{"bundle_type":"pith_open_graph_bundle","bundle_version":"1.0","pith_number":"pith:2026:E6R4RZBV336IMX34222BJNARCP","short_pith_number":"pith:E6R4RZBV","canonical_record":{"source":{"id":"2607.28677","kind":"arxiv","version":1},"metadata":{"license":"http://creativecommons.org/licenses/by/4.0/","primary_cat":"cs.AI","submitted_at":"2026-07-29T07:12:46Z","cross_cats_sorted":[],"title_canon_sha256":"611edf34ef8c892bad2326d58b956cbb06a09dbfc5e87d5c7a73a79e59814f8a","abstract_canon_sha256":"4e2a94d683b6adb041e91d1df42c278ca7a8f738744d4ba732d3ccce5629dc7f"},"schema_version":"1.0"},"canonical_sha256":"27a3c8e435defc865f7cd6b414b41113c40476655f81ac6a77b03b52e31473c7","source":{"kind":"arxiv","id":"2607.28677","version":1},"source_aliases":[{"alias_kind":"arxiv","alias_value":"2607.28677","created_at":"2026-08-03T00:12:09Z"},{"alias_kind":"arxiv_version","alias_value":"2607.28677v1","created_at":"2026-08-03T00:12:09Z"},{"alias_kind":"doi","alias_value":"10.48550/arxiv.2607.28677","created_at":"2026-08-03T00:12:09Z"},{"alias_kind":"pith_short_12","alias_value":"E6R4RZBV336I","created_at":"2026-08-03T00:12:09Z"},{"alias_kind":"pith_short_16","alias_value":"E6R4RZBV336IMX34","created_at":"2026-08-03T00:12:09Z"},{"alias_kind":"pith_short_8","alias_value":"E6R4RZBV","created_at":"2026-08-03T00:12:09Z"}],"events":[{"event_type":"record_created","subject_pith_number":"pith:2026:E6R4RZBV336IMX34222BJNARCP","target":"record","payload":{"canonical_record":{"source":{"id":"2607.28677","kind":"arxiv","version":1},"metadata":{"license":"http://creativecommons.org/licenses/by/4.0/","primary_cat":"cs.AI","submitted_at":"2026-07-29T07:12:46Z","cross_cats_sorted":[],"title_canon_sha256":"611edf34ef8c892bad2326d58b956cbb06a09dbfc5e87d5c7a73a79e59814f8a","abstract_canon_sha256":"4e2a94d683b6adb041e91d1df42c278ca7a8f738744d4ba732d3ccce5629dc7f"},"schema_version":"1.0"},"canonical_sha256":"27a3c8e435defc865f7cd6b414b41113c40476655f81ac6a77b03b52e31473c7","receipt":{"kind":"pith_receipt","key_id":"pith-v1-2026-05","algorithm":"ed25519","signed_at":"2026-08-03T00:12:09.076851Z","signature_b64":"T2dlnr7M2dMIb/fJPa8WICETFLozU61XUdAj1SfHiOc8xiqr4YzLHyB8SALeKsTCG2o6HFGfacySr4o55lH2Cw==","signed_message":"canonical_sha256_bytes","builder_version":"pith-number-builder-2026-05-17-v1","receipt_version":"0.3","canonical_sha256":"27a3c8e435defc865f7cd6b414b41113c40476655f81ac6a77b03b52e31473c7","last_reissued_at":"2026-08-03T00:12:09.074392Z","signature_status":"signed_v1","first_computed_at":"2026-08-03T00:12:09.074392Z","public_key_fingerprint":"8d4b5ee74e4693bcd1df2446408b0d54"},"source_kind":"arxiv","source_id":"2607.28677","source_version":1,"attestation_state":"computed"},"signer":{"signer_id":"pith.science","signer_type":"pith_registry","key_id":"pith-v1-2026-05","public_key_fingerprint":"8d4b5ee74e4693bcd1df2446408b0d54"},"created_at":"2026-08-03T00:12:09Z","supersedes":[],"prev_event":null,"signature":{"signature_status":"signed_v1","algorithm":"ed25519","key_id":"pith-v1-2026-05","public_key_fingerprint":"8d4b5ee74e4693bcd1df2446408b0d54","signature_b64":"u/xxRF8BkW4FXJH5lN/QF273c2N1XgX7VlrlrgIS1FEhluZxmlz6k1oW2N+ozsLHN3nKYfURHafQPbaHrbi8CQ==","signed_message":"open_graph_event_sha256_bytes","signed_at":"2026-08-05T10:34:23.441338Z"},"content_sha256":"c1b78d265deb3a4e6eb3f24bcf09e503fadfb355d940a6e9c22a87ab56a3c514","schema_version":"1.0","event_id":"sha256:c1b78d265deb3a4e6eb3f24bcf09e503fadfb355d940a6e9c22a87ab56a3c514"},{"event_type":"graph_snapshot","subject_pith_number":"pith:2026:E6R4RZBV336IMX34222BJNARCP","target":"graph","payload":{"graph_snapshot":{"paper":{"title":"Reasoning