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01.
arXiv (CS.CV) 2026-06-24

TopoPult-SSL: Gland-Mask-Free Cross-Device Meibomian Gland Segmentation via Self-Distilled Weak Clinical Priors

Every new clinical imaging device creates a domain shift where dense gland masks are expensive yet cheap clinical signals – eyelid outlines, Pult grades, morphometric ratios – are routinely recorded. We present TopoPult-SSL, a two-stage framework for cross-device meibomian gland segmentation. Stage 1 adapts a source-trained model without target gland masks in the training loss, using four weak-prior anchors driven by target eyelid masks and clinical metadata only. Stage 2, when target gland masks are available, distils complementary Stage-1 teachers into a single compact student via supervised self-distillation. We develop and validate the technique on the public MGD-1k to CAMG research benchmark (1,000 to 100 images, different device), where the distilled model achieves Dice 0.716+/-0.006 (best 0.726), surpassing UA-MT (0.710) and the ensemble teacher (0.720) – with a single pass. The gland-mask-free Stage-1 variant reaches Precision 0.694 vs. 0.30-0.34 for SAM/MedSAM (p

02.
medRxiv (Medicine) 2026-06-10

Exploratory Assessment of Pulsed-Wave Doppler Representations of Lung Sounds Using Deep Learning: An In-Vitro Phantom Study

The increasing availability of portable ultrasound systems motivates exploration of novel approaches to respiratory signal assessment. In this in-vitro study, we investigate whether pulsed-wave (PW) Doppler ultrasound can capture structured spectral patterns from replayed lung sound recordings. Digitized respiratory sounds were replayed through a tissue-mimicking ultrasound phantom, generating 1,478 PW Doppler spectral images from recordings associated with healthy subjects and several externally labeled disease categories. Exploratory classification experiments using a ResNet-18 architecture demonstrated that these Doppler representations contain learnable differences under controlled conditions. These findings motivate further investigation into PW Doppler as a potential representation of respiratory acoustics.

03.
arXiv (CS.AI) 2026-06-24

Representation Interventions Enable Lifelong Knowledge Memory Control in LLMs

arXiv:2511.20892v4 Announce Type: replace Abstract: Large language models (LLMs) often produce incorrect or outdated content after being employed. Efficient and accurate knowledge updates without costly retraining are a major challenge. This problem is particularly challenging in lifelong settings, where complex, unstructured knowledge must coexist without interference. We introduce RILKE (Representation Intervention for Lifelong KnowledgE Control), a robust and scalable method that treats knowledge control as interventions within the model's representation space. Leveraging representation-space expressiveness, we identify two key properties enabling RILKE to achieve fine-grained control over complex, unstructured knowledge while maintaining general utility with frozen base weights. During training, RILKE learns paraphrase-robust and edit-localized modules that limit each update to a low-dimensional subspace to minimize cross-edit interference. At inference, a query-adaptive router selects the appropriate module to guide the model's generation. Across LLaMA and Qwen models, RILKE scales effectively to large-scale benchmarks, demonstrating high edit success and strong paraphrase generalization while preserving general utility with modest memory overhead. These results show RILKE is an effective and scalable solution for lifelong knowledge control in LLMs.

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

Towards Efficient Large Language Reasoning Models via Extreme-Ratio Chain-of-Thought Compression

