Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

最近显示外部眼睛照片显示出糖尿病性视网膜疾病和HBA1C升高的迹象。在本文中，我们评估外部眼睛照片是否包含有关其他系统性医疗状况的信息。我们开发了一个深度学习系统（DLS），该系统将外部眼睛的照片作为输入，并预测多个全身参数，例如与肝脏有关的参数（白蛋白，AST）；肾脏（EGFR使用无种族的2021 CKD-EPI肌酐方程，尿液ACR）；骨与矿物质（钙）;甲状腺（TSH）;和血数（HGB，WBC，血小板）。开发利用了49,015例糖尿病患者的151,237张图像，在加利福尼亚州洛杉矶县的11个地点接受糖尿病眼镜筛查。评估重点是9个预先指定的全身参数，并利用了3个验证集（a，b，c），涵盖了28,869名患有和没有糖尿病的患者，在加利福尼亚州洛杉矶县和大亚特兰大地区的3个独立地点进行了眼睛筛查。我们将结合了可用临床人口统计学变量的基线模型（例如年龄，性别，种族/种族，糖尿病年）进行了比较。相对于基线，DLS在检测AST> 36，钙<8.6，egfr <60，HGB <11，血小板<150，ACR> = 300和WBC <4时，在检测AST> 36，钙<8.6，Egfr <60，HGB <60，HGB <60，calcium <8.6，Egfr <60，calcium <8.6和wbc <4时，达到了统计学上的显着性能，并且类似于开发集的人口），其中DLS的AUC超过基线的AUC，增长了5.2-19.4％。在验证集B和C方面，与开发集相比，患者人群的差异很大，DLS的表现优于ACR> = 300的基线，而HGB <11升至7.3-13.2％。我们的发现提供了进一步的证据，表明外部眼睛照片包含跨越多器官系统的全身健康生物标志物。需要进一步的工作来研究这些生物标志物是否以及如何转化为临床影响。

医疗人工智能（AI）的最新进展已提供了可以达到临床专家水平绩效的系统。但是，当在与训练环境不同的临床环境中评估时，这种系统往往会证明次优的“分布式”性能。一种常见的缓解策略是使用特定地点数据为每个临床环境开发单独的系统[1]。但是，这很快变得不切实际，因为医疗数据很耗时，可以注释且昂贵[2]。因此，“数据有效概括”的问题给医学AI开发带来了持续的困难。尽管代表性学习的进展显示出希望，但并未对其好处进行严格的研究，特别是用于分布的设置。为了应对这些挑战，我们提出了RESEDIS，这是一种统一的代表学习策略，以提高医学成像AI的鲁棒性和数据效率。雷雷迪斯使用大规模监督转移学习与自我监督学习的通用组合，几乎不需要特定于任务的自定义。我们研究各种医学成像任务，并使用回顾性数据模拟三个现实的应用程序场景。 RESEDIS表现出明显改善的分布性能，而在强有力的基线上，诊断准确性相对相对提高了11.5％。更重要的是，我们的策略会导致对医学成像AI的强大数据有效的概括，并使用跨任务的1％至33％的重新培训数据匹配强有力的监督基线。这些结果表明，Repedis可以显着加速医学成像AI开发的生命周期，从而为医学成像AI提供了重要的一步，以产生广泛的影响。

We propose a simple solution to use a single Neural Machine Translation (NMT) model to translate between multiple languages. Our solution requires no changes to the model architecture from a standard NMT system but instead introduces an artificial token at the beginning of the input sentence to specify the required target language. The rest of the model, which includes an encoder, decoder and attention module, remains unchanged and is shared across all languages. Using a shared wordpiece vocabulary, our approach enables Multilingual NMT using a single model without any increase in parameters, which is significantly simpler than previous proposals for Multilingual NMT. On the WMT'14 benchmarks, a single multilingual model achieves comparable performance for English→French and surpasses state-of-the-art results for English→German. Similarly, a single multilingual model surpasses state-of-the-art results for French→English and German→English on WMT'14 and WMT'15 benchmarks, respectively. On production corpora, multilingual models of up to twelve language pairs allow for better translation of many individual pairs. In addition to improving the translation quality of language pairs that the model was trained with, our models can also learn to perform implicit bridging between language pairs never seen explicitly during training, showing that transfer learning and zero-shot translation is possible for neural translation. Finally, we show analyses that hints at a universal interlingua representation in our models and show some interesting examples when mixing languages.

