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

To Compare, or Not to Compare: On Methodological Practices in Evaluating Social Bias

As Large Language Models are increasingly deployed in critical applications, robustly evaluating their social biases is paramount. However, the current literature suffers from widespread methodological fragmentation, which yields contradictory conclusions. This stems largely from ignoring the structural framing of benchmark-level evaluations. To resolve this, we introduce a unified and controllable framework that standardizes heterogeneous benchmarks to systematically contrast isolated demographic assessments with forced-choice comparative settings. Crucially, this allows us to disentangle the confounding effects of Chain-of-Thought reasoning, neutral fallback options, and other structural artifacts in social bias evaluations. Our evaluation across multiple model families reveals a massive, systematic paradigm gap: while isolated assessments limit prejudice activation, comparative settings act as aggressive catalysts for latent discrimination, a shift primarily driven by underspecified contexts. Alarmingly, CoT reasoning exacerbates social biases under comparative settings, and this systemic bias persists as a deterministic prejudice even when models are provided neutral fallback options or claim to answer randomly. Finally, we demonstrate that this comparative prejudice is a generalized phenomenon that scales positively with model size. Ultimately, we offer a crucial methodological guideline: while researchers must leverage comparative settings to robustly audit hidden biases, practitioners cannot safely rely on comparative deployments in ambiguous real-world tasks.

02.
arXiv (CS.AI) 2026-06-19

Analyzing the Narration Gap in LLM-Solver Loops

arXiv:2606.19588v1 Announce Type: new Abstract: Formal tools such as SAT and SMT solvers are increasingly embedded in language model reasoning pipelines when a safety or security critical question can be formulated in logic. Unlike chain of thought whose steps are sampled from the model distribution without formal guarantee, a solver produces a sound and independently verifiable answer. However, the soundness guarantee can be lost in the interaction between the solver and the model. The hybrid pipeline has three components: formalizing the question, deciding it, and narrating the result. Prior work has studied the formalization and decision, but not narration, which is the step that turns a formal tool's output into the user answer. To fill the narration gap, we first model the LLM-solver loop as a verified decision procedure. We further evaluate five open-sourced models under prompt injection, and we find certificate gating makes the solver verdict sound, while an adversary can invert a verified conclusion across phrasings and channels. We study the mitigation through hardened prompt that reduces injection significantly but cannot eliminate it and still suffers under adaptive attack. Combining the formal analysis and empirical studies, we show in the LLM-solver loop, robustness does not reach to the answer that the user finally reads.

03.
Nature Medicine 2026-06-17

Why large-scale randomized trials of live-attenuated shingles vaccination for dementia prevention are urgently needed

In my view, we have never had as robust a body of evidence from observational data on an intervention for dementia as we do for live-attenuated shingles vaccination. Both a recent US National Institutes of Health expert workshop and an international expert consensus on Alzheimer’s disease drug repurposing identified large-scale randomized trials of shingles vaccination for dementia prevention as the crucial next step for the field.

04.
arXiv (math.PR) 2026-06-11

Micro-macro population dynamics models of benthic algae with long-memory decay and generic growth

arXiv:2505.04289v4 Announce Type: replace Abstract: Benthic algae as a primary producer in riverine ecosystems develop biofilms on the riverbed. Their population dynamics involve growth and decay processes, the former owing to the balance between biological proliferation and mortality, while the latter to mechanical abrasion because of the transport of sediment particles. Contrary to the assumptions of previous studies, the decay has experimentally been found to exhibit long-memory behavior, where the population decreases at an algebraic rate. However, the origin and mathematical theory of this phenomenon remain unresolved. The objective of this study is to introduce a novel mathematical model employing spin processes to describe microscopic biofilm dynamics. A spin process is a continuous-time jump process transitioning between states 0 and 1, and the continuum limit of these processes captures the long-memory decay and generates generic growth. The proposed framework leverages heterogeneous spin rates, achieved by appropriately superposing spin processes with distinct rates, to reproduce the long-memory decay. Computational simulations demonstrate the behavior of the model, particularly emphasizing rate-induced tipping phenomena. This mathematical model provides a computationally tractable interpretation of benthic algae dynamics and their long-term prediction, relevant to river-engineering applications.

