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01.
medRxiv (Medicine) 2026-06-12

High coverage, persistent gaps: quality of Antenatal Care and its determinants in Zambia based on the 2024 Demographic and Health Survey.

Abstract Background Evaluating antenatal care (ANC) quality is critical to reducing maternal and neonatal mortality. In Zambia, despite high basic ANC attendance, comprehensive national evidence on the clinical content and quality of services remains limited. This study assessed the coverage of WHO-recommended ANC interventions and identified factors associated with care quality using the latest national data. Methods A cross-sectional analysis was conducted using data from the 2024 Zambia Demographic and Health Survey. The final analytic sample comprised 4,829 women aged 15-49 with a live birth in the preceding 5 years. A composite index of 15 selected, equally weighted WHO-recommended components evaluated clinical assessment, counseling/screening, preventive interventions, and utilization. Survey-weighted Poisson regression estimated adjusted incidence rate ratios (aIRRs) for the count of ANC components received. Results The mean ANC quality score was 12.5 out of 15 (95% CI: 12.4-12.6), and 78.5% (95% CI: 77.0-80.0) of women achieved adequate ANC ([≥] 12/15 components). While individual clinical and counseling coverage generally exceeded 90%, only 47.2% (95% CI: 45.3-49.0) of women initiated care during the first trimester, and just 4.8% (95% CI: 4.1-5.6) achieved [≥] 8 ANC contacts. Maternal education was the strongest and most stable predictor of quality across all models. Compared to no education, higher education was associated with an 8.0% higher expected quality score (aIRR = 1.080, 95% CI: 1.051-1.110). Lower ANC quality was significantly associated with unwanted pregnancies (aIRR = 0.970, 95% CI: 0.956-0.993) and with residence in Western (aIRR = 0.923, 95% CI: 0.897-0.951) and North Western (aIRR = 0.966, 95% CI: 0.937-0.996) provinces. Absence of distance barriers and residence in Eastern, Luapula, and Copperbelt provinces were associated with higher quality scores. Conclusion While average ANC component coverage in Zambia is high, critical gaps persist in early initiation and total contact frequency. Care adequacy is strongly influenced by maternal education, relationship status, pregnancy intention, and regional inequities. These findings underscore the need for interventions targeted at uneducated women, preventing unintended pregnancies, and underserved regions such as Western and North Western Provinces. Keywords: Antenatal care quality, ANC content, Zambia, maternal education.

02.
bioRxiv (Bioinfo) 2026-06-16

Infectious Disease Forecasting via Physics-Informed Machine Learning

Infectious disease transmission evolves as a dynamic process shaped by biological mechanisms, population behavior, and intervention policies, yet public health responses are often driven by lagging indicators. Accurate short- and long-term disease forecasting is essential for the timely deployment of intervention strategies, healthcare capacity planning, and uncertainty-aware, risk-informed decision-making. To address this challenge, three broad classes of forecasting models have traditionally been used: statistical, machine learning, and mechanistic approaches. However, each of these modeling paradigms faces fundamental limitations. In particular, traditional statistical models often lack the flexibility needed to capture complex disease dynamics, machine learning approaches require large, high-quality data streams, and mechanistic models are notoriously difficult to calibrate. To overcome these challenges, we propose a novel physics-informed machine learning (PIML) framework for forecasting infectious disease dynamics. Our approach simultaneously forecasts new case and hospitalization counts, along with other key epidemiological quantities such as the time-varying reproduction number. This is achieved through the design of a machine learning model and estimation strategy regularized by a system of differential equations that encode disease dynamics of the SIHR model, thereby bridging the gap between purely data-driven and mechanistic models. We demonstrate the proposed methodology through in-depth numerical studies and an application to COVID-19 data collected in the state of South Carolina.

