arXiv subjects

Lei Clifton

Publications and source records attributed to Lei Clifton.

17 recordsLinked to original sources

arXiv2026

When Text and Numbers Disagree: Evidence Arbitration in Large Language Models

Large language models (LLMs) are increasingly used in settings where textual summaries, numerical observations, and external tool outputs may provide conflicting evidence. We study how LLMs arbitrate between such sources when they support opposing decisions. To do so, we introduce a controlled synthetic benchmark in which latent risk trajectories generate both numerical time series and natural language summaries, allowing us to construct conflicts where exactly one evidence source is aligned with the ground-truth label. This design lets us independently manipulate modality, temporal recency, source reliability, and evidence provenance. Across open-weight instruction-tuned models, we find that arbitration behaviour is systematic rather than random: models exhibit distinct text-versus-number preferences, follow temporal recency more consistently than explicit reliability cues, and can over-rely on external forecasts even when they conflict with direct contextual evidence. These results suggest that current LLMs often rely on heuristic arbitration strategies when integrating heterogeneous evidence, highlighting a failure mode for tool-augmented decision systems.

cs.CL↗

arXiv2026

Measuring Epistemic Resilience of LLMs Under Misleading Medical Context

Large language models (LLMs) now reach expert-level scores on medical licensing exams, encouraging the assumption that high scores imply safe medical judgment while patients increasingly use them for health advice. We show this assumption is fragile: when misleading context is injected into questions that LLMs originally answer correctly, they abandon the correct answer. We call the ability to maintain correct judgment under adversarial context epistemic resilience, and introduce MedMisBench to measure it. MedMisBench contains 10,932 medical question items and 48,889 misleading context-option pairs spanning medical reasoning, agentic capability, and patient-journey evaluation. Across 11 model configurations, mean accuracy falls from 71.1% on original questions to 38.0% under focused misleading context, with 51.5% attack success. The most damaging injections are formal, rule-like fabrications: authority-framed falsehoods reach 69.5% attack success and exception-poisoning claims reach 64.1%. A 14-member clinical panel from 7 countries identified serious potential harm in 38.2% of reviewed cases. MedMisBench exposes a structural blind spot in LLM evaluation in medical settings: existing benchmarks measure what models know, but not whether they preserve correct medical judgment under misleading context.

cs.CL↗

arXiv2026

Extending Pretrained 10-Second ECG Foundation Models to Longer Horizons

Electrocardiogram (ECG) foundation models pretrained on typical diagnostic 10-second ECG segments, have demonstrated strong transferability across a range of clinical applications. However, many real-world applications produce recordings that are typically longer, and are varied in duration during inference time. These 10-second models have no built-in way to combine information across time. Extending them to longer horizons introduces two challenges: structural incompatibilities arising from input-length disparities, and semantic challenges that limit meaningful temporal aggregation. We propose a parameter-efficient framework that extends pretrained ECG foundation models to longer and variable-length ECGs without retraining the backbone. Guided by a frozen pretrained 10-second model, we introduce a lightweight plug-in module that extends the model in two complementary ways: (i) structurally compatible long-sequence processing and (ii) semantically informed temporal modeling. Experiments on multiple long-horizon ECG tasks, datasets, and foundation model backbones demonstrate that our method enables robust long-horizon extension from pretrained snapshot models, consistently outperforming sliding-window and pooling-based baselines with strong parameter efficiency.

cs.LG↗

arXiv2026

Geometric Characterisation and Structured Trajectory Surrogates for Clinical Dataset Condensation

Dataset condensation constructs compact synthetic datasets that retain the training utility of large real-world datasets, enabling efficient model development and potentially supporting downstream research in governed domains such as healthcare. Trajectory matching (TM) is a widely used condensation approach that supervises synthetic data using changes in model parameters observed during training on real data, yet the structure of this supervision signal remains poorly understood. In this paper, we provide a geometric characterisation of trajectory matching, showing that a fixed synthetic dataset can only reproduce a limited span of such training-induced parameter changes. When the resulting supervision signal is spectrally broad, this creates a conditional representability bottleneck. Motivated by this mismatch, we propose Bezier Trajectory Matching (BTM), which replaces SGD trajectories with quadratic Bezier trajectory surrogates between initial and final model states. These surrogates are optimised to reduce average loss along the path while replacing broad SGD-derived supervision with a more structured, lower-rank signal that is better aligned with the optimisation constraints of a fixed synthetic dataset, and they substantially reduce trajectory storage. Experiments on five clinical datasets demonstrate that BTM consistently matches or improves upon standard trajectory matching, with the largest gains in low-prevalence and low-synthetic-budget settings. These results indicate that effective trajectory matching depends on structuring the supervision signal rather than reproducing stochastic optimisation paths.