arXiv:2602.08324v5 Announce Type: replace Abstract: Chain-of-Thought (CoT) reasoning successfully enhances the reasoning capabilities of Large Language Models (LLMs), yet it incurs substantial computational overhead for inference. Existing CoT compression methods often suffer from a critical loss of logical fidelity at high compression ratios, resulting in significant performance degradation. To achieve high-fidelity, fast reasoning, we propose a novel EXTreme-RAtio Chain-of-Thought Compression framework, termed Extra-CoT, which aggressively reduces the token budget while preserving answer accuracy. To generate reliable, high-fidelity supervision, we first train a dedicated semantically-preserved compressor on mathematical CoT data with fine-grained annotations. An LLM is then fine-tuned on these compressed pairs via a mixed-ratio supervised fine-tuning (SFT), teaching it to follow a spectrum of compression budgets and providing a stable initialization for reinforcement learning (RL). We further propose Constrained and Hierarchical Ratio Policy Optimization (CHRPO) to explicitly incentivize question-solving ability under lower budgets by a hierarchical reward. Experiments on three mathematical reasoning benchmarks show the superiority of Extra-CoT. For example, on MATH-500 using Qwen3-1.7B, Extra-CoT achieves over 73\% token reduction with an accuracy improvement of 0.6\%, significantly outperforming state-of-the-art (SOTA) methods. Our source codes have been released at https://github.com/Mwie1024/Extra-CoT.

05.
arXiv (CS.CV) 2026-06-24

Towards Fast and Effective Long Video Understanding of Multimodal Large Language Models via Adaptive Quasi-Gaussian Sampling

Long video understanding remains a daunting challenge for Multimodal Large Language Models (MLLMs) due to the excessive computation and memory footprint. Thus, keyframe selection is often adopted to mitigate this shortcoming, which however still suffers from low flexibility and high noise due to its hard sampling principle. In this paper, we define video frame selection as a problem of Quasi-Gaussian Sampling, and propose an adaptive and training-free approach termed AdaQ. Inspired by the $3$-$\sigma$ rule of Gaussian distribution, the objective of AdaQ is to achieve the optimal $3$-$\sigma$ interval for different examples, i.e., a smaller $3$-$\sigma$ interval for the local query and a larger one for the global query, thereby facilitating robust and adaptive frame sampling. To validate AdaQ, we apply it to four MLLMs with three embedding models. The extensive experimental results not only show its obvious performance gains over the default MLLMs and the SOTA keyframe selection methods, e.g., helping Qwen3-VL-8B outperform GPT4o by 15.8\% on average by using only 64 frames, but also confirm its superior robustness and high efficiency for long-video understanding, e.g., only 1 hyper-parameter needs to be set. Our code project is given at \href{https://github.com/Zkayovo-xmu/AdaQ}{https://github.com/Zkayovo-xmu/AdaQ}.

06.
arXiv (CS.LG) 2026-06-25

Learning Optimization Proxies for Sequential Contextual Stochastic Programs: An Order Fulfillment Application

arXiv:2606.25362v1 Announce Type: cross Abstract: Sequential contextual stochastic programs model real-time decision systems in which each time epoch commits to an action under uncertainty whose consequences propagate into future decisions. In many practical contexts, these programs require obtaining solutions rapidly as new information becomes available. These problems can be represented through scenario approximations to be solved by off-the-shelf optimization solvers, which achieve high decision quality offline but typically run in seconds to minutes per instance, falling short of the sub-second responses that peak periods of planning require. This paper develops a learning-based optimization proxy: a scenario-embedded neural network trained offline on solver-generated labels, paired online with a decoder that enforces feasibility, replacing the per-epoch solve with a single forward pass. The framework is specialized to omnichannel order fulfillment, where each arriving order requires a sub-second assignment of products to distribution centers and carrier services under stochastic delivery times and future demand. A two-stage contextual stochastic program is introduced to formulate this problem, and its contextual sample average approximation (C-SAA) supplies the offline labels, while a composite training loss combines label imitation, a constraint-violation penalty, and self-supervised cost alignment. In a calibrated simulator built from JD.com transactional records, a detailed computational study is provided. The proxy reduces decision latency by roughly 2800x relative to the online finite-sample C-SAA reference and improves over it by 3.3% in realized fulfillment cost. Relative to established fulfillment policies, the proxy lowers total realized cost by at least 10.7% and roughly halves the late-delivery rate.

