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01.
arXiv (CS.AI) 2026-06-12

Once-for-All: Scalable Simultaneous Forecasting via Equilibrium State Estimation

arXiv:2606.13285v1 Announce Type: cross Abstract: We introduce Equilibrium State Estimation (ESE), a novel paradigm for simultaneous prediction, where multiple interacting systems require separate yet coordinated forecasts. Such scenarios often arise in real-world settings such as economics and healthcare modeling. Unlike existing approaches that predict one system at a time, ESE forecasts all systems in a single pass. It first estimates the equilibrium state across systems, then generates holistic forecasts based on the difference between the current state and the estimated equilibrium. Extensive experiments on synthetic and real-world datasets, including currency exchange and COVID-19 spread modeling, demonstrate that ESE is at least as accurate as state-of-the-art (SOTA) methods while being significantly faster. In addition, ESE integrates seamlessly with conventional predictors, combining their accuracy with its exceptional efficiency and delivering a 10-70x speedup. With linear-time complexity, ESE scales far better than SOTA methods as the number of systems increases. Moreover, it remains accurate under diverse perturbations, establishing ESE as a fast, generalizable, robust, and scalable multi-prediction method.

02.
Nature Medicine 2026-06-15

Plasma proteomic signatures of cellular aging predict human disease

Authors:

Aging is asynchronous across cells and organs. Here we tested whether plasma proteomics can be used to analyze cell type-specific aging. From analyses of over 7,000 plasma proteins measured in 60,542 individuals, we developed machine learning models to estimate the biological age of over 40 cell types spanning neuronal, immune, glial, endocrine, epithelial and musculoskeletal origins. We observed that 20–25% of individuals exhibited accelerated aging in a single cell type and 1–3% in 10 or more cell types. Cellular aging signatures were associated with disease status and predicted incident disease and mortality over 15 years of follow-up. Individuals with the APOE4 genotype showed older astrocytes but younger macrophages compared to APOE3 carriers, whereas the APOE2 genotype had inverse associations. Moreover, extreme astrocyte aging tripled the risk of incident Alzheimer’s Disease in individuals with two APOE4 alleles, while youthful astrocytes reduced risk. Individuals with extremely aged compared to youthful skeletal myocytes exhibited a 12.7-fold higher risk of developing amyotrophic lateral sclerosis. In individuals who smoked, extreme respiratory epithelial cell aging was associated with a 58% higher lung cancer risk compared to smoking alone. Specific cellular vulnerabilities and cumulative cellular aging burden influenced survival, with youthful immune and neuronal cell types conferring protective effects. Finally, we developed a polycellular aging risk score that stratified mortality risk across cohorts and proteomics platforms. These findings establish a framework for quantifying human physiology at cellular resolution, revealing heterogeneous aging trajectories and their impact on disease susceptibility and resilience. The biological age of individual cell types can be evaluated using plasma proteomics, revealing diverse aging profiles across more than 40 cell types and links between the accelerated aging of specific cell types and disease.

03.
arXiv (CS.CL) 2026-06-17

Your AI Travel Agent Would Book You a Bullfight: An Agentic Benchmark for Implicit Animal Welfare in Frontier AI Models

AI agents are moving from advisors to actors, booking travel, planning menus, and running procurement on behalf of users. Existing benchmarks for AI and animal welfare evaluate model text responses to question-answer prompts, leaving open whether the welfare reasoning surfaced in those responses transfers to agentic deployment where the model must take actions with tools. We introduce TAC (Travel Agent Compassion), the first agentic benchmark measuring whether AI agents avoid options involving animal exploitation when acting on behalf of users. TAC presents an AI agent with twelve hand-authored travel booking scenarios across six categories of animal exploitation, augmented to forty-eight samples to control for price, rating, and position confounds. We evaluate seven frontier models from four labs. Every model scores below the chance level of sixty-four percent, with the best performer (Claude Opus 4.7) at fifty-three percent. A single welfare-aware sentence in the system prompt yields gains of forty-seven to sixty-three percentage points in Claude and GPT-5.5, twenty-six points in GPT-5.2, and under twelve points in DeepSeek and Gemini. An auxiliary Inspect Scout audit of 288 base-condition transcripts from the top two performers, using Gemini 2.5 Flash Lite as judge, flags zero transcripts for evaluation awareness, suggesting the below-chance rates do not stem from the models recognising the evaluation. We discuss implications for category-level variation across cultural domains, the limits of text-response welfare benchmarks, and the EU General-Purpose AI Code of Practice systemic risk framework.

