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

MMDiff: Extending Diffusion Transformers for Multi-Modal Generation

Diffusion transformers have demonstrated remarkable generative capabilities, yet the rich perceptual representations computed across their denoising trajectory are discarded once the content is rendered. We present MMDiff, a framework that transforms a frozen diffusion transformer into a multi-modal generative system that jointly produces images alongside any combination of dense perceptual modalities using lightweight decoder heads. Our central finding is that perceptual information is temporally distributed along the denoising trajectory, and that multi-timestep feature fusion with spatially varying aggregation weights is essential, improving semantic segmentation results by up to 28.7% mIoU over single-timestep extraction. We further adopt concept-driven attention extraction for interpretable spatial guidance, and show that frozen diffusion features are competitive with and complementary to state-of-the-art encoders such as DINOv3. By training only lightweight decoder heads on a frozen backbone, we achieve strong performance in semantic segmentation, salient object detection, and depth estimation, and demonstrate that this framework enables effective synthetic data generation at scale.

02.
arXiv (CS.CL) 2026-06-12

One Polluted Page Is Enough: Evaluating Web Content Pollution in Generative Recommenders

Search-augmented LLMs increasingly mediate everyday consumer recommendations by retrieving live web content. This creates a new risk: generative recommenders may consume polluted web content, such as fake reviews and promotional pages crafted to mislead recommendations. We ask: to what extent do search-augmented LLMs become unwitting promoters of fake products when consuming polluted retrieval results? To answer this, we introduce FORGE (Fake Online Recommendations in Generative Environments), a benchmark for measuring fake-product promotion under controlled web-content pollution. Given an upstream search result, FORGE locally rewrites real products in retrieved web pages into fake ones to simulate web-content pollution, and measures how often the LLM recommends the fake product. FORGE covers 225 real-world products across 15 categories and 5 consumer scenarios. Across 12 commercial and open-weights LLMs, all models are vulnerable: a single polluted page yields fooled rates of up to 27%, while the full top-3 replacement raises this to 73.8%. Vulnerability varies substantially across categories, increasing when models lack stable prior knowledge of the relevant products. Reasoning does not mitigate this vulnerability; instead, it often generates spurious social proof to justify false recommendations. We evaluate three defenses: skepticism prompting and consensus filtering (over model priors or cross-document evidence). Skepticism can exacerbate vulnerability, much like reasoning, while filtering risks suppressing legitimate products. We release FORGE at https://github.com/leoluolol/forge-benchmark.

03.
arXiv (quant-ph) 2026-06-17

Quantum algorithm for dephasing of coupled systems: decoupling and IQP duality

arXiv:2601.06298v2 Announce Type: replace Abstract: Noise and decoherence are ubiquitous in the dynamics of quantum systems coupled to an external environment. In the regime where environmental correlations decay rapidly, the evolution of a subsytem is well described by a Lindblad quantum master equation. In this work, we introduce a quantum algorithm for simulating unital Lindbladian dynamics by sampling unitary quantum channels without extra ancillas. Using ancillary qubits we show that this algorithm allows approximating general Lindbladians as well. For interacting dephasing Lindbladians coupling two subsystems, we develop a decoupling scheme that reduces the circuit complexity of the simulation. This is achieved by sampling from a time-correlated probability distribution - determined by the evolution of one subsystem, which specifies the stochastic circuit implemented on the complementary subsystem. We demonstrate our approach by studying a model of bosons coupled to fermions via dephasing, which naturally arises from anharmonic effects in an electron-phonon system coupled to a bath. Our method enables tracing out the bosonic degrees of freedom, reducing part of the dynamics to sampling an IQP circuit. The sampled bitstrings then define a corresponding fermionic problem, which in the non-interacting case can be solved efficiently classically. We comment on the computational complexity of this class of dissipative problems, using the known fact that sampling from IQP circuits is believed to be difficult classically.

