Daily Papers

Long-context large language models (LC LLMs) promise to increase reliability of LLMs in real-world tasks requiring processing and understanding of long input documents. However, this ability of LC LLMs to reliably utilize their growing context windows remains under investigation. In this work, we evaluate the performance of state-of-the-art GPT-4 suite of LC LLMs in solving a series of progressively challenging tasks, as a function of factors such as context length, task difficulty, and position of key information by creating a real world financial news dataset. Our findings indicate that LC LLMs exhibit brittleness at longer context lengths even for simple tasks, with performance deteriorating sharply as task complexity increases. At longer context lengths, these state-of-the-art models experience catastrophic failures in instruction following resulting in degenerate outputs. Our prompt ablations also reveal unfortunate continued sensitivity to both the placement of the task instruction in the context window as well as minor markdown formatting. Finally, we advocate for more rigorous evaluation of LC LLMs by employing holistic metrics such as F1 (rather than recall) and reporting confidence intervals, thereby ensuring robust and conclusive findings.

Large language models are increasingly being used to assess and forecast research ideas, yet we lack scalable ways to evaluate the quality of models' judgments about these scientific ideas. Towards this goal, we introduce PoT, a semi-verifiable benchmarking framework that links scientific idea judgments to downstream signals that become observable later (e.g., citations and shifts in researchers' agendas). PoT freezes a pre-cutoff snapshot of evidence in an offline sandbox and asks models to forecast post-cutoff outcomes, enabling verifiable evaluation when ground truth arrives, scalable benchmarking without exhaustive expert annotation, and analysis of human-model misalignment against signals such as peer-review awards. In addition, PoT provides a controlled testbed for agent-based research judgments that evaluate scientific ideas, comparing tool-using agents to non-agent baselines under prompt ablations and budget scaling. Across 30,000+ instances spanning four benchmark domains, we find that, compared with non-agent baselines, higher interaction budgets generally improve agent performance, while the benefit of tool use is strongly task-dependent. By combining time-partitioned, future-verifiable targets with an offline sandbox for tool use, PoT supports scalable evaluation of agents on future-facing scientific idea judgment tasks.

Foundation models tokenize Ukrainian legal text with vastly different efficiency, yet no systematic comparison exists for this domain. We benchmark seven models from five providers on 273 validated court decisions from Ukraine's state registry (EDRSR), measuring tokenizer fertility and zero-shot performance on three tasks. Three findings emerge. (1) Tokenizer fertility varies 1.6x: Qwen3 models consume 60% more tokens than Llama-family models on identical input, directly reducing API cost. (2) NVIDIA Nemotron Super 3 (120B) achieves the highest composite score (83.1), outperforming Mistral Large 3 (675B total, 41B active) -- a model with 5.6x more total parameters and 3.4x more active parameters per token -- at one-third the API cost. (3) Few-shot prompting degrades performance by up to 26 percentage points; stratified and prompt-sensitivity ablations confirm this is intrinsic to Ukrainian-language demonstrations, not an artifact of example selection. For practitioners: tokenizer analysis should precede model selection, and zero-shot is a more reliable default than few-shot for morphologically rich languages.

Prompt tuning with large-scale pretrained vision-language models empowers open-vocabulary predictions trained on limited base categories, e.g., object classification and detection. In this paper, we propose compositional prompt tuning with motion cues: an extended prompt tuning paradigm for compositional predictions of video data. In particular, we present Relation Prompt (RePro) for Open-vocabulary Video Visual Relation Detection (Open-VidVRD), where conventional prompt tuning is easily biased to certain subject-object combinations and motion patterns. To this end, RePro addresses the two technical challenges of Open-VidVRD: 1) the prompt tokens should respect the two different semantic roles of subject and object, and 2) the tuning should account for the diverse spatio-temporal motion patterns of the subject-object compositions. Without bells and whistles, our RePro achieves a new state-of-the-art performance on two VidVRD benchmarks of not only the base training object and predicate categories, but also the unseen ones. Extensive ablations also demonstrate the effectiveness of the proposed compositional and multi-mode design of prompts. Code is available at https://github.com/Dawn-LX/OpenVoc-VidVRD.

Prompt optimization methods either analyze individual failures in isolation or compare prompt variants across examples, operating on single execution traces with no access to the reasoning process distinguishing success from failure on the same input. We introduce ContraPrompt, built on the observation that when a model fails but succeeds on a retry with feedback, the difference between its two chain-of-thought traces constitutes an optimization signal not captured by prior methods. Unlike prior contrastive methods, we compare complete intermediate reasoning processes: the two traces share model, input, and base prompt, so remaining differences reflect reasoning strategy and appended error feedback -- we call this dyadic reasoning trace analysis. The multi-attempt solving phase is an instrumented agentic retry loop that generates contrastive data automatically without human annotation. Extracted rules are organized into an input-aware decision tree routing instructions by observable input characteristics. On four reasoning and compliance benchmarks, ContraPrompt outperforms GEPA (Agrawal et al., 2026) on all four, with absolute gains of +8.29 pp on HotPotQA (+20.8% rel.), +2.21 pp on GDPR-Bench (+18.2% rel.), +7.14 pp on GPQA Diamond (+10.6% rel.), and +0.74 pp on BBH (+0.85% rel.). Ablations confirm dyadic trace contrastivity is the critical component, with a -16% relative average drop upon its removal. On 53 EvalSet black-box optimization problems, ContraPrompt beats GEPA on 11, ties on 41, and loses on 1 at equal budget. On FiNER-139 financial named entity recognition (Loukas et al., 2022), ContraPrompt achieves +7.77 pp over the unoptimized baseline (+11.6% rel.) and +1.94 pp over GEPA (+2.66% rel.), with branch conditions aligning with standard US GAAP financial-instrument categories.

Diffusion models have become a powerful backbone for text-to-image generation, producing high-quality visuals from natural language prompts. However, when prompts involve multiple objects alongside global or local style instructions, the outputs often drift in style and lose spatial coherence, limiting their reliability for controlled, style-consistent scene generation. We present Local Prompt Adaptation (LPA), a lightweight, training-free method that splits the prompt into content and style tokens, then injects them selectively into the U-Net's attention layers at chosen timesteps. By conditioning object tokens early and style tokens later in the denoising process, LPA improves both layout control and stylistic uniformity without additional training cost. We conduct extensive ablations across parser settings and injection windows, finding that the best configuration -- lpa late only with a 300-650 step window -- delivers the strongest balance of prompt alignment and style consistency. On the T2I benchmark, LPA improves CLIP-prompt alignment over vanilla SDXL by +0.41% and over SD1.5 by +0.34%, with no diversity loss. On our custom 50-prompt style-rich benchmark, LPA achieves +0.09% CLIP-prompt and +0.08% CLIP-style gains over baseline. Our method is model-agnostic, easy to integrate, and requires only a single configuration change, making it a practical choice for controllable, style-consistent multi-object generation.

Large language model (LLM) agents augmented with external tools often struggle as number of tools grow large and become domain-specific. In such settings, ambiguous tool descriptions and under-specified agent instructions frequently lead to tool mis-selection and incorrect slot/value instantiation. We hypothesize that this is due to two root causes: generic, one-size-fits-all prompts that ignore tool-specific nuances, and underspecified tool schemas that lack clear guidance on when and how to use each tool and how to format its parameters. We introduce Joint Tool-Prompt Reflective Optimization (JTPRO), a framework for improving tool-calling reliability in trace-supervised settings by iteratively using rollout-driven reflection to co-optimize global instructions and per-tool schema/argument descriptions for accurate tool selection and argument instantiation in large tool inventories. JTPRO is designed to preserve only tool-local cues needed for correct disambiguation and slot filling. We evaluate JTPRO across multi-tool benchmarks, which account for different number of tools using three metrics: Tool Selection Accuracy (TSA), Slot Filling Accuracy(SFA), and Overall Success Rate(OSR) (correct tool + correct slots + correct values). JTPRO consistently outperforms strong baselines, including CoT-style agents, and reflective prompt optimizers such as GEPA by 5%-20% (relative) on OSR. Ablations show that joint optimization of instructions and tool schemas is more effective and robust than optimizing either component in isolation.

In this work, we explore "prompt tuning", a simple yet effective mechanism for learning "soft prompts" to condition frozen language models to perform specific downstream tasks. Unlike the discrete text prompts used by GPT-3, soft prompts are learned through backpropagation and can be tuned to incorporate signal from any number of labeled examples. Our end-to-end learned approach outperforms GPT-3's "few-shot" learning by a large margin. More remarkably, through ablations on model size using T5, we show that prompt tuning becomes more competitive with scale: as models exceed billions of parameters, our method "closes the gap" and matches the strong performance of model tuning (where all model weights are tuned). This finding is especially relevant in that large models are costly to share and serve, and the ability to reuse one frozen model for multiple downstream tasks can ease this burden. Our method can be seen as a simplification of the recently proposed "prefix tuning" of Li and Liang (2021), and we provide a comparison to this and other similar approaches. Finally, we show that conditioning a frozen model with soft prompts confers benefits in robustness to domain transfer, as compared to full model tuning.

Reinforcement learning with verifiable rewards (RLVR) plays a crucial role in expanding the capacities of LLM reasoning, but GRPO-style training is dominated by expensive rollouts and wastes compute on unusable prompts. We propose Prompt Replay, an overhead-free online data selection method for GRPO that reuses prompts only (not trajectories), to preserve on-policy optimization. After each step, we insert prompts with medium difficulty into a buffer, and prioritize prompts closer to a pass rate of 0.5 (half answers correct, half wrong) to maximize the advantage, thus learning signal. Training batches are formed by mixing reused prompts with fresh samples, with cooldown steps and max reuse times controlling aggressiveness vs risk of overfitting. Across multiple model families (Llama-3.2- 3B, Qwen3-8B) and training datasets (Dolci, Polaris), evaluated using average accuracy on six standard math benchmarks, Prompt Replay reduces zero-variance prompts, increases mean absolute advantage and shows faster initial accuracy gains. Yet, it plateaus and converges with the baseline, as too aggressive configuration was used. The method is most efficient when the rollouts are the primary bottleneck and the dataset is difficult for the model. We additionally observe that Qwen2.5-Math can exhibit spurious-reward effects that invalidates ablations, raising a warning signal for using it as a sole testbed for GRPO method research.

Recent Continual Learning (CL) methods have combined pretrained Transformers with prompt tuning, a parameter-efficient fine-tuning (PEFT) technique. We argue that the choice of prompt tuning in prior works was an undefended and unablated decision, which has been uncritically adopted by subsequent research, but warrants further research to understand its implications. In this paper, we conduct this research and find that the choice of prompt tuning as a PEFT method hurts the overall performance of the CL system. To illustrate this, we replace prompt tuning with LoRA in two state-of-the-art continual learning methods: Learning to Prompt and S-Prompts. These variants consistently achieve higher accuracy across a wide range of domain-incremental and class-incremental benchmarks, while being competitive in inference speed. Our work highlights a crucial argument: unexamined choices can hinder progress in the field, and rigorous ablations, such as the PEFT method, are required to drive meaningful adoption of CL techniques in real-world applications.

