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01.
medRxiv (Medicine) 2026-06-18

The Effectiveness of aromatherapy and its supportive Interventions on anxiety and pain among breast cancer patients: A systematic review and meta-analysis

作者:
Estervil↗N. O↗Carmichael↗C. L↗Feyissa↗G. T↗

Introduction: Breast cancer treatments are often associated with pain and anxiety, which can hinder physical functioning and overall quality of life, even after treatment. Complementary therapies, such as aromatherapy, can be used to alleviate pain and reduce anxiety in breast cancer patients. This project aimed to synthesize current global evidence on the effectiveness of aromatherapy. Method: This systematic review followed the PRISMA 2020 guidelines, with a comprehensive, systematic search conducted in PubMed, CINAHL, Cochrane Library, and SCOPUS for randomized controlled trials (RCTS) published from 2015 to 2025. Eligible studies included adult women breast cancer surgery patients who received aromatherapy during various periods of breast cancer. Where possible, data from the included studies were pooled using meta-analysis. GRADE approach was used to assess certainty of findings. Results: The search yielded 84 studies. Out of these, six were included in this review. On average, aromatherapy reduces pain and anxiety scores by 0.79 (standard mean difference (SMD)=-0.79, 95% CI -1.42, -0.16) and 0.53 (SMD=-0.53, 95 CI=-0.90, -0.16) units, respectively, compared to control condition [Low-quality of evidence]. The combination of aromatherapy with music reduces pain and anxiety by 1.26 (SMD= -1.26, 95 CI=-1.65, -0.87) and 1.08 (SMD = -1.08, 95 % CI: -1.45, -0.70) units respectively compared to standard care [Low-quality of evidence]. Conclusion: There is a potential role for the use of aromatherapy and music therapy, to alleviate anxiety and pain, especially for non-preoperative anxiety and pain. Further research is needed to inform the integration of aromatherapy into the management of anxiety and pain.

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02.
arXiv (CS.CV) 2026-06-24

Sat2City v2: Native 3D City Asset Generation from a Single Satellite Image

作者:
Tongyan Hua↗Dongli Wu↗Jinjing Zhu↗Yinrui Ren↗Zhongcheng Hong↗Ying-Cong Chen↗Hui Xiong↗Wufan Zhao↗

Generating explicit 3D city assets from a single satellite image is important for digital twins, urban simulation, and geospatial intelligence. Unlike satellite-to-street-view synthesis, the task requires a reusable textured mesh with plausible geometry and controllable appearance rather than a 3D proxy optimized only for rendering a small set of images or videos. The ICCV Sat2City framework made a first step by conditioning cascaded sparse-voxel latent diffusion on satellite-derived height maps, but its appearance was random, its training data were synthetic, and its task-specific VAE did not scale well to noisy real-world reconstructions. We present Sat2City v2, a journal extension that adapts a pretrained native structured-latent 3D foundation model to weakly aligned satellite images and textured meshes. We build a real-world dataset with 16,241 satellite-mesh pairs across 24 regions in 9 cities. Instead of learning a 3D representation from noisy city meshes, Sat2City v2 encodes each mesh into a pretrained native 3D latent space, fine-tunes a satellite-conditioned geometry flow, and uses the decoded shape to anchor satellite-conditioned texturing. This retains Sat2City's geometry-to-appearance cascade while enabling appearance-controllable generation from the satellite input. Experiments on metric-scale DSM reconstruction and generative city-asset benchmarks for geometry and appearance show that Sat2City v2 achieves the best overall performance among evaluated baselines. Overall, Sat2City v2 advances satellite-to-city generation from rendering-oriented 3D proxies to explicit textured mesh assets, supported by, to the best of our knowledge, the first documented satellite-mesh paired dataset collected from matched geographic crops for this asset-level task. Project page: https://ai4city-hkust.github.io/Sat2City-v2/

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03.
arXiv (CS.CL) 2026-06-12

ChiKhaPo: A Large-Scale Multilingual Benchmark for Evaluating Lexical Comprehension and Generation in Large Language Models

作者:
Emily Chang↗Niyati Bafna↗

Existing benchmarks for large language models (LLMs) are largely restricted to high- or mid-resource languages, and often evaluate performance on higher-order tasks in reasoning and generation. However, plenty of evidence points to the fact that LLMs lack basic linguistic competence in the vast majority of the world's 3800+ written languages. We introduce ChiKhaPo, consisting of 8 subtasks of varying difficulty designed to evaluate the lexical comprehension and generation abilities of generative models. ChiKhaPo draws on existing lexicons, monolingual data, and bitext, and provides coverage for 2700+ languages for 2 subtasks, surpassing any existing benchmark in terms of language coverage. We further show that 6 SOTA models struggle on our benchmark, and discuss the factors contributing to performance scores, including language family, language resourcedness, task, and comprehension versus generation directions. With ChiKhaPo, we hope to enable and encourage the massively multilingual benchmarking of LLMs.

