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01.
arXiv (CS.AI) 2026-06-19

Formal Verification of Learned Multi-Agent Communication Policies via Decision Tree Distillation

arXiv:2606.19632v1 Announce Type: cross Abstract: Multi-agent reinforcement learning (MARL) enables agents to develop coordination strategies through emergent communication, but neural policies lack the formal safety guarantees required for safety-critical robotic deployment in drone swarms and autonomous vehicle fleets. We present the first end-to-end framework for safety verification of learned multi-agent communication policies through policy abstraction: neural policies are distilled into interpretable decision trees, then formally verified, with empirical validation confirming that verified safety properties transfer to original networks. Our four-stage pipeline consists of domain-specific feature extraction from agent observations, decision tree distillation achieving 97.9% +/- 1.2% fidelity to neural policies, automated translation to PRISM probabilistic model checker specifications with complete feature-to-state-variable correspondence, and compositional verification of Probabilistic Computation Tree Logic (PCTL) properties via pairwise decomposition with union-bound aggregation and empirical neighbor modeling. Evaluating Vector-Quantized Variational Information Bottleneck (VQ-VIB) policies for multi-drone coordination with 5-7 agents, we verify 18 temporal logic properties across safety, liveness, and cooperation, achieving 88.9% property satisfaction with all five safety thresholds satisfied (0.3% collision probability vs. 1% threshold). Monte Carlo validation of original neural policies confirms that verified safety properties transfer with

02.
medRxiv (Medicine) 2026-06-22

Cumulative Metabolic Exposure to Hyperglycemia and Risk of Cardiovascular and Limb Events in Peripheral Artery Disease

Background: Although diabetes is a potent risk factor for the development of peripheral artery disease (PAD), the effect of cumulative metabolic exposure to hyperglycemia on risk of cardiovascular or limb events in patients with PAD remains unclear. Methods: The Peripheral Artery Disease: Long-term Survival (PEARLS) is a longitudinal registry of Veterans with newly diagnosed PAD identified using a natural language processing approach. Included patients had ankle brachial index [≤]0.9 or toe brachial index [≤]0.7, and no history of lower extremity revascularization or major amputation. Among patients with diabetes in this cohort, we assessed cumulative exposure to hyperglycema based on a 24-month rolling average of hemoglobin (Hgb) A1c values, categorized as [≤]7%, >7% to [≤]8%, and >8%. Multivariable Cox regression models evaluated the association between categories of HgbA1c, modeled as a time-varying exposure, and risk of cardiovascular (CV: myocardial infarction or stroke) and limb (chronic limb threatening ischemia [CLTI] or major amputation) events. Results: Among 45,109 patients with new diagnosis of PAD and pre-existing diabetes, the mean HgbA1c at baseline was 7.5%, with nearly one-third (30.4%) having HgbA1c >8%. The mean age was 70.4 years, 19.8% were Black and 4% were Hispanic. Patients with baseline HgbA1c >8% were younger and compared to those with HgbA1c [≤]7%, more likely to have coronary disease, kidney disease, and obesity. Over a median follow up of 4.2 years, 8,306 (18.4%) patients experienced a CV event, and 8,199 (18.2%) experienced a limb event. The adjusted association between HgbA1c and hazard of CV events was 12% higher in patients exposed to HgbA1c >7% to [≤]8% (HR 1.12; 95%CI: 1.05-1.18) and 38% higher in those exposed to HgbA1c >8% (HR 1.38; 95%CI: 1.30-1.46), compared to HgbA1c 7% to [≤]8% (HR 1.20; 95%CI: 1.13-1.28) and HgbA1c >8% (HR 1.60; 95%CI: 1.51-1.70), respectively when compared to HgbA1c [≤]7%. These findings were consistent in subgroups based on age and severity of PAD. Conclusions: Among diabetic patients with PAD, cumulatiave metabolic exposure to hyperglycemia is associated with a markedly increased risk of clinical events, especially limb events.

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

GUMP-Net: An interpretable model-data-driven intelligent algorithm for multi-class pelvic segmentation

Pelvic segmentation is one of the most important and fundamental research problems in precise and intelligent diagnosis and treatment, as well as surgical planning and navigation for pelvic fractures. By combining an improved geodesic active contour model with deep neural networks, we propose GUMP-Net, an interpretable model-data-driven intelligent algorithm for multi-class pelvic segmentation, in which three network modules are designed to constitute the overall segmentation framework together: the object detection module for automatic level set initialization, the edge detector module for learning an anatomy-aware edge detector function and the iteration module for deep level set evolution. Leveraging the advantages of level set representation and deep learning, GUMP-Net shows more accurate, robust and consistent segmentation performance, especially in small training data situation, compared to the state-of-the-art methods. Extensive experiments on pelvic datasets demonstrate the rationality and effectiveness of the proposed algorithm. Further experiments extended to ankle dataset indicate broader applications to other anatomies. The proposed algorithm not only provides an efficient segmentation method for complex fracture reduction, but also gives an interpretable geometric perspective for understanding deep learning segmentation.

