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01.
arXiv (CS.AI) 2026-06-25

Attractive and Repulsive Pattern Control in Sequence Generation

arXiv:2606.24911v1 Announce Type: cross Abstract: Variable-order Markov models preserve local symbolic syntax by adapting context length, but long continuations can enter recurring high-order "tunnels": repeated suffixes, locally periodic passages, or copied fragments longer than the formal Markov order. This paper introduces signed pattern control for variable-order Markov generation with BP-Regular sampling. A weighted recurrence automaton computes an activation R for a chosen family of target patterns, and belief propagation samples exactly from P_beta(x) proportional to P_0(x) exp(beta R(x)). Negative coupling makes the target patterns costly during sampling; positive coupling rewards the same patterns and turns them into controlled attractors. The target family may be mined online from overactive generated material, supplied by a score or style vocabulary, or designed as an experimental probe. The main experiments use the online homeostatic case, choosing patterns that become overactive in the sampling history. On six duration-bearing monophonic sources, including Bach and Telemann material, the negative branch reduces generated 8-gram self-reuse, increases the effective number of generated 8-grams, and increases coverage of training-supported 4-gram contexts while preserving substantial lower-order support. A pitch-sequence replication on five Weimar Jazz Database solos gives the same anti-reuse signature outside Baroque material. The same signed mechanism also provides a positive branch for probing attractor basins, phase transitions, and hysteresis in the underlying variable-order model.

02.
bioRxiv (Bioinfo) 2026-06-11

VFUSE: Virulent Feature Understanding with Sparse autoEncoders

Generative models have shown remarkable progress in a variety of domains such as protein design, but such power enables the opaque generation of hazardous proteins. In this work, we introduce VFUSE (Virulent Feature Understanding with Sparse autoEncoders), a mechanistic interpretability approach that trains SAEs on diffusion-transformer activations to audit protein models for hazard-aware features. We apply VFUSE to RoseTTAFold3 and RFDiffusion3, popular open-weight models for protein folding and synthesis. We find that for certain blocks, linear probes detect hazardous designs significantly better when fit in the SAE latent space over the original model's representations: improving interpretability without sacrificing model performance. Furthermore, we identify monosemantic features from the SAE that fire only on hazardous designs at up to AUROC 0.84 (q < 10-13).

03.
arXiv (CS.LG) 2026-06-11

Learning What to Say to Your VLA: Mostly Harmless Vision Language Action Model Steering

arXiv:2606.12299v1 Announce Type: cross Abstract: Vision-Language-Action (VLA) models provide a natural language interface to robot control, but the mapping from language to behavior is often brittle and unintuitive: semantically similar instructions can induce drastically different behaviors, while some capabilities may not be elicitable through prompting alone. As a result, both human instructions and zero-shot language models can fail to reliably steer VLAs toward successful task execution. In this work, we propose a framework that interactively searches for language sequences that improve closed-loop VLA task performance, distills these sequences into a test-time language feedback policy (LFP), and learns an improvement head that predicts when language steering will improve performance. We conformalize this improvement head to prevent harmful steering interventions, where the LFP decreases task performance relative to the original instruction on out-of-distribution scenarios. Crucially, our approach operates on arbitrary frozen pre-trained VLAs, requiring neither access to the original training distribution nor fine-tuning of the underlying model. On seen environments, our conformalized LFP improves base VLA performance by 24.7% in simulation and 65.0% in hardware. On visual and semantic perturbations, our conformalized LFP has strong harmlessness guarantees, and produces recovery behaviors not observed with open-loop prompting.

