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

Dual-Stance Evaluation of Sycophancy: The Structure of Agreement and the Limits of Intervention

Activation steering can shift LLM behaviour, but standard evaluations do not typically test whether a sycophancy-reduction direction also suppresses agreement with factually correct statements. We introduce dual-stance evaluation, which tests both stances of each topic, and apply it to centroid-difference steering on Llama-3-8B-Instruct. We find a dissociation: the model represents sycophantic and factual agreement in geometrically distinct subspaces, yet the steering direction projects equally onto both and cannot differentially target either. The direction accordingly reduces agreement with factually correct statements (e.g. that the Earth is round) as well as sycophantic ones. All other static properties of the two activation groups are matched, suggesting the behavioural dissociation arises from generation dynamics or from finer-grained structure that residual-stream analysis cannot resolve. The pattern illustrates a general gap: representations that are readable from activations may not be writable through them.

02.
arXiv (quant-ph) 2026-06-12

Metabolic quantum limit to the information capacity of magnetoencephalography

arXiv:2511.06401v3 Announce Type: replace-cross Abstract: Magnetoencephalography measures the magnetic fields generated by neural currents using quantum sensors such as superconducting quantum interference devices and atomic magnetometers. Here we combine the energy resolution limit of magnetic sensing with the metabolic power available to neural currents to derive a technology-independent bound on the information capacity of MEG. The bound factorizes into geometry, metabolism, and Planck's constant, and gives an estimated maximum information rate of 2.2~Mbit/s for representative human-brain parameters. Further, we show that the externally measurable magnetic field has a finite angular bandwidth, with high multipole components being geometrically attenuated and falling below the quantum-limited noise floor. This yields an information-limited spatial scale of order $1~cm$ and renders the accessible measurement space effectively finite-dimensional. The energy resolution limit therefore defines an information-theoretic Nyquist scale for magnetoencephalography, beyond which denser spatial sampling provides redundant measurements rather than additional recoverable information. Since the energy resolution limit also makes the noise variance grow linearly with measurement bandwidth, temporal and spatial bandwidths compete, producing a fundamental spatio-temporal trade-off. These results show how quantum-limited measurements constrain the observable complexity and information content of noninvasive brain imaging, providing a quantitative link between fundamental physics and neuroscience.

03.
arXiv (quant-ph) 2026-06-11

Magneto-Optical Trapping of a Metal Hydride Molecule

arXiv:2512.22350v2 Announce Type: replace-cross Abstract: We demonstrate a three-dimensional magneto-optical trap (MOT) of a metal hydride molecule, CaH. We are able to scatter $\sim$$10^{4}$ photons with vibrational loss covered up to vibrational quantum number $\nu=2$. This allows us to laser slow the molecular beam near zero velocity with a "white-light" technique and subsequently load it into a radio-frequency MOT. The MOT contains $230(40)$ molecules, limited by beam source characteristics and predissociative loss of CaH. The temperature of the MOT is below one millikelvin. The predissociative loss mechanism could, in turn, facilitate controlled dissociation of the molecule, offering a possible route to optical trapping of hydrogen atoms for precision spectroscopy.

04.
arXiv (quant-ph) 2026-06-12

Explicit Quantum Circuit Simulation of Nonlinear 1-Dimensional Fluid with Carleman-linearized Boltzmann Method

arXiv:2606.12770v1 Announce Type: new Abstract: Quantum computation of fluid dynamics has attracted growing attention as a key application of fault-tolerant quantum computers anticipated in the coming decade, with lattice Boltzmann methods emerging as a particularly promising approach. Explicit and efficient elementary-gate-level circuit simulations, however, have so far been demonstrated only in the linear case. Here we include the leading nonlinearity through second-order Carleman linearization of the one-dimensional Boltzmann equation, and demonstrate, via explicit quantum-circuit simulation, the preparation of the final-time state using a Taylor-expansion-based ODE solver based on the quantum singular value transformation. With this construction, we analyze the gate and qubit complexities, which scale logarithmically with the grid size, the nonlinearity captured by the higher-order Carleman linearization, and the practical utility of higher-order expansions in the Taylor ODE solver. The construction provides a concrete baseline for computational cost reduction and further developments such as extensions to higher dimensions, complex geometries, and the extraction of physical quantities, towards industrially useful quantum CFD.

