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01.
medRxiv (Medicine) 2026-06-22

Regional Service-System Conditions Associated with Facility-Linked Home-Based Specialist Care in Japan: A Claims-Based Ecological Study of Home Dialysis

Authors:
Suzuki↗K. T↗

Background Complex chronic care is increasingly delivered in patients' homes while remaining linked to specialist facilities for training, monitoring, and backup care. Home dialysis provides a useful case because peritoneal dialysis (PD) and home hemodialysis (HHD) share a home-facility delivery structure but differ in technical and operational requirements. This study examined regional service-system conditions associated with the presence and scale of PD and HHD in Japan. Methods This ecological study used publicly available claims, administrative, census, and geospatial data harmonized to 334 Secondary Medical Areas. Regional indicators were organized into four domains: dialysis service delivery, implementation support for home-based care, hospital backup capacity, and living and sociodemographic context. Diffusion was examined using claims-based indicators of regional presence and post-presence scale, analyzed separately for PD and HHD with Firth penalized logistic regression and zero-truncated negative binomial regression, respectively. Results PD was observed in 271 regions and HHD in 109. Patterns of associated regional conditions differed by modality and stage. PD was associated mainly with existing dialysis-service organization, whereas HHD was associated with broader regional supports, including home-care delivery, living infrastructure, transition support, and hospital-system indicators. Conditions associated with presence differed from those associated with scale. Cross-modality associations suggested that shared regional factors may shape the distribution of both modalities. Conclusions Regional conditions for home dialysis diffusion in Japan differed by modality and stage. PD was linked mainly to existing dialysis-service organization, whereas HHD was linked to multi-domain regional support for technically demanding home treatment. Under standardized reimbursement, local service-system capacity may remain important for modality- and stage-specific diffusion of home dialysis.

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02.
medRxiv (Medicine) 2026-06-22

A blinded, counterbalanced rater design for evaluating AI-assisted summarisation of tertiary clinical genomics reports: methodology of the QNOMX-VHIR-CPSP-001 Phase 1 study

Authors:
Creeden↗Olivecrona↗Soriano↗

Background. Tertiary clinical genomics reports condense layered molecular findings into documents that treating oncologists must read, translate, and act upon; manual summarisation of these reports is time-consuming and variable. Tools that assist summarisation and translation into local languages are emerging, yet the field lacks an agreed methodology for evaluating such tools before any downstream clinical use. The appropriate first endpoint is fidelity of the generated summary to its source report, assessed by qualified human raters under blinded scoring, not downstream variant classification. Methods. QNOMX-VHIR-CPSP-001 Phase 1 is a single-site, non-interventional clinical performance study conducted at Vall d'Hebron Institut de Recerca (VHIR) under ISO 20916:2019 as a Clinical Performance Study Protocol. De-identified tertiary cancer genomics reports from pediatric oncology cases are summarised by the AI-assisted summarisation system under evaluation and, in parallel, by the standard manual workflow. Qualified raters score both summary types against the source genomics report using the Quality Summary Index (QSI), a six-dimension, five-point rubric adapted from the Provider Documentation Summarization Quality Instrument, under a blinded, counterbalanced, two-period crossover with a minimum fourteen-day washout. Two co-primary composite endpoints, content and presentation, are analysed for non-inferiority under a Bayesian hierarchical model, with a frequentist linear mixed model as the convergence check. Inter-rater reliability is reported as Krippendorff's ; a Monte-Carlo power analysis of the fixed clustered design is pre-specified. Discussion. The design isolates summarisation quality from clinical decision-making by scoring both summary types against the same source report under blinding, counterbalancing, and a fourteen-day washout. Conclusion. The QSI rubric, the counterbalanced crossover, and the pre-specified Bayesian primary with frequentist convergence check define a replicable protocol for early-stage evaluation of AI-assisted summarisation in tertiary genomics reporting; observed variance components will inform sample-size determination for Phase 2.

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03.
arXiv (CS.LG) 2026-06-18

P$^2$CE: Model-Agnostic Plausible Pareto-Optimal Counterfactual Explanations

Authors:
Arthur Hendricks Mendes de Oliveira↗Giovani Valdrighi↗Marcos Medeiros Raimundo↗

arXiv:2606.18418v1 Announce Type: new Abstract: The increasing use of machine learning algorithms in social applications has raised concerns about fairness and transparency, leading to the development of counterfactual explanations. These explanations supports individuals to understand and potentially alter unfavorable decisions in areas such as loan applications, job selections, and more, by providing actionable changes to input features that would lead to a desired outcome. Existing methods often struggle to balance feasibility, plausibility, and computational efficiency. To address this, we introduce P$^2$CE, an algorithm for generating plausible Pareto-optimal counterfactual explanations, offering users a diverse set of optimal trade-offs between different notions of feasibility. P$^2$CE employs an auxiliary isolation forest outlier detector to ensure that explanations are in accordance with the data distribution and leverages SHAP values to obtain optimal results with short computing times, regardless of the underlying model. Our algorithm was empirically evaluated on three datasets, demonstrating superior performance in terms of both solution quality and computational efficiency compared to related techniques.

