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01.
arXiv (CS.CV) 2026-06-16

LLM-Based Visual Explanation Evaluation Framework for Assessing the Explainability of Facial Skin Disease Classification Models

作者:

This study proposes a domain-specific LLM-based Visual Explanation Evaluation Framework for assessing Grad-CAM explanations in facial skin disease diagnosis models. While previous studies have primarily focused on improving classification performance through data augmentation techniques, relatively few studies have systematically examined whether model explanations are grounded in clinically relevant lesion regions. In this study, geometric augmentation, color-based augmentation, and mixed augmentation strategies were applied to facial skin disease classification models based on EfficientNet-B0, MobileNetV3, and ResNet18. Grad-CAM was employed to generate visual explanations representing the models' decision-making processes. Furthermore, an LLM-as-a-Judge evaluation framework was designed using GPT-5.5, Gemini 3.5 Flash, and Claude Sonnet 4.6 to assess Grad-CAM explanations from the perspectives of lesion localization and explanation trustworthiness. To improve evaluation consistency and clinical grounding, a progressive prompt engineering strategy was introduced, incorporating evaluation rubrics, clinical knowledge, penalty rules, and structured output formats.

02.
arXiv (CS.CL) 2026-06-18

Structured Inference with Large Language Gibbs

The knowledge encoded in large language models (LLMs) can serve as a substrate for structured reasoning over variables describing a complex world, but accessing this knowledge in a probabilistically coherent manner poses a difficult inference problem. We propose Large Language Gibbs, a scheme for structured probabilistic inference that uses conditional distributions of an LLM as transition operators. Rather than sampling structured objects through single-pass autoregressive generation, we iteratively resample individual variables conditioned on others using an LLM's next-token conditionals. This approach avoids order-dependent biases and produces a stationary distribution that reflects a compromise between all local conditionals. We apply this approach to sampling from synthetic distributions, consistent reasoning tasks, and Bayesian structure learning. The results suggest that the use of LLM conditionals in MCMC is a practical alternative to one-pass generation for structured probabilistic inference under a world prior accessible through noisy LLM conditionals.

03.
arXiv (CS.AI) 2026-06-25

Convex–Concave Quadratic Spectral Filtering for Graph Neural Networks

arXiv:2606.24956v1 Announce Type: cross Abstract: Spectral graph neural networks (GNNs) interpret message passing as frequency-selective filtering. While low-order spectral filters are efficient, their limited selectivity often leads to weak attenuation outside the passband, whereas high-order alternatives introduce optimization challenges. We propose DCQ-GNN, a spectral GNN based on a compact bank of adaptive convex–concave quadratic filters. By restricting the filter order to two while explicitly exploiting complementary curvature, DCQ-GNN improves spectral selectivity as quantified by Dirichlet energy and entropy measures without resorting to high-order polynomial expansions. The model fuses filter outputs through a node-adaptive gating mechanism to enable node-wise structure-aware spectral selection. We provide a formal spectral analysis grounded in Dirichlet energy attenuation, von Neumann entropy, and curvature polarity, and derive explicit characterizations of filter behavior across varying levels of homophily and structural perturbations. Extensive benchmarks on 10 datasets show that DCQ-GNN ties for the top average rank (3.0) on heterophilic graphs and obtains the second-best rank (4.2) on homophilic graphs, remaining competitive with representative high-order polynomial spectral filters. Furthermore, under strong structural perturbations, DCQ-GNN exhibits substantially smaller performance degradation compared to both first-order and high-order baselines. These results demonstrate that curvature-aware quadratic banks provide a robust and efficient alternative to high-order spectral models while preserving optimization stability and computational efficiency.

04.
medRxiv (Medicine) 2026-06-15

Evaluation of AI-Generated Synthetic Data for Clinical Research in Secondary Cardiovascular Prevention among Dyslipidemia Patients

Background: Access to high-quality clinical data is essential for advancing medical research and developing effective medical statistical and Artificial Intelligence models. However, privacy regulations and logistical barriers often hinder timely access to real-world data. Synthetic data offer a promising solution, preserving the statistical characteristics of original datasets while protecting patient privacy. Objectives: This study investigates the use of synthetic data for secondary cardiovascular prevention in patients with dyslipidemia, using two real-world datasets from Centro Cardiologico Monzino. Methods: Given the high dimensionality and limited sample size of the datasets, we employed a custom generative framework based on Large Language Models (LLMs). Pre-trained LLMs were fine-tuned on original clinical records to synthesize tabular data replicating source-data distributions. Fine-tuning was performed within the Centro Cardiologico Monzino's secure infrastructure to ensure data sovereignty. We evaluate clinical utility and privacy using fidelity and privacy metrics, identifying the optimal generative model and benchmarking against traditional anonymization methods. Results: Synthetic data achieved a superior trade-off than classically anonymized datasets. Real and synthetic datasets showed strong agreement, with significant distributional differences limited to few variables. Models trained on synthetic data replicated key associations from the original dataset, including therapy modification and creatine phosphokinase as predictors of SAMS, and pharmacological intensity as the main driver of LDL-C reduction. Conclusions: Results support the feasibility of using synthetic data as a proxy for real-world datasets in exploratory analyses and model development. Despite slight attenuation of some effect sizes, preserved clinical relationships reinforce the validity of synthetic data in medical research.

