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01.
arXiv (CS.CV) 2026-06-17

Reinforcing Dual-Path Reasoning in Spatial Vision Language Models

Spatial VLMs have made substantial progress in geometric perception, yet complex spatial reasoning requiring multi-step inference over depth, distance, and scene relations remains challenging. Moreover, different spatial queries call for fundamentally different strategies: some are best addressed through purely linguistic, step-by-step deduction, while others require explicit 3D grounding before quantitative inference. We present Dual-Path Spatial Reasoning via Reinforcement Learning for Spatial VLMs (SR-REAL), a unified framework that equips a spatial VLM with two complementary reasoning paths: Language-Only Reasoning (LOR), which performs step-by-step linguistic deduction, and Detect-Then-Reason (DTR), which detects 3D geometric cues (e.g., centers or bounding boxes) via region tokens before explicit geometric inference. SR-REAL begins with a cold-start supervised fine-tuning stage that constructs LOR and DTR chain-of-thought supervision and exposes a region-to-3D interface, followed by RL that optimizes the policy model with accuracy and format rewards; for DTR, a discrete center-based detection reward further refines geometric alignment. Across diverse spatial benchmarks, SR-REAL significantly outperforms spatial VLM baselines: (i) a single RL-trained model supports both reasoning paths, with DTR excelling in region-aware tasks through precise 3D localization and LOR enhancing general spatial reasoning; (ii) jointly training both paths fosters mutual reinforcement; (iii) high-quality, blended cold-start data is crucial for stable RL optimization; and (iv) the model generalizes across datasets and domains without per-task tuning, demonstrating positive transfer between LOR and DTR.

02.
PLOS Medicine 2026-05-20

Brain morphology in Anorexia Nervosa and its subtypes: A multi-cohort study of individual participant data

by Fabio Bernardoni, Dominic Arold, Luis Schoppik, Klaas Bahnsen, Ruiyang Ge, Clara Moreau, Lasse Bang, Federico D’Agata, Giovanni Abbate-Daga, Christian K. Tamnes, Iain Campbell, Owen O’Daly, Ulrike Schmidt, Guido Frank, Stefanie Horndasch, Andreas Hess, Arnd Dörfler, Hans-Christoph Friederich, Joe Simon, Angela Favaro, Luca Lavagnino, Christina E. Wierenga, Amanda Bischoff-Grethe, Amy E. Miles, Allan Kaplan, Aristotle Voineskos, Paul A. M. Smeets, Annemarie A. van Elburg, Unna Danner, Sophia I. Thomopoulos, Laura Berner, Neda Jahanshad, Sophia Frangou, Joseph A. King, Paul Thompson, Stefan Ehrlich Background In a recent coordinated meta-analysis of neuroimaging data, we reported gray matter (GM) alterations in acutely underweight patients with anorexia nervosa (AN). Here, we extend these findings by examining individual variation in brain structure within AN, individual-level differentiation between AN and healthy controls (HC), and differences between AN subtypes, with potential relevance for understanding clinical heterogeneity. Methods and findings We analyzed individual-level data from 11 international sites in the ENIGMA Eating Disorders Working Group, including 570 female participants with AN and 739 HC. We examined cortical thickness, cortical surface area and subcortical volumes in AN versus HC using three complementary approaches: (i) group-level differences in a mega-analysis correcting for age effects, (ii) frequencies of extreme deviations (infra-/supranormal; z  1.96) based on normative reference models by the CentileBrain Initiative, and (iii) individual-level classification performance using machine learning. The same analytic framework was applied to compare AN restricting versus binge-eating/purging subtype, additionally correcting for BMI effects.Mega-analyses reinforced previous meta-analytic findings of pronounced and widespread GM deficits in AN compared to HC. Normative modelling revealed that the frequency of infranormal z-scores (23/68 cortical thickness, 13/14 subcortical volume metrics) and supranormal z-scores (35/68 cortical thickness, 17/68 cortical surface area metrics) was significantly higher in AN than expected based on reference data. Individuals with AN could be reliably differentiated from HC using machine-learning classifiers (ROC–AUC = 0.75–0.81). In contrast, neither group-level differences nor frequency of extreme z-scores differed between AN subtypes, and individuals with different subtypes could not be reliably differentiated from each other. Importantly, the observational design cannot distinguish neurobiological differences related to AN from the effects of starvation or low BMI in the AN versus HC analyses. The lack of differences between subtypes does not exclude brain structural differences between AN subtypes that might be detectable with other modalities or analytic approaches. Conclusion Using a mega-analytic approach, we confirm widespread GM deficits in AN, show that these alterations are (in some patients) extreme, and demonstrate that they enable robust classification with superior performance compared to most MRI-based psychiatric classification studies. The absence of differences between AN subtypes may reflect shared neurobiology, though other imaging modalities may reveal distinctions beyond brain structure.