in Real World Clinical Care: Why Large Language Models Are Not Yet Safe for Autonomous Clinical Decision Support","license":"http://creativecommons.org/licenses/by/4.0/","headline":"","cross_cats":[],"primary_cat":"cs.AI","authors_text":"Alexey Matyushkin, Gabriele C DeLuca, James Hillis, Manoj Ramachandran, Max Solovyev, Mehdi Zadem, Nicolas von Mallinckrodt, Prakash Jayakumar, Ryaan Sultan, Sanjeeva Jeyaretna, Shayndhan Sivanathan, Shravan Nageswaran, Sumon Sadhu","submitted_at":"2026-07-29T07:12:46Z","abstract_excerpt":"LLM now pass medical licensing examinations and, in curated cases, can rival physicians at diagnostic reasoning. These developments have accelerated the use of LLMs for symptom assessment and clinical decision support in diagnostic and treatment guidance, administrative documentation, and rules-based alert enhancement. This Perspective concerns the most consequential of these applications: the autonomous triage of self-presenting, undifferentiated patients, with little or no clinician in the loop. For that task, the evidence of safety does not yet exist. The gap is not in medical knowledge but"},"claims":{"count":0,"items":[],"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57"},"source":{"id":"2607.28677","kind":"arxiv","version":1},"verdict":{"id":null,"model_set":{},"created_at":null,"strongest_claim":"","one_line_summary":"","pipeline_version":null,"weakest_assumption":"","pith_extraction_headline":""},"integrity":{"clean":true,"summary":{"advisory":0,"critical":0,"by_detector":{},"informational":0},"endpoint":"/pith/2607.28677/integrity.json","findings":[],"available":true,"detectors_run":[],"snapshot_sha256":"c28c3603d3b5d939e8dc4c7e95fa8dfce3d595e45f758748cecf8e644a296938"},"references":{"count":0,"sample":[],"resolved_work":0,"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57","internal_anchors":0},"formal_canon":{"evidence_count":0,"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57"},"author_claims":{"count":0,"strong_count":0,"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57"},"builder_version":"pith-number-builder-2026-05-17-v1"},"verdict_id":null},"signer":{"signer_id":"pith.science","signer_type":"pith_registry","key_id":"pith-v1-2026-05","public_key_fingerprint":"8d4b5ee74e4693bcd1df2446408b0d54"},"created_at":"2026-08-03T00:12:09Z","supersedes":[],"prev_event":null,"signature":{"signature_status":"signed_v1","algorithm":"ed25519","key_id":"pith-v1-2026-05","public_key_fingerprint":"8d4b5ee74e4693bcd1df2446408b0d54","signature_b64":"UKJJxV1Eubn8AKr+9UtDa+tB4lxuxzP9ozvOaeDG0oCkyN3pbgHd3ryDDpQYa4F9rsUI92IU4ulKKjo83mr2CA==","signed_message":"open_graph_event_sha256_bytes","signed_at":"2026-08-05T10:34:23.442513Z"},"content_sha256":"e0f9815c255a7f2f04b4999e624ee6a90401641afe2f03e95d35e78eda78f4ce","schema_version":"1.0","event_id":"sha256:e0f9815c255a7f2f04b4999e624ee6a90401641afe2f03e95d35e78eda78f4ce"}],"timestamp_proofs":[],"mirror_hints":[{"mirror_type":"https","name":"Pith Resolver","base_url":"https://pith.science","bundle_url":"https://pith.science/pith/E6R4RZBV336IMX34222BJNARCP/bundle.json","state_url":"https://pith.science/pith/E6R4RZBV336IMX34222BJNARCP/state.json","well_known_bundle_url":"https://pith.science/.well-known/pith/E6R4RZBV336IMX34222BJNARCP/bundle.json","status":"primary"}],"public_keys":[{"key_id":"pith-v1-2026-05","algorithm":"ed25519","format":"raw","public_key_b64":"stVStoiQhXFxp4s2pdzPNoqVNBMojDU/fJ2db5S3CbM=","public_key_hex":"b2d552b68890857171a78b36a5dccf368a953413288c353f7c9d9d6f94b709b3","fingerprint_sha256_b32_first128bits":"RVFV5Z2OI2J3ZUO7ERDEBCYNKS","fingerprint_sha256_hex":"8d4b5ee74e4693bcd1df2446408b0d54","rotates_at":null,"url":"https://pith.science/pith-signing-key.json","notes":"Pith uses this Ed25519 key to sign canonical record SHA-256 digests. Verify with: ed25519_verify(public_key, message=canonical_sha256_bytes, signature=base64decode(signature_b64))."