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01.
arXiv (CS.AI) 2026-06-11

OmniBioTwin: A System-of-Twinned-Systems Framework for Health Digital Twins

arXiv:2606.11264v1 Announce Type: cross Abstract: Health digital twins (HDTs) promise patient-specific modeling and decision support but current approaches remain structurally fragmented: monolithic models that address a single organ or task lack cross-scale fidelity, while system-level twins lack generalizable architectural frameworks. We propose OmniBioTwin, a System-of-Twinned-Systems (SoTS) framework that organizes HDTs as modular computational entities coupled through explicit interaction operators within a multi-layer network architecture. The framework comprises seven coordinated layers - spanning data integration, autonomous twin modeling, cross-scale coupling, temporal synchronization, and human-in-the-loop decision support. We demonstrate OmniBioTwin by instantiating a multiscale twin for glucagon-like peptide-1 (GLP-1) signaling pathways in Alzheimer's disease, illustrating how molecular, cellular, and organ-level twins can be composed and coupled within a unified system.

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

MedSynth: Realistic, Synthetic Medical Dialogue-Note Pairs

Physicians spend significant time documenting clinical encounters, a burden that contributes to professional burnout. To address this, robust automation tools for medical documentation are crucial. We introduce MedSynth – a novel dataset of synthetic medical dialogues and notes designed to advance the Dialogue-to-Note (Dial-2-Note) and Note-to-Dialogue (Note-2-Dial) tasks. Informed by an extensive analysis of disease distributions, this dataset includes over 10,000 dialogue-note pairs covering over 2000 ICD-10 codes. We demonstrate that our dataset markedly enhances the performance of models in generating medical notes from dialogues, and dialogues from medical notes. The dataset provides a valuable resource in a field where open-access, privacy-compliant, and diverse training data are scarce. Code is available at https://github.com/ahmadrezarm/MedSynth/tree/main and the dataset is available at https://huggingface.co/datasets/Ahmad0067/MedSynth.

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

Existence Precedes Value: Joint Modeling of Observational Existence and Evolving States in Time Series Forecasting

arXiv:2606.13571v1 Announce Type: cross Abstract: Real-world time series are often highly incomplete and irregular due to sensor dormancy, transmission delays, and event-driven sampling, making reliable forecasting fundamentally challenging. Existing methods have evolved from impute-then-forecast pipelines to continuous-time models such as Neural ODEs and continuous-time graph networks. While these approaches improve the modeling of historical irregularity, they still rely on an implicit oracle assumption at inference time: the timestamps of future valid observations are presumed to be known in advance. This assumption limits practical relevance, since in many real systems the more fundamental question is not only what the future value will be, but also whether a valid observation will occur at all. In this paper, we propose Timeflies, a unified framework that reformulates forecasting as a joint problem of future observability inference and value estimation. To explicitly model the interaction between observation dynamics and state evolution, Timeflies adopts an observation stream and a value stream, coupled through three dedicated modules for reliability-aware embedding, observation-guided dependency modeling, and joint prediction. We further construct Shadow, a benchmark that combines natural missingness from public datasets with real-world industrial data, and introduce the Observation-Value Joint Entropy (OVJE) metric to comprehensively evaluate this coupled predictability. Extensive experiments show that Timeflies consistently outperforms existing methods, highlighting the importance of explicitly modeling future observability in time series forecasting with missing values. Code and dataset are available in https://github.com/ant-intl/Timeflies.

04.
arXiv (CS.CL) 2026-06-12

Agents' Last Exam

Recent AI systems have achieved strong results on a wide range of benchmarks, yet these gains have not translated into economically meaningful deployment across many professional domains. We argue that this gap is largely an evaluation problem: widely used benchmarks lack sustained performance measurement on real and economically valuable workflows. This paper introduces Agents' Last Exam (ALE), a benchmark designed to evaluate AI agents on long horizon, economically valuable, real world tasks with verifiable outcomes. Developed in collaboration with 250+ industry experts, ALE covers non-physical industries defined with reference to O*NET / SOC 2018 (the U.S. federal occupational taxonomy). It is organized around a task taxonomy with 55 sub fields grouped into 13 industry clusters covering 1K+ tasks. Current results show that the hardest tier remains far from saturated: across mainstream harness and backbone configurations, the average full pass rate is below 1%. ALE is designed as a living benchmark: its task pool grows continuously as new workflows and industries are onboarded. More broadly, ALE is intended not merely as another leaderboard, but as an instrument for closing the gap between benchmark success and GDP relevant impact.

