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01.
arXiv (CS.CL) 2026-06-24

Towards Spec Learning: Inference-Time Alignment from Preference Pairs

Steering a large language model (LLM) toward a desired behavior typically relies on an iterative process of hand-crafting a prompt based on a careful inspection of the model's responses. This is an involved, brittle, and error-prone process. Preference-based fine-tuning is a more rigorous but often prohibitively expensive solution. We propose spec learning, a framework that relies on a brief user instruction and a small set of preference judgments. These are compiled into specifications in the form of natural-language prompts for an LLM. Specifications condition LLMs at inference time, and no parameter updates to the underlying models are required. We show that the responses generated based on the compiled specifications often outperform direct preference optimization (DPO) on datasets from specialized domains whose preference signal is dense. Unlike opaque weight updates, the resulting specifications are human-readable and double as interpretable and transparent written embodiments of the preference signal that produced them.

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

Towards Functional Correctness of Large Code Models with Selective Generation

arXiv:2505.13553v3 Announce Type: replace-cross Abstract: The hallucination of code generation models hinders their applicability to systems requiring higher safety standards. One critical bottleneck in addressing code hallucination is the difficulty of identifying the functional correctness of generated code, due to its unnatural form. We address this core bottleneck by automatically generating unit tests using dynamic code analysis tools, leveraging the executable nature of code. Accordingly, we propose a selective code generator that abstains from uncertain generations – based on the functional correctness evaluated by generated unit tests – to theoretically control the correctness among non-abstained answers, \ie the false discovery rate. Finally, we propose to use generated unit tests in evaluation as well as in learning for precise code evaluation, calling this paradigm FuzzEval. We demonstrate the efficacy of our method along with the controllability of code hallucination and reasonable selection efficiency.

03.
arXiv (CS.CL) 2026-06-16

Connecting Speech to Words through Images

How can we learn the mapping between written words and their spoken counterparts in the absence of explicit textual supervision? We present a visually grounded method for building a vocabulary of spoken words using only images and their spoken descriptions. First, image captioning systems are used to build a vocabulary of written words representing salient visual concepts in the images. For each word, we then find utterances whose image captions contain that word. Then we use an unsupervised word discovery technique to align these utterances to locate instances of the target word. The result is spoken word segments that are linked to written words – all accomplished without any text supervision. In spoken word retrieval and keyword spotting experiments, the proposed approach outperforms a strong neural baseline while being more interpretable. These results demonstrate the feasibility of the approach in English and motivate future work on low-resource languages without transcripts.

04.
arXiv (CS.CV) 2026-06-16

A Survey on 3D Skeleton Based Person Re-Identification: Taxonomy, Advances, Challenges, and Interdisciplinary Prospects

Person re-identification via 3D skeletons is an important emerging research area that attracts increasing attention within the pattern recognition community. With distinctive advantages across various application scenarios, numerous 3D skeleton based person re-identification (SRID) methods with diverse skeleton modeling and learning paradigms have been proposed in recent years. In this paper, we provide a comprehensive review and analysis of recent SRID advances. First of all, we define the SRID task and provide an overview of its origin and major advancements. Secondly, we formulate a systematic taxonomy that organizes existing methods into three categories centered on hand-crafted, sequence-based, and graph-based modeling. Then, we elaborate on the representative models along these three types with an illustration of foundational mechanisms. Meanwhile, we provide an overview of mainstream supervised, self-supervised, and unsupervised SRID learning paradigms and corresponding common methods. A thorough evaluation of state-of-the-art SRID methods is further conducted over various types of benchmarks and protocols to compare their effectiveness, efficiency, and key properties. Finally, we present the key challenges and prospects to advance future research, and highlight interdisciplinary applications of SRID with a case study.

