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01.
arXiv (CS.AI) 2026-06-11

Market Design for AI: Beyond the Copyright Binary

arXiv:2606.12260v1 Announce Type: cross Abstract: How can we design a market of human-generated content for use in training AI models that both enables technological progress and preserves individual incentives for high-quality content creation? Existing approaches take polar positions: a "free-for-all" model based on fair use and a "strong intellectual property rights" model. We show that both fail: Free-for-all does not compensate creators, and – by modeling as a static Stackelberg game – strong intellectual property rights also underpower creative incentives. We find this especially true for more innovative creators, a phenomenon we term the "originality penalty." Extending this insight to a dynamic model, we find another market failure undermining AI model performance, even for an initially good model: Such a model induces greater reliance by humans on AI-assisted creation, resulting in homogenized content feeding back into training, which degrades the model performance – a "curse of precision." We further propose a market design with a data intermediary internalizing cross-creator externalities and subsidizing innovative contributions, thereby restoring efficiency.

02.
arXiv (CS.AI) 2026-06-16

CmdNeedle: Measuring the Incompleteness of Command Denylists for AI Agents

arXiv:2606.15549v1 Announce Type: cross Abstract: The adoption of AI agents is increasing rapidly. Terminal AI agents, i.e., AI agents that run in terminal environments, are a widely used type of AI agents. Terminal AI agents rely heavily on shell command execution to interact with the host systems. They adopt a three-list command-gating mechanism to mitigate security risks introduced by command execution, with denylists serving as the load-bearing component. However, modern operating systems often ship a large, ever-expanding set of shell commands with complex functionalities. Our observation is that even a built-in denylist of Claude Code, well-maintained by its developers, can overlook bypass commands that invalidate its effectiveness. Such negligence leads to fragile command denylists that cannot even block operations that practitioners expect them to block. This paper presents the first systematic characterization of command denylist fragility in terminal AI agents. The paper formalizes the command denylist fragility problem and proposes an LLM-driven pipeline, CmdNeedle, to detect such fragility. It prompts the LLM to propose possible bypasses and iteratively repairs them using feedback from a validator that executes them in a sandbox. In the evaluation, we applied CmdNeedle to 1,709 real-world command denylists (containing 13,332 denylist rules) collected from GitHub. The evaluation shows several key findings, including that 69.0–98.6% of the denylists are fragile, that this fragility occurs consistently across projects and agents, and the validity of several possible root causes for this fragility. Our pipeline and findings will hopefully facilitate future research and practice regarding the command denylists used by AI agents.

04.
arXiv (CS.CL) 2026-06-12

Detect, Remask, Repair: Diffusion Editing for Faithful Summarization of Evolving Contexts

Summaries of real-world events can become outdated as contexts evolve and new information arrives. A common response is to generate a new summary from the updated context, but full regeneration discards the previous draft, can obscure what changed, and may be unnecessary when only a few claims are unsupported. We study localized faithfulness repair: updating outdated spans in an existing summary while preserving supported content. We propose DETECT-REMASK-REPAIR, a diffusion-based framework that identifies, remasks, and repairs outdated regions with masked diffusion language models. To evaluate evolving-context summarization, we introduce StreamSum, a benchmark of synthetic event timelines. Experiments on DialogSum and StreamSum show that localized diffusion repair provides a controllable alternative to full rewriting: faithfulness-steered repair improves early drafts, one-step repair reduces repair cost to under half a second, with the framework enabling faithfulness-speed-preservation tradeoffs across datasets. We also find that the framework can provide a post-hoc correction step that improves faithfulness for autoregressive systems.

05.
arXiv (CS.LG) 2026-06-19

Matching Markets meet Cumulative Prospect Theory: Towards Optimal and Adversarially Robust Learning

