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01.
arXiv (CS.CL) 2026-06-18

SAGE: Stochastic Prompt Optimization via Agent-Guided Exploration

Context engineering has emerged as a primary lever for improving AI systems without parameter updates. Recent work showing that textual gradients do not function as real gradients motivates treating automatic prompt optimization (APO) as black-box search. We introduce SPO (Stochastic Prompt Optimization), a framework for stochastic search over prompt space, and compare three strategies of increasing sophistication: error-informed random search, a genetic algorithm with evolutionary operators, and SAGE (SPO via Agent-Guided Exploration), a multi-agent pipeline with diagnostic code execution. Across three benchmarks, no single strategy dominates; effectiveness depends on the interaction of landscape structure with error type. We further deploy SAGE on a mental-health chatbot under a continuous optimization paradigm, where it compounds eight cycles of individually-noisy A/B tests into a statistically robust gain in next-day retention. We argue that coupling qualitative diagnosis with quantitative validation is what makes agentic optimization effective for open-ended task-oriented dialogue.

02.
arXiv (CS.CL) 2026-06-11

Calibration Drift Under Reasoning: How Chain-of-Thought Budgets Induce Overconfidence in Large Language Models

The ability of large language models (LLMs) to express calibrated uncertainty is important for safe deployment. Chain-of-thought (CoT) reasoning is widely used to improve accuracy and reliability, but its effect on calibration is not fully understood. We show that this picture is incomplete: in some settings, increasing the reasoning budget beyond a task-specific threshold can cause models to become systematically overconfident, assigning high confidence to incorrect answers. We call this phenomenon Calibration Drift Under Reasoning (CDUR) and study it both theoretically and empirically. We define reasoning budget B and analyze conditions under which Expected Calibration Error ECE(B) follows a non-monotonic pattern: it first decreases as reasoning corrects errors, then increases as longer reasoning produces internally consistent but incorrect explanations. We propose a Hypothesis Lock-In model based on autoregressive generation to explain this behavior. We evaluate Llama-3.1-8B and Llama-3.3-70B on 47 reasoning-trap questions across four reasoning budgets and three seeds (1,368 API calls; 574 valid responses). The 8B model shows non-monotonic calibration behavior, while results for the 70B model are limited to baseline evaluation and are inconclusive for budget-dependent effects. We introduce CABStop, a calibration-aware stopping rule that halts reasoning when confidence diverges from an auxiliary accuracy estimate. These results suggest that increasing reasoning depth does not always improve reliability and should be monitored carefully.

03.
arXiv (CS.CL) 2026-06-16

Mapping Geopolitical Bias in 11 Large Language Models: A Bilingual, Dual-Framing Analysis of U.S.-China Tensions

Large language models are how hundreds of millions of people now encounter contested political questions, raising a subtle measurement problem: a model that simply agrees with whatever it is told can masquerade as biased, contaminating any claim that models hold political opinions. We address this by importing balanced keying from survey psychometrics, posing each proposition and its swapped reverse and signing the response so acquiescence cancels and genuine conviction accumulates. The result is a reproducible, quantitative instrument that maps geopolitical stance across 11 models and 2 languages (19,712 responses). Developer origin, query language and issue domain emerge as three near-equal, additive factors; every model, including those built in the United States, leans more Pro-China in Mandarin; and two models with identical agreement bias are told apart, one neutral, one biased. We release it as an open, interactive tool that extends to any contested-opinion domain.

