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01.
arXiv (CS.CV) 2026-06-16

CASHEW: Stabilizing Multimodal Reasoning via Iterative Trajectory Aggregation

Vision-language models achieve strong performance across a wide range of multimodal understanding and reasoning tasks, yet their multi-step reasoning remains unstable. Repeated sampling over the same input often produces divergent reasoning trajectories and inconsistent final predictions. To address this, we introduce two complementary approaches inspired by test-time scaling: (1) CASHEW, an inference-time framework that stabilizes reasoning by iteratively aggregating multiple candidate trajectories into higher-quality reasoning traces, with explicit visual verification filtering hallucinated steps and grounding reasoning in visual evidence, and (2) CASHEW-RL, a learned variant that internalizes this aggregation behavior within a single model. CASHEW-RL is trained using Group Sequence Policy Optimization (GSPO) with a composite reward that encourages correct answers grounded in minimal yet sufficient visual evidence, while adaptively allocating reasoning effort based on task difficulty. This training objective enables robust self-aggregation at inference. Extensive experiments on 13 image understanding, video understanding, and video reasoning benchmarks show significant performance improvements, including gains of up to +26.2 percentage points on ScienceQA and +9.1 percentage points on EgoSchema.

02.
arXiv (CS.CL) 2026-06-16

CentroidKV: Efficient Long-Context LLM Inference via KV Cache Clustering

Large language models (LLMs) with extended context windows have become increasingly prevalent for tackling complex tasks. However, the substantial Key-Value (KV) cache required for long-context LLMs poses significant deployment challenges. Existing approaches either discard potentially critical information needed for future generations or offer limited efficiency gains due to high computational overhead. In this paper, we introduce CentroidKV, a simple yet effective framework for online KV cache clustering. Our approach is based on the observation that key states exhibit high similarity along the sequence dimension. To enable efficient clustering, we divide the sequence into chunks and propose Chunked Soft Matching, which employs an alternating partition strategy within each chunk and identifies clusters based on similarity. CentroidKV then merges the KV cache within each cluster into a single centroid. Additionally, we provide a theoretical analysis of the computational complexity and the optimality of the intra-chunk partitioning strategy. Extensive experiments across various models and long-context benchmarks demonstrate that CentroidKV achieves up to 75% reduction in KV cache memory usage while maintaining comparable model performance. Moreover, with minimal computational overhead, CentroidKV accelerates the decoding stage of inference by up to $1.92\times$ and increases the serving throughput by up to $4\times$.

03.
medRxiv (Medicine) 2026-06-10

Towards the Virtual Amyotrophic Lateral Sclerosis Patient: Inferring Cortical Excitability through Whole-Brain Dynamical Modeling

Amyotrophic lateral sclerosis (ALS) is increasingly recognized as a multisystem neurodegenerative disorder in which motor-neuron degeneration is accompanied by widespread alterations in cortical dynamics. Among its most reproducible neurophysiological signatures is cortical hyperexcitability, yet how this local excitability imbalance shapes distributed whole-brain activity remains poorly understood. Here, we combined source-reconstructed resting-state MEG data, tractography-informed whole-brain modeling, and simulation-based inference to investigate whether ALS-related alterations in large-scale brain dynamics can be mechanistically explained by changes in cortical excitability. First, we characterized empirical brain dynamics using complementary features spanning regional activity amplitude and variability, functional connectivity, and avalanche-based metrics. These analyses revealed significant alterations in ALS patients relative to healthy controls, as well as associations with clinical impairment and disease staging. To mechanistically interpret these changes, we employed a reduced Wong-Wang whole-brain model in which local recurrent excitation modulates emergent large-scale neural dynamics. Simulations showed that increasing excitability systematically reproduced the empirical dynamical signatures observed in ALS. We then applied a simulation-based inference framework to estimate latent excitability parameters directly from empirical observations. Whole-brain model inversion revealed increased excitability in ALS patients compared with controls. The recovered excitability parameter was associated with disease staging, supporting its clinical relevance as a model-derived descriptor of ALS progression. Finally, by extending the model to estimate frontal and non-frontal excitability separately, we found that ALS-related alterations were predominantly associated with increased frontal excitability, whereas non-frontal regions appeared comparatively less affected. The recovered parameters related to disease staging. Together, these findings provide a mechanistic framework linking altered large-scale brain dynamics in ALS to selective cortical hyperexcitability, explaining how local excitability changes can give rise to global network reorganization. More broadly, they show how computational model inversion can recover latent multiscale pathophysiological processes from empirical neural recordings, offering a non-perturbative alternative to complex experimental paradigms typically required to causally probe local-to-global mechanisms.

