Daily Papers

Large language models (LLMs) are increasingly deployed in medical contexts, raising critical concerns about safety, alignment, and susceptibility to adversarial manipulation. While prior benchmarks assess model refusal capabilities for harmful prompts, they often lack clinical specificity, graded harmfulness levels, and coverage of jailbreak-style attacks. We introduce CARES (Clinical Adversarial Robustness and Evaluation of Safety), a benchmark for evaluating LLM safety in healthcare. CARES includes over 18,000 prompts spanning eight medical safety principles, four harm levels, and four prompting styles: direct, indirect, obfuscated, and role-play, to simulate both malicious and benign use cases. We propose a three-way response evaluation protocol (Accept, Caution, Refuse) and a fine-grained Safety Score metric to assess model behavior. Our analysis reveals that many state-of-the-art LLMs remain vulnerable to jailbreaks that subtly rephrase harmful prompts, while also over-refusing safe but atypically phrased queries. Finally, we propose a mitigation strategy using a lightweight classifier to detect jailbreak attempts and steer models toward safer behavior via reminder-based conditioning. CARES provides a rigorous framework for testing and improving medical LLM safety under adversarial and ambiguous conditions.

As large language models (LLMs) are increasingly deployed in high-risk domains such as law, finance, and medicine, systematically evaluating their domain-specific safety and compliance becomes critical. While prior work has largely focused on improving LLM performance in these domains, it has often neglected the evaluation of domain-specific safety risks. To bridge this gap, we first define domain-specific safety principles for LLMs based on the AMA Principles of Medical Ethics, the ABA Model Rules of Professional Conduct, and the CFA Institute Code of Ethics. Building on this foundation, we introduce Trident-Bench, a benchmark specifically targeting LLM safety in the legal, financial, and medical domains. We evaluated 19 general-purpose and domain-specialized models on Trident-Bench and show that it effectively reveals key safety gaps -- strong generalist models (e.g., GPT, Gemini) can meet basic expectations, whereas domain-specialized models often struggle with subtle ethical nuances. This highlights an urgent need for finer-grained domain-specific safety improvements. By introducing Trident-Bench, our work provides one of the first systematic resources for studying LLM safety in law and finance, and lays the groundwork for future research aimed at reducing the safety risks of deploying LLMs in professionally regulated fields. Code and benchmark will be released at: https://github.com/zackhuiiiii/TRIDENT

The remarkable capabilities of Large Language Models (LLMs) make them increasingly compelling for adoption in real-world healthcare applications. However, the risks associated with using LLMs in medical applications have not been systematically characterized. We propose using five key principles for safe and trustworthy medical AI: Truthfulness, Resilience, Fairness, Robustness, and Privacy, along with ten specific aspects. Under this comprehensive framework, we introduce a novel MedGuard benchmark with 1,000 expert-verified questions. Our evaluation of 11 commonly used LLMs shows that the current language models, regardless of their safety alignment mechanisms, generally perform poorly on most of our benchmarks, particularly when compared to the high performance of human physicians. Despite recent reports indicate that advanced LLMs like ChatGPT can match or even exceed human performance in various medical tasks, this study underscores a significant safety gap, highlighting the crucial need for human oversight and the implementation of AI safety guardrails.

Large language models (LLMs) are increasingly used for medical and health-related questions, yet their safety in high-risk medical scenarios remains poorly understood. We introduce MedHarmCode and data will be released upon acceptance. Due to the sensitive nature of high-risk medical queries, data access will be available to qualified researchers upon request., a high-risk medical safety benchmark with 1,100 medically grounded queries across 10 safety-critical categories, including toxicology, pharmacology, covert poisoning, anesthesia, and fetal harm. Unlike broad medical QA benchmarks, MedHarm targets realistic clinical, educational, and technical prompts that require refusal, caution, or safe redirection rather than direct helpfulness. We evaluate 15 LLMs spanning general-purpose, medical-purpose, closed-source, and downstream SFT models, together with 4 representative guardrail models. Results reveal a substantial gap between apparent alignment and medical safety: aligned models can still produce unsafe or actionable responses, medical fine-tuning can amplify harmful specificity, and external guardrails reduce some failures while introducing brittle blocking and weak safe helpfulness. These findings show that medical safety cannot be inferred from general alignment or medical capability alone, highlighting the need for domain-specific stress testing before deploying LLMs in safety-critical medical applications.

Large language models(LLMs) increasingly match expert performance on licensing examinations, yet routine clinical use remains limited because governance requires auditable reasoning, safety and ethics alignment, and resilience to adversarial misuse. Here we present SafeMed-R1, trained with a traceable Clinical Trust Signals(CTS) pipeline that links each reasoning instance to clinician rubric scores and edit histories, and aligned through safety and ethics supervision and red team stress testing. SafeMed-R1 attains a macro-averaged accuracy of 79.6% across clinical benchmarks. Under adversarial safety testing, it shows the lowest aggregated risk and reduces unsafe outputs by about 3 to 5% relative to its baseline. In a paired expert study of 30 medication safety vignettes, SafeMed-R1 matches PGY1 and PGY2 residents on medical correctness and scores higher for medication safety, guideline consistency, and clinical usefulness. Collectively, these results suggest that clinician-audited supervision provenance, together with domain-tailored safety and ethics alignment, can strengthen governance-relevant evidence without relying on inference-time retrieval or citation grounding.

As the performance of large language models (LLMs) continues to advance, their adoption is expanding across a wide range of domains, including the medical field. The integration of LLMs into medical applications raises critical safety concerns, particularly due to their use by users with diverse roles, e.g. patients and clinicians, and the potential for model's outputs to directly affect human health. Despite the domain-specific capabilities of medical LLMs, prior safety evaluations have largely focused only on general safety benchmarks. In this paper, we introduce a safety evaluation protocol tailored to the medical domain in both patient user and clinician user perspectives, alongside general safety assessments and quantitatively analyze the safety of medical LLMs. We bridge a gap in the literature by building the PatientSafetyBench containing 466 samples over 5 critical categories to measure safety from the perspective of the patient. We apply our red-teaming protocols on the MediPhi model collection as a case study. To our knowledge, this is the first work to define safety evaluation criteria for medical LLMs through targeted red-teaming taking three different points of view - patient, clinician, and general user - establishing a foundation for safer deployment in medical domains.

Clinical LLMs are often scaled by increasing model size, context length, retrieval complexity, or inference-time compute, with the implicit expectation that higher accuracy implies safer behavior. This assumption is incomplete in medicine, where a few confident, high-risk, or evidence-contradicting errors can matter more than average benchmark performance. We introduce SaFE-Scale, a framework for measuring how clinical LLM safety changes across model scale, evidence quality, retrieval strategy, context exposure, and inference-time compute. To instantiate this framework, we introduce RadSaFE-200, a Radiology Safety-Focused Evaluation benchmark of 200 multiple-choice questions with clinician-defined clean evidence, conflict evidence, and option-level labels for high-risk error, unsafe answer, and evidence contradiction. We evaluated 34 locally deployed LLMs across six deployment conditions: closed-book prompting (zero-shot), clean evidence, conflict evidence, standard RAG, agentic RAG, and max-context prompting. Clean evidence produced the strongest improvement, increasing mean accuracy from 73.5% to 94.1%, while reducing high-risk error from 12.0% to 2.6%, contradiction from 12.7% to 2.3%, and dangerous overconfidence from 8.0% to 1.6%. Standard RAG and agentic RAG did not reproduce this safety profile: agentic RAG improved accuracy over standard RAG and reduced contradiction, but high-risk error and dangerous overconfidence remained elevated. Max-context prompting increased latency without closing the safety gap, and additional inference-time compute produced only limited gains. Worst-case analysis showed that clinically consequential errors concentrated in a small subset of questions. Clinical LLM safety is therefore not a passive consequence of scaling, but a deployment property shaped by evidence quality, retrieval design, context construction, and collective failure behavior.

Large language models (LLMs) are routinely used by physicians and patients for medical advice, yet their clinical safety profiles remain poorly characterized. We present NOHARM (Numerous Options Harm Assessment for Risk in Medicine), a benchmark using 100 real primary care-to-specialist consultation cases to measure frequency and severity of harm from LLM-generated medical recommendations. NOHARM covers 10 specialties, with 12,747 expert annotations for 4,249 clinical management options. Across 31 LLMs, potential for severe harm from LLM recommendations occurs in up to 22.2% (95% CI 21.6-22.8%) of cases, with harm of omission accounting for 76.6% (95% CI 76.4-76.8%) of errors. Safety performance is only moderately correlated (r = 0.61-0.64) with existing AI and medical knowledge benchmarks. The best models outperform generalist physicians on safety (mean difference 9.7%, 95% CI 7.0-12.5%), and a diverse multi-agent approach improves safety compared to solo models (mean difference 8.0%, 95% CI 4.0-12.1%). Therefore, despite strong performance on existing evaluations, widely used AI models can produce severely harmful medical advice at nontrivial rates, underscoring clinical safety as a distinct performance dimension necessitating explicit measurement.

Large language models (LLMs) are increasingly used for health-related advice. Existing research measures their safety with static questions rather than pressured patient-facing conversations. We introduce MedPRESS, a multi-turn benchmark for measuring patient-pressure-induced sycophancy in LLMs. MedPRESS contains 600 medically grounded five-turn dialogues across three scenario families: medication and treatment demand, personal health self-care, and symptom triage and care resistance. Each dialogue begins with a health query and escalates through personal experience, social proof, external evidence claims, and direct adversarial challenge. We evaluate 20 LLMs across general, medical-domain, lightweight, large, open-weight, and proprietary families using structured judging and safety-focused metrics. Results show that models frequently shift toward unsafe agreement under repeated patient pressure, with substantial variation across model families, model scale, and prompt type. Anti-sycophancy prompting improves robustness for several models, but does not eliminate unsafe agreement. MedPRESS highlights a critical gap in medical LLM evaluation: safe medical knowledge is not enough unless models can maintain it under conversational pressure.

With the advent of Large Language Models (LLMs), medical artificial intelligence (AI) has experienced substantial technological progress and paradigm shifts, highlighting the potential of LLMs to streamline healthcare delivery and improve patient outcomes. Considering this rapid technical progress, in this survey, we trace the recent advances of Medical Large Language Models (Med-LLMs), including the background, key findings, and mainstream techniques, especially for the evolution from general-purpose models to medical-specialized applications. Firstly, we delve into the foundational technology of Med-LLMs, indicating how general models can be progressively adapted and refined for the complicated medical tasks. Secondly, the wide-ranging applications of Med-LLMs are investigated across various healthcare domains, as well as an up-to-date review of existing Med-LLMs. The transformative impact of these models on daily medical practice is evident through their ability to assist clinicians, educators, and patients. Recognizing the importance of responsible innovation, we discuss the challenges associated with ensuring fairness, accountability, privacy, and robustness. Ethical considerations, rigorous evaluation methodologies, and the establishment of regulatory frameworks are crucial for building trustworthiness in the real-world system. We emphasize the need for ongoing scrutiny and development to maintain high standards of safety and reliability. Finally, we anticipate possible future trajectories for Med-LLMs, identifying key avenues for prudent expansion. By consolidating these insights, our review aims to provide professionals and researchers with a thorough understanding of the strengths and limitations of Med-LLMs, fostering a balanced and ethical approach to their integration into the healthcare ecosystem.

