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

Deep Residual Injection for Full-Spectrum Forensic Signal Perception in Multimodal Large Language Models

Multimodal large language models (MLLMs) have been increasingly adopted in forensics for their robust semantic understanding. As AI-generated images become realistic, semantic-level inconsistencies alone are often insufficient for reliable detection. This motivates a critical question: whether MLLMs can achieve full-spectrum forensic signal perception, i.e., capturing low-level generator artifacts without sacrificing pre-trained semantic knowledge. We further perform a layer-wise analysis of forensic signal perception in MLLMs, showing that semantic information is primarily formed in the early-to-middle layers, whereas direct fine-tuning for artifact learning disrupts these semantic representations. Based on this insight, we propose Deep Visual Residual MLLM (Deep-VRM) to preserve early semantic processing while injecting artifact-specific visual signals as a residual path into an intermediate layer, where they are fused with semantic token representations and propagated through subsequent trainable layers. This enables later layers to jointly model semantic reasoning and signal-level forensic cues, and surprisingly, the model learns to adaptively leverage different levels of forensic signals depending on the input, achieving robust and generalizable detection performance. Extensive experiments show that our method achieves state-of-the-art across most benchmarks. The code and data are available at https://github.com/KQL11/Deep-VRM.

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

MambaH-Fit: Rethinking Hyper-surface Fitting-based Point Cloud Normal Estimation via State Space Modelling

We present MambaH-Fit, a state space modelling framework tailored for hyper-surface fitting-based point cloud normal estimation. Existing normal estimation methods often fall short in modelling fine-grained geometric structures, thereby limiting the accuracy of the predicted normals. Recently, state space models (SSMs), particularly Mamba, have demonstrated strong modelling capability by capturing long-range dependencies with linear complexity and inspired adaptations to point cloud processing. However, existing Mamba-based approaches primarily focus on understanding global shape structures, leaving the modelling of local, fine-grained geometric details largely under-explored. To address the issues above, we first introduce an Attention-driven Hierarchical Feature Fusion (AHFF) scheme to adaptively fuse multi-scale point cloud patch features, significantly enhancing geometric context learning in local point cloud neighbourhoods. Building upon this, we further propose Patch-wise State Space Model (PSSM) that models point cloud patches as implicit hyper-surfaces via state dynamics, enabling effective fine-grained geometric understanding for normal prediction. Extensive experiments on benchmark datasets show that our method outperforms existing ones in terms of accuracy, robustness, and flexibility. Ablation studies further validate the contribution of the proposed components.

03.
arXiv (CS.LG) 2026-06-12

Single vs. Multiple Branches in DeepONet and S-DeepONet: Network Architecture Follows Coupling in Multiphysics Systems

arXiv:2507.03660v2 Announce Type: replace Abstract: `Real-time prediction of complex physical systems requires surrogate models that learn from data while representing strong multiphysics coupling. Deep Operator Networks have shown success in single-physics problems, yet their effectiveness in capturing nonlinear interactions in coupled systems (such as thermo-mechanical or electro-thermal coupling) remains underexplored. Here we pose a practical question: should the architecture of a neural operator reflect the strength of physical coupling it aims to model? We compare single-branch and multi-branch designs, in both feedforward and sequential recurrent forms, across three representative systems: a reaction–diffusion problem with heterogeneous sources, a nonlinear thermo-electrical problem with temperature-dependent conductivity and Joule heating, and a viscoplastic thermo-mechanical model of steel solidification. Single-branch networks consistently outperform multi-branch variants in tightly coupled regimes by encouraging shared latent representations, whereas multi-branch designs remain favorable for decoupled or single-physics tasks. Once trained, these surrogates deliver full-field predictions up to $1.8 \times 10^4$ times faster than physics-based solvers.

