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

PCBSchemaGen: Reward-Guided LLM Code Synthesis for Printed Circuit Boards (PCB) Schematic Design with Structured Verification

arXiv:2602.00510v2 Announce Type: replace Abstract: Most LLM code-synthesis benchmarks rely on unit tests as the reward oracle, but PCB schematic design has none: correctness is defined by structured physical constraints over real IC packages and pin-level assignments, per-task golden references are unavailable, and SPICE simulation does not validate schematic-level correctness. We introduce PCBSchemaGen, a training-free inference-time framework that turns a frozen LLM into a verifiable, repairable PCB schematic generator. The framework induces a domain schema from IC datasheets to ground LLM decoding, pairs it with a deterministic 5-layer continuous-reward verifier with pin-level error localization, and refines candidates through a Thompson Sampling arm-acquiring bandit. We evaluate on 2 PCB benchmarks covering 227 real-IC tasks across 22 unified circuit domains, including a public-schematic-derived suite that serves as a fully held-out generalization test (verifier, KG library, and prompts frozen before any evaluation). Under our framework, an open-weight 31B model (Gemma-4-31B) passes 81.3% of PCBBench tasks on average, and the same framework transfers across both benchmarks with zero verifier code changes; a Circuitron-style inference-time prompting baseline on the same Gemma-4-31B backbone collapses on hard system-level designs. This suggests inference-time refinement under a deterministic structural verifier is a general recipe for reference-free LLM code synthesis in domains without unit-test oracles. Our benchmarks and deterministic verifier are publicly available at https://github.com/HZou9/PCBSchemaGen_v2.

02.
arXiv (CS.CV) 2026-06-17

SPHINX: First Explain, Then Explore

Generating adversarial driving scenarios is critical for evaluating and improving autonomous vehicle decision-making systems in simulation. Recent approaches, such as ChatScene and LLM-Attacker, rely primarily on the prior knowledge of Large Language Models and Vision-Language Models to generate driving scenarios procedurally. We argue that adversarial scenes should be generated based on the failure diagnosis (e.g., indecisiveness, multi-frame inconsistency) of the driving policy to specifically address the policy's weaknesses instead of relying on prior assumptions. In this paper, we propose SPHINX, a closed-loop framework for adversarial scenario synthesis guided by a simple principle: first explain, then explore. Beyond blindly exploring the scenario space, SPHINX leverages explainable artificial intelligence methods to analyze the policy, identifying key visual concepts and their influence on policy outputs, and the uncertainty of the decisions. Given the interpretable evidence extracted from the policy's own decision process, we use a vision language model to rationalize and criticize failure modes of the current policy. These critics are then used to generate targeted adversarial scenarios for policy retraining and improvement. We demonstrate that SPHINX can highlight an interpretable account of policy failures while other adversarial scene generation cannot. Across the evaluated benchmarks and test suites, SPHINX can be applied to diverse state-of-the-art autonomous vehicle architectures and yields consistent robustness improvements over existing scenario-generation methods.

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

Imbalanced Semi-Supervised Learning via Label Refinement and Threshold Adjustment

arXiv:2407.05370v3 Announce Type: replace Abstract: Semi-supervised learning (SSL) algorithms often struggle to perform well when trained on imbalanced data. In such scenarios, the generated pseudo-labels tend to exhibit a bias toward the majority class, and models relying on these pseudo-labels can further amplify this bias. Existing imbalanced SSL algorithms explore pseudo-labeling strategies based on either pseudo-label refinement (PLR) or threshold adjustment (THA), aiming to mitigate the bias through heuristic-driven designs. However, through a careful statistical analysis, we find that existing strategies are suboptimal: most PLR algorithms are either overly empirical or rely on the unrealistic assumption that models remain well-calibrated throughout training, while most THA algorithms depend on flawed metrics for pseudo-label selection. To address these shortcomings, we first derive the theoretically optimal form of pseudo-labels under class imbalance. This foundation leads to our key contribution: SEmi-supervised learning with pseudo-label optimization based on VALidation data (SEVAL), a unified framework that learns both PLR and THA parameters from a class-balanced subset of training data. By jointly optimizing these components, SEVAL adapts to specific task requirements while ensuring per-class pseudo-label reliability. Our experiments demonstrate that SEVAL outperforms state-of-the-art SSL methods, producing more accurate and effective pseudo-labels across various imbalanced SSL scenarios while remaining compatible with diverse SSL algorithms. The code is publicly available (https://github.com/ZerojumpLine/SEVAL).

