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01.
arXiv (CS.CL) 2026-06-18

Improving Medical Communication using Rubric-Guided Counterfactual Recommendations

Text-based telemedicine increasingly relies on lightweight patient feedback, however, such feedback primarily reflects perceived communication quality rather than medical accuracy. We introduce an LM-guided counterfactual recommendation pipeline that discovers and refines interpretable communication features such as tone, personalization, actionability and completeness in addressing patient concerns, without interfering with the medical content. These features are used together with patient-doctor interaction metadata to estimate positive feedback. At inference time, the system searches over low-cost ordinal feature changes and recommends minimal communication changes predicted to increase the probability of positive feedback, while independent auditor models test whether these gains generalize beyond the selection model. Across interactions, recommendations yield a mean +6.41% gain in predicted positive feedback probability under independent auditors, and are non-negative for 93.31% of recommendations. These results suggest that small, interpretable communication changes can capture most predicted gains while preserving the doctor's control over medical reasoning and final wording.

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

Filtered Conformal Ellipsoids for Graph-Native Time Series

arXiv:2606.17014v1 Announce Type: new Abstract: Joint prediction sets for multivariate time series should control a single event while adapting to cross-coordinate dependence. We study filtered conformal ellipsoids: a frozen state-space filter emits a one-step predictive mean and covariance, and split-conformal calibration is applied to the resulting Mahalanobis scores. The filter is used to choose the ellipsoid shape; conformal calibration chooses the scalar radius, so the construction benefits from a learned predictive covariance without relying on Gaussian tail probabilities for coverage. The main difficulty is that filtered scores are dependent and learned recurrent filters need not contract in their raw hidden state; we therefore analyse contraction in an observable predictive-law quotient that identifies hidden states producing the same future sequence of emitted Gaussian laws. Under a stable Bayes Gaussian-projection filter, covariance bounds, and a finite-horizon observability Fisher condition, small excess Gaussian negative log-likelihood implies contraction of the learned emitted laws. Combined with a threshold-autocovariance envelope this yields a Chebyshev-type approximate coverage bound for filtered split-conformal prediction under dependence; a sharper Bernstein-type bound requires an additional geometric-mixing concentration assumption. Under Gaussian oracle realisability we also obtain a near-oracle log-volume comparison within the class of conditionally valid Gaussian ellipsoid rules. We instantiate the framework with a GCN-GRU filter with diagonal-plus-low-rank covariance. On moderate-size graph-native traffic benchmarks (METRLA-$20$ and PEMSBAY-$50$), the learned filter gives sharper at-target ellipsoids than static-covariance and non-filter baselines; at full-graph scale and on non-graph-native datasets, factor and copula baselines can be stronger.

04.
arXiv (quant-ph) 2026-06-11

Fabricating fiber cavity mirror substrates compatible with high coupling efficiency

arXiv:2606.12168v1 Announce Type: cross Abstract: Fiber optical cavities offer small mode volumes and correspondingly strong light-matter interactions in an open Fabry-Perot geometry. However, existing fabrication techniques do not reliably produce substrates with surface profiles amenable to high mode matching between the cavity mode and fiber core, thereby limiting the achievable collection efficiency. Here we present a technique to fabricate fiber mirror substrates while using $in situ$ reflectometry to constrain the achievable mode matching prior to coating. By measuring the back-reflection from freshly cleaved fiber tips, we pre-select 138 fibers compatible with 96.5-99.5% mode matching, and after a single CO$_2$ laser ablation pulse, these fibers remained compatible with 95.3-99.2\%. This simple technique provides rapid feedback during each stage of substrate fabrication, greatly enhancing the yield of viable fiber mirror substrates prior to (expensive) coating runs.