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

ChronoSurv: A Clinical Pathway-Guided Graph Framework for Multimodal Survival Analysis

arXiv:2606.19140v1 Announce Type: new Abstract: Accurate survival prediction is essential for personalized treatment planning in head and neck cancer, yet remains challenging due to the heterogeneous and high-dimensional nature of multimodal clinical data. While deep survival models have improved predictive performance over classical statistical approaches, existing methods typically rely on static fusion strategies or temporally agnostic modeling, limiting their ability to capture structured clinical workflows. In this work, we propose ChronoSurv, a heterogeneous hierarchical directed graph framework for multimodal survival analysis. ChronoSurv represents patient care as a progression-aware clinical trajectory using directed graphs aligned with key diagnostic steps. A hierarchical topology incorporates fine-grained, coarse, and global representations, further supporting flexible adaptation to missing modalities, while heterogeneous message passing models complex and asymmetric relationships across modalities and clinical steps. Experimental results on two public datasets demonstrate that ChronoSurv achieves state-of-the-art discriminative performance while maintaining statistically reliable calibration. Comprehensive ablation studies further confirm the contribution of each architectural component, highlighting the potential of trajectory-aware graph modeling for multimodal survival prediction.

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

Hölder++: Improving the Quality-Coherence Trade-off in Multimodal VAEs

arXiv:2606.13381v1 Announce Type: new Abstract: Existing approaches for multimodal variational autoencoders (VAEs) face a trade-off between generative quality and coherence-i.e., they struggle to generate realistic and diverse samples that, at the same time, are semantically consistent across modalities. A recent work shows that using a simple approximation to Hölder pooling as an aggregation method improves coherence over the SOTA MMVAE+, despite assuming a single shared representation across all modalities. Yet, it slightly compromises sample diversity. Inspired by this insight, we propose Hölder++, a novel multimodal VAE that improves the generative quality-coherence trade-off through: (i) the first implementation of Hölder pooling without any approximation for multimodal VAEs; (ii) an extended architecture that models distinct shared and private (i.e., modality-specific) representations (Hölder+); and (iii) hierarchical inference that further enhances the disentanglement between the shared and private representations (Hölder++). Our experiments corroborate that Hölder++ consistently improves the generative quality-coherence trade-off, yields more structured latent spaces, and learns shared representations that are informative for downstream tasks.

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

MultiToP: Learning to Patch Visual Tokens to Mitigate Hallucinations in Video Large Multimodal Models

Video Large Multimodal Models have achieved remarkable progress in video understanding, yet they remain prone to hallucinations, where generated responses are not faithfully supported by the input video. In this paper, we propose MultiToP, a multimodal-context-aware visual token patching framework that mitigates hallucinations by refining unreliable visual tokens before language generation. MultiToP introduces a lightweight Visual Token Patcher to predict token-level replacement distributions and selectively substitute unreliable visual tokens with a dynamic global patch token. To train the patcher effectively, we further propose information-guided rank calibration, which uses answer-conditioned frame-level information cues derived from the backbone to guide token replacement. Combined with ground-truth answer supervision and sparsity regularization, MultiToP enables localized visual evidence refinement without modifying the original model. Extensive experiments demonstrate that MultiToP effectively reduces hallucinations on Vript-HAL with negligible inference overhead, improving the F1 scores of Qwen3-VL-4B-Instruct by 50.60% over the vanilla model. Meanwhile, MultiToP preserves general video understanding ability, yielding an 18.58% relative accuracy gain on ActivityNet-QA for Video-LLaVA-7B.

07.
arXiv (CS.AI) 2026-06-16

The Missing Knowledge Layer in Cognitive Architectures for AI Agents

arXiv:2604.11364v2 Announce Type: replace Abstract: The two most influential cognitive architecture frameworks for AI agents, CoALA [21] and JEPA [12], both lack an explicit Knowledge layer with its own persistence semantics. This gap produces a category error: systems apply cognitive decay to factual claims, or treat facts and experiences with identical update mechanics. We survey persistence semantics across existing memory systems and identify eight convergence points, from Karpathy's LLM Knowledge Base [10] to the BEAM benchmark's near-zero contradiction-resolution scores [22], all pointing to related architectural gaps. We propose a four-layer decom position (Knowledge, Memory, Wisdom, Intelligence) where each layer has fundamentally different persistence semantics: indefinite supersession, Ebbinghaus decay, evidence-gated revision, and ephemeral inference respectively. Companion implementations in Python and Rust demonstrate the architectural separation is feasible. We borrow terminology from cognitive science as a useful analogy (the Knowledge/Memory distinction echoes Tulving's trichotomy), but our layers are engineering constructs justified by persistence-semantics requirements, not by neural architecture. We argue that these distinctions demand distinct persistence semantics in engineering implementations, and that no current framework or system provides this.

