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01.
arXiv (quant-ph) 2026-06-24

Quantum Adaptive Self-Attention for Quantum Transformer Models

arXiv:2504.05336v4 Announce Type: replace Abstract: A recurring weakness in quantum machine learning (QML) is that reported ``quantum advantages'' are seldom tested against a capacity-matched classical control, leaving it unclear whether a gain comes from the quantum substrate or from the architectural change that accompanies it. Our primary contribution is methodological: a protocol for attributing such gains honestly – a capacity-matched classical bottleneck of identical parameter budget, transparent reporting of where quantum does not help, and validation on real quantum hardware – which we develop and apply through a concrete case study. That case study is Quantum Adaptive Self-Attention (QASA), a hybrid Transformer that replaces the value projection of a single encoder layer with a 36-parameter parameterized quantum circuit (PQC), keeping all other layers classical. Across nine synthetic benchmarks and the real-world ETTh1 dataset, QASA improves on a full-capacity classical Transformer for chaotic and trend-dominated signals. To ask whether this is a genuinely quantum effect, we introduce a control rarely applied in quantum machine learning – a capacity-matched classical bottleneck with the same parameter budget – and find that it matches the PQC on the error metrics. The gain is therefore attributable to the low-rank value-projection bottleneck (an architectural parsimony principle), not to quantumness; adding further quantum layers only degrades performance and trainability. We accordingly position the quantum layer not as a source of accuracy advantage but as a competitive instantiation of this principle: its low-rank compression onto the signal's intrinsic dimensionality is matched by a classical bottleneck, so the gain is architectural rather than quantum.

02.
arXiv (CS.LG) 2026-06-17

Learning Credal Ensembles via Distributionally Robust Optimization

arXiv:2602.08470v3 Announce Type: replace Abstract: Credal predictors are models that are aware of epistemic uncertainty and produce a convex set of probabilistic predictions. They offer a principled way to quantify predictive epistemic uncertainty (EU) and have been shown to improve model robustness in various settings. However, most state-of-the-art methods mainly define EU as disagreement caused by random training initializations, which mostly reflects sensitivity to optimization randomness rather than uncertainty from deeper sources. To address this, we define EU as disagreement among models trained with varying relaxations of the i.i.d. assumption between training and test data. Based on this idea, we propose CreDRO, which learns an ensemble of plausible models through distributionally robust optimization. As a result, CreDRO captures EU not only from training randomness but also from meaningful disagreement due to potential distribution shifts between training and test data. Empirical results show that CreDRO consistently outperforms existing credal methods on tasks such as out-of-distribution detection across multiple benchmarks and selective classification in medical applications.

03.
arXiv (quant-ph) 2026-06-19

Smooth time-dependent control of dipolar Bose-Einstein condensates

arXiv:2606.20507v1 Announce Type: cross Abstract: We consider protocols for control of dipolar Bose-Einstein condensates where the critical role is played by the long-range anisotropic interatomic magnetic dipole-dipole interaction. The phase diagram of such a condensate has been explored theoretically and experimentally with certain values of the interatomic scattering length corresponding to superfluid and supersolid phases, where supersolidity appears as a modulation in the ground state density. Preparation of this modulated ground state is challenging, since excitations appear as a result of a finite-time evolution required to produce qualitative changes in the wavefunction density. To solve this problem we consider the time-dependent control of a dipolar Bose-Einstein condensate using shortcuts to adiabaticity techniques, concentrating on design of the time-dependent scattering length, a parameter of the system easily tunable by contemporary experiments. The first technique is the variational approach based on the Euler-Lagrange equations for a separable ansatz describing the evolution of the superfluid state. Secondly, we study the transition from superfluid to supersolid using a direct optimization protocol. We discuss the fidelity of the developed protocols in terms of the evolution time.

