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

Agentomics: Economic Foundations for the Valuation, Attribution, and Pricing of AI Agents in Human-AI Workflows

作者:

arXiv:2606.14769v1 Announce Type: cross Abstract: Agentic AI systems are increasingly being deployed as productive resources in organizational workflows, yet existing evaluation methods primarily measure isolated technical performance rather than economic contribution. This paper introduces Agentomics, a workflow-based framework for valuing, attributing, and pricing human and artificial agents. The framework models a workflow as a configuration of heterogeneous agents whose collective performance determines gross value, deployment cost, reliability, and expected failure loss. Workflow value is treated as a team-level quantity that may include complementarities, substitution effects, bottlenecks, and nonlinear production; additive stage-level value is only a special case. Building on this workflow model, the paper formulates AI deployment as a coalition-formation problem and defines coalition value as the incremental net surplus generated relative to a benchmark human workflow. The Shapley value is then used to attribute economic surplus among participating AI agents, yielding a principled connection among valuation, accountability, and market pricing. The resulting Shapley pricing equilibrium provides a normative benchmark for assessing whether agent prices reflect expected marginal contribution. A security-operations case study illustrates how the framework accounts for productivity gains, deployment costs, reliability losses, and coalition-level complementarities in hybrid human–AI workflows.

02.
arXiv (math.PR) 2026-06-12

Conditional means, vector pricings, amenability and fixed points in cones

arXiv:2512.13829v4 Announce Type: replace Abstract: We develop a generalization of conditional probability for arbitrary ordered vector spaces. A related problem is that of assigning a numerical value to one vector relative to another. We characterize the groups for which these generalized probabilities can be stationary, respectively invariant. Our results deviate from the setting of classical probability and lead to a new criterion for amenability and for fixed points in cones.

03.
arXiv (CS.CV) 2026-06-19

How Fragile Are Training-Free AI-Generated Image Detectors? A Controlled Audit of Score Direction, Preprocessing, and Compression

Training-free detectors of AI-generated images promise generator-agnostic deployment without classifier training, yet their reported numbers are rarely compared under a single controlled protocol. We audit two representative training-free scores – an autoencoder-reconstruction score (AEROBLADE-style) and a noise-perturbation feature-similarity score (RIGID-style) – plus a naive feature-kNN control, on a common 1,500-image GenImage-derived benchmark spanning seven generators and JPEG compression at quality 70 and 50. The audit yields three cautionary findings. (i) Implementation details masquerade as method differences: replacing the LPIPS backbone (AlexNet -> VGG-16) changes overall AUROC by +0.085, and switching between resize-to-512 and native-resolution preprocessing flips per-generator conclusions by up to 0.38 AUROC. (ii) Score direction is not a property of the method but of its hyperparameters: the RIGID-style score is inverted (AUROC < 0.5) on SD1.5 and Wukong at noise level sigma=0.05, recovers to >0.5 for every generator at sigma=0.01, and collapses to 0.15 at sigma=0.3. (iii) Dataset format bias inflates robustness claims: without unified re-encoding, AUROC under JPEG-50 exceeds the clean condition for the AlexNet-backbone reconstruction score; after bias correction the residual anomaly localizes to a single generator (BigGAN). The audited scores have complementary per-generator failure sets, but naive z-score fusion does not beat the best single score, indicating that exploiting complementarity requires direction-aware combination.

04.
arXiv (CS.LG) 2026-06-19

Score Approximation for Diffusion Models on Arbitrary Low-Dimensional Structures

arXiv:2606.19894v1 Announce Type: new Abstract: The remarkable success of score-based diffusion models has spurred significant efforts to establish their theoretical foundations. However, existing complexity bounds for score approximation rely heavily on restrictive assumptions like Lipschitz continuous densities or smooth manifold supports, which are routinely violated by the singularities, sharp boundaries, and disjoint clusters inherent to real-world perceptual data. This work establishes a universal score approximation theorem that works for any distribution supported on any compact set of upper Minkowski dimension $d$. Using a novel discrete-mixture formulation, we prove that the score function can be approximated with a ReLU network whose complexity grows exponentially only with $d$, thus breaking the exponential curse of ambient dimensionality. Combined with existing theories on accurately solving the backward diffusion SDE for arbitrary compact distributions, our work shows that diffusion models readily adapt to irregular, non-smooth data structures, explaining their competence in real-world generative tasks.

