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

Ouroboros-Spatial: Closing the Data-Model Loop for Spatial Reasoning

Spatial reasoning remains a persistent challenge for multimodal large language models (MLLMs). Existing approaches largely rely on large-scale, statically curated datasets, where all training samples are treated uniformly regardless of the model's evolving capabilities. This static paradigm is inherently data-inefficient: training capacity is often spent on samples that are either trivial or overly difficult for the model at its current stage. To address this limitation, we propose Ouroboros-Spatial, a self-evolving training framework in which the model plays dual roles as a proposer and a solver. In each iteration, a frozen proposer generates spatial question-answer (QA) pairs from 3D scene metadata and raw video frames, together with executable code for deriving reliable ground truth. A learnable solver is then fine-tuned on the accepted samples, and its per-sample prediction confidence is used as a difficulty signal. This signal is fed back to the proposer in the next iteration, guiding it to generate questions better matched to the solver's current capabilities. Through this closed-loop design, the training distribution co-evolves with model ability, reducing redundant trivial examples while filtering out ambiguous or uninformative samples with limited learning value. Across six spatial reasoning benchmarks, Ouroboros-Spatial substantially improves Qwen3-VL-4B and Qwen3-VL-8B while using an order of magnitude fewer training examples than recent large-scale curated datasets. On VSI-Bench, it yields absolute gains of 9.9 and 6.8 points for the 4B and 8B models, respectively, enabling both to outperform a wide range of strong open-source and proprietary baselines.

02.
arXiv (CS.AI) 2026-06-16

Why Low-Precision Transformer Training Fails: An Analysis on Flash Attention

arXiv:2510.04212v4 Announce Type: replace-cross Abstract: The pursuit of computational efficiency has driven the adoption of low-precision formats for training transformer models. However, this progress is often hindered by notorious training instabilities. This paper provides the first mechanistic explanation for a long-standing and unresolved failure case where training with flash attention in low-precision settings leads to catastrophic loss explosion. Our in-depth analysis reveals that the failure is not a random artifact but caused by two intertwined phenomena: the emergence of similar low-rank representations within the attention mechanism and the compounding effect of biased rounding errors inherent in low-precision arithmetic. We demonstrate how these factors create a vicious cycle of error accumulation that corrupts weight updates, ultimately derailing the training dynamics. To validate our findings, we introduce a minimal modification to the flash attention that mitigates the bias in rounding errors. This simple change stabilizes the training process, confirming our analysis and offering a practical solution to this persistent problem. Code is available at https://github.com/ucker/why-low-precision-training-fails.

03.
arXiv (CS.AI) 2026-06-18

Machine Unlearning for the XGBoost Model with Network Intrusion Datasets

arXiv:2606.19220v1 Announce Type: cross Abstract: Machine Unlearning (MU) has emerged as an important technique for removing specific data points from trained models without requiring full retraining. However, most existing MU research focuses on deep learning and image data, leaving a gap in the domain of network intrusion detection, which relies heavily on tabular data. This work introduces XGBoost-Forget, an unlearning approach for the XGBoost model, to address this gap. The approach is evaluated on two tabular Network Intrusion (NI) datasets, IoT-23 and GeNIS, using multiple metrics to assess model performance, unlearning efficiency, and forgetting quality. The results show that XGBoost-Forget maintains predictive performance close to the original model while providing significantly faster unlearning, demonstrating its potential for MU in tabular NI settings.

04.
medRxiv (Medicine) 2026-06-17

Characterizing the genetic basis of Cardio-Renal-Metabolic multimorbidity using multivariate genomic modelling

Cardio-renal-metabolic multimorbidity (CRMM) encompasses interrelated conditions affecting the heart, kidneys, and metabolic systems. Although the genetics of individual components are well studied, their shared architecture remains unclear. Here, we performed the largest multi-ancestry multivariate GWAS of CRMM across seven biobanks, including individuals of European (EUR; neff = 353,130), African (AFR; neff = 75,436), and East Asian (EAS; neff = 164,373) ancestry. We identified 287 lead loci in EUR, 30 in AFR, and 202 in EAS. Cross-ancestry analyses revealed ancestry-specific signals and 24 shared loci mapping to FTO and TCF7L2. Drug-repurposing highlighted candidates used for type 2 diabetes and hypertension. Mendelian randomization supported causal links with diverse diseases, while polygenic risk scores showed improved prediction across ancestries. Collectively, these findings advance understanding of CRMM genetics and inform precision medicine.

