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

SkillAudit: Ground-Truth-Free Skill Evolution via Paired Trajectory Auditing

arXiv:2606.14239v1 Announce Type: new Abstract: Agent skills are structured procedural packages that guide frozen LLM agents in specialized workflows. Skills rarely remain sufficient after deployment: edge cases, API changes, and deployment constraints become visible only through use, making skill evolution a practical necessity. Existing methods depend on privileged feedback such as held-out validation scores, hidden test outcomes, or environment rewards – signals often unavailable when a practitioner has only a task description and workspace data. We introduce SkillAudit, a framework for evolving agent skills without ground-truth feedback. The key idea is paired trajectory auditing: at each iteration, the same task is executed with and without the candidate skill, isolating how the skill changes agent behavior without external labels. To turn behavioral differences into edit guidance, SkillAudit uses Process-Aligned Contrastive Evaluation (PACE), a cluster of evaluators that maps trajectory divergences to diagnostic signals linked to specific passages in the skill document. A structural verifier, compiled once from the task specification and then fixed, checks task constraints and rolls back harmful updates. SkillAudit routes edits through two pipelines: Refine removes noisy or irrelevant guidance from broadly useful skills, while Repair replaces passages that conflict with the task. Across 89 containerized tasks spanning 8 professional domains, SkillAudit achieves 73.9% average task reward, outperforming an agent without skills (40.9%) and the static expert skill (56.7%). These gains are obtained without accessing hidden tests, reference solutions, or external scoring functions during evolution.

02.
arXiv (CS.CL) 2026-06-15

MedLatentDx: Latent Multi-Agent Communication for Cross-Hospital Rare-Disease Diagnosis

Rare diseases affect over $300$ million patients across more than $7{,}000$ conditions, yet no single hospital encounters enough cases of any one condition for reliable diagnosis. Cross-hospital collaboration could help by allowing a diagnosing institution to use distributed, case-specific diagnostic evidence, but privacy regulations restrict the transmission of identifiable clinical text across institutional boundaries. This setting raises two challenges: existing medical agent systems often rely on textual evidence exchange, while raw latent states such as hidden states and KV caches may still reveal prompt-derived clinical content. We introduce MedLatentDx, a latent multi-agent communication framework in which hospital agents keep private clinical records and retrieved cases local, and send compact latent KV blocks to a host agent for rare-disease diagnosis. MedLatentDx supports two deployment settings: same-backbone hospital agents use latent KV distillation, while hospitals with different LLM backbones use cross-family latent alignment. On CrossRare-Bench, a self-built large-scale rare-disease benchmark with hospital-level partitions, MedLatentDx improves cross-hospital diagnostic performance while reducing reconstructable clinical content relative to raw-latent communication baselines.

03.
arXiv (CS.CV) 2026-06-11

Time-Conditioned and Multi-Time Survival Prediction from 2D PET/CT Projections in Lung Cancer

Accurate prediction of overall survival (OS) from positron emission tomography/computed tomography (PET/CT) can support personalized treatment and follow-up strategies in oncology. However, the impact of temporal modeling on imaging-based survival prediction remains insufficiently explored. We investigate how different temporal formulations influence survival prediction by developing two complementary approaches: Attention-guided Time-Conditioned Survival (ATCS) and Multi-Time Survival (MTS). We retrospectively analyzed pre-treatment PET/CT images from 848 patients with non-small cell lung cancer (NSCLC), including 556 for model development and 292 for held-out testing. A previously proposed Time-Conditioned Survival (TCS) model was used as a baseline. Models were trained using 5-fold cross-validation and evaluated on the test set using time-dependent area under the curve (AUC) at 6-month intervals from 0.5 to 5 years. Both ATCS and MTS outperformed the baseline TCS model, achieving mean AUCs of 0.794 and 0.793, respectively, compared to 0.767. ATCS performed better at earlier time points (0.5-3 years), whereas MTS performed better at later intervals (3.5-5 years). Combining tumor-specific and tissue-wise PET/CT features improved performance over either input alone. Finer temporal discretization improved short-term prediction, while coarser intervals provided more stable long-term estimates. These findings demonstrate that temporal modeling and input design influence PET/CT-based survival prediction. The proposed approaches enable time-specific survival estimation from pre-treatment imaging and may support improved risk stratification and clinical decision-making.

