Florian Odi Stummer

Florian Odi Stummer

Clinical AI systems routinely train on health data structurally distorted by documentation workflows, billing incentives, and terminology fragmentation. Prior work has characterised the mechanisms of this distortion: the three-forces model of documentary enactment, the reification feedback loop through which AI may amplify coding artefacts, and terminology governance failures that allow semantic drift to accumulate. Yet translating these insights into implementable software architecture remains an open problem. This paper proposes seven ontology-aware design patterns in Gang-of-Four pattern language for building clinical AI pipelines resilient to ontological distortion. The patterns address data ingestion validation (Ontological Checkpoint), low-frequency signal preservation (Dormancy-Aware Pipeline), continuous drift monitoring (Drift Sentinel), parallel representation maintenance (Dual-Ontology Layer), feedback loop interruption (Reification Circuit Breaker), terminology evolution management (Terminology Version Gate), and pluggable regulatory compliance (Regulatory Compliance Adapter). Each pattern is specified with Problem, Forces, Solution, Consequences, Known Uses, and Related Patterns. We illustrate their composition in a reference architecture for a primary care AI system and provide a walkthrough tracing all seven patterns through a diabetes risk prediction scenario. This paper does not report empirical validation; it offers a design vocabulary grounded in theoretical analysis, subject to future evaluation in production systems. Three patterns have partial precedent in existing systems; the remaining four have not been formally described. Limitations include the absence of runtime benchmarks and restriction to the German and EU regulatory context.

Florian Odi Stummer

Current prompting paradigms for large language models (LLMs), including Chain-of-Thought (CoT) and Tree-of-Thoughts (ToT), follow linear or tree-structured reasoning paths that lack persistent memory, strategic dormancy, and cross-domain synthesis. We present the Enhanced Mycelium of Thought (EMoT) framework, a bio-inspired reasoning architecture that organises cognitive processing into a four-level hierarchy (Micro, Meso, Macro, Meta), implements strategic dormancy and reactivation of reasoning nodes, and integrates a Memory Palace with five mnemonic encoding styles. EMoT is a research prototype for complex, multi-domain problems, not a general-purpose prompting enhancement. Two complementary evaluations reveal a characteristic trade-off. In a blind LLM-as-Judge evaluation across three domains, EMoT achieved near-parity with CoT (4.20 vs. 4.33/5.0) with higher stability, and outperformed CoT on Cross-Domain Synthesis (4.8 vs. 4.4). Ablation studies show that strategic dormancy is architecturally essential (quality collapsed from 4.2 to 1.0 when disabled). On a 15-item short-answer benchmark, EMoT (27%) substantially underperformed simpler baselines, confirming systematic overthinking on simple problems. These results are subject to important limitations: small sample sizes (n=3 complex cases, n=15 short-answer items), LLM-as-Judge evaluation with potential self-preference bias, and approximately 33-fold computational cost overhead. To our knowledge, EMoT is the first reasoning framework to combine hierarchical topology, strategic thought dormancy with reactivation, and mnemonic memory encoding in a single architecture.