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

Bridging Modality Disconnect in Self-Reflection via Closed-Loop Visually Grounded Verification

Authors:
Haoyu Zhang↗Yuwei Wu↗Pengxiang Li↗Xintong Zhang↗Zhi Gao↗Rui Gao↗Mingyang Gao↗Che Sun↗Yunde Jia↗

In the era of Vision-Language Models (VLMs), enhancing multimodal reasoning capabilities remains a critical challenge, particularly in handling ambiguous or complex visual inputs, where initial inferences often lead to hallucinations or logic errors. Existing VLMs often produce plausible yet ungrounded answers, and even when prompted to "reflect", their corrections may remain detached from the image evidence. To address this, we propose the MIRROR framework for Multimodal Iterative Reasoning via Reflection On visual Regions. By embedding visual reflection as a core mechanism, MIRROR is formulated as a closed-loop process comprising draft, critique, region-based verification, and revision, which are repeated until the output is visually grounded. To facilitate training of this model, we construct **ReflectV**, a visual reflective dataset for multi-turn supervision that explicitly contains reflection triggers, region-based verification actions, and answer revision grounded in visual evidence. Experiments on both general vision-language benchmarks and representative vision-language reasoning benchmarks show that MIRROR improves correctness and reduces visual hallucinations, demonstrating the value of training reflection as an evidence-seeking, region-aware verification process rather than a purely textual revision step.

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03.
arXiv (CS.LG) 2026-06-11

Restless bandits with imperfect binary feedback: PCL-indexability analysis and computation

Authors:
Jos\'e Ni\~no-Mora↗

arXiv:2606.11192v1 Announce Type: new Abstract: We study restless bandits with binary latent states and imperfect binary feedback, motivated by opportunistic spectrum access with sensing errors. For the associated belief-state model, we develop a partial conservation laws (PCL)-based analytical and computational framework for establishing indexability and evaluating the Whittle index, building on a verification theorem for real-state discounted restless bandits. The framework analyzes the stochastic dynamics via an associated deterministic skeleton, renewal decompositions, and combinatorics on words. It yields tractable expressions for discounted reward and resource metrics in several threshold regimes, enabling full verification of the PCL-indexability conditions there. For the remaining regime, where a complete analytic verification is not achieved in this paper, we derive efficient numerical schemes for computing the relevant marginal metrics and the marginal productivity (MP) index, which equals the Whittle index when those conditions hold. Extensive computational experiments provide strong evidence that these conditions also hold in that regime across broad parameter ranges and without the stringent parameter restrictions imposed in prior work. The experiments further show that theMP index policy typically outperforms standard benchmark policies, often by a substantial margin.

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04.
arXiv (math.PR) 2026-06-16

Quantitative Oppenheim Conjecture for Random Quadratic Forms and Optimal Variance Bounds in Function Fields

Authors:
Jiyoung Han↗Noy Soffer Aranov↗

arXiv:2606.16699v1 Announce Type: cross Abstract: We prove a quantitative version of Oppenheim's conjecture in the function field setting. In order to do so, we compute the higher moments of the Siegel transform. In particular, we find an optimal bound on the variance of the number of lattice points in a set. Moreover, we compute the exact variance of the number of lattice points in a ball, which is of independent interest.

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

CoVar: Confidence-Variance-Guided Pseudo-Label Selection for Semi-Supervised Learning

Authors:
Jinshi Liu↗Lei He↗Pan Liu↗

arXiv:2601.11670v3 Announce Type: replace-cross Abstract: Pseudo-label selection in semi-supervised learning is commonly driven by maximum-confidence thresholds, yet confidence alone can be unreliable under model overconfidence and class imbalance. We propose CoVar, a confidence–variance framework that assesses pseudo-label reliability by jointly modeling Maximum Confidence (MC) and Residual-Class Variance (RCV). Starting from entropy minimization, we derive a second-order cross-entropy approximation showing that low-loss pseudo-labels are favored when MC is high and RCV is low, with a confidence-dependent penalty that becomes stronger for near-certain predictions. Based on this criterion, CoVar embeds predictions into a two-dimensional confidence–variance space and uses SVD-based spectral relaxation to separate reliable and unreliable predictions without hand-tuned confidence thresholds. Cluster-wise Gaussian weighting then converts this separation into per-sample training weights. The resulting weights can be integrated into existing semi-supervised segmentation and classification pipelines during training and introduce no inference-time overhead. Experiments on PASCAL VOC 2012, Cityscapes, CIFAR-10, CIFAR-100, SVHN, and STL-10 show clear gains on VOC and Cityscapes under matched backbones, as well as competitive or improved error rates on standard classification benchmarks. These results indicate that residual-class dispersion provides a useful signal complementary to confidence for robust pseudo-label selection.

