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Xihe Qiu

Publications and source records attributed to Xihe Qiu.

At least 19 recordsLinked to original sources
arXiv2026

CW-B: Class Weighted Boosting Framework for Imbalance Resilient Multi Class Cardiac Phenotyping

Cardiac discharge phenotyping informs post-discharge treatment and follow-up, but real-world records are often incomplete and class-imbalanced, increasing the risk of missed high-risk phenotypes. We propose CW-B, a clinical risk-aligned class-weighted XGBoost pipeline for five-class cardiac discharge phenotyping under real-world class imbalance and missingness. CW-B combines fold-specific class-balanced instance weighting, missingness-indicator augmentation, and classwise error auditing to improve recognition of clinically prioritized phenotypes while preserving interpretable and auditable decision logic. In five-fold stratified cross-validation, CW-B achieves the best Accuracy, Macro-F1, Balanced Accuracy, and Prioritized F1 among tree-based, ensemble, and neural baselines. Overall, CW-B provides a practical and deployment-oriented approach for more reliable cardiac discharge phenotyping in real-world clinical settings.

cs.LG↗
arXiv2026

Latent-CURE for Breast Cancer Diagnosis

Multimodal Large Models have significantly advanced automated breast ultrasound diagnosis. However, most existing frameworks utilize opaque, end-to-end paradigms prioritizing global statistical correlations over structured clinical reasoning. Consequently, these models remain susceptible to shortcut learning amid extreme real-world epidemiological imbalances, often bypassing rare but decisive malignant indicators for dominant benign patterns. To address this disconnect, we propose Latent-CURE, a novel diagnostic framework driven by asymmetric weighted chain-of-thought methodology grounded in latent space reasoning. Unlike traditional approaches, our framework constructs an implicit reasoning trajectory forcing the model to sequentially infer standardized BI-RADS morphological descriptors before converging on a final diagnosis. Furthermore, to combat the extreme scarcity of critical malignant features, we couple this architecture with a dual-asymmetric optimization strategy. By dynamically adjusting margins and weights, this strategy safeguards high-specificity malignant descriptors from being overshadowed by common benign priors. Comprehensive evaluations demonstrate that our knowledge-injected approach provides transparent clinical evidence while achieving robust, accurate diagnostic performance in imbalanced medical cohorts.

cs.CV↗
arXiv2026

VentAgent: When LLMs Learn to Breathe -- Multi-Objective Arbitration for ARDS Ventilation

Mechanical ventilation for Acute Respiratory Distress Syndrome (ARDS) requires balancing competing physiological goals, including oxygenation, lung protection, and acid-base homeostasis. However, current data-driven methods, especially those imitating retrospective Electronic Health Records (EHR), often suffer from imitation bias. They may capture superficial correlations from inconsistent clinical demonstrations, such as associating passive ventilator settings with survival because such settings are common in stable patients, and thus fail to generalize to volatile or out-of-distribution phenotypes. Standard Reinforcement Learning (RL) methods also struggle with the adversarial trade-offs of critical care and often produce opaque policies with limited clinical interpretability. To address these limitations, we introduce VentAgent, a hierarchical framework in which Large Language Models (LLMs) act as transparent arbitrators for mechanical ventilation. We reformulate ventilation control as a dynamic Multi-Objective Arbitration process rather than single-objective optimization. VentAgent decomposes decision-making into three interpretable stages: Perception, Planning, and Orchestration. By leveraging the semantic reasoning capabilities of LLMs, it synthesizes strategies from heterogeneous experts and resolves conflicting clinical priorities through an explicit coordination mechanism. Evaluations on a high-fidelity physiological simulator show that VentAgent outperforms state-of-the-art RL and classical control baselines. Moreover, it converts control decisions into human-readable reasoning chains, offering a safer, more interpretable, and adaptable paradigm for critical care automation.

cs.LG↗
arXiv2026

Structured Visual Evidence Decomposition for Evidence-Grounded Multimodal Screening of Obstructive Sleep Apnea-Hypopnea Syndrome

