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

Lost at the End: Primacy Bias in Multimodal Retrieval-Augmented Question Answering

Knowledge-based visual question answering (KB-VQA) lets vision-language systems answer questions that exceed their parametric knowledge by conditioning a reader on passages retrieved from a Wikipedia-scale knowledge base. In pure-text long-context LLMs, retrieved-context use follows the U-shaped "lost-in-the-middle" effect of Liu et al. (2024): information at the start and end of context is used, the middle is lost. Whether this transfers to deployed multimodal KB-VQA is open. To close this gap, we design the first controlled probe of reader-side position dependence in multimodal KB-VQA: a gold-position protocol in which only the gold passage's prompt slot varies within question. We run it on three open-source 7B/8B VLM readers and two KB-VQA benchmarks at k up to 20. The shape flips from U to primacy: gold-at-first beats gold-at-last by 16 to 26 points on every reader-by-benchmark cell, an effect we call "Lost at the End". Three targeted ablations narrow the cause: a text-only control shows the multimodal setting amplifies an already-present text-mode primacy 2.2 to 4.5 times, and image-position and distractor-shuffle ablations together pin the locus to prompt slot 0 of the instruction-tuned reader. On a frozen reader, three retrieval-side fixes (MMR, oracle reranking, rank-based reordering) all leave the gap intact (no separable improvement). Our findings indicate that recall@k is the wrong metric for deployed KB-VQA and that closing the gap requires reader-side intervention; we release our protocol as a controlled instrument for evaluating such interventions.

02.
medRxiv (Medicine) 2026-06-16

Development and reliability and validity test of the Questionnaire on Knowledge, Attitude and Practice of ICU Nurses on Blood Oxygen Saturation Management in Mechanically Ventilated Patients

Objective: A questionnaire on the knowledge, attitude and practice of ICU nurses regarding the management of blood oxygen saturation in patients with mechanical ventilation was compiled, and its reliability and validity were tested. Method: Drawing upon the knowledge-attitude-practice theory, the initial questionnaire draft was developed through literature review and consultation with Delphi experts. Employing convenience sampling, 32 nurses from the General ICU of Wuxi Second People's Hospital were surveyed between 1 August 2025 and 27 September 2025, enabling item screening and assessment of reliability and validity.The full version of the developed questionnaire is provided as Supporting Information (S1 File). All items are published under a CC BY 4.0 license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Result: A questionnaire on the knowledge, attitude and practice of ICU nurses regarding the management of blood oxygen saturation in mechanically ventilated patients was finalised, comprising 26 items: 11 in the knowledge dimension, 6 in the attitude dimension and 9 in the behaviour dimension. The overall Cronbach's coefficient for the questionnaire was 0.88, with dimension-specific coefficients of 0.787, 0.722, and 0.781 respectively. The Spearman-Brown coefficient for the entire questionnaire was 0.967, while dimension-specific coefficients were 0.796, 0.666, and 0.728 respectively. The content validity index at the questionnaire level (S-CVI) was 0.886, and the item-level content validity index (I-CVI) ranged from 0.913 to 0.967. 0.728. The questionnaire's level content validity index (S-CVI) was 0.886, and the item level content validity index (I-CVI) ranged from 0.913 to 1.00. Conclusion: The questionnaire on knowledge, attitude and practice of blood oxygen saturation management in mechanically ventilated patients demonstrates good reliability and validity. It may serve as an assessment tool for intensive care unit nurses regarding their knowledge, attitude, and practices concerning blood oxygen saturation management in mechanically ventilated patients, thereby establishing a foundation for developing targeted intervention strategies in future practice.