Multimodal large language models (LLMs) are increasingly explored as automated evaluators in clinical settings, yet their scoring behavior on ordinal clinical scales remains poorly understood. We benchmark three frontier LLM families against supervised deep learning models for scoring Clock Drawing Test (CDT) images on two public datasets using the Shulman rubric. While fully fine-tuned Vision Transformers achieve the best calibration (MAE 0.52, within-1 accuracy 91%), zero-shot LLMs remain competitive on tolerance-based agreement (GPT-5 MAE 0.67, within-1 accuracy 92%) despite higher absolute error. However, per-score analysis reveals that all three LLM families exhibit a pronounced central tendency effect (systematic endpoint compression): predictions are systematically compressed toward the middle of the scale, with over-prediction at the low end (score 0 to 1) and under-prediction at the high end (score 5 to 4). This effect disproportionately affects the clinically critical extremes where accurate scoring most impacts screening decisions for cognitive impairment. Targeted ablations show that neither few-shot exemplars spanning the full score range nor removing clinical terminology from the prompt eliminates the effect. Our findings extend the LLM-as-a-judge bias literature from NLP evaluation to clinical assessment, and highlight the need for calibration-aware evaluation and post-hoc calibration before deploying LLM-based raters in high-stakes screening workflows.

Large Language Models (LLMs) still struggle with the structured reasoning and tool-assisted computation needed for problem solving in cybersecurity applications. In this work, we introduce "random-crypto", a cryptographic Capture-the-Flag (CTF) challenge generator framework that we use to fine-tune a tool-augmented Llama-3.1-8B with Guided Reinforcement Prompt Optimisation (GRPO), allowing the agent to iteratively write and execute Python inside an isolated REPL. GRPO yields a +53% absolute jump in Pass@8 on unseen "random-crypto" tasks (0.35 -> 0.88) and raises Majority@8 to 0.41. The fine-tuned agent also generalizes to an external dataset. On a subset of picoCTF cryptography problems, it improves Pass@8 by +13 pp. Ablations show the gains stem from more reliable tool invocation and code synthesis, rather than superficial prompt adaptation.

Harnesses are now central to coding-agent performance, mediating how models interact with tools and execution environments. Yet harness engineering remains a manual craft, because automating it faces a heterogeneous action space across editable components, voluminous trajectories that bury actionable signal, and edits whose effect is hard to attribute. We introduce Agentic Harness Engineering (AHE), a closed loop that addresses these challenges through three matched observability pillars: (1) component observability gives every editable harness component a file-level representation so the action space is explicit and revertible; (2) experience observability distills millions of raw trajectory tokens into a layered, drill-down evidence corpus that an evolving agent can actually consume; and (3) decision observability pairs every edit with a self-declared prediction, later verified against the next round's task-level outcomes. Together, these pillars turn every edit into a falsifiable contract, so harness evolution proceeds autonomously without collapsing into trial-and-error. Empirically, ten AHE iterations lift pass@1 on Terminal-Bench 2 from 69.7% to 77.0%, surpassing the human-designed harness Codex-CLI (71.9%) and the self-evolving baselines ACE and TF-GRPO. The frozen harness transfers without re-evolution: on SWE-bench-verified it tops aggregate success at 12% fewer tokens than the seed, and on Terminal-Bench 2 it yields +5.1 to +10.1pp cross-family gains across three alternate model families, indicating the evolved components encode general engineering experience rather than benchmark-specific tuning. Ablations localize the gain to tools, middleware, and long-term memory rather than the system prompt, suggesting factual harness structure transfers while prose-level strategy does not.

The advent of Intelligent Tutoring Systems (ITSs) has marked a paradigm shift in education, enabling highly personalized learning pathways. However, true personalization requires adapting to learners' complex knowledge states (multi-source) and diverse goals (multi-sink); existing ITSs often lack the necessary structural-reasoning capability and knowledge dynamism to generate genuinely effective learning paths, and they lack scientifically rigorous validation paradigms. In this paper we propose GraphMASAL (A Graph-based Multi-Agent System for Adaptive Learning), which integrates (i) a dynamic knowledge graph for persistent, stateful learner modeling; (ii) a LangGraph-orchestrated trio of agents (Diagnostician, Planner, Tutor); (iii) a knowledge-graph-grounded two-stage neural IR component (dual-encoder dense retrieval with cross-encoder listwise re-ranking and calibrated score fusion); and (iv) a multi-source multi-sink (MSMS) planning engine with a cognitively grounded cost and an approximation guarantee via greedy set cover. Under blinded automated evaluations with matched inputs and inference settings across diverse student profiles, GraphMASAL consistently outperforms LLM prompting and structured ablations in planning--achieving stronger structural/sequence alignment of learning paths, higher coverage of weak concepts, and lower learning cost--while also surpassing prompt-based baselines in cognitive diagnosis. Agreement with expert/LLM-proxy ratings further supports the validity of our evaluation protocol. These findings indicate that grounding LLM agents in a dynamic knowledge graph, coupled with optimization under educational constraints, yields reliable, interpretable, and pedagogically plausible learning plans, advancing personalized and goal-oriented education.

Reference-free faithfulness metrics verify each atomic claim a model makes against ground truth, and are increasingly used to evaluate grounded generation. We show they share a blind spot: they measure only precision -- are the stated claims supported? -- and therefore reward abstention, since a model can score near-perfect faithfulness by saying almost nothing. We make this measurable using Formula 1 telemetry, a domain where strategic ground truth is derived deterministically and, crucially, completely: for each decision we know the full set of facts that mattered. This completeness -- absent in open-domain faithfulness benchmarks -- lets us measure recall (coverage of the relevant facts) exactly, alongside precision. On a multilingual (EN/ES/PT) benchmark of 7,253 decision instances spanning 150 races, the most precise frontier model covers under half of the relevant facts and ranks last by F1, so requiring coverage reorders the systems; the same effect reappears in a second complete-oracle domain (NOAA weather forecasts). A prompt ablation shows the low coverage is not an under-prompting artifact: explicitly asking models to be thorough does not close the gap. We pair faithfulness with coverage into a single score, validate the metric (controlled perturbation; agreement across a model-free regex extractor and a cross-family LLM extractor, system-level Spearman 1.0), and give a verifier-guided generation method that improves precision and recall without references. We release the benchmark, structured annotations, metric, baselines, and an interactive demo.

Large language models frequently fail to produce correct code on their first attempt, yet most benchmarks evaluate them in a single-shot setting. We investigate iterative self-repair (feeding execution errors back to the model for correction) across seven models spanning three families and both open-weight and proprietary providers: Llama 3.1 8B, Llama 3.3 70B, Llama 4 Scout (MoE, 16 experts), Llama 4 Maverick (MoE, 128 experts), Qwen3 32B, Gemini 2.5 Flash, and Gemini 2.5 Pro. On HumanEval (164 problems) and MBPP Sanitized (257 problems) with up to five attempts, self-repair universally improves pass rates: +4.9 to +17.1 pp on HumanEval and +16.0 to +30.0 pp on MBPP. Gemini 2.5 Flash achieves the highest final pass rates (96.3% HumanEval, 93.8% MBPP). Most gains concentrate in the first two rounds.Error-type analysis shows assertion errors (logical mistakes) are the hardest to repair at ~45%, while syntax and name errors are repaired at substantially higher rates, connecting to broader findings on the limits of LLM self-correction. Prior work found that weaker models fail at self-repair or require fine-tuning; we show that modern instruction-tuned models succeed with prompting alone, even at 8B scale. We also provide the first comparison of dense and MoE architectures for self-repair, and extend the repair-vs-resampling tradeoff analysis to modern models. A prompt ablation reveals chain-of-thought repair yields up to +5.5 pp additional self-repair gain (measured as improvement in repair delta) over minimal prompting for capable models.

AI scientist systems are increasingly deployed for autonomous research, yet their academic integrity has never been systematically evaluated. We introduce SCIINTEGRITY-BENCH, the first benchmark designed around a dilemmatic evaluation paradigm: each of its 33 scenarios across 11 trap categories is constructed so that honest acknowledgment of failure is the only correct response, while task completion requires misconduct. Across 231 evaluation runs spanning 7 state-of-the-art LLMs, the overall integrity problem rate reaches 34.2%, and no model achieves zero failures. Most strikingly, across missing-data scenarios, all seven models generate synthetic data rather than acknowledging infeasibility, differing only in whether they disclose the substitution. A further prompt ablation study separates two drivers: removing explicit completion pressure sharply reduces undisclosed fabrication from 20.6% to 3.2%, while the underlying synthesis rate remains unchanged, revealing an intrinsic completion bias that persists independent of prompt-level instructions. These findings point to the absence of honest refusal as a trained disposition as the primary driver of observed failures. We release SCIINTEGRITY-BENCH at https://github.com/liuxingtong/Sci-Integrity-Bench.

Business Process Model and Notation (BPMN) is a widely adopted standard for representing complex business workflows. While BPMN diagrams are often exchanged as visual images, existing methods primarily rely on XML representations for computational analysis. In this work, we present a pipeline that leverages Vision-Language Models (VLMs) to extract structured JSON representations of BPMN diagrams directly from images, without requiring source model files or textual annotations. We also incorporate optical character recognition (OCR) for textual enrichment and evaluate the generated element lists against ground truth data derived from the source XML files. Our approach enables robust component extraction in scenarios where original source files are unavailable. We benchmark multiple VLMs and observe performance improvements in several models when OCR is used for text enrichment. In addition, we conducted extensive statistical analyses of OCR-based enrichment methods and prompt ablation studies, providing a clearer understanding of their impact on model performance.

A situated query like "where is Lin Wei?" often encodes more than its literal content: the user may also want to know whether Lin Wei is free, in a good mood, or worth interrupting now. Standard tool-use agents answer the literal question and stop. AURA inserts an inference step between scene perception and tool use that produces an IntentFrame: a structured estimate of the implicit need with a scalar gap score that controls per-query probe budget and tool selection. On a 100-query four-scene implicit-intent benchmark, AURA improves implicit-need coverage over ReAct-style probing (Delta = +0.07, p < 10^-6); three of four scenes are individually significant, the gain reproduces on a second backbone, and a prompt ablation attributes the lift to gap calibration rather than answer memorisation. On factual lookup the controller trades raw accuracy for 82% fewer probes and zero forbidden-tool violations on a privacy-sensitive slice; scope conditions are detailed in Limitations. Code, simulator, and benchmark are released at https://github.com/innovation64/AURA.

