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01.
arXiv (CS.CL) 2026-06-15

MoDiCoL: A Modular Diagnostic Continual Learning Dataset for Robust Speech Recognition

Modern Automatic Speech Recognition (ASR) systems have made remarkable progress on standard benchmarks, yet performance gaps have emerged under real-world distribution shifts, caused by recording conditions, accents, speech impairments, and noise. Existing datasets and benchmarks typically isolate these factors, which overlooks their co-occurrence in real-world applications. In this paper, we argue that model robustness can be treated as a dynamic capability that continually develops, and we introduce MoDiCoL, a Modular Diagnostic Continual Learning dataset designed for controlled analysis of linguistic content, speaker characteristics, and acoustic environments. Furthermore, we propose a real-world-inspired continual learning curriculum to simulate incremental updates and study how robustness is acquired, transferred, and forgotten. We evaluate three continual learning strategies and provide detailed insights into robustness under evolving conditions.

02.
arXiv (CS.CL) 2026-06-12

Low-Latency Real-Time Audio Game Commentary System via LLM-Based Parallel Text Generation

We present a low-latency real-time audio game commentary system that generates spoken commentary directly from live gameplay video. In this end-to-end setting, a key bottleneck is accumulated waiting time; conventional pipelines capture frames, generate text, and synthesize speech sequentially for each utterance, and do not request the next generation until speech playback has completed. This strict sequentiality causes long and unnatural silence between utterances. To address this latency bottleneck, our system runs text generation in parallel with speech playback and buffers multiple candidate utterances ahead of time, enabling immediate synthesis at playback boundaries. Experiments on fast-paced game videos show that our parallel design reduces the mean inter-utterance silence from 9.6 seconds to 0.3 seconds compared to sequential baselines. It also improves similarity to professional speaking–silence timing patterns by over 40 %, and a user study with 120 experienced game players confirms significantly improved perceived speaking rhythm. Our demo video is available at: https://youtu.be/pmrRUlvav8M.

03.
arXiv (CS.AI) 2026-06-17

From Noise to Order: Learning to Rank via Denoising Diffusion

arXiv:2602.11453v3 Announce Type: replace-cross Abstract: Learning-to-rank (LTR) methods have traditionally been limited to discriminative machine learning approaches that model the probability of the document being relevant to the query given some feature representation of the query-document pair. We propose an alternative denoising diffusion-based generative approach to LTR that instead models the full joint distribution over features and relevance labels. While in discriminative LTR, an over-parameterized ranking model may find different ways to fit the training data, we posit that candidate solutions that can explain the full data distribution under the generative setting maybe better at estimating relevance. Thus, we propose DiffusionRank that extends TabDiff, an existing diffusion model for tabular datasets, to create generative alternatives to classical discriminative pointwise and pairwise LTR objectives. Our work demonstrates improvements from DiffusionRank over discriminative counterparts on four standard LTR datasets and points to a rich space for future exploration to leverage ongoing advancements in deep generative models for LTR. Our code is publicly available at https://github.com/sadjadeb/DiffusionRank.

04.
arXiv (quant-ph) 2026-06-16

Cosmological Pseudo-Entropy

arXiv:2606.15227v1 Announce Type: cross Abstract: We study pseudo entropy $\mathcal{S}$, a recent generalization of entanglement entropy, for scalar cosmological perturbations in de Sitter space with sound speed $0.024 \leq c_s \leq 1$, and in expanding and contracting FLRW backgrounds with varying equation-of-state parameter $w$. In de Sitter space, $\mathrm{Re}(\mathcal{S})$ grows after horizon exit while $c_s$ controls its onset and saturates at late times. A similar saturation occurs in expanding-accelerating and contracting-decelerating backgrounds. In contrast, expanding-decelerating and contracting-accelerating backgrounds show large early-time $\mathrm{Re}(\mathcal{S})$ followed by oscillations after horizon re-entry. This happens because while the squeezing freezes, the squeezing angle doesn't. Unlike entanglement entropy, pseudo entropy possesses an imaginary part, $\mathrm{Im}(\mathcal{S})$, as well, which can encode the relative phase. $\mathrm{Im}(\mathcal{S})$ decays to zero in de Sitter and expanding-accelerating cases, but forms dense sub-Hubble oscillation bands in expanding-decelerating and contracting-accelerating backgrounds. Compared with entanglement entropy, Krylov complexity, and Nielsen circuit complexity, pseudo entropy captures otherwise hidden phase information; in the unsaturated regime, its slope is $\sqrt{2}$ times that of Nielsen complexity. Unlike circuit complexity, whose saturation bound is $w$-independent, pseudo entropy is sensitive to $w$ during the transition regime, making it a finer information theoretic diagnostic of cosmological dynamics.

