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01.
arXiv (CS.LG) 2026-06-12

Forecasting Is Not Attribution: Localizing Decoder Bypass in Graph-Based Neural Marketing Mix Models

arXiv:2606.12687v1 Announce Type: new Abstract: Marketing mix models are used to forecast business outcomes and to attribute those outcomes to marketing channels, but these goals are not equivalent. We study a failure mode in graph-based neural MMM called attribution bypass: a high-capacity decoder can obtain low forecasting error through target autoregression, dense communication, co-movement, context, or latent memory while failing to route counterfactual sensitivity through the graph used as the attribution object. We introduce DICE-MMM as a bounded diagnostic and training framework. We do not claim that observational neural MMM identifies causal effects. Instead, DICE separates three questions often conflated in graph-based MMM: graph recovery, forecasting accuracy, and whether the trained decoder's perturbation-induced influence is graph aligned. Stage 1 trains a graph encoder with a restricted graph-mediated decoder. Stage 2 freezes the selected encoder and trains a graph-safe latent decoder whose cross-node communication must pass through the supplied graph. Decoder use is evaluated with CIG, AR-CIG, and graph-swap tests. Across controlled R/d/T swaps and an external multi-graph rawlog stress test, DICE improves stable graph recovery over CausalMMM. The experiments show that forecasting accuracy is not an attribution certificate: in a sparse-target benchmark, no-graph and full-graph decoders achieve MSE@7 around 0.004 while AR-CIG nAUPRC remains near or below zero, whereas an oracle graph reaches 0.807 +/- 0.129 at comparable MSE. Frozen graph-swap localizes the bottleneck: the same DICE-hard-trained decoder moves from nAUPRC -0.044 +/- 0.006 under learned graph inputs to 0.894 +/- 0.027 with the oracle graph. The contribution is a stress test and failure-localization framework showing that low MSE can hide attribution bypass and that the unresolved bottleneck is graph-support selection, not forecasting or decoder capacity.

02.
arXiv (math.PR) 2026-06-11

Heat kernel estimates for Markov processes with blowing-up jump kernels

arXiv:2512.24807v2 Announce Type: replace Abstract: In this paper, we establish sharp two-sided heat kernel estimates for a large class of purely discontinuous symmetric Markov processes on closed subsets $F$ of $\mathbb{R}^d$, whose jump kernels blow up on a Borel subset $\Sigma$ of $F$. We assume that $F\setminus \Sigma$ is a $\kappa$-fat set and is dense in $F$. To the best of our knowledge, this is the first work establishing sharp heat kernel estimates for jump processes whose jump kernels blow up on part of the state space. The jump kernels under consideration take the form $J(x,y)=|x-y|^{-d-\alpha}{\mathcal B}(x,y)$, where $\alpha\in (0,2)$ and the function ${\mathcal B}(x,y)$ blows up at a subset $\Sigma$ of $F$. A fundamental obstacle is that the tails of the jump measures are not uniformly bounded, and hence standard techniques in heat kernel analysis do not provide a priori off-diagonal estimates. To overcome this difficulty, we develop a new approach based on weighted integral estimates for the heat kernel that are sensitive to both the blow-up behavior of the jump kernel and the geometry of $F\setminus \Sigma$. Examples of processes falling within our general framework include traces of isotropic $\alpha$-stable processes in $C^{1,\rm Dini}$ sets, processes in Lipschitz sets arising in connection with the nonlocal Neumann problem, and a large class of resurrected self-similar processes in the closed upper half-space.

