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01.
medRxiv (Medicine) 2026-06-22

REPRODUCIBILITY OF 7T MRI MEASUREMENTS OF THE SUSCEPTIBILITY AND VOLUME OF HIPPOCAMPAL SUBFIELDS

PURPOSE: The UK7T travelling head dataset was used to characterise the reproducibility of 7T measurements of the susceptibility of the hippocampal subfields, focusing on the Cornu Ammonis (CA1, CA2 and CA3), dentate gyrus (DG), subiculum (SUB), tail of the hippocampus (TAIL) and entorhinal cortex (ERC). METHODS: Susceptibility maps were created from whole-brain 3D single-echo GRE data (TE=20 ms; 0.7 mm isotropic resolution) using Multi-Scale Dipole Inversion. Automatic Segmentation of Hippocampal Subfields (ASHS) was applied to high resolution T1- and T2-weighted images for segmentation. The mean magnetic susceptibility and volume of hippocampal subfields was evaluated in 50 data sets, comprising 5 repeat acquisitions on 10 healthy participants (age 32 + or -6 years; 3 female). RESULTS: Averaging over subjects, susceptibility values spanned an 18ppb range over the hippocampus (ranging from -13.3ppb in DG to 4.7ppb in ERC). Susceptibility values in the larger hippocampal subfields showed a consistent pattern of variation across subjects, being generally more positive in ERC and SUB than in CA1 and more positive in CA1 than in DG and TAIL. The standard deviation of subfield susceptibilities over subjects ranged from 8.2ppb in the TAIL to 1.7ppb in CA1, and the average standard deviation across repeated measurements, which ranges from 1.7 to 4 ppb, was less than half of the inter-participant standard deviation in all subfields. Susceptibility values in the smaller subfields (CA2 and CA3) were more variable, but ICC(2,k) values for all subfields were >0.82. CONCLUSION: The reported data characterises the variation and reproducibility of hippocampal subfield susceptibility measurements at 7T.

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

A Clinician-Centered Pipeline for Annotation and Evaluation in Ultrasound AI Studies

arXiv:2606.19174v1 Announce Type: cross Abstract: Clinician-centered evaluation is critical for validating medical AI systems, especially in ultrasound imaging where quantitative metrics do not always capture clinical usability. Existing medical image platforms primarily focus on dataset labeling. They lack integrated support for blinded model comparison and reproducible evaluation workflows. We present a clinician-centered pipeline for remote annotation and evaluation in ultrasound AI studies. The proposed pipeline uses a centralized server and lightweight browser interfaces to enable clinicians to perform annotation, blinded ranking, and review without local dataset downloads. The pipeline also supports multi-rater participation, centralized result aggregation, and automated statistical analysis. We validate the pipeline in a fetal ultrasound segmentation study with six raters spanning expert, generalist, and non-expert experience levels. The system automatically generated Spearman correlation, Kendall's $\tau$, and top-1 selection statistics. Results indicated moderate to strong agreement across experts and other groups. The blinded evaluation results showed a tendency for later active learning models to be preferred. These outcomes suggest that the pipeline can support clinician-centered annotation and reproducible human-\ac{AI} evaluation studies in ultrasound imaging. The proposed pipeline is available on \href{https://github.com/13204942/SonoRate}{GitHub}.

03.
medRxiv (Medicine) 2026-06-10

Human genetic evidence links serine biosynthesis to diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN) is a common and disabling condition for which no disease-modifying therapies are available. Glycemic and metabolic drivers do not fully explain why only a subset of individuals with diabetes develop DPN, and genetic contributors remain poorly defined. We aimed to perform a multi-population genome-wide association study (GWAS) of DPN to highlight potential new etiological pathways and therapeutic targets. Methods We performed a multi-population GWAS of neuropathy in people with and without diabetes using the VA Million Veteran Program and UK Biobank, followed by replication in the All of Us Research Program (AoU), and gene-based and gene-set analyses to identify implicated pathways. Causal relationships between circulating serine levels and DPN were further tested using two sample Mendelian randomization. To further evaluate pathogenic potential, we analyzed rare, high impact variants in GWAS implicated genes among individuals with unresolved inherited neuropathies using the GENESIS platform. Findings Among individuals with type 2 diabetes, we identified seven genome wide significant loci (p