04.
arXiv (CS.CL) 2026-06-17

Toward Accessible Psychotherapy Training Using AI-Driven Interactive Patient Avatars

Training psychotherapists in evidence-based interventions such as Acceptance and Commitment Therapy (ACT) requires repeated practice with meaningful feedback, yet opportunities for safe, standardized training are limited by ethical, logistical, and resource constraints. We introduce a system designed to support ACT-oriented psychotherapy training through spoken dialogue with an embodied virtual patient. The system uses large language models to simulate patient behavior conditioned on profiles derived from real therapy sessions and configurable clinical scenarios, while a separate automated evaluator provides turn-by-turn feedback on therapist responses based on established ACT fidelity criteria. Rather than aiming to replace supervision, the system is intended to support deliberate practice by enabling experimentation, reflection, and immediate feedback in low-risk settings. Expert evaluation with practicing psychologists confirmed high realism in patient behavior and demonstrated that immediate turn-by-turn ACT feedback increased therapists' awareness of intervention choices and enabled effective experimentation with alternative responses. Quantitative evaluation across 49 therapy transcripts identified GPT-4o-mini as the optimal feedback model, achieving the lowest mean absolute error (MAE = 6.12) in replicating human supervisor ACT fidelity ratings with statistically significant agreement. This work demonstrates the potential of fidelity-aware simulated patients as a scalable complement to psychotherapy training.

05.
arXiv (math.PR) 2026-06-12

The Lov\'{a}sz Local Lemma: Foundations and Applications

作者:

arXiv:2603.07245v5 Announce Type: replace-cross Abstract: The Lov\'{a}sz Local Lemma (LLL) is a central tool in probabilistic combinatorics, providing a sufficient condition under which a finite collection of undesirable events with limited dependencies can be simultaneously avoided with positive probability. This paper offers a self-contained expository treatment of the lemma and its strengthened versions, emphasizing mathematical foundations, conceptual clarity, and applications. We begin with a pedagogically motivated proof of the LLL based entirely on unconditional probability inequalities. Particular attention is given to the symmetric form of the lemma and several subsequent strengthenings. The paper also discusses a variety of classical applications of both the symmetric and asymmetric forms of the LLL in combinatorics and graph theory, including bounds for the edge-disjoint paths problem, satisfiability of Boolean formulas in conjunctive normal form, lower bounds on diagonal and off-diagonal Ramsey numbers, hypergraph coloring results, structural properties of directed graphs, and acyclic graph colorings. Additional observations and refinements are provided throughout. We also introduce the algorithmic framework of Moser and Tardos, highlighting its constructive counterpart to the LLL, together with an introduction to the entropy-compression principle. The lopsided LLL, a refinement of the LLL, is presented along with an application to the Latin transversal problem. We further discuss the cluster-expansion lemma and its relation to the LLL, and present an alternative treatment of the Latin transversal problem from the cluster-expansion perspective that yields an improved result. The paper concludes with a high-level overview of the iterated LLL, also known as the semi-random method.

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

Extensible Fluxonium Architecture Using Tunable Couplers with Low Shunt Capacitance

arXiv:2606.01647v2 Announce Type: replace Abstract: Fluxonium qubits have demonstrated high-fidelity operations and long coherence times in small-scale systems, highlighting their promise for quantum computing. However, large-scale integration into a high-performance two-dimensional (2D) qubit array remains the central challenge for practical applications. In this work, we introduce an extensible architecture for scaling up fluxonium qubits in 2D grids. To address the key challenges, namely achieving controllable strong interaction and high connectivity for qubits featuring small shunting capacitors (footprints), we propose using low-shunt-capacitance couplers to enable tunable interactions between fluxonium qubits. When embedded into 2D square lattices, large couplings can be achieved even with relatively small coupling capacitances, thus enabling multiple connections with sufficient capacitance budget. We further propose coupler realizations based on generalized flux qubit circuits, specifically the quarton and the fluxonium, and demonstrate that both enable fast, high-fidelity gates with low spectator errors, while supporting multiple connections on 2D grids.

07.
arXiv (CS.AI) 2026-06-16

Proximal Policy Optimization for Amortized Discrete Sampling

arXiv:2606.15793v1 Announce Type: cross Abstract: This paper explores policy gradient algorithms for training stochastic policies to sample from structured discrete probability distributions under the Generative Flow Network (GFlowNet) framework. Building on extensive theoretical connections between GFlowNets and entropy-regularized reinforcement learning, we derive equivalents of standard policy gradient algorithms for training GFlowNets, as well as experimentally explore their various methodological aspects, including baseline training and advantage estimation. Most importantly, our work is the first to derive and successfully apply proximal policy optimization to GFlowNets, showing its improved convergence speed and data efficiency compared to standard GFlowNet training objectives on benchmarks ranging from synthetic energies to molecular graph generation.

