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01.
arXiv (CS.CL) 2026-06-15

Rethinking the Trust Region in LLM Reinforcement Learning

Reinforcement learning (RL) has become a cornerstone for fine-tuning Large Language Models (LLMs), with Proximal Policy Optimization (PPO) serving as the de facto standard algorithm. Despite its ubiquity, we argue that the core ratio clipping mechanism in PPO is structurally ill-suited for the large vocabularies inherent to LLMs. PPO constrains policy updates based on the probability ratio of sampled tokens, which serves as a noisy single-sample Monte Carlo estimate of the true policy divergence. This creates a sub-optimal learning dynamic: updates to low-probability tokens are aggressively over-penalized, while potentially catastrophic shifts in high-probability tokens are under-constrained, leading to training inefficiency and instability. To address this, we propose Divergence Proximal Policy Optimization (DPPO), which substitutes heuristic clipping with a more principled constraint based on a direct estimate of policy divergence (e.g., Total Variation or KL). To avoid huge memory footprint, we introduce the efficient Binary and Top-K approximations to capture the essential divergence with negligible overhead. Extensive empirical evaluations demonstrate that DPPO achieves superior training stability and efficiency compared to existing methods, offering a more robust foundation for RL-based LLM fine-tuning. Our code is available at https://github.com/sail-sg/Stable-RL.

02.
arXiv (CS.LG) 2026-06-12

Adaptive generative moment matching networks for improved learning of dependence structures

arXiv:2508.21531v2 Announce Type: replace-cross Abstract: An adaptive bandwidth selection procedure for the mixture kernel in the maximum mean discrepancy (MMD) for fitting generative moment matching networks (GMMNs) is introduced, and improved learning of copula random number generators is demonstrated. Based on the relative error of the training loss, the number of kernels is increased during training; additionally, the relative error of the validation loss is used as an early stopping criterion. While training time remains similar, adaptively training GMMNs (AGMMNs) significantly increases training performance, which is shown based on validation MMD trajectories, samples and validation MMD values. Superiority of AGMMNs over GMMNs and parametric copula models is also demonstrated in terms of three applications. First, convergence rates of estimators based on quasi-random versus pseudo-random samples from copulas are investigated in dimensions as large as 100 for the first time. Second, replicated validation MMDs, as well as Monte Carlo and quasi-Monte Carlo applications demonstrate the improved training of AGMMNs for a copula model implied by the 50 constituents of the S&P 500 index after deGARCHing. Last, both the latter dataset and 50 constituents of the FTSE 100 are used to demonstrate that the improved training of AGMMNs indeed translates to an improved model prediction.

03.
arXiv (CS.AI) 2026-06-18

An In-depth Study of LLM Contributions to the Bin Packing Problem

arXiv:2510.27353v2 Announce Type: replace Abstract: Recent studies have suggested that Large Language Models (LLMs) could provide interesting ideas contributing to mathematical discovery. This claim was motivated by reports that LLM-based genetic algorithms produced heuristics offering new insights into the online bin packing problem under uniform and Weibull distributions. In this work, we reassess this claim through a detailed analysis of the heuristics produced by LLMs, examining both their behavior and interpretability. Despite being human-readable, these heuristics remain largely opaque even to domain experts. Building on this analysis, we propose a new class of algorithms tailored to these specific bin packing instances. The derived algorithms are significantly simpler, more efficient, more interpretable, and more generalizable, suggesting that the considered instances are themselves relatively simple. We then discuss the limitations of the claim regarding LLMs' contribution to this problem, which appears to rest on the mistaken assumption that the instances had previously been studied. Our findings instead emphasize the need for rigorous validation and contextualization when assessing the scientific value of LLM-generated outputs.

