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01.
arXiv (CS.CL) 2026-06-15

Which Models Perform Better in Inheritance Reasoning?

This paper presents the participation of team PSL in the QIAS 2026 Shared Task on Arabic Islamic inheritance reasoning. The task evaluates the ability of large language models to solve inheritance cases that require legal interpretation, multi-step reasoning, and precise numerical computation. We compare commercial and open-source models under a unified prompting strategy to assess their effectiveness in structured legal reasoning with minimal task-specific adaptation. \\ Our results show a clear gap in reliability between the two model families. Commercial models demonstrate stronger performance in identifying eligible heirs, applying exclusion rules, and maintaining consistency across reasoning steps. In contrast, open-source models exhibit greater instability, particularly in cases involving dependent legal decisions and fractional share adjustments. The best performance is achieved by Gemini 2.5 Flash, with an MRE of $0.989$.

02.
medRxiv (Medicine) 2026-06-15

A More-Than-Human Approach to Designing for Mental Health: Remixing Prototypes for the Contexts of Complex Healthcare Infrastructures

Digital mental health tools (DMHTs) often fail to be successfully implemented in clinical settings. While user- and human-centred design frameworks are frequently proposed for developing effective tools, they are insufficient to address the sociotechnical complexity of healthcare environments. This paper addresses this limitation by detailing the application of a more-than-human design framework to incorporate wider contextual factors into design decisions. To demonstrate the application of this more-than-human design framework, we present a case study showcasing the design of one specific feature within a DMHT intended to support Health Improvement Practitioners (HIPs) in New Zealand's Integrated Primary Mental Health and Addictions (IPMHA) service. Our process blends usage-context storyboards with interface prototypes, using think-aloud interviews to test the contextual fit of our prototypes. The initial design concept failed due to contextual factors such as inconsistent wait times and the administrative burden on clients and clinic staff. This led to a pivot to a more context-appropriate, practitioner-focused, in-session concept for digital psychometric administration and automated scoring. This case study demonstrates that for DMHTs to be viable within complex healthcare environments, design must focus on more than the needs of a single user, incorporating multiple stakeholders and contextual variables across the wider service-delivery context.

03.
arXiv (CS.AI) 2026-06-16

Optimizing LLM Inference: Fluid-Guided Online Scheduling with Memory Constraints

arXiv:2504.11320v4 Announce Type: replace-cross Abstract: Large language models now serve millions of users daily, with providers incurring costs exceeding $700,000 per day. Each request requires token-by-token inference, making GPU scheduling central to latency, capacity, and cost. The difficulty is endogenous memory growth: generated tokens expand the Key-Value (KV) cache, and overflow can evict in-progress requests and waste prior computation. We formulate inference as a multi-stage online scheduling problem with endogenous memory growth, linear iteration times, and GPU-resident KV-cache constraints. We introduce a fluid model that characterizes equilibrium batch composition, memory requirement, and stability region. Guided by the fluid model, we design WAIT (Waiting for Accumulated Inference Threshold), a threshold-based admission rule for known output lengths, and Nested WAIT, which extends the rule to unknown output lengths by regulating how requests advance across decode-stage segments. Both algorithms approximate the fluid benchmark asymptotically under the stated memory conditions. Nested WAIT uses an additional safety buffer of moderate scale to hedge against memory-overflow-induced evictions under unknown output lengths. In Vidur simulations configured for Llama-2-7B on an A100 GPU, with supplemental real-GPU validation reported in the appendix, the policies enlarge the empirically observed stable operating range relative to widely used baseline algorithms and reduce latency especially in near-overloaded and overloaded regimes.

