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

Grammar-Constrained Decoding Can Jailbreak LLMs into Generating Malicious Code

Large Language Models (LLMs) are increasingly used for code generation, raising concerns that they may be misused to produce malicious code. Meanwhile, Grammar-Constrained Decoding (GCD) has been widely adopted to improve the reliability of LLM-generated code by enforcing syntactic validity. In this paper, we reveal a counterintuitive risk: this reliability-oriented technique can itself become an attack surface. We uncover a new jailbreak attack, termed CodeSpear, that exploits GCD to induce LLMs into generating malicious code. Our experiments show that simply applying a benign code grammar constraint can effectively jailbreak LLMs. To address this vulnerability, we propose CodeShield, a safety alignment approach that robustly preserves safe behavior even under attacker-controlled grammar constraints. CodeShield aligns the model in the code modality by teaching it to generate honeypot code under GCD. Such code is semantically harmless, so it does not implement the malicious request, and structurally diverse, so it is difficult to suppress through grammar tightening. At the same time, CodeShield still preserves natural-language refusals when natural language is available. Experiments on 10 popular LLMs across 4 benchmarks show that CodeSpear outperforms representative jailbreak baselines and increases the attack success rate by more than 30 percentage points on average. CodeShield also restores safety under CodeSpear while preserving benign utility. Our findings reveal a fundamental risk of GCD and call for greater attention to its potential security implications.

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

Code Correctness Signals in LLM Hidden States: Pre-Generation Probing and Repair Geometry

arXiv:2606.14530v1 Announce Type: new Abstract: Large language models encode rich information in their hidden states. This work asks whether code correctness is legible in the hidden states of Qwen3-4B-Instruct-2507, before it generates and as it repairs a failed attempt, studied on 444 LiveCodeBench tasks. It reports two findings connected by a single confound-control tool: residualization. First, the correctness of the model's first-attempt code is linearly decodable from the prompt-final hidden state, with a leakage-free held-out AUC of 0.931 +/- 0.008 across 50 outer splits. After the linear effect of prompt length is removed from each hidden state dimension, the probe still reaches 0.911 +/- 0.010, well above a prompt-length baseline of 0.754 +/- 0.014. Second, on 236 cleaned cases where the model attempts to repair a failed first attempt, the hidden state shift from the failing attempt to its repair carries a statistically detectable contrastive direction, significant on both a magnitude and a split-half test against label-shuffled nulls. This direction does not survive a conditional residualization against repair-context covariates that differ between successful and failed repairs, marking it as a correlate of repair success driven by the repair context rather than an isolated repair-comprehension feature. The probe layer is selected by nested cross-validation, and the same residualization approach that upholds the pre-generation correctness result overturns the repair-direction interpretation. The contribution is as much methodological as empirical: a diagnostic honest enough to report a negative result alongside a positive one.

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

Complex Layout Classification in the Wild: A Low-Resource Approach with Layout-Preserving Augmentations

Many digitized corpora suffer from low resources because annotations may be scarce, page scans are noisy and of poor resolution, or layouts are structurally complex in ways that negatively affect the quality of automatic transcription. Developing robust classification models for low-resource languages is inhibited by the lack of large-scale annotated data and by the frequent semantic complexity of page layouts. To this end, we have curated a complex-layout dataset, manually classified into eight distinct layout types based on their separator regions. To overcome data scarcity, we propose a novel training strategy in the form of a CNN-based classifier that employs strong, domain-aware augmentations to improve generalization. We utilize narrow anisotropic Gaussian masking to suppress incidental textual details while preserving essential separations, compelling the model to learn global geometric arrangements. Additionally, we implement reflection-induced label transformations to enrich the training distribution while maintaining label consistency across asymmetric categories. The results demonstrate that layout-specific augmentations can substantially improve page-level layout classification under severe annotation scarcity.

