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01.
medRxiv (Medicine) 2026-06-23

Antibodies against influenza A/H1N1pdm2009 and B/Victoria strains but not A/H3N2 are increased in recent onset type 1 narcolepsy versus matched controls

Study Objectives: Onsets of Narcolepsy type-1 (NT1) increased following A/H1N1 vaccination with PandemrixTM in Europe and with A/H1N1pdm2009 infections in China and other countries. To test if other strains could trigger narcolepsy, we measured strain-specific antibodies in patients with recent onset NT1 compared to controls. Methods: Antibodies against hemagglutinin (HA) and neuraminidase (NA) were tested in 62 patients with very recent onset (onset and blood collection following a single flu season, mean +/- SEM: 0.44 +/- 0.06 years since onset) and 100 controls matched by age, sex, season and year of collection (2000-2025). Results were next extended to 181 recent onset patients (mean +/- SEM: 1.00 +/- 0.05 years) versus 260 controls, matched by sex, season and year, but having a slightly higher mean age. HA inhibition (HAI) and NA inhibition (NAI) assays were conducted using flu strains known to circulate during the corresponding flu seasons. HAI results are shown as % positive (titers >= 40) and NAI results as geometric mean titers. Odds ratio (OR) and coefficient were used to compare antibody titers in NT1 versus controls. The contribution of each assay to prediction was finally quantified in the larger sample set using Shapley decomposition. Results: NT1 patients had increased anti-HA and anti-NA antibodies against A/H1N1pdm2009 (anti-HA OR = 3.86, anti-NA coefficient = 0.35) and B/Victoria (anti-HA OR =1.90, anti-NA coefficient = 0.22), but not A/H1N1pre2009, A/H3N2, or B/Yamagata, independent of HLA-DQB1*06:02 status, age, sex, and flu season. Correlations between anti-HA and anti-NA antibodies titers were weak to moderate but significant (r2=-0.10 to 0.34). Multivariable model outperformed age-only baseline (McFadden R2 = 0.19 vs. 0.03; AUC = 0.79 vs. 0.64; likelihood-ratio test X2 = 51, p

02.
arXiv (CS.CV) 2026-06-19

TriFlow: Generating Artist-Like 3D Mesh Topology via Nearest-Vertex Vector Fields

We present TriFlow, a new generative approach for producing compact 3D meshes with artist-like triangle topology directly from input geometry conditions such as signed distance fields. Our key insight is to represent mesh topology as a nearest-vertex vector field (NVF) defined over the surface, where each point encodes its association to the nearest triangle vertex in the local barycentric frame. We train a latent flow-matching model to synthesize this field, enabling topology generation conditioned on the input geometry. To extract a coherent mesh, we cluster surface regions using the generated NVF and guide a constrained quadric error metric (QEM) mesh simplification with topology-aware optimization. This yields output meshes that closely match the input geometry while exhibiting structured, artist-like connectivity. Experiments demonstrate that TriFlow achieves stronger generalization and significantly improved topology quality compared to state-of-the-art learning-based approaches, alongside 90% lower Chamfer Distance and an 8x speedup.

03.
arXiv (math.PR) 2026-06-18

Rigidity of infinite exchangeable sequences with Gaussian marginals

arXiv:2606.18654v1 Announce Type: new Abstract: We study infinite exchangeable sequences with Gaussian one-dimensional marginals. We formulate the conjecture that joint Gaussianity of a single pair of coordinates forces the entire sequence to be a Gaussian process. Although this conjecture remains open, we prove that joint Gaussianity of the first four coordinates is sufficient. We also establish the corresponding two-point criterion under the additional assumption that the directing measure is almost surely infinitely divisible.

