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01.
medRxiv (Medicine) 2026-06-12

Opportunistic CKD Screening in Hospitalized Patients

Authors:
Segal↗Levy↗Ghosheh↗Wolak↗Ben-Dov↗

Background. Chronic kidney disease (CKD) affects 10-13% of adults worldwide but remains largely undiagnosed until advanced stages. Hospitalization provides an opportunity for early detection through opportunistic urine albumin-to-creatinine ratio (UACR) measurement. Methods. We conducted a prospective three-arm study of opportunistic CKD screening in general internal medicine wards at Hadassah Mt. Scopus (MS), Hadassah Ein Kerem (EK), and Shaare Zedek Medical Center (SZMC) in Jerusalem (Protocol HMO-23-0300). Adult inpatients without known CKD or recent UACR were enrolled. Pathological UACR was defined as [≥]30 mg/g. Confirmed CKD required two pathological measurements [≥]90 days apart (KDIGO-compatible). eGFR was computed using the 2021 CKD-EPI race-free equation. Pooled proportions were estimated by fixed-effects logit meta-analysis; odds ratios by DerSimonian-Laird random-effects models. Results. A total of 158 patients were enrolled (MS n=50, EK n=57, SZMC n=51). Pathological first UACR was identified in 43/158 patients (27.2%; 95% CI 21.3-34.1%; I2=0% across centers). Of 24 patients with a second UACR available, 14 (58%) confirmed CKD, yielding a pooled confirmed-CKD rate of 8.9% of all screened patients. In-hospital mortality was significantly higher among patients with pathological UACR (9.3% vs ~2%; Fisher's exact p=0.012). In per-center multivariate logistic regression, three predictors reached pooled significance: BUN (OR 1.10 per mg/dL, 95% CI 1.04-1.17, p=0.002, I2=0%), heart failure (OR 3.21, 95% CI 1.34-7.70, p=0.009, I2=0%), and diabetes mellitus (OR 2.54, 95% CI 1.11-5.82, p=0.028, I2=17%). Cardiac/vascular admissions had the highest pathological UACR rate (~42%); GI/hepatic admissions had 0%. Conclusions. Opportunistic inpatient UACR screening identifies previously unrecognized CKD in approximately 9% of general internal medicine patients, with consistent results across three independent centers. BUN elevation, heart failure, and diabetes are the strongest independent predictors. Pathological UACR carries significant short-term mortality risk, supporting integration of routine screening into inpatient care pathways.

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02.
arXiv (CS.AI) 2026-06-24

ASymPO: Asymmetric-Scale Policy Optimization for Asynchronous LLM Post-Training Without Behavior Information

Authors:
Zehua Liu↗Yuxuan Yao↗Xiaojin Fu↗Tao Zhong↗Mingxuan Yuan↗

arXiv:2606.03070v3 Announce Type: replace-cross Abstract: Asynchronous reinforcement learning can improve language-model post-training throughput by decoupling response generation from policy optimization, but stale responses introduce distribution drift. Standard behavior-corrected methods control this drift with behavior-policy probabilities, importance ratios, or clipping, which requires token-aligned, versioned, and numerically consistent behavior log-probabilities across rollout and learner systems. We ask whether asynchronous group-relative RL can instead be stabilized using only current-policy probabilities. We identify a scale-imbalance failure mode: when stale responses are evaluated under the current policy, positive and negative loss terms can appear at different negative log-probability scales, so zero-sum advantages no longer imply balanced loss contributions. We propose Asymmetric-Scale Policy Optimization (ASymPO), which normalizes each response's token loss by its current average token negative log-probability. ASymPO requires no behavior-policy probabilities, restores response-level zero-sum balance, and preserves a nonzero learning signal. We also introduce Scaled Policy Optimization (SPO), a fixed negative-scaling baseline, and evaluate both current-policy-only objectives in asynchronous mathematical reasoning post-training.

