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01.
Nature (Science) 2026-06-24

Immunological mechanisms of mRNA vaccines for infectious diseases

Authors:

Nucleoside-modified mRNA–lipid-nanoparticle (mRNA–LNP) vaccines confer a high level of protection against severe COVID-19 and, since their first authorization for human use in 2020, have saved millions of lives. The efficacy of this vaccine platform relies on the induction of powerful and coordinated innate and adaptive immune responses. A deep understanding of the mechanisms of action by which mRNA–LNP vaccines drive protective immunity is crucial for advancing the development of next-generation mRNA vaccines with improved immunogenicity and tolerability. A flurry of recent studies has shed light on aspects of this vaccine modality’s modus operandi. Nonetheless, key gaps in knowledge remain, including understanding how LNPs are sensed by the immune system and exert their adjuvant activity, identifying the specific signals and cellular pathways critical for eliciting protective immune responses and determining whether it is feasible to uncouple vaccine immunogenicity and reactogenicity. Here we review the known and unknown features of the immunological mechanisms of mRNA–LNP vaccines for infectious diseases. Furthermore, we discuss how the components of this vaccine platform can be modified to fine-tune immune responses against challenging pathogens for which effective vaccines do not exist or need improvement. A Review of the immunological mechanisms of mRNA–lipid-nanoparticle vaccines for infectious diseases discusses how the components of this vaccine platform can be modified to fine-tune immune responses against challenging pathogens.

02.
arXiv (CS.LG) 2026-06-17

Questioning the Coverage-Length Metric in Conformal Prediction: When Shorter Intervals Are Not Better

arXiv:2601.21455v2 Announce Type: replace-cross Abstract: Conformal prediction(CP) has become a cornerstone of distribution-free uncertainty quantification, conventionally evaluated by its coverage and interval length. This work critically examines the sufficiency of these standard metrics. We demonstrate that the interval length might be deceptively improved through a counter-intuitive approach termed Prejudicial Trick(PT), while the coverage remains valid. Specifically, for any given test sample, PT probabilistically returns an interval, which is either null or constructed using an adjusted confidence level, thereby preserving marginal coverage. While PT potentially yields a deceptively lower interval length, it introduces practical vulnerabilities: the same input can yield completely different prediction intervals across repeated runs of the algorithm. We formally derive the conditions under which PT achieves these misleading improvements and provide extensive empirical evidence across various regression and classification tasks. Furthermore, we introduce a new metric interval stability which helps detect whether a new CP method implicitly improves the length based on such PT-like techniques. Code is available at https://github.com/benben-cd/PT-Conformal-Prediction.

03.
arXiv (CS.CL) 2026-06-19

DeepSeek-V4: Towards Highly Efficient Million-Token Context Intelligence

We present a preview version of DeepSeek-V4 series, including two strong Mixture-of-Experts (MoE) language models – DeepSeek-V4-Pro with 1.6T parameters (49B activated) and DeepSeek-V4-Flash with 284B parameters (13B activated) – both supporting a context length of one million tokens. DeepSeek-V4 series incorporate several key upgrades in architecture and optimization: (1) a hybrid attention architecture that combines Compressed Sparse Attention (CSA) and Heavily Compressed Attention (HCA) to improve long-context efficiency; (2) Manifold-Constrained Hyper-Connections (mHC) that enhance conventional residual connections; (3) and the Muon optimizer for faster convergence and greater training stability. We pre-train both models on more than 32T diverse and high-quality tokens, followed by a comprehensive post-training pipeline that unlocks and further enhances their capabilities. DeepSeek-V4-Pro-Max, the maximum reasoning effort mode of DeepSeek-V4-Pro, redefines the state-of-the-art for open models, outperforming its predecessors in core tasks. Meanwhile, DeepSeek-V4 series are highly efficient in long-context scenarios. In the one-million-token context setting, DeepSeek-V4-Pro requires only 27% of single-token inference FLOPs and 10% of KV cache compared with DeepSeek-V3.2. This enables us to routinely support one-million-token contexts, thereby making long-horizon tasks and further test-time scaling more feasible. The model checkpoints are available at https://huggingface.co/collections/deepseek-ai/deepseek-v4.