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

Look Again Before You Abstain:Budgeted Conformal Evidence Acquisition for Reliable Vision-Language Model

Large vision-language models (LVLMs) hallucinate: they assert visual details that the image does not support. A principled remedy is selective prediction with a distribution-free guarantee-verify each claim and abstain when the claim is not grounded, so that the hallucination rate among asserted claims is provably bounded. We show, however, that this guarantee is bought at a brutal price: to keep the hallucination rate below $5\%$ on a balanced object-existence benchmark, a state-of-the-art conformal filter must abstain on more than $80\%$ of claims. We argue that abstention is wasteful when more visual evidence is cheaply available, and introduce Budgeted Conformal Evidence Acquisition (BCEA), which replaces the binary answer/abstain decision with a three-way choice: answer, abstain, or acquire additional visual evidence by re-examining the image (zooming, cropping, or applying a claim-specific intervention) under a bounded compute budget. We make two observations. First, acquisition that is plugged naively into a calibrated filter breaks the statistical guarantee – realized risk overshoots the target by up to $17$ points – because the acquisition step destroys the exchangeability that conformal calibration relies on. Second, folding the entire acquisition policy into the score function and re-calibrating on post-acquisition scores restores the finite-sample guarantee while still recovering coverage. BCEA further uses structured, claim-type-specific interventions. Across the POPE benchmark and COCO-constructed existence and spatial-relation claims, on four open VLMs, BCEA controls the hallucination rate at the target level and consistently improves coverage over a guaranteed-abstention baseline.

05.
arXiv (CS.AI) 2026-06-15

When Errors Become Narratives: A Longitudinal Taxonomy of Silent Failures in a Production LLM Agent Runtime

Authors:

arXiv:2606.14589v1 Announce Type: cross Abstract: LLM agent systems increasingly run as long-lived autonomous runtimes: scheduling jobs, calling tools, maintaining memory, and pushing results to humans. We present a longitudinal study of silent failures in one such system: a personal-assistant agent runtime in continuous production since March 2026, with roughly 40 scheduled jobs, 8 LLM providers, a tool-governance proxy, and a knowledge-base memory plane, defended by 4,286 unit tests and 827 governance checks. Over eight weeks we documented 22 incidents with full root-cause postmortems, in which one meta-pattern – a failure whose error signal never reaches a human in actionable form – manifested at least 28 times. We derive a five-class, mechanism-oriented taxonomy: (A) environment and platform quirks, (B) design-assumption mismatches, (C) error swallowing and dilution, (D) chained hallucination and fabrication, (E) operational omission and forensic blind spots. Class D is unique to LLM systems and the most dangerous: the system does not merely fail to report an error – the LLM transforms it into fluent, plausible narrative delivered to the user. We term this fail-plausible: gray failure's differential observability escalated – the observer is not just blind, it is convincingly lied to by the failure itself. Three findings: about 70% of silent failures were caught by human user-view observation, not tests or audits; a retrospective audit of 15 incidents found 0% ex-ante prevention but 87% regression blocking – audits are regression engines, not prediction engines; incident latency (13 hours to 60 days) tracks failure mechanism, not code complexity – the longest-lived failures lived in the seams between components, where no test runs. We describe the resulting defense framework and distill design principles for agent systems whose failures are loud, attributable, and boring. All postmortems and artifacts are public.

06.
arXiv (CS.AI) 2026-06-15

Causal Object-Centric Models for Planning with Monte Carlo Tree Search

arXiv:2606.14418v1 Announce Type: new Abstract: We introduce COMET (Causal Object-centric Model for Efficient Tree search), a model-based reinforcement learning algorithm that performs Monte Carlo Tree Search in a slot-structured latent space. COMET pairs a frozen unsupervised object-centric encoder with a transformer-based world model, in which actions are bound to objects through a novel action-slot fusion mechanism that is used in slot transition prediction. Policy and value heads use object-causal attention, modulating token interactions by learned per-slot relevance scores so that decision-making concentrates on task-relevant entities. COMET adds an explicit object-level inductive bias to MuZero-style latent planning. Across eight visually and dynamically diverse tasks from the Object-Centric Visual RL benchmark, ManiSkill, Robosuite, and VizDoom, COMET achieves a higher mean normalized score during the early stages of training compared to object-centric and monolithic baselines.