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

GeoCFNet: Geometry-Aware Confidence Field Network for Robot-Assisted Endoscopic Submucosal Dissection

Authors:
Rui Tang↗Guankun Wang↗Long Bai↗Haochen Yin↗Huxin Gao↗Jiewen Lai↗Jiazheng Wang↗Hongliang Ren↗

Advanced surgical robotics has made robot-assisted endoscopic submucosal dissection (ESD) a promising approach for the en-bloc resection of large lesions, with the potential to reduce recurrence and improve long-term outcomes. However, the technical complexity and risk of complications in ESD demand stable and precise visual guidance to maintain an accurate dissection corridor and a safe tissue margin. Dense confidence fields provide an effective representation for this purpose by describing both the preferred dissection region and its spatial transition to surrounding tissue. However, reliable confidence field estimation remains challenging in dynamic endoscopic scenes due to smoke, specular highlights, tissue deformation, weak texture, and the thin geometric structure of the target region. To address these challenges, we formulate dissection guidance as a geometry-aware confidence field estimation problem and propose GeoCFNet, a geometry-aware confidence field network built on a pretrained DINOv3 backbone. GeoCFNet integrates a Token-Differentiated Fusion module to aggregate class-token context with dense patch representations, a SegFormer decoder for confidence regression, and Geometry-Aware Spatial Regularization (GASR) to preserve spatial coherence and local geometric transitions. Experimental results show that GeoCFNet achieves RMSE 0.0480, PSNR 27.1995, SSIM 0.3397, and CC 0.2466, indicating accurate and geometrically stable confidence field estimation for robot-assisted ESD guidance.

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04.
arXiv (CS.CL) 2026-06-18

Attention as Frustrated Synchronization

Authors:
Joshua Nunley↗

A network of oscillators that synchronizes perfectly computes nothing further, so an attention architecture built from synchronization must locate its computation in structured departures from agreement. We introduce the Frustrated Synchronization Network (FSN), whose token states are phases on a torus and whose entire value pathway is one learned complex coupling kernel over harmonics and a one-step delay. Each component of the kernel is a frustration in the sense of the synchronization literature. The complex phases are static Kuramoto-Sakaguchi frustration angles, the signed harmonics are repulsive Daido components, and the delay term, which couples each token to the successors of the tokens it attends to, is algebraically identical to Kuramoto-Sakaguchi coupling whose frustration angle is the data's own transition, so next-token prediction is implemented as synchronization frustrated by the data. At matched one-million-parameter and training budgets on character-level text and code, the FSN's validation loss is below a tuned RoPE-SwiGLU transformer's at every epoch measured, and the comparison survives training the baseline to convergence: every thirty-epoch enwik8 seed finishes below the transformer's converged fifty-epoch loss of 1.611, and the FSN's completed fifty-epoch runs converge to 1.5953 +/- 0.0014. A variant with every feed-forward block replaced by mean-field coupling to learned collective modes, leaving no multilayer perceptron in the stack, tracks the transformer. On natural text the unfrustrated base layer falls behind the converged transformer at every copy depth, worst on long-range copy events; the kernel reverses the deficit at every depth of four and beyond. Headline comparisons are at the one-million-parameter scale; a scale ladder is complete through four million parameters with the advantage persisting, and remaining arms are marked as in progress.

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05.
arXiv (CS.AI) 2026-06-11

Knowing When to Ask: Self-Gated Clarification for Hierarchical Language Agents

Authors:
Aijing Gao↗Yiming Kang↗Mengdie Flora Wang↗Jae Oh Woo↗

arXiv:2606.11349v1 Announce Type: new Abstract: In hierarchical reasoning, failures often originate at intermediate decision points where the agent commits to a wrong branch without recognizing that it lacks critical information. Rather than treating clarification as an external uncertainty trigger, we propose ACTION-RATING, a formulation that places it inside the agent's action space on a shared ordinal scale with navigation, so that asking competes directly with acting at every decision point and help-seeking becomes observable at intermediate states. Two structurally distinct information-seeking modes emerge from the agent's own ratings: mandatory (no viable branch) and opportunistic (residual uncertainty despite a leading candidate). On Harmonized Tariff Schedule classification (30,000-node taxonomy, three benchmarks, 9~LLMs across 4 families), we observe a regime shift from mandatory to opportunistic clarification, with Information-Seeking Effectiveness (ISE), a local diagnostic defined as the fraction of help interactions followed by a correct next navigation step (not a final-task metric), rising from 50% to 74%. Three diagnostic contrasts fail to reproduce this structure. A separability test shows that the information-seeking pattern (mode split, ISE ranking) persists when answer quality is degraded (-18.8% accuracy), supporting an empirical separation between where an agent seeks help and the quality of the help it receives. Under the controlled answer channel, accuracy gains reach +16.2% at 10-digit; we read this as an upper bound on what better localization could unlock, not a deployment estimate.

