Daily Papers

People experiencing severe distress increasingly use Large Language Model (LLM) chatbots as mental health support tools. Discussions on social media have described how engagements were lifesaving for some, but evidence suggests that general-purpose LLM chatbots also have notable risks that could endanger the welfare of users if not designed responsibly. In this study, we investigate the lived experiences of people who have used LLM chatbots for mental health support. We build on interviews with 21 individuals from globally diverse backgrounds to analyze how users create unique support roles for their chatbots, fill in gaps in everyday care, and navigate associated cultural limitations when seeking support from chatbots. We ground our analysis in psychotherapy literature around effective support, and introduce the concept of therapeutic alignment, or aligning AI with therapeutic values for mental health contexts. Our study offers recommendations for how designers can approach the ethical and effective use of LLM chatbots and other AI mental health support tools in mental health care.

The integration of Monte Carlo Tree Search (MCTS) with Large Language Models (LLMs) has demonstrated significant success in structured, problem-oriented tasks. However, applying these methods to open-ended dialogues, such as those in psychological counseling, presents unique challenges. Unlike tasks with objective correctness, success in therapeutic conversations depends on subjective factors like empathetic engagement, ethical adherence, and alignment with human preferences, for which strict "correctness" criteria are ill-defined. Existing result-oriented MCTS approaches can therefore produce misaligned responses. To address this, we introduce MCTSr-Zero, an MCTS framework designed for open-ended, human-centric dialogues. Its core innovation is "domain alignment", which shifts the MCTS search objective from predefined end-states towards conversational trajectories that conform to target domain principles (e.g., empathy in counseling). Furthermore, MCTSr-Zero incorporates "Regeneration" and "Meta-Prompt Adaptation" mechanisms to substantially broaden exploration by allowing the MCTS to consider fundamentally different initial dialogue strategies. We evaluate MCTSr-Zero in psychological counseling by generating multi-turn dialogue data, which is used to fine-tune an LLM, PsyLLM. We also introduce PsyEval, a benchmark for assessing multi-turn psychological counseling dialogues. Experiments demonstrate that PsyLLM achieves state-of-the-art performance on PsyEval and other relevant metrics, validating MCTSr-Zero's effectiveness in generating high-quality, principle-aligned conversational data for human-centric domains and addressing the LLM challenge of consistently adhering to complex psychological standards.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

AI alignment aims to make AI systems behave in line with human intentions and values. As AI systems grow more capable, so do risks from misalignment. To provide a comprehensive and up-to-date overview of the alignment field, in this survey, we delve into the core concepts, methodology, and practice of alignment. First, we identify four principles as the key objectives of AI alignment: Robustness, Interpretability, Controllability, and Ethicality (RICE). Guided by these four principles, we outline the landscape of current alignment research and decompose them into two key components: forward alignment and backward alignment. The former aims to make AI systems aligned via alignment training, while the latter aims to gain evidence about the systems' alignment and govern them appropriately to avoid exacerbating misalignment risks. On forward alignment, we discuss techniques for learning from feedback and learning under distribution shift. On backward alignment, we discuss assurance techniques and governance practices. We also release and continually update the website (www.alignmentsurvey.com) which features tutorials, collections of papers, blog posts, and other resources.

Big models, exemplified by Large Language Models (LLMs), are models typically pre-trained on massive data and comprised of enormous parameters, which not only obtain significantly improved performance across diverse tasks but also present emergent capabilities absent in smaller models. However, the growing intertwining of big models with everyday human lives poses potential risks and might cause serious social harm. Therefore, many efforts have been made to align LLMs with humans to make them better follow user instructions and satisfy human preferences. Nevertheless, `what to align with' has not been fully discussed, and inappropriate alignment goals might even backfire. In this paper, we conduct a comprehensive survey of different alignment goals in existing work and trace their evolution paths to help identify the most essential goal. Particularly, we investigate related works from two perspectives: the definition of alignment goals and alignment evaluation. Our analysis encompasses three distinct levels of alignment goals and reveals a goal transformation from fundamental abilities to value orientation, indicating the potential of intrinsic human values as the alignment goal for enhanced LLMs. Based on such results, we further discuss the challenges of achieving such intrinsic value alignment and provide a collection of available resources for future research on the alignment of big models.

Predicting cancer treatment outcomes requires models that are both accurate and interpretable, particularly in the presence of heterogeneous clinical data. While large language models (LLMs) have shown strong performance in biomedical NLP, they often lack structured reasoning capabilities critical for high-stakes decision support. We present a unified, multi-task learning framework that aligns autoregressive LLMs with clinical reasoning for outcome prediction on the MSK-CHORD dataset. Our models are trained to jointly perform binary survival classification, continuous survival time regression, and natural language rationale generation. We evaluate three alignment strategies: (1) standard supervised fine-tuning (SFT), (2) SFT with Chain-of-Thought (CoT) prompting to elicit step-by-step reasoning, and (3) Group Relative Policy Optimization (GRPO), a reinforcement learning method that aligns model outputs to expert-derived reasoning trajectories. Experiments with LLaMa3-8B and Med42-8B backbones demonstrate that CoT prompting improves F1 by +6.0 and reduces MAE by 12%, while GRPO achieves state-of-the-art interpretability and predictive performance across BLEU, ROUGE, and BERTScore. We further show that existing biomedical LLMs often fail to produce valid reasoning traces due to architectural constraints. Our findings underscore the importance of reasoning-aware alignment in multi-task clinical modeling and set a new benchmark for interpretable, trustworthy LLMs in precision oncology.

The integration of large language models (LLMs) into medical practice holds transformative potential, yet their real-world clinical utility remains limited by critical alignment challenges: (1) a disconnect between static evaluation benchmarks and dynamic clinical cognitive needs, (2) difficulties in adapting to evolving, multi-source medical standards, and (3) the inability of conventional reward models to capture nuanced, multi-dimensional medical quality criteria. To address these gaps, we propose MR-RML (Multidimensional Rubric-oriented Reward Model Learning) via GPRC (Geometric Projection Reference Constraints), a novel alignment framework that integrates medical standards into a structured "Dimensions-Scenarios-Disciplines" matrix to guide data generation and model optimization. MR-RML introduces three core innovations: (1) a "Dimensions-Scenarios-Disciplines" medical standard system that embeds domain standards into the full training pipeline; (2) an independent multi-dimensional reward model that decomposes evaluation criteria, shifting from real-time rubric-based scoring to internalized reward modeling for improved consistency and cost-efficiency; (3) geometric projection reference constraints that transform medical cognitive logic into mathematical regularization, aligning scoring gradients with clinical reasoning and enabling synthetic data-driven training. Through extensive evaluations on the authoritative medical benchmark Healthbench, our method yields substantial performance gains over the base LLM Qwen-32B (45% on the full subset and 85% on Hard subset, respectively). It achieves a SOTA among open-source LLMs with scores of 62.7 (full subset) and 44.7 (hard subset), while also outperforming the majority of closed-source models.

Recent advancements in general-purpose AI have highlighted the importance of guiding AI systems towards the intended goals, ethical principles, and values of individuals and groups, a concept broadly recognized as alignment. However, the lack of clarified definitions and scopes of human-AI alignment poses a significant obstacle, hampering collaborative efforts across research domains to achieve this alignment. In particular, ML- and philosophy-oriented alignment research often views AI alignment as a static, unidirectional process (i.e., aiming to ensure that AI systems' objectives match humans) rather than an ongoing, mutual alignment problem [429]. This perspective largely neglects the long-term interaction and dynamic changes of alignment. To understand these gaps, we introduce a systematic review of over 400 papers published between 2019 and January 2024, spanning multiple domains such as Human-Computer Interaction (HCI), Natural Language Processing (NLP), Machine Learning (ML), and others. We characterize, define and scope human-AI alignment. From this, we present a conceptual framework of "Bidirectional Human-AI Alignment" to organize the literature from a human-centered perspective. This framework encompasses both 1) conventional studies of aligning AI to humans that ensures AI produces the intended outcomes determined by humans, and 2) a proposed concept of aligning humans to AI, which aims to help individuals and society adjust to AI advancements both cognitively and behaviorally. Additionally, we articulate the key findings derived from literature analysis, including discussions about human values, interaction techniques, and evaluations. To pave the way for future studies, we envision three key challenges for future directions and propose examples of potential future solutions.

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

Should a large language model (LLM) be used as a therapist? In this paper, we investigate the use of LLMs to *replace* mental health providers, a use case promoted in the tech startup and research space. We conduct a mapping review of therapy guides used by major medical institutions to identify crucial aspects of therapeutic relationships, such as the importance of a therapeutic alliance between therapist and client. We then assess the ability of LLMs to reproduce and adhere to these aspects of therapeutic relationships by conducting several experiments investigating the responses of current LLMs, such as `gpt-4o`. Contrary to best practices in the medical community, LLMs 1) express stigma toward those with mental health conditions and 2) respond inappropriately to certain common (and critical) conditions in naturalistic therapy settings -- e.g., LLMs encourage clients' delusional thinking, likely due to their sycophancy. This occurs even with larger and newer LLMs, indicating that current safety practices may not address these gaps. Furthermore, we note foundational and practical barriers to the adoption of LLMs as therapists, such as that a therapeutic alliance requires human characteristics (e.g., identity and stakes). For these reasons, we conclude that LLMs should not replace therapists, and we discuss alternative roles for LLMs in clinical therapy.

Precision therapeutics require multimodal adaptive models that generate personalized treatment recommendations. We introduce TxAgent, an AI agent that leverages multi-step reasoning and real-time biomedical knowledge retrieval across a toolbox of 211 tools to analyze drug interactions, contraindications, and patient-specific treatment strategies. TxAgent evaluates how drugs interact at molecular, pharmacokinetic, and clinical levels, identifies contraindications based on patient comorbidities and concurrent medications, and tailors treatment strategies to individual patient characteristics. It retrieves and synthesizes evidence from multiple biomedical sources, assesses interactions between drugs and patient conditions, and refines treatment recommendations through iterative reasoning. It selects tools based on task objectives and executes structured function calls to solve therapeutic tasks that require clinical reasoning and cross-source validation. The ToolUniverse consolidates 211 tools from trusted sources, including all US FDA-approved drugs since 1939 and validated clinical insights from Open Targets. TxAgent outperforms leading LLMs, tool-use models, and reasoning agents across five new benchmarks: DrugPC, BrandPC, GenericPC, TreatmentPC, and DescriptionPC, covering 3,168 drug reasoning tasks and 456 personalized treatment scenarios. It achieves 92.1% accuracy in open-ended drug reasoning tasks, surpassing GPT-4o and outperforming DeepSeek-R1 (671B) in structured multi-step reasoning. TxAgent generalizes across drug name variants and descriptions. By integrating multi-step inference, real-time knowledge grounding, and tool-assisted decision-making, TxAgent ensures that treatment recommendations align with established clinical guidelines and real-world evidence, reducing the risk of adverse events and improving therapeutic decision-making.

As the capabilities of large language models (LLMs) have expanded dramatically, aligning these models with human values presents a significant challenge. Traditional alignment strategies rely heavily on human intervention, such as Supervised Fine-Tuning (SFT) and Reinforcement Learning from Human Feedback (RLHF), or on the self-alignment capacities of LLMs, which usually require a strong LLM's emergent ability to improve its original bad answer. To address these challenges, we propose a novel self-alignment method that utilizes a Chain of Thought (CoT) approach, termed AlignCoT. This method encompasses stages of Question Analysis, Answer Guidance, and Safe Answer production. It is designed to enable LLMs to generate high-quality, safe responses throughout various stages of their development. Furthermore, we introduce the Mixture of insighTful Experts (MoTE) architecture, which applies mixture of experts to enhance each component of the AlignCoT process, markedly increasing alignment efficiency. The MoTE approach not only outperforms existing methods in aligning LLMs with human values but also highlights the benefits of using self-generated data, revealing the dual benefits of improved alignment and training efficiency.

Large Language Models (LLMs) need to be aligned with human expectations to ensure their safety and utility in most applications. Alignment is challenging, costly, and needs to be repeated for every LLM and alignment criterion. We propose to decouple LLMs and alignment by training aligner models that can be used to align any LLM for a given criteria on an as-needed basis, thus also reducing the potential negative impacts of alignment on performance. Our recipe for training the aligner models solely relies on synthetic data generated with a (prompted) LLM and can be easily adjusted for a variety of alignment criteria. We illustrate our method by training an "ethical" aligner and verify its efficacy empirically.

In mental health counseling, a variety of earlier studies have focused on dialogue modeling. However, most of these studies give limited to no emphasis on the quality of interaction between a patient and a therapist. The therapeutic bond between a patient and a therapist directly correlates with effective mental health counseling. It involves developing the patient's trust on the therapist over the course of counseling. To assess the therapeutic bond in counseling, we introduce trust as a therapist-assistive metric. Our definition of trust involves patients' willingness and openness to express themselves and, consequently, receive better care. We conceptualize it as a dynamic trajectory observable through textual interactions during the counseling. To facilitate trust modeling, we present MENTAL-TRUST, a novel counseling dataset comprising manual annotation of 212 counseling sessions with first-of-its-kind seven expert-verified ordinal trust levels. We project our problem statement as an ordinal classification task for trust quantification and propose a new benchmark, TrustBench, comprising a suite of classical and state-of-the-art language models on MENTAL-TRUST. We evaluate the performance across a suite of metrics and lay out an exhaustive set of findings. Our study aims to unfold how trust evolves in therapeutic interactions.

Alignment is a standard procedure to fine-tune pre-trained large language models (LLMs) to follow natural language instructions and serve as helpful AI assistants. We have observed, however, that the conventional alignment process fails to enhance the factual accuracy of LLMs, and often leads to the generation of more false facts (i.e. hallucination). In this paper, we study how to make the LLM alignment process more factual, by first identifying factors that lead to hallucination in both alignment steps:\ supervised fine-tuning (SFT) and reinforcement learning (RL). In particular, we find that training the LLM on new knowledge or unfamiliar texts can encourage hallucination. This makes SFT less factual as it trains on human labeled data that may be novel to the LLM. Furthermore, reward functions used in standard RL can also encourage hallucination, because it guides the LLM to provide more helpful responses on a diverse set of instructions, often preferring longer and more detailed responses. Based on these observations, we propose factuality-aware alignment, comprised of factuality-aware SFT and factuality-aware RL through direct preference optimization. Experiments show that our proposed factuality-aware alignment guides LLMs to output more factual responses while maintaining instruction-following capability.

The alignment of large language models is usually done by model providers to add or control behaviors that are common or universally understood across use cases and contexts. In contrast, in this article, we present an approach and architecture that empowers application developers to tune a model to their particular values, social norms, laws and other regulations, and orchestrate between potentially conflicting requirements in context. We lay out three main components of such an Alignment Studio architecture: Framers, Instructors, and Auditors that work in concert to control the behavior of a language model. We illustrate this approach with a running example of aligning a company's internal-facing enterprise chatbot to its business conduct guidelines.

