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01.
arXiv (CS.AI) 2026-06-18

scGTN: Deep Siamese Graph Transformer Network for Single-cell RNA Sequencing Clustering

arXiv:2606.18672v1 Announce Type: cross Abstract: Single-cell RNA sequencing (scRNA-seq) serves a pivotal role in characterizing gene expression at the cellular level, enabling the identification of cell types and advancing the understanding of cellular heterogeneity. Despite the significant progress in scRNA-seq data clustering, we argue that current methods always ignore the sparsity and noise, as well as the complex intercellular structural information inherent in scRNA-seq data. Toward this end, in this paper, we propose a novel single-cell RNA-seq clustering framework via deep Siamese Graph Transformer Network (termed scGTN), which explicitly integrates gene expression profile and intercellular structural dependencies for cell clustering. In particular, we formulate scRNA-seq data as a graph and construct two augmented graph views that serve as dual views to capture complementary intercellular information. Then, a Siamese graph transformer network is employed to explicitly incorporate shortest-path information and node-wise distances for capturing richer structural relationships between cells. Finally, we employ an optimal transport strategy to guide the cell clustering in a self-supervised manner. Extensive experiments on multiple benchmark scRNA-seq datasets demonstrate that our scGTN consistently outperforms existing methods. Our code is available at https://github.com/W-RMSL/scGTN.

02.
PLOS Computational Biology 2026-06-01

A statistical framework for comparing epidemic forests

Authors:

by Cyril Geismar, Peter J. White, Anne Cori, Thibaut Jombart Inferring who infected whom in an outbreak is essential for characterising transmission dynamics and guiding public health interventions. However, this task is challenging due to limited surveillance data and the complexity of immunological and social interactions. Instead of a single definitive transmission tree, epidemiologists often consider multiple plausible trees forming epidemic forests. Various inference methods and assumptions can yield different epidemic forests, yet no formal test exists to assess whether these differences are statistically significant. We propose such a framework using a chi-square test and permutational multivariate analysis of variance (PERMANOVA). We assessed each method’s ability to distinguish simulated epidemic forests generated under different offspring distributions. While both methods achieved perfect specificity for forests with 100+ trees, PERMANOVA consistently outperformed the chi-square test in sensitivity across all epidemic and forest sizes. Implemented in the R package mixtree, we provide the first statistical framework to robustly compare epidemic forests.

03.
arXiv (quant-ph) 2026-06-11

Sharing quantum indistinguishability with multiple parties

arXiv:2512.15199v3 Announce Type: replace Abstract: Quantum indistinguishability of non-orthogonal quantum states is a valuable resource in quantum information applications such as cryptography and randomness generation. In this article, we present a sequential state-discrimination scheme that enables multiple parties to share quantum uncertainty, in terms of the max relative entropy, generated by a single party. Our scheme is based upon maximum-confidence measurements and takes advantages of weak measurements to allow a number of parties to perform state discrimination on a single quantum system. We review known sequential state discrimination and show how our scheme would work through a number of examples where ensembles may or may not contain symmetries. Our results will have a role to play in understanding the ultimate limits of sequential information extraction and guide the development of quantum resource sharing in sequential settings.

04.
arXiv (quant-ph) 2026-06-15

Extending Covariant Fluctuation Theorems into Quantum Regime through Quasiprobability Approach

arXiv:2606.14519v1 Announce Type: cross Abstract: The covariant formulation of stochastic thermodynamics requires treating the stochastic work as a 4-vector, posing significant challenges for quantum systems due to the non-commutativity. We introduce a new quasiprobability distribution for the work 4-vector, which combines the Wigner and Margenau-Hill quasiprobabilities. This extends the covariant fluctuation theorems from classical to quantum regime. We illustrate our findings with a scalar field driven by classical particles with a generalized version of trace formula. Our work establishes a quasiprobability approach to studying relativistic quantum thermodynamics in a covariant way.