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06.
bioRxiv (Bioinfo) 2026-06-20

MIRATS framework: Normative multiscale characterization of brain regulatory systems across sex and age using multimodal MRI

Authors:
Ge↗Dou↗

Deep brain systems involved in arousal, autonomic regulation, sensory integration, and homeostatic control remain underrepresented in conventional whole-brain neuroimaging frameworks. In particular, diencephalic and brainstem nuclei are often insufficiently represented in cortex-centered analyses, limiting the normative references needed to interpret systems-level variation in health and disease. To address this gap, we developed a unified multiscale framework with explicit representation of deep nuclei. By integrating cerebral, cerebellar, diencephalic, and brainstem atlases in standard space, we constructed a 220-region whole-brain parcellation and extracted complementary features at three analytical scales: nodal properties, edge-wise connectivity, and persistent-homology-based topological descriptors. We applied this framework to healthy adults from the Human Connectome Project-Aging cohort to characterize normative multiscale organization and test sex- and age-related variation. Applied to this cohort, our framework revealed pronounced heterogeneity across anatomical systems. Brainstem and diencephalic nuclei showed multiscale feature profiles distinct from those of cerebral and cerebellar regions across nodal, edge-wise, and higher-order topological scales. Sex comparisons identified selective differences across different scales, whereas age modeling revealed widespread but feature- and system-dependent variation across adulthood. Together, these findings show that normative whole-brain organization in this deep-system-aware space is structured by system-specific rather than globally uniform patterns. These findings establish a normative multiscale framework for characterizing brainstem-diencephalic-cerebellar-cerebral organization in healthy adults and provide a quantitative reference for future translational studies of disease-related abnormalities in deep regulatory systems.

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07.
arXiv (CS.CL) 2026-06-25

How Large Language Models Source Brand Reputation Across Languages and Markets

Authors:
Dmitrij Zatuchin↗

When a large language model (LLM) answers a question about a company, it grounds the answer in retrieved web sources, and those sources decide what the model says. Most analysis of AI brand visibility looks at the answer text. This study looks one step earlier, at the citations. We merge three Rankfor.AI datasets covering 128 brands across 12 home markets and 13 languages, and analyse 167,551 URL-grounded citations (189,974 total attribution rows). We classify each citation by domain and source type and measure where AI gets its brand information, by language and by market. Four patterns hold. First, AI grounds brand answers overwhelmingly in third-party sources: 85.7% of citations point to sites the brand does not own, against 14.3% owned. Second, the source base is concentrated and long-tailed: 80% of citations come from about 18% of domains, fitting a Zipf law (alpha = 0.86, R^2 = 0.983). Third, one reference site dominates almost everywhere: Wikipedia is the most-cited domain in 11 of 12 languages, the exception being Lithuanian, where the business daily vz.lt edges it (4.38%). Fourth, the source mix is market-specific at the margin: for 46 Polish national brands the most-cited domain is YouTube, and four HR and careers portals supply 637 citations against 297 for Polish Wikipedia, about twice as many.

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

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

Authors:
Daniel Commey↗

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.