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04.
bioRxiv (Bioinfo) 2026-06-16

DynamicDemiLog: A Single Sketch for Ultrafast Similarity, Frequency, and Cardinality Estimation

Authors:
Bushnell↗B. J↗

Probabilistic cardinality estimators (HyperLogLog), similarity sketches (MinHash), and frequency estimators (Count-Min Sketch) are fundamental approximate data structures that each target one primary problem. We present DynamicDemiLog (DDL), a sketch that unifies cardinality estimation, set similarity, containment, element frequency and composition in one tiny data structure built from a single pass over the input stream. Using an inverted index over 200,687 RefSeq sketches (159,567 organisms), DDL performs all-to-all sketch similarity comparison of the full database in 30 seconds (128 threads, indexed) - over 375x faster per query than Mash's brute-force all-to-all comparison of 91,282 sketches, or 31x faster without the index, at double the sketch resolution. DDL extends the LogLog register with a mantissa: each register stores a floating-point-encoded hash value consisting of an integer exponent (the leading-zero count) and a fractional mantissa (the sub-leading-zero bits), rather than the integer leading-zero count alone. This preserves enough hash information for meaningful register-by-register comparison - a property that standard 6-bit registers lack - while improving on LogLog's cardinality estimation machinery, including DynamicLogLog's early exit mask for high-throughput streaming. With a default 10 mantissa bits (16-bit registers, 2,048 buckets, 4 KB), DDL achieves a per-register false-match rate of 0.018% on unrelated random same-size sets (compared to 17.0% for LL6, a basic HyperLogLog implementation), enabling Weighted Kmer Identity (WKID), Average Nucleotide Identity (ANI), containment, and completeness estimation from register comparison alone. A 16-bit per-register observation counter provides element frequency information at trivial additional computation cost, and an additional byte tracks element composition (GC content, for biological data). Furthermore, DDL's high-specificity registers enable an inverted index structure (DDLIndex) that answers similarity queries against a database of N sketches in O(B + M) time, where M is the number of matching index entries, compared to O(NxB) for pairwise comparison.

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05.
arXiv (CS.LG) 2026-06-16

Filtered Conformal Ellipsoids for Graph-Native Time Series

Authors:
Yannick Limmer↗

arXiv:2606.17014v1 Announce Type: new Abstract: Joint prediction sets for multivariate time series should control a single event while adapting to cross-coordinate dependence. We study filtered conformal ellipsoids: a frozen state-space filter emits a one-step predictive mean and covariance, and split-conformal calibration is applied to the resulting Mahalanobis scores. The filter is used to choose the ellipsoid shape; conformal calibration chooses the scalar radius, so the construction benefits from a learned predictive covariance without relying on Gaussian tail probabilities for coverage. The main difficulty is that filtered scores are dependent and learned recurrent filters need not contract in their raw hidden state; we therefore analyse contraction in an observable predictive-law quotient that identifies hidden states producing the same future sequence of emitted Gaussian laws. Under a stable Bayes Gaussian-projection filter, covariance bounds, and a finite-horizon observability Fisher condition, small excess Gaussian negative log-likelihood implies contraction of the learned emitted laws. Combined with a threshold-autocovariance envelope this yields a Chebyshev-type approximate coverage bound for filtered split-conformal prediction under dependence; a sharper Bernstein-type bound requires an additional geometric-mixing concentration assumption. Under Gaussian oracle realisability we also obtain a near-oracle log-volume comparison within the class of conditionally valid Gaussian ellipsoid rules. We instantiate the framework with a GCN-GRU filter with diagonal-plus-low-rank covariance. On moderate-size graph-native traffic benchmarks (METRLA-$20$ and PEMSBAY-$50$), the learned filter gives sharper at-target ellipsoids than static-covariance and non-filter baselines; at full-graph scale and on non-graph-native datasets, factor and copula baselines can be stronger.

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

Neural Variability Enhances Artificial Network Robustness

Authors:
Robin Preble↗Praveen Venkatesh↗Stefan Mihalas↗Kameron Decker Harris↗

arXiv:2606.13801v1 Announce Type: new Abstract: Neural responses in cortex exhibit substantial trial-to-trial variability in response to repeated stimuli, while peripheral sensory neurons respond far more consistently, leading many to wonder whether stochasticity may carry meaning. Existing work has argued that noise and signal correlations may be optimized for discrimination in animals, whereas artificial neural network (ANN) studies have shown similar benefits of noise in machine learning tasks, although most ANN work has neglected the effects of correlations. Here we investigate whether correlated noise improves the robustness of artificial neural networks to adversarial attacks and naturalistic image modifications. Using the covariance of activations under modified versus clean inputs, we find that structured noise may significantly improve network robustness. Robustness to naturalistic image modifications benefits most from structure, but this structure transfers poorly across modification types. In contrast, noise structure from adversarial attacks can generalize to other kinds of attacks. These results suggest that structured noise in ANN activations generally improves robustness, establishing a biologically plausible strategy for creating robust artificial neural networks that only relies on local information.