05.
medRxiv (Medicine) 2026-06-10

Assessment of the accuracy of lung lesions diagnosis in adolescents with osteosarcoma using artificial intelligence

Background. Lung metastases in osteosarcoma (OS) are the main cause of the death. The accuracy of the diagnosis of nodules by computed tomography (CT) of the lungs is critically important for determining the disseminated stage of the disease and planning surgical treatment. The use of artificial intelligence (AI) in the search for lung nodules increases the accuracy of diagnosis and reduces the chance of missing metastases. Objective: to evaluate the accuracy of lung nodules diagnosis in adolescents with OS using AI. Methods. A retrospective assessment of CT scans of adolescents with OS was performed. A pathological nodule with an average size of [≥]4 mm was considered a target finding. The diagnostic accuracy of an AI algorithm previously trained on an adult dataset was evaluated, and the number of false positives (FP) and false negatives (FN) was determined. Sensitivity, specificity, accuracy, area under the ROC curve (AUC), positive predictive value, negative predictive value, and F1-measure were calculated. Based on the obtained results, the effectiveness of the algorithm was assessed. Results. 248 CT scans of adolescents with OS were evaluated. The following results were obtained: in 5 cases, the AI algorithm showed a FP result (2.02%), in 34 cases, it showed a FN result (13.71%), and in 209 cases, a correct result (both true positive and true negative) (84.27%). The diagnostic accuracy of the algorithm was 0.843 (95% CI 0.794-0.887). The application of the AI algorithm in the practice of an X-ray doctor in a specific clinical task would allow to increase the sensitivity from 0.805 to 0.891, while ensuring an absolute decrease in the number of FN results by 8.59% and a relative decrease by 44%. Conclusion. The obtained results confirm the practical value of the application of the AI algorithm and justify the implementation of AI-assisted systems in the diagnostic protocols for lung metastases in adolescents with OS.

06.
medRxiv (Medicine) 2026-06-22

Multi-omics data fusion reveals divergent molecular signatures of intra-articular micro-fragmented adipose tissue and hyaluronic acid treatment in inflammatory-phenotype knee osteoarthritis

Knee osteoarthritis (KOA) affects an estimated 374 million people worldwide and has no approved disease-modifying treatment. Intra-articular micro-fragmented adipose tissue (MFAT) outperformed hyaluronic acid (HA) on patient-reported outcomes in our recent double-blind randomized trial (ISRCTN88966184), yet the molecular basis of this differential efficacy is unknown, and the two interventions have not previously been compared at the level of their in vivo molecular response in human KOA. Here we apply an interpretable artificial-intelligence data-fusion framework, based on non-negative matrix tri-factorization, to longitudinally collected plasma from this cohort, integrating proteomics, N-glycomics, miRNA transcriptomics and patient genetics with prior protein-protein and miRNA-gene regulatory networks at baseline, one and six months. The framework jointly decomposes all data modalities at each timepoint into shared, interpretable factors, from which we derive data-driven pathways of genes and of miRNAs and recover new patient-gene and patient-miRNA associations. These pathways were biologically coherent, showing significant enrichment in Gene Ontology Biological Process and Reactome Pathway annotations. By six months, the two treatments left clearly distinct molecular signatures: HA remained dominated by canonical OA pathogenic processes, including cartilage-degrading effectors such as MMP13 and LIMK2 and markers of synovial inflammation, whereas MFAT shifted the systemic landscape toward chondroprotection, anti-inflammatory signalling and bone-cartilage homeostasis, with prioritized effectors including SIRT7 and NDUFC1. To our knowledge, these are the first systems-level molecular data directly comparing the in vivo response to the two treatments in human KOA, providing initial evidence that MFAT acts as a disease-modifying intervention and demonstrating the value of interpretable data fusion for uncovering treatment mechanisms in small translational cohorts.