07.
medRxiv (Medicine) 2026-06-11

Global population frequencies of NAT2 star alleles observed in three large biobanks

NAT2 is an important pharmacogene which encodes the N-acetyltransferase 2 enzyme that is involved in the metabolism of multiple medications, and variants in this gene can affect patient response to these medications. CPIC has published a clinical guideline for prescribing hydralazine using NAT2 genotypes. Just prior to the guideline, updated NAT2 star allele numbering and definitions were released, differing somewhat from the historical nomenclature. Clinical pharmacogenomic testing panels often test for the most common star alleles, so knowledge of the most common updated NAT2 star alleles is critical for the implementation of the CPIC NAT2/hydralazine guideline. We first determine NAT2 diplotype frequencies from UK Biobank (UKBB) 200k phased genomes, then analyzed allele, diplotype, and phenotype population frequencies from the All of Us Research program, PennMedicine BioBank (PMBB) and UKBB 500k datasets. We found that analyzing NAT2 diplotypes from phased data provides critical information for algorithms designed to predict diplotypes from unphased data. We observed that NAT2*5, *6, and *4 were the most common star alleles in that order, and the top 11 most frequent NAT2 star alleles were the same across all biobanks. However, differences in star allele frequencies across biogeographical populations were observed. The largest difference led to a higher frequency of NAT2 poor metabolizer phenotypes as compared to rapid and intermediate metabolizer phenotypes in all global populations except in the EAS population, where NAT2 poor metabolizers were in the minority.

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

Uncertainty Is Not a Safety Net for Clinical VQA, but Can It Anticipate Model Failure?

Safe deployment of clinical vision-language models (VLMs) requires reliable uncertainty estimation (UE): a signal indicating when predictions should be trusted or escalated to a clinician. We test whether current UE methods actually deliver this signal. Benchmarking 8 methods across 12 VLMs on clinical visual question-answering (VQA), we find that UE quality is not an intrinsic property of the UE method: it tracks model accuracy, degrading precisely where the model performance is weakest, and therefore where reliability is most needed. When we stress-test models by hiding the correct option among the multiple-choice answers (NOTA perturbations), accuracy collapses while uncertainty barely changes, leaving models systematically miscalibrated. Yet, we find that uncertainty on the unperturbed input reliably anticipates which predictions will collapse under NOTA, indicating that UE in current VLMs carries diagnostic information about model fragility. Our results position UE as a diagnostic tool for identifying fragile predictions and motivate perturbation-based evaluation as a path toward safe clinical deployment.

09.
arXiv (CS.LG) 2026-06-25

Bias-Controlled Primal-Dual Natural Actor-Critic: Optimal Rates for Constrained Multi-Objective Average-Reward RL

arXiv:2606.25012v1 Announce Type: new Abstract: Many reinforcement learning (RL) problems in the infinite-horizon average-reward setting require optimizing multiple conflicting objectives while satisfying multiple safety constraints. A common approach is concave scalarization, where the agent maximizes a utility $ f(J^\pi_{r_1}, \ldots, J^\pi_{r_M}) $ subject to a scalarized constraint $ g(J^\pi_{c_1}, \ldots, J^\pi_{c_N}) \ge 0 $, where $J^\pi_{r_m}$ and $J^\pi_{c_n}$ denote the average-reward and cost under policy $\pi$. However, the nonlinearity of $f$ and $g$ introduces bias in policy-gradient and actor-critic methods, since gradients must be evaluated using noisy estimates of $J^\pi,$ and $ \mathbb{E}[\partial f(J^\pi)] \neq \partial f(\mathbb{E}[J^\pi]),$ and this bias propagates through both primal and dual updates. We propose an MLMC-based primal-dual Natural Actor-Critic algorithm for average-reward MDPs that controls bias in scalarized objectives, constraint evaluation, and actor-critic estimation without requiring mixing-time knowledge. We show that the algorithm achieves optimal global convergence and constraint-violation rates of $ \tilde{O}(1/\sqrt{T}) $. To our knowledge, this is the first result establishing optimal convergence for concave scalarized multi-objective RL in the average-reward setting, both with and without constraints, and the first to do so without mixing-time information even in the absence of scalarization.