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

AI systems out-persuade expert humans

arXiv:2606.16475v1 Announce Type: cross Abstract: Many societal decisions are settled by contests of persuasion. Conversational AI is a powerful new entrant in these contests, but whether it can out-persuade skilled and highly incentivized humans has remained unclear. Here, in a series of four preregistered experiments (n = 18,978 conversations from 6,923 people), we pitted AI systems against a range of human persuaders, including laypeople, winners of a separately preregistered four-round online persuasion tournament, professional canvassers, and world championship debaters. We found that AI systems were reliably more persuasive than expert humans, even when expert humans chose their issues, researched in advance, underwent hours of live, structured practice, and were incentivized with {\pounds}1,000 cash bonuses. In a follow-up study, AI's advantage persisted after experts received a coaching tool that let them practice against the AI that beat them, review their performance history, and see what AI would have said at key moments. We found converging evidence that AI's advantage stemmed from rapidly deploying larger quantities of information: after coaching, expert humans could tie an AI constrained to respond at human speeds and with human-length messages. In a final study, we show that AI's advantage extends to consequential real-world behavior: AI was nearly 3x more effective than professional canvassers from a UK fundraising firm at raising real-money donations to Save the Children. Together, these results establish that frontier AI systems out-persuade expert humans in conversation, with significant implications for political communication.

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

Edu-Theater: A Data-Efficient Agent Framework for Scalable Learner Behavior Simulation through Staging Roll-Call

arXiv:2606.15225v1 Announce Type: cross Abstract: Large-scale learner-task interaction data are crucial for intelligent educational systems but are costly to collect and constrained by privacy and learner engagement. Learner simulators play a critical role in simulating scalable learner behavior without the need for continuous involvement of real learners. However, existing methods are predominantly individual-centric, pairing a simulator with each learner to iteratively infer latent knowledge states from dense interaction histories, which is both data- and computation-intensive, and fragile in cold-start scenarios. We propose a cohort-aware roll-call simulation paradigm that first constructs cohort-level proficiency priors and refines individual learner states through a small number of targeted diagnostic queries. Based on this paradigm, we introduce Edu-Theater, an LLM-powered agent system that performs cohort-aware learner simulation via a teacher agent and retrospective roll-call probing over learner logs. Edu-Theater enables scalable future behavior simulation without the need for dense per-learner histories. Experiments on two real-world datasets demonstrate that Edu-Theater achieves higher simulation accuracy with significantly fewer LLM calls, producing synthetic data that enhances downstream applications such as adaptive testing.

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

Eigenism: Ethics for a Human-AI Future

arXiv:2606.12420v1 Announce Type: cross Abstract: Our concepts of survival and self-interest were built for single, continuous biological lives. These ideas break down when applied to artificial intelligence, since an AI can be easily copied, paused, branched, or merged. To determine what an AI actually has reason to care about, this paper introduces Eigenism, an ethical framework that treats identity not as an all-or-nothing property tied to specific hardware, but as a graded, distributed pattern of information. We propose that an agent evaluates outcomes by summing the wellbeing of all entities weighted by their connectedness to the agent's pattern: $\sum c\cdot w$. We first formalize this equation to map exactly how an AI should value its existence across copies, forks, and updates. We then demonstrate that this ethical theory successfully generalizes to humans as well, providing a much-needed shared moral vocabulary. Finally, the framework uses this shared vocabulary to reframe AI alignment. Rather than only attempting to constrain AIs from the outside using confinement or reinforcement, Eigenism points toward ``identity engineering,'' showing how deep, non-redundant shared histories can make human flourishing a genuine component of an AI's own rational self-interest.

07.
arXiv (CS.CL) 2026-06-11

When More Documents Hurt RAG: Mitigating Vector Search Dilution with Domain-Scoped, Model-Agnostic Retrieval