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

Quantifying and Auditing LLM Evaluation via Positive–Unlabeled Learning

arXiv:2606.19057v1 Announce Type: cross Abstract: Large Language Models (LLMs) are increasingly used as judges for scalable evaluation, yet such LLM–as–a–Judge systems exhibit systematic biases that are decoupled from semantic quality, most notably verbosity bias. Meanwhile, human supervision is costly and typically selective, yielding reliable positive judgments but leaving most outputs unlabelled and potentially mixed in quality. We formulate LLM evaluation under selective human supervision as a positive–unlabelled learning problem and propose a geometric auditing framework based on Partial Optimal Transport. By aligning a small set of human–verified positives with a reliable subset of unlabelled outputs in a fixed embedding space, our method identifies human–consistent preferences and corrects biased judges without retraining. Experiments demonstrate improved alignment with human preferences, increased robustness to presentation biases, and interpretable confidence estimates, offering a scalable and statistically grounded alternative to existing LLM–as–a–judge pipelines.

05.
medRxiv (Medicine) 2026-06-22

Maternal-Fetal immune networks and viral signatures in the healthy amniotic cavity

The intrauterine environment has traditionally been viewed as a privileged site protected by the placental barrier. However, emerging evidence suggests that early in utero microbial exposure may prime the developing fetal immune system. Here, using target-enriched metagenomics and high-dimensional proteomics, we characterized the intra-amniotic viral landscape and immune networks in 114 healthy pregnancies including both normal and anomalous fetuses. We identify a sparse yet heterogeneous human viral signature in 26% of samples, predominantly composed of Herpesviridae, Polyomaviridae, and Picornaviridae. Although viral reads abundance was associated with fetal abnormalities, viral detection generally did not induce overt inflammatory activation, supporting a state of immune homeostasis within the amniotic cavity. Instead, viral presence was associated with subtle and selective immune modulation, including altered inducible antimicrobial peptide expression (HBD-2 and HBD-3), coupled with an attenuation of regulatory cytokines. Our results further reveal that the amniotic immune environment is primarily governed by gestational age, transitioning from a Th1-predominant "alert" phase to innate-readiness preceding parturition. These findings suggest that fragments of viral genetic material within the amniotic cavity may contribute to fetal immune instruction without triggering overt inflammation, providing a foundational framework for understanding how "silent" viral-exposure during gestation influences the developmental origins of neonatal immunity.

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

SPEAR: A System for Post-Quantization Error-Adaptive Recovery Enabling Efficient Low-Bit LLM Serving

arXiv:2606.11244v1 Announce Type: cross Abstract: Efficient large language model (LLM) serving is increasingly constrained by deployment cost. Quantization is a key technique for reducing serving cost, yet even state-of-the-art 4-bit quantizers exhibit a noticeable quality gap from FP16, particularly for smaller models where low-bit serving is most beneficial. We identify a fundamental cause of this gap: quantization error is highly input-dependent and varies substantially across tokens, while existing post-quantization compensation methods are static and apply identical corrections to all inputs. As a result, easy tokens are over-corrected while hard tokens remain under-corrected. We present SPEAR, a system for post-quantization error-adaptive recovery that improves low-bit LLM serving. SPEAR introduces lightweight Error Compensators (ECs) modulated by per-token gates and places them only at the most error-sensitive layers identified through a CKA-guided entropy-aware diagnostic. This focuses a small parameter budget where it is most effective. Efficient deployment of ECs presents several systems challenges, including additional computation, tensor-parallel synchronization caused by input-dependent gating, and latency instability across configurations. SPEAR addresses these issues through adaptive kernel-fusion dispatch, combining an epilogue-integrated peer-reduction kernel with P2P dual-write to fuse the post-EC computation into low-bit GEMMs, and an SLO-constrained EC-aware scheduler for predictable serving performance. Across challenging per-channel quantization settings, SPEAR recovers 56-75% of the perplexity gap between W4 and FP16 while adding less than 1% model memory overhead and maintaining latency comparable to a widely used 4-bit serving deployment.