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06.
Nature (Science) 2026-06-24

AI tool spots antibiotics that fight drug-resistant gonorrhoea

Authors: Unknown Author

The bacterium Neisseria gonorrhoeae has evolved resistance to most antibiotics used to treat it, but a machine-learning screen reveals potential therapies. The bacterium Neisseria gonorrhoeae has evolved resistance to most antibiotics used to treat it, but a machine-learning screen reveals potential therapies.

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

Nonlinear Two-Time-Scale Stochastic Approximation: A Sharp Phase Transition and How to Beat It

Authors:
Dhruv Sarkar↗Vaneet Aggarwal↗

arXiv:2606.14488v1 Announce Type: cross Abstract: Recent finite-time analyses of nonlinear two-time-scale stochastic approximation show that under contractive assumptions the slow iterate $Y_k$ with stepsizes $\beta_k=\Theta(k^{-1})$ and $\alpha_k=\Theta(k^{-a})$, $a\in(1/2,1)$, generally satisfies a mean-square rate of order $k^{-a}$; decoupled $k^{-1}$ rates require strong local linearity. We identify a sharp regularity-dependent boundary. In a rate-determining normal form where the slow drift contains a locally linear leakage and a nonlinear remainder of order $1+\rho$ ($\rho\in[0,1]$), the uncorrected recursion satisfies \[ \mathbb{E}\|Y_k\|^2 \le C\bigl(k^{-1}+k^{-a(1+\rho)}\bigr), \] and a matching scalar Gaussian lower bound shows that the slower term is unavoidable without modifying the update. Thus the decoupled $k^{-1}$ rate is guaranteed for the uncorrected recursion exactly when $a(1+\rho)\ge 1$. This lower bound concerns only the naive update; it is not an information-theoretic obstruction. We demonstrate this by equipping the normal-form recursion with an auxiliary online bias estimator \[ M_{k+1}=M_k+\gamma_k(R(X_k)-M_k),\qquad \beta_k\ll\gamma_k\ll\alpha_k, \] and subtracting $M_k$ from the slow update. Under the same stability, moment, and remainder assumptions, the corrected recursion achieves $\mathbb{E}\|\widetilde Y_k\|^2=O(k^{-1})$ for every $\rho\in[0,1]$, including regimes where the uncorrected update provably suffers the slower rate. Finally, we prove localized transfer theorems that extend the phase-transition mechanism to general nonlinear TTSA in fast-manifold coordinates. The proofs are non-asymptotic and rely on two Abel-transform cancellations: one for the locally linear fast-error leakage, and one for the tracked nonlinear bias.

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08.
arXiv (CS.CL) 2026-06-11

BaltiVoice: A Speech Corpus and Fine-tuned Whisper ASR System for the Balti Language

Authors:
Muhammad Ali↗

We present BaltiVoice, a 16.8-hour read-speech corpus for Balti (ISO 639-3: bft), a Tibetic language spoken in Gilgit-Baltistan, Pakistan, with no prior publicly available ASR resources. The corpus contains 10,060 validated utterances in native Nastaliq script, derived from Mozilla Common Voice recordings. Fine-tuning OpenAI Whisper-small yields a Word Error Rate (WER) of 26.74% and a Character Error Rate (CER) of 8.67% on a 538-utterance speaker-disjoint validation set, down from a zero-shot baseline of 159.19% WER and 152.52% CER. A Whisper-base fine-tuned on the same data achieves 44.54% WER and 15.61% CER, confirming that model capacity matters for this low-resource setting. The dataset, fine-tuned model, and a live transcription demo are publicly available on HuggingFace.

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09.
arXiv (CS.CL) 2026-06-15

Non-Parametric Machine Text Detection via Multi-View Gaussian Processes

Authors:
Aleem Khan↗Nicholas Andrews↗

Adversarial conditions such as paraphrasing and targeted style transfer sharply degrade the accuracy of machine text detectors. A document, however, carries multiple complementary signals (e.g., stylistic features, likelihood and rank-order features, and structural features), and an attack that suppresses one may leave others intact. While a parametric classifier can learn to combine these features given sufficient supervision, classifiers are prone to making confidently incorrect predictions when the distribution shifts (e.g., novel attacks or unseen language models). To address this, we propose a multi-view, non-parametric detection framework that extracts complementary feature views from the same document and aggregates per-view evidence through a Gaussian process ensemble. By aggregating evidence across views, an adversary must simultaneously defeat multiple independent axes of detection, substantially raising the cost of evasion. The Gaussian process formulation additionally provides calibrated probabilities and principled abstention on out-of-distribution inputs, supporting reliable deployment in high-stakes settings. We evaluate on three benchmarks spanning diverse generators and attacks: the DetectRL and RAID benchmarks, and the PAN2025 shared task and demonstrate that our multi-view detector maintains strong performance under the considered attacks, outperforming existing approaches against held out attacks.

