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02.
Nature Medicine 2026-06-15

Adaptive deep brain stimulation for dynamic gait control in Parkinson’s disease: a randomized feasibility trial

Authors:
Kenneth H. Louie↗

A randomized crossover study of five patients with Parkinson’s disease (PD) demonstrates that gait-synchronized adaptive deep brain stimulation is feasible and safe, and reduces falls compared with continuous stimulation. Gait dysfunction in PD is a major source of disability and is often insufficiently treated by continuous deep brain stimulation (cDBS). Although adaptive DBS (aDBS) has shown efficacy for other motor symptoms using β-based, state-driven neural signals, gait is a dynamic, cyclical behavior that may require temporally precise modulation. Here we evaluated a behavior-contingent aDBS approach that synchronizes stimulation to gait phase. We reported a single-center, blinded, randomized, crossover study evaluating the feasibility of identifying patient-specific biomarkers to drive aDBS. The primary outcome was feasibility of successful identification of gait-phase biomarkers to implement aDBS. Five participants with PD undergoing pallidal DBS and subdural electrode paddle implantation were enrolled. We successfully identified personalized gait-phase biomarkers from cortical or pallidal field potentials in all five patients and embedded them into a bidirectional neurostimulator. During acute in-clinic testing, aDBS improved step variability and step symmetry versus cDBS. Three participants subsequently completed a double-blinded, multi-day crossover phase. In this setting, aDBS maintained general motor symptom control, reduced falls and yielded patient-specific gait improvements. No adverse events occurred and aDBS was well tolerated. These findings establish the feasibility of biomarker-driven, movement-synchronized neuromodulation and support the development of a larger randomized trial to determine clinical efficacy. ClinicalTrial.gov registration: NCT04675398 . A randomized crossover study shows that gait-phase-synchronized adaptive deep brain stimulation is feasible and safe, and reduces falls compared to continuous stimulation in Parkinson’s disease.

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03.
arXiv (CS.AI) 2026-06-19

TerraMind: Large-Scale Generative Multimodality for Earth Observation

Authors:
Johannes Jakubik↗Felix Yang↗Benedikt Blumenstiel↗Erik Scheurer↗Rocco Sedona↗Stefano Maurogiovanni↗Jente Bosmans↗Nikolaos Dionelis↗Valerio Marsocci↗Niklas Kopp↗Rahul Ramachandran↗Paolo Fraccaro↗…

arXiv:2504.11171v5 Announce Type: replace-cross Abstract: We present TerraMind, the first any-to-any generative, multimodal foundation model for Earth observation (EO). Unlike other multimodal models, TerraMind is pretrained on dual-scale representations combining both token-level and pixel-level data across modalities. On a token level, TerraMind encodes high-level contextual information to learn cross-modal relationships, while on a pixel level, TerraMind leverages fine-grained representations to capture critical spatial nuances. We pretrained TerraMind on nine geospatial modalities of a global, large-scale dataset. In this paper, we demonstrate that (i) TerraMind's dual-scale early fusion approach unlocks a range of zero-shot and few-shot applications for Earth observation, (ii) TerraMind introduces "Thinking-in-Modalities" (TiM) – the capability of generating additional artificial data during finetuning and inference to improve the model output – and (iii) TerraMind achieves beyond state-of-the-art performance in community-standard benchmarks for EO like PANGAEA. The pretraining dataset, the model weights, and our code are open-sourced under a permissive license.

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04.
arXiv (quant-ph) 2026-06-19

A Quantum Encoding of Traveling Salesperson Tours via Route Generation, Cost Phases, and a Reversible Valid-Permutation Oracle

Authors:
Alexander Johannes Stasik↗Franz Georg Fuchs↗

arXiv:2603.21283v3 Announce Type: replace Abstract: For a traveling salesperson problem (TSP) of n cities, we present a compact quantum encoding based on a time-register representation of tours. A candidate route is represented as a sequence of n-1 city labels over discrete time steps, with one fixed start city and the remaining cities encoded in binary registers. We describe three ingredients of the construction: uniform route generation over the route register, a reversible validity oracle, and a phase oracle that encodes the total tour cost. The validity oracle checks both that the non-start city labels form a permutation and, for incomplete graphs, that every directed edge used by the route exists. The cost oracle then accumulates the start-edge, intermediate-transition, and return-edge costs into a tour-dependent phase for valid routes. This yields a coherent superposition of candidate routes with feasibility and tour-length information embedded directly in the quantum state. The complete construction uses O(n log n) qubits, while a naive implementation has worst-case elementary-gate complexity O(n^3 log n). The encoding is compatible with amplitude amplification or spectral filtering techniques such as the quantum singular value transform (QSVT) or Grover's algorithm. However, due to the exponentially small fraction of valid tours, the overall complexity remains exponential even when combined with amplitude amplification.