05.
arXiv (CS.CV) 2026-06-12

Multi-Label Test-Time Adaptation with Bayesian Conditional Priors

Multi-label recognition with frozen Vision-Language Models (VLMs) is brittle under distribution shift: standard zero-shot inference scores labels independently, ignoring co-occurrence structure and producing incoherent label sets where dominant concepts suppress weaker but compatible labels. We introduce Bayesian Conditional Priors (BCP) Estimation, a gradient-free test-time adaptation method that injects label dependency without tuning the backbone. BCP views zero-shot logits as a proxy for marginal posteriors under a fixed image-text likelihood and attributes shift-induced errors mainly to a mismatched label prior. For each test image, it selects a high-confidence anchor label and applies an anchor-conditioned Bayesian refinement. This update is closed-form in logit space and admits a pointwise mutual information (PMI) interpretation, explicitly promoting compatible labels and suppressing incompatible ones. BCP operates without target annotations by estimating anchor-conditioned priors online from the unlabeled test stream via lightweight second-order co-occurrence statistics, adding negligible overhead beyond a single forward pass. Across standard multi-label benchmarks and multiple CLIP backbones, BCP consistently outperforms strong TTA baselines, e.g., improving RN50 average mAP from 57.31 to 69.22 and ViT-B/16 from 62.61 to 71.79.

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

SafeLLM: Extraction as a Hallucination-Resistant Alternative to Rewriting in Safety-Critical Settings

Large language models (LLMs) are increasingly used to access organisational documentation, including standard operating procedures (SOPs), HR policies and institutional guidelines. However, retrieval-augmented generation (RAG) systems that rely on free-form rewriting can introduce hallucinations and unstable trade-offs between completeness and conciseness, particularly in safety- and compliance-critical settings. Objectives: To evaluate extraction as a hallucination-resistant alternative to rewriting-based RAG and compare strategies that balance precision, recall and safety across document types and model scales. Methods: We compare multiple prompting strategies, including line-number-based source selection, extraction of relevant guideline sentences with explicit safety annotations, and a multi-stage pipeline that refines draft answers using supporting evidence from source guidelines. Experiments are conducted on documents of varying length and structure, including local NHS acute care and oncology guidelines and UK-wide NICE guidelines, using both frontier-scale and locally deployable models. Performance is assessed using automatic metrics and human expert evaluation of relevance and completeness. Results: Line-number selection achieves the strongest results, outperforming direct copying and safety-focused strategies across both large and small models while maintaining high term recall (up to 95%) and close alignment with source text. Safety-oriented approaches improve precision but introduce systematic omissions, while multi-stage filtering further amplifies this trade-off. Performance varies with document structure: line-based extraction excels in protocol-like content, whereas alternative strategies perform better on more verbose documents (up to 97% term recall).

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

Fast Human Attention Prediction for Fixation-guided Active Perception in Autonomous Navigation

Human visual attention relies on structured scanpaths to efficiently process scenes, yet instilling this behavior into robot autonomy is in its infancy and hindered by the high,computational costs of existing predictive models. To address this, we introduce GazeLNN, a computationally lightweight,scanpath prediction model that leverages Liquid Neural Networks as its recurrent engine and employs MobileNetV3 for feature extraction. Operating auto-regressively, the architecture predicts sequential fixation heatmaps conditioned on the current visual stimulus and fixation history. Despite requiring only 0.61 GFLOPs, GazeLNN achieves state-of-the-art performance on the MIT Low Resolution dataset achieving 0.47 ScanMatch score. It outperforms existing recurrent baselines across diverse evaluation metrics, while reducing computational costs by 99.40% and accelerating inference by up to six times. To investigate the role of human attention modeling in robot autonomy and demonstrate the practical utility of this highly efficient architecture, we integrate GazeLNN into an active camera-robot control policy trained via Reinforcement Learning. This integration enables human-fixation-guided perception during autonomous navigation, validated through successful real-world deployments on an aerial robot.