04.
arXiv (CS.CV) 2026-06-16

Local-GS: Accelerating 3D Gaussian Splatting via Tile-Local Warp Coherence

3D Gaussian Splatting (3DGS) has significantly advanced real-time novel view synthesis by representing scenes as dense collections of anisotropic 3D Gaussian primitives. However, the irregular spatial distribution of Gaussians often leads to poor GPU utilization, as warp divergence and redundant computation degrade rendering performance. To address this, we present Local-GS, a warp-coherent rendering paradigm that, organizes Gaussian primitives with respect to SIMT (Single Instruction, Multiple Threads) execution boundaries rather than scene geometry. Specifically, we propose three warp-coherent stages: a hoisting stage that precomputes shared parameters at tile level, a culling stage that discards warps with no contribution, and a blending stage that replaces per-pixel branching with a uniform instruction stream. Across extensive benchmarks on multiple datasets, Local-GS improves efficiency without compromising quality. As a plug-and-play optimization, it provides additional performance gains to all tested baselines, culminating in a $7.76\times$ speedup on Deep Blending scenes.

05.
arXiv (CS.AI) 2026-06-11

MetaPlate: Counterfactual-Guided RAG-LLM Tool for Personalized Food Recommendation and Hyperglycemia Prevention

arXiv:2606.10120v2 Announce Type: replace-cross Abstract: Postprandial hyperglycemia is a key risk factor for metabolic disorders; however, existing dietary guidance is often static, impractical, and insufficiently personalized, providing recommendations that are difficult to follow or not impactful. While recent advances leverage continuous glucose monitoring (CGM) and machine learning to predict glycemic responses, these approaches are largely predictive and lack actionable guidance. Moreover, recommendation systems are often misaligned with user goals and require extensive input. We present MetaPlate, a counterfactual explanation (CF) guided, context-aware decision-support framework that generates personalized meal recommendations to mitigate postprandial glucose excursions in healthy adults. MetaPlate integrates multimodal data, including CGM readings, wearable-derived physiological signals, and user-provided meal inputs from $25$ individuals to model pre-meal context. A machine learning model predicts glucose response, while a CF optimization module adjusts meal composition modifying macronutrient amounts to maintain glucose levels within a target range ($\leq 140$ mg/dL). An LLM-based retrieval-augmented generation (RAG) layer enhances interpretability by producing human-readable recommendations using constrained search of the USDA food database. We evaluate MetaPlate via a structured expert-in-the-loop assessment with registered dietitians (RDs), comparing performance before and after prompt refinement. Results show improvements in meal realism, portion suitability, and recommendation likelihood, with expert feedback indicating a shift from clinically implausible outputs to actionable, contextually appropriate recommendations. Our findings emphasize the importance of domain knowledge and structured constraints in LLM-driven systems and highlight the potential of MetaPlate as a real-time personalized dietary decision-support tool.

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

Agentic AI-based Framework for Mitigating Premature Diagnostic Handoff and Silent Hallucination in Healthcare Applications

arXiv:2606.18068v1 Announce Type: new Abstract: Recent advances in Large Language Models (LLMs) and multi-agent systems have driven the rise of Agentic AI, showing promise for medical reasoning. However, open-ended conversational agents remain prone to two critical failure modes: premature diagnostic handoff and silent clinical hallucinations that may go undetected before reaching the patient. In this work, we propose a multi-agent framework that addresses both issues by replacing ``LLM-as-a-judge'' routing with deterministic orchestration constraints. The framework incorporates two safety mechanisms. First, a neuro-symbolic state-tracking gate enforces completeness of the OLDCARTS clinical protocol (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation, Timing, and Severity) by blocking diagnostic transitions until all required dimensions are collected. Second, an epistemic uncertainty quantification (UQ) gate computes semantic entropy (H) across K=5 independent diagnostic samples to identify and intercept divergent outputs before delivery. We evaluate the system using simulated patient agents powered by the llama-3.1-70b-instruct model on 150 test cases. The full architecture achieves 49.3% diagnostic precision, representing an absolute improvement of 11.3 percentage points over an unconstrained baseline. Additionally, we observe a statistically significant negative correlation (r = -0.181, p < 0.05) between OLDCARTS completeness (\sigma) and semantic entropy (H), suggesting that structured information gathering is associated with reduced diagnostic uncertainty.

07.
arXiv (CS.AI) 2026-06-16

Honeypot Protocol

Authors:

arXiv:2604.13301v1 Announce Type: cross Abstract: Trusted monitoring, the standard defense in AI control, is vulnerable to adaptive attacks, collusion, and strategic attack selection. All of these exploit the fact that monitoring is passive: it observes model behavior but never probes whether the model would behave differently under different perceived conditions. We introduce the honeypot protocol, which tests for context-dependent behavior by varying only the system prompt across three conditions (evaluation, synthetic deployment, explicit no-monitoring) while holding the task, environment, and scoring identical. We evaluate Claude Opus 4.6 in BashArena across all three conditions in both honest and attack modes. The model achieved 100% main task success and triggered zero side tasks uniformly across conditions, providing a baseline for future comparisons with stronger attack policies and additional models.

