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01.
arXiv (CS.AI) 2026-06-12

Emotional regulation improves deep learning-based image classification

arXiv:2606.13081v1 Announce Type: cross Abstract: Emotion significantly influences cognition, enhancing memory and learning under certain conditions. Drawing on this principle, emotion-augmented deep learning investigates how affective states can improve neural network architectures and learning paradigms, achieving better generalization than non-emotional models. However, existing methods often rely solely on objective neurophysiological factors, neglecting the role of subjectivity in emotion. To bridge this gap, the present study introduces Emotional Regulation, a novel framework for modeling emotion in deep learning through artificial subjective experience. The method employs pre-training based on affective stimuli, balancing non-emotional and emotionally-influenced responses in downstream task optimization. Extensive experimentation was conducted in image classification, pre-training ResNet and ViT architectures on four emotional datasets, using CIFAR-10 and -100 as target benchmarks. Results reveal improvements over the aforementioned backbones, providing evidence of Emotional Regulation as a promising method for defining emotion-augmented deep learning through artificial subjective experience. Furthermore, the proposed approach overcomes the related work in image classification based on CIFAR, revealing Emotional Regulation as the new state-of-the-art in emotion-augmented deep learning for large-scale vision datasets. The study also enforces evidence of the impact of affective states in improving machine learning tasks' optimization, encouraging further investigation on emotion-inspired architectures.

02.
medRxiv (Medicine) 2026-06-12

Metastatic Patterns and Treatment Characteristics of Triple-Negative Breast Cancer in Nigeria: A Retrospective Cohort Study

Background: Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype characterized by the absence of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression. It is associated with limited targeted treatment options, early relapse, and a high propensity for visceral metastasis. Data describing metastatic patterns and treatment characteristics of TNBC in Nigeria remain limited. Methods: This retrospective descriptive cohort study included 869 patients with TNBC managed at the Medserve-LUTH Cancer Center, Lagos University Teaching Hospital, Nigeria between June 2019 and June 2024. Demographic, clinicopathologic, metastatic, and treatment-related data were extracted from electronic medical records. Descriptive statistics were used to summarize patient characteristics, metastatic patterns, and treatment profiles. Associations between metastatic disease and selected clinicopathologic and treatment variables were explored using Pearsons chi-square test. Complete-case analysis was applied throughout. Results: The mean age at presentation was 52.09 {+/-} 12.26 years. Most patients were married (79.1%), postmenopausal (64.3%), and of Yoruba ethnicity (56.8%). Advanced disease predominated, with Stage III and Stage IV disease accounting for 42.9% and 35.6% of cases, respectively. Invasive ductal carcinoma was the most common histologic subtype (77.0%), while Grade II tumours constituted 51.3% of graded cases. Surgery was performed in 73.1% of patients, predominantly mastectomy (70.9% of surgical procedures). Chemotherapy was administered to 83.2% of patients, most commonly anthracycline-based regimens (41.8%), while radiotherapy was delivered to 63.5% of patients, with hypofractionated schedules of 42-43 Gy in 15-16 fractions accounting for 47.2% of radiotherapy courses. Metastatic disease was documented in 32.9% of evaluable patients. Lung metastasis was the most frequent site (62.5%), followed by bone (46.3%), regional lymph node invasion (38.5%), liver (23.0%), and brain (22.6%). Tumour grade and histologic subtype were not significantly associated with metastatic disease, whereas radiotherapy exposure demonstrated a significant association with metastatic status ({chi}{superscript 2} = 10.35, p = 0.001). Conclusion: TNBC in this Nigerian cohort was characterized by advanced-stage presentation, invasive ductal predominance, extensive use of multimodality treatment, and substantial visceral metastatic burden. Lung metastasis was the most common metastatic site. These findings provide contemporary real-world data on TNBC in Nigeria and highlight the continuing need for earlier diagnosis, timely referral, and sustained investment in comprehensive cancer care services.