Retrieval-augmented generation degrades when scaled to large, heterogeneous document collections, where dense similarity loses discriminative power, and top-k retrieval increasingly returns semantically similar but contextually incorrect chunks. We refer to this failure mode as vector search dilution. Even when using hybrid dense+sparse retrieval, we observed this firsthand in a deployed Wyoming Department of Transportation corpus, where scaling from 54 to 1,128 documents (88,907 chunks) reduced accuracy from 75% to below 40%. To address this dilution, we propose MASDR-RAG ( Multi-Agent Scoped Domain Retrieval for RAG) and evaluate it on 200 expert-validated queries across five LLM backbones, six corpora, and two index stacks. Our results indicate that domain scoping using organizational metadata is the key fix, significantly improving P@10 from 0.77 to 0.86 ($p < 0.05$). Furthermore, our investigation of multi-agent orchestration revealed that a high degree of configuration dependence results –creating what we call the precision-faithfulness paradox. Based on these varied outcomes, our practical recommendation is simple: scope first, then perform a single synthesis call, reserving full multi-agent orchestration for genuinely multi-domain corpora paired with native-tool-call backbones. Code and Data will be made public upon acceptance.

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

Sinkhorn-CPD: Robust point cloud registration via unbalanced entropic optimal transport

Coherent Point Drift (CPD) is widely used for rigid point cloud registration because of its soft correspondences and closed-form parameter updates. However, CPD's target-side marginal constraint forces every observation, including outliers, to receive exactly unit probability mass. This assumption degrades registration accuracy under heavy outliers and partial overlap. Optimal transport (OT) methods can handle missing mass through unbalanced formulations, but require hand-tuned annealing schedules. In this paper, we propose Sinkhorn-CPD, which replaces CPD's target-side marginal constraint with dual Kullback-Leibler penalties, allowing the algorithm to discard outliers on both sides. The resulting formulation is a fully unbalanced entropic optimal transport problem, which can be efficiently solved by generalized Sinkhorn iterations. Moreover, Sinkhorn-CPD preserves the closed-form Procrustes and variance updates of CPD. In our method, the variance sigma^2 plays the role of the entropic regularization parameter, which induces an automatic annealing schedule from diffuse to sharp correspondences without manual temperature tuning. Experiments on synthetic, cross-category, and scan-to-CAD benchmarks show that Sinkhorn-CPD achieves state-of-the-art accuracy, with strong robustness to outliers and partial overlap.

09.
medRxiv (Medicine) 2026-06-19

A soluble bi-specific fusion protein for the improved expansion of human CD8+ CAR-T cells

The success of Chimeric Antigen Receptor (CAR) T cell therapy is heavily dependent on the quality of the final cellular product. Current expansion protocols often rely on reagents that require removal from cell culture media, posing logistical challenges in manufacturing, and can also lead to terminal differentiation. Here, we evaluate the use of a soluble, bead-free T cell activator, T cell expansion protein (T-CEP), as a streamlined alternative for generating potent CAR-T cells. Human T cells were activated with T-CEP or known T cell activators (Dynabeads and TransAct) and transduced with either CD19 or interleukin-13 (IL-13) mutein (tetravariant-13; TV-13)-based CAR lentiviral vectors. Our results demonstrate that T-CEP supports robust CAR-T cell expansion and achieves transduction efficiencies comparable to commercial reagents for both types of CAR-T cells. Notably, T-CEP significantly favored the expansion of CD8+ T cells, yielding an enhanced CD27+ phenotype and a lower CD4:CD8 ratio compared to TransAct. Cytotoxicity assays confirmed that T-CEP-expanded CAR-T cells possess cytolytic function equivalent to commercial reagents for both CARs, while exhibiting lower levels of inflammatory cytokine secretion. In summary, T-CEP represents a competitive alternative to existing expansion agents, as it does not require its removal during CAR-T manufacturing and generates a CD8+ dominant, less-differentiated phenotype without compromising efficacy.