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04.
medRxiv (Medicine) 2026-06-22

Clinical-grade Cuffless Blood Pressure Monitoring via Deep-tissue Diffuse Speckle Pulsatile Flowmetry

作者:
Choo↗T. W. J↗Yap↗A. A. M↗Kawaja↗Chao↗V. T. T↗Ng↗C. J↗Olivo↗Bi↗

Blood pressure (BP) is a vital sign which is measured to diagnose and manage hypertension. However, current methods to measure BP use inflatable cuffs which cause discomfort and limit the frequency at which measurements can be made, or intra-arterial catheters which are invasive and pose infection risks. Here, we propose and evaluate the use of Diffuse Speckle Pulsatile Flowmetry (DSPF) as a cuffless BP measurement method to address these limitations. DSPF is a laser speckle-based technique which simultaneously records blood flow rate and blood volume (i.e. photoplethysmography or PPG) signals from relatively deep vascular tissue. Using information from these signals, we studied DSPFs effectiveness in measuring systolic BP (SBP) and diastolic BP (DBP) through an outpatient study in which 133 patients were recruited, and in measuring beat-to-beat BP waveforms through an inpatient study in which two patients were recruited. In the outpatient study, the DSPF method was able to achieve mean absolute errors (MAEs) of 4.17 mmHg and 2.42 mmHg for SBP and DBP respectively compared to conventional cuff-based methods. It was also able to fulfil the requirements of the AAMI/ESH/ISO 81060-2:2018 standard for BP measurement devices and attain an "A" grade according to the British Hypertension Society grading scheme. For the inpatient study, it produced BP waveforms which had MAEs of 2.35 mmHg and 3.06 mmHg compared to arterial-line measurements for the two patients, respectively. Compared to PPG which has been studied more extensively as a cuffless BP measurement method, we found through ablation studies that DSPF was able to reach significantly lower MAEs and hence better accuracies. DSPF augments the performance of PPG-only methods by leveraging additional information from the blood flow rate signal, and we therefore find it to be a superior cuffless BP measurement method which can potentially be used in outpatient, inpatient, and remote settings.

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05.
arXiv (CS.CV) 2026-06-17

MM++: Unsupervised Scale-Invariant Multilayer OOD Detection via Top-K Gated Feature Fusion

作者:
Rahim Hossain↗Md Tawheedul Islam Bhuian↗Md Farhan Shadiq↗Kyoung-Don Kang↗

We introduce MM++ (Multilayer Mahalanobis++), a fully unsupervised, strictly post-hoc, and scale-invariant framework for Out-of-Distribution (OOD) detection. To address the trade-off between scale invariance and hierarchical expressivity, MM++ constructs a principled joint feature space. It first identifies discriminative intermediate layers by measuring entropy density drops, which mark the boundaries of sharp semantic compression. By fusing these selected layers with the terminal representation, the framework captures latent cross-layer correlations while mitigating early-layer noise. Crucially, a Ledoit-Wolf regularized tied covariance matrix stabilizes this unified space, enabling reliable distance estimation. Requiring no auxiliary OOD data, classifier fine-tuning, or architectural modifications, MM++ delivers robust performance across distinct architectures for both near- and far-OOD detection.

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

REFLEX: Reflective Evolution from LLM Experience

作者:
Pan Wang↗

Large multimodal language models (LLMs) have emerged as powerful tools for guiding evolutionary search toward interpretable programmatic policies. However, existing frameworks rely on a monolithic model call to simultaneously interpret visual behavioral evidence and synthesize corrective code. This diagnosis-repair entanglement creates an opaque feedback loop, obscuring the rationale behind mutations and preventing the retention of algorithmic insights across independent runs. To achieve auditable and efficient policy search, we argue that visual diagnosis must be structurally decoupled from code generation. We present REFLEX, a train-free evolutionary framework that operationalizes this decoupling. In REFLEX, a vision-enabled Critic first distills task-specific behavioral evidence into structured, auditable diagnoses. Subsequently, a text-optimized Actor synthesizes child policies using these diagnoses alongside a persistent, self-evolving Skill Memory of reusable code snippets. This architecture not only provides transparent mutation traces but also enables cross-run programmatic knowledge transfer. Extensive evaluations across control benchmarks (Lunar Lander, Acrobot, Pendulum) and a 36-dimensional antenna array synthesis task demonstrate exceptional sample efficiency. Notably, REFLEX solves Acrobot and Pendulum in under 10 LLM calls and reaches a best Normalized Weighted Score of 1.092 on Lunar Lander, achieving highly competitive final performance while significantly accelerating the early-stage discovery of transparent policies.

