Revisiting ML Training under Fully Homomorphic Encryption: Convergence Guarantees, Differential Privacy, and Efficient Algorithms

We present the first theoretical convergence analysis of machine learning training under fully homomorphic encryption (FHE), combined with a differentially private (DP) training algorithm tailored to encrypted computation. Our approach improves computational efficiency over standard differentially private gradient descent (DP-GD) while achieving comparable utility. In particular, we prove convergence of approximate gradient descent using polynomial approximations of activation and loss functions, which are required for FHE compatibility. To preserve privacy in downstream tasks, we integrate differential privacy without relying on costly per-sample gradient clipping, enabling scalable encrypted learning. We also provide data-independent hyperparameter selection and theoretically grounded strategies for polynomial approximation which can be of independent interest. Together, these contributions advance the feasibility of efficient, private, and secure machine learning on sensitive data.

MedGuideX: Internalizing Decision Logic from Executable Guidelines into Large Language Models for Clinical Reasoning

Clinical practice guidelines (CPGs) encode evidence-based decision logic that clinicians apply by evaluating patient variables, conditional criteria, and recommendation rules. However, existing methods often use CPGs as free-text training data or retrieval sources, underutilizing their procedural decision structure. To better exploit this structure, we introduce a guideline-derived training pipeline that transforms CPG recommendations into executable clinical decision logic and uses it to generate factual and counterfactual question-answering data. Theses data teach models both guideline-supported decisions and how decisions change under different patient conditions. Post-training a medical LLM on the generated data yields MedGuideX. Across four clinical reasoning benchmarks, MedGuideX achieves a 10.28% relative improvement in average accuracy. Physician evaluation further shows that MedGuideX better recovers clinician authored reasoning steps and produces physician-preferred rationales in faithfulness, validity, completeness, and clarity. Overall, our results show that executable decision logic from CPGs can be transformed into scalable supervision for building reliable medical LLMs.

MedConceal: A Benchmark for Clinical Hidden-Concern Reasoning Under Partial Observability

Patient-clinician communication is an asymmetric-information problem: patients often do not disclose fears, misconceptions, or practical barriers unless clinicians elicit them skillfully. Effective medical dialogue therefore requires reasoning under partial observability: clinicians must elicit latent concerns, confirm them through interaction, and respond in ways that guide patients toward appropriate care. However, existing medical dialogue benchmarks largely sidestep this challenge by exposing hidden patient state, collapsing elicitation into extraction, or evaluating responses without modeling what remains hidden. We present MedConceal, a benchmark with an interactive patient simulator for evaluating hidden-concern reasoning in medical dialogue, comprising 300 curated cases and 600 clinician-LLM interactions. Built from clinician-answered online health discussions, each case pairing clinician-visible context with simulator-internal hidden concerns derived from prior literature and structured using an expert-developed taxonomy. The simulator withholds these concerns from the dialogue agent, tracks whether they have been revealed and addressed via theory-grounded turn-level communication signals, and is clinician-reviewed for clinical plausibility. This enables process-aware evaluation of both task success and the interaction process that leads to it. We study two abilities: confirmation, surfacing hidden concerns through multi-turn dialogue, and intervention, addressing the primary concern and guiding the patient toward a target plan. Results show that no single system dominates: frontier models lead on different confirmation metrics, while human clinicians (N=159) remain strongest on intervention success. Together, these results identify hidden-concern reasoning under partial observability as a key unresolved challenge for medical dialogue systems.

Joint Optimization of Reasoning and Dual-Memory for Self-Learning Diagnostic Agent

Clinical expertise improves not only by acquiring medical knowledge, but by accumulating experience that yields reusable diagnostic patterns. Recent LLMs-based diagnostic agents have shown promising progress in clinical reasoning for decision support. However, most approaches treat cases independently, limiting experience reuse and continual adaptation. We propose SEA, a self-learning diagnostic agent with cognitively inspired dual-memory module. We design a reinforcement training framework tailored to our designed agent for joint optimization of reasoning and memory management. We evaluate SEA in two complementary settings. On standard evaluation with MedCaseReasoning dataset, SEA achieves 92.46% accuracy, outperforming the strongest baseline by +19.6%, demonstrating the benefit of jointly optimizing reasoning and memory. On the long-horizon with ER-Reason dataset, SEA attains the best final accuracy (0.7214) and the largest improvement (+0.35 Acc@100), while baseline methods show limited or unstable gains. Expert evaluation further indicates that rules consolidated from SEA show strong clinical correctness, usefulness and trust, suggesting that the induced rules in dual-memory module are reliable and practically meaningful. Overall, SEA improves both diagnostic reasoning ability and continual learning by effectively transforming experience into reusable knowledge.