05.
arXiv (CS.LG) 2026-06-25

Low Variance Trust Region Optimization with Independent Actors and Sequential Updates in Cooperative Multi-agent Reinforcement Learning

arXiv:2606.25526v1 Announce Type: new Abstract: Cooperative multi-agent reinforcement learning assumes each agent shares the same reward function and can be trained effectively using the Trust Region framework of single-agent. Instead of relying on other agents' actions, the independent actors setting considers each agent to act based only on its local information, thus having more flexible applications. However, in the sequential update framework, it is required to re-estimate the joint advantage function after each individual agent's policy step. Despite the practical success of importance sampling, the updated advantage function suffers from exponentially high variance problems, which likely result in unstable convergence. In this work, we first analyze the high variance advantage both empirically and theoretically. To overcome this limitation, we introduce a clipping objective to control the upper bounds of the advantage fluctuation in sequential updates. With the proposed objective, we provide a monotonic bound with sub-linear convergence to $\epsilon$-Nash Equilibria. We further derive two new practical algorithms using our clipping objective. The experiment results on three popular multi-agent reinforcement learning benchmarks show that our proposed method outperforms the tested baselines in most environments. By carefully analyzing different training settings, our proposed method is highlighted with both stable convergence properties and the desired low advantage variance estimation. For reproducibility purposes, our source code is publicly available at https://github.com/giangbang/Low-Variance-Trust-Region-MARL.

06.
medRxiv (Medicine) 2026-06-17

Short-term relaxation after cervical rotatory manipulation is more closely associated with somatosensory input than cracking sound: a randomized controlled EEG study

Background Cervical rotatory manipulation is commonly used for neck-related symptoms and is often accompanied by a cracking sound. This sound is frequently regarded as a sign of successful manipulation, but whether it contributes substantially to the immediate relaxation response remains unclear. Objective This study examined whether short-term relaxation after cervical rotatory manipulation is more closely related to manipulation-associated sensory input than to the cracking sound cue alone. Methods In this single-session, three-arm, parallel randomized controlled study, 54 healthy volunteers were allocated to cervical rotatory manipulation, sham manipulation, or sham manipulation plus simulated cracking sound. Subjective outcomes were assessed before and after intervention, including positive affect, negative affect, comfort, and satisfaction. Eyes-closed resting-state electroencephalography was recorded before and after intervention. Prespecified neural outcomes included frontal alpha power, frontal alpha/beta ratio, occipital individual alpha frequency, and alpha-band fronto-parietal and fronto-temporal functional connectivity. Results Cervical rotatory manipulation produced greater improvements in positive affect, comfort, and satisfaction than sham manipulation or sham manipulation plus simulated cracking sound, whereas negative affect remained generally stable across groups. These subjective responses were accompanied by short-term electroencephalography changes, particularly in frontal alpha/beta and alpha-band fronto-parietal and fronto-temporal functional connectivity. Changes in frontal alpha/beta ratio were positively associated with changes in positive affect. In contrast, simulated cracking sound alone did not reproduce the full subjective or electroencephalography response observed after real manipulation. Conclusions The immediate relaxation response after cervical rotatory manipulation appears to be more closely related to manipulation-associated sensory input than to the cracking sound cue alone. These findings provide preliminary neurophysiological evidence for distinguishing real manipulation effects from sound-related contextual cues.

