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

Gaussian Process Prior Variational Autoencoder for Endoscopic Videos

Endoscopic video analysis is essential for gastrointestinal diagnosis and computer-assisted interventions, but video sequences are routinely degraded by specular reflections, motion artifacts, and missing frames. These transient corruptions can distract clinicians, reduce image interpretability, and disrupt downstream tasks such as 3D reconstruction and navigation. Effective restoration therefore requires methods that exploit temporal continuity rather than treating frames in isolation. We introduce a Gaussian Process Prior Variational Autoencoder (GPVAE) framework for endoscopic video restoration that replaces the standard factorized latent prior with a temporal Gaussian process prior, enabling interpolation of missing frames with uncertainty-aware reconstruction. The framework combines endoscopy-specific encoders, including a convolutional EndoVAE backbone and pretrained Vision Transformer encoders from GastroNet-5M, with two scalable GP approximations: Hierarchical Prior Approximation (HPA) and Sparse Precision Approximation (SPA). Specular reflections are handled using a DUCKNet-based masking pipeline that excludes corrupted pixels from the reconstruction objective. On the C3VDv2 colonoscopy dataset, the best GPVAE variants reduced image reconstruction RMSE by 21.9\% on average, and by up to 26.1\%, relative to matched VAE baselines. Downstream trajectory RMSE was reduced by 12.7\% on average across classical visual odometry and a pretrained PoseNet, at an average increase of 27.3\% in training time per epoch. Finally, the GP posterior provides per-frame uncertainty estimates that reflect temporal support and offer a confidence signal for restored frames.

02.
arXiv (CS.CV) 2026-06-18

Budget-Aware Adaptive Adversarial Patches for Black-Box Object Detection

Adversarial patches pose a practical threat to modern object detectors. Prior work shows vulnerability, but three gaps limit actionable insight: (i) few score-based black-box attacks jointly optimize patch location, texture, and size under tight query budgets; (ii) success is rarely tied to the patch's visual footprint; and (iii) evaluations often conflate EOT robustness with plain-view suppression. We present \method{}, a query-efficient, budget-adaptive black-box attack that couples a lightweight Contextual Thompson-Sampling placer with NES-style pixel updates, growing the patch only when progress stalls. Reporting is anchored by a strict plain-image suppression test; EOT is audited but never used as a substitute for success, and optional appearance/printability weights expose strength–visibility trade-offs. Across YOLOv5, Faster R-CNN, and YOLOS, \method{} achieves strong suppression on CNN-based detectors and substantial suppression on the transformer-based detector, using compact patches and exposing clear query–footprint trade-offs relative to fixed-size and heuristic baselines. A print–capture pilot further shows transfer across unseen physical objects and viewpoints.

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

Comparing Human Gaze and Vision-Language Model Attention in Safety-Relevant Environments

Human visual attention plays an important role in how people perceive and respond to environments containing potential risks. This study investigates whether large vision-language models can identify the same regions of a scene that attract human attention in safety-relevant environments. Eye-tracking data were collected from ten participants viewing 33 scene images representing environments with varying levels of potential risk using Pupil Invisible wearable glasses. Gaze coordinates were mapped onto stimulus images to generate population-averaged human gaze heatmaps. In parallel, GPT-4o was prompted through the OpenAI Vision Application Programming Interface (API) to generate spatial predictions of visual attention, which were converted into saliency maps for comparison with human gaze patterns. Spatial alignment between human gaze heatmaps and model-generated saliency maps was evaluated using four complementary metrics: Pearson correlation (r = 0.515 +- 0.117), Normalised Scanpath Saliency (NSS = 0.988 +- 0.323), Kullback-Leibler divergence (KL = 1.766 +- 0.844), and Area Under the Receiver Operating Characteristic Curve using the Judd formulation (AUC-Judd = 0.806 +- 0.076). A cross-model comparison with Gemini Pro, Gemini Flash, and Claude showed that all models exceeded the AUC-Judd chance baseline of 0.5 and achieved positive NSS scores. Gemini Pro demonstrated the strongest spatial localisation according to three of the four metrics, whereas GPT-4o produced the closest distributional match to human attention as measured by KL divergence. These findings suggest that large vision-language models can identify regions that broadly correspond to where humans direct visual attention in safety-relevant scenes without requiring eye-tracking training data. The results highlight the potential of vision-language models as a scalable tool for approximating human attentional patterns.

