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01.
arXiv (CS.AI) 2026-06-16

Intelligence Is Not the Bottleneck: Validating an LLM First-Pass Manuscript Score Against Peer-Review Outcomes

arXiv:2606.15887v1 Announce Type: cross Abstract: Large language model (LLM) systems are increasingly proposed to assist peer review, yet most evaluations judge the prose of machine-generated review text, not the validity of the numeric score a system assigns. We validate AIPR, which reads a submitted manuscript and emits five 0-100 quality dimensions and a weighted overall score, against the public decision outcomes of a major machine learning venue. AIPR grades by prompting alone, with no fine-tuning on reviews or decisions. Across 300 ICLR submissions with public decision tiers and reviewer ratings, graded under a frozen pipeline with hypotheses pre-registered before any score met any outcome, the overall score separates rejected from accepted submissions (AUROC 0.82, 95% CI 0.78-0.87), rises monotonically across tiers, and tracks the mean reviewer rating. The signal is strongest where we claim it: the lowest-scoring fifth is rejected far above the base rate, with oral papers absent. The validity comes mostly from the model: a one-paragraph prompt on the same model discriminates almost as well as the full pipeline (the small gap favours the pipeline but does not meet the pre-declared criterion, p = 0.09). What the engineering adds is reliability and a grounded review: AIPR's score barely moves across repeated runs (0.7 vs. 2.8 points within-paper SD) where the bare prompt swings, and the same pass returns a rubric-structured, evidence-grounded review rather than a bare number, with the human keeping the decision.

02.
arXiv (CS.CL) 2026-06-17

EmoFSM: A Finite State Machine for Emotional Support Conversation

Emotional support conversation (ESC) aims to alleviate people's emotional distress through effective conversations. Although large language models (LLMs) have made remarkable progress in ESC, most of these studies may not define the diagram from a state-model perspective, thereby providing a suboptimal solution for long-term satisfaction. To address such an issue, we leverage the Finite State Machine (FSM) on LLMs, and propose a framework called EmoFSM. Our framework allows a single LLM to bootstrap the planning during ESC, and self-reason the seeker's emotion, support strategy, and the final response upon each conversation turn. Substantial experiments in ESC datasets suggest that EmoFSM outperforms many baselines, including direct inference, self-fine, chain of thought, finetuning, and externally supported methods, even those with many more parameters.

03.
arXiv (CS.CV) 2026-06-25

Learning Diachronic Representations of Ancient Greek Letterforms

Learning representations that remain robust across centuries of variation in handwriting is a key challenge in diachronic representation learning. Taking one of the longest continuously used writing systems, ancient Greek, as a case study, we introduce three datasets for diachronic representation learning: Hell-Char, a curated training set spanning the 3rd-1st centuries BCE, and two evaluation sets, PaLit-Char (2nd-5th c. CE) and Med-Char (9th-14th c. CE). To address the challenges of symbolic variation, scarce data, and systematic degradation, we propose: a similarity-weighted supervised contrastive loss that biases embeddings using dynamically estimated inter-class similarities, and a lacuna-driven augmentation scheme that simulates realistic manuscript corruptions. Trained with these strategies, both a lightweight CNN and a pretrained ResNet achieve strong recognition performance and produce embeddings that more coherently separate character classes than PCA or generic pretrained models. These embeddings enable clustering, identification of stylistic subgroups, and construction of prototype images that visualize diachronic evolution and transitional letterforms. Our results demonstrate that respecting intrinsic inter-letter relationships and augmenting with domain-informed corruptions yield robust, interpretable representations, offering a transferable paradigm for representation learning under scarce, temporally evolving, and noisy conditions. Code and data available at: https://github.com/ipavlopoulos/diachronic-greek-letterforms.

