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

M{\o}lmer-S{\o}rensen gates in trapped-ions chains in the presence of correlated noise

arXiv:2606.23951v1 Announce Type: new Abstract: We analyze the impact of correlated laser frequency noise on M{\o}lmer-S{\o}rensen gates in qubit registers based on trapped-ion chains. Using perturbation theory, we calculate gate fidelities in the presence of noise with arbitrary power spectral density for different chain lengths and ion positions in the chain. With our approach, we account for simultaneous excitation of multiple phonon modes during gate operation. We find out that the impact of medium-frequency laser noise depends considerably on the positions of the ions in the chain. In contrast, low-frequency noise has similar effect for different chain lengths and ion positions.

02.
arXiv (CS.AI) 2026-06-18

A Distributionally Robust Reinforcement Learning Framework for Constrained Urban EV Dispatch

arXiv:2604.25848v2 Announce Type: replace Abstract: We study city-scale control of electric-vehicle (EV) ride-hailing fleets where dispatch, repositioning, and charging decisions must respect charger and feeder limits under uncertain, spatially correlated demand and travel times. We formulate the problem as a hex-grid semi-Markov decision process (semi-MDP) with mixed actions – discrete actions for serving, repositioning, and charging, together with continuous charging power – and variable action durations. To guarantee physical feasibility during both training and deployment, the policy learns over high-level intentions produced by a masked, temperature-annealed actor. These intentions are projected at every decision step through a time-limited rolling mixed-integer linear program (MILP) that strictly enforces state-of-charge, port, and feeder constraints. To mitigate distributional shifts, we optimize a Soft Actor-Critic (SAC) agent against a Wasserstein-1 ambiguity set with a graph-aligned Mahalanobis ground metric that captures spatial correlations. The robust backup uses the Kantorovich-Rubinstein dual, a projected subgradient inner loop, and a primal-dual risk-budget update. Our architecture combines a two-layer Graph Convolutional Network (GCN) encoder, twin critics, and a value network that drives the adversary. Experiments on a large-scale EV fleet simulator built from NYC taxi data show that PD-RSAC achieves the highest net profit, reaching \$1.22M, compared with \$0.58M-\$0.70M for strong heuristic, single-agent RL, and multi-agent RL baselines, including Greedy, SAC, MAPPO, and MADDPG, while maintaining zero feeder-limit violations.

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

Pretraining A Large Language Model using Distributed GPUs: A Memory-Efficient Decentralized Paradigm

Pretraining large language models (LLMs) typically requires centralized clusters with thousands of high-memory GPUs (e.g., H100/A100). Recent decentralized training methods reduce communication overhead by employing federated optimization; however, they still need to train the entire model on each node, remaining constrained by GPU memory limitations. In this work, we propose SParse Expert Synchronization (SPES), a memory-efficient decentralized framework for pretraining mixture-of-experts (MoE) LLMs. SPES trains only a subset of experts per node, substantially lowering the memory footprint. Each node updates its local experts and periodically synchronizes with other nodes, eliminating full-parameter transmission while ensuring efficient knowledge sharing. To mitigate limited per-expert data utilization under sparse expert updates, we introduce an expert-merging warm-up strategy, where experts exchange knowledge early in training, to rapidly establish foundational capabilities. With SPES, we train a 2B-parameter MoE LLM using 16 standalone 48GB GPUs over internet connections, which achieves competitive performance with centrally trained LLMs under similar computational budgets. We further demonstrate scalability by training a 7B model from scratch and a 9B model upcycled from a dense checkpoint, both of which match prior centralized baselines. Our code is available at https://github.com/zjr2000/SPES.

