---
license: cc-by-nc-4.0
language:
  - pt
  - en
tags:
  - rare-disease
  - digital-twin
  - world-model
  - patient-trajectory
  - knowledge-graph
  - primekg
  - hgt
  - tgnn
  - txgnn
  - neural-survival
  - causal-inference
  - brazilian-sus
  - datasus
library_name: pytorch
pipeline_tag: graph-ml
datasets:
  - DATASUS-SIH-RD
  - DATASUS-APAC-SIA
  - DATASUS-BPA-I
  - DATASUS-SIM
  - PrimeKG
  - RareBench
metrics:
  - c-index
  - recall-at-k
  - mrr
  - auroc
  - brier
extra_gated_prompt: >-
  This module is released for **research only**. It is NOT a medical device,
  NOT approved by any regulator, and MUST NOT be used to inform diagnosis or
  treatment without physician oversight and regulatory clearance.
extra_gated_fields:
  Name: text
  Affiliation: text
  Intended use: text
  I agree to non-clinical research use only: checkbox
---

# GEMEO Twin Stack — Application Layer for the GEMEO Patient World Model

> The graph-native **digital-twin application stack** that runs on top of
> the [GEMEO World Model](https://huggingface.co/Raras-AI/gemeo-world-model).
> Six inference modes — trajectory, diagnosis, risk/survival,
> counterfactual, repurposing, cohort — wired together with auxiliary heads,
> KG embeddings, and a FastAPI surface. Research preview. **Not a medical device.**

**Authors:** Raras.ai team · **Contact:** dimas@raras.ai
**Source:** github companion repo (raras.org)
**Paper v1 (Zenodo):** [DOI 10.5281/zenodo.20092131](https://doi.org/10.5281/zenodo.20092131)
**🌍 World Model (the dynamics core this stack runs on top of):** [Raras-AI/gemeo-world-model](https://huggingface.co/Raras-AI/gemeo-world-model)
**📱 Mobile decision-support sibling:** [Raras-AI/araras-gemma4](https://huggingface.co/Raras-AI/araras-gemma4)
**License:** CC-BY-NC 4.0 + non-clinical-use rider (see [LICENSE](./LICENSE))

> **Note on naming.** Previously released as `Raras-AI/gemeo-world-model`
> (HF auto-redirects). Renamed to `gemeo-twin-stack` because the actual
> world model — the generative dynamics core — is the Causal Diffusion
> Forcing transformer now living at the new `gemeo-world-model` slug. This
> repo is the **application layer** (encoder, cohort, risk, whatif,
> repurpose, ask, ground_sus, api) that turns the world model into a
> usable digital twin with six inference modes.

---

## What this is

This is the **application layer** of GEMEO — a module (≈22k LOC) that
takes the GEMEO World Model (a Causal Diffusion Forcing transformer,
published separately at [Raras-AI/gemeo-world-model](https://huggingface.co/Raras-AI/gemeo-world-model))
and wires it together with auxiliary heads, KG embeddings, and tooling
to produce a complete digital-twin product. Each inference mode has a
clean Python API, a bootstrap implementation that runs today, and an
optional learned slot that drops in when a checkpoint exists.

```
GEMEO Twin Stack  (this repo)
├── Patient embedding       (gemeo/encoder.py)        HGT scaffolded; bootstrap = weighted KG embedding
├── Cohort retrieval        (gemeo/cohort.py)         kNN + Cypher overlap on PrimeKG
├── Subgraph reasoning      (gemeo/subgraph.py)       1-hop sparsification (learned variant in train/)
├── Trajectory mode         (gemeo/trajectory.py)     ← calls into the GEMEO World Model
├── Diagnostic mode         (deeprare_diagnosis.py +  ← multi-agent over PrimeKG paths
│                            fast_dx.py, ensemble)
├── Risk / survival         (gemeo/risk.py)           NeuralSurv trained on DATASUS SIM (c-index 0.70)
├── Drug repurposing        (gemeo/repurpose.py)      TxGNN slot + SUS auxiliary head
├── Counterfactual          (gemeo/whatif.py)         do-calculus mutator; uses world-model rollout
├── Active learning         (gemeo/ask.py)            info-gain over KG annotations
├── SUS grounding           (gemeo/ground_sus.py)     PCDT/CEAF/UF coverage check
└── FastAPI                 (gemeo/api.py)            production /api/gemeo/* endpoints

GEMEO World Model  (separate repo: Raras-AI/gemeo-world-model)
└── Causal Diffusion Forcing transformer (19.86M params)
    The generative dynamics core. Trajectory + counterfactual modes
    above delegate to it.
```

---

## Headline numbers (real, audited)

| Mode | Metric | Value | Notes |
|---|---|---|---|
| **Diagnosis** (RareBench, 200 cases, v49) | R@1 canonical | **57.0%** (114/200) | matches DeepRare phenotype-only published level |
| | R@5 canonical | **81.5%** | |
| | R@1 strict (ORPHA-code) | 39.5% | strict pattern matching |
| | timeout rate | 0.0% | |
| **Risk / survival** (NeuralSurv, DATASUS SIM) | val c-index | **0.70** (best @ ep 30) | 4,624 SIM mortality records, 37,494 censoring samples |
| | final c-index | 0.694 | after 100 epochs |
| **World Model backbone** ([gemeo-world-model](https://huggingface.co/Raras-AI/gemeo-world-model)) | val cross-entropy | 0.030 | per-token diffusion forcing |
| | calibration ICI | 0.0006 | well calibrated |
| | training | 5.8 min on 1×H100 | $0.48 |

These are the audited, end-to-end numbers from the same swarm-py module —
they are NOT promises or projections.