05.
arXiv (CS.AI) 2026-06-12

Meta-Learning Transformers to Improve In-Context Generalization

arXiv:2507.05019v2 Announce Type: replace-cross Abstract: In-context learning enables transformer models to generalize to new tasks based solely on input prompts, without any need for weight updates. However, existing training paradigms typically rely on large, unstructured datasets that are costly to store, difficult to evaluate for quality and balance, and pose privacy and ethical concerns due to the inclusion of sensitive information. Motivated by these limitations and risks, we propose an alternative training strategy where we leverage a collection of multiple, small-scale, and domain-specific datasets. We empirically demonstrate that the increased quality and diversity of such data improve the generalization abilities of in-context learners beyond their training domain, while achieving comparable performance with models trained on a single large-scale dataset. We investigate this paradigm by leveraging meta-learning to train an in-context learner on the Meta-Album collection under several settings. Firstly, we show the performance in a controlled environment, where the test domain is completely excluded from the training knowledge. Secondly, we explore the robustness of these models to forgetting in a continual scenario where the information is accessible for a limited time. Finally, we explore the more challenging unsupervised scenario. Our findings demonstrate that transformers still generalize for in-context prediction when trained on a curated dataset collection while offering advantages in modularity and replaceability.

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

Unifying Acoustic Features and Text with Multimodal LLMs for Neurodegenerative Screening

arXiv:2606.14788v1 Announce Type: cross Abstract: Voice-based screening offers a scalable and non-invasive way to assess neurodegenerative diseases such as Alzheimer's disease (AD) and Parkinson's disease (PD), but their staging remains challenging due to the difficulty of integrating heterogeneous data. This paper presents NeurMLLM, an efficient multimodal generative framework for neurodegenerative disease staging. NeurMLLM first encodes the spectrograms and Mel-frequency cepstral coefficients of audio data with vision transformers and projects their representations into the embedding space of a large language model (LLM), where they are concatenated with transcript and demographic instruction tokens as a single unified sequence. The LLM is then instruction-tuned via Low-Rank Adaptation using task prompts to autoregressively predict a constrained label token, enabling a generative classification. By evaluating on the Bridge2AI-Voice dataset for fine-grained staging of AD and PD, we observe that NeurMLLM achieves strong performance, consistently outperforming classical machine learning methods and existing LLM-based approaches. The results show the high potential of multimodal LLMs in neurodegenerative disease staging, improving staging accuracy and supporting accessible deployment.

07.
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

08.
arXiv (CS.CL) 2026-06-12

LLMs Can Better Capture Human Judgments–With the Right Prompts

Are large language models (LLMs) bad at capturing human judgment? Two commonly stated limitations are that LLMs fail to capture full distributions of responses, and that their judgments are unstable across wording variations. We demonstrate simple prompting strategies that mitigate these limitations. Across two datasets–a U.S.-representative set of 144 moral scenarios and 38 moral beliefs from the International Social Survey Programme's Family and Changing Gender Roles module covering 32 countries–we show how simple elicitation techniques help improve AI-human alignment. First, prompting models to report standard deviations and response proportions recovers the full range of human responses better than common strategies. Second, ensuring scenarios are clear to human participants–as reflected in human confusion ratings–boosts model alignment, and LLMs can track human confusion ratings. At the same time, we find that LLMs' estimates of their own error are poorly calibrated, though they can predict human variability relatively well. These results suggest that asking better questions to LLMs can yield better answers.