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

Steady-State Noise Signatures of Lindbladian Exceptional Points

arXiv:2606.13377v1 Announce Type: new Abstract: Exceptional points (EPs) are non-Hermitian degeneracies at which two or more eigenvalues and their corresponding eigenvectors coalesce. In open quantum systems, exceptional points can arise in the Lindbladian governing the dissipative dynamics. Their signatures have so far been mainly identified in finite-time observables, such as transient currents, while steady-state average currents generally provide no direct evidence of the underlying exceptional-point structure. In this work, we demonstrate that signatures of Lindbladian EPs can nevertheless be accessed in the steady-state regime through current noise. We derive general expressions for current correlation functions within a Lindblad master-equation framework and show, in particular, how exceptional points affect their behaviour as a function of the time delay. We illustrate these results with the paradigmatic example of two interacting qubits coupled to two reservoirs, where the steady-state noise clearly distinguishes overdamped, underdamped, and critical regimes. Our results establish current correlation functions as a steady-state probe of Lindbladian EPs in open quantum systems.

07.
arXiv (CS.CV) 2026-06-12

On the Reliability of Cue Conflict and Beyond

Understanding how neural networks rely on visual cues offers a human-interpretable view of their internal decision processes. The cue-conflict benchmark has been influential in probing shape-texture preference and in motivating the insight that stronger, human-like shape bias is often associated with improved in-domain performance. However, we find that the current stylization-based instantiation can yield unstable and ambiguous bias estimates. Specifically, stylization may not reliably instantiate perceptually valid and separable cues nor control their relative informativeness, ratio-based bias can obscure absolute cue sensitivity, and restricting evaluation to preselected classes can distort model predictions by ignoring the full decision space. Together, these factors can confound preference with cue validity, cue balance, and recognizability artifacts. We introduce REFINED-BIAS, an integrated dataset and evaluation framework for reliable and interpretable shape-texture bias diagnosis. REFINED-BIAS constructs balanced, human- and model- recognizable cue pairs using explicit definitions of shape and texture, and measures cue-specific sensitivity over the full label space via a ranking-based metric, enabling fairer cross-model comparisons. Across diverse training regimes and architectures, REFINED-BIAS enables fairer cross-model comparison, more faithful diagnosis of shape and texture biases, and clearer empirical conclusions, resolving inconsistencies that prior cue-conflict evaluations could not reliably disambiguate.

08.
arXiv (CS.AI) 2026-06-11

Conformal Risk-Averse Decision Making with Action Conditional Guarantee

arXiv:2606.05551v2 Announce Type: replace-cross Abstract: Reliable decision making pipelines powered by machine learning models require uncertainty quantification (UQ) methods that come with explicit safety guarantees. Conformal prediction provides such UQ by wrapping ML predictions into prediction sets, and recent work by Kiyani et al. (2025b) established that these sets can be translated into optimal risk-averse decision policies – yet only inheriting marginal safety guarantees. We generalize and strengthen their results by (i) introducing action-conditional conformal prediction, which yields safety guarantees conditioned explicitly on each action taken by the decision maker, (ii) showing that action-conditional prediction sets serve as a proxy for the feasible decision space for risk-averse decision makers aiming to optimize action-conditional value-at-risk, and (iii) proposing a principled finite-sample algorithm based on pinball-loss minimization, connecting the framework of Gibbs et al. (2025) to action-conditional guarantees. Experiments on two real-world datasets confirm that our approach significantly improves action-conditional performance over conformal baselines.

09.
arXiv (quant-ph) 2026-06-15

Compact graphs and quantum automorphisms

arXiv:2606.13928v1 Announce Type: new Abstract: Compact graphs are graphs for which the fractional automorphism polytope has no genuinely fractional vertices. This paper proposes a quantum analogue of this idea by evaluating the fundamental magic unitary of the quantum automorphism group on states, which we show to produce a closed convex set of doubly stochastic matrices sitting between the classical automorphism polytope and the full fractional automorphism polytope. Our main result is that the natural quantum analogue of compactness is classical, that is, a quantum compact graph is classically compact. We also relate this set to the quantum orbital algebra and obtain a hierarchy of classical and quantum compactness pseudo notions. The framework recovers familiar consequences of compactness through commutants and suggests quantum analogues of generous transitivity and distance-transitivity. We also isolate examples and open problems indicating where quantum symmetries may strictly refine the classical compactness theory.