04.
arXiv (CS.AI) 2026-06-24

From Spatial to Spectral: An Efficient, Frequency-Guided Feature Representation Learner for Small Object Detection

arXiv:2606.23825v1 Announce Type: cross Abstract: Efficient small object detection is bottlenecked by the inherent feature scarcity of tiny targets, which is further aggravated by operations of spatial-domain detectors that indiscriminately discard critical high-frequency details. Recovering these fragile cues within the spatial domain is notoriously difficult, as it often requires computationally expensive architectural upscaling that inadvertently amplifies background noise. To bridge this gap, we propose a paradigm shift from spatial to spectral feature processing, introducing a holistic solution with the following novelty: (1) A versatile Frequency-Guided Feature Representation framework that generalizes across diverse detector architectures (both CNN and Transformer-based), offering a robust alternative to spatial-only feature extraction; (2) The unified Decompose–Enhance–Reconstruct (DER) operator, instantiated via three lightweight, plug-and-play modules – Wavelet-Difference Gate (WDG), Log-Gabor Enhancer (LGE), and Frequency-Driven Head (FDHead) – to systematically inject frequency-aware modulation into the backbone, neck, and head. This mechanism decouples feature modeling from resolution reduction, capturing discriminative high-frequency components to enable accurate localization with significantly reduced parameter redundancy; (3) Extensive validation on multi-domain benchmarks (VisDrone2019, UAVDT, TinyPerson, DOTAv1) demonstrating consistent gains. Notably, our proposed DERNet series outperforms YOLOv11 models under the same scale while requiring only 1/6 of the parameters, backed by rigorous spectral diagnostics and error decomposition analysis.

05.
arXiv (math.PR) 2026-06-15

Semiclassical limit of Polyakov-Liouville measure and Q-Curvature Uniformization on evev-dimensional manifolds

arXiv:2606.14443v1 Announce Type: new Abstract: We study the semiclassical limit of the Polyakov-Liouville measure $\boldsymbol{\nu}_\gamma$, which is a non-Gaussian measure on $H^{-\eps}(M)$ that has recently been extended from Riemann surfaces to general Riemannian manifolds $(M,g)$ of even dimension. We show that under an appropriate rescaling in the semiclassical limit as $\gamma\to0$, the normalized Polyakov-Liouville measure $\Q_\gamma$ concentrates on the unique smooth weight $u$ for which the conformal metric $e^{2u}g$ on $M$ has constant $Q$-curvature.

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

Revealing Hidden Vulnerabilities in Autoencoders through Gradient Signal Restoration

Adversarial robustness of deep autoencoders (AEs) has received less attention than that of discriminative models, although their compressed latent representations induce ill-conditioned mappings that can amplify small input perturbations and destabilize reconstructions. Existing white-box attacks for AEs, which optimize norm-bounded adversarial perturbations to maximize reconstruction damage, often converge to suboptimal perturbations, thereby potentially overstating AE robustness. We show that this limitation is linked to vanishing adversarial loss gradients during backpropagation through ill-conditioned layers, associated with near-zero singular values in their intermediate weight matrices. To address this, we propose GRILL (Gradient Signal Restoration in Ill-Conditioned Layers), a framework designed to mitigate gradient degradation and improve the reliability of adversarial robustness evaluation in encoder-decoder architectures. GRILL is designed to mitigate adversarial gradient degradation during optimization, enabling attacks to better approximate high-distortion perturbations under fixed norm constraints. Through extensive experiments across multiple AE architectures, under both sample-specific and universal attacks, as well as standard and adaptive attack settings, we show that GRILL significantly increases attack effectiveness, thereby exposing vulnerabilities hidden by existing attack limitations. Beyond AEs, we provide preliminary evidence that modern multimodal encoder-decoder architectures exhibit similar vulnerabilities.

07.
arXiv (CS.AI) 2026-06-12

Structured vs. Unstructured Pruning: An Exponential Gap

arXiv:2603.02234v3 Announce Type: replace-cross Abstract: The Strong Lottery Ticket Hypothesis (SLTH) states that large, randomly initialized neural networks contain sparse subnetworks capable of approximating a target function at initialization without training, suggesting that pruning alone is sufficient. Pruning methods are typically classified as unstructured, where individual weights can be removed from the network, and structured, where parameters are removed according to specific patterns, as in neuron pruning. Existing theoretical results supporting the SLTH rely almost exclusively on unstructured pruning, showing that logarithmic overparameterization suffices to approximate simple target networks. In contrast, neuron pruning has received limited theoretical attention, despite its practical appeal for direct hardware speedups. In this work, we consider the problem of approximating a single bias-free ReLU neuron by pruning hidden units of a randomly initialized two-layer ReLU network, effectively isolating the intrinsic limitations of neuron pruning. We show that achieving an $\varepsilon$-approximation requires a starting network size of $\Omega(1/\varepsilon)$ for neuron pruning, whereas weight pruning succeeds with only $O(\log(1/\varepsilon))$ hidden units, revealing an exponential separation between the two approaches.

