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01.
arXiv (CS.CL) 2026-06-25

MedLayBench-V: A Large-Scale Benchmark for Expert-Lay Semantic Alignment in Medical Vision Language Models

Medical Vision-Language Models (Med-VLMs) have achieved expert-level proficiency in interpreting diagnostic imaging. However, current models are predominantly trained on professional literature, limiting their ability to communicate findings in the lay register required for patient-centered care. While text-centric research has actively developed resources for simplifying medical jargon, there is a critical absence of large-scale multimodal benchmarks designed to facilitate lay-accessible medical image understanding. To bridge this resource gap, we introduce MedLayBench-V, the first large-scale multimodal benchmark dedicated to expert-lay semantic alignment. Unlike naive simplification approaches that risk hallucination, our dataset is constructed via a Structured Concept-Grounded Refinement (SCGR) pipeline. This method enforces strict semantic equivalence by integrating Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs) with micro-level entity constraints. MedLayBench-V provides a verified foundation for training and evaluating next-generation Med-VLMs capable of bridging the communication divide between clinical experts and patients.

02.
medRxiv (Medicine) 2026-06-24

Food additive exposure associated with reduction in gut microbiota diversity

Consumption of ultra-processed foods is rising globally and has been implicated in inflammation and metabolic dysfunction, yet the impact of specific food additives on the human gut microbiota remains poorly understood. Using dietary data from the Food & You study (approximately 1000 participants in Switzerland), we identified 257 unique additives from 4,119 unique packaged products to quantify each participant's daily additive exposure. Higher exposure to a combination of high intensity sweeteners and sugar polyols, commonly found in low calorie products, was independently associated with reduced gut microbial Shannon diversity (beta = -0.39, p < 0.001), after adjustment for demographics, diet quality, BMI and bowel movement frequency. At a broader level, total additive exposure and fast food consumption were each negatively associated with gut microbial diversity; however, additive exposure remained independently associated and also specifically attenuated the diversity benefits of vegetable rich diets. Furthermore, microbial log ratio signatures linked to additive exposure showed strong negative correlations with Shannon diversity, including emulsifiers and thickeners (r = -0.66) and preservatives and antioxidants (r = -0.56). Integrating additive exposure with healthy dietary components such as HEI, fruits, or vegetables strengthened associations with gut microbial diversity; for example, vegetable linked correlations with Shannon diversity increased from r = 0.52 to r = 0.65 when contrasted against preservative-antioxidant exposure. Concordantly, microbial signatures associated with the sweeteners and sugar polyols additive combination showed depletion of fiber associated commensal taxa, and enrichment of pathways involved in polyol and aromatic compound metabolism. Notably, these associations emerged despite packaged foods representing only approximately 15% of logged dietary intake, underscoring the sensitivity of gut microbial diversity to limited exposure, and demonstrating that without integrating additive and processed-food metrics, one of the largest effect-size phenomena in human gut microbiota diversity would remain undetected.

03.
medRxiv (Medicine) 2026-06-24

Association Between Intermittent Water Supply and Helicobacter pylori Prevalence: A Global Ecological Study

Background: Helicobacter pylori is a major global pathogen with recognized potential for waterborne transmission. Intermittent water supply affects over one billion worldwide and may promote H. pylori contamination of municipal sources. Whether water supply discontinuity contributes to population-level H. pylori burden has not been examined globally. Materials and Methods: We conducted a cross-sectional ecological analysis of 79 countries with matched utility-level water infrastructure data and country-level H. pylori prevalence estimates from a published global meta-analysis. The primary exposure was continuity of water supply (hours/day). Secondary exposures included non-revenue water percentage (NRW %), pipe breaks per utility, and operating cost coverage ratio. Unadjusted and adjusted linear regression models with heteroscedasticity-consistent standard errors were estimated, controlling for basic sanitation coverage and log-transformed population density. A sensitivity analysis used a population-based measure of water availability on demand. Results: Greater water supply continuity was independently associated with lower H. pylori prevalence in both unadjusted ({beta} = -0.987, 95% CI -1.669 to -0.305, p = 0.005) and adjusted models ({beta} = -1.125, 95% CI -1.876 to -0.375, p = 0.004). Higher NRW % and lower operating cost coverage were each associated with higher H. pylori prevalence after adjustment. Pipe breaks were not significant in regression models though the Spearman correlation was in the expected direction. Sensitivity analysis produced consistent findings. Conclusion: IWS and broader water infrastructure deterioration are associated with higher H. pylori prevalence at the country level. These findings implicate water supply continuity as a potentially relevant environmental determinant of H. pylori transmission and suggest a role for water system investment within long-term gastric cancer prevention strategies.

