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01.
medRxiv (Medicine) 2026-06-15

Routine use of oral iron for people with heart failure and iron deficiency in primary care; retrospective cohort study

Aims: Iron deficiency is common among people with heart failure and associated with morbidity and mortality. While intravenous iron improves clinical outcomes, oral iron continues to be prescribed in routine practice despite limited evidence of benefit. Methods: We completed a retrospective primary care cohort study (2016 to 2021) to investigate the proportion of people with an incident diagnosis of heart failure who had iron deficiency identified (defined as ferritin

03.
arXiv (CS.CL) 2026-06-17

When Tables Go Crazy: Evaluating Multimodal Models on French Financial Documents

Vision-language models (VLMs) perform well on many document understanding tasks, yet their reliability in specialized, non-English domains remains underexplored. This gap is especially critical in finance, where documents mix dense regulatory text, numerical tables, and visual charts, and where extraction errors can have real-world consequences. We introduce Scribe Finance, the first multimodal benchmark for evaluating French financial document understanding. The dataset contains 1,204 expert-validated questions spanning text extraction, table comprehension, chart interpretation, and multi-turn conversational reasoning, drawn from real investment prospectuses, KIDs, and PRIIPs. We evaluate six open-weight VLMs (8B-124B parameters) using an LLM-as-judge protocol. While models achieve strong performance on text and table tasks (85-90% accuracy), they struggle with chart interpretation (34-62%). Most notably, multi-turn dialogue reveals a sharp failure mode: early mistakes propagate across turns, driving accuracy down to roughly 50% regardless of model size. These results show that current VLMs are effective for well-defined extraction tasks but remain brittle in interactive, multi-step financial analysis. Scribe Finance offers a challenging benchmark to measure and drive progress in this high-stakes setting.

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

BoRAD: Bootstrap your Own Representations for Multi-class Anomaly Detection

Reconstruction-based anomaly detection is attractive for industrial inspection, but scaling it from category-specific training to a one-for-all setting is challenging. A single model must reconstruct diverse normal appearances without copying abnormal details, which exposes two coupled failure modes: identical shortcut, where anomalies pass through the reconstruction path, and mis-reconstruction, where normal categories are confused with one another. We propose BoRAD, a label-free training framework that treats this as a representation-capacity allocation problem. BoRAD uses a shared learnable prototype bank to impose two complementary regularizers: spatial prototype alignment contracts local within-prototype variation to suppress anomaly copying, while prototype-relative global alignment preserves between-prototype structure and improves sensitivity to abnormal angular deviations. The prototype bank and prediction heads are used only during training; inference remains a standard teacher-student feature discrepancy pass, with no class labels, negative pairs, memory retrieval, or prototype lookup. BoRAD achieves competitive one-for-all anomaly detection performance, including 86.2\% mAD on MVTec AD, 80.7\% mAD on VisA and 73.1\% mAD on Real-IAD. Diagnostic analyses further show reduced anomaly leakage, improved normal-category separability, and stronger anomaly-normal score separation.

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

Dual Dimensionality for Local and Global Attention

Decoder-only Transformers compute attention over the KV cache of preceding tokens. Keys (and Values) are typically represented with the same dimensionality, regardless of its distance from the prediction target. In natural language, however, the next word is most strongly influenced by the immediately preceding tokens. We hypothesize that local and distant tokens impose asymmetric demands on representational capacity: local tokens are more critical for predicting immediate outputs and thus require richer representations, whereas distant tokens primarily serve as long-range memory, for which lower-dimensional representations may suffice. We formalize this idea as Distance-Adaptive Representation (DAR), implemented in a controlled setting that preserves full-dimensional representations within a local context window while assigning reduced-dimensional representations (e.g. 1/4 of the original dimensionality) to tokens beyond that window. Across multiple pretraining scales (70M to 410M parameters), as well as continued supervised fine-tuning on a 1B-scale model, this approach closely matches the performance of full-dimensional baselines. In contrast, uniformly reducing dimensionality across all token positions leads to worse performance. These results challenge the common assumption that key and value dimensionality should be uniform across token positions. Our findings suggest a new direction for designing attention architectures that adaptively allocate representational capacity across sequences, enabling further reductions in KV cache during inference.

