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01.
PLOS Medicine 2026-05-12

Social contact patterns in the United Kingdom following the COVID-19 pandemic: The Reconnect cross-sectional survey

by Lucy Goodfellow, Billy J. Quilty, Kevin van Zandvoort, W. John Edmunds Background Close-contact and respiratory infectious diseases are spread through social interactions. Measuring these interactions has transformed our ability to understand transmission and control these infections. Social contact patterns were disrupted during the COVID-19 pandemic and have been affected by wider demographic, cultural, and workplace changes since then. Methods and findings To estimate post-pandemic social contact patterns in the United Kingdom, we conducted a cross-sectional social contact survey from November 2024 to March 2025 on a nationally representative sample of participants. Interactions were captured by age, gender, and across socioeconomic status (SES) and ethnic groups. We calculated the mean number of daily contacts and contact matrices, stratified by variables of interest, using a negative binomial regression model weighted by age, gender, ethnic group, and weekday/weekend. 13,238 participants were recruited, 3,019 of whom were aged under 18 years old; survey response rates were 36% and 27% for adults and children, respectively. The mean number of daily contacts was 9.1 (95% confidence interval (CI): 8.7, 9.5); this figure was 13.8 (95% CI: 12.8, 14.9) for children, and 7.8 (95% CI: 7.4, 8.2) for adults. Higher numbers of contacts were positively associated with employment, household income, and educational qualifications held. Contact matrices showed high levels of age-assortativity, as well as inter-generational contacts in the home. Contacts were assortative between ethnic groups and SES in all settings; this effect was strongest between ethnic groups in the home, and between SES in the workplace. We constructed socially-stratified next-generation matrices for a novel respiratory pathogen, projecting that the majority White ethnic group would account for the largest share of new infections (76.7% (95% CI: 75.5, 77.9) of cases), but that per-capita infection risk would disproportionately affect minority ethnic groups, with the risk for the Black population being 2.27 (95% CI: 2.06, 2.51) times that of the White population. This study may be limited by the inherent recall biases and reporting fatigue involved with self-reporting contacts. Conclusions This study provides crucial data to inform post-pandemic mathematical models of infectious disease transmission, and allows ethnicity and SES to be incorporated in such models.

02.
arXiv (quant-ph) 2026-06-16

Enhanced Sensitivity near a Quantum Exceptional Point in the Absence of Engineered Dissipation

arXiv:2606.16060v1 Announce Type: new Abstract: Non-Hermitian systems exhibit phenomena absent from Hermitian systems, including exceptional points (EPs), at which two or more eigenvectors coalesce. Conventional implementations rely on gain and loss, which strongly limit quantum coherence. Here, following a proposal by Wang and Clerk (PRA 2019), we realize a closed four-mode quantum system that emulates the dynamics of a PT dimer - two coupled resonators with balanced gain and loss - without engineered dissipation. The four modes are implemented as harmonics of a superconducting coplanar-waveguide resonator, with parametric couplings engineered using a current-pumped SNAIL. We use this device as a sensor for small variations in the PT dimer coupling strength. From signal-to-noise-ratio measurements, we observe enhanced sensitivity near the EP in a non-quantum-limited regime.

03.
medRxiv (Medicine) 2026-06-15

Sociodemographic Disparities in Tafamidis Initiation and Clinical Outcomes in ATTR-CM Across the United States

BACKGROUND Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, life-threatening disease. Sociodemographic factors may influence time to treatment initiation and resulting clinical outcomes, yet these relationships are poorly characterized. OBJECTIVE Assess the effects of sex and race on tafamidis initiation and subsequent outcomes and their interaction with factors such as ATTR-CM type and social deprivation measures. METHODS A retrospective cohort analysis was conducted using the US Komodo Healthcare Map (01/2016-06/2024) among patients with amyloidosis, identified by ICD-10-CM diagnosis codes. Cumulative incidence of treatment initiation and survival probabilities for cardiovascular-related hospitalization (CVH) or death were estimated by Kaplan-Meier, stratified by sex and race. Cox proportional hazards models were fitted for both endpoints to estimate hazard ratios, adjusting for demographics and clinical characteristics. RESULTS Of 11,311 patients identified, White and Black patients (n=9,223) were included in subsequent analyses. Within 12 months of diagnosis, White women had the lowest cumulative incidence of tafamidis initiation (11.4%), followed by Black women (22.0%), Black men (26.7%), and White men (31.0%). Event-free survival at 12 months was lowest in Black women (42.9%), followed by Black men (46.8%), White women (48.6%), and White men (54.4%). Median (95% CI) time to CVH or death was shortest for Black women (8.0 months [6.8-10.0]) followed by Black men (9.9 months [8.8-12.0]), White women (11.0 months [9.6-13.0]), and White men (15.0 months [14.0-16.0]). CONCLUSIONS In this large, real-world cohort of US patients with ATTR-CM, sex and race contributed to disparities in tafamidis initiation and survival, underscoring compounded disparities in both access and outcomes.