04.
arXiv (CS.AI) 2026-06-24

ASymPO: Asymmetric-Scale Policy Optimization for Asynchronous LLM Post-Training Without Behavior Information

arXiv:2606.03070v3 Announce Type: replace-cross Abstract: Asynchronous reinforcement learning can improve language-model post-training throughput by decoupling response generation from policy optimization, but stale responses introduce distribution drift. Standard behavior-corrected methods control this drift with behavior-policy probabilities, importance ratios, or clipping, which requires token-aligned, versioned, and numerically consistent behavior log-probabilities across rollout and learner systems. We ask whether asynchronous group-relative RL can instead be stabilized using only current-policy probabilities. We identify a scale-imbalance failure mode: when stale responses are evaluated under the current policy, positive and negative loss terms can appear at different negative log-probability scales, so zero-sum advantages no longer imply balanced loss contributions. We propose Asymmetric-Scale Policy Optimization (ASymPO), which normalizes each response's token loss by its current average token negative log-probability. ASymPO requires no behavior-policy probabilities, restores response-level zero-sum balance, and preserves a nonzero learning signal. We also introduce Scaled Policy Optimization (SPO), a fixed negative-scaling baseline, and evaluate both current-policy-only objectives in asynchronous mathematical reasoning post-training.

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

Graph2Idea:Retrieval-Augmented Scientific Idea Generation with Graph-Structured Contexts

arXiv:2606.09105v3 Announce Type: replace Abstract: Generating novel, feasible, and high-quality research ideas is an important yet challenging task in scientific discovery. Recent Large Language Model (LLM)-based methods often ground idea generation with retrieved literature, but the retrieved evidence is usually provided as flat text, such as titles, abstracts, or summaries. Such flat contexts may contain redundant or weakly relevant information, while making cross-paper relations among problems, methods, mechanisms, and findings difficult to identify and trace. To address this challenge, we propose Graph2Idea, a knowledge graph-guided framework for retrieval-augmented scientific idea generation.Graph2Idea first retrieves papers according to the input topic, transforms them into structured knowledge triples, and dynamically constructs a target-centered knowledge graph to make literature relations explicit. It then extracts compact graph-derived contexts that retain target-relevant relational evidence while reducing noisy textual input. Based on these contexts, a two-stage generation process first identifies promising research directions and then guides the LLM to synthesize candidate ideas from graph-grounded evidence. Experiments on a scientific idea generation benchmark show that Graph2Idea outperforms representative baselines under the automatic evaluation protocol. Compared with the strongest baseline scores, it improves Novelty from 0.45 to 0.52, Quality from 0.24 to 0.29, and Feasibility from 0.22 to 0.28. These results suggest that graph-structured evidence helps LLMs generate research ideas through more explicit, compact, and traceable recombination of prior scientific knowledge.

06.
arXiv (math.PR) 2026-06-11

Stochastic epidemic model with varying infectivity and waning immunity: the law of large numbers with unbounded infectivity

arXiv:2606.11845v1 Announce Type: new Abstract: We revisit the large population limit of our epidemic model with infection age dependent infectivity and progressive immunity waning, under the assumption that the supremum in $t$ of the random infectivity function has a finite expectation, while the previous proofs assumed that this supremum admits a deterministic upper bound.

07.
bioRxiv (Bioinfo) 2026-06-14

Generative design of antigen-specific T-cell receptor sequences with a conditional diffusion model

T cell receptor (TCR)-based immunotherapy holds immense potential for treating cancers and infectious diseases, where highly antigen-specific TCR recognition is crucial for adaptive immunity against tumors and pathogens. Engineering or de novo generation of the complementarity-determining region 3 (CDR3) loops of TCRs using artificial intelligence offers a powerful alternative to designing reactive TCRs rather than laborious experimental screening. However, current in silico approaches are constrained by weak conditional guidance, limited flexibility, and a lack of rigorous functional validation. To address these limitations, we introduce TCRDiff, a generative diffusion framework for designing antigen-specific TCRs conditioned on peptide-MHC (pMHC) targets and germline-encoded variable genes. By leveraging pre-trained knowledge from massive T-cell repertoires and TCR-pMHC recognition data, TCRDiff generates CDR3{beta} sequences with state-of-the-art fidelity to native binding TCRs through a denoising diffusion process. Furthermore, incorporating the interface geometry features generated TCR-pMHC complexes with superior structural plausibility. As a proof of concept, we deployed TCRDiff in a systematic pipeline to design candidate TCRs for immunotherapy. In vitro activation assays validated that TCRDiff-generated TCRs specifically recognize the MAGE-A3 epitope with minimized off-target cross-reactivity. Together, TCRDiff establishes a powerful, validated computational paradigm to accelerate the development of TCR-based immunotherapies.