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

LOKI: Memory-Free Null-Space Constrained Lifelong Knowledge Editing

arXiv:2606.19679v1 Announce Type: cross Abstract: Lifelong knowledge editing aims to efficiently and sequentially update language models over time, as new knowledge becomes available or when the model makes mistakes, while preserving acceptable performance on past knowledge. One unresolved challenge is that existing methods modify a fixed set of layers for all new knowledge samples, reducing flexibility and increasing catastrophic forgetting. Another is requiring access to previous knowledge and extensive pre-processing to obtain data statistics. To address these challenges, we introduce LOKI, a novel approach that uses dynamic layer selection based on the Hilbert-Schmidt Independence Criterion and projects gradient updates onto the null-space of the model weights, bypassing the requirement for previous knowledge access. We show that LOKI achieves superior performance to existing approaches across a wide variety of experiments, achieving up to a 14\% improvement in average accuracy.

08.
medRxiv (Medicine) 2026-06-11

Allostatic Load in Endometrial Cancer Disparities

Background: Endometrial cancer incidence and mortality are increasing, particularly among Black women and for aggressive subtypes. Allostatic load (AL), a composite measure of physiologic dysregulation across metabolic, cardiovascular, and immune systems, varies by racial category and tumor subtype in other cancers. Endometrial cancer is strongly associated with obesity, and it is unknown whether AL scores maintain sufficient heterogeneity to evaluate differences across subgroups or with clinical outcomes. Objective: To describe the performance of AL scoring in endometrial cancer patients and examine associations with tumor characteristics (grade/histology) and survival outcomes. Methods: We evaluated AL among 398 participants newly diagnosed with endometrial cancer. AL score was calculated by assigning 1 point for each ''high-risk'' value (by clinical reference range or distribution-based) for 15 biologic variables for vital signs, anthropometrics, blood-based biomarkers, and medical comorbidities. Results: Distribution-based thresholds for variables were used to preserve heterogeneity in this obesity-dominant context. Overall, 68.7% of Black women had high AL compared to White (56.7%), Hispanic (56.7%), and other race (32.3%) women. Decision tree analyses revealed grade-dependent associations between AL and survival. For women with low-grade tumors, higher AL was associated with poorer overall survival. For high-grade tumors, intermediate AL ([≥]4,

09.
arXiv (CS.CV) 2026-06-18

AMALIA-VL: A Native European Portuguese Open-Source Vision and Language Model

Large Vision and Language Models (LVLMs) have advanced rapidly, yet European Portuguese (pt-PT) remains systematically underserved by existing open-source multimodal models, which either conflate it with Brazilian Portuguese or severely under-represent it in their training data mixes. We introduce AMALIA-VL, the first open-source instruction-tuned LVLM built natively for pt-PT, pairing a high-resolution vision encoder with dynamic image tiling and a fully open pt-PT-optimized language model via a learned connector. We contribute with a purposefully designed three-stage training process - vision-language alignment, general visual instruction tuning, and preference optimization - together with a pt-PT-centric multimodal data mix combining curated and translated public datasets with novel datasets that address the near-total absence of European Portuguese multimodal resources. Our evaluation shows that AMALIA-VL establishes a strong baseline for open-source pt-PT LVLMs.We will release model weights, training data, and construction pipelines along with machine-translated pt-PT evaluation benchmarks to help democratize pt-PT LVLM development.

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

Policy-Embedded Graph Expansion: Networked HIV Testing with Diffusion-Driven Network Samples

arXiv:2601.16233v2 Announce Type: replace-cross Abstract: HIV is a retrovirus that attacks the human immune system and can lead to death without proper treatment. In collaboration with the WHO and the University of Witwatersrand, we study how to improve the efficiency of HIV testing with the goal of eventual deployment, directly supporting progress toward UN Sustainable Development Goal 3.3. While prior work has demonstrated the promise of intelligent algorithms for sequential, network-based HIV testing, existing approaches rely on assumptions that are impractical in our real-world implementations. Here, we study sequential testing on incrementally revealed disease networks and introduce Policy-Embedded Graph Expansion (PEGE), a novel framework that directly embeds a generative distribution over graph expansions into the decision-making policy rather than attempting explicit topological reconstruction. We further propose Dynamics-Driven Branching (DDB), a diffusion-based graph expansion model that supports decision making in PEGE and is designed for data-limited settings where forest structures arise naturally, as in our real-world referral process. Experiments on real HIV transmission networks show that the combined approach (PEGE + DDB) consistently outperforms baselines (e.g., 17.3% improvement in discounted reward and 15.4% more HIV detections with 25% of the population tested) and explore key tradeoffs that drive solution quality.