03.
medRxiv (Medicine) 2026-06-11

Computer Vision Scoring of Figure Copy and Recall

Objective. Figure copy and recall tests are sensitive measures of visuoconstruction and visual episodic memory, but their clinical is constrained by labor-intensive manual scoring. We developed and validated an automated, element-level scoring pipeline using Vertex AI object detection for the tablet-based figure copy and recall tasks in the California Cognitive Assessment Battery (CCAB). The automated scoring pipeline duplicated the scoring procedures used by expert manual raters. Methods. A normative sample of 2,011 community-dwelling adults aged 18-90 completed figure copy and delayed recall trials at baseline, with subsamples retested at 1 day and at 6, 18, and 30 months. Participants completed the drawings with their index finger on a tablet computer with finger position digitized to analyze the speed and timing of individual drawing strokes A convolutional object-detection model trained on the Vertex AI AutoML Vision platform identified each of twelve canonical figure elements in rendered drawings. Separate element presence and location scores were computed after homographically warping drawings onto a canonical template to produce trial-level Element, Location, and Total scores. To compare Vertex and human scores, Vertex AI and expert human raters independently scored 1500 randomly selected drawings to evaluate inter-rater agreement, including a common subset of 100 drawings scored by Vertex AI and all raters. Results. Total scores were virtually indistinguishable (r = 0.966) from human-human agreement (mean r = 0.971) as were Element presence scores (mean r = 0.959 vs. r = 0.963). Location-score agreement (r = 0.951) was slightly below the human-human mean (r = 0.972) due to pixel-level analysis by Vertex AI that was impossible for human raters. The Vertex pipeline showed no preferential advantage for the single expert rater who categorized Elements during training. Automated scores showed strong demographic gradients, age effects on Recall (r = -0.32) were approximately twice those in Copy conditions (r = -0.16). A Memory Cost score (Recall - Copy) showed a monotonic age-related decline from +0.40 z in the youngest subjects to -0.54 z in the oldest. Kinetic analysis revealed that drawing speed and efficiency showed significant age-related changes. Overnight test-retest reliability was high (Recall r = 0.72) and the Recall trial showed a large overnight learning effect ({Delta} = +1.18) that continued with repeated tests up to 30 months ({Delta} = +0.75).

04.
arXiv (CS.AI) 2026-06-19

Grounded Inference: Principles for Deterministically Encapsulated Generative Models

arXiv:2606.19753v1 Announce Type: new Abstract: The incorporation of generative models into traditional computational systems presents both enormous opportunity and tremendous peril. Although many early adopters have realized these perils at great expense, the field still requires foundational frameworks to de-risk incorporation of AI into traditional systems. This manuscript establishes this foundation through the definition of four specific primitives of AI blended architecture, designed to enable deterministic encapsulation of probabilistic models. It further establishes two overarching anti-patterns broadly represented across industry to serve as warnings for engineers in this field. This framework was designed to enable successful integration of AI into traditional systems while providing a foundation upon which generative model providers could build the next generation of generative model interfaces.

05.
arXiv (quant-ph) 2026-06-11

Controlled ion-ion interactions and cavity-enhanced emission of a coherent dinuclear Eu$^{3+}$ complex

arXiv:2606.11947v1 Announce Type: new Abstract: Molecular rare-earth-ion complexes offer unique opportunities for quantum technologies by combining the intrinsic coherence properties of rare-earth ions with chemically tunable molecular environments. A crucial capability is the realization of multi-qubit architectures with defined qubit couplings to enable two-qubit quantum gates. Here, we investigate the optical coherence properties and excitation-induced interactions of two Eu$^{3+}$-based molecular complexes, comparing a mononuclear reference system with a dinuclear analogue in which two Eu$^{3+}$ ions are positioned at a well-defined intramolecular distance of about 7 Angstrom. Using cryogenic ensemble spectroscopy, including spectral hole burning, free-induction decay, and photon echo measurements at temperatures down to 100 mK, we demonstrate long optical coherence times $T_{2,o}$ of up to 9 $\mu$s. As a key step toward scalable multi-qubit architectures, a control-target sequence was implemented to probe conditional ion-ion interactions, revealing a stronger interaction-induced dephasing in the dinuclear complex. Finally, we show the integration of the dinuclear complex into a fiber-based optical microcavity, and observe an 380-fold emission enhancement of the $\mathrm{}^5\mathrm{D}_0\rightarrow\mathrm{}^7\mathrm{F}_0$ transition. Together, these results position molecular rare-earth complexes as versatile and chemically tunable building blocks for scalable quantum technologies.

06.
medRxiv (Medicine) 2026-06-17

Brain age gap correlates with DTI-derived microstructural abnormalities in multiple sclerosis.

Background: Brain age gap (BAG) is increased in multiple sclerosis (MS), but whether it reflects microstructural pathology beyond conventional atrophy remains unclear. Objective: To test whether BAG is elevated in MS and correlates with conventional and diffusion tensor imaging (DTI) abnormalities relative to healthy controls. Methods: A case-control study of 43 people with MS and 18 healthy controls was performed. BAG was estimated from T1-weighted MRI using brainageR. Controls were used as MRI reference distributions. MRI values were expressed as deviation z-scores and correlated with BAG within MS. Conventional MRI and DTI domains were analysed using age/sex-adjusted partial correlations with domain-wise Benjamini-Hochberg FDR correction, where appropriate. Results: BAG was higher in MS than controls (4.79 vs -2.58 years; p