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

DeepForestVisionV2: Ecology-Driven Taxonomy Expansion for Camera-Trap Monitoring in African Tropical Forests

Camera-trap monitoring in African tropical forests increasingly extends beyond closed-canopy interiors to riverbanks, clearings, and park edges. Among available open tools for African forest camera-trap classification, DeepForestVision is the only one providing a matched offline workflow for both photographs and videos, and previous work showed that it outperformed other available baselines on a comparable benchmark. However, it was designed for closed-canopy, ground-level forest interiors and uses a 35-class prediction space that becomes too coarse when deployments encounter arboreal primates, birds, semi-aquatic taxa, or human-associated confounders such as livestock. We present DeepForestVisionV2, an ecology-driven expansion from 35 to 64 prediction classes (61 animal classes plus human, vehicle, and blank) designed to address three recurrent deployment gradients: vertical stratification, scene openness, and anthropogenic interfaces. DeepForestVisionV2 retains the same offline workflow and is trained on 1,535,010 photographs and 243,354 videos from multi-country African tropical-forest projects. Evaluation combines a cross-country cropped-photo validation set, used to assess robustness across sites and camera-trap settings, with three held-out Uganda video benchmarks spanning the targeted gradients. On the validation set, DeepForestVisionV2 reaches 0.86 accuracy, 0.82 macro-F1, and 0.81 balanced accuracy. On the deployment benchmarks, it preserves or improves baseline accuracy despite its harder classification task, while increasing the number of identified taxa from 22 to 29 in forest-interior videos and from 4 to 9 at riverbanks. In the park-edge use case, it raises accuracy from 0.62 to 0.86 and reduces false alarms from 11 to 0. These results show that DeepForestVisionV2 materially improves field utility while preserving robustness across sites, habitats, and camera-trap settings.

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

CMIP-Forge: An Agentic System that Retrieves, Computes, and Self-Reviews Climate Science

arXiv:2606.17076v1 Announce Type: cross Abstract: The Coupled Model Intercomparison Project Phase 6 (CMIP6) has generated thousands of peer-reviewed publications documenting model configurations, evaluation procedures, emergent constraints, and projection uncertainties. As the community transitions toward CMIP7, efficiently extracting and operationalizing this unstructured knowledge alongside live data analysis represents a critical bottleneck. Here we present CMIP-Forge, a hybrid retrieval-augmented generation (RAG) and autonomous analysis system that bridges the gap between scientific literature and Earth System Grid Federation (ESGF) data archives. The system pairs a curated corpus of 6,581 CMIP6-related open-access publications (101,828 indexed chunks) with an agentic pipeline in which a tool-augmented worker plans and executes Python workflows over live climate data, while a panel of independent reviewer models audits its methodology end to end. CMIP-Forge introduces a multi-layered Defense-in-Depth architecture that enforces physical and methodological invariants through executable mechanisms: Abstract Syntax Tree (AST) static analysis, audited scientific primitives, and an autonomous adversarial peer-review protocol. We demonstrate the system's capabilities through end-to-end autonomous research pipelines spanning atmospheric teleconnections, ocean dynamics, regional extremes, and global warming projections. An agentic analysis system grounded in peer-reviewed literature, constrained by automated code guardrails, and audited by an independent adversarial review loop can complete complex climate-research workflows autonomously. The same experiments expose concrete failure modes of the review loop (sycophantic regression, REVISE verdicts that are never resolved, and the submission of stub code for review), each diagnosable from the immutable telemetry and provenance record released with the article.

