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

The Holistic Storage of Verb+Up Phrases in Text-based and Audio-based Language Models

A crucial aspect of linguistic capability is the ability to trade off between stored representations and abstract knowledge: one must retrieve learned representations, but also generate novel ones by applying productive rules. While recent work has examined abstract knowledge in language models, holistic storage of multi-word units has received far less attention. We probe internal representations in text-based LLMs and an ASR model, testing whether V+up phrasal verbs develop distinct representations as a function of frequency and predictability. All models show evidence of holistic storage driven by frequency and predictability, further supporting usage-based theories of language.

02.
arXiv (CS.CV) 2026-06-12

Navigating Gigapixel Pathology Images with Large Multimodal Models

Recent advances in large multimodal models have allowed for the development of interactive chat models that can converse and reason about pathology whole-slide images (WSIs). However, existing slide-level chat systems are often highly specialized, typically compressing WSIs into fixed slide-level embeddings or relying on multi-component pipelines, which can lose multi-scale detail and limit generalizability beyond the target task. We present GIANT (Gigapixel Image Agent for Navigating Tissue), a simple, training-free approach that lets general-purpose multimodal models navigate WSIs on their own, iteratively selecting multi-magnification crops and aggregating evidence over time. To evaluate generalizability in WSI question answering and to promote reproducibility, we introduce MultiPathQA, a benchmark suite spanning five clinical challenges and 934 questions over 868 unique WSIs. This includes a new set of 128 pathologist-authored multiple-choice questions designed to mirror real diagnostic search and multi-scale reasoning. Using GPT-5, GIANT outperforms models specialized for pathology question answering, achieving state-of-the-art performance on four out of five benchmarks.

03.
arXiv (CS.CV) 2026-06-11

CoCoSI: Collaborative Cognitive Map Construction for Spatial Intelligence

Spatial intelligence is a key frontier for multimodal large language models (MLLMs), enabling them to reason about the physical world from visual experience. Inspired by human spatial cognition, recent approaches construct grid-based cognitive maps from multi-frame visual inputs to maintain coherent spatial representations over time. However, limited context lengths still challenge spatial understanding, while existing methods, such as long-context modeling and external memory, often require architectural changes, memory modules, or finetuning, limiting their applicability to off-the-shelf pretrained MLLMs. This motivates a lightweight, model-agnostic method for preserving spatial information beyond the native context window. To this end, we propose a plug-and-play multi-agent framework that collaboratively constructs cognitive maps as structured spatial memory, enhancing the spatial understanding of arbitrary pretrained MLLMs without architectural modification or additional training. Our framework features local-global agent coordination, cognitive map construction with atomic commits, and cross-agent verification. Extensive experiments demonstrate that our method achieves superior performance on spatial understanding tasks while remaining fully training-free. Code will be released.

04.
arXiv (CS.CL) 2026-06-25

Evaluating Japanese Dialect Robustness Across Speech and Text-based Large Language Models

Dialogue systems based on large language models (LLMs) have advanced significantly in recent years. However, dialectal variation remains a major challenge, particularly for systems that process spoken input. LLM-based speech language models (SLMs), which integrate LLMs with speech processing components, show promise for spoken language tasks, yet their ability to comprehend dialects has not been sufficiently studied. Moreover, it remains unclear how the dialectal understanding of the base LLM affects SLM performance. This study investigates the dialectal robustness of both LLMs and SLMs using Japanese dialects as a test case. We define robustness as the ratio of performance on dialectal versus standard inputs, enabling fair comparisons. Our experiments show that SLM robustness correlates with that of their text-based counterparts. Furthermore, training with dialectal data and fine-tuning the speech encoder each improves robustness in SLMs.