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

Closing the Approximation Gap in Simulation-free Latent SDEs

作者:
Henry D. Smith↗Brian L. Trippe↗Scott W. Linderman↗

arXiv:2606.16138v1 Announce Type: cross Abstract: Recovering dynamical systems from noisy observations is a recurring challenge across scientific domains, including neuroscience and physics. Latent stochastic differential equations (SDEs) address this by modeling the system as an unobserved state that evolves according to a learnable SDE and generates the observations. Variational inference (VI) provides a tractable objective for fitting latent SDEs. Traditional VI algorithms evaluate this objective by numerical simulation over a time discretization, trading fidelity for computational cost. A recent class of algorithms, simulation-free VI, sidesteps this tradeoff by parameterizing the posterior through its instantaneous marginals rather than its drift. In this work, we show that the efficiency of existing simulation-free VI algorithms comes at a price: their parameterizations restrict the approximate posterior to a subset of the SDEs available to simulation-based methods, degrading posterior inference and parameter learning. We propose Helmholtz-SDE, a simulation-free VI algorithm that closes this gap by optimizing over path laws compatible with a prescribed collection of marginals. Helmholtz-SDE recovers dynamics more faithfully than prior simulation-free methods, with the largest gains under high posterior uncertainty. It further matches the performance of simulation-based VI at a fraction of the runtime.

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

Momentum-Guided Semantic Forecasting (MoFore) for Self-Supervised Video Representation Learning

作者:
Qinwu Xu↗

Self-supervised video representation learning has recently advanced through contrastive learning, masked reconstruction, and predictive representation learning. Reconstruction-based approaches such as MAE and VideoMAE learn representations by recovering masked visual content [he2022mae,tong2022videomae], while contrastive methods such as CLIP learn semantically meaningful embedding spaces through representation alignment [radford2021clip]. In this work, we introduce a Momentum-Guided Semantic Forecasting framework (MoFore) for self-supervised video representation learning. Instead of optimizing for pixel-level reconstruction or task-specific semantic alignment, the proposed method learns temporally predictive video representations by forecasting future latent embeddings from temporally distant context clips. To improve robustness across temporal scales, we further introduce randomized temporal-gap forecasting during training. The framework combines predictive latent forecasting with contrastive regularization to encourage temporal consistency while preventing representation collapse. Experiments on the UCF101 dataset demonstrate that the proposed framework learns temporally consistent and semantically meaningful video representations without using action labels during training. Quantitative analysis shows strong temporal stability and emergent category-level structure in the learned embedding space, while qualitative retrieval experiments reveal motion-aware organization across related activities. Overall, the results suggest that long-range latent forecasting provides an effective and computationally efficient approach for self-supervised video representation learning without relying on reconstruction-based objectives.

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09.
arXiv (CS.AI) 2026-06-24

Weight-Space Geometry of Offline Reasoning Training

作者:
Aleksandr Nikolich↗Igor Kiselev↗Vladimir Platonov↗Karina Romanova↗

arXiv:2606.23740v1 Announce Type: cross Abstract: Offline reinforcement-learning losses (RFT, RIFT, DFT, Offline GRPO, DPO) are widely used to distill reasoning from large teachers into smaller students, and are typically compared on downstream accuracy alone. We ask whether they are mechanistically distinct or converge to a similar weight update. Training six methods (SFT, RFT, DFT, RIFT, Offline GRPO, DPO) on identical math rollouts from a single base model (Qwen3-4B) with attention-only LoRA, we analyze the resulting deltas via cosine similarity, principal-angle subspace analysis, linear mode connectivity, and CKA. We observe: (i) SFT, RFT, and RIFT have nearly colinear weight deltas (cosine >= 0.97, top-1 principal angle ~7 deg median over 144 modules) and comparable GSM8K accuracy (87-88%, n=1319; pairwise McNemar p >= 0.15); (ii) DFT diverges further in direction than any reward-weighted method despite using the same data; (iii) Offline GRPO adds a substantial component orthogonal to the SFT direction (~67% globally, up to ~86% in late layers) while staying in the SFT loss basin; (iv) DPO sits in a near-orthogonal subspace, shows a mode-connectivity barrier, and collapses late-layer CKA to ~0.46. DPO also reaches the highest accuracy in our protocol on both GSM8K (93.5%, McNemar p < 10^-9 vs. each other method) and AIME26 (30.0% vs. 3.3-10.0%); its training uses a 10x smaller learning rate than the others (the standard convention), so the update-norm and accuracy gaps reflect loss-function and optimizer choices jointly, and a learning-rate-matched DPO comparison is left for future work.

