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01.
arXiv (CS.AI) 2026-06-19

Simulation of Language Evolution under Regulated Social Media Platforms: A Synergistic Approach of Large Language Models and Genetic Algorithms

arXiv:2502.19193v2 Announce Type: replace-cross Abstract: Social media platforms frequently impose restrictive policies to moderate user content, prompting the emergence of creative evasion language strategies. This paper presents a multi-agent framework based on Large Language Models (LLMs) to simulate the iterative evolution of language strategies under regulatory constraints. In this framework, participant agents, as social media users, continuously evolve their language expression, while supervisory agents emulate platform-level regulation by assessing policy violations. To achieve a more faithful simulation, we employ a dual design of language strategies (constraint and expression) to differentiate conflicting goals and utilize an LLM-driven GA (Genetic Algorithm) for the selection, mutation, and crossover of language strategies. The framework is evaluated using two distinct scenarios: an abstract password game and a realistic simulated illegal pet trade scenario. Experimental results demonstrate that as the number of dialogue rounds increases, both the number of uninterrupted dialogue turns and the accuracy of information transmission improve significantly. Furthermore, a user study with 40 participants validates the real-world relevance of the generated dialogues and strategies. Moreover, ablation studies validate the importance of the GA, emphasizing its contribution to long-term adaptability and improved overall results.

02.
arXiv (quant-ph) 2026-06-19

Unveiling coherent dynamics in non-Markovian open quantum systems: exact expression and recursive perturbation expansion

arXiv:2506.04097v2 Announce Type: replace Abstract: We introduce a systematic framework to derive the effective Hamiltonian governing the coherent dynamics of non-Markovian open quantum systems. By applying the minimal dissipation principle, we uniquely isolate the coherent contribution to the time-local generator of the reduced dynamics. We derive a general expression for the effective Hamiltonian and develop a recursive perturbative expansion that expresses it in terms of system-bath interaction terms and bath correlation functions. This expansion provides a systematic tool for analyzing energy renormalization effects across different coupling regimes. Applying our framework to paradigmatic spin systems, we reveal how environmental correlations influence energy shifts and eigenbasis rotations, offering new insights into strong-coupling effects and non-Markovian quantum thermodynamics.

03.
medRxiv (Medicine) 2026-06-11

What level of expertise is necessary to generate ACLS training test questions: pre-med students vs. artificial intelligence?

Abstract Introduction In-hospital cardiac arrest carries high mortality despite standardized ACLS training. Educators face increasing time constraints in developing assessment tools for ACLS training. Two possible solutions to this problem are using pre-medical students or using artificial intelligence to generate test questions. This study compared the quality of pre-medical student-generated ACLS test questions vs. AI-generated ACLS test questions, testing the hypothesis that AI-generated questions are non-inferior to student-generated questions. Methods Ten pre-medical students created ACLS questions following predefined criteria, while an AI model (Northwell's Artificial Intelligence Hub) generated comparable questions. A blinded ACLS-certified physician evaluated questions on the qualities of Alignment, Clarity, Cognitive Level, and Question Design using a standardized rubric (Likert scale: 1 = poor quality, 5 = excellent). Student's T-test and Chi-square analysis were used to compare the quality of questions on different rubric domains within each arm (student vs. AI) and within one domain (eg, question Clarity) between arms. The Student's T test was used when 2 comparator groups were compared (eg, Clarity of student-generated vs. AI-generated questions) within one arm. The ANOVA test was used when comparing more than 2 comparator groups (eg, Alignment vs. Clarity vs. Cognitive Level) within one arm. Statistical significance was set as a priority at p

