Causal Modeling of Adverse Pregnancy Outcomes via Adaptive LLM Proposals

Adverse Pregnancy Outcomes (APOs) such as preterm birth and gestational diabetes can have long-term consequences for both the mother and child, yet an understanding of their causes remains elusive. Causal discovery in this domain is especially challenging due to a paucity of data and incomplete domain knowledge. As a result, pure data-driven methods fail, and Large Language Model (LLM) outputs remain inconsistent or contradictory. We introduce a neurosymbolic framework for generating plausible causal hypotheses that iteratively combines the broad prior knowledge of LLMs with empirical scoring on data. Our method treats the LLM as an adaptive proposal distribution, generating hypotheses that are scored against empirical data; the resulting high-scoring graphs are then used to update the LLM's context, steering subsequent generations toward more promising regions of the hypothesis space. We evaluate our approach on a real-world clinical dataset for modeling APOs and their risk factors, comparing our results against an expert-constructed causal graph. Our method recovers all expert-validated edges and identifies additional plausible causal relations not previously listed by experts, potentially providing new insights for targeted interventions.

Dynamic Structural Causal Modeling for Sleep

The causal dynamics of sleep-disordered breathing are complex and vary across patient populations, hindering the development of targeted interventions. We learn dynamic causal graphs of sleep-disordered breathing from Home Sleep Apnea Test (HSAT) recordings, revealing systematic differences in causal structure across sex and age subcohorts. We do so using the PCMCI+ algorithm on windowed fractional variables derived from 105 HSAT recordings, exploiting domain knowledge via edge blacklisting and employing bootstrap aggregation to address small subcohort sizes. The learned graphs show that temporal self-dependencies and the apnea-desaturation relationship persist across all cohorts, while other relationships vary substantially.

Amortized Bayesian Causal Discovery of Extended Factor Graphs

Learning causal graphs from interventional data is a challenging problem with broad applications. In molecular biology, for example, a central goal is to uncover gene regulatory networks from large-scale perturbation data. An ideal algorithm for this task should scale to thousands of nodes, incorporate interventions even when their targets are unknown, quantify uncertainty, and provide identifiability guarantees. However, existing approaches---e.g. approaches using score-based optimization or approximate Bayesian inference---often fail to meet all of these criteria. To address these limitations, we develop Amortized Bayesian Causal Discovery of Extended Factor Graphs (ABCDEFG). Our method guarantees exact acyclicity, scales to graphs with thousands of nodes, and naturally handles interventions even when their targets are unknown. Additionally, ABCDEFG estimates a posterior distribution whose maximum a posteriori estimate provably identifies the true causal graph up to an equivalence class. On simulated datasets, ABCDEFG achieves state-of-the-art accuracy, producing a well-calibrated posterior distribution while outperforming previous score-based and approximate Bayesian methods. Applied to large-scale single-cell perturbation data, ABCDEFG identifies both established and novel gene targets of growth factors.

Causal ASCEND: Scalable Two-tier Causal Discovery on High Dimensional Multi-omics Data

Biological systems exhibit a hierarchical structure, characterised by directed flow from upstream regulators to downstream effects. Although this ordering provides a natural scaffold for causal inference, most causal discovery and GRN methods either ignore the tiered organisation or condition on all upstream variables, which becomes infeasible for high-dimensional omics data. We present ASCEND (Ancestral Scalable Causal discovEry via iNherited Descent), a constraint-based framework that leverages known two-tiered structure to enable genome-scale causal discovery. ASCEND introduces a divide-and-conquer strategy that maintains dynamically updated ancestral conditioning sets for each downstream variable, dramatically reducing the number of conditional independence tests required, and achieves polynomial-time complexity where traditional approaches face exponential blow-up. Through extensive simulations and real biological data, we demonstrate that ASCEND accurately recovers ancestral relationships, scales properly and much faster, and outperforms existing gene regulatory network inference methods in both causal precision and computational efficiency. The algorithm's ability to resolve directionality makes it particularly suited for integrating multi-omic data where upstream regulators (e.g., SNPs, methylation sites) and downstream responses (e.g., gene expression) are measured jointly.

A Neuroimaging Simulation Framework for Developing and Evaluating Causal AI

Causally linking disease-related factors to image-derived biomarkers provides a powerful pathway to understanding disease mechanisms. Despite growing interest in applying causal artificial intelligence (AI) approaches for this task, these methods still need to be adapted for complex medical images, and especially, neuroimaging. However, the lack of ground-truth data presents a barrier to development. To bridge this gap, we developed and tested a method for generating synthetic neuroimages, which adhere to a user-specified causal structure describing the non-image to image variable relationships, permitting the creation of ground-truth neuroimaging datasets. In the simulated T1-weighted magnetic resonance images, anatomical variability is modeled by sampling from a subspace estimated from real data and deforming a template image to create unique simulated subjects. Causal relationships are encoded via precise volumetric changes of any region-of-interest without unwanted global artifacts. We achieved relative volume errors of 0.3-2.66% for the targeted regions-of-interest and demonstrate their statistically significant causal relationships, while maintaining mean absolute errors for non-target brain regions between 0.034-0.397ml. An initial evaluation of causal discovery methods exposes their limited ability to suppress spurious connections, highlighting the need for image-appropriate methods. Our framework is the first to enable the generation of realistic synthetic 3D neuroimages with explicit causal control that can serve as the missing ground-truth data necessary for the objective benchmarking and development of causal AI methods.

