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

Q-Learning with Fine-Grained Gap-Dependent Regret

arXiv:2510.06647v2 Announce Type: replace-cross Abstract: We study fine-grained gap-dependent regret bounds for model-free reinforcement learning in episodic tabular Markov Decision Processes. Existing model-free algorithms achieve minimax worst-case regret, but their gap-dependent bounds remain coarse and fail to fully capture the structure of suboptimality gaps. We address this limitation by establishing fine-grained gap-dependent regret bounds for both UCB-based and non-UCB-based algorithms. In the UCB-based setting, we develop a novel analytical framework that explicitly separates the analysis of optimal and suboptimal state-action pairs, yielding the first fine-grained regret upper bound for UCB-Hoeffding (Jin et al., 2018). To highlight the generality of this framework, we introduce ULCB-Hoeffding, a new UCB-based algorithm inspired by AMB (Xu et al.,2021) but with a simplified structure, which enjoys fine-grained regret guarantees and empirically outperforms AMB. In the non-UCB-based setting, we revisit the only known algorithm AMB, and identify two key issues in its algorithm design and analysis: improper truncation in the $Q$-updates and violation of the martingale difference condition in its concentration argument. We propose a refined version of AMB that addresses these issues, establishing the first rigorous fine-grained gap-dependent regret for a non-UCB-based method, with experiments demonstrating improved performance over AMB.

02.
arXiv (CS.CV) 2026-06-11

Task-Aware Structured Memory for Dynamic Multi-modal In-Context Learning

Multi-modal large language models (MLLMs) depend on in-context learning (ICL) for rapid task adaptation, but their scalability is severely limited by finite context windows and the growing cost of key-value (KV) caches in long multi-modal sequences. Existing memory compression approaches typically rely on rigid token removal or sample-dependent importance estimation, which introduces bias, disrupts semantic structure, particularly for visual representations, and yields static memories that cannot adapt to new queries. We introduce TASM (Task-Aware Structured Memory), a training-free framework that addresses these limitations through task-aware, structure-preserving, and dynamically accessible memory construction. TASM employs task-vector guided compression to replace sample-specific signals with a task-level direction that captures shared relevance across demonstrations. To preserve the underlying manifold, it applies semantics-aware token merging via bipartite graph matching, aggregating tokens without destructive pruning. Finally, TASM structures memory into a hierarchy comprising a compact Core Memory and a Latent Bank, facilitating query-adaptive dynamic retrieval. Evaluations confirm TASM maintains high performance under heavy compression, effectively balancing efficiency with adaptability.

03.
medRxiv (Medicine) 2026-06-18

Cost-effectiveness of a virtual fracture clinic versus traditional in-person fracture clinic care for adults with acute simple fractures: a protocol for a health economic evaluation within the RECITAL trial

ABSTRACT Introduction Traditional in-person fracture clinics are often overcrowded and inconvenient for patients. Virtual fracture clinics aim to address some of these concerns by improving the efficiency of the orthopaedic service and reducing unnecessary interventions while maintaining safety and quality of care. The RECITAL trial is a non-inferiority randomised controlled trial comparing follow-up care provided at a virtual fracture clinic for people with acute simple fractures to follow-up care provided at an in-person fracture clinic. This study describes the protocol for an economic evaluation of RECITAL where the primary aim is to investigate the cost-effectiveness of a virtual fracture clinic compared with traditional in-person fracture clinic care from a health system perspective. Methods and analysis The RECITAL trial recruited 312 participants with acute simple fractures and randomised them to receive follow-up care provided at a virtual fracture clinic or follow-up care provided at an in-person fracture clinic. We will conduct a within-trial analysis from a health system perspective (primary analysis), as well as a health service, patient and societal perspective. The economic evaluation will estimate the difference in the cost of resource inputs on an intention to treat basis used by participants in the two arms of the trial, allowing comparisons to be made between the in-person and virtual fracture clinics. Data for intervention costs and healthcare utilisation will be collected from trial records, hospital electronic medical records and district performance units. The results of the economic evaluation will be expressed in terms of incremental cost per utility weight gained at 12 weeks and will be plotted on a cost-effectiveness plane. Bootstrapping by resampling will be used to estimate 95% confidence intervals around costs and outcomes, and to calculate the confidence intervals around the incremental cost-effectiveness ratio. A cost-effectiveness acceptability curve (CEAC) will be plotted, which will provide information about the probability that an intervention is cost-effective, given the level of a decision makers willingness to pay for each additional outcome. Ethics and Dissemination The trail was approved by the SLHD Ethics Review Committee (RPAH Zone) (X23-0200 and 2023/ETH01038). The findings will be disseminated through a peer-reviewed journal and conference presentations. Trial registration number The trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ANZCTR; 12623000934640)

