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01.
arXiv (math.PR) 2026-06-12

Non-commutative Law of iterated logarithm

arXiv:2509.22037v2 Announce Type: replace-cross Abstract: We prove optimal non-commutative analogues of the classical Law of Iterated Logarithm (LIL) for both martingales and sequences of independent (non-commutative) random variables. The classical martingale version was established by Stout [Sto70b] and the independent case by Hartman-Wintner [HW41]. Our approach relies on a key exponential inequality essentially due to Randrianantoanina [Ran24] that improves that from Junge and Zeng [JZ15]. It allows to derive an optimal non-commutative Stout-type LIL just as in [Zen15], from that martingale result we then deduce a non-commutative Hartman-Wintner type LIL for independent sequences of random variables.

02.
arXiv (CS.LG) 2026-06-12

DynamicPTQ: Mitigating Activation Quantization Collapse via Residual-Stream Dynamics

arXiv:2606.12487v1 Announce Type: new Abstract: Post-training quantization (PTQ) is essential for efficient large language model inference, but reliably quantizing activations remains challenging when weights, activations, and KV caches are all quantized to 4-bit precision. A key difficulty lies in massive activations, whose extreme values dominate the activation range and amplify quantization errors. State-of-the-art methods mainly mitigate massive activations through transformation-based smoothing, such as orthogonal rotations and affine scaling, but overlook the cross-layer dynamics of the residual stream. In this paper, we show that massive activations emerge and disappear in a phase-wise pattern across network depth, triggering large residual changes. These changes cause newly injected layer-wise updates to dominate the 4-bit quantization scale and weaken historical residual information. To characterize this behavior, we introduce Jump Ratio and Historical Feature SNR. This suggests that static transformation-based smoothing cannot fully resolve dynamic quantization instability caused by cross-layer residual changes. Based on this analysis, we propose DynamicPTQ, a Dynamic Post-Training Quantization policy for phase-aware mixed-precision activation quantization. DynamicPTQ identifies quantization-sensitive layers from residual-stream dynamics and assigns 8-bit activation precision only to these layers, while keeping weights, KV caches, and other activations in 4-bit precision. It can be directly integrated with strong PTQ baselines such as QuaRot, SpinQuant, and FlatQuant. Experiments on LLaMA-2 and LLaMA-3 show that DynamicPTQ consistently improves perplexity and zero-shot QA performance under W4A4KV4 quantization, while achieving 1.05 to 1.07 times throughput improvement with modest memory overhead. These results demonstrate a practical path toward robust low-bit LLM inference.

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

INFRAMIND: Infrastructure-Aware Multi-Agent Orchestration

arXiv:2606.11440v1 Announce Type: new Abstract: Existing multi-agent LLM orchestration methods, ranging from brute-force ensembles to learned routers, select models and topologies based on task and model features. However, these methods do not consider the runtime state of the serving infrastructure. On shared GPU clusters under concurrent load, this infrastructure blindness causes systematic resource underutilization: preferred models accumulate deep request queues while equally capable alternatives sit idle. In multi-agent pipelines, where each query triggers multiple sequential model calls, these delays then compound across every downstream step. Closing this gap is challenging because the relevant infrastructure signals (queue depths, KV-cache pressure, latencies) are dynamic and noisy, and they must drive three different decisions: planning, per-step routing, and scheduling. We introduce INFRAMIND, a framework that makes the entire multi-agent stack infrastructure-aware. An infra-aware planner conditions topology and role selection on real-time system load and remaining budget, biasing toward simpler graphs under congestion and richer ones at low load. An infra-aware executor then observes per-model queue depths, cache utilization, and response latencies at each agent step to decide which model to call and how deeply to reason; a budget-aware scheduler further reorders each model's queue so that urgent requests are served first. Cast as a hierarchical constrained MDP and solved end-to-end via reinforcement learning, the system learns to balance quality against latency automatically. Across five benchmarks, INFRAMIND delivers up to +7.6 pp accuracy over the prior baseline at low load with up to 7x lower latency, and sustains up to 99.9% SLO compliance under high load where every baseline drops below 50%.