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

TW-LegalBench: Measuring Taiwanese Legal Understanding

Large language models (LLMs) have shown impressive capabilities across diverse tasks, yet their performance on jurisdiction-specific legal reasoning remains underexplored. We present TW-LegalBench that utilizes Taiwanese legal system's rich official corpus open to the public to fill the gap in evaluating LLMs on Taiwanese law, among common-law benchmarks that focus on English sources and civil-law benchmarks focusing on sources of Simplified Chinese. TW-LegalBench comprises three task types: (1) over 16,000 multiple-choice questions (MCQs) across five years of official examinations in 18 professional domains; (2) 117 open-ended essay questions (OEQs) from examinations for legal professionals with official scoring rubrics; and (3) more than 14,000 legal judgment prediction (LJP) instances covering hundreds of crime categories. We evaluate 13 LLMs using accuracy for MCQs, a decomposed LLM-as-Judge framework based on the scoring rubric points for OEQs, and metrics for sentencing accuracy and statute citation for LJP. Our results reveal that top-performing models exceed the passing threshold for qualified lawyers (passing rate: 11%) but fall short of that for judges and prosecutors (passing rate: 1~2%). For LJP, while models demonstrate reasonable verdict type accuracy and sentence prediction capability, they struggle to cite exact legal articles. These findings highlight that reliable legal text generation remains challenging for LLMs, even though their performance on qualification examinations approaches human level.

04.
arXiv (CS.AI) 2026-06-19

Evaluation of EEG Foundation Models for Event-Based Burst-Suppression Detection in ICU

arXiv:2606.20074v1 Announce Type: cross Abstract: Burst suppression (BS) is a clinically relevant electroencephalographic (EEG) pattern used to monitor sedation depth and brain activity in critically ill patients, particularly during induced coma in Intensive Care Units (ICUs). Automatic burst detection remains challenging because BS patterns vary substantially between patients and annotated datasets are scarce. Recently, EEG Foundation Models (FMs) have shown promise across several downstream EEG applications, but their usefulness for BS detection remains unexplored. We present the first study to evaluate EEG FMs for burst detection in reduced-montage ICU EEG without patient-specific calibration. We compare REVE-base, LUNA-large and LuMamba-Tiny with an adaptive thresholding baseline and a task-specific EEGNet baseline. Additionally, we complement conventional EEG window-based classification with event-based burst detection evaluation. This helps assessing clinically whether burst episodes are correctly detected, reducing the impact of expected annotation variability. The best model, REVE-base, achieved the highest event-based F1-score ($0.868 \pm 0.167$) and reduced burst-per-minute error by 52.1% and 36.2% compared to EEGNet and adaptive thresholding respectively, supporting FMs for scalable EEG monitoring in ICU. Ablation experiments showed that full fine-tuning was the most effective adaptation strategy with respect to frozen-backbone training, two-step fine-tuning, and LoRA-based adaptation, improving event-based F1-score over frozen-backbone training by up to $+0.102$ for LUNA-large. With reduced labeled datasets, pretrained REVE-base outperformed random initialization by $+0.723$ event-based F1 points at 25% of the cohort, demonstrating the benefit of pretraining FM representations when adapted to burst detection with limited labeled data.

05.
arXiv (CS.CL) 2026-06-19

Your Mouse and Eyes Secretly Leak Your Preference: LLM Alignment using Implicit Feedback from Users

To align a Large Language Model (LLM), most existing methods collect explicit human feedback and train a reward model to predict the human preference based on the response text. These existing methods have two key limitations. First, the users rarely provide explicit feedback for LLM responses, which makes the high-quality preference annotation expensive to collect. Second, the methods do not leverage implicit human feedback, which has proven vital to the economic moats of Internet giants. To quantify the value of implicit feedback, we build a new dataset called IFLLM, which collects 1336 multi-turn questions from the 59 Mechanical Turk workers, their mouse trajectories, and eye gazing points to the LLMs' responses from their webcams. IFLLM shows that the users have very diverse types of gazing behavior and mouse trajectories. Our reward model based on the implicit user feedback boosts the accuracy of the text-based reward model from 55% to 64% and nearly triples the relative response quality improvements after applying the DPO to eight LLMs, demonstrating the value of implicit feedback in the wild. Our data collection website, dataset, and codes can be found at https://github.com/themehulpatwari/llm-implicit-feedback/.