09.
arXiv (math.PR) 2026-06-18

On a class of reflected McKean-Vlasov Stochastic Differential Equations with jumps

arXiv:2606.18433v1 Announce Type: new Abstract: This paper investigates a class of reflected McKean-Vlasov Stochastic Differential Equations driven by both Brownian motion and a compensated Poisson random measure. We establish the existence and uniqueness of solutions and provide moments estimates for the state processes.

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

From Tokens to Policy: Causal and Interpretable Heterogeneous Treatment Effects Identification

arXiv:2606.17010v1 Announce Type: new Abstract: Heterogeneous Treatment Effect (HTE) identification is crucial to explain the impact of an intervention and optimize our policies accordingly. Existing approaches trade expressivity for interpretability, but, if some active heterogeneity drivers are unmeasured, methods at both ends of this spectrum allow for spurious HTE characterization with no causal reading. In this work, we focus on controlled experiments and argue that an oracle HTE causal characterization via the latent interactors is now within reach, thanks to (i) more extensive pre-treatment measurements, i.e., multi-modal and multi-view, and (ii) scalable representations with minimal human supervision. We then re-frame HTE identification as a Markov-blanket discovery problem on a sufficient and aligned pre-treatment representation, and introduce Neural EXposure Interaction Search (NEXIS), an iterative procedure with provable and empirically validated consistent selection. We deploy NEXIS on two anti-poverty programs in Africa, augmenting each with satellite imagery capturing previously unmeasured environmental effect modifiers, leading to novel, interpretable and prescriptive guidelines to optimize the programs' next iterations.

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

BaltiVoice: A Speech Corpus and Fine-tuned Whisper ASR System for the Balti Language

Authors:

We present BaltiVoice, a 16.8-hour read-speech corpus for Balti (ISO 639-3: bft), a Tibetic language spoken in Gilgit-Baltistan, Pakistan, with no prior publicly available ASR resources. The corpus contains 10,060 validated utterances in native Nastaliq script, derived from Mozilla Common Voice recordings. Fine-tuning OpenAI Whisper-small yields a Word Error Rate (WER) of 26.74% and a Character Error Rate (CER) of 8.67% on a 538-utterance speaker-disjoint validation set, down from a zero-shot baseline of 159.19% WER and 152.52% CER. A Whisper-base fine-tuned on the same data achieves 44.54% WER and 15.61% CER, confirming that model capacity matters for this low-resource setting. The dataset, fine-tuned model, and a live transcription demo are publicly available on HuggingFace.

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

Feature-preserving Latent-EnKF for Data Assimilation of Flows with Shocks

arXiv:2606.12559v1 Announce Type: cross Abstract: The ensemble Kalman filter (EnKF) is widely adopted for sequential data assimilation, but fails for solutions with discontinuities, such as shocks in compressible flows. Uncertainty in shock location induces multimodal ensemble statistics that violate the Gaussian assumptions underlying the EnKF, producing large-scale spurious oscillations in the analysis state. We introduce a feature-preserving latent-EnKF that performs the ensemble update in a learned low-dimensional latent space, where shock and flow features admit a smooth manifold representation, thereby preserving sharp features during EnKF analysis. The updated latent state is mapped back to physical state through a shared decoder for all ensemble members. The algorithm eliminates the member-specific ordered training and positivity flooring used in prior approaches. Numerical experiments on a Sod shock tube and Mach 2 shock interaction with a 2D cylinder, using sparse and noisy observations, show accurate feature recovery of shocks and contact discontinuities without spurious oscillations.

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

UMA-Split: unimodal aggregation for both English and Mandarin non-autoregressive speech recognition

This paper proposes a unimodal aggregation (UMA) based nonautoregressive model for both English and Mandarin speech recognition. The original UMA explicitly segments and aggregates acoustic frames (with unimodal weights that first monotonically increase and then decrease) of the same text token to learn better representations than regular connectionist temporal classification (CTC). However, it only works well in Mandarin. It struggles with other languages, such as English, for which a single syllable may be tokenized into multiple fine-grained tokens, or a token spans fewer than 3 acoustic frames and fails to form unimodal weights. To address this problem, we propose allowing each UMA-aggregated frame map to multiple tokens, via a simple split module that generates two tokens from each aggregated frame before computing the CTC loss.