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

WOMBET: World Model-Based Experience Transfer for Robust and Sample-efficient Reinforcement Learning

arXiv:2604.08958v3 Announce Type: replace-cross Abstract: Reinforcement learning (RL) in robotics is often limited by the cost and risk of data collection, motivating experience transfer from a source task to a target task. Offline-to-online RL leverages prior data but typically assumes a given fixed dataset and does not address how to generate reliable data for transfer. We propose World Model-Based Experience Transfer (WOMBET), a framework that jointly generates and utilizes prior data. WOMBET learns a world model in the source task and generates offline data via uncertainty-penalized planning, followed by filtering trajectories with high return and low epistemic uncertainty. It then performs online fine-tuning in the target task using adaptive sampling between offline and online data, enabling a stable transition from prior-driven initialization to task-specific adaptation. We show that the uncertainty-penalized objective provides a lower bound on the true return and derive a finite-sample error decomposition capturing distribution mismatch and approximation error. Empirically, WOMBET improves sample efficiency and final performance over strong baselines on continuous control benchmarks, demonstrating the benefit of jointly optimizing data generation and transfer.

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

Can Agents Read the Room? Benchmarking Visual Social Intelligence in Multimodal Simulation

Social interaction depends on both language and visible social signals, such as facial expressions, posture, gaze, and emotional shifts. Yet existing social-agent benchmarks are largely text-based and rarely test whether multimodal agents can use visual cues to guide interaction. We introduce \textsc{\benchmarkname{}}, a benchmark evaluating visual social intelligence in multimodal social simulation. It contains 240 scenarios, 585 role instances, and 2,340 role-task instances, combining aligned textual-visual evidence, structured role profiles, and four role-level tasks: expression task, characteristic task, interaction regulation task, and interaction outcome task. Evaluating seven recent MLLMs under verbalized-vision and direct-vision reveals a clear gap between local role enactment and interaction management: role-specific expression and conflict handling are near saturation, whereas interaction regulation and visually grounded outcome achievement remain substantially more difficult. The code is released at https://github.com/JunsWan/AgentViSS, and the dataset is available at https://huggingface.co/datasets/JunsWan/AgentViSS.

09.
arXiv (CS.LG) 2026-06-19

Tracking Representation Dynamics in Large Language Models with Persistent Homology

arXiv:2606.19542v1 Announce Type: new Abstract: Large language models are commonly aligned through supervised fine-tuning, yet little is known about how their internal representations evolve during this process. We study alignment dynamics using persistent homology by tracking the topology of activation spaces throughout fine-tuning. Across four transformer language models ranging from 1B to 7B parameters and three alignment objectives corresponding to helpful, harmless, and mixed training data, we find that the majority of topological reorganization occurs during the earliest stages of training. A dense checkpoint analysis reveals a transient peak in topological activity followed by rapid stabilization. We further show that different alignment objectives induce distinguishable topological trajectories, while instruction-tuned and pretrained models exhibit qualitatively different patterns of evolution. Our results suggest that persistent homology provides a complementary perspective on alignment, revealing representation-level changes that are not apparent from behavioral metrics alone.

