Agentic reinforcement learning (RL) and multi-teacher on-policy distillation (MOPD) offer complementary routes to post-training. For visual agents, however, tool use presents two related challenges. Models may overlook useful tool-returned observations, while poorly grounded actions can limit the evidence available for subsequent distillation. We introduce Reframe, a post-training framework that treats the observation state, rather than only the output distribution, as an object of alignment. First, Ground-Drop-GRPO (GD-GRPO) trains spatial and temporal specialists with evidence-aware rewards and stochastic removal of the original visual input, encouraging them to acquire grounded evidence and use the returned observations. Second, Observation-Gated-MOPD (OG-MOPD) replaces deficient tool actions with canonical ones mid-rollout and resumes distillation from the repaired observation. The two stages complement each other, as learning to rely on tool-returned observations can help the policy benefit from observation repair. Neither stage requires a task-specific SFT cold start. Extensive experiments over 14 image and video benchmarks demonstrate that Reframe outperforms both Mix-RL and vanilla MOPD. Ablation results show that GD-GRPO increases observation dependence and tool gain compared with outcome-based GRPO.
Large language model (LLM) agents are proposed for clinical prediction but are untested in pediatrics, where cohorts are small and outcomes are uncommon. Using records from 2,489 youth with type 2 diabetes (T2D) and 4,018 with type 1 diabetes (T1D), spanning structured data, note-derived social determinants and, in T1D, continuous glucose monitoring data, we predicted seven T2D outcomes, four also in T1D, at 24 months from 18 months of follow-up. CEDAR (Clinical Evidence-Driven Agent for Risk-prediction), an evidence-citing, self-auditing LLM pipeline, outperformed trained machine learning in both cohorts (pooled area under the receiver operating characteristic curve 0.815 versus 0.656 to 0.700 in T2D and 0.756 versus 0.603 to 0.631 in T1D), most on the sparsely screened outcomes. Only 4 of 70,246 values it cited did not match the chart. Reading only the evidence and reasoning cited by CEDAR, two pediatric endocrinologists reached the same prediction as CEDAR in about nine of ten cases, agreeing with each other on 90.5%.