arXiv:2606.19883v1 Announce Type: new Abstract: We study a multi-agent multi-armed bandit problem in the competitive setup with two-sided matching markets under a human centric decision making model. To capture human preferences, we use cumulative prospect theory (CPT) that weighs the actions of the agent in a nonlinear fashion using a ($\alpha$-Hölder continuous) weight function. CPT has been widely used in behavioral economics and risk sensitive machine learning to emulate human preferences. We analyze the state-of-the-art learning algorithm with CPT weight distorted rewards and obtain a player optimal regret of $\mathcal{O}(K\log T \left(\frac{1}{\Delta}\right)^{2/\alpha})$, where $K$ denotes the number of arms, $T$ is the learning horizon, and $\Delta$ represents (suitably defined) players' minimum preference gap. Noticing the dependence on $\Delta$ to be sub-optimal, we further improve this regret by judiciously selecting the active set of arms during exploration, which removes the dependence on $K$ in the dominant term and achieves an improved (optimal) regret guarantees in the setting where the number of arms $K$ is significantly larger than the number of players $N$. In addition, we consider adversarial markets where the observed rewards of the agents may be corrupted. We propose and analyze algorithms for robust markets with CPT as risk sensitive measure in both settings where the total corruption budget is known and where it is unknown, and establish logarithmic player-optimal regret guarantees in both cases.

06.
Science (Express) 2026-04-23

Structural N- and O-glycans revealed by high-resolution cryo-EM analysis of tubular mastigonemes | Science

作者: 未知作者

The chemical complexity and non-templated biosynthesis of glycans have posed significant challenges for establishing sequence-structure relationships. Here we report cryo-EM structures of tubular mastigonemes from a golden alga species, Ochromonas danica , in which a large number of N- and O-glycans are resolved at 1.8-2.2 Å resolution. Beyond high-mannose and complex N-glycans, we identify a non-canonical N-glycan on the Ala- Asn -Asp (A N D) motif. The surface spikes comprise dense O-glycans coating PSXX tetrapeptide repeats, with two glycans linked on trihydroxylated proline and one on serine per repeat. In addition to various types of sugars and their covalent modifiers, water molecules (>10% of resolved volume) and cations are clearly resolved and mediate the structural assembly. Our study establishes a framework for investigating glycan folding in high-order biological assemblies.

07.
arXiv (CS.AI) 2026-06-25

Privacy Vulnerabilities of Attention Layers in Tabular Foundation Models and Protection of High-Risk Queries

arXiv:2606.26021v1 Announce Type: cross Abstract: Tabular foundation models are commonly assumed to present limited privacy concerns as they are often pre-trained on large collections of synthetic data. However, these models leverage in-context learning, where sensitive records may be provided directly at inference time as labelled context examples. In this paper, we demonstrate that predictions generated via the attention mechanism leak sufficient information to enable effective Membership Inference Attacks (MIAs). To highlight this vulnerability, we propose AMIA (Attention-based Membership Inference Attack), a shadow-model-free attack that exploits the concentration of transformer attention patterns. Our results show that attention mechanisms reveal strong membership signals, which exceed classical confidence-based attacks, achieving an average gain of 7.7\%, specially in low false-positive regimes. To mitigate this risk, we introduce an inference-time defence inspired by $k$-anonymity principles. This approach reduces the uniqueness of context-key representations without introducing random noise or retraining the model. By targeting only high-risk queries identified through AMIA scores, the defence substantially reduces membership leakage of this attack by an average of 50\% and 25\% against confidence-based attacks, while preserving predictive utility with only 3.9\% performance degradation. Beyond showing that context examples are vulnerable, we further demonstrate that fine-tuning introduces an additional source of privacy risk. In particular, samples whose prediction confidence increases after fine-tuning become more susceptible to MIAs, indicating that fine-tuning can amplify memorisation and expose sensitive training information through confidence shifts.

08.
arXiv (CS.LG) 2026-06-24

QC-SMOTE: Quality-Controlled SMOTE for Imbalanced Classification

arXiv:2606.24625v1 Announce Type: new Abstract: Class imbalance poses a significant challenge in classification, where existing methods such as SMOTE often generate low-quality synthetic samples in regions with noise or class overlap. We propose QC-SMOTE, a quality-controlled oversampling framework that estimates minority sample reliability using a composite neighbourhood trustworthiness score combining local density, safe-level, and isolation from the majority class. Synthetic candidates are generated using an IPQ-guided best-of-K strategy that evaluates midpoint purity and, when required, majority clearance, with allocation guided by sample reliability and boundary informativeness. Generation behaviour adapts across overlap–imbalance regimes, adjusting interpolation range and selection criteria to match local data geometry. Low-quality synthetic samples are replaced with original minority duplicates when neighbourhood purity falls below an adaptive threshold, providing graceful degradation by reverting to duplication in severely noisy regions. Experiments on 30 imbalanced datasets using repeated stratified cross-validation show that QC-SMOTE achieves the strongest average AUC-ROC and Macro F1 among the compared oversampling methods, with particularly clear gains under moderate and severe imbalance. These results demonstrate the importance of quality-aware, geometry-adaptive synthetic sampling for robust imbalanced classification.

