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01.
medRxiv (Medicine) 2026-06-12

Microbial etiology, antibiotic susceptibility profiles, and multidrug resistance of urinary tract infections at a secondary healthcare facility in Ghana

Background: Rising antibiotic resistance challenges empirical therapies for urinary tract infections (UTIs). This study evaluated the microbial etiology, susceptibility profiles, and multidrug resistance (MDR) patterns of uropathogens among outpatients at the Berekum Holy Family Hospital, Ghana. Methods: This cross-sectional study (February to August 2021) screened 263 symptomatic outpatients. Mid-stream urine samples underwent quantitative culture, biochemical identification, and antimicrobial susceptibility testing via the Kirby-Bauer disc diffusion method following the 2021 CLSI guidelines. Results: Significant bacteriuria prevalence was 22.8% (60/263). UTIs predominated in females (78.3%, 47/60; p = 0.1501) and individuals [≥]45 years (33.3%, 20/60). Gram-negative rods accounted for 90.0% of isolates, primarily Escherichia coli (26.7%), Citrobacter spp. (25.0%), and Enterobacter spp. (21.7%); Staphylococcus aureus (10.0%) was the only Gram-positive pathogen. Extreme phenotypic resistance was observed against piperacillin/tazobactam (98.3%), cefotaxime (93.3%), tetracycline (88.3%), and cefoperazone (85.0%). Conversely, highest therapeutic susceptibilities were retained by amikacin (78.3%), levofloxacin (61.7%), and gentamicin (58.3%). Conclusion: The high prevalence of MDR uropathogens against advanced beta-lactamase inhibitor combinations and cephalosporins necessitates an immediate re-evaluation of regional empirical protocols. Amikacin, levofloxacin, and gentamicin remain viable options prior to culture confirmation. These findings establish a crucial phenotypic baseline to guide localized prescribing policies and regional antimicrobial resistance tracking strategies.

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

Self-Supervised Learning of Iterative Solvers for Constrained Optimization

arXiv:2409.08066v3 Announce Type: replace Abstract: The real-time solution of parametric optimization problems is critical for applications that demand high accuracy under tight real-time constraints, such as model predictive control. To this end, this work presents a learning-based iterative solver for constrained optimization, comprising a neural network predictor that generates initial primal-dual solution estimates, followed by a learned iterative solver that refines these estimates to reach high accuracy. We introduce a novel loss function based on Karush-Kuhn-Tucker (KKT) optimality conditions, enabling fully self-supervised training without pre-solved optimizer solutions. Theoretical guarantees ensure that the training loss function attains minima exclusively at KKT points. A convexification procedure enables application to nonconvex problems while preserving these guarantees. Experiments on two nonconvex case studies demonstrate speedups of up to one order of magnitude compared to state-of-the-art solvers such as IPOPT, while achieving orders of magnitude higher accuracy than competing learning-based approaches.

03.
arXiv (CS.LG) 2026-06-19

Representing Piecewise-Linear Functions by Functions with Minimal Arity

arXiv:2406.02421v2 Announce Type: replace-cross Abstract: Any continuous piecewise-linear function $F\colon \mathbb{R}^{n}\to \mathbb{R}$ can be represented as a linear combination of $\max$ functions of at most $n+1$ affine-linear functions. In our previous paper [``Representing piecewise linear functions by functions with small arity'', AAECC, 2023], we showed that this upper bound of $n+1$ arguments is tight. In the present paper, we extend this result by establishing a correspondence between the function $F$ and the minimal number of arguments that are needed in any such decomposition. We show that the tessellation of the input space $\mathbb{R}^{n}$ induced by the function $F$ has a direct connection to the number of arguments in the $\max$ functions.