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

ClawEnvKit: Automatic Environment Generation for Claw-Like Agents

Constructing environments for training and evaluating claw-like agents remains a manual, human-intensive process that does not scale. We argue that what is needed is not just a dataset, but an automated pipeline capable of generating diverse, verified environments on demand. To this end, we introduce ClawEnvKit, an autonomous generation pipeline that instantiates this formalism from natural language descriptions. The pipeline comprises three modules: (1) a parser that extracts structured generation parameters from natural language input; (2) a generator that produces the task specification, tool interface, and scoring configuration; and (3) a validator that enforces feasibility, diversity, structural validity, and internal consistency across the generated environments. Using ClawEnvKit, we construct Auto-ClawEval, the first large-scale benchmark for claw-like agents, comprising 1,040 environments across 24 categories. Empirically, Auto-ClawEval matches or exceeds human-curated environments on coherence and clarity at 13,800x lower cost. Evaluated across 4 model families and 8 agent harness frameworks, we find that harness engineering boosts performance by up to 15.7 percentage points over a bare ReAct baseline, completion remains the primary axis of variation with no model saturating the benchmark, and automated generation enables evaluation at a scale previously infeasible. Beyond static benchmarking, ClawEnvKit enables live evaluation: users describe a desired capability in natural language and obtain a verified environment on demand, turning evaluation into a continuous, user-driven process. The same mechanism serves as an on-demand training environment generator, producing task distributions that adapt to an agent's current weaknesses rather than being bounded by existing user logs.

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

SpatialAvatar-0: High-Quality 4D Head Avatar with Multi-Stage Reconstruction

High-quality 4D head avatars from one or a few source portraits are central to telepresence, AR/VR, and digital-human interaction. 3D Gaussian Splatting (3DGS) has emerged as the dominant representation, with two complementary regimes (generalizable feed-forward predictors and per-subject refiners) maturing in parallel. However, existing feed-forward predictors are trained on a single dataset family with a hard-coded source count, inheriting the corresponding domain bias. Per-subject refiners require 300K–600K iterations and rely on adaptive densification that destroys upstream Gaussian layouts, preventing the two regimes from sharing a representation end-to-end. To bridge both regimes we propose SpatialAvatar-0 on a shared FLAME-mesh-bound Gaussian representation: a feed-forward generator with a parameter-free K-source mean-pool and a monocular-temporal to multi-view-spatial two-phase schedule that anchors against identity-prior collapse onto the smaller multi-view set. We further introduce a 10K-iter layout-preserving per-subject refinement loop that freezes the FLAME-binding and Gaussian count and replaces densification with a three-component anti-spike regularization. On VFHQ/HDTF cross-domain zero-shot we surpass the in-domain leader GAGAvatar by +1.5 dB PSNR despite never training on either test domain, and on the SplattingAvatar monocular benchmark we lead every reported metric, surpassing the 300K-iter GeoAvatar by +1.3 dB PSNR at up to 60x shorter per-subject schedule than common SOTA baselines. Website: https://spatialwalk.github.io/SpatialAvatar-0.

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

Stochastic Linear Contextual Bandits with Bounded Noise: A Set-Membership Approach

arXiv:2606.20022v1 Announce Type: cross Abstract: This paper considers stochastic linear contextual bandits (SLCB) with bounded reward noise. Existing works typically assume sub-Gaussian reward noise and bounded expected rewards, under which the optimal regret bound scales as $\tilde{O}(\sqrt{T})$ in terms of horizon $T$. However, in many applications, realized/observed rewards are also naturally bounded, implying bounded reward noise. Bounded noise is more informative than the sub-Gaussian condition but has not been leveraged explicitly in the SLCB literature. In this paper, we propose a novel algorithm SME-OFU by utilizing an uncertainty quantification method called set-membership estimation (SME) and applying the principle of optimism in the face of uncertainty (OFU). Our algorithm enjoys an improved regret bound $O(\log T)$. Notice that this does not contradict the existing optimal bound $\tilde{O}(\sqrt{T})$ for sub-Gaussian noise because bounded noise is a stronger condition. Finally, simulations show empirical improvements of SME-OFU over a benchmark algorithm designed for sub-Gaussian noise when the reward noise is bounded.