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

Topological Flow Matching

arXiv:2606.15897v1 Announce Type: cross Abstract: Flow matching is a powerful generative modeling framework, valued for its simplicity and strong empirical performance. However, its standard formulation treats signals on structured spaces, such as fMRI data on brain graphs, as points in Euclidean space, overlooking the rich topological features of their domains. To address this, we introduce topological flow matching, a topology-aware generalization of flow matching. We interpret flow matching as a framework for solving a degenerate Schrödinger bridge problem and inject topological information by augmenting the reference process with a Laplacian-derived drift. This principled modification captures the structure of the underlying domain while preserving the desirable properties of flow matching: a stable, simulation-free objective and deterministic sample paths. As a result, our framework serves as a drop-in replacement for standard flow matching. We demonstrate its effectiveness on diverse structured datasets, including brain fMRIs, ocean currents, seismic events, and traffic flows.

10.
arXiv (quant-ph) 2026-06-25

From Meta Idea to Advanced Mathematical Discovery – Human-AI Co-Discovery of Sign-Embedding Quantum Algorithms

arXiv:2606.24899v1 Announce Type: cross Abstract: AI-assisted mathematics is often evaluated on solving predefined problems. In practice, however, many important advances begin earlier, when a vague research intuition is transformed into a concrete problem, a promising route, and a theorem family worth proving. This report studies that stage through a case study that led to sign-embedding quantum algorithms for matrix equations and matrix functions, foundational primitives in quantum linear algebra and operator-output quantum algorithms. The project began with a human-originated intuition that rational approximation is especially effective for jump-type functions such as the sign function, and might therefore serve as a design principle for quantum algorithms. Rather than merely assisting after the problem was fixed, AI-assisted exploration, including workflows later integrated into the agentic AI-mathematician system AIM, played a key role in expanding this intuition into a route map, comparing candidate formulations, and converging toward sign embedding as the central framework. AIM then helped connect a known matrix-sign identity to wider classes of matrix equations and matrix functions, and drafted proof and complexity calculations. The decisive scientific judgments remained human: selecting which human-AI-expanded routes were worth pursuing, rejecting a Cayley-trapezoidal approximation when its validity required a hidden condition, and refining the Sylvester implementation from a coarse quadratic-gap query route to the final factorized and scaled analysis. The report argues that human-AI co-discovery workflows, with systems such as AIM as important components, are most valuable not as standalone theorem provers, but as research partners for problem formation, connection discovery, derivation, and skeptical review inside a human-gated research loop.

11.
arXiv (CS.AI) 2026-06-24

Engineering Reliable Autonomous Systems: Challenges and Solutions

arXiv:2606.23760v1 Announce Type: cross Abstract: Engineering reliable autonomous systems is an important and growing topic in computer science. As autonomous systems become more prevalent, easy-to-use techniques for building them reliably are increasingly important. This workshop report captures and expands on the discussions at the Lorentz Center Workshop "Engineering Reliable Autonomous Systems" (ERAS), held from 10 to 14 June 2024. The workshop was co-organised by the organisers of the Workshop on Formal Methods for Autonomous Systems (FMAS) and the Workshop on Agents and Robots for reliable Engineered Autonomy (AREA). It brought together members of the FMAS and AREA communities, industry practitioners, and representatives from sectors where autonomous systems pose distinctive engineering challenges. The workshop focused on three main research topics: techniques for verification and validation of autonomous systems; engineering real-world autonomous systems; and software architectures for safe autonomous systems. Its main outcome is a catalogue of challenges in these areas and, most importantly, a pathway to solutions. Some challenges can already be tackled by techniques that are well known in academia but have not yet become regularly used in practice. Other challenges remain unresolved and require further research. This roadmap is intended to support future research and industrial collaboration.

