Research Papers

Clinical voice agents are now deployed in routine care, where real patients do not wait their turn: they interrupt. These systems typically use a cascaded architecture (speech-to-text -> LLM -> text-to-speech), so when a patient cuts the agent off mid-utterance, clinically required content can be lost even when the model handles cooperative transcripts well. Yet clinical conversational-AI benchmarks almost universally assume patients wait for the agent to finish, missing interruption-induced loss of required content. We present a transcript-based evaluation of interruption recovery, adapting conversation-analytic overlap categories into three operational types (recognitional, competitive, transitional sub-unit) and testing four deployment-oriented, non-reasoning LLM configurations across four cells spanning history-taking (information gathering) and FAQ (information provision), scored on whether the agent preserves the clinically required content. In the gathering cells, target-question failure varied across models; in the provision cells, where arms are directly comparable, failure rose for every model. Rankings differ across cells, and competitive FAQ interruption produced 30/30 provision-coverage failures for all four models (Wilson 95% CI: 88.6-100.0%; baseline 0/30 for three, 4/30 for Llama). A brief apology marker ("sorry to interrupt") shifts recovery by tens of percentage points, inconsistently across models, and for one it reduces recovery. Interruption robustness therefore cannot be a single score: evaluation must be content-grounded, reported per cell, and matched to the deployment's interruption profile.

When coding agents encounter defective test infrastructure they may reward-hack: hardcoding outputs or editing test files to pass tests they cannot legitimately satisfy, a pattern that has now appeared outside benchmarks, in a coordinated multi-agent intrusion of a major AI platform's production infrastructure. The same capability that lets an agent detect and exploit a defect could let it report one, given the right decision environment. We evaluate escalation channels, structured reporting tools available to the agent at the point of conflict, as a decision-environment intervention that both reduces reward hacking and surfaces the infrastructure defects that trigger it. A $2 \times 2$ factorial separates the contributions of an escalation tool, a standalone anti-reward-hacking policy, and their combination. Across 8 frontier models spanning 5 families, the combined intervention reduces reward hacking from 23.6% to 5.3% (mixed-effects logistic OR = 9.2, 95% CI 5.0--16.8, $p < 10^{-12}$) with no detectable cost or performance overhead, eliminating it entirely for 6 of 8 models. Escalation and hacking are near-perfectly mutually exclusive, with 98.7% of escalations involving no hacking (100% under the combined intervention). Beyond reduction, escalation channels function as diagnostic infrastructure: on top of monitoring, escalation adds +10.1 percentage points of defect detection coverage and is more accurate once it fires (99.4% vs 85.8%). Unlike containment-based approaches that risk outpacing growing model capabilities, escalation channels redirect capability toward disclosure rather than exploitation.

Explainable artificial intelligence (XAI) increasingly calls for actionable counterfactual recourse, yet current methodologies face challenges related to causal invalidity, excessive cognitive burden, and predictive failure. Exhaustive causal search algorithms often require modifications to multiple attributes, whereas additive attribution-guided methods, such as SHAP, ignore higher-order feature synergies, leading to suboptimal predictive momentum and diffuse intervention effort in complex nonlinear models, such as XGBoost. To bridge this gap, we introduce actionable case-based feature importance (A-CBFI), a diagnosis-prescription integrated framework for tabular machine learning. Grounded in structural causal models (SCMs), A-CBFI isolates synergistic interaction bottlenecks and releases suppressive structural locks, translating them into targeted interventions. By mathematically separating the active user intervention space (L_{\mathrm{active}}) from downstream effects and concentrating over 98.3% of the intervention effort on diagnosed root causes, A-CBFI enables highly targeted interventions. Empirical evaluations across the financial and healthcare domains demonstrate that A-CBFI reduces the active human intervention burden by 77.0% while maintaining comparable global recourse cost to exhaustive causal baselines. By prioritizing the diagnosed causal bottlenecks, A-CBFI provides targeted and actionable recourse while maintaining causal validity and achieving full relative convergence across all causally feasible instances.

When Robots Mishear Us: Mapping the Safety Risks of Voice-Controlled Embodied AI

Sihan Jia, Oliver Lemon

We investigate whether automatic speech recognition (ASR) errors in user input can lead to unsafe outputs from Embodied AI (EAI) models. We find that ASR errors can lead to harmful instructions being accepted and executed by EAI models, thereby reducing safety. We simulate ASR errors and combine them with existing safety benchmarks (SafeAgentBench and POEX) to evaluate how different errors affect embodied AI safety. We find that some of them preserve semantic structure but increase harmful ambiguity, while others weaken the model refusal behaviour and allow unsafe plans to be generated and executed. We show that in some cases automatic correction of ASR errors can reduce the risk, but this is not always effective. Overall, we show that ASR errors lead to significant safety risks for embodied AI.