07.
arXiv (CS.AI) 2026-06-11

When Researchers Say Mental Model/Theory of Mind of AI, What Are They Really Talking About?

arXiv:2510.02660v2 Announce Type: replace-cross Abstract: When researchers claim AI systems possess ToM or mental models, they are fundamentally discussing behavioral predictions and bias corrections rather than genuine mental states. This position paper argues that the current discourse conflates sophisticated pattern matching with authentic cognition, missing a crucial distinction between simulation and experience. While recent studies show LLMs achieving human-level performance on ToM laboratory tasks, these results are based only on behavioral mimicry. More importantly, the entire testing paradigm may be flawed in applying individual human cognitive tests to AI systems, but assessing human cognition directly in the moment of human-AI interaction. I suggest shifting focus toward mutual ToM frameworks that acknowledge the simultaneous contributions of human cognition and AI algorithms, emphasizing the interaction dynamics, instead of testing AI in isolation.

08.
arXiv (CS.CL) 2026-06-16

Virtual Speech Therapist: A Clinician-in-the-Loop AI Speech Therapy Agent for Personalized and Supervised Therapy

This paper develops Virtual Speech Therapist (VST), an intelligent agent-based platform that streamlines stuttering assessment and delivers customized therapy planning through automated and adaptive AI-driven workflows. VST integrates state-of-the-art deep learning-based stuttering classification, and multi-agent large language model (LLM) reasoning to support evidence-based clinical decision-making. The VST begins with the acquisition and feature extraction of patient speech samples, followed by robust classification of stuttering types. Building on these outputs, VST initiates an agentic reasoning process in which specialized LLM agents autonomously generate, critique, and iteratively refine individualized therapy plans. A dedicated critic agent evaluates all generated therapy plans to ensure clinical safety, methodological soundness, and alignment with peer-reviewed evidence and established professional guidelines. The resulting output is a comprehensive, patient-specific therapy draft intended for clinician review. Incorporating clinician feedback, the system then produces a finalized therapy plan suitable for patient delivery, thereby maintaining a clinician-in-the-loop paradigm. Experimental evaluation by expert speech therapists confirms that VST consistently generates high-quality, evidence-based therapy recommendations. These findings demonstrate the system's potential to augment clinical workflows, reduce clinician burden, and improve therapeutic outcomes for individuals with speech impairments. An interactive user interface for the proposed system is available online at: https://vocametrix.com/ai/stuttering-therapy-planning-agent , facilitating real-time stuttering assessment and personalized therapy planning.

09.
arXiv (CS.LG) 2026-06-12

NetCause: Counterfactual Learning for Root Cause Analysis in Large-Scale Networks

arXiv:2606.13543v1 Announce Type: cross Abstract: Can a learned model capture how faults propagate through a large-scale network and use this knowledge to causally attribute customer impact to its underlying root cause? Existing root cause analysis techniques often rely on static rules, correlation heuristics, or topology-local reasoning, which struggle to generalize in dynamic environments where faults propagate across complex physical and logical dependencies. We present NetCause, a self-supervised learning-based framework that models network incidents as graph-temporal processes and uses counterfactual simulation to rank candidate root causes. This approach produces an interpretable ranking of root cause hypotheses and integrates naturally with operator-defined mitigation and remediation actions. We train the model on over 1,500 incidents collected over six months from a leading cloud provider's production network and evaluate it on 31 expert-labeled incidents. NetCause consistently improves root cause ranking quality in the regime most relevant to operational decision-making, achieving a 16.1% accuracy improvement over a rule-based heuristic baseline. While training is computationally intensive, inference is lightweight, requiring only seconds of GPU runtime per incident (well below typical telemetry collection latencies).