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

Boltzmann Attention: Learnable Ising Couplings for Cooperative Attention

arXiv:2606.12478v1 Announce Type: new Abstract: Attention mechanisms are central to modern sequence models, yet standard attention computes relevance primarily through individual query–key similarities. Although softmax normalization introduces competition among positions, a standard attention layer does not explicitly parameterize learnable interactions between attention decisions. This limits its ability to directly model cooperative or antagonistic co-attention structure within the attention mechanism itself. We propose Boltzmann attention, an energy-based generalization in which attention patterns are governed by an interacting Ising model. The method augments the usual data-dependent local fields with learnable pairwise couplings, allowing the model to represent inter-position correlations beyond those captured by softmax or sigmoid attention. Experiments on character-level language modeling and synthetic bracket matching show that Boltzmann attention consistently improves over standard softmax attention within a standard Transformer architecture, with the advantage becoming more pronounced as sequence length increases. A four-way ablation confirms that the improvement arises from the learnable pairwise couplings. These results suggest that explicit inter-position interactions provide a principled enhancement for attention-based sequence modeling. Moreover, the Ising formulation opens a natural path toward quantum-computing-based sampling strategies: we demonstrate that diabatic quantum annealing provides a practical training method while maintaining competitive performance with exact Boltzmann computation.

05.
arXiv (CS.CL) 2026-06-17

Learning from the Self-future: On-policy Self-distillation for dLLMs

On-policy self-distillation (OPSD) has proven effective for post-training large language models (LLMs), yet its application to diffusion LLMs (dLLMs) remains unexplored. Existing OPSD methods are inherently autoregressive-centric. They inject privileged information via left-to-right prefix conditioning with token-level divergence supervision, a design that fundamentally conflicts with the arbitraryorder generation of dLLMs. We introduce d-OPSD, the first OPSD framework tailored for dLLMs. Our approach makes two core contributions. First, we reframe self-teacher construction by using self-generated answers as suffix conditioning, enabling the student model to learn from "self future-experience" rather than privileged prefixes. Second, we shift supervision from token-level to step-level, aligning training with the iterative denoising process of dLLMs. Experiments across four reasoning benchmarks show that d-OPSD consistently outperforms RLVR and SFT baselines with superior sample efficiency, requiring only around 10% of the optimization steps by RLVR and opening a promising pathway for dLLM posttraining. The code is available at https://github.com/xingzhejun/d-OPSD.

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

AURA: Active-Response Attribution under Treatment Ambiguity in Bacterial Cytological Profiling

When a bacterial sample is exposed to several antibiotics, not every applied drug necessarily acts: if the organism is resistant to one of them, that drug leaves no morphological trace. The clinically meaningful quantity is therefore not which antibiotics were applied, but which ones were active. We show that these two are sharply decoupled in real E. coli microscopy - naively assuming the applied combination equals the active one is correct only about 37% of the time - yet existing computational tools are ill-suited to recovering the active set. Forward perturbation models such as scGen, CPA, and IMPA are designed to predict appearance from treatment, not the reverse, and inverting them degrades sharply; discriminative image classifiers tend to memorise strain- and batch-specific texture and fail to transfer across experimental replicates. We introduce AURA, which reframes the task as constrained, energy-based inverse attribution. Its central inductive bias is that the active set must be a subset of the applied set; this collapses the candidate space and lets AURA infer the active subset of applied antibiotics by decomposing residual morphology into antibiotic response atoms and selecting the subset with the lowest reconstruction energy, using no strain label at test time. AURA-E adds evidence-aware abstention, withholding a prediction when candidate explanations remain near-equally plausible. On cross-replicate transfer in an E. coli cytological profiling dataset, AURA recovers the active antibiotic combination with 95.47% exact-match accuracy.