cs.LG↗

arXiv2026

Democratising Clinical AI through Dataset Condensation for Classical Clinical Models

Dataset condensation (DC) learns a compact synthetic dataset that enables models to match the performance of full-data training, prioritising utility over distributional fidelity. While typically explored for computational efficiency, DC also holds promise for healthcare data democratisation, especially when paired with differential privacy, allowing synthetic data to serve as a safe alternative to real records. However, existing DC methods rely on differentiable neural networks, limiting their compatibility with widely used clinical models such as decision trees and Cox regression. We address this gap using a differentially private, zero-order optimisation framework that extends DC to non-differentiable models using only function evaluations. Empirical results across six datasets, including both classification and survival tasks, show that the proposed method produces condensed datasets that preserve model utility while providing effective differential privacy guarantees - enabling model-agnostic data sharing for clinical prediction tasks without exposing sensitive patient information.

cs.LG↗

arXiv2026

RiskAgent: Synergizing Language Models with Validated Tools for Evidence-Based Risk Prediction

Large Language Models (LLMs) achieve competitive results compared to human experts in medical examinations. However, it remains a challenge to apply LLMs to complex clinical decision-making, which requires a deep understanding of medical knowledge and differs from the standardized, exam-style scenarios commonly used in current efforts. A common approach is to fine-tune LLMs for target tasks, which, however, not only requires substantial data and computational resources but also remains prone to generating `hallucinations'. In this work, we present RiskAgent, which synergizes language models with hundreds of validated clinical decision tools supported by evidence-based medicine, to provide generalizable and faithful recommendations. Our experiments show that RiskAgent not only achieves superior performance on a broad range of clinical risk predictions across diverse scenarios and diseases, but also demonstrates robust generalization in tool learning on the external MedCalc-Bench dataset, as well as in medical reasoning and question answering on three representative benchmarks, MedQA, MedMCQA, and MMLU.

cs.LG↗

arXiv2025

Clinical-R1: Empowering Large Language Models for Faithful and Comprehensive Reasoning with Clinical Objective Relative Policy Optimization

Recent advances in large language models (LLMs) have shown strong reasoning capabilities through large-scale pretraining and post-training reinforcement learning, demonstrated by DeepSeek-R1. However, current post-training methods, such as Grouped Relative Policy Optimization (GRPO), mainly reward correctness, which is not aligned with the multi-dimensional objectives required in high-stakes fields such as medicine, where reasoning must also be faithful and comprehensive. We introduce Clinical-Objective Relative Policy Optimization (CRPO), a scalable, multi-objective, verifiable reinforcement learning method designed to align LLM post-training with clinical reasoning principles. CRPO integrates rule-based and verifiable reward signals that jointly optimize accuracy, faithfulness, and comprehensiveness without relying on human annotation. To demonstrate its effectiveness, we train Clinical-R1-3B, a 3B-parameter model for clinical reasoning. The experiments on three benchmarks demonstrate that our CRPO substantially improves reasoning on truthfulness and completeness over standard GRPO while maintaining comfortable accuracy enhancements. This framework provides a scalable pathway to align LLM reasoning with clinical objectives, enabling safer and more collaborative AI systems for healthcare while also highlighting the potential of multi-objective, verifiable RL methods in post-training scaling of LLMs for medical domains.

cs.AI↗

arXiv2025

Individualised Treatment Effects Estimation with Composite Treatments and Composite Outcomes

Estimating individualised treatment effect (ITE) -- that is the causal effect of a set of variables (also called exposures, treatments, actions, policies, or interventions), referred to as \textit{composite treatments}, on a set of outcome variables of interest, referred to as \textit{composite outcomes}, for a unit from observational data -- remains a fundamental problem in causal inference with applications across disciplines, such as healthcare, economics, education, social science, marketing, and computer science. Previous work in causal machine learning for ITE estimation is limited to simple settings, like single treatments and single outcomes. This hinders their use in complex real-world scenarios; for example, consider studying the effect of different ICU interventions, such as beta-blockers and statins for a patient admitted for heart surgery, on different outcomes of interest such as atrial fibrillation and in-hospital mortality. The limited research into composite treatments and outcomes is primarily due to data scarcity for all treatments and outcomes. To address the above challenges, we propose a novel and innovative hypernetwork-based approach, called \emph{H-Learner}, to solve ITE estimation under composite treatments and composite outcomes, which tackles the data scarcity issue by dynamically sharing information across treatments and outcomes. Our empirical analysis with binary and arbitrary composite treatments and outcomes demonstrates the effectiveness of the proposed approach compared to existing methods.

