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

Bring My Cup! Personalizing Vision-Language-Action Models with Visual Attentive Prompting

arXiv:2512.20014v3 Announce Type: replace-cross Abstract: While Vision-Language-Action (VLA) models generalize well to generic instructions, they struggle with personalized commands such as "bring my cup," where the robot must act on one specific instance among visually similar objects. We study this setting of manipulating personal objects, in which a VLA must identify and control a user-specific object unseen during training using only a few reference images. To address this challenge, we propose Visual Attentive Prompting (VAP), a simple-yet-effective training-free perceptual adapter that equips frozen VLAs with top-down selective attention. VAP treats the reference images as a non-parametric visual memory, grounds the personal object in the scene through open-vocabulary detection and embedding-based matching, and then injects this grounding as a visual prompt by highlighting the object and rewriting the instruction. We construct two simulation benchmarks, Personalized-SIMPLER and Personalized-VLABench, and a real-world tabletop benchmark to evaluate personalized manipulation across multiple robots and tasks. Experiments show that VAP consistently outperforms generic policies and token-learning baselines in both success rate and correct-object manipulation, helping to bridge the gap between semantic understanding and instance-level control.

02.
arXiv (CS.CL) 2026-06-18

LLMZero: Discovering Adaptive Training Strategies for RL Post-Training via LLM Agents

RL post-training strategies are dataset-dependent and reveal a recurring empirical pattern: capacity parameters accumulate monotonically across stages, while regularization parameters predominantly oscillate in response to shifting training dynamics. This distinction matters because fixed schedules commit all parameters to fixed trajectories and therefore cannot express the non-stationary exploration-exploitation tradeoffs that regularization must track; the principle provides actionable design rules for multi-stage training. We discover this through LLMZero, a system where LLM agents search over training trajectories via tree search, diagnosing pathologies at each checkpoint and proposing coordinated multi-parameter transitions. Across 4 diverse GRPO tasks, LLMZero discovers strategies that improve over the base model by 9% to 140% relative and over grid search by 6% to 15% relative, consistently outperforming random search and the skill-based agent. The structural principle transfers across tasks, providing an explanation for why discovered strategies take qualitatively different forms yet share similar parameter dynamics.

03.
arXiv (CS.CL) 2026-06-16

IMPACTeen: Intentions, Manipulation, Persuasion, Annotations, and Consequences in Teen Communication Dataset

IMPACTeen is a dataset of textual social influence scenarios spanning interpersonal, media-based, and digital settings in an adolescent context. It contains 1,021 texts, 5,100 individual annotation records, and gold labels for social influence techniques, with each text annotated from five distinct perspectives: teenagers, parents, psychologists, communication experts, and teachers. The resource was constructed through constrained LLM generation, followed by a two-step human editing and validation phase aimed at ensuring youth-context realism. A multi-dimensional annotation covered influence presence, techniques, intentions, consequences, resistance, reactions, and annotation confidence. The dataset supports research on social influence detection, annotator disagreement, cross-lingual modeling, and the training and evaluation of language models. The dataset was created in Polish and is accompanied by a corresponding English version.

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

Token Complexity Theory for AI-Augmented Computing

Authors:

arXiv:2606.12647v1 Announce Type: cross Abstract: AI-augmented computing delegates natural language queries, code generation requests, and other open-ended tasks to a cluster of AI models that processes queries and generates responses. This paradigm introduces a resource dimension that neither classical time nor space complexity captures: the cost of sending queries to and receiving responses from such a cluster. We introduce token complexity, a formal resource measure defined as the minimum expected token cost to achieve a specified level of output quality on a task, and develop a taxonomy classifying AI systems by the strength of their probabilistic properties. We develop token complexity within the framework of AI-Oracle Turing machines, in which a probabilistic Turing machine interacts with a stochastic oracle via dedicated query and response tapes. We prove basic theorems establishing that token complexity behaves as expected: monotonicity (higher quality costs more tokens), convexity (quality improvements become progressively more expensive), price sensitivity (small price changes produce bounded cost changes), and price-relativity of task ordering (the token complexity ordering of tasks can reverse depending on the query-to-response cost ratio). We prove that the complexity frontier, defined as the set of all feasible resource bounds in tokens, time, and space, is non-empty, upward-closed, and convex.