05.
PLOS Computational Biology 2026-06-08

Assessing the inference of single-cell phylogenies and population dynamics from CRISPR lineage recordings

by Julia Pilarski, Tanja Stadler, Sophie Seidel Multicellular organisms develop from a single cell by repeated rounds of cell division, differentiation, and death, which can be represented as a single-cell phylogenetic tree. Genetic lineage tracing allows us to investigate this development by tracking the ancestry of individual cells as populations grow and change over time. However, accurate reconstruction of the cell phylogeny and quantification of the corresponding phylodynamic parameters – cell division, differentiation, and death rates – from this tracking data remains challenging and needs to be systematically evaluated. We perform simulations and assess, using the Bayesian framework, the joint inference of time-scaled cell phylogenies and phylodynamic parameters from CRISPR lineage recordings with random or sequential edits. Principally, we characterize the inference improvements as the recorder capacity increases. We observe more accurate phylogenetic reconstruction from sequential compared to random recordings, but no substantial improvement in phylodynamic inference when using the additional information contained in the order of edits. Overall, we find that CRISPR lineage recordings carry a strong signal on the rates of cell division when appropriate models are used. However, we detect biases in the inferred rates of cell division and death under phylodynamic model misspecification, i.e., when fitting classic memoryless birth-death processes to synchronous cell divisions. Moreover, for scenarios when cells differentiate into distinct types, we demonstrate that Bayesian phylodynamic analysis of sparse end-point measurements can resolve these cell differentiation trajectories by lineage and time. Under prototypical dynamics, we recover cell type-specific division and death rates, and cell type transition rates in over 80% of simulations. Overall, this simulation study explores how much information on cellular development can be extracted from state-of-the-art genetic lineage tracing data using phylogenetic and phylodynamic methodology.

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

Strategic Feature Selection

arXiv:2606.18867v1 Announce Type: new Abstract: When algorithmic predictors inform resource allocation in high-stakes domains such as healthcare, these predictors must account for strategic manipulation of input features. The typical solution is to redesign the predictor itself to explicitly account for strategic interactions. In practice, however, decision makers are often constrained to adjusting coarser levers within existing prediction pipelines. For example, healthcare organizations often select which features to exclude based on perceived manipulability, while using standard regularization procedures to shrink the coefficients of retained features. In this work, we initiate a formal study of strategic classification through feature selection and its interaction with ridge regularization. Our main finding is that excluding individual features based on their manipulability alone is generally suboptimal. We provide a fine-grained characterization of the performance of a feature subset under optimal regularization, yielding new insights for policy design. Motivated by this characterization, we develop a practical algorithm for jointly choosing the feature set and the level of ridge regularization. Through a real-world case study on a healthcare payments benchmark, we illustrate how our algorithm can guide the design of coarse policy levers in practice. Our results provide a principled, practical framework for mitigating the effects of strategic behavior in algorithmic decision-making systems.

07.
arXiv (math.PR) 2026-06-18

Probabilistic representation and classical solutions of wave equations with complex polynomial nonlinearities

arXiv:2606.18919v1 Announce Type: cross Abstract: We review the probabilistic representation of solutions of wave equations with polynomial nonlinearities in spatial dimensions d=1,2,3 using stochastic branching processes. Under regularity assumptions on the initial data, we derive conditions ensuring the integrability of the corresponding Monte Carlo estimator, and the existence and smoothness of mild and classical solutions. We also present numerical results and comparisons with grid-based algorithms for the solution of nonlinear wave equations.

08.
arXiv (CS.LG) 2026-06-19

Variational Consensus Monte Carlo for Bayesian Mixture

arXiv:2606.19643v1 Announce Type: cross Abstract: Motivated by the privacy, sensitivity and sharing limitations of health data, we present a comprehensive pipeline for inference of Bayesian mixture models within a federated learning setting, i.e. when data cannot be fully shared or pooled across compute nodes. We adopt a Consensus Monte Carlo (CMC) approach, in which an MCMC algorithm is run independently within each data silo to estimate local posterior distributions, which are then aggregated to approximate the posterior over the full data. The variational CMC approach of Rabinovich, Angelino and Jordan (2015) [1] frames the aggregation step as a variational inference problem, but their application to mixtures assumes the number of clusters and key mixture parameters to be known. Our main methodological contributions are: (i) an extension of variational CMC to over-fitted Bayesian mixture models that infer the number of clusters and all model parameters, without requiring conjugacy; (ii) novel cluster-matching algorithms suitable for cross-silo settings in which not every cluster appears in each local dataset; (iii) a number of inference strategies for the aggregation step, matched to different federated learning constraints; and (iv) guidelines for choosing among these in practice. A comprehensive simulation study validates the framework and allows us to compare to state-of-the-art federated learning alternatives. Notably, we show that when the composition of local datasets reflects the underlying clustering structure in the data, our approach can recover small clusters with greater accuracy than standard MCMC applied to the pooled data. We illustrate the framework on large-scale electronic health record data, identifying multi-morbidity patterns in a British geriatric population.

