Clinical diagnosis is inherently sequential: clinicians escalate from cheap to costly tests only when additional evidence is expected to resolve diagnostic uncertainty. We present ActiveMedAgent, a framework that brings this cost-aware sequential logic to multimodal medical AI. Given a frozen, API-accessed vision-language model, ActiveMedAgent probability distributions over candidate diagnoses induced each acquisition by its per-step diagnostic utility minus cost. A lightweight MLP controller is then trained offline on these scored trajectories, learning when to request additional evidence and when to commit. Across three commonly used benchmarks, trajectory-based policy learning consistently outperforms both unguided acquisition and full-modality baselines. Notably, we identify an information overload effect. In 175 cases, the agent produces a correct diagnosis with fewer channels while the full-modality baseline fails, showing that learning what to omit can be as important as learning what to acquire

Lifelong editing of LLMs requires storing thousands of edits after acquisition. A widely used family of approaches attaches one LoRA adapter per edit, which preserves behavior but grows linearly in storage. To address this challenge, we propose LadderEdit, a method that compresses each LoRA adapter after it is acquired. Each edit is first stored at low rank as a cheap sketch. We then check whether this sketch still satisfies the rewrite, generalization, and locality contract on probe prompts. Edits that pass keep the sketch; those that fail are promoted to a higher rank along a ladder until the contract is met. Because every edit retains some representation, coverage is maintained, and only hard edits consume more rank. Across ZsRE, CounterFact, and WikiBigEdit benchmarks on LLaMA-3-8B, Mistral-7B, and Qwen2.5-7B, LadderEdit tracks exact LoRA storage at 5.2× less memory and remains effective at 50,000 sequential edits.

Segment Anything Model 3 (SAM3) advances open-vocabulary segmentation through promptable concept segmentation, enabling users to segment all instances associated with a given concept using short noun-phrase (NP) prompts. While effective for concept-level grounding, real-world interactions often involve far richer natural-language instructions that combine attributes, relations, actions, states, or implicit reasoning. Currently, SAM3 relies on external multi-modal agents to convert complex instructions into NPs and conducts iterative mask filtering, leading to coarse representations and limited instance specificity. In this work, we present SAM3-I, an instruction-following extension of the SAM family that unifies concept-level grounding and instruction-level reasoning within a single segmentation framework. Built upon SAM3, SAM3-I introduces an instruction-aware cascaded adaptation mechanism with dedicated alignment losses that progressively aligns expressive instruction semantics with SAM3’s vision-language representations, enabling direct interpretation of natural-language instructions while preserving its strong concept recall ability. To enable instruction-following learning, we introduce HMPL-Instruct, a large-scale instruction-centric dataset that systematically covers hierarchical instruction semantics and diverse target granularities. Experiments demonstrate that SAM3-I achieves appealing performance across referring and reasoning-based segmentation, showing that SAM3 can be effectively extended to follow complex natural-language instructions without sacrificing its original concept-driven strengths. Code and dataset are available at https://github.com/debby-0527/SAM3-I.