03.
arXiv (CS.AI) 2026-06-19

The Algorithmic-Human Manager: AI, Apps, and Workers in the Indian Gig Economy

arXiv:2606.19975v1 Announce Type: cross Abstract: This paper examines the impact of artificial intelligence and digital technologies on the blue-collar gig economy in India, focusing on algorithmic management. This paper examines the impact of artificial intelligence and digital technologies on the blue collar gig economy in India, focusing on algorithmic management he use of automated systems to allocate, monitor, and evaluate work in location-based services such as ride sharing and delivery. Using a social justice framework and a mixed-methods approach comprising interviews with 16 gig workers and 21 key stakeholders, the study uncovers a dual reality: while AI-powered systems expand access to work and generate operational efficiencies, they simultaneously introduce significant challenges related to fairness, transparency, and worker dignity. Key findings reveal that algorithmic systems are opaque by design, produce inequitable outcomes, and are not structured to reward additional labour with proportionate pay. The study advocates for a pragmatic hybrid governance model an Algorithmic Human Manager framework in which technological efficiency and human accountability operate together rather than in opposition. The findings carry implications for policymakers, platform companies, and civil society organizations working to design equitable AI governance frameworks for the gig economy in India and across the Global South.

04.
arXiv (CS.CL) 2026-06-15

Learning to Hear Hesitation: Continual Learning for Disfluency-Aware ASR

Despite advances in large-scale Automatic Speech Recognition (ASR), disfluent speech remains challenging, as state-of-the-art systems are often optimized to omit disfluencies, leading to information loss and hallucinations. Prior work has focused on verbatim transcription and the integration of disfluency markers, but adapting models on limited datasets can lead to catastrophic forgetting of general-domain knowledge. We address this gap by leveraging continual learning (CL) with explicit disfluency tokens. We first introduce these tokens into a pretrained ASR model to establish stable token mechanisms, and then continue training on additional datasets with varying disfluency distributions. Through a detailed analysis of model dynamics during training, we identify a trade-off between marker learning and ASR performance, and a consistent cross-attention head mechanism shared across CL methods.

05.
arXiv (CS.CV) 2026-06-18

Bridging Single Distortion Artifacts and Mmultifactorial Clinical Quality: Few-shot Biparametric MRI Quality Assessment via Distortion-trained Prototypical Networks

Clinical prostate multi-parametric MRI relies heavily on high-quality diffusion-weighted imaging (DWI), yet reading DWI is frequently compromised by geometric distortion, often caused by rectal air. Assessing quality via the PI-QUAL scoring system is an emerging clinical standard, but it is subjective, time-consuming and suffers from a class imbalance where low-quality cases are diverse and relatively scarce. Using the PRIME clinical trial as an example, there are $6\%$ images with PI-QUAL scores lower than 4, $87\%$ of DWI issues are due to distortion. Many of the other clinical quality issues are under-represented. To address this common dual-scarcity of annotated clinical data, we propose a few-shot biparametric prototypical network for automated image quality assessment (IQA). Our framework utilizes a dual-branch 3D ResNet to fuse T2-weighted and DWI features, providing anatomical context to distinguish true morphology from distortion. To handle real-world heterogeneity, we introduce feature-wise linear modulation (FiLM) and a gradient reversal layer (GRL) to align feature distributions conditioned on varying b-values while suppressing acquisition-related biases. We demonstrate that a model meta-trained solely on comparatively objective, readily obtainable distortion labels can effectively adapt to predicting complex, multi-factorial clinical quality scores such as PI-QUAL using only five representative samples. Experimental results on two datasets show that our method significantly outperforms few-shot learning baselines for this challenging IQA task, offering a practically feasible and data-efficient solution for standardizing prostate MRI quality control in clinical workflows.