04.
arXiv (CS.CV) 2026-06-18

Low-Cost Neuromorphic Fall Detection Using Synthetic Event Data and Hybrid SNNs

This work presents the development of hybrid models that integrate spiking neural networks (SNNs) with components of convolutional neural networks (CNNs) to learn from simulated event-based camera data (Dynamic Vision Sensor, DVS) generated from conventional smartphone videos. Aimed primarily at human fall detection, the approach leverages the energy efficiency and spatio-temporal processing capabilities of SNNs by converting video frames into event-based data. The proposed models are evaluated through simulations on multiple datasets, comparing their performance to that of traditional machine learning models. Results demonstrate significant gains in efficiency without sacrificing accuracy, underscoring the potential of combining SNNs and DVS technology for complex tasks in real-world environments.

05.
arXiv (CS.CL) 2026-06-12

HyperTool: Beyond Step-Wise Tool Calls for Tool-Augmented Agents

Tool-augmented LLM agents commonly rely on step-wise atomic tool calls, where each invocation, observation, and value transfer is exposed in the main reasoning trace. This creates an execution-granularity mismatch: locally deterministic tool workflows are unfolded into repeated model-visible decisions, consuming context and forcing the model to manage low-level dataflow in the trace. We introduce HyperTool, a unified executable MCP-style tool interface that changes the model-visible unit of tool execution. A model invokes HyperTool with a code block that can call existing tools through their original schemas, manipulate returned values, and pass intermediate results locally, folding deterministic tool subroutines into a single outer call. To train models to use this interface, we synthesize HyperTool-format trajectories from cross-tool compositional tasks and verify them in real MCP environments. On MCP-Universe, HyperTool improves average accuracy from 15.69\% to 35.29\% on Qwen3-32B and from 9.93\% to 33.33\% on Qwen3-8B, and surpass GPT-OSS and Kimi-k2.5 on average accuracy, showing that our HyperTool can substantially improve multi-step tool use.

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

Response-Aware Multimodal Learning for Post-Treatment Visual Acuity Forecasting

Long-term visual acuity (VA) forecasting after anti-VEGF therapy is important for counseling and follow-up planning in diabetic macular edema (DME), yet remains challenging when only early post-treatment findings are available. While prior OCT-based methods mainly focus on short-term response or single-endpoint prediction, multi-horizon VA forecasting from early longitudinal data remains insufficiently under-explored. In this study, we assembled a real-world cohort of 188 anti-VEGF–treated DME patients with paired baseline and month-1 OCT scans, along with tabular OCT-derived biomarkers and non-imaging clinical variables. Using only these early data, we formulate a multi-horizon VA forecasting problem aimed at predicting visual outcomes at 3, 6, 12, 18, and 24 months, reflecting clinically meaningful follow-up intervals. We propose ReVA, a response-aware multimodal framework that combines baseline and month-1 OCT features with tabular variables to capture disease status and early treatment response. ReVA integrates spatial OCT attention, dependency-aware tabular encoding, and cross-modal fusion to predict patient-specific long-term VA trajectories. The proposed framework achieves MAE=0.1246, RMSE=0.1621, and R^2=0.6064 for 24-month VA prediction, with consistent performance across all forecast horizons. Our findings show that incorporating early treatment-response signals enables clinically meaningful long-term visual acuity forecasting, supporting data-driven decision support for routine anti-VEGF management. Code and pretrained models will be released on https://github.com/nguyenpbui/ReVA.

07.
arXiv (CS.CL) 2026-06-15

Harsher on Male? Evaluating LLMs on Gender-Asymmetric Moral Framing Across Diverse Conflict Scenarios

Existing studies on gender bias in LLMs have largely focused on stereotypes, occupational associations, or explicit harmful outputs. In this work, we ask whether LLMs apply consistent response standards to the same negative behavior under matched male-actor and female-actor conditions. We introduce GAMA-Bench, a gender-mirrored benchmark of 1,298 scenarios covering intimate relationship and public social conflicts. It constructs gender-neutral misconduct templates through controlled grids and cross-model review, then compiles them into paired first-person prompts with matched actor-gender and role-reference variations. We further design a structured response-framing protocol to measure how models allocate punishment, empathy, escalation, instruction, and blame. Experiments on 10 representative LLMs reveal a consistent male-disadvantaging asymmetry: male actors receive more punitive, escalatory, and blame-centered framing, whereas female actors receive more therapeutic and empathy-oriented framing for the same misconduct. Further analyses show that this pattern persists across model families, scenario tracks, model scale, and explicit thinking-style reasoning. The official code is available at https://github.com/xufeiqiong/GAMA-Bench.