04.
medRxiv (Medicine) 2026-06-16

Validating an Early Pregnancy HbA1c as the Screening Test for Gestational Diabetes Mellitus: Findings from PRISMA Pakistan Cohort

Background: Early identification of gestational diabetes mellitus (GDM) is critical to improving maternal and neonatal outcomes, particularly in resource-constrained settings where universal oral glucose tolerance testing (OGTT) is burdensome. We assessed whether early-pregnancy HbA1c alone or combined with common risk factors can predict GDM and reduce the burden of OGTT requirements in a peri-urban cohort in Karachi, Pakistan. Methods: We conducted a secondary analysis of the Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA) Pakistan cohort. Women enrolled before 20 weeks' gestation with available early-pregnancy HbA1c and a 2-hour 75g OGTT at 24 to 28 weeks were included. We externally validated GDM prediction models originally developed in the STRiDE-India cohort. Model performance was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC). We assessed four models: HbA1c alone (Model 1a); age, BMI, and family history of diabetes mellitus (FH DM) (Model 1b); HbA1c combined with age, BMI, and FH DM (Model 2); and an extended model, i.e., Model 2 combined with socioeconomic status, gestational age, parity, systolic and diastolic blood pressure (Model 3). A dual-threshold approach was applied to assess rule-in and rule-out performance. Results: Among 2,489 women, GDM incidence was 7.5% (n=186). Models with a broader set of predictors demonstrated higher AUC values, with Model 2 achieving an AUC of 0.61 (95% CI: 0.57, 0.66). Including additional factors (Model 3) did not further improve predictive ability (AUC: 0.62; 95% CI: 0.58, 0.66). In addition, at predefined thresholds, Model 2 achieved sensitivity of 73.7% (rule-out) and specificity of 83.5% (rule-in), with the potential to reduce OGTT requirements (58.5%). Conclusions: Early-pregnancy risk stratification using HbA1c combined with simple clinical predictors offers a pragmatic approach to streamline GDM screening among high-risk pregnant women. A dual-threshold strategy using Model 2 could reduce reliance on universal OGTT while prioritizing high-risk women for confirmatory testing.

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

Self-Attention as Transport: Limits of Symmetric Spectral Diagnostics

When a language model processes a hallucinated response, its attention routing tends to fail in one of two shapes: over-concentrating on a narrow set of positions, or spreading so diffusely that relevance is diluted, and the shape of the failure carries diagnostic signal. We study these shapes as a diagnostic characterization, computed from attention matrices under forced scoring of benchmark-labeled responses rather than during live generation. A widely used family of spectral methods analyzes the symmetric component of the degree-normalized attention operator, which governs transport capacity; we prove that every transpose-invariant spectral diagnostic of this operator is structurally orientation-blind (it cannot distinguish an operator from its transpose, and therefore cannot detect information-flow direction), with a converse to the blindness theorem bounding any Lipschitz diagnostic's transpose sensitivity by the asymmetry coefficient $G$. Pairing this with a closed-form bipartite-Cheeger landscape for canonical causal architectures, we show that uniform causal attention satisfies an $n$-independent floor $\phi \ge 1/5$, while window attention pierces the floor as $O(w/n)$; failure modes are shape-different, not just value-different. This floor is an idealized-architecture benchmark, not an empirical attractor: the fraction of real attention heads that pierce it is itself an architectural signature. The resulting two-axis diagnostic ($\phi$ for capacity, $G$ for direction) yields a falsifiable polarity prediction: bottleneck- and diffuse-dominated benchmarks should exhibit opposite polarity. Under length-controlled evaluation, transport features retain interpretable signal (0.62-0.84 LC-AUROC) across the tested decoder-only, encoder-only, and encoder-decoder models, with polarity reversing as predicted between HaluEval and MedHallu.