07.
arXiv (math.PR) 2026-06-12

A mathematical study of the excess growth rate

arXiv:2510.25740v2 Announce Type: replace-cross Abstract: The excess growth rate, defined as the gap in Jensen's inequality for the logarithm, is a fundamental functional in portfolio theory. In this paper, we present a mathematical study motivated by information theory. We begin by establishing its properties and showing that it has rich connections with information theoretic concepts such as the Helmholtz free energy, L. Campbell's measure of average code length and large deviations. Our main results consist of three axiomatic characterization theorems of the excess growth rate, in terms of (i) the relative entropy, (ii) the gap in Jensen's inequality, and (iii) the logarithmic divergence that generalizes the Bregman divergence. Furthermore, we study maximization of the excess growth rate and compare it with the growth optimal portfolio. Our results not only provide theoretical justifications of the significance of the excess growth rate, but also establish new connections between information theory and quantitative finance.

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

Mosaic: Data-Free Knowledge Distillation via Mixture-of-Experts for Heterogeneous Distributed Environments

arXiv:2505.19699v2 Announce Type: replace-cross Abstract: Federated Learning (FL) is a decentralized machine learning paradigm that enables clients to collaboratively train models while preserving data privacy. However, the coexistence of model and data heterogeneity gives rise to inconsistent representations and divergent optimization dynamics across clients, ultimately hindering robust global performance. To transcend these challenges, we propose Mosaic, a novel data-free knowledge distillation framework tailored for heterogeneous distributed environments. Mosaic first trains local generative models to approximate each client's personalized distribution, enabling synthetic data generation that safeguards privacy through strict separation from real data. Subsequently, Mosaic forms a Mixture-of-Experts (MoE) from client models based on their specialized knowledge, and distills it into a global model using the generated data. To further enhance the MoE architecture, Mosaic integrates expert predictions via a lightweight meta model trained on a few representative prototypes. Extensive experiments on standard image and multimodal benchmarks demonstrate that Mosaic consistently outperforms state-of-the-art approaches under both model and data heterogeneity. The source code has been published at https://github.com/Wings-Of-Disaster/Mosaic.

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

FitVTON: Fit-aware Virtual Try-On via Body-Garment Size Control

While diffusion-based virtual try-on has achieved impressive visual realism, most methods treat the task as 2D inpainting, prioritizing texture preservation over physical plausibility. Consequently, they often produce plausible-looking images that fail to reflect authentic garment fit across diverse body shapes. We present FitVTON, a Fit-aware virtual try-on model on different bodies in the wild. FitVTON encodes garment-body size through structured text prompts, and learn from simulated try-on triplets from parameterized garment model. To improve the fitting effects over garment silhouettes, we introduce two auxiliary head to predict the masks for both the garment and the exposed body. We further introduce a texture rectification stage to improve realistic appearance from simulated data. To evaluate the fitting fidelity, we curate a real-world dataset, FittingEffect3K, combining VLM-based scoring protocol. Both subjective and quantitive experiments show that FitVTON demonstrate authentic fitting fidelity, with significant sizing accuracy and shape preservation over state-of-the-art methods while maintaining competitive image quality. Project Page: https://zenoning.github.io/FitVTON/.

11.
bioRxiv (Bioinfo) 2026-06-11

Viability of engineered AAVs via protein language models

Capsid engineering has greatly improved the performance of recombinant AAV vectors used for gene therapy. One commonly used strategy is the insertion of a short, 7-mer, peptide into surface-exposed loops to modify receptor interactions and enhance cell entry. While effective in receptor retargeting and improved transduction, these insertions might destabilize the capsid protein, hinder assembly, and thus limit production. While previous attempts have used deep mutational scanning and AI to predict which insertions are viable, there is lack in understanding the structural consequences of these peptide insertions at the amino-acid level. Here we combined experiments, deep sequencing and large protein language models to gain insight on the impact of 7-mer insertions on the VR-VIII region. We first characterize the biochemical properties of viable insertions, thus identifying which residues are well tolerated, and which should instead be avoided. We then focus on the nearby context of those insertions, by studying the effect of the linkers, either for highly diverse libraries or for individual variants known for their efficiency. Next, we study the broader context, by extending our analysis to the whole capsid sequence, and identifying regions that can tolerate insertions without long-ranged structural deformations that could affect capsid functionality. We conclude with a cross-serotype comparison and a viability analysis of tens of previously engineered variants. Our work showcases how AI can uncover structure-function rules governing the success of engineered AAV capsids.