10.
bioRxiv (Bioinfo) 2026-06-10

HOMED enables hierarchical and multimodal optimization of DNA methylation deconvolution across tissues

Cellular heterogeneity is a major confounder in bulk DNA methylation data for epigenome-wide association studies. Existing reference-based DNAm deconvolution methods often ignore hierarchies among related cell types and may generalize poorly across datasets due to limited variability in reference profiles. We developed HOMED (Hierarchically Optimized Methylation Deconvolution), a framework that integrates cell-lineage hierarchies, single-cell RNA sequencing-guided deconvolution, and paired bulk RNA-seq/DNAm data for CpG signature optimization. Across simulated and real peripheral blood mononuclear cell, lung, and placental datasets, HOMED consistently yielded the highest PCCs and lowest RMSEs, outperforming existing scRNA-seq-guided DNAm deconvolution methods, improving accuracy, resolution, and cross-tissue generalizability.

11.
arXiv (CS.LG) 2026-06-18

Hierarchical Planning with Latent World Models

arXiv:2604.03208v2 Announce Type: replace Abstract: World models are a promising path to zero-shot embodied control through planning. However, existing world model planners struggle on long-horizon, multi-stage tasks: prediction errors compound and naive search is exponential in the planning horizon. Hierarchy mitigates both by decomposing tasks into shorter, tractable subproblems; yet prior hierarchical approaches either amortize control into task-specific policies (hierarchical RL) or assume low-dimensional states and known dynamics (classical hierarchical MPC). We present Hierarchical Planning with Latent World Models (HWM), an architecture and planning paradigm for hierarchical model predictive control (MPC) directly on visual world models trained solely via next-latent prediction. HWM learns world models at multiple temporal scales within a shared latent space, so predictions from the long-horizon model serve as subgoals for the short-horizon model via latent matching, without task-specific rewards, skill learning, or hierarchical policies. To keep long-horizon search tractable, HWM learns an action encoder that compresses primitive action chunks into latent macro-actions. On real-world Franka manipulation, HWM solves pick-and-place from a single goal image at 70% success vs. 0% for single-level planning. Across simulated push manipulation and maze navigation, HWM consistently improves performance on long-horizon tasks while requiring up to 3x less planning compute.

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

From Affect Prediction to Affect Forecasting: Evidence for Distinct Information Sources in Longitudinal Text

Modeling dimensional affect in longitudinal text requires distinguishing current affect estimation from future affective change forecasting. Existing approaches often treat each text as an independent observation and apply similar assumptions to both tasks, without testing whether they rely on different information sources. This paper investigates that distinction using longitudinal self-reported ecological essays and feeling-word entries. We propose the Trait–State Affective Prediction (TSAP) framework and its temporal extension E-TSAP for per-text valence and arousal prediction, evaluated on a held-out prediction test set of 1,737 entries from 91 users. We further propose the Affective Change Forecaster Hybrid (ACF-Hybrid) for next-step affective change forecasting, evaluated on a held-out forecasting test set of 46 users. For prediction, E-TSAP achieves composite Pearson correlations of 0.670 for valence and 0.449 for arousal. For forecasting, textual representations perform worse than compact numeric trajectory baselines: the text-inclusive model achieves only r=0.316 for valence and r=0.284 for arousal, whereas a simple prior-state baseline reaches r=0.615 and r=0.670, respectively. ACF-Hybrid, using dimension-specific numeric trajectory features, achieves r=0.659 for valence and $r=0.658$ for arousal. These results show that textual semantics support current affect prediction, whereas future affective change is better captured through prior numeric trajectory dynamics.

