Self-Supervised Learning for Knee Osteoarthritis: Diagnostic Limitations and Prognostic Value of Uncurated Hospital Data

This study assesses whether self-supervised learning (SSL) improves knee osteoarthritis (OA) modeling for diagnosis and prognosis relative to ImageNet-pretrained initialization. We compared (i) image-only SSL pretrained on knee radiographs from the OAI, MOST, and NYU cohorts, and (ii) multimodal image-text SSL pretrained on uncurated hospital knee radiographs paired with radiologist impressions. For diagnostic Kellgren-Lawrence (KL) grade prediction, SSL offered mixed results. While image-only SSL improved accuracy during linear probing (frozen encoder), it did not outperform ImageNet pretraining during full fine-tuning. Similarly, multimodal SSL failed to improve grading performance. We attribute this to severe bias in the uncurated hospital pretraining corpus (93% estimated KL grade 3), which limited alignment with the balanced diagnostic task. In contrast, this same multimodal initialization significantly improved prognostic modeling. It outperformed ImageNet baselines in predicting 4-year structural incidence and progression, including on external validation (MOST AUROC: 0.701 vs. 0.599 at 10% labeled data). Overall, while uncurated hospital image-text data may be ineffective for learning diagnosis due to severity bias, it provides a strong signal for prognostic modeling when the downstream task aligns with pretraining data distribution

Scaling Recurrence-aware Foundation Models for Clinical Records via Next-Visit Prediction

While large-scale pretraining has revolutionized language modeling, its potential remains underexplored in healthcare with structured electronic health records (EHRs). We present RAVEN, a novel generative pretraining strategy for sequential EHR data based on Recurrence-Aware next-Visit EveNt prediction. Leveraging a dataset of over one million unique individuals, our model learns to autoregressively generate tokenized clinical events for the next visit conditioned on patient history. We introduce regularization on predicting repeated events and highlight a key pitfall in EHR-based foundation model evaluations: repeated event tokens can inflate performance metrics when new onsets are not distinguished from subsequent occurrences. Furthermore, we empirically investigate the scaling behaviors in a data-constrained, compute-saturated regime, showing that simply increasing model size is suboptimal without commensurate increases in data volume. We evaluate our model via zero-shot prediction for forecasting the incidence of a diverse set of diseases, where it rivals fully fine-tuned representation-based Transformer models and outperforms widely used simulation-based next-token approaches. Finally, without additional parameter updates, we show that RAVEN can generalize to an external patient cohort under lossy clinical code mappings and feature coverage gaps.

Cerebra: A Multidisciplinary AI Board for Multimodal Dementia Characterization and Risk Assessment

Modern clinical practice increasingly depends on reasoning over heterogeneous, evolving, and incomplete patient data. Although recent advances in multimodal foundation models have improved performance on various clinical tasks, most existing models remain static, opaque, and poorly aligned with real-world clinical workflows. We present Cerebra, an interactive multi-agent AI team that coordinates specialized agents for EHR, clinical notes, and medical imaging analysis. These outputs are synthesized into a clinician-facing dashboard that combines visual analytics with a conversational interface, enabling clinicians to interrogate predictions and contextualize risk at the point of care. Cerebra supports privacy-preserving deployment by operating on structured representations and remains robust when modalities are incomplete. We evaluated Cerebra using a massive multi-institutional dataset spanning 3 million patients from four independent healthcare systems. Cerebra consistently outperformed both state-of-the-art single-modality models and large multimodal language model baselines. In dementia risk prediction, it achieved AUROCs up to 0.80, compared with 0.74 for the strongest single-modality model and 0.68 for language model baselines. For dementia diagnosis, it achieved an AUROC of 0.86, and for survival prediction, a C-index of 0.81. In a reader study with experienced physicians, Cerebra significantly improved expert performance, increasing accuracy by 17.5 percentage points in prospective dementia risk estimation. These results demonstrate Cerebra's potential for interpretable, robust decision support in clinical care.