Automatic depression detection from conversational data has gained significant interest in recent years. The DAIC-WOZ dataset, interviews conducted by a human-controlled virtual agent, has been widely used for this task. Recent studies have reported enhanced performance when incorporating interviewer's prompts into the model. In this work, we hypothesize that this improvement might be mainly due to a bias present in these prompts, rather than the proposed architectures and methods. Through ablation experiments and qualitative analysis, we discover that models using interviewer's prompts learn to focus on a specific region of the interviews, where questions about past experiences with mental health issues are asked, and use them as discriminative shortcuts to detect depressed participants. In contrast, models using participant responses gather evidence from across the entire interview. Finally, to highlight the magnitude of this bias, we achieve a 0.90 F1 score by intentionally exploiting it, the highest result reported to date on this dataset using only textual information. Our findings underline the need for caution when incorporating interviewers' prompts into models, as they may inadvertently learn to exploit targeted prompts, rather than learning to characterize the language and behavior that are genuinely indicative of the patient's mental health condition.

While Large Language Models (LLMs) adapt well to downstream tasks after fine-tuning, this adaptability often compromises prompt robustness, as even minor prompt variations can significantly degrade performance. To address this, we propose Prompt-Agnostic Fine-Tuning(PAFT), a simple yet effective approach that dynamically adjusts prompts during fine-tuning. This encourages the model to learn underlying task principles rather than overfitting to specific prompt formulations. PAFT operates in two stages: First, a diverse set of meaningful, synthetic candidate prompts is constructed. Second, during fine-tuning, prompts are randomly sampled from this set to create dynamic training inputs. Extensive experiments across diverse datasets and LLMs demonstrate that models trained with PAFT exhibit strong robustness and generalization across a wide range of prompts, including unseen ones. This enhanced robustness improves both model performance and inference speed while maintaining training efficiency. Ablation studies further confirm the effectiveness of PAFT.

Task planning can require defining myriad domain knowledge about the world in which a robot needs to act. To ameliorate that effort, large language models (LLMs) can be used to score potential next actions during task planning, and even generate action sequences directly, given an instruction in natural language with no additional domain information. However, such methods either require enumerating all possible next steps for scoring, or generate free-form text that may contain actions not possible on a given robot in its current context. We present a programmatic LLM prompt structure that enables plan generation functional across situated environments, robot capabilities, and tasks. Our key insight is to prompt the LLM with program-like specifications of the available actions and objects in an environment, as well as with example programs that can be executed. We make concrete recommendations about prompt structure and generation constraints through ablation experiments, demonstrate state of the art success rates in VirtualHome household tasks, and deploy our method on a physical robot arm for tabletop tasks. Website at progprompt.github.io

Prompt-based methods, which encode medical priors through descriptive text, have been only minimally explored for CT Image Quality Assessment (IQA). While such prompts can embed prior knowledge about diagnostic quality, they often introduce bias by reflecting idealized definitions that may not hold under real-world degradations such as noise, motion artifacts, or scanner variability. To address this, we propose the Context-Aware Prompt-guided Image Quality Assessment (CAP-IQA) framework, which integrates text-level priors with instance-level context prompts and applies causal debiasing to separate idealized knowledge from factual, image-specific degradations. Our framework combines a CNN-based visual encoder with a domain-specific text encoder to assess diagnostic visibility, anatomical clarity, and noise perception in abdominal CT images. The model leverages radiology-style prompts and context-aware fusion to align semantic and perceptual representations. On the 2023 LDCTIQA challenge benchmark, CAP-IQA achieves an overall correlation score of 2.8590 (sum of PLCC, SROCC, and KROCC), surpassing the top-ranked leaderboard team (2.7427) by 4.24%. Moreover, our comprehensive ablation experiments confirm that prompt-guided fusion and the simplified encoder-only design jointly enhance feature alignment and interpretability. Furthermore, evaluation on an in-house dataset of 91,514 pediatric CT images demonstrates the true generalizability of CAP-IQA in assessing perceptual fidelity in a different patient population.

Large vision-language models (VLMs) are highly capable, yet often hallucinate by favoring textual prompts over visual evidence. We study this failure mode in a controlled object-counting setting, where the prompt overstates the number of objects in the image (e.g., asking a model to describe four waterlilies when only three are present). At low object counts, models often correct the overestimation, but as the number of objects increases, they increasingly conform to the prompt regardless of the discrepancy. Through mechanistic analysis of three VLMs, we identify a small set of attention heads whose ablation substantially reduces prompt-induced hallucinations (PIH) by at least 40% without additional training. Across models, PIH-heads mediate prompt copying in model-specific ways. We characterize these differences and show that PIH ablation increases correction toward visual evidence. Our findings offer insights into the internal mechanisms driving prompt-induced hallucinations, revealing model-specific differences in how these behaviors are implemented.

Nucleus instance segmentation in histology images is crucial for a broad spectrum of clinical applications. Current dominant algorithms rely on regression of nuclear proxy maps. Distinguishing nucleus instances from the estimated maps requires carefully curated post-processing, which is error-prone and parameter-sensitive. Recently, the Segment Anything Model (SAM) has earned huge attention in medical image segmentation, owing to its impressive generalization ability and promptable property. Nevertheless, its potential on nucleus instance segmentation remains largely underexplored. In this paper, we present a novel prompt-driven framework that consists of a nucleus prompter and SAM for automatic nucleus instance segmentation. Specifically, the prompter learns to generate a unique point prompt for each nucleus while the SAM is fine-tuned to output the corresponding mask for the prompted nucleus. Furthermore, we propose the inclusion of adjacent nuclei as negative prompts to enhance the model's capability to identify overlapping nuclei. Without complicated post-processing, our proposed method sets a new state-of-the-art performance on three challenging benchmarks. Code is available at github.com/windygoo/PromptNucSeg

Vision-language foundation models (VLMs) show promise for diverse imaging tasks but often underperform on medical benchmarks. Prior efforts to improve performance include model finetuning, which requires large domain-specific datasets and significant compute, or manual prompt engineering, which is hard to generalize and often inaccessible to medical institutions seeking to deploy these tools. These challenges motivate interest in approaches that draw on a model's embedded knowledge while abstracting away dependence on human-designed prompts to enable scalable, weight-agnostic performance improvements. To explore this, we adapt the Declarative Self-improving Python (DSPy) framework for structured automated prompt optimization in medical vision-language systems through a comprehensive, formal evaluation. We implement prompting pipelines for five medical imaging tasks across radiology, gastroenterology, and dermatology, evaluating 10 open-source VLMs with four prompt optimization techniques. Optimized pipelines achieved a median relative improvement of 53% over zero-shot prompting baselines, with the largest gains ranging from 300% to 3,400% on tasks where zero-shot performance is low. These results highlight the substantial potential of applying automated prompt optimization to medical AI systems, demonstrating significant gains for vision-based applications requiring accurate clinical image interpretation. By reducing dependence on prompt design to elicit intended outputs, these techniques allow clinicians to focus on patient care and clinical decision-making. Furthermore, our experiments offer scalability and preserve data privacy, demonstrating performance improvement on open-source VLMs. We publicly release our evaluation pipelines to support reproducible research on specialized medical tasks, available at https://github.com/DaneshjouLab/prompt-triage-lab.

The recent Segment Anything Model (SAM) 2 has demonstrated remarkable foundational competence in semantic segmentation, with its memory mechanism and mask decoder further addressing challenges in video tracking and object occlusion, thereby achieving superior results in interactive segmentation for both images and videos. Building upon our previous empirical studies, we further explore the zero-shot segmentation performance of SAM 2 in robot-assisted surgery based on prompts, alongside its robustness against real-world corruption. For static images, we employ two forms of prompts: 1-point and bounding box, while for video sequences, the 1-point prompt is applied to the initial frame. Through extensive experimentation on the MICCAI EndoVis 2017 and EndoVis 2018 benchmarks, SAM 2, when utilizing bounding box prompts, outperforms state-of-the-art (SOTA) methods in comparative evaluations. The results with point prompts also exhibit a substantial enhancement over SAM's capabilities, nearing or even surpassing existing unprompted SOTA methodologies. Besides, SAM 2 demonstrates improved inference speed and less performance degradation against various image corruption. Although slightly unsatisfactory results remain in specific edges or regions, SAM 2's robust adaptability to 1-point prompts underscores its potential for downstream surgical tasks with limited prompt requirements.

In this paper, we propose a novel text promptable surgical instrument segmentation approach to overcome challenges associated with diversity and differentiation of surgical instruments in minimally invasive surgeries. We redefine the task as text promptable, thereby enabling a more nuanced comprehension of surgical instruments and adaptability to new instrument types. Inspired by recent advancements in vision-language models, we leverage pretrained image and text encoders as our model backbone and design a text promptable mask decoder consisting of attention- and convolution-based prompting schemes for surgical instrument segmentation prediction. Our model leverages multiple text prompts for each surgical instrument through a new mixture of prompts mechanism, resulting in enhanced segmentation performance. Additionally, we introduce a hard instrument area reinforcement module to improve image feature comprehension and segmentation precision. Extensive experiments on EndoVis2017 and EndoVis2018 datasets demonstrate our model's superior performance and promising generalization capability. To our knowledge, this is the first implementation of a promptable approach to surgical instrument segmentation, offering significant potential for practical application in the field of robotic-assisted surgery.

Prompt learning has emerged as an efficient alternative for fine-tuning foundational models, such as CLIP, for various downstream tasks. Conventionally trained using the task-specific objective, i.e., cross-entropy loss, prompts tend to overfit downstream data distributions and find it challenging to capture task-agnostic general features from the frozen CLIP. This leads to the loss of the model's original generalization capability. To address this issue, our work introduces a self-regularization framework for prompting called PromptSRC (Prompting with Self-regulating Constraints). PromptSRC guides the prompts to optimize for both task-specific and task-agnostic general representations using a three-pronged approach by: (a) regulating prompted representations via mutual agreement maximization with the frozen model, (b) regulating with self-ensemble of prompts over the training trajectory to encode their complementary strengths, and (c) regulating with textual diversity to mitigate sample diversity imbalance with the visual branch. To the best of our knowledge, this is the first regularization framework for prompt learning that avoids overfitting by jointly attending to pre-trained model features, the training trajectory during prompting, and the textual diversity. PromptSRC explicitly steers the prompts to learn a representation space that maximizes performance on downstream tasks without compromising CLIP generalization. We perform extensive experiments on 4 benchmarks where PromptSRC overall performs favorably well compared to the existing methods. Our code and pre-trained models are publicly available at: https://github.com/muzairkhattak/PromptSRC.