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

AI4SLT: Empirical Processes in Lean 4 for Formal Statistical Learning Theory

We present the first comprehensive Lean 4 formalization of statistical learning theory (SLT) grounded in empirical process theory. Our en-to-end formal infrastructure implement the missing contents in latest Lean library, including a complete development of Gaussian Lipschitz concentration, Dudley's entropy integral theorem for sub-Gaussian processes, and an application to least-squares (sparse) regression with a sharp rate. The project was carried out using a human-AI collaborative workflow, in which humans design proof strategies and AI agents execute tactical proof construction, leading to the human-verified Lean 4 toolbox for SLT. Beyond implementation, the formalization process exposes and resolves implicit assumptions and missing details in standard SLT textbooks, enforcing a granular, line-by-line understanding of the theory. This work establishes a reusable formal foundation and opens the door for future developments in machine learning theory. The code is provided in https://github.com/YuanheZ/lean-stat-learning-theory.

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

Sorries Are Not the Hard Part: An Expert-Review Case Study of a Semi-Autonomous Formalization

arXiv:2606.13925v1 Announce Type: new Abstract: Large language models can often close proof gaps in interactive theorem provers, but a verified theorem is not the same thing as a reusable library contribution. We study this distinction through a detailed case study: a semi-autonomous formalization of Grothendieck's vanishing theorem. The initial version compiles with no sorries, but an expert review found serious problems in definitions, theorem generality, file organization, and the API. We then ran a review-driven refactor and compression process and obtained a second expert review. The before-and-after comparison shows a sharp split: agents adapted well to local, mechanically checkable feedback, but remained weak at choosing definitions and designing APIs. We argue that autoformalization should be evaluated not only by closed sorries, but by whether the resulting formalization survives expert review.

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

Reasoning as Intersection: Consensus-Frame Alignment for Visual Focus in Video-MLLMs

Reinforcement learning has improved the reasoning ability of large language models, but applying outcome-only rewards to video multimodal large language models (Video-MLLMs) provides limited guidance on which visual evidence should support the answer. Inspired by multisensory integration, where consistent cues can enhance the salience and reliability of perceptual estimates, we introduce Consensus Frame GRPO (CF-GRPO), a temporal-annotation-free process-level reward framework for evidence-aware video reasoning. CF-GRPO constructs a consensus frame prior from intrinsic video cues, including temporal coverage, scene-transition cues, and query-conditioned visual relevance. It then computes a model-side frame-use score from visual and response representations and optimizes their agreement through the Consensus Frame Reward (CFR). With salience-aware sparse aggregation and distribution sharpening, CFR provides a high-contrast reward signal without requiring human temporal annotations. Experiments show that VideoCFR achieves competitive performance across complex video reasoning benchmarks and improves several metrics over representative Video-MLLM and RL baselines, while the consensus prior provides an interpretable view of the evidence frames emphasized during training. The implementation is available at https://github.com/1Pansy/VideoCFR.

15.
arXiv (CS.CL) 2026-06-17

NarrativeWorldBench: A Frontier-Saturated Benchmark and a Latent World Model for Long-Horizon Co-Creative Audio Drama

Long-form serialized audio drama, with arcs that run for 200 to 800 episodes, is a major creative medium and a setting where frontier large language models (LLMs) fail. We benchmark 21 models, spanning classical, fine-tuned, open-frontier, closed-frontier, and reasoning tiers, on a uniform set of structural narrative metrics. All closed-frontier systems saturate at a plot-beat F1 in the band [0.78, 0.81] and collapse by about -0.20 F1 at horizon h=200. We introduce NarrativeWorldBench, an open benchmark of nine narrative-structure metrics evaluated across horizons h in {10, 20, 50, 100, 200}, with cross-lingual evaluation across four Indic languages (Hindi, Tamil, Telugu, Marathi). We introduce N-VSSM, a Narrative Variational State-Space Model that maintains a structured 256-dimensional latent world state over more than 200 episodes via a Mamba-2 backbone with an event-conditioned posterior and an 8B decoder. N-VSSM holds plot-beat F1 >= 0.84 across all horizons at 4x lower compute than the closed-frontier band. A learned Cultural Transfer Function lifts cross-language fidelity by +0.20 to +0.23 Likert points. In a within-subjects writer study (n = 12 professional authors, 240 trials), N-VSSM is preferred over Claude Opus 4.5 on long-arc consistency 71% of the time and rated +1.3 Likert points higher on controllability.