04.
arXiv (CS.CL) 2026-06-11

SOMA-SQL: Resolving Multi-Source Ambiguity in NL-to-SQL via Synthetic Log and Execution Probing

Natural language interfaces to databases aim to translate user questions into executable SQL, yet remain brittle in real-world settings where questions are underspecified and schemas are large and ambiguous. Ambiguity across user questions, database schemas, and model interpretations are central failure modes in NL2SQL, leading to misaligned intent, incorrect schema grounding, and erroneous SQL generation. Existing approaches rely on human clarification or treat ambiguity as a schema representation problem, but these do not scale nor resolve ambiguity autonomously. We propose SOMA-SQL to automatically resolve ambiguity via targeted synthetic query log and ambiguity-driven probing. SOMA-SQL constructs synthetic query log to ground schema interpretation and guide candidate SQL generation; it then executes targeted probing queries, driven by a structured ambiguity taxonomy and candidate disagreements, to produce disambiguation evidence for final SQL selection and repair. This active approach to ambiguity discovery and resolution generalizes across unseen schemas and query distributions without human-in-the-loop. Experiments on six public benchmarks demonstrate that SOMA-SQL improves execution accuracy by 13.0% on average over state-of-the-art baselines, with gains of up to 16.7% on ambiguous questions.

05.
medRxiv (Medicine) 2026-06-12

Microbial etiology, antibiotic susceptibility profiles, and multidrug resistance of urinary tract infections at a secondary healthcare facility in Ghana

Background: Rising antibiotic resistance challenges empirical therapies for urinary tract infections (UTIs). This study evaluated the microbial etiology, susceptibility profiles, and multidrug resistance (MDR) patterns of uropathogens among outpatients at the Berekum Holy Family Hospital, Ghana. Methods: This cross-sectional study (February to August 2021) screened 263 symptomatic outpatients. Mid-stream urine samples underwent quantitative culture, biochemical identification, and antimicrobial susceptibility testing via the Kirby-Bauer disc diffusion method following the 2021 CLSI guidelines. Results: Significant bacteriuria prevalence was 22.8% (60/263). UTIs predominated in females (78.3%, 47/60; p = 0.1501) and individuals [≥]45 years (33.3%, 20/60). Gram-negative rods accounted for 90.0% of isolates, primarily Escherichia coli (26.7%), Citrobacter spp. (25.0%), and Enterobacter spp. (21.7%); Staphylococcus aureus (10.0%) was the only Gram-positive pathogen. Extreme phenotypic resistance was observed against piperacillin/tazobactam (98.3%), cefotaxime (93.3%), tetracycline (88.3%), and cefoperazone (85.0%). Conversely, highest therapeutic susceptibilities were retained by amikacin (78.3%), levofloxacin (61.7%), and gentamicin (58.3%). Conclusion: The high prevalence of MDR uropathogens against advanced beta-lactamase inhibitor combinations and cephalosporins necessitates an immediate re-evaluation of regional empirical protocols. Amikacin, levofloxacin, and gentamicin remain viable options prior to culture confirmation. These findings establish a crucial phenotypic baseline to guide localized prescribing policies and regional antimicrobial resistance tracking strategies.

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

DreamReasoner-8B: Block-Size Curriculum Learning for Diffusion Reasoning Models

Block diffusion language models accelerate decoding through parallel block-wise denoising, yet whether they can be reliably scaled for long chain-of-thought (CoT) reasoning remains unresolved. To this end, we develop DreamReasoner-8B, an open-source block diffusion reasoning model, and conduct a systematic study of how training and inference block sizes affect long-CoT reasoning. Our analysis reveals a stark performance disparity: training with large block sizes yields remarkably poor reasoning, whereas small block sizes preserve effective reasoning. To bridge this granularity gap, we propose block-size curriculum learning, which gradually transitions training from fine-grained to coarse-grained block sizes, thereby overcoming this limitation and enabling strong reasoning performance that generalizes across diverse inference block sizes. On mathematical and code reasoning benchmarks, DreamReasoner-8B achieves results competitive with leading open autoregressive models such as Qwen3-8B. This work establishes a practical foundation for efficient, reasoning-capable diffusion language models. We release our model at https://github.com/DreamLM/DreamReasoner.