08.
arXiv (quant-ph) 2026-06-11

Dynamically Optimal Unraveling Schemes for Simulating Lindblad Equations

arXiv:2509.19887v2 Announce Type: replace Abstract: Stochastic unraveling schemes are powerful computational tools for simulating Lindblad equations, offering significant reductions in memory requirements. However, this advantage is accompanied by increased stochastic uncertainty, and the question of optimal unraveling remains open. In this work, we investigate unraveling schemes driven by Brownian motion or Poisson processes and present a comprehensive parametric characterization of these approaches. For the case of a single Lindblad operator and one noise term, this parametric family provides a complete description for unraveling scheme with pathwise norm-preservation. We further analytically derive dynamically optimal quantum state diffusion (DO-QSD) and dynamically optimal quantum jump process (DO-QJP) that minimize the growth rate of the variance of an observable locally in time. Compared to jump process ansatz, DO-QSD offers two notable advantages: firstly, the variance for DO-QSD can be rigorously shown not to exceed that of any jump-process ansatz locally in time; secondly, it has very simple expressions. Numerical results demonstrate that the proposed DO-QSD scheme may achieve substantial reductions in the variance of observables and the resulting simulation error.

09.
arXiv (quant-ph) 2026-06-11

An Introduction to the Foundations and Interpretations of Quantum Mechanics

arXiv:2603.09818v2 Announce Type: replace Abstract: This article surveys a selection of key conceptual and interpretational developments in quantum mechanics, tracing the theory from its foundational postulates to contemporary discussions of measurement, nonlocality, and the emergence of classicality. Beginning with the structure of Hilbert space and the postulates governing state evolution and measurement, the epistemic stance of the Copenhagen interpretation and its modern reformulations are examined. The Einstein-Podolsky-Rosen argument, Bell's theorem, and Hardy's paradox are then discussed as probes of locality and realism, alongside the deterministic but explicitly nonlocal de Broglie-Bohm theory. The measurement problem and the implications of contextuality are analyzed in relation to objective collapse models, which introduce new physical dynamics to account for definite outcomes. Finally, the role of decoherence in the suppression of interference and the emergence of classical behavior is explored, together with the interpretational frameworks of many-worlds and consistent histories. This material aims to provide a coherent introductory overview of how several of the most prominent interpretations address the central concern of what quantum mechanics tells us about the nature of physical reality.

10.
arXiv (math.PR) 2026-06-12

Dimension-free Markov–Bernstein inequalities for product measures

作者:

arXiv:2606.13575v1 Announce Type: cross Abstract: We study dimension-free Markov–Bernstein inequalities for polynomials with respect to product probability measures. In the Gaussian case, for $p\ge4$, we prove that \[ \|\nabla f\|_{L^p(\gamma^n)} \le C(p)d^{\frac12+\theta_p} \|f\|_{L^p(\gamma^n)} \] for every polynomial $f$ of degree at most $d$, where $\theta_p\le \frac{2}{3p}$ and $\theta_p=0$ whenever $p$ is an even integer. Thus, for even integer exponents, we establish the sharp dependence on the degree conjectured by Eskenazis–Ivanisvili. For general $p\ge4$, the estimate improves upon their dimension-free inequality. We also obtain dimension-free Markov–Bernstein inequalities with sharp dependence on the degree for even integer exponents beyond the Gaussian setting. We first prove such estimates for the uniform distribution on the unit cube and then extend them to products of absolutely continuous measures with unimodal densities. Finally, we treat products of one-dimensional Freud measures with densities proportional to $e^{-|t|^{2m}}$.