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

From Parameters to Feature Space: Task Arithmetic for Backdoor Mitigation in Model Merging

arXiv:2606.12498v1 Announce Type: cross Abstract: Model merging (MM) has gained significant attention as a cost-effective approach to integrate multiple task-specific models into a unified model. However, recent work reveals that MM is highly susceptible to backdoor attacks. Existing defenses based on task arithmetic often fail to eliminate backdoors without substantially degrading clean-task performance, owing to their reliance on direct parameter-space editing. To address this gap, we propose Linear Feature Path Minimization (LFPM), a backdoor mitigation framework for model merging, which introduces an anti-backdoor task vector into the backdoored merged model. Unlike prior approaches, LFPM formulates the backdoor robustness of the merged model from a unified feature-space perspective under the Cross-Task Linearity (CTL) framework, which leverages the approximate linearity of features across tasks. This perspective guides the optimization of the anti-backdoor task to suppress backdoors while preserving clean-task performance. Furthermore, we introduce an effective optimization mechanism based on gradient accumulation and loss path-integral, ensuring robust backdoor suppression along the interpolation path. Extensive experiments demonstrate that LFPM consistently exhibits strong robustness against backdoor attacks in both full fine-tuning and Parameter-Efficient Fine-Tuning (PEFT) settings.

07.
arXiv (CS.AI) 2026-06-17

Ensemble RL through Classifier Models: Enhancing Risk-Return Trade-offs in Trading Strategies

作者:

arXiv:2502.17518v3 Announce Type: replace-cross Abstract: This paper presents a comprehensive study on the use of ensemble Reinforcement Learning (RL) models in financial trading strategies, leveraging classifier models to enhance performance. By combining RL algorithms such as A2C, PPO, and SAC with traditional classifiers like Support Vector Machines (SVM), Decision Trees, and Logistic Regression, we investigate how different classifier groups can be integrated to improve risk-return trade-offs. The study evaluates the effectiveness of various ensemble methods, comparing them with individual RL models across key financial metrics, including Cumulative Returns, Sharpe Ratios (SR), Calmar Ratios, and Maximum Drawdown (MDD). Our original experimental results demonstrate that ensemble methods often outperform base models in terms of risk-adjusted returns, providing better management of drawdowns and overall stability. However, both the original analysis and the additional reproduction reported in this version show that ensemble performance is sensitive to the choice of variance threshold \(\tau\), classifier group, RL-agent pair, and market universe. The reproduction evidence strengthens the conclusion that classifier-assisted ensemble selection can improve robustness, while also clarifying that the advantage is conditional rather than automatic across all datasets. This study emphasizes the value of combining RL with classifiers for adaptive decision-making, with implications for financial trading, robotics, and other dynamic environments.

08.
arXiv (CS.AI) 2026-06-19

AI4SE and SE4AI Exploration: A Decade Looking Back and Forward

arXiv:2606.19630v1 Announce Type: new Abstract: The March 2020 INCOSE INSIGHT special issue on AI and Systems Engineering (SE) became the most downloaded issue in the publication's history and launched a research community that now draws over 250 registrants to its annual workshop. In this article, we trace the progress in AI and SE across three phases (labeled here foundational, applied, and LLM inflection) based on the authors' reading of the field's core papers, and describe our opinions of where the community has converged and where critical gaps remain. Separately, a human-AI agreement literature review leveraging both human expertise and six AI models was performed to assess the relevance of 1,712 INCOSE INSIGHT articles and 889 SERC publications. The results identify five critical research gaps and offer guidance for practitioners navigating AI adoption, assurance, and workforce transformation in SE. We share the agreement data and the AI4SE/SE4AI Explorer web application so readers can compare their own relevance judgments with the human and AI raters.

09.
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]

10.
arXiv (CS.LG) 2026-06-15

Zeta: Dual Whitening for Matrix Optimization via Coordinate-Adaptive Preconditioning

arXiv:2606.14187v1 Announce Type: new Abstract: Large-scale neural network training increasingly relies on matrix-aware optimizers that exploit the structure of weight parameters beyond element-wise adaptation. However, existing matrix-aware methods such as Muon have an underappreciated vulnerability: their core operation, Newton-Schulz iteration, depends critically on input conditioning, yet the raw momentum matrices exhibit severe coordinate-wise scale heterogeneity. In this paper, we first verify this scale heterogeneity through a chi-square uniformity test, showing that intra-matrix scale imbalance is prevalent across Transformer layers and that coordinate whitening effectively corrects it. Motivated by this finding, we propose Zeta, a dual whitening optimizer that applies coordinate whitening and spectral whitening in a strictly ordered pipeline. The ordering is not a tunable choice but follows from a mathematical dependency: coordinate whitening establishes the statistical isotropy that spectral whitening requires to function reliably. We further prove that this dual pipeline strictly reduces orthogonalization error relative to pure spectral methods by improving the condition number of the input. Empirically, Zeta matches or surpasses strong baselines across language modeling (0.6B to 8B parameters), mixture-of-experts architectures, and vision tasks, demonstrating that resolving scale imbalance before orthogonalization leads to faster convergence and better generalization. Code is available at https://gitcode.com/kevin259/MindSpeed.