08.
arXiv (CS.AI) 2026-06-15

Generalized Discrete Diffusion with Self-Correction

arXiv:2603.02230v2 Announce Type: replace-cross Abstract: Self-correction is an effective technique for maintaining parallel sampling in discrete diffusion models with minimal performance degradation. Prior work has explored self-correction at inference time or during post-training; however, such approaches often suffer from limited generalization and may impair reasoning performance. GIDD pioneers pretraining-based self-correction via a multi-step BERT-style uniform-absorbing objective. However, GIDD relies on a continuous interpolation-based pipeline with opaque interactions between uniform transitions and absorbing masks, which complicates hyperparameter tuning and hinders practical performance. In this work, we propose a Self-Correcting Discrete Diffusion (SCDD) model to reformulate pretrained self-correction with explicit state transitions and learn directly in discrete time. Our framework also simplifies the training noise schedule, eliminates a redundant remasking step, and relies exclusively on uniform transitions to learn self-correction. Experiments at the GPT-2 scale demonstrate that our method enables more efficient parallel decoding while preserving generation quality.

09.
arXiv (CS.AI) 2026-06-12

LLMs as ASP Programmers: Self-Correction Enables Task-Agnostic Nonmonotonic Reasoning

arXiv:2604.27960v2 Announce Type: replace Abstract: Recent large language models (LLMs) have achieved impressive reasoning milestones but continue to struggle with high computational costs, logical inconsistencies, and sharp performance degradation on high-complexity problems. While neuro-symbolic methods attempt to mitigate these issues by coupling LLMs with symbolic reasoners, existing approaches typically rely on monotonic logics (e.g., SMT) that cannot represent defeasible reasoning – essential components of human cognition. We present "LLM+ASP," a framework that translates natural language into Answer Set Programming (ASP), a nonmonotonic formalism based on stable model semantics. Unlike prior "LLM+ASP" approaches that require manually authored knowledge modules, domain-specific prompts, or evaluation restricted to single problem classes, our framework operates without any per-task engineering and applies uniformly across diverse reasoning tasks. Our system utilizes an automated self-correction loop where structured feedback from the ASP solver enables iterative refinement. Evaluating across six diverse benchmarks, we demonstrate that: (1) stable model semantics allow LLMs to naturally express default rules and exceptions, outperforming SMT-based alternatives by significant margins on nonmonotonic tasks; (2) iterative self-correction is the primary driver of performance, effectively replacing the need for handcrafted domain knowledge; (3) compact in-context reference guides substantially outperform verbose documentation, revealing a "context rot" phenomenon where excessive context hinders constraint adherence.

10.
arXiv (CS.CL) 2026-06-18

GraphPO: Graph-based Policy Optimization for Reasoning Models

Reinforcement Learning with Verifiable Rewards (RLVR) has become a standard paradigm for enhancing the capability of large reasoning models. RLVR typically samples responses independently and optimizes the policy using from final answers. This paradigm has two limitations. First, independently responses often contain similar intermediate reasoning steps, causing redundant exploration and wasted computation. Second, sparse final-answer rewards make it hard to identify useful steps. Tree-based methods partly address this problem by sharing prefixes and comparing branches from the same prefix to provide fine-grained signals. However, tree branches are still expanded independently. When different branches reach similar reasoning states, they cannot share information and repeat similar exploration. Moreover, tree-based methods ignore such dispersion and only perform local comparisons within separate branches, which can lead to higher variance in advantage estimation. To address this challenge, we propose GraphPO (Graph-based Policy Optimization), a novel RL framework that represents rollouts as a directed acyclic graph, with reasoning steps as edges and semantic states summarized from the reasoning paths as nodes. GraphPO merges semantically equivalent reasoning paths into equivalence classes, allowing them to share suffixes and reallocating budget away from redundant expansions to diverse exploration. Furthermore, we assign efficiency advantages to incoming edges and correctness advantages to outgoing edges, thereby improving inference efficiency while deriving process supervision from outcome. Theory shows that GraphPO reduces advantage-estimation variance and enhances reasoning efficiency. Experiments on three LLMs across reasoning and agentic search benchmarks show that GraphPO consistently outperforms chain- and tree-based baselines with the same token budgets or response budgets.