08.
Nature Medicine 2026-06-22

<b>PROTEUS trial heralds perioperative therapy for prostate cancer</b>

Perioperative androgen-deprivation therapy plus apalutamide could represent a new treatment option for patients with high-risk, localized prostate cancer. Perioperative androgen-deprivation therapy plus apalutamide could represent a new treatment option for patients with high-risk, localized prostate cancer.

10.
arXiv (CS.CV) 2026-06-11

DroneShield-AI: A Multi-Modal Sensor Fusion Framework for Real-Time Autonomous Drone Threat Detection, Behavioral Intent Classification, and Swarm Intelligence in Contested Airspace

Unmanned Aerial Vehicle (UAV) threats have emerged as a defining security challenge of the 21st century. This paper presents DroneShield-AI, a unified open framework integrating six processing layers: RF signal classification, acoustic motor-signature detection, YOLOv8-based visual detection, evidence-weighted sensor fusion, a Behavioral Intent Classification Engine (BICE), and a Graph Neural Network Swarm Intelligence Module (GNN-SIM). BICE introduces the first systematic six-class threat taxonomy for drone flight patterns, enabling predictive operator alerts with a 30-second advance-warning horizon. GNN-SIM is the first open framework for adversarial multi-drone formation analysis using Graph Attention Networks. Evaluated on three publicly available real-world datasets, the fused pipeline achieves 96.1% detection accuracy, 3.2% false alarm rate, AUC-ROC: 0.981, and 142ms end-to-end latency on commodity CPU-class hardware at approximately $500-$780 USD total system cost. All code, model weights, and simulation datasets are publicly released at submission.

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

ScoreGate: Adaptive Chunk Selection for Retrieval-Augmented Generation via Dual-Score Statistical Fusion

Fixed-cardinality retrieval injects a constant top-K chunks into the generator regardless of query complexity, causing over-retrieval for narrow queries and under-retrieval for compositional ones. We describe ScoreGate, a lightweight score-space decision mechanism that controls retrieval cardinality at inference time using two scores already produced by the standard pipeline: bi-encoder similarity s_i and cross-encoder reranker score r_i, with no additional model inference calls required. Its core insight is that cross-encoder affirmation can rescue semantically relevant chunks that bi-encoder retrieval ranks poorly due to vocabulary mismatch – a failure mode unaddressed by fixed-K or single-score thresholding. On MS MARCO (200 dev queries), ScoreGate achieves MRR@10 = 0.401 with 35% fewer retained chunks than Standard Top-K. On an internal benchmark (n=300, Fleiss' kappa=0.87), ScoreGate observed zero false positives (95% CI [96.4%, 100%]) at 97.77-99.34% recall, with 34.8% fewer tokens per query and only 31ms added latency. Results on both MS MARCO and real-world production traffic suggest that adaptive retrieval cardinality can improve retrieval efficiency without degrading retrieval quality.

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

Multi-Bitwidth Quantization for LLMs Using Additive Codebooks

As large language models (LLMs) are increasingly deployed across heterogeneous hardware with varying resource constraints, the ability to adaptively manage the trade-off between performance and efficiency without retraining is critical. We propose Drop-by-Drop, a novel multi-bitwidth post-training quantization framework that enables inference-time precision control over LLM weights from a single trained model. Our method is theoretically grounded in information theory and successive refinement. We establish that LLM weights, which commonly follow a Gaussian distribution, can be optimally reconstructed with increasing fidelity as additional bits are incorporated, under a weighted mean squared error distortion motivated by LLM loss functions. To realize this in practice, Drop-by-Drop incorporates Matryoshka-style supervision into the loss function, exploiting the structure of additive codebooks. Drop-by-Drop produces a single model where ordered subsets of codebooks yield accurate partial reconstructions at each precision level. This approach significantly reduces storage and memory overhead by allowing a single checkpoint to serve multiple bitwidths, while maintaining competitive perplexity and accuracy across major architectures, such as Qwen, LLaMA, Gemma, and Mistral.