04.
Nature (Science) 2026-06-10

A prognostic human brain network for diffuse midline glioma

作者:

Diffuse midline gliomas (DMGs) are near-universally lethal tumours of the childhood central nervous system1,2. In animal models, DMGs form brain-wide integrated networks through neuron-to-glioma synapses3–6 and glioma-to-glioma gap junctional coupling3. This extensive connectivity robustly promotes the growth and invasion of DMG3–9 and other glial malignancies10–12 through paracrine mechanisms and direct neuron-to-glioma synapses. However, the organization and clinical implications of these connections in the living human brain remain to be elucidated. Here, we develop tumour network mapping to compute the brain-wide connectivity profile of DMG, defining a conserved brain network across pontine and thalamic DMG associated with patient short-term survival (DMG network). Tumour functional connectivity with the DMG network was independently predictive of patient overall survival across two external validation cohorts. Tumour growth mapped to DMG network-specific trajectories and peak in-network neurometabolic changes across development spatiotemporally aligned with the peak age incidence of DMG. Analyses of single-nucleus RNA sequencing data confirmed diverse synaptic gene enrichment in high-connectivity DMG. Strikingly, incidental surgical resection of high-connectivity thalamic DMG tissue conferred a significant survival advantage. Collectively, these data define a conserved and prognostically important brain network in children with DMG, consistent with the hypothesis that DMGs exploit otherwise healthy brain circuits to promote tumour growth. Tumour network mapping of diffuse midline glioma (DMG) defines a conserved and prognostically important brain network in children with DMG, consistent with the hypothesis that DMGs exploit otherwise healthy brain circuits to promote tumour growth.

05.
arXiv (CS.AI) 2026-06-16

Your Agent Has a Genome: Sequence-Level Behavioral Analysis and Runtime Governance of LLM-Powered Autonomous Agents

作者:

arXiv:2606.15579v1 Announce Type: new Abstract: We propose Base Sequence Analysis, a framework that encodes the runtime behavior of LLM-powered autonomous agents into compact symbolic sequences using a four-letter alphabet: X (Explore), E (Execute), P (Plan), and V (Verify). Drawing an analogy to genomic sequence analysis, we apply n-gram pattern mining, Markov transition matrices, and point-biserial correlation to 347 real-world execution traces collected from a production ReAct agent system over 8 days. Our analysis reveals that (1) the trigram P-X-P is the only statistically significant high-risk pattern, lowering success rate by 10.4%; (2) P-ratio is the strongest negative predictor of success (r=-0.256, pV transition probability is only 2.1%, indicating a systemic verification deficit. Based on these findings, we design Governor, a three-layer runtime intervention system comprising a rule engine, a statistical accumulator, and a chi-square-based threshold adaptor. In a natural before/after deployment evaluation (N=101 vs. N=246), Governor achieves a +6.2% absolute increase in task success rate while simultaneously reducing average token consumption by 44%. To validate cross-system generality, we apply the XEPV encoding to 2,000 public SWE-agent trajectories on SWE-bench, confirming that exploration spirals and the E->V verification deficit replicate in an independent system. We outline six research directions including base sequence language models, cross-agent behavioral fingerprinting, and reward shaping, and release an open-source toolkit for reproducibility.

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

TextMesh4D: Zero-shot Text-to-4D Mesh Generation

Large-scale, high-quality dynamic 3D (4D) assets are essential for learning physically grounded representations, but remain costly to capture and annotate at scale. This limits the viability of supervised 4D learning and motivates zero-shot text-to-4D generation leveraging pretrained diffusion priors. To model complex dynamics, prior methods typically adopt implicit 3D representations (e.g., NeRFs or 3DGS) for their deformation capacity. However, their implicit nature provides limited control over surface topology, which hinders high-fidelity geometry and makes temporally coherent surface reconstruction challenging. To address these limitations, we explore zero-shot text-to-4D mesh generation. However, a structural mismatch arises when combining diffusion-based guidance with topology-constrained meshes: the guidance is noisy and spatially inconsistent, while meshes impose severe topological constraints, making direct vertex-level deformation unstable. In this paper, we introduce TextMesh4D, the first zero-shot framework for text-to-4D that directly generates dynamic meshes by addressing the above challenge at two complementary levels. Geometrically, we shift deformation modeling from vertices to faces via a Jacobian Deformation Field (JDF), enabling topology-aware surface reconstruction through an integrability-enforcing integration formulation. Semantically, we propose a Local-Global Semantic Regularizer (LGSR) that preserves identity over time by jointly constraining local deformation plausibility and global shape consistency. Extensive experiments demonstrate state-of-the-art temporal consistency, structural fidelity, and visual quality, while remaining efficient on a single 24GB GPU.