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

LIBERO-Occ: Evaluating and Improving Vision-Language-Action Models under Scene-Induced Occlusion via Viewpoint Imagination

Vision-Language-Action (VLA) models achieve strong performance on standard manipulation benchmarks, but most evaluations assume that task-relevant objects are fully visible. This assumption often fails in realistic settings, where occlusion makes manipulation partially observable. In this paper, we study scene-induced occlusion as a fundamental challenge for VLA models and introduce LIBERO-Occ, an occlusion-oriented extension of LIBERO. Experiments show that state-of-the-art VLAs suffer substantial performance degradation under occlusion. To address this issue, we propose Viewpoint Imagination (VIM), which generates a complementary view from an occluded primary observation and conditions action prediction on both observed and imagined evidence. VIM improves robustness across task suites, occlusion types, and severity levels without requiring additional cameras at deployment time, suggesting that viewpoint imagination is an promising mechanism for perception completion in partially observable manipulation. Our benchmark and corresponding code are available at: \href{https://github.com/litsh/Libero-Occ}{https://github.com/litsh/Libero-Occ}.

09.
arXiv (math.PR) 2026-06-16

Sharp connectivity bounds for the vacant set of random interlacements

arXiv:2504.02777v2 Announce Type: replace Abstract: We consider percolation of the vacant set of random interlacements at intensity $u$ in dimensions three and higher, and derive lower bounds on the truncated two-point function for all values of $u>0$. These bounds are sharp up to principal exponential order for all $u$ in dimension three and all $u \neq u_\ast$ in higher dimensions, where $u_*$ refers to the critical parameter of the model, and they match the upper bounds derived in the article arXiv:2503.14497. In dimension three, our results further imply that the truncated two-point function grows at large distances $x$ at a rate that depends on $x$ only through its Euclidean norm, which offers a glimpse of the expected (Euclidean) invariance of the scaling limit at criticality. The rate function is atypical, it incurs a logarithmic correction and comes with an explicit pre-factor that converges to $0$ as the parameter $u$ approaches the critical point $u_*$ from either side. A particular challenge stems from the combined effects of lack of monotonicity due to the truncation in the super-critical phase, and the precise (rotationally invariant) controls we seek, that measure the effects of a certain "harmonic humpback" function. Among others, their derivation relies on rather fine estimates for hitting probabilities of the random walk in arbitrary direction $e$, which witness this invariance at the discrete level, and preclude straightforward applications of projection arguments.

10.
arXiv (CS.LG) 2026-06-18

When Does Trajectory-Level Supervision Permit Efficient Offline Reinforcement Learning?

arXiv:2606.18531v1 Announce Type: cross Abstract: Offline reinforcement learning is typically analyzed under process-level reward supervision, yet many sequential decision datasets record only trajectory-level outcomes. We develop a statistical theory for offline policy optimization from such outcome-level supervision. We first study the canonical setting where the target remains the expected cumulative reward, but each offline trajectory provides only a scalar label whose conditional mean is the cumulative return. We propose OPAC, a pessimistic actor-critic algorithm that learns a latent reward model and optimizes a policy from trajectory-level labels. We prove a high-probability guarantee of order $\widetilde O(H^2\sqrt{C_{sa}(\pi^\star)/n})$ and a matching lower bound, characterizing the sharp statistical cost of replacing process-level rewards with one trajectory-level label. We then extend the principle to preference-based feedback, preserving the leading horizon and concentrability dependence up to preference-model constants. Finally, we study generalized outcome-based offline RL, where both the supervision and the objective are trajectory-level quantities induced by a nonlinear aggregation of latent per-step rewards. This problem is not learnable in general: for all-success objectives, any offline learner may require $\Omega(2^H)$ trajectories even with deterministic transitions and constant concentrability. We then identify a tractable regime through two structural coefficients, $\kappa_\mu(\sigma)$ and $\chi_\mu(\sigma)$, capturing information loss in outcome aggregation and generalized Bellman updates, under which generalized OPAC achieves polynomial sample complexity. Together, our results delineate when outcome-level supervision enables sample-efficient offline control and when missing process-level rewards create fundamental statistical barriers.