04.
bioRxiv (Bioinfo) 2026-06-15

Biological meaning in protein embedding space is resolution-dependent

Protein language model embeddings are increasingly used to organise biological sequences, yet how biological meaning is encoded within embedding neighbourhoods remains poorly understood. Using two independent hierarchical enzyme systems, carbohydrate-active enzymes and peptidases, we investigated how biological interpretation changes across embedding organisations aligned to different levels of biological hierarchy. Different embedding organisations give rise to distinct neighbourhood semantics. When aligned to membership-boundary resolution, embeddings robustly separated artefacts and unrelated proteins from members of the target category. However, embeddings aligned to functional-grouping resolution maintained compositional neighbourhood structure for multi-domain proteins spanning more than one functional or catalytic group. Finally, embeddings aligned to local-family resolution recovered compact family-like neighbourhoods, including families withheld from training, while weakening broader membership-boundary and functional-grouping relationships. Moreover, embeddings optimised toward the same level of biological organisation retain different biological relationships depending on optimisation trajectory employed. Together, our results show that proximity in protein embedding space has no fixed biological interpretation. Instead, biological meaning emerges across embedding resolutions through selective preservation of different forms of biological organisation.

05.
arXiv (quant-ph) 2026-06-19

Benchmark of quantum algorithms for ground state preparation in the presence of noise

arXiv:2606.20551v1 Announce Type: new Abstract: We compare the performance of representative cooling, adiabatic, and optimization algorithms for ground-state preparation in the presence of noise. Using an exactly solvable family of quadratic fermionic Hamiltonians subject to depolarizing noise, we derive the scaling of the achievable relative energy as a function of the noise rate and support these results with numerical simulations. The Hamiltonian exhibits two phases, separated by a quantum phase transition. As expected, the performance of the different algorithms depends on the phase: adiabatic evolution is favorable in the trivial phase, while a multi-frequency cooling algorithm, as proposed in [1], becomes competitive or superior in the topological phase, where gap-closing limits adiabatic protocols. We further present numerical results for the quantum approximate optimization algorithm [2], showing that it performs competitively with cooling in the trivial phase but is typically outperformed in the topological regime. Finally, we show that for this model the cooling protocol exhibits enhanced robustness to parameter imperfections, highlighting its potential advantage for realistic implementations of noisy quantum state preparation. The analytical approach developed here, in conjunction with numerical validation, establishes an extendable approach to benchmarking ground-state preparation algorithms.

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

DC-Motion: Decoupling Semantics and Details via Discrete-Continuous Tokens for Human Motion Generation

Text-to-motion generation requires synthesizing physically realistic dynamics that strictly follow complex and long-horizon textual instructions. Existing approaches rely on homogeneous representation spaces that may fail to capture the hierarchical nature of human motion, with diffusion models struggling at compositional semantic reasoning and AR models sacrificing fine-grained physical details due to quantization. To solve it, we introduce DC-Motion, a factorized generative framework designed to explicitly decouple semantics and details via discrete-continuous tokens. A Discrete-Continuous VAE (DC-VAE) first decomposes motion into discrete tokens for semantics and continuous residuals for fine-grained dynamics. Then, a masked AR model predicts the discrete structure from text, and a lightweight residual diffusion model recovers the continuous physical details. Extensive experiments demonstrate that DC-Motion effectively improves the capability to follow complex instructions. By effectively balancing semantic controllability and physical realism, our approach offers a highly adaptable modeling paradigm for human motion generation. On both HumanML3D and KIT-ML datasets, DC-Motion achieves state-of-the-art performance, delivering the best FID for motion realism and R-precision for text alignment.

07.
arXiv (quant-ph) 2026-06-16

Simulation of Non-Hermitian Hamiltonians with Bivariate Quantum Signal Processing

