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01.
arXiv (CS.CV) 2026-06-24

Multilevel Stochastic Plug-and-Play for Sparse-View CT Reconstruction

Sparse-view computed tomography (SVCT) reduces radiation exposure and acquisition time, but the limited number of projection views makes the reconstruction problem severely ill-posed and leads to streak artifacts when analytical methods are used. Plug-and-Play (PnP) methods provide an effective way to combine data fidelity with learned image priors, while stochastic PnP methods further improve robustness by matching the denoiser input distribution through re-noising. However, these methods often require many iterations to converge, which limits their practical efficiency. In this work, we propose a multilevel (ML) stochastic PnP method for SVCT that accelerates stochastic PnP reconstruction. We highlight that, in the stochastic setting, directly enforcing prior coherence across levels would require accurately estimating fine-level prior gradients through multiple denoiser function evaluations, which substantially increases the computational cost. Motivated by this observation, we perform the multilevel steps in multiresolution analysis (MRA) approximation spaces. This choice is supported by the structure of the wavelet decomposition, which causes the prior-coherence correction to vanish in expectation, thereby avoiding costly estimation of fine-level stochastic prior gradients for the coarse-level corrections. Experiments on SVCT reconstruction show that our method, called Multilevel Stochastic Plug-and-Play (ML-SPnP), achieves reconstruction quality comparable to state-of-the-art methods while substantially reducing runtime.

02.
arXiv (CS.CL) 2026-06-16

Prior over Evidence: Stereotype-Driven Diagnosis in LLM-Based L2 Pronunciation Feedback

Large language models are increasingly deployed for written pronunciation feedback in second-language (L2) English learning, under the assumption that their diagnoses are grounded in the supplied speech evidence rather than in priors from pretraining. This assumption is tested on 1,800 L2-Arctic utterances spanning six L1 backgrounds, three audio-capable LLMs, four pronunciation dimensions, and five evidence conditions ranging from a text-only baseline to numeric acoustic features and raw audio. Each (utterance x model x condition x dimension) cell is scored on three metrics: Rating Accuracy (RA) against gold labels, Evidence Coherence (EC) assessing internal consistency without ground truth, and Grounded Correctness (GC) evaluated against gold evidence. Results show three findings across models. First, rating accuracy and grounded reasoning decouple: 39.6% of judged cells contain internally coherent reasoning that supports a wrong rating, against only 15.8% where the reasoning supports a correct rating. Second, phoneme-level feedback converges to a fixed inventory of L2-English difficulty phones that recurs across all six L1 backgrounds and all evidence conditions. Third, acoustic evidence improves the rating only when the supplied feature directly probes the target dimension: textualised F0 range raises pitch-variation grounding from (0.18-0.19) to (0.45-0.62) across all three models, while stress and phoneme correctness, which require target-to-realisation alignment, remain ungrounded. The same audio waveform without textualised F0 values does not reproduce this improvement. These findings indicate that current general-purpose LLMs are more reliable as verbalisers of externally computed pronunciation evidence than as standalone diagnostic engines.

03.
medRxiv (Medicine) 2026-06-15

The clinical utility of functional testing in fibroblasts to diagnose primary mitochondrial disease

Genome sequencing of the heterogeneous primary mitochondrial disorders (PMD) frequently reveals variants of uncertain significance that require functional tests for diagnosis, and does not identify variants in all patients. We analyzed mitochondrial enzyme assays, blue native polyacrylamide gel electrophoresis (BN-PAGE) with in-gel activity staining, complex I assembly blot, and select protein abundances in fibroblasts of a case series of 204 PMD patients divided into functional classes, in comparison to 51 controls and 53 differential diagnostic conditions. Overall, sensitivity and specificity for respiratory chain enzyme assays were 46% and 93% respectively, for BN-PAGE 40% and 98%, for complex I assembly assay 49% and 99%. The overall sensitivity of all tests was 76%, specificity 93%, with positive predictive value 96% and negative predictive value 67%. Categories with high sensitivity were isolated complex deficiencies, nuclear DNA-encoded mitochondrial protein synthesis defects, co-factor defects, and mitochondrial amino-acyl-tRNA synthetase conditions when aided by protein abundance. Mitochondrial DNA mutations and maintenance disorders showed poor sensitivities. Secondary dysfunctions were rare. A complete battery of functional tests showed strong diagnostic clinical utility in fibroblasts.

