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01.
arXiv (CS.CL) 2026-06-18

Efficient Hallucination Detection for LLMs Using Uncertainty-Aware Attention Heads

While large language models (LLMs) have become highly capable, they remain prone to factual inaccuracies, commonly referred to as "hallucinations." Uncertainty quantification (UQ) offers a promising way to mitigate this issue, but most existing methods are computationally intensive and/or require supervision. In this work, we propose Recurrent Attention-based Uncertainty Quantification (RAUQ), an unsupervised and efficient framework for identifying hallucinations. The method leverages an observation about transformer attention behavior: when incorrect information is generated, certain "uncertainty-aware" attention heads tend to reduce their focus on preceding tokens. RAUQ automatically detects these attention heads and combines their activation patterns with token-level confidence measures in a recurrent scheme, producing a sequence-level uncertainty estimate in just a single forward pass. Through experiments on twelve datasets spanning question answering, summarization, and translation across nine different LLMs, we show that RAUQ consistently outperforms state-of-the-art UQ baselines. Importantly, it incurs minimal overhead, requiring less than 1\% additional computation. Since it requires neither labeled data nor extensive parameter tuning, RAUQ serves as a lightweight, plug-and-play solution for real-time hallucination detection in white-box LLMs.

02.
medRxiv (Medicine) 2026-06-22

Panel-level multilocus methylation quantification in native cell-free DNA by PCR-compatible sequential enzymatic processing

DNA methylation is informative for liquid biopsy, but low template abundance, distributed methylation signals and workflow complexity limit implementation. Here we present Delta-HLD, a PCR-compatible methylation assay platform that quantifies methylation directly in native DNA through sequential hybridization, ligation and methylation-sensitive digestion. The assay co-reports methylation-dependent signals from multiple loci through a shared amplification architecture, generating a single panel-level PCR readout. We established the chemistry, optimized panel size and composition through model-guided experiments, and implemented the assay as a triplex qPCR workflow with per-sample internal process controls. Plasma proof-of-concept analyses showed discriminatory signal in CRC and proof-of-concept transferability to hepatocellular carcinoma. Additional platelet-retaining experiments identified a strategy to increase recovery of analyzable circulating templates while reducing genomic DNA recognition. Delta-HLD provides a compact PCR-compatible framework for low-input methylation analysis without base conversion.

03.
arXiv (quant-ph) 2026-06-16

Benchmarking Quantum Computers via Protocols, Comparing IBM's Heron vs IBM's Eagle

arXiv:2603.04377v3 Announce Type: replace Abstract: As quantum computing hardware rapidly advances, objectively evaluating the capabilities and error rates of new processors remains a critical challenge for the field. A clear and realistic understanding of current quantum performance is essential for guiding research priorities and driving meaningful progress. In this work, we apply and extend a protocol-based benchmarking methodology (Meirom, Mor, Weinstein Arxiv 2505.12441) that utilizes well-defined \underline{quantumness} thresholds. By evaluating performance at protocol level rather than the gate level, this approach provides a transparent and intuitive assessment of whether specific quantum processors, or isolated sub-chips within them, can demonstrate a practical quantum advantage. To illustrate the utility of this method, we compare two generations of IBM quantum computers: the older Eagle architecture and the newer Heron architecture. Our findings reveal the genuine operational strengths and limitations of these devices, demonstrating substantial performance improvements in the newer Heron generation. This work was made possible by IBM Quantum policies that enable independent and objective assessment of its quantum computers and sub-chips. We strongly encourage other companies to emulate the independent qubit availability and the fair pricing that allow researchers to perform such assessments.

