待翻译：Inhibitory Attention for Clinical Long-Context Reasoning: Characterizing and Mitigating Lost-in-the-Middle Effects in EHR Processing

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--> [Submitted on 15 Jun 2026] Title:Inhibitory Attention for Clinical Long-Context Reasoning: Characterizing and Mitigating Lost-in-the-Middle Effects in EHR Processing View a PDF of the paper titled Inhibitory Attention for Clinical Long-Context Reasoning: Characterizing and Mitigating Lost-in-the-Middle Effects in EHR Processing, by Sanjay Basu View PDF HTML (experimental) Abstract:Electronic health records now routinely exceed 100,000 tokens per patient. Yet large language models exhibit the lost-in-the-middle (LitM) effect: information near the center of a long context is retrieved less reliably than information near the edges. In clinical use this is not benign: the single most consequential fact in a note can sit at its center. We term this the clinical lost-in-the-middle (CLitM) problem, give its first systematic characterization using MedAlign, and compare context-selection strategies as remedies. Across 2,196 instruction-response pairs and six language models, we observe a 21.9 percentage-point gap between peak accuracy (59.5%, 95% CI [46.3, 71.0], 20-30% decile) and trough accuracy (37.6% [23.2, 52.5] at 70-80%); 67.8% of reference answers fall between the 10th and 90th percentiles of the EHR timeline, inside the CLitM trough. We introduce Query-Conditioned Clinical Suppression (QCCS), a lightweight query-conditioned selection gate, and evaluate it against BM25, BM25 with section-header filtering, dense retrieval, and cross-encoder reranking (N=83 held-out instructions). With Qwen2.5-7B-Instruct (16k context), QCCS outperforms all five comparators under LLM-as-judge scoring: for middle-position instructions QCCS reaches 16.7% versus BM25 3.3%, cross-encoder 0.0%, dense 0.0%, and full context 6.7%; overall QCCS reaches 25.3% versus at most 3.6% for retrieval-only comparators. This advantage is not explained by retrieval recall: at k=20, BM25 retrieves the gold evidence sentence in 98.8% of instructions (QCCS 34.9%), yet retrieval arms stay at most 2.6% accurate even when they retrieve it, whereas QCCS reaches 25.0% even when it does not. In this proof-of-concept evaluation, query-aligned context selection predicts EHR instruction-following accuracy better than gold-sentence retrieval recall. Comments: 29 pages, 5 figures. Code: this https URL Subjects: Computation and Language (cs.CL); Artificial Intelligence (cs.AI) ACM classes: I.2.7; J.3 Cite as: arXiv:2608.20348 [cs.CL] (or arXiv:2608.20348v1 [cs.CL] for this version) https://doi.org/10.48550/arXiv.2608.20348 arXiv-issued DOI via DataCite Submission history From: Sanjay Basu [view email] [v1] Mon, 15 Jun 2026 16:26:46 UTC (930 KB) Full-text links: Access Paper: View a PDF of the paper titled Inhibitory Attention for Clinical Long-Context Reasoning: Characterizing and Mitigating Lost-in-the-Middle Effects in EHR Processing, by Sanjay Basu View PDF HTML (experimental) TeX Source view license Current browse context: cs.CL new | recent | 2026-08 Change to browse by: cs cs.AI References & Citations NASA ADS Google Scholar Semantic Scholar Loading... Data provided by: Bibliographic Tools Bibliographic and Citation Tools Bibliographic Explorer Toggle Bibliographic Explorer (What is the Explorer?) Connected Papers Toggle Connected Papers (What is Connected Papers?) Litmaps Toggle Litmaps (What is Litmaps?) scite.ai Toggle scite Smart Citations (What are Smart Citations?) Code, Data, Media Code, Data and Media Associated with this Article alphaXiv Toggle alphaXiv (What is alphaXiv?) Links to Code Toggle CatalyzeX Code Finder for Papers (What is CatalyzeX?) DagsHub Toggle DagsHub (What is DagsHub?) GotitPub Toggle Gotit.pub (What is GotitPub?) Huggingface Toggle Hugging Face (What is Huggingface?) ScienceCast Toggle ScienceCast (What is ScienceCast?) Demos Demos Replicate Toggle Replicate (What is Replicate?) Spaces Toggle Hugging Face Spaces (What is Spaces?) Spaces Toggle TXYZ.AI (What is TXYZ.AI?) Related Papers Recommenders and Search Tools Link to Influence Flower Influence Flower (What are Influence Flowers?) Core recommender toggle CORE Recommender (What is CORE?) Author Venue Institution Topic About arXivLabs arXivLabs: experimental projects with community collaborators arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website. Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them. Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs. Which authors of this paper are endorsers? | Disable MathJax (What is MathJax?)