07.
arXiv (CS.AI) 2026-06-17

CogGen: Cognitive-Load-Inspired Fully Unsupervised Deep Generative Modeling for Compressively Sampled MRI Reconstruction

arXiv:2603.04438v3 Announce Type: replace-cross Abstract: Fully unsupervised deep generative modeling (FU-DGM) offers significant potential for compressively sampled magnetic resonance imaging (CS-MRI) reconstruction. Representative FU-DGM formulations, such as deep image prior (DIP) and implicit neural representation (INR), employ architectural bias to induce a low-dimensional manifold in the image space that aligns with the forward observation. However, as the underlying inverse system is highly ill-posed, prolonged iterative fitting in FU-DGM typically leads to poor efficiency and noise amplification. In this paper, guided by the cognitive principle of easy-to-hard learning, we propose CogGen, an FU-DGM framework that reformulates CS-MRI reconstruction as a staged inversion problem. Specifically, CogGen implements an self-paced curriculum learning (SPCL)-driven progressive scheduling strategy through an MRI-aware dual-threshold weighting criterion, which adaptively regulates k-space measurement participation. The data-consistency residual thresholding evaluates the fitting reliability of the current generator, while the k-space radius thresholding controls stage-wise measurement exposure, thereby avoiding uniform fitting throughout optimization. Theoretically, our analysis shows that, when early stages favor easy-to-fit measurements, CogGen yields a reduced local sufficient-iteration bound and a smaller cumulative noise-amplification bound, explaining the improved convergence behavior and reconstruction fidelity of CogGen within a finite iteration budget. Numerical experiments demonstrate that both CogGen instantiations, CogGen-DIP and CogGen-INR, achieve superior performance over prevailing CS-MRI reconstruction techniques, including unsupervised and supervised pipelines.

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

ALIGNBEAM : Inference-Time Alignment Transfer via Cross-Vocabulary Logit Mixing

Domain fine-tuning degrades the safety of large language models: fine-tuned specialists readily comply with harmful prompts framed in domain language. Existing inference-time defenses that mix logits from a safe anchor model require both models to share a vocabulary, which rules them out for the cross-family specialists where safety is most degraded. We present ALIGNBEAM, a training-free method that lifts this restriction by translating anchor logits into the target model's vocabulary token-by-token at each decoding step; a small LLM judge then selects the safest among K candidate continuations. No weights are changed, and the safety-utility trade-off can be tuned at deployment without retraining. Across both cross-vocabulary and same-vocabulary evaluation pairs, ALIGNBEAM substantially raises refusal on adversarial benchmarks while keeping task accuracy and inference overhead within practical bounds. The results show that safety alignment can be transferred between model families at inference time, without touching either model's weights.

09.
arXiv (quant-ph) 2026-06-15

Dynamically frozen long-distance entanglement via non-Hermitian PT-symmetric systems

arXiv:2606.14177v1 Announce Type: new Abstract: In distributed quantum networks, interacting spin systems can mediate the generation of highly entangled links between distant nodes. We investigate the role of effective parity-time (PT)-symmetric non-Hermitian spin-1/2 bulks weakly coupled to two quantum links, obtained due to the environmental interactions affecting both the bulk and the links. Focusing on effective non-Hermitian nearest-neighbor (NN) Su-Schrieffer-Heeger (SSH) models, we analyze how non-Hermiticity influences the dynamical formation of long-distance entanglement (LDE). For a paradigmatic model consisting of a quantum XX bulk subjected to imaginary staggered magnetic fields, we analytically determine the exceptional points arising from the resulting bulk-mediated interactions between the links. Combining analytical and numerical methods, we demonstrate that an initially fully separable state can dynamically evolve into highly entangled link states near these exceptional points in the broken regime. Further, after optimizing over time and system parameters, near-unit time-averaged entanglement between the links emerges under weak imaginary magnetic fields and bulk-link couplings, which cannot be attained in the corresponding Hermitian systems. Moreover, the non-Hermitian dynamics exhibit a freezing of high entanglement in the vicinity of exceptional points, a feature absent in Hermitian counterparts. We also identify regimes of long-range interaction strengths that yield a higher time-averaged entanglement than the corresponding NN models. Furthermore, we establish that LDE persists in the stationary regime, highlighting the promise of engineered non-Hermitian dynamics for realizing robust and frozen entangled links in quantum networks.