}],"merge_version":"pith-open-graph-merge-v1","built_at":"2026-08-05T10:34:23Z","links":{"resolver":"https://pith.science/pith/E6R4RZBV336IMX34222BJNARCP","bundle":"https://pith.science/pith/E6R4RZBV336IMX34222BJNARCP/bundle.json","state":"https://pith.science/pith/E6R4RZBV336IMX34222BJNARCP/state.json","well_known_bundle":"https://pith.science/.well-known/pith/E6R4RZBV336IMX34222BJNARCP/bundle.json"},"state":{"state_type":"pith_open_graph_state","state_version":"1.0","pith_number":"pith:2026:E6R4RZBV336IMX34222BJNARCP","merge_version":"pith-open-graph-merge-v1","event_count":2,"valid_event_count":2,"invalid_event_count":0,"equivocation_count":0,"current":{"canonical_record":{"metadata":{"abstract_canon_sha256":"4e2a94d683b6adb041e91d1df42c278ca7a8f738744d4ba732d3ccce5629dc7f","cross_cats_sorted":[],"license":"http://creativecommons.org/licenses/by/4.0/","primary_cat":"cs.AI","submitted_at":"2026-07-29T07:12:46Z","title_canon_sha256":"611edf34ef8c892bad2326d58b956cbb06a09dbfc5e87d5c7a73a79e59814f8a"},"schema_version":"1.0","source":{"id":"2607.28677","kind":"arxiv","version":1}},"source_aliases":[{"alias_kind":"arxiv","alias_value":"2607.28677","created_at":"2026-08-03T00:12:09Z"},{"alias_kind":"arxiv_version","alias_value":"2607.28677v1","created_at":"2026-08-03T00:12:09Z"},{"alias_kind":"doi","alias_value":"10.48550/arxiv.2607.28677","created_at":"2026-08-03T00:12:09Z"},{"alias_kind":"pith_short_12","alias_value":"E6R4RZBV336I","created_at":"2026-08-03T00:12:09Z"},{"alias_kind":"pith_short_16","alias_value":"E6R4RZBV336IMX34","created_at":"2026-08-03T00:12:09Z"},{"alias_kind":"pith_short_8","alias_value":"E6R4RZBV","created_at":"2026-08-03T00:12:09Z"}],"graph_snapshots":[{"event_id":"sha256:e0f9815c255a7f2f04b4999e624ee6a90401641afe2f03e95d35e78eda78f4ce","target":"graph","created_at":"2026-08-03T00:12:09Z","signer":{"key_id":"pith-v1-2026-05","public_key_fingerprint":"8d4b5ee74e4693bcd1df2446408b0d54","signer_id":"pith.science","signer_type":"pith_registry"},"payload":{"graph_snapshot":{"author_claims":{"count":0,"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57","strong_count":0},"builder_version":"pith-number-builder-2026-05-17-v1","claims":{"count":0,"items":[],"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57"},"formal_canon":{"evidence_count":0,"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57"},"integrity":{"available":true,"clean":true,"detectors_run":[],"endpoint":"/pith/2607.28677/integrity.json","findings":[],"snapshot_sha256":"c28c3603d3b5d939e8dc4c7e95fa8dfce3d595e45f758748cecf8e644a296938","summary":{"advisory":0,"by_detector":{},"critical":0,"informational":0}},"paper":{"abstract_excerpt":"LLM now pass medical licensing examinations and, in curated cases, can rival physicians at diagnostic reasoning. These developments have accelerated the use of LLMs for symptom assessment and clinical decision support in diagnostic and treatment guidance, administrative documentation, and rules-based alert enhancement. This Perspective concerns the most consequential of these applications: the autonomous triage of