Neural Machine Translation (NMT) is an end-to-end learning approach for automated translation, with the potential to overcome many of the weaknesses of conventional phrase-based translation systems. Unfortunately, NMT systems are known to be computationally expensive both in training and in translation inference -sometimes prohibitively so in the case of very large data sets and large models. Several authors have also charged that NMT systems lack robustness, particularly when input sentences contain rare words. These issues have hindered NMT's use in practical deployments and services, where both accuracy and speed are essential. In this work, we present GNMT, Google's Neural Machine Translation system, which attempts to address many of these issues. Our model consists of a deep LSTM network with 8 encoder and 8 decoder layers using residual connections as well as attention connections from the decoder network to the encoder. To improve parallelism and therefore decrease training time, our attention mechanism connects the bottom layer of the decoder to the top layer of the encoder. To accelerate the final translation speed, we employ low-precision arithmetic during inference computations. To improve handling of rare words, we divide words into a limited set of common sub-word units ("wordpieces") for both input and output. This method provides a good balance between the flexibility of "character"-delimited models and the efficiency of "word"-delimited models, naturally handles translation of rare words, and ultimately improves the overall accuracy of the system. Our beam search technique employs a length-normalization procedure and uses a coverage penalty, which encourages generation of an output sentence that is most likely to cover all the words in the source sentence. To directly optimize the translation BLEU scores, we consider refining the models by using reinforcement learning, but we found that the improvement in the BLEU scores did not reflect in the human evaluation. On the WMT'14 English-to-French and English-to-German benchmarks, GNMT achieves competitive results to state-of-the-art. Using a human side-by-side evaluation on a set of isolated simple sentences, it reduces translation errors by an average of 60% compared to Google's phrase-based production system.

Generalized linear models with nonlinear feature transformations are widely used for large-scale regression and classification problems with sparse inputs. Memorization of feature interactions through a wide set of cross-product feature transformations are effective and interpretable, while generalization requires more feature engineering effort. With less feature engineering, deep neural networks can generalize better to unseen feature combinations through low-dimensional dense embeddings learned for the sparse features. However, deep neural networks with embeddings can over-generalize and recommend less relevant items when the user-item interactions are sparse and high-rank. In this paper, we present Wide & Deep learning-jointly trained wide linear models and deep neural networks-to combine the benefits of memorization and generalization for recommender systems. We productionized and evaluated the system on Google Play, a commercial mobile app store with over one billion active users and over one million apps. Online experiment results show that Wide & Deep significantly increased app acquisitions compared with wide-only and deep-only models. We have also open-sourced our implementation in TensorFlow.

The recently introduced continuous Skip-gram model is an efficient method for learning high-quality distributed vector representations that capture a large number of precise syntactic and semantic word relationships. In this paper we present several extensions that improve both the quality of the vectors and the training speed. By subsampling of the frequent words we obtain significant speedup and also learn more regular word representations. We also describe a simple alternative to the hierarchical softmax called negative sampling. An inherent limitation of word representations is their indifference to word order and their inability to represent idiomatic phrases. For example, the meanings of "Canada" and "Air" cannot be easily combined to obtain "Air Canada". Motivated by this example, we present a simple method for finding phrases in text, and show that learning good vector representations for millions of phrases is possible.

We propose two novel model architectures for computing continuous vector representations of words from very large data sets. The quality of these representations is measured in a word similarity task, and the results are compared to the previously best performing techniques based on different types of neural networks. We observe large improvements in accuracy at much lower computational cost, i.e. it takes less than a day to learn high quality word vectors from a 1.6 billion words data set. Furthermore, we show that these vectors provide state-of-the-art performance on our test set for measuring syntactic and semantic word similarities.

There is no settled universal 3D representation for geometry with many alternatives such as point clouds, meshes, implicit functions, and voxels to name a few. In this work, we present a new, compelling alternative for representing shapes using a sequence of cross-sectional closed loops. The loops across all planes form an organizational hierarchy which we leverage for autoregressive shape synthesis and editing. Loops are a non-local description of the underlying shape, as simple loop manipulations (such as shifts) result in significant structural changes to the geometry. This is in contrast to manipulating local primitives such as points in a point cloud or a triangle in a triangle mesh. We further demonstrate that loops are intuitive and natural primitive for analyzing and editing shapes, both computationally and for users.

We study the capabilities of speech processing systems trained simply to predict large amounts of transcripts of audio on the internet. When scaled to 680,000 hours of multilingual and multitask supervision, the resulting models generalize well to standard benchmarks and are often competitive with prior fully supervised results but in a zero-shot transfer setting without the need for any fine-tuning. When compared to humans, the models approach their accuracy and robustness. We are releasing models and inference code to serve as a foundation for further work on robust speech processing.