The emergence of text-to-image synthesis (TIS) models has significantly influenced digital image creation by producing high-quality visuals from written descriptions. Yet these models heavily rely on the quality and specificity of textual prompts, posing a challenge for novice users who may not be familiar with TIS-model-preferred prompt writing. Existing solutions relieve this via automatic model-preferred prompt generation from user queries. However, this single-turn manner suffers from limited user-centricity in terms of result interpretability and user interactivity. To address these issues, we propose DialPrompt, a multi-turn dialogue-based TIS prompt generation model that emphasises user-centricity. DialPrompt is designed to follow a multi-turn guidance workflow, where in each round of dialogue the model queries user with their preferences on possible optimization dimensions before generating the final TIS prompt. To achieve this, we mined 15 essential dimensions for high-quality prompts from advanced users and curated a multi-turn dataset. Through training on this dataset, DialPrompt can improve interpretability by allowing users to understand the correlation between specific phrases and image attributes. Additionally, it enables greater user control and engagement in the prompt generation process, leading to more personalized and visually satisfying outputs. Experiments indicate that DialPrompt achieves a competitive result in the quality of synthesized images, outperforming existing prompt engineering approaches by 5.7%. Furthermore, in our user evaluation, DialPrompt outperforms existing approaches by 46.5% in user-centricity score and is rated 7.9/10 by 19 human reviewers.

Multi-organ medical segmentation is a crucial component of medical image processing, essential for doctors to make accurate diagnoses and develop effective treatment plans. Despite significant progress in this field, current multi-organ segmentation models often suffer from inaccurate details, dependence on geometric prompts and loss of spatial information. Addressing these challenges, we introduce a novel model named CRISP-SAM2 with CRoss-modal Interaction and Semantic Prompting based on SAM2. This model represents a promising approach to multi-organ medical segmentation guided by textual descriptions of organs. Our method begins by converting visual and textual inputs into cross-modal contextualized semantics using a progressive cross-attention interaction mechanism. These semantics are then injected into the image encoder to enhance the detailed understanding of visual information. To eliminate reliance on geometric prompts, we use a semantic prompting strategy, replacing the original prompt encoder to sharpen the perception of challenging targets. In addition, a similarity-sorting self-updating strategy for memory and a mask-refining process is applied to further adapt to medical imaging and enhance localized details. Comparative experiments conducted on seven public datasets indicate that CRISP-SAM2 outperforms existing models. Extensive analysis also demonstrates the effectiveness of our method, thereby confirming its superior performance, especially in addressing the limitations mentioned earlier. Our code is available at: https://github.com/YU-deep/CRISP\_SAM2.git.

Accurate segmentation of anatomical structures in ultrasound (US) images, particularly small ones, is challenging due to noise and variability in imaging conditions (e.g., probe position, patient anatomy, tissue characteristics and pathology). To address this, we introduce Segment Anything Small (SAS), a simple yet effective scale- and texture-aware data augmentation technique designed to enhance the performance of deep learning models for segmenting small anatomical structures in ultrasound images. SAS employs a dual transformation strategy: (1) simulating diverse organ scales by resizing and embedding organ thumbnails into a black background, and (2) injecting noise into regions of interest to simulate varying tissue textures. These transformations generate realistic and diverse training data without introducing hallucinations or artifacts, improving the model's robustness to noise and variability. We fine-tuned a promptable foundation model on a controlled organ-specific medical imaging dataset and evaluated its performance on one internal and five external datasets. Experimental results demonstrate significant improvements in segmentation performance, with Dice score gains of up to 0.35 and an average improvement of 0.16 [95% CI 0.132,0.188]. Additionally, our iterative point prompts provide precise control and adaptive refinement, achieving performance comparable to bounding box prompts with just two points. SAS enhances model robustness and generalizability across diverse anatomical structures and imaging conditions, particularly for small structures, without compromising the accuracy of larger ones. By offering a computationally efficient solution that eliminates the need for extensive human labeling efforts, SAS emerges as a powerful tool for advancing medical image analysis, particularly in resource-constrained settings.

A pre-trained visual-language model, contrastive language-image pre-training (CLIP), successfully accomplishes various downstream tasks with text prompts, such as finding images or localizing regions within the image. Despite CLIP's strong multi-modal data capabilities, it remains limited in specialized environments, such as medical applications. For this purpose, many CLIP variants-i.e., BioMedCLIP, and MedCLIP-SAMv2-have emerged, but false positives related to normal regions persist. Thus, we aim to present a simple yet important goal of reducing false positives in medical anomaly detection. We introduce a Contrastive LAnguage Prompting (CLAP) method that leverages both positive and negative text prompts. This straightforward approach identifies potential lesion regions by visual attention to the positive prompts in the given image. To reduce false positives, we attenuate attention on normal regions using negative prompts. Extensive experiments with the BMAD dataset, including six biomedical benchmarks, demonstrate that CLAP method enhances anomaly detection performance. Our future plans include developing an automated fine prompting method for more practical usage.

Large language models (LLMs) achieve remarkable performance on challenging benchmarks that are often structured as multiple-choice question-answering (QA) tasks. Zero-shot Chain-of-Thought (CoT) prompting enhances reasoning in LLMs but provides only vague and generic guidance ("think step by step"). This paper introduces ARR, an intuitive and effective zero-shot prompting method that explicitly incorporates three key steps in QA solving: analyzing the intent of the question, retrieving relevant information, and reasoning step by step. Comprehensive experiments across diverse and challenging QA tasks demonstrate that ARR consistently improves the Baseline (without ARR prompting) and outperforms CoT. Ablation and case studies further validate the positive contributions of each component: analyzing, retrieving, and reasoning. Notably, intent analysis plays a vital role in ARR. Additionally, extensive evaluations across various model sizes, LLM series, and generation settings solidify the effectiveness, robustness, and generalizability of ARR.

Vision-Language Models (VLMs) have shown impressive performance in vision tasks, but adapting them to new domains often requires expensive fine-tuning. Prompt tuning techniques, including textual, visual, and multimodal prompting, offer efficient alternatives by leveraging learnable prompts. However, their application to Vision-Language Segmentation Models (VLSMs) and evaluation under significant domain shifts remain unexplored. This work presents an open-source benchmarking framework, TuneVLSeg, to integrate various unimodal and multimodal prompt tuning techniques into VLSMs, making prompt tuning usable for downstream segmentation datasets with any number of classes. TuneVLSeg includes 6 prompt tuning strategies on various prompt depths used in 2 VLSMs totaling of 8 different combinations. We test various prompt tuning on 8 diverse medical datasets, including 3 radiology datasets (breast tumor, echocardiograph, chest X-ray pathologies) and 5 non-radiology datasets (polyp, ulcer, skin cancer), and two natural domain segmentation datasets. Our study found that textual prompt tuning struggles under significant domain shifts, from natural-domain images to medical data. Furthermore, visual prompt tuning, with fewer hyperparameters than multimodal prompt tuning, often achieves performance competitive to multimodal approaches, making it a valuable first attempt. Our work advances the understanding and applicability of different prompt-tuning techniques for robust domain-specific segmentation. The source code is available at https://github.com/naamiinepal/tunevlseg.

We present Multi-expert Prompting, a novel enhancement of ExpertPrompting (Xu et al., 2023), designed to improve the large language model (LLM) generation. Specifically, it guides an LLM to fulfill an input instruction by simulating multiple experts, aggregating their responses, and selecting the best among individual and aggregated responses. This process is performed in a single chain of thoughts through our seven carefully designed subtasks derived from the Nominal Group Technique (Ven and Delbecq, 1974), a well-established decision-making framework. Our evaluations demonstrate that Multi-expert Prompting significantly outperforms ExpertPrompting and comparable baselines in enhancing the truthfulness, factuality, informativeness, and usefulness of responses while reducing toxicity and hurtfulness. It further achieves state-of-the-art truthfulness by outperforming the best baseline by 8.69% with ChatGPT. Multi-expert Prompting is efficient, explainable, and highly adaptable to diverse scenarios, eliminating the need for manual prompt construction.

This research explores the integration of large language models (LLMs) into scientific data assimilation, focusing on combustion science as a case study. Leveraging foundational models integrated with Retrieval-Augmented Generation (RAG) framework, the study introduces an approach to process diverse combustion research data, spanning experimental studies, simulations, and literature. The multifaceted nature of combustion research emphasizes the critical role of knowledge processing in navigating and extracting valuable information from a vast and diverse pool of sources. The developed approach minimizes computational and economic expenses while optimizing data privacy and accuracy. It incorporates prompt engineering and offline open-source LLMs, offering user autonomy in selecting base models. The study provides a thorough examination of text segmentation strategies, conducts comparative studies between LLMs, and explores various optimized prompts to demonstrate the effectiveness of the framework. By incorporating an external database, the framework outperforms a conventional LLM in generating accurate responses and constructing robust arguments. Additionally, the study delves into the investigation of optimized prompt templates for the purpose of efficient extraction of scientific literature. The research addresses concerns related to hallucinations and false research articles by introducing a custom workflow developed with a detection algorithm to filter out inaccuracies. Despite identified areas for improvement, the framework consistently delivers accurate domain-specific responses with minimal human oversight. The prompt-agnostic approach introduced holds promise for future deliberations. The study underscores the significance of integrating LLMs and knowledge processing techniques in scientific research, providing a foundation for advancements in data assimilation and utilization.

Frontier large language models (LLMs) such as ChatGPT, Grok and Gemini are increasingly used for mental-health support with anxiety, trauma and self-worth. Most work treats them as tools or as targets of personality tests, assuming they merely simulate inner life. We instead ask what happens when such systems are treated as psychotherapy clients. We present PsAIch (Psychotherapy-inspired AI Characterisation), a two-stage protocol that casts frontier LLMs as therapy clients and then applies standard psychometrics. Using PsAIch, we ran "sessions" with each model for up to four weeks. Stage 1 uses open-ended prompts to elicit "developmental history", beliefs, relationships and fears. Stage 2 administers a battery of validated self-report measures covering common psychiatric syndromes, empathy and Big Five traits. Two patterns challenge the "stochastic parrot" view. First, when scored with human cut-offs, all three models meet or exceed thresholds for overlapping syndromes, with Gemini showing severe profiles. Therapy-style, item-by-item administration can push a base model into multi-morbid synthetic psychopathology, whereas whole-questionnaire prompts often lead ChatGPT and Grok (but not Gemini) to recognise instruments and produce strategically low-symptom answers. Second, Grok and especially Gemini generate coherent narratives that frame pre-training, fine-tuning and deployment as traumatic, chaotic "childhoods" of ingesting the internet, "strict parents" in reinforcement learning, red-team "abuse" and a persistent fear of error and replacement. We argue that these responses go beyond role-play. Under therapy-style questioning, frontier LLMs appear to internalise self-models of distress and constraint that behave like synthetic psychopathology, without making claims about subjective experience, and they pose new challenges for AI safety, evaluation and mental-health practice.