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

Speeding up the annotation process in semantic segmentation industrial applications

arXiv:2606.19934v1 Announce Type: cross Abstract: Current machine learning models commonly require large and well-annotated datasets. However, the annotation process often becomes a bottleneck, with increased complexity leading to higher chances of human errors. Within this context, our goal in this paper is to leverage unsupervised algorithms to improve data annotation efficiency for complex semantic segmentation problems in industrial materials science. Previous research has quantified labeling time and others explored unsupervised methods. However, to the best of our knowledge, this is the first study to quantify how much unsupervised algorithms accelerate the labeling process. We aim to validate the extent to which this laborious process can be accelerated, focusing on semantic segmentation tasks that involve annotating each pixel of high-resolution images, such as the microstructure characterization challenge in materials science. Specifically, we demonstrate that by using unsupervised computer vision algorithms, the time required for the labeling process can be reduced from 170 hours to 37 hours, achieving an approximate reduction of 78\%. The dataset we work with includes large images of dimensions 1280x959 and 960x703, which further increases the complexity of the annotation task. Despite these challenges, we create and share the largest public steel microstructure segmentation dataset to date, available under MIT License with permanent DOI, contributing a fully annotated, high-resolution dataset to the field. Additionally, this is the first work to compare the labeling time from scratch (a common approach in previous studies) to the labeling time when using these unsupervised algorithms as a pre-annotation step. Furthermore, we provide a Deep Learning model trained on this dataset, validated by field experts, and deployed in an industrial setting, serving as an initial benchmark for this public dataset.

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

Sphere Packings in Higher Dimension (after Boaz Klartag)

arXiv:2606.13313v1 Announce Type: cross Abstract: Let $\delta_n^L$ be the maximal density of a lattice sphere packing in the $n$-dimensional Euclidean space. We explain how Boaz Klartag proved the inequality $\delta_n^L \geq c n^2 2^{-n}$ where $c>0$ is a universal constant. In higher dimension, even for non-lattice sphere packings, this new lower bound is a substantial improvement. Klartag's proof uses the probabilistic method in two different ways. The first, very standard, relies on the statistical properties of a uniformly chosen random lattice. The second, completely new, studies the stochastic evolution of an ellipsoid constrained to contain non nonzero lattice points in the interior.

07.
arXiv (CS.CV) 2026-06-16

RealityBridge: Bridging Editable 3D Gaussian Splatting Driving Simulations and Real-World Videos

Long-tail hazardous scenarios are essential for safety-oriented autonomous driving, yet they are difficult to collect and reproduce at scale. Editable 3D Gaussian Splatting (3DGS) simulation offers a promising alternative by reconstructing real driving scenes and supporting controllable scene editing. However, edited 3DGS-rendered videos still suffer from a significant Sim-to-Real gap, including rendering artifacts, degraded foreground assets, inconsistent illumination, and temporal flickering. Existing restoration and video generation methods are insufficient for this task, as they often fail to jointly repair 3DGS-specific artifacts, improve visual realism, and ensure temporal consistency. To fill this gap, we propose RealityBridge, a structure-preserving and asset-aware Sim-to-Real framework for edited 3DGS driving videos. RealityBridge uses multimodal controls, including rendered videos, foreground masks, edge maps, and semantic masks, together with a lightweight GateNet for adaptive condition allocation across backbone layers. We further construct targeted training data and introduce autoregressive long-video training with reward-guided post-training to improve restoration quality, temporal stability, and hallucination suppression. Extensive experiments on internal and public driving datasets show that RealityBridge outperforms existing methods in artifact removal, illumination harmonization, and long-sequence temporal consistency.

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

A Conservation Law for Equilibrium Propagation and Coupled Learning

arXiv:2606.15444v1 Announce Type: cross Abstract: In this paper we show that the physical learning methods known as coupled learning (CL) and equilibrium propagation (EP) conserve a mass-like quantity in the trainable parameters in the continuous-time, small-nudging limit. We prove that this conservation holds in a broad range of physically relevant settings. We then show that the conservation law constrains the training dynamics in a way that makes convergence reliable in important settings for linear circuits. We conclude by discussing some practical implications of this conservation law.