07.
arXiv (CS.CV) 2026-06-15

NEST3D: A High-Resolution Multimodal Dataset of Sociable Weaver Tree Nests

Sociable weaver nests function as complex ecological structures offering thermoregulatory microhabitats and sustaining diverse species; however, datasets used in prior studies lack fine-grained 3D structural detail. Producing usable and accurate 3D weaver nest data is challenging due to their irregular geometry and integration with complex host vegetation. We bridge this gap with an open-access, 1.4 TB multimodal drone dataset of 104 nest-bearing trees, comprising 27,945 RGB images, 111,780 multispectral images, approximately 781 million 3D points, and expert-annotated semantic segmentation labels. We benchmark semantic segmentation using KPConv, RandLA-Net, and Point Transformer V3, with PT-v3 achieving an mIoU of 86.35% on the test set. While the results demonstrate strong performance for transformer-based and point-wise methods, they also highlight architecture-dependent challenges, particularly for convolution-based approaches such as KPConv. By uniquely combining spectral, spatial, and structural information, the presented dataset advances 3D reconstruction, segmentation, and classification algorithms, enabling ecological applications from nest volume estimation to species conservation, and serves as a demanding benchmark that exposes architecture-dependent performance under extreme class imbalance.

08.
medRxiv (Medicine) 2026-06-22

Development and validation of a risk prediction algorithm to estimate all-cause mortality among community-dwelling Canadians: the Mortality Population Risk Tool (MPoRT)

BACKGROUND: The risk of all-cause mortality can inform decision-making for chronic disease prevention. We developed a predictive algorithm to estimate the 5-year risk of death among community-dwelling adults. METHODS: We derived and validated the Mortality Population Risk Tool (MPoRT) using data from population health surveys in Canada (the Canadian Community Health Survey) and the United States (the National Health Interview Survey), survey years 2001 to 2011, linked to vital statistics. The outcome was death within five years of the survey response. The algorithm was developed using data from Ontario respondents using a Cox proportional hazards model, then modified and re-estimated to allow cross-national assessment in Canada and the United States. Twenty-three prespecified predictors were assessed: seven sociodemographic, six behavioural, and ten general health and chronic disease. RESULTS: 527,369 respondents aged 20 to 105 years were included in the Canadian and United States development and validation cohorts, with 43,758 deaths during 3.68 million person-years follow-up. The final sex-specific MPoRT algorithms each contained 21 variables, showing strong discrimination (C-statistic: females 0.874 [0.871–0.877]; males 0.867 [0.865–0.871]) and good calibration overall and in 246 of 247 subgroups. Discrimination was modestly attenuated (0.01 decrease in C-statistic) in cross-national validation between Canada and the United States, with good calibration across all 71 subgroups. INTERPRETATION: MPoRT accurately discriminated all-cause mortality using only self-reported data, enabling broad application without clinical measures. While validation outside North America is needed to confirm broader applicability, MPoRT is designed for straightforward recalibration using routinely available national mortality data. This supports targeted chronic disease prevention strategies at both the population and individual levels, though the limitations inherent to self-reported predictors should be considered when interpreting predictions.

09.
arXiv (CS.CV) 2026-06-17

MeiBRD: Meta-Learning Intraoperative Biomechanical Residual Deformation

Accurate intraoperative liver registration is challenging due to substantial soft-tissue deformation yet sparse intraoperative measurements. Biomechanical models regularize this ill-posedness with prior knowledge but exhibit persistent prediction bias due to simplifying assumptions, while data-driven learning solutions struggle with data efficiency, generalization, and physical plausibility. We propose a hybrid registration framework that adapts a biomechanical prior using sparse intraoperative correspondences. Rather than learning a full deformation field, we learn a residual deformation function that corrects linear biomechanical predictions, modeled as a graph neural diffusion function with geometry-aware attention over the 3D liver mesh. To enable long-range information transfer of sparse observations, we take a novel perspective of sparse intraoperative measurements as context samples where input-output pairs of the residual deformation function are fully observed, casting the problem into learning-to-learn this residual function from intraoperative context samples with feedforward meta-learners. Experiments on a deformable liver phantom dataset demonstrate improved registration accuracy and generalization compared to rigid, biomechanical, and data-driven baselines, particularly for out-of-distribution geometries and deformations.