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07.
bioRxiv (Bioinfo) 2026-06-18

Elucidating the Design Space of Generative Models for Single-Cell Perturbation Prediction

Authors:
Bhattacharya↗Gensbigler↗Karim↗Lees↗

Next-token prediction has produced predictable scaling in language, but the recipe presumes a sequence of tokens with a meaningful order. Single-cell RNA-seq counts have no natural gene ordering, so applying the recipe directly to raw expression fails under an ill-suited left-to-right bias. We instead ask whether a learned latent can supply the structure the recipe needs. We introduce texttt{ExpressionVAE} (eVAE), a discrete-latent perturbation model that compresses each cell into a short sequence of discrete codes through a finite-scalar-quantization (FSQ) bottleneck and trains a perturbation-conditioned discrete prior over those codes. On Replogle and Parse~1M, eVAE sets a new state of the art on every distributional metric and leads on most cell-eval perturbation metrics, with Fr'echet distance and $mathrm{MMD}^2$ roughly $3$ to $20times$ lower than the strongest continuous-latent baseline. Swapping the prior between autoregressive and masked discrete diffusion leaves performance near-identical, isolating the gain to the discrete latent itself rather than the prior family. A decoder-head ablation then exposes a single design axis, the richness of the predictive distribution at inference, that splits the standard metrics into two groups, variance-sensitive and mean-sensitive, which move in opposite directions along the axis. Finally, on a held-out CRISPRi reversion benchmark of $1{,}732$ perturbations under inflammatory cytokine stress, the frozen eVAE encoder outperforms UMAP and differential expression and matches scGPT on perturbation ranking at a fraction of the data.

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08.
arXiv (CS.CV) 2026-06-18

Hybrid Transformer-Mamba for Weakly Supervised Volumetric Medical Segmentation

Authors:
Yiheng Lyu↗Lian Xu↗Coen Arrow↗Mohammed Bennamoun↗Farid Boussaid↗Girish Dwivedi↗

Weakly supervised segmentation enables model training from plane-level labels. Existing methods often rely on 2D encoders, neglecting the volumetric nature of medical data. We propose TranSamba, a hybrid Transformer-Mamba architecture designed to capture 3D context via cross-plane modeling. TranSamba augments a Vision Transformer backbone with Cross-Plane Mamba blocks, leveraging linear-time modeling for efficient information exchange across neighboring planes. This exchange improves in-plane self-attention and subsequent attention maps for object localization. TranSamba maintains linear time complexity and constant space complexity with respect to the input volume depth. Extensive experiments on three datasets covering diverse modalities and pathologies show that TranSamba achieves state-of-the-art performance, demonstrating the generalizable efficacy of cross-plane modeling. Code is available at: https://github.com/YihengLyu/TranSamba.

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09.
arXiv (CS.LG) 2026-06-11

Reverse Flow Matching: A Unified Framework for Online Reinforcement Learning with Diffusion and Flow Policies

Authors:
Zeyang Li↗Sunbochen Tang↗Navid Azizan↗

arXiv:2601.08136v2 Announce Type: replace Abstract: Diffusion and flow policies are gaining prominence in online reinforcement learning (RL) due to their expressive power, yet training them efficiently remains a critical challenge. A fundamental difficulty that distinguishes online RL from standard generative modeling is the lack of direct samples from the target Boltzmann distribution defined by the Q-function. To address this, two seemingly distinct families of methods have been proposed for diffusion policies: a noise-expectation family, which uses a weighted average of noise as the training target, and a gradient-expectation family, which employs a weighted average of Q-function gradients. However, it remains unclear how these objectives are formally related, or whether they can be synthesized into a more general formulation. In this paper, we propose a unified framework, reverse flow matching (RFM), which rigorously addresses the problem of training diffusion and flow models without direct target samples. By adopting a reverse inferential perspective, we formulate the training target as a posterior mean estimation problem given an intermediate noisy sample. Crucially, we introduce Langevin Stein operators to construct zero-mean control variates, deriving a general class of estimators that share the same expectation. We show that existing noise-expectation and gradient-expectation methods are simply two specific instances within this broader class. This unified view yields two key advancements: it extends the capability of targeting Boltzmann distributions from diffusion to flow policies, and it enables the principled combination of Q-value and Q-gradient information to form an effective estimator, thereby improving training efficiency and stability. We instantiate RFM to train a flow policy in online RL and demonstrate improved performance on continuous-control benchmarks compared to diffusion policy baselines.