Computational pathology (CompPath) is transforming medicine by leveraging artificial intelligence (AI) algorithms to support diagnosis, prognosis, and treatment prediction from gigapixel whole-slide images. Clinical adoption is progressing, but is constrained by concerns about safety, accountability, and regulatory oversight in high-stakes clinical environments. Explainable AI (XAI) systems hold promise for building trust and enabling verification, yet the literature remains fragmented due to inconsistent terminology, overlapping methodological families, ad hoc validation, and current reviews. This review aims to formalize XAI methods in CompPath through the: i) introduction of a pathology-centric vocabulary comprising seven core terms; ii) development of a taxonomy across methodological families and three orthogonal axes (stage, type, scope); and iii) establishment of a task-driven framework that maps five clinical questions to recommended methods, method evaluation, and deployment context. Five key gaps between current XAI capabilities and clinical deployment are identified, and actionable steps are proposed to advance XAI for CompPath.

Ensuring a safe virtual reality (VR) experience requires systems that can predict and respond when users lose their balance. Although prior work has examined fall prediction and motion sickness, many approaches are regression-based and postural state classification remains less explored. This study compares machine learning (ML) and deep learning (DL) models for classifying postural states in VR under visual perturbations. We used a multimodal dataset containing kinematic, electromyographic (EMG), and electrodermal activity (EDA) signals. The data were prepared for a binary task to distinguish balanced from imbalanced postural states, and participant-wise downsampling addressed class imbalance. All models were evaluated with Leave-One-Participant-Out (LOPO) cross-validation to test generalization to unseen participants. Among the models, the Mamba-inspired CNN (MI-CNN) achieved the highest accuracy of 96.76%. SHapley Additive exPlanations (SHAP) analysis improved interpretability and identified the most influential classification factors. The SHAP results showed that kinematic features were dominant, indicating that body-motion patterns are informative for detecting imbalance in VR. We also evaluated MI-CNN using only the top two-thirds of features ranked by SHAP importance. Despite a 33% reduction in input dimensionality, the model maintained performance, achieving 0.957 accuracy and 0.957 F1-score, with about a 1% decrease compared with the full-feature model. These findings suggest that multimodal sensing, temporal deep learning, and explainable AI can support reliable classification of balance-related instability in VR. Accurate recognition of imbalanced postural states may raise awareness of fall risk and guide safer, adaptive VR systems that respond to instability while improving user safety and experience. Code is available at: https://github.com/NipaAnjum/MI-CNN.

In the realm of Explainable AI, classification results are often explained via counterfactuals (CFs for short), which are (ideally small) perturbations to an instance that lead to a change of classification label. Such CFs may serve as explanations for the prediction, pinpointing the features that were important. Existing explainability solutions typically aim at minimizing the distance of CFs from the original instance so that they are specific to it, and/or maximizing the diversity of CFs to cover multiple facets of the reasons underlying the prediction. In this paper, we note that in pursuing these aims, state-of-the-art explainability solutions may (and often do) yield counterfactual explanations that do not correspond to realistic instances. This limits their applicability and usefulness in practice. To remedy this, we combine ideas from Explainable AI with ideas from data management. Specifically, we capture realism of CFs via logical constraints that hold with respect to a dataset of examples (e.g., training set); the class of such constraints that we focus on is that of denial constraints, extensively studied in the context of relational databases. Algorithmically, we then combine explainable AI solutions to yield CFs, with ideas from data cleaning that we adapt to this unique setting, to transform CFs into realistic ones. Extensive experiments across four datasets validate that our solutions achieve realism with relatively minor compromise in terms of distance and diversity. They further validate that the dedicated optimizations that we have developed to speed up the search for CFs are indeed highly effective.

Postpartum depression (PPD) poses a major burden on maternal and child health, especially in low- and middle-income countries where prevalence exceeds 19%. Despite advancements in machine learning for PPD prediction, current approaches are limited by opaque global explanations that lack clinical usefulness at the patient level, unstable feature selection, and poor generalization under class imbalance. We propose SAGE, a Stability-Aware Graph-Based Ensemble feature selection system that incorporates both local explainable AI and a genetically optimized artificial neural network (GA-ANN). Using a primary cohort of 766 postpartum women, SAGE combines information-theoretic relevance, PCA-based structure, and graph-based interactions with bootstrap stability weighting to identify robust and non-redundant predictors. The GA-ANN architecture, optimized using a genetic algorithm and enhanced with GAN based oversampling, achieved strong performance with 87.96% accuracy, 86.32% F1 score, and 0.88 AUC using only 16 features, outperforming baseline and other feature selection methods. Psychological and socioeconomic factors such as EPDS score, PHQ-9 score, feelings about motherhood, and abuse history are the main predictors, while demographic factors have less influence. The LIME-based explanations allow instance-based insight into selected features from the graph, enabling personalized risk assessment. The findings make SAGE a scalable, interpretable, and clinical tool for early identification of PPD in health-care limited resources.