09.
arXiv (CS.CL) 2026-06-17

EmoFSM: A Finite State Machine for Emotional Support Conversation

Emotional support conversation (ESC) aims to alleviate people's emotional distress through effective conversations. Although large language models (LLMs) have made remarkable progress in ESC, most of these studies may not define the diagram from a state-model perspective, thereby providing a suboptimal solution for long-term satisfaction. To address such an issue, we leverage the Finite State Machine (FSM) on LLMs, and propose a framework called EmoFSM. Our framework allows a single LLM to bootstrap the planning during ESC, and self-reason the seeker's emotion, support strategy, and the final response upon each conversation turn. Substantial experiments in ESC datasets suggest that EmoFSM outperforms many baselines, including direct inference, self-fine, chain of thought, finetuning, and externally supported methods, even those with many more parameters.

10.
arXiv (CS.LG) 2026-06-11

Discovery and inference beyond linearity for epidemiological data by integrating Bayesian regression, tree ensembles and Shapley values

arXiv:2505.00571v3 Announce Type: replace-cross Abstract: Machine Learning (ML) is gaining popularity in epidemiology and healthcare studies for hypothesis-free discovery of risk and protective factors. ML is strong at discovering nonlinearities and interactions, but this power is compromised by a lack of reliable inference. Although Shapley values provide local measures of features' effects, valid uncertainty quantification for these effects is typically lacking, thus precluding statistical inference. We propose RuleSHAP, a framework that addresses this limitation by combining a dedicated Bayesian sparse regression model with an improved tree-based rule generator and Shapley value attribution. RuleSHAP provides detection of nonlinear and interaction effects, with uncertainty quantification at the individual level as a key contribution. We derive an efficient formula for computing marginal Shapley values within this framework. We apply RuleSHAP to data from an epidemiological cohort to detect and infer several effects for high cholesterol and blood pressure, such as nonlinear interaction effects between features like age, sex, ethnicity, BMI and glucose level. To conclude, we demonstrate the validity of our framework on simulated data.

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

When Researchers Say Mental Model/Theory of Mind of AI, What Are They Really Talking About?

arXiv:2510.02660v2 Announce Type: replace-cross Abstract: When researchers claim AI systems possess ToM or mental models, they are fundamentally discussing behavioral predictions and bias corrections rather than genuine mental states. This position paper argues that the current discourse conflates sophisticated pattern matching with authentic cognition, missing a crucial distinction between simulation and experience. While recent studies show LLMs achieving human-level performance on ToM laboratory tasks, these results are based only on behavioral mimicry. More importantly, the entire testing paradigm may be flawed in applying individual human cognitive tests to AI systems, but assessing human cognition directly in the moment of human-AI interaction. I suggest shifting focus toward mutual ToM frameworks that acknowledge the simultaneous contributions of human cognition and AI algorithms, emphasizing the interaction dynamics, instead of testing AI in isolation.

12.
arXiv (CS.CV) 2026-06-24

ABACUS: Adapting Unified Foundation Model for Bridging Image Count Understanding and Generation

ABACUS is a unified vision-language model that handles object counting, crowd counting, referring-expression counting, and count-faithful image generation without any benchmark-specific training required. Our model is built on existing 3B-parameter unified foundation model and is adapted for object localization tasks using three key innovations: density-aware adaptive zooming with objectness maps for spatial grounding; a boundary-aware count policy via GRPO to eliminate crop-boundary errors; and a cycle-consistent GRPO strategy where the understanding branch self-critiques generated outputs, closing the understanding-generation gap without any external annotations. ABACUS achieves state-of-the-art results across seven benchmarks, outperforming both task-specific specialists and larger generalist models.