11.
PLOS Computational Biology 2026-06-11

Catecholamine precursor modulation of human exploration: Evidence from a large gender-balanced sample

by Angela Mariele Brands, Kilian Knauth, David Mathar, Tim Roedder, Kerstin Lisner, Jan Peters The catecholamine precursor Tyrosine has been linked to improved cognitive performance, but investigations into decision-making and reinforcement learning processes known to be under catecholamine control are sparse. We examined the impact of a single dose of Tyrosine (2g) on reinforcement learning and exploration in a large (n = 63) gender-balanced sample in a within-subjects preregistered study. Reinforcement learning performance was significantly improved under Tyrosine. Based on previous work, we preregistered the hypotheses that Tyrosine would reduce directed exploration, response times, and physiological arousal. However, neither response times nor physiological arousal revealed the predicted reductions. Computational modelling using an established pre-registered reinforcement learning model revealed that the performance improvement under Tyrosine was due to an increase value-driven exploitation, without affecting directed exploration. Non-preregistered modelling analyses then revealed that accounting for higher-order perseveration substantially improved model fit, and substantiated the observation of increased value-driven exploitation under Tyrosine. Furthermore, it revealed reliable reductions in directed exploration and value-independent perseveration under Tyrosine. Tyrosine thus improved reinforcement learning performance by stabilizing choice patterns in the service of optimizing reward accumulation, modulating several computational mechanisms thought to be under catecholamine control.

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

ShapeBench: A Scalable Benchmark and Diagnostic Suite for Standardized Evaluation in Aerodynamic Shape Optimization

arXiv:2605.20763v2 Announce Type: replace Abstract: Rapid progress in aerodynamic shape optimization (ASO) has outpaced currently-available standardized evaluation frameworks. Fair comparison requires a unified benchmark spanning diverse shape classes, objective formulations, and matched-budget state-of-the-art baselines. We introduce ShapeBench, an open-source ASO benchmark with a unified API spanning 103 tasks across eight shape categories and multiple optimization regimes. Each ShapeBench task includes a validated surrogate for fast search; when feasible, a high-fidelity Computational Fluid Dynamics (CFD) pipeline for final verification is available, enabling systematic fidelity-gap analysis. ShapeBench provides a reproducible protocol with well-configured baselines to compare fairly using a consistent budget metric, allowing for comparison among both classical and LLM-driven methods, including general-purpose optimizers and a new domain-specialized evolutionary LLM baseline, ShapeEvolve. Results on ShapeBench demonstrate substantial variance in optimizer rankings across shape categories and problem formulations, with mean pairwise Spearman $\rho = 0.013$, so single-task conclusions do not reliably generalize across problem classes. The benchmark is also far from saturation; classical methods are rarely applicable across all shape categories and tasks, further highlighting the need for more general-purpose approaches.

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

Where's the Plan? Locating Latent Planning in Language Models with Lightweight Mechanistic Interventions

arXiv:2605.07984v2 Announce Type: replace-cross Abstract: We study planning site formation in language models – where internal representations of structurally-constrained future tokens form during the forward pass, and whether they causally drive generation. Using rhyming-couplet completion as a clean test of forward-looking constraint, we apply two lightweight methods (linear probing and activation patching) across Qwen3, Gemma-3, and Llama-3 at more than ten scales. Probing shows that future-rhyme information is linearly decodable at the line boundary, with signal that strengthens with scale in all three families. Activation patching reveals that only Gemma-3-27B causally relies on this encoding, exhibiting a handoff in which the causal driver migrates from the rhyme word to the line boundary around layer 30. Every other model we test conditions on the rhyme word throughout generation, with near-zero causal effect at the line boundary despite strong probe signal. We localize the Gemma-3-27B handoff to five attention heads through two-stage path patching that recover ~90% of the rhyme-routing capacity at the newline.