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05.
arXiv (CS.AI) 2026-06-11

The Art of Interrogation: Consistency Amplifies Factuality in Spatial Reasoning

Authors:
Theo Uscidda↗Marta Tintore Gazulla↗Maks Ovsjanikov↗Federico Tombari↗Leonidas Guibas↗

arXiv:2606.11918v1 Announce Type: new Abstract: Current Large Reasoning Models (LRMs) exhibit remarkable general capabilities but significantly underperform in spatial reasoning tasks. Existing approaches treat this gap as a knowledge deficit, relying on supervised fine-tuning (SFT) to ingest labeled spatial data from external vision sources or synthetic engines. In contrast, we argue that for many tasks, spatial reasoning capabilities are already present in pre-trained LRMs but require alignment through logical coherence under geometric 2D and 3D constraints. In this work, we propose a self-supervised reinforcement learning (RL) framework that targets the internal reasoning process without requiring ground-truth annotations. By formalizing the notion of consistency verifiers – reward functions that check for geometric and semantic consistency under transformations – we demonstrate that models can improve their spatial reasoning abilities. We use both image transformations, like flipping, and textual transformations, like swapping the order of objects in the question, and propose a new optimal transport-based RL strategy, OT-GRPO, which is a minimal-matching variant of group relative policy optimization tailored to pairwise verifiers. We show that this label-free consistency training approaches the accuracy of models trained with ground-truth supervision and achieves similar generalization across diverse tasks and data domains.

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

Distribution Alignment for One-Shot Federated Learning via Optimal Transport

Authors:
Daniele Berardini↗Vito Paolo Pastore↗Vittorio Murino↗

arXiv:2606.16655v1 Announce Type: new Abstract: One-Shot Federated Learning (OSFL) addresses extreme communication regimes in which clients interact with the server only once, amplifying the impact of heterogeneous client data distributions. In particular, the interaction of domain shift and label shift across clients induces misaligned feature representations that cannot be corrected through iterative optimization. Existing OSFL methods rely on distillation, server-side generation or ensemble-based aggregation, but assume aligned representations or address domain and label shift separately. We introduce SLOT-Align (Single-round, Learning-free Optimal Transport Alignment), a geometry-aware feature harmonization framework for OSFL. SLOT-Align uses a shared frozen encoder to extract compact feature statistics, constructs a global reference via Bures-Wasserstein barycenters, and aligns local representations using closed-form geodesic optimal transport maps. The method is computationally efficient and can be combined with existing OSFL pipelines relying on frozen encoders without modifying their training procedures. Extensive experiments across multiple benchmarks, pretrained backbones, and OSFL methods show that SLOT-Align consistently improves accuracy and robustness under joint domain and label shift.

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

An Open-Source Monitoring Framework for Data Exploration and Progress Tracking in Multi-Center Radiology Studies

Authors:
Markus Bujotzek↗Jonas Scherer↗Stefan Denner↗Peter Neher↗Benjamin Hamm↗Lorenz Feineis↗Uenal Akuenal↗Andreas Bucher↗Tobias Penzkofer↗Klaus Maier-Hein↗

Multi-center studies are crucial for advancing medical and radiological research. Data exploration, collaboration discovery, and study progress monitoring are essential for maximizing their potential. However, in practice these processes often rely on manual communication and shared tables, which quickly become outdated and hinder efficient coordination in large distributed studies. This highlights the need for dedicated monitoring solutions that provide transparent and up-to-date insights into study progress. We propose a lightweight, open-source monitoring architecture for multi-center studies based on the widely used Grafana-Prometheus stack. The framework collects aggregated monitoring metrics from distributed study sites and visualizes them through configurable dashboards. As a real-world deployment example, the framework is integrated into the medical imaging platform Kaapana and evaluated within a large multi-center research network. By deploying our solution within the Germany-wide RACOON consortium, we demonstrate its ability to enable privacy-preserving data exploration and study progress monitoring across all 38 German university clinics. The monitoring framework supports transparent coordination of distributed research activities and can facilitate more efficient management of large-scale multi-center studies. The source code and Kaapana integration are publicly available at https://github.com/MIC-DKFZ/study-monitoring-kaapana.

