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01.
arXiv (quant-ph) 2026-06-17

Acceleration-induced spectral blind spots in stimulated atomic transitions

arXiv:2606.17396v1 Announce Type: cross Abstract: Stimulated transitions are among the most fundamental processes in light-matter interaction, underlying resonant absorption and emission in atomic systems. Here we show that uniform acceleration can convert this familiar response into a frequency-selective absence of response. Specifically, when an incident photon has a nonzero momentum component transverse to the acceleration, the stimulated transition probability vanishes at a discrete set of frequencies fixed by the acceleration, the atomic transition frequency, and the photon propagation angle. At these spectral blind spots, both ordinary stimulated absorption and acceleration-induced excitation are simultaneously suppressed, rendering the atom effectively unresponsive to the incident radiation. The effect arises from the nontrivial response of accelerated atoms to quantum vacuum fluctuations and provides a distinctive signature of the Unruh effect through the absence, rather than the enhancement, of stimulated transitions. We further provide an order-of-magnitude estimate showing that an electron-based implementation with spin splitting in combined electric and magnetic fields could access the required parameter regime. These results reveal an unexplored form of acceleration-modified light-matter interaction and identify spectral blind spots as a new manifestation of the Unruh effect.

02.
arXiv (CS.CV) 2026-06-11

MedCTA: A Benchmark for Clinical Tool Agents

To make clinically grounded decisions, medical AI agents are expected to go beyond simple recognition and be capable of tool retrieval, evidence acquisition, and integration. Existing benchmarks largely evaluate isolated perception or single-turn question answering, and therefore provide limited visibility into failures of planning, tool recruitment, and rollout reliability. We introduce MedCTA, a benchmark for evaluating medical tool agents on clinician-validated, step-implicit tasks grounded in realistic multimodal clinical inputs, including radiology images, pathology slides, and reports. MedCTA comprises 107 real-world clinical tasks with clinician-verified executable trajectories over 5 deployed tools, and supports process-aware evaluation of tool selection, argument validity, execution stability, trajectory fidelity, and outcome quality. We benchmark 18 open- and closed-source multimodal models and find that even frontier systems remain brittle in multi-step clinical tool use: autonomous rollouts are dominated by protocol failures, premature stopping, and incorrect tool recruitment, while gold-standard tool routing yields large but still incomplete gains. These results show that strong backbone perception does not translate into reliable agentic behavior in clinical settings. MedCTA provides a rigorous testbed for auditing, diagnosing, and advancing trustworthy medical AI agents. The dataset and evaluation suite are available at https://ivul-kaust.github.io/MedCTA/

03.
arXiv (CS.AI) 2026-06-15

FedRot-LoRA: Mitigating Rotational Misalignment in Federated LoRA

arXiv:2602.23638v3 Announce Type: replace-cross Abstract: Federated LoRA provides a communication-efficient mechanism for fine-tuning large language models on decentralized data. In practice, however, a discrepancy between the factor-wise averaging used to preserve low rank and the mathematically correct aggregation of local updates can cause significant aggregation error and unstable training. We argue that a major source of this problem is rotational misalignment, arising from the rotational invariance of low-rank factorizations – semantically equivalent updates can be represented in different latent subspaces across clients since $(B_i R_i)(R_i^\top A_i) = B_i A_i$. When such misaligned factors are averaged directly, they interfere destructively and degrade the global update. To address this issue, we propose FedRot-LoRA, a federated LoRA framework that aligns client updates via orthogonal transformations prior to aggregation. This alignment preserves the semantic update while reducing cross-client subspace mismatch, without increasing communication cost or restricting model expressivity. We provide a convergence analysis that examines the aggregation error induced by factor-wise averaging and shows how rotational alignment yields a tighter upper bound on this error. Extensive experiments on natural language understanding and generative tasks demonstrate that FedRot-LoRA consistently outperforms existing federated LoRA baselines across a range of heterogeneity levels and LoRA ranks.