05.
arXiv (CS.LG) 2026-06-24

Data Augmentation: A Fourier Analysis Perspective

arXiv:2606.24418v1 Announce Type: new Abstract: Data augmentation is a simple and model-agnostic approach for exploiting known invariances in learning problems. Given a group acting on the input space, one augments the training set with transformed copies of each sample. Because it exploits symmetries without modifying the underlying learning algorithm, data augmentation can be applied broadly across learning methods. However, this universality comes at a computational cost: when the group is large, full group-sized augmentation quickly becomes computationally infeasible. This raises a fundamental question: Can partial data augmentation achieve the same statistical benefits as full augmentation in terms of generalization and sample complexity? We develop a general framework for investigating this question using Fourier analysis and the representation theory of finite groups. We show that, for a broad class of classical learning problems, partial data augmentation based on a randomly sampled subset of group elements achieves the same minimax rates as full augmentation, up to an approximation error that vanishes as the subset size increases. Our results provide a theoretical explanation for why partial augmentation can retain the statistical benefits of full augmentation despite enforcing symmetry only approximately, and shed light on a recently raised question in learning with symmetries: whether statistically optimal learning under general group invariances can be achieved using computationally scalable methods. Moreover, we prove a complementary impossibility result: enforcing exact invariance via data augmentation requires averaging over the entire group, and cannot be achieved by any strict subset when the hypothesis space is sufficiently expressive. Together, these results provide a unified perspective on full and partial data augmentation, as well as exact and approximate symmetry enforcement.

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

Constrained hybrid modelling to predict microbial dynamics and organic matter turnover in soil systems

arXiv:2606.20329v1 Announce Type: new Abstract: Soil microorganisms control organic matter cycling and largely determine how soil systems can cope with and mitigate climate change and environmental threats. Representing microbial dynamics in process-based soil models is therefore critical to predict carbon cycling in soils, albeit highly challenging to inform from data. One promising approach to improve their parametrisation is the integration of genomic data, yet modelling the complex and unknown relationship between genomes and the processes the microbes are driving is an unsolved problem. In this work, we present the first hybrid modeling framework for deriving biokinetic parameter values of a process-based soil organic matter turnover model from metagenome-inferred functional traits based on DNA sequencing data. Our model predicts biokinetic parameters of the process-based model from genomic trait data with a neural network and integrates constraints from ecological theory and literature to ensure realistic behavior, even of non-observed state variables. We evaluate our method on synthetic genomic trait datasets of varying complexity and on real data, showing that our approach improves performance over multiple baselines and learns the dynamics of unmeasurable components of the process-based model effectively, even for small training datasets.

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

A Conservation Law for Equilibrium Propagation and Coupled Learning

arXiv:2606.15444v1 Announce Type: cross Abstract: In this paper we show that the physical learning methods known as coupled learning (CL) and equilibrium propagation (EP) conserve a mass-like quantity in the trainable parameters in the continuous-time, small-nudging limit. We prove that this conservation holds in a broad range of physically relevant settings. We then show that the conservation law constrains the training dynamics in a way that makes convergence reliable in important settings for linear circuits. We conclude by discussing some practical implications of this conservation law.

08.
arXiv (CS.LG) 2026-06-16

NanoQuant: Efficient Sub-1-Bit Quantization of Large Language Models

arXiv:2602.06694v3 Announce Type: replace Abstract: Weight-only quantization has become a standard approach for efficiently serving large language models (LLMs). However, existing methods fail to efficiently compress models to binary (1-bit) levels, as they either require large amounts of data and compute or incur additional storage. In this work, we propose NanoQuant, the first post-training quantization (PTQ) method to compress LLMs to both binary and sub-1-bit levels. NanoQuant formulates quantization as a low-rank binary factorization problem, and compresses full-precision weights to low-rank binary matrices and scales. Specifically, it utilizes an efficient alternating direction method of multipliers (ADMM) solver to precisely initialize latent binary matrices and scales, and then tunes the initialized parameters through a block and model reconstruction process. Consequently, NanoQuant establishes a new Pareto frontier in low-memory post-training quantization, and enables sub-1-bit compression. NanoQuant makes large-scale deployment feasible on consumer hardware. For example, it compresses Llama2-70B by 25.8$\times$ in just 13 hours on a single H100, enabling a 70B model to operate on a consumer 8 GB GPU. Code is available at https://github.com/SamsungLabs/NanoQuant.