07.
arXiv (CS.AI) 2026-06-15

AdaTKG: Adaptive Memory for Temporal Knowledge Graph Reasoning

arXiv:2605.07121v2 Announce Type: replace Abstract: Temporal knowledge graphs (TKGs) represent time-stamped relational facts and support a wide range of reasoning tasks over evolving events. However, existing methods produce entity representations that are static at the entity level, in that each representation is a function of learned parameters only and retains no trace of the interactions in which the entity has participated. In this paper, we depart from this static view and propose that each entity be modeled as an adaptive process whose representation is refined every time the entity participates in a fact. To this end, we propose AdaTKG, which maintains a per-entity memory that is updated with every observed interaction, with the memory accumulating online and predictions improving as more interactions arrive. Specifically, we instantiate the memory update as a learnable exponential moving average governed by a single shared scalar instead of using learnable parameters for each entity, enabling AdaTKG to handle entities unseen during training. Extensive experiments confirm consistent gains over TKG baselines, demonstrating the effectiveness of adaptive memory. Code is available at: https://github.com/seunghan96/AdaTKG

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

Hubs or Fringes: Pretraining Data Selection via Web Graph Centrality

The performance of modern language models depends critically on pretraining data composition. Yet existing data selection methods rely on auxiliary classifiers for document scoring or mixture optimization, adding computational overhead and dependence on labeled data. We propose WebGraphMix, a lightweight data selection framework that computes structural centrality scores over the Common Crawl host-level web graph and uses them to vary the proportion of central versus peripheral documents in the pretraining mixture. We hypothesize that central hosts expose models to reusable abstractions, while peripheral hosts encode specialized, long-tail knowledge. WebGraphMix computes centrality scores efficiently at web scale, requiring no model training, labeled data, or downstream supervision. We integrate WebGraphMix into the DataComp-LM pipeline and train models at 400M and 1B parameter scales with 8B and 28B tokens respectively, evaluating on 23 tasks ranging from factual knowledge to symbolic reasoning. Our experiments show that central and peripheral web regions encode complementary capabilities. Mixture combining both at a ratio of 1:1 achieves 41.4% on average, compared to 39.8% for uniform sampling. Combining structural scores with document-level quality classifier scores further improves performance to 43.8%. These findings demonstrate that web graph topology is a meaningful axis for pretraining data curation, capturing information that is largely orthogonal to existing content-based approaches.

09.
arXiv (math.PR) 2026-06-16

Malliavin Calculus for the stochastic Cahn-Hilliard equation driven by fractional noise

arXiv:2601.10490v2 Announce Type: replace Abstract: The stochastic partial differential equation analyzed in this work is the Cahn-Hilliard equation perturbed by an additive fractional white noise (fractional in time and white in space). We work in the case of one spatial dimension and apply Malliavin calculus to investigate the existence of a density for the stochastic solution $u$. In particular, we show that $u$ admits continuous paths almost surely and construct a localizing sequence through which we prove that its Malliavin derivative exists locally, and that its law is absolutely continuous with respect to the Lebesgue measure on $\bf R$, establishing thus that a density exists. A key contribution of this work is the analysis of the stochastic integral appearing in the mild formulation: we derive sharp estimates for the expectation of the $p$-th power ($p \geq 2$) of the $L^{\infty}(D)$-norm of this stochastic integral as well as for the integral involving the $L^{\infty}(D)$-norm of the operator associated with the kernel appearing in the integral representation of the fractional noise, all of which are essential for this study.

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

Effective Dimension Governs Generalization in Quantum Kernel Vision Models

arXiv:2606.20183v1 Announce Type: new Abstract: Recent quantum vision models-quantum vision transformers and quantum convolutional networks-report two striking but unexplained empirical phenomena: (i) ansatze with more, or more uniformly distributed, entanglement generalize better, and (ii) injecting quantum noise can improve test accuracy rather than degrade it. These observations are currently treated as curiosities, discovered by grid search and explained, if at all, by hand. We show that both are manifestations of a single, measurable quantity: the effective dimension $d_eff$ of the (noise-shaped) quantum feature kernel. Working primarily with quantum-kernel vision models-a quantum feature map read out by a kernel classifier-we give a spectral account in which entanglement structure and quantum noise are two knobs that move $d_eff$; in an overfitting regime, contracting $d_eff$ acts as ridge-like regularization. We analyze the mechanism: an exact decomposition of the depolarized kernel $K_p=(1-p)^2K+\tfrac{p(2-p)}{D}\mathbf{1}\mathbf{1}^\top$ with $d_eff(K_p)\to1$, a contraction result (and its boundary) for amplitude damping, a kernel-machine capacity bound, and a capacity/alignment risk decomposition; the monotone contraction operative in our entangled experiments is verified empirically, not proven in general. Along the one-parameter depolarizing family the collapse is instead exact by construction; we use it only to confirm the kernel decomposition to machine precision and at up to $12$ qubits, not as evidence for $d_eff$. Amplitude damping contracts $d_eff$ and lifts test accuracy by up to $+13\%$ along an inverted-U sweet spot; the effect's sign flips between the over- and under-fitting regimes; noise injection matches an explicit spectral-filtering frontier. Our results organize two reported anecdotes into a single measurable principle for designing quantum-vision models.

