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01.
arXiv (CS.AI) 2026-06-16

SPRI: SVD-Partitioned Residual Initialization for Data-Constrained MoE Upcycling

arXiv:2606.16456v1 Announce Type: cross Abstract: Mixture-of-Experts (MoE) models enable efficient scaling, but training them from scratch remains prohibitively expensive. MoE upcycling mitigates this cost by converting pretrained dense models into sparse MoE models. However, existing upcycling methods typically rely on large-scale continued training and often perform poorly under data-constrained supervised adaptation, due to either homogeneous experts or overly disruptive perturbations to pretrained parameters. In this setting, effective upcycling must leverage pretrained weight structure while introducing sufficient diversity among routed experts. To this end, we propose SVD-Partitioned Residual Initialization (SPRI), which distributes SVD-partitioned residuals derived from pretrained feed-forward network (FFN) weights across routed experts, introducing controlled expert diversity grounded in pretrained spectral structure. We further introduce a two-stage training strategy to improve adaptation stability. We evaluate SPRI on multilingual speech-to-text translation, where limited supervised data challenges MoE upcycling and multiple target languages provide natural routing heterogeneity. On CoVoST2 across 15 En-to-XX directions, SPRI improves average BLEU and COMET over fully fine-tuned dense models by 2.58 and 3.32 points, respectively, and outperforms the prior best MoE upcycling baseline by 3.39 BLEU and 4.34 COMET points.

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

Decidable By Construction: Design-Time Verification for Trustworthy AI

arXiv:2603.25414v4 Announce Type: replace-cross Abstract: A prevailing assumption in machine learning is that model correctness must be enforced after the fact. We observe that the properties determining whether an AI model is numerically stable, computationally correct, or consistent with a physical domain do not necessarily demand post hoc enforcement. They can be verified at design time, before training begins, at marginal computational cost, with particular relevance to models deployed in high-leverage decision support and scientifically constrained settings. These properties share a specific algebraic structure: they are expressible as constraints over finitely generated abelian groups $\mathbb{Z}^n$, where inference is decidable in polynomial time and the principal type is unique. A framework built on this observation composes three prior results (arXiv:2603.16437, arXiv:2603.17627, arXiv:2603.18104): a dimensional type system carrying arbitrary annotations as persistent codata through model elaboration; a program hypergraph that infers Clifford algebra grade and derives geometric product sparsity from type signatures alone; and an adaptive domain model architecture preserving both invariants through training via forward-mode coeffect analysis and exact posit accumulation. We believe this composition yields a novel information-theoretic result: Hindley-Milner unification over abelian groups computes the maximum a posteriori hypothesis under a computable restriction of Solomonoff's universal prior, placing the framework's type inference on the same formal ground as universal induction. We compare four contemporary approaches to AI reliability and show that each imposes overhead that can compound across deployments, layers, and inference requests. This framework eliminates that overhead by construction.

03.
arXiv (CS.CL) 2026-06-12

Given, When, Then, Again: Mining Subscenario Refactoring Candidates in Behaviour-Driven Test Suites with ML Classifiers and LLM-Judge Baselines

Context. Behaviour-Driven Development (BDD) test suites accumulate duplicated step subsequences. Three published refactoring patterns are available (within-file Background, within-repo reusable-scenario invocation, cross-organisational shared higher-level step), but no prior work automates which recurring subsequences are worth extracting or which mechanism applies. Objective. Rank recurring step subsequences ("slices") by refactoring suitability (extraction-worthy), pre-map each to one of the three patterns, and quantify prevalence across the public BDD ecosystem. Method. Every contiguous L-step window (L in [2, 18]) in a 339-repository / 276-upstream-owner Gherkin corpus is keyed by paraphrase-robust cluster identifiers and counted under three scopes. SBERT / UMAP / HDBSCAN clustering recovers paraphrase-equivalent slices. Three authors label a stratified 200-slice pool against a written rubric. An XGBoost extraction-worthy classifier trained under 5-fold cross-validation is compared with a tuned rule baseline and two open-weight Large Language Model (LLM) judges. Results. The miner produces 5,382,249 slices collapsing to 692,020 recurring patterns. Three-author Fleiss' kappa = 0.56 (extraction-worthy) and 0.79 (mechanism). The classifier reaches out-of-fold F1 = 0.891 (95% CI [0.852, 0.927]), outperforming both the rule baseline (F1 = 0.836, p = 0.017) and the better LLM judge (F1 = 0.728, p = 1.5e-4). 75.0%, 59.5%, and 11.7% of scenarios carry a within-file Background, within-repo reusable-scenario, and cross-organisational shared-step candidate, respectively; the figures are stable under a sweep of the classifier decision threshold. Conclusion. Paraphrase-robust subscenario discovery yields a corpus-wide census of BDD refactoring candidates; pipeline, classifier predictions, labelled pool, and rubric are released under Apache-2.0.