12.
arXiv (CS.AI) 2026-06-16

Thinking with Visual Grounding

arXiv:2606.16122v1 Announce Type: new Abstract: Visual thinking should not only sound right; it should show its evidence. While recent vision-language models (VLMs) can produce natural-language reasoning traces, these traces often leave the supporting image regions implicit, making them hard to verify and difficult to supervise. We introduce visually grounded thinking, a reasoning process in which models interleave natural-language thoughts with explicit point or box groundings of the visual evidence used at each step. This lets the model express intermediate reasoning in language while grounding key objects in the image regions they refer to. To train this behavior, we construct a scalable synthesis pipeline that distills correct visual reasoning traces, extracts the visual objects required by the traces, grounds them with a SAM3-based agent, and derives aligned point and box supervision from the resulting masks. We further propose grounding-aware reinforcement learning, which combines answer correctness rewards with dense grounding rewards that score whether generated object references match the correct image evidence. Across two counting benchmarks and four spatial reasoning benchmarks, adding visually grounded thinking to Gemma3-4B-IT consistently improves performance over the original model and the non-grounded thinking baseline. On spatial reasoning, the visually grounded thinking 4B models match, and in some cases surpass, Gemma3-27B-IT from the same model family. Our analysis shows that point grounding is well suited to counting, while box grounding benefits most from explicit grounding rewards on spatial tasks. Overall, our results show that VLMs think better when their intermediate thoughts are tied to the image regions that make them true.

13.
arXiv (CS.AI) 2026-06-24

Governed Shared Memory for Multi-Agent LLM Systems

arXiv:2606.24535v1 Announce Type: new Abstract: Multi-agent LLM environments require robust mechanisms for shared knowledge management. This paper formalizes the fleet-memory problem and identifies four foundational failure modes: unauthorized leakage, stale propagation, contradiction persistence, and provenance collapse. To address these, we define explicit systems-level primitives: scoped retrieval, temporal supersession, provenance tracking, and policy-governed memory propagation. These primitives are implemented in MemClaw, a production multi-tenant memory service, and evaluated via ArgusFleet, a reproducible harness testing four governance dimensions. Rather than a baseline comparison, this study measures a live production service, emphasizing real-world architectural insights and negative results. Key Evaluation Results Provenance: Successfully reconstructed 100% of depth-four derivation chains with correct writer identity at sub-second per-hop latency. Propagation: Demonstrated high intra-fleet visibility with zero cross-fleet leakage. Under strong write mode, write-to-visible latency was optimized to a single search round-trip. Production Architectural Issues Discovered Asymmetric Scope Enforcement: Tenant isolation held, but sub-tenant scope was initially bypassed on direct GET-by-id requests for agent-scoped credentials (disclosed and remediated during the study). Pipeline Ordering Conflict: While contradiction supersession works for admitted writes, a synchronous near-duplicate gate can prematurely reject contradictory writes before the asynchronous contradiction detector can evaluate them. Conclusion: Long-context retrieval alone is insufficient for production multi-agent memory. Governed shared memory demands explicit systems-level abstractions, and live evaluation is vital to expose enforcement and pipeline-ordering failures missed by design-only treatments.

14.
arXiv (quant-ph) 2026-06-17

Unclonable Encryption in the Haar Random Oracle Model

arXiv:2603.11437v2 Announce Type: replace-cross Abstract: We construct unclonable encryption (UE) in the Haar random oracle model, where all parties have query access to $U,U^\dagger,U^*,U^T$ for a Haar random unitary $U$. Our scheme satisfies the standard notion of unclonable indistinguishability security, supports reuse of the secret key, and can encrypt arbitrary-length messages. That is, we give the first evidence that (reusable) UE, which requires computational assumptions, exists in "microcrypt", a world where one-way functions may not exist. As one of our central technical contributions, we build on the recently introduced path recording framework to prove a natural ``unitary reprogramming lemma'', which may be of independent interest.

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

Multi-Fidelity SINDy: Sparse Discovery of Nonlinear Dynamical Systems with Fidelity-Weighted Measurements

arXiv:2606.15690v1 Announce Type: new Abstract: Data from simulations and experiments are rarely noise-free and often exhibit heterogeneous levels of fidelity. Measurement uncertainty may vary across repeated observations, sensing devices, or even within a single experiment. This work addresses the problem of discovering nonlinear dynamical systems from such inhomogeneous data. We extend the Sparse Identification of Nonlinear Dynamical Systems (SINDy) framework to account for variable noise levels by combining Ensemble SINDy and Weak SINDy within a weighted regression formulation derived from generalized least squares. A statistical justification for the weighting strategy is also provided. The methodology is validated on several benchmark systems, including ordinary and partial differential equations. In addition, we show the benefit of multi-fidelity integration for forecasting the dynamics of a double pendulum system. The results confirm that the proposed approach mitigates the adverse effects of heteroscedastic noise and that repeated, low-cost, low-quality measurements can improve model recovery, in some cases matching or outperforming reconstructions obtained using only high-fidelity data.

