OPGAgent: An Agent for Auditable Dental Panoramic X-ray Interpretation

Orthopantomograms (OPGs) are the standard panoramic radiograph in dentistry, used for full-arch screening across multiple diagnostic tasks. While Vision Language Models (VLMs) now allow multi-task OPG analysis through natural language, they underperform task-specific models on most individual tasks. Agentic systems that orchestrate specialized tools offer a path to both versatility and accuracy, this approach remains unexplored in the field of dental imaging. To address this gap, we propose OPGAgent, a multi-tool agentic system for auditable OPG interpretation. OPGAgent coordinates specialized perception modules with a consensus mechanism through three components: (1) a Hierarchical Evidence Gathering module that decomposes OPG analysis into global, quadrant, and tooth-level phases with dynamically invoking tools, (2) a Specialized Toolbox encapsulating spatial, detection, utility, and expert zoos, and (3) a Consensus Subagent that resolves conflicts through anatomical constraints. We further propose OPG-Bench, a structured-report protocol based on (Location, Field, Value) triples derived from real clinical reports, which enables a comprehensive review of findings and hallucinations, extending beyond the limitations of VQA indicators. On our OPG-Bench and the public MMOral-OPG benchmark, OPGAgent outperforms current dental VLMs and medical agent frameworks across both structured-report and VQA evaluation. Code will be released upon acceptance.

Training-Free Acceleration for Document Parsing Vision-Language Model with Hierarchical Speculative Decoding

Document parsing is a fundamental task in multimodal understanding, supporting a wide range of downstream applications such as information extraction and intelligent document analysis. Benefiting from strong semantic modeling and robust generalization, VLM-based end-to-end approaches have emerged as the mainstream paradigm in recent years. However, these models often suffer from substantial inference latency, as they must auto-regressively generate long token sequences when processing long-form documents. In this work, motivated by the extremely long outputs and complex layout structures commonly found in document parsing, we propose a training-free and highly efficient acceleration method. Inspired by speculative decoding, we employ a lightweight document parsing pipeline as a draft model to predict batches of future tokens, while the more accurate VLM verifies these draft predictions in parallel. Moreover, we further exploit the layout-structured nature of documents by partitioning each page into independent regions, enabling parallel decoding of each region using the same draft-verify strategy. The final predictions are then assembled according to the natural reading order. Experimental results demonstrate the effectiveness of our approach: on the general-purpose OmniDocBench, our method provides a 2.42x lossless acceleration for the dots.ocr model, and achieves up to 4.89x acceleration on long-document parsing tasks. We will release our code to facilitate reproducibility and future research.

A Vision-Language Foundation Model for Zero-shot Clinical Collaboration and Automated Concept Discovery in Dermatology

Medical foundation models have shown promise in controlled benchmarks, yet widespread deployment remains hindered by reliance on task-specific fine-tuning. Here, we introduce DermFM-Zero, a dermatology vision-language foundation model trained via masked latent modelling and contrastive learning on over 4 million multimodal data points. We evaluated DermFM-Zero across 20 benchmarks spanning zero-shot diagnosis and multimodal retrieval, achieving state-of-the-art performance without task-specific adaptation. We further evaluated its zero-shot capabilities in three multinational reader studies involving over 1,100 clinicians. In primary care settings, AI assistance enabled general practitioners to nearly double their differential diagnostic accuracy across 98 skin conditions. In specialist settings, the model significantly outperformed board-certified dermatologists in multimodal skin cancer assessment. In collaborative workflows, AI assistance enabled non-experts to surpass unassisted experts while improving management appropriateness. Finally, we show that DermFM-Zero's latent representations are interpretable: sparse autoencoders unsupervisedly disentangle clinically meaningful concepts that outperform predefined-vocabulary approaches and enable targeted suppression of artifact-induced biases, enhancing robustness without retraining. These findings demonstrate that a foundation model can provide effective, safe, and transparent zero-shot clinical decision support.

MedScope: Incentivizing "Think with Videos" for Clinical Reasoning via Coarse-to-Fine Tool Calling

Long-form clinical videos are central to visual evidence-based decision-making, with growing importance for applications such as surgical robotics and related settings. However, current multimodal large language models typically process videos with passive sampling or weakly grounded inspection, which limits their ability to iteratively locate, verify, and justify predictions with temporally targeted evidence. To close this gap, we propose MedScope, a tool-using clinical video reasoning model that performs coarse-to-fine evidence seeking over long-form procedures. By interleaving intermediate reasoning with targeted tool calls and verification on retrieved observations, MedScope produces more accurate and trustworthy predictions that are explicitly grounded in temporally localized visual evidence. To address the lack of high-fidelity supervision, we build ClinVideoSuite, an evidence-centric, fine-grained clinical video suite. We then optimize MedScope with Grounding-Aware Group Relative Policy Optimization (GA-GRPO), which directly reinforces tool use with grounding-aligned rewards and evidence-weighted advantages. On full and fine-grained video understanding benchmarks, MedScope achieves state-of-the-art performance in both in-domain and out-of-domain evaluations. Our approach illuminates a path toward medical AI agents that can genuinely "think with videos" through tool-integrated reasoning. We will release our code, models, and data.