09.
arXiv (CS.CL) 2026-06-25

Continual Knowledge Updating in LLM Systems: Learning Through Multi-Timescale Memory Dynamics

LLMs are trained once, then deployed into a world that never stops changing. External memory compensates for this, but most systems manage it explicitly rather than letting it adapt on its own. Biological memory works differently: coupled multi-timescale dynamics make new associations immediately usable, strengthen what repetition confirms, and let the rest fade. We argue that external memory should follow a similar principle. In Memini, this view takes the form of an associative memory that organizes knowledge as a directed graph. Each edge carries two coupled internal variables, one fast and one slow, following the Benna-Fusi model of synaptic consolidation. From this coupling, episodic sensitivity, gradual consolidation, and selective forgetting are expected to emerge as facets of a single mechanism, reframing external memory as a learning substrate that reorganizes through its own dynamics. This workshop article describes an early-stage conceptual design without experimental evaluation.

10.
arXiv (math.PR) 2026-06-12

Sub-Riemannian spectral distance

arXiv:2606.12804v1 Announce Type: cross Abstract: We study eigenvalues and eigenfunctions of the ``div-grad type" sub-Laplacian with respect to Popp's volume on a compact equiregular sub-Riemannian manifold $M$. Since Popp's volume is canonically determined by the sub-Riemannian structure of $M$, the spetra of the sub-Laplacian carry geometric meanings. In this paper, we first embed $M$ into the Hilbert space of square-summable sequences using eigenfunctions and then define a spectral distance between two compact equiregular sub-Riemannian manifolds. Our result is a sub-Riemannian analogue of Berard-Besson-Gallot's classical work in the Riemannian case.

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

A Scalable PyTorch Abstraction for Multi-GPU Gaussian Splatting

Gaussian splatting methods have become increasingly popular for neural reconstruction of the real world. However, they are often limited in scale and resolution due to compute and memory constraints. We present a multi-GPU Gaussian splatting approach that scales reconstruction to higher resolutions and larger scenes while abstracting away the code complexity typically associated with distributing a model. To accomplish this, we propose a PyTorch backend that distributes the Gaussian parameters and splatting operators across GPUs via CUDA unified memory and NVLink. Because distribution occurs at the operator level, the model code requires no explicit cross-device communication. More broadly, the backend exposes multiple GPUs as an aggregate PyTorch device and supports other PyTorch operators. We demonstrate city-scale reconstructions with street-level detail consisting of over 1 billion Gaussian splats, more than 25 times as many as the current state of the art.

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

ScoutVLA: UAV-Centric Active Perception via a Dual-Expert VLA Model for Open-World Embodied Question Answering

Aerial Embodied Question Answering (EQA) requires Unmanned Aerial Vehicles (UAVs) to actively perceive the environment and answer natural language questions. Existing outdoor EQA systems usually stop once the target enters the UAV's field of view, leaving the fine-grained viewpoint adjustment needed for evidence-seeking questions largely unresolved. To address this issue, we introduce FG-EQA, a fine-grained active perception EQA benchmark with more than 40K simulated trajectories and 1K real-world trajectories. Drawing inspiration from the ``waggle dance'' of scout bees, which iteratively adjust their flight paths to verify target information, we propose ScoutVLA, an evidence-driven Vision-Language-Action model for outdoor EQA. To emulate this active exploration behavior, ScoutVLA features a decoupled dual-expert architecture: a vision-language expert infers the semantic intent to identify missing evidence, while an independent action expert employs high-DoF flow matching to generate continuous viewpoint-refinement trajectories. To balance the competing demands of continuous control and semantic reasoning, we devise a decoupled training strategy with a knowledge insulation mechanism that prevents the action gradients from erasing the model's multimodal reasoning ability. Extensive simulated experiments and a qualitative real-world field study both verify the superiority of ScoutVLA over the state-of-the-art baselines, demonstrating a 10.48$\boldsymbol{\times}$ higher average strict success rate and a 7.72$\boldsymbol{\times}$ higher average QA correctness.