05.
bioRxiv (Bioinfo) 2026-06-11

DivQuant: Estimation of Species Richness and Entropy from Small Samples

Estimating diversity properties of discrete distributions from a small observed sample is a fundamental problem in algorithmic statistics that has applications in many fields, in particular bioinformatics, but also in ecology or linguistics. The two most common diversity measures are the number of distinct elements in a multiset, also referred to as species richness in ecology or alpha diversity in microbial analysis, and the Shannon entropy, also referred to as evenness. Estimating these properties from a small sample is particularly challenging for distributions with many rare elements. Thus, many estimators have been proposed in the past that, in practice, work well for different types of distributions. We present DivQuant, an optimization-based, extrapolating richness and entropy estimator with three contributions. First, we formulate the upsampling problem as a convex quadratic program with a Neyman {chi}2 objective. Unlike the linear program of its predecessor RichnEst, DivQuant admits confidence intervals via {chi}2 test inversion that are empirically well-calibrated. Second, we replace RichnEst's fixed-threshold fingerprint truncation with the rare/abundant fingerprint split of Valiant and Valiant, which strongly reduces problem size and preserves enough degrees of freedom for the confidence-interval program to remain valid and feasible. Third, we plug the optimal population fingerprint returned by the program into Shannon's entropy formula to obtain an entropy estimate. DivQuant attains close-to-nominal 95% confidence intervals in essentially all tested regimes, including six simulated distribution families, Tara Oceans microbiome data, and 10X Genomics scRNA-seq data, while competing state-of-the-art methods (RichnEst, iNext, PreSeq) miss the true richness in up to 80% of instances, well above the nominal 5%. In addition, DivQuant outperforms classical asymptotic entropy estimators (Miller-Madow, CAE) and the extrapolating iNext estimator. Running times remain competitive, with DivQuant typically completing in seconds. DivQuant is available as a command-line tool at https://gitlab.com/rahmannlab/divquant.

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

Asymptotically Optimal Sequential Testing with Markovian Data

arXiv:2602.17587v3 Announce Type: replace-cross Abstract: We study one-sided and $\alpha$-correct sequential hypothesis testing for data generated by an ergodic, finite-state Markov chain. The null hypothesis is that the unknown transition matrix belongs to a prescribed set $P$ of stochastic matrices, and the alternative corresponds to a disjoint set $Q$. We establish a non-asymptotic instance-dependent lower bound on the expected stopping time of any valid sequential test under the alternative, which is asymptotically tight. Our novel analysis improves the existing lower bounds, which are either asymptotic or provably sub-optimal in this setting. Our lower bound incorporates both the stationary distribution and the transition structure induced by the unknown Markov chain. We further propose an optimal test whose expected stopping time matches this lower bound asymptotically as $\alpha \to 0$. We illustrate the usefulness of our framework through applications to sequential detection of model misspecification in Markov Chain Monte Carlo and to testing structural properties, such as the linearity of transition dynamics, in Markov decision processes. Our findings yield a sharp and general characterization of optimal sequential testing procedures under Markovian dependence.

08.
Nature (Science) 2026-06-17

Navigating a crowded developing brain leaves neurons with broken DNA

As neurons migrate to their final destinations in the forming brain, their DNA gets damaged. The brain has evolved a fix, but there can be lasting consequences if repair fails. As neurons migrate to their final destinations in the forming brain, their DNA gets damaged. The brain has evolved a fix, but there can be lasting consequences if repair fails.

