Resolving the bias-precision paradox with stochastic causal representation learning for personalized medicine

Estimating individualized treatment effects from longitudinal observational data is central to data-driven medicine, yet existing methods face a fundamental limitation: reducing confounding bias often suppresses clinically informative heterogeneity, degrading patient-specific predictions. Here, we identify this tension as a bias-precision paradox in causal representation learning and introduce sampling-based maximum mean discrepancy (sMMD), a stochastic alignment strategy that replaces global adversarial balancing with subset-level matching. We instantiate this approach in a framework for counterfactual outcome prediction with attribution-grounded interpretability. Across two large-scale ICU cohorts (n = 27,783), our framework improves accuracy under distribution shift, reducing error by up to 11.5% and substantially increasing recall in high-risk tasks. Mechanistic analyses show that sMMD selectively preserves clinically decisive variables. In human-AI evaluation, our method outperforms clinicians-in-training and large language models, and improves clinician accuracy by 14.7% while reducing decision time, enabling interpretable, real-time clinical decision support.

Deep Learning Based Estimation of Blood Glucose Levels from Multidirectional Scleral Blood Vessel Imaging

Regular monitoring of glycemic status is essential for diabetes management, yet conventional blood-based testing can be burdensome for frequent assessment. The sclera contains superficial microvasculature that may exhibit diabetes related alterations and is readily visible on the ocular surface. We propose ScleraGluNet, a multiview deep-learning framework for three-class metabolic status classification (normal, controlled diabetes, and high-glucose diabetes) and continuous fasting plasma glucose (FPG) estimation from multidirectional scleral vessel images. The dataset comprised 445 participants (150/140/155) and 2,225 anterior-segment images acquired from five gaze directions per participant. After vascular enhancement, features were extracted using parallel convolutional branches, refined with Manta Ray Foraging Optimization (MRFO), and fused via transformer-based cross-view attention. Performance was evaluated using subject-wise five-fold cross-validation, with all images from each participant assigned to the same fold. ScleraGluNet achieved 93.8% overall accuracy, with one-vs-rest AUCs of 0.971,0.956, and 0.982 for normal, controlled diabetes, and high-glucose diabetes, respectively. For FPG estimation, the model achieved MAE = 6.42 mg/dL and RMSE = 7.91 mg/dL, with strong correlation to laboratory measurements (r = 0.983; R2 = 0.966). Bland Altman analysis showed a mean bias of +1.45 mg/dL with 95% limits of agreement from -8.33 to +11.23$ mg/dL. These results support multidirectional scleral vessel imaging with multiview learning as a promising noninvasive approach for glycemic assessment, warranting multicenter validation before clinical deployment.