16.
Nature (Science) 2026-06-22

Isotopic evidence for a cold and distant origin of 3I/ATLAS

Interstellar objects provide the only directly observable samples of icy planetesimals formed around other stars, and can therefore provide insight into the diversity of physical and chemical conditions occurring during exoplanet formation1−3. Here we report isotopic measurements of the interstellar comet 3I/ATLAS, which reveal an elemental composition unlike any Solar System body. The water in 3I/ATLAS is enriched in deuterium, at a level of D/H = (0.98 ± 0.06)%, which is more than an order of magnitude higher than in known comets, while its range of 12C/13C ratios (141–191 for CO2 and 123–172 for CO) exceeds typical values found in the Solar System, as well as nearby interstellar clouds and protoplanetary disks. Such extreme isotopic signatures indicate formation at temperatures  ≲ 30 K in a relatively metal-poor environment. When interpreted with respect to models for Galactic chemical evolution, the carbon isotopic composition implies that 3I/ATLAS may have accreted as long ago as 12 billion years, following a period of intense, early star formation. 3I/ATLAS thus represents a preserved fragment of an ancient planetary system.

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

APEX: Automated Prompt Engineering eXpert with Dynamic Data Selection

Large Language Models are highly sensitive to prompt formulation, necessitating automatic prompt optimization to unlock their full potential. While evolutionary algorithms have emerged as the dominant paradigm, they suffer from a critical bottleneck: data efficiency. Current methods treat the development dataset as a static benchmark, wasting significant compute budget on uninformative data. In this work, we introduce APEX (Automatic Prompt Engineering eXpert), a novel framework that optimizes the data usage alongside the prompt search. APEX dynamically stratifies the dataset into Easy, Hard, and Mixed tiers based on the optimization lineage. By prioritizing the Mixed tier, which identifies the data where the LLM has mixed performance, we identify two high-leverage subsets: the addressable frontier for generating informative mutations and the rank-sensitive frontier for distinguishing candidate quality. We evaluate APEX across three diverse benchmarks: IFBench, SimpleQA Verified, and FACTS Grounding. Under a fixed budget of 5,000 evaluation calls, due to its data efficiency, APEX outperforms the initial prompt by an average of 11.2% on Gemini 2.5 Flash and 6.8% on Gemma 3 27B, demonstrating that a data-centric approach is key to efficient and effective prompt optimization.

18.
arXiv (quant-ph) 2026-06-24

Concatenating Algebraic Codes over High-Rate Quantum LDPC Codes

arXiv:2605.21898v2 Announce Type: replace Abstract: Different quantum error correction schemes trade off overhead, error suppression, and hardware connectivity. Code concatenation can relax these tradeoffs by using an outer code whose non-local connectivity is supplied by logical operations of an inner code rather than directly by hardware. Prior works showed that this can reduce memory overhead for local low-rate inner codes such as the surface code. Here, we study concatenation over non-local, high-rate inner codes. Such inner codes experience correlated errors among the many logical qubits in a single codeblock. We handle this by treating each block as a single logical Galois qudit, enabling concatenation with algebraic outer codes with excellent parameters and, crucially, list decoders. In particular, we consider a memory system formed by concatenating quantum Reed-Solomon outer codes over the gross code. For fault-tolerant syndrome extraction, we develop a Galois qudit Shor scheme using "time-like" Reed-Solomon protection against measurement errors. Interestingly, a lightweight fault tolerance scheme, that would fail for qubits, works well for large-alphabet qudits, suggesting a very different theory of fault tolerance for such qudits. The whole protocol is optimised via improved bicycle instruction logical error rates, novel compilation strategies, and recent decoder post-selection rules. At uniform $10^{-3}$ physical noise, the concatenated gross code reaches the teraquop regime, which it previously could not access, with a lower space overhead than the $288$-qubit two-gross code, while offering several advantages from the engineering standpoint. Beyond our main case study, we believe the core ideas of Galois qudits, quantum Reed-Solomon outer codes, and list decoding, will prove generically powerful and highly transferable ideas across high-rate quantum architectures.