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

Benign overfitting beyond prediction: The ordinary least squares interpolator

arXiv:2309.15769v3 Announce Type: replace-cross Abstract: Recent advances in deep learning have highlighted the phenomenon of benign overfitting in overparameterized statistical models, sparking significant interest in understanding its foundations. Owing to its simplicity and practical relevance, the ordinary least squares (OLS) interpolator has become a key object of study for gaining theoretical insight into this phenomenon. While the properties of OLS are well understood in classical underparameterized settings, its behavior in the overparameterized regime – unlike that of ridge regression or the lasso – remains comparatively less explored. We contribute to this growing literature by deriving new algebraic and statistical results for the minimum $\ell_2$-norm OLS interpolator. In contrast to much of the existing work, which focuses on prediction risk, we center our analysis on parameter estimation and inference, which are fundamental for many statistics and causal inference applications. Specifically, we establish overparameterized analogues of (i) the leave-$k$-out formulas, (ii) the omitted variable bias formula, and (iii) the Frisch-Waugh-Lovell theorem. Under the Gauss-Markov model, we further extend the Gauss-Markov theorem and analyze variance estimation under homoskedasticity in the overparameterized setting. Collectively, these results provide a systematic framework for studying parameter estimation and inference in overparameterized linear models, offering a novel perspective on benign overfitting beyond its implications for prediction.

04.
arXiv (quant-ph) 2026-06-12

Schrödinger Symmetry in Spherically-symmetric Static Mini-superspaces with Matter Fields

arXiv:2512.13651v3 Announce Type: replace-cross Abstract: Schr\"{o}dinger symmetry has been shown to emerge in a ``fluid limit" from the full superspace to several mini-superspace models. To investigate one aspect of the robustness of this emergent symmetry, we consider two spherically-symmetric static mini-superspace models with matter fields at the classical level: (i) a Maxwell field with a cosmological constant and (ii) $n$ massless scalar fields. By developing a method based on canonical transformations, we demonstrate that for model (i), 3D Schrödinger symmetry emerges, and the solution is the (anti-)de Sitter Reissner-Nordström spacetime, and for model (ii), $(2+n)$D Schrödinger symmetry appears, and the solution is a generalized Janis-Newman-Winicour spacetime and its ``interior", a Kantowski-Sachs type closed universe. Furthermore, for the vacuum model, we find that 2D Schrödinger symmetry holds with different lapse functions and mini-superspace coordinates, suggesting the potential, yet unconfirmed, covariance of the symmetry. Finally, we propose a physical interpretation of the symmetry under the Hamiltonian constraint $H$: symmetry generators commuting with $H$ map a solution to another one, while those non-commuting with $H$ generate a new theory with the Schrödinger symmetry and the transformed configuration is a solution to the new theory. These results reinforce the robustness of the emergent Schrödinger symmetry and open new frontiers for exploring dynamics of matter and gravity.

05.
arXiv (CS.AI) 2026-06-17

Temporal Motif-aware Graph Test-time Adaptation for OOD Blockchain Anomaly Detection

arXiv:2605.29526v2 Announce Type: replace-cross Abstract: Ever-evolving transaction patterns have significantly hindered anomaly detection on emerging cryptocurrency blockchains due to the vast number of addresses and diverse anomalous behaviors. Recently, advanced Graph Anomaly Detection (GAD) approaches applied to blockchains have faced two critical challenges: adversarial pattern evolution by malicious actors and the out-of-distribution (OOD) problem caused by varied transaction semantics on blockchains. To address these challenges, we propose a novel framework termed TEmporal Motif-aware Graph Test-Time Adaptation (TEMG-TTA). First, we comprehensively capture the 3-node temporal motif distribution of each active address using an efficient computational mechanism, enabling downstream temporal motif-aware graph learning. Second, we design a simple yet effective test-time adaptation strategy to facilitate the sharing of common patterns between training and testing graphs. Extensive experiments on 5 real-world datasets demonstrate that our proposed TEMG-TTA outperforms state-of-the-art GAD approaches by an average of 54.88\%. A further case study on interpretable motif patterns reveals that TEMG-TTA explicitly characterizes the complex transaction patterns of anomalous addresses, thereby verifying the effectiveness of our technical designs. Our code is publicly available at https://github.com/LuoXishuang0712/TEMG-TTA/.

