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01.
arXiv (CS.CL) 2026-06-15

Implicit Reasoning for Large Language Model-based Generative Recommendation

Large Language Models (LLMs) are increasingly adopted as backbones for Generative Recommendation (GR), promising access to pretrained world knowledge. Yet reliably invoking this knowledge for GR remains poorly understood. A key obstacle is that LLM-based GR typically represents items with Semantic IDs (SIDs), disrupting LLMs' natural-language reasoning interface because these tokens are unseen by the LLM during pretraining. Existing approaches address this with expensive multi-stage pipelines that ground SIDs and elicit explicit rationales, but offer limited insight into when and why each stage is necessary. In this work, we systematically decompose explicit reasoning training pipelines for LLM-based GR, revealing three key limitations: weakened world-knowledge verbalization, misalignment between SID and natural-language token embedding spaces, and sensitivity to rationale quality, all of which hurt explicit reasoning performance. To circumvent these issues, we propose PauseRec, a lightweight implicit reasoning paradigm tailored for GR. PauseRec is exceptionally practical, avoiding costly reasoning trace acquisition and reasoning alignment training, leading to a multitude of benefits: (1) it outperforms standard explicit CoT methods by up to 6.22%, (2) it reduces training cost by up to 65% GPU hours, and (3) it speeds up inference by up to 71.3%. These results position PauseRec as a lightweight alternative to explicit rationale generation, enabling more effective and efficient LLM-based GR.

02.
arXiv (CS.CL) 2026-06-18

Decoupling Search from Reasoning: A Vendor-Agnostic Grounding Architecture for LLM Agents

Production LLM agents increasingly depend on real-time search, yet native search grounding bundles retrieval policy, provider choice, evidence injection, cost, latency, and generation behavior behind a single model-provider boundary. This coupling makes grounding hard to inspect, tune, reuse, or port, and can trigger Search-Induced Verbosity that breaks strict output contracts. We present Decoupled Search Grounding (DSG), a vendor-agnostic boundary that moves grounding outside the reasoning model through an MCP-compatible gateway, exposing provider routing, source-aware context rendering, configured fallback, retrieval-depth control, and exact plus semantic caching as first-class controls. Across five frontier models on SimpleQA, FreshQA, and HotpotQA, native search leads on recency-sensitive FreshQA, but DSG exposes a stronger frontier when control matters: on SimpleQA it nearly matches native accuracy (86.1% vs. 87.7%) at 91% lower search cost, preserves concise answer contracts, and reaches a 99.4% warm-cache hit rate with 68% lower latency. Deployed as a shared production grounding layer for large-scale agentic workloads with interchangeable models, DSG matches or slightly exceeds native-search accuracy on an e-commerce query-understanding (QIU) workload while cutting search cost by over 98%. Real-time grounding is best treated as an optimizable interface boundary, not a fixed model feature.

03.
medRxiv (Medicine) 2026-06-23

Timing of S. aureus-related mortality in a large randomized clinical trial: Implications for future study design

Background: Longer follow-up periods in clinical trials for S. aureus bacteremia (SAB) may capture unrelated deaths, adding random noise that risks biasing trial results towards the null. Objective: To evaluate the timing and infection-relatedness of deaths within a large SAB clinical trial platform. Design: Blinded duplicate adjudication of trial deaths using a modified 7-point Likert-Scale. A third reviewer settled disagreements. Setting: 37 Canadian hospitals participating in the S. aureus Network Adaptive Platform (SNAP) Trial. Participants: 1515 adult patients recruited to SNAP between February 2022 and May 2026. Measurements: Timing and relatedness of 90-day deaths categorized as at least possibly SAB-related not likely to be SAB-related. Optimal follow-up cut-off was determined using Youden's index and graphically. Results: 247 deaths occurred; 97 (39.3%) were adjudicated as at least possibly SAB-related and 150 (60.7%) as not likely related. For probably/definitely related deaths, interrater agreement was 85.0% (Gwet's AC 0.73, substantial); for at least possibly related, it was 77.3% (Gwet's AC 0.55, moderate). Median survival was significantly shorter for SAB-related deaths (12 vs. 30.5 days; difference: 19 days earlier, 95% CI: 12-26, p

04.
arXiv (CS.CL) 2026-06-16

Nemotron 3 Ultra: Open, Efficient Mixture-of-Experts Hybrid Mamba-Transformer Model for Agentic Reasoning