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10.
arXiv (CS.AI) 2026-06-16

SDS-LoRA: Overcoming Anisotropic Gradient Scaling in Low-Rank Adaptation

作者:
Junghun Oh↗Sungyong Baik↗Kyoung Mu Lee↗

arXiv:2606.16454v1 Announce Type: cross Abstract: Low-Rank Adaptation (LoRA) enables efficient adaptation of large pre-trained models to downstream tasks by parameterizing weight updates with low-rank matrices. In this paper, we investigate the limitations of the LoRA parameterization from a geometric perspective. Specifically, we show that when a full fine-tuning gradient is backpropagated to the low-rank matrices, it undergoes anisotropic scaling driven by their singular values. We argue that this phenomenon is undesirable because it distorts the full fine-tuning gradient by skewing it toward dominant singular directions while suppressing others. Our analyses demonstrate that anisotropic gradient scaling reduces the effective rank of the low-rank matrices' gradients and results in suboptimal alignment between the full fine-tuning gradient and its low-rank approximation in LoRA, thereby exacerbating the gap to full fine-tuning. To address these limitations, we propose a new low-rank parameterization, SDS-LoRA, which structurally decouples singular values from the backward pass. Our method ensures that the full fine-tuning gradient backpropagates only through the orthonormal bases of the low-rank matrices' subspaces, independent of their scales. Convergence analysis demonstrates that while LoRA's convergence rate degrades with the condition number of the low-rank matrices, SDS-LoRA remains independent of it. Experimental results across natural language and vision benchmarks show that SDS-LoRA improves loss convergence and reduces the gap to full fine-tuning, significantly enhancing adaptation performance.

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

Timestep Rescheduling in Diffusion Inversion

作者:
Shangquan Sun↗Ting Gong↗Zhirui Liu↗Jiamin Wu↗Runkai Zhao↗Mianxin Liu↗Wenqi Ren↗Xiaochun Cao↗

Diffusion inversion, which maps images back to the Gaussian latent space of a diffusion model, is a critical task for image reconstruction and editing. While DDIM enables fast deterministic inversion, it inherently introduces deviations that accumulate into noticeable inversion errors. Existing methods often address this by solving a fixed-point problem but largely overlook how the selection of the diffusion timestep in the noise scheduler influences inversion fidelity. In this work, we reveal that the deviation scale in diffusion inversion is strongly dependent on the timestep size, and exhibits a parabolic trend, with larger errors concentrated at both small and large timesteps. Based on this finding, we propose a simple yet effective nonuniform timestep scheduler that integrates a global rescaling with a local dynamic programming based rescheduling, enabling a strategic allocation of computational effort that minimizes the overall inversion error and preserves higher inversion accuracy. Our method serves as an off-the-shelf enhancement for existing inversion techniques and requires no extra parameters or computational overhead. Through extensive experiments, we verify that integrating our scheduler consistently boosts the performance of existing inversion methods, achieving superior results in image reconstruction and editing.

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12.
PLOS Medicine 2026-06-23

Parental body mass index and offspring childhood body size and eating behaviour: A structural equation modelling analysis in the Norwegian Mother, Father and Child Cohort Study

作者:
Tom A. Bond↗

by Tom A. Bond, Tom A. McAdams, Nicole M. Warrington, Laurie J. Hannigan, Espen Moen Eilertsen, Ziada Ayorech, Fartein A. Torvik, George Davey Smith, Deborah A. Lawlor, Eivind Ystrom, Alexandra Havdahl, David M. Evans Background The intergenerational transmission of obesity-related traits could propagate an accelerating cycle of obesity, if parental adiposity causally influences offspring adiposity. The extent to which intergenerational obesity associations are due to such causal effects, as opposed to genetic confounding (inheritance), is unclear. We aimed to establish whether associations between parental peri-pregnancy body mass index (BMI) and offspring birth weight (BW), BMI until 8 years of age, and 8-year-old eating behaviour are due to genetic confounding. Methods and findings Data were from the Norwegian Mother, Father and Child Cohort Study, a prospective population-based birth cohort born between 1999 and 2009 at 50 out of 52 hospital maternity units in Norway. We compared the strength of the associations of maternal pre-pregnancy BMI versus paternal BMI during pregnancy, with offspring outcomes including birth weight and BMI assessed between age 6 months and 8 years of age, and appetite-related eating behaviour traits assessed at age 8 years via the Child Eating Behaviour Questionnaire (CEBQ), adjusting for potential confounders including parity, parental/grandparental language group and parental age, smoking, education and income). We then used an extended children of twins structural equation model (SEM) to quantify the extent to which associations were due to genetic confounding. Up to 85,866 children (51.3% male) were included in linear regression models, whereas SEM models included up to 50,999 children. Maternal BMI was more strongly associated than paternal BMI with offspring BW, but the maternal-paternal difference decreased for offspring BMI after birth. Greater parental BMI was associated with obesity-related offspring eating behaviours. SEM results indicated that genetic confounding did not explain the association between parental BMI and offspring BW, but explained the majority of the association with offspring BMI from 6 months onwards. For 8-year BMI, genetic confounding explained 79% (95% CI [62, 95]; p = 1.9 × 10−12) of the covariance with maternal BMI and 94% (95% CI [72, 113]; p = 2.7 × 10−14) of the covariance with paternal BMI. Limitations of this study include selective recruitment and attrition, potential bias due to parental assortative mating, and that findings may not generalise beyond high-income country settings with high obesity prevalence. Conclusions We found strong evidence that parent–child BMI associations may primarily be due to genetic confounding. When considered alongside prior evidence, this finding may argue against a strong causal effect of maternal or paternal adiposity on childhood adiposity via intrauterine or periconceptional mechanisms.