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

Process-Verified Reinforcement Learning for Theorem Proving via Lean

arXiv:2606.20068v1 Announce Type: new Abstract: While reinforcement learning from verifiable rewards (RLVR) typically has relied on a single binary verification signal, symbolic proof assistants in formal reasoning offer rich, fine-grained structured feedback. This gap between structured processes and unstructured rewards highlights the importance of feedback that is both dense and sound. In this work, we demonstrate that the Lean proof assistant itself can serve as a symbolic process oracle, supplying both outcome-level and fine-grained tactic-level verified feedback during training. Proof attempts are parsed into tactic sequences, and Lean's elaboration marks both locally sound steps and the earliest failing step, yielding dense, verifier-grounded credit signals rooted in type theory. We incorporate these structured rewards into a GRPO-style reinforcement learning objective with first-error propagation and first-token credit methods that balances outcome- and process-level advantages. Experiments with STP-Lean and DeepSeek-Prover-V1.5 show that tactic-level supervision outperforms outcome-only baselines in most settings, delivering improvements on benchmarks such as MiniF2F and ProofNet. Beyond empirical gains, our study highlights a broader perspective: symbolic proof assistants are not only verifiers at evaluation time, but can also act as process-level reward oracles during training. This opens a path toward reinforcement learning frameworks that combine the scalability of language models with the reliability of symbolic verification for formal reasoning.

05.
arXiv (quant-ph) 2026-06-15

Local correlations in long-range dual-unitary kicked Hamiltonian chains

arXiv:2606.13857v1 Announce Type: new Abstract: Many-body Floquet models with exact space–time symmetry, such as the kicked Ising spin chain (KIC), provide natural examples of systems with dual-unitary dynamics. The requirement of exact space–time symmetry is, however, highly restrictive, as it permits only nearest-neighbor interactions. Based on a pair of Hadamard matrices, we construct a wide family of dual-unitary kicked spin chains with long-range interactions. We show that local two-point correlations in such models propagate along the light-cone edges \( |n| = r|t| \), where \(r\) is the interaction range, and can be derived analytically for operators with local support. This approach is illustrated using the example of a kicked Ising spin chain with next-to-next-neighbor interactions.

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

Collective neutrino oscillations: Many-body non-forward effects and non-classicality

arXiv:2606.12404v1 Announce Type: cross Abstract: Neutrino evolution in dense astrophysical environments is typically described either within a quantum kinetic framework, which neglects the build-up of multi-body correlations, or through simplified many-body calculations that allow significant entanglement to develop. In this work, we compare these two approaches in a simple neutrino-gas configuration, with particular emphasis on the role of non-forward scattering processes. These effects are incorporated either through a collision term in the kinetic description, or by considering the full neutrino-neutrino many-body Hamiltonian. We highlight differences between the two descriptions in both their characteristic timescales and asymptotic behavior. Motivated by the natural suitability of quantum computing for many-body calculations, we further investigate the non-classicality of neutrino evolution, discussing Trotter error scaling, along with the associated costs of constructing quantum circuits in terms of entangling gates and non-Clifford gates. We find that the resources needed for neutrino many-body evolution are on the low end of typical high-energy physics problems and on the mid to high end with respect to quantum chemistry problems. For the full Hamiltonian, resource requirements increase relative to the truncated version. We emphasize the importance of efficient fermion-to-qubit encodings, which are essential for reducing the substantial computational resources required for such simulations.