14.
arXiv (CS.CV) 2026-06-11

Benchmarking Cross-Domain Audio-Visual Deception Detection

Automated deception detection is crucial for assisting humans in accurately assessing truthfulness and identifying deceptive behavior. Conventional contact-based techniques, like polygraph devices, rely on physiological signals to determine the authenticity of an individual's statements. Nevertheless, recent developments in automated deception detection have demonstrated that multimodal features derived from both audio and video modalities may outperform human observers on publicly available datasets. Despite these positive findings, the generalizability of existing audio-visual deception detection approaches across different scenarios remains largely unexplored. To close this gap, we present the first cross-domain audio-visual deception detection benchmark, that enables us to assess how well these methods generalize for use in real-world scenarios. We used widely adopted audio and visual features and different architectures for benchmarking, comparing single-to-single and multi-to-single domain generalization performance. To further exploit the impacts using data from multiple source domains for training, we investigate three types of domain sampling strategies, including domain-simultaneous, domain-alternating, and domain-by-domain for multi-to-single domain generalization evaluation. We also propose an algorithm to enhance the generalization performance by maximizing the gradient inner products between modality encoders, named ``MM-IDGM". Furthermore, we proposed the Attention-Mixer fusion method to improve performance, and we believe that this new cross-domain benchmark will facilitate future research in audio-visual deception detection.

16.
arXiv (CS.CV) 2026-06-17

FATE: Pillar Encoding and Frequency-Aware Training for Event-Based Object Detection

Event cameras are bio-inspired sensors that asynchronously capture logarithmic intensity changes, offering inherent advantages in high-speed and high-dynamic-range scenarios. However, the sparse and asynchronous nature of event streams poses a fundamental challenge for modern deep learning architectures. To enable compatibility with standard models, most existing approaches partition the accumulation window into fixed temporal sub-bins. While effective for spatial processing, this internal discretization discards fine-grained temporal structure and constrains inference to the low temporal frequencies imposed by training supervision. To address this limitation, we propose FATE, a unified framework built upon a novel Pillar Encoding (PE). While operating over discrete macro-accumulation windows dictated by the target frequency, PE avoids internal temporal sub-binning. It organizes events into spatial pillars and approximates their intra-window evolution via projection onto a continuous-time orthogonal polynomial basis. This formulation yields an L2-optimal representation that retains rich temporal dynamics in a dense pseudo-image, mitigating information loss under sparse event conditions. To fully leverage this representation, we introduce Frequency-Aware Training (FAT), a soft mean-teacher curriculum that generates temporally dense pseudo-labels, effectively bridging the mismatch between low-frequency supervision and high-frequency inference. Extensive experiments demonstrate that FATE generalizes across architectural paradigms and consistently outperforms strong baselines. It enables robust object detection at high temporal resolutions up to 200 Hz, while incurring minimal overhead in parameter count and inference latency

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

EquiDexFlow: Contact-Grounded SE(3)-Equivariant Dexterous Grasp Generative Flows

Most learned dexterous grasp generators relegate contact forces to a downstream verification step, so a kinematically-plausible pose can still violate the conditions for a stable physical grasp. We address this with EquiDexFlow, an SE(3)-equivariant flow-matching model that jointly predicts wrist pose, joint angles, fingertip contacts, surface normals, and contact forces from an object point cloud. Our architecture projects contacts onto the object surface and forces into the Coulomb friction cone by construction, so placement and friction compliance hold without loss penalties. We prove end-to-end SE(3) equivariance and verify it empirically over 200 rotations, with wrist residuals below $0.04^\circ$ and exactly zero joint deviation. Trained on 8,100 force-closure grasps across 81 objects for the 16-DoF Allegro Hand, our model achieves zero friction violations, the best composite score, and the lowest wrench residual among all ablation variants. We retarget decoded fingertip contacts to a 16-DoF LEAP Hand via per-finger inverse kinematics, and our hardware-feasible refinement places every joint at least 5% inside its actuator envelope while preserving wrench balance. On the physical robot, retargeted EquiDexFlow-decoded grasps complete open-loop pick-and-hold trials on all six test objects, with every asymmetric object succeeding at both the canonical pose and a $120^\circ$ co-rotation. Videos, code, and checkpoints are available at https://equidexflow.github.io.

