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

Re-feeding Is Not Replaying: Measuring Replay Noise in Counterfactual Token-Credit Estimation

Per-token counterfactual credit estimation asks which token in a language-model rollout caused the final answer to be right or wrong: cut the transcript at a pivot, substitute an alternative token, replay continuations, and compare outcomes. Published methods re-feed the transcript prefix as a fresh prompt, assuming this reproduces the state the model passed through during generation. We measure what that assumption costs on a stock inference engine, with a three-pass design: continuations resumed from the verified decode-time KV state, an identical second exact pass (a replica noise floor), and a re-feed pass. Across six configurations and three models (including a GRPO-trained checkpoint), at low-margin decision tokens, re-feeding changes the credit estimate at rates 14-28 percentage points above the replica floor (7-21pp under a treatment-independent conditioning; problem-clustered t = 2.9-6.4). Most changes are zero-boundary crossings of the quantized estimator rather than polarity reversals, and the perturbation is consistent with mean-zero, so averaged quantities are largely safe; but selection is not: a critical-token set chosen by thresholding $|\hat{A}_t|$ under re-feed overlaps the exact-resume selection at Jaccard 0.34-0.90, versus a 0.63-0.96 replica ceiling. A causal confirmation closes the loop: under vLLM's batch-invariant kernels all three passes are identical on every measured channel, with both disagreement rates exactly zero. Replica passes themselves disagree on 9-23% of eligible estimates: single-sample credit measurements at decision tokens are unreliable under any replay. Settings were fixed in advance; exact-pass cache hits in the second campaign are instrumented (100% hit rate, 3,434 pivots); total compute was under 10 USD. We recommend that counterfactual credit studies resume decoder state or use batch-invariant kernels, and report a replica floor.

02.
arXiv (CS.LG) 2026-06-17

A 3D Isovist World Model – Revealing a City's Unseen Geometry and Its Emergent Cross-City Signature

arXiv:2606.03609v3 Announce Type: replace-cross Abstract: Embodied agents that navigate cities rely on world models that predict how their surroundings will change as they move. But for navigation, what matters is not what the buildings look like; it is where the agent can go. Most world models nonetheless predict appearance, learning how a scene looks rather than the space an agent can move through. Those that do target geometry, such as bird's-eye-view occupancy grids, flatten the three-dimensional environment onto a ground plane, discarding the above-ground and multi-level structure that shapes real navigation. What is missing is a predictive target that captures the navigable geometry an agent actually traverses, without photometric entanglement and without collapsing the third dimension. Our key idea is to model the open volume between buildings, the negative space, encoded as a 3D isovist: a spherical visibility-depth map recording the distance to the nearest surface in every direction. We introduce an embodied world model that predicts the next isovist from a short history of past isovists and a movement action. The prediction is formulated as a depth residual so the decoder inherits sharp building edges, trained with self-rollout scheduled sampling to keep corrupted context on the geometry manifold, and equipped with a persistent latent bird's-eye-view spatial map for cross-path consistency. Our central finding is emergent and unexpected: a single city-blind model trained on Manhattan and Paris develops a cross-city spatial signature, with city identity linearly decodable from its temporal latents far above single-frame baselines, so the signature lives in the learned dynamics rather than in appearance. The representation is lightweight, interpretable, and reproducible, offering a geometric substrate for spatial reasoning in embodied AI, robotics, and urban analysis, released with an open dataset and pipeline.

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

OnDeFog: Online Decision Transformer under Frame Dropping

arXiv:2606.19721v1 Announce Type: cross Abstract: In challenging real-world reinforcement learning applications, communication delays or sensor failures often cause frame dropping, in which the agent cannot receive the dropped states and associated rewards. To address the performance degradation caused by frame dropping, the Decision Transformer under Random Frame Dropping (DeFog) was developed by incorporating additional mechanisms into the decision transformer to tackle frame dropping. Although DeFog can mitigate performance degradation in frame-dropping environments, since DeFog is an offline learning method, it struggles to effectively generalize to novel states not adequately represented in the training dataset. In this study, we propose OnDeFog, which integrates the mechanisms in DeFog with the online decision transformer (ODT), an online reinforcement learning method that learns policies through direct environmental interaction. Comprehensive experimental evaluation demonstrates that our proposed OnDeFog achieves superior performance compared to ODT in environments characterized by high dropping frame rate and outperforms DeFog on datasets containing a large amount of low-reward data.

