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01.
medRxiv (Medicine) 2026-06-22

Reliable quantification of renal function from frozen blood samples

BACKGROUND: Differences in renal function may affect Alzheimer disease (AD) blood biomarker levels independent of AD pathology. Although renal function was unaccounted for in foundational AD blood biomarker studies, there is potential to address this through quantification of estimated glomerular filtration rate (eGFR) from frozen serum and plasma samples. However, the validity of eGFR evaluation from long-term frozen blood samples is unknown. METHODS: Adults aged 50-85 with at least 2 vascular risk factors were recruited from vascular surgery or cardiology clinics in Tucson, Arizona from 2022-2025. Individuals with creatinine assessments in point-of-care whole blood (POC-WB) and frozen serum and plasma samples using the iSTAT (Abbott) were included. eGFR was calculated using the 2021 CKD-EPI creatinine equation without race. Agreement between POC-WB and frozen blood samples was assessed using Cohen's kappa with linear weights. RESULTS: 134 participants (mean [SD] age: 72.6 [7.5] years, 39.6% female, 23.1% chronic kidney disease) had POC-WB eGFR available. Frozen serum and plasma samples had strong agreement with POC-WB for eGFR (Kw= 0.90-0.95, P

02.
medRxiv (Medicine) 2026-06-22

A Controlled Human Malaria Infection model for relapsing Plasmodium vivax

Background Plasmodium vivax malaria relapses are a major source of morbidity and onward transmission of infection. The underlying mechanisms are poorly understood and current therapies sub-optimal. We examined the safety and feasibility of a controlled human malaria infection (CHMI) model for relapsing P. vivax. Methods We conducted an open-label, proof-of-concept, CHMI study of relapsing P. vivax. Healthy, malaria-naive, Duffy-positive adults aged 18-45 years with extensive CYP2D6 metaboliser phenotype and normal blood glucose-6-phosphate dehydrogenase (G6PD) levels were recruited in Oxford, UK. Mosquito-bite CHMI was performed in Nijmegen, The Netherlands, using Anopheles stephensi mosquitoes infected with PvW1, a clonal isolate of P. vivax from Thailand. All follow-up visits were conducted in Oxford, UK. Primary P. vivax infections (qPCR > 500 genome copies/mL) were treated with artemether-lumefantrine (80mg/480mg at 8, 24, 36, 48 and 60 hours). From Day 28 following CHMI, participants attended a fortnightly clinic for clinical review and qPCR blood sampling, with additional assessments performed for any reported symptoms. P. vivax relapse infections (qPCR > 500 genome copies/mL) were treated with artemether-lumefantrine as per primary infection. Definitive anti-malarial treatment with atovaquone-proguanil (1000mg/400mg once daily for three days) and primaquine (0{middle dot}5 mg/kg/day for 14 days) was administered six months following CHMI, regardless of parasitaemia or symptoms. The primary objective was to assess the safety, feasibility and frequency of relapsing P. vivax after CHMI. Remote follow-up (5 years) is ongoing. The study is registered with ISRCTN registry (ISRCTN48625883). Findings 20 participants were screened for eligibility from 21 January 2025. Five participants (median age 22 years) underwent CHMI (five infected mosquitoes per participant) on 15 April 2025. All participants developed primary P. vivax infection and experienced at least one relapse infection. Two participants experienced a second relapse. Overall incidence rate was 3{middle dot}6 relapse infections per person-year. Solicited adverse events were mild or moderate and there were no serious adverse events. Definitive anti-malarial treatment was administered to all participants. One participant experienced primaquine-induced methaemoglobinaemia, resolving with early discontinuation of treatment (total dose 5{middle dot}3 mg/kg). To date, more than six months after primaquine treatment, no further relapses have been recorded. Interpretation CHMI of relapsing P. vivax is safe and feasible, allowing exploration of the mechanisms underlying relapse infections and providing a platform for future anti-relapse efficacy studies. Funding European Union Horizon Europe programme and UK Research and Innovation (UKRI) via OptiVivax consortium; UK National Institute for Health and Care Research Biomedical Research Centre: Oxford; and UK Medical Research Council.