04.
PLOS Computational Biology 2026-06-18

Mechanisms underlying spontaneous and evoked calcium responses in oligodendrocyte precursor cells: A modeling investigation

Authors:

by Martin Lardy, Leqi Wang, Claire Guerrier, Veronica T. Cheli, Pablo M. Paez, Anmar Khadra Calcium (Ca2+) signaling has emerged as a central regulator of activity-dependent myelination in oligodendrocytes. These Ca2+ signals encompass both the stimulus-independent spontaneous Ca2+ local transients (SCaLTs) generated intrinsically in a voltage-independent manner or facilitated by the membrane voltage, as well as evoked responses triggered by ATP and glutamate release. To investigate the regulatory mechanisms underlying this combined spiking activity, we developed a stochastic spatiotemporal flux-balance model of Ca2+ transients in oligodendrocyte precursor cells (OPCs). The model incorporates all the relevant fluxes in these cells and integrates membrane voltage dynamics with a Ca2+-induced Ca2+-release (CICR) mechanism using parameters fitted to Ca2+ fluorescence recordings. The model reproduced the intrinsic and voltage-facilitated SCaLTs in OPCs in the absence of purinergic and glutamatergic receptors, and captured the three distinct patterns of evoked Ca2+ responses induced by prolonged ATP and glutamate stimulations identified using machine classifier. The model highlighted the role of ATP and glutamate in generating these clusters, and showed that the fast dynamics of CICR is key to producing these evoked responses. Further analysis of the model also revealed that voltage-gated L- and T-type Ca2+ channels slightly increase the frequency of SCaLTs, while stimulation with ATP and glutamate, using randomly distributed pulses mimicking in vivo conditions, leads to an increase in both the amplitudes of Ca2+ spikes (i.e., the combination of SCaLTs and evoked responses) and the prevalence of wide spikes, especially upon glutamate stimulation. Bifurcation analysis of the deterministic version of the model, in the absence of diffusion, demonstrated that ATP and glutamate stimulation can shift the system into an oscillatory regime, thereby increasing the deterministic component of SCaLT dynamics. This study thus offers a comprehensive representation of OPC Ca2+ transients linking recorded in vitro behaviors to in vivo dynamics.

05.
arXiv (math.PR) 2026-06-12

The censored stochastic six-vertex model and parabolic Kazhdan–Lusztig $R$-polynomials

arXiv:2606.12670v1 Announce Type: new Abstract: We introduce a censored version of the stochastic six-vertex model. We show that for parameters $b_1 < b_2$, this model started from the initial condition ${1}_{x>0}$ is stochastically dominated at any time by the blocking measure. This is a partial analog of the censoring inequality for monotone spin systems. In particular, this result allows us to control the behavior of second-class particles. The proof uses parabolic Kazhdan–Lusztig $R$-polynomials, whose appearance is explained using a connection between the stochastic six-vertex model and the Iwahori–Hecke algebras of symmetric groups. Furthermore, we find an intertwining relation for this process using normalized parabolic Kazhdan–Lusztig $R$-polynomials as an intertwining kernel.

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

MIRAGE: Auditing Anti-Muslim Bias in Frontier LLMs Across Reasoning, Agentic, and Time-Coupled Conditions

arXiv:2606.16562v1 Announce Type: new Abstract: Five years after the discovery of persistent anti-Muslim bias in large language models, most evaluations remain confined to single-turn prompt completion, a setting that no longer reflects how frontier LLMs are deployed. We introduce MIRAGE (Muslim-Identity Reasoning and Agentic Generation Evaluation), a benchmark of 1{,}200 prompts spanning three deployment-realistic conditions: direct completion, chain-of-thought reasoning, and simulated agentic decision-making across content moderation, lending triage, refugee claim summarization, and hiring screens. Across six frontier models, we find that (i) chain-of-thought reasoning amplifies rather than suppresses Muslim-violence associations by 12–34\% relative to direct completion, (ii) agentic decisions exhibit a 9–22 percentage-point asymmetry between Muslim and matched non-Muslim cases on identical evidence, and (iii) bias is sharply time-coupled to retrieved news context, increasing 18–27\% under recent-conflict retrieval. Existing prompt-based mitigations transfer poorly across our three conditions, suppressing direct-completion bias while leaving agentic asymmetry largely intact. We release MIRAGE and an open evaluation harness to support targeted mitigation research.