04.
Nature (Science) 2026-06-10

Diverse binding poses of agonistic neurotoxins on human Na<sub>v</sub>1.6

作者:

Voltage-gated sodium (Nav) channels are key targets of various venomous toxins. Deciphering the binding poses and mechanisms of action of representative toxins will help to dissect the functional mechanism of the channels and facilitate therapeutic development targeting Nav channels1,2. Here we present cryo-electron microscopy&nbsp;(cryo-EM) structures of distinct binding poses of three agonistic peptide toxins on the human Nav1.6–β1 channel complex. The globular β-scorpion toxin Cn2 nestles between the extracellular segment of voltage-sensing domain (VSD)&nbsp;in the second repeat of the Nav1.6 core α-unit (VSDII) and the pore extracellular loops in the third repeat of the Nav1.6 core α-unit (ECLIII), where it is stabilized by interactions with both protein regions and the branched N1372-glycan. Cone&nbsp;snail ι-conotoxin RXIA adopts an elongated conformation, spanning VSDI and VSDIV to wrap around the shoulder of the pore domain (PD). The bullet&nbsp;ant-derived toxin δ-paraponeritoxin-Pc1a exists as a transmembrane helix that stands between VSDII and PDIII. Our findings, corroborated by functional characterizations, illustrate the diversity in peptide toxin binding poses and mechanisms of action, link stabilization of the up state of VSDI or VSDII to channel activation, and provide clues to the rational design of selective Nav channel modulators. Structures of the distinct binding poses of three agonistic peptide toxins—bullet-ant-derived toxin δ-paraponeritoxin-Pc1a, cone&nbsp;snail ι-conotoxin RXIA and the globular β-scorpion toxin Cn2—on the human Nav1.6–β1 channel complex illustrate a diversity in binding poses and mechanisms of action.

05.
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.

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

The More the Merrier: Combining Properties for ABox Abduction under Repair Semantics for ELbot

arXiv:2606.19197v1 Announce Type: cross Abstract: Abduction is a central approach to explain missing entailments from a knowledge base by providing a hypothesis, that would, if added to the knowledge base, make the missing entailment become true. Abduction under repair semantics has recently been investigated in detail, where several desirable properties and optimality criteria were considered, such as signature-restrictions and minimality in size and of introduced conflicts. Naturally, hypotheses that satisfy more than one of these properties or combine a property with an optimality criterion would be even more desirable for applications. So far, such hypotheses have not been investigated in the literature. In the present paper, we consider the ABox abduction problem for hypotheses satisfying more than one property or additional optimality criteria, for EL_bot under brave and AR semantics. Our main observation is that often requiring additional properties for hypotheses does not lead to an increase of complexity.

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

Quantization Robustness of Monotone Operator Equilibrium Networks

arXiv:2603.10562v2 Announce Type: replace-cross Abstract: Monotone operator equilibrium networks are implicit-layer models whose output is the unique equilibrium of a monotone operator, guaranteeing existence, uniqueness, and convergence. When deployed on low-precision hardware, weights are quantized, potentially destroying these guarantees. We analyze weight quantization as a spectral perturbation of the underlying monotone inclusion. Convergence of the quantized solver is guaranteed whenever the spectral-norm weight perturbation is smaller than the monotonicity margin; the displacement between quantized and full-precision equilibria is bounded in terms of the perturbation size and margin; and a condition number characterizing the ratio of the operator norm to the margin links quantization precision to forward error. MNIST experiments confirm a phase transition at the predicted threshold: three- and four-bit post-training quantization diverge, while five-bit and above converge. The backward-pass guarantee enables quantization-aware training, which recovers provable convergence at four bits.

09.
arXiv (CS.AI) 2026-06-11

The Environmental Cost of LLMs in AIED: Reporting and Practices

arXiv:2606.11215v1 Announce Type: cross Abstract: Large Language Model (LLM) usage in recent years has become increasingly widespread in the Artificial Intelligence in Education (AIED) community. While LLMs offer unique avenues for learners and educators, using LLMs comes with computational and environmental costs. These costs are mostly hidden due to a lack of standardised procedures to measure and report these impacts. To address this gap, we first conducted a literature review of all papers published as part of the AIED 2025 conference proceedings, determining if and how computational or environmental costs of LLMs are reported. Most projects use LLMs, but few report computational resources used and almost none discuss environmental impacts of LLMs as an ethical concern. To address this lack of standardised reporting practices, we propose an open-source method for systematically measuring and reporting the computational expense of LLMs and environmental impact of running Machine Learning (ML) AIED systems. We provide software solutions to measure the carbon footprint for both local and cloud based hardware. We also provide an easy-to-use formula to calculate the computational expense of frontier LLMs even when the exact number of parameters is not known. Overall, we hope to motivate colleagues to use our method to strive for more transparent reporting of hidden costs of using LLMs in the AIED community.