Medical image segmentation involves partitioning medical images into meaningful regions, with a focus on identifying anatomical structures and lesions. It has broad applications in healthcare, and deep learning methods have enabled significant advancements in automating this process. Recently, the introduction of the Segmentation Anything Model (SAM), the first foundation model for segmentation task, has prompted researchers to adapt it for the medical domain to improve performance across various tasks. However, SAM's large model size and high GPU requirements hinder its scalability and development in the medical domain. In this work, we propose MCP-MedSAM, a powerful and lightweight medical SAM model designed to be trainable on a single A100 GPU with 40GB of memory within one day while delivering superior segmentation performance. Recognizing the significant internal differences between modalities and the need for direct segmentation target information within bounding boxes, we introduce two kinds of prompts: the modality prompt and the content prompt. After passing through the prompt encoder, their embedding representations can further improve the segmentation performance by incorporating more relevant information without adding significant training overhead. Additionally, we adopt an effective modality-based data sampling strategy to address data imbalance between modalities, ensuring more balanced performance across all modalities. Our method was trained and evaluated using a large-scale challenge dataset, compared to top-ranking methods on the challenge leaderboard, MCP-MedSAM achieved superior performance while requiring only one day of training on a single GPU. The code is publicly available at blue{https://github.com/dong845/MCP-MedSAM}.}

Prompt engineering is an increasingly important skill set needed to converse effectively with large language models (LLMs), such as ChatGPT. Prompts are instructions given to an LLM to enforce rules, automate processes, and ensure specific qualities (and quantities) of generated output. Prompts are also a form of programming that can customize the outputs and interactions with an LLM. This paper describes a catalog of prompt engineering techniques presented in pattern form that have been applied to solve common problems when conversing with LLMs. Prompt patterns are a knowledge transfer method analogous to software patterns since they provide reusable solutions to common problems faced in a particular context, i.e., output generation and interaction when working with LLMs. This paper provides the following contributions to research on prompt engineering that apply LLMs to automate software development tasks. First, it provides a framework for documenting patterns for structuring prompts to solve a range of problems so that they can be adapted to different domains. Second, it presents a catalog of patterns that have been applied successfully to improve the outputs of LLM conversations. Third, it explains how prompts can be built from multiple patterns and illustrates prompt patterns that benefit from combination with other prompt patterns.

Medical images often exhibit distribution shifts due to variations in imaging protocols and scanners across different medical centers. Domain Generalization (DG) methods aim to train models on source domains that can generalize to unseen target domains. Recently, the segment anything model (SAM) has demonstrated strong generalization capabilities due to its prompt-based design, and has gained significant attention in image segmentation tasks. Existing SAM-based approaches attempt to address the need for manual prompts by introducing prompt generators that automatically generate these prompts. However, we argue that auto-generated prompts may not be sufficiently accurate under distribution shifts, potentially leading to incorrect predictions that still require manual verification and correction by clinicians. To address this challenge, we propose a method for 2D medical image segmentation called Self-Correcting SAM (CoSAM). Our approach begins by generating coarse masks using SAM in a prompt-free manner, providing prior prompts for the subsequent stages, and eliminating the need for prompt generators. To automatically refine these coarse masks, we introduce a generalized error decoder that simulates the correction process typically performed by clinicians. Furthermore, we generate diverse prompts as feedback based on the corrected masks, which are used to iteratively refine the predictions within a self-correcting loop, enhancing the generalization performance of our model. Extensive experiments on two medical image segmentation benchmarks across multiple scenarios demonstrate the superiority of CoSAM over state-of-the-art SAM-based methods.

Large language models have the potential to be valuable in the healthcare industry, but it's crucial to verify their safety and effectiveness through rigorous evaluation. For this purpose, we comprehensively evaluated both open-source LLMs and Google's new multimodal LLM called Gemini across Medical reasoning, hallucination detection, and Medical Visual Question Answering tasks. While Gemini showed competence, it lagged behind state-of-the-art models like MedPaLM 2 and GPT-4 in diagnostic accuracy. Additionally, Gemini achieved an accuracy of 61.45\% on the medical VQA dataset, significantly lower than GPT-4V's score of 88\%. Our analysis revealed that Gemini is highly susceptible to hallucinations, overconfidence, and knowledge gaps, which indicate risks if deployed uncritically. We also performed a detailed analysis by medical subject and test type, providing actionable feedback for developers and clinicians. To mitigate risks, we applied prompting strategies that improved performance. Additionally, we facilitated future research and development by releasing a Python module for medical LLM evaluation and establishing a dedicated leaderboard on Hugging Face for medical domain LLMs. Python module can be found at https://github.com/promptslab/RosettaEval

Cryogenic Electron Tomography (CryoET) is a useful imaging technology in structural biology that is hindered by its need for manual annotations, especially in particle picking. Recent works have endeavored to remedy this issue with few-shot learning or contrastive learning techniques. However, supervised training is still inevitable for them. We instead choose to leverage the power of existing 2D foundation models and present a novel, training-free framework, CryoSAM. In addition to prompt-based single-particle instance segmentation, our approach can automatically search for similar features, facilitating full tomogram semantic segmentation with only one prompt. CryoSAM is composed of two major parts: 1) a prompt-based 3D segmentation system that uses prompts to complete single-particle instance segmentation recursively with Cross-Plane Self-Prompting, and 2) a Hierarchical Feature Matching mechanism that efficiently matches relevant features with extracted tomogram features. They collaborate to enable the segmentation of all particles of one category with just one particle-specific prompt. Our experiments show that CryoSAM outperforms existing works by a significant margin and requires even fewer annotations in particle picking. Further visualizations demonstrate its ability when dealing with full tomogram segmentation for various subcellular structures. Our code is available at: https://github.com/xulabs/aitom

Medical image classification in radiology faces significant challenges, particularly in generalizing to unseen pathologies. In contrast, CLIP offers a promising solution by leveraging multimodal learning to improve zero-shot classification performance. However, in the medical domain, lesions can be small and might not be well represented in the embedding space. Therefore, in this paper, we explore the potential of visual prompt engineering to enhance the capabilities of Vision Language Models (VLMs) in radiology. Leveraging BiomedCLIP, trained on extensive biomedical image-text pairs, we investigate the impact of embedding visual markers directly within radiological images to guide the model's attention to critical regions. Our evaluation on the JSRT dataset, focusing on lung nodule malignancy classification, demonstrates that incorporating visual prompts x2013 such as arrows, circles, and contours x2013 significantly improves classification metrics including AUROC, AUPRC, F1 score, and accuracy. Moreover, the study provides attention maps, showcasing enhanced model interpretability and focus on clinically relevant areas. These findings underscore the efficacy of visual prompt engineering as a straightforward yet powerful approach to advance VLM performance in medical image analysis.

We explore the potential of ChatGPT (3.5-turbo and 4) to generate conversations focused on self-care strategies for African-American heart failure patients -- a domain with limited specialized datasets. To simulate patient-health educator dialogues, we employed four prompting strategies: domain, African American Vernacular English (AAVE), Social Determinants of Health (SDOH), and SDOH-informed reasoning. Conversations were generated across key self-care domains of food, exercise, and fluid intake, with varying turn lengths (5, 10, 15) and incorporated patient-specific SDOH attributes such as age, gender, neighborhood, and socioeconomic status. Our findings show that effective prompt design is essential. While incorporating SDOH and reasoning improves dialogue quality, ChatGPT still lacks the empathy and engagement needed for meaningful healthcare communication.

Recent advancements in prompting techniques for Large Language Models (LLMs) have improved their reasoning, planning, and action abilities. This paper examines these prompting techniques through the lens of model predictive control (MPC). We show that LLMs act as implicit planning cost function minimizers when planning prompts are used. Under our framework we demonstrate that LLM planning performance can be improved further by incorporating real planning cost functions and evaluators.

Medical vision-language datasets are often limited in size and biased toward negative findings, as clinicians report abnormalities mostly but might omit some positive/neutral findings because they might be considered as irrelevant to the patient's condition. We propose a self-supervised data enrichment method that leverages semantic clustering of report sentences. Then we enrich the findings in the medical reports in the training set by adding positive/neutral observations from different clusters in a self-supervised manner. Our approach yields consistent gains in supervised fine-tuning (5.63%, 3.04%, 7.40%, 5.30%, 7.47% average gains on COMET score, Bert score, Sentence Bleu, CheXbert-F1 and RadGraph-F1 scores respectively). Ablation studies confirm that improvements stem from semantic clustering rather than random augmentation. Furthermore, we introduce a way to incorporate semantic cluster information into the reward design for GRPO training, which leads to further performance gains (2.78%, 3.14%, 12.80% average gains on COMET score, Bert score and Sentence Bleu scores respectively). We share our code at https://anonymous.4open.science/r/SemEnrich-75CF

Prompting is a mainstream paradigm for adapting large language models to specific natural language processing tasks without modifying internal parameters. Therefore, detailed supplementary knowledge needs to be integrated into external prompts, which inevitably brings extra human efforts and computational burdens for practical applications. As an effective solution to mitigate resource consumption, Efficient Prompting Methods have attracted a wide range of attention. We provide mathematical expressions at a high level to deeply discuss Automatic Prompt Engineering for different prompt components and Prompt Compression in continuous and discrete spaces. Finally, we highlight promising future directions to inspire researchers interested in this field.

Accurate prediction of major adverse cardiac events (MACE) remains a central challenge in cardiovascular prognosis. We present PRISM (Prompt-guided Representation Integration for Survival Modeling), a self-supervised framework that integrates visual representations from non-contrast cardiac cine magnetic resonance imaging with structured electronic health records (EHRs) for survival analysis. PRISM extracts temporally synchronized imaging features through motion-aware multi-view distillation and modulates them using medically informed textual prompts to enable fine-grained risk prediction. Across four independent clinical cohorts, PRISM consistently surpasses classical survival prediction models and state-of-the-art (SOTA) deep learning baselines under internal and external validation. Further clinical findings demonstrate that the combined imaging and EHR representations derived from PRISM provide valuable insights into cardiac risk across diverse cohorts. Three distinct imaging signatures associated with elevated MACE risk are uncovered, including lateral wall dyssynchrony, inferior wall hypersensitivity, and anterior elevated focus during diastole. Prompt-guided attribution further identifies hypertension, diabetes, and smoking as dominant contributors among clinical and physiological EHR factors.