04.
arXiv (CS.CL) 2026-06-12

MemRefine: LLM-Guided Compression for Long-Term Agent Memory

Large language model (LLM) agents are increasingly expected to operate over long-term interactions, where information from past dialogues must be preserved and recalled to support future tasks. However, as interactions accumulate, the memory store grows without bound and fills with redundant entries that inflate storage cost and degrade retrieval by crowding out the most useful evidence. Furthermore, this is especially limiting on resource-constrained platforms with hard memory budgets, motivating us to formulate storage-budgeted memory management, the task of keeping an already constructed memory store within a fixed budget while preserving information useful for future interactions. To this end, we then propose MemRefine, an LLM-guided framework that, since surface similarity poorly reflects factual value, uses similarity only to propose candidate pairs and defers delete, merge, and preserve decisions to an LLM judge based on factual content, iterating until the budget is met. Across multiple memory frameworks and long-term conversation benchmarks, MemRefine consistently meets target budgets while preserving downstream performance and outperforming rule-based baselines under tight budgets.

05.
arXiv (CS.LG) 2026-06-15

Towards Steering without Sacrifice: Principled Training of Steering Vectors for Prompt-only Interventions

arXiv:2605.05983v2 Announce Type: replace Abstract: Recently, steering vectors (SVs) have emerged as an effective and lightweight approach to steer behaviors of large language models (LLMs), among which fine-tuned SVs are more effective than optimization-free ones. However, current approaches to fine-tuned SVs suffer from two limitations. First, they require careful selection of steering factors on a per-SV basis to balance steering effectiveness and generation quality at inference time. Second, they operate as full-sequence SVs (FSSVs), which can sacrifice generation quality regardless of factor selection due to excessive intervention on the model generation process. To address the first limitation, we propose joint training of steering factors and directions, such that post-hoc factor selection is no longer required. Using neural network scaling theory, we find that moderately large initialization sizes and learning rates for steering factors are essential for stability and efficiency of joint training. To tackle the second limitation, we draw inspiration from representation fine-tuning and introduce Prompt-only SV (PrOSV), an SV that intervenes only on a few prompt tokens. Our empirical results show that PrOSV outperforms traditional FSSVs on AxBench when using our joint training scheme. We also find that PrOSV achieves a better tradeoff between general model utility and adversarial robustness than FSSV.

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

Predicting gestational age at birth in the context of preterm birth from multi-modal fetal MRI

arXiv:2606.20172v1 Announce Type: new Abstract: Preterm birth is associated with significant mortality and a risk for lifelong morbidity. The complex multifactorial aetiology hampers accurate prediction and thus optimal care. A pipeline consisting of bespoke machine learning methods for data imputation, feature selection, and regression models to predict gestational age (GA) at birth was developed and evaluated from comprehensive multi-modal morphological and functional fetal MRI data from 333 control cases and 93 preterm birth cases. The GA at birth predictions were classified into term and preterm categories and their accuracy, sensitivity, and specificity were reported. An ablation study was performed to further validate the design of the pipeline. Performance was evaluated using stratified 10-fold cross-validation. The pipeline achieves an R2 score of 0.13 and a mean absolute error of 2.74 weeks. It also achieves a 0.77 accuracy, 0.59 sensitivity, and 0.82 specificity across folds. The predominant features selected by the pipeline include cervical length and statistics derived from placental T2* values. The confluence of fast, motion-robust and multi-modal fetal MRI techniques and machine learning prediction allowed the prediction of the gestation at birth. This information is essential for any pregnancy. To the best of our knowledge, preterm birth had only been addressed as a classification problem in the literature. Therefore, this work provides a proof of concept. Future work will increase the cohort size to allow for finer stratification within the preterm birth cohort. Our code is available at https://github.com/dfajardorojas/ml-for-preterm-birth-.

