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

Insulin4RL: Real-Time Insulin Management in the Intensive Care Unit for Offline Reinforcement Learning

arXiv:2606.19481v1 Announce Type: new Abstract: Offline reinforcement learning (ORL) offers the potential to improve the quality of clinical decision-making using historical electronic health record (EHR) data. Current training and evaluative practices in this field rely heavily on EHR datasets that have been temporally discretised into fixed, regular time intervals. Discretisation creates fictional representations of complex clinical scenarios and compromises the generalisability of retrospective model evaluations. In this paper, we introduce Insulin4RL, a healthcare ORL dataset featuring naturally irregular inputs and actions from real clinical trajectories. Derived from MIMIC-IV, Insulin4RL comprises over 375,000 labelled decisions across 12,209 patients requiring insulin infusion titration in the Intensive Care Unit. The dataset can thus be used for research into ORL model performance under realistic clinical sampling assumptions. We provide a description of the dataset's structure and characteristics, baseline performance metrics using model-free offline reinforcement learning, and a standardised evaluation protocol using fitted Q-evaluation. We conclude with suggested areas for future research that could be addressed using this resource.

02.
arXiv (CS.CL) 2026-06-25

BiPACE: Bisimulation-Guided Policy Optimization with Action Counterfactual Estimation for LLM Agents

Stepwise group-based RL is an attractive way to train long-horizon LLM agents without a learned critic: it reuses multiple sampled rollouts to estimate local advantages. Its weakness is less visible but more fundamental: every group-relative estimator assumes that the steps it compares are equivalent for credit assignment. We show that current agentic variants violate this assumption through a state-action credit mismatch. The observation-hash partition is overly fine on the state side, creating singleton groups with zero step-level signal, while a single within-group mean is too coarse on the action side, mixing state-value estimation with action-specific credit. We introduce BiPACE (Bisimulation-Guided Policy Optimization with Action Counterfactual Estimation), a drop-in advantage estimator that fixes both sides without adding a critic, auxiliary loss, or extra rollouts. BiGPO clusters steps by cosine distance in the actor's own hidden-state geometry, an empirical policy-induced proxy for bisimulation that substantially lowers the singleton rate left by observation hashing. PACE then recenters returns within each behavioral cluster using action-conditioned peer baselines; its Q-style instance estimates a local Q(s,a)-V(s) nonparametrically. On ALFWorld/Qwen2.5-7B, BiPACE_Q raises overall validation success from GiGPO's 90.8 to $97.1\pm0.9$ over three seeds, and crosses the 95% threshold on every seed, which GiGPO never does within the same budget. On Qwen2.5-1.5B it reaches $93.5\pm1.2$ versus GiGPO's 86.7, and on WebShop and TextCraft it improves over GRPO and GiGPO at both model scales. The measured BiPACE-specific overhead is 11.3% of a single training-step wall time. Yet it changes the estimator's comparison unit from surface identity to approximate behavioral equivalence plus action-side counterfactuals. The code is available at https://github.com/TianxiangZhao/BiPACE.

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

Beyond Runtime Enforcement: Shield Synthesis as Defensibility Analysis for Adversarial Networks

arXiv:2606.13621v1 Announce Type: new Abstract: Shielded reinforcement learning is typically presented as a runtime safety mechanism that compiles temporal-logic specifications into automata restricting an agent's actions. We argue this is the wrong product. The same automata-theoretic machinery – specification compilation, product game construction, attractor computation, and winning-region extraction – is better read as a design-time analytical instrument whose outputs are structural insights about a system rather than runtime constraints on a deployed agent. We instantiate this through a constrained two-player safety game for network defense. The two specifications are enforced asymmetrically: the defender specification defines the unsafe region of the game, whereas the attacker specification restricts the adversary's legal actions during attractor computation. Solving the game yields a defensibility verdict – a formal certificate that a topology-specification pair is or is not defensible – with the associated winning region and shield. Beyond the binary verdict, we derive topology-level metrics from the attractor structure and combine them with post-convergence behavior from shield-constrained adversarial multi-agent reinforcement learning. Together these form a defensibility fingerprint capturing both a network's formal safety properties and its operational behavior under adaptive play. A what-if analysis shows that formal defensibility and operational effectiveness capture distinct aspects of security: small architectural changes can produce large shifts in operational outcomes while leaving formal safety margins nearly unchanged. Shield synthesis is thus most valuable not as a deployment mechanism for safe agents, but as a framework for answering architectural questions about whether, where, and how a system can be defended. The defensibility verdict is the output, not the safe policy.