04.
arXiv (CS.CV) 2026-06-17

Visuals Lie, Consistency Speaks: Disentangling Spatial Attention from Reliability in Vision-Language Models

Multimodal Foundation Models are increasingly used as reasoning agents, making reliability, knowing when a model may hallucinate, critical. A common intuition, which we call the Attention-Confidence Assumption, holds that reliability follows from "structural" visual perception: tight attention on relevant regions should signal a trustworthy answer, while scattered attention signals confusion. We challenge this through the VLM Reliability Probe (VRP), a systematic cross-family study of reliability signals in contemporary Vision-Language Models (VLMs). We introduce structural-attention metrics, cluster counts (C_k) and spatial entropy (H_s), to quantify the visual encoder's gaze, and track its evolution (Delta H_s) across layers. This reveals a "Symbolic Detachment": models often "Early Lock" visual features only to diffuse attention later, severing early perception from final generation. Contrary to the grounding hypothesis, we find a "Cluster Failure": spatial attention has near-zero correlation (R approx 0.001) with accuracy. Instead, reliability is a phenomenon of generation dynamics and internal-state distributions. Self-Consistency, the agreement rate across sampled reasoning paths, is the dominant predictor of truth (R = 0.429). Scaling causal interventions exposes a sharp architectural divergence: LLaVA locks its prediction in a fragile late-stage bottleneck, whereas PaliGemma and Qwen2-VL distribute reliability globally, staying resilient even when ~50% or more of their most predictive layer is destroyed. For current VLMs, reliability signals are detached from visual grounding maps and are best inferred from generation-time dynamics and hidden-state probes.

05.
arXiv (CS.CV) 2026-06-16

CASHEW: Stabilizing Multimodal Reasoning via Iterative Trajectory Aggregation

Vision-language models achieve strong performance across a wide range of multimodal understanding and reasoning tasks, yet their multi-step reasoning remains unstable. Repeated sampling over the same input often produces divergent reasoning trajectories and inconsistent final predictions. To address this, we introduce two complementary approaches inspired by test-time scaling: (1) CASHEW, an inference-time framework that stabilizes reasoning by iteratively aggregating multiple candidate trajectories into higher-quality reasoning traces, with explicit visual verification filtering hallucinated steps and grounding reasoning in visual evidence, and (2) CASHEW-RL, a learned variant that internalizes this aggregation behavior within a single model. CASHEW-RL is trained using Group Sequence Policy Optimization (GSPO) with a composite reward that encourages correct answers grounded in minimal yet sufficient visual evidence, while adaptively allocating reasoning effort based on task difficulty. This training objective enables robust self-aggregation at inference. Extensive experiments on 13 image understanding, video understanding, and video reasoning benchmarks show significant performance improvements, including gains of up to +26.2 percentage points on ScienceQA and +9.1 percentage points on EgoSchema.

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

Beyond task performance: Decoding bioacoustic embeddings with speech features

arXiv:2606.14662v1 Announce Type: new Abstract: Pretrained audio embeddings are standard in bioacoustics, yet little is known about which acoustic features these models encode, nor which are useful for a given task. This hinders transparency and limits extension to rare species or data-scarce domains. Here we reveal which speech-like features are encoded in bioacoustic representations. Using the 88~eGeMAPS features across six taxonomic groups, we apply linear and nonlinear regression probes to quantify which acoustic properties each model captures. Results confirm a ``no free lunch'' pattern: no single model captures the full feature space. A concatenated embedding achieves the highest performance, suggesting complementary acoustic space coverage across models. Loudness features are best encoded ($R^2 = 0.76$) while F0 is hardest to recover ($R^2 = 0.33$). By cross-referencing recoverability with per-species feature salience (NMI), we derive data-driven model selection guidance for bioacoustics.