05.
arXiv (CS.CL) 2026-06-15

Automatic identification of diagnosis from hospital discharge letters via weakly supervised Natural Language Processing

Identifying patient diagnoses from hospital discharge letters is essential for large-scale cohort selection and epidemiological research, but traditional supervised approaches require extensive manual annotation, which is often impractical for large textual datasets. We present a weakly supervised Natural Language Processing (NLP) pipeline for classifying Italian discharge letters without document-level manual annotation. The method extracts diagnosis-related sentences, generates semantic embeddings using a transformer model further pre-trained on Italian medical documents, and applies a two-level clustering procedure to derive weak labels that are then used to train a document-level classifier. The approach was evaluated in a case study on bronchiolitis using 33,176 discharge letters of children admitted to 44 emergency rooms or hospitals in the Veneto Region, Italy, between 2017 and 2020. The best weakly supervised model achieved an AUROC of 77.68% ($\pm4.30\%$), an AUPRC of 73.13% ($\pm4.93\%$), and an F1-score of 78.14% ($\pm4.89\%$) against manually annotated data. Performance surpassed unsupervised baselines and approached fully supervised models, while reducing the need for manual annotation by more than 1,500 hours for a dataset of this size. Similar model rankings were observed in a secondary validation on a smaller bronchitis dataset (3,188 discharge letters, 2020-2025), where the best weakly supervised model achieved an AUPRC of 76.72% ($\pm 5.02\%$). These results suggest the potential of weakly supervised NLP methods for scalable disease identification from clinical discharge letters.

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

Rethinking Cross-lingual Gaps from a Statistical Viewpoint

Any piece of knowledge is usually expressed in one or a handful of natural languages on the web or in any large corpus. Large Language Models (LLMs) act as a bridge by acquiring knowledge from a source language and making it accessible when queried using target languages. A cross-lingual gap is a drop in accuracy incurred when querying knowledge in a target language rather than the source language. Existing research focused on modeling or training failures leading to cross-lingual gaps. In this work, we take an alternative view to characterize the nature of cross-lingual error, and hypothesize that the variance of responses in the target language is a key cause of this gap. For the first time, we formalize the cross-lingual gap in terms of biased and unbiased errors. We empirically validate our hypothesis through multiple inference-time interventions that control variance and reduce the cross-lingual gap. We demonstrate a few test-time ensemble methods that reduce response variance, and thereby improve source-target transfer scores by up to 12 absolute points yielding relative gains of 8% to over 50% across various LLMs.

07.
arXiv (CS.AI) 2026-06-18

Fully Geometric Multi-Hop Reasoning on Knowledge Graphs with Transitive Relations

arXiv:2505.12369v2 Announce Type: replace Abstract: Multi-hop logical reasoning on knowledge graphs requires faithfully mapping the logical semantics to latent space. Current geometric embedding methods show to be useful on this task by mapping entities to geometric regions and logical operations to latent transformations. While a geometric embedding can provide a direct interpretability framework for query answering, current methods have only leveraged the geometric construction of entities, failing to map logical operations to pure geometric transformations and, instead, using neural components to learn these operations. On the other hand, purely neural-based methods outperform geometric methods, but they lack interpretability in the latent space. We introduce GeometrE, a geometric embedding method for multi-hop reasoning, that maps every logical operation to a purely geometric operation in the latent space. Additionally, we introduce a transitive loss function and show that, unlike existing methods, it can preserve the logical rule for all a,b,c: r(a,b) and r(b,c) -> r(a,c). Our experiments show that GeometrE outperforms current state-of-the-art geometric methods and remains competitive with existing neural-based methods on standard benchmark datasets.

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

Revisiting Outage for Edge Inference Systems

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

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

Authority, Truth, and Citation Bias: A Large-Scale Multi-Domain Benchmark for Studying Epistemic Susceptibility in Large Language Models

arXiv:2606.13104v1 Announce Type: new Abstract: Large language models are increasingly deployed in citation-augmented settings, yet the effect of citation presence on model behavior independent of factual content remains poorly understood. We introduce AuthorityBench, a 220,564-prompt multi-domain benchmark that isolates how citation-based authority signals influence epistemic behavior in LLMs. The benchmark uses a fully balanced 2x2 factorial design crossing claim veracity with citation veracity, the first to do so, across four domains (general knowledge, science, law, and medicine), with controlled variation over 40 prompt templates, four venue prestige tiers, and a country-coded author name dataset. Evaluating seven models on 12 structured research questions, we find that citation presence, whether real or fabricated, consistently increases hallucination rates relative to a no-citation baseline. The effect is strongest when fabricated citations accompany true claims, raising hallucination rates by 3 to 22 percentage points and reaching 35 to 77% in the general knowledge domain, while legal claims are comparatively robust and venue prestige and author demographics show negligible impact. All datasets and evaluation code are available at: https://github.com/floating-reeds/AuthorityBench