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

Evolutionary Dynamics of Cooperation in Next-Generation LLM Agent Systems: A Cross-Provider Empirical Extension

arXiv:2605.29874v2 Announce Type: replace-cross Abstract: Do next-generation LLM agents inherit the cooperative biases documented in their predecessors, or does scale and provider diversity reshape equilibrium behaviour in competitive multi-agent settings? Willis et al. established a benchmark for this question using evolutionary game theory and the Iterated Prisoner's Dilemma (IPD), finding consistent cooperative biases in ChatGPT-4o and Claude 3.5 Sonnet. We extend this benchmark to four frontier models released in 2025-2026 - Claude Sonnet 4.6, Gemini 2.5 Flash, Gemini 3.1 Pro, and GPT-5.4 Mini - applying the identical protocol across three prompting styles (Default, Prose, Self-Refine) and four population compositions (balanced and biased, with and without noise). Cooperative bias persists across providers (H1): ten of twelve model-prompt combinations favour cooperative equilibria in balanced noiseless conditions. Cross-provider divergence is substantial (H3): Gemini 2.5 Flash reaches up to 77% aggressive equilibria under biased conditions, while GPT-5.4 Mini reaches 70% cooperative equilibria under Self-Refine. Support for aggressive capability parity is partial (H2): Self-Refine raises ICD in all models and Gemini 3.1 Pro Refine achieves the highest ICD in the dataset (0.925), but Default and Prose prompts show no systematic narrowing. Evidence on noise robustness is directionally positive but not robustly confirmed (H4): with n=500 Moran iterations per condition, average noise sensitivity is about 6 percentage points for Claude Sonnet 4.6 versus 13 pp for Claude 3.5 Sonnet, but this cross-study gap is not statistically significant once the predecessor's unreported sampling error is propagated. Provider identity, rather than model generation, is the strongest correlate of equilibrium outcomes; noise remains a universal challenge regardless of model size or vintage.

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

Predicting Mergeability of Parameter-Efficient Fine-Tuning Updates

arXiv:2606.19549v1 Announce Type: new Abstract: Low-rank adaptation (LoRA) makes it cheap to train many domain- and task-specific language model adapters, but whether two adapters can be merged is usually discovered only after both have been fully trained and evaluated. This late feedback is costly: adapters that are strong in isolation can interfere destructively once their updates are combined. We ask whether this outcome can be anticipated. We formalize adapter mergeability as the degree to which an adapter preserves its single-task utility after merging, and show that it can be forecast from signals measured in the first few percent of training – chiefly how the low-rank updates and their gradients align across tasks and how much they disturb shared representations. We package these signals into MergeProbe, a lightweight predictor that estimates pairwise and set-level retention and turns the estimate into a concrete decision: merge directly, reweight, prune, or route. On MERGE-PEFT, a five-domain benchmark spanning math, code, science, instruction following, and safety, MergeProbe attains the best average and worst-case retention among strong interference-aware merge baselines while adding far less deployment overhead than full task routing. This turns LoRA merging from a post-hoc engineering step into an anticipatory measurement problem.

08.
arXiv (CS.AI) 2026-06-16

Looking Is Not Picking: An Attention-Segment Account of Tool-Selection Failures in LLM Agents

作者:

arXiv:2606.16364v1 Announce Type: new Abstract: LLM agents mis-call tools, and the natural guess is that the model failed to see the right tool in a crowded harness. We show the opposite through a lens concurrent work sets aside – the model's attention to labeled tool-definition segments. On real BFCL failures, by per-candidate attention argmax the model attends most to the correct tool 80% of the time (vs. 21% chance), and the gold is the under-attended segment on only 10%: it looks at the right tool and still picks wrong. This directly refutes the intuitive "crowded-harness / lost-in-the-middle" explanation: the failure is at the decision readout, not the harness, and we pin it there three ways. (1) Input vs. readout: repairing the prompt (reordering or duplicating the gold tool) recovers

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

Simple Domain Generalization Methods are Strong Baselines for Open Domain Generalization