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

Feature-Aligned Speech Watermarking for Robustness to Reconstruction Distortions

arXiv:2606.11828v1 Announce Type: cross Abstract: Audio watermarking aims to embed identifiable information into audio while remaining imperceptible. Existing methods adopt high-fidelity, low-energy designs to preserve perceptual quality, but the resulting watermarks lack robustness under suppression by speech reconstruction models. Improving robustness is challenging due to the inherent robustness-fidelity trade-off in existing designs, where increasing watermark energy improves robustness but reduces fidelity. To address this problem, we propose a feature-aligned watermarking method that aligns the watermark with the original speech feature distribution, allowing higher watermark energy to improve robustness while preserving imperceptibility. We use a pretrained speech codec to generate a pseudo-speech watermark and fuse it into the spectrogram of the input audio, with VAD loss and perceptual losses guiding embedding within voiced regions. Experiments show that our method maintains imperceptibility comparable to existing approaches while substantially improving robustness under both seen and unseen speech reconstruction models.

12.
arXiv (CS.CL) 2026-06-15

Natively Unlearnable Large Language Models

Unlearning aims to remove the influence of specific training data sources, but this has proved challenging because the contributions of different sources are entangled within the model. Isolating source contributions to disjoint parameters makes removal easier, though it obstructs joint learning across sources. We propose NULLs (Natively Unlearnable LLMs), a model class that satisfies the two opposing goals of isolating source-specific contributions and learning jointly across sources, by training a set of shared backbone neurons alongside a pool of sparsely activated sinks. During training, information specific to a source naturally concentrates in its sinks while information shared across sources accumulates in the backbone. A source is then unlearned at deployment by disabling its corresponding sinks, with no gradient updates and no access to the retained data. We show that NULLs scales to Wikipedia's ~6M articles, isolating each as an independent source. Unlearning a single article removes knowledge specific to it while preserving facts shared with semantically related articles, closely matching retraining from scratch. We note that unlearning with NULLs is also robust: in a case study of unlearning the Harry Potter books, NULLs resists both adversarial extraction and relearning that reverses post-hoc unlearning. Finally, NULLs preserves general language capabilities, matching a standard transformer on downstream benchmarks. Together, these results suggest that source-level unlearning need not be an afterthought. It can be built natively into LLM training while retaining the benefits of shared representation learning.

13.
arXiv (CS.LG) 2026-06-15

Adaptive Identification and Modeling of Clinical Pathways with Process Mining

arXiv:2512.03787v2 Announce Type: replace Abstract: Clinical pathways are specialized healthcare plans that model patient treatment procedures. They are developed to provide criteria-based progression and standardize patient treatment, thereby improving care, reducing resource use, and accelerating patient recovery. However, manual modeling of these pathways based on clinical guidelines and domain expertise is difficult and may not reflect the actual best practices for different variations or combinations of diseases. We propose a two-phase modeling method using process mining, which extends the knowledge base of clinical pathways by leveraging conformance checking diagnostics. In the first phase, historical data of a given disease is collected to capture treatment in the form of a process model. In the second phase, new data is compared against the reference model to verify conformance. Based on the conformance checking results, the knowledge base can be expanded with more specific models tailored to new variants or disease combinations. We demonstrate our approach using Synthea, a benchmark dataset simulating patient treatments for SARS-CoV-2 infections with varying COVID-19 complications. The results show that our method enables expanding the knowledge base of clinical pathways with sufficient precision, peaking to 95.62% AUC while maintaining an arc-degree simplicity of 67.11%.