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

XFlow: An Executable Protocol Programming System for Reliable Multi-Agent Workflows

arXiv:2606.14790v1 Announce Type: cross Abstract: LLM-based multi-agent systems increasingly coordinate planning, reasoning, tool use, and human interaction, yet their reliability remains limited. A central source of this limitation is the underspecified prompt–harness boundary. Current systems lack a principled way to decide which workflow commitments should remain in prompts and which should become harness structure. We present XFlow, an executable protocol programming system for reliable multi-agent workflows, and XPF (XFlow Protocol Format), its domain-specific protocol programming language. XFlow occupies a middle position between prompt-only orchestration and markup-like workflow descriptions. XPF remains readable as a literate protocol, but it is compiled and executed as a program. Its design keeps informal semantic work inside actors while moving selected commitments into harness structure that can be checked, preserved, and enforced. At runtime, XFlow stages uncertainty through lifecycle-governed symbols, which are typed state cells with validation and commit states. Actor outputs are mediated before they become shared state, instead of spreading through prompts, transcripts, or implicit memory. Our experiments cover Constrained Interaction, Long-Context Reasoning, and Agentic Software Engineering. They show that XFlow improves reliability by making constraints, evidence handling, and process requirements explicit and enforceable.

11.
medRxiv (Medicine) 2026-06-10

"We don't complain; it's just part of being a woman": frequency, knowledge, and sociocultural beliefs about dysmenorrhoea in a South African university cohort

Introduction Dysmenorrhoea is highly prevalent globally and interferes with engagement in education, work, social participation, and quality of life. Although evidence suggests that sociocultural beliefs influence how menstrual pain is understood and managed, relatively little research has explored dysmenorrhoea-related knowledge and beliefs within South Africa. This study aimed to (1) determine the frequency of dysmenorrhoea, (2) assess dysmenorrhoea-related knowledge and compare knowledge between menstruating and non-menstruating individuals, and (3) explore commonly held generational, cultural, and religious beliefs related to dysmenorrhoea in a South African university cohort. Methods We analysed data collected as part of a cross-sectional survey conducted among staff and students at a South African university. Participants completed demographic questions, items assessing dysmenorrhoea-related knowledge, and an adapted Working Ability, Location, Intensity, Days of Pain, Dysmenorrhoea (WaLIDD) questionnaire. Participants were also invited to provide free-text responses describing generational, cultural, and religious beliefs about dysmenorrhoea. Quantitative data were analysed descriptively and compared between menstruating and non-menstruating participants. Free-text responses were analysed using reflexive thematic analysis. Results A total of 863 participants completed the survey, including 578 current or past menstruators. The frequency (95%CI) of dysmenorrhoea was 75.4% (71.7-78.9). Most participants were classified as having moderate (53%) or severe (31%) dysmenorrhoea on the WaLIDD scale. Awareness of dysmenorrhoea was higher among participants who had menstruated than among those who had never menstruated (80.4% vs 55.3%, p

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

iTRIALSPACE: Programmable Virtual Lesion Trials for Controlled Evaluation of Lung CT Models

We introduce iTRIALSPACE, a programmable evaluation framework for controlled assessment of lung CT models. Standard benchmarks are static retrospective collections that entangle lesion size, lobe prevalence, anatomy, and acquisition context, making it difficult to determine what structurally drives model accuracy. iTRIALSPACE addresses this limitation by composing real clinical CTs and lesion profiles into controlled virtual lesion trials through a four-stage pipeline: multidataset nodule profiling, explicit trial specification, anatomy-aware mask insertion, and ControlNet-conditioned CT synthesis. The framework is built on a unified 54-attribute nodule-profile dataset spanning 13,140 annotated nodules from seven public CT sources and instantiated as 13 trial modes. We evaluate iTRIALSPACE in a 55,469-sample Virtual Lesion Study spanning three medical VLMs, four spatialguidance conditions, and three clinical tasks. Across all 13 modes, the synthetic substrate remains within the real-to-real FID baseline, and synthetic performance rankings transfer strongly to real clinical data ($\rho$ = 0.93, p < 10$^{-15}$). Controlled trial modes expose findings unavailable to fixed-distribution benchmarks, including shortcut-driven size prediction collapse under lobe-equalized sampling and hostto-donor variance ratios of 8.9x and 3.3x in twin-cross analysis. These results position iTRIALSPACE as an auditable evaluation infrastructure for controlled, falsifiable testing beyond static retrospective benchmarks.