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

LearnOpt: Recovering the Latent Cognitive Structure of Standardized Examinations via Knowledge Graphs and Constrained Optimization

arXiv:2606.15349v1 Announce Type: cross Abstract: Standardized examinations are typically treated as uniform syllabus coverage problems. We argue they are better understood as adversarial systems with stable latent cognitive structures diverging systematically from official syllabi. We introduce LearnOpt, which recovers this structure from historical question papers and generates personalized, time-bounded study plans. Applied to nine years of NEET questions (2016-2024, n=1,496), LearnOpt builds an exam knowledge graph from LLM-tagged questions, extracts a five-category latent skill distribution, and formulates study planning as a knapsack-variant optimization over prerequisite-aware subgraphs with Bayesian Knowledge Tracing. Central finding: NEET's latent skill distribution is stable within a syllabus regime (consecutive-year KL divergence 0.004-0.032 for 2016-2021, non-significant under permutation testing) but shifts significantly with NCERT's 2023 syllabus rationalization: pooling 2016-2021 (n=1,072) vs 2023-2024 (n=392) gives KL=0.040 (p=0.0005), with Elimination/Negation questions rising from ~20-29% to ~31-35%. Latent structure, while not permanently stationary, is piecewise stable, with shifts detectable and attributable to curricular events. Within either regime, subject predicts skill profile more strongly than year. An optimization evaluation, using one real and two synthetic mastery profiles, shows the skill-weighted objective produces a modest but real reordering of recommended topics over a mastery-conditioned frequency baseline. Applying the pipeline to JEE Advanced reveals a profile dominated by Multi-concept Integration (80.9% vs. 33.3% for NEET), with a JEE-vs-NEET divergence (KL=0.505) exceeding NEET's largest cross-subject divergence: exam tier shapes latent cognitive structure more than subject, which shapes it more than time within a regime. Code, knowledge graph, and annotated dataset are released publicly.

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

GIST-CMTF: Goal-State Inference for Causal Minimal Tool Filtering in LLM Agents

arXiv:2606.16813v1 Announce Type: new Abstract: Tool-augmented LLM agents rely on runtime filtering to decide which tools should be visible at each step. Causal Minimal Tool Filtering (CMTF) reduces tool-choice confusion by exposing only the next causally necessary tool frontier, but it assumes that the user request has already been mapped to a symbolic goal state. In practice, requests such as "handle my appointment" or "take care of this email" may correspond to multiple possible goals. This creates wrong-goal execution, where an agent follows a valid causal tool path for an unintended objective. We introduce GIST-CMTF, a goal-state inference layer that predicts candidate symbolic goals over the same state-transition vocabulary used by CMTF, estimates ambiguity, and either applies CMTF or exposes clarification as a causal action that produces missing goal or state variables. We evaluate GIST-CMTF across seven model backends, six filtering methods, and 120 controlled tool-use tasks. GIST-CMTF achieves 97.0% task success, compared with 80.1% for top-goal CMTF and 82.9% for semantic-goal CMTF. It reduces wrong-goal execution from 19.4% under top-goal CMTF to 2.5%, while preserving the one-tool exposure of causal filtering and using substantially fewer tokens than all-tools exposure. These results suggest that reliable tool-augmented agents should validate goal state, not only tool relevance, before exposing external actions.

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

Exact Posterior Score Estimation for Solving Linear Inverse Problems

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.

07.
arXiv (CS.LG) 2026-06-17

Reducing Learner Redundancy in Boosting via Residual Orthogonalization

arXiv:2606.17567v1 Announce Type: new Abstract: While sequential residual fitting is the bedrock of standard boosting frameworks, it inherently breeds learner redundancy by repeatedly revisiting correlated error components. To address this bottleneck, we propose a shift from residual fitting to residual orthogonalization and introduce SCBoost. Our framework tackles redundancy through two complementary mechanisms: Spectral Residual Projection (SRP) and Covariance-Regularized Weighting (CRW). During training, SRP projects each residual target onto the orthogonal complement of the historical prediction subspace, forcing successive learners to capture only novel empirical innovations. During aggregation, CRW optimizes ensemble weights on a validation set with an explicit covariance penalty to mitigate remaining correlations. Theoretically, we provide a finite-sample geometric characterization proving that SRP yields an exact additive residual-energy decomposition. Furthermore, under an isotropic-noise assumption, we rigorously establish the conditions under which this projection improves the effective Signal-to-Noise Ratio. Extensive experiments across ten benchmark datasets demonstrate that SCBoost delivers strong out-of-the-box performance, particularly in accuracy and F1 score. This work reinterprets boosting through a geometric lens, suggesting that explicit redundancy control is a principled and necessary step toward more efficient ensemble architectures.