04.
arXiv (CS.CV) 2026-06-25

Kuramoto Oscillatory Phase Encoding: Neuro-inspired Synchronization for Improved Learning Efficiency

Spatiotemporal neural dynamics and oscillatory synchronization are widely implicated in biological information processing and have been hypothesized to support flexible coordination such as feature binding. By contrast, most deep learning architectures represent and propagate information through activation values, neglecting the joint dynamics of rate and phase. In this work, we introduce Kuramoto oscillatory Phase Encoding (KoPE) as an additional, evolving phase state to Vision Transformers, incorporating a neuro-inspired synchronization mechanism to advance learning efficiency. We show that KoPE can improve training, parameter, and data efficiency of vision models through synchronization-enhanced structure learning. Moreover, KoPE benefits tasks requiring structured understanding, including semantic and panoptic segmentation, representation alignment with language, and few-shot abstract visual reasoning (ARC-AGI). Theoretical analysis and empirical verification further suggest that KoPE can accelerate attention concentration for learning efficiency. These results indicate that synchronization can serve as a scalable, neuro-inspired mechanism for advancing state-of-the-art neural network models. Code is avaliable at https://github.com/microsoft/Neuro-inspired_Phase_Encoding.

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

Domain-Shift Aware Neural Networks for Unbalance Characterization in Rotating Systems

arXiv:2606.18882v1 Announce Type: cross Abstract: This work investigates the application of a domain-shift aware neural network for regression tasks aimed at estimating unbalance masses in rotating shafts under varying operating conditions. Experimental data were collected from a test rig in which a primary shaft, equipped with a flange carrying unbalanced masses, was driven at different rotational speeds, while a secondary shaft could be optionally activated to introduce domain discrepancy. The unbalance masses were positioned at a fixed radial distance, and the dynamic response of the system was recorded using triaxial accelerometers. The inverse problem of mass estimation is formulated within a domain adaptation framework, where the network is trained with a maximum mean discrepancy strategy to align feature representations across source and target distributions. The results demonstrate the effectiveness of explicitly addressing domain shift in improving prediction accuracy, especially when the system's physical behavior and sources of domain discrepancy are not fully known and fall outside the training conditions. These findings highlight the potential of domain-shift aware models for regression tasks in Structural Health Monitoring.

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

PhysMetrics.Weather: An Evaluation Framework for Physical Consistency in ML Weather Models

arXiv:2606.10642v2 Announce Type: replace Abstract: Machine learning weather prediction (MLWP) models have achieved impressive forecasting performance at a small fraction of the computational costs required for traditional physics-based methods. However, they are primarily (1) data-driven and (2) evaluated using pixel-wide error metrics (e.g., RMSE), so there are no guarantees that their forecasts are consistent with known physical laws. We introduce PhysMetrics$.$Weather, an evaluation framework that assesses the physical realism of MLWP models across three types of metrics: conservation, spectral, and dynamical. By quantifying physical realism, this tool guides the development of physics-informed architectures and helps evaluate whether MLWP models are reliable for operational use. Our framework is available on Github at https://github.com/Emmakast/PhysMetrics.Weather.

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

Question-Aware Evidence Ledgers for Video Relational Reasoning

The VRR-QA challenge evaluates visual relational reasoning in videos, where answers often depend on implicit spatial relations, event boundaries, target identity, and dialogue context rather than a single salient frame. We present a test-time reasoning pipeline built around a strong GPT-5.5 video QA solver and a set of question-aware evidence ledgers. The initial solver answers each question from a uniform video representation, while routed ledgers are prompted to make the required targets, count units, reference frames, and temporal or spatial scope explicit for counting, spatial, endpoint, viewpoint, and dialogue reasoning. External tools such as open-vocabulary detection, depth cues, pair crops, ASR, and scene-graph ledgers are used only as evidence sources. A conservative gate keeps the current answer unless independent evidence uniquely supports a different option. The final evidence-gated pipeline achieves 92.95% overall accuracy and 93.79% macro accuracy on the challenge test split.