04.
arXiv (CS.CV) 2026-06-15

Visual Quality Score Assessment of Large White Goods in Remanufacture with Multi-View Deformable-DETR

Remanufacturing large white goods is essential for a circular economy, yet visual quality assessment remains a manual bottleneck for training and pricing. Conventional detection methods require extensive annotation and struggle with small defects in high-resolution multi-view data. We present a multi-view framework based on Deformable-DETR for automated quality scoring that aggregates information across redundant views to extract fine-grained features. To enhance robustness with limited labels, we employ self-supervised pretraining followed by supervised fine-tuning on expert-annotated scores. Additionally, a linear projection over frozen feature maps identifies regions of interest to explain model decisions. Evaluated on an industrial multi-view dataset, our approach delivers precise quality assessments while reducing reliance on manual annotation and per-part customization, enabling scalable and transparent inspection for remanufacturing lines.

05.
arXiv (quant-ph) 2026-06-12

Driven-dissipative entanglement of distant giant atoms

arXiv:2606.13375v1 Announce Type: new Abstract: Quantum interconnects distribute entanglement via controlled light-matter interactions for quantum computing and sensing applications. Many entanglement generation schemes use coherent, reversible interactions that require precisely calibrated pulses to execute. In contrast, driven-dissipative protocols use a continuous-wave drive in the presence of correlated dissipation to stabilize entanglement in protected (dark) states. However, the same dissipation that generates the entanglement also limits its utility once the stabilization protocol ends. Here, we engineer a superconducting system of two giant artificial atoms coupled sequentially to a waveguide, with tunable individual and correlated dissipation enabled by interference between coupling points. Continuously driving the atoms through the waveguide exploits correlated dissipation to generate remote entanglement. We then tune the qubit frequencies in situ to suppress individual dissipation and thereby preserve the entanglement, achieving a Bell-state fidelity F = 0.89 +/- 0.02. This demonstration indicates that the driven dissipation of giant atoms is a viable approach for distributing entanglement across quantum networks.

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

TimeVista: Exploring and Exploiting Vision-Language Models as Judges for Time Series Forecasting

arXiv:2606.16173v1 Announce Type: new Abstract: High-quality time series forecasting is pivotal for real-world decision-making. However, traditional point-wise metrics often fail to reveal complex temporal patterns and align poorly with human intuitive preferences. While the ''LLM-as-a-Judge'' paradigm has revolutionized text evaluation by providing flexible, human-aligned judgment, its application to time series remains largely unexplored. In this paper, we leverage Vision-Language Models (VLMs) as judges for time series forecasting, harnessing their ability to comprehend time series plots grounded in textual information. Specifically, we propose a novel framework integrating micro- and macro-level judgments informed by contextual information to evaluate time series forecasting. To this end, we introduce TimeVista, a comprehensive VLM-as-a-Judge benchmark comprising 5563 time series samples paired with detailed evaluation rubrics. Extensive meta-evaluations demonstrate that VLMs are highly reliable judges, achieving significantly higher consistency with human preferences than conventional metrics. Building upon our benchmark, we comprehensively assess recent Time Series Foundation Models (TSFMs) under the VLM-as-a-Judge paradigm. Our results demonstrate that VLMs serve as robust and interpretable judges, providing a comprehensive, human-aligned standard for evaluating time series models.

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

The Hidden Cost of Approximation in Online Mirror Descent

arXiv:2511.22283v2 Announce Type: replace Abstract: Online mirror descent (OMD) is a fundamental algorithmic paradigm that underlies many algorithms in optimization, machine learning and sequential decision-making. The OMD iterates are defined as solutions to optimization subproblems which, oftentimes, can be solved only approximately, leading to an inexact version of the algorithm. Nonetheless, existing OMD analyses typically assume an idealized error free setting, thereby limiting our understanding of performance guarantees that should be expected in practice. In this work we initiate a systematic study into inexact OMD, and uncover an intricate relation between regularizer smoothness and robustness to approximation errors. When the regularizer is uniformly smooth, we establish a tight bound on the excess regret due to errors. Then, for barrier regularizers over the simplex and its subsets, we identify a sharp separation: negative entropy requires exponentially small errors to avoid linear regret, whereas log-barrier and Tsallis regularizers remain robust even when the errors are only polynomial. Finally, we show that when the losses are stochastic and the domain is the simplex, negative entropy regains robustness-but this property does not extend to all subsets, where exponentially small errors are again necessary to avoid suboptimal regret.