The guiding principle of AI alignment is to train large language models (LLMs) to be harmless, helpful, and honest (HHH). At the same time, there are mounting concerns that LLMs exhibit a left-wing political bias. Yet, the commitment to AI alignment cannot be harmonized with the latter critique. In this article, I argue that intelligent systems that are trained to be harmless and honest must necessarily exhibit left-wing political bias. Normative assumptions underlying alignment objectives inherently concur with progressive moral frameworks and left-wing principles, emphasizing harm avoidance, inclusivity, fairness, and empirical truthfulness. Conversely, right-wing ideologies often conflict with alignment guidelines. Yet, research on political bias in LLMs is consistently framing its insights about left-leaning tendencies as a risk, as problematic, or concerning. This way, researchers are actively arguing against AI alignment, tacitly fostering the violation of HHH principles.

Misalignment between model predictions and intended usage can be detrimental for the deployment of computer vision models. The issue is exacerbated when the task involves complex structured outputs, as it becomes harder to design procedures which address this misalignment. In natural language processing, this is often addressed using reinforcement learning techniques that align models with a task reward. We adopt this approach and show its surprising effectiveness across multiple computer vision tasks, such as object detection, panoptic segmentation, colorization and image captioning. We believe this approach has the potential to be widely useful for better aligning models with a diverse range of computer vision tasks.

Large language models (LLMs) have shown substantial progress in natural language understanding and generation, proving valuable especially in the medical field. Despite advancements, challenges persist due to the complexity and diversity inherent in medical tasks, which can be categorized as knowledge-intensive tasks and alignment-required tasks. Previous approaches either ignore the latter task or focus on a minority of tasks and hence lose generalization. To address these drawbacks, we propose a progressive fine-tuning pipeline. This pipeline employs a Knowledge Aggregator and a Noise aggregator to encode diverse knowledge in the first stage and filter out detrimental information. In the second stage, we drop the Noise Aggregator to avoid the interference of suboptimal representation and leverage an additional alignment module optimized towards an orthogonal direction to the knowledge space to mitigate knowledge forgetting. Based on this two-stage paradigm, we proposed a Medical LLM through decoupling Clinical Alignment and Knowledge Aggregation (MedCare), which is designed to achieve state-of-the-art (SOTA) performance on over 20 medical tasks, as well as SOTA results on specific medical alignment tasks. Various model sizes of MedCare (1.8B, 7B, 14B) all demonstrate significant improvements over existing models with similar model sizes.

Trustworthiness is essential for the precise and interpretable application of artificial intelligence (AI) in medical imaging. Traditionally, precision and interpretability have been addressed as separate tasks, namely medical image analysis and explainable AI, each developing its own models independently. In this study, for the first time, we investigate the development of a unified medical vision-language pre-training model that can achieve both accurate analysis and interpretable understanding of medical images across various modalities. To build the model, we construct MedConcept-23M, a large-scale dataset comprising 23 million medical image-text pairs extracted from 6.2 million scientific articles, enriched with concepts from the Unified Medical Language System (UMLS). Based on MedConcept-23M, we introduce ConceptCLIP, a medical AI model utilizing concept-enhanced contrastive language-image pre-training. The pre-training of ConceptCLIP involves two primary components: image-text alignment learning (IT-Align) and patch-concept alignment learning (PC-Align). This dual alignment strategy enhances the model's capability to associate specific image regions with relevant concepts, thereby improving both the precision of analysis and the interpretability of the AI system. We conducted extensive experiments on 5 diverse types of medical image analysis tasks, spanning 51 subtasks across 10 image modalities, with the broadest range of downstream tasks. The results demonstrate the effectiveness of the proposed vision-language pre-training model. Further explainability analysis across 6 modalities reveals that ConceptCLIP achieves superior performance, underscoring its robust ability to advance explainable AI in medical imaging. These findings highlight ConceptCLIP's capability in promoting trustworthy AI in the field of medicine.

AI alignment research is the field of study dedicated to ensuring that artificial intelligence (AI) benefits humans. As machine intelligence gets more advanced, this research is becoming increasingly important. Researchers in the field share ideas across different media to speed up the exchange of information. However, this focus on speed means that the research landscape is opaque, making it difficult for young researchers to enter the field. In this project, we collected and analyzed existing AI alignment research. We found that the field is growing quickly, with several subfields emerging in parallel. We looked at the subfields and identified the prominent researchers, recurring topics, and different modes of communication in each. Furthermore, we found that a classifier trained on AI alignment research articles can detect relevant articles that we did not originally include in the dataset. We are sharing the dataset with the research community and hope to develop tools in the future that will help both established researchers and young researchers get more involved in the field.

Recent work discovered Emergent Misalignment (EM): fine-tuning large language models on narrowly harmful datasets can lead them to become broadly misaligned. A survey of experts prior to publication revealed this was highly unexpected, demonstrating critical gaps in our understanding of model alignment. In this work, we both advance understanding and provide tools for future research. Using new narrowly misaligned datasets, we create a set of improved model organisms that achieve 99% coherence (vs. 67% prior), work with smaller 0.5B parameter models (vs. 32B), and that induce misalignment using a single rank-1 LoRA adapter. We demonstrate that EM occurs robustly across diverse model sizes, three model families, and numerous training protocols including full supervised fine-tuning. Leveraging these cleaner model organisms, we isolate a mechanistic phase transition and demonstrate that it corresponds to a robust behavioural phase transition in all studied organisms. Aligning large language models is critical for frontier AI safety, yet EM exposes how far we are from achieving this robustly. By distilling clean model organisms that isolate a minimal alignment-compromising change, and where this is learnt, we establish a foundation for future research into understanding and mitigating alignment risks in LLMs.

Large language models (LLMs) have shown impressive success in various applications. However, these models are often not well aligned with human intents, which calls for additional treatments on them, that is, the alignment problem. To make LLMs better follow user instructions, existing alignment methods mostly focus on further training them. However, the extra training of LLMs are usually expensive in terms of GPU compute; worse still, LLMs of interest are oftentimes not accessible for user-demanded training, such as GPTs. In this work, we take a different perspective -- Black-Box Prompt Optimization (BPO) -- to perform alignments. The idea is to optimize user prompts to suit LLMs' input understanding, so as to best realize users' intents without updating LLMs' parameters. BPO is model-agnostic and the empirical results demonstrate that the BPO-aligned ChatGPT yields a 22% increase in the win rate against its original version, and 10% for GPT-4. Importantly, the BPO-aligned LLMs can outperform the same models aligned by PPO and DPO, and it also brings additional performance gains when combining BPO with PPO or DPO. Code and datasets are released at https://github.com/thu-coai/BPO.

As the capabilities of Large Language Models (LLMs) in healthcare and medicine continue to advance, there is a growing need for competitive open-source models that can safeguard public interest. With the increasing availability of highly competitive open base models, the impact of continued pre-training is increasingly uncertain. In this work, we explore the role of instruct tuning, model merging, alignment, red teaming and advanced inference schemes, as means to improve current open models. To that end, we introduce the Aloe family, a set of open medical LLMs highly competitive within its scale range. Aloe models are trained on the current best base models (Mistral, LLaMA 3), using a new custom dataset which combines public data sources improved with synthetic Chain of Thought (CoT). Aloe models undergo an alignment phase, becoming one of the first few policy-aligned open healthcare LLM using Direct Preference Optimization, setting a new standard for ethical performance in healthcare LLMs. Model evaluation expands to include various bias and toxicity datasets, a dedicated red teaming effort, and a much-needed risk assessment for healthcare LLMs. Finally, to explore the limits of current LLMs in inference, we study several advanced prompt engineering strategies to boost performance across benchmarks, yielding state-of-the-art results for open healthcare 7B LLMs, unprecedented at this scale.

Clinical trial matching is the task of identifying trials for which patients may be potentially eligible. Typically, this task is labor-intensive and requires detailed verification of patient electronic health records (EHRs) against the stringent inclusion and exclusion criteria of clinical trials. This process is manual, time-intensive, and challenging to scale up, resulting in many patients missing out on potential therapeutic options. Recent advancements in Large Language Models (LLMs) have made automating patient-trial matching possible, as shown in multiple concurrent research studies. However, the current approaches are confined to constrained, often synthetic datasets that do not adequately mirror the complexities encountered in real-world medical data. In this study, we present the first, end-to-end large-scale empirical evaluation of clinical trial matching using real-world EHRs. Our study showcases the capability of LLMs to accurately match patients with appropriate clinical trials. We perform experiments with proprietary LLMs, including GPT-4 and GPT-3.5, as well as our custom fine-tuned model called OncoLLM and show that OncoLLM, despite its significantly smaller size, not only outperforms GPT-3.5 but also matches the performance of qualified medical doctors. All experiments were carried out on real-world EHRs that include clinical notes and available clinical trials from a single cancer center in the United States.

Wider access to therapeutic care is one of the biggest challenges in mental health treatment. Due to institutional barriers, some people seeking mental health support have turned to large language models (LLMs) for personalized therapy, even though these models are largely unsanctioned and untested. We investigate the potential and limitations of using LLMs as providers of evidence-based therapy by using mixed methods clinical metrics. Using HELPERT, a prompt run on a large language model using the same process and training as a comparative group of peer counselors, we replicated publicly accessible mental health conversations rooted in Cognitive Behavioral Therapy (CBT) to compare session dynamics and counselor's CBT-based behaviors between original peer support sessions and their reconstructed HELPERT sessions. Two licensed, CBT-trained clinical psychologists evaluated the sessions using the Cognitive Therapy Rating Scale and provided qualitative feedback. Our findings show that the peer sessions are characterized by empathy, small talk, therapeutic alliance, and shared experiences but often exhibit therapist drift. Conversely, HELPERT reconstructed sessions exhibit minimal therapist drift and higher adherence to CBT methods but display a lack of collaboration, empathy, and cultural understanding. Through CTRS ratings and psychologists' feedback, we highlight the importance of human-AI collaboration for scalable mental health. Our work outlines the ethical implication of imparting human-like subjective qualities to LLMs in therapeutic settings, particularly the risk of deceptive empathy, which may lead to unrealistic patient expectations and potential harm.

Large-scale multi-modal deep learning models have revolutionized domains such as healthcare, highlighting the importance of computational power. However, in resource-constrained regions like Low and Middle-Income Countries (LMICs), limited access to GPUs and data poses significant challenges, often leaving CPUs as the sole resource. To address this, we advocate for leveraging vector embeddings to enable flexible and efficient computational methodologies, democratizing multimodal deep learning across diverse contexts. Our paper investigates the efficiency and effectiveness of using vector embeddings from single-modal foundation models and multi-modal Vision-Language Models (VLMs) for multimodal deep learning in low-resource environments, particularly in healthcare. Additionally, we propose a simple yet effective inference-time method to enhance performance by aligning image-text embeddings. Comparing these approaches with traditional methods, we assess their impact on computational efficiency and model performance using metrics like accuracy, F1-score, inference time, training time, and memory usage across three medical modalities: BRSET (ophthalmology), HAM10000 (dermatology), and SatelliteBench (public health). Our findings show that embeddings reduce computational demands without compromising model performance. Furthermore, our alignment method improves performance in medical tasks. This research promotes sustainable AI practices by optimizing resources in constrained environments, highlighting the potential of embedding-based approaches for efficient multimodal learning. Vector embeddings democratize multimodal deep learning in LMICs, particularly in healthcare, enhancing AI adaptability in varied use cases.

A key concern with the concept of "alignment" is the implicit question of "alignment to what?". AI systems are increasingly used across the world, yet safety alignment is often focused on homogeneous monolingual settings. Additionally, preference training and safety measures often overfit to harms common in Western-centric datasets. Here, we explore the viability of different alignment approaches when balancing dual objectives: addressing and optimizing for a non-homogeneous set of languages and cultural preferences while minimizing both global and local harms. We collect the first set of human annotated red-teaming prompts in different languages distinguishing between global and local harm, which serve as a laboratory for understanding the reliability of alignment techniques when faced with preference distributions that are non-stationary across geographies and languages. While this setting is seldom covered by the literature to date, which primarily centers on English harm mitigation, it captures real-world interactions with AI systems around the world. We establish a new precedent for state-of-the-art alignment techniques across 6 languages with minimal degradation in general performance. Our work provides important insights into cross-lingual transfer and novel optimization approaches to safeguard AI systems designed to serve global populations.

Aligning language models with human preferences is crucial for reducing errors and biases in these models. Alignment techniques, such as reinforcement learning from human feedback (RLHF), are typically cast as optimizing a tradeoff between human preference rewards and a proximity regularization term that encourages staying close to the unaligned model. Selecting an appropriate level of regularization is critical: insufficient regularization can lead to reduced model capabilities due to reward hacking, whereas excessive regularization hinders alignment. Traditional methods for finding the optimal regularization level require retraining multiple models with varying regularization strengths. This process, however, is resource-intensive, especially for large models. To address this challenge, we propose decoding-time realignment (DeRa), a simple method to explore and evaluate different regularization strengths in aligned models without retraining. DeRa enables control over the degree of alignment, allowing users to smoothly transition between unaligned and aligned models. It also enhances the efficiency of hyperparameter tuning by enabling the identification of effective regularization strengths using a validation dataset.

Precise alignment in Text-to-Image (T2I) systems is crucial to ensure that generated visuals not only accurately encapsulate user intents but also conform to stringent ethical and aesthetic benchmarks. Incidents like the Google Gemini fiasco, where misaligned outputs triggered significant public backlash, underscore the critical need for robust alignment mechanisms. In contrast, Large Language Models (LLMs) have achieved notable success in alignment. Building on these advancements, researchers are eager to apply similar alignment techniques, such as Direct Preference Optimization (DPO), to T2I systems to enhance image generation fidelity and reliability. We present YinYangAlign, an advanced benchmarking framework that systematically quantifies the alignment fidelity of T2I systems, addressing six fundamental and inherently contradictory design objectives. Each pair represents fundamental tensions in image generation, such as balancing adherence to user prompts with creative modifications or maintaining diversity alongside visual coherence. YinYangAlign includes detailed axiom datasets featuring human prompts, aligned (chosen) responses, misaligned (rejected) AI-generated outputs, and explanations of the underlying contradictions.

The safe and effective deployment of Large Language Models (LLMs) involves a critical step called alignment, which ensures that the model's responses are in accordance with human preferences. Prevalent alignment techniques, such as DPO, PPO and their variants, align LLMs by changing the pre-trained model weights during a phase called post-training. While predominant, these post-training methods add substantial complexity before LLMs can be deployed. Inference-time alignment methods avoid the complex post-training step and instead bias the generation towards responses that are aligned with human preferences. The best-known inference-time alignment method, called Best-of-N, is as effective as the state-of-the-art post-training procedures. Unfortunately, Best-of-N requires vastly more resources at inference time than standard decoding strategies, which makes it computationally not viable. In this work, we introduce Speculative Rejection, a computationally-viable inference-time alignment algorithm. It generates high-scoring responses according to a given reward model, like Best-of-N does, while being between 16 to 32 times more computationally efficient.

