Can we generate portable representations for clinical time series data using LLMs?

Deploying clinical ML is slow and brittle: models that work at one hospital often degrade under distribution shifts at the next. In this work, we study a simple question -- can large language models (LLMs) create portable patient embeddings i.e. representations of patients enable a downstream predictor built on one hospital to be used elsewhere with minimal-to-no retraining and fine-tuning. To do so, we map from irregular ICU time series onto concise natural language summaries using a frozen LLM, then embed each summary with a frozen text embedding model to obtain a fixed length vector capable of serving as input to a variety of downstream predictors. Across three cohorts (MIMIC-IV, HIRID, PPICU), on multiple clinically grounded forecasting and classification tasks, we find that our approach is simple, easy to use and competitive with in-distribution with grid imputation, self-supervised representation learning, and time series foundation models, while exhibiting smaller relative performance drops when transferring to new hospitals. We study the variation in performance across prompt design, with structured prompts being crucial to reducing the variance of the predictive models without altering mean accuracy. We find that using these portable representations improves few-shot learning and does not increase demographic recoverability of age or sex relative to baselines, suggesting little additional privacy risk. Our work points to the potential that LLMs hold as tools to enable the scalable deployment of production grade predictive models by reducing the engineering overhead.

Dialogue to Question Generation for Evidence-based Medical Guideline Agent Development

Evidence-based medicine (EBM) is central to high-quality care, but remains difficult to implement in fast-paced primary care settings. Physicians face short consultations, increasing patient loads, and lengthy guideline documents that are impractical to consult in real time. To address this gap, we investigate the feasibility of using large language models (LLMs) as ambient assistants that surface targeted, evidence-based questions during physician-patient encounters. Our study focuses on question generation rather than question answering, with the aim of scaffolding physician reasoning and integrating guideline-based practice into brief consultations. We implemented two prompting strategies, a zero-shot baseline and a multi-stage reasoning variant, using Gemini 2.5 as the backbone model. We evaluated on a benchmark of 80 de-identified transcripts from real clinical encounters, with six experienced physicians contributing over 90 hours of structured review. Results indicate that while general-purpose LLMs are not yet fully reliable, they can produce clinically meaningful and guideline-relevant questions, suggesting significant potential to reduce cognitive burden and make EBM more actionable at the point of care.

MDM-Prime-v2: Binary Encoding and Index Shuffling Enable Compute-optimal Scaling of Diffusion Language Models

Masked diffusion models (MDM) exhibit superior generalization when learned using a Partial masking scheme (Prime). This approach converts tokens into sub-tokens and models the diffusion process at the sub-token level. We identify two limitations of the MDM-Prime framework. First, we lack tools to guide the hyperparameter choice of the token granularity in the subtokenizer. Second, we find that the function form of the subtokenizer significantly degrades likelihood estimation when paired with commonly used Byte-Pair-Encoding (BPE) tokenizers. To address these limitations, we study the tightness of the variational bound in MDM-Prime and develop MDM-Prime-v2, a masked diffusion language model which incorporates Binary Encoding and Index Shuffling. Our scaling analysis reveals that MDM-Prime-v2 is 21.8$\times$ more compute-efficient than autoregressive models (ARM). In compute-optimal comparisons, MDM-Prime-v2 achieves 7.77 perplexity on OpenWebText, outperforming ARM (12.99), MDM (18.94), and MDM-Prime (13.41). When extending the model size to 1.1B parameters, our model further demonstrates superior zero-shot accuracy on various commonsense reasoning tasks.

Frequentist Consistency of Prior-Data Fitted Networks for Causal Inference

Foundation models based on prior-data fitted networks (PFNs) have shown strong empirical performance in causal inference by framing the task as an in-context learning problem.However, it is unclear whether PFN-based causal estimators provide uncertainty quantification that is consistent with classical frequentist estimators. In this work, we address this gap by analyzing the frequentist consistency of PFN-based estimators for the average treatment effect (ATE). (1) We show that existing PFNs, when interpreted as Bayesian ATE estimators, can exhibit prior-induced confounding bias: the prior is not asymptotically overwritten by data, which, in turn, prevents frequentist consistency. (2) As a remedy, we suggest employing a calibration procedure based on a one-step posterior correction (OSPC). We show that the OSPC helps to restore frequentist consistency and can yield a semi-parametric Bernstein-von Mises theorem for calibrated PFNs (i.e., both the calibrated PFN-based estimators and the classical semi-parametric efficient estimators converge in distribution with growing data size). (3) Finally, we implement OSPC through tailoring martingale posteriors on top of the PFNs. In this way, we are able to recover functional nuisance posteriors from PFNs, required by the OSPC. In multiple (semi-)synthetic experiments, PFNs calibrated with our martingale posterior OSPC produce ATE uncertainty that (i) asymptotically matches frequentist uncertainty and (ii) is well calibrated in finite samples in comparison to other Bayesian ATE estimators.