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

REACH: Interpretability-Driven Feature Identification and Architecture Compression for Multi-Channel Vehicular Channel Estimation

arXiv:2606.11857v1 Announce Type: cross Abstract: Multi-channel mixed-SNR training improves out-of-distribution (OOD) generalisation of deep learning channel estimators for IEEE 802.11p vehicular communications, yet the internal mechanism responsible for this remains unexplained. This work presents REACH (Relevance-based Explanation and Architectural Compression for cHannel estimators), a gradient-based interpretability framework that operates at two levels. Input-level attribution identifies a subset of time-frequency features consistently relevant across all evaluated channel conditions, enabling input dimensionality reduction with minimal performance loss. Filter-level attribution reveals a near-universal internal representation, providing a representational account of the observed OOD generalisation. Guided by the resulting filter taxonomy, relevance-guided architecture compression substantially reduces both the number of parameters and the number of floating-point operations (FLOPs) with sub-1 dB normalised mean square error (NMSE) degradation, and OOD generalisation degrades more slowly than within-distribution accuracy under increasing compression.

05.
Nature (Science) 2026-06-24

Ductile alloys offering 100 MPa tensile strength at 2,400 °C

Authors:

Extreme applications call for materials that are not only strong to withstand thermomechanical loads at temperatures in excess of 2,000 °C (refs. 1–3), but also highly formable at room temperature to allow for processing into complex-shaped parts. The latter excludes brittle ceramics4 and intermetallic compounds5, limiting the selection to highly ductile metals and their alloys, but for them, an adequate strength at ultrahigh temperatures seems unreachable. Here we show a breakthrough in casting alloys that achieve both simultaneously. A boron-stabilized HfO2-strengthened Ta-based alloy was carefully crafted using a new boron-intervened in situ oxidation reaction, producing about 50-nm diameter oxide particles dispersed densely and uniformly in the grain interior. The new alloy fills the blank at ultrahigh temperatures in terms of tensile yield strength, around 200 MPa at 2,000 °C and 100 MPa at 2,400 °C, while simultaneously possessing an excellent strength–ductility balance at room temperature (ultimate tensile strength >800 MPa, elongation-to-failure of about 35%), a property combination surpassing all previous refractory (including multi-principal-element) alloys. Moreover, the boron segregation around the oxide nanoparticles imparts excellent thermal stability against coarsening at 2,000–2,400 °C. Our strategy thus goes beyond traditional oxide-dispersion strengthening to enable highly ductile refractory alloys that are capable of load-bearing applications at extreme temperatures. A boron-stabilized oxide-strengthened tantalum alloy combines exceptional room-temperature ductility with record ultrahigh-temperature strength, enabling load-bearing applications above 2,000 °C.

06.
arXiv (quant-ph) 2026-06-11

A quantum implementation of high-order power method for estimating geometric entanglement of pure states

arXiv:2405.19134v3 Announce Type: replace Abstract: Entanglement is one of the fundamental properties of a quantum state and is a crucial differentiator between classical and quantum computation. There are many ways to define entanglement and its measure, depending on the problem or application under consideration. Each of these measures may be computed or approximated by multiple methods. However, hardly any of these methods can be run on near-term quantum hardware. This work presents a quantum adaptation of the iterative high-order power method for estimating the geometric measure of entanglement of multi-qubit pure states using rank-1 tensor approximation. This method is executable on early fault-tolerant (hybrid) quantum hardware and does not depend on quantum memory. We simulate this algorithm and mitigate the effects of noise on the results of the computation using a theoretical model based on a known mitigation approach, which assumes a global depolarising noise channel.