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

Gender Differences in AI Literacy Workshop Outcomes and Deepfake Engagement

arXiv:2606.14718v1 Announce Type: cross Abstract: As Artificial Intelligence (AI) literacy initiatives expand in K-12 settings, understanding how gender shapes student baseline perceptions, tool-use, and responsiveness to interventions is essential for equitable curriculum design. This study examines gender differences in AI literacy, safety awareness, and STEM career aspirations among Australian secondary students (Years 7, 8, and 10; N(pre) = 199, n(post) = 136) from two co-educational government schools who participated in a one-day AI literacy workshop. Using statistical regression methods controlling for year level and school, we found that pre-workshop, male students reported significantly higher STEM career interest across all three domains (AI, computer science, and engineering), while female students were significantly more likely to use AI for schoolwork and to seek advice from AI tools. Gender-differentiated patterns also emerged in deepfake behaviours: males were significantly more likely to have created or shared deepfake content. Both genders improved in AI knowledge post-intervention, yet females showed a richer profile of gains: wider conceptual understanding, greater confidence, and meaningful increases in AI and CS career interest that partially narrowed the gender STEM gap. These findings highlight the need for gender-responsive AI curricula, particularly deepfake safety education for male students, and demonstrate that even single-day workshops can narrow gender gaps in STEM aspirations and AI confidence.

05.
arXiv (CS.LG) 2026-06-11

Provable Recovery of Locally Important Signed Features and Interactions from Random Forest

arXiv:2512.11081v2 Announce Type: replace-cross Abstract: Feature and Interaction Importance (FII) methods are essential in supervised learning for assessing the relevance of input variables and their interactions in complex prediction models. In many domains, such as personalized medicine, local interpretations for individual predictions are often required, rather than global scores summarizing overall feature importance. Random Forests (RFs) are widely used in these settings, and existing interpretability methods typically exploit tree structures and split statistics to provide model-specific insights. However, theoretical understanding of local FII methods for RF remains limited, making it unclear how to interpret high importance scores for individual predictions. We propose a novel, local, model-specific FII method that identifies frequent co-occurrences of features along decision paths, combining global patterns with those observed on paths specific to a given test point. We prove that our method consistently recovers the true local signal features and their interactions under a Locally Spike Sparse (LSS) model and also identifies whether large or small feature values drive a prediction. We illustrate the usefulness of our method and theoretical results through simulation studies and a real-world data example.

06.
medRxiv (Medicine) 2026-06-15

Semantic Embeddings and the Peripheral Transcriptome in Ischemic Stroke: Connecting Molecular Signatures to NANDA-I Diagnoses

Objective: To construct and evaluate, in an exploratory manner, a pathophysiologic rationale link- ing biological pathways derived from the peripheral transcriptome in ischemic stroke (IS) to nursing diagnoses in the NANDA-I 2024-2026 taxonomy, while emphasizing that this association is not di- rect, deterministic, or automatically inferable from textual similarity with large language models (LLMs). Methods: A computational study was conducted using public secondary data from the Gene Ex- pression Omnibus series GSE16561, which includes 63 peripheral blood samples: 39 from indi- viduals with IS and 24 from healthy controls. The pipeline integrated transcriptomic analysis and functional enrichment, semantic mapping through ClinicalBERT embeddings, and mechanistic and clinical-conceptual judgment using Claude Sonnet 4.6 as a judge. The judgment stage was treated as the central interpretive layer, designed to mediate the transcriptome, pathophysiology, functional manifestation, and NANDA-I diagnosis. Results: The analysis identified a bimodal transcriptomic pattern, with activation of pathways re- lated to innate immunity and suppression of pathways related to adaptive immunity. Semantic map- ping generated 158 pathway-diagnosis pairs. The Spearman correlation between cosine similarity and the mechanistic score was negative and statistically significant (rho = -0.243; p = 2.09e-03), but weak in magnitude. This effect size indicates that semantic similarity explained less than 6% of the variance in mechanistic plausibility, reinforcing the insufficiency of embeddings as a stand- alone criterion. Of the 158 pairs, 14 were classified as high concordance, 8 as moderate, and 136 as divergent. Conclusion: The main value of this study lies in demonstrating that translating biological pathways into nursing diagnoses requires pathophysiologic, functional, and clinical-conceptual mediation. The prioritized pairs represent mechanistically plausible hypotheses for future research, without implying causality, direct clinical confirmation, or immediate care recommendations.

