time period, of three key outcomes: clinical diagnosis, Alzheimer's Disease Assessment Scale Cognitive Subdomain (ADAS-Cog13), and total volume of the ventricles. The methods used by challenge participants included multivariate linear regression, machine learning methods such as support vector machines and deep neural networks, as well as disease progression models. No single submission was best at predicting all three outcomes. For clinical diagnosis and ventricle volume prediction, the best algorithms strongly outperform simple baselines in predictive ability. However, for ADAS-Cog13 no single submitted prediction method was significantly better than random guesswork. Two ensemble methods based on taking the mean and median over all predictions, obtained top scores on almost all tasks. Better than average performance at diagnosis prediction was generally associated with the additional inclusion of features from cerebrospinal fluid (CSF) samples and diffusion tensor imaging (DTI). On the other hand, better performance at ventricle volume prediction was associated with inclusion of summary statistics, such as the slope or maxima/minima of biomarkers. TADPOLE's unique results suggest that current prediction algorithms provide sufficient accuracy to exploit biomarkers related to clinical diagnosis and ventricle volume, for cohort refinement in clinical trials for Alzheimer's disease. However, results call into question the usage of cognitive test scores for patient selection and as a primary endpoint in clinical trials.

Dynamic Algorithm Configuration (DAC) aims to dynamically control a target algorithm's hyperparameters in order to improve its performance. Several theoretical and empirical results have demonstrated the benefits of dynamically controlling hyperparameters in domains like evolutionary computation, AI Planning or deep learning. Replicating these results, as well as studying new methods for DAC, however, is difficult since existing benchmarks are often specialized and incompatible with the same interfaces. To facilitate benchmarking and thus research on DAC, we propose DACBench, a benchmark library that seeks to collect and standardize existing DAC benchmarks from different AI domains, as well as provide a template for new ones. For the design of DACBench, we focused on important desiderata, such as (i) flexibility, (ii) reproducibility, (iii) extensibility and (iv) automatic documentation and visualization. To show the potential, broad applicability and challenges of DAC, we explore how a set of six initial benchmarks compare in several dimensions of difficulty.

Clinicians spend a significant amount of time reviewing medical images and transcribing their findings regarding patient diagnosis, referral and treatment in text form. Vision-language models (VLMs), which automatically interpret images and summarize their findings as text, have enormous potential to alleviate clinical workloads and increase patient access to high-quality medical care. While foundational models have stirred considerable interest in the medical community, it is unclear whether their general capabilities translate to real-world clinical utility. In this work, we show that foundation VLMs markedly underperform compared to practicing ophthalmologists on specialist tasks crucial to the care of patients with age-related macular degeneration (AMD). To address this, we initially identified the essential capabilities required for image-based clinical decision-making, and then developed a curriculum to selectively train VLMs in these skills. The resulting model, RetinaVLM, can be instructed to write reports that significantly outperform those written by leading foundation medical VLMs in disease staging (F1 score of 0.63 vs. 0.11) and patient referral (0.67 vs. 0.39), and approaches the diagnostic performance of junior ophthalmologists (who achieve 0.77 and 0.78 on the respective tasks). Furthermore, in a reader study involving two senior ophthalmologists with up to 32 years of experience, RetinaVLM's reports were found to be similarly correct (78.6% vs. 82.1%) and complete (both 78.6%) as reports written by junior ophthalmologists with up to 10 years of experience. These results demonstrate that our curriculum-based approach provides a blueprint for specializing generalist foundation medical VLMs to handle real-world clinical tasks.

The ability of large language models (LLMs) to follow natural language instructions with human-level fluency suggests many opportunities in healthcare to reduce administrative burden and improve quality of care. However, evaluating LLMs on realistic text generation tasks for healthcare remains challenging. Existing question answering datasets for electronic health record (EHR) data fail to capture the complexity of information needs and documentation burdens experienced by clinicians. To address these challenges, we introduce MedAlign, a benchmark dataset of 983 natural language instructions for EHR data. MedAlign is curated by 15 clinicians (7 specialities), includes clinician-written reference responses for 303 instructions, and provides 276 longitudinal EHRs for grounding instruction-response pairs. We used MedAlign to evaluate 6 general domain LLMs, having clinicians rank the accuracy and quality of each LLM response. We found high error rates, ranging from 35% (GPT-4) to 68% (MPT-7B-Instruct), and an 8.3% drop in accuracy moving from 32k to 2k context lengths for GPT-4. Finally, we report correlations between clinician rankings and automated natural language generation metrics as a way to rank LLMs without human review. We make MedAlign available under a research data use agreement to enable LLM evaluations on tasks aligned with clinician needs and preferences.

Large language models (LLMs) have exhibited remarkable capabilities across various domains and tasks, pushing the boundaries of our knowledge in learning and cognition. The latest model, OpenAI's o1, stands out as the first LLM with an internalized chain-of-thought technique using reinforcement learning strategies. While it has demonstrated surprisingly strong capabilities on various general language tasks, its performance in specialized fields such as medicine remains unknown. To this end, this report provides a comprehensive exploration of o1 on different medical scenarios, examining 3 key aspects: understanding, reasoning, and multilinguality. Specifically, our evaluation encompasses 6 tasks using data from 37 medical datasets, including two newly constructed and more challenging question-answering (QA) tasks based on professional medical quizzes from the New England Journal of Medicine (NEJM) and The Lancet. These datasets offer greater clinical relevance compared to standard medical QA benchmarks such as MedQA, translating more effectively into real-world clinical utility. Our analysis of o1 suggests that the enhanced reasoning ability of LLMs may (significantly) benefit their capability to understand various medical instructions and reason through complex clinical scenarios. Notably, o1 surpasses the previous GPT-4 in accuracy by an average of 6.2% and 6.6% across 19 datasets and two newly created complex QA scenarios. But meanwhile, we identify several weaknesses in both the model capability and the existing evaluation protocols, including hallucination, inconsistent multilingual ability, and discrepant metrics for evaluation. We release our raw data and model outputs at https://ucsc-vlaa.github.io/o1_medicine/ for future research.

Diagnosing and managing a patient is a complex, sequential decision making process that requires physicians to obtain information -- such as which tests to perform -- and to act upon it. Recent advances in artificial intelligence (AI) and large language models (LLMs) promise to profoundly impact clinical care. However, current evaluation schemes overrely on static medical question-answering benchmarks, falling short on interactive decision-making that is required in real-life clinical work. Here, we present AgentClinic: a multimodal benchmark to evaluate LLMs in their ability to operate as agents in simulated clinical environments. In our benchmark, the doctor agent must uncover the patient's diagnosis through dialogue and active data collection. We present two open medical agent benchmarks: a multimodal image and dialogue environment, AgentClinic-NEJM, and a dialogue-only environment, AgentClinic-MedQA. We embed cognitive and implicit biases both in patient and doctor agents to emulate realistic interactions between biased agents. We find that introducing bias leads to large reductions in diagnostic accuracy of the doctor agents, as well as reduced compliance, confidence, and follow-up consultation willingness in patient agents. Evaluating a suite of state-of-the-art LLMs, we find that several models that excel in benchmarks like MedQA are performing poorly in AgentClinic-MedQA. We find that the LLM used in the patient agent is an important factor for performance in the AgentClinic benchmark. We show that both having limited interactions as well as too many interaction reduces diagnostic accuracy in doctor agents. The code and data for this work is publicly available at https://AgentClinic.github.io.

The rapid proliferation of Large Language Models (LLMs) has been a driving force in the growth of cloud-based LLM services, which are now integral to advancing AI applications. However, the dynamic auto-regressive nature of LLM service, along with the need to support exceptionally long context lengths, demands the flexible allocation and release of substantial resources. This presents considerable challenges in designing cloud-based LLM service systems, where inefficient management can lead to performance degradation or resource wastage. In response to these challenges, this work introduces DistAttention, a novel distributed attention algorithm that segments the KV Cache into smaller, manageable units, enabling distributed processing and storage of the attention module. Based on that, we propose DistKV-LLM, a distributed LLM serving system that dynamically manages KV Cache and effectively orchestrates all accessible GPU and CPU memories spanning across the data center. This ensures a high-performance LLM service on the cloud, adaptable to a broad range of context lengths. Validated in a cloud environment with 32 NVIDIA A100 GPUs in configurations from 2 to 32 instances, our system exhibited 1.03-2.4x end-to-end throughput improvements and supported context lengths 2-19x longer than current state-of-the-art LLM service systems, as evidenced by extensive testing across 18 datasets with context lengths up to 1,900K.

Objective: To determine if a realistic, but computationally efficient model of the electrocardiogram can be used to pre-train a deep neural network (DNN) with a wide range of morphologies and abnormalities specific to a given condition - T-wave Alternans (TWA) as a result of Post-Traumatic Stress Disorder, or PTSD - and significantly boost performance on a small database of rare individuals. Approach: Using a previously validated artificial ECG model, we generated 180,000 artificial ECGs with or without significant TWA, with varying heart rate, breathing rate, TWA amplitude, and ECG morphology. A DNN, trained on over 70,000 patients to classify 25 different rhythms, was modified the output layer to a binary class (TWA or no-TWA, or equivalently, PTSD or no-PTSD), and transfer learning was performed on the artificial ECG. In a final transfer learning step, the DNN was trained and cross-validated on ECG from 12 PTSD and 24 controls for all combinations of using the three databases. Main results: The best performing approach (AUROC = 0.77, Accuracy = 0.72, F1-score = 0.64) was found by performing both transfer learning steps, using the pre-trained arrhythmia DNN, the artificial data and the real PTSD-related ECG data. Removing the artificial data from training led to the largest drop in performance. Removing the arrhythmia data from training provided a modest, but significant, drop in performance. The final model showed no significant drop in performance on the artificial data, indicating no overfitting. Significance: In healthcare, it is common to only have a small collection of high-quality data and labels, or a larger database with much lower quality (and less relevant) labels. The paradigm presented here, involving model-based performance boosting, provides a solution through transfer learning on a large realistic artificial database, and a partially relevant real database.

This paper presents our approach to accelerate computer architecture simulation by leveraging machine learning techniques. Traditional computer architecture simulations are time-consuming, making it challenging to explore different design choices efficiently. Our proposed model utilizes a combination of application features and micro-architectural features to predict the performance of an application. These features are derived from simulations of a small portion of the application. We demonstrate the effectiveness of our approach by building and evaluating a machine learning model that offers significant speedup in architectural exploration. This model demonstrates the ability to predict IPC values for the testing data with a root mean square error of less than 0.1.

We introduce the Formally Verified Automated Programming Progress Standards, or FVAPPS, a benchmark of 4715 samples for writing programs and proving their correctness, the largest formal verification benchmark, including 1083 curated and quality controlled samples. Previously, APPS provided a benchmark and dataset for programming puzzles to be completed in Python and checked against unit tests, of the kind seen in technical assessments in the software engineering industry. Building upon recent approaches for benchmarks in interactive theorem proving, we generalize the unit tests to Lean 4 theorems given without proof (i.e., using Lean's "sorry" keyword). On the 406 theorems of 100 randomly selected samples, Sonnet correctly proves 30% and Gemini correctly proves 18%. We challenge the machine learning and program synthesis communities to solve both each general purpose programming problem and its associated correctness specifications. The benchmark is available at https://huggingface.co/datasets/quinn-dougherty/fvapps.

Large Language Models (LLMs) have shown remarkable performance across various tasks, but the escalating demands on computational resources pose significant challenges, particularly in the extensive utilization of full fine-tuning for downstream tasks. To address this, parameter-efficient fine-tuning (PEFT) methods have been developed, but they often underperform compared to full fine-tuning and struggle with memory efficiency. In this work, we introduce Gradient Weight-Normalized Low-Rank Projection (GradNormLoRP), a novel approach that enhances both parameter and memory efficiency while maintaining comparable performance to full fine-tuning. GradNormLoRP normalizes the weight matrix to improve gradient conditioning, facilitating better convergence during optimization. Additionally, it applies low-rank approximations to the weight and gradient matrices, significantly reducing memory usage during training. Extensive experiments demonstrate that our 8-bit GradNormLoRP reduces optimizer memory usage by up to 89.5% and enables the pre-training of large LLMs, such as LLaMA 7B, on consumer-level GPUs like the NVIDIA RTX 4090, without additional inference costs. Moreover, GradNormLoRP outperforms existing low-rank methods in fine-tuning tasks. For instance, when fine-tuning the RoBERTa model on all GLUE tasks with a rank of 8, GradNormLoRP achieves an average score of 80.65, surpassing LoRA's score of 79.23. These results underscore GradNormLoRP as a promising alternative for efficient LLM pre-training and fine-tuning. Source code: https://github.com/Jhhuangkay/Gradient-Weight-normalized-Low-rank-Projection-for-Efficient-LLM-Training

It is a common belief that large language models (LLMs) are better than smaller-sized ones. However, larger models also require significantly more time and compute during inference. This begs the question: what happens when both models operate under the same budget? (e.g., compute, run-time). To address this question, we analyze code generation LLMs of various sizes and make comparisons such as running a 70B model once vs. generating five outputs from a 13B model. We consider a standard unit-test setup, which can be used to select the correct output from the smaller model. Our findings reveal that the repeated use of smaller models can yield consistent improvements, with gains of up to 15% across five tasks. On the other hand, in scenarios where unit-tests are unavailable, a ranking-based selection of candidates from the smaller model falls short of the performance of a single output from larger ones. Our results highlight the potential of using smaller models instead of larger ones, and the importance of studying approaches for ranking LLM outputs.

Med42-v2 introduces a suite of clinical large language models (LLMs) designed to address the limitations of generic models in healthcare settings. These models are built on Llama3 architecture and fine-tuned using specialized clinical data. They underwent multi-stage preference alignment to effectively respond to natural prompts. While generic models are often preference-aligned to avoid answering clinical queries as a precaution, Med42-v2 is specifically trained to overcome this limitation, enabling its use in clinical settings. Med42-v2 models demonstrate superior performance compared to the original Llama3 models in both 8B and 70B parameter configurations and GPT-4 across various medical benchmarks. These LLMs are developed to understand clinical queries, perform reasoning tasks, and provide valuable assistance in clinical environments. The models are now publicly available at https://huggingface.co/m42-health{https://huggingface.co/m42-health}.