08.
medRxiv (Medicine) 2026-06-18

Effectiveness and Safety of Bempedoic Acid Across Clinically Relevant Subgroups: Insights from the CLEAR Taiwan Study

Background Despite available lipid-lowering therapies (LLT), many patients fail to achieve low-density lipoprotein cholesterol (LDL-C) targets. This gap persists across clinically relevant subgroups. Bempedoic acid has demonstrated effective LDL-C lowering with a favorable safety profile in the CLEAR Taiwan study; however, its effects across subgroups in Asian populations remains limited. Methods The phase IV CLEAR Taiwan study (NCT06925100) enrolled patients with inadequately controlled hypercholesterolemia who received bempedoic acid for 12 weeks in addition to background LLT. This analysis evaluated changes in lipid parameters, high-sensitivity C-reactive protein (hsCRP), and safety outcomes in clinically relevant subgroups, including cardiovascular risk, diabetes, age, statin tolerance, and sex. Results A total of 180 patients were included. Bempedoic acid achieved significant LDL-C reductions in all subgroups. Numerically greater LDL-C reductions were observed in primary prevention, statin-intolerant, younger (< 65 years), and female patients, while comparable reductions were observed across diabetes status. Reductions in non-high-density lipoprotein cholesterol, total cholesterol, and apolipoprotein B were consistent with LDL-C findings. Significant decreases in hsCRP were observed in all subgroups, with numerically greater reductions in patients aged < 65 years and those without diabetes. Bempedoic acid was well tolerated, with a low incidence of adverse events and no new safety signals identified. Changes in liver enzymes, renal function, and uric acid were minimal within subgroups. Conclusion Subgroup analyses from the CLEAR Taiwan study demonstrate consistent efficacy and safety of bempedoic acid across clinically relevant subgroups and support its use as a flexible option to address residual gaps in lipid management.

09.
arXiv (quant-ph) 2026-06-15

Spin mixing induced dynamics of spinor solitons in $F=1$ Bose Einstein condensates

arXiv:2606.14231v1 Announce Type: cross Abstract: We explore soliton interactions in a homogeneous spinor $F=1$ Bose Einstein Condensate (BEC) in the presence of a magnetic field, focusing on dark bright dark and bright dark bright configurations. We investigate how these interactions depend on the phase differences among bright solitons and their influence during the dynamics. Our findings align with prior non spinor results, i.e., repulsion among in phase bright solitons and attraction among out of phase pairs in self repulsive atomic BECs. The potential bright soliton attraction, added to the short range repulsion of dark dark soliton interactions, can lead to bound states. However, we find that these bound states break in the presence of spinor interactions due to the particle exchange dynamics between the hyperfine states of the components. Additonally, we develop an effective classical model to describe the soliton dynamics, using a Lagrangian approach. The accuracy of the model is tested by comparing it against numerical simulations. Our results suggest that the proposed model captures the essential features of soliton behavior in the presence of spin interactions, and provides congruent soliton trajectories and interspecies particle exchange dynamics in most of the cases.

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

Minim: Privacy-Aware Minimal View for Agents via Trusted Local Sanitization

arXiv:2606.13949v1 Announce Type: new Abstract: Modern LLM-powered autonomous agents increasingly rely on rich user interface (UI) state observations to achieve reliable action grounding in complex digital environments. However, many deployments transmit the full UI state to remote inference servers even when most elements are irrelevant to the current task, which can leak sensitive but unnecessary context such as authentication codes, private notifications, and background application states. We propose MINIM, a trusted local broker that performs privacy-aware minimization on the client side before any observation leaves the device. Grounded in Contextual Integrity (CI), MINIM learns a dual-score representation for each UI element by predicting an inherent sensitivity score (s) and a task-conditioned necessity score (n). These scores drive a ternary disclosure policy that keeps essential elements, abstracts sensitive attributes when needed, and removes task-irrelevant content. We optimize a CI-aware objective that penalizes necessity errors more strongly on high-risk content, enabling aggressive pruning while preserving task-critical information. Experiments on real-world UI observations derived from WebArena show that MINIM substantially reduces task-irrelevant sensitive leakage while preserving task-critical semantic context and the interactive affordances required for reliable agent actions.