14.
medRxiv (Medicine) 2026-06-19

Performance of family history-based colorectal cancer screening criteria by race and age at diagnosis in the Disparities and Cancer Epidemiology (DANCE) study

Importance: Family history (FH) and age are the primary criteria employed for early colorectal cancer (CRC) risk stratification. We evaluated how well these criteria identify individuals diagnosed with CRC across age and racial groups. Objective: To evaluate the performance of FH and age based screening criteria for identifying individuals with CRC, with attention to differences by race and age at diagnosis. Design, Setting, and Participants: This case control and case only analysis used data from the Disparities and Cancer Epidemiology (DANCE) cohort, a population based study of invasive CRC cases diagnosed from 2013 to 2022, recruited through the Metropolitan Detroit Cancer Surveillance System and the Louisiana Tumor Registry. Analyses included 1,158 non-Hispanic Black (NHB) and non-Hispanic White (NHW) CRC cases and 1,434 cancer-free controls from the Inflammation Health and Lung Epidemiology (INHALE) study, enrolled from the same Detroit catchment area. Data were analyzed in 2025. Exposures: Self reported cancer FH among first-degree (FD) relatives and grandparents, summarized into three FH-based screening criteria: at least one FD relative with CRC (colon early-screening criterion), any FH of Lynch syndrome related cancers, and meeting NCCN criteria for Lynch syndrome genetic testing. Main Outcomes and Measures: Proportion of cases meeting each FH based screening criterion stratified by race and age at diagnosis (

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

Illumination-Robust Camera-Based Heart-Rate Estimation for Physiological Sensing in Robots

Physiological awareness is important for service, social, and assistive robots that interact with humans in everyday environments. Remote photoplethysmography (rPPG) enables non-contact heart-rate (HR) estimation from an RGB camera, making it a promising sensing modality for robot-mounted vision systems. However, illumination variation remains a major barrier to robust deployment. This paper presents an end-to-end spatial-temporal transformer framework for remote HR estimation on a new dataset with varied illumination. Our estimator integrates PRNet-based 3D face alignment, clip-level illumination augmentation, the Residual Temporal Standardization Module, and controlled hybrid temporal-frequency supervision. The training objective combines a Soft-Shifted Pearson waveform loss with a spectral Kullback-Leibler divergence loss, where a tuned weight ($\mathbf{\beta}$) controls the contribution of frequency-domain heart-rate guidance. Experiments on a static all-level mix protocol covering three illumination levels show that $\mathbf{\beta}=5$ provides the strongest result among the tested beta settings, achieving a best-run HR mean absolute error (MAE) of 0.79 bpm and an HR correlation of 0.982. Compared with the PhysFormer baseline evaluated on our dataset, our estimator reduces HR MAE by 93.6 %, while increasing HR correlation from 0.088 to 0.982, making it usable when illumination varies.

16.
arXiv (CS.LG) 2026-06-24

Density-Informed Pseudo-Counts for Calibrated Evidential Deep Learning

arXiv:2602.01477v2 Announce Type: replace-cross Abstract: Evidential Deep Learning (EDL) is a popular framework for uncertainty-aware classification that models predictive uncertainty via Dirichlet distributions parameterized by neural networks. Despite its popularity, its theoretical foundations and behavior under distributional shift remain poorly understood. In this work, we provide a principled statistical interpretation by proving that EDL training corresponds to amortized variational inference in a hierarchical Bayesian model with a tempered pseudo-likelihood. This perspective reveals a major drawback: standard EDL conflates epistemic and aleatoric uncertainty, leading to systematic overconfidence on out-of-distribution (OOD) inputs. To address this, we introduce Density-Informed Pseudo-count EDL (DIP-EDL), a new parametrization that decouples class prediction from the magnitude of uncertainty by separately estimating the conditional label distribution and the marginal covariate density. This separation preserves evidence in high-density regions while shrinking predictions toward a uniform prior for OOD data. Theoretically, we prove that DIP-EDL achieves asymptotic concentration. Empirically, we show that our method enhances interpretability and improves robustness and uncertainty calibration under distributional shift.