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

A Unified Perspective on the Dynamics of Deep Transformers

Authors:
Val\'erie Castin↗Pierre Ablin↗Jos\'e Antonio Carrillo↗Gabriel Peyr\'e↗

arXiv:2501.18322v2 Announce Type: replace Abstract: Transformers, which are state-of-the-art in most machine learning tasks, represent the data as sequences of vectors called tokens. This representation is then exploited by the attention function, which learns dependencies between tokens and is key to the success of Transformers. However, the iterative application of attention across layers induces complex dynamics that remain to be fully understood. To analyze these dynamics, we identify each input sequence with a probability measure and model its evolution as a Vlasov equation called Transformer PDE, whose velocity field is non-linear in the probability measure. Our first set of contributions focuses on compactly supported initial data. We show the Transformer PDE is well-posed and is the mean-field limit of an interacting particle system, thus generalizing and extending previous analysis to several variants of self-attention: multi-head attention, L2 attention, Sinkhorn attention, Sigmoid attention, and masked attention–leveraging a conditional Wasserstein framework. In a second set of contributions, we are the first to study non-compactly supported initial conditions, by focusing on Gaussian initial data. Again for different types of attention, we show that the Transformer PDE preserves the space of Gaussian measures, which allows us to analyze the Gaussian case theoretically and numerically to identify typical behaviors. This Gaussian analysis captures the evolution of data anisotropy through a deep Transformer. In particular, we highlight a clustering phenomenon that parallels previous results in the non-normalized discrete case.

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11.
arXiv (CS.CV) 2026-06-16

ToaSt: Token Channel Selection and Structured Pruning for Efficient ViT

Authors:
Hyunchan Moon↗Cheonjun Park↗Steven L. Waslander↗

Vision Transformers (ViTs) have achieved remarkable success across various vision tasks, yet their deployment is often hindered by prohibitive computational costs. While structured weight pruning and token compression have emerged as promising solutions, they suffer from prolonged retraining and inter-layer dependencies that complicate optimization, respectively. We propose ToaSt, a decoupled framework applying specialized strategies to distinct ViT components. We apply coupled head-wise structured pruning to Multi-Head Self-Attention modules, leveraging attention operation characteristics to enhance robustness. For Feed-Forward Networks (over 60% of FLOPs), we introduce Token Channel Selection (TCS), a training-free method that filters redundant noise channels at inference time. Extensive evaluations across nine diverse models, including DeiT, ViT-MAE, and Swin Transformer, demonstrate that ToaSt achieves superior trade-offs between accuracy and efficiency, consistently outperforming existing baselines. On ViT-MAE-Huge, ToaSt achieves 88.52% accuracy (+1.64%p) with 39.4% FLOPs reduction. ToaSt also transfers effectively to diverse downstream tasks (COCO detection, ADE20K segmentation, CIFAR-100 classification), achieving 52.2 versus 51.9 mAP on COCO. Code: github.com/SHANNonLab-HUFS/ToaSt

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

VISA: VLM-Guided Instance Semantic Auditing for 3D Occupancy World Models

Authors:
Ruiqi Xian↗Yuehan Xian↗Jing Liang↗Xuewei Qi↗Dinesh Manocha↗

Semantic 3D occupancy provides a voxelized world state for autonomous driving and robot decision making, but object and rare-class errors can affect free-space interpretation, collision checking, and temporal state propagation. We show that a common VLM strategy, aligning 3D voxel or object features with crop-caption embeddings, improves text-space similarity without reliably improving closed-set occupancy mIoU. Motivated by this mismatch, we propose VISA, a training-time semantic auditing approach for existing occupancy world models. VISA queries an offline VLM on a representative crop of each physical object instance, obtains a structured audit with class hypotheses, plausible confusions, reliability, attributes, and evidence, and propagates it along the object track. The audit is grounded to matched 3D object voxels and distilled into semantic logits through reliability-weighted taxonomy, attribute-factor, and scene-level audit graph losses, while inference remains unchanged and requires no VLM. On nuScenes, averaged across three runs, VISA improves OccWorld from 19.06 to 20.05 mIoU and GaussianWorld from 21.36 to 21.91 mIoU; on GaussianWorld, object mIoU improves from 18.18 to 19.16 and rare-class mIoU from 15.60 to 16.79. These results suggest that VLMs are better suited to closed-set occupancy as reliability-aware semantic auditors than as generic caption-embedding targets.