04.
arXiv (math.PR) 2026-06-15

Upper tails for irregular graphs beyond the mean-field regime

arXiv:2606.14564v1 Announce Type: new Abstract: Let $G_{n,p}$ be the binomial random graph of density $p$ and let $X_H$ be the number of copies of a fixed graph $H$ in $G_{n,p}$. We prove asymptotically tight bounds on the logarithmic upper-tail probability of $X_H$ whenever $H$ is a connected, irregular graph with maximum degree $\Delta \ge 2$ and $p \ge n^{-1/\Delta - \varepsilon_H} (\log n)^{\omega(1)}$ for an explicit $\varepsilon_H >0$. These bounds are expressed in terms of a new variational problem that generalises the combinatorial optimisation problem arising from the naïve mean-field approximation. This new variational problem includes an entropy term that corresponds to the large number of embeddings of certain highly structured graphs in $K_n$. For a certain class of irregular graphs $H$ that we call stable, we show that this description of the upper-tail probability is valid in a range of densities that is optimal up to a poly($\log\log n$) factor. For a further subclass of stable graphs, which includes all irregular complete bipartite graphs, we show that this range of densities is optimal up to a multiplicative constant.

05.
arXiv (quant-ph) 2026-06-11

Magneto-Optical Trapping of a Metal Hydride Molecule

arXiv:2512.22350v2 Announce Type: replace-cross Abstract: We demonstrate a three-dimensional magneto-optical trap (MOT) of a metal hydride molecule, CaH. We are able to scatter $\sim$$10^{4}$ photons with vibrational loss covered up to vibrational quantum number $\nu=2$. This allows us to laser slow the molecular beam near zero velocity with a "white-light" technique and subsequently load it into a radio-frequency MOT. The MOT contains $230(40)$ molecules, limited by beam source characteristics and predissociative loss of CaH. The temperature of the MOT is below one millikelvin. The predissociative loss mechanism could, in turn, facilitate controlled dissociation of the molecule, offering a possible route to optical trapping of hydrogen atoms for precision spectroscopy.

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

Zone of Proximal Policy Optimization: Teacher in Prompts, Not Gradients

Knowledge distillation transfers a teacher's competence to a small student but is brittle in the small-student regime: forcing the student to imitate logits from a much larger teacher concentrates it on the teacher's sharpest modes, hurting generalization on benchmark families beyond the training corpus. Reinforcement learning (RL) avoids logit imitation by training on the student's own rollouts. However, on questions where every rollout fails-yielding zero advantage and being silently discarded-injecting a stronger teacher's response into the policy gradient breaks the on-policy assumption and induces drift. We introduce Zone of Proximal Policy Optimization (ZPPO), inspired by Vygotsky's zone of proximal development, which keeps the teacher inside the prompt rather than the policy gradient. On hard questions, ZPPO constructs two reformulated prompts: a Binary Candidate-included Question (BCQ) pairs one correct teacher response with one incorrect student response as anonymized candidates the student must discriminate, and a Negative Candidate-included Question (NCQ) aggregates the student's wrong rollouts into a single prompt to surface their shared failure modes. A prompt replay buffer recirculates each hard question until it either graduates-the student's mean rollout accuracy on it reaches half- or is FIFO-evicted under finite capacity, amplifying BCQ and NCQ inside the student's current zone of proximal development. On the Qwen3.5 family at four student scales (0.8B-9B) with a 27B teacher, post-trained as vision-language models and evaluated on a 31-benchmark suite (16 VLM, 10 LLM, 5 Video), ZPPO outperforms off/on-policy distillation and GRPO, with the largest gains at the smallest scale.

07.
medRxiv (Medicine) 2026-06-24

Cardiologists perspectives on sociocultural and structural factors shaping cardiovascular genetic testing

Introduction: Genetic testing is increasingly central to the diagnosis and management of cardiovascular genetic conditions. However, use and follow-through vary across patient populations. Examining clinician perspectives on sociocultural and structural factors influencing testing is important for understanding these differences and informing public health genomics research and implementation efforts. Methods: We conducted semi-structured interviews with 15 cardiologists from health systems across the United States who have integrated cardiogenetics in their practice. Interviews explored experiences diagnosing cardiovascular genetic conditions among patients from underrepresented backgrounds, as well as approaches to incorporating social and contextual information into care. Data were coded thematically and analyzed using a framework analysis guided by the Health Equity Implementation Framework and Social Determinants of Health domains. Results: Clinicians described multi-level factors shaping genetic testing practices, including patient-provider interactions, clinical workflows, health system infrastructure, and broader policy contexts. Key themes included challenges communicating complex genetic information across language and literacy differences; patient trust shaped by prior healthcare experiences; fragmented insurance coverage separating genetic testing from genetic counseling; and challenges interpreting variants of uncertain significance, particularly for populations underrepresented in genomic reference databases. Clinicians also described adaptive strategies, such as interdisciplinary collaboration, telehealth, and patient assistance programs, that supported testing in some settings but were often inconsistent or resource-dependent. Conclusion: Among cardiologists using genetic testing, system-level and sociocultural factors shape the feasibility and downstream use of cardiovascular genetic testing. Findings highlight considerations for public health-informed genomic infrastructure that accounts for social context, supports communication, and reduces reliance on individual clinician workarounds, with implications for clinical decision support and related public health genomics initiatives.