09.
arXiv (CS.CV) 2026-06-11

From Simulation to Real-World: An In-Field 6D Pose Dataset and Baseline for Robotic Strawberry Harvesting

Robotic strawberry harvesting requires precise 6D pose estimation; however, collecting 6D pose ground truth in real agricultural fields is inherently challenging. Existing 6D pose estimation methods have therefore relied solely on synthetic data that lacks scene-level realism, leaving their performance under real agricultural field conditions unquantified. In this work, we present, to the best of our knowledge, the first real-world 6D pose ground truth dataset of strawberries collected in actual agricultural fields (12,040 images). We also introduce a synthetic dataset rendered in NVIDIA Isaac Sim, featuring scene-level realism and domain randomization. Nevertheless, our experiments reveal that a significant sim-to-real gap persists, underscoring the necessity of real agricultural field data for reliable evaluation. We further quantify the sim-to-real gap through baseline 6D pose estimation results across backbone encoders, serving as a reference for future work. The real-world dataset will be made available upon acceptance.

10.
arXiv (CS.CV) 2026-06-17

Effective Gaussian Management for High-fidelity Object Reconstruction

This paper proposes an effective Gaussian management framework for high-fidelity scene reconstruction of both appearance and geometry. Unlike recent Gaussian Splatting (GS) pipelines that treat all primitives uniformly during optimization, our framework explicitly manages the attribute activation, representation and pruning of Gaussian. Specifically, our framework first introduces GauSep, a novel densification strategy that selectively activates Gaussian color or normal attributes to alleviate destructive gradient conflicts arising from dual supervision. We further propose GauRep, an adaptive Gaussian representation that dynamically adjusts spherical harmonics (SHs) orders and performs task-decoupled pruning to reduce redundancy at both the individual and global levels. To provide reliable geometric supervision for above mangement process, we additionally introduce CoRe, an regularized surface reconstruction module that distills robust normal fields from an SDF branch to the Gaussian representation through a confidence mechanism. Notably, the proposed Gaussian management is compatible with various reconstruction architectures and can be seamlessly integrated to improve performance while reducing size of the model. Extensive experiments demonstrate that our approach achieves superior or comparable performance in appearance and geometry reconstruction compared with state-of-the-art methods, while using significantly fewer parameters.

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

MVAD: A Benchmark Dataset for Multimodal AI-Generated Video-Audio Detection

The rapid advancement of AI-generated multimodal video-audio content has raised significant concerns regarding information security and content authenticity. Existing synthetic video datasets predominantly focus on the visual modality alone, while the few incorporating audio are largely confined to facial deepfakes–a limitation that fails to address the expanding landscape of general multimodal AI-generated content and substantially impedes the development of trustworthy detection systems. To bridge this critical gap, we introduce the Multimodal Video-Audio Dataset (MVAD), the first comprehensive dataset specifically designed for detecting AI-generated multimodal video-audio content. Our dataset exhibits three key characteristics: (1) genuine multimodality with samples generated according to three realistic video-audio forgery patterns; (2) high perceptual quality achieved through diverse state-of-the-art generative models; and (3) comprehensive diversity spanning realistic and anime visual styles, four content categories (humans, animals, objects, and scenes), and four video-audio multimodal data types. Our dataset will be available at https://github.com/HuMengXue0104/MVAD.

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

Revisiting Structural Dependency in Autoregressive Multi-Task Table Recognition via Order-Independent Cell-Level Representations

Multi-task table recognition jointly addresses table structure prediction, cell localization, and cell content recognition within a unified framework. Existing approaches often rely on autoregressive decoders to generate table structures and reuse their hidden states for cell localization and content recognition. This autoregressive generation process can make cell representations order-dependent, degrading global consistency across cells. This paper proposes a structural refinement module that produces order-independent cell features through non-causal attention. This design enables parallel inference of cell contents while conditioning each cell on global context encoded in the refined features. Experiments on two large datasets demonstrate consistent gains in cell localization and end-to-end recognition, while reducing overall inference time by around threefold.