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13.
arXiv (CS.LG) 2026-06-25

When Do Conservation Laws Survive Learned Representations? Certified Horizons for Latent World Models

Authors:
Hongbo Wang↗

arXiv:2606.24945v1 Announce Type: new Abstract: We ask a representation-learning question about physical world models: when does a conservation law remain certifiable after a model learns a latent representation? A certified horizon bounds – in advance, from measurable model defects – how many steps a rollout provably stays on a physical invariant's level set. The key design choice is what is certified: not a learned latent Hamiltonian or a learned scalar witness (a model can conserve either while drifting in true energy), but the decoded physical invariant obtained by decoding the latent state and evaluating the known invariant. Around this object we derive shell-horizon certificates whose budget decomposes into representation, readout, and latent-dynamics defects, with a monotone alignment bridge through which a soft learned witness yields a certified horizon for the decoded invariant, and test them across state, learned-lift, and pixel observations on conservative systems. Conservation certificates can survive learned representation, but not all geometric priors survive equally: hard canonical symplectic structure yields the longest horizons in known phase coordinates yet does not cross a learned chart, whereas a controlled-Lipschitz-aligned soft invariant survives in the learned-representation settings we test; pixel certification is recovered on a readout-stable sub-tube; and the Kepler problem exposes a geometric boundary. The central object is therefore not a latent Hamiltonian, but a decoded physical invariant whose robustness to representation learning can be measured, certified, and falsified.

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14.
PLOS Computational Biology 2026-06-22

CoDaLoMic: An R package for modeling microbiome compositional and longitudinal data

Authors:
Irene Creus-Martí↗

by Irene Creus-Martí, Andrés Moya, Francisco J. Santonja In this paper we present CoDaLoMic, an R package for analyzing longitudinal and compositional microbiome datasets. The CoDaLoMic package implements three models specifically designed for the analysis of microbiome data that are both compositional and longitudinal. Unlike many existing methods that focus solely on pairwise interactions, CoDaLoMic also captures interactions among groups of bacteria, providing a more robust methodological framework for studying microbial relationships at the community level. In addition, the package facilitates the analysis of microbiome variability in relation to host health status and allows for the identification of groups of taxa that exhibit similar temporal dynamics. Working with time series data makes it possible to understand not only the current state of a microbial community but also its dynamics over time, which is essential for identifying patterns of ecological succession, detecting events of dysbiosis or recovery, and inferring potential causal relationships between taxa. On the other hand, focusing on interactions among groups of bacteria, rather than analyzing only pairwise relationships, enables a more integrated and functionally meaningful view of the microbiome. Many key ecological functions are the result of the collective behavior of functionally related groups of taxa. Two datasets have been considered in CoDaLoMic, one real and one simulated. The real dataset contains the information of the genera present in the microbiome of the Blatella germanica cockroach at 105 time points. The simulated dataset is defined taking Lotka-Volterra structure into account. CoDaLoMic is available at CRAN.

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

A Comprehensive Survey of Medical Image Segmentation: Challenges, Benchmarks, and Beyond

Authors:
Pengyu Zhu↗Xiaojing Zhang↗Kunbo Zhang↗Chunyan Zhang↗Zhenyu Wang↗

Medical image segmentation plays a critical role in clinical diagnostics, treatment planning, disease monitoring, and neurological disorder identification. This article presents a comprehensive review of its systematic development, covering widely used public datasets, representative methods built on the U-Net, Transformer, and SAM architectures, and key evaluation metrics with their differences, followed by an analysis of major challenges from multiple perspectives. Unlike surveys that focus on a single model family or a specific clinical application, this review organizes U-Net-, Transformer-, and SAM-based methods within a unified analytical framework, with a particular focus on their effectiveness in improving segmentation accuracy and efficiency. This work aims to guide future research and support clinical translation of medical image segmentation, with all related resources publicly available in our GitHub repository: https://github.com/andrew-pengyu/Awsome_MedSeg/tree/main.