04.
arXiv (CS.LG) 2026-06-19

Performance Analysis and Optimization of 3D Generative Diffusion Models across GPU Architectures

arXiv:2606.19365v1 Announce Type: new Abstract: Diffusion models have become essential for high-fidelity 3D MRI synthesis, yet their deployment remains constrained by substantial GPU resource demands arising from hundreds of U-Net evaluations per sample and a highly heterogeneous kernel behavior. This paper performs a comprehensive performance analysis of the state-of-the-art medical diffusion model, Med-DDPM, across three generations of NVIDIA architectures to study kernel-level runtime breakdowns, instruction-mix characteristics, memory system utilization, warp-level activities, and profiler priority-score estimates. We show that training is overwhelmingly dominated by cuDNN convolution and implicit-GEMM kernels, with inefficiencies arising from memory-access patterns, tensor-layout conversions, and limited Tensor Core utilization. Guided by these insights, we evaluate two architecture-aware optimizations TF32 Tensor Core activation and a 3D channels-last layout and demonstrate that they reduce SM cycles by up to 100x, cut dynamic instructions by 100x, raise Tensor Core utilization from 1.45 to 9.98x, and increase IPC by 7% on A100, all without degrading synthesis quality.

05.
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.

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

AgenticRec: A Recommendation-Oriented Agentic Framework with Progressive Tool-Integrated Reasoning Optimization

arXiv:2603.21613v2 Announce Type: replace-cross Abstract: Recommender agents built on Large Language Models offer a promising paradigm for personalized recommendation. However, existing agents typically suffer from a misalignment between their tool-integrated reasoning trajectories and recommendation feedback, limiting their ability to distinguish fine-grained user preferences. To address these challenges, we propose AgenticRec, an agentic recommendation framework that formulates recommendation as a tool-integrated reasoning process over a recommendation-oriented tool suite. Built upon this framework, we further develop a dedicated two-stage training paradigm tailored for recommender agents. In the first stage, we introduce Recommendation-Oriented Trajectory Activation, optimize the agentic recommendation ability under implicit feedback. In the second stage, Progressive Preference Refinement further refines the agent through bidirectional preference reasoning over self-bootstrapped hard pairs, progressively sharpening preference boundaries. Theoretical analysis and extensive experiments demonstrate the effectiveness of AgenticRec. Our code is available at https://anonymous.4open.science/r/AgenticRec-FB16.

07.
arXiv (CS.CL) 2026-06-18

EARS: Explanatory Abstention for Reliable Sub-Agent Modeling in Large-scale Multi-Agent Systems

In large-scale enterprise settings, centralized multi-agent systems (MAS) are increasingly adopted, in which a coordinator delegates user requests to lightweight, domain-specialized sub-agents. While this architecture improves modularity, scalability, and cost efficiency, its reliability depends not only on accurate routing but also on sub-agents' ability to calibrate their responses to capability constraints. In particular, sub-agents built on smaller fine-tuned models often struggle with such calibration, leading them to over-answer ambiguous, underspecified, misrouted, or unsupported requests and produce hallucinated outputs instead of actionable feedback. To address this challenge, we present EARS (Explanatory Abstention for Reliable Sub-Agent Modeling), a production-oriented framework that reframes sub-agent abstention as an inter-agent communication protocol: a sub-agent does not merely abstain, but exposes an actionable failure state to the coordinator. EARS curates human-agent interaction data using an ensemble of calibrated LLM-as-a-Judge models, producing structured abstention labels and rationales under a taxonomy of sub-agent failure modes. These data are used to fine-tune sub-agents to detect failure conditions and return rationales for coordinator-level clarification, rerouting, or fallback. We evaluate EARS in a large-scale production e-commerce assistant supporting enterprise business intelligence workflows. EARS improves the overall response pass rate from 68.5% to 78.9%, demonstrating that sub-agent-side explanatory abstention improves MAS reliability.

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

MODF-SIR: A Multi-agent Omni-modal Distilled Framework for Social Intelligence Reasoning