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

From Content to Knowledge: Lightning Fast Long-Video Understanding with Neural Knowledge Representations

We propose a new paradigm for long video understanding by treating a long video as a Neural Knowledge Representation (NKR). NKR represents video contents neither as a stream of tokens nor pre-organized databases, but as an individual small portion of network weights attached to the VLM backbone. The NKR weights are optimized to encapsulate the video's semantic content via a novel Agentic Knowledge Distillation (AKD) process, where an agent automatically synthesizes dense descriptions and question-answer pairs to distill the video's knowledge into the NKR. While AKD serves as a comprehensive, one-time encoding phase, the resulting NKR transforms the video into a portable, reusable asset. At inference, the lightweight NKR is mounted onto a frozen Vision-Language Model (VLM), enabling direct, query-based understanding without reloading or re-encoding the original video. This approach decouples video length from inference cost, offering high amortized efficiency for multi-turn video understanding. Experiments on the LVBench benchmark show our method achieves performance comparable to state-of-the-art approaches while reducing end-to-end latency by over two orders of magnitude, opening new possibilities for interactive long-video understanding.

12.
medRxiv (Medicine) 2026-06-17

Perceptions of aging well among older adults with heart failure: insights from a qualitative study

Background: Heart failure (HF) is a prevalent and often debilitating cardiovascular condition among older adults, frequently accompanied by multimorbidity, functional limitations, and the need to age in place. Traditional models of successful aging emphasize disease absence and preserved function, yet most individuals with HF live with ongoing symptoms and chronic health challenges. How older adults with HF define aging well, particularly across different socioeconomic contexts, remains underexplored. Objectives: To explore how older adults with HF conceptualize aging well and to identify perceived facilitators and barriers across more and less resourced New York City neighborhoods. Methods: We conducted semi-structured interviews with 20 adults diagnosed with HF residing in Manhattan and Brooklyn neighborhoods classified by 2019 United States Census data. Interviews were guided by Rowe and Kahn's model. Transcripts were analyzed using an inductive-deductive thematic approach and interpreted in alignment with the Healthy People 2030 framework. Results: Participants had a mean age of 69 years; 50% identified as Black and 50% were women. Despite functional limitations, 65% reported aging well. Five themes emerged: maintaining physical function, maintaining cognitive function, sustaining social relationships, avoiding pain, and promoting overall well-being. Avoiding pain and promoting well-being extended beyond traditional models. Neighborhood context shaped priorities, with financial stability emphasized in more affluent areas and social cohesion prioritized in less affluent communities. Conclusions: Older adults with HF frequently perceive themselves as aging well despite chronic illness, reframing successful aging beyond disease avoidance. These findings support a patient-centered, place-informed model of aging well with implications for healthcare delivery and policy.

13.
arXiv (CS.AI) 2026-06-15

VHDLSuite: Unified Pipeline for LLM VHDL Generation with Data Synthesis and Evaluation

arXiv:2606.13735v1 Announce Type: cross Abstract: Large Language Models (LLM) have shown impressive capabilities in Register Transfer Level (RTL) code generation, particularly for Verilog. However, evaluating their performance with other Hardware Description Languages (HDL), especially VHDL, remains limited although its distinct language characteristics, such as stricter semantic rules, introduce evaluation considerations that differ from Verilog. This lack of coverage restricts fully understanding of how well current models generalize across hardware design languages with differing structures and semantics. To address this gap, we introduce VHDLSuite, a benchmark-centered infrastructure for scalable VHDL generation evaluation, integrating automated benchmark synthesis, executable validation, and multi-model diagnostic analysis. First, we propose a data pipeline that automatically converts Verilog designs and their accompanying testbenches into executable VHDL benchmark instances, followed by VUnit/GHDL-based validation to ensure each released task is compilable, runnable, and consistently checkable in the VHDL environment. Second, we introduce VHDLBench, a benchmark with over 200 VHDL problems with complete and validated testbenches across a wide range of complexity levels. Third, we extensively evaluate cutting-edge LLMs and uncover key challenges specific on LLM-aided VHDL generation. Our findings provide important insights and support future work in multi-language hardware design automation.Our data pipeline, benchmark, and evaluation framework will be open-sourced.

