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01.
arXiv (CS.AI) 2026-06-19

Emergent Alignment

arXiv:2606.19527v1 Announce Type: new Abstract: Can Large Language Models (LLMs) discern when their own outputs are misaligned with human ethics? And can they self-correct? We endow an LLM with a conscience step that reviews its own reasoning and outputs, and we extend the training loss with an alignment component using Direct Preference Optimization (DPO) to steer the model away from non-ethical outputs. The result is an online technique to align models in a wide range of applications: training, fine-tuning, adversarial prompting, and zero-shot learning. It does not require a weaker or stronger judge, relying instead on a frozen copy of itself. In previous work, the Emergent Misalignment scenario showed a range of emergent unethical behaviors from fine-tuning the model to hack code. Instead, we empirically show how to achieve Emergent Alignment: a single high-level introspective question steers training toward an ethical model under the same code hacking scenario.

02.
arXiv (CS.AI) 2026-06-19

Too long; didn't solve

arXiv:2604.07593v2 Announce Type: replace Abstract: Mathematical benchmarks consisting of a range of mathematics problems are widely used to evaluate the reasoning abilities of large language models, yet little is known about how their structural properties influence model behaviour. In this work, we investigate two structural length variables, prompt length and solution length, and analyse how they relate to model performance on a newly constructed adversarial dataset of expert-authored mathematics problems. We find that both prompt and solution lengths correlate positively with increased model failure across models. We also include a secondary, exploratory analysis of cross-model disagreement. Under a difficulty-adjusted normalised analysis, both variables retain weak negative associations with realised model separation, slightly stronger for prompt length. Overall, our main robust finding is that structural length is linked to empirical difficulty in this dataset.

03.
arXiv (CS.LG) 2026-06-11

PAWS: Preference Learning with Advantage-Weighted Segments

arXiv:2606.11982v1 Announce Type: new Abstract: Preference-based reinforcement learning (PbRL) learns policies from human trajectory-level comparisons, avoiding explicit reward design and expert demonstrations. Existing methods typically train utility functions on trajectory or segment-level preferences while relying on per-step utility estimates during policy optimization. This training and inference mismatch induces a distribution shift that severely degrades temporal credit assignment and limits policy learning. We analyze this issue and propose PAWS, a segment-based preference learning method that performs policy updates directly using segment-level advantage functions. By aligning utility training with policy optimization, PAWS preserves trajectory-level preference information and avoids unreliable per-step learning signals. Experiments on simulated robotic manipulation and locomotion tasks demonstrate that PAWS consistently outperforms existing PbRL approaches, highlighting the importance of distribution-consistent preference learning.

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

Right Regions, Wrong Labels: Semantic Label Flips in Segmentation under Correlation Shift

The robustness of machine learning models can be compromised by spurious correlations between non-causal features in the input data and target labels. A common way to test for such correlations is to train on data where the label is strongly tied to some non-causal cue, then evaluate on examples where that tie no longer holds. This idea is well established for classification tasks, but for semantic segmentation the specific failure modes are not well understood. We show that a model may achieve reasonable overlap while assigning the wrong semantic label, swapping one plausible foreground class for another, even when object boundaries are largely correct. We focus on this semantic label-flip behaviour and quantify it with a simple diagnostic (Flip) that counts how often ground truth foreground pixels are assigned the wrong foreground identity while remaining predicted as foreground. In a setting where category and scene are correlated during training, increasing the correlation consistently widens the gap between common and rare test conditions and increases these within-object label swaps on counterfactual groups. Overall, our results motivate assessing segmentation robustness under distribution shift beyond overlap by decomposing foreground errors into correct pixels, flipped-identity pixels, and missed-to-background pixels. We also propose an entropy-based, ground truth label-free `flip-risk' score, which is computed from foreground identity uncertainty, and show that it can flag flip-prone cases at inference time. Code is available at https://github.com/acharaakshit/label-flips.

05.
arXiv (math.PR) 2026-06-18

Probabilistic representation and classical solutions of wave equations with complex polynomial nonlinearities

arXiv:2606.18919v1 Announce Type: cross Abstract: We review the probabilistic representation of solutions of wave equations with polynomial nonlinearities in spatial dimensions d=1,2,3 using stochastic branching processes. Under regularity assumptions on the initial data, we derive conditions ensuring the integrability of the corresponding Monte Carlo estimator, and the existence and smoothness of mild and classical solutions. We also present numerical results and comparisons with grid-based algorithms for the solution of nonlinear wave equations.