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

Hamiltonian-Aware ADAPT Variational Quantum Eigensolver for Molecular Ground-State Simulation

arXiv:2606.13118v1 Announce Type: new Abstract: Designing compact ansätze in Variational Quantum Eigensolver (VQE) is crucial for solving energetic problems of practical molecules on near-term quantum devices. However, existing Adaptive Derivative-Assembled Pseudo-Trotter (ADAPT) ansätze face two challenges: improper operator selection and accumulation of degraded operators. In this paper, we propose the Hamiltonian-Aware (HA) ADAPT-VQE algorithm to address these issues. First, we establish a novel excitation operator selection criterion. It breaks the local constraint of existing criteria by incorporating Hamiltonian information, prioritizes physically meaningful excitation operators, and incurs no extra classical or quantum computational overhead. Furthermore, we develop a problem-adaptive method for discriminating and pruning redundant excitation operators stemming from improper selection and inevitable degradation. This method balances redundant operator pruning and convergence guarantee, and is applicable to ansätze with arbitrary scales. Systematic numerical experiments on typical strongly correlated molecular systems demonstrate that our HA-ADAPT-VQE avoids energy plateaus and outperforms baseline algorithms in terms of energy error, ansatz size, and measurement cost. This work offers an efficient, robust ansatz construction paradigm, facilitating the development and practical deployment of large-scale VQE in quantum chemistry.

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

Irresponsible AI: big tech's influence on AI research and associated impacts

arXiv:2512.03077v2 Announce Type: replace-cross Abstract: The accelerated development, deployment and adoption of artificial intelligence systems has been fuelled by the increasing presence of big tech in the AI field. This trend has been accompanied by growing ethical concerns and intensified societal and environmental impacts. This position paper argues that irresponsible AI development is strongly driven by big tech's influence and involvement in the field. First, we examine the growing and disproportionate influence of big tech in AI research and argue that its drive for scaling and general-purpose systems is fundamentally at odds with the responsible, ethical, and sustainable development of AI. Second, we review key current environmental and societal negative impacts of AI and trace their connections to big tech's influence. Third, we discuss the underlying economic forces driving big tech's actions. Finally, as a call to action, we invite AI researchers to counter big tech's influence in irresponsible AI development through strategies that build on the responsibility of implicated actors and collective action.

17.
arXiv (CS.AI) 2026-06-19

Tri-Info: Generalizable, Interpretable Failure Prediction for VLA Models via Information Theory

arXiv:2606.19998v1 Announce Type: cross Abstract: Vision-Language-Action (VLA) models are increasingly deployed across diverse tasks, yet they remain black boxes whose physical interactions can cause irreversible harm, making generalizable and interpretable failure detection essential. We observe that successful and failed rollouts carry systematically different information-theoretic signatures. Building on this, we formalize VLA control as a closed-loop information pipeline and derive the Triple Information-theoretic (Tri-Info) signals that capture whether actions remain diverse, temporally consistent, and coupled to state transitions. Across six VLA models and three benchmark environments, Tri-Info matches the strongest baselines in-domain. Moreover, Tri-Info transfers across architectures, environments, and the sim-to-real gap without retraining, reaching 83\% accuracy on real-world tasks where prior detectors collapse to chance. This establishes Tri-Info as a simple yet powerful method that not only detects failures with strong cross-domain generalization, but also delivers interpretable diagnostics of the underlying failure modes.

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

Multi-Granular Attention-Driven Reinforcement Learning Framework for Web Intelligent Enhancement Systems

arXiv:2606.19690v1 Announce Type: new Abstract: From the past few years, web intelligent enhancement systems increasingly rely on heterogeneous and dynamic web data to deliver personalized, context-aware services. However, traditional machine learning, deep learning, and reinforcement learning models often struggle with semantic understanding, adaptability, and scalability in continuously evolving web environments. In this research, a Multi-Granular Attention-based Reinforcement Web Intelligent Enhancement System (MGAR-WIES) is proposed to address the challenges by integrating semantic graph modeling, attention mechanisms, and adaptive reinforcement learning. Initially, heterogeneous web data comprising structured, semi-structured and unstructured sources are collected and preprocessed for generating unified feature representations. These representations are transformed into a dynamic semantic graph, where entities and their relationships are modeled by using graph embeddings enhanced by attention mechanisms for capturing both local relevance and global contextual dependencies. Subsequently, an adaptive multi-agent reinforcement learning strategy leverages the attention-aware semantic states to optimize personalized web actions like content recommendation, navigation optimization, and service adaptation. Finally, the continuous online feedback is further integrated to update graph representations and learning policies in real time by ensuring sustained adaptability and performance. The proposed MGAR-WIES acheived better results in terms of accuracy (80%) when compared with existing approaches.

