FlyingLawnmower

Good point re: documentation...

We have support for Huggingface Transformers, llama.cpp, vLLM, SGLang, and TensorRT-LLM, along with some smaller providers (e.g. mistral.rs). Using any of these libraries as an inference host means you can use an OSS model with the guidance backend for full support. Most open source models will run on at least one of these backends (with vLLM probably being the most popular hosted solution, and transformers/llama.cpp being the most popular local model solutions)

We're also the backend used by OpenAI/Azure OpenAI for structured outputs on the closed source model side.

Thanks :)

Great question re: adoption...it's definitely dominated by JSON. Most API providers have standardized on JSON outputs, so application teams have started building shims that map other formats to JSON and back. Similarly, with models heavily being post-trained to generate "good" JSON, I think there's a better model-constraint alignment story with JSON than most arbitrary grammars.

That said, internally, we experiment quite a lot with custom grammars all across the stack. It's more complicated to write a grammar than a JSON schema (though LMs are very good at grammar writing now) and more error prone to debug, but it can help significantly in certain cases (e.g. having models write custom DSLs not commonly found on the internet, at various parts of a model training pipeline, etc. etc.). I'm hoping that with the right tooling around it, the broader community will start nudging beyond JSON.

To that end, the python guidance library is really an attempt to make writing grammars more friendly to a python programmer. More to be done here of course!

Yes. They are about entirely different patient reports.

Artificial intelligence holds great promise for expanding access to expert medical knowledge and reasoning. However, most evaluations of language models rely on static vignettes and multiple-choice questions that fail to reflect the complexity and nuance of evidence-based medicine in real-world settings. In clinical practice, physicians iteratively formulate and revise diagnostic hypotheses, adapting each subsequent question and test to what they've just learned, and weigh the evolving evidence before committing to a final diagnosis. To emulate this iterative process, we introduce the Sequential Diagnosis Benchmark, which transforms 304 diagnostically challenging New England Journal of Medicine clinicopathological conference (NEJM-CPC) cases into stepwise diagnostic encounters. A physician or AI begins with a short case abstract and must iteratively request additional details from a gatekeeper model that reveals findings only when explicitly queried. Performance is assessed not just by diagnostic accuracy but also by the cost of physician visits and tests performed. We also present the MAI Diagnostic Orchestrator (MAI-DxO), a model-agnostic orchestrator that simulates a panel of physicians, proposes likely differential diagnoses and strategically selects high-value, cost-effective tests. When paired with OpenAI's o3 model, MAI-DxO achieves 80% diagnostic accuracy--four times higher than the 20% average of generalist physicians. MAI-DxO also reduces diagnostic costs by 20% compared to physicians, and 70% compared to off-the-shelf o3. When configured for maximum accuracy, MAI-DxO achieves 85.5% accuracy. These performance gains with MAI-DxO generalize across models from the OpenAI, Gemini, Claude, Grok, DeepSeek, and Llama families. We highlight how AI systems, when guided to think iteratively and act judiciously, can advance diagnostic precision and cost-effectiveness in clinical care.