11.
arXiv (quant-ph) 2026-06-12

Spectral analysis of equilibration: information leakage in isolated quantum systems

arXiv:2606.12545v1 Announce Type: new Abstract: We develop a unified dynamical-spectral framework for equilibration in isolated quantum systems based on a subspace coarse-graining approach. Central to our formulation is the Leakage Fidelity Function (LFF), defined as the probability that a unitarily evolving state escapes the support of its initial subspace. This quantity provides a direct, operational measure of information flow and memory loss without invoking ensemble assumptions or perturbative arguments. We derive universal bounds on temporal fluctuations of the LFF, in terms of the spectral gap structure and the square of the effective dimension, evincing that large spectral delocalization suppresses fluctuations and guarantees equilibration on average. By introducing spectral power distributions and associated entropic measures, we establish a quantitative link between phase mixing, gap participation, and dynamical stability. We further investigate the equilibration timescale by connecting the LFF to quantum speed limits, thereby revealing the average time required for equilibration. Our results provide a state-dependent, geometrically transparent perspective on how spectral complexity and subspace information leakage jointly govern irreversibility in closed quantum many-body systems.

12.
arXiv (CS.AI) 2026-06-19

Hierarchical Control in Multi-Agent Games: LLM-based Planning and RL Execution

arXiv:2606.20014v1 Announce Type: cross Abstract: Reinforcement learning (RL) has achieved strong performance in sequential decision-making, yet scaling to complex multi-agent environments remains challenging due to sparse rewards, large state-action spaces, and the difficulty of learning coordinated strategies. We propose a hierarchical architecture where a pretrained large language model (LLM) acts as a centralized strategic controller that selects among specialized RL skill policies for a team of agents, while RL policies handle reactive low-level execution. We evaluate this hybrid system in a competitive 2v2 King of the Hill environment against behavior tree (BT) and ``Flat'' RL (end-to-end training without skill decomposition) baselines. The LLM+RL system achieves task performance statistically equivalent to hand-crafted BT (46.4\% vs 51.5\% win rate, $p=0.103$) while both significantly outperform Flat RL trained without skill decomposition. A user study ($n=15$) reveals that 60\% of participants perceive LLM+RL agents as the most human-like ($p=0.027$), citing behavioral adaptability and tactical variability. These results demonstrate that pretrained LLM reasoning can effectively orchestrate pretrained RL skills, achieving competitive multi-agent coordination and superior perceived believability without manual rule engineering.

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

Bilevel Data Curation for LLM Fine-tuning: Offline Selection and Online Self-Refining Generation

Supervised fine-tuning (SFT) datasets are critical to the downstream performance of large language models, yet they often contain low-quality or harmful question-response pairs. To improve SFT data quality, we develop a unified bilevel framework that combines offline data selection with the online self-refining generation. In the offline setting, bilevel data selection (BDS) selects question-response pairs from the offline SFT dataset to maximize the validation performance. We theoretically show that the optimal model given by BDS outperforms direct data mixing approach in useful data coverage. Moreover, we provide a global convergence analysis for gradient-based BDS approach for one-layer Transformer, showing that the epsilon-global optimum of offline BDS is achievable in finite time. Although efficient, offline BDS discards potentially harmful questions together with responses, thereby reducing question diversity. We address this limitation by refining the responses to selected questions using online self-refining generation framework. However, BDS is inefficient to update the response weights when responses are regenerated online. To address this issue, we introduce bilevel multi-objective optimization (BMO) for response-level weighting. We show that BMO recovers the same validation-aligned solution as BDS, but admits a closed-form importance-ratio weight that adapts to regenerated responses. Experiments on LLM quality enhancement and safety-aware fine-tuning demonstrate that the proposed framework consistently improves both data quality and downstream fine-tuning performance.

14.
arXiv (CS.AI) 2026-06-24

EMAgnet: Parameter-Space EMA Regularization for Policy Gradient Self-Play in Large Games

arXiv:2606.23995v1 Announce Type: cross Abstract: Recent work has established that regularized policy gradient methods such as PPO, when used in self-play, can match or exceed specialized game-theoretic algorithms for solving two-player zero-sum imperfect-information games. The uniform distribution has emerged as a strong policy regularization target for this purpose, but it regularizes equally toward all actions regardless of their viability. We introduce EMAgnet, which instead regularizes toward an exponential moving average (EMA) of the last-iterate policy's parameters, providing an adaptive regularization target that evolves with the agent's improving strategy. We evaluate EMAgnet on both standard two-player zero-sum benchmarks and modified benchmarks with exploration challenges and large numbers of strictly dominated strategies. Relative to PPO self-play with uniform-magnet regularization under both linear and power-law annealing schedules, EMAgnet achieves lower exploitability in the majority of tested environments, with consistent performance gains across games containing strictly dominated strategies.