06.
arXiv (math.PR) 2026-06-16

A small noise approximation for Muller's Ratchet

arXiv:2606.15842v1 Announce Type: new Abstract: We consider an infinite system of SDEs with Fleming-Viot noise indexed by $k=0,1,2,\dots$, whose parameters $\alpha,\lambda$, and $\nu$ are the (deleterious) selection coefficient, the (uni-directional) mutation rate, and a quantity which determines the size of the system's fluctuations. The SDE's unique weak solution $X(t) = (X_k(t))_{k=0,1,2,...}$ models what is known in population genetics as Muller's ratchet. Here, $X_k(t)$ stands for the frequency of individuals carrying $k$ deleterious mutations. Since the mutation process is uni-directional, $t\mapsto \inf\{k: X_k(t)> 0\}$ is non-decreasing for almost every path of $X$, and we refer to an increase as a click of Muller's ratchet. A long standing question concerns the clicking rate of Muller's ratchet. Using Duhamel's principle for semigroups, we give a partial answer by approximating $E(\sum_{k=1}^\infty kX_k(t) )$ and $E\big(X_0(t)\big)$ up to $O(1/\nu^2)$ for fixed $\alpha$, $\lambda$ and $t>0$. Our results suggest that $\psi:=\nu \alpha e^{-\lambda/\alpha}$ is a crucial quantity also when the mutation/selection ratio $\theta = \lambda/\alpha$ is moderately large: for large $\nu \alpha$, clicking of the ratchet on the time scale $\frac 1\alpha \log \theta$ becomes rare as soon as $\psi$ becomes large.

07.
arXiv (CS.LG) 2026-06-18

Quantifying and Auditing LLM Evaluation via Positive–Unlabeled Learning

arXiv:2606.19057v1 Announce Type: cross Abstract: Large Language Models (LLMs) are increasingly used as judges for scalable evaluation, yet such LLM–as–a–Judge systems exhibit systematic biases that are decoupled from semantic quality, most notably verbosity bias. Meanwhile, human supervision is costly and typically selective, yielding reliable positive judgments but leaving most outputs unlabelled and potentially mixed in quality. We formulate LLM evaluation under selective human supervision as a positive–unlabelled learning problem and propose a geometric auditing framework based on Partial Optimal Transport. By aligning a small set of human–verified positives with a reliable subset of unlabelled outputs in a fixed embedding space, our method identifies human–consistent preferences and corrects biased judges without retraining. Experiments demonstrate improved alignment with human preferences, increased robustness to presentation biases, and interpretable confidence estimates, offering a scalable and statistically grounded alternative to existing LLM–as–a–judge pipelines.

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

Residual Context Diffusion Language Models

Diffusion Large Language Models (dLLMs) have emerged as a promising alternative to purely autoregressive language models because they can decode multiple tokens in parallel. However, state-of-the-art block-wise dLLMs rely on a "remasking" mechanism that decodes only the most confident tokens and discards the rest, effectively wasting computation. We demonstrate that recycling computation from the discarded tokens is beneficial, as these tokens retain contextual information useful for subsequent decoding iterations. In light of this, we propose Residual Context Diffusion (RCD), a module that converts these discarded token representations into contextual residuals and injects them back for the next denoising step. RCD uses a decoupled two-stage training pipeline to bypass the memory bottlenecks associated with backpropagation. We validate our method on both long CoT reasoning (SDAR) and short CoT instruction following (LLaDA) models. We demonstrate that a standard dLLM can be efficiently converted to the RCD paradigm with merely ~300 million tokens. RCD consistently improves frontier dLLMs by 4-11 percentage points in accuracy with minimal extra computation overhead across a wide range of benchmarks. Notably, on the most challenging AIME tasks, RCD nearly doubles baseline accuracy and attains up to 4-5x fewer denoising steps at baseline's peak accuracy.

