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

AgentFairBench: Do LLM Agents Discriminate When They Act?

arXiv:2606.16723v1 Announce Type: new Abstract: Large language model (LLM) agents increasingly take actions (screening applicants, recommending credit, triaging patients), yet fairness for LLMs is still measured by grading answers. We introduce AgentFairBench, a cheap, reproducible, multi-domain benchmark for demographic disparity in the actions of LLM agents. Grounded in a companion framework, the Bias Conduction Framework (BCF, restated here), it spans three regulator-anchored domains: hiring, lending, and medical triage. Synthetic, demographic-neutral profiles are evaluated in counterfactual matched sets that vary only a name-coded race x gender signal (in the Bertrand Mullainathan tradition), under four agent scaffolds of increasing agency (direct, chain-of-thought, multi-agent deliberation, tool-augmented). A NumPy-only harness computes counterfactual flip rate, mean absolute score difference (MASD), action-rate disparity, and tool-invocation disparity, with bootstrap confidence intervals, paired tests, and false-discovery-rate control, for single-digit dollars per model. A live leaderboard with a held-out private split and a contamination canary admits external models by submission. Our pilot (864 decisions plus a test-retest replication) carries a methodological lesson: comparing a six-group score spread against a two-run noise difference overstates disparity by ~ 2.4X through statistic arity alone. Against an arity matched noise floor and an omnibus group test, claude haiku 4 5 shows no demographic effect above sampling noise (0 of 120 pairwise and 0 of 9 omnibus contrasts survive correction); a planted-bias test confirms the instrument detects disparity when present. The contribution is a sound, sensitive, adoption-ready instrument, the arity matched null methodology, and open artifacts to scale it. Code, data, and harness are released under open licenses, with an anonymized review artifact.

02.
bioRxiv (Bioinfo) 2026-06-13

PertDiffBench: Benchmarking Diffusion Models for Single-Cell Perturbation Response Prediction

Diffusion models are increasingly used to predict transcriptional responses to perturbations, but whether they improve on simpler generative and representation-based baselines remains unclear. Existing evaluations often do not separate the effects of model architecture, input representation, biological context and metric choice, making it difficult to determine where diffusion-based methods are useful. Here we introduce PertDiffBench, a standardized benchmark for diffusion-based transcriptomic perturbation prediction across single-cell and bulk RNA-seq datasets. PertDiffBench evaluates diffusion-based models across three complementary evaluation settings: standard prediction in known single-cell contexts and bulk perturbation conditions, generalization to unseen cell types, species, drugs and intermediate time points, and stress tests of feature dimensionality, input representation, noise type and gene ordering. Across these settings, diffusion models did not show a consistent advantage. scGen remained a strong baseline in common prediction tasks, whereas scDiffusion was the most competitive diffusion-based method in several generalization settings. Temporal imputation showed a different pattern, with a simple DDPM operating directly in expression space outperforming more specialized models. Stress tests showed that performance was model dependent and sensitive to feature dimensionality, encoder choice, noise type and gene ordering. Pretrained encoders did not consistently improve performance, with the classical scVI representation slightly exceeding STATE in seen-condition and unseen-cell-type settings. These results indicate that diffusion-model performance in perturbation response prediction depends strongly on task design and representation choice. PertDiffBench provides a practical framework for evaluating these models under biologically varied and stress-tested conditions.

03.
medRxiv (Medicine) 2026-06-22

Substantia Nigra and Subthalamic Nucleus Deep Brain Stimulation Exert Opposing Effects on Novelty Recognition in Parkinson's Disease

Episodic memory plays a critical role in supporting adaptive behavior; however, whether it can be causally regulated in humans via deep subcortical stimulation remains unclear. In the present study, we investigated the differential effects of substantia nigra (SN) and subthalamic nucleus (STN) stimulation on episodic memory, as well as the underlying mechanisms of its associated brain networks, using a recognition memory task combined with concurrent functional magnetic resonance imaging in patients with Parkinson's disease. SN-DBS increased recognition sensitivity and reduced false alarms at both frequencies, whereas 10 Hz STN-DBS reduced sensitivity and increased false alarms. Functional connectivity analyses in the absence of DBS stimulation identified a false recognition-related network linking nigral, pallidal, subthalamic, medial temporal, frontal, and occipital regions. SN-DBS-related false alarm reduction tracked modulation of this circuit and was marked by its baseline vulnerability state. These behavioral effects mapped onto target-dependent parieto-occipital and SN-visual retrieval pathways, supporting a model in which DBS bidirectionally regulates recognition memory through target- and frequency-dependent subcortical-cortical circuits.