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

MacrOData: New Benchmarks of Thousands of Datasets for Tabular Outlier Detection

Authors:
Xueying Ding↗Simon Kl\"uttermann↗Haomin Wen↗Yilong Chen↗Leman Akoglu↗

arXiv:2602.09329v3 Announce Type: replace Abstract: Quality benchmarks are essential for fairly and accurately tracking scientific progress and enabling practitioners to make informed methodological choices. Outlier detection (OD) on tabular data underpins numerous real-world applications, yet existing OD benchmarks remain limited. The prominent OD benchmark AdBench is the de facto standard in the literature, yet comprises only 57 datasets. In addition to other shortcomings discussed in this work, its small scale severely restricts diversity and statistical power. We introduce MacrOData, a large-scale benchmark suite for tabular OD comprising three carefully curated components: OddBench, with 790 datasets containing real-world semantic anomalies; OvrBench, with 856 datasets featuring real-world statistical outliers; and SynBench, with 800 synthetically generated datasets spanning diverse data priors and outlier archetypes. Owing to its scale and diversity, MacrOData enables comprehensive and statistically robust evaluation of tabular OD methods. Our benchmarks further satisfy several key desiderata: We provide standardized train/test splits for all datasets, public/private benchmark partitions with held-out test labels for the latter reserved toward an online leaderboard, and annotate our datasets with semantic metadata. We conduct extensive experiments across all benchmarks, evaluating a broad range of OD methods comprising classical, deep, and foundation models, over diverse hyperparameter configurations. We report detailed empirical findings, practical guidelines, as well as individual performances as references for future research. All benchmarks containing 2,446 datasets combined are open-sourced, along with a publicly accessible leaderboard hosted at https://huggingface.co/MacrOData-CMU.

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11.
arXiv (CS.AI) 2026-06-19

A Multi-Agent system for Multi-Objective constrained optimization

Authors:
Federica Filippini↗

arXiv:2606.20236v1 Announce Type: new Abstract: Many decision-making problems in computing and networking systems can be naturally formulated as cost-minimization problems under performance constraints. In dynamic environments, reinforcement learning (RL) is often used to solve such problems at runtime by embedding both costs and constraint violations into a single scalar reward through weighted penalty terms, following a Lagrangian-inspired formulation. However, in this context the behavior of the learned policy critically depends on the choice of these weights, which are typically selected manually. This makes it difficult to identify an appropriate trade-off between optimizing the primary objective and effectively avoiding constraint violations, particularly in non-stationary environments where their relative importance may change. This paper presents MAMO (Multi-Agent system for Multi-Objective constrained optimization), an approach to tackle this balancing problem through multi-agent RL. MAMO decouples task execution from objective design by formulating the selection of reward weights as a learning problem, providing a !rst step towards more autonomous and robust RL-based solutions for constrained optimization problems in dynamic environments.

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12.
arXiv (CS.CV) 2026-06-16

Revealing Artifacts via Noise Amplification: A Novel Perspective for AI-Generated Video Detection

Authors:
Renxi Cheng↗Jie Gui↗Hongsong Wang↗

With the rapid advancement of video generation models, distinguishing between AI-generated and authentic videos has emerged as a challenging endeavor. The majority of existing research endeavors concentrate on the development of detectors for identifying samples generated by generative adversarial networks. Nevertheless, the detection of AI-generated videos, particularly those produced by text-to-video models, still remains an uncharted territory. Although state-of-the-art text-to-video models can generate realistic visual content similar to real videos, they fall short of generating the details of the images and the changes in details within the videos. Inspired by this, we address AI-generated video detection from a novel perspective of bit-planes, which can effectively describe the details or noises in images or videos. To this end, we propose a simple yet effective approach called Noise Amplification. This approach first extracts noise signals based on bit-planes, then amplifies these noise signals, and finally feeds them into the discriminator networks for video fake classification. Noise amplification is comprehensively constructed by incorporating three aspects: pixel-level intensity enhancement, region-level spatial amplification, and frame-level temporal aggregation. To evaluate methods of AI-generated video detection in challenging scenarios, we also introduce a benchmark named HardGVD. Extensive experiments on both the large-scale dataset GenVidBench and HardGVD show that our simple approach significantly outperforms state-of-the-art methods.

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

Which Models Perform Better in Inheritance Reasoning?

Authors:
Mohammed Amine Mouhoub↗Chahinez Bouchekif↗

This paper presents the participation of team PSL in the QIAS 2026 Shared Task on Arabic Islamic inheritance reasoning. The task evaluates the ability of large language models to solve inheritance cases that require legal interpretation, multi-step reasoning, and precise numerical computation. We compare commercial and open-source models under a unified prompting strategy to assess their effectiveness in structured legal reasoning with minimal task-specific adaptation. \\ Our results show a clear gap in reliability between the two model families. Commercial models demonstrate stronger performance in identifying eligible heirs, applying exclusion rules, and maintaining consistency across reasoning steps. In contrast, open-source models exhibit greater instability, particularly in cases involving dependent legal decisions and fractional share adjustments. The best performance is achieved by Gemini 2.5 Flash, with an MRE of $0.989$.