13.
arXiv (quant-ph) 2026-06-19

Arrival times of an atomic Bose-Einstein condensate

arXiv:2606.20281v1 Announce Type: cross Abstract: The times of flight of an atomic Bose-Einstein condensate are theoretically investigated in the experimentally unexplored regime corresponding to detection close to the trap of the condensate. In this regime, there is no consensus on how to calculate the distribution of times of arrival onto the detector. For non-interacting particles, distinct theoretical predictions have been made in the past. This work analyses how these predictions are modified for an interacting Bose-Einstein condensate. For this purpose, a time-dependent Gross-Pitaevskii equation is solved analytically and numerically.

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

CADO: From Imitation to Cost Minimization for Heatmap-based Solvers in Combinatorial Optimization

arXiv:2602.08210v2 Announce Type: replace Abstract: Heatmap-based solvers have emerged as a promising paradigm for Combinatorial Optimization (CO). However, we argue that the dominant Supervised Learning (SL) training paradigm suffers from a fundamental objective mismatch: minimizing imitation loss (e.g., cross-entropy) does not guarantee solution cost minimization. We dissect this mismatch into two deficiencies: Decoder-Blindness (being oblivious to the non-differentiable decoding process) and Cost-Blindness (prioritizing structural imitation over solution quality). We empirically demonstrate that these intrinsic flaws impose a hard performance ceiling. To overcome this limitation, we propose CADO (Cost-Aware Diffusion models for Optimization), a streamlined Reinforcement Learning fine-tuning framework that formulates the diffusion denoising process as an MDP to directly optimize the post-decoded solution cost. We introduce Label-Centered Reward, which repurposes ground-truth labels as unbiased baselines rather than imitation targets, and Hybrid Fine-Tuning for parameter-efficient adaptation. CADO achieves state-of-the-art performance across diverse benchmarks, validating that objective alignment is essential for unlocking the full potential of heatmap-based solvers.

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

Reference-Driven Multi-Speaker Audio Scene Generation from In-the-Wild Priors

Existing multi-speaker dialogue systems bind speakers to utterances through structured supervision: per-turn tags, multi-stream transcriptions, or learnable speaker embeddings. These systems operate within speech-only pipelines that produce clean vocal sequences without the ambient texture of real conversations. We take a different approach. Our method, ScenA, conditions a text-to-audio flow-matching foundation model, pretrained on large-scale in-the-wild data, directly on multiple reference voices and a free-form natural language prompt that describes an entire multi-speaker audio scene. Leveraging such a foundational model allows us to inherit its capacity for natural, non-studio audio: background noise, room acoustics, overlapping dialogue, and spontaneous paralinguistic events, while adding multi-speaker control without any per-turn structure. Concretely, reference latents are concatenated into the model's token sequence and distinguished by lightweight identity-aware positional encodings. However, we identify a critical obstacle to this approach: the Reference Shortcut. During training under standard noise schedules, the model can identify the matching reference by acoustic similarity to the noisy target, bypassing the text prompt entirely. We address this with a high-noise-biased timestep distribution that forces the model to rely on the text prompt for speaker assignment. We evaluate ScenA on the CoVoMix2-Dialogue benchmark, showing that it outperforms existing multi-speaker systems on speaker-binding metrics while generating rich conversational audio with overlapping speech, emotional vocalizations, and ambient sound. Our results demonstrate the advantage of using a general-purpose audio model conditioned on a free-form scene description, rather than passing structured dialog scripts through a speech-only pipeline.

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

Does Head Pose Correction Improve Biometric Facial Recognition?