07.
arXiv (CS.AI) 2026-06-12

Different Layers, Different Manifolds: Module-Wise Weight-Space Geometry in Transformer Optimization

arXiv:2606.13276v1 Announce Type: cross Abstract: Weight-space geometry plays a central role in neural network optimization, yet manifold constraints are often applied uniformly across all weight matrices. In this work, we ask whether different transformer modules prefer different manifold geometries. We study Manifold Muon for GPT-2 pretraining and compare layer-wise assignments of Stiefel and DGram constraints across attention and MLP blocks. Our results show a clear asymmetry: constraining attention layers with Stiefel geometry while assigning DGram geometry to MLP layers gives the best performance among the tested configurations, whereas the inverted assignment and all-DGram configuration become unstable under the shared hyperparameter setting. We trace this failure to singular value growth in DGram-constrained attention weights, which can amplify attention logits and induce softmax saturation. These findings suggest that symmetry-aware and geometry-aware optimization for transformers should be module-specific rather than uniform.

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

InstantForget: Update-Free Backdoor Unlearning with Inference-Time Feature Reset

Authors:

arXiv:2606.15730v1 Announce Type: cross Abstract: Backdoor unlearning aims to remove a malicious trigger behavior from a deployed model while preserving clean utility. We study the update-free inference-time setting, where model parameters remain frozen. First, we audit a common projection assumption under oracle paired clean and triggered features. Projection succeeds mainly on BadNets and leaves WaNet, Blended, and SIG at 0.683, 0.888, and 0.941 ASR on CIFAR-10 ResNet-18. This failure is not explained by spectral compactness, spatial locality, or subspace misalignment. It is predicted by a logit-triplet gap involving the target margin, target-logit drop, and non-target logit rise. We then introduce InstantForget, a clean-calibrated gated reset that flags anomalous features with a Mahalanobis score and moves only flagged features toward a neutral non-target representation. With one fixed operating point selected on held-out triggered validation, InstantForget reduces average ASR to 0.071 across four non-adaptive CIFAR-10 triggers without triggered samples or parameter updates at deployment. It also reaches 0.981 detection AUROC and transfers to six of eight tested backbones. Reported failures under WaNet, ModelNet10 point blend, two backbone geometries, and adaptive feature-compactness attacks define the method's scope.

09.
arXiv (CS.CL) 2026-06-12

Small LLMs for Biomedical Claim Verification: Cost-Effective Fine-Tuning, Structural Dataset Shortcuts, and Cross-Domain Generalization

Authors:

Large Language Models such as GPT-4o and GPT-5 achieve strong zero-shot performance on biomedical claim verification, but cost and opacity limit scalable use. We fine-tune three small LLMs: Phi-3-mini (3.8B), Qwen2.5-3B, and Mistral-7B, via QLoRA on SciFact and HealthVer, providing the first study of QLoRA models against GPT-4o and fine-tuned BioLinkBERT encoders. Mistral-7B QLoRA surpasses both GPT-4o and GPT-5 (up to 12% F1 gain) at a fractional cost using just 1,008 training examples. We conduct extensive in-domain and cross-domain evaluation: models trained on SciFact tested on HealthVer and vice versa, at matched sizes to isolate dataset structure from data quantity. We identify a previously unreported structural artifact in SciFact that inflates in-domain scores, and show through bidirectional out-of-domain evaluation that training on structurally sound data enables robust cross-domain transfer. We plan to release all code and adapter checkpoints.

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

Decoding Insect Song: A Multitask Semisupervised Orthoptera Bioacoustic Classifier

arXiv:2606.13236v1 Announce Type: cross Abstract: Passive acoustic monitoring holds great promise for ecological inference, yet existing automated tools are typically narrowly trained and non-transferable. We address these limitations with PULSE, a semi-supervised, multi-task framework for Orthoptera bioacoustics, combining weakly-supervised species classification, self-supervised learning on unlabelled field audio, and knowledge distillation from a general-purpose bioacoustic model. Our domain-adapted specialist model outperforms a state-of-the-art general model across all metrics (macro F1: 0.21 vs. 0.07; AUC: 0.74 vs. 0.45; AP: 0.32 vs. 0.19), with active learning further raising F1 to 0.34 and AUC to 0.84. Beyond classification, the learned embeddings encode ecologically meaningful structure, exposed through an interactive visualisation tool for ecological discovery.