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

Let's Ask Gauss: Improved One-Run Privacy Auditing

arXiv:2606.12733v1 Announce Type: new Abstract: Privacy auditing provides an important safeguard by estimating the actual information leaked by a model, thus ensuring that theoretical privacy guarantees hold in practice. We study empirical privacy auditing for differentially private (DP) machine learning, focusing on efficient one-run methods for mechanisms such as DP-SGD. Prior one-run approaches threshold training examples or "canaries" into binary membership guesses, which discards useful information. We show that, in the white-box DP-SGD setting, canary-aligned signals naturally form a sequence of random variables whose normalized sum is asymptotically Gaussian. Leveraging this distributional perspective, we develop a DP-auditing framework that leads to tighter privacy lower bounds from a single training run.

12.
Nature (Science) 2026-06-10

Diverse binding poses of agonistic neurotoxins on human Na<sub>v</sub>1.6

作者:

Voltage-gated sodium (Nav) channels are key targets of various venomous toxins. Deciphering the binding poses and mechanisms of action of representative toxins will help to dissect the functional mechanism of the channels and facilitate therapeutic development targeting Nav channels1,2. Here we present cryo-electron microscopy&nbsp;(cryo-EM) structures of distinct binding poses of three agonistic peptide toxins on the human Nav1.6–β1 channel complex. The globular β-scorpion toxin Cn2 nestles between the extracellular segment of voltage-sensing domain (VSD)&nbsp;in the second repeat of the Nav1.6 core α-unit (VSDII) and the pore extracellular loops in the third repeat of the Nav1.6 core α-unit (ECLIII), where it is stabilized by interactions with both protein regions and the branched N1372-glycan. Cone&nbsp;snail ι-conotoxin RXIA adopts an elongated conformation, spanning VSDI and VSDIV to wrap around the shoulder of the pore domain (PD). The bullet&nbsp;ant-derived toxin δ-paraponeritoxin-Pc1a exists as a transmembrane helix that stands between VSDII and PDIII. Our findings, corroborated by functional characterizations, illustrate the diversity in peptide toxin binding poses and mechanisms of action, link stabilization of the up state of VSDI or VSDII to channel activation, and provide clues to the rational design of selective Nav channel modulators. Structures of the distinct binding poses of three agonistic peptide toxins—bullet-ant-derived toxin δ-paraponeritoxin-Pc1a, cone&nbsp;snail ι-conotoxin RXIA and the globular β-scorpion toxin Cn2—on the human Nav1.6–β1 channel complex illustrate a diversity in binding poses and mechanisms of action.

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

InstantForget: Update-Free Backdoor Unlearning with Inference-Time Feature Reset

作者:

arXiv:2606.15730v1 Announce Type: cross Abstract: Backdoor unlearning aims to remove a malicious trigger behavior from a deployed model while preserving clean utility. We study the update-free inference-time setting, where model parameters remain frozen. First, we audit a common projection assumption under oracle paired clean and triggered features. Projection succeeds mainly on BadNets and leaves WaNet, Blended, and SIG at 0.683, 0.888, and 0.941 ASR on CIFAR-10 ResNet-18. This failure is not explained by spectral compactness, spatial locality, or subspace misalignment. It is predicted by a logit-triplet gap involving the target margin, target-logit drop, and non-target logit rise. We then introduce InstantForget, a clean-calibrated gated reset that flags anomalous features with a Mahalanobis score and moves only flagged features toward a neutral non-target representation. With one fixed operating point selected on held-out triggered validation, InstantForget reduces average ASR to 0.071 across four non-adaptive CIFAR-10 triggers without triggered samples or parameter updates at deployment. It also reaches 0.981 detection AUROC and transfers to six of eight tested backbones. Reported failures under WaNet, ModelNet10 point blend, two backbone geometries, and adaptive feature-compactness attacks define the method's scope.

