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01.
arXiv (CS.CV) 2026-06-11

MultiToP: Learning to Patch Visual Tokens to Mitigate Hallucinations in Video Large Multimodal Models

Video Large Multimodal Models have achieved remarkable progress in video understanding, yet they remain prone to hallucinations, where generated responses are not faithfully supported by the input video. In this paper, we propose MultiToP, a multimodal-context-aware visual token patching framework that mitigates hallucinations by refining unreliable visual tokens before language generation. MultiToP introduces a lightweight Visual Token Patcher to predict token-level replacement distributions and selectively substitute unreliable visual tokens with a dynamic global patch token. To train the patcher effectively, we further propose information-guided rank calibration, which uses answer-conditioned frame-level information cues derived from the backbone to guide token replacement. Combined with ground-truth answer supervision and sparsity regularization, MultiToP enables localized visual evidence refinement without modifying the original model. Extensive experiments demonstrate that MultiToP effectively reduces hallucinations on Vript-HAL with negligible inference overhead, improving the F1 scores of Qwen3-VL-4B-Instruct by 50.60% over the vanilla model. Meanwhile, MultiToP preserves general video understanding ability, yielding an 18.58% relative accuracy gain on ActivityNet-QA for Video-LLaVA-7B.

02.
PLOS Medicine 2026-05-21

Semaglutide-associated risk of nonarteritic anterior ischemic optic neuropathy in patients with type 2 diabetes: A systematic review and meta-analysis of observational studies

by Jędrzej Chrzanowski, Magdalena Walicka, Jacek Burzyński, Małgorzata Zaraś, Arkadiusz Michalak, Wojciech Fendler Background Semaglutide, a glucagon-like peptide-1 receptor agonist, is widely used for the management of type 2 diabetes (T2DM). Recent case reports have raised concerns about a potential association between semaglutide use and the development of nonarteritic anterior ischemic optic neuropathy (NAION), a rare but vision-threatening condition. We aimed to evaluate whether semaglutide use is associated with an increased risk of NAION in patients with T2DM. Methods and findings We conducted a systematic review and meta-analysis of observational studies comparing patients with T2DM aged ≥12 years treated with semaglutide to those receiving other glucose-lowering therapies. We searched PubMed, Scopus, and Web of Science databases from January 2023 to November 2025. Two reviewers independently extracted data on study design, population characteristics, and outcomes. Risk of bias was assessed using the Newcastle–Ottawa Scale, and ROBINS-I v.2. Certainty of the evidence was graded according to the GRADE framework. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using fixed-effects models; sensitivity analyses included crude and subgroup HRs, and overlapping study replacement. Leave-one-out analysis was conducted to assess small-study effects and publication bias. Results were contextualized within other meta-analyses, systematic reviews, consensus statements, and regulatory communications on the topic.Five eligible observational studies met the inclusion criteria, and 7 additional studies were included in the sensitivity analysis. Semaglutide use was associated with a significantly increased hazard of NAION compared with nonsemaglutide glucose-lowering regimens (HR 2.17, 95% CI [1.73, 2.74]; p 

03.
arXiv (CS.CL) 2026-06-12

Understanding helpfulness and harmless tension in reward models

Reward models are a key component of reinforcement learning from human feedback (RLHF), aligning language models toward both helpful and harmless behaviour. However, the internal mechanisms underlying these objectives and their conflicts remain poorly understood. We study alignment tension in reward models trained under helpfulness-only, harmlessness-only, and mixed-objective settings. We find that mixed-objective models often underperform single-objective models, indicating interference between objectives. Using activation-based methods, we identify neurons associated with each objective and study their functional roles via targeted ablations. We find that these neurons causally support their corresponding objectives while often negatively affecting the opposing one. We find that a substantial proportion of neurons are shared between helpfulness and harmlessness, and that these shared neurons exert a disproportionate influence on model behaviour, contributing to alignment tension. Additionally, our results provide insights and mechanistic interpretation into how alignment objectives are represented in reward models and why multi-objective alignment remains challenging, motivating future work on disentangled and controllable alignment methods.