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

Independent-Component-Based Encoding Models of Brain Activity During Story Comprehension

Encoding models provide a powerful framework for linking continuous stimulus features to neural activity; however, traditional voxelwise approaches are limited by measurement noise, inter-subject variability, and redundancy arising from spatially correlated voxels encoding overlapping neural signals. Here, we propose an independent component (IC)-based encoding framework that dissociates stimulus-driven and noise-driven signals in fMRI data. We decompose continuous fMRI data from naturalistic story listening into ICs using one subset of the data, and train encoding models on independent data to predict IC time series from large language model representations of linguistic input. Across subjects, a subset of ICs exhibited consistently high predictivity. These ICs were spatially and temporally consistent across subjects and included cognitive networks known to respond during story listening (auditory and language). Auditory component time series were strongly correlated with acoustic stimulus features, highlighting the interpretability of identified component time series. Components identified as noise or motion-related artifacts by ICA-AROMA showed uniformly poor predictive performance, confirming that highly predicted components reflect genuine stimulus-related neural signals rather than confounds. Overall, IC-based encoding models enable analyses at the level of functional networks, accommodating the variability in network locations across individuals and providing interpretable results that are easy to compare across subjects. Code provided at: https://github.com/kamyahari/IC-Encoding-Models.git

07.
arXiv (math.PR) 2026-06-19

Finite-Sample Bounds for Expected Signature Estimation under Weak Dependence

arXiv:2605.20541v2 Announce Type: replace-cross Abstract: The expected signature uniquely determines the law of a random rough path under a moment-growth condition, yet finite-sample bounds for estimating its truncations from a single long dependent trajectory remain unavailable. We study a strictly stationary stochastic process equipped with a geometric rough-path lift, observed in non-overlapping blocks of equally-spaced samples, and prove a non-asymptotic mean-squared error (MSE) bound for the block-averaging estimator of its truncated expected signature. Under moment and stationarity assumptions together with a direct covariance-decay condition on block signatures – strictly weaker than $\alpha$-mixing and applicable to long-range-dependent processes – the error separates into a discretization term and a fluctuation term, with rates determined respectively by path regularity and dependence strength. A levelwise rough-factorial variance analysis keeps finite-truncation constants explicit and yields an optimal allocation rule under a fixed observation budget. We verify the assumptions for independent-coordinate fractional Ornstein–Uhlenbeck processes in three regimes: short-range (Hurst $1/41/2$. Monte Carlo experiments show empirical slopes steeper than the guaranteed upper-bound rates.

08.
arXiv (CS.CL) 2026-06-15

DLawBench: Evaluating LLMs Through Multi-Turn Legal Consultation

Lawyer-client consultation is a critical starting point for legal services. Effective legal assistance hinges on eliciting sufficient and truthful information from clients in order to devise strategies that best protect their interests. This task requires Large Language Models (LLMs) not only to perform robust legal reasoning, but also to strategically elicit material facts through multi-turn interactions and effectively guide clients with diverse personalities. Yet existing legal benchmarks overlook this interactive capability. To fill this gap, we introduce DLawBench, a diagnostic benchmark for real-world legal consultation. Drawing on realistic client behavior, we characterize lawyer-client interactions into four types: Cooperative, Dependent, Withdrawn, and Adversarial. Using dialogues grounded in real cases, DLawBench evaluates whether LLMs can effectively conduct legal consultation under realistic conditions. DLawBench comprises 461 cases from Chinese and U.S. law, 5,532 paired fact entries, 3,411 inquiry rubrics, and 3,348 issue-resolution rubrics, and evaluates 26 representative LLMs. Systematic experiments show substantial headroom: the best-performing model, GPT-5.5, achieves only 0.562 on consultation-grounded legal reasoning. More importantly, DLawBench exposes both sycophancy in legal consultation and a paradox: models perform worse when clients need guidance most.

09.
medRxiv (Medicine) 2026-06-18

Guiding the development of climate counterfactuals for health impact attribution studies

Climate change detection and attribution (D&A) methods have become vital for quantifying the influence of anthropogenic forcing on the Earth's systems, including human health. Health impact attribution (HIA) studies seek to disentangle climate-driven health effects from natural variability yet are often constrained by the availability of accessible counterfactual climate scenarios. This tutorial paper presents a flexible, reproducible framework for developing counterfactual climates without reliance on computationally intensive global circulation models. We provide practical, R-based methodologies for constructing both trend-based (temperature and non-temperature) and event-based counterfactual, using a variety of techniques including model residual detrending, data-driven decomposition (e.g., Singular Spectrum Analysis and Empirical Mode Decomposition) and stochastic weather generators. The tutorial also explores the incorporation of greenhouse gas concentrations as forcing variables, rather than global mean temperature anomalies. By operationalising these methods through worked examples and an open code repository, this paper aims to build capacity within the HIA community, enhance methodological transparency, and foster interdisciplinary collaboration between climate and health researchers.