07.
arXiv (quant-ph) 2026-06-16

Study of the triangular-lattice Hubbard model with constrained-path quantum Monte Carlo

arXiv:2603.14808v2 Announce Type: replace-cross Abstract: We benchmark constrained-path Monte Carlo (CPMC) on the triangular-lattice Hubbard model for several fillings and $U$ values and show that symmetry-adapted trial wave functions substantially improve quantitative accuracy. Away from half-filling, simple free-electron-based trials that preserve the ground state symmetry yield energy deviations $\lesssim 1\%$ from exact diagonalization and density matrix renormalization group results. At half-filling, strong frustration in the intermediate to large $U$ regimes necessitates symmetry-projected trials to reach comparable accuracy, where both free-electron and symmetry-broken Hartree-Fock trials incur substantial constraint bias. Since the computational cost of CPMC with symmetry projection scales polynomially with system size, our results motivate its use as a practical route for studying competing ground states in strongly correlated, frustrated systems.

08.
arXiv (CS.CL) 2026-06-12

Agents' Last Exam

Recent AI systems have achieved strong results on a wide range of benchmarks, yet these gains have not translated into economically meaningful deployment across many professional domains. We argue that this gap is largely an evaluation problem: widely used benchmarks lack sustained performance measurement on real and economically valuable workflows. This paper introduces Agents' Last Exam (ALE), a benchmark designed to evaluate AI agents on long horizon, economically valuable, real world tasks with verifiable outcomes. Developed in collaboration with 250+ industry experts, ALE covers non-physical industries defined with reference to O*NET / SOC 2018 (the U.S. federal occupational taxonomy). It is organized around a task taxonomy with 55 sub fields grouped into 13 industry clusters covering 1K+ tasks. Current results show that the hardest tier remains far from saturated: across mainstream harness and backbone configurations, the average full pass rate is below 1%. ALE is designed as a living benchmark: its task pool grows continuously as new workflows and industries are onboarded. More broadly, ALE is intended not merely as another leaderboard, but as an instrument for closing the gap between benchmark success and GDP relevant impact.

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

Service-Induced Congestion in Memory-Constrained LLM Serving

arXiv:2606.15555v1 Announce Type: cross Abstract: In large language model (LLM) serving, each request accumulates persistent graphics processing unit (GPU) memory during service as its key-value cache grows with every generated token. Under high concurrency, aggregate memory usage therefore increases endogenously over time: the service process itself creates future capacity pressure. When memory capacity is exceeded, systems evict active requests, discarding cached state and restarting them later, which wastes computation and reduces throughput. We develop a discrete-time dynamical model of memory-constrained LLM inference that captures admission, memory growth, and eviction under continuous batching. In the saturated-input regime, the system admits both eviction-free fixed points and limit cycles with evictions. For homogeneous workloads, we show that the eviction-free equilibrium is unstable and that, except for a Lebesgue-measure-zero exact-capture set, the system converges to a unique worst-case limit cycle that is asymptotically stable outside this exceptional set, with throughput losses as large as 50%. For heterogeneous workloads, we prove a stability criterion in the two-class common-input setting and explain how the survival-polynomial mechanism generalizes to multiple classes and heterogeneous-input lengths. Under an input-dominated scaling regime, coprime decoding lengths stabilize the eviction-free equilibrium, while non-coprime lengths create synchronized modes that drive instability. These results characterize when workload heterogeneity desynchronizes completions and helps stabilize memory-constrained serving. More broadly, we identify service-induced congestion as a structural instability mechanism and derive scheduling design principles for sustaining high throughput.

10.
arXiv (CS.AI) 2026-06-19

Spatial-Aware Reduction Framework: Towards Efficient and Faithful Visual State Space Models

arXiv:2606.19932v1 Announce Type: cross Abstract: Mamba demonstrates strong efficiency in modeling long visual sequences. However, when token reduction is applied to structurally enhanced Mamba variants, these models exhibit a severe performance collapse. We attribute this degradation to the spatially agnostic nature of existing reduction methods, which violate the two-dimensional structural premise required by the selective scanning mechanism. In this work, we propose STORM, a spatial-aware token reduction framework designed to maintain structural integrity throughout the compression process. STORM reformulates reduction into a structured operation on spatial units, enforcing localized constraints to maintain both grid topology and neighborhood coherence. As a plug-and-play module, STORM equips existing reduction pipelines with explicit spatial awareness without any training. Empirical results demonstrate that STORM achieves state-of-the-art pruning accuracy across diverse vision Mamba backbones under training-free settings. Notably, STORM delivers a substantial accuracy recovery on VMamba, outperforming prior methods by up to 63.3\% in top-1 accuracy. Meanwhile, STORM incurs only a 1.0\% accuracy drop on PlainMamba, achieving performance comparable to ViT.