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10.
arXiv (CS.CV) 2026-06-15

Feature-Space Planes Searcher: A Universal Domain Adaptation Framework for Interpretability and Computational Efficiency

Authors:
Zhitong Cheng↗Yiran Jiang↗Yulong Ge↗Yufeng Li↗Zhongheng Qin↗Rongzhi Lin↗Jianwei Ma↗

Domain shift, characterized by degraded model performance during transition from labeled source domains to unlabeled target domains, poses a persistent challenge for deploying deep learning systems. Current unsupervised domain adaptation (UDA) methods predominantly rely on fine-tuning feature extractors - an approach limited by inefficiency, reduced interpretability, and poor scalability to modern architectures. Our analysis reveals that models pretrained on large-scale data exhibit domain-invariant geometric patterns in their feature space, characterized by intra-class clustering and inter-class separation, thereby preserving transferable discriminative structures. These findings indicate that domain shifts primarily manifest as boundary misalignment rather than feature degradation. Unlike fine-tuning entire pre-trained models - which risks introducing unpredictable feature distortions - we propose the Feature-space Planes Searcher (FPS): a novel domain adaptation framework that optimizes decision boundaries by leveraging these geometric patterns while keeping the feature encoder frozen. This streamlined approach enables interpretative analysis of adaptation while substantially reducing memory and computational costs through offline feature extraction, permitting full-dataset optimization in a single computation cycle. Evaluations on public benchmarks demonstrate that FPS achieves competitive or superior performance to state-of-the-art methods. FPS scales efficiently with multimodal large models and shows versatility across diverse domains including protein structure prediction, remote sensing classification, and earthquake detection. We anticipate FPS will provide a simple, effective, and generalizable paradigm for transfer learning, particularly in domain adaptation tasks. .

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11.
arXiv (CS.CV) 2026-06-16

SiGnature: Explicit Motion Diffusion for Stylized Semantic Gesture

Authors:
Adi Rosenthal↗Tomer Koren↗Nadav Shaked↗Doron Friedman↗Ariel Shamir↗

While recent advances in co-speech gesture generation have achieved impressive rhythmic synchronization, synthesizing gestures that are both semantically meaningful and faithful to a speaker's unique non-verbal style remains an open challenge. Semantic gestures, such as iconic shapes or deictic pointing, are statistically sparse, making them difficult to learn effectively within standard generative models. We present SiGnature, a framework for Stylized and Semantic Gesture generation that reconciles precise semantic control with high-fidelity style preservation. Unlike prevalent methods that rely on entangled latent representations, SiGnature operates in an explicit joint-rotation space. This design enables our core contribution, Joint Motion Integration (JMI), a training-free inference mechanism capable of injecting any external motion sequence, particularly in-the-wild semantic gestures, directly into the diffusion process. JMI automatically identifies the specific ``active joints'' conveying a semantic action and injects them into the generation, while relying on the diffusion backbone to synthesize the remaining body dynamics, including posture and flow, in accordance with the pre-learned style of the target speaker. This allows for the plug-and-play integration of arbitrary motions, including complex semantic gestures, without retraining or introducing the ``Frankenstein'' artifacts typical of cut-and-paste methods. Extensive experiments and perceptual studies demonstrate that SiGnature offers superior semantic motion control while maintaining smooth and natural co-speech gesture generation and preserving the distinct characteristics of the speaker, thereby outperforming state-of-the-art baselines.

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

BindEdit: Taming Attention Leakage for Precise Multi-Object Image Editing

Authors:
Chaewon Park↗Soyoon Lee↗Naeun Lee↗Minjung Shin↗Seogkyu Jeon↗Kibeom Hong↗

Real image editing enables precise manipulation of visual content, yet existing methods often fail in complex multi-object scenarios, causing semantic blending, object duplication, or incomplete edits. We attribute these failures to attention leakage, where signals across spatial regions and text tokens become entangled during the denoising process. Specifically, we identify two distinct forms of leakage: Edit-Token Leakage, where ambiguous token-region alignment leads to object blending, and Source Dominance Leakage, where tokens of unchanged source objects overwhelm the attention intended for target entities. To resolve these leakages, we propose BindEdit, which enforces attention-level constraints within a single diffusion trajectory. To suppress Edit-Token Leakage, BindEdit jointly regularizes cross- and self-attention so that each target token group is bound to its corresponding spatial region while maintaining instance-level separation. To suppress Source Dominance Leakage, a cross-attention re-balancing mechanism amplifies target token influence and attenuates residual source semantics within editable regions. Moreover, a region fidelity term ensures that each target concept is expressed coherently across the entire editing mask. Additionally, we propose a comprehensive multi-object benchmark encompassing diverse object counts and categories. Extensive experiments demonstrate that BindEdit consistently outperforms existing methods within a single diffusion trajectory, maintaining robust performance across both single- and multi-object editing scenarios.

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13.
medRxiv (Medicine) 2026-06-18

Chest X-Ray as a critical screening tool for Household Contacts of TB: Lessons from Three Years of Programmatic Data in India