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14.
arXiv (CS.CL) 2026-06-12

A Unifying Lens on Reward Uncertainty in RLHF

Authors:
Ely Hahami↗Yoel Zimmermann↗Ray Zhou↗Jack Benarroch Jedlicki↗

Reinforcement learning from human feedback (RLHF) is bottlenecked by reward hacking, where the policy exploits errors in a proxy reward model (RM) and produces high RM scores without genuine quality gains. A natural mitigation is pessimism: lowering rewards in regions where the RM is uncertain. However, standard scalar RMs provide no principled notion of uncertainty. We argue that the right object is a distributional reward model $p(r\mid x,y)$. Under either a Bayesian inference or a KL-distributionally robust optimization (KL-DRO) lens, the KL-regularized RLHF objective admits a closed-form effective reward $\tilde r(x,y) = \pm\beta\log\mathbb{E}_p[e^{\pm r/\beta}]$. The pessimistic branch unifies the prior heuristics for RM ensemble aggregation: mean aggregation, worst-case optimization (WCO), and uncertainty-weighted optimization (UWO) all emerge as limits or truncations of this single expression. This also clarifies the implicit assumptions of each existing rule.

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

NeuroSonic: Conditional Flow Matching for EEG-to-Speech Reconstruction

Authors:
Wenhao Gao↗Yifan Wang↗Yijia Ma↗Carl Yang↗Wen Li↗Chenyu You↗

arXiv:2606.24087v1 Announce Type: new Abstract: Reconstructing continuous speech from scalp electroencephalography (EEG) remains fundamentally challenging. EEG provides a weak, spatially diffuse, and highly variable measurement of distributed cortical activity, whereas speech is organized as a coherent acoustic trajectory with strong harmonic and temporal structure. The resulting mismatch makes waveform regression unstable and causes stochastic multi-step generation to be sensitive to artifact-dependent conditioning and subject variability. We introduce NeuroSonic, a conditional flow-matching framework for EEG-to-speech reconstruction. Instead of predicting waveforms directly or refining them through stochastic denoising, NeuroSonic learns a deterministic probability-flow velocity field that transports a noise-corrupted acoustic state toward clean speech under EEG conditioning. EEG and audio are embedded into a shared token space and processed by a time-conditioned gated Transformer that parameterizes the transport ordinary differential equation. This formulation models trajectory evolution explicitly while avoiding iterative stochastic sampling. We evaluate NeuroSonic on the CineBrain and EAV benchmarks under cross-subject evaluation. Across both datasets, the proposed method improves distributional realism, spectral fidelity, and perceptual quality over representative GAN-, diffusion-, and mean-flow baselines, with up to a 26.3\% gain in overall perceptual quality. The performance gap is most evident in artifact-heavy segments, where conditioning variability is strongest. These findings indicate that deterministic conditional transport provides a stable and effective formulation for EEG-driven speech reconstruction. Code is available at https://github.com/Y-Research-SBU/NeuroSonic/ .

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16.
medRxiv (Medicine) 2026-06-22

Agentic Artificial Intelligence for Hospital Readmission Review: A Single-Center Blinded Evaluation and Exploratory Qualitative Analysis

Authors:
Gensheimer↗M. F↗Adhikari↗Parmer-Chow↗Liu↗Ma↗Shieh↗

Background: Manual review of 30-day hospital readmissions can identify actionable quality and safety problems, but it is labor-intensive. We developed and evaluated an agentic AI workflow for evidence-grounded readmission review. Materials and methods: We studied adult patients with unplanned 30-day readmission after discharge from a medicine hospitalist service at a single academic health system. An AI agent using a large language model queried a database containing notes, encounters, procedures, laboratory results, and other clinical data, and completed the same structured readmission-review rubric used by physicians. In the primary comparative evaluation, 20 randomly selected readmissions from 2025 were each reviewed by two physicians and the AI system. Blinded physician evaluators rated review quality. After rubric refinement, the AI workflow was applied to 100 recent readmissions in an exploratory expanded-cohort analysis of recurring improvement opportunities. Results: In the primary comparative evaluation, the AI classified 9/20 readmissions (45%) as preventable, compared with 19/40 physician reviews (47.5%). Blinded overall quality ratings were similar for AI and physician reviews (4.35 vs. 4.20 on a 1-5 scale; mean difference 0.15, 95% CI -0.20 to 0.48; p=0.49), as were factuality/support and usefulness/actionability ratings. No AI hallucinations were identified during factuality review. Agreement on preventability and primary readmission category was low for both AI-human and human-human comparisons. The AI system cost $0.23 per chart; physician reviewers took a median of 15 minutes, corresponding to an estimated $42.43 per chart. In the exploratory expanded-cohort analysis, AI-assisted review identified recurring vulnerabilities in post-discharge follow-up plans, incomplete inpatient workups, medication-safety transitions, and indwelling-device transitions. Conclusions: Agentic AI produced readmission reviews with similar blinded quality ratings to physician reviews in this small single-center primary comparative evaluation and supported identification of recurring quality-improvement themes in the exploratory expanded-cohort analysis. Preventability judgments remained variable among both AI and physicians, underscoring the need for human oversight and prospective evaluation before operational use.