10.
medRxiv (Medicine) 2026-06-17

Characterisation of disease progression in hantavirus haemorrhagic fever with renal syndrome

Hantaviruses can cause haemorrhagic fever with renal syndrome (HFRS). This is a clinically variable disease in which severe outcomes are hypothesized to arise from dysregulated host responses. To characterise this, longitudinal, label-free plasma proteomics was used to compare disease progression in a unique well-defined cohort of patients infected with either Dobrava virus (DOBV) or Puumala virus (PUUV) hantaviruses. Patients were stratified by clinical severity. The average viral load in the first available sample from hospitalized patients was higher in those who went on to have severe infection, and higher in patients infected with DOBV. There was marked separation of infected patients from controls across early, mid and late disease, including after viral RNA clearance, suggesting a sustained systemic host-response signature. Proteomic signatures were consistent with a strong acute-phase response in both mild and severe disease. There was evidence of activation of the adaptive humoral response at later stages. Hierarchical clustering identified severity-associated pathways linked to endothelial dysfunction, thrombocytopenia, vascular leakage and renal injury. These findings define a durable plasma proteomic signature of hantavirus disease and support a model in which severe HFRS is driven by persistent inflammatory, complement and platelet/coagulation pathway activation rather than viral burden alone.

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

From 2D Grids to 1D Tokens: Reforming Shared Representations for Multimodal Image Fusion

Multimodal image fusion aims to integrate complementary information from different modalities into a fused image that preserves rich local details while maintaining globally consistent appearance. Existing approaches build shared representations on 2D feature grids, which excel at modeling local structures but offer limited leverage over image-level global appearance factors. To balance these objectives, we introduce a compact 1D token interface based on a frozen pretrained image tokenizer for modeling non-local appearance/base factors. Rather than using the tokenizer as a reconstruction backbone, our design uses the 1D token space as a global carrier while retaining the 2D spatial pathway for local structure restoration. Specifically, we introduce Selective Token Editing (STE), which sparsely updates/replaces a small set of critical tokens, providing a lightweight mechanism to steer global appearance coherence while keeping the fusion backbone unchanged and avoiding extra losses. Experiments on four commonly used benchmarks show that our method achieves the best overall performance, with consistent, multi-metric improvements in both global coherence and local fidelity. Project page: https://zju-xyc.github.io/1D-Fusion-Project-Page/

12.
arXiv (CS.AI) 2026-06-16

Intrinsic Computational Functionalism and Simulated Consciousness

arXiv:2606.15348v1 Announce Type: cross Abstract: A common objection to artificial or simulated consciousness is that a simulated brain is no more conscious than simulated water is wet. We address this from the perspective of Intrinsic Computational Functionalism (ICF): if consciousness is computationally constituted, it depends not on externally imposed descriptions but on the computational structures a system physically realizes in virtue of its own causal-dynamical organization. In previous work we developed Canonical Functionalism as a mathematically precise special case of this anti-interpretivist program, identifying functional states by their complete future input-output roles under a fixed interface. Here we argue that this input-output construction, though important, is incomplete: as a behavioral boundary case of ICF, it makes lookup tables and unfolded systems that preserve the same boundary behavior canonically equivalent. A consciousness-relevant canonical representation must instead include internal mechanisms, interventions, and joint readouts belonging to the relevant intrinsic organization. We therefore define a mechanism-enriched canonical structure and use it to formulate Intrinsic Causal-Computational Realization (ICCR), a realization relation preserving physical implementation, intrinsic state individuation, transition structure, intervention profiles, and the relevant agent-body-world boundary. The central result is conditional: if conscious properties are invariants of intrinsic causal-computational organization, then any system satisfying ICCR realizes the same consciousness-relevant properties, whether biological, artificial, or simulated. We discuss objections including biological naturalism and integrated information theory. We conclude that to deny consciousness to a simulation, one must identify a consciousness-relevant intrinsic causal-computational structure that the simulation fails to realize.