11.
arXiv (CS.CL) 2026-06-18

Continuous Audio Thinking for Large Audio Language Models

Large audio language models (LALMs) have shown impressive capabilities on diverse audio understanding tasks, ranging from speech transcription to music analysis. However, because LALMs are typically trained to produce text-aligned responses, their hidden states are progressively shaped for text generation rather than for preserving acoustic information. As a result, the diverse acoustic content that audio carries, such as phonetic detail, prosody, sound events, affect, and pitch, is lost along the way and difficult to leverage in the response. We introduce Continuous Audio Thinking (CoAT), a framework that equips audio language models with a continuous latent workspace for organizing acoustic information prior to response generation, grounded by distillation from audio experts. Within the thinking space, the model can utilize the rich acoustic information provided by expert distillation when generating its response. Furthermore, the proposed continuous thinking block can be processed in a single prefill, so CoAT does not require additional autoregressive decoding cost over the baseline. Across three LALMs, Qwen2-Audio, Qwen2.5-Omni-7B, and Audio Flamingo~3, performance gains on a broad benchmark suite spanning audio reasoning, audio understanding, music classification, speech emotion, and speech transcription demonstrate the effectiveness of CoAT. Further analysis confirms that the auxiliary supervision propagates from the thinking positions to the model's textual responses.

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

Identifiability Without Gaussianity: Symbolic World Models and Near-Infinite Temporal Consistency

Klindt, LeCun, and Balestriero (arXiv:2605.26379) proved that Joint-Embedding Predictive Architectures (JEPAs) achieve linear identifiability, the linear recovery of the world's true latent variables, if and only if the world's latent dynamics follow a Gaussian, stationary process. This Gaussian boundary implies a fundamental limit on temporal consistency: for any non-Gaussian physical system, the representation error of a statistical World Model grows monotonically with time. We prove that this limit is an artifact of the statistical alignment mechanism, not a property of World Models in general. We introduce the Physics-Grounded Symbolic Architecture (PGSA) and prove three results: (1) a PGSA achieves exact linear identifiability for all physical regimes, regardless of the latent distribution; (2) the per-step error of a PGSA is bounded by numerical precision alone; and (3) as a direct consequence, a PGSA maintains temporal consistency for an unbounded number of transitions, a property we term near-infinite temporal consistency. We further prove that statistical World Models cannot achieve this property for any non-Gaussian system, regardless of model capacity or the volume of training data. The algebraic cores of four of the theorems are formalized in Lean 4 with Mathlib4 v4.31.0 (zero sorry placeholders); the Klindt et al. converse is taken as an external premise. The contrast establishes that symbolic grounding in the causal generator of the world's dynamics is the sufficient condition and, in non-Gaussian regimes, the only condition for near-infinite temporal consistency.

13.
arXiv (CS.CV) 2026-06-18

Characterizing Brazilian Atlantic Forest Restoration Outcomes with Geospatial AlphaEarth Embeddings

作者:

The Atlantic Forest in Brazil is a critical biodiversity hotspot, yet less than 12-15% of its original cover remains. Although monitoring forest restoration on a large scale is essential, traditional methods are limited by the impracticality of on-the-ground reporting on such a scale and by the saturation of remote-sensing indices such as NDVI. Furthermore, reforestation is a gradual process as opposed to the rapid spectral changes caused by deforestation. In this study, we examine 1,729 restoration sites in S\~ao Paulo, using satellite embeddings from the AlphaEarth Foundation's model to evaluate their effectiveness in characterising early restoration success. We introduce the concept of a 'Reference Trajectory Embedding', defining a metric of restoration success based on cosine similarity to reference sites of mature secondary forest. We observe distinct clusters in embedding space according to different land use and land cover (LULC) types, and we can identify sites with clear change vectors. However, the signal can be noisy, and embeddings may require further fine-tuning to capture and predict site metadata beyond LULC.

