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01.
arXiv (CS.AI) 2026-06-11

Precomputing Multi-Agent Path Replanning Using Temporal Flexibility

arXiv:2601.04884v3 Announce Type: replace Abstract: Executing a multi-agent plan can be challenging when an agent is delayed, because this typically creates conflicts with other agents. So, we need to quickly find a new safe plan. Replanning only the delayed agent often does not yield an efficient plan, and sometimes cannot even yield a feasible one. On the other hand, replanning other agents may lead to a cascade of changes and delays, and it is computationally expensive. We show how to efficiently replan a single delayed agent by tracking and using the temporal flexibility of other agents while avoiding cascading delays. This flexibility is the maximum delay that the agent can take without changing the order with agents other than the initially delayed agent, or further delaying other agents. Our algorithm, FlexSIPP, precomputes all possible plans for the delayed agent and returns the changes to the other agents within the given scenario. We demonstrate our method in a real-world case study of replanning trains in the densely-used Dutch railway network and in the MovingAI MAPF benchmark set. Our experiments show that FlexSIPP provides effective solutions relevant to real-world adjustments, and within a reasonable timeframe.

02.
arXiv (CS.LG) 2026-06-15

BigPower: Hierarchical Source-Level Module Power Estimation for CPUs with Large Language Models

arXiv:2606.13747v1 Announce Type: cross Abstract: Accurate power estimation is important for understanding and optimizing CPU power behavior, yet practical workflows often rely on simulation-derived information or post-silicon analysis. In this work, we present BigPower, a hierarchical source-level surrogate model for fine-grained module-level power estimation during CPU design. BigPower leverages large language model-based representations together with architectural hierarchy, module connectivity, configuration parameters, and workload context to estimate module-level power consumption directly from source-level design information, without requiring additional simulation during inference. Experimental results in the open-source XiangShan processor family demonstrate practical fine-grained power estimation across diverse configurations and workloads, offering an efficient alternative to conventional simulation-based workflows.

03.
arXiv (CS.CV) 2026-06-17

A geometric and deep learning reproducible pipeline for monitoring floating anthropogenic debris in urban rivers using in situ cameras

The proliferation of floating anthropogenic debris in rivers has emerged as a pressing environmental concern, exerting a detrimental influence on biodiversity, water quality, and human activities such as navigation and recreation. The present study proposes a novel methodological framework for the monitoring the aforementioned waste, utilising fixed, in-situ cameras. This study provides two key contributions: (i) the continuous quantification and monitoring of floating debris using deep learning and (ii) the identification of the most suitable deep learning model in terms of accuracy and inference speed under complex environmental conditions. These models are tested in a range of environmental conditions and learning configurations, including experiments on biases related to data leakage. Furthermore, a geometric model is implemented to estimate the actual size of detected objects from a 2D image. This model takes advantage of both intrinsic and extrinsic characteristics of the camera. The findings of this study underscore the significance of the dataset constitution protocol, particularly with respect to the integration of negative images and the consideration of temporal leakage. In conclusion, the feasibility of metric object estimation using projective geometry coupled with regression corrections is demonstrated. This approach paves the way for the development of robust, low-cost, automated monitoring systems for urban aquatic environments.

04.
arXiv (quant-ph) 2026-06-16

Comparative Performance Analysis of NIST PQC Standards: From STM32 Software Limitations to FPGA-SoC Acceleration