Authors:
Sodhi↗Das↗Khanna↗Dhawan↗Taralekar↗Dabas↗Mannan↗Singh↗

Introduction: Household contacts (HHCs) of pulmonary TB patients remain at high risk for TB infection and disease progression, yet many remain asymptomatic and are missed by symptom-screening pathways. While India expanded its TB preventative guidelines to include all HHCs in 2021, chest X-ray (CXR) screening continues to be used selectively, representing a missed opportunity in early case detection. Methods: The analysis uses programmatic data from Project JEET 2.0 (Joint Effort for Elimination of Tuberculosis), implemented by the William J. Clinton Foundation in India, between October 2021 and March 2024. Eligible HHCs (>=5 years) were offered CXR screening as part of TB preventive therapy (TPT) evaluation. Descriptive and multivariable analyses examined predictors of CXR uptake and TB yield. A two-stage logistic regression model estimated potential TB yield under universal CXR coverage. Model performance was evaluated using the area under the curve (AUC), and bootstrap simulations generated counterfactual estimates of missed TB cases. Results: Among 1,034,621 HHCs, 1.02% individuals were found positive for TB, which includes 7,786 HHCs who were on TB treatment already, while an additional 2,812 were identified during pre-TPT evaluation. Among eligible HHCs (n = 1,026,835), 70% were screened with CXR, of which 2.4% had suggestive TB findings. Of these, 79% went for further TB assessment. Symptomatic HHCs were more likely to be CXR screened (84% vs 69%) and assessed for TB, yet two-thirds of all detected TB cases were asymptomatic. It is estimated that universal CXR coverage and TB testing for suggestive cases can increase TB detection by at least 87%. Conclusion: The study provides a scalable approach to expand CXR coverage through public-private partnerships, enabling early TB detection among HHCs, especially among asymptomatic contacts. Future implementations will benefit from integrating AI-enabled reading, along with systematic follow up for those with suggestive findings.

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14.
arXiv (CS.CV) 2026-06-11

OpenMedReason: Scientific Reasoning Supervision for Medical Vision-Language Models

Authors:
Negin Baghbanzadeh↗Pritam Sarkar↗Michael Colacci↗Abeer Badawi↗Adibvafa Fallahpour↗Arash Afkanpour↗Leonid Sigal↗Ali Etemad↗Elham Dolatabadi↗

High-stakes clinical use of large vision-language models (LVLMs) requires reasoning that is grounded in visual evidence and clinical knowledge, not just correct final answers. We introduce OpenMedReason, a large-scale, open multimodal medical reasoning corpus comprising approximately 450K image-question-answer instances whose reasoning traces are primarily derived from curated biomedical, human-authored scientific articles. OpenMedReason provides high-fidelity supervision beyond synthetic chains of thought, covering diverse medical domain vision modalities such as radiological scans, microscopic images, visible light photographs, charts, and others. We complement it with OpenMedReason-Bench, a held-out benchmark that allows fine-grained evaluation of LVLMs along three complementary axes of capability, including perception, medical knowledge, and rationale, enabling diagnostic evaluation beyond final-answer accuracy. OpenMedReason is a rich training resource that exhibits its effectiveness in both supervised fine-tuning (SFT) and reinforcement-based alignment. Training with OpenMedReason yields a 20% average improvement in VQA accuracy over the base model and achieves performance within 4.2% of the strongest comparable-scale medical LVLMs. Fine-grained performance analysis confirms that the gains are not concentrated in any single axis: OpenMedReason improves perception, medical knowledge, and rationale jointly, and its reasoning traces are preferred over those of the base model in 86.1% of pairwise comparisons. We release the code and dataset at huggingface.co/datasets/neginb/OpenMedReason.

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15.
arXiv (math.PR) 2026-06-15

Universality for Products of Random Matrices with i.i.d. Entries and the Fuss–Catalan Number

Authors:
Yanjin Xiang↗Kun Chen↗Zhihua Zhang↗

arXiv:2606.14450v1 Announce Type: cross Abstract: Let \((w_{ij})_{i,j\ge1}\) be a single infinite array of independent identically distributed real- or complex-valued entries of mean zero, variance \(\sigma^2\), and finite fourth moment. Set \(W_n=(w_{ij})_{1\le i,j\le n}\) and \(X_n=n^{-1/2}W_n\). For every fixed \(k\ge1\), we identify the almost sure limiting operator norm of several fixed products built from this family. Define the \(k\)-th freeness coefficient by \[ \gamma_k:=\sqrt{\frac{(k+1)^{k+1}}{k^k}}. \] Then we prove \[ \|X_n^k\|\to\sigma^k\gamma_k \qquad almost surely. \] The same limit holds for products sampled with replacement from any fixed finite pool of independent copies of \(X_n\); in particular, it holds for the product of \(k\) independent copies. Thus, the freeness coefficient captures the non-commuting characteristic between large random matrices %powers and independent or fixed-pool sampled products under the finite fourth moment assumption. The improvement of the classical Bai–Yin-type power estimate from the scale \(\sigma^k(k{+}1)\) to \(\sigma^k \sqrt{k{+}1}\) is a direct corollary of our result. The main technical challenge is to prove the upper bound using a high-moment expansion of %the upper bound is proved by a high-moment expansion of \(\E\Tr((X_n^kX_n^{*k})^m)\). The leading zero-defect trace words are tree-like and are counted by the Fuss–Catalan number \[ F_{k,m}= \frac1{km+1}\binom{(k+1)m}{m}. \] The combinatorial tool helps to devise a defect-sensitive global enumeration: if \(L=km\) and \[ r=(L+1-v)+(L-q), \] then the number of admissible word classes with defect \(r\) is at most \(F_{k,m}(Cm)^{Dr}\). This polynomial-in-\(m\) loss, with degree proportional to the defect, is summable in the logarithmic moment range.