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

Equity with Efficiency: An Empirical Study of Tokenizers for Multilingual Large Language Models

Multilingual large language models (LLMs) depend on subword tokenization to bridge discrete text and continuous neural representation. State-of-the-art multilingual LLMs often use Byte-level Byte-Pair Encoding (BPE) tokenizers that structurally favor high-resource languages and Latin scripts. For speakers of underrepresented languages, particularly those across Southeast Asia, this bias inflates inference costs and widens cross-lingual capability gaps. We present the first systematic comparison of equitable tokenizers on a unified benchmark spanning 11 Southeast Asian languages. Beyond tokenizer-level analysis of compression efficiency and cross-lingual equity, we assess downstream task performance through controlled 1.5B-parameter language model training using the same training data. Our results show that Parity-aware BPE lies on the Pareto frontier of the efficiency-equity trade-off, achieving strong compression parity at competitive cost. Morphology-Driven Byte Encoding delivers the best semantic reasoning performance through morphologically richer representations, albeit at a higher computational expense. Byte Latent Transformer underperforms on downstream tasks, possibly because its architectural assumptions misalign with the constraints of limited low-resource training data. Together, our findings demonstrate that cross-lingual fairness and tokenization efficiency are not fundamentally at odds, and offer practical guidance for designing equitable multilingual models.

15.
arXiv (CS.LG) 2026-06-11

From inverse problems to neural operators: prediction, mechanism, and generalization of data-driven models

作者:

arXiv:2606.08956v2 Announce Type: replace Abstract: Scientists have historically relied on mathematical models based on differential equations to relate system inputs – forces, fluxes, or heat sources – to outputs, such as displacement, velocity, concentration, and temperature. These models rely on deep domain knowledge to determine the form of the governing differential equation, which is then calibrated with data by solving an inverse problem. In recent years, the field of Scientific Machine Learning has introduced a variety of alternative modeling strategies for physical systems. A method called Sparse Identification of Nonlinear Dynamics learns the governing equation as a sparse linear combination of terms in a user-defined library. Neural Ordinary Differential Equations construct the governing equation by taking in the state and its derivatives at the input layer of a neural network. Entirely foregoing the modeling framework of differential equations, neural operators directly learn a non-linear mapping between the system inputs and outputs. From inverse problems to neural operators, all of these modeling strategies can be conceptualized as data-driven machinery to predict a system's response over a range of inputs. It is then natural to wonder how exactly these various strategies relate to each other, and whether they can be neatly taxonomized. Drawing from the philosophical literature on scientific models, we argue that many model types have a common structure, differing only in the assumed model class of the input-output relation they define. Connecting to philosophical ideas on mechanism, and arguing that data from physical systems arises from solutions to parsimonious differential equations, we propose that only certain models are capable of mechanism discovery, and thus generalization. Our analysis is intended to unite apparently disparate modeling strategies and provide insight into their appropriate use cases.

16.
arXiv (CS.LG) 2026-06-19

Representing Piecewise-Linear Functions by Functions with Minimal Arity

arXiv:2406.02421v2 Announce Type: replace-cross Abstract: Any continuous piecewise-linear function $F\colon \mathbb{R}^{n}\to \mathbb{R}$ can be represented as a linear combination of $\max$ functions of at most $n+1$ affine-linear functions. In our previous paper [``Representing piecewise linear functions by functions with small arity'', AAECC, 2023], we showed that this upper bound of $n+1$ arguments is tight. In the present paper, we extend this result by establishing a correspondence between the function $F$ and the minimal number of arguments that are needed in any such decomposition. We show that the tessellation of the input space $\mathbb{R}^{n}$ induced by the function $F$ has a direct connection to the number of arguments in the $\max$ functions.