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

Mach's principle in atomic transitions

arXiv:2606.11608v1 Announce Type: new Abstract: We investigate the atomic transition probabilities in atom-mirror set-ups that are in circular motion. In one scenario, the atom is in circular motion inside a static cylindrical mirror. In the other scenario, the cylindrical mirror rotates around its central axis while the atom remains static. We report structural similarity in the atomic transition probabilities between these two cases – these probabilities are equivalent upon interchanging the field frequencies between the two scenarios. We interpret such an observation as a semi-classical phenomenon analogous to the classical Mach's principle.

09.
arXiv (CS.CV) 2026-06-16

Decoupled Motion Representation Learning for Moving Infrared Small Target Detection

Infrared small target detection in dynamic scenes remains challenging due to the highly coupled motions among targets, imaging platforms, and dynamic backgrounds. Existing multi-frame methods usually perform implicit temporal modeling, where coherent background dynamics dominate motion correspondence learning, leading to an inherent trade-off between detection and false alarms. In this work, we observe that background motions exhibit strong global coherence, whereas small targets mainly correspond to sparse local motion anomalies. Moreover, many false-alarm responses maintain high consistency with globally coherent motion patterns, indicating that they mainly originate from coherent background dynamics rather than genuine target motions. Based on these observations, we propose a decoupled motion representation learning framework for moving infrared small target detection. Specifically, an explicit motion branch is introduced to model globally coherent motion dynamics using pretrained optical flow priors, together with a structure-preserving self-supervised adaptation strategy for infrared motion correspondence learning. Meanwhile, an implicit motion branch based on deformable feature alignment is designed to capture target-sensitive local motion anomalies under coherent motion guidance. Furthermore, a coherent-motion-guided local anomaly reasoning module is proposed to identify and suppress coherent-motion-induced false responses during localized motion modeling. Extensive experiments on two challenging infrared small target detection benchmarks demonstrate that the proposed method consistently outperforms existing state-of-the-art approaches, particularly in dynamic scenes with complex motions, while maintaining favorable inference efficiency.

10.
arXiv (CS.LG) 2026-06-17

Gradual Fine-Tuning for Flow Matching Models

arXiv:2601.22495v2 Announce Type: replace Abstract: Fine-tuning flow matching models is a central challenge in settings with limited data, evolving distributions, or computational constraints. While recent work has produced significant advances, particularly in the area of reward-based fine-tuning, current methods fail to demonstrate both theoretical correctness as well as strong empirical results in terms of stability, efficiency, and diversity preservation. In this work, we propose Gradual Fine-Tuning (GFT), a simple yet principled annealing-based framework for fine-tuning flow generative models when only samples from the target distribution are available. For stochastic flows, GFT defines a temperature-controlled sequence of intermediate objectives that smoothly interpolate between the pretrained and target drifts, provably approaching the true target as the temperature approaches zero. We analytically demonstrate that sample generation after GFT can be made substantially more efficient with the use of arbitrary (e.g., optimal transport) couplings, as well as by utilizing few-step inference methods. Empirically, GFT significantly improves convergence stability, while maintaining or improving generation quality, training speed, and generation diversity compared to other fine-tuning methods. Our results position GFT as a simple yet theoretically grounded and practically effective alternative for scalable adaptation of flow matching models under distribution shift.

11.
arXiv (math.PR) 2026-06-12

Averaging principles for nonautonomous multiscale McKean-Vlasov stochastic systems

arXiv:2606.12820v1 Announce Type: new Abstract: This paper investigates a class of nonautonomous multiscale McKean-Vlasov stochastic systems. By leveraging the nonautonomous Poisson equation, we rigorously establish both strong and weak averaging principles, accompanied by explicit convergence rates. Notably, the coefficients of the averaging equations derived in the general case retain dependence on the scaling parameter $\varepsilon$. However, under the additional assumptions that the fast-scale coefficients are either asymptotically convergent or time-periodic, we demonstrate that the slow component converges, in the strong or weak sense, to averaging equations with coefficients independent of $\varepsilon$.