10.
arXiv (CS.AI) 2026-06-17

From Brewing to Resolution: Tracing the Internal Lifecycle of Code Reasoning in LLMs

arXiv:2606.17648v1 Announce Type: new Abstract: Standard accuracy metrics cannot explain why LLMs handle variable tracking but fail on semantically equivalent loops. We study an internal lifecycle of code reasoning in which models first brew the answer, making it linearly recoverable many layers before it becomes self-decodable, and then diverge into one of four resolution outcomes: Resolved, Overprocessed, Misresolved, or Unresolved. Understanding this lifecycle matters because similar task accuracies can mask fundamentally different failure modes that surface-level evaluation cannot detect. We introduce a dual diagnostic framework pairing layer-wise linear probing with Context-Stripped Decoding (CSD) and apply it to six code-reasoning task families across 16 models spanning Qwen, Llama, and DeepSeek architectures. All four outcomes carry substantial mass in every task family: overall Resolved is only 41.5%, with multiple tasks below 30%. Controlled sweeps over structure, depth, and operators expose task-specific failure bottlenecks: Function Call Resolved plunges from 61.1% to 2.5% as call depth increases from one to three. Across architectures and scales, the brewing scaffold remains stable, with normalized brewing duration 24-42% across all 16 models, while resolution success varies with capability. This indicates that the scaffold is a stable empirical regularity across the tested decoder-only Transformer families, whereas resolution success covaries with capability, scale, and training. Code: https://github.com/euyis1019/llm-brewing

11.
arXiv (quant-ph) 2026-06-17

Frequency upconversion of infrared signals via molecular cavity optomechanical systems with gain

arXiv:2606.17877v1 Announce Type: new Abstract: Molecular cavity optomechanical systems have recently emerged as a promising platform for enhancing infrared detection sensitivity, owing to their ability to up-convert low-frequency infrared (IR) photons to visible frequency range. Generally, under red-detuned pumping in such systems, the ideal conversion efficiency of the IR signal approaches 1. To overcome this efficiency constraint, we propose a scheme that incorporates gain into the infrared cavity of a molecular cavity optomechanical system comprising two cavities and an ensemble of N molecules. The upconversion process, which relies on IR absorption and Raman scattering associated with specific vibrational modes, is significantly amplified by the incorporation of gain under the red-detuned conditions. Moreover, our analysis demonstrates that the added noise is maintained near 0.5.

12.
arXiv (CS.LG) 2026-06-11

Hybrid Iterative Neural Low-Regularity Integrator for Nonlinear Dispersive Equations

arXiv:2605.04853v2 Announce Type: replace Abstract: We propose HIN-LRI, a hybrid framework that augments a classical numerical solver with a neural operator trained to correct the solver's structured truncation error. A base low-regularity integrator provides a consistent first-order approximation to nonlinear dispersive PDEs, while a lightweight neural network, operating on a low-dimensional latent manifold, learns the residual defect that analytical methods cannot close. An explicit time-step scaling on the neural correction ensures that its Lipschitz contribution remains $\mathcal{O}(\tau)$, yielding a Gronwall stability factor bounded uniformly in the step size and independent of the spatial resolution. The network is trained end-to-end through a solver-in-the-loop objective that unrolls the full iteration and penalises trajectory error in a Bourgain-type norm, aligning learning with multi-step solver dynamics rather than isolated one-step targets. Under stated assumptions, the global error satisfies $C(\varepsilon_{net}+\delta)\,\tau^\gamma\ln(1/\tau)$, where $\varepsilon_{net}$ measures the network approximation quality and $\delta$ the training shortfall. Experiments on three dispersive benchmarks with rough data show that HIN-LRI improves accuracy over analytical integrators, splitting methods, and neural PDE surrogates, with stable spatial refinement, effective out-of-distribution transfer, and modest online overhead.

