Recent advances in Large Language Models (LLMs) have demonstrated significant potential in the field of Recommendation Systems (RSs). Most existing studies have focused on converting user behavior logs into textual prompts and leveraging techniques such as prompt tuning to enable LLMs for recommendation tasks. Meanwhile, research interest has recently grown in multimodal recommendation systems that integrate data from images, text, and other sources using modality fusion techniques. This introduces new challenges to the existing LLM-based recommendation paradigm which relies solely on text modality information. Moreover, although Multimodal Large Language Models (MLLMs) capable of processing multi-modal inputs have emerged, how to equip MLLMs with multi-modal recommendation capabilities remains largely unexplored. To this end, in this paper, we propose the Multimodal Large Language Model-enhanced Sequential Multimodal Recommendation (MLLM-MSR) model. To capture the dynamic user preference, we design a two-stage user preference summarization method. Specifically, we first utilize an MLLM-based item-summarizer to extract image feature given an item and convert the image into text. Then, we employ a recurrent user preference summarization generation paradigm to capture the dynamic changes in user preferences based on an LLM-based user-summarizer. Finally, to enable the MLLM for multi-modal recommendation task, we propose to fine-tune a MLLM-based recommender using Supervised Fine-Tuning (SFT) techniques. Extensive evaluations across various datasets validate the effectiveness of MLLM-MSR, showcasing its superior ability to capture and adapt to the evolving dynamics of user preferences.

Dynamic treatment regimes (DTRs) are critical to precision medicine, optimizing long-term outcomes through personalized, real-time decision-making in evolving clinical contexts, but require careful supervision for unsafe treatment risks. Existing efforts rely primarily on clinician-prescribed gold standards despite the absence of a known optimal strategy, and predominantly using structured EHR data without extracting valuable insights from clinical notes, limiting their reliability for treatment recommendations. In this work, we introduce SAFER, a calibrated risk-aware tabular-language recommendation framework for DTR that integrates both structured EHR and clinical notes, enabling them to learn from each other, and addresses inherent label uncertainty by assuming ambiguous optimal treatment solution for deceased patients. Moreover, SAFER employs conformal prediction to provide statistical guarantees, ensuring safe treatment recommendations while filtering out uncertain predictions. Experiments on two publicly available sepsis datasets demonstrate that SAFER outperforms state-of-the-art baselines across multiple recommendation metrics and counterfactual mortality rate, while offering robust formal assurances. These findings underscore SAFER’s potential as a trustworthy and theoretically grounded solution for high-stakes DTR applications.

OBJECTIVES: Racial disparities in kidney transplant access and posttransplant outcomes exist between non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients in the United States, with the site of care being a key contributor. Using multi-site data to examine the effect of site of care on racial disparities, the key challenge is the dilemma in sharing patient-level data due to regulations for protecting patients' privacy. MATERIALS AND METHODS: We developed a federated learning framework, named dGEM-disparity (decentralized algorithm for Generalized linear mixed Effect Model for disparity quantification). Consisting of 2 modules, dGEM-disparity first provides accurately estimated common effects and calibrated hospital-specific effects by requiring only aggregated data from each center and then adopts a counterfactual modeling approach to assess whether the graft failure rates differ if NHB patients had been admitted at transplant centers in the same distribution as NHW patients were admitted. RESULTS: Utilizing United States Renal Data System data from 39 043 adult patients across 73 transplant centers over 10 years, we found that if NHB patients had followed the distribution of NHW patients in admissions, there would be 38 fewer deaths or graft failures per 10 000 NHB patients (95% CI, 35-40) within 1 year of receiving a kidney transplant on average. DISCUSSION: The proposed framework facilitates efficient collaborations in clinical research networks. Additionally, the framework, by using counterfactual modeling to calculate the event rate, allows us to investigate contributions to racial disparities that may occur at the level of site of care. CONCLUSIONS: Our framework is broadly applicable to other decentralized datasets and disparities research related to differential access to care. Ultimately, our proposed framework will advance equity in human health by identifying and addressing hospital-level racial disparities.