arXiv:2605.12450v2 Announce Type: replace Abstract: We achieve query-optimal quantum simulations of non-Hermitian Hamiltonians $H_{\mathrm{eff}} = H_R + iH_I$, where $H_R$ is Hermitian and $H_I \succeq 0$, using a bivariate extension of quantum signal processing (QSP) with non-commuting signal operators. The algorithm encodes the interaction-picture Dyson series as a polynomial on the bitorus, implemented through a structured multivariable QSP (M-QSP) circuit. A constant-ratio condition guarantees scalar angle-finding for M-QSP circuits with arbitrary non-commuting signal operators. A degree-preserving sum-of-squares spectral factorization permits scalar complementary polynomials in two variables. Angles are deterministically calculated in a classical precomputation step, running in $\mathcal{O}(d_R \cdot d_I)$ classical operations. Operator norms $\alpha_R\,,\beta_I$ contribute additively with query complexity $\mathcal{O}((\alpha_R + \beta_I)T + \log(1/\varepsilon)/\log\log(1/\varepsilon))$ matching an information-theoretic lower bound in the separate-oracle model, where $H_R$ and $H_I$ are accessed through independent block encodings. The postselection success probability is $e^{-2\beta_I T}\|e^{-iH_{\mathrm{eff}}T}|\psi_0\rangle\|^2\cdot (1 - \mathcal{O}(\varepsilon))$, decomposing into a state-dependent factor $\|e^{-iH_{\mathrm{eff}}T}|\psi_0\rangle\|^2$ from the intrinsic barrier and an $e^{-2\beta_I T}$ overhead from polynomial block-encoding.

08.
Nature (Science) 2026-06-18

Daily briefing: The brain builds a sentence neuron by neuron

Authors:

Researchers have tracked the electrical activity of individual brain cells during conversation in real time. Plus, the history of GPS and a cross-species transplant that could reveal clues about the origin of animals. Researchers have tracked the electrical activity of individual brain cells during conversation in real time. Plus, the history of GPS and a cross-species transplant that could reveal clues about the origin of animals.

09.
arXiv (CS.CV) 2026-06-15

WAM4D: Fast 4D World Action Model via Spatial Register Tokens

World action models (WAMs) have recently shown promise in jointly modeling future observations and executable robot actions. However, most existing WAMs still operate in 2D video or latent spaces, where visually plausible rollouts miss the 3D spatial constraints and occluded contact geometry required for precise manipulation. While geometric foundation models offer strong priors for recovering dense 3D structure and motion from visual observations, forcing WAMs to predict the dense 4D representation introduces costly geometric decoding and slows down causal action generation. To address the trade-off, we present WAM4D, a fast 4D world action model that uses lightweight spatial register tokens as training-time future-depth readouts to transfer pretrained geometric priors into a causal video-action transformer, then removes the register branch for lightweight action inference. To prevent non-causal shortcuts, we further design causal mixture attention for the Mixture-of-Transformers (MoT) WAM backbone, defining modality-specific visibility among video, action, and geometry tokens. Comprehensive experiments on RoboTwin 2.0 and challenging real-world manipulation tasks show that WAM4D improves spatial consistency and achieves competitive action prediction while maintaining efficient inference.

10.
arXiv (CS.LG) 2026-06-16

Amortized mean-shift interacting particles

Authors:

arXiv:2606.15871v1 Announce Type: cross Abstract: Bayesian inference for inverse problems is run to evaluate integrals – posterior expectations, tail probabilities, and risks – across a stream of observations. The standard estimate averages the integrand over posterior samples, a Monte-Carlo average whose error decays only as the square root of the sample size, so accuracy demands many samples – prohibitive when each one calls a partial-differential-equation forward model. Mean-shift interacting particles need far fewer: they return a small set of signed-weight nodes – a deterministic quadrature whose weighted averages estimate those integrals. Finding the nodes, however, is a per-observation optimization that, in its most accurate form, reads the posterior score at every step – returning the cost it meant to save. We introduce amortized mean-shift interacting particles, a learned map that emits the weighted nodes from an observation and a few posterior samples in a single forward pass. Training asks only for joint parameter-observation samples and a posterior to draw from – a conditional normalizing flow, an empirical conditional, or any reference the user can sample – and the map learns to integrate that posterior from samples alone, evaluating neither its density nor its score. Once trained, it generalizes to unseen observations and integrands at any node budget and improves on independent samples in two ways: by reweighting them, provably no worse than the equal weights of Monte-Carlo; and by moving them, which empirically lowers it further. Across closed-form, sampled, learned, and physics-based posteriors – up to a thousand-coefficient groundwater field – it integrates more accurately than the same number of samples at every budget, and a posterior-whitened, dimension-aware kernel removes the high-dimensional wall. The result is a Pareto improvement on Monte-Carlo integration, not a competitor to drawing more samples.