03.
medRxiv (Medicine) 2026-06-23

Linking mpox wastewater surveillance with reported clinical cases in three countries in Sub-Saharan Africa

The emergence of the novel monkeypox virus (MPXV) clade Ib in the Democratic Republic of the Congo (DRC) and neighboring countries in late 2023 highlighted the need for rapid, scalable surveillance approaches to support outbreak detection and response. As part of the ODIN-Mpox project, wastewater surveillance (WWS) systems were established as an emergency public health measure in three Sub-Saharan African countries (DRC, Tanzania, and Burkina Faso) to evaluate the feasibility of wastewater-based monitoring for mpox and strengthen local surveillance capacity. Between January 2025 and April 2026, 117 wastewater samples were collected from selected sites and analyzed for MPXV DNA using targeted qPCR assays. Clinical mpox data were obtained from national surveillance systems and WHO reports to assess epidemiological linkages between wastewater detections and reported infections. Six wastewater samples tested positive for MPXV DNA. During the study period, DRC experienced the highest disease burden, with weekly reported cases peaking at about 3,000 in January 2025, while Tanzania reported a peak of 20 weekly cases in March 2025. No confirmed clinical cases were reported in Burkina Faso. No clear relationship was observed between reported case numbers and qPCR Ct values in positive wastewater samples. Despite the low detection frequency, the project demonstrated the operational feasibility of implementing MPXV wastewater surveillance in resource-limited settings and established laboratory capacity for environmental monitoring of emerging infectious diseases. Given the early stage of WWS implementation in the region, the study identified opportunities for further system strengthening, including optimization of sample processing and reporting workflows, improved access to laboratory supplies, and enhanced integration of environmental and clinical surveillance data streams. These findings highlight the value of WWS as a complementary component of integrated public health surveillance systems and emphasize the need for continued investment in laboratory capacity, harmonized methodologies, governance frameworks, and knowledge exchange to enhance outbreak preparedness and response in low-resource settings.

04.
medRxiv (Medicine) 2026-06-22

Repeat expansions in Parkinson's disease and parkinsonism across ancestries: insights from a global genetic cohort

Expanded short tandem repeats contribute to a broad spectrum of neurodegenerative diseases, yet their roles in Parkinson's disease (PD) and parkinsonism remain incompletely characterized, especially across diverse ancestries. We analyzed short-read whole-genome (WGS) and clinical exome sequencing (CES) data from 38,365 individuals (28,861 WGS; 9,504 CES), encompassing 23,242 patients with PD, 4,729 patients with atypical parkinsonism and 10,394 healthy controls from 11 genetic ancestries. To determine carrier frequencies and characterize repeat structures across diverse ancestries, we genotyped 12 established pathogenic loci where normal, intermediate, and pathogenic alleles can be reliably differentiated using short-read sequencing data. Additionally, we conducted threshold-based associations to determine the minimum threshold associated with increased PD risk in 15,995 individuals (8,591 PD, 7,404 controls) of European ancestry. Pathogenic repeat expansions were detected in 62 patients (56 PD and 6 atypical parkinsonism) and 5 controls across seven loci (AR, ATXN1, ATXN2, ATXN3, CACNA1A, HTT and THAP11), spanning seven ancestries. Among these, ATXN2 expansions were the most frequently observed in PD and were present in African, East Asian, European and Middle Eastern ancestries. Additionally, intermediate ATXN2 repeat expansions exhibited a strong, length-dependent association with PD risk in the European population, with individuals with [≥]32 repeats having a more than four-fold increased risk (odds ratio 4.25, 95% confidence interval 1.80-12.05). Overall, >92% of expanded alleles harbor CAA interruptions within the CAG tract. Pathogenic expansions at other loci, such as ATXN3 and THAP11, showed more ancestry-specific distributions. Clinically, individuals with pathogenic ATXN2 and ATXN3 expansions most often presented with typical PD features but frequently showed earlier disease onset and a strong family history of PD. This large-scale, multi-ancestry study comprehensively maps the genetic landscape of pathogenic and intermediate repeat expansions in PD. Our findings confirm a length- and structure-dependent risk association for ATXN2 with PD in the European population, and highlight the pleiotropic effects of repeat expansions across the parkinsonian spectrum.

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

Does AI Reviewer See the Full Picture? Attacking and Defending Multimodal Peer Review

The integration of Large Language Models (LLMs) and Multimodal LLMs (MLLMs) into scientific peer-review workflows introduces novel and significant risks for adversarial manipulation, especially given the multimodal nature of scientific papers where figures, not just text, convey core evidence. This creates a significant gap: current robustness studies on AI peer-review are overwhelmingly text-only. Moreover, the problem is distinct from standard jailbreaking, as a peer-review attack seeks to induce a domain-specific, targeted failure (e.g., "inflate this score") rather than a general safety policy violation, for which no practical defenses exist. To address this, we introduce PaperGuard, the first comprehensive benchmark designed to systematically evaluate and defend AI-generated peer-review against these domain-specific, cross-modal attacks. Our framework is built on three pillars: (1) a new multimodal peer-review dataset spanning multiple scientific domains; (2) a unified suite of attacks, including black-box prompt injections and white-box perturbations, specifically designed to target both text (GCG) and figures (PGD); and (3) a practical defense, motivated by the long-context challenge of academic papers, that uses chunk-based embedding search to efficiently localize and mitigate harmful instructions. Our extensive experiments, conducted across state-of-the-art models, confirm that AI reviewers are pervasively vulnerable. PaperGuard establishes the foundational benchmark, protocols, and actionable defense necessary to pioneer trustworthy, attack-resilient AI-assisted scholarly reviewing.