In real-world applications, a machine learning model is required to handle an open-set recognition (OSR), where unknown classes appear during the inference, in addition to a domain shift, where the data distribution differs between the training and inference phases. Domain generalization (DG) aims to handle the domain shift situation where the target domain of the inference phase is inaccessible during the model training. Open domain generalization (ODG) considers DG and OSR. Domain-augmented meta-learning (DAML) is a method targeting ODG; however, it has a complicated learning process. By contrast, although various DG methods have been proposed, they have not been evaluated in ODG situations. In this study, we comprehensively evaluate the existing DG methods in ODG and show that the two simple DG methods, CORrelation ALignment (CORAL) and maximum mean discrepancy (MMD), are competitive with DAML in several cases. In addition, we propose simple extensions of CORAL and MMD by introducing the techniques used in DAML, such as ensemble learning and Dirichlet mixup data augmentation. The experimental evaluation demonstrates that the extended CORAL and MMD can perform comparably to DAML with lower computational costs. This suggests that the simple DG methods and their simple extensions are strong baselines for ODG.

10.
medRxiv (Medicine) 2026-06-22

The circulating blood proteome of childhood acute leukemia

The circulating blood proteome provides a systemic readout of disease biology and holds promise for advancing diagnostics and disease monitoring in pediatric leukemia. Here, we profiled 3072 proteins in diagnostic serum from 54 children with acute lymphoblastic leukemia (ALL), 21 with acute myeloid leukemia (AML), and 12 healthy controls using the Olink Proximity Extension Assay. We observed profound alterations in circulating protein levels in leukemia patients compared with controls and identified immunophenotype-specific proteins, including SIGLEC15 in B-cell precursor ALL (BCP-ALL), NOTCH1 in T-ALL, and CEBPA in AML, all which remained high even in patients with low (

11.
arXiv (CS.CV) 2026-06-12

SalArt-VQA: Diagnosing Whether VLMs Understand Salient Artifacts in Generated Images

Vision-language models (VLMs) are increasingly used to detect whether AI-generated images contain visible artifacts, yet their ability to analyze such artifacts remains poorly understood. A correct image-level decision can still hide important failures: a model may correctly flag an artifact while relying on the wrong visual cue, selecting the wrong region, or describing a defect that the image does not support. To evaluate these behaviors directly, we introduce SalArt-VQA, a diagnostic benchmark for fine-grained SALient ARTifact understanding in AI-generated images. SalArt-VQA contains 950 images and 3,681 human-authored multiple-choice questions spanning artifact images, matched real reference images, and paired generated reference images. Four aligned question types evaluate presence detection, semantic localization, spatial grounding, and evidence-grounded defect identification, while the reference splits test calibration and abstention when the annotated defect is absent. Across 20 VLMs, SalArt-VQA reveals failures that image-level detection accuracy hides: the strongest model reaches 99.37% detection recall on artifact images but answers all four artifact-side questions correctly on only 53.26% of images. Comparing artifact images with artifact-free references reveals a sensitivity-calibration tradeoff: sensitive models often make unsupported artifact claims, while conservative models avoid false alarms largely by missing real artifacts. These results show that high artifact detection accuracy alone does not imply grounded artifact understanding. SalArt-VQA exposes these hidden failure modes and provides a fine-grained evaluation of whether VLM artifact claims are supported by local visual evidence.

12.
arXiv (quant-ph) 2026-06-19

Unleashing Emergent Fermions with Rydberg Atom Simulators

arXiv:2606.19444v1 Announce Type: cross Abstract: Rydberg atom simulators, in both analog and digital modes, have attracted significant recent interest due to their versatile geometric reconfigurability. In this work, leveraging this feature, we propose two complementary approaches, one for each mode, to characterize emergent fermions in critical quantum many-body systems. In the analog mode, we assemble the Rydberg atoms in a "developable" (namely, preserving local couplings) Möbius band geometry to realize antiperiodic boundary conditions, where fermionic states reside. Spectroscopic measurement in this sector then reveals universal energy ratios of the bosonic and fermionic states. In the digital mode, we carry out a fermionic version of Kibble-Zurek ramping with a quantum circuit, directly addressing the fermionic scaling form. Reconfigurability allows an exponential speed-up of this task, with an $O(\log L\log\log L)$ circuit-depth overhead. Our work establishes the Rydberg atom simulator as a uniquely powerful platform to attack the notoriously difficult issue of experimentally probing emergent fermions that are nonlocally defined in a bosonic system.