11.
arXiv (CS.CL) 2026-06-15

Multi-component Causal Tracing in Large Language Models

Causal tracing systematically intervenes on a large language model's (LLM's) internal representations to uncover and quantify the causal pathways linking specific inputs or computations to specific metrics of interest, quantifying the LLM's behavior. Building on previous single-component or single-layer studies, this paper presents a unified framework for causally tracing multiple components simultaneously. This framework systematically identifies the subsets of components (e.g., attention heads and multi-layer perceptron neurons) most critical to a desired target performance metric (e.g., accuracy and fairness). This is achieved by incorporating flexible interventions applied to a wide range of desired metrics. To address the combinatorial complexity of the multi-component problem, an efficient algorithm is designed that leverages soft interventions and a carefully designed metric transformation, converting the combinatorial search problem into a continuous one that can be solved efficiently under proper constraints, thereby generating proper binary decisions for selecting components. Experimental results demonstrate that the proposed method efficiently identifies subsets of the model's components that have a high impact on the target metric, outperforming existing baseline approaches. Our code is available at https://github.com/ZiruiYan/multi-component-causal-tracing.

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

Fine-tuning LLMs for Passive Depression Severity Estimation from AI Mental Health Dialogue

Depression is the leading cause of disability worldwide, and early detection of symptom change is essential for timely intervention. Validated instruments such as the Patient Health Questionnaire-9 (PHQ-9) support symptom monitoring at scale, but real-world completion rates are low, introducing response bias and systematic missingness. Passive approaches that infer severity from routinely generated data could close this gap. We address this by predicting PHQ-9 total scores directly from transcripts of conversations between users and an AI mental health application, requiring only conversation text and no additional clinical data. We fine-tune a Qwen3.5-27B backbone with a regression head, augment 3,111 ground-truth labels with pseudolabels generated by a reasoning model (Claude Opus) and iteratively trained intermediate models, for a combined dataset of 6,283 users. On a held-out test set of 842 users, our best model achieves MAE = 2.6, RMSE = 4.0, Pearson r = 0.80, and AUC = 0.91 at the PHQ-9 >= 10 clinical threshold. We also find AUC > 0.87 at every severity threshold from PHQ-9 >= 3 to PHQ-9 >= 24, demonstrating that the model captures depression severity across the full clinical spectrum. This work opens the door to passive, continuous symptom monitoring in AI mental health platforms, without requiring users to complete self-report measures.

13.
arXiv (quant-ph) 2026-06-15

Perturbative Input-Output Theory of Floquet Cavity Magnonics and Magnon Energy Shifts

arXiv:2512.12103v2 Announce Type: replace-cross Abstract: We develop a perturbative input-output formalism to compute the reflectance and transmittance spectra of cavity magnonics systems subject to a Floquet modulation. The method exploits the strong hierarchy between the magnetic-dipole couplings transverse (drive field) and parallel (modulation field) to the static bias field, which naturally introduces the small parameter $\epsilon = (2Ns)^{-1/2}$ associated with the total spin $Ns$ of the ferromagnet. By organizing the cavity and magnon fields in a systematic expansion in $\epsilon$, we obtain compact analytic expressions for the spectra up to second order. Using these results, we reproduce the characteristic sideband structure observed in recent Floquet cavity electromagnonics experiments. Furthermore, accounting for the Zeeman interaction between the modulation field and the fully polarized ground state - a contribution typically neglected in previous treatments - we predict an additional magnon detuning of approximately $0.8\,\mathrm{GHz}$, independent of both modulation frequency and sample size and determined solely by the spatial volume occupied by the modulation field. This identifies a measurable and previously overlooked shift relevant for the interpretation and design of cavity magnonics experiments.

14.
arXiv (CS.CV) 2026-06-15

Towards Physically Realizable Adversarial Attenuation Patch against SAR Object Detection

Deep neural networks have demonstrated excellent performance in SAR target detection tasks but remain susceptible to adversarial attacks. Existing SAR-specific attack methods can effectively deceive detectors; however, they often introduce noticeable perturbations and are largely confined to digital domain, neglecting physical implementation constrains for attacking SAR systems. In this paper, a novel Adversarial Attenuation Patch (AAP) method is proposed that employs energy-constrained optimization strategy coupled with an attenuation-based deployment framework to achieve a seamless balance between attack effectiveness and stealthiness. More importantly, AAP exhibits strong potential for physical realization by aligning with signal-level electronic jamming mechanisms. Experimental results show that AAP effectively degrades detection performance while preserving high imperceptibility, and shows favorable transferability across different models. This study provides a physical grounded perspective for adversarial attacks on SAR target detection systems and facilitates the design of more covert and practically deployable attack strategies. The source code is made available at https://github.com/boremycin/SAAP.