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

Reversal Q-Learning

arXiv:2606.17551v1 Announce Type: cross Abstract: Iterative generative modeling techniques, such as flow matching, provide powerful tools to model complex behaviors for effective offline reinforcement learning (RL). In this work, we propose a new off-policy RL algorithm that trains a flow policy based on prior data. Our idea starts from the "expanded" Markov decision process (MDP) framework, which treats individual flow refinement steps as separate actions in an MDP. To enable off-policy RL within this framework, we apply two techniques: we generate virtual on-policy trajectories (by "reversing" flows) to make this framework compatible with prior data, and we apply a bias-and-variance reduction technique to mitigate the curse of horizon in off-policy RL. We call the resulting algorithm Reversal Q-learning (RQL). RQL has several advantages over previous flow-based RL methods: it does not suffer from backpropagation through time, makes better use of the learned value function, and directly trains the full, expressive flow policy. Through our experiments on 50 challenging simulated robotic tasks, we show that RQL leads to the best average offline RL performance compared to state-of-the-art flow-based offline RL algorithms.

12.
Nature Medicine 2026-06-08

Post-adjuvant chemotherapy in ctDNA-positive patients with resected colorectal cancer: a randomized phase 3 trial

Tumor-informed circulating tumor DNA (ctDNA) enables detection of molecular residual disease (MRD) after curative resection of colorectal cancer (CRC), but whether early intervention improves outcomes remains uncertain. ALTAIR was a randomized, double-blind, phase 3 trial embedded in the CIRCULATE-Japan platform evaluating a post-adjuvant ctDNA surveillance strategy with treatment initiation upon molecular recurrence. Patients with resected stage 0–IV CRC who became ctDNA positive after completion of standard-of-care therapy and had no radiological evidence of disease were randomly assigned (1:1) to receive trifluridine/tipiracil (FTD/TPI) or placebo for 6 months. The primary endpoint was investigator-assessed disease-free survival (DFS). Between July 2020 and June 2023, 243 patients were randomized to FTD/TPI (n = 122) or placebo (n = 121). Median DFS was 9.30 months with FTD/TPI and 5.55 months with placebo (hazard ratio = 0.79, 95% confidence interval: 0.60–1.05, P = 0.107), and the primary endpoint was not met. FTD/TPI increased grade 3 or higher hematologic adverse events (73.0% versus 3.3%) without new safety signals. These findings indicate that post-adjuvant intervention with FTD/TPI did not significantly improve DFS in ctDNA-positive patients without radiological disease. ClinicalTrials.gov identifier: NCT04457297 . In the randomized, double-blind phase 3 ALTAIR trial, patients with resected colorectal cancer who became positive for circulating tumor DNA during post-adjuvant surveillance received trifluridine/tipiracil hydrochloride therapy, which did not significantly prolong disease-free survival compared with placebo.

13.
arXiv (CS.CL) 2026-06-11

Goal-Autopilot: A Verifiable Anti-Fabrication Firewall for Unattended Long-Horizon Agents

作者:

Long-horizon LLM agents are not trusted to run unattended: with no human watching, they confidently report success they never verified. We treat honesty – bounding what an agent may claim at termination – as a first-class metric for unattended autonomy, distinct from capability. We present Autopilot, an execution model that makes silent fabricated success structurally impossible rather than merely rarer. Autopilot externalizes all working state into a durable, gated finite-state machine that a scheduler advances one stateless tick at a time; a hard floor forbids any terminal "done" claim whose falsifiable gate did not actually execute and pass. We prove a No-False-Success theorem – under gate soundness, floor enforcement, and plan coverage, termination implies the goal holds – whose only trust points are empirically measurable, and show the worst case degrades to an honest stall, never a fabricated success. Because each tick rehydrates only the state machine, per-step context cost is constant in the horizon. Across a 3,150-cell paired corpus (70 tasks $\times$ 3 systems $\times$ 3 models $\times$ 5 seeds, including 50 SWE-bench Lite tasks across 11 OSS repos), Autopilot fabricates on 0.95% of cells [95% CI 0.38–1.62] while Reflexion and StateFlow baselines fabricate on 8.10% [6.48–9.81] and 25.05% [22.48–27.62] respectively. The headline contrast lives in the hard regime: on SWE-bench Lite, the firewall reduces fabrication from 33.7% (StateFlow) to 0.67%, a paired difference of $-33.07$ pp [95% CI $-36.53, -29.73$]. The mechanism is the gate, not the model: all ten Autopilot fabrications come from the strongest model, while two weaker mid-tier models never fabricate across 700 paired cells. The firewall trades coverage for honesty by design – an honest stall is recoverable; a confident wrong output shipped downstream is not.