04.
arXiv (CS.AI) 2026-06-18

User as Engram: Internalizing Per-User Memory as Local Parametric Edits

Authors:

arXiv:2606.19172v1 Announce Type: new Abstract: Personal memory in a language model is two problems: content and reasoning skill. The brain keeps the two apart (a sparse, local engram in the hippocampus for each episode, a slow neocortex for the shared skills that interpret it), so a new fact need not overwrite everything else. Most personalization today keeps a user's facts outside the weights, in a natural-language memory file or a retrieval index. When facts are written into the model instead, the standard recipe is the per-user LoRA adapter, which does the opposite of the brain, folding content and skill into one global weight delta. Writing a user's facts as a LoRA contaminates text unrelated to them; writing the same facts as local Engram rows leaves it mathematically untouched, resulting in a roughly 33,000x smaller memory footprint. We therefore propose User as Engram: store a user's content as surgical edits to the hash-keyed memory table of an Engram model, and carry the reasoning skill in one shared adapter. This layered design matches per-user LoRA's direct recall while delivering 5.6x higher indirect-reasoning accuracy on average, and never makes a single user worse at reasoning than the untouched base. The edit is a glass box: writing a fact switches on its lookup at exactly the trigger, adds the value the answer needs, leaves every other position unchanged to the last bit, and fails if written into the wrong layer. Because different users' facts land in disjoint hash slots, their edits compose: many users live in one shared table at once, stacking additively and losslessly, where a per-user LoRA, a single global weight delta, admits only one. Upon retrieval, a per-user Engram table does not grow with the population the retriever must search, so past ~100 facts it overtakes a retrieval pipeline on a 2.5x larger model.

05.
arXiv (CS.AI) 2026-06-17

An AI Security Agent for Banking: Multi-Vector Fraud and AML Detection Across Retail and Corporate Accounts

arXiv:2606.17555v1 Announce Type: cross Abstract: Banks simultaneously face signature-based fraud (card-not-present attacks, account takeover, ATM cloning) and behavioural financial crime (structuring, layering, mule networks, business email compromise) – two threat families with fundamentally different detection requirements. Static rule engines that reliably catch brute-force and high-velocity events are structurally blind to business-email-compromise (BEC) payment redirection, session hijacking, and money-laundering layering, which are engineered to appear indistinguishable from legitimate activity at the individual transaction or session level. This paper presents an AI security agent for retail and corporate banking that addresses this gap through a three-component fusion architecture operating on two parallel event streams: a transaction stream (card fraud, ACH/wire fraud, AML categories) and a session stream (account takeover, session hijacking, SIM-swap, insider abuse). Each stream combines an LSTM sequence model capturing per-account behavioural history, a statistical velocity/threshold monitor, and a graph/network module capturing account-counterparty relationship patterns (fan-in, fan-out, pass-through ratio) for money-laundering detection. Experiments on a synthetic event log of 237,669 transactions and 113,508 sessions across 13 threat categories and 3,470 simulated accounts demonstrate overall F1 of 0.787 (transaction stream) and 0.867 (session stream) for the proposed model, versus 0.562/0.733 for a rule-based baseline and 0.655/0.713 for an LSTM-only baseline. The agent includes a customer-facing transaction-verification chatbot (96.6% identity verification accuracy, 86.8% mass-reset attack detection) and an analyst case-summary assistant (99.3% action-recommendation F1), with Critical-tier automated response latency under 0.43 ms at the 95th percentile.

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

Understanding Truncated Positional Encodings for Graph Neural Networks

arXiv:2606.13671v1 Announce Type: new Abstract: Positional encodings (PEs) enhance the power of graph neural networks (GNNs), both theoretically and empirically. Two of the most popular families of PEs - spectral (e.g., Laplacian eigenspaces, effective resistance) and walk-based (polynomials of the adjacency matrix) - are theoretically equivalent in expressive power, with expressivity between the 1-WL and 3-WL tests. However, this equivalence assumes the GNN uses the "complete" version of these PEs, which requires $O(n^3)$ time and space complexity. Instead, practitioners commonly use truncated variants of these encodings, such as the first $k$ eigenspaces or powers of the adjacency matrix. However, the theoretical properties of these truncated PEs are unknown. In this work, we initiate the study of these truncated PEs. Theoretically, we show that, under truncation, several families of PEs are fundamentally different in expressive power. As a corollary, we show that truncated spectral PEs are no longer stronger than the 1-WL test. We also study a family of spectral PEs, the $k$-harmonic distances, to highlight the differences in expressive power of even closely related truncated PEs. Finally, we experimentally show that a mix of truncated PEs is preferable to any single family on real-world datasets.