07.
arXiv (quant-ph) 2026-06-16

Adaptively secure unitary designs with constant non-Clifford cost

arXiv:2510.08129v2 Announce Type: replace Abstract: Randomness is a fundamental resource in quantum information, with crucial applications in cryptography, algorithms, and error correction. A central challenge is to construct unitary $k$-designs that closely approximate Haar-random unitaries while minimizing the costly use of non-Clifford operations. In this work, we present a protocol able to generate unitary $k$-designs on $n$ qubits, secure against any adversarial quantum measurement, with a system-size-independent number of non-Clifford gates. Our construction applies a $k$-design only to a subsystem of size $\Theta(k)$, independent of $n$. This ``seed'' design is then ``diluted'' across the entire $n$-qubit system by sandwiching it between two random Clifford operators. The resulting ensemble forms an $\varepsilon$-approximate unitary $k$-design on $n$ qubits. We prove that this construction achieves full quantum security against adaptive adversaries using only $\tilde{O}(k^2 \log\varepsilon^{-1})$ non-Clifford gates. If one requires security only against polynomial-time adaptive adversaries, the non-Clifford cost decreases to $\tilde{O}(k + \log^{1+c} \varepsilon^{-1})$. This is optimal, since we show that at least $\Omega(k)$ non-Clifford gates are required in this setting. Compared to existing approaches, our method significantly reduces non-Clifford overhead while strengthening security guarantees to adaptive security as well as removing artificial assumptions between $n$ and $k$. These results make high-order unitary designs practically attainable in near-term fault-tolerant quantum architectures.

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

Light-weight Pronunciation Assessment via Discrete Speech Token Surprisal

Training automated pronunciation assessment often relies on labeled learner errors or non-native corpora that are costly to collect. We propose a lightweight framework trained only on native speech resources, operating unsupervised or lightly calibrated with a small set of scored utterances. At inference, learner speech is discretized with an SSL encoder and a K-means codebook. A token language model trained on native sequences computes surprisal where higher surprisal indicates phonotactic deviation. We add a transcript-guided Text2DUnit–DTW module that predicts native token sequences from reference text and aligns them to acoustic tokens to derive error-sensitive features. Surprisal and alignment features are fused via simple regression. On SpeechOcean762, PCC improves from 0.60 to 0.66 with transcript guidance, near supervised baselines. Cross-dataset evaluation on L2-ARCTIC shows consistent gains.

09.
arXiv (quant-ph) 2026-06-15

Compact graphs and quantum automorphisms

arXiv:2606.13928v1 Announce Type: new Abstract: Compact graphs are graphs for which the fractional automorphism polytope has no genuinely fractional vertices. This paper proposes a quantum analogue of this idea by evaluating the fundamental magic unitary of the quantum automorphism group on states, which we show to produce a closed convex set of doubly stochastic matrices sitting between the classical automorphism polytope and the full fractional automorphism polytope. Our main result is that the natural quantum analogue of compactness is classical, that is, a quantum compact graph is classically compact. We also relate this set to the quantum orbital algebra and obtain a hierarchy of classical and quantum compactness pseudo notions. The framework recovers familiar consequences of compactness through commutants and suggests quantum analogues of generous transitivity and distance-transitivity. We also isolate examples and open problems indicating where quantum symmetries may strictly refine the classical compactness theory.

10.
arXiv (CS.AI) 2026-06-11

When Do Data-Driven Systems Exhibit the Capability to Infer?

arXiv:2606.11769v1 Announce Type: new Abstract: The European AI Act is the first comprehensive regulation of artificial intelligence (AI), setting out extensive obligations, particularly for so-called high-risk and general-purpose AI systems. A key distinguishing feature of AI systems under the AI Act is the capability to infer. Since the AI Act does not clearly define what inference is, there is a gray area for certain data-driven systems. A specific example is credit scoring systems, which are listed by Annex III of the AI Act. At the same time, however, these are often implemented using statistical models for which it is unclear whether they have the capability to infer and thus fall under the AI definition of the AI Act at all. Motivated by statistical learning theory, this work develops a framework for grading different levels of the capability to infer. Based on the AI Act and the Commission Guidelines on the definition of an artificial intelligence system, we analyze which levels constitute sufficient capability to infer within the meaning of the AI Act and where further regulatory clarity is needed. We illustrate the framework by creating two realistic credit scoring workflows and show whether and where inference occurs in them. Our analysis illustrates that not only individual models but the entire data processing workflow must be considered. It also shows that the involvement of human experts during development can have significant influence on the capability to infer. Code can be found at https://github.com/fraunhofer-iais/inference-framework-creditscorecards.