07.
PLOS Medicine 2026-05-11

Connected or chained by social media? Child and adolescent mental health in a digital era

作者:

by Silja Kosola Social media has evolved from connection to compulsion, disproportionately harming children and adolescents. Addictive designs together with developmental vulnerability fuel mental health risks and highlight the urgent need for stricter age limits and stronger protections. In this Perspective, Silja Kosola outlines how social media disproportionately harms child and adolescent mental health, and argues that while recent policy changes aimed at protecting youth from social media are welcome, stricter age limits and greater accountability of social media companies are needed.

08.
arXiv (CS.LG) 2026-06-18

Regular Fourier Features for Nonstationary Gaussian Processes

arXiv:2602.23006v2 Announce Type: replace-cross Abstract: Simulating a Gaussian process requires sampling from a high-dimensional Gaussian distribution, which scales cubically with the number of sample locations. Spectral methods address this challenge by exploiting the Fourier representation and treating the spectral density as a probability distribution suitable for Monte Carlo approximation. Although this probabilistic interpretation is valid for stationary processes, it is overly restrictive for the nonstationary case, where spectral densities are generally not probability measures. We propose regular Fourier features for harmonizable processes to avoid this limitation. Our method discretizes the spectral representation directly, preserving the correlation structure among spectral weights without requiring probability assumptions. Under a finite-spectral-support assumption, this yields an efficient low-rank approximation that is consistent and positive semi-definite by construction. When the spectral density is unknown, the framework extends naturally to kernel learning from data. We demonstrate the method on locally stationary and harmonizable mixture kernels, the latter with a complex-valued spectral density, and apply the kernel-learning extension to real and synthetic data.

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

StyleShield: Exposing the Fragility of AIGC Detectors through Continuous Controllable Style Transfer

arXiv:2605.00924v2 Announce Type: replace-cross Abstract: AI-generated content (AIGC) detectors are increasingly deployed in high-stakes settings such as academic integrity screening, yet their reliability rests on a fundamental paradox: as language models are trained on human-written corpora, the statistical boundary between AI and human writing will inevitably dissolve as models improve. Commercial incentives have further distorted this landscape – detection services and "de-AIification" tools often operate within the same supply chain, replacing evaluation of content quality with judgment of content origin. We present StyleShield, the first flow matching framework for conditional text style transfer, operating directly in continuous token embedding space via a DiT backbone with zero-initialized cross-attention adapters conditioned on frozen Qwen-7B representations. At inference, we adapt the SDEdit paradigm from image synthesis to text embeddings, with a single parameter gamma providing smooth continuous control over the evasion-preservation trade-off. On a multi-domain Chinese benchmark, StyleShield achieves 94.6% evasion against the training detector and >=99% against three unseen detectors, maintaining 0.928 semantic similarity. We further introduce RateAudit, a document-level scheduling algorithm that demonstrates detection-rate verdicts can be set to arbitrary values, directly questioning the reliability of score-based evaluation.

10.
arXiv (math.PR) 2026-06-19

Extremal representations of functions of matrices and applications to multivariate prediction

arXiv:2606.19359v1 Announce Type: cross Abstract: Motivated by two seminal results of multivariate prediction theory by Helson and Lowdenslager and by Wiener and Masani we prove extremal representations of functions of matrices and derive their prediction-theoretic consequences. We also sketch a way to obtain matricial inequalities from our results. The main goal of the paper is the computation of the infimum of a set of values of the form $tr(A \Delta A^*)$, where $\Delta$ is a given non-negative Hermitian $n \times n$ matrix and the choices for $A$ exhauste a certain set of $n \times n$ matrices. In particular, we focus on norm-bounded unit spheres with certain types of properties of unitary invariance, what allows an application of the theory of majorization.