09.
arXiv (CS.CL) 2026-06-18

IndicContextEval: A Benchmark for Evaluating Context Utilisation in Audio Large Language Models Across 8 Indic Languages

AudioLLMs enable speech recognition conditioned on textual prompts such as domain descriptions or entity lists. However, it remains unclear whether these models genuinely utilise such context or rely on parametric knowledge learned during pretraining. Existing benchmarks cannot answer this question because they evaluate transcription under fixed prompting conditions and rarely include explicit contextual inputs. We introduce IndicContextEval, a 56-hour multilingual benchmark of natural speech from 555 speakers across 8 Indian languages and 23 professional domains. We design a 7-level prompting framework that progressively introduces contextual signals, including metadata, natural-language descriptions, entity lists in English and native script, and adversarial prompts with incorrect entities. Evaluating five models reveals substantial differences in context utilisation behaviour, highlighting the need for explicit evaluation of contextual grounding in AudioLLMs.

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

Augmenting Dysarthric Speech Severity Assessment with MOS Supervision

arXiv:2606.18645v1 Announce Type: cross Abstract: Dysarthria is a speech disorder marked by reduced intelligibility and communicative effectiveness. Automatic utterance-level assessment of dysarthric speech can support scalable speech monitoring and therapy-related analysis. Yet training such systems is bottlenecked by the scarcity of clinically annotated dysarthric speech. This work proposes to augment dysarthric speech assessment using data from speech synthesis evaluations, specifically human-annotated utterances with Mean Opinion Score (MOS) labels from the QualiSpeech corpus. Experiments show that fine-tuning on speech synthesis assessment data consistently improves performance on both intelligibility and naturalness prediction, while joint training yields gains primarily on naturalness. These results suggest that synthesis artifacts and dysarthric speech share perceptual commonalities, and speech synthesis evaluation corpora offer a practical augmentation source that reduces reliance on scarce clinical annotations.

11.
arXiv (CS.CV) 2026-06-12

PaLMR: Towards Faithful Visual Reasoning via Multimodal Process Alignment

Reinforcement learning has recently improved the reasoning ability of Large Language Models and Multimodal LLMs, yet prevailing reward designs emphasise final-answer correctness and consequently tolerate process hallucinations–cases where models reach the right answer while misperceiving visual evidence. We address this process-level misalignment with PaLMR, a framework that aligns not only outcomes but also the reasoning process itself. PaLMR comprises two complementary components: a perception-aligned data layer that constructs process-aware reasoning data with structured pseudo-ground-truths and verifiable visual facts, and a process-aligned optimisation layer that constructs a hierarchical reward fusion scheme with a process-aware scoring function to encourage visually faithful chains-of-thought and improve training stability. Experiments on Qwen2.5-VL-7B show that our approach substantially reduces reasoning hallucinations and improves visual reasoning fidelity, achieving state-of-the-art results on HallusionBench while maintaining strong performance on MMMU, MathVista, and MathVerse. These findings indicate that PaLMR offers a principled and practical route to process-aligned multimodal reasoning, advancing the reliability and interpretability of MLLMs.

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

Infant Spontaneous Movement Noise Improves Exploration in Deep RL

arXiv:2606.16590v1 Announce Type: cross Abstract: Exploration in deep reinforcement learning (RL) is commonly implemented as temporally uncorrelated white noise. However, recent works show that temporally correlated colored noise can improve exploration efficiency by producing smooth trajectories with better coverage of the state space. We inquire whether action noise inspired by infant spontaneous movements can also improve exploration in deep RL. We find that the power spectral densities of babies' end-effector velocities follow a colored noise process where the spectral exponent increases with age. Inspired by this developmental pattern, we introduce a mechanism that progressively increases the temporal auto-correlation of exploration noise during RL training, matching the infant statistics. Experiments across several RL environments show that infant-inspired noise produces structured exploratory behavior and can improve learning efficiency compared to conventional exploration strategies. These findings suggest that human motor and cognitive development can provide useful guidance for designing learning mechanisms in artificial agents. Our code is available at https://github.com/trieschlab/baby-noise-rl.