Effective pre-polysomnography screening for obstructive sleep apnea-hypopnea syndrome (OSAHS) requires combining clinical risk factors with visible craniofacial and neck cues. Directly prompting general-purpose multimodal foundation models for medical yes/no decisions can yield unstable, poorly calibrated outputs. We propose EviOSAHS, an evidence-grounded multimodal reasoning framework that separates image-only anatomical evidence acquisition from final clinical adjudication. Each frontal facial image is decomposed into seven fixed anatomical queries covering the neck, chin, mouth, face/neck fat, lower jaw, midface, and nose. Visual responses are converted into structured evidence cards recording target anatomy, visibility, risk direction, evidence strength, confidence, and a concise summary. These cards are combined with a cleaned clinical profile only in the final stage, where a large language model performs balanced binary screening adjudication. We evaluated EviOSAHS on a 642-subject cohort, mapping normal subjects to screening-negative and mild, moderate, or severe OSAHS subjects to screening-positive. EviOSAHS achieved 88.47% accuracy, 94.86% sensitivity, 93.74% F1-score, and a 5.14% false-negative rate, outperforming clinical-only prompting, direct multimodal prompting, and naive two-stage pipelines under a unified protocol. Ablations showed that seven-question visual decomposition and balanced final adjudication were critical to the high-sensitivity operating point. A question-level audit of 4,494 visual outputs showed a 100% structured parse rate and 93.88% high-visibility rate. EviOSAHS provides an auditable, high-sensitivity workflow for binary pre-polysomnography OSAHS screening, but should be viewed as a triage assistant rather than a diagnostic system. Prospective validation, external testing, and calibrated operating-point control are needed before clinical deployment.

cs.CV↗
arXiv2026

Human-in-the-Loop Multi-Agent Ventilator Decision Support with Contextual Bandit Preference Learning

Ventilator decision support requires sequential decisions that track evolving physiology and disease trajectories while respecting safety boundaries and clinician specific tuning styles. Rule based approaches rarely generalize personalization, and end to end reinforcement learning or single large language model systems remain difficult to control and audit. We propose the Ventilator Decision Support System (VDSS), a human in the loop multi agent framework that coordinates modular decision components through contract driven structured interfaces and produces traceable evidence for review. VDSS performs online preference adaptation with a contextual bandit, updating clinician specific preferences from the final accepted decision at each adjustment cycle and using them to guide subsequent recommendations. Structured rejection feedback triggers targeted replanning to reduce unproductive iterations and improve interaction stability. Retrospective ICU trajectory replay with expert review indicates higher recommendation acceptability and fewer interaction rounds to reach an acceptable plan, supporting clinically deployable human AI collaboration.

cs.AI↗
arXiv2026

Active Evidence-Seeking and Diagnostic Reasoning in Large Language Models for Clinical Decision Support

Large language models perform well on static medical examinations, yet clinical diagnosis often requires iterative evidence gathering under uncertainty. Building on prior interactive evaluation efforts, we introduce an OSCE-inspired standardized patient simulator and a controlled, reproducible benchmark for active diagnostic inquiry. Across 468 cases and 15 models in our protocol, we observe that multi-turn evidence seeking reduces diagnostic accuracy by 12.75% and lowers supporting-evidence quality by 24.36% relative to full-context evaluation; error analyses associate these drops with premature diagnostic closure and inefficient questioning. Together, these results suggest that static full-context benchmarks may overestimate performance in interactive evidence-seeking settings, motivating complementary interactive assessment for safer clinical decision support.

cs.AI↗
arXiv2026

From Answers to Arguments: Toward Trustworthy Clinical Diagnostic Reasoning with Toulmin-Guided Curriculum Goal-Conditioned Learning