08.
bioRxiv (Bioinfo) 2026-06-11

EditorForge: An Active-Site-Aware Framework for Inverse-Folding-Based Protein Redesign

Inverse-folding models can rapidly generate protein sequences compatible with a supplied backbone, but unconstrained redesign is poorly suited to enzyme and genome-editor-associated domains, where catalytic, substrate-proximal, and conserved structural regions must remain protected. In this paper, we present EditorForge, a modular constraint-and-audit suite for editor-domain protein redesign that wraps fixed-backbone inverse folding with explicit design masks, fixed-position enforcement, active-site-proximity auditing, active-site-shielded regeneration, and downstream structural quality control. Using full-length Moloney murine leukemia virus reverse transcriptase structure 4MH8 (MMLV RT 4MH8) as a demonstration target, EditorForge first restricted redesign to a bounded 25-position envelope while fixing 428 residues. An initial audit detected active-site-proximal failure modes despite fixed-position integrity. Later, the Active Site Shield module then removed five unsafe design positions, replaced them with lower-contact alternatives, and regenerated candidates under stricter constraints. Post Shield Audit evaluated 24 regenerated candidates, all of which satisfied the hard sequence/mask and active-site-shield constraints. For the eight candidates that were selected or returned for structure-prediction/refolding quality control. Enhanced RefoldQC found that all 8 evaluated predicted structures passed the computational structure-QC screen. That said, the selected 8 candidates passed the computational structure-QC screen, with global C RMSD values of 1.2061–1.5555~[A], active-site C RMSD values of 0.4098–1.8397~[A], mutation-neighborhood C RMSD values of 1.3155-1.6848~[A], and average pLDDT-like confidence values of 94.87-95.11. In short, EditorForge provides a reproducible triage layer that converts general inverse-folding output into constrained and editor-specific candidate sets for downstream structural and biological review on top of existing structural prediction tools.

09.
medRxiv (Medicine) 2026-06-18

Empirical Validation and Predictive Utility of the Perinatal Grief Scale in Men after Perinatal Loss

Background. The Perinatal Grief Scale (PGS) is a widely used instrument for assessing grief following pregnancy loss, yet no study has validated it specifically in men despite documented use in several studies. This gap is critical given fathers' persistent underrepresentation in perinatal bereavement research and the absence of empirically supported screening thresholds for this population. Methods. This cross-sectional validation study used data from the OPALE project (Observatory on PerinatAL hEalth) conducted by the CiaoLapo Foundation in Italy. Among 276 fathers who experienced stillbirth or miscarriage, we examined criterion validity by testing the association between PGS scores and trauma-related symptomatology assessed via three validated instruments: the Revised Impact of Event Scale (RIES, n=103), National Stressful Events Survey Short Scale (NSESSS, n=95), and SCL-90 (n=173). We systematically tested multiple threshold combinations to identify optimal discriminative performance. Results. The PGS demonstrated excellent criterion validity. The optimal threshold (PGS >=92) showed sensitivity 81.0%, specificity 81.8%, and Youden's J index 0.628. Fathers scoring >=92 had 19.12 times the odds of high trauma symptoms (95% CI: 9.35 to 39.14, p

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

PATCH: Action-Chunk-Conditioned Latent Patch Innovation Monitoring for Robot Manipulation

Learning-based manipulation policies have made substantial progress in real-world robot manipulation, particularly for short-horizon action generation. However, deployment in open workspaces remains fragile under unexpected local scene dynamics, such as moving objects, transient occlusions, or disturbances near the intended motion. Existing runtime monitors often rely on global observation anomalies, policy uncertainty, or frame-level visual changes, and struggle to distinguish task-relevant execution risk from benign visual variation. We introduce PATCH, an action-chunk-conditioned latent patch innovation monitor for deployment-time intervention. Given the active action chunk, PATCH defines a projected execution corridor, predicts latent patch evolution inside it, and accumulates persistent residuals unexplained by the robot's own motion. These residuals form a localized intervention signal that allows PATCH-Router to pause execution, select an available recovery source, and resume the original policy once localized innovation subsides. Experiments on real robot rollout data show that PATCH produces more stable and context-relevant triggers than competing runtime monitors. Real-robot deployment further demonstrates monitor-driven intervention and policy resumption for disturbance-aware manipulation. Project Page: https://yananzhou5555.github.io/PATCH/.

11.
Nature (Science) 2026-06-16

Daily briefing: How many elementary particles are there?