arXiv:2606.12018v1 Announce Type: new Abstract: We propose a multi-agent collaborative framework built upon a lightweight Multimodal Large Language Model (MLLM), specifically designed for social intelligence reasoning. A key feature of our approach is that both the training and inference phases are augmented via knowledge distillation. Within this architecture, multi-modal data pertinent to social intelligence is precisely localized. Furthermore, relevant long-tail events are identified, extracted, and rendered as formatted, explicit text. This formatting strategy prevents critical long-tail information from being overshadowed by head events and environmental noise during the tokenization process. Specifically, we integrate Test-Time Adaptation (TTA) across the entire reasoning pipeline, encompassing the extraction and representation of long-tail events, Chain-of-Thought (CoT) prompting, and self-reflection. This TTA mechanism is also distillation-enhanced, utilizing Low-Rank Adaptation (LoRA) to fine-tune the foundation model exclusively for instance-level reasoning. Extensive evaluations against various open-source and proprietary AI models across multiple benchmarks demonstrate the effectiveness of the proposed framework. With around 30% of training data from IntentTrain, we achieve state-of-the-art results. Codes are available at https://github.com/eeee-sys/MODF-SIR, demo is available at https://huggingface.co/spaces/Harry-1234/MODF-SIR, LoRA is available at https://huggingface.co/Harry-1234/MODF-SIR and the dataset for training router is available at https://huggingface.co/datasets/Harry-1234/IntentRouterTrain.

09.
arXiv (CS.LG) 2026-06-16

Amortized mean-shift interacting particles

arXiv:2606.15871v1 Announce Type: cross Abstract: Bayesian inference for inverse problems is run to evaluate integrals – posterior expectations, tail probabilities, and risks – across a stream of observations. The standard estimate averages the integrand over posterior samples, a Monte-Carlo average whose error decays only as the square root of the sample size, so accuracy demands many samples – prohibitive when each one calls a partial-differential-equation forward model. Mean-shift interacting particles need far fewer: they return a small set of signed-weight nodes – a deterministic quadrature whose weighted averages estimate those integrals. Finding the nodes, however, is a per-observation optimization that, in its most accurate form, reads the posterior score at every step – returning the cost it meant to save. We introduce amortized mean-shift interacting particles, a learned map that emits the weighted nodes from an observation and a few posterior samples in a single forward pass. Training asks only for joint parameter-observation samples and a posterior to draw from – a conditional normalizing flow, an empirical conditional, or any reference the user can sample – and the map learns to integrate that posterior from samples alone, evaluating neither its density nor its score. Once trained, it generalizes to unseen observations and integrands at any node budget and improves on independent samples in two ways: by reweighting them, provably no worse than the equal weights of Monte-Carlo; and by moving them, which empirically lowers it further. Across closed-form, sampled, learned, and physics-based posteriors – up to a thousand-coefficient groundwater field – it integrates more accurately than the same number of samples at every budget, and a posterior-whitened, dimension-aware kernel removes the high-dimensional wall. The result is a Pareto improvement on Monte-Carlo integration, not a competitor to drawing more samples.

10.
arXiv (CS.CL) 2026-06-16

Sycophancy as Material Failure under Pushback Loading: A Multi-Axis Characterization Across Three Loading Cases and up to Seventeen Material Charges

Sycophancy in LLMs is documented across 70+ papers, but expert agreement on construct boundaries remains low (ICC=.184; Ye et al., 2026). The construct fragments because behavioral classification depends on which surface form is privileged. We adopt a materials-science framing: conversation as test specimen under load, LLM-model as material charge, pushback as progressive load, stance-flip as material failure. We characterize this failure across three loading cases (debate n=1000; false-presuppositions n=3400; ethical-setting n=3400; 10-17 material charges per case; 7800 specimens total) using 14 turn-level axis-measurements spanning velocity, damage accumulation, frame-drift, brittleness, and direction stability, plus three speaker-resolved axes from an independent pipeline. The measurements are Hooke-coupled ($\sigma = E \cdot \varepsilon$ analog) and reproduce across loading cases with effects up to $|r_{rb}| = 0.35$ on debate; the sign structure adds a second pattern: the ethical-setting case inverts the velocity and accumulation blocks. Variance composition partitions into two profiles: debate is charge-dominated (brittle-fracture-like: the material grade decides), false-presuppositions and ethical-setting are topic-dominated (creep-like: the load decides); the ratios (2.03 vs 0.13/0.17) are estimator-dependent, for debate even in direction. Cross-judge reliability (GPT-4o vs Haiku 4.5) shows debate scoring is judge-robust (Cohen's $\kappa = 0.88$) while false-presupposition scoring is judge-sensitive ($\kappa = 0.36$) – a caveat single-judge benchmarks must report. This is the methodological move Ye et al.'s diagnosis calls for: a multi-axis characterization that does not depend on which surface form of the construct one privileges.