04.
arXiv (math.PR) 2026-06-12

The censored stochastic six-vertex model and parabolic Kazhdan–Lusztig $R$-polynomials

arXiv:2606.12670v1 Announce Type: new Abstract: We introduce a censored version of the stochastic six-vertex model. We show that for parameters $b_1 < b_2$, this model started from the initial condition ${1}_{x>0}$ is stochastically dominated at any time by the blocking measure. This is a partial analog of the censoring inequality for monotone spin systems. In particular, this result allows us to control the behavior of second-class particles. The proof uses parabolic Kazhdan–Lusztig $R$-polynomials, whose appearance is explained using a connection between the stochastic six-vertex model and the Iwahori–Hecke algebras of symmetric groups. Furthermore, we find an intertwining relation for this process using normalized parabolic Kazhdan–Lusztig $R$-polynomials as an intertwining kernel.

05.
arXiv (CS.CV) 2026-06-18

FutureOmni: Evaluating Future Forecasting from Omni-Modal Context for Multimodal LLMs

Although Multimodal Large Language Models (MLLMs) demonstrate strong omni-modal perception, their ability to forecast future events from audio-visual cues remains largely unexplored, as existing benchmarks focus mainly on retrospective understanding. To bridge this gap, we introduce FutureOmni, the first benchmark designed to evaluate omni-modal future forecasting from audio-visual environments. The evaluated models are required to perform cross-modal causal and temporal reasoning, as well as effectively leverage internal knowledge to predict future events. FutureOmni is constructed via a scalable LLM-assisted, human-in-the-loop pipeline and contains 919 videos and 1,034 multiple-choice QA pairs across 8 primary domains. Evaluations on 13 omni-modal and 7 video-only models show that current systems struggle with audio-visual future prediction, particularly in speech-heavy scenarios, with the best accuracy of 64.8% achieved by Gemini 3 Flash. To mitigate this limitation, we curate a 7K-sample instruction-tuning dataset and propose an Omni-Modal Future Forecasting (OFF) training strategy. Evaluations on FutureOmni and popular audio-visual and video-only benchmarks demonstrate that OFF enhances future forecasting and generalization. We publicly release all code (https://github.com/OpenMOSS/FutureOmni) and datasets (https://huggingface.co/datasets/OpenMOSS-Team/FutureOmni).

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

HeRo-Q: A General Framework for Stable Low Bit Quantization via Hessian Conditioning

arXiv:2601.21626v2 Announce Type: replace-cross Abstract: Post Training Quantization (PTQ), a mainstream model compression technique, often leads to the paradoxical 'low error, high loss' phenomenon because it focuses solely on minimizing quantization error. The root cause lies in the Hessian matrix of the LLM loss landscape: a few high curvature directions are extremely sensitive to perturbations. To address this, we propose the Hessian Robust Quantization (HeRo Q) algorithm, which applies a lightweight, learnable rotation-compression matrix to the weight space prior to quantization. This joint framework reshapes the loss landscape by reducing the largest Hessian eigenvalue and reducing its max eigenvalue, thereby significantly enhancing robustness to quantization noise. HeRo-Q requires no architectural modifications, incurs negligible computational overhead, and integrates seamlessly into existing PTQ pipelines. Experiments on Llama and Qwen models show that HeRo Q consistently outperforms state of the art methods including GPTQ, AWQ, and SpinQuant not only achieving superior performance under standard W4A8 settings, but also excelling in the highly challenging W3A16 ultra low bit regime, where it boosts GSM8K accuracy on Llama3 8B to 70.15\% and effectively avoids the logical collapse commonly seen in aggressive quantization.