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

Improving Neural Network Training by Decoupling the Magnitude and Direction of Weight Vectors

arXiv:2606.25971v1 Announce Type: new Abstract: Modern neural network training relies on optimizers such as Adam and Muon which act on each weight matrix as a single object. Yet every weight matrix carries two distinct quantities – a magnitude and a direction – and all optimizers stepping in the matrix as a whole couple their dynamics: the directional change from an update depends on the current magnitude, while the magnitude drifts as a byproduct of learning the direction, so neither is governed directly by the learning rate. Typical training therefore leans on surrounding recipes such as weight decay and warmup to keep learning stable at scale, though these regulate the coupling only indirectly; other recent methods instead constrain the weight to a fixed-norm sphere, but add no learnable magnitude, leaving scale control to normalization layers alone. We propose Magnitude–Direction (MD) Decoupling, an optimizer modification that factorizes each weight into a fixed-norm direction on a hypersphere and learnable per-row and per-column magnitude gains, updated at separate learning rates, all while the model still sees a single fused weight tensor. The method is agnostic to the base optimizer and removes the need for weight decay and warmup. Across both Adam and Muon, MD Decoupling improves on well-tuned baselines, transfers the optimal LR across model width without retuning, and continues to help at scale on large Mixture-of-Experts (MoE) models. Treating magnitude and direction as separately controlled quantities thus yields more predictable training dynamics and a simple, broadly applicable improvement to modern optimizers.

20.
arXiv (CS.CV) 2026-06-25

Contrastive Conditional-Unconditional Alignment for Long-tailed Diffusion Model

Training data for class-conditional image synthesis often exhibit a long-tailed distribution with limited amount of images for tail classes. Such an imbalance causes mode collapse and reduces the diversity of synthesized images for tail classes. For class-conditional diffusion models trained with imbalanced data, we aim to improve the diversity and fidelity of tail class images without compromising the quality of head class images. We propose contrastive conditional-unconditional alignment (CCUA), which comprises two synergistic loss functions. Our first loss is an Alignment Loss (AL) that aligns class-conditional generation with unconditional generation at large timesteps. Alignment loss makes the denoising process insensitive to class conditions for the initial steps, which enriches tail classes through knowledge sharing from head classes. Secondly, we diversify unconditional generation via an Unsupervised Contrastive Loss (UCL) to increase the distance/dissimilarity among synthetic images. We combine the two losses to implicitly diversify conditional generation. Our framework is easy to implement as demonstrated on both U-Net based architecture and Diffusion Transformer. Our method outperforms vanilla denoising diffusion probabilistic models, score-based diffusion model, and alternative contrastive methods for class-imbalanced image generation across various datasets, in particular ImageNet-LT with 256$\times$256 resolution.

22.
medRxiv (Medicine) 2026-06-15

Toward a National Registry for Inborn Errors of Immunity in Peru: A Qualitative Implementation Study

Background: Peru lacks an integrated information system for patients with Inborn Errors of Immunity (IEI). Although disease registries are essential tools for data management and health planning, their success depends on implementation science approaches that account for local contextual factors. This study reports Phase I of a three-phase mixed-methods implementation project to design and develop a national IEI registry. Methods: Phase I consisted of a phenomenological qualitative study exploring stakeholder perspectives. Semi-structured focus groups and in-depth interviews were conducted with 29 key stakeholders across four groups: policy-makers, clinical experts, end-users (immunologists, residents, allied health personnel), and patient organization representatives. Interviews followed a guide structured around four a priori domains (structure, navigation, feasibility, and perception of existing systems). Discussions were conducted in Spanish, audio-recorded, transcribed verbatim, and coded using ATLAS.ti. A hybrid thematic analysis combining deductive and inductive coding was performed. Data elements proposed for the registry were triangulated with qualitative findings. Results: Thirty-six initial codes were consolidated into 15 categories, which were further integrated into four overarching themes conceptualized as pathways toward intention to use: (1) Environment, where governance, regulatory backing, and sustainable financing were identified as key enablers, while limited interoperability emerged as a structural barrier; (2) Technical Dimension, emphasizing usability, alignment with clinical workflow, and a hierarchical data architecture (demographic, clinical, therapeutic); (3) Users, highlighting clinical leadership, protected time, digital readiness, and perceived usefulness as stronger motivators than financial incentives; and (4) Patients, underscoring data protection, transparency, trust, and advocacy as essential for legitimacy and sustainability. Conclusions: A national IEI registry in Peru is perceived as necessary and feasible if implemented with strong regulatory foundations, interoperable design, robust data security, and user-centered architecture. These findings informed the development of an initial functional prototype and the operational plan for Phase II, focused on usability evaluation.