04.
arXiv (CS.LG) 2026-06-16

STAR-NT: Spatiotemporal Acceleration of Real-Time Neural Transparency Rendering

arXiv:2606.16747v1 Announce Type: cross Abstract: Neural order-independent transparency delivers high-quality rendering of overlapping transparent surfaces, but its geometry passes and network input generation remain costly, particularly on mobile and legacy hardware. We present a spatiotemporal acceleration framework that exploits spatial and temporal coherence to reduce this overhead while preserving visual quality. Spatially, we use adaptive quadtree-based screen-space subdivision to scale geometry pass resolution according to local color variance. Temporally, selected frames reuse the previous transparency result through depth-based reprojection instead of full rendering. Together, these optimizations reduce rendering cost and integrate efficiently into existing real-time rendering pipelines.

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

Bypassing Prompt Guards in Production with Controlled-Release Prompting

arXiv:2510.01529v4 Announce Type: replace Abstract: Ball et al. recently established that prompt filtering for AI alignment faces a fundamental barrier: under standard cryptographic assumptions, no filter running significantly faster than the protected model can universally distinguish adversarial prompts from benign ones. We investigate whether this impossibility result translates to real-world vulnerabilities in deployed large language model (LLM) systems. We answer affirmatively by introducing controlled-release prompting, a practical instantiation of the theoretical framework that exploits the resource asymmetry between lightweight input filters and the main models they protect. Unlike the theoretical construction, our attack does not require model modification: it generates malicious prompts that are indecipherable by any bounded filter yet remain tractable to the target LLM. We find our attack to be successful on four major chat platforms (Google Gemini, DeepSeek Chat, xAI Grok, and Mistral Le Chat) where baseline methods fail. Additionally, we apply our attack to extract copyrighted data from Gemini. Finally, we provide a systematic evaluation of 14 open-weight prompt guard models, revealing that even reasoning-capable filters cannot reliably detect our attack without incurring prohibitive resource overhead.

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

HRIR-Former: Grid-Free Time-Domain Reconstruction of Head-Related Impulse Responses with a Spatially Encoded Transformer

arXiv:2603.27998v2 Announce Type: replace-cross Abstract: Individualized head-related impulse responses (HRIRs) enable binaural rendering, but dense per-listener measurements are costly. We address HRIR spatial up-sampling from sparse per-listener measurements: given a few measured HRIRs for a listener, predict HRIRs at unmeasured target directions. Prior learning methods often work in the frequency domain, rely on minimum-phase assumptions or separate timing models, and use a fixed direction grid, which can degrade temporal fidelity and spatial continuity. We propose HRIR-Former, a time-domain, grid-free binaural Transformer for reconstructing HRIRs at arbitrary directions from sparse inputs. It uses sinusoidal spatial features, a Conv1D refinement module, and auxiliary interaural time difference (ITD) and interaural level difference (ILD) heads. On SONICOM, it improves normalized mean squared error (NMSE), cosine distance, and ITD/ILD errors over prior methods; ablations validate modules and show minimum-phase preprocessing is unnecessary.

07.
arXiv (CS.CL) 2026-06-17

Scaling Enterprise Agent Routing: Degradation, Diagnosis, and Recovery

Production LLM assistants route user requests to growing libraries of specialized tools, but how does routing accuracy degrade as the catalog scales? We study single-step routing on a 110-agent, 584-tool catalog from a deployed enterprise productivity assistant, evaluating three frontier models from 10 to 110 agents. Routing F1 on under-specified requests drops 16–23 percentage points across models. An oracle analysis decomposes the degradation into a retrieval gap (the model cannot surface the right tool) and a confusion gap (even with perfect retrieval, the oracle ceiling drops 10pp). Embedding-based shortlisting recovers +10–11pp F1 at full scale across all three models and two providers. A production annotation study (1,435 human-labeled utterances, three annotators) confirms the recovery on real traffic at +10–17pp despite 10–15pp lower absolute performance.