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

From Sparse Features to Trustworthy Proxies: Certifying SAE-Based Interpretability

Sparse autoencoders (SAEs) are increasingly used to extract interpretable features from language models (LMs), yet a central question remains: when can an SAE-based explanation be treated as a faithful view of an underlying frozen LM We study this through a post-hoc generalization framework that certifies the LM via a sparse proxy, obtained by replacing a native hidden activation with its pretrained SAE reconstruction. Our framework derives an upper bound on the base model's expected risk using four measurable quantities: proxy risk, SAE reconstruction gap, concept-pool mismatch, and sparse complexity. We interpret this certificate as an operational criterion for explanatory faithfulness. In particular, a non-vacuous bound indicates that the extracted sparse features retain meaningful predictive information, while small reconstruction and mismatch errors indicate that the proxy remains behaviorally close to the original model. Empirically, we show that the bound becomes non-vacuous on GPT-2 Small, Gemma-2B, and Llama-3-8B at practical sample sizes. A detailed layerwise analysis of Llama-3-8B reveals a strong depth dependence, with later layers becoming much easier to certify, associated with both stronger local fidelity and weaker downstream error amplification. Finally, through feature-shuffling ablations, we show that the decomposition distinguishes genuine semantic alignment from mere statistical sparsity, providing a useful diagnostic for when SAE-based explanations become less reliable.

10.
medRxiv (Medicine) 2026-06-24

Durability and Seasonal Variation in the Effectiveness of Nirsevimab over Three Seasons in Connecticut

Background Nirsevimab has been widely administered in the United States since 2023 to protect infants and young children from severe disease caused by respiratory syncytial virus (RSV). Although early post-licensure studies have shown high effectiveness against medically attended RSV infection, uncertainty remains about the durability of protection, effectiveness beyond the first RSV season, and the extent to which changing RSV seasonality influences real-world effectiveness. Objective To estimate the effectiveness of nirsevimab against medically attended RSV infection across three consecutive RSV seasons and to examine how effectiveness varies by season and time since immunization. Methods We conducted a test-negative case-control study utilizing electronic health records of infants and young children tested for RSV by polymerase chain reaction in outpatient and inpatient settings within the Yale New Haven Health System between October 1, 2023, and March 1, 2026. Effectiveness of nirsevimab was estimated using multivariable logistic regression, adjusting for age, weekly RSV activity, pre-existing risk factors, and other potential confounders. Variation in effectiveness was examined by season, encounter setting, and time since immunization up to 24 months. Results Overall, 17,755 infants and young children were tested for RSV infection, of whom 2,388 (13.4%) were cases and 15,367 (86.6%) were controls. The overall effectiveness of nirsevimab was 67.3% (95% confidence interval [CI]: 59.8, 73.3%) against all medically-attended RSV infections, 60.2% (95% CI: 49.6, 68.5%) against RSV-associated outpatient visits, and 88.9% (95% CI: 82.3, 93.0%) against RSV-associated hospitalization. Effectiveness against medically attended RSV infection declined across seasons, from 76.7% (95% CI: 60.5, 86.3%) in 2023/24 to 54.4% (95% CI: 33.0, 68.9%) in 2025/26. Lower season-specific effectiveness in later seasons corresponded with progressively delayed RSV activity over. Protection against RSV-associated hospitalization declined with increasing time since immunization, from 92.5% (95% credible interval [CrI]: 85.9, 96.4%) at 1 month, to 77.2% (95% CrI: 60.4, 87.6%) at 6 months, and 39.9% (95% CrI: 2.4, 63.3%) at 12 months post-immunization, after which effectiveness plateaued. Conclusions Nirsevimab remained effective against RSV-associated hospitalization through 6 to 12 months after immunization. Delayed RSV activity was associated with lower effectiveness, highlighting the importance of aligning administration with local RSV circulation.