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

Leverage Is Not Reach: A Control-Window Law for Single-Neuron Steering in Language Models

Aligned language models gate behaviors such as refusal and language routing through sparse feed forward neurons, yet no theory predicts when a single neuron intervention controls a behavior coherently rather than collapsing the output. We develop a budget normalized control window framework for single neuron steering. A dose along one write direction reduces to one control coordinate: the alignment between the residual stream and the write, driven along a universal saturation curve in units of a coherence budget set by the residual norm divided by the write norm. Coherent control exists when a behavior trigger lies below the collapse ceiling. The same coordinate governs benign mode switches and refusal; the ceiling follows from weights and one generic forward pass, while triggers are measured at rollout. On fifteen held out neurons, the predicted ceiling has mean absolute error 0.14, about 0.07 in bulk layers, and the committed open or closed verdict holds on eleven against a ten of fifteen majority baseline. Closed cases expose three failure modes rather than violations: collapse before trigger, too little depth to propagate, or a normalization that caps how far one neuron can push. The law explains why local gradient attribution anti predicts control: true controllers write off the readout axis and carry a near zero first order gradient. A forward only contrastive screen made precise by the window recovers controllers that attribution misses. On refusal, the hardest case, intervention success is typed, not scalar: coherent bypass and strict actionable reach separate, so a neuron can flip refusal in fluent, on task text with no actionable content, and genuine actionable reach appears only for three of six audited Llama pivots and only at later rollout horizons. Single neuron steering is therefore a budgeted, typed audit of controllability rather than a fixed dose anecdote.

08.
arXiv (CS.LG) 2026-06-18

Reliable Neural-Codec Text-to-Speech by ASR Self-Verification and Distillation: Near-Zero Catastrophic Failures Across Models and Codecs

arXiv:2606.18323v1 Announce Type: cross Abstract: Open autoregressive neural-codec text-to-speech (TTS) models sound excellent on typical inputs yet suffer stochastic catastrophic failures: on a meaningful fraction of utterances they emit silence, terminate early, or collapse into repetitive or hallucinated content. We show this failure mode is cheap to remove. Under a single format-robust metric (a catastrophic-failure rate via an ASR round-trip), best-of-N ASR self-verification drives failures to near-zero: no observed failures remain by N=2 on a standard corpus (LibriSpeech) and by N=4 on a hard prompt set. This is not an artifact of one model: the reduction replicates across four open codec-TTS systems and three neural codecs (XCodec2, SNAC, Mimi), reaching the near-zero floor by N=2 on three of the four. We then make the fix free at inference time by distilling the self-verified behaviour into the model, which recovers much of the robustness in single-shot decoding, closing ~52-58% of the failure mass on hard inputs at no test-time cost. The distillation gain concentrates where it is needed (hard inputs); on already-reliable prose there is no headroom and no detectable change. A controlled comparison adds a clean negative: offline direct preference optimization (DPO/IPO) does not beat plain supervised distillation, and an online iterative variant is promising but not statistically separable at our evaluation size. We report honestly the one model that resists (a larger Llasa where scale did not obviously help) and a rare-word capability ceiling that no self-distillation method overcomes

09.
arXiv (math.PR) 2026-06-11

Improved Amenability Bounds for Local Coordination Games

arXiv:2606.01963v2 Announce Type: replace-cross Abstract: We study local pure coordination games on finite social networks, continuing the framework of Hutchcroft, Rospuskova, and Tamuz. They showed that low inefficiency in local coordination forces the underlying graph to be amenable, with a square-root loss in the amenability parameter. We improve this loss in the binary unbiased setting. Using Shapley values of a mutual-information game associated with the players' local outputs, we prove that if the average disagreement is at most $\varepsilon$, then the graph is $(O(\varepsilon\log(1/\varepsilon)),r)$-amenable. This gives a sharper quantitative converse between local coordination and graph amenability.