We introduce Nemotron 3 Ultra, a 550 billion total and 55 billion active parameter Mixture-of-Experts Hybrid Mamba-Attention language model. We pre-trained Nemotron 3 Ultra on 20 trillion text tokens, then extended the context length to 1M tokens, and post-trained using Supervised Fine Tuning (SFT), Reinforcement Learning (RL), and Multi-teacher On-Policy Distillation (MOPD). Nemotron 3 Ultra is our most capable model yet, employing multiple key technologies - LatentMoE, Multi Token Prediction (MTP), NVFP4 pre-training, multi-environment RLVR, MOPD, and reasoning budget control. Nemotron 3 Ultra achieves up to ~6x higher inference throughput as compared to state-of-the-art publicly available LLMs while attaining on-par accuracy. The state-of-the-art accuracy, high inference throughput, and 1M token context length make Nemotron 3 Ultra ideal for long-running autonomous agentic tasks. We open-source the base, post-trained, and quantized checkpoints, along with the training data and recipe on HuggingFace.

05.
medRxiv (Medicine) 2026-06-10

Longitudinal brain structural changes during clozapine treatment: associations with neuroreceptor architecture and clinical response

In treatment-resistant schizophrenia, clozapine treatment has been associated with longitudinal reductions in subcortical volumes, ventricular enlargement, and widespread cortical thinning. However, it is unknown how these structural changes relate to clozapines pharmacological profile and clinical efficacy. We combined five longitudinal datasets with MRI acquired before and on average 5 months after clozapine initiation in 143 individuals to quantify brain structural changes and their association with normative maps relating to neuroreceptor architecture and physiological systems, and improvement in symptom severity. Clozapine treatment was associated with grey matter volume reductions across multiple subcortical regions (including the amygdala, hippocampus, thalamus, caudate, putamen and nucleus accumbens), increases in pallidal volume, ventricular enlargement, and widespread cortical thinning. Cortical regions showing the greatest magnitude of thinning corresponded to areas with higher normative densities of serotonergic 5-HT1A, 5-HT2A and 5-HT4 receptors. Changes in subcortical volume or cortical thickness during clozapine treatment were not associated with changes in total or positive symptom severity. In addition, baseline subcortical volume, cortical thickness, or gyrification prior to starting clozapine did not predict subsequent symptom improvement. Cortical thinning may partly reflect clozapines activity at serotonergic receptors, which have been implicated in cortical network stabilisation and neuroplasticity, however structural remodelling during clozapine treatment may reflect a process independent from its clinical efficacy in improving core symptoms of psychosis.

06.
medRxiv (Medicine) 2026-06-22

The impact of changes in age-based eligibility criteria on seasonal influenza vaccine uptake in England between 2019 and 2024: A retrospective cohort study

Objectives: To examine changes in seasonal influenza vaccine uptake among clinical risk groups over periods of differing age-based eligibility. Design: Retrospective cohort study. Setting: Individuals in England registered in the Clinical Practice Research Datalink Aurum. Participants: Between 1,239,802 (2019/20) and 1,289,330 (2023/24) individuals aged 40-69 years in clinical risk groups. Interventions: Natural experiment involving temporary expansion of age-based eligibility for influenza vaccination to include 50-64-year-olds from 2020/21 to 2022/23. Main outcome measures: Influenza vaccine uptake from 1st September to 28th February, incidence rate ratio (IRR) of vaccine uptake across consecutive seasons within age groups, and the ratio of IRRs between age groups. Results: Influenza vaccine uptake increased in all age groups in 2020/21 relative to 2019/20. The increase was larger in individuals aged 50-64 years (13.3%; IRR 1.50, 95% CI 1.50-1.51) compared with those aged 40-49 years (8.3%; IRR 1.35, 95% CI 1.34-1.35) and 65-69 years (6.8%; IRR 1.34, 95% CI 1.33-1.35). From 2020/21 to 2022/23, vaccine uptake decreased, with a more pronounced decline among those aged 40-49 years (-5.4%) compared with age-eligible groups (50-64 years: -3.0%; 65-69 years: -3.1%). The reversion of age eligibility in 2023/24 was associated with a larger decrease in uptake among those aged 50-64 years (-9.6% vs 2022/23; IRR 0.79, 95% CI: 0.79-0.79) compared with those aged 40-49 years (-4.9%; IRR 0.87, 95% CI: 0.87-0.88) and 65-69 years (-3.3%; IRR 0.97, 95% CI: 0.96-0.97). Patterns were broadly consistent across clinical risk groups. Conclusions: The COVID-19 pandemic saw a general increase in seasonal influenza vaccine uptake in clinical risk groups. This increase was larger and more sustained in 50-64 year-olds who had also become eligible based on age. Our findings highlight the potential gains in vaccine coverage among clinical risk groups based on expanded age-based eligibility.