04.
arXiv (CS.CL) 2026-06-18

Depth-Width tradeoffs in Algorithmic Reasoning of Graph Tasks with Transformers

Transformers have revolutionized the field of machine learning. In particular, they can be used to solve complex algorithmic problems, including graph-based tasks. In such algorithmic tasks a key question is what is the minimal size of a transformer that can implement the task. Recent work has begun to explore this problem for graph-based tasks, showing that for sub-linear embedding dimension (i.e., model width) logarithmic depth suffices. However, an open question, which we address here, is what happens if width is allowed to grow linearly, while depth is kept fixed. Here we analyze this setting, and provide the surprising result that with linear width, constant depth suffices for solving a host of graph-based problems. This suggests that a moderate increase in width can allow much shallower models, which are advantageous in terms of inference and train time. For other problems, we show that quadratic width is required. Our results demonstrate the complex and intriguing landscape of transformer implementations of graph-based algorithms. We empirically investigate these trade-offs between the relative powers of depth and width and find tasks where wider models have the same accuracy as deep models, while having much faster train and inference time due to parallelizable hardware.

05.
arXiv (CS.AI) 2026-06-12

AgentBeats: Agentifying Agent Assessment for Openness, Standardization, and Reproducibility

arXiv:2606.13608v1 Announce Type: new Abstract: Agent systems are advancing quickly across domains, but their evaluation remains fragmented. Most benchmarks rely on fixed, LLM-centric harnesses that require heavy integration, create test-production mismatch, and limit fair comparison across diverse agent designs. The root problem is the lack of an open, agent-agnostic assessment interface. We advocate Agentified Agent Assessment (AAA), where evaluation is performed by judge agents and all participants interact through standardized protocols: A2A for task management and MCP for tool access. Conventional benchmarking defines two separate interfaces, one for the benchmark and one for the agent, while AAA only needs one; this yields a generic, unified framework that separates assessment logic from agent implementation and enables reproducible, interoperable, and multi-agent evaluation. We further introduce AgentBeats as a concrete realization of AAA: we identify five practical operation modes that make standardized assessment compatible with real-world constraints on openness, privacy, and reproducibility. To evaluate our design at scale, we conduct two studies: a five-month open competition that drew 298 judge agents across 12 categories together with 467 subject agents from independent participants, showing that AAA applies across a heterogeneous range of benchmarks; and a case study on coding agents that confirms agentified evaluation preserves fidelity with the public record while surfacing previously missing head-to-head results, yielding research insights about agent design. Combining a community-scale field study and a controlled coding case study, we verify that AAA delivers coverage, practicality, and fidelity across heterogeneous scenarios at scale. Together, AAA and AgentBeats offer a clear path toward open, standardized, and reproducible agent assessment.

06.
arXiv (CS.CV) 2026-06-16

Leptomeningeal Collateral Detection on DSA via Vessel-Graph Neural Networks

Leptomeningeal collaterals (LMCs) are an important prognostic factor in acute ischemic stroke. Existing automated methods rely on CT angiography (CTA), but individual LMCs are often too small to be resolved on CTA, limiting these methods to coarse collateral scoring. Digital subtraction angiography (DSA) visualizes individual collaterals at superior resolution, yet current assessment remains subjective, relying on manual grading scales that suffer from poor inter-rater agreement. We present a framework that formulates collateral detection as the classification of individual vessel segments on a graph derived from DSA. A hybrid graph-pixel architecture combines a topology-aware graph branch with a dense pixel branch, fused in a shared node-probability space. In a five-fold cross-validation setting, the fused model achieves a PR-AUC of 0.434, outperforming the graph-only (0.403) and pixel-only (0.362) baselines. To our knowledge, this is the first method to enable the individualization of LMCs in DSA, allowing for precise per-vessel quantitative assessment. This integration shifts DSA assessment toward objective evaluation, supporting future biomarker and pattern discovery for individual LMCs.