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

Generalized Schrödinger Bridge on Graphs

arXiv:2602.04675v2 Announce Type: replace Abstract: Transportation on graphs is a fundamental challenge across many domains, where decisions must respect topological and operational constraints. Despite the need for actionable policies, existing graph-transport methods lack this expressivity. They rely on restrictive assumptions, fail to generalize across sparse topologies, and scale poorly with graph size and time horizon. To address these issues, we introduce Generalized Schrödinger Bridge on Graphs (GSBoG), a novel scalable data-driven framework for learning executable controlled continuous-time Markov chain (CTMC) policies on arbitrary graphs under state cost augmented dynamics. Notably, GSBoG learns trajectory-level policies, avoiding dense global solvers and thereby enhancing scalability. This is achieved via a likelihood optimization approach, satisfying the endpoint marginals, while simultaneously optimizing intermediate behavior under state-dependent running costs. Extensive experimentation on challenging real-world graph topologies shows that GSBoG reliably learns accurate, topology-respecting policies while optimizing application-specific intermediate state costs, highlighting its broad applicability and paving new avenues for cost-aware dynamical transport on general graphs.

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

Least-Action-Guided Diffusion for Physical Extrapolation

arXiv:2606.11277v1 Announce Type: new Abstract: Reliable extrapolation remains a central challenge for generative models in computational physics, because models trained over finite ranges of time, parameters, or geometries may produce physically inconsistent predictions outside the training distribution. We introduce a least-action-principle-guided diffusion, LAPG, a framework that promotes physical consistency during inference rather than relying solely on constraints imposed during training. The method combines a conditional score-based diffusion model with an action-derived physical guidance score. In the first stage, the learned score model generates an in-distribution proposal; in the second, an action-based variational prior refines this proposal toward the target out-of-distribution condition. This formulation turns the principle of least action into a differentiable inference-time correction mechanism and provides an alternative to pointwise residual penalties that often require empirical loss balancing. We evaluate LAPG on representative ordinary- and partial-differential-equation systems, including free fall, conservative and dissipative spring-mass dynamics, interacting point vortices, and potential flow over parameterized airfoils. In temporal, parameter, and geometric extrapolation tests, LAPG reduces phase drift, preserves dissipative decay, captures vortex motion, and improves the lift response of airfoil flows compared with training-time physics-informed baselines.

13.
medRxiv (Medicine) 2026-06-22

Image-based deep learning for emergency electrocardiogram classification

Automated electrocardiogram analysis has advanced largely through digital waveforms, yet many emergency-care workflows rely on ECGs available only as printed tracings, scanned reports, PDFs or mobile photographs. We developed an image-based deep learning system for emergency ECG classification and evaluated it in InCor-EMG, an expert-adjudicated dataset of 18,519 emergency ECGs spanning 12 ECG categories, with labels from 19 cardiologists. On the held-out test set, the final ConvNeXt ensemble achieved a macro F1-score of 0.807 (95% CI, 0.788-0.825), compared with 0.820 (95% CI, 0.805-0.832) for annotating cardiologists, and higher F1-scores than Mortara Veritas in most evaluated categories. Performance was associated more strongly with inter-reader agreement than with training sample size and remained informative across scanned and photographed ECGs, with supportive performance in model-enriched temporal and heterogeneous public-image evaluations. These findings support ECG image classification when digital waveforms are unavailable.

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

Motion-Focused Latent Action Enables Cross-Embodiment VLA Training from Human EgoVideos

Training generalist Vision-Language-Action(VLA) models typically requires massive, diverse robotic datasets with high-fidelity action annotations. While egocentric human manipulation videos are abundant and capture significant environmental diversity, the absence of action labels makes them difficult to use in conventional training paradigms. To address this, we propose a latent-action-based framework designed to extract general action priors from unlabeled human videos. The architecture features a Hybrid Disentangled VQ-VAE that decouples motion dynamics from environmental backgrounds through physical masks, enabling the construction of a cross-embodiment action codebook. By pre-training on human videos with the codebook, the VLM backbone learns deep representations of action intent. For adaptation to specific embodiments, we introduce an intent-perception decoupling strategy where the VLM predicts the action intent while a separate frozen visual encoder provides state-specific features to the action expert, thereby reducing action hallucinations. Results in simulation and real-world environments show that our method, pre-trained exclusively on unlabeled human videos, performs competitively with state-of-the-art VLA models trained on massive annotated datasets, requiring only 50 trajectories for downstream adaptation.