10.
arXiv (CS.CV) 2026-06-16

From Static Inference to Dynamic Interaction: A Survey of Streaming Large Language Models

Standard Large Language Models (LLMs) are predominantly designed for static inference with pre-defined inputs, which limits their applicability in dynamic, real-time scenarios. To address this gap, the streaming LLM paradigm has emerged. However, existing definitions of streaming LLMs remain fragmented, conflating streaming generation, streaming inputs, and interactive streaming architectures, while a systematic taxonomy is still lacking. This paper provides a comprehensive overview and analysis of streaming LLMs. First, we establish a unified definition of streaming LLMs based on data flow and dynamic interaction to clarify existing ambiguities. Building on this definition, we propose a systematic taxonomy of current streaming LLMs and conduct an in-depth discussion on their underlying methodologies. Furthermore, we explore the applications of streaming LLMs in real-world scenarios and outline promising research directions to support ongoing advances in streaming intelligence. We maintain a continuously updated repository of relevant papers at https://github.com/EIT-NLP/Awesome-Streaming-LLMs.

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

InfoNCE Induces Gaussian Distribution

arXiv:2602.24012v2 Announce Type: replace Abstract: Contrastive learning has become a cornerstone of modern representation learning, allowing training with massive unlabeled data for both task-specific and general (foundation) models. A prototypical loss in contrastive training is InfoNCE and its variants. In this work, we show that the InfoNCE objective induces Gaussian structure in representations that emerge from contrastive training. We establish this result in two complementary regimes. First, we show that under certain alignment and concentration assumptions, projections of the high-dimensional representation asymptotically approach a multivariate Gaussian distribution. Next, under less strict assumptions, we show that adding a small asymptotically vanishing regularization term that promotes low feature norm and high feature entropy leads to similar asymptotic results. We support our analysis with experiments on synthetic and CIFAR-10 datasets across multiple encoder architectures and sizes, demonstrating consistent Gaussian behavior. This perspective provides a principled explanation for commonly observed Gaussianity in contrastive representations. The resulting Gaussian model enables principled analytical treatment of learned representations and is expected to support a wide range of applications in contrastive learning.

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

FrameOracle: Learning What to See and How Much to See in Videos

Vision-language models (VLMs) advance video understanding but operate under tight computational budgets, making performance dependent on selecting a small, high-quality subset of frames. Existing frame sampling strategies, such as uniform or fixed-budget selection, fail to adapt to variations in content density or task complexity. To address this, we present FrameOracle, a lightweight, plug-and-play module that predicts both (1) which frames are most relevant to a given query and (2) how many frames are needed. FrameOracle is trained via a curriculum that progresses from weak proxy signals, such as cross-modal similarity, to stronger supervision with FrameOracle-41K, the first large-scale VideoQA dataset with validated keyframe annotations specifying minimal sufficient frames per question. Extensive experiments across five VLMs and six benchmarks show that FrameOracle reduces 16-frame inputs to an average of 10.4 frames without accuracy loss. When starting from 64-frame candidates, it reduces inputs to 13.9 frames on average while improving accuracy by 1.5%, achieving state-of-the-art efficiency-accuracy trade-offs for scalable video understanding.

13.
bioRxiv (Bioinfo) 2026-06-17

DesignMaster: A Multi-Conditional Diffusion Framework for Rational PROTAC Design

Motivation: Proteolysis-targeting chimeras (PROTACs) enable targeted protein degradation through ternary complex formation with E3 ubiquitin ligase. However, the rational design of PROTACs remains highly challenging due to limited structure-activity relationship data and the vast conformational diversity of linkers. Existing computational approaches can be broadly divided into structure-based ternary modelling methods and fragment-based linker generation models. Although these approaches have advanced PROTAC design, they typically neglect key physicochemical constraints and linker-length control during the generation process, causing the generated PROTACs to lack balanced structural properties required for effective ternary complex formation with drug-like characteristics. Results: To address these limitations, we propose DesignMaster, a diffusion-based generative framework that explicitly incorporates linker length and physicochemical properties as controllable conditioning signals. DesignMaster employs an E(3)-equivariant graph Transformer with a gated multi-condition fusion module to inject linker length and physicochemical constraints throughout the diffusion process, enabling fine-grained and constraint-aware molecular generation. Experiments on PROTAC-DB 2.0 and 3.0 demonstrate that DesignMaster outperforms state-of-the-art baselines, with a 3.2% improvement in validity and a 34.4% improvement in recovery. The Case study shows DesignMaster achieves a 51.78% reduction in RMSD when predicting the linker of PROTAC BCPyr targeting 6W7O, highlighting its potential for practical structure-guided PROTAC design. Availability: The source code and datasets are available at https://github.com/ABILiLab/DesignMaster.