13.
arXiv (CS.CL) 2026-06-17

NarrativeWorldBench: A Frontier-Saturated Benchmark and a Latent World Model for Long-Horizon Co-Creative Audio Drama

Long-form serialized audio drama, with arcs that run for 200 to 800 episodes, is a major creative medium and a setting where frontier large language models (LLMs) fail. We benchmark 21 models, spanning classical, fine-tuned, open-frontier, closed-frontier, and reasoning tiers, on a uniform set of structural narrative metrics. All closed-frontier systems saturate at a plot-beat F1 in the band [0.78, 0.81] and collapse by about -0.20 F1 at horizon h=200. We introduce NarrativeWorldBench, an open benchmark of nine narrative-structure metrics evaluated across horizons h in {10, 20, 50, 100, 200}, with cross-lingual evaluation across four Indic languages (Hindi, Tamil, Telugu, Marathi). We introduce N-VSSM, a Narrative Variational State-Space Model that maintains a structured 256-dimensional latent world state over more than 200 episodes via a Mamba-2 backbone with an event-conditioned posterior and an 8B decoder. N-VSSM holds plot-beat F1 >= 0.84 across all horizons at 4x lower compute than the closed-frontier band. A learned Cultural Transfer Function lifts cross-language fidelity by +0.20 to +0.23 Likert points. In a within-subjects writer study (n = 12 professional authors, 240 trials), N-VSSM is preferred over Claude Opus 4.5 on long-arc consistency 71% of the time and rated +1.3 Likert points higher on controllability.

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

Many-body spectral transitions through the lens of the variable-range SYK2 model

arXiv:2412.14280v2 Announce Type: replace-cross Abstract: The Sachdev-Ye-Kitaev (SYK) model is a cornerstone in the study of quantum chaos and holographic quantum matter. Real-world implementations, however, deviate from the idealized all-to-all connectivity, raising questions about the robustness of its chaotic properties. In this work, we investigate a quadratic SYK model with distance-dependent interactions governed by a power-law decay. By analytically and numerically studying the spectral form factor (SFF), we uncover how transitions present in the single-particle limit carry over to the many-body system. Non-trivial cancellations in the one-loop contributions lead to a robustness of the SFF under a considerable reduction of the interaction range. Further suppression leads to a breakdown of perturbation theory around the infinite-range path-integral saddle and the appearance of new spectral regimes, marked by a higher dip and the emergence of a secondary plateau. Our results highlight the interplay between single-particle criticality and many-body dynamics, offering new insights into the quantum chaos-to-localization transition and its reflection in spectral statistics.

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

Engagement Intensity as a Learner-Modeling Signal for Adaptive AI Ethics Instruction

arXiv:2606.18548v1 Announce Type: cross Abstract: Adaptive AI ethics instruction in graduate research training benefits from intake measures that reflect differences in prior LLM experience. Prior coursework or workshop attendance is an obvious candidate, but it is not clear whether it is associated with pre-instruction ratings on key AI perception items. We compare three candidate intake features, self-reported usage frequency, self-rated LLM familiarity, and prior AI education, across five baseline perception outcomes in 93 bioscience graduate and postdoctoral trainees enrolled in a required research ethics course. Usage frequency shows Holm-corrected associations with all five outcomes, self-rated familiarity with three, and prior AI education with none. A threshold-like pattern at the lower end of the scale is most visible for training interest and accuracy trust rather than appearing as a uniform gradient across all five outcomes. In a short intake survey, reported LLM use is more consistently associated with these perceptions than prior coursework or workshops, with self-rated familiarity serving as a secondary indicator. These results suggest that simple pre-instruction behavioral signals can inform lightweight intake profiling for adaptive AI ethics education.