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

MM++: Unsupervised Scale-Invariant Multilayer OOD Detection via Top-K Gated Feature Fusion

We introduce MM++ (Multilayer Mahalanobis++), a fully unsupervised, strictly post-hoc, and scale-invariant framework for Out-of-Distribution (OOD) detection. To address the trade-off between scale invariance and hierarchical expressivity, MM++ constructs a principled joint feature space. It first identifies discriminative intermediate layers by measuring entropy density drops, which mark the boundaries of sharp semantic compression. By fusing these selected layers with the terminal representation, the framework captures latent cross-layer correlations while mitigating early-layer noise. Crucially, a Ledoit-Wolf regularized tied covariance matrix stabilizes this unified space, enabling reliable distance estimation. Requiring no auxiliary OOD data, classifier fine-tuning, or architectural modifications, MM++ delivers robust performance across distinct architectures for both near- and far-OOD detection.

11.
arXiv (CS.CL) 2026-06-12

Shopping Reasoning Bench: An Expert-Authored Benchmark for Multi-Turn Conversational Shopping Assistants

Conversational shopping assistants now serve hundreds of millions of customers, yet no existing benchmark jointly evaluates the open-ended multi-turn reasoning, domain expertise, and criterion-level quality that real shopping conversations demand. Shopping reasoning is unique among language model applications. Unlike factual question answering or verifiable code generation, it requires balancing subjective preferences, budget constraints, and cross-product trade-offs across multi-turn dialogue, capabilities absent from previous e-commerce and general-purpose benchmarks. We introduce the Shopping Reasoning Bench, an expert-authored benchmark of 525 missions (232 single-turn, 293 multi-turn) with 10863 importance-weighted binary rubrics authored by retail domain experts. These criteria are organized under a taxonomy of five reasoning categories and fifteen subcategories covering diverse demands such as preference refinement, trade-off analysis, and compatibility assessment. An evaluation of nine models across three families (GPT, Claude, Gemini) shows that pass rates reach only 57–77% overall. On multi-turn missions, all models score 13–29 points lower on optional above-and-beyond criteria than on required ones, and performance degrades 4–18 points as conversations progress. These gaps show that current models handle basic shopping assistance but fall short of expert-level advice, making Shopping Reasoning Bench a challenging testbed for future shopping assistant development.

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

EERLoss: A Novel Loss Function for Training Deep Biometric Models. A Case Study in Keystroke Dynamics

Deep learning approaches to biometric verification are commonly trained by optimizing indirect objectives, creating a misalignment between the optimization process and the primary evaluation metric, typically the Equal Error Rate (EER). This paper introduces EERLoss: a subdifferentiable, arbitrarily accurate approximation to EER for training deep biometric models. Furthermore, this framework has the potential to be adapted to optimize any specific operating point on the DET curve, enhancing its generalizability. To validate this approach, EERLoss is evaluated on a particularly demanding behavioral biometric modality: keystroke dynamics verification. This task is characterized by its high intra-class and low inter-class variability. Experiments are conducted on the large-scale KVC-onGoing benchmark, incorporating data from over 185,000 subjects across different scenarios. A comprehensive ablation study initially demonstrates the superiority of EERLoss in comparison to existing state-of-the-art loss functions. It also converges substantially faster compared to other losses, reducing the overall training cost. Additionally, a comparison is made between the proposed loss and the KVC-winning architecture by re-training it with EERLoss, demonstrating that the proposed approach significantly outperforms the original SoTA, achieving a relative EER reduction of up to approx. 30\%. This improvement on a challenging, large-scale benchmark validates the effectiveness of EERLoss as a task-aligned training objective specifically suited for high-variance biometric traits.

