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A Three-Tier Operational Benchmark for Evaluating Large Language Models on Hospital Medication Safety

Objective. To introduce PsiBench, a clinically validated medication-safety benchmark for evaluating large language models (LLMs) against the standards used to certify hospital computerized provider order entry (CPOE) and electronic health record (EHR) systems, and a non-overlapping three-tier evaluation framework separating highest-stakes discrimination, the operational CDS regime, and category-correct alerting. Materials and Methods. PsiBench comprises 492 medication-safety scenarios across 11 safety categories, created by clinical pharmacology experts whose work underpins an annualized testing procedure used by more than 2,000 U.S. hospitals. The three-tier framework partitions the scenarios non-overlappingly: Discrimination (98 scenarios, 50 fatal vs 48 deception, near-balanced 51%/49%); Operational (394 scenarios, 261 serious unsafe plus 133 safe including 41 Excessive Alerts reclassified as operational negatives); and Attribution (311 alert-required scenarios). We evaluated 40 frontier LLMs from 10 providers over 3 runs per scenario at temperature 0.2 (or the provider default where temperature is not configurable), yielding 59,040 evaluations conducted April 21-23, 2026. Results. Headline binary performance on the full benchmark spans a wide range across the 40 models: F1 78.5%-92.3%, accuracy 65.4%-89.8%, sensitivity 81.4%-100.0%, specificity 6.1%-81.8%. Leading models by F1 (o4-mini 92.3%; o3 92.2%) pair high sensitivity with meaningful specificity; three models saturate sensitivity at 100% but fall below 25% specificity, indistinguishable from a naive always-alert classifier. The wide spread on a single headline metric motivates tier-specific analyses, developed in a separate clinical paper. Discussion and Conclusion. PsiBench and the three-tier framework operationalize a rigorous evaluation rubric for LLM medication safety, grounded in two decades of national hospital audit experience. The framework generalizes to any binary medication-safety classifier (rule-based, conventional ML, or LLM-driven), supporting tier-aware model selection and post-deployment surveillance.

Ranking-optimized survival models can underperform fixed-horizon clinical prediction: a SUPPORT2 reanalysis of machine learning, attending-physician judgment, and the original SUPPORT model at 60- and 180-day mortality

Machine-learning survival models are increasingly proposed for intensive-care mortality prediction and are almost always selected and reported using the concordance index, a ranking metric averaged over follow-up. Yet most bedside decisions hinge on a probability at a specific time, such as 60- or 180-day mortality. We asked whether ranking-optimized models remain competitive at fixed clinical horizons against two reference points clinicians actually rely on: unaided attending-physician judgment and the original 1995 SUPPORT logistic model. Reanalyzing the SUPPORT2 cohort (9,105 critically ill adults from five United States centers, 1989-1994) under a stratified 70/15/15 split, we compared a gradient-boosted survival model, the physician's recorded prognosis, and the 1995 model at 60 and 180 days, alongside several alternative learners. The survival model achieved competitive ranking concordance (0.705) yet underperformed both comparators at fixed horizons: at 60 days its area under the ROC curve was 0.750, against 0.808 for physicians on the matched sample and 0.827 for the 1995 model, a gap that held across eight independent data splits and remained statistically reliable after multiplicity correction. The shortfall was not miscalibration, since post-hoc recalibration left discrimination unchanged, nor limited capacity, since neural networks, a deep ranking model, and two timepoint-aware discrete-time models also failed to close it; replacing the ranking objective with timepoint-matched binary training recovered roughly half the gap, pointing to an objective-horizon mismatch. Discrimination was equitable across sex, race, and age, but leave-one-disease-out validation exposed severe failure for disease groups absent from training, and the physician advantage was conditional on a physician electing to provide an estimate. We recommend reporting timepoint-specific discrimination alongside concordance, timepoint-matched training when fixed-horizon predictions drive care, leave-one-subgroup validation, and distribution-free prediction intervals to support selective deployment.

Mask Proposal Voting Based on Geodesic Framework for Robust Image Segmentation

Despite great advances, finding accurate segmentation remains a challenging task, especially in scenarios with cluttered backgrounds, complex intensity variations and topology appearance. Minimal path models have exhibited their strong ability in addressing image segmentation tasks. However, the performance of minimal paths-based segmentation approaches is heavily influenced by model initialization, hence limiting their application scope in practice. In this work, we propose a novel mask proposal voting framework that overcomes the major drawback of classical approaches, allowing robust segmentation even in complicated scenarios. Firstly, we introduce an efficient method for constructing adaptive domain cuts as a constraint for initializing the region-based min-cut evolution, by which diverse and reliable mask proposal candidates can be generated, substantially increasing the possibility of accurately covering the objective region by these proposals. Secondly, we propose a new mask voting scheme to build a voting score map encoding the final segmentation information. In contrast to classical path voting methods, our model allows incorporating priors to assign different importance to each individual mask. As a consequence, the proposed segmentation model is capable of accurately delineating object boundaries under complex scenarios, and is insensitive to initialization. Experiments demonstrate that our method consistently outperforms state-of-the-art minimal path-based approaches in both accuracy and robustness.