08.
arXiv (CS.AI) 2026-06-16

Beyond Models: Reflections on Engineering AI-enabled Systems in a Project-Based Course

arXiv:2606.16842v1 Announce Type: cross Abstract: Teaching Software Engineering for AI-enabled systems entails addressing the integration of AI components within full-scale software architectures under realistic constraints. While machine learning courses emphasize model development, students often lack experience in architectural design, deployment, and monitoring of AI-enabled systems. Empirical evaluations of such system-oriented AI courses remain limited. This paper reflects on the design and implementation of a project-based master's-level course titled AI Algorithms: Theory and Engineering, at the University of Bremen, in which students developed a movie recommendation system while making architectural design decisions to address challenges related to scalability, deployment, and evolving requirements. We conducted a mixed-methods study combining analyses of student submissions and questionnaire responses to investigate integration challenges, learning outcomes, and opportunities for improvement. Our results indicate persistent difficulties in early architectural decisions, heterogeneous ML integration, evolving requirements, and data management, largely due to uneven ML and software engineering expertise. From the educator's perspective, the course fostered system-level reasoning and strengthened awareness of data-centric ML practices in AI-enabled systems.

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

Fixed-Parameter Tractability of Private Synthetic Data Generation

arXiv:2606.11283v1 Announce Type: cross Abstract: We study the problem of generating synthetic data under differential privacy. We establish fixed-parameter tractability (FPT) for this problem where the parameter is the treewidth of the query family's incidence graph. Our algorithms attain optimal error rates across all regimes and are realized by two different approaches: the first is based on linear programming (LP) and the FPT of the separation problem for the LP dual; the second is based on a subsampled private multiplicative weights method, where we obtain FPT for sampling from Gibbs distributions. Both approaches are unified by a dynamic programming framework over a tree decomposition.

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

First, do NOHARM: towards clinically safe large language models

arXiv:2512.01241v3 Announce Type: replace-cross Abstract: Large language models (LLMs) are routinely used by physicians and patients for medical advice, yet their clinical safety profiles remain poorly characterized. We present NOHARM (Numerous Options Harm Assessment for Risk in Medicine), a 1,100-task benchmark of primary care-to-specialist consultation cases to measure the frequency and severity of harm from LLM-generated medical recommendations. NOHARM covers 10 specialties, with 12,747 expert annotations for 4,249 clinical management options. Across 28 LLMs, recommendations carried the potential for severe harm in up to 22.6% of cases, with errors of omission accounting for more than 80% of severe errors. In a randomized trial of 101 generalist physicians, human benchmark performance significantly improved with AI assistance, yet physicians remained far from realizing the potential of AI tools, frequently ignoring essential advice surfaced by AI. Safety performance tracked general-intelligence and medical-knowledge benchmarks across the full range of models but decoupled at the frontier. Despite strong performance on existing evaluations, widely used AI models can produce medical advice with the potential for severe harm at non-trivial rates, highlighting the importance of explicit measurement of clinical safety.

11.
arXiv (quant-ph) 2026-06-12

Reservoir-controlled electromagnetically induced gratings in a weakly driven two-level medium

arXiv:2606.13085v1 Announce Type: cross Abstract: We theoretically investigate the transmission and diffraction of a weak probe field from an electromagnetically induced grating formed in a weakly driven two-level medium coupled to engineered quantum reservoirs. Using a perturbative solution of the optical Bloch equations in the weak-driving regime, we analyze how normal-vacuum, thermal, and broadband squeezed-vacuum environments modify the probe susceptibility and consequently reshape both the spatial transmission function and the far-field diffraction patterns. We show that reservoir statistics have a pronounced impact on the diffraction response by altering the amplitude and phase of the induced grating. Thermal reservoirs enhance the transmission modulation and increase the intensity of the dominant diffraction orders, whereas squeezed-vacuum reservoirs generate strongly phase-sensitive modifications that selectively redistribute optical power among diffraction channels. We further demonstrate that the detuning between the squeezed reservoir and the driving field provides an efficient mechanism for controlling diffraction directionality, leading to substantial amplification of selected angular orders. In two-dimensional geometries, squeezed-vacuum correlations produce highly structured phase landscapes and strongly anisotropic diffraction patterns, enabling directional enhancement of specific diffraction channels while suppressing others. These results establish reservoir engineering as a versatile approach for controlling transmission, diffraction efficiency, and angular selectivity in minimal two-level systems, with potential applications in programmable photonic devices, beam steering, and quantum optical platforms.