Authors:

Estimates range from 17 to 995.5. Plus, one man with paralysis is using a brain–computer interface at home and GLP-1 obesity drugs appear to boost testosterone and sperm quality. Estimates range from 17 to 995.5. Plus, one man with paralysis is using a brain–computer interface at home and GLP-1 obesity drugs appear to boost testosterone and sperm quality.

12.
arXiv (CS.AI) 2026-06-17

A Risk Decomposition Framework for Pre-Hoc Fine-Tuning Prediction

arXiv:2606.17649v1 Announce Type: cross Abstract: The high cost of fine-tuning LLMs poses a significant economic barrier; pre-hoc performance prediction offers a critical solution to substantially reduce this expense. However, the theoretical limits of pre-hoc performance prediction remain unexplored. We formulate it as a stochastic estimation problem under information constraints, decomposing prediction risk into two components: an intrinsic limit (static data-model compatibility) and a reducible optimization variance. We prove that optimization variance admits a necessary lower bound on its decay rate, implying fundamental constraints on how quickly uncertainty dissipates, regardless of the predictor used. Based on these dynamics, we derive a budget-optimal probing principle and introduce a predictability phase diagram that organizes tasks into three distinct regimes: Static-Sufficient, Dynamic-Critical, and Noise-Dominant. Extensive experiments on synthetic and real-world benchmarks validate these theoretical regimes and demonstrate the efficiency of our probing strategy.

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

A Systematic Evaluation of Large Language Models for PTSD Severity Estimation: The Role of Contextual Knowledge and Modeling Strategies

Large language models (LLMs) are increasingly being used in a zero-shot (generative) fashion to assess mental health conditions, yet we have limited knowledge on what factors affect their accuracy. In this study, we use a clinical dataset of natural language narratives and self-reported PTSD severity scores from 1,437 individuals to comprehensively evaluate the performance of 11 state-of-the-art LLMs. To understand the factors affecting model's assessment accuracy, we systematically varied (i) contextual knowledge prompted to the models like subscale definitions, distribution summary, and interview questions, and (ii) modeling strategies including zero-shot vs few shot, amount of reasoning effort, model sizes, structured subscales vs direct scalar prediction, output rescaling and nine ensemble methods. Our findings indicate that (a) LLMs are most accurate when provided with detailed construct definitions and context of the narrative, even exceeding human raters agreement with self-reported scores; (b) increased reasoning effort leads to better estimation accuracy; (c) performance of open-weight models (Llama, DeepSeek) plateaus beyond 70B parameters while closed-weight (gpt-o3-mini, gpt-5) alternatives improve with newer generations; and (d) best performance is achieved when ensembling a supervised model with the zero-shot LLMs. Beyond agreement with self-reports, LLMs' estimates discriminated PTSD severity from depression, anxiety, and alcohol use, and prospectively predicted future mental healthcare expenditure. Together, these results suggest that contextual knowledge and modeling strategies meaningfully affect accuracy and clinical utility of LLM-based assessments of PTSD severity.

14.
arXiv (CS.CV) 2026-06-16

Revealing Artifacts via Noise Amplification: A Novel Perspective for AI-Generated Video Detection

With the rapid advancement of video generation models, distinguishing between AI-generated and authentic videos has emerged as a challenging endeavor. The majority of existing research endeavors concentrate on the development of detectors for identifying samples generated by generative adversarial networks. Nevertheless, the detection of AI-generated videos, particularly those produced by text-to-video models, still remains an uncharted territory. Although state-of-the-art text-to-video models can generate realistic visual content similar to real videos, they fall short of generating the details of the images and the changes in details within the videos. Inspired by this, we address AI-generated video detection from a novel perspective of bit-planes, which can effectively describe the details or noises in images or videos. To this end, we propose a simple yet effective approach called Noise Amplification. This approach first extracts noise signals based on bit-planes, then amplifies these noise signals, and finally feeds them into the discriminator networks for video fake classification. Noise amplification is comprehensively constructed by incorporating three aspects: pixel-level intensity enhancement, region-level spatial amplification, and frame-level temporal aggregation. To evaluate methods of AI-generated video detection in challenging scenarios, we also introduce a benchmark named HardGVD. Extensive experiments on both the large-scale dataset GenVidBench and HardGVD show that our simple approach significantly outperforms state-of-the-art methods.