04.
arXiv (CS.LG) 2026-06-19

Shifting-based Optimizable Linear Relaxations for General Activation Functions

arXiv:2606.20292v1 Announce Type: new Abstract: The use of neural networks (NNs) is rapidly increasing, including in safety- and security-critical domains. To provide formal guarantees about NN behavior, many verification methods rely on optimizable linear relaxations of activation functions. However, existing techniques depend on hand-crafted relaxations for each activation function. Extension to state-of-the-art activation functions therefore requires substantial manual effort. In contrast, our approach SLiR (Shifting-based Linear Relaxations) is broadly applicable, requiring only a Lipschitz constant or a set of critical points. SLiR parameterizes relaxations by their slope and computes the corresponding offset via a shifting procedure that ensures sound upper and lower bounds over the input domain, enabling efficient optimization while maintaining correctness. Our experiments show that SLiR produces tight relaxations across a wide range of practical activation functions and enables verification of up to 7.8x more properties compared to state-of-the-art methods.

05.
arXiv (CS.AI) 2026-06-18

Structured Cognitive Loop for Behavioral Intelligence in Large Language Model Agents (Extended Revision: From Behavioral Architecture to Epistemic Accountability)

Authors:

arXiv:2510.05107v5 Announce Type: replace Abstract: The central challenge for AI agents is not only performance but accountability. Agents that act through opaque prompt sequences may produce correct outputs, but they provide little basis for verifying why an action was permitted, where an error occurred, or how responsibility should be assigned. This paper presents the Structured Cognitive Loop as an architecture for accountable behavior in large language model agents. SCL separates cognition, memory, control, and action into distinct modules. The language model proposes. External memory preserves verified state. A lightweight controller checks preconditions, prevents redundant actions, and authorizes execution before tools are used. We evaluate SCL against ReAct and common LangChain agent variants across travel planning, conditional email drafting, and constraint guided image generation. Across 360 episodes, SCL achieves 86.3 percent task success compared with 70.5 to 76.8 percent for prompt based baselines. It also improves goal fidelity, reduces redundant tool calls, increases reuse of intermediate state, and lowers unsupported assertions. This extended revision situates SCL within a broader architecture of epistemic accountability. Subsequent extensions integrate context aware Human in the Loop control, Pool Gated Retrieval, and the Horizon Warrant Commitment framework. Together these components define an agent architecture in which the model proposes, structure decides, evidence is warranted before use, and human judgment is embedded in the trace rather than imposed after the fact. The result is a foundation for AI agents whose decisions are not only effective but also authorized, inspectable, and accountable.

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

Impact of Hand Impairment and Occlusions on Hand Pose Estimation Accuracy in Augmented Reality Applications

Mixed reality applications can be designed for hand rehabilitation. Augmented reality (AR) head mounted displays (HMDs) specifically allow for ecologically valid tasks because individuals can see their real environment and interact with real objects while receiving additional cues on the HMD. While these applications rely on accurate hand pose estimation, there is a gap in investigating the influence of hand impairment or occlusion from real-object interactions on pose estimation accuracy. Further, comparisons between AR HMD predictions and state-of-the-art pose estimation methods have not been established. The current study assessed pose estimation accuracy of the HoloLens 2 HMD and state-of-the-art pose estimation algorithms (WiLoR, HaMeR, WildHands, and MediaPipe) while individuals with cervical spinal cord injury (cSCI; n = 13, Neurological Level of Injury: C3-C6; American Spinal Injury Association Impairment Scale: A-D) and 15 uninjured controls interacted with clear and opaque objects. Ground truth estimates of 3D joint positions were generated via triangulation from a multi-camera setup. Pose estimation accuracy did not differ between the cSCI and uninjured control groups suggesting that 3D joint predictions from the HoloLens 2 and pose estimation algorithms can generalize to populations with hand impairment. Further, clear objects provided a small accuracy advantage over opaque objects (0.1 mm) and predictions from both WiLoR and HaMeR were slightly more accurate than the HoloLens 2 (2 mm). Overall, these results suggest that the HoloLens 2 may be viable for hand rehabilitation applications and the dataset generated can be used to refine pose estimation methods for hand-impaired populations.