14.
arXiv (CS.CV) 2026-06-12

InterleaveThinker: Reinforcing Agentic Interleaved Generation

Recent image generators have demonstrated impressive photorealism and instruction-following capabilities in single-image generation and editing. However, constrained by their architectures, they cannot achieve interleaved generation (text-image sequence), which has crucial applications in visual narratives, guidance, and embodied manipulation. Even the latest open-source Unified Multimodal Models (UMMs) exhibit limited performance in this regard. In this paper, we introduce InterleaveThinker, the first multi-agent pipeline designed to endow any existing image generator with interleaved generation capabilities. Specifically, we employ a planner agent to organize the image-text input sequence, instructing the image generator on the required execution at each step. Subsequently, we introduce a critic agent to evaluate the generator's outputs, identify samples that deviate from the planned instructions, and refine the instructions for regeneration. To implement this pipeline, we construct the Interleave-Planner-SFT-80k and Interleave-Critic-SFT-112k to perform a format cold-start. Then we develop Interleave-Critic-RL-13k to reinforce the step-wise instruction correction capability within a generation trajectory using GRPO. Since a single interleaved generation trajectory may involve over 25 generator calls, optimizing the entire trajectory is computationally impractical. Therefore, we propose accuracy reward and step-wise reward, allowing single-step RL to effectively guide the entire generation trajectory. The results show that InterleaveThinker improves performance across various image generators. On interleaved generation benchmarks, it achieves performance comparable to Nano Banana and GPT-5. Surprisingly, it also significantly enhances the base model on reasoning-based benchmarks; for example, on 4-step FLUX.2-klein, we observe substantial gains on WISE and RISE.

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

VLADriveBench: Evaluating CoT-Action Relationship in VLA for Autonomous Driving

Vision-language-action (VLA) models generate chain-of-thought (CoT) reasoning alongside driving trajectories, but existing benchmarks evaluate only trajectory quality and do not assess whether the CoT is relevant, consistent, or causally connected to the driving action. We introduce VLADriveBench, a framework that combines observational metrics (mentioning, hallucination, contradiction, action alignment) with a CoT intervention protocol to provide complementary views of the CoT-action relationship. Applying VLADriveBench to three models across two architectures, we find that the two analyses can diverge sharply: ORION scores highest on observational alignment yet its CoT is epiphenomenal, while Alpamayo v1.5 scores lower yet its CoT is strongly causal, with visual salience gating the extent of CoT influence.

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

AI Contagion in Social Networks

arXiv:2606.15206v1 Announce Type: cross Abstract: We study how artificial intelligence (AI) interacts with social communication networks to shape the stability of collective knowledge. Agents exchange information through a network while receiving AI-generated content, and AI systems retrain on the aggregate social information they influence. This interaction generates two feedback forces: an AI contagion channel, through which distortions diffuse across the network, and an AI social distortion multiplier, through which retraining amplifies past errors. Despite the high dimensionality of the environment, we show that the long-run behavior of the system admits a two-dimensional representation whose spectral radius determines whether AI-mediated information systems are dynamically stable or unstable. We characterize a sharp regulatory frontier identifying the minimum filtering required for stability and show how network topology shapes systemic informational risk.