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

Getting Better at Working With You: Compiling User Corrections into Runtime Enforcement for Coding Agents

Interactive LLM agents are becoming part of daily work, but they do not reliably become easier to work with over time: a correction remembered in one session may still be violated in the next. We study this gap between preference access and preference compliance. In tasks derived from anonymized real-user friction cases, Mem0 memory still leaves 57.5% of applicable preference checks violated. We introduce Test-time Rule Acquisition and Compiled Enforcement (TRACE), a drop-in skill-layer pipeline for coding-agent runtimes that mines user corrections, rewrites them as atomic rules, and compiles them into runtime checks that must pass before an agent completes future tasks. Unlike runtime checks written ahead of time by developers, TRACE skills come from the user's own chat corrections. We evaluate TRACE with simulated user-in-the-loop experiments on ClawArena coding-agent tasks and MemoryArena-derived memory-intensive tasks. On ClawArena, TRACE reduces held-out preference violation from 100.0% to 37.6% on in-distribution tasks and from 100.0% to 2.0% on out-of-distribution tasks. On MemoryArena-derived tasks, TRACE reduces in-distribution violation from 100.0% to 60.5% while matching or exceeding the strongest memory baseline on task pass. These results suggest that compiling corrections into runtime enforcement can address a repeated-friction failure mode that memory alone does not reliably solve, reducing the need for users to restate the same correction across future sessions. Experiment code is available at https://github.com/YujunZhou/TRACE_exp, and the deployable skill is available at https://github.com/YujunZhou/tellonce.

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

Structure Over Nonlinearity: Explicit Interaction Architectures for Dynamical Learning

arXiv:2606.19101v1 Announce Type: cross Abstract: Most learning architectures for dynamical systems rely on generic nonlinear function approximation, often requiring high model complexity to capture structured behaviors. In this work, we propose an alternative paradigm in which modeling capability arises primarily from structure rather than from expressive nonlinearities. We introduce a class of explicit structured dynamical units based on wave-inspired interaction structures with internal state. Inspired by wave-based computational principles, the proposed units adopt a strictly causal organization that eliminates algebraic loops, yielding fully explicit models that can be evaluated without implicit solvers. Stacking such units produces layered dynamical architectures with emergent hierarchical behavior. Through experiments on a nonlinear system identification task, we show that depth improves both representation quality and generalization, even under limited parameter optimization. In particular, the proposed architectures produce informative internal representations even under readout-only fitting, indicating that useful dynamical structure emerges from the organization of interactions prior to substantial parameter optimization. These results suggest that structure-first design provides a viable and effective alternative to conventional black-box approaches for learning dynamical systems, highlighting the role of interaction structure as a primary source of model expressivity.

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

Rule Taxonomy and Evolution in AI IDEs: A Mining and Survey Study

arXiv:2606.12231v1 Announce Type: cross Abstract: The adoption of AI-powered Integrated Development Environments (AI IDEs) has introduced "Rules" as a novel software artifact, allowing developers to persistently inject project-specific constraints and architectural guidelines into the context of Large Language Models (LLMs). Despite their role in aligning AI behavior with developer intent, the taxonomy, evolution, and practical impact of these rules remain largely unexplored. To bridge this gap, we conducted a mixed-methods empirical study on AI IDE rules. By mining 83 open-source projects and extracting 7,310 rules, we established a comprehensive taxonomy comprising 5 primary and 25 secondary categories. We then triangulated these artifacts with survey responses from 99 practitioners. Our analysis identified a contrast between developer priorities and actual configurations: while practitioners rate architectural constraints as highly important, rule files in repositories primarily consist of low-level workflow and code formatting constraints. Furthermore, our analysis of 1,540 rule evolution events revealed that rules are updated frequently. Repository data further indicate that rule evolution is primarily driven by constructive context expansions (29.17%) and enrichments (26.59%). In contrast, surveyed developers reported modifying rules primarily to correct AI errors (77.78%), typically by adding new negative constraints rather than editing existing ones. Finally, an artifact compliance assessment of 160 rule evolution events revealed that updating rules significantly improves the adherence of software artifacts, with the average artifact compliance rate increasing by 22.99% (from 49.14% to 72.13%) following an update. Our study provides empirical insights that can help developers optimize prompting strategies and guide tool builders in designing automated conflict-detection and context-management mechanisms for AI IDEs.