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

Simulating Students' Java Programming Errors with Large Language Models

Understanding student errors in the programming is a cornerstone of programming education, yet obtaining a representative set of student errors for any newly designed task remains slow and costly, since authentic submissions only accumulate after extensive classroom deployment. This paper explores whether large language models (LLMs) can serve as scalable proxies for students by simulating realistic logical errors in code submissions. Using the CodeWorkout dataset of 74,000+ unique student Java submissions across 37 problems, we evaluate five LLMs under three mainstream prompting strategies: Input-Output (IO), Chain-of-Thought (CoT), and iterative Self-Refine. We assess performance along two key dimensions: diversity (the range of distinct error patterns) and alignment (alignment with authentic student mistakes), and examine how these vary by struggling level of programming tasks. Our quantitative findings reveal that while all models generate diverse errors, their alignment to human submissions diverges: Claude Sonnet 4 achieves the most balanced performance. In addition, we conducted a blinded expert annotation study (N = 401) comparing synthetic and authentic errors. This qualitative analysis confirms that the generated errors are functionally indistinguishable from authentic student errors. Moreover, higher-struggling-level problems elicit more diverse but less student-like errors. These results highlight trade-offs in using LLMs to simulate human learners and suggest design considerations for integrating synthetic errors into teachable agents, intelligent tutoring systems, and large-scale learning analytics.

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

Principled RL for Flow Matching Emerges from the Chunk-level Policy Optimization

Recent Progress in post-training flow matching for text-to-image (T2I) generation with Group Relative Policy Optimization (GRPO) has demonstrated strong potential. However, it is hindered by a critical limitation: inaccurate advantage attribution. In this work, we argue that aggregating consecutive steps into a coherent 'chunk' and shifting the policy optimization paradigm from GRPO's step level to the chunk level can effectively mitigate the negative impact of this issue. Building on this insight, we propose Group Chunking Policy Optimization (GCPO), the first chunk-level reinforcement learning approach for post-training flow matching. Extensive experiments demonstrate that GCPO achieves superior performance on both standard T2I benchmarks and preference alignment, with up to 43% relative gains over GRPO, highlighting the promise of chunk-level policy optimization. The code is available on https://github.com/xingzhejun/GCPO.

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

A theoretical model for task routing in mixture-of-expert transformers

arXiv:2606.14398v1 Announce Type: new Abstract: Mixture-of-experts (MoE) layers enable the scaling of transformer models while keeping the inference compute fixed. While task-expert specialization has been observed in empirical studies of frontier MoE transformer models, existing theoretical work analyzes this using continuous mixture models that cannot be used to model natural language effectively. An important open question is to theoretically explain task-expert specialization in transformer MoE models using discrete models of language. To address this, we represent structured knowledge via syntactic templates and finite key-value dictionaries, and prove formally that a single-layer MoE transformer can encode knowledge by using experts that specialize in the corresponding tasks. Our construction shows how queries are routed to unique, task-specific experts whose size depends solely on the intrinsic complexity of the given task (i.e. the combined size of its syntactic templates and factual dictionary). Our construction provides a theoretical support for empirical results on localized knowledge circuits in MoE models. We support our theoretical findings with experiments evaluating model performance under varying MoE loss functions.

14.
arXiv (quant-ph) 2026-06-15

Spin disorder competing with positional symmetry breaking governs the metal-insulator behavior in oxide paramagnets

arXiv:2606.14624v1 Announce Type: cross Abstract: Numerous transition-metal oxides have low-temperature antiferromagnetic (AFM) states and high-temperature paramagnetic (PM) phases, where the AFM state is usually insulating while the PM phase can be either insulating or metallic. Without involving strong correlation, we use symmetry-broken density-functional theory (DFT) to obtain the PM phases of insulating NaFeO3 vs the recently discovered metallic NaOsO3. We develop the understanding of insulating and metallic behaviors in paramagnetic oxides by analyzing the interactions between magnetic and positional symmetry breaking: The insulating gap is governed by the competition between the spin disorder that induces a distribution of different magnitudes of local magnetic moments and the polymorphous distribution of off-center atomic displacements. NaFeO3, on the other hand, has large positional displacement with small spin-disorder-induced moments distribution, leading to insulating PM phase, whereas NaOsO3 has a pronounced spin-disorder-induced moments distribution that forces the PM phase to become metallic. Our work identifies this symmetry-breaking competition as a general framework to bridge seemingly disparate metal-insulator behaviors in transition-metal oxides paramagnets without invoking strong correlation.