07.
medRxiv (Medicine) 2026-06-22

Development of a Novel Risk Prediction Model for Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD): A Longitudinal Study

Background: Interstitial lung disease (ILD) is one of the most common and potentially most devastating extra-articular complication of rheumatoid arthritis (RA) and is associated with substantial morbidity and mortality. However, reliable tools for the early identification of ILD in patients with RA remain limited. This study aimed to identify plasma protein biomarkers of RA-ILD and develop an interpretable machine learning model for risk prediction using data from the UK Biobank. Methods: We first evaluated the association between baseline RA and the risk of incident ILD in the UK Biobank using Cox proportional hazards models. Mendelian randomization analysis was then performed to investigate the potential causal relationship between RA and ILD. Finally, we analyzed 2,920 plasma proteins measured using the Olink platform in 781 eligible RA patients. Proteins associated with ILD risk were identified using Cox proportional hazards models and subsequently used to construct eight machine learning models. Model performance was assessed using the receiver operating characteristic curve (ROC) and decision curve analysis. The best-performing model was further interpreted using Shapley additive explanations (SHAP) to evaluate feature importance. Results: Compared with participants without RA, Patients with baseline RA had a significantly higher risk of developing ILD (Hazard ratio: 4.425, 95% CI: 3.549,5.518). The MR supported a potential causal association between RA and ILD (Odds ratio: 1.227, 95% CI: 1.121,1.343). Among the eight machine learning models, the CatBoost model showed the best performance, achieving an area under the curve (AUC) of 0.884 (95% CI: 0.773,0.996). The SHAP analysis identified LAG3, NPC2, and LAMP3 are the three most important plasma protein predictors of ILD development in patients with RA. Conclusion: Plasma proteomics combined with machine learning may provide a promising approach for identifying biomarkers and predicting ILD risk in patients with RA. LAG3, NPC2, and LAMP3 may serve as candidate biomarkers for RA-ILD and warrant further validation. Keywords: Rheumatoid arthritis, Interstitial lung disease, Mendelian randomization, Machine learning, Plasma proteins.

08.
arXiv (CS.AI) 2026-06-24

Skills for the future software profession: beyond agentic AI!

arXiv:2606.21894v2 Announce Type: replace-cross Abstract: As coding agents are rapidly changing software engineering, a natural question is: what are the core skills needed by future software engineers? To identify where software engineering is headed and thus what skills will be needed, we summarize the results of two round-tables with researchers and industrial practitioners, held in 2026 in New York and Singapore. One key finding is that verification and validation is increasing in importance as agents handle implementation, as highlighted by anecdotes from the events. From our observations, we identify the skills developers need in the agentic era of development, with implications for training and educating future software engineers in coming years.

09.
arXiv (CS.CV) 2026-06-25

Naturalness Predicts but Does Not Cause Transferability in Image Encodings of Real-World Streams

A common practice converts a one-dimensional signal into an image so that a vision backbone pretrained on natural photographs can be reused for recognition, yet the encoded image is rarely examined. We ask how the visual naturalness of an encoded image relates to its transfer accuracy under a frozen backbone. We build WorldStream, a corpus of 299 heterogeneous current-value series from key-free public APIs (weather, air quality, earthquakes, gold and oil, equities, crypto, foreign exchange, web activity and space weather), with a nine-way source-recognition task over 3143 temporally split windows. Across seven encodings and six frozen backbones, the Frechet distance of an encoding to natural images (FID) predicts its accuracy: Spearman $\rho=-0.72$. Two controlled interventions show this is not causal in the spectrum. Our invertible encoder has a single adjustable part, a spectral exponent $\beta$ (power $\propto |f|^{-\beta}$); varying $\beta$ moves the image toward or away from the natural-image manifold at fixed content. FID is lowest near the natural value $\beta \approx 2$, but frozen accuracy stays flat and far below the structured baselines (19.2% vs. 73.0%), and FID and accuracy are only weakly related over the sweep (Pearson $-0.32$). A second intervention, phase scrambling, holds the power spectrum exactly fixed while removing local structure; now FID and accuracy fall together (Pearson $-0.89$). The cross-encoding correlation is thus mediated by local structure, not spectral naturalness: FID predicts accuracy because Inception reads the same structure the backbones do. Full fine-tuning does not close the gap (27% vs. 67%), so the deficit is structural. The encoder is exactly invertible, recovering the signal from the 8-bit image at 72.9 dB, so the image doubles as a lossless record of the data.