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

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

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

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

Imbalanced Classification under Capacity Constraints

arXiv:2605.03289v2 Announce Type: replace-cross Abstract: Detecting observations from a minority class under severe class imbalance is a central challenge in applications such as fraud detection, medical screening, and industrial quality control. In these settings, each positive prediction triggers a costly follow-up action, an MRI scan, a transaction audit, whose execution is subject to real operational constraints. This paper proposes a formal classification framework under capacity constraints: given a user-defined bound limit $b$ on the proportion of observations that can be labeled as belonging to the minority class, the goal is to find the classifier that maximizes sensitivity on that class. We characterize the optimal classifier under this constraint and establish its equivalence with the classical Bayes classifier under a reweighting of the prior probabilities. We also introduce a capacity-adjusted performance metric $M$ that accounts for the effective detection rate when the capacity constraint is binding. The framework is implemented on top of standard learning methods, k-NN, SVM, random forests, and neural networks, and statistical consistency is established for each. We further show that these methods reduce to post-hoc thresholding when no hyperparameters are oriented toward the capacity-constrained objective, and introduce a capacity-aware support vector machine that exploits the constraint during training and achieves the strongest empirical performance. Experiments on the Taiwanese credit card default dataset confirm that capacity-constrained classifiers substantially outperform both classical approaches and SMOTE under high imbalance regimes. The framework extends naturally to multiclass settings and online environments.

19.
medRxiv (Medicine) 2026-06-16

Fidelity-Derived Quantum Dissimilarity-Enhanced k-Nearest Neighbor Algorithm for Arterial Hypertension Prediction

We present a quantum-enhanced version of the classic k-Nearest Neighbors (kNN) classification algorithm, applied to the prediction of arterial hypertension. The traditional Euclidean distance metric of the kNN algorithm is replaced with a Fidelity-derived quantum dissimilarity measure to evaluate the similarity between data samples. We map classical real-world clinical and ECG-derived data features into quantum states via the Dense-Angle Encoding, which efficiently utilizes parameterized rotation gates to pack multiple features into minimal qubits while maintaining pure states. We evaluate the performance of the dissimilarity measure using both the noiseless state vector Simulator and the IBM Qiskit Estimator primitives. The quantum circuit demonstrates robust predictive capabilities comparable to the classical model. While it does not claim computational supremacy over the classical baseline, the framework proves that fidelity-based similarity is a physically meaningful and efficient approach for hybrid quantum classical classification.

20.
arXiv (CS.CV) 2026-06-16

Double-Helix Vision (DH-V2): A Geometry-Based Visual Sampler for Bandwidth-Constrained Perception

作者:

We present Double-Helix Vision (DH), a geometry-based visual sampler that compresses 2D images into compact 1D signals using paired golden-ratio-inspired spiral trajectories. Rather than processing every pixel uniformly, DH employs two phase-shifted helices (Alpha and Beta, offset by 180 degrees) to sample the image with biologically-inspired foveation: high density at the center, sparse coverage at the periphery. At 4K resolution, DH achieves a 1,433x compression ratio (99.93% reduction) while preserving the geometric structure of the scene. The full perception pipeline – including spatial mapping, temporal collision detection, and intra-frame structural disparity estimation – runs in 0.52 ms at 1080p on CPU-only hardware, with no neural network dependencies. On CIFAR-10 at extreme sampling budgets (K=128 points per helix), DH achieves a +6.03% accuracy gain over uniform random sampling. A JSON-serializable Robotics API is provided, delivering sub-millisecond spatial perception reports in 2.7 KB packets. Code and benchmarks are available under the MIT License.

21.
arXiv (CS.CL) 2026-06-12

LEDGER: A Long-Context Benchmark of Corporate Annual Reports for Grounded Financial Retrieval and Extraction

Finance reporting is a natural proving ground for large language models, and the very-long-context capabilities of recent models across all sizes make rigorous evaluation in this domain an increasingly pressing need. Yet most public financial resources reduce the task to plain-text SEC 10-K filings paired with a handful of question-answer items. We release LEDGER (Long-context Evaluation of Documents for Grounded Extraction and Retrieval), a corpus of 4,999 digitized corporate annual reports - full documents with figures, tables, and narrative, not just regulatory filings. Each report is labeled with 31 consolidated financial KPIs to be extracted and linked to the market's reaction at the earnings date. From this data we derive three evaluation benchmarks spanning the difficulty spectrum: a pure page-level KPI retrieval task with TREC-style relevance judgments over 118,048 questions in natural language, a conversational "needle-in-a-haystack" single-value lookup, and a full KPI extraction task, both from long, numerically dense reports. We additionally provide human OCR-quality annotations with inter-annotator agreement and the complete extraction, validation, and scoring toolchain. We further demonstrate the dataset's research utility with a case study linking CEO-letter rhetoric to post-publication market impact.