07.
arXiv (CS.AI) 2026-06-17

ANEForge: Python for direct computation on the Apple Neural Engine

arXiv:2606.17090v1 Announce Type: cross Abstract: ANEForge is a Python package that programs the Apple Neural Engine (ANE), the fixed-function neural accelerator on every recent Apple device, directly and without CoreML. In production the engine is reachable only through CoreML, which treats it as a scheduling option: no configuration requires the ANE, and a model can silently run on the CPU or GPU instead. ANEForge compiles a lazy tensor graph, built from 58 fused operators and 19 native bridge operators, into a single ANE program. The program is dispatched through the same ANE daemon and kernel-driver stack as Apple's internal framework. Beyond inference, the package reaches the engine's native fused attention, streams int8, int4, and sparse weights, keeps decoder and optimizer state resident across steps, and runs the forward pass, backward pass, and optimizer update of training on the engine. A small fused program completes a call in about 90us, near the engine's 70us per-program dispatch floor, and a pretrained ResNet-18 forward runs end-to-end in 0.33ms. ResNet-18, a sentence encoder, and a Vision Transformer run end-to-end against framework references, and a Stable Diffusion U-Net validates its forward pass. ANEForge targets Apple Silicon under macOS 14 and later. Each release is verified against a recorded macOS and ANE-compiler version.

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

Beyond NL2Code: A Structured Survey of Multimodal Code Intelligence

While LLMs have substantially advanced text-to-code synthesis, many real programming tasks specify intent through visual artifacts such as screenshots, charts, documents, vector drawings, videos, and interactive states. These tasks require models to connect visual perception to executable programs, because correctness depends not only on syntax but also on layout, geometry, data semantics, editability, interaction behavior, and domain-specific constraints that apply after execution. This survey examines Multimodal Code Intelligence, covering systems that generate, edit, refine, execute, or reason with code under visually grounded inputs and outputs. We first formulate the field by the role that code plays in each task, distinguishing code as a rendered artifact, an editable symbolic structure, a scientific representation, an intermediate reasoning trace, or an executable policy or tool interface. We then organize benchmarks and methods into four domains: Graphical User Interface, Scientific Visualization, Structured Graphics, and Frontier Tasks and Frameworks. This taxonomy connects mature artifact-generation problems to emerging agentic and unified settings and allows us to compare how different tasks treat evidence of correctness. Looking ahead, we argue that future research may benefit from four verification-centered directions. Multi-signal validation can combine complementary evidence of correctness, multi-state verification can test behavior across execution trajectories, cross-task transfer testing can probe reusable visual-code skills, and verifiable agent traces can reveal whether agent actions are grounded in visual evidence. Together, these directions may move multimodal code generation from single-output imitation toward evidence-grounded executable systems.

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

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

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

10.
arXiv (quant-ph) 2026-06-12

Interference of critical dynamics associated with zero modes

arXiv:2606.13200v1 Announce Type: new Abstract: We study the interference of critical dynamics associated with zero modes (ICDZM) in the generalized Creutz ladders using closed quench paths that pass through two critical points successively. By reading out the final zero-mode transfer probability, we find rich ICDZM interference patterns dependent on the quench path. In particular, when the closed path links two topologically nontrivial phases, the ICDZM pattern may either vanish or exhibit period doubling. Within the framework of WKB analysis, this phenomenon is well clarified by the interference phase accumulated in the quench procedure. We also demonstrate that the zero-mode transfer probability can be detected by the deviation of the boundary particle number from its initial fractional value, which arises from the blending of bulk modes in the critical dynamics. As an edge defect, the zero-mode transfer probability captures both the ICDZM oscillation and the known anomalous defect production in a non-closed quench path. These results identify ICDZM and the corresponding edge defect as probes for critical dynamics associated with topological zero modes.