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

Beyond IGO-Flow: Toward Convergence Analysis of IGO in Continuous Spaces

arXiv:2606.17523v1 Announce Type: cross Abstract: Information-Geometric Optimization (IGO) provides a unified framework for black-box optimization by interpreting the adaptation of a search distribution as a natural gradient update. Despite its conceptual importance, the convergence theory of IGO remains limited: most existing results concern continuous-time idealizations such as the IGO flow, rather than discrete-time updates with non-infinitesimal learning rates. In this paper, we study discrete-time IGO in continuous spaces, formulated as natural gradient updates in the expectation-parameter coordinates of an exponential family. In particular, we analyze IGO over the multivariate Gaussian family on strongly convex quadratic objective functions. Our analysis covers a setting that simultaneously incorporates full covariance adaptation, a fixed positive learning rate, and quantile-based weights. In this setting, we prove that the covariance matrix converges to the zero matrix. We further show that the mean vector converges to the global optimum, provided that the condition number of the appropriately scaled covariance matrix is bounded at sufficiently frequent iterations. These results advance the convergence theory of IGO and help bridge the gap between the mathematical theory of IGO and practical covariance-adaptive search methods such as CMA-ES.

07.
medRxiv (Medicine) 2026-06-10

Prediction of immunotherapy response using live tumor fragments from routine clinical biopsies

Functional ex vivo assays using live tumor tissues have demonstrated strong predictive accuracy for response to immune checkpoint inhibitors (ICIs) but are not scalable, requiring manual processing of large resections collected at academic centers. Here, an ex vivo live tumor fragment (LTF) platform was developed using standard-of-care biopsies from 228 patients with suspected malignancy collected across prospective, multicenter observational trials and biobanks. Hierarchical clustering of ICI-mediated changes in cytokine production identified two groups: responders and nonresponders. A binary classifier (elive index) using 8 cytokines achieved an AUC of 0.99 for cluster prediction. elive index correctly predicted clinical benefit in 93% (26/28) of patients (P = 3.2x10-5) and accurately identified 83% (10/12) of objective responders. Critically, elive responders were identified among biomarker-negative patients, highlighting the platform as a scalable approach that complements existing companion diagnostics and expands the population of patients identified to benefit from ICI therapy.

08.
medRxiv (Medicine) 2026-06-22

Body composition subphenotypes, cardiometabolic risk and incident outcomes: validation in the population-based NAKO and UK Biobank imaging cohorts

Background Anthropometric measures do not adequately capture heterogeneity in body fat distribution and corresponding cardiometabolic risk, whereas magnetic resonance imaging (MRI) enables precise differentiation and quantification of adipose tissue compartments and ectopic fat. We aimed to validate previously derived MRI-based body composition subphenotypes and their cardiometabolic risk profiles in two independent European cohorts. Methods Using deep learning-based image analysis, we quantified bone marrow, visceral, subcutaneous, cardiac, renal sinus, hepatic, skeletal muscle, and pancreatic fat in the imaging substudies of two population-based cohorts: the German National Cohort (NAKO, N=29,314, age range 19-74 years) and the UK Biobank (N=36,109, age range 40-69 years). Body composition subphenotypes, previously identified by k-means clustering, were evaluated using a rigorous statistical cluster validation framework with method-based and results-based approaches. In NAKO, cross-sectional associations between subphenotypes and estimated cardiovascular disease risk scores were examined using linear regression. In UK Biobank, longitudinal associations between subphenotypes and incident cardiometabolic outcomes, ascertained through hospital record linkage, were analysed using Cox regression. Findings All five body composition subphenotypes were robustly validated across both cohorts, and showed distinct fat distribution patterns and cardiometabolic risk profiles: I "lean", II "average adiposity", III "bone and muscle adiposity", IV "hepato-abdominal adiposity", and V "general and pancreatic adiposity". Subphenotypes I-III showed progressive adipose tissue remodelling patterns likely reflecting ageing trajectories. The "hepato-abdominal adiposity" subphenotype showed highest risk of incident diabetes, whereas the "general and pancreatic adiposity" subphenotype showed highest overall cardiovascular disease burden and metabolic impairment. Interpretation MRI-derived body composition subphenotypes represent distinct fat distribution patterns that reflect ageing- and disease-related processes, which supports the potential of body composition phenotyping for improved cardiometabolic risk stratification and targeted prevention.