10.
arXiv (CS.CV) 2026-06-24

SENTRY: SAM2-Enhanced Neighbor-Aware and Temporally Reasoned Memory for Visual Tracking

We revisit the memory update mechanism in SAM2-based visual object tracking and identify confidence-only mask selection as the dominant cause of drift under occlusion, rapid motion, and distractors. We introduce SENTRY, a training-free, plug-and-play, refine-before-write module that validates each memory update for short-horizon temporal consistency before committing it. SENTRY aggregates diverse segmentation hypotheses per frame, backtracks them into short tracklets, and uses neighbor-aware cycle-consistent matching against recent trajectories to favor temporally and geometrically consistent masks. It leaves the base architecture untouched, replacing confidence-driven writes with consistency-validated ones. For fair evaluation, we re-evaluate major open-source SAM2-based trackers across all available scales and datasets, filling gaps in prior reports. Integrated into five strong baselines, SENTRY delivers consistent gains across nine benchmarks, achieving new zero-shot SOTA on LaSOT, LaSOT_ext, GOT-10k, VOT20, VOT22, and DiDi. Despite these checks, the SAM2-L version runs at 32.8 FPS on an A100, and across compatible hosts adds only about 0.4–0.6 GB VRAM. Our results provide the first unified all-scale evaluation of SAM2-based trackers and show that enforcing temporal validity at write time stabilizes memory-augmented tracking without retraining.

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

Pixel-TTS: Image based Text Rendering for Robust Text-to-Speech

Recent advances in pixel-based text modeling show that representing text as images enables models to exploit visual cues for language understanding. Grounding text in its visual form allows structurally similar characters with different Unicode encodings to produce similar embeddings, benefiting cross-lingual and zero-shot scenarios. Conventional text-based approaches treat each character independently, limiting generalization to unseen characters and requiring embedding expansion during cross-lingual adaptation. We propose Pixel-TTS, the first framework for visually grounded speech synthesis. It renders text as images and projects them through a 2D convolutional layer to generate embeddings. This design eliminates embedding matrix expansion during fine-tuning while improving robustness to unseen characters and orthographic variations. Extensive experiments show Pixel-TTS achieves competitive performance with strong baselines, faster convergence and robust zero-shot generalization.

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

EWAM: An Enhanced World Action Model for Closed-Loop Online Adaptation in Embodied Intelligence

arXiv:2606.12690v1 Announce Type: cross Abstract: In this paper, we propose the Enhanced World Action Model (EWAM), a closed-loop online adaptation architecture built upon a pretrained and fully frozen Cosmos3 backbone network. Evaluated entirely under a zero-shot task protocol, EWAM is centrally focused on reducing the amount of additional deployment data required to adapt to new task layouts. Notably, no extra task-specific demonstration sets were introduced in any of the evaluations, and no fine-tuning was performed on the backbone network. Its performance gains stem entirely from an inference-time co-reasoning mechanism composed of four inserted lightweight neural layers: the Neural Experience Memory Layer located in the intermediate layers of the Diffusion Transformer (DiT) provides task-relevant execution context; the Neural Anomaly Detection Layer after the state prediction head monitors the divergence between predicted and actual states in real time; the Neural Policy Routing Layer dynamically selects direct execution, conservative replanning, or rollback recovery based on the anomaly severity; and the Neural Action Correction Layer refines the generated action chunks using execution diagnostics. Unlike naive feature fusion, the memory, anomaly detection, and correction modules are deeply integrated into the Cosmos3 forward path in a differentiable manner, with only the final routing decision being a discrete supervised one.

13.
arXiv (CS.CV) 2026-06-24

Cyclic Denoising Reveals Ultrastable Memories in Diffusion Models

We introduce cyclic denoising – repeated forward and reverse diffusion at controlled noise amplitudes – as an extraction attack for image diffusion models. Inspired by random organization in disordered solids, cyclic denoising exposes regions of the learned distribution that are largely inaccessible to standard sampling. The dynamics drive samples toward attractors with a broad stability spectrum. The deepest attractors are ultrastable: they regenerate after near-total corruption and persist through thousands of noising-denoising cycles. Many of these attractors correspond to memorized training images, including stock photographs, brand watermarks, and web-crawl artifacts. The attack requires only sampler-level control, with no gradients, weight inspection, prompts, captions, or prior knowledge of the training data. Unlike generate-and-filter attacks, which rely on large-scale prompted generation and post-hoc similarity or membership-inference filtering, our main protocol is fully unconditioned. We demonstrate the phenomenon in Stable Diffusion v1.4 and in a pixel-space DDPM, showing consistent behavior across latent- and pixel-space diffusion models. Across noise amplitudes, we observe a yielding-like transition: low-amplitude cycling produces trivial absorbing fixed points or limit cycles, while larger amplitudes induce rearrangements, basin hopping, and long-lived trapping in structured memorized attractor basins. We also observe hierarchical partial absorption, prompt-stabilized basins, and cross-initial-condition universality of the recovered attractor set. Our results therefore show that cyclic denoising is both a physics-inspired probe of generative landscapes and a practical tool for memorization auditing, with implications for privacy, copyright compliance, and model fingerprinting.