11.
arXiv (CS.CV) 2026-06-17

UoU: A Universal Fingerprint Foundation Model Based on Large-Scale Unsupervised Learning

Fingerprint recognition is still dominated by task-specific pipelines, where enhancement, structural parsing, alignment, and matching are optimized in isolation. Although effective in narrow settings, this design limits representation reuse across sensors, qualities, and downstream applications. We therefore present UoU, short for ``a Universal fingerprint foundation model based on large-scale Unsupervised learning,'' which reframes fingerprint feature extraction as a domain-specific foundation-model problem. UoU is organized around a multi-level representation hierarchy spanning image restoration, structural fields, semantic tokens, point-level biometric entities, and compact global descriptors. Its training recipe combines a supervised cold start on precise annotations, large-scale weakly supervised refinement, and large-scale unsupervised consolidation, with the latter two stages iterated during large-scale training so that weak supervision broadens semantic coverage while unsupervised learning stabilizes correspondences, invariances, and representation geometry. Rather than treating fingerprint imagery as generic texture, UoU exploits domain-specific symmetries and intermediate structure, including orientation flow, periodic ridge patterns, sparse biometric entities, and spatial equivariance. The framework is intentionally architecture-agnostic: while the present study includes an initial transformer-based structured-prediction instantiation, the broader design supports multi-task learning, scalable model configurations, and downstream specialization for matching, alignment, enhancement, registration, and related fingerprint applications. This paper presents the technical motivation, system design, and validation protocol of UoU, and part of the baseline implementation is publicly available at https://github.com/XiongjunGuan/UoU.

12.
arXiv (quant-ph) 2026-06-16

Synthesizing Arbitrary Non-Hermitian Hamiltonian with Stochastic Floquet Engineering

arXiv:2606.15664v1 Announce Type: new Abstract: The conventional Floquet engineering scheme synthesizes a given target Hamiltonian with a deterministic temporal periodic driving field. In this work, we introduce the stochastic Floquet engineering scheme that can synthesize an arbitrary non-Hermitian target Hamiltonian using a time-periodic driving field with noisy amplitude. Our method is rooted in the Hermitian dynamics taking noise as a valuable quantum resource with no need for loss or gain in prior. We apply our method to engineer a cavity Hamiltonian with dissipative coupling between Fock states, and to prepare a given quantum state from a generally arbitrary quantum state. The stochastic Floqut engineering also provides a way to generate non-unitary quantum gates, which take advantage in certain tasks compared to unitary quantum computing, without the need for ancillae or state-dependent updating.

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

Neural Variability Enhances Artificial Network Robustness

arXiv:2606.13801v1 Announce Type: new Abstract: Neural responses in cortex exhibit substantial trial-to-trial variability in response to repeated stimuli, while peripheral sensory neurons respond far more consistently, leading many to wonder whether stochasticity may carry meaning. Existing work has argued that noise and signal correlations may be optimized for discrimination in animals, whereas artificial neural network (ANN) studies have shown similar benefits of noise in machine learning tasks, although most ANN work has neglected the effects of correlations. Here we investigate whether correlated noise improves the robustness of artificial neural networks to adversarial attacks and naturalistic image modifications. Using the covariance of activations under modified versus clean inputs, we find that structured noise may significantly improve network robustness. Robustness to naturalistic image modifications benefits most from structure, but this structure transfers poorly across modification types. In contrast, noise structure from adversarial attacks can generalize to other kinds of attacks. These results suggest that structured noise in ANN activations generally improves robustness, establishing a biologically plausible strategy for creating robust artificial neural networks that only relies on local information.

14.
arXiv (CS.CV) 2026-06-15

Context-Guided Semantic Alignment for Feature Fusion Networks

Feature fusion networks are fundamental components in modern object detectors, aggregating multi-scale features to detect objects of varying sizes. However, directly fusing features from different pyramid levels often introduces semantic inconsistency due to their heterogeneous representations. In this paper, we propose Feature Interaction NEtwork (FINE), a lightweight semantic alignment module that refines low-level features via high-level contextual guidance using cross-level attention prior to fusion. To bridge the structural gap and ensure computational efficiency, we introduce an Alignment-Aware Token Sampling that aligns corresponding spatial regions across scales, reducing the attention complexity by an order of magnitude. The resulting attention weights generate a spatial-channel modulation map that is upsampled and applied to the low-level features via residual element-wise modulation. This mechanism ensures that the network selectively enhances semantically relevant pixels while preserving the sub-pixel localization accuracy necessary for dense prediction tasks. FINE is generally applicable to various detectors and consistently improves detection accuracy without compromising efficiency.

