Daily Papers

Green's functions are a useful technique for interpreting atmospheric state responses to changes in the spatial pattern of sea surface temperature (SST). Here we train version 2 of the Ai2 Climate Emulator (ACE2) on reference historical SST simulations of the US Department of Energy's EAMv3 global atmosphere model. We compare how well the SST Green's functions generated by ACE2 match those of EAMv3, following the protocol of the Green's Function Model Intercomparison Project (GFMIP). The spatial patterns of top-of-atmosphere (TOA) radiative response from the individual GFMIP SST patch simulations are similar for ACE and the EAMv3 reference. The derived sensitivity of global net TOA radiation sensitivity to SST patch location is qualitatively similar in ACE as in EAMv3, but there are statistically significant discrepancies for some SST patches, especially over the subtropical northeast Pacific. These discrepancies may reflect insufficient diversity in the SST patterns sampled over the course of the EAMv3 AMIP simulation used for training ACE. Both ACE and EAMv3 Green's functions reconstruct the historical record of the global annual-mean TOA radiative flux from a reference EAMv3 AMIP simulation reasonably well. Notably, under our configuration and compute resources, ACE achieves these results approximately 100 times faster in wall-clock time compared to EAMv3, highlighting its potential as a powerful and efficient tool for tackling other computationally intensive problems in climate science.

At the heart of medicine lies the physician-patient dialogue, where skillful history-taking paves the way for accurate diagnosis, effective management, and enduring trust. Artificial Intelligence (AI) systems capable of diagnostic dialogue could increase accessibility, consistency, and quality of care. However, approximating clinicians' expertise is an outstanding grand challenge. Here, we introduce AMIE (Articulate Medical Intelligence Explorer), a Large Language Model (LLM) based AI system optimized for diagnostic dialogue. AMIE uses a novel self-play based simulated environment with automated feedback mechanisms for scaling learning across diverse disease conditions, specialties, and contexts. We designed a framework for evaluating clinically-meaningful axes of performance including history-taking, diagnostic accuracy, management reasoning, communication skills, and empathy. We compared AMIE's performance to that of primary care physicians (PCPs) in a randomized, double-blind crossover study of text-based consultations with validated patient actors in the style of an Objective Structured Clinical Examination (OSCE). The study included 149 case scenarios from clinical providers in Canada, the UK, and India, 20 PCPs for comparison with AMIE, and evaluations by specialist physicians and patient actors. AMIE demonstrated greater diagnostic accuracy and superior performance on 28 of 32 axes according to specialist physicians and 24 of 26 axes according to patient actors. Our research has several limitations and should be interpreted with appropriate caution. Clinicians were limited to unfamiliar synchronous text-chat which permits large-scale LLM-patient interactions but is not representative of usual clinical practice. While further research is required before AMIE could be translated to real-world settings, the results represent a milestone towards conversational diagnostic AI.

While previous versions of the Ai2 Climate Emulator (ACE) have been trained with CO_2 as a forcing, they are only accurate within a narrow range of scenarios, for example climate over the last 80 years forced by observed sea surface temperature (SST), sea ice, and CO_2 (AMIP), or equilibrium or near-equilibrium climates with CO_2 concentrations ranging from 1x to 4x that of the present day. Attempting to simulate climate forced by AMIP SST perturbed by +4 K or the response to an abrupt quadrupling of CO_2, results in unphysical behavior. We attribute this to these models being trained on datasets where the SST and CO_2 are correlated, limiting their ability to accurately learn their separate effects. In this study we introduce a new class of "random-CO_2" reference simulations where the SST and CO_2 are prescribed to vary independently. Trained on a balance of AMIP, equilibrium-climate, and random-CO_2 data, and including a total energy conservation constraint for improved interpretability, we present a more data-efficient model that not only accurately emulates its reference model in scenarios in which previous models excelled, but also scenarios like AMIP +4 K and slab-ocean-coupled abrupt 4xCO_2 where they did not. Limitations are that it has simplified or prescribed representations of other Earth system components like the ocean, land, and sea ice; does not expose other known climate drivers as forcings; and relies solely on physics-based model output for training data, inheriting the biases relative to observations thereof. Each of these represent opportunities for future work.