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

Emergence of Hierarchical Emotion Organization in Large Language Models

Authors:
Maya Okawa↗Bo Zhao↗Eric J. Bigelow↗Rose Yu↗Tomer Ullman↗Ekdeep Singh Lubana↗Hidenori Tanaka↗

As large language models (LLMs) increasingly power conversational agents, understanding how they model users' emotional states is critical for ethical deployment. Inspired by emotion wheels, i.e., a psychological framework that argues emotions organize hierarchically, we analyze probabilistic dependencies between emotional states in model outputs. We find that LLMs naturally form hierarchical emotion trees that align with human psychological models, and larger models develop more complex hierarchies. We also uncover systematic biases in emotion recognition across socioeconomic personas, with compounding misclassifications for intersectional, underrepresented groups. Human studies reveal striking parallels, suggesting that LLMs internalize aspects of social perception. Beyond highlighting emergent emotional reasoning in LLMs, our results hint at the potential of using cognitively-grounded theories for developing better model evaluations.

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17.
arXiv (CS.LG) 2026-06-19

Does Text Actually Help? Uncovering and Resolving Text Collapse in Multimodal Time Series Forecasting

Authors:
Huu Hiep Nguyen↗Minh Hoang Nguyen↗Dung Nguyen↗Hung Le↗

arXiv:2606.19413v1 Announce Type: new Abstract: Multimodal time series forecasting, which pairs numerical sequences with domain-relevant textual reports, promises to inject world knowledge into forecasting pipelines. However, we uncover a critical failure mode in existing frameworks that we term text collapse: the text branch converges to a content-independent transformation, contributing negligible discriminative signal regardless of the input description. We argue that text collapse is a consequence of a fundamental asymmetry in time series forecasting: the numerical input is strongly autocorrelated with the output, making the numerical backbone inherently dominant, while the text branch, despite carrying complementary and often critical information, is insufficiently utilized, leading to its systematic underexploitation. To address this, we propose REST-TS (Residual-Exclusive Supervision for Text in Time Series), which turns the asymmetry into a design principle: the numerical backbone produces its own independent numerical forecast, and the text branch is exclusively supervised to predict the structured components of the residual, the prediction gap that numbers cannot explain. Because no numerical pathway can reduce these losses, the text branch must extract genuine content from the input description. Evaluated across diverse real-world domains and backbone architectures, REST-TS achieves state-of-the-art performance and consistently demonstrates greater text-branch utilization than existing frameworks, providing strong empirical evidence that supervising the text branch on the residual compels it to extract genuine content from the input.

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18.
medRxiv (Medicine) 2026-06-17

Non-Medical COVID-19 Impacts and Hearing Status: A Global Study of Differential Health Impact Among Deaf, Hard of Hearing, and Hearing Populations

Authors:
Siddiqi↗Murray↗Hall↗Koplitz↗Dye↗T. D. V↗

Background: Deaf and hard of hearing (HoH) experienced complex challenges during the COVID19 pandemic, including obscured visual communication from mask mandates, inaccessible public health messaging, and inadequate interpreter availability. We examined whether hearing status predicted nonmedical COVID19 impact on a global level. Methods: We conducted a nested cross-sectional analysis within a global study collecting data across two waves (April to May 2020 and July to August 2022) from 184 countries. Participants (N=7,998) were categorized as Deaf (n=304), Hard of Hearing (HoH; n=951), or Hearing (n=6,743). The primary outcome was a composite COVID-related non-medical Personal Impact TScore derived from 14 items across employment, resource access, and healthcare domains. Multinomial logistic regression models progressively adjusted for demographic, structural, and psychosocial variables. Results: Deaf participants reported substantially higher rates of pandemic-related job loss (28.9% vs. 9.6% hearing), healthcare cancellations (39.9% vs. 24.6%), and inability to obtain basic supplies. Over half (55.9%) of Deaf participants scored above the median composite impact index, compared to 39.2% of hearing participants. In the fully adjusted model, Deaf status remained an independent predictor of high non-medical impact (aOR=1.6, 95% CI: 1.1 to 2.4). HoH status showed no statistically significant difference from hearing participants in any model. Conclusions: People identifying as Deaf experienced significant disparities during COVID19 when compared with HoH or hearing people, driven by language access barriers and institutional exclusion rather than hearing loss per se. These experiences underscore the importance for systemic interventions centering on accessible communication, Deaf-centered needs, and reducing audism in Deaf-hearing interaction.