05.
arXiv (quant-ph) 2026-06-12

Unifying spacetime approaches to quantum mechanics

arXiv:2606.12539v1 Announce Type: new Abstract: Recent efforts to formulate quantum mechanics in a way that treats space and time on a more equal footing have led to a large variety of spacetime-oriented approaches. In this work we present a detailed study of spacetime states, the objects that play the role of quantum states in the recently introduced framework of spacetime quantum mechanics, and show that the main proposals in the literature are different manifestations of the same underlying object. Path integrals, quantum states over time, pseudo-density matrices, the Page and Wootters mechanism, superdensity operators, and timelike-entanglement proposals all arise from spacetime states through particular evaluations, reduced information, linear maps, or quantum channels. This unification provides explicit mathematical representations of these formalisms, reveals relations among them, and clarifies the spacetime information each one captures. We also study the broader relevance of the spacetime-state point of view for Leggett-Garg inequalities, OTOCs, temporal tensor networks, fermionic systems, relativistic QFTs, quantum reference frames, and classical physics, together with additional insights and perspectives revealed by the common unifying framework.

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

From Isolation to Entanglement: When Do Interpretability Methods Identify and Disentangle Known Concepts?

A goal of interpretability is to recover disentangled representations of latent concepts (features) from the activations of neural networks. The quality of features is typically evaluated in isolation, and under implicit independence assumptions that may not hold in practice. Thus, it is unclear to what extent common featurization methods such as sparse autoencoders (SAEs) and probes disentangle one concept from another. We propose a multi-concept evaluation setting using concepts including sentiment, domain, voice, and tense. We evaluate how well featurizers produce disentangled representations of each concept, observing that features are typically sensitive to only one concept, but also that concepts are distributed across many features. Then, we steer these features, measuring whether each concept is independently manipulable, and whether features interact. Even in idealized settings, steering a feature often affects many concepts, despite a near absence of interaction effects. These results suggest that correlational metrics are insufficient to establish steering selectivity, and that demonstrating that two features operate in separate spaces is insufficient to claim that they will be selective for one concept. These results underscore the importance of multi-concept evaluations in interpretability research.

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

CogCanvas: A Benchmark for Evaluating Multi-Subject Reference-Based Image Generation

Multi-subject reference-based image generation requires jointly preserving multiple human identities, binding per-person objects and fashion items, and respecting a specified background scene, a regime where current diffusion models remain brittle. Existing benchmarks evaluate only one axis at a time and none jointly captures multi-identity composition with human-object interaction, background grounding, and spatial plausibility. We introduce CogCanvas, a benchmark of 1,952 curated reference images spanning 100 celebrity identities, 115 distinctive objects and fashion items, and 29 real-world background scenes including landmarks, from which we construct 1,361 compositional prompts covering 2-5 person group sizes. The curation pipeline combines DINOv2-based deduplication, two-stage aesthetic filtering, and automated derivation of structured interaction and position graphs that serve as ground-truth supervision. CogCanvas supports three tasks, reference-based multi-human-object generation (primary), text-to-image compositional generation, and reference retrieval, under a unified six-axis evaluation protocol. We introduce two metrics tailored to the multi-reference setting: BG-Sim, which scores background fidelity on SAM 3-masked regions via DINOv3 feature similarity, and Attr-VQA, which uses a multimodal LLM to verify per-subject attribute binding and inter-person interactions against the structured graphs. Benchmarking five SOTA methods reveals that every model degrades substantially as group size grows from 2 to 5, with near-complete failure on object/fashion binding beyond three subjects.