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

DRIVE: Distributional and Retrieval-Augmented Bidding with Value Evaluation

arXiv:2606.14192v1 Announce Type: new Abstract: Auto-bidding is a core component of real-time advertising systems, where decisions must optimize long-term performance under budget and cost constraints, while online exploration is prohibitively risky. Offline reinforcement learning and, more recently, Transformer-based sequence modeling have shown promise for learning bidding policies from logged data, but their unimodal and purely parametric formulations often collapse multiple effective bidding strategies into suboptimal averaged actions and perform unreliably under sparse or long-tail traffic. To mitigate these limitations, we propose DRIVE (Distributional and Retrieval-Augmented Bidding with Value Evaluation), a unified Transformer-based framework that decouples candidate action generation from decision making for offline auto-bidding. DRIVE combines distributional action modeling, retrieval-augmented candidate generation from high-quality historical decisions, and value-based evaluation to select the most promising bid at inference time. Extensive experiments on AuctionNet and additional offline reinforcement learning benchmarks demonstrate that DRIVE consistently improves bidding performance and generalizes well across multiple Transformer-based methods.

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

Conditional Multi-Event Temporal Grounding in Long-Form Video

Multimodal large language models have made rapid progress in video temporal grounding, yet real-world applications routinely require localizing every event that satisfies compositional temporal and spatial conditions. Existing benchmarks fall short: they localize only a single moment per query, count without temporal conditions, or treat grounding and counting as disjoint tasks. We introduce CoMET-Bench for Conditional Multi-Event Temporal Grounding in long-form video, comprising 2789 queries over 600 videos averaging 33.8 minutes across five real-world domains, with each query composed from 4 temporal conditions, 3 spatial conditions, and a dedicated negative-query subset. We further propose a unified evaluation protocol jointly measuring counting, grounding, and negative-query recognition, including a new Rejection-F1 metric that prevents trivial gaming by lazy "always-empty" models. Benchmarking a broad suite of MLLMs, agent-based, and grounding-specialized methods reveals that existing approaches remain far from solving this task. Building on these findings, we propose CoMET-Agent, a training-free agentic framework that reformulates the task as structured search-and-aggregate, improving F1@0.5 by 6.1% over GPT-5 purely through structural reasoning. Failure analysis further surfaces three open directions: fine-grained entity tracking, position-uniform retrieval, and causal event pairing.

15.
arXiv (CS.LG) 2026-06-18

The Illusion of Improvement: Reject Inference Strategies in Credit Scoring

arXiv:2606.18479v1 Announce Type: new Abstract: Reject inference methods are widely used to mitigate survival bias in credit scoring, yet their effectiveness remains poorly understood. We systematically evaluate several such methods and uncover a structural failure mode: in a natural retraining cycle, models whose accuracy improves while recall collapses create an illusion of improvement that leads practitioners to believe the system is getting better when, in fact, its rejection quality – the ability to correctly screen out defaulters – is deteriorating. We then propose a controlled exploration strategy that breaks the feedback loop without statistical assumptions: the lender deliberately approves a fraction of rejected applicants and observes their true outcomes. We show that accuracy and rejection quality give opposite recommendations on whether to explore: accuracy favors no exploration, while rejection quality improves with it, confirming that standard evaluation metrics are misleading under selection bias. Even minimal exploration rates (2–5\%) prove sufficient in our experiments to diagnose the severity of the feedback loop at near-zero cost. Our findings are consistent across two machine learning methods and three real-world datasets, and suggest that standard evaluation protocols are inadequate for assessing models trained under survival bias.