13.
arXiv (CS.CL) 2026-06-11

MA-DLE: Speech-based Automatic Depression Level Estimation via Memory Augmentation

Speech-based automatic estimation of depression levels is essential for enabling early detection and timely intervention, particularly in resource-constrained mental health settings. In recent years, deep learning has demonstrated impressive success across various domains, including affective computing and mental health assessment. Most existing approaches rely on RNN-based architectures (such as LSTM and GRU) to model temporal information for depression estimation. However, the extracted features often emphasize only a few adjacent speech segments, limiting their ability to capture long-range dependencies. To overcome this limitation, we introduce a memory-based feature augmentation method that enhances the representational capacity of GRU-extracted features. Rather than indiscriminately incorporating historical data, our memory bank is designed to selectively integrate two types of components in order to reduce redundancy and irrelevance: (1) historical temporal features that closely resemble the current GRU output, offering complementary contextual information; and (2) dynamic memory features identified based on feature variability, which capture behavioral and emotional fluctuations indicative of depressive symptoms. To effectively fuse the memory-augmented features with GRU outputs, we further design a Hierarchical Attention Fusion (HAF) module. Our method is evaluated on the widely used DAIC-WOZ and E-DAIC datasets, achieving state-of-the-art performance.

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

A Practical Evaluation Method for Long-Form Simultaneous Speech-to-Speech Translation

Simultaneous speech-to-speech translation (SimulS2ST) enables real-time cross-lingual communication, but existing evaluation has focused largely on short or pre-segmented speech rather than long-form, continuous input. Prior approaches are difficult to reproduce and make assumptions that do not hold for end-to-end systems. We present a practical evaluation method for long-form SimulS2ST. Given source speech, pre-segmented source transcripts, and reference translations, we run automatic speech recognition (ASR) and forced alignment on the generated target speech to recover token-level timestamps, then apply a sentence-embedding-based aligner to match the target text to its corresponding source sentences. This enables sentence-level computation of latency and quality metrics, including YAAL and xCOMET, which are then aggregated into final system-level scores. Experiments on representative SimulS2ST systems show that the method is effective in practice and reveal that current systems suffer from substantial latency accumulation on long speech.

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

All about quantum error correction: distillation, mitigation, self-correction and beyond

作者:

arXiv:2606.14034v1 Announce Type: new Abstract: In this work, it is shown that many quantum error-manipulating techniques, such as distillation, error mitigation, and dynamical decoupling, are special cases of the most general framework for quantum error correction. This unifying perspective is achieved by extending quantum error correction to include state-adaptive and channel-adaptive settings, as well as multi-stage coding scenarios. Based on this insight, a model of self-correcting quantum memory is also proposed. This work clarifies the relationship among these techniques and illustrates, through explicit constructions, how the unified perspective can guide the design of reliable quantum information systems.

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

Search Discipline for Long-Horizon Research Agents

arXiv:2606.11522v1 Announce Type: new Abstract: Autoresearch agents now propose, evaluate, and select scientific candidates against a metric, and that metric is usually an aggregate reduced over a heterogeneous space of regions, slices, or cohorts. We show that when scientific validity lives in that disaggregated structure, the aggregate can rank the wrong candidate first. The headline number improves while the structure underneath inverts, so a decision made on the number accepts a candidate that quietly breaks the model. The failure is not domain-specific. It appears wherever a candidate's validity is multi-dimensional but its verifier is a single reduction. We demonstrate the inversion on a fire-model task in the Ecosystem Demography model. The highest-scoring candidate and a slightly lower one are within noise of each other on global score, yet the top-scoring one collapses the protected boreal regions while the other preserves them. What separates them is the per-region behavior, not the headline number. This decision should not be left to the agent that produced the candidates. The agent optimizing the score is the last party likely to catch the score being wrong, and a prompt has no remaining turn once the agent has stopped. We move the decision to an external control loop that audits each candidate on its disaggregated behavior and acts after the agent has decided. It can demote a candidate the agent would have accepted, and it can reopen a run the agent had declared finished. Our contribution is the inversion finding itself, and a search-discipline protocol that decides on reviewable candidate-effect evidence instead of the score.