10.
Nature Medicine 2026-06-15

Adaptive deep brain stimulation for dynamic gait control in Parkinson’s disease: a randomized feasibility trial

A randomized crossover study of five patients with Parkinson’s disease (PD) demonstrates that gait-synchronized adaptive deep brain stimulation is feasible and safe, and reduces falls compared with continuous stimulation. Gait dysfunction in PD is a major source of disability and is often insufficiently treated by continuous deep brain stimulation (cDBS). Although adaptive DBS (aDBS) has shown efficacy for other motor symptoms using β-based, state-driven neural signals, gait is a dynamic, cyclical behavior that may require temporally precise modulation. Here we evaluated a behavior-contingent aDBS approach that synchronizes stimulation to gait phase. We reported a single-center, blinded, randomized, crossover study evaluating the feasibility of identifying patient-specific biomarkers to drive aDBS. The primary outcome was feasibility of successful identification of gait-phase biomarkers to implement aDBS. Five participants with PD undergoing pallidal DBS and subdural electrode paddle implantation were enrolled. We successfully identified personalized gait-phase biomarkers from cortical or pallidal field potentials in all five patients and embedded them into a bidirectional neurostimulator. During acute in-clinic testing, aDBS improved step variability and step symmetry versus cDBS. Three participants subsequently completed a double-blinded, multi-day crossover phase. In this setting, aDBS maintained general motor symptom control, reduced falls and yielded patient-specific gait improvements. No adverse events occurred and aDBS was well tolerated. These findings establish the feasibility of biomarker-driven, movement-synchronized neuromodulation and support the development of a larger randomized trial to determine clinical efficacy. ClinicalTrial.gov registration: NCT04675398 . A randomized crossover study shows that gait-phase-synchronized adaptive deep brain stimulation is feasible and safe, and reduces falls compared to continuous stimulation in Parkinson’s disease.

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

DeepRoot: A KG-Coordinated Multi-Agent System for Therapeutic Reasoning over Historical Medical Texts

arXiv:2606.15931v1 Announce Type: cross Abstract: Historical medical archives and traditional medicines hold immense potential for drug discovery and remain a primary source for current drug development. However, pre-ontological prose and idiosyncratic taxonomies prevent the standardization and medical modernization of the data for use in current biomedical pipelines. Furthermore, no existing LLM agent system, whether tool-calling, retrieval-augmented, or agentic deep-research, can convert such text into verifiable drug-discovery leads at scale. We close this gap with DeepRoot, a multi-agent LLM system that jointly builds and utilizes a verified knowledge graph, showing that grounding and reasoning – often conflated – are separable axes the system can compose for therapeutic reasoning. Applied to the Shen Nong Ben Cao Jing, DeepRoot recovers $10$ of $21$ held-out compound-disease treatment pairs at R@$20$ ($47.6\%$ vs $4.8\%$ for a raw corpus LLM and $\sim\!2.4\%$ random) and dominates an LLM-as-judge audit for reasoning quality over baseline LLMs and LLMs with direct tool-call access to the same APIs DeepRoot itself queries. Tool-using LLMs hallucinate evidence on $87\%$ of claims, versus 7-10% for DeepRoot. Graph-only inference hallucinates $0\%$ but ranks lowest on reasoning coherence; DeepRoot KG+LLM is the only condition to win on both axes, pointing toward a route for systematic mining and repurposing of historical medical knowledge.

12.
medRxiv (Medicine) 2026-06-17

Cost-effectiveness of measles rapid diagnostic tests for replacing or expanding laboratory testing in Ethiopia

Background: In low- and middle-income countries, laboratory testing to rapidly detect measles outbreaks is limited by infrastructure availability and high costs. This study estimates the potential impact and cost-effectiveness of measles rapid diagnostic tests (RDTs) if implemented nationally in Ethiopia to either replace or expand current testing. Methods: An agent-based model to simulate measles outbreaks was calibrated to Ethiopian measles surveillance data. Modelled outbreak outcomes were aggregated over a 10-year period. Scenarios included using RDTs to (1) replace laboratory testing; (2) replace epidemiological linkage; and (3) increase case detection, in addition to replacing laboratory testing and epidemiological linkage. Testing and outbreak response costs (in 2025 US$) were obtained from Ethiopian Public Health Institute from a government perspective. Total costs and disability-adjusted life years (DALYs) for each scenario were compared to baseline. Results: All scenarios were cost saving compared to baseline. Replacing laboratory testing with RDTs saved US$4.2M (3.2M-4.9M) over 10-years, but due to very low testing rates the benefits of eliminating laboratory testing delays were offset by missed cases from the lower RDT sensitivity, leading to similar outbreak detection times and DALYs. Replacing epidemiological linkage with RDTs had similar DALYs but increased the cost savings to US$9.7M. Using RDTs to double case detection reduced outbreak detection time from 113 to 80 days, averted 17,000 DALYs, and saved US$4.3M. Conclusions: In Ethiopia, use of measles RDTs could be cost saving, and if used to expand testing could prevent measles infections through faster outbreak detection and response.