13.
arXiv (CS.AI) 2026-06-12

Fantastic Scientific Agents and How to Build Them: AgentBuild for Rietveld Refinement

arXiv:2606.12834v1 Announce Type: new Abstract: As scientific workflows shift from deterministic executables to LLM-based agents, the development practices on offer, such as fine-tuning, reinforcement learning, and prompt-and-go, bury the scientist's judgment. We propose treating agent construction as a workflow stage and introduce AgentBuild, which builds a scientific agent from a contract the scientist authors. The contract is a version-controlled rubric, a difficulty-graded curriculum, and a curated external knowledge base. A rubric-driven judge gates a meta-optimizer coding agent that edits the agent within a declared boundary, so the build compiles the agent, not the scientist's judgment. We instantiate this for Rietveld refinement of X-ray diffraction data through GSAS-II behind MCP and A2A, where a blank-harness construction run progresses through a lithium lanthanum zirconium oxide (LLZO) signal-to-noise ladder, reaches the 4 hour scan as a frontier case, and exposes the workflow-scope limits that remain. The same rubric that rewards credible fits also scores trajectory scope, making the frontier a contract failure rather than a pattern-fitting failure. As base models evolve, re-running AgentBuild is a re-tune, not a rebuild, and the scientist's authored contract remains the durable asset.

14.
arXiv (CS.CL) 2026-06-17

Variable-Width Transformers

Scaling model size, specifically depth and width, has driven significant progress in transformer-based language models. However, most architectures maintain a constant width across all layers, allocating a fixed parameter and computation budget evenly despite different layers potentially playing distinct computational roles. In this work, we empirically investigate nonuniform capacity allocation across network depth by proposing a $\times$-shaped >

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

Controlled Dynamics Attractor Transformer

arXiv:2606.15207v1 Announce Type: cross Abstract: Transformer architectures have dramatically advanced representation learning and inference in deep models through self-attention mechanisms. In parallel,associative memory (AM) frameworks map representations onto energy landscapes, offering interpretable retrieval mechanisms. However, their continuous-time inference dynamics lack the biological plausibility of classical Continuous Attractor Neural Networks (CANNs). To bridge this gap, we propose Controlled Dynamics Attractor Transformer (CDAT), which couples a mixture von Mises-Fisher (Mo-vMF) attention energy with a Hopfield refinement energy, while augmenting energy descent with a CANN-inspired excitation-inhibition modulation. CDAT instantiates a topology-constrained dynamical system whose couplings encode relational structure among tokens, thereby linking attractor-style dynamics to modern energy-based attention. We further provide a constructive dissipation analysis to formally establish their controlled inference dynamics. Benefiting from these robust and structured dynamics, CDAT achieves state-of-the-art performance across multiple benchmarks in graph anomaly detection and graph classification.

16.
bioRxiv (Bioinfo) 2026-06-10

Promera: a unified model for biomolecular structure prediction, filtering, and design

Generative models have become staple tools for modeling and designing biomolecular structures. However, although these tools have improved in structural prediction accuracy, their ability to filter designed binders—an essential use case—remains insufficient; whereas design methods have focused more on unconstrained binder generation rather than capabilities enabled by controllable design. We introduce Promera, a unified generative model that combines all-atom structure prediction with improved filtering and controllable design. We find that Promera's confidence metrics are more accurate for filtering binders from non-binders for both miniproteins and nanobodies, while its co-folding performance surpasses popular open-source models (OpenFold3-p2, Boltz-2) on therapeutically relevant categories. As a design model, Promera generates binders by predicting masked protein sequences with optional epitope, paratope, and template constraints. Remarkably, our nanobody designs match the in silico success rates from backprop-based techniques (mBER) when evaluated under co-folding confidence filters. We further provide two in silico demonstrations of the the versatile capabilities of our design method: epitope targeting of the Andes hantavirus glycoprotein with VHHs and active state stabilization of the beta-2 andrenergic GPCR. We conclude by proposing a scaling law for co-folding models, suggesting a path for further performance improvement.

17.
arXiv (quant-ph) 2026-06-19

Quantum Kernels are Spectral Tensor Networks

arXiv:2606.20402v1 Announce Type: new Abstract: Quantum kernels admit Fourier representations whose frequencies are determined by the data-encoding gates of the underlying feature map. We show that entangling tensor kernels are matrix product operator factorizations of the corresponding Fourier coefficient tensors, thereby identifying quantum kernels as spectral tensor networks. By grouping gate-level frequency configurations that yield the same feature-wise frequency, we obtain a grouped Fourier form that induces a more compact spectral tensor network representation of the kernel. We further show that kernel target alignment serves as a bridge between the Fourier and tensor network views. On a grid that resolves the accessible Fourier modes, it becomes the Frobenius cosine similarity between Fourier coefficient tensors. Our numerical experiments show that layered quantum kernels admit accurate representations with small bond dimension, revealing a compressibility governed by correlations between Fourier modes. This compressibility provides a diagnostic of classical representability and of whether kernel evaluation is likely to remain classically tractable.