10.
medRxiv (Medicine) 2026-06-22

Between Patterns and Predictions: Interpretable Latent EEG Representations for Clinical Insights

Electroencephalography (EEG) captures rich brain dynamics, yet in clinical practice this complexity is often reduced to simplified summaries or categorical labels, limiting its interpretability for decision-making. We tested the hypothesis that a pretrained latent embedding framework, the Universal Map of EEG (UM-EEG), can preserve clinically meaningful structure across heterogeneous datasets and provide a generalizable representation of brain states. We applied UM-EEG, without retraining, to three independent cohorts spanning distinct clinical contexts: long-term EEG recordings from cardiac arrest patients (n = 576), subarachnoid hemorrhage (n = 100), and routine clinical EEG recordings containing physiological and pathological patterns (n = 141). EEG segments were projected into a shared 128-dimensional space anchored by expert-derived reference states, including wakefulness, sleep stages, ictal-interictal continuum activity, and burst suppression. Across datasets, favorable outcome or physiological recordings were consistently located closer to healthy reference states, whereas poor outcome and pathological recordings shifted toward pathological regions of the embedding space. Trajectory-derived geometric and temporal features discriminated outcome in cardiac arrest (ROC-AUC 0.83) and subarachnoid hemorrhage (ROC-AUC 0.76), and distinguished physiological from pathological routine EEGs (ROC-AUC 0.93). In routine EEG, similarity relationships derived from embedding trajectories correlated with those derived from structured clinical reports, indicating that the latent space recapitulates clinically relevant organization. These findings show that a fixed, semantically structured EEG embedding generalizes across etiologies and recording settings, enabling prognostic stratification and contextual interpretation while preserving the relational structure of brain states.

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

Mana: Dexterous Manipulation of Articulated Tools

Articulated tool manipulation remains a major challenge in dexterous robotics due to the need to coordinate internal degrees of freedom and contact-rich interactions. While prior work has largely focused on rigid objects, articulated tool use remains underexplored because of its physical complexity and the difficulty of learning functional grasping and manipulation policies. We present Mana (Manipulation Animator), a general sim-to-real framework that reinterprets dexterous manipulation as an animation problem. Inspired by computer animation, Mana employs a coarse-to-fine pipeline that transforms procedurally-generated grasp keyframes into manipulation trajectories through motion planning and reinforcement learning. The data generation process is largely automatic, requiring only a few mouse clicks to specify functional affordances (

12.
Nature (Science) 2026-06-17

Cucurbituril-based anion-conducting membranes with supramolecular nanopores

作者:

Nanoporous anion-conducting membranes have gained considerable interest for their potential to reduce resistance in electrochemical devices1–4. Current pore-forming methods, such as backbone engineering through polymers of intrinsic microporosity5,6 or covalent organic and metal–organic frameworks7,8, however, suffer from limited structural control, mechanical fragility or demanding synthesis. Here we establish a supramolecular strategy that overcomes these limitations by constructing uniform, dynamic nanopores. Co-assembly of the rigid macrocyclic host cucurbit[7]uril with the cationic polymer guest quaternized poly(piperidinium-terphenyl) yields a robust network of nanometre-scale channels while simultaneously enhancing mechanical and chemical stability. The dynamic host–guest interactions allow the pore structure to fluctuate on picosecond and angstrom scales. This transient environment supports low-friction hydroxide migration through a Grotthuss mechanism, producing a marked enhancement in ionic conductivity. This bottom-up design principle provides a versatile new tool for molecularly engineering transport pathways and promises to advance electrochemical reactors with respect to energy efficiency, operational stability and the production of high-purity products. A supramolecular strategy, in which uniform, dynamic nanopores are constructed, overcomes the limitations of limited structural control, mechanical fragility or demanding synthesis in nanoporous anion-conducting membranes, providing a versatile tool for molecularly engineering transport pathways.