13.
arXiv (CS.AI) 2026-06-18

Code-Augur: Agentic Vulnerability Detection via Specification Inference

arXiv:2606.18619v1 Announce Type: cross Abstract: The advent of agentic vulnerability detection is already becoming a watershed moment for software security. Audits conducted entirely by autonomous LLM agents are uncovering critical vulnerabilities in fundamental software underpinning digital society. Many of these vulnerabilities remained masked for years, surfacing only now with AI agents. Yet the reasoning behind these discoveries remains alarmingly opaque and unvalidated. What assumptions did the agent make about a function's inputs when it deemed that function to be secure? Failures in reasoning and incorrect assumptions can lead to missed vulnerabilities and reduce trust in agentic analysis. We propose a security-specification-first paradigm that (1) exposes the agent's tacit assumptions explicitly as security specifications and (2) continuously refines those specifications via runtime falsification. We realize our approach in Code-Augur, a novel harness for agentic vulnerability detection. Given a codebase, Code-Augur analyzes each component of the system for vulnerable code. When it deems a component to be secure, it commits the local invariants behind that judgment as in-source assertions. In parallel, Code-Augur leverages a guided fuzzer to attempt to falsify those assumptions. When the fuzzer triggers an assertion, this either reveals a genuine vulnerability or a flawed specification to refine. In both cases, this process grounds the agent's understanding, aligning its view of code intent with how the code actually behaves. On real-world subjects, Code-Augur effectively leverages security specifications to detect more vulnerabilities than other state-of-the-art agents. Additionally, Code-Augur found 22 new vulnerabilities in key open-source projects. Compared to curated specialized models like Claude Mythos, Code-Augur offers effective agentic vulnerability detection built on widely available LLMs like Sonnet and DeepSeek.

14.
arXiv (CS.LG) 2026-06-18

Beyond AHI: An Interpretable Causal-Discovery-Guided Framework for Sleep Recovery in Connected Health

arXiv:2606.18506v1 Announce Type: new Abstract: Objective sleep assessment relies on polysomnography (PSG), yet clinical impact is often better reflected in patient-reported outcomes (PROs) such as sleepiness and fatigue. Existing summary indices, including the Apnea-Hypopnea Index (AHI), provide limited insight into the multidomain physiology underlying functional recovery. We propose an interpretable, causal-discovery–guided framework for deriving a hierarchical Sleep Recovery Score (SRS) from multimodal PSG. Using two large population cohorts (MESA: n=1540; MrOS: n=825), we apply directed acyclic graph (DAG) learning to identify candidate physiological drivers spanning respiratory burden, hypoxic burden, sleep fragmentation, sleep architecture, and autonomic regulation. Although derived from clinical PSG, these domains map naturally to sensing streams increasingly available in connected health technologies, including wearable ECG, oximetry, and sleep-stage estimation devices. To preserve mechanistic plausibility, we introduce a two-stage screening process that combines physiology-based constraints with constrained LLM-assisted auditing to identify and remove structural confounders and construct-overlapping variables. Across cohorts, these five domains emerge as recurrent physiological domains associated with recovery, and the resulting SRS shows up to 2.5$\times$ stronger alignment with perceived recovery than AHI. By linking multimodal sleep physiology to patient-centered outcomes through an interpretable, bias-aware, and domain structured framework, this work provides a practical foundation for recovery modeling across both clinical sleep studies and emerging smart and connected health settings.

15.
arXiv (math.PR) 2026-06-16

Structure preserving properties of higher order moment closures for TASEP

arXiv:2604.15925v2 Announce Type: replace-cross Abstract: The totally asymmetric simple exclusion process (TASEP) is a stochastic model for the unidirectional flow of interacting particles on a 1D-lattice that is much used in systems biology and statistical physics. Its master equation describes the evolution of the probability distribution on the configuration space. The size of the master equation grows exponentially with the length of the lattice. It is known that the complexity of the system may be reduced using mean-field approximations. We provide a rigorous definition of a family of such models using moments of any order and an extension to the pair approximation for obtaining closures for the system. The dimension of these models grows linearly with the lattice size and exponentially in the order of the approximation. Moreover, we show that the states of these models still have a probabilistic interpretation and that basic structural properties of the master equation are preserved. This extends known results on the Ribosome Flow Model which can be viewed as the first order approximation for TASEP.