17.
arXiv (CS.CL) 2026-06-12

LLMs Can Better Capture Human Judgments–With the Right Prompts

Are large language models (LLMs) bad at capturing human judgment? Two commonly stated limitations are that LLMs fail to capture full distributions of responses, and that their judgments are unstable across wording variations. We demonstrate simple prompting strategies that mitigate these limitations. Across two datasets–a U.S.-representative set of 144 moral scenarios and 38 moral beliefs from the International Social Survey Programme's Family and Changing Gender Roles module covering 32 countries–we show how simple elicitation techniques help improve AI-human alignment. First, prompting models to report standard deviations and response proportions recovers the full range of human responses better than common strategies. Second, ensuring scenarios are clear to human participants–as reflected in human confusion ratings–boosts model alignment, and LLMs can track human confusion ratings. At the same time, we find that LLMs' estimates of their own error are poorly calibrated, though they can predict human variability relatively well. These results suggest that asking better questions to LLMs can yield better answers.

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

Symplectic Transversality and Endpoint Green Estimates for Finite-Horizon Pontryagin Systems

arXiv:2606.17762v1 Announce Type: cross Abstract: We study horizon-uniform local branches of finite-horizon discrete-time Pontryagin boundary value systems after smooth control elimination. The central input is a two-point endpoint inverse for the linearization. We verify this inverse from scaled stable–unstable boundary transversality, prove the associated endpoint-corrected Green estimate, and combine it with weighted contractions to obtain existence, uniqueness, Lipschitz dependence, and first-order expansions with constants independent of the horizon. The framework covers smooth nonlinear endpoint maps, including the original Pontryagin rows that fix the initial state and couple the terminal costate to the terminal state. Symplectic and Riccati criteria verify the inverse hypothesis at the level of the matrix data; in particular, every stabilizable linear-quadratic system with invertible dynamics and definite weights is covered, including noncommuting coupled data. A numerical section illustrates the certificates and the horizon-uniform first-order expansion.

19.
medRxiv (Medicine) 2026-06-11

Assessment of occupational aerosol exposure for laboratory technicians: A quantitative study using {Phi}X174 phage as a substitute virus

作者:

This study aimed to clarify aerosol exposure risks throughout the workflow of a Biosafety Level 2 (BSL-2) polymerase chain reaction (PCR) laboratory, validate the suitability of the {Phi}X174 bacteriophage as an indicator virus, and provide evidence for biosafety control measures. The {Phi}X174 bacteriophage was used to simulate viral samples, and a concentration-bacteriophage plaque standard curve was constructed (R2=0.998). Five operational steps in a simulated PCR laboratory were quantitatively monitored for aerosol concentration using double-layer agar plates, with blank controls used to eliminate interference. Statistical analysis was employed to identify risk differences. Sample homogenization ((5.67 {+/-} 1.23) x 104 plaque-forming units (PFU)/m3) and nucleic acid extraction ((3.45 {+/-} 0.89) x 104 PFU/m3) were identified as high-/very high-risk steps. The viral load in the samples was strongly positively correlated with the aerosol concentration (r = 0.926, P

20.
medRxiv (Medicine) 2026-06-22

Referral pathways, ETAT triage acuity, and inpatient outcomes among children presenting to a national tertiary paediatric emergency unit in Ghana: a prospective cohort study