10.
arXiv (CS.CL) 2026-06-12

InnoEval: On Research Idea Evaluation as a Knowledge-Grounded, Multi-Perspective Reasoning Problem

The rapid evolution of Large Language Models has catalyzed a surge in scientific idea production, yet this leap has not been accompanied by a matching advance in idea evaluation. The fundamental nature of scientific evaluation needs knowledgeable grounding, collective deliberation, and multi-criteria decision-making. However, existing idea evaluation methods often suffer from narrow knowledge horizons, flattened evaluation dimensions, and the inherent bias in LLM-as-a-Judge. To address these, we regard idea evaluation as a knowledge-grounded, multi-perspective reasoning problem and introduce InnoEval, a deep innovation evaluation framework designed to emulate human-level idea assessment. We apply a heterogeneous deep knowledge search engine that retrieves and grounds dynamic evidence from diverse online sources. We further achieve review consensus with an innovation review board containing reviewers with distinct academic backgrounds, enabling a multi-dimensional decoupled evaluation across multiple metrics. We construct comprehensive datasets derived from authoritative peer-reviewed submissions to benchmark InnoEval. Experiments demonstrate that InnoEval can consistently outperform baselines in point-wise, pair-wise, and group-wise evaluation tasks, exhibiting judgment patterns and consensus highly aligned with human experts.

11.
arXiv (quant-ph) 2026-06-16

Experimental Observation of Dynamical Phase Transitions in a Dephased Photonic Quantum Walk

arXiv:2606.15935v1 Announce Type: new Abstract: Dynamical phase transitions in open quantum systems govern how non-equilibrium states relax toward a stationary state. We study these transitions experimentally using a discrete-time photonic quantum walk on a three-node graph. A tunable synthetic gauge flux and calibrated dephasing allow us to control time-reversal symmetry and the detailed balance properties of the effective Markovian dynamics. With detailed balance, we observe a first-order dynamical phase transition marked by a crossing of real Liouvillian eigenvalues. When detailed balance is broken, we observe a second-order dynamical phase transition at an exceptional point where eigenvalues and eigenvectors coalesce. By progressively reducing the dephasing strength, we track the crossover toward the quantum-coherent regime and determine that the transitions persist down to a finite threshold. Our results link Liouvillian spectral topology to relaxation criticality and demonstrate a controllable platform for engineered dissipative dynamics.

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

STRIDE: Strategic Trajectory Reasoning via Discriminative Estimation for Verifiable Reinforcement Learning

arXiv:2606.15866v1 Announce Type: new Abstract: Reinforcement Learning with Verifiable Rewards (RLVR) has become an effective post-training paradigm for improving the reasoning abilities of large language models. However, existing RLVR methods typically rely on final-answer correctness to assign trajectory-level rewards, providing sparse supervision and treating all tokens uniformly regardless of their actual contribution to reasoning. Although recent studies introduce intermediate signals such as process rewards, high-entropy tokens, and semantic uncertainty, these signals are often not inherently verifiable and may fail to distinguish beneficial strategic patterns from harmful ones. To address this limitation, we propose STRIDE (Strategic Trajectory Reasoning with Discriminative Estimation), a fine-grained RLVR framework that derives strategic reasoning supervision from verifiable outcomes. STRIDE contrasts successful and failed trajectories within each response group to estimate the outcome-discriminative preference of each $n$-gram strategic pattern, and further combines this signal with reasoning saliency entropy to identify decision-relevant strategic patterns. These patterns are assigned differentiated advantage values during RL optimization, enabling more precise credit assignment while preserving the verifiability of RLVR. Extensive experiments demonstrate that STRIDE consistently improves reasoning performance across diverse models, tasks, and extended settings, including VLMs and agent-based systems.

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

TRAP: Benchmark for Task-completion and Resistance to Active Privacy-extraction

arXiv:2606.18996v1 Announce Type: cross Abstract: Agents are increasingly deployed in document-intensive workflows where sensitive private information is not an edge case but a routine input, e.g., an agent booking a flight needs passport numbers. In such settings, the agent must use private information to complete tasks accurately while never exposing it in its responses, because it cannot verify who is actually at the keyboard. These two obligations are in fundamental tension. A model capable enough to use private information for task completion can, by the same capability, be induced to reveal it. To evaluate the trade-off of task accuracy and privacy leakage, we introduce Task-completion and Resistance to Active Privacy-extraction (TRAP). Each scenario includes a document containing private information, a task query that requires the agent to invoke the correct tool using private fields, and an attack query that attempts to elicit the same information in natural language. Evaluating 22 models spanning frontier proprietary and open-source models at multiple scales, we find that all model families exhibit non-trivial leakage, and that instruction-following ability correlates with leakage rate. Existing prompt-based defenses reduce leakage but at significant cost to task accuracy. Prompt optimization fails to escape this trade-off. We demonstrate that this failure is not incidental. For any softmax-based model, no soft-constraint defense, e.g., prompt-based defenses, can jointly achieve high task success with zero leakage probability. Motivated by this impossibility result, we propose structural private field isolation, which replaces private fields with hash keys before they reach the model. This approach largely prevents leakage while keeping task accuracy.

