Cohort Discovery: A Survey on LLM-Assisted Clinical Trial Recruitment

Recent advances in LLMs have greatly improved general-domain NLP tasks. Yet, their adoption in critical domains, such as clinical trial recruitment, remains limited. As trials are designed in natural language and patient data is represented as both structured and unstructured text, the task of matching trials and patients benefits from knowledge aggregation and reasoning abilities of LLMs. Classical approaches are trial-specific and LLMs with their ability to consolidate distributed knowledge hold the potential to build a more general solution. Yet recent applications of LLM-assisted methods rely on proprietary models and weak evaluation benchmarks. In this survey, we are the first to analyze the task of trial-patient matching and contextualize emerging LLM-based approaches in clinical trial recruitment. We critically examine existing benchmarks, approaches and evaluation frameworks, the challenges to adopting LLM technologies in clinical research and exciting future directions.

Beyond Multiple Choice: Evaluating Steering Vectors for Adaptive Free-Form Summarization

Steering vectors are a lightweight method for controlling text properties by adding a learned bias to language model activations at inference time. So far, steering vectors have predominantly been evaluated in multiple-choice settings, while their effectiveness in free-form generation tasks remains understudied. Moving "Beyond Multiple Choice," we thoroughly evaluate the effectiveness of steering vectors in adaptively controlling topical focus, sentiment, toxicity, and readability in abstractive summaries of the NEWTS dataset. We find that steering effectively controls the targeted summary properties, but high steering strengths consistently degrade both intrinsic and extrinsic text quality. Compared to steering, prompting offers weaker control, while preserving text quality. Combining steering and prompting yields the strongest control over text properties and offers the most favorable efficacy-quality trade-off at moderate steering strengths. Our results underscore the practical trade-off between control strength and text quality preservation when applying steering vectors to free-form generation tasks.

Understanding (Un)Reliability of Steering Vectors in Language Models

Steering vectors are a lightweight method to control language model behavior by adding a learned bias to the activations at inference time. Although steering demonstrates promising performance, recent work shows that it can be unreliable or even counterproductive in some cases. This paper studies the influence of prompt types and the geometry of activation differences on steering reliability. First, we find that all seven prompt types used in our experiments produce a net positive steering effect, but exhibit high variance across samples, and often give an effect opposite of the desired one. No prompt type clearly outperforms the others, and yet the steering vectors resulting from the different prompt types often differ directionally (as measured by cosine similarity). Second, we show that higher cosine similarity between training set activation differences predicts more effective steering. Finally, we observe that datasets where positive and negative activations are better separated are more steerable. Our results suggest that vector steering is unreliable when the target behavior is not represented by a coherent direction.

Paths Not Taken: Understanding and Mending the Multilingual Factual Recall Pipeline

Multilingual large language models (LLMs) often exhibit factual inconsistencies across languages, with significantly better performance in factual recall tasks in English than in other languages. The causes of these failures, however, remain poorly understood. Using mechanistic analysis techniques, we uncover the underlying pipeline that LLMs employ, which involves using the English-centric factual recall mechanism to process multilingual queries and then translating English answers back into the target language. We identify two primary sources of error: insufficient engagement of the reliable English-centric mechanism for factual recall, and incorrect translation from English back into the target language for the final answer. To address these vulnerabilities, we introduce two vector interventions, both independent of languages and datasets, to redirect the model toward better internal paths for higher factual consistency. Our interventions combined increase the recall accuracy by over 35 percent for the lowest-performing language. Our findings demonstrate how mechanistic insights can be used to unlock latent multilingual capabilities in LLMs.

TRIM: Achieving Extreme Sparsity with Targeted Row-wise Iterative Metric-driven Pruning

Large Language Models (LLMs) present significant computational and memory challenges due to their extensive size, making pruning essential for their efficient deployment. Existing one-shot pruning methods often apply uniform sparsity constraints across layers or within each layer, resulting in suboptimal performance, especially at high sparsity ratios. This work introduces TRIM (Targeted Row-wise Iterative Metric-driven pruning), a novel approach that applies varying sparsity ratios to individual output dimensions (rows) within each layer. TRIM employs an iterative adjustment process guided by quality metrics to optimize dimension-wise sparsity allocation, focusing on reducing variance in quality retention across outputs to preserve critical information. TRIM can be seamlessly integrated with existing layer-wise pruning strategies. Our evaluations on perplexity and zero-shot tasks across diverse LLM families (Qwen2.5, LLaMA-2, and OPT) and sparsity levels demonstrate that TRIM achieves new state-of-the-art results and enhances stability. For instance, at 80% sparsity, TRIM reduces perplexity by 48% for Qwen2.5-14B and over 90% for OPT-13B compared to baseline methods. We conclude that fine-grained, dimension-wise sparsity adaptation is crucial for pushing the limits of extreme LLM compression. Code available at: https://github.com/flobk/TRIM

Pixels Versus Priors: Controlling Knowledge Priors in Vision-Language Models through Visual Counterfacts

Multimodal Large Language Models (MLLMs) perform well on tasks such as visual question answering, but it remains unclear whether their reasoning relies more on memorized world knowledge or on the visual information present in the input image. To investigate this, we introduce Visual CounterFact, a new dataset of visually-realistic counterfactuals that put world knowledge priors (e.g, red strawberry) into direct conflict with visual input (e.g, blue strawberry). Using Visual CounterFact, we show that model predictions initially reflect memorized priors, but shift toward visual evidence in mid-to-late layers. This dynamic reveals a competition between the two modalities, with visual input ultimately overriding priors during evaluation. To control this behavior, we propose Pixels Versus Priors (PvP) steering vectors, a mechanism for controlling model outputs toward either world knowledge or visual input through activation-level interventions. On average, PvP successfully shifts 92.5% of color and 74.6% of size predictions from priors to counterfactuals. Together, these findings offer new tools for interpreting and controlling factual behavior in multimodal models.