13.
arXiv (quant-ph) 2026-06-17

Quantum Computing Algebra (QCA), the theory and implementation

arXiv:2606.17621v1 Announce Type: new Abstract: We present a real geometric algebra framework designed for the direct translation of the Dirac formalism into geometric algebra representations. Unlike previous approaches based on positive-definite signatures, QCA employs a split-signature construction that enables a natural realization of quantum states and operators while simplifying computational implementation. We further present an implementation of QCA using the GAALOP software and show how quantum gates and multi-qubit systems can be efficiently represented and generated computationally. As an application, we demonstrate the use of QCA in quantum game theory, where the real-algebraic formulation provides computational advantages for modeling entangled strategies and quantum interactions. The proposed framework establishes a practical bridge between the abstract formalism of quantum computation and efficient geometric algebra implementations.

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

The limits of interpretability in multiple linear regression

arXiv:2606.16013v1 Announce Type: cross Abstract: Interpreting machine-learning models has attracted increasing attention, particularly in the physical sciences, where one often seeks to understand the underlying mechanisms rather than merely make predictions. Multiple linear regression is often regarded as an interpretable alternative to more complex models, such as deep neural networks, because its predictions are expressed as explicit weighted sums of input features. However, when input features are strongly correlated, namely in the presence of multicollinearity, the learned weights can exhibit large dataset-to-dataset fluctuations and oscillatory behavior across physically similar features, making their interpretation difficult or even impossible. Although the instability of the weights under multicollinearity is well known in statistics, its consequences for physical interpretation, in particular its connection to oscillatory weights across physically similar features, have not been systematically clarified. Here, we theoretically discuss the mechanism behind this loss of interpretability by analyzing the eigenmodes of the feature correlation matrix. We show that small-eigenvalue modes associated with multicollinearity amplify fluctuations in the weights and generate oscillatory patterns that do not necessarily reflect meaningful contributions. We test this theoretical picture numerically on physics datasets and show that Ridge regularization suppresses these unstable modes, although the resulting weights must still be interpreted with caution. We further confirm the generality of our findings beyond physics by analyzing a diverse collection of publicly available datasets. Our results clarify why, in the presence of multicollinearity, physical interpretation can remain difficult even for linear regression models.

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

Adapting Reinforcement Learning with Chain-of-Thought Supervision for Explainable Detection of Hateful and Propagandistic Memes

Hateful and propagandistic memes exploit the interplay between images and text to convey harmful intent that neither modality reveals alone. Although thinking-based multimodal large language models (MLLMs) have advanced vision-language understanding, their application to meme content moderation remains underexplored. We propose a reinforcement learning-based post-training method that improves classification performance and reference-based explanation quality in thinking-based MLLMs via task-specific rewards and Group Relative Policy Optimization (GRPO). Concretely, we (i) conduct a systematic empirical study of off-the-shelf MLLMs for hateful and propagandistic meme understanding across English and Arabic benchmarks, (ii) extend existing meme datasets with weakly supervised chain-of-thought (CoT) rationales via distillation and multi-LLM fine-grained propaganda annotations, (iii) introduce a GRPO-based objective with thinking-length regularization that jointly optimizes classification accuracy and explanation quality, and (iv) investigate self-supervised GRPO on unlabeled memes using consensus-based pseudo-labels. Experiments on the Hateful Memes and ArMeme benchmarks show that our approach improves over previously reported results on FHM accuracy (up to +2.1%, from 79.9% to 82.0%) and on ArMeme macro-F1 (up to +7.6 points, from 0.536 to 0.612 with explanations; +6.1 compared to the original ArMeme benchmark), while also generating natural-language explanations. On ArMeme, sequence-classification baselines remain stronger in terms of raw accuracy, whereas our approach provides more balanced per-class performance along with explanations. We publicly release our code, data extensions, and evaluation resources.

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

To GAN or Not To GAN: Segmentation Analysis on Mars DEM

arXiv:2606.13252v1 Announce Type: new Abstract: To better understand Martian Surface, which is needed to enable Rovers navigate Mars with ease, it is necessary to be able to determine the location of mounds. Detecting and studying these morphologies can also help us find evidence of extraterrestrial life, in this case, more specifically, water or signs of life conducive environments. Detection of mounds was done by manually mapping morphological parameters onto Digital Elevation Models. This paper solves the problem by automatically detecting and or predicting mounds on Mars using Neural Network based Semantic Segmentation methodologies. This is done by using supervised semantic segmentation model and generative adversarial approach. A comparison of the approaches shows that adding extra artificially generated data did not improve the result.