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

ARB4WM: An Adversarial Robustness Benchmark for World Models in Continuous Control

arXiv:2606.16605v1 Announce Type: new Abstract: World models are widely used in robotic and agentic engineering control systems due to their ability to learn latent dynamics for planning and decision-making. As these systems are increasingly deployed in safety-critical settings, understanding their robustness under adversarial conditions has become essential. However, existing evaluations lack a unified benchmark for testing adversarial threats across the policy, value, and latent-dynamics levels of world-model agents. To fill this gap, we present ARB4WM, a unified evaluation framework for pre-deployment robustness and risk assessment of world-model agents under visual perturbations. ARB4WM defines five white-box loss objectives across these three levels and studies their effects when combined with single-step or multi-step perturbation strategies and temporal attack modes, including full-frame, half-sequence, and sparse-frame exposure. Specifically, we evaluate four Dreamer-style agents across 20 tasks from MetaWorld and the DeepMind Control Suite under different loss objectives, perturbation strategies, and temporal attack modes. Results show that attacks targeting value estimation, latent representations, and RSSM dynamics can be as damaging as direct policy disruption, and that early or frequent perturbations are especially harmful, while input-level defenses provide limited recovery under adaptive attacks. These findings suggest that safety, risk, and reliability assessment for world models should cover multiple component-oriented attack objectives and temporal exposure protocols rather than relying solely on action-space robustness. Source code is available at https://github.com/zaoanguai/ARB4WM.

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

Context-Aware Multimodal Claim Verification in Spoken Dialogues

Every day, millions absorb claims from podcasts and streams that no fact-checker ever sees. Spoken misinformation is built through conversation, where credibility comes not from facts alone but from how claims are framed, reinforced, or left unchallenged across turns. Yet fact-checking has focused on isolated text, leaving dialogue audio under-studied. We introduce MAD2, a new Multi-turn Audio Dialogues benchmark for spoken claim verification, containing 1,000 two-speaker dialogues with 3,368 check-worthy claims and approximately 10 hours of audio, and propose calibrated multimodal fusion of a context-aware audio encoder and a dialogue-aware text model. Across settings, adding dialogue context improves verification, but the gains depend on scenario type. Using only preceding context often matches offline performance, supporting live-moderation settings, and audio contributes most when transcript-based models are destabilized by additional context. Overall, conversational structure matters more for verification than misinformation framing.

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

AIRMap: AI-Generated Radio Maps for Wireless Digital Twins

arXiv:2511.05522v4 Announce Type: replace-cross Abstract: Accurate, low-latency channel modeling is essential for real-time wireless network simulation and digital-twin applications. Traditional modeling methods like ray tracing are however computationally demanding and unsuited to model dynamic conditions. In this paper, we propose AIRMap, a deep-learning framework for ultra-fast radio-map estimation, along with an automated pipeline for creating the largest radio-map dataset to date. AIRMap uses a single-input U-Net autoencoder that processes only a 2D elevation map of terrain and building heights. Trained on 1.2M Boston-area samples and validated across four distinct urban and rural environments with varying terrain and building density, AIRMap predicts path gain with under 4 dB RMSE in 4 ms per inference on an NVIDIA L40S-over 100x faster than GPU-accelerated ray tracing based radio maps. A lightweight calibration using just 20% of field measurements reduces the median error to approximately 5%, significantly outperforming traditional simulators, which exceed 50% error. Integration into the Colosseum emulator and the Sionna SYS platform demonstrate near-zero error in spectral efficiency and block-error rate compared to measurement-based channels. These findings validate AIRMap's potential for scalable, accurate, and real-time radio map estimation in wireless digital twins.

18.
medRxiv (Medicine) 2026-06-19

"Us with them": Co-designing a caesarean section consent and debriefing intervention in West Cameroon