15.
arXiv (quant-ph) 2026-06-16

Against probability: A quantum state is more than a list of probability distributions

arXiv:2601.18872v2 Announce Type: replace Abstract: The state of a quantum system can be represented by listing the outcome probabilities for a tomographically complete set of measurements. Such representations appear throughout physics, for example, in quantum field theory via correlation functions and in quantum foundations within generalized probabilistic frameworks. In this paper, we show a no-go result: To enable useful statements, the probability representation must be topologically robust$\unicode{x2014}$preserving the notion of closeness between states. Yet, a topologically robust probability representation cannot simultaneously retain other essential structure, such as the subsystem structure.

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

Are We Ready For An Agent-Native Memory System?

Memory for large language model (LLM) agents has rapidly evolved from simple retrieval-augmented mechanisms into a data management system that supports persistent information storage, retrieval, update, consolidation, and dynamic lifecycle governance throughout agent execution. Despite this evolution, existing evaluations still benchmark agent memory mainly through end-to-end task success metrics (e.g., F1, BLEU), while treating the underlying system as a monolithic black box. As a result, critical system-level concerns, including operational costs, architectural trade-offs across memory modules, and robustness under dynamic knowledge updates, remain insufficiently explored. In this paper, we present a systematic experimental study of agent memory from a data management perspective. We propose an analytical framework that decomposes agent memory into four core modules: memory representation and storage, extraction, retrieval and routing, and maintenance. Under this framework, we evaluate 12 representative memory systems and two reference baselines across five benchmark workloads spanning 11 datasets. Our extensive end-to-end evaluation shows that no single architecture dominates across all scenarios; instead, effectiveness depends heavily on how well the memory structure aligns with the workload bottleneck. Furthermore, through fine-grained ablation studies, we quantify their individual effects on representation fidelity, retrieval precision, update correctness, and long-horizon stability. Finally, we reveal cost-performance trade-offs under realistic workloads, showing localized maintenance is more cost-efficient than global reorganization. Based on these findings, we identify promising directions towards building truly agent-native memory systems. The code is publicly available at https://github.com/OpenDataBox/MemoryData.

17.
arXiv (CS.LG) 2026-06-11

Apertus LLM Family Expansion via Distillation and Quantization

arXiv:2605.29128v2 Announce Type: replace Abstract: The wide adoption of LLMs has led to their use in great variety of applications and scenarios, such as chatbot assistants and data annotation, creating the need for the models to satisfy certain budget and hardware constraints. This has led to the trend of LLMs being released in batches consisting of similar models of various sizes for the family of models to adhere to as wide of a range of constraints as possible. In this paper, we validate distillation and quantization as a cost-effective way to expand model families to new sizes and hardware formats. Based on the open-recipe Apertus 8B LLM, we produce Apertus-v1.1 - a distilled family of models with up to 4B parameters trained on 1.7T permissive license tokens. We demonstrate cost-efficiency and strong accuracy performance of our approach for covering large ranges of hardware and systems requirements.

18.
arXiv (quant-ph) 2026-06-19

General circuit mapping algorithm for neutral atom quantum computers

arXiv:2606.20503v1 Announce Type: new Abstract: Neutral atom quantum computers (NAQC) are emerging as a promising, scalable quantum computing platform because of their long qubit coherence, flexible qubit arrangement, and multiqubit gate capabilities. However, circuit execution often requires physically moving qubits, making compilation a critical optimization challenge. We propose a circuit independent mathematical framework built on graph-theoretic combinatorial optimization that determines the minimal number of required qubit transfers. This model captures spatial constraints specific to NAQC platforms with zone-limited gate operations and multi-qubit gates. From this framework, we encode the qubit mapping problem as a nonlinear integer program and solve it using a genetic algorithm, enabling trade-offs between minimizing the total traveled distance and the number of parallel transfer operations. Compared to the state-of-the-art scalable compiler for zoned architectures, our approach consistently finds fewer transfers. Depending on the optimization focus, our method produces shorter traveled distances or fewer parallel transfer operations. This work provides both theoretical guaranties and a practical tool for efficient, architecture-aware quantum circuit compilation. As a result, practitioners can generate hardware-aware mappings that reduce movement-induced errors and better exploit atom transfer parallelism, directly improving execution efficiency on NAQC devices.