A Multidisciplinary AI Board for Multimodal Dementia Characterization and Risk Assessment

Modern clinical practice increasingly depends on reasoning over heterogeneous, evolving, and incomplete patient data. Although recent advances in multimodal foundation models have improved performance on various clinical tasks, most existing models remain static, opaque, and poorly aligned with real-world clinical workflows. We present Cerebra, an interactive multi-agent AI team that coordinates specialized agents for EHR, clinical notes, and medical imaging analysis. These outputs are synthesized into a clinician-facing dashboard that combines visual analytics with a conversational interface, enabling clinicians to interrogate predictions and contextualize risk at the point of care. Cerebra supports privacy-preserving deployment by operating on structured representations and remains robust when modalities are incomplete. We evaluated Cerebra using a massive multi-institutional dataset spanning 3 million patients from four independent healthcare systems. Cerebra consistently outperformed both state-of-the-art single-modality models and large multimodal language model baselines. In dementia risk prediction, it achieved AUROCs up to 0.80, compared with 0.74 for the strongest single-modality model and 0.68 for language model baselines. For dementia diagnosis, it achieved an AUROC of 0.86, and for survival prediction, a C-index of 0.81. In a reader study with experienced physicians, Cerebra significantly improved expert performance, increasing accuracy by 17.5 percentage points in prospective dementia risk estimation. These results demonstrate Cerebra's potential for interpretable, robust decision support in clinical care.

Conformal Policy Control

An agent must try new behaviors to explore and improve. In high-stakes environments, an agent that violates safety constraints may cause harm and must be taken offline, curtailing any future interaction. Imitating old behavior is safe, but excessive conservatism discourages exploration. How much behavior change is too much? We show how to use any safe reference policy as a probabilistic regulator for any optimized but untested policy. Conformal calibration on data from the safe policy determines how aggressively the new policy can act, while provably enforcing the user's declared risk tolerance. Unlike conservative optimization methods, we do not assume the user has identified the correct model class nor tuned any hyperparameters. Unlike previous conformal methods, our theory provides finite-sample guarantees even for non-monotonic bounded constraint functions. Our experiments on applications ranging from natural language question answering to biomolecular engineering show that safe exploration is not only possible from the first moment of deployment, but can also improve performance.

Characterizing the Predictive Impact of Modalities with Supervised Latent-Variable Modeling

Despite the recent success of Multimodal Large Language Models (MLLMs), existing approaches predominantly assume the availability of multiple modalities during training and inference. In practice, multimodal data is often incomplete because modalities may be missing, collected asynchronously, or available only for a subset of examples. In this work, we propose PRIMO, a supervised latent-variable imputation model that quantifies the predictive impact of any missing modality within the multimodal learning setting. PRIMO enables the use of all available training examples, whether modalities are complete or partial. Specifically, it models the missing modality through a latent variable that captures its relationship with the observed modality in the context of prediction. During inference, we draw many samples from the learned distribution over the missing modality to both obtain the marginal predictive distribution (for the purpose of prediction) and analyze the impact of the missing modalities on the prediction for each instance. We evaluate PRIMO on a synthetic XOR dataset, Audio-Vision MNIST, and MIMIC-III for mortality and ICD-9 prediction. Across all datasets, PRIMO obtains performance comparable to unimodal baselines when a modality is fully missing and to multimodal baselines when all modalities are available. PRIMO quantifies the predictive impact of a modality at the instance level using a variance-based metric computed from predictions across latent completions. We visually demonstrate how varying completions of the missing modality result in a set of plausible labels.

Paradox of De-identification: A Critique of HIPAA Safe Harbour in the Age of LLMs

Privacy is a human right that sustains patient-provider trust. Clinical notes capture a patient's private vulnerability and individuality, which are used for care coordination and research. Under HIPAA Safe Harbor, these notes are de-identified to protect patient privacy. However, Safe Harbor was designed for an era of categorical tabular data, focusing on the removal of explicit identifiers while ignoring the latent information found in correlations between identity and quasi-identifiers, which can be captured by modern LLMs. We first formalize these correlations using a causal graph, then validate it empirically through individual re-identification of patients from scrubbed notes. The paradox of de-identification is further shown through a diagnosis ablation: even when all other information is removed, the model can predict the patient's neighborhood based on diagnosis alone. This position paper raises the question of how we can act as a community to uphold patient-provider trust when de-identification is inherently imperfect. We aim to raise awareness and discuss actionable recommendations.