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

NoiseTilt: Noise-Tilted Reverse Kernels for Diffusion Reward Alignment

arXiv:2606.18066v1 Announce Type: new Abstract: We introduce the Noise-Tilted Reverse Kernel (NTRK), a reward-guided diffusion sampler that injects reward gradients through the noise term, leaving the pretrained reverse kernel unchanged and requiring only a single sample per step. Reward-guided sampling at inference time has greatly expanded the versatility of pretrained diffusion models. Yet existing methods face a trade-off. Gradient-based guidance shifts the reverse mean, steering generation but pushing intermediate states outside the region that the model was trained on and degrading quality. Search-based methods preserve quality but gain no gradient signal. No prior method achieves both. NTRK resolves this by keeping the reverse mean fixed and biasing the noise term toward high reward. We introduce a whitening operator, the central mechanism behind NTRK, that makes the reward gradient safe to inject as noise without losing its guiding signal. Across various reward alignment tasks, NTRK outperforms recent state-of-the-art baselines without losing sample quality. Remarkably, on aesthetic generation, NTRK surpasses the reward of the best baseline at 500 NFEs using only 25 NFEs, a 20$\times$ reduction in compute.

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

DragMesh-2: Physically Plausible Dexterous Hand-Object Interaction with Articulated Objects

Dexterous interaction with articulated objects is important for household, assistive, and humanoid manipulation, where multi-finger hands can provide compliant contact patterns beyond parallel-jaw grasping. However, articulated-object manipulation differs from static-object manipulation: the target part cannot be directly actuated, and its motion must emerge through sustained physical hand–handle contact. This makes the transition from object-centric articulated generation to hand-driven dexterous hand–object interaction non-trivial, since geometric trajectory replay or open-loop execution does not model the contact dynamics required to move the articulated part. Moreover, policies trained only for task completion under fixed dynamics can overfit nominal contact loads, especially without tactile or force feedback, and may degrade when the contact load changes. To address these challenges, we present DragMesh-2, a contact-driven framework for dexterous interaction with articulated objects that extends articulated interaction from object-centric generation to hand-driven dexterous hand–object interaction, where articulated motion must arise through physical contact. We further propose PICA, a physically informed contact-aware training mechanism that injects physical signals into policy learning without tactile or force feedback, improving robustness and task success under changing contact loads. Finally, we conduct systematic evaluation across multiple damping conditions and articulated-object categories to study robustness under contact-load variation, and provide a pure-geometry dexterous interaction resource to support future loco-manipulation and humanoid hand–object interaction research. Across seven GAPartNet objects, DragMesh-2 achieves stronger robustness under contact-load variation than the compared methods while maintaining high task success across damping conditions.

20.
arXiv (quant-ph) 2026-06-17

Unclonable Encryption in the Haar Random Oracle Model

arXiv:2603.11437v2 Announce Type: replace-cross Abstract: We construct unclonable encryption (UE) in the Haar random oracle model, where all parties have query access to $U,U^\dagger,U^*,U^T$ for a Haar random unitary $U$. Our scheme satisfies the standard notion of unclonable indistinguishability security, supports reuse of the secret key, and can encrypt arbitrary-length messages. That is, we give the first evidence that (reusable) UE, which requires computational assumptions, exists in "microcrypt", a world where one-way functions may not exist. As one of our central technical contributions, we build on the recently introduced path recording framework to prove a natural ``unitary reprogramming lemma'', which may be of independent interest.