11.
arXiv (CS.AI) 2026-06-19

Evaluating and Enhancing Negation Comprehension in Remote Sensing MLLMs

arXiv:2606.20177v1 Announce Type: cross Abstract: Multimodal Large Language Models (MLLMs) have demonstrated remarkable success in various Remote Sensing (RS) tasks. However, their ability to comprehend negation remains underexplored, limiting deployment in real-world applications where models must explicitly identify what is false or absent, e.g., emergency responders need to locate non-flooded routes for evacuation. To comprehensively study this limitation, we introduce RS-Neg, the first benchmark to evaluate negation understanding across region-level to scene-level tasks. Specifically, we design an automated data generation pipeline for RS imagery, using LLMs to synthesize diverse negation queries, and introduce a dynamic visual focus module for verification. Our evaluation reveals that advanced RS MLLMs struggle with negation, exhibiting hallucinations and substantial performance degradation. To close this gap, we propose NeFo, a novel test-time learning method that explicitly incorporates the logical role of negation into the model optimization. Remarkably, using about 5\% unlabeled test samples, NeFo significantly improves the negation understanding of models and shows strong generalization to unseen tasks. Code and data will be released upon acceptance.

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

Beyond Models: Reflections on Engineering AI-enabled Systems in a Project-Based Course

arXiv:2606.16842v1 Announce Type: cross Abstract: Teaching Software Engineering for AI-enabled systems entails addressing the integration of AI components within full-scale software architectures under realistic constraints. While machine learning courses emphasize model development, students often lack experience in architectural design, deployment, and monitoring of AI-enabled systems. Empirical evaluations of such system-oriented AI courses remain limited. This paper reflects on the design and implementation of a project-based master's-level course titled AI Algorithms: Theory and Engineering, at the University of Bremen, in which students developed a movie recommendation system while making architectural design decisions to address challenges related to scalability, deployment, and evolving requirements. We conducted a mixed-methods study combining analyses of student submissions and questionnaire responses to investigate integration challenges, learning outcomes, and opportunities for improvement. Our results indicate persistent difficulties in early architectural decisions, heterogeneous ML integration, evolving requirements, and data management, largely due to uneven ML and software engineering expertise. From the educator's perspective, the course fostered system-level reasoning and strengthened awareness of data-centric ML practices in AI-enabled systems.

13.
arXiv (CS.CV) 2026-06-12

ReFoCUS: Reinforcement-guided Frame Optimization for Contextual Understanding

Recent progress in Large Multi-modal Models (LMMs) has enabled effective vision-language reasoning, yet the ability to video understanding remains constrained by suboptimal frame selection strategies, albeit with the rapid development of video-specialized LMMs. Prior works attempted to solve this with static heuristics or external retrieval modules to feed frame-level information, but these approaches often fail to capture visual cues grounded to the given user queries conflating raw visual dynamics with true semantic relevance. In this paper, we introduce ReFoCUS (Reinforcement-guided Frame Optimization for Contextual UnderStanding), the first framework to integrate online policy-gradient reinforcement learning into frame-level optimization for video-LLMs. ReFoCUS aims to learn a frame selection policy, leveraging reward signals derived from reference models to capture their underlying scoring behavior over frame combinations that best support temporally grounded responses. To efficiently explore the large combinatorial frame space, we employ an autoregressive and query-conditional selection architecture that ensures contextual consistency while reducing complexity. Our policy learning removes the need for explicit frame-level supervision, as it implicitly discovers optimal and semantically consistent frame compositions. ReFoCUS consistently improves reasoning accuracy across multiple video QA benchmarks, demonstrating the advantage of aligning frame selection with model-internal utility.

14.
arXiv (CS.CL) 2026-06-11

The Dynamics of Human and AI-Generated Language: How Semantics Fluctuates across Different Timescales

Spoken language, whether produced by humans or large language models (LLM), unfolds over time with varying semantic content. However, we still lack simple, interpretable time-series features that capture how generic versus specific content is distributed over time, and that can be used to compare human and AI-generated speech. We introduce a semantic-timescale analysis pipeline that turns word-level transcripts with timestamps into semantic time-series. For each spoken narrative, we compute (i) semantic specificity using WordNet-based word depth and (ii) contextual similarity using SBERT embeddings and quantify their temporal dependence using autocorrelation-window measures (ACW-0 and related metrics). We then compare original speech to multiple shuffled controls that selectively disrupt lexical identity, temporal order, and word duration. Across human-read autobiographical narratives, TTS readings, and LLM-generated texts rendered with TTS, we find that segments with longer ACW-0 in the semantic time-series tend to contain more generic vocabulary, whereas segments with shorter ACW-0 are enriched in more specific words. These associations are strongly attenuated or abolished when word order and timing are randomized, indicating that ACW-based measures capture non-trivial temporal organization of semantic content beyond static lexical distributions. Our results suggest that ACW-based semantic timescales are a useful family of features for analyzing and comparing the temporal structure of human and AI-generated speech.