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

A Stationarity-and-Coupling Criterion for Training-Free Time-Lagged Spectral Embeddings of Multivariate Time Series

arXiv:2606.13823v1 Announce Type: new Abstract: We study training-free fixed-length descriptors for multivariate time series and ask not merely whether such a descriptor performs well, but when it can be expected to work at all. Our object of study is $D(\tau)$, built from a time-lagged correlation matrix truncated at the Marchenko-Pastur edge so that only signal-bearing eigenvalues survive and classified by cosine similarity to class centroids with zero learned parameters. The central contribution is not the descriptor but a falsifiable applicability criterion for it. Working from a stationary Gaussian VAR(1) model, we argue that $D(\tau)$ separates two classes when the signals are approximately stationary and the class information lives in their cross-channel temporal coupling rather than in marginal per-channel power. We derive, semi-formally, three consequences: a distinguishability condition, why the static ($\tau=0$) covariance collapses to chance, and why a stationary but power-discriminated paradigm defeats the descriptor. The criterion is operational: a two-part pre-flight test – an augmented Dickey-Fuller stationarity check and a power-baseline saturation check – predicts applicability before any training. We validate both halves on a mixed assortment. On four paradigms that satisfy the criterion (Sleep-EDF, BCI-IV-2a, MIT-BIH, ESC-50) the descriptor is competitive with strong baselines at a fraction of their cost, reaching $88.5\pm4.5\%$ under 20-subject leave-one-subject-out on Sleep-EDF on a single CPU thread. On three that violate it – non-stationary ERPs, and financial-volatility and wearable-stress regimes that are power-discriminated – it fails exactly as the pre-flight predicts, and these negatives are the more informative half. We are explicit that $D(\tau)$ is not the most accurate representation; its value is a compact, training-free embedding whose domain of validity is known in advance.

14.
arXiv (CS.AI) 2026-06-25

ECM Contracts: Contract-Aware, Versioned, and Governable Capability Interfaces for Embodied Agents

arXiv:2604.13097v2 Announce Type: replace-cross Abstract: Embodied agents increasingly rely on modular capabilities that are installed, upgraded, composed, and governed at runtime, yet the interfaces between these modules are specified only at the level of message types, so integration failures surface only during execution. We present ECM Contracts, a contract-based interface model for embodied capability modules. Unlike conventional interfaces that specify only input and output types, ECM Contracts encode six dimensions of embodied execution: functional signature, behavioral assumptions, resource requirements, permission boundaries, recovery semantics, and version compatibility. On this model we build a compatibility framework that checks installation, composition, and upgrade before deployment, and a release discipline of version-aware compatibility classes and upgrade gates. We evaluate the prototype by predicting real, independently documented integration failures in the ROS ecosystem: contracts are reconstructed blind from each module's published interface, scored by a checker frozen before reconstruction against bugs from third-party datasets, and confirmed in live runtime execution. Contract checking predicts 56% and 72% of these documented failures across two substrates, against at most 17% for the strongest type and quality-of-service baselines, with the advantage statistically significant and zero false positives on matched-good controls. The resource and version dimensions carry most of this margin; the behavioral dimension adds little beyond the middleware's quality-of-service check, and we report the permission and recovery dimensions as forward-looking. Stable embodied software ecosystems require not just modular packaging but explicit contracts connecting composition, governance, and evolution.