Crosslingual Reasoning through Test-Time Scaling

Reasoning capabilities of large language models are primarily studied for English, even when pretrained models are multilingual. In this work, we investigate to what extent English reasoning finetuning with long chain-of-thoughts (CoTs) can generalize across languages. First, we find that scaling up inference compute for English-centric reasoning language models (RLMs) improves multilingual mathematical reasoning across many languages including low-resource languages, to an extent where they outperform models twice their size. Second, we reveal that while English-centric RLM's CoTs are naturally predominantly English, they consistently follow a quote-and-think pattern to reason about quoted non-English inputs. Third, we discover an effective strategy to control the language of long CoT reasoning, and we observe that models reason better and more efficiently in high-resource languages. Finally, we observe poor out-of-domain reasoning generalization, in particular from STEM to cultural commonsense knowledge, even for English. Overall, we demonstrate the potentials, study the mechanisms and outline the limitations of crosslingual generalization of English reasoning test-time scaling. We conclude that practitioners should let English-centric RLMs reason in high-resource languages, while further work is needed to improve reasoning in low-resource languages and out-of-domain contexts.

Beyond Contrastive Learning: Synthetic Data Enables List-wise Training with Multiple Levels of Relevance

Recent advancements in large language models (LLMs) have allowed the augmentation of information retrieval (IR) pipelines with synthetic data in various ways. Yet, the main training paradigm remains: contrastive learning with binary relevance labels and the InfoNCE loss, where one positive document is compared against one or more negatives. This objective treats all documents that are not explicitly annotated as relevant on an equally negative footing, regardless of their actual degree of relevance, thus (a) missing subtle nuances that are useful for ranking and (b) being susceptible to annotation noise. To overcome this limitation, in this work we forgo real training documents and annotations altogether and use open-source LLMs to directly generate synthetic documents that answer real user queries according to several different levels of relevance. This fully synthetic ranking context of graduated relevance, together with an appropriate list-wise loss (Wasserstein distance), enables us to train dense retrievers in a way that better captures the ranking task. Experiments on various IR datasets show that our proposed approach outperforms conventional training with InfoNCE by a large margin. Without using any real documents for training, our dense retriever significantly outperforms the same retriever trained through self-supervision. More importantly, it matches the performance of the same retriever trained on real, labeled training documents of the same dataset, while being more robust to distribution shift and clearly outperforming it when evaluated zero-shot on the BEIR dataset collection.

Forgotten Polygons: Multimodal Large Language Models are Shape-Blind

Despite strong performance on vision-language tasks, Multimodal Large Language Models (MLLMs) struggle with mathematical problem-solving, with both open-source and state-of-the-art models falling short of human performance on visual-math benchmarks. To systematically examine visual-mathematical reasoning in MLLMs, we (1) evaluate their understanding of geometric primitives, (2) test multi-step reasoning, and (3) explore a potential solution to improve visual reasoning capabilities. Our findings reveal fundamental shortcomings in shape recognition, with top models achieving under 50% accuracy in identifying regular polygons. We analyze these failures through the lens of dual-process theory and show that MLLMs rely on System 1 (intuitive, memorized associations) rather than System 2 (deliberate reasoning). Consequently, MLLMs fail to count the sides of both familiar and novel shapes, suggesting they have neither learned the concept of sides nor effectively process visual inputs. Finally, we propose Visually Cued Chain-of-Thought (VC-CoT) prompting, which enhances multi-step mathematical reasoning by explicitly referencing visual annotations in diagrams, boosting GPT-4o's accuracy on an irregular polygon side-counting task from 7% to 93%. Our findings suggest that System 2 reasoning in MLLMs remains an open problem, and visually-guided prompting is essential for successfully engaging visual reasoning. Code available at: https://github.com/rsinghlab/Shape-Blind.

K-Paths: Reasoning over Graph Paths for Drug Repurposing and Drug Interaction Prediction

Drug discovery is a complex and time-intensive process that requires identifying and validating new therapeutic candidates. Computational approaches using large-scale biomedical knowledge graphs (KGs) offer a promising solution to accelerate this process. However, extracting meaningful insights from large-scale KGs remains challenging due to the complexity of graph traversal. Existing subgraph-based methods are tailored to graph neural networks (GNNs), making them incompatible with other models, such as large language models (LLMs). We introduce K-Paths, a retrieval framework that extracts structured, diverse, and biologically meaningful paths from KGs. Integrating these paths enables LLMs and GNNs to effectively predict unobserved drug-drug and drug-disease interactions. Unlike traditional path-ranking approaches, K-Paths retrieves and transforms paths into a structured format that LLMs can directly process, facilitating explainable reasoning. K-Paths employs a diversity-aware adaptation of Yen's algorithm to retrieve the K shortest loopless paths between entities in an interaction query, prioritizing biologically relevant and diverse relationships. Our experiments on benchmark datasets show that K-Paths improves the zero-shot performance of Llama 8.1B's F1-score by 12.45 points on drug repurposing and 13.42 points on interaction severity prediction. We also show that Llama 70B achieves F1-score gains of 6.18 and 8.46 points, respectively. K-Paths also improves the supervised training efficiency of EmerGNN, a state-of-the-art GNN, by reducing KG size by 90% while maintaining strong predictive performance. Beyond its scalability and efficiency, K-Paths uniquely bridges the gap between KGs and LLMs, providing explainable rationales for predicted interactions. These capabilities show that K-Paths is a valuable tool for efficient data-driven drug discovery.