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13.
medRxiv (Medicine) 2026-06-22

Hyperlipidemia Pharmacotherapy in Skilled Nursing Facilities: A Real-World Evidence Study

作者:
Ashraf↗Mathers↗K. E↗Wagner↗Saumur↗

Objectives: To estimate hyperlipidemia medication order prevalence and associated variables in U.S. skilled nursing facility (SNF) residents. Design: Retrospective, observational study. Setting and Participants: Electronic Health Record data from 447,080 SNF residents with a hyperlipidemia diagnosis identified in PointClickCare's Life Sciences clinical database (January-April 2025) were reviewed. Methods: The presence and absence of medication orders for hyperlipidemia treatments recommended by the American Heart Association were assessed. Descriptive analyses summarized demographic and clinical characteristics, and a modified Poisson regression model was used to estimate risk ratios for having a medication order, adjusting for demographic, clinical, and facility characteristics. Results: Overall, 83.3% of residents diagnosed with hyperlipidemia had at least one hyperlipidemia medication order. Statins were ordered by 96.2% of active order residents, while other medication classes i.e., omega-3 fatty acids, cholesterol absorption inhibitors, fibrates were less common (

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14.
arXiv (CS.CV) 2026-06-19

Mix-QVLA: Task-Evidence-Aware Mixed-Precision Quantization of Vision-Language-Action Models

作者:
Navin Ranjan↗Andreas Savakis↗

We propose Mix-QVLA, a task-evidence-aware mixed-precision PTQ framework for VLA models. Mix-QVLA anchors each quantized variant to the full-precision action-token reference decision and evaluates whether quantization preserves task-relevant evidence across key VLA functional boundaries. It computes normalized gradient-weighted task-evidence maps from boundary activations and compares full-precision and quantized maps using evidence-mass and attribution-distribution distortion, capturing changes in both the strength and allocation of decision-supporting evidence. A soft-bottleneck objective aggregates boundary-level degradation into layer-wise sensitivity scores. Mix-QVLA further models sensitivity throughout task execution, capturing phase-dependent shifts in layer importance rather than assuming a fixed sensitivity profile. The resulting evidence- and time-aware scores guide mixed-precision bit allocation under model-size and BitOps budgets. Extensive evaluations on OpenVLA-style policies show that Mix-QVLA improves the accuracy-efficiency trade-off of low-bit VLA deployment. On LIBERO, Mix-QVLA reduces OpenVLA-OFT memory from 15.4 GB to 4.1 GB, retains 96.3 average success compared with 97.1 for the BF16 model, and achieves a 1.52x inference speedup.

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

Generalized Discrete Diffusion with Self-Correction

作者:
Linxuan Wang↗Ziyi Wang↗Yikun Bai↗Wei Deng↗Guang Lin↗Qifan Song↗

arXiv:2603.02230v2 Announce Type: replace-cross Abstract: Self-correction is an effective technique for maintaining parallel sampling in discrete diffusion models with minimal performance degradation. Prior work has explored self-correction at inference time or during post-training; however, such approaches often suffer from limited generalization and may impair reasoning performance. GIDD pioneers pretraining-based self-correction via a multi-step BERT-style uniform-absorbing objective. However, GIDD relies on a continuous interpolation-based pipeline with opaque interactions between uniform transitions and absorbing masks, which complicates hyperparameter tuning and hinders practical performance. In this work, we propose a Self-Correcting Discrete Diffusion (SCDD) model to reformulate pretrained self-correction with explicit state transitions and learn directly in discrete time. Our framework also simplifies the training noise schedule, eliminates a redundant remasking step, and relies exclusively on uniform transitions to learn self-correction. Experiments at the GPT-2 scale demonstrate that our method enables more efficient parallel decoding while preserving generation quality.