16.
bioRxiv (Bioinfo) 2026-06-20

SAbDab2: The structural antibody database in the age of machine learning

The Structural Antibody Database (SAbDab) is a publicly available repository of experimentally determined antibody structures, first released in 2013. Explicit support for single-domain antibodies was added in 2021, with SAbDab-nano. Recently, increasing interest in antibodies has led to a proliferation of novel antibody formats, while simultaneous advances in machine learning have increased demand for standardised, high-quality structure data. Here, we present SAbDab2, re-engineered for the machine-learning age. It introduces support for a variety of new formats, and makes it easy to retrieve and compare all known structures of a given antibody. In addition, SAbDab2 provides ready access to ML-grade structures of antibody and antibody–antigen-complexes, with standardised, versioned train/test splits. These will be updated every six months going forward, and are available at https://zenodo.org/records/20083995. SAbDab2 itself is updated weekly and is freely available at https://sabdab2.opig.stats.ox.ac.uk.

17.
arXiv (CS.CL) 2026-06-15

Can Post-Training Turn LLMs into Good Medical Coders? An Empirical Study of Generative ICD Coding

Automated International Classification of Diseases (ICD) coding is a core medical-coding task for billing, epidemiology, and clinical decision support. Generative large language models (LLMs) are often reported as weak medical coders, but this finding mainly comes from inference-time settings such as prompting, retrieval, reranking, or tool use, leaving the role of task-specific post-training underexplored. We present a controlled empirical study of post-training for generative ICD coding, comparing discriminative baselines with LLM coders across prompting, supervised fine-tuning, and reinforcement learning under a common protocol and metric set. To our knowledge, this is the first study to evaluate RL-based post-training for generative LLM coders in ICD coding. We further introduce PHI, a diagnostic curriculum that extends GRPO to refine missed-code cases. Our results show that prompting-only evaluation substantially underestimates the potential of LLMs for ICD coding. SFT provides the main capability jump, GRPO further improves code-set prediction beyond SFT, and PHI provides targeted gains on macro-level performance. These findings suggest that the main bottleneck is not the generative formulation alone, but how the model is adapted and optimized for full-taxonomy recall. We release our code, data splits, and checkpoints at https://github.com/AlexandreWANG915/LLM4ICD.

18.
arXiv (CS.AI) 2026-06-12

Examining the Usage of Generative AI Models in Student Learning Activities for Software Programming

arXiv:2511.13271v2 Announce Type: replace-cross Abstract: The rise of Generative AI (GenAI) tools like ChatGPT has created new opportunities and challenges for computing education. Existing research has primarily focused on GenAI's ability to complete educational tasks and its impact on student performance, often overlooking its effects on knowledge gains. In this study, we investigate how GenAI assistance compares to conventional online resources in supporting knowledge gains across different proficiency levels. We conducted a controlled user experiment with 24 undergraduate students of two different levels of programming experience (beginner, intermediate) to examine how students interact with ChatGPT while solving programming tasks. We analyzed task performance, conceptual understanding, and interaction behaviors. Our findings reveal that generating complete solutions with GenAI significantly improves task performance, especially for beginners, but does not consistently result in knowledge gains. Importantly, usage strategies differ by experience: beginners tend to rely heavily on GenAI toward task completion often without knowledge gain in the process, while intermediates adopt more selective approaches. We find that both over-reliance and minimal use result in weaker knowledge gains overall. Based on our results, we call on students and educators to adopt GenAI as a learning rather than a problem solving tool. Our study highlights the urgent need for guidance when integrating GenAI into programming education to foster deeper understanding.

19.
arXiv (CS.CL) 2026-06-16

GRACE-DS: a Guarded Reward-guided Agent Correction Environment in Data Science

We introduce GRACE-DS, a Guarded Reward-guided Agent Correction Environment in Data Science for pre-deployment evaluation of LLM-powered AutoML agents. GRACE-DS is a set of evaluation metrics in an isolated environment that can be applied to tabular ML tasks specific to a particular organization. It exposes agents to realistic workflow stages, from planning and data inspection through feature engineering, model development, validation, and code repair to final submission, while hidden executable validators measure not only final predictive performance but also leakage avoidance, reproducibility, protocol validity, correction behavior, and reward alignment. The strongest structured regime, flexible iterative interaction (our approach), achieves higher end-to-end normalized hidden-test quality than single-shot generation, unstructured interaction, and restart-based baselines, while also improving protocol-valid completion. Validated across more than 7,000 episodes, these results establish GRACE-DS as a robust platform for assessing the capacity of LLM-based AutoML agents to execute machine learning workflows under production-like conditions and in accordance with organization-specific requirements.