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

Scaling Human and G2P Supervision for Robust Phonetic Transcription

Expert phonetic annotation is costly, especially for non-standard dialects and atypical speech. A common alternative is using Grapheme-to-Phoneme (G2P) models to auto-generate phonetic labels from text transcripts at scale. We study how automatic phonetic transcription performance scales with human and G2P supervision in English. Using a curated 80-hour benchmark spanning native, non-native and post-stroke speech, we identify a supervision quality threshold: G2P supervision helps only when fewer than 20-30 hours of human annotation are available. Beyond this threshold, it provides no significant benefit and can reduce cross-dialect robustness. What is effective after this threshold is ASR pretraining which we use to achieve a 2.3x reduction in weighted phone feature error rate over prior systems, with strong gains on non-native and aphasic speech. These results suggest that quantity-driven G2P scaling may yield diminishing returns for robust generalization.

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

Discriminative Span as a Predictor of Synthetic Data Utility via Classifier Reconstruction

In many real-world computer vision applications, including medical imaging and industrial inspection, binary classification tasks are characterized by a severe scarcity of positive samples. A widely adopted solution is to generate synthetic positive data using image-to-image transformations applied to negative samples. However, a fundamental challenge remains: how can we reliably assess whether such synthetic data will improve downstream model performance? In this work, we propose a geometry-driven metric that predicts the utility of synthetic data without requiring model training. Our approach operates in the embedding space of a pre-trained foundation model and represents the dataset through difference vectors between samples. We evaluate whether the weight vector of a linear classifier can be expressed within the subspace spanned by these variations by measuring the relative projection error. Intuitively, if the variations induced by synthetic data capture task-relevant directions, their span can approximate the classifier, resulting in low projection error. Conversely, poor synthetic data fails to span these directions, leading to higher error. Across multiple datasets and architectures, we show that this metric exhibits strong correlation with downstream classification performance of CNNs trained on mixtures of real negative and synthetic positive data. These findings suggest that the proposed metric serves as a practical and informative tool for evaluating synthetic data quality in data-scarce settings.

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

No One Knows the State of the Art in Geospatial Foundation Models

Geospatial foundation models (GFMs) have been proposed as generalizable backbones for disaster response, land-cover mapping, food-security monitoring, and other high-stakes Earth-observation tasks. Yet the published work about these models does not give reviewers or users enough information to tell which model fits a given task. We argue that nobody knows what the current state of the art is in geospatial foundation models. The methods may be useful, but the GFM literature does not standardize evaluations, training and testing protocols, released weights, or pretraining controls well enough for anyone to compare or rank them. In a 152-paper audit, we find 46 cross-paper disagreements of at least 10 points for the same model, benchmark, and protocol; 94/126 papers with extractable pretraining data use a configuration no other paper uses; and 39% of GFM papers release no model weights. This lack of community standards can be solved. We propose six concrete expectations: named-license weight release, shared core evaluations, copied-versus-rerun baseline annotations, variance reporting, one shared evaluation harness, and data-vs-architecture-vs-algorithm controls. These gaps are a coordination failure, not a fault of any individual lab; the authors of this paper, like many others in the GFM community, have contributed to them. Rather than just critiquing the community, we aim to provide concrete steps toward a shared understanding of how to innovate GFMs.

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

SHARD: Safe and Helpful Alignment via Self-Reframing Distillation

Large language models often struggle with sensitive prompts. They may refuse outright, provide generic safety boilerplate, or fail to address the user's legitimate informational needs that can be answered safely. We introduce SHARD, a self-reframing distillation method to improve safe-helpfulness. It first rewrites sensitive prompts to surface benign intent using philosophical guidelines, then reframes its original responses into safe, more helpful ones, and finally fine-tunes the model on its self-reframed responses. Across DNA and the English subset of LINGUASAFE, SHARD improves helpfulness for most model families while preserving safety. It also remains competitive with distillation from a larger teacher model, suggesting that models can internalize safe and helpful behavior elicited from their own. Warning: This paper contains content that may be offensive or harmful.