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

RGB-S: Image-Aligned Tactile Saliency for Robust Dexterous Manipulation

Effective visuo-tactile integration is critical for robotic dexterous manipulation, especially when visual observations are unreliable or occluded. However, robustly aligning sparse, heterogeneous tactile measurements with dense visual representations remains a fundamental challenge. Most existing approaches require policies to learn cross-modal correspondences implicitly from limited demonstrations, without leveraging geometric priors. As a result, they are often data-inefficient and generalize poorly when visual observations are degraded. To address this limitation, we propose a framework that explicitly grounds physical contacts in the image domain. Using robot forward kinematics and camera calibration, we project tactile sensor locations directly onto the RGB image plane. We then render force-modulated Gaussian saliency maps to model spatial uncertainty arising from kinematic and calibration errors. By integrating these 2D spatial anchors through a zero-initialized conditioning architecture, our method injects physical contact priors into standard visual backbones while preserving pre-trained visual representations. We evaluate our method on six dexterous manipulation tasks in both simulation and the real world under severe visual occlusions. Real-world experiments show that explicit RGB-S grounding in the image domain improves real-world occluded manipulation success rates by $26.7$ percentage points over the strongest implicit visuo-tactile baseline, suggesting its improved spatial reasoning and robustness to occlusion. Project page: touch-as-saliency.github.io

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

Semantic Editing with Coupled Stochastic Differential Equations

Editing the content of an image with a pretrained text-to-image model remains challenging. Existing methods often distort fine details or introduce unintended artifacts. We propose using coupled stochastic differential equations (coupled SDEs) to guide the sampling process of any pre-trained generative model that can be sampled by solving an SDE, including diffusion and rectified flow models. By driving both the source image and the edited image with the same correlated noise, our approach steers new samples toward the desired semantics while preserving visual similarity to the source. The method works out-of-the-box, without retraining or auxiliary networks, and achieves high prompt fidelity along with near-pixel-level consistency. These results position coupled SDEs as a simple yet powerful tool for controlled generative AI. Project page: https://z-jianxin.github.io/syncSDE-release/. Code: https://github.com/Z-Jianxin/syncSDE-release.

08.
bioRxiv (Bioinfo) 2026-06-17

In silico characterization of lysis and host-recognition modules in Staphylococcus aureus bacteriophage genomes

Background/aim: Antimicrobial resistance in methicillin-resistant Staphylococcus aureus (MRSA) requires precision non-antibiotic therapeutics, yet phage lytic efficacy is poorly predicted by phenotypic assays, as shown by paradoxical biofilm responses. This study characterized the genomic architecture of lytic S. aureus bacteriophages, focusing on the conservation of the lysis module and the variability of host-recognition modules, to provide a rational basis for phage candidate selection. Materials and methods: Twenty-two complete S. aureus phage genomes were retrieved from NCBI GenBank. Genomic features were extracted with custom Biopython scripts. Lysis (endolysin, holin) and host-recognition (tail fiber/receptor-binding protein) modules were annotated and validated by InterPro domain analysis, with disrupted endolysins resolved by tBLASTn. Phylogeny was reconstructed from large terminase subunit (TerL) sequences using maximum likelihood. Results: Genome size spanned three classes, from 17.5 to 148.6 kb. The LysK-type endolysin (CHAP, Amidase, SH3b) was highly conserved, whereas tail fiber/RBP genes were detected in only 14 of 22 phages. Domain analysis reclassified two proteins annotated as endolysins as virion-associated peptidoglycan hydrolases, and identified two independent mechanisms, HNH endonuclease insertion and intron splitting, that interrupt lysis-module genes and confound automated annotation. Maximum likelihood analysis recovered a strongly supported, highly conserved core clade with EW and SA13 as divergent lineages. Conclusion: Lysis modules are conserved whereas host-recognition modules are variable, indicating that host recognition rather than the lytic enzyme is the principal determinant of host range and the more rational target for phage selection and engineering.

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

Semantic Grading of Written Answers in Low-Resource Language Bangla Using a Fine-Tuned Lightweight Language Model

Bangla is among the world's most widely spoken languages, yet it remains underserved in educational NLP research. In many remote and rural regions, access to qualified subject teachers is limited, and written answers are consequently graded largely by hand, restricting timely and consistent feedback. Automatic assessment is challenging because semantically correct responses can vary substantially in surface form. We present a bilingual (Bangla-English) evaluation system designed for low-resource educational settings that prioritizes semantic correctness over lexical overlap. Our approach fine-tunes a lightweight language model to grade each response using the question, reference answer, and student answer, producing a numeric score and concise, context-grounded feedback suitable for classroom deployment. We also construct a synthetic bilingual dataset to enable controlled training and evaluation. Across proprietary and open-source LLMs evaluated under a unified protocol, our QLoRA-tuned Qwen3-8B confirms consistent improvement by producing the most leakage-resistant feedback (RoRa = 0.819) in synthetic evaluation and the strongest agreement with human scores (rho = 0.936, MAE = 0.725) in a dedicated human study.

10.
Nature Medicine 2026-06-17

General-purpose chatbots outperform clinical AI tools on physicians’ real-world questions

作者: 未知作者

Specialized clinical AI tools are entering medical practice with little independent testing. In a head-to-head evaluation across two public benchmarks and real questions from physicians, three general-purpose frontier large language models outperformed two leading clinical AI tools, which performed no better than Google search AI overview.