20.
Nature (Science) 2026-06-10

Daily briefing: Ancient ground squirrels ate like ‘zombies of the Pleistocene’

Authors:

Evidence from fossilized poo reveals the diverse diet of ancient ground squirrels. Plus, the science behind the peptide craze and our innate tendency to wander anticlockwise. Evidence from fossilized poo reveals the diverse diet of ancient ground squirrels. Plus, the science behind the peptide craze and our innate tendency to wander anticlockwise.

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

NSVQ: Mitigating Codebook Collapse by Stabilizing Encoder Drift in Vector Quantization

Vector quantization is central to modern generative modeling pipelines, but large-codebook VQ models often suffer from codebook collapse. We identify encoder drift as a key driver of this failure: as the encoder moves the latent distribution, sparsely updated code vectors can lag behind, lose assignments, and increase quantization error, creating a feedback loop through the straight-through estimator. We propose NSVQ, a non-stationary-aware VQ training strategy that combines a dense non-stationary embedding loss, codebook replacement, and stage-wise encoder freezing. NSVQ first helps the codebook track encoder drift during early training, then freezes the encoder to consolidate the codebook under a fixed latent geometry, and finally reintroduces adversarial refinement. Experiments on ImageNet-1k show that NSVQ improves reconstruction quality while maintaining full codebook utilization. On ImageNet-1k at 128$\times$128 with 65,536 codes, NSVQ reduces rFID from 2.39 to 2.10 compared with SimVQ, while both methods maintain 100\% utilization. Additional latent diffusion experiments show that NSVQ also improves downstream ImageNet generation FID.

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

PoseGAM: Robust Unseen Object Pose Estimation via Geometry-Aware Multi-View Reasoning

6D object pose estimation, which predicts the transformation of an object relative to the camera, remains challenging for unseen objects. Existing approaches typically rely on explicitly constructing feature correspondences between the query image and either the object model or template images. In this work, we propose PoseGAM, a geometry-aware multi-view framework that directly predicts object pose from a query image and multiple template images, eliminating the need for explicit matching. Built upon recent multi-view-based foundation model architectures, the method integrates object geometry information through two complementary mechanisms: explicit point-based geometry and learned features from geometry representation networks. In addition, we construct a large-scale synthetic dataset containing more than 190k objects under diverse environmental conditions to enhance robustness and generalization. Extensive evaluations across multiple benchmarks demonstrate our state-of-the-art performance, yielding an average AR improvement of 5.1% over prior methods and achieving up to 17.6% gains on individual datasets, indicating strong generalization to unseen objects. Project page: https://windvchen.github.io/PoseGAM/ .

23.
medRxiv (Medicine) 2026-06-17

Determinants of non-utilization of insecticide-treated nets among children under five in Rwanda: analyses of the 2024 Rwanda malaria indicator survey

Background Insecticide-treated nets (ITNs) are effective for preventing malaria among children under five years, who bear a disproportionate burden of malaria. This study assessed the prevalence and determinants of ITN non-utilization among children under five in Rwanda using data from the 2024 Rwanda Malaria Indicator Survey (RMIS).Methodology This cross-sectional study utilized nationally representative data from the 2024 RMIS. Analyses were restricted to children under five residing in households that owned at least one ITN. The outcome was non-utilization of ITN, defined as not sleeping under an ITN the night preceding the survey. Survey-weighted descriptive statistics were used to estimate the prevalence of ITN non-utilization. Factors associated with non-utilization were identified using a survey-weighted Poisson regression model. Adjusted prevalence ratios (aPRs), 95% confidence intervals and p-values were reported.Results A total of 1,979 children were included in the study. The weighted prevalence of ITN non-utilization among children under five years was 20.11% (95% CI: 17.81 - 22.63). After adjusting for other factors, children aged 2 - 3 years were associated with an 83% higher prevalence of ITN non-utilization compared with those aged [&le;]1 year (aPR = 1.83, 95% CI: 1.423 - 2.352, p < 0.001). Compared with households that owned only one ITN, children in households with three or more ITNs were associated with a 76% lower prevalence of ITN non-utilization (aPR = 0.24, 95% CI: 0.171 - 0.332, p < 0.001). Children living in households with 5 - 7 members were associated with an 87% higher prevalence of ITN non-utilization compared with those in households with 1 - 4 members (aPR = 1.87, 95% CI: 1.476 - 2.358, p < 0.001).Conclusion The findings suggest that ITN utilization among children is influenced not only by household access to nets but also by household composition and dynamics that shape the allocation and use of available preventive resources.