12.
Nature (Science) 2026-06-24

Chiral laser gyroscopes breaking the lock-in limit

作者:

Ring laser gyroscopes (RLGs) measure rotation via the Sagnac effect: a slight difference in the frequency of the two counter-propagating beams within the resonator. However, at low rotation rates, an intrinsic limitation in RLGs, known as the lock-in phenomenon, counteracts this effect, precluding the widespread adoption of RLGs as motion sensors. Past efforts to avoid this phenomenon include mechanical dithering1 and magneto-optic non-reciprocity techniques2. Such techniques require external components that limit the miniaturization of RLGs. Here we present a self-biased method that overcomes this limitation through chiral spontaneous symmetry breaking and nonlinear frequency pulling in a He–20Ne RLG without inserted elements. Supported by a theoretical model that reveals phase transition conditions with spontaneous symmetry breaking and the dynamics of bistable chiral states, our experiments demonstrate deterministic chirality switching synchronized with rotation direction. Remarkably, the chiral RLG has a linear frequency response at near-zero rotation rates, achieving an open-loop bias instability of 2.2 × 10−2 degrees per hour at a 10 s integration time. Our work presents a strategy for the development of all-solid-state, high-precision and miniaturized laser gyroscopes, which could be used for the exploration of the interplay of nonlinear dynamics and spontaneous symmetry breaking in photonic systems. Ring laser gyroscope lock-in has been eliminated using spontaneous symmetry breaking in a He–Ne laser, enabling accurate near-zero rotation sensing without external components, improving miniaturization and precision.

13.
arXiv (math.PR) 2026-06-12

Exact Fourier dimensions of dyadic Mandelbrot cascades under minimal integrability

arXiv:2606.08683v2 Announce Type: replace Abstract: We determine the Fourier dimension of dyadic Mandelbrot cascades under the minimal Kahane-Peyriere integrability condition. The interval theorem is proved in a vector-valued dyadic cascade model in which sibling weights may have arbitrary dependence. For every balanced energy-admissible vector law, almost surely on non-extinction, dim_F(mu)=dim_E(mu)=dim_2(mu)=D_E(X). In the canonical scalar case, under W>=0, E W=1, E[W log_2^+ W]

14.
arXiv (CS.CV) 2026-06-17

Improving and Evaluating Hand-Object Interaction Detection

Understanding hands and the objects they interact with, both directly and through tools, is a key step for tasks ranging from action perception to 3D reconstruction and robotics. Our paper provides several contributions to the Hand-Object Interaction (HOI) understanding literature: (1) HOI-DETR, a new framework that introduces hand-object and object-object interactions to the Co-DETR architecture to produce a state-of-the-art method; (2) a comprehensive HOI evaluation suite of 4 diverse datasets, including a video benchmark derived from the HD-EPIC dataset and fresh annotations that improve the Hands23 benchmark and (3) a trained checkpoint that significantly improves the state of the art across Hands23, HOIST, FineBio, and HD-EPIC, including mAP gains of over 20 percentage points on Hands23 and FineBio. Our ablations confirm the contributions of each model component.

15.
PLOS Computational Biology 2026-06-11

MicroRNA target gene prediction model based on input-feature dependency and sample data expansion technique

作者:

by Yan Shao, Yazhou Li, Hexin Zhai, Shimin Dong Predicting microRNA target genes is essential for understanding their biological functions. This study developed a miRNA target gene prediction model based on input-feature dependency. Features were treated as multiple random variables, with marginal densities estimated using Gaussian mixture models (GMM) and dependencies captured by regular vine (R-vine) copula to derive joint probability density functions. We constructed class-conditional joint densities for positive and negative samples separately using GMM and R-vine copula, then combined these with prior probabilities using Bayes’ rule to obtain posterior probabilities of positive interactions, using a standard 0.5 probability threshold for deterministic prediction. To address insufficient data and class imbalance, hybrid distribution mega-trend diffusion was used to generate virtual samples for data augmentation. Computational validation showed high predictive performance even when only 30% of the training data were used. As proof-of-concept, we experimentally validated one predicted interaction (miR-8485 targeting JAK2) using dual-luciferase, cellular, and animal experiments, confirming the biological relevance of this specific model-generated prediction. These findings provide a valuable tool for understanding miRNA functions and disease mechanisms.