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

Temporal Straightening for Latent Planning

Authors:
Ying Wang↗Oumayma Bounou↗Gaoyue Zhou↗Randall Balestriero↗Tim G. J. Rudner↗Yann LeCun↗Mengye Ren↗

arXiv:2603.12231v2 Announce Type: replace Abstract: Learning good representations is essential for latent planning with world models. While pretrained visual encoders produce strong semantic visual features, they are not tailored to planning and contain information irrelevant – or even detrimental – to planning. Inspired by the perceptual straightening hypothesis in human visual processing, we introduce temporal straightening to improve representation learning for latent planning. Using a curvature regularizer that encourages locally straightened latent trajectories, we jointly learn an encoder and a predictor of a Joint-Embedding Predictive Architecture (JEPA) world model. We show that reducing curvature this way makes the Euclidean distance in latent space a better proxy for the geodesic distance and improves the conditioning of the planning objective. We demonstrate empirically that temporal straightening makes gradient-based planning more stable and yields significantly higher success rates across a suite of goal-reaching tasks. Our code is available at https://agenticlearning.ai/temporal-straightening.

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

A Unified Latent Space Disentanglement VAE Framework with Robust Disentanglement Effectiveness Evaluation

Authors:
Xiaoan Lang↗Md Mostafizer Rahman↗Fang Liu↗

arXiv:2603.11242v2 Announce Type: replace-cross Abstract: Evaluating and interpreting latent representations, such as variational autoencoders (VAEs), remains a significant challenge for diverse data types, especially when ground-truth generative factors are unknown. To address this, we unify several state-of-the-art disentangled VAE approaches for latent space disentanglement into one framework – bfVAE. To assess the effectiveness of a disentangled VAE model and enhance latent space interpretability, we propose Feature Variance Heterogeneity via Latent Traversal (FVH-LT) and Dirty Block Sparse Regression in Latent Space (DBSR-LS). To ensure robust interpretability of learned latent space, we develop a greedy alignment strategy (GAS) that mitigates label switching and aligns latent dimensions across runs to set the foundation of result aggregation. We also introduce a convenient scalar latent space separation index (LSSI) based on the GAS-aligned outputs of FVH-LT and DBSR-LS to summarize the overall latent structural separation without knowledge of the ground-truth generative factors. We compare bfVAE to five VAE models and validate the effectiveness FVH-LT, DBSR-LS, and LSSI in on seven tabular and image datasets. Under our examined experimental settings, bfVAE provides a more flexible disentanglement framework achieves more favorable overall trade-off between disentanglement and reconstruction than the benchmark VAE models; FVH-LT and DBSR-LS reliably uncover semantically meaningful and domain-relevant latent structures and generally yield consistent results; and LSSI makes an effective quantitative summary of latent structural separation.

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19.
Nature (Science) 2026-06-09

Good recycling starts at home — and benefits the world

Authors: Unknown Author

New research supports the value of household-level waste separation. But policies must also carefully consider consumer behaviours to maximize the quality of material collected. New research supports the value of household-level waste separation. But policies must also carefully consider consumer behaviours to maximize the quality of material collected.

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20.
arXiv (CS.AI) 2026-06-25

Tinker Tales: A Tangible Dialogue System for Child-AI Co-Creative Storytelling

Authors:
Nayoung Choi↗Jiseung Hong↗Peace Cyebukayire↗Ikseon Choi↗Jinho D. Choi↗

arXiv:2602.04109v2 Announce Type: replace-cross Abstract: Conversational AI agents are increasingly explored as creative partners, yet how conversation design shapes child-AI dialogue in co-creative settings remains underexplored. We present Tinker Tales, a tangible dialogue system for child-AI collaborative storytelling, in which educational frameworks (narrative development and social-emotional learning) are instantiated as conversation design, shaping how the agent engages children across four narrative stages. The system combines a physical storytelling board, NFC-embedded toys, and a mobile app mediating multimodal interaction through tangible manipulation and voice-based dialogue. We conducted a home-based user study with 10 children (ages 6-8) across two conversation design conditions varying in how the agent structured elaboration, with and without educational scaffolding. Our findings show that prompt framing shapes the form and consistency of children's narrative contributions, structuring how they participate in co-creative dialogue with AI.