While the general machine learning (ML) community has benefited from public datasets, tasks, and models, the progress of ML in healthcare has been hampered by a lack of such shared assets. The success of foundation models creates new challenges for healthcare ML by requiring access to shared pretrained models to validate performance benefits. We help address these challenges through three contributions. First, we publish a new dataset, EHRSHOT, which contains deidentified structured data from the electronic health records (EHRs) of 6,739 patients from Stanford Medicine. Unlike MIMIC-III/IV and other popular EHR datasets, EHRSHOT is longitudinal and not restricted to ICU/ED patients. Second, we publish the weights of CLMBR-T-base, a 141M parameter clinical foundation model pretrained on the structured EHR data of 2.57M patients. We are one of the first to fully release such a model for coded EHR data; in contrast, most prior models released for clinical data (e.g. GatorTron, ClinicalBERT) only work with unstructured text and cannot process the rich, structured data within an EHR. We provide an end-to-end pipeline for the community to validate and build upon its performance. Third, we define 15 few-shot clinical prediction tasks, enabling evaluation of foundation models on benefits such as sample efficiency and task adaptation. Our model and dataset are available via a research data use agreement from the Stanford AIMI Center. Code to reproduce our results are available at our Github repo: https://github.com/som-shahlab/ehrshot-benchmark

We introduce Differential Performance Evaluation (DPE), a framework designed to reliably evaluate Large Language Models (LLMs) for efficient code generation. Traditional coding benchmarks often fail to provide reliable insights into code efficiency, due to their reliance on simplistic test inputs and the absence of effective compound metrics. DPE addresses these issues by focusing on efficiency-demanding programming tasks and establishing an insightful compound metric for performance evaluation. DPE operates in two phases: To curate efficiency datasets, it selects efficiency-demanding tasks from existing coding benchmarks and generates computationally expensive inputs to stress the efficiency of LLM solutions. To assess the code efficiency, DPE profiles the new solution and compares it globally against a set of reference solutions that exhibit distinct efficiency levels, where the matched level defines its efficiency score. As a proof of concept, we use DPE to create EvalPerf, a benchmark with 121 performance-challenging coding tasks. Our comprehensive evaluation draws interesting findings on the efficiency impact of model sizes, instruction tuning, and prompting. For example, while the scaling law fails to account for code efficiency, general instruction tuning benefits both code correctness and efficiency. We also evaluate the evaluation by examining the effectiveness of DPE, showing that EvalPerf is reliable and convenient to use even across platforms.

The availability of large public datasets and the increased amount of computing power have shifted the interest of the medical community to high-performance algorithms. However, little attention is paid to the quality of the data and their annotations. High performance on benchmark datasets may be reported without considering possible shortcuts or artifacts in the data, besides, models are not tested on subpopulation groups. With this work, we aim to raise awareness about shortcuts problems. We validate previous findings, and present a case study on chest X-rays using two publicly available datasets. We share annotations for a subset of pneumothorax images with drains. We conclude with general recommendations for medical image classification.

Tumor documentation in Germany is largely done manually, requiring reading patient records and entering data into structured databases. Large language models (LLMs) could potentially enhance this process by improving efficiency and reliability. This evaluation tests eleven different open source LLMs with sizes ranging from 1-70 billion model parameters on three basic tasks of the tumor documentation process: identifying tumor diagnoses, assigning ICD-10 codes, and extracting the date of first diagnosis. For evaluating the LLMs on these tasks, a dataset of annotated text snippets based on anonymized doctors' notes from urology was prepared. Different prompting strategies were used to investigate the effect of the number of examples in few-shot prompting and to explore the capabilities of the LLMs in general. The models Llama 3.1 8B, Mistral 7B, and Mistral NeMo 12 B performed comparably well in the tasks. Models with less extensive training data or having fewer than 7 billion parameters showed notably lower performance, while larger models did not display performance gains. Examples from a different medical domain than urology could also improve the outcome in few-shot prompting, which demonstrates the ability of LLMs to handle tasks needed for tumor documentation. Open source LLMs show a strong potential for automating tumor documentation. Models from 7-12 billion parameters could offer an optimal balance between performance and resource efficiency. With tailored fine-tuning and well-designed prompting, these models might become important tools for clinical documentation in the future. The code for the evaluation is available from https://github.com/stefan-m-lenz/UroLlmEval. We also release the dataset as a new valuable resource that addresses the shortage of authentic and easily accessible benchmarks in German-language medical NLP.

Purpose: Recent advancements in large language models (LLMs) have expanded their capabilities in a multimodal fashion, potentially replicating the image interpretation of human radiologists. This study aimed to develop open-source multimodal large language model for interpreting chest X-ray images (CXR-LLaVA). We also examined the effect of prompt engineering and model parameters such as temperature and nucleus sampling. Materials and Methods: For training, we collected 659,287 publicly available CXRs: 417,336 CXRs had labels for certain radiographic abnormalities (dataset 1); 241,951 CXRs provided free-text radiology reports (dataset 2). After pre-training the Resnet50 as an image encoder, the contrastive language-image pre-training was used to align CXRs and corresponding radiographic abnormalities. Then, the Large Language Model Meta AI-2 was fine-tuned using dataset 2, which were refined using GPT-4, with generating various question answering scenarios. The code can be found at https://github.com/ECOFRI/CXR_LLaVA. Results: In the test set, we observed that the model's performance fluctuated based on its parameters. On average, it achieved F1 score of 0.34 for five pathologic findings (atelectasis, cardiomegaly, consolidation, edema, and pleural effusion), which was improved to 0.46 through prompt engineering. In the independent set, the model achieved an average F1 score of 0.30 for the same pathologic findings. Notably, for the pediatric chest radiograph dataset, which was unseen during training, the model differentiated abnormal radiographs with an F1 score ranging from 0.84 to 0.85. Conclusion: CXR-LLaVA demonstrates promising potential in CXR interpretation. Both prompt engineering and model parameter adjustments can play pivotal roles in interpreting CXRs.

In the field of medical sciences, reliable detection and classification of brain tumors from images remains a formidable challenge due to the rarity of tumors within the population of patients. Therefore, the ability to detect tumors in anomaly scenarios is paramount for ensuring timely interventions and improved patient outcomes. This study addresses the issue by leveraging deep learning (DL) techniques to detect and classify brain tumors in challenging situations. The curated data set from the National Brain Mapping Lab (NBML) comprises 81 patients, including 30 Tumor cases and 51 Normal cases. The detection and classification pipelines are separated into two consecutive tasks. The detection phase involved comprehensive data analysis and pre-processing to modify the number of image samples and the number of patients of each class to anomaly distribution (9 Normal per 1 Tumor) to comply with real world scenarios. Next, in addition to common evaluation metrics for the testing, we employed a novel performance evaluation method called Patient to Patient (PTP), focusing on the realistic evaluation of the model. In the detection phase, we fine-tuned a YOLOv8n detection model to detect the tumor region. Subsequent testing and evaluation yielded competitive performance both in Common Evaluation Metrics and PTP metrics. Furthermore, using the Data Efficient Image Transformer (DeiT) module, we distilled a Vision Transformer (ViT) model from a fine-tuned ResNet152 as a teacher in the classification phase. This approach demonstrates promising strides in reliable tumor detection and classification, offering potential advancements in tumor diagnosis for real-world medical imaging scenarios.

Large language models (LLMs) have demonstrated remarkable capabilities in natural language understanding and generation across various domains, including medicine. We present a comprehensive evaluation of GPT-4, a state-of-the-art LLM, on medical competency examinations and benchmark datasets. GPT-4 is a general-purpose model that is not specialized for medical problems through training or engineered to solve clinical tasks. Our analysis covers two sets of official practice materials for the USMLE, a three-step examination program used to assess clinical competency and grant licensure in the United States. We also evaluate performance on the MultiMedQA suite of benchmark datasets. Beyond measuring model performance, experiments were conducted to investigate the influence of test questions containing both text and images on model performance, probe for memorization of content during training, and study probability calibration, which is of critical importance in high-stakes applications like medicine. Our results show that GPT-4, without any specialized prompt crafting, exceeds the passing score on USMLE by over 20 points and outperforms earlier general-purpose models (GPT-3.5) as well as models specifically fine-tuned on medical knowledge (Med-PaLM, a prompt-tuned version of Flan-PaLM 540B). In addition, GPT-4 is significantly better calibrated than GPT-3.5, demonstrating a much-improved ability to predict the likelihood that its answers are correct. We also explore the behavior of the model qualitatively through a case study that shows the ability of GPT-4 to explain medical reasoning, personalize explanations to students, and interactively craft new counterfactual scenarios around a medical case. Implications of the findings are discussed for potential uses of GPT-4 in medical education, assessment, and clinical practice, with appropriate attention to challenges of accuracy and safety.

Benchmarks for large multimodal language models (MLMs) now serve to simultaneously assess the general capabilities of models instead of evaluating for a specific capability. As a result, when a developer wants to identify which models to use for their application, they are overwhelmed by the number of benchmarks and remain uncertain about which benchmark's results are most reflective of their specific use case. This paper introduces Task-Me-Anything, a benchmark generation engine which produces a benchmark tailored to a user's needs. Task-Me-Anything maintains an extendable taxonomy of visual assets and can programmatically generate a vast number of task instances. Additionally, it algorithmically addresses user queries regarding MLM performance efficiently within a computational budget. It contains 113K images, 10K videos, 2K 3D object assets, over 365 object categories, 655 attributes, and 335 relationships. It can generate 750M image/video question-answering pairs, which focus on evaluating MLM perceptual capabilities. Task-Me-Anything reveals critical insights: open-source MLMs excel in object and attribute recognition but lack spatial and temporal understanding; each model exhibits unique strengths and weaknesses; larger models generally perform better, though exceptions exist; and GPT4o demonstrates challenges in recognizing rotating/moving objects and distinguishing colors.

Although large language models (LLMs) have been largely successful in generating functionally correct programs, conditioning models to produce efficient solutions while ensuring correctness remains a challenge. Further, unreliability in benchmarking code efficiency is a hurdle across varying hardware specifications for popular interpreted languages such as Python. In this paper, we present ECCO, a reproducible benchmark for evaluating program efficiency via two paradigms: natural language (NL) based code generation and history-based code editing. On ECCO, we adapt and thoroughly investigate the three most promising existing LLM-based approaches: in-context learning, iterative refinement with execution or NL feedback, and fine-tuning conditioned on execution and editing history. While most methods degrade functional correctness and moderately increase program efficiency, we find that adding execution information often helps maintain functional correctness, and NL feedback enhances more on efficiency. We release our benchmark to support future work on LLM-based generation of efficient code.

There is enormous enthusiasm and concerns in using large language models (LLMs) in healthcare, yet current assumptions are all based on general-purpose LLMs such as ChatGPT. This study develops a clinical generative LLM, GatorTronGPT, using 277 billion words of mixed clinical and English text with a GPT-3 architecture of 20 billion parameters. GatorTronGPT improves biomedical natural language processing for medical research. Synthetic NLP models trained using GatorTronGPT generated text outperform NLP models trained using real-world clinical text. Physicians Turing test using 1 (worst) to 9 (best) scale shows that there is no significant difference in linguistic readability (p = 0.22; 6.57 of GatorTronGPT compared with 6.93 of human) and clinical relevance (p = 0.91; 7.0 of GatorTronGPT compared with 6.97 of human) and that physicians cannot differentiate them (p < 0.001). This study provides insights on the opportunities and challenges of LLMs for medical research and healthcare.

The emergence of large multimodal models has unlocked remarkable potential in AI, particularly in pathology. However, the lack of specialized, high-quality benchmark impeded their development and precise evaluation. To address this, we introduce PathMMU, the largest and highest-quality expert-validated pathology benchmark for LMMs. It comprises 33,573 multimodal multi-choice questions and 21,599 images from various sources, and an explanation for the correct answer accompanies each question. The construction of PathMMU capitalizes on the robust capabilities of GPT-4V, utilizing approximately 30,000 gathered image-caption pairs to generate Q\&As. Significantly, to maximize PathMMU's authority, we invite six pathologists to scrutinize each question under strict standards in PathMMU's validation and test sets, while simultaneously setting an expert-level performance benchmark for PathMMU. We conduct extensive evaluations, including zero-shot assessments of 14 open-sourced and three closed-sourced LMMs and their robustness to image corruption. We also fine-tune representative LMMs to assess their adaptability to PathMMU. The empirical findings indicate that advanced LMMs struggle with the challenging PathMMU benchmark, with the top-performing LMM, GPT-4V, achieving only a 51.7\% zero-shot performance, significantly lower than the 71.4\% demonstrated by human pathologists. After fine-tuning, even open-sourced LMMs can surpass GPT-4V with a performance of over 60\%, but still fall short of the expertise shown by pathologists. We hope that the PathMMU will offer valuable insights and foster the development of more specialized, next-generation LLMs for pathology.

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

Advances in large language models (LLMs) provide new opportunities in healthcare for improved patient care, clinical decision-making, and enhancement of physician and administrator workflows. However, the potential of these models importantly depends on their ability to generalize effectively across clinical environments and populations, a challenge often underestimated in early development. To better understand reasons for these challenges and inform mitigation approaches, we evaluated ClinicLLM, an LLM trained on [HOSPITAL]'s clinical notes, analyzing its performance on 30-day all-cause readmission prediction focusing on variability across hospitals and patient characteristics. We found poorer generalization particularly in hospitals with fewer samples, among patients with government and unspecified insurance, the elderly, and those with high comorbidities. To understand reasons for lack of generalization, we investigated sample sizes for fine-tuning, note content (number of words per note), patient characteristics (comorbidity level, age, insurance type, borough), and health system aspects (hospital, all-cause 30-day readmission, and mortality rates). We used descriptive statistics and supervised classification to identify features. We found that, along with sample size, patient age, number of comorbidities, and the number of words in notes are all important factors related to generalization. Finally, we compared local fine-tuning (hospital specific), instance-based augmented fine-tuning and cluster-based fine-tuning for improving generalization. Among these, local fine-tuning proved most effective, increasing AUC by 0.25% to 11.74% (most helpful in settings with limited data). Overall, this study provides new insights for enhancing the deployment of large language models in the societally important domain of healthcare, and improving their performance for broader populations.