04.
arXiv (CS.AI) 2026-06-11

When Context Returns: Toward Robust Internalization in On-Policy Distillation

arXiv:2606.11627v1 Announce Type: cross Abstract: Recent work has shown that on-policy distillation can internalize privileged context, such as system prompts or task hints, into a student model so that the context is no longer needed at inference time. Although this approach successfully improves the student's no-context performance, we identify an interesting and previously unstudied phenomenon: in many settings, reintroducing the original privileged context to the distilled student actually degrades its performance, even on instances it already solves correctly without context. We term this context-induced degradation and argue that robust internalization demands not only matching the teacher's context-conditioned behavior, but also remaining stable when the context is reintroduced, a property we call context removability. Motivated by this observation, we propose a lightweight consistency regularizer that first anchors the student's no-context output via stop-gradient, then penalizes the context-conditioned output for deviating from it via forward KL divergence. This simple addition requires only one extra forward pass per training step, yet it effectively mitigates context-induced degradation and, in many cases, even improves no-context performance. Across 12 configurations spanning diverse domains and model families, our method improves context-conditioned accuracy in the majority of settings, reduces context-induced harm in 11 out of 12 settings, and effectively eliminates response-length inflation. A mechanistic case study further confirms that context removability is achieved at the representation level, with hidden states remaining nearly identical regardless of whether the context is present.

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

LOKI: Memory-Free Null-Space Constrained Lifelong Knowledge Editing

arXiv:2606.19679v1 Announce Type: cross Abstract: Lifelong knowledge editing aims to efficiently and sequentially update language models over time, as new knowledge becomes available or when the model makes mistakes, while preserving acceptable performance on past knowledge. One unresolved challenge is that existing methods modify a fixed set of layers for all new knowledge samples, reducing flexibility and increasing catastrophic forgetting. Another is requiring access to previous knowledge and extensive pre-processing to obtain data statistics. To address these challenges, we introduce LOKI, a novel approach that uses dynamic layer selection based on the Hilbert-Schmidt Independence Criterion and projects gradient updates onto the null-space of the model weights, bypassing the requirement for previous knowledge access. We show that LOKI achieves superior performance to existing approaches across a wide variety of experiments, achieving up to a 14\% improvement in average accuracy.

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

Would you still call this Dax? Novel Visual References in VLMs and Humans

Vision-language models (VLMs), like human learners, are frequently exposed to new visual concepts, but how they map novel visual references to language after exposure remains largely underexplored, particularly when those references contradict prior knowledge from pre-training. To study this, we present the Novel Visual References Dataset (NVRD): 19,176 images spanning 90 visual concepts across different levels of visual novelty, each with up to 20 increasingly perturbed versions of the original object to probe generalization. Unlike prior work on visual augmentations of familiar concepts, NVRD comprises entirely novel, open-ended stimuli constructed from scratch, mirroring how humans encounter genuinely new concepts. We evaluate 3 open- and 2 closed-source models alongside 2,400 human judgments for direct human-model comparison, and find that (i) models struggle to acquire novel concepts in-context when they contradict prior knowledge, and (ii) while models and humans show correlated sensitivity to visual perturbations, models significantly overgeneralize, extending learned labels to stimuli that humans reject. We contribute NVRD as a corpus and benchmark for research on visual concept learning in both humans and machines.

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

Few-Shot Biomedical Relation Extraction with Large Language Models: A Viable Alternative to Supervised Learning?