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

Scratched Lenses, Shifted Depth: Passive Camera-Side Optical Attacks

Physical adversarial attacks on vision systems are typically studied through scene manipulation, such as adversarial patches or projections, where the adversary controls what the camera observes. Camera-side attacks using stickers or auxiliary optics have also been explored, but they treat attacks as image-space perturbations from designed patterns. This misses how physical imperfections interact with scene-dependent lighting and optics. We identify a threat: passive lens-side damage that is persistent yet trigger-conditioned, producing optical artifacts that bias geometric inference under particular visual conditions. We instantiate this threat through Scratch-induced Lens Adversarial Streak Hijacking SLASH, a physical-world attack caused by small scratches on a camera lens or protective cover. Scratches interact with bright light sources and specular reflections to create structured streak artifacts that distort depth cues. Since the perturbation is fixed in the optical path but triggered by the scene, it is both persistent and selective. We formulate the attack in optical space, model the scratch pattern as a trigger-conditioned optical channel, and optimize one fixed configuration across diverse viewing conditions. We evaluate SLASH on monocular depth estimation and monocular 3D object detection in digital and real-world settings. Under the fixed-scratch constraint, directional depth shifts reach up to 32% relative error for monocular depth estimation, with consistent effects on monocular 3D object detection. Physical experiments confirm transfer to real camera recordings, inducing depth shifts above the model's natural prediction baseline. These findings reveal an attack surface where benign-looking hardware imperfections act as latent, scene-triggered adversarial mechanisms, challenging assumptions about physical robustness and motivating defenses for secure vision systems.

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

LoRDO: Distributed Low-Rank Optimization with Infrequent Communication

arXiv:2602.04396v2 Announce Type: replace-cross Abstract: Distributed training of foundation models via $\texttt{DDP}$ is limited by interconnect bandwidth. While infrequent communication strategies reduce synchronization frequency, they remain bottlenecked by the memory and communication requirements of optimizer states. Low-rank optimizers can alleviate these constraints; however, in the local-update regime, workers lack access to the full-batch gradients required to compute low-rank projections, which degrades performance. We propose $\texttt{LoRDO}$, a principled framework unifying low-rank optimization with infrequent synchronization. We first demonstrate that, while global projections based on pseudo-gradients are theoretically superior, they permanently restrict the optimization trajectory to a low-rank subspace. To restore subspace exploration, we introduce a full-rank quasi-hyperbolic update. $\texttt{LoRDO}$ achieves near-parity with low-rank $\texttt{DDP}$ in language modeling and downstream tasks at model scales of $125$M–$720$M, while reducing communication by $\approx 10 \times$. Finally, we show that $\texttt{LoRDO}$ improves performance even more in very low-memory settings with small rank/batch size.

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

Visualizing Uncertainty: Spatial Maps of Missing and Conflicting Evidence in Deep Learning

arXiv:2606.15767v1 Announce Type: cross Abstract: Understanding when and why deep neural networks are uncertain is crucial for deploying reliable machine learning systems in safety-critical domains. While existing uncertainty quantification methods provide scalar measures of model confidence, they offer limited insight into which spatial regions of an input contribute to different types of uncertainty. We propose a novel visualization framework, Uncertainty Activation Map (UAM), that combines Evidential Deep Learning (EDL) with Full-Gradient Class Activation Mapping (FullGrad) to generate interpretable spatial uncertainty activation maps. Our approach distinguishes between two fundamental types of uncertainty: vacuity, representing lack of evidence, and dissonance, capturing conflicting evidence between competing hypotheses. By leveraging the complete gradient decomposition property of FullGrad and the principled uncertainty quantification of Subjective Logic, our method produces theoretically grounded visualizations that highlight specific image regions responsible for model uncertainty. With this framework, vacuity and dissonance activation maps are generated by computing belief-weighted attributions, enabling identification of where models lack knowledge versus where they encounter ambiguous evidence. Extensive evaluations across multiple benchmark datasets demonstrate that the proposed framework effectively addresses the critical gap between uncertainty quantification and explainability, providing intuitive visual feedback to assess model reliability in complex visual recognition tasks.