04.
medRxiv (Medicine) 2026-06-23

Attention and memory in Parkinson's disease: a discriminant analysis approach

Background. Cognitive impairment in Parkinson's disease (PD) is highly prevalent and heterogeneous. Assessing multiple cognitive domains is challenging and risks redundancy. This study evaluated whether a discriminant analysis approach could optimize the selection of specific tasks and measures for identifying attention and memory deficits in PD. Methods. Thirty PD patients and 25 cognitively unimpaired (CU) controls completed four experimental tasks: two assessing attention (flanker and spatial Stroop), one for recognition memory, one for working memory (n-back). Following group-level difference analyses, a discriminant analysis was performed to identify which tasks, and performance metrics possessed the highest sensitivity for distinguishing PD patients from CU individuals. Results. At the group level, PD patients exhibited significantly worse conflict costs in both attention tasks and lower sensitivity scores (d') in the recognition memory task compared to CU controls. The discriminant analysis revealed that time-based measures from the spatial Stroop task and the sensitivity score from the recognition memory task provided the highest discriminating power to differentiate between the two groups. Conclusion. These findings suggest that cognitive deficits in PD can be identified with high diagnostic accuracy using a targeted subset of metrics, eliminating the need for extensive and redundant neuropsychological testing batteries for attention and memory, without needing an extensive number of cognitive tasks for attention and memory.

05.
arXiv (math.PR) 2026-06-25

Haagerup property and group-invariant percolation

arXiv:2303.17429v3 Announce Type: replace-cross Abstract: Let $\mathcal G$ be the Cayley graph of a finitely generated, infinite group $\Gamma$. We show that $\Gamma$ has the Haagerup property if and only if for every $\alpha\alpha\mathrm{deg}_{\mathcal G}(g)$ for every vertex $g$ and with the two-point function $\tau(g,h)=\mathbb P\big[g\leftrightarrow h\big]$ vanishing as $d(g,h)\to\infty$. On the other hand, we show that $\Gamma$ has Kazhdan's property (T) if and only if there exists a threshold $\alpha^*\alpha^*\mathrm{deg}(o)$ implies that the two-point function is uniformly bounded away from zero. These results in particular answer questions raised by Lyons (J. Math. Phys. 41. 1099-1126 (2000)) about characterizations of properties of groups beyond amenability through group-invariant percolations. The method of proof is new and is based on a construction of percolations with suitable dependence structures built from invariant point processes on spaces with measured walls. This construction furthermore leads to quantitative bounds on the two-point functions, exhibiting in particular exponential decay of the two-point function in several prominent examples of Haagerup groups, including co-compact Fuchsian groups, co-compact discrete subgroups of $\mathrm{Isom}(\mathbb H^n)$ and lamplighters over free groups. This method also allows us to extend the aforementioned characterization of property (T) to the setting of relative property (T) and provide an application to Bernoulli percolation at the uniqueness threshold.

06.
medRxiv (Medicine) 2026-06-16

Adherence to Red Reflex and Vision Screening Recommendations: A Deep Dive into Primary Care Implementation Gaps

Introduction: Early childhood vision screening is critical for detecting amblyopia and other vision-threatening conditions. Despite screening recommendations during well-child visits, rates remain low. Red reflex assessment is recommended to identify serious ocular pathology, yet its use in primary care is not well described. We examined rates and drivers of vision screening in pediatric primary care. Methods: We conducted a retrospective review of electronic health records for children 3 to 5 years attending well-child visits in 2022 in one of three representative primary care clinics within a university health system. Outcomes were documented red reflex and functional vision tests. We evaluated associations with patient demographics and clinic site using multivariable logistic regression Results: Among 1,003 visits, 21.1% (n=212) had a documented red reflex assessment, and 60.8% (n=610) a functional vision test. Younger children (ages 3 and 4 vs. 5 years) had higher odds of red reflex assessment [adjusted odds ratio (aOR) 9.00 and 8.64], and lower odds of a functional vision (aOR 0.47 and 0.59) test. Females had higher odds of red reflex assessment (aOR 1.53). Other/Multiracial children had lower odds of red reflex assessment than Non-Hispanic White children (aOR 0.48). Screening rates varied significantly by clinic site Conclusions: Visual function and red reflex assessment are inconsistently performed in pediatric primary care, with particularly low rates of red reflex documentation. Screening rates varied between clinics and were affected by age. These findings highlight missed opportunities for early detection of vision-threatening conditions and identify targets for improving adherence to pediatric vision screening recommendations

07.
arXiv (CS.LG) 2026-06-19

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

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

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

A Formal Framework for Declarative Agentic AI in Business Process Analysis

arXiv:2606.15291v1 Announce Type: new Abstract: Agentic AI opens new opportunities for automating Business Process (BP), enabling autonomous decision-making and dynamic adaptation. However, realising this potential requires BP entities and their interactions to be defined with formal precision. This paper presents a formal framework for Agentic BP analysis through the AGO methodology. AGO captures the modelling perspective in terms of who is acting (Agents), why it is carried out (Goals), and what the relevant entities are (Objects). Grounded in set theory and mathematical logic, we formally define the AGO entity types and their interactions, organising all definitions into a BP Knowledge Base (BPKB). The resulting BPKB supports structured querying, incremental updates, and automatic generation of BP workflows, while ensuring soundness and completeness of the derived paths.