17.
arXiv (CS.LG) 2026-06-18

Investigating Inductive Biases for Machine Learning Emulation of Sudden Stratospheric Warmings in Idealised Isca Simulations

arXiv:2606.18857v1 Announce Type: new Abstract: Machine-learning emulators are increasingly used for weather prediction and have the potential to extend skill on subseasonal-to-seasonal timescales by learning dynamically important sources of predictability. A key challenge is whether the models can exploit predictability anchors, such as stratospheric variability, that influence tropospheric circulation beyond short lead times. We test how architectural inductive bias affects emulation of sudden stratospheric warming (SSW) dynamics using paired idealised Isca simulations that differ only in an imposed wave-2 heating perturbation. Across convolutional, transformer, and graph-based architectures trained for one-step prediction, model differences are modest when the stratosphere is dynamically quiet but widen substantially when SSW-like variability is active. Our results identify explicit three-dimensional vertical coupling as a key inductive bias for machine-learning emulation of stratospheric dynamics. However, Eliassen-Palm flux diagnostics show that low forecast error does not guarantee physically faithful wave-mean-flow interaction, with coherent errors remaining in stratospheric wave-driving structure.

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

Engineering Robustness into Personal Agents with the AI Workflow Store

arXiv:2605.10907v3 Announce Type: replace-cross Abstract: The dominant paradigm for AI agents is an "on-the-fly" loop in which agents synthesize plans and execute actions within seconds or minutes in response to user prompts. We argue that this paradigm short-circuits disciplined software engineering (SE) processes – iterative design, rigorous testing, adversarial evaluation, staged deployment, and more – that have delivered the (relatively) reliable and secure systems we use today. By focusing on rapid, real-time synthesis, are AI agents effectively delivering users improvised prototypes rather than systems fit for high-stakes scenarios in which users may unwittingly apply them? This paper argues for the need to integrate rigorous SE processes into the agentic loop to produce production-grade, hardened, and deterministically-constrained agent *workflows* that substantially outperform the potentially brittle and vulnerable results of on-the-fly synthesis. Doing so may require extra compute and time, and if so, we must amortize the cost of rigor through reuse across a broad user community. We envision an *AI Workflow Store* that consists of hardened and reusable workflows that agents can invoke with far greater reliability and security than improvised tool chains. We outline the research challenges of this vision, which stem from a broader flexibility-robustness tension that we argue requires moving beyond the ``on-the-fly'' paradigm to navigate effectively.

19.
PLOS Medicine 2026-06-04

Comparative impacts and cost-effectiveness of tuberculosis systematic screening strategies in prisons in Brazil, Colombia, and Peru: A mathematical modeling study

作者:

by Yiran E. Liu, José Victor Bortolotto Bampi, Ronan F. Arthur, Argita D. Salindri, Caroline Busatto, Pedro Avedillo Jiménez, Daniele Maria Pelissari, Fernanda Dockhorn Costa Johansen, Robert Arana-Narvaez, Alvaro Fernando Moreno Roca, Wilfredo Santos Solís Tupes, Esther Mori Jiu, Christian Alfredo Moreno Roca, Erika Albertina Abregú Contreras, Valentina Antonieta Alarcón Guizado, Julián Trujillo Trujillo, Belkys Marcelino, Mónica Alonso Gonzalez, Mayra Cecilia Córdova Ayllon, Ted Cohen, Moises A. Huaman, Jeremy D. Goldhaber-Fiebert, Julio Croda, Jason R. Andrews Background Incarceration is a leading driver of tuberculosis in Latin America. Systematic screening in prisons may reduce tuberculosis burden, but optimal strategies and cost-effectiveness remain uncertain. We examined the population-wide health impacts and cost-effectiveness of systematic screening in prisons in Brazil, Colombia, and Peru, comparing different timepoints, frequencies, and screening algorithms. Methods and findings Using dynamic transmission models calibrated to Brazil, Colombia, and Peru, we simulated annual or biannual (twice-yearly) prison-wide screening, alone or combined with entry and exit screening from 2026 to 2035. We evaluated four algorithms: (1) symptom screening, (2) chest X-ray with computer-aided detection (CXR-CAD), (3) symptoms and CXR-CAD (follow-up testing if either is positive), and (4) GeneXpert Ultra (Xpert) with pooled sputum. Individuals screening positive then received individual Xpert. We projected impacts on within-prison and population-level tuberculosis incidence in 2035, along with discounted costs (2023 US dollars) and disability-adjusted life years (DALYs). Model projections showed that combined entry, exit, and biannual screening with CXR-CAD was highly impactful and cost-effective across countries, reducing tuberculosis incidence by 61%–87% in prisons and 18%–28% population-wide. Compared to only biannual CXR-CAD (the next best strategy), the incremental cost per DALY averted of adding entry and exit screening was $2,984 (Brazil), $2,925 (Colombia), and $645 (Peru). Adding symptom screening to CXR-CAD marginally increased benefit and was only cost-effective in Peru’s higher-incidence prisons. Biannual screening alone remained cost-effective at prison incidence levels well below national averages, as well as at far lower willingness-to-pay thresholds. In settings without CXR-CAD, pooled Xpert was an impactful, cost-effective alternative. Key limitations include the model’s simplified representation of tuberculosis disease states and lack of stratification by age, gender/sex, HIV, or drug resistance. Conclusions These modeling results support immediate national-level adoption of prison-wide tuberculosis screening twice-yearly and at entry and exit, using CXR-CAD or pooled Xpert.