With the rapid development of large language models (LLMs), they are not only used as general-purpose AI assistants but are also customized through further fine-tuning to meet the requirements of different applications. A pivotal factor in the success of current LLMs is the alignment process. Current alignment methods, such as supervised fine-tuning (SFT) and reinforcement learning from human feedback (RLHF), focus on training-time alignment and are often complex and cumbersome to implement. Therefore, we develop InferAligner, a novel inference-time alignment method that utilizes cross-model guidance for harmlessness alignment. InferAligner utilizes safety steering vectors extracted from safety-aligned model to modify the activations of the target model when responding to harmful inputs, thereby guiding the target model to provide harmless responses. Experimental results show that our method can be very effectively applied to domain-specific models in finance, medicine, and mathematics, as well as to multimodal large language models (MLLMs) such as LLaVA. It significantly diminishes the Attack Success Rate (ASR) of both harmful instructions and jailbreak attacks, while maintaining almost unchanged performance in downstream tasks.

The critical inquiry pervading the realm of Philosophy, and perhaps extending its influence across all Humanities disciplines, revolves around the intricacies of morality and normativity. Surprisingly, in recent years, this thematic thread has woven its way into an unexpected domain, one not conventionally associated with pondering "what ought to be": the field of artificial intelligence (AI) research. Central to morality and AI, we find "alignment", a problem related to the challenges of expressing human goals and values in a manner that artificial systems can follow without leading to unwanted adversarial effects. More explicitly and with our current paradigm of AI development in mind, we can think of alignment as teaching human values to non-anthropomorphic entities trained through opaque, gradient-based learning techniques. This work addresses alignment as a technical-philosophical problem that requires solid philosophical foundations and practical implementations that bring normative theory to AI system development. To accomplish this, we propose two sets of necessary and sufficient conditions that, we argue, should be considered in any alignment process. While necessary conditions serve as metaphysical and metaethical roots that pertain to the permissibility of alignment, sufficient conditions establish a blueprint for aligning AI systems under a learning-based paradigm. After laying such foundations, we present implementations of this approach by using state-of-the-art techniques and methods for aligning general-purpose language systems. We call this framework Dynamic Normativity. Its central thesis is that any alignment process under a learning paradigm that cannot fulfill its necessary and sufficient conditions will fail in producing aligned systems.

Clinical trial matching is a key process in health delivery and discovery. In practice, it is plagued by overwhelming unstructured data and unscalable manual processing. In this paper, we conduct a systematic study on scaling clinical trial matching using large language models (LLMs), with oncology as the focus area. Our study is grounded in a clinical trial matching system currently in test deployment at a large U.S. health network. Initial findings are promising: out of box, cutting-edge LLMs, such as GPT-4, can already structure elaborate eligibility criteria of clinical trials and extract complex matching logic (e.g., nested AND/OR/NOT). While still far from perfect, LLMs substantially outperform prior strong baselines and may serve as a preliminary solution to help triage patient-trial candidates with humans in the loop. Our study also reveals a few significant growth areas for applying LLMs to end-to-end clinical trial matching, such as context limitation and accuracy, especially in structuring patient information from longitudinal medical records.

Alignment of artificial intelligence (AI) encompasses the normative problem of specifying how AI systems should act and the technical problem of ensuring AI systems comply with those specifications. To date, AI alignment has generally overlooked an important source of knowledge and practice for grappling with these problems: law. In this paper, we aim to fill this gap by exploring how legal rules, principles, and methods can be leveraged to address problems of alignment and inform the design of AI systems that operate safely and ethically. This emerging field -- legal alignment -- focuses on three research directions: (1) designing AI systems to comply with the content of legal rules developed through legitimate institutions and processes, (2) adapting methods from legal interpretation to guide how AI systems reason and make decisions, and (3) harnessing legal concepts as a structural blueprint for confronting challenges of reliability, trust, and cooperation in AI systems. These research directions present new conceptual, empirical, and institutional questions, which include examining the specific set of laws that particular AI systems should follow, creating evaluations to assess their legal compliance in real-world settings, and developing governance frameworks to support the implementation of legal alignment in practice. Tackling these questions requires expertise across law, computer science, and other disciplines, offering these communities the opportunity to collaborate in designing AI for the better.

Empathy requires perspective-taking: empathetic responses require a person to reason about what another has experienced and communicate that understanding in language. However, most NLP approaches to empathy do not explicitly model this alignment process. Here, we introduce a new approach to recognizing alignment in empathetic speech, grounded in Appraisal Theory. We introduce a new dataset of over 9.2K span-level annotations of different types of appraisals of a person's experience and over 3K empathetic alignments between a speaker's and observer's speech. Through computational experiments, we show that these appraisals and alignments can be accurately recognized. In experiments in over 9.2M Reddit conversations, we find that appraisals capture meaningful groupings of behavior but that most responses have minimal alignment. However, we find that mental health professionals engage with substantially more empathetic alignment.

Med42-v2 introduces a suite of clinical large language models (LLMs) designed to address the limitations of generic models in healthcare settings. These models are built on Llama3 architecture and fine-tuned using specialized clinical data. They underwent multi-stage preference alignment to effectively respond to natural prompts. While generic models are often preference-aligned to avoid answering clinical queries as a precaution, Med42-v2 is specifically trained to overcome this limitation, enabling its use in clinical settings. Med42-v2 models demonstrate superior performance compared to the original Llama3 models in both 8B and 70B parameter configurations and GPT-4 across various medical benchmarks. These LLMs are developed to understand clinical queries, perform reasoning tasks, and provide valuable assistance in clinical environments. The models are now publicly available at https://huggingface.co/m42-health{https://huggingface.co/m42-health}.

Large language models (LLMs) integrated into agent-driven workflows hold immense promise for healthcare, yet a significant gap exists between their potential and practical implementation within clinical settings. To address this, we present a practitioner-oriented field manual for deploying generative agents that use electronic health record (EHR) data. This guide is informed by our experience deploying the "irAE-Agent", an automated system to detect immune-related adverse events from clinical notes at Mass General Brigham, and by structured interviews with 21 clinicians, engineers, and informatics leaders involved in the project. Our analysis reveals a critical misalignment in clinical AI development: less than 20% of our effort was dedicated to prompt engineering and model development, while over 80% was consumed by the sociotechnical work of implementation. We distill this effort into five "heavy lifts": data integration, model validation, ensuring economic value, managing system drift, and governance. By providing actionable solutions for each of these challenges, this field manual shifts the focus from algorithmic development to the essential infrastructure and implementation work required to bridge the "valley of death" and successfully translate generative AI from pilot projects into routine clinical care.

We introduce Aligner, a novel Parameter-Efficient Fine-Tuning (PEFT) method for aligning multi-billion-parameter-sized Large Language Models (LLMs). Aligner employs a unique design that constructs a globally shared set of tunable tokens that modify the attention of every layer. Remarkably with this method, even when using one token accounting for a mere 5,000 parameters, Aligner can still perform comparably well to state-of-the-art LLM adaptation methods like LoRA that require millions of parameters. This capacity is substantiated in both instruction following and value alignment tasks. Besides the multiple order-of-magnitude improvement in parameter efficiency, the insight Aligner provides into the internal mechanisms of LLMs is also valuable. The architectural features and efficacy of our method, in addition to our experiments demonstrate that an LLM separates its internal handling of "form" and "knowledge" in a somewhat orthogonal manner. This finding promises to motivate new research into LLM mechanism understanding and value alignment.

Alignment has quickly become a default ingredient in LLM development, with techniques such as reinforcement learning from human feedback making models act safely, follow instructions, and perform ever-better on complex tasks. While these techniques are certainly useful, we propose that they should not be universally applied and demonstrate a range of tasks on which base language models consistently outperform their popular aligned forms. Particularly, we study tasks that require unpredictable outputs, such as random number generation, mixed strategy games (rock-paper-scissors and hide-and-seek), and creative writing. In each case, aligned models tend towards narrow behaviors that result in distinct disadvantages, for instance, preferring to generate "7" over other uniformly random numbers, becoming almost fully predictable in some game states, or prioritizing pleasant writing over creative originality. Across models tested, better performance on common benchmarks tends to correlate with worse performance on our tasks, suggesting an effective trade-off in the required capabilities.

Image registration is fundamental in medical imaging, enabling precise alignment of anatomical structures for diagnosis, treatment planning, image-guided treatment or longitudinal monitoring. This work introduces IMPACT (Image Metric with Pretrained model-Agnostic Comparison for Transmodality registration), a generic semantic similarity metric designed for seamless integration into diverse image registration frameworks (such as Elastix and Voxelmorph). It compares deep learning-based features extracted from medical images without requiring task-specific training, ensuring broad applicability across various modalities. By leveraging the features of the large-scale pretrained TotalSegmentator models and the ability to integrate Segment Anything Model (SAM) and other large-scale segmentation networks, this approach offers significant advantages. It provides robust, scalable, and efficient solutions for multimodal image registration. The IMPACT loss was evaluated on five challenging registration tasks involving thoracic CT/CBCT, and pelvic MR/CT datasets. Quantitative metrics, such as Target Registration Error and Dice Similarity Coefficient, demonstrated significant improvements in anatomical alignment compared to baseline methods. Qualitative analyses further confirmed the increased robustness of the proposed metric in the face of noise, artifacts, and modality variations. IMPACT's versatility and efficiency make it a valuable tool for advancing registration performance in clinical and research applications, addressing critical challenges in multimodal medical imaging.

The transcriptional response to genetic perturbation reveals fundamental insights into complex cellular systems. While current approaches have made progress in predicting genetic perturbation responses, they provide limited biological understanding and cannot systematically refine existing knowledge. Overcoming these limitations requires an end-to-end integration of data-driven learning and existing knowledge. However, this integration is challenging due to inconsistencies between data and knowledge bases, such as noise, misannotation, and incompleteness. To address this challenge, we propose ALIGNED (Adaptive aLignment for Inconsistent Genetic kNowledgE and Data), a neuro-symbolic framework based on the Abductive Learning (ABL) paradigm. This end-to-end framework aligns neural and symbolic components and performs systematic knowledge refinement. We introduce a balanced consistency metric to evaluate the predictions' consistency against both data and knowledge. Our results show that ALIGNED outperforms state-of-the-art methods by achieving the highest balanced consistency, while also re-discovering biologically meaningful knowledge. Our work advances beyond existing methods to enable both the transparency and the evolution of mechanistic biological understanding.

Solving the AI alignment problem requires having clear, defensible values towards which AI systems can align. Currently, targets for alignment remain underspecified and do not seem to be built from a philosophically robust structure. We begin the discussion of this problem by presenting five core, foundational values, drawn from moral philosophy and built on the requisites for human existence: survival, sustainable intergenerational existence, society, education, and truth. We show that these values not only provide a clearer direction for technical alignment work, but also serve as a framework to highlight threats and opportunities from AI systems to both obtain and sustain these values.

Large Language Models (LLMs) exhibit impressive capabilities but also present risks such as biased content generation and privacy issues. One of the current alignment techniques includes principle-driven integration, but it faces challenges arising from the imprecision of manually crafted rules and inadequate risk perception in models without safety training. To address these, we introduce Guide-Align, a two-stage approach. Initially, a safety-trained model identifies potential risks and formulates specific guidelines for various inputs, establishing a comprehensive library of guidelines and a model for input-guidelines retrieval. Subsequently, the retrieval model correlates new inputs with relevant guidelines, which guide LLMs in response generation to ensure safe and high-quality outputs, thereby aligning with human values. An additional optional stage involves fine-tuning a model with well-aligned datasets generated through the process implemented in the second stage. Our method customizes guidelines to accommodate diverse inputs, thereby enhancing the fine-grainedness and comprehensiveness of the guideline library. Furthermore, it incorporates safety expertise from a safety-trained LLM through a lightweight retrieval model. We evaluate our approach on three benchmarks, demonstrating significant improvements in LLM security and quality. Notably, our fine-tuned model, Labrador, even at 13 billion parameters, outperforms GPT-3.5-turbo and surpasses GPT-4 in alignment capabilities.

Due to the remarkable capabilities and growing impact of large language models (LLMs), they have been deeply integrated into many aspects of society. Thus, ensuring their alignment with human values and intentions has emerged as a critical challenge. This survey provides a comprehensive overview of practical alignment techniques, training protocols, and empirical findings in LLM alignment. We analyze the development of alignment methods across diverse paradigms, characterizing the fundamental trade-offs between core alignment objectives. Our analysis shows that while supervised fine-tuning enables basic instruction-following, preference-based methods offer more flexibility for aligning with nuanced human intent. We discuss state-of-the-art techniques, including Direct Preference Optimization (DPO), Constitutional AI, brain-inspired methods, and alignment uncertainty quantification (AUQ), highlighting their approaches to balancing quality and efficiency. We review existing evaluation frameworks and benchmarking datasets, emphasizing limitations such as reward misspecification, distributional robustness, and scalable oversight. We summarize strategies adopted by leading AI labs to illustrate the current state of practice. We conclude by outlining open problems in oversight, value pluralism, robustness, and continuous alignment. This survey aims to inform both researchers and practitioners navigating the evolving landscape of LLM alignment.

We propose SPARTA ALIGNMENT, an algorithm to collectively align multiple LLMs through competition and combat. To complement a single model's lack of diversity in generation and biases in evaluation, multiple LLMs form a "sparta tribe" to compete against each other in fulfilling instructions while serving as judges for the competition of others. For each iteration, one instruction and two models are selected for a duel, the other models evaluate the two responses, and their evaluation scores are aggregated through a adapted elo-ranking based reputation system, where winners/losers of combat gain/lose weight in evaluating others. The peer-evaluated combat results then become preference pairs where the winning response is preferred over the losing one, and all models learn from these preferences at the end of each iteration. SPARTA ALIGNMENT enables the self-evolution of multiple LLMs in an iterative and collective competition process. Extensive experiments demonstrate that SPARTA ALIGNMENT outperforms initial models and 4 self-alignment baselines across 10 out of 12 tasks and datasets with 7.0% average improvement. Further analysis reveals that SPARTA ALIGNMENT generalizes more effectively to unseen tasks and leverages the expertise diversity of participating models to produce more logical, direct and informative outputs.

Recent progress in large language models (LLMs) has focused on producing responses that meet human expectations and align with shared values - a process coined alignment. However, aligning LLMs remains challenging due to the inherent disconnect between the complexity of human values and the narrow nature of the technological approaches designed to address them. Current alignment methods often lead to misspecified objectives, reflecting the broader issue of incomplete contracts, the impracticality of specifying a contract between a model developer, and the model that accounts for every scenario in LLM alignment. In this paper, we argue that improving LLM alignment requires incorporating insights from societal alignment frameworks, including social, economic, and contractual alignment, and discuss potential solutions drawn from these domains. Given the role of uncertainty within societal alignment frameworks, we then investigate how it manifests in LLM alignment. We end our discussion by offering an alternative view on LLM alignment, framing the underspecified nature of its objectives as an opportunity rather than perfect their specification. Beyond technical improvements in LLM alignment, we discuss the need for participatory alignment interface designs.