11.
PLOS Medicine 2026-06-12

Placenta accreta spectrum in the 21st century: Challenging dogma and redefining disorder

Authors:

by Eric Jauniaux, Helena C. Bartels, Yalda Afshar Placenta accreta spectrum (PAS) is a serious pregnancy complication caused by abnormal placental attachment to the uterus. In this Perspective, Eric Jauniaux and colleagues discuss emerging evidence that challenges our long-held pathophysiological understanding of PAS, and argue that a critical reassessment of definition, diagnosis, and management is overdue. In this Perspective, Jonathan Evans and colleagues discuss why restricting access to joint replacement surgery based on BMI alone is not supported by evidence, and highlight how such rest rictions risk exacerbating stigma, inequity and avoidable harm to those who would benefit from surgery.

12.
Nature (Science) 2026-06-17

Cortical development dynamics across autism spectrum disorder mouse models

Despite the functional diversity of over 100 causal genes1–3, phenotypic convergence across models may reveal common neurobiological processes in autism spectrum disorder (ASD). Here we profiled 251 samples from 11 monogenic mouse models of ASD using single-nucleus multi-omic sequencing across three developmental stages, both sexes and two brain regions. Despite genetic heterogeneity, ASD-linked mutations converged on perturbations of the radial glial cell lineage. These alterations reflect a transient developmental delay rather than lasting lineage misspecification and resolve by postnatal stages. Molecularly, the largest transcriptional differences emerged in neurons at early postnatal stages. These changes included downregulation of synaptic and ion channel-related genes, consistent with homeostatic adaptation or delayed maturation. Network analysis showed molecular convergence across models within each developmental stage, suggesting that diverse mutations linked to ASD impinge on common, stage-specific processes. Convergence becomes less pronounced by postnatal day 14, highlighting the dynamic nature of ASD-associated changes. Cross-genotype heterogeneity is superimposed on stage-specific effects. Electrophysiology corroborated this pattern: mutants generally showed altered neuronal excitability and synaptic properties with model-specific nuances. Our study also highlighted sex-specific gene expression alterations, with female mice often displaying larger effect sizes than male mice. Together, our findings provide a comprehensive view of developmental cellular and molecular dynamics across models of ASD. Using single-nucleus multi-omic sequencing, diverse autism spectrum disorder-linked gene mutations converge on transient, stage-specific disruptions in early brain development, and highlight sex-specific gene expression alterations.

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

Fast When, Careful Who: Dual-Process Multiparty Turn-Taking with Diffusion Augmentation

Reliable turn-taking is essential for spoken dialogue systems. However, most existing methods are designed for two-speaker interaction and struggle with realistic multiparty audio containing overlap and rapid speaker changes. We study multiparty turn-taking on the VoxConverse dataset and propose an audio-only two-stage pipeline that separates when to trigger a turn boundary from whether the floor is actually transferring. A fast trigger scans the audio and proposes candidate end-of-turn times, while a lightweight verifier runs only at those times to decide \textsc{Hold} or \textsc{Shift} and support next-speaker prediction. We report results in the full multiparty setting and a controlled dyadic top-2 projection for comparability. We also investigate diffusion-based, label-preserving background-audio mixing as a data augmentation strategy. Results show improved shift detection over a baseline, with further improvements from diffusion augmentation.