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08.
arXiv (CS.LG) 2026-06-25

A Geometry-Aware Efficient Algorithm for Compositional Entropic Risk Minimization

Authors:
Xiyuan Wei↗Linli Zhou↗Bokun Wang↗Chih-Jen Lin↗Tianbao Yang↗

arXiv:2602.02877v2 Announce Type: replace Abstract: This paper studies optimization for a family of problems termed $compositional entropic risk minimization$, in which each data's loss is formulated as a Log-Expectation-Exponential (Log-E-Exp) function. The Log-E-Exp formulation serves as an abstraction of the Log-Sum-Exponential (LogSumExp) function when the explicit summation inside the logarithm is taken over a gigantic number of items and is therefore expensive to evaluate. While entropic risk objectives of this form arise in many machine learning problems, existing optimization algorithms suffer from several fundamental limitations including non-convergence, numerical instability, and slow convergence rates. To address these limitations, we propose a geometry-aware stochastic algorithm, termed $SCENT$, for the dual formulation of entropic risk minimization cast as a min–min optimization problem. The key to our design is a $stochastic proximal mirror descent (SPMD)$ update for the dual variable, equipped with a Bregman divergence induced by a negative exponential function that faithfully captures the geometry of the objective. Our main contributions are threefold: (i) we establish an $O(1/\sqrt{T})$ convergence rate of the proposed SCENT algorithm for convex problems; (ii) we theoretically characterize the advantages of SPMD over standard SGD update for optimizing the dual variable; and (iii) we demonstrate the empirical effectiveness of SCENT on extreme classification, partial AUC maximization, contrastive learning and distributionally robust optimization, where it consistently outperforms existing baselines. Code is available at https://github.com/Optimization-AI/SCENT.

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09.
arXiv (CS.CL) 2026-06-17

Structural Role Injection in Handlebars-Templated LLM Prompts: Triple-Brace Interpolation, Delimiter Family, and the Limits of HTML Auto-Escaping

Authors:
Mohammadreza Rashidi↗

Large language model applications build prompts from templates, and Handlebars is a widely used templating engine and the default prompt-template format in Microsoft Semantic Kernel. Its double-brace {{x}} expression HTML-escapes the interpolated value and is documented as the safe default; its triple-brace {{{x}}} expression inserts the value raw. We show that this choice silently governs an application's exposure to structural role injection, where attacker-controlled data carries chat role delimiters that forge a higher-privilege turn. A model-free analysis establishes the mechanism: Handlebars escaping rewrites angle brackets but not square brackets, colons, or Markdown hashes, so it neutralises ChatML, Llama-3, and XML role delimiters (survival rate 0.00) while leaving Llama-2 [INST], legacy Human:/Assistant:, and Markdown ### delimiters intact (survival rate 1.00 for the last two). We then run 5760 trials across seven delimiter families, two attack objectives, and four models (GPT-3.5 Turbo, GPT-4o mini, GPT-4.1 mini, Claude Haiku 4.5) at a combined API cost of 1.63 USD. GPT-3.5 Turbo follows the task-hijack instruction in 97% of raw and 91% of escaped trials, with the escaping protection concentrated in the angle-bracket families and absent for the colon- and Markdown-based families; the harder secret-exfiltration objective, which does not saturate, exposes the same family interaction more cleanly. Claude Haiku 4.5 resists both objectives almost entirely. The escaped default protects only the delimiter schemes whose characters HTML escaping happens to cover, gives no protection for the rest, and cannot substitute for a structural separation of instruction and data.