RetiSEM: Generalising Causal Models for Fragmented Biomedical Data

Learning causal models from fragmented biomedical data is challenging because clinical, molecular, and imaging variables are often incomplete or not jointly observed. We propose RetiSEM, a domain-constrained structural equation modelling (SEM) framework for causal graph recovery and mediation analysis under limited multimodal resources. This proposed work organises variables into biologically informed blocks, applies forbidden-edge constraints, and decomposes pathway-level effects into TE, NDE, and NIE components. We evaluate RetiSEM across ten synthetic benchmark scenarios that vary in dimensionality, nonlinearity, causal depth, and pathway structure, together with a fragmented real-world setting that combines NHANES clinical variables with externally derived retinal representations. This approach achieves lower structural error and higher causal accuracy than unconstrained baselines across the synthetic benchmarks. In the real-data analysis, retinal variables behave mainly as downstream biomarker-like indicators, with smaller but detectable indirect effects. These findings support our strategy as an interpretable framework for testing structured causal hypotheses in limited-resource biomedical AI. The code and resources for this work are publicly available at: https://github.com/Inamullah-Colab/ReitSEM.

Beyond AHI: An Interpretable Causal-Discovery-Guided Framework for Sleep Recovery in Connected Health

Objective sleep assessment relies on polysomnography (PSG), yet clinical impact is often better reflected in patient-reported outcomes (PROs) such as sleepiness and fatigue. Existing summary indices, including the Apnea-Hypopnea Index (AHI), provide limited insight into the multidomain physiology underlying functional recovery. We propose an interpretable, causal-discovery-guided framework for deriving a hierarchical Sleep Recovery Score (SRS) from multimodal PSG. Using two large population cohorts (MESA: \(n=1{,}540\); MrOS: \(n=825\)), we apply directed acyclic graph (DAG) learning to identify candidate physiological drivers spanning respiratory burden, hypoxic burden, sleep fragmentation, sleep architecture, and autonomic regulation. Although derived from clinical PSG, these domains map naturally to sensing streams increasingly available in connected health technologies, including wearable ECG, oximetry, and sleep-stage estimation devices. To preserve mechanistic plausibility, we introduce a two-stage screening process that combines physiology-based constraints with constrained LLM-assisted auditing to identify and remove structural confounders and construct-overlapping variables. Across cohorts, these five domains emerge as recurrent physiological domains associated with recovery, and the resulting SRS shows up to \(3.4\times\) stronger alignment with perceived recovery than AHI. By linking multimodal sleep physiology to patient-centered outcomes through an interpretable, bias-aware, and domain-structured framework, this work provides a practical foundation for recovery modeling across both clinical sleep studies and emerging smart and connected health settings.

Correlation Is Not Enough: Embedding Human Metadata for Individual Causal Discovery

Ask a pretrained biomedical language model whether "cortisol 28 ug/dL" and "stock-market volatility" are related, and it returns a cosine similarity of 0.83 on a scale where 1.0 means identical. The two share no mechanism. This is not a corner case: every off-the-shelf biomedical encoder we tested (BioBERT, PubMedBERT, BioM-ELECTRA) scores unrelated cross-domain pairs between 0.76 and 0.92 when the answer should be near zero. Accuracy on cross-domain discrimination is 0%. Retrieval systems survive this, because a language model downstream filters the noise. A Large Behavioural Model (LBM), a foundation model whose subject is a person rather than a sentence, does not: it reasons over a graph of a user's life and treats embedding proximity as evidence that two events are causally linked. False proximity writes a false causal edge, and everything downstream inherits the error. Here, embedding geometry is not a tuning knob; it is correctness. We report the fix. A contrastive pass over 72,034 pairs raises PubMedBERT BIOSSES correlation from 0.633 to 0.828 and within-vs-across-domain separation from 1.05x to 1.63x. A second pass, BODHI, mines hard negatives from edges absent in a biomedical knowledge graph and lifts separation to 2.30x and the discrimination gap to +0.392, at a 4.5% BIOSSES cost. On an Intel Xeon 6737P with AMX, OpenVINO cuts single-query latency from 1367 ms to 10 ms (133x) and reaches 555 sentences/sec. One finding contradicts standard advice: FP16 beats INT8 on this silicon at every serving batch size, and we explain why. The same model on a no-AMX Ice Lake instance runs 13-27x slower. We release the benchmark suite, training corpora, the BODHI generator, and the OpenVINO scripts.