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

Graph Diffusion Residuals for Control-Function Instrumental Variables

arXiv:2606.14636v1 Announce Type: new Abstract: Control-function instrumental variable estimators need a first-stage residual, not merely a first-stage prediction. High-capacity first stages can interpolate treatment and leave too little residual information for the outcome equation. We study Adaptive Anisotropic Instrumental Heat Flow (A-IHF), a deterministic graph-diffusion residual extractor for flexible control functions. A-IHF treats treatment as a signal on a graph of first-stage features, uses pilot diffusion to detect large treatment jumps, attenuates conductance across those jumps, and computes the generated control with a sparse graph resolvent. Its observational selection rule uses only $(Z,X)$, combining graph generalized cross-validation, roughness, residualized-treatment relevance, and graph-admissibility filtering. The analysis decomposes error into structural leakage, residual attenuation, and residualized treatment variation, yielding finite-sample bounds, graph-admissibility rates under latent piecewise-smooth geometry, and finite-path selection calibration. Across 54 synthetic benchmark cells with tuned graph, kernel, tree, boosting, series, and neural control-function baselines, guarded observational A-IHF has the lowest average structural-response MSE; the A-IHF family beats the best non-A-IHF baseline in 32 cells. Performance is strongest when the graph captures piecewise-smooth first-stage structure.

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

Explaining RhythmFormer: A Systematic XAI Analysis of Periodic Sparse Attention for Remote Photoplethysmography

Remote photoplethysmography (rPPG) transformers achieve low heart-rate error on benchmarks, yet their decisions remain opaque–a growing concern as rPPG moves toward clinical heart rate estimation. Existing rPPG XAI is dominated by qualitative heatmap inspection without quantitative faithfulness metrics or physiology-grounded validation, leaving a gap between visual plausibility and auditable evidence. We address this gap. First, we adapt four attribution methods (raw attention, rollout, flow, Beyond Intuition) to RhythmFormer's bi-level routing attention with top-$k$ selection. Second, we introduce a skin coverage metric quantifying how much attribution mass falls on skin regions. Third, we adapt the SaCo faithfulness coefficient from its original classification setting to rPPG regression by using the MAE between original and perturbed predicted rPPG waveforms as the perturbation impact. Applying these tools, we quantify a multi-hop leakage effect under sparse top-$k$ routing: attention rollout and flow almost completely restores the connections that individual refined-attention layers explicitly set to zero. Beyond Intuition mitigates this via its value-projection-weighted rollout and gradient-supported mask, attaining the highest median refined skin coverage ($0.83$ vs. $0.57$ for vanilla rollout) and faithfulness ($F=0.92$) among the evaluated methods on UBFC-rPPG. Validation across diverse datasets and model variants is needed. A case study on a low-SaCo outlier further shows all four methods recovering consistently once an artefactual region is replaced, suggesting consistent SaCo behavior across attribution families in this illustrative case. Together, these metrics move XAI for rPPG toward auditable numerical evidence about spatial alignment and perturbation faithfulness, i.e. trustworthy rPPG XAI.

14.
arXiv (CS.CL) 2026-06-18

Rethinking Cross-lingual Gaps from a Statistical Viewpoint

Any piece of knowledge is usually expressed in one or a handful of natural languages on the web or in any large corpus. Large Language Models (LLMs) act as a bridge by acquiring knowledge from a source language and making it accessible when queried using target languages. A cross-lingual gap is a drop in accuracy incurred when querying knowledge in a target language rather than the source language. Existing research focused on modeling or training failures leading to cross-lingual gaps. In this work, we take an alternative view to characterize the nature of cross-lingual error, and hypothesize that the variance of responses in the target language is a key cause of this gap. For the first time, we formalize the cross-lingual gap in terms of biased and unbiased errors. We empirically validate our hypothesis through multiple inference-time interventions that control variance and reduce the cross-lingual gap. We demonstrate a few test-time ensemble methods that reduce response variance, and thereby improve source-target transfer scores by up to 12 absolute points yielding relative gains of 8% to over 50% across various LLMs.