08.
arXiv (quant-ph) 2026-06-25

Rounding Almost Commuting Hamiltonians

arXiv:2605.26096v2 Announce Type: replace Abstract: Commuting Hamiltonians lie at the boundary between classical constraint satisfaction and quantum many-body physics, exhibiting rich quantum structure while remaining more tractable than general noncommuting models. In contrast, physical Hamiltonians are rarely exactly commuting, which naturally motivates the study of almost commuting Hamiltonians. Despite their relevance, the implications of approximate commutation are only poorly understood. In this work, we show how to efficiently approximate any almost commuting $2$-local qubit Hamiltonian by a commuting one: we give a new locality-preserving algorithmic rounding technique that maps any $2$-local Hamiltonian $H=\sum_{i=1}^m h_i$ with $\|[h_i,h_j]\| \leq \epsilon$ to a nearby Hamiltonian $\hat{H}$ whose terms pair-wise commute, and which is within overall distance $\|H-\hat{H}\| = O(m\,\epsilon^{1/6})$. As a consequence, we show that $\delta$-approximations to the ground energy for $\epsilon$-almost commuting $2$-local qubit Hamiltonians lie in $\mathsf{NP}$ when $\delta \gg m\epsilon^{1/6}$, extending the classical containment well beyond the commuting setting. Finally, we present two applications of our rounding framework: Gibbs sampling and fast Hamiltonian simulation for almost commuting systems.

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

MiniPIC: Flexible Position-Independent Caching in <100LOC

Retrieval-augmented and agentic workloads repeatedly prefill recurring predictable structured inputs (which we call "spans") such as documents and code files. Yet, prefix caching in engines such as vLLM cannot reuse their KV entries unless they share identical prefixes with another request, while Position-Independent Caching (PIC) implementations within production-grade inference servers typically either require substantial server code changes or keep KV state outside the server, incurring host-to-device transfer overhead. We present Minimalistic PIC (MiniPIC): a minimal, flexible and fast vLLM design built from two ingredients: positional-encoding-free KV cache and user-controlled cache-reuse primitives. MiniPIC stores unrotated K vectors in the KV cache, applies RoPE to K tiles inside attention using per-request logical positions, and exposes three user-facing and token-level primitives: block-aligned padding, span separator (SSep), and prompt depend (PDep), that modify hashing behavior and effective block-level causal attention structure. With fewer than 100 lines of core-engine changes plus a custom attention backend, these primitives are sufficient to realize multiple PIC methods, including Block-Attention, EPIC, and Prompt Cache, within the same running vLLM instance, while natively integrating with KV cache CPU offload implementations. On 2WikiMultihopQA, MiniPIC with interleaved scheduling improves prefill throughput by 49% over baseline vLLM, reduces cached-span time-to-first-token by up to two orders of magnitude, preserves the linear prefill scaling of uncached spans, and incurs only 5.7% worst-case overhead.

10.
bioRxiv (Bioinfo) 2026-06-24

Statistical tests for bivariate spatial association across multi-omics data with disjoint coordinates

Spatial biology has entered a new era of multimodal profiling, with multiple, high-dimensional spatial omics types being measured on consecutive tissue slices, or co-assayed on the same slice. Interest then lies in statistical testing for spatial association between the features of the different modalities, to gain insight in biological processes. One major challenge is the multitude of bivariate combinations, leading to high computational demands. Another difficulty is the difference in spatial resolution between technologies, implying no one-to-one matching between the measurement spots of the two modalities, even after alignment. As a result, common statistical measures such as joint distributions and correlations are not defined, and tests need to rely on spatial vicinity only. Moreover, we argue that many existing bivariate association tests address an inappropriate null hypothesis, or make inappropriate assumptions, both implying absence of spatial autocorrelation in any of the features and leading to misleading conclusions. As a remedy, we modify tests for the detection of spatially variable genes (Moran's I, Gaussian processes and generalized additive models (splines)) to derive bivariate tests across modalities with non-overlapping coordinate sets and provide variance estimators that do account for spatial autocorrelation. We develop inference methods for single sections as well as for replicated experiments with multiple sections, and compare their performance in nonparametric and parametric simulations. Finally, we apply the newly developed methods to two co-assayed spatial transcriptomics and metabolomics datasets from mouse and human. The full suite of tests is available from github.com/sthawinke/sbivar as the R-package sbivar.