07.
arXiv (CS.AI) 2026-06-15

Scalable Production Scheduling: Linear Complexity via Unified Homogeneous Graphs

arXiv:2604.23841v2 Announce Type: replace-cross Abstract: Efficiently solving the Job Shop Scheduling Problem in real-world industrial applications requires policies that are both computationally lean and topologically robust. While Reinforcement Learning has shown potential in automating dispatching rules, existing models often struggle with a scalability bottleneck caused by quadratic graph complexity or the architectural overhead of heterogeneous layers. We introduce a unified graph framework that employs feature-based homogenization to project distinct node roles into a shared latent space. This allows a standard homogeneous Graph Isomorphism Network to capture complex resource contention with linear complexity, ensuring low-latency inference for large-scale industrial applications. Our empirical results demonstrate that our framework achieves state-of-the-art performance while exhibiting consistent zero-shot generalization. We identify the job-to-machine ratio as the primary driver of policy effectiveness, rather than absolute problem size. Based on this, we propose a hypothesis of structural saturation, demonstrating that policies trained on critically congested instances ($\mathcal{J} \approx \mathcal{M}$) learn scale-invariant resolution strategies. Agents trained at this saturation point internalize invariant conflict-resolution logic, allowing them to treat massive rectangular instances as a sequential concatenation of saturated sub-problems. This approach eliminates the need for expensive scale-specific retraining and prevents overfitting to statistical shortcuts, providing a robust and efficient pathway for deploying RL solutions in dynamic production environments.

08.
arXiv (CS.CV) 2026-06-18

On-Manifold Variational Learning with Heat-Kernel Priors

Learning unsupervised representations of medical imaging cohorts can reveal clinically meaningful prototypes without expert labels, which are often noisy and fail to capture true pathological heterogeneity. However, existing deep latent-variable models estimate Gaussian mixture priors via Euclidean averaging, producing prototypes that drift off the curved data manifold and degenerate as the number of sub-populations grows. We propose a manifold-anchored variational framework built on a geometry-aware Expectation-Maximization (EM) algorithm, whose M-step selects each sub-population prototype as the graph medoid with the highest diffusion centrality on a heat-kernel-weighted latent graph, ensuring that every prototype remains on-manifold. A Dirichlet energy regularizer enforces geometric smoothness of the latent space, and a per-sub-population uncertainty score enables label-free quality assessment. \rev{The manifold-anchored EM is a general-purpose geometric tool that extends standard EM and applies readily to other latent-variable models beyond this setting.} On cardiac scar and brain MRI benchmarks, our framework attains the highest accuracy among all compared methods, produces the sharpest prototypes reported to date, and remains stable at large sub-population counts where all baselines degenerate.

09.
arXiv (math.PR) 2026-06-11

Markov property and path regularity for the solutions to SPDEs driven by cylindrical-martingale valued measures

arXiv:2606.12381v1 Announce Type: new Abstract: In this paper we prove the Markov property for the solution to stochastic partial differential equations driven by a cylindrical orthogonal martingale-valued measure. We assume our coefficients are time-dependent and satisfy some growth and Lipschitz conditions. We also prove that for time-independent coefficients and under mild assumptions on the cylindrical orthogonal martingale-valued measure, the solutions to our stochastic partial differential equations are Feller. Finally, in the case that the $C_{0}$-semigroup is quasi-contraction, we show that the solution to our stochastic partial differential equation possesses a càdlàg version.