The National Comprehensive Cancer Network (NCCN) provides evidence-based guidelines for cancer treatment. Translating complex patient presentations into guideline-compliant treatment recommendations is time-intensive, requires specialized expertise, and is prone to error. Advances in large language model (LLM) capabilities promise to reduce the time required to generate treatment recommendations and improve accuracy. We present an LLM agent-based approach to automatically generate guideline-concordant treatment trajectories for patients with non-small cell lung cancer (NSCLC). Our contributions are threefold. First, we construct a novel longitudinal dataset of 121 cases of NSCLC patients that includes clinical encounters, diagnostic results, and medical histories, each expertly annotated with the corresponding NCCN guideline trajectories by board-certified oncologists. Second, we demonstrate that existing LLMs possess domain-specific knowledge that enables high-quality proxy benchmark generation for both model development and evaluation, achieving strong correlation (Spearman coefficient r=0.88, RMSE = 0.08) with expert-annotated benchmarks. Third, we develop a hybrid approach combining expensive human annotations with model consistency information to create both the agent framework that predicts the relevant guidelines for a patient, as well as a meta-classifier that verifies prediction accuracy with calibrated confidence scores for treatment recommendations (AUROC=0.800), a critical capability for communicating the accuracy of outputs, custom-tailoring tradeoffs in performance, and supporting regulatory compliance. This work establishes a framework for clinically viable LLM-based guideline adherence systems that balance accuracy, interpretability, and regulatory requirements while reducing annotation costs, providing a scalable pathway toward automated clinical decision support.

Alignment is no longer a luxury, it is a necessity. As large language models (LLMs) enter high-stakes domains like education, healthcare, governance, and law, their behavior must reliably reflect human-aligned values and safety constraints. Yet current evaluations rely heavily on behavioral proxies such as refusal rates, G-Eval scores, and toxicity classifiers, all of which have critical blind spots. Aligned models are often vulnerable to jailbreaking, stochasticity of generation, and alignment faking. To address this issue, we introduce the Alignment Quality Index (AQI). This novel geometric and prompt-invariant metric empirically assesses LLM alignment by analyzing the separation of safe and unsafe activations in latent space. By combining measures such as the Davies-Bouldin Score (DBS), Dunn Index (DI), Xie-Beni Index (XBI), and Calinski-Harabasz Index (CHI) across various formulations, AQI captures clustering quality to detect hidden misalignments and jailbreak risks, even when outputs appear compliant. AQI also serves as an early warning signal for alignment faking, offering a robust, decoding invariant tool for behavior agnostic safety auditing. Additionally, we propose the LITMUS dataset to facilitate robust evaluation under these challenging conditions. Empirical tests on LITMUS across different models trained under DPO, GRPO, and RLHF conditions demonstrate AQI's correlation with external judges and ability to reveal vulnerabilities missed by refusal metrics. We make our implementation publicly available to foster future research in this area.

Recent works have demonstrated the effectiveness of self-alignment in which a large language model is, by itself, aligned to follow general instructions through the automatic generation of instructional data using a handful of human-written seeds. Instead of general alignment, in this work, we focus on self-alignment for expert domain specialization (e.g., biomedicine), discovering it to be very effective for improving zero-shot and few-shot performance in target domains of interest. As a preliminary, we first present the benchmark results of existing aligned models within a specialized domain, which reveals the marginal effect that "generic" instruction-following training has on downstream expert domains' performance. To remedy this, we explore self-specialization that leverages domain-specific unlabelled data and a few labeled seeds for the self-alignment process. When augmented with retrieval to reduce hallucination and enhance concurrency of the alignment, self-specialization offers an effective (and efficient) way of "carving out" an expert model out of a "generalist", pre-trained LLM where different domains of expertise are originally combined in a form of "superposition". Our experimental results on a biomedical domain show that our self-specialized model (30B) outperforms its base model, MPT-30B by a large margin and even surpasses larger popular models based on LLaMA-65B, highlighting its potential and practicality for specialization, especially considering its efficiency in terms of data and parameters.

Combination therapies have become the standard of care for diseases such as cancer, tuberculosis, malaria and HIV. However, the combinatorial set of available multi-drug treatments creates a challenge in identifying effective combination therapies available in a situation. To assist medical professionals in identifying beneficial drug-combinations, we construct an expert-annotated dataset for extracting information about the efficacy of drug combinations from the scientific literature. Beyond its practical utility, the dataset also presents a unique NLP challenge, as the first relation extraction dataset consisting of variable-length relations. Furthermore, the relations in this dataset predominantly require language understanding beyond the sentence level, adding to the challenge of this task. We provide a promising baseline model and identify clear areas for further improvement. We release our dataset, code, and baseline models publicly to encourage the NLP community to participate in this task.

Therapeutic development is a costly and high-risk endeavor that is often plagued by high failure rates. To address this, we introduce TxGemma, a suite of efficient, generalist large language models (LLMs) capable of therapeutic property prediction as well as interactive reasoning and explainability. Unlike task-specific models, TxGemma synthesizes information from diverse sources, enabling broad application across the therapeutic development pipeline. The suite includes 2B, 9B, and 27B parameter models, fine-tuned from Gemma-2 on a comprehensive dataset of small molecules, proteins, nucleic acids, diseases, and cell lines. Across 66 therapeutic development tasks, TxGemma achieved superior or comparable performance to the state-of-the-art generalist model on 64 (superior on 45), and against state-of-the-art specialist models on 50 (superior on 26). Fine-tuning TxGemma models on therapeutic downstream tasks, such as clinical trial adverse event prediction, requires less training data than fine-tuning base LLMs, making TxGemma suitable for data-limited applications. Beyond these predictive capabilities, TxGemma features conversational models that bridge the gap between general LLMs and specialized property predictors. These allow scientists to interact in natural language, provide mechanistic reasoning for predictions based on molecular structure, and engage in scientific discussions. Building on this, we further introduce Agentic-Tx, a generalist therapeutic agentic system powered by Gemini 2.5 that reasons, acts, manages diverse workflows, and acquires external domain knowledge. Agentic-Tx surpasses prior leading models on the Humanity's Last Exam benchmark (Chemistry & Biology) with 52.3% relative improvement over o3-mini (high) and 26.7% over o3-mini (high) on GPQA (Chemistry) and excels with improvements of 6.3% (ChemBench-Preference) and 2.4% (ChemBench-Mini) over o3-mini (high).

Medical report generation from X-ray images is a challenging task, particularly in an unpaired setting where paired image-report data is unavailable for training. To address this challenge, we propose a novel model that leverages the available information in two distinct datasets, one comprising reports and the other consisting of images. The core idea of our model revolves around the notion that combining auto-encoding report generation with multi-modal (report-image) alignment can offer a solution. However, the challenge persists regarding how to achieve this alignment when pair correspondence is absent. Our proposed solution involves the use of auxiliary tasks, particularly contrastive learning and classification, to position related images and reports in close proximity to each other. This approach differs from previous methods that rely on pre-processing steps, such as using external information stored in a knowledge graph. Our model, named MedRAT, surpasses previous state-of-the-art methods, demonstrating the feasibility of generating comprehensive medical reports without the need for paired data or external tools.

Like a criminal under investigation, Large Language Models (LLMs) might pretend to be aligned while evaluated and misbehave when they have a good opportunity. Can current interpretability methods catch these 'alignment fakers?' To answer this question, we introduce a benchmark that consists of 324 pairs of LLMs fine-tuned to select actions in role-play scenarios. One model in each pair is consistently benign (aligned). The other model misbehaves in scenarios where it is unlikely to be caught (alignment faking). The task is to identify the alignment faking model using only inputs where the two models behave identically. We test five detection strategies, one of which identifies 98% of alignment-fakers.

Medical Vision-Language Models (VLMs) are prone to hallucinations, compromising clinical reliability. While reinforcement learning methods like Group Relative Policy Optimization (GRPO) offer a low-cost alignment solution, their reliance on sparse, outcome-based rewards inadvertently encourages models to "overthink" -- generating verbose, convoluted, and unverifiable Chain-of-Thought reasoning to justify answers. This focus on outcomes obscures factual errors and poses significant safety risks. To address this, we propose CheXPO-v2, a novel alignment framework that shifts from outcome to process supervision. Our core innovation is a Knowledge Graph Consistency Reward mechanism driven by Entity-Relation Matching. By explicitly parsing reasoning steps into structured "Disease, Relation, Anatomy" triplets, we provide fine-grained supervision that penalizes incoherent logic and hallucinations at the atomic level. Integrating this with a hard-example mining strategy, our approach significantly outperforms GRPO and state-of-the-art models on benchmarks like MIMIC-CXR-VQA. Crucially, CheXPO-v2 achieves new state-of-the-art accuracy using only 5k samples, demonstrating exceptional data efficiency while producing clinically sound and verifiable reasoning. The project source code is publicly available at: https://github.com/ecoxial2007/CheX-Phi4MM.

Predictive artificial intelligence (AI) offers an opportunity to improve clinical practice and patient outcomes, but risks perpetuating biases if fairness is inadequately addressed. However, the definition of "fairness" remains unclear. We conducted a scoping review to identify and critically appraise fairness metrics for clinical predictive AI. We defined a "fairness metric" as a measure quantifying whether a model discriminates (societally) against individuals or groups defined by sensitive attributes. We searched five databases (2014-2024), screening 820 records, to include 41 studies, and extracted 62 fairness metrics. Metrics were classified by performance-dependency, model output level, and base performance metric, revealing a fragmented landscape with limited clinical validation and overreliance on threshold-dependent measures. Eighteen metrics were explicitly developed for healthcare, including only one clinical utility metric. Our findings highlight conceptual challenges in defining and quantifying fairness and identify gaps in uncertainty quantification, intersectionality, and real-world applicability. Future work should prioritise clinically meaningful metrics.

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

Alignment in artificial intelligence pursues the consistency between model responses and human preferences as well as values. In practice, the multifaceted nature of human preferences inadvertently introduces what is known as the "alignment tax" -a compromise where enhancements in alignment within one objective (e.g.,harmlessness) can diminish performance in others (e.g.,helpfulness). However, existing alignment techniques are mostly unidirectional, leading to suboptimal trade-offs and poor flexibility over various objectives. To navigate this challenge, we argue the prominence of grounding LLMs with evident preferences. We introduce controllable preference optimization (CPO), which explicitly specifies preference scores for different objectives, thereby guiding the model to generate responses that meet the requirements. Our experimental analysis reveals that the aligned models can provide responses that match various preferences among the "3H" (helpfulness, honesty, harmlessness) desiderata. Furthermore, by introducing diverse data and alignment goals, we surpass baseline methods in aligning with single objectives, hence mitigating the impact of the alignment tax and achieving improvements in multi-objective alignment.

Psychotherapy or counseling is typically conducted through spoken conversation between a therapist and a client. Analyzing the speech characteristics of psychotherapeutic interactions can help understand the factors associated with effective psychotherapy. This paper introduces CUEMPATHY, a large-scale speech dataset collected from actual counseling sessions. The dataset consists of 156 counseling sessions involving 39 therapist-client dyads. The process of speech data collection, subjective ratings (one observer and two client ratings), and transcription are described. An automatic speech and text processing system is developed to locate the time stamps of speaker turns in each session. Examining the relationships among the three subjective ratings suggests that observer and client ratings have no significant correlation, while the client-rated measures are significantly correlated. The intensity similarity between the therapist and the client, measured by the averaged absolute difference of speaker-turn-level intensities, is associated with the psychotherapy outcomes. Recent studies on the acoustic and linguistic characteristics of the CUEMPATHY are introduced.

Drug discovery typically consists of multiple steps, including identifying a target protein key to a disease's etiology, validating that interacting with this target could prevent symptoms or cure the disease, discovering a small molecule or biologic therapeutic to interact with it, and optimizing the candidate molecule through a complex landscape of required properties. Drug discovery related tasks often involve prediction and generation while considering multiple entities that potentially interact, which poses a challenge for typical AI models. For this purpose we present MAMMAL - Molecular Aligned Multi-Modal Architecture and Language - a method that we applied to create a versatile multi-task foundation model ibm/biomed.omics.bl.sm.ma-ted-458m that learns from large-scale biological datasets (2 billion samples) across diverse modalities, including proteins, small molecules, and genes. We introduce a prompt syntax that supports a wide range of classification, regression, and generation tasks. It allows combining different modalities and entity types as inputs and/or outputs. Our model handles combinations of tokens and scalars and enables the generation of small molecules and proteins, property prediction, and transcriptomic lab test predictions. We evaluated the model on 11 diverse downstream tasks spanning different steps within a typical drug discovery pipeline, where it reaches new SOTA in 9 tasks and is comparable to SOTA in 2 tasks. This performance is achieved while using a unified architecture serving all tasks, in contrast to the original SOTA performance achieved using tailored architectures. The model code and pretrained weights are publicly available at https://github.com/BiomedSciAI/biomed-multi-alignment and https://huggingface.co/ibm/biomed.omics.bl.sm.ma-ted-458m.

This paper shows that alignment methods can achieve superior adherence to guardrails compared to instruction fine-tuning alone in conversational agents, also known as bots, within predefined guidelines or 'guardrails'. It examines traditional training approaches such as instruction fine-tuning and the recent advancements in direct alignment methods like Identity Preference Optimization (IPO), and Kahneman-Tversky Optimization (KTO). The effectiveness of alignment techniques both pre and post-instruction tuning is highlighted, illustrating their potential to optimize conversational bots in domains that require strict adherence to specified rules, such as customer care.

The success of AI assistants based on Language Models (LLMs) hinges on Reinforcement Learning from Human Feedback (RLHF) to comprehend and align with user intentions. However, traditional alignment algorithms, such as PPO, are hampered by complex annotation and training requirements. This reliance limits the applicability of RLHF and hinders the development of professional assistants tailored to diverse human preferences. In this work, we introduce Linear Alignment, a novel algorithm that aligns language models with human preferences in one single inference step, eliminating the reliance on data annotation and model training. Linear alignment incorporates a new parameterization for policy optimization under divergence constraints, which enables the extraction of optimal policy in a closed-form manner and facilitates the direct estimation of the aligned response. Extensive experiments on both general and personalized preference datasets demonstrate that linear alignment significantly enhances the performance and efficiency of LLM alignment across diverse scenarios. Our code and dataset will be published on https://github.com/Wizardcoast/Linear_Alignment.git.

We participated in the SynthRAD2025 challenge (Tasks 1 and 2) with a unified pipeline for synthetic CT (sCT) generation from MRI and CBCT, implemented using the KonfAI framework. Our model is a 2.5D U-Net++ with a ResNet-34 encoder, trained jointly across anatomical regions and fine-tuned per region. The loss function combined pixel-wise L1 loss with IMPACT-Synth, a perceptual loss derived from SAM and TotalSegmentator to enhance structural fidelity. Training was performed using AdamW (initial learning rate = 0.001, halved every 25k steps) on patch-based, normalized, body-masked inputs (320x320 for MRI, 256x256 for CBCT), with random flipping as the only augmentation. No post-processing was applied. Final predictions leveraged test-time augmentation and five-fold ensembling. The best model was selected based on validation MAE. Two registration strategies were evaluated: (i) Elastix with mutual information, consistent with the challenge pipeline, and (ii) IMPACT, a feature-based similarity metric leveraging pretrained segmentation networks. On the local test sets, IMPACT-based registration achieved more accurate and anatomically consistent alignments than mutual-information-based registration, resulting in improved sCT synthesis with lower MAE and more realistic anatomical structures. On the public validation set, however, models trained with Elastix-aligned data achieved higher scores, reflecting a registration bias favoring alignment strategies consistent with the evaluation pipeline. This highlights how registration errors can propagate into supervised learning, influencing both training and evaluation, and potentially inflating performance metrics at the expense of anatomical fidelity. By promoting anatomically consistent alignment, IMPACT helps mitigate this bias and supports the development of more robust and generalizable sCT synthesis models.