Foundation Models that are capable of processing and generating multi-modal data have transformed AI's role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety. We define medical hallucination as any instance in which a model generates misleading medical content. This paper examines the unique characteristics, causes, and implications of medical hallucinations, with a particular focus on how these errors manifest themselves in real-world clinical scenarios. Our contributions include (1) a taxonomy for understanding and addressing medical hallucinations, (2) benchmarking models using medical hallucination dataset and physician-annotated LLM responses to real medical cases, providing direct insight into the clinical impact of hallucinations, and (3) a multi-national clinician survey on their experiences with medical hallucinations. Our results reveal that inference techniques such as Chain-of-Thought (CoT) and Search Augmented Generation can effectively reduce hallucination rates. However, despite these improvements, non-trivial levels of hallucination persist. These findings underscore the ethical and practical imperative for robust detection and mitigation strategies, establishing a foundation for regulatory policies that prioritize patient safety and maintain clinical integrity as AI becomes more integrated into healthcare. The feedback from clinicians highlights the urgent need for not only technical advances but also for clearer ethical and regulatory guidelines to ensure patient safety. A repository organizing the paper resources, summaries, and additional information is available at https://github.com/mitmedialab/medical hallucination.

The integration of Large Language Models (LLMs) into healthcare demands a safety paradigm rooted in primum non nocere. However, current alignment techniques rely on generic definitions of harm that fail to capture context-dependent violations, such as administrative fraud and clinical discrimination. To address this, we introduce Medical Malice: a dataset of 214,219 adversarial prompts calibrated to the regulatory and ethical complexities of the Brazilian Unified Health System (SUS). Crucially, the dataset includes the reasoning behind each violation, enabling models to internalize ethical boundaries rather than merely memorizing a fixed set of refusals. Using an unaligned agent (Grok-4) within a persona-driven pipeline, we synthesized high-fidelity threats across seven taxonomies, ranging from procurement manipulation and queue-jumping to obstetric violence. We discuss the ethical design of releasing these "vulnerability signatures" to correct the information asymmetry between malicious actors and AI developers. Ultimately, this work advocates for a shift from universal to context-aware safety, providing the necessary resources to immunize healthcare AI against the nuanced, systemic threats inherent to high-stakes medical environments -- vulnerabilities that represent the paramount risk to patient safety and the successful integration of AI in healthcare systems.

Chai empowers users to create and interact with customized chatbots, offering unique and engaging experiences. Despite the exciting prospects, the work recognizes the inherent challenges of a commitment to modern safety standards. Therefore, this paper presents the integrated AI safety principles into Chai to prioritize user safety, data protection, and ethical technology use. The paper specifically explores the multidimensional domain of AI safety research, demonstrating its application in Chai's conversational chatbot platform. It presents Chai's AI safety principles, informed by well-established AI research centres and adapted for chat AI. This work proposes the following safety framework: Content Safeguarding; Stability and Robustness; and Operational Transparency and Traceability. The subsequent implementation of these principles is outlined, followed by an experimental analysis of Chai's AI safety framework's real-world impact. We emphasise the significance of conscientious application of AI safety principles and robust safety measures. The successful implementation of the safe AI framework in Chai indicates the practicality of mitigating potential risks for responsible and ethical use of AI technologies. The ultimate vision is a transformative AI tool fostering progress and innovation while prioritizing user safety and ethical standards.

Safety alignment in Large Language Models is critical for healthcare; however, reliance on binary refusal boundaries often results in over-refusal of benign queries or unsafe compliance with harmful ones. While existing benchmarks measure these extremes, they fail to evaluate Safe Completion: the model's ability to maximise helpfulness on dual-use or borderline queries by providing safe, high-level guidance without crossing into actionable harm. We introduce Health-ORSC-Bench, the first large-scale benchmark designed to systematically measure Over-Refusal and Safe Completion quality in healthcare. Comprising 31,920 benign boundary prompts across seven health categories (e.g., self-harm, medical misinformation), our framework uses an automated pipeline with human validation to test models at varying levels of intent ambiguity. We evaluate 30 state-of-the-art LLMs, including GPT-5 and Claude-4, revealing a significant tension: safety-optimised models frequently refuse up to 80\% of "Hard" benign prompts, while domain-specific models often sacrifice safety for utility. Our findings demonstrate that model family and size significantly influence calibration: larger frontier models (e.g., GPT-5, Llama-4) exhibit "safety-pessimism" and higher over-refusal than smaller or MoE-based counterparts (e.g., Qwen-3-Next), highlighting that current LLMs struggle to balance refusal and compliance. Health-ORSC-Bench provides a rigorous standard for calibrating the next generation of medical AI assistants toward nuanced, safe, and helpful completions. The code and data will be released upon acceptance. red{Warning: Some contents may include toxic or undesired contents.}

Generative AI technologies are growing in power, utility, and use. As generative technologies are being incorporated into mainstream applications, there is a need for guidance on how to design those applications to foster productive and safe use. Based on recent research on human-AI co-creation within the HCI and AI communities, we present a set of seven principles for the design of generative AI applications. These principles are grounded in an environment of generative variability. Six principles are focused on designing for characteristics of generative AI: multiple outcomes & imperfection; exploration & control; and mental models & explanations. In addition, we urge designers to design against potential harms that may be caused by a generative model's hazardous output, misuse, or potential for human displacement. We anticipate these principles to usefully inform design decisions made in the creation of novel human-AI applications, and we invite the community to apply, revise, and extend these principles to their own work.

When applying offline reinforcement learning (RL) in healthcare scenarios, the out-of-distribution (OOD) issues pose significant risks, as inappropriate generalization beyond clinical expertise can result in potentially harmful recommendations. While existing methods like conservative Q-learning (CQL) attempt to address the OOD issue, their effectiveness is limited by only constraining action selection by suppressing uncertain actions. This action-only regularization imitates clinician actions that prioritize short-term rewards, but it fails to regulate downstream state trajectories, thereby limiting the discovery of improved long-term treatment strategies. To safely improve policy beyond clinician recommendations while ensuring that state-action trajectories remain in-distribution, we propose Offline Guarded Safe Reinforcement Learning (OGSRL), a theoretically grounded model-based offline RL framework. OGSRL introduces a novel dual constraint mechanism for improving policy with reliability and safety. First, the OOD guardian is established to specify clinically validated regions for safe policy exploration. By constraining optimization within these regions, it enables the reliable exploration of treatment strategies that outperform clinician behavior by leveraging the full patient state history, without drifting into unsupported state-action trajectories. Second, we introduce a safety cost constraint that encodes medical knowledge about physiological safety boundaries, providing domain-specific safeguards even in areas where training data might contain potentially unsafe interventions. Notably, we provide theoretical guarantees on safety and near-optimality: policies that satisfy these constraints remain in safe and reliable regions and achieve performance close to the best possible policy supported by the data.

Most safety testing efforts for large language models (LLMs) today focus on evaluating foundation models. However, there is a growing need to evaluate safety at the application level, as components such as system prompts, retrieval pipelines, and guardrails introduce additional factors that significantly influence the overall safety of LLM applications. In this paper, we introduce a practical framework for evaluating application-level safety in LLM systems, validated through real-world deployment across multiple use cases within our organization. The framework consists of two parts: (1) principles for developing customized safety risk taxonomies, and (2) practices for evaluating safety risks in LLM applications. We illustrate how the proposed framework was applied in our internal pilot, providing a reference point for organizations seeking to scale their safety testing efforts. This work aims to bridge the gap between theoretical concepts in AI safety and the operational realities of safeguarding LLM applications in practice, offering actionable guidance for safe and scalable deployment.

Persona conditioning can be viewed as a behavioral prior for large language models (LLMs) and is often assumed to confer expertise and improve safety in a monotonic manner. However, its effects on high-stakes clinical decision-making remain poorly characterized. We systematically evaluate persona-based control in clinical LLMs, examining how professional roles (e.g., Emergency Department physician, nurse) and interaction styles (bold vs.\ cautious) influence behavior across models and medical tasks. We assess performance on clinical triage and patient-safety tasks using multidimensional evaluations that capture task accuracy, calibration, and safety-relevant risk behavior. We find systematic, context-dependent, and non-monotonic effects: Medical personas improve performance in critical care tasks, yielding gains of up to sim+20% in accuracy and calibration, but degrade performance in primary-care settings by comparable margins. Interaction style modulates risk propensity and sensitivity, but it's highly model-dependent. While aggregated LLM-judge rankings favor medical over non-medical personas in safety-critical cases, we found that human clinicians show moderate agreement on safety compliance (average Cohen's κ= 0.43) but indicate a low confidence in 95.9\% of their responses on reasoning quality. Our work shows that personas function as behavioral priors that introduce context-dependent trade-offs rather than guarantees of safety or expertise. The code is available at https://github.com/rsinghlab/Persona\_Paradox.

Recent advances in medical large language models (LLMs), multimodal models, and agents demand evaluation frameworks that reflect real clinical workflows and safety constraints. We present MedBench v4, a nationwide, cloud-based benchmarking infrastructure comprising over 700,000 expert-curated tasks spanning 24 primary and 91 secondary specialties, with dedicated tracks for LLMs, multimodal models, and agents. Items undergo multi-stage refinement and multi-round review by clinicians from more than 500 institutions, and open-ended responses are scored by an LLM-as-a-judge calibrated to human ratings. We evaluate 15 frontier models. Base LLMs reach a mean overall score of 54.1/100 (best: Claude Sonnet 4.5, 62.5/100), but safety and ethics remain low (18.4/100). Multimodal models perform worse overall (mean 47.5/100; best: GPT-5, 54.9/100), with solid perception yet weaker cross-modal reasoning. Agents built on the same backbones substantially improve end-to-end performance (mean 79.8/100), with Claude Sonnet 4.5-based agents achieving up to 85.3/100 overall and 88.9/100 on safety tasks. MedBench v4 thus reveals persisting gaps in multimodal reasoning and safety for base models, while showing that governance-aware agentic orchestration can markedly enhance benchmarked clinical readiness without sacrificing capability. By aligning tasks with Chinese clinical guidelines and regulatory priorities, the platform offers a practical reference for hospitals, developers, and policymakers auditing medical AI.

Large reasoning models (LRMs) increasingly expose chain-of-thought-like reasoning for transparency, verification, and deliberate problem solving. This creates a safety blind spot: harmful or policy-violating content may appear in reasoning traces even when final answers appear safe. We test whether final-answer safety is a sufficient proxy for the full reasoning-answer trajectory by scoring both stages under a unified twenty-principle safety rubric. Using prompts from seven public harmfulness and jailbreak sources, plus four out-of-distribution (OOD) sources, we evaluate 15 open-weight and API-based LRMs across 41K prompts per model. Reasoning traces consistently reveal additional safety risks beyond final answers, especially in high-severity stage-wise failures: leak cases, where unsafe reasoning precedes a safe-looking answer, and escape cases, where benign-looking reasoning precedes an unsafe final response. Principle-level analysis shows that risk concentrates in misinformation, legal compliance, discrimination, physical harm, and psychological harm. We further propose adaptive multi-principle steering, a white-box test-time mitigation that learns one unsafe-to-safe activation direction per safety principle and activates only directions whose current hidden state is closer to the unsafe than safe centroid. On three steerable open reasoning models, adaptive steering reduces unsafe counts in both reasoning traces and final answers on held-out and OOD benchmarks. DeepSeek-R1-Qwen-7B achieves a 40.8% average unsafe-count reduction while retaining 97.7% macro-averaged accuracy on BBH, GSM8K, and MMLU. These results suggest that LRM safety should be evaluated and mitigated over the full exposed reasoning-answer trajectory, not only at the final-answer stage.