08.
Nature Medicine 2026-06-15

Activity-dependent adaptive deep brain stimulation improves gait in Parkinson’s disease

Parkinson’s disease leads to a spectrum of locomotor deficits that vary in severity with the nature of daily activities and the fluctuating physiology of patients. Many of these deficits remain inadequately addressed by existing deep brain stimulation therapies that rely on activity-agnostic parameters optimized for cardinal motor symptoms. By contrast, therapies embedding activity-specific parameters have the potential to better address the entire range of symptoms. Here we expose physiological principles that enable real-time decoding of ongoing locomotor activities across motor fluctuations from the neural dynamics of the subthalamic nucleus. This decoding steered activity-dependent adaptations of deep brain stimulation therapies that improved locomotor deficits while preserving efficacy for cardinal motor symptoms across activities of daily living. Our activity-dependent framework provides a blueprint for next-generation neuromodulation therapies that continuously select parameters optimized to the behavioral context and fluctuating physiology of each patient. ClinicalTrials.gov registration NCT06791902 . Neural decoding algorithms that leverage physiological principles of locomotor encoding support activity-dependent deep brain stimulation therapies that improve locomotor deficits in people with Parkinson’s disease.

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

From AGI to ASI

arXiv:2606.12683v1 Announce Type: new Abstract: Over the last decade, building human-level artificial general intelligence has moved from far-fetched speculation to being a concrete next-decade target for many of the largest AI organisations. Achieving this goal would have profound and far-reaching impacts on human society, which raises many complex questions for the decade ahead. This report investigates how AI itself might continue to develop in a post-AGI world along the continuum of machine intelligence. The endpoint of this continuum, Universal AI, is theoretically well understood, which provides some formal grounding for the main focus of this report: the transition from human-level AGI to artificial general superintelligence, which, intuitively, can be understood as a system that is more intelligent and cognitively capable than large organisations of humans. After characterizing ASI, the report discusses four potential pathways from AGI to ASI: scaling AGI, AI paradigm shifts, recursive improvement, and ASI emerging from large-scale multi-agent collectives. The report then discusses possible frictions and bottlenecks along these pathways. Determining whether the impact of these frictions will be negligible or substantial raises a number of concrete open research questions. Due to large uncertainties for predicting ASI progress, it cannot be ruled out that AI progress might continue to accelerate over the next years. This could imply that the image of a single transformative step change, caused by the introduction of human-level AGI into our society, could be inaccurate. More apt might be the prospect of a series of transformative societal changes caused by AI-enabled progress and breakthroughs across many areas of science and technology. Preparing for this prospect requires a massively interdisciplinary endeavour of global scope and interest.

10.
arXiv (CS.AI) 2026-06-17

Decidable By Construction: Design-Time Verification for Trustworthy AI

arXiv:2603.25414v4 Announce Type: replace-cross Abstract: A prevailing assumption in machine learning is that model correctness must be enforced after the fact. We observe that the properties determining whether an AI model is numerically stable, computationally correct, or consistent with a physical domain do not necessarily demand post hoc enforcement. They can be verified at design time, before training begins, at marginal computational cost, with particular relevance to models deployed in high-leverage decision support and scientifically constrained settings. These properties share a specific algebraic structure: they are expressible as constraints over finitely generated abelian groups $\mathbb{Z}^n$, where inference is decidable in polynomial time and the principal type is unique. A framework built on this observation composes three prior results (arXiv:2603.16437, arXiv:2603.17627, arXiv:2603.18104): a dimensional type system carrying arbitrary annotations as persistent codata through model elaboration; a program hypergraph that infers Clifford algebra grade and derives geometric product sparsity from type signatures alone; and an adaptive domain model architecture preserving both invariants through training via forward-mode coeffect analysis and exact posit accumulation. We believe this composition yields a novel information-theoretic result: Hindley-Milner unification over abelian groups computes the maximum a posteriori hypothesis under a computable restriction of Solomonoff's universal prior, placing the framework's type inference on the same formal ground as universal induction. We compare four contemporary approaches to AI reliability and show that each imposes overhead that can compound across deployments, layers, and inference requests. This framework eliminates that overhead by construction.

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

MemRefine: LLM-Guided Compression for Long-Term Agent Memory

Large language model (LLM) agents are increasingly expected to operate over long-term interactions, where information from past dialogues must be preserved and recalled to support future tasks. However, as interactions accumulate, the memory store grows without bound and fills with redundant entries that inflate storage cost and degrade retrieval by crowding out the most useful evidence. Furthermore, this is especially limiting on resource-constrained platforms with hard memory budgets, motivating us to formulate storage-budgeted memory management, the task of keeping an already constructed memory store within a fixed budget while preserving information useful for future interactions. To this end, we then propose MemRefine, an LLM-guided framework that, since surface similarity poorly reflects factual value, uses similarity only to propose candidate pairs and defers delete, merge, and preserve decisions to an LLM judge based on factual content, iterating until the budget is met. Across multiple memory frameworks and long-term conversation benchmarks, MemRefine consistently meets target budgets while preserving downstream performance and outperforming rule-based baselines under tight budgets.