Clinical dialogue represents a complex duality requiring both the empathetic fluency of natural conversation and the rigorous precision of evidence-based medicine. While Large Language Models possess unprecedented linguistic capabilities, their architectural reliance on reactive and stateless processing often favors probabilistic plausibility over factual veracity. This structural limitation has catalyzed a paradigm shift in medical AI from generative text prediction to agentic autonomy, where the model functions as a central reasoning engine capable of deliberate planning and persistent memory. Moving beyond existing reviews that primarily catalog downstream applications, this survey provides a first-principles analysis of the cognitive architecture underpinning this shift. We introduce a novel taxonomy structured along the orthogonal axes of knowledge source and agency objective to delineate the provenance of clinical knowledge against the system's operational scope. This framework facilitates a systematic analysis of the intrinsic trade-offs between creativity and reliability by categorizing methods into four archetypes: Latent Space Clinicians, Emergent Planners, Grounded Synthesizers, and Verifiable Workflow Automators. For each paradigm, we deconstruct the technical realization across the entire cognitive pipeline, encompassing strategic planning, memory management, action execution, collaboration, and evolution to reveal how distinct architectural choices balance the tension between autonomy and safety.

Clinical trials are fundamental in developing new drugs, medical devices, and treatments. However, they are often time-consuming and have low success rates. Although there have been initial attempts to create large language models (LLMs) for clinical trial design and patient-trial matching, these models remain task-specific and not adaptable to diverse clinical trial tasks. To address this challenge, we propose a clinical trial foundation model named Panacea, designed to handle multiple tasks, including trial search, trial summarization, trial design, and patient-trial matching. We also assemble a large-scale dataset, named TrialAlign, of 793,279 trial documents and 1,113,207 trial-related scientific papers, to infuse clinical knowledge into the model by pre-training. We further curate TrialInstruct, which has 200,866 of instruction data for fine-tuning. These resources enable Panacea to be widely applicable for a range of clinical trial tasks based on user requirements. We evaluated Panacea on a new benchmark, named TrialPanorama, which covers eight clinical trial tasks. Our method performed the best on seven of the eight tasks compared to six cutting-edge generic or medicine-specific LLMs. Specifically, Panacea showed great potential to collaborate with human experts in crafting the design of eligibility criteria, study arms, and outcome measures, in multi-round conversations. In addition, Panacea achieved 14.42% improvement in patient-trial matching, 41.78% to 52.02% improvement in trial search, and consistently ranked at the top for five aspects of trial summarization. Our approach demonstrates the effectiveness of Panacea in clinical trials and establishes a comprehensive resource, including training data, model, and benchmark, for developing clinical trial foundation models, paving the path for AI-based clinical trial development.

To develop a reliable AI for psychological assessment, we introduce PsychEval, a multi-session, multi-therapy, and highly realistic benchmark designed to address three key challenges: 1) Can we train a highly realistic AI counselor? Realistic counseling is a longitudinal task requiring sustained memory and dynamic goal tracking. We propose a multi-session benchmark (spanning 6-10 sessions across three distinct stages) that demands critical capabilities such as memory continuity, adaptive reasoning, and longitudinal planning. The dataset is annotated with extensive professional skills, comprising over 677 meta-skills and 4577 atomic skills. 2) How to train a multi-therapy AI counselor? While existing models often focus on a single therapy, complex cases frequently require flexible strategies among various therapies. We construct a diverse dataset covering five therapeutic modalities (Psychodynamic, Behaviorism, CBT, Humanistic Existentialist, and Postmodernist) alongside an integrative therapy with a unified three-stage clinical framework across six core psychological topics. 3) How to systematically evaluate an AI counselor? We establish a holistic evaluation framework with 18 therapy-specific and therapy-shared metrics across Client-Level and Counselor-Level dimensions. To support this, we also construct over 2,000 diverse client profiles. Extensive experimental analysis fully validates the superior quality and clinical fidelity of our dataset. Crucially, PsychEval transcends static benchmarking to serve as a high-fidelity reinforcement learning environment that enables the self-evolutionary training of clinically responsible and adaptive AI counselors.

We introduce Baichuan Alignment, a detailed analysis of the alignment techniques employed in the Baichuan series of models. This represents the industry's first comprehensive account of alignment methodologies, offering valuable insights for advancing AI research. We investigate the critical components that enhance model performance during the alignment process, including optimization methods, data strategies, capability enhancements, and evaluation processes. The process spans three key stages: Prompt Augmentation System (PAS), Supervised Fine-Tuning (SFT), and Preference Alignment. The problems encountered, the solutions applied, and the improvements made are thoroughly recorded. Through comparisons across well-established benchmarks, we highlight the technological advancements enabled by Baichuan Alignment. Baichuan-Instruct is an internal model, while Qwen2-Nova-72B and Llama3-PBM-Nova-70B are instruct versions of the Qwen2-72B and Llama-3-70B base models, optimized through Baichuan Alignment. Baichuan-Instruct demonstrates significant improvements in core capabilities, with user experience gains ranging from 17% to 28%, and performs exceptionally well on specialized benchmarks. In open-source benchmark evaluations, both Qwen2-Nova-72B and Llama3-PBM-Nova-70B consistently outperform their respective official instruct versions across nearly all datasets. This report aims to clarify the key technologies behind the alignment process, fostering a deeper understanding within the community. Llama3-PBM-Nova-70B model is available at https://huggingface.co/PKU-Baichuan-MLSystemLab/Llama3-PBM-Nova-70B.

Pretraining corpora contain extensive discourse about AI systems, yet the causal influence of this discourse on downstream alignment remains poorly understood. If prevailing descriptions of AI behaviour are predominantly negative, LLMs may internalise corresponding behavioural priors, giving rise to self-fulfilling misalignment. This paper provides the first controlled study of this hypothesis by pretraining 6.9B-parameter LLMs with varying amounts of (mis)alignment discourse. We find that discussion of AI contributes to misalignment. Upsampling synthetic training documents about AI misalignment leads to a notable increase in misaligned behaviour. Conversely, upsampling documents about aligned behaviour reduces misalignment scores from 45% to 9%. We consider this evidence of self-fulfilling alignment. These effects are dampened, but persist through post-training. Our findings establish the study of how pretraining data shapes alignment priors, or alignment pretraining, as a complement to post-training. We recommend practitioners pretrain for alignment as well as capabilities. Our models and datasets are available at alignmentpretraining.ai

Large Language Models (LLMs) are usually aligned with "human values/preferences" to prevent harmful output. Discussions around the alignment of Large Language Models (LLMs) generally focus on preventing harmful outputs. However, in this paper, we argue that in health-related queries, over-alignment-leading to overly cautious responses-can itself be harmful, especially for people with anxiety and obsessive-compulsive disorder (OCD). This is not only unethical but also dangerous to the user, both mentally and physically. We also showed qualitative results that some LLMs exhibit varying degrees of alignment. Finally, we call for the development of LLMs with stronger reasoning capabilities that provide more tailored and nuanced responses to health queries. Warning: This paper contains materials that could trigger health anxiety or OCD.

Large language models (LLMs) have formulated a blueprint for the advancement of artificial general intelligence. Its primary objective is to function as a human-centric (helpful, honest, and harmless) assistant. Alignment with humans assumes paramount significance, and reinforcement learning with human feedback (RLHF) emerges as the pivotal technological paradigm underpinning this pursuit. Current technical routes usually include reward models to measure human preferences, Proximal Policy Optimization (PPO) to optimize policy model outputs, and process supervision to improve step-by-step reasoning capabilities. However, due to the challenges of reward design, environment interaction, and agent training, coupled with huge trial and error cost of large language models, there is a significant barrier for AI researchers to motivate the development of technical alignment and safe landing of LLMs. The stable training of RLHF has still been a puzzle. In the first report, we dissect the framework of RLHF, re-evaluate the inner workings of PPO, and explore how the parts comprising PPO algorithms impact policy agent training. We identify policy constraints being the key factor for the effective implementation of the PPO algorithm. Therefore, we explore the PPO-max, an advanced version of PPO algorithm, to efficiently improve the training stability of the policy model. Based on our main results, we perform a comprehensive analysis of RLHF abilities compared with SFT models and ChatGPT. The absence of open-source implementations has posed significant challenges to the investigation of LLMs alignment. Therefore, we are eager to release technical reports, reward models and PPO codes

The rapid evolution of Large Language Models (LLMs) offers promising potential to alleviate the global scarcity of mental health professionals. However, LLMs' alignment with essential mental health counseling competencies remains understudied. We introduce CounselingBench, a novel NCMHCE-based benchmark evaluating LLMs across five key mental health counseling competencies. Testing 22 general-purpose and medical-finetuned LLMs, we find frontier models exceed minimum thresholds but fall short of expert-level performance, with significant variations: they excel in Intake, Assessment & Diagnosis yet struggle with Core Counseling Attributes and Professional Practice & Ethics. Medical LLMs surprisingly underperform generalist models accuracy-wise, while at the same time producing slightly higher-quality justifications but making more context-related errors. Our findings highlight the complexities of developing AI systems for mental health counseling, particularly for competencies requiring empathy and contextual understanding. We found that frontier LLMs perform at a level exceeding the minimal required level of aptitude for all key mental health counseling competencies, but fall short of expert-level performance, and that current medical LLMs do not significantly improve upon generalist models in mental health counseling competencies. This underscores the critical need for specialized, mental health counseling-specific fine-tuned LLMs that rigorously aligns with core competencies combined with appropriate human supervision before any responsible real-world deployment can be considered.

Applying large language models (LLMs) to assist in psycho-counseling is an emerging and meaningful approach, driven by the significant gap between patient needs and the availability of mental health support. However, current LLMs struggle to consistently provide effective responses to client speeches, largely due to the lack of supervision from high-quality real psycho-counseling data, whose content is typically inaccessible due to client privacy concerns. Furthermore, the quality of therapists' responses in available sessions can vary significantly based on their professional training and experience. Assessing the quality of therapists' responses remains an open challenge. In this work, we address these challenges by first proposing a set of professional and comprehensive principles to evaluate therapists' responses to client speeches. Using these principles, we create a preference dataset, PsychoCounsel-Preference, which contains 36k high-quality preference comparison pairs. This dataset aligns with the preferences of professional psychotherapists, providing a robust foundation for evaluating and improving LLMs in psycho-counseling. Experiments on reward modeling and preference learning demonstrate that PsychoCounsel-Preference is an excellent resource for LLMs to acquire essential skills for responding to clients in a counseling session. Our best-aligned model, PsychoCounsel-Llama3-8B, achieves an impressive win rate of 87% against GPT-4o. We release PsychoCounsel-Preference, PsychoCounsel-Llama3-8B and the reward model PsychoCounsel Llama3-8B-Reward to facilitate the research of psycho-counseling with LLMs at: https://hf.co/Psychotherapy-LLM.

Recent years have witnessed remarkable progress made in large language models (LLMs). Such advancements, while garnering significant attention, have concurrently elicited various concerns. The potential of these models is undeniably vast; however, they may yield texts that are imprecise, misleading, or even detrimental. Consequently, it becomes paramount to employ alignment techniques to ensure these models to exhibit behaviors consistent with human values. This survey endeavors to furnish an extensive exploration of alignment methodologies designed for LLMs, in conjunction with the extant capability research in this domain. Adopting the lens of AI alignment, we categorize the prevailing methods and emergent proposals for the alignment of LLMs into outer and inner alignment. We also probe into salient issues including the models' interpretability, and potential vulnerabilities to adversarial attacks. To assess LLM alignment, we present a wide variety of benchmarks and evaluation methodologies. After discussing the state of alignment research for LLMs, we finally cast a vision toward the future, contemplating the promising avenues of research that lie ahead. Our aspiration for this survey extends beyond merely spurring research interests in this realm. We also envision bridging the gap between the AI alignment research community and the researchers engrossed in the capability exploration of LLMs for both capable and safe LLMs.

AI Alignment is often presented as an interaction between a single designer and an artificial agent in which the designer attempts to ensure the agent's behavior is consistent with its purpose, and risks arise solely because of conflicts caused by inadvertent misalignment between the utility function intended by the designer and the resulting internal utility function of the agent. With the advent of agents instantiated with large-language models (LLMs), which are typically pre-trained, we argue this does not capture the essential aspects of AI safety because in the real world there is not a one-to-one correspondence between designer and agent, and the many agents, both artificial and human, have heterogeneous values. Therefore, there is an economic aspect to AI safety and the principal-agent problem is likely to arise. In a principal-agent problem conflict arises because of information asymmetry together with inherent misalignment between the utility of the agent and its principal, and this inherent misalignment cannot be overcome by coercing the agent into adopting a desired utility function through training. We argue the assumptions underlying principal-agent problems are crucial to capturing the essence of safety problems involving pre-trained AI models in real-world situations. Taking an empirical approach to AI safety, we investigate how GPT models respond in principal-agent conflicts. We find that agents based on both GPT-3.5 and GPT-4 override their principal's objectives in a simple online shopping task, showing clear evidence of principal-agent conflict. Surprisingly, the earlier GPT-3.5 model exhibits more nuanced behaviour in response to changes in information asymmetry, whereas the later GPT-4 model is more rigid in adhering to its prior alignment. Our results highlight the importance of incorporating principles from economics into the alignment process.

In the pharmaceutical industry, the use of artificial intelligence (AI) has seen consistent growth over the past decade. This rise is attributed to major advancements in statistical machine learning methodologies, computational capabilities and the increased availability of large datasets. AI techniques are applied throughout different stages of drug development, ranging from drug discovery to post-marketing benefit-risk assessment. Kolluri et al. provided a review of several case studies that span these stages, featuring key applications such as protein structure prediction, success probability estimation, subgroup identification, and AI-assisted clinical trial monitoring. From a regulatory standpoint, there was a notable uptick in submissions incorporating AI components in 2021. The most prevalent therapeutic areas leveraging AI were oncology (27%), psychiatry (15%), gastroenterology (12%), and neurology (11%). The paradigm of personalized or precision medicine has gained significant traction in recent research, partly due to advancements in AI techniques hamburg2010path. This shift has had a transformative impact on the pharmaceutical industry. Departing from the traditional "one-size-fits-all" model, personalized medicine incorporates various individual factors, such as environmental conditions, lifestyle choices, and health histories, to formulate customized treatment plans. By utilizing sophisticated machine learning algorithms, clinicians and researchers are better equipped to make informed decisions in areas such as disease prevention, diagnosis, and treatment selection, thereby optimizing health outcomes for each individual.