17.
arXiv (CS.LG) 2026-06-11

Querying Counterfactuals on Tissue Graphs with Supervised Disentanglement

arXiv:2606.08493v2 Announce Type: replace-cross Abstract: Tissue graph counterfactuals ask how a cell's expression would change under altered spatial neighbor contexts. Such queries are central to predicting cell behavior in tissues, but lack a unified definition, with existing methods targeting specific intervention types or treating cells as i.i.d. In this work, we first formalize tissue graph counterfactuals as a class of spatial interventions that either rewire connections between cells (edge perturbation) or modify the expression of their neighbors (node perturbation). We then introduce Cellina (https://cellina.readthedocs.io) - a framework that uses supervised disentanglement to decompose a cell's intrinsic state from its spatial context, using the latter as a conditioning input for counterfactual predictions. Across benchmarks spanning over 2.5 million spatially-resolved cells in colorectal cancer and mouse brain, Cellina outperforms spatially-informed and non-spatial competitors in in-silico graph perturbations, disentanglement, and scalability. Additionally, we show that Cellina reveals biologically distinct cancer subdomains in an unsupervised manner and enables targeted neighbor perturbation simulations.

18.
arXiv (math.PR) 2026-06-16

A Low-Regularity Semigroup Sewing Lemma via Quotient Structures

arXiv:2606.16164v1 Announce Type: new Abstract: We develop a low-regularity Sewing theory for the semigroup coboundary $\hat\delta=\delta-a$ associated with a strongly continuous semigroup $S$. Unlike the ordinary low-regularity Sewing problem, the semigroup setting has an intrinsic algebraic non-uniqueness below the threshold $1$, in the sense that solutions are canonical only modulo semigroup cocycles. Accordingly, the natural target is a quotient space rather than an increment space. We identify this quotient structure and construct the corresponding semigroup Sewing map. The construction uses a frozen terminal-time transform, which rewrites semigroup defects, for each terminal time, as ordinary low-regularity Sewing problems on a frozen simplex. This reduction, however, does not by itself produce a genuine semigroup increment; the main additional step is to prove that the frozen solution classes are compatible as the terminal time varies and hence assemble into a canonical quotient class for $\hat\delta$. This yields canonical classes for $0

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

Self-Evolving Multi-Agent Systems via Textual Backpropagation

arXiv:2506.09046v3 Announce Type: replace-cross Abstract: Leveraging multiple Large Language Models (LLMs) has proven effective for addressing complex, high-dimensional tasks, but current approaches often rely on static, manually engineered multi-agent configurations. To overcome these constraints, we present the Agentic Neural Network (ANN), a framework that conceptualizes multi-agent collaboration as a layered neural network architecture. In this design, each agent operates as a node, and each layer forms a cooperative team focused on a specific subtask. Our framework follows a two-phase optimization strategy: (1) Forward Phase - Drawing inspiration from neural network forward passes, tasks are dynamically decomposed into subtasks, and cooperative agent teams with suitable aggregation methods are constructed layer by layer. (2) Backward Phase - Mirroring backpropagation, we refine both global and local collaboration through iterative feedback, allowing agents to self-evolve their roles, prompts, and coordination. This neuro-symbolic approach enables our framework to create new or specialized agent teams post-training, delivering notable gains in accuracy and adaptability. Across seven benchmark datasets, our work surpasses leading multi-agent baselines under the same configurations, showing consistent performance improvements.

20.
Nature (Science) 2026-06-09

Don’t compete, collaborate: why collective funding applications are the future

Scientists with disparate expertise writing grants together can identify knowledge gaps and drive progress — but systems must change to incentivize them. Scientists with disparate expertise writing grants together can identify knowledge gaps and drive progress — but systems must change to incentivize them.

21.
arXiv (CS.AI) 2026-06-15

Hy-Embodied-0.5-VLA: From Vision-Language-Action Models to a Real-World Robot Learning Stack

arXiv:2606.14409v1 Announce Type: cross Abstract: In this report, we present Hy-Embodied-0.5-VLA, abbreviated as HyVLA-0.5, an end-to-end system that spans the full robot learning stack: data collection, model design, continued pre-training and supervised fine-tuning, RL post-training, and real-world deployment. Each component serves a distinct role in this stack.

