Clinical diagnosis is fundamentally interactive and incremental, yet the dominant paradigm for evaluating Large Language Models (LLMs) in medicine remains static QA benchmarks or template-based dialogues. These benchmarks say little about whether a model can serve as a diagnostic agent in a dynamic clinical encounter, with LLMs showing significant accuracy and reliability degradation in multi-turn settings. To address this issue, we present MTDiag, a large multi-turn diagnostic dialogue dataset constructed from three heterogeneous sources: DDXPlus, MIMIC-IV, and published case reports (AJCR), covering common ED presentations as well as long-tail rare and atypical conditions. All cases are normalized into a canonical PatientVector schema anchored in the most comprehensive and widely-adopted medical knowledge bases (UMLS concept identifiers, with ICD-10 diagnosis codes). We release the PatientVector schema, a UserLM-8B-based utterance-generation pipeline, and the physician-validated dataset that converts structured clinical evidence into natural-language utterances. Importantly, we introduce and motivate clinical knowledge-grounded metrics for evaluating LLMs as diagnostic agents, beyond diagnostic accuracy, for the task of multi-turn differential diagnosis.

Natural language conveys information at varying levels of granularity, from fine-grained references to broad descriptions. While granularity is fundamental to human communication, existing measures mostly capture surface detail or sentence specificity. We introduce Granuscore, a reference-free measure of granularity that leverages structural properties of a hierarchical embedding space. Granuscore reliably recovers hierarchical orderings on the Granola-EQ dataset and captures expected differences in granularity across discourse contexts. Across domains, we further show that Granuscore explains non-linear variation in sentence specificity beyond sentence length. Finally, we apply Granuscore to four question-answering benchmarks and analyze how granularity differs for questions, gold answers, and model outputs across response outcomes. The analysis reveals consistent differences in model behavior and provides a principled lens for characterizing the difficulty of QA datasets. Together, the results position Granuscore as a scalable, broadly applicable tool for analyzing granularity in text.

Transformers have dominated sequence processing tasks for the past seven years—most notably language modeling. However, the inherent quadratic complexity of their attention mechanism remains a significant bottleneck as context length increases. We review and distill the recent efforts to overcome this bottleneck, including advances in (sub-quadratic) attention variants, recurrent neural networks, state space models, and hybrid architectures. We critically analyze approaches regarding compute and memory complexity, benchmark results, and fundamental limitations to assess whether the dominance of pure-attention transformers may soon be challenged, which we consider possible, particularly in domain-specific and edge-device applications.