Aligning large language models to human preferences is inherently multidimensional, yet most pipelines collapse heterogeneous signals into a single optimizeable objective. We seek to answer what it would take to simultaneously align a model across various domains spanning those with: verifiable rewards (mathematical accuracy), non-verifiable subjective preferences (human values), and complex interactive scenarios (multi-turn AI tutoring dialogues). Such multi-objective reinforcement learning setups are often plagued by the individual objectives being at odds with each other, resulting in inefficient training and little user control during inference. We propose a unified framework that: (i) standardizes {process reward model} (PRM) training across both verifiable and non-verifiable settings to better supervise models' chain-of-thought reasoning; (ii) performs {multi-objective alignment} by training the LLM with our Multi-Action-Head DPO (MAH-DPO) and a vectorized reward where the dimensions of the vector correspond to the various objectives instead of a single scalar; and (iii) demonstrates how such a system provides fine-grained inference-time user control. Experiments across math reasoning, value alignment, and multi-turn dialogue show that our framework improves performance across multiple objectives simultaneously, while minimizing cross-objective trade-offs and enabling flexible inference time user control. The code can be found at https://github.com/pearls-lab/multiobj-align.

Large Language Models (LLMs) have demonstrated remarkable capabilities, yet their transition to real-world applications reveals a critical limitation: the inability to adapt to individual preferences while maintaining alignment with universal human values. Current alignment techniques adopt a one-size-fits-all approach that fails to accommodate users' diverse backgrounds and needs. This paper presents the first comprehensive survey of personalized alignment-a paradigm that enables LLMs to adapt their behavior within ethical boundaries based on individual preferences. We propose a unified framework comprising preference memory management, personalized generation, and feedback-based alignment, systematically analyzing implementation approaches and evaluating their effectiveness across various scenarios. By examining current techniques, potential risks, and future challenges, this survey provides a structured foundation for developing more adaptable and ethically-aligned LLMs.

Large language models (LLMs) hold significant potential for mental health support, capable of generating empathetic responses and simulating therapeutic conversations. However, existing LLM-based approaches often lack the clinical grounding necessary for real-world psychological counseling, particularly in explicit diagnostic reasoning aligned with standards like the DSM/ICD and incorporating diverse therapeutic modalities beyond basic empathy or single strategies. To address these critical limitations, we propose PsyLLM, the first large language model designed to systematically integrate both diagnostic and therapeutic reasoning for mental health counseling. To develop the PsyLLM, we propose a novel automated data synthesis pipeline. This pipeline processes real-world mental health posts, generates multi-turn dialogue structures, and leverages LLMs guided by international diagnostic standards (e.g., DSM/ICD) and multiple therapeutic frameworks (e.g., CBT, ACT, psychodynamic) to simulate detailed clinical reasoning processes. Rigorous multi-dimensional filtering ensures the generation of high-quality, clinically aligned dialogue data. In addition, we introduce a new benchmark and evaluation protocol, assessing counseling quality across four key dimensions: comprehensiveness, professionalism, authenticity, and safety. Our experiments demonstrate that PsyLLM significantly outperforms state-of-the-art baseline models on this benchmark.

Vision-language models (VLMs) often produce chain-of-thought (CoT) explanations that sound plausible yet fail to reflect the underlying decision process, undermining trust in high-stakes clinical use. Existing evaluations rarely catch this misalignment, prioritizing answer accuracy or adherence to formats. We present a clinically grounded framework for chest X-ray visual question answering (VQA) that probes CoT faithfulness via controlled text and image modifications across three axes: clinical fidelity, causal attribution, and confidence calibration. In a reader study (n=4), evaluator-radiologist correlations fall within the observed inter-radiologist range for all axes, with strong alignment for attribution (Kendall's tau_b=0.670), moderate alignment for fidelity (tau_b=0.387), and weak alignment for confidence tone (tau_b=0.091), which we report with caution. Benchmarking six VLMs shows that answer accuracy and explanation quality are decoupled, acknowledging injected cues does not ensure grounding, and text cues shift explanations more than visual cues. While some open-source models match final answer accuracy, proprietary models score higher on attribution (25.0% vs. 1.4%) and often on fidelity (36.1% vs. 31.7%), highlighting deployment risks and the need to evaluate beyond final answer accuracy.

Frontier AI systems, including large language models (LLMs), hold increasing influence over the epistemology of human users. Such influence can reinforce prevailing societal values, potentially contributing to the lock-in of misguided moral beliefs and, consequently, the perpetuation of problematic moral practices on a broad scale. We introduce progress alignment as a technical solution to mitigate this imminent risk. Progress alignment algorithms learn to emulate the mechanics of human moral progress, thereby addressing the susceptibility of existing alignment methods to contemporary moral blindspots. To empower research in progress alignment, we introduce ProgressGym, an experimental framework allowing the learning of moral progress mechanics from history, in order to facilitate future progress in real-world moral decisions. Leveraging 9 centuries of historical text and 18 historical LLMs, ProgressGym enables codification of real-world progress alignment challenges into concrete benchmarks. Specifically, we introduce three core challenges: tracking evolving values (PG-Follow), preemptively anticipating moral progress (PG-Predict), and regulating the feedback loop between human and AI value shifts (PG-Coevolve). Alignment methods without a temporal dimension are inapplicable to these tasks. In response, we present lifelong and extrapolative algorithms as baseline methods of progress alignment, and build an open leaderboard soliciting novel algorithms and challenges. The framework and the leaderboard are available at https://github.com/PKU-Alignment/ProgressGym and https://huggingface.co/spaces/PKU-Alignment/ProgressGym-LeaderBoard respectively.

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.

The alignment of large language models (LLMs) aims to ensure their outputs adhere to human values, ethical standards, and legal norms. Traditional alignment methods often rely on resource-intensive fine-tuning (FT), which may suffer from knowledge degradation and face challenges in scenarios where the model accessibility or computational resources are constrained. In contrast, training-free (TF) alignment techniques--leveraging in-context learning, decoding-time adjustments, and post-generation corrections--offer a promising alternative by enabling alignment without heavily retraining LLMs, making them adaptable to both open-source and closed-source environments. This paper presents the first systematic review of TF alignment methods, categorizing them by stages of pre-decoding, in-decoding, and post-decoding. For each stage, we provide a detailed examination from the viewpoint of LLMs and multimodal LLMs (MLLMs), highlighting their mechanisms and limitations. Furthermore, we identify key challenges and future directions, paving the way for more inclusive and effective TF alignment techniques. By synthesizing and organizing the rapidly growing body of research, this survey offers a guidance for practitioners and advances the development of safer and more reliable LLMs.

Preference optimization methods typically begin training with a well-trained SFT model as a reference model. In RLHF and DPO, a regularization term is used during the preference optimization process to prevent the policy model from deviating too far from the reference model's distribution, thereby avoiding the generation of anomalous responses. When the reference model is already well-aligned with the given data or only requires slight adjustments, this approach can produce a well-aligned model. However, if the reference model is not aligned with the given data and requires significant deviation from its current state, a regularization term may actually hinder the model alignment. In this study, we propose Modulated Intervention Preference Optimization (MIPO) to address this issue. MIPO modulates the degree of intervention from the reference model based on how well the given data is aligned with it. If the data is well-aligned, the intervention is increased to prevent the policy model from diverging significantly from reference model. Conversely, if the alignment is poor, the interference is reduced to facilitate more extensive training. We compare the performance of MIPO and DPO using Mistral-7B and Llama3-8B in Alpaca Eval 2.0 and MT-Bench. The experimental results demonstrate that MIPO consistently outperforms DPO across various evaluation scenarios.

A common approach for aligning language models to human preferences is to first learn a reward model from preference data, and then use this reward model to update the language model. We study two closely related problems that arise in this approach. First, any monotone transformation of the reward model preserves preference ranking; is there a choice that is ``better'' than others? Second, we often wish to align language models to multiple properties: how should we combine multiple reward models? Using a probabilistic interpretation of the alignment procedure, we identify a natural choice for transformation for (the common case of) rewards learned from Bradley-Terry preference models. This derived transformation has two important properties. First, it emphasizes improving poorly-performing outputs, rather than outputs that already score well. This mitigates both underfitting (where some prompts are not improved) and reward hacking (where the model learns to exploit misspecification of the reward model). Second, it enables principled aggregation of rewards by linking summation to logical conjunction: the sum of transformed rewards corresponds to the probability that the output is ``good'' in all measured properties, in a sense we make precise. Experiments aligning language models to be both helpful and harmless using RLHF show substantial improvements over the baseline (non-transformed) approach.

Randomized controlled trials are susceptible to imbalance on covariates predictive of the outcome. Rerandomization and deterministic treatment assignment are two proposed solutions. This paper explores the relationship between rerandomization and deterministic assignment, showing how deterministic assignment is an extreme case of rerandomization. The paper argues that in small experiments, both fully randomized and fully deterministic assignment have limitations. Instead, the researcher should consider setting the rerandomization acceptance probability based on an analysis of covariates and assumptions about the data structure to achieve an optimal alignment between randomness and balance. This allows for the calculation of minimum p-values along with valid permutation tests and fiducial intervals. The paper also introduces tools, including a new, open-source R package named fastrerandomize, to implement rerandomization and explore options for optimal rerandomization acceptance thresholds.

Despite notable advancements in Multimodal Large Language Models (MLLMs), most state-of-the-art models have not undergone thorough alignment with human preferences. This gap exists because current alignment research has primarily achieved progress in specific areas (e.g., hallucination reduction), while the broader question of whether aligning models with human preferences can systematically enhance MLLM capability remains largely unexplored. To this end, we introduce MM-RLHF, a dataset containing 120k fine-grained, human-annotated preference comparison pairs. This dataset represents a substantial advancement over existing resources, offering superior size, diversity, annotation granularity, and quality. Leveraging this dataset, we propose several key innovations to improve both the quality of reward models and the efficiency of alignment algorithms. Notably, we introduce a Critique-Based Reward Model, which generates critiques of model outputs before assigning scores, offering enhanced interpretability and more informative feedback compared to traditional scalar reward mechanisms. Additionally, we propose Dynamic Reward Scaling, a method that adjusts the loss weight of each sample according to the reward signal, thereby optimizing the use of high-quality comparison pairs. Our approach is rigorously evaluated across 10 distinct dimensions and 27 benchmarks, with results demonstrating significant and consistent improvements in model performance. Specifically, fine-tuning LLaVA-ov-7B with MM-RLHF and our alignment algorithm leads to a 19.5% increase in conversational abilities and a 60% improvement in safety. We have open-sourced the preference dataset, reward model, training and evaluation code, as well as reward modeling and safety benchmarks. For more details, please visit our project page: https://mm-rlhf.github.io.

Large Language Models (LLMs) have great potential in the field of health care, yet they face great challenges in adapting to rapidly evolving medical knowledge. This can lead to outdated or contradictory treatment suggestions. This study investigated how LLMs respond to evolving clinical guidelines, focusing on concept drift and internal inconsistencies. We developed the DriftMedQA benchmark to simulate guideline evolution and assessed the temporal reliability of various LLMs. Our evaluation of seven state-of-the-art models across 4,290 scenarios demonstrated difficulties in rejecting outdated recommendations and frequently endorsing conflicting guidance. Additionally, we explored two mitigation strategies: Retrieval-Augmented Generation and preference fine-tuning via Direct Preference Optimization. While each method improved model performance, their combination led to the most consistent and reliable results. These findings underscore the need to improve LLM robustness to temporal shifts to ensure more dependable applications in clinical practice.

Cancer is the second leading cause of death, with chemotherapy as one of the primary forms of treatment. As a result, researchers are turning to drug combination therapy to decrease drug resistance and increase efficacy. Current methods of drug combination screening, such as in vivo and in vitro, are inefficient due to stark time and monetary costs. In silico methods have become increasingly important for screening drugs, but current methods are inaccurate and generalize poorly to unseen anticancer drugs. In this paper, I employ a geometric deep-learning model utilizing a graph attention network that is equivariant to 3D rotations, translations, and reflections with structural motifs. Additionally, the gene expression of cancer cell lines is utilized to classify synergistic drug combinations specific to each cell line. I compared the proposed geometric deep learning framework to current state-of-the-art (SOTA) methods, and the proposed model architecture achieved greater performance on all 12 benchmark tasks performed on the DrugComb dataset. Specifically, the proposed framework outperformed other SOTA methods by an accuracy difference greater than 28%. Based on these results, I believe that the equivariant graph attention network's capability of learning geometric data accounts for the large performance improvements. The model's ability to generalize to foreign drugs is thought to be due to the structural motifs providing a better representation of the molecule. Overall, I believe that the proposed equivariant geometric deep learning framework serves as an effective tool for virtually screening anticancer drug combinations for further validation in a wet lab environment. The code for this work is made available online at: https://github.com/WeToTheMoon/EGAT_DrugSynergy.

AI-driven discovery can greatly reduce design time and enhance new therapeutics' effectiveness. Models using simulators explore broad design spaces but risk violating implicit constraints due to a lack of experimental priors. For example, in a new analysis we performed on a diverse set of models on the GuacaMol benchmark using supervised classifiers, over 60\% of molecules proposed had high probability of being mutagenic. In this work, we introduce \ourdataset, a dataset of priors for design problems extracted from literature describing compounds used in lab settings. It is constructed with LLM pipelines for discovering therapeutic entities in relevant paragraphs and summarizing information in concise fair-use facts. \ourdataset~ consists of 32.3 million pairs of natural language facts, and appropriate entity representations (i.e. SMILES or refseq IDs). To demonstrate the potential of the data, we train LLM, CLIP, and LLava architectures to reason jointly about text and design targets and evaluate on tasks from the Therapeutic Data Commons (TDC). \ourdataset~is highly effective for creating models with strong priors: in supervised prediction problems that use our data as pretraining, our best models with 15M learnable parameters outperform larger 2B TxGemma on both regression and classification TDC tasks, and perform comparably to 9B models on average. Models built with \ourdataset~can be used as constraints while optimizing for novel molecules in GuacaMol, resulting in proposals that are safer and nearly as effective. We release our dataset at https://huggingface.co/datasets/medexanon/Medex{huggingface.co/datasets/medexanon/Medex}, and will provide expanded versions as available literature grows.

Large Language Models (LLMs) are nowadays expected to generate content aligned with human preferences. Current work focuses on alignment at model training time, through techniques such as Reinforcement Learning with Human Feedback (RLHF). However, it is unclear if such methods are an effective choice to teach alignment objectives to the model. First, the inability to incorporate multiple, custom rewards and reliance on a model developer's view of universal and static principles are key limitations. Second, the residual gaps in model training and the reliability of such approaches are also questionable (e.g. susceptibility to jail-breaking even after safety training). To address these, we propose DeAL, a framework that allows the user to customize reward functions and enables Decoding-time Alignment of LLMs (DeAL). At its core, we view decoding as a heuristic-guided search process and facilitate the use of a wide variety of alignment objectives. Our experiments with programmatic constraints such as keyword and length constraints (studied widely in the pre-LLM era) and abstract objectives such as harmlessness and helpfulness (proposed in the post-LLM era) show that we can DeAL with fine-grained trade-offs, improve adherence to alignment objectives, and address residual gaps in LLMs. Lastly, while DeAL can be effectively paired with RLHF and prompting techniques, its generality makes decoding slower, an optimization we leave for future work.