09.
arXiv (CS.CV) 2026-06-18

Cosmos 3: Omnimodal World Models for Physical AI

We introduce Cosmos 3, a family of omnimodal world models designed to jointly process and generate language, image, video, audio, and action sequences within a unified mixture-of-transformers architecture. By supporting highly flexible input-output configurations, Cosmos 3 seamlessly unifies critical modalities for Physical AI – effectively subsuming vision-language models, video generators, world simulators, and world-action models into a single framework. Our evaluation demonstrates that Cosmos 3 establishes a new state-of-the-art across a diverse suite of understanding and generation tasks, demonstrating omnimodal world models as scalable, general-purpose backbones for embodied agents. Our post-trained Cosmos 3 models were ranked as the best open-source Text-to-Image and Image-to-Video models by Artificial Analysis, and the best policy model by RoboArena at the time the technical report was written. To accelerate open research and deployment in Physical AI, we make our code, model checkpoints, curated synthetic datasets, and evaluation benchmark available under the Linux Foundation's OpenMDW-1.1 License at https://github.com/nvidia/cosmos and https://huggingface.co/collections/nvidia/cosmos3. The project website is available at https://research.nvidia.com/labs/cosmos-lab/cosmos3.

10.
arXiv (CS.CV) 2026-06-19

HEad and neCK TumOR (HECKTOR) 2025: Benchmark of Segmentation, Diagnosis, and Prognosis in Multimodal PET/CT

Head and neck cancers (HNC) represent a significant global health burden, with accurate tumor delineation being essential for effective radiotherapy planning. The complexity of the oropharyngeal anatomy, combined with the heterogeneous appearance of tumors on imaging, makes manual segmentation time-intensive and subject to inter-observer variability. Beyond segmentation, predicting long-term clinical outcomes, such as recurrence-free survival (RFS), and determining human papillomavirus (HPV) status from noninvasive imaging, remain challenging yet clinically valuable goals. The HECKTOR 2025 challenge addresses these needs by establishing a comprehensive benchmark for automated HNC analysis using multimodal PET/CT imaging and electronic health records. Building on previous editions (2020-2022), this challenge features an expanded multi-institutional dataset comprising over 1,100 patients from 10 centers worldwide. Participants were tasked with three complementary objectives: (1) segmenting primary gross tumor volumes (GTVp) and metastatic lymph nodes (GTVn), (2) predicting recurrence-free survival, and (3) classifying HPV status. The challenge attracted 35 registered teams, with 15 final submissions evaluated on a held-out test set. Top-performing algorithms achieved a mean Dice similarity coefficient of 0.75 for segmentation, a concordance index of 0.66 for survival prediction, and a balanced accuracy of 0.56 for HPV classification. This paper presents a comprehensive analysis of the submitted methodologies, evaluates their performance across different lesion characteristics, and discusses their implications for clinical translation in automated oncology workflows and decision support systems.

11.
arXiv (quant-ph) 2026-06-16

Dressed Floquet scars from protected zero modes in a Rydberg chain

arXiv:2606.15605v1 Announce Type: cross Abstract: In this Letter, we present an approximate analytic construction of two zero quasienergy quantum many-body scars in a periodically driven model of Rydberg atoms on a ring, which persist over a range of driving amplitudes and frequencies for finite sizes. An index theorem protects an exponentially large number (in system size) of exact zero energy modes of the Floquet Hamiltonian in this setting. Unlike most of these zero modes which continuously change with drive parameters, these two quantum many-body scars retain the memory of particular states. They can be expressed as {\it dressed versions} of two contrasting states, the Rydberg vacuum and a unitarily rotated variant of a volume-law scar [Ivanov and Motrunich, Phys. Rev. Lett. {\bf 134}, 050403 (2025)], respectively. We provide an analytic understanding of their existence using a Floquet perturbation theory and show their resilience beyond the perturbative regime using exact diagonalization in finite systems. Our study provides insight into the structure of protected zero modes in interacting Floquet settings.

12.
arXiv (CS.CL) 2026-06-24

RASC+: Retrieval-Constrained LLM Adjudication for Clinical Value Set Authoring

Clinical value sets define the standardized terminology codes used in quality measurement, phenotyping, cohort construction, and clinical decision support. The recently introduced Retrieval-Augmented Set Completion (RASC) benchmark showed that direct zero-shot large language model (LLM) generation is poorly suited to this task: clinical code systems are large, version-controlled, and not reliably memorized by language models. We study a stage-wise alternative in which candidate-pool construction is optimized for recall and a constrained LLM adjudicator is optimized for candidate selection. On the full 3,744-value-set RASC test split, Qwen3-based retrieval with vocabulary-aware expansion and code-display rescue retrieval increases candidate-pool recall from the original RASC retrieval baseline of 0.553 to 0.730; on the held-out-publisher stratum, pool recall is 0.655. The higher-recall pool alone is not sufficient: applying the original SAPBert cross-encoder to this expanded pool gives full-test macro F1 of 0.287 and held-out-publisher macro F1 of 0.233. Replacing the stage-2 selector with blinded GPT-5 adjudication over the same pool increases full-test macro F1 to 0.549 and held-out-publisher macro F1 to 0.533. These results show that retrieval-constrained LLM adjudication can substantially improve value set completion while preserving the safety constraint that all returned codes must come from an auditable candidate pool.