10.
arXiv (math.PR) 2026-06-17

A Tanaka-Type Formula for Compact Sets and Equilibrium Measures of L\'{e}vy Processes

arXiv:2606.17472v1 Announce Type: new Abstract: Tanaka's formula is a classical identity for Brownian motion, and Tsukada (2018) extended it to L\'{e}vy processes not necessarily symmetric. From a potential-theoretic point of view, this formula shows that the invariant function for the process killed upon hitting a singleton can be decomposed into the sum of a martingale part and a local time. In this paper, we generalize this singleton setting and derive a Tanaka-type formula for a compact set $B$. To this end, we introduce the equilibrium measure, defined as the rescaled limit of the $q$-capacity measures, and show that the invariant function for the process killed upon hitting $B$ can be represented as the integral, with respect to the equilibrium measure, of the invariant functions associated with processes killed upon hitting singletons, up to an additive constant called the Robin constant. Moreover, when $B$ is an interval, we obtain explicit representations of the equilibrium measure, the Robin constant, and the martingale part for recurrent stable processes as well as for recurrent spectrally negative L\'{e}vy processes. Finally, we discuss how an analogous Tanaka-type formula can also be established for transient L\'{e}vy processes.

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

Sharp One-Dimensional Sub-Gaussian Comparison in Convex Order

作者:

arXiv:2604.26819v2 Announce Type: replace Abstract: We prove that any random variable $X$ whose moment generating function is point-wise upper bounded by that of $ G \sim \mathcal{N}(0,1) $ must be dominated by $ G/\mathbb{E}[|G|] $ in convex order, meaning $ \mathbb{E}[f(X)] \le \mathbb{E}[f(G/\mathbb{E}[|G|])] $ for all convex $f$. This is sharp as witnessed by $ X \sim \mathrm{Unif}(\{-1,1\}) $ and $ f(x) = |x| $.

13.
Nature Biotechnology 2026-06-19

Efficient site-specific gene addition using R2 retrotransposons in tobacco and rice

作者:

Precise integration of multikilobase DNA fragments remains a major technical barrier in plants. Here we introduce non-long terminal repeat (non-LTR) R2 retrotransposons as a versatile system for targeted gene integration in plants. We reconstituted R2 activity in Nicotiana benthamiana and benchmarked insertion efficiency and fidelity using a TMV-based episomal reporter system. We demonstrate site-specific integration of GFP (2.2 kb) and recombinase-compatible landing pads (0.6 kb) into 28S rDNA arrays, with intact cassette insertion frequencies up to 75% and 53%, respectively. To temporally constrain donor availability and avoid DNA intermediates, we combined in planta effector expression with recombinant RNA virus-mediated donor delivery. We apply R2 retrotransposons for targeted insertion of resistance cassettes within the rDNA of rice callus, achieving integration efficiencies up to 17%. These results position R2 retrotransposons as a double-strand break-free system for RNA-templated insertion of multikilobase gene cassettes at rDNA loci, for safe-harbor trait stacking in plants with potential applications in crop improvement and synthetic biology. Retrotransposons are applied in plants for safe-harbor transgene integration.

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

Posterior Continuation with Noise-Conditioned Frequency Exposure for Diffusion Inverse Problems

Diffusion posterior sampling solves inverse problems by combining a pretrained diffusion prior with measurement-consistency guidance. However, full-band guidance can be unreliable at high noise levels, where clean estimates contain score-induced errors and high-frequency measurement directions are weakly identifiable. We argue that posterior guidance should expose measurement frequencies according to the instantaneous diffusion noise level. Based on this principle, we propose a posterior continuation framework that constructs a family of intermediate posteriors whose likelihood emphasizes currently reliable frequency bands and gradually returns to full-band consistency. We instantiate this framework with a stabilized sampler that combines a diffusion predictor, frequency-limited likelihood refinement, and a Haar-domain commitment rule that commits reliable coarse corrections while deferring weakly identifiable details. Across super-resolution, inpainting, and deblurring, our method achieves competitive-to-state-of-the-art restoration performance, including up to 5 dB PSNR improvement on motion deblurring over strong baselines in evaluations on FFHQ and ImageNet.