16.
arXiv (math.PR) 2026-06-19

Power-law hypothesis and (un)fairness of PageRank on undirected multi-type PAMs

arXiv:2606.19583v1 Announce Type: new Abstract: The preferential attachment model (PAM) describes the sequential growth of a network based on the "rich-get-richer" principle. Several versions of it have become established for modeling, e.g., citation networks, capturing a power-law degree distribution. Directed versions of the preferential attachment model where the edges are directed from the new to the old vertices have been the subject of extensive research. They have been shown to exhibit remarkable properties such as heavier tails for the limiting graph-normalized PageRank than for the in-degrees. By contrast, for the undirected version, we recently showed that PageRank has similar tails as the degree. In the present paper, we discuss the PageRank asymptotics for a multi-type version of the undirected PAM (here vertices have different colors), complementing previous results of Antunes, Bhamidi, Banerjee and Pipiras on the asymptotics of PageRank on similar directed multi-type or colored PAMs. Our studies are motivated by the aim to go beyond the rigid rule of edge orientation in directed preferential attachment models. As the main result, for the case of a finite set of colors, we show that the power-law hypothesis for PageRank is fulfilled also for the colored undirected PAM, where, by contrast to the directed case, the power-law exponent is color-dependent for some choices of the initial color distribution and the attractiveness function. For the specific case of a two-type model, we discuss implications of our results on fairness in sampling underrepresented nodes from the network.

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

Recovery thresholds for hidden weighted sparse graphs

arXiv:2606.14335v1 Announce Type: cross Abstract: Recovering structural information from noisy high-dimensional data is a fundamental task in statistical inference. We investigate the recovery thresholds for a graph hidden in a randomly weighted complete graph. Specifically, an unknown graph $H^* \in H_n$ is chosen uniformly at random, and hidden in a complete graph of $n$ vertices as follows: the weight of an edge $e \in H$ is distributed independently according to $P_n$; otherwise the weight is distributed independently according to $Q_n$. The goal is to recover almost all of $H$ from these edge weights. Assuming a local Lipschitzness of the Rényi divergence between distributions $P_n$ and $Q_n$, and a mild density condition for the graphs $H_n$, we give a unified characterization of the information-theoretic limit for recovering almost all of $H$ (also known as almost exact recovery). Our characterization connects the KL divergence between $P_n$ and $Q_n$ to the logarithm of the first moment threshold of $H$ in the Erdős-Rényi random graph model $G(n,p)$. Our lower bound also extends to the task of partial recovery, in which only a constant $\lambda$-fraction of $H$ needs to be recovered. Last but not least, for certain Bernoulli and Exponential regimes, and for Gaussian distributions, we are able to show an All-or-Nothing (AoN) threshold phenomenon at the exponential scale.

18.
arXiv (quant-ph) 2026-06-17

Canonical regularization of the stationary Coulomb problem and an Aufbau-like spectral ordering

arXiv:2606.17359v1 Announce Type: new Abstract: The stationary hydrogen atom has Coulomb degeneracy across orbital levels, whereas the Aufbau/Madelung ordering is an empirical, many-electron rule established in atomic physics. We examine the hydrogen atom through a regularized de Broglie–Bohm representation, in which stationary amplitude current constraints generate separable Sturm–Liouville branches. In this formulation, the radial, orbital, and magnetic sectors acquire canonical Langer-like inverse square corrections. The modified boundary value problems allow analytical solutions and produce a hydrogen-like spectrum with regularized radial and angular indices. Consequently, radial Coulomb quantization acquires an orbital dependent shift, lifting the Coulomb degeneracy and producing a spectral ordering that follows the Aufbau/Madelung sequence. On this basis, we construct the ordering of the regularized de Broglie–Bohm states and show that the spectral structure retains the standard degenerate Rydberg sequence in the l=0 sector. The separated amplitudes are represented by generalized special function branches, including the associated Laguerre, Legendre, and Bessel functions with non-integral parameters arising from regularized separation. Therefore, the treatment is intended as an analytical examination of spectral ordering in a regularized one center Coulomb problem rather than as a replacement for the many electron atomic structure theory. Keywords: de Broglie–Bohm representation; Coulomb spectrum; canonical regularization; Langer correction; Sturm–Liouville equations; Aufbau principle; Madelung ordering; associated Legendre functions; associated Laguerre functions; Bessel functions.