Background Women-centred maternity care is a rights issue that determines the use of services. Such care ensures responsiveness to womens needs which is enacted through shared decision-making, review and response. In the West Region of Cameroon, informed consent (IC) and Debriefing for caesarean section (c-section) have been shown to be suboptimal or absent. This paper describes the participatory design of a quality-improvement hospital-based intervention. Methods From February to May 2025, we conducted a co-design process with three groups of stakeholders: 59 post c-section women and community representatives, 78 frontline c-section providers, and 29 directors of public and private hospitals. We followed four phases: planning, conducting, evaluating, and reporting. The conduct phase comprised five all-day workshops with post c-section women and community representatives, followed by five all-day workshops with the c-section providers. Finally, we held an 11th workshop with the hospital directors to scrutinize suggested interventions, evaluate their feasibility, and establish a consensus on their components. We described the intervention using the TIDieR (Template for Intervention Description and Replication) checklist. We documented the co-design process, using open-ended narratives to delineate interventions, and carried out real-time synthesis on visual aids (whiteboards and flipcharts). Intervention feasibility was quantified using a structured ad hoc matrix, while insights on facilitators and barriers were captured through qualitative free-text entries. We coupled data collection with constant comparison and triangulation through contemporaneous field notes, photographic documentation, and thematic mapping of stakeholders perceptions and interactive dynamics. Results Participants perspectives on the co-design were positive, and their motivation were very high although less than 50% reported previous involvement in co-design processes. More than 80% of participants found rated the co-design process as either good or very good. The final intervention comprised four components: (i) an in-service training; (ii) a standard operating procedure including a harmonised consent form and debriefing checklist; (ii) systematic supportive supervision, monitoring & evaluation; and (iv) a routine clinical audit. Each group of stakeholders upheld specific dimensions of the consent and debrief intervention. Post c-section women and community members emphasized emotional support, written discharge advice after debriefing, and zero tolerance of suboptimal consent and debriefing practices. Frontline c-section providers insisted on robust documentation for medico-legal protection. Hospitals Directors emphasized capacity-building and cultural friendliness. All the groups supported womans autonomous decision making. The intervention feasibility was rated high or very high by hospital directors except for the financial, infrastructural and technical domains. Conclusion This co-design process yielded a context-specific, multi-component intervention that was well accepted and deemed feasible across stakeholders. It provides a methodological approach to strengthening informed consent and debriefing as core elements of women-centred, accountable maternity care, and warrants implementation.

19.
PLOS Computational Biology 2026-06-10

Interpreting higher-order dependence in multimorbidity using cohort data: A partial information decomposition approach

by Cillian Hourican, Geeske Peeters, René J. F. Melis, Almar Kok, Natasja M. van Schoor, Sandra Wezeman, Mike Lees, Marcel G. M. Olde Rikkert, Rick Quax In the context of multimorbidity, clinical features seldom act in isolation: symptoms, signs and behaviours form interdependent systems in which joint effects on function can be demonstrated only when features are considered together. We introduce an open, reusable workflow that detects and interprets these “together-only” interactions using bivariate Partial Information Decomposition (PID; two sources to one target), linking synergy-based dependence to the broader network of clinical variables rather than to a single target. The workflow estimates synergy with small-sample bias correction and summarises each pair in a Breadth–Uniformity–Synergy–Total (BUST) map: breadth of synergy across target variables (broad “generalist” vs narrow “specialist” patterns), cross-stratum uniformity across age, sex and multimorbidity (uniform vs subgroup-specific), synergy strength, and total shared information. Simple diagnostics contrast observed targets with additive expectations, revealing the specific joint configurations through which non-additive effects arise. Applied to data from the Longitudinal Ageing Study Amsterdam, we treated all health-related variables—covering symptoms, clinical signs, behaviours, lifestyle factors, and self-rated health indicators—as both sources and targets in the PID framework. This symmetric design permits synergy to be quantified for every pair of variables with respect to every other variable. The workflow identifies synergistic constellations that additive models miss. Multidomain cliques involving subjective health, pain, cognition and grip strength showed multiple non-additive configurations, whereas pairs such as alcohol use with grip strength exhibited focused, narrow but uniform synergy. Notably, the pairs with the strongest synergistic contributions were largely distinct from those with the highest total mutual information, indicating that synergy captures dependency structure overlooked by conventional association measures. Rather than a new measure, this work provides a bias-aware workflow that makes higher-order dependence visible and transferable. Our results support synergy-aware mapping as a practical complement to conventional multimorbidity analyses: it highlights specific combinations of routinely assessed features whose joint states may be especially informative across multiple health targets and therefore candidates for prioritised joint assessment and future multi-domain intervention studies.

20.
arXiv (CS.AI) 2026-06-16

CmdNeedle: Measuring the Incompleteness of Command Denylists for AI Agents

arXiv:2606.15549v1 Announce Type: cross Abstract: The adoption of AI agents is increasing rapidly. Terminal AI agents, i.e., AI agents that run in terminal environments, are a widely used type of AI agents. Terminal AI agents rely heavily on shell command execution to interact with the host systems. They adopt a three-list command-gating mechanism to mitigate security risks introduced by command execution, with denylists serving as the load-bearing component. However, modern operating systems often ship a large, ever-expanding set of shell commands with complex functionalities. Our observation is that even a built-in denylist of Claude Code, well-maintained by its developers, can overlook bypass commands that invalidate its effectiveness. Such negligence leads to fragile command denylists that cannot even block operations that practitioners expect them to block. This paper presents the first systematic characterization of command denylist fragility in terminal AI agents. The paper formalizes the command denylist fragility problem and proposes an LLM-driven pipeline, CmdNeedle, to detect such fragility. It prompts the LLM to propose possible bypasses and iteratively repairs them using feedback from a validator that executes them in a sandbox. In the evaluation, we applied CmdNeedle to 1,709 real-world command denylists (containing 13,332 denylist rules) collected from GitHub. The evaluation shows several key findings, including that 69.0–98.6% of the denylists are fragile, that this fragility occurs consistently across projects and agents, and the validity of several possible root causes for this fragility. Our pipeline and findings will hopefully facilitate future research and practice regarding the command denylists used by AI agents.