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10.
arXiv (CS.AI) 2026-06-25

Internal Data Repetition Destroys Language Models

Authors:
Jessica Chudnovsky↗Joshua Kazdan↗Noam Levi↗Rylan Schaeffer↗Yegor Denisov-Blanch↗Bo He↗Mehmet Donmez↗Sanmi Koyejo↗David Donoho↗

arXiv:2606.24998v1 Announce Type: cross Abstract: Language models are running out of high-quality training data, and even aggressively deduplicated corpora retain some amount of repetition. Earlier controlled studies predated Chinchilla-style scaling laws and could only measure the cost of repetition indirectly. We revisit repetition in the Chinchilla era, using a fitted no-repetition scaling law to report Compute-Equivalent Gain and Compute-Equivalent Loss. We show that under this modernized paradigm, repetition damage is systematic in three ways. First, holding compute allocated to repeated data constant, eval loss peaks at an intermediate repeat count $\Rep$; repeating a moderately sized subset a moderate number of times damages performance more than repeating a large subset a few times or a small subset many times. Second, the location of this peak is well-fit by a power law in model size; this scaling law reveals that the most damaging number of repeated data grows more quickly than compute. Finally, when repeated documents consume 10\% of the FLOPs budget in a controlled exact-document repetition setting, the compute-equivalent loss can be large: on FineWeb-Edu-Dedup, the most damaging repeat count for a Qwen3-style 344M-parameter model at $\operatorname{OT}=1$ matches the loss of a no-repetition run using 67% of the FLOPs. We demonstrate that these phenomena are not language-model-specific, and can be analytically understood in a simple statistical model: a misspecified linear regression with verbatim duplicates reproduces the same qualitative loss peak, quantifying how such peaks can arise from a statistical tradeoff between memorization and generalization. Our findings add precision to the study of duplication in language models, allowing practitioners to quantify the wasted compute incurred by the presence and repeat structure of duplicates in pretraining corpora.

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

Learning on a Razor's Edge: Identifiability and Singularity of Polynomial Neural Networks

Authors:
Vahid Shahverdi↗Giovanni Luca Marchetti↗Kathl\'en Kohn↗

arXiv:2505.11846v3 Announce Type: replace Abstract: We study function spaces parametrized by neural networks, referred to as neuromanifolds. Specifically, we focus on deep Multi-Layer Perceptrons (MLPs) and Convolutional Neural Networks (CNNs) with an activation function that is a sufficiently generic polynomial. First, we address the identifiability problem, showing that, for almost all functions in the neuromanifold of an MLP, there exist only finitely many parameter choices yielding that function. For CNNs, the parametrization is generically one-to-one. As a consequence, we compute the dimension of the neuromanifold. Second, we describe singular points of neuromanifolds. We characterize singularities completely for CNNs, and partially for MLPs. In both cases, they arise from sparse subnetworks. For MLPs, we prove that these singularities often correspond to critical points of the mean-squared error loss, which does not hold for CNNs. This provides a geometric explanation of the sparsity bias of MLPs. All of our results leverage tools from algebraic geometry.

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

Grad Detect: Gradient-Based Hallucination Detection in LLMs

Authors:
Anand Kamat↗Daniel Blake↗Brent M. Werness↗

arXiv:2606.24790v1 Announce Type: cross Abstract: Large Language Models (LLMs) have demonstrated remarkable capabilities across diverse tasks, yet they remain prone to generating hallucinations. Detecting these hallucinations is critical for deploying LLMs reliably in high-stakes applications. We present Grad Detect, a gradient-based approach for predicting hallucinations by analyzing layer-wise gradient patterns from a single forward-backward pass during inference. Our method shows that the internal gradient structure of a model carries rich information about the correctness of its output. This information is not accessible through output-level signals alone. We evaluate Grad Detect on several Q&A benchmarks across both hallucination detection and model abstention prediction, where it consistently outperforms confidence-based and sampling-based baselines. Through comprehensive layer ablation studies across all eleven models from four architectural families, we find that the final five layers concentrate over 97% of the discriminative gradient signal, enabling efficient deployment with minimal performance loss. Grad Detect provides a unified framework for predicting multiple dimensions of LLM reliability, offering strong predictive performance alongside interpretable insights into where and how model failures originate.

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13.
arXiv (CS.AI) 2026-06-18