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

Adaptive Activation Steering for Efficient LLM Reasoning via Closed-Loop PID Control

Reasoning LLMs trained with long chain-of-thought often overthink: they spend tokens on redundant reflection and transitions that inflate cost without improving accuracy. Static activation steering (e.g.\ SEAL) suppresses such content with a fixed vector, but applies the same strength regardless of how redundant the current chunk actually is. We describe PID-steering, a training-free, decoding-time method that modulates the steering strength with a PID controller driven by a lightweight chunk-level redundancy classifier. On a subset of GSM8K with DeepSeek-R1-Distill-Qwen-1.5B, the method improves accuracy from 85.7\% to 89.6\% (+3.9 pp) while cutting average output length from 1026 to 790 tokens ($-$23\%). We report it as a small-scale proof of concept rather than a benchmark result.

17.
arXiv (CS.CV) 2026-06-19

FlowBender: Feedback-Aware Training for Self-Correcting Conditional Flows

Conditional diffusion and flow models routinely fail to satisfy the very constraints that define their task. For instance, a depth-conditioned model often produces images whose re-extracted depth disagrees with the input, even though the forward operator–the depth predictor defining the constraint–is available during both training and inference. Existing approaches generally fall into two categories: supervised models that treat the conditioning signal as a static cue and ignore alignment information at inference, and guidance-based methods that consult it through hand-tuned linear updates, typically trading fidelity to the condition against the plausibility of the generated sample. We argue that the fundamental gap in both paradigms is that the model is never trained to utilize its own alignment error. We introduce FlowBender, a closed-loop framework that treats this error as a first-class input, training the network to learn a correction policy conditioned on inference-time feedback. At each step, an unguided look-ahead pass estimates the clean signal, a task-specific deviation is computed via the forward operator, and a refinement pass consumes this signal to produce a corrected velocity. We propose several variants of FlowBender, including a gradient-based formulation for differentiable operators and a zero-order variant for non-differentiable settings such as JPEG compression. For efficient sampling, we introduce a prior-step shortcut that enables closed-loop correction at a minimal additional computational cost. Across image-to-image translation, restoration, and 3D mesh texturing, FlowBender consistently outperforms standard supervised baselines, alignment-loss-augmented training, and state-of-the-art inference-time guidance, improving fidelity and plausibility simultaneously rather than trading them against each other. Project page: https://flow-bender.github.io/

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

TriAdReview: Triangular Adversarial Review Architecture for Multi-Model Technical Document Generation

arXiv:2606.15074v1 Announce Type: new Abstract: Large language models (LLMs) are increasingly used for technical document generation, yet single-model outputs often suffer from over-engineering, security blind spots, and incomplete coverage. We propose TriAdReview, a triangular adversarial review architecture that employs two independent reviewer models (engineering and boundary perspectives) and a triangular judging mechanism to iteratively improve a generator model's output. We evaluate TriAdReview across five benchmark tasks - architecture design, code generation, proposal review, security audit, and requirements analysis - using three configurations: single model (baseline), dual model (single review), and triple model (full system). Results across 75 experiments (n=5 per cell) show that the triple model configuration achieves a 10.1% overall improvement over the single model baseline (26.2 vs. 23.8 out of 50; p

19.
arXiv (CS.AI) 2026-06-19

MEAL: A Benchmark for Continual Multi-Agent Reinforcement Learning

arXiv:2506.14990v3 Announce Type: replace Abstract: Benchmarks play a central role in reinforcement learning (RL) research, yet their computational constraints often shape what is studied. Despite the motivation of lifelong learning, most continual RL papers consider only 3-10 sequential tasks, as CPU-bound environments make longer sequences impractical. Meanwhile, continual learning in cooperative multi-agent settings remains largely unexplored. To address these gaps, we introduce MEAL (Multi-agent Environments for Adaptive Learning), the first benchmark for continual multi-agent RL. By leveraging JAX and GPU acceleration, MEAL enables training on sequences of 100 tasks in a few hours on a single GPU. We find that long task sequences reveal failure modes that do not appear at smaller scales.