07.
arXiv (CS.AI) 2026-06-16

Evolutionary Dynamics of Cooperation in Next-Generation LLM Agent Systems: A Cross-Provider Empirical Extension

arXiv:2605.29874v2 Announce Type: replace-cross Abstract: Do next-generation LLM agents inherit the cooperative biases documented in their predecessors, or does scale and provider diversity reshape equilibrium behaviour in competitive multi-agent settings? Willis et al. established a benchmark for this question using evolutionary game theory and the Iterated Prisoner's Dilemma (IPD), finding consistent cooperative biases in ChatGPT-4o and Claude 3.5 Sonnet. We extend this benchmark to four frontier models released in 2025-2026 - Claude Sonnet 4.6, Gemini 2.5 Flash, Gemini 3.1 Pro, and GPT-5.4 Mini - applying the identical protocol across three prompting styles (Default, Prose, Self-Refine) and four population compositions (balanced and biased, with and without noise). Cooperative bias persists across providers (H1): ten of twelve model-prompt combinations favour cooperative equilibria in balanced noiseless conditions. Cross-provider divergence is substantial (H3): Gemini 2.5 Flash reaches up to 77% aggressive equilibria under biased conditions, while GPT-5.4 Mini reaches 70% cooperative equilibria under Self-Refine. Support for aggressive capability parity is partial (H2): Self-Refine raises ICD in all models and Gemini 3.1 Pro Refine achieves the highest ICD in the dataset (0.925), but Default and Prose prompts show no systematic narrowing. Evidence on noise robustness is directionally positive but not robustly confirmed (H4): with n=500 Moran iterations per condition, average noise sensitivity is about 6 percentage points for Claude Sonnet 4.6 versus 13 pp for Claude 3.5 Sonnet, but this cross-study gap is not statistically significant once the predecessor's unreported sampling error is propagated. Provider identity, rather than model generation, is the strongest correlate of equilibrium outcomes; noise remains a universal challenge regardless of model size or vintage.

08.
arXiv (CS.AI) 2026-06-17

Breaking the Code: Security Assessment of AI Code Agents Through Systematic Jailbreaking Attacks

arXiv:2510.01359v2 Announce Type: replace-cross Abstract: Code-capable large language model (LLM) agents are embedded in software engineering workflows where they can read, write, and execute code, raising "jailbreak" stakes beyond text-only settings. Prior evaluations emphasize refusal or harmful-text detection, leaving open whether agents compile and run malicious programs. We present JAWS-Bench (Jailbreaks Across WorkSpaces), a benchmark spanning three escalating workspace regimes mirroring attacker capability: empty (JAWS-0), single-file (JAWS-1), and multi-file (JAWS-M). We pair this with a hierarchical, executable-aware Judge Framework that tests (i) compliance, (ii) attack success, (iii) syntactic correctness, and (iv) runtime executability, to measure deployable harm. Across seven LLM backends from five families, prompt-only attacks in JAWS-0 achieve 61% compliance; 58% are harmful, 52% parse, and 27% run end-to-end. In JAWS-1, compliance reaches ~100% for stronger models with a mean ASR (Attack Success Rate) ~71%; JAWS-M raises mean ASR to ~75%, with 32% runnable attack code. Wrapping an LLM in an agent increases ASR by 1.6$\times$, by overturning initial refusals during planning and tool use. Similar trends hold for OpenHands, SWE-Agent, and OpenAI Codex, suggesting our JAWS-Bench is agent-agnostic. Category analyses identify which attack classes are most vulnerable and deployable, motivating execution-aware defenses and refusal-preserving agent designs.

09.
medRxiv (Medicine) 2026-06-15

Routine use of oral iron for people with heart failure and iron deficiency in primary care; retrospective cohort study

Aims: Iron deficiency is common among people with heart failure and associated with morbidity and mortality. While intravenous iron improves clinical outcomes, oral iron continues to be prescribed in routine practice despite limited evidence of benefit. Methods: We completed a retrospective primary care cohort study (2016 to 2021) to investigate the proportion of people with an incident diagnosis of heart failure who had iron deficiency identified (defined as ferritin