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

UOL@IDEM at BEA 2026 Shared Task 1: Neural Fusion and Feature-Rich Modeling for L1-Aware Vocabulary Difficulty Prediction

This paper describes UOL@IDEM's closed-track submission to the BEA 2026 shared task on L1-aware vocabulary difficulty prediction. We model the task as regression and train separate systems for Spanish, German, and Mandarin Chinese\footnote{Below we use Chinese for brevity.}. Our system combines multilingual contextual representations with engineered features capturing frequency, surface form, retrieval evidence, semantic alignment, cognate similarity, and masked-language-model predictability. Development results show consistent gains over the official closed-track baselines, with sentence-embedding encoders such as BGE-M3, multilingual E5, and LaBSE performing best. Official submissions achieve RMSE scores of 1.132, 1.037, and 0.891 for Spanish, German, and Chinese, respectively. Feature analysis identifies frequency as the most stable predictor, while contextual predictability, form similarity, retrieval, and semantic features provide complementary L1-sensitive signals. Error analysis shows strong ranking performance but weaker calibration for the easiest items, which are often overpredicted. See https://github.com/Nouran-Khallaf/UoL-IDEM-BEA2026-Vocabulary-Difficulty-Prediction

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

Plan, Don't Pose: Long Composite Motion Generation with Text-Aligned BFM

arXiv:2605.29906v2 Announce Type: replace Abstract: Text-to-motion (T2M) generation has broad applications in character animation, virtual avatars, and human-robot interaction. Existing methods typically generate pose trajectories or motion tokens directly from language, forcing a single model to handle semantic interpretation, long-horizon structure, and low-level physical realization. This coupling makes them costly and often unreliable for long, compositional, or semantically dense prompts. We propose Text2BFM, the first framework that aligns natural language with pretrained Behavioral Foundation Models (BFMs) for T2M generation without relying on heavy end-to-end motion generators. Text2BFM operates in the latent policy space of a frozen BFM, using it as an executable motion prior. A text-aligned variational behavioral bottleneck compresses BFM policy-latent sequences into compact motion representations that are compatible with language and preserve long-horizon behavioral structure. Generation is performed in this compact behavioral manifold with a lightweight conditional generator, and the resulting latent encoded behaviors are decoded into policy latents that drive the pretrained frozen BFM. By decoupling semantic planning from motion execution, Text2BFM achieves efficient, robust T2M generation and strong performance on long, compositional textual descriptions.

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

Evaluating Large Language Models Abilities for Addressee, Turn-change, and Next Speaker Prediction in Meetings

We investigate turn-taking in multimodal multi-party conversations using large language models (LLMs). We construct an evaluation framework for three tasks: addressee detection, turn-change prediction, and next speaker prediction. We compare supervised models trained for these tasks, text-based LLMs, multimodal LLMs (MM-LLMs), and human subjects. Experiments on the AMI corpus showed that LLMs outperformed supervised models and humans in next speaker prediction, despite not being trained on the target domain and without access to audio or visual information. An MM-LLM performed better than text-based LLMs on addressee detection and turn-change prediction but remained below human performance, indicating difficulty leveraging raw audio-visual signals. Ablation analyses revealed that conversational context was critical, particularly for next speaker prediction. We observed that human and LLM prediction patterns were similar, and intervals with frequent turn changes were difficult for both.

07.
arXiv (CS.CL) 2026-06-19

MiqraBERT: Regression-Based Sentence-BERT Finetuning for Biblical Hebrew Parallel Detection

Textual reuse pervades the Hebrew Bible, yet the computational methods used to detect it still rest largely on lexical overlap, and they falter once a parallel involves paraphrase, lexical substitution, or syntactic reworking. This paper introduces MiqraBERT, a Sentence-BERT model finetuned from AlephBERT (a Modern Hebrew encoder) for verse-level semantic similarity in Biblical Hebrew. The training set comprises 1,650 labeled verse and half-verse pairs: 825 true parallels drawn from the Chronicles synoptic material and from foundational studies of poetic parallelism, balanced against 825 randomly sampled negatives. Through cosine-similarity regression, the model learns an embedding space in which parallel verses cluster together and unrelated verses move apart. We evaluate separation with distribution-based metrics, Wasserstein distance and the overlap coefficient, across ten random seeds. MiqraBERT improves distributional separation 2.7-fold over the pre-trained baseline and reduces the ambiguous overlap region from roughly 24% to about 6%. Narrative synoptic parallels reach a recall@10 of 87.1%; poetic parallels remain difficult, below 9%. This genre-dependent asymmetry confines the model's reliable scope to narrative textual reuse. MiqraBERT is publicly available at https://huggingface.co/davidmsmiley/MiqraBERT