13.
arXiv (CS.CV) 2026-06-16

Domain-Guided Prompting of the Segment Anything Model for Seismic Interpretation: The Role of Attributes, Visualization, and Hybrid Prompts

The advent of large pretrained foundation models for computer vision has significantly improved the efficiency of visual data interpretation. The Segment Anything Model (SAM), in particular, offers powerful zero shot segmentation capabilities through prompt based interaction, thus making it a promising tool for seismic interpretation. However, most existing applications of SAM rely on fine tuning for specific geological targets, which requires extensive labeled data, incurs high computational cost, and often compromises the model's generalization capability. In this study, we introduce a principled framework for zero shot adaptation of foundation models to seismic data. The framework is built on two key components: (1) aligning seismic attributes and visualization choices (e.g., colormaps) with the geological target of interest, and (2) employing a hybrid prompting strategy that combines sparse user defined point prompts with dense mask prompts derived from SAM's internal feature activations. We systematically evaluate this framework across multiple geological targets, datasets, prompt configurations, and seismic attribute representations. Our results demonstrate that geologic target aware selection of seismic attributes and colormaps, combined with hybrid prompting, enhances the separability of geological features and improves boundary delineation and segmentation accuracy relative to point based prompting alone. Our findings show that, when these components are jointly applied, SAM can achieve competitive segmentation performance in a fully zero shot setting, thereby eliminating the need to retrain SAM for each geologic feature. This work establishes a practical and scalable pathway to leverage foundation models in seismic interpretation, reducing reliance on labeled data while preserving model generality.

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

Towards an Agent-First Web: Redesigning the Web for AI Agents

arXiv:2606.19116v1 Announce Type: new Abstract: The World Wide Web was built on an assumption held for three decades: the primary consumer of web content is a human being. This permeates every layer; its access model presumes human visitors, its economics rest on human attention, and its content targets human perception. The rapid emergence of AI agents as intermediaries between humans and web content invalidates this assumption. Yet the web resists agents through blanket blocking, CAPTCHA-based exclusion, and economic models that treat agent access as extraction rather than legitimate interaction. This paper proposes a principled redesign across three layers. At the access layer, agents acting for humans should inherit equivalent access rights, governed by rate limiting and agent identification metadata in HTTP requests, analogous to browser headers, alongside a dual-layer architecture serving human-readable and agent-optimized content from the same domain. At the economic layer, we propose an intent-based tier framework grounded in the agent-as-human-proxy principle: an agent's economic obligation mirrors that of the human it represents. A token-based subscription model meters content in tokens rather than pageviews, alongside a commissioned content economy anchoring AI content production in human intentionality. At the content layer, we identify epistemic recursion, the self-referential loop in which AI-generated content is consumed by agents to produce further content, progressively detaching web knowledge from human ground truth. We propose the Agent Text Markup Language (ATML), a four-level human supervision tier model, and a cryptographic provenance chain to counter this threat. Together these constitute ten design principles for an agent-first internet, one in which agents are first-class citizens whose integration requires renegotiating the web's foundational social contract across access, economics, and content.

15.
medRxiv (Medicine) 2026-06-10

Towards the Virtual Amyotrophic Lateral Sclerosis Patient: Inferring Cortical Excitability through Whole-Brain Dynamical Modeling

Amyotrophic lateral sclerosis (ALS) is increasingly recognized as a multisystem neurodegenerative disorder in which motor-neuron degeneration is accompanied by widespread alterations in cortical dynamics. Among its most reproducible neurophysiological signatures is cortical hyperexcitability, yet how this local excitability imbalance shapes distributed whole-brain activity remains poorly understood. Here, we combined source-reconstructed resting-state MEG data, tractography-informed whole-brain modeling, and simulation-based inference to investigate whether ALS-related alterations in large-scale brain dynamics can be mechanistically explained by changes in cortical excitability. First, we characterized empirical brain dynamics using complementary features spanning regional activity amplitude and variability, functional connectivity, and avalanche-based metrics. These analyses revealed significant alterations in ALS patients relative to healthy controls, as well as associations with clinical impairment and disease staging. To mechanistically interpret these changes, we employed a reduced Wong-Wang whole-brain model in which local recurrent excitation modulates emergent large-scale neural dynamics. Simulations showed that increasing excitability systematically reproduced the empirical dynamical signatures observed in ALS. We then applied a simulation-based inference framework to estimate latent excitability parameters directly from empirical observations. Whole-brain model inversion revealed increased excitability in ALS patients compared with controls. The recovered excitability parameter was associated with disease staging, supporting its clinical relevance as a model-derived descriptor of ALS progression. Finally, by extending the model to estimate frontal and non-frontal excitability separately, we found that ALS-related alterations were predominantly associated with increased frontal excitability, whereas non-frontal regions appeared comparatively less affected. The recovered parameters related to disease staging. Together, these findings provide a mechanistic framework linking altered large-scale brain dynamics in ALS to selective cortical hyperexcitability, explaining how local excitability changes can give rise to global network reorganization. More broadly, they show how computational model inversion can recover latent multiscale pathophysiological processes from empirical neural recordings, offering a non-perturbative alternative to complex experimental paradigms typically required to causally probe local-to-global mechanisms.