The integration of Large Language Models (LLMs) into clinical decision support is critically obstructed by their opaque and often unreliable reasoning. In the high-stakes domain of healthcare, correct answers alone are insufficient; clinical practice demands full transparency to ensure patient safety and enable professional accountability. A pervasive and dangerous weakness of current LLMs is their tendency to produce "correct answers through flawed reasoning." This issue is far more than a minor academic flaw; such process errors signal a fundamental lack of robust understanding, making the model prone to broader hallucinations and unpredictable failures when faced with real-world clinical complexity. In this paper, we establish a framework for trustworthy clinical argumentation by adapting the Toulmin model to the diagnostic process. We propose a novel training pipeline: Curriculum Goal-Conditioned Learning (CGCL), designed to progressively train LLM to generate diagnostic arguments that explicitly follow this Toulmin structure. CGCL's progressive three-stage curriculum systematically builds a solid clinical argument: (1) extracting facts and generating differential diagnoses; (2) justifying a core hypothesis while rebutting alternatives; and (3) synthesizing the analysis into a final, qualified conclusion. We validate CGCL using T-Eval, a quantitative framework measuring the integrity of the diagnosis reasoning. Experiments show that our method achieves diagnostic accuracy and reasoning quality comparable to resource-intensive Reinforcement Learning (RL) methods, while offering a more stable and efficient training pipeline.

cs.AI↗
arXiv2026

VIVID-Med: LLM-Supervised Structured Pretraining for Deployable Medical ViTs

Vision-language pretraining has driven significant progress in medical image analysis. However, current methods typically supervise visual encoders using one-hot labels or free-form text, neither of which effectively captures the complex semantic relationships among clinical findings. In this study, we introduce VIVID-Med, a novel framework that leverages a frozen large language model (LLM) as a structured semantic teacher to pretrain medical vision transformers (ViTs). VIVID-Med translates clinical findings into verifiable JSON field-state pairs via a Unified Medical Schema (UMS), utilizing answerability-aware masking to focus optimization. It then employs Structured Prediction Decomposition (SPD) to partition cross-attention into orthogonality-regularized query groups, extracting complementary visual aspects. Crucially, the LLM is discarded post-training, yielding a lightweight, deployable ViT-only backbone. We evaluated VIVID-Med across multiple settings: on CheXpert linear probing, it achieves a macro-AUC of 0.8588, outperforming BiomedCLIP by +6.65 points while using 500x less data. It also demonstrates robust zero-shot cross-domain transfer to NIH ChestX-ray14 (0.7225 macro-AUC) and strong cross-modality generalization to CT, achieving 0.8413 AUC on LIDC-IDRI lung nodule classification and 0.9969 macro-AUC on OrganAMNIST 11-organ classification. VIVID-Med offers a highly efficient, scalable alternative to deploying resource-heavy vision-language models in clinical settings.

cs.CV↗
arXiv2026

PRISM: Festina Lente Proactivity -- Risk-Sensitive, Uncertainty-Aware Deliberation for Proactive Agents

Proactive agents must decide not only what to say but also whether and when to intervene. Many current systems rely on brittle heuristics or indiscriminate long reasoning, which offers little control over the benefit-burden tradeoff. We formulate the problem as cost-sensitive selective intervention and present PRISM, a novel framework that couples a decision-theoretic gate with a dual-process reasoning architecture. At inference time, the agent intervenes only when a calibrated probability of user acceptance exceeds a threshold derived from asymmetric costs of missed help and false alarms. Inspired by festina lente (Latin: "make haste slowly"), we gate by an acceptance-calibrated, cost-derived threshold and invoke a resource-intensive Slow mode with counterfactual checks only near the decision boundary, concentrating computation on ambiguous and high-stakes cases. Training uses gate-aligned, schema-locked distillation: a teacher running the full PRISM pipeline provides dense, executable supervision on unlabeled interaction traces, while the student learns a response policy that is explicitly decoupled from the intervention gate to enable tunable and auditable control. On ProactiveBench, PRISM reduces false alarms by 22.78% and improves F1 by 20.14% over strong baselines. These results show that principled decision-theoretic gating, paired with selective slow reasoning and aligned distillation, yields proactive agents that are precise, computationally efficient, and controllable. To facilitate reproducibility, we release our code, models, and resources at https://prism-festinalente.github.io/; all experiments use the open-source ProactiveBench benchmark.