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

Reasoning Text-to-Video Retrieval for Operating Room Clips via Action-Driven Digital Twins

Text-to-video retrieval in operating rooms (OR) is an enabling technology for OR safety, as it allows stakeholders to retrieve and inspect recordings of specific events. However, because the most safety-critical events may not follow the common structure, to unlock its full potential text-to-video retrieval must be able to handle implicit queries that require reasoning to identify the right video (e.g., the step right before clipping). However, existing methods rely on global embeddings that cannot reason over such queries. We propose OR3, a text-to-video retrieval method that converts clips into action-driven digital twins (ActDTs), grouping concurrent subject-action-object triplets under non-overlapping temporal intervals. Moreover, rather than cross-modal matching through paired encoders, OR3 performs imagination-based retrieval where an LLM generates hypothetical ActDTs from queries. This enables intra-modal matching via a single encoder trained with ActDT-tailored hard negatives. Finally, evidence-grounded refinement revises imagined ActDTs based on discrepancies with top candidates to capture procedure-specific patterns. We construct a benchmark from MM-OR with 276 implicit queries across four reasoning categories over 386 clips from robotic knee procedures. OR3 achieves 57.6 R@1 and 77.3 R@5, outperforming the strongest baseline. These results demonstrate that OR3 enables fine-grained discrimination between visually similar OR video clips through temporal action reasoning.

12.
PLOS Medicine 2026-05-21

U = U for all: Advancing equity in HIV prevention

by Thiago S. Torres, Paula M. Luz Suppression of HIV with antiretrovirals eliminates HIV transmission risk, summarized as Undetectable = Untransmittable (U = U). However, U = U literacy remains unevenly understood and shared, and stigmas persist. Equitable and accurate awareness of U = U requires culturally tailored interventions, improved provider education, and supportive policy environments beyond biomedical evidence alone. Suppression of HIV with antiretrovirals eliminates HIV transmission risk, summarized as Undetectable = Untransmittable (U=U). However, U=U literacy remains unevenly understood and shared, and stigmas persist. In this Perspective, Thiago Torres and Paula Luz outline what is needed to improve equity and accuracy in global awareness and education of U=U.

13.
arXiv (CS.CL) 2026-06-11

Sonar-TS: Search-Then-Verify Natural Language Querying for Time Series Databases

Natural Language Querying for Time Series Databases (NLQ4TSDB) aims to assist non-expert users retrieve meaningful events, intervals, and summaries from massive temporal records. However, existing Text-to-SQL methods are not designed for continuous morphological intents such as shapes or anomalies, while time series models struggle to handle ultra-long histories. To address these challenges, we propose Sonar-TS, a neuro-symbolic framework that tackles NLQ4TSDB via a Search-Then-Verify pipeline. Analogous to active sonar, it utilizes a feature index to ping candidate windows via SQL, followed by generated Python programs to lock on and verify candidates against raw signals. To enable effective evaluation, we introduce NLQTSBench, the first large-scale benchmark designed for NLQ over TSDB-scale histories. Our experiments highlight the unique challenges within this domain and demonstrate that Sonar-TS effectively navigates complex temporal queries where traditional methods fail. This work presents the first systematic study of NLQ4TSDB, offering a general framework and evaluation standard to facilitate future research.