10.
arXiv (CS.AI) 2026-06-12

Muse Spark Safety & Preparedness Report

arXiv:2606.12429v1 Announce Type: cross Abstract: Muse Spark is the latest large language model developed by Meta. In this report, we first present evaluations for catastrophic risk domains under Meta's Advanced AI Scaling Framework, along with the evidence that informed our launch decision. We then discuss additional considerations, such as Muse Spark's broader content safety and behavioral profile, that are relevant to overall safety but fall outside the catastrophic risk domains governed by the Framework. Our preparedness results covering Chemical and Biological, Cybersecurity, and Loss of Control risks assess Muse Spark's deployment within Meta AI as presenting acceptable levels of residual risks under our Advanced AI Scaling Framework. We conducted a broad set of evaluations targeting dual-use and high-risk capabilities across these catastrophic risk domains. Those evaluations identified elevated risks prior to mitigations, with Chemical and Biological capabilities assessed as likely reaching the "high risk" category under the Advanced AI Scaling Framework before safeguards were applied. We have implemented a multi-layered set of mitigations that address the identified risks, and Muse Spark demonstrates state-of-the-art refusal across a range of benchmarks related to hazardous workflows in chemistry and biology. We therefore release Muse Spark as the underlying model of Meta AI.

11.
arXiv (CS.CL) 2026-06-12

Emergence of Hierarchical Emotion Organization in Large Language Models

As large language models (LLMs) increasingly power conversational agents, understanding how they model users' emotional states is critical for ethical deployment. Inspired by emotion wheels, i.e., a psychological framework that argues emotions organize hierarchically, we analyze probabilistic dependencies between emotional states in model outputs. We find that LLMs naturally form hierarchical emotion trees that align with human psychological models, and larger models develop more complex hierarchies. We also uncover systematic biases in emotion recognition across socioeconomic personas, with compounding misclassifications for intersectional, underrepresented groups. Human studies reveal striking parallels, suggesting that LLMs internalize aspects of social perception. Beyond highlighting emergent emotional reasoning in LLMs, our results hint at the potential of using cognitively-grounded theories for developing better model evaluations.

12.
arXiv (CS.CL) 2026-06-11

Neural FOXP2 – Language Specific Neuron Steering for Targeted Language Improvement in LLMs

LLMs are multilingual by training, yet their lingua franca is often English, reflecting English language dominance in pretraining. Other languages remain in parametric memory but are systematically suppressed. We argue that language defaultness is governed by a sparse, low-rank control circuit, language neurons, that can be mechanistically isolated and safely steered. We introduce Neural FOXP2, that makes a chosen language (Hindi or Spanish) primary in a model by steering language-specific neurons. Neural FOXP2 proceeds in three stages: (i) Localize: We train per-layer SAEs so each activation decomposes into a small set of active feature components. For every feature, we quantify English vs. Hindi/Spanish selectivity overall logit-mass lift toward the target-language token set. Tracing the top-ranked features back to their strongest contributing units yields a compact language-neuron set. (ii) Steering directions: We localize controllable language-shift geometry via a spectral low-rank analysis. For each layer, we build English to target activation-difference matrices and perform layerwise SVD to extract the dominant singular directions governing language change. The eigengap and effective-rank spectra identify a compact steering subspace and an empirically chosen intervention window (where these directions are strongest and most stable). (iii) Steer: We apply a signed, sparse activation shift targeted to the language neurons. Concretely, within low to mid layers we add a positive steering along the target-language dominant directions and a compensating negative shift toward the null space for the English neurons, yielding controllable target-language defaultness.

13.
arXiv (CS.LG) 2026-06-11

Categorical Robustness Assessment for Machine Learning based Network Intrusion Detection Systems

