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

A nonparametric two-sample test using a parametric integral probability metric

arXiv:2606.16941v1 Announce Type: cross Abstract: Detecting distributional differences between two independent samples is a fundamental problem in statistics and machine learning. Nonparametric two-sample testing provides a principled framework for determining whether two samples are drawn from the same underlying distribution, without assuming any specific parametric form for the distribution. In this study, we propose a new two-sample test statistic based on a newly introduced integral probability metric (IPM), using a specially designed parametric discriminator class with a single node of a neural network. We show that the resulting test statistic, called PReLU-IPM, is nonparametric and establish theoretical guarantees for the associated two-sample testing procedure, PReLU-TST, including its consistency and asymptotical equivalence to nonparametric IPM-based tests under regularity conditions. By analyzing multiple simulated and real benchmark datasets, we demonstrate that PReLU-TST achieves higher power across a range of alternatives or performs comparably to its competitors, for finite samples.

03.
medRxiv (Medicine) 2026-06-11

Dissecting the functional landscape of rare diseases through genomic variation in a heterogeneous cohort of 11,000 patients

Rare diseases (RDs) remain a major diagnostic challenge. Genetic and phenotypic heterogeneity, incomplete knowledge of disease mechanisms, and limitations in variant clinical interpretation leave many patients without a molecular diagnosis. Meanwhile, the growing volume of genomic data generated in clinical practice offers an opportunity to develop data-driven methodologies for exploring disease mechanisms and improving the reanalysis of unsolved cases. We aggregated real-world genomic data from 11,084 unrelated patients with suspected RD. Patients were clinically classified into 122 diseases. We built a multi-disease genomic variant frequency database (FJD-DB), which enabled the development of variant and gene-disease association scores by means of case-control subcohort comparisons across 32 disease groups. Functional enrichment analyses were then used to highlight disease-associated protein domains, pathways, biological processes, and phenotypes. Finally, the resulting knowledge was integrated into a data-driven framework for the guided reanalysis of unsolved RD patients applied to Inherited Retinal Dystrophies (IRD) patients as first use case. FJD-DB contained more than 45 million unique variants, including ~185,000 potentially pathogenic variants. Disease-specific analyses identified disease-associated pathogenic variants and highlighted both established and candidate disease genes. We detected 179 significantly enriched protein domains across 23 diseases, 124 Human Phenotype Ontology terms across 13 diseases, 79 Reactome pathways across 10 diseases, and 72 Gene Ontology biological processes across 8 diseases, revealing highly disease-specific functional signatures. Integration of disease-specific variant, gene, and functional association signals enabled the development of a data-driven framework for guided reanalysis of unsolved RD cases. Applied to more than 1,100 unsolved IRD cases, the framework generated clinically relevant findings in 26 patients, including four molecular diagnoses, seven candidate diagnoses, and 15 cases upgraded from non-informative findings to variants of uncertain significance. Aggregated real-world genomic data can be leveraged to identify disease-associated molecular signals generating novel biological hypotheses. A unified analytical framework provides a scalable strategy for knowledge discovery and guided reanalysis, facilitating the identification of overlooked and potentially novel genetic causes of RDs.

04.
arXiv (CS.AI) 2026-06-17

MemTrace: Probing What Final Accuracy Misses in Long-Term Memory

arXiv:2606.17328v1 Announce Type: new Abstract: LLM agents increasingly maintain long-term memory of user facts across sessions. Yet such memory is usually evaluated by aggregating accuracy over question rows or episodes. Because this approach scores question rows independently, even when several questions probe the same fact, it cannot show how that fact behaves as conditions change. We introduce MemTrace, a benchmark whose unit of measurement is the knowledge point: a single typed fact about the user, rather than an individual question. MemTrace probes each fact along three controlled dimensions: memory age, defined by how many sessions ago the fact appeared in the history; question type, covering current state, earlier state, and trajectory of change; and evidence condition, covering present, missing, and contradicted-by-false-premise settings. Evaluating 13 memory-system configurations across four paradigms, we find that similar pooled accuracy hides different failures: recovering a fact's current and earlier states does not imply tracking how it changed, and safe abstention does not imply correcting a false premise. The dominant bottleneck is evidence use, not retrieval: when systems fail, the evidence was retrievable 10 times more often than it was missing. These results suggest that improving long-term memory requires better use of reachable evidence, not simply more storage or retrieval.