arXiv:2606.15744v1 Announce Type: new Abstract: The rapid advancement of quantum computing poses a significant threat to classical public-key cryptographic systems, necessitating the transition to Post-Quantum Cryptography (PQC). This study investigates the implementation challenges of NISTstandardized signature schemes on resource-constrained embedded hardware. We present a comparative analysis of SPHINCS+ and CRYSTALS-Dilithium on an ARM Cortex-M4 (STM32F407G) microcontroller. Our findings reveal that SPHINCS+ is practically unusable in this software-only environment, with impractical execution times. Furthermore, the reference Dilithium implementation failed to execute entirely on the MCU due to severe RAM and timing constraints. To overcome these hardware limitations, we integrated a hardware-accelerated Dilithium core onto a Xilinx Zynq-7000 ZedBoard SoC. By implementing a specialized Number Theoretic Transform (NTT) accelerator in the FPGA fabric, we achieved successful execution with performance rates for key generation and signature generation at millisecond levels. These results demonstrate that while pure software PQC is non-viable for standard microcontrollers, a hardware-software codesign approach provides the necessary efficiency for quantumresistant embedded systems.

05.
arXiv (CS.CL) 2026-06-12

AI SciBrief as a Gateway to Research: A Framework for Onboarding Students into New Research Areas

Students at all levels of higher education face a significant barrier in the form of information overload, which often paralyzes the initial stages of the research process and suppresses motivation. In response, this article introduces a pedagogical framework that leverages AI SciBrief, a platform powered by a Large Language Model (LLM) designed to automatically generate digests of scientific trends. We describe how this multidisciplinary tool - with initial coverage in finance, medicine, and education - can be integrated into the curriculum to overcome this "entry barrier." The framework provides concrete methodologies for utilizing these digests to facilitate topic selection for term papers, accelerate literature reviews for dissertations, and enable postgraduate students to continuously monitor emerging trends. We conclude that AI SciBrief functions as a "gateway to research" effectively reducing students' cognitive load and empowering them to transition more rapidly from information searching to knowledge creation.

07.
arXiv (CS.AI) 2026-06-19

MetaResearcher: Scaling Deep Research via Self-Reflective Reinforcement Learning in Adversarial Virtual Environments

arXiv:2606.19893v1 Announce Type: new Abstract: Deep research agents have demonstrated remarkable capabilities in autonomous information gathering and synthesis, yet their training remains constrained by the static nature of simulated environments, the limits of fact-retrieval-only task designs, and the inefficiency of outcome-based reinforcement learning. In this work, we propose MetaResearcher, a novel framework that scales deep research agent training across four synergistic dimensions. First, we introduce an Evolving Virtual World that injects temporal dynamics and adversarial misinformation into the training environment, forcing agents to develop source credibility assessment and temporal conflict resolution skills. Second, we design Discovery-Oriented Tasks – including hypothesis generation and contradiction resolution – that transcend simple fact retrieval and push agents toward genuine research behaviors. Third, we propose a Self-Reflective Meta-Reward mechanism within the GRPO framework that jointly optimizes for answer correctness, search path efficiency, reflection depth, and tool call diversity, directly addressing the repetitive action loop problem observed in prior work. Fourth, we introduce a Heterogeneous Multi-Agent Swarm architecture comprising specialized Scout, Filter, and Synthesizer models that learn collaborative research strategies through coordinated reinforcement learning. Built upon the LiteResearcher infrastructure, MetaResearcher requires zero marginal API cost for training while targeting substantial improvements in both benchmark performance (GAIA, Xbench-DS) and epistemic robustness under adversarial conditions. We present the complete framework design, training methodology, and planned experimental validation.

08.
Nature (Science) 2026-06-24

Zero-shot design of drug-binding proteins via neural iterative selection−expansion

Authors:

The design of proteins that bind to small molecules has been challenging because it requires simultaneous optimization of the protein sequence, protein structure and ligand conformation1–7. Current deep-learning algorithms have struggled to navigate this landscape, precluding the zero-shot design of binders. Here we show that by combining two neural networks in an iterative design algorithm, small-molecule binding proteins can be created from scratch with high accuracy. We trained a graph neural network—ligand-aware sequence engineering message-passing neural network (LASErMPNN)—to design compatible protein sequences for an input protein backbone and docked ligand. We paired  LASErMPNN with a structure predictor that models a three-dimensional protein–ligand complex for an input protein sequence and ligand identity. The closed-loop iteration of these reciprocal networks optimized sequence–structure–ligand compatibility, and outperformed a comparable design loop using a physics-based energy function. We used our strategy, termed neural iterative selection–expansion (NISE), to design proteins that, using different folds, specifically bind to two chemically distinct small-molecule drugs, exatecan and apixaban, with success rates of 100% and 83%, respectively. The tightest NISE binders had nanomolar-to-picomolar affinities, surpassing those of the next-leading method by 70-fold for exatecan and nearly 10,000-fold for apixaban. LASErMPNN then suggested two amino-acid substitutions that improved the affinity of the tightest exatecan binder by 100-fold without any experimental input. The optimized binder protected the labile lactone ring of exatecan from hydrolysis for days. Our work describes a general recipe for using neural networks to automate the design of small-molecule binding proteins for applications in drug delivery, sensing and catalysis.  By pairing two neural networks in an iterative optimization algorithm, small-molecule binding proteins can be designed from scratch with high accuracy, affinity and success rates, showing promise for applications in drug delivery and sequestration.

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

The Answer Lies Within: Self-Derived Rewards Enable Explainable Relation Extraction

Despite the remarkable reasoning capabilities of large language models, they still struggle with one-shot relation extraction without predefined relation labels. We identify two pitfalls: models are often misled by irrelevant tokens instead of relation-conveying semantics, and they often fail to align with the abstraction level human annotators expect. We introduce a novel framework that closes this gap with two components: (1) COGRE, a cognitively-inspired reasoning framework that structures RE into a series of processes mimicking human text-processing; and (2) HIT@DICT, a reinforcement learning intermediate reward strategy that encourages reasoning to align with relational labels by rewarding relation-relevant phrases in reasoning. The reward is derived on a credit dictionary automatically extracted from correct predictions. Our experiments show that our framework improves both accuracy and explanation quality by addressing these two pitfalls. For example, COGRE with Qwen2.5-14B-Instruct on One-shot NYT29 achieves 24.65% F1, surpassing prior reasoning-based designs. Optimizing this approach with RL using HIT@DICT further improves performance by +23.46% points. Finally, human evaluation shows that our best model generates relational phrases closely aligned with gold labels, increasing human explanation quality ratings by 54% (relative).

10.
medRxiv (Medicine) 2026-06-16

Risk beliefs, intensive digital information and demand for a new preventative health product in public clinics: Evidence from an experiment in Zimbabwe.

Demand for preventative health care is weak in low-income settings. In a field experiment in a low-income, high-risk setting, we evaluated whether demand for a new bio-medical preventative health product, offered free at public health clinics, responds to digital feedback-based intensive information on health risks and benefits of prevention along with a clinic referral enabling access to the product. In our sample of women aged 18-24 years, we find a large correction in risk beliefs sustained six months after the intervention. Against a background of very low baseline usage, within six months we find a 5.8 percentage point increase in take up of the prevention method, a level of uptake which is very large relative to the control group. Reassuringly, there is no meaningful difference in up-take amongst baseline high- risk and low-risk individuals.

11.
arXiv (CS.LG) 2026-06-18

Wasserstein Policy Learning for Distributional Outcomes

arXiv:2606.19117v1 Announce Type: cross Abstract: Offline policy learning has received growing attention in causal inference. The primary objective is to learn a policy (individualized treatment rule) as a mapping from covariates to treatment that maximizes the empirical welfare defined as the mean of scalar-valued potential outcomes. In this paper, we study offline policy learning with distribution-valued outcomes, where each potential outcome is a probability measure on $\mathbb{R}$ and the reward is defined through a utility functional applied to the Wasserstein barycenter of induced outcome distributions. We establish statistical guarantees for the policy learning framework based on both Inverse Probability Weighting (IPW) and Doubly Robust (DR) estimators. By handling the challenging uniform deviation over the product of the combinatorial policy class and the infinite-dimensional quantile domain, we prove that the finite-sample regret has leading dependence $\widetilde{\mathcal{O}}(\sqrt{\mathrm{N-dim}(\Pi)/N})$. In the one-dimensional Wasserstein setting and under the stated regularity conditions, the leading regret rate is still governed by the policy-class complexity. Moreover, we provide a minimax lower bound establishing the sharpness of the leading dependence on $N$ and $\mathrm{N-dim}(\Pi)$.