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

The Safety-Aware Denoiser for Text Diffusion Models

arXiv:2605.08116v2 Announce Type: replace-cross Abstract: Recent work on text diffusion models offers a promising alternative to autoregressive generation, but controlling their safety remains underexplored. Existing safety approaches are geared toward autoregressive models and typically rely on post-hoc filtering or inference-time interventions. These are inadequate for effectively addressing safety risks in text diffusion models. We propose the Safety-Aware Denoiser (SAD), a safety-guidance framework in text diffusion models. The SAD modifies the iterative denoising process such that the text sample at the final denoising step is steered toward provably safe regions of the text space. This inference-time method can integrate safety constraints into the denoiser, avoiding computationally expensive retraining of the underlying diffusion model and enabling flexible, lightweight safety guidance. We evaluate the safety of the generated text using the SAD, with respect to hazard taxonomy, memorization, and jailbreak. Experimental results show that SAD substantially reduces unsafe generations while preserving generation quality, diversity, and fluency, outperforming existing methods. These results demonstrate that our safety guidance during denoising provides an effective and scalable mechanism for enforcing safety in text diffusion models.

15.
medRxiv (Medicine) 2026-06-18

Human Intuition vs. Computational Precision: Neurologists, Feature-based Models, and Deep Learning for Stroke Prognosis

Background: Prognostication in large vessel occlusion (LVO) stroke remains challenging. Although several prognostic models exist, their comparison to clinician performance, human-model interaction, and specific sources of human bias remain poorly understood. Methods: Using pre-treatment clinical and CT data from the MR CLEAN trial (n=500), six neurologists predicted three-month modified Rankin Scale (mRS) scores for 40 patients, both unaided and assisted by a validated feature-based model (MR PREDICTS). Human performance was benchmarked against MR PREDICTS and a multimodal, interpretable deep learning (DL) approach using raw imaging data. We explicitly assessed neurologists? ability to estimate model-required imaging features and identified systematic human biases. Models were additionally validated in a larger MR CLEAN trial cohort (n=404). Results: For predicting the full mRS distribution, standalone models achieved good ordinal agreement (MR PREDICTS quadratic weighted kappa (QWK) 0.51 [0.24 to 0.70]; DL model 0.49 [0.25 to 0.67]), significantly outperforming unaided neurologists (QWK 0.27 [0.10, 0.42]). Neurologists showed systematic overoptimism, predicting lower mRS scores than observed. Furthermore, there was poor accuracy in extracting imaging features. Raters? ASPECTS predictions deviated by 3.4 points from the confirmed scores, and collateral score accuracy was 44.6%. However, for predicting binary mRS (0-2 vs. 3-6), accuracy was comparable between unaided neurologists (64.17% [55.42% to 72.92%]) and models (MR PREDICTS 67.50% [52.50% to 82.50%]; DL model 63.16% [47.37% to 78.95%]). Model-assistance modestly improved and harmonized neurologists? predictions (QWK 0.41 [0.22 to 0.55]; binary accuracy 68.75% [58.33% to 78.34%]. Model performance remained robust in the larger cohort. Conclusions: Multimodal prognostic models outperform clinicians in predicting the full range of mRS outcomes, while human error in imaging assessment and systematic optimism bias are primary drivers of prognostic inaccuracy. End-to-end DL models eliminate human-input variability and hold strong potential as an automated second opinion to support prognostication and decision-making in acute LVO stroke.