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

CredibleDFGO: Differentiable Factor Graph Optimization with Credibility Supervision

arXiv:2605.06100v2 Announce Type: replace-cross Abstract: Global navigation satellite system (GNSS) positioning is widely used for urban navigation, but the covariance reported by the GNSS solver is often unreliable in urban canyons. Existing differentiable factor graph optimization (DFGO) methods learn measurement weighting through the solver, but they still use position-only objectives. As a result, the position estimate may improve while the reported covariance remains too small, too large, or incorrectly oriented. We propose CredibleDFGO (CDFGO), a differentiable GNSS factor graph framework that makes covariance credibility an explicit training target. A Weighting Generation Network (WGN) predicts per-satellite reliability weights, and a differentiable Gauss-Newton solver maps these weights to a position estimate and a Hessian-derived posterior covariance. We use proper scoring rules to supervise the East-North predictive distribution end to end. We study negative log-likelihood (NLL), the energy score (ES), and their combination. Results on three UrbanNav test scenes show consistent gains in covariance credibility. Positioning accuracy also improves on the medium-urban and harsh-urban scenes; on the deep-urban scene, both the mean horizontal error and the 95th-percentile error improve. On the harsh-urban Mong Kok (MK) scene, CDFGO-Combined reduces the mean horizontal error from 13.77 m to 11.68 m, reduces NLL from 40.63 to 6.59, and reduces ES from 12.31 to 9.05 relative to DFGO (MAE). Case studies link the MK improvement to better axis-wise consistency, more credible local covariance ellipses, and satellite-level reweighting.

16.
arXiv (quant-ph) 2026-06-16

TENSO: Software Package for Numerically Exact Open Quantum Dynamics Based on Efficient Tree Tensor Network Decomposition of the Hierarchical Equations of Motion

arXiv:2603.17711v2 Announce Type: replace-cross Abstract: TENSO is a versatile and powerful open-source software package for numerically exact simulations of the dynamics of quantum systems immersed in structured thermal environments. It is based on a tree tensor network decomposition of the hierarchical equations of motion (HEOM) that efficiently curbs its curse of dimensionality with bath complexity. As such, TENSO enables exact non-Markovian open quantum dynamics simulations even with complex environments typical of chemistry and quantum information science. TENSO allows for time-dependent drive in the system, and for non-commuting fluctuations. More generally, TENSO efficiently propagates the dynamics for any method with a generator of the dynamics that can be expressed in a sum-of-products form, including the HEOM and multi-layer multiconfigurational time-dependent Hartree methods. TENSO enables simulations using tensor trees and trains of arbitrary order, and implements three propagation strategies for the coupled master equations; two fixed-rank methods that require a constant memory footprint during the dynamics and one adaptive rank method with a variable memory footprint controlled by the target level of computational error. In contrast to the accompanying theory and algorithmic paper [J. Chem. Phys. 163, 104109 (2025)] the focus here is on the practical usage and applications of TENSO with underlying theoretical concepts introduced only as needed.

17.
medRxiv (Medicine) 2026-06-22

Deep-Tissue Hemodynamic Sensing: Comparing Impedance and Photoplethysmography for Wearable Blood Pressure Estimation

The pursuit of continuous, cuffless blood pressure (BP) monitoring is constrained by the superficial sensing depth of photoplethysmography (PPG). Impedance plethysmography (IPG) offers deeper tissue penetration, but its comparative value over PPG remains unquantified at scale. In this comparative study of 261 participants (130 hypertensive, 131 non-hypertensive), we utilized a custom dual-modality wearable prototype to capture simultaneous IPG and PPG signals. Over 150,000 cardiac cycles were analyzed using an unsupervised archetype discovery pipeline to quantify beat-to-beat morphological heterogeneity. IPG resolved up to three distinct morphological modes per participant, whereas co-located PPG converged into highly conserved, uniform profiles. IPG captured specific signatures of pathological arterial remodeling and physiological habitus; ventral forearm IPG pulse amplitude exhibited a significant main effect for BP status (p = 0.024), a relationship absent in the co-located PPG signal. Furthermore, increasing body mass index (BMI) significantly attenuated the prevalence of steep-upstroke archetypes in IPG (p = 0.035), quantifying a likely damping effect of adipose tissue. Deep-tissue bioimpedance captures rich, heterogeneous hemodynamic signatures including arterial-dominant morphologies that are invisible to optical sensors. Transitioning from optical pulse wave analysis to bioimpedance-based models may offer a promising pathway for accurate wearable cardiovascular monitoring.