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

What Limits Does Quantization Place on Dense Top-$k$ Retrieval? A Theoretical Study

arXiv:2606.11780v1 Announce Type: cross Abstract: We establish conditions for embedding a corpus of $N$ documents as $d$-dimensional vectors such that every $k$-subset $S \subseteq [N]$ is realizable as a result of top-$k$ retrieval by some query vector. Recent work shows that $d = O(k)$ suffices for such embeddings to exist in $\mathbb{R}^d$, independently of $N$. We theoretically prove that this corpus-independent bound is specific to infinite precision. With $B$ bits per coordinate, perfect top-$k$ retrieval requires $Bd = \Omega(k \ln N)$; thus, at any fixed precision, the dimension must grow at least logarithmically with $N$. Specializing to a $\ell_2$-normalized $B$-bit uniform scalar quantization model, we also identify a threshold on the precision $B^{*} = O(\ln \ln N)$ below which no dimension suffices, together with two further regimes that bound the feasible $(B, d)$ pairs. Our result implies that in practical vector databases and dense retrieval systems where quantization is standard, the embedding dimension and possibly the precision must grow with the corpus size.

14.
arXiv (math.PR) 2026-06-19

Hermite trace polynomials and chaos decompositions for the Hermitian Brownian motion

arXiv:2207.13180v4 Announce Type: replace Abstract: For a non-zero parameter $q$, we define Hermite trace polynomials, which are multivariate polynomials indexed by permutations. We prove several combinatorial properties for them, such as expansions and product formulas. The linear functional determined by these trace polynomials is a state for $q = \frac{1}{N}$ for $N$ a non-zero integer. For such $q$, Hermite trace polynomials of different degrees are orthogonal. The product formulas extend to the closure with respect to the state. The state can be identified with the expectation induced by the $N \times N$ Hermitian Brownian motion. Hermite trace polynomials are martingales for this Brownian motion, while the elements in the closure can be interpreted as stochastic integrals with respect to it. Using the grading on the algebra, we prove several chaos decompositions for such integrals, as well as analyze corresponding creation and annihilation operators. In the univariate, pure trace polynomial case, trace Hermite polynomials can be identified with the Hermite polynomials of matrix argument.

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

The Shrinking Lifespan of LLMs in Science

arXiv:2604.07530v2 Announce Type: replace-cross Abstract: Scaling laws describe how language model capabilities grow with compute and data, but say nothing about how long a model matters once released. We introduce time-to-peak and lifespan as measures of model obsolescence and use them to characterize the scientific adoption trajectories of 62 LLMs across more than 108k citing papers (2019-2025), separating active adoption from background citation to recover per-model trajectories that citation counts cannot resolve. We find that a model's longevity is shaped more by when it was released than by its characteristics: release year predicts time-to-peak and lifespan more strongly than architecture, openness, or scale. LLM adoption follows an inverted-U curve (rising after release, peaking, and then declining), but this pattern is rapidly compressing. Each successive release year is associated with a 27% shorter time-to-peak and a 23% shorter lifespan ($p < 0.001$), robust to minimum-age thresholds and controls for model size. These adoption-side dynamics are invisible to scaling laws and suggest that specialization on any single model may be a depreciating investment, with costs falling on reproducibility and migration.