16.
arXiv (math.PR) 2026-06-11

Stochastic epidemic model with varying infectivity and waning immunity: the law of large numbers with unbounded infectivity

arXiv:2606.11845v1 Announce Type: new Abstract: We revisit the large population limit of our epidemic model with infection age dependent infectivity and progressive immunity waning, under the assumption that the supremum in $t$ of the random infectivity function has a finite expectation, while the previous proofs assumed that this supremum admits a deterministic upper bound.

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

On the Adversarial Robustness of Multimodal LLM Judges

Multimodal Large Language Models (MLLMs) are increasingly used as automated judges, e.g., for image quality and safety assessment. However, their adversarial robustness remains largely unexplored, threatening the fairness and reliability of automated judging. To bridge this gap, we introduce RobustMLLMJudge, the first general framework for evaluating the adversarial robustness of general-purpose MLLMs when functioning as judges. It covers diverse attacks against popular judge approaches across quality and safety evaluation scenarios. Using RobustMLLMJudge, we reveal that i) different MLLM judges are highly vulnerable to score-inflating adversarial attacks; and ii) although effective, these attack methods face a critical challenge due to unique constraints in the evaluation protocols of MLLM judges. We further propose MGSIA, namely Manifold-Guided Semantic Induction Attack, a novel method that bypasses these constraints to enable more effective and transferable attacks on MLLM judges. The core idea of MGSIA is to combine affirmative semantic induction with high-score manifold alignment: it maximizes the probability that judges yield affirmative responses (e.g., "Yes") to binary semantic queries, while regularizing adversarial representations toward high-score centers estimated from proxy protocols. Together, these objectives yield transferable score-inflating perturbations. Extensive experiments demonstrate the superiority and generalizability of MGSIA in deceiving advanced MLLM judges under different evaluation scenarios, highlighting the need for robust MLLM judges. Code and data will be made available at https://github.com/mala-lab/RobustMLLMJudge.

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

Zero-order Parameter-free Optimization for LMO-based Methods: Novel Approach for Efficient Fine-tuning

arXiv:2606.14970v1 Announce Type: new Abstract: Fine-tuning large language models (LLMs) has become a central application of modern optimization, enabling pretrained models to adapt to diverse downstream tasks and domain-specific data. A major obstacle in large-scale fine-tuning is the memory overhead of backpropagation, which requires storing activations, gradients, and optimizer states. Zeroth-order (ZO) optimization offers a memory-efficient alternative, but its performance is highly sensitive to the stepsize and smoothing parameter, often requiring costly task-specific tuning. Parameter-free (PF) optimization addresses this issue by adapting algorithmic parameters without prior knowledge of problem-dependent constants. Moreover, large-scale fine-tuning can benefit from geometry-aware updates that account for the heterogeneous structure of parameter blocks, which can be modeled through methods that exploit linear minimization oracle (LMO). In this work, we study PF adaptation for LMO-based ZO optimization and introduce $\texttt{AdaNAGED}$, a method that unifies gradient-free training, adaptive tuning, and non-Euclidean update geometry. We establish convergence guarantees and validate the method on large-scale LLM fine-tuning task with $\texttt{OPT}-1.3\mathrm{B}$ model.