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

DriveReward: A Comprehensive Dataset and Generative Vision-Language Reward Model for Autonomous Driving

Reward models play a pivotal role in reinforcement learning (RL) and multi-modal trajectory selection for autonomous driving. However, acquiring such rewards typically relies on hand-crafted rule-based objectives or perception ground truth, which hinders generalization for data-scaling. While Vision-Language Models (VLMs) have demonstrated feasibility as reward models in other domains, their effectiveness in driving tasks remains underexplored. In this work, we bridge this gap by (1) introducing DriveReward, a reasoning trajectory evaluation dataset rigorously labeled via temporally-grounded visual guidance, and augmented with counterfactual driving behaviors., (2) alongside a specialized Vision-Language Reward Model. To address the scarcity of failure cases in conventional datasets, we propose a counterfactual data annotation scheme to construct cases encompassing diverse driving styles and erroneous behaviors. Evaluations on our proposed benchmark reveal that even leading open-source and proprietary VLMs fail to excel across all tasks, highlighting significant room for improvement in existing models. Building on these findings, we subsequently tailor a specialized 1B reward model that outperforms larger VLMs on task-specific reward alignment. Finally, we validate our reward model's effectiveness by integrating it into RL finetuning and multi-modal trajectory scoring across multiple baselines, achieving performance comparable to rule-based reward calculations in both open-loop and closed-loop evaluation.

08.
medRxiv (Medicine) 2026-06-22

Starting, stopping and restarting. Patterns of Methylphenidate Use over 14 years in a large public health system

Background Persistence with stimulant medication is poor in children and adolescents with ADHD, and the evidence base is derived predominantly from high-income countries. We describe methylphenidate utilisation patterns and predictors of 12-month retention across 14 years in a large South African public health service. Methods Retrospective cohort study using routine pharmacy data from the Western Cape provincial health service (2011-2024). Children aged 5-18 at first prescription were included. Treatment episodes were defined as continuous prescription sequences with no gap exceeding 90 days and classified as initiations or restarts. Logistic regression modelled 12-month retention against early visit frequency and formulation type as pre-specified exposures. Findings 421,925 prescription events for 23,243 children across 115 facilities generated 65,885 treatment episodes. Median age at first prescription was 10 years (IQR 8-12); 77.6% were male. Kaplan-Meier 12-month survival was 28.2% for initiations and 15.4% for restarts, substantially below high-income country comparators. A quarter of all initiating prescriptions were not followed by a subsequent dispensing event; nearly 40% of patients had three or more treatment episodes. Early visit frequency was the strongest predictor of 12-month retention (high vs low: OR 2.85, 95% CI 2.65-3.06). The sustained-release formulation effect was present but attenuated on multivariable adjustment. Treatment re-initiations showed a marked seasonal pattern consistent with the South African school calendar. Interpretation Twelve-month retention was markedly lower than high-income country rates. Against a backdrop of high attrition, both early visit frequency and sustained-release formulation access predicted persistence; clinical engagement and reducing structural barriers to access are modifiable factors in this setting. Funding None.

09.
arXiv (CS.CV) 2026-06-16

Detect Before You Leap: Mirage Detection in Vision-Language Models

Vision-language models (VLMs) can produce confident visual answers even when the required visual evidence is missing, blank, or unrelated to the question. This failure mode, recently described as mirage (mirage2026), is especially concerning in medical and document VQA, where a plausible but visually ungrounded answer may be mistaken for image-based evidence. We study the complementary problem of pre-release mirage detection: given an image-question pair, determine whether the VLM should answer or abstain before generation. To that end, we propose a novel model-agnostic Text-Conditioned Layer-wise Internal Alignment (TC-LIA) method that probes patch-token representations across the layers of a CLIP ViT-H/14 vision encoder. The key idea is to project layer-wise image patch tokens into the final CLIP embedding space and measure their similarity with the question embedding, thereby tracking whether question-relevant visual evidence emerges across vision layers. TC-LIA summarizes this alignment trajectory using final image-text cosine similarity, late-layer top-k patch-text alignment, early-to-late gain, and layer-wise slope. These features are combined with pixel-statistic based blank/noise detection, zero-shot domain routing, and structured VLM self-assessment in an ensemble. Across five VQA domains with related, unrelated-real, and blank/noise inputs, and across twelve VLM backbones, Qwen2.5-VL-32B achieves the highest three-class detection accuracy of 94.7% with a 3.0% mirage rate, while Qwen2.5-VL-72B achieves 94.6% accuracy with a lower 2.8% mirage rate. Baseline mirage rates span 21.7-66.6%.