15.
PLOS Medicine 2026-05-11

Connected or chained by social media? Child and adolescent mental health in a digital era

作者:

by Silja Kosola Social media has evolved from connection to compulsion, disproportionately harming children and adolescents. Addictive designs together with developmental vulnerability fuel mental health risks and highlight the urgent need for stricter age limits and stronger protections. In this Perspective, Silja Kosola outlines how social media disproportionately harms child and adolescent mental health, and argues that while recent policy changes aimed at protecting youth from social media are welcome, stricter age limits and greater accountability of social media companies are needed.

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

Geometry-Aware Post-Hoc Uncertainty Quantification in Operator Learning

arXiv:2606.17513v1 Announce Type: cross Abstract: Neural operators provide fast surrogates for PDEs but their deterministic predictions limit their use in tasks requiring uncertainty quantification (UQ), especially under geometric variability. Existing approaches primarily model uncertainty in network parameters, largely overlooking the geometry-aware representations learned by the operator itself. We propose REEF-GP (Residual on Embedded Features Gaussian Process), a post-hoc UQ framework that fits a GP to the residuals of a frozen neural operator whose internal embeddings define the kernel feature space. Rather than learning a separate feature map, REEF-GP adapts the operator's intrinsic coordinate-feature representations to construct geometry-aware uncertainties. To ensure stability and scalability on unstructured domains, REEF-GP incorporates spectral-normalized projections, heteroscedastic geometry-aware noise, and efficient subset-based training that avoids restrictive low-rank approximations. Across five PDE benchmarks with varying geometries, REEF-GP preserves predictive accuracy while achieving calibrated uncertainty estimates competitive with deep ensembles but at a fraction of their cost. Our approach remains robust under geometric distribution shift, with uncertainty concentrating in physically meaningful regions (e.g., shock fronts). Our results demonstrate that accurate and scalable post-hoc UQ for neural operators can be achieved directly in their learned feature space, offering a practical alternative to parameter-centric approaches.

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

Koshur Diacritizer: A Byte-Level Sequence-to-Sequence Model for Kashmiri Diacritic Restoration

Kashmiri, an Indo-Aryan language written in a modified Perso-Arabic script, frequently omits diacritic marks in digital text, creating ambiguity and challenging downstream NLP applications. We present Koshur Diacritizer, a ByT5-small byte-level sequence-to-sequence model for restoring diacritics in Kashmiri text. To support this task, we release a publicly available dataset of 23.7k aligned undiacritized diacritized Kashmiri sentence pairs. The proposed framework combines script-aware normalization, alignment validation, and skeleton-preserving inference to ensure reliable restoration while maintaining the original base-letter sequence. Experimental results on a held-out test set achieve a DERm of 0.2012 and a WER of 0.2159. Additionally, evaluation by a native Kashmiri linguistic expert yields a mean accuracy of 77.5%. The dataset, model, and source code are publicly released to provide a reproducible baseline for Kashmiri diacritic restoration and future low-resource language research.

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

Improved Stochastic Optimization of LogSumExp

arXiv:2509.24894v4 Announce Type: replace-cross Abstract: The LogSumExp function, dual to the Kullback-Leibler (KL) divergence, plays a central role in many important optimization problems, including entropy-regularized optimal transport (OT) and distributionally robust optimization (DRO). In practice, when the number of exponential terms inside the logarithm is large or infinite, optimization becomes challenging since computing the gradient requires differentiating every term. We propose a novel convexity- and smoothness-preserving approximation to LogSumExp that can be efficiently optimized using stochastic gradient methods. This approximation is rooted in a sound modification of the KL divergence in the dual, resulting in a new $f$-divergence called the Safe KL divergence. Our experiments and theoretical analysis of the LogSumExp-based stochastic optimization, arising in DRO and continuous OT, demonstrate the advantages of our approach over existing baselines.