07.
arXiv (CS.CV) 2026-06-19

TimeProVe: Propose, then Verify for Efficient Long Video Temporal Reasoning in Activities of Daily Living

Long Video Question Answering (LVQA) requires identifying sparse, query-relevant evidence within hours-long untrimmed videos. Existing approaches either process videos densely with large vision-language models (VLMs), incurring prohibitive computational cost, or rely on sparse caption-based reasoning, which often misses temporally localized and motion-centric evidence. We introduce TimeProVe, a cost-efficient hybrid framework for temporally grounded reasoning in long videos. TimeProVe first employs lightweight modules to generate action-grounded answer–evidence hypotheses and subsequently invokes an expensive VLM only for targeted verification. The core of our framework lies in the Action-based Candidate Evidence (ACE) module, which converts temporally localized actions into query-conditioned candidate answers and supporting evidence windows through lightweight LLM reasoning. We further introduce OpenTSUBench (OTB), an open-ended benchmark designed to evaluate temporally grounded reasoning in real-world Activities of Daily Living (ADL) scenarios. Experiments show that TimeProVe outperforms the strongest baseline on OTB by 7.3%, while reducing VLM calls by 75% and inference cost by 93%. Furthermore, without explicit temporal grounding training, TimeProVe achieves competitive performance on Charades-STA, and reaches state-of-the-art results when enhanced with grounding VLMs.

08.
arXiv (CS.LG) 2026-06-17

A fairness-aware extension of Stochastic Multicriteria Acceptability Analysis for ranking

arXiv:2606.17756v1 Announce Type: new Abstract: Fairness has become a central concern in ranking problems involving individuals or social groups, particularly under the Responsible Artificial Intelligence agenda. In Multi-Criteria Decision Analysis, Stochastic Multicriteria Acceptability Analysis (SMAA) provides a robust framework for handling uncertainty and incomplete preference information, but it does not explicitly address fairness in the resulting rankings. This paper proposes SMAA-Fair, a fairness-aware extension of SMAA for ranking problems. The approach reweights the simulated rankings generated by SMAA according to their level of group fairness, so that fairer rankings contribute more strongly to the acceptability indices and central weights vector. The framework is independent of the aggregation model and can incorporate different fairness metrics. In this study, Statistical Parity, normalized discounted Kullback–Leibler divergence (rKL) and normalized discounted cumulative Kullback–Leibler divergence (nDKL) are adopted. Rankings are derived from the fairness-adjusted acceptability matrix using expected ranking and maximum acceptability ranking. We also derive the central weight according to the degree of fairness in the obtained rankings. Numerical experiments with synthetic and real data show that SMAA-Fair improves the representation of protected groups among favourable ranking positions, while preserving robustness to preference uncertainty.

09.
arXiv (CS.CL) 2026-06-18

Graph-ESBMC-PLC: Formal Verification of Graphical PLCopen XML Ladder Diagram Programs Using SMT-Based Model Checking

PLCopen XML defines two encoding formats for IEC 61131-3 Ladder Diagram programs: a textual encoding using elements, and a graphical encoding that represents rung logic as a directed graph of localId/refLocalId connections. ESBMC-PLC supported the textual format but parsed graphical exports from CONTROLLINO, Beremiz, and OpenPLC Editor into an empty GOTO intermediate representation, causing vacuous verification success. This paper presents Graph-ESBMC-PLC, which closes this gap with a DFS-based graphical LD resolver. The resolver traverses the connection graph from leftPowerRail to each coil, extracts rung paths as Boolean contact conjunctions, and applies a three-tier I/O inference scheme. Ordering coils by rightPowerRail connectionPointIn sequence ensures SET coils process before RESET coils, matching IEC scan-cycle semantics. The graphical-to-IR conversion leaves the ESBMC backend unchanged. Validation on 3 graphical LD programs from CONTROLLINO/OpenPLC Editor shows all produce full GOTO IR with nondeterministic inputs and rung logic, versus the empty IR previously. All 3 verify SAFE at k=2 under 70ms. The 11 textual LD benchmarks are fully preserved, with no regression. Two Beremiz examples with no LD content or unsupported timer semantics are reported as discovered limitations. Artifact at Zenodo (DantasCordeiro2026graphical, doi:10.5281/zenodo.20699856).