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

More Skills, Worse Agents? Skill Shadowing Degrades Performance When Expanding Skill Libraries

arXiv:2605.24050v2 Announce Type: replace-cross Abstract: Skill libraries allow LLM agents to load task-specific instructions on demand, letting non-expert users solve domain-specific tasks through natural language without knowing which skills exist or how they work. However, performance degrades as libraries grow – by up to 21\% when scaling from a small set of helpful skills to a 202-skill library. In this work, we formulate this performance degradation as the pass rate drop between loading a library of known-helpful skills and the full library. Moreover, we propose to decompose the pass rate drop by conditioning on the skill(s) invocation – which skills the agent selects during a trajectory – into two effects: skill shadowing, where the agent selects wrong skills more often as the library expands, and context overhead, where the enlarged context degrades execution even when selection is correct. We derive upper bounds on both effects to characterize their magnitudes of impacts to the pass rate drop. Our empirical estimates of the effects and their upper bounds both show that the skill shadowing effect grows with library size and significantly contributes to the performance degradation, whereas the context overhead effect remains small and indistinguishable from zero. This observed asymmetry establishes that the skill selection failure, not the enlarged context, is the primary bottleneck when expanding the skill libraries.

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

Spectro-Temporal Interference Confounds Phase Encoding in Spatial Audio Foundation Models

Recent spatial self supervised audio models achieve high performance on localization tasks, raising questions about their encoding of microsecond interaural phase fine structures. We propose a psychoacoustic benchmark based on the binaural masking level difference to evaluate this. Using an equalization cancellation baseline and a GCC PHAT positive control we evaluate nine frozen audio models spanning binaural SSL, monaural SSL, and neural audio codecs. Four monaural negative controls yield zero BMLD confirming binaural specificity. Two general purpose binaural SSL models exhibit minimal phase sensitivity while dedicated binaural spatial SSL models achieve BMLD comparable to the analytical baseline. Progressive physical ablations show that general purpose binaural SSL models rely on spectro temporal interference textures rather than cross channel phase computation. High detection rates in speech reflect a confounding reliance on broadband envelopes rather than genuine phase encoding.

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

Memento: Reconstruct to Remember for Consistent Long Video Generation

Long-form video generation requires recurring subjects to remain consistent across various shots, viewpoints, motions, and scene transitions. Existing temporal decomposition methods improve scalability by generating videos shot by shot. However, they mainly focus on optimizing plausible next-shot continuations without verifying whether the historical memory preserves identity-critical subject evidence. Consequently, as generation proceeds, recurring subjects may be diluted, overwritten, or forgotten. In this paper, we propose Memento, a subject-reconstruction-guided framework that treats subject preservation as an explicit identity grounding problem, based on the premise that a memory bank faithfully preserving a subject should support reconstructing that subject from memory alone. Specifically, Memento jointly trains autoregressive next-shot generation with memory-based subject reconstruction, recovering target appearances using historical memory and global story captions. To disentangle long-range subject evidence from short-range cues, Memento introduces a dual-query memory mechanism, where one query retrieves identity-relevant memory and the other selects short-context keyframes for coherent continuation. Additionally, a subject-aware cinematic data pipeline provides precise reconstruction supervision via consistent, pronoun-free subject descriptions. Experiments demonstrate that Memento achieves state-of-the-art performance in long-term subject consistency, cross-shot coherence, and visual quality.