13.
arXiv (CS.AI) 2026-06-12

Reducing the Complexity of Deep Learning Models for EEG Analysis on Wearable Devices

arXiv:2606.12742v1 Announce Type: new Abstract: Wearable healthcare devices are the fastest-growing Internet of Things (IoT) sector. Many automated healthcare services rely on two crucial biological signals, namely ECG and EEG, which reflect the activity of the heart and brain, respectively. Although deep neural networks are considered the primary way to process and analyze these signals, the very tight energy and computational power constraints in wearable devices are far below the computational, energy, and memory bandwidth demands of DNN models, thereby impeding the deployment of deep learning in many practical wearable services. This paper investigates the feasibility of deploying state-of-the-art DNN models in resource-constrained wearable devices. Notably, we explore the trade-off between accuracy and computational complexity of DNNs when parameter quantization and electrode reduction methods are used. Our investigation centers on several state-of-the-art DNN models designed for EEG signal analysis, specifically for detecting epileptic seizures. Our findings demonstrate that, when applied judiciously, these techniques can significantly reduce the complexity of the DNNs under consideration with minimal adverse effects on accuracy. These results reveal the explicit trade-offs between accuracy and complexity reduction encountered when adapting DNN-based online EEG analysis for wearable devices.

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

A New Perspective on Precision and Recall for Generative Models

arXiv:2511.02414v3 Announce Type: replace Abstract: With the recent success of generative models in image and text, the question of their evaluation has recently gained a lot of attention. While most methods from the state of the art rely on scalar metrics, the introduction of Precision and Recall (PR) for generative model has opened up a new avenue of research. The associated PR curve allows for a richer analysis, but their estimation poses several challenges. In this paper, we present a new framework for estimating entire PR curves based on a binary classification standpoint. We conduct a thorough statistical analysis of the proposed estimates. As a byproduct, we obtain a minimax upper bound on the PR estimation risk. We also show that our framework extends several landmark PR metrics of the literature which by design are restrained to the extreme values of the curve. Finally, we study the different behaviors of the curves obtained experimentally in various settings.

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

Spin-orbit coupling by design in quantum state engineering of atomically defined quantum dots

arXiv:2606.14487v1 Announce Type: cross Abstract: Tuning spin-orbit coupling is essential in controlling both spin and charge in confined semiconductor nanostructures, yet it is rarely a truly controllable parameter. Here, we show control over the spin-orbit Hamiltonian in quantum dots and the resulting quantum states by tailoring the confinement potential with atomic-scale precision. Using scanning tunnelling microscopy and spectroscopy, we pattern individual Cs ions into designer quantum dot structures on the surface of indium antimonide, in which electrons from a two-dimensional electron gas are confined with chosen in-plane electric-field gradients. We then quantify the atomic level structure, both spatially resolving the orbital character of the electronic states and their magnetic-field evolution. We demonstrate that the level structure, including the induced zero-field splitting, can be tailored by the designed geometry of the local electric fields. These effects can be described using a Hamiltonian that allows consistent treatment of the confinement-induced spin-orbit coupling beyond the conventional Bychkov-Rashba description. This Hamiltonian is derived from a multiband k.p model and takes the energy dependence of the relevant physical parameters into account. Such precise control of spin-orbit coupling in semiconductor quantum dots is relevant to quantum and spintronic technologies.

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

Bridging Information Asymmetry: A Hierarchical Framework for Blind Face Restoration with Reduced Uncertainty

Blind face restoration remains a persistent challenge due to the inherent ill-posedness of reconstructing holistic structures from severely constrained observations. Current generative paradigms, while capable of synthesizing realistic facial details, remain limited by the under-constrained nature of blind restoration, where severely degraded inputs can be mapped to plausible yet identity-inconsistent outputs. To address this issue, we present Pref-Restore, a hierarchical framework for BFR with reduced restoration uncertainty. Our design is organized around three complementary principles: (1) Semantic Information Augmentation, where an auto-regressive semantic branch converts image and text cues into structured tokens that provide a stable high-level anchor; (2) Texture-level Fidelity Alignment, where the diffusion generator is trained under this anchor to recover identity-relevant details; and (3) Fidelity-constrained Preference Optimization, where a face-aware reward refines the diffusion trajectory while controlling the quality–fidelity trade-off. Extensive experiments on synthetic and real-world benchmarks show that Pref-Restore achieves state-of-the-art performance, with stronger identity-sensitive fidelity and lower restoration uncertainty across repeated sampling. Systematic ablations further attribute these gains to the proposed hierarchical design, showing the necessity of staged training, the robustness and quality dependence of the text pathway, and the benefit of fidelity-constrained preference optimization.