14.
bioRxiv (Bioinfo) 2026-06-13

Virus-human protein-protein interactions predict viral phenotypes

Viral phenotypes such as host and tissue tropism are critical determinants of viral infection and transmission. Inferring viral phenotypes presents unique challenges compared to cellular organisms, as viruses rely entirely on host machinery for replication and survival. Current methods for predicting viral phenotypes mainly rely on viral genomic data, often overlooking host-related information. Here, we evaluated the utility of predicted virus-human protein-protein interactions (PPIs) in inferring diverse viral phenotypes using machine-learning algorithms. For predicting human infectivity, a PPI-based machine learning model outperformed both virus genomic and protein sequence-based models that used large language model embeddings. It also surpassed previous methods that incorporated both viral and host genomic data. The human proteins identified by the model were significantly enriched in functions related to viral infection and immune response. In predicting various phenotypes of human RNA viruses, PPI-based models performed better than virus sequence-based models in forecasting virulence, human transmissibility and transmission routes, while showing comparable performance to genomic sequence-based models in predicting tissue tropism. Finally, we demonstrated that a PPI-based model could distinguish high-risk HPV genotypes from low-risk ones. Proteins associated with high-risk HPV were involved in apoptosis and immune regulation, whereas those linked to low-risk HPV were enriched in telomere maintenance and DNA repair. Collectively, this study is the first to demonstrate the value of predicted virus-human PPIs in inferring viral phenotypes, thereby enhancing our understanding of the molecular mechanisms underlying these phenotypes. It also provides effective tools for risk assessment of emerging viruses, contributing to improved pandemic preparedness.

15.
arXiv (quant-ph) 2026-06-16

Generalized symmetries, invariant solutions and conservation laws in the Jaynes-Cummings model

arXiv:2606.15538v1 Announce Type: cross Abstract: In this work, we investigate the Jaynes–Cummings model (JCM) using Lie symmetry analysis and conservation-law theory. The dynamics is formulated as a system of partial differential equations by projecting the von Neumann equation onto the atomic degrees of freedom and representing the field mode through its characteristic function. We determine the admitted point and generalized symmetries and construct invariant solutions satisfying the physical conditions imposed by quantum mechanics. The conventional dressed-state dynamics is recovered while a second class of solutions with radial dependence expressed through Heun polynomials is obtained for coupled atom–field configurations. We also apply the generating functions methodology to derive local conservation laws of the JCM differential system. Besides recovering the conservation of the total number of excitations, we obtain additional conserved currents involving atomic populations, coherence, reduced-state purity, and moments of the field characteristic function. In particular, we derive a balance equation for a combination of atomic purity and coherence whose evolution is controlled by the atom–field coupling and is linked to atom–field correlation and entanglement dynamics. The symmetry structure further generates generalized symmetries and an infinite hierarchy of conservation laws.

16.
medRxiv (Medicine) 2026-06-15

Epileptogenicity alters intrahippocampal ripple propagation

Objective: Tracing the propagation of high-frequency oscillations (HFOs) aids in localizing epileptogenic regions and improving surgical outcomes. We examined how hippocampal epileptogenicity influences the propagation properties of the HFOs it generates. Methods: We analyzed non-REM sleep stereo-EEG from 49 patients (68 hemispheres) with verified hippocampal contacts. Hippocampi were stratified by excitability: 28 seizure onset zone (SOZ), 22 more-irritative non-SOZ (>6 interictal epileptiform discharges [IED]/min), and 18 less-irritative non-SOZ (

17.
Nature (Science) 2026-06-17

A blastoporal organizer in a ctenophore

In an iconic experiment in 1924, Hilde Mangold and Hans Spemann established that the dorsal blastopore lip of amphibian embryos functions as an organizer and induces a secondary body axis when transplanted into a host embryo1. This discovery demonstrated that specific embryonic regions can regulate embryonic patterning and lead to the establishment of an entire body axis. Subsequent studies have revealed that cnidarians, the sister group to Bilateria, also possess a blastoporal embryonic organizer2,3. However, the evolutionary origin of the organizer remains unclear. Here we report that the blastopore lip of the ctenophore Mnemiopsis leidyi, a member of the evolutionary sister group to all other metazoans4,5, exhibits organizer activity. We show that transplanted fragments of blastopore lip tissue from M. leidyi gastrula induce secondary pharynx and mouth formation. Moreover, transphyletic transplantation experiments show that the blastopore lip of M. leidyi leads to the generation of a secondary body axis in embryos of the cnidarian Nematostella vectensis. Organizer function in M. leidyi requires both β-catenin and TGFβ signalling, and the TGFβ-family ligands probably provide this inductive capacity. These findings reveal the deep homology of the blastoporal organizer in ctenophores, cnidarians and vertebrates, implying the ancestral organizer role of the blastopore lip. We propose that the emergence of the organizer was an essential innovation that facilitated the change from the temporal cell differentiation of unicellular relatives to the spatial cell differentiation of the first multicellular embryo. Experiments using the comb jelly Mnemiopsis leidyi and the sea anemone Nematostella vectensis reveal that the emergence of a core signalling pathway may have been a key innovation enabling the transition to multicellularity in animals.