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

Adaptive Distance-Aware Trunk Deep Operator Learning for Long-Span Roadway Bridges

Authors:
Bilal Ahmed↗Diab W. Abueidda↗Waleed El-Sekelly↗Tarek Abdoun↗Mostafa E. Mobasher↗

arXiv:2606.20015v1 Announce Type: new Abstract: Long-span roadway bridges exhibit highly localized structural responses under vehicular loading, making repeated FE analysis computationally expensive for applications such as influence surface generation and structural digital twins. Existing SciML approaches struggle to accurately capture these localized responses. To address this challenge, this study proposes an adaptive-trunk DeepONet for localized structural response prediction in large-scale bridge systems. The framework dynamically constructs a load-dependent learning domain using a KNN strategy, allowing the network to focus on structural influence zones. The trunk network is further enhanced using distance-aware features that encode the geometric relationship between the load and structural nodes. A physics-based full-field reconstruction is incorporated through a stiffness-informed Schur complement formulation, enabling predictions at adaptive nodes to be extended to the entire structural domain. To enable scalable training, response data are generated using a reduced-order equivalent shell model that preserves the dominant global behavior while significantly reducing computational cost. The proposed framework is validated on both a benchmark bridge model and the real-world Mussafah Bridge. Results show that the method achieves FEM-level accuracy with relative errors below 5%, while reducing the total response evaluation time (including full-field reconstruction) by approximately 60x; excluding the post-processing reconstruction step, the AD-DeepONet inference is up to four orders of magnitude faster than FEM. In addition, the framework enables rapid generation of full-field responses, influence lines, and influence surfaces under arbitrary vehicular loading configurations, demonstrating strong potential for large-scale bridge analysis and digital twin applications.

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20.
medRxiv (Medicine) 2026-06-16

A Poisson Process Life Expectancy framework for optimising patient lifetime during chemotherapy

Authors:
Tzamarias↗B. D. E↗Burroughs↗

Cancer therapy balances between two competing objectives - treatment efficacy against the tumour and the risk of treatment related severe adverse events, including patient death. Most existing optimal control theory (OCT) formulations rely on optimising heuristic cost functionals that lack direct clinical interpretability. In clinical practice treatment efficacy and patient tolerability are primarily assessed through survival metrics and adverse event rates. Here we introduce the Continuous Lifetime Payoff (CLP), a novel OCT objective functional that directly links treatment decisions to patient survival. It explicitly incorporates tumour dynamics, tumour eradication, and patient mortality from tumour progression, drug-related toxicity and age. We fit age-related mortality from life tables and infer parameters from simulated survival data. The CLP provides a clinically grounded framework for optimising chemotherapy regimens.

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21.
arXiv (CS.AI) 2026-06-17

Treatment Response Optimized Clinical Decision Support AI System via Digital Twin Simulation

Authors:
Xinyu Qin↗Anil K. Sood↗Ruiheng Yu↗Sara Corvigno↗Elaine Stur↗Lu Wang↗

arXiv:2606.17405v1 Announce Type: new Abstract: Clinical decision support AI systems (CDSASs) must adapt to evolving patient conditions in real-time while adhering to strict safety constraints. We present an online adaptive framework that integrates Treatment Effect (TE) estimation to quantify clinical benefits, a patient Digital Twin (DT) to simulate treatment trajectories, and Reinforcement Learning (RL) for sequential decision-making. The AI system is initially trained on historical medical records and operates in a continuous learning loop. To ensure safety, a rule-based module monitors vital signs and blocks contraindicated treatments. Cases with strong internal model disagreement are flagged for clinician review, simulated in our experiments via a pre-trained outcome model. We validate our framework using both a synthetic clinical simulator and a real-world ovarian cancer dataset from The Cancer Genome Atlas (TCGA). In both simulated and clinical settings, our method demonstrated superior effectiveness and stability in recommending treatments compared to standard computational baselines. Furthermore, the AI system maintains low latency and requires expert consultation for only a minority of cases in our experimental validation, demonstrating its potential as a safe, clinician-supervised tool for personalized medicine that continuously improves through practical use.

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22.
arXiv (CS.AI) 2026-06-18

TLA-Prover: Verifiable TLA+ Specification Synthesis via Preference-Optimized Low-Rank Adaptation

Authors:
Eric Spencer↗Arslan Bisharat↗Brian Ortiz↗Khushboo Bhadauria↗TaiNing Wang↗George K. Thiruvathukal↗Konstantin Laufer↗Mohammed Abuhamad↗

arXiv:2606.06133v2 Announce Type: replace-cross Abstract: TLA+ is a formal specification language for verifying distributed systems and safety-critical protocols. Large language models (LLMs) frequently produce TLA+ specifications that fail the TLC model checker for semantic reasons. Across 25 LLMs, the best public baseline is 26.6% syntactic parse and 8.6% semantic model-check. We present TLA-Prover, a 20-billion-parameter model for TLA+ specification synthesis. Training combines supervised fine-tuning (SFT) on verified examples with repair-based group-relative policy optimization (GRPO). In the GRPO stage, the model learns to fix its own rejected specifications. We also train a direct preference optimization (DPO) variant from the same SFT checkpoint as an ablation. TLC provides the reward signal directly, with no learned reward model. Four tiers grade each output: Bronze (parses), Silver (no warnings), Gold (passes TLC), and Diamond. To reach Diamond, the model's correctness property is automatically altered in a small way; TLC must then detect a violation. If TLC still passes, the property was always-true and contributes nothing; the output fails Diamond. TLA-Prover reaches 9/30 (i.e. pass@1 = 30%) at both Gold and Diamond on a held-out 30-problem benchmark. This is roughly 3.5x the 8.6% untuned baseline. The DPO variant reaches 20% at Diamond. Gold and Diamond coincide at every checkpoint; this prevents the trivial-property failure mode.