X+Slides: Benchmarking Audience-Conditioned Slide Generation

Authors:
Haodong Chen↗Xuanhe Zhou↗Wei Zhou↗Xinyue Shao↗Yanbing Zhu↗Bo Wang↗Jiawei Hong↗Anya Jia↗Fan Wu↗

arXiv:2606.19256v1 Announce Type: new Abstract: Automatically generating slide decks from source documents is an important application of large language models (LLMs). Existing benchmarks primarily assess slide completeness and technical depth, while overlooking the target audience as a critical real-world factor. For instance, specialists demand rigorous proofs, whereas decision-makers prioritize actionable conclusions. To bridge this gap, we introduce X+Slides, a benchmark specifically designed for audience-conditioned slide generation. Built on a diverse corpus spanning 113 topics and seven presentation scenes, X+Slides employs a dynamic evaluation framework constructed from 8,133 deduplicated, source-grounded probes. By assigning audience-specific utility weights to the same source-grounded probes, X+Slides reports four complementary metrics: Audience Coverage measures how much audience-essential information is conveyed, Domain-wise Coverage shows which information types are covered, Efficiency measures delivered utility per unit of attention cost, and Correctness verifies whether slide claims are supported by the source. Experiments on DeepPresenter, SlideTailor, and NotebookLM show that current systems can recover a substantial but still incomplete part of audience-essential information: at $\tau_A=0.7$, DeepPresenter reaches a best Audience Coverage of 0.714, SlideTailor reaches 0.594, and the NotebookLM ablation reaches 0.853 while showing clear grounding differences. These results indicate that visual quality and broad topic coverage should not be treated as evidence support without source-grounded evaluation.

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14.
arXiv (CS.AI) 2026-06-19

FAPO: Fully Autonomous Prompt Optimization of Multi-Step LLM Pipelines

Authors:
Paul Kassianik↗Baturay Saglam↗Huaibo Zhao↗Blaine Nelson↗Supriti Vijay↗Aman Priyanshu↗Amin Karbasi↗

arXiv:2606.19605v1 Announce Type: cross Abstract: Multi-step LLM pipelines fail through interactions among retrieval, reasoning, and formatting steps, so prompt-only optimization can miss bottlenecks in the chain. We present FAPO (Fully Autonomous Prompt Optimization), a framework that lets Claude Code optimize an LLM pipeline inside a standardized codebase. FAPO evaluates a pipeline, inspects intermediate steps, diagnoses failures, proposes scoped changes, and validates variants repeatedly to optimize against a score function. It first tries prompt edits and, only when prompt optimization appears insufficient, changes chain structure within the permitted scope when attribution identifies a structural bottleneck. Across six benchmarks and three task models, FAPO beats the baseline GEPA in 15 of 18 model-benchmark comparisons. In 11 model-benchmark comparisons, FAPO wins with non-overlapping mean $\pm$ trial-standard-deviation ranges, and the mean FAPO-GEPA gain is +14.1 pp. In the six HoVer and IFBench comparisons where prompt-first search escalated to structural changes, FAPO wins all six with a mean gain of +33.8 pp. FAPO also improves performance on security tasks: on CTIBench-RCM, a security CVE-to-CWE task, prompt-only FAPO lifts test accuracy by +4.0 pp on GPT-5, +7.1 pp on Foundation-Sec-8B-Instruct, and +2.0 pp on Foundation-Sec-8B-Reasoning. These results position FAPO as a state-of-the-art pipeline optimization technique for both general-purpose and security-focused tasks.

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15.
arXiv (CS.CL) 2026-06-24

Selective Capability Unlearning in End-to-End Spoken Language Understanding

Authors:
Akanksha Singh↗Vinod Kumar Kurmi↗

Modern spoken language understanding (SLU) systems are increasingly deployed in real-world settings, where specific functionalities may need to be removed due to policy or safety constraints. In SLU, a functionality corresponds to an intent and its associated slot-generation behavior. However, in autoregressive models, suppressing a target intent does not eliminate the conditional mapping that generates slots conditioned on that intent. When the intent prefix is externally supplied, the model can reconstruct the original intent-slot structure. We identify this structural failure as capability persistence. We propose \underline{Binding \underline{S}ubspace (BSU)}, a representation-level framework that isolates and attenuates intent-conditioned directions underlying this mapping. Across SLU benchmarks, BSU substantially reduces forced-prefix recoverability while preserving retained performance.

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16.
arXiv (CS.AI) 2026-06-17

L-Proto: Language-Aware Episodic Prototypical Training for Multilingual Speaker Verification

Authors:
Hyung-Seok Oh↗Deok-Hyeon Cho↗Seung-Bin Kim↗Seong-Whan Lee↗

arXiv:2606.17416v1 Announce Type: cross Abstract: Multilingual speaker verification remains challenging because language-dependent acoustic variability causes speaker identity to become entangled with linguistic characteristics, degrading generalization across languages. In multilingual training, embeddings often encode language cues with speaker identity, causing speakers to form language-specific clusters. We propose L-Proto, a language-aware episodic prototypical training strategy that constructs language-consistent episodes. By sampling speakers from a single language per episode, L-Proto reduces language-driven variation during training and encourages embeddings to focus more directly on speaker identity. Experiments on the TidyVoice Challenge benchmark demonstrate consistent performance improvements over conventional fine-tuning and random episodic sampling across multiple backbone architectures.