09.
arXiv (CS.CV) 2026-06-12

NavWAM: A Navigation World Action Model for Goal-Conditioned Visual Navigation

Goal-conditioned visual navigation requires a robot to act under partial observability by anticipating how its motion will change the future egocentric view and whether that change brings it closer to the goal. Navigation world models provide such visual foresight, but they remain prediction modules that require an external planner to convert predicted futures into closed-loop control. We propose Navigation World Action Model (NavWAM), a diffusion-transformer policy that turns navigation world-model prediction into executable action by representing future observations, goal-progress values, and action chunks in a shared latent sequence. By learning future prediction jointly with the action and value targets that determine closed-loop behavior, NavWAM makes visual foresight directly usable for robot control. We build NavWAM through simulation pretraining and real-robot adaptation, and evaluate it on image-goal navigation against planning-based world models and a representative direct navigation policy. Across offline benchmarks and closed-loop real-robot deployment, NavWAM improves over planning-based world-model baselines in our evaluations while using the default policy mode without CEM-style action search. Project page: https://dachii-azm.github.io/navwam/

10.
arXiv (CS.CV) 2026-06-25

Cross-Attention Multimodal Learning for Predicting Response to Neoadjuvant Imatinib in Gastrointestinal Stromal Tumors: A Multicenter Retrospective Study

Background: Response to neoadjuvant imatinib in gastrointestinal stromal tumors (GISTs) is highly variable and cannot be reliably predicted using current clinical or molecular markers. This study developed and evaluated an explainable multimodal deep learning framework integrating computed tomography (CT) imaging and clinical variables to predict treatment response. Methods: Patients from four tertiary centers were retrospectively included between 2000-2023 in independent pretraining (n=935) and prediction (n=213) cohorts. A cross-attention framework integrating clinical variables and tumor-centered CT imaging was developed to predict response to neoadjuvant imatinib. Two training strategies were evaluated: (1) self-supervised pretraining with low-rank adaptation and (2) training from scratch. Hyperparameters were optimized using SMAC3. Performance was assessed through internal cross-validation and external testing. Ablation analyses and attention-based explanations were used to quantify modality contributions. Results: Among 213 patients (54.5% responders), responders had larger tumors (112 vs. 89 mm, P=0.026), higher mitotic index (3 vs. 0, P

11.
arXiv (CS.CL) 2026-06-15

Small LLMs: Pruning vs. Training from Scratch

Pruning promises a shortcut to strong small language models. In this work, we examine this promise by pruning Llama-3.1-8B at pruning ratios of 0.5–0.8 with six methods spanning depth, width, and sparse granularities, under two controlled token-matched settings. (1) With the same training token budget, pruned initialization consistently outperforms random initialization. This shows that the parent model provides a strong starting point, although the advantage narrows as the training token budget grows and as the pruning ratio rises, nearly vanishing at the highest pruning ratio we study. (2) When training from scratch is instead given the full token budget consumed by the whole pipeline, pruning at finer granularities still retains an advantage, while coarser structured pruning can be matched or surpassed. This suggests that the parent model transfers knowledge that additional training tokens alone cannot fully recover, but only at fine granularity. Taken together, our results yield a clear recommendation: with a large pretrained model in hand and a limited training token budget, pruning is better than training from scratch; when the training budget is not limited, training from scratch can be competitive for coarser pruning, so a large pretrained parent is not always necessary.