DynaSubVAE: Adaptive Subgrouping for Scalable and Robust OOD Detection

Real-world observational data often contain existing or emerging heterogeneous subpopulations that deviate from global patterns. The majority of models tend to overlook these underrepresented groups, leading to inaccurate or even harmful predictions. Existing solutions often rely on detecting these samples as Out-of-domain (OOD) rather than adapting the model to new emerging patterns. We introduce DynaSubVAE, a Dynamic Subgrouping Variational Autoencoder framework that jointly performs representation learning and adaptive OOD detection. Unlike conventional approaches, DynaSubVAE evolves with the data by dynamically updating its latent structure to capture new trends. It leverages a novel non-parametric clustering mechanism, inspired by Gaussian Mixture Models, to discover and model latent subgroups based on embedding similarity. Extensive experiments show that DynaSubVAE achieves competitive performance in both near-OOD and far-OOD detection, and excels in class-OOD scenarios where an entire class is missing during training. We further illustrate that our dynamic subgrouping mechanism outperforms standalone clustering methods such as GMM and KMeans++ in terms of both OOD accuracy and regret precision.

CausalPFN: Amortized Causal Effect Estimation via In-Context Learning

Causal effect estimation from observational data is fundamental across various applications. However, selecting an appropriate estimator from dozens of specialized methods demands substantial manual effort and domain expertise. We present CausalPFN, a single transformer that amortizes this workflow: trained once on a large library of simulated data-generating processes that satisfy ignorability, it infers causal effects for new observational datasets out-of-the-box. CausalPFN combines ideas from Bayesian causal inference with the large-scale training protocol of prior-fitted networks (PFNs), learning to map raw observations directly to causal effects without any task-specific adjustment. Our approach achieves superior average performance on heterogeneous and average treatment effect estimation benchmarks (IHDP, Lalonde, ACIC). Moreover, it shows competitive performance for real-world policy making on uplift modeling tasks. CausalPFN provides calibrated uncertainty estimates to support reliable decision-making based on Bayesian principles. This ready-to-use model does not require any further training or tuning and takes a step toward automated causal inference (https://github.com/vdblm/CausalPFN).

Reliably detecting model failures in deployment without labels

The distribution of data changes over time; models operating operating in dynamic environments need retraining. But knowing when to retrain, without access to labels, is an open challenge since some, but not all shifts degrade model performance. This paper formalizes and addresses the problem of post-deployment deterioration (PDD) monitoring. We propose D3M, a practical and efficient monitoring algorithm based on the disagreement of predictive models, achieving low false positive rates under non-deteriorating shifts and provides sample complexity bounds for high true positive rates under deteriorating shifts. Empirical results on both standard benchmark and a real-world large-scale internal medicine dataset demonstrate the effectiveness of the framework and highlight its viability as an alert mechanism for high-stakes machine learning pipelines.

Diverse Prototypical Ensembles Improve Robustness to Subpopulation Shift

The subpopulationtion shift, characterized by a disparity in subpopulation distributibetween theween the training and target datasets, can significantly degrade the performance of machine learning models. Current solutions to subpopulation shift involve modifying empirical risk minimization with re-weighting strategies to improve generalization. This strategy relies on assumptions about the number and nature of subpopulations and annotations on group membership, which are unavailable for many real-world datasets. Instead, we propose using an ensemble of diverse classifiers to adaptively capture risk associated with subpopulations. Given a feature extractor network, we replace its standard linear classification layer with a mixture of prototypical classifiers, where each member is trained to classify the data while focusing on different features and samples from other members. In empirical evaluation on nine real-world datasets, covering diverse domains and kinds of subpopulation shift, our method of Diverse Prototypical Ensembles (DPEs) often outperforms the prior state-of-the-art in worst-group accuracy. The code is available at https://github.com/minhto2802/dpe4subpop

Beyond Masked and Unmasked: Discrete Diffusion Models via Partial Masking

Masked diffusion models (MDM) are powerful generative models for discrete data that generate samples by progressively unmasking tokens in a sequence. Each token can take one of two states: masked or unmasked. We observe that token sequences often remain unchanged between consecutive sampling steps; consequently, the model repeatedly processes identical inputs, leading to redundant computation. To address this inefficiency, we propose the Partial masking scheme (Prime), which augments MDM by allowing tokens to take intermediate states interpolated between the masked and unmasked states. This design enables the model to make predictions based on partially observed token information, and facilitates a fine-grained denoising process. We derive a variational training objective and introduce a simple architectural design to accommodate intermediate-state inputs. Our method demonstrates superior performance across a diverse set of generative modeling tasks. On text data, it achieves a perplexity of 15.36 on OpenWebText, outperforming previous MDM (21.52), autoregressive models (17.54), and their hybrid variants (17.58), without relying on an autoregressive formulation. On image data, it attains competitive FID scores of 3.26 on CIFAR-10 and 6.98 on ImageNet-32, comparable to leading continuous generative models.

ExOSITO: Explainable Off-Policy Learning with Side Information for Intensive Care Unit Blood Test Orders

Ordering a minimal subset of lab tests for patients in the intensive care unit (ICU) can be challenging. Care teams must balance between ensuring the availability of the right information and reducing the clinical burden and costs associated with each lab test order. Most in-patient settings experience frequent over-ordering of lab tests, but are now aiming to reduce this burden on both hospital resources and the environment. This paper develops a novel method that combines off-policy learning with privileged information to identify the optimal set of ICU lab tests to order. Our approach, EXplainable Off-policy learning with Side Information for ICU blood Test Orders (ExOSITO) creates an interpretable assistive tool for clinicians to order lab tests by considering both the observed and predicted future status of each patient. We pose this problem as a causal bandit trained using offline data and a reward function derived from clinically-approved rules; we introduce a novel learning framework that integrates clinical knowledge with observational data to bridge the gap between the optimal and logging policies. The learned policy function provides interpretable clinical information and reduces costs without omitting any vital lab orders, outperforming both a physician's policy and prior approaches to this practical problem.