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

LentiAvatar: Pseudo-Multiview Reconstruction and Subpixel Prism Rendering for Real-Time Stereoscopic Communication

Real-time stereoscopic video communication has long been a goal of immersive telepresence, yet practical systems still require specialized capture rigs or reduce remote users to a single portrait view. We present LentiAvatar, a Gaussian head-avatar system that connects monocular avatar capture with subpixel-encoded glasses-free lenticular display for real-time autostereoscopic communication. From a monocular portrait video, LentiAvatar reconstructs a controllable head avatar and optimizes it for the lateral viewing zones induced by the display. The method uses natural head turns as pseudo-multiview (PMV) supervision to constrain regions that are otherwise weakly observed in monocular training, including hair, ears, jaw contours, and neck boundaries. Reliable side frames are yaw-binned, aligned to virtual cameras, and supervised within a strict head-and-hair domain; contour-aware losses and staged regularization further suppress ghosting, alpha leakage, and depth instability while preserving lateral detail. At runtime, LentiAvatar renders 32 virtual views and encodes them into a 4K lenticular raster with calibrated subpixel-routing masks. The live-tracker prototype sustains 10.65 FPS, and a subject-specific distilled driver raises the same display pipeline to 38.49 FPS.

17.
arXiv (quant-ph) 2026-06-11

Scaling-optimal purification of noisy qubit unitary channels

arXiv:2606.12394v1 Announce Type: new Abstract: We consider the problem of purifying noisy qubit unitary channels. Given the ability to apply an unknown qubit unitary channel followed by depolarizing noise, we aim to construct a superchannel that purifies the noisy unitary back to the original unknown unitary. We first provide numerical evidence that sequential strategies can strictly outperform parallel strategies when the number of channel uses is finite, highlighting the fundamental distinction from state purification. We then provide a concrete $\mathrm{U}(2)$-covariant parallel protocol based on a novel entanglement-assisted quantum error-correcting code that suppresses the first-order noise strength as $O(1/n)$ with $n$ channel uses and show this scaling is asymptotically optimal in the low-noise regime, even when sequential strategies are allowed.

18.
medRxiv (Medicine) 2026-06-15

Differential DNA Methylation and Delirium After Anesthesia and Surgery

Background: DNA methylation is an epigenetic modification that regulates gene expression in response to environmental exposures. We measured differential DNA methylation levels in blood before after general anesthesia and surgery in participants with and without postoperative delirium (POD) and postoperative neurocognitive disorder (PNCD). Methods: Blood sampling, delirium assessment and cognitive testing were prospectively performed at baseline before non-cardiac, non-neurologic surgery, and at 24 hours (24h) and 6 weeks (6wk) thereafter in 94 participants comprising 13 with POD and 81 without POD, and 40 with PNCD and 54 without PNCD 6wk after surgery who were matched for age and sex in the INTUIT and MADCO cohorts. DNA methylation was assessed using the Illumina Infinium MethylationEPIC Beadchip. Results: 132 differentially methylated positions (DMPs) annotated to 198 differentially methylated genes (DMGs) were identified in 94 participants 24h after surgery compared to baseline with a local false discovery rate (LFDR)

19.
arXiv (CS.LG) 2026-06-15

Free Heavy-Tailed Lunch for Muon: A Theoretical Justification of Empirical Success

arXiv:2606.14560v1 Announce Type: cross Abstract: Non-Euclidean optimisation methods with matrix-valued updates, such as Muon and Scion, have recently shown strong empirical performance for training Transformer models, yet their theoretical advantages over Euclidean methods remain poorly understood. We address this gap in the heavy-tailed non-convex regime, where stochastic gradients have bounded $p$-th central moments, $p \in (1,2]$. We show that certain non-Euclidean methods achieve optimal sample complexity under stronger stationarity measures, while Euclidean methods incur additional dimension-dependent costs. As a consequence, for $m \times n$ matrices, Muon finds an $\varepsilon$-stationary point in nuclear norm within $\mathcal{O}\left(\min\{m, n\} \frac{\Delta_1 L}{\varepsilon^2} \left(\frac \sigma \varepsilon \right)^{\frac p {p-1}}\right)$ samples, absorbing heavy-tailed noise without extra dimension dependence, unlike Euclidean methods. We further prove this sample complexity, including its dimension dependence, is optimal for all first-order methods under nuclear-norm stationarity. Experiments on large language models support our theory. Surprisingly, our results suggest that other Schatten geometries beyond the spectral geometry of Muon can perform competitively in certain settings.