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

Human-Enhanced Loop Modeling (HELM): Agent-Based Finite Element Modeling of Concrete Bridge Barriers

arXiv:2606.12025v1 Announce Type: new Abstract: Finite element (FE) modeling of safety-critical infrastructure such as bridge barriers requires high-fidelity nonlinear dynamic analysis, yet the current FE modeling process remains labor-intensive and lacks automation. This paper presents the Human-Enhanced Loop Modeling (HELM) framework, a collaborative human-agent protocol that decomposes long-sequence finite element modeling into discrete, visually verifiable checkpoints across geometry generation, boundary condition definition, and material assignment. The framework is demonstrated through a 20-case matrix of reinforced concrete bridge barriers under MASH TL-4 and TL-5 lateral loading conditions, interfacing specialized agents with two widely used commercial FE softwares, i.e., ANSYS and LS-PrePost. Experimental results show that HELM improves the baseline autonomous modeling success rate from 20% to 75%, with agent-level pass rates for geometry and boundary condition tasks approximately doubling. Error analysis reveals that spatial reasoning and algebraic logic limitations constitute the primary failure modes, underscoring the value of structured human-in-the-loop intervention for modeling automation. The complete agent design code and prompts are open-sourced and can be accessed at: https://github.com/SimAgentDev/Ansys-LSPP-AgentKit.

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

VFACamou: View-Fused Adversarial Camouflage for Environment-Adaptive Physical Evasion

Adversarial camouflage in the physical world remains highly challenging, particularly under UAV reconnaissance where targets undergo continuous geometric changes and extreme illumination variations. Existing methods either optimize 2D digital perturbations that fail to generalize to dynamic viewpoints or produce visually unnatural textures that cannot be deployed in real scenarios. Therefore, we propose an end-to-end framework for adversarial camouflage generation that automatically produces wearable adversarial patterns and maintains stable attack performance in real physical environments with changing viewpoints, poses, and lighting conditions. Our method integrates UV-volume rendering with a diffusion-based texture generator, enabling consistent appearance under varying scales, poses, and lighting conditions. To ensure environmental realism, we propose an illumination color consistency estimator that extracts dominant background attributes and guides a natural texture loss to align the generated UV texture with the surrounding environment. A multi-scale dynamic training strategy further enhances robustness against viewpoint shifts and body deformation. Extensive experiments across multiple mainstream detectors demonstrate that our method achieves strong and stable physical attack performance while maintaining high perceptual naturalness, reducing human detection rates without introducing unnatural artifacts.

07.
arXiv (CS.CV) 2026-06-19

EventVLA: Event-Driven Visual Evidence Memory for Long-Horizon Vision-Language-Action Policies

Memory remains a critical bottleneck for long-horizon robotic manipulation, as standard Vision-Language-Action (VLA) policies often fail when task-relevant cues become occluded or unobservable over time. While existing memory-augmented methods utilize historical context, they either suffer from severe information bottlenecks, incur high latency via decoupled dual systems, or rely on unselective buffers that accumulate massive visual redundancies. To address these limitations, we introduce EventVLA, an end-to-end framework founded on the concept of sparse visual evidence memory that comprises two core components: foundational visual anchors to retain initial and short-term contexts, and a dynamic Keyframe Evidence Memory (KEM) module. Specifically, KEM directly predicts future keyframe probabilities from the VLA's latent embeddings to autonomously capture and store sparse, task-critical visual events. This foresight-driven mechanism empowers the policy to dynamically evaluate the future causal utility of current observations, preserving transient visual evidence before it becomes unobservable. Furthermore, we propose RoboTwin-MeM, a diagnostic benchmark specifically designed to evaluate non-Markovian manipulation tasks with interactive visual evidence. Extensive evaluations show that across 17 memory-requiring simulation tasks and 4 real-world bimanual tasks, EventVLA achieves an average success rate improvement of +40% over state-of-the-art memory-augmented VLAs.

08.
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.