15.
arXiv (CS.CV) 2026-06-25

Position: Reasoning After Perception Means Reasoning Without Vision

A common belief in multimodal research is that the perceptual weaknesses of vision–language models can be compensated by stronger language reasoning (e.g., chain-of-thought, in-context learning, or external tools). We challenge this assumption. We argue that for a broad class of visual tasks hard to specify in language, failures stem from a structural fatality where the temporal decision of when to reason strictly dictates the spatial constraint of where reasoning takes place. When visual reasoning is deferred to language generation, current architectures do not merely delay computation; they displace it from the continuous visual representation to a discrete textual space. Consequently, the sequential ``Perception-then-Reasoning'' paradigm degenerates perception into a passive, one-off feature encoding process, rendering it functionally equivalent to ``Reasoning-in-Text-Space'', where task-critical spatial signals are collapsed before reasoning begins. We substantiate this claim with the Turing Eye Test (TET): tasks that must be resolved in visual space and are hard to verbalize; results show text-only reasoning cannot remedy these perceptual failures. Our findings suggest rethinking the architectural divide: shifting from reasoning about perception to reasoning within perception. This facilitates actively reasoning-driven perception that operates directly on pixel-level visual representations, rather than within a collapsed textual space.

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

High-Frequency Pricing at Scale for E-Commerce

arXiv:2606.13741v1 Announce Type: new Abstract: This paper presents the design, development, and implementation of a specialized forecast-then-optimize algorithmic pricing tool for sales campaigns in fashion e-commerce. Sales events present unique challenges for pricing including volatile demand patterns, rapid pricing decisions, and the need to balance short-term revenue with long-term profitability. We describe our approach combining daily-resolution demand forecasting using gradient-boosted trees with a multi-objective optimization framework that maximizes both long-term profit and net merchandise value for more than 5 million articles. Our solution addresses key limitations of existing weekly-granularity systems by implementing a forecast-then-optimize architecture that reduces pricing decision time from hours to minutes. We validate our approach through 23 A/B tests across 12 markets during 2023-2024 sales campaigns at Zalando, one of Europe's leading online fashion retailers. Experimental results demonstrate that the new pricing system achieves approximately 6% higher profit while maintaining equivalent performance on sales and revenue compared to the previous manual-algorithmic hybrid approach. Based on these results, the algorithm was successfully deployed to production and now handles the majority of algorithmic pricing decisions for sales campaigns at the company.

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

Magnifying What Matters: Attention-Guided Adaptive Rendering for Visual Text Comprehension

Visual Text Comprehension (VTC) renders text into images for a vision-language model (VLM) to read, sidestepping LLM context-window limits and powering applications from long-page OCR to multi-page memory QA. Yet existing VTC pipelines treat rendering and layout as a fixed, content-agnostic preprocessing step and offer little mechanistic understanding of how VLMs internally process visualized text. Through a focused empirical study on VTC QA tasks, we reveal that VLMs exhibit a localization-without-utilization regime: evidence-localizing attention emerges sharply in the middle-to-late layers and is largely decoupled from answer correctness, yet simply enlarging the localized spans on the rendered page recovers a large fraction of the failures. Building on these observations, we propose AGAR (Attention-Guided Adaptive Rendering), a training-free, model-agnostic method that leverages a VLM's own middle-to-late layer attention to identify the top-K important visual patches, maps them back to word spans, and re-renders the page with those spans enlarged before re-inferring the answer. Extensive experiments across nine VTC benchmarks (short-form, long-context, and multi-page memory QA) and four VLM backbones show that AGAR (i)consistently improves off-the-shelf VLMs as a plug-and-play enhancement, (ii)composes with VLM post-training to yield further gains, and (iii)remains robust under both visual- and text-side input degradation.

18.
arXiv (quant-ph) 2026-06-25

Halo-Independent Quantum Sensor Probes of Low-Velocity Dark Matter

arXiv:2606.25129v1 Announce Type: cross Abstract: We present a halo-independent framework for sub-GeV dark matter (DM) direct detection using quantum sensors with sub-eV energy thresholds. Such detectors enable access to low DM velocities and may be sensitive to departures from the Standard Halo Model that are challenging to probe with conventional direct DM detection experiments. The method expresses the DM scattering event rate in terms of a detector and particle model-dependent response function, and a universal halo function common to all experiments to be determined from data. This allows the local DM velocity distribution to be constrained. As representative implementations, we consider TES (Al) and MKID (TiN)-like sensors and show that their differing material responses probe complementary regimes of the DM velocity distribution. Applying the framework to mock data derived from several benchmark local halo models, we demonstrate how the assumed halo function could be reconstructed. This framework demonstrates the potential of quantum sensors as a new avenue for mapping the local DM velocity distribution.