Biomedical relation extraction (BioRE) is a key step in transforming biomedical literature into structured knowledge. However, most existing approaches rely on supervised models trained on costly annotated datasets, limiting their scalability and adaptability across relation types and domains. We investigate few-shot BioRE using prompt-based learning with large language models (LLMs) and compare two task formulations: pairwise classification, which predicts relations for individual entity pairs, and joint generation, which extracts multiple relations in a single model call. Experiments on the BioREDirect dataset reveal a clear precision-recall trade-off. Pairwise classification achieves higher recall, whereas joint generation is more precise and computationally efficient. The best-performing model achieves a micro-F1 score of 0.44, substantially outperforming previous few-shot results (0.34) while remaining below the supervised baseline (0.56). Much of this gap is attributable to a single ambiguously defined relation type. When evaluated using macro-F1, which better captures performance across relation types in an imbalanced setting, prompt-based approaches outperform the supervised baseline (0.45 vs. 0.38), particularly on rare relation types. These findings highlight the potential of LLMs for BioRE in low-resource settings and underscore the importance of well-defined relation schemas.

08.
bioRxiv (Bioinfo) 2026-06-11

OCOO-T : A SIMPLE AND SCALABLE VIRTUAL CELL MODEL FOR TRANSCRIPTIONAL PERTURBATION RESPONSE PREDICTION

Predicting single-cell transcriptional responses to genetic, chemical and cytokine perturbations is a fundamental challenge in computational biology and AI Virtual Cell (AIVC) modeling, with direct implications for drug discovery and the elucidation of gene regulatory networks. Existing approaches often rely on auxiliary cell-state encoders, hierarchical variational autoencoders, dedicated Transformer encoder-decoder modules, or gene-interaction priors to compress high-dimensional expression profiles into latent representations. While effective, these designs increase architectural complexity and may limit scalability and generalizability. This paper introduces OCOO-T, a minimalist flow-matching-based AIVC model for transcriptional perturbation response prediction. OCOO-T utilizes a vanilla Transformer stack that operates directly on continuous gene expression profiles and formulates perturbation response prediction as a continuous-time denoising process. Perturbation embeddings, dosage information, and cell-line/cell-type specificity are integrated through adaptive layer normalization and in-context tokens. Comprehensive evaluations on Tahoe100M, Replogle, and PBMC benchmarks demonstrate that OCOO-T achieves state-of-the-art performance across diverse perturbations and cell types while effectively scaling to long transcriptional profiles through patching and depatching of cellular contexts. By leveraging the simplicity of Transformer-based denoising for single-cell omics, OCOO-T provides an effective and scalable framework for in-silico cellular simulation.

09.
arXiv (CS.LG) 2026-06-15

FreshRetailNet-LT: A Stockout-Annotated Censored Demand Dataset for Latent Demand Recovery and Forecasting in Fresh Retail

arXiv:2505.16319v4 Announce Type: replace Abstract: Accurate demand estimation is critical for the retail business in guiding the inventory and pricing policies of perishable products. However, it faces fundamental challenges from censored sales data during stockouts, where unobserved demand creates systemic policy biases. Existing datasets lack the temporal resolution and annotations needed to address this censoring effect. To fill this gap, we present FreshRetailNet-50K, the first large-scale benchmark for censored demand estimation. It comprises 50,000 store-product time series of detailed hourly sales data from 898 stores in 18 major cities, encompassing 863 perishable SKUs meticulously annotated for stockout events. The hourly stock status records unique to this dataset, combined with rich contextual covariates, including promotional discounts, precipitation, and temporal features, enable innovative research beyond existing solutions. We demonstrate one such use case of two-stage demand modeling: first, we reconstruct the latent demand during stockouts using precise hourly annotations. We then leverage the recovered demand to train robust demand forecasting models in the second stage. Experimental results show that this approach achieves a 2.73% improvement in prediction accuracy while reducing the systematic demand underestimation from 7.37% to near-zero bias. With unprecedented temporal granularity and comprehensive real-world information, FreshRetailNet-50K opens new research directions in demand imputation, perishable inventory optimization, and causal retail analytics. The unique annotation quality and scale of the dataset address long-standing limitations in retail AI, providing immediate solutions and a platform for future methodological innovation. The data (https://huggingface.co/datasets/Dingdong-Inc/FreshRetailNet-50K) and code (https://github.com/Dingdong-Inc/frn-50k-baseline}) are openly released.