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17.
arXiv (quant-ph) 2026-06-19

Spatial Localization of Relativistic Quantum Systems: The Commutativity Requirement and the Locality Principle. Part II: A Model from Local QFT

Authors:
Valter Moretti↗

arXiv:2604.04173v3 Announce Type: replace-cross Abstract: This paper is the second and final part of a two-part study. We construct positive-energy relativistic spatial localization observables in Minkowski spacetime within standard quantum field theory, using the stress–energy–momentum tensor smeared with suitable test functions. For each fixed timelike direction, the construction gives positive operator-valued measures (POVMs) on spacelike hypersurfaces, well defined on every $n$-particle sector and satisfying a relativistic causality condition excluding superluminal propagation of detection probabilities. The observables are built from local or quasi-local field-theoretic quantities, thus providing a rigorous version of earlier heuristic proposals. In the one-particle sector, the construction reduces to the observable previously introduced by the author, and its first moment gives the Newton–Wigner position operator under appropriate normalization and centering assumptions. Because the Reeh–Schlieder theorem prevents the normally ordered stress–energy–momentum tensor from being positive on the full Fock space, we use quantum energy inequalities to obtain lower bounds controlling deviations from positivity. This leads to regularized operator families, bounded from below, which approximate the localization effects. Finally, we define conditional localization observables for finite laboratories through modified local energy operators. By Haag duality, the corresponding conditional POVMs belong to local von Neumann algebras and commute for causally separated regions, in accordance with the Araki–Haag–Kastler framework. The results show how commutativity of localization observables is recovered for conditional measurements in finite spacetime regions.

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18.
arXiv (CS.LG) 2026-06-19

Understanding Key Features of Time Series Foundation Models from Epidemic Forecasting

Authors:
Alireza Jafari↗Judy Fox↗Geoffrey C. Fox↗Madhav Marathe↗Aniruddha Adiga↗

arXiv:2606.19560v1 Announce Type: new Abstract: Seasonal influenza infects millions of people and causes substantial morbidity and mortality in the United States each year, making accurate short-term forecasting a core public-health need. Reliable forecasts of epidemic time series can inform vaccination timing, hospital staffing, and resource allocation, yet the comparative behavior of modern forecasting architectures on infectious-disease surveillance data remains insufficiently characterized. We address this gap through a systematic evaluation of regional influenza forecasting using influenza-like illness surveillance and influenza-associated hospitalization time series under both temporal and spatial generalization settings for 1-4-week-ahead prediction. We compare classical neural network architectures, numerical transformer-based models, pretrained time series foundation models, and LLM-based forecasting approaches. Across tasks, we demonstrate that a mixture-of-experts model that fuses multiple pretrained forecasters achieves the strongest overall performance, indicating that heterogeneous pretrained representations provide complementary predictive information. Our results further show that numerical transformer-based models produce reliable forecasts, while pretraining provides the largest gains at longer horizons, particularly when the pretraining domain is mechanistically aligned with influenza dynamics. In contrast, LLM-based time series methods underperform relative to numerical forecasters in this setting. Finally, we examine hospitalization information as both an auxiliary covariate and a pretraining source. Hospitalization signals provide complementary improvements in selected settings and clarify when additional surveillance streams enhance the robustness of multi-horizon forecasting. These findings provide actionable guidance on model selection, pretraining strategy, and auxiliary-signal use for influenza preparedness.

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19.
medRxiv (Medicine) 2026-06-18

Cost-effectiveness of a virtual fracture clinic versus traditional in-person fracture clinic care for adults with acute simple fractures: a protocol for a health economic evaluation within the RECITAL trial

Authors:
Charteris↗Traeger↗A. C↗Maher↗C. G↗Copp↗Pickles↗Teng↗M. J↗Khoudair↗Warnock↗Shaw↗…