17.
arXiv (CS.AI) 2026-06-18

From Memorization to Creation: Evaluating the Cognitive Depth of LLM-Generated Educational Questions

arXiv:2606.18257v1 Announce Type: cross Abstract: While LLMs show promise in automating educational content creation, their ability to generate questions that stimulate higher-order thinking remains understudied. This work evaluates six widely-used LLMs through a Bloom's Taxonomy lens, focusing on their capacity to transcend rote memorization and achieve cognitive leaps. Using a hybrid human–AI evaluation protocol, we generate and analyze 20{,}700 questions across computer science, K–12 math, and social-science domains. Key contributions include: (1) a fine-grained prompting strategy that reduces question repetitiveness by 24.45\% for Qwen2.5-7B-Instruct, and increases the proportion of higher-order cognitive level outputs by 11.53\% for InternLM3-8B-Instruct; (2) quantitative metrics for cognitive shift intensity (CogShift) and category drift, revealing InternLM3's superior performance in multi-level transitions; (3) an interpretability analysis revealing metric-level correlations that enhance the transparency of Chain-of-Thought prompting. Our findings highlight the importance of cognitive-aware prompt design and provide benchmarks for deploying LLMs in personalized learning systems.

18.
medRxiv (Medicine) 2026-06-16

Presurgical immune biomarkers associated with pain intensity and pain interference recovery after total knee arthroplasty: findings from the PRIME-KNEE study

Chronic postsurgical pain (CPSP) prevalence after total knee arthroplasty (TKA) is >20%. Circulating immune biomarkers are known factors of musculoskeletal pain but poorly understood as CPSP predictors. This prospective, longitudinal study of 203 patients s/p TKA tested presurgical plasma biomarkers associated with 6-month CPSP, using promising approaches from geriatrics biomarker research: expected recovery differential (ERD; resilience outcome) and penalized, machine-learning regularization modeling (elastic net and LASSO regression). Forty-nine presurgical candidate biomarkers were considered. CPSP was operationalized using ERDs built around PROMIS pain intensity and pain interference, which quantified the difference between observed and expected recovery after accounting for demographic, comorbidity, reserve, and perioperative factors. Plasma/ERDs from ~130 patients revealed 13 biomarkers with the highest selection stability criteria, and either positive or negative (+/-) associations with ERDs. Interleukin (IL) 5 (-) and Lipopolysaccharide-Binding Protein (LBP; +) were associated with both ERDs. Unique associations with pain intensity ERD included Cytomegalovirus-Specific IgG Negative (CMV IGg-; -), Macrophage Inflammatory Protein-1 Beta (MIP1b; -), IL12p70 (-, Cluster of Differentiation 30 (sCD30;-), Interferon alpha 2a (IFN2a;+), and Leukemia Inhibitory Factor (LIF;+). Unique associations with pain interference ERD included Lipopolysaccharide (LPS;-), Activin A (-), IL8 (-), Serum Amyloid A (SAA;-), and IL7 (+). Protein-protein interaction analyses and topology motifs suggest a centralized network with higher-than-expected connectivity, involving IL5, IL7, IL8, MIP1{beta}, and IFN2a, among others. This study proposes rigorous yet feasible approaches to expedite pain biomarker research, and introduces presurgical biomarkers t0 consider in future TKA-CPSP biosignature derivation.

19.
arXiv (CS.CV) 2026-06-15

Dual Cross-Attention Siamese Transformer for Rectal Tumor Regrowth Assessment in Watch-and-Wait Endoscopy