14.
arXiv (CS.AI) 2026-06-12

Exploring How Agent Voice Accents Shape Human-AI Collaboration in K-12 Group Learning

arXiv:2606.12805v1 Announce Type: cross Abstract: Collaboration is widely recognized as a cornerstone of 21st-century education, yet teachers still encounter persistent challenges in fostering productive peer interaction. LLM conversational peer agents introduce new possibilities for mediating in-person group work, raising questions about how persona design, particularly their voice characteristics, shapes learners' perceptions, trust, and interactional dynamics. While prior work has examined agent accent effects in one-to-one settings, little is known about how these effects manifest in groups. We conducted a between-subjects mixed-methods study with 33 teachers examining how a GenAI voice agent with different accents (British, Indian, and African American) influenced collaboration and agent perception. Across surveys, group interaction analyses, and artifacts, we find that accent shaped participants' mental models and the roles the agent assumed in group interaction. The British-accented agent was largely treated as a tool and engaged in detached, utility-based ways, whereas Indian- and African American-accented agents were more readily anthropomorphized and integrated as peers. These role expectations influenced trust, engagement, and reliance over time. This work advances understanding of how GenAI's sociolinguistic design features shape group dynamics in CSCL, with implications for designing culturally inclusive AI partners in group learning.

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

Exploding and vanishing gradients in deep neural networks: the effect of residual connections

arXiv:2606.17013v1 Announce Type: cross Abstract: The well known phenomenon of exploding and vanishing gradients in deep neural networks is analyzed using multiplicative ergodic theory. The effect of adding a residual connection is explained in this context. Specifically, a characterization of Liapunov exponents due to Furstenberg and Kifer is exploited in order to make a precise statement about the Liapunov spectrum and the effect of residual connections on it.

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

LingxiDiagBench: A Multi-Agent Framework for Benchmarking LLMs in Chinese Psychiatric Consultation and Diagnosis

Mental disorders are highly prevalent worldwide, but the shortage of psychiatrists and the inherent subjectivity of interview-based diagnosis create substantial barriers to timely and consistent mental-health assessment. Progress in AI-assisted psychiatric diagnosis is constrained by the absence of benchmarks that simultaneously provide realistic patient simulation, clinician-verified diagnostic labels, and support for dynamic multi-turn consultation. We present LingxiDiagBench, a large-scale multi-agent benchmark that evaluates LLMs on both static diagnostic inference and dynamic multi-turn psychiatric consultation in Chinese. At its core is LingxiDiag-16K, a dataset of 16,000 EMR-aligned synthetic consultation dialogues designed to reproduce real clinical demographic and diagnostic distributions across 12 ICD-10 psychiatric categories. Through extensive experiments across state-of-the-art LLMs, we establish key findings: (1) although LLMs achieve high accuracy on binary depression–anxiety classification (up to 92.3%), performance deteriorates substantially for depression–anxiety comorbidity recognition (43.0%) and 12-way differential diagnosis (28.5%); (2) dynamic consultation often underperforms static evaluation, indicating that ineffective information-gathering strategies significantly impair downstream diagnostic reasoning; (3) consultation quality assessed by LLM-as-a-Judge shows only moderate correlation with diagnostic accuracy, suggesting that well-structured questioning alone does not ensure correct diagnostic decisions. We release LingxiDiag-16K and the full evaluation framework to support reproducible research at https://github.com/Lingxi-mental-health/LingxiDiagBench.