cs.LG↗

arXiv2025

Improving Clinical Dataset Condensation with Mode Connectivity-based Trajectory Surrogates

Dataset condensation (DC) enables the creation of compact, privacy-preserving synthetic datasets that can match the utility of real patient records, supporting democratised access to highly regulated clinical data for developing downstream clinical models. State-of-the-art DC methods supervise synthetic data by aligning the training dynamics of models trained on real and those trained on synthetic data, typically using full stochastic gradient descent (SGD) trajectories as alignment targets; however, these trajectories are often noisy, high-curvature, and storage-intensive, leading to unstable gradients, slow convergence, and substantial memory overhead. We address these limitations by replacing full SGD trajectories with smooth, low-loss parametric surrogates, specifically quadratic Bézier curves that connect the initial and final model states from real training trajectories. These mode-connected paths provide noise-free, low-curvature supervision signals that stabilise gradients, accelerate convergence, and eliminate the need for dense trajectory storage. We theoretically justify Bézier-mode connections as effective surrogates for SGD paths and empirically show that the proposed method outperforms state-of-the-art condensation approaches across five clinical datasets, yielding condensed datasets that enable clinically effective model development.

cs.LG↗

arXiv2025

Sample Selection Bias in Machine Learning for Healthcare

While machine learning algorithms hold promise for personalised medicine, their clinical adoption remains limited, partly due to biases that can compromise the reliability of predictions. In this paper, we focus on sample selection bias (SSB), a specific type of bias where the study population is less representative of the target population, leading to biased and potentially harmful decisions. Despite being well-known in the literature, SSB remains scarcely studied in machine learning for healthcare. Moreover, the existing machine learning techniques try to correct the bias mostly by balancing distributions between the study and the target populations, which may result in a loss of predictive performance. To address these problems, our study illustrates the potential risks associated with SSB by examining SSB's impact on the performance of machine learning algorithms. Most importantly, we propose a new research direction for addressing SSB, based on the target population identification rather than the bias correction. Specifically, we propose two independent networks(T-Net) and a multitasking network (MT-Net) for addressing SSB, where one network/task identifies the target subpopulation which is representative of the study population and the second makes predictions for the identified subpopulation. Our empirical results with synthetic and semi-synthetic datasets highlight that SSB can lead to a large drop in the performance of an algorithm for the target population as compared with the study population, as well as a substantial difference in the performance for the target subpopulations that are representative of the selected and the non-selected patients from the study population. Furthermore, our proposed techniques demonstrate robustness across various settings, including different dataset sizes, event rates, and selection rates, outperforming the existing bias correction techniques.

cs.LG↗

arXiv2025

Sensing Cardiac Health Across Scenarios and Devices: A Multi-Modal Foundation Model Pretrained on Heterogeneous Data from 1.7 Million Individuals

Cardiac biosignals, such as electrocardiograms (ECG) and photoplethysmograms (PPG), are of paramount importance for the diagnosis, prevention, and management of cardiovascular diseases, and have been extensively used in a variety of clinical tasks. Conventional deep learning approaches for analyzing these signals typically rely on homogeneous datasets and static bespoke models, limiting their robustness and generalizability across diverse clinical settings and acquisition protocols. In this study, we present a cardiac sensing foundation model (CSFM) that leverages advanced transformer architectures and a generative, masked pretraining strategy to learn unified representations from vast, heterogeneous health records. Our model is pretrained on an innovative multi-modal integration of data from multiple large-scale datasets (including MIMIC-III-WDB, MIMIC-IV-ECG, and CODE), comprising cardiac signals and the corresponding clinical or machine-generated text reports from approximately 1.7 million individuals. We demonstrate that the embeddings derived from our CSFM not only serve as effective feature extractors across diverse cardiac sensing scenarios, but also enable seamless transfer learning across varying input configurations and sensor modalities. Extensive evaluations across diagnostic tasks, demographic information recognition, vital sign measurement, clinical outcome prediction, and ECG question answering reveal that CSFM consistently outperforms traditional one-modal-one-task approaches. Notably, CSFM exhibits robust performance across multiple ECG lead configurations from standard 12-lead systems to single-lead setups, and in scenarios where only ECG, only PPG, or a combination thereof is available. These findings highlight the potential of CSFM as a versatile and scalable solution, for comprehensive cardiac monitoring.