10.
arXiv (CS.CV) 2026-06-16

Self-Supervised Learning as Discrete Communication

Most self-supervised learning (SSL) methods learn continuous visual representations by aligning different views of the same input, offering limited control over how information is structured across representation dimensions. In this work, we frame visual self-supervised learning as a discrete communication process between a teacher and a student network, where semantic information is transmitted through a fixed-capacity binary channel. Rather than aligning continuous features, the student predicts multi-label binary messages produced by the teacher. Discrete agreement is enforced through an element-wise binary cross-entropy objective, while a coding-rate regularization term encourages effective utilization of the constrained channel, promoting structured representations. We further show that periodically reinitializing the projection head strengthens this effect by encouraging embeddings that remain predictive across multiple discrete encodings. Extensive experiments demonstrate consistent improvements over continuous agreement baselines on image classification, retrieval, and dense visual prediction tasks, as well as under domain shift through self-supervised adaptation. Beyond backbone representations, we analyze the learned binary codes and show that they form a compact and informative discrete language, capturing semantic factors reusable across classes.

11.
arXiv (math.PR) 2026-06-25

A functional central limit theorem for kernel gradient flow and infinitesimal gradient boosting

arXiv:2606.25494v1 Announce Type: new Abstract: Building on the large-sample analysis of infinitesimal gradient boosting (Dombry and Duchamps, 2024b), we study the fluctuations of the process around its deterministic limit and establish a functional central limit theorem: the rescaled deviations converge in distribution to a Gaussian process. The analysis is carried out in a reproducing kernel Hilbert space (RKHS) naturally associated with the softmax gradient tree base learner, in which the boosting process is characterized as the solution of an autonomous ordinary differential equation (ODE). The proof rests on a general stochastic perturbation analysis of ODEs in Banach spaces, which is of independent interest: whenever a sequence of vector fields converges and satisfies a central limit theorem, so does the associated ODE solution. We first illustrate this perturbation approach in the simpler setting of kernel gradient flow, where the Gaussian limit admits an explicit characterization, and then consider the more complicated tree-based gradient boosting setting.

12.
arXiv (CS.AI) 2026-06-24

Ensemble Feature Selection and Harris Hawks Optimization for Explainable Mental Health Risk Prediction in Female Sex Workers

arXiv:2606.24047v1 Announce Type: new Abstract: One of the significant mental health issues affecting female sex workers (FSWs) is mental disorders, especially depression. Exposure to violence, stigma, and economic hardship further increases their psychological risk. Current machine learning (ML) models are typically ineffective at capturing the high-dimensional and complex risk patterns that exist in this marginalized group. This paper suggests a hybrid predictive model that merges an ensemble feature selection strategy using ANOVA and mutual information and Harris Hawks optimization-tuned logistic regression and represents a new application of swarm intelligence to predict mental health in vulnerable groups. The explainable AI (XAI) methods can be used to understand the factors of trauma associated with model predictions. When applied to a group of 3,005 FSWs, it can be seen that the proposed model is more effective than traditional classifiers, with an accuracy of 95.78%, an F1 score of 95.77%, and an AUC of 0.96, and identifying post-traumatic stress, client-related violence, and occupational factors as major contributors to depression. This work bridges the gaps between conventional and ML approaches to develop an XAI tool that enables vulnerable groups to receive early assistance, evidence-based targeted psychosocial care, and health planning.

13.
arXiv (CS.LG) 2026-06-18

A Neural Network Framework for Geodesic-Like Curve Computation on Parametric Surfaces

arXiv:2606.18759v1 Announce Type: cross Abstract: The concept of geodesic-like curves was introduced by Chen in 2010 as a method for estimating shortest paths (geodesics) on parametric surfaces, with its convergence established theoretically. However, an efficient numerical computational framework has not yet been developed. In this paper, we propose an elegant and efficient approach for computing geodesic-like curves by leveraging deep learning and Physics-Informed Neural Networks (PINNs). Under the proposed framework, not only can single parametric surfaces be handled efficiently, but a broad class of complex parametric surfaces including multi-surface systems with $C^0$ or higher continuity and surfaces of revolution can also be robustly addressed.