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21.
arXiv (quant-ph) 2026-06-11

Dynamically Optimal Unraveling Schemes for Simulating Lindblad Equations

Authors:
Yu Cao↗Mingfeng He↗Xiantao Li↗

arXiv:2509.19887v2 Announce Type: replace Abstract: Stochastic unraveling schemes are powerful computational tools for simulating Lindblad equations, offering significant reductions in memory requirements. However, this advantage is accompanied by increased stochastic uncertainty, and the question of optimal unraveling remains open. In this work, we investigate unraveling schemes driven by Brownian motion or Poisson processes and present a comprehensive parametric characterization of these approaches. For the case of a single Lindblad operator and one noise term, this parametric family provides a complete description for unraveling scheme with pathwise norm-preservation. We further analytically derive dynamically optimal quantum state diffusion (DO-QSD) and dynamically optimal quantum jump process (DO-QJP) that minimize the growth rate of the variance of an observable locally in time. Compared to jump process ansatz, DO-QSD offers two notable advantages: firstly, the variance for DO-QSD can be rigorously shown not to exceed that of any jump-process ansatz locally in time; secondly, it has very simple expressions. Numerical results demonstrate that the proposed DO-QSD scheme may achieve substantial reductions in the variance of observables and the resulting simulation error.

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22.
arXiv (CS.AI) 2026-06-24

Uncertainty-Aware Longitudinal Forecasting of Alzheimer's Disease Progression Using Deep Learning

Authors:
Arya Hariharan↗Shreyank N Gowda↗Anala M R↗

arXiv:2606.24604v1 Announce Type: new Abstract: Longitudinal modelling of Alzheimer's disease progression is clinically useful only if it can describe not just the most likely next diagnosis, but how a patient may evolve over time and how reliable that forecast is. Most deep learning approaches reduce this problem to single-step classification, treating cognitively normal, mild cognitive impairment, and dementia as flat categories while providing limited insight into how uncertainty accumulates across future visits. We propose a probabilistic framework that combines ordinal diagnosis prediction, multi-horizon trajectory generation, and decomposed uncertainty estimation. A Temporal Fusion Transformer encoder is adapted with a CORAL ordinal output layer, asymmetric loss weighting, and converter oversampling to respect disease-stage ordering and improve sensitivity to MCI-to-dementia transitions. Conditioned on the learned patient-context representation, an autoregressive Mixture Density Network generates five-year probabilistic trajectories for diagnosis state, CDR Sum of Boxes, MMSE orientation, and hippocampal volume. On ADNI, the model outperforms linear, recurrent, and transformer baselines for next-visit diagnosis prediction, with the strongest gains on MCI-versus-dementia discrimination. Generated trajectories achieve near-nominal 90% credible interval coverage, widening uncertainty across the forecast horizon, and biomarker dynamics consistent with expected Alzheimer's disease progression. We further separate aleatoric from epistemic uncertainty using analytic mixture variance and a five-member bootstrap ensemble, which provides the strongest encoder diversity and output-level epistemic signal. Epistemic uncertainty is higher for rare progression archetypes, MCI and dementia patients, and under external evaluation on OASIS-3, where it increases alongside prediction error.

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

Possible or Definite? A Benchmark for Evaluating Diagnostic Uncertainty Preservation in Clinical Text

Authors:
Hongbo Du↗Zixin Lu↗Jiaming Qu↗

Large language models (LLMs) are increasingly used for clinical text tasks such as summarization and revision. While most studies evaluate the fluency and coherence of LLM-generated text, whether LLMs correctly preserve diagnostic uncertainty remains underexplored. In clinical practice, phrases such as ``possible pneumonia'' communicate the strength of available evidence and directly guide decisions about follow-up testing and treatment. Altering these uncertainty expressions can change the clinical meaning entirely. In this paper, we systematically evaluated this problem in two steps. First, we constructed a benchmark of 1,200 clinical documents with 9,184 uncertainty annotations across five levels. Second, we evaluated three LLMs on this benchmark. Our results show that (1) LLMs preserve the original uncertainty cues poorly, often less than half the time; (2) LLMs struggle with nuanced distinctions between adjacent levels. This work reveals a failure mode not captured by standard evaluation metrics and provides implications for the safe deployment of LLMs in clinical workflows.