Increasing evidence supports watch-and-wait (WW) surveillance for patients with rectal cancer who show clinical complete response (cCR) at restaging following total neoadjuvant treatment (TNT). However, accurate methods to early detect local regrowth (LR) from follow-up endoscopy images during WW are essential to manage care and prevent distant metastases. Hence, we developed a Siamese Swin Transformer with Dual Cross-Attention (SSDCA) to combine longitudinal endoscopic images at restaging and follow-up and distinguish cCR from LR. SSDCA leverages pretrained Swin Transformers to extract domain agnostic features and enhance robustness to imaging variations. Dual cross attention is implemented to emphasize features from the paired scans without requiring any spatial alignment to predict response. SSDCA as well as Swin-based baselines were trained using image pairs from 135 patients and evaluated on a held-out set of image pairs from 62 patients. SSDCA produced the best balanced accuracy (81.76% $\pm$ 0.04), sensitivity (90.07% $\pm$ 0.08), and specificity (72.86% $\pm$ 0.05). Robustness analysis showed stable performance irrespective of artifacts including blood, stool, telangiectasia, and poor image quality. UMAP clustering of extracted features showed maximal inter-cluster separation (1.45 $\pm$ 0.18) and minimal intra-cluster dispersion (1.07 $\pm$ 0.19) with SSDCA, confirming discriminative representation learning. Code and weights available at: https://github.com/Jotanator/SSDCA

20.
arXiv (CS.CV) 2026-06-16

What Should a Streaming Video Model Remember?

Streaming video understanding models must answer queries at any moment during an ongoing stream, using only what they have observed so far and under fixed memory and computation budgets. Existing methods address this by adding memory banks, retrieval modules, or visual token compression to preserve long-range history. However, strong recent-window baselines show that indiscriminate history injection can dilute current-scene perception, suggesting that the key challenge is not whether to use memory, but how to allocate it selectively. We formulate this as budgeted online latent evidence allocation and propose SelectStream, a selective latent-memory framework that keeps the current observation directly visible to a frozen VLM while exposing historical information only through a compact, query-conditioned evidence budget. Three coordinated mechanisms govern when to write, what to preserve, and how to retrieve: surprise-driven adaptive windowing, priority-preserving consolidation, and query-conditioned graph reasoning over a fixed-capacity latent memory graph. Retrieved evidence is calibrated and injected as latent tokens for answer generation, without replaying frames or growing the context with stream length. Experimental results show that SelectStream achieves strong online streaming performance and preserves general video understanding, reaching 82.67\% on StreamingBench, 67.03\% on OVO-Bench, and 74.4\% average accuracy on offline video benchmarks, while outperforming strong recent-window baselines and prior streaming memory methods.

21.
arXiv (CS.CL) 2026-06-25

Beyond Next-Observation Prediction: Agent-Authored World Modeling for Sequential Decision Making

Recent studies on world modeling for Large Language Model (LLM) agents typically formulate the learning objective as next-observation prediction. However, this objective ties supervision to what a transition happens to reveal, which may omit the dynamics most relevant to the agent's current decision. To bridge this gap, we propose Agent-Authored World Modeling (AAWM), a training procedure that constructs supervision from the policy's own decision needs. Specifically, at each state, the agent identifies what it needs to understand about the environment before acting. These needs drive the retrieval of relevant transition evidence across trajectories, which is then synthesized into training targets that capture decision-oriented dynamics instead of reconstructing the next observation. This aligns the training objective with the dynamics the policy needs before acting, not with the contents of the next observation. Experimental results validate the effectiveness of AAWM across multiple environments and training settings. These results show that decision-aware world-model targets provide a more effective learning signal than next-observation prediction.

22.
PLOS Medicine 2026-06-12

Placenta accreta spectrum in the 21st century: Challenging dogma and redefining disorder

Authors:

by Eric Jauniaux, Helena C. Bartels, Yalda Afshar Placenta accreta spectrum (PAS) is a serious pregnancy complication caused by abnormal placental attachment to the uterus. In this Perspective, Eric Jauniaux and colleagues discuss emerging evidence that challenges our long-held pathophysiological understanding of PAS, and argue that a critical reassessment of definition, diagnosis, and management is overdue. In this Perspective, Jonathan Evans and colleagues discuss why restricting access to joint replacement surgery based on BMI alone is not supported by evidence, and highlight how such rest rictions risk exacerbating stigma, inequity and avoidable harm to those who would benefit from surgery.