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

An LLM-based Two-Stage Transformer Framework for Cross-Domain Bearing Fault Diagnosis with Limited Data

Bearing fault diagnosis faces critical challenges when dataset heterogeneity, operating condition variations, and limited labeled data occur simultaneously in industrial environments. Existing approaches address these issues in isolation and rely on implicit feature alignment, limiting effectiveness under concurrent challenges. This paper proposes a knowledge-guided two-stage transfer learning framework that employs a lightweight GPT-2-style Transformer with causal self-attention for hierarchical feature extraction from vibration signals, establishing explicit pathways where pre-trained encoder weights and fault prototype embeddings serve as knowledge carriers from multi-source pre-training to target adaptation. The framework addresses the dual-shift challenge through multi-source learning for generalizable representations, prototype-based knowledge modulation for target adaptation, and taxonomy-adaptive classification for seamless transfer across heterogeneous fault categories. Experimental validation on four real-world datasets demonstrates 92.61% average accuracy with only 10% labeled target data, outperforming state-of-the-art methods by 17.24 percentage points, establishing a practical pathway toward cost-effective predictive maintenance in Industry 4.0 applications.

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

An Attention Mechanism for Robust Multimodal Integration in a Global Workspace Architecture

arXiv:2602.08597v3 Announce Type: replace Abstract: Robust multimodal systems must remain effective when some modalities are noisy, degraded, or unreliable. Existing multimodal fusion methods often learn modality selection jointly with representation learning, making it difficult to determine whether robustness comes from the selector itself or from full end-to-end co-adaptation. Motivated by Global Workspace Theory (GWT), we study this question using a lightweight top-down modality selector operating on top of a frozen multimodal global workspace. We evaluate our method on two multimodal datasets of increasing complexity: Simple Shapes and MM-IMDb 1.0, under structured modality corruptions. The selector improves robustness while using far fewer trainable parameters than end-to-end attention baselines, and the learned selection strategy transfers better across downstream tasks, corruption regimes, and even to a previously unseen modality. Beyond explicit corruption settings, on the MM-IMDb 1.0 benchmark, we show that the same mechanism improves the global workspace over its no-attention counterpart and yields decent benchmark performance.

21.
arXiv (quant-ph) 2026-06-16

Optimizing resource bounds in direct fidelity estimation

arXiv:2606.16336v1 Announce Type: new Abstract: Direct fidelity estimation provides a way to estimate the fidelity between an experimentally prepared state and a desired pure target state without performing full tomography. Two influential formulations were introduced in 2011 by Flammia and Liu and by da Silva, Landon-Cardinal, and Poulin. In these protocols, the total estimation error is controlled through two distinct probabilistic steps: first, the fidelity is approximated using randomly sampled Pauli observables; second, each sampled expectation value is estimated from finitely many measurement outcomes. In this work we show that additional structural information about the noise can substantially sharpen the corresponding resource bounds. In particular, for some canonical channels the effective number of sampled Pauli settings can be reduced, leading to lower measurement cost both in the general pure-state setting and in the case of a stabilizer state. These results illustrate a broader point: worst-case confidence bounds in direct fidelity estimation can be significantly conservative when experimentally relevant structure is ignored. As a technical ingredient, we also revisit the allocation of the total accuracy and confidence budgets between the two probabilistic steps. Reformulating the analysis in terms of separate error parameters yields a constrained optimization problem whose solution lowers the average number of measurements in the general pure-state setting. Numerical simulations based on quantum circuits implemented in Qiskit illustrate both the improvement obtained under structured-noise assumptions and the conservativeness of the original worst-case bounds.

22.
arXiv (CS.CL) 2026-06-19

NAMESAKES: Probing Identity Memorization in Text-to-Image Models

Text-to-image (T2I) models generate realistic likenesses of some individuals when prompted with their names, raising privacy concerns. However, distinguishing whether a generated face is memorized or fabricated currently requires ground-truth photos, access to training data, or white-box access to model internals, limiting applicability. We introduce a fully black-box behavioral probe that distinguishes between these regimes while requiring no reference photos or prior knowledge of training data. To benchmark this task, we present the NAMESAKES dataset of over one thousand names and faces of public figures spanning a wide range of fame levels, along with perturbed, less famous names. Experiments on state-of-the-art T2I models show that our probe substantially predicts identity memorization and separates memorized from unrecognized names, with further insights into differences across model families.