Code Language Models have been trained to generate accurate solutions, typically with no regard for runtime. On the other hand, previous works that explored execution optimisation have observed corresponding drops in functional correctness. To that end, we introduce Code-Optimise, a framework that incorporates both correctness (passed, failed) and runtime (quick, slow) as learning signals via self-generated preference data. Our framework is both lightweight and robust as it dynamically selects solutions to reduce overfitting while avoiding a reliance on larger models for learning signals. Code-Optimise achieves significant improvements in pass@k while decreasing the competitive baseline runtimes by an additional 6% for in-domain data and up to 3% for out-of-domain data. As a byproduct, the average length of the generated solutions is reduced by up to 48% on MBPP and 23% on HumanEval, resulting in faster and cheaper inference. The generated data and codebase will be open-sourced at www.open-source.link.

Current research on generative language models (GLMs) for automated text scoring (ATS) has focused almost exclusively on querying proprietary models via Application Programming Interfaces (APIs). Yet such practices raise issues around transparency and security, and these methods offer little in the way of efficiency or customizability. With the recent proliferation of smaller, open-source models, there is the option to explore GLMs with computers equipped with modest, consumer-grade hardware, that is, for the "GPU poor." In this study, we analyze the performance and efficiency of open-source, small-scale GLMs for ATS. Results show that GLMs can be fine-tuned to achieve adequate, though not state-of-the-art, performance. In addition to ATS, we take small steps towards analyzing models' capacity for generating feedback by prompting GLMs to explain their scores. Model-generated feedback shows promise, but requires more rigorous evaluation focused on targeted use cases.

Recent advancements in large language model(LLM) performance on medical multiple choice question (MCQ) benchmarks have stimulated interest from healthcare providers and patients globally. Particularly in low-and middle-income countries (LMICs) facing acute physician shortages and lack of specialists, LLMs offer a potentially scalable pathway to enhance healthcare access and reduce costs. However, their effectiveness in the Global South, especially across the African continent, remains to be established. In this work, we introduce AfriMed-QA, the first large scale Pan-African English multi-specialty medical Question-Answering (QA) dataset, 15,000 questions (open and closed-ended) sourced from over 60 medical schools across 16 countries, covering 32 medical specialties. We further evaluate 30 LLMs across multiple axes including correctness and demographic bias. Our findings show significant performance variation across specialties and geographies, MCQ performance clearly lags USMLE (MedQA). We find that biomedical LLMs underperform general models and smaller edge-friendly LLMs struggle to achieve a passing score. Interestingly, human evaluations show a consistent consumer preference for LLM answers and explanations when compared with clinician answers.

Various benchmarks have been proposed to assess the performance of large language models (LLMs) in different coding scenarios. We refer to them as code-related benchmarks. However, there are no systematic guidelines by which such a benchmark should be developed to ensure its quality, reliability, and reproducibility. We propose How2Bench, which is comprised of a 55- 55-criteria checklist as a set of guidelines to govern the development of code-related benchmarks comprehensively. Using HOW2BENCH, we profiled 274 benchmarks released within the past decade and found concerning issues. Nearly 70% of the benchmarks did not take measures for data quality assurance; over 10% did not even open source or only partially open source. Many highly cited benchmarks have loopholes, including duplicated samples, incorrect reference codes/tests/prompts, and unremoved sensitive/confidential information. Finally, we conducted a human study involving 49 participants, which revealed significant gaps in awareness of the importance of data quality, reproducibility, and transparency.

With the introduction of ChatGPT, Large Language Models (LLMs) have received enormous attention in healthcare. Despite their potential benefits, researchers have underscored various ethical implications. While individual instances have drawn much attention, the debate lacks a systematic overview of practical applications currently researched and ethical issues connected to them. Against this background, this work aims to map the ethical landscape surrounding the current stage of deployment of LLMs in medicine and healthcare. Electronic databases and preprint servers were queried using a comprehensive search strategy. Studies were screened and extracted following a modified rapid review approach. Methodological quality was assessed using a hybrid approach. For 53 records, a meta-aggregative synthesis was performed. Four fields of applications emerged and testify to a vivid exploration phase. Advantages of using LLMs are attributed to their capacity in data analysis, personalized information provisioning, support in decision-making, mitigating information loss and enhancing information accessibility. However, we also identifies recurrent ethical concerns connected to fairness, bias, non-maleficence, transparency, and privacy. A distinctive concern is the tendency to produce harmful misinformation or convincingly but inaccurate content. A recurrent plea for ethical guidance and human oversight is evident. Given the variety of use cases, it is suggested that the ethical guidance debate be reframed to focus on defining what constitutes acceptable human oversight across the spectrum of applications. This involves considering diverse settings, varying potentials for harm, and different acceptable thresholds for performance and certainty in healthcare. In addition, a critical inquiry is necessary to determine the extent to which the current experimental use of LLMs is necessary and justified.

Transformers have significantly advanced the modeling of Electronic Health Records (EHR), yet their deployment in real-world healthcare is limited by several key challenges. Firstly, the quadratic computational cost and insufficient context length of these models pose significant obstacles for hospitals in processing the extensive medical histories typical in EHR data. Additionally, existing models employ separate finetuning for each clinical task, complicating maintenance in healthcare environments. Moreover, these models focus exclusively on either clinical prediction or EHR forecasting, lacking the flexibility to perform well across both. To overcome these limitations, we introduce EHRMamba, a robust foundation model built on the Mamba architecture. EHRMamba can process sequences up to four times longer than previous models due to its linear computational cost. We also introduce a novel approach to Multitask Prompted Finetuning (MTF) for EHR data, which enables EHRMamba to simultaneously learn multiple clinical tasks in a single finetuning phase, significantly enhancing deployment and cross-task generalization. Furthermore, our model leverages the HL7 FHIR data standard to simplify integration into existing hospital systems. Alongside EHRMamba, we open-source Odyssey, a toolkit designed to support the development and deployment of EHR foundation models, with an emphasis on data standardization and interpretability. Our evaluations on the MIMIC-IV dataset demonstrate that EHRMamba advances state-of-the-art performance across 6 major clinical tasks and excels in EHR forecasting, marking a significant leap forward in the field.

Most popular benchmarks for comparing LLMs rely on a limited set of prompt templates, which may not fully capture the LLMs' abilities and can affect the reproducibility of results on leaderboards. Many recent works empirically verify prompt sensitivity and advocate for changes in LLM evaluation. In this paper, we consider the problem of estimating the performance distribution across many prompt variants instead of finding a single prompt to evaluate with. We introduce PromptEval, a method for estimating performance across a large set of prompts borrowing strength across prompts and examples to produce accurate estimates under practical evaluation budgets. The resulting distribution can be used to obtain performance quantiles to construct various robust performance metrics (e.g., top 95% quantile or median). We prove that PromptEval consistently estimates the performance distribution and demonstrate its efficacy empirically on three prominent LLM benchmarks: MMLU, BIG-bench Hard, and LMentry. For example, PromptEval can accurately estimate performance quantiles across 100 prompt templates on MMLU with a budget equivalent to two single-prompt evaluations. Our code and data can be found at https://github.com/felipemaiapolo/prompt-eval.

The performance of machine learning models often degrades after deployment due to data distribution shifts. In many use cases, it is impossible to calculate the post-deployment performance because labels are unavailable or significantly delayed. Proxy methods for evaluating model performance stability, like drift detection techniques, do not properly quantify data distribution shift impact. As a solution, we propose a robust and accurate performance estimation method for evaluating ML classification models on unlabeled data that accurately quantifies the impact of covariate shift on model performance. We call it multi-calibrated confidence-based performance estimation (M-CBPE). It is model and data-type agnostic and works for any performance metric. It does not require access to the monitored model - it uses the model predictions and probability estimates. M-CBPE does not need user input on the nature of the covariate shift as it fully learns from the data. We evaluate it with over 600 dataset-model pairs from US census data and compare it with multiple benchmarks using several evaluation metrics. Results show that M-CBPE is the best method to estimate the performance of classification models in any evaluation context.

Electrocardiogram (ECG) serves as the primary non-invasive diagnostic tool for cardiac conditions monitoring, are crucial in assisting clinicians. Recent studies have concentrated on classifying cardiac conditions using ECG data but have overlooked ECG report generation, which is not only time-consuming but also requires clinical expertise. To automate ECG report generation and ensure its versatility, we propose the Multimodal ECG Instruction Tuning (MEIT) framework, the first attempt to tackle ECG report generation with LLMs and multimodal instructions. To facilitate future research, we establish a benchmark to evaluate MEIT with various LLMs backbones across two large-scale ECG datasets. Our approach uniquely aligns the representations of the ECG signal and the report, and we conduct extensive experiments to benchmark MEIT with nine open source LLMs, using more than 800,000 ECG reports. MEIT's results underscore the superior performance of instruction-tuned LLMs, showcasing their proficiency in quality report generation, zero-shot capabilities, and resilience to signal perturbation. These findings emphasize the efficacy of our MEIT framework and its potential for real-world clinical application.

As large language models (LLMs) continue to evolve, efficient evaluation metrics are vital for assessing their ability to compress information and reduce redundancy. While traditional metrics like Matrix Entropy offer valuable insights, they are computationally intensive for large-scale models due to their \( O(n^3) \) time complexity with Singular Value Decomposition (SVD). To mitigate this issue, we introduce the Matrix Nuclear-Norm, which not only serves as a metric to quantify the data compression proficiency of LLM but also provides a convex approximation of matrix rank to capture both predictive discriminability and diversity. By employing the \( L_{1,2}-norm \) to further approximate the nuclear norm, we can effectively assess the model's information compression capabilities. This approach reduces the time complexity to \( O(n^2) \) and eliminates the need for SVD computation. Consequently, the Matrix Nuclear-Norm achieves speeds 8 to 24 times faster than Matrix Entropy for the CEREBRAS-GPT model as sizes increase from 111M to 6.7B. This performance gap becomes more pronounced with larger models, as validated in tests with other models like Pythia. Additionally, evaluations on benchmarks and model responses confirm that our proposed Matrix Nuclear-Norm is a reliable, scalable, and efficient tool for assessing LLMs' performance, striking a balance between accuracy and computational efficiency. The code is available at https://github.com/MLGroupJLU/MatrixNuclearNorm.

Software engineers mainly write code by editing existing programs. In contrast, large language models (LLMs) autoregressively synthesize programs in a single pass. One explanation for this is the scarcity of open-sourced edit data. While high-quality instruction data for code synthesis is already scarce, high-quality edit data is even scarcer. To fill this gap, we develop a synthetic data generation algorithm called LintSeq. This algorithm refactors existing code into a sequence of code edits by using a linter to procedurally sample across the error-free insertions that can be used to sequentially write programs. It outputs edit sequences as text strings consisting of consecutive program diffs. To test LintSeq, we use it to refactor a dataset of instruction + program pairs into instruction + program-diff-sequence tuples. Then, we instruction finetune a series of smaller LLMs ranging from 2.6B to 14B parameters on both the re-factored and original versions of this dataset, comparing zero-shot performance on code synthesis benchmarks. We show that during repeated sampling, edit sequence finetuned models produce more diverse programs than baselines. This results in better inference-time scaling for benchmark coverage as a function of samples, i.e. the fraction of problems "pass@k" solved by any attempt given "k" tries. For example, on HumanEval pass@50, small LLMs finetuned on synthetic edit sequences are competitive with GPT-4 and outperform models finetuned on the baseline dataset by +20% (+/-3%) in absolute score. Finally, we also pretrain our own tiny LMs for code understanding. We show that finetuning tiny models on synthetic code edits results in state-of-the-art code synthesis for the on-device model class. Our 150M parameter edit sequence LM matches or outperforms code models with twice as many parameters, both with and without repeated sampling, including Codex and AlphaCode.

For patients suffering from central nervous system tumors, prognosis estimation, treatment decisions, and postoperative assessments are made from the analysis of a set of magnetic resonance (MR) scans. Currently, the lack of open tools for standardized and automatic tumor segmentation and generation of clinical reports, incorporating relevant tumor characteristics, leads to potential risks from inherent decisions' subjectivity. To tackle this problem, the proposed Raidionics open-source software has been developed, offering both a user-friendly graphical user interface and stable processing backend. The software includes preoperative segmentation models for each of the most common tumor types (i.e., glioblastomas, lower grade gliomas, meningiomas, and metastases), together with one early postoperative glioblastoma segmentation model. Preoperative segmentation performances were quite homogeneous across the four different brain tumor types, with an average Dice around 85% and patient-wise recall and precision around 95%. Postoperatively, performances were lower with an average Dice of 41%. Overall, the generation of a standardized clinical report, including the tumor segmentation and features computation, requires about ten minutes on a regular laptop. The proposed Raidionics software is the first open solution enabling an easy use of state-of-the-art segmentation models for all major tumor types, including preoperative and postsurgical standardized reports.

Large language models (LLMs) show remarkable potential to act as computer agents, enhancing human productivity and software accessibility in multi-modal tasks that require planning and reasoning. However, measuring agent performance in realistic environments remains a challenge since: (i) most benchmarks are limited to specific modalities or domains (e.g. text-only, web navigation, Q&A, coding) and (ii) full benchmark evaluations are slow (on order of magnitude of days) given the multi-step sequential nature of tasks. To address these challenges, we introduce the Windows Agent Arena: a reproducible, general environment focusing exclusively on the Windows operating system (OS) where agents can operate freely within a real Windows OS and use the same wide range of applications, tools, and web browsers available to human users when solving tasks. We adapt the OSWorld framework (Xie et al., 2024) to create 150+ diverse Windows tasks across representative domains that require agent abilities in planning, screen understanding, and tool usage. Our benchmark is scalable and can be seamlessly parallelized in Azure for a full benchmark evaluation in as little as 20 minutes. To demonstrate Windows Agent Arena's capabilities, we also introduce a new multi-modal agent, Navi. Our agent achieves a success rate of 19.5% in the Windows domain, compared to 74.5% performance of an unassisted human. Navi also demonstrates strong performance on another popular web-based benchmark, Mind2Web. We offer extensive quantitative and qualitative analysis of Navi's performance, and provide insights into the opportunities for future research in agent development and data generation using Windows Agent Arena. Webpage: https://microsoft.github.io/WindowsAgentArena Code: https://github.com/microsoft/WindowsAgentArena

Instruction fine-tuning pretrained LLMs for diverse downstream tasks has demonstrated remarkable success and has captured the interest of both academics and practitioners. To ensure such fine-tuned LLMs align with human preferences, techniques such as RLHF and DPO have emerged. At the same time, there is increasing interest in smaller parameter counts for models. In this work, using OpenLLaMA 3Bv2 as a base model, we describe the recipe used to fine-tune the OpenBezoar family of models. In this recipe: We first generate synthetic instruction fine-tuning data using an open and commercially non-restrictive instruction fine-tuned variant of the Falcon-40B model under three schemes based on: LaMini-LM, WizardLM/Evol-Instruct (with databricks-dolly-15k as a seed dataset) and Orca (with the Flan Collection as a seed dataset), then filter these generations using GPT-4 as a human proxy. We then perform cost-effective QLoRA-based supervised fine-tuning sequentially with each scheme. The resulting checkpoint is further fine-tuned with a subset of the HH-RLHF dataset to minimize distribution shift prior to using the DPO loss to obtain the final checkpoint. Evaluation is done with the LM Eval Harness tasks/metrics as well as on MT-Bench using the "LLM-as-a-judge" framework with Claude 2.1, with the finding that the final checkpoint, "OpenBezoar-HH-RLHF-DPO", demonstrates superior performance over many models at the 3B parameter scale, even outperforming the top model in one of the categories on the Huggingface Open LLM Leaderboard. We release "OpenBezoar-SFT", "OpenBezoar-HH-RLHF-SFT", "OpenBezoar-HH-RLHF-DPO" checkpoints, alongside our generated datasets on HuggingFace at https://huggingface.co/collections/SurgeGlobal/open-bezoar-6620a24923e12127e9e2b9cc and our codebase at https://bitbucket.org/paladinanalytics/workspace/projects/OP.