15.
arXiv (CS.AI) 2026-06-24

Cost-Optimal Decision Diagrams for Stochastic Boolean Function Evaluation

arXiv:2606.24672v1 Announce Type: new Abstract: In many decision-making scenarios, acquiring information incurs different costs. We consider the problem of constructing a deterministic evaluation strategy that minimizes the expected cost of evaluating a propositional formula under variable costs and a probability distribution over truth assignments. We present a branch-and-bound algorithm with variable-selection heuristics, pruning, and caching. To the best of our knowledge, it is the first practical exact algorithm for this level of generality. Experiments on random instances demonstrate scalability and quantify the efficiency-quality trade-off of a greedy beam-search variant. We additionally evaluate a structured heart-disease diagnosis instance. Finally, we prove that the problem is $\#P$-hard and contained in $\mathrm{PSPACE}$.

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

Landscape-Similarity-Guided Optimization in Divide-and-Conquer QAOA

arXiv:2602.21689v3 Announce Type: replace Abstract: Divide-and-conquer strategies mitigate hardware constraints for the Quantum Approximate Optimization Algorithm (QAOA) on Noisy Intermediate-Scale Quantum (NISQ) devices by partitioning large interaction graphs into smaller, hardware-compatible sub-problems. However, this approach introduces a severe classical training bottleneck: a decomposition across $m$ boundary nodes generates $2^m$ distinct sub-problems that typically require independent optimization. In this work, we demonstrate that across diverse synthetic and real-world interaction graphs, the variational landscapes of these reduced QAOA instances actually exhibit a robust universality. Adapting the replica-overlap framework of spin-glass physics, we define a landscape-overlap order parameter $q$ to quantify geometric correlations between energy landscapes, revealing a sharp landscape-similarity transition as graph connectivity is tuned. Exploiting this, we introduce Doubly Optimized QAOA (DO-QAOA), an adaptive pipeline that collapses the sub-problems from $2^m$ distinct sub-problems into $K=\mathcal{O}(1)$ effective landscape classes. By performing optimization on a single representative sub-problem and dynamically transferring parameters to remaining sub-problems, DO-QAOA lowers runtime and quantum measurement overhead by orders of magnitude while maintaining a competitive Approximation Ratio Gap (ARG).

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

PERRY: Policy Evaluation with Confidence Intervals using Auxiliary Data

arXiv:2507.20068v2 Announce Type: replace Abstract: Off-policy evaluation (OPE) methods estimate the value of a new reinforcement learning (RL) policy prior to deployment. Recent advances have shown that leveraging auxiliary datasets, such as those synthesized by generative models, can improve the accuracy of OPE methods. Unfortunately, such auxiliary datasets may also be biased, and existing methods for using data augmentation within OPE lack principled uncertainty quantification. In high stakes domains like healthcare, reliable uncertainty estimates are important for ensuring safe and informed deployment of RL policies. In this work, we propose two methods to construct valid confidence intervals for OPE with data augmentation. The first provides a confidence interval over $V^{\pi}(s)$, the policy value conditioned on an initial state $s$. To do so we introduce a new conformal prediction method suitable for Markov Decision Processes (MDPs) with continuous state spaces, extending prior work to higher-dimensional settings. Second, we consider the more common task of estimating the average policy performance over all initial states, $V^{\pi}$; we introduce a method that draws on ideas from doubly robust estimation and prediction powered inference. Across simulators spanning inventory management, robotics, healthcare, and a real healthcare dataset from MIMIC-IV, we find that our methods can effectively leverage auxiliary data and consistently produce confidence intervals that cover the ground truth policy values, unlike previously proposed methods. Our work enables a future in which OPE can provide rigorous uncertainty estimates for high-stakes domains.