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

SafeLLM: Extraction as a Hallucination-Resistant Alternative to Rewriting in Safety-Critical Settings

Large language models (LLMs) are increasingly used to access organisational documentation, including standard operating procedures (SOPs), HR policies and institutional guidelines. However, retrieval-augmented generation (RAG) systems that rely on free-form rewriting can introduce hallucinations and unstable trade-offs between completeness and conciseness, particularly in safety- and compliance-critical settings. Objectives: To evaluate extraction as a hallucination-resistant alternative to rewriting-based RAG and compare strategies that balance precision, recall and safety across document types and model scales. Methods: We compare multiple prompting strategies, including line-number-based source selection, extraction of relevant guideline sentences with explicit safety annotations, and a multi-stage pipeline that refines draft answers using supporting evidence from source guidelines. Experiments are conducted on documents of varying length and structure, including local NHS acute care and oncology guidelines and UK-wide NICE guidelines, using both frontier-scale and locally deployable models. Performance is assessed using automatic metrics and human expert evaluation of relevance and completeness. Results: Line-number selection achieves the strongest results, outperforming direct copying and safety-focused strategies across both large and small models while maintaining high term recall (up to 95%) and close alignment with source text. Safety-oriented approaches improve precision but introduce systematic omissions, while multi-stage filtering further amplifies this trade-off. Performance varies with document structure: line-based extraction excels in protocol-like content, whereas alternative strategies perform better on more verbose documents (up to 97% term recall).

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

Large-scale semantic mapping of learner agency and autonomy reveals what measurement and generative AI research overlook

arXiv:2606.10881v2 Announce Type: replace Abstract: Learner agency and autonomy are foundational to personal development, yet a pervasive "jingle-jangle" fallacy (i.e. identical terms denoting different constructs, distinct terms denoting identical ones) has substantially hindered cumulative knowledge. Treating meaning as a phenomenon constituted through use in linguistic practice, we extracted 8,954 definitions and 2,700 scale items from over 14,000 publications, to investigate how researchers actually used learner agency and autonomy with a semantic analysis pipeline. The definitional landscape of two constructs resolves into three dimensions: regulation and control of learning (task), intrinsic motivation and internal decision-making (person), and social-relational action (sociocultural), thereby empirically quantifying the jingle-jangle fallacy. Existing scales, however, systematically underrepresent the sociocultural dimension. Critically, current generative AI research in education concentrates on learning regulation and control, narrowing the behavioral repertoire that AI-mediated learning environments are designed to cultivate. Beyond conceptual clarification, this work carries direct implications for conceptualization, measurement, and practice towards supporting the multidimensional learner agency and autonomy.

14.
arXiv (CS.AI) 2026-06-19

VERITAS: Verifier-Guided Proof Search for Zero-Shot Formal Theorem Proving

arXiv:2606.19399v1 Announce Type: cross Abstract: LLM-based formal provers often collapse rich verifier signals (syntax errors, type mismatches, partial goal progress) into a binary pass/fail bit. We present VERITAS, a zero-shot framework that routes every verifier signal back into proof search through a two-phase protocol: Best-of-N sampling first, then a critic-guided MCTS pass that ingests Phase 1 failures as explicit negative examples. The protocol preserves every theorem solved by its own Phase 1 sweep, so Phase 2's additional solves are attributable to feedback-driven exploration. VERITAS reaches 40.6% on miniF2F (vs. an independently run Best-of-5 at 36.9%, Portfolio 26.2%) and 7.3% on VERITAS-CombiBench, a 55-theorem combinatorics benchmark we release on which Best-of-5 (1.8%) falls below Portfolio (3.6%), exposing that unguided sampling hurts when correct lemma names must be recovered iteratively from verifier feedback. Artifacts are available on GitHub.