12.
arXiv (CS.CV) 2026-06-18

HeatKV: Head-tuned KV-cache Compression for Visual Autoregressive Modeling

Visual Autoregressive (VAR) models have recently demonstrated impressive image generation quality while maintaining low latency. However, they suffer from severe KV-cache memory constraints, often requiring gigabytes of memory per generated image. We introduce HeatKV, a novel compression method that adapts cache allocation in each head based on its attention to previously generated scales. Using a small offline calibration set, the attention heads are ranked according to their attention scores over prior scales. Based on this ranking, we construct a static pruning schedule tailored to a given memory budget. Applied to the Infinity-2B model, HeatKV achieves $2 \times$ higher compression ratio in memory allocation for KV cache compared to existing methods, while maintaining similar or better image fidelity, prompt alignment and human perception score. Our method achieves a new state-of-the-art (SOTA) for VAR model KV-cache compression, showcasing the effectiveness of fine-grained, head-specific cache allocation. Code and calibration script available at https://github.com/arm-research/heatkv.

13.
Nature Medicine 2026-06-12

The Hong Kong Genome Project is a flagship initiative for precision medicine in Chinese populations

作者: 未知作者

The Hong Kong Genome Project established a genome sequencing database that provides improved diagnoses for patients and more efficient, population-tailored carrier status screening. Actionable pharmacogenomic variants were identified in almost all participants, informing drug prescriptions. This work establishes a genomic resource and a transferable model for equitable precision medicine in underrepresented populations worldwide.

14.
medRxiv (Medicine) 2026-06-24

Computational Decomposition of New Memory Failure in Alzheimer's Disease Through a Hippocampal Cortical Consolidation Bottleneck Model

Alzheimer's disease (AD) is clinically marked by difficulty retaining newly learned information, yet routine memory scores often conflate poor initial encoding with failure to stabilise information after encoding. This ambiguity limits the mechanistic interpretability of cognitive assessment during the transition from mild cognitive impairment to AD. Here we propose a Hippocampal Cortical Consolidation Bottleneck (HCCB) model to computationally separate these two components of new memory failure. The model represents newly presented information as a rapidly formed hippocampal trace and a slowly stabilised cortical trace, predicting a residual bottleneck when delayed recall falls below the level expected from immediate recall. We operationalised this prediction as Consolidation Bottleneck Index*(CBI*), a cognitively normal reference normalised residual index, and evaluated it using Alzheimer's Disease Neuroimaging Initiative (ADNI) cognitive and MRI data, with independent dynamical support from OpenNeuro EEG. Simulations showed recent memory vulnerability when hippocampal vulnerability exceeded cortical vulnerability. In ADNI, CBI* increased from cognitively normal participants to mild cognitive impairment nonconverters, reached Alzheimer like levels in mild cognitive impairment converters, and was associated with hippocampal atrophy. CBI* added minimal discrimination beyond established clinical and structural predictors, supporting its role as a mechanistic phenotype rather than a replacement prognostic model. OpenNeuro EEG further showed increased neurodynamic rigidity in AD. Our findings provide a computational framework for quantifying failed stabilisation of newly encoded information in AD progression.

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

Constraining the outputs of ReLU neural networks

arXiv:2508.03867v2 Announce Type: replace-cross Abstract: We introduce a class of algebraic varieties naturally associated with ReLU neural networks, arising from the piecewise linear structure of their outputs across activation regions in input space, and the piecewise multilinear structure in parameter space. By analyzing the rank constraints on the network outputs within each activation region, we derive polynomial equations that characterize the functions representable by the network. We further investigate conditions under which these varieties attain their expected dimension, providing insight into the expressive and structural properties of ReLU networks.