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

MAMVI: 3D Test-Time Adaptation via Masked Multi-View Point Clouds

3D point cloud models suffer significant performance degradation under distribution shifts caused by sensor noise, occlusions, and environmental changes. Test-time adaptation (TTA) has emerged as a practical paradigm for mitigating this issue during inference. Recently, leveraging multi-view augmentation has shown promise in improving 3D TTA performance. However, existing multi-view approaches are often constrained by sequential optimization that treats each view independently. This sequential optimization leads to substantial inference latency due to repetitive optimization steps, making real-time adaptation impractical. To address this, we propose Masked Multi-View Test-Time Adaptation (MAMVI), which replaces sequential optimization with a unified single-step adaptation. Specifically, MAMVI utilizes a hybrid masking strategy that combines fixed ratios for stability with Beta-distributed sampling for diversity. By aggregating losses across multiple views, MAMVI performs adaptation through a single backward pass based on multi-view consensus. Additionally, a confidence-based adaptive learning rate is used to dynamically adjust the adaptation intensity for each sample. Extensive experiments on ModelNet-40C, ShapeNet-C, and ScanObjectNN-C demonstrate that MAMVI achieves state-of-the-art accuracy on ShapeNet-C and ScanObjectNN-C. Moreover, it remains competitive on ModelNet-40C while delivering 4.9-8.9 times faster inference, making it highly suitable for real-time applications. Our code is available at https://github.com/Inseok-kong/MAMVI

20.
arXiv (quant-ph) 2026-06-24

Teleportation-based quantum state tomography

arXiv:2511.18621v2 Announce Type: replace Abstract: We explicitly show that the quantum teleportation protocol can be employed to completely reconstruct arbitrary two- and three-qubit density matrices. We also extend the present analysis to n-qubit density matrices. The only quantum resources needed to implement the teleportation-based quantum state tomography protocol are the ability to make Bell measurements and the ability to prepare a few different single qubit states to be teleported from Alice to Bob.

21.
arXiv (CS.LG) 2026-06-15

A General Framework for Decision Trees via Bregman Divergences

arXiv:2606.13984v1 Announce Type: cross Abstract: Decision trees are one of the fundamental tools in statistical learning due to their interpretability, flexibility, and their ability to adapt to nonlinear structures. Among them, the Classification and Regression Trees, introduced by Breiman, Friedman, Olshen, and Stone in 1984, became one of the most influential algorithms and remains one of the most widely used methods for classification and regression problems. On the other hand, Bregman divergences, introduced by Lev Bregman in 1967 in the context of convex optimization, provide a broad family of loss functions that naturally generalize the squared Euclidean distance. This family includes, among others, the Kullback-Leibler divergence, the Poisson divergence, and the Itakura-Saito divergence, as well as several losses associated with distributions belonging to the exponential family. Moreover, Bregman divergences possess a rich geometric structure and deep connections with convex analysis and information geometry. In this work, we propose a generalization of the CART paradigm based on Bregman divergences, thereby obtaining a broader family of decision trees adapted to different statistical models and underlying geometries. Although algorithms such as CART or classical implementations such as rpart incorporate different impurity criteria, these are usually introduced in an ad hoc manner for each specific model. In contrast, the Bregman divergence approach provides a unified framework that allows these criteria to be derived and interpreted from common convex and geometric principles. Beyond the algorithmic construction, we also investigate theoretical properties of these trees. In particular, we study how properties of the generating convex function – such as strong convexity or smoothness – influence impurity gains between parent and child nodes, as well as stability and consistency properties of the estimator.

22.
arXiv (CS.CV) 2026-06-12

Surflo: Consistent 3D Surface Flow Model with Global State

Geometry is invariant to viewpoint, which makes any collection of images a redundant encoding of a single 3D state. Existing feed-forward reconstruction models fail to exploit this: per-view methods emit overlapping, unaligned pointmaps that grow linearly with input count, while global-latent methods commit to a fixed, low-resolution output. We introduce Surflo, which compresses a variable number of unposed RGB views into K latent tokens-one global state-and decodes oriented 3D surface points by independently transporting them from noise onto the surface via flow matching. This frees the output from any fixed grid or token budget: the same latent yields from a few thousand to a million points in a single forward pass. To suppress the local inconsistencies inherent to independent per-point decoding, an inference-time guidance term correlates nearby points by injecting a photometric gradient during ODE integration. Surflo matches or surpasses feed-forward baselines on surface metrics, runs an order of magnitude faster than optimization-based methods that require hundreds of views, and is the only feed-forward approach to combine a global latent with arbitrary-resolution decoding.