The recent surge of open-source large language models (LLMs) enables developers to create AI-based solutions while maintaining control over aspects such as privacy and compliance, thereby providing governance and ownership of the model deployment process. To utilize these LLMs, inference engines are needed. These engines load the model's weights onto available resources, such as GPUs, and process queries to generate responses. The speed of inference, or performance, of the LLM, is critical for real-time applications, as it computes millions or billions of floating point operations per inference. Recently, advanced inference engines such as vLLM have emerged, incorporating novel mechanisms such as efficient memory management to achieve state-of-the-art performance. In this paper, we analyze the performance, particularly the throughput (tokens generated per unit of time), of 20 LLMs using two inference libraries: vLLM and HuggingFace's pipelines. We investigate how various hyperparameters, which developers must configure, influence inference performance. Our results reveal that throughput landscapes are irregular, with distinct peaks, highlighting the importance of hyperparameter optimization to achieve maximum performance. We also show that applying hyperparameter optimization when upgrading or downgrading the GPU model used for inference can improve throughput from HuggingFace pipelines by an average of 9.16% and 13.7%, respectively.

Recent advances in generative vision-language models (VLMs) have exciting potential implications for AI in radiology, yet VLMs are also known to produce hallucinations, nonsensical text, and other unwanted behaviors that can waste clinicians' time and cause patient harm. Drawing on recent work on direct preference optimization (DPO), we propose a simple method for modifying the behavior of pretrained VLMs performing radiology report generation by suppressing unwanted types of generations. We apply our method to the prevention of hallucinations of prior exams, addressing a long-established problem behavior in models performing chest X-ray report generation. Across our experiments, we find that DPO fine-tuning achieves a 3.2-4.8x reduction in lines hallucinating prior exams while maintaining model performance on clinical accuracy metrics. Our work is, to the best of our knowledge, the first work to apply DPO to medical VLMs, providing a data- and compute- efficient way to suppress problem behaviors while maintaining overall clinical accuracy.

Due to the high computational demands executing a rigorous comparison between hyperparameter optimization (HPO) methods is often cumbersome. The goal of this paper is to facilitate a better empirical evaluation of HPO methods by providing benchmarks that are cheap to evaluate, but still represent realistic use cases. We believe these benchmarks provide an easy and efficient way to conduct reproducible experiments for neural hyperparameter search. Our benchmarks consist of a large grid of configurations of a feed forward neural network on four different regression datasets including architectural hyperparameters and hyperparameters concerning the training pipeline. Based on this data, we performed an in-depth analysis to gain a better understanding of the properties of the optimization problem, as well as of the importance of different types of hyperparameters. Second, we exhaustively compared various different state-of-the-art methods from the hyperparameter optimization literature on these benchmarks in terms of performance and robustness.

Large Language Models (LLMs) applied to code-related applications have emerged as a prominent field, attracting significant interest from both academia and industry. However, as new and improved LLMs are developed, existing evaluation benchmarks (e.g., HumanEval, MBPP) are no longer sufficient for assessing their capabilities. In this work, we propose LiveCodeBench, a comprehensive and contamination-free evaluation of LLMs for code, which continuously collects new problems over time from contests across three competition platforms, namely LeetCode, AtCoder, and CodeForces. Notably, our benchmark also focuses on a broader range of code related capabilities, such as self-repair, code execution, and test output prediction, beyond just code generation. Currently, LiveCodeBench hosts four hundred high-quality coding problems that were published between May 2023 and February 2024. We have evaluated 9 base LLMs and 20 instruction-tuned LLMs on LiveCodeBench. We present empirical findings on contamination, holistic performance comparisons, potential overfitting in existing benchmarks as well as individual model comparisons. We will release all prompts and model completions for further community analysis, along with a general toolkit for adding new scenarios and model

This paper introduces Safurai-Csharp, an open-source model designed to specialize in the generation, completion, and debugging of C# code. Safurai-Csharp is built upon the novel CodeLlama 34B model and leverages the EvolInstruct technique, creating a refined and expanded dataset for its fine-tuning process. The results of its performance, a notable score of 56.33% on the Manual MultiPL-E benchmark (Zero-Shot, Pass@1), signal its high capacity to streamline developers' workflows and aid code learning. It shows promise in setting new stakes in the landscape of open-source C# LLMs and hopes to inspire more inclusive and wide-ranging development in the field of language-specific LLMs.

With the advent of Vision-Language Models (VLMs), medical artificial intelligence (AI) has experienced significant technological progress and paradigm shifts. This survey provides an extensive review of recent advancements in Medical Vision-Language Models (Med-VLMs), which integrate visual and textual data to enhance healthcare outcomes. We discuss the foundational technology behind Med-VLMs, illustrating how general models are adapted for complex medical tasks, and examine their applications in healthcare. The transformative impact of Med-VLMs on clinical practice, education, and patient care is highlighted, alongside challenges such as data scarcity, narrow task generalization, interpretability issues, and ethical concerns like fairness, accountability, and privacy. These limitations are exacerbated by uneven dataset distribution, computational demands, and regulatory hurdles. Rigorous evaluation methods and robust regulatory frameworks are essential for safe integration into healthcare workflows. Future directions include leveraging large-scale, diverse datasets, improving cross-modal generalization, and enhancing interpretability. Innovations like federated learning, lightweight architectures, and Electronic Health Record (EHR) integration are explored as pathways to democratize access and improve clinical relevance. This review aims to provide a comprehensive understanding of Med-VLMs' strengths and limitations, fostering their ethical and balanced adoption in healthcare.

Benchmarks are essential for consistent evaluation and reproducibility. The integration of Artificial Intelligence into Software Engineering (AI4SE) has given rise to numerous benchmarks for tasks such as code generation and bug fixing. However, this surge presents challenges: (1) scattered benchmark knowledge across tasks, (2) difficulty in selecting relevant benchmarks, (3) the absence of a uniform standard for benchmark development, and (4) limitations of existing benchmarks. In this paper, we review 173 studies and identify 204 AI4SE benchmarks. We classify these benchmarks, analyze their limitations, and expose gaps in practices. Based on our review, we created BenchScout, a semantic search tool to find relevant benchmarks, using automated clustering of the contexts from associated studies. We conducted a user study with 22 participants to evaluate BenchScout's usability, effectiveness, and intuitiveness which resulted in average scores of 4.5, 4.0, and 4.1 out of 5. To advance benchmarking standards, we propose BenchFrame, a unified method to enhance benchmark quality. As a case study, we applied BenchFrame to the HumanEval benchmark and addressed its main limitations. This led to HumanEvalNext, featuring (1) corrected errors, (2) improved language conversion, (3) expanded test coverage, and (4) increased difficulty. We then evaluated ten state-of-the-art code language models on HumanEval, HumanEvalPlus, and HumanEvalNext. On HumanEvalNext, models showed a pass@1 score reduction of 31.22% and 19.94% compared to HumanEval and HumanEvalPlus, respectively.

The critique capacity of Large Language Models (LLMs) is essential for reasoning abilities, which can provide necessary suggestions (e.g., detailed analysis and constructive feedback). Therefore, how to evaluate the critique capacity of LLMs has drawn great attention and several critique benchmarks have been proposed. However, existing critique benchmarks usually have the following limitations: (1). Focusing on diverse reasoning tasks in general domains and insufficient evaluation on code tasks (e.g., only covering code generation task), where the difficulty of queries is relatively easy (e.g., the code queries of CriticBench are from Humaneval and MBPP). (2). Lacking comprehensive evaluation from different dimensions. To address these limitations, we introduce a holistic code critique benchmark for LLMs called CodeCriticBench. Specifically, our CodeCriticBench includes two mainstream code tasks (i.e., code generation and code QA) with different difficulties. Besides, the evaluation protocols include basic critique evaluation and advanced critique evaluation for different characteristics, where fine-grained evaluation checklists are well-designed for advanced settings. Finally, we conduct extensive experimental results of existing LLMs, which show the effectiveness of CodeCriticBench.

When trying to solve a computational problem, we are often faced with a choice between algorithms that are guaranteed to return the right answer but differ in their runtime distributions (e.g., SAT solvers, sorting algorithms). This paper aims to lay theoretical foundations for such choices by formalizing preferences over runtime distributions. It might seem that we should simply prefer the algorithm that minimizes expected runtime. However, such preferences would be driven by exactly how slow our algorithm is on bad inputs, whereas in practice we are typically willing to cut off occasional, sufficiently long runs before they finish. We propose a principled alternative, taking a utility-theoretic approach to characterize the scoring functions that describe preferences over algorithms. These functions depend on the way our value for solving our problem decreases with time and on the distribution from which captimes are drawn. We describe examples of realistic utility functions and show how to leverage a maximum-entropy approach for modeling underspecified captime distributions. Finally, we show how to efficiently estimate an algorithm's expected utility from runtime samples.

While recent multimodal large language models (MLLMs) have advanced automated ECG interpretation, they still face two key limitations: (1) insufficient multimodal synergy between time series signals and visual ECG representations, and (2) limited explainability in linking diagnoses to granular waveform evidence. We introduce GEM, the first MLLM unifying ECG time series, 12-lead ECG images and text for grounded and clinician-aligned ECG interpretation. GEM enables feature-grounded analysis, evidence-driven reasoning, and a clinician-like diagnostic process through three core innovations: a dual-encoder framework extracting complementary time series and image features, cross-modal alignment for effective multimodal understanding, and knowledge-guided instruction generation for generating high-granularity grounding data (ECG-Grounding) linking diagnoses to measurable parameters (e.g., QRS/PR Intervals). Additionally, we propose the Grounded ECG Understanding task, a clinically motivated benchmark designed to comprehensively assess the MLLM's capability in grounded ECG understanding. Experimental results on both existing and our proposed benchmarks show GEM significantly improves predictive performance (CSN 7.4% uparrow), explainability (22.7% uparrow), and grounding (24.8% uparrow), making it more suitable for real-world clinical applications. GitHub repository: https://github.com/lanxiang1017/GEM.git

In response to the pressing need for advanced clinical problem-solving tools in healthcare, we introduce BooksMed, a novel framework based on a Large Language Model (LLM). BooksMed uniquely emulates human cognitive processes to deliver evidence-based and reliable responses, utilizing the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework to effectively quantify evidence strength. For clinical decision-making to be appropriately assessed, an evaluation metric that is clinically aligned and validated is required. As a solution, we present ExpertMedQA, a multispecialty clinical benchmark comprised of open-ended, expert-level clinical questions, and validated by a diverse group of medical professionals. By demanding an in-depth understanding and critical appraisal of up-to-date clinical literature, ExpertMedQA rigorously evaluates LLM performance. BooksMed outperforms existing state-of-the-art models Med-PaLM 2, Almanac, and ChatGPT in a variety of medical scenarios. Therefore, a framework that mimics human cognitive stages could be a useful tool for providing reliable and evidence-based responses to clinical inquiries.

Evaluating the real-world applicability of large language models (LLMs) provides valuable insights for their development and use in software development tasks. Existing benchmarks often focus on standalone coding problems or specific libraries, overlooking multi-file, project-based scenarios and lacking a rigorous evaluation of consistency. The HackerRank-ASTRA Benchmark introduces project-based coding problems that mirror real-world scenarios. It evaluates model consistency through 32 runs (k = 32) and median standard deviation while incorporating taxonomy-level analysis to assess sub-skill capabilities. Initial evaluations on 65 problems show that the top three models -- o1, o1-preview, and Claude-3.5-Sonnet-1022 -- achieved comparable average scores of 75%, with no statistically significant differences in performance. Notably, Claude-3.5-Sonnet-1022 demonstrated the highest consistency across problems, with low variability (SD = 0.0497), which was statistically significant compared to other models, highlighting its reliability for real-world software development tasks.

This paper presents Safurai-001, a new Large Language Model (LLM) with significant potential in the domain of coding assistance. Driven by recent advancements in coding LLMs, Safurai-001 competes in performance with the latest models like WizardCoder [Xu et al., 2023], PanguCoder [Shen et al., 2023] and Phi-1 [Gunasekar et al., 2023] but aims to deliver a more conversational interaction. By capitalizing on the progress in data engineering (including latest techniques of data transformation and prompt engineering) and instruction tuning, this new model promises to stand toe-to-toe with recent closed and open source developments. Recognizing the need for an efficacious evaluation metric for coding LLMs, this paper also introduces GPT4-based MultiParameters, an evaluation benchmark that harnesses varied parameters to present a comprehensive insight into the models functioning and performance. Our assessment shows that Safurai-001 can outperform GPT-3.5 by 1.58% and WizardCoder by 18.78% in the Code Readability parameter and more.