Biometric facial recognition models often demonstrate significant decreases in accuracy when processing real-world images, often characterized by poor quality, non-frontal subject poses, and subject occlusions. We investigate whether targeted, AI-driven, head-pose correction and image restoration can improve recognition accuracy. Using a model-agnostic, large-scale, forensic-evaluation pipeline, we assess the impact of three restoration approaches: 3D reconstruction (NextFace), 2D frontalization (CFR-GAN), and feature enhancement (CodeFormer). We find that naive application of these techniques substantially degrades facial recognition accuracy. However, we also find that selective application of CFR-GAN combined with CodeFormer yields meaningful improvements.

18.
arXiv (CS.LG) 2026-06-11

SpaTeoGL: Spatiotemporal Graph Learning for Interpretable Seizure Onset Zone Analysis from Intracranial EEG

arXiv:2602.11801v2 Announce Type: replace Abstract: Accurate localization of the seizure onset zone (SOZ) from intracranial EEG (iEEG) is essential for epilepsy surgery but is challenged by complex spatiotemporal seizure dynamics. We propose SpaTeoGL, a spatiotemporal graph learning framework for interpretable seizure network analysis. SpaTeoGL jointly learns window-level spatial graphs capturing interactions among iEEG electrodes and a temporal graph linking time windows based on similarity of their spatial structure. The method is formulated within a smooth graph signal processing framework and solved via an alternating block coordinate descent algorithm with convergence guarantees. Experiments on a multicenter iEEG dataset with successful surgical outcomes show that SpaTeoGL is competitive with a baseline based on horizontal visibility graphs and logistic regression, while improving non-SOZ identification and providing interpretable insights into seizure onset and propagation dynamics.

19.
arXiv (math.PR) 2026-06-15

Scaling limits of multitype Bienaymé trees

arXiv:2507.23241v2 Announce Type: replace Abstract: We consider critical multitype Bienaymé trees that are either irreducible or possess a critical irreducible component with attached subcritical components. These trees are studied under two distinct conditioning frameworks: first, conditioning on the value of a linear combination of the numbers of vertices of given types; and second, conditioning on the precise number of vertices belonging to a selected subset of types. We prove that, under a finite exponential moment condition, the scaling limit as the tree size tends to infinity is given by the Brownian Continuum Random Tree. Additionally, we establish strong nonasymptotic tail bounds for the height of such trees. Our main tools include a flattening operation applied to multitype trees and sharp estimates regarding the structure of monotype trees with a given sequence of degrees.

20.
arXiv (CS.LG) 2026-06-18

OpenAnt: LLM-Powered Vulnerability Discovery Through Code Decomposition, Adversarial Verification, and Dynamic Testing

arXiv:2606.19149v1 Announce Type: cross Abstract: Automated vulnerability discovery in large codebases remains challenging: traditional static analysis produces high false-positive rates, while dynamic approaches such as fuzzing require substantial infrastructure and often target narrow classes of bugs. Recent advances in large language models (LLMs) enable semantic reasoning about program behavior, but applying LLMs to repository-scale security analysis introduces challenges related to context management, cost, and verification. We present OpenAnt, an open-source vulnerability discovery system that integrates static program analysis with LLM-based reasoning in a multi-stage pipeline. OpenAnt introduces three key techniques. First, codebases are decomposed into self-contained analysis units filtered by reachability from external entry points, reducing the analysis surface by up to 97% while preserving attack-relevant code. Second, candidate vulnerabilities undergo adversarial verification through constrained attacker simulation, where the model evaluates exploitability under realistic attacker capabilities. Third, findings are validated through dynamic verification, in which exploit environments are generated automatically, executed in sandboxed containers, and discarded after use. Evaluation on widely used open-source projects including OpenSSL, WordPress, and Flowise shows that this architecture can identify previously unknown vulnerabilities while maintaining manageable analysis cost and substantially reducing false positives. Our results suggest that closed-loop vulnerability discovery pipelines, combining semantic reasoning with exploit validation, provide a practical path toward scalable automated security analysis. OpenAnt is released as open source under the Apache 2.0 license at https://github.com/knostic/OpenAnt.