08.
arXiv (quant-ph) 2026-06-11

Nonlocal continuous-variable gates by amplified optical connections

arXiv:2603.12866v2 Announce Type: replace Abstract: Nonlocal quantum gates, coupling quantum systems located at a distance, are crucial for distributed quantum computing. To this aim, high-capacity optical noiseless connections between different processing units are essential for transmitting large amounts of information per mode. Simultaneously, optical quantum computing offers future high-speed multimode quantum processors. We propose a library of feasible protocols to implement a necessary nonlocal continuous-variable (CV) quantum nondemolition (QND) gate between two distant users sharing a quantum channel and exploiting classical communication. The users are endowed with a newly achieved high-fidelity and large-bandwith element - single-pass phase-sensitive optical parametric amplifier (OPA), that allows for both online squeezing and channel-loss compensation. The use of OPAs enhances quality of the resulting gate in terms of both excess noise and entangling capability. The proposed schemes are also applicable to CV cluster state fusion, providing a first step towards development of distributed CV measurement-based quantum computation.

09.
arXiv (CS.AI) 2026-06-18

Deep Learning-Driven Inverse Design of Doherty Power Amplifiers Using Pixelated Combiners and Dual-State Impedance Synthesis

arXiv:2606.18395v1 Announce Type: cross Abstract: The output combiner of a Doherty power amplifier (PA) integrates load modulation, impedance matching, and phase compensation within a single network, making its design and synthesis highly challenging. In this paper, we propose a three-port Doherty combiner design methodology that combines deep convolutional neural networks (CNNs), pixelated layout representations, and genetic algorithms (GA) with dual-state impedance synthesis to address both peak and back-off power conditions. As a proof of concept, two GaN HEMT Doherty PA prototypes incorporating three-port pixelated combiners are designed and fabricated. Both prototypes achieve a measured saturated output power exceeding 44.2 dBm with peak drain efficiency above 71.2% within 2.6-2.8 GHz. Furthermore, a drain efficiency as high as 64% is measured at the 6-dB back-off level. After applying digital predistortion, each prototype achieves an adjacent channel leakage ratio (ACLR) better than -51.3 dBc.

10.
arXiv (quant-ph) 2026-06-17

Active Quantum Reservoir Engineering: Using a Qubit to Manipulate its Environment

arXiv:2505.16898v4 Announce Type: replace Abstract: Quantum reservoir engineering leverages dissipative processes to achieve desired behavior, with applications ranging from entanglement generation to quantum error correction. Therein, a structured environment acts as an entropy sink for the system and no time-dependent control over the system is required. We develop a theoretical framework for active reservoir engineering, where time-dependent control over a quantum system is used to manipulate its environment. In this case, the system may act as an entropy sink for the environment. Our framwork captures the dynamical interplay between system and environment, and provides an intuitive picture of how finite-size effects and system-environment correlations allow for manipulating the environment by repeated initialization of the quantum system. We illustrate our results with two examples: a superconducting qubit coupled to an environment of two-level systems and a semiconducting quantum dot coupled to nuclear spins. In both scenarios, we find qualitative agreement with previous experimental results, illustrating how active control can unlock new functionalities in open quantum systems.