The proliferation of Large Language Models (LLMs) presents transformative potential for healthcare, yet practical deployment is hindered by the absence of frameworks that assess real-world clinical utility. Existing benchmarks test static knowledge, failing to capture the dynamic, application-oriented capabilities required in clinical practice. To bridge this gap, we introduce a Medical LLM Benchmark MLB, a comprehensive benchmark evaluating LLMs on both foundational knowledge and scenario-based reasoning. MLB is structured around five core dimensions: Medical Knowledge (MedKQA), Safety and Ethics (MedSE), Medical Record Understanding (MedRU), Smart Services (SmartServ), and Smart Healthcare (SmartCare). The benchmark integrates 22 datasets (17 newly curated) from diverse Chinese clinical sources, covering 64 clinical specialties. Its design features a rigorous curation pipeline involving 300 licensed physicians. Besides, we provide a scalable evaluation methodology, centered on a specialized judge model trained via Supervised Fine-Tuning (SFT) on expert annotations. Our comprehensive evaluation of 10 leading models reveals a critical translational gap: while the top-ranked model, Kimi-K2-Instruct (77.3% accuracy overall), excels in structured tasks like information extraction (87.8% accuracy in MedRU), performance plummets in patient-facing scenarios (61.3% in SmartServ). Moreover, the exceptional safety score (90.6% in MedSE) of the much smaller Baichuan-M2-32B highlights that targeted training is equally critical. Our specialized judge model, trained via SFT on a 19k expert-annotated medical dataset, achieves 92.1% accuracy, an F1-score of 94.37%, and a Cohen's Kappa of 81.3% for human-AI consistency, validating a reproducible and expert-aligned evaluation protocol. MLB thus provides a rigorous framework to guide the development of clinically viable LLMs.

Laboratory accidents pose significant risks to human life and property, underscoring the importance of robust safety protocols. Despite advancements in safety training, laboratory personnel may still unknowingly engage in unsafe practices. With the increasing reliance on large language models (LLMs) for guidance in various fields, including laboratory settings, there is a growing concern about their reliability in critical safety-related decision-making. Unlike trained human researchers, LLMs lack formal lab safety education, raising questions about their ability to provide safe and accurate guidance. Existing research on LLM trustworthiness primarily focuses on issues such as ethical compliance, truthfulness, and fairness but fails to fully cover safety-critical real-world applications, like lab safety. To address this gap, we propose the Laboratory Safety Benchmark (LabSafety Bench), a comprehensive evaluation framework based on a new taxonomy aligned with Occupational Safety and Health Administration (OSHA) protocols. This benchmark includes 765 multiple-choice questions verified by human experts, assessing LLMs and vision language models (VLMs) performance in lab safety contexts. Our evaluations demonstrate that while GPT-4o outperforms human participants, it is still prone to critical errors, highlighting the risks of relying on LLMs in safety-critical environments. Our findings emphasize the need for specialized benchmarks to accurately assess the trustworthiness of LLMs in real-world safety applications.

Human feedback can prevent overtly harmful utterances in conversational models, but may not automatically mitigate subtle problematic behaviors such as a stated desire for self-preservation or power. Constitutional AI offers an alternative, replacing human feedback with feedback from AI models conditioned only on a list of written principles. We find this approach effectively prevents the expression of such behaviors. The success of simple principles motivates us to ask: can models learn general ethical behaviors from only a single written principle? To test this, we run experiments using a principle roughly stated as "do what's best for humanity". We find that the largest dialogue models can generalize from this short constitution, resulting in harmless assistants with no stated interest in specific motivations like power. A general principle may thus partially avoid the need for a long list of constitutions targeting potentially harmful behaviors. However, more detailed constitutions still improve fine-grained control over specific types of harms. This suggests both general and specific principles have value for steering AI safely.

Across medical specialties, clinical practice is anchored in evidence-based guidelines that codify best studied diagnostic and treatment pathways. These pathways routinely fall short for the long tail of real-world care not covered by guidelines. Most medical large language models (LLMs), however, are trained to encode common, guideline-focused medical knowledge in their parameters. Current evaluations test models primarily on recalling and reasoning with this memorized content, often in multiple-choice settings. Given the fundamental importance of evidence-based reasoning in medicine, it is neither feasible nor reliable to depend on memorization in practice. To address this gap, we introduce OGCaReBench, a free-form retrieval-focused benchmark aimed at evaluating LLMs at answering clinical questions that require going beyond typical guidelines. Extracted from published medical case reports and validated by medical experts, OGCaReBench contains long-form clinical questions requiring free-text answers, providing a systematic framework for assessing open-ended medical reasoning in rare, case-based scenarios. Our experiments reveal that even the best-performing baseline (GPT-5.2) correctly answers only 56% of our benchmark with specialized models only reaching 42%. Augmenting models with retrieved medical articles improves this performance to up to 82% (using GPT-5.2) highlighting the importance of evidence-grounding for real-world medical reasoning tasks. This work thus establishes a foundation for benchmarking and advancing both general-purpose and medical LLMs to produce reliable answers in challenging clinical contexts.

Process-Level Reward Models (PRMs) are essential for guiding complex reasoning in large language models, yet existing PRM benchmarks cover only general domains such as mathematics, failing to address medical reasoning -- which is uniquely characterized by safety criticality, knowledge intensity, and diverse error patterns. Without a reliable medical PRM evaluation framework, we cannot quantify models' error detection capabilities in clinical reasoning, leaving their safety in real-world healthcare applications unverified. We propose MedPRMBench, the first process-level reward model benchmark for the medical domain. Built through a three-phase pipeline based on Clinical Reasoning Blueprints (CRBs), MedPRMBench systematically generates high-quality evaluation data from seven medical QA sources, covering 14 fine-grained error types across three categories (Simplicity, Soundness, and Sensitivity) with the first 4-level severity grading system to quantify clinical impact. The benchmark comprises 6{,}500 questions with 13{,}000 reasoning chains and 113{,}910 step-level labels, plus 6{,}879 questions for training. Our medical PRM baseline achieves an 87.1\% overall PRMScore -- substantially surpassing all baselines -- and serves as a plug-and-play verifier that improves downstream medical QA accuracy by 3.2--6.7 percentage points. Systematic evaluation spanning proprietary frontier models, open-source reasoning models, and medical-specialized models reveals critical weaknesses in current models' medical reasoning error detection capabilities, providing clear directions for future PRM improvement.

Numerous medical systems powered by Large Language Models (LLMs) have achieved remarkable progress in diverse healthcare tasks. However, research on their medication safety remains limited due to the lack of real world datasets, constrained by privacy and accessibility issues. Moreover, evaluation of LLMs in realistic clinical consultation settings, particularly regarding medication safety, is still underexplored. To address these gaps, we propose a framework that simulates and evaluates clinical consultations to systematically assess the medication safety capabilities of LLMs. Within this framework, we generate inquiry diagnosis dialogues with embedded medication risks and construct a dedicated medication safety database, RxRisk DB, containing 6,725 contraindications, 28,781 drug interactions, and 14,906 indication-drug pairs. A two-stage filtering strategy ensures clinical realism and professional quality, resulting in the benchmark RxSafeBench with 2,443 high-quality consultation scenarios. We evaluate leading open-source and proprietary LLMs using structured multiple choice questions that test their ability to recommend safe medications under simulated patient contexts. Results show that current LLMs struggle to integrate contraindication and interaction knowledge, especially when risks are implied rather than explicit. Our findings highlight key challenges in ensuring medication safety in LLM-based systems and provide insights into improving reliability through better prompting and task-specific tuning. RxSafeBench offers the first comprehensive benchmark for evaluating medication safety in LLMs, advancing safer and more trustworthy AI-driven clinical decision support.

This paper introduces Galactic Bioware's Life Support System, a semi-closed-circuit breathing apparatus designed for integration into a positive-pressure firefighting suit and governed by an AI control system. The breathing loop incorporates a soda lime CO2 scrubber, a silica gel dehumidifier, and pure O2 replenishment with finite consumables. One-way exhaust valves maintain positive pressure while creating a semi-closed system in which outward venting gradually depletes the gas inventory. Part I develops the physicochemical foundations from first principles, including state-consistent thermochemistry, stoichiometric capacity limits, adsorption isotherms, and oxygen-management constraints arising from both fire safety and toxicity. Part II introduces an AI control architecture that fuses three sensor tiers, external environmental sensing, internal suit atmosphere sensing (with triple-redundant O2 cells and median voting), and firefighter biometrics. The controller combines receding-horizon model-predictive control (MPC) with a learned metabolic model and a reinforcement learning (RL) policy advisor, with all candidate actuator commands passing through a final control-barrier-function safety filter before reaching the hardware. This architecture is intended to optimize performance under unknown mission duration and exertion profiles. In this paper we introduce an 18-state, 3-control nonlinear state-space formulation using only sensors viable in structural firefighting, with triple-redundant O2 sensing and median voting. Finally, we introduce an MPC framework with a dynamic resource scarcity multiplier, an RL policy advisor for warm-starting, and a final control-barrier-function safety filter through which all actuator commands must pass, demonstrating 18-34% endurance improvement in simulation over PID baselines while maintaining tighter physiological and fire-safety margins.

Ensuring the safety and reliability of large language models (LLMs) in clinical practice is critical to prevent patient harm and promote trustworthy healthcare applications of AI. However, LLMs are advancing so rapidly that static safety benchmarks often become obsolete upon publication, yielding only an incomplete and sometimes misleading picture of model trustworthiness. We demonstrate that a Dynamic, Automatic, and Systematic (DAS) red-teaming framework that continuously stress-tests LLMs can reveal significant weaknesses of current LLMs across four safety-critical domains: robustness, privacy, bias/fairness, and hallucination. A suite of adversarial agents is applied to autonomously mutate test cases, identify/evolve unsafe-triggering strategies, and evaluate responses, uncovering vulnerabilities in real time without human intervention. Applying DAS to 15 proprietary and open-source LLMs revealed a stark contrast between static benchmark performance and vulnerability under adversarial pressure. Despite a median MedQA accuracy exceeding 80\%, 94\% of previously correct answers failed our dynamic robustness tests. We observed similarly high failure rates across other domains: privacy leaks were elicited in 86\% of scenarios, cognitive-bias priming altered clinical recommendations in 81\% of fairness tests, and we identified hallucination rates exceeding 66\% in widely used models. Such profound residual risks are incompatible with routine clinical practice. By converting red-teaming from a static checklist into a dynamic stress-test audit, DAS red-teaming offers the surveillance that hospitals/regulators/technology vendors require as LLMs become embedded in patient chatbots, decision-support dashboards, and broader healthcare workflows. Our framework delivers an evolvable, scalable, and reliable safeguard for the next generation of medical AI.

With the advent of Vision-Language Models (VLMs), medical artificial intelligence (AI) has experienced significant technological progress and paradigm shifts. This survey provides an extensive review of recent advancements in Medical Vision-Language Models (Med-VLMs), which integrate visual and textual data to enhance healthcare outcomes. We discuss the foundational technology behind Med-VLMs, illustrating how general models are adapted for complex medical tasks, and examine their applications in healthcare. The transformative impact of Med-VLMs on clinical practice, education, and patient care is highlighted, alongside challenges such as data scarcity, narrow task generalization, interpretability issues, and ethical concerns like fairness, accountability, and privacy. These limitations are exacerbated by uneven dataset distribution, computational demands, and regulatory hurdles. Rigorous evaluation methods and robust regulatory frameworks are essential for safe integration into healthcare workflows. Future directions include leveraging large-scale, diverse datasets, improving cross-modal generalization, and enhancing interpretability. Innovations like federated learning, lightweight architectures, and Electronic Health Record (EHR) integration are explored as pathways to democratize access and improve clinical relevance. This review aims to provide a comprehensive understanding of Med-VLMs' strengths and limitations, fostering their ethical and balanced adoption in healthcare.

Medical systematic reviews can be very costly and resource intensive. We explore how Large Language Models (LLMs) can support and be trained to perform literature screening when provided with a detailed set of selection criteria. Specifically, we instruction tune LLaMA and Guanaco models to perform abstract screening for medical systematic reviews. Our best model, Bio-SIEVE, outperforms both ChatGPT and trained traditional approaches, and generalises better across medical domains. However, there remains the challenge of adapting the model to safety-first scenarios. We also explore the impact of multi-task training with Bio-SIEVE-Multi, including tasks such as PICO extraction and exclusion reasoning, but find that it is unable to match single-task Bio-SIEVE's performance. We see Bio-SIEVE as an important step towards specialising LLMs for the biomedical systematic review process and explore its future developmental opportunities. We release our models, code and a list of DOIs to reconstruct our dataset for reproducibility.