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

OmniTraffic: A Controllable Generation Pipeline and Benchmark for Spatio-Temporal Traffic Reasoning

Traffic scene understanding requires models to reason beyond object recognition, including lane topology, multi-view geometry, temporal evolution, and signal-phase semantics. However, existing traffic-oriented multimodal benchmarks largely emphasize passive visual recognition or isolated video understanding, offering limited support for evaluating structure-aware traffic reasoning under controlled conditions. We introduce OmniTraffic, a controllable generation pipeline and benchmark for spatio-temporal traffic reasoning. Built around 12 real-world intersections reconstructed into editable 3D traffic environments and complemented by surveillance footage from two countries, OmniTraffic supports both controlled and natural-condition evaluation. It defines a three-level task hierarchy spanning scene perception, multi-view and temporal reasoning, and decision support. Using structured traffic metadata, OmniTraffic generates synchronized multi-view VQA samples covering vehicle states, lane functions, view–BEV correspondence, temporal dynamics, and signal-phase analysis, resulting in 8M VQA samples and a 3K human-verified test set. Evaluation of eleven frontier MLLMs reveals a large human–model gap, with the most pronounced failures in topology-grounded and spatio-temporal reasoning tasks. Fine-tuning a lightweight MLLM on simulated OmniTraffic data further improves performance on real-world traffic scenes, demonstrating the value of simulation-generated supervision for traffic-specific multimodal reasoning. Beyond a fixed dataset, OmniTraffic provides an extensible pipeline with configurable intersections, camera views, traffic demands, signal phases, visual conditions, and rare events.

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

Instance-Aware Knowledge Distillation for Semi-Supervised Learning of an On-Board Multi-Task Dense Prediction Model for Collision Avoidance System

Collision avoidance systems have evolved toward camera-based deep learning approaches for driving scene understanding. However, deployment in edge environments such as country clubs is constrained by limited computational resources and unreliable communication infrastructure. Moreover, constructing large-scale datasets for the target domain involves substantial annotation cost. To address these limitations, we propose an instance-aware knowledge distillation framework for semi-supervised learning. Specifically, we generate pseudo labels that mitigate teacher bias by leveraging domain priors from the teacher and instance-centric knowledge from foundation models. The trained lightweight student is deployed in the proposed collision avoidance system and performs multiple dense prediction tasks in real-time. The system detects frontal obstacles and encodes their spatial information into controller area network messages for automated guided vehicle operation. To achieve this, we construct a large-scale country club dataset and perform field validation of the proposed system. Experimental results demonstrate that the student outperforms the large teacher in instance segmentation while mitigating performance degradation in monocular depth estimation. Compared with the teacher, the student reduces FLOPs by 22.68$\times$ and parameters by 14.33$\times$, achieving 6.46 FPS on a low-cost edge device.

13.
arXiv (CS.AI) 2026-06-24

It's Complicated: On the Design and Evaluation of AI-Powered AAC Interfaces

arXiv:2606.24854v1 Announce Type: cross Abstract: Artificial intelligence (AI) can enhance what people who use augmentative and alternative communication (AAC) are able to do with their systems. However, evaluating AI-powered AAC interfaces can be difficult. People are intersectional beings and current evaluation metrics can struggle to capture the multifaceted and nuanced desires people may have for their AAC. We explore the complicated nature of six AAC problem spaces, explore how AI might be used in these spaces, and suggest more robust methods of evaluation that take the intersectional nuances of people into account. We also discuss broader issues that arise across these problem spaces and how they could be addressed using our proposed evaluation methods.

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

Structuring The Future: Diffusion LLM Speculative Decoding via Calibrated Draft Graphs

Diffusion LLMs (dLLMs) have recently emerged as a powerful alternative to autoregressive LLMs (AR-LLMs) with the potential to operate at significantly higher token-generation rates. To unlock this potential, we present Spiffy, a speculative decoding algorithm to accelerate dLLM inference while provably preserving the model's output distribution. This work addresses the unique challenges involved in applying ideas from speculative decoding of AR-LLMs to dLLMs. Spiffy performs auto-speculation to eliminate the overheads of an independent draft model, structuring draft states in the form of a novel directed draft graph to take advantage of the bidirectional, blockwise nature of dLLM generation. These draft graphs are calibrated offline to maximize acceptance rates and are dynamically pruned during inference for improved computational efficiency. We present a detailed formulation of Spiffy and demonstrate its ability to accelerate LLaDA, Dream, and SDAR models in combination with KV caching and threshold-based dynamic unmasking leading to up to $8.6\times$ reduction in model inferences and $6.3\times$ acceleration in token rate.

15.
arXiv (CS.AI) 2026-06-24

Large-Language-Model Discovery of Quantum LDPC Codes through Structured Concept Evolution

arXiv:2606.24808v1 Announce Type: cross Abstract: Quantum computers could outperform classical machines on important problems, but only if the errors that pervade quantum hardware can be corrected at scale. Quantum low-density parity-check (qLDPC) codes offer