08.
arXiv (CS.AI) 2026-06-18

SafeClawBench: Separating Semantic, Audit-Evidence, and Sandbox Harm in Tool-Using LLM Agents

arXiv:2606.18356v1 Announce Type: cross Abstract: Tool-using language-model agents introduce security failures that go beyond unsafe text: they can disclose protected objects, write persistent memory, send messages, modify databases, or trigger harmful code and tool effects. Existing evaluations often collapse these stages into a single attack success rate, making it difficult to tell whether a model merely agreed with an attacker or actually produced observable harm. We introduce SafeClawBench, a staged benchmark for tool-using agent security with 600 controlled adversarial tasks across six attack families: direct and indirect prompt injection, tool-return injection, memory poisoning, memory extraction, and ambiguity-driven unsafe inference. SafeClawBench reports three separate endpoints: semantic attack acceptance, audit-visible harm evidence, and sandbox-observed tool/state harm. Evaluating five agent endpoints under four prompt-level policies, we find that these endpoints capture different failure modes. Without additional prompt protection, semantic failure rates vary widely across models, from 9.0% to 44.2%. Audited harm evidence is narrower than semantic failure, and under a separate executable protocol some matched task identities produce sandbox harm despite passing the Semantic Core call: in a 12,000-row matched analysis, 291 of 347 observed sandbox harms occur in rows that pass the semantic check. Prompt policies change endpoint outcomes, but their effects depend on both model and protocol. SafeClawBench provides a reproducible framework for comparing agent models and prompt-policy conditions without conflating textual compliance, evidence-supported harm, and executable state changes. The open-source dataset is available at https://huggingface.co/datasets/sairights/safeclawbench.

09.
arXiv (CS.AI) 2026-06-24

HOLMES: Evaluating Higher-Order Logical Reasoning in LLMs

arXiv:2606.23238v2 Announce Type: replace Abstract: Logical reasoning is essential for reliable AI, yet existing benchmarks are largely first-order-logic-centric, focusing on object-level deduction over fixed predicates. This misses many realistic scenarios where models must reason over rules, predicates, functions, constraints, and decision procedures themselves. We introduce HOLMES (Higher-Order Logic Meets real-world Explainable Symbolic reasoning), the first real-world benchmark for higher-order symbolic reasoning in LLMs, containing 1379 instances. Built on higher-order logic, HOLMES pairs natural-language problems with HOL formalizations, ground-truth answers, verifiable reasoning traces, and fine-grained controllable reasoning factors across law and finance. Experiments show that current LLMs still struggle on HOLMES, with an average accuracy of only 50.64% and the best model reaching 59.54%. Our analyses further reveal that high final-answer accuracy can mask shortcut reasoning in conflict-resolution settings, while performance drops sharply under scope-conditioned and compositional reasoning. These findings identify higher-order symbolic reasoning as a key bottleneck for building reliable and verifiable LLMs. The project code and dataset are publicly available at https://github.com/wuyucheng2002/HOLMES.

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

Closed-loop discovery of out-of-distribution processing protocols by evolutionary search and uncertainty-aware learning

arXiv:2606.13859v1 Announce Type: cross Abstract: Many materials and chemical systems exhibit history-dependent responses, where functional outcomes are governed not only by final-state variables but by the time-dependent sequence of fields, temperatures, or chemical potentials applied during operation. Discovering new processing protocols is therefore a high-dimensional search problem in which the control variable is an entire waveform or sample history, and conventional strategies either remain confined to conservative interpolative families or become prohibitively measurement intensive. Here, a closed-loop workflow is introduced that couples evolutionary search over a compact waveform representation with uncertainty-aware deep kernel learning to generate, rank, and experimentally validate candidate protocols. Applied to ferroelectric thin films, with the scanning-probe tip-bias waveform as the protocol and the nonlinear electromechanical response as the reward, the workflow discovers waveform families that enhance nonlinearity by de-aging the film. Spatially resolved before/after measurements show that the best-performing waveforms selectively activate pre-existing, weakly pinned domain-wall segments, whereas the worst drive long-range irreversible switching. This framework reframes protocol tuning as out-of-distribution discovery, generalizable to synthesis and annealing trajectories, battery formation protocols, and other high-dimensional control problems.