Recent advances in large language models (LLMs) have increased the demand for comprehensive benchmarks to evaluate their capabilities as human-like agents. Existing benchmarks, while useful, often focus on specific application scenarios, emphasizing task completion but failing to dissect the underlying skills that drive these outcomes. This lack of granularity makes it difficult to deeply discern where failures stem from. Additionally, setting up these environments requires considerable effort, and issues of unreliability and reproducibility sometimes arise, especially in interactive tasks. To address these limitations, we introduce the Massive Multitask Agent Understanding (MMAU) benchmark, featuring comprehensive offline tasks that eliminate the need for complex environment setups. It evaluates models across five domains, including teal{Tool-use}, teal{Directed Acyclic Graph (DAG) QA}, teal{Data Science and Machine Learning coding}, teal{Contest-level programming} and teal{Mathematics}, and covers five essential capabilities: orange{Understanding}, orange{Reasoning}, orange{Planning}, orange{Problem-solving}, and orange{Self-correction}. With a total of 20 meticulously designed tasks encompassing over 3K distinct prompts, MMAU provides a comprehensive framework for evaluating the strengths and limitations of LLM agents. By testing 18 representative models on MMAU, we provide deep and insightful analyses. Ultimately, MMAU not only sheds light on the capabilities and limitations of LLM agents but also enhances the interpretability of their performance. Datasets and evaluation scripts of MMAU are released at https://github.com/apple/axlearn/docs/research/mmau.

We investigate large language model performance across five orders of magnitude of compute scaling in eleven recent model architectures. We show that average benchmark performance, aggregating over many individual tasks and evaluations as in the commonly-used BIG-Bench dataset, is decently predictable as a function of training compute scale. Specifically, when extrapolating BIG-Bench Hard performance across one order of magnitude in compute, we observe average absolute errors of 6 percentage points (pp). By contrast, extrapolation for individual BIG-Bench tasks across an order of magnitude in compute yields higher average errors of 18pp. Nonetheless, individual task performance remains significantly more predictable than chance. Overall, our work suggests compute scaling provides a promising basis to forecast AI capabilities in diverse benchmarks, though predicting performance in specific tasks poses challenges.

The emergence of large language models (LLMs) has significantly pushed the frontiers of program synthesis. Advancement of LLM-based program synthesis calls for a thorough evaluation of LLM-generated code. Most evaluation frameworks focus on the (functional) correctness of generated code; efficiency, as an important measure of code quality, has been overlooked in existing evaluations. In this work, we develop ENAMEL (EfficeNcy AutoMatic EvaLuator), a rigorous and high-standard benchmark for evaluating the capability of LLMs in generating efficient code. Firstly, we propose a new efficiency metric called eff@k, which generalizes the pass@k metric from correctness to efficiency and appropriately handles right-censored execution time. Furthermore, we derive an unbiased and variance-reduced estimator of eff@k via Rao--Blackwellization; we also provide a numerically stable implementation for the new estimator. Secondly, to set a high-standard for efficiency evaluation, we employ a human expert to design best algorithms and implementations as our reference solutions of efficiency, many of which are much more efficient than existing canonical solutions in HumanEval and HumanEval+. Moreover, to ensure a rigorous evaluation, we employ a human expert to curate strong test case generators to filter out wrong code and differentiate suboptimal algorithms. An extensive study across 30 popular LLMs using our benchmark ENAMEL shows that LLMs still fall short of generating expert-level efficient code. Using two subsets of our problem set, we demonstrate that such deficiency is because current LLMs struggle in designing advanced algorithms and are barely aware of implementation optimization. Our benchmark is publicly available at https://github.com/q-rz/enamel .

Test-Time Adaptation (TTA) has recently emerged as a promising approach for tackling the robustness challenge under distribution shifts. However, the lack of consistent settings and systematic studies in prior literature hinders thorough assessments of existing methods. To address this issue, we present TTAB, a test-time adaptation benchmark that encompasses ten state-of-the-art algorithms, a diverse array of distribution shifts, and two evaluation protocols. Through extensive experiments, our benchmark reveals three common pitfalls in prior efforts. First, selecting appropriate hyper-parameters, especially for model selection, is exceedingly difficult due to online batch dependency. Second, the effectiveness of TTA varies greatly depending on the quality and properties of the model being adapted. Third, even under optimal algorithmic conditions, none of the existing methods are capable of addressing all common types of distribution shifts. Our findings underscore the need for future research in the field to conduct rigorous evaluations on a broader set of models and shifts, and to re-examine the assumptions behind the empirical success of TTA. Our code is available at https://github.com/lins-lab/ttab.

How to evaluate Large Language Models (LLMs) in code generation is an open question. Many benchmarks have been proposed but are inconsistent with practical software projects, e.g., unreal program distributions, insufficient dependencies, and small-scale project contexts. Thus, the capabilities of LLMs in practical projects are still unclear. In this paper, we propose a new benchmark named DevEval, aligned with Developers' experiences in practical projects. DevEval is collected through a rigorous pipeline, containing 2,690 samples from 119 practical projects and covering 10 domains. Compared to previous benchmarks, DevEval aligns to practical projects in multiple dimensions, e.g., real program distributions, sufficient dependencies, and enough-scale project contexts. We assess five popular LLMs on DevEval (e.g., gpt-4, gpt-3.5-turbo, CodeLLaMa, and StarCoder) and reveal their actual abilities in code generation. For instance, the highest Pass@1 of gpt-3.5-turbo only is 42 in our experiments. We also discuss the challenges and future directions of code generation in practical projects. We open-source DevEval and hope it can facilitate the development of code generation in practical projects.

Large Language Models (LLMs) like ChatGPT demonstrate significant potential in the medical field, often evaluated using multiple-choice questions (MCQs) similar to those found on the USMLE. Despite their prevalence in medical education, MCQs have limitations that might be exacerbated when assessing LLMs. To evaluate the effectiveness of MCQs in assessing the performance of LLMs, we developed a fictional medical benchmark focused on a non-existent gland, the Glianorex. This approach allowed us to isolate the knowledge of the LLM from its test-taking abilities. We used GPT-4 to generate a comprehensive textbook on the Glianorex in both English and French and developed corresponding multiple-choice questions in both languages. We evaluated various open-source, proprietary, and domain-specific LLMs using these questions in a zero-shot setting. The models achieved average scores around 67%, with minor performance differences between larger and smaller models. Performance was slightly higher in English than in French. Fine-tuned medical models showed some improvement over their base versions in English but not in French. The uniformly high performance across models suggests that traditional MCQ-based benchmarks may not accurately measure LLMs' clinical knowledge and reasoning abilities, instead highlighting their pattern recognition skills. This study underscores the need for more robust evaluation methods to better assess the true capabilities of LLMs in medical contexts.

Large language models (LLMs) are leading significant progress in code generation. Beyond one-pass code generation, recent works further integrate unit tests and program verifiers into LLMs to iteratively refine the generated programs. However, these works consider the generated programs as an indivisible entity, which falls short for LLMs in debugging the programs, especially when the programs contain complex logic flows and data operations. In contrast, when human developers debug programs, they typically set breakpoints and selectively examine runtime execution information. The execution flow and the intermediate variables play a crucial role in the debugging process, yet they are underutilized in the existing literature on code generation. In this study, we introduce Large Language Model Debugger (LDB), a novel debugging framework that enables LLMs to refine their generated programs with the runtime execution information. Specifically, LDB segments the programs into basic blocks and tracks the values of intermediate variables after each block throughout the runtime execution. This allows LLMs to concentrate on simpler code units within the overall execution flow, verify their correctness against the task description block by block, and efficiently pinpoint any potential errors. Experiments demonstrate that LDB consistently enhances the baseline performance by up to 9.8% across the HumanEval, MBPP, and TransCoder benchmarks, archiving new state-of-the-art performance in code debugging for various LLM selections.

With advances in foundational and vision-language models, and effective fine-tuning techniques, a large number of both general and special-purpose models have been developed for a variety of visual tasks. Despite the flexibility and accessibility of these models, no single model is able to handle all tasks and/or applications that may be envisioned by potential users. Recent approaches, such as visual programming and multimodal LLMs with integrated tools aim to tackle complex visual tasks, by way of program synthesis. However, such approaches overlook user constraints (e.g., performance / computational needs), produce test-time sample-specific solutions that are difficult to deploy, and, sometimes, require low-level instructions that maybe beyond the abilities of a naive user. To address these limitations, we introduce MMFactory, a universal framework that includes model and metrics routing components, acting like a solution search engine across various available models. Based on a task description and few sample input-output pairs and (optionally) resource and/or performance constraints, MMFactory can suggest a diverse pool of programmatic solutions by instantiating and combining visio-lingual tools from its model repository. In addition to synthesizing these solutions, MMFactory also proposes metrics and benchmarks performance / resource characteristics, allowing users to pick a solution that meets their unique design constraints. From the technical perspective, we also introduced a committee-based solution proposer that leverages multi-agent LLM conversation to generate executable, diverse, universal, and robust solutions for the user. Experimental results show that MMFactory outperforms existing methods by delivering state-of-the-art solutions tailored to user problem specifications. Project page is available at https://davidhalladay.github.io/mmfactory_demo.

We introduce a new benchmark, ChartMimic, aimed at assessing the visually-grounded code generation capabilities of large multimodal models (LMMs). ChartMimic utilizes information-intensive visual charts and textual instructions as inputs, requiring LMMs to generate the corresponding code for chart rendering. ChartMimic includes 1,000 human-curated (figure, instruction, code) triplets, which represent the authentic chart use cases found in scientific papers across various domains(e.g., Physics, Computer Science, Economics, etc). These charts span 18 regular types and 4 advanced types, diversifying into 191 subcategories. Furthermore, we propose multi-level evaluation metrics to provide an automatic and thorough assessment of the output code and the rendered charts. Unlike existing code generation benchmarks, ChartMimic places emphasis on evaluating LMMs' capacity to harmonize a blend of cognitive capabilities, encompassing visual understanding, code generation, and cross-modal reasoning. The evaluation of 3 proprietary models and 11 open-weight models highlights the substantial challenges posed by ChartMimic. Even the advanced GPT-4V, Claude-3-opus only achieve an average score of 73.2 and 53.7, respectively, indicating significant room for improvement. We anticipate that ChartMimic will inspire the development of LMMs, advancing the pursuit of artificial general intelligence.

Current long-context benchmarks primarily focus on retrieval-based tests, requiring Large Language Models (LLMs) to locate specific information within extensive input contexts, such as the needle-in-a-haystack (NIAH) benchmark. Long-context generation refers to the ability of a language model to generate coherent and contextually accurate text that spans across lengthy passages or documents. While recent studies show strong performance on NIAH and other retrieval-based long-context benchmarks, there is a significant lack of benchmarks for evaluating long-context generation capabilities. To bridge this gap and offer a comprehensive assessment, we introduce a synthetic benchmark, LongGenBench, which allows for flexible configurations of customized generation context lengths. LongGenBench advances beyond traditional benchmarks by redesigning the format of questions and necessitating that LLMs respond with a single, cohesive long-context answer. Upon extensive evaluation using LongGenBench, we observe that: (1) both API accessed and open source models exhibit performance degradation in long-context generation scenarios, ranging from 1.2% to 47.1%; (2) different series of LLMs exhibit varying trends of performance degradation, with the Gemini-1.5-Flash model showing the least degradation among API accessed models, and the Qwen2 series exhibiting the least degradation in LongGenBench among open source models.

Although recent advances in scaling large language models (LLMs) have resulted in improvements on many NLP tasks, it remains unclear whether these models trained primarily with general web text are the right tool in highly specialized, safety critical domains such as clinical text. Recent results have suggested that LLMs encode a surprising amount of medical knowledge. This raises an important question regarding the utility of smaller domain-specific language models. With the success of general-domain LLMs, is there still a need for specialized clinical models? To investigate this question, we conduct an extensive empirical analysis of 12 language models, ranging from 220M to 175B parameters, measuring their performance on 3 different clinical tasks that test their ability to parse and reason over electronic health records. As part of our experiments, we train T5-Base and T5-Large models from scratch on clinical notes from MIMIC III and IV to directly investigate the efficiency of clinical tokens. We show that relatively small specialized clinical models substantially outperform all in-context learning approaches, even when finetuned on limited annotated data. Further, we find that pretraining on clinical tokens allows for smaller, more parameter-efficient models that either match or outperform much larger language models trained on general text. We release the code and the models used under the PhysioNet Credentialed Health Data license and data use agreement.

We introduce WiCkeD, a simple method to increase the complexity of existing multiple-choice benchmarks by randomly replacing a choice with "None of the above", a method often used in educational tests. We show that WiCkeD can be automatically applied to any existing benchmark, making it more challenging. We apply WiCkeD to 6 popular benchmarks and use it to evaluate 18 open-weight LLMs. The performance of the models drops 12.1 points on average with respect to the original versions of the datasets. When using chain-of-thought on 3 MMLU datasets, the performance drop for the WiCkeD variant is similar to the one observed when using the LLMs directly, showing that WiCkeD is also challenging for models with enhanced reasoning abilities. WiCkeD also uncovers that some models are more sensitive to the extra reasoning required, providing additional information with respect to the original benchmarks. We relase our code and data at https://github.com/ahmedselhady/wicked-benchmarks.

Recent advances in large language models (LLMs) have led to the development of various evaluation benchmarks. These benchmarks typically rely on a single instruction template for evaluating all LLMs on a specific task. In this paper, we comprehensively analyze the brittleness of results obtained via single-prompt evaluations across 6.5M instances, involving 20 different LLMs and 39 tasks from 3 benchmarks. To improve robustness of the analysis, we propose to evaluate LLMs with a set of diverse prompts instead. We discuss tailored evaluation metrics for specific use cases (e.g., LLM developers vs. developers interested in a specific downstream task), ensuring a more reliable and meaningful assessment of LLM capabilities. We then implement these criteria and conduct evaluations of multiple models, providing insights into the true strengths and limitations of current LLMs.

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well-understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

Recent advancements in Large Language Models (LLMs) and their utilization in code generation tasks have significantly reshaped the field of software development. Despite the remarkable efficacy of code completion solutions in mainstream programming languages, their performance lags when applied to less ubiquitous formats such as OpenAPI definitions. This study evaluates the OpenAPI completion performance of GitHub Copilot, a prevalent commercial code completion tool, and proposes a set of task-specific optimizations leveraging Meta's open-source model Code Llama. A semantics-aware OpenAPI completion benchmark proposed in this research is used to perform a series of experiments through which the impact of various prompt-engineering and fine-tuning techniques on the Code Llama model's performance is analyzed. The fine-tuned Code Llama model reaches a peak correctness improvement of 55.2% over GitHub Copilot despite utilizing 25 times fewer parameters than the commercial solution's underlying Codex model. Additionally, this research proposes an enhancement to a widely used code infilling training technique, addressing the issue of underperformance when the model is prompted with context sizes smaller than those used during training. The dataset, the benchmark, and the model fine-tuning code are made publicly available.