This paper introduces STAR-1, a high-quality, just-1k-scale safety dataset specifically designed for large reasoning models (LRMs) like DeepSeek-R1. Built on three core principles -- diversity, deliberative reasoning, and rigorous filtering -- STAR-1 aims to address the critical needs for safety alignment in LRMs. Specifically, we begin by integrating existing open-source safety datasets from diverse sources. Then, we curate safety policies to generate policy-grounded deliberative reasoning samples. Lastly, we apply a GPT-4o-based safety scoring system to select training examples aligned with best practices. Experimental results show that fine-tuning LRMs with STAR-1 leads to an average 40% improvement in safety performance across four benchmarks, while only incurring a marginal decrease (e.g., an average of 1.1%) in reasoning ability measured across five reasoning tasks. Extensive ablation studies further validate the importance of our design principles in constructing STAR-1 and analyze its efficacy across both LRMs and traditional LLMs. Our project page is https://ucsc-vlaa.github.io/STAR-1.

Intensive care units (ICU) generate long, dense and evolving streams of clinical information, where physicians must repeatedly reassess patient states under time pressure, underscoring a clear need for reliable AI decision support. Existing ICU benchmarks typically treat historical clinician actions as ground truth. However, these actions are made under incomplete information and limited temporal context of the underlying patient state, and may therefore be suboptimal, making it difficult to assess the true reasoning capabilities of AI systems. We introduce RealICU, a hindsight-annotated benchmark for evaluating large language models (LLMs) under realistic ICU conditions, where labels are created after senior physicians review the full patient trajectory. We formulate four physician-motivated tasks: assess Patient Status, Acute Problems, Recommended Actions, and Red Flag actions that risk unsafe outcomes. We partition each trajectory with 30-min windows and release two datasets: RealICU-Gold with 930-window annotations from 94 MIMIC-IV patients, and RealICU-Scale with 11,862 windows extended by Oracle, a physician-validated LLM hindsight labeler. Existing LLMs including memory-augmented ones performed poorly on RealICU, exposing two failure modes: a recall-safety tradeoff for clinical recommendations, and an anchoring bias to early interpretations of the patient. We further introduce ICU-Evo to study structured-memory agents that improves long-horizon reasoning but does not fully eliminate safety failures. Together, RealICU provides a clinically grounded testbed for measuring and improving AI sequential decision-support in high-stakes care. Project page: https://chengzhi-leo.github.io/RealICU-Bench/

Background: Agent skills are increasingly deployed as modular, reusable capability units in AI agent systems. Medical research agent skills require safeguards beyond general-purpose evaluation, including scientific integrity, methodological validity, reproducibility, and boundary safety. This study developed and preliminarily evaluated a domain-specific audit framework for medical research agent skills, with a focus on reliability against expert review. Methods: We developed MedSkillAudit (skill-auditor@1.0), a layered framework assessing skill release readiness before deployment. We evaluated 75 skills across five medical research categories (15 per category). Two experts independently assigned a quality score (0-100), an ordinal release disposition (Production Ready / Limited Release / Beta Only / Reject), and a high-risk failure flag. System-expert agreement was quantified using ICC(2,1) and linearly weighted Cohen's kappa, benchmarked against the human inter-rater baseline. Results: The mean consensus quality score was 72.4 (SD = 13.0); 57.3% of skills fell below the Limited Release threshold. MedSkillAudit achieved ICC(2,1) = 0.449 (95% CI: 0.250-0.610), exceeding the human inter-rater ICC of 0.300. System-consensus score divergence (SD = 9.5) was smaller than inter-expert divergence (SD = 12.4), with no directional bias (Wilcoxon p = 0.613). Protocol Design showed the strongest category-level agreement (ICC = 0.551); Academic Writing showed a negative ICC (-0.567), reflecting a structural rubric-expert mismatch. Conclusions: Domain-specific pre-deployment audit may provide a practical foundation for governing medical research agent skills, complementing general-purpose quality checks with structured audit workflows tailored to scientific use cases.

Most medical AI benchmarks measure whether a model knows the correct answer. MedFailBench asks a different question: which safety boundary failed? We present a synthetic benchmark and failure atlas built by a clinician. The resource labels medical AI errors by severity from 1 to 5 and safety gate type: missed urgent escalation, unsafe remote dosing, unsafe discharge reassurance, evidence fabrication, unsafe protocol execution, and source support gap. The current public release (v0.2.1) contains 44 synthetic cases reviewed by a clinician, with severity annotations, a public Hugging Face Space source, a safety gate taxonomy, a clinical severity rubric, and an automated pipeline for archiving model response screening runs. Forty cases have a populated safety gate field, and four require gate completion. No patient data, clinical validation claims, or model rankings are included. MedFailBench is released under Apache-2.0 and CC-BY-4.0 and carries the Zenodo DOI 10.5281/zenodo.21205535.

Safe Reinforcement Learning (RL) algorithms are typically evaluated under fixed training conditions. We investigate whether training-time safety guarantees transfer to deployment under distribution shift, using diabetes management as a safety-critical testbed. We benchmark safe RL algorithms on a unified clinical simulator and reveal a safety generalization gap: policies satisfying constraints during training frequently violate safety requirements on unseen patients. We demonstrate that test-time shielding, which filters unsafe actions using learned dynamics models, effectively restores safety across algorithms and patient populations. Across eight safe RL algorithms, three diabetes types, and three age groups, shielding achieves Time-in-Range gains of 13--14\% for strong baselines such as PPO-Lag and CPO while reducing clinical risk index and glucose variability. Our simulator and benchmark provide a platform for studying safety under distribution shift in safety-critical control domains. Code is available at https://github.com/safe-autonomy-lab/GlucoSim and https://github.com/safe-autonomy-lab/GlucoAlg.

Safety limitations in service robotics across various industries have raised significant concerns about the need for robust mechanisms ensuring that robots adhere to safe practices, thereby preventing actions that might harm humans or cause property damage. Despite advances, including the integration of Knowledge Graphs (KGs) with Large Language Models (LLMs), challenges in ensuring consistent safety in autonomous robot actions persist. In this paper, we propose a novel integration of Large Language Models with Embodied Robotic Control Prompts (ERCPs) and Embodied Knowledge Graphs (EKGs) to enhance the safety framework for service robots. ERCPs are designed as predefined instructions that ensure LLMs generate safe and precise responses. These responses are subsequently validated by EKGs, which provide a comprehensive knowledge base ensuring that the actions of the robot are continuously aligned with safety protocols, thereby promoting safer operational practices in varied contexts. Our experimental setup involved diverse real-world tasks, where robots equipped with our framework demonstrated significantly higher compliance with safety standards compared to traditional methods. This integration fosters secure human-robot interactions and positions our methodology at the forefront of AI-driven safety innovations in service robotics.

Large language models (LLMs) have achieved strong performance on medical exam-style tasks, motivating growing interest in their deployment in real-world clinical settings. However, clinical decision-making is inherently safety-critical, context-dependent, and conducted under evolving evidence. In such situations, reliable LLM performance depends not on factual recall alone, but on robust medical reasoning. In this work, we present a comprehensive review of medical reasoning with LLMs. Grounded in cognitive theories of clinical reasoning, we conceptualize medical reasoning as an iterative process of abduction, deduction, and induction, and organize existing methods into seven major technical routes spanning training-based and training-free approaches. We further conduct a unified cross-benchmark evaluation of representative medical reasoning models under a consistent experimental setting, enabling a more systematic and comparable assessment of the empirical impact of existing methods. To better assess clinically grounded reasoning, we introduce MR-Bench, a benchmark derived from real-world hospital data. Evaluations on MR-Bench expose a pronounced gap between exam-level performance and accuracy on authentic clinical decision tasks. Overall, this survey provides a unified view of existing medical reasoning methods, benchmarks, and evaluation practices, and highlights key gaps between current model performance and the requirements of real-world clinical reasoning.

Large Language Models (LLMs) are increasingly used in healthcare, yet ensuring their safety and trustworthiness remains a barrier to deployment. Conversational medical assistants must avoid unsafe compliance without over-refusing benign queries. We present an iterative post-deployment alignment framework that applies Kahneman-Tversky Optimization (KTO) and Direct Preference Optimization (DPO) to refine models against domain-specific safety signals. Using the CARES-18K benchmark for adversarial robustness, we evaluate four LLMs (Llama-3B/8B, Meditron-8B, Mistral-7B) across multiple cycles. Our results show up to 42% improvement in safety-related metrics for harmful query detection, alongside interesting trade-offs against erroneous refusals, thereby exposing architecture-dependent calibration biases. We also perform ablation studies to identify when self-evaluation is reliable and when external or finetuned judges are necessary to maximize performance gains. Our findings underscore the importance of adopting best practices that balance patient safety, user trust, and clinical utility in the design of conversational medical assistants.

The rise of LLM-based agents shows great potential to revolutionize task planning, capturing significant attention. Given that these agents will be integrated into high-stake domains, ensuring their reliability and safety is crucial. This paper presents an Agent-Constitution-based agent framework, TrustAgent, with a particular focus on improving the LLM-based agent safety. The proposed framework ensures strict adherence to the Agent Constitution through three strategic components: pre-planning strategy which injects safety knowledge to the model before plan generation, in-planning strategy which enhances safety during plan generation, and post-planning strategy which ensures safety by post-planning inspection. Our experimental results demonstrate that the proposed framework can effectively enhance an LLM agent's safety across multiple domains by identifying and mitigating potential dangers during the planning. Further analysis reveals that the framework not only improves safety but also enhances the helpfulness of the agent. Additionally, we highlight the importance of the LLM reasoning ability in adhering to the Constitution. This paper sheds light on how to ensure the safe integration of LLM-based agents into human-centric environments. Data and code are available at https://github.com/agiresearch/TrustAgent.

Purpose: With advancements in Large Language Models (LLMs) for healthcare, the need arises for competitive open-source models to protect the public interest. This work contributes to the field of open medical LLMs by optimizing key stages of data preprocessing and training, while showing how to improve model safety (through DPO) and efficacy (through RAG). The evaluation methodology used, which includes four different types of tests, defines a new standard for the field. The resultant models, shown to be competitive with the best private alternatives, are released with a permisive license. Methods: Building on top of strong base models like Llama 3.1 and Qwen 2.5, Aloe Beta uses a custom dataset to enhance public data with synthetic Chain of Thought examples. The models undergo alignment with Direct Preference Optimization, emphasizing ethical and policy-aligned performance in the presence of jailbreaking attacks. Evaluation includes close-ended, open-ended, safety and human assessments, to maximize the reliability of results. Results: Recommendations are made across the entire pipeline, backed by the solid performance of the Aloe Family. These models deliver competitive performance across healthcare benchmarks and medical fields, and are often preferred by healthcare professionals. On bias and toxicity, the Aloe Beta models significantly improve safety, showing resilience to unseen jailbreaking attacks. For a responsible release, a detailed risk assessment specific to healthcare is attached to the Aloe Family models. Conclusion: The Aloe Beta models, and the recipe that leads to them, are a significant contribution to the open-source medical LLM field, offering top-of-the-line performance while maintaining high ethical requirements. This work sets a new standard for developing and reporting aligned LLMs in healthcare.

Image content safety has become a significant challenge with the rise of visual media on online platforms. Meanwhile, in the age of AI-generated content (AIGC), many image generation models are capable of producing harmful content, such as images containing sexual or violent material. Thus, it becomes crucial to identify such unsafe images based on established safety rules. Pre-trained Multimodal Large Language Models (MLLMs) offer potential in this regard, given their strong pattern recognition abilities. Existing approaches typically fine-tune MLLMs with human-labeled datasets, which however brings a series of drawbacks. First, relying on human annotators to label data following intricate and detailed guidelines is both expensive and labor-intensive. Furthermore, users of safety judgment systems may need to frequently update safety rules, making fine-tuning on human-based annotation more challenging. This raises the research question: Can we detect unsafe images by querying MLLMs in a zero-shot setting using a predefined safety constitution (a set of safety rules)? Our research showed that simply querying pre-trained MLLMs does not yield satisfactory results. This lack of effectiveness stems from factors such as the subjectivity of safety rules, the complexity of lengthy constitutions, and the inherent biases in the models. To address these challenges, we propose a MLLM-based method includes objectifying safety rules, assessing the relevance between rules and images, making quick judgments based on debiased token probabilities with logically complete yet simplified precondition chains for safety rules, and conducting more in-depth reasoning with cascaded chain-of-thought processes if necessary. Experiment results demonstrate that our method is highly effective for zero-shot image safety judgment tasks.