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

LLM Consumer Behavior Theory: Foundations of a Novel Research Field

arXiv:2606.18005v1 Announce Type: new Abstract: Large language models (LLMs) are increasingly deployed as autonomous agents that make consumption decisions on behalf of users. This shift raises fundamental questions for consumer theory, which has traditionally modeled humans as the primary decision-makers. In this paper, we introduce LLM Consumer Behavior Theory, a new field of study concerned with analyzing consumer behavior in agentic markets. Drawing on classical and behavioral economics alongside recent advances in Natural Language Processing, we formalize how human preferences are reflected and acted upon by LLM-based agents, and how agent-level decisions aggregate into market demand. We unify previously fragmented literature on LLM decision-making, human behavior simulation, and preference elicitation under a common economic lens, highlighting where assumptions, such as rationality and heterogeneity, may fail in agentic markets. Rather than providing empirical validation, this paper outlines the scope of LLM consumer behavior and identifies open research questions related to alignment, preference representation, and market dynamics.

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

DiffMath: Symbol- and Graph-Aware Latent Diffusion Transformer for Handwritten Mathematical Expression Generation

Handwritten Mathematical Expression Generation (HMEG) is challenging due to the complex two-dimensional layouts and long-range structural dependencies of mathematical expressions. Existing methods typically rely on explicit spatial supervision, such as symbol-level bounding boxes, which incurs high annotation costs and limits scalability. In this work, we propose DiffMath, a symbol- and graph-aware latent diffusion framework that leverages the hierarchical structure inherent in LaTeX as a structural prior, eliminating the need for positional supervision. First, we design a Relational Abstract Syntax Tree (RelAST), a generation-oriented representation that distills MathML trees into compact triplet sequences [S, R, D], where each token directly encodes a symbol identity, spatial relation, or nesting depth. Second, we introduce MathVAE, which learns structure-preserving latent representations through symbol-aware and relation-aware perceptual regularization, ensuring that the latent space captures both character semantics and spatial topology. Third, MathDiT performs conditional denoising in this structured latent space, further guided by a global symbol-count prior via Adaptive Layer Normalization (AdaLN) to improve structural coherence. Experiments show that DiffMath produces structurally consistent handwritten expressions, achieves superior performance over existing methods, and improves the accuracy of downstream OCR models through synthetic data augmentation.

13.
arXiv (CS.AI) 2026-06-16

RL-Index: Reinforcement Learning for Retrieval Index Reasoning

arXiv:2606.16316v1 Announce Type: cross Abstract: Retrieving external knowledge is essential for solving real-world tasks, yet it remains challenging when the relationship between a query and its relevant knowledge involves implicit and complex reasoning beyond surface-level semantic or lexical matching (e.g., mathematical problems relying on the same theorem or coding requiring deep reasoning). Existing approaches primarily rely on query-side reasoning (e.g., query rewriting), which introduces significant online latency and underutilizes the opportunity to perform reasoning over the knowledge corpus itself (i.e., index-side reasoning). In this paper, we propose RL-Index, an agentic indexing framework that formulates retrieval index reasoning as a reinforcement learning problem. Instead of performing reasoning at query time, RL-Index shifts reasoning to the indexing stage by augmenting documents with LLM-generated rationales that explicitly encode the latent query-knowledge relationship. To optimize the quality of these rationales, we employ Group Relative Policy Optimization (GRPO) and use retrieval similarity as a verifiable reward signal, enabling direct optimization of indexing decisions for retrieval effectiveness. Extensive experiments on the BRIGHT benchmark demonstrate that RL-Index consistently improves both retrieval and downstream question-answering performance, while significantly reducing online inference latency. Moreover, the learned rationale augmentation generalizes across diverse retrievers and generators, highlighting its robustness as a plug-and-play indexing strategy across different retrieval systems.

14.
arXiv (CS.CV) 2026-06-15

PMOF: A Dataset and Benchmark for Passenger Monitoring Using Overhead Fisheye Cameras

Autonomous staff-free public transport requires reliable in-vehicle passenger monitoring. However, perception inside moving vehicles is challenged by confined spaces, variable illumination, motion-induced background variation, occlusion, and limited viewpoints. To mitigate these spatial constraints, ceiling-mounted fisheye cameras provide full-scene coverage from a single viewpoint. Yet existing public overhead fisheye datasets are recorded in static environments and do not capture the domain shift introduced by vehicle motion. To fill this gap, we introduce PMOF, Passenger Monitoring using Overhead Fisheye cameras, the first public dataset of top-view fisheye imagery captured inside a moving vehicle, comprising over 19k manually annotated frames. PMOF provides rotated bounding boxes, tracking identifiers, and action labels, supporting object detection, tracking, and action recognition. We benchmark PMOF using YOLO26m-obb models fine-tuned under multiple dataset configurations that combine PMOF with existing overhead fisheye datasets. Cross-domain fine-tuning with custom rotation-aware augmentation achieves 94.8% AP50 on PMOF and 96.5% AP50 on an unseen overhead fisheye dataset from a different domain. Our results highlight the domain gap between static and moving environments and show that incorporating PMOF improves detection performance and advances generalization beyond passenger monitoring to broader fisheye-based person detection tasks. The dataset and code are available at https://swermuth.github.io/pmof/.