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

Test-Time Adaptation in Optical Coherence Tomography Using Trajectory-Aligned Time-Independent Flow

Optical coherence tomography (OCT) is essential in ophthalmology, but inconsistent image quality especially in low-cost devices hinders automated analysis. To address this, we introduce a flow-matching-based test-time adaptation method that generates high-quality surrogate images from noisy inputs. Typically, domain gaps between test and training data cause pixel distribution mismatches during the denoising process. We overcome this by matching the test image's histogram to synthetic reference trajectories, successfully aligning the input with expected distributions. Additionally, we remove the network's time conditioning to account for slight deviations in real-world noise distributions. Our approach achieves state-of-the-art performance in segmenting critical biomarkers for two stages of Age-related Macular Degeneration (AMD). Code is available: https://github.com/Veit21/tta-flow.

24.
medRxiv (Medicine) 2026-06-10

General-purpose large language models can achieve physician-level accuracy in complex medical data extraction

Background: Unstructured data represent about 80% of total electronic health records (EHR) data. Structuring this free text is essential for advancing clinical research, including cohort selection for trials, retrospective studies, and the development of disease registries. While manual chart review (MCR) remains the gold standard for extracting this clinical data, the process is inherently slow, resource-intensive, and susceptible to errors from human fatigue. We evaluated the extraction accuracy, safety, and efficiency of the HeLIX (Hepatology Logic-Integrated Extraction) framework, a Large Language Model (LLM) protocol using Google Gemini 3 Pro, compared to a gold-standard Manual Chart Review (MCR). Methods: A prospective validation study was conducted using 50 high-complexity, simulated hepatology discharge summaries designed to replicate the real-world heterogeneity of EHRs. The HeLIX framework employed a Zero-Shot, Structured Chain-of-Thought (CoT) prompting strategy enforced by a three-layer architecture: Clinical Reasoning Trace, Schema Enforcement, and Evidence Verification. The model extracted 45 distinct clinical variables. Performance was benchmarked against a consensus MCR. Results: Across 2,250 evaluated data points, the model achieved an overall Extraction Accuracy of 99.24% (95% CI: 98.8%-99.5%), with perfect concordance in 35/45 (77.8%) variables. For binary diagnostic variables, the model demonstrated an overall F1-score of 0.98, Recall of 0.99 and substantial inter-rater reliability (Cohens {kappa} = 0.97). Hallucinations were exceptionally rare (2/2250; 0.08%). Critical errors affecting clinical management occurred in only 2 instances (

25.
medRxiv (Medicine) 2026-06-24

Study partner profile effects on CDR-SB change in anti-amyloid therapy evaluation

INTRODUCTION: The Clinical Dementia Rating Sum of Boxes (CDR-SB), a primary outcome in anti-amyloid therapy (AAT) trials, integrates information from participants and study partners. CDR-SB scores may vary by study partner characteristics, but their impact on 18-month change interpretation remains unclear. METHODS: Using the NACC Uniform Data Set, we fitted linear mixed-effects calibration models in an Alzheimer's disease (AD)-primary early symptomatic cohort and propagated study partner-associated coefficients through Monte Carlo simulations. We estimated components of 18-month CDR-SB change under observed profile changes, simulated follow-up imbalance in a common female living-with profile, and tipping-point scenarios. Analyses were repeated in amyloid-positive and trial-like cohorts. RESULTS: The AD-primary cohort included 15,061 participants and 7,683 baseline-to-18-month pairs. Observed profile changes generated a negligible cohort-level component (mean 0.0014 points, 95% simulation interval 0.0006 to 0.0022). Simulated follow-up imbalance generated differences of 0.014 to 0.071 points across 10% to 50% reassignment. Under the primary calibration model, generating a 0.45-point difference, equal to the reported Clarity AD CDR-SB group difference, required median net imbalance >100% and was feasible in 48% of iterations. Amyloid-positive and trial-like cohorts had lower median tipping points but wider intervals, reflecting coefficient imprecision. DISCUSSION: In the large AD-primary cohort, observed study partner profile changes and simulated follow-up imbalance generated CDR-SB differences that were small relative to the 0.45-point Clarity AD benchmark. Biomarker-confirmed estimates were less stable because of coefficient imprecision. These findings suggest limited impact under typical AD-primary conditions but support systematic study partner profile collection and sensitivity analyses in observational and external-comparator CDR-SB studies for AAT evaluation.