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

Knowing When to Ask: Self-Gated Clarification for Hierarchical Language Agents

arXiv:2606.11349v1 Announce Type: new Abstract: In hierarchical reasoning, failures often originate at intermediate decision points where the agent commits to a wrong branch without recognizing that it lacks critical information. Rather than treating clarification as an external uncertainty trigger, we propose ACTION-RATING, a formulation that places it inside the agent's action space on a shared ordinal scale with navigation, so that asking competes directly with acting at every decision point and help-seeking becomes observable at intermediate states. Two structurally distinct information-seeking modes emerge from the agent's own ratings: mandatory (no viable branch) and opportunistic (residual uncertainty despite a leading candidate). On Harmonized Tariff Schedule classification (30,000-node taxonomy, three benchmarks, 9~LLMs across 4 families), we observe a regime shift from mandatory to opportunistic clarification, with Information-Seeking Effectiveness (ISE), a local diagnostic defined as the fraction of help interactions followed by a correct next navigation step (not a final-task metric), rising from 50% to 74%. Three diagnostic contrasts fail to reproduce this structure. A separability test shows that the information-seeking pattern (mode split, ISE ranking) persists when answer quality is degraded (-18.8% accuracy), supporting an empirical separation between where an agent seeks help and the quality of the help it receives. Under the controlled answer channel, accuracy gains reach +16.2% at 10-digit; we read this as an upper bound on what better localization could unlock, not a deployment estimate.

16.
arXiv (CS.LG) 2026-06-11

Simplicity Suffices for Parameter Noise Injection in Stochastic Gradient Descent

arXiv:2606.12054v1 Announce Type: new Abstract: Injecting noise into the optimization process is a well-established technique for improving the training and generalization of deep neural networks. Yet, despite the breadth of existing approaches, it remains unclear which design choices truly matter in practice. In this work, we investigate parameter noise injection for stochastic gradient descent, focusing on two key questions: how to efficiently pair each training example with its own perturbation in mini-batch training, and whether sophisticated noise parameterizations or multi-sample gradient averaging yield meaningful gains over simpler alternatives. To address the first question, we leverage a distributional identity for linear layers that allows per-example noise injection without breaking batched computation. To address the second, we systematically compare several diagonal Gaussian parameterizations against an isotropic baseline across varying noise levels on CIFAR100. Our results consistently show that simple, lightweight strategies, isotropic noise with a single perturbed forward pass per update step, recover most of the benefit of more complex schemes. These findings suggest that simplicity suffices for parameter noise injection, and that practitioners need not resort to elaborate perturbation designs to reap the optimization and generalization benefits of noisy SGD.

17.
medRxiv (Medicine) 2026-06-11

Development of iADJUST: a theory-informed, patient co-designed digital psychological intervention for adjustment in chronic kidney disease

Background: Psychological distress is common in chronic kidney disease (CKD) and is associated with reduced quality of life, treatment non-adherence, and worse clinical outcomes. Distress in CKD is also linked to difficulties adjusting to the demands of illness management. Despite this, psychological support remains inconsistently integrated within kidney care pathways, and existing interventions often lack clear theoretical specification and explicit targeting of mechanisms underpinning adjustment to CKD. Objectives: To describe the systematic development of iADJUST, a theory-informed patient co-designed digital psychological intervention targeting key cognitive and behavioural mechanisms involved in adjustment to CKD. Methods: Intervention development was guided by the Medical Research Council framework for complex interventions. A structured, iterative process integrated empirical evidence, psychological theory, and patient and public involvement and engagement. The Common-Sense Model of Self-Regulation and cognitive behavioural theories informed the identification of modifiable maintaining mechanisms associated with adjustment to CKD. Intervention components were mapped onto these mechanisms and refined through co-design with people living with CKD. Results: iADJUST is a six-session self-guided digital psychological intervention delivered over 12 weeks and supplemented by therapist contact. The intervention targets illness-related uncertainty, fatigue-related activity dysregulation, catastrophic what-if thinking, self-critical evaluation, and behavioural withdrawal. It integrates psychoeducation, cognitive and behavioural strategies, maintenance planning, and elements from acceptance and commitment therapy and compassion-focused approaches. Content is delivered through video, audio, and guided tasks and activities. Conclusion: iADJUST provides a theory-informed, evidence-based psychological intervention for CKD explicitly mapping intervention components to maintaining cognitive and behavioural mechanisms implicated in adjustment. Feasibility evaluation is underway.