Emergency referral systems in sub-Saharan Africa are fragmented, and children reaching tertiary facilities through different referral pathways often arrive in advanced clinical states. Prospective data simultaneously characterising referral patterns, triage acuity at presentation, diagnostic case mix, and inpatient mortality at a national tertiary paediatric emergency unit are lacking from West Africa. This prospective cohort study enrolled 675 consecutively presenting children aged one month to 12 years at the Paediatric Emergency Unit of Korle Bu Teaching Hospital, Accra, Ghana, from February to December 2019. The primary outcome was all-cause inpatient mortality. Key variables collected included referral status and facility tier, Emergency Triage Assessment and Treatment (ETAT) triage category, ICD-10 diagnostic classification, Oyedeji socioeconomic classification, and time from symptom onset to PEU registration. Crude odds ratios were computed for all candidate predictors. Multivariable logistic regression was conducted using complete case analysis (n = 613). Of 675 children, 63.0% (n = 425) were referred from another health facility; referred children had higher ETAT emergency triage category rates than self-presenting children (32.7% vs 27.6%, p < 0.001). Overall inpatient mortality was 9.9% (67/675). Mortality varied by referral source: 16.7% among secondary/regional hospital referrals, 11.0% among lower-tier facility referrals (district, municipal, CHAG, polyclinic, private, health centre, and maternity home facilities combined, n = 356), 7.6% among self-presenting children, and 7.4% among tertiary referrals. Overall, 30.8% of children were classified as ETAT emergencies on arrival, with case fatility rate of 21.6%. The three most common diagnostic domains were respiratory conditions (17.2%), blood and haematological disorders (17.0%), and digestive presentations (16.4%). Inpatient mortality was highest in neoplastic disease (33.3%, n = 30) and circulatory presentations (31.0%, n = 29). In the primary multivariable analysis (n = 613, 51 events; events-per-variable ratio 4.2), no referral tier was independently associated with inpatient mortality after adjustment. Referral from secondary/regional hospitals showed a borderline non-significant association (adjusted odds ratio 3.09, 95% CI 0.96 to 9.90, p = 0.058). School going children (60-119 months) had higher odds of inpatient death than infants (adjusted odds ratio 5.56, 95% CI 1.16 to 26.53, p = 0.032), as did adolescents (adjusted odds ratio 10.01, 95% CI 2.15 to 46.69, p = 0.003). ETAT emergency category and lower socioeconomic status were not independently significant in this model. A pre-specified sensitivity analysis using the full analytic cohort (n = 674, events-per-variable ratio 6.7) with collapsed referral categories did not confirm any referral tier association; ETAT emergency category and lower SES were independently associated in the sensitivity model. All multivariable estimates should be regarded as exploratory. This prospective cohort provides simultaneous characterisation of referral patterns, ETAT triage acuity, diagnostic case mix, and inpatient mortality at a national tertiary paediatric emergency unit in West Africa. The referral-mortality gradient and high ETAT emergency category proportion document the severity of illness arriving through different referral pathways at this facility. The association between secondary/regional hospital referral and inpatient mortality is hypothesis-generating and requires replication in an adequately powered multicentre study before any service-level conclusions can be drawn.

21.
Nature Medicine 2026-06-08

Apitegromab for lean mass preservation during tirzepatide-induced weight loss: a randomized, double-blind, placebo-controlled phase 2 trial

Loss of lean mass in proportion to total weight loss is observed with incretin mimetic therapies such as tirzepatide and has the potential to adversely affect health and function. Apitegromab is an investigational, fully human monoclonal antibody that selectively inhibits myostatin activation and is, thereby, capable of increasing muscle mass. In the randomized, double-blind, placebo-controlled phase 2 EMBRAZE study, adults with overweight or obesity (n = 102) were randomized 1:1 to receive tirzepatide plus apitegromab (10 mg kg−1) or tirzepatide plus placebo. At week 24, apitegromab resulted in a least square mean (80% confidence interval (CI)) of 1.9 (1.2−2.7) kg less lean mass loss than placebo (P = 0.001), despite similar total body weight loss between groups, representing a 54.9% retention of lean mass relative to placebo. In participants receiving apitegromab, trough concentrations of apitegromab and total latent myostatin, a pharmacodynamic marker, both increased over time and reached a plateau after approximately 16 weeks. Incidence of adverse events (AEs) (% (95% CI)) was generally similar across apitegromab-treated participants and placebo-treated participants, with 39 of 51 (76% (63−86%)) and 36 of 51 (71% (57−81%)) participants experiencing an AE, respectively. Serious adverse events (SAEs) were balanced and experienced by one of 51 (2% (0−10%)) participants in each arm. In summary, this proof-of-concept study demonstrated that selective targeting of myostatin by apitegromab was well tolerated and effective in preserving lean mass when combined with tirzepatide. ClinicalTrials.gov identifier: NCT06445075 . In the phase 2 EMBRAZE study, participants receiving tirzepatide and apitegromab lost less lean mass compared to participants receiving tirzepatide and placebo.