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24.
medRxiv (Medicine) 2026-06-22

Cumulative Metabolic Exposure to Hyperglycemia and Risk of Cardiovascular and Limb Events in Peripheral Artery Disease

Authors:
James↗Li↗Somisetty↗Nguyen↗Vaughan-Sarrazin↗M. S↗Lund↗Tsai↗Smolderen↗K. G↗Hoffman↗R. M↗…

Background: Although diabetes is a potent risk factor for the development of peripheral artery disease (PAD), the effect of cumulative metabolic exposure to hyperglycemia on risk of cardiovascular or limb events in patients with PAD remains unclear. Methods: The Peripheral Artery Disease: Long-term Survival (PEARLS) is a longitudinal registry of Veterans with newly diagnosed PAD identified using a natural language processing approach. Included patients had ankle brachial index [≤]0.9 or toe brachial index [≤]0.7, and no history of lower extremity revascularization or major amputation. Among patients with diabetes in this cohort, we assessed cumulative exposure to hyperglycema based on a 24-month rolling average of hemoglobin (Hgb) A1c values, categorized as [≤]7%, >7% to [≤]8%, and >8%. Multivariable Cox regression models evaluated the association between categories of HgbA1c, modeled as a time-varying exposure, and risk of cardiovascular (CV: myocardial infarction or stroke) and limb (chronic limb threatening ischemia [CLTI] or major amputation) events. Results: Among 45,109 patients with new diagnosis of PAD and pre-existing diabetes, the mean HgbA1c at baseline was 7.5%, with nearly one-third (30.4%) having HgbA1c >8%. The mean age was 70.4 years, 19.8% were Black and 4% were Hispanic. Patients with baseline HgbA1c >8% were younger and compared to those with HgbA1c [≤]7%, more likely to have coronary disease, kidney disease, and obesity. Over a median follow up of 4.2 years, 8,306 (18.4%) patients experienced a CV event, and 8,199 (18.2%) experienced a limb event. The adjusted association between HgbA1c and hazard of CV events was 12% higher in patients exposed to HgbA1c >7% to [≤]8% (HR 1.12; 95%CI: 1.05-1.18) and 38% higher in those exposed to HgbA1c >8% (HR 1.38; 95%CI: 1.30-1.46), compared to HgbA1c 7% to [≤]8% (HR 1.20; 95%CI: 1.13-1.28) and HgbA1c >8% (HR 1.60; 95%CI: 1.51-1.70), respectively when compared to HgbA1c [≤]7%. These findings were consistent in subgroups based on age and severity of PAD. Conclusions: Among diabetic patients with PAD, cumulatiave metabolic exposure to hyperglycemia is associated with a markedly increased risk of clinical events, especially limb events.

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25.
arXiv (CS.CL) 2026-06-24

Speculative Pipeline Decoding: Higher-Accruacy and Zero-Bubble Speculation via Pipeline Parallelism

Authors:
Yijiong Yu↗Huazheng Wang↗Shuai Yuan↗Ruilong Ren↗Ji Pei↗

Speculative Decoding (SD) accelerates low-concurrency LLM inference by employing a draft-then-verify paradigm. However, mainstream methods typically rely on multi-token prediction, which introduces escalating prediction difficulty and serial drafting latency. To address these, we propose Speculative Pipeline Decoding (SPD), a groundbreaking framework that unlocks the true potential of pipeline parallelism. By partitioning the target LLM into $n$ pipeline stages, SPD allows LLM to process $n$ tokens within single sequence in parallel to accelerate decoding. To continuous fill the pipeline in single sequence decoding, a speculation module aggregates intermediate features across different pipeline depths to predict the next token, executing strictly in parallel with the target model's pipeline step, to realize bounded difficulty, higher acceptance rates, and zero latency bubbles. Our experiments demonstrate that SPD achieves significantly higher theoretical and wall-clock speedup compared to mainstream baselines at moderate pipeline depth, though more aggressive settings require further improvement. Our code is available at https://github.com/yuyijiong/speculative_pipeline_decoding

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