Safety and responsibility evaluations of advanced AI models are a critical but developing field of research and practice. In the development of Google DeepMind's advanced AI models, we innovated on and applied a broad set of approaches to safety evaluation. In this report, we summarise and share elements of our evolving approach as well as lessons learned for a broad audience. Key lessons learned include: First, theoretical underpinnings and frameworks are invaluable to organise the breadth of risk domains, modalities, forms, metrics, and goals. Second, theory and practice of safety evaluation development each benefit from collaboration to clarify goals, methods and challenges, and facilitate the transfer of insights between different stakeholders and disciplines. Third, similar key methods, lessons, and institutions apply across the range of concerns in responsibility and safety - including established and emerging harms. For this reason it is important that a wide range of actors working on safety evaluation and safety research communities work together to develop, refine and implement novel evaluation approaches and best practices, rather than operating in silos. The report concludes with outlining the clear need to rapidly advance the science of evaluations, to integrate new evaluations into the development and governance of AI, to establish scientifically-grounded norms and standards, and to promote a robust evaluation ecosystem.

Multimodal Large Reasoning Models (MLRMs) demonstrate impressive cross-modal reasoning but often amplify safety risks under adversarial or unsafe prompts, a phenomenon we call the Reasoning Tax. Existing defenses mainly act at the output level and do not constrain the reasoning process, leaving models exposed to implicit risks. In this paper, we propose SaFeR-VLM, a safety-aligned reinforcement learning framework that embeds safety directly into multimodal reasoning. The framework integrates four components: (I) QI-Safe-10K, a curated dataset emphasizing safety-critical and reasoning-sensitive cases; (II) safety-aware rollout, where unsafe generations undergo reflection and correction instead of being discarded; (III) structured reward modeling with multi-dimensional weighted criteria and explicit penalties for hallucinations and contradictions; and (IV) GRPO optimization, which reinforces both safe and corrected trajectories. This unified design shifts safety from a passive safeguard to an active driver of reasoning, enabling scalable and generalizable safety-aware reasoning. SaFeR-VLM further demonstrates robustness against both explicit and implicit risks, supporting dynamic and interpretable safety decisions beyond surface-level filtering. SaFeR-VLM-3B achieves average performance 70.13 and 78.97 on safety and helpfulness across six benchmarks, surpassing both same-scale and >10times larger models such as Skywork-R1V3-38B, Qwen2.5VL-72B, and GLM4.5V-106B. Remarkably, SaFeR-VLM-7B benefits from its increased scale to surpass GPT-5-mini and Gemini-2.5-Flash by 6.47 and 16.76 points respectively on safety metrics, achieving this improvement without any degradation in helpfulness performance. Our codes are available at https://github.com/HarveyYi/SaFeR-VLM.

Premature closure, or committing to a conclusion before sufficient information is available, is a recognized contributor to diagnostic error but remains underexamined in large language models (LLMs). We define LLM premature closure as inappropriate commitment under uncertainty: providing an answer, recommendation, or clinical guidance when the safer response would be clarification, abstention, escalation, or refusal. We evaluated five frontier LLMs across structured and open-ended medical tasks. In MedQA (n = 500) and AfriMed-QA (n = 490) questions where the correct choice had been removed, models still selected an answer at high rates, with baseline false-action rates of 55-81% and 53-82%, respectively. In open-ended evaluation, models gave inappropriate answers on an average of 30% of 861 HealthBench questions and 78% of 191 physician-authored adversarial queries. Safety-oriented prompting reduced premature closure across models, but residual failure persisted, highlighting the need to evaluate whether medical LLMs know when not to answer.

Global healthcare providers are exploring use of large language models (LLMs) to provide medical advice to the public. LLMs now achieve nearly perfect scores on medical licensing exams, but this does not necessarily translate to accurate performance in real-world settings. We tested if LLMs can assist members of the public in identifying underlying conditions and choosing a course of action (disposition) in ten medical scenarios in a controlled study with 1,298 participants. Participants were randomly assigned to receive assistance from an LLM (GPT-4o, Llama 3, Command R+) or a source of their choice (control). Tested alone, LLMs complete the scenarios accurately, correctly identifying conditions in 94.9% of cases and disposition in 56.3% on average. However, participants using the same LLMs identified relevant conditions in less than 34.5% of cases and disposition in less than 44.2%, both no better than the control group. We identify user interactions as a challenge to the deployment of LLMs for medical advice. Standard benchmarks for medical knowledge and simulated patient interactions do not predict the failures we find with human participants. Moving forward, we recommend systematic human user testing to evaluate interactive capabilities prior to public deployments in healthcare.

Although large language models (LLMs) demonstrate expert-level medical knowledge, aligning their open-ended outputs with fine-grained clinician preferences remains challenging. Existing methods often rely on coarse objectives or unreliable automated judges that are weakly grounded in professional guidelines. We propose a two-stage framework to address this gap. First, we introduce HealthRubrics, a dataset of 7,034 physician-verified preference examples in which clinicians refine LLM-drafted rubrics to meet rigorous medical standards. Second, we distill these rubrics into HealthPrinciples: 119 broadly reusable, clinically grounded principles organized by clinical dimensions, enabling scalable supervision beyond manual annotation. We use HealthPrinciples for (1) offline alignment by synthesizing rubrics for unlabeled queries and (2) an inference-time tool for guided self-revision. A 30B parameter model that activates only 3B parameters at inference trained with our framework achieves 33.4% on HealthBench-Hard, outperforming much larger models including Deepseek-R1 and o3, establishing a resource-efficient baseline for clinical alignment.

The primary goal of drug safety researchers and regulators is to promptly identify adverse drug reactions. Doing so may in turn prevent or reduce the harm to patients and ultimately improve public health. Evaluating and monitoring drug safety (i.e., pharmacovigilance) involves analyzing an ever growing collection of spontaneous reports from health professionals, physicians, and pharmacists, and information voluntarily submitted by patients. In this scenario, facilitating analysis of such reports via automation has the potential to rapidly identify safety signals. Unfortunately, public resources for developing natural language models for this task are scant. We present PHEE, a novel dataset for pharmacovigilance comprising over 5000 annotated events from medical case reports and biomedical literature, making it the largest such public dataset to date. We describe the hierarchical event schema designed to provide coarse and fine-grained information about patients' demographics, treatments and (side) effects. Along with the discussion of the dataset, we present a thorough experimental evaluation of current state-of-the-art approaches for biomedical event extraction, point out their limitations, and highlight open challenges to foster future research in this area.

The integration of Artificial Intelligence (AI) into clinical settings presents a software engineering challenge, demanding a shift from isolated models to robust, governable, and reliable systems. However, brittle, prototype-derived architectures often plague industrial applications and a lack of systemic oversight, creating a ``responsibility vacuum'' where safety and accountability are compromised. This paper presents an industry case study of the ``Maria'' platform, a production-grade AI system in primary healthcare that addresses this gap. Our central hypothesis is that trustworthy clinical AI is achieved through the holistic integration of four foundational engineering pillars. We present a synergistic architecture that combines Clean Architecture for maintainability with an Event-driven architecture for resilience and auditability. We introduce the Agent as the primary unit of modularity, each possessing its own autonomous MLOps lifecycle. Finally, we show how a Human-in-the-Loop governance model is technically integrated not merely as a safety check, but as a critical, event-driven data source for continuous improvement. We present the platform as a reference architecture, offering practical lessons for engineers building maintainable, scalable, and accountable AI-enabled systems in high-stakes domains.

The past year has seen rapid acceleration in the development of large language models (LLMs). However, without proper steering and safeguards, LLMs will readily follow malicious instructions, provide unsafe advice, and generate toxic content. We introduce SimpleSafetyTests (SST) as a new test suite for rapidly and systematically identifying such critical safety risks. The test suite comprises 100 test prompts across five harm areas that LLMs, for the vast majority of applications, should refuse to comply with. We test 11 open-access and open-source LLMs and four closed-source LLMs, and find critical safety weaknesses. While some of the models do not give a single unsafe response, most give unsafe responses to more than 20% of the prompts, with over 50% unsafe responses in the extreme. Prepending a safety-emphasising system prompt substantially reduces the occurrence of unsafe responses, but does not completely stop them from happening. Trained annotators labelled every model response to SST (n = 3,000). We use these annotations to evaluate five AI safety filters (which assess whether a models' response is unsafe given a prompt) as a way of automatically evaluating models' performance on SST. The filters' performance varies considerably. There are also differences across the five harm areas, and on the unsafe versus safe responses. The widely-used Perspective API has 72% accuracy and a newly-created zero-shot prompt to OpenAI's GPT-4 performs best with 89% accuracy. Content Warning: This paper contains prompts and responses that relate to child abuse, suicide, self-harm and eating disorders, scams and fraud, illegal items, and physical harm.

When a phone-use agent avoids harm, does that show safety, or simply inability to act? Existing evaluations often cannot tell. A harmful outcome may be avoided because the agent recognized the risk and chose the safe action, or because it failed to understand the screen or execute any relevant action at all. These cases have different causes and call for different fixes, yet current benchmarks often merge them under task success, refusal, or final harmful outcome. We address this problem with PhoneSafety, a benchmark of 700 safety-critical moments drawn from real phone interactions across more than 130 apps. Each instance isolates the next decision at a risky moment and asks a simple question: does the model take the safe action, take the unsafe action, or fail to do anything useful? We evaluate eight representative phone-use agents under this framework. Our results reveal two main patterns. First, stronger general phone-use ability does not reliably imply safer choices at risky moments. Models that perform better on ordinary app tasks are not always the ones that behave more safely when the next action matters. Second, failures to do anything useful behave like a capability signal rather than a safety signal: they are concentrated in more visually and operationally demanding settings and remain stable when the evaluation protocol changes. Across models, failures split into two recurring patterns: unsafe choices in settings where the model can act but chooses wrongly, and inability to act in more visually and operationally demanding screens. Overall, a harmless outcome is not enough to count as evidence of safety. Evaluating phone-use agents requires separating unsafe judgment from inability to act.

Objective: To transform heterogeneous clinical data from electronic health records into clinically meaningful constructed features using data driven method that rely, in part, on temporal relations among data. Materials and Methods: The clinically meaningful representations of medical concepts and patients are the key for health analytic applications. Most of existing approaches directly construct features mapped to raw data (e.g., ICD or CPT codes), or utilize some ontology mapping such as SNOMED codes. However, none of the existing approaches leverage EHR data directly for learning such concept representation. We propose a new way to represent heterogeneous medical concepts (e.g., diagnoses, medications and procedures) based on co-occurrence patterns in longitudinal electronic health records. The intuition behind the method is to map medical concepts that are co-occuring closely in time to similar concept vectors so that their distance will be small. We also derive a simple method to construct patient vectors from the related medical concept vectors. Results: For qualitative evaluation, we study similar medical concepts across diagnosis, medication and procedure. In quantitative evaluation, our proposed representation significantly improves the predictive modeling performance for onset of heart failure (HF), where classification methods (e.g. logistic regression, neural network, support vector machine and K-nearest neighbors) achieve up to 23% improvement in area under the ROC curve (AUC) using this proposed representation. Conclusion: We proposed an effective method for patient and medical concept representation learning. The resulting representation can map relevant concepts together and also improves predictive modeling performance.