15.
medRxiv (Medicine) 2026-06-15

Toward a National Registry for Inborn Errors of Immunity in Peru: A Qualitative Implementation Study

Background: Peru lacks an integrated information system for patients with Inborn Errors of Immunity (IEI). Although disease registries are essential tools for data management and health planning, their success depends on implementation science approaches that account for local contextual factors. This study reports Phase I of a three-phase mixed-methods implementation project to design and develop a national IEI registry. Methods: Phase I consisted of a phenomenological qualitative study exploring stakeholder perspectives. Semi-structured focus groups and in-depth interviews were conducted with 29 key stakeholders across four groups: policy-makers, clinical experts, end-users (immunologists, residents, allied health personnel), and patient organization representatives. Interviews followed a guide structured around four a priori domains (structure, navigation, feasibility, and perception of existing systems). Discussions were conducted in Spanish, audio-recorded, transcribed verbatim, and coded using ATLAS.ti. A hybrid thematic analysis combining deductive and inductive coding was performed. Data elements proposed for the registry were triangulated with qualitative findings. Results: Thirty-six initial codes were consolidated into 15 categories, which were further integrated into four overarching themes conceptualized as pathways toward intention to use: (1) Environment, where governance, regulatory backing, and sustainable financing were identified as key enablers, while limited interoperability emerged as a structural barrier; (2) Technical Dimension, emphasizing usability, alignment with clinical workflow, and a hierarchical data architecture (demographic, clinical, therapeutic); (3) Users, highlighting clinical leadership, protected time, digital readiness, and perceived usefulness as stronger motivators than financial incentives; and (4) Patients, underscoring data protection, transparency, trust, and advocacy as essential for legitimacy and sustainability. Conclusions: A national IEI registry in Peru is perceived as necessary and feasible if implemented with strong regulatory foundations, interoperable design, robust data security, and user-centered architecture. These findings informed the development of an initial functional prototype and the operational plan for Phase II, focused on usability evaluation.

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

SMGFM: Spectral Multimodal Graph Pretraining for Multimodal-Attributed Graphs

arXiv:2606.12867v1 Announce Type: new Abstract: Multimodal-attributed graphs (MAGs) couple graph topology with node semantics from text, images, and other modalities. Traditional graph learning contextualizes node semantics by coupling topology with node features. However, this coupling design becomes troublesome in MAGs, where structure-induced and modality-intrinsic semantics may contribute differently to downstream tasks. Structure-induced semantics promote relational consistency through smooth topological variation, whereas modality-intrinsic semantics often encode local, fine-grained distinctions that should not be uniformly smoothed or aligned. Therefore, the key challenge is to identify semantic roles before cross-modal fusion. To this end, we leverage graph-frequency variation as a prior, where low-frequency components capture topology-consistent semantics and high-frequency components preserve modality-specific semantics. Based on this intuition, we propose SMGFM, a spectral multimodal graph pretraining framework that decomposes each modality-specific node signal into graph-frequency bands and assigns band-level semantic roles before cross-modal interaction. Concretely, SMGFM constructs frequency-resolved modality tokens with scalable Chebyshev filters, estimates their coupling reliability through topology-conditioned routing, and performs band-modality interaction before fusion. Its frequency-routed objectives align smooth consensus routes while preserving modality-specific routes, mitigating spatial-domain entanglement and uniform cross-modal alignment. Extensive experiments conducted on the MAG datasets demonstrate that SMGFM achieves state-of-the-art performance across graph-level and modality-level tasks.

17.
arXiv (CS.LG) 2026-06-15

Neural ARFIMA model for forecasting BRIC exchange rates with long memory

arXiv:2509.06697v3 Announce Type: replace-cross Abstract: Exchange rate forecasting remains a challenging problem, particularly for emerging economies, where the observed time series exhibit pronounced long-memory dependence, nonlinear dynamics, and sensitivity to macro-financial drivers. Classical models such as ARFIMA capture long-range persistence but fail to adequately represent nonlinear relationships, while modern machine learning approaches often neglect the underlying long-memory structure in macroeconomic series. To address this gap, we propose a Neural AutoRegressive Fractionally Integrated Moving Average (NARFIMA) model that integrates ARFIMA-based long-memory modeling with neural networks for nonlinear function approximation, while incorporating exogenous macroeconomic and uncertainty indicators. The framework provides a unified approach for capturing persistence, nonlinear dynamics, and external shocks. We establish asymptotic stationarity of the NARFIMA process and develop conformal prediction intervals for distribution-free uncertainty quantification. Empirical results for BRIC exchange rates show that NARFIMA consistently outperforms a broad range of forecasting benchmarks across multiple horizons, underscoring the importance of explicitly modeling long-memory dependence in exchange rate dynamics. The `narfima' R package provides an implementation of our approach.