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

Inference-Time Decision Calibration for Temporal Classification

arXiv:2606.16034v1 Announce Type: new Abstract: Temporal classification errors are often treated as representation failures, but they can also arise from how available evidence is converted into decisions. This paper proposes a representation–calibration decomposition for temporal classification. We keep a trained native classifier frozen and separate two inference-time interventions: a conservative residual multi-scale branch that adds auxiliary logits to the native prediction, and a post-hoc branch-aware calibrator that recombines native and residual evidence at decision time. This design distinguishes missing temporal evidence from underused decision-level evidence without retraining the backbone. Across FI-2010, PTB-XL, UCI-HAR, MHEALTH, and HARTH, we find that gains are strongly regime-dependent. Residual multi-scale evidence is most useful in noisy or representation-limited settings, especially short-horizon FI-2010 and weaker recurrent backbones, while branch-aware calibration helps when native and auxiliary logits contain complementary evidence not fully exploited by the raw decision rule. Near-saturated settings show limited gains from either intervention. These results suggest that temporal classification should be understood not only as representation learning, but also as the problem of trusting, combining, and calibrating evidence from multiple views.

12.
arXiv (CS.AI) 2026-06-16

From Correlation to Causation in Lane Change Prediction for Automated Driving: A Causal Explanation Framework

arXiv:2606.15756v1 Announce Type: cross Abstract: Lane-change prediction is a central task in intelligent vehicles, where early maneuver anticipation can support safer decision-making. However, many existing approaches mainly learn statistical associations between observed driving variables and future maneuvers, while overlooking the causal dependencies among the input variables themselves. This limits interpretability, especially when physically related variables such as longitudinal gap, relative longitudinal velocity, and Time-To-Collision (TTC) are treated as independent flat inputs. This article presents a causal-inference-based framework for lane-change prediction and explanation. The proposed approach combines linguistic feature construction, expert-constrained causal discovery, deep structural causal modeling with Deep End-to-end Causal Inference (DECI), intervention-based effect analysis, refutation testing, and recursive causal-chain explanation. The objective is not only to predict the future maneuver, but also to identify candidate variables that directly contribute to the prediction, the upstream factors influencing them, and the causal chains through which these effects propagate. The framework achieves average F1-scores above 95% during the first three seconds before the lane-marking crossing event. Beyond prediction accuracy, the framework uses intervention-based effect analysis to distinguish influential from weakly influential variables under the learned causal structure. It further distinguishes candidate direct contributors from mediated effects and generates contrastive causal-chain explanations that clarify why the predicted maneuver is favored and why the alternative maneuvers are less supported. The main contribution is therefore a mechanism-aware lane-change prediction pipeline that moves beyond correlation-based classification toward more interpretable causal reasoning for maneuver prediction.

13.
arXiv (CS.LG) 2026-06-19

Multi-Task Bayesian In-Context Learning

arXiv:2606.20538v1 Announce Type: new Abstract: Bayesian predictive inference provides a principled framework for uncertainty quantification, data efficiency, and robust generalization. However, exact inference is often intractable, and scalable approximations may remain computationally expensive or require restrictive modeling assumptions that degrade predictive performance. Prior-Data Fitted and in-context models have recently emerged as an amortized alternative by learning to map datasets directly to predictive distributions, but existing approaches are tightly coupled to the support of the training prior and lack explicit mechanisms for adapting to new priors at test time, resulting in limited robustness under distribution shift. We introduce a multi-task in-context learning framework for amortized hierarchical Bayesian predictive inference that explicitly represents prior information as a prefix of in-context datasets. A transformer trained on sequences of prior and target tasks learns to adapt its predictions across families of priors. On a suite of evaluations with increasing difficulty, including out-of-meta-distribution priors and priors with high-dimensional latent structures, our method matches oracle Bayesian predictors while being orders of magnitude faster. We further demonstrate its practical relevance on a real-world spatiotemporal temperature prediction benchmark. Code is available at https://github.com/martianmartina/multi-task-bayesian-icl/.

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

Revealing Hidden Vulnerabilities in Autoencoders through Gradient Signal Restoration