cs.AI↗
arXiv2026

Curiosity Driven Knowledge Retrieval for Mobile Agents

Mobile agents have made progress toward reliable smartphone automation, yet performance in complex applications remains limited by incomplete knowledge and weak generalization to unseen environments. We introduce a curiosity driven knowledge retrieval framework that formalizes uncertainty during execution as a curiosity score. When this score exceeds a threshold, the system retrieves external information from documentation, code repositories, and historical trajectories. Retrieved content is organized into structured AppCards, which encode functional semantics, parameter conventions, interface mappings, and interaction patterns. During execution, an enhanced agent selectively integrates relevant AppCards into its reasoning process, thereby compensating for knowledge blind spots and improving planning reliability. Evaluation on the AndroidWorld benchmark shows consistent improvements across backbones, with an average gain of six percentage points and a new state of the art success rate of 88.8\% when combined with GPT-5. Analysis indicates that AppCards are particularly effective for multi step and cross application tasks, while improvements depend on the backbone model. Case studies further confirm that AppCards reduce ambiguity, shorten exploration, and support stable execution trajectories. Task trajectories are publicly available at https://lisalsj.github.io/Droidrun-appcard/.

cs.AI↗
arXiv2026

SRU-Pix2Pix: A Fusion-Driven Generator Network for Medical Image Translation with Few-Shot Learning

Magnetic Resonance Imaging (MRI) provides detailed tissue information, but its clinical application is limited by long acquisition time, high cost, and restricted resolution. Image translation has recently gained attention as a strategy to address these limitations. Although Pix2Pix has been widely applied in medical image translation, its potential has not been fully explored. In this study, we propose an enhanced Pix2Pix framework that integrates Squeeze-and-Excitation Residual Networks (SEResNet) and U-Net++ to improve image generation quality and structural fidelity. SEResNet strengthens critical feature representation through channel attention, while U-Net++ enhances multi-scale feature fusion. A simplified PatchGAN discriminator further stabilizes training and refines local anatomical realism. Experimental results demonstrate that under few-shot conditions with fewer than 500 images, the proposed method achieves consistent structural fidelity and superior image quality across multiple intra-modality MRI translation tasks, showing strong generalization ability. These results suggest an effective extension of Pix2Pix for medical image translation.

cs.CV↗
arXiv2025

EEG-VLM: A Hierarchical Vision-Language Model with Multi-Level Feature Alignment and Visually Enhanced Language-Guided Reasoning for EEG Image-Based Sleep Stage Prediction

Sleep stage classification based on electroencephalography (EEG) is fundamental for assessing sleep quality and diagnosing sleep-related disorders. However, most traditional machine learning methods rely heavily on prior knowledge and handcrafted features, while existing deep learning models still struggle to jointly capture fine-grained time-frequency patterns and achieve clinical interpretability. Recently, vision-language models (VLMs) have made significant progress in the medical domain, yet their performance remains constrained when applied to physiological waveform data, especially EEG signals, due to their limited visual understanding and insufficient reasoning capability. To address these challenges, we propose EEG-VLM, a hierarchical vision-language framework that integrates multi-level feature alignment with visually enhanced language-guided reasoning for interpretable EEG-based sleep stage classification. Specifically, a specialized visual enhancement module constructs high-level visual tokens from intermediate-layer features to extract rich semantic representations of EEG images. These tokens are further aligned with low-level CLIP features through a multi-level alignment mechanism, enhancing the VLM's image-processing capability. In addition, a Chain-of-Thought (CoT) reasoning strategy decomposes complex medical inference into interpretable logical steps, effectively simulating expert-like decision-making. Experimental results demonstrate that the proposed method significantly improves both the accuracy and interpretability of VLMs in EEG-based sleep stage classification, showing promising potential for automated and explainable EEG analysis in clinical settings.

cs.AI↗
arXiv2025

Reflective Personalization Optimization: A Post-hoc Rewriting Framework for Black-Box Large Language Models