14.
arXiv (quant-ph) 2026-06-24

Quantum algorithm for Valiant-Vazirani reduction

arXiv:2606.18428v2 Announce Type: replace Abstract: There is growing interest in extensions of the standard model of gate-based quantum computation to include auxiliary degrees of freedom evolving according to a nonlinear Schrödinger equation. By reducing the Boolean satisfiability problem SAT to quantum state discrimination, Abrams and Lloyd argued that the right type of nonlinearity can be used to solve NP and #P problems in polynomial time, at least in an idealized noise-free limit. For practical implementation, however, we are restricted to simulated and emergent nonlinearities, such as that appearing in mean field models for ultracold atoms and similar ensembles. A prominent example is the torsion model, which arises in two-component Bose-Einstein condensates and spin models with all-to-all Ising interaction. But torsion-based state discrimination appears to fall short of solving SAT. Here we close this gap by constructing the filtered oracle of the Valiant-Vazirani theorem, providing a randomized polynomial-time reduction from SAT to UNIQUE SAT, a promise problem where there is at most 1 satisfying assignment. In the noise-free limit, the UNIQUE SAT problem can be solved in polynomial time using torsion nonlinearity. Quantum Valiant-Vazirani reduction is no faster than the efficient classical version, but a fault-tolerant implementation coupled to a nonlinear quantum coprocessor simulating torsion would enable polynomial time solution to NP (but not #P) problems.

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

Fulde-Ferrell superfluids in an asymmetric three-component Fermi Gas

arXiv:2602.24006v2 Announce Type: replace-cross Abstract: An asymmetric three-component Fermi gas, featuring Raman-induced spin-orbit coupling between the first and second components and contact interaction only between the first and third components, introduces both spin-orbit coupling and population imbalance-two mechanisms known to stabilize the Fulde-Ferrell superfluids.We systematically study Fulde-Ferrell superfluids in an asymmetric three-component Fermi gas { in two dimensions and at zero temperature} by finding the global minima of the thermodynamic potential. We reveal a new class of composite Fulde-Ferrell superfluids that emerges when strong spin-orbit coupling generates a double-well structure in momentum space within the lower spin-orbit-coupled band. The key features of these composite superfluids are identified.

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

Frequency-Aware Flow Matching for Continuous and Consistent Robotic Action Generation

arXiv:2606.20135v1 Announce Type: cross Abstract: Flow matching has emerged as a standard paradigm for robotic manipulation owing to its strong expressive power for modelling complex, multimodal action distributions, alongside similar approaches like diffusion policy. However, existing methods rely on discretized action chunks, making them brittle to demonstrations collected at heterogeneous control frequencies and prone to temporally inconsistent actions that degrade control stability. In this paper, we propose Frequency-Aware Flow Matching (FAFM), which outputs continuous, temporally consistent actions. To handle heterogeneous frequency input, we transform discrete action sequences into the frequency domain with the discrete cosine transform (DCT), perform flow matching over the resulting coefficients, and reconstruct continuous actions via cosine basis expansion. To generate temporally consistent actions, we regularize the first-order temporal derivative to promote smooth actions. This corresponds to a Sobolev-type constraint that suppresses high-frequency errors and discourages abrupt action changes. Our FAFM is simple, introduces no additional network parameters and applies to standalone flow-matching policies and vision-language action models. Across synthetic toy benchmark, obstacle avoidance, LapGym, and LIBERO, FAFM improves success rates, multimodal expressivity, motion smoothness, convergence speed, robustness to mechanical bias and mixed-frequency input. These gains are consistent when deployed on a real-world Franka robot. Code available at https://anonymous.4open.science/r/FAFM.