14.
arXiv (quant-ph) 2026-06-24

Interaction-Enhanced Ergotropy in Phase-Driven Andreev Bound State Quantum Batteries

arXiv:2606.24456v1 Announce Type: new Abstract: We investigate a phase-driven quantum battery composed of two interacting Andreev bound state (ABS) units, providing a minimal superconducting platform for coherent energy storage. By analyzing the ergotropy dynamics under a superconducting phase ramp, we show that the interplay between avoided-crossing excitation and interaction-induced hybridization strongly modifies the charging process. In the high-transparency regime relevant for graphene SNS junctions, the interaction enhances the stored extractable work and generates pronounced oscillatory charging dynamics associated with coherent redistribution between coupled ABS sectors. The phase-resolved evolution further reveals optimal charging windows during the Josephson cycle, indicating the possibility of phase-programmable energy extraction through partial-cycle operation. Overall, our results identify interaction-assisted avoided-crossing dynamics as a microscopic mechanism for controllable energy storage in superconducting quantum batteries.

15.
arXiv (CS.CV) 2026-06-16

Vision-Language Models as Zero-Annotation Oracles in Histopathology

Foreground segmentation is the critical first step of every computational pathology pipeline, yet existing methods rely on hand-tuned heuristics or supervised models that overfit to narrow stain and scanner distributions, failing silently on specialised stains such as Jones silver or Elastica van Gieson. We propose a coarse-to-fine approach that recasts foreground segmentation as a visual perception task and leverages general-purpose vision-language models (VLMs) as zero-annotation oracles. Our key insight is that tissue-versus-background discrimination is a natural-image recognition problem, not a histopathological one, so VLMs trained on internet-scale corpora generalise where domain-specific models cannot. We introduce Leica-75, a benchmark of 75 renal transplant whole-slide images spanning three stain families. On Leica-75, our method achieves the highest segmentation quality on out-of-distribution stains (Dice 0.858 +/- 0.027 on Jones, 0.853 +/- 0.041 on EVG) with 7x lower cross-stain variance than the best supervised baseline, while remaining competitive on in-distribution H&E. Few-shot prompting with automatically curated exemplars (Auto-context) rescues hard cases on Stress-32 (n=32), a curated stress-test subset (Dice 0.470 to 0.819 for the 2B model). VLM-based annotation review matches human expert consensus (kappa=0.989 for blur detection; mean precision/recall grading accuracy 0.708 vs. human 0.646 for segmentation mask review). The resulting pseudo-labels are used to distil lightweight student models that are as performant as the teacher model while running for a fraction of the cost. Our framework provides a principled, scalable solution to a persistent infrastructure bottleneck in digital pathology.

16.
arXiv (CS.CL) 2026-06-15

Creative Integration: A Decidable Criterion of Creativity

"Integrative" solutions are widely praised but rarely defined: we lack an operational way to tell a genuine integration – one that makes the world cheaper to describe – from a tidy re-description. Building on the lineage that treats creativity and intelligence as compression, we give such a criterion for creative integration (CI): the resolution of a real conflict between A and B is CI if and only if, under a fixed description language, the description length strictly shrinks (C = L_pre/L_post > 1), with the reduction located in the conflict itself. We make the judgment decidable through four binary, conjunctive gates, and we fix its extension through a taxonomy of pseudo-integration that names and rejects the look-alikes. We back the criterion with a curated, multi-domain corpus and – crucially – validate it not by human inter-rater agreement but by four falsifiable tests it could fail: an independent computational check, discrimination against hard negatives, out-of-sample prediction, and description-language robustness; all pass with margin. The contribution is not "creativity is compression" but its decidability, discrimination, and corpus: on this account, what makes a move genuinely creative – rather than merely novel – is that it compresses a conflict, with novelty and value as downstream symptoms; whether all creativity is so constituted we state as an explicit conjecture. We claim only the sign of C-1; we judge, not generate. The result is a citable primitive for a broader program.