15.
arXiv (CS.CV) 2026-06-17

Million-scale multimodal pollen microscopy with expert-guided foundation models

Automated pollen identification from microscopy remains a bottleneck in aerobiology, palaeoecology and biodiversity monitoring, because scalable systems must generalise across specimen preparation, scanner settings and geographic origins while retaining palynological interpretability. To address this gap, we present a million-scale multimodal pollen microscopy resource, Pollen AI Atlas, assembled from pure-species whole-slide bright-field images spanning four geographic origins, four scanner settings and 46 taxon labels across 31 botanical families. Seeded by one manually selected exemplar per source slide, token-level mining and filtering produced 1,511,390 released grain detections with 99.6\% proposal precision in expert-curated test regions. Each detection was paired with machine-generated grain-level morphological captions from five open-weight vision-language models, guided by expert-verified palynological anchors, yielding structured descriptions of aperture systems, wall ornamentation, shape and size. Among the evaluated models, Gemma4 provided the most controlled primary caption set, combining tight length control, no leakage and the strongest text-retrieval performance. Baseline benchmarks with frozen visual features reached 88.16\% top-1 accuracy, while cross-regional retrieval showed that caption-derived text embeddings remained robust when image similarity degraded (mAP@20 0.811 versus 0.262). Released data, annotations, captions, splits, code, and weights provide a benchmark for pollen recognition, cross-regional domain adaptation and domain-specific multimodal microscopy learning.

16.
arXiv (quant-ph) 2026-06-11

Emergent mirror symmetry in the optimization of the central-spin quantum battery

arXiv:2606.11557v1 Announce Type: new Abstract: Quantum batteries provide a useful setting for exploring nonequilibrium many-body effects in energy storage. Here we investigate the optimization of a quantum battery based on the central-spin model. We identify two complementary structural indicators associated with the effective charging dynamics: one yields an upper bound on the average charging power, while the other characterizes the buildup of stored energy. We show that these two indicators are jointly optimized at a distinguished initial charger excitation number, which selects a particular Dicke sector of the model. At this common optimal point, the effective charging Hamiltonian becomes exactly mirror symmetric, suggesting mirror symmetry as a useful structural indicator for optimizing quantum batteries. We further show that the corresponding optimal dynamics can be closely approximated by product initial states, in particular by spin coherent states whose excitation-number distribution is centered at the symmetry-selected point. Our results establish a direct connection between charging performance, optimal-state structure, and emergent symmetry in the central-spin quantum battery, and suggest symmetry as a useful organizing principle for efficient charging in interacting many-body quantum systems.

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

GAS-Leak-LLM: Genetic Algorithm-Based Suffix Optimization for Black-Box LLM Jailbreaking

arXiv:2606.15788v1 Announce Type: cross Abstract: Large Language Models (LLMs) constitute pivotal components within the AI-dominated information technology ecosystem. To mitigate risks associated with harmful or policy-violating outputs, commercial systems employ advanced alignment strategies and multi-layered content moderation mechanisms. Despite these safeguards, recent research has demonstrated that LLMs remain vulnerable to adversarial manipulation, particularly through jailbreaking and prompt injection techniques. In this work, we propose GAS-Leak-LLM a novel jailbreaking attack based on a genetic algorithm that systematically evolves adversarial suffix to bypass safety constraints. Operating in a strict black-box setting, our method requires no access to model parameters or internals, thereby reflecting realistic threat scenarios in deployed systems. Through the iterative application of selection, mutation, and crossover heuristics, the framework systematically explores the discrete prompt space to identify high-fitness adversarial suffixes. Empirical findings reveal critical shortcomings in existing safety enforcement mechanisms and confirm the effectiveness and practical viability of the proposed attack.

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

Forecasting Future Behavior as a Learning Task

arXiv:2606.11445v1 Announce Type: new Abstract: Trust in an AI system is often anchored by explanations of how it works, which one then uses to forecast its behavior on new inputs. For large reasoning models (LRMs), this conventional route is particularly difficult to follow: explanation methods for single token generations do not naturally generalize to long trajectories, and the trajectories themselves are often not faithful when read as natural language. We propose an alternative that bypasses the explanation step: treat behavior forecasting as a learnable task and train Behavior Forecasters that operates on a single reasoning trajectory to make the same forecasts one would typically seek from an explanation. The forecaster's training data is obtained by querying the LRM with no human annotation, and its inference is done in a single forward pass. We instantiate this approach on two tasks: how likely the LRM is to repeat its answer on re-runs, and how removing parts of the input changes its answer. We evaluate this approach on both tasks across three diverse reasoning datasets and find that trained Behavior Forecasters are more accurate than GPT-5.4 and Claude Opus-4.6 reading the same trajectories as naive readers, at a small fraction of their inference cost. We find that fine-tuning the backbone end-to-end and initializing it from the target LRM are each necessary for strong performance. These results show that the reasoning trajectory carries information about the LRM's future behavior that goes beyond what naive reading conveys.