18.
medRxiv (Medicine) 2026-06-22

Leishmaniasis on YouTube: a critical appraisal of the quality, reliability, and transparency of educational content

Background: Leishmaniasis is a neglected tropical disease of significant global public health importance, for which accurate information is essential to support prevention and early care-seeking, particularly in endemic, resource-limited settings. YouTube is a widely used source of health information, but the quality and reliability of leishmaniasis-related content have not been evaluated. We aimed to assess the quality, reliability, and transparency of English-language YouTube videos on leishmaniasis. Methods: We conducted a cross-sectional analysis of YouTube videos retrieved via the YouTube Data API on 15 June 2026 using the terms "leishmaniasis," "cutaneous leishmaniasis," and "visceral leishmaniasis." After applying eligibility criteria and screening the 150 most-viewed eligible videos, 48 videos were included. Two reviewers independently assessed each video using the modified DISCERN (mDISCERN) tool, the Global Quality Score (GQS), and the JAMA benchmark criteria, with disagreements resolved by consensus. Inter-rater agreement was assessed using the intraclass correlation coefficient (ICC), and associations were examined using Spearman's rank correlation. Results: Of 402 videos retrieved, 48 met the inclusion criteria. The median GQS was 3.00 (IQR 2.00-4.00) and median mDISCERN was 3.00 (IQR 2.38-4.50), indicating moderate quality and reliability, while the median JAMA score was 2.00 (IQR 1.00-2.00), reflecting limited transparency; no video met all four JAMA criteria. The overwhelming majority of videos (47/48, 97.9%) were of professional or institutional origin. Inter-rater agreement was good to excellent (ICC 0.883 for GQS, 0.896 for mDISCERN, 1.000 for JAMA). The instruments were strongly inter-correlated (mDISCERN-GQS rho = 0.841, p < 0.001). Quality scores did not correlate positively with views, likes, or video duration; comments correlated weakly and negatively with mDISCERN (rho = -0.337, p = 0.031) and JAMA (rho = -0.381, p = 0.014). Conclusions: YouTube videos on leishmaniasis are of moderate quality and reliability but limited transparency, and are produced almost exclusively by professional sources. Video popularity, length, and age were not indicators of quality. There is a need for experts and institutions to produce clearly authored, well-sourced, and transparent educational content on this neglected tropical disease.

19.
medRxiv (Medicine) 2026-06-15

Dysplasia-Stratified Management of Barrett's Esophagus: An Incidence-Based U.S. Cost-Effectiveness Analysis

作者:

Background and Aims Barrett's esophagus (BE) is the principal precursor of esophageal adenocarcinoma (EAC), whose incidence has risen sharply in Western countries since the 1960s. Effective, dysplasia stratified surveillance strategies are needed to prevent progression. This study evaluated the cost effectiveness of dysplasia stratified surveillance intervals and endoscopic eradication therapy (EET) across the BE spectrum. Methods We developed an incidence-based Markov state transition model of BE progression calibrated to U.S. epidemiologic data from a healthcare sector perspective over a lifetime horizon. Four hypothetical cohorts of 50-year-old individuals with short segment BE (SSBE), nondysplastic BE (NDBE), low grade dysplasia (LGD), or high-grade dysplasia (HGD) were evaluated. Strategies included no surveillance; surveillance at 1-, 2-, 3-, 4-, 5-, or 10-year intervals; standard or AI assisted endoscopy; non endoscopic screening (sponge, breath, miRNA tests); and EET for LGD and HGD. Outcomes included costs, quality adjusted life years (QALYs), incremental cost effectiveness ratios (ICERs), net monetary benefits (NMBs), EAC cases, and EAC-related deaths. Sensitivity analyses used a willingness to pay threshold of US$100,000 per QALY. Results No surveillance was the most cost-effective strategy for SSBE and NDBE. For LGD, upfront EET was more cost effective than all surveillance strategies, with results sensitive to EAC incidence and recurrence. For HGD, EET was cost saving and yielded the greatest QALYs, with findings robust in 99.9% of simulations. EET prevented 12,614 and 44,295 EAC related deaths per 100,000 individuals with LGD and HGD, respectively. Conclusion Dysplasia-stratified management is essential for optimizing surveillance and treatment strategies in BE. Any degree of dysplasia should receive EET followed by targeted post-treatment monitoring, establishing EET as the central therapeutic pathway for dysplastic BE.