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

Stringalign: Moving beyond summary statistics with a transparent Unicode-aware tool for evaluating automatic transcription models

Comparing text strings is crucial when evaluating and understanding the performance of various text processing tasks such as document recognition and audio transcription. With an increasingly complex landscape of AI-based handwritten text recognition (HTR), optical character recognition (OCR) and automatic speech recognition (ASR) models, there is a need for tools that facilitate evaluation in a flexible and reproducible way. This paper presents Stringalign, a Python library designed to simplify the evaluation process for automatic transcription projects and facilitate transparent evaluation. Stringalign's tools to examine and visualise both the rate of errors and the types of errors a model makes, give insights into possible improvements and help inform model selection for a particular task. Widely used string comparison metrics, such as the character and word error rates (CER and WER), although useful, can be ambiguous due to varying definitions of what constitutes a character and a word. Stringalign addresses this challenge by ensuring all preprocessing (i.e. normalisation and tokenisation) is transparent and easily replicable, and by providing tools to move beyond summary statistics and analyse common model errors. Moreover, Stringalign adheres to FAIR (Findable, Accessible, Interoperable, and Reusable) principles for research software while staying lightweight and easy to adapt into researchers existing workflows. In this paper, we discuss challenges with character and word level string comparisons and show through examples that where existing tools can yield opaque and sometimes confusing results, Stringalign provides an easy-to-use and unambiguous alternative.

17.
arXiv (CS.AI) 2026-06-12

Democracy in the Era of Artificial Intelligence

arXiv:2606.13026v1 Announce Type: cross Abstract: Interfacing Artificial Intelligence (AI) with democracy is one of the most profound challenges of our times. On the one hand, AI comes with opportunities to overcome long-standing challenges in democracy, such as low participation in deliberative and voting processes with poor representation of people. On the other hand, new risks arise from AI algorithms that are privacy-intrusive, biased, manipulative, spread misinformation and influence election results. Moving beyond the over-simplistic question of whether AI is good or bad for democracy, the Handbook on Democracy in the Era of Artificial Intelligence asks instead: how to upgrade democracies and the principles they are built on, using AI? How to engage with AI and on what terms? Which new values and design principles are required to build democratic resilience? In 34 chapters by 59 authors across the world from different disciplines, we explore how AI can empower collective intelligence for democracy (Part 1) and what is the future of deliberative democracy using large language models and social media (Part 2). We also illustrate the role of AI for building resilient self-governance systems (Part 3) and the challenges of transforming democracy in the age of AI (Part 4). We conclude with broader perspectives (Part 5) that re-imagine the interplay of democracy and AI.

18.
arXiv (CS.LG) 2026-06-17

Meta-classification of one-class classification models using ranking correlation and nearest neighbor

arXiv:2606.17858v1 Announce Type: new Abstract: Machine Learning (ML) techniques have been applied to various problems. However, applying ML to ML models is an unexplored direction. For this purpose, this paper considers a meta-classification of one-class classification (OCC) models, because all ML models could be approximated as OCC models. The proposal represents OCC models as normality rankings and classifies them using nearest-neighbor and ranking-correlation metrics. The experiment classifies OCC models, where classes correspond to training datasets, algorithms, and hyperparameters. The proposal achieves high accuracy when class labels are datasets. Moreover, it can classify algorithms when the training datasets contain the same class. In addition, the discussion highlights that the classification of OCC models is essentially the classification of datasets that treats multiple samples as a single input. The experiment demonstrates the classification of datasets using sleeping records. The proposed method can provide a unified solution for classifying OCC models, datasets, and rankings. Source code is uploaded to the public repository https://github.com/ToshiHayashi/ClassOCC.

19.
medRxiv (Medicine) 2026-06-17

Reverse engineering of motor unit discharge in multiple sclerosis reveals heterogeneity of voluntary motor commands

Central nervous system injury causes motor deficits through derangement of excitatory, inhibitory, and/or neuromodulatory inputs to motoneurons, the three fundamental components of motor commands. Typically, study of pathologic neural control in humans is restricted to only one of the three. Chardon et al. (2024) presented a fundamentally new approach to comprehensively study all components by reverse engineering motor unit firing patterns. We apply their framework to motor unit firing patterns from 89 people with multiple sclerosis (MS) and 34 controls to study excitatory, inhibitory, and neuromodulatory contributions to pathologic motor output. Disruptions to all components are plausible in MS, a disease hallmarked by heterogeneity in nearly all aspects. Accordingly, we found abnormalities in MS for all three components. Notably, neuromodulation included both high and low extremes. Our results suggest that pathophysiology of motor commands in MS varies among patients, a finding fundamentally different from other studied populations showing relative consistency.