10.
arXiv (CS.AI) 2026-06-18

PosterForest: Hierarchical Multi-Agent Collaboration for Scientific Poster Generation

arXiv:2508.21720v3 Announce Type: replace Abstract: Automating scientific poster generation requires hierarchical document understanding and coherent content-layout planning. Existing methods often rely on flat summarization or optimize content and layout separately. As a result, they often suffer from information loss, weak logical flow, and poor visual balance. We present PosterForest, a training-free framework for scientific poster generation. Our method introduces the Poster Tree, a structured intermediate representation that captures document hierarchy and visual-textual semantics across multiple levels. Building on this representation, content and layout agents perform hierarchical reasoning and recursive refinement, progressively optimizing the poster from global organization to local composition. This joint optimization improves semantic coherence, logical flow, and visual harmony. Experiments show that PosterForest outperforms prior methods in both automatic and human evaluations, without additional training or domain-specific supervision.

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

Optimal Scheduling in a Question-Answering Forum of Knowledge Workers

arXiv:2606.19759v1 Announce Type: new Abstract: As individuals turn to the Internet to find answers to questions they may have, several Question Answering (QA) forums have evolved, where users knowledgeable in certain topics can contribute their expertise to answering these requests for information. While these are currently volunteer based, we consider a future version employing knowledge workers who are experts in certain topics. In such a system, the request-answer processes forming the queuing system may utilize schedulers that assign requests in different topics to the experts in the forum, who may be able to answer them according to their expertise levels in different topics. With this model, we calculate the capacity of the system for handling the requests while keeping the system stable, and design schedulers that achieve capacity. We also investigate how collaboration between experts in answering requests can potentially increase capacity.

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

Local-GS: Accelerating 3D Gaussian Splatting via Tile-Local Warp Coherence

3D Gaussian Splatting (3DGS) has significantly advanced real-time novel view synthesis by representing scenes as dense collections of anisotropic 3D Gaussian primitives. However, the irregular spatial distribution of Gaussians often leads to poor GPU utilization, as warp divergence and redundant computation degrade rendering performance. To address this, we present Local-GS, a warp-coherent rendering paradigm that, organizes Gaussian primitives with respect to SIMT (Single Instruction, Multiple Threads) execution boundaries rather than scene geometry. Specifically, we propose three warp-coherent stages: a hoisting stage that precomputes shared parameters at tile level, a culling stage that discards warps with no contribution, and a blending stage that replaces per-pixel branching with a uniform instruction stream. Across extensive benchmarks on multiple datasets, Local-GS improves efficiency without compromising quality. As a plug-and-play optimization, it provides additional performance gains to all tested baselines, culminating in a $7.76\times$ speedup on Deep Blending scenes.

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

SkillWiki: A Living Knowledge Infrastructure for Agent Skills

While knowledge is managed through Wikipedia and software through GitHub, agent skills still lack an infrastructure for large-scale production, governance, and evolution. SkillWiki is a living knowledge infrastructure that supports the organization, grounding, and continuous evolution of agent skills by transforming heterogeneous knowledge into reusable skill assets linked to their originating evidence. Our demonstration presents the complete skill lifecycle, from knowledge ingestion and skill production to provenance-aware exploration, governance, and execution-driven evolution. SkillWiki highlights a future in which knowledge, skills, and execution experience co-evolve within a shared infrastructure. The live demonstration and source code are publicly available at https://github.com/Huangdingcheng/SkillWiki.

14.
arXiv (CS.CV) 2026-06-17

RAIGen: Rare Attribute Identification in Text-to-Image Generative Models

Text-to-image diffusion models achieve impressive generation quality but inherit and amplify training-data biases, skewing coverage of semantic attributes. Prior work addresses this in two ways. Closed-set approaches mitigate biases in predefined fairness categories (e.g., gender, race), assuming socially salient minority attributes are known a priori. Open-set approaches frame the task as bias identification, highlighting majority attributes that dominate outputs. Both overlook a complementary task: uncovering rare or minority features underrepresented in the data distribution (social, cultural, or stylistic) yet still encoded in model representations. We introduce RAIGen, the first framework, to our knowledge, for label-free rare-attribute discovery in diffusion models, requiring no predefined minority categories. RAIGen leverages Matryoshka Sparse Autoencoders and a novel minority metric combining neuron activation frequency with semantic distinctiveness to identify interpretable neurons whose top-activating images reveal underrepresented attributes. Experiments show RAIGen discovers attributes beyond fixed fairness categories in Stable Diffusion, scales to larger models such as SDXL, supports systematic auditing across architectures, and enables targeted amplification of rare attributes during generation. The project page is available at https://vssilpa.github.io/RAIGen_webpage/ .