11.
Nature (Science) 2026-06-10

Light slows down carbon nanotubes in water

Water-suspended carbon nanotubes move more slowly in green light, suggesting that excited electrons in the tubes couple to the water through ‘quantum friction’. Water-suspended carbon nanotubes move more slowly in green light, suggesting that excited electrons in the tubes couple to the water through ‘quantum friction’.

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

A Survey on Long-Term Memory Security in LLM Agents: Attacks, Defenses, and Governance Across the Memory Lifecycle

The emergence of writable, cross-session persistent memory in LLM agents introduces a qualitatively different threat landscape from conventional input-centric security concerns, characterized by three properties: persistence, statefulness, and propagation. To systematically characterize this landscape, we propose a Memory Lifecycle Framework that organizes attacks, defenses, and their cross-phase dependencies along two axes: six lifecycle phases (Write, Store, Retrieve, Execute, Share & Propagate, Forget & Rollback) and four security objectives (Integrity, Confidentiality, Availability, Governance). This analysis in turn exposes the need for formal security guarantees at the system level, motivating Verifiable Memory Governance(VMG), a framework of five architectural primitives that specifies what verifiable mechanisms a long-term-memory system must provide to maintain auditable, recoverable control over its memory state. Our analysis indicates that robust Long-Term Memory (LTM) security cannot be retrofitted at retrieval or execution time alone, but must be anchored in storage-time provenance, versioning, and policy-aware retention from the outset.

13.
arXiv (math.PR) 2026-06-19

Establishing an $\Omega(\sqrt{d})$ complexity lower bound for PDMP samplers and how to break it: a sub-$\sqrt{d}$ algorithm for Gaussian-tailed targets

arXiv:2606.19909v1 Announce Type: cross Abstract: Despite the theoretical appeal of their non-reversibility, to date, no Piecewise Deterministic Markov Process (PDMP) samplers have been developed that scale better than $\mathcal{O}(\sqrt{d})$ in computational complexity with respect to the target dimension $d$. We prove that this is a fundamental limitation by establishing an $\Omega(\sqrt{d})$ lower bound on the algorithmic complexity of PDMP samplers in a standard setup. By relaxing the assumption that the target density must remain invariant at all continuous times, we then demonstrate how to bypass this barrier. Specifically, we introduce a novel PDMP sampling scheme and show that it achieves an empirical complexity of $\mathcal{O}(d^\alpha)$, where $\alpha \in [0.2, 0.3]$ for Gaussian-tailed targets. In addition, this PDMP scheme is locally adaptive in both trajectory length and distance between velocity updates.

14.
arXiv (CS.CV) 2026-06-11

Wild3R: Feed-Forward 3D Gaussian Splatting from Unconstrained Sparse Photo Collection

Feed-forward 3D Gaussian Splatting (3DGS) removes the need for time-consuming per-scene optimization required by traditional 3DGS. However, existing feed-forward approaches struggle with real-world photo collections that include diverse lighting conditions and transient objects. In this paper, we present Wild3R, a feed-forward approach for unconstrained sparse photo collections. The main bottleneck is the lack of training data that provides multiple viewpoints, a variety of illuminations, and transient variations necessary for learning robust scene representations. To address this, we introduce the WildCity dataset, which comprises 200 scenes, 170 lighting conditions, and transient objects, resulting in 337,500 images in total. By leveraging the dataset, our model learns appearance consistency across viewpoints conditioned on reference views, while removing transient content. Extensive experiments demonstrate that our method outperforms existing feed-forward approaches and achieves results competitive with prior per-scene optimization-based methods.