22.
bioRxiv (Bioinfo) 2026-06-15

SMLMFlow: Improving Structural Resolution in Single Molecule Localization Microscopy with Flow Matching

While Single Molecule Localization Microscopy (SMLM) aims to generate precise coordinates of molecular targets in cells, the resulting point clouds are inherently blurred by additive noise sources across the experimental, imaging, and processing workflow. This blurring often limits SMLM's ability to accurately quantify complex assembled structures required to address biological issues, despite reported localization precision down to a couple of nanometers. Here, we present SMLMFlow, a machine learning framework for improving structural resolution in SMLM datasets that combines a graph neural network and a hierarchical transformer with flow matching. We show that SMLMFlow improves structural resolution and downstream quantification across different structures, including filaments and protein nano-clusters, and generalizes to new unseen photophysics models.

23.
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.

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

Mind the Gap: Diagnosing Constraint Discovery Failures in Text-in-Image Editing

作者:

A key challenge in multimodal reasoning is determining which visual dependencies become relevant under a specific task, rather than merely recognizing visible content. We study this through edit-induced constraint discovery in text-in-image editing, a controlled diagnostic setting where a local text change can activate secondary consistency constraints: given a valid editing instruction and an image, can a model identify the secondary regions that must also change? Across 461 diagnostic cases, four MLLMs, and 19 constraint subtypes, models recover only 46% case-level macro recall under unguided prompting versus 94% when constraints are explicitly provided, suggesting that a substantial portion of the failure arises when models must decide which unstated dependencies to surface. Oracle-field decomposition shows that case-specific causal explanations are the most effective partial guidance (0.782 recall), above region names (0.610) or type labels (0.646), suggesting that edit-specific causal cues account for much of the oracle gain. A downstream experiment further shows that higher self-discovery recall does not necessarily improve task performance: unverified self-discovery introduces false positives that offset recall gains, motivating precision-aware constraint elicitation.

25.
medRxiv (Medicine) 2026-06-18

Biomedical Capacity, Governance, and Health Security: A Dominican Republic Research Analysis of Stakeholder Perspectives

The COVID-19 pandemic exposed critical vulnerabilities in globally concentrated biomedical supply chains and accelerated interest in nearshoring and hemispheric health-security strategies. The Dominican Republic, already the third-largest medical device exporter in Latin America, occupies a strategically significant but institutionally constrained position within this realignment. This study evaluates stakeholder perceptions of the principal opportunities and barriers affecting biomedical ecosystem development in the Dominican Republic, with particular attention to governance, workforce capacity, and value-chain upgrading pathways. Methods. A concurrent mixed-methods design was employed, integrating a cross-sectional electronic survey of 142 purposively sampled domain experts (administered September-December 2025) with a qualitative executive consultation with senior government and industry leaders. Survey analyses combined descriptive statistics, one-sample t-tests against the scale neutral midpoint, chi-square goodness-of-fit tests, Friedman non-parametric ranking, Spearman rank correlations, and exploratory linear and logistic multivariable regression. Qualitative responses were analyzed using a framework approach grounded in the Triple Helix model of innovation systems. Results. Perceived government support was significantly below neutral (mean = 2.67, SD = 1.12; p = 0.034). Workforce shortages (83.3%) and weak academia-industry collaboration (71.4%) were the most frequently endorsed barriers ({chi}2(5) = 18.7, p = 0.002). Regulatory modernization (88.1%) and workforce development (85.7%) ranked as the highest-priority policy levers (Friedman p = 0.005). Clinical trials and contract research organization services were the dominant sub-sector priority (76.2%, binomial p < 0.001). In multivariable analysis, perceived government support, talent availability, and confidence in IP protection jointly explained 46% of the variance in sector competitiveness (R2 = 0.46, p < 0.001). Strong majority support existed for a formal public-private biomedical coordination authority (73.8%, p < 0.001).Conclusion. Institutional credibility and advanced human capital–rather than geography or market access–are the perceived binding constraints on the Dominican Republics biomedical trajectory. Regulatory modernization, targeted workforce investment, and the establishment of a national biomedical coordination authority represent the highest-leverage interventions for positioning the country as a hemispheric hub for biomedical manufacturing, clinical research, and health security.