19.
arXiv (quant-ph) 2026-06-12

Non-invertible symmetries out of equilibrium: Eigenstate order and Floquet physics

arXiv:2508.14213v2 Announce Type: replace-cross Abstract: Through the study of the Rep($D_8$) non-invertible symmetry, we show how non-invertible symmetries manifest in dynamics. Results are presented for dynamics generated by Hamiltonians as well as Floquet unitaries. For both examples, the role of the non-invertible symmetry is studied through the appearance of non-invertible symmetry protected edge modes. In addition, the role of the non-invertible symmetry for the Hamiltonian is studied through eigenstate order. In particular, by considering the effect of symmetry preserving disorder, the non-invertible symmetry is shown to give rise to degeneracies in the spectra of the Hamiltonian that can only be completely lifted at orders of perturbation that scale with system size. The eigenstates of disordered Hamiltonians, whose ground state correspond to non-trivial symmetry protected topological (SPT) states, are shown to have either trivial or non-trivial SPT order that are detected as non-zero expectation value of string order-parameters. In contrast, non-trivial SPT order is absent in the eigenstates of trivial SPT Hamiltonians with disorder. The interface between two different SPT phases host edge modes whose dynamics is studied numerically and analytically. The edge mode is shown to oscillate at frequencies related to different effective chain lengths that are weighted by the temperature, becoming an exact zero mode in the limit of zero temperature. A Floquet model with the non-invertible symmetry is constructed whose edge mode is shown to exhibit period-doubled dynamics at low effective-temperatures. The zero and period-doubled edge modes differ from those in conventional SPTs by being symmetric under the invertible symmetry, while being charged under the non-invertible symmetry.

20.
medRxiv (Medicine) 2026-06-23

Differential Recovery Trajectories of Emergency Otolaryngologic Conditions across the COVID-19 Pandemic: A Six-year Longitudinal Study from an Urban Emergency Center

作者:

Objective: The COVID-19 pandemic markedly altered social activity patterns, healthcare utilization, and the epidemiology of infectious diseases. However, its long-term impact on emergency otolaryngologic conditions remains incompletely understood. This study investigated long-term trends in emergency otolaryngologic conditions before, during, and after the COVID-19 pandemic using comprehensive data from a large urban emergency clinic in Osaka, Japan. Methods: All new otolaryngologic outpatients who visited the Chuo Emergency Medical Clinic (CEMC) in Osaka City between 2019 and 2024were retrospectively analyzed. Annual trends in absolute numbers and relative proportions of emergency otolaryngologic conditions were examined by anatomical region and disease category, using 2019 as the pre-pandemic baseline. Results: A total of 99,324 new otolaryngologic outpatients were analyzed. Overall emergency visits declined sharply to approximately half of baseline in 2020, followed by a gradual but incomplete recovery toward pre-pandemic levels by 2024. Most anatomical categories declined to 45-61% of baseline in 2020 and exhibited gradual yet incomplete recovery through 2023; in stark contrast, laryngeal conditions diverged sharply, surging beyond pre-pandemic levels after 2022. Acute infectious otorhinolaryngologic diseases fell to 23-50% of baseline in 2020 and showed variable recovery (69-103%) by 2024. Notably, laryngitis exceeded the baseline, reaching 132% in 2023, whereas epiglottic edema exhibited only a transient increase approaching the baseline in 2021. Non-infectious emergency conditions generally showed only a marginal decrease in 2020 and remained relatively stable throughout the study period, except for sudden sensorineural hearing loss (SSNHL), which dropped sharply to 39% of the baseline in 2020 and remained persistently reduced through 2024. Traumatic emergencies declined variably to 53-81% of the baseline in 2020, followed by an incomplete recovery, reaching only 55-69% by 2024. Conclusion: Emergency otolaryngologic conditions demonstrated heterogeneous recovery trajectories following the COVID-19 pandemic. While most infectious and traumatic conditions gradually but incompletely normalized, laryngeal conditions showed a distinct post-pandemic surge, and SSNHL remained persistently suppressed. These findings reveal heterogeneous, condition-specific recovery trajectories that reflect both genuine shifts in community pathogen burden, true traumatic incidence, and persistent alterations in healthcare-seeking behaviors, insights essential for resource allocation during future public health emergencies.