Group Contrastive Learning for Weakly Paired Multimodal Data

We present GROOVE, a semi-supervised multi-modal representation learning approach for high-content perturbation data where samples across modalities are weakly paired through shared perturbation labels but lack direct correspondence. Our primary contribution is GroupCLIP, a novel group-level contrastive loss that bridges the gap between CLIP for paired cross-modal data and SupCon for uni-modal supervised contrastive learning, addressing a fundamental gap in contrastive learning for weakly-paired settings. We integrate GroupCLIP with an on-the-fly backtranslating autoencoder framework to encourage cross-modally entangled representations while maintaining group-level coherence within a shared latent space. Critically, we introduce a comprehensive combinatorial evaluation framework that systematically assesses representation learners across multiple optimal transport aligners, addressing key limitations in existing evaluation strategies. This framework includes novel simulations that systematically vary shared versus modality-specific perturbation effects enabling principled assessment of method robustness. Our combinatorial benchmarking reveals that there is not yet an aligner that uniformly dominates across settings or modality pairs. Across simulations and two real single-cell genetic perturbation datasets, GROOVE performs on par with or outperforms existing approaches for downstream cross-modal matching and imputation tasks. Our ablation studies demonstrate that GroupCLIP is the key component driving performance gains. These results highlight the importance of leveraging group-level constraints for effective multi-modal representation learning in scenarios where only weak pairing is available.

TwinWeaver: An LLM-Based Foundation Model Framework for Pan-Cancer Digital Twins

Precision oncology requires forecasting clinical events and trajectories, yet modeling sparse, multi-modal clinical time series remains a critical challenge. We introduce TwinWeaver, an open-source framework that serializes longitudinal patient histories into text, enabling unified event prediction as well as forecasting with large language models, and use it to build Genie Digital Twin (GDT) on 93,054 patients across 20 cancer types. In benchmarks, GDT significantly reduces forecasting error, achieving a median Mean Absolute Scaled Error (MASE) of 0.87 compared to 0.97 for the strongest time-series baseline (p<0.001). Furthermore, GDT improves risk stratification, achieving an average concordance index (C-index) of 0.703 across survival, progression, and therapy switching tasks, surpassing the best baseline of 0.662. GDT also generalizes to out-of-distribution clinical trials, matching trained baselines at zero-shot and surpassing them with fine-tuning, achieving a median MASE of 0.75-0.88 and outperforming the strongest baseline in event prediction with an average C-index of 0.672 versus 0.648. Finally, TwinWeaver enables an interpretable clinical reasoning extension, providing a scalable and transparent foundation for longitudinal clinical modeling.

Neural Neural Scaling Laws

Neural scaling laws predict how language model performance improves with increased compute. While aggregate metrics like validation loss can follow smooth power-law curves, individual downstream tasks exhibit diverse scaling behaviors: some improve monotonically, others plateau, and some even degrade with scale. We argue that predicting downstream performance from validation perplexity suffers from two limitations: averaging token-level losses obscures signal, and no simple parametric family can capture the full spectrum of scaling behaviors. To address this, we propose Neural Neural Scaling Laws (NeuNeu), a neural network that frames scaling law prediction as time-series extrapolation. NeuNeu combines temporal context from observed accuracy trajectories with token-level validation losses, learning to predict future performance without assuming any bottleneck or functional form. Trained entirely on open-source model checkpoints from HuggingFace, NeuNeu achieves 2.04% mean absolute error in predicting model accuracy on 66 downstream tasks -- a 38% reduction compared to logistic scaling laws (3.29% MAE). Furthermore, NeuNeu generalizes zero-shot to unseen model families, parameter counts, and downstream tasks. Our work suggests that predicting downstream scaling laws directly from data outperforms parametric alternatives.