ABSTRACT Introduction Traditional in-person fracture clinics are often overcrowded and inconvenient for patients. Virtual fracture clinics aim to address some of these concerns by improving the efficiency of the orthopaedic service and reducing unnecessary interventions while maintaining safety and quality of care. The RECITAL trial is a non-inferiority randomised controlled trial comparing follow-up care provided at a virtual fracture clinic for people with acute simple fractures to follow-up care provided at an in-person fracture clinic. This study describes the protocol for an economic evaluation of RECITAL where the primary aim is to investigate the cost-effectiveness of a virtual fracture clinic compared with traditional in-person fracture clinic care from a health system perspective. Methods and analysis The RECITAL trial recruited 312 participants with acute simple fractures and randomised them to receive follow-up care provided at a virtual fracture clinic or follow-up care provided at an in-person fracture clinic. We will conduct a within-trial analysis from a health system perspective (primary analysis), as well as a health service, patient and societal perspective. The economic evaluation will estimate the difference in the cost of resource inputs on an intention to treat basis used by participants in the two arms of the trial, allowing comparisons to be made between the in-person and virtual fracture clinics. Data for intervention costs and healthcare utilisation will be collected from trial records, hospital electronic medical records and district performance units. The results of the economic evaluation will be expressed in terms of incremental cost per utility weight gained at 12 weeks and will be plotted on a cost-effectiveness plane. Bootstrapping by resampling will be used to estimate 95% confidence intervals around costs and outcomes, and to calculate the confidence intervals around the incremental cost-effectiveness ratio. A cost-effectiveness acceptability curve (CEAC) will be plotted, which will provide information about the probability that an intervention is cost-effective, given the level of a decision makers willingness to pay for each additional outcome. Ethics and Dissemination The trail was approved by the SLHD Ethics Review Committee (RPAH Zone) (X23-0200 and 2023/ETH01038). The findings will be disseminated through a peer-reviewed journal and conference presentations. Trial registration number The trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ANZCTR; 12623000934640)

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20.
arXiv (CS.AI) 2026-06-11

The Unreasonable Effectiveness of Discrete-Time Gaussian Process Mixtures for Robot Policy Learning

Authors:
Jan Ole von Hartz↗Adrian R\"ofer↗Joschka Boedecker↗Abhinav Valada↗

arXiv:2505.03296v2 Announce Type: replace-cross Abstract: We present Mixture of Discrete-time Gaussian Processes (MiDiGap), a novel approach for flexible policy representation and imitation learning in robot manipulation. MiDiGap enables learning from as few as five demonstrations using only camera observations and generalizes across a wide range of challenging tasks. It excels at long-horizon behaviors such as making coffee, highly constrained motions such as opening doors, dynamic actions such as scooping with a spatula, and multimodal tasks such as hanging a mug. MiDiGap learns these tasks on a CPU in less than a minute and scales linearly to large datasets. We also develop a rich suite of tools for inference-time steering using evidence such as collision signals and robot kinematic constraints. This steering enables novel generalization capabilities, including obstacle avoidance and cross-embodiment policy transfer. MiDiGap achieves state-of-the-art performance on diverse few-shot manipulation benchmarks. On constrained RLBench tasks, it improves policy success by 76 percentage points and reduces trajectory cost by 67%. On multimodal tasks, it improves policy success by 48 percentage points and increases sample efficiency by a factor of 20. In cross-embodiment transfer, it more than doubles policy success. We make the code publicly available at https://midigap.cs.uni-freiburg.de.

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

FactCheck: Feasibility-aware Long-term Action Anticipation with Multi-agent Collaboration

Authors:
Rui Cao↗Jiannong Cao↗Bo Yuan↗Zhiyuan Wen↗Mingjin Zhang↗

Long-term action anticipation (LTA) aims to predict an ordered sequence of future verb-noun actions from a partially observed video. While this task serves as the foundation for embodied intelligence, anticipating physically feasible long-term actions remains a critical challenge. Existing methods, which operate in an open-loop manner, often hallucinate non-existent objects, violate object affordances, or disregard object states, as they lack explicit mechanisms to verify action feasibility against the physical environment. To address this, we propose FactCheck, a novel multi-agent collaboration framework that improves feasibility through a closed-loop "Observe-Plan-Verify" mechanism. FactCheck decomposes the complex LTA task into specialized roles: an Observer that recognizes historical actions from video observations and constructs a dual-form structured memory, comprising a History Action Abstract that captures high-level human intentions and environmental status, and a History Action Graph that encodes object states and temporal dependencies; a Planner that generates draft future actions conditioned on both low-level historical actions and high-level History Action Abstract; and a Verifier that rigorously validates the draft against the History Action Graph and refines infeasible actions. Extensive experiments on the EPIC-Kitchens-55 and EGTEA Gaze+ benchmarks demonstrate that FactCheck consistently outperforms state-of-the-art methods. Our work establishes a new paradigm for feasibility-aware long-term action anticipation, effectively closing the loop of action recognition, action prediction and action verification.