21.
arXiv (CS.LG) 2026-06-19

Insulin4RL: Real-Time Insulin Management in the Intensive Care Unit for Offline Reinforcement Learning

arXiv:2606.19481v1 Announce Type: new Abstract: Offline reinforcement learning (ORL) offers the potential to improve the quality of clinical decision-making using historical electronic health record (EHR) data. Current training and evaluative practices in this field rely heavily on EHR datasets that have been temporally discretised into fixed, regular time intervals. Discretisation creates fictional representations of complex clinical scenarios and compromises the generalisability of retrospective model evaluations. In this paper, we introduce Insulin4RL, a healthcare ORL dataset featuring naturally irregular inputs and actions from real clinical trajectories. Derived from MIMIC-IV, Insulin4RL comprises over 375,000 labelled decisions across 12,209 patients requiring insulin infusion titration in the Intensive Care Unit. The dataset can thus be used for research into ORL model performance under realistic clinical sampling assumptions. We provide a description of the dataset's structure and characteristics, baseline performance metrics using model-free offline reinforcement learning, and a standardised evaluation protocol using fitted Q-evaluation. We conclude with suggested areas for future research that could be addressed using this resource.

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

Medical Heuristic Learning: An LLM-Driven Framework for Interpretable and Auditable Clinical Decision Rules

arXiv:2606.16337v1 Announce Type: new Abstract: Predictive modeling for clinical tabular data is central to clinical decision support and therefore requires not only strong predictive performance but also transparent decision logic. Although deep learning and tree-based ensemble methods can achieve high accuracy, their black-box nature remains a major obstacle to clinical deployment. This challenge is further compounded by common characteristics of medical data, including limited sample sizes, severe class imbalance, and feature evolution arising from changes in diagnostic criteria and clinical documentation. To address these issues, we propose Medical Heuristic Learning (MHL), an instantiation of the learning-beyond-gradients paradigm for clinical tabular prediction. Instead of relying on neural network weight updates, MHL uses a large language model (LLM)-driven workflow that integrates statistical probes, medical knowledge probes, rule synthesis, and code-level iterative refinement to optimize a deterministic and executable decision system. The resulting model is expressed not as opaque parameters, but as versioned pure-Python decision rules that are explicitly interpretable, fully auditable, and clinically grounded. MHL also supports continual learning by starting from previously validated rules and iteratively revising them using updated feature information under data drift or feature evolution. Comprehensive experiments on medical datasets show that MHL achieves performance comparable to state-of-the-art methods while maintaining strong behavior in small-sample and highly imbalanced settings. The results further indicate that this explicit rule update mechanism can help alleviate catastrophic forgetting under feature evolution. Overall, these findings suggest that non-gradient-based heuristic systems offer a transparent and adaptable alternative for high-stakes clinical decision support.

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

Knowledge-Based Zero-Replay Debugging of Multi-Agent LLM Traces

arXiv:2606.14805v1 Announce Type: cross Abstract: Reliable operation of multi-agent large language model (LLM) systems depends on debugging long execution traces, where the few causally decisive events are buried in unstructured logs of messages, routes, memory writes, and tool calls. The standard tool is counterfactual replay (rewind, edit, and re-run the trajectory to measure each event's effect), but its cost grows linearly with the number of candidate events, making exhaustive replay infeasible at scale. We frame trace debugging as a knowledge-based decision-support problem. Each trace is compiled into a structured event knowledge graph over routing, memory, tool-use, uncertainty, and latent evidence, and a calibrated predictor decides where a scarce replay budget should be spent. We do not propose a new replay oracle; we propose a method to predict its results without paying the replay cost. We formulate zero-replay counterfactual-effect prediction: given a trace under a fixed budget, predict which events the oracle would mark high-effect before any replay is performed. BranchPoint-Latent is a lightweight predictor over observable, structural, uncertainty, and latent features of the knowledge graph. Calibrated against a deterministic replay oracle across 37 trace families, a single learning-to-rank gradient-boosted predictor raises per-trace localization (Branch Recall@5) from 0.73 to 0.93 on held-out families at zero oracle-replay cost. Rather than claiming universal dominance, we characterize when cheap graph centrality suffices and when learned evidence is necessary. The result is an auditable, cost-efficient decision-support system for AI-reliability debugging, positioned explicitly on the cost-accuracy frontier with reproducible artifacts.