11.
Nature (Science) 2026-06-08

Targeting Cancer-Specific Mutations with RNA-Triggered Chromatin Shredding

Authors:

Genetic mutations that drive cancer often occur in tumor suppressor proteins, including the p53 transcription factor which is altered in ~40-50% of cases1,2. However, current therapies fail to target most such mutations because the mutant proteins typically lack defined drug-binding pockets, and restoring the endogenous function has proven challenging. Here, we programmed CRISPR-Cas12a2, an RNA-guided nuclease with trans-nucleolytic cleavage activities3,4, to selectively kill cancer cells by targeting cancer-specific transcripts. This approach limits cell growth by inducing trans shredding of chromatin, triggering DNA damage responses and cell death. Unlike existing methods, RNA-guided Cas12a2 senses cellular RNA signatures, enabling precise targeting of undruggable mutations. Transcript-activated chromatin shredding provides a new approach to precision disease treatments for undruggable targets.

12.
Nature (Science) 2026-06-17

A mosaic of whole-body representations on the human precentral gyrus

Authors:

Understanding how the body is represented in the motor cortex is key to understanding how the brain controls movement. Although the motor cortex has been mapped in animal models at a fine scale1–10, characterization in humans remains primarily limited to low-resolution recording11–16 and stimulation techniques17–20. Here we created a comprehensive map of the human motor cortex at single-neuron resolution, spanning microelectrode array recordings from 20 arrays across 8 individuals with paralysis from spinal cord injury, amyotrophic lateral sclerosis or brainstem stroke, all enrolled in brain–computer interface clinical trials. These arrays broadly sample the crown of the precentral gyrus (PCG; thought to be composed largely of the premotor cortex (Brodmann area 6)). We found that body parts were highly intermixed, such that the entire body was represented in all sampled locations of the PCG, although the relative strength of body parts was roughly consistent with the motor homunculus17,18. We also found two speech-preferential areas with a broadly tuned, orofacial-dominant area in between them. Throughout the PCG, movement representations of the four limbs were interlinked, with homologous movements of different limbs (for example, toe curl and hand close) having correlated representations. These data provide evidence consistent with an intermixed, interrelated and behaviour-centred organization of the motor cortex3,21. The resulting map also provides important targeting information for brain–computer interfaces that seek to restore motor function. A comprehensive map of the human motor cortex at single-neuron resolution is described.

13.
arXiv (CS.LG) 2026-06-16

Context-Aware Markov VAE for CSI Compression in Wireless Systems

arXiv:2606.16607v1 Announce Type: cross Abstract: This paper considers neural channel state information (CSI) compression for time-varying massive multiple-input multiple-output (MIMO) channels in frequency division duplex (FDD) systems with limited feedback resources. The main challenge lies in obtaining a compact and efficient representation of the CSI given that it exhibits strong temporal correlation across successive snapshots. Existing memoryless compression models do not exploit this property, while simple temporal extensions often incorporate multiple observations without explicitly modeling the latent dynamics. We propose a context-aware compression framework based on a k-memory Markov variational autoencoder (k-MMVAE), which uses a finite temporal window to capture the evolution of CSI in the latent space. The model introduces Markov-structured latent dynamics with finite memory, enabling efficient use of temporal dependencies for compression. Simulation results show that the proposed approach improves target CSI reconstruction performance compared to memoryless and weakly sequential baselines, particularly at low and moderate compression rates. These results suggest that explicit latent temporal modeling can provide an effective mechanism for CSI compression under limited feedback constraints.

14.
arXiv (CS.CL) 2026-06-15

Detecting Historical Turning Points in Italian Media: A Complex Systems Approach to a Diachronic News Corpus

The increasing availability of large-scale textual corpora has opened new possibilities for data-driven, quantitative approaches to historical analysis using Natural Language Processing (NLP). However, diachronic corpora with historical relevance from the pre-digital era remain scarce and often incomplete. We present a quantitative approach to historical analysis based on the reconstruction and exploration of a diachronic corpus of around 600,000 articles from the Italian newspaper "La Repubblica", covering all the articles published from the 1st of January 1985 to the 31st of December 2000 - a period of major political, social, and geopolitical change in Italy and globally. Using NLP techniques, we analyze the text at both lexical and semantic levels; we then apply tools from complex systems and statistical physics to trace shifts in media discourse over time. This allows us to detect key transition periods, such as the transition from the First Republic to the Second Republic in Italy, or major international conflicts like the Gulf War or the Kosovo War, without relying on prior labeling. The results show how combining computational linguistics with ideas from complex systems can offer new quantitative insight into historical changes, opening up new paths for studying the dynamics of media and society through large-scale textual data.