15.
medRxiv (Medicine) 2026-06-18

Biomedical Capacity, Governance, and Health Security: A Dominican Republic Research Analysis of Stakeholder Perspectives

The COVID-19 pandemic exposed critical vulnerabilities in globally concentrated biomedical supply chains and accelerated interest in nearshoring and hemispheric health-security strategies. The Dominican Republic, already the third-largest medical device exporter in Latin America, occupies a strategically significant but institutionally constrained position within this realignment. This study evaluates stakeholder perceptions of the principal opportunities and barriers affecting biomedical ecosystem development in the Dominican Republic, with particular attention to governance, workforce capacity, and value-chain upgrading pathways. Methods. A concurrent mixed-methods design was employed, integrating a cross-sectional electronic survey of 142 purposively sampled domain experts (administered September-December 2025) with a qualitative executive consultation with senior government and industry leaders. Survey analyses combined descriptive statistics, one-sample t-tests against the scale neutral midpoint, chi-square goodness-of-fit tests, Friedman non-parametric ranking, Spearman rank correlations, and exploratory linear and logistic multivariable regression. Qualitative responses were analyzed using a framework approach grounded in the Triple Helix model of innovation systems. Results. Perceived government support was significantly below neutral (mean = 2.67, SD = 1.12; p = 0.034). Workforce shortages (83.3%) and weak academia-industry collaboration (71.4%) were the most frequently endorsed barriers ({chi}2(5) = 18.7, p = 0.002). Regulatory modernization (88.1%) and workforce development (85.7%) ranked as the highest-priority policy levers (Friedman p = 0.005). Clinical trials and contract research organization services were the dominant sub-sector priority (76.2%, binomial p < 0.001). In multivariable analysis, perceived government support, talent availability, and confidence in IP protection jointly explained 46% of the variance in sector competitiveness (R2 = 0.46, p < 0.001). Strong majority support existed for a formal public-private biomedical coordination authority (73.8%, p < 0.001).Conclusion. Institutional credibility and advanced human capital–rather than geography or market access–are the perceived binding constraints on the Dominican Republics biomedical trajectory. Regulatory modernization, targeted workforce investment, and the establishment of a national biomedical coordination authority represent the highest-leverage interventions for positioning the country as a hemispheric hub for biomedical manufacturing, clinical research, and health security.

16.
medRxiv (Medicine) 2026-06-11

Computer Vision Scoring of Figure Copy and Recall

Objective. Figure copy and recall tests are sensitive measures of visuoconstruction and visual episodic memory, but their clinical is constrained by labor-intensive manual scoring. We developed and validated an automated, element-level scoring pipeline using Vertex AI object detection for the tablet-based figure copy and recall tasks in the California Cognitive Assessment Battery (CCAB). The automated scoring pipeline duplicated the scoring procedures used by expert manual raters. Methods. A normative sample of 2,011 community-dwelling adults aged 18-90 completed figure copy and delayed recall trials at baseline, with subsamples retested at 1 day and at 6, 18, and 30 months. Participants completed the drawings with their index finger on a tablet computer with finger position digitized to analyze the speed and timing of individual drawing strokes A convolutional object-detection model trained on the Vertex AI AutoML Vision platform identified each of twelve canonical figure elements in rendered drawings. Separate element presence and location scores were computed after homographically warping drawings onto a canonical template to produce trial-level Element, Location, and Total scores. To compare Vertex and human scores, Vertex AI and expert human raters independently scored 1500 randomly selected drawings to evaluate inter-rater agreement, including a common subset of 100 drawings scored by Vertex AI and all raters. Results. Total scores were virtually indistinguishable (r = 0.966) from human-human agreement (mean r = 0.971) as were Element presence scores (mean r = 0.959 vs. r = 0.963). Location-score agreement (r = 0.951) was slightly below the human-human mean (r = 0.972) due to pixel-level analysis by Vertex AI that was impossible for human raters. The Vertex pipeline showed no preferential advantage for the single expert rater who categorized Elements during training. Automated scores showed strong demographic gradients, age effects on Recall (r = -0.32) were approximately twice those in Copy conditions (r = -0.16). A Memory Cost score (Recall - Copy) showed a monotonic age-related decline from +0.40 z in the youngest subjects to -0.54 z in the oldest. Kinetic analysis revealed that drawing speed and efficiency showed significant age-related changes. Overnight test-retest reliability was high (Recall r = 0.72) and the Recall trial showed a large overnight learning effect ({Delta} = +1.18) that continued with repeated tests up to 30 months ({Delta} = +0.75).