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

Statistical Foundations of LLM-based A/B Testing: A Surrogacy Framework for Human Causal Inference

arXiv:2606.17165v1 Announce Type: cross Abstract: Organizations and researchers show increasing interest in using large language models (LLMs) in place of human participants in A/B tests, in the hope of experimenting faster and at lower cost. We study when a treatment effect estimated on LLM outcomes recovers the effect that would have been measured on the human population of interest. Distributional equivalence between LLM and human outcomes would make any standard estimator valid but is unrealistic. We therefore develop a statistical framework that adapts surrogate endpoint theory to LLMs. The framework shows that calibrating LLM outcomes to human outcomes identifies the average treatment effect under surrogacy and comparability conditions that are jointly weaker than distributional equivalence. When these conditions fail, the effect of interest is only partially identified, and we provide diagnostics that can falsify surrogacy on historical experiments together with a bound on the worst-case bias from limited overlap. We further show that the stochasticity inherent to LLMs introduces both bias and variance, but using an average of multiple draws as the surrogate mitigates both. We illustrate the methods and theory in simulations and an application to A/B tests on Upworthy headlines. A central takeaway from our work is that the validity of LLM outcomes as surrogates can only be falsified for past treatments and never verified for new ones, so human experiments remain indispensable for novel interventions. We discuss the role of LLM choice, prompting, and temperature as design variables, and how to size human experiments for validation.

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

The Dark Regulome: Disentangling Predictability from Regulation in Genomic Foundation Models

High-grade gliomas integrate into neural circuits through functional synapses with neurons, raising the question of which noncoding elements shape synaptogenic gene expression in tumor cells. The regulatory program written across the dark genome, what we call the $dark regulome$, is the natural substrate to probe, and sequence foundation models offer a zero-shot route through in-silico mutagenesis (ISM); yet likelihood-based scoring is tautologically coupled to local sequence predictability, leaving the regulatory interpretation underdetermined. Across three architecturally distinct foundation models (Caduceus-Ph, HyenaDNA, Enformer) and 30,448 dark genome elements at 92 glioma-relevant loci, we introduce a residualization-and-permutation diagnostic that separates predictability-driven from regulation-driven RIS variance. A sharp 10kb proximal-regulatory horizon survives every control we apply, but the LM-derived element-class hierarchy does not: a six-feature linear baseline matches Caduceus top-decile membership at AUC $= 0.985$. Cross-architecture decomposition cleanly separates a sequence-predictability layer (the two language models co-rank long well-predicted transposable elements) from a regulatory-output layer (Enformer alone retains residual cCRE-discriminative signal), with literally zero overlap between the two top-100 lists. Conservation, brain cis-eQTL, and STRING-PPI cross-checks then anchor what biology survives: top-100 elements across all three models are $3.3\times$ enriched per model for matching brain eQTLs ($p_\mathrm{emp} < 5\times 10^{-3}$), while a tempting transposable-element regulatory layer and a striking NRXN1+NLGN1 protein-pair convergence both fail proper permutation tests once those tests are constructed. We deliver the diagnostic as a general methodological tool for any ISM-based regulatory study.

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

Do LLMs Reliably Identify Correct Information Units in Aphasic Discourse?

Correct Information Units (CIUs) are central to discourse assessment in aphasia because they quantify communicative informativeness rather than linguistic form alone. However, CIU scoring is time intensive and requires trained raters. This study examined whether instruction-tuned large language models (LLMs) can reliably perform token-level CIU classification from aphasic discourse transcripts. Sixteen picture-description transcripts elicited with the Cat Rescue stimulus were annotated for CIU status according to Nicholas and Brookshire (1993). The sample spanned four severity strata: control, mild, moderate, and severe aphasia. Four publicly available instruction-tuned LLMs were benchmarked under zero-shot and two few-shot prompting conditions across five stratified random seeds. Performance was evaluated against consensus human labels using accuracy, precision, recall, F1, and Cohen's kappa. Zero-shot prompting was insufficient across models. In contrast, few-shot prompting yielded substantial gains and produced competitive performance for three viable models. Mean few-shot F1 scores ranged from 0.776 to 0.817 across Llama-3.1-8B, Qwen2.5-7B, and Mistral-7B, with no significant differences between fixed global and per-chunk local example selection. Phi-3-mini was unstable and did not yield reliable performance. Viable models showed high recall but lower precision, suggesting systematic over-classification of tokens as CIUs. Performance also varied by discourse severity, with the weakest results in more severe aphasia. Few-shot LLM prompting can support automated CIU identification without gradient-based task training, but agreement with human annotation remains insufficient for fully autonomous use. These findings support LLM-based CIU scoring as a promising human-in-the-loop component of discourse assessment systems.