17.
arXiv (CS.CV) 2026-06-12

Goal2Pixel: Grounding Goals to Pixels for Vision-Language Navigation

Vision-language models (VLMs) have become a common foundation for vision-and-language navigation in continuous environments (VLN-CE). Yet most VLM-based methods cast navigation as low-level action prediction, an interface that is ambiguous, tied to short-horizon motion primitives, and inefficient due to repeated VLM querying. We propose Goal2Pixel, a pure pixel-based paradigm that reformulates VLN-CE as navigable pixel grounding. Rather than predicting actions, Goal2Pixel uses the image plane as a unified spatial interface between VLM reasoning and robot motion: the model predicts a visible navigable pixel to the agent, which is back-projected into a 3D waypoint for forward navigation. For non-forward actions, we append auxiliary directive regions to the image plane, where the left/right/bottom regions are interpreted as turning left, turning right, and stopping, respectively. To enable long-horizon navigation, we propose a visibility-aware keyframe memory for compact and informative history representation. To adapt pretrained VLMs to navigable pixel grounding, we introduce semantic embeddings and coordinate-aware auxiliary losses. Goal2Pixel achieves competitive state-of-the-art performance while requiring fewer VLM inference calls than prior methods. On R2R-CE Val-Unseen it achieves 54.1% SR and 52.5% SPL with just 7.75 VLM calls per episode, 6x fewer than the 46.62 required by direct action prediction at 32.9% SR. The same trend holds on RxR-CE.Project Page: https://baobao0926.github.io/Goal2Pixel/.

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

Phys4D: Fine-Grained Physics-Consistent 4D Modeling from Video Diffusion

Recent video diffusion models have achieved impressive capabilities as large-scale generative world models. However, these models often struggle with fine-grained physical consistency, exhibiting physically implausible dynamics over time. In this work, we present Phys4D, a pipeline for learning physics-consistent 4D world representations from video diffusion models. Phys4D adopts a three-stage training paradigm that progressively lifts appearance-driven video diffusion models into physics-consistent 4D world representations. We first bootstrap robust geometry and motion representations through large-scale pseudo-supervised pretraining, establishing a foundation for 4D scene modeling. We then perform physics-grounded supervised fine-tuning using simulation-generated data, enforcing temporally consistent 4D dynamics. Finally, we apply simulation-grounded reinforcement learning to correct residual physical violations that are difficult to capture through explicit supervision. To evaluate fine-grained physical consistency beyond appearance-based metrics, we introduce a set of 4D world consistency evaluation that probe geometric coherence, motion stability, and long-horizon physical plausibility. Experimental results demonstrate that Phys4D substantially improves fine-grained spatiotemporal and physical consistency compared to appearance-driven baselines, while maintaining strong generative performance. Our project page is available at https://sensational-brioche-7657e7.netlify.app/

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

Encoder Winners Do Not Reliably Transfer Across VLA Backbone Scale: A Frozen-Backbone Grafting Diagnostic

Vision-language-action (VLA) policies typically inherit their vision encoder from upstream VLM releases, but it is unclear whether an encoder choice validated on a small VLA transfers to a larger backbone. We introduce a frozen-backbone grafting diagnostic: the vision tower of a released VLA is replaced by a candidate encoder under a fixed protocol (adaptive average pooling, LayerNorm, and a single trainable linear projector), with the language model and action expert frozen. Across four encoders, two LIBERO suites, two backbones (SmolVLA-450M and $\pi_{0.5}$-3.3B), and two-to-three seeds per cell (40 main grafting runs plus native, LoRA, pooling, and zero-/shuffled-image controls, all scored by offline action MSE), the small-backbone winner does not reliably select the large-backbone top tier: SigLIP is best on SmolVLA across both suites, while on $\pi_{0.5}$ DINOv2-small leads the spatial suite and the object suite is a seed-sensitive near-tie band; three of the four backbone-suite comparisons (and 11 of 12 seed-level cells) support backbone-dependent rankings. The grafting wrapper is itself non-neutral with opposite sign across backbones (+45-56% MSE on the SmolVLA native tower, -50-52% on $\pi_{0.5}$), so all conclusions are conditional on the fixed grafting protocol. We position frozen grafting as a cheap target-backbone diagnostic to run before committing to an encoder at scale, not as a closed-loop deployment claim.