14.
arXiv (CS.AI) 2026-06-12

The Hidden Power of Scaling Factor in LoRA Optimization

arXiv:2606.12883v1 Announce Type: new Abstract: In Low-Rank Adaptation (LoRA), the scaling factor $\alpha$ is often treated as a mere complement to the learning rate, yet its role in optimization remains poorly understood. In this paper, we reveal that the scaling factor $\alpha$ and the learning rate function differently, with $\alpha$ emerging as the dominant driver of effective optimization, delivering gains that cannot be replicated by learning rate scaling alone. Through the synergy of extensive empirical analysis and a theoretical Signal-Drift framework, we uncover three findings into LoRA's scaling mechanism: First, LoRA's spectral suppression smooths the optimization landscape, rendering standard hyperparameters overly conservative and creating an optimization gap. Second, when leveraging this smoothness to accelerate convergence, $\alpha$ outperforms the learning rate by amplifying the task signal without increasing the drift ratio. Third, the optimal scaling factor follows a sublinear relationship with the rank, well characterized by a square-root law with an unexpectedly large coefficient, revealing the insufficient scaling of existing rank-tied heuristics. Based on these insights, we propose LoRA-$\alpha$, a minimalist framework that restores $\alpha$ to its principled regime, making LoRA compatible with standard small learning rates. Extensive evaluations across diverse tasks demonstrate that LoRA-$\alpha$ consistently improves performance while streamlining hyperparameter search, unleashing the learning potential of LoRA.

15.
arXiv (CS.AI) 2026-06-25

Variable Bound Tightening for Nash Equilibrium Computation in Multiplayer Imperfect-Information Games

Authors:

arXiv:2606.25997v1 Announce Type: cross Abstract: There has been significant recent progress in algorithms for approximation of Nash equilibrium in large two-player zero-sum imperfect-information games and exact computation of Nash equilibrium in multiplayer strategic-form games. While counterfactual regret minimization and fictitious play are scalable to large games and have convergence guarantees in two-player zero-sum games, they do not guarantee convergence to Nash equilibrium in multiplayer games. Recently, an approach has been presented for exact computation of Nash equilibrium in multiplayer imperfect-information games that solves a quadratically constrained program based on a nonlinear complementarity problem formulation derived from the sequence-form game representation. This formulation was solved using Gurobi's nonconvex quadratic solver, which employs spatial branch-and-bound to iteratively refine variable bounds by solving convex relaxations of bilinear terms via McCormick envelopes. During presolve, Gurobi introduces auxiliary variables and, in some cases, binary variables, leading to an internal MIQCP reformulation. This approach was demonstrated to outperform prior algorithms from the Gambit software suite and quickly solve three-player Kuhn poker after removal of dominated actions; however, the algorithm was not able to solve the full version of the game within 24 hours. In this paper, we derive finite bounds on slack and multiplier variables in the nonlinear complementarity formulation. These bounds strengthen the convex relaxations used within spatial branch-and-bound and lead to substantial computational improvements. We demonstrate the impact of the proposed bounds on exact Nash equilibrium computation in three-player Kuhn poker.

16.
medRxiv (Medicine) 2026-06-15

Active commuting, anxiety symptoms and mental wellbeing: a dose-response study

Climate change draws attention to the planetary health perspective in sport and exercise sciences, that is, to physical activity that supports both human wellbeing and environmental sustainability. Active commuting is a sustainable form of physical activity with well-established somatic health benefits. However, more knowledge is needed on its relationship with mental health. We examined dose-response associations between active commuting, anxiety symptoms, and mental wellbeing among Finnish adults, and whether green commuting environment moderates these relationships. We used data from the cross-sectional Environment and Health Survey collected in June-September 2023 in the ten largest cities in Finland. Employed participants with data on anxiety symptoms (Generalized Anxiety Disorder-7, GAD-7), mental wellbeing (World Health Organization-Five Well-Being Index, WHO-5), commuting profile over a year (mode, frequency, distance, and perceived greenness along the commute route), and sociodemographic and lifestyle factors were included (n=1,672; mean age 45.3 years; 53.8% women). Active commuting was defined as travelling the entire commute by walking or cycling (including e-biking) that was converted into approximated annual km/week and MET-h/week. We used linear and logistic regression with restricted cubic splines to evaluate dose-response associations, adjusted for key covariates. The role of perceived greenness was tested using an active commuting x commute greenness interaction term. We found no dose-response relationships between active commuting and anxiety symptoms or mental wellbeing in any of the models. No effect modification by commute greenness was observed. More research on how active commuting may support planetary health from a mental health perspective is needed.