---

## Six inference modes

### 1 · Trajectory (digital twin)

```python
from gemeo import build_gemeo

twin = await build_gemeo(
    case_text="5-year-old boy, progressive ataxia, telangiectasia, elevated AFP.",
    patient_info={"age": 5, "sex": "M"},
    context={"sus_region": "SP"},
)
twin.trajectory.horizons   # 6/12/24-month event predictions
```

Backbone: bootstrap LLM-over-natural-history today, [Causal Diffusion
Forcing](https://huggingface.co/Raras-AI/gemeo-world-model) when the CDF
checkpoint is mounted.

### 2 · Diagnosis

```python
twin.diagnoses[:5]   # top hypotheses ranked, with evidence chain
```

Three diagnostic engines wired in:
- `deeprare_diagnosis.py` (DeepRare-style multi-agent over PrimeKG paths)
- `fast_dx.py` (low-latency phenotype → ORPHA ranking)
- `ensemble_diagnostic.py` (ensemble over the above)

Baseline RareBench numbers reported above. v49 corresponds to the
checkpoint shipping in this repo.

### 3 · Risk / survival

```python
twin.risk.survival_curve   # months → P(alive), with bootstrap CI
```

`artifacts/neuralsurv.pt` (186 KB) — Bayesian-style neural survival head
over KG-walk features. Trained on DATASUS SIM (n=4,624 deaths,
n=37,494 censoring samples). See `artifacts/neuralsurv_datasus_summary.json`
for the per-ORPHA sanity check (e.g., ORPHA:586 / cystic fibrosis: 96.4%
alive at 12 m, 80.3% at 72 m).

### 4 · Counterfactual (what-if)

```python
twin.what_if({"add_treatment": "ivacaftor"})   # mutated trajectory
```

Bootstrap = heuristic snapshot mutation; learned variant = CF-GNNExplainer
slot.

### 5 · Drug repurposing

```python
twin.drugs.candidates[:5]   # KG-walk Disease→Gene→Drug, SUS-availability ranked
```

TxGNN slot + SUS auxiliary head (filters by CONITEC/PCDT coverage).

### 6 · Cohort + active learning

```python
twin.cohort.members[:10]      # patients-like-mine (kNN on PrimeKG)
twin.next_questions[:3]       # information-gain ranked clinical questions
```

---

## What's in this repo

```
src/gemeo/                            # 22 k LOC, the world-model module
├── core.py, api.py, types.py         # orchestrator + FastAPI + types
├── encoder.py, cohort.py, subgraph.py
├── trajectory.py, risk.py, whatif.py
├── repurpose.py, ask.py, ground_sus.py
├── deeprare_diagnosis-style modules  # diagnostic mode wiring
├── train/                            # HGT, TGNN, TxGNN, NeuralSurv training
├── datasus/                          # DATASUS pull (SIH, APAC, SIM, CNS linkage)
└── cwm/                              # earlier causal-world-model exploration

artifacts/
├── neuralsurv.pt                     # 186 KB, NeuralSurv risk head (c-index 0.70)
├── neuralsurv_datasus_summary.json   # per-ORPHA survival sanity check
└── dt_fm.pt                          # 7.6 MB, decision-time foundation-model baseline

data_derived/                         # ALL derived from PrimeKG (CC-BY 4.0)
├── fused_embeddings_fp16.npz         # 43 MB, 3072-dim disease/HPO/gene embeddings
├── graph_embeddings.npz              # 7 MB, 768-dim KG node embeddings
├── hetero_graph.json                 # 6 MB, edge index by relation
└── node_ids.json                     # 530 KB, id → ORPHA/HPO/HGNC mapping

benchmarks/
└── rarebench_v49_diagnose_200.json   # 200-case RareBench eval, per-case results

examples/
└── quickstart.py                     # minimal usage

LICENSE
README.md   ← this file
```

The GEMEO World Model (the Causal Diffusion Forcing dynamics core) is
published separately at
[**Raras-AI/gemeo-world-model**](https://huggingface.co/Raras-AI/gemeo-world-model)
(~80 MB) — keep that repo for the heavy ckpt, this repo for the
application stack that runs on top of it.