Improving Clinical Diagnosis with Counterfactual Multi-Agent Reasoning

Clinical diagnosis is a complex reasoning process in which clinicians gather evidence, form hypotheses, and test them against alternative explanations. In medical training, this reasoning is explicitly developed through counterfactual questioning--e.g., asking how a diagnosis would change if a key symptom were absent or altered--to strengthen differential diagnosis skills. As large language model (LLM)-based systems are increasingly used for diagnostic support, ensuring the interpretability of their recommendations becomes critical. However, most existing LLM-based diagnostic agents reason over fixed clinical evidence without explicitly testing how individual findings support or weaken competing diagnoses. In this work, we propose a counterfactual multi-agent diagnostic framework inspired by clinician training that makes hypothesis testing explicit and evidence-grounded. Our framework introduces counterfactual case editing to modify clinical findings and evaluate how these changes affect competing diagnoses. We further define the Counterfactual Probability Gap, a method that quantifies how strongly individual findings support a diagnosis by measuring confidence shifts under these edits. These counterfactual signals guide multi-round specialist discussions, enabling agents to challenge unsupported hypotheses, refine differential diagnoses, and produce more interpretable reasoning trajectories. Across three diagnostic benchmarks and seven LLMs, our method consistently improves diagnostic accuracy over prompting and prior multi-agent baselines, with the largest gains observed in complex and ambiguous cases. Human evaluation further indicates that our framework produces more clinically useful, reliable, and coherent reasoning. These results suggest that incorporating counterfactual evidence verification is an important step toward building reliable AI systems for clinical decision support.

AD-Copilot: A Vision-Language Assistant for Industrial Anomaly Detection via Visual In-context Comparison

Multimodal Large Language Models (MLLMs) have achieved impressive success in natural visual understanding, yet they consistently underperform in industrial anomaly detection (IAD). This is because MLLMs trained mostly on general web data differ significantly from industrial images. Moreover, they encode each image independently and can only compare images in the language space, making them insensitive to subtle visual differences that are key to IAD. To tackle these issues, we present AD-Copilot, an interactive MLLM specialized for IAD via visual in-context comparison. We first design a novel data curation pipeline to mine inspection knowledge from sparsely labeled industrial images and generate precise samples for captioning, VQA, and defect localization, yielding a large-scale multimodal dataset Chat-AD rich in semantic signals for IAD. On this foundation, AD-Copilot incorporates a novel Comparison Encoder that employs cross-attention between paired image features to enhance multi-image fine-grained perception, and is trained with a multi-stage strategy that incorporates domain knowledge and gradually enhances IAD skills. In addition, we introduce MMAD-BBox, an extended benchmark for anomaly localization with bounding-box-based evaluation. The experiments show that AD-Copilot achieves 82.3% accuracy on the MMAD benchmark, outperforming all other models without any data leakage. In the MMAD-BBox test, it achieves a maximum improvement of $3.35\times$ over the baseline. AD-Copilot also exhibits excellent generalization of its performance gains across other specialized and general-purpose benchmarks. Remarkably, AD-Copilot surpasses human expert-level performance on several IAD tasks, demonstrating its potential as a reliable assistant for real-world industrial inspection. All datasets and models will be released for the broader benefit of the community.

Multi-Head Low-Rank Attention

Long-context inference in large language models is bottlenecked by Key--Value (KV) cache loading during the decoding stage, where the sequential nature of generation requires repeatedly transferring the KV cache from off-chip High-Bandwidth Memory (HBM) to on-chip Static Random-Access Memory (SRAM) at each step. While Multi-Head Latent Attention (MLA) significantly reduces the total KV cache size, it suffers from a sharding bottleneck during distributed decoding via Tensor Parallelism (TP). Since its single latent head cannot be partitioned, each device is forced to redundantly load the complete KV cache for every token, consuming excessive memory traffic and diminishing TP benefits like weight sharding. In this work, we propose Multi-Head Low-Rank Attention (MLRA), which enables partitionable latent states for efficient 4-way TP decoding. Extensive experiments show that MLRA achieves state-of-the-art perplexity and downstream task performance, while also delivering a 2.8$\times$ decoding speedup over MLA. Code is available at https://github.com/SongtaoLiu0823/MLRA. Pretrained weights, along with the training and evaluation data, are available at https://huggingface.co/Soughing/MLRA.