23.
arXiv (CS.LG) 2026-06-18

Context-Aware Optimization of Follow-Up Intervals for Type 2 Diabetes Care Using Markov Decision Processes

arXiv:2606.19092v1 Announce Type: cross Abstract: Chronic disease management relies on regular patient-provider interactions to follow-up on disease progression and control. For Type 2 Diabetes (T2D), current guidelines prescribe fixed time intervals between subsequent primary care visits for all patients, overlooking heterogeneity in clinical trajectories and patient characteristics. This study introduces a Contextual Markov Decision Process (CMDP) model to optimize subpopulation-specific follow-up interval decisions using Electronic Health Record (EHR) data from 22,154 T2D patients across 10 primary care clinics. Contexts are identified by: i) dimensionality reduction of variables representing the individual health trajectories utilizing Principal Component Analysis, and ii) assigning patients to contexts via principal components and additional patient-level features using clustering. Two distinct contexts emerged, representing a lower- and a higher-risk subpopulation. CMDP-derived policies recommend: (i) follow-up within 1 month if lab value at current visit is unmeasured; (ii) up to 3 months for elevated lab values or recent hospitalizations; and (iii) 6 to 12 months for sustained glycemic control, with shorter follow-up intervals for patients in high-risk context. The optimal policies achieved lower expected cumulative cost than benchmarks (e.g., in the higher-comorbidity context, the CMDP policy reduced cost by about 34.8%, and in the lower-comorbidity context by about 6.4%, relative to an American Diabetes Association-like fixed interval follow-up policy. These findings demonstrate how context-aware approaches can inform adaptive follow-up strategies, and have the potential to advance chronic care management in primary care by synthesizing machine learning and probabilistic decision models.

24.
arXiv (quant-ph) 2026-06-15

Resolving the Edge of a Quantum Pyramid

arXiv:2606.14698v1 Announce Type: new Abstract: Standing on the shoulders of giants, we resolve the quantum pyramids conjecture, confirming the globally information-optimal measurement for an ensemble of equiangular equiprobable pure states, as conjectured by Englert and \v{R}eháček (arXiv:0905.0510). We do so by proving the remaining entropy inequalities of Holevo and Utkin (arXiv:2506.06700), which certify optimality for obtuse and flat pyramids. For obtuse pyramids, our key contribution is a rigorous proof that local minimizers of the corresponding entropy inequality cannot have three distinct coordinate values. We show that eliminating this family can be reduced to a neat algebraic reciprocal inequality relating branches of the Lambert $W$ function, which may be of independent interest. For flat pyramids, we prove a tight $\ell^p$ inequality for zero-sum vectors that was recently conjectured, proved analytically in dimension $d=3$, and computationally verified for $d\leq 200$ by Holevo and Utkin (arXiv:2603.24017). We prove this bound for all $d\geq 2$ via a technique in symmetric inequalities known as the equal variables method.

25.
medRxiv (Medicine) 2026-06-22

Early-life nutritional environment is associated with late-life cognition in the Health and Retirement Study, a pellagra epidemic natural experiment

Early-life exposures are important to several late-life health outcomes. We sought to study the effect of an in utero nutritional environment and its interaction with Alzheimer's disease (AD) genetic risk on late-life cognitive function. We used a natural experiment created by the pellagra epidemic, a nutritional disease caused by a vitamin B3 deficiency, to evaluate the association between in utero pellagra epidemic exposure and late-life cognitive function in the Health and Retirement Study (N = 18,285). We also evaluated whether the in utero exposure could modify the AD polygenic score's (PGS) effect on cognition. In utero pellagra epidemic exposure was significantly associated with cognition ({beta} = -0.025). However, these effects were not isolated to the prenatal period as exposure during childhood periods also had an effect. The interaction between the in utero exposure and the AD PGS was significant, where the genetic effect on cognition was amplified with increasing (progressively worse) in utero exposure levels. These associations imply that the early-life nutritional environment affects late-life cognitive function and that these effects can modify genetic risk.