Brian Anthony

Shan Chen, Mingye Gao, Kuleen Sasse et al. · harvard

Background: Large language models (LLMs) are trained to follow directions, but this introduces a vulnerability to blindly comply with user requests even if they generate wrong information. In medicine, this could accelerate the generation of misinformation that impacts human well-being. Objectives/Methods: We analyzed compliance to requests to generate misleading content about medications in settings where models know the request is illogical. We investigated whether in-context directions and instruction-tuning of LLMs to prioritize logical reasoning over compliance reduced misinformation risk. Results: While all frontier LLMs complied with misinformation requests, both prompt-based and parameter-based approaches can improve the detection of logic flaws in requests and prevent the dissemination of medical misinformation. Conclusion: Shifting LLMs to prioritize logic over compliance could reduce risks of exploitation for medical misinformation.

Zengyi Qin, Jinyuan Chen, Yunze Man et al.

Training computer use agents requires full-featured OS sandboxes with GUI environments, which consume substantial hardware resources as the number of sandboxes scales. Stochastic errors arising from diverse software execution within these sandboxes further demand robust infrastructure design and reliable error recovery. We present OSGym, a scalable OS environment infrastructure for computer use agents, built around these key optimization strategies: (1) Decentralized OS state management, which isolates failures to individual replicas and significantly enhances overall system reliability; (2) Hardware-aware OS replica orchestration, which addresses CPU-bounded scaling bottlenecks and substantially reduces compute overhead; (3) KVM virtualization with copy-on-write disk management, which shares a common bootable disk across VM instances and provisions only instance-specific modifications, reducing physical disk consumption by 88% and increasing disk provisioning speed by 37 times; and (4) Robust container pool with multi-layer fault recovery. Together, these optimizations yield strong scalability and resource efficiency: OSGym manages over a thousand OS replicas under constrained resources, supports parallel trajectory generation at 1420 multi-turn trajectories per minute, and reduces per-replica cost to 0.2-0.3 USD per day, a 90% reduction over standard deployment. Our experiments validate OSGym across end-to-end pipelines for data collection and training for computer use agents. We believe OSGym establishes a new foundation for scalable, general-purpose computer use agent research.

Mingye Gao, Aman Varshney, Shan Chen et al.

Cancer clinical trials often face challenges in recruitment and engagement due to a lack of participant-facing informational and educational resources. This study investigated the potential of Large Language Models (LLMs), specifically GPT4, in generating patient-friendly educational content from clinical trial informed consent forms. Using data from ClinicalTrials.gov, we employed zero-shot learning for creating trial summaries and one-shot learning for developing multiple-choice questions, evaluating their effectiveness through patient surveys and crowdsourced annotation. Results showed that GPT4-generated summaries were both readable and comprehensive, and may improve patients' understanding and interest in clinical trials. The multiple-choice questions demonstrated high accuracy and agreement with crowdsourced annotators. For both resource types, hallucinations were identified that require ongoing human oversight. The findings demonstrate the potential of LLMs "out-of-the-box" to support the generation of clinical trial education materials with minimal trial-specific engineering, but implementation with a human-in-the-loop is still needed to avoid misinformation risks.

Jian Jiang, Chenxi Lin, Yiming Gu et al.

Surgical scene understanding demands not only accurate predictions but also interpretable reasoning that surgeons can verify against clinical expertise. However, existing surgical vision-language models generate predictions without reasoning chains, and general-purpose reasoning models fail on compositional surgical tasks without domain-specific knowledge. We present Surg-R1, a surgical Vision-Language Model that addresses this gap through hierarchical reasoning trained via a four-stage pipeline. Our approach introduces three key contributions: (1) a three-level reasoning hierarchy decomposing surgical interpretation into perceptual grounding, relational understanding, and contextual reasoning; (2) the largest surgical chain-of-thought dataset with 320,000 reasoning pairs; and (3) a four-stage training pipeline progressing from supervised fine-tuning to group relative policy optimization and iterative self-improvement. Evaluation on SurgBench, comprising six public benchmarks and six multi-center external validation datasets from five institutions, demonstrates that Surg-R1 achieves the highest Arena Score (64.9%) on public benchmarks versus Gemini 3.0 Pro (46.1%) and GPT-5.1 (37.9%), outperforming both proprietary reasoning models and specialized surgical VLMs on the majority of tasks spanning instrument localization, triplet recognition, phase recognition, action recognition, and critical view of safety assessment, with a 15.2 percentage point improvement over the strongest surgical baseline on external validation.

Aparna Nair-Kanneganti, Trevor J. Chan, Shir Goldfinger et al.

Despite huge advances, LLMs still lack convenient and reliable methods to quantify the uncertainty in their responses, making them difficult to trust in high-stakes applications. One of the simplest approaches to eliciting more accurate answers is to select the mode of many responses, a technique known as ensembling. In this work, we expand on typical ensembling approaches by looking at ensembles with a variable voting threshold. We introduce a theoretical framework for question answering and show that, by permitting ensembles to "abstain" from providing an answer when the dominant response falls short of the threshold, it is possible to dramatically increase the trustworthiness of the remaining answers. From this framework, we derive theoretical results as well as report experimental results on two problem domains: arithmetic problem solving and clinical-note question-answering. In both domains, we observe that large gains in answer trustworthiness can be achieved using highly restrictive voting ensembles, while incurring relatively modest reductions in response yield and accuracy. Due to this quality, voting ensembles may be particularly useful in applications - such as healthcare and data annotation - that require a high degree of certainty but which may not require that every question receive an automated answer.

Shan Chen, Jack Gallifant, Mingye Gao et al.

Large language models (LLMs) are increasingly essential in processing natural languages, yet their application is frequently compromised by biases and inaccuracies originating in their training data. In this study, we introduce Cross-Care, the first benchmark framework dedicated to assessing biases and real world knowledge in LLMs, specifically focusing on the representation of disease prevalence across diverse demographic groups. We systematically evaluate how demographic biases embedded in pre-training corpora like $ThePile$ influence the outputs of LLMs. We expose and quantify discrepancies by juxtaposing these biases against actual disease prevalences in various U.S. demographic groups. Our results highlight substantial misalignment between LLM representation of disease prevalence and real disease prevalence rates across demographic subgroups, indicating a pronounced risk of bias propagation and a lack of real-world grounding for medical applications of LLMs. Furthermore, we observe that various alignment methods minimally resolve inconsistencies in the models' representation of disease prevalence across different languages. For further exploration and analysis, we make all data and a data visualization tool available at: www.crosscare.net.