23.
arXiv (CS.CV) 2026-06-18

APT: Atomic Physical Transitions for Causal Video-Language Understanding

Physical events are not understood by their names alone, but by the causal state changes that compose them. A clip-level label such as "bounce" can be correct while hiding the process that makes the event physically valid, from support loss and contact onset to rebound and settling. To make this hidden process explicit, we introduce Atomic Physical Transitions (APTs): minimal, temporally localized state changes that bind a visible cue to an active physical mechanism and before/after dynamical regimes. An APT chain represents a video as an ordered causal transition sequence rather than a single aggregate event label: event labels tell what happened; APT chains explain why it happened. To make APTs learnable by VLMs, we construct mixed-source APT data from human annotations and simulator ground truth, covering 14 transition types across contact, gravity, friction, and rotation/stability, with 27,303 timed instances over 1,246 trials. Using this data, we find that current VLMs miss transition-level physics, with zero-shot recall at most 14% and errors dominated by missed transitions. Direct fine-tuning on APT chains improves transition detection but causes event-level forgetting, indicating that the model learns a specialized answer format rather than a reusable physical representation. We therefore propose APT-Tune, a parameter-efficient recipe that teaches VLMs to use causal transitions without forgetting how to answer video questions. It combines image-pad-aware supervision, format-conditional co-training, and mechanism-conditioned domain-to-type decoding to make APT learning format-robust and physically grounded. With only 11 M LoRA parameters on Qwen3-VL-2B, APT-Tune substantially improves APT recall while also improving event-level video transfer. These results show that APTs are not a new answer format, but a human-aligned causal supervision signal for physical video understanding.

24.
medRxiv (Medicine) 2026-06-23

A pharmacometric grey zone reconciles high metronidazole resistance rates with bismuth quadruple therapy efficacy in Helicobacter pylori

Summary Background Metronidazole (MET) resistance in Helicobacter pylori (H. pylori) exceeds 50-60% globally, yet MET-containing bismuth quadruple therapy (BQT) achieves &gt90% eradication in MET-resistant infections. We hypothesise this discordance stems from a structural limitation of two-fold dilution: a pharmacometric grey zone between the 128 and 256 &microg/mL breakpoints where treatable isolates are systematically misclassified as high-level resistance. Methods In a real-world cohort of 4610 treatment-na&iumlve children (2019-2024), checkerboard assays determined the bismuth-MET synergy factor (SF). Population PK/PD modelling simulated gastric MET exposure (AUC

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

Geometry-Aware Superpixel Graph Transformer with Metadata for Skin Lesion Classification

Automated skin cancer classification from dermoscopic images remains challenging due to heterogeneous lesion structure, strong intra-class variability, and subtle visual differences between benign and malignant cases. Existing CNN/ViT pipelines typically rely on global or patch-level features and often combine patient metadata via late fusion, which limits spatially grounded multimodal reasoning. We present a novel region-based graph learning framework that explicitly models lesions as graphs of spatially coherent superpixel regions represented as frozen CNN features. To capture fine-grained lesion arrangements, we encode inter-regional geometry as edge attributes and introduce a dedicated metadata context node connected to all regions, providing structured integration of demographic/clinical variables within the same relational space. Node representations are updated using our edge-aware graph transformer followed by attention-driven propagation, and a final graph-level embedding for benign-malignant classification. Experiments on four public benchmarks demonstrate that explicit region-level relational modeling and graph-native multimodal fusion yield consistent gains over the state-of-the-art. Consequently, we establish a new graph-centric perspective in which CNN features are modeled as relational nodes and improved through contextual integration, yielding more expressive and robust classifications.