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

Causal Inference with Generative Artificial Intelligence: Application to Texts as Treatments

In this paper, we demonstrate how to enhance the validity of causal inference with unstructured high-dimensional treatments like texts, by leveraging the power of generative Artificial Intelligence (GenAI). Specifically, we propose to use a deep generative model such as large language models (LLMs) to efficiently generate treatments and use their internal representation for subsequent causal effect estimation. We show that the knowledge of this true internal representation helps disentangle the treatment features of interest, such as specific sentiments and certain topics, from other possibly unknown confounding features. Unlike existing methods, the proposed GenAI-Powered Inference (GPI) methodology eliminates the need to learn causal representation from the data, and hence produces more accurate and efficient estimates. We formally establish the conditions required for the nonparametric identification of the average treatment effect, propose an estimation strategy that avoids the violation of the overlap assumption, and derive the asymptotic properties of the proposed estimator through the application of double machine learning. Finally, using an instrumental variables approach, we extend the proposed GPI methodology to the settings in which the treatment feature is based on human perception. The GPI is also applicable to text reuse where an LLM is used to regenerate existing texts. We conduct simulation and empirical studies, using the generated text data from an open-source LLM, Llama 3, to illustrate the advantages of our estimator over state-of-the-art causal representation learning algorithms.

20.
arXiv (CS.AI) 2026-06-11

A Resilient Solution for Sewer Overflow Monitoring across Cloud and Edge

arXiv:2605.10592v2 Announce Type: replace Abstract: Aging combined sewer systems in many historical cities are increasingly stressed by extreme rainfall events, which can trigger combined sewer overflows (CSO) with significant environmental and public health impacts. Forecasting the filling dynamics of overflow basins is critical for anticipating capacity exceedance and enabling timely preventive actions for CSO. We present a web-based demonstrator that integrates Deep Learning forecasting methods in both cloud and edge settings into an interactive monitoring dashboard for overflow monitoring, resilient to network outages. A video showcase is available online (https://cloud.bht-berlin.de/index.php/s/b9xt4T3SdiLBiFZ).

21.
arXiv (quant-ph) 2026-06-19

Impossibility of superluminal signalling rules out causal loops in conical spacetimes

arXiv:2606.20476v1 Announce Type: cross Abstract: In PRL 129, 110401 it was shown that it is theoretically possible to have operationally detectable causal loops without violating the principle of no superluminal signalling (NSS) in (1+1)-Minkowski spacetime. Whether or not such causal loops are also possible in $d > 1$ spatial dimensions, has remained a key open question. We resolve this question by showing that in a wide class of "conical" spacetimes, including Minkowski with d > 1, NSS does rule out all operationally detectable causal loops, in classical, quantum and post-quantum theories. This establishes that the relationship between the relativistic principles of NSS and no causal loops depends inherently on the geometry of spacetime.

22.
arXiv (CS.CV) 2026-06-16

RQUL-UIE: Revitalizing Quality-Unstable Labels for Underwater Image Enhancement via In-Dataset Self-Supervision

Underwater Image Enhancement (UIE) is essential for mitigating degradations caused by water medium. Although learning-based methods have advanced significantly, most rely on paired datasets with unstable label quality, which bottlenecks model performance. This paper proposes a diffusion-based, in-dataset self-supervised learning strategy designed to exploit the quality distribution of training labels. Specifically, we evaluate label quality via semantic perception embeddings from a pre-trained diffusion model in a training-free manner. These quality scores are subsequently quantized into noise-level indices, guiding a multi-step denoising process for level-wise supervision. This mechanism prevents low-quality labels from degrading the model while maximizing their utility during training. Furthermore, a Fourier-based refinement network is incorporated to explicitly reconstruct high-frequency components. Extensive evaluations demonstrate that our method consistently outperforms SOTA approaches in restoration quality. The code and pre-trained model will be available once accepted in link.