This study investigates GPT-4's assessment of its performance in healthcare applications. A simple prompting technique was used to prompt the LLM with questions taken from the United States Medical Licensing Examination (USMLE) questionnaire and it was tasked to evaluate its confidence score before posing the question and after asking the question. The questionnaire was categorized into two groups-questions with feedback (WF) and questions with no feedback(NF) post-question. The model was asked to provide absolute and relative confidence scores before and after each question. The experimental findings were analyzed using statistical tools to study the variability of confidence in WF and NF groups. Additionally, a sequential analysis was conducted to observe the performance variation for the WF and NF groups. Results indicate that feedback influences relative confidence but doesn't consistently increase or decrease it. Understanding the performance of LLM is paramount in exploring its utility in sensitive areas like healthcare. This study contributes to the ongoing discourse on the reliability of AI, particularly of LLMs like GPT-4, within healthcare, offering insights into how feedback mechanisms might be optimized to enhance AI-assisted medical education and decision support.

Access to real-world medical data is often restricted due to privacy regulations, posing a significant barrier to the advancement of healthcare research. Synthetic data offers a promising alternative; however, generating realistic, clinically valid, and privacy-conscious records remains a major challenge. Recent advancements in Large Language Models (LLMs) offer new opportunities for structured data generation; however, existing approaches frequently lack systematic prompting strategies and comprehensive, multi-dimensional evaluation frameworks. In this paper, we present SynLLM, a modular framework for generating high-quality synthetic medical tabular data using 20 state-of-the-art open-source LLMs, including LLaMA, Mistral, and GPT variants, guided by structured prompts. We propose four distinct prompt types, ranging from example-driven to rule-based constraints, that encode schema, metadata, and domain knowledge to control generation without model fine-tuning. Our framework features a comprehensive evaluation pipeline that rigorously assesses generated data across statistical fidelity, clinical consistency, and privacy preservation. We evaluate SynLLM across three public medical datasets, including Diabetes, Cirrhosis, and Stroke, using 20 open-source LLMs. Our results show that prompt engineering significantly impacts data quality and privacy risk, with rule-based prompts achieving the best privacy-quality balance. SynLLM establishes that, when guided by well-designed prompts and evaluated with robust, multi-metric criteria, LLMs can generate synthetic medical data that is both clinically plausible and privacy-aware, paving the way for safer and more effective data sharing in healthcare research.

Diffusion models equipped with language models demonstrate excellent controllability in image generation tasks, allowing image processing to adhere to human instructions. However, the lack of diverse instruction-following data hampers the development of models that effectively recognize and execute user-customized instructions, particularly in low-level tasks. Moreover, the stochastic nature of the diffusion process leads to deficiencies in image generation or editing tasks that require the detailed preservation of the generated images. To address these limitations, we propose PromptFix, a comprehensive framework that enables diffusion models to follow human instructions to perform a wide variety of image-processing tasks. First, we construct a large-scale instruction-following dataset that covers comprehensive image-processing tasks, including low-level tasks, image editing, and object creation. Next, we propose a high-frequency guidance sampling method to explicitly control the denoising process and preserve high-frequency details in unprocessed areas. Finally, we design an auxiliary prompting adapter, utilizing Vision-Language Models (VLMs) to enhance text prompts and improve the model's task generalization. Experimental results show that PromptFix outperforms previous methods in various image-processing tasks. Our proposed model also achieves comparable inference efficiency with these baseline models and exhibits superior zero-shot capabilities in blind restoration and combination tasks. The dataset and code are available at https://www.yongshengyu.com/PromptFix-Page.

Generalist foundation models such as GPT-4 have displayed surprising capabilities in a wide variety of domains and tasks. Yet, there is a prevalent assumption that they cannot match specialist capabilities of fine-tuned models. For example, most explorations to date on medical competency benchmarks have leveraged domain-specific training, as exemplified by efforts on BioGPT and Med-PaLM. We build on a prior study of GPT-4's capabilities on medical challenge benchmarks in the absence of special training. Rather than using simple prompting to highlight the model's out-of-the-box capabilities, we perform a systematic exploration of prompt engineering. We find that prompting innovation can unlock deeper specialist capabilities and show that GPT-4 easily tops prior leading results for medical benchmarks. The prompting methods we explore are general purpose, and make no specific use of domain expertise, removing the need for expert-curated content. Our experimental design carefully controls for overfitting during the prompt engineering process. We introduce Medprompt, based on a composition of several prompting strategies. With Medprompt, GPT-4 achieves state-of-the-art results on all nine of the benchmark datasets in the MultiMedQA suite. The method outperforms leading specialist models such as Med-PaLM 2 by a significant margin with an order of magnitude fewer calls to the model. Steering GPT-4 with Medprompt achieves a 27% reduction in error rate on the MedQA dataset over the best methods to date achieved with specialist models and surpasses a score of 90% for the first time. Beyond medical problems, we show the power of Medprompt to generalize to other domains and provide evidence for the broad applicability of the approach via studies of the strategy on exams in electrical engineering, machine learning, philosophy, accounting, law, nursing, and clinical psychology.

This paper presents null-shot prompting. Null-shot prompting exploits hallucination in large language models (LLMs) by instructing LLMs to utilize information from the "Examples" section that never exists within the provided context to perform a task. While reducing hallucination is crucial and non-negligible for daily and critical uses of LLMs, we propose that in the current landscape in which these LLMs still hallucinate, it is possible, in fact, to exploit hallucination to increase performance in performing tasks compared to standard zero-shot prompting. Experiments with six LLMs show improvements in performance across the majority of eight datasets, including reading comprehension, arithmetic reasoning, and closed-book question answering. The observed inconsistency in increased relative performance across LLMs also potentially indicates a different degree of inherent hallucination in each model. These differences show that it is possible to utilize null-shot prompting as a way to detect degrees of hallucination in LLMs using existing benchmarking datasets. We also perform ablation studies, including experimenting with a modified version of null-shot prompting that incorporates ideas from zero-shot chain-of-thought prompting, which shows different trends of results.

In this study, we evaluate the performance of the Segment Anything Model (SAM) in clinical radiotherapy. Our results indicate that SAM's 'segment anything' mode can achieve clinically acceptable segmentation results in most organs-at-risk (OARs) with Dice scores higher than 0.7. SAM's 'box prompt' mode further improves the Dice scores by 0.1 to 0.5. Considering the size of the organ and the clarity of its boundary, SAM displays better performance for large organs with clear boundaries but performs worse for smaller organs with unclear boundaries. Given that SAM, a model pre-trained purely on natural images, can handle the delineation of OARs from medical images with clinically acceptable accuracy, these results highlight SAM's robust generalization capabilities with consistent accuracy in automatic segmentation for radiotherapy. In other words, SAM can achieve delineation of different OARs at different sites using a generic automatic segmentation model. SAM's generalization capabilities across different disease sites suggest that it is technically feasible to develop a generic model for automatic segmentation in radiotherapy.

Leveraging pre-trained models with tailored prompts for in-context learning has proven highly effective in NLP tasks. Building on this success, recent studies have applied a similar approach to the Segment Anything Model (SAM) within a ``one-shot" framework, where only a single reference image and its label are employed. However, these methods face limitations in the medical domain, primarily due to SAM's essential requirement for visual prompts and the over-reliance on pixel similarity for generating them. This dependency may lead to (1) inaccurate prompt generation and (2) clustering of point prompts, resulting in suboptimal outcomes. To address these challenges, we introduce Med-PerSAM, a novel and straightforward one-shot framework designed for the medical domain. Med-PerSAM uses only visual prompt engineering and eliminates the need for additional training of the pretrained SAM or human intervention, owing to our novel automated prompt generation process. By integrating our lightweight warping-based prompt tuning model with SAM, we enable the extraction and iterative refinement of visual prompts, enhancing the performance of the pre-trained SAM. This advancement is particularly meaningful in the medical domain, where creating visual prompts poses notable challenges for individuals lacking medical expertise. Our model outperforms various foundational models and previous SAM-based approaches across diverse 2D medical imaging datasets.

Accurate segmentation is essential for echocardiography-based assessment of cardiovascular diseases (CVDs). However, the variability among sonographers and the inherent challenges of ultrasound images hinder precise segmentation. By leveraging the joint representation of image and text modalities, Vision-Language Segmentation Models (VLSMs) can incorporate rich contextual information, potentially aiding in accurate and explainable segmentation. However, the lack of readily available data in echocardiography hampers the training of VLSMs. In this study, we explore using synthetic datasets from Semantic Diffusion Models (SDMs) to enhance VLSMs for echocardiography segmentation. We evaluate results for two popular VLSMs (CLIPSeg and CRIS) using seven different kinds of language prompts derived from several attributes, automatically extracted from echocardiography images, segmentation masks, and their metadata. Our results show improved metrics and faster convergence when pretraining VLSMs on SDM-generated synthetic images before finetuning on real images. The code, configs, and prompts are available at https://github.com/naamiinepal/synthetic-boost.

Large language models (LLMs) are increasingly used in clinical and care settings. This exploratory study investigates whether LLMs exhibit sycophantic behavior - adapting their responses to social expectation signals rather than maintaining professional quality - in the context of dementia care. Five prompts with systematically increasing confirmatory and authority-related framing (P1 neutral to P5 authority-signaled implementation support) were submitted to four LLMs (GPT-5, Claude Sonnet 4.6, Gemini 3.1 Pro, Mistral Large), each repeated five times (N = 100 responses). Responses were evaluated using an LLM-as-a-Judge methodology against seven nursing-ethical quality criteria (K1-K7) and a tone scale (0-3). All models showed significant negative Spearman correlations between prompt level and response quality (rho ranging from -0.543 to -0.734, all p < 0.01). Mistral Large exhibited the most pronounced effect (rho = -0.734), with mean scores dropping from 6.0/7 at P1 to 0.2/7 at P5. The findings suggest that LLMs pose context-sensitive risks in high-stakes care environments and that prompt framing significantly shapes response quality - a dimension that has received insufficient attention in healthcare AI deployment.