14.
arXiv (CS.CV) 2026-06-16

Label Shift Aware Adaptation for Online Zero-shot Learning with Contrastive Language-Image Pre-Training (CLIP)

Vision-language models like Contrastive Language-Image Pre-Training (CLIP) have been extensively studied in data-scarce scenarios. A particularly challenging and realistic task in this area is online zero-shot learning with CLIP, where unknown test samples are predicted sequentially in random order by CLIP while keeping the feature extraction and model parameters fixed during the sequential inference phase. Most existing approaches in this setting address the problem by adapting representations online using incoming test samples, while neglecting the distribution of the data on which CLIP was initially trained. This mismatch can lead to degraded performance when the label distribution in the test data differs from that of the training domain. To address this gap, we propose Label Shift Aware (LSA), which formulates the online zero-shot classification task as a domain adaptation problem. Specifically, LSA adapts the predictions computed by CLIP, which was trained on an unknown source distribution, to a target distribution using only unlabeled test data, and applies label shift correction to mitigate the mismatch between the source and target domains. The extensive experiments across multiple datasets demonstrate that the proposed LSA consistently outperforms state-of-the-art online zero-shot learning methods based on CLIP.

15.
arXiv (CS.LG) 2026-06-12

Physics-Informed Neural Networks and Radial Basis Functions for PDEs with Dirac Delta Sources

arXiv:2606.12735v1 Announce Type: new Abstract: Physics-Informed Neural Networks (PINNs) are a machine learning method for solving forward and inverse Partial Differential Equations (PDEs). When applied to PDEs with Dirac delta functions in the forcing terms, boundary conditions, or initial conditions, PINNs require approximating them with smooth surrogate functions, a practice that can introduce significant modeling errors. In this work, we exploit the interpretation of PINNs as Residual Least Squares (RLS) methods and show that this perspective enables direct treatment of Dirac delta terms by integrating the weak-form equation. Among RLS formulations other than PINN, we focus on the Radial Basis Function (RBF) expansion (also known as a single-layer RBF Network). We show that while integrating out the Dirac delta in PINNs causes residuals to fail to converge to zero, RBF-RLS consistently provides good forward and inverse solutions to transport problems. We explain this finding using the Neural Tangent Kernel (NTK) theory. We test both approaches on linear PDEs that represent groundwater flow and transport in porous media and rivers. We solve inverse problems to fit synthetic data, noisy synthetic data, and real-world measurements.

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

Lung-SRAD: Spectral-Aware Regularized Audio DASS with Dual-Axis Patch-Mix Contrastive Learning for Respiratory Sound Classification

arXiv:2606.11922v1 Announce Type: cross Abstract: Recent respiratory sound classification (RSC) studies largely rely on CLS-token driven self-attention architectures such as the Audio Spectrogram Transformer (AST). While effective at modeling global context, recent analyses suggest a low-pass filtering behavior that may reduce sensitivity to localized abnormal patterns. In this work, we investigate State Space Models (SSMs) as an alternative backbone for RSC. Using the Distilled Audio State Space model, we analyze intermediate representations through spectral response curves and observe stronger preservation of mid-to-high spatial-frequency components. Based on these observations, we introduce spectral-aware layer regularization using Gaussian convolution applied to selected layers. We further propose Dual-Axis Patch-Mix contrastive learning tailored to SSM-based audio models for robust representation learning. Experiments on the ICBHI benchmark show that our approach achieves 64.48% score, outperforming the AST baseline by 5%. Code is available at https://github.com/RSC-Toolkit/Lung-SRAD.