17.
medRxiv (Medicine) 2026-06-22

Development of a Novel Risk Prediction Model for Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD): A Longitudinal Study

Background: Interstitial lung disease (ILD) is one of the most common and potentially most devastating extra-articular complication of rheumatoid arthritis (RA) and is associated with substantial morbidity and mortality. However, reliable tools for the early identification of ILD in patients with RA remain limited. This study aimed to identify plasma protein biomarkers of RA-ILD and develop an interpretable machine learning model for risk prediction using data from the UK Biobank. Methods: We first evaluated the association between baseline RA and the risk of incident ILD in the UK Biobank using Cox proportional hazards models. Mendelian randomization analysis was then performed to investigate the potential causal relationship between RA and ILD. Finally, we analyzed 2,920 plasma proteins measured using the Olink platform in 781 eligible RA patients. Proteins associated with ILD risk were identified using Cox proportional hazards models and subsequently used to construct eight machine learning models. Model performance was assessed using the receiver operating characteristic curve (ROC) and decision curve analysis. The best-performing model was further interpreted using Shapley additive explanations (SHAP) to evaluate feature importance. Results: Compared with participants without RA, Patients with baseline RA had a significantly higher risk of developing ILD (Hazard ratio: 4.425, 95% CI: 3.549,5.518). The MR supported a potential causal association between RA and ILD (Odds ratio: 1.227, 95% CI: 1.121,1.343). Among the eight machine learning models, the CatBoost model showed the best performance, achieving an area under the curve (AUC) of 0.884 (95% CI: 0.773,0.996). The SHAP analysis identified LAG3, NPC2, and LAMP3 are the three most important plasma protein predictors of ILD development in patients with RA. Conclusion: Plasma proteomics combined with machine learning may provide a promising approach for identifying biomarkers and predicting ILD risk in patients with RA. LAG3, NPC2, and LAMP3 may serve as candidate biomarkers for RA-ILD and warrant further validation. Keywords: Rheumatoid arthritis, Interstitial lung disease, Mendelian randomization, Machine learning, Plasma proteins.

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

Beyond Global Replanning: Hierarchical Recovery for Cross-Device Agent Systems

Real-world computer-use tasks often span multiple applications and devices, requiring agents to coordinate heterogeneous environments under dynamic runtime failures. Existing multi-device agent systems support task decomposition and cross-device assignment, but recovery remains largely coarse-grained: when execution fails, they typically retry the same strategy, reassign the subtask, or revise the global plan, without systematically modeling the device-local strategy space. This limits their ability to distinguish failures that can be repaired within the current device from those that require cross-device replanning. We propose H-RePlan, a hierarchical replanning framework for multi-device agents with unified API–CLI–GUI execution. H-RePlan equips each device with interchangeable execution strategies and separates device-local strategy recovery from orchestrator-level global replanning through a compact cross-layer failure abstraction. To evaluate this capability, we introduce HeraBench, a fault-injected benchmark that constructs cross-device workflows over Linux and Android devices and injects strategy- and device-level failures. Experiments show that H-RePlan substantially outperforms single-strategy and coarse-grained multi-device baselines, achieving higher completion, instruction adherence, and perfect-pass rates while reducing the token cost required for reliable end-to-end success. These results demonstrate that scope-aware hierarchical recovery is essential for robust multi-device agent execution.

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

DriveStack-VLA: Render-Teacher Alignment for BEV-Based DeepStack Vision-Language-Action Model

Vision-Language-Action driving models convert a pretrained Vision-Language Model into a driving policy, allowing them to use world knowledge and follow language guidances. However, existing VLA driving models still lack driving-oriented spatial intelligence: their policies are mainly grounded on perspective image tokens and language priors, while precise motion planning requires metric geometry, top-down scene structure, and attention to safety-critical perceptual cues. This limitation makes current models vulnerable to weak visual geometry modeling and perceptual coverage in expert demonstrations. In this paper, we present DriveStack-VLA, a framework built upon a large VLM backbone. To strengthen the spatial grounding of VLA driving, we develop dual visual modeling components. We inject a Bird-Eye-View representation into the Large Language Model decoder through a DeepStack-style connection, and propose Render-Teacher Alignment to align the perceptual focus of real images with that of rasterized images. Furthermore, to bridge the gap in multimodal trajectory selection, we introduce a head-based self-critique module that ranks sampled trajectories and conditionally refines the best one. DriveStack-VLA achieves 91.6 PDMS on NAVSIMv1, 91.0 EPDMS on NAVSIMv2 (with the human penalty filter enabled), and a driving score of 79.49 with a success rate of 56.36\% on the closed-loop Bench2Drive. More visualizations are available on our project page: https://anonymous.4open.science/w/drivestack-vla/.