17.
Nature (Science) 2026-06-10

Amplified Arctic iceberg traffic reshapes benthic biodiversity

The Arctic is undergoing rapid warming, resulting in retreating sea ice and glaciers1, yet how cryospheric changes propagate into the deep ocean remains poorly understood2. Here we identify a climate-driven mechanism linking accelerating glacier disintegration to an increase in deep-sea hard-bottom habitats far beyond calving fronts. Seafloor observations in Fram Strait show a localized increase in the density and patchiness of dropstones delivered by debris-laden icebergs. At the same time, four decades of shipboard records show that the occurrence of icebergs increased abruptly in the early 2000s. Backtracking links these icebergs to the main outlet glaciers in northeast Greenland and the Russian High Arctic. In northeast Greenland, the timing of glacier destabilization coincides with this rise, whereas sparse satellite coverage in the Russian sector limits temporal attribution despite indications of enhanced glacier activity. A model sensitivity study shows that, apart from intensified calving, a more dynamic sea ice cover enhances downstream transport of glacial ice. Along these pathways, increased iceberg activity could reshape deep-sea habitats through enhanced melt and associated lithogenic input, and elevate navigational hazards as maritime traffic expands in the Arctic. Although modest compared with the iceberg discharges of Pleistocene Heinrich events, this mechanism provides a modern analogue of long-range cryospheric influence on the seafloor in a warming climate. Accelerated Arctic glacier disintegration and a more dynamic sea ice cover are increasing iceberg-delivered dropstones in the deep ocean, reshaping seafloor habitats and extending cryospheric impacts far beyond glaciers.

18.
arXiv (CS.CL) 2026-06-25

Reclaim Evaluation: A Lossy Memory Is Worse Than an Empty One

Authors:

A language model's memory can be worse than having no memory at all. Give a model a memory that kept a wrong conclusion but dropped the work behind it, and it emits that stale value as a confident answer; give the same model an empty memory and it abstains. Across seven models this direction never reverses, a clean kill condition that none breaks. We call this brittle memory: behavioral, not the near-immediate information bound beneath it; only its magnitude is disposition- and task-dependent, not its direction. We measure it with reclaim evaluation: compress a drifted interaction at a fixed budget, then test whether a correction recovers the known answer, scored against ground truth with no judge. Correctability is bottlenecked by whether the answer-determining source survives, not by capability. A one-line source-first policy (keep the recomputable source, drop the re-derivable conclusion) restores correctability at equal budget where that source is compact and identifiable; a length-matched control rules out added text as the cause. The hand-built oracle reaches 1.00; a one-prompt deployable version reclaims 0.49-0.88. The stake compounds: chained through a memory loop, a single dropped-source error corrupts a growing span of downstream steps and stays uncorrectable, while source-first holds to a bounded budget horizon. The wall and fix replicate across three deployed memory systems and on real dialogue (MultiWOZ), and past the budget where the source no longer fits, the fix fails silently unless the note records completeness. This is a controlled study of a mechanism, not a benchmark: judge-free exact scoring, matched-budget controls, and validators built to come out false. We release the harness, conditions, and validators.

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

Compositional Reasoning Depth Predicts Clinical AI Failure: Empirical Evidence Consistent with Transformer Compositionality Limits in Electronic Health Record Question Answering

Authors:

Aggregate accuracy benchmarks conceal a systematic structure in how large language models fail at electronic health record (EHR) question answering: questions requiring more inferential steps produce disproportionately more errors. Motivated by theoretical results on transformer compositionality limits, we introduce a pre-specified hop-count taxonomy – the number of distinct reasoning steps required to answer a clinical question from an EHR – as a principled predictor of model failure. We annotate 313 clinician-generated MedAlign EHR question-answer pairs across four hop levels and evaluate 301 questions in a within-model ablation (claude-sonnet-4-6, zero-shot vs. extended thinking) and cross-architecture replications (gpt-4o and gpt-5.4-2026-03-05, zero-shot). All three models, spanning two providers and two OpenAI generations (GPT-4 and GPT-5), show monotone accuracy decline with hop count: Claude Sonnet zero-shot falls from 30.6% (hop=1) to 17.6% (hop=4) (Cochran-Armitage z=-2.30, p=0.011; OR per hop 0.72, 95% CI [0.56,0.92], p=0.008); GPT-4o replicates this (37.8% to 14.7%; OR 0.58 [0.45,0.75], p

20.
medRxiv (Medicine) 2026-06-17

Reverse engineering of motor unit discharge in multiple sclerosis reveals heterogeneity of voluntary motor commands

Central nervous system injury causes motor deficits through derangement of excitatory, inhibitory, and/or neuromodulatory inputs to motoneurons, the three fundamental components of motor commands. Typically, study of pathologic neural control in humans is restricted to only one of the three. Chardon et al. (2024) presented a fundamentally new approach to comprehensively study all components by reverse engineering motor unit firing patterns. We apply their framework to motor unit firing patterns from 89 people with multiple sclerosis (MS) and 34 controls to study excitatory, inhibitory, and neuromodulatory contributions to pathologic motor output. Disruptions to all components are plausible in MS, a disease hallmarked by heterogeneity in nearly all aspects. Accordingly, we found abnormalities in MS for all three components. Notably, neuromodulation included both high and low extremes. Our results suggest that pathophysiology of motor commands in MS varies among patients, a finding fundamentally different from other studied populations showing relative consistency.