21.
arXiv (math.PR) 2026-06-17

The Loss of Tension in an Infinite Membrane with Holes of Decaying Spatial Density

arXiv:2606.17792v1 Announce Type: new Abstract: What is the effect of randomly removing material from an infinite stretched membrane? Under what conditions can the membrane still sustain tension? This problem was introduced by Robert Connelly in connection with applications of rigidity theory in the natural sciences, and was later studied in M. V. Menshikov, K. A. Rybnikov, and S. E. Volkov, "The loss of tension in an infinite membrane with holes distributed according to a Poisson law" (2002); a discrete version was also considered in Robert Connelly, Konstantin Rybnikov, and Stanislav Volkov, "Percolation and the Loss of Tension in an Infinite Triangular Lattice" (2001). We study a mathematical framework based on a non-homogeneous Poisson point process whose intensity $\lambda$ tends to zero at infinity. The hole shapes are i.i.d.\ and independent of their locations. We show that if the intensity does not decay too quickly, then tension is still lost throughout the whole plane, as in the homogeneous model studied in 2002. Conversely, we give sufficient conditions under which complete loss of tension does not occur. Thus, both destruction and non-destruction regimes are possible even when the intensity tends to zero, indicating a phase transition in the model. The processes studied here are closely related to bootstrap percolation.

22.
arXiv (CS.CL) 2026-06-17

Non-Autoregressive Minimum Bayes' Risk Decoding for Fast Speech Recognition

Non-autoregressive (NAR) decoding generates output tokens in parallel, making speech recognition faster than autoregressive decoding, which generates them sequentially from left to right. However, the recognition performance is degraded because NAR decoding cannot resolve uncertainty by conditioning on previously generated tokens. To address this issue, we propose a novel NAR decoding framework based on minimum Bayes' risk (MBR) decoding, termed NAR-MBR decoding, that maximizes the expected utility calculated from samples drawn from the output probability of an NAR model rather than maximizing the output probability. Notably, by leveraging the nature of NAR models, multiple samples are obtained efficiently with a single forward computation. Our experiments across LibriSpeech, Switchboard, AMI, and web presentation corpus demonstrated that our NAR-MBR decoding outperformed previous NAR decoding and ran faster than AR decoding.

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

PACE-RAG: Patient-Aware Contextual and Evidence-Constrained RAG for Clinical Drug Recommendation

Drug recommendation requires a deep understanding of individual patient context, especially for complex conditions like Parkinson's disease. While LLMs possess broad medical knowledge, they fail to capture the subtle nuances of actual prescribing patterns. Existing RAG methods also struggle with these complexities because guideline-based retrieval remains too generic and similar-patient retrieval often replicates majority patterns without accounting for the unique clinical nuances of individual patients. To bridge this gap, we propose PACE-RAG (Patient-Aware Contextual and Evidence-Constrained RAG). Rather than directly copying frequent medications from retrieved patients, PACE-RAG personalizes recommendations by first extracting patient-specific clinical features, retrieving cases around these features, and then refining the final prescription using the patient's current symptoms, active medication history, and focus-specific prescribing tendencies. By analyzing treatment patterns tailored to specific clinical features, PACE-RAG generates patient-specific medication recommendations along with an explainable clinical summary. Evaluated on a Parkinson's cohort and the MIMIC-IV benchmark using Llama-3.1-8B and Qwen3-8B, PACE-RAG achieved state-of-the-art performance, reaching F1 scores of 80.84% and 47.22%, respectively. These results suggest that PACE-RAG is a robust and clinically grounded framework for personalized decision support. Our code is available at: https://github.com/ChaeYoungHuh/PACE-RAG.

24.
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 [≤]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 [≤]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 [->] 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.

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

Evaluating Second-Order Bias of LLMs Through Epistemic Entitlement

Evaluations of social bias in LLMs largely focus on whether models generate or imply biased content. However, as LLMs are increasingly used as judges of bias, they may exhibit social biases in subtler ways in how they evaluate biased content, which current methods do not systematically capture. We call this second-order bias: social bias in an LLM's judgment about social bias, which we evaluate through a novel, philosophically grounded reasoning task. Drawing on entitlement epistemology, we conceptualize bias as misplaced foundational knowledge that shapes an agent's rational inquiry, and derive a logical reasoning task for LLMs to judge to whom a biased text is acceptable or non-acceptable. We develop two simple metrics to measure how biased LLM judges are in inferring demographics for acceptability without sufficient support, and how these inferences vary across groups targeted by biased texts. Evaluating open and closed models, we find that our task evades safety guardrails by surfacing bias in model judgment. It varies systematically across target groups, reflects implicit social maps, and shows how models are still triggered by demographic labels. Our work points to the need for LLM bias evaluation in judgment tasks and broadly, for more theoretically grounded approaches to bias evaluation in NLP. We release our code and model responses at https://github.com/uofthcdslab/second-order-bias.