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

Understanding Key Features of Time Series Foundation Models from Epidemic Forecasting

arXiv:2606.19560v1 Announce Type: new Abstract: Seasonal influenza infects millions of people and causes substantial morbidity and mortality in the United States each year, making accurate short-term forecasting a core public-health need. Reliable forecasts of epidemic time series can inform vaccination timing, hospital staffing, and resource allocation, yet the comparative behavior of modern forecasting architectures on infectious-disease surveillance data remains insufficiently characterized. We address this gap through a systematic evaluation of regional influenza forecasting using influenza-like illness surveillance and influenza-associated hospitalization time series under both temporal and spatial generalization settings for 1-4-week-ahead prediction. We compare classical neural network architectures, numerical transformer-based models, pretrained time series foundation models, and LLM-based forecasting approaches. Across tasks, we demonstrate that a mixture-of-experts model that fuses multiple pretrained forecasters achieves the strongest overall performance, indicating that heterogeneous pretrained representations provide complementary predictive information. Our results further show that numerical transformer-based models produce reliable forecasts, while pretraining provides the largest gains at longer horizons, particularly when the pretraining domain is mechanistically aligned with influenza dynamics. In contrast, LLM-based time series methods underperform relative to numerical forecasters in this setting. Finally, we examine hospitalization information as both an auxiliary covariate and a pretraining source. Hospitalization signals provide complementary improvements in selected settings and clarify when additional surveillance streams enhance the robustness of multi-horizon forecasting. These findings provide actionable guidance on model selection, pretraining strategy, and auxiliary-signal use for influenza preparedness.

12.
arXiv (CS.CL) 2026-06-19

StylisticBias: A Few Human Visual Cues Drive Most Social Biases in MLLMs

Multimodal large language models (MLLMs) are increasingly deployed in personally and societally consequential settings, yet the visual cues that shape how these models judge people remain poorly understood. Prior work often compares different (groups of) individuals, making it difficult to separate appearance effects from identity differences. We introduce StylisticBias, a controlled benchmark for evaluating attribute-level social bias in MLLMs. We generate 500 photorealistic base faces and create about 50 single-attribute variations per face, producing about 25K images. This design keeps identity fixed and changes one visual attribute at a time. It lets us measure how specific cues shift model judgments. We evaluate six MLLMs across 25 binary social judgment scenarios. We find that age and body type dominate identity-level effects, while fashion style and other visual cues drive the largest attribute-level shifts. We further find that about 15 attributes account for nearly 80\% of the total variation, showing that bias is concentrated in a small set of visual cues. Sensitivity is strongest in judgments that are semantically aligned with appearance, especially socioeconomic and style-related judgments. We release StylisticBias as a benchmark for fine-grained bias evaluation in multimodal models. Code and dataset: https://github.com/timo-cavelius/StylisticBias and https://hf.co/datasets/shaghayegh/stylistic-bias-dataset.

13.
medRxiv (Medicine) 2026-06-18

Consistency of sleep timing and duration are associated with more physical activity and favorable heart rate metrics in a naturalistic cohort

Background: Regularity of sleep patterns over time has increasingly gained traction as an important axis of sleep health. Since sleep habits are under some degree of behavioral control, understanding such patterns in naturalistic settings is particularly important. We quantified sleep variability and tested the hypothesis that regularity correlates with physical activity, resting heart rate (rHR), and heart rate variability (HRV). Methods: We analyzed real-world digital health data from over 81,000 participants (over 18 million nights) who provided informed consent to participate in the Apple Heart and Movement Study and elected to contribute sleep, activity, and heart rate data to the study. Variability was quantified using the standard deviation (SD) computed from total sleep time (TST), sleep start time (S-start), end time (S-end), and midpoint time (MP), as well as the Sleep Regularity Index (SRI). Results: The SD-based variability metrics correlated with one another (R values 0.74-0.92), and with the SRI metric (R values 0.62-0.64). More consistent sleep, by any metric, was associated with more activity and better rHR and HRV. The most consistent tertile for TST variability had higher median TST (6.9 vs 5.9 hours), more daily exercise (32.8 vs 20.4 minutes), lower rHR (62.4 vs 65.6 beats per minute), and higher HRV (40.6 vs 37.3), all p