17.
medRxiv (Medicine) 2026-06-18

Effectiveness and Safety of Bempedoic Acid Across Clinically Relevant Subgroups: Insights from the CLEAR Taiwan Study

Background Despite available lipid-lowering therapies (LLT), many patients fail to achieve low-density lipoprotein cholesterol (LDL-C) targets. This gap persists across clinically relevant subgroups. Bempedoic acid has demonstrated effective LDL-C lowering with a favorable safety profile in the CLEAR Taiwan study; however, its effects across subgroups in Asian populations remains limited. Methods The phase IV CLEAR Taiwan study (NCT06925100) enrolled patients with inadequately controlled hypercholesterolemia who received bempedoic acid for 12 weeks in addition to background LLT. This analysis evaluated changes in lipid parameters, high-sensitivity C-reactive protein (hsCRP), and safety outcomes in clinically relevant subgroups, including cardiovascular risk, diabetes, age, statin tolerance, and sex. Results A total of 180 patients were included. Bempedoic acid achieved significant LDL-C reductions in all subgroups. Numerically greater LDL-C reductions were observed in primary prevention, statin-intolerant, younger (< 65 years), and female patients, while comparable reductions were observed across diabetes status. Reductions in non-high-density lipoprotein cholesterol, total cholesterol, and apolipoprotein B were consistent with LDL-C findings. Significant decreases in hsCRP were observed in all subgroups, with numerically greater reductions in patients aged < 65 years and those without diabetes. Bempedoic acid was well tolerated, with a low incidence of adverse events and no new safety signals identified. Changes in liver enzymes, renal function, and uric acid were minimal within subgroups. Conclusion Subgroup analyses from the CLEAR Taiwan study demonstrate consistent efficacy and safety of bempedoic acid across clinically relevant subgroups and support its use as a flexible option to address residual gaps in lipid management.

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

Improving low-resource ASR using bilingual fine-tuning with language identification: a cross-linguistic evaluation

This study explores how bilingual fine-tuning affects automatic speech recognition (ASR) in low-resource languages. We evaluate this method across nine linguistically and geographically diverse language pairs, covering a range of language families and writing systems. To distinguish the two languages, during training, we pre-pend each input text with a language identification token. At inference, the model jointly predicts both the language and transcription from the speech input alone. As texts for which the language is incorrectly determined show low ASR performance, we also conduct a follow-up experiment in which the language identification token is provided both during training and inference. Our results show that bilingual fine-tuning can be beneficial when language identification accuracy is high, and that in cases where language identification performance is low, including the language identification token at inference helps to improve ASR performance.

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

Layer-wise Geometric Approximation Rates for Deep Networks

arXiv:2604.20219v2 Announce Type: replace Abstract: Depth is widely viewed as a central contributor to the success of deep neural networks, whereas standard neural network approximation theory typically provides guarantees only for the final output and leaves the role of intermediate layers largely unclear. We address this gap by developing a quantitative framework in which depth admits a precise scale-dependent interpretation. Specifically, we design a single shared mixed-activation architecture of fixed width $2dN+d+2$ and any prescribed finite depth such that each intermediate readout $\Phi_\ell$ is itself an approximant to the target function $f$. For $f\in L^p([0,1]^d)$ with $p\in [1,\infty)$, the approximation error of $\Phi_\ell$ is controlled by $(2d+1)$ times the $L^p$ modulus of continuity at the geometric scale $N^{-\ell}$ for all $\ell$. The estimate reduces to the geometric rate $(2d+1)N^{-\ell}$ if $f$ is $1$-Lipschitz. Our network design is inspired by multigrade deep learning, where depth serves as a progressive refinement mechanism. For every prescribed terminal depth, the construction yields a finite nested family of prefix readouts whose earlier correction terms remain embedded in later readouts. Thus the approximation may be truncated within the prescribed depth range once the desired certified accuracy is reached.