While large language models (LLMs) have shown promise in diagnostic dialogue, their capabilities for effective management reasoning - including disease progression, therapeutic response, and safe medication prescription - remain under-explored. We advance the previously demonstrated diagnostic capabilities of the Articulate Medical Intelligence Explorer (AMIE) through a new LLM-based agentic system optimised for clinical management and dialogue, incorporating reasoning over the evolution of disease and multiple patient visit encounters, response to therapy, and professional competence in medication prescription. To ground its reasoning in authoritative clinical knowledge, AMIE leverages Gemini's long-context capabilities, combining in-context retrieval with structured reasoning to align its output with relevant and up-to-date clinical practice guidelines and drug formularies. In a randomized, blinded virtual Objective Structured Clinical Examination (OSCE) study, AMIE was compared to 21 primary care physicians (PCPs) across 100 multi-visit case scenarios designed to reflect UK NICE Guidance and BMJ Best Practice guidelines. AMIE was non-inferior to PCPs in management reasoning as assessed by specialist physicians and scored better in both preciseness of treatments and investigations, and in its alignment with and grounding of management plans in clinical guidelines. To benchmark medication reasoning, we developed RxQA, a multiple-choice question benchmark derived from two national drug formularies (US, UK) and validated by board-certified pharmacists. While AMIE and PCPs both benefited from the ability to access external drug information, AMIE outperformed PCPs on higher difficulty questions. While further research would be needed before real-world translation, AMIE's strong performance across evaluations marks a significant step towards conversational AI as a tool in disease management.

Large language models (LLMs) have shown remarkable progress in encoding clinical knowledge and responding to complex medical queries with appropriate clinical reasoning. However, their applicability in subspecialist or complex medical settings remains underexplored. In this work, we probe the performance of AMIE, a research conversational diagnostic AI system, in the subspecialist domain of breast oncology care without specific fine-tuning to this challenging domain. To perform this evaluation, we curated a set of 50 synthetic breast cancer vignettes representing a range of treatment-naive and treatment-refractory cases and mirroring the key information available to a multidisciplinary tumor board for decision-making (openly released with this work). We developed a detailed clinical rubric for evaluating management plans, including axes such as the quality of case summarization, safety of the proposed care plan, and recommendations for chemotherapy, radiotherapy, surgery and hormonal therapy. To improve performance, we enhanced AMIE with the inference-time ability to perform web search retrieval to gather relevant and up-to-date clinical knowledge and refine its responses with a multi-stage self-critique pipeline. We compare response quality of AMIE with internal medicine trainees, oncology fellows, and general oncology attendings under both automated and specialist clinician evaluations. In our evaluations, AMIE outperformed trainees and fellows demonstrating the potential of the system in this challenging and important domain. We further demonstrate through qualitative examples, how systems such as AMIE might facilitate conversational interactions to assist clinicians in their decision making. However, AMIE's performance was overall inferior to attending oncologists suggesting that further research is needed prior to consideration of prospective uses.

Large language models (LLMs) are increasingly proposed as clinical agents, yet static, single-turn benchmarks cannot capture how a model dynamically delivers care across an encounter: gathering information, planning treatment, and adapting longitudinal management across successive patient states. Medical education has long addressed an analogous challenge through standardized patients (SPs): trained actors who consistently portray clinical cases, enabling realistic practice and objective, scripted assessment. Here we introduce MedSP1000, an SP-derived interactive benchmark for clinical-agent evaluation, including 1,638 SP cases with 24,602 trajectory-level peer-reviewed rubrics. MedSP1000 converts peer-reviewed SP teaching cases into executable scenarios with defined SP case scripts, clinical environment contexts, and human-validated structured rubric. In each simulation evaluation run, a clinical agent interacts in closed loop with a patient agent and an environment controller, and its behaviour is scored throughout the encounter against expert criteria specified in the original materials. Applying MedSP1000 to a range of general-purpose and medically specialized LLMs, we find that performance on static benchmarks does not reliably translate to such educational scenarios. The best-performing model, GPT-5.5, completes only 60.4% of expert-defined rubric items, whereas the strongest medically specialized model reaches 40.0%; increasing test-time compute produces no measurable gain. These results suggest that current LLMs, including agentic systems tuned for medicine, are not yet reliable enough to be safely integrated into actual clinical practice. More broadly, MedSP1000 shows how process-level, SP-style evaluation can reveal clinically relevant failure modes that single-turn benchmarks miss.