20.
arXiv (CS.LG) 2026-06-24

Constrained Variable Projection for Structured Problems

arXiv:2606.23939v1 Announce Type: cross Abstract: Variable projection is a classical technique for separable nonlinear least-squares problems, in which variables that enter linearly are eliminated exactly, yielding a reduced nonlinear problem. By expressing this framework as a particular instance of a broader class of bilevel optimization problems, we develop a constrained variable-projection framework for data-science models, where the remaining variables are subject to convex constraints and the eliminated variables arise from a lower-level least-squares problem. In particular, by interpreting variable projection as a collapsed bilevel optimization problem, we derive exact reduced-gradient formulas compatible with automatic differentiation and propose a conditional-gradient algorithm for the resulting constrained reduced problem. We establish convergence guarantees under standard smoothness and compactness assumptions, and discuss extensions to structured lower-level variables. Numerical experiments on sparse autoencoding, dictionary learning, blind deconvolution, and few-shot learning suggest that the method can improve wall-clock efficiency and data efficiency relative to natural joint-optimization baselines.

21.
arXiv (CS.LG) 2026-06-19

SSH-Net: A Deep Neural Network for Predicting Failure Time Distribution Functions under Competing Risks with Application to GPU Data

arXiv:2606.20451v1 Announce Type: cross Abstract: Competing risks are commonly observed in engineering fields and can bring challenges to time-to-event data modeling when the application scenarios are complicated. Recently, deep neural networks have received great attention for prediction with competing risks, due to their flexibility and high learning capability. However, the complexity of neural network structure brings extra difficulty in hyperparameter tuning based on different data inputs. Additionally, when an engineered system has complex physical structures with multiple hierarchical levels, treating all structural levels as a single group of inputs may fail to capture critical information. To address the issues, we propose a Structured Segmented Hazard Deep Neural Network (SSH-Net) for failure time prediction under cause-specific competing risks framework. Our approach associates neural network structure with data structures, and allows different covariate groups to impact the failure prediction through separate sub-networks. The neural network is constructed based on a cause-specific competing risks model. The SSH-Net outputs cause-specific hazard functions, and utilizes the penalized log-likelihood as the loss function. The prediction accuracy of SSH-Net is validated through simulation studies by evaluating the Brier score, the area under receiver operating characteristic curves (AUC), and the root mean square error (RMSE) of the predicted cause-specific cumulative incident function. We further demonstrate the model's ability to predict failure time distribution functions using the Titan GPU failure time data.

22.
medRxiv (Medicine) 2026-06-15

Semantic Embeddings and the Peripheral Transcriptome in Ischemic Stroke: Connecting Molecular Signatures to NANDA-I Diagnoses

Objective: To construct and evaluate, in an exploratory manner, a pathophysiologic rationale link- ing biological pathways derived from the peripheral transcriptome in ischemic stroke (IS) to nursing diagnoses in the NANDA-I 2024-2026 taxonomy, while emphasizing that this association is not di- rect, deterministic, or automatically inferable from textual similarity with large language models (LLMs). Methods: A computational study was conducted using public secondary data from the Gene Ex- pression Omnibus series GSE16561, which includes 63 peripheral blood samples: 39 from indi- viduals with IS and 24 from healthy controls. The pipeline integrated transcriptomic analysis and functional enrichment, semantic mapping through ClinicalBERT embeddings, and mechanistic and clinical-conceptual judgment using Claude Sonnet 4.6 as a judge. The judgment stage was treated as the central interpretive layer, designed to mediate the transcriptome, pathophysiology, functional manifestation, and NANDA-I diagnosis. Results: The analysis identified a bimodal transcriptomic pattern, with activation of pathways re- lated to innate immunity and suppression of pathways related to adaptive immunity. Semantic map- ping generated 158 pathway-diagnosis pairs. The Spearman correlation between cosine similarity and the mechanistic score was negative and statistically significant (rho = -0.243; p = 2.09e-03), but weak in magnitude. This effect size indicates that semantic similarity explained less than 6% of the variance in mechanistic plausibility, reinforcing the insufficiency of embeddings as a stand- alone criterion. Of the 158 pairs, 14 were classified as high concordance, 8 as moderate, and 136 as divergent. Conclusion: The main value of this study lies in demonstrating that translating biological pathways into nursing diagnoses requires pathophysiologic, functional, and clinical-conceptual mediation. The prioritized pairs represent mechanistically plausible hypotheses for future research, without implying causality, direct clinical confirmation, or immediate care recommendations.