17.
arXiv (CS.AI) 2026-06-12

PhononBench:A Large-Scale Phonon-Based Benchmark for Dynamical Stability in Crystal Generation

arXiv:2512.21227v3 Announce Type: replace-cross Abstract: In recent years, generative artificial intelligence has made significant advances in the design of crystalline materials, giving rise to approaches based on graph neural networks, diffusion models, and large language models. Existing evaluations commonly follow the stability-uniqueness-novelty (S.U.N.) framework, where stability is primarily assessed using thermodynamic criteria, which do not fully capture the dynamical stability essential for a material's practical existence. Dynamical stability is a key determinant of whether a material can be synthesized and persist, with phonon spectrum calculations serving as the standard for its evaluation. However, the high computational cost of such calculations has prevented large-scale assessment of dynamical stability in generated crystals. In this work, we introduce PhononBench, the first large-scale benchmark for dynamical stability in AI-generated crystals. Leveraging the recently developed MatterSim interatomic potential, which achieves density-functional-theory (DFT)-level accuracy in phonon predictions across more than 10,000 materials, PhononBench enables efficient phonon calculations and dynamical-stability analysis for 133,838 crystal structures generated by 7 leading crystal generation models. PhononBench reveals a widespread limitation of current generative models: unless otherwise specified, all reported dynamical-stability metrics are evaluated at a phonon-frequency threshold of -0.1 THz, with the average dynamical-stability rate across all generated structures being only 32.15%, and the top-performing model, MatterGen, reaching just 45.05%.In addition, we identify 32,995 crystal structures that are phonon-stable across the entire Brillouin zone under a strict threshold of -0.001 THz. In addition, a web-based service is accessible at http://phononbench.cn/, enabling minute-level ultra-fast phonon predictions.

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

Efficient Neural Network Model Selection for Few-Class Application Datasets

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

19.
medRxiv (Medicine) 2026-06-10

Human genetic evidence links serine biosynthesis to diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN) is a common and disabling condition for which no disease-modifying therapies are available. Glycemic and metabolic drivers do not fully explain why only a subset of individuals with diabetes develop DPN, and genetic contributors remain poorly defined. We aimed to perform a multi-population genome-wide association study (GWAS) of DPN to highlight potential new etiological pathways and therapeutic targets. Methods We performed a multi-population GWAS of neuropathy in people with and without diabetes using the VA Million Veteran Program and UK Biobank, followed by replication in the All of Us Research Program (AoU), and gene-based and gene-set analyses to identify implicated pathways. Causal relationships between circulating serine levels and DPN were further tested using two sample Mendelian randomization. To further evaluate pathogenic potential, we analyzed rare, high impact variants in GWAS implicated genes among individuals with unresolved inherited neuropathies using the GENESIS platform. Findings Among individuals with type 2 diabetes, we identified seven genome wide significant loci (p

20.
arXiv (CS.CL) 2026-06-12

Evaluating Pluralism in LLMs through Latent Perspectives

The growing need to represent diverse perspectives has increased interest in pluralistic LLM generation. Although difficult to operationalize, identifying perspectives expressed in text would provide clear guidance on pluralistic alignment and more clearly articulate the pluralistic gap in LLM generation. While models have been shown to reduce the diversity of training data and generate homogeneously, this has been demonstrated primarily on multiple-choice questionnaires or using high-level characteristics of free-form text. In this paper, we introduce and implement a domain-agnostic multi-layered framework for unsupervised extraction of perspectives suitable for identifying the pluralistic gap in LLM-generated text. We evaluate our framework on book reviews, a highly opinionated dataset representing diverse perspectives, and compare various prompts and models. Our results show that while some models and prompting techniques come close to covering a broad spectrum of perspectives, rarer perspectives remain disproportionately underrepresented, resulting in distributions that diverge from human text.