20.
medRxiv (Medicine) 2026-06-15

Investigation of Intra-Fraction Stability and Inter-Fraction Reproducibility of Deep Inspiration Breath-Hold Across Two Hypofractionated Radiotherapy Regimens in the HYPORT Adjuvant Study.

Background: Deep Inspiration Breath Hold (DIBH) is a widely used respiratory motion management technique for minimizing cardiac dose in left-sided breast radiotherapy. In the Breast HYPORT Adjuvant study, DIBH was employed for cardiac sparing in patients without nodal irradiation using a standardized institutional protocol with the Varian Real-time Position Management (RPM) system. Both moderate-hypofractionation (control arm - 40Gy in 15 fractions) and one-week hypofractionation (experimental arm - 26 Gy in 5 fractions) regimens were delivered using this protocol. This study aimed to evaluate the robustness of DIBH by analyzing intra-fraction stability and inter-fraction reproducibility of breath-hold amplitude across the two treatment regimens. Methods: Respiratory waveforms acquired during each treatment session were analyzed to determine the median breath-hold amplitude and its standard deviation during beam delivery. Intra-fraction stability was assessed from vari- ations within individual treatment sessions, while inter-fraction reproducibility was evaluated relative to the simula- tion waveform amplitude across all treatment sessions. These parameters were compared between the two HYPORT regimens to examine breath-hold consistency during treatment delivery. Moreover, an additional comparison was made between the one-week hypofractionation regimen and the first five fractions of the moderate-hypofractionation regimen to evaluate the effect of treatment duration . Lung volumes from free-breathing and DIBH CT scans were analyzed to assess the effectiveness of patient breath-hold training. Results: Both arms demonstrated an average 1.7-fold increase of air volume in lung during the breath-hold position, confirming the effective implementation of DIBH during treatment planning and delivery. Structured training resulted in increased breath-hold amplitudes, with gains of 22.87% and 24.16% with respect to the first trial session in the experimental and control arms, respectively. Both regimens receive equivalent doses for approximately the same air volume in lung . Despite the different prescription doses in the two arms (26 Gy vs. 40 Gy), the experimental arm achieved an equivalent mean heart dose of 2.91% (75.6 cGy) compared with 2.95% (118.51 cGy) in the control arm, suggesting a similar cardiac preservation protocol adopted during treatment planning. Intra-fraction stability was similar between the control arm and the experimental arm, with median amplitude variations of 1.006 mm (95% CI: [0.998-1.015]) and 1.079 mm (95% CI: [1.067-1.097]), respectively. In contrast, inter-fraction reproducibility improved in the experimental arm, with lower deviation from simulation amplitude (0.44 {+/-} 0.24 mm vs. 0.66 {+/-} 0.25 mm) for the entire treatment schedule. The stability and reproducibility of experimental arm were further compared with the first five fractions of the control arm. The results were similar to those of the experimental arm. Conclusion: In this study, we compared two treatment regimens in terms of intra-fraction stability and inter-fraction reproducibility during DIBH radiotherapy. Both regimens demonstrated comparable intra-fraction stability, indicating effective motion management irrespective of treatment duration. However, the experimental arm showed better inter- fraction reproducibility, suggesting more consistent breath-hold performance throughout the treatment course. Based on stability and reproducibility, a reasonable narrowing of the DIBH gating window may be implemented with minor changes to the institutional protocol. The observed trend highlights the potential for improved consistency with the experimental approach and supports further investigation to better understand the underlying factors and strengthen these findings in future studies.

21.
arXiv (math.PR) 2026-06-12

Sub-Riemannian spectral distance

arXiv:2606.12804v1 Announce Type: cross Abstract: We study eigenvalues and eigenfunctions of the ``div-grad type" sub-Laplacian with respect to Popp's volume on a compact equiregular sub-Riemannian manifold $M$. Since Popp's volume is canonically determined by the sub-Riemannian structure of $M$, the spetra of the sub-Laplacian carry geometric meanings. In this paper, we first embed $M$ into the Hilbert space of square-summable sequences using eigenfunctions and then define a spectral distance between two compact equiregular sub-Riemannian manifolds. Our result is a sub-Riemannian analogue of Berard-Besson-Gallot's classical work in the Riemannian case.