24.
medRxiv (Medicine) 2026-06-18

Cost analysis of overseas versus domestic vaccination of US-bound refugees

Context: To ensure healthy resettlement and protect US health security, the Vaccination Program for US-bound Refugees (VPR) offers some recommended vaccines to refugees overseas before resettlement to the United States. The selected vaccines and number of doses vary by country of departure. VPR was found to be cost-saving in 2018 but had since expanded to more sites. Objective: Assess VPR's current costs and impact on post-arrival domestic vaccination needs and costs. Setting and Participants: A model-based analysis of the Federal government costs for VPR and post-arrival (US) vaccination of resettled refugees separated across five regions: Africa, Asia, the Middle East and North Africa/Republic of Turkiye and Middle East, Europe, and the Americas using fiscal year 2024 data. Design: We quantified and compared full vaccination costs for refugees under two scenarios: (1) 'No VPR' and (2) 'VPR'. Refugees would receive no vaccines overseas and be fully vaccinated after US arrival under 'No VPR'. Under 'VPR', refugees receive one or two doses of selected vaccines overseas before completing vaccination schedules after arrival. Main Outcomes: Costs were reported in 2023 US dollars for 'VPR' and 'No VPR' scenarios and further subdivided by grouping countries/sites depending on whether the International Organization for Migration (IOM) provides vaccination services for refugees (IOM sites) versus non-IOM providers (non-IOM sites). Results: 'VPR' resulted in average net cost savings of $147 per person or $14.7 million per 100,000-refugee cohort compared to providing all vaccines after US arrival ('No VPR'). 'VPR' was cost-saving across most regions, except for IOM sites in Europe, where a net cost of $44 per person was observed. Net cost savings per person were highest for IOM sites in Africa ($333). Conclusions: VPR remains a cost-saving strategy, while protecting US-bound refugees' health and US health security by preventing disease outbreaks during resettlement.

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

Service-Induced Congestion in Memory-Constrained LLM Serving

arXiv:2606.15555v1 Announce Type: cross Abstract: In large language model (LLM) serving, each request accumulates persistent graphics processing unit (GPU) memory during service as its key-value cache grows with every generated token. Under high concurrency, aggregate memory usage therefore increases endogenously over time: the service process itself creates future capacity pressure. When memory capacity is exceeded, systems evict active requests, discarding cached state and restarting them later, which wastes computation and reduces throughput. We develop a discrete-time dynamical model of memory-constrained LLM inference that captures admission, memory growth, and eviction under continuous batching. In the saturated-input regime, the system admits both eviction-free fixed points and limit cycles with evictions. For homogeneous workloads, we show that the eviction-free equilibrium is unstable and that, except for a Lebesgue-measure-zero exact-capture set, the system converges to a unique worst-case limit cycle that is asymptotically stable outside this exceptional set, with throughput losses as large as 50%. For heterogeneous workloads, we prove a stability criterion in the two-class common-input setting and explain how the survival-polynomial mechanism generalizes to multiple classes and heterogeneous-input lengths. Under an input-dominated scaling regime, coprime decoding lengths stabilize the eviction-free equilibrium, while non-coprime lengths create synchronized modes that drive instability. These results characterize when workload heterogeneity desynchronizes completions and helps stabilize memory-constrained serving. More broadly, we identify service-induced congestion as a structural instability mechanism and derive scheduling design principles for sustaining high throughput.