13.
medRxiv (Medicine) 2026-06-23

Changes in hierarchical brain dynamics of rumination following mindfulness-based cognitive therapy for depression

Major depressive disorder (MDD) is a leading cause of disability worldwide with risk of onset and recurrence linked to depressive ruminative thought patterns. Mindfulness-based cognitive therapy (MBCT) is an evidence-based treatment for depression that targets the ability to recognise, decenter, and disengage from ruminative thought patterns. Elucidating how MBCT impacts hierarchical brain organisation may be key to understanding the processes by which MBCT can modulate ruminative tendencies. In a randomised controlled functional magnetic resonance imaging (fMRI) trial on individuals with MDD (N=80) before and after MBCT in addition to treatment as usual (TAU), we investigated changes in hierarchical brain organisation during resting-state and rumination. We built whole-brain models to obtain generative connectivity (GEC) matrices per patient and quantified brain hierarchy by measuring the global directedness and regional trophic levels in each GEC, in which greater directedness reflects more directional information flow and less recurrence. Global directedness in MBCT+TAU compared to TAU increased during rumination, with no changes during resting-state. Furthermore, increased regional breadth of hierarchy during rumination was related to improvements in clinical and behavioural outcomes following MBCT+TAU. Increased brain hierarchy during rumination following mindfulness training may be consistent with a shift away from self-reinforcing negative mental loops towards more differentiated and less coupled cognitive and bodily cycles, supporting MBCT's ability to interrupt ruminative processes. Hierarchical brain dynamics may hold promise as a treatment-sensitive marker and a potential mechanism of therapeutic change in MBCT for depression.

14.
PLOS Computational Biology 2026-06-15

Fung-AI: An AI/ML-driven pipeline for antifungal peptide discovery

by Daniel S. Berman, Libby M. Lewis, Tom D. Curtis, Olivia N. Tiburzi, Daniel F. Q. Smith, Arturo Casadevall, Laura J. Dunphy Emerging fungal pathogens represent a concerning threat to both global health and food security. In this study, we aimed to address our rising vulnerability to fungal pathogens through the development of the Fung-AI pipeline: an AI/ML-driven approach for antifungal discovery. A generative adversarial network (GAN) was trained to generate novel candidate antifungal peptide sequences. Next, in silico antifungal and hemolytic classifiers were built to further prioritize AI-generated peptides for experimental validation. From a pool of ~10,000 candidates, thirteen peptides were selected for testing over two-stages of experimentation. Five peptides were found to display mild antifungal activity against the wheat pathogen, Fusarium graminearum, with minimal inhibitory concentrations (MICs) ranging from 250 µg/mL to 500 µg/mL. Four of the five peptides also showed activity against the human pathogen, Candida albicans (MIC: 500 µg/mL). Two of our AI-generated antifungal peptides additionally demonstrated low cytotoxicity in HepG2 human liver carcinoma cells (LC50 > 704.2 µg/mL) indicating that they may be useful as scaffolds for future optimization for therapeutic applications. None of our peptides were found to considerably inhibit the emerging pathogen C. auris, suggesting the need for pathogen-specific down-selection of candidate peptides. Overall, we present a proof-of-principle, generative-AI-based approach for the rapid design of de novo antifungal peptides.

15.
arXiv (quant-ph) 2026-06-12

Supersymmetry of dissipative Bose-Fermi systems with application to Jaynes-Cummings and Dicke models

arXiv:2606.12682v1 Announce Type: new Abstract: We demonstrate how supersymmetries of Hamiltonians for coupled Bose-Fermi systems can be used to place the Hamiltonians of the Jaynes-Cummings model and Dicke model under the rotating wave approximation in matrix form and provide explicit analytic solutions for their eigenvalues. We then use this supersymmetry to place the Liouvillians of the associated Markovian open systems in matrix form and provide explicit solutions for their eigenvalues. These results are a consequence of the fact that the Hamiltonian of the Jaynes-Cummings model commutes with the linear Casimir invariant of the superalgebra $u(1|1)$ and that the Hamiltonian of the Dicke model commutes both with the linear invariant of $\sum_{i} u_{i}(1|1)$ and with the invariant of an additional $su(2)$ algebra. Our methods apply to various coupled Bose-Fermi systems with $u(1|1)$ and more generally with $u(n|m)$ dynamical superalgebras, and may provide efficient tools for studying more complicated examples.