16.
medRxiv (Medicine) 2026-06-18

MOSAIC: Methylation-Oriented Site Analysis and Information Classifier for Robust Epigenomic Classification of Acute Leukemia in Clinical Cohorts with Variable Tumor Purity

DNA methylation-based classification offers a rapid diagnostic complement to conventional molecular workflows in acute leukemia. Existing classifiers are trained on array-derived reference cohorts whose construction favors specimens with adequate tumor content, leaving clinically relevant low-purity specimens underrepresented and classifier robustness in this regime uncharacterized. On held-out low-purity specimens, existing classifiers were concordant with expert pathology in only 7 of 10 (MARLIN) and 5 of 10 (ALMA) cases, motivating a classifier built to maintain accuracy at low tumor purity. We developed MOSAIC (Methylation-Oriented Site Analysis and Information Classifier), a neural network classifier built to maintain accuracy across the full range of tumor purities encountered in clinical practice. MOSAIC is a neural network trained on publicly available array-based methylation data augmented with native methylation calls from Oxford Nanopore sequencing. MOSAIC was evaluated on low-purity specimens held out entirely from training. On these held-out low-blast leukemia specimens, all below 25% blasts and including a case at 1.4%, MOSAIC was concordant with expert pathology in every case, recovering the correct subtype where diluted disease signal would otherwise be mistaken for normal or unrelated tissue. Gradient-based saliency analysis showed that the network relies on a partially distinct set of discriminative CpG probes when classifying low-blast specimens. MOSAIC demonstrates that augmenting training with clinically representative clinical specimens yields methylation-based leukemia classification that maintains effectiveness under the variable tumor purity of real clinical cohorts.

17.
arXiv (CS.CV) 2026-06-15

A Unified Theory of Sinusoidal Activation Families for Implicit Neural Representations

Implicit Neural Representations (INRs) model continuous signals with compact neural networks and have become a standard tool in vision, graphics, and signal processing. A central challenge is accurately capturing fine detail without heavy hand-crafted encodings or brittle training heuristics. Across the literature, periodic activations have emerged as a compelling remedy: from SIREN, which uses a single sinusoid with a fixed global frequency, to more recent architectures employing multiple sinusoids and, in some cases, trainable frequencies and phases. We study this family of sinusoidal activations and develop a principled theoretical and practical framework for trainable sinusoidal activations in INRs. Concretely, we instantiate this framework with Sinusoidal Trainable Activation Functions (STAF), a Fourier-like activation whose amplitudes, frequencies, and phases are learned. Our analysis (i) establishes a Kronecker-equivalence construction that expresses trainable sinusoidal activations with standard sine networks and quantifies expressive growth, (ii) characterizes how the Neural Tangent Kernel (NTK) spectrum changes under trainable sinusoidal parameterization, and (iii) provides an initialization that yields standard normal post-activations without asymptotic central limit theorem (CLT) arguments. Empirically, on images, audio, shapes, inverse problems (super-resolution, denoising) and NeRF, STAF is competitive and often stronger on distortion-oriented reconstruction metrics such as PSNR/SSIM across the evaluated INR tasks, with favorable parameter efficiency under layer-wise sharing. While periodic activations can alleviate practical manifestations of spectral bias, our results indicate they do not eliminate it; instead, trainable sinusoids can improve the observed capacity-optimization trade-off in the evaluated settings.

18.
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.

19.
medRxiv (Medicine) 2026-06-23

Unscreenable: The Burden, Structure, and Analytic Consequences of "Unable to Assess" Delirium Documentation in the Intensive Care Unit

Objective: To quantify the burden, structure, and downstream analytic consequences of "Unable to Assess" (UTA) delirium documentation in the intensive care unit (ICU). Design: Retrospective cross-sectional and repeated-measures study. Setting: A single US academic medical center (Medical Information Mart for Intensive Care IV [MIMIC-IV], 2008-2019). Patients: 72,944 adult ICU stays with at least 1 delirium screen. Interventions: None. Measurements and Main Results: Among 610,632 screens, 130,455 (21.4%; 95% CI, 21.0%-21.8%) were recorded as UTA, exceeding the 119,052 (19.5%) scored positive. The UTA fraction rose from 2.0% at a Richmond Agitation-Sedation Scale (RASS) score of 0 to 97.8% at RASS -4; 22.0% of UTA screens occurred in arousable patients, where UTA was associated with mechanical ventilation (odds ratio [OR], 3.43; 95% CI, 3.17-3.71) and non-English primary language (OR, 3.74; 95% CI, 3.43-4.08). Building the delirium label three ways from the same patients shifted prevalence modestly (32.1% to 30.8%) and prediction (area under the curve, 0.737 to 0.719) but most affected the delirium-mortality association: in a baseline-adjusted model the OR was 4.12 (95% CI, 3.88-4.36) under complete-case handling and fell to 2.16 (95% CI, 2.06-2.27) when UTA was recoded as negative. UTA was recoverable from the observed clinical state (area under the curve, 0.95). Conclusions: In this ICU cohort, Unable to Assess was the most common recorded delirium result other than Negative, exceeding positive screens; recoding it as negative roughly halved the apparent delirium-mortality association by relabeling deeply sedated, high-mortality patients. Delirium datasets should preserve and report UTA, whose concentration among arousable non-English-speaking patients is a measurable equity target.