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

Adaptive Speech-to-Spike Encoding for Spiking Neural Networks

arXiv:2606.19039v1 Announce Type: cross Abstract: The mismatch between continuous acoustic signals and discrete event-driven processing remains a fundamental bottleneck for neuromorphic speech processing. Current systems typically rely on fixed spike encoders, forcing downstream Spiking Neural Networks (SNNs) to compensate for non-adaptive input representations. To address this, we present a learnable residual speech-to-spike encoder jointly trained end-to-end with a Recurrent Leaky Integrate-and-Fire (R-LIF) backbone. We validate this approach on the Google Speech Commands v2 (GSC-v2) benchmark, achieving up to 94.97% accuracy. Notably, the learned encoder remains highly parameter-efficient with a compact 35k-parameter variant that reaches 89.8%, matching or exceeding prior baselines that require an order of magnitude more parameters. Our encoder-focused analysis, including linear probing and gradient-residual inspection, indicates that the encoder does not target faithful signal reconstruction but instead learns task-aligned spike representations that enhance class separability. Finally, we benchmark bio-inspired, hardware-friendly credit assignment by comparing Direct Feedback Alignment (DFA) with surrogate-gradient BPTT under identical architectures and training conditions. We find that DFA reaches 91.5% accuracy, quantifying the performance trade-off of bio-inspired learning rules for modern neuromorphic audio.

19.
medRxiv (Medicine) 2026-06-22

Regional Service-System Conditions Associated with Facility-Linked Home-Based Specialist Care in Japan: A Claims-Based Ecological Study of Home Dialysis

Background Complex chronic care is increasingly delivered in patients' homes while remaining linked to specialist facilities for training, monitoring, and backup care. Home dialysis provides a useful case because peritoneal dialysis (PD) and home hemodialysis (HHD) share a home-facility delivery structure but differ in technical and operational requirements. This study examined regional service-system conditions associated with the presence and scale of PD and HHD in Japan. Methods This ecological study used publicly available claims, administrative, census, and geospatial data harmonized to 334 Secondary Medical Areas. Regional indicators were organized into four domains: dialysis service delivery, implementation support for home-based care, hospital backup capacity, and living and sociodemographic context. Diffusion was examined using claims-based indicators of regional presence and post-presence scale, analyzed separately for PD and HHD with Firth penalized logistic regression and zero-truncated negative binomial regression, respectively. Results PD was observed in 271 regions and HHD in 109. Patterns of associated regional conditions differed by modality and stage. PD was associated mainly with existing dialysis-service organization, whereas HHD was associated with broader regional supports, including home-care delivery, living infrastructure, transition support, and hospital-system indicators. Conditions associated with presence differed from those associated with scale. Cross-modality associations suggested that shared regional factors may shape the distribution of both modalities. Conclusions Regional conditions for home dialysis diffusion in Japan differed by modality and stage. PD was linked mainly to existing dialysis-service organization, whereas HHD was linked to multi-domain regional support for technically demanding home treatment. Under standardized reimbursement, local service-system capacity may remain important for modality- and stage-specific diffusion of home dialysis.

20.
medRxiv (Medicine) 2026-06-19

"Us with them": Co-designing a caesarean section consent and debriefing intervention in West Cameroon

Background Women-centred maternity care is a rights issue that determines the use of services. Such care ensures responsiveness to womens needs which is enacted through shared decision-making, review and response. In the West Region of Cameroon, informed consent (IC) and Debriefing for caesarean section (c-section) have been shown to be suboptimal or absent. This paper describes the participatory design of a quality-improvement hospital-based intervention. Methods From February to May 2025, we conducted a co-design process with three groups of stakeholders: 59 post c-section women and community representatives, 78 frontline c-section providers, and 29 directors of public and private hospitals. We followed four phases: planning, conducting, evaluating, and reporting. The conduct phase comprised five all-day workshops with post c-section women and community representatives, followed by five all-day workshops with the c-section providers. Finally, we held an 11th workshop with the hospital directors to scrutinize suggested interventions, evaluate their feasibility, and establish a consensus on their components. We described the intervention using the TIDieR (Template for Intervention Description and Replication) checklist. We documented the co-design process, using open-ended narratives to delineate interventions, and carried out real-time synthesis on visual aids (whiteboards and flipcharts). Intervention feasibility was quantified using a structured ad hoc matrix, while insights on facilitators and barriers were captured through qualitative free-text entries. We coupled data collection with constant comparison and triangulation through contemporaneous field notes, photographic documentation, and thematic mapping of stakeholders perceptions and interactive dynamics. Results Participants perspectives on the co-design were positive, and their motivation were very high although less than 50% reported previous involvement in co-design processes. More than 80% of participants found rated the co-design process as either good or very good. The final intervention comprised four components: (i) an in-service training; (ii) a standard operating procedure including a harmonised consent form and debriefing checklist; (ii) systematic supportive supervision, monitoring & evaluation; and (iv) a routine clinical audit. Each group of stakeholders upheld specific dimensions of the consent and debrief intervention. Post c-section women and community members emphasized emotional support, written discharge advice after debriefing, and zero tolerance of suboptimal consent and debriefing practices. Frontline c-section providers insisted on robust documentation for medico-legal protection. Hospitals Directors emphasized capacity-building and cultural friendliness. All the groups supported womans autonomous decision making. The intervention feasibility was rated high or very high by hospital directors except for the financial, infrastructural and technical domains. Conclusion This co-design process yielded a context-specific, multi-component intervention that was well accepted and deemed feasible across stakeholders. It provides a methodological approach to strengthening informed consent and debriefing as core elements of women-centred, accountable maternity care, and warrants implementation.