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

MILE: A Mechanically Isomorphic Hand Exoskeleton and Visuotactile Robotic Hand for Data Collection in Dexterous Manipulation

Dexterous robotic hands are expected to perform complex, contact-rich object manipulation, but learning such skills remains challenging because high-dimensional hands require high-fidelity demonstrations. Imitation learning provides a practical route for acquiring dexterous manipulation skills from human demonstrations, yet collecting synchronized multimodal demonstrations with accurate hand actions and tactile observations remains a key bottleneck. We present MILE, a teleoperation-based data-collection system comprising the human-first MILE exoskeleton and the mechanically corresponding MILE-Tac robotic hand. The system integrates custom-designed and fabricated modular joint encoders and compact MILE fingertip visuotactile sensor modules. The exoskeleton is informed by human-hand anatomy and ergonomic constraints, while the robotic hand is co-designed to preserve the selected four-finger kinematic topology. This correspondence enables joint-space command transfer and reduces reliance on task-space IK-based retargeting. The system synchronously records task-specific visual observations, four fingertip visuotactile streams, robot-hand proprioception, and exoskeleton-derived action commands. We evaluate MILE through a four-task teleoperation benchmark against representative glove-based and vision-based interfaces, and through imitation-learning experiments that compare policies trained with and without fingertip tactile input. The project page is available at https://sites.google.com/view/mile-system.

17.
arXiv (CS.AI) 2026-06-25

Velocity Prediction in Automatic Guitar Transcription

arXiv:2606.24912v1 Announce Type: cross Abstract: Automatic Music Transcription (AMT) models have achieved a high level of success in polyphonic transcription of various instruments. Velocity, typically a measure of note intensity, is less commonly predicted in these models due to the absence of velocity labels in available datasets and lack of a proper definition for instruments other than piano. We present a methodology and model for velocity prediction in Automatic Guitar Transcription (AGT) which uses virtual instruments to generate synthetic training data with velocity labels. We first pretrain a model on this synthetic data. These weights are then transferred to a different model and trained on real guitar audio, allowing the model to retain the working velocity prediction while also achieving high performance and generalisability from the real training data. The velocity prediction is shown to outperform a baseline model which does not use the pretrained velocity weights, when evaluated on synthetic data. In addition, using the pretrained velocity weights offers a small improvement in note transcription, though the magnitude of this improvement is limited and not always significant depending on the testing data. Overall the model achieves results comparable to the state of the art in guitar transcription, while also successfully predicting velocity.

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

CausalMotion: Structured Physical Reasoning as Keyframe and Trajectory Guidance for Training-Free Video Generation

Recent advances in diffusion-based video generation have significantly improved visual quality and short-term temporal coherence. However, existing methods still struggle to produce videos with physically consistent and causally plausible dynamics, especially in scenarios involving long-horizon interactions. This limitation arises from the fact that video diffusion models primarily learn physical consistency implicitly, while vision-language models can directly model physical laws. Based on this idea, in this work, we propose CausalMotion, a training-free framework that injects explicit physical reasoning into video generation through structured intermediate representations. Our key idea is to decouple reasoning from generation by leveraging a vision-language model to decompose a text prompt into a sequence of causally consistent keyframes and object-centric motion trajectories. These representations are then aligned and integrated as soft constraints to guide a pretrained video diffusion model during inference. This design enables explicit modeling of object dynamics and causal transitions without requiring additional training or supervision. Extensive experiments show that our method consistently improves physical plausibility and temporal coherence, particularly in dynamics-intensive scenarios, while maintaining high perceptual video quality.

20.
arXiv (CS.CL) 2026-06-25

Beyond Function Calling: Benchmarking Tool-Using Agents under Tool-Environment Unreliability

Large language models are increasingly deployed as agents that solve tasks by interacting with external tool environments. Although recent tool-use benchmarks increasingly cover complex task settings, they still largely assume clean, stable, and trustworthy tool environments, leaving tool-environment unreliability insufficiently examined. We introduce ToolBench-X, a benchmark for evaluating agents under recoverable reliability hazards. ToolBench-X contains executable multi-step tasks across diverse domains and sequential, parallel, and mixed workflows, each paired with deterministic tools and a canonical final answer for automatic evaluation. Starting from clean tool environments, ToolBench-X injects five structured hazard types: Specification Drift, Invocation Error, Execution Failure, Output Drift, and Cross-source Conflict. Crucially, each injected instance remains solvable through at least one valid recovery path, such as retrying, fallback, verification, or cross-checking. Experiments reveal a substantial reliability gap: agents that perform well with reliable tools often fail under recoverable hazards. Further analysis shows that failures are driven less by tool-use volume or inference budget than by limited hazard diagnosis and ineffective recovery. Targeted recovery hints recover many failed tasks, while test-time scaling yields more limited gains. These results suggest that tool-use evaluation should move beyond function-call accuracy toward task completion under unreliable tool environments. The code and data is available at https://github.com/Foreverskyou/ToolBench-X.