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

FlowMPC: Improving Flow Matching policies with World Models

作者:
Chandon Hamel↗

arXiv:2606.16286v1 Announce Type: cross Abstract: Flow Matching (FM) is a powerful approach for behavior cloning in multimodal action spaces [Jiang et al., 2025], but because it is not trained to directly maximize expected return, there is still room to improve how FM policies act at test time. This work investigates whether a learned world model can improve FM policies by enabling Model Predictive Path Integral (MPPI) planning over candidate action sequences proposed by the policy. Building on TD-MPC2 [Hansen et al., 2024], I introduce FlowMPC, a framework that combines an imitation-learned FM policy with a learned world model for test-time planning in ManiSkill manipulation tasks [Tao et al., 2025]. Across PickCube and PickSingleYCB, adding the world model improved performance over the FM policy alone, with especially clear gains in end-of-episode success. These results suggest that world-model-based planning can effectively complement flow-based imitation policies without modifying the FM training objective.

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17.
medRxiv (Medicine) 2026-06-19

Cardiometabolic multimorbidity and care experiences in primary healthcare among Brazilian adults aged 50 and over (ELSI-Brazil)

作者:
Souza↗F. H. A. d↗Delpino↗F. M↗Batista↗S. R. R↗

Background: Population aging and the rising burden of non-communicable diseases have increased the prevalence of cardiometabolic multimorbidity (CM-MM) among older adults. Patient-reported experience measures (PREMs) are recognized as essential components of healthcare quality assessment, yet evidence on primary care experiences among individuals with CM-MM remains scarce. Objective: To analyze primary care experiences according to the presence of cardiometabolic multimorbidity among Brazilians aged 50 years and older. Methods: Cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021; n = 9,949). CM-MM was defined as the self-reported coexistence of two or more of the following conditions: hypertension, diabetes mellitus, dyslipidemia, acute myocardial infarction, and stroke. Primary care experiences were assessed using a validated 12-item instrument organized into four domains: first-contact access, longitudinality, communication, and care coordination. Associations were estimated using Poisson regression adjusted for sociodemographic, health conditions, and healthcare utilization variables, with stratified analysis by Family Health Strategy (FHS) coverage. Results: CM-MM prevalence was 25.5%, with a progressive increase by age and an inverse gradient by education. Individuals with CM-MM reported significantly more positive experiences in longitudinality (mean index 2.53 vs. 2.34; adjusted PR = 1.22; 95%CI 1.12-1.33; p < 0.001) and, to a lesser extent, in communication (mean index 2.68 vs. 2.58; adjusted PR = 1.10; 95%CI 1.00-1.20; p = 0.041). No statistically significant differences were found in first-contact access or care coordination. After stratified by FHS coverage, the observed differences in longitudinality and communication were no longer statistically significant. Conclusions: CM-MM was associated with more positive primary care experiences in longitudinality and communication. The absence of differentiated experiences in first-contact access and coordination highlights structural gaps in primary care responsiveness to individuals with greater clinical complexity. Keywords: Multimorbidity; Cardiometabolic diseases; Primary Care; Patient-reported experience measures; Older adults; ELSI-Brazil.

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

Entropy Estimation in Multi-Qutrit Systems via Variational and Classical Neural Networks

作者:
Sai Sakunthala Guddanti↗Anil Prabhakar↗Ria Rushin Joseph↗

arXiv:2606.20504v1 Announce Type: cross Abstract: We present a systematic study of von Neumann entropy estimation in multi-qutrit quantum systems using two complementary approaches: variational quantum algorithms (VQAs) and classical convolutional neural networks (CNNs), evaluated using an ideal (noise-free) quantum simulator. For systems up to three qutrits, we construct and evaluate 11 hardware-efficient SU(3)-inspired ansatzes. A parameter sweep shows that estimation accuracy is primarily determined by the number of trainable parameters, provided sufficient entanglement is present. Based on this study, we fix the parameter count to approximately 120 for subsequent experiments, observing that increasing entangling-gate counts beyond a threshold yields only marginal improvements. For larger systems (two to five qutrits), we use a CNN trained on measurement outcomes from tensor-product mutually unbiased bases. The model achieves accurate and stable predictions and exhibits a systematic improvement in performance with system size, with the highest errors for two-qutrit systems and the lowest for five-qutrit systems. Notably, using only 12.5% of the measurements required for full state tomography is sufficient to reach 90th-percentile absolute errors of approximately 0.13-0.16 nats for both four- and five-qutrit systems. The CNN model is also robust to shot noise and generalizes well to out-of-distribution states. Overall, within the simulated settings studied here, our results indicate a transition in practical methods: VQAs are effective for small systems, while CNN-based estimators offer improved scalability and robustness for larger qutrit systems.