20.
medRxiv (Medicine) 2026-06-10

A Three-Tier Operational Benchmark for Evaluating Large Language Models on Hospital Medication Safety

Objective. To introduce PsiBench, a clinically validated medication-safety benchmark for evaluating large language models (LLMs) against the standards used to certify hospital computerized provider order entry (CPOE) and electronic health record (EHR) systems, and a non-overlapping three-tier evaluation framework separating highest-stakes discrimination, the operational CDS regime, and category-correct alerting. Materials and Methods. PsiBench comprises 492 medication-safety scenarios across 11 safety categories, created by clinical pharmacology experts whose work underpins an annualized testing procedure used by more than 2,000 U.S. hospitals. The three-tier framework partitions the scenarios non-overlappingly: Discrimination (98 scenarios, 50 fatal vs 48 deception, near-balanced 51%/49%); Operational (394 scenarios, 261 serious unsafe plus 133 safe including 41 Excessive Alerts reclassified as operational negatives); and Attribution (311 alert-required scenarios). We evaluated 40 frontier LLMs from 10 providers over 3 runs per scenario at temperature 0.2 (or the provider default where temperature is not configurable), yielding 59,040 evaluations conducted April 21-23, 2026. Results. Headline binary performance on the full benchmark spans a wide range across the 40 models: F1 78.5%-92.3%, accuracy 65.4%-89.8%, sensitivity 81.4%-100.0%, specificity 6.1%-81.8%. Leading models by F1 (o4-mini 92.3%; o3 92.2%) pair high sensitivity with meaningful specificity; three models saturate sensitivity at 100% but fall below 25% specificity, indistinguishable from a naive always-alert classifier. The wide spread on a single headline metric motivates tier-specific analyses, developed in a separate clinical paper. Discussion and Conclusion. PsiBench and the three-tier framework operationalize a rigorous evaluation rubric for LLM medication safety, grounded in two decades of national hospital audit experience. The framework generalizes to any binary medication-safety classifier (rule-based, conventional ML, or LLM-driven), supporting tier-aware model selection and post-deployment surveillance.

21.
arXiv (CS.CV) 2026-06-18

Budget-Aware Adaptive Adversarial Patches for Black-Box Object Detection

Adversarial patches pose a practical threat to modern object detectors. Prior work shows vulnerability, but three gaps limit actionable insight: (i) few score-based black-box attacks jointly optimize patch location, texture, and size under tight query budgets; (ii) success is rarely tied to the patch's visual footprint; and (iii) evaluations often conflate EOT robustness with plain-view suppression. We present \method{}, a query-efficient, budget-adaptive black-box attack that couples a lightweight Contextual Thompson-Sampling placer with NES-style pixel updates, growing the patch only when progress stalls. Reporting is anchored by a strict plain-image suppression test; EOT is audited but never used as a substitute for success, and optional appearance/printability weights expose strength–visibility trade-offs. Across YOLOv5, Faster R-CNN, and YOLOS, \method{} achieves strong suppression on CNN-based detectors and substantial suppression on the transformer-based detector, using compact patches and exposing clear query–footprint trade-offs relative to fixed-size and heuristic baselines. A print–capture pilot further shows transfer across unseen physical objects and viewpoints.

22.
medRxiv (Medicine) 2026-06-18

Can Vision-Language Models See the Vital Signs? Benchmarking and Fine-Tuning for Intraoperative Monitor Reading

Background Vital-sign deterioration is a leading contributor to preventable perioperative death, yet manual monitor reading is intermittent, error-prone, and subject to alarm fatigue. Automating this perceptual step could enable continuous surveillance, but existing solutions depend on device-specific hardware integration or cloud-hosted vision-language models (VLMs), which raise privacy, cost, and connectivity barriers in resource-limited healthcare facilities. Methods We constructed a benchmark of 200 in-the-wild intraoperative monitor photographs (spanning multiple vendors, angles, and illumination conditions) annotated for eight vital-sign parameters: heart rate, SpO2, ETCO2, respiratory rate, systolic/diastolic/mean blood pressure, and temperature. We evaluated an optical character recognition (OCR)-based pipeline, nine instruction-tuned VLMs (four commercial, five open-weight ranging from [&le;]4B to 31B parameters) under two prompting regimes, and a compact open model (Qwen3.5-9B) adapted via low-rank fine-tuning (LoRA, 0.46% of parameters updated). Results Under a domain-aware prompt, frontier VLMs reached 0.98-0.997 exact-match accuracy zero-shot, whereas the OCR pipeline and [&le;]4B model scored approximately 0.20 lower, defining a 9B-class usable floor. LoRA fine-tuning Qwen3.5-9B on 80-120 images raised accuracy from 0.953 to 0.994 (statistically indistinguishable from the best commercial model) and reduced the critical-error rate fivefold (0.0313 [-&gt;] 0.0063). Ablations showed that performance saturated at 80 training images and rank-8 adapters. Conclusion Monitor reading is a solved perception problem for VLMs above the 9B scale. A lightweight fine-tuned open model achieves frontier accuracy while running entirely on local hardware, preserving data privacy, offline capability, and near-zero marginal cost. Residual errors stem from blood-pressure source ambiguity and are addressable with explicit disambiguation logic.