---

## Quickstart

```python
import sys; sys.path.append("src")
from gemeo import build_gemeo

twin = await build_gemeo(
    case_text="Menino, 5 anos, ataxia progressiva, telangiectasia, AFP elevado.",
    patient_info={"age": 5, "sex": "M"},
    context={"sus_region": "SP"},
)

twin.diagnoses[:3]              # → e.g. Ataxia-Telangiectasia (ORPHA:100) at top
twin.cohort.members[:5]         # patients-like-mine
twin.risk.survival_curve        # months → P(alive)
twin.drugs.candidates[:3]       # repurposing
twin.next_questions[:3]         # active learning
twin.sus_check.pcdt_url         # PCDT compliance link
```

For the FastAPI server (production layout — same as raras.org runs):

```bash
pip install -r requirements.txt
uvicorn gemeo.api:app --reload --port 8000
# POST /api/gemeo/build           — create a twin
# POST /api/gemeo/{id}/evolve     — add new clinical data
# POST /api/gemeo/{id}/whatif     — counterfactual
# GET  /api/gemeo/{id}/{cohort,subgraph,trajectory,risk,drugs,trials,next-questions,sus,viz}
```

---

## Data, ethics, governance

- **Source:** Brazilian DATASUS subsystems (SIH-RD, APAC-SIA, BPA-I, SIM).
- **Linkage:** CNS-hash deterministic (Tier 1 via APAC).
- **De-identification:** ages bucketed (5y); UF only (no município); k-anonymity ≥ 5.
- **Ethics:** Brazilian Res. CNS 466/2012 + 510/2016. LGPD-compliant.
- **Not on this repo:** PHI, raw CNS hashes, individual-level data. Only
  derived embeddings (PrimeKG), trained weights (NeuralSurv, DT-FM),
  source code, and aggregate metrics.

---

## What's in development (and what Mayo would enable)

The architecture is mode-complete: every box has a working bootstrap or
trained slot. The bottleneck is **data substrate**:

| Mode | SUS today | What Mayo / multimodal substrate unlocks |
|---|---|---|
| Trajectory | events only (no notes) | + 1.65 B clinical notes → richer event tokens |
| Diagnosis | R@1 57% canonical / 200 cases | + WES variants + HPO from notes → target R@1 ≥ 78% (DeepRare bar) |
| Risk | c-index 0.70 on 4,624 deaths | + longitudinal labs + meds → target c-index ≥ 0.80 |
| Counterfactual | heuristic | + trial-emulation labels → causal-grade what-if |
| Repurposing | TxGNN + SUS heuristics | + Mayo trial outcomes → real evidence ranking |

This is the basis of our Mayo Clinic Platform_Accelerate proposal: same
world model, multimodal substrate.

---

## Citation

```bibtex
@misc{gemeo_world_model_2026,
  title  = {GEMEO: A Patient World Model for Rare Disease, Grounded in
            Brazilian SUS Data},
  author = {Timmers, Dimas and the Raras.ai team},
  year   = {2026},
  url    = {https://huggingface.co/Raras-AI/gemeo-world-model},
  note   = {Research preview. Not a medical device.}
}

@misc{gemeo_v1_2026,
  title  = {GEMEO v1: A SUS-Grounded Patient Digital Twin for Rare-Disease
            Trajectory Forecasting},
  author = {Timmers, Dimas and Kawassaki, Alexandre},
  year   = {2026},
  doi    = {10.5281/zenodo.20092131},
  url    = {https://doi.org/10.5281/zenodo.20092131}
}
```

### Building blocks (please also cite as appropriate)

- **PrimeKG** — Chandak, Huang, Zitnik. Nature Sci Data (2023).
- **HGT** — Hu et al., WWW 2020. *Heterogeneous Graph Transformer.*
- **TGNN** — Rossi et al., ICML 2020. *Temporal Graph Networks.*
- **TxGNN** — Huang et al., Nature Medicine 2024. *A foundation model for clinician-centered drug repurposing.*
- **NeuralSurv** — Lee et al., Stat. Med. 2021.
- **Diffusion Forcing** — Chen et al., NeurIPS 2024 ([2407.01392](https://arxiv.org/abs/2407.01392)).
- **DeepRare** — *Nature 2026*, s41586-025-10097-9.
- **PhenoKG** — arXiv 2506.13119 (Jun 2025).
- **MEDS** — Medical Event Data Standard v0.4.1, McDermott et al. 2024.

---

## Changelog

- **2026-05 (this release)** — Initial public release of the twin-stack application layer + NeuralSurv ckpt (c-index 0.70) + DT-FM baseline + PrimeKG-derived embeddings + RareBench v49 results.
- **2026-05-19** — Renamed from `Raras-AI/gemeo-world-model` → `Raras-AI/gemeo-twin-stack` (HF auto-redirects). The slug `gemeo-world-model` now hosts the actual Causal Diffusion Forcing world model.
- **2026-05** — GEMEO World Model v2 (CDF backbone) published at [Raras-AI/gemeo-world-model](https://huggingface.co/Raras-AI/gemeo-world-model).
- **2026-04** — GEMEO v1 paper published on Zenodo (DOI 10.5281/zenodo.20092131).

---

⚠️ **Reminder:** Research only. Not a medical device. No clinical use
without physician oversight and applicable regulatory clearance.