20.
arXiv (CS.CL) 2026-06-18

PatchWorld: Gradient-Free Optimization of Executable World Models

Text-agent environments are typically modeled as partially observable Markov decision processes (POMDPs), assuming that the simulator's latent state and transition dynamics are hidden from the agent. Yet little work has examined whether executable code can be induced to serve as a world model for prediction and planning under partial observability. We introduce PatchWorld, a gradient-free framework that turns offline trajectories into executable Python world models through counterexample-guided code repair. Instead of predicting the next observation with a black-box model, PatchWorld induces symbolic belief-state programs whose action updates can be inspected, replayed, and locally patched. Across seven AgentGym environments, PatchWorld-Simple achieves the highest code-based planning score among evaluated methods, reaching 76.4\% macro success in live one-step lookahead while invoking no LLM calls inside the world-model prediction module itself. We further find that a human-specified residual-memory bias improves surface observation fidelity but weakens decision utility. This exposes a tradeoff in executable world models, since improving observation fidelity can come at the expense of action-discriminative dynamics, and vice versa. Code is available at https://github.com/HKBU-KnowComp/PatchWorld.

21.
arXiv (CS.LG) 2026-06-17

Physics-Constrained Neural Networks for Improved Short-Term Weather Forecasting: A Case Study over the South Pacific

arXiv:2606.17659v1 Announce Type: new Abstract: This study introduces enhancements to physics-constrained neural networks (PCNNs) that improve the accuracy and stability of hybrid short-term weather forecasting models. Building on the WeatherGFT architecture, three innovations are proposed. First, an upgraded numerical solver, combining a fifth-order weighted essentially non-oscillatory scheme (WENO-5), a beta-plane approximation, and subgrid-scale viscosity, permits a fourfold increase in the integration time step to 1200 s while reducing the daily mean squared error by up to 26%. Second, a unified autoregressive hybrid block replaces the original chain of 24 specialised modules, eliminating overfitting to specific lead times. Third, the physical core is integrated with two state-of-the-art neural backbones, resulting in PI-PredFormer and PI-IAM4VP. Evaluation on the WeatherBench South Pacific subset from 2000 to 2004 shows that these hybrids reduce root mean squared error at 1-12 h lead times by 8-22% compared to purely neural counterparts, while better preserving physical consistency. These results demonstrate that incremental refinement of hybrid components offers a practical route toward more accurate and efficient short-range weather forecasting.

22.
arXiv (CS.CV) 2026-06-18

Characterizing Brazilian Atlantic Forest Restoration Outcomes with Geospatial AlphaEarth Embeddings

Authors:

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

23.
arXiv (quant-ph) 2026-06-11

Enhancing Many-Body Chaos via Entropy Injection from Environment

arXiv:2606.11784v1 Announce Type: new Abstract: In closed quantum systems, local information spreads throughout the entire system and becomes highly complex under unitary evolution. In contrast, when the system is embedded in an environment, system-environment coupling can transfer information from the system into the environment, thereby reducing the rate of complexity growth within the system. This leads to the environment-induced scrambling transition established in previous works. In this work, we identify entropy injection from the environment as a different physical process that instead enhances many-body chaos. Our setup consists of coupling a system that is already in equilibrium with one environment to another environment, which serves as an entropy reservoir and drives the system into a non-equilibrium state. When entropy flows into the system through either heat transfer or particle transfer, the effective Hilbert space explored by the system enlarges, a mechanism that can enhance many-body chaos. We explicitly demonstrate this idea by constructing a solvable complex Brownian SYK model, in which both the relaxation toward the steady state and the steady-state quantum Lyapunov exponent can be computed analytically. Our results provide a controllable mechanism for tuning quantum scrambling through entropy flow in quantum many-body systems coupled to environments.