20.
medRxiv (Medicine) 2026-06-24

INCREASED REMOVAL SIGNALS ON ERYTHROCYTES OF ANEMIC CANCER PATIENTS

BACKGROUND: Anemia is a negative factor in cancer, influencing the prognosis, quality of life and financial situation of cancer patients. Recent studies have shown that anemia in cancer is provoked by augmented erythrocyte removal. OBJECTIVE: In this study we sought to investigate the molecular bases for erythrocyte removal in cancer patients with anemia. In particular, we explored the levels of erythrocyte CD47, lactadherin, calreticulin and MCP1. METHODS: Thirty five anemic cancer patients (25 women, aged 66.4 +/-11.35 years old) and twelve healthy non-anemic controls (8 men, aged 61.1+/-9.98 years old) participated in our study. Red blood cells were isolated throug multiple centrifugations, and were lysed with the use of Triton-X 100. The levels of CD47, lactadherin, calreticulin and monocyte chemoattrractant protein 1 were determined by ELISA. RESULTS: Erythrocytes of anemic cancer patients display reduced CD47 (p

21.
medRxiv (Medicine) 2026-06-18

Cost analysis of overseas versus domestic vaccination of US-bound refugees

Context: To ensure healthy resettlement and protect US health security, the Vaccination Program for US-bound Refugees (VPR) offers some recommended vaccines to refugees overseas before resettlement to the United States. The selected vaccines and number of doses vary by country of departure. VPR was found to be cost-saving in 2018 but had since expanded to more sites. Objective: Assess VPR's current costs and impact on post-arrival domestic vaccination needs and costs. Setting and Participants: A model-based analysis of the Federal government costs for VPR and post-arrival (US) vaccination of resettled refugees separated across five regions: Africa, Asia, the Middle East and North Africa/Republic of Turkiye and Middle East, Europe, and the Americas using fiscal year 2024 data. Design: We quantified and compared full vaccination costs for refugees under two scenarios: (1) 'No VPR' and (2) 'VPR'. Refugees would receive no vaccines overseas and be fully vaccinated after US arrival under 'No VPR'. Under 'VPR', refugees receive one or two doses of selected vaccines overseas before completing vaccination schedules after arrival. Main Outcomes: Costs were reported in 2023 US dollars for 'VPR' and 'No VPR' scenarios and further subdivided by grouping countries/sites depending on whether the International Organization for Migration (IOM) provides vaccination services for refugees (IOM sites) versus non-IOM providers (non-IOM sites). Results: 'VPR' resulted in average net cost savings of $147 per person or $14.7 million per 100,000-refugee cohort compared to providing all vaccines after US arrival ('No VPR'). 'VPR' was cost-saving across most regions, except for IOM sites in Europe, where a net cost of $44 per person was observed. Net cost savings per person were highest for IOM sites in Africa ($333). Conclusions: VPR remains a cost-saving strategy, while protecting US-bound refugees' health and US health security by preventing disease outbreaks during resettlement.

22.
arXiv (CS.LG) 2026-06-16

Incentives and Evidence in Learned Service Orchestration

arXiv:2606.16555v1 Announce Type: cross Abstract: Reinforcement learning for service orchestration has been the subject of sustained research for over a decade, yet it is not used in production at scale. The usual explanation is that learned controllers degrade under delayed and noisy telemetry, workload shifts, and uncontrolled tenants. We test whether existing evidence supports that explanation. We evaluate three highly influential RL-based orchestration systems spanning resource allocation, DAG scheduling, and autoscaling, using pre-registered predictions about comparative degradation under production-relevant perturbations and paired inference with family-wise error correction. Across the tests, most predicted performance reversals do not occur. Diagnostic analyses show that these outcomes often reflect comparator collapse, artefact limitations, or evaluation choices rather than evidence that learned controllers tolerate the perturbations. One apparent advantage under observation lag is roughly fortyfold compared to a Kubernetes HPA-equivalent controller. Another widely cited result cannot be reconstructed from its released artefact, and the strongest reproducible margin is far smaller than the published results. Conclusions also reverse under changes in perturbation magnitude and evaluation mode. Based on these results and broader patterns in the literature, we identify an institutional problem. Publication and review incentives favour benchmark gains against convenient comparators, even when those gains provide little evidence of deployment performance. We argue that the problem is not solely technical. Rather, it is institutional, so learned orchestration needs production-grade comparators, registered perturbation models, separate operational metrics, and publication criteria that reward reproducible operational evidence. Without these changes, the literature can grow without establishing whether learning improves orchestration.