10.
medRxiv (Medicine) 2026-06-22

UKBAnalytica: an integrated R package for scalable phenotyping and reproducible epidemiological analysis within the UK Biobank Research Analysis Platform

作者:

UK Biobank provides longitudinal health-related data for approximately 500,000 participants, and its Research Analysis Platform (RAP) has shifted large-scale analyses toward secure cloud-based computation. However, many existing tools address only specific steps of the analytical workflow, leaving a need for an integrated framework that connects multi-source disease phenotyping, survival-ready cohort construction, and downstream analysis on the RAP. Here, we present UKBAnalytica, an extensible R package for scalable phenotyping and integrated analysis of UK Biobank data within the RAP environment. It currently includes 52 predefined baseline variables and a built-in library of 331 curated disease definitions. These definitions are based on multiple UK Biobank data sources, including ICD-10, ICD-9, self-reported conditions, death registry records, algorithmically defined outcomes, and OPCS-4 procedure codes. UKBAnalytica distinguishes prevalent and incident cases, constructs follow-up time, generates analysis-ready survival datasets, and summarizes participant flow. Beyond phenotype construction, UKBAnalytica provides integrated modules for epidemiological analysis, omics analysis, and machine-learning-based modeling and interpretation. By linking endpoint definition with downstream modeling under a consistent data structure, UKBAnalytica reduces repetitive scripting and improves analytical transparency. Furthermore, we demonstrate the package's practical utility through a case study on chronic obstructive pulmonary disease (COPD) proteomics. The findings align closely with previously reported conclusions, underscoring the robustness and reliability of our analytical framework. This phenotype-centered framework complements existing UK Biobank tools and facilitates reproducible RAP-based biomedical research. UKBAnalytica is freely available at https://github.com/Hinna0818/UKBAnalytica.

11.
medRxiv (Medicine) 2026-06-18

Consistency of sleep timing and duration are associated with more physical activity and favorable heart rate metrics in a naturalistic cohort

Background: Regularity of sleep patterns over time has increasingly gained traction as an important axis of sleep health. Since sleep habits are under some degree of behavioral control, understanding such patterns in naturalistic settings is particularly important. We quantified sleep variability and tested the hypothesis that regularity correlates with physical activity, resting heart rate (rHR), and heart rate variability (HRV). Methods: We analyzed real-world digital health data from over 81,000 participants (over 18 million nights) who provided informed consent to participate in the Apple Heart and Movement Study and elected to contribute sleep, activity, and heart rate data to the study. Variability was quantified using the standard deviation (SD) computed from total sleep time (TST), sleep start time (S-start), end time (S-end), and midpoint time (MP), as well as the Sleep Regularity Index (SRI). Results: The SD-based variability metrics correlated with one another (R values 0.74-0.92), and with the SRI metric (R values 0.62-0.64). More consistent sleep, by any metric, was associated with more activity and better rHR and HRV. The most consistent tertile for TST variability had higher median TST (6.9 vs 5.9 hours), more daily exercise (32.8 vs 20.4 minutes), lower rHR (62.4 vs 65.6 beats per minute), and higher HRV (40.6 vs 37.3), all p

12.
medRxiv (Medicine) 2026-06-22

Modelling the decadal expansion of West Nile virus in Italy: the role of climatic, anthropogenic, and macroecological drivers

Abstract BACKGROUND West Nile virus (WNV) is a growing health burden in Italy. Anticipating human infection risk is hampered by the pathogen's complex ecology, highlighting the need for comprehensive early-warning tools. AIM We aimed to model municipal-level WNV risk in Italy and characterize its decadal expansion in Italy, providing a comprehensive ecological understanding of viral emergence. METHODS We applied a machine learning framework to annual human WNV case data from 2014 to 2024. The model integrated a suite of environmental, socio-economic, and macroecological predictors to generate risk projections. We evaluated the model's performance through multiple validation settings. We also performed an anticipation test for the 2025 epidemic season, using 2024 environmental data to assess the model's predictive accuracy against observed 2025 human cases. RESULTS Our model achieved robust performance (True Skill Statistic > 0.4) and captured WNV progressive expansion from 184 predicted positive municipalities in 2014 to 2,012 in 2024 (an 11-fold increase in 11 years). Seasonal minimum temperature was the primary risk driver, followed by monitoring year and population density, indicating active spatial spread. Environmental suitability consistently preceded clinical detection. Municipalities with cases in 2023-2024 exhibited significantly higher predicted suitability during 2018-2022 than those without cases (average risk 0.58 vs 0.20). Our model successfully identified emerging risk hotspots along the Adriatic coast and southern Italy before the official human spillover of 2025. CONCLUSION Embedding macroecological drivers into WNV risk modelling provides an improved understanding of drivers of rapid WNV expansion. Our model enables proactive risk mapping, surveillance efforts, and targeted public health measures.