10.
arXiv (CS.AI) 2026-06-12

From Verdict to Process: Agentic Reinforcement Learning for Multi-Stage Fact Verification

arXiv:2606.13262v1 Announce Type: new Abstract: Recent approaches combining Large Language Models (LLMs) with retrieval-augmented reasoning have shown promise for automated fact verification. To process complex claims, these verification pipelines typically execute multi-stage workflows that coordinate tightly coupled modules, including claim decomposition, evidence gathering, and verdict prediction. However, existing methods optimize individual stages in isolation or rely on fixed heuristics, which limits adaptive coordination among stages and can lead to suboptimal outcomes. In this work, we propose ProFact, an agentic reinforcement learning framework for end-to-end optimization of multi-stage fact verification trajectories. ProFact trains a unified policy to coordinate claim decomposition, evidence seeking, answer generation, and verdict prediction. To address the sparse and delayed supervision provided by final veracity labels, ProFact introduces process-aware rewards that provide stage-level learning signals throughout the verification process. Empirical evaluation shows that ProFact consistently outperforms strong baselines in both verification performance and inference efficiency. These results highlight the effectiveness of process-aware trajectory optimization for multi-stage fact verification.

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

PolyKV: Heterogeneous Retention and Allocation for KV Cache Compression

arXiv:2606.15157v1 Announce Type: cross Abstract: KV cache compression is essential for reducing the memory cost of long-context large language model inference. Existing approaches, however, typically apply a single compression policy and a uniform cache budget across all transformer layers. This uniform design ignores the fact that different layers can play different roles during prefill and decoding, and may therefore require different eviction strategies and cache capacities. We present PolyKV, a layer-wise KV cache optimization framework that considers design space with method selection and budget allocation. PolyKV routes each layer to a suitable KV compression policy based on layer-level signals, while assigning non-uniform budgets under a fixed total budget. This formulation enables heterogeneous compositions of existing KV cache methods. Experiments on LLaMA-3.1-8B and Qwen3-8B show that, under the same 512-token average KV budget, PolyKV recovers 54.5% and 25.7% of the LongBench performance gap between the strongest single-policy baseline and FullKV, respectively. Across 128-1024 budget sweep, PolyKV consistently improves over the strongest baseline by 1.7%-6.4%, corresponding to 40.0%-54.5% recovery of the FullKV gap.

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

InnoEval: On Research Idea Evaluation as a Knowledge-Grounded, Multi-Perspective Reasoning Problem

The rapid evolution of Large Language Models has catalyzed a surge in scientific idea production, yet this leap has not been accompanied by a matching advance in idea evaluation. The fundamental nature of scientific evaluation needs knowledgeable grounding, collective deliberation, and multi-criteria decision-making. However, existing idea evaluation methods often suffer from narrow knowledge horizons, flattened evaluation dimensions, and the inherent bias in LLM-as-a-Judge. To address these, we regard idea evaluation as a knowledge-grounded, multi-perspective reasoning problem and introduce InnoEval, a deep innovation evaluation framework designed to emulate human-level idea assessment. We apply a heterogeneous deep knowledge search engine that retrieves and grounds dynamic evidence from diverse online sources. We further achieve review consensus with an innovation review board containing reviewers with distinct academic backgrounds, enabling a multi-dimensional decoupled evaluation across multiple metrics. We construct comprehensive datasets derived from authoritative peer-reviewed submissions to benchmark InnoEval. Experiments demonstrate that InnoEval can consistently outperform baselines in point-wise, pair-wise, and group-wise evaluation tasks, exhibiting judgment patterns and consensus highly aligned with human experts.

14.
arXiv (quant-ph) 2026-06-11

Quantum ergodicity and semiclassical measures: mathematical results

arXiv:2606.12098v1 Announce Type: new Abstract: In this chapter we review some results describing the high-frequency eigenmodes of the Laplacian on compact manifolds, or Euclidean domains, for which the geodesic flow is chaotic. We focus on the macroscopic distribution of these eigenmodes, which is described by the concept of semiclassical measure. The main result on the question is the Quantum Ergodicity theorem, originally due to Schnirelman. We provide the detailed proof of this theorem, including the adjustments necessary to treat the case of manifolds with boundary. We also discuss the Quantum Unique Ergodicity conjecture, and some progress towards this conjecture for strongly chaotic (Anosov) systems. In particular, we describe the constraints on admissible semiclassical measures, in terms of their Kolmogorov-Sinai entropy, as well as more recent delocalization results.