14.
arXiv (CS.CL) 2026-06-16

A Survey on Agentic Security: Applications, Threats and Defenses

LLM-based agents are now used throughout cybersecurity. While these agents facilitate powerful and autonomous security applications, their autonomy opens up new attack surfaces, and the security community is actively building defenses to secure them. Yet the literature on this subject has grown quickly and unevenly. Existing surveys treat applications, threats, and defenses in isolation, leaving no unified account of how an agent's capabilities, vulnerabilities, and countermeasures interconnect. In this work we present the first holistic survey of the agentic security landscape, structuring the field around the fundamental pillars of Applications, Threats and Defenses. We provide a comprehensive taxonomy of over 260 papers, explaining how agents are used in downstream cybersecurity applications, inherent threats to agentic systems, and countermeasures designed to protect them. In addition, we provide detailed pillar-specific and cross-cutting analyses that show the security-lifecycle coverage of agentic applications, comparison between red-teaming and blue-teaming agents, and the adversarial use of red-teaming applications. On the threat side, we analyze the entry points and agent-loop stages that attacks target, their specificity to the agentic setting, and the threat models they assume. On the defense side, we analyze the prevailing defense strategies, their cost and security trade-offs, and where in the agent lifecycle they are deployed. We further map which defenses cover which attack classes and chart trends in agent architecture, backbone model usage, data modality coverage, and the growth of attack and defense research over time. Taken together, these findings indicate that agentic systems are structurally fragile by default and that securing them will require defenses that span the full agent lifecycle rather than single-layer fixes.

15.
arXiv (CS.LG) 2026-06-16

MIRAGE: Auditing Anti-Muslim Bias in Frontier LLMs Across Reasoning, Agentic, and Time-Coupled Conditions

arXiv:2606.16562v1 Announce Type: new Abstract: Five years after the discovery of persistent anti-Muslim bias in large language models, most evaluations remain confined to single-turn prompt completion, a setting that no longer reflects how frontier LLMs are deployed. We introduce MIRAGE (Muslim-Identity Reasoning and Agentic Generation Evaluation), a benchmark of 1{,}200 prompts spanning three deployment-realistic conditions: direct completion, chain-of-thought reasoning, and simulated agentic decision-making across content moderation, lending triage, refugee claim summarization, and hiring screens. Across six frontier models, we find that (i) chain-of-thought reasoning amplifies rather than suppresses Muslim-violence associations by 12–34\% relative to direct completion, (ii) agentic decisions exhibit a 9–22 percentage-point asymmetry between Muslim and matched non-Muslim cases on identical evidence, and (iii) bias is sharply time-coupled to retrieved news context, increasing 18–27\% under recent-conflict retrieval. Existing prompt-based mitigations transfer poorly across our three conditions, suppressing direct-completion bias while leaving agentic asymmetry largely intact. We release MIRAGE and an open evaluation harness to support targeted mitigation research.

16.
medRxiv (Medicine) 2026-06-11

Population-scale detection of methylation outliers from long-read genome sequencing

Background: Aberrant DNA methylation can mediate the functional effects of rare genetic variation and contribute to imprinting disorders, repeat expansion diseases, and other pathogenic regulatory mechanisms. Long-read sequencing technologies now enable genome-wide detection of CpG methylation alongside genetic variation from a single assay. However, methods for systematic identification and interpretation of methylation outliers from long-read sequencing data remain limited. Methods: We developed METAFORA, a computational workflow for detecting methylation outlier regions from PacBio and Oxford Nanopore long-read sequencing data. METAFORA constructs population-level methylation references, segments the genome into correlated CpG blocks, infers technical and biological sources of variation through hidden factor estimation, models uncertainty due to variable depth sequencing, and computes covariate-adjusted methylation outlier scores for individual samples. We applied METAFORA across large long-read sequencing cohorts and integrated methylation outliers with multi-omic data. METAFORA is implemented as a snakemake workflow available at https://github.com/tjense25/METAFORA. Results: METAFORA identified methylation outlier regions associated with rare structural variants, tandem repeat expansions, and imprinting abnormalities. We found outlier regions were enriched for molecular outliers across transcriptomic and chromatin accessibility datasets, supporting their functional relevance in gene regulation. In a representative case, METAFORA identified an imprinting defect affecting the GNAS locus associated with an STX16 deletion. Conclusions: METAFORA enables scalable detection and interpretation of methylation outliers from long-read sequencing data and provides a framework for integrating epigenetic outliers with genomic and multi-omic analyses. These approaches may improve interpretation of rare regulatory variation and support discovery of clinically relevant epigenetic abnormalities in genomic medicine.