16.
arXiv (CS.LG) 2026-06-18

Stealthy World Model Manipulation via Data Poisoning

arXiv:2606.18697v1 Announce Type: new Abstract: Model-based learning agents use learned world models to predict future states, plan actions, and adapt to new environments. However, the process of updating world models from collected experience creates a training-time attack surface: adversarially poisoned fine-tuning trajectories can manipulate the learned dynamics and thereby corrupt downstream planning. In this paper, we propose SWAAP, the first two-stage data poisoning framework for learned world models. In the first stage, SWAAP identifies a harmful target world model that induces low-return behavior under planning while remaining close to clean dynamics, using first-order bilevel optimization enabled by a transition-gradient theorem. In the second stage, SWAAP realizes this target through stealth-constrained gradient matching, modifying only a limited fraction of fine-tuning transition targets so that the induced training gradients steer the victim model toward the adversarial target, while a prediction-error regularizer encourages the poisoned targets to remain close to the world model's natural approximation error. To assess attack stealthiness, we evaluate defenses and detectability across three stages of the poisoning pipeline: pre-training detection of poisoned transitions, robust training during fine-tuning, and test-time monitoring of the resulting world model. Across diverse continuous-control tasks, SWAAP causes substantial performance degradation while keeping poisoned transitions close to clean data and evading the evaluated non-adaptive residual/CUSUM/TRIM-style defenses. These results reveal a practical vulnerability in world-model adaptation pipelines and highlight the need for robustness methods that protect both world-model training data and learned dynamics.

17.
Nature (Science) 2026-06-09

Good recycling starts at home — and benefits the world

作者: 未知作者

New research supports the value of household-level waste separation. But policies must also carefully consider consumer behaviours to maximize the quality of material collected. New research supports the value of household-level waste separation. But policies must also carefully consider consumer behaviours to maximize the quality of material collected.

18.
arXiv (CS.LG) 2026-06-15

Structured Noise Adaptation for Sequential Bayesian Filtering with Embedded Latent Transfer Operators

arXiv:2606.14195v1 Announce Type: new Abstract: Kalman filters based on the Embedded Latent Transfer Operators (ELTO) emerge as novel statistical tools for sequential state estimation. However, a critical limitation stems from their use of simplified noise models, which fail to dynamically adapt to non-stationary processes. To address this limitation, we introduce an ELTO-based Bayesian filtering approach with a new structured parameterization for the filter's noise model. This parameterization enables structured noise adaptation, which couples the data-driven learning of an optimal time-invariant noise model with dynamic parameter adaptation that responds to changes in dynamics within non-stationary processes. Empirical results show that our structured noise adaptation improves the filter's dynamic state estimation performance in noisy, time-varying environments.

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

Resilient Consensus in Agentic AI

arXiv:2606.15024v1 Announce Type: cross Abstract: Large language model (LLM) agents are increasingly deployed in multi-agent systems where they must coordinate and agree on shared decisions. We ask whether classical resilient consensus theory, developed for deterministic agents, transfers to LLM agents that may behave adversarially. Framing LLM agreement as a Byzantine consensus game, we run controlled experiments on complete and general communication graphs. We find that prompted LLM agents fail to reach agreement that is achievable in principle: consensus can fail even in settings where classical theory guarantees that a convergent algorithm exists, and this failure persists across temperatures and horizons. At the same time, wrapping the agents with classical resilient consensus filters improves agreement. The benefit of filtering depends on how much robustness the underlying topology already provides. Our results suggest that classical resilient consensus theory is a useful lens for the safety of agentic AI.

20.
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.

21.
bioRxiv (Bioinfo) 2026-06-19

Children's DNA Methylation and Family Dynamics in a Congo Basin Subsistence Community: Links with Parental Conflict and Fathers' Caregiving

Family environments may contribute to children's long-term health through biological processes, including epigenetic regulation such as DNA methylation (DNAm). However, most studies in this area focus on Euro-American populations while also rarely including fathering data. The current study investigated children's blood DNAm associations with positive (father caregiving) and negative (parental conflict) family dynamics in a smaller-scale subsistence society living in the Congo Basin rainforest. We measured DNAm from dried blood spots of 54 children (mean age=8.48 years) and conducted three epigenome-wide association studies aimed at discovering differential co-methylated regions (CMRs) associated with family dynamics. Via path models, we investigated the health implications and shared contribution of family factors of the identified CMRs. Differential DNAm associated with family dynamics was localized to genes related to stress, immunology, development, and aging, thus possibly linking to children's physical health and were simultaneously connected to other family factors such as number of siblings. Our findings suggested similarities in biological embedding of family factors across socio-ecologically diverse contexts.