16.
medRxiv (Medicine) 2026-06-18

Antimicrobial-resistant E. coli in human, animal and environmental reservoirs in rural Bangladeshi households with young children

In low-income countries, ESBL-producing Escherichia coli (ESBL-EC) is frequently detected in humans, animals and household environments, indicating widespread exposure to antimicrobial resistance (AMR). Established risk factors such as antibiotic use do not explain the high community carriage of AMR in all settings; identifying the dominant exposure pathways can inform interventions against AMR. We aimed to investigate (i) animal-human-environment sharing of AMR by assessing associations between the abundance of ESBL-EC in the household environment, domestic animal feces and young children's stool and (ii) household factors associated with ESBL-EC abundance in these reservoirs. We enrolled 112 households from the CRADLE trial in rural Bangladesh. We enumerated ESBL-EC in drinking water, food, child hand rinses, outdoor soil, indoor floor swabs, chicken and cow feces, and stool from children aged 6 months. We recorded indicators of sanitation, animal ownership/management, human and animal antibiotic use, and child exposure behaviors using structured questionnaires and spot checks. The highest prevalence of ESBL-EC was in child stool (95.6%) and animal feces (82.3-96.9%), followed by soil (48.2%) and floors (36.6%); < 10% of food, child hands and drinking water harbored ESBL-EC. The abundance of ESBL-EC in child stool was not associated with its abundance in any sampled matrix; the abundance in chicken but not cow feces showed positive correlations with soil, floors, child hands, and drinking water (correlation coefficients: 0.19-0.39, p-values < 0.05). Higher-quality latrines (improved, pour-flush, with slab) were associated with lower ESBL-EC abundance across matrices; unsafe animal management (animals roaming or spending the night inside the home) was associated with higher abundance. Child antibiotic use and exposure behaviors (soil ingestion, time spent on floor) were not associated with ESBL-EC abundance in child stool. We observed high AMR colonization among young children and domestic animals in rural Bangladesh not explained by traditional fecal-oral exposure pathways. Future studies should explore additional pathways and assess whether sanitation and animal management improvements can reduce AMR.

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

Reading between the Lines: Leveraging Large Language Models for Global Dementia and Depression Assessment from Clinical Interviews

Dementia and depression are the most prevalent neuropsychiatric disorders in geriatric populations, and their overlapping symptoms pose major challenges for differential diagnosis. In this study, we investigate open-weights Large Language Models (LLMs) for predicting dementia and depression severity from speech samples collected during standardized history taking interviews with 154 German-speaking subjects. We introduce an observer-based Global Depression Scale (GDS-D) aligned with the established Global Deterioration Scale (GDS), enabling parallel global staging of affective and cognitive symptoms. We compare three LLMs (Mistral 3.1, DeepHermes, Qwen3) in two settings: (1) zero-shot prediction and (2) LLM-based feature extraction for Support Vector Regression, using human and pause-enriched transcripts. Results show that LLMs effectively predict depression severity in zero-shot settings (best MAE of 0.60), while dementia assessment benefits substantially from structured feature extraction (best MAE of 0.78), reducing errors by up to 35% over zero-shot baselines. Pause-enriched transcripts achieve competitive performance with human transcriptions, demonstrating the viability of fully automatic screening pipelines for differential neuropsychiatric assessment.

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

Dango: A Strictly L1-Only Large Language Model for Studying Second Language Acquisition

We introduce Dango, a 1.8B-parameter large language model designed for controlled studies of L1-to-L2 (Japanese-to-English) transfer in second language acquisition (SLA). While previous studies have explored SLA in language models, they have predominantly relied on smaller or non-decoder models, limiting their ability to generate open-ended text and reducing their suitability as practical L2 simulators. We identify a key challenge when scaling models to this size: L2 contamination within the "monolingual" pretraining corpus used for L1 acquisition. To address this, we propose a filtering method to reduce premature exposure to English while preserving realistic, minimal exposure. We then fine-tune the model on LLM-generated L2-learning lessons to simulate the L2 acquisition process. Our evaluations confirm that Dango develops human-like L2 production patterns, outperforming both unfiltered and standard multilingual baselines. We release the model, data, and code to facilitate reproducible computational SLA research and learner-facing applications.