18.
arXiv (math.PR) 2026-06-17

Optional Stopping for Superhedging Supermartingales

arXiv:2606.17452v1 Announce Type: new Abstract: Superhedging supermartingales, introduced by the authors in previous work, are non-probabilistic processes defined via subadditive outer integrals that carry a purely financial interpretation in terms of superhedging cost. Building on the Leinert-König theory of non-lattice integration, the present paper establishes several results that are classical in probability theory but whose non-probabilistic proofs require fundamentally new arguments: (i) a tower inequality for the conditional outer integral \overline{\sigma}_j applied at stopping times, reducing to equality when the integrand is conditionally integrable; (ii) three versions of Doob's optional stopping theorem, organised by the class of supermartingale and the range of the stopping times; and (iii) Dubins' upcrossing inequality in both finite- and infinite-time horizons. A key structural result, property (K)-a.e., identifies conditions under which the two superhedging operators \overline{\sigma}_j and \overline{I}_j coincide on non-negative functions, extending the scope of all preceding results to the positive operator \overline{I}_j. None of the proofs invoke classical measure-theoretic tools; in particular, (classical) integrability and measurability are not assumed. The analogues of classical stochastic results acquire a purely financial interpretation and, in this way, gain depth and generality by providing a context that is independent of any a priori probabilistic structure.

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

Exploding and vanishing gradients in deep neural networks: the effect of residual connections

arXiv:2606.17013v1 Announce Type: cross Abstract: The well known phenomenon of exploding and vanishing gradients in deep neural networks is analyzed using multiplicative ergodic theory. The effect of adding a residual connection is explained in this context. Specifically, a characterization of Liapunov exponents due to Furstenberg and Kifer is exploited in order to make a precise statement about the Liapunov spectrum and the effect of residual connections on it.

20.
arXiv (CS.CV) 2026-06-16

SLUM-i: Semi-supervised Learning for Urban Mapping of Informal Settlements and Data Quality Benchmarking

Rapid urban expansion has fueled the growth of informal settlements in major cities of low- and middle-income countries, with Lahore and Karachi in Pakistan and Mumbai in India serving as prominent examples. However, large-scale mapping of these settlements is severely constrained not only by the scarcity of annotations but by inherent data quality challenges, specifically high spectral ambiguity between formal and informal structures and significant annotation noise. We address this by introducing a benchmark dataset for Lahore, constructed from scratch, along with companion datasets for Karachi and Mumbai, which were derived from verified administrative boundaries, totaling approximately 900 $km^2$ of urban area. This collection is supplemented by four cities from prior literature across Sub-Saharan Africa and Latin America, with comprehensive data quality assessments provided for each city. We also propose a semi-supervised segmentation framework designed to mitigate the class imbalance and distribution mismatch inherent in standard semi-supervised learning pipelines. Our method integrates a Class-Aware Adaptive Thresholding mechanism that dynamically adjusts confidence thresholds to prevent minority class suppression, and a DINOv2-based unlabeled pool filter that removes out-of-distribution tiles prior to training to reduce covariate shift. Extensive experiments across seven cities spanning three continents, repeated over five random seeds, demonstrate gains of up to +5.9 pp mIoU over state-of-the-art semi-supervised baselines, with both components being architecture-agnostic and adding no inference overhead.

21.
medRxiv (Medicine) 2026-06-16

Adherence to Red Reflex and Vision Screening Recommendations: A Deep Dive into Primary Care Implementation Gaps