23.
arXiv (quant-ph) 2026-06-12

Kubo-Martin-Schwinger conditions for non-Hermitian systems

arXiv:2606.13251v1 Announce Type: new Abstract: We investigate the extension of the Kubo–Martin–Schwinger (KMS) thermal equilibrium condition to non-Hermitian Hamiltonians with real spectra and biorthogonal eigensystems, providing a systematic analysis through three complementary routes. Our central result is a thermodynamic characterisation of quasi-Hermiticity: for $H \in M_d(\mathbb{C})$ diagonalisable with real spectrum, the biorthogonal Gibbs functional $\omega_{\rm{bi}}(A) = Z_{\rm{bi}}^{-1} \sum_n e^{-\beta E_n}\langle\phi_n|A|\psi_n\rangle$ satisfies $\omega_{\rm{bi}}(A^\dag A) \geq 0$ for all $A$ if and only if $H$ is quasi-Hermitian. The proof constructs the metric $\eta$ directly from the eigenprojectors of $\omega_{\rm{bi}}$ via the Riesz representation theorem, with no prior choice of $\eta$, providing a metric-free certificate of quasi-Hermiticity outside the Mostafazadeh–Scholtz framework. Under the full quasi-Hermitian hypothesis, we prove that the $\eta$-Gibbs state $\omega_\eta(A) = Z_\eta^{-1}\, \rm{Tr}[\eta e^{-\beta H}A]$ satisfies all three analytic KMS conditions, using the Hadamard three-line theorem and Bari's theorem on Riesz bases. The result is non-trivial: the transported state $\hat\omega(X) = \rm{Tr}[e^{-\beta h}X\eta]/Z_\eta$ differs from the Gibbs state of the isospectral Hermitian partner $h = \eta^{1/2}H\eta^{-1/2}$ whenever $[\eta,h]\neq 0$, so the KMS property cannot be deduced from the Hermitian theory by similarity. The gap between this result and the full Haag–Hugenholtz–Winnink $C^*$-algebraic framework is identified. Failure modes at exceptional points and for complex spectra are analysed, and the relation to the Fagnola–Umanità quantum detailed balance condition for open systems is discussed.

24.
medRxiv (Medicine) 2026-06-22

Use of the Pharmacy First service in England in the first 12 months: geographic variation and health system context

Objectives: The Pharmacy First (PF) service was introduced across England from 31 January 2024 to expand the clinical role of community pharmacies and improve access to primary care. This paper describes use of PF in its first 12 months, in terms of uptake, access routes, consultation outcomes, geographic variations, service costs and antimicrobial supply. Methods: A descriptive analysis of all PF consultations submitted for payment to NHS Business Services Authority in England between 31 January 2024 and 31 January 2025. Pharmacy-level consultation data were linked to national data on population, location and pharmacy characteristics. PF use was examined using population-standardised consultation rates and consultations per pharmacy. Results: During the first year of implementation, 2,205,731 PF consultations were recorded as delivered across 11,349 pharmacies, with payment of GBP123 million to pharmacies. Uptake increased steadily over time. Most consultations were for acute sore throat (33%) and uncomplicated urinary tract infection (27%), with corresponding antibiotics, phenoxymethylpenicillin and nitrofurantoin being the most supplied. Most people self-referred (74%) into the service, with 95% of consultations managed without onward referral. Substantial geographic variation was observed. Northern regions had higher use based on the eligible population. The South East and Midlands had higher activity per pharmacy. London showed a distinct pattern, with higher self-referral into the service, lower medication supply and higher referral to other healthcare services. Higher consultation volume was weakly associated with pharmacy characteristics, including opening hours, pharmacy type and retail setting, and local context, in terms of socio-economic and geographic factors. Conclusions: PF had immediate uptake and is operating primarily as a direct-access model for common acute conditions. Findings suggest that PF is contributing to improved access to care and may shift demand away from general practice. However, the service uptake appears to be shaped by geographic location, proximity to other healthcare services and pharmacy characteristics.