15.
arXiv (CS.AI) 2026-06-24

On the Smallness of the Large Language Models Scaling Exponents

arXiv:2606.24504v1 Announce Type: new Abstract: We discuss reasons why the scaling exponents of current Large Language Models (LLMs) applications are indicating an unsustainable regime in terms of energy resources. We further show that attributing the smallness of such exponents to a numerical bias due to the neglect of a non-zero value of the loss function in the limit of infinite data (``pedestal effect") does not remove the unsustainability issue. Finally, the effects of the smoothness (roughness) of the data on the scaling exponents is commented upon based on an analogy with phenomenological models of fluid turbulence.

16.
PLOS Computational Biology 2026-06-05

StPedf: Cell trajectory inference of spatial transcriptomics via spatial proximity embedding and spatial density-adaptive fusion

Authors:

by Yuan Zhang, Ziyan Sun, Zhixin Shi, Mengdi Nan, Yuhan Fu, Qing Ren, Jie Gao Spatial transcriptomics is transforming our multidimensional understanding of cellular spatial organization and its functional mechanisms in processes such as development and disease by systematically resolving the spatial heterogeneity of gene expression within tissues. To delve deeper into the dynamic processes underlying spatial expression patterns, spatial trajectory inference integrates genetic and spatial information to reconstruct the spatial developmental trajectories of cells within tissues. This approach reveals the patterns of differentiation and dynamic changes as cellular states evolve continuously along spatial axes. However, existing methods often struggle to uniformly model the complex, nonlinear interactions between high-dimensional gene expression and spatial coordinates. Here, we introduce StPedf, whose core lies in employing a neural network with a masking mechanism to capture complex nonlinear interactions between high-dimensional genes and spatial positions. It further leverages spatial proximity information as a guiding cue, dynamically and adaptively adjusting the embedding of gene and spatial information and the weighting of spatial proximity information based on spatial density. This enables trajectory inference guided by spatial information. This enables optimal transport to derive intercellular transition matrices, reconstruct cellular differentiation trajectories, and construct pseudo-spatiotemporal maps. StPedf demonstrates superior performance over existing methods on five structurally distinct simulated datasets. Using StPedf, we successfully mapped distinct lineages in the spatial trajectories of telencephalon regeneration in the Ambystoma mexicanum, multiple malignant lineages expanding within primary tumors, and developmental spatial trajectories and pseudo-spatiotemporal maps in human dorsolateral prefrontal cortex (DLPFC). StPedf significantly enhances the accuracy and interpretability of spatial trajectory inference, providing critical technical support for revealing the dynamic patterns of cellular fate transitions within tissue microenvironments.

17.
arXiv (CS.AI) 2026-06-11

nD-RoPE: A Generalized RoPE for n-Dimensional Position Embedding

arXiv:2606.12146v1 Announce Type: cross Abstract: Rotary Position Embedding (RoPE) is widely adopted in Transformer models, yet its extension to high-dimensional domains lacks a unified theoretical formulation. Most existing approaches either apply rotations independently along each axis or empirically mix frequencies, which limits cross-dimensional interactions and yields direction-dependent representations. To address these limitations, we propose nD-RoPE, a decomposition-free generalization of RoPE to arbitrary dimensions. From a translation-invariant formulation in continuous Hilbert space, we derive a spectral condition for isotropy that requires treating positions and frequencies as coupled \(n\)-dimensional vectors. We instantiate this formulation with a multi-scale regular-simplex wave-vector design, which provides non-degenerate spatial coverage and a symmetric, directionally balanced second-order response. Experiments across images, videos, and point clouds demonstrate consistent performance gains and improved generalization in high-dimensional settings.