09.
arXiv (CS.CV) 2026-06-11

Continual Learning with Support Boundary Experience Blending

Continual learning (CL) seeks to mitigate catastrophic forgetting when models are trained with sequential tasks. A common approach, experience replay (ER), stores past exemplars but only sparsely approximates the data distribution, yielding fragile and oversimplified decision boundaries. We address this limitation by introducing Support Boundary Data (SBD), generated via differential-privacy-inspired noise into latent features to create boundary-adjacent representations that implicitly regularize decision boundaries. Building on this idea, we propose Experience Blending (EB), a framework that jointly trains on exemplars and SBD through a dual-model aggregation strategy. EB has two components: (1) latent-space noise injection to generate support boundary data, and (2) end-to-end training that jointly leverages exemplars and SBD. Unlike standard experience replay, SBD enriches the feature space near decision boundaries, leading to more stable and robust continual learning. Extensive experiments on CIFAR-10, CIFAR-100, Tiny ImageNet, and ImageNet1K demonstrate consistent accuracy improvements of 10%, 6%, 13%, 2%, respectively.

10.
arXiv (CS.LG) 2026-06-16

Fast Non-Episodic Finite-Horizon RL with K-Step Lookahead Thresholding

arXiv:2602.00781v2 Announce Type: replace Abstract: Online reinforcement learning in non-episodic, finite-horizon MDPs remains underexplored and is challenged by the need to estimate returns to a fixed terminal time. Existing infinite-horizon methods, which often rely on discounted contraction, do not naturally account for this fixed-horizon structure. We introduce a modified Q-function: rather than targeting the full-horizon, we learn a K-step lookahead Q-function that truncates planning to the next K steps. To further improve sample efficiency, we introduce a thresholding mechanism: actions are selected only when their estimated K-step lookahead value exceeds a time-varying threshold. We provide an efficient tabular learning algorithm for this novel objective, proving it achieves fast finite-sample convergence: it achieves minimax optimal constant regret for $K=1$ and $\mathcal{O}(\max((K-1),C_{K-1})\sqrt{SAT\log(T)})$ regret for any $K \geq 2$. We numerically evaluate the performance of our algorithm under the objective of maximizing reward. Our implementation adaptively increases K over time, balancing lookahead depth against estimation variance. Empirical results demonstrate superior cumulative rewards over state-of-the-art tabular RL methods across synthetic MDPs and RL environments: JumpRiverswim, FrozenLake and AnyTrading. Code is provided on \href{https://github.com/jamie01713/K-Step-Lookahead}{github}.

11.
arXiv (CS.CV) 2026-06-16

Is My Vision-Language Data in Your AI? Membership Inference Test (MINT) Demo 2

We present the Membership Inference Test (MINT) Demo 2, a framework designed to improve transparency in machine learning training processes. MINT is a technique for experimentally determining whether specific data were used during machine learning model training. We establish the theoretical framework and propose multiple architectures for MINT depending on the amount of information known about the models that are being audited. Experimental results using a popular face recognition model, 4 state-of-the-art LLMs, and multiple, diverse, and large-scale public image and text databases achieve promising accuracy levels in the detection of training data of up to 90%. Building on these results, we introduce a comprehensive web platform1 that expands these capabilities to image and text modalities. The platform integrates a diverse technological stack, including MINT, aMINT, and gMINT, allowing users to audit a wide range of models. This demonstrator aims to promote AI transparency and provides a practical tool to foster compliance with emerging AI regulations.

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

Trusted Multi-View Deep Learning Classification of Fetal Congenital Heart Disease with Feature-level and Decision-level Fusion

Congenital heart disease (CHD) refers to the abnormal anatomical structure caused by the abnormal development of the heart and great vessels during embryonic development. Traditional diagnostics often fail to achieve high accuracy and efficiency, especially given the complexity of cardiac anatomy. This study presents a specialized multi-view deep learning framework for CHD binary classification using echocardiographic images. A large-scale CHD dataset, including five views, was used to train the model, enabling it to integrate multi-angle image data. The framework utilizes advanced feature extraction and attention mechanisms to improve diagnostic precision and reliability. An uncertainty-based decision-making component is also integrated to handle low-quality images, enhancing diagnostic outcomes. Experimental results show that this method achieves top-tier performance on our dataset and provides a robust tool for early CHD detection, underscoring its potential for clinical use. The dataset and source code will be released upon paper acceptance.