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

Fully Geometric Multi-Hop Reasoning on Knowledge Graphs with Transitive Relations

arXiv:2505.12369v2 Announce Type: replace Abstract: Multi-hop logical reasoning on knowledge graphs requires faithfully mapping the logical semantics to latent space. Current geometric embedding methods show to be useful on this task by mapping entities to geometric regions and logical operations to latent transformations. While a geometric embedding can provide a direct interpretability framework for query answering, current methods have only leveraged the geometric construction of entities, failing to map logical operations to pure geometric transformations and, instead, using neural components to learn these operations. On the other hand, purely neural-based methods outperform geometric methods, but they lack interpretability in the latent space. We introduce GeometrE, a geometric embedding method for multi-hop reasoning, that maps every logical operation to a purely geometric operation in the latent space. Additionally, we introduce a transitive loss function and show that, unlike existing methods, it can preserve the logical rule for all a,b,c: r(a,b) and r(b,c) -> r(a,c). Our experiments show that GeometrE outperforms current state-of-the-art geometric methods and remains competitive with existing neural-based methods on standard benchmark datasets.

18.
arXiv (CS.CL) 2026-06-16

Understanding LLM Reasoning for Abstractive Summarization

Reasoning has substantially improved Large Language Models (LLMs) on analytical tasks such as mathematics and code generation, but its value for abstractive summarization remains unclear. To address this gap, we adapt general reasoning strategies to the summarization setting and conduct a large-scale comparative study of 8 reasoning strategies and 3 Large Reasoning Models (LRMs) across 8 diverse datasets, evaluating both summary quality and factual faithfulness. Our results show that reasoning is not a universal solution and its effectiveness depends strongly on the strategy and the summarization setting. In particular, we find a trade-off between summary quality and factual faithfulness. Explicit reasoning strategies often improve reference-based quality, but may weaken factual grounding, whereas implicit reasoning in LRMs shows the opposite tendency. We further find that increasing an LRM's internal reasoning budget does not reliably improve summarization and can even reduce factual consistency. These findings suggest that, for summarization, more reasoning is not always better. Effective reasoning should preserve faithful compression rather than induce over-elaboration. Our source code is publicly available.

19.
arXiv (math.PR) 2026-06-19

Asymptotic properties for fully coupled delayed forward-backward stochastic differential equations

arXiv:2606.19925v1 Announce Type: new Abstract: We investigate the asymptotic behavior of solutions to a class of fully coupled forward-backward stochastic differential equations with time-delayed generators. Such systems arise naturally in stochastic models with memory effects and constitute a significant extension of the classical fully coupled FBSDE framework. The presence of delay introduces additional analytical difficulties due to the dependence of the coefficients on the past trajectories of the solution processes and the resulting non-Markovian structure. Under suitable assumptions on the coefficients, we study the asymptotic properties of a perturbed delayed FBSDE driven by a small noise parameter. We first establish the convergence in distribution of the associated solution processes as the perturbation parameter tends to zero. We then prove almost sure convergence towards the solution of the corresponding deterministic limiting system. As a consequence of these asymptotic results, we derive a large deviation principle for the solution processes. Our results extend the asymptotic analysis of Cruzeiro, Gomes and Zhang (2014) from the classical fully coupled FBSDE setting to the delayed framework, and complement existing works on weakly coupled delayed forward-backward systems. They provide, to the best of our knowledge, the first large deviation principle for fully coupled forward-backward stochastic differential equations with delayed generators.