21.
medRxiv (Medicine) 2026-06-23

Linking mpox wastewater surveillance with reported clinical cases in three countries in Sub-Saharan Africa

The emergence of the novel monkeypox virus (MPXV) clade Ib in the Democratic Republic of the Congo (DRC) and neighboring countries in late 2023 highlighted the need for rapid, scalable surveillance approaches to support outbreak detection and response. As part of the ODIN-Mpox project, wastewater surveillance (WWS) systems were established as an emergency public health measure in three Sub-Saharan African countries (DRC, Tanzania, and Burkina Faso) to evaluate the feasibility of wastewater-based monitoring for mpox and strengthen local surveillance capacity. Between January 2025 and April 2026, 117 wastewater samples were collected from selected sites and analyzed for MPXV DNA using targeted qPCR assays. Clinical mpox data were obtained from national surveillance systems and WHO reports to assess epidemiological linkages between wastewater detections and reported infections. Six wastewater samples tested positive for MPXV DNA. During the study period, DRC experienced the highest disease burden, with weekly reported cases peaking at about 3,000 in January 2025, while Tanzania reported a peak of 20 weekly cases in March 2025. No confirmed clinical cases were reported in Burkina Faso. No clear relationship was observed between reported case numbers and qPCR Ct values in positive wastewater samples. Despite the low detection frequency, the project demonstrated the operational feasibility of implementing MPXV wastewater surveillance in resource-limited settings and established laboratory capacity for environmental monitoring of emerging infectious diseases. Given the early stage of WWS implementation in the region, the study identified opportunities for further system strengthening, including optimization of sample processing and reporting workflows, improved access to laboratory supplies, and enhanced integration of environmental and clinical surveillance data streams. These findings highlight the value of WWS as a complementary component of integrated public health surveillance systems and emphasize the need for continued investment in laboratory capacity, harmonized methodologies, governance frameworks, and knowledge exchange to enhance outbreak preparedness and response in low-resource settings.

22.
arXiv (CS.LG) 2026-06-15

NeST: Neuron Selective Tuning for LLM Safety

arXiv:2602.16835v2 Announce Type: replace-cross Abstract: Safety alignment is essential for the responsible deployment of Large Language Models (LLMs). Yet, existing approaches often rely on heavyweight fine-tuning that is costly to update, audit, and maintain across model families. Full fine-tuning incurs substantial computational and storage overhead, while parameter-efficient methods, e.g., Low-Rank Adaptation (LoRA), trade efficiency for inconsistent safety gains and sensitivity to design choices. Safety intervention mechanisms reduce unsafe outputs without modifying model weights, but do not directly shape or preserve the internal representations that govern safety behavior. We present NeST, a Neuron-Selective Tuning framework for efficient post-hoc safety alignment. NeST identifies safety-relevant feed-forward neurons via activation probing on vanilla harmful and benign prompts, clusters neurons with similar activation profiles, and trains shared cluster-level updates while freezing the rest of the model. Importantly, NeST is trained only on vanilla malicious prompts, without using jailbreak-specific attack data, yet generalizes robustly to diverse jailbreaks. The learned updates are then folded into the original weights, incurring no inference-time overhead. Evaluated on 14 open-weight language and multimodal models, NeST outperforms lightweight baselines and approaches full fine-tuning robustness with significantly fewer trainable parameters. On text-only models, NeST reduces average jailbreak attack success rate from 44.5% to 1.1% while training only 0.4M parameters on average. Across multimodal settings, it reduces ASR from 55.3% to 1.1%, and for downstream fine-tuned variants, it restores safety by reducing ASR from 53.8% to 0.8%. These results show that robust, maintainable safety alignment can be achieved by concentrating adaptation on localized, functionally coherent safety structures.

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

Detect Before You Leap: Mirage Detection in Vision-Language Models

Vision-language models (VLMs) can produce confident visual answers even when the required visual evidence is missing, blank, or unrelated to the question. This failure mode, recently described as mirage (mirage2026), is especially concerning in medical and document VQA, where a plausible but visually ungrounded answer may be mistaken for image-based evidence. We study the complementary problem of pre-release mirage detection: given an image-question pair, determine whether the VLM should answer or abstain before generation. To that end, we propose a novel model-agnostic Text-Conditioned Layer-wise Internal Alignment (TC-LIA) method that probes patch-token representations across the layers of a CLIP ViT-H/14 vision encoder. The key idea is to project layer-wise image patch tokens into the final CLIP embedding space and measure their similarity with the question embedding, thereby tracking whether question-relevant visual evidence emerges across vision layers. TC-LIA summarizes this alignment trajectory using final image-text cosine similarity, late-layer top-k patch-text alignment, early-to-late gain, and layer-wise slope. These features are combined with pixel-statistic based blank/noise detection, zero-shot domain routing, and structured VLM self-assessment in an ensemble. Across five VQA domains with related, unrelated-real, and blank/noise inputs, and across twelve VLM backbones, Qwen2.5-VL-32B achieves the highest three-class detection accuracy of 94.7% with a 3.0% mirage rate, while Qwen2.5-VL-72B achieves 94.6% accuracy with a lower 2.8% mirage rate. Baseline mirage rates span 21.7-66.6%.