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

How Linear Is a Transformer Feed-Forward Block? Per-Block Linear Recoverability Is Learned, Not Architectural

Authors:

Transformer feed-forward networks (FFNs) are often treated as nonlinear stores of computation, yet how nonlinear a trained FFN block actually is has rarely been measured. We treat each FFN as a position-wise input-to-output map and split it into the exact least-squares linear approximation plus a residual. The held-out variance the closed-form linear map explains defines a block's linear recoverability (R^2_lin), an optimiser-free measure of its linearity. Across all twelve blocks of GPT-2, Pythia-160m, and llama-160m, R^2_lin is highly heterogeneous and non-monotone with depth, ranging from near-linear (>0.99) to strongly nonlinear (

12.
arXiv (CS.AI) 2026-06-15

Quantile-Free Uncertainty Quantification in Graph Neural Networks

arXiv:2605.04847v2 Announce Type: replace-cross Abstract: Uncertainty quantification (UQ) in graph neural networks (GNNs) is crucial in high-stakes domains but remains a significant challenge. In graph settings, message passing often relies on strong assumptions such as exchangeability, which are rarely satisfied in practice, and achieving reliable UQ typically requires costly resampling or post-hoc calibration. To address these issues, we introduce Quantile-free Prediction Interval GNN (QpiGNN), a framework that builds on quantile regression (QR) to enable GNN-based UQ by directly optimizing coverage and interval width without requiring quantile inputs or post-processing. QpiGNN employs a dual-head architecture that decouples prediction and uncertainty, and is trained with label-only supervision through a quantile-free joint loss. This design allows efficient training and yields robust prediction intervals, with theoretical guarantees of asymptotic coverage and near-optimal width under mild assumptions. Experiments on 19 synthetic and real-world benchmarks show QpiGNN achieves average 22% higher coverage and 50% narrower intervals than baselines, while ensuring efficiency and robustness to noise and structural shifts.

13.
arXiv (CS.CL) 2026-06-24

AGORA: An Archive-Grounded Benchmark for Agentic Workplace Document Reasoning

Large language models are increasingly deployed as agents that reason over documents rather than answer from parametric knowledge. We study archive-grounded reasoning: locating sparse evidence across a large, messy collection of workplace files, reconciling inconsistent terminology, units, and time conventions, and computing an answer. Existing benchmarks address only parts of this setting and none jointly stresses archive-groundedness, agentic exploration, and cross-domain coverage. We introduce Agora, a benchmark pairing 362 questions with eight domain collections of 9,664 authentic documents and 372M tokens, far exceeding any model's context window, so agents must explore deliberately rather than scan exhaustively. Agora is built by an agentic pipeline combining cross-document task synthesis, leakage-preventing obfuscation, and difficulty filtering. Evaluating eight models, we find the task far from solved: even the strongest reaches only 59.4% accuracy, with notable variation across domains.

14.
Nature Medicine 2026-06-15

Plasma proteomic signatures of cellular aging predict human disease

Authors:

Aging is asynchronous across cells and organs. Here we tested whether plasma proteomics can be used to analyze cell type-specific aging. From analyses of over 7,000 plasma proteins measured in 60,542 individuals, we developed machine learning models to estimate the biological age of over 40 cell types spanning neuronal, immune, glial, endocrine, epithelial and musculoskeletal origins. We observed that 20–25% of individuals exhibited accelerated aging in a single cell type and 1–3% in 10 or more cell types. Cellular aging signatures were associated with disease status and predicted incident disease and mortality over 15 years of follow-up. Individuals with the APOE4 genotype showed older astrocytes but younger macrophages compared to APOE3 carriers, whereas the APOE2 genotype had inverse associations. Moreover, extreme astrocyte aging tripled the risk of incident Alzheimer’s Disease in individuals with two APOE4 alleles, while youthful astrocytes reduced risk. Individuals with extremely aged compared to youthful skeletal myocytes exhibited a 12.7-fold higher risk of developing amyotrophic lateral sclerosis. In individuals who smoked, extreme respiratory epithelial cell aging was associated with a 58% higher lung cancer risk compared to smoking alone. Specific cellular vulnerabilities and cumulative cellular aging burden influenced survival, with youthful immune and neuronal cell types conferring protective effects. Finally, we developed a polycellular aging risk score that stratified mortality risk across cohorts and proteomics platforms. These findings establish a framework for quantifying human physiology at cellular resolution, revealing heterogeneous aging trajectories and their impact on disease susceptibility and resilience. The biological age of individual cell types can be evaluated using plasma proteomics, revealing diverse aging profiles across more than 40 cell types and links between the accelerated aging of specific cell types and disease.