20.
arXiv (CS.AI) 2026-06-16

Proximal Policy Optimization for Amortized Discrete Sampling

arXiv:2606.15793v1 Announce Type: cross Abstract: This paper explores policy gradient algorithms for training stochastic policies to sample from structured discrete probability distributions under the Generative Flow Network (GFlowNet) framework. Building on extensive theoretical connections between GFlowNets and entropy-regularized reinforcement learning, we derive equivalents of standard policy gradient algorithms for training GFlowNets, as well as experimentally explore their various methodological aspects, including baseline training and advantage estimation. Most importantly, our work is the first to derive and successfully apply proximal policy optimization to GFlowNets, showing its improved convergence speed and data efficiency compared to standard GFlowNet training objectives on benchmarks ranging from synthetic energies to molecular graph generation.

21.
arXiv (quant-ph) 2026-06-25

Recursive QLSTM with Dynamic Variational Quantum Circuit Adaptation

arXiv:2606.24932v1 Announce Type: new Abstract: Recent advances in quantum computing and machine learning have motivated the development of quantum models for sequential data processing. In this paper, we propose a Recursive Quantum Long Short-Term Memory model, or Recursive QLSTM, which extends QLSTM through metacore-based recursive constructions. We numerically test the model under different input sequence lengths, metacore designs, and recursive rules, and identify the best-performing architecture among these variants. For this selected model, we further provide theoretical arguments explaining why its recursive structure improves temporal information propagation and enhances learning performance. Our results suggest that Recursive QLSTM offers a flexible and effective framework for quantum recurrent learning over input time series of various lengths.

22.
medRxiv (Medicine) 2026-06-15

Investigation of Intra-Fraction Stability and Inter-Fraction Reproducibility of Deep Inspiration Breath-Hold Across Two Hypofractionated Radiotherapy Regimens in the HYPORT Adjuvant Study.

Background: Deep Inspiration Breath Hold (DIBH) is a widely used respiratory motion management technique for minimizing cardiac dose in left-sided breast radiotherapy. In the Breast HYPORT Adjuvant study, DIBH was employed for cardiac sparing in patients without nodal irradiation using a standardized institutional protocol with the Varian Real-time Position Management (RPM) system. Both moderate-hypofractionation (control arm - 40Gy in 15 fractions) and one-week hypofractionation (experimental arm - 26 Gy in 5 fractions) regimens were delivered using this protocol. This study aimed to evaluate the robustness of DIBH by analyzing intra-fraction stability and inter-fraction reproducibility of breath-hold amplitude across the two treatment regimens. Methods: Respiratory waveforms acquired during each treatment session were analyzed to determine the median breath-hold amplitude and its standard deviation during beam delivery. Intra-fraction stability was assessed from vari- ations within individual treatment sessions, while inter-fraction reproducibility was evaluated relative to the simula- tion waveform amplitude across all treatment sessions. These parameters were compared between the two HYPORT regimens to examine breath-hold consistency during treatment delivery. Moreover, an additional comparison was made between the one-week hypofractionation regimen and the first five fractions of the moderate-hypofractionation regimen to evaluate the effect of treatment duration . Lung volumes from free-breathing and DIBH CT scans were analyzed to assess the effectiveness of patient breath-hold training. Results: Both arms demonstrated an average 1.7-fold increase of air volume in lung during the breath-hold position, confirming the effective implementation of DIBH during treatment planning and delivery. Structured training resulted in increased breath-hold amplitudes, with gains of 22.87% and 24.16% with respect to the first trial session in the experimental and control arms, respectively. Both regimens receive equivalent doses for approximately the same air volume in lung . Despite the different prescription doses in the two arms (26 Gy vs. 40 Gy), the experimental arm achieved an equivalent mean heart dose of 2.91% (75.6 cGy) compared with 2.95% (118.51 cGy) in the control arm, suggesting a similar cardiac preservation protocol adopted during treatment planning. Intra-fraction stability was similar between the control arm and the experimental arm, with median amplitude variations of 1.006 mm (95% CI: [0.998-1.015]) and 1.079 mm (95% CI: [1.067-1.097]), respectively. In contrast, inter-fraction reproducibility improved in the experimental arm, with lower deviation from simulation amplitude (0.44 {+/-} 0.24 mm vs. 0.66 {+/-} 0.25 mm) for the entire treatment schedule. The stability and reproducibility of experimental arm were further compared with the first five fractions of the control arm. The results were similar to those of the experimental arm. Conclusion: In this study, we compared two treatment regimens in terms of intra-fraction stability and inter-fraction reproducibility during DIBH radiotherapy. Both regimens demonstrated comparable intra-fraction stability, indicating effective motion management irrespective of treatment duration. However, the experimental arm showed better inter- fraction reproducibility, suggesting more consistent breath-hold performance throughout the treatment course. Based on stability and reproducibility, a reasonable narrowing of the DIBH gating window may be implemented with minor changes to the institutional protocol. The observed trend highlights the potential for improved consistency with the experimental approach and supports further investigation to better understand the underlying factors and strengthen these findings in future studies.