07.
medRxiv (Medicine) 2026-06-22

Starting, stopping and restarting. Patterns of Methylphenidate Use over 14 years in a large public health system

Background Persistence with stimulant medication is poor in children and adolescents with ADHD, and the evidence base is derived predominantly from high-income countries. We describe methylphenidate utilisation patterns and predictors of 12-month retention across 14 years in a large South African public health service. Methods Retrospective cohort study using routine pharmacy data from the Western Cape provincial health service (2011-2024). Children aged 5-18 at first prescription were included. Treatment episodes were defined as continuous prescription sequences with no gap exceeding 90 days and classified as initiations or restarts. Logistic regression modelled 12-month retention against early visit frequency and formulation type as pre-specified exposures. Findings 421,925 prescription events for 23,243 children across 115 facilities generated 65,885 treatment episodes. Median age at first prescription was 10 years (IQR 8-12); 77.6% were male. Kaplan-Meier 12-month survival was 28.2% for initiations and 15.4% for restarts, substantially below high-income country comparators. A quarter of all initiating prescriptions were not followed by a subsequent dispensing event; nearly 40% of patients had three or more treatment episodes. Early visit frequency was the strongest predictor of 12-month retention (high vs low: OR 2.85, 95% CI 2.65-3.06). The sustained-release formulation effect was present but attenuated on multivariable adjustment. Treatment re-initiations showed a marked seasonal pattern consistent with the South African school calendar. Interpretation Twelve-month retention was markedly lower than high-income country rates. Against a backdrop of high attrition, both early visit frequency and sustained-release formulation access predicted persistence; clinical engagement and reducing structural barriers to access are modifiable factors in this setting. Funding None.

08.
medRxiv (Medicine) 2026-06-16

Language fMRI lateralization success and head motion in pediatric epilepsy patients with ADHD, and improvements based on fMRI task training

Introduction Language functional MRI (fMRI) is a valuable tool for presurgical planning in epilepsy. Functional MRI can be challenging in children, and head motion can compromise its utility. The candidacy of patients with ADHD for fMRI is sometimes queried regarding concerns about possible head motion. In 2020, we implemented an fMRI task training program, via telehealth and/or mock MRI. We aimed to determine whether training increased language lateralisation success and/or reduced head motion in all patients, and in those with ADHD. We also aimed to determine whether patients with ADHD exhibited more head motion during fMRI than those without ADHD. Methods We retrospectively identified 223 epilepsy (85%) and other neurosurgery patients, (241 scans including repeats) with language fMRI at Royal Children's Hospital, Melbourne, Australia, 2016-2024. There were 24 individuals with ADHD listed in the Electronic Medical Record, five of whom had diagnoses of both ADHD and autism; and nine with autism. Language lateralisation success was determined by clinician description recorded as left/right/bilateral in the medical record. 99 patients were provided the training including fMRI task practise. Head motion was quantified by maximum Framewise Displacement (FDmax; mm). Results ADHD was associated with lower language lateralisation success. Training was associated with greater language lateralisation success, across all patients, and in those with ADHD. Regarding ADHD and head motion, outliers in FDmax were seen in 5 young patients with ADHD. Data were trimmed to allow separate investigation of FDmax for the sample with and without extremes of head motion. In untrimmed data, FDmax was significantly higher in patients with ADHD than in those without. In trimmed data, FDmax was on average lower in patients with ADHD than those without, however this was not statistically supported. Regarding training and head motion, across all patients, FDmax was significantly lower for scans with training than without. In patients with ADHD, FDmax was on average lower for scans with training, however training was not associated with FDmax. Conclusions Language fMRI training was associated with higher language lateralization success, particularly in patients with ADHD. Training was associated with reduced head motion across all patients. Although some young patients with ADHD had substantial head motion, most in our sample did not move more than those without ADHD. We conclude that the training program increases success of language fMRI, and that an ADHD diagnosis should not be a contraindication to language fMRI.