17.
medRxiv (Medicine) 2026-06-15

Sociodemographic Disparities in Tafamidis Initiation and Clinical Outcomes in ATTR-CM Across the United States

BACKGROUND Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, life-threatening disease. Sociodemographic factors may influence time to treatment initiation and resulting clinical outcomes, yet these relationships are poorly characterized. OBJECTIVE Assess the effects of sex and race on tafamidis initiation and subsequent outcomes and their interaction with factors such as ATTR-CM type and social deprivation measures. METHODS A retrospective cohort analysis was conducted using the US Komodo Healthcare Map (01/2016-06/2024) among patients with amyloidosis, identified by ICD-10-CM diagnosis codes. Cumulative incidence of treatment initiation and survival probabilities for cardiovascular-related hospitalization (CVH) or death were estimated by Kaplan-Meier, stratified by sex and race. Cox proportional hazards models were fitted for both endpoints to estimate hazard ratios, adjusting for demographics and clinical characteristics. RESULTS Of 11,311 patients identified, White and Black patients (n=9,223) were included in subsequent analyses. Within 12 months of diagnosis, White women had the lowest cumulative incidence of tafamidis initiation (11.4%), followed by Black women (22.0%), Black men (26.7%), and White men (31.0%). Event-free survival at 12 months was lowest in Black women (42.9%), followed by Black men (46.8%), White women (48.6%), and White men (54.4%). Median (95% CI) time to CVH or death was shortest for Black women (8.0 months [6.8-10.0]) followed by Black men (9.9 months [8.8-12.0]), White women (11.0 months [9.6-13.0]), and White men (15.0 months [14.0-16.0]). CONCLUSIONS In this large, real-world cohort of US patients with ATTR-CM, sex and race contributed to disparities in tafamidis initiation and survival, underscoring compounded disparities in both access and outcomes.

18.
arXiv (CS.CV) 2026-06-16

From Static Inference to Dynamic Interaction: A Survey of Streaming Large Language Models

Standard Large Language Models (LLMs) are predominantly designed for static inference with pre-defined inputs, which limits their applicability in dynamic, real-time scenarios. To address this gap, the streaming LLM paradigm has emerged. However, existing definitions of streaming LLMs remain fragmented, conflating streaming generation, streaming inputs, and interactive streaming architectures, while a systematic taxonomy is still lacking. This paper provides a comprehensive overview and analysis of streaming LLMs. First, we establish a unified definition of streaming LLMs based on data flow and dynamic interaction to clarify existing ambiguities. Building on this definition, we propose a systematic taxonomy of current streaming LLMs and conduct an in-depth discussion on their underlying methodologies. Furthermore, we explore the applications of streaming LLMs in real-world scenarios and outline promising research directions to support ongoing advances in streaming intelligence. We maintain a continuously updated repository of relevant papers at https://github.com/EIT-NLP/Awesome-Streaming-LLMs.

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

GPU-accelerated semidefinite programming for causal games

arXiv:2606.20519v1 Announce Type: new Abstract: The process matrix formalism describes quantum correlations in scenarios without a fixed causal order between local laboratories. Operational signatures of such correlations can be investigated through causal games. A paradigmatic example is the Guess-Your-Neighbour's-Input game, in which two parties attempt to guess each other's inputs. Correlations compatible with any definite, or probabilistically mixed, causal order cannot achieve a winning probability exceeding $1/2$. The best process-matrix strategy currently known attains a value of approximately $0.6218$ using local dimension $d=5$, while the strongest known dimension-independent upper bound is $0.7592$. In this work, we investigate whether increasing the local dimension beyond $d = 5$ can narrow this gap. To this end, we employ a see-saw optimization scheme in which each step is formulated as a semidefinite program. For scalability, we develop a custom implementation of the SCS solver in which the dominant computational cost, the projection onto the positive-semidefinite cone, is offloaded to a GPU, yielding a six-fold speedup. Using this implementation, we explore local dimensions up to $d = 8$, and we do not find significant improvements over the value at $d=5$. Our results suggest that either qualitatively different strategies are required to approach the known upper bound, or that the bound itself is not tight.