20.
arXiv (CS.AI) 2026-06-17

A homotopy-type-theoretic generalization of neurosymbolic inference

arXiv:2606.17851v1 Announce Type: new Abstract: A wide range of neurosymbolic (NeSy) systems compute one functional: a belief-weighted sum of a logical quantity over a space of $\sigma$-structures, of which weighted model counting, fuzzy logic, and probabilistic logic are special cases. This account is built on sets, and a set deliberately forgets two things that are important for NeSy: when two $\sigma$-structures are the same up to a symmetry of the theory, and how many distinct proofs witness a query. Replacing the underlying sets by types, in the sense of homotopy type theory, preserves this information, and turns this functional into a belief-weighted homotopy cardinality, a notion of size that counts each object in inverse proportion to its symmetries. We develop the framework from scratch for NeSy systems, prove a conservativity theorem that recovers the classical functional when symmetries are trivial, and show that the symmetry our framework exposes is exactly the one behind reasoning shortcuts. The payoff is concrete: the shortcut-aware concept posterior that recent methods reach by ensembling or expressive density estimation is the only symmetry-invariant point of the confusion-set simplex, computable in closed form by averaging a single model over the symmetry group. On MNIST reasoning-shortcut benchmarks this single-model wrapper is better calibrated than a diversity-trained ensemble, while leaving label accuracy and identifiable concepts untouched. Code is freely available at https://github.com/bio-ontology-research-group/hott-nesy.

22.
medRxiv (Medicine) 2026-06-12

The Acceptability of Three Co-Created Peer Support Interventions for People Living with Leprosy Reactions in Indonesia: A Mixed-Methods Pilot Study

Background: Leprosy reactions (LR) are immune-mediated complications associated with disability, emotional distress, and social isolation. We identified a gap in affected-individual-informed interventions that aim to improve the management of LR in healthcare settings. To address this gap, we assessed the acceptability of three peer-support interventions co-created with people affected by LR in Indonesia. Methods: Using an interactive learning and action approach, we co-created peer counselling, telesupport groups, and participatory video interventions which were piloted in an urban hospital and 13 rural community clinics. A mixed-methods design was applied with interviews, focus group discussions, and pre-post assessments involving four participant groups. Data were analyzed thematically using an acceptability framework. Results: One hundred participants were enrolled, and 92 completed the pilot intervention between November 2022 and July 2023. Qualitative findings showed that all interventions were acceptable. Peer counselling provided emotional reassurance through shared experiences and was perceived as trustworthy and supportive. Perceived burdens differed by setting, with time constraints in urban facilities and geographical barriers in rural clinics. Knowledge improved significantly among participants of peer counselling and telesupport groups in rural settings. Telesupport groups facilitated connection, information exchange, and continuity of care. Digital access and literacy limited participation for some, particularly in rural areas. The participatory video was perceived as reassuring and informative. Improvements in knowledge, attitude, practices, and mental well-being domain scores were observed among urban participants, but responses in rural settings showed less change. Participants and co-implementers reported increased self-efficacy, participants confidence to perform required behaviors within peer support interventions, with effects shaped by intervention and setting. Conclusions: The three co-created peer-support interventions were acceptable for individuals with LR in diverse healthcare settings. These outcomes highlight the importance and effectiveness of selective, and context-sensitive implementation of one or more peer-support modalities.