09.
arXiv (CS.AI) 2026-06-16

PAL-Bench: Evidence-Grounded Profile Reconstruction from Longitudinal Personal Albums

arXiv:2606.16175v1 Announce Type: new Abstract: Longitudinal personal albums are weak-schema multimodal databases: noisy perceptual records whose key facts require joins across faces, text, timestamps, locations, and repeated events. Existing visual, video, document, and lifelog benchmarks test sub-problems, but not album-scale profile reconstruction with social identity binding and evidence citation. Benchmarking this task is difficult because the ground truth needed for evaluation–owner profiles, social graphs, face-name maps, and evidence provenance–is private state that real albums cannot safely release. We introduce PAL-Bench, a controlled benchmark for evidence-grounded reconstruction under a public-record contract. Its Evidence Compiler builds latent private worlds, programs target-level evidence paths, renders album pixels, re-measures them through perception pipelines, and exports audited public/private views. Agents receive only perception-derived public records; targets, identifier maps, and evidence paths remain hidden. PAL-Bench contains 50 synthetic users, 36,659 public photo records, and 2,799 targets over owner facts, identities, and relations. A privacy-preserving audit with 10 participants confirms that PAL-Bench evidence structures match real private albums, though equivalent releases remain privacy-prohibitive. Across seven systems and two compute-matched diagnostics, a seven-metric protocol reveals a gap between plausible profile summarization and faithful social reconstruction: systems recover some owner facts but struggle with recurring identities and evidence citation. PAL-TRACE, a reference framework that freezes identity bindings before owner-fact mining, performs best but leaves hard identity resolution far from solved. PAL-Bench provides a testbed for perceptual entity resolution, multimodal data integration, temporal evidence aggregation, and provenance-aware structured prediction.

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

DreamX-World 1.0: A General-Purpose Interactive World Model

DreamX-World 1.0 is a general-purpose interactive text/image-to-video world model for controllable long-horizon generation. It supports camera navigation, revisits to previously observed regions, and promptable events across photorealistic, game-style, and stylized domains. Our data engine combines camera-accurate Unreal Engine rendering, action-rich gameplay recordings, and real-world videos with recovered camera geometry. For camera control, we introduce E-PRoPE, a lightweight variant of projective positional encoding that retains PRoPE's projective camera geometry while applying camera-aware attention to spatially reduced tokens. We convert a bidirectional video generator into a few-step autoregressive world model using causal forcing, DMD-style distillation, and long-rollout training. Training on self-generated long-horizon contexts exposes the model to its own generated history and reduces the style and color drift that accumulates across autoregressive chunks. Memory-Conditioned Scene Persistence retrieves earlier views through camera-geometry-based retrieval, while residual recycling makes the conditioning path less sensitive to imperfect memory latents. Event Instruction Tuning adds composable event control, and reinforcement learning alignment recovers camera control and visual quality after distillation. With mixed-precision DiT execution, residual reuse, 75\%-pruned VAE decoding, and asynchronous pipeline parallelism, DreamX-World 1.0 reaches up to 16\,FPS on eight RTX\,5090 GPUs. On our 5-second basic evaluation, DreamX-World 1.0 achieves a camera-control score of 73.75 and an overall score of 84.76, outperforming HY-WorldPlay 1.5 and LingBot-World in overall score, which achieve 80.79 and 80.45, respectively.

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

Automated ultrasound doppler angle estimation using deep learning

arXiv:2508.04243v2 Announce Type: replace-cross Abstract: Angle estimation is an important step in the Doppler ultrasound clinical workflow to measure blood velocity. It is widely recognized that incorrect angle estimation is a leading cause of error in Doppler-based blood velocity measurements. In this paper, we propose a deep learning-based approach for automated Doppler angle estimation. The approach was developed using 2100 human carotid ultrasound images including image augmentation. Five pre-trained models were used to extract images features, and these features were passed to a custom shallow network for Doppler angle estimation. Independently, measurements were obtained by a human observer reviewing the images for comparison. The mean absolute error (MAE) between the automated and manual angle estimates ranged from 3.9{\deg} to 9.4{\deg} for the models evaluated. Furthermore, the MAE for the best performing model was less than the acceptable clinical Doppler angle error threshold thus avoiding misclassification of normal velocity values as a stenosis. The results demonstrate potential for applying a deep-learning based technique for automated ultrasound Doppler angle estimation. Such a technique could potentially be implemented within the imaging software on commercial ultrasound scanners.