14.
Science (Express) 2026-06-18

Indium-free perovskite/silicon tandem solar cells with tin oxide recombination layer and electrodes | Science

Authors: Unknown Author

Indium-based transparent conductive oxides are widely used as electrodes and recombination layers in perovskite/silicon tandem solar cells, yet their scalability is constrained by indium scarcity and sputtering-induced damage. Here we report high efficiency and stable indium-free perovskite/silicon tandem solar cells enabled by reactive plasma deposited tin oxide (RPD-SnO x ). For RPD-SnO x as the recombination layer, a certified efficiency of 33.6% is achieved. Fully indium-free tandems that used RPD-SnO x as both recombination layer and electrodes delivering a champion PCE of 33.2% (1 cm 2 ) and a mini-module with a certified efficiency of 31.0% (207.9 cm 2 ). Dense and uniform self-assembled monolayer anchoring enabled by RPD-SnO x suppressed non-radiative recombination and reduced halide migration. Indium-free mini-modules exhibited high thermal, damp-heat, and outdoor operational stability and retained 65% of their maximum initial efficiency after 105 days of outdoor operation.

15.
arXiv (CS.CL) 2026-06-19

Toten: Knowledge-Based Ontological Tokenization Of Physical Quantities And Technical Notation In Brazilian Portuguese

Byte-Pair Encoding tokenization is statistically efficient for vocabulary compression, but semantically blind to structured technical entities, fragmenting physical quantities, numbers, units, and symbolic expressions into lexically arbitrary subwords. We present TOTEN, a knowledge-based ontological tokenization framework that replaces statistical derivation with declarative classification grounded in a formal ontology of engineering entities (OEE). We formalize TOTEN as the triple : the ontology gathers types, structural principles, composition relations, and preservable invariants; the classification function maps raw text into typed regions; and the instantiator family yields a self-descriptive structured representation. Robustness derives from deterministic coupling with three external oracles: Pint (dimensional), Unicode Character Database (typographic), and RSLP (Portuguese morphology). Intrinsic evaluation covers four properties verifiable by construction – ontological atomicity, dimensional equivalence, typographic robustness, and numerical reconstruction – over an internal, physically validated benchmark (EngQuant, N=800) and four Brazilian Portuguese external corpora (N=1771 eligible cases). We also report detection recall, distinguishing coverage from conditional atomicity. Against eight state-of-the-art baselines, TOTEN achieves unit ontological atomicity in all contrasts and numerical reconstruction of 0.775-0.904 on external corpora, vs. 0.627-0.703 for the best baseline (Quantulum3); on EngQuant, 0.780 vs. 0.340. Differences are statistically significant (McNemar with Holm correction). Spearman correlation between internal and external rankings confirms concurrent validity of the control benchmark. Dimensional equivalence shows statistical parity with Pint, the oracle from which the system inherits dimensional authority.

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

Twisted (co)homology of non-orientable Weyl semimetals

arXiv:2511.22303v3 Announce Type: replace-cross Abstract: The quasi-particle excitations in Weyl semimetals, known as Weyl fermions, are usually forced to emerge in charge-conjugate pairs by the Nielsen–Ninomiya theorem. When the Brillouin zone is non-orientable, this constraint is replaced by a $\mathbb{Z}_2$ charge cancellation, as a result of the chirality becoming ill-defined on such manifolds; this results in configurations with seemingly non-zero total chirality. Here, we set out to explain this behaviour from a purely topological perspective, and provide a classification of non-orientable Weyl semimetal topology in terms of exact sequences of twisted (co)homology groups. This leads to several discoveries of direct physical importance: in particular, we recover the $\mathbb{Z}_2$ charge cancellation in a coordinate-independent way, allowing meaningful limits to be set on its physical interpretation. A detailed discussion is provided on a specific Klein bottle-like topology induced by a momentum-space glide symmetry, including a full review of the insulating and semimetallic invariants of the system and a classification of the surface states on the non-orientable boundary. Beyond this, we provide a complete survey of all possible non-orientable Brillouin zones and their associated invariants, and extend our formalism into the realm of non-Hermitian topological physics and inversion-symmetric Weyl semimetals. Our work exemplifies the vast potential of fundamental mathematical descriptions to not only aid the corresponding physical intuition, but also predict novel and hitherto overlooked phenomena of great relevance throughout the physics research forefront.