19.
arXiv (CS.AI) 2026-06-16

Understanding Diversity Collapse in RLVR via the Lens of Overtraining

arXiv:2606.15455v1 Announce Type: cross Abstract: Reinforcement learning with verifiable rewards (RLVR) has become a key approach for enhancing the reasoning abilities of large language models. However, RLVR often suffers from diversity collapse: Pass@$1$ improves while high-$k$ Pass@$k$ degrades, which is viewed as a narrowing of the model's reasoning boundary. We formalize this diversity collapse through the lens of overtraining: once a problem's contribution to the reference metric has effectively saturated, further updates no longer expand what the model can solve but still concentrate probability mass on the trajectories favored by on-policy sampling. Under a standard setup with few rollouts per problem, even a single observed success places a problem in a nearly saturated regime for high-$k$ Pass@$k$, so most updates in standard RLVR are overtraining from the boundary perspective. This perspective also suggests a reading of whether RLVR can expand the model's reasoning abilities beyond the base model: since RLVR is structurally biased against high-$k$ Pass@$k$, its aggregate decline does not by itself mean that no new reasoning gains occurred. Interventionally, restricting updates to problems with zero observed success lifts Pass@$256$ above the base model on difficult benchmarks; observationally, a non-trivial fraction of initially unsolvable problems become solvable during standard RLVR training. Building on these findings, we propose Bayesian Boundary Gating (BBG), which redirects optimization away from overtraining by estimating each problem's marginal contribution to the reasoning boundary. Across multiple reasoning benchmarks, BBG improves average Pass@$k$ across a wide range of $k$.

20.
arXiv (CS.AI) 2026-06-24

A global log for medical AI

arXiv:2510.04033v2 Announce Type: replace Abstract: Modern computer systems rely on syslog, a universal protocol that records critical events across heterogeneous infrastructure. Medicine's rapidly growing AI stack has no equivalent. As medicine deploys AI tools at scale, there is no standard way to record how, when, by whom, and for whom these models are used. Without such records, it is difficult to measure real-world performance and outcomes, detect adverse events, or identify bias and dataset drift. Here we introduce MedLog, a protocol for event-level logging of medical AI. Each time an AI model interacts with a human, another algorithm, or an automated workflow, MedLog creates a record. Each record contains nine core fields: header, model, user, target, inputs, artifacts, outputs, outcomes, and feedback. We apply MedLog across four deployments in the US, Switzerland, and Vietnam: ICU deterioration prediction, tetanus progression monitoring from wearable signals, automated sepsis quality reporting, and patient attendance prediction. MedLog records capture model behavior, workflow interactions, and downstream outcomes, including AI performance degradation during severe weather events in patient attendance prediction and increased laboratory testing after ICU deterioration alerts. MedLog limits the data footprint through risk-based sampling, lifecycle-aware retention policies, and write-behind caching, enabling deployment in low-resource settings. It also supports detailed traces for complex, agentic, or multi-stage workflows, creating a foundation for continuous monitoring, auditing, and improvement of medical AI.

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

Physics-Guided Spatiotemporal Learning for Coastal Wave Peak Period Estimation from Video

arXiv:2606.13302v1 Announce Type: new Abstract: Wave parameters in the nearshore are crucial for coastal engineering, shoreline protection, marine hazard assessment, and coastal management for climate resilience. Traditional monitoring systems like buoys and radar platforms offer accurate monitoring but can have high installation and maintenance expenses and limited spatial coverage. Passive ocean monitoring using video has been achieved by leveraging deep learning, however, many methods are not physically interpretable, feasible, and validated for oceanography. In thiswork, a Physics-Guided Deep Spatiotemporal Learning Framework for direct estimation of nearshore wave peak periods from passive coastal video stream is proposed. The framework combines automated temporal-variance based region-of-interest detection, multi-stage Sim-to-Real transfer learning, and physics-informed regularization to enhance the predictive accuracy and physical consistency. A variety of spatiotemporal architectures were assessed, such as transformer-based and recurrent-convolutional ones, alongside synthetic pretraining,silver-label adaptation, and expert fine-tuning. The results show that transformer-based architectures outperformed in terms of the accuracy of the instantaneous prediction, while lightweight recurrent-convolutional architectures achieved higher temporal stability and operational oceanographic skill. Ablation studies also demonstrated the benefits of physics-guided regularization in terms of trend-following consistency, and physically implausible predictions. Explainability auditing also helped to focus attention in hydrodynamically active surf-zone regions and showed good agreement with the physically derived wave propagation behavior. In general, the proposed framework shows the promise of physics-guided video-based deep learning systems for long-term coastal wave monitoring that are cost-efficient and operationally feasible.