15.
arXiv (quant-ph) 2026-06-12

Quantum Network Routing based on Surface Code Error Correction

arXiv:2606.12781v1 Announce Type: new Abstract: Quantum networks encounter unavoidable channel noises and erasure errors, presenting a huge obstacle in designing protocols that attain both high reliability and efficiency. Typically, quantum networks fall into two categories: those utilize quantum entanglements for quantum teleportation, and those directly transfer the actual quantum messages. In this paper, we present SurfNet, a quantum network that inherits the main advantages from both categories. It employs surface codes as logical qubits for encoding messages, and utilizes two parallel communication channels to fault-tolerantly transfer each surface code in a modular manner. Our approach of using surface codes can timely correct both operational and photon loss errors within the network, and the integration of the two channels within the network can greatly improve network throughput. For the implementation of SurfNet, we propose a novel network architecture, designed to better integrate surface codes into quantum networks. We also propose a novel error correction decoder, designed to fully utilize the modular characteristic of surface codes within our network. Simulation results demonstrate that SurfNet with its decoder significantly enhances the communication fidelity within quantum networks.

16.
medRxiv (Medicine) 2026-06-17

Clinician knowledge and self-efficacy in snakebite management: A cross-sectional assessment in Northern Uganda

Background: Snakebite envenomation (SBE) is a major public health crisis in rural Uganda, yet it remains a neglected tropical disease. Effective management is often compromised by systemic barriers and a lack of clinician training. This study assessed clinician self-efficacy and objective knowledge regarding SBE management in Northern Uganda. Methods: A descriptive, cross-sectional study was conducted between February and July 2025 among 379 healthcare workers in Gulu, Omoro, and Pader districts. A validated questionnaire was used to collect data on socio-demographics, self-reported efficacy (scale 1-10), and objective knowledge. Knowledge scores [&ge;]70% were categorized as adequate. Multivariable logistic regression identified independent predictors of adequate knowledge, and Spearmans correlation ({rho}) assessed the relationship between knowledge and self-efficacy. Results: The participants had a mean age of 35.6 years (SD {+/-}7.3), were predominantly female (56.5%, 214/379), and most (83.6%, 317/379) practiced at Health Centre III level facilities. While 53.8% (204/379) reported prior training, 48.3% (183/379) of these had not received an update in over 10 years. Adequate knowledge was demonstrated by 51.5% (195/379) of participants. In the multivariable analysis, practicing in Omoro (adjusted odds ratio [aOR]: 0.3, 95% CI: 0.1-0.6, p < 0.001) or Pader (aOR: 0.2, 95% CI: 0.1-0.4, p < 0.001) was associated with lower odds of adequate knowledge compared to Gulu district. Prior training significantly increased the odds of adequate knowledge (aOR: 2.3, 95% CI: 1.3-4.2, p = 0.006). A moderate positive correlation was observed between self-efficacy and objective knowledge (Spearmans {rho} = 0.33, p < 0.0001). Conclusion: Approximately half of the frontline healthcare workers in Northern Uganda lack adequate knowledge on SBE management, with significant geographic differences and outdated training. The gap between clinician self-efficacy and objective knowledge poses a risk to patient safety. Regular, mandatory refresher training and targeted educational outreach to remote districts are required to reduce SBE-related morbidity and mortality.

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

SAGE: Scalable AI Governance & Evaluation

arXiv:2602.07840v4 Announce Type: replace-cross Abstract: Evaluating relevance in large-scale search systems is fundamentally constrained by the governance gap between nuanced, resource-constrained human oversight and the high-throughput requirements of production systems. While traditional approaches rely on engagement proxies or sparse manual review, these methods often fail to capture the full scope of high-impact relevance failures. We present SAGE (Scalable AI Governance \& Evaluation), a framework that operationalizes high-quality human product judgment as a scalable evaluation signal. At the core of SAGE is a bidirectional calibration loop where natural-language Policy, curated Precedent, and an LLM Surrogate Judge co-evolve. SAGE systematically resolves semantic ambiguities and misalignments, transforming subjective relevance judgment into an executable, multi-dimensional rubric with near human-level agreement. To bridge the gap between frontier model reasoning and industrial-scale inference, we apply teacher-student distillation to transfer high-fidelity judgments into compact student surrogates at 92$\times$ lower cost. Deployed within LinkedIn Search ecosystems, SAGE guided model iteration through simulation-driven development, distilling policy-aligned models for online serving and enabling rapid offline evaluation. In production, it powered policy oversight that measured ramped model variants and detected regressions invisible to engagement metrics. Collectively, these drove a 0.25\% lift in LinkedIn daily active users.