14.
arXiv (CS.LG) 2026-06-18

SCAN: Enhance Time Series Anomaly Detection via Multi-Scale Neighborhood-Centered Clustering

arXiv:2606.19255v1 Announce Type: new Abstract: Time series anomaly detection plays a crucial role in a wide range of real-world applications. Reconstruction-based methods have become the mainstream paradigm, but they suffer from over-generalization and under-generalization problems, which are challenging to balance. To address this, we introduce multi-scale clustering to enhance reconstruction-based methods. At the representation level, we integrate the cluster center representations of normal patterns to constrain the model to target representative normal patterns for reconstruction, preventing dominance of powerful capacity and representation capability. At the anomaly criterion level, we derive anomaly confidence score based on cluster membership probability and combine it with reconstruction error, providing dual criteria for detection. Furthermore, the effectiveness of the cluster center representations and anomaly confidence score depends on the clustering performance. Accordingly, we extract neighborhood-centered representations for multi-view clustering to improve clustering performance. Extensive experiments on multiple real-world datasets from diverse application domains demonstrate the state-of-the-art performance of SCAN.

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

Optimal classical shadow estimation of unitary channels at Heisenberg limit

arXiv:2606.13638v1 Announce Type: new Abstract: Full tomography of an unknown quantum evolution is resource-intensive and often unnecessary when the goal is only to predict selected properties. This motivates the study of classical shadow estimation of unitary channels (CSEU), a task in which one queries an unknown $d$-dimensional unitary $U$ and stores classical data that can later be used to predict expectation values $\mathrm{tr}[O \cdot U\rho U^\dagger]$ up to additive error $\varepsilon$ for arbitrary input states $\rho$ and observables $O$. We propose a parallel, non-adaptive CSEU protocol using $\mathcal{O}(d\varepsilon^{-1})$ queries when the input states or observables have constant rank. This achieves Heisenberg scaling with respect to $\varepsilon$ and is query-optimal, as we prove a matching $\Omega(d\varepsilon^{-1})$ lower bound that remains valid even with stronger access to the unknown unitary. Our query-optimal CSEU protocol provides a versatile and powerful tool for quantum learning theory, pushing the performance limits of several fundamental learning tasks, including unitary channel tomography, Hamiltonian learning, boundary-regime quantum channel tomography, Pauli transfer matrix learning, inverse-free amplitude estimation, pure-state property estimation, and shallow-circuit learning. Remarkably, we show that optimal unitary channel tomography can be achieved using only parallel queries, closing the gap between the best achievable efficiency of parallel and sequential tomography protocols. Together, these applications establish our framework as a fundamental tool for learning properties of quantum processes, particularly for certain key tasks that require high precision.

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

DiRecT: Safe Diffusion-Based Planning via Receding-Horizon Denoising

arXiv:2606.15359v1 Announce Type: new Abstract: Diffusion models have emerged as powerful tools for planning and control by learning multimodal distributions over actions and trajectories. Yet reliable inference-time safety enforcement remains a key barrier to their deployment in safety-critical tasks. Existing approaches typically project each denoising iterate onto the feasible set, even though constraints are defined only on the final clean trajectory. Enforcing feasibility on noisy intermediate samples can therefore overconstrain the sampling dynamics, substantially degrading sample quality. To address this limitation, we introduce DiRecT (Diffusion-based planning via Receding-horizon denoising with Terminal constraints), a training-free algorithm for constrained sampling from diffusion models via stochastic optimal control (SOC). DiRecT enforces constraints only on the final clean sample, avoiding unnecessary restrictions on the intermediate denoising dynamics. Inspired by model predictive control, we derive a principled receding-horizon surrogate for the otherwise intractable constrained SOC formulation, yielding an efficient algorithm that cleanly separates stochastic denoising from constraint satisfaction, progressively steering samples toward feasible final trajectories without distorting the learned diffusion dynamics. Furthermore, DiRecT is highly flexible: it can leverage off-the-shelf or domain-specific optimizers, incorporate priors over environment dynamics, and optimize additional soft rewards. Extensive experiments on safe planning benchmarks demonstrate that DiRecT substantially improves deployment safety and task performance over existing diffusion-based planning baselines.