18.
Nature (Science) 2026-06-10

Improved quantum processor logical error rates via correction and detection

作者:

Performing quantum algorithms for critical problems in physics and chemistry requires substantially lower error rates than the physical error rates of present quantum computers. Achieving such low logical error rates requires quantum error correction1,2 and physical error rates below a critical threshold value3–8. We experimentally demonstrate on a trapped-ion quantum charge-coupled device (QCCD)9,10 improvements in logical error rates ranging from 11× to 800× compared with several physical circuit baselines, including quantum computation on multiple qubits. Our results hinge on two quantum error correction code constructions optimized for an ion-trap processor: a 12-qubit code encoding two qubits inspired by Knill11 and a 16-qubit tesseract colour code encoding four qubits12,13. These constructions are combined with a scalable method of error detection and post-selection to achieve reduced logical error rates. Our results show that state-of-the-art quantum devices are already able to make use of fault tolerance and error correction to strongly suppress errors in non-trivial quantum circuit computations. Experimental demonstration of quantum error-correcting codes combined with error detection and post-selection applied to a trapped-ion quantum processor shows improvements in logical error rates ranging from 11× to 800× compared with several physical circuit baselines.

19.
arXiv (CS.LG) 2026-06-12

Ride, Track, and Recover: Pilot Randomized Trial of a Wearable Digital Self-Management Intervention During a Veteran Endurance-Cycling Program

arXiv:2606.13529v1 Announce Type: cross Abstract: Post-traumatic stress disorder (PTSD) in veterans is characterized by persistent hyperarousal and comorbid anxiety and depressive symptoms that are difficult to monitor and manage outside clinical settings. Thirteen veterans participating in a Project Hero cycling event in Texas were randomized by computer-generated sequence in a naturalistic setting to two arms: (1) digital intervention plus physical activity, or (2) physical activity only, plus a third at-home monitoring control cohort consisting of 7 veterans selected from the broader Project Hero veteran community. Continuous smartwatch sensing combined heart rate and accelerometer features to detect hyperarousal events, which were confirmed in real time by participants. Weekly self-report measures of anxiety, depression, and PTSD severity were collected. Generalized additive mixed models characterized nonlinear trajectories over time. Baseline-normalized hyperarousal trajectories differed significantly across conditions, with the digital intervention group (n=7) showing structured stabilization compared to late-study escalation in the physical-only group (n=3). Both cycling groups exhibited acute symptom improvements during the endurance event; however, the digital intervention group demonstrated a higher overall maintenance of gains. The at-home control group (n=4) showed gradual symptom declines. Perceived precision of ML detections varied substantially across individuals and was positively associated with symptom severity, with higher-severity participants confirming a greater proportion of detected events. These results suggest that coupling wearable detection with digital self-management tools may support stabilization of hyperarousal and symptom improvement while emphasizing the importance of personalization and human-centered design in wearable mental health systems.

20.
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.

21.
Nature Medicine 2026-06-17

Why large-scale randomized trials of live-attenuated shingles vaccination for dementia prevention are urgently needed

In my view, we have never had as robust a body of evidence from observational data on an intervention for dementia as we do for live-attenuated shingles vaccination. Both a recent US National Institutes of Health expert workshop and an international expert consensus on Alzheimer’s disease drug repurposing identified large-scale randomized trials of shingles vaccination for dementia prevention as the crucial next step for the field.

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

Self-Questioning Vision-Language Models: Reinforcement Learning for Compositional Visual Reasoning

Vision-Language Models (VLMs) are AI systems that process both images and text, yet they often struggle with compositional visual reasoning questions that require chaining multiple steps together, such as identifying objects, counting them, and comparing the results. Existing approaches improve this reasoning by training models on human-written step-by-step explanations, but creating these annotations is expensive and difficult to scale. We propose a self-questioning framework that trains a VLM to break visual questions into smaller sub-questions and answer each one before producing a final response, using a reinforcement learning algorithm called Group Relative Policy Optimization (GRPO). The model is never shown examples of how to decompose questions, it discovers this behavior on its own, guided by a reward signal that scores whether the output contains sub-questions and whether the final answer is correct. We apply this framework to a 3-billion-parameter model, training on both synthetic scenes of geometric shapes (CLEVR) and real-world photographs (A-OKVQA). On A-OKVQA, both self-questioning and standard reinforcement learning substantially improve accuracy over the untrained model (52.2% and 51.6% vs. 46.8%). We introduce the first self-questioning VLM by rewarding not only the final answer like standard RL but additionally for generating intermediate sub-questions, enabling it to discover compositional decomposition strategies. These results suggest that teaching AI systems to ask themselves intermediate questions is a promising strategy for complex visual reasoning, particularly when the difficulty of a question warrants explicit step-by-step decomposition.