15.
arXiv (CS.CV) 2026-06-17

RAIGen: Rare Attribute Identification in Text-to-Image Generative Models

Text-to-image diffusion models achieve impressive generation quality but inherit and amplify training-data biases, skewing coverage of semantic attributes. Prior work addresses this in two ways. Closed-set approaches mitigate biases in predefined fairness categories (e.g., gender, race), assuming socially salient minority attributes are known a priori. Open-set approaches frame the task as bias identification, highlighting majority attributes that dominate outputs. Both overlook a complementary task: uncovering rare or minority features underrepresented in the data distribution (social, cultural, or stylistic) yet still encoded in model representations. We introduce RAIGen, the first framework, to our knowledge, for label-free rare-attribute discovery in diffusion models, requiring no predefined minority categories. RAIGen leverages Matryoshka Sparse Autoencoders and a novel minority metric combining neuron activation frequency with semantic distinctiveness to identify interpretable neurons whose top-activating images reveal underrepresented attributes. Experiments show RAIGen discovers attributes beyond fixed fairness categories in Stable Diffusion, scales to larger models such as SDXL, supports systematic auditing across architectures, and enables targeted amplification of rare attributes during generation. The project page is available at https://vssilpa.github.io/RAIGen_webpage/ .

16.
arXiv (CS.CV) 2026-06-17

BrainWorld: A Structural-Prior-Conditioned Generative Model for Whole-Brain 4D fMRI Dynamics

Whole-brain 4D fMRI generation is valuable for modeling functional brain dynamics, yet existing fMRI foundation models mainly target representation learning and downstream prediction rather than conditional predictive generation. We introduce BrainWorld, a structural-prior-conditioned generative model for whole-brain 4D fMRI dynamics. BrainWorld uses sMRI as subject-level anatomical context to guide future fMRI generation, integrating structural information into the denoising process rather than treating it as a parallel modality. Evaluated on 22 datasets spanning diverse cohorts and brain states, BrainWorld generates stable 4D fMRI trajectories up to 400 frames, improves downstream performance through generated-example augmentation, and learns transferable multimodal representations that outperform baselines. Together, these results establish BrainWorld as a condition-aware generative framework for long-horizon brain dynamics modeling and multimodal representation learning.

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

Entity Binding Failures in Speech LLM Reasoning: Diagnosis and Chain-of-Thought Intervention

Speech Large Language Models (SLLMs) underperform their text counterparts on complex reasoning. We reveal that this gap is not a uniform cognitive deficit. Evaluating two architecturally diverse SLLMs, we show speech-to-text (S2T) matches or exceeds text-to-text (T2T) on spatial, syntactic, and factual tasks. Yet on logical tasks requiring entity tracking, S2T accuracy collapses to chance. We diagnose this as an entity binding failure: continuous speech features blur precise entity-property associations during implicit reasoning. To validate this diagnosis, we introduce Entity-Aware Chain-of-Thought (EA-CoT), a lightweight inference-time intervention forcing SLLMs to enumerate entities and bind them to claims before reasoning. EA-CoT bridges the gap, even when spoken names are misrecognized, yielding up to a 24.4 percentage-point accuracy gain. Ablations confirm the gains stem from explicit semantic binding, reframing the gap as an elicitation failure rather than a missing capability.