OneVision-Encoder: Codec-Aligned Sparsity as a Foundational Principle for Multimodal Intelligence

Hypothesis. Artificial general intelligence is, at its core, a compression problem. Effective compression demands resonance: deep learning scales best when its architecture aligns with the fundamental structure of the data. These are the fundamental principles. Yet, modern vision architectures have strayed from these truths: visual signals are highly redundant, while discriminative information, the surprise, is sparse. Current models process dense pixel grids uniformly, wasting vast compute on static background rather than focusing on the predictive residuals that define motion and meaning. We argue that to solve visual understanding, we must align our architectures with the information-theoretic principles of video, i.e., Codecs. Method. OneVision-Encoder encodes video by compressing predictive visual structure into semantic meaning. By adopting Codec Patchification, OV-Encoder abandons uniform computation to focus exclusively on the 3.1%-25% of regions rich in signal entropy. To unify spatial and temporal reasoning under irregular token layouts, OneVision-Encoder employs a shared 3D RoPE and is trained with a large-scale cluster discrimination objective over more than one million semantic concepts, jointly capturing object permanence and motion dynamics. Evidence. The results validate our core hypothesis: efficiency and accuracy are not a trade-off; they are positively correlated. When integrated into LLM, it consistently outperforms strong vision backbones such as Qwen3-ViT and SigLIP2 across 16 image, video, and document understanding benchmarks, despite using substantially fewer visual tokens and pretraining data. Notably, on video understanding tasks, OV-Encoder achieves an average improvement of 4.1% over Qwen3-ViT. Codec-aligned, patch-level sparsity is a foundational principle, enabling OV-Encoder as a scalable engine for next-generation visual generalists.

AdaptOVCD: Training-Free Open-Vocabulary Remote Sensing Change Detection via Adaptive Information Fusion

Remote sensing change detection plays a pivotal role in domains such as environmental monitoring, urban planning, and disaster assessment. However, existing methods typically rely on predefined categories and large-scale pixel-level annotations, which limit their generalization and applicability in open-world scenarios. To address these limitations, this paper proposes AdaptOVCD, a training-free Open-Vocabulary Change Detection (OVCD) architecture based on dual-dimensional multi-level information fusion. The framework integrates multi-level information fusion across data, feature, and decision levels vertically while incorporating targeted adaptive designs horizontally, achieving deep synergy among heterogeneous pre-trained models to effectively mitigate error propagation. Specifically, (1) at the data level, Adaptive Radiometric Alignment (ARA) fuses radiometric statistics with original texture features and synergizes with SAM-HQ to achieve radiometrically consistent segmentation; (2) at the feature level, Adaptive Change Thresholding (ACT) combines global difference distributions with edge structure priors and leverages DINOv3 to achieve robust change detection; (3) at the decision level, Adaptive Confidence Filtering (ACF) integrates semantic confidence with spatial constraints and collaborates with DGTRS-CLIP to achieve high-confidence semantic identification. Comprehensive evaluations across nine scenarios demonstrate that AdaptOVCD detects arbitrary category changes in a zero-shot manner, significantly outperforming existing training-free methods. Meanwhile, it achieves 84.89\% of the fully-supervised performance upper bound in cross-dataset evaluations and exhibits superior generalization capabilities. The code is available at https://github.com/Dmygithub/AdaptOVCD.

LLM-Inspired Pretrain-Then-Finetune for Small-Data, Large-Scale Optimization

We consider small-data, large-scale decision problems in which a firm must make many operational decisions simultaneously (e.g., across a large product portfolio) while observing only a few, potentially noisy, data points per instance. Inspired by the success of large language models (LLMs), we propose a pretrain-then-finetune approach built on a designed Transformer model to address this challenge. The model is first pretrained on large-scale, domain-informed synthetic data that encode managerial knowledge and structural features of the decision environment, and is then fine-tuned on real observations. This new pipeline offers two complementary advantages: pretraining injects domain knowledge into the learning process and enables the training of high-capacity models using abundant synthetic data, while finetuning adapts the pretrained model to the operational environment and improves alignment with the true data-generating regime. While we have leveraged the Transformer's state-of-the-art representational capacity, particularly its attention mechanism, to efficiently extract cross-task structure, our approach is not an off-the-shelf application. Instead, it relies on problem-specific architectural design and a tailored training procedure to match the decision setting. Theoretically, we develop the first comprehensive error analysis regarding Transformer learning in relevant contexts, establishing nonasymptotic guarantees that validate the method's effectiveness. Critically, our analysis reveals how pretraining and fine-tuning jointly determine performance, with the dominant contribution governed by whichever is more favorable. In particular, finetuning exhibits an economies-of-scale effect, whereby transfer learning becomes increasingly effective as the number of instances grows.