18.
arXiv (CS.CV) 2026-06-12

Fully Distributed Multi-View 3D Tracking in Real-Time

Multi-camera tracking with overlapping fields of view typically relies on centralized fusion, which creates computational bottlenecks that prevent deployment at scale. We present MV3DT, a fully distributed framework for real-time multi-view 3D tracking that achieves accurate identity propagation and occlusion recovery through peer-to-peer coordination, eliminating the need for central aggregation. Each camera node executes a lightweight modular pipeline comprising monocular 3D perception, distributed multi-view association, and collaborative fusion via lightweight messaging. MV3DT achieves 94.3% IDF1 and 93.3% MOTA on WILDTRACK, competitive with state-of-the-art centralized methods, while demonstrating superior scalability by sustaining 30 FPS on 100 cameras with less than 10 ms inter-camera latency and only 2.2% communication overhead. MV3DT operates in a zero-shot regime given camera calibrations, requiring no scene-specific learning and making it directly deployable in new environments. These results establish MV3DT as a practical solution for real-time multi-view tracking in large-scale overlapping camera networks.

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

Fault Lines: Navigating Ethics and Responsible AI Where National Policy Meets Local Practice in Public Sector Transformation

arXiv:2606.13039v1 Announce Type: cross Abstract: The UK government has adopted a pro-AI stance to help transform public service delivery in the face of severe financial pressures, but the path to translate this vision into responsible AI practice remains ill-defined. While UK policy is often set at the national level, local authorities are responsible for most public service delivery, and the rapid advance of AI-first narratives in the public sector is exposing fault lines in knowledge and practice at this national-local interface. This paper examines how responsible AI is interpreted and implemented at the interface between the UK's central government and local authorities, taking the high-stakes area of Special Educational Needs and Disabilities (SEND) as a case study. We present a thematic analysis of 17 semi-structured interviews with policymakers, practitioners, and third-sector professionals to identify barriers and enabling conditions for responsible AI where national policy meets local practice. We identify five interconnected challenges facing local authorities: shadow usage of AI and data privacy risks, market-government asymmetry in AI provision, insufficient workforce readiness, a lack of standardised definitions and measurements, and gaps in human accountability. For each, participants proposed actionable steps, from strengthening data protection frameworks and rebalancing the market-government relationship to enhancing workforce capacity. Our examination of SEND brings these challenges into sharper focus, showing how high-stakes decisions affecting vulnerable children and families intensify tensions around accountability, fairness, and human oversight, exposing the limits of a principle-based regulatory approach. We argue that responsible public sector AI requires both national policy adjustments and structural reforms to institutional capacity, values, and governance mechanisms at the local level.

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

AI-Driven Test Case Generation from Natural Language Requirements: A Survey of Techniques and Research Gaps

arXiv:2606.06563v2 Announce Type: replace-cross Abstract: Software testing is critical for verifying that systems meet specified requirements, yet remains among the most time-consuming and expensive activities in development. Requirements-based test generation allows test cases to be derived early from requirements artifacts, but generating them directly from natural language is challenging due to inherent ambiguity and imprecision. Recent advances in AI, natural language processing (NLP), and large language models (LLMs) have made automating this pipeline increasingly feasible, while introducing new risks including hallucination, reduced traceability, and inconsistent evaluation. This survey addresses four research questions: what AI and NLP techniques have been proposed for generating test cases from natural language requirements; what tools and frameworks support these approaches; how generated test cases are evaluated; and what research gaps remain. Following Kitchenham and Charters' systematic review guidelines, we searched major scholarly databases spanning 2000-2025 and, after applying strict inclusion criteria, identified 21 primary studies. The literature is organized into three evolutionary eras, revealing that no existing approach simultaneously satisfies six key quality dimensions: automation, ambiguity handling, domain applicability, traceability, evaluation thoroughness, and hallucination control. The survey makes three main contributions: a three-era evolutionary synthesis of AI-based test generation; a six-criteria gap analysis showing no current approach fully addresses all quality dimensions; and four actionable research guidelines targeting hallucination, traceability, complexity sensitivity, and compliance.