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

FP8 is All You Need (Part 2): Efficient Ozaki-Bailey Style FFT Through Tensor-core Garner Reformulation and Kulisch Escape Route

Authors:
Satoshi Matsuoka↗

arXiv:2606.23698v1 Announce Type: cross Abstract: NVIDIA's Blackwell Ultra (B300) cuts FP64 vector throughput to ~1.3 TFLOPS per GPU, roughly 30x below B200 and well below the level at which bandwidth-limited FP64 workloads stay memory-bound. The Ozaki Scheme II framework recovers FP64-equivalent throughput by routing dense matrix multiply through FP8 tensor cores with a mantissa-sliced Chinese-remainder reconstruction. A companion Part (1) paper covers dense GEMM, batched GEMV, stencils, and SpMV; this paper adds the fifth canonical primitive, the 3-D FFT. We present Ozaki-Bailey FFT, an emulated 3-D FFT via the Bailey six-step decomposition with both 1-D FFT GEMMs on FP8 tensor cores. Bailey's small inner factor k ~ sqrt(N) (k=32 for N=1024) puts the kernel in the regime k

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18.
arXiv (CS.LG) 2026-06-12

Retrieval-Augmented Foundation Models for Water Level Prediction in the Everglades

Authors:
Rahuul Rangaraj↗Jimeng Shi↗Rajendra Paudel↗Giri Narasimhan↗Yanzhao Wu↗

arXiv:2508.04888v2 Announce Type: replace Abstract: Accurate water level forecasting in the Everglades is essential for flood mitigation, drought management, water resource planning, and biodiversity conservation. While recent time-series foundation models have shown strong performance on generic tasks (represented in their pre-training), their effectiveness in domain-specific applications remains insufficiently understood. In this work, we curate a domain-specific dataset for water-level forecasting in the Everglades and observe that the performance of current state-of-the-art models remains limited. To address this gap, we leverage a retrieval-augmented mechanism that retrieves analogous multivariate hydrological episodes from an external archive of historical observations to enrich the input context of those pre-trained models. We study two retrieval strategies, statistical similarity-based retrieval and mutual information-based retrieval, and analyze how incorporating retrieved historical contexts affects predictive performance. Extensive experiments show that retrieval augmentation consistently improves long-horizon water level forecasts and yields disproportionately larger gains during extreme events, which is particularly critical for environmental decision-making. Our study provides empirical evidence that analog-based retrieval can benefit pretrained time-series foundation models in environmental science, offering practical insights into their strengths, limitations, and failure modes when applied to hydrological forecasting in the Everglades. Although evaluated in the Everglades, the proposed framework is general and can be applied to other hydrological systems given time series data. The code and data have been made publicly available at https://github.com/rahuul2992000/WaterRAF.

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19.
Nature Medicine 2026-06-15

Long-term independent use of an intracortical brain–computer interface for speech and cursor control

Authors:
Nicholas S. Card↗

Brain–computer interfaces (BCIs) can provide naturalistic communication and digital access to people with severe paralysis by decoding neural activity associated with attempted speech and movement. Recent work has demonstrated highly accurate intracortical BCIs for speech and cursor control, but two critical capabilities needed for practical viability were unmet: independent at-home operation without researcher assistance and reliable long-term performance supporting accurate speech and cursor decoding. Here we demonstrate the independent and near-daily use of a multimodal BCI with novel brain-to-text speech and computer cursor decoders by a man with paralysis and severe dysarthria due to amyotrophic lateral sclerosis. Over nearly 2 years, the participant used the BCI for more than 3,800 h at home with no researchers present to maintain rich interpersonal communication with his family and friends, independently control his personal computer and sustain full-time employment—despite being paralyzed. He communicated 183,060 sentences—totaling 1,960,163 words—at an average rate of 56 words per minute. He labeled 92% of sentences as being decoded at least mostly correctly. In formal quantifications of performance where he was asked to say words presented on a screen, attempted speech was consistently decoded with more than 99% word accuracy (125,000 word vocabulary). The participant also used the speech BCI as keyboard input and the cursor BCI as mouse input to control his personal computer, enabling him to send text messages and emails and to browse the internet. These results demonstrate that intracortical BCIs have the potential to support independent use in the home, marking a critical step toward practical assistive technology for people with severe motor impairment. An automated intracortical brain–computer interface, used at home with no researcher intervention, provides long-term and accurate restoration of speech-based communication and cursor-based computer usage in a person with severe dysarthria due to amyotrophic lateral sclerosis.