Adversarial robustness of deep autoencoders (AEs) has received less attention than that of discriminative models, although their compressed latent representations induce ill-conditioned mappings that can amplify small input perturbations and destabilize reconstructions. Existing white-box attacks for AEs, which optimize norm-bounded adversarial perturbations to maximize reconstruction damage, often converge to suboptimal perturbations, thereby potentially overstating AE robustness. We show that this limitation is linked to vanishing adversarial loss gradients during backpropagation through ill-conditioned layers, associated with near-zero singular values in their intermediate weight matrices. To address this, we propose GRILL (Gradient Signal Restoration in Ill-Conditioned Layers), a framework designed to mitigate gradient degradation and improve the reliability of adversarial robustness evaluation in encoder-decoder architectures. GRILL is designed to mitigate adversarial gradient degradation during optimization, enabling attacks to better approximate high-distortion perturbations under fixed norm constraints. Through extensive experiments across multiple AE architectures, under both sample-specific and universal attacks, as well as standard and adaptive attack settings, we show that GRILL significantly increases attack effectiveness, thereby exposing vulnerabilities hidden by existing attack limitations. Beyond AEs, we provide preliminary evidence that modern multimodal encoder-decoder architectures exhibit similar vulnerabilities.

15.
arXiv (CS.CV) 2026-06-15

CausalMotion: Structured Physical Reasoning as Keyframe and Trajectory Guidance for Training-Free Video Generation

Recent advances in diffusion-based video generation have significantly improved visual quality and short-term temporal coherence. However, existing methods still struggle to produce videos with physically consistent and causally plausible dynamics, especially in scenarios involving long-horizon interactions. This limitation arises from the fact that video diffusion models primarily learn physical consistency implicitly, while vision-language models can directly model physical laws. Based on this idea, in this work, we propose CausalMotion, a training-free framework that injects explicit physical reasoning into video generation through structured intermediate representations. Our key idea is to decouple reasoning from generation by leveraging a vision-language model to decompose a text prompt into a sequence of causally consistent keyframes and object-centric motion trajectories. These representations are then aligned and integrated as soft constraints to guide a pretrained video diffusion model during inference. This design enables explicit modeling of object dynamics and causal transitions without requiring additional training or supervision. Extensive experiments show that our method consistently improves physical plausibility and temporal coherence, particularly in dynamics-intensive scenarios, while maintaining high perceptual video quality.

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

Nonlinear Two-Time-Scale Stochastic Approximation: A Sharp Phase Transition and How to Beat It

arXiv:2606.14488v1 Announce Type: cross Abstract: Recent finite-time analyses of nonlinear two-time-scale stochastic approximation show that under contractive assumptions the slow iterate $Y_k$ with stepsizes $\beta_k=\Theta(k^{-1})$ and $\alpha_k=\Theta(k^{-a})$, $a\in(1/2,1)$, generally satisfies a mean-square rate of order $k^{-a}$; decoupled $k^{-1}$ rates require strong local linearity. We identify a sharp regularity-dependent boundary. In a rate-determining normal form where the slow drift contains a locally linear leakage and a nonlinear remainder of order $1+\rho$ ($\rho\in[0,1]$), the uncorrected recursion satisfies \[ \mathbb{E}\|Y_k\|^2 \le C\bigl(k^{-1}+k^{-a(1+\rho)}\bigr), \] and a matching scalar Gaussian lower bound shows that the slower term is unavoidable without modifying the update. Thus the decoupled $k^{-1}$ rate is guaranteed for the uncorrected recursion exactly when $a(1+\rho)\ge 1$. This lower bound concerns only the naive update; it is not an information-theoretic obstruction. We demonstrate this by equipping the normal-form recursion with an auxiliary online bias estimator \[ M_{k+1}=M_k+\gamma_k(R(X_k)-M_k),\qquad \beta_k\ll\gamma_k\ll\alpha_k, \] and subtracting $M_k$ from the slow update. Under the same stability, moment, and remainder assumptions, the corrected recursion achieves $\mathbb{E}\|\widetilde Y_k\|^2=O(k^{-1})$ for every $\rho\in[0,1]$, including regimes where the uncorrected update provably suffers the slower rate. Finally, we prove localized transfer theorems that extend the phase-transition mechanism to general nonlinear TTSA in fast-manifold coordinates. The proofs are non-asymptotic and rely on two Abel-transform cancellations: one for the locally linear fast-error leakage, and one for the tracked nonlinear bias.