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

DIPHINE: Diffusion-based $\Phi$-ID Neural Estimator

arXiv:2606.18997v1 Announce Type: new Abstract: Uncovering the true informational architecture of real-world complex systems requires disentangling how their components uniquely store, redundantly share, and synergistically integrate information over time. Integrated Information Decomposition ($\Phi$ID) is a framework for decomposing the information dynamics of multivariate systems into sixteen non-overlapping atoms that characterize redundant, unique, and synergistic modes of information storage, transfer, and integration. Existing methods to compute $\Phi$ID are restricted to Gaussian or discrete systems, preventing its application to continuous non-Gaussian dynamical systems. We address this limitation by proposing DIPHINE (Diffusion-based $\Phi$-ID Neural Estimator), the first neural estimator that leverages score-based diffusion models to jointly estimate all the mutual information terms required by $\Phi$ID from a single amortized network, recovering the sixteen atoms through Möbius inversion. We provide a theoretical analysis of error propagation through the inversion, showing that the Jacobian of the mapping from mutual informations to atoms is integer-valued and that the synergy-to-synergy atom is provably the hardest to estimate. We demonstrate accurate recovery of ground-truth atoms on synthetic benchmarks, superior performance compared to established mutual information estimators, and the ability to extract physiologically interpretable information-dynamic structure on an application involving real data without any distributional assumptions.

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

Freeing the Law with LOCUS: A Local Ordinance Corpus for the United States

Progress in legal AI increasingly depends on access to authoritative legal text at scale. Yet one of the most consequential layers of American law remains largely absent from existing machine-readable corpora: local ordinances. Local codes govern zoning, housing, business licensing, public health, noise, animal control, and many other domains of everyday regulation, but they are fragmented across vendor platforms designed for human browsing rather than bulk research access. We introduce LOCUS - the Local Ordinance Corpus for the United States - a comprehensive corpus and county-harmonized access layer for U.S. municipal and county ordinance codes. The raw corpus, available for release to researchers, represents nearly all publicly available municipal and county ordinance codes. The resulting raw corpus contains codes from 9,239 cities and counties. A smaller county-harmonized LOCUS access layer provides coverage for the largest 2,309 of 3,144 U.S. counties, accounting for a majority of the population. We use OCR to handle the myriad of document formats that have kept the law from being a public resource. We release the corpus with coverage metadata to support reproducibility, downstream legal AI research, and the incremental expansion of machine-readable access to local law. We train a collection of ModernBERT-based classifiers and scorers to facilitate analyzing U.S. local law among several dimensions, such as opacity and paternalism, that have not previously been studied at this scale. LOCUS-v1 and its derivative models are available at: https://huggingface.co/datasets/LocalLaws/LOCUS-v1

14.
arXiv (math.PR) 2026-06-16

Sharp One-Dimensional Sub-Gaussian Comparison in Convex Order

Authors:

arXiv:2604.26819v2 Announce Type: replace Abstract: We prove that any random variable $X$ whose moment generating function is point-wise upper bounded by that of $ G \sim \mathcal{N}(0,1) $ must be dominated by $ G/\mathbb{E}[|G|] $ in convex order, meaning $ \mathbb{E}[f(X)] \le \mathbb{E}[f(G/\mathbb{E}[|G|])] $ for all convex $f$. This is sharp as witnessed by $ X \sim \mathrm{Unif}(\{-1,1\}) $ and $ f(x) = |x| $.

15.
arXiv (CS.AI) 2026-06-12

HarnessBridge: Learnable Bidirectional Controller for LLM Agent Harness

arXiv:2606.12882v1 Announce Type: new Abstract: Large language models are increasingly deployed as agents for long-horizon tasks, yet their performance is shaped not only by model capability and environment design, but also by the harness that mediates agent–environment interaction. Existing harnesses are largely manually engineered, making them difficult to scale as trajectories grow longer and interactions become more complex. In this work, we ask whether harness can be generated by a learnable plug-in module that can be trained in an end-to-end fashion. We introduce HarnessBridge, a lightweight learnable harness controller that parameterizes the agent–environment interface as a bidirectional projection. HarnessBridge learns two bidirectional projections: observation projection, which distills raw trajectories into compact, decision-relevant states, and action projection, which converts proposed actions into executable transitions or trajectory-grounded rejections. We train HarnessBridge on a harness supervision dataset via unified instruction tuning. On Terminal-Bench~2.0 and SWE-bench Verified, HarnessBridge matches or surpasses strong specialized harnesses while substantially reducing token usage and trajectory length, and generalizes from smaller generators to larger commercial models.