21.
arXiv (CS.CL) 2026-06-24

RASC+: Retrieval-Constrained LLM Adjudication for Clinical Value Set Authoring

Clinical value sets define the standardized terminology codes used in quality measurement, phenotyping, cohort construction, and clinical decision support. The recently introduced Retrieval-Augmented Set Completion (RASC) benchmark showed that direct zero-shot large language model (LLM) generation is poorly suited to this task: clinical code systems are large, version-controlled, and not reliably memorized by language models. We study a stage-wise alternative in which candidate-pool construction is optimized for recall and a constrained LLM adjudicator is optimized for candidate selection. On the full 3,744-value-set RASC test split, Qwen3-based retrieval with vocabulary-aware expansion and code-display rescue retrieval increases candidate-pool recall from the original RASC retrieval baseline of 0.553 to 0.730; on the held-out-publisher stratum, pool recall is 0.655. The higher-recall pool alone is not sufficient: applying the original SAPBert cross-encoder to this expanded pool gives full-test macro F1 of 0.287 and held-out-publisher macro F1 of 0.233. Replacing the stage-2 selector with blinded GPT-5 adjudication over the same pool increases full-test macro F1 to 0.549 and held-out-publisher macro F1 to 0.533. These results show that retrieval-constrained LLM adjudication can substantially improve value set completion while preserving the safety constraint that all returned codes must come from an auditable candidate pool.

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

What sentiment analysis can't see: Measuring whether customers were helped, and what went wrong, across 70,000 support conversations

Most companies read their customer support data at scale using sentiment analysis, which measures how customers sound rather than whether they were satisfied with the result. We tested a richer alternative on 70,450 support conversations from a leading online fundraising platform: alongside tone, we used GPT-5.4 to estimate each customer's satisfaction and to flag whether they reported a concrete problem, then validated all three readings against the 1-to-5 ratings customers left on the conversations they rated. The satisfaction estimate tracked those ratings far better than sentiment did, correlating at 0.47 against 0.36 and flagging unhappy customers with far fewer false alarms. The structured read also sees what sentiment cannot: tone and satisfaction disagree in 44% of conversations, a single "Neutral" label hides everything from quietly satisfied customers to ones who quietly gave up, and the largest group of all is "tolerated friction," customers who are satisfied but still reporting a fixable problem, a standing issue that no sentiment-based dashboard can surface. The broader finding is that LLM-based annotation can capture far more than the tonality of a customer's language, offering strong potential for new business metrics grounded instead in the customer's state (whether they were satisfied) and the cause of their problem extracted directly from the raw textual data of interactions and feedback.

23.
medRxiv (Medicine) 2026-06-23

Differential Recovery Trajectories of Emergency Otolaryngologic Conditions across the COVID-19 Pandemic: A Six-year Longitudinal Study from an Urban Emergency Center

作者:

Objective: The COVID-19 pandemic markedly altered social activity patterns, healthcare utilization, and the epidemiology of infectious diseases. However, its long-term impact on emergency otolaryngologic conditions remains incompletely understood. This study investigated long-term trends in emergency otolaryngologic conditions before, during, and after the COVID-19 pandemic using comprehensive data from a large urban emergency clinic in Osaka, Japan. Methods: All new otolaryngologic outpatients who visited the Chuo Emergency Medical Clinic (CEMC) in Osaka City between 2019 and 2024were retrospectively analyzed. Annual trends in absolute numbers and relative proportions of emergency otolaryngologic conditions were examined by anatomical region and disease category, using 2019 as the pre-pandemic baseline. Results: A total of 99,324 new otolaryngologic outpatients were analyzed. Overall emergency visits declined sharply to approximately half of baseline in 2020, followed by a gradual but incomplete recovery toward pre-pandemic levels by 2024. Most anatomical categories declined to 45-61% of baseline in 2020 and exhibited gradual yet incomplete recovery through 2023; in stark contrast, laryngeal conditions diverged sharply, surging beyond pre-pandemic levels after 2022. Acute infectious otorhinolaryngologic diseases fell to 23-50% of baseline in 2020 and showed variable recovery (69-103%) by 2024. Notably, laryngitis exceeded the baseline, reaching 132% in 2023, whereas epiglottic edema exhibited only a transient increase approaching the baseline in 2021. Non-infectious emergency conditions generally showed only a marginal decrease in 2020 and remained relatively stable throughout the study period, except for sudden sensorineural hearing loss (SSNHL), which dropped sharply to 39% of the baseline in 2020 and remained persistently reduced through 2024. Traumatic emergencies declined variably to 53-81% of the baseline in 2020, followed by an incomplete recovery, reaching only 55-69% by 2024. Conclusion: Emergency otolaryngologic conditions demonstrated heterogeneous recovery trajectories following the COVID-19 pandemic. While most infectious and traumatic conditions gradually but incompletely normalized, laryngeal conditions showed a distinct post-pandemic surge, and SSNHL remained persistently suppressed. These findings reveal heterogeneous, condition-specific recovery trajectories that reflect both genuine shifts in community pathogen burden, true traumatic incidence, and persistent alterations in healthcare-seeking behaviors, insights essential for resource allocation during future public health emergencies.