23.
arXiv (CS.AI) 2026-06-11

Precomputing Multi-Agent Path Replanning Using Temporal Flexibility

arXiv:2601.04884v3 Announce Type: replace Abstract: Executing a multi-agent plan can be challenging when an agent is delayed, because this typically creates conflicts with other agents. So, we need to quickly find a new safe plan. Replanning only the delayed agent often does not yield an efficient plan, and sometimes cannot even yield a feasible one. On the other hand, replanning other agents may lead to a cascade of changes and delays, and it is computationally expensive. We show how to efficiently replan a single delayed agent by tracking and using the temporal flexibility of other agents while avoiding cascading delays. This flexibility is the maximum delay that the agent can take without changing the order with agents other than the initially delayed agent, or further delaying other agents. Our algorithm, FlexSIPP, precomputes all possible plans for the delayed agent and returns the changes to the other agents within the given scenario. We demonstrate our method in a real-world case study of replanning trains in the densely-used Dutch railway network and in the MovingAI MAPF benchmark set. Our experiments show that FlexSIPP provides effective solutions relevant to real-world adjustments, and within a reasonable timeframe.

24.
medRxiv (Medicine) 2026-06-22

Cumulative Metabolic Exposure to Hyperglycemia and Risk of Cardiovascular and Limb Events in Peripheral Artery Disease

Background: Although diabetes is a potent risk factor for the development of peripheral artery disease (PAD), the effect of cumulative metabolic exposure to hyperglycemia on risk of cardiovascular or limb events in patients with PAD remains unclear. Methods: The Peripheral Artery Disease: Long-term Survival (PEARLS) is a longitudinal registry of Veterans with newly diagnosed PAD identified using a natural language processing approach. Included patients had ankle brachial index [&le;]0.9 or toe brachial index [&le;]0.7, and no history of lower extremity revascularization or major amputation. Among patients with diabetes in this cohort, we assessed cumulative exposure to hyperglycema based on a 24-month rolling average of hemoglobin (Hgb) A1c values, categorized as [&le;]7%, >7% to [&le;]8%, and >8%. Multivariable Cox regression models evaluated the association between categories of HgbA1c, modeled as a time-varying exposure, and risk of cardiovascular (CV: myocardial infarction or stroke) and limb (chronic limb threatening ischemia [CLTI] or major amputation) events. Results: Among 45,109 patients with new diagnosis of PAD and pre-existing diabetes, the mean HgbA1c at baseline was 7.5%, with nearly one-third (30.4%) having HgbA1c >8%. The mean age was 70.4 years, 19.8% were Black and 4% were Hispanic. Patients with baseline HgbA1c >8% were younger and compared to those with HgbA1c [&le;]7%, more likely to have coronary disease, kidney disease, and obesity. Over a median follow up of 4.2 years, 8,306 (18.4%) patients experienced a CV event, and 8,199 (18.2%) experienced a limb event. The adjusted association between HgbA1c and hazard of CV events was 12% higher in patients exposed to HgbA1c >7% to [&le;]8% (HR 1.12; 95%CI: 1.05-1.18) and 38% higher in those exposed to HgbA1c >8% (HR 1.38; 95%CI: 1.30-1.46), compared to HgbA1c 7% to [&le;]8% (HR 1.20; 95%CI: 1.13-1.28) and HgbA1c >8% (HR 1.60; 95%CI: 1.51-1.70), respectively when compared to HgbA1c [&le;]7%. These findings were consistent in subgroups based on age and severity of PAD. Conclusions: Among diabetic patients with PAD, cumulatiave metabolic exposure to hyperglycemia is associated with a markedly increased risk of clinical events, especially limb events.

25.
arXiv (CS.LG) 2026-06-16

We Need Explanation Cards to Connect Explanation Algorithms to the Real World

arXiv:2606.16786v1 Announce Type: new Abstract: Algorithmic explanations are intended to help stakeholders understand opaque algorithmic decisions, but in practice, they often fall short. First, the meaning of algorithmic explanations is often not what one might intuitively expect, so expert knowledge is required to interpret them correctly. Second, recent work has shown that popular explanation algorithms are uninformative about the behavior of complex decision functions. Together, these issues create a gap between what explanations appear to convey and what they actually provide. In this work, we propose Explanation Cards for Explanation Algorithms, which augment standard explanations with complementary information about robustness and validity, as well as clear instructions for interpretation. The complementary information can render otherwise uninformative explanations practically useful, while also helping to detect cases where they are not. Importantly, the interpretation instructions in explanation cards shift responsibility from users to providers: Rather than expecting users to recognize what can and cannot be concluded from an explanation, providers must make this explicit upfront. Using counterfactual explanations and SHAP as examples, we demonstrate how providers can construct explanation cards and that these cards provide users with the guidance needed for sound interpretation. We further argue that explanation cards offer a practical means of operationalising the explainability provisions of the EU AI Act. Overall, explanation cards are a significant step toward making explanation algorithms fit for real-world use cases.