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20.
medRxiv (Medicine) 2026-06-18

Age as a moderator of a brief alcohol intervention among injury patients in Northern Tanzania

Authors:
Mwita↗W. C↗Nickenig Vissoci↗J. R. C↗de Souza↗J. V. P↗Phillips↗A. J↗Moshi↗Madundo↗Muro↗F. J↗…

Background: Alcohol use is a leading modifiable risk factor for injury in sub-Saharan Africa. In Tanzania, young people ([≤]24 years) experience greater alcohol-related harm despite drinking less frequently than adults. Punguza Pombe kwa Afya Yako (PPKAY) is a culturally adapted, brief intervention for injury patients in Tanzania. This study examined whether age moderates its effectiveness. Methods: We conducted an exploratory secondary analysis of baseline and 3-month data from the PPKAY randomized trial among injury patients aged [≥]18 years at Kilimanjaro Christian Medical Centre, Tanzania. Eligible participants reporting alcohol use before injury, AUDIT [≥]8, or positive breathalyzer were randomized to usual care or PPKAY with SMS boosters. The primary outcome was binge drinking days. Count outcomes were analyzed using negative binomial regression with robust SEs and continuous outcomes using mixed-effects models. Effect modification was assessed using a three-way interaction (Time x intervention x Age). Results: Among 543 participants (mean age 36.8 years; 16.2% aged 18–24), age moderated the intervention effect for drinking days (IRR = 0.27, 95% CI 0.07 – 0.98; p = 0.046) and drinks consumed (IRR = 0.17, 95% CI 0.04 – 0.77; p = 0.021). The intervention reduced 4 drinking days (95% CI -7.1 to -0.8) and 27.5 drinks (95% CI -42.8 to -12.2) among young people, while adults showed reductions in both arms, without intervention-specific effect. Conclusion: The effects of ED-based brief alcohol interventions are not uniform, varying across both age groups and alcohol-related outcomes. We found a greater responsiveness in drinking frequency and quantity reported among young people.

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21.
medRxiv (Medicine) 2026-06-12

Heterogeneity of Treatment Effect of Aspirin and Clinically Significant Bleeding in Older Adults

Authors:
Tzimas↗Tchoua↗R. B↗Vanghelof↗J. C↗Wolfe↗R. C↗Cloud↗Mahady↗Du↗Ernst↗M. E↗…

Aim: The global population of older adults is growing, and older age is linked to higher bleeding risk. Although guidelines discourage aspirin for primary prevention in healthy older adults due to bleeding harms outweighing benefits, many continue taking it without a clear indication. It remains unclear whether all older adults face uniform aspirin-related bleeding risk or if certain subgroups are more vulnerable. Methods: We analyzed data from 19,114 ASPREE trial participants to develop machine learning models using 116 baseline variables. Random forest (RF) and random survival forest (RSF) models predicted 5-year bleeding risk, and participants were stratified into low, intermediate, and high-risk groups based on the 20th and 80th percentiles of predicted risk. We assessed heterogeneity of treatment effect (HTE) by testing treatment-by-risk group interactions on the relative scale using Fine-Gray models, and on the absolute scale using observed 5-year cumulative incidence rates. Results: Over a median follow-up of 4.7 years, 626 major bleeding events occurred. The RF model had moderate discrimination (AUC = 0.65, 95% CI: 0.63-0.67) and good calibration (Brier = 0.032, 95% CI: 0.029-0.034). Statistically significant HTE was observed on the relative scale, with the greatest relative increase in bleeding risk seen in the low-risk group (subdistribution hazard ratio = 2.26, 95% CI: 1.27-4.01). On the absolute scale, low-risk participants experienced higher bleeding with aspirin (absolute risk difference (ARD) = 1.17%, 95% CI: 0.37-1.95), but heterogeneity in ARDs was not statistically significant (Cochran's Q p > 0.45). Similar findings were observed when using the RSF model. Conclusion: Participants at lowest baseline bleeding risk experienced the greatest relative increase in bleeding risk with aspirin therapy. We found statistically significant heterogeneity in treatment effects on the relative but not absolute scale. These findings support an individualized, risk-based approach to aspirin therapy decision-making in older adults.