19.
arXiv (quant-ph) 2026-06-16

Light-induced nonadiabatic dissipative quantum dynamics of the Na2 molecule

arXiv:2606.15292v1 Announce Type: new Abstract: Strong light-matter coupling between molecules and optical or plasmonic cavity modes has emerged as a promising platform for advancing photonics, materials science, and chemistry. However, optical cavities and plasmonic resonators in particular are inherently lossy systems characterized by finite photon lifetimes. Accurate theoretical descriptions of molecular dynamics under strong coupling therefore require a proper treatment of cavity losses. In this work, we compare three theoretical approaches for modeling dissipative molecule-cavity dynamics within a realistic parameter regime: the Lindblad master equation, the stochastic Schrödinger equation, and the non-Hermitian Schrödinger equation. As an example, we consider the two lowest energy state of Na2 molecule coupled to a cavity mode and analyze the time evolution of the excited-state population and the mean photon number. Our results demonstrate that the stochastic Schrödinger equation provides an accurate and computationally efficient alternative to the Lindblad master equation, while the non-Hermitian Schrödinger approach is found to be applicable only within a limited range of conditions. Furthermore, we show that inclusion of molecular rotation leads to rotational-vibrational-photonic coupling and gives rise to pronounced nonadiabatic dynamics through light-induced conical intersections. These findings highlight the importance of both dissipation and rotational degrees of freedom for a realistic description of molecular dynamics in strongly coupled molecule-cavity systems.

20.
arXiv (CS.CL) 2026-06-11

Context-Aware Multimodal Claim Verification in Spoken Dialogues

Every day, millions absorb claims from podcasts and streams that no fact-checker ever sees. Spoken misinformation is built through conversation, where credibility comes not from facts alone but from how claims are framed, reinforced, or left unchallenged across turns. Yet fact-checking has focused on isolated text, leaving dialogue audio under-studied. We introduce MAD2, a new Multi-turn Audio Dialogues benchmark for spoken claim verification, containing 1,000 two-speaker dialogues with 3,368 check-worthy claims and approximately 10 hours of audio, and propose calibrated multimodal fusion of a context-aware audio encoder and a dialogue-aware text model. Across settings, adding dialogue context improves verification, but the gains depend on scenario type. Using only preceding context often matches offline performance, supporting live-moderation settings, and audio contributes most when transcript-based models are destabilized by additional context. Overall, conversational structure matters more for verification than misinformation framing.

21.
arXiv (CS.CL) 2026-06-16

Evaluating the Robustness of Proof Autoformalization in Lean 4

Proof autoformalization aims to translate a mathematical informal proof written in natural language into a formal proof in a formal language such as Lean~4. Several works have developed LLM-based models for proof autoformalization. However, existing evaluations have typically focused on translating well-formed informal proofs from curated datasets. We argue that a robust proof autoformalizer must remain faithful even for informal proofs that diverge from these idealized ones, and we present the first study on the robustness of proof autoformalization models. We formulate two categories of perturbations and evaluate robustness under each: a global perturbation paraphrases the informal proof in a different style, under which the formalization should remain consistent; a local perturbation alters a value, symbol, or proof step, possibly in a counterfactual way, and a robust formalization should faithfully reflect the perturbation rather than reverting to the original one or inferring a different one on its own. We build a benchmark with both perturbations on miniF2F and MATH-500, and automatically measure how stable a proof autoformalization's correctness is under global perturbations and how faithfully its output reflects local perturbations. We evaluate seven recent models, all of which are sensitive to global perturbations and mostly fail to remain faithful under local perturbations. Code and data are available via https://github.com/ucr-rai/robust-proof-autoformalization.