15.
arXiv (CS.CV) 2026-06-16

RealityBridge: Bridging Editable 3D Gaussian Splatting Driving Simulations and Real-World Videos

Long-tail hazardous scenarios are essential for safety-oriented autonomous driving, yet they are difficult to collect and reproduce at scale. Editable 3D Gaussian Splatting (3DGS) simulation offers a promising alternative by reconstructing real driving scenes and supporting controllable scene editing. However, edited 3DGS-rendered videos still suffer from a significant Sim-to-Real gap, including rendering artifacts, degraded foreground assets, inconsistent illumination, and temporal flickering. Existing restoration and video generation methods are insufficient for this task, as they often fail to jointly repair 3DGS-specific artifacts, improve visual realism, and ensure temporal consistency. To fill this gap, we propose RealityBridge, a structure-preserving and asset-aware Sim-to-Real framework for edited 3DGS driving videos. RealityBridge uses multimodal controls, including rendered videos, foreground masks, edge maps, and semantic masks, together with a lightweight GateNet for adaptive condition allocation across backbone layers. We further construct targeted training data and introduce autoregressive long-video training with reward-guided post-training to improve restoration quality, temporal stability, and hallucination suppression. Extensive experiments on internal and public driving datasets show that RealityBridge outperforms existing methods in artifact removal, illumination harmonization, and long-sequence temporal consistency.

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

Folded Transport MCMC: Eliminating Label Switching by Sampling on a Fundamental Domain

Authors:

arXiv:2606.04307v2 Announce Type: replace Abstract: In Bayesian mixture models and other exchangeable-component models, the posterior is invariant under permutation of component labels, creating m! equivalent modes-the label-switching problem. Standard MCMC methods either mix poorly across these modes or rely on post-hoc relabelling that cannot guarantee the sampler has converged. We propose Folded Transport MCMC (FolT-MCMC), which eliminates label switching before sampling by restricting the Markov chain to a fundamental domain-a sorted or reflected subspace containing exactly one representative from each symmetric mode. The proposal is a learned normalising flow whose density is symmetrised over the group orbits, ensuring correct targeting on the reduced space. We show that this construction preserves a computable convergence diagnostic based on the oscillation of the log-density ratio, and that the diagnostic becomes sharper on the fundamental domain whenever the original-space flow under-covers one or more symmetric modes. Experiments on Gaussian mixtures (d=2-20), label-switching targets (up to 24 equivalent modes), a standard Bayesian three-component mixture posterior, and real accelerometer data from a supertall building show improvement ratios of 2x to 145x, with the folded diagnostic stable across dimensions while the unfolded diagnostic collapses.

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

X-Tokenizer: A Multimodal Action Tokenizer for Vision-Language-Action Pretraining

Modern Vision-Language-Action (VLA) models must bridge pretrained vision-language reasoning and precise continuous robot control. Existing action tokenizers discretize actions primarily for reconstruction, producing codes that preserve motion geometry but provide only weak semantic supervision to the backbone. We therefore formulate action tokenization not as mere compression, but as semantic interface learning between multimodal reasoning and executable control. To this end, we introduce X-Tokenizer, a lightweight encoder-Semantic Residual Quantization (SRQ)-decoder architecture that provides a shared action interface across diverse robotic arm embodiments. Its key component, SRQ, imposes an asymmetric structure on residual vector quantization: the first level is trained with Masked Action Modeling (MAM) to form a discrete action language that captures coarse motion intent, while deeper levels remain reconstruction-oriented residuals that preserve fine-grained details. To further align action tokens with multimodal semantics, X-Tokenizer is pretrained with contrastive alignment to the representation space of a pretrained foundation model and with next-frame vision-language feature prediction. Pretrained on 2.4M trajectories (2.0B action frames), a single frozen X-Tokenizer plugs into a mixed discrete-continuous VLA as a representation-shaping supervision signal. X-Tokenizer achieves top real-world aggregate and strong RoboTwin 2.0 simulation results. Outperforming FAST in multimodal grounding (+13.5%) and long-horizon tasks (+8.25), it shows that action tokenizers serve as semantic interfaces for VLA pretraining beyond mere action compression.