20.
arXiv (CS.AI) 2026-06-19

Confidence Calibration for Multimodal LLMs: An Empirical Study through Medical VQA

arXiv:2606.19950v1 Announce Type: cross Abstract: Multimodal Large Language Models (MLLMs) show great potential in medical tasks, but their elicited confidence often misaligns with actual accuracy, potentially leading to misdiagnosis or overlooking correct advice. This study presents the first comprehensive analysis of the relationship between accuracy and confidence in medical MLLMs. It proposes a novel method that combines Multi-Strategy Fusion-Based Interrogation (MS-FBI) with auxiliary expert LLM assessment, aiming to improve confidence calibration in Medical Visual Question Answering (VQA). Experiments demonstrate that our method reduces the Expected Calibration Error (ECE) by an average of 40\% across three Medical VQA datasets, significantly enhancing MLLMs' reliability. The findings highlight the importance of domain-specific calibration for MLLMs in healthcare, offering a more trustworthy solution for AI-assisted diagnosis.

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

LLM-Based Visual Explanation Evaluation Framework for Assessing the Explainability of Facial Skin Disease Classification Models

作者:

This study proposes a domain-specific LLM-based Visual Explanation Evaluation Framework for assessing Grad-CAM explanations in facial skin disease diagnosis models. While previous studies have primarily focused on improving classification performance through data augmentation techniques, relatively few studies have systematically examined whether model explanations are grounded in clinically relevant lesion regions. In this study, geometric augmentation, color-based augmentation, and mixed augmentation strategies were applied to facial skin disease classification models based on EfficientNet-B0, MobileNetV3, and ResNet18. Grad-CAM was employed to generate visual explanations representing the models' decision-making processes. Furthermore, an LLM-as-a-Judge evaluation framework was designed using GPT-5.5, Gemini 3.5 Flash, and Claude Sonnet 4.6 to assess Grad-CAM explanations from the perspectives of lesion localization and explanation trustworthiness. To improve evaluation consistency and clinical grounding, a progressive prompt engineering strategy was introduced, incorporating evaluation rubrics, clinical knowledge, penalty rules, and structured output formats.

22.
medRxiv (Medicine) 2026-06-11

Long-term Penetrance of Disease Variants in Genes Prioritized for Genomic Newborn Screening: Evidence from Adult Biobanks

Importance: Genomic newborn screening (gNBS) is a potential public health intervention, but its positive predictive value (PPV) remains uncertain. Estimating the prevalence and penetrance of pathogenic and likely pathogenic (P/LP) variants in genes prioritized for screening may clarify the long-term PPV and clinical utility of gNBS. Objective: To compare ICD-based ascertainment, electronic medical record (EMR) review, and clinical assessment of genetic disorders in adults with P/LP variants in 54 genes prioritized for gNBS. Design: Two-cohort observational study with EMR review and clinical assessment in the hospital-based cohort. Setting: The U.K. Biobank (UKB) and Mass General Brigham Biobank (MGBB). Participants: 451,877 adults from the UKB and 53,371 from the MGBB, all with exome sequencing data. Exposures: P/LP variants in 54 genes prioritized through expert consensus for gNBS, in genotypes consistent with each gene's inheritance pattern. Main outcomes and measures: The primary outcome was the absolute difference in the proportion of MGBB participants identified as affected by ICD versus EMR ascertainment. Secondary outcomes included findings from clinical assessments of undiagnosed MGBB participants, corrected UKB penetrance estimates, and extrapolation to U.S.. annual birth cohorts and living adults. Results: P/LP variants were identified in 665 UKB participants (0.15%) and 82 MGBB participants (0.15%), approximately 1 in 650. In MGBB, EMR review revealed that 58/82 individuals (70.7%) were undiagnosed, although 25 of 58 (43.1%) had documented symptoms. Disease-associated ICD codes were found in 39.0% (32/82) of participants, whereas EMR review identified symptoms in 59.8% (49/82, McNemar P