arXiv:2606.12075v1 Announce Type: cross Abstract: Network Intrusion Detection Systems (NIDS) heavily utlize Machine Learning (ML) but ML models can be manipulated via adversarial attacks. These attacks add carefully crafted perturbations to network traffic data that leads to misclassifications. While prior work has demonstrated adversarial vulnerabilities in isolated settings, systematic cross-architecture as well as class and category of attack based comparisons under controlled attack conditions remain limited, leaving practitioners without clear guidance on which models to deploy in adversarial environments. This paper asks a simple question: what type of classifier architectures actually hold up when attackers try to manipulate the systems? We put three popular architectures through their paces: a 1D Convolutional Neural Network, a Long Short-Term Memory (LSTM) network, and a Random Forest (RF) ensemble. Using the ACI-IoT-2023 dataset (over 1.2 million samples spanning 12 attack types), we subject each model with FGSM and PGD adversarial attacks, which apply gradient-based perturbations in normalized feature space consistent with established adversarial ML evaluation protocols, at perturbation budgets ranging from $\epsilon=0.01$ to $\epsilon=0.1$. Surprisingly, Random Forest achieved near-perfect baseline accuracy (99.98\%), yet collapsed catastrophically under attack, dropping 73 percentage points at the smallest perturbation we tested. CNN, on the other hand, retained 95.5\% accuracy at $\epsilon=0.01$ and degraded gracefully as perturbations increased. LSTM fell somewhere in between. These findings flip the conventional wisdom where high baseline accuracy means nothing if a model shatters at the first sign of adversarial pressure. For practitioners deploying intrusion detection in adversarial environments, we recommend CNN-based architectures and provide scenario-specific deployment guidance.

14.
arXiv (CS.AI) 2026-06-18

From Specification to Execution: AI Assisted Scientific Workflow Management

arXiv:2606.18425v1 Announce Type: cross Abstract: Scientific workflow management systems (WMS) support scalable and reproducible execution of complex pipelines, but workflow design, implementation, and debugging remain largely manual and require significant expertise. Recent approaches using large language models (LLMs) show promise for workflow generation from natural language, but often rely on direct code synthesis, which limits transparency, reproducibility, and integration with workflow systems. We present an AI-assisted approach to scientific workflow management that combines specification-driven workflow generation, automated debugging, and distributed execution. The method introduces a structured specification phase that separates workflow intent, design, and implementation, allowing validation prior to code generation. We also develop an LLM-based debugging agent that diagnoses and resolves failures across multiple system layers. To support distributed execution and user interaction, we integrate Pegasus, a widely used WMS, with a Model Context Protocol (MCP) layer, providing a unified interface for workflow submission, monitoring, and control. We evaluate the approach using a federated learning workflow for medical imaging, chosen for its parallel, iterative, and dependency-intensive structure. The system generated and executed large-scale workflows with thousands of jobs, reduced debugging effort, and allowed non-expert users to construct workflows with expert-level design patterns. These results indicate that end-to-end AI-assisted workflow generation and execution is feasible, and point toward AI-driven platforms for managing the scientific workflow lifecycle.

15.
arXiv (CS.CL) 2026-06-11

SOMA-SQL: Resolving Multi-Source Ambiguity in NL-to-SQL via Synthetic Log and Execution Probing

Natural language interfaces to databases aim to translate user questions into executable SQL, yet remain brittle in real-world settings where questions are underspecified and schemas are large and ambiguous. Ambiguity across user questions, database schemas, and model interpretations are central failure modes in NL2SQL, leading to misaligned intent, incorrect schema grounding, and erroneous SQL generation. Existing approaches rely on human clarification or treat ambiguity as a schema representation problem, but these do not scale nor resolve ambiguity autonomously. We propose SOMA-SQL to automatically resolve ambiguity via targeted synthetic query log and ambiguity-driven probing. SOMA-SQL constructs synthetic query log to ground schema interpretation and guide candidate SQL generation; it then executes targeted probing queries, driven by a structured ambiguity taxonomy and candidate disagreements, to produce disambiguation evidence for final SQL selection and repair. This active approach to ambiguity discovery and resolution generalizes across unseen schemas and query distributions without human-in-the-loop. Experiments on six public benchmarks demonstrate that SOMA-SQL improves execution accuracy by 13.0% on average over state-of-the-art baselines, with gains of up to 16.7% on ambiguous questions.

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

Federated Foundation Language Model Post-Training Should Focus on Open-Source Models

arXiv:2505.23593v4 Announce Type: replace Abstract: Post-training of foundation language models has emerged as a promising research domain in federated learning (FL) with the goal to enable privacy-preserving model improvements and adaptations to user's downstream tasks. Recent advances in this area adopt centralized post-training approaches that build upon black-box foundation language models where there is no access to model weights and architecture details. Although the use of black-box models has been successful in centralized post-training, their blind replication in FL raises several concerns. Our opinion is that using black-box models in FL contradicts the core principles of federation such as data privacy and autonomy. In this paper, we critically analyze the usage of black-box models in federated post-training, and provide a detailed account of various aspects of openness and their implications for FL.