15.
medRxiv (Medicine) 2026-06-10

Gendered pathways to adolescent mental health: An empirical assessment of a new conceptual framework

Introduction Gender norms and roles are important determinants of physical and mental health in the key period of adolescence. Yet, the gendered pathways to mental health in adolescents are not fully understood. Using a conceptual framework for global adolescent mental health that we developed based on a Delphi process, we empirically investigated the associations between six gender-related constructs and adolescent mental health. Methods We used cross-sectional Gender and Adolescence: Global Evidence (GAGE) data from Ethiopia (2020) to explore the associations between sex, gender norms, psychological competencies, gender attitudes, gender roles, with the latter two also serving as mediators, and psychological distress (GHQ-12), using Structural Equation Modelling (SEM). Results The SEM model contained measurements from 1,584 adolescents, including 843 girls and 741 boys, with a median age of 13 years. Out of 14 pathways tested, we found statistically significant associations between psychological competencies and psychological distress; sex and gender attitudes; and between gender norms and psychological competencies, gender attitudes, and gender roles. Hence, the gender-related constructs were mostly associated with each other, rather than with psychological distress. Conclusion The gender-related constructs are strongly interrelated, thereby attenuating their individual effects on psychological distress. The interplay of gender-related constructs should be considered when developing interventions to promote mental health in adolescents.

16.
arXiv (CS.CL) 2026-06-15

Personal Care Utility: Health as Everyday Infrastructure

Healthcare is essential, expert, and episodic by design - built around the roughly one hour per year a person spends with a clinician. The 8,759 hours outside clinical settings, where eating, sleeping, movement, medication, and stress actually shape long-term health, have no comparable infrastructure. The bottleneck for personalized health is not raw data or reasoning capability; it is the absence of that infrastructure layer. This paper introduces the Personal Care Utility (PCU): a layered, event-driven architecture proposed as the missing utility for everyday health, in the way that payments, networks, and power are utilities for their domains. PCU organizes continuous personal signals into semantically meaningful life events through a Personicle, estimates dynamic health state against personal baselines, reasons about cause and context, and routes guidance through an orchestrator that separates clinical decision logic, behavioral strategy selection, and natural-language expression. This separation lets large language models support reasoning and communication while keeping safety-critical clinical decisions grounded in validated evidence. We instantiate PCU for Type 2 Diabetes - turning CGM, meal, activity, medication, sleep, stress, and clinical data into glycemic events, individualized state estimates, causal explanations, and knowledge-grounded interventions. A day-in-the-life scenario shows the same infrastructure producing real-time nudges, weekly summaries, medication check-ins, silence, or deterministic safety alerts depending on context and risk. We close with how PCU generalizes to other chronic conditions and the governance questions any always-on personal health utility must address. The result is a blueprint that treats personalization not as a final messaging layer, but as an architectural property of everyday health guidance.

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

Improving End-to-End Speech Recognition for Dysarthric Speech through In-Domain Data Augmentation