18.
arXiv (math.PR) 2026-06-24

Uniform Sampling from High-dimensional Spectral Norm Balls

arXiv:2606.24134v1 Announce Type: new Abstract: Motivated by an application in machine learning optimization, this paper focuses on the challenges of sampling a matrix uniformly from the unit spectral norm ball. It is proven that all singular values of sampled matrices converge to 1 almost surely as the matrix dimensions increase. This result provides the theoretical justification for a proposed simple sampling method applicable for large dimension sizes matching matrices found in modern large language models. Experimental results demonstrate both the convergence of the singular values, as well as the exact and proposed approximate sampling methods.

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

Running hardware-aware neural architecture search on embedded devices under 512MB of RAM

arXiv:2606.14824v1 Announce Type: cross Abstract: This document proposes a novel approach to hardware-aware neural architecture search (HW NAS) that considers the resources available on the computing platform running it, enabling its execution on various embedded devices. The presented HW NAS produces tiny convolutional neural networks (CNNs) targeting low-end microcontroller units (MCUs), typically involved in the Internet of Things (IoT) or wearable robotics, opening new use cases. A gateway could run it to tailor CNNs' architecture on the acquired data without using external servers, ensuring privacy. The proposed technique achieves state-of-the-art results in the human-recognition tasks on the Visual Wake Word dataset, a standard TinyML benchmark, on several embedded devices.

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

Adversarial dynamical systems characterize when data-driven learning succeeds or fails

arXiv:2407.06312v2 Announce Type: replace-cross Abstract: Many systems resist analytical modeling, making data-driven inference of dynamics important. Yet data-driven methods can fail to converge or generalize, leaving open a central question: When can system behavior be learned reliably from data, and when is such learning impossible? We answer this question using adversarial dynamical systems to identify the boundary between accessible and inaccessible regimes. In Koopman operator learning, a leading framework for representing nonlinear dynamics through linear spectral objects, we design optimal data-driven spectral algorithms with convergence and certification guarantees under conditions arising broadly in physical systems. This yields a convergence theory for Koopman-operator approximations and resolves a longstanding open problem in Koopman spectral analysis. Conversely, by constructing adversarial systems, we prove matching impossibility results: without these conditions, no single-sequence limiting procedure can guarantee learning, regardless of data quality. These results sharply characterize when data-driven spectral learning can succeed and when it must fail. We validate the framework on oscillators, chaotic fluid flows and Arctic sea ice concentration forecasting. In the latter, we uncover hidden modes of Arctic sea ice decline, deliver long-range forecasts with geographic error bounds, and outperform state-of-the-art dynamical and deep learning models at substantially lower computational cost, enabling real-time deployment on standard CPUs.

21.
arXiv (CS.CL) 2026-06-11

When Generic Prompt Improvements Hurt: Evaluation-Driven Iteration for LLM Applications

Authors:

Evaluating Large Language Model (LLM) applications differs from conventional software testing because outputs are probabilistic, semantically variable, and sensitive to prompt and model changes. This technical report proposes the Minimum Viable Evaluation Suite (MVES), an audit-oriented structure for application-level LLM evaluation. MVES links application categories to failure modes, metrics, required artifacts, and validation evidence across general LLM applications, retrieval-augmented systems, and agentic workflows. We pair the framework with a reproducible local evaluation harness covering structured extraction, RAG citation/content-compliance, and instruction-following checks. Using Ollama with Llama 3 8B Instruct and Qwen 2.5 7B Instruct, we evaluate five prompt conditions over expanded 30-case-per-suite ablations. The results show that, in the tested local conditions, generic prompt additions do not produce monotonic improvements: stronger output-contract prompts improve strict extraction for both models, while RAG citation/content-compliance declines under some generic-rule conditions. The largest observed decline occurs for Qwen 2.5 on RAG when generic rules are appended to the user prompt, from 26/30 to 9/30. These findings support evaluation-driven prompt iteration: prompt changes should be treated as potential regression risks and tested against task-specific suites before deployment. The accompanying repository contains the test suites, prompt variants, evaluation harness, raw result logs, and scripts needed to reproduce the reported local ablations.