24.
bioRxiv (Bioinfo) 2026-06-11

Calibrated Uncertainty Quantification for Patient-Level AML Drug Sensitivity Prediction Using Split Conformal Prediction

Accurate prediction of ex vivo drug sensitivity in acute myeloid leukemia (AML) patients from transcriptomic data is a critical challenge for precision oncology. Existing computational approaches have explored uncertainty quantification in cancer drug response prediction primarily using cell line data, while patient-level AML models typically rely on heuristic confidence measures rather than statistically calibrated uncertainty estimates. Here, we present a framework applying split conformal prediction to patient-level AML drug response modeling using the BeatAML 2.0 cohort. We trained Elastic Net and XGBoost regressors on bulk RNA-seq gene expression profiles from 318 AML patients, analyzing 34,764 patient-drug observations across 122 compounds. Baseline models achieved median Pearson R values of 0.291 (Elastic Net) and 0.281 (XGBoost) across 122 drugs. Wrapping these models with split conformal prediction yielded well-calibrated prediction intervals across three confidence levels: empirical coverages of 81.4%, 90.7%, and 95.5% against nominal targets of 80%, 90%, and 95%, respectively. Analysis of prediction interval widths revealed substantial drug-class-specific uncertainty patterns, with HDAC and BCL-2 inhibitors exhibiting markedly higher uncertainty than MDM2 inhibitors, suggesting a potential association between transcriptomic predictability and drug mechanism of action, although several drug classes were represented by only a small number of compounds. Predictive uncertainty was not significantly associated with ELN2017 molecular risk classification (Kruskal-Wallis p=0.395) or NPM1 mutation status (p=0.788). These results demonstrate that statistically valid uncertainty quantification can be achieved for patient-level AML drug response prediction despite substantial biological heterogeneity. to the best of our knowledge, no published study has applied split conformal prediction to patient-level ex vivo drug sensitivity prediction in the BeatAML cohort, providing a principled alternative to heuristic confidence scoring approaches. Keywords: Acute myeloid leukemia (AML); Ex vivo drug sensitivity; Conformal prediction; Uncertainty quantification; Precision oncology; BeatAML; Transcriptomic biomarkers; Machine learning.

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medRxiv (Medicine) 2026-06-19

Validation of an Artificial Intelligence-Assisted Mobile Application for Dietary Oxalate Assessment in Kidney Stone Prevention

Background: Calcium oxalate nephrolithiasis is the most common type of kidney stone disease. Dietary oxalate intake is an important modifiable factor. Assessing dietary oxalate exposure in clinical practice poses challenges due to limitations of traditional dietary recall tools and variability in food composition data. Artificial intelligence (AI) applications in mobile health may offer scalable solutions for better dietary monitoring and kidney stone prevention. We examined the ability of StoneFree AI to estimate dietary oxalate from verbal and image-based food inputs. Objective: To evaluate the accuracy and limitations of StoneFree AI, for estimating dietary oxalate intake from verbal food descriptions and meal images, and to evaluate errors from entries that may inform future clinical use in kidney stone prevention. Methods: StoneFree AI is a cross-platform mobile application that uses a multimodal large language model (Google Gemini) to interpret verbal food descriptions and visual food images. The identified foods were mapped to oxalate values using the Harvard Oxalate Database. System performance was evaluated using 804 verbal food entries and 276 portion-size food images obtained from the ASA24 dietary assessment database. Verbal inputs were compared with reference oxalate values using absolute error and predefined agreement thresholds ({+/-}1, {+/-}5, {+/-}10 mg). Image-based inputs were evaluated against mutually exclusive primary error categories, including food identification, portion estimation, ingredient recognition, oxalate reference selection, and non-analyzable cases. Results: For verbal food entries, the AI system showed strong agreement with reference oxalate values. Overall, 82.1% of estimates were within {+/-}1 mg, 91.5% within {+/-}5 mg, and 94.5% within {+/-}10 mg of reference values. The mean absolute error was 3.32 mg, the median absolute error was 0.10 mg, and the concordance correlation coefficient (CCC) was 0.860. Image-based inputs showed a higher overall error rate of 63.0%, primarily due to food identification errors (33.0%), inaccurate portion estimation (11.0%), and ingredient recognition errors (9.8%). Most errors occurred with visually complex meals, such as mixed dishes and grain-based foods. Conclusions: AI-assisted estimation of dietary oxalate intake demonstrated high accuracy when structured verbal inputs were used but was less reliable for image-based meal analysis. These findings suggest AI-enabled mobile tools may support dietary monitoring for kidney stone prevention, particularly when user input is structured. Further refinement of computer vision models and prospective clinical validation are required before widespread clinical implementation.