17.
arXiv (math.PR) 2026-06-17

How long does it take to train an Elephant Random Walk

Authors:

arXiv:2509.15049v2 Announce Type: replace Abstract: We study how conditioning on the first $k$ steps, which we think of as training, affects the long-term behavior of the Elephant Random Walk. When the elephant is conditioned to be at position $k$ at time $k$, the first return time to the origin scales as $k^{(4-4p)/(3-4p)}$ in the diffusive regime, and grows exponentially in the critical regime. We loosely interpret this as a measurement of the rate at which the elephant forgets its training.

18.
arXiv (quant-ph) 2026-06-19

Unveiling coherent dynamics in non-Markovian open quantum systems: exact expression and recursive perturbation expansion

arXiv:2506.04097v2 Announce Type: replace Abstract: We introduce a systematic framework to derive the effective Hamiltonian governing the coherent dynamics of non-Markovian open quantum systems. By applying the minimal dissipation principle, we uniquely isolate the coherent contribution to the time-local generator of the reduced dynamics. We derive a general expression for the effective Hamiltonian and develop a recursive perturbative expansion that expresses it in terms of system-bath interaction terms and bath correlation functions. This expansion provides a systematic tool for analyzing energy renormalization effects across different coupling regimes. Applying our framework to paradigmatic spin systems, we reveal how environmental correlations influence energy shifts and eigenbasis rotations, offering new insights into strong-coupling effects and non-Markovian quantum thermodynamics.

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

The Autonomy Tax: Defense Training Breaks LLM Agents

arXiv:2603.19423v2 Announce Type: replace-cross Abstract: Large language model (LLM) agents increasingly rely on external tools (file operations, API calls, database transactions) to autonomously complete complex multi-step tasks. Practitioners deploy defense-trained models to protect against prompt injection attacks that manipulate agent behavior through malicious observations or retrieved content. We reveal a fundamental capability-alignment paradox: defense training designed to improve safety systematically destroys agent competence while failing to prevent sophisticated attacks. Evaluating defended models against undefended baselines across 97 agent tasks and 1,000 adversarial prompts, we uncover three systematic biases unique to multi-step agents. Agent incompetence bias manifests as immediate tool execution breakdown, with models refusing or generating invalid actions on benign tasks before observing any external content. Cascade amplification bias causes early failures to propagate through retry loops, pushing defended models to timeout on 99\% of tasks compared to 13\% for baselines. Trigger bias leads to paradoxical security degradation where defended models perform worse than undefended baselines while straightforward attacks bypass defenses at high rates. Root cause analysis reveals these biases stem from shortcut learning: models overfit to surface attack patterns rather than semantic threat understanding, evidenced by extreme variance in defense effectiveness across attack categories. Our findings demonstrate that current defense paradigms optimize for single-turn refusal benchmarks while rendering multi-step agents fundamentally unreliable, necessitating new approaches that preserve tool execution competence under adversarial conditions.

20.
medRxiv (Medicine) 2026-06-11

What level of expertise is necessary to generate ACLS training test questions: pre-med students vs. artificial intelligence?

Abstract Introduction In-hospital cardiac arrest carries high mortality despite standardized ACLS training. Educators face increasing time constraints in developing assessment tools for ACLS training. Two possible solutions to this problem are using pre-medical students or using artificial intelligence to generate test questions. This study compared the quality of pre-medical student-generated ACLS test questions vs. AI-generated ACLS test questions, testing the hypothesis that AI-generated questions are non-inferior to student-generated questions. Methods Ten pre-medical students created ACLS questions following predefined criteria, while an AI model (Northwell's Artificial Intelligence Hub) generated comparable questions. A blinded ACLS-certified physician evaluated questions on the qualities of Alignment, Clarity, Cognitive Level, and Question Design using a standardized rubric (Likert scale: 1 = poor quality, 5 = excellent). Student's T-test and Chi-square analysis were used to compare the quality of questions on different rubric domains within each arm (student vs. AI) and within one domain (eg, question Clarity) between arms. The Student's T test was used when 2 comparator groups were compared (eg, Clarity of student-generated vs. AI-generated questions) within one arm. The ANOVA test was used when comparing more than 2 comparator groups (eg, Alignment vs. Clarity vs. Cognitive Level) within one arm. Statistical significance was set as a priority at p