18.
Nature (Science) 2026-06-22

Stereoretentive decarbonylative C(sp<sup>3</sup>)-C(sp<sup>3</sup>) cross-coupling

Authors:

While C(sp3)–C(sp3) bond-forming cross-coupling methods have become more common, stereocontrolled bond-formation remains a challenge,1 despite its importance for drug discovery, where there is a emerging demand for molecules with increased sp3 character.2-4 Enantiospecific cross-coupling approaches would complement advances in enantioselective coupling,5-8 but have been limited to specialized substrates with lower availability5,9 because stereospecific oxidative addition of more abundant chiral alkyl electrophiles is unknown.10 Inspired by the classic, stereoretentive Curtius rearrangement,11 herein we disclose a catalytic strategy that proceeds by an analogous stereoretentive decarbonylation step to form a versatile chiral alkylnickel intermediate from easily-available chiral amino-acid and α-hydroxy-acid derivatives. The chiral alkylnickel intermediates decompose and/or racemize on the order of minutes, but are sufficiently stable to enable stereoretentive cross-electrophile coupling12 with alkyl radicals (derived from alkyl iodides) at relatively low temperature (22-40 °C). This mechanistic strategy provides a straightforward approach to stereocontrolled C(sp3)–C(sp3) bond formation, including diastereomers that are inaccessible by stereoselective radical mechanisms. The “metallo-Curtius” strategy described in this study lays a mechanistic foundation for the development many new stereospecific cross-coupling reactions.

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

Offline Reinforcement Learning for Warehouse SLAM Throughput Control

arXiv:2606.23978v1 Announce Type: cross Abstract: We present an offline reinforcement learning (RL) framework for optimizing SLAM throughput control in a warehouse fulfillment environment. SLAM (Scan/Label/Apply/Manifest) throughput directly influences system congestion and operational efficiency. Our RL-based control approach dynamically recommends SLAM throughput settings that adaptively balance throughput maximization with downstream stability through intelligent adjustment of throttling behavior. We include a history-informed state representation, action space abstraction for delayed-impact control, and a reward function that captures both upstream and downstream operational metrics. Our approach is algorithm-agnostic, enabling integration of multiple offline RL methods under a unified architecture. We instantiate our framework with three state-of-the-art offline RL algorithms, and trained the models offline using de-identified historical operational logs from a large-scale warehouse. Policy performance is evaluated using a comprehensive multi-method strategy. These include model-free approaches including immediate reward estimation via regression models and long-horizon Fitted Q Evaluation (FQE), as well as model-based Deep Koopman dynamics evaluation. Empirical results reveal that the CQL policy consistently outperforms alternatives, improving system health by 22.97% and reducing average throttling duration by 3.18%. These findings demonstrate the potential of offline RL for safe and scalable warehouse throughput control optimization.

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

When Does Trajectory-Level Supervision Permit Efficient Offline Reinforcement Learning?

arXiv:2606.18531v1 Announce Type: cross Abstract: Offline reinforcement learning is typically analyzed under process-level reward supervision, yet many sequential decision datasets record only trajectory-level outcomes. We develop a statistical theory for offline policy optimization from such outcome-level supervision. We first study the canonical setting where the target remains the expected cumulative reward, but each offline trajectory provides only a scalar label whose conditional mean is the cumulative return. We propose OPAC, a pessimistic actor-critic algorithm that learns a latent reward model and optimizes a policy from trajectory-level labels. We prove a high-probability guarantee of order $\widetilde O(H^2\sqrt{C_{sa}(\pi^\star)/n})$ and a matching lower bound, characterizing the sharp statistical cost of replacing process-level rewards with one trajectory-level label. We then extend the principle to preference-based feedback, preserving the leading horizon and concentrability dependence up to preference-model constants. Finally, we study generalized outcome-based offline RL, where both the supervision and the objective are trajectory-level quantities induced by a nonlinear aggregation of latent per-step rewards. This problem is not learnable in general: for all-success objectives, any offline learner may require $\Omega(2^H)$ trajectories even with deterministic transitions and constant concentrability. We then identify a tractable regime through two structural coefficients, $\kappa_\mu(\sigma)$ and $\chi_\mu(\sigma)$, capturing information loss in outcome aggregation and generalized Bellman updates, under which generalized OPAC achieves polynomial sample complexity. Together, our results delineate when outcome-level supervision enables sample-efficient offline control and when missing process-level rewards create fundamental statistical barriers.