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

Scalable Training of Spatially Grounded 2D Vision-Language Models for Radiology

We study how to train visually grounded vision-language models (VLMs) for radiology without manual spatial annotations. We introduce RefRad2D, a large-scale bilingual (German/English) dataset of 1.2M CT and MR image-text pairs derived from clinical practice, with task-specific VQA and spatial grounding subsets generated automatically via LLM-based curation and automated segmentation. Trained on this data, our model RadGrounder jointly performs report generation, visual question answering, and spatial grounding via bounding-box detection or segmentation. On external VQA benchmarks (Slake, VQA-RAD), RadGrounder achieves competitive results with specialized medical VLMs. Adding our clinical data to the training mixture improves open-ended VQA over fine-tuning on the downstream datasets alone, showing the transferability of our dataset. Crucially, adding grounding supervision does not degrade language quality, enabling spatially verifiable outputs at no cost to VQA performance.

23.
medRxiv (Medicine) 2026-06-15

Supporting people to access social security payments through the Special Rules for End of Life: a qualitative study of the perspectives of patients, carers and health care professionals

Background: People living with terminal illness face a double financial burden from additional costs and loss of earning for themselves and their carers. Social security benefits are intended to help alleviate some of this financial pressure, and in the UK and other countries people are eligible for fast-tracked access to financial support via the Special Rules for End of Life. One in 3 people who are eligible miss out on this support, yet there is limited evidence on the reasons for this take-up deficit. Objectives: The aim of this study is to understand the barriers and facilitators to claiming benefits for terminally ill people from the perspectives of patients, carers, and health care professionals. Methods: This is a qualitative study combining i) focus groups with healthcare professionals recruited via professional networks and social media, and ii) interviews with patients and carers recruited in hospital and hospice settings. We analysed the data using Practical Thematic Analysis Results: Fifty-five multidisciplinary healthcare professionals participated in 11 focus groups, and we interviewed 10 patients and carers. We constructed five descriptive themes to summarise the data: Navigating priorities and uncertainty; positive impacts alongside a sense of shame and stigma; talking about money, difficulties and dividends; everybodys, yet nobodys, responsibility; and sticking points in the system. Conclusion: The themes reveal several challenges that may contribute to people not taking up this financial support. However, discussions about access to benefits were also seen as a core part of holistic care, a positive way to offer support and a gateway to other discussions about end-of-life care preferences and decisions. Recommendations for policy and practice include evaluating the adoption of a diagnostic rather than a prognostic eligibility criteria, integrating discussions about benefits into existing processes such as advance care planning, and improving education and support for clinicians.

25.
medRxiv (Medicine) 2026-06-11

A global cross-sectional survey of health professionals' interest-confidence gaps in value-based health care implementation: a learning needs assessment

Abstract Objectives Value-Based Health Care (VBHC) increasingly guides health system redesign internationally. Despite the increasing availability of VBHC education, gaps remain between health professionals' conceptual understanding of VBHC and their confidence to implement it in practice. This study assessed perceived learning needs and preferences of healthcare professionals across foundational topics essential to VBHC implementation. Design Cross-sectional online survey study Setting and participants The survey was distributed to the global VBHC community and yielded 518 responses. Most respondents were based in the UK and Ireland (51%) and 65% had more than 10 years of experience in the health sector. Participants represented a variety of professional backgrounds, including clinicians (34%), operational or executive managers and leaders (22%), and life sciences or procurement professionals (13%). Primary and secondary outcome measures Primary outcome measures included self-reported interest and confidence across 15 VBHC domains and the magnitude of the gap between them. Secondary outcomes included perceived implementation challenges and preferred VBHC learning approaches, including prior engagement with VBHC-related learning. Results Respondents identified substantial VBHC implementation challenges, including implementing outcome measurement (62.4%), conflicting priorities (57.7%), and resistance to change (56.8%). Interest in all VBHC domains was high (median >= 80/10), while confidence to implement remained substantially lower across most domains (median