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

ToolMenuBench: Benchmarking Tool-Menu Filtering Strategies for Reliable and Efficient LLM Agents

arXiv:2606.15508v1 Announce Type: new Abstract: Tool-augmented large language model agents increasingly operate over large tool libraries, but existing evaluations often focus on whether a model can call a tool correctly rather than how the visible tool menu shapes reliability, efficiency, and safety-relevant risk exposure. We introduce ToolMenuBench, a benchmark for evaluating tool-menu construction in multi-step LLM agents. ToolMenuBench varies tool-menu size, distractor type, state-dependent task structure, and risk exposure, and reports both filter-level and downstream agent metrics, including visible-tool count, risky-tool exposure, task success, wrong-tool calls, premature actions, and token usage. In a controlled evaluation across seven model backends, three tool-menu sizes, six filtering methods, and seven evaluation settings, CMTF improves task success from 32.1% under all-tools exposure to 85.7%, while reducing average token usage by roughly 98%. Causal minimal tool filtering achieves the strongest overall tradeoff, reducing visible tools, wrong-tool calls, premature actions, and risky-tool exposure relative to unfiltered exposure, lexical filtering, state-aware filtering, and broader causal-path baselines. ToolMenuBench provides a reusable evaluation framework for studying the agent-interface problem: which tools should be visible, when they should be visible, and under what cost or risk constraints.

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

S$^2$COPE: Self-Supervised Concept Discovery via Preference Learning

Current representation learning paradigms force a fundamental compromise: self-supervised methods scale to massive datasets but yield opaque features, whereas interpretable models remain bottlenecked by the need for dense human annotation. We introduce Self-Supervised Concept discOvery via Preference lEarning (\model), a label-free framework that resolves this dilemma. Instead of treating Vision-Large-Language Models (VLLMs) as static feature extractors, \model leverages them as active participants in a self-supervised preference optimization loop. By autonomously hypothesizing, validating, and reinforcing candidate visual attributes directly from raw imagery, our framework discovers novel, structured concepts without a single label. Extensive experiments across natural, medical, and physics domains demonstrate that \model successfully extracts domain-specific concepts where standard VLLMs often fail to generate. By amortizing concept discovery directly into the VLLM backbone through our self-supervised preference objective – rather than relying on static generation and disjoint filtering – we achieve up to a 24-point absolute improvement in downstream top-1 classification accuracy on unseen data. Our work suggest that interpretability can emerge through a model's autonomous interaction with incidental visual structures, without any human supervision.

17.
arXiv (CS.LG) 2026-06-15

Beyond the Training Distribution: Evaluating Predictions Under Distribution Shift and Selection Bias

arXiv:2606.14506v1 Announce Type: cross Abstract: Understanding how a prediction model will perform in a new environment before deployment is essential to preventing harm when algorithms inform decision-making. Two common sources of model performance degradation are (i) covariate shift, where the target covariate distribution differs from the source, and (ii) selective labels, where the observability of outcomes depends on historical decisions. We study pre-deployment model evaluation under the joint presence of covariate shift and labeling of outcomes selectively based on observed features. In particular, we present a double machine learning procedure for estimating the target risk of an arbitrary black-box prediction model under a general loss function. We show identification of this estimand under standard assumptions and derive a bias-corrected estimator based on the influence function of the target risk. Finally, we evaluate our estimator through experiments using the eICU electronic health records database, showing that it tracks the true target risk more accurately than methods that address either selective labels or covariate shift alone, as well as baselines that combine standard plug-in approaches.

18.
arXiv (CS.AI) 2026-06-12

Iterating Toward Better Search: A Two-Agent Simulation Framework for Evaluating Agentic Search Architectures in E-Commerce

arXiv:2606.12924v1 Announce Type: new Abstract: We present a modular two-agent simulation framework for evaluating conversational shopping assistant architectures. An independent buyer agent, configured with personas, missions, and patience levels, is paired with an interchangeable responder that integrates with a real e-commerce search API. Holding the buyer constant across experiments enables controlled comparison of responder designs on identical scenarios. Using 2011 conversations across 14 persona buckets, we establish four empirical findings. First, rolling-window memory outperforms intent-extraction memory on all quality metrics while being 35% faster per query. Second, illustrating rapid evidence-driven iteration, a systematic failure analysis of a responder version enables targeted fixes that reduce failure and near-failure rates by 62% across the full dataset. Third, swapping the responder LLM backbone from Gemini~2.5 to Llama~3.3~70B costs 0.16–0.45 points despite identical architecture. Finally, we document systematic philosophical disagreement between frontier LLM judges: Gemini rewards process correctness while Claude demands concrete outcomes, despite using the same evaluation prompt.