23.
arXiv (CS.CV) 2026-06-17

A Quantitative Analysis of Multimodal Biomarkers in Alzheimer's Disease

Despite increasing adoption of multimodal approaches in Alzheimer's Disease (AD) research – aimed at integrating molecular, structural, clinical, and genetic biomarkers to enhance disease characterization – the relationships among these modalities remain poorly understood. A systematic analysis of their dynamic interaction is essential for improving disease modeling, identifying redundant assessments, and reducing patient burden and acquisition costs. In this paper, we present a quantitative analysis of multimodal AD biomarkers by integrating tau-PET, structural MRI, cognitive scores (MMSE and CDR), and APOE4 data from 789 subjects drawn from the ADNI dataset. In our analyses, we (A) quantify cross-modal mutual information and explained variance to assess redundancy and predictive dependencies; (B) examine associations between tau topologies and structural atrophy across brain regions to select informative ROIs; (C) perform a statistical decomposition of the tau-cognition association into atrophy-related and atrophy-independent components; (D) and identify a dominant neurodegenerative trajectory that aligns with cognitive decline. This study provides a systematic characterization of cross-modal relationships, improving the interpretability and selection of biomarkers in AD. Code is publicly available at: https://github.com/antonioscardace/Multimodal-AD.

24.
medRxiv (Medicine) 2026-06-11

Incremental costs of transitioning from four to eight WHO-recommended antenatal care visits in Uganda: A costing analysis from a societal perspective

Background In 2016, the World Health Organization revised its antenatal care (ANC) recommendation from four to eight visits. For low- and middle-income countries like Uganda, where achieving even four visits remains a challenge, this transition has significant cost implications for both the health system and households. This study estimated the incremental costs of adopting the eight-visit model from a societal perspective. Methods The study was conducted in six government health facilities in southwestern Uganda. A micro-costing approach estimated health facility costs (personnel, equipment, consumables, and overhead). Costs incurred at patients end (transport, ultrasound, medical expenses, and time) were collected from 785 women using a questionnaire, with all costs in 2025 USD. Results For an average of 4.3 visits, total cost per woman was $100.1: facility costs $43.7 (43.7%), and patient costs $56.4 (56.3%). Transitioning to eight visits would increase total cost by $57.8 (57.8%), of which $36.4 (63.0%) would fall on households, equivalent to 68.8% of average monthly household income. Total costs would rise by 55.4% ($115.5 to $179.5) at Health Center IVs and 64.3% ($102.3 to $168.1) at Health Center IIIs, with facility costs up 43.4% and 62.9% and patient costs up 61.2% and 65.7%, respectively. Conclusion Transitioning to eight ANC visits would impose a large financial burden on households, with the incremental patient cost equivalent to more than two-thirds of average monthly household income. Equitable implementation requires improving availability of medicines and diagnostics, subsidizing transport, exploring telemedicine or community-based models, and improving efficiency at lower-tier health centers.

25.
arXiv (CS.AI) 2026-06-17

Belief-Space Control for Personalized Cancer Treatment via Active Inference

arXiv:2606.10376v2 Announce Type: replace Abstract: Cancer treatment is at the core a sequential decision-making problem with partial observability, latent patient heterogeneity, and explicit constraints on the budget for medical measurements. Unlike standard Reinforcement Learning (RL) approaches that control state trajectories, cancer treatments permanently modify patients' transition dynamics, changing how states evolve over time. We model cancer treatment as a belief-space planning problem using active inference, deriving an expected free-energy objective that unifies goal-directed control and information acquisition under measurement budgets without. We implement this framework using real clinical cancer data from the AACR Project GENIE Biopharma Collaborative dataset. Results on clinical data demonstrate a simultaneous patient categorization and high treatment efficacy, under real measurement and treatment constraints.