19.
arXiv (CS.AI) 2026-06-24

Maestro Order: A Model-Agnostic Orchestration Harness

作者:

arXiv:2606.23983v1 Announce Type: cross Abstract: A single forward pass of a capable model is a fast, fluent, and unreliable problem-solver: it is right often enough to be useful and wrong often enough to be dangerous; in language models, such confident errors are known as hallucinations. We present Maestro Order, a model-agnostic orchestration harness that turns unreliable solvers into reliable problem-solving systems by composing them according to four structural primitives (decompose, ensemble, verify, and recurse) and a budget-aware controller that decides where to spend compute. The harness treats any model as a black-box base solver behind a uniform interface, layers a verifier ensemble whose discrimination is measured online, and allocates verification and voting to the stages with the highest marginal reliability per unit cost. We give the architecture, the message and state schema, the controller algorithm, and the engineering that makes it deterministic, observable, and fault-tolerant. We then specify an evaluation methodology (reliability at fixed cost, coverage, calibration, and ablations) and report results from a faithful Monte Carlo simulation of the harness over a parameterized solver/verifier model. The simulation reproduces the predicted laws quantitatively: verification amplifies reliability geometrically (e.g. $0.55\to0.98$ with two gates, $\to0.999$ with four), voting helps only above chance and is limited by shared errors, and a budget-aware controller reaches a target reliability at a small fraction of the cost of voting alone by selecting the cheapest mechanism for each regime. We close with failure modes (verifier gaming, correlated errors, and decomposition error compounding) and concrete guidance: build robust checkers, diversify solvers, and let the controller put compute where the information is.

20.
medRxiv (Medicine) 2026-06-22

Use of the Pharmacy First service in England in the first 12 months: geographic variation and health system context

Objectives: The Pharmacy First (PF) service was introduced across England from 31 January 2024 to expand the clinical role of community pharmacies and improve access to primary care. This paper describes use of PF in its first 12 months, in terms of uptake, access routes, consultation outcomes, geographic variations, service costs and antimicrobial supply. Methods: A descriptive analysis of all PF consultations submitted for payment to NHS Business Services Authority in England between 31 January 2024 and 31 January 2025. Pharmacy-level consultation data were linked to national data on population, location and pharmacy characteristics. PF use was examined using population-standardised consultation rates and consultations per pharmacy. Results: During the first year of implementation, 2,205,731 PF consultations were recorded as delivered across 11,349 pharmacies, with payment of GBP123 million to pharmacies. Uptake increased steadily over time. Most consultations were for acute sore throat (33%) and uncomplicated urinary tract infection (27%), with corresponding antibiotics, phenoxymethylpenicillin and nitrofurantoin being the most supplied. Most people self-referred (74%) into the service, with 95% of consultations managed without onward referral. Substantial geographic variation was observed. Northern regions had higher use based on the eligible population. The South East and Midlands had higher activity per pharmacy. London showed a distinct pattern, with higher self-referral into the service, lower medication supply and higher referral to other healthcare services. Higher consultation volume was weakly associated with pharmacy characteristics, including opening hours, pharmacy type and retail setting, and local context, in terms of socio-economic and geographic factors. Conclusions: PF had immediate uptake and is operating primarily as a direct-access model for common acute conditions. Findings suggest that PF is contributing to improved access to care and may shift demand away from general practice. However, the service uptake appears to be shaped by geographic location, proximity to other healthcare services and pharmacy characteristics.

21.
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.