13.
arXiv (CS.AI) 2026-06-15

ChronoID: Infusing Explicit Temporal Signals into Semantic IDs for Generative Recommendation

arXiv:2606.14260v1 Announce Type: cross Abstract: Semantic IDs are crucial in generative recommendation, but with a fundamental limitation: temporal information is not well incorporated into semantic IDs. Instead, time influences recommendation only implicitly (e.g., through session construction heuristics, preference alignment, or sequence order), while existing semantic ID learning remains entirely time-agnostic. This design conflates interactions occurring under distinct temporal contexts into identical semantic representations, implicitly assuming that item semantics and user intent are temporally stationary. Such an assumption is misaligned with real-world recommendation scenarios, where evolving interaction rhythms play a central role. In this work, we investigate where and how the explicit time should be incorporated into semantic ID for generative recommendation. First, we systematically characterize the design space along three orthogonal dimensions of temporal signals and present a unified framework, ChronoID, for time-aware semantic ID learning. Then, by contributing a new time-explicit generation recommendation benchmark, ChronoID answers the questions: what is the effective way of infusing time, how to design the architecture, and where does the gain come from.

14.
Nature (Science) 2026-06-10

Two-component exciton condensates in an electron–hole bilayer

作者:

Macroscopic quantum coherence emerges when bosons condense into a Bose–Einstein condensate (BEC)1–5. Excitons are a long-sought solid-state route to high-temperature BECs with strong interactions, electrical tunability and potentially multicomponent spinor order, but conclusive evidence for equilibrium condensation has remained elusive. Here we report evidence for two-component exciton BECs in MoSe2/hBN/WSe2 electron–hole bilayers6–9 by probing the spin–valley susceptibility of constituent electrons and holes. This heterostructure hosts equilibrium exciton fluids with four spin–valley flavours. Magneto-optical spectroscopy in a dilution refrigerator reveals three exciton condensate phases with distinct flavour polarizations. At zero magnetic field, the many-body ground state is a coherent superposition of two condensed intravalley exciton flavours. Under a magnetic field, the intravalley exciton condensate first switches to a two-component intervalley condensate through a first-order quantum phase transition at a weak critical field and then turns into a fully polarized single-component condensate at high fields. The condensate signatures form a dome in density–temperature space, persisting up to approximately 1.8 K. Our results establish van der Waals electron–hole bilayers as a versatile platform for strongly interacting, multicomponent exciton BECs. Macroscopic quantum coherence arises in two-component exciton Bose–Einstein condensates within MoSe2/hBN/WSe2 electron–hole bilayers, exhibiting distinct spin–valley polarized phases, quantum phase transitions under magnetic fields and stable condensate behaviour up to approximately 1.8 K.

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

STARE: Surprisal-Guided Token-Level Advantage Reweighting for Policy Entropy Stability

Reinforcement Learning with Verifiable Rewards algorithms like GRPO have emerged as the dominant post-training paradigm for complex reasoning in LLMs, yet commonly suffer from policy entropy collapse during training. We conduct a first-order gradient analysis of token-level entropy dynamics under GRPO and identify a token-level credit assignment mismatch: the per-token entropy variation decomposes into the product of the trajectory-level advantage and an entropy sensitivity function over the next-token distribution, yielding an advantage-surprisal four-quadrant structure and a near-criticality property. Motivated by it, we propose STARE (Surprisal-guided Token-level Advantage Reweighting for policy Entropy stability), which identifies entropy-critical token subsets via batch-internal surprisal quantiles, selectively reweights their effective advantages, and incorporates a target-entropy closed-loop gate for stable entropy regulation. Across model scales from 1.5B to 32B and three task families (Short CoT, Long CoT, and Multi-Turn Tool Use), STARE sustains stable RL training over thousands of steps while maintaining policy entropy within the target band. On AIME24 and AIME25, STARE outperforms DAPO and other competitive baselines by 4%-8% in average accuracy, with reflection tokens and response length growing in tandem, indicating sustained exploration-exploitation balance that further unlocks RL training potential.Code is available at https://github.com/hp-luo/STARE.