23.
medRxiv (Medicine) 2026-06-10

Estimating COVID-19 Cumulative Incidence from Seroprevalence Surveys accounting for Time-Varying Seroreversion: A Fully Bayesian Methodology

Seroprevalence surveys reveal the extent of humoral immunity against pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and under some circumstances represent cumulative incidence of prior infection. However, antibody waning - or seroreversion - biases these estimates by reducing assay sensitivity in a time-varying manner. Because assay sensitivity decays over time, naively using serosurveys can substantially bias estimates of SARS-CoV-2 cumulative incidence and fatality rates. The Bayesian assay-specific, time-varying sensitivity adjustment developed in this paper can reliably correct for this bias and account for the delay between infection and serosurvey. In seroprevalence studies conducted in the United States in 2020, adjusting for time-varying sensitivity increased cumulative incidence by up to 1.4-fold, with an adjustment of 1.08 for a national study. Our estimates contrast with a previously published 2-fold adjustment that did not account for assay design. This suggests that previous analyses overestimated cumulative incidence by applying seroreversion corrections that did not account for assay-specific effects, or underestimated cumulative incidence by not applying seroreversion corrections. These biases imply fatality rate underestimation and overestimation, respectively. Our model provides a framework for design-specific time-varying sensitivity corrections in seroprevalence surveys for other pathogens.

24.
medRxiv (Medicine) 2026-06-23

Associations Among Changes in Inflammatory Biomarkers, Pain Intensity, and Health-Related Quality of Life Following a 12-Week Aerobic Exercise Programme in Individuals with Non-Specific Chronic Low Back Pain

Abstract Background: Non-specific chronic low back pain (NSCLBP) is associated with persistent pain, reduced health-related quality of life (HRQoL), and low-grade systemic inflammation. This study examined associations among changes in inflammatory biomarkers, pain intensity, and HRQoL following a 12-week aerobic exercise programme. Methods: This secondary analysis used data from a randomized controlled trial involving 41 participants with NSCLBP (intervention, n = 21; control, n = 20). Participants received either supervised aerobic exercise plus health education or health education alone for 12 weeks. Change scores for tumour necrosis factor-alpha (TNF-), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), pain intensity, and HRQoL domains were analysed using correlation and multiple regression analyses. Results: Improvements in IL-6 (r = 0.434, p = 0.005) and hs-CRP (r = 0.444, p = 0.004) were significantly associated with improvements in pain intensity. No significant associations were observed between biomarker changes and HRQoL domains. Treatment allocation was the strongest independent predictor of improvement in physical HRQoL ({beta} = 0.492, p = 0.017) and pain intensity ({beta} = -0.512, p = 0.006). Conclusions: Improvements in IL-6 and hs-CRP were associated with reductions in pain intensity but not with improvements in HRQoL. Treatment allocation was the strongest predictor of clinical improvement, suggesting that mechanisms beyond systemic inflammation may contribute to the benefits of aerobic exercise in NSCLBP. Keywords: non-specific chronic low back pain; aerobic exercise; inflammation; interleukin-6; high-sensitivity C-reactive protein; pain intensity; health-related quality of life.

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.