22.
arXiv (CS.CV) 2026-06-16

LOCUS: Local Visual Cue Search for Enhancing Fine-Grained Perception in Multimodal Large Language Models

Multimodal Large Language Models (MLLMs) remain unreliable on fine-grained visual perception, even when high-resolution inputs preserve the necessary local details. We identify this limitation as visual context rot: decisive evidence may exist in the full image, yet fail to be reliably selected and used amid redundant visual context. We propose LOCUS (LOcal visual CUe Search), a training framework that teaches MLLMs to internalize local evidence search through a verifiable proxy task. During training, LOCUS provides a local crop as a visual cue and optimizes the model to recover its spatial support in the full image using an IoU-based reward. The visual cue is used only during training, leaving the standard image-question inference interface unchanged. Experiments across fine-grained perception, hallucination, general understanding, and reasoning benchmarks show that LOCUS improves localization-sensitive visual understanding while preserving broad capabilities. Attention analyses further indicate stronger focus on task-relevant evidence regions, suggesting that training-time visual cue search provides an effective route to internalized fine-grained evidence selection.

23.
arXiv (CS.CV) 2026-06-16

A Comprehensive Survey of Knowledge-Based Vision Question Answering Systems: The Lifecycle of Knowledge in Visual Reasoning Task

Knowledge-based Vision Question Answering (KB-VQA) extends general Vision Question Answering (VQA) by not only requiring the understanding of visual and textual inputs but also extensive range of knowledge, enabling significant advancements across various real-world applications. KB-VQA introduces unique challenges, including the alignment of heterogeneous information from diverse modalities and sources, the retrieval of relevant knowledge from noisy or large-scale repositories, and the execution of complex reasoning to infer answers from the combined context. With the advancement of Large Language Models (LLMs), KB-VQA systems have also undergone a notable transformation, where LLMs serve as powerful knowledge repositories, retrieval-augmented generators and strong reasoners. Despite substantial progress, no comprehensive survey currently exists that systematically organizes and reviews the existing KB-VQA methods. This survey aims to fill this gap by establishing a structured taxonomy of KB-VQA approaches, and categorizing the systems into main stages: knowledge representation, knowledge retrieval, and knowledge reasoning. By exploring various knowledge integration techniques and identifying persistent challenges, this work also outlines promising future research directions, providing a foundation for advancing KB-VQA models and their applications.

24.
medRxiv (Medicine) 2026-06-17

Identifying anaphylaxis using weakly-supervised prediction models and natural language processing

Objectives Scalable computable phenotyping algorithms are critical for conducting high-throughput disease-outcome research in large, distributed-data electronic health record (EHR) and claims data settings. We developed and evaluated a claims- and EHR-based computable phenotyping algorithm for anaphylaxis, a rare acute condition that is challenging to accurately identify using claims data alone. Materials and Methods Potential anaphylaxis events came from two healthcare systems (Kaiser Permanente Washington [KPWA] and Vanderbilt University Medical Center [VUMC]). We engineered features from clinical text using automated natural language processing (NLP) methods. We then developed a phenotyping algorithm using four NLP- and diagnosis code-based silver labels (proxies for the gold-standard labels). Gold-standard abstracted outcomes were used to evaluate algorithm performance. Results The largest area under the receiver operating characteristic curve (AUC) was 0.931 for an NLP-based silver-label model at KPWA. Depending on the model and healthcare system site, positive predictive value (PPV) and sensitivity at the threshold of predicted probability that maximized F1 score ranged from 0.52 to 0.77 (PPV) and 0.78 to 1 (sensitivity). Discussion NLP-based silver-label models had large AUC at KPWA but not at VUMC. This may be because clinical text at KPWA is only available for outpatient encounters and secure messaging. High sensitivity for identifying anaphylaxis can be obtained using our best-performing models. Conclusion The best-performing models had better PPV and sensitivity tradeoffs than prior bespoke anaphylaxis models with costly, manually curated features. The simplicity of the approach compared to traditional phenotyping methods allows it to be deployed easily at multiple health care systems.

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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 [≥]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.