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

Random Rule Forest (RRF): Interpretable and Manageable Ensembles of LLM-Generated Questions for Predicting Success from Unstructured Data

Authors:
Ben Griffin↗Aaron Ontoyin Yin↗Diego Vidaurre↗Ugur Koyluoglu↗Joseph Ternasky↗Fuat Alican↗Yigit Ihlamur↗

arXiv:2505.24622v3 Announce Type: replace Abstract: Many high-stakes screening tasks require predicting rare outcomes from unstructured text, where errors are costly and decisions must be auditable. We introduce Random Rule Forest (RRF), an interpretable ensemble that uses a large language model (LLM) not as an end-to-end predictor but as a generator of simple YES/NO questions. Each question acts as a weak learner, and their responses are combined by a plain unit-weight vote into an auditable ``green-flags'' scorecard: enough independent positive signals indicate a higher chance of success. We argue this deliberate simplicity is a robust default when positives are scarce and learned weights are hard to estimate. We evaluate RRF in two low-base-rate domains. On early-stage startup screening from founder profiles, RRF produces a transparent scorecard whose precision is several times the base rate (with light expert input raising it further) and, unlike direct prompting, its operating point can be controlled directly. On an established Phase~I clinical-trial benchmark, RRF outperforms published baselines on the threshold-independent metrics PR-AUC and ROC-AUC. Together these show that LLMs can serve as auditable feature generators for high-stakes text-based decisions, combining transparency with competitive predictive performance.

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24.
arXiv (CS.CL) 2026-06-11

From Explicit Elements to Implicit Intent: A Predefined Library for Auditable Behavioral Inference

Authors:
Liu hung ming↗

We present SemantiClean, a modular framework for extracting structured semantic signals from e-commerce session data and driving pluggable inference targets including purchase intent, customer segmentation, and product affinity through a shared element library. Unlike conventional end-to-end predictors that optimise solely for accuracy, SemantiClean prioritises auditability, structural governance, and sigma=0 reproducibility, explicitly trading marginal predictive gains for element-level transparency and defensible decision trails. Built upon the Online Shoppers Purchasing Intention (OSPI) dataset, the framework organises twenty-four behavioural elements into a four-layer architecture (Functional, Interaction, Systemic, Contextual) and enforces signal quality through three anti-inflation mechanisms: RedundancyGroup contribution caps, TieredPenaltyCalculator bias penalties, and AdaptiveConstraintMode cold-start protection.This report introduces the LLM-Integrated Semantic Inference Engine, a fully implemented two-phase LLM-driven inference architecture that leverages complete element metadata at inference time. All quantitative results reported herein are produced by this engine. Deterministic engine outputs remain fully reproducible (sigma=0); LLM-dependent results (E8, E10) are subject to controlled output variability under fixed provider/model/temperature settings. The gender inference target remains non-functional in the current implementation and is excluded from all quantitative results.

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

Divide, Deliberate, Decide: A Multi-Agent Framework for Fine-Grained Egocentric Action Recognition

Authors:
Alessandro Sottovia↗Alessandro Torcinovich↗Oswald Lanz↗

Fine-grained action recognition in egocentric video is challenging for Vision-Language Models (VLMs): actions often differ only in small visual cues, and a single model tends to be biased toward a subset of these cues. We propose Divide, Deliberate, Decide, a fully-local, zero-shot multi-agent framework in which (i) a VLM orchestrator chunks the video and proposes a top-k candidate label list per segment, (ii) an ensemble of heterogeneous VLM specialists, drawn from different open model families, engages in a structured deliberation that includes a peer-consultation round of questions, and (iii) agent rankings are aggregated with a Borda count and the orchestrator re-ranks its own prediction in light of the specialists' evidence. The entire pipeline runs locally with no fine-tuning. Experiments show that our method positively improves zero-shot action recognition performance over the baseline, highlighting the influence of a heterogeneous deliberation step, showing that the gain stems from decorrelated model priors rather than from additional compute.

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