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

Model-Native Computing Architecture: Envisioning Future System Architecture Through the Lens of Computer Architecture

arXiv:2606.00288v2 Announce Type: replace Abstract: Large language models are undergoing a transition from model technology to system technology. Engineering challenges like cache reuse, context capacity, agent scheduling, and permission control resemble classical computer systems problems. This raises a question: if we treat the LLM as a CPU, KV cache as processor cache, context window as main memory, and agent framework as an operating system, can decades of computer architecture wisdom guide next generation model native systems? This paper pursues this analogy as a visionary survey. We map computer architecture concepts onto the emerging model native stack, survey literature across LLM as OS, memory management, agent frameworks, tool protocols, multi agent coordination, cognitive architectures, and safety governance, finding that each addresses a different layer without a unifying model. We propose the Intelligent Computing Architecture (ICA): six functional layers with interface contracts and design axioms. We resolve the tension over whether the LLM resembles a CPU or OS via a dual plane architecture a probabilistic execution plane (what can be computed) and a deterministic control plane (what should be computed), with every layer passing through as a graded crossover. We propose three Amdahl style design heuristics Semantic Locality, Context Budget, and Agent Speedup as organizing back of envelope models, illustrate their parameter ranges with published data, and identify predictive validation as the principal open task. We articulate analogy boundaries, note differences between silicon and model era architectures, and propose a research roadmap. This is a conceptual and survey contribution with no new experimental results.

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

Learning Dynamics Reveal a Hierarchy of Weight-Induced Layerwise Gram Metrics

arXiv:2606.09744v3 Announce Type: replace Abstract: We study feed-forward ReLU networks with fixed readout and quadratic loss. The aim is to rewrite gradient descent not primarily as a dynamics in weight space, but as a collective dynamics closed in terms of fields defined on the training-set space. For a single hidden layer, the weight variables can be eliminated from the activation dynamics, yielding a closed equation for the residuals governed by a collective kernel that factorizes into an input-geometric matrix and a dynamical co-activation matrix. For deeper networks, the residual dynamics retains a clean layer-wise kernel structure. However, from depth three onward, closure requires a hierarchy of weight-induced Gram operators that mediate information transport across layers. Moreover, the conjugate-field dynamics is governed by operators satisfying a backward pullback recursion, of which the weight-induced Gram operators are the first nontrivial instances.

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

A Minimal Model of Bounded Trade-Off Screening in Multi-Attribute Choice

arXiv:2606.13201v1 Announce Type: new Abstract: Human decision-making often involves choosing between multi-attribute alternatives, yet classical models assume fully compensatory utility aggregation despite evidence that people reject options with poor performance on critical attributes. We propose a bounded trade-off reasoning framework in which decisions are governed by a screening process that evaluates the balance between gains and losses across attributes. The model introduces a trade-off tolerance parameter that controls acceptable imbalance and can vary across contexts. Through simulation, we show that this mechanism produces preference patterns that differ from standard utility-based models and captures context-dependent variation in trade-off behavior. These results establish bounded trade-off screening as a plausible computational mechanism for multi-attribute choice and generate testable predictions for future behavioral studies.

19.
arXiv (CS.CV) 2026-06-11

MLT-Dedup: Efficient Large-Scale Online Video Deduplication via Multi-Level Representations and Spatial-Temporal Matching

The explosive growth of user-generated video content on online platforms is accompanied by the emergence of numerous near-duplicate videos–videos that are identical or highly similar but differ by partial edits. These duplicates degrade user experience and increase storage and bandwidth costs, making large-scale video deduplication a critical task. Existing video deduplication frameworks face a fundamental challenge in retrieving sufficient high-quality candidates under a limited index budget, as well as trade-offs between efficiency and precision. To address these issues, we propose MLT-Dedup, an efficient large-scale online video deduplication framework with Multi-Level representations and spatial-Temporal matching. Our approach employs a Multi-Level Video Encoder (ML-VE) to extract both fine-grained frame-level and sparse clip-level embeddings: sparse embeddings support efficient candidate retrieval, while fine-grained embeddings are loaded for precise pairwise matching. During matching, we introduce DiF-SiM, a Differential Feature-enhanced Similarity Module capable of locating duplicated temporal segments and providing reliable similarity evidence to support policy-driven deduplication decisions. Extensive experiments on a real-world large-scale platform demonstrate that MLT-Dedup reduces online repetition rates by 91% at 90% precision. Furthermore, our sparse retrieval design achieves a 5x increase in indexing capacity, enabling broader candidate coverage in real-world deployment.