22.
arXiv (CS.CL) 2026-06-24

PETRA: Transforming Web Text for Petroleum-Engineering Domain Adaptation

Petroleum-engineering search exposes a supervision gap for strong general retrievers: relevant evidence exists in public web text, but domain relevance labels are scarce. To address this gap, we propose PETRA, a large-scale Petroleum Engineering Text for Retrieval Adaptation dataset and pipeline that converts noisy public web data into a curated domain corpus and synthetic supervision for dense retrieval and reranking. PETRA contains 1.36M curated chunks, approximately 2B token equivalents, $\approx$859k, embedding training rows from $\approx$224k anchors, and roughly 400k teacher-scored reranker candidate rows. Its construction combines high-recall energy-domain curation, an energy-domain classifier with 98.4% test accuracy, chunk-grounded query generation, LLM-written hard negatives, and retrieval-mined candidate lists. PETRA improves first-stage in-domain Normalized Discounted Cumulative Gain (nDCG) from 0.703 to 0.763 through score fusion. Reranker adaptation improves the public Earth Science benchmark by 44% relative and a six-task reasoning-intensive panel by 23%. Failed training recipes show that high train-holdout accuracy on synthetic labels does not predict retrieval gains; retrieval-mined data helps only after being repackaged as teacher-scored candidate lists sampled from the inference-time candidate distribution.

23.
arXiv (CS.CV) 2026-06-16

Human Cognition in Machines: A Unified Perspective of World Models

This report of world models distinguishes prior works by the cognitive functions they innovate. Many works claim an almost human-like cognitive capability in their world models. To evaluate these claims requires a proper grounding in first principles from human and machine cognition theory. In moving towards human-like world models we present a conceptual unified framework for world models that fully incorporates all the cognitive functions (i.e., memory, perception, language, reasoning, imagining, motivation, and metacognition) and identify gaps in existing research as a guide for future states of the art. In particular, we find that motivation (especially intrinsic motivation) and metacognition remain drastically under-researched, and we propose concrete directions to address these gaps informed by active inference and global workspace theory. We also introduce epistemic world models, a new category encompassing agent frameworks for scientific discovery that operate over structured knowledge. Our taxonomy, applied to video, embodied, and epistemic world models, suggests research directions where prior taxonomies have not.

24.
arXiv (CS.AI) 2026-06-25

Neglected Free Lunch from Post-training: Progress Advantage for LLM Agents

arXiv:2606.26080v1 Announce Type: cross Abstract: Process reward models enable fine-grained, step-level evaluation of LLMs, yet building them for agentic settings remains prohibitively difficult: long-horizon interactions, irreversible actions, and stochastic environment feedback make both human annotation and Monte Carlo estimation infeasible at scale. In this work, we show that reinforcement learning (RL) post-training already provides the ingredients for effective step-level scoring, eliminating the need for dedicated reward model training altogether. Concretely, we derive an implicit advantage under a general stochastic Markov decision process, which we term progress advantage – log-probability ratio between the RL-trained policy and its reference policy exactly recovers the optimal advantage function. This formulation makes the resulting signal annotation-free, domain-agnostic, and available as a byproduct of the standard RL post-training pipeline. We validate the effectiveness of the progress advantage across three different applications: test-time scaling, uncertainty quantification, and failure attribution on five benchmarks and four model families. Across all settings, it consistently outperforms confidence-based baselines and, despite requiring no task-specific training, surpasses dedicated trained reward models. We complement these results with deeper analyses on characteristics of progress advantage, offering practical guidance for adoption in real-world agentic systems.

25.
arXiv (CS.AI) 2026-06-17

Querying an astronomical database using large language models: the ALeRCE text-to-SQL system

arXiv:2606.18108v1 Announce Type: cross Abstract: We develop a text-to-SQL (structured query language) system based on large language models (LLMs) using in-context learning and apply it to the Automatic Learning for the Rapid Classification of Events (ALeRCE) astronomical database. ALeRCE is a community broker for the Zwicky Transient Facility and the Vera C. Rubin Observatory. The system enables users to query the database in natural language (NL) and generates executable SQL queries. To develop and evaluate the system, we constructed a dataset of 110 NL/SQL pairs. We propose a step-by-step generation framework comprising four modules: schema linking, query classification, prompt decomposition, and self-correction. The performance of thirteen LLMs is evaluated using in-context learning and prompt engineering techniques. Text-to-SQL performance is assessed using the perfect-match (PM) rate for row identifiers (e.g., object identifiers) and column identifiers (i.e., column names). The proposed step-by-step framework consistently outperforms a direct-inference baseline, while the self-correction module consistently reduces execution errors. For Claude Opus 4.6, PM performance on row (column) identifiers is high for simple queries, reaching 0.97 (0.94), and decreases with query complexity to 0.44 (0.72) for medium queries and 0.59 (0.49) for hard queries. Among the thirteen evaluated models, the best-performing LLMs for the text-to-SQL task are Claude Opus 4.6, Gemini 2.5 Pro, Gemini 3 Flash, and GPT-5.2-Codex.