22.
arXiv (CS.AI) 2026-06-11

Vision-Language-Action Jump-Starting for Reinforcement Learning Robotic Agents

arXiv:2604.13733v2 Announce Type: replace-cross Abstract: Reinforcement learning (RL) enables high-frequency, closed-loop control for robotic manipulation, but scaling to long-horizon tasks with sparse or imperfect rewards remains difficult due to inefficient exploration and poor credit assignment. Vision-Language-Action (VLA) models leverage large-scale multimodal pretraining to provide generalist, task-level reasoning, but current limitations hinder their direct use in fast and precise manipulation. In this paper, we propose Vision-Language-Action Jump-Starting (VLAJS), a method that bridges sparse VLA guidance with on-policy RL to improve exploration and learning efficiency. VLAJS treats VLAs as transient sources of high-level action suggestions that bias early exploration and improve credit assignment, while preserving the high-frequency, state-based control of RL. Our approach augments Proximal Policy Optimization (PPO) with a directional action-consistency regularization that softly aligns the RL agent's actions with VLA guidance during early training, without enforcing strict imitation, requiring demonstrations, or relying on continuous teacher queries. VLA guidance is applied sparsely and annealed over time, allowing the agent to adapt online and ultimately surpass the guiding policy. We evaluate VLAJS on six challenging manipulation tasks: lifting, pick-and-place, peg reorientation, peg insertion, poking, and pushing in simulation, and validate a subset on a real Franka Panda robot. VLAJS consistently outperforms PPO and distillation-style baselines in sample efficiency, reducing required environment interactions by over 50% in several tasks. Real-world experiments demonstrate zero-shot sim-to-real transfer and robust execution under clutter, object variation, and external perturbations.

23.
arXiv (CS.LG) 2026-06-11

Finding Multiple Interpretations in Datasets

arXiv:2606.12277v1 Announce Type: new Abstract: In this paper, we propose an approach to finding sets of similar-performing models (in terms of loss/accuracy measurements) with highly different context-aware characteristics. Through experiments on the METABRIC dataset, we show that the proposed method finds multiple models with highly different gene expressions than those found by the control methodology without performance penalties. We argue that the proposed methodology is important whenever one aims to analyze any global characteristic of a model to extract insight into the underlying phenomenon being studied.

24.
arXiv (CS.CL) 2026-06-19

PsyScore: A Psychometrically-Aware Framework for Trait-Adaptive Essay Scoring and ZPD-Scaffolded Feedback

Effective Automated Essay Scoring (AES) are expected to support both reliable assessment and actionable instructional feedback. However, existing approaches often treat scoring and feedback as separate components: neural scoring models provide limited interpretability, while Large Language Model (LLM)-based feedback is typically insensitive to learners proficiency levels. To address this fragmentation, this work proposes PsyScore, a psychometrically-aware framework that integrates diagnostic assessment with instructional scaffolding through a shared latent ability representation. PsyScore comprises three key modules: a Trait-Adaptive Neural IRT Scorer that incorporates the Graded Partial Credit Model (GPCM) into a neural architecture, enabling the precise estimation of student ability while maintaining psychometric interpretability, a ZPD-Scaffolded Feedback Generator, which conditions multi-agent feedback strategies on the diagnosed ability parameter to adapt instructional focus across different proficiency levels, and a Multi-Perspective Feedback Evaluation Strategy that assesses feedback quality via pairwise preference judgements and student revision simulations. Experiments on the ASAP++ dataset demonstrate that PsyScore achieves competitive scoring performance while providing more pedagogically aligned feedback.

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arXiv (CS.LG) 2026-06-19

Critical Percolation as a Synthetic Data Model for Interpretability

arXiv:2606.20347v1 Announce Type: new Abstract: Neural networks learn features that reflect the hierarchical, multi-scale structure of natural data. Synthetic datasets used to evaluate interpretability methods typically lack this structure, limiting their value as realistic toy models. To close this gap, we introduce a family of synthetic datasets consisting of hierarchical functions defined on critical mean-field percolation clusters embedded in a high-dimensional data space. The percolation data consists of sparse, low-dimensional fractal clusters with a power-law size distribution. Latent variables modeling a taxonomic hierarchy generate each data point's target value. The data model is analytically tractable with known critical exponents that fix its properties without requiring hyperparameter tuning. We leverage a mapping between percolation clusters, random trees, and additive coalescence to propose an almost linear-time algorithm to jointly sample a random tree and its hierarchical latent decomposition, enabling data generation at arbitrary scale. Using probing experiments, we find that the model's ground-truth latent variables can be linearly decoded from neural network activations. Together, sparsity, self-similarity, power-law statistics, and analytical tractability make critical percolation a principled testbed for interpretability research.