09.
medRxiv (Medicine) 2026-06-17

The interaction between chronic hepatitis B (CHB) and Metabolic dysfunction-associated steatotic liver disease (MASLD) in a diverse central London population

Introduction: The overlap between chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging global health challenge. We investigated the impact of MASLD and metabolic comorbidity in a diverse London viral hepatitis clinic. Methods: This retrospective cross-sectional study (May 2018-Feb 2024) included adults with CHB having controlled attenuation parameter (CAP) measurements. MASLD was defined as CAP >264 dB/m plus [≥]1 cardiometabolic factor (CMF). We used univariable and multivariable models to examine MASLD's relationship with liver stiffness and hepatitis B viral load (HBV VL). Results: Among 323 individuals (67% male, median age 36), most were from Black (35%) or non-white British/Irish (29%) backgrounds. Overall, 64% had [≥]1 CMF, and 20% had MASLD. The CHB/MASLD group was significantly older (median 43 vs 35 years, p

10.
arXiv (CS.LG) 2026-06-17

On the Memorization Behavior of LLMs in Generative Recommendation: Observations, Implications, and Training Strategies

arXiv:2606.17276v1 Announce Type: cross Abstract: Generative recommendation (GR) has emerged as a promising direction for recommender systems. Recently, large language models (LLMs) have been increasingly adopted for GR, as their rich pretrained knowledge is expected to help them generalize beyond common user behavior patterns that traditional memorization-oriented baselines can capture. However, existing LLM-based GR works largely ignore LLMs' well-known tendency to memorize, which, if present in LLMs fine-tuned for GR, would restrict their utilization of pretrained knowledge. In this work, we investigate this concern by examining one-hop memorization, where a model recommends items that are direct successors of items in the training data. We show that LLMs do this more than non-LLM-based GR models-in fact, the vast majority of their gains over GR baselines are actually on users whose target items can be predicted through one-hop memorization. We intuit that improving performance on the remaining users requires LLMs to learn richer item-item relations beyond one-hop transitions. To achieve this, we propose IIRG, a novel training strategy that teaches LLMs to capture: (1) collaborative relations derived from item co-occurrences across multiple hops in user sequences, and (2) semantic relations among items with similar themes, both of which can serve as useful recommendation signals. We show that IIRG significantly improves over LLMs trained solely with standard next-item prediction, with especially large gains for users whose test items are not covered by train-time one-hop transitions.

11.
medRxiv (Medicine) 2026-06-15

Instrumental Activities of Daily Living in Older Adults with Epilepsy: A Cross-Sectional and Longitudinal Multicenter Study

Objective: Instrumental activities of daily living (IADLs) represent a critical but understudied measure of day-to-day function in persons with epilepsy(PWE). In the multicenter Brain Aging and Cognition in Epilepsy (BrACE) study of PWE aged greater than or equal to 55 years, we examined the proportion, clinical correlates, epilepsy-related predictors, and longitudinal trajectory of IADL impairment. Methods: IADLs were assessed using the Functional Activities Questionnaire (FAQ; range=0 to 30; higher=more impaired); a FAQ greater than or equal to 2 defines MCI-level impairment, and a FAQ greater than or equal to 5 defines dementia-level functional impairment. Multivariable logistic regression identified predictors of baseline function. Global cognition (Montreal Cognitive Assessment [MoCA]), individual cognitive measures, and quality of life (QOL) were compared between the impaired and unimpaired groups. Linear regression evaluated predictors of longitudinal functional decline. Results: Of 57 participants (mean age=66.6 years; female=52.6%), 38.6% (n=22) had MCI-level functional impairment and 17.5% (n=10) had dementia-level functional impairment. In univariate analyses, worse FAQ scores were associated with lower education, higher area deprivation index, early-onset epilepsy (EOE less than 60 years), antiseizure medication polytherapy, and epilepsy localization. In multivariable analysis, temporal lobe epilepsy (OR=4.46, 95% CI=1.09, 21.83,p=0.047), EOE(OR=7.14, 95% CI=1.16, 59.97, p=0.046), and lower education(OR=0.70,95% CI=0.49, 0.93, p=0.025) remained independently associated with baseline MCI-level functional-impairment. Lower education (OR=0.55,95% CI=0.29, 0.84, p=0.021) was the only factor associated with dementia-level IADL-impairment. IADL-impaired participants demonstrated lower verbal memory scores (adjusted p=0.041) and MoCA scores (adjusted p