17.
medRxiv (Medicine) 2026-06-16

Cross-sectional study of the association between depressive symptoms and attentional bias to emotional stimuli in patients with acute stroke: Study protocol

Post-stroke depression affects approximately 30% of patients after stroke and is associated with delayed recovery in activities of daily living, reduced rehabilitation effectiveness, and poorer quality of life. Attentional bias modification may provide a low-burden, nonpharmacological approach for patients in the acute phase of stroke. However, before such an intervention can be implemented in clinical practice, it is necessary to clarify whether attentional bias is present in patients with acute stroke and depressive symptoms, whether cognitive function influences the manifestation of this bias, and which task and stimulus formats are most appropriate for assessment. This multicenter, cross-sectional observational study will enroll patients with acute stroke between 7-30 days after stroke onset. Depressive symptoms will be assessed using the depression subscale of the Hospital Anxiety and Depression Scale. Attentional bias will be measured under four task conditions based on the dot-probe task and the cue-target task, using face and word stimuli. Secondary assessments will include cognitive function, anxiety symptoms, activities of daily living, health-related quality of life, and clinical background variables. The aims of this study are to investigate the association between depressive symptoms and attentional bias in patients with acute stroke, compare attentional bias characteristics across task and stimulus types, and examine the potential influence of cognitive function on this association. The findings are expected to provide an empirical basis for designing future attentional bias modification protocols targeting post-stroke depression in the acute phase. This study has been registered with the UMIN Clinical Trials Registry (UMIN000059166).

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

Leveraging Audio-LLMs to Filter Speech-to-Speech Training Data

Large-scale mined corpora provide abundant training data for end-to-end speech-to-speech translation (S2ST) but may contain noise, misalignment, and semantic errors. Filtering noisy data is crucial to maintain robust speech translation performance. We study how to train an audio-language model to make keep/drop decisions on paired speech directly from audio. To obtain reliable supervision without manual labels, we adopt a scalable two-stage Rank-to-Distill strategy. A lightweight ranker generates keep/drop pseudo-labels from noisy speech pairs, then trains an audio large language model to predict keep/drop directly from raw paired speech. The resulting model jointly captures acoustic fidelity and cross-lingual semantic consistency for the selection of speech-conditioned data. Experiments on CVSS-C and SpeechMatrix show consistent improvements over unfiltered training, yielding up to +1.4 ASR-BLEU for end-to-end S2ST.

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

Model Stealing Through the Lens of Model Multiplicity

arXiv:2606.15493v1 Announce Type: new Abstract: Model stealing attacks, where adversaries create high-fidelity surrogate models, are a significant threat to the intellectual property of machine learning services. Conventional wisdom suggests these surrogates could provide adversaries with economic leverage comparable to the original service providers. This paper challenges this assumption by evaluating model stealing attacks beyond mere fidelity to the target model. Because query-based extraction provides only partial supervision of the target's input-output behavior, the surrogate is not uniquely identified: many near-optimal surrogates can achieve comparable fidelity while differing in deployment-relevant properties. Instead of performing a classic learning-based model stealing attack, we compute the Rashomon Set (i.e., the set of almost-equally-accurate models) of surrogate models, and evaluate its diversity using multiplicity metrics (ambiguity, discrepancy, and Rashomon Capacity) and group fairness metrics. Across tabular, medical imaging, and NLP tasks, our experiments on real-world datasets reveal that despite exhibiting similar fidelity to the target model, surrogate models can display significant variances in other critical performance metrics. These findings cast doubt on the presumed equivalence between high-fidelity surrogates and the target model in practical deployment scenarios.

20.
arXiv (CS.CV) 2026-06-24

DivRL: Disentangled Self-Similarity Rewards for Diverse Subject-Driven Generation

Subject-driven image generation faces an "Identity-Diversity Paradox", where strong identity preservation often leads to rigid and low-diversity outputs. We propose a post-training framework called DivRL that jointly optimizes identity consistency and structural diversity simultaneously by leveraging disentangled visual features from a robust similarity model. Specifically, we introduce a Negative Self-Similarity Measure (nSSM) to quantify structural diversity, and Visual Semantic Matching (VSM) to evaluate identity consistency. We propose an "Explore-and-Suppress" strategy that treats VSM as a gated constraint: the model freely explores structurally diverse configurations, and only samples that violate the identity threshold are penalized via a quadratic hinge loss. This converts identity preservation from a competing objective into a feasibility constraint, allowing nSSM and VSM to improve jointly. Experiments demonstrate that our method effectively pushes the model to generate both consistent and diverse images and improves structural diversity while maintaining comparable identity consistency through a gated optimization formulation.