21.
medRxiv (Medicine) 2026-06-18

Excess mortality in Germany during 2020-2023: A descriptive age-stratified analysis

Authors:

This study investigates excess mortality in Germany in the years from 2020 to 2023 and its temporal alignment with reported COVID-19 deaths. The analysis uses annual and weekly all-cause mortality data and linear baseline trends derived from pre-pandemic years. Possible effects of demographic and population changes on baseline trends were also examined. Excess mortality was analysed over time and across age groups. Excess mortality was observed in all investigated years, rising from 2020 to its highest value in 2022. In absolute terms, the age group [≥]80 years accounted for the largest proportion of excess deaths throughout the study period. After 2021, elevated mortality relative to baseline was also observed in younger age groups down to 15 years of age, although absolute numbers remained substantially lower than in older groups. No evidence of excess mortality was observed for individuals younger than 15 years. Periods of excess mortality were temporally aligned with waves of reported COVID-19 deaths. In 2020, cumulative excess mortality after calendar week 11 closely matched reported COVID-19 deaths (43 876 vs. 41 835 deaths). Weekly excess mortality, reported COVID-19 deaths and wastewater viral load, when available showed strong temporal synchrony, although excess mortality increasingly exceeded reported COVID-19 deaths during later pandemic waves. Temporal patterns differed from the typical seasonal mortality peaks commonly associated with influenza epidemics during the early months of the year. In 2023, excess mortality declined substantially, possibly indicating a return to mortality levels before the emergence of SARS-CoV-2.

22.
medRxiv (Medicine) 2026-06-23

Default Handling of the Non-Assessable Verbal Glasgow Coma Scale Misclassifies Illness Severity in Mechanically Ventilated Patients: A Retrospective Analysis

Background: The Glasgow Coma Scale (GCS) is a universal neurologic severity score in the intensive care unit and is incorporated into APACHE, SOFA, mortality prediction models, ICU benchmarking, and quality metrics. In mechanically ventilated patients, however, the verbal component cannot be assessed. Common conventions, including assigning a normal total GCS of 15 or excluding patients with missing verbal scores, may misclassify the sickest patients as neurologically normal or remove them from analysis. Objective: To quantify non-assessable verbal GCS examinations after acute brain injury and determine how different handling conventions affect severity scoring and mortality-model performance across two independent critical care databases. Materials and Methods: We conducted a retrospective cohort study of adults with acute brain injury during their first ICU stay in MIMIC-IV, with replication in eICU-CRD. A verbal examination was considered non-assessable when documented as No Response-ETT. We measured the burden and determinants of non-assessability, compared the MIMIC-IV derived GCS convention with a component-aware GCS, and evaluated mortality-model handling strategies. Results: Among 14,230 patients, 45.2% had a non-assessable verbal examination, and 47.5% of ventilated patients had no assessable verbal score in the first 24 hours. Non-assessability was strongly associated with mechanical ventilation and mortality. The MIMIC-IV derived GCS assigned a score of 15 to 42.9% of patients and placed 11.6% in the lowest severity category despite eye and motor findings consistent with GCS [≤]9. Complete-case handling excluded 28.5% of patients, who accounted for 50.2% of deaths. Similar distortions were observed in eICU-CRD/APACHE across 171 hospitals. Discussion: Default-to-normal scoring can make severely ill intubated patients appear neurologically normal, while complete-case analysis removes the highest-risk patients. Conclusion: Non-assessable verbal GCS in mechanically ventilated patients should be explicitly flagged and reported in ICU severity scores, risk-adjusted mortality models, and benchmarking systems.