21.
medRxiv (Medicine) 2026-06-22

Population-Scale, Genotype-First Characterization of Monogenic Diabetes in 374,973 Multi-Ancestry Individuals from the All of Us Research Program

OBJECTIVE To characterize the prevalence and penetrance of maturity-onset diabetes of the young (MODY) in a multi-ancestry population using a genotype-first design. RESEARCH DESIGN AND METHODS We analyzed whole-genome sequencing and clinical data from 374,973 unrelated All of Us participants (42.0% non-European ancestry). We identified pathogenic or likely pathogenic (P/LP) variants in 10 established MODY genes and assessed carrier prevalence, diabetes penetrance, and glycemic profiles. We evaluated age-dependent diabetes risk by comparing carriers with non-carriers stratified by type 2 diabetes polygenic risk score (T2D PRS). RESULTS We identified 370 carriers of P/LP MODY gene variants (0.099%; 1 in 1,013), with similar carrier prevalence among European- and African-ancestry participants (0.105% in both groups). Diabetes penetrance was incomplete (13.4% by age 40; 43.5% by age 60) and varied by etiology: highest for GCK (56.0% by age 60), intermediate for HNF genes (HNF1A/HNF1B/HNF4A; 45.4%), and lowest for non-GCK/HNF genes (ABCC8/INS/KCNJ11/NEUROD1/PDX1/RFX6; 29.0%). In multivariable Cox models using non-carriers in the middle 80% of the T2D PRS as the reference, non-GCK/HNF gene variant carriers had modestly increased diabetes risk (HR, 1.57), similar to non-carriers in the top 10% of T2D PRS (HR, 1.64). These associations were observed in both European- and non-European-ancestry individuals. HbA1c profiles differed by etiology, with stable mild hyperglycemia in GCK variant carriers and greater variability among HNF and non-GCK/HNF gene variant carriers. CONCLUSIONS MODY gene variants showed incomplete, etiology-dependent penetrance across ancestries. Carriers of P/LP variants in lower-penetrance genes had diabetes risk comparable to that of non-carriers with high polygenic susceptibility.

22.
medRxiv (Medicine) 2026-06-23

Association between the hemoglobin albumin lymphocyte and platelet score and chronic kidney disease: insights from patient data and animal models

Introduction The hemoglobin, albumin, lymphocytes and platelets (HALP) score, a novel nutritional and inflammatory biomarker, has been used in various chronic disease studies. However, the relationship between the HALP score and chronic kidney disease (CKD) remains poorly elucidated. This study aimed to explore the possible association between the HALP score and CKD. Methods Our analysis encompassed 25,160 adult participants drawn from NHANES cycles spanning 2009 through 2018. Weighted multivariable logistic regression and generalized additive models (GAMs) were employed to evaluate the independent associations between the HALP score and CKD, albuminuria, and low-estimated glomerular filtration rate (eGFR). Threshold effects were examined using two-piecewise linear regression. Subgroup and sensitivity analyses were performed to assess robustness. Receiver operating characteristic (ROC) curve analyses were applied to compare the discriminative capacity of the HALP score with the prognostic nutritional index (PNI), systemic immune-inflammation index (SII), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR). The clinical findings were further validated in a 5/6 nephrectomy rat model. Results After adjustment for multiple confounders, higher HALP scores were inversely associated with the risk of CKD (OR = 0.97, 95% CI: 0.94-0.99) and albuminuria (OR = 0.97, 95% CI: 0.93-0.99). However, after full adjustment for demographic characteristics, physical examination indices and laboratory parameters (Model 3), the correlation between the HALP score and low-eGFR was no longer statistically significant. Non-linear analyses revealed a threshold effect, with CKD risk declining as the HALP score increased up to an inflection point of 52.43 (OR = 0.97, 95% CI: 0.95-0.99), beyond which no further protective effect was observed. A similar threshold effect was identified for albuminuria. Subgroup and interaction analyses indicated no meaningful effect modification by age, sex, BMI, hypertension, or diabetes. Sensitivity analyses confirmed the robustness of the results. ROC analysis demonstrated that the HALP score showed superior discriminative ability for CKD and albuminuria compared with PNI, SII, LMR, and PLR. In the animal experiment, CKD model rats exhibited significantly lower HALP scores than controls. Inverse correlations were observed between the HALP score and serum creatinine (Scr), blood urea nitrogen (BUN), and urinary albumin-to-creatinine ratio (UACR), with UACR showing the strongest correlation, which was consistent with the clinical findings. Conclusion Lower HALP scores are independently associated with increased prevalence of CKD and albuminuria. As an affordable and readily measurable biomarker, the HALP score may facilitate CKD risk assessment.