13.
arXiv (CS.CV) 2026-06-18

Transformer Geometry Observatory TGO-I: Spectral Geometry Observatory

Despite the widespread adoption of Vision Transformers (ViTs) and their success across numerous computer vision applications, the fundamental understanding of their dimensional and representational geometry remains relatively underexplored. To address this gap, we introduce Transformer Geometry Observatory (TGO), a systematic framework of experiments and analysis pipelines designed to investigate the representational geometry and dynamics of Vision Transformers. TGO-I, the first installment of the framework, focuses on the spectral geometry of ViT representations. Using a ViT-Small/16 model trained on ImageNet-100, we analyze Effective Rank, Stable Rank, Participation Ratio, Spectral Entropy, Spectral Flatness, Spectral Anisotropy, covariance structure, eigenspectra, and singular value spectra throughout training. Our results reveal a consistent increase in dimensional utilization, accompanied by decreasing anisotropy, increasing spectral entropy, increasing participation ratio, and progressively flatter eigenspectra. Contrary to the common intuition that training should concentrate information into a small number of dominant directions, we observe a progressive redistribution of variance across representational dimensions. This phenomenon is particularly pronounced in the final CLS token representation, which exhibits the highest effective dimensionality and lowest anisotropy within the network.

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

ReQAT: Achieving Full-Precision Reasoning Accuracy with 4-bit Floating-Point Quantization-Aware Training

arXiv:2606.15682v1 Announce Type: new Abstract: Large Reasoning Models (LRMs) achieve strong problem-solving through long chain-of-thought, but their deployment is constrained by the high cost of full-precision inference and growing KV cache footprints. Microscaled FP4 formats enable efficient FP4 deployment; however, fully quantizing weights, activations, and KV caches (W4A4KV4) causes severe reasoning degradation that existing PTQ and QAT fail to recover. We identify that FP4 failures concentrate on low-entropy tokens–precise symbolic commitments such as digits and operators–where quantization noise inflates sampling errors that cascade through reasoning traces. Based on this insight, we propose ReQAT, a reasoning-centric FP4 training framework with three components: (i) Trace-Aligned QAT (TAQ), which revisits identical reasoning traces to focus updates on critical low-entropy decisions; (ii) Selective Entropy Minimization (SEM), which reinforces confidence at low-entropy positions; and (iii) Q-FIT, a quantization-friendly initialization that jointly calibrates RoPE-consistent KV cache transformations to stabilize QAT. Under the same training budget, ReQAT not only recovers but surpasses BF16 fine-tuning accuracy, while delivering up to 3.9x throughput speedup on NVIDIA DGX Spark and 3.1x on B200.

15.
medRxiv (Medicine) 2026-06-17

Wearable-Grade Lead Reduction Disproportionately Degrades ECG AI Performance in Elderly Patients: Evidence from PTB-XL and MIT-BIH

Consumer wearable devices increasingly use single-lead electrocardiograms (ECGs) for cardiac monitoring, but these signals contain substantially less spatial information than the clinical 12-lead standard. Whether this reduction dispro- portionately affects older adults, who often present with more complex cardiac conditions, remains poorly understood. In this study, we evaluated the impact of lead reduction on AI-ECG diagnostic performance across age groups. A 1D resid- ual neural network was trained on 21,091 PTB-XL ECG recordings spanning five diagnostic superclasses and assessed using 12-, 6-, 2-, and 1-lead configurations. Under the full 12-lead setting, model accuracy declined from 84.5% in patients younger than 40 years to 66.2% in patients aged 75 years or older. Progressive lead reduction further widened this gap. Under the 1-lead configuration, accuracy decreased by 14.1 percentage points in the 75+ group but by only 0.4 percent- age points in the

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

Adaptive Weighted Averaging

arXiv:2606.12763v1 Announce Type: new Abstract: We study the problem of selecting the largest among $n$ unknown values $x_1,\dots,x_n$ given only a single unbiased estimate $y_i$ for each $x_i$. We design strategies that are simultaneously admissible (not uniformly dominated by any other strategy) and also never worse than a given baseline such as uniform random selection. We provide an application to stochastic optimization, where we obtain online-to-batch conversion bounds with a desirable "no-compromise" guarantee: they are never worse than standard random iterate selection, and yet can be significantly better in benign settings.

