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Transformers have defined the state-of-the-art for clinical prediction tasks involving electronic health records (EHRs). The recently introduced Mamba architecture outperformed an advanced Transformer (Transformer++) based on Llama in handling long context lengths, while using fewer model parameters. Despite the impressive performance of these architectures, a systematic approach to empirically analyze model performance and efficiency under various settings is not well established in the medical domain. The performances of six sequence models were investigated across three architecture classes (Transformers, Transformers++, Mambas) in a large Swedish heart failure (HF) cohort (N = 42820), providing a clinically relevant case study. Patient data included diagnoses, vital signs, laboratories, medications and procedures extracted from in-hospital EHRs. The models were evaluated on three one-year prediction tasks: clinical instability (a readmission phenotype) after initial HF hospitalization, mortality after initial HF hospitalization and mortality after latest hospitalization. Ablations account for modifications of the EHR-based input patient sequence, architectural model configurations, and temporal preprocessing techniques for data collection. Llama achieves the highest predictive discrimination, best calibration, and showed robustness across all tasks, followed by Mambas. Both architectures demonstrate efficient representation learning, with tiny configurations surpassing other large-scaled Transformers. At equal model size, Llama and Mambas achieve superior performance using 25% less training data. This paper presents a first ablation study with systematic design choices for input tokenization, model configuration and temporal data preprocessing. Future model development in clinical prediction tasks using EHRs could build upon this study's recommendation as a starting point.

Objective: Machine learning (ML) predictive models are often developed without considering downstream value trade-offs and clinical interpretability. This paper introduces a cost-aware prediction (CAP) framework that combines cost-benefit analysis assisted by large language model (LLM) agents to communicate the trade-offs involved in applying ML predictions. Materials and Methods: We developed an ML model predicting 1-year mortality in patients with heart failure (N = 30,021, 22% mortality) to identify those eligible for home care. We then introduced clinical impact projection (CIP) curves to visualize important cost dimensions - quality of life and healthcare provider expenses, further divided into treatment and error costs, to assess the clinical consequences of predictions. Finally, we used four LLM agents to generate patient-specific descriptions. The system was evaluated by clinicians for its decision support value. Results: The eXtreme gradient boosting (XGB) model achieved the best performance, with an area under the receiver operating characteristic curve (AUROC) of 0.804 (95% confidence interval (CI) 0.792-0.816), area under the precision-recall curve (AUPRC) of 0.529 (95% CI 0.502-0.558) and a Brier score of 0.135 (95% CI 0.130-0.140). Discussion: The CIP cost curves provided a population-level overview of cost composition across decision thresholds, whereas LLM-generated cost-benefit analysis at individual patient-levels. The system was well received according to the evaluation by clinicians. However, feedback emphasizes the need to strengthen the technical accuracy for speculative tasks. Conclusion: CAP utilizes LLM agents to integrate ML classifier outcomes and cost-benefit analysis for more transparent and interpretable decision support.

Avoiding bias and understanding the real-world consequences of AI-supported decision-making are critical to address fairness and assign accountability. Existing approaches often focus either on technical aspects, such as datasets and models, or on high-level socio-ethical considerations - rarely capturing how these elements interact in practice. In this paper, we apply an information flow-based modeling framework to a real-world recruitment process that integrates automated candidate matching with human decision-making. Through semi-structured stakeholder interviews and iterative modeling, we construct a multi-level representation of the recruitment pipeline, capturing how information is transformed, filtered, and interpreted across both algorithmic and human components. We identify where biases may emerge, how they can propagate through the system, and what downstream impacts they may have on candidates. This case study illustrates how information flow modeling can support structured analysis of fairness risks, providing transparency across complex socio-technical systems.

Federated Learning (FL) enables collaborative model training across decentralized clients while preserving data privacy by keeping raw data local. However, FL suffers from significant communication overhead due to the frequent exchange of high-dimensional model updates over constrained networks. In this paper, we present FedSparQ, a lightweight compression framework that dynamically sparsifies the gradient of each client through an adaptive threshold, applies half-precision quantization to retained entries and integrates residuals from error feedback to prevent loss of information. FedSparQ requires no manual tuning of sparsity rates or quantization schedules, adapts seamlessly to both homogeneous and heterogeneous data distributions, and is agnostic to model architecture. Through extensive empirical evaluation on vision benchmarks under independent and identically distributed (IID) and non-IID data, we show that FedSparQ substantially reduces communication overhead (reducing by 90% of bytes sent compared to FedAvg) while preserving or improving model accuracy (improving by 6% compared to FedAvg non-compressed solution or to state-of-the-art compression models) and enhancing convergence robustness (by 50%, compared to the other baselines). Our approach provides a practical, easy-to-deploy solution for bandwidth-constrained federated deployments and lays the groundwork for future extensions in adaptive precision and privacy-preserving protocols.

Rapid changes and increasing climatic variability across the widely varied Koppen-Geiger regions of northern Europe generate significant needs for adaptation. Regional planning needs high-resolution projected temperatures. This work presents an integrative downscaling framework that incorporates Vision Transformer (ViT), Convolutional Long Short-Term Memory (ConvLSTM), and Geospatial Spatiotemporal Transformer with Attention and Imbalance-Aware Network (GeoStaNet) models. The framework is evaluated with a multicriteria decision system, Deep Learning-TOPSIS (DL-TOPSIS), for ten strategically chosen meteorological stations encompassing the temperate oceanic (Cfb), subpolar oceanic (Cfc), warm-summer continental (Dfb), and subarctic (Dfc) climate regions. Norwegian Earth System Model (NorESM2-LM) Coupled Model Intercomparison Project Phase 6 (CMIP6) outputs were bias-corrected during the 1951-2014 period and subsequently validated against earlier observations of day-to-day temperature metrics and diurnal range statistics. The ViT showed improved performance (Root Mean Squared Error (RMSE): 1.01 degrees C; R^2: 0.92), allowing for production of credible downscaled projections. Under the SSP5-8.5 scenario, the Dfc and Dfb climate zones are projected to warm by 4.8 degrees C and 3.9 degrees C, respectively, by 2100, with expansion in the diurnal temperature range by more than 1.5 degrees C. The Time of Emergence signal first appears in subarctic winter seasons (Dfc: approximately 2032), signifying an urgent need for adaptation measures. The presented framework offers station-based, high-resolution estimates of uncertainties and extremes, with direct uses for adaptation policy over high-latitude regions with fast environmental change.

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