22.
medRxiv (Medicine) 2026-06-16

Higher Population Coverage with Typhoid Conjugate Vaccine is Needed to Induce Herd Protection: Evidence from a Cluster-Randomized Trial in Urban Bangladesh

Introduction: A cluster randomized trial (CRT) in Bangladesh found that Vi-tetanus toxoid (Vi-TT) vaccine conferred 85% protection to vaccinees at 18 months of follow-up; however, it failed to confer significant herd protection to non-vaccinees. Methods: In the CRT, children aged 9 months to

23.
arXiv (math.PR) 2026-06-16

Plateau Gaps of Poisson Correctors Encode Metastable Reaction Rates

arXiv:2606.14789v1 Announce Type: cross Abstract: Metastable reaction rates are commonly inferred from transition-state fluxes, mean first-passage times, or fitted kinetic models. We show that they are directly encoded in the plateau gap of an occupation-time Poisson corrector. For a centered basin-occupation observable, the Poisson corrector develops metastable plateaus in the reactant and product basins, and their separation determines the forward and backward transition rates. This construction requires only the generator, stationary measure, and metastable partition, and therefore does not rely on a predefined transition-state surface. In overdamped and underdamped double-well dynamics, the plateau-gap rate recovers the Kramers, Grote-Hynes, and Pollak-Grabert-Hänggi hierarchy. The same corrector-martingale decomposition yields a reactive-noise density, revealing where stochastic forcing contributes to transitions in configuration or phase space. Thus, reaction rates and their fluctuation sources emerge from a single corrector field.

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

VinQA: Visual Elements Interleaved Long-form Answer Generation for Real-World Multimodal Document QA

Real-world documents combine text with tables, charts, photographs, and diagrams arranged in diverse layouts, yet existing research on multimodal large language models (MLLMs) for document QA predominantly produces text-only responses, underutilizing these visual elements. We introduce VinQA, a dataset for long-form answer generation where cited visual elements are explicitly interleaved with their supporting text and grounded in relevant document pages. To support this task, we study two encoding methods for feeding raw document page images into an MLLM, along with their visual-element citation mechanisms: (1) Page Encoding, which directly encodes full-page images with bounding boxes of visual elements and treats these boxed regions as citable units; and (2) Modality Encoding, which parses each page to extract text and crop visual elements, encodes them separately, and uses these cropped elements as citable units. In our experiments, we propose M-GroSE, a multimodal evaluation framework extending GroUSE to assess answers along four dimensions: completeness, answer relevancy, faithfulness, and unanswerability. We additionally report Visual Source F1 to directly measure visual citation accuracy. Although proprietary frontier models still achieve the best overall scores on the VinQA test split, fine-tuning open Qwen2.5-VL models on the training split substantially improves their performance and narrows this gap. Modality Encoding is initially more robust for complex documents with long text, many visual elements, and diverse citation requirements. After training on VinQA, however, Page Encoding reaches a comparable level, competing effectively even without the explicit parsing used in Modality Encoding. Finally, Visual G-Eval, an MLLM-based judge, confirms that fine-tuned models insert visual elements at semantically appropriate positions with faithful supporting text.

25.
medRxiv (Medicine) 2026-06-24

Multifactorial tuberculosis severity score for people living with HIV based on the Rand Appropriateness Method

Background In people living with Human Immunodeficiency Virus (PLWH), tuberculosis (TB) is the leading cause of death and is often associated with substantial morbidity. Better identifying PLWH with severe forms of TB could help target early interventions to reduce mortality and severe morbidity. Existing TB severity assessment tools may be sub-optimal for assessing disease severity in PLWH, since they incompletely integrate key determinants of disease severity. We aimed to develop a consensus-based TB severity score tailored to PLWH. Methods We developed a multifactorial TB severity score (TBSS) for PLWH using a modified Delphi process with a multidisciplinary group of international TB experts as the second part of a RAND/UCLA Appropriateness Method, following a previously published systematic review. Results Eight of 15 invited experts (53%) participated in both Delphi rounds. Of 62 candidate factors, 15 reflecting TB-related characteristics, host-related characteristics as well as characteristics related to both TB and host were rated as having high appropriateness for inclusion in the final TBSS. The total score ranges from 0 (no severity) to 61 (highest severity). Conclusion This study represents a first step towards the development of a multidimensional TB severity assessment tool for PLWH. However, its clinical usefulness, feasibility, and added value compared with existing severity scores remain to be demonstrated through validation studies before routine implementation can be considered. Key words: tuberculosis, HIV, severity.