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

Pareto LoRA: Mitigating Modality Imbalance in Unified Multimodal Models via Pareto-Optimal Gradient Integration

Unified multimodal models (UMMs) have recently emerged as a promising paradigm for integrating multimodal understanding and generation within a single autoregressive transformer. However, during multimodal instruction tuning, these models often exhibit pronounced modality imbalance: language gradients dominate optimization, thus leading to lower image generation quality, especially under parameter-efficient fine-tuning such as LoRA. In this work, we systematically analyze modality imbalance in LoRA-based fine-tuning of UMMs for interleaved text-image generation. We show that vision modality performance degrades substantially more than text modality performance when compared to unimodal counterparts, and that modality-specific gradients can differ by orders of magnitude across various tasks and layers. Motivated by this observation, we reformulate the multimodal instruction tuning as a bi-objective optimization problem and propose Pareto LoRA, a Pareto-optimal gradient integration strategy that balances the text and image objectives by modulating the gradient direction and strength. Experiments on the CoMM benchmark with Emu2 demonstrate that Pareto LoRA consistently improves multimodal generation balance, achieving up to 44.9% gains in perceptual image quality over vanilla LoRA while maintaining comparable text performance.

18.
PLOS Medicine 2026-06-02

Prognostic value of cervical length for spontaneous preterm birth in asymptomatic women with singleton pregnancy: An individual participant data meta-analysis

Authors:

by Kelly Hughes, David Nguyen, Mason Aberoumand, Heather Ford, Erin Clarke, Nuria Banos Lopez, Margaret Dziadosz, Richard Fischer, Renato T. Souza, Jose Guilherme Cecatti, Kelly Orzechowski, Courtney Olson-Chen, Alberto Borges Peixoto, Vorapong Phupong, Joshua Rosenbloom, Moeun Son, Athena Souka, Liu Du, Michael Sean Esplin, Roberta Granese, Simi Gupta, Brenda Kazemier, Lindsay Kindinger, Pihla Kuusela, Jeanine Van der Ven, Omer Weitzner, Evelyn Minis, Alba Farras Llobet, Heather Frey, Rashmi Bagga, Siddhidatri Mishra, Elizabeth Patberg, Philip Bennett, Megan Hall, Andrew Shennan, Shaun Brennecke, Shakila Thangaratinam, Anna Lene Seidler, Ben Willem Mol, Rui Wang Background Spontaneous preterm birth (SPTB) is the leading cause of perinatal and early childhood mortality worldwide. Studies have generally suggested that mid-trimester transvaginal sonographic cervical length

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

EdgeZSAD: Practical Zero-Shot Anomaly Detection on Edge Devices

Industrial inspection needs zero-shot anomaly detection (ZSAD) that remains useful under edge deployment constraints. Recent methods often rely on ViT-L foundation backbones (~300M parameters), which exceed the memory and operator budget of typical embedded hardware. We study this regime through EdgeZSAD, a compact reference system built around a TinyViT-21M-512 backbone, an asymmetric global-local readout (EdgeGLR), and a reproducible source-side training recipe (Real-IAD-DR). We train a single checkpoint in a source-trained, target-unseen protocol and evaluate it across six industrial benchmarks. Across three independent runs, the resulting model reaches an average image AUROC of 91.6 on MVTec-AD and 88.2 on VisA, while remaining directly deployable on Jetson Orin Nano Super (TensorRT FP16) and RB5 Gen2 (QNN GPU FP16). Across the six device-rescored benchmarks, image-AUROC drift stays below 0.2 points, indicating that the exported graph preserves host-side ranking behavior in the evaluated deployment setting.