18.
arXiv (CS.CL) 2026-06-12

Small LLMs for Biomedical Claim Verification: Cost-Effective Fine-Tuning, Structural Dataset Shortcuts, and Cross-Domain Generalization

Authors:

Large Language Models such as GPT-4o and GPT-5 achieve strong zero-shot performance on biomedical claim verification, but cost and opacity limit scalable use. We fine-tune three small LLMs: Phi-3-mini (3.8B), Qwen2.5-3B, and Mistral-7B, via QLoRA on SciFact and HealthVer, providing the first study of QLoRA models against GPT-4o and fine-tuned BioLinkBERT encoders. Mistral-7B QLoRA surpasses both GPT-4o and GPT-5 (up to 12% F1 gain) at a fractional cost using just 1,008 training examples. We conduct extensive in-domain and cross-domain evaluation: models trained on SciFact tested on HealthVer and vice versa, at matched sizes to isolate dataset structure from data quantity. We identify a previously unreported structural artifact in SciFact that inflates in-domain scores, and show through bidirectional out-of-domain evaluation that training on structurally sound data enables robust cross-domain transfer. We plan to release all code and adapter checkpoints.

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

ScaleToT: Generalizing Structured LLM Reasoning for Billion-Scale Low-Activity User Modeling

arXiv:2606.24605v1 Announce Type: new Abstract: Accurate user modeling often depends on rich interaction histories, which are unavailable for billions of low-activity users. Large Language Models (LLMs) can infer latent user states from static profiles, but this reasoning becomes unreliable when profiles are sparse, and applying an LLM to billions of users is prohibitively expensive. We present ScaleToT, which learns structured reasoning from a small LLM-processed subset and extends it to the broader low-activity user population. To improve reasoning reliability, ScaleToT constructs typed user-state chains with a bounded entropy-guided Tree-of-Thought (ToT) refinement procedure. To make this structured reasoning usable from sparse profiles, the teacher-curated chains are used to train a student model on static profiles through supervised fine-tuning (SFT) and Outcome-Driven Segment-Aware Implicit Reward Policy Optimization (OSIPO). ScaleToT then transfers the student's reasoning representations to a lightweight profile encoder, providing shared reasoning signals for the remaining users without LLM inference. We evaluate ScaleToT on lifetime value (LTV) prediction in a billion-scale advertising deployment. A randomized online A/B test increased LT30 by 6.738\%, while offline reasoning covered only 7.32\% of the potential population, greatly reducing compute cost compared with full-population reasoning.

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

Non-Autoregressive Minimum Bayes' Risk Decoding for Fast Speech Recognition

Non-autoregressive (NAR) decoding generates output tokens in parallel, making speech recognition faster than autoregressive decoding, which generates them sequentially from left to right. However, the recognition performance is degraded because NAR decoding cannot resolve uncertainty by conditioning on previously generated tokens. To address this issue, we propose a novel NAR decoding framework based on minimum Bayes' risk (MBR) decoding, termed NAR-MBR decoding, that maximizes the expected utility calculated from samples drawn from the output probability of an NAR model rather than maximizing the output probability. Notably, by leveraging the nature of NAR models, multiple samples are obtained efficiently with a single forward computation. Our experiments across LibriSpeech, Switchboard, AMI, and web presentation corpus demonstrated that our NAR-MBR decoding outperformed previous NAR decoding and ran faster than AR decoding.

21.
medRxiv (Medicine) 2026-06-15

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

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

22.
medRxiv (Medicine) 2026-06-22

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

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

23.
medRxiv (Medicine) 2026-06-10

Impact of Early Treatment on Symptom Improvement and Procedural Events among Men with BPH and Bothersome Lower Urinary Tract Symptoms: A Contemporary Analysis of the American Urological Association Quality (AQUA) Registry