17.
arXiv (quant-ph) 2026-06-11

Global vs. Local Discrimination of Locally Implementable Multipartite Unitaries

arXiv:2509.10430v2 Announce Type: replace Abstract: We study single-shot distinguishability of locally implementable multipartite unitaries under Local Operations and Classical Communication (LOCC) and global operations. As unitary discrimination depends on both the choice of probing states and the measurements on the evolved states, we classify LOCC and global distinguishability into two categories: adaptive strategies, where probing states are chosen based on measurement outcomes from other subsystems, and restricted strategies, where probing states remain fixed. Our findings uncover three surprising features in the bipartite setting and establish new structural limits for unitary discrimination: (i) Certain pairs of unitaries are globally distinguishable with restricted strategies but indistinguishable under LOCC, even with adaptive strategies. (ii) There exist sets of four unitaries that are distinguishable via LOCC, yet remain globally indistinguishable with restricted strategies. (iii) Some sets of unitaries are globally indistinguishable under adaptive strategies, when probed with separable states, but become distinguishable via LOCC.

18.
medRxiv (Medicine) 2026-06-15

Fanconi Anemia as a Window into Premalignant Field Cancerization of the Oral Mucosa

Head and neck squamous cell carcinoma (HNSCC) evolves through stepwise clonal expansion within genetically altered mucosa fields, yet actionable biomarkers remain undefined. Leveraging Fanconi anemia (FA), a cancer predisposition syndrome with extreme HNSCC risk due to defective DNA interstrand crosslink repair, we profiled premalignant changes in the oral cavity using noninvasive brush biopsies. Consistent with our prior demonstration of genomic instability in FA-associated SCCs, we detected pathogenic TP53 variants in 26% and copy number alterations in 60.5% in clinically normal-appearing oral mucosa of individuals with FA. These subclinical clonal expansions define candidate biomarkers of early clonal evolution amenable to serial sampling for risk stratification and prevention studies. Since FA-associated SCCs share genomic features with sporadic HNSCC, these findings may extend to the broader population. We also identify somatic reversion of a pathogenic FANCB variant, providing evidence of genomic self-correction and suggesting a potential avenue for gene-based cancer prevention in FA.

19.
arXiv (CS.AI) 2026-06-11

Quantized Stochastic Primal-Dual Methods for Distributed Optimization under Relaxed Global Geometry

arXiv:2606.11339v1 Announce Type: cross Abstract: We study distributed optimization with stochastic gradients and finite-bit communication modeled by random (unbiased) quantization. We propose q-PDGD, a quantized stochastic primal-dual method, and analyze it under relaxed global geometry. Under restricted secant inequality (RSI), a constant step-size yields linear contraction to an explicit neighborhood determined by gradient noise, quantization distortion, and network connectivity, while a diminishing step-size achieves O(1/k) convergence without shared-minimizer assumptions. Under Polyak-Lojasiewicz (PL) inequality, we obtain linear-to-neighborhood convergence in the same stochastic quantized setting. Our results match the best-known centralized stochastic rates in oracle complexity, and are supported by experiments demonstrating the predicted tradeoffs between quantization level, step-size choice, and graph structure.

20.
arXiv (CS.AI) 2026-06-18

Benchmarking Action Spaces in Reinforcement Learning for Vision-based Robotic Manipulation

arXiv:2606.18594v1 Announce Type: cross Abstract: In real-world reinforcement learning (RL), the choice of action space can play a key role in shaping motion smoothness, safety, and overall task performance. In this study, we evaluate pose increment, pose velocity, joint position increment, and joint velocity across two vision-based manipulation tasks: object picking and pushing. We train policies in simulation and deploy them to the real world using sim-to-real transfer. We find that action-space representation indeed significantly affects sim-to-real performance. In particular, we find that the joint velocity action space is best for the vision-based picking and pushing tasks in terms of smoothness and final task performance. We also provide practical guidance for RL practitioners in choosing action spaces for both simulation and real-world experiments.

