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Designing healthcare strategies requires anticipating their clinical and operational consequences before implementation, a task that often relies on health system simulation. Such a simulation necessitates modeling how patient states evolve and generate care demands. However, conventional approaches typically tailor compact state transitions to a single policy question and omit history-dependent dynamics, thus requiring the redefinition of states and transitions when there is a new question that entails different clinical information. We propose to learn a patient world model from longitudinal EHRs using a neural network to provide a shared clinical representation of patient trajectories that can serve simulation questions across scenarios. Taking ICU operations as an example, we train the model on MIMIC-IV, freeze it, and couple its time-queryable predictions to shared ICU calendars, resources, and queues via scenario-specific mappings, so that one model renders admission demand, care tasks, and discharge proposals across simulations evaluating ICU bed capacity, care dispatch, and post-ICU transfer capacity. Experiments show that our model matches Markov and semi-Markov comparators in aggregate occupancy and directional responses to capacity and dispatch policies. It also reproduces policy gains from replayed observed trajectories. For patients entering the same support state from different prior trajectories, the learned representation captures a 24-h recovery difference (-6.4 predicted versus -6.7 observed percentage points), a contrast missed by compact state models, which propagates into distinct simulated care demand, queue burden, and bed use. These results indicate that a learned world model of patient dynamics has the potential to replace question-specific state models, allowing new care policies to be evaluated by reconfiguring the scenario without model rebuilding.

Reliable robotic manipulation requires both semantic understanding and precise control in three-dimensional space. However, vision-language-action (VLA) foundations largely inherit visual representations from 2D vision-language pre-training, while spatial supervision is often introduced only during task-specific adaptation. Developing spatial understanding as a transferable foundation-model capability therefore calls for learning from broader robot experience. We present SLA, a Spatial-Language-Action Model that scales implicit spatial alignment to continual pre-training and maintains it during downstream post-training. Initialized from a pretrained pi05 policy, SLA jointly optimizes action prediction and alignment between intermediate visual embeddings and spatial representations from a frozen 3D perception model. We curate and unify heterogeneous robot datasets to support spatial learning across diverse embodiments, tasks, and scenes. To accommodate this diversity, we introduce feature-dependent gates that adaptively aggregate visual embeddings from multiple VLA layers for spatial supervision. The teacher further exploits partially available depth and camera calibration alongside RGB observations, enabling effective use of heterogeneous geometric annotations. Probabilistic state dropout encourages reliance on visual cues and mitigates overfitting to demonstration trajectories. All auxiliary components are used only during training, allowing direct reuse of pretrained VLA weights and preserving the original inference architecture.

Financial backtests of large language models (LLMs) are meaningful only if the model did not already know the outcomes it is asked to predict. Practitioners guard against this by trusting a vendor's stated knowledge cutoff, by asking the model what it knows, or by instructing it to answer as of a past date. To verify whether any of these safeguards can be trusted, we introduce FinDendro, a benchmark of 2,226 dated U.S. facts from 1999 to 2026, covering monthly macroeconomic series, month-end stock prices and Federal Reserve decisions. Each fact yields four prompts: a value question, Recall and Predict questions that pair each candidate value with a claim of knowing or guessing without a declared date, and a Predict question with a historical declared date. Controls for persistence and dominant outcomes keep chance accuracy near 0.27. Results show that for most frontier models, self-reports understate knowledge. GPT-5 answers 76% of controlled facts correctly but claims to know 38%, and answers 61% of the facts it says it does not know. Knowledge claims can persist beyond the measured knowledge boundary, by up to seven quarters, and a declared date removes most of the claims of prior knowledge while leaving accuracy unchanged. Backtests inside a model's training window therefore cannot be certified leak-free by self-report, instruction or stated cutoff. These findings motivate behavioral measurement of temporal knowledge boundaries, and FinDendro provides a benchmark and procedure for selecting backtest periods based on demonstrated factual knowledge.

Vision-language-action (VLA) models increasingly pair a pre-trained vision-language model (VLM) with a flow-matching expert that conditions its action predictions on the VLM's key-value representations. Those representations must carry information useful for control, yet the VLM was never trained for the action expert's flow-matching objective. Two signals can address this: gradients backpropagated from the expert's loss (coupling), or VLM supervision to predict discrete tokens encoding the same target actions. Prominent training recipes forgo the first, blocking expert-to-VLM gradients (insulation) to protect the VLM's existing capabilities, while also supervising it on vision-language data and action tokens. Because vision-language co-training also aims to preserve those capabilities, the additional protection provided by insulation is unclear. At the same time, insulation removes a direct signal about which features continuous action prediction requires. On the other hand, action-token supervision offers an alternative way to learn action-relevant representations, which may explain why insulation succeeds in practice. We disentangle these factors in autonomous driving and manipulation by independently varying action-token supervision and whether the expert's loss updates the VLM. In open-loop driving, insulation is competitive with coupling when action tokens are supervised; without them, coupling reduces trajectory-prediction error by roughly 25%. When both components are trained jointly from the outset, coupling increases closed-loop driving route progress by approximately 17% with action-token supervision and 40% without it, and similarly improves robot manipulation performance under both settings. These findings show that the value of gradient insulation depends on the VLM's action supervision and the evaluation setting, challenging insulation as a default VLA training recipe.