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

Multimodal Brain Tumour Classification Using Feature Fusion

Clinicians diagnose brain tumors by synthesizing patient symptoms, medical history, and quantitative imaging data from modalities such as MRI and CT scans into a unified clinical judgement. However, most deep learning models rely on MRI/CT images alone, failing to replicate the clinicians multimodal reasoning. We explore a two-branch multimodal network combining raw MRI scans with 91 extracted radiomic features (intensity, texture, shape, and boundary descriptors) to classify brain tumors into glioma, meningioma, pituitary, and no-tumor. A pre-trained CNN backbone encodes the image stream, whereas a dedicated MLP encodes the radiomic stream. Both streams are fused via concatenation, gated, or bidirectional cross-modal attention strategies. Across nine experimental runs on a balanced 7,200 image dataset, all multimodal configurations outperform unimodal baselines with gated fusion achieving the best accuracy of 96.13%.

19.
arXiv (math.PR) 2026-06-18

Phase transitions for contact processes on sparse random graphs via metastability and local limits

arXiv:2505.22471v2 Announce Type: replace Abstract: We propose a new perspective on the asymptotic regimes of fast and slow extinction in the contact process on locally converging sequences of sparse finite graphs. We characterise the phase boundary by the existence of a metastable density, which makes the study of the phase transition particularly amenable to local-convergence techniques. We use this approach to derive general conditions for the coincidence of the critical threshold with the survival/extinction threshold in the local limit. We further argue that the correct time scale to separate fast extinction from slow extinction in sparse graphs is, in general, the exponential scale, by showing that fast extinction may occur on stretched exponential time scales in sparse scale-free spatial networks. Together with {the results of} Nam, Nguyen and Sly (Trans.\ Am.\ Math.\ Soc.\ 375, 2022), our methods can be applied to deduce that the fast/slow threshold in sparse configuration models coincides with the survival/extinction threshold on the limiting Galton-Watson tree.

20.
arXiv (math.PR) 2026-06-16

An Analytical Methodology for Quantifying Airspace Conflict Rate and Complexity

arXiv:2606.14897v1 Announce Type: cross Abstract: Air traffic growth, advanced air mobility, and increasingly autonomous operations are driving the need for scalable and adaptive airspace design methodologies. Central to this challenge is quantifying how traffic flow structure and demand, governed in part by airspace geometry, influence conflict generation and operational complexity. This paper presents an analytical framework for computing conflict rate and conflict probability in structured airspace using stochastic flow models. Traffic streams are modeled as renewal processes with prescribed inter-arrival time distributions, while interactions between flows are captured through geometry-dependent minimum spacing constraints at merges and crossings. Within this formulation, closed-form upper bounds on the expected conflict rate and conflict probability per aircraft are derived as functions of flow configuration and demand. These metrics are interpreted as complementary measures of airspace complexity, reflecting controller workload and per-aircraft operational risk. The methodology is applied to representative hexagonal cell geometries with varying routing structures and flow distributions. Results reveal non-monotonic tradeoffs between routing flexibility, capacity, and conflict generation, with intermediate flow configurations outperforming both highly constrained and highly distributed cases. The proposed framework provides a tractable tool for evaluating airspace design alternatives and complexity-informed traffic management strategies.