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

LoComposition: Terrain-Adaptive Energy-Efficient Quadruped Locomotion without Gait Priors

arXiv:2606.15896v1 Announce Type: cross Abstract: Learning-based quadrupedal locomotion typically relies on complex reward formulations that entangle task specification, operational limits, gait preference, and terrain adaptation within a single optimization objective. We instead treat these functions through distinct mechanisms: rewards for task specification, constraints for operational limits, energy minimization for gait preference, and exteroceptive perception for adapting energy use to terrain difficulty. We show that these components jointly enable efficient, terrain-adaptive locomotion, and that removing each component exposes a distinct failure mode. Our formulation removes explicit gait priors (including air-time, contact-count, and foot-clearance targets) in favor of emergent behavior. Compared to a conventional complex-reward baseline, our formulation achieves comparable terrain traversal while reducing cost of transport by 56% and operational-limit violations by 96%. The resulting policies transfer zero-shot to a physical Unitree Go2 using LiDAR-based elevation mapping. Project website with videos: https://tinyurl.com/locomposition.

20.
arXiv (CS.CV) 2026-06-16

Unified Multimodal Model for Brain MRI Imputation and Understanding

Multimodal large language models (MLLMs) hold great potential for medicine, as they inherit knowledge from LLM and allow multiple data modalities to be integrated, analysed and interpreted in natural language. However, the field of medical MLLMs is constrained by non-trivial challenges, notably the scarcity of high-quality training data and the frequent occurrence of missing data in the real-world clinical setting. Here, we propose a novel unified multimodal model, UniBrain, for brain magnetic resonance image (MRI) analysis. To address potential missing brain MRI modalities, we employ a unified training strategy to perform joint imaging modality imputation and brain image understanding. During training, an interleaved and description-enriched data flow is constructed to train the model in an autoregressive manner, enabling medical reasoning with generated multimodal data. A self-alignment strategy is introduced to leverage dense image embeddings to learn fine-grained anatomical features without requiring detailed image captions. Furthermore, we propose a dynamic hidden state mechanism to alleviate the exposure bias during long-context multimodal inference. Extensive experiments on multi-disease brain MRI dataset demonstrate that UniBrain achieves high performance for brain image imputation, understanding, and disease diagnosis under various extents of modality incompleteness.

21.
arXiv (CS.AI) 2026-06-19

Stabilizing the Q-Gradient Field for Policy Smoothness in Actor-Critic Methods

arXiv:2601.22970v2 Announce Type: replace-cross Abstract: Policies learned via continuous actor-critic methods often exhibit erratic, high-frequency oscillations, making them unsuitable for physical deployment. Current approaches attempt to enforce smoothness by directly regularizing the policy's output. We argue that this approach treats the symptom rather than the cause. In this work, we theoretically establish that policy non-smoothness is fundamentally governed by the differential geometry of the critic. By applying implicit differentiation to the actor-critic objective, we prove that the sensitivity of the optimal policy is bounded by the ratio of the Q-function's mixed-partial derivative (noise sensitivity) to its action-space curvature (signal distinctness). To empirically validate this theoretical insight, we introduce PAVE (Policy-Aware Value-field Equalization), a critic-centric regularization framework that treats the critic as a scalar field and stabilizes its induced action-gradient field. PAVE rectifies the learning signal by minimizing the Q-gradient volatility while preserving local curvature. Experimental results demonstrate that PAVE achieves smoothness comparable to policy-side smoothness regularization methods, while maintaining competitive task performance, without modifying the actor.