17.
arXiv (CS.AI) 2026-06-16

Constitutional Value Potentials: reading and steering internal priority margins in language models

arXiv:2606.15420v1 Announce Type: cross Abstract: A constitution tells a language model what to value, but little tells us whether it does. Adherence is judged from outputs, and output evidence is most fragile on value conflicts, where what matters is not which value a model mentions but which one it is willing to sacrifice. We provide evidence that this arbitration can be read from activations in a structured margin readout. We introduce Constitutional Value Potentials (CVP). For each value we learn a scalar potential from the hidden state: an internal pressure to preserve that value, supervised not by the prompt but by an independent judge's verdict on which value the model's own response actually preserved. The signed difference of two potentials is a priority margin. A constitutional clause becomes the claim that a margin stays positive, and a single monitor score flags when it does not. The monitor predicts conflict violations with AUROC up to 0.95, beats a strong hidden-state probe, and generalizes to held-out synthetic conflicts across three Qwen2.5 scales. The signal appears as the answer begins, from the prompt tail and first response token. Read this early, the same signal reveals whether an adversarial priority hack has actually pushed the model toward a violation, rather than only whether the prompt looks adversarial. The same directions also support intervention tests: under selected steering settings, moving along a value direction shifts judged trade-offs in the intended direction. Together, these results suggest that some constitution-relevant priorities are accessible as activation-space margins, rather than only as output behavior.

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

Counterfactual Optimization of Baseball Pitch Sequences and Estimation of Its Impact on Season-Level Statistics

arXiv:2606.17345v1 Announce Type: cross Abstract: Although pitch sequencing is a central topic in baseball analytics, previous studies have primarily focused on optimizing the final pitch within a single plate appearance, leaving the role of preceding setup pitches and their impact on long-term season-level performance insufficiently examined. To address these issues, this study conducted counterfactual analyses using MLB Statcast data. A Transformer-based machine-learning model was trained to predict whether a target pitch would result in an in-play outcome or swing-out. Counterfactual pitch sequences were then generated by replacing either the final pitch or the preceding setup pitch with alternative pitch types and locations while keeping the surrounding contextual information fixed. Optimal counterfactual selections were defined as those that minimized the predicted in-play probability, and their expected effects on pitchers' seasonal statistics were estimated using regression models linking model outputs to season statistics. The results suggest that the optimization of both final and setup pitches may substantially influence season-level performance, including improvements of more than 1.0 in K/9. The analyses also provided several practical insights, including velocity-band-specific effective locations, the importance of pitch commands, and the expansion of pitch-selection options through middle-velocity pitches. These findings quantitatively support the strategic importance of pitch sequencing in baseball.

19.
arXiv (quant-ph) 2026-06-11

Collective neutrino oscillations: Many-body non-forward effects and non-classicality

arXiv:2606.12404v1 Announce Type: cross Abstract: Neutrino evolution in dense astrophysical environments is typically described either within a quantum kinetic framework, which neglects the build-up of multi-body correlations, or through simplified many-body calculations that allow significant entanglement to develop. In this work, we compare these two approaches in a simple neutrino-gas configuration, with particular emphasis on the role of non-forward scattering processes. These effects are incorporated either through a collision term in the kinetic description, or by considering the full neutrino-neutrino many-body Hamiltonian. We highlight differences between the two descriptions in both their characteristic timescales and asymptotic behavior. Motivated by the natural suitability of quantum computing for many-body calculations, we further investigate the non-classicality of neutrino evolution, discussing Trotter error scaling, along with the associated costs of constructing quantum circuits in terms of entangling gates and non-Clifford gates. We find that the resources needed for neutrino many-body evolution are on the low end of typical high-energy physics problems and on the mid to high end with respect to quantum chemistry problems. For the full Hamiltonian, resource requirements increase relative to the truncated version. We emphasize the importance of efficient fermion-to-qubit encodings, which are essential for reducing the substantial computational resources required for such simulations.

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

Closed-loop discovery of out-of-distribution processing protocols by evolutionary search and uncertainty-aware learning

arXiv:2606.13859v1 Announce Type: cross Abstract: Many materials and chemical systems exhibit history-dependent responses, where functional outcomes are governed not only by final-state variables but by the time-dependent sequence of fields, temperatures, or chemical potentials applied during operation. Discovering new processing protocols is therefore a high-dimensional search problem in which the control variable is an entire waveform or sample history, and conventional strategies either remain confined to conservative interpolative families or become prohibitively measurement intensive. Here, a closed-loop workflow is introduced that couples evolutionary search over a compact waveform representation with uncertainty-aware deep kernel learning to generate, rank, and experimentally validate candidate protocols. Applied to ferroelectric thin films, with the scanning-probe tip-bias waveform as the protocol and the nonlinear electromechanical response as the reward, the workflow discovers waveform families that enhance nonlinearity by de-aging the film. Spatially resolved before/after measurements show that the best-performing waveforms selectively activate pre-existing, weakly pinned domain-wall segments, whereas the worst drive long-range irreversible switching. This framework reframes protocol tuning as out-of-distribution discovery, generalizable to synthesis and annealing trajectories, battery formation protocols, and other high-dimensional control problems.