self-presenting, undifferentiated patients, with little or no clinician in the loop. For that task, the evidence of safety does not yet exist. The gap is not in medical knowledge but","authors_text":"Alexey Matyushkin, Gabriele C DeLuca, James Hillis, Manoj Ramachandran, Max Solovyev, Mehdi Zadem, Nicolas von Mallinckrodt, Prakash Jayakumar, Ryaan Sultan, Sanjeeva Jeyaretna, Shayndhan Sivanathan, Shravan Nageswaran, Sumon Sadhu","cross_cats":[],"headline":"","license":"http://creativecommons.org/licenses/by/4.0/","primary_cat":"cs.AI","submitted_at":"2026-07-29T07:12:46Z","title":"Reasoning in Real World Clinical Care: Why Large Language Models Are Not Yet Safe for Autonomous Clinical Decision Support"},"references":{"count":0,"internal_anchors":0,"resolved_work":0,"sample":[],"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57"},"source":{"id":"2607.28677","kind":"arxiv","version":1},"verdict":{"created_at":null,"id":null,"model_set":{},"one_line_summary":"","pipeline_version":null,"pith_extraction_headline":"","strongest_claim":"","weakest_assumption":""}},"verdict_id":null}}],"author_attestations":[],"timestamp_anchors":[],"storage_attestations":[],"citation_signatures":[],"replication_records":[],"corrections":[],"mirror_hints":[],"record_created":{"event_id":"sha256:c1b78d265deb3a4e6eb3f24bcf09e503fadfb355d940a6e9c22a87ab56a3c514","target":"record","created_at":"2026-08-03T00:12:09Z","signer":{"key_id":"pith-v1-2026-05","public_key_fingerprint":"8d4b5ee74e4693bcd1df2446408b0d54","signer_id":"pith.science","signer_type":"pith_registry"},"payload":{"attestation_state":"computed","canonical_record":{"metadata":{"abstract_canon_sha256":"4e2a94d683b6adb041e91d1df42c278ca7a8f738744d4ba732d3ccce5629dc7f","cross_cats_sorted":[],"license":"http://creativecommons.org/licenses/by/4.0/","primary_cat":"cs.AI","submitted_at":"2026-07-29T07:12:46Z","title_canon_sha256":"611edf34ef8c892bad2326d58b956cbb06a09dbfc5e87d5c7a73a79e59814f8a"},"schema_version":"1.0","source":{"id":"2607.28677","kind":"arxiv","version":1}},"canonical_sha256":"27a3c8e435defc865f7cd6b414b41113c40476655f81ac6a77b03b52e31473c7","receipt":{"algorithm":"ed25519","builder_version":"pith-number-builder-2026-05-17-v1","canonical_sha256":"27a3c8e435defc865f7cd6b414b41113c40476655f81ac6a77b03b52e31473c7","first_computed_at":"2026-08-03T00:12:09.074392Z","key_id":"pith-v1-2026-05","kind":"pith_receipt","last_reissued_at":"2026-08-03T00:12:09.074392Z","public_key_fingerprint":"8d4b5ee74e4693bcd1df2446408b0d54","receipt_version":"0.3","signature_b64":"T2dlnr7M2dMIb/fJPa8WICETFLozU61XUdAj1SfHiOc8xiqr4YzLHyB8SALeKsTCG2o6HFGfacySr4o55lH2Cw==","signature_status":"signed_v1","signed_at":"2026-08-03T00:12:09.076851Z","signed_message":"canonical_sha256_bytes"},"source_id":"2607.28677","source_kind":"arxiv","source_version":1}}},"equivocations":[],"invalid_events":[],"applied_event_ids":["sha256:c1b78d265deb3a4e6eb3f24bcf09e503fadfb355d940a6e9c22a87ab56a3c514","sha256:e0f9815c255a7f2f04b4999e624ee6a90401641afe2f03e95d35e78eda78f4ce"],"state_sha256":"b08bba7ec89cfc5cc6f1ae04aa538d6569ba0f4dc1c7005fbc631c71126028d7"},"bundle_signature":{"signature_status":"signed_v1","algorithm":"ed25519","key_id":"pith-v1-2026-05","public_key_fingerprint":"8d4b5ee74e4693bcd1df2446408b0d54","signature_b64":"FOaNGFLb7WefkWNqpLGhhWXy7iVsBGwKqHK9vnxP3lb0Ou4g0FL1Kqnrh21F+wBPJPrdk49NxyG0d5kXN2+9BA==","signed_message":"bundle_sha256_bytes","signed_at":"2026-08-05T10:34:23.452300Z","bundle_sha256":"d3950d2de90326f7f3f9045f48747c18e3cb4c31973ddb65d3f847035f3ef9ae"}}