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

Privacy-Preserving Federated Autoencoder for ECG Anomaly Detection on Edge Devices

arXiv:2606.11556v1 Announce Type: cross Abstract: Continuous electrocardiography (ECG) monitoring could surface rhythm abnormalities before they escalate into cardiovascular events. However, a deployable system must satisfy three requirements simultaneously: legal-grade privacy (GDPR, HIPAA), real-time inference on constrained edge hardware, and detection quality under non-IID cross-hospital data. We design and evaluate an end-to-end federated system addressing all three for unsupervised 12-lead ECG anomaly detection on PTB-XL dataset, combining three autoencoder families (VanillaAE, ConvAE, VAE), Flower-based federated averaging (FedAvg) across ten simulated hospitals, client-side differentially private SGD (DP-SGD) with a Rényi-DP accountant, and 8-bit integer (INT8) post-training quantization with Raspberry Pi 4 benchmarking. Our main contributions are: an empirical characterization of how these mechanisms compose, practical DP-specific recommendations, and technical and security insights for a clinically sensitive setting. Federated learning matches or exceeds the centralized baseline across all architectures (ConvAE federated area under the ROC curve, AUROC, $0.782$), and an $\varepsilon$ sweep identifies $\varepsilon=4$ as the recommended clinical operating point. INT8 quantization roughly halves model size and cuts Pi 4 latency by up to $44%$ with $

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

Data-Driven Decoding of Russell's Circumplex Model of Affect

Affective computing increasingly relies on deep learning to represent emotions, yet latent spaces often remain opaque, high-dimensional black boxes. This paper investigates whether Transformers' embeddings recover the geometric regularities of Russell's circumplex model. We unify two complementary experiments testing the hypothesis that, after training models on text and speech, their resulting latent spaces encode a topology consistent with valence-arousal and reproduce human-like neighborhood relations. Specifically, we evaluate deep representations extracted from Transformer-based text (RoBERTa) and speech (wav2vec 2.0) encoders, along with a multimodal Transformer fusion architecture, across naturalistic datasets like MSP-Podcast and controlled LLM-generated stimuli. Our analysis reveals that multimodal fusion of text and audio yields perfect topological alignment with Russell's primary emotion ordering. Furthermore, in a zero-shot setting using generic text embeddings, projected fine-grained emotion terms fall close to their established human-mapped coordinates. Our contribution is a novel, data-driven framework for validating emotion models, demonstrating that Russell's circumplex structure is intrinsically encoded in the embeddings of these modalities rather than being solely an artifact of human labeling, thereby bridging the gap between psychological theory and representation learning.

12.
arXiv (CS.CL) 2026-06-15

Fodor and Pylyshyn's Systematicity Challenge Still Stands

The recent successes of neural networks producing human-like language have caused significant stir in cognitive science, with many researchers arguing that classical puzzles about human cognition and challenges to artificial intelligence are being solved by neural networks. A notable case is the argument from systematicity due to Jerry Fodor and Zenon Pylyshyn, argues that humans display systematic biconditional dependencies. For example, someone can understand the sentence "John saw Mary" just in case that they understand the sentence "Mary saw John." Symbolic systems explain this systematicity of language and thought, while neural networks offer no immediate explanation. Several recent articles argue that this challenge has now been met by neural networks. In particular, Brenden Lake and Marco Baroni argue that their meta-learning for compositionality protocol matches and perhaps explains human systematicity. We demonstrate that these conclusions are premature. Among other results, we found that their model struggles to learn rules that are even slightly out of distribution compared to their training data. Furthermore, the model behaves unsystematically even on many within-distribution problems. We conclude that Fodor and Pylyshyn's challenge to neural networks remains unmet.