EHR-RAG: Bridging Long-Horizon Structured Electronic Health Records and Large Language Models via Enhanced Retrieval-Augmented Generation

Electronic Health Records (EHRs) provide rich longitudinal clinical evidence that is central to medical decision-making, motivating the use of retrieval-augmented generation (RAG) to ground large language model (LLM) predictions. However, long-horizon EHRs often exceed LLM context limits, and existing approaches commonly rely on truncation or vanilla retrieval strategies that discard clinically relevant events and temporal dependencies. To address these challenges, we propose EHR-RAG, a retrieval-augmented framework designed for accurate interpretation of long-horizon structured EHR data. EHR-RAG introduces three components tailored to longitudinal clinical prediction tasks: Event- and Time-Aware Hybrid EHR Retrieval to preserve clinical structure and temporal dynamics, Adaptive Iterative Retrieval to progressively refine queries in order to expand broad evidence coverage, and Dual-Path Evidence Retrieval and Reasoning to jointly retrieves and reasons over both factual and counterfactual evidence. Experiments across four long-horizon EHR prediction tasks show that EHR-RAG consistently outperforms the strongest LLM-based baselines, achieving an average Macro-F1 improvement of 10.76%. Overall, our work highlights the potential of retrieval-augmented LLMs to advance clinical prediction on structured EHR data in practice.

Dr. Assistant: Enhancing Clinical Diagnostic Inquiry via Structured Diagnostic Reasoning Data and Reinforcement Learning

Clinical Decision Support Systems (CDSSs) provide reasoning and inquiry guidance for physicians, yet they face notable challenges, including high maintenance costs and low generalization capability. Recently, Large Language Models (LLMs) have been widely adopted in healthcare due to their extensive knowledge reserves, retrieval, and communication capabilities. While LLMs show promise and excel at medical benchmarks, their diagnostic reasoning and inquiry skills are constrained. To mitigate this issue, we propose (1) Clinical Diagnostic Reasoning Data (CDRD) structure to capture abstract clinical reasoning logic, and a pipeline for its construction, and (2) the Dr. Assistant, a clinical diagnostic model equipped with clinical reasoning and inquiry skills. Its training involves a two-stage process: SFT, followed by RL with a tailored reward function. We also introduce a benchmark to evaluate both diagnostic reasoning and inquiry. Our experiments demonstrate that the Dr. Assistant outperforms open-source models and achieves competitive performance to closed-source models, providing an effective solution for clinical diagnostic inquiry guidance.

Interleaving Reasoning for Better Text-to-Image Generation

Unified multimodal understanding and generation models recently have achieve significant improvement in image generation capability, yet a large gap remains in instruction following and detail preservation compared to systems that tightly couple comprehension with generation such as GPT-4o. Motivated by recent advances in interleaving reasoning, we explore whether such reasoning can further improve Text-to-Image (T2I) generation. We introduce Interleaving Reasoning Generation (IRG), a framework that alternates between text-based thinking and image synthesis: the model first produces a text-based thinking to guide an initial image, then reflects on the result to refine fine-grained details, visual quality, and aesthetics while preserving semantics. To train IRG effectively, we propose Interleaving Reasoning Generation Learning (IRGL), which targets two sub-goals: (1) strengthening the initial think-and-generate stage to establish core content and base quality, and (2) enabling high-quality textual reflection and faithful implementation of those refinements in a subsequent image. We curate IRGL-300K, a dataset organized into six decomposed learning modes that jointly cover learning text-based thinking, and full thinking-image trajectories. Starting from a unified foundation model that natively emits interleaved text-image outputs, our two-stage training first builds robust thinking and reflection, then efficiently tunes the IRG pipeline in the full thinking-image trajectory data. Extensive experiments show SoTA performance, yielding absolute gains of 5-10 points on GenEval, WISE, TIIF, GenAI-Bench, and OneIG-EN, alongside substantial improvements in visual quality and fine-grained fidelity. The code, model weights and datasets will be released in: https://github.com/Osilly/Interleaving-Reasoning-Generation .