22.
medRxiv (Medicine) 2026-06-22

The direct economic impact of surgical non-response in orthopaedic hip, knee, and spine surgery for osteoarthritis: a cost-utility analysis

Background Annually, nearly 2 million hip, knee, and spinal inpatient surgeries are performed in Canada and the US for osteoarthritis (OA), costing over $37 billion in hospital expenditures. However, 15-30% of patients experience limited or no improvement, resulting in poor value for money. This study evaluated the one-year cost-utility of joint and spine procedures for OA by comparing non-responders to responders, considering various responder definitions. Methods Individual micro-costing data were collected for 1,175 elective hip, knee, and spine patients enrolled in the Longitudinal Evaluation in the Arthritis Program - Osteoarthritis (LEAP-OA) between 2014 and 2018. Quality-adjusted life years (QALYs) were derived using the SF-6D utility index. One-year incremental cost-utility ratios (ICURs) were calculated from the hospital perspective. Results Responder rates varied by definition, ranging from 78%-94% for hip replacements, 64%-90% for knee replacements, 60%-64% for spine fusions, and 50%-68% for spine decompressions. Corresponding ICURs were: $45,956-$51,773/QALY for responders versus $108,593-$485,762/QALY for non-responders for hip replacements; $54,831-$71,151/QALY for responders versus $200,486-$1,203,596/QALY for non-responders for knee replacements; $65,980-$74,422/QALY for responders versus $262,039-$729,686/QALY for non-responders for spine fusions; and $29,947-$42,168/QALY for responders versus $63,195-$662,586/QALY for non-responders for spine decompressions. Conclusions While surgical response rates were highly dependent on the responder definition, ICURs for non-responders were significantly higher than those for responders across all definitions. Beyond the negative impact on patients, there is a compelling economic argument for investment in improved pre-operative identification of patients at risk of surgical non-response. Such efforts could enable more personalized, value-based care pathways and reduce the provision of low-value surgical interventions.

23.
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.

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

SpatialWorld: Benchmarking Interactive Spatial Reasoning of Multimodal Agents in Real-World Tasks

Spatial reasoning is a foundational capability for multimodal large language models (MLLMs) to perceive and operate within the physical world. However, existing benchmarks predominantly rely on passive evaluation (e.g., static VQA) or simulator-specific pipelines, failing to assess general interactive spatial understanding. We introduce SpatialWorld, a unified benchmark designed specifically for evaluating the interactive spatial understanding of multimodal agents in complex real-world tasks. Integrating eight heterogeneous simulation backends under a shared, simulator-agnostic protocol, SpatialWorld features 760 human-annotated tasks across diverse domains (e.g., household routines, travel, social collaboration). Agents must solve tasks under vision-only partial observability, actively gathering egocentric visual evidence and expressing decisions via a unified, text-based action interface native to MLLMs. For reliable evaluation, each task includes a human-validated initial state, a reference trajectory, and a terminal-state verifier. Evaluating 15 advanced agents reveals that robust spatial task solving remains challenging: the strongest model, GPT-5, achieves an average task success rate (TSR) of only 17.4%, while the leading open-source model, Qwen-3.5, reaches 14.1%. Further analysis exposes a clear mismatch between task success and execution efficiency, alongside substantial domain-specific performance variations. These bottlenecks in active exploration and long-horizon planning position SpatialWorld as a rigorous testbed for future spatial agents.

25.
arXiv (CS.AI) 2026-06-11

Generalizing Beyond Suboptimality: Offline Reinforcement Learning Learns Effective Scheduling through Random Solutions

arXiv:2509.10303v2 Announce Type: replace-cross Abstract: Online reinforcement learning (RL) approaches have demonstrated strong performance on Job Shop Scheduling (JSP) and Flexible JSP (FJSP) problems by learning scheduling policies through direct interaction with simulated environments. However, these methods often require extensive training interactions, limiting their sample efficiency and practical applicability. Motivated by this challenge, we introduce Conservative Discrete Quantile Actor-Critic (CDQAC), an offline RL algorithm that learns effective scheduling policies directly from static, suboptimal datasets. CDQAC couples a quantile-based critic with delayed policy updates to estimate the return distribution of machine-operation pairs. Extensive experiments on JSP and FJSP benchmarks demonstrate that CDQAC consistently outperforms the data-generating heuristics, surpasses state-of-the-art offline and online RL baselines, and is highly sample efficient, requiring only 1 to 5% of the original dataset to learn high-quality policies. Our analysis suggests that, in scheduling, offline RL performance is governed mainly by state-action coverage rather than the quality of individual trajectories. Scheduling couples a dense reward aligned with the makespan objective with equal-length trajectories across heuristics, enabling effective learning from a broad range of behaviors. Consistent with this observation, datasets generated by a simple random heuristic with broader coverage let it outperform policies trained on datasets produced by stronger heuristics such as Genetic Algorithms.