24.
medRxiv (Medicine) 2026-06-22

A Controlled Human Malaria Infection model for relapsing Plasmodium vivax

Background Plasmodium vivax malaria relapses are a major source of morbidity and onward transmission of infection. The underlying mechanisms are poorly understood and current therapies sub-optimal. We examined the safety and feasibility of a controlled human malaria infection (CHMI) model for relapsing P. vivax. Methods We conducted an open-label, proof-of-concept, CHMI study of relapsing P. vivax. Healthy, malaria-naive, Duffy-positive adults aged 18-45 years with extensive CYP2D6 metaboliser phenotype and normal blood glucose-6-phosphate dehydrogenase (G6PD) levels were recruited in Oxford, UK. Mosquito-bite CHMI was performed in Nijmegen, The Netherlands, using Anopheles stephensi mosquitoes infected with PvW1, a clonal isolate of P. vivax from Thailand. All follow-up visits were conducted in Oxford, UK. Primary P. vivax infections (qPCR > 500 genome copies/mL) were treated with artemether-lumefantrine (80mg/480mg at 8, 24, 36, 48 and 60 hours). From Day 28 following CHMI, participants attended a fortnightly clinic for clinical review and qPCR blood sampling, with additional assessments performed for any reported symptoms. P. vivax relapse infections (qPCR > 500 genome copies/mL) were treated with artemether-lumefantrine as per primary infection. Definitive anti-malarial treatment with atovaquone-proguanil (1000mg/400mg once daily for three days) and primaquine (0{middle dot}5 mg/kg/day for 14 days) was administered six months following CHMI, regardless of parasitaemia or symptoms. The primary objective was to assess the safety, feasibility and frequency of relapsing P. vivax after CHMI. Remote follow-up (5 years) is ongoing. The study is registered with ISRCTN registry (ISRCTN48625883). Findings 20 participants were screened for eligibility from 21 January 2025. Five participants (median age 22 years) underwent CHMI (five infected mosquitoes per participant) on 15 April 2025. All participants developed primary P. vivax infection and experienced at least one relapse infection. Two participants experienced a second relapse. Overall incidence rate was 3{middle dot}6 relapse infections per person-year. Solicited adverse events were mild or moderate and there were no serious adverse events. Definitive anti-malarial treatment was administered to all participants. One participant experienced primaquine-induced methaemoglobinaemia, resolving with early discontinuation of treatment (total dose 5{middle dot}3 mg/kg). To date, more than six months after primaquine treatment, no further relapses have been recorded. Interpretation CHMI of relapsing P. vivax is safe and feasible, allowing exploration of the mechanisms underlying relapse infections and providing a platform for future anti-relapse efficacy studies. Funding European Union Horizon Europe programme and UK Research and Innovation (UKRI) via OptiVivax consortium; UK National Institute for Health and Care Research Biomedical Research Centre: Oxford; and UK Medical Research Council.

25.
PLOS Medicine 2026-05-06

Pathways of emergency care for severely ill children in Nigerian and Ugandan hospitals: A process mapping study

Authors:

by Rami Subhi, Abiodun Sogbesan, Dan Muramuzi, Mikael Burhin, Ayobami A. Bakare, Adegoke G. Falade, Freddy E. Kitutu, Freddie Ssengooba, Carina King, Sumit Kane, Belinda Dawson-McClaren, Hamish R. Graham, the MOXY-Implementation Research Collaboration Background Child mortality remains high in countries with weak emergency care systems. Facility organisation for paediatric emergency care is heterogeneous and under-described. We examined how hospitals in Uganda and Nigeria are organised to deliver emergency care for neonates and children. Methods and findings We conducted a qualitative, multi-method study in 26 purposively selected secondary and tertiary facilities in Uganda and Nigeria from October 2023 to December 2024. Embedded researchers documented patient pathways, resources for care, and care processes for severely ill children (