12.
arXiv (CS.AI) 2026-06-16

Mitigating scalability challenges in LUT-based neural networks via pruning optimisations

arXiv:2407.02362v3 Announce Type: replace-cross Abstract: Modern deep neural networks heavily rely on a large number of multiply-accumulate operations, which constitute the predominant computational cost. To address this, Look-Up Table (LUT)-based matrix multiplications have emerged as a promising alternative for reducing the computational cost and time of the multiply-accumulate operations in a neural network. However, the LUT-based neural network still faces the scalability challenge due to the inherent limitations of LUT-based matrix multiplication. To mitigate these scalability limitations, this paper proposes a scalable and energy-efficient LUT-based approximate matrix multiplication unit (LUT-MU) constituting the basic component of the neural networks by integrating a pruning strategy on the MADDNESS algorithm, a LUT-based matrix multiplication methodology. With increasing problem size and precision demands in matrix multiplication, our proposed LUT-MU architecture effectively constrains resource expansion. The case study shows that deploying our LUT-MU in neural network architectures, including fully connected layers (MNIST) and ResNets (CIFAR-10, ImageNet)-on XCZU7EV and XCZU19EG FPGAs, produces up to $1.6 \times$ throughput improvement and $4.2 \times$ energy efficiency gains over mainstream CUDA-based network implementations, and $1.8\times$ energy efficiency compared to leading quantised neural network implementations, with moderate impact on accuracy. Compared to original MADDNESS-based neural networks, our LUT-MU shows $1.3$ to $2.6\times$ resource savings based on various resolution configuration settings of MADDNESS.

13.
arXiv (CS.AI) 2026-06-19

PrefSQA: Pairwise Preference Prediction for Speech Quality Assessment and the Critical Role of High Quality Datasets

arXiv:2606.19597v1 Announce Type: cross Abstract: Mean opinion scores (MOS) are widely used for speech quality assessment, yet scalar labels are sensitive to rater variability and listening test differences. This introduces labeling noise, which limits the reliability of MOS prediction. Preference prediction reduces this variability as listeners compare signals directly, producing cleaner labels. We study MOS-free preference prediction and propose PrefSQA, which incorporates uncertainty-aware logits, an impairment attention head, and a module based on non-matching-reference comparisons. We use and refine five datasets, including MOS-derived and low-noise simulated sets with matching and non-matching content, experiment with human preference sets, and test on unseen data. Experiments show small improvements on MOS-derived data, while other sets reveal clear improvement over the baselines, highlighting the value of high-quality preference data and demonstrating the effectiveness of the proposed method.

14.
arXiv (CS.LG) 2026-06-16

Formalizing and Mitigating Structural Distortion in LLM Attention for Zero-Shot Graph Reasoning

arXiv:2606.15633v1 Announce Type: new Abstract: Large Language Models (LLMs) have shown promise for reasoning over Text-Attributed Graphs (TAGs). However, applying LLMs to graphs requires linearizing their structure into sequences, introducing distortion rooted in the graph bandwidth problem. While this distortion has been shown to degrade performance, it is often attributed to prompt design or model scale, leaving the underlying mechanism unclear. In this work, we show how rotary positional embeddings turn graph linearization into bandwidth-dependent attention decay, suppressing attention between graph-adjacent nodes that are forced far apart in the serialized sequence. This shifts the focus of LLM-based graph reasoning from prompt engineering and scaling toward correcting attention misalignment. Motivated by this analysis, we propose Graph-aligned Language Attention (GaLA), a lightweight, inference-time modification for LLMs. GaLA biases attention toward graph-adjacent nodes while preserving the LLM's sequential inductive biases. Across TAG benchmarks, GaLA improves performance with negligible overhead, demonstrating that distortion is a correctable bottleneck in LLM-based graph reasoning.

15.
arXiv (math.PR) 2026-06-16

Stein's method for the matrix normal distribution

arXiv:2601.11422v2 Announce Type: replace-cross Abstract: This work presents the first systematic development of Stein's method for matrix distributions. We establish the basic essential ingredients of Stein's method for matrix normal approximation: we derive an extended-generator-based Stein identity from a matrix Ornstein-Uhlenbeck diffusion with two-sided scales, provide an explicit semigroup representation for the solution of the Stein equation, and obtain regularity estimates for the solution. The new methodology is demonstrated in three examples: (i) smooth Wasserstein distance bounds to quantify the matrix central limit theorem (a didactic example), (ii) a Wasserstein distance bound for the matrix normal approximation of the centered matrix $T$ distribution, and (iii) a Stein's method-of-moments approach to estimating the row and column covariance factors of the matrix normal, yielding a flexible class of weighted flip-flop Stein estimators that generalize Dutilleul's classical flip-flop algorithm and naturally accommodate row/column importance weights, systematic missingness, and projection onto structured covariance families. The latter two examples are intrinsically matrix-valued and cannot be treated using naive vectorization.