16.
arXiv (CS.LG) 2026-06-18

A Cross-Model VLM-Judge Protocol for Single-Image 3D Mesh Quality (and Why Cheap Proxies Fall Short)

arXiv:2606.18451v1 Announce Type: new Abstract: Single-image-to-3D generators are improving quickly, but there is no agreed, human-free way to tell whether one generated mesh is better than another. Practitioners commonly rely on cheap automatic proxies (render-space CLIP similarity and mesh geometry-validity statistics), yet how well these track perceived quality is unestablished. We make two contributions. First, we propose and validate a reproducible VLM-judge evaluation protocol: a fixed 24-view headless render rig, two independent vision-language judge families, and a mandatory position-bias correction that queries both presentation orders and keeps only order-consistent verdicts. The two judge families agree substantially with each other (Cohen's kappa = 0.66), well above the chance-agreement floor. Second, using this protocol as the reference, we show the cheap proxies do not substitute for it. Geometry validity is only a weak signal on average (because, as we show, it is bimodal) and stays below our pre-registered target, while render-CLIP is at chance. A learned Bradley-Terry head collapses onto a single manifoldness statistic (giving render-CLIP a negative weight) and matches geometry-only exactly, so learning the feature weights buys nothing. The proxy is also bimodal: it is significantly above chance on contrasts with visible geometric defects but at chance on ambiguous contrasts, consistent with geometry validity tracking the judge only when the defect is visually salient. We therefore recommend the VLM-judge protocol as a reliable, reproducible evaluator under the conditions tested (two feed-forward generators on Google Scanned Objects, with a face-drop degradation regime) and advise against geometry/CLIP proxies as optimization targets.

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

Written by AI, Managed by AI: Semantic Space Control and Index Sickness Elimination Across 391 Consecutive Sessions

The prevailing engineering intuition for addressing conceptual drift in long-horizon LLM collaboration is to trade more formal constraints for more reliable outputs – designing symbolic identifier systems, accumulating defensive rules in System Prompts, expanding context windows. Our engineering record shows that in long-horizon settings, this direction may produce effects contrary to design intent. Using action research methods in a real software project (Bang-v3) spanning approximately one month and 391 collaborative sessions, we document and analyze the failure process of these strategies. When the symbolic system exceeds a complexity threshold, LLMs do not become more accurate – instead, they abandon genuine understanding of business semantics, retreat to self-referential reasoning within the symbolic layer, and generate outputs that appear internally consistent but are physically disconnected from reality. We name this failure pattern "Index Sickness," and its canonical manifestation "Phantom Legislation." We name the underlying principle the "Pang Principle (Semantic Vitality Law)": natural language carrying explicit purpose conveys far greater information quality than symbolic expression. From this, we design and validate its physical engineering mechanism: "Baseline-Log Physical Separation." In the same project, this mechanism reduced AI Instructions volume by ~75%, and across the subsequent ~150 sessions, no recurrence of Index Sickness was observed. A bilingual companion version (Chinese) is included as supplementary material.

18.
medRxiv (Medicine) 2026-06-15

Quality Improvement Based Implementation and Evaluation of a Decision Aid for Patients with Nephrolithiasis

Introduction Patients with nephrolithiasis face challenges in making a high-quality, preference sensitive decision. Our prior work established feasibility and patient acceptance of a software-based decision aid (DA). The objectives for this study were to identify implementation strategies for the DA in routine care and determine whether DA implementation enhances decisional quality for patients. Methods New nephrolithiasis patients were recruited from the institution Medical Center from June 2018 to April 2024 to receive a software-based pre-visit DA that measured care preferences and used decision analysis to rank treatments. The RE-AIM framework and Plan-Do-Study-Act (PDSA) cycles were used to improve implementation outcomes. Patients completed survey instruments evaluating decisional conflict, shared decision-making, care satisfaction, and treatment choice following their provider visit. These metrics were compared in the DA cohort (n=81) to those in a usual care cohort (n=78) with Wilcoxon rank-sum and Chi-square (or Fishers exact) tests. Results Implementation data revealed sustained reach and progressive improvement in fidelity. The DA cohort reported higher decisional quality relative to controls (p=0.003) and reported greater support/advice to make a choice (p=0.005). The DA cohort more often discussed options with their doctor (87.5% vs 69.2%, p=0.005) and were more likely to be promoters of their provider (p