21.
medRxiv (Medicine) 2026-06-15

Quality Improvement Based Implementation and Evaluation of a Decision Aid for Patients with Nephrolithiasis

Introduction Patients with nephrolithiasis face challenges in making a high-quality, preference sensitive decision. Our prior work established feasibility and patient acceptance of a software-based decision aid (DA). The objectives for this study were to identify implementation strategies for the DA in routine care and determine whether DA implementation enhances decisional quality for patients. Methods New nephrolithiasis patients were recruited from the institution Medical Center from June 2018 to April 2024 to receive a software-based pre-visit DA that measured care preferences and used decision analysis to rank treatments. The RE-AIM framework and Plan-Do-Study-Act (PDSA) cycles were used to improve implementation outcomes. Patients completed survey instruments evaluating decisional conflict, shared decision-making, care satisfaction, and treatment choice following their provider visit. These metrics were compared in the DA cohort (n=81) to those in a usual care cohort (n=78) with Wilcoxon rank-sum and Chi-square (or Fishers exact) tests. Results Implementation data revealed sustained reach and progressive improvement in fidelity. The DA cohort reported higher decisional quality relative to controls (p=0.003) and reported greater support/advice to make a choice (p=0.005). The DA cohort more often discussed options with their doctor (87.5% vs 69.2%, p=0.005) and were more likely to be promoters of their provider (p

22.
arXiv (CS.AI) 2026-06-15

SkillAudit: Ground-Truth-Free Skill Evolution via Paired Trajectory Auditing

arXiv:2606.14239v1 Announce Type: new Abstract: Agent skills are structured procedural packages that guide frozen LLM agents in specialized workflows. Skills rarely remain sufficient after deployment: edge cases, API changes, and deployment constraints become visible only through use, making skill evolution a practical necessity. Existing methods depend on privileged feedback such as held-out validation scores, hidden test outcomes, or environment rewards – signals often unavailable when a practitioner has only a task description and workspace data. We introduce SkillAudit, a framework for evolving agent skills without ground-truth feedback. The key idea is paired trajectory auditing: at each iteration, the same task is executed with and without the candidate skill, isolating how the skill changes agent behavior without external labels. To turn behavioral differences into edit guidance, SkillAudit uses Process-Aligned Contrastive Evaluation (PACE), a cluster of evaluators that maps trajectory divergences to diagnostic signals linked to specific passages in the skill document. A structural verifier, compiled once from the task specification and then fixed, checks task constraints and rolls back harmful updates. SkillAudit routes edits through two pipelines: Refine removes noisy or irrelevant guidance from broadly useful skills, while Repair replaces passages that conflict with the task. Across 89 containerized tasks spanning 8 professional domains, SkillAudit achieves 73.9% average task reward, outperforming an agent without skills (40.9%) and the static expert skill (56.7%). These gains are obtained without accessing hidden tests, reference solutions, or external scoring functions during evolution.

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

LakeFM: Toward a Foundation Model for Aquatic Ecosystems Using Irregular Multivariate Multi-depth Time Series Data

arXiv:2606.11268v1 Announce Type: new Abstract: Understanding and forecasting lake dynamics is critical for monitoring water quality and ecosystem health across lakes and reservoirs. While machine learning methods have been recently applied to ecological time-series data, existing works assume regular sampling in time and depth, and struggle to generalize across lakes with heterogeneous variables, depths, and observation patterns. To address these limitations, we introduce \textsc{LakeFM}, a foundation model for aquatic systems, pre-trained on large-scale ecological datasets comprising both simulated and observed lakes. Through extensive empirical evaluation, we show that \textsc{LakeFM} learns meaningful representations spanning broader lake-level characteristics, and achieves competitive or often superior-forecasting performance compared to existing time-series foundation and non-foundation models, while producing physically plausible predictions consistent with real-world lake dynamics.