arXiv:2606.19797v1 Announce Type: cross Abstract: Dysarthric speech recognition is crucial for facilitating effective communication among individuals with dysarthria. However, accurately recognizing dysarthric speech poses significant challenges due to varying severity levels and limited data availability. In this paper, we explore data augmentation techniques for dysarthric automatic speech recognition (ASR) systems by fine-tuning the End-to-End pre-trained Wav2Vec2 model, with a specific focus on severity levels. To address the challenges of data scarcity and the need for extensive data in fine-tuning pre-trained ASR systems for dysarthric speech, we investigate four prominent data augmentation methods: Speaking-Rate Modification (SRM), Pitch Modification (PM), Formant Modification (FM), and vocal tract Length Perturbation (VTLP), tailored to different aspects of dysarthria. The study uses individually fine-tuned Wav2Vec2 models for each severity class as baseline systems. Additionally, we conducted severity-specific fine-tuning of the ASR model using augmented data. Results demonstrate distinct efficacy patterns for each augmentation technique across severity levels. The best WERs were achieved with SRM ($s$=0.8) for low (9.02\%) and medium (38.11\%) severities, and with PM ($\tau$=0.8) for high severity (55.15\%), reflecting relative improvements of 30.02\%, 16.64\%, and 15.47\%, respectively. These results confirm the effectiveness of the augmentation methods in improving dysarthric ASR performance.

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

Unreduced Persistence Diagrams for Topological Machine Learning

arXiv:2507.07156v2 Announce Type: replace-cross Abstract: Supervised machine learning pipelines trained on features derived from persistent homology have been experimentally observed to ignore much of the information contained in a persistence diagram. Computing persistence diagrams is often the most computationally demanding step in such a pipeline, however. To explore this dynamic, we introduce several methods to generate topological feature vectors from unreduced boundary matrices and investigate their theoretical and computational properties. We compared the performance of pipelines trained on vectorizations of unreduced PDs to vectorizations of fully-reduced PDs across several data and task types. Our results indicate that models trained on PDs built from unreduced diagrams can perform on par and even outperform those trained on fully-reduced diagrams on some tasks. We also benchmarked the computational performance of an algorithm for computing unreduced diagrams, which was implemented as a heavily modified version of Ripser. These computations are parallelizable and required an order of magnitude less memory on average compared to computing full persistence diagrams. Our results suggest that machine learning pipelines which incorporate topology-based features may benefit in terms of computational cost and performance by utilizing information contained in unreduced boundary matrices.

20.
arXiv (CS.AI) 2026-06-15

Learning Coordinated Preference for Multi-Objective Multi-Agent Reinforcement Learning

arXiv:2606.14693v1 Announce Type: cross Abstract: Cooperative multi-objective multi-agent reinforcement learning (MOMARL) models team decision making under multiple, potentially conflicting objectives. In this setting, conflicts arise not only across objectives but also across agents with different observations, roles, and contributions. We propose Preference Coordinated Multi-agent Policy Optimization (PCMA), which learns coordinated agent-specific preferences to enable complementary trade-offs among agents. Theoretically, we formulate cooperative MOMARL as a team-optimal game and show that, under suitable conditions, preference diversity can induce team improvement through a first-order improvement decomposition. Experiments on multiple cooperative MOMA environments and a practical traffic-control scenario show that PCMA improves both performance and trade-off coordination.

21.
arXiv (math.PR) 2026-06-15

Hierarchical symmetry selects log-Poisson cascades: classification, uniqueness, and stability

arXiv:2604.01632v2 Announce Type: replace Abstract: Within i.i.d. multiplicative cascades, a single axiom – the hierarchical symmetry, a linear contraction on incremental scaling exponents – is shown to be necessary and sufficient for the cascade multiplier to be log-Poisson. We prove: (1) a characterization theorem determining the log-Poisson law with explicit parameters, within the class of all multipliers with finite lattice moments; (2) a classification theorem locating the log-Poisson class inside the log-infinitely-divisible family and identifying the mechanism by which every rival sub-family fails the symmetry; (3) a stability theorem with sharp constants – $(1+\beta)^{1/2}$ when the limiting increment is known, $\sqrt{2}$ when it is fitted – and (4) an unconditional propagation theorem transferring the bound to the multiplier distribution at the sharp rate $\Theta(\sqrt{\varepsilon})$, with a matching lower bound. Beyond independence, the classification extends exactly at the level of asymptotic statistics (limiting cumulant generating function, large deviations, multifractal spectrum) and provably not at the level of laws: an explicit stationary ergodic Markov multiplier satisfies the symmetry exactly with a non-log-Poisson marginal, while exchangeable multipliers collapse to the i.i.d. log-Poisson cascade and finite-state Markov multipliers cannot satisfy the symmetry at all. In the continuous category of exactly scale-invariant log-infinitely-divisible multifractal random measures, no finite moment window of structure-function exponents identifies the cascade class, whereas at the level of the scale-invariance generator the symmetry selects exactly the Barral-Mandelbrot compound Poisson cascade, with scale-ratio-free stability constants. The proofs reduce to second-moment identities on [0,1] via the change of variables $u = e^{kx}$, boundedness of the multiplier, and multiplicative couplings.