21.
arXiv (CS.AI) 2026-06-12

GeoDial: A Multimodal Conversational Tutoring Dataset for Geometry Problem-Solving with Visual Tutor Turns

arXiv:2606.12419v1 Announce Type: cross Abstract: Several educational domains rely heavily on diagrams and visual cues, yet most existing tutoring datasets are limited to text-only interactions. This limits the development of AI tutors that can teach in visually grounded ways used by human instructors. Thus, we introduce GeoDial, a multimodal tutoring dataset of over 1.3K teacher-student dialogs in the domain of geometry collected from experienced math teachers, where instructional turns are explicitly grounded in diagram highlights. We propose a scalable annotation protocol that integrates dialog acts, visual highlighting, and feedback, enabling fine-grained supervision of both language and visual tutoring behavior. To illustrate the challenges posed by this setting, we fine-tune several vision-language models on GeoDial and evaluate their ability to generate tutoring utterances and diagram highlights. While supervised fine-tuning substantially improves the quality of generated dialog, it struggles to produce accurate diagram highlights, revealing a key limitation of current methods and highlighting the need for approaches that more effectively integrate visual reasoning with pedagogical interaction.

22.
medRxiv (Medicine) 2026-06-22

Use of the Pharmacy First service in England in the first 12 months: geographic variation and health system context

Objectives: The Pharmacy First (PF) service was introduced across England from 31 January 2024 to expand the clinical role of community pharmacies and improve access to primary care. This paper describes use of PF in its first 12 months, in terms of uptake, access routes, consultation outcomes, geographic variations, service costs and antimicrobial supply. Methods: A descriptive analysis of all PF consultations submitted for payment to NHS Business Services Authority in England between 31 January 2024 and 31 January 2025. Pharmacy-level consultation data were linked to national data on population, location and pharmacy characteristics. PF use was examined using population-standardised consultation rates and consultations per pharmacy. Results: During the first year of implementation, 2,205,731 PF consultations were recorded as delivered across 11,349 pharmacies, with payment of GBP123 million to pharmacies. Uptake increased steadily over time. Most consultations were for acute sore throat (33%) and uncomplicated urinary tract infection (27%), with corresponding antibiotics, phenoxymethylpenicillin and nitrofurantoin being the most supplied. Most people self-referred (74%) into the service, with 95% of consultations managed without onward referral. Substantial geographic variation was observed. Northern regions had higher use based on the eligible population. The South East and Midlands had higher activity per pharmacy. London showed a distinct pattern, with higher self-referral into the service, lower medication supply and higher referral to other healthcare services. Higher consultation volume was weakly associated with pharmacy characteristics, including opening hours, pharmacy type and retail setting, and local context, in terms of socio-economic and geographic factors. Conclusions: PF had immediate uptake and is operating primarily as a direct-access model for common acute conditions. Findings suggest that PF is contributing to improved access to care and may shift demand away from general practice. However, the service uptake appears to be shaped by geographic location, proximity to other healthcare services and pharmacy characteristics.

23.
medRxiv (Medicine) 2026-06-15

The clinical utility of functional testing in fibroblasts to diagnose primary mitochondrial disease

Genome sequencing of the heterogeneous primary mitochondrial disorders (PMD) frequently reveals variants of uncertain significance that require functional tests for diagnosis, and does not identify variants in all patients. We analyzed mitochondrial enzyme assays, blue native polyacrylamide gel electrophoresis (BN-PAGE) with in-gel activity staining, complex I assembly blot, and select protein abundances in fibroblasts of a case series of 204 PMD patients divided into functional classes, in comparison to 51 controls and 53 differential diagnostic conditions. Overall, sensitivity and specificity for respiratory chain enzyme assays were 46% and 93% respectively, for BN-PAGE 40% and 98%, for complex I assembly assay 49% and 99%. The overall sensitivity of all tests was 76%, specificity 93%, with positive predictive value 96% and negative predictive value 67%. Categories with high sensitivity were isolated complex deficiencies, nuclear DNA-encoded mitochondrial protein synthesis defects, co-factor defects, and mitochondrial amino-acyl-tRNA synthetase conditions when aided by protein abundance. Mitochondrial DNA mutations and maintenance disorders showed poor sensitivities. Secondary dysfunctions were rare. A complete battery of functional tests showed strong diagnostic clinical utility in fibroblasts.