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

Minimal Oversight: Uncertainty-Aware Governance for Delegated AI Systems

arXiv:2606.15563v1 Announce Type: new Abstract: AI systems increasingly delegate decisions to specialized models, evaluators, tools, and supervisory controllers. The central AI problem is no longer only model accuracy, but uncertainty-aware governance: how much autonomy to grant, which evidence should calibrate trust, what performance ceiling a delegated AI system can sustain, and when human intervention becomes necessary. We propose the Minimum Sufficient Oversight Principle (MSO), a variational principle for principled autonomy delegation: minimize governance burden on the Fisher information manifold subject to a delivery constraint. The resulting Euler-Lagrange solution yields a water-filling allocation of governed delegation across the task space. Building on a revealed-action governed delegation channel model, we prove a capacity theorem for stationary symbolwise review policies, derive a local first-order approximation relating workflow complexity to quality degradation, and give a drift-dominated autonomy-time scaling law linking intervention timing to effective capacity, complexity, and drift. Within this framework, masking appears as a structural AI-governance pathology: corrected performance can hide the competence signal needed to calibrate trust. Synthetic simulations and a semi-real reconstructed workflow support design prescriptions including upstream-first correction, sensitivity-based intervention, and explicit feasibility checks before autonomy is expanded. The result is a computable framework for uncertainty, planning, and oversight in delegated AI systems. A companion Python package is available at https://github.com/crbazevedo/delegation-lab.

22.
arXiv (CS.LG) 2026-06-15

Denoising Score Matching with Random Features: Insights on Diffusion Models from Precise Learning Curves

arXiv:2502.00336v3 Announce Type: replace Abstract: We theoretically investigate the phenomena of generalization and memorization in diffusion models. Empirical studies suggest that these phenomena are influenced by model complexity and the size of the training dataset. In our experiments, we further observe that the number of noise samples per data sample ($m$) used during Denoising Score Matching (DSM) plays a significant and non-trivial role. We capture these behaviors and shed insights into their mechanisms by deriving asymptotically precise expressions for test and train errors of DSM under a simple theoretical setting. The score function is parameterized by random features neural networks, with the target distribution being $d$-dimensional Gaussian. We operate in a regime where the dimension $d$, number of data samples $n$, and number of features $p$ tend to infinity while keeping the ratios $\psi_n=\frac{n}{d}$ and $\psi_p=\frac{p}{d}$ fixed. By characterizing the test and train errors, we identify regimes of generalization and memorization as a function of $\psi_n,\psi_p$, and $m$. Our theoretical findings are consistent with the empirical observations.

23.
arXiv (CS.CV) 2026-06-18

PEFT-MedSAM: Efficient Fine-Tuning of Medical Foundation Models for Explainable Skin Lesion Segmentation

Automated segmentation of skin lesions using deep learning models for dermoscopic images can be very helpful in finding melanomas earlier than they would normally be detected. However, most deep learning methods available do not perform well. The aim of this paper is to present a parameter-efficient fine-tuning method called PEFT-MedSAM for adapting the Medical Segment Anything Model (MedSAM) to automatically segment dermoscopic skin lesions. The PEFT-MedSAM method uses only the lightweight mask decoder for training the model while keeping the pre-trained image encoder and prompt encoder frozen. The experiments performed on the ISIC 2018 benchmark dataset shows that PEFT-MedSAM obtains a dice coefficient of .9411 and an intersection over union value of .8918 when compared to both a fully trained U-Net baseline (.8715 dice coefficient) and zero-shot MedSAM inference (.8997 dice coefficient). The external validation of the model using PH2 dataset shows .9467 dice coefficient with +/- .0310 standard deviation. Supportive evidence for these claims include a p-value less than .0001 for Wilcoxon signed rank tests comparing the two datasets and bootstrap-estimated 95% confidence intervals of [.9364,.9447] that represent the estimated range of possible values for the average dice coefficient obtained by repeating the test. To increase clinical trustworthiness, we used Grad-CAM explainability along with a pointing game based evaluation methodology to evaluate the CNN baseline model on the validation set. The results showed that we had an accuracy rate of 98.27% on the validation set of 519 images and confirmed that the model classified regions containing skin lesions.