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

Beyond English: Uncovering the Multilingual Gap in Vision-Language-Action Models

Authors:
Hanyang Chen↗Hongliang Li↗Jiarui Cao↗Yang Li↗Yang Jiang↗Haonan Wen↗Kaiyu Huang↗Shengnan Guo↗Huaiyu Wan↗

Vision-Language-Action models have recently demonstrated promising capabilities in learning generalist robot policies from large-scale multimodal data. However, most existing VLA systems are trained and evaluated primarily with English instructions, leaving their ability to understand and execute instructions in other languages largely unexplored. While the underlying large language models often possess multilingual capabilities, it remains unclear whether these multilingual capabilities transfer to VLAs during training. In this work, we present the first systematic study of multilingual instruction following in VLA models. We first construct multilingual instructions by extending existing benchmarks with translations of their instructions. Using these instructions, we evaluate several representative VLA models across a range of tasks in simulation settings. Our experiments reveal a significant multilingual gap: models trained primarily on English instructions exhibit substantial performance degradation when evaluated on other languages, even when the underlying language backbone is multilingual. We provide several findings and analyses to understand the multilingual gap. Cross-lingual transfer behavior analysis shows that performance drops correlate with both instruction understanding and action execution. Representation analyses suggest that multilingual instruction-caused representation shifts may contribute to the multilingual gap. Motivated by these findings, we further explore strategies to improve multilingual performance in VLAs. We propose a simple yet effective multilingual fine-tuning approach, Multilingual Principal Component Alignment, which leverages Principal Component Analysis to get the principal component subspace and align projected multilingual representations, effectively reducing the multilingual performance gap.

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

PACE-RAG: Patient-Aware Contextual and Evidence-Constrained RAG for Clinical Drug Recommendation

Authors:
Chaeyoung Huh↗Hyunmin Hwang↗Jung Hwan Shin↗Sungyang Jo↗Jinse Park↗Jong Chul Ye↗

Drug recommendation requires a deep understanding of individual patient context, especially for complex conditions like Parkinson's disease. While LLMs possess broad medical knowledge, they fail to capture the subtle nuances of actual prescribing patterns. Existing RAG methods also struggle with these complexities because guideline-based retrieval remains too generic and similar-patient retrieval often replicates majority patterns without accounting for the unique clinical nuances of individual patients. To bridge this gap, we propose PACE-RAG (Patient-Aware Contextual and Evidence-Constrained RAG). Rather than directly copying frequent medications from retrieved patients, PACE-RAG personalizes recommendations by first extracting patient-specific clinical features, retrieving cases around these features, and then refining the final prescription using the patient's current symptoms, active medication history, and focus-specific prescribing tendencies. By analyzing treatment patterns tailored to specific clinical features, PACE-RAG generates patient-specific medication recommendations along with an explainable clinical summary. Evaluated on a Parkinson's cohort and the MIMIC-IV benchmark using Llama-3.1-8B and Qwen3-8B, PACE-RAG achieved state-of-the-art performance, reaching F1 scores of 80.84% and 47.22%, respectively. These results suggest that PACE-RAG is a robust and clinically grounded framework for personalized decision support. Our code is available at: https://github.com/ChaeYoungHuh/PACE-RAG.

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25.
arXiv (CS.CV) 2026-06-16

Exact Posterior Score Estimation for Solving Linear Inverse Problems

Authors:
Abbas Mammadov↗Ozgur Kara↗Kaan Oktay↗Iskander Azangulov↗Adil Kaan Akan↗Hyungjin Chung↗James Matthew Rehg↗Yee Whye Teh↗

Diffusion and flow-based models learn powerful data priors by training a denoiser to reverse Gaussian corruption. To use this prior to solve a linear inverse problem, one needs to sample from the posterior, but the score that the prior provides is the unconditional score, not the posterior score. Existing methods either steer a fixed pretrained denoiser with approximate measurement-matching corrections, or train a conditional restoration model that abandons the denoising structure of the prior. We derive the exact posterior score in closed form for linear Gaussian inverse problems under general Gaussian interpolants, and show that posterior sampling reduces to a denoising problem at an operator-dependent shifted pivot under an anisotropic noise covariance. We turn this identity into Exact Posterior Score (EPS), a denoising training objective that preserves the input/output structure of standard pretraining and can therefore be trained from scratch or fine-tuned from a pretrained denoiser. At inference, EPS uses the same sampler as the underlying backbone, with no likelihood gradients or projections. We evaluate EPS on five linear inverse problems across FFHQ and ImageNet, where it outperforms training-free and training-based baselines on fidelity, perceptual, and distributional metrics, while using roughly an order of magnitude fewer denoiser evaluations than gradient-based posterior samplers.

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