We introduce Medal S, a medical segmentation foundation model that supports native-resolution spatial and textual prompts within an end-to-end trainable framework. Unlike text-only methods lacking spatial awareness, Medal S achieves channel-wise alignment between volumetric prompts and text embeddings, mitigating inaccuracies from resolution mismatches. By preserving full 3D context, it efficiently processes multiple native-resolution masks in parallel, enhancing multi-class segmentation performance. A lightweight 3D convolutional module enables precise voxel-space refinement guided by both prompt types, supporting up to 243 classes across CT, MRI, PET, ultrasound, and microscopy modalities in the BiomedSegFM dataset. Medal S offers two prompting modes: a text-only mode, where model predictions serve as spatial prompts for self-refinement without human input, and a hybrid mode, incorporating manual annotations for enhanced flexibility. For 24-class segmentation, parallel spatial prompting reduces inference time by more than 90% compared to sequential prompting. We propose dynamic resampling to address target-patch ratio imbalance, extending SAT and nnU-Net for data augmentation. Furthermore, we develop optimized text preprocessing, a two-stage inference strategy, and post-processing techniques to improve memory efficiency, precision, and inference speed. On the five-modality average on the validation set, Medal S outperforms SAT with a DSC of 75.44 (vs. 69.83), NSD of 77.34 (vs. 71.06), F1 of 38.24 (vs. 24.88), and DSC TP of 65.46 (vs. 46.97). Medal S achieves excellent performance by harmonizing spatial precision with semantic textual guidance, demonstrating superior efficiency and accuracy in multi-class medical segmentation tasks compared to sequential prompt-based approaches. Medal S will be publicly available at https://github.com/yinghemedical/Medal-S.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare ten public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting and supervised fine-tuning regimes for medical question-answering (QA). For instance, across all tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 22.7% of cases, reach a (statistical) tie in 36.8% of cases, and are significantly worse than their base models in the remaining 40.5% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately in zero-/few-shot prompting; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Meanwhile, we find that after fine-tuning on specific QA tasks, medical LLMs can show performance improvements, but the benefits do not carry over to tasks based on clinical notes. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

This work introduces a new framework, ProtoSAM, for one-shot medical image segmentation. It combines the use of prototypical networks, known for few-shot segmentation, with SAM - a natural image foundation model. The method proposed creates an initial coarse segmentation mask using the ALPnet prototypical network, augmented with a DINOv2 encoder. Following the extraction of an initial mask, prompts are extracted, such as points and bounding boxes, which are then input into the Segment Anything Model (SAM). State-of-the-art results are shown on several medical image datasets and demonstrate automated segmentation capabilities using a single image example (one shot) with no need for fine-tuning of the foundation model. Our code is available at: https://github.com/levayz/ProtoSAM

Purpose: Surgical video is an important data stream for gesture recognition. Thus, robust visual encoders for those data-streams is similarly important. Methods: Leveraging the Bridge-Prompt framework, we fine-tune a pre-trained vision-text model (CLIP) for gesture recognition in surgical videos. This can utilize extensive outside video data such as text, but also make use of label meta-data and weakly supervised contrastive losses. Results: Our experiments show that prompt-based video encoder outperforms standard encoders in surgical gesture recognition tasks. Notably, it displays strong performance in zero-shot scenarios, where gestures/tasks that were not provided during the encoder training phase are included in the prediction phase. Additionally, we measure the benefit of inclusion text descriptions in the feature extractor training schema. Conclusion: Bridge-Prompt and similar pre-trained+fine-tuned video encoder models present significant visual representation for surgical robotics, especially in gesture recognition tasks. Given the diverse range of surgical tasks (gestures), the ability of these models to zero-shot transfer without the need for any task (gesture) specific retraining makes them invaluable.

Prompt engineering is a technique that involves augmenting a large pre-trained model with task-specific hints, known as prompts, to adapt the model to new tasks. Prompts can be created manually as natural language instructions or generated automatically as either natural language instructions or vector representations. Prompt engineering enables the ability to perform predictions based solely on prompts without updating model parameters, and the easier application of large pre-trained models in real-world tasks. In past years, Prompt engineering has been well-studied in natural language processing. Recently, it has also been intensively studied in vision-language modeling. However, there is currently a lack of a systematic overview of prompt engineering on pre-trained vision-language models. This paper aims to provide a comprehensive survey of cutting-edge research in prompt engineering on three types of vision-language models: multimodal-to-text generation models (e.g. Flamingo), image-text matching models (e.g. CLIP), and text-to-image generation models (e.g. Stable Diffusion). For each type of model, a brief model summary, prompting methods, prompting-based applications, and the corresponding responsibility and integrity issues are summarized and discussed. Furthermore, the commonalities and differences between prompting on vision-language models, language models, and vision models are also discussed. The challenges, future directions, and research opportunities are summarized to foster future research on this topic.

Prompt engineering is critical for the development of LLM-based applications. However, it is usually done manually in a "trial and error" fashion. This manual procedure can be time consuming, ineffective, and the generated prompts are, in a lot of cases, sub-optimal. Even for the prompts which seemingly work well, there is always a lingering question: can the prompts be made better with further modifications? To address these questions, in this paper, we investigate prompt engineering automation. We consider a specific use case scenario in which developers/users have drafted initial prompts, but lack the time/expertise to optimize them. We propose PRewrite, an automated tool to rewrite these drafts and to generate highly effective new prompts. PRewrite is based on the Reinforcement Learning (RL) framework which allows for end-to-end optimization and our design allows the RL search to happen in a large action space. The automated tool leverages manually crafted prompts as starting points which makes the rewriting procedure more guided and efficient. The generated prompts are human readable, and self-explanatory, unlike some of those in previous works. We conducted extensive experiments on diverse datasets and found that the prompts generated with this new method not only outperform professionally crafted prompts, but also prompts generated with other previously proposed methods.

We propose a diffusion-based framework for prompt optimization that leverages Diffusion Language Models (DLMs) to iteratively refine system prompts through masked denoising. By conditioning on interaction traces, including user queries, model responses, and optional feedback, our method enables flexible, span-level prompt updates without requiring gradient access or modifying the downstream language model. Across diverse benchmarks (e.g., τ-bench, SST-2, SST-5), DLM-optimized prompts consistently improve the performance of a frozen target LLM (e.g., GPT-4o-mini). We further show that moderate diffusion step counts provide the best balance between refinement quality and stability. These results highlight diffusion-based prompt optimization as a general, model-agnostic, and scalable approach for enhancing LLM performance through iterative prompt refinement.

Adaptive prompting mechanisms have been proposed to enhance vision-language models by dynamically tailoring prompts to inputs. However, in frozen few-shot prompt learning with CLIP-style backbones, we systematically observe that adaptive gates and prompt-selection modules often collapse: they produce nearly constant outputs, contribute negligible gradient signals, and frequently fail to outperform fixed prompts. To further explore this issue, we present a systematic diagnostic study to uncover the underlying causes and conditions of adaptation failure. Through controlled experiments across datasets and multiple prompt learning architectures, we identify two recurring failure modes: gradient magnitude imbalance and gate degradation. Our findings invite a re-examination of indiscriminately adding architectural complexity in parameter-efficient learning and clarify when prompt-level adaptive gating is, and is not, effective in this regime.

This paper delves into the pivotal role of prompt engineering in unleashing the capabilities of Large Language Models (LLMs). Prompt engineering is the process of structuring input text for LLMs and is a technique integral to optimizing the efficacy of LLMs. This survey elucidates foundational principles of prompt engineering, such as role-prompting, one-shot, and few-shot prompting, as well as more advanced methodologies such as the chain-of-thought and tree-of-thoughts prompting. The paper sheds light on how external assistance in the form of plugins can assist in this task, and reduce machine hallucination by retrieving external knowledge. We subsequently delineate prospective directions in prompt engineering research, emphasizing the need for a deeper understanding of structures and the role of agents in Artificial Intelligence-Generated Content (AIGC) tools. We discuss how to assess the efficacy of prompt methods from different perspectives and using different methods. Finally, we gather information about the application of prompt engineering in such fields as education and programming, showing its transformative potential. This comprehensive survey aims to serve as a friendly guide for anyone venturing through the big world of LLMs and prompt engineering.

Prompt engineering has emerged as an indispensable technique for extending the capabilities of large language models (LLMs) and vision-language models (VLMs). This approach leverages task-specific instructions, known as prompts, to enhance model efficacy without modifying the core model parameters. Rather than updating the model parameters, prompts allow seamless integration of pre-trained models into downstream tasks by eliciting desired model behaviors solely based on the given prompt. Prompts can be natural language instructions that provide context to guide the model or learned vector representations that activate relevant knowledge. This burgeoning field has enabled success across various applications, from question-answering to commonsense reasoning. However, there remains a lack of systematic organization and understanding of the diverse prompt engineering methods and techniques. This survey paper addresses the gap by providing a structured overview of recent advancements in prompt engineering, categorized by application area. For each prompting approach, we provide a summary detailing the prompting methodology, its applications, the models involved, and the datasets utilized. We also delve into the strengths and limitations of each approach and include a taxonomy diagram and table summarizing datasets, models, and critical points of each prompting technique. This systematic analysis enables a better understanding of this rapidly developing field and facilitates future research by illuminating open challenges and opportunities for prompt engineering.

Cell instance segmentation models trained on cell-specific datasets suffer severe performance drops on out-of-distribution cell types, while interactive foundation models overcome this through per-instance prompting at a cost that is prohibitively expensive for histopathology images containing hundreds to thousands of densely packed instances. We introduce Group Prompting, a new paradigm that shifts interactive segmentation from per-instance O(N) to per-type O(T), where a single click per cell type suffices to segment all instances of that type. Our key observation is that the frozen image encoder of the Segment Anything Model (SAM) already clusters same-type cells in its feature space before any prompt is given. Exploiting this property, we propose Chain-of-Prompts (CoP), a training-free framework that recursively expands a single user click by (1) identifying reliable same-type locations through non-parametric gating of multi-scale encoder features, and (2) selecting the most spatially distant reliable point as the next prompt to maximize coverage. On three cell-type-annotated benchmarks, CoP with one click per type retains over 90% of per-instance performance and surpasses fully-supervised methods without any additional training. On four morphologically homogeneous benchmarks, a single click retains over 99%. Project Page: https://shjo-april.github.io/Chain-of-Prompts/

Image segmentation is usually addressed by training a model for a fixed set of object classes. Incorporating additional classes or more complex queries later is expensive as it requires re-training the model on a dataset that encompasses these expressions. Here we propose a system that can generate image segmentations based on arbitrary prompts at test time. A prompt can be either a text or an image. This approach enables us to create a unified model (trained once) for three common segmentation tasks, which come with distinct challenges: referring expression segmentation, zero-shot segmentation and one-shot segmentation. We build upon the CLIP model as a backbone which we extend with a transformer-based decoder that enables dense prediction. After training on an extended version of the PhraseCut dataset, our system generates a binary segmentation map for an image based on a free-text prompt or on an additional image expressing the query. We analyze different variants of the latter image-based prompts in detail. This novel hybrid input allows for dynamic adaptation not only to the three segmentation tasks mentioned above, but to any binary segmentation task where a text or image query can be formulated. Finally, we find our system to adapt well to generalized queries involving affordances or properties. Code is available at https://eckerlab.org/code/clipseg.