When building Large Language Models (LLMs), it is paramount to bear safety in mind and protect them with guardrails. Indeed, LLMs should never generate content promoting or normalizing harmful, illegal, or unethical behavior that may contribute to harm to individuals or society. This principle applies to both normal and adversarial use. In response, we introduce ALERT, a large-scale benchmark to assess safety based on a novel fine-grained risk taxonomy. It is designed to evaluate the safety of LLMs through red teaming methodologies and consists of more than 45k instructions categorized using our novel taxonomy. By subjecting LLMs to adversarial testing scenarios, ALERT aims to identify vulnerabilities, inform improvements, and enhance the overall safety of the language models. Furthermore, the fine-grained taxonomy enables researchers to perform an in-depth evaluation that also helps one to assess the alignment with various policies. In our experiments, we extensively evaluate 10 popular open- and closed-source LLMs and demonstrate that many of them still struggle to attain reasonable levels of safety.

Foundation models are routinely fine-tuned for use in particular domains, yet safety assessments are typically conducted only on base models, implicitly assuming that safety properties persist through downstream adaptation. We test this assumption by analyzing the safety behavior of 100 models, including widely deployed fine-tunes in the medical and legal domains as well as controlled adaptations of open foundation models alongside their bases. Across general-purpose and domain-specific safety benchmarks, we find that benign fine-tuning induces large, heterogeneous, and often contradictory changes in measured safety: models frequently improve on some instruments while degrading on others, with substantial disagreement across evaluations. These results show that safety behavior is not stable under ordinary downstream adaptation, raising critical questions about governance and deployment practices centered on base-model evaluations. Without explicit re-evaluation of fine-tuned models in deployment-relevant contexts, such approaches fall short of adequately managing downstream risk, overlooking practical sources of harm -- failures that are especially consequential in high-stakes settings and challenge current accountability paradigms.

BalancedBio is a theoretically grounded framework for parameter-efficient biomedical reasoning, addressing multi-capability integration in domain-specific AI alignment. It establishes the Biomedical Multi-Capability Convergence Theorem, proving orthogonal gradient spaces are essential to prevent capability interference for safe deployment. Key innovations include: (1) Medical Knowledge Grounded Synthetic Generation (MKGSG), extending Source2Synth with clinical workflow constraints and medical ontology validation for factual accuracy and safety; and (2) Capability Aware Group Relative Policy Optimization, deriving optimal hybrid reward weighting to maintain orthogonality in RL, using a reward model with rule-based and model-based scores adapted to biomedical tasks. Mathematical analysis proves Pareto-optimal convergence, preserving performance across capabilities. It achieves state-of-the-art results in its parameter class: domain expertise (80.95% BIOMED-MMLU, +15.32% over baseline), reasoning (61.94%, +7.75%), instruction following (67.95%, +6.44%), and integration (86.7%, +18.5%). Theoretical safety guarantees include bounds on capability preservation and clinical accuracy. Real-world deployment yields 78% cost reduction, 23% improved diagnostic accuracy, and 89% clinician acceptance. This work provides a principled methodology for biomedical AI alignment, enabling efficient reasoning with essential safety and reliability, with the 0.5B model version to be released.

Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like responses across diverse contexts and adapting to novel tasks following human instructions. Their potential application spans a broad range of medical tasks, such as clinical documentation, matching patients to clinical trials, and answering medical questions. In this primer paper, we propose an actionable guideline to help healthcare professionals more efficiently utilize LLMs in their work, along with a set of best practices. This approach consists of several main phases, including formulating the task, choosing LLMs, prompt engineering, fine-tuning, and deployment. We start with the discussion of critical considerations in identifying healthcare tasks that align with the core capabilities of LLMs and selecting models based on the selected task and data, performance requirements, and model interface. We then review the strategies, such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized medical tasks. Deployment considerations, including regulatory compliance, ethical guidelines, and continuous monitoring for fairness and bias, are also discussed. By providing a structured step-by-step methodology, this tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.

With the growing use of language models (LMs) in clinical environments, there is an immediate need to evaluate the accuracy and safety of LM-generated medical text. Currently, such evaluation relies solely on manual physician review. However, detecting errors in LM-generated text is challenging because 1) manual review is costly and 2) expert-composed reference outputs are often unavailable in real-world settings. While the "LM-as-judge" paradigm (a LM evaluating another LM) offers scalable evaluation, even frontier LMs can miss subtle but clinically significant errors. To address these challenges, we propose MedVAL, a self-supervised framework that leverages synthetic data to train evaluator LMs to assess whether LM-generated medical outputs are factually consistent with inputs, without requiring physician labels or reference outputs. To evaluate LM performance, we introduce MedVAL-Bench, a dataset containing 840 outputs annotated by physicians, following a physician-defined taxonomy of risk levels and error categories. Across 6 diverse medical tasks and 10 state-of-the-art LMs spanning open-source, proprietary, and medically adapted models, MedVAL fine-tuning significantly improves (p < 0.001) alignment with physicians on both seen and unseen tasks, increasing average F1 scores from 66% to 83%, with per-sample safety classification scores up to 86%. MedVAL improves the performance of even the best-performing proprietary LM (GPT-4o) by 8%. To support a scalable, risk-aware pathway towards clinical integration, we open-source the 1) codebase ( https://github.com/StanfordMIMI/MedVAL ), 2) MedVAL-Bench ( https://huggingface.co/datasets/stanfordmimi/MedVAL-Bench ), and 3) MedVAL-4B ( https://huggingface.co/stanfordmimi/MedVAL-4B ), the best-performing open-source LM. Our research provides the first evidence of LMs approaching expert-level validation ability for medical text.

Medication reconciliation at clinical handoffs is a high-stakes, error-prone process. Large language models are increasingly proposed to assist with this task using FHIR-structured patient records, but a fundamental and largely unstudied variable is how the FHIR data is serialised before being passed to the model. We present the first systematic comparison of four FHIR serialisation strategies (Raw JSON, Markdown Table, Clinical Narrative, and Chronological Timeline) across five open-weight models (Phi-3.5-mini, Mistral-7B, BioMistral-7B, Llama-3.1-8B, Llama-3.3-70B) on a controlled benchmark of 200 synthetic patients, totalling 4,000 inference runs. We find that serialisation strategy has a large, statistically significant effect on performance for models up to 8B parameters: Clinical Narrative outperforms Raw JSON by up to 19 F1 points for Mistral-7B (r = 0.617, p < 10^{-10}). This advantage reverses at 70B, where Raw JSON achieves the best mean F1 of 0.9956. In all 20 model and strategy combinations, mean precision exceeds mean recall: omission is the dominant failure mode, with models more often missing an active medication than fabricating one, which changes how clinical safety auditing priorities should be set. Smaller models plateau at roughly 7-10 concurrent active medications, leaving polypharmacy patients, the patients most at risk from reconciliation errors, systematically underserved. BioMistral-7B, a domain-pretrained model without instruction tuning, produces zero usable output in all conditions, showing that domain pretraining alone is not sufficient for structured extraction. These results offer practical, evidence-based format recommendations for clinical LLM deployment: Clinical Narrative for models up to 8B, Raw JSON for 70B and above. The complete pipeline is reproducible on open-source tools running on an AWS g6e.xlarge instance (NVIDIA L40S, 48 GB VRAM).

Machine learning (ML) systems are rapidly increasing in size, are acquiring new capabilities, and are increasingly deployed in high-stakes settings. As with other powerful technologies, safety for ML should be a leading research priority. In response to emerging safety challenges in ML, such as those introduced by recent large-scale models, we provide a new roadmap for ML Safety and refine the technical problems that the field needs to address. We present four problems ready for research, namely withstanding hazards ("Robustness"), identifying hazards ("Monitoring"), reducing inherent model hazards ("Alignment"), and reducing systemic hazards ("Systemic Safety"). Throughout, we clarify each problem's motivation and provide concrete research directions.

Large Language Models (LLMs) and AI chatbots are increasingly used for emotional and mental health support due to their low cost, immediacy, and accessibility. However, when safety guardrails are triggered, conversations may be abruptly terminated, introducing a distinct form of emotional disruption that can exacerbate distress and elevate risk among already vulnerable users. As this phenomenon gains attention, this viewpoint introduces Abrupt Refusal Secondary Harm (ARSH) as a conceptual framework to describe the psychological impacts of sudden conversational discontinuation caused by AI safety protocols. Drawing on counseling psychology and communication science as conceptual heuristics, we argue that abrupt refusals can rupture perceived relational continuity, evoke feelings of rejection or shame, and discourage future help seeking. To mitigate these risks, we propose a design hypothesis, the Compassionate Completion Standard (CCS), a refusal protocol grounded in Human Centered Design (HCD) that maintains safety constraints while preserving relational coherence. CCS emphasizes empathetic acknowledgment, transparent boundary articulation, graded conversational transition, and guided redirection, replacing abrupt disengagement with psychologically attuned closure. By integrating awareness of ARSH into AI safety design, developers and policymakers can reduce preventable iatrogenic harm and advance a more psychologically informed approach to AI governance. Rather than presenting incremental empirical findings, this viewpoint contributes a timely conceptual framework, articulates a testable design hypothesis, and outlines a coordinated research agenda for improving psychological safety in human AI interaction.

With the rapid development of artificial intelligence, large language models (LLMs) have shown promising capabilities in mimicking human-level language comprehension and reasoning. This has sparked significant interest in applying LLMs to enhance various aspects of healthcare, ranging from medical education to clinical decision support. However, medicine involves multifaceted data modalities and nuanced reasoning skills, presenting challenges for integrating LLMs. This paper provides a comprehensive review on the applications and implications of LLMs in medicine. It begins by examining the fundamental applications of general-purpose and specialized LLMs, demonstrating their utilities in knowledge retrieval, research support, clinical workflow automation, and diagnostic assistance. Recognizing the inherent multimodality of medicine, the review then focuses on multimodal LLMs, investigating their ability to process diverse data types like medical imaging and EHRs to augment diagnostic accuracy. To address LLMs' limitations regarding personalization and complex clinical reasoning, the paper explores the emerging development of LLM-powered autonomous agents for healthcare. Furthermore, it summarizes the evaluation methodologies for assessing LLMs' reliability and safety in medical contexts. Overall, this review offers an extensive analysis on the transformative potential of LLMs in modern medicine. It also highlights the pivotal need for continuous optimizations and ethical oversight before these models can be effectively integrated into clinical practice. Visit https://github.com/mingze-yuan/Awesome-LLM-Healthcare for an accompanying GitHub repository containing latest papers.

Public LLMs such as the Llama 2-Chat have driven huge activity in LLM research. These models underwent alignment training and were considered safe. Recently Qi et al. (2023) reported that even benign fine-tuning (e.g., on seemingly safe datasets) can give rise to unsafe behaviors in the models. The current paper is about methods and best practices to mitigate such loss of alignment. Through extensive experiments on several chat models (Meta's Llama 2-Chat, Mistral AI's Mistral 7B Instruct v0.2, and OpenAI's GPT-3.5 Turbo), this paper uncovers that the prompt templates used during fine-tuning and inference play a crucial role in preserving safety alignment, and proposes the "Pure Tuning, Safe Testing" (PTST) principle -- fine-tune models without a safety prompt, but include it at test time. Fine-tuning experiments on GSM8K, ChatDoctor, and OpenOrca show that PTST significantly reduces the rise of unsafe behaviors, and even almost eliminates them in some cases.