21.
medRxiv (Medicine) 2026-06-23

Agentic Autodiscovery of Diastolic Dysfunction Phenotypes from Surface Electrocardiogram

Background: Left ventricular diastolic dysfunction (LVDD) is a major determinant of heart failure (HF), yet its assessment relies on multiparametric echocardiography, limiting scalability. We previously demonstrated that generative artificial intelligence (AI) can synthesize tissue Doppler imaging (TDI) waveforms from the 12-lead ECG. The growing complexity of candidate architecture creates a need for automated model-discovery frameworks. Objectives: To evaluate agentic AI-based auto-discovery for ECG-based LVDD assessment using either raw ECG or synthetic TDI waveforms. Methods: Two attention-based agentic AI architectures were developed using an automated large language model-driven refinement framework that optimized transfer-learning and multimodal architectures through autonomous proposal, validation, and selection of candidate model configurations. Development was performed in 1,011 paired ECG-echocardiography studies and externally validated in 983 patients using two reference frameworks: (i) data-driven phenogroups and (ii) the 2025 ASE Diastolic Function Guidelines. External validation was performed in CODE-15% (n=219,567) for HF-related mortality and EchoNext (n=35,718) for structural heart disease associations. Results: Despite the modest cohort size, the ECG-based agentic search achieved area under the receiver operating characteristic curve (AUCs) of 0.87 (95% CI: 0.85-0.89) and 0.83 (95% CI: 0.80-0.86) for phenogroup and guideline-based LVDD severity classification. Corresponding AUCs for the synthetic TDI-based model were 0.82 (95% CI: 0.80-0.85) and 0.80 (95% CI: 0.77-0.84), respectively. In large-scale external validation, both models stratified incident HF mortality with subdistribution hazard ratios ranging 5.5 to 9.5 (Gray's p

22.
arXiv (CS.AI) 2026-06-19

SleepMaMi: A Universal Sleep Foundation Model for Integrating Macro- and Micro-structures

arXiv:2602.07628v2 Announce Type: replace Abstract: While the shift toward unified foundation models has revolutionized many deep learning domains, sleep medicine remains largely restricted to task-specific models that focus on localized micro-structure features. These approaches often neglect the rich, multi-modal context of Polysomnography (PSG) and fail to capture the global macro-structure of a full night's sleep. To address this, we introduce SleepMaMi , a Sleep Foundation Model engineered to master both hour-long sleep architectures and fine-grained signal morphologies. Our framework utilizes a hierarchical dual-encoder design: a Macro-Encoder to model full-night temporal dependencies and a Micro-Encoder to capture short-term characteristics from biosignals. Macro-Encoder is trained via Demographic-Guided Contrastive Learning, which aligns overnight sleep patterns with objective subject metadata, such as age, sex and BMI to refine global representations. Micro-Encoder is optimized via a hybrid Masked Autoencoder (MAE) and multi-modal contrastive objective. Pre-trained on a massive corpus of $>$20,000 PSG recordings (158K hours),SleepMaMi outperforms or matches state-of-the-art existing foundation models across a diverse suite of downstream tasks, demonstrating superior generalizability and label-efficient adaptation for clinical sleep analysis.

23.
medRxiv (Medicine) 2026-06-22

Artificial Intelligence-Enabled Cardiac Function Estimation from Phone Videos of Echocardiograms