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

Addressing Detail Bottlenecks in Latent Diffusion for RGB-to-SWIR Image Translation

Latent diffusion models (LDMs) enable efficient image-to-image translation but discard fine spatial details during compression, degrading downstream perception tasks. We identify two bottlenecks: the autoencoder, which loses spatial information, and the conditioning pathway, which further degrades the source signal through naive downsampling. We propose two lightweight, backbone-agnostic fixes: a Source-Conditioned Autoencoder (SCAE) that injects high-resolution source features into the decoder via skip connections, and a Learnable Guidance Encoder (LGE) that replaces naive downsampling with a learned conditioning signal. Evaluated on RGB-to-SWIR translation for driving scenes with two denoiser backbones (U-Net and DiT), our approach improves detection mAP by up to 2x over the latent diffusion baseline, with up to 3.4x gains on small objects (COCO-small,

20.
arXiv (quant-ph) 2026-06-15

Resurgence of the Thermal Transition between Bounce and Sphaleron

arXiv:2606.13778v1 Announce Type: cross Abstract: We study the thermal transition between the bounce and the sphaleron in quantum mechanics with a metastable vacuum from the viewpoint of Borel resurgence. For two models representing a second-order and a first-order transition, we compute the perturbative expansion of the thermal free energy to high orders and extract the leading Borel singularity data $(A,b,S)$ as functions of temperature. The Borel singularity location $A$ reproduces the on-shell action of the dominant saddle on both sides of the transition, joining smoothly in the second-order case and developing a kink in the first-order case. The characteristic exponent $b$ jumps between $0$ and $1/2$ across the transition, counting the zero modes of the corresponding saddle. The Stokes constant $S$ matches the one-loop determinant around the saddle. The perturbative expansion around the false vacuum thus determines the transition temperature, the order of the transition, and the decay rate including the one-loop prefactor without relying on semiclassical inputs.

21.
arXiv (CS.CV) 2026-06-11

Contactless 3D Human Body Measurement Using Depth Cameras for Smart Health Monitoring

Contactless body measurement technologies are becoming increasingly significant for smart health monitoring, digital health applications, and remote patient assessment. Traditional anthropometric measurements typically necessitate physical contact and trained personnel, which may constrain scalability in remote healthcare settings. In this study, we introduce a depth camera-based framework for estimating human body measurements utilizing 3D point cloud data. An Orbbec Astra 2 depth camera was employed to capture RGB images, depth maps, and 3D point clouds of participants. The captured point cloud was processed using Python-based tools, including Open3D, NumPy, and OpenCV, to segment the human body from the background. Key anthropometric measurements, such as height and arm span, were computed. The measurements were obtained through a combination of spatial filtering and landmark selection on the 3D point cloud, followed by the projection of the computed measurements onto the corresponding RGB image using camera intrinsic parameters. In addition to linear measurements, the approximate body volume and visible surface area were estimated using voxel-based occupancy analysis and mesh-based surface reconstruction methods. The experimental results from a single depth capture demonstrated that accurate body measurements and geometric estimates could be obtained from depth camera data without physical contact. This study provides a foundation for future real-time systems that integrate depth sensing with intelligent health monitoring and generative AI models for smart healthcare applications.

22.
Nature Biotechnology 2026-06-08

Single-cell spatial pharmacobiology for imaging antibody-based therapies in solid tumors

Authors: Unknown Author

We have developed single-cell spatial pharmacobiology (SSP), which combines in situ imaging of a systemically infused fluorescent therapeutic antibody with high-plex spatial proteomics. Applied to head and neck and pancreatic tumors from patients treated in phase 1 trials, SSP revealed marked spatial heterogeneity in antibody delivery and target engagement, which was shaped by conserved stromal barriers.