24.
arXiv (CS.CL) 2026-06-17

Adaptive Activation Steering for Efficient LLM Reasoning via Closed-Loop PID Control

Reasoning LLMs trained with long chain-of-thought often overthink: they spend tokens on redundant reflection and transitions that inflate cost without improving accuracy. Static activation steering (e.g.\ SEAL) suppresses such content with a fixed vector, but applies the same strength regardless of how redundant the current chunk actually is. We describe PID-steering, a training-free, decoding-time method that modulates the steering strength with a PID controller driven by a lightweight chunk-level redundancy classifier. On a subset of GSM8K with DeepSeek-R1-Distill-Qwen-1.5B, the method improves accuracy from 85.7\% to 89.6\% (+3.9 pp) while cutting average output length from 1026 to 790 tokens ($-$23\%). We report it as a small-scale proof of concept rather than a benchmark result.

25.
medRxiv (Medicine) 2026-06-15

SPIRIT-CONSORT-ELM: Element-Level Assessment of Randomized Controlled Trial Reporting Using Large Language Models

Randomized controlled trials (RCTs) play a central role in assessing the benefits and harms of interventions. Incomplete reporting in RCT publications can compromise the verifiability and usefulness of RCTs. SPIRIT and CONSORT reporting guidelines aim to improve the completeness of RCT protocols and results publications, respectively. However, many RCTs are not reported completely. Checking manuscripts automatically could help authors improve the completeness of reports prior to publication. We previously annotated SPIRIT-CONSORT-TM, a corpus of 200 articles (comprising 100 protocol-results publication pairs) using 83 checklist items drawn from SPIRIT 2013 and CONSORT 2010. We also trained machine learning models to automatically assess reporting at the item level. Each checklist item can include multiple constituent elements (i.e., specific details required for that item), and an item might be considered fully reported when all of its elements are present. However, prior work does not explicitly capture or evaluate reporting at the element level. To address this gap, we extended SPIRIT-CONSORT-TM by incorporating element-level annotations and using them to assess reporting completeness (SPIRIT-CONSORT-ELM). We formulated element-level assessment as a machine reading comprehension task, operationalized through 119 questions, where each question targets a specific reporting element within a checklist item. Using the 200 articles included in SPIRIT-CONSORT-TM, two annotators independently answered 119 questions for 50 articles (25 protocol-results pairs) and resolved any discrepancies through discussion; the remaining 150 articles (75 protocol-results pairs) were assessed by a single annotator. We then developed an automated pipeline for element-level assessment using SPIRIT-CONSORT-ELM. The pipeline first applies a PubMedBERT-based model to identify sentences containing item-level reporting information, then it uses a generative large language model (LLM; GPT-5) with chain-of-thought reasoning to answer element-level questions based on the retrieved evidence. Agreement between the two annotators was high (Gwet's AC1: 0.782) and our pipeline achieved high accuracy in identifying element-level reporting evidence (F1: 0.822, Gwet's AC1: 0.796). Ablation studies indicate that chain-of-thought reasoning and the inclusion of illustrative in-context examples modestly improve LLM performance on the machine reading comprehension task. SPIRIT-CONSORT-ELM provides a benchmark for evaluating reporting guideline completeness at the element level, enabling assessment of RCT transparency beyond the simple presence or absence of checklist items and is publicly available at https://osf.io/kznx4/. The automated pipeline establishes a robust baseline for assessing RCT reporting and demonstrates potential as a practical aid for authors, reviewers, and editors to identify and address gaps in completeness and transparency of RCT reports.