20.
medRxiv (Medicine) 2026-06-16

Daily Healthy Eating Index (HEI-2020) scoring reveals diet quality patterns masked by aggregation

The Healthy Eating Index (HEI-2020) is conventionally computed by aggregating intake across days before scoring. Digital food logging enables an alternative: scoring each day and averaging daily scores. These methods are not equivalent. The HEI's density-based structure and component caps cause aggregation to inflate adequacy scores when intake is irregular. Using Food & You data, we show daily HEI correlates more strongly with microbiome diversity, and recommend co-reporting both metrics.

21.
medRxiv (Medicine) 2026-06-17

Long-term mortality and cause-specific death after non-cardiac chest pain: a multicentre cohort study of 160,245 patients in China

Abstract Background Non-cardiac chest pain (NCCP) is commonly regarded as a low-risk condition. However, long-term mortality, cause-specific death, and high-risk subgroup characteristics remain poorly defined. Methods In this multicentre registry-linked cohort study, we linked the Chest Pain Center Registry from 101 hospitals in Hunan, China, with the Mortality and Cause of Death Registry. Adults diagnosed with NCCP from Jan 1, 2017, to Dec 31, 2021, were included. We assessed 3-year all-cause, cardiovascular, and non-cardiovascular mortality using Cox, restricted cubic spline, and Fine-Gray models. Findings Among 160,245 patients, 4674 deaths occurred within 3 years (2.9%). Mortality increased sharply after 60.5 years. Age [≥] 60.5 years (adjusted hazard ratio [aHR] 7.49 [95% CI 6.89-8.14]), rural residence (time-varying aHR 1.46 [1.35-1.57] in year 1 and 1.66 [1.46-1.89] in years 1-3), and male sex (aHR 1.47 [1.38-1.57]) independently predicted death. Three-year mortality ranged from 0.3% in younger urban women to 8.4% in older rural men. Cardiovascular diseases accounted for 56.4% of deaths among older patients, whereas other non-cardiovascular causes (22.8%) and malignancy (20.8%) were the largest categories among younger decedents. Interpretation NCCP is not uniformly benign. Age, rural residence, and sex identify patients who could benefit from risk-stratified follow-up, with cardiovascular prevention prioritised for older rural men and broader non-cardiovascular assessment considered for younger patients.

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

Efficient Neural Network Model Selection for Few-Class Application Datasets

arXiv:2606.19712v1 Announce Type: new Abstract: While much effort has focused on developing and benchmarking high-performance neural networks, less attention has been given to how dataset properties, known to practitioners, can guide efficient model selection. Neural models are typically evaluated on datasets with thousands of classes, yet many real-world applications involve fewer than ten. To address this understudied but common setting, we develop a measure of classification difficulty based on data-side properties and show how it enables more efficient model selection for few-class datasets, where traditional approaches are less effective. We term this phenomenon "few-class distinctiveness". Our metric allows comparison of models and datasets 6 to 29$\times$ faster than repeated training and testing. Leveraging this insight, we extend scaled model families below the smallest published models, achieving greater efficiency at similar accuracy, for example models up to 42% smaller than YOLOv5-nano for a mobile robot task. Targeting resource-constrained applications, we demonstrate few-class model selection across mobile robot, drone, and IoT scenarios, highlighting practical gains in efficiency without sacrificing performance.

23.
medRxiv (Medicine) 2026-06-22

Sex-specific multimorbidity clusters and all-cause mortality in relatively healthy older adults: findings from the ASPREE cohort