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

Language Models as Interfaces, Not Oracles: A Hybrid LLM-ML System for Pediatric Appendicitis

Large language models (LLMs) can make clinical decision support more accessible by interpreting free-text documentation, but their direct use as diagnostic engines is limited by sensitivity to prompts, information order, and plausible but incorrect outputs. Structured machine-learning models offer more stable risk prediction, yet they require tabular inputs that are difficult to integrate with narrative clinical workflows. We present ClaMPAPP (Clinical Language-assisted Machine-learning Pipeline for Appendicitis), a hybrid system that uses an LLM as an interface rather than as the final decision-maker. ClaMPAPP extracts schema-constrained clinical features from note-like narratives, applies deterministic plausibility checks, and passes validated features to an XGBoost classifier trained on clinical, laboratory, and ultrasound variables. We evaluated ClaMPAPP on two independent pediatric appendicitis cohorts from German hospitals and compared it with end-to-end LLM baselines, including open-source and proprietary models. To preserve ground truth while testing free-text input, narratives were generated from structured electronic health records through template rendering and constrained LLM rewriting, with additional sentence-order permutation to assess positional robustness. ClaMPAPP achieved the strongest overall diagnostic performance in both internal and external validation while minimizing missed appendicitis cases, the key safety concern in acute triage. End-to-end LLMs showed unstable sensitivity-specificity trade-offs and greater degradation under narrative reordering. These results support an LLM-as-interface, ML-as-predictor design that separates natural-language usability from predictive inference and provides a more auditable pathway for clinical decision support.

23.
medRxiv (Medicine) 2026-06-17

A multistate model of frailty progression after severe infections in adults >=65 years in England: a matched-cohort study

Background Evidence on frailty progression following severe infections is limited. We compared rates of transition to greater frailty or death between adults with and without severe infection in England. Methods We conducted a matched-cohort study among adults aged [&ge;]65 years (1,452,117: median age 76 years, 45% male) in Clinical Practice Research Datalink Aurum (2006-2019). Adults with severe infection (hospitalised primarily due to infection) were matched on calendar time to individuals without severe infection on age, sex, and primary care practice. The admission date was used as index date and same was assigned to matched unexposed adults. We measured frailty using Electronic Frailty Index, a proportion of 36 health deficits in validated categories (Fit 0-0.12, Mild >0.12-0.24, Moderate >0.24-0.36, Severe >0.36). In a time-varying Markov multistate model, we focused on forward transitions from baseline or intermediate frailty states to higher states or death. For each transition, we used Cox regression to estimate cause-specific transition hazard ratios (HR) with 95% confidence intervals (CIs), comparing adults with and without severe infection. We adjusted for baseline frailty score, age, sex, deprivation, harmful alcohol use, smoking, and primary care infection history 5 years before index date. We estimated state occupancy probabilities, and expected length of stay (ELOS) in each state at year five among adults with and without severe infection. We explored effect modification by infection type. Results Across all transitions, severe infection was associated with higher adjusted hazards of transitioning to worsening frailty or death, HR, 95% CI: (fit to: mild[1.56, 1.54-1.58], moderate[2.51, 1.79-3.51], death[4.57, 4.50-4.65]; mild to: moderate[1.52, 1.50-1.53], severe[1.90, 1.43-2.52], death[2.67, 2.64-2.70]; moderate to: severe[1.40, 1.38-1.42], death[1.87, 1.85-1.90]; severe to death[1.48, 1.46-1.50]). Transition hazard ratios were strongest for lower respiratory tract infections, followed by sepsis, urinary tract infections, meningitis/encephalitis, gastroenteritis, and skin and soft tissue infections. At five years, adults with severe infection had higher probabilities of transitioning to greater frailty or death across all transitions and lower ELOS in each frailty state than those without severe infection. Interpretation Severe infections may accelerate frailty deterioration in older age. Prevention through vaccination, early detection, and prompt management may help mitigate this decline.

25.
arXiv (CS.CV) 2026-06-11

CellNet – Localizing Cells using Sparse and Noisy Point Annotations

Counting living cells is an important step in many biological research workflows. Our collaborators at the Wellcome Sanger Institute study vital genes in humans via large scale saturation genome editing screening, which requires repeatedly counting cells a great number of times. Computer Vision based automation is crucial for high throughput and resource efficiency. In this work, we develop a regression-based deep learning computer vision algorithm to detect and count cells in phase-contrast microscopy images. To reduce annotation effort, which in practice often becomes a bottleneck, we focus on counting cells only using sparse point annotations, which are fast and easy to acquire. By comparison to state-of-the-art 0-shot methods, we show that regression-based counting is a promising alternative in low data regimes. Through developing methods to automatically count living cells in microscopy images, we contribute to valuable research on the human genome. The code is available at https://github.com/beijn/cellnet.