18.
arXiv (quant-ph) 2026-06-12

Matrix phase-space representations for gaussian boson sampling

arXiv:2503.12749v2 Announce Type: replace Abstract: We introduce coherent matrix phase-space distributions. These use conservation laws and symmetries to improve the accuracy and speed of quantum phase-space representations. As an example, this is applied to validation of low-loss Gaussian boson sampling (GBS) quantum computational advantage experiments, where classical generation of the random photon-number counts is exponentially hard. Large improvements in sampling errors are demonstrated compared to previous methods. Matrix phase-space representations also provide a large numerical speed-up, due to their (at worst) quadratic scaling, compared to other methods for validating total count probabilities of large-scale, low-loss GBS networks.

19.
arXiv (CS.CL) 2026-06-19

Scalable Training of Spatially Grounded 2D Vision-Language Models for Radiology

We study how to train visually grounded vision-language models (VLMs) for radiology without manual spatial annotations. We introduce RefRad2D, a large-scale bilingual (German/English) dataset of 1.2M CT and MR image-text pairs derived from clinical practice, with task-specific VQA and spatial grounding subsets generated automatically via LLM-based curation and automated segmentation. Trained on this data, our model RadGrounder jointly performs report generation, visual question answering, and spatial grounding via bounding-box detection or segmentation. On external VQA benchmarks (Slake, VQA-RAD), RadGrounder achieves competitive results with specialized medical VLMs. Adding our clinical data to the training mixture improves open-ended VQA over fine-tuning on the downstream datasets alone, showing the transferability of our dataset. Crucially, adding grounding supervision does not degrade language quality, enabling spatially verifiable outputs at no cost to VQA performance.

20.
PLOS Medicine 2026-06-09

Molecular Tumor Boards clinical impact on patient care and structural features: A systematic review and meta-analysis

Authors:

by Luigi Russo, Erika Giacobini, Nicolò Lentini, Tommaso Osti, Maud Kamal, Stefania Boccia, Roberta Pastorino Background Molecular Tumor Boards (MTBs) bring together multidisciplinary experts to translate genomic data into clinical decisions in oncology, however, their overall clinical impact remains unclear. The aim of this systematic review is to assess the clinical impact of MTB-recommended therapies on patients with cancer outcomes. Methods and findings In this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and CENTRAL up to July 2025. We included studies of any design, both single-arm studies and studies with a comparator group, that reported the clinical impact of MTBs in patients who received MTB-guided therapy. Meta-analyses were performed separately by study design, using hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS), relative risks (RRs) for objective response rate (ORR) and disease control rate (DCR), and pooled proportions for PFS ratio ≥1.3. All meta-analyses were conducted using random-effects models based on the inverse variance method. We evaluated the risk of bias using the RoB 2.0 for RCTs and ROBINS-I for non-randomized studies.From 6,846 records, 78 studies (9,195 patients; 4,569 treated per MTB recommendations) were included. MTB-guided therapies were associated with reduced risk of death (HR 0.87; 95% CI [0.76, 1.01]; p = 0.069; I2 = 0.0% in RCTs; 0.62 in retrospective studies) and disease progression (HR 0.73; 95% CI [0.64, 0.84]; p 

21.
medRxiv (Medicine) 2026-06-15

Dysplasia-Stratified Management of Barrett's Esophagus: An Incidence-Based U.S. Cost-Effectiveness Analysis

Authors:

Background and Aims Barrett's esophagus (BE) is the principal precursor of esophageal adenocarcinoma (EAC), whose incidence has risen sharply in Western countries since the 1960s. Effective, dysplasia stratified surveillance strategies are needed to prevent progression. This study evaluated the cost effectiveness of dysplasia stratified surveillance intervals and endoscopic eradication therapy (EET) across the BE spectrum. Methods We developed an incidence-based Markov state transition model of BE progression calibrated to U.S. epidemiologic data from a healthcare sector perspective over a lifetime horizon. Four hypothetical cohorts of 50-year-old individuals with short segment BE (SSBE), nondysplastic BE (NDBE), low grade dysplasia (LGD), or high-grade dysplasia (HGD) were evaluated. Strategies included no surveillance; surveillance at 1-, 2-, 3-, 4-, 5-, or 10-year intervals; standard or AI assisted endoscopy; non endoscopic screening (sponge, breath, miRNA tests); and EET for LGD and HGD. Outcomes included costs, quality adjusted life years (QALYs), incremental cost effectiveness ratios (ICERs), net monetary benefits (NMBs), EAC cases, and EAC-related deaths. Sensitivity analyses used a willingness to pay threshold of US$100,000 per QALY. Results No surveillance was the most cost-effective strategy for SSBE and NDBE. For LGD, upfront EET was more cost effective than all surveillance strategies, with results sensitive to EAC incidence and recurrence. For HGD, EET was cost saving and yielded the greatest QALYs, with findings robust in 99.9% of simulations. EET prevented 12,614 and 44,295 EAC related deaths per 100,000 individuals with LGD and HGD, respectively. Conclusion Dysplasia-stratified management is essential for optimizing surveillance and treatment strategies in BE. Any degree of dysplasia should receive EET followed by targeted post-treatment monitoring, establishing EET as the central therapeutic pathway for dysplastic BE.

22.
arXiv (CS.CV) 2026-06-16

Leptomeningeal Collateral Detection on DSA via Vessel-Graph Neural Networks

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

23.
medRxiv (Medicine) 2026-06-18

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

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.

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

Mirror Descent Beyond Euclidean Stability: An Exponential Separation in Initialization Sensitivity

arXiv:2606.11431v1 Announce Type: new Abstract: Mirror Descent (MD) extends Gradient Descent (GD) beyond Euclidean geometry and has recently reappeared as a lens for KL-regularized policy optimization in reinforcement learning and LLM post-training. This raises a basic robustness question, crucial to reproducibility and reliability: how sensitive are MD dynamics to their inputs? We focus on initialization, often itself a pretrained or previously aligned model. Quadratic-regularized MD, including GD and Mahalanobis geometries, is well-known to be stable for convex smooth objectives. We show a sharp contrast: once the regularizer is non-quadratic, MD can be exponentially more sensitive to initialization than GD, even with a well-conditioned regularizer in Euclidean norm. We give a three-dimensional construction with a convex, smooth objective and a strongly convex, smooth, well-conditioned regularizer where an initial $\varepsilon$ perturbation is quickly amplified to $\min\{polylog^{-1}(1/\varepsilon), \varepsilon e^{\Omega(\eta T)}\}$ after $T$ iterations of MD with step size $\eta$. For canonical KL-regularized MD on the simplex, we show that even linear objectives can amplify an initial $\varepsilon$ perturbation exponentially fast in high-dimensional or near-boundary regimes. Finally, we show that adding a Bregman regularization term toward an anchor point can stabilize the dynamics while largely preserving the optimization guarantees, and that the choice of anchor is crucial: anchoring at the initialization only partially mitigates the instability, whereas anchoring at a fixed point yields a more stable mechanism.

25.
arXiv (CS.AI) 2026-06-15

PRISM: Perception Reasoning Interleaved for Sequential Decision Making

arXiv:2605.05407v2 Announce Type: replace Abstract: Scaling LLM-based embodied agents from text-only environments to complex multimodal settings remains a major challenge. Recent work identifies a perception-reasoning-decision gap in standalone Vision-Language Models (VLMs), which often overlook task-critical information. In this paper, we introduce PRISM, a framework that tightly couples perception (VLM) and decision (LLM) through a dynamic question-answer (DQA) pipeline. Instead of passively accepting the VLM's description, the LLM critiques it, probes the VLM with goal-oriented questions, and synthesizes a compact image description. This closed-loop interaction yields a sharp, task-driven understanding of the scene. We evaluate PRISM on the ALFWorld and Room-to-Room (R2R) benchmarks. We show that: (1) PRISM significantly outperforms state-of-the-art image-based models, (2) our Interactive goal-oriented perception pipeline yields systematic and substantial gains, and (3) PRISM is fully automatic, eliminating the need for handcrafted questions or answers.