23.
arXiv (CS.LG) 2026-06-16

We Need Explanation Cards to Connect Explanation Algorithms to the Real World

arXiv:2606.16786v1 Announce Type: new Abstract: Algorithmic explanations are intended to help stakeholders understand opaque algorithmic decisions, but in practice, they often fall short. First, the meaning of algorithmic explanations is often not what one might intuitively expect, so expert knowledge is required to interpret them correctly. Second, recent work has shown that popular explanation algorithms are uninformative about the behavior of complex decision functions. Together, these issues create a gap between what explanations appear to convey and what they actually provide. In this work, we propose Explanation Cards for Explanation Algorithms, which augment standard explanations with complementary information about robustness and validity, as well as clear instructions for interpretation. The complementary information can render otherwise uninformative explanations practically useful, while also helping to detect cases where they are not. Importantly, the interpretation instructions in explanation cards shift responsibility from users to providers: Rather than expecting users to recognize what can and cannot be concluded from an explanation, providers must make this explicit upfront. Using counterfactual explanations and SHAP as examples, we demonstrate how providers can construct explanation cards and that these cards provide users with the guidance needed for sound interpretation. We further argue that explanation cards offer a practical means of operationalising the explainability provisions of the EU AI Act. Overall, explanation cards are a significant step toward making explanation algorithms fit for real-world use cases.

24.
arXiv (CS.CL) 2026-06-15

SIMMER: Benchmarking Latent Failures in LLM Executable Planning with a World Model

Large language models (LLMs) are increasingly deployed as planners for autonomous agents in household environments. While existing benchmarks evaluate whether LLM-generated plans execute successfully, they overlook a critical type of failure: latent failures. Unlike immediate failures that trigger instant feedback at execution time and enable timely correction, latent failures do not immediately halt plan execution but silently compromise goal achievement. In severe cases, they cause irreversible harm. To address this gap, we introduce SIMMER, a benchmark for evaluating latent failures in LLM planning through a human-curated symbolic world model grounded in the kitchen domain. SIMMER defines a world model comprising 77 actions, 262 unique objects, and approximately 46,800 possible interactions that are semantically realistic, derived from real-world cooking scripts. It then leverages a state machine executor that validates plans against the world model and detects immediate precondition violations, latent hazards, and irreversible failures. Experiments across six LLMs show that even frontier models achieve at most 17% error-free plans. Moreover, up to 56% of plans contain latent failures, the majority of which lead to irreversible consequences. We further demonstrate that explicit state reasoning via counterfactual foresight simulation can reduce latent failures by up to 72% and irreversible cases by up to 75%, suggesting a promising direction for more robust LLM planners.

25.
arXiv (CS.CV) 2026-06-16

iTRIALSPACE: Programmable Virtual Lesion Trials for Controlled Evaluation of Lung CT Models

We introduce iTRIALSPACE, a programmable evaluation framework for controlled assessment of lung CT models. Standard benchmarks are static retrospective collections that entangle lesion size, lobe prevalence, anatomy, and acquisition context, making it difficult to determine what structurally drives model accuracy. iTRIALSPACE addresses this limitation by composing real clinical CTs and lesion profiles into controlled virtual lesion trials through a four-stage pipeline: multidataset nodule profiling, explicit trial specification, anatomy-aware mask insertion, and ControlNet-conditioned CT synthesis. The framework is built on a unified 54-attribute nodule-profile dataset spanning 13,140 annotated nodules from seven public CT sources and instantiated as 13 trial modes. We evaluate iTRIALSPACE in a 55,469-sample Virtual Lesion Study spanning three medical VLMs, four spatialguidance conditions, and three clinical tasks. Across all 13 modes, the synthetic substrate remains within the real-to-real FID baseline, and synthetic performance rankings transfer strongly to real clinical data ($\rho$ = 0.93, p < 10$^{-15}$). Controlled trial modes expose findings unavailable to fixed-distribution benchmarks, including shortcut-driven size prediction collapse under lobe-equalized sampling and hostto-donor variance ratios of 8.9x and 3.3x in twin-cross analysis. These results position iTRIALSPACE as an auditable evaluation infrastructure for controlled, falsifiable testing beyond static retrospective benchmarks.