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

NeuroSymbolic AI for Legal AI-TRISM: Trustworthy, Reliable, Interpretable, Safe Models

arXiv:2606.15646v1 Announce Type: new Abstract: Large Language Models (LLMs) have transformed natural language processing, but their lack of interpretable reasoning and tendency to hallucinate pose significant challenges for legal applications. While LLMs show promise for legal text analysis and generation, they struggle with accurate citation attribution and precedent verification. For example, in legal contexts, a single incorrect precedent can jeopardize a case. Current approaches to improve LLM reliability in legal domains suffer from two key limitations: inadequate integration of structured legal knowledge during training or fine-tuning, and insufficient verification mechanisms for generated legal content. To address these challenges, we propose the TRISM (Trustworthy, Reliable, Interpretable, Safe Models) framework, which integrates NeuroSymbolic AI principles with LLMs to leverage both neural learning capabilities and symbolic reasoning over structured legal knowledge. The TRISM approach addresses the above limitations while maintaining interpretable decision pathways. Our framework formalizes the extraction of symbolic knowledge from legal textual documents and incorporates Retrieval-Augmented Generation (RAG) as a core component for grounding LLM outputs in verified legal sources. In this position paper, we make the following contributions: (1) An analysis of the limitations of AI in law; (2) Introduce RASOR RAG which creates foundations for neurosymbolic RAG by generating explicit interpretable rationales that could be formalized into symbolic representations; (3) A formalized methodology for creating symbolic legal knowledge bases that support both interpretable reasoning and output verification in LLMs; and (4) The TRISM framework for integrating symbolic legal knowledge with LLMs.

20.
medRxiv (Medicine) 2026-06-22

Starting, stopping and restarting. Patterns of Methylphenidate Use over 14 years in a large public health system

Background Persistence with stimulant medication is poor in children and adolescents with ADHD, and the evidence base is derived predominantly from high-income countries. We describe methylphenidate utilisation patterns and predictors of 12-month retention across 14 years in a large South African public health service. Methods Retrospective cohort study using routine pharmacy data from the Western Cape provincial health service (2011-2024). Children aged 5-18 at first prescription were included. Treatment episodes were defined as continuous prescription sequences with no gap exceeding 90 days and classified as initiations or restarts. Logistic regression modelled 12-month retention against early visit frequency and formulation type as pre-specified exposures. Findings 421,925 prescription events for 23,243 children across 115 facilities generated 65,885 treatment episodes. Median age at first prescription was 10 years (IQR 8-12); 77.6% were male. Kaplan-Meier 12-month survival was 28.2% for initiations and 15.4% for restarts, substantially below high-income country comparators. A quarter of all initiating prescriptions were not followed by a subsequent dispensing event; nearly 40% of patients had three or more treatment episodes. Early visit frequency was the strongest predictor of 12-month retention (high vs low: OR 2.85, 95% CI 2.65-3.06). The sustained-release formulation effect was present but attenuated on multivariable adjustment. Treatment re-initiations showed a marked seasonal pattern consistent with the South African school calendar. Interpretation Twelve-month retention was markedly lower than high-income country rates. Against a backdrop of high attrition, both early visit frequency and sustained-release formulation access predicted persistence; clinical engagement and reducing structural barriers to access are modifiable factors in this setting. Funding None.

21.
medRxiv (Medicine) 2026-06-22

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

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

22.
arXiv (math.PR) 2026-06-12

Data-driven subsampling rates for diffusion parameter estimation of SDEs

arXiv:2606.13615v1 Announce Type: new Abstract: We study the problem of diffusion parameter estimation for stochastic differential equation (SDE) models in scenarios where data and model are compatible only on specific scales that have yet to be determined. We introduce a simple and efficient method for selecting suitable rates at which given time series data should be subsampled in order to ensure that the statistical structure of the subsampled data is consistent with the behavior of the SDE model on an infinitesimal scale. Our approach is based on analyzing the statistics of the lengths of monotonically increasing or decreasing segments in the subsampled data sequence, which we refer to as monotone runs. As an analytical foundation, we prove for a large class of SDEs with additive noise that the lengths of monotone runs at an infinitesimal scale are approximately geometrically distributed with success probability $1/2$. This universal characterization is employed to derive an automated method for selecting appropriate subsampling rates for given time series data that is directly applicable in real-world scenarios and does not rely on an asymptotic framework of multiscale diffusions. The approach is demonstrated using an application from industrial mathematics concerning surrogate models for fiber lay-down curves in production processes of nonwoven textiles.