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

Green SARC: Predictive Cost and Carbon Governance for Agentic AI Systems

arXiv:2606.15954v1 Announce Type: cross Abstract: Agentic AI systems act through tools and sub-agents, yet the controls meant to bound their financial and environmental cost still sit on dashboards evaluated beside or after execution. Green SARC applies the SARC governance-by-architecture framework – four enforcement sites in the agent loop – to FinOps and GreenOps, contributing the theory of what to enforce and how to predict it. We report four policy-independent results. (i) The unconstrained "State Snowball" is $\Theta(n^2)$ in loop depth; on 3,000 real multi-step plans (SWE-rebench) it holds on 100%, with median curvature $\hat{c}_2=216$ exceeding the linear-accretion prediction $p/2=134$ – real plans accrete faster than the model. (ii) On real residuals the Normal-$\sigma$ gate under-covers (92% at nominal 95%); split-conformal calibration holds (95.2%). (iii) A soft Lagrangian penalty tuned to the budget in expectation breaches it on 91.5% of seeds; the architectural gate breaches 0%. (iv) Under binding budgets the gate's over-budget incidence is 0% on synthetic and real (BurstGPT) arrivals. End-to-end token/USD/carbon savings (47–55%) are real but policy-dependent in magnitude – set by a scope-cap knob, not by gate rejections. The library is open-source, dependency-free, and ships a regeneration script for every cited number.

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.CV) 2026-06-16

iTRIALSPACE: Programmable Virtual Lesion Trials for Controlled Evaluation of Lung CT Models

We introduce iTRIALSPACE, a programmable evaluation framework for controlled assessment of lung CT models. Standard benchmarks are static retrospective collections that entangle lesion size, lobe prevalence, anatomy, and acquisition context, making it difficult to determine what structurally drives model accuracy. iTRIALSPACE addresses this limitation by composing real clinical CTs and lesion profiles into controlled virtual lesion trials through a four-stage pipeline: multidataset nodule profiling, explicit trial specification, anatomy-aware mask insertion, and ControlNet-conditioned CT synthesis. The framework is built on a unified 54-attribute nodule-profile dataset spanning 13,140 annotated nodules from seven public CT sources and instantiated as 13 trial modes. We evaluate iTRIALSPACE in a 55,469-sample Virtual Lesion Study spanning three medical VLMs, four spatialguidance conditions, and three clinical tasks. Across all 13 modes, the synthetic substrate remains within the real-to-real FID baseline, and synthetic performance rankings transfer strongly to real clinical data ($\rho$ = 0.93, p < 10$^{-15}$). Controlled trial modes expose findings unavailable to fixed-distribution benchmarks, including shortcut-driven size prediction collapse under lobe-equalized sampling and hostto-donor variance ratios of 8.9x and 3.3x in twin-cross analysis. These results position iTRIALSPACE as an auditable evaluation infrastructure for controlled, falsifiable testing beyond static retrospective benchmarks.