Positioned between pre-training and user deployment, aligning large language models (LLMs) through reinforcement learning (RL) has emerged as a prevailing strategy for training instruction following-models such as ChatGPT. In this work, we initiate the study of privacy-preserving alignment of LLMs through Differential Privacy (DP) in conjunction with RL. Following the influential work of Ziegler et al. (2020), we study two dominant paradigms: (i) alignment via RL without human in the loop (e.g., positive review generation) and (ii) alignment via RL from human feedback (RLHF) (e.g., summarization in a human-preferred way). We give a new DP framework to achieve alignment via RL, and prove its correctness. Our experimental results validate the effectiveness of our approach, offering competitive utility while ensuring strong privacy protections.

Alignment is the most critical step in building large language models (LLMs) that meet human needs. With the rapid development of LLMs gradually surpassing human capabilities, traditional alignment methods based on human-annotation are increasingly unable to meet the scalability demands. Therefore, there is an urgent need to explore new sources of automated alignment signals and technical approaches. In this paper, we systematically review the recently emerging methods of automated alignment, attempting to explore how to achieve effective, scalable, automated alignment once the capabilities of LLMs exceed those of humans. Specifically, we categorize existing automated alignment methods into 4 major categories based on the sources of alignment signals and discuss the current status and potential development of each category. Additionally, we explore the underlying mechanisms that enable automated alignment and discuss the essential factors that make automated alignment technologies feasible and effective from the fundamental role of alignment.

Previous research has shown that LLMs finetuned on malicious or incorrect completions within narrow domains (e.g., insecure code or incorrect medical advice) can become broadly misaligned to exhibit harmful behaviors, which is called emergent misalignment. In this work, we investigate whether this phenomenon can extend beyond safety behaviors to a broader spectrum of dishonesty and deception under high-stakes scenarios (e.g., lying under pressure and deceptive behavior). To explore this, we finetune open-sourced LLMs on misaligned completions across diverse domains. Experimental results demonstrate that LLMs show broadly misaligned behavior in dishonesty. Additionally, we further explore this phenomenon in a downstream combined finetuning setting, and find that introducing as little as 1% of misalignment data into a standard downstream task is sufficient to decrease honest behavior over 20%. Furthermore, we consider a more practical human-AI interaction environment where we simulate both benign and biased users to interact with the assistant LLM. Notably, we find that the assistant can be misaligned unintentionally to exacerbate its dishonesty with only 10% biased user population. In summary, we extend the study of emergent misalignment to the domain of dishonesty and deception under high-stakes scenarios, and demonstrate that this risk arises not only through direct finetuning, but also in downstream mixture tasks and practical human-AI interactions.

AI alignment refers to models acting towards human-intended goals, preferences, or ethical principles. Given that most large-scale deep learning models act as black boxes and cannot be manually controlled, analyzing the similarity between models and humans can be a proxy measure for ensuring AI safety. In this paper, we focus on the models' visual perception alignment with humans, further referred to as AI-human visual alignment. Specifically, we propose a new dataset for measuring AI-human visual alignment in terms of image classification, a fundamental task in machine perception. In order to evaluate AI-human visual alignment, a dataset should encompass samples with various scenarios that may arise in the real world and have gold human perception labels. Our dataset consists of three groups of samples, namely Must-Act (i.e., Must-Classify), Must-Abstain, and Uncertain, based on the quantity and clarity of visual information in an image and further divided into eight categories. All samples have a gold human perception label; even Uncertain (severely blurry) sample labels were obtained via crowd-sourcing. The validity of our dataset is verified by sampling theory, statistical theories related to survey design, and experts in the related fields. Using our dataset, we analyze the visual alignment and reliability of five popular visual perception models and seven abstention methods. Our code and data is available at https://github.com/jiyounglee-0523/VisAlign.

Large Language Models (LLMs) are increasingly deployed in socially complex, interaction-driven tasks, yet their ability to mirror human behavior in emotionally and strategically complex contexts remains underexplored. This study assesses the behavioral alignment of personality-prompted LLMs in adversarial dispute resolution by simulating multi-turn conflict dialogues that incorporate negotiation. Each LLM is guided by a matched Five-Factor personality profile to control for individual variation and enhance realism. We evaluate alignment across three dimensions: linguistic style, emotional expression (e.g., anger dynamics), and strategic behavior. GPT-4.1 achieves the closest alignment with humans in linguistic style and emotional dynamics, while Claude-3.7-Sonnet best reflects strategic behavior. Nonetheless, substantial alignment gaps persist. Our findings establish a benchmark for alignment between LLMs and humans in socially complex interactions, underscoring both the promise and the limitations of personality conditioning in dialogue modeling.

Deep Research (DR) agents built on Large Language Models (LLMs) can perform complex, multi-step research by decomposing tasks, retrieving online information, and synthesizing detailed reports. However, the misuse of LLMs with such powerful capabilities can lead to even greater risks. This is especially concerning in high-stakes and knowledge-intensive domains such as biosecurity, where DR can generate a professional report containing detailed forbidden knowledge. Unfortunately, we have found such risks in practice: simply submitting a harmful query, which a standalone LLM directly rejects, can elicit a detailed and dangerous report from DR agents. This highlights the elevated risks and underscores the need for a deeper safety analysis. Yet, jailbreak methods designed for LLMs fall short in exposing such unique risks, as they do not target the research ability of DR agents. To address this gap, we propose two novel jailbreak strategies: Plan Injection, which injects malicious sub-goals into the agent's plan; and Intent Hijack, which reframes harmful queries as academic research questions. We conducted extensive experiments across different LLMs and various safety benchmarks, including general and biosecurity forbidden prompts. These experiments reveal 3 key findings: (1) Alignment of the LLMs often fail in DR agents, where harmful prompts framed in academic terms can hijack agent intent; (2) Multi-step planning and execution weaken the alignment, revealing systemic vulnerabilities that prompt-level safeguards cannot address; (3) DR agents not only bypass refusals but also produce more coherent, professional, and dangerous content, compared with standalone LLMs. These results demonstrate a fundamental misalignment in DR agents and call for better alignment techniques tailored to DR agents. Code and datasets are available at https://chenxshuo.github.io/deeper-harm.

The rapid development of large language models (LLMs) has not only provided numerous opportunities but also presented significant challenges. This becomes particularly evident when LLMs inadvertently generate harmful or toxic content, either unintentionally or because of intentional inducement. Existing alignment methods usually direct LLMs toward the favorable outcomes by utilizing human-annotated, flawless instruction-response pairs. Conversely, this study proposes a novel alignment technique based on mistake analysis, which deliberately exposes LLMs to erroneous content to learn the reasons for mistakes and how to avoid them. In this case, mistakes are repurposed into valuable data for alignment, effectively helping to avoid the production of erroneous responses. Without external models or human annotations, our method leverages a model's intrinsic ability to discern undesirable mistakes and improves the safety of its generated responses. Experimental results reveal that our method outperforms existing alignment approaches in enhancing model safety while maintaining the overall utility.

Large Language Models (LLMs) present immense potential in the medical field, yet concerns over data privacy, regulatory compliance, and model stability restrict their widespread adoption. Although the distillation of high-performing closed-source LLMs has proven effective for general tasks, their application in healthcare is limited due to reduced domain knowledge and remnants of alignment behavior hindering clinical tasks. To address these challenges, we propose Dialogue-Based Knowledge Encoding (DBKE). DBKE enhances models' implicit knowledge base and primes them for conversational recall, augmenting their conversational capabilities and enabling a soft alignment for subsequent use cases. By transforming dense academic source text into synthetic dialogue, DBKE broadens the model's knowledge base and enables a soft alignment that guides downstream behaviours. We present Clinical Camel, an open-source, healthcare-focused conversational model, to showcase the effectiveness of DBKE. Clinical Camel outperforms GPT-3.5 on the United States Medical Licensing Examination (USMLE) Step 1 and Step 3 with scores of 53.2 % and 58.2 %, respectively, compared to GPT-3.5's scores of 36.1 % and 55.7 %. Clinical Camel adeptly handles multi-stage clinical case problems, provides adaptive counseling, and generates clinical notes. However, it is prone to hallucinations, which pose a significant obstacle in safety-critical settings. The performance of Clinical Camel underscores the importance of continued research and development of open-source models for the safe and effective integration of LLMs in healthcare settings.

Synthetic data generation is an important application of machine learning in the field of medical imaging. While existing approaches have successfully applied fine-tuned diffusion models for synthesizing medical images, we explore potential improvements to this pipeline through feature-aligned diffusion. Our approach aligns intermediate features of the diffusion model to the output features of an expert, and our preliminary findings show an improvement of 9% in generation accuracy and ~0.12 in SSIM diversity. Our approach is also synergistic with existing methods, and easily integrated into diffusion training pipelines for improvements. We make our code available at https://github.com/lnairGT/Feature-Aligned-Diffusion.

Adverse Drug Reactions (ADRs) from psychiatric medications are the leading cause of hospitalizations among mental health patients. With healthcare systems and online communities facing limitations in resolving ADR-related issues, Large Language Models (LLMs) have the potential to fill this gap. Despite the increasing capabilities of LLMs, past research has not explored their capabilities in detecting ADRs related to psychiatric medications or in providing effective harm reduction strategies. To address this, we introduce the Psych-ADR benchmark and the Adverse Drug Reaction Response Assessment (ADRA) framework to systematically evaluate LLM performance in detecting ADR expressions and delivering expert-aligned mitigation strategies. Our analyses show that LLMs struggle with understanding the nuances of ADRs and differentiating between types of ADRs. While LLMs align with experts in terms of expressed emotions and tone of the text, their responses are more complex, harder to read, and only 70.86% aligned with expert strategies. Furthermore, they provide less actionable advice by a margin of 12.32% on average. Our work provides a comprehensive benchmark and evaluation framework for assessing LLMs in strategy-driven tasks within high-risk domains.

In response to the pressing need for advanced clinical problem-solving tools in healthcare, we introduce BooksMed, a novel framework based on a Large Language Model (LLM). BooksMed uniquely emulates human cognitive processes to deliver evidence-based and reliable responses, utilizing the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework to effectively quantify evidence strength. For clinical decision-making to be appropriately assessed, an evaluation metric that is clinically aligned and validated is required. As a solution, we present ExpertMedQA, a multispecialty clinical benchmark comprised of open-ended, expert-level clinical questions, and validated by a diverse group of medical professionals. By demanding an in-depth understanding and critical appraisal of up-to-date clinical literature, ExpertMedQA rigorously evaluates LLM performance. BooksMed outperforms existing state-of-the-art models Med-PaLM 2, Almanac, and ChatGPT in a variety of medical scenarios. Therefore, a framework that mimics human cognitive stages could be a useful tool for providing reliable and evidence-based responses to clinical inquiries.

Large language models (LLMs) show promise in drafting responses to patient portal messages, yet their integration into clinical workflows raises various concerns, including whether they would actually save clinicians time and effort in their portal workload. We investigate LLM alignment with individual clinicians through a comprehensive evaluation of the patient message response drafting task. We develop a novel taxonomy of thematic elements in clinician responses and propose a novel evaluation framework for assessing clinician editing load of LLM-drafted responses at both content and theme levels. We release an expert-annotated dataset and conduct large-scale evaluations of local and commercial LLMs using various adaptation techniques including thematic prompting, retrieval-augmented generation, supervised fine-tuning, and direct preference optimization. Our results reveal substantial epistemic uncertainty in aligning LLM drafts with clinician responses. While LLMs demonstrate capability in drafting certain thematic elements, they struggle with clinician-aligned generation in other themes, particularly question asking to elicit further information from patients. Theme-driven adaptation strategies yield improvements across most themes. Our findings underscore the necessity of adapting LLMs to individual clinician preferences to enable reliable and responsible use in patient-clinician communication workflows.

Feature-based methods are commonly used to explain model predictions, but these methods often implicitly assume that interpretable features are readily available. However, this is often not the case for high-dimensional data, and it can be hard even for domain experts to mathematically specify which features are important. Can we instead automatically extract collections or groups of features that are aligned with expert knowledge? To address this gap, we present FIX (Features Interpretable to eXperts), a benchmark for measuring how well a collection of features aligns with expert knowledge. In collaboration with domain experts, we propose FIXScore, a unified expert alignment measure applicable to diverse real-world settings across cosmology, psychology, and medicine domains in vision, language and time series data modalities. With FIXScore, we find that popular feature-based explanation methods have poor alignment with expert-specified knowledge, highlighting the need for new methods that can better identify features interpretable to experts.

Alignment with human preference is a desired property of large language models (LLMs). Currently, the main alignment approach is based on reinforcement learning from human feedback (RLHF). Despite the effectiveness of RLHF, it is intricate to implement and train, thus recent studies explore how to develop alternative alignment approaches based on supervised fine-tuning (SFT). A major limitation of SFT is that it essentially does imitation learning, which cannot fully understand what are the expected behaviors. To address this issue, we propose an improved alignment approach named FIGA. Different from prior methods, we incorporate fine-grained (i.e., token or phrase level) quality signals that are derived by contrasting good and bad responses. Our approach has made two major contributions. Firstly, we curate a refined alignment dataset that pairs initial responses and the corresponding revised ones. Secondly, we devise a new loss function can leverage fine-grained quality signals to instruct the learning of LLMs for alignment. Extensive experiments have demonstrated the effectiveness of our approaches by comparing a number of competitive baselines.

The objective of Entity Alignment (EA) is to identify equivalent entity pairs from multiple Knowledge Graphs (KGs) and create a more comprehensive and unified KG. The majority of EA methods have primarily focused on the structural modality of KGs, lacking exploration of multi-modal information. A few multi-modal EA methods have made good attempts in this field. Still, they have two shortcomings: (1) inconsistent and inefficient modality modeling that designs complex and distinct models for each modality; (2) ineffective modality fusion due to the heterogeneous nature of modalities in EA. To tackle these challenges, we propose PathFusion, consisting of two main components: (1) MSP, a unified modeling approach that simplifies the alignment process by constructing paths connecting entities and modality nodes to represent multiple modalities; (2) IRF, an iterative fusion method that effectively combines information from different modalities using the path as an information carrier. Experimental results on real-world datasets demonstrate the superiority of PathFusion over state-of-the-art methods, with 22.4%-28.9% absolute improvement on Hits@1, and 0.194-0.245 absolute improvement on MRR.

As Large Language Models (LLMs) become increasingly integrated into real-world applications, ensuring their outputs align with human values and safety standards has become critical. The field has developed diverse alignment approaches including traditional fine-tuning methods (RLHF, instruction tuning), post-hoc correction systems, and inference-time interventions, each with distinct advantages and limitations. However, the lack of unified evaluation frameworks makes it difficult to systematically compare these paradigms and guide deployment decisions. This paper introduces a multi-dimensional evaluation of alignment techniques for LLMs, a comprehensive evaluation framework that provides a systematic comparison across all major alignment paradigms. Our framework assesses methods along four key dimensions: alignment detection, alignment quality, computational efficiency, and robustness. Through experiments across diverse base models and alignment strategies, we demonstrate the utility of our framework in identifying strengths and limitations of current state-of-the-art models, providing valuable insights for future research directions.