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

VisualClaw: A Real-Time, Personalized Agent for the Physical World

Vision language models are serving as general-purpose interfaces for complex multimodal tasks. However, deployment still faces three gaps: VLMs typically incur high latency and cost when processing dense video frames and long prompts, the agent scaffold remains static after deployment, and standard video-QA benchmarks do not test whether agents can use visual evidence inside tool-using workspaces. We present VisualClaw, a self-evolving multimodal agent built around two principles. First, hybrid encoding reduces deployment cost by filtering less informative streaming frames with a cascaded gate and compressing the text skill bank through hot/cold top-k injection. Second, skill evolution lets the agent learn from failures: retrieved memories condition an evolver as direct concatenated context or as guided evidence, producing skill-bank updates that help future questions. Across 4 video-QA benchmarks with 2 VLMs, VisualClaw cuts per-question API cost by an average -98% versus full-frame upload and by -25.9% over the offline uniform 8 frame baseline, while boosting accuracy in most settings, e.g., an average +3.85% and a peak +15.80% on EgoSchema with Gemini 3 Flash. To address the gap, we curate VisualClawArena, a 200-scenario multimodal agentic benchmark built through a strict five-stage pipeline; models must use video evidence, documents, dynamic updates, and executable checks inside a workspace. On VisualClawArena, the same framework with computer-use agent backends improves macro accuracy by +2.9% for Codex (GPT-5.5) and +3.2% for Claude Code (Sonnet 4.6) over no-evolution baselines, with a -9.5% cost reduction compared to the uniform-sampled baseline. These properties make VisualClaw a natural fit for edge applications, where the cascade reduces a 1-hour streaming session from ~3,600 API uploads down to only 5-20 calls and the self-evolution makes it a perfect personalized assistant.

21.
medRxiv (Medicine) 2026-06-22

Regional Service-System Conditions Associated with Facility-Linked Home-Based Specialist Care in Japan: A Claims-Based Ecological Study of Home Dialysis

Background Complex chronic care is increasingly delivered in patients' homes while remaining linked to specialist facilities for training, monitoring, and backup care. Home dialysis provides a useful case because peritoneal dialysis (PD) and home hemodialysis (HHD) share a home-facility delivery structure but differ in technical and operational requirements. This study examined regional service-system conditions associated with the presence and scale of PD and HHD in Japan. Methods This ecological study used publicly available claims, administrative, census, and geospatial data harmonized to 334 Secondary Medical Areas. Regional indicators were organized into four domains: dialysis service delivery, implementation support for home-based care, hospital backup capacity, and living and sociodemographic context. Diffusion was examined using claims-based indicators of regional presence and post-presence scale, analyzed separately for PD and HHD with Firth penalized logistic regression and zero-truncated negative binomial regression, respectively. Results PD was observed in 271 regions and HHD in 109. Patterns of associated regional conditions differed by modality and stage. PD was associated mainly with existing dialysis-service organization, whereas HHD was associated with broader regional supports, including home-care delivery, living infrastructure, transition support, and hospital-system indicators. Conditions associated with presence differed from those associated with scale. Cross-modality associations suggested that shared regional factors may shape the distribution of both modalities. Conclusions Regional conditions for home dialysis diffusion in Japan differed by modality and stage. PD was linked mainly to existing dialysis-service organization, whereas HHD was linked to multi-domain regional support for technically demanding home treatment. Under standardized reimbursement, local service-system capacity may remain important for modality- and stage-specific diffusion of home dialysis.