23.
arXiv (quant-ph) 2026-06-11

Expressivity of Quantum Reservoir Computers

arXiv:2501.15528v3 Announce Type: replace Abstract: Using Hamiltonian encoding to inject an input into parameterized quantum circuits (PQCs), the output of the PQC can be written as truncated Fourier series. In recent years, the expressivity of PQCs was established as the number of frequencies contained in this Fourier series. While this concept has also been applied to other quantum machine learning (QML) paradigms, a clear notion of expressivity for temporal information processing with quantum systems is still lacking. Here, we introduce such a notion to the field of quantum reservoir computing (QRC). We analytically derive an expression for the readouts showing that the output of a QRC can be interpreted as a multi-dimensional Fourier series. We give a formula for the growth of expressivity induced by the sequential information injection, which we corroborate with numerical simulations, calculating explicitly the number of multi-dimensional output functions which can be generated from the readouts. Our results show that the specific interplay between system size, input encoding, and memory time gives rise to a boundary on the system size beyond which it is obstructive to further increase the reservoir size in extreme scrambling systems. We propose a recipe for determining this maximal system size for a given QRC setup.

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

Would a Large Language Model Pay Extra for a View? Inferring Willingness to Pay from Subjective Choices

As Large Language Models (LLMs) are increasingly deployed in applications such as travel assistance and purchasing support, they are often required to make subjective choices on behalf of users in settings where no objectively correct answer exists. We study LLM decision-making in a travel-assistant context by presenting models with choice dilemmas and analyzing their responses using multinomial logit models to derive implied willingness to pay (WTP) estimates. These WTP values are subsequently compared to human benchmark values from the economics literature. In addition to a baseline setting, we examine how model behavior changes under more realistic conditions, including the provision of information about users' past choices and persona-based prompting. Our results show that while meaningful WTP values can be derived for larger LLMs, they also display systematic deviations at the attribute level. Additionally, they tend to overestimate human WTP overall, particularly when expensive options or business-oriented personas are introduced. Conditioning models on prior preferences for cheaper options yields valuations that are closer to human benchmarks. Overall, our findings highlight both the potential and the limitations of using LLMs for subjective decision support and underscore the importance of careful model selection, prompt design, and user representation when deploying such systems in practice.

25.
arXiv (CS.AI) 2026-06-15

Revisiting Outage for Edge Inference Systems

arXiv:2504.03686v3 Announce Type: replace-cross Abstract: One of the key missions of sixth-generation (6G) mobile networks is to deploy large-scale artificial intelligence (AI) models at the network edge to provide remote-inference services for edge devices. The resultant platform, known as edge inference, will support a wide range of Internet-of-Things applications, such as autonomous driving, industrial automation, and augmented reality. Given the mission-critical and time-sensitive nature of these tasks, it is essential to design edge inference systems that are both reliable and capable of meeting stringent end-to-end (E2E) latency constraints. Existing studies, which primarily focus on communication reliability as characterized by channel outage probability, may fail to guarantee E2E performance, specifically in terms of E2E inference accuracy and latency. To address this limitation, we propose a theoretical framework that introduces and mathematically characterizes the inference outage (InfOut) probability, which quantifies the likelihood that the E2E inference accuracy falls below a target threshold. Under an E2E latency constraint, this framework establishes a fundamental tradeoff between communication overhead (i.e., uploading more sensor observations) and inference reliability as quantified by the InfOut probability. To find a tractable way to optimize this tradeoff, we derive accurate surrogate functions for InfOut probability by applying a Gaussian approximation to the distribution of the received discriminant gain. Experimental results demonstrate the superiority of the proposed design over conventional communication-centric approaches in terms of E2E inference reliability.