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

Self-Recognition Finetuning can Prevent and Reverse Emergent Misalignment

作者:
Arush Tagade↗Shaoheng Zhou↗Jiaxin Wen↗Shi Feng↗

Emergent misalignment (EM) has been linked to the activation of misaligned persona vectors and evil character traits, suggesting that EM operates through disruption of the model's aligned character rather than direct learning of harmful content. Motivated by this connection, we study self-generated text recognition (SGTR) finetuning as a character-targeted intervention that is distinct from existing in-training defenses. We conduct two-stage finetuning experiments across three models (GPT-4.1, Qwen2.5-32B-Instruct, Seed-OSS-36B-Instruct) and multiple EM datasets to compare SGTR finetuning against benign finetuning baselines (correct domain-specific data, general knowledge, and word counting) to find it an effective defense in both reversal and prevention settings. We find that all interventions produce comparable EM reversal, but only when restoring capabilities that EM had degraded. For prevention, only SGTR finetuning consistently reduces misalignment without exacerbating any individual metric, suggesting that character fortification specifically drives prevention. We provide further evidence for EM's relation to the LLM's default character by showing that EM finetuning induces diversity into the LLM's identity self-reports, artificially corrupting self-recognition exacerbates misalignment caused by EM finetuning, and that removing the model's identity-bearing system prompt substantially reduces the effect of EM finetuning. Together, these findings reframe EM not as the adoption of a coherent misaligned persona but as the destabilization of aligned character.

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

Prism: Cost-Efficient Multi-LLM Serving via GPU Memory Ballooning

作者:
Shan Yu↗Yifan Qiao↗Mingyuan Ma↗Yangmin Li↗Shuo Yang↗Xinyuan Tong↗Yang Wang↗Zhiqiang Xie↗Yuwei An↗Shiyi Cao↗Ke Bao↗Deepak Vij↗…

arXiv:2505.04021v3 Announce Type: replace-cross Abstract: Inference providers must maintain availability for many LLMs, including low-volume but essential models, making resource efficiency increasingly important as token prices fall. Analysis of production traces reveals a dynamic bursty-group pattern in which sets of models become active together and shift over time; existing space- and time-sharing approaches lack principled mechanisms to adapt to this variability, forcing trade-offs between SLO adherence and efficiency. We observe that elastic memory allocation can unify spatial and temporal sharing. Based on this insight, we have developed Prism, a memory-centric LLM co-serving framework that applies memory ballooning to reclaim memory across models and support both forms of sharing under a single scheme. Prism's balloon driver, referred to as kvcached, has been open-sourced at https://github.com/ovg-project/kvcached, and deployed in production environments across 10K+ GPUs.

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22.
medRxiv (Medicine) 2026-06-15

The clinical utility of functional testing in fibroblasts to diagnose primary mitochondrial disease

作者:
Van Hove↗J. L. K↗Friederich↗M. W↗R. A↗Lee↗J. C↗Knight↗K. M↗Donovan↗T. E↗Silveira↗…

Genome sequencing of the heterogeneous primary mitochondrial disorders (PMD) frequently reveals variants of uncertain significance that require functional tests for diagnosis, and does not identify variants in all patients. We analyzed mitochondrial enzyme assays, blue native polyacrylamide gel electrophoresis (BN-PAGE) with in-gel activity staining, complex I assembly blot, and select protein abundances in fibroblasts of a case series of 204 PMD patients divided into functional classes, in comparison to 51 controls and 53 differential diagnostic conditions. Overall, sensitivity and specificity for respiratory chain enzyme assays were 46% and 93% respectively, for BN-PAGE 40% and 98%, for complex I assembly assay 49% and 99%. The overall sensitivity of all tests was 76%, specificity 93%, with positive predictive value 96% and negative predictive value 67%. Categories with high sensitivity were isolated complex deficiencies, nuclear DNA-encoded mitochondrial protein synthesis defects, co-factor defects, and mitochondrial amino-acyl-tRNA synthetase conditions when aided by protein abundance. Mitochondrial DNA mutations and maintenance disorders showed poor sensitivities. Secondary dysfunctions were rare. A complete battery of functional tests showed strong diagnostic clinical utility in fibroblasts.

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23.
arXiv (CS.CL) 2026-06-16

Evaluating and Preserving Lexical Stress in English-to-Chinese Speech-to-Speech Translation

作者:
Yuchen Song↗Xi Chen↗Mingze Li↗Satoshi Nakamura↗

Speech-to-speech translation (S2ST) systems have achieved impressive progress in semantic accuracy and speech naturalness. However, the cross-lingual transfer of lexical stress, a vital cue for emphasis and speaker intent, remains heavily underexplored, compounded by a lack of reliable automatic evaluation metrics for tonal languages like Chinese. We investigate English-to-Chinese S2ST stress transfer by constructing a stress-annotated Chinese dataset and an XLS-R-based Mandarin stress detector. Integrating this with the English EmphAssess system, we propose a novel objective metric for cross-lingual stress evaluation. Furthermore, we fine-tune CosyVoice3 to build a stress-aware S2ST system. Experiments demonstrate that our proposed S2ST architecture significantly outperforms existing systems in stress translation capability while maintaining competitive translation quality. Furthermore, our evaluation metric exhibits a strong correlation with human subjective judgments.