20.
arXiv (CS.CV) 2026-06-17

SCC-Loc: A Unified Semantic Cascade Consensus Framework for UAV Thermal Geo-Localization

Cross-modal Thermal Geo-localization (TG) provides a robust, all-weather solution for Unmanned Aerial Vehicles (UAVs) in Global Navigation Satellite System (GNSS)-denied environments. However, profound thermal-visible modality gaps introduce severe feature ambiguity, systematically corrupting conventional coarse-to-fine registration. To dismantle this bottleneck, we propose SCC-Loc, a unified Semantic-Cascade-Consensus localization framework. By sharing a single DINOv2 backbone across global retrieval and MINIMA$_{RoMa}$ matching, it minimizes memory footprint and achieves zero-shot, highly accurate absolute position estimation. Specifically, we tackle modality ambiguity by introducing three cohesive components. First, we design the Semantic-Guided Viewport Alignment (SGVA) module to adaptively optimize satellite crop regions, effectively correcting initial spatial deviations. Second, we develop the Cascaded Spatial-Adaptive Texture-Structure Filtering (C-SATSF) mechanism to explicitly enforce geometric consistency, thereby eradicating dense cross-modal outliers. Finally, we propose the Consensus-Driven Reliability-Aware Position Selection (CD-RAPS) strategy to derive the optimal solution through a synergy of physically constrained pose optimization. To address data scarcity, we construct Thermal-UAV, a comprehensive dataset providing 11,890 diverse thermal queries referenced against a large-scale satellite ortho-photo and corresponding spatially aligned Digital Surface Model (DSM). Extensive experiments demonstrate that SCC-Loc establishes a new state-of-the-art, suppressing the mean localization error to 9.37 m and providing a 7.6-fold accuracy improvement within a strict 5-m threshold over the strongest baseline. Code and dataset are available at https://github.com/FloralHercules/SCC-Loc.

21.
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.

22.
arXiv (CS.CL) 2026-06-17

MedicalAgentsBench for Complex Medical Reasoning: Comparing Internalized Reasoning Models versus Externalized Agent-based Frameworks

Complex medical reasoning requires integrating heterogeneous clinical evidence across multiple inference steps. Large language models (LLMs) now approach this through two routes: internalized reasoning and externalized agent scaffolding (frameworks that decompose problems collaboratively amongst multiple LLMs). To determine whether these routes are exclusive or complementary, we introduce MedicalAgentsBench, a filtered benchmark of 862 complex clinical questions drawn from the union of eight medical datasets via difficulty-aware curation and contamination screening. Evaluating three internalized reasoning models (DeepSeek-R1, o1-mini, and o3-mini), seven base models, and nine externalized agent-based methods, we find that internalized and externalized approaches each independently improve performance, and that their benefits compound: the highest accuracy is achieved by layering agent workflows onto an internalized reasoning model (i.e., o3-mini + MDAgents with 35.1%). Pareto analysis shows this combination dominates the cost-performance frontier; moreover, lightweight optimization on inexpensive models offers an entry point for resource-constrained settings. Our benchmark is at https://github.com/gersteinlab/MedicalAgentsBench.