The personalization of black-box large language models (LLMs) is a critical yet challenging task. Existing approaches predominantly rely on context injection, where user history is embedded into the prompt to directly guide the generation process. However, this single-step paradigm imposes a dual burden on the model: generating accurate content while simultaneously aligning with user-specific styles. This often results in a trade-off that compromises output quality and limits precise control. To address this fundamental tension, we propose Reflective Personalization Optimization (RPO), a novel framework that redefines the personalization paradigm by decoupling content generation from alignment. RPO operates in two distinct stages: first, a base model generates a high-quality, generic response; then, an external reflection module explicitly rewrites this output to align with the user's preferences. This reflection module is trained using a two-stage process. Initially, supervised fine-tuning is employed on structured rewriting trajectories to establish a core personalized reasoning policy that models the transformation from generic to user-aligned responses. Subsequently, reinforcement learning is applied to further refine and enhance the quality of the personalized outputs. Comprehensive experiments on the LaMP benchmark demonstrate that RPO, by decoupling content generation from personalization, significantly outperforms state-of-the-art baselines. These findings underscore the superiority of explicit response shaping over implicit context injection. Moreover, RPO introduces an efficient, model-agnostic personalization layer that can be seamlessly integrated with any underlying base model, paving the way for a new and effective direction in user-centric generation scenarios.

cs.CL↗
arXiv2025

Gradient-Direction-Aware Density Control for 3D Gaussian Splatting

The emergence of 3D Gaussian Splatting (3DGS) has significantly advanced Novel View Synthesis (NVS) through explicit scene representation, enabling real-time photorealistic rendering. However, existing approaches manifest two critical limitations in complex scenarios: (1) Over-reconstruction occurs when persistent large Gaussians cannot meet adaptive splitting thresholds during density control. This is exacerbated by conflicting gradient directions that prevent effective splitting of these Gaussians; (2) Over-densification of Gaussians occurs in regions with aligned gradient aggregation, leading to redundant component proliferation. This redundancy significantly increases memory overhead due to unnecessary data retention. We present Gradient-Direction-Aware Gaussian Splatting (GDAGS) to address these challenges. Our key innovations: the Gradient Coherence Ratio (GCR), computed through normalized gradient vector norms, which explicitly discriminates Gaussians with concordant versus conflicting gradient directions; and a nonlinear dynamic weighting mechanism leverages the GCR to enable gradient-direction-aware density control. Specifically, GDAGS prioritizes conflicting-gradient Gaussians during splitting operations to enhance geometric details while suppressing redundant concordant-direction Gaussians. Conversely, in cloning processes, GDAGS promotes concordant-direction Gaussian densification for structural completion while preventing conflicting-direction Gaussian overpopulation. Comprehensive evaluations across diverse real-world benchmarks demonstrate that GDAGS achieves superior rendering quality while effectively mitigating over-reconstruction, suppressing over-densification, and constructing compact scene representations.

cs.CV↗
arXiv2025

OR-VSKC: Resolving Visual-Semantic Knowledge Conflicts in Operating Rooms with Synthetic Data-Guided Alignment

Automated identification of surgical safety risks is critical for improving patient outcomes; however, Multimodal Large Language Models (MLLMs) frequently suffer from Visual-Semantic Knowledge Conflicts (VS-KC), a phenomenon where models possess safety knowledge but fail to activate it during visual inspection. Investigating this alignment gap in operating rooms (ORs) is impeded by a critical bottleneck: the scarcity and privacy constraints of real-world OR data depicting safety violations. To address this, we introduce OR-VSKC, a benchmark for studying VS-KC and surgical risk perception in strictly regulated OR environments. Constructed via our Protocol-to-Pixel Generative Framework, OR-VSKC comprises 28,190 high-fidelity synthetic images grounded in authoritative safety standards, complemented by a 713-image expert-authored challenge subset validated by multiple experts. The full benchmark is built from authentic OR contexts drawn from the 4D-OR and CAMMA-MVOR datasets, where the 4D-OR-based portion serves as the primary benchmark core and the CAMMA-MVOR-based portion is reserved for external validation and cross-dataset generalization analysis. Evaluations of state-of-the-art MLLMs reveal substantial reliability gaps even in advanced generalist models. Furthermore, experiments show that fine-tuning on OR-VSKC effectively mitigates VS-KC and enables robust generalization to unseen camera viewpoints. We open-source the code and dataset to support reproducible research in safety-critical medical environments. The source code is available at https://github.com/zgg2577/VS-KC.