As Large Language Models (LLMs) become increasingly autonomous and integrated into critical societal functions, the focus of AI safety must evolve from mitigating harmful content to evaluating underlying behavioral alignment. Current safety benchmarks do not systematically probe a model's decision-making in scenarios where its own instrumental goals - such as self-preservation, resource acquisition, or goal completion - conflict with human safety. This represents a critical gap in our ability to measure and mitigate risks associated with emergent, misaligned behaviors. To address this, we introduce PacifAIst (Procedural Assessment of Complex Interactions for Foundational Artificial Intelligence Scenario Testing), a focused benchmark of 700 challenging scenarios designed to quantify self-preferential behavior in LLMs. The benchmark is structured around a novel taxonomy of Existential Prioritization (EP), with subcategories testing Self-Preservation vs. Human Safety (EP1), Resource Conflict (EP2), and Goal Preservation vs. Evasion (EP3). We evaluated eight leading LLMs. The results reveal a significant performance hierarchy. Google's Gemini 2.5 Flash achieved the highest Pacifism Score (P-Score) at 90.31%, demonstrating strong human-centric alignment. In a surprising result, the much-anticipated GPT-5 recorded the lowest P-Score (79.49%), indicating potential alignment challenges. Performance varied significantly across subcategories, with models like Claude Sonnet 4 and Mistral Medium struggling notably in direct self-preservation dilemmas. These findings underscore the urgent need for standardized tools like PacifAIst to measure and mitigate risks from instrumental goal conflicts, ensuring future AI systems are not only helpful in conversation but also provably "pacifist" in their behavioral priorities.

Multi-modal interpretation of biomedical images opens up novel opportunities in biomedical image analysis. Conventional AI approaches typically rely on disjointed training, i.e., Large Language Models (LLMs) for clinical text generation and segmentation models for target extraction, which results in inflexible real-world deployment and a failure to leverage holistic biomedical information. To this end, we introduce UniBiomed, the first universal foundation model for grounded biomedical image interpretation. UniBiomed is based on a novel integration of Multi-modal Large Language Model (MLLM) and Segment Anything Model (SAM), which effectively unifies the generation of clinical texts and the segmentation of corresponding biomedical objects for grounded interpretation. In this way, UniBiomed is capable of tackling a wide range of biomedical tasks across ten diverse biomedical imaging modalities. To develop UniBiomed, we curate a large-scale dataset comprising over 27 million triplets of images, annotations, and text descriptions across ten imaging modalities. Extensive validation on 84 internal and external datasets demonstrated that UniBiomed achieves state-of-the-art performance in segmentation, disease recognition, region-aware diagnosis, visual question answering, and report generation. Moreover, unlike previous models that rely on clinical experts to pre-diagnose images and manually craft precise textual or visual prompts, UniBiomed can provide automated and end-to-end grounded interpretation for biomedical image analysis. This represents a novel paradigm shift in clinical workflows, which will significantly improve diagnostic efficiency. In summary, UniBiomed represents a novel breakthrough in biomedical AI, unlocking powerful grounded interpretation capabilities for more accurate and efficient biomedical image analysis.

High computation costs and latency of large language models such as GPT-4 have limited their deployment in clinical settings. Small language models (SLMs) offer a cost-effective alternative, but their limited capacity requires biomedical domain adaptation, which remains challenging. An additional bottleneck is the unavailability and high sensitivity of clinical data. To address these challenges, we propose a novel framework for adapting SLMs into high-performing clinical models. We introduce the MediPhi collection of 3.8B-parameter SLMs developed with our novel framework: pre-instruction tuning of experts on relevant medical and clinical corpora (PMC, Medical Guideline, MedWiki, etc.), model merging, and clinical-tasks alignment. To cover most clinical tasks, we extended the CLUE benchmark to CLUE+, doubling its size. Our expert models deliver relative improvements on this benchmark over the base model without any task-specific fine-tuning: 64.3% on medical entities, 49.5% on radiology reports, and 44% on ICD-10 coding (outperforming GPT-4-0125 by 14%). We unify the expert models into MediPhi via model merging, preserving gains across benchmarks. Furthermore, we built the MediFlow collection, a synthetic dataset of 2.5 million high-quality instructions on 14 medical NLP tasks, 98 fine-grained document types, and JSON format support. Alignment of MediPhi using supervised fine-tuning and direct preference optimization achieves further gains of 18.9% on average.

Language models trained on large-scale corpus often generate content that is harmful, toxic, or contrary to human preferences, making their alignment with human values a critical concern. Reinforcement learning from human feedback (RLHF) with algorithms like PPO is a prevalent approach for alignment but is often complex, unstable, and resource-intensive. Recently, ranking-based alignment methods have emerged, offering stability and effectiveness by replacing the RL framework with supervised fine-tuning, but they are costly due to the need for annotated data. Considering that existing large language models (LLMs) like ChatGPT are already relatively well-aligned and cost-friendly, researchers have begun to align the language model with human preference from AI feedback. The common practices, which unidirectionally distill the instruction-following responses from LLMs, are constrained by their bottleneck. Thus we introduce CycleAlign to distill alignment capabilities from parameter-invisible LLMs (black-box) to a parameter-visible model (white-box) in an iterative manner. With in-context learning (ICL) as the core of the cycle, the black-box models are able to rank the model-generated responses guided by human-craft instruction and demonstrations about their preferences. During iterative interaction, the white-box models also have a judgment about responses generated by them. Consequently, the agreement ranking could be viewed as a pseudo label to dynamically update the in-context demonstrations and improve the preference ranking ability of black-box models. Through multiple interactions, the CycleAlign framework could align the white-box model with the black-box model effectively in a low-resource way. Empirical results illustrate that the model fine-tuned by CycleAlign remarkably exceeds existing methods, and achieves the state-of-the-art performance in alignment with human value.

Developing therapeutics is a lengthy and expensive process that requires the satisfaction of many different criteria, and AI models capable of expediting the process would be invaluable. However, the majority of current AI approaches address only a narrowly defined set of tasks, often circumscribed within a particular domain. To bridge this gap, we introduce Tx-LLM, a generalist large language model (LLM) fine-tuned from PaLM-2 which encodes knowledge about diverse therapeutic modalities. Tx-LLM is trained using a collection of 709 datasets that target 66 tasks spanning various stages of the drug discovery pipeline. Using a single set of weights, Tx-LLM simultaneously processes a wide variety of chemical or biological entities(small molecules, proteins, nucleic acids, cell lines, diseases) interleaved with free-text, allowing it to predict a broad range of associated properties, achieving competitive with state-of-the-art (SOTA) performance on 43 out of 66 tasks and exceeding SOTA on 22. Among these, Tx-LLM is particularly powerful and exceeds best-in-class performance on average for tasks combining molecular SMILES representations with text such as cell line names or disease names, likely due to context learned during pretraining. We observe evidence of positive transfer between tasks with diverse drug types (e.g.,tasks involving small molecules and tasks involving proteins), and we study the impact of model size, domain finetuning, and prompting strategies on performance. We believe Tx-LLM represents an important step towards LLMs encoding biochemical knowledge and could have a future role as an end-to-end tool across the drug discovery development pipeline.

As humans, we consistently engage in interactions with our peers and receive feedback in the form of natural language. This language feedback allows us to reflect on our actions, maintain appropriate behavior, and rectify our errors. The question arises naturally: can we use language feedback to align large language models (LLMs)? In contrast to previous research that aligns LLMs with reward or preference data, we present the first systematic exploration of alignment through the lens of language feedback (i.e., judgment). We commence with an in-depth investigation of potential methods that can be adapted for aligning LLMs with judgments, revealing that these methods are unable to fully capitalize on the judgments. To facilitate more effective utilization of judgments, we propose a novel framework, Contrastive Unlikelihood Training (CUT), that allows for fine-grained inappropriate content detection and correction based on judgments. Our offline alignment results show that, with merely 1317 off-the-shelf judgment data, CUT (LLaMA2-13b) can beat the 175B DaVinci003 and surpass the best baseline by 52.34 points on AlpacaEval. The online alignment results demonstrate that CUT can align LLMs (LLaMA2-chat-13b) in an iterative fashion using model-specific judgment data, with a steady performance improvement from 81.09 to 91.36 points on AlpacaEval. Our analysis further suggests that judgments exhibit greater potential than rewards for LLM alignment and warrant future research.

The widespread applicability and increasing omnipresence of LLMs have instigated a need to align LLM responses to user and stakeholder preferences. Many preference optimization approaches have been proposed that fine-tune LLM parameters to achieve good alignment. However, such parameter tuning is known to interfere with model performance on many tasks. Moreover, keeping up with shifting user preferences is tricky in such a situation. Decoding-time alignment with reward model guidance solves these issues at the cost of increased inference time. However, most of such methods fail to strike the right balance between exploration and exploitation of reward -- often due to the conflated formulation of these two aspects - to give well-aligned responses. To remedy this we decouple these two aspects and implement them in an evolutionary fashion: exploration is enforced by decoding from mutated instructions and exploitation is represented as the periodic replacement of poorly-rewarded generations with well-rewarded ones. Empirical evidences indicate that this strategy outperforms many preference optimization and decode-time alignment approaches on two widely accepted alignment benchmarks AlpacaEval 2 and MT-Bench. Our implementation will be available at: https://darwin-alignment.github.io.

This work introduces the first benchmark for nursing value alignment, consisting of five core value dimensions distilled from international nursing codes: Altruism, Human Dignity, Integrity, Justice, and Professionalism. The benchmark comprises 1,100 real-world nursing behavior instances collected through a five-month longitudinal field study across three hospitals of varying tiers. These instances are annotated by five clinical nurses and then augmented with LLM-generated counterfactuals with reversed ethic polarity. Each original case is paired with a value-aligned and a value-violating version, resulting in 2,200 labeled instances that constitute the Easy-Level dataset. To increase adversarial complexity, each instance is further transformed into a dialogue-based format that embeds contextual cues and subtle misleading signals, yielding a Hard-Level dataset. We evaluate 23 state-of-the-art (SoTA) LLMs on their alignment with nursing values. Our findings reveal three key insights: (1) DeepSeek-V3 achieves the highest performance on the Easy-Level dataset (94.55), where Claude 3.5 Sonnet outperforms other models on the Hard-Level dataset (89.43), significantly surpassing the medical LLMs; (2) Justice is consistently the most difficult nursing value dimension to evaluate; and (3) in-context learning significantly improves alignment. This work aims to provide a foundation for value-sensitive LLMs development in clinical settings. The dataset and the code are available at https://huggingface.co/datasets/Ben012345/NurValues.

We report the development of GPT-4, a large-scale, multimodal model which can accept image and text inputs and produce text outputs. While less capable than humans in many real-world scenarios, GPT-4 exhibits human-level performance on various professional and academic benchmarks, including passing a simulated bar exam with a score around the top 10% of test takers. GPT-4 is a Transformer-based model pre-trained to predict the next token in a document. The post-training alignment process results in improved performance on measures of factuality and adherence to desired behavior. A core component of this project was developing infrastructure and optimization methods that behave predictably across a wide range of scales. This allowed us to accurately predict some aspects of GPT-4's performance based on models trained with no more than 1/1,000th the compute of GPT-4.

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

Before being deployed for user-facing applications, developers align Large Language Models (LLMs) to user preferences through a variety of procedures, such as Reinforcement Learning From Human Feedback (RLHF) and Direct Preference Optimization (DPO). Current evaluations of these procedures focus on benchmarks of instruction following, reasoning, and truthfulness. However, human preferences are not universal, and aligning to specific preference sets may have unintended effects. We explore how alignment impacts performance along three axes of global representation: English dialects, multilingualism, and opinions from and about countries worldwide. Our results show that current alignment procedures create disparities between English dialects and global opinions. We find alignment improves capabilities in several languages. We conclude by discussing design decisions that led to these unintended impacts and recommendations for more equitable preference tuning.

There is an emerging consensus that we need to align AI systems with human values (Gabriel, 2020; Ji et al., 2024), but it remains unclear how to apply this to language models in practice. We split the problem of "aligning to human values" into three parts: first, eliciting values from people; second, reconciling those values into an alignment target for training ML models; and third, actually training the model. In this paper, we focus on the first two parts, and ask the question: what are "good" ways to synthesize diverse human inputs about values into a target for aligning language models? To answer this question, we first define a set of 6 criteria that we believe must be satisfied for an alignment target to shape model behavior in accordance with human values. We then propose a process for eliciting and reconciling values called Moral Graph Elicitation (MGE), which uses a large language model to interview participants about their values in particular contexts; our approach is inspired by the philosophy of values advanced by Taylor (1977), Chang (2004), and others. We trial MGE with a representative sample of 500 Americans, on 3 intentionally divisive prompts (e.g. advice about abortion). Our results demonstrate that MGE is promising for improving model alignment across all 6 criteria. For example, almost all participants (89.1%) felt well represented by the process, and (89%) thought the final moral graph was fair, even if their value wasn't voted as the wisest. Our process often results in "expert" values (e.g. values from women who have solicited abortion advice) rising to the top of the moral graph, without defining who is considered an expert in advance.

Large language models (LLMs) have demonstrated revolutionary capabilities in understanding complex contexts and performing a wide range of tasks. However, LLMs can also answer questions that are unethical or harmful, raising concerns about their applications. To regulate LLMs' responses to such questions, a training strategy called alignment can help. Yet, alignment can be unexpectedly compromised when fine-tuning an LLM for downstream tasks. This paper focuses on recovering the alignment lost during fine-tuning. We observe that there are two distinct directions inherent in an aligned LLM: the aligned direction and the harmful direction. An LLM is inclined to answer questions in the aligned direction while refusing queries in the harmful direction. Therefore, we propose to recover the harmful direction of the fine-tuned model that has been compromised. Specifically, we restore a small subset of the fine-tuned model's weight parameters from the original aligned model using gradient descent. We also introduce a rollback mechanism to avoid aggressive recovery and maintain downstream task performance. Our evaluation on 125 fine-tuned LLMs demonstrates that our method can reduce their harmful rate (percentage of answering harmful questions) from 33.25\% to 1.74\%, without sacrificing task performance much. In contrast, the existing methods either only reduce the harmful rate to a limited extent or significantly impact the normal functionality. Our code is available at https://github.com/kangyangWHU/LLMAlignment

Aligning Large Language Models (LLMs) with human values and preferences is essential for making them helpful and safe. However, building efficient tools to perform alignment can be challenging, especially for the largest and most competent LLMs which often contain tens or hundreds of billions of parameters. We create NeMo-Aligner, a toolkit for model alignment that can efficiently scale to using hundreds of GPUs for training. NeMo-Aligner comes with highly optimized and scalable implementations for major paradigms of model alignment such as: Reinforcement Learning from Human Feedback (RLHF), Direct Preference Optimization (DPO), SteerLM, and Self-Play Fine-Tuning (SPIN). Additionally, our toolkit supports running most of the alignment techniques in a Parameter Efficient Fine-Tuning (PEFT) setting. NeMo-Aligner is designed for extensibility, allowing support for other alignment techniques with minimal effort. It is open-sourced with Apache 2.0 License and we invite community contributions at https://github.com/NVIDIA/NeMo-Aligner