A General Model for Retinal Segmentation and Quantification

Retinal imaging is fast, non-invasive, and widely available, offering quantifiable structural and vascular signals for ophthalmic and systemic health assessment. This accessibility creates an opportunity to study how quantitative retinal phenotypes relate to ocular and systemic diseases. However, such analyses remain difficult at scale due to the limited availability of public multi-label datasets and the lack of a unified segmentation-to-quantification pipeline. We present RetSAM, a general retinal segmentation and quantification framework for fundus imaging. It delivers robust multi-target segmentation and standardized biomarker extraction, supporting downstream ophthalmologic studies and oculomics correlation analyses. Trained on over 200,000 fundus images, RetSAM supports three task categories and segments five anatomical structures, four retinal phenotypic patterns, and more than 20 distinct lesion types. It converts these segmentation results into over 30 standardized biomarkers that capture structural morphology, vascular geometry, and degenerative changes. Trained with a multi-stage strategy using both private and public fundus data, RetSAM achieves superior segmentation performance on 17 public datasets. It improves on prior best methods by 3.9 percentage points in DSC on average, with up to 15 percentage points on challenging multi-task benchmarks, and generalizes well across diverse populations, imaging devices, and clinical settings. The resulting biomarkers enable systematic correlation analyses across major ophthalmic diseases, including diabetic retinopathy, age-related macular degeneration, glaucoma, and pathologic myopia. Together, RetSAM transforms fundus images into standardized, interpretable quantitative phenotypes, enabling large-scale ophthalmic research and translation.

A Federated and Parameter-Efficient Framework for Large Language Model Training in Medicine

Large language models (LLMs) have demonstrated strong performance on medical benchmarks, including question answering and diagnosis. To enable their use in clinical settings, LLMs are typically further adapted through continued pretraining or post-training using clinical data. However, most medical LLMs are trained on data from a single institution, which faces limitations in generalizability and safety in heterogeneous systems. Federated learning (FL) is a promising solution for enabling collaborative model development across healthcare institutions. Yet applying FL to LLMs in medicine remains fundamentally limited. First, conventional FL requires transmitting the full model during each communication round, which becomes impractical for multi-billion-parameter LLMs given the limited computational resources. Second, many FL algorithms implicitly assume data homogeneity, whereas real-world clinical data are highly heterogeneous across patients, diseases, and institutional practices. We introduce the model-agnostic and parameter-efficient federated learning framework for adapting LLMs to medical applications. Fed-MedLoRA transmits only low-rank adapter parameters, reducing communication and computation overhead, while Fed-MedLoRA+ further incorporates adaptive, data-aware aggregation to improve convergence under cross-site heterogeneity. We apply the framework to clinical information extraction (IE), which transforms patient narratives into structured medical entities and relations. Accuracy was assessed across five patient cohorts through comparisons with BERT models, and LLaMA-3 and DeepSeek-R1, GPT-4o models. Evaluation settings included (1) in-domain training and testing, (2) external validation on independent cohorts, and (3) a low-resource new-site adaptation scenario using real-world clinical notes from the Yale New Haven Health System.

LLM Collusion

We study how delegating pricing to large language models (LLMs) can facilitate collusion in a duopoly when both sellers rely on the same pre-trained model. The LLM is characterized by (i) a propensity parameter capturing its internal bias toward high-price recommendations and (ii) an output-fidelity parameter measuring how tightly outputs track that bias; the propensity evolves through retraining. We show that configuring LLMs for robustness and reproducibility can induce collusion via a phase transition: there exists a critical output-fidelity threshold that pins down long-run behavior. Below it, competitive pricing is the unique long-run outcome. Above it, the system is bistable, with competitive and collusive pricing both locally stable and the realized outcome determined by the model's initial preference. The collusive regime resembles tacit collusion: prices are elevated on average, yet occasional low-price recommendations provide plausible deniability. With perfect fidelity, full collusion emerges from any interior initial condition. For finite training batches of size $b$, infrequent retraining (driven by computational costs) further amplifies collusion: conditional on starting in the collusive basin, the probability of collusion approaches one as $b$ grows, since larger batches dampen stochastic fluctuations that might otherwise tip the system toward competition. The indeterminacy region shrinks at rate $O(1/\sqrt{b})$.