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

DeepMine-Mamba: Mitigating Information Dilution in Mamba-Based State Space Models for Document Image Binarization

Document image binarization aims to separate foreground text from degraded backgrounds while preserving thin, broken, and low-contrast strokes. Although deep learning methods have improved binarization performance, most existing approaches rely on convolutional, transformer-based, or generative architectures, while Mamba-based state space models remain largely unexplored for this task. In this work, we investigate Mamba-based feature propagation and observe that direct state-space propagation may dilute weak foreground cues during long-range modeling, especially faint ink traces, fragmented characters, and boundary-sensitive stroke details. To address this problem, we propose DeepMine-Mamba, a Mamba-based binarization framework equipped with a novel Anti-Dilution Gate that estimates propagation-induced feature changes and selectively restores stroke-sensitive local responses while suppressing unnecessary background enhancement. Experiments on DIBCO/H-DIBCO benchmarks under a strict leave-one-year-out protocol show that DeepMine-Mamba achieves competitive overall performance, with strong average FM and Fps across benchmark years. Ablation results further show that the Anti-Dilution Gate is the key component for mitigating propagation-induced foreground dilution and improving stroke preservation.

23.
arXiv (CS.CV) 2026-06-17

Training LLMs with Reinforcement Learning over Digital Twin Representations for Reasoning-Intensive Surgical VideoQA

Surgical video question answering requires multi-step reasoning across semantic, spatial, and temporal dimensions. Existing methods architecturally compress videos into discrete token representations and couple visual perception with reasoning. This approach fragments continuous spatial-temporal relationships and has been shown to restrict multi-step reasoning capabilities. We introduce a reinforcement learning (RL) framework that trains large language models (LLMs) to decouple perception from reasoning by operating over digital twin representations constructed from surgical foundation models. Additionally, we introduce hierarchical representations across frame, temporal window, and procedure levels with probabilistic uncertainty estimates. Finally, we propose a novel reward that combines format validation with accuracy assessment through clinical plausibility evaluation and uncertainty-aware calibration for training. To demonstrate the capabilities of this approach, we introduce REAL-Colon-Reason, a colonoscopic benchmark with 2000 question-answer pairs across three complexity levels. We achieve state-of-the-art performance on REAL-Colon-Reason and two existing surgical VideoQA benchmarks REAL-Colon-VQA and EndoVis18-VQA.

24.
medRxiv (Medicine) 2026-06-22

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

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

25.
arXiv (CS.CL) 2026-06-11

Fine-tuning Multi-modal LLMs with ART: Art-based Reinforcement Training

There are two main Parameter-Efficient Fine-Tuning (PEFT) techniques for Large Language Models (LLMs). While Low-Rank Adaptation (LoRA) introduces additional weights between the LLM layers, Soft Prompting introduces additional fine-tuning-specific raw tokens to an LLM input. However, both require modification to the computational graphs of precompiled, preoptimized LLMs. As a result, neither is fully supported in high-throughput engines like vLLM. We propose fine-tuning with ART (Art-based Reinforcement Training). The method injects information into a frozen Multimodal Large Language Model (MLLM) by optimizing only its raw visual input, thus enabling the soft-token approach on pre-compiled computational graphs. It relies on backpropagation of gradients back into a plain pixel array and thus supports any fine-tuning objective. Moreover, the optimized visual input can be stylized as task-relevant computational artworks. The approach's effectiveness is confirmed for different sizes of a popular open Qwen architecture and for several textual benchmarks. Specifically, ART reaches accuracy competitive with LoRA across mathematics and structured-tool-use benchmarks.