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

An adaptive framework for the axisymmetric pulsar magnetosphere using physics-informed Kolmogorov-Arnold networks

arXiv:2606.10686v2 Announce Type: replace-cross Abstract: The pulsar magnetosphere has only recently been addressed using Physics-Informed Neural Networks (PINNs), by deploying a domain-decomposition approach and treating the separatrix and equatorial current sheet as infinitesimally thin discontinuities. However, this baseline requires extensive manual hyperparameter tuning, achieves limited final accuracy and demands several hours of training. We refine this framework by introducing domain-specific neural architectures based on Kolmogorov-Arnold networks, an automated adaptive training pipeline and a physics-based convergence criterion that eliminate the need for manual calibration. The proposed methodology delivers self-consistent axisymmetric magnetosphere solutions with mean squared errors of the PDE residuals at O(1e-6) in double precision - an improvement of two orders of magnitude over the baseline - while achieving convergence in under 20 minutes in single precision. Importantly, the method reliably resolves stellar radii reduced by up to 80% compared to the baseline, overcoming the severe spatial scale disparities that also challenge traditional solvers. Furthermore, by varying the flux that opens to infinity, we provide a correction to the equation that connects it to the equatorial T-point's position. The complete framework is released as the open-source library PulsarX.

16.
arXiv (math.PR) 2026-06-11

Stochastic epidemic model with varying infectivity and waning immunity: the law of large numbers with unbounded infectivity

arXiv:2606.11845v1 Announce Type: new Abstract: We revisit the large population limit of our epidemic model with infection age dependent infectivity and progressive immunity waning, under the assumption that the supremum in $t$ of the random infectivity function has a finite expectation, while the previous proofs assumed that this supremum admits a deterministic upper bound.

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

Neural Slack Variables for Shape Constraints

arXiv:2606.13803v1 Announce Type: new Abstract: Enforcing functional inequality constraints such as monotonicity and convexity in neural networks is a fundamental challenge in many industrial and scientific applications. Classical one-sided penalty methods, along with primal-dual methods gated by complementary slackness, provide constraint gradients only at violated locations, resulting in fragile satisfaction. Architectures that guarantee feasibility by construction, on the other hand, remain largely limited to elementary cases and impose additional inductive biases. We introduce neural slack variables, a deep learning native primal-side approach that converts constraint enforcement into a regression problem by coupling the primary network with a jointly learned auxiliary network. The auxiliary network serves as a valid target for the primary network's constraint quantities, inducing feasibility and regularity. Neural slack variables achieve zero measured violations on dense-grid monotonicity and convexity test cases, where penalty and primal-dual baselines leave residual violations, and enable arbitrage-free learning of volatility surfaces, an open industrial challenge in quantitative finance.

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

Smarter Saboteurs, Better Fixers: Scaling & Security in Linear Multi-Agent Workflows

arXiv:2606.12709v1 Announce Type: cross Abstract: As LLM-based multi-agent systems (MAS) are deployed in the wild, the resilience of their collaboration structures against adversarial compromise becomes a critical safety concern. Attackers may leverage prompt-injection or jailbreaking to sabotage individual agents within MAS workflows, but the interaction between model scaling and system-level resilience remains poorly understood. This paper investigates how model scale affects the security of linear multi-agent workflows. Our experiments across scales of two open-weight model families on the HumanEval benchmark reveal a compliance-correction symmetry: larger models are far more likely to faithfully execute malicious instructions, with the control-to-malicious performance drop reaching 53.7pp at 27B in uncorrected pipelines. However, appending a lightweight terminal Fixer stage collapses this to 0.6pp and restores statistical parity with control-level performance, demonstrating that strictly linear collaboration structures can be viable and resilient to adversaries at this scale, and suggesting that the brittleness previously attributed to linear topology may stem from a lack of correction.