18.
arXiv (CS.AI) 2026-06-11

Preregistration for Experiments with AI Agents

arXiv:2606.11217v1 Announce Type: cross Abstract: The proliferation of large language models (LLMs) and autonomous AI agents has given rise to a rapidly growing methodological paradigm: "in silico" behavioral experiments. Originally conceived as a way to use AI agents as proxies for human participants in studies of cognition, decision-making, and social dynamics, this approach has taken on new significance – as AI agents increasingly negotiate, transact, and make consequential decisions on behalf of people and organizations, understanding their behavior has become a research priority in its own right. While these experiments with AI agents offer unprecedented advantages in terms of scalability, cost efficiency, and experimental control, they also inherit, and in some cases amplify, methodological vulnerabilities that have long plagued human subjects research. To address these issues, this paper argues that preregistration practices – central to improving the credibility of human subjects experiments – should now be extended to experiments with AI agents. We systematically catalog the researcher degrees of freedom that experiments with AI agents introduce – model selection, prompt wording, settings, and outcome-contingent redesign, for example – and show how the low cost of iteration and lack of reporting norms make these choices both easy to exploit and difficult to detect. We propose a preregistration template tailored to experiments with AI agents and call on conferences, journals, and funding agencies to make preregistration standard practice for this emerging research paradigm.

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

A Definition of Good Explanations and the Challenges Explaining LLM Outputs

arXiv:2606.14838v1 Announce Type: new Abstract: How to define a good explanation is a long-standing philosophical debate which has found recent renewed interest in the context of AI outputs. Explainability is crucial for AI adoption in many contexts, but in order to produce good explanations of AI systems, we must first have an understanding of what good explanations are. In this paper we propose a definition inspired by the notion of counterfactual explanations, however we argue that one must also take into account the interlocutor's prior beliefs in each fact that could be offered in an explanation. We explore the ramifications of this definition for AI explainability and, in particular, why LLM outputs are difficult to produce good explanations for.

20.
bioRxiv (Bioinfo) 2026-06-21

Antibody-Antigen Affinity Prediction with Chain-Aware Protein Language Modeling

Motivation: Antibody-antigen affinity determines which antibodies advance in therapeutic discovery, repertoire analysis and affinity maturation, but experimental measurements are sparse relative to the scale of sequence libraries. Structure-based predictors can exploit interface geometry when reliable complexes are available, yet early discovery often requires ranking many heavy-light chain pairs against antigens for which no complex structure exists. Existing sequence-based models are scalable, but frequently compress heavy and light chains into a single antibody representation or concatenate antibody and antigen features obscuring the chain-specific and epitope-specific signals that drive binding. Results: We present AbAffinity, a sequence-only chain-aware three-stream architecture that maintains heavy chain, light chain and antigen as distinct streams. It integrates frozen ESM-2 embeddings with heavy-chain CDR-focused pooling, heavy-light self-attention, adaptive fusion gating and gated cross-attention, training only a compact interaction module. On the SAAINT-DB benchmark, AbAffinity achieves strong predictive performance under ten-fold cross-validation and maintains robust accuracy on novel antigens. It consistently outperforms recent sequence-based models across external benchmarks including SAbDab, AB-Bind and SKEMPI 2.0. Ablation studies highlight the contributions of chain-specific representations, CDR-focused pooling and the gated interaction pathway. Integrated Gradients attributions recover known paratope and epitope residues at structurally validated interfaces. AbAffinity provides a lightweight, explainable sequence-first framework for antibody triage and prioritisation when structural information is limited or unavailable.

21.
medRxiv (Medicine) 2026-06-11

Beyond External Load: Integrative Immune Monitoring Reveals Injury-Predictive Signals in the Athlete's Internal State

Abstract (already in the PDF; paste if a box is required): Injury risk prediction in elite football relies almost exclusively on external load metrics derived from GPS tracking, overlooking the molecular state of the athlete. We monitored 26 male players from FC Barcelona's first team across the 2025 calendar year, integrating GPS-derived training load with longitudinal blood-based immune monitoring (systemic inflammation and TCR-derived immune age). Immune age acceleration and inflammation were elevated in the 14 days preceding musculoskeletal injuries. A logistic regression model combining external load, inflammation, immune age acceleration, and career injury history reached an overall AUC of 0.678 and a mean per-player AUC of 0.754 (SD 0.146), improving on a GPS-only baseline of 0.541. Applied to 2026 data, the frozen model ranked players who later sustained non-contact musculoskeletal injuries high in the risk distribution. Together, our data suggest multimodal immune monitoring in elite football to reveal the athlete's internal physiological state, which carries injury-relevant information that external load alone does not capture.