Introduction: Early childhood vision screening is critical for detecting amblyopia and other vision-threatening conditions. Despite screening recommendations during well-child visits, rates remain low. Red reflex assessment is recommended to identify serious ocular pathology, yet its use in primary care is not well described. We examined rates and drivers of vision screening in pediatric primary care. Methods: We conducted a retrospective review of electronic health records for children 3 to 5 years attending well-child visits in 2022 in one of three representative primary care clinics within a university health system. Outcomes were documented red reflex and functional vision tests. We evaluated associations with patient demographics and clinic site using multivariable logistic regression Results: Among 1,003 visits, 21.1% (n=212) had a documented red reflex assessment, and 60.8% (n=610) a functional vision test. Younger children (ages 3 and 4 vs. 5 years) had higher odds of red reflex assessment [adjusted odds ratio (aOR) 9.00 and 8.64], and lower odds of a functional vision (aOR 0.47 and 0.59) test. Females had higher odds of red reflex assessment (aOR 1.53). Other/Multiracial children had lower odds of red reflex assessment than Non-Hispanic White children (aOR 0.48). Screening rates varied significantly by clinic site Conclusions: Visual function and red reflex assessment are inconsistently performed in pediatric primary care, with particularly low rates of red reflex documentation. Screening rates varied between clinics and were affected by age. These findings highlight missed opportunities for early detection of vision-threatening conditions and identify targets for improving adherence to pediatric vision screening recommendations

23.
arXiv (CS.CV) 2026-06-17

ProCUA-SFT Technical Report

Training computer-use agents (CUAs) – models that interact with graphical desktops through screenshots and keyboard/mouse actions – requires large-scale, diverse trajectory data collected in full desktop environments. The largest public resource, AgentNet (22.5K human trajectories), leads to negative transfer when used for supervised fine-tuning (SFT): continuing training UI-TARS 7B on AgentNet causes OSWorld success rate to fall from 26.3% to 8-10%. We present ProCUA-SFT, a dataset of 3.1M step-level SFT samples distilled from 93K synthetic trajectories across 2,484 application combinations. The dataset is produced by a fully automated pipeline that (i) synthesizes grounded tasks on live desktops seeded with real-world content – 912 spreadsheets from SpreadsheetBench, approximately 10K permissively-licensed presentations from Zenodo10K, and multi-application OSWorld configs – and (ii) verifies each task's feasibility through binary precondition checking before rollout. A single VLM (Kimi-K2.5) serves as goal generator, precondition judge, and trajectory executor, eliminating planner-actor capability gaps. Each trajectory is expanded into step-prefix samples that exactly reproduce the context layout seen at inference time. Fine-tuning UI-TARS 7B on ProCUA-SFT for one epoch yields 45.0% on OSWorld – an 18.7 percentage-point improvement over the base model and over 35% above AgentNet-trained counterparts. A subset of ProCUA was incorporated into the training data for the Nemotron 3 Nano Omni model, contributing to its computer-use capabilities.

25.
medRxiv (Medicine) 2026-06-19

Cardiometabolic multimorbidity and care experiences in primary healthcare among Brazilian adults aged 50 and over (ELSI-Brazil)

Background: Population aging and the rising burden of non-communicable diseases have increased the prevalence of cardiometabolic multimorbidity (CM-MM) among older adults. Patient-reported experience measures (PREMs) are recognized as essential components of healthcare quality assessment, yet evidence on primary care experiences among individuals with CM-MM remains scarce. Objective: To analyze primary care experiences according to the presence of cardiometabolic multimorbidity among Brazilians aged 50 years and older. Methods: Cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021; n = 9,949). CM-MM was defined as the self-reported coexistence of two or more of the following conditions: hypertension, diabetes mellitus, dyslipidemia, acute myocardial infarction, and stroke. Primary care experiences were assessed using a validated 12-item instrument organized into four domains: first-contact access, longitudinality, communication, and care coordination. Associations were estimated using Poisson regression adjusted for sociodemographic, health conditions, and healthcare utilization variables, with stratified analysis by Family Health Strategy (FHS) coverage. Results: CM-MM prevalence was 25.5%, with a progressive increase by age and an inverse gradient by education. Individuals with CM-MM reported significantly more positive experiences in longitudinality (mean index 2.53 vs. 2.34; adjusted PR = 1.22; 95%CI 1.12-1.33; p < 0.001) and, to a lesser extent, in communication (mean index 2.68 vs. 2.58; adjusted PR = 1.10; 95%CI 1.00-1.20; p = 0.041). No statistically significant differences were found in first-contact access or care coordination. After stratified by FHS coverage, the observed differences in longitudinality and communication were no longer statistically significant. Conclusions: CM-MM was associated with more positive primary care experiences in longitudinality and communication. The absence of differentiated experiences in first-contact access and coordination highlights structural gaps in primary care responsiveness to individuals with greater clinical complexity. Keywords: Multimorbidity; Cardiometabolic diseases; Primary Care; Patient-reported experience measures; Older adults; ELSI-Brazil.