13.
arXiv (CS.CV) 2026-06-16

BBR-Net: Boundary-Balanced Replay for Continual Medical Image Segmentation

Continual learning for medical image segmentation remains challenging under domain shift because replay-based methods often preserve appearance information without explicitly modeling anatomical structure. This study investigates whether structural consistency governs knowledge retention in continual cardiac ultrasound segmentation. We propose the Boundary-Balanced Replay Network (BBR-Net), which selects replay samples using boundary-aware priority and class balance to preserve anatomically informative regions. The method is evaluated on CAMUS and CardiacNet under forward (CAMUS to CardiacNet) and reverse (CardiacNet to CAMUS) task orders. In the forward setting, BBR-Net retains source-task performance close to an offline joint-training reference, while markedly reducing catastrophic forgetting and preserving competitive target-task adaptation. Ablation results show that boundary-aware prioritization contributes to retention and improves the balance between source-task preservation and target-task adaptation when combined with class-aware sampling. In contrast, the reverse setting reveals that structure-aware replay fails when initial representations are learned from noisy and structurally inconsistent data. To isolate this effect, we conduct a controlled structural perturbation analysis by progressively corrupting source-task boundaries while keeping the dataset, architecture, and training protocol fixed. Forgetting increases consistently as structural reliability decreases, suggesting that replay effectiveness is strongly influenced by the quality of stored structural information, rather than by memory capacity alone. These findings indicate that preserving anatomical structure under domain shift is a central factor in continual medical image segmentation, and that replay mechanisms should account for structural reliability to support robust knowledge retention.

14.
arXiv (CS.CV) 2026-06-11

EvoLMM: Self-Evolving Large Multimodal Models with Continuous Rewards

Recent advances in large multimodal models (LMMs) have enabled impressive reasoning and perception abilities, yet most existing training pipelines still depend on human-curated data or externally verified reward models, limiting their autonomy and scalability. In this work, we strive to improve LMM reasoning capabilities in a purely unsupervised fashion (without any annotated data or reward distillation). To this end, we propose a self-evolving framework, named EvoLMM, that instantiates two cooperative agents from a single backbone model: a Proposer, which generates diverse, image-grounded questions, and a Solver, which solves them through internal consistency, where learning proceeds through a continuous self-rewarding process. This dynamic feedback encourages both the generation of informative queries and the refinement of structured reasoning without relying on ground-truth or human judgments. When using the popular Qwen2.5-VL as the base model, our EvoLMM yields consistent gains upto $\sim$3\% on multimodal math-reasoning benchmarks, including ChartQA, MathVista, and MathVision, using only raw training images. We hope our simple yet effective approach will serve as a solid baseline easing future research in self-improving LMMs in a fully-unsupervised fashion. Our code and models are available at https://github.com/mbzuai-oryx/EvoLMM.

15.
arXiv (quant-ph) 2026-06-11

Controlled ion-ion interactions and cavity-enhanced emission of a coherent dinuclear Eu$^{3+}$ complex

arXiv:2606.11947v1 Announce Type: new Abstract: Molecular rare-earth-ion complexes offer unique opportunities for quantum technologies by combining the intrinsic coherence properties of rare-earth ions with chemically tunable molecular environments. A crucial capability is the realization of multi-qubit architectures with defined qubit couplings to enable two-qubit quantum gates. Here, we investigate the optical coherence properties and excitation-induced interactions of two Eu$^{3+}$-based molecular complexes, comparing a mononuclear reference system with a dinuclear analogue in which two Eu$^{3+}$ ions are positioned at a well-defined intramolecular distance of about 7 Angstrom. Using cryogenic ensemble spectroscopy, including spectral hole burning, free-induction decay, and photon echo measurements at temperatures down to 100 mK, we demonstrate long optical coherence times $T_{2,o}$ of up to 9 $\mu$s. As a key step toward scalable multi-qubit architectures, a control-target sequence was implemented to probe conditional ion-ion interactions, revealing a stronger interaction-induced dephasing in the dinuclear complex. Finally, we show the integration of the dinuclear complex into a fiber-based optical microcavity, and observe an 380-fold emission enhancement of the $\mathrm{}^5\mathrm{D}_0\rightarrow\mathrm{}^7\mathrm{F}_0$ transition. Together, these results position molecular rare-earth complexes as versatile and chemically tunable building blocks for scalable quantum technologies.