21.
arXiv (CS.AI) 2026-06-16

RollArt: Disaggregated Multi-Task Agentic RL Training at Scale

arXiv:2512.22560v2 Announce Type: replace-cross Abstract: Agentic Reinforcement Learning (RL) trains LLMs through multi-turn interactions with environments, producing workloads that mix compute-bound prefill, bandwidth-bound decoding, CPU-heavy environment execution, and bursty reward evaluation. Existing systems either colocate all stages on a single GPU cluster or decouple them only at a coarse granularity, overlooking hardware heterogeneity and incurring substantial synchronization overhead across stages. We present ROLLART, a system for multi-task agentic RL on disaggregated infrastructure. ROLLART maps each pipeline stage to best-fit hardware, routing prefill-heavy tasks to compute-optimized GPUs, decode-heavy tasks to bandwidth-optimized GPUs, and environments to CPU clusters. It decouples rollout at the trajectory level, allowing generation, environment interaction, and reward scoring to proceed independently, so that slow or failed environments never block the others. ROLLART offloads stateless reward computation to serverless infrastructure and overlaps rollout with training via staleness-bounded asynchronous weight synchronization. Our results demonstrate that ROLLART effectively improves training throughput and achieves 1.31–2.05 \(\times\) training time reduction compared to various RL systems. We also evaluated ROLLART by training a hundreds-of-billions-parameter MoE model for Qoder product on an Alibaba cluster with above 3,000 GPUs, demonstrating its stability and scalability.

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

Exploring Starts Are Not Enough: Counterexamples and a Fix for Monte Carlo Exploring Starts

arXiv:2606.15247v1 Announce Type: cross Abstract: The asymptotic behaviour of Monte Carlo Exploring Starts (MCES) is a long-standing open question in reinforcement learning, even in the tabular setting. We investigated the convergence properties of tabular MCES by constructing examples in which the algorithm converges to suboptimal solutions. This paper presents new counterexamples for both initial-visit and first-visit MCES and gives a convergence-restoring modification for the initial-visit case. We show that stable suboptimal solutions may exist for initial-visit MCES with sample-average updates even when greedy actions are updated more often than non-greedy actions on average. However, by scaling learning rates inversely to update frequencies on a state-by-state basis, convergence to optimality is guaranteed. Unlike previous uniformisation methods, this modification is applicable to large-scale problems that require approximating the estimated value function. We then extend the example to show that sample-average first-visit MCES may also converge to suboptimal solutions. This largely settles a fundamental open problem and shows that exploring starts alone do not guarantee convergence to optimality. More broadly, these results highlight that convergence depends critically on the relative size and frequency of updates applied to different actions, making the choice of learning rates and the balance between exploration and exploitation central to the analysis of MCES and the implementation of scalable Monte Carlo control methods.

23.
arXiv (quant-ph) 2026-06-19

Entanglement structure of the dynamical phases in the sub-Ohmic spin-boson model

arXiv:2606.20313v1 Announce Type: new Abstract: The sub-Ohmic spin-boson model exhibits three distinct dynamical regimes in its spin population dynamics, classified as coherent, incoherent, and pseudo-coherent. Whether these regimes correspond to distinct spin-bath entanglement structures remains an open question. Here we address this using tree tensor network states with projector-splitting time evolution (TTN-TDVP-PS), scanning a broad grid in the sub-Ohmic $(s, \alpha)$ plane. We find that the spin entanglement entropy $S_\mathrm{spin}(t)$ reaches a stationary plateau on a timescale shorter than the polarization relaxation, enabling construction of a stationary entropy landscape from the stationary value $S_\mathrm{stable}$. Within this scalar entropy landscape, the entropy ridge broadly follows the population-based phase boundary at small $s$, but does not reproduce the two-branch structure at large $s$. The ridge remains single-valued within the incoherent region rather than separately tracking both population-based transitions. The Bloch-sphere representation provides a geometric interpretation of this behavior. The entropy plateau corresponds to trajectories settling onto constant-radius shells, with the ridge marking the parameters of smallest stationary Bloch radius. Mode-resolved bath entanglement shows that low-frequency modes dominate the environmental entropy scale and that coherent dynamics enhance bath-mode correlations beyond direct spin–mode correlations. These results establish the stationary spin entanglement entropy as a physically informative observable that complements population-based classifications of dissipative quantum dynamics.