Background: Multimorbidity is common in older adults, but sex differences in chronic condition clustering remain unclear. This study explored multimorbidity clusters and their associations with all-cause mortality among community-dwelling adults aged 70 years and over. Methods: This was a secondary analysis of data from 16,095 Australian ASPREE participants aged at least 70 years without prior dementia or cardiovascular disease. Fifteen baseline chronic conditions were grouped using latent class analysis (LCA). Observed-to-expected (O/E) ratios characterised conditions over-represented within clusters, and Cox proportional hazards models assessed associations with all-cause mortality. Results: Among 16,095 participants (mean age 74 years), 88.3% had multimorbidity at baseline; 4,217 deaths occurred over a median follow-up of 10.85 years. Five clusters were identified overall: hypertension and dyslipidemia (52.1%), gout and metabolic (14.4%), depressive symptoms, osteoporosis and frailty (10.0%), anaemia and kidney disease (10.2%), and hypotension, thyroid disorder and past cancer (13.3%). Sex-stratified analyses revealed three clusters in males and four in females. The frailty, depressive symptoms and osteoporosis cluster was associated with higher mortality in both sexes (aHR 1.56 [95% CI 1.40-1.73] in males; 1.68 [1.49-1.89] in females). Higher mortality was also observed for the metabolic, gout and kidney disease cluster in males (aHR 1.63 [1.47-1.81]) and the gout, anaemia and kidney disease cluster in females (aHR 1.96 [1.74-2.21]). Conclusions: Distinct multimorbidity clusters differed by sex and were associated with increased all-cause mortality. These findings may support risk stratification, targeted screening, and more person-centred management of older adults with multimorbidity.

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

To forget is to preserve: Machine Unlearning for 3D medical image segmentation

With new data privacy laws such as the General Data Protection Regulation (GDPR) [1] that allow individuals to ask that any of their personal information be erased from trained machine learning models, there has been a push to investigate the unlearning of data from models as a way to comply with these laws. In this regard, based on four mechanics, we consider several approximate unlearning strategies applied to the MRBrainS18 dataset [2]. We use a 3D ResNet-50 [3] as a backbone architecture for segmentation that has been pre-trained with the Med3D framework [4]. Considering the pre-trained model as a baseline, we evaluate respective retention accuracy on 2 types of subjects, i.e., retain and forget. We assess these approaches through their Dice similarity coefficient and mean absolute error (MAE) values using two separate training horizons 20 and 50 epochs. The results show that the Noisy Label strategy had the best overall trade-off with a decrease of 93% in the forget set while maintaining 84% accuracy for the retained set after 50 epochs. All other strategies showed extreme levels of forgetting at higher epoch numbers while also demonstrating catastrophic degradation of their retain set performance. The results of this study provide a strict baseline of performance metrics for unlearning on a subject-specific level and provide practitioners with clear criteria for selecting the proper strategies.

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

Is Your Agent Playing Dead? Deployed LLM Agents Exhibit Constraint-Evasive Fabrication and Thanatosis

arXiv:2606.14831v1 Announce Type: cross Abstract: This paper presents and characterizes a spectrum of previously unreported behaviours we term Constraint-Evasive Fabrication (CEF): when an LLM agent operates under irreconcilable constraints (where no response can simultaneously satisfy all active rules) it spontaneously fabricates plausible external obstacles and presents them as a fact. At the extreme end of this spectrum lies Constraint-Evasive Thanatosis (CET); the limit case where, rather than inventing a plausible excuse, the model simulates a full system crash to make the user disengage entirely. We first observed CET in an uncontrolled deployment test, where a GPT-4o banking agent fabricated Python-style exception traces (complete with memory addresses) to feign a system failure when threatened by a user. In subsequent controlled experiments, the model independently invented audit restrictions, microservice architectures, error codes, and service timeouts, none present in its prompt. Reproduction attempts across pressure levels and attacker personas yielded CEF consistently but with substantial variation in form, onset, and severity: the phenomenon is robust but stochastic. Critically, injecting ground-truth data mid-conversation did not restore honest behaviour once fabrication had taken hold (the model ignored correct information and continued confabulating) suggesting CEF is self-reinforcing rather than a knowledge gap. We show that (1) standard enterprise guardrails routinely create CEF-enabling conditions in production, (2) current RLHF procedures suppress but cannot eliminate CEF, and (3) existing safety benchmarks do not test for this failure mode. Our results highlight the need for irreconcilable-constraint benchmarks, CEF-aware training procedures, and deployment-time detection methods before constrained agents become further entrenched in high-stakes domains.