20.
arXiv (CS.LG) 2026-06-18

Smoothness-Based Derandomization of PAC-Bayes Bounds

arXiv:2606.19105v1 Announce Type: new Abstract: We study PAC-Bayes derandomization for smooth loss functions. Our goal is to obtain generalization bounds that hold with high probability for deterministic predictors by exploiting smoothness properties of both the loss and the predictor class. We show that passing from the Gibbs predictor to the deterministic predictor at the posterior mean has a precise cost, given by the generalization gap of the Jensen gap class. We control this class through its Rademacher complexity, leading to bounds for deterministic predictors that involve flatness quantities expressed in terms of parameter Jacobians and Hessians of the score map. The framework applies to both bounded and unbounded smooth loss functions, and we specialize the results to linear predictors and smooth neural networks. Finally, the Jacobian and Hessian quantities appearing in the theory motivate a practical regularizer. For BatchNorm networks, we compute this regularizer with respect to effective BatchNorm weights obtained by folding the BatchNorm transformation into the adjacent affine weights. Experiments on CIFAR-10 illustrate the behavior of this regularizer under different batch sizes.

21.
arXiv (CS.LG) 2026-06-17

Resource-Efficient Variational Quantum Classifier

arXiv:2511.09204v3 Announce Type: replace-cross Abstract: We introduce the unambiguous quantum classifier based on Hamming distance measurements combined with classical post-processing. The proposed approach improves classification performance through a more effective use of ansatz expressivity, while requiring significantly fewer circuit evaluations. Moreover, the method demonstrates enhanced robustness to noise, which is crucial for near-term quantum devices. We evaluate the proposed method on a breast cancer classification dataset. The unambiguous classifier achieves an average accuracy of 90%, corresponding to an improvement of 6.9 percentage points over the baseline, while requiring eight times fewer circuit executions per prediction. In the presence of noise, the improvement is reduced to approximately 3.1 percentage points, with the same reduction in execution cost. We substantiate our experimental results with theoretical evidence supporting the practical performance of the approach.

22.
arXiv (CS.CL) 2026-06-17

MemSlides: A Hierarchical Memory Driven Agent Framework for Personalized Slide Generation with Multi-turn Local Revision

Personalized presentation generation requires more than conditioning on a current prompt or template: agents must preserve stable user preferences across tasks, retain newly introduced preferences and constraints during multi-turn revision, and carry out local edits reliably. We propose MemSlides, a hierarchical memory framework for personalized presentation agents that separates long-term memory from working memory and further divides long-term memory into user profile memory and tool memory. User profile memory stores intent-conditioned profiles for round-0 personalization, working memory carries active preferences and session constraints across revision rounds, and tool memory stores reusable execution experience for reliable localized editing. MemSlides pairs this memory design with scoped slide-local revision, so targeted updates act on the smallest affected region instead of repeatedly regenerating the full deck. In controlled experiments, user profile memory improves persona-alignment judgments on a multi-persona, multi-intent profile bank, tool-memory injection improves closed-loop modify behavior in diagnostic matched-pair settings, and qualitative cases illustrate working memory's ability to carryover preferences. Taken together, these results suggest that effective personalization in presentation authoring depends on separating persistent user profiles, session-level working memory, and reusable execution experience across generation and localized revision.