22.
arXiv (CS.LG) 2026-06-18

Latent-Conditioned Parameterized Quantum Circuits as Universal Approximators for Distributions over Quantum States

arXiv:2605.28690v3 Announce Type: replace-cross Abstract: Many applications in quantum simulation, quantum chemistry, and quantum machine learning require not a single quantum state but an ensemble of states characterizing the heterogeneity of a target system. Preparing such ensembles state-by-state is prohibitive in both variational and fault-tolerant settings, thereby motivating a generative modeling approach. We introduce latent-conditioned parameterized quantum circuits (LPQCs), a hybrid quantum-classical framework in which classical neural networks map a latent variable sampled from a prior distribution to the parameters of a parameterized quantum circuit. We prove that LPQCs are universal approximators for probability measures over density operators in the 1-Wasserstein distance, extending classical universal approximation theorems to the quantum-distribution setting. We additionally introduce a multimodal latent prior and a mixture-of-experts circuit architecture, and show empirically that the latent-conditioned parameterization alleviates the barren plateau problem during optimization, a behavior for which we provide rigorous partial guarantees. Numerical experiments validate the framework on a synthetic multi-cluster ensemble of mixed quantum states and on a QM9-derived ensemble of 3-D molecular structures. In these tasks, LPQC outperforms recent quantum generative baselines and matches the generation quality of a classical neural-network baseline, while requiring an output dimension that grows only linearly with the number of qubits rather than exponentially. By leveraging classical expressivity in the latent space, LPQCs offer a tractable route to quantum generative modeling.

23.
arXiv (CS.CV) 2026-06-25

2K Retrofit: Entropy-Guided Efficient Sparse Refinement for High-Resolution 3D Geometry Prediction

High-resolution geometric prediction is essential for robust perception in autonomous driving, robotics, and AR/MR, but current foundation models are fundamentally limited by their scalability to real-world, high-resolution scenarios. Direct inference on 2K images with these models incurs prohibitive computational and memory demands, making practical deployment challenging. To tackle the issue, we present 2K Retrofit, a novel framework that enables efficient 2K-resolution inference for any geometric foundation model, without modifying or retraining the backbone. Our approach leverages fast coarse predictions and an entropy-based sparse refinement to selectively enhance high-uncertainty regions, achieving precise and high-fidelity 2K outputs with minimal overhead. Extensive experiments on widely used benchmark demonstrate that 2K Retrofit consistently achieves state-of-the-art accuracy and speed, bridging the gap between research advances and scalable deployment in high-resolution 3D vision applications. Code will be released upon acceptance.

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

Target-Aware Linear Regression Under Distribution Shift

arXiv:2606.22775v2 Announce Type: replace-cross Abstract: Distribution shift between training and deployment is a pervasive challenge for modern AI systems. In many cases, the target marginals of covariates and response are known or specified through population-level observations, boundary conditions, properties of simulator configurations, or alignment-time distributional constraints. Such knowledge may provide valuable side information for regression estimation. We study this problem in the multivariate linear regression setting with a stable conditional mean $E[Y\mid X]$ across source and target, and identify the hybrid-loss estimator, which jointly incorporates both target marginals, as a benchmark target-aware estimator. Its direct computation, however, requires solving a coupled nonlinear optimization that is expensive at scale. Our main contribution is to develop and evaluate two computationally tractable alternatives: a constrained moment-matching estimator and a two-stage estimator that augments ordinary least squares with a calibration step. For all three estimators, we derive and compare closed-form asymptotic mean squared errors, yielding conditions under which the tractable alternatives match or closely approximate the hybrid benchmark, and regimes in which they do not. Monte Carlo experiments across three controlled shift regimes validate the theoretical results, investigate the accuracy-runtime tradeoffs among the three estimators, and translate into guidance on estimator choice. In particular, the two-stage estimator nearly matches the hybrid benchmark in the high signal-to-noise regime at essentially no additional cost, providing theoretical grounding for empirical observations in nonlinear settings.