We introduce self-invoking code generation, a new task designed to evaluate the progressive reasoning and problem-solving capabilities of LLMs. In this task, models are presented with a base problem and a related, more complex problem. They must solve the base problem and then utilize its solution to address the more complex one. This work features three key contributions. First, we propose a general recipe for generating more challenging versions of existing benchmarks, resulting in three new benchmarks: HumanEval Pro, MBPP Pro, and BigCodeBench-Lite Pro, specifically designed to assess LLMs on self-invoking code generation. Second, from the analysis of experimental results over twenty LLMs on our benchmarks, we have two important observations: (i) Most LLMs excel in traditional code generation benchmarks like HumanEval and MBPP, but their performance declines on self-invoking tasks. For example, o1-mini achieves 96.2% pass@1 on HumanEval but only 76.2% on HumanEval Pro. (ii) On self-invoking code generation task, the instruction-tuned models demonstrate only marginal improvements compared to the base models. Third, we disclose the types of failure modes that exist in our evaluation results. All these results underscore the need for further advancements in self-invoking code generation tasks and provide a new direction for future research on enhancing LLMs' code reasoning capabilities.

The advancement of natural language processing (NLP) systems in healthcare hinges on language model ability to interpret the intricate information contained within clinical notes. This process often requires integrating information from various time points in a patient's medical history. However, most earlier clinical language models were pretrained with a context length limited to roughly one clinical document. In this study, We introduce ClinicalMamba, a specialized version of the Mamba language model, pretrained on a vast corpus of longitudinal clinical notes to address the unique linguistic characteristics and information processing needs of the medical domain. ClinicalMamba, with 130 million and 2.8 billion parameters, demonstrates a superior performance in modeling clinical language across extended text lengths compared to Mamba and clinical Llama. With few-shot learning, ClinicalMamba achieves notable benchmarks in speed and accuracy, outperforming existing clinical language models and general domain large models like GPT-4 in longitudinal clinical notes information extraction tasks.

The rapid deployment of Large Language Models (LLMs) requires careful consideration of their effect on cybersecurity. Our work aims to improve the selection process of LLMs that are suitable for facilitating Secure Coding (SC). This raises challenging research questions, such as (RQ1) Which functionality can streamline the LLM evaluation? (RQ2) What should the evaluation measure? (RQ3) How to attest that the evaluation process is impartial? To address these questions, we introduce LLMSecCode, an open-source evaluation framework designed to assess LLM SC capabilities objectively. We validate the LLMSecCode implementation through experiments. When varying parameters and prompts, we find a 10% and 9% difference in performance, respectively. We also compare some results to reliable external actors, where our results show a 5% difference. We strive to ensure the ease of use of our open-source framework and encourage further development by external actors. With LLMSecCode, we hope to encourage the standardization and benchmarking of LLMs' capabilities in security-oriented code and tasks.

Despite the vast repository of global medical knowledge predominantly being in English, local languages are crucial for delivering tailored healthcare services, particularly in areas with limited medical resources. To extend the reach of medical AI advancements to a broader population, we aim to develop medical LLMs across the six most widely spoken languages, encompassing a global population of 6.1 billion. This effort culminates in the creation of the ApolloCorpora multilingual medical dataset and the XMedBench benchmark. In the multilingual medical benchmark, the released Apollo models, at various relatively-small sizes (i.e., 0.5B, 1.8B, 2B, 6B, and 7B), achieve the best performance among models of equivalent size. Especially, Apollo-7B is the state-of-the-art multilingual medical LLMs up to 70B. Additionally, these lite models could be used to improve the multi-lingual medical capabilities of larger models without fine-tuning in a proxy-tuning fashion. We will open-source training corpora, code, model weights and evaluation benchmark.

Medical knowledge is context-dependent and requires consistent reasoning across various natural language expressions of semantically equivalent phrases. This is particularly crucial for drug names, where patients often use brand names like Advil or Tylenol instead of their generic equivalents. To study this, we create a new robustness dataset, RABBITS, to evaluate performance differences on medical benchmarks after swapping brand and generic drug names using physician expert annotations. We assess both open-source and API-based LLMs on MedQA and MedMCQA, revealing a consistent performance drop ranging from 1-10\%. Furthermore, we identify a potential source of this fragility as the contamination of test data in widely used pre-training datasets. All code is accessible at https://github.com/BittermanLab/RABBITS, and a HuggingFace leaderboard is available at https://huggingface.co/spaces/AIM-Harvard/rabbits-leaderboard.

Recent artificial intelligence (AI) systems have reached milestones in "grand challenges" ranging from Go to protein-folding. The capability to retrieve medical knowledge, reason over it, and answer medical questions comparably to physicians has long been viewed as one such grand challenge. Large language models (LLMs) have catalyzed significant progress in medical question answering; Med-PaLM was the first model to exceed a "passing" score in US Medical Licensing Examination (USMLE) style questions with a score of 67.2% on the MedQA dataset. However, this and other prior work suggested significant room for improvement, especially when models' answers were compared to clinicians' answers. Here we present Med-PaLM 2, which bridges these gaps by leveraging a combination of base LLM improvements (PaLM 2), medical domain finetuning, and prompting strategies including a novel ensemble refinement approach. Med-PaLM 2 scored up to 86.5% on the MedQA dataset, improving upon Med-PaLM by over 19% and setting a new state-of-the-art. We also observed performance approaching or exceeding state-of-the-art across MedMCQA, PubMedQA, and MMLU clinical topics datasets. We performed detailed human evaluations on long-form questions along multiple axes relevant to clinical applications. In pairwise comparative ranking of 1066 consumer medical questions, physicians preferred Med-PaLM 2 answers to those produced by physicians on eight of nine axes pertaining to clinical utility (p < 0.001). We also observed significant improvements compared to Med-PaLM on every evaluation axis (p < 0.001) on newly introduced datasets of 240 long-form "adversarial" questions to probe LLM limitations. While further studies are necessary to validate the efficacy of these models in real-world settings, these results highlight rapid progress towards physician-level performance in medical question answering.

The discharge summary is a one of critical documents in the patient journey, encompassing all events experienced during hospitalization, including multiple visits, medications, tests, surgery/procedures, and admissions/discharge. Providing a summary of the patient's progress is crucial, as it significantly influences future care and planning. Consequently, clinicians face the laborious and resource-intensive task of manually collecting, organizing, and combining all the necessary data for a discharge summary. Therefore, we propose "NOTE", which stands for "Notable generation Of patient Text summaries through an Efficient approach based on direct preference optimization". NOTE is based on Medical Information Mart for Intensive Care- III dataset and summarizes a single hospitalization of a patient. Patient events are sequentially combined and used to generate a discharge summary for each hospitalization. In the present circumstances, large language models' application programming interfaces (LLMs' APIs) are widely available, but importing and exporting medical data presents significant challenges due to privacy protection policies in healthcare institutions. Moreover, to ensure optimal performance, it is essential to implement a lightweight model for internal server or program within the hospital. Therefore, we utilized DPO and parameter efficient fine tuning (PEFT) techniques to apply a fine-tuning method that guarantees superior performance. To demonstrate the practical application of the developed NOTE, we provide a webpage-based demonstration software. In the future, we will aim to deploy the software available for actual use by clinicians in hospital. NOTE can be utilized to generate various summaries not only discharge summaries but also throughout a patient's journey, thereby alleviating the labor-intensive workload of clinicians and aiming for increased efficiency.

Medical coding is the task of assigning medical codes to clinical free-text documentation. Healthcare professionals manually assign such codes to track patient diagnoses and treatments. Automated medical coding can considerably alleviate this administrative burden. In this paper, we reproduce, compare, and analyze state-of-the-art automated medical coding machine learning models. We show that several models underperform due to weak configurations, poorly sampled train-test splits, and insufficient evaluation. In previous work, the macro F1 score has been calculated sub-optimally, and our correction doubles it. We contribute a revised model comparison using stratified sampling and identical experimental setups, including hyperparameters and decision boundary tuning. We analyze prediction errors to validate and falsify assumptions of previous works. The analysis confirms that all models struggle with rare codes, while long documents only have a negligible impact. Finally, we present the first comprehensive results on the newly released MIMIC-IV dataset using the reproduced models. We release our code, model parameters, and new MIMIC-III and MIMIC-IV training and evaluation pipelines to accommodate fair future comparisons.

Large Language Models (LLMs) have propelled groundbreaking advancements across several domains and are commonly used for text generation applications. However, the computational demands of these complex models pose significant challenges, requiring efficient hardware acceleration. Benchmarking the performance of LLMs across diverse hardware platforms is crucial to understanding their scalability and throughput characteristics. We introduce LLM-Inference-Bench, a comprehensive benchmarking suite to evaluate the hardware inference performance of LLMs. We thoroughly analyze diverse hardware platforms, including GPUs from Nvidia and AMD and specialized AI accelerators, Intel Habana and SambaNova. Our evaluation includes several LLM inference frameworks and models from LLaMA, Mistral, and Qwen families with 7B and 70B parameters. Our benchmarking results reveal the strengths and limitations of various models, hardware platforms, and inference frameworks. We provide an interactive dashboard to help identify configurations for optimal performance for a given hardware platform.

Objective: Data unavailability has been one of the biggest barriers in clinical natural language processing. This paper is aimed at providing a large-scale and publicly available patient note dataset, named PMC-Patients, with relevant articles and similar patients annotations. The ultimate goal of PMC-Patients is to facilitate the development of retrieval-based clinical decision support systems. Materials and Methods: To collect PMC-Patients, we extract patient notes from case reports in PubMed Central by recognizing certain section patterns. Patient-article relevance and patient-patient similarity are annotated by citation relationships in PubMed. In addition, we perform three tasks with PMC-Patients to demonstrate its utility in providing clinical decision support for a given patient, including (1) classifying whether another patient is similar, (2) retrieving similar patients in PMC-Patients, and (3) retrieving relevant articles in PubMed. Results: We collect and release PMC-Patients under the CC BY-NC-SA license, which becomes the largest publicly available patient note dataset so far. PMC-Patients contains 167k patient notes that are annotated with 3.1M relevant articles and 293k similar patients. Qualitative and quantitative analyses reveal the high quality and richness of our dataset. Experiments show that classifying the similarity of patient pairs is relatively easy, but it is hard to retrieve similar patients or relevant articles for a given patient from a large set of candidates. Conclusion: We present PMC-Patients, a large-scale dataset of patient notes with high quality, easy access, diverse conditions, and rich annotations. The proposed dataset can also serve as a hard benchmark for evaluating retrieval-based clinical decision support systems.

Large Language Models (LLMs) have demonstrated exceptional coding capability. However, as another critical component of programming proficiency, the debugging capability of LLMs remains relatively unexplored. Previous evaluations of LLMs' debugging ability are significantly limited by the risk of data leakage, the scale of the dataset, and the variety of tested bugs. To overcome these deficiencies, we introduce `DebugBench', an LLM debugging benchmark consisting of 4,253 instances. It covers four major bug categories and 18 minor types in C++, Java, and Python. To construct DebugBench, we collect code snippets from the LeetCode community, implant bugs into source data with GPT-4, and assure rigorous quality checks. We evaluate two commercial and three open-source models in a zero-shot scenario. We find that (1) while closed-source models like GPT-4 exhibit inferior debugging performance compared to humans, open-source models such as Code Llama fail to attain any pass rate scores; (2) the complexity of debugging notably fluctuates depending on the bug category; (3) incorporating runtime feedback has a clear impact on debugging performance which is not always helpful. As an extension, we also compare LLM debugging and code generation, revealing a strong correlation between them for closed-source models. These findings will benefit the development of LLMs in debugging.

Deep learning is currently the state-of-the-art for automated detection of referable diabetic retinopathy (DR) from color fundus photographs (CFP). While the general interest is put on improving results through methodological innovations, it is not clear how good these approaches perform compared to standard deep classification models trained with the appropriate settings. In this paper we propose to model a strong baseline for this task based on a simple and standard ResNet-18 architecture. To this end, we built on top of prior art by training the model with a standard preprocessing strategy but using images from several public sources and an empirically calibrated data augmentation setting. To evaluate its performance, we covered multiple clinically relevant perspectives, including image and patient level DR screening, discriminating responses by input quality and DR grade, assessing model uncertainties and analyzing its results in a qualitative manner. With no other methodological innovation than a carefully designed training, our ResNet model achieved an AUC = 0.955 (0.953 - 0.956) on a combined test set of 61007 test images from different public datasets, which is in line or even better than what other more complex deep learning models reported in the literature. Similar AUC values were obtained in 480 images from two separate in-house databases specially prepared for this study, which emphasize its generalization ability. This confirms that standard networks can still be strong baselines for this task if properly trained.

A crucial step within secondary analysis of electronic health records (EHRs) is to identify the patient cohort under investigation. While EHRs contain medical billing codes that aim to represent the conditions and treatments patients may have, much of the information is only present in the patient notes. Therefore, it is critical to develop robust algorithms to infer patients' conditions and treatments from their written notes. In this paper, we introduce a dataset for patient phenotyping, a task that is defined as the identification of whether a patient has a given medical condition (also referred to as clinical indication or phenotype) based on their patient note. Nursing Progress Notes and Discharge Summaries from the Intensive Care Unit of a large tertiary care hospital were manually annotated for the presence of several high-context phenotypes relevant to treatment and risk of re-hospitalization. This dataset contains 1102 Discharge Summaries and 1000 Nursing Progress Notes. Each Discharge Summary and Progress Note has been annotated by at least two expert human annotators (one clinical researcher and one resident physician). Annotated phenotypes include treatment non-adherence, chronic pain, advanced/metastatic cancer, as well as 10 other phenotypes. This dataset can be utilized for academic and industrial research in medicine and computer science, particularly within the field of medical natural language processing.