16.
arXiv (math.PR) 2026-06-16

Experimentation for Different Scheduling Policies on Queues: Mixed Differences-in-Q Estimators Based on Little's Law

arXiv:2605.29641v2 Announce Type: replace-cross Abstract: In data centers, tasks are dispatched to various servers to evenly distribute the workload. When a data center considers implementing a new scheduling algorithm, it typically conducts an A/B test prior to deployment to assess the real-world impact of this new method. However, a straightforward A/B test might be interfered with so-called ``Markovian'' interference. We utilized the Differences-in-Q estimator, as developed by Farias et al. (2022), and introduced mixed Differences-in-Q estimators grounded in Little's Law. We show that our A/B testing methods significantly reduce bias and variance when testing various scheduling policies. Extensive simulations were conducted under scenarios like non-stationary arrival rates, heterogeneous service rates, and communication delays. These simulations highlight the robustness and efficacy of our A/B testing approach.

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

Recursive Binding on a Budget: Subspace Carving in Order-p Tensor Memories

arXiv:2606.11391v1 Announce Type: new Abstract: Tensor Product Representations provide the structural fidelity required for symbolic reasoning in models but suffer from exponential dimensionality growth when encoding deep recursive structures. Conversely, Vector Symbolic Architectures maintain constant dimensionality but sacrifice capacity and fidelity due to noisy compression via superposition. In this work, we propose Orthogonal Subspace Carving (OSC), a memory architecture that binds fillers to roles by projecting onto the null space of the role basis before aggregating into a fixed order-p tensor. OSC uses projections to enforce geometric orthogonality between bound structures within a static memory trace. We show that this mechanism decouples the tensor order from the structural depth, enabling deep recursive binding within a constant memory footprint. By performing retrieval via recognition, this construction allows for component vectors that are orders of magnitude smaller than the memory tensor, giving superior memory efficiency in settings involving high superposition. We also show that TPR is a special case of binding in Clifford algebra, and give a Clifford formulation of OSC.

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

Structural MRI Synthesis for Alzheimer's Disease via Conditional Diffusion on Anatomical Masks

arXiv:2606.18354v1 Announce Type: cross Abstract: Recent advances in generative machine learning models have significantly improved medical imaging, offering promising solutions for data augmentation, privacy preservation, and improved model generalization. However, synthesizing high-quality structural MRI data for Alzheimer's Disease (AD) remains challenging due to the subtle, region-specific, and progressive anatomical changes associated with neurodegeneration. In this paper, we extend the Med-DDPM conditional diffusion model – originally designed for brain tumor synthesis – to generate 3D structural MRIs specifically tailored to AD. We adopted Med-DDPM due to its established stability and structural fidelity compared to other generative models, which makes it particularly suitable for capturing the subtle anatomical changes characteristic of AD. Our approach conditions the diffusion process on anatomical segmentation masks derived from the ADNI dataset, incorporating key AD-relevant brain structures into the generation process. We systematically evaluate the quality and utility of the synthetic images by training segmentation models on real, synthetic, and hybrid (mixed) datasets. Experimental results demonstrate that segmentation models trained exclusively on synthetic data achieve comparable Dice scores (0.6532) to those trained on real data (0.6513), while exhibiting significantly enhanced recall. Notably, models trained on hybrid datasets (mixing real and synthetic images) outperform both real and synthetic-only baselines, achieving a Dice score of 0.7244. These findings underscore the successful use of conditional diffusion models for generating anatomically accurate, AD-specific synthetic MRIs, and highlight their potential for enhancing training data availability, improving diagnostic accuracy, and promoting research reproducibility in neuroimaging studies.

19.
medRxiv (Medicine) 2026-06-19

Cardiometabolic multimorbidity and care experiences in primary healthcare among Brazilian adults aged 50 and over (ELSI-Brazil)