21.
arXiv (quant-ph) 2026-06-17

Stochastic signal sensing with finite energy and dead time at the fundamental quantum limit

arXiv:2606.18133v1 Announce Type: new Abstract: State preparation, measurement, and reset operations take finite time and use finite energy in realistic experiments, yet the impact of this on optimal quantum metrological protocols is not properly understood. We study the effect on sensing a stochastic signal, relevant for the detection of ultralight dark matter and other searches for fundamental physics. We prove that two-mode squeezed vacuum is the optimal probe state given a finite mean-energy constraint for a family of incoherent sensing problems, including noise sensing and quantum illumination. For estimating a gain independent of a loss, we show that entanglement is a required resource to achieve the fundamental quantum limit and observe a non-Gaussian to Gaussian transition in the optimal unentangled state as the dead time increases. We apply our results to bulk acoustic wave resonators.

22.
medRxiv (Medicine) 2026-06-16

Comparative Effectiveness and Safety of Prophylactic Vasopressors for Preventing Post-induction Hypotension in the Elderly: A Systematic Review and Network Meta-analysis

Background: Post-induction hypotension is a predictable haemodynamic hazard in older adults undergoing general anaesthesia. Prevention remains divided among volume optimisation, anaesthetic dose reduction, rescue treatment after hypotension occurs and proactive vasoactive support. Methods: We searched PubMed, Embase, Web of Science, CENTRAL, CNKI, Wanfang and VIP from inception to 30 March 2026. Eligible studies were randomised trials of prophylactic vasoactive drugs given before, during or immediately after induction in older adults. The primary outcome was post-induction hypotension. Secondary outcomes were post-induction mean arterial pressure (MAP), systolic arterial pressure (SBP), heart rate (HR) and reported haemodynamic adverse events. Random-effects network meta-analysis was used, and confidence in network estimates was assessed using CINeMA principles. Results: Thirty-one trials including 2,821 participants were included in the revised network. Compared with placebo/control, all active agents favoured lower post-induction hypotension. The most favourable point estimates were observed for phenylephrine (odds ratio [OR] 0.17, 95% confidence interval [CI] 0.01 to 2.16) and metaraminol (OR 0.19, 95% CI 0.02 to 1.53), although both were imprecise. More precise reductions were observed for methoxamine (OR 0.23, 95% CI 0.13 to 0.43), norepinephrine (OR 0.25, 95% CI 0.13 to 0.47) and ephedrine (OR 0.34, 95% CI 0.19 to 0.63). Phenylephrine ranked highest for MAP support, norepinephrine ranked highest for SBP support, and ephedrine ranked highest for HR preservation. Global inconsistency was detected for SBP but not for hypotension incidence, MAP or HR, supporting cautious profile-based interpretation. Conclusions: Prophylactic vasopressor choice during induction should be guided by haemodynamic phenotype rather than ranking alone. In the revised network, active prophylaxis consistently favoured lower hypotension, but sparse nodes produced uncertainty. Norepinephrine retained a comparatively balanced profile when vasodilatory post-induction hypotension is anticipated, phenylephrine and related alpha-agonists provided stronger pressure support when HR and cardiac-output reserve are preserved, and ephedrine was most relevant when chronotropic support is desired. Keywords: general anaesthesia; induction; hypotension; norepinephrine; phenylephrine; ephedrine; network meta-analysis; older adults.

23.
medRxiv (Medicine) 2026-06-18

Can Vision-Language Models See the Vital Signs? Benchmarking and Fine-Tuning for Intraoperative Monitor Reading