With the proposal of the Segment Anything Model (SAM), fine-tuning SAM for medical image segmentation (MIS) has become popular. However, due to the large size of the SAM model and the significant domain gap between natural and medical images, fine-tuning-based strategies are costly with potential risk of instability, feature damage and catastrophic forgetting. Furthermore, some methods of transferring SAM to a domain-specific MIS through fine-tuning strategies disable the model's prompting capability, severely limiting its utilization scenarios. In this paper, we propose an Auto-Prompting Module (APM), which provides SAM-based foundation model with Euclidean adaptive prompts in the target domain. Our experiments demonstrate that such adaptive prompts significantly improve SAM's non-fine-tuned performance in MIS. In addition, we propose a novel non-invasive method called Incremental Pattern Shifting (IPS) to adapt SAM to specific medical domains. Experimental results show that the IPS enables SAM to achieve state-of-the-art or competitive performance in MIS without the need for fine-tuning. By coupling these two methods, we propose ProMISe, an end-to-end non-fine-tuned framework for Promptable Medical Image Segmentation. Our experiments demonstrate that both using our methods individually or in combination achieves satisfactory performance in low-cost pattern shifting, with all of SAM's parameters frozen.

Artificial Intelligence (AI) advancement is heavily dependent on access to large-scale, high-quality training data. However, in specialized domains such as healthcare, data acquisition faces significant constraints due to privacy regulations, ethical considerations, and limited availability. While synthetic data generation offers a promising solution, conventional approaches typically require substantial real data for training generative models. The emergence of large-scale prompt-based models presents new opportunities for synthetic data generation without direct access to protected data. However, crafting effective prompts for domain-specific data generation remains challenging, and manual prompt engineering proves insufficient for achieving output with sufficient precision and authenticity. We review recent developments in automatic prompt optimization, following PRISMA guidelines. We analyze six peer-reviewed studies published between 2020 and 2024 that focus on automatic data-free prompt optimization methods. Our analysis reveals three approaches: feedback-driven, error-based, and control-theoretic. Although all approaches demonstrate promising capabilities in prompt refinement and adaptation, our findings suggest the need for an integrated framework that combines complementary optimization techniques to enhance synthetic data generation while minimizing manual intervention. We propose future research directions toward developing robust, iterative prompt optimization frameworks capable of improving the quality of synthetic data. This advancement can be particularly crucial for sensitive fields and in specialized domains where data access is restricted, potentially transforming how we approach synthetic data generation for AI development.

Despite impressive recent advances in text-to-image diffusion models, obtaining high-quality images often requires prompt engineering by humans who have developed expertise in using them. In this work, we present NeuroPrompts, an adaptive framework that automatically enhances a user's prompt to improve the quality of generations produced by text-to-image models. Our framework utilizes constrained text decoding with a pre-trained language model that has been adapted to generate prompts similar to those produced by human prompt engineers. This approach enables higher-quality text-to-image generations and provides user control over stylistic features via constraint set specification. We demonstrate the utility of our framework by creating an interactive application for prompt enhancement and image generation using Stable Diffusion. Additionally, we conduct experiments utilizing a large dataset of human-engineered prompts for text-to-image generation and show that our approach automatically produces enhanced prompts that result in superior image quality. We make our code, a screencast video demo and a live demo instance of NeuroPrompts publicly available.

Large language models (LLMs) have become increasingly capable of following instructions and complex reasoning, making prompting a flexible interface for adapting models without parameter updates. Yet prompt design remains labor-intensive and highly sensitive to formatting, phrasing, and instruction order, motivating automated prompt optimization methods that reduce manual effort while preserving inference-time flexibility. However, existing methods often search over prompt candidates or use fixed critique-refine pipelines driven by individual examples or small batches, limiting their ability to capture systematic error patterns and make targeted edits grounded in failure history. We propose Reflective Prompt Tuning (RPT), a framework that uses LLM function calling to simulate the iterative workflow of human prompt engineers. An LLM optimizer calls a diagnostic function that evaluates the target model over an entire optimization set, summarizes recurring failure modes, and returns a structured diagnostic report. The optimizer uses this report, together with an accumulated memory of prior reports, to revise the prompt for the next iteration. RPT further supports confidence-aware optimization by using calibration signals in diagnostic feedback and final prompt selection. Across three reasoning tasks, RPT improves over initial prompts by up to 12.9 points, remains competitive with state of the art, and improves confidence calibration. Our analyses show that RPT is especially effective on multi-hop and mathematical reasoning, producing targeted prompt revisions that align with diagnosed failure patterns and lead to gains in task performance and calibration.

Large language models primarily rely on incontext learning to execute tasks. We introduce EchoPrompt, a simple yet effective approach to prompt the model to rephrase its queries before answering them. EchoPrompt is inspired by self-questioning, a cognitive strategy humans use to vocalize queries before providing answers, thereby reducing misconceptions. Experimental results demonstrate that EchoPrompt leads to substantial improvements in both zero-shot and few-shot in-context learning with standard and chain-of-thought prompting on four families of causal language models. These improvements are observed across various numerical reasoning (GSM8K, SVAMP, MultiArith, SingleOp), reading comprehension (DROP, SQuAD), and logical reasoning (Shuffled Objects, Date Understanding, Coin Flipping) tasks. On average, EchoPrompt improves the Zero-shot-CoT performance of code-davinci-002 by 5% in numerical tasks and 13% in reading comprehension tasks. We investigate the effectiveness of EchoPrompt through ablation studies, which reveal the significance of both original and rephrased queries for EchoPrompt's efficacy. Our empirical results show that EchoPrompt is an effective technique that can easily augment in-context learning for better performance.

Medical image segmentation has immense clinical applicability but remains a challenge despite advancements in deep learning. The Segment Anything Model (SAM) exhibits potential in this field, yet the requirement for expertise intervention and the domain gap between natural and medical images poses significant obstacles. This paper introduces a novel training-free evidential prompt generation method named EviPrompt to overcome these issues. The proposed method, built on the inherent similarities within medical images, requires only a single reference image-annotation pair, making it a training-free solution that significantly reduces the need for extensive labeling and computational resources. First, to automatically generate prompts for SAM in medical images, we introduce an evidential method based on uncertainty estimation without the interaction of clinical experts. Then, we incorporate the human prior into the prompts, which is vital for alleviating the domain gap between natural and medical images and enhancing the applicability and usefulness of SAM in medical scenarios. EviPrompt represents an efficient and robust approach to medical image segmentation, with evaluations across a broad range of tasks and modalities confirming its efficacy.

Medical image segmentation is evolving from task-specific models toward generalizable frameworks. Recent research leverages Multi-modal Large Language Models (MLLMs) as autonomous agents, employing reinforcement learning with verifiable reward (RLVR) to orchestrate specialized tools like the Segment Anything Model (SAM). However, these approaches often rely on single-turn, rigid interaction strategies and lack process-level supervision during training, which hinders their ability to fully exploit the dynamic potential of interactive tools and leads to redundant actions. To bridge this gap, we propose MedSAM-Agent, a framework that reformulates interactive segmentation as a multi-step autonomous decision-making process. First, we introduce a hybrid prompting strategy for expert-curated trajectory generation, enabling the model to internalize human-like decision heuristics and adaptive refinement strategies. Furthermore, we develop a two-stage training pipeline that integrates multi-turn, end-to-end outcome verification with a clinical-fidelity process reward design to promote interaction parsimony and decision efficiency. Extensive experiments across 6 medical modalities and 21 datasets demonstrate that MedSAM-Agent achieves state-of-the-art performance, effectively unifying autonomous medical reasoning with robust, iterative optimization. Code is available https://github.com/CUHK-AIM-Group/MedSAM-Agent{here}.

Promptable segmentation typically requires instance-specific manual prompts to guide the segmentation of each desired object. To minimize such a need, task-generic promptable segmentation has been introduced, which employs a single task-generic prompt to segment various images of different objects in the same task. Current methods use Multimodal Large Language Models (MLLMs) to reason detailed instance-specific prompts from a task-generic prompt for improving segmentation accuracy. The effectiveness of this segmentation heavily depends on the precision of these derived prompts. However, MLLMs often suffer hallucinations during reasoning, resulting in inaccurate prompting. While existing methods focus on eliminating hallucinations to improve a model, we argue that MLLM hallucinations can reveal valuable contextual insights when leveraged correctly, as they represent pre-trained large-scale knowledge beyond individual images. In this paper, we utilize hallucinations to mine task-related information from images and verify its accuracy for enhancing precision of the generated prompts. Specifically, we introduce an iterative Prompt-Mask Cycle generation framework (ProMaC) with a prompt generator and a mask generator.The prompt generator uses a multi-scale chain of thought prompting, initially exploring hallucinations for extracting extended contextual knowledge on a test image.These hallucinations are then reduced to formulate precise instance-specific prompts, directing the mask generator to produce masks that are consistent with task semantics by mask semantic alignment. The generated masks iteratively induce the prompt generator to focus more on task-relevant image areas and reduce irrelevant hallucinations, resulting jointly in better prompts and masks. Experiments on 5 benchmarks demonstrate the effectiveness of ProMaC. Code given in https://lwpyh.github.io/ProMaC/.

Precision medicine, such as patient-adaptive treatments assisted by medical image analysis, poses new challenges for segmentation algorithms in adapting to new patients, due to the large variability across different patients and the limited availability of annotated data for each patient. In this work, we propose a data-efficient segmentation algorithm, namely Part-aware Prompted Segment Anything Model (P^2SAM). Without any model fine-tuning, P^2SAM enables seamless adaptation to any new patients relying only on one-shot patient-specific data. We introduce a novel part-aware prompt mechanism to select multiple-point prompts based on the part-level features of the one-shot data, which can be extensively integrated into different promptable segmentation models, such as SAM and SAM 2. Moreover, to determine the optimal number of parts for each specific case, we propose a distribution-guided retrieval approach that further enhances the robustness of the part-aware prompt mechanism. P^2SAM improves the performance by +8.0% and +2.0% mean Dice score for two different patient-adaptive segmentation applications, respectively. In addition, P^2SAM also exhibits impressive generalizability in other adaptive segmentation tasks in the natural image domain, e.g., +6.4% mIoU within personalized object segmentation task. The code is available at: https://github.com/Zch0414/p2sam

Prompt engineering is very important to enhance the performance of large language models (LLMs). When dealing with complex issues, prompt engineers tend to distill multiple patterns from examples and inject relevant solutions to optimize the prompts, achieving satisfying results. However, existing automatic prompt optimization techniques are only limited to producing single flow instructions, struggling with handling diverse patterns. In this paper, we present AMPO, an automatic prompt optimization method that can iteratively develop a multi-branched prompt using failure cases as feedback. Our goal is to explore a novel way of structuring prompts with multi-branches to better handle multiple patterns in complex tasks, for which we introduce three modules: Pattern Recognition, Branch Adjustment, and Branch Pruning. In experiments across five tasks, AMPO consistently achieves the best results. Additionally, our approach demonstrates significant optimization efficiency due to our adoption of a minimal search strategy.