24.
PLOS Medicine 2026-06-04

Comparative impacts and cost-effectiveness of tuberculosis systematic screening strategies in prisons in Brazil, Colombia, and Peru: A mathematical modeling study

Authors:

by Yiran E. Liu, José Victor Bortolotto Bampi, Ronan F. Arthur, Argita D. Salindri, Caroline Busatto, Pedro Avedillo Jiménez, Daniele Maria Pelissari, Fernanda Dockhorn Costa Johansen, Robert Arana-Narvaez, Alvaro Fernando Moreno Roca, Wilfredo Santos Solís Tupes, Esther Mori Jiu, Christian Alfredo Moreno Roca, Erika Albertina Abregú Contreras, Valentina Antonieta Alarcón Guizado, Julián Trujillo Trujillo, Belkys Marcelino, Mónica Alonso Gonzalez, Mayra Cecilia Córdova Ayllon, Ted Cohen, Moises A. Huaman, Jeremy D. Goldhaber-Fiebert, Julio Croda, Jason R. Andrews Background Incarceration is a leading driver of tuberculosis in Latin America. Systematic screening in prisons may reduce tuberculosis burden, but optimal strategies and cost-effectiveness remain uncertain. We examined the population-wide health impacts and cost-effectiveness of systematic screening in prisons in Brazil, Colombia, and Peru, comparing different timepoints, frequencies, and screening algorithms. Methods and findings Using dynamic transmission models calibrated to Brazil, Colombia, and Peru, we simulated annual or biannual (twice-yearly) prison-wide screening, alone or combined with entry and exit screening from 2026 to 2035. We evaluated four algorithms: (1) symptom screening, (2) chest X-ray with computer-aided detection (CXR-CAD), (3) symptoms and CXR-CAD (follow-up testing if either is positive), and (4) GeneXpert Ultra (Xpert) with pooled sputum. Individuals screening positive then received individual Xpert. We projected impacts on within-prison and population-level tuberculosis incidence in 2035, along with discounted costs (2023 US dollars) and disability-adjusted life years (DALYs). Model projections showed that combined entry, exit, and biannual screening with CXR-CAD was highly impactful and cost-effective across countries, reducing tuberculosis incidence by 61%–87% in prisons and 18%–28% population-wide. Compared to only biannual CXR-CAD (the next best strategy), the incremental cost per DALY averted of adding entry and exit screening was $2,984 (Brazil), $2,925 (Colombia), and $645 (Peru). Adding symptom screening to CXR-CAD marginally increased benefit and was only cost-effective in Peru’s higher-incidence prisons. Biannual screening alone remained cost-effective at prison incidence levels well below national averages, as well as at far lower willingness-to-pay thresholds. In settings without CXR-CAD, pooled Xpert was an impactful, cost-effective alternative. Key limitations include the model’s simplified representation of tuberculosis disease states and lack of stratification by age, gender/sex, HIV, or drug resistance. Conclusions These modeling results support immediate national-level adoption of prison-wide tuberculosis screening twice-yearly and at entry and exit, using CXR-CAD or pooled Xpert.

25.
arXiv (CS.CV) 2026-06-16

UtVAA: Ultra-tiny Vision Transformer with Affix Attention for Mobile Image Classification

Vision Transformers (ViTs) have demonstrated strong representation capability in image classification. However, their quadratic self-attention complexity and large parameter counts limit deployment on resource-constrained mobile and edge devices. This paper introduces UtVAA, an ultra-tiny Vision Transformer architecture designed for efficient visual recognition under strict computational budgets. It incorporates a novel Affix Attention block that combines depthwise-pointwise local feature extraction, linear self-attention, coordinate attention for spatial dependency modelling, and a lightweight ternary fusion strategy to integrate local and global representations. In addition, Dilated Bottleneck blocks expand the receptive field using dilated depthwise separable convolutions while maintaining low FLOPs and stable optimisation through residual connections. UtVAA is implemented in scalable Tiny, Medium, and Large variants, with the smallest model containing 204.67K parameters and 53.95M FLOPs. Experimental results on CIFAR-10, CIFAR-100, PlantVillage-Tomato and SLIF-Tomato datasets show that UtVAA achieves competitive accuracy within a sub-million-parameter regime. Overall, the results demonstrate that transformer-based vision models can be redesigned into ultra-tiny architectures without significant loss in discriminative performance, making UtVAA suitable for mobile and edge deployment. Code is available at https://github.com/romiyal/UtVAA