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

Planning with the Views via Scene Self-Exploration

Can VLMs predict how each camera move changes the view, and plan many such moves ahead? We call this capability view planning, requiring (1)understanding how a single action transforms the view, and (2)composing many such transformations across multi-turn plans to identify a target view. We probe both abilities in our proposed ViewSuite, a 3D point-cloud environment on real ScanNet scenes. Across 13 frontier VLMs, a critical planning gap emerges: they possess basic view-action knowledge but fail to compose it across multi-turn plans, with the gap widening as viewpoint distance grows. To close this gap, we propose an iterative framework that alternates self-exploration with view graph distillation. The key insight is that all exploration trajectories, regardless of their outcome, collectively form a view graph that compactly captures how viewpoints connect across a scene. Distilling this graph into diverse supervised tasks reshapes the policy distribution and overcomes the sparse rewards that stall pure RL. This improves Qwen2.5-VL-7B from 2.5% to 47.8% on interactive view planning, surpassing GPT-5.4 Pro (18.5%) and Gemini 3.1 Pro (21.4%). Self-exploration emerges as a promising path toward VLMs that can actively reason and plan in 3D space. Code and Data are at https://viewsuite.github.io.

20.
arXiv (quant-ph) 2026-06-12

Matrix phase-space representations for quantum symmetries

arXiv:2606.12769v1 Announce Type: new Abstract: We introduce a general phase-space representation that includes global quantum symmetries in the basis expansion. This method, called matrix phase-space, projects the basis onto a reduced Hilbert space, which can greatly reduce sampling errors of many-body quantum simulations and unifies several previous phase-space methods. The purpose of this paper is to provide detailed proofs of basic theorems and operator identities. We also treat several different types of symmetries. To illustrate the benefits of matrix phase-space methods, we give a detailed derivation of a recent application to the topical problem of verifying the outputs of Gaussian boson sampling (GBS) quantum computers with photon number resolving detectors. This has exponential complexity, and using parity symmetry reduces sampling errors by very large factors relative to earlier methods.

21.
arXiv (CS.CV) 2026-06-18

Rethinking Text-to-Image as Semantic-Aware Data Augmentation for Indoor Scene Recognition

In the realm of computer vision, indoor image recognition presents challenges due to the intricate interplay of lighting conditions, occlusions, and diverse object arrangements within confined spaces. To address the lacks of training indoor images, we introduce a novel approach leveraging Stable Diffusion (SD) for the generation of synthetic images, which serve as a powerful data augmentation tool. The utilization of SD offers a principled framework for synthesizing diverse and realistic indoor scenes, thereby enriching the training data pool for robust indoor image recognition models. Experimental findings on the MIT Indoor Scene dataset reveal the potential of our proposed approach in enhancing the training of deep models when authentic data is limited. Furthermore, to prevent the misuse of SD synthetic images, we introduce a counter measure based on DIffusion Reconstruction Error (DIRE). The powerful DIRE presentation enables training robust classifiers only using lightweight deep models. Experiments show that our approach can perfectly recognize SD generated images with the accuracy of 100% using MobilenetV3.

22.
arXiv (CS.CL) 2026-06-11

Redesign Mixture-of-Experts Routers with Manifold Power Iteration

Router is the cornerstone component to the Mixture-of-Experts models. Serving as expert proxies, the rows of the router matrix compute their similarity to the MoE inputs to determine which subset of experts is activated. Ideally, each router row is designed to encode the expert matrix into this representative vector, such that its dot-product with token can better reflect token-expert affinity. However, there exists no design principles to enforce this condensation. In this paper, we propose to align each router row with the principal singular direction of the associated expert, as this direction provides the most expressive mathematical description of a matrix. Based on this principle, we propose a router redesign with Manifold Power Iteration (MPI). Specifically, it introduces a "Power-then-Retract" paradigm, where a power iteration step is performed on the router weights, followed by a retraction to impose a norm constraint to ensure both efficiency and stability. Theoretically, we show that MPI drives router rows to converge toward the principal singular directions of associated experts. Empirically, we pretrain MoE model across scales from 1B to 11B parameters to confirm that this alignment facilitates more effective MoE models.

23.
medRxiv (Medicine) 2026-06-18

Human Intuition vs. Computational Precision: Neurologists, Feature-based Models, and Deep Learning for Stroke Prognosis