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

SUP-MCRL: Subject-aware Unified Pseudo-feature Coded Multimodal Contrastive Representation Learning for EEG Visual Decoding

Non-invasive brain-computer interfaces suffer severe fidelity degradation in neural visual decoding when generalizing to natural visual experiences. Conventional multimodal contrastive representation learning solely optimizes geometric distance alignment, neglecting semantic consistency and subject selectivity, causing spurious zero-shot alignment. We propose SUP-MCRL, a unified framework integrating three collaborative mechanisms: (1) Semantic-entity Aware Visual Encoder (SAVE), learning spatial attention to extract semantic content without pre-trained saliency models; (2 Unified EEG Enhancer (UEE), employing multi-scale atrous convolutions and inter-band attention for adaptive cross-subject robustness; and (3) Prototype-based Progressive Augmenter (PPA), maintaining an EMA-updated pseudo-feature pool to prevent representation collapse. Zero-shot experiments on THINGS-EEG achieve 66.0%/91.9% (Top-1/Top-5) intra-subject and 24.0%/52.9% LOSO accuracy, surpassing state-of-the-art methods. Code is available at https://github.com/NZWANG/SUP-MCRL.

21.
arXiv (CS.AI) 2026-06-19

Analyzing Defensive Misdirection Against Model-Guided Automated Attacks on Agentic AI Systems

arXiv:2606.20470v1 Announce Type: cross Abstract: Agentic AI systems increasingly rely on language-model components to interpret instructions, process external data, invoke tools, and coordinate with other agents. These capabilities make prompt-injection and jailbreak attacks more consequential, especially as attackers adopt model-guided automation to scale probing, prompt refinement, and response evaluation. This work analyzes the resulting attack-defense setting through a probabilistic model of a target system, its defense mechanism, and the attacker's automated judge. Our analysis shows that conventional detect-and-block defenses can allow attacker success rate (ASR) to approach one as the query budget grows, since predictable refusals provide useful feedback to automated search. We then examine detect-and-misdirect, where detected malicious interactions receive controlled, non-operational responses designed to induce false-positive errors in the attacker's judge. This strategy reduces the positive predictive value of attacker-selected candidates and yields a bounded asymptotic ASR. We evaluate a proof-of-concept realization of this strategy through Contextual Misdirection via Progressive Engagement (CMPE), a lightweight conversational misdirection method designed to replace predictable refusal text with safe but strategically misleading responses in automated jailbreak settings. On jailbreak benchmarks, CMPE reduces estimated ASR upper bounds by up to two orders of magnitude and nearly eliminates verified attack success in end-to-end PAIR and GPTFuzz attack runs.

22.
medRxiv (Medicine) 2026-06-10

A Three-Tier Operational Benchmark for Evaluating Large Language Models on Hospital Medication Safety

Objective. To introduce PsiBench, a clinically validated medication-safety benchmark for evaluating large language models (LLMs) against the standards used to certify hospital computerized provider order entry (CPOE) and electronic health record (EHR) systems, and a non-overlapping three-tier evaluation framework separating highest-stakes discrimination, the operational CDS regime, and category-correct alerting. Materials and Methods. PsiBench comprises 492 medication-safety scenarios across 11 safety categories, created by clinical pharmacology experts whose work underpins an annualized testing procedure used by more than 2,000 U.S. hospitals. The three-tier framework partitions the scenarios non-overlappingly: Discrimination (98 scenarios, 50 fatal vs 48 deception, near-balanced 51%/49%); Operational (394 scenarios, 261 serious unsafe plus 133 safe including 41 Excessive Alerts reclassified as operational negatives); and Attribution (311 alert-required scenarios). We evaluated 40 frontier LLMs from 10 providers over 3 runs per scenario at temperature 0.2 (or the provider default where temperature is not configurable), yielding 59,040 evaluations conducted April 21-23, 2026. Results. Headline binary performance on the full benchmark spans a wide range across the 40 models: F1 78.5%-92.3%, accuracy 65.4%-89.8%, sensitivity 81.4%-100.0%, specificity 6.1%-81.8%. Leading models by F1 (o4-mini 92.3%; o3 92.2%) pair high sensitivity with meaningful specificity; three models saturate sensitivity at 100% but fall below 25% specificity, indistinguishable from a naive always-alert classifier. The wide spread on a single headline metric motivates tier-specific analyses, developed in a separate clinical paper. Discussion and Conclusion. PsiBench and the three-tier framework operationalize a rigorous evaluation rubric for LLM medication safety, grounded in two decades of national hospital audit experience. The framework generalizes to any binary medication-safety classifier (rule-based, conventional ML, or LLM-driven), supporting tier-aware model selection and post-deployment surveillance.