Large language models (LLM) have achieved impressive performance on medical question-answering benchmarks. However, high benchmark accuracy does not imply that the performance generalizes to real-world clinical settings. Medical question-answering benchmarks rely on assumptions consistent with quantifying LLM performance but that may not hold in the open world of the clinic. Yet LLMs learn broad knowledge that can help the LLM generalize to practical conditions regardless of unrealistic assumptions in celebrated benchmarks. We seek to quantify how well LLM medical question-answering benchmark performance generalizes when benchmark assumptions are violated. Specifically, we present an adversarial method that we call MedFuzz (for medical fuzzing). MedFuzz attempts to modify benchmark questions in ways aimed at confounding the LLM. We demonstrate the approach by targeting strong assumptions about patient characteristics presented in the MedQA benchmark. Successful "attacks" modify a benchmark item in ways that would be unlikely to fool a medical expert but nonetheless "trick" the LLM into changing from a correct to an incorrect answer. Further, we present a permutation test technique that can ensure a successful attack is statistically significant. We show how to use performance on a "MedFuzzed" benchmark, as well as individual successful attacks. The methods show promise at providing insights into the ability of an LLM to operate robustly in more realistic settings.

In this study, we aim to initiate the development of Radiology Foundation Model, termed as RadFM.We consider the construction of foundational models from the perspectives of data, model design, and evaluation thoroughly. Our contribution can be concluded as follows: (i), we construct a large-scale Medical Multi-modal Dataset, MedMD, consisting of 16M 2D and 3D medical scans. To the best of our knowledge, this is the first multi-modal dataset containing 3D medical scans. (ii), We propose an architecture that enables visually conditioned generative pre-training, allowing for the integration of text input interleaved with 2D or 3D medical scans to generate response for diverse radiologic tasks. The model was initially pre-trained on MedMD and subsequently domain-specific fine-tuned on RadMD, a radiologic cleaned version of MedMD, containing 3M radiologic visual-language pairs. (iii), we propose a new evaluation benchmark that comprises five tasks, aiming to comprehensively assess the capability of foundation models in handling practical clinical problems. Our experimental results confirm that RadFM significantly outperforms existing multi-modal foundation models. The codes, data, and model checkpoint will all be made publicly available to promote further research and development in the field.

The development of large language models tailored for handling patients' clinical notes is often hindered by the limited accessibility and usability of these notes due to strict privacy regulations. To address these challenges, we first create synthetic large-scale clinical notes using publicly available case reports extracted from biomedical literature. We then use these synthetic notes to train our specialized clinical large language model, Asclepius. While Asclepius is trained on synthetic data, we assess its potential performance in real-world applications by evaluating it using real clinical notes. We benchmark Asclepius against several other large language models, including GPT-3.5-turbo and other open-source alternatives. To further validate our approach using synthetic notes, we also compare Asclepius with its variants trained on real clinical notes. Our findings convincingly demonstrate that synthetic clinical notes can serve as viable substitutes for real ones when constructing high-performing clinical language models. This conclusion is supported by detailed evaluations conducted by both GPT-4 and medical professionals. All resources including weights, codes, and data used in the development of Asclepius are made publicly accessible for future research.

Mixture of Expert Tuning (MoE-Tuning) has effectively enhanced the performance of general MLLMs with fewer parameters, yet its application in resource-limited medical settings has not been fully explored. To address this gap, we developed MoE-TinyMed, a model tailored for medical applications that significantly lowers parameter demands. In evaluations on the VQA-RAD, SLAKE, and Path-VQA datasets, MoE-TinyMed outperformed LLaVA-Med in all Med-VQA closed settings with just 3.6B parameters. Additionally, a streamlined version with 2B parameters surpassed LLaVA-Med's performance in PathVQA, showcasing its effectiveness in resource-limited healthcare settings.

The automatic evaluation of instruction following typically involves using large language models (LLMs) to assess response quality. However, there is a lack of comprehensive evaluation of these LLM-based evaluators across two dimensions: the base LLMs and the evaluation protocols. Therefore, we present a thorough meta-evaluation of instruction following, including 25 base LLMs and 15 recently proposed evaluation protocols, on 4 human-annotated datasets, assessing the evaluation accuracy of the LLM-evaluators. Our evaluation allows us to identify the best-performing base LLMs and evaluation protocols with a high degree of robustness. Moreover, our large-scale evaluation reveals: (1) Base LLM performance ranking remains largely consistent across evaluation protocols, with less capable LLMs showing greater improvement from protocol enhancements; (2) Robust evaluation of evaluation protocols requires many base LLMs with varying capability levels, as protocol effectiveness can depend on the base LLM used; (3) Evaluation results on different datasets are not always consistent, so a rigorous evaluation requires multiple datasets with distinctive features. We release our meta-evaluation suite ReIFE, which provides the codebase and evaluation result collection for more than 500 LLM-evaluator configurations, to support future research in instruction-following evaluation.

Evaluating radiology reports is a challenging problem as factual correctness is extremely important due to the need for accurate medical communication about medical images. Existing automatic evaluation metrics either suffer from failing to consider factual correctness (e.g., BLEU and ROUGE) or are limited in their interpretability (e.g., F1CheXpert and F1RadGraph). In this paper, we introduce GREEN (Generative Radiology Report Evaluation and Error Notation), a radiology report generation metric that leverages the natural language understanding of language models to identify and explain clinically significant errors in candidate reports, both quantitatively and qualitatively. Compared to current metrics, GREEN offers: 1) a score aligned with expert preferences, 2) human interpretable explanations of clinically significant errors, enabling feedback loops with end-users, and 3) a lightweight open-source method that reaches the performance of commercial counterparts. We validate our GREEN metric by comparing it to GPT-4, as well as to error counts of 6 experts and preferences of 2 experts. Our method demonstrates not only higher correlation with expert error counts, but simultaneously higher alignment with expert preferences when compared to previous approaches."

We introduce Codex, a GPT language model fine-tuned on publicly available code from GitHub, and study its Python code-writing capabilities. A distinct production version of Codex powers GitHub Copilot. On HumanEval, a new evaluation set we release to measure functional correctness for synthesizing programs from docstrings, our model solves 28.8% of the problems, while GPT-3 solves 0% and GPT-J solves 11.4%. Furthermore, we find that repeated sampling from the model is a surprisingly effective strategy for producing working solutions to difficult prompts. Using this method, we solve 70.2% of our problems with 100 samples per problem. Careful investigation of our model reveals its limitations, including difficulty with docstrings describing long chains of operations and with binding operations to variables. Finally, we discuss the potential broader impacts of deploying powerful code generation technologies, covering safety, security, and economics.

Estimating the performance difficulty of a musical score is crucial in music education for adequately designing the learning curriculum of the students. Although the Music Information Retrieval community has recently shown interest in this task, existing approaches mainly use machine-readable scores, leaving the broader case of sheet music images unaddressed. Based on previous works involving sheet music images, we use a mid-level representation, bootleg score, describing notehead positions relative to staff lines coupled with a transformer model. This architecture is adapted to our task by introducing an encoding scheme that reduces the encoded sequence length to one-eighth of the original size. In terms of evaluation, we consider five datasets -- more than 7500 scores with up to 9 difficulty levels -- , two of them particularly compiled for this work. The results obtained when pretraining the scheme on the IMSLP corpus and fine-tuning it on the considered datasets prove the proposal's validity, achieving the best-performing model with a balanced accuracy of 40.34\% and a mean square error of 1.33. Finally, we provide access to our code, data, and models for transparency and reproducibility.

With the increasing code reasoning capabilities of existing large language models (LLMs) and breakthroughs in reasoning models like OpenAI o1 and o3, there is a growing need to develop more challenging and comprehensive benchmarks that effectively test their sophisticated competition-level coding abilities. Existing benchmarks, like LiveCodeBench and USACO, fall short due to the unavailability of private test cases, lack of support for special judges, and misaligned execution environments. To bridge this gap, we introduce CodeElo, a standardized competition-level code generation benchmark that effectively addresses all these challenges for the first time. CodeElo benchmark is mainly based on the official CodeForces platform and tries to align with the platform as much as possible. We compile the recent six months of contest problems on CodeForces with detailed information such as contest divisions, problem difficulty ratings, and problem algorithm tags. We introduce a unique judging method in which problems are submitted directly to the platform and develop a reliable Elo rating calculation system that aligns with the platform and is comparable with human participants but has lower variance. By testing on our CodeElo, we provide the Elo ratings of 30 existing popular open-source and 3 proprietary LLMs for the first time. The results show that o1-mini and QwQ-32B-Preview stand out significantly, achieving Elo ratings of 1578 and 1261, respectively, while other models struggle even with the easiest problems, placing in the lowest 20 percent among all human participants. Detailed analysis experiments are also conducted to provide insights into performance across algorithms and comparisons between using C++ and Python, which can suggest directions for future studies.

Foundation models are rapidly being developed for computational pathology applications. However, it remains an open question which factors are most important for downstream performance with data scale and diversity, model size, and training algorithm all playing a role. In this work, we present the result of scaling both data and model size, surpassing previous studies in both dimensions, and introduce two new models: Virchow 2, a 632M parameter vision transformer, and Virchow 2G, a 1.85B parameter vision transformer, each trained with 3.1M histopathology whole slide images. To support this scale, we propose domain-inspired adaptations to the DINOv2 training algorithm, which is quickly becoming the default method in self-supervised learning for computational pathology. We achieve state of the art performance on twelve tile-level tasks, as compared to the top performing competing models. Our results suggest that data diversity and domain-specific training can outperform models that only scale in the number of parameters, but, on average, performance benefits from domain-tailoring, data scale, and model scale.

In this work we explore recent advances in instruction-tuning language models on a range of open instruction-following datasets. Despite recent claims that open models can be on par with state-of-the-art proprietary models, these claims are often accompanied by limited evaluation, making it difficult to compare models across the board and determine the utility of various resources. We provide a large set of instruction-tuned models from 6.7B to 65B parameters in size, trained on 12 instruction datasets ranging from manually curated (e.g., OpenAssistant) to synthetic and distilled (e.g., Alpaca) and systematically evaluate them on their factual knowledge, reasoning, multilinguality, coding, and open-ended instruction following abilities through a collection of automatic, model-based, and human-based metrics. We further introduce T\"ulu, our best performing instruction-tuned model suite finetuned on a combination of high-quality open resources. Our experiments show that different instruction-tuning datasets can uncover or enhance specific skills, while no single dataset (or combination) provides the best performance across all evaluations. Interestingly, we find that model and human preference-based evaluations fail to reflect differences in model capabilities exposed by benchmark-based evaluations, suggesting the need for the type of systemic evaluation performed in this work. Our evaluations show that the best model in any given evaluation reaches on average 83% of ChatGPT performance, and 68% of GPT-4 performance, suggesting that further investment in building better base models and instruction-tuning data is required to close the gap. We release our instruction-tuned models, including a fully finetuned 65B T\"ulu, along with our code, data, and evaluation framework at https://github.com/allenai/open-instruct to facilitate future research.

This paper explores the limits of the current generation of large language models for program synthesis in general purpose programming languages. We evaluate a collection of such models (with between 244M and 137B parameters) on two new benchmarks, MBPP and MathQA-Python, in both the few-shot and fine-tuning regimes. Our benchmarks are designed to measure the ability of these models to synthesize short Python programs from natural language descriptions. The Mostly Basic Programming Problems (MBPP) dataset contains 974 programming tasks, designed to be solvable by entry-level programmers. The MathQA-Python dataset, a Python version of the MathQA benchmark, contains 23914 problems that evaluate the ability of the models to synthesize code from more complex text. On both datasets, we find that synthesis performance scales log-linearly with model size. Our largest models, even without finetuning on a code dataset, can synthesize solutions to 59.6 percent of the problems from MBPP using few-shot learning with a well-designed prompt. Fine-tuning on a held-out portion of the dataset improves performance by about 10 percentage points across most model sizes. On the MathQA-Python dataset, the largest fine-tuned model achieves 83.8 percent accuracy. Going further, we study the model's ability to engage in dialog about code, incorporating human feedback to improve its solutions. We find that natural language feedback from a human halves the error rate compared to the model's initial prediction. Additionally, we conduct an error analysis to shed light on where these models fall short and what types of programs are most difficult to generate. Finally, we explore the semantic grounding of these models by fine-tuning them to predict the results of program execution. We find that even our best models are generally unable to predict the output of a program given a specific input.

Continual pre-training has increasingly become the predominant approach for adapting Large Language Models (LLMs) to new domains. This process involves updating the pre-trained LLM with a corpus from a new domain, resulting in a shift in the training distribution. To study the behavior of LLMs during this shift, we measured the model's performance throughout the continual pre-training process. we observed a temporary performance drop at the beginning, followed by a recovery phase, a phenomenon known as the "stability gap," previously noted in vision models classifying new classes. To address this issue and enhance LLM performance within a fixed compute budget, we propose three effective strategies: (1) Continually pre-training the LLM on a subset with a proper size for multiple epochs, resulting in faster performance recovery than pre-training the LLM on a large corpus in a single epoch; (2) Pre-training the LLM only on high-quality sub-corpus, which rapidly boosts domain performance; and (3) Using a data mixture similar to the pre-training data to reduce distribution gap. We conduct various experiments on Llama-family models to validate the effectiveness of our strategies in both medical continual pre-training and instruction tuning. For example, our strategies improve the average medical task performance of the OpenLlama-3B model from 36.2% to 40.7% with only 40% of the original training budget and enhance the average general task performance without causing forgetting. Furthermore, we apply our strategies to the Llama-3-8B model. The resulting model, Llama-3-Physician, achieves the best medical performance among current open-source models, and performs comparably to or even better than GPT-4 on several medical benchmarks. We release our models at https://huggingface.co/YiDuo1999/Llama-3-Physician-8B-Instruct.

Diabetes is a chronic disease that poses a significant global health burden, and optimizing diabetes management requires multi-stakeholder collaboration. Large language models (LLMs) have shown promise in various healthcare scenarios, but their effectiveness across a diverse range of diabetes tasks remains unproven. In this study, we introduced a framework to train and validate diabetes-specific LLMs. We first developed a comprehensive data processing pipeline that includes data collection, filtering, augmentation and refinement. This approach contributes to creating a high-quality, diabetes-specific dataset, and several evaluation benchmarks entirely from scratch. Utilizing the collected training dataset, we fine-tuned a diabetes-specific LLM family that demonstrated state-of-the-art proficiency in understanding and processing various diabetes tasks compared to other LLMs. Furthermore, clinical studies showed the potential applications of our models in diabetes care, including providing personalized healthcare, assisting medical education, and streamlining clinical tasks. In conclusion, our study introduced a framework to develop and evaluate a diabetes-specific LLM family, and highlighted its potential to enhance clinical practice and provide personalized, data-driven support for diabetes support when facing different end users. The code is provided via GitHub at https://github.com/waltonfuture/Diabetica.