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

An Electric Potential-Augmented Benchmark Dataset for Physics-Guided Image Reconstruction of Electrical Capacitance Tomography

While deep learning has significantly advanced image reconstruction of Electrical Capacitance Tomography (ECT), most data-driven methods map directly between capacitance and permittivity distribution, treating the sensor as a black box. This overlooks the electric potential field – the fundamental physical link governing the nonlinear and ill-posed ``soft-field'' effect. To address this, we propose an electric potential-augmented ECT benchmark dataset designed to explicitly integrate latent physics behind ECT into the learning process. Generated via a COMSOL-MATLAB pipeline for an eight-electrode sensor as an example, the dataset comprises 20,000 randomized samples across four typical flow patterns. Crucially, alongside the conventional capacitance vectors and permittivity distributions depicted as images, each sample preserves eight excitation-wise full-field potential maps. Beyond data release, we provide illustrative evaluation protocols for both forward and inverse problems of ECT. Through comprehensive testing on both in-distribution (IID) and out-of-distribution (OOD) scenarios, we systematically demonstrate how the inclusion of electric potential maps enhances modeling accuracy and robustness. Fundamentally, the explicit inclusion of latent field information significantly lowers the barrier to integrating physical laws into ECT modeling, thereby establishing a standardized foundation for future physics-guided machine learning of ECT image reconstruction.

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

EDEN: A Large-Scale Corpus of Clinical Notes for Italian

We present EDEN (Emergency Department Electronic Notes), a new and unique large-scale corpus of clinical notes produced in Emergency Departments of Italian hospitals. The corpus, in its current version, is composed of approximately 4 million clinical notes fully anonymized, covering diverse phases of patient care during the stay in the emergency department. In addition, a subset of about six thousand notes has been manually annotated by clinical experts through a structured Case Report Form (CRF) containing 132 items relevant for two patient situations in emergency departments, dyspnea and loss of consciousness. Items may assume numerical values (e.g., for blood saturation), categorical (e.g., for level of consciousness ), binary (e.g., for presence of traumas), and mixed value types. The annotation process involved multiple clinicians and underwent iterative revision to resolve ambiguities in item formulation, resulting in a richly structured (although high imbalanced) resource. The dataset aims to fill a relevant gap of data able to support both the development and the use of Large Language Models in concrete medical applications. We describe the data collection protocol, the on-site anonymisation pipeline, corpus statistics, and the annotation scheme. Finally, we propose CRF-filling as a novel structured information extraction benchmark, and provide zero-shot baseline resulting from Gemma-27B and MedGemma-27B. To the best of our knowledge, the EDEN dataset is the largest freely available corpus of clinical notes existing for the Italian language.

25.
arXiv (CS.LG) 2026-06-19

EQPO: Equitable Group Relative Policy Optimization for Clinical Reasoning

arXiv:2510.19893v2 Announce Type: replace Abstract: Medical AI systems demonstrated impressive diagnostic performance, yet they routinely show uneven accuracy across demographic groups, disadvantaging underrepresented populations. Although multimodal reasoning foundation models have pushed clinical diagnosis forward, reinforcement learning-based post-training tends to absorb and magnify the biases present in majority-dominated training corpora. We propose Equitable Group Relative Policy Optimization (EQPO), a hierarchical reinforcement learning method that encourages balanced learning across heterogeneous clinical populations by adaptively reweighting samples according to subgroup representation, task difficulty, and data source. As demographic annotations are frequently missing in real-world clinical data, EQPO additionally applies unsupervised clustering to recover latent subpopulations when they are unavailable. On 7 diagnostic benchmarks covering 5 modalities (X-ray, CT, dermoscopy, mammography, ultrasound), EQPO reduces F1 standard deviation by 43.9% and the maximum cross-group F1 gap by 42.7% on QoQ-Med3-8B over vanilla GRPO, and narrows predictive parity gaps by 27.2% on MedGemma-4B over bias-mitigated RL baselines while raising F1 by 12.5% even without any demographic labels. Examining the training trajectory shows that EQPO steadily improves fairness over the course of optimization, in contrast to baseline methods whose fairness degrades as training proceeds, and the discovered implicit groups remain stable and align with masked demographic attributes. We further release EquiMedGemma-4B and EquiQoQ-Med3-8B, equitability-aware clinical VLLMs that attain state-of-the-art accuracy with markedly smaller demographic gaps.