24.
arXiv (CS.CL) 2026-06-19

Investigating Human-Model Discrepancies in Speech Quality Assessment via Acoustic and Prosodic Perturbations

Mean opinion score (MOS) prediction models are widely used as proxy metrics in text-to-speech (TTS) research, yet their ability to capture quality differences beyond acoustic fidelity remains unclear. We investigate this via controlled perturbations on speech: acoustic degradation, prosodic errors, and manipulation of speaker-specific characteristics such as pitch and speaking rate. We obtained MOS predictions for these speech samples from both human listeners and the model, and analyzed the differences in their perceptual characteristics. Results show that most models track acoustic degradation well, while all are insensitive to prosodic errors despite large subjective score drops. For speaker characteristics, models exhibit a double dissociation: strong mean fundamental frequency (F0) biases absent in human ratings, yet insensitivity to speaking rate and F0 variability that humans notice. These findings highlight limitations of scalar MOS prediction beyond acoustic fidelity.

25.
medRxiv (Medicine) 2026-06-15

Wellbeing After Stroke-2 (WAterS-2): a feasibility study with process evaluation exploring inclusive, accessible, online psychological support after stroke

Objectives: Explore feasibility and acceptability of upskilling a workforce to deliver a co-developed intervention, based on Acceptance and Commitment Therapy (ACT), to support psychological adjustment post-stroke targeting underserved groups. Design: Multi-site, single-arm feasibility study with embedded mixed-methods process evaluation (ISRCTN17628580). Setting: Four NHS community stroke services across England. Participants: 1. Stroke survivors [&ge;]18 years of age, [&ge;]4 months post-stroke, reporting psychological difficulties adjusting to stroke, able to consent and access remote group sessions in English; 2. Group facilitators from NHS stroke services, not ACT specialists. Intervention: WAterS-2: an eight-session, remotely-delivered ACT-informed group intervention. Outcome measures: Recruitment, fidelity, safety, acceptability and perceived value were assessed using fidelity checklists, post-intervention surveys and semi-structured interviews with stroke survivors and facilitators. Clinical outcomes including mood (HADS), wellbeing (ONS4), psychological flexibility (AAQ-ABI), measured post-group and three-months later. Results: Nineteen stroke survivors recruited (mean 9.6 months post-stroke; n=5 (26%) minoritised ethnicities; n=10 (52%) with aphasia). Thirteen facilitators - including two peer support workers - delivered the intervention with fidelity following structured training across four services. Drop-out was low (2/19; 11%); with 15 (79%) attending [&ge;]5/8 sessions. Remote data collection was feasible (79% follow-up completion), with no adverse events recorded. Acceptability was high: survivors valued peer connection, grounding and mindfulness practices. ACT metaphors were helpful for some but challenging for others, including some with aphasia. Online delivery was suitable but limited informal connection. Facilitators reported increased capability, incorporating ACT skills into routine care. NHS workforce pressures and geographically-constrained referral pathways limited recruitment reach. Conclusions: WAterS-2 is feasible, safe, acceptable and inclusive. A mixed workforce, including NHS peer support workers, can be upskilled to deliver with fidelity. Inclusion of underserved groups is achievable but requires active strategies beyond standard NHS referral routes. Findings inform a provisional logic model and a future pragmatic trial.