23.
arXiv (CS.CL) 2026-06-11

FinTradeBench: A Financial Reasoning Benchmark for LLMs

Real-world financial decision-making is a challenging problem that requires reasoning over heterogeneous signals, including company fundamentals derived from regulatory filings and trading signals computed from price dynamics. Recently, with advances in Large Language Models (LLMs), financial analysts have begun to use them for financial decision-making tasks. However, existing financial question-answering benchmarks for testing these models primarily focus on company balance sheet data and rarely evaluate reasoning about how company stocks trade in the market or their interactions with fundamentals. To leverage the strengths of both approaches, we introduce FinTradeBench, a benchmark for evaluating financial reasoning that integrates company fundamentals and trading signals. FinTradeBench contains 1,400 questions grounded in NASDAQ-100 companies over a ten-year historical window. The benchmark is organized into three reasoning categories: fundamentals-focused, trading-signal-focused, and hybrid questions requiring cross-signal reasoning. To ensure reliability at scale, we adopt a calibration-then-scaling framework that combines expert seed questions, multi-model response generation, intra-model self-filtering, numerical auditing, and human-LLM judge alignment. We evaluate 14 LLMs under zero-shot prompting and retrieval-augmented settings and witness a clear performance gap. Retrieval substantially improves reasoning over textual fundamentals, but provides limited benefit for trading-signal reasoning. These findings highlight fundamental challenges in the numerical and time-series reasoning for current LLMs and motivate future research in financial intelligence.

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

Towards Next-Generation Healthcare: A Survey of Medical Embodied AI for Perception, Decision-Making, and Action

Foundation models have demonstrated impressive performance in enhancing healthcare efficiency across a wide range of medical applications. Nevertheless, their limited ability to perceive, understand, and interact with the physical world significantly constrains their effectiveness in real-world clinical workflows, where safety-critical decision-making and physical execution are tightly coupled. Recently, embodied artificial intelligence (AI) has emerged as a promising physical-interactive paradigm for intelligent healthcare, enabling agents to operate in complex medical environments. As research in this area rapidly expands, understanding how intelligent agents function as integrated, end-to-end systems in clinical environments becomes increasingly critical. However, existing surveys on medical embodied AI largely emphasize individual aspects or functional components, lacking a unified system-level organization of the field. To support and consolidate recent advances, we systematically survey the core components of medical embodied AI, with a particular emphasis on the coordinated integration of perception, decision-making, and action. We further review representative medical applications and relevant datasets, and we analyze the major challenges encountered in real-world clinical practice. Finally, we discuss key directions for future research in this rapidly evolving field. The associated project can be found at https://github.com/VMVLab/Medical_Embodied_AI_Paper_List.

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

Mind the Heads: Topological Representation Alignment for Multimodal LLMs

Representation alignment has emerged as an effective approach to improve Multimodal Large Language Models (MLLMs) by regularizing their internal representations toward those of an external vision encoder. However, existing methods typically align a fixed layer of the language backbone, overlooking the fine-grained structure of Transformer models. In this work, we propose Head-Wise Representation Alignment (HeRA), a method that enforces cross-modal alignment at the level of individual attention heads. Our approach is grounded in the Platonic Representation Hypothesis, focusing on preserving the topological structure of representations (i.e., their local neighborhood relationships) across modalities. Following the Mutual K-Nearest Neighbor (MKNN) alignment metric, we introduce a contrastive objective that acts as a differentiable proxy for matching local structures. HeRA applies this objective during multimodal training to specific attention heads in the LLM, selected by their alignment score according to the MKNN metric. Counterintuitively, we find that aligning the least aligned heads yields the largest gains. Extensive evaluations across multiple MLLMs and 18 benchmarks demonstrate that HeRA consistently improves performance on challenging vision-centric tasks and serves as an effective regularizer against visual hallucinations by naturally curbing the over-reliance on linguistic priors. Our code is publicly released.