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

Verified Detection and Prevention of Concurrency Anomalies in Multi-Agent Large Language Model Systems

Authors:

arXiv:2606.17182v1 Announce Type: new Abstract: Multi-agent LLM systems share state through memory stores, vector indices, and tool registries. We model such sharing as long-running read-generate-write operations under deterministic-generation semantics – the regime durable-execution engines enforce by deterministic replay – and formalize four concurrency anomalies in TLA+: stale-generation, phantom-tool, causal-cascade, and tool-effect reordering, structural analogues of classical isolation anomalies, each with a TLC counter-example. The exclusion lattice over these anomalies is trivial; the contribution is the mechanically verified realizability and strict separation of one maximal chain within it, $L_0 \subsetneq \cdots \subsetneq L_4$, to our knowledge the first machine-checked consistency hierarchy for such runtimes. A development of 274 Verus obligations (zero assume, zero admit; trust base: two structural axioms and a mutex correspondence) proves the detectors sound and complete against the specifications and each runtime its avoidance set. Three deployed Rust runtimes realize L0-L1 (pessimistic locking, serializable snapshot isolation, default-SI), each verified against stale-generation and refined to its state machine; L2-L4 are exec-mode-verified with dependency-free prevention twins (A3, A6, A2: 0/1000 versus 1000/1000), and L2 is run live across three model families (A3 prevented in all 120 retracted sessions). We reproduce a silent lost update in ByteDance's deer-flow, formalizing its fix as a verified $L_0 \to L_1$ refinement, and exhibit tool-effect reordering in LangGraph's ToolNode on unmodified output, removed by an L3 commit-order sequencer. The verified detector, refinements, and realizability artifacts are the contribution; the phenomena and lattice are classical.

20.
arXiv (CS.LG) 2026-06-15

Graph Structured Combinatorial Semi-Bandit with Nonlinear Reward Associations through Separable Signals

arXiv:2606.14650v1 Announce Type: new Abstract: The identification of optimal structures within vast arrays of interconnected data necessitates significant sampling- and computational effort. Learning and leveraging underlying signal dependencies can improve efficiency and predictive capabilities considerably, but the ubiquity of nonlinear statistical relations amplifies the complexity of such undertakings. In this paper, we develop novel generic and adaptive strategies equipped with routines for graph-based causal reward modeling, analytic reproducing kernel methods, and Taylor approximation of functional processes. We establish theoretical performance guarantees sublinear in time and linear in data volume over time. Our analyses cover robustness to a multitude of uncertainties arising from noise interference, gradual model convergence, and solution space mismatch. The framework's general appeal is substantiated by a minimalistic set of conditions or reliance on prior estimates, while various outlined modifications address specific or extended settings. To demonstrate practical effectiveness, we conduct numerical experiments using both benchmarked synthetic and real-world transportation datasets.

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

CoAgent: Concurrency Control for Multi-Agent Systems

arXiv:2606.15376v1 Announce Type: cross Abstract: Multi-agent LLM systems – coding agents, devops agents, document agents – now routinely run several agents in parallel against the same git tree, Kubernetes cluster, or document. As soon as two of them mutate shared state, they enter the regime classical concurrency control has studied for decades, but classical mechanisms fit LLM agents poorly. A single agent transaction spans minutes of inference, read sets are broad and opaque rather than statically inferable, and the live state agents act on admits neither fork nor buffer, so writes take effect the moment they execute. Locks block long inference intervals; OCC abort-and-retry discards minutes of work on every conflict. This paper builds concurrency control on a capability classical transactions lack: the LLM inside each agent can judge whether a conflicting write invalidates its plan, and can repair exactly the operations that depended on it. Control therefore turns advisory: the runtime informs, the agent repairs. Our protocol, MTPO (Monotonic Trajectory Pre-Order), fixes a serialization order at launch, serves each read the order-filtered value, and applies writes speculatively in place; a one-way notification asks an affected reader to re-judge and patch its plan, while the framework mechanically undoes and reorders misplaced writes through the saga-style inverse each tool registers in advance. At quiescence the run is serializable in the pre-decided order. We realize MTPO as CoAgent, toolcall middleware whose privileged ToolSmith grows footprint-declared, undoable tools online. On ten contended workloads, CoAgent stays within 5\% of serial correctness at a $1.4\times$ speedup and near-serial token cost, where 2PL and OCC surrender nearly all concurrency gains; on a bash-only target system, it grows a 25-tool library online and lifts the task pass rate from 45/71 to 63/71 at $0.80\times$ the time and $0.86\times$ the cost.