cs.LG↗

arXiv2025

Bridging the Generalisation Gap: Synthetic Data Generation for Multi-Site Clinical Model Validation

Ensuring the generalisability of clinical machine learning (ML) models across diverse healthcare settings remains a significant challenge due to variability in patient demographics, disease prevalence, and institutional practices. Existing model evaluation approaches often rely on real-world datasets, which are limited in availability, embed confounding biases, and lack the flexibility needed for systematic experimentation. Furthermore, while generative models aim for statistical realism, they often lack transparency and explicit control over factors driving distributional shifts. In this work, we propose a novel structured synthetic data framework designed for the controlled benchmarking of model robustness, fairness, and generalisability. Unlike approaches focused solely on mimicking observed data, our framework provides explicit control over the data generating process, including site-specific prevalence variations, hierarchical subgroup effects, and structured feature interactions. This enables targeted investigation into how models respond to specific distributional shifts and potential biases. Through controlled experiments, we demonstrate the framework's ability to isolate the impact of site variations, support fairness-aware audits, and reveal generalisation failures, particularly highlighting how model complexity interacts with site-specific effects. This work contributes a reproducible, interpretable, and configurable tool designed to advance the reliable deployment of ML in clinical settings.

cs.LG↗

arXiv2024

CE-SSL: Computation-Efficient Semi-Supervised Learning for ECG-based Cardiovascular Diseases Detection

The label scarcity problem is the main challenge that hinders the wide application of deep learning systems in automatic cardiovascular diseases (CVDs) detection using electrocardiography (ECG). Tuning pre-trained models alleviates this problem by transferring knowledge learned from large datasets to downstream small datasets. However, bottlenecks in computational efficiency and detection performance limit its clinical applications. It is difficult to improve the detection performance without significantly sacrificing the computational efficiency during model training. Here, we propose a computation-efficient semi-supervised learning paradigm (CE-SSL) for robust and computation-efficient CVDs detection using ECG. It enables a robust adaptation of pre-trained models on downstream datasets with limited supervision and high computational efficiency. First, a random-deactivation technique is developed to achieve robust and fast low-rank adaptation of pre-trained weights. Subsequently, we propose a one-shot rank allocation module to determine the optimal ranks for the update matrices of the pre-trained weights. Finally, a lightweight semi-supervised learning pipeline is introduced to enhance model performance by leveraging labeled and unlabeled data with high computational efficiency. Extensive experiments on four downstream datasets demonstrate that CE-SSL not only outperforms the state-of-the-art methods in multi-label CVDs detection but also consumes fewer GPU footprints, training time, and parameter storage space. As such, this paradigm provides an effective solution for achieving high computational efficiency and robust detection performance in the clinical applications of pre-trained models under limited supervision. Code and Supplementary Materials are available at https://github.com/KAZABANA/CE-SSL

cs.LG↗

arXiv2024

Large Language Models in the Clinic: A Comprehensive Benchmark

The adoption of large language models (LLMs) to assist clinicians has attracted remarkable attention. Existing works mainly adopt the close-ended question-answering (QA) task with answer options for evaluation. However, many clinical decisions involve answering open-ended questions without pre-set options. To better understand LLMs in the clinic, we construct a benchmark ClinicBench. We first collect eleven existing datasets covering diverse clinical language generation, understanding, and reasoning tasks. Furthermore, we construct six novel datasets and clinical tasks that are complex but common in real-world practice, e.g., open-ended decision-making, long document processing, and emerging drug analysis. We conduct an extensive evaluation of twenty-two LLMs under both zero-shot and few-shot settings. Finally, we invite medical experts to evaluate the clinical usefulness of LLMs. The benchmark data is available at https://github.com/AI-in-Health/ClinicBench.

cs.CL↗

arXiv2024

A Survey of Large Language Models in Medicine: Progress, Application, and Challenge