23.
arXiv (CS.CV) 2026-06-11

Towards Fully Automated Exam Grading: Fairness-Aware Recognition of Handwritten Answers with Foundation Models

Correcting handwritten exams by hand is time-consuming and error-prone, particularly for large cohorts, while fully digital exams tend to force a didactic narrowing towards closed question formats. A practical middle ground keeps paper-based, problem-oriented tasks but records the assessment-relevant answers as single capital letters in a table that a machine can read. The open question is whether this reading can be made accurate and, above all, fair enough for unsupervised grading. Earlier automated approaches reached only about 88%–91% recognition – too low – and failed on the cases that matter most: answers placed outside the cell, crossed out, or written in cursive. We show that general-purpose vision-language foundation models (VLMs), which interpret the page rather than match pixel templates, close this gap. On a benchmark of 61 anonymised exams (3141 answer positions) the best model reaches 98.4% accuracy, well above the previous baseline. Crucially, we centre the evaluation on fairness: we distinguish false negatives (a correct answer marked wrong, which disadvantages the student) from false positives, and a lightweight prompt that supplies the reference solution as context lowers the false-negative rate to 0.58%. Under an exemplary grading scheme only three of the 61 exams would be graded worse, all caught by a student self-review step. Fully automated, fairness-aware exam grading at scale is therefore defensible; we release the anonymised benchmark to support reproducibility.

24.
medRxiv (Medicine) 2026-06-15

Quantitative insights into the role of phages and plasmids in the persistence of nontuberculous mycobacteria in chloraminated drinking water

Nontuberculous mycobacteria (NTM) are opportunistic pathogens that persist in chloraminated drinking water systems, yet the roles of phages and plasmids in their persistence remain largely unexplored. Using genome-resolved and quantitative metagenomics, we characterized NTM, phages, prophages, and plasmids in a chloraminated building plumbing system. Bacterial metagenome-assembled genomes (MAGs) and viral operational taxonomic units (vOTUs) were quantified at mean concentrations of 8.41 * 10^7 and 8.00 * 10^8 copies/L, respectively, including seven NTM MAGs at a mean total concentration of 4.01 * 10^5 copies/L. NTM concentrations were highest at the site with the lowest bacterial and viral diversity. Predicted NTM-infecting virus concentrations were inversely related to NTM concentrations across sites, suggesting complex phage-host dynamics that warrant direct experimental investigation. NTM, putative phages, prophages, and plasmids encoded functions related to disinfectant tolerance, stress response, metal resistance, and secretion. These findings identify phage interactions, prophages, and plasmids as overlooked genomic and ecological dimensions of NTM persistence in engineered water systems.

25.
arXiv (CS.CL) 2026-06-19

Code-Switching Reveals Language Anchoring in Multilingual LLMs

Multilingual Large Language Models (MLLMs) are increasingly expected to handle Code-Switched (CS) inputs, yet mixing languages frequently degrades performance relative to source- or target-language monolingual counterparts. To understand this degradation, we use grammar-forced CS as a controlled diagnostic setting for locating CS representations relative to their source and target counterparts. We introduce Anchor Bias, a geometric measure that quantifies language anchoring, whether a CS hidden state aligns closer to its source or target language counterpart. Across diverse MLLMs, Anchor Bias reveals a consistent grammar-frame effect: source-framed CS stays source-anchored, whereas target-framed CS shifts target-ward and shows larger Question Answering (QA) degradation. Motivated by this representational pattern, we propose CANVAS (Contextual Anchor-based Neural Vector Alignment Steering), an inference-time intervention that extracts a source-side canvas from the input and softly steers target-language hidden states toward the source anchor during prefill. CANVAS consistently recovers QA F1 across MLLMs and CS conditions, showing that internal anchoring signals provide an actionable target for mitigating CS inference failures.