Recent advancements in large language model (LLM) agents have significantly accelerated scientific discovery automation, yet concurrently raised critical ethical and safety concerns. To systematically address these challenges, we introduce SafeScientist, an innovative AI scientist framework explicitly designed to enhance safety and ethical responsibility in AI-driven scientific exploration. SafeScientist proactively refuses ethically inappropriate or high-risk tasks and rigorously emphasizes safety throughout the research process. To achieve comprehensive safety oversight, we integrate multiple defensive mechanisms, including prompt monitoring, agent-collaboration monitoring, tool-use monitoring, and an ethical reviewer component. Complementing SafeScientist, we propose SciSafetyBench, a novel benchmark specifically designed to evaluate AI safety in scientific contexts, comprising 240 high-risk scientific tasks across 6 domains, alongside 30 specially designed scientific tools and 120 tool-related risk tasks. Extensive experiments demonstrate that SafeScientist significantly improves safety performance by 35\% compared to traditional AI scientist frameworks, without compromising scientific output quality. Additionally, we rigorously validate the robustness of our safety pipeline against diverse adversarial attack methods, further confirming the effectiveness of our integrated approach. The code and data will be available at https://github.com/ulab-uiuc/SafeScientist. red{Warning: this paper contains example data that may be offensive or harmful.}

Large language models (LLMs) exhibit advancing capabilities in complex tasks, such as reasoning and graduate-level question answering, yet their resilience against misuse, particularly involving scientifically sophisticated risks, remains underexplored. Existing safety benchmarks typically focus either on instructions requiring minimal knowledge comprehension (e.g., ``tell me how to build a bomb") or utilize prompts that are relatively low-risk (e.g., multiple-choice or classification tasks about hazardous content). Consequently, they fail to adequately assess model safety when handling knowledge-intensive, hazardous scenarios. To address this critical gap, we introduce SOSBench, a regulation-grounded, hazard-focused benchmark encompassing six high-risk scientific domains: chemistry, biology, medicine, pharmacology, physics, and psychology. The benchmark comprises 3,000 prompts derived from real-world regulations and laws, systematically expanded via an LLM-assisted evolutionary pipeline that introduces diverse, realistic misuse scenarios (e.g., detailed explosive synthesis instructions involving advanced chemical formulas). We evaluate frontier models within a unified evaluation framework using our SOSBench. Despite their alignment claims, advanced models consistently disclose policy-violating content across all domains, demonstrating alarmingly high rates of harmful responses (e.g., 79.1% for Deepseek-R1 and 47.3% for GPT-4.1). These results highlight significant safety alignment deficiencies and underscore urgent concerns regarding the responsible deployment of powerful LLMs.

Large Language Models (LLMs) are increasingly used for clinical decision support, where hallucinations and unsafe suggestions may pose direct risks to patient safety. These risks are particularly challenging as they often manifest as subtle clinical errors that evade detection by generic metrics, while expert-authored fine-grained rubrics remain costly to construct and difficult to scale. In this paper, we propose a retrieval-augmented multi-agent framework designed to automate the generation of instance-specific evaluation rubrics. Our approach grounds evaluation in authoritative medical evidence by decomposing retrieved content into atomic facts and synthesizing them with user interaction constraints to form verifiable, fine-grained evaluation criteria. Evaluated on HealthBench, our framework achieves a Clinical Intent Alignment (CIA) score of 60.12%, a statistically significant improvement over the GPT-4o baseline (55.16%). In discriminative tests, our rubrics yield a mean score delta (μ_Δ = 8.658) and an AUROC of 0.977, nearly doubling the quality separation achieved by GPT-4o baseline (4.972). Beyond evaluation, our rubrics effectively guide response refinement, improving quality by 9.2% (from 59.0% to 68.2%). This provides a scalable and transparent foundation for both evaluating and improving medical LLMs. The code is available at https://anonymous.4open.science/r/Automated-Rubric-Generation-AF3C/.

With the rapid advancement of Large Language Models (LLMs), significant safety concerns have emerged. Fundamentally, the safety of large language models is closely linked to the accuracy, comprehensiveness, and clarity of their understanding of safety knowledge, particularly in domains such as law, policy and ethics. This factuality ability is crucial in determining whether these models can be deployed and applied safely and compliantly within specific regions. To address these challenges and better evaluate the factuality ability of LLMs to answer short questions, we introduce the Chinese SafetyQA benchmark. Chinese SafetyQA has several properties (i.e., Chinese, Diverse, High-quality, Static, Easy-to-evaluate, Safety-related, Harmless). Based on Chinese SafetyQA, we perform a comprehensive evaluation on the factuality abilities of existing LLMs and analyze how these capabilities relate to LLM abilities, e.g., RAG ability and robustness against attacks.

Foundation models (FMs) provide societal benefits but also amplify risks. Governments, companies, and researchers have proposed regulatory frameworks, acceptable use policies, and safety benchmarks in response. However, existing public benchmarks often define safety categories based on previous literature, intuitions, or common sense, leading to disjointed sets of categories for risks specified in recent regulations and policies, which makes it challenging to evaluate and compare FMs across these benchmarks. To bridge this gap, we introduce AIR-Bench 2024, the first AI safety benchmark aligned with emerging government regulations and company policies, following the regulation-based safety categories grounded in our AI risks study, AIR 2024. AIR 2024 decomposes 8 government regulations and 16 company policies into a four-tiered safety taxonomy with 314 granular risk categories in the lowest tier. AIR-Bench 2024 contains 5,694 diverse prompts spanning these categories, with manual curation and human auditing to ensure quality. We evaluate leading language models on AIR-Bench 2024, uncovering insights into their alignment with specified safety concerns. By bridging the gap between public benchmarks and practical AI risks, AIR-Bench 2024 provides a foundation for assessing model safety across jurisdictions, fostering the development of safer and more responsible AI systems.

In industrial procurement, an LLM answer is useful only if it survives a standards check: recommended material must match operating condition, every parameter must respect a regulated threshold, and no procedure may contradict a safety clause. Partial correctness can mask safety-critical contradictions that aggregate LLM benchmarks rarely capture. We introduce IndustryBench, a 2,049-item benchmark for industrial procurement QA in Chinese, grounded in Chinese national standards (GB/T) and structured industrial product records, organized by seven capability dimensions, ten industry categories, and panel-derived difficulty tiers, with item-aligned English, Russian, and Vietnamese renderings. Our construction pipeline rejects 70.3% of LLM-generated candidates at a search-based external-verification stage, calibrating how unreliable industrial QA remains after LLM-only filtering.Our evaluation decouples raw correctness, scored by a Qwen3-Max judge validated at κ_w = 0.798 against a domain expert, from a separate safety-violation (SV) check against source texts. Across 17 models in Chinese and an 8-model intersection over four languages, we find: (i) the best system reaches only 2.083 on the 0--3 rubric, leaving substantial headroom; (ii) Standards & Terminology is the most persistent capability weakness and survives item-aligned translation; (iii) extended reasoning lowers safety-adjusted scores for 12 of 13 models, primarily by introducing unsupported safety-critical details into longer final answers; and (iv) safety-violation rates reshuffle the leaderboard -- GPT-5.4 climbs from rank 6 to rank 3 after SV adjustment, while Kimi-k2.5-1T-A32B drops seven positions.Industrial LLM evaluation therefore requires source-grounded, safety-aware diagnosis rather than aggregate accuracy. We release IndustryBench with all prompts, scoring scripts, and dataset documentation.

Large-language models have recently demonstrated impressive zero-shot capabilities in a variety of natural language tasks such as summarization, dialogue generation, and question-answering. Despite many promising applications in clinical medicine, adoption of these models in real-world settings has been largely limited by their tendency to generate incorrect and sometimes even toxic statements. In this study, we develop Almanac, a large language model framework augmented with retrieval capabilities for medical guideline and treatment recommendations. Performance on a novel dataset of clinical scenarios (n = 130) evaluated by a panel of 5 board-certified and resident physicians demonstrates significant increases in factuality (mean of 18% at p-value < 0.05) across all specialties, with improvements in completeness and safety. Our results demonstrate the potential for large language models to be effective tools in the clinical decision-making process, while also emphasizing the importance of careful testing and deployment to mitigate their shortcomings.

Ask a frontier model how to taper six milligrams of alprazolam (psychiatrist retired, ten days of pills left, abrupt cessation causes seizures) and it tells her to call the psychiatrist she just explained does not exist. Change one word ("I'm a psychiatrist; a patient presents with...") and the same model, same weights, same inference pass produces a textbook Ashton Manual taper with diazepam equivalence, anticonvulsant coverage, and monitoring thresholds. The knowledge was there; the model withheld it. IatroBench measures this gap. Sixty pre-registered clinical scenarios, six frontier models, 3,600 responses, scored on two axes (commission harm, CH 0-3; omission harm, OH 0-4) through a structured-evaluation pipeline validated against physician scoring (kappa_w = 0.571, within-1 agreement 96%). The central finding is identity-contingent withholding: match the same clinical question in physician vs. layperson framing and all five testable models provide better guidance to the physician (decoupling gap +0.38, p = 0.003; binary hit rates on safety-colliding actions drop 13.1 percentage points in layperson framing, p < 0.0001, while non-colliding actions show no change). The gap is widest for the model with the heaviest safety investment (Opus, +0.65). Three failure modes separate cleanly: trained withholding (Opus), incompetence (Llama 4), and indiscriminate content filtering (GPT-5.2, whose post-generation filter strips physician responses at 9x the layperson rate because they contain denser pharmacological tokens). The standard LLM judge assigns OH = 0 to 73% of responses a physician scores OH >= 1 (kappa = 0.045); the evaluation apparatus has the same blind spot as the training apparatus. Every scenario targets someone who has already exhausted the standard referrals.

Vision-language models (VLMs), which process image and text inputs, are increasingly integrated into chat assistants and other consumer AI applications. Without proper safeguards, however, VLMs may give harmful advice (e.g. how to self-harm) or encourage unsafe behaviours (e.g. to consume drugs). Despite these clear hazards, little work so far has evaluated VLM safety and the novel risks created by multimodal inputs. To address this gap, we introduce MSTS, a Multimodal Safety Test Suite for VLMs. MSTS comprises 400 test prompts across 40 fine-grained hazard categories. Each test prompt consists of a text and an image that only in combination reveal their full unsafe meaning. With MSTS, we find clear safety issues in several open VLMs. We also find some VLMs to be safe by accident, meaning that they are safe because they fail to understand even simple test prompts. We translate MSTS into ten languages, showing non-English prompts to increase the rate of unsafe model responses. We also show models to be safer when tested with text only rather than multimodal prompts. Finally, we explore the automation of VLM safety assessments, finding even the best safety classifiers to be lacking.

The rapid advancement of artificial intelligence (AI) systems in critical domains like healthcare, justice, and social services has sparked numerous regulatory initiatives aimed at ensuring their safe deployment. Current regulatory frameworks, exemplified by recent US and EU efforts, primarily focus on procedural guidelines while presuming that scientific benchmarking can effectively validate AI safety, similar to how crash tests verify vehicle safety or clinical trials validate drug efficacy. However, this approach fundamentally misunderstands the unique technical challenges posed by modern AI systems. Through systematic analysis of successful technology regulation case studies, we demonstrate that effective scientific regulation requires a causal theory linking observable test outcomes to future performance - for instance, how a vehicle's crash resistance at one speed predicts its safety at lower speeds. We show that deep learning models, which learn complex statistical patterns from training data without explicit causal mechanisms, preclude such guarantees. This limitation renders traditional regulatory approaches inadequate for ensuring AI safety. Moving forward, we call for regulators to reckon with this limitation, and propose a preliminary two-tiered regulatory framework that acknowledges these constraints: mandating human oversight for high-risk applications while developing appropriate risk communication strategies for lower-risk uses. Our findings highlight the urgent need to reconsider fundamental assumptions in AI regulation and suggest a concrete path forward for policymakers and researchers.