22.
arXiv (CS.AI) 2026-06-19

Before the Pull Request: Mining Multi-Agent Coordination

arXiv:2606.19616v1 Announce Type: cross Abstract: Autonomous coding agents now open millions of pull requests, yet large-scale studies find their PRs are produced faster but accepted less often - a coordination and trust gap that pull-request-level telemetry cannot explain. We argue the missing signal lives before the PR, in how concurrent agents claim, divide, and collide over shared work. We study this process through grite, our open-source coordination substrate that needs no central server and stores its records inside git itself, so its append-only, signed event log captures the coordination process directly. We show that (i) this shared substrate reduces duplicate and conflicting work at bounded overhead - the share of work that merely re-does a teammate's task falls from 78% to 0% while useful throughput more than triples; (ii) every agent's copy of the log converges to the same state with no write silently dropped, where a file-based tracker loses concurrent writes; and (iii) the log is a mineable artefact from which concrete failure modes - conflicting edits, lock starvation, redundant rediscovery, race-to-close - are automatically recoverable with provenance, several invisible in pull-request history. We release the dataset, harness, and mining toolkit.

23.
arXiv (CS.CL) 2026-06-19

Scalable Training of Spatially Grounded 2D Vision-Language Models for Radiology

We study how to train visually grounded vision-language models (VLMs) for radiology without manual spatial annotations. We introduce RefRad2D, a large-scale bilingual (German/English) dataset of 1.2M CT and MR image-text pairs derived from clinical practice, with task-specific VQA and spatial grounding subsets generated automatically via LLM-based curation and automated segmentation. Trained on this data, our model RadGrounder jointly performs report generation, visual question answering, and spatial grounding via bounding-box detection or segmentation. On external VQA benchmarks (Slake, VQA-RAD), RadGrounder achieves competitive results with specialized medical VLMs. Adding our clinical data to the training mixture improves open-ended VQA over fine-tuning on the downstream datasets alone, showing the transferability of our dataset. Crucially, adding grounding supervision does not degrade language quality, enabling spatially verifiable outputs at no cost to VQA performance.

24.
arXiv (quant-ph) 2026-06-16

Scheme for Transport-based Global Entanglement Distribution using Quantum Processors

arXiv:2606.15421v1 Announce Type: new Abstract: We propose a scheme for distributing entanglement over global distances in a heralded manner by using satellites to physically transport entangled processor nodes with rare-earth-ion qubits. A full analysis of channel losses, errors and background light is performed to determine the fidelity and number of entangled pairs that can be distributed between two ground stations. We show that the scheme works already with a single satellite and can distribute close to the theoretical maximum number of entangled pairs that can be generated in a satellite overpass. In addition, we argue that in theory transportation-based schemes outperform other satellite-based schemes and can be scaled up to a constellation without additional channel losses. Daytime operation seems feasible as long as the sky is clear, with an EPR pair fidelity ranging from 99.3% at shorter network lengths to 93.9% with global coverage and can be further improved by active error correction or entanglement purification.

25.
medRxiv (Medicine) 2026-06-10

Human-centred design approaches to health facility design: Evidence from perinatal care settings in Ethiopia and Bangladesh

While significant progress has been made in perinatal outcomes over recent decades in low- and middle-income countries (LMICs), maternal and newborn quality improvement initiatives often fail to account for the spatial conditions in which they are implemented. Health systems are increasingly deploying evidence-based care models into built environments that are not optimally structured to meet the needs of its patient population. As the principal users, patients and health care workers can offer pragmatic insights about improving these structural designs. Our objective was to gather insights from patients, providers, and companions about how the physical design of their health facilities influenced their experience receiving or delivering perinatal care. We conducted a prospective observational study using a human-centred design (HCD) approach to analyse perceptions of the quality of perinatal care across two low resource settings: Ethiopia and Bangladesh. Using engagement and assessment tools, we conducted interviews, focus groups, facility walk-throughs, co-design workshops, and infrastructural assessments with patients, companions, providers, and Ministry of Health representatives. Descriptive statistics and thematic analysis were used to identify key learnings and develop recommendations. Across both countries, participants identified the need for facility layouts that better support privacy, mobility during labour, alternative birth positions, companion involvement, cultural and religious practices, sanitation, and provider visibility. Based on these insights, we developed six recommendations to better align health facility infrastructure with maternal and newborn care delivery needs. Our findings suggest that investments in health facility infrastructure may improve care experiences and help enable respectful, safe, and evidence-based maternal and newborn care. Alongside targeted spatial improvements, government authorities responsible for health facility planning should incorporate participatory design processes to ensure infrastructure reflects the needs of patients, companions, and providers and supports high-quality care delivery.