Background: Prognostication in large vessel occlusion (LVO) stroke remains challenging. Although several prognostic models exist, their comparison to clinician performance, human-model interaction, and specific sources of human bias remain poorly understood. Methods: Using pre-treatment clinical and CT data from the MR CLEAN trial (n=500), six neurologists predicted three-month modified Rankin Scale (mRS) scores for 40 patients, both unaided and assisted by a validated feature-based model (MR PREDICTS). Human performance was benchmarked against MR PREDICTS and a multimodal, interpretable deep learning (DL) approach using raw imaging data. We explicitly assessed neurologists? ability to estimate model-required imaging features and identified systematic human biases. Models were additionally validated in a larger MR CLEAN trial cohort (n=404). Results: For predicting the full mRS distribution, standalone models achieved good ordinal agreement (MR PREDICTS quadratic weighted kappa (QWK) 0.51 [0.24 to 0.70]; DL model 0.49 [0.25 to 0.67]), significantly outperforming unaided neurologists (QWK 0.27 [0.10, 0.42]). Neurologists showed systematic overoptimism, predicting lower mRS scores than observed. Furthermore, there was poor accuracy in extracting imaging features. Raters? ASPECTS predictions deviated by 3.4 points from the confirmed scores, and collateral score accuracy was 44.6%. However, for predicting binary mRS (0-2 vs. 3-6), accuracy was comparable between unaided neurologists (64.17% [55.42% to 72.92%]) and models (MR PREDICTS 67.50% [52.50% to 82.50%]; DL model 63.16% [47.37% to 78.95%]). Model-assistance modestly improved and harmonized neurologists? predictions (QWK 0.41 [0.22 to 0.55]; binary accuracy 68.75% [58.33% to 78.34%]. Model performance remained robust in the larger cohort. Conclusions: Multimodal prognostic models outperform clinicians in predicting the full range of mRS outcomes, while human error in imaging assessment and systematic optimism bias are primary drivers of prognostic inaccuracy. End-to-end DL models eliminate human-input variability and hold strong potential as an automated second opinion to support prognostication and decision-making in acute LVO stroke.

24.
PLOS Medicine 2026-06-09

Molecular Tumor Boards clinical impact on patient care and structural features: A systematic review and meta-analysis

作者:

by Luigi Russo, Erika Giacobini, Nicolò Lentini, Tommaso Osti, Maud Kamal, Stefania Boccia, Roberta Pastorino Background Molecular Tumor Boards (MTBs) bring together multidisciplinary experts to translate genomic data into clinical decisions in oncology, however, their overall clinical impact remains unclear. The aim of this systematic review is to assess the clinical impact of MTB-recommended therapies on patients with cancer outcomes. Methods and findings In this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and CENTRAL up to July 2025. We included studies of any design, both single-arm studies and studies with a comparator group, that reported the clinical impact of MTBs in patients who received MTB-guided therapy. Meta-analyses were performed separately by study design, using hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS), relative risks (RRs) for objective response rate (ORR) and disease control rate (DCR), and pooled proportions for PFS ratio ≥1.3. All meta-analyses were conducted using random-effects models based on the inverse variance method. We evaluated the risk of bias using the RoB 2.0 for RCTs and ROBINS-I for non-randomized studies.From 6,846 records, 78 studies (9,195 patients; 4,569 treated per MTB recommendations) were included. MTB-guided therapies were associated with reduced risk of death (HR 0.87; 95% CI [0.76, 1.01]; p = 0.069; I2 = 0.0% in RCTs; 0.62 in retrospective studies) and disease progression (HR 0.73; 95% CI [0.64, 0.84]; p 

25.
medRxiv (Medicine) 2026-06-18

Web-based education on Metabolism and Obesity is associated with improved lifestyle and health behaviours among Brazilian school teachers

Background: Obesity is a major global public health challenge, and teachers play a critical role in school-based health promotion. This study examined the perceived impact of a web-based educational program on metabolism and obesity delivered to Brazilian school teachers. Methods: This analytical cross-sectional study included 217 teachers who responded to the evaluation questionnaire after attending the course between 2017 and 2022. Statistical analyses included logistic regression and chi-square tests. Findings: Course completion rate was 81.98%, substantially exceeding the 5-15% typical of global MOOCs. However, ethnic disparities were observed: White respondents were 4.95 times more likely to complete the course than Black respondents (p=0.00097) and Brown respondents were 3.05 times more likely (p=0.0268) than Black respondents. Among non-completers, lack of time (64.7%) was the primary barrier. Participation was concentrated in Sao Paulo (77%), with no respondents from three northern states. Perceived difficulty showed a non-significant trend (p=0.0893) where by Black respondents had the lowest predicted difficulty; the most challenging course material was Scientific Content/Reading papers (50%). Completion was strongly associated with applying learned activities in teaching (p