23.
arXiv (quant-ph) 2026-06-11

Superspace Concentration and Adversarial Robustness in Quantum Algorithms

arXiv:2606.11580v1 Announce Type: new Abstract: We study superspace concentration as a quantum resource, formalized through the focus measure F(\r{ho}) = {\lambda}_max(\r{ho}_super) - the largest eigenvalue of the reduced superspace state - which quantifies the capacity of a quantum system to concentrate informational weight into a preferred subspace of an extended degree-of-freedom space. We develop a complete resource-theoretic framework around this measure and validate its properties through GPU-accelerated numerical simulation. Analytic decoherence predictions are confirmed to machine precision (1.11 x 10^{-16}) for superspace dimensions dS in {2,4,8,16,32}. Focus monotonicity holds across 10,000 random states with zero violations under four focus-non-generating channels across six system configurations. Focused quantum states resist coherent unitary attacks with significantly greater resilience than standard fidelity predicts, with focus remaining above 0.9 at attack strength {\epsilon} = 0.302 versus {\epsilon} = 0.174 for fidelity. We further demonstrate that the focus measure and the U(dS)-asymmetry measure are operationally distinct: asymmetry remains near zero and provides no robustness signal under coherent and targeted attacks while focus tracks spectral concentration and remains robust until {\epsilon} > 0.3. The connection between Grover's algorithm and superspace concentration is made explicit via the identity F(|{\psi}_k>

24.
medRxiv (Medicine) 2026-06-12

Cancer care disruption during the COVID-19 pandemic in Ontario, Canada: A sequential mixed-methods study

Introduction The COVID-19 pandemic profoundly disrupted healthcare delivery worldwide, with cancer care among the most affected services. Prior studies documented delays in referrals, reduced specialist access, and increased provider burden. However, the extent to which these experiences were reflected at the system level remains unclear. Objective To document cancer care experiences and examine whether these experiences were reflected in population-level health system indicators across Ontario, Canada. Methods We used an exploratory sequential mixed-methods design. Qualitative data were collected through focus groups and semi-structured interviews with 32 participants, including patients with cancer (n=8), caregivers (n=5), healthcare providers (n=14), and decision-makers (n=5) across two hospital settings in Ontario, Canada. Emergent themes informed the development of quantitative indicators. We then conducted a retrospective population-based analysis of linked administrative health databases for cancer patients in Ontario (n=87,786) to assess the prevalence of identified themes. Results Four themes emerged: (I) delays in diagnosis and screening; (II) disrupted access to primary care; (III) barriers to specialist and mental health services; and (IV) fragmented care for patients with multimorbidity. Quantitative findings corroborated major themes. Screening rates declined for cervical (64.8% to 57.5%) and breast cancer (64.5% to 57.2%). While in-person primary care shifted almost entirely to virtual modalities (8.5% to 95.4%), overall visit volumes remained stable. Specialist care showed uneven patterns, with increased oncology visits but declines in cardiology and mental health services. Patients with multiple comorbidities experienced the largest reductions in non-oncology specialist care. Conclusion The pandemic disrupted key components of cancer care, particularly screening, access to certain specialist services, and care for patients with complex needs. Integrating qualitative and quantitative evidence highlights areas of system vulnerability and underscores the need for coordinated, resilient cancer care capable of maintaining essential services during future crises.

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

DynFS-MoE: Dynamic Functional-Structural Mixture-of-Experts for Post-Traumatic Epilepsy Diagnosis

Post-traumatic epilepsy (PTE) is a severe complication of traumatic brain injury (TBI), yet early identification remains challenging due to the complex structural and functional alterations it induces in the brain. To address this, we propose a dynamic multimodal Mixture-of-Experts (MoE) framework that integrates functional and structural MRI through time-aware functional-structural encoding and class-conditioned expert routing. Within this framework, modality-specific and cross-modal experts learn complementary representations, while a Modality-Class MoE (MCoE) module dynamically dispatches expert weights according to each classification objective. Experimental results across three binary classification tasks demonstrate that the framework consistently outperforms static fusion baselines, and high-interpretability analyses further reveal meaningful region-of-interest (ROI) interactions. This dynamic multimodal expert framework effectively captures class-dependent brain interaction patterns and provides an interpretable approach for PTE diagnosis and risk stratification.