Importance: Mobile phone-recorded echocardiogram videos are commonly used in point of care, telemedicine, and resource-limited workflows, but artificial intelligence models for left ventricular ejection fraction (LVEF) estimation have primarily been evaluated on native Digital Imaging and Communications in Medicine (DICOM) videos. Objective: To evaluate whether previously described artificial intelligence models for LVEF estimation retain performance when applied to mobile phone-recorded echocardiographic videos. Design: Multicenter model validation study comparing model-estimated LVEF with clinician reported LVEF. Setting: Three medical centers: Kaiser Permanente Northern California, Beth Israel Deaconess Medical Center through MIMIC-IV-ECHO, and Cedars-Sinai Medical Center. Participants: Source studies with clinician reported LVEF and apical 4-chamber or apical 2-chamber views, yielding 6209 phone-recorded videos from 2648 studies and 2611 patients. Exposures: Mobile phone recording of native echocardiographic videos and fine-tuning of pretrained models using mobile phone-recorded videos from the Kaiser Permanente Northern California training cohort. Main Outcomes and Measures: Mean absolute error in ejection fraction percentage points, R^2 for continuous estimation, and area under the receiver operating characteristic curve for identifying ejection fraction greater than 50%. Results: The study included 6209 mobile phone recorded echocardiographic videos from 2648 studies and 2611 patients; the weighted mean age was 68.4 years, and 1031 patients were male (39.5%). Without phone-video fine-tuning, the primary model achieved a mean absolute error of 7.00 percentage points, coefficient of determination of 0.49, and area under the receiver operating characteristic curve of 0.91 on phone-recorded videos; corresponding native DICOM performance was 6.08 percentage points, 0.60, and 0.93, respectively. On the 2396-video fine-tuning evaluation cohort, fine-tuning improved primary model performance to a mean absolute error of 6.96 percentage points, coefficient of determination of 0.61, and area under the receiver operating characteristic curve of 0.93. Fine-tuning the public EchoNet-Dynamic model improved performance from 9.36 percentage points, 0.37, and 0.84 to 7.86 percentage points, 0.50, and 0.89, respectively. Progressive central zoom preprocessing degraded model performance. Conclusions and Relevance: These findings suggest that artificial intelligence assisted left ventricular ejection fraction estimation from mobile phone-recorded echocardiograms may be feasible when native image export is unavailable, although prospective evaluation is needed before clinical deployment.

24.
arXiv (CS.CL) 2026-06-17

GameCraft-Bench: Can Agents Build Playable Games End-to-End in a Real Game Engine?

Game generation is an emerging application of coding agents, requiring models to transform natural-language specifications into playable interactive systems. Unlike traditional coding tasks, game generation takes place within a game engine, where scripts, scenes, assets, rendering, and runtime interactions must jointly produce coherent gameplay. We formalize end-to-end game generation as the problem of producing a complete game artifact that realizes a specification through observable player-game interaction in a target environment. We argue that evaluating this setting requires three desiderata: Engine Grounding, Artifact Completeness, and Interactive Verification. We propose an interaction-grounded evaluation framework that assesses executable gameplay through replayed demonstrations and rubric-guided multimodal judging. We instantiate this framework as GameCraft-Bench, a benchmark comprising 140 Godot tasks across 15 game families. Evaluations of frontier coding agents show that end-to-end game generation remains highly challenging: the strongest agent achieves only 41.46%, and most agents score below 40%. Further analysis reveals that while agents often implement recognizable mechanics, they struggle to deliver complete games with sufficient content, functional visual feedback, and coherent presentation. See https://tongxuluo.github.io/gamecraft-bench-website for demos, code, and data.

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

Iterating Toward Better Search: A Two-Agent Simulation Framework for Evaluating Agentic Search Architectures in E-Commerce

arXiv:2606.12924v1 Announce Type: new Abstract: We present a modular two-agent simulation framework for evaluating conversational shopping assistant architectures. An independent buyer agent, configured with personas, missions, and patience levels, is paired with an interchangeable responder that integrates with a real e-commerce search API. Holding the buyer constant across experiments enables controlled comparison of responder designs on identical scenarios. Using 2011 conversations across 14 persona buckets, we establish four empirical findings. First, rolling-window memory outperforms intent-extraction memory on all quality metrics while being 35% faster per query. Second, illustrating rapid evidence-driven iteration, a systematic failure analysis of a responder version enables targeted fixes that reduce failure and near-failure rates by 62% across the full dataset. Third, swapping the responder LLM backbone from Gemini~2.5 to Llama~3.3~70B costs 0.16–0.45 points despite identical architecture. Finally, we document systematic philosophical disagreement between frontier LLM judges: Gemini rewards process correctness while Claude demands concrete outcomes, despite using the same evaluation prompt.