24.
arXiv (quant-ph) 2026-06-25

Tripartite Entanglement in $e^+ e^- \to t \bar{t} Z$

arXiv:2606.11296v3 Announce Type: replace-cross Abstract: Multipartite entanglement is a uniquely quantum form of correlation that captures collective properties of a composite quantum state beyond those encoded in its bipartite subsystems. We investigate this phenomenon in the process $e^+e^-\to t\bar tZ$ at a future lepton collider, where the final state spins span the tripartite Hilbert space $\mathscr{H} = \mathbb{C}^2 \otimes \mathbb{C}^2 \otimes \mathbb{C}^3$. Starting from the Standard Model helicity amplitudes, we reconstruct the full $12\times 12$ spin density matrix and characterise its entanglement structure through one-to-one negativities, one-to-other negativities, and the genuine multipartite negativity, evaluated at three increasingly inclusive levels of phase space integration. Pairwise entanglement is generally suppressed relative to the collective (one-to-other) and the genuine multipartite entanglement, and all measures decrease as more kinematic information is integrated out. Assuming quantum tomography in the fully leptonic decay channel at $\sqrt{s}=1$ TeV, we find that collective entanglement should be accessible at a realistic high-luminosity polarised lepton collider. By contrast, certifying genuine multipartite entanglement is more challenging, with only limited sensitivity projected for a specific polarisation benchmark within the expected ILC luminosity. The study establishes $e^+e^-\to t \bar{t}Z$ as an attractive laboratory for probing multipartite entanglement in high-energy collisions and provides a general mixed state framework that applies to any tripartite spin system.

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bioRxiv (Bioinfo) 2026-06-17

Beyond phylogeny: Genome-wide DNA sequence patterns suggest DNA physical properties associated with thermal adaptation in extremophile microbes

Temperature is a fundamental constraint on biological systems, yet how it is reflected in genome sequence organization remains unclear. Here, we show that genome-wide distributions of short DNA sequences contain a robust signal of thermal adaptation that is largely independent of phylogeny. Using Structural Topic Modelling (STM), a machine-learning approach for identifying groups of co-occurring sequence motifs, we analyze canonical 6-mer and 9-mer frequency profiles of bacterial and archaeal genome proxies (randomly sampled genomic regions) and identify motif families systematically associated with thermophiles and psychrophiles. In bacterial thermophiles, the identified motif families are dominated by highly specific, overrepresented and co-occurring C- and G-stacked hexamers, and a distinct family of CG-periodic hexamers recurring across multiple temperature comparisons. In contrast, bacterial psychrophile-associated motifs are dominated by low-complexity A-, T-, and AT-run hexamers. Thermophilic archaea generally exhibit a distinct CTAG-centred hexamer family, suggesting that different domains may adapt to similar environmental constraints through different sequence-level solutions. However, this domain-level contrast is not absolute: in a targeted analysis of two thermophilic bacterium–archaeon pairs, we find unusually similar frequencies of all the STM-identified thermophile-associated hexamer families, suggesting that shared high-temperature environments can, in specific cases, partially override phylogenetic divergence. Notably, the identified motif families constitute only a small and highly selective subset of the vast space of possible G+C-rich or A+T-rich sequences. This indicates that thermal adaptation is associated with specific sequence architectures rather than broad shifts in nucleotide composition. Accordingly, the observed signal cannot be explained by overall base composition alone, but instead arises from structured combinations and positional arrangements of nucleotides within short sequence contexts. Related motif families are recovered at both k=6 and k=9, indicating that the signal reflects systematic shifts in genome-wide sequence organization rather than isolated sequence motifs. These patterns are consistent with known sequence-dependent DNA physical properties documented in biochemical and biophysical studies, including differences in base-stacking interactions and conformational flexibility. Together, our results suggest that genome-wide sequence organization reflects sequence-dependent DNA physical properties associated with thermal adaptation, revealing a previously underappreciated physical layer of genomic information beyond phylogenetic history.