21.
medRxiv (Medicine) 2026-06-11

Validity and Limitations of the Empatica E4 Wristband for Autonomic and Thermoregulatory Sleep Monitoring Against Concurrent Polysomnography: A Wearanize+ Dataset Study

The Empatica E4 wristband provides continuous multi-modal physiological monitoring including blood volume pulse (BVP), electrodermal activity (EDA) and skin temperature (TEMP) but its validity for sleep-stage-specific autonomic and thermoregulatory monitoring has not been systematically evaluated against concurrent polysomnography (PSG). Using the Wearanize+ dataset which provides synchronised PSG, Empatica E4, and Zmax EEG recordings from 100 home-recorded participants; a systematic validation of Empatica E4 physiological signals against PSG ground truth across five sleep stages was conducted. Of 100 participants, 92 had Empatica data; 69 met Zmax EEG signal quality criteria and formed the analysis sample. Heart rate (HR) from the pre-computed Empatica HR channel showed valid stage-specific patterns (Wake: 70.9 bpm, N3: 61.2 bpm) and moderate inter-device MeanNN correspondence with PSG ECG (Spearman r=0.35-0.42 across stages). Skin temperature showed the expected thermoregulatory pattern (Wake: 33.92C, N3: 35.48C) and is recommended for downstream analyses. Tonic EDA showed an inverted stage pattern attributable to wrist sweat accumulation during deep sleep, representing a known confound for wrist-worn EDA during sleep. Phasic EDA showed plausible patterns and may be used with caution. These findings establish a validated feature set for Empatica E4 sleep research and directly inform multimodal psychiatric biomarker studies using the Wearanize+ dataset.

22.
medRxiv (Medicine) 2026-06-22

Hyperlipidemia Pharmacotherapy in Skilled Nursing Facilities: A Real-World Evidence Study

Objectives: To estimate hyperlipidemia medication order prevalence and associated variables in U.S. skilled nursing facility (SNF) residents. Design: Retrospective, observational study. Setting and Participants: Electronic Health Record data from 447,080 SNF residents with a hyperlipidemia diagnosis identified in PointClickCare's Life Sciences clinical database (January-April 2025) were reviewed. Methods: The presence and absence of medication orders for hyperlipidemia treatments recommended by the American Heart Association were assessed. Descriptive analyses summarized demographic and clinical characteristics, and a modified Poisson regression model was used to estimate risk ratios for having a medication order, adjusting for demographic, clinical, and facility characteristics. Results: Overall, 83.3% of residents diagnosed with hyperlipidemia had at least one hyperlipidemia medication order. Statins were ordered by 96.2% of active order residents, while other medication classes i.e., omega-3 fatty acids, cholesterol absorption inhibitors, fibrates were less common (

23.
medRxiv (Medicine) 2026-06-11

Maternal deaths associated factors in the Conflict-Affected North West Region of Cameroon. Lessons from a cross-sectional survey

