arXiv:2609.12277v1 Announce Type: cross Abstract: Electronic health record (EHR) foundation models trained on longitudinal patient trajectories have demonstrated strong performance across diverse clinical prediction tasks. However, their clinical reasoning capabilities remain constrained by next-token prediction on limited and incomplete EHR data. To address this, we propose a reinforcement learning (RL) fine-tuning framework that treats EHR foundation models as generative policies over patient trajectories. We formulate common clinical prediction problems (e.g., hospital readmission) as event-conditioned, time-windowed reasoning tasks. We then design time-aware, rollout-sensitive rewards to account for finite rollout lengths and temporally inconclusive outcomes. We find that RL fine-tuning consistently improves over pre-trained backbones and strong baselines. Notably, it enables smaller models to surpass larger pre-trained models in data-limited regimes and induces positive transfer across tasks. Further analysis shows that RL fine-tuned models generate trajectories with stronger structural and semantic alignment to ground truth and greater downstream utility.

arXiv:2603.16513v4 Announce Type: replace-cross Abstract: Structured data is widely used in domains such as healthcare, finance, and scientific data management. Recent studies on structured data foundation models (SFMs) aim to support data analysis and mining tasks over such data, but still face scalability and generalization challenges when applied to real-world enterprise databases. First, many SFMs rely on full self-attention, which introduces an O(N^2) computational bottleneck and limits the number of tuples that can be processed jointly. Second, directly replacing attention with linear-complexity sequence models may conflict with the permutation-invariant nature of structured data, introducing artificial order bias and degrading representation quality. Moreover, models trained only on synthetic data may struggle to generalize to the heavy-tailed and heterogeneous distributions commonly found in real-world databases. To address these challenges, we propose FEAT, a linear-complexity foundation model for extremely large structured data. FEAT replaces quadratic attention with a multi-layer dual-axis encoding architecture. It integrates an adaptive-fusion bidirectional state-space model (AFBM) with convolutional gated linear attention (Conv-GLA), enabling cross-tuple contextualization in O(N) time while supporting permutation-invariant representation learning. To improve robustness under real-world data skewness, FEAT further adopts a hybrid structural causal pre-training pipeline with a robust reconstruction objective. Experiments on 12 real-world database benchmarks show that FEAT consistently outperforms representative SFMs on zero-shot tasks and scales linearly with structured-data sample length, achieving up to 50x faster inference latency.