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22.
arXiv (CS.LG) 2026-06-16

Petrov-Galerkin Variational Physics-Informed Neural Network Framework for Two-Dimensional Singularly Perturbed Problems

Authors:
Vijay Kumar↗Gautam Singh↗

arXiv:2606.16510v1 Announce Type: cross Abstract: This study proposes a Petrov-Galerkin based Variational Physics-Informed Neural Network (VPINN) for efficiently solving two-dimensional singularly perturbed problems (SPPs) with one and two small perturbation parameters. The approach employs neural networks to construct the trial solution space, while tensor-product hat functions are adopted as test functions to enforce the variational form. To accurately resolve of sharp boundary layers, the variational form is implemented using a Petrov-Galerkin formulation. Dirichlet boundary conditions are imposed directly, while the source terms are computed using automatic differentiation. Computational experiments on standard two-dimensional problems demonstrate that the proposed method achieves high accuracy in both the maximum and L_2 norms. These results confirm the efficiency and robustness of the Petrov-Galerkin VPINN approach in accurately capturing the multiscale features of two-dimensional SPPs.

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23.
arXiv (CS.LG) 2026-06-18

Task-Restricted Symmetries in Recurrent Weight Space

Authors:
Simon Dr\"ager↗

arXiv:2606.18457v1 Announce Type: new Abstract: Recurrent networks can contain substantial functional redundancy in weight space: changing a recurrent matrix may leave the input-output rollout nearly unchanged on a task distribution, while similar-scale changes can destroy the same behavior. We study this redundancy in one-layer tanh RNNs using ordered real Schur coordinates. The Schur form separates spectral blocks from directed nonnormal couplings, giving a diagnostic basis for structured ablations that keep the input and readout maps fixed. In a fixed-length copy task, selected nonnormal Schur couplings can be removed with little loss in some trained solutions, whereas other couplings are necessary for accurate autonomous replay. Across flip-flop, sine generation, and context-dependent integration, the loss-preserving ablation profile varies across tasks and trained solutions. These results identify candidate approximate functional invariances, not universal symmetries of recurrent weight space. Schur-coordinate ablations provide a practical diagnostic for which structured perturbations preserve a trained recurrent solution and which ones disrupt its computation.

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

A Validated LBM Dataset and Pipeline for Surrogate Modeling of Turbulent 3D Obstructed Channel Flows

Authors:
Lukas Schr\"oder↗Shubham Kavane↗Harald K\"ostler↗

arXiv:2606.16765v1 Announce Type: new Abstract: Evaluating neural operators for 3D turbulent flow requires validated datasets with physical benchmarks. We present a reproducible pipeline generating training data for 3D channel flows around generated geometries at Re=1,000-10,000. Our lattice Boltzmann solver with cumulant collision operators is rigorously verified against experimental measurements (Strouhal number, drag coefficients, turbulent fluctuations) with comprehensive grid convergence studies at resolution 1024x512x512. Building upon an established framework, this validated pipeline enables standardized surrogate model comparison. We outline planned systematic evaluation of Fourier Neural Operator and U-Net variants on forecasting, super-resolution, and error correction tasks, using physics-informed metrics to assess turbulent energy cascade representation. Future work will compare computational efficiency between numerical solvers and neural surrogates, exploring practical application. We seek community feedback on our validation approach, planned benchmark methodology, and evaluation priorities for neural operators in turbulent flows.

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

Evaluating Scene-based In-Situ Item Labeling for Immersive Conversational Recommendation

Authors:
Jiazhou Liang↗Yifan Simon Liu↗David Guo↗Minqi Sun↗Yilun Jiang↗Scott Sanner↗

arXiv:2604.09698v2 Announce Type: replace-cross Abstract: The growing ubiquity of Extended Reality (XR) is driving Conversational Recommendation Systems (CRS) toward visually immersive experiences. We formalize this paradigm as Immersive CRS (ICRS), where recommended items are highlighted directly in the user's scene-based visual environment and augmented with in-situ labels. While item recommendation has been widely studied, the problem of how to select and evaluate which information to present as immersive labels remains an open problem. To this end, we introduce a principled categorization of information needs into explicit intent satisfaction and proactive information needs and use these to define novel evaluation metrics for item label selection. We benchmark IR-, LLM-, and VLM-based methods across three datasets and ICRS scenarios: fashion, movie recommendation, and retail shopping. Our evaluation reveals three important limitations of existing methods: (1) they fail to leverage scenario-specific information modalities (e.g., visual cues for fashion, meta-data for retail), (2) they present redundant information that is visually inferable, and (3) they poorly anticipate users' proactive information needs from explicit dialogue alone. In summary, this work provides both a novel evaluation paradigm for in-situ item labeling in ICRS and highlights key challenges for future work.

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