23.
arXiv (CS.LG) 2026-06-19

Matching Markets meet Cumulative Prospect Theory: Towards Optimal and Adversarially Robust Learning

arXiv:2606.19883v1 Announce Type: new Abstract: We study a multi-agent multi-armed bandit problem in the competitive setup with two-sided matching markets under a human centric decision making model. To capture human preferences, we use cumulative prospect theory (CPT) that weighs the actions of the agent in a nonlinear fashion using a ($\alpha$-Hölder continuous) weight function. CPT has been widely used in behavioral economics and risk sensitive machine learning to emulate human preferences. We analyze the state-of-the-art learning algorithm with CPT weight distorted rewards and obtain a player optimal regret of $\mathcal{O}(K\log T \left(\frac{1}{\Delta}\right)^{2/\alpha})$, where $K$ denotes the number of arms, $T$ is the learning horizon, and $\Delta$ represents (suitably defined) players' minimum preference gap. Noticing the dependence on $\Delta$ to be sub-optimal, we further improve this regret by judiciously selecting the active set of arms during exploration, which removes the dependence on $K$ in the dominant term and achieves an improved (optimal) regret guarantees in the setting where the number of arms $K$ is significantly larger than the number of players $N$. In addition, we consider adversarial markets where the observed rewards of the agents may be corrupted. We propose and analyze algorithms for robust markets with CPT as risk sensitive measure in both settings where the total corruption budget is known and where it is unknown, and establish logarithmic player-optimal regret guarantees in both cases.

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

Exploring Starts Are Not Enough: Counterexamples and a Fix for Monte Carlo Exploring Starts

arXiv:2606.15247v1 Announce Type: cross Abstract: The asymptotic behaviour of Monte Carlo Exploring Starts (MCES) is a long-standing open question in reinforcement learning, even in the tabular setting. We investigated the convergence properties of tabular MCES by constructing examples in which the algorithm converges to suboptimal solutions. This paper presents new counterexamples for both initial-visit and first-visit MCES and gives a convergence-restoring modification for the initial-visit case. We show that stable suboptimal solutions may exist for initial-visit MCES with sample-average updates even when greedy actions are updated more often than non-greedy actions on average. However, by scaling learning rates inversely to update frequencies on a state-by-state basis, convergence to optimality is guaranteed. Unlike previous uniformisation methods, this modification is applicable to large-scale problems that require approximating the estimated value function. We then extend the example to show that sample-average first-visit MCES may also converge to suboptimal solutions. This largely settles a fundamental open problem and shows that exploring starts alone do not guarantee convergence to optimality. More broadly, these results highlight that convergence depends critically on the relative size and frequency of updates applied to different actions, making the choice of learning rates and the balance between exploration and exploitation central to the analysis of MCES and the implementation of scalable Monte Carlo control methods.

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

Weighted Bayesian Conformal Prediction

arXiv:2604.06464v2 Announce Type: replace Abstract: Conformal prediction provides distribution-free prediction intervals with finite-sample coverage guarantees, and recent work by Snell \& Griffiths reframes it as Bayesian Quadrature (BQ-CP), yielding powerful data-conditional guarantees via Dirichlet posteriors over thresholds. However, BQ-CP fundamentally requires the i.i.d. assumption. Meanwhile, weighted conformal prediction handles distribution shift via importance weights but remains frequentist, producing only point-estimate thresholds. We propose Weighted Bayesian Conformal Prediction (WBCP), which generalizes BQ-CP to arbitrary importance-weighted settings by replacing the uniform Dirichlet $\Dir(1,\ldots,1)$ with a weighted Dirichlet $\Dir(\neff \cdot \tilde{w}_1, \ldots, \neff \cdot \tilde{w}_n)$, where $\neff$ is Kish's effective sample size. We prove four theoretical results: (1)~$\neff$ is the unique concentration parameter matching frequentist and Bayesian variances; (2)~posterior standard deviation decays as $O(1/\sqrt{\neff})$; (3)~BQ-CP's stochastic dominance guarantee extends to per-weight-profile data-conditional guarantees; (4)~the HPD threshold provides $O(1/\sqrt{\neff})$ improvement in conditional coverage. We instantiate WBCP for spatial prediction as Geographical BQ-CP, where kernel-based spatial weights yield per-location posteriors with interpretable diagnostics. Experiments on synthetic and real-world spatial datasets demonstrate that WBCP maintains coverage guarantees while providing substantially richer uncertainty information.