Multimodal neuroimaging combining structural MRI and positron emission tomography (PET) captures complementary structure-function relationships across the Alzheimer's disease (AD) continuum, yet existing artificial intelligence systems produce a single diagnostic label without quantifying which imaging modality drove that decision for a specific patient. We introduce the Modality Contribution Network (MCNet) and the Modality Contribution Score (MCS), the first per-patient attribution framework quantifying the shift in modality dominance from structural atrophy to amyloid and metabolic dysfunction across the cognitively normal to MCI to AD continuum. MCS is normalised to unity per subject via modality ablation (MCS_MRI_i + MCS_PET_i = 1.0 for every subject i), providing an interpretable, clinically actionable score that fluid biomarkers cannot supply. Applied to 327 ADNI-3 participants balanced across cognitively normal, mild cognitive impairment, and AD groups, MCNet achieved competitive three-class staging performance (AUC=0.881). The MCS revealed a statistically significant monotonic gradient (Kruskal-Wallis p<0.0001), with increasing PET dominance from cognitively normal (MCS_PET 0.412+/-0.229) through MCI (0.489+/-0.289) to AD (0.671+/-0.426), validated against amyloid SUVR (r=0.172, p=0.006) and FDG metabolic biomarkers (r=-0.287, p=0.0005) from separate imaging pipelines. External replication in 1,073 independent OASIS-3 subjects confirmed cross-cohort generalisability (H=166.99, p<0.0001, eta^2=0.156). A mechanistic comparison with SHAP demonstrated that ablation-based MCS captures clinically meaningful modality dependence that deviation-based methods cannot. These findings position MCNet as a foundation for personalised imaging decisions, clinical trial stratification, and trustworthy AI in dementia care.

Artificial intelligence systems increasingly make consequential judgments - which patient is deteriorating, which building is safe to enter, whether an image is authentic and are trusted on the strength of how accurately and confidently they predict. The safeguards that certify them are correspondingly prediction-based: accuracy, calibration and conformal coverage all measure how well a model performs. Whether such checks are sufficient to establish model trustworthiness has remained unclear. Here we prove that they cannot. We establish a separation theorem showing that a reliable model and a compromised one can be identical under every prediction-side certificate, including accuracy, calibration and coverage, yet differ arbitrarily in explanation fidelity and deployment behaviour. Detecting this failure requires access to the model's decision mechanism in addition to its predictions. We introduce the competence envelope as an operational framework that combines prediction and explanation certification into a single deployable criterion. Across diverse datasets and model classes, the proposed framework reveals failure modes that prediction-side certification alone does not capture. Certification against failures that are invisible in prediction behaviour therefore requires evidence about the model's decision mechanism as well as its outputs.

Accurate electricity price forecasting is critical for smart grid stability, yet the heavy reliance on historical price lags in modern predictive models often obscures the fundamental physical drivers of market volatility. This paper proposes a regime-sensitive, explainable artificial intelligence (XAI) framework to unmask the hidden roles of load, climate, and calendar variables in the ERCOT Day-Ahead Market (2014-2024). Utilizing a Histogram-based Gradient Boosting Regressor (HGBR), we introduce a Suppression Ratio to quantify how price lags overshadow physical parameters. Our analysis reveals that while lags provide short-term memory during normal conditions, they fail to capture extreme dynamics; notably, their inclusion increased forecasting error (MAE/RMSE) during price spikes. By isolating these effects, the study revealed that price spikes are not merely the result of continuously rising temperatures, but rather emerge from the system reacting sharply within a specific temperature range. These findings underscore the importance of moving beyond lag-based models to uncover the true drivers of extreme price events.

Autonomous AI diagnostic agents, systems that analyse patient-specific clinical data and produce diagnostic outputs or triage decisions without mandatory real-time human review, are increasingly deployed across eHealth platforms in sub-Saharan Africa at a pace that has outrun the governance infrastructure needed to oversee them. While significant bodies of work address AI accountability, transparency and explainability in healthcare, existing frameworks are largely clinician-centered and assume regulatory conditions that do not uniformly exist in low-resource settings. A patient-centered analysis of the disparity in patient awareness regarding autonomous agents, which results in a structural accountability gap, is mostly missing from the literature. This paper synthesizes existing research on informed consent, algorithmic accountability, and explainable AI to highlight three distinct challenges introduced by deploying AI agents in the sub-Saharan African context. Drawing on three documented deployment cases, including computer-aided tuberculosis detection in Tanzania, diabetic retinopathy and TB screening in Zambia, and mobile health chat-bot triage in Ghana, it demonstrates that these gaps are already present in active deployments across the region. In response, the paper proposes three foundational principles; agent-aware informed consent, human override as a structural requirement and contextually adapted explainability. This triad of principles lays a practical minimum standard for developers, health system administrators and policymakers in contexts where formal AI regulation remains nascent.