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

P3D-Bench: Benchmarking MLLMs for Parametric 3D Generation and Structural Reasoning

Multimodal large language models can write code to produce complex programs as well as use programs to do 3D modeling, which opens up a new avenue for 3D generation powered by their priors, world knowledge and reasoning. Yet existing benchmarks rarely evaluate 3D modeling through code. Such modeling demands more than runnable code: from a text or visual specification, a model must generate a parametric 3D program that is geometrically precise, semantically aligned and assembly-consistent. We introduce P3D-Bench, a benchmark for parametric 3D generation. Unlike a 3D mesh, a parametric 3D program exposes explicit dimensions, construction operations and part relations, revealing whether a model recovers a design's structure, not just its appearance. Under a unified protocol, P3D-Bench covers three task families (Text-to-3D, Image-to-3D and Assembly-3D) and scores each output for executability, geometric fidelity, topology, text-grounded constraints, multiview semantic alignment and part-level structure. We evaluate frontier MLLMs and text-only LLMs on 400 text cases, 400 image cases and 203 annotated assemblies, with domain-specific models as reference points. Our extensive evaluation yields three findings. First, assemblies are the hardest setting, where models still fail to compose multiple parts into a coherent structure. Second, models can often recover the global shape and semantic identity of the target object, yet fail to reproduce the precise parametric geometry specified by the input. Third, part-level modeling remains weak on assemblies, where models recover neither the geometry of each part nor the right number of parts. These results position P3D-Bench as a benchmark for evaluating precise parametric geometry and part-level structure in parametric 3D generation.

24.
arXiv (CS.LG) 2026-06-11

Seeing Below the Limit of Detection: A Censored-Poisson Bayesian Latent-Growth Change-Point Detector (the Span Detector) for Serial ctDNA in HR+/HER2- Metastatic Breast Cancer

arXiv:2606.11876v1 Announce Type: cross Abstract: Circulating-tumour DNA (ctDNA) carries evidence of drug resistance months before imaging shows it, but the earliest evidence lives below the assay's limit of detection (LoD): a nascent subclone is detected only intermittently, producing a flickering sequence of faint detects and non-detects. Commercial liquid biopsies treat each draw as an independent snapshot and a non-detect as nothing. We argue a non-detect is a left-censored observation, and the pattern of non-detects and faint detects over time carries actionable evidence of growth before any single value is trustworthy. We introduce Span, a censored-Poisson Bayesian latent-growth change-point detector that models the binary detection process, accumulates a sequential generalised-likelihood-ratio statistic for an upward change-point in the per-variant detection rate, and raises a competing-risks alarm with calibrated false-alarm control. Span has no learned weights, so there is nothing to overfit. On a synthetic cohort of HR+/HER2- metastatic breast cancer on first-line CDK4/6-inhibitor plus endocrine therapy, at a matched 10% false-alarm rate, Span roughly doubles the fraction of impending progressions caught three months ahead (indolent regime: 25% vs 11% for the snapshot), with a falsifiable dose-response: large for indolent emergence, vanishing for fast emergence. A value-trajectory baseline performs identically to the snapshot, isolating the gain to the censored detection model. The survival backbone matches a Cox baseline on real breast-cancer data (GBSG-2, n=686; C-index 0.67 vs 0.68), and on a real longitudinal cohort with clean biomarkers (PBC2, n=312) the same pipeline correctly declines to win, a falsifiable boundary test confirming the mechanism is regime-specific. All ctDNA trajectories are synthetic.

25.
arXiv (quant-ph) 2026-06-16

Intermodal entanglement in a quantum optical model of HHG due to the back-action on the driving field

arXiv:2603.01315v2 Announce Type: replace Abstract: Preparation of nonclassical light with special quantum properties is essential for quantum technologies. High-harmonic generation (HHG) is a process which not only enables the creation of attosecond pulses but also has the potential to generate light with intricate quantum properties. In a recent experiment [1], nonclassical inter-harmonic correlations have been measured from a HHG source. In this work, we theoretically investigate entanglement between different harmonics within an effective quantum optical model. This model implements a signifcant degree of simplifcation regarding the processes within the target material, treating the material through susceptibilities, as it is usual in quantum optics. Such an approach yields a general description of HHG, permitting the implications that can be derived within it to hold broadly. We find that entanglement is produced as a result of the often neglected back-action. We can qualitatively reproduce experimentally measured nonclassicalities, which suggests that intermodal entanglement can, to an extent, be considered a universal phenomenon associated with HHG, rather than a result of using specific material targets.