Background: Population aging and the rising burden of non-communicable diseases have increased the prevalence of cardiometabolic multimorbidity (CM-MM) among older adults. Patient-reported experience measures (PREMs) are recognized as essential components of healthcare quality assessment, yet evidence on primary care experiences among individuals with CM-MM remains scarce. Objective: To analyze primary care experiences according to the presence of cardiometabolic multimorbidity among Brazilians aged 50 years and older. Methods: Cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021; n = 9,949). CM-MM was defined as the self-reported coexistence of two or more of the following conditions: hypertension, diabetes mellitus, dyslipidemia, acute myocardial infarction, and stroke. Primary care experiences were assessed using a validated 12-item instrument organized into four domains: first-contact access, longitudinality, communication, and care coordination. Associations were estimated using Poisson regression adjusted for sociodemographic, health conditions, and healthcare utilization variables, with stratified analysis by Family Health Strategy (FHS) coverage. Results: CM-MM prevalence was 25.5%, with a progressive increase by age and an inverse gradient by education. Individuals with CM-MM reported significantly more positive experiences in longitudinality (mean index 2.53 vs. 2.34; adjusted PR = 1.22; 95%CI 1.12-1.33; p < 0.001) and, to a lesser extent, in communication (mean index 2.68 vs. 2.58; adjusted PR = 1.10; 95%CI 1.00-1.20; p = 0.041). No statistically significant differences were found in first-contact access or care coordination. After stratified by FHS coverage, the observed differences in longitudinality and communication were no longer statistically significant. Conclusions: CM-MM was associated with more positive primary care experiences in longitudinality and communication. The absence of differentiated experiences in first-contact access and coordination highlights structural gaps in primary care responsiveness to individuals with greater clinical complexity. Keywords: Multimorbidity; Cardiometabolic diseases; Primary Care; Patient-reported experience measures; Older adults; ELSI-Brazil.

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

Risk Stratification for ICU Delirium using Pervasive Ambient Sensing Information

arXiv:2606.19292v1 Announce Type: new Abstract: Delirium is a common and serious complication in the Intensive Care Unit (ICU), associated with increased morbidity, prolonged hospital stays, and higher healthcare costs. Despite its prevalence, early prediction and prevention remain challenging. Environmental factors such as ambient sound and light may influence the onset of delirium, yet they are often overlooked in risk assessments. In this study, we examined whether light intensity and sound pressure levels can independently predict delirium across multiple prediction horizons. We evaluated four efficient sequential neural network models on data collected from 9 ICUs across 309 patients to predict delirium for 10 prediction-window sizes. We reported feature importance and direction of influence using Shapley Additive Explanations analysis. The convolutional model achieved the strongest discrimination, with AUC = 0.80 on sound data and on combined data. Sound features were the dominant predictors overall. Integrating sound with light improved short-term ($

21.
medRxiv (Medicine) 2026-06-16

Care Delivery Gap framework: a proof-of-concept patient-reported measure of guideline-referenced care-process omissions in sickle cell disease

Abstract Background:Sickle cell disease (SCD) is concentrated in sub-Saharan Africa, where delivery of guideline-referenced care remains challenging. Current evaluation approaches rely largely on access indicators and clinical outcomes, which do not directly measure care delivery. We developed the Care Delivery Gap (CDG) framework, a patient-reported approach for identifying care-process omissions, and conducted a proof-of-concept study to assess feasibility and explore variation across income strata. Methods: We conducted a cross-sectional framework-development study involving a proof-of-concept sample of 52 individuals with SCD or caregivers recruited through clinics and moderated SCD communities across Africa, North America, and Europe between June 2025 and March 2026. The CDG framework assessed patient-reported omissions in specialist involvement, follow-up continuity, cardiovascular screening, and biochemical surveillance. Analyses were descriptive. Results: Substantial multi-domain care-process omissions were identified despite high reported healthcare engagement. Across geographic income strata, cardiovascular screening was reported by 4/35 (11%) LMIC versus 16/17 (94%) HIC participants, and regular follow-up within the preceding 12 months by 14/35 (40%) versus 16/17 (94%), respectively. High CDG scores, representing 1 omissions across three or four domains, occurred in 20/35 (57%) LMIC compared with 1/17 (6%) HIC participants. Similar disparities were observed across specialist review and vitamin B12 surveillance domains. Conclusion: A structured patient-reported framework identified multi-domain omissions in guideline-referenced SCD care, including among individuals reporting healthcare access. The divergence between access indicators and reported care delivery suggests that service contact alone may not reflect care quality. The framework provides a feasible foundation for future process-level quality measurement in high-burden settings.

