Dimension-reduced outcome-weighted learning for estimating individualized treatment regimes in observational studies

Individualized treatment regimes (ITRs) aim to improve clinical outcomes by assigning treatment based on patient-specific characteristics. However, existing methods often struggle with high-dimensional covariates, limiting accuracy, interpretability, and real-world applicability. We propose a novel sufficient dimension reduction approach that directly targets the contrast between potential outcomes and identifies a low-dimensional subspace of the covariates capturing treatment effect heterogeneity. This reduced representation enables more accurate estimation of optimal ITRs through outcome-weighted learning. To accommodate observational data, our method incorporates kernel-based covariate balancing, allowing treatment assignment to depend on the full covariate set and avoiding the restrictive assumption that the subspace sufficient for modeling heterogeneous treatment effects is also sufficient for confounding adjustment. We show that the proposed method achieves universal consistency, i.e., its risk converges to the Bayes risk, under mild regularity conditions. We demonstrate its finite sample performance through simulations and an analysis of intensive care unit sepsis patient data to determine who should receive transthoracic echocardiography.

Learned Hemodynamic Coupling Inference in Resting-State Functional MRI

Functional magnetic resonance imaging (fMRI) provides an indirect measurement of neuronal activity via hemodynamic responses that vary across brain regions and individuals. Ignoring this hemodynamic variability can bias downstream connectivity estimates. Furthermore, the hemodynamic parameters themselves may serve as important imaging biomarkers. Estimating spatially varying hemodynamics from resting-state fMRI (rsfMRI) is therefore an important but challenging blind inverse problem, since both the latent neural activity and the hemodynamic coupling are unknown. In this work, we propose a methodology for inferring hemodynamic coupling on the cortical surface from rsfMRI. Our approach avoids the highly unstable joint recovery of neural activity and hemodynamics by marginalizing out the latent neural signal and basing inference on the resulting marginal likelihood. To enable scalable, high-resolution estimation, we employ a deep neural network combined with conditional normalizing flows to accurately approximate this intractable marginal likelihood, while enforcing spatial coherence through priors defined on the cortical surface that admit sparse representations. The proposed approach is extensively validated using synthetic data and real fMRI datasets, demonstrating clear improvements over current methods for hemodynamic estimation and downstream connectivity analysis.

Why Text Prevails: Vision May Undermine Multimodal Medical Decision Making

With the rapid progress of large language models (LLMs), advanced multimodal large language models (MLLMs) have demonstrated impressive zero-shot capabilities on vision-language tasks. In the biomedical domain, however, even state-of-the-art MLLMs struggle with basic Medical Decision Making (MDM) tasks. We investigate this limitation using two challenging datasets: (1) three-stage Alzheimer's disease (AD) classification (normal, mild cognitive impairment, dementia), where category differences are visually subtle, and (2) MIMIC-CXR chest radiograph classification with 14 non-mutually exclusive conditions. Our empirical study shows that text-only reasoning consistently outperforms vision-only or vision-text settings, with multimodal inputs often performing worse than text alone. To mitigate this, we explore three strategies: (1) in-context learning with reason-annotated exemplars, (2) vision captioning followed by text-only inference, and (3) few-shot fine-tuning of the vision tower with classification supervision. These findings reveal that current MLLMs lack grounded visual understanding and point to promising directions for improving multimodal decision making in healthcare.