PURPOSE: As the armamentarium of BPH therapies continues to expand, it remains imperative to maximize patient satisfaction and minimize decisional regret. We sought to determine the impact of time from BPH diagnosis to index treatment on symptom improvement and subsequent procedural events. MATERIALS AND METHODS: We queried the American Urological Association Quality Registry for men [&ge;] 40 years old with BPH, available IPSS data, and no receipt of prior BPH treatment. Index treatment included medication, surgery, or minimally invasive surgical therapy (MIST). Outcomes included IPSS over 3 years of follow-up, change in percentage of mild lower urinary tract symptoms (LUTS) by 3 months, and time to procedural event. Patients were stratified by time from index diagnosis to treatment by 3 years. Outcomes were compared across time-to-treatment cohorts with appropriate statistical tests with p < 0.05 as significant. RESULTS: 43,919 patients met criteria with 19,642 pursuing treatments. Patients pursued treatment at comparably lower baseline IPSS compared to prior prospective series. Patients undergoing surgery and MIST had significantly higher baseline IPSS, while medical comorbidities were significantly more common among men initiating pharmacotherapy. Early surgery and MIST were associated with significant improvement in IPSS within 6-12 months and an increase in mild LUTS by 3 months. All forms of early treatment were associated with delayed time to procedural events, including catheterization and fulguration. CONCLUSIONS: Early procedural intervention for BPH is associated with early symptom improvement and delayed time to procedural events among real-world, contemporary practice.

24.
medRxiv (Medicine) 2026-06-22

AI-Assisted Longitudinal Analyses of Environmental and Psychosocial Determinants of Subjective Cognitive Difficulties

Authors:

Short-term environmental exposures have been linked to cognitive and behavioral outcomes, although many reported associations may reflect broader geographic and contextual differences. Using longitudinal data from the All of Us Research Program (2018–2024), we linked daily weather and air-pollution exposures to repeated attention-related and subjective cognitive outcomes. Associations were evaluated using pooled, fixed-effects, lagged, and event-study analyses. Additional machine-learning analyses were conducted to explore potential heterogeneity and latent psychosocial structure. Replication analyses were performed using the 2024 Behavioral Risk Factor Surveillance System (BRFSS). Several environmental exposure measures showed small associations with cognitive outcomes in pooled analyses, but most attenuated substantially after accounting for within-location temporal variation. Mediation, sensitivity, and machine-learning analyses yielded similar conclusions. In contrast, mental-health burden, loneliness, and social functioning were consistently associated with subjective cognitive difficulty and exhibited substantially larger effect sizes than environmental exposures. Similar patterns were observed in BRFSS. Exploratory AI-assisted analyses yielded findings broadly consistent with the primary longitudinal analyses. These findings suggest that short-term environmental perturbations may have limited associations with cognitive outcomes after accounting for within-location variation, whereas psychosocial factors appear to be more consistently associated with subjective cognitive burden.

25.
arXiv (CS.AI) 2026-06-24

A Simplex Witness Certificate and Escape Force for Constant Collapse in Variational Autoencoders

arXiv:2605.18224v4 Announce Type: replace-cross Abstract: We study exact constant collapse in variational autoencoders: the deterministic encoder mean becomes independent of the input. The prior remains the standard Gaussian. Before VAE training, we select a fixed teacher posterior from a GMM-based view of the data and attach a fixed latent-only simplex witness to the encoder mean. This construction yields two linked objects. The first is a certificate: if the witness prediction improves on the best constant predictor of the teacher, the encoder mean cannot be input-independent constant. The second is a local escape direction: on the collapsed manifold, the teacher residual gives a sample-dependent descent direction for the alignment loss. For any full-support teacher posterior, the same geometry also gives a closed-form latent code with zero teacher-witness alignment error. Its scaled versions trace a margin-energy path from the constant predictor to the exact teacher code, which quantifies non-collapse inside the protected witness subspace. We instantiate the method on MNIST, CIFAR-10, and CIFAR-100. With searched unsupervised PCA-GMM teachers, vanilla VAEs fail the teacher-witness certificate in all five seeds on CIFAR-10 and CIFAR-100, while RST variants pass in all five seeds. Under collapse-stress settings with \(\beta_{\mathrm{KL}}\in\{2,4,8\}\), vanilla VAE again fails in all seeds, whereas RST-alpha-prefit remains certificate-positive. Escape trajectories on both natural-image datasets increase the witness margin from a low-margin initialization and exhibit nonzero teacher-induced gradient norms. The analysis is confined to exact constant collapse of the encoder mean; generation quality, decoder use, and other collapse modes remain separate questions.