24.
medRxiv (Medicine) 2026-06-22

Anterior-superior hypothalamic enlargement as specific marker in episodic migraine: converging evidence from an independent discovery-replication design

Background: Growing evidence implicates the hypothalamus as a key structure in migraine pathophysiology; however, our understanding of its precise role and of the specific nuclei involved remains limited. We combined MRI data from our laboratory with publicly available MRI datasets from OpenNeuro to examine hypothalamic subunit volumes in episodic migraine and assess the specificity of these alterations relative to chronic pain conditions. Methods: Structural MRI combined with an automated atlas-based segmentation algorithm and a discovery-replication design was employed to investigate cross-sectional volumetric differences across 5 bilateral hypothalamic subunits in two independent migraine cohorts: DS1-MIG (DS1-MIG-base, n = 111 patients, n = 35 controls) and DS2-MIG (n = 27 patients, n = 31 controls). The adjusted volumes were compared between groups using MANOVA as an omnibus test, followed by Welch t-tests to test univariate follow-up. Longitudinal volumetric changes were additionally assessed in DS1-MIG participants with available follow-up scans using linear mixed models. To assess the specificity of findings to migraine, the same pipeline was applied to two chronic pain datasets, one including patients with fibromyalgia (DS-FM, n = 33 patients, n = 33 controls) and the other including patients with trigeminal neuralgia (n = 119 patients, n = 55 controls). Results: MANOVA revealed significant multivariate group differences in the discovery and replication migraine cohorts (DS1-MIG-base: = .006; DS2-MIG: = .008). Follow-up univariate analyses identified a consistent enlargement of the left anterior-superior subunit across both cohorts (FDR = .023 in DS1-MIG-base and FDR = .046 in DS2-MIG), representing the only cross-cohort replication finding. Beyond this shared signature, DS2-MIG exhibited additional significant enlargements of the right anterior-inferior and right tubular-inferior subunits. Longitudinal analyses in DS1-MIG showed that hypothalamic subunit volumes remained broadly stable over time within both migraine patients and control participants. No significant volumetric alterations were detected in the fibromyalgia or trigeminal neuralgia cohorts, either in multivariate or univariate analyses, underscoring migraine-specific findings. Conclusions: These findings provide evidence for subunit-specific hypothalamic structural alterations in migraine localized in the left anterior hypothalamic subunit. The stability of these differences over time and their absence in other chronic pain conditions suggest a migraine-specific structural organisation of hypothalamic circuitry.

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

Automated ultrasound doppler angle estimation using deep learning

arXiv:2508.04243v2 Announce Type: replace-cross Abstract: Angle estimation is an important step in the Doppler ultrasound clinical workflow to measure blood velocity. It is widely recognized that incorrect angle estimation is a leading cause of error in Doppler-based blood velocity measurements. In this paper, we propose a deep learning-based approach for automated Doppler angle estimation. The approach was developed using 2100 human carotid ultrasound images including image augmentation. Five pre-trained models were used to extract images features, and these features were passed to a custom shallow network for Doppler angle estimation. Independently, measurements were obtained by a human observer reviewing the images for comparison. The mean absolute error (MAE) between the automated and manual angle estimates ranged from 3.9{\deg} to 9.4{\deg} for the models evaluated. Furthermore, the MAE for the best performing model was less than the acceptable clinical Doppler angle error threshold thus avoiding misclassification of normal velocity values as a stenosis. The results demonstrate potential for applying a deep-learning based technique for automated ultrasound Doppler angle estimation. Such a technique could potentially be implemented within the imaging software on commercial ultrasound scanners.