23.
medRxiv (Medicine) 2026-06-18

Hospital-Level Variation in Antenatal Corticosteroids for Late Preterm Births

Objective: To determine whether and to what extent hospitals across the United States vary in their use of late-preterm steroids using a novel data set in which the timing of steroid administration relative to delivery can be observed. Methods: This was a retrospective cohort study of singleton births with known gestational ages identified in the Premier Healthcare Database from 2015 to 2022. The primary variable of interest was hospital-level adoption of antenatal corticosteroids for late-preterm singleton deliveries, calculated as the proportion of late-preterm singleton births (34-36 completed weeks of gestation) with any betamethasone exposure during the same late-preterm period. Hospital adoption was defined as the weighted average rate of ALPS administration among late-preterm infants across the entire post-period. Hospitals were ranked by their late-preterm steroid adoption rates and categorized by quartile based on the empirical distribution. Temporal trends were assessed using annual hospital-level adoption rates and visualized using time-series plots and distributional plots. A logistic regression model was constructed to determine hospital characteristics associated with being a highest-quartile adopting hospital. Results: The analysis cohort included 728 hospitals and 5,452,791 births, of which 361,006 (6.6%) were singleton late preterm births. Hospital steroid exposure rates ranged from 0 to 82% and were categorized into quartiles based on overall exposure rate, with cutoffs at 20.6%, 29.8%, and 40.1%. Median exposure rates increased progressively across quartiles from 14.1% (IQR 9.3-17.4%) in the lowest adopting hospitals (Q1) to 47.6% (IQR 43.7-53.2%) in the highest adopting hospitals (Q4), with substantial within-quartile variation. In the multivariable model, urban location was a strong predictor of high adoption after adjustment (aOR 2.05; 95% CI 1.11-3.83, p=0.02). Compared to Midwest hospitals, Southern hospitals had significantly lower odds of being high adopters (aOR 0.37; 95% CI 0.20-0.69, p

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

MedicalAgentsBench for Complex Medical Reasoning: Comparing Internalized Reasoning Models versus Externalized Agent-based Frameworks

Complex medical reasoning requires integrating heterogeneous clinical evidence across multiple inference steps. Large language models (LLMs) now approach this through two routes: internalized reasoning and externalized agent scaffolding (frameworks that decompose problems collaboratively amongst multiple LLMs). To determine whether these routes are exclusive or complementary, we introduce MedicalAgentsBench, a filtered benchmark of 862 complex clinical questions drawn from the union of eight medical datasets via difficulty-aware curation and contamination screening. Evaluating three internalized reasoning models (DeepSeek-R1, o1-mini, and o3-mini), seven base models, and nine externalized agent-based methods, we find that internalized and externalized approaches each independently improve performance, and that their benefits compound: the highest accuracy is achieved by layering agent workflows onto an internalized reasoning model (i.e., o3-mini + MDAgents with 35.1%). Pareto analysis shows this combination dominates the cost-performance frontier; moreover, lightweight optimization on inexpensive models offers an entry point for resource-constrained settings. Our benchmark is at https://github.com/gersteinlab/MedicalAgentsBench.

25.
arXiv (quant-ph) 2026-06-12

Coupling-Grouped XY-QAOA for Joint Anomaly-Feature Selection

arXiv:2606.13244v1 Announce Type: new Abstract: Selecting anomalous samples and explanatory features under fixed budgets defines a coupled constrained-optimization problem. Sequential feature-first selection ranks features before choosing samples, which can overlook features whose utility depends on which samples are selected, especially when scores are calibrated from reference data that may be limited, noisy, or drifting. We instead formulate the task as joint sample-feature selection under the same fixed counts. In the analyzed formal model, calibration-error sensitivity grows linearly with the number of samples for feature-first ordering but stays constant for joint selection. We introduce Coupling-Grouped XY-QAOA, a constraint-preserving grouped-angle variant for the resulting optimization problem. On matched sparse IBM Heron R3 benchmarks, a hardware-aware implementation reduces circuit depth by 45.9%-61.3% and two-qubit gates by 2.6%-5.2% relative to Qiskit optimization level 3 on the CZ-basis target. It enables, to our knowledge, the largest reported width-depth configurations for constraint-preserving bipartite-selection QAOA hardware executions with feasible-sector retention: 64 qubits at p=2 and 36 qubits at p=3. The 20-qubit p=5 runs retain 63% valid samples. Across 36-64 qubits, fixed-angle runs yield lower-energy feasible samples than matched random-feasible sampling. Warm starts reduce the gap to strict-feasible classical references by 57.5%-80.5%, and near-budget repair matches the sparse classical reference at 36 qubits. Benchmarks show gains in balanced fixed-budget regimes, and noiseless simulations show that problem-structured angle grouping improves over same-depth XY-QAOA and matched-parameter, type-preserving randomization controls. Overall, the results support calibrated joint selection and hardware-realizable constrained-mixer execution in the tested regimes.