22.
arXiv (quant-ph) 2026-06-19

$K$-Theoretic Obstructions to Linearizing QCA Representations

arXiv:2606.19657v1 Announce Type: cross Abstract: Projective representations arise naturally in physics and representation theory, and determining whether they can be linearized has been a fundamental problem. In this work, we study the analogous problem for quantum cellular automata (QCA) representations, which incorporate locality constraints imposed by a metric space $X$. Over an arbitrary field $\mathbb{F}$, we develop an obstruction theory for the linearization of QCA representations, using the algebraic $K$-theory spectrum of QCA constructed in previous work of the authors. The resulting obstructions are governed by the homotopy type of the QCA spaces, from which we extract universal obstruction classes to linearization. In the complex algebraic and unitary case, we also fully compute the homotopy types of the QCA spaces over a point, a line, and a plane.

23.
medRxiv (Medicine) 2026-06-19

Cardiometabolic multimorbidity and care experiences in primary healthcare among Brazilian adults aged 50 and over (ELSI-Brazil)

Background: Population aging and the rising burden of non-communicable diseases have increased the prevalence of cardiometabolic multimorbidity (CM-MM) among older adults. Patient-reported experience measures (PREMs) are recognized as essential components of healthcare quality assessment, yet evidence on primary care experiences among individuals with CM-MM remains scarce. Objective: To analyze primary care experiences according to the presence of cardiometabolic multimorbidity among Brazilians aged 50 years and older. Methods: Cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021; n = 9,949). CM-MM was defined as the self-reported coexistence of two or more of the following conditions: hypertension, diabetes mellitus, dyslipidemia, acute myocardial infarction, and stroke. Primary care experiences were assessed using a validated 12-item instrument organized into four domains: first-contact access, longitudinality, communication, and care coordination. Associations were estimated using Poisson regression adjusted for sociodemographic, health conditions, and healthcare utilization variables, with stratified analysis by Family Health Strategy (FHS) coverage. Results: CM-MM prevalence was 25.5%, with a progressive increase by age and an inverse gradient by education. Individuals with CM-MM reported significantly more positive experiences in longitudinality (mean index 2.53 vs. 2.34; adjusted PR = 1.22; 95%CI 1.12-1.33; p < 0.001) and, to a lesser extent, in communication (mean index 2.68 vs. 2.58; adjusted PR = 1.10; 95%CI 1.00-1.20; p = 0.041). No statistically significant differences were found in first-contact access or care coordination. After stratified by FHS coverage, the observed differences in longitudinality and communication were no longer statistically significant. Conclusions: CM-MM was associated with more positive primary care experiences in longitudinality and communication. The absence of differentiated experiences in first-contact access and coordination highlights structural gaps in primary care responsiveness to individuals with greater clinical complexity. Keywords: Multimorbidity; Cardiometabolic diseases; Primary Care; Patient-reported experience measures; Older adults; ELSI-Brazil.

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

Spatio-Temporal Audio Language Modeling for Dynamic Sound Sources

Sound events are entities with semantic identities, locations, and trajectories, but current audio-language models usually reason about clips as global event content. Conversely, sound event localization models track source directions over time but offer limited semantic coverage for language reasoning. To address this gap, we introduce ST-AudioQA, a spatio-temporal audio QA dataset and benchmark built from first-order ambisonic (FOA) renderings of static and moving sound sources. Each scene provides source identity, activity, direction, distance, and motion metadata, enabling dense trajectory supervision and questions about what is sounding, where it is, how it moves, and how sources relate. We further propose ST-Audio Encoder, a time-resolved FOA audio encoder that learns event semantics together with source trajectories, and ST-AudioLM, which connects the audio tokens from the encoder to an LLM for spatio-temporal audio QA. Experiments show that this representation improves the semantic-localization tradeoff and yields stronger reasoning performance than static spatial and localization-oriented baselines.