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

When Calibration Fails the Vulnerable Hospital: Federated Conformal Risk Control via Risk-Curve Shrinkage

arXiv:2606.20115v1 Announce Type: new Abstract: Conformal risk control (CRC) provides distribution-free guarantees on segmentation quality by calibrating a prediction-set threshold on held-out data. In federated deployments, the standard approach pools calibration scores across sites into a single threshold. We provide the first quantification, on real multi-institutional brain tumor data (FeTS-2022, 1,251 subjects, 20 institutions), showing that this naive pooled CRC protects the average hospital but violates coverage at 40% of individual institutions, with the worst site exceeding the target false-negative rate by 7.8 percentage points. The naive alternative, per-site local CRC, largely restores coverage but inflates prediction sets by 83x, rendering them clinically useless. We propose a shrinkage-based federated CRC protocol: each site transmits only its empirical risk curve (G scalars) to a server, which computes a shrinkage-regularized threshold per site. A single hyperparameter n0 smoothly trades worst-case coverage for prediction-set efficiency; leave-one-site-out sensitivity analysis identifies n0=19, achieving 2.7/20 violations at 2.0x stretch. We further show that direct Lagrangian optimization of coverage budgets fails, concentrating risk on vulnerable hospitals, and that the finite-sample correction term is essential: removing it triples violations. The marginal CRC guarantee is preserved by construction under the stated site-mixture assumption; per-site coverage is validated across four targets with three seeds. No patient-level images, masks, or per-volume scores leave any site.

25.
PLOS Computational Biology 2026-05-29

Structural and dynamic basis of NOD2 tandem CARD association and NOD1/2–RIP2 signaling complexes

by Jitendra Maharana, Aritra Bej, Debasish Biswal, Debashis Panda, Arjun Sharma NOD1 and NOD2, founding members of the NOD-like receptor (NLR) family, play a crucial role in host defense against bacterial infections. Recognition of peptidoglycan-derived ligands triggers ATP-dependent oligomerization of the NACHT domain, exposing the CARD domains that recruit the adaptor protein RIP2 via CARD–CARD interactions to activate the NF-κB signaling cascade. Although NOD1/2-RIP2 interactions and RIP2CARD filament assembly are established, the precise interfaces that stabilize hetero–CARD filaments remain poorly defined. Here, we integrate in silico structural modeling with molecular dynamics (MD) simulations to elucidate structurally compatible arrangements of NOD1–RIP2 and NOD2–RIP2 hetero–CARD filaments. Our results reveal that NOD1CARD subunits form a structurally compatible homomeric scaffold via canonical (type-I–III) interfaces, accommodating multiple tiers of RIP2CARD rings at both filament termini. Meanwhile, the NOD2 tandem CARDs adopt multiple discrete conformations, reflecting a more intricate structural mechanism. In stable filament conformations, tandem CARDs converge at the type-II interface, with RIP2CARD rings stacking onto CARDa (top-down) and CARDb (bottom-up) interfaces, highlighting the structural role of NOD2CARDb in RIP2-mediated CARD–CARD interaction. In silico mutagenesis, involving charge-reversal and alanine scanning of key interfacial residues, disrupts NOD1–RIP2 and NOD2–RIP2 interactions at both top-down and bottom-up interfaces, leading to rapid interface destabilization within 0.1–0.4 μs of simulation. Together, these results reveal conserved and receptor-specific mechanisms governing NOD1/2–RIP2 CARD–CARD interactions and provide deeper structural and dynamic insights into the complex structural mechanisms for NLR-mediated inflammatory signaling.