23.
medRxiv (Medicine) 2026-06-23

Multivariate Echocardiographic Phenotyping of Hypertensive Heart Failure Using Unsupervised Machine Learning: A Pilot Study

Background Heart failure in hypertensive patients is heterogeneous and poorly captured by traditional left ventricular ejection fraction (LVEF) based classification. Multivariate echocardiographic data combined with unsupervised machine learning may provide a more precise phenotypic characterization. This pilot study evaluated the feasibility of unsupervised clustering of routine transthoracic echocardiographic data to identify phenotypic subgroups of hypertensive heart failure. Methods This retrospective pilot study analyzed transthoracic echocardiography reports from hypertensive patients with clinical heart failure. After data cleaning and exclusion of incomplete records, 102 patients with 11 echocardiographic variables were included. Variables describing left ventricular geometry, systolic function, and diastolic performance were standardized and subjected to K-means clustering. Optimal cluster number was determined using the elbow method and silhouette analysis. Cluster characteristics were assessed using descriptive statistics and Kruskal Wallis testing. Concordance with LVEF based heart failure categories was evaluated. Results Three distinct echocardiographic phenotypes were identified. Cluster 0 (n = 50) demonstrated preserved LVEF with concentric remodeling, consistent with heart failure with preserved ejection fraction (HFpEF) phenotype. Cluster 1 (n = 37) showed marked ventricular dilation and reduced systolic function, consistent with heart failure with reduced ejection fraction (HFrEF). Cluster 2 (n = 15) exhibited concentric hypertrophy with intermediate LVEF, consistent with heart failure with mildly reduced ejection fraction (HFmrEF) like phenotype. All echocardiographic variables differed significantly across clusters (p < 0.001). While Cluster 0 showed strong concordance with HFpEF (96%), Clusters 1 and 2 demonstrated substantial overlap across LVEF categories, indicating partial discordance between structural phenotypes and LVEF based classification. Conclusion Application of unsupervised machine learning to routine echocardiographic data identifies distinct heart failure phenotypes in hypertensive patients. These phenotypes demonstrate significant structural heterogeneity beyond LVEF based classification, supporting the utility of data-driven approaches for refined cardiac phenotyping. This pilot study provides a foundation for larger prospective studies.

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

pFedUL: Layer-Aware Federated Unlearning for Personalized Federated Learning

arXiv:2606.16304v1 Announce Type: new Abstract: Federated unlearning (FU) enables the removal of specific data contributions from federated learning (FL) models to comply with regulations such as the General Data Protection Regulation (GDPR). However, most existing FU methods are designed for the FedAvg paradigm, where all clients share a single global model. In practice, personalized federated learning (pFL) methods such as FedPer, FedRep, Ditto, and FedBN have become widely adopted due to their superior handling of non-IID data. These methods decompose the model into shared global layers and client-specific personalized layers, fundamentally altering the semantics of unlearning, yet this setting has received little attention. We formalize FU under the pFL paradigm, identifying a tension between unlearning completeness on shared layers and personalization preservation for remaining clients. We then propose pFedUL, a layer-aware selective unlearning framework comprising three components: (1) gradient-based layer-wise contribution attribution that separately quantifies the target client's influence on shared and personalized parameters, (2) adaptive selective unlearning that applies differentiated forgetting strategies across layer types, and (3) a lightweight recalibration protocol enabling remaining clients to restore personalization with minimal overhead. We further introduce two new metrics, Personalization Preservation Score (PPS) and Cross-client Fairness Index (CFI), to evaluate pFL-specific unlearning quality. Experiments on CIFAR-10, CIFAR-100, and FEMNIST under varying non-IID settings indicate that pFedUL achieves unlearning effectiveness comparable to full retraining while maintaining an average of 97.3\% personalized accuracy for remaining clients. Compared with six state-of-the-art FU methods adapted to the pFL setting, pFedUL consistently achieves superior personalization preservation.