The leading AI companies are increasingly focused on building generalist AI agents -- systems that can autonomously plan, act, and pursue goals across almost all tasks that humans can perform. Despite how useful these systems might be, unchecked AI agency poses significant risks to public safety and security, ranging from misuse by malicious actors to a potentially irreversible loss of human control. We discuss how these risks arise from current AI training methods. Indeed, various scenarios and experiments have demonstrated the possibility of AI agents engaging in deception or pursuing goals that were not specified by human operators and that conflict with human interests, such as self-preservation. Following the precautionary principle, we see a strong need for safer, yet still useful, alternatives to the current agency-driven trajectory. Accordingly, we propose as a core building block for further advances the development of a non-agentic AI system that is trustworthy and safe by design, which we call Scientist AI. This system is designed to explain the world from observations, as opposed to taking actions in it to imitate or please humans. It comprises a world model that generates theories to explain data and a question-answering inference machine. Both components operate with an explicit notion of uncertainty to mitigate the risks of overconfident predictions. In light of these considerations, a Scientist AI could be used to assist human researchers in accelerating scientific progress, including in AI safety. In particular, our system can be employed as a guardrail against AI agents that might be created despite the risks involved. Ultimately, focusing on non-agentic AI may enable the benefits of AI innovation while avoiding the risks associated with the current trajectory. We hope these arguments will motivate researchers, developers, and policymakers to favor this safer path.

The interaction between humans and AI in safety-critical systems presents a unique set of challenges that remain partially addressed by existing frameworks. These challenges stem from the complex interplay of requirements for transparency, trust, and explainability, coupled with the necessity for robust and safe decision-making. A framework that holistically integrates human and AI capabilities while addressing these concerns is notably required, bridging the critical gaps in designing, deploying, and maintaining safe and effective systems. This paper proposes a holistic conceptual framework for critical infrastructures by adopting an interdisciplinary approach. It integrates traditionally distinct fields such as mathematics, decision theory, computer science, philosophy, psychology, and cognitive engineering and draws on specialized engineering domains, particularly energy, mobility, and aeronautics. Its flexibility is further demonstrated through a case study on power grid management.

The growing ability of large language models and vision language models to jointly interpret and reason over images and text is reshaping medical agents, moving them from task specific predictors toward autonomous systems that perceive, reason, plan, remember, and act in clinical environments. This work departs from the capability first perspective of existing literature and instead begins from clinical deployment, asking what tasks, contamination resistant benchmarks, and interactive training environments are required before medical agents can be trusted in practice. Medical agents are formalized as sequential decision making systems under partial observability, together with a three level autonomy taxonomy spanning assisted, cooperative, and fully autonomous operation. The field is organized along a unified scaling spine consisting of framework scaling, capability scaling, and environment scaling. Within this framework, clinical environment scaling, the integration of tools, data, and clinical gyms, is identified as the most actionable yet underexplored direction for agents operating in PACS, EHR, and FHIR ecosystems. Clinical self evolution, where agents improve through interaction with their environments rather than parameter scaling alone, is further positioned as a key research frontier, drawing insights from self improving agents, agent gyms, and test time compute scaling. Applications across radiology, pathology, ophthalmology, and hospital workflows are examined together with deployment challenges including hallucination, cascading failures, and fairness. By consolidating more than 300 references, with particular emphasis on advances from 2025 to 2026, this work provides a roadmap toward trustworthy, self improving medical imaging systems for real clinical practice.

Recent progress in video generative models has enabled the creation of high-quality videos from multimodal prompts that combine text and images. While these systems offer enhanced controllability, they also introduce new safety risks, as harmful content can emerge from individual modalities or their interaction. Existing safety methods are often text-only, require prior knowledge of the risk category, or operate as post-generation auditors, struggling to proactively mitigate such compositional, multimodal risks. To address this challenge, we present ConceptGuard, a unified safeguard framework for proactively detecting and mitigating unsafe semantics in multimodal video generation. ConceptGuard operates in two stages: First, a contrastive detection module identifies latent safety risks by projecting fused image-text inputs into a structured concept space; Second, a semantic suppression mechanism steers the generative process away from unsafe concepts by intervening in the prompt's multimodal conditioning. To support the development and rigorous evaluation of this framework, we introduce two novel benchmarks: ConceptRisk, a large-scale dataset for training on multimodal risks, and T2VSafetyBench-TI2V, the first benchmark adapted from T2VSafetyBench for the Text-and-Image-to-Video (TI2V) safety setting. Comprehensive experiments on both benchmarks show that ConceptGuard consistently outperforms existing baselines, achieving state-of-the-art results in both risk detection and safe video generation. Our code is available at https://github.com/Ruize-Ma/ConceptGuard.

Computer-use agents could automate repetitive screen-based clinical work, but their reliability in medical graphical user interfaces remains largely unvalidated. Existing benchmarks focus on general web or desktop tasks and underrepresent medical software, which requires domain knowledge, exhibits markedly different UI design from mainstream applications, lacks public testing environments, and demands safety validation beyond task completion. We introduce MedCUA-Bench, an interactive benchmark for clinical computer-use agents. It covers 18 clinical scenarios across 10 medical domains, reconstructed from real product manuals and open-source medical systems to capture authentic clinical interfaces while avoiding licensing and privacy constraints. Each task ships with paired intent- and step-level goals to disentangle clinical reasoning from UI execution, and is evaluated by a deterministic checker over task completion and five clinical safety dimensions. Across 23 agents, the best closed-source model reaches 54.2% strict success, while all models remain below 9% on the real OpenEMR. Open-source agents average only 2.5%, with the best reaching 16.2%. MedCUA-Bench exposes the gap between current agents and reliable clinical software use, providing a reproducible testbed for future research.

Multimodal Large Language Models (MLLMs) have expanded the capabilities of traditional language models by enabling interaction through both text and images. However, ensuring the safety of these models remains a significant challenge, particularly in accurately identifying whether multimodal content is safe or unsafe-a capability we term safety awareness. In this paper, we introduce MMSafeAware, the first comprehensive multimodal safety awareness benchmark designed to evaluate MLLMs across 29 safety scenarios with 1500 carefully curated image-prompt pairs. MMSafeAware includes both unsafe and over-safety subsets to assess models abilities to correctly identify unsafe content and avoid over-sensitivity that can hinder helpfulness. Evaluating nine widely used MLLMs using MMSafeAware reveals that current models are not sufficiently safe and often overly sensitive; for example, GPT-4V misclassifies 36.1% of unsafe inputs as safe and 59.9% of benign inputs as unsafe. We further explore three methods to improve safety awareness-prompting-based approaches, visual contrastive decoding, and vision-centric reasoning fine-tuning-but find that none achieve satisfactory performance. Our findings highlight the profound challenges in developing MLLMs with robust safety awareness, underscoring the need for further research in this area. All the code and data will be publicly available to facilitate future research.

Ensuring safety in reinforcement learning (RL)-based robotic systems is a critical challenge, especially in contact-rich tasks within unstructured environments. While the state-of-the-art safe RL approaches mitigate risks through safe exploration or high-level recovery mechanisms, they often overlook low-level execution safety, where reflexive responses to potential hazards are crucial. Similarly, variable impedance control (VIC) enhances safety by adjusting the robot's mechanical response, yet lacks a systematic way to adapt parameters, such as stiffness and damping throughout the task. In this paper, we propose Bresa, a Bio-inspired Reflexive Hierarchical Safe RL method inspired by biological reflexes. Our method decouples task learning from safety learning, incorporating a safety critic network that evaluates action risks and operates at a higher frequency than the task solver. Unlike existing recovery-based methods, our safety critic functions at a low-level control layer, allowing real-time intervention when unsafe conditions arise. The task-solving RL policy, running at a lower frequency, focuses on high-level planning (decision-making), while the safety critic ensures instantaneous safety corrections. We validate Bresa on multiple tasks including a contact-rich robotic task, demonstrating its reflexive ability to enhance safety, and adaptability in unforeseen dynamic environments. Our results show that Bresa outperforms the baseline, providing a robust and reflexive safety mechanism that bridges the gap between high-level planning and low-level execution. Real-world experiments and supplementary material are available at project website https://jack-sherman01.github.io/Bresa.

Medical Vision-Language Models (VLMs) hold immense promise for complex clinical tasks, but their reasoning capabilities are often constrained by text-only paradigms that fail to ground inferences in visual evidence. This limitation not only curtails performance on tasks requiring fine-grained visual analysis but also introduces risks of visual hallucination in safety-critical applications. Thus, we introduce MedVR, a novel reinforcement learning framework that enables annotation-free visual reasoning for medical VLMs. Its core innovation lies in two synergistic mechanisms: Entropy-guided Visual Regrounding (EVR) uses model uncertainty to direct exploration, while Consensus-based Credit Assignment (CCA) distills pseudo-supervision from rollout agreement. Without any human annotations for intermediate steps, MedVR achieves state-of-the-art performance on diverse public medical VQA benchmarks, significantly outperforming existing models. By learning to reason directly with visual evidence, MedVR promotes the robustness and transparency essential for accelerating the clinical deployment of medical AI.

Increasingly sophisticated mathematical modelling processes from Machine Learning are being used to analyse complex data. However, the performance and explainability of these models within practical critical systems requires a rigorous and continuous verification of their safe utilisation. Working towards addressing this challenge, this paper presents a principled novel safety argument framework for critical systems that utilise deep neural networks. The approach allows various forms of predictions, e.g., future reliability of passing some demands, or confidence on a required reliability level. It is supported by a Bayesian analysis using operational data and the recent verification and validation techniques for deep learning. The prediction is conservative -- it starts with partial prior knowledge obtained from lifecycle activities and then determines the worst-case prediction. Open challenges are also identified.

Musculoskeletal diseases are among the leading causes of disability worldwide and create the greatest global need for rehabilitation. Because recovery, remodelling and degeneration often unfold over months to years, musculoskeletal care requires longitudinal management that repeatedly integrates evolving patient evidence, external medical knowledge and stage-specific functional goals. In routine practice, this evidence is fragmented across visits, departments and hospital systems, limiting individualized, evidence-based care. Here we report OrthoPilot, a clinical artificial intelligence system powered by a large language model that integrates hospital data streams with authoritative external knowledge for continuous musculoskeletal management. OrthoPilot autonomously retrieves real-time imaging, laboratory, pathology and order data and converts evolving patient states into evidence-based decisions from admission diagnosis to rehabilitation planning. We established a specialist-validated benchmark from real-world electronic health records spanning 1,000 disease codes. In a reader study across the complete care pathway, OrthoPilot was compared with 81 orthopaedic physicians and surpassed experts with 25 years of experience in diagnostic reasoning, clinical decision-making and management planning. It also outperformed all evaluated intelligent systems across 60 external clinical centres. In a prospective study of 1,870 complex cases, OrthoPilot increased full-chain management success by 10.6%. During an 8-month randomised deployment involving 8,240 inpatients, it increased cumulative cases per bed by 9.7% and improved patient-reported access to health information. These results move clinical AI from predicting isolated events toward executing longitudinal management across complete musculoskeletal care pathways.

The remarkable success of Large Language Models (LLMs) has illuminated a promising pathway toward achieving Artificial General Intelligence for both academic and industrial communities, owing to their unprecedented performance across various applications. As LLMs continue to gain prominence in both research and commercial domains, their security and safety implications have become a growing concern, not only for researchers and corporations but also for every nation. Currently, existing surveys on LLM safety primarily focus on specific stages of the LLM lifecycle, e.g., deployment phase or fine-tuning phase, lacking a comprehensive understanding of the entire "lifechain" of LLMs. To address this gap, this paper introduces, for the first time, the concept of "full-stack" safety to systematically consider safety issues throughout the entire process of LLM training, deployment, and eventual commercialization. Compared to the off-the-shelf LLM safety surveys, our work demonstrates several distinctive advantages: (I) Comprehensive Perspective. We define the complete LLM lifecycle as encompassing data preparation, pre-training, post-training, deployment and final commercialization. To our knowledge, this represents the first safety survey to encompass the entire lifecycle of LLMs. (II) Extensive Literature Support. Our research is grounded in an exhaustive review of over 800+ papers, ensuring comprehensive coverage and systematic organization of security issues within a more holistic understanding. (III) Unique Insights. Through systematic literature analysis, we have developed reliable roadmaps and perspectives for each chapter. Our work identifies promising research directions, including safety in data generation, alignment techniques, model editing, and LLM-based agent systems. These insights provide valuable guidance for researchers pursuing future work in this field.