22.
medRxiv (Medicine) 2026-06-18

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

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

23.
medRxiv (Medicine) 2026-06-15

Therapeutic efficacy study on shoulder impingement syndrome in swimmers: a network meta-analysis

Shoulder impingement syndrome (SIS), including subacromial impingement and rotator cuff tendinitis, is commonly caused by repetitive swimming movements and associated shoulder joint dysfunction. Despite numerous available treatment options, no consensus exists on the most effective treatment option. Therefore, this systematic review and network meta-analysis aimed to investigate treatment methods for SIS in swimmers. Using a frequentist framework and Cochrane PICOS principles, we compared SIS treatments, constructed network evidence diagrams, and assessed heterogeneity. A total of 45 studies were included in the qualitative synthesis, and 42 contributed to the network meta-analysis, comprising 1752 participants, 9 treatment categories, and outcome measures. For pain outcomes, some adjunctive interventions combined with exercise showed favorable ranking probabilities, although several estimates were accompanied by wide confidence intervals. For shoulder range-of-motion outcomes, taping, acupuncture, manual therapy, and sport-specific training showed favorable effects in selected comparisons, particularly for external and internal rotation. According to surface under the cumulative ranking curve (SUCRA) rankings, exercise combined with medium-frequency therapy ranked highly for pain reduction, whereas exercise combined with acupuncture or extracorporeal shock wave therapy ranked highly for shoulder flexion. Exercise combined with taping ranked highly for external rotation, and exercise combined with manual therapy ranked highly for internal rotation. However, the interpretation of ranking results should remain cautious because uncertainty and inconsistency were present in some comparisons. Exercise-based rehabilitation appears to remain central to the management of SIS in swimmers. Several adjunctive interventions showed favorable findings for selected outcomes, especially pain relief and shoulder rotational function. However, the available evidence was affected by heterogeneity, inconsistency, and imprecision across some treatment comparisons. More rigorously designed swimmer-specific randomized controlled trials are needed before firm treatment hierarchies can be established. Trial registration: The protocol for this systematic review is registered with PROSPERO (www.crd.york.ac.uk/PROSPERO; registration number: CRD42024498851). The first submission of PROSPERO was on January 15, 2024, and it was revised and updated on March 25, 2026.

24.
medRxiv (Medicine) 2026-06-18

Guiding the development of climate counterfactuals for health impact attribution studies

Climate change detection and attribution (D&A) methods have become vital for quantifying the influence of anthropogenic forcing on the Earth's systems, including human health. Health impact attribution (HIA) studies seek to disentangle climate-driven health effects from natural variability yet are often constrained by the availability of accessible counterfactual climate scenarios. This tutorial paper presents a flexible, reproducible framework for developing counterfactual climates without reliance on computationally intensive global circulation models. We provide practical, R-based methodologies for constructing both trend-based (temperature and non-temperature) and event-based counterfactual, using a variety of techniques including model residual detrending, data-driven decomposition (e.g., Singular Spectrum Analysis and Empirical Mode Decomposition) and stochastic weather generators. The tutorial also explores the incorporation of greenhouse gas concentrations as forcing variables, rather than global mean temperature anomalies. By operationalising these methods through worked examples and an open code repository, this paper aims to build capacity within the HIA community, enhance methodological transparency, and foster interdisciplinary collaboration between climate and health researchers.

25.
arXiv (quant-ph) 2026-06-15

Simultaneous Estimation of Partial-Transpose Moments with Active Memory Independent of the Moment Order

arXiv:2606.14204v1 Announce Type: new Abstract: We study the simultaneous estimation of partial-transpose moments $p_j(\rho_{AB})=\mathrm{Tr}[(\rho_{AB}^{T_B})^j]$, $j=2,\ldots,K$, of an unknown bipartite $n$-qubit state from independent copies under an explicit active-memory constraint. We give a sequential qubit-reuse realization of the partial-transpose permutation that uses at most $2n+1$ active qubits, independent of $K$, and estimates all moments $p_2,\ldots,p_K$ to uniform additive error $\epsilon$ with total copy complexity $O(K\log K/\epsilon^2)$. We also prove two converse bounds. First, any uniformly accurate simultaneous estimator requires $\Omega(K/\epsilon^2)$ copies in the worst case. Second, the same scaling holds on an explicit isospectral two-qubit negative-partial-transpose (NPT) family whose ordinary moments are constant while the partial-transpose moments vary. These results characterize the copy complexity of the partial-transpose moment hierarchy up to a logarithmic factor and extend simultaneous nonlinear-functional estimation from ordinary state powers to partial-transpose spectral data under active quantum memory independent of the target moment order.