Background Vital-sign deterioration is a leading contributor to preventable perioperative death, yet manual monitor reading is intermittent, error-prone, and subject to alarm fatigue. Automating this perceptual step could enable continuous surveillance, but existing solutions depend on device-specific hardware integration or cloud-hosted vision-language models (VLMs), which raise privacy, cost, and connectivity barriers in resource-limited healthcare facilities. Methods We constructed a benchmark of 200 in-the-wild intraoperative monitor photographs (spanning multiple vendors, angles, and illumination conditions) annotated for eight vital-sign parameters: heart rate, SpO2, ETCO2, respiratory rate, systolic/diastolic/mean blood pressure, and temperature. We evaluated an optical character recognition (OCR)-based pipeline, nine instruction-tuned VLMs (four commercial, five open-weight ranging from [≤]4B to 31B parameters) under two prompting regimes, and a compact open model (Qwen3.5-9B) adapted via low-rank fine-tuning (LoRA, 0.46% of parameters updated). Results Under a domain-aware prompt, frontier VLMs reached 0.98-0.997 exact-match accuracy zero-shot, whereas the OCR pipeline and [≤]4B model scored approximately 0.20 lower, defining a 9B-class usable floor. LoRA fine-tuning Qwen3.5-9B on 80-120 images raised accuracy from 0.953 to 0.994 (statistically indistinguishable from the best commercial model) and reduced the critical-error rate fivefold (0.0313 [->] 0.0063). Ablations showed that performance saturated at 80 training images and rank-8 adapters. Conclusion Monitor reading is a solved perception problem for VLMs above the 9B scale. A lightweight fine-tuned open model achieves frontier accuracy while running entirely on local hardware, preserving data privacy, offline capability, and near-zero marginal cost. Residual errors stem from blood-pressure source ambiguity and are addressable with explicit disambiguation logic.

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

CentroidKV: Efficient Long-Context LLM Inference via KV Cache Clustering

Large language models (LLMs) with extended context windows have become increasingly prevalent for tackling complex tasks. However, the substantial Key-Value (KV) cache required for long-context LLMs poses significant deployment challenges. Existing approaches either discard potentially critical information needed for future generations or offer limited efficiency gains due to high computational overhead. In this paper, we introduce CentroidKV, a simple yet effective framework for online KV cache clustering. Our approach is based on the observation that key states exhibit high similarity along the sequence dimension. To enable efficient clustering, we divide the sequence into chunks and propose Chunked Soft Matching, which employs an alternating partition strategy within each chunk and identifies clusters based on similarity. CentroidKV then merges the KV cache within each cluster into a single centroid. Additionally, we provide a theoretical analysis of the computational complexity and the optimality of the intra-chunk partitioning strategy. Extensive experiments across various models and long-context benchmarks demonstrate that CentroidKV achieves up to 75% reduction in KV cache memory usage while maintaining comparable model performance. Moreover, with minimal computational overhead, CentroidKV accelerates the decoding stage of inference by up to $1.92\times$ and increases the serving throughput by up to $4\times$.

25.
arXiv (CS.AI) 2026-06-19

LLM Doesn't Know What It Doesn't Know: Detecting Epistemic Blind Spots via Cross-Model Attribution Divergence on Clinical Tabular Data

arXiv:2606.19509v1 Announce Type: new Abstract: Large language models (LLMs) are increasingly applied to structured clinical data, yet whether they can recognize the limits of their own knowledge on such tasks remains unexplored. We study this question through the lens of cross-model attribution divergence with the goal of reducing epistemic uncertainty for structured tasks, comparing Qwen 2.5 7B and XGBoost on a prediction task via attribution divergence analysis. We report four findings. First, LLM verbalized confidence is epistemically vacuous, it outputs a near-constant (0.856-0.937) regardless of whether accuracy is 49% or 75.3%, tracking prompt format rather than prediction quality. Second, the LLM exhibits an inverse difficulty effect: accuracy drops to 64.8% when XGBoost is 99% correct, but matches XGBoost (73.8% vs. 73.1%) when it is moderately uncertain. Third, few-shot examples and SHAP-derived feature evidence are orthogonal, super-additive interventions: they reduce the Attribution Disagreement Score (ADS) from 1.54 to 0.38 and improve accuracy from 49% to 75.3% without training. Fourth, a cross-model calibrator that determined LLM reliability using attribution divergence signals reduces expected calibration error from 0.254 to 0.080, replacing uninformative verbalized confidence with patient-specific reliability estimates, without accessing model internals or requiring repeated inference. We frame these findings as a cold start problem for LLMs on structured data and outline a path toward genuine epistemic self-awareness.