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

PASQA: Pitch-Accent-Focused Speech Quality Assessment Model Trained on Synthetic Speech with Accent Errors

Existing mean opinion score (MOS) prediction models typically predict utterance-level naturalness MOS and can be insensitive to localized pitch-accent errors. We propose Pitch-Accent-focused Speech Quality Assessment (PASQA), which explicitly targets pitch-accent correctness. To train our model, we construct a controlled Japanese accent-error dataset by changing accent patterns using an accent-controllable text-to-speech system, and compute a pseudo accent-quality score from the accent-error rate. PASQA builds on self-supervised representations and employs mora-conditioned fusion, ranking loss, an auxiliary accent-error localization task, and speaker-invariant training. Experiments show that conventional models fail to preserve the ordering by accent-error severity, whereas PASQA achieves high ordering accuracy on both seen and unseen speakers. Further, PASQA shows stronger agreement with human accent-correctness judgments. The code is available at https://github.com/lycorp-jp/PASQA.

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

Structural Role Injection in Handlebars-Templated LLM Prompts: Triple-Brace Interpolation, Delimiter Family, and the Limits of HTML Auto-Escaping

Large language model applications build prompts from templates, and Handlebars is a widely used templating engine and the default prompt-template format in Microsoft Semantic Kernel. Its double-brace {{x}} expression HTML-escapes the interpolated value and is documented as the safe default; its triple-brace {{{x}}} expression inserts the value raw. We show that this choice silently governs an application's exposure to structural role injection, where attacker-controlled data carries chat role delimiters that forge a higher-privilege turn. A model-free analysis establishes the mechanism: Handlebars escaping rewrites angle brackets but not square brackets, colons, or Markdown hashes, so it neutralises ChatML, Llama-3, and XML role delimiters (survival rate 0.00) while leaving Llama-2 [INST], legacy Human:/Assistant:, and Markdown ### delimiters intact (survival rate 1.00 for the last two). We then run 5760 trials across seven delimiter families, two attack objectives, and four models (GPT-3.5 Turbo, GPT-4o mini, GPT-4.1 mini, Claude Haiku 4.5) at a combined API cost of 1.63 USD. GPT-3.5 Turbo follows the task-hijack instruction in 97% of raw and 91% of escaped trials, with the escaping protection concentrated in the angle-bracket families and absent for the colon- and Markdown-based families; the harder secret-exfiltration objective, which does not saturate, exposes the same family interaction more cleanly. Claude Haiku 4.5 resists both objectives almost entirely. The escaped default protects only the delimiter schemes whose characters HTML escaping happens to cover, gives no protection for the rest, and cannot substitute for a structural separation of instruction and data.

25.
arXiv (CS.CV) 2026-06-15

Pix2Pix-Hybrid: Structure-Guided Conditional Synthesis of Hajj Crowd Images with Multi-Channel Conditioning and Weak Attribute Supervision

Developing accurate crowd-counting models for Hajj pilgrimage scenes remains challenging because domain-specific annotated images are scarce and data collection during large gatherings raises privacy concerns. To address these limitations, this paper proposes Pix2Pix-Hybrid (P2P-H), a hybrid conditional GAN for structure-guided Hajj crowd-image synthesis and data augmentation. P2P-H builds on Pix2Pix and employs a U-Net generator conditioned on eight input channels that jointly encode structural cues (edges and grayscale) and contextual attributes (crowd density and time of day). To capture detailed textures in dense scenes, the framework integrates two multi-scale PatchGAN discriminators operating at different resolutions. The training procedure combines adversarial, perceptual, and feature-matching objectives with adaptive data augmentation and stabilization strategies. The model was trained on 993 real Hajj frames collected from 60 publicly available video sources, with conditioning attributes derived automatically to reduce manual labeling effort. Using this framework, we constructed CrowdH, a synthetic dataset of 10,000 high-resolution Hajj crowd images. Experimental results show that P2P-H improves structure-preserving conditional synthesis quality compared with Pix2Pix and StyleGAN2-ADA baselines and shows favorable transfer to other crowd datasets. To assess downstream utility, we further constructed CrowdH-Mix-469, an annotated mixed real-synthetic dataset comprising 384 real Hajj images and 85 selected synthetic images,and evaluated five crowd-counting models under real-only and real-plus-synthetic training. The selected synthetic data reduced MAE across all five models, with the strongest gain observed for CSRNet.