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

Not All Skills Help: Measuring and Repairing Agent Knowledge

LLM agents can improve without weight updates by accumulating natural-language skills from experience, but current systems entrust every decision about which skills to keep and how to apply them to LLM judgment alone. We argue that this conflates two distinct roles: generating a skill from experience is a creative act that judgment handles well, while deciding whether that skill actually helps requires empirical evidence across many tasks. Measuring per-skill causal contributions via randomized masking, we find that skill libraries exhibit pervasive causal heterogeneity: individual skills routinely help on some task types while hurting on others, yet their opposing effects cancel in aggregate, making them invisible to global curation methods. We propose ASSAY, a framework that separates generation from curation: it computes a per-skill causal attribution on a small development set, restructures the library offline, and suppresses skills with negative predicted effect for each test task. Across seven base models spanning four providers and two benchmarks (AppWorld and tau-bench), ASSAY consistently improves over prior skill-curation approaches. On AppWorld's hardest split, DeepSeek-V3 achieves 69.3% task-goal completion (47.4% relative improvement), a new state of the art among all published methods including weight-tuned approaches. On tau-bench retail, GPT-4.1 improves by 8.7% relative, advancing past o4-mini, o1, and GPT-4.5 on the public leaderboard without any weight modification. Ablation traces the dominant gain to per-task masking, confirming that the bottleneck is matching skills to tasks at inference time, not removing bad skills globally. Code is available at https://github.com/aiming-lab/assay.

24.
arXiv (CS.LG) 2026-06-11

Self-Supervised Multisensory Pretraining for Contact-Rich Robot Reinforcement Learning

arXiv:2511.14427v4 Announce Type: replace-cross Abstract: Effective contact-rich manipulation requires robots to synergistically leverage vision, force, and proprioception. However, Reinforcement Learning agents struggle to learn in such multisensory settings, especially amidst sensory noise and dynamic changes. We propose MultiSensory Dynamic Pretraining (MSDP), a novel framework for learning expressive multisensory representations tailored for task-oriented policy learning. MSDP is based on masked autoencoding and trains a transformer-based encoder by reconstructing multisensory observations from only a subset of sensor embeddings, leading to cross-modal prediction and sensor fusion. For downstream policy learning, we introduce a novel asymmetric architecture, where a cross-attention mechanism allows the critic to extract dynamic, task-specific features from the frozen embeddings, while the actor receives a stable pooled representation to guide its actions. Our method demonstrates accelerated learning and robust performance under diverse perturbations, including sensor noise, and changes in object dynamics. Evaluations in multiple challenging, contact-rich robot manipulation tasks in simulation and the real world showcase the effectiveness of MSDP. Our approach exhibits strong robustness to perturbations and achieves high success rates on the real robot with as few as 6,000 online interactions, offering a simple yet powerful solution for complex multisensory robotic control. Website: https://msdp-pearl.github.io/

25.
arXiv (CS.CV) 2026-06-12

BSViT: A Burst Spiking Vision Transformer for Expressive and Efficient Visual Representation Learning

Spiking Vision Transformers (S-ViTs) offer a promising framework for energy-efficient visual learning. However, existing designs remain limited by two fundamental issues: the restricted information capacity of binary spike coding and the dense token interactions introduced by global self-attention. To address these challenges, this work proposes BSViT, a burst spiking-driven Vision Transformer featuring a Dual-Channel Burst Spiking Self-Attention (DBSSA) mechanism. DBSSA encodes queries with binary spikes and keys with burst spikes to enhance representational capacity. The value pathway adopts dual excitatory and inhibitory binary channels, enabling signed modulation and richer spike interactions. Importantly, the entire attention operation preserves addition-only computation, ensuring compatibility with energy-efficient neuromorphic hardware. To further reduce spike activity and incorporate spatial priors, a patch adjacency masking strategy is introduced to restrict attention to local neighborhoods, resulting in structure-aware sparsity and reduced computational overhead. In addition, burst spike coding is systematically integrated across the network to increase spike-level representational capacity beyond conventional binary spiking. Extensive experiments on both static and event-based vision benchmarks demonstrate that BSViT consistently outperforms existing spiking Transformers in accuracy while maintaining competitive energy efficiency.