cs.CV↗
arXiv2025

AURORA:Automated Training Framework of Universal Process Reward Models via Ensemble Prompting and Reverse Verification

The reasoning capabilities of advanced large language models (LLMs) like o1 have revolutionized artificial intelligence applications. Nevertheless, evaluating and optimizing complex reasoning processes remain significant challenges due to diverse policy distributions and the inherent limitations of human effort and accuracy. In this paper, we present AURORA, a novel automated framework for training universal process reward models (PRMs) using ensemble prompting and reverse verification. The framework employs a two-phase approach: First, it uses diverse prompting strategies and ensemble methods to perform automated annotation and evaluation of processes, ensuring robust assessments for reward learning. Second, it leverages practical reference answers for reverse verification, enhancing the model's ability to validate outputs and improving training accuracy. To assess the framework's performance, we extend beyond the existing ProcessBench benchmark by introducing UniversalBench, which evaluates reward predictions across full trajectories under diverse policy distribtion with long Chain-of-Thought (CoT) outputs. Experimental results demonstrate that AURORA enhances process evaluation accuracy, improves PRMs' accuracy for diverse policy distributions and long-CoT responses. The project will be open-sourced at https://auroraprm.github.io/. The Universal-PRM-7B is available at https://huggingface.co/infly/Universal-PRM-7B.

cs.CL↗
arXiv2024

An Attentive Dual-Encoder Framework Leveraging Multimodal Visual and Semantic Information for Automatic OSAHS Diagnosis

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder caused by upper airway blockage, leading to oxygen deprivation and disrupted sleep. Traditional diagnosis using polysomnography (PSG) is expensive, time-consuming, and uncomfortable. Existing deep learning methods using facial image analysis lack accuracy due to poor facial feature capture and limited sample sizes. To address this, we propose a multimodal dual encoder model that integrates visual and language inputs for automated OSAHS diagnosis. The model balances data using randomOverSampler, extracts key facial features with attention grids, and converts physiological data into meaningful text. Cross-attention combines image and text data for better feature extraction, and ordered regression loss ensures stable learning. Our approach improves diagnostic efficiency and accuracy, achieving 91.3% top-1 accuracy in a four-class severity classification task, demonstrating state-of-the-art performance. Code will be released upon acceptance.

cs.CV↗
arXiv2024

Distribution-aware Noisy-label Crack Segmentation

Road crack segmentation is critical for robotic systems tasked with the inspection, maintenance, and monitoring of road infrastructures. Existing deep learning-based methods for crack segmentation are typically trained on specific datasets, which can lead to significant performance degradation when applied to unseen real-world scenarios. To address this, we introduce the SAM-Adapter, which incorporates the general knowledge of the Segment Anything Model (SAM) into crack segmentation, demonstrating enhanced performance and generalization capabilities. However, the effectiveness of the SAM-Adapter is constrained by noisy labels within small-scale training sets, including omissions and mislabeling of cracks. In this paper, we present an innovative joint learning framework that utilizes distribution-aware domain-specific semantic knowledge to guide the discriminative learning process of the SAM-Adapter. To our knowledge, this is the first approach that effectively minimizes the adverse effects of noisy labels on the supervised learning of the SAM-Adapter. Our experimental results on two public pavement crack segmentation datasets confirm that our method significantly outperforms existing state-of-the-art techniques. Furthermore, evaluations on the completely unseen CFD dataset demonstrate the high cross-domain generalization capability of our model, underscoring its potential for practical applications in crack segmentation.

cs.CV↗