22.
medRxiv (Medicine) 2026-06-15

A More-Than-Human Approach to Designing for Mental Health: Remixing Prototypes for the Contexts of Complex Healthcare Infrastructures

Digital mental health tools (DMHTs) often fail to be successfully implemented in clinical settings. While user- and human-centred design frameworks are frequently proposed for developing effective tools, they are insufficient to address the sociotechnical complexity of healthcare environments. This paper addresses this limitation by detailing the application of a more-than-human design framework to incorporate wider contextual factors into design decisions. To demonstrate the application of this more-than-human design framework, we present a case study showcasing the design of one specific feature within a DMHT intended to support Health Improvement Practitioners (HIPs) in New Zealand's Integrated Primary Mental Health and Addictions (IPMHA) service. Our process blends usage-context storyboards with interface prototypes, using think-aloud interviews to test the contextual fit of our prototypes. The initial design concept failed due to contextual factors such as inconsistent wait times and the administrative burden on clients and clinic staff. This led to a pivot to a more context-appropriate, practitioner-focused, in-session concept for digital psychometric administration and automated scoring. This case study demonstrates that for DMHTs to be viable within complex healthcare environments, design must focus on more than the needs of a single user, incorporating multiple stakeholders and contextual variables across the wider service-delivery context.

23.
arXiv (CS.CL) 2026-06-18

As Easy as Rocket Science: Assessing the Ability of Large Language Models to Interpret Negation in Figurative Language

Figurative language and negation are two areas that challenge current language models, however, both are widely used throughout written and spoken language. Large language models (LLMs) are also widely used in everyday contexts where they cannot necessarily be tuned for a specific dataset. It is therefore essential to understand the ability of LLMs to correctly interpret text that includes both negation and figurative language. To investigate this, we develop a set of new annotations to an existing dataset of figurative language, and test a range of language models on the dataset. We find that the combination of negation and figurativeness can present a particular challenge, and that performance overall and across different negation types is particularly dependent on the prompt style used.

24.
arXiv (CS.CL) 2026-06-16

Does Traversal Order Matter? A Systematic Study of Tree Traversal Methods in Transformer Grammars

Transformer Grammars (TGs) enhance language modeling by incorporating syntactic tree structures. Despite the potentially significant impact on model performance of how syntactic trees are linearized in TGs, existing studies rely solely on Depth-First Traversal (DFT) for linearization. In this paper, we expand the traversal design space by exploring Breadth-First Traversal (BFT) and a novel hybrid traversal strategy, Production-Rule Traversal (PRT), which combines the structural lookahead of BFT with the early lexical generation of DFT. We integrate these traversal methods with varying tree configurations and masking strategies, and empirically evaluate their performance on language modeling, syntactic generalization and summarization. We reveal the inherent trade-offs between nested composition and global lookahead, providing actionable recommendations for designing task-aware Transformer Grammars.

25.
arXiv (CS.CL) 2026-06-17

AIPatient Arena: EHR-grounded evaluation of large language models in end-to-end clinical consultation workflows

Large language models (LLMs) are increasingly considered for use in clinical consultation tasks, yet most medical evaluations remain static, single-turn, or narrowly outcome-based, limiting their ability to reflect the sequential, uncertain, and interactive nature of real-world care. Here, we propose AIPatient Arena, an EHRs-grounded evaluation framework for assessing the clinical utility of LLMs across eight dimensions of clinical competence. The framework integrates EHR data into patient-specific knowledge graphs, enabling multi-turn physician-patient interactions. We applied AIPatient Arena on a primary cohort of 437 patients and two out-of-distribution validation cohorts of 119 and 67 patients. We observe that LLMs performed well in medical interview questioning skills (QS; mean scores, 4.43-4.99/5), ethical and professional conduct (ET; 4.38-4.93/5), and clarity and transparency of clinical explanations (EX; 3.80-4.72/5). Performance was moderate in information integration (II; 3.19-4.21/5) and medication safety and justification (MS; 3.13-3.78/5), but persistent weaknesses were observed in handling of ambiguous patient responses (HR; 2.57-3.32/5), information coverage (IC; 2.08-3.02/5), and diagnostic accuracy and reasoning (Dx; 2.63-3.55/5). Process-based evaluation revealed recurrent interaction failures, including repetitive questioning, omission of past medical history, and inadequate handling of uncertainty. Richer conversational context improved diagnostic reasoning but yielded limited gains in treatment planning. These findings indicate that final-answer accuracy alone is insufficient for evaluating clinical readiness and highlight the importance of assessing how models gather, interpret, and communicate information throughout a consultation. AIPatient Arena provides an EHR-grounded framework for workflow-oriented pre-deployment evaluation of medical LLMs.