Large language models (LLMs), such as ChatGPT, have received substantial attention due to their capabilities for understanding and generating human language. While there has been a burgeoning trend in research focusing on the employment of LLMs in supporting different medical tasks (e.g., enhancing clinical diagnostics and providing medical education), a review of these efforts, particularly their development, practical applications, and outcomes in medicine, remains scarce. Therefore, this review aims to provide a detailed overview of the development and deployment of LLMs in medicine, including the challenges and opportunities they face. In terms of development, we provide a detailed introduction to the principles of existing medical LLMs, including their basic model structures, number of parameters, and sources and scales of data used for model development. It serves as a guide for practitioners in developing medical LLMs tailored to their specific needs. In terms of deployment, we offer a comparison of the performance of different LLMs across various medical tasks, and further compare them with state-of-the-art lightweight models, aiming to provide an understanding of the advantages and limitations of LLMs in medicine. Overall, in this review, we address the following questions: 1) What are the practices for developing medical LLMs 2) How to measure the medical task performance of LLMs in a medical setting? 3) How have medical LLMs been employed in real-world practice? 4) What challenges arise from the use of medical LLMs? and 5) How to more effectively develop and deploy medical LLMs? By answering these questions, this review aims to provide insights into the opportunities for LLMs in medicine and serve as a practical resource. We also maintain a regularly updated list of practical guides on medical LLMs at https://github.com/AI-in-Health/MedLLMsPracticalGuide

cs.CL↗

arXiv2023

At-Admission Prediction of Mortality and Pulmonary Embolism in COVID-19 Patients Using Statistical and Machine Learning Methods: An International Cohort Study

By September, 2022, more than 600 million cases of SARS-CoV-2 infection have been reported globally, resulting in over 6.5 million deaths. COVID-19 mortality risk estimators are often, however, developed with small unrepresentative samples and with methodological limitations. It is highly important to develop predictive tools for pulmonary embolism (PE) in COVID-19 patients as one of the most severe preventable complications of COVID-19. Using a dataset of more than 800,000 COVID-19 patients from an international cohort, we propose a cost-sensitive gradient-boosted machine learning model that predicts occurrence of PE and death at admission. Logistic regression, Cox proportional hazards models, and Shapley values were used to identify key predictors for PE and death. Our prediction model had a test AUROC of 75.9% and 74.2%, and sensitivities of 67.5% and 72.7% for PE and all-cause mortality respectively on a highly diverse and held-out test set. The PE prediction model was also evaluated on patients in UK and Spain separately with test results of 74.5% AUROC, 63.5% sensitivity and 78.9% AUROC, 95.7% sensitivity. Age, sex, region of admission, comorbidities (chronic cardiac and pulmonary disease, dementia, diabetes, hypertension, cancer, obesity, smoking), and symptoms (any, confusion, chest pain, fatigue, headache, fever, muscle or joint pain, shortness of breath) were the most important clinical predictors at admission. Our machine learning model developed from an international cohort can serve to better regulate hospital risk prioritisation of at-risk patients.

q-bio.QM↗

arXiv2023

Lightweight Transformers for Clinical Natural Language Processing

Specialised pre-trained language models are becoming more frequent in NLP since they can potentially outperform models trained on generic texts. BioBERT and BioClinicalBERT are two examples of such models that have shown promise in medical NLP tasks. Many of these models are overparametrised and resource-intensive, but thanks to techniques like Knowledge Distillation (KD), it is possible to create smaller versions that perform almost as well as their larger counterparts. In this work, we specifically focus on development of compact language models for processing clinical texts (i.e. progress notes, discharge summaries etc). We developed a number of efficient lightweight clinical transformers using knowledge distillation and continual learning, with the number of parameters ranging from 15 million to 65 million. These models performed comparably to larger models such as BioBERT and ClinicalBioBERT and significantly outperformed other compact models trained on general or biomedical data. Our extensive evaluation was done across several standard datasets and covered a wide range of clinical text-mining tasks, including Natural Language Inference, Relation Extraction, Named Entity Recognition, and Sequence Classification. To our knowledge, this is the first comprehensive study specifically focused on creating efficient and compact transformers for clinical NLP tasks. The models and code used in this study can be found on our Huggingface profile at https://huggingface.co/nlpie and Github page at https://github.com/nlpie-research/Lightweight-Clinical-Transformers, respectively, promoting reproducibility of our results.

cs.CL↗