24.
medRxiv (Medicine) 2026-06-24

Differential COVID-19 Outcomes Across Lysosomal Disorders

Background Lysosomal disorders (LDs) are a heterogeneous group of rare inherited disorders characterized by multi-system involvement and high comorbidity burden, which raises concerns about severe COVID-19 outcomes. Conversely, because SARS-CoV-2 relies on endolysosomal pathways for cellular entry and replication, certain LDs may exert a protective effect against viral pathogenesis. Prior clinical evidence investigating LDs and severe SARS-CoV-2 infection has been limited by small sample sizes and inconsistent findings. Therefore, to resolve these conflicting biological hypotheses and estimate population-level outcomes, we conducted a large-scale retrospective cohort study using nationwide U.S. harmonized electronic health record data from the National Clinical Cohort Collaborative (N3C). This design utilized longitudinal records starting January 1, 2018, to evaluate COVID-19 infections captured between January 1, 2020, and July 11, 2024. Results The study included 16,380 individuals, comprising 5,460 patients with lysosomal disorders and 10,920 matched controls. Patients with LDs had significantly higher odds of COVID-19 hospitalization compared with controls (OR = 1.86, 95% CI: 1.70-2.04). Elevated odds were observed across the evaluated categories, but varied substantially. Notably, neurodegenerative LDs such as neuronal ceroid lipofuscinosis (OR = 9.32) and metachromatic leukodystrophy (OR = 2.33) remained associated with hospitalization after adjustment for comorbidities. Contrarily, the elevated odds for Fabry disease and Gaucher disease were no longer significant after adjustment. Mortality among hospitalized patients with LDs was comparable to that of matched controls (one-year survival: 82.1% vs 82.0%), suggesting that LD status does not independently worsen survival once hospitalization occurs. Conclusions Patients with LDs were at an increased odds of COVID-19 hospitalization, driven by a combination of elevated comorbidity burden and disorder-specific effects, which vary significantly across LD categories. This study clarifies that excess risk is concentrated in the transition to hospitalization. These patients may thus require personalized clinical care to mitigate the negative consequences of COVID-19.

25.
medRxiv (Medicine) 2026-06-18

Cost analysis of overseas versus domestic vaccination of US-bound refugees

Context: To ensure healthy resettlement and protect US health security, the Vaccination Program for US-bound Refugees (VPR) offers some recommended vaccines to refugees overseas before resettlement to the United States. The selected vaccines and number of doses vary by country of departure. VPR was found to be cost-saving in 2018 but had since expanded to more sites. Objective: Assess VPR's current costs and impact on post-arrival domestic vaccination needs and costs. Setting and Participants: A model-based analysis of the Federal government costs for VPR and post-arrival (US) vaccination of resettled refugees separated across five regions: Africa, Asia, the Middle East and North Africa/Republic of Turkiye and Middle East, Europe, and the Americas using fiscal year 2024 data. Design: We quantified and compared full vaccination costs for refugees under two scenarios: (1) 'No VPR' and (2) 'VPR'. Refugees would receive no vaccines overseas and be fully vaccinated after US arrival under 'No VPR'. Under 'VPR', refugees receive one or two doses of selected vaccines overseas before completing vaccination schedules after arrival. Main Outcomes: Costs were reported in 2023 US dollars for 'VPR' and 'No VPR' scenarios and further subdivided by grouping countries/sites depending on whether the International Organization for Migration (IOM) provides vaccination services for refugees (IOM sites) versus non-IOM providers (non-IOM sites). Results: 'VPR' resulted in average net cost savings of $147 per person or $14.7 million per 100,000-refugee cohort compared to providing all vaccines after US arrival ('No VPR'). 'VPR' was cost-saving across most regions, except for IOM sites in Europe, where a net cost of $44 per person was observed. Net cost savings per person were highest for IOM sites in Africa ($333). Conclusions: VPR remains a cost-saving strategy, while protecting US-bound refugees' health and US health security by preventing disease outbreaks during resettlement.