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

Islamic Large Language Models: From Knowledge Acquisition to Trustworthy and Hallucination-Resistant AI

Large language models (LLMs) are increasingly used for knowledge-intensive question answering, including religious and legal questions. Islamic knowledge is a particularly demanding setting: answers are expected to be grounded in authoritative sources, citations must be exact, Arabic varieties differ substantially from the language of classical sources, and legitimate jurisprudential disagreement must be represented rather than collapsed into a single answer. This survey reviews the emerging field of Islamic LLMs and trustworthy Islamic AI. We organize the literature around Arabic NLP and Arabic-centric LLMs, Islamic NLP resources, Qur'anic question answering, Islamic knowledge benchmarks, retrieval-augmented generation, Islamic legal reasoning, inheritance reasoning, hallucination evaluation, and trustworthiness. We argue that fluency in Arabic is not sufficient for Islamic AI. Reliable systems require curated sources, retrieval and verification modules, citation-aware generation, madhhab-aware reasoning, human expert evaluation, and benchmarks that measure not only answer accuracy but also faithfulness, source validity, and reasoning quality. The survey concludes with a research agenda for hallucination-resistant Islamic AI systems.

24.
arXiv (math.PR) 2026-06-16

Exponential Convengence of DLRA for SDEs

arXiv:2606.15843v1 Announce Type: new Abstract: We study dynamical orthogonal (DO) approximations of stochastic differential equations and investigate their long-time behaviour. The DO formulation represents the solution by a low-rank decomposition and leads to a coupled system consisting of an evolution equation on the Stiefel manifold and a reduced stochastic process. We establish the well-posedness of the strong DO system and derive quantitative error estimates between the original stochastic differential equation and its low-rank approximation in the Wasserstein distance. Our main contribution is the analysis of invariant probability measures for the DO dynamics. Under suitable dissipativity, Lipschitz continuity, and non-degeneracy assumptions on the coefficients, we prove the existence of an invariant probability measure for the strong DO system. The proof combines uniform moment estimates, a Krylov–Bogoliubov argument for an associated frozen system, and a Kakutani-Fan-Glicksberg fixed-point theorem to recover the self-consistent dynamics. We further show that the induced low-rank process admits an invariant probability measure and discuss the structure of invariant measures through several illustrative examples. These results provide a rigorous foundation for the use of dynamical low-rank approximations in the approximation of long-time statistical properties of stochastic dynamical systems.

25.
medRxiv (Medicine) 2026-06-22

Use of the Pharmacy First service in England in the first 12 months: geographic variation and health system context

Objectives: The Pharmacy First (PF) service was introduced across England from 31 January 2024 to expand the clinical role of community pharmacies and improve access to primary care. This paper describes use of PF in its first 12 months, in terms of uptake, access routes, consultation outcomes, geographic variations, service costs and antimicrobial supply. Methods: A descriptive analysis of all PF consultations submitted for payment to NHS Business Services Authority in England between 31 January 2024 and 31 January 2025. Pharmacy-level consultation data were linked to national data on population, location and pharmacy characteristics. PF use was examined using population-standardised consultation rates and consultations per pharmacy. Results: During the first year of implementation, 2,205,731 PF consultations were recorded as delivered across 11,349 pharmacies, with payment of GBP123 million to pharmacies. Uptake increased steadily over time. Most consultations were for acute sore throat (33%) and uncomplicated urinary tract infection (27%), with corresponding antibiotics, phenoxymethylpenicillin and nitrofurantoin being the most supplied. Most people self-referred (74%) into the service, with 95% of consultations managed without onward referral. Substantial geographic variation was observed. Northern regions had higher use based on the eligible population. The South East and Midlands had higher activity per pharmacy. London showed a distinct pattern, with higher self-referral into the service, lower medication supply and higher referral to other healthcare services. Higher consultation volume was weakly associated with pharmacy characteristics, including opening hours, pharmacy type and retail setting, and local context, in terms of socio-economic and geographic factors. Conclusions: PF had immediate uptake and is operating primarily as a direct-access model for common acute conditions. Findings suggest that PF is contributing to improved access to care and may shift demand away from general practice. However, the service uptake appears to be shaped by geographic location, proximity to other healthcare services and pharmacy characteristics.