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24.
medRxiv (Medicine) 2026-06-23

Social networks and their association with quality of life among older adults in rural Burkina Faso

作者:
Welgama↗Goodman-Palmer↗Harling↗G. P↗Agyapong-Badu↗Greig↗Inghels↗Witham↗Ouermi↗Coulibaly↗HIrschhorn↗L. R↗…

Objective: This study aimed to identify the types of social networks present among older adults in a rural, low-income country setting and describe their association with quality of life (QoL). Methods: A population-representative, cross-sectional survey was conducted in 60 villages around Nouna in Burkina Faso from July to August 2021. Data were collected from resident adults aged 40 years and older. Variables captured were sociodemographic status; social network characteristics (using the Practitioner Assessment of Network Typology (PANT)); quality of life (using the EuroHIS-8 tool); presence of non-communicable diseases, mental health conditions, and disability. Additionally, social networks were broadly categorised as aggregated integrated and aggregated less-integrated groups. Social network types and the groups were described separately, and a multivariable linear regression model was used to understand the association between social network types and QoL, adjusted for sociodemographic and morbidity factors. Results: Among the 2390 respondents, median age was 55 yrs (IQR: 47-64 yrs) and 55.8% were female. Locally Integrated (35.4%) or Family Dependent (30.3%) were the most common PANT social network types, followed by a mixed group (having characteristics of two or more social network types) (30.5%). Private Restricted (2.1%), Locally Self-Contained (1.2%), and Wider Community-Focussed (0.4%) types were uncommon. Adults with aggregated integrated network groups (36.1%) and aggregated less-integrated group (36.0%) were near equal, while others were non-aggregable. Although Wider Community-Focused type showed a significantly better QoL ({beta}= 8.69, 95%CI: 4.10 to 13.27), the association between social networks and QoL were subdued when controlled for morbidity factors, and hence no significant associations were observed between other types or the aggregated groups. Conclusion: Although having integrated social networks lead to a better QoL, morbidity has a greater effect on the QoL among older adults in Nouna and hence, investing more on improving the physical and mental health needs appears more beneficial.

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25.
medRxiv (Medicine) 2026-06-12

Genomic wastewater surveillance of seasonal and zoonotic influenza A viruses in California during the 2024-2025 flu season

作者:
Wang↗A. L.-W↗Lamtyugina↗Jiang↗Yu↗A. T↗Lu↗Wadford↗Burnor↗Pipes↗Kantor↗Nelson↗…

Wastewater genomic surveillance provides an opportunity to detect human and animal influenza A virus (IAV). We aimed to implement an IAV genomic surveillance framework agnostic to subtype, which enables recovery of IAV from multiple hosts and estimation of proportions across subtypes. We conducted IAV genomic surveillance in wastewater during the 2024-2025 flu season at multiple sites in California and compared these data with available human clinical IAV sequences and test positivity. We applied a custom whole-genome, multi-host IAV probe enrichment panel and adapted our custom expectation-maximization (EM) algorithm to deconvolute IAV mixtures in wastewater and infer subtype relative abundances. Absolute IAV concentrations were quantified using RT-PCR-based assays. H5N1 wastewater and clinical sequences were further characterized by constructing a whole-genome maximum-likelihood phylogenetic tree. Finally, we performed variant analysis to examine amino acid substitutions detected in wastewater. Our IAV probe enrichment method and EM algorithm successfully enriched all eight segments of three circulating IAV subtypes and accurately estimated subclade relative abundances for mixed IAV samples. Seasonal human H1N1pdm09 and H3N2 were detected throughout the study period from both wastewater and clinical sequencing data, with H1N1 subclades 6B.1A.5a.2a.1 and 6B.1A.5a.2a co-circulating, and H3N2 dominated by subclade 3C.2a1b.2a.2a.3a.1. Wastewater surveillance consistently detected H5N1 clade 2.3.4.4b across three monitored wastewater sites, while clinical H5N1 detections, from anywhere in CA, were sporadic and rare. Whole-genome phylogenetic analysis revealed that wastewater H5N1 sequences clustered with reference sequences associated with dairy cow and avian infections, while all human clinical H5N1 sequences clustered exclusively with reference sequences associated with dairy cow infections. Amino acid substitutions were identified across viral segments, and no mutations associated with mammalian adaptation were observed from wastewater samples.

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