16.
medRxiv (Medicine) 2026-06-19

Validation of an Artificial Intelligence-Assisted Mobile Application for Dietary Oxalate Assessment in Kidney Stone Prevention

Background: Calcium oxalate nephrolithiasis is the most common type of kidney stone disease. Dietary oxalate intake is an important modifiable factor. Assessing dietary oxalate exposure in clinical practice poses challenges due to limitations of traditional dietary recall tools and variability in food composition data. Artificial intelligence (AI) applications in mobile health may offer scalable solutions for better dietary monitoring and kidney stone prevention. We examined the ability of StoneFree AI to estimate dietary oxalate from verbal and image-based food inputs. Objective: To evaluate the accuracy and limitations of StoneFree AI, for estimating dietary oxalate intake from verbal food descriptions and meal images, and to evaluate errors from entries that may inform future clinical use in kidney stone prevention. Methods: StoneFree AI is a cross-platform mobile application that uses a multimodal large language model (Google Gemini) to interpret verbal food descriptions and visual food images. The identified foods were mapped to oxalate values using the Harvard Oxalate Database. System performance was evaluated using 804 verbal food entries and 276 portion-size food images obtained from the ASA24 dietary assessment database. Verbal inputs were compared with reference oxalate values using absolute error and predefined agreement thresholds ({+/-}1, {+/-}5, {+/-}10 mg). Image-based inputs were evaluated against mutually exclusive primary error categories, including food identification, portion estimation, ingredient recognition, oxalate reference selection, and non-analyzable cases. Results: For verbal food entries, the AI system showed strong agreement with reference oxalate values. Overall, 82.1% of estimates were within {+/-}1 mg, 91.5% within {+/-}5 mg, and 94.5% within {+/-}10 mg of reference values. The mean absolute error was 3.32 mg, the median absolute error was 0.10 mg, and the concordance correlation coefficient (CCC) was 0.860. Image-based inputs showed a higher overall error rate of 63.0%, primarily due to food identification errors (33.0%), inaccurate portion estimation (11.0%), and ingredient recognition errors (9.8%). Most errors occurred with visually complex meals, such as mixed dishes and grain-based foods. Conclusions: AI-assisted estimation of dietary oxalate intake demonstrated high accuracy when structured verbal inputs were used but was less reliable for image-based meal analysis. These findings suggest AI-enabled mobile tools may support dietary monitoring for kidney stone prevention, particularly when user input is structured. Further refinement of computer vision models and prospective clinical validation are required before widespread clinical implementation.

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

Bridging Day and Night: Unsupervised Cross-Domain Re-Identification with Synergistic Prompt and Prototype Learning

Cross-domain day-night re-identification (ReID) is fundamentally challenged by the substantial visual appearance discrepancies between daytime and nighttime scenes. Existing fully supervised methods rely heavily on labor-intensive annotations, which are costly and exhibit limited generalization across domains. In this work, we investigate unsupervised day-night ReID and propose a novel framework that synergistically combines prompt learning and prototype-based representation learning to associate identities across domains without requiring manual labels. Our approach follows a progressive two-stage training strategy. In the first stage, we exploit the vision-language model to generate instance-specific textual prompts in an annotation-free manner. We employ an instance-level alignment mechanism to embed visual features and textual prompts into a unified semantic space, aligning unlabeled day/night images with learnable prompts via instance-aware dynamic-bias adaptation. In the second stage, we construct domain-specific prototype memory banks and introduce two complementary modules: i) an intra-domain identity association module to enhance feature discriminability within each domain, and ii) a cross-domain prototype matching module to reliably identify positive and negative prototype pairs, thereby establishing robust identity correspondences across day and night. Extensive experiments on public benchmarks validate the effectiveness of our method. Under the unsupervised setting, our framework attains Rank-1 accuracy comparable to state-of-the-art fully supervised methods.