Background Maternal mortality is a significant global public health crisis, particularly in sub-Saharan Africa and conflict-affected regions. Cameroon's maternal mortality ratio is high at 406 deaths per 100,000 live births, while the ongoing Anglophone conflict has further exacerbated maternal healthcare delivery in the North West Region (NWR){middle dot} Despite the evidence-based interventions like partographs, obstetric kits, birth preparedness plans, and active management of the third stage of labour, implementation gaps persist across health facilities. Objective The study aimed to assess factors related to preventable maternal deaths in the NWR of Cameroon by exploring maternal health service usage, implementation of obstetric measures, demand-side challenges, accessibility barriers, and health system weaknesses. Methodology The study employed a quantitative descriptive cross-sectional survey design{middle dot} Data was collected with structured questionnaires from postpartum women and healthcare workers in selected health facilities and catchment communities in the NWR{middle dot} Also, a multistage sampling technique was adopted, and Cochran's formula generated a sample size of 109 respondents{middle dot} In addition, data were analysed using SPSS version 27 and Stata version 18, employing descriptive and inferential statistics. Results In this study, while 70{middle dot}64 percent of females attended at least 4 ANC visits, only 38{middle dot}53 percent met WHO ANC adequacy requirements. Facility delivery was 96{middle dot}33 percent, yet only 38{middle dot}46 percent received completed delivery plans. Conflict-related challenges affected access, with 44{middle dot}95 percent reporting insecurity-associated movement difficulties, while 44{middle dot}95 percent reported increased transportation expenses due to the conflict. Near-miss complications were reported among 27.52 percent of participants. Delivery record reviews indicated that obstetric kits were utilised in 81{middle dot}76 percent of deliveries, partographs were accessible in 86{middle dot}49 percent of records but correctly filled in just 60{middle dot}81 percent , while oxytocin administration was 95{middle dot}95 percent. Integrated Health Centres showed poorer adherence with intrapartum interventions compared with District and Regional Hospitals (p

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

CODA-BENCH: Can Code Agents Handle Data-Intensive Tasks?

Advanced agents are increasingly demonstrating the potential to operate as autonomous engineers, creating a growing demand for evaluation benchmarks that capture the complexity of real-world development. Such environments typically involve both complex code and large-scale data (i.e., file system). However, existing benchmarks usually evaluate code-centric or data-centric capabilities in isolation, leaving a clear gap with real development scenarios. In this paper, we bridge this gap by introducing CODA-BENCH, the first benchmark to jointly evaluate code and data intelligence in a data-intensive environment. We construct a data-intensive Linux sandbox based on the Kaggle ecosystem (containing hundreds of datasets), where agents must actively explore complex file hierarchies to identify relevant resources and generate code for data-driven analytical tasks. CODA-BENCH comprises 1,009 tasks spanning 31 communities, with each task environment containing an average of 980 files, simulating realistic data scale and noise. Evaluations of advanced agents reveal that even top-performing systems struggle to effectively integrate data discovery with code execution, achieving a success rate of only 61.1%. These results highlight a substantial gap in current agentic capabilities for data-intensive tasks and point to promising directions for future research.

25.
medRxiv (Medicine) 2026-06-16

Validating an Early Pregnancy HbA1c as the Screening Test for Gestational Diabetes Mellitus: Findings from PRISMA Pakistan Cohort

Background: Early identification of gestational diabetes mellitus (GDM) is critical to improving maternal and neonatal outcomes, particularly in resource-constrained settings where universal oral glucose tolerance testing (OGTT) is burdensome. We assessed whether early-pregnancy HbA1c alone or combined with common risk factors can predict GDM and reduce the burden of OGTT requirements in a peri-urban cohort in Karachi, Pakistan. Methods: We conducted a secondary analysis of the Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA) Pakistan cohort. Women enrolled before 20 weeks' gestation with available early-pregnancy HbA1c and a 2-hour 75g OGTT at 24 to 28 weeks were included. We externally validated GDM prediction models originally developed in the STRiDE-India cohort. Model performance was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC). We assessed four models: HbA1c alone (Model 1a); age, BMI, and family history of diabetes mellitus (FH DM) (Model 1b); HbA1c combined with age, BMI, and FH DM (Model 2); and an extended model, i.e., Model 2 combined with socioeconomic status, gestational age, parity, systolic and diastolic blood pressure (Model 3). A dual-threshold approach was applied to assess rule-in and rule-out performance. Results: Among 2,489 women, GDM incidence was 7.5% (n=186). Models with a broader set of predictors demonstrated higher AUC values, with Model 2 achieving an AUC of 0.61 (95% CI: 0.57, 0.66). Including additional factors (Model 3) did not further improve predictive ability (AUC: 0.62; 95% CI: 0.58, 0.66). In addition, at predefined thresholds, Model 2 achieved sensitivity of 73.7% (rule-out) and specificity of 83.5% (rule-in), with the potential to reduce OGTT requirements (58.5%). Conclusions: Early-pregnancy risk stratification using HbA1c combined with simple clinical predictors offers a pragmatic approach to streamline GDM screening among high-risk pregnant women. A dual-threshold strategy using Model 2 could reduce reliance on universal OGTT while prioritizing high-risk women for confirmatory testing.