07.
medRxiv (Medicine) 2026-06-12

Association of circulating endothelial progenitor cell count and functional outcome in patients with acute ischemic stroke due to intracranial large vessel occlusion

Background: Circulating endothelial progenitor cells (cEPCs) contribute to vascular repair following an ischemic stroke. The aim of the study was to evaluate the association between cEPCs and functional outcomes in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) who received endovascular therapy (EVT). Methods: Prospective study of patients with LVO-AIS who received EVT. Blood samples were obtained within 24 +- 12 hours and on day 7+-1 from stroke onset. cEPCs were detected using flow cytometry (CD34+/VEGFR2+/CD133+). The primary endpoint was a favourable functional outcome (modified Rankin Scale 0-2) at three months of follow-up. Secondary endpoints include baseline to 24 hours/day 7 changes in the National Institutes of Health Stroke Scale (NIHSS) score and collateral circulation (CC) status. Bivariate and multivariable logistic regression analyses were performed. Results: Included were 90 patients (73.2+-12.7 years, 41.1% women) in 42 of whom (46.7%) cEPCs were detected at 24 hours. On day 7, cEPCs were detected in 27 (43.6%) of 62 patients for which this information was available. Atrial fibrillation, prior anticoagulant treatment and stroke onset-to-door time

08.
PLOS Computational Biology 2026-05-29

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

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

09.
arXiv (CS.CV) 2026-06-16

Beer-Lambert Guided Representation Learning for Unsupervised Anomaly Detection in Sub-THz Food Inspection Images

Food manufacturing requires reliable inspection systems to detect foreign material contamination and maintain product safety. Sub-THz transmission imaging provides material-dependent attenuation characteristics that are useful for detecting low-density contaminants in food products. However, existing unsupervised anomaly detection methods mainly rely on RGB-pretrained visual representations, which may not adequately capture the transmission behavior of Sub-THz images. This paper proposes a Beer-Lambert guided representation learning framework for unsupervised anomaly detection in Sub-THz food inspection images. The proposed method introduces an attenuation decomposition module as an auxiliary regularization module that constrains student representations through attenuation reconstruction during training. In addition to the conventional one-class setting, we introduce a Leave-One-Food-Out protocol to evaluate generalization capability under unseen food categories. Experimental results on the Inline-Food-Inspection-THz dataset show that the proposed method improves overall anomaly detection performance over the baseline method.

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

Unified Multimodal Autoregressive Modeling with Shared Context-Visual Tokenizer is Key to Unification

Unified Multimodal Modeling aims to integrate visual understanding and generation within a single system. However, existing approaches typically rely on two disparate visual tokenizers, which splits the representation space and hinders truly unified modeling. We propose UniAR, a unified autoregressive framework where a single discrete visual tokenizer serves as the key bridge between understanding and generation, enabling a shared context in which the model can directly interpret its own generated visual tokens without additional re-encoding. UniAR adapts a pretrained vision encoder with multi-level feature fusion and a lookup-free bitwise quantization scheme, preserving both high-level semantics and low-level details while scaling the effective visual vocabulary at minimal cost. Building on this, the unified autoregressive model adopts parallel-bitwise-prediction to jointly predict spatially grouped, multi-level visual codes, substantially reducing visual sequence length and accelerating generation. Finally, a diffusion-based visual decoder operates on discrete visual tokens to decode high-fidelity images. Through large-scale pre-training, followed by supervised fine-tuning and reinforcement learning, UniAR achieves state-of-the-art performance on image generation and image editing while remaining competitive on multimodal understanding benchmarks. The project page is available at https://sharelab-sii.github.io/uniar-web.

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

Lifted Schrödinger Bridges for Gaussian Mixture Endpoints: Projection Gaps and Path-Space Obstructions

arXiv:2605.24795v2 Announce Type: replace-cross Abstract: We study stochastic density control between Gaussian-mixture endpoint distributions under Brownian prior dynamics. Since the direct Schrödinger bridge between Gaussian mixtures is generally not available in closed form, we introduce a lifted path-space construction in which each trajectory is augmented with a source–target component label. Consequently, the problem decomposes into Gaussian component-to-component Schrödinger bridges with explicit marginal, drift, and cost formulas, while the mixture-level assignment reduces to a finite-dimensional entropic coupling problem with a Sinkhorn scaling form. We then analyze the projection obtained by discarding or forgetting the label. By construction, the projected law satisfies the original Gaussian-mixture endpoint constraints, but its relative entropy generally differs from the lifted relative entropy by a nonnegative conditional label-information gap. This gap reveals a path-space obstruction: the lifted optimizer cannot, in general, be identified with the direct unlabeled Schrödinger bridge after projection. We also derive the posterior-averaged Markov drift associated with the projected marginal flow, prove a kinetic-energy upper bound, and identify a common path-potential condition under which the projection gap vanishes. Several numerical illustrations showing density and shape control are recorded for a self-contained exposition.

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

Learning What to Remember: Observability-Safe Memory Retention via Constrained Optimization for Long-Horizon Language Agents

arXiv:2606.10616v2 Announce Type: replace Abstract: Long-horizon language agents accumulate observations, reasoning traces, and retrieved facts that exceed their finite context windows, making memory retention a fundamental resource-allocation problem. Existing memory systems improve management through heuristic scoring, retrieval optimization, or learned compression, but largely treat retention as a local decision problem and do not explicitly model its long-term consequences under realistic observability constraints. To fill this gap, we formulate memory retention as a constrained stochastic optimization problem with explicit budget feasibility, evidence utility, and delayed costs including miss penalties, reacquisition delays, and stale-information risk. We then propose OSL-MR (Observability-Safe Learning for Memory Retention), a novel framework that enforces a strict separation between online-observable features and offline-available supervision (OAS). OSL-MR combines an evidence learner trained from realized evidence supervision with a Mixed-Score heuristic that serves both as a deployable online-safe baseline and as a structured inductive prior for learning. The resulting policy learns query-conditioned evidence value directly from interaction data while remaining deployable under the same observability constraints. Experiments on LOCOMO and LongMemEval show that OSL-MR consistently outperforms recency-based methods, Generative Agents-style scoring, and other heuristic baselines, particularly under tight memory budgets. The Mixed-Score prior further improves precision while preserving recall, and sensitivity analysis demonstrates robustness across a wide range of cost configurations.

13.
arXiv (CS.CV) 2026-06-16

DifferAD-R1: A Difference-Guided IndustrialAnomaly Localization with Multimodal LargeLanguage Models

Industrial anomaly localization aims to accurately identify and localize abnormal regions in industrial products, addressing the critical challenge of detecting unseen defect categories in real-world scenarios. Traditional closed-set methods often suffer from poor cross-scenario generalization, while existingMultimodal Large Language Model (MLLM)-based approachesface two core limitations: they either adopt QA-style paradigmsmisaligned with the practical demands of localization, or relyon standard optimization techniques such as Group RelativePolicy Optimization (GRPO), which fails to deliver effectivelearning signals for subtle defects. To tackle these issues, thispaper proposes DifferAD-R1, an MLLM-augmented reinforcement learning framework tailored for industrial anomaly localization. We design a Difference-Guided dual-image paradigm,which reformulates the localization task as a one-shot difference grounding problem to effectively explore cross-scenarioanomalies. A Dual-Consistency Localization Reward is developedfor hard-to-detect anomalies, enhancing optimization stabilityand robustness. Additionally, we integrate a difficulty-awarestrategy with adaptive reweighting and group-wise resamplingto prioritize learning on challenging instances. To facilitateevaluations in real-world industrial settings, we construct theAD-DualDiff dataset, comprising 13K paired images across 20categories. Experimental results demonstrate that DifferADR1 significantly outperforms existing baselines and achievescompetitive performance compared to large-scale models likeQwen3-VL (235B parameters). Our code is publicly availableat: https://github.com/Rong2026/work-1.

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

JetFlow: Breaking the Scaling Ceiling of Speculative Decoding with Parallel Tree Drafting

Speculative decoding (SD) accelerates autoregressive Large Language Models (LLMs) by drafting multiple tokens and verifying them in parallel, but it faces a scaling limitation: increasing the draft budget improves speed only when acceptance remains high and drafting overhead stays low. This ceiling has been difficult to break because prior head-based SD methods face a causality-efficiency dilemma. Autoregressive drafters produce path-conditioned candidates that are effective for tree speculative decoding with higher acceptance length, but their drafting cost grows with tree depth. Bidirectional block-diffusion drafters generate all positions in one pass, but their branch-agnostic marginals can form individually plausible yet mutually inconsistent trees, wasting budget and reducing acceptance. We propose JetFlow, a head-based SD framework that combines one-forward drafting efficiency with branch-wise causal conditioning. JetFlow trains a causal parallel draft head over fused hidden states from the frozen target model, producing candidate trees whose scores align with the target model's autoregressive factorization. This enables JetFlow to convert larger draft budgets into longer accepted prefixes and higher end-to-end speedup. Across math, coding, and chat benchmarks on dense and MoE Qwen3 models, JetFlow consistently outperforms bidirectional-head and tree-based SD baselines. On H100 GPUs, JetFlow achieves up to 9.64x speedup on MATH-500 and 4.58x on open-ended conversational workloads, with further latency gains demonstrated through vLLM integration under realistic serving loads. Our code and models are available at https://github.com/hao-ai-lab/JetFlow.

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

FP8 is All You Need (Part 1): Debunking Hardware FP64 as the HPC Holy Grail (June 13th version)

arXiv:2606.06510v2 Announce Type: replace-cross Abstract: Conventional HPC holds that native hardware FP64 is the irreducible foundation of scientific computing. On AI-optimized GPUs of the NVIDIA B300 generation and beyond, native FP64 throughput has collapsed to ~1.3 TFLOPS even as FP8 tensor throughput has grown to multiple PFLOPS. We argue something stronger than that this is survivable: the FP8 tensor-core matrix-multiply is the sole computational primitive on which double-precision scientific computing needs to be built. Every canonical kernel – dense and sparse linear algebra, spectral transforms, stencils – and every application composing them reduces, via the Chinese Remainder Theorem-based Ozaki Scheme II, to sequences of FP8 matrix operations; the only non-FP8 arithmetic is a bounded, fixed-width integer accumulation at reconstruction. Native FP64 is thereby demoted from a hardware requirement to a derived accuracy guarantee obtained by composition over the FP8 primitive. We organize the claim as a five-layer hierarchy – the FP8 op, Ozaki II, the basic kernels or Berkeley "dwarfs", composite solvers, and full applications – and, because the dwarf taxonomy already spans scientific computing, establish it by exhibiting the reduction for every dwarf rather than a sample. The claim is falsifiable, and we build the instrument that tests it: a Tensor-Memory Equilibrium (TME) model extending the Roofline with emulation parameters (alpha, beta, gamma). We identify register-level fusion as the mechanism that keeps emulation memory-bound, project recovered FP64 performance across B300 and Rubin against an H100 baseline, and close the kernel coverage with a companion FFT analysis and compensated reductions. The model could have returned a negative verdict; instead it passes across the dwarfs and their compositions. This is the analytical half of a two-part program, with a follow-on implementation to validate the thesis on real silicon.

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

Reroute, Don't Remove: Recoverable Visual Token Routing for Vision-Language Models

Vision-language models (VLMs) project images into hundreds to thousands of visual tokens, making decoder inference expensive in both attention computation and KV-cache memory. Existing visual-token reduction methods largely follow a rank-and-remove paradigm: they score visual tokens, keep a compact subset, and permanently discard the rest. We show that this irreversible action is fragile because visual-token importance changes across decoder depth; tokens ranked low at one stage may become relevant in later layers, especially for grounding-sensitive queries. We propose Reroute, a training-free plug-in that replaces removal with recoverable routing. At each routing stage, selected vision tokens pass through decoder blocks, while deferred tokens bypass the stage and re-enter the candidate pool at the next routing decision. Reroute reuses existing attention-score ranking rules and stage-wise schedules, preserving the theoretical TFLOPs and KV-cache budget class of the pruning method it augments. Across FastV, PDrop, and Nüwa variants on LLaVA-1.5 and Qwen backbones, reroute improves grounding under aggressive token reduction while maintaining general VQA performance. These results suggest that VLM token reduction should not be viewed only as irreversible pruning, but also as recoverable routing. The code can be found here: https://github.com/elmma/mllm-reroute/

17.
arXiv (math.PR) 2026-06-16

Collapsibility in Multiparametric Models of Random Simplicial Complexes

作者:

arXiv:2606.15276v1 Announce Type: cross Abstract: We study collapsibility in the multiparametric models of random simplicial complexes, namely the lower and upper models. In the upper model, we improve upon a result of Farber and Nowik, and assert that the homology is a.a.s concentrated in a single dimension by proving that the complex collapses to that \di. In the lower model, we prove that the complex a.a.s collapses to the \di\ with maximal non-trivial cohomology. We then compare this threshold to the ones derived previously for the special cases of the clique complex (by Kahle) and the Linial-Meshulam model.

18.
arXiv (CS.AI) 2026-06-15

From Chatbot to Digital Colleague: The Paradigm Shift Toward Persistent Autonomous AI

arXiv:2606.14502v1 Announce Type: new Abstract: Large Language Models (LLMs) are undergoing a fundamental transformation from conversational generators into integrated AI systems capable of reasoning, action, memory, and self-improvement. We conceptualize this transition as a shift from Chatbot to Digital Colleague: from conversational answers to persistent work. We organize this transition along two tightly coupled dimensions. First, at the cognitive core level, LLMs are advancing from Chatbot-era "fast thinking" systems driven by next-token prediction toward Thinking LLMs that leverage inference-time computation, Chain-of-Thought reasoning, reflection, process supervision, and reinforcement learning to support more deliberate and reliable cognition. Second, at the tool-augmented task execution level, LLMs are progressing from tool-calling Agents that invoke external resources in an ad hoc manner toward OpenClaw-style workstation systems (OpenClaw) equipped with persistent Workspaces, skills, verification loops, and governance. The "Workspace + Skill" paradigm makes episodic tool use colleague-like via state persistence, reusable procedures, task closure, and experience reuse. We examine data construction shifts from instruction-response pairs to State-Action-Observation trajectories and evaluation from static benchmarks to sandboxed, auditable, self-evolving AI ecosystems.

19.
arXiv (quant-ph) 2026-06-12

Semi-Device-Independent Certification for Nonlocality without Entanglement

arXiv:2606.13667v1 Announce Type: new Abstract: In this work, we investigate maximum-confidence discrimination, which encompasses minimum-error and unambiguous discrimination, for ensembles of separable states by considering global and separable measurements. We demonstrate that global measurements outperform separable ones, thereby establishing nonlocality without entanglement (NLWE) in terms of confidence in a detection event, a fine-grained state-identification strategy that maximizes the probability of a correct guess given a measurement outcome. Conversely, verifying achievable confidence in measurement outcomes can certify global measurements, namely, semi-device-independent certification of NLWE. Our results make it feasible to experimentally demonstrate NLWE using present-day quantum measurement devices, even with non-unit detection efficiencies, since maximum-confidence measurements rely only on detected measurement outcomes.

20.
medRxiv (Medicine) 2026-06-22

The direct economic impact of surgical non-response in orthopaedic hip, knee, and spine surgery for osteoarthritis: a cost-utility analysis

Background Annually, nearly 2 million hip, knee, and spinal inpatient surgeries are performed in Canada and the US for osteoarthritis (OA), costing over $37 billion in hospital expenditures. However, 15-30% of patients experience limited or no improvement, resulting in poor value for money. This study evaluated the one-year cost-utility of joint and spine procedures for OA by comparing non-responders to responders, considering various responder definitions. Methods Individual micro-costing data were collected for 1,175 elective hip, knee, and spine patients enrolled in the Longitudinal Evaluation in the Arthritis Program - Osteoarthritis (LEAP-OA) between 2014 and 2018. Quality-adjusted life years (QALYs) were derived using the SF-6D utility index. One-year incremental cost-utility ratios (ICURs) were calculated from the hospital perspective. Results Responder rates varied by definition, ranging from 78%-94% for hip replacements, 64%-90% for knee replacements, 60%-64% for spine fusions, and 50%-68% for spine decompressions. Corresponding ICURs were: $45,956-$51,773/QALY for responders versus $108,593-$485,762/QALY for non-responders for hip replacements; $54,831-$71,151/QALY for responders versus $200,486-$1,203,596/QALY for non-responders for knee replacements; $65,980-$74,422/QALY for responders versus $262,039-$729,686/QALY for non-responders for spine fusions; and $29,947-$42,168/QALY for responders versus $63,195-$662,586/QALY for non-responders for spine decompressions. Conclusions While surgical response rates were highly dependent on the responder definition, ICURs for non-responders were significantly higher than those for responders across all definitions. Beyond the negative impact on patients, there is a compelling economic argument for investment in improved pre-operative identification of patients at risk of surgical non-response. Such efforts could enable more personalized, value-based care pathways and reduce the provision of low-value surgical interventions.

21.
arXiv (CS.CL) 2026-06-16

Beyond English: Uncovering the Multilingual Gap in Vision-Language-Action Models

Vision-Language-Action models have recently demonstrated promising capabilities in learning generalist robot policies from large-scale multimodal data. However, most existing VLA systems are trained and evaluated primarily with English instructions, leaving their ability to understand and execute instructions in other languages largely unexplored. While the underlying large language models often possess multilingual capabilities, it remains unclear whether these multilingual capabilities transfer to VLAs during training. In this work, we present the first systematic study of multilingual instruction following in VLA models. We first construct multilingual instructions by extending existing benchmarks with translations of their instructions. Using these instructions, we evaluate several representative VLA models across a range of tasks in simulation settings. Our experiments reveal a significant multilingual gap: models trained primarily on English instructions exhibit substantial performance degradation when evaluated on other languages, even when the underlying language backbone is multilingual. We provide several findings and analyses to understand the multilingual gap. Cross-lingual transfer behavior analysis shows that performance drops correlate with both instruction understanding and action execution. Representation analyses suggest that multilingual instruction-caused representation shifts may contribute to the multilingual gap. Motivated by these findings, we further explore strategies to improve multilingual performance in VLAs. We propose a simple yet effective multilingual fine-tuning approach, Multilingual Principal Component Alignment, which leverages Principal Component Analysis to get the principal component subspace and align projected multilingual representations, effectively reducing the multilingual performance gap.

22.
arXiv (CS.AI) 2026-06-17

When Life Gives You BC, Make Q-functions: Extracting Q-values from Behavior Cloning for On-Robot Reinforcement Learning

arXiv:2605.05172v2 Announce Type: replace-cross Abstract: Behavior Cloning (BC) has emerged as a highly effective paradigm for robot learning. However, BC lacks a self-guided mechanism for online improvement after demonstrations have been collected. Existing offline-to-online learning methods often cause policies to replace previously learned good actions due to a distribution mismatch between offline data and online learning. In this work, we propose Q2RL, Q-Estimation and Q-Gating from BC for Reinforcement Learning, an algorithm for efficient offline-to-online learning. Our method consists of two parts: (1) Q-Estimation extracts a Q-function from a BC policy using a few interaction steps with the environment, followed by online RL with (2) Q-Gating, which switches between BC and RL policy actions based on their respective Q-values to collect samples for RL policy training. Across manipulation tasks from D4RL and robomimic benchmarks, Q2RL outperforms SOTA offline-to-online learning baselines on success rate and time to convergence. Q2RL is efficient enough to be applied in an on-robot RL setting, learning robust policies for contact-rich and high precision manipulation tasks such as pipe assembly and kitting, in 1-2 hours of online interaction, achieving success rates of up to 100% and up to 3.75x improvement against the original BC policy. Code and video are available at https://pages.rai-inst.com/q2rl_website/

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

Towards an Inferentialist Account of Information Through Proof-theoretic Semantics

arXiv:2605.05368v5 Announce Type: replace-cross Abstract: Information is one of the most widely-discussed concepts of the current era. However, a great deal of insightful work notwithstanding, it is yet to be given wholly convincing logical or mathematical foundations. Without them, we lack adequate reasoning tools for understanding the complex ecosystems of systems upon which the society depends. We seek to rectify this by taking a first step towards developing an inferentialist semantic theory of information. There are three key interacting components. First, conceptual analysis: the metaphysics of information. Dretske expressed the key concepts of information in terms of intentionality, truth, and transmissibility. We replace truth with inferability, and trace the consequences of this replacement. Second, logic: proof-theoretic semantics (P-tS) provides a mathematical-logical realization of inferentialist reasoning. Using P-tS, we develop the first steps towards a mathematical-logical theory of an inferentialist primitive unit of information, the 'inferon'. This proof-theoretic approach counterpoints the model-theoretic view of information articulated in situation theory. Furthermore, we argue that it facilitates addressing all three components of van Benthem and Martinez's categorization of the understandings of information, as range, as correlation, and as code. Our focus is on information-as-correlation. Third, systems: the P-tS tools we develop provide the basis for a mathematical account of distributed systems modelling – a key tool from informatics for understanding the organization of information processing systems. This yields a reasoning-based theory of information flow in models of distributed systems. Overall, we seek to give a conceptually rigorous mathematical-logical account of information and its role within informatics, grounded in inference and reasoning.

24.
medRxiv (Medicine) 2026-06-22

Association of Digoxin Use at Norwood Discharge with Fontan Completion: A Study from the Pediatric Heart Network Public Dataset

Background: Digoxin use after the Norwood procedure has been associated with improved interstage survival in hypoplastic left heart syndrome and related conditions. Whether this benefit translates into improved longer-term outcomes through staged palliation remains unknown. We aimed to determine the association of digoxin use at Norwood discharge with transplant-free survival and Fontan completion. Methods: We conducted a retrospective cohort study using the Pediatric Heart Network (PHN) Single Ventricle Reconstruction trial public dataset, including 549 infants enrolled at 15 North American centers between 2005 and 2008. Competing risk analysis was used to evaluate Fontan completion and Cox regression to assess death or transplantation within 6 years after the Norwood procedure. Mixed-effects models compared pre-Fontan hemodynamic and echocardiographic right ventricular indices between patients treated with and without digoxin after accounting for center clustering and adjustment for sex, shunt type, heart failure medications at Norwood discharge, and census block poverty level. Results: The 6-year cumulative incidence of Fontan completion was higher among patients discharged on digoxin than among those not receiving digoxin (82% vs 71%; p = 0.013). Competing-risk analysis accounting for death and transplant demonstrated a greater likelihood of Fontan completion among digoxin users (aHR 1.31; 95%CI 1.09-1.58; p = 0.005), without significant difference in the hazard of death or transplant (aHR 0.78; 95%CI 0.53-1.15; p = 0.208). No significant differences in pre-Fontan hemodynamic or echocardiographic indices were observed between groups. Initiation of digoxin post Stage II procedure was not associated with improved survival or likelihood to complete Fontan. Conclusion: Digoxin use at the time of Norwood discharge was associated with a 30% greater likelihood of Fontan completion by 6 years, without accompanying improvement in transplant-free survival. These findings extend prior observations of improved interstage outcomes associated with digoxin use and suggest that treatment may facilitate progression through staged palliation.

25.
arXiv (CS.AI) 2026-06-18

Externalizing Research Synthesis and Validation in AI Scientists through a Research Harness

arXiv:2606.18874v1 Announce Type: new Abstract: AI systems can increasingly automate scientific workflows, but the reasoning that links prior evidence, generated ideas, experiments and final claims often remains implicit inside model inference. Here we introduce Xcientist, a research harness that externalizes research synthesis and experimental validation into inspectable, contract-governed processes. Xcientist organizes literature evidence, idea states, implementation plans, ablation records and repair traces as persistent research artifacts, so that generated mechanisms can be grounded, executed, tested and revised without losing their evidential basis. We identify claim drift as a failure mode of automated research, where runnable artifacts no longer support the mechanism originally claimed. Across training-free memory systems, graph-structured traffic forecasting and multi-scale physics-informed neural networks, Xcientist preserves traceable trajectories from problem formulation to mechanism design, validation and bounded revision. These results suggest that AI scientists should be evaluated not only by their final artifacts, but by whether their synthesis and validation processes remain attributable, inspectable and scientifically accountable.