24.
medRxiv (Medicine) 2026-06-15

GLLaucoMed: A Secure LLM-Powered Agentic Workflow for Automated Medication Extraction from Free-Text Glaucoma Clinical Notes

Purpose: To evaluate the efficacy of large language models (LLMs) in extracting medication-related information from glaucoma clinical notes in the electronic health record (EHR). Design: Cross-sectional. Subjects: 1,250 subjects in the Bascom Palmer Ophthalmic Repository. Methods: Extracted clinical notes from glaucoma-related encounters between 2014 and 2024 were labeled by two glaucoma specialists with a third serving as an adjudicator. Graders were asked to label current topical medications (CTM), proposed changes to topical medications ({Delta}TM), current oral medications (COM), and proposed changes to oral medications ({Delta}OM) in a structured fashion. The dataset was split into development (10%), validation (10%), and test (80%) sets stratified by clinician. Development and validation sets were used to engineer and refine prompts, and the held-out test set was used for model assessment. Five LLMs (Claude Opus 4.6, DeepSeek-V3.2, GPT 5.2, Grok 4.1, and Qwen3.6-35B-A3B) were accessed via Microsoft Azure AI Foundry within a HIPAA-compliant environment. Inter-grader agreement was assessed with Gwet AC1. LLM performance was initially assessed in a binary fashion with F1 scores, and the degree of text match among positive cases was evaluated using exact match accuracy and Jaccard Index (JI). Main Outcome Measures: F1 score, exact match accuracy, JI. Results: Gwet AC1 for intergrader agreement was 0.799, 0.888, 0.985, and 0.988 for CTM, {Delta}TM, COM, and {Delta}OM, respectively. F1 scores for CTM were 0.985, 0.971, 0.978, 0.968, and 0.970 for Claude, Deepseek, GPT, Grok, and Qwen, respectively; for {Delta}TM: 0.905, 0.826, 0.897, 0.842, 0.855, respectively; for COM: 0.923, 0.887, 0.899, 0.906, 0.894, respectively; for {Delta}OM: 0.958, 0.815, 0.937, 0.835, 0.940, respectively. Among positive cases, range of exact match accuracies for CTM (N=1354) was 0.730- 0.882 and range of JIs was 0.809-0.918. For {Delta}TM (N=404), exact match accuracy range was 0.619-0.780 and JI range was 0.668-0.827. For COM (N=47), exact match accuracy range was 0.766-0.872 and JI range was 0.765-0.870. For {Delta}OM (N=25), exact match accuracy range was 0.583-0.920 and JI range was 0.583-0.922. Conclusions: The GLLaucoMed pipeline demonstrated high performance in extracting and standardizing medication data from unstructured clinical notes, including both current medications and proposed changes. Claude and GPT exhibited the strongest performance.

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arXiv (CS.CV) 2026-06-16

teasr: training-efficient any-step diffusion transformer for real-world image super-resolution

Diffusion models excel in Real-World Image Super-Resolution (Real-ISR) due to their powerful generative priors but suffer from slow iterative sampling. Although existing one-step distillation methods accelerate inference, they typically require auxiliary teacher models that inflate training memory and restrict scalability to large-scale architectures. Furthermore, these fixed-step models lack the flexibility to trade off speed for quality. In this paper, we propose TEASR, a training-efficient any-step diffusion framework for Real-ISR that enables both one-step and multi-step restoration within a unified model. Our key idea is to perform self-adversarial distillation within a single diffusion model, eliminating the need for auxiliary teachers or discriminators. Specifically, we propose a timestep-aware rectification strategy that stabilizes one-step generation across noise levels. These two designs further enables the distillation of 20B-parameter diffusion models on a single GPU, significantly improving training efficiency. Moreover, we introduce a dual-branch diffusion transformer with decoupled timestep condition to separate the current noise state and the denoising target to enhance sampling quality. Extensive experiments demonstrate that TEASR supports seamless any-step sampling and consistently outperforms state-of-the-art methods across multiple datasets.