Evaluation of Large Language Models (LLMs) is challenging because aligning to human values requires the composition of multiple skills and the required set of skills varies depending on the instruction. Recent studies have evaluated the performance of LLMs in two ways, (1) automatic evaluation on several independent benchmarks and (2) human or machined-based evaluation giving an overall score to the response. However, both settings are coarse-grained evaluations, not considering the nature of user instructions that require instance-wise skill composition, which limits the interpretation of the true capabilities of LLMs. In this paper, we introduce FLASK (Fine-grained Language Model Evaluation based on Alignment SKill Sets), a fine-grained evaluation protocol that can be used for both model-based and human-based evaluation which decomposes coarse-level scoring to an instance-wise skill set-level. Specifically, we define 12 fine-grained skills needed for LLMs to follow open-ended user instructions and construct an evaluation set by allocating a set of skills for each instance. Additionally, by annotating the target domains and difficulty level for each instance, FLASK provides a holistic view with a comprehensive analysis of a model's performance depending on skill, domain, and difficulty. Through using FLASK, we compare multiple open-sourced and proprietary LLMs and observe highly-correlated findings between model-based and human-based evaluations. FLASK enables developers to more accurately measure the model performance and how it can be improved by analyzing factors that make LLMs proficient in particular skills. For practitioners, FLASK can be used to recommend suitable models for particular situations through comprehensive comparison among various LLMs. We release the evaluation data and code implementation at https://github.com/kaistAI/FLASK.

Visual instruction tuning has recently shown encouraging progress with open-source large multimodal models (LMM) such as LLaVA and MiniGPT-4. However, most existing studies of open-source LMM are performed using models with 13B parameters or smaller. In this paper we present an empirical study of scaling LLaVA up to 33B and 65B/70B, and share our findings from our explorations in image resolution, data mixing and parameter-efficient training methods such as LoRA/QLoRA. These are evaluated by their impact on the multi-modal and language capabilities when completing real-world tasks in the wild. We find that scaling LMM consistently enhances model performance and improves language capabilities, and performance of LoRA/QLoRA tuning of LMM are comparable to the performance of full-model fine-tuning. Additionally, the study highlights the importance of higher image resolutions and mixing multimodal-language data to improve LMM performance, and visual instruction tuning can sometimes improve LMM's pure language capability. We hope that this study makes state-of-the-art LMM research at a larger scale more accessible, thus helping establish stronger baselines for future research. Code and checkpoints will be made public.

This paper presents a comprehensive evaluation of GPT-4V's capabilities across diverse medical imaging tasks, including Radiology Report Generation, Medical Visual Question Answering (VQA), and Visual Grounding. While prior efforts have explored GPT-4V's performance in medical image analysis, to the best of our knowledge, our study represents the first quantitative evaluation on publicly available benchmarks. Our findings highlight GPT-4V's potential in generating descriptive reports for chest X-ray images, particularly when guided by well-structured prompts. Meanwhile, its performance on the MIMIC-CXR dataset benchmark reveals areas for improvement in certain evaluation metrics, such as CIDEr. In the domain of Medical VQA, GPT-4V demonstrates proficiency in distinguishing between question types but falls short of the VQA-RAD benchmark in terms of accuracy. Furthermore, our analysis finds the limitations of conventional evaluation metrics like the BLEU scores, advocating for the development of more semantically robust assessment methods. In the field of Visual Grounding, GPT-4V exhibits preliminary promise in recognizing bounding boxes, but its precision is lacking, especially in identifying specific medical organs and signs. Our evaluation underscores the significant potential of GPT-4V in the medical imaging domain, while also emphasizing the need for targeted refinements to fully unlock its capabilities.

Machine learning has demonstrated remarkable performance over finite datasets, yet whether the scores over the fixed benchmarks can sufficiently indicate the model's performance in the real world is still in discussion. In reality, an ideal robust model will probably behave similarly to the oracle (e.g., the human users), thus a good evaluation protocol is probably to evaluate the models' behaviors in comparison to the oracle. In this paper, we introduce a new robustness measurement that directly measures the image classification model's performance compared with a surrogate oracle (i.e., a foundation model). Besides, we design a simple method that can accomplish the evaluation beyond the scope of the benchmarks. Our method extends the image datasets with new samples that are sufficiently perturbed to be distinct from the ones in the original sets, but are still bounded within the same image-label structure the original test image represents, constrained by a foundation model pretrained with a large amount of samples. As a result, our new method will offer us a new way to evaluate the models' robustness performance, free of limitations of fixed benchmarks or constrained perturbations, although scoped by the power of the oracle. In addition to the evaluation results, we also leverage our generated data to understand the behaviors of the model and our new evaluation strategies.

Chest X-rays (CXRs) are the most frequently performed imaging test in clinical practice. Recent advances in the development of vision-language foundation models (FMs) give rise to the possibility of performing automated CXR interpretation, which can assist physicians with clinical decision-making and improve patient outcomes. However, developing FMs that can accurately interpret CXRs is challenging due to the (1) limited availability of large-scale vision-language datasets in the medical image domain, (2) lack of vision and language encoders that can capture the complexities of medical data, and (3) absence of evaluation frameworks for benchmarking the abilities of FMs on CXR interpretation. In this work, we address these challenges by first introducing CheXinstruct - a large-scale instruction-tuning dataset curated from 28 publicly-available datasets. We then present CheXagent - an instruction-tuned FM capable of analyzing and summarizing CXRs. To build CheXagent, we design a clinical large language model (LLM) for parsing radiology reports, a vision encoder for representing CXR images, and a network to bridge the vision and language modalities. Finally, we introduce CheXbench - a novel benchmark designed to systematically evaluate FMs across 8 clinically-relevant CXR interpretation tasks. Extensive quantitative evaluations and qualitative reviews with five expert radiologists demonstrate that CheXagent outperforms previously-developed general- and medical-domain FMs on CheXbench tasks. Furthermore, in an effort to improve model transparency, we perform a fairness evaluation across factors of sex, race and age to highlight potential performance disparities. Our project is at https://stanford-aimi.github.io/chexagent.html.

Over 85 million computed tomography (CT) scans are performed annually in the US, of which approximately one quarter focus on the abdomen. Given the current radiologist shortage, there is a large impetus to use artificial intelligence to alleviate the burden of interpreting these complex imaging studies. Prior state-of-the-art approaches for automated medical image interpretation leverage vision language models (VLMs). However, current medical VLMs are generally limited to 2D images and short reports, and do not leverage electronic health record (EHR) data for supervision. We introduce Merlin - a 3D VLM that we train using paired CT scans (6+ million images from 15,331 CTs), EHR diagnosis codes (1.8+ million codes), and radiology reports (6+ million tokens). We evaluate Merlin on 6 task types and 752 individual tasks. The non-adapted (off-the-shelf) tasks include zero-shot findings classification (31 findings), phenotype classification (692 phenotypes), and zero-shot cross-modal retrieval (image to findings and image to impressions), while model adapted tasks include 5-year disease prediction (6 diseases), radiology report generation, and 3D semantic segmentation (20 organs). We perform internal validation on a test set of 5,137 CTs, and external validation on 7,000 clinical CTs and on two public CT datasets (VerSe, TotalSegmentator). Beyond these clinically-relevant evaluations, we assess the efficacy of various network architectures and training strategies to depict that Merlin has favorable performance to existing task-specific baselines. We derive data scaling laws to empirically assess training data needs for requisite downstream task performance. Furthermore, unlike conventional VLMs that require hundreds of GPUs for training, we perform all training on a single GPU.

We introduce QuArch, a dataset of 1500 human-validated question-answer pairs designed to evaluate and enhance language models' understanding of computer architecture. The dataset covers areas including processor design, memory systems, and performance optimization. Our analysis highlights a significant performance gap: the best closed-source model achieves 84% accuracy, while the top small open-source model reaches 72%. We observe notable struggles in memory systems, interconnection networks, and benchmarking. Fine-tuning with QuArch improves small model accuracy by up to 8%, establishing a foundation for advancing AI-driven computer architecture research. The dataset and leaderboard are at https://harvard-edge.github.io/QuArch/.

As the capabilities of Large Language Models (LLMs) in healthcare and medicine continue to advance, there is a growing need for competitive open-source models that can safeguard public interest. With the increasing availability of highly competitive open base models, the impact of continued pre-training is increasingly uncertain. In this work, we explore the role of instruct tuning, model merging, alignment, red teaming and advanced inference schemes, as means to improve current open models. To that end, we introduce the Aloe family, a set of open medical LLMs highly competitive within its scale range. Aloe models are trained on the current best base models (Mistral, LLaMA 3), using a new custom dataset which combines public data sources improved with synthetic Chain of Thought (CoT). Aloe models undergo an alignment phase, becoming one of the first few policy-aligned open healthcare LLM using Direct Preference Optimization, setting a new standard for ethical performance in healthcare LLMs. Model evaluation expands to include various bias and toxicity datasets, a dedicated red teaming effort, and a much-needed risk assessment for healthcare LLMs. Finally, to explore the limits of current LLMs in inference, we study several advanced prompt engineering strategies to boost performance across benchmarks, yielding state-of-the-art results for open healthcare 7B LLMs, unprecedented at this scale.

Background: General-purpose large language models that utilize both text and images have not been evaluated on a diverse array of challenging medical cases. Methods: Using 934 cases from the NEJM Image Challenge published between 2005 and 2023, we evaluated the accuracy of the recently released Generative Pre-trained Transformer 4 with Vision model (GPT-4V) compared to human respondents overall and stratified by question difficulty, image type, and skin tone. We further conducted a physician evaluation of GPT-4V on 69 NEJM clinicopathological conferences (CPCs). Analyses were conducted for models utilizing text alone, images alone, and both text and images. Results: GPT-4V achieved an overall accuracy of 61% (95% CI, 58 to 64%) compared to 49% (95% CI, 49 to 50%) for humans. GPT-4V outperformed humans at all levels of difficulty and disagreement, skin tones, and image types; the exception was radiographic images, where performance was equivalent between GPT-4V and human respondents. Longer, more informative captions were associated with improved performance for GPT-4V but similar performance for human respondents. GPT-4V included the correct diagnosis in its differential for 80% (95% CI, 68 to 88%) of CPCs when using text alone, compared to 58% (95% CI, 45 to 70%) of CPCs when using both images and text. Conclusions: GPT-4V outperformed human respondents on challenging medical cases and was able to synthesize information from both images and text, but performance deteriorated when images were added to highly informative text. Overall, our results suggest that multimodal AI models may be useful in medical diagnostic reasoning but that their accuracy may depend heavily on context.

The integration of Large Language Models (LLMs) into healthcare promises to transform medical diagnostics, research, and patient care. Yet, the progression of medical LLMs faces obstacles such as complex training requirements, rigorous evaluation demands, and the dominance of proprietary models that restrict academic exploration. Transparent, comprehensive access to LLM resources is essential for advancing the field, fostering reproducibility, and encouraging innovation in healthcare AI. We present Hippocrates, an open-source LLM framework specifically developed for the medical domain. In stark contrast to previous efforts, it offers unrestricted access to its training datasets, codebase, checkpoints, and evaluation protocols. This open approach is designed to stimulate collaborative research, allowing the community to build upon, refine, and rigorously evaluate medical LLMs within a transparent ecosystem. Also, we introduce Hippo, a family of 7B models tailored for the medical domain, fine-tuned from Mistral and LLaMA2 through continual pre-training, instruction tuning, and reinforcement learning from human and AI feedback. Our models outperform existing open medical LLMs models by a large-margin, even surpassing models with 70B parameters. Through Hippocrates, we aspire to unlock the full potential of LLMs not just to advance medical knowledge and patient care but also to democratize the benefits of AI research in healthcare, making them available across the globe.

Scaling test-time compute is a promising axis for improving LLM capabilities. However, test-time compute can be scaled in a variety of ways, and effectively combining different approaches remains an active area of research. Here, we explore this problem in the context of solving real-world GitHub issues from the SWE-bench dataset. Our system, named CodeMonkeys, allows models to iteratively edit a codebase by jointly generating and running a testing script alongside their draft edit. We sample many of these multi-turn trajectories for every issue to generate a collection of candidate edits. This approach lets us scale "serial" test-time compute by increasing the number of iterations per trajectory and "parallel" test-time compute by increasing the number of trajectories per problem. With parallel scaling, we can amortize up-front costs across multiple downstream samples, allowing us to identify relevant codebase context using the simple method of letting an LLM read every file. In order to select between candidate edits, we combine voting using model-generated tests with a final multi-turn trajectory dedicated to selection. Overall, CodeMonkeys resolves 57.4% of issues from SWE-bench Verified using a budget of approximately 2300 USD. Our selection method can also be used to combine candidates from different sources. Selecting over an ensemble of edits from existing top SWE-bench Verified submissions obtains a score of 66.2% and outperforms the best member of the ensemble on its own. We fully release our code and data at https://scalingintelligence.stanford.edu/pubs/codemonkeys.

Code generation models have increasingly become integral to aiding software development, offering assistance in tasks such as code completion, debugging, and code translation. Although current research has thoroughly examined the correctness of code produced by code generation models, a vital aspect, i.e., the efficiency of the generated code, has often been neglected. This paper presents EffiBench, a benchmark with 1,000 efficiency-critical coding problems for assessing the efficiency of code generated by code generation models. EffiBench contains a diverse set of LeetCode coding problems. Each problem is paired with an executable human-written canonical solution. With EffiBench, we empirically examine the capability of 21 Large Language Models (13 open-sourced and 8 closed-sourced) in generating efficient code. The results demonstrate that GPT-4-turbo generates the most efficient code, significantly outperforming Palm-2-chat-bison, Claude-instant-1, Gemini-pro, GPT-4, and GPT-3.5. Nevertheless, its code efficiency is still worse than the efficiency of human-written canonical solutions. In particular, the average and worst execution time of GPT-4-turbo generated code is 1.69 and 45.49 times that of the canonical solutions.