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

Matrix phase-space representations for quantum symmetries

arXiv:2606.12769v1 Announce Type: new Abstract: We introduce a general phase-space representation that includes global quantum symmetries in the basis expansion. This method, called matrix phase-space, projects the basis onto a reduced Hilbert space, which can greatly reduce sampling errors of many-body quantum simulations and unifies several previous phase-space methods. The purpose of this paper is to provide detailed proofs of basic theorems and operator identities. We also treat several different types of symmetries. To illustrate the benefits of matrix phase-space methods, we give a detailed derivation of a recent application to the topical problem of verifying the outputs of Gaussian boson sampling (GBS) quantum computers with photon number resolving detectors. This has exponential complexity, and using parity symmetry reduces sampling errors by very large factors relative to earlier methods.

20.
medRxiv (Medicine) 2026-06-18

Cost-effectiveness of a virtual fracture clinic versus traditional in-person fracture clinic care for adults with acute simple fractures: a protocol for a health economic evaluation within the RECITAL trial

ABSTRACT Introduction Traditional in-person fracture clinics are often overcrowded and inconvenient for patients. Virtual fracture clinics aim to address some of these concerns by improving the efficiency of the orthopaedic service and reducing unnecessary interventions while maintaining safety and quality of care. The RECITAL trial is a non-inferiority randomised controlled trial comparing follow-up care provided at a virtual fracture clinic for people with acute simple fractures to follow-up care provided at an in-person fracture clinic. This study describes the protocol for an economic evaluation of RECITAL where the primary aim is to investigate the cost-effectiveness of a virtual fracture clinic compared with traditional in-person fracture clinic care from a health system perspective. Methods and analysis The RECITAL trial recruited 312 participants with acute simple fractures and randomised them to receive follow-up care provided at a virtual fracture clinic or follow-up care provided at an in-person fracture clinic. We will conduct a within-trial analysis from a health system perspective (primary analysis), as well as a health service, patient and societal perspective. The economic evaluation will estimate the difference in the cost of resource inputs on an intention to treat basis used by participants in the two arms of the trial, allowing comparisons to be made between the in-person and virtual fracture clinics. Data for intervention costs and healthcare utilisation will be collected from trial records, hospital electronic medical records and district performance units. The results of the economic evaluation will be expressed in terms of incremental cost per utility weight gained at 12 weeks and will be plotted on a cost-effectiveness plane. Bootstrapping by resampling will be used to estimate 95% confidence intervals around costs and outcomes, and to calculate the confidence intervals around the incremental cost-effectiveness ratio. A cost-effectiveness acceptability curve (CEAC) will be plotted, which will provide information about the probability that an intervention is cost-effective, given the level of a decision makers willingness to pay for each additional outcome. Ethics and Dissemination The trail was approved by the SLHD Ethics Review Committee (RPAH Zone) (X23-0200 and 2023/ETH01038). The findings will be disseminated through a peer-reviewed journal and conference presentations. Trial registration number The trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ANZCTR; 12623000934640)

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

Energy-Conserved Neural Pipelines: Attenuating Error Propagation in Modular Neural Networks via Physical Conservation Constraints

arXiv:2606.11341v1 Announce Type: new Abstract: Modular neural network pipelines suffer from error compounding: noise at any module boundary propagates and potentially amplifies through subsequent modules. We introduce energy conservation as a hard physical constraint on inter-module information flow. Activation energy (the squared L2 norm of feature vectors) is enforced to be exactly preserved at every module boundary. Unlike soft energy penalties, conservation is an inviolable law: the network may redistribute energy across neurons but cannot create or destroy it. Four experiments on CIFAR-10 demonstrate: (1) conservation retains 77.4% of clean accuracy at noise sigma=0.2, versus 35.1% for baselines and 30.9% for energy-penalized models (p

22.
arXiv (CS.LG) 2026-06-19

Data Bias Mitigation under Coverage Constraints & The Price of Fairness

arXiv:2606.20461v1 Announce Type: new Abstract: Machine learning models have been shown to exhibit discriminatory outcomes or degraded performance for individuals at the intersection of multiple sensitive attributes, such as race and gender. This stems in part from two interrelated challenges: the lack of principled measures for quantifying bias (potentially intersectional), and insufficient representation of intersectional subgroups in training data. We extend a recent bias mitigation framework to incorporate coverage constraints that enforce sufficient representation across groups, including intersectional subgroups. Since achieving exactly zero bias for all groups may not be data efficient (meaning it may require large amounts of data), our solution trades small approximation errors in bias for greater data efficiency while satisfying coverage constraints. We also formulate bias mitigation as an integer linear program that optimizes over all mitigation strategies, and characterize the price of fairness, the minimum data modification cost, as a function of fairness tolerance. This is essential both for legal compliance, where regulations may mandate specific fairness thresholds, and for data governance, enabling practitioners to make informed trade-offs between bias reduction and data modification (particularly, data purchasing) costs. We evaluate our techniques on publicly available datasets, demonstrating that bias mitigation via our framework preserves predictive accuracy across multiple classifiers, and that coverage constraints, while motivated by statistical considerations, are essential for preserving downstream ML performance.

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

Who Flips? Self- and Cross-Model Counterarguments Reveal Answer Instability in LLMs

Standard accuracy benchmarks are designed to test how closely large language models (LLMs) approach correct answers, but are not suitable for testing whether LLMs stick with a correct answer when that answer is challenged by a plausible counter-argument. We introduce a controlled protocol for evaluating answer stability: after a model answers a multiple-choice question correctly, we challenge the model's answer with a coherent argument for an incorrect option and measure whether the model flips. The setup a) isolates argumentative content from overt social pressure and b) varies argument length, self-attribution, and cross-model source. Across seven frontier models and 57 MMLU subjects, flip rates range from 17.5% to 97.3%, revealing large differences in stability that are not captured by accuracy metrics alone. We find that self-attribution consistently increases flip rates (mean +7.1pp, up to +18.7pp). Also, pooling wrong-answer arguments across models and selecting the most effective one per question yields stronger adversarial challenges than relying on any single source model. We further construct MaxFlip, a curated challenge set that amplifies flips by up to +23.6pp over standard self-generated challenges. We release the protocol, challenge records, and MaxFlip to support stability evaluation alongside standard accuracy benchmarks. Materials are available at https://github.com/nafisenik/WhoFlips and https://hf.co/datasets/nafisehNik/WhoFlips.

24.
arXiv (CS.LG) 2026-06-17

Accelerated Convex Optimization via Hamiltonian Dynamics with Deterministic Integration Time

arXiv:2606.17260v1 Announce Type: cross Abstract: We develop Hamiltonian dynamics-based algorithms for smooth convex optimization that achieve accelerated rates of convergence. By exploiting contraction of averaged Hamiltonian flow trajectories rather than requiring contraction at trajectory endpoints, we show that Hamiltonian dynamics-based optimization methods admit deterministic and accelerated convergence guarantees, extending prior work that is limited to quadratic objectives or holds only in expectation. We analyze an idealized continuous-time algorithm and derive practical discrete-time implementations with optimal first-order complexity, thereby establishing Hamiltonian dynamics as a useful algorithmic primitive for deterministic accelerated convex optimization.

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

Deep Residual Injection for Full-Spectrum Forensic Signal Perception in Multimodal Large Language Models

Multimodal large language models (MLLMs) have been increasingly adopted in forensics for their robust semantic understanding. As AI-generated images become realistic, semantic-level inconsistencies alone are often insufficient for reliable detection. This motivates a critical question: whether MLLMs can achieve full-spectrum forensic signal perception, i.e., capturing low-level generator artifacts without sacrificing pre-trained semantic knowledge. We further perform a layer-wise analysis of forensic signal perception in MLLMs, showing that semantic information is primarily formed in the early-to-middle layers, whereas direct fine-tuning for artifact learning disrupts these semantic representations. Based on this insight, we propose Deep Visual Residual MLLM (Deep-VRM) to preserve early semantic processing while injecting artifact-specific visual signals as a residual path into an intermediate layer, where they are fused with semantic token representations and propagated through subsequent trainable layers. This enables later layers to jointly model semantic reasoning and signal-level forensic cues, and surprisingly, the model learns to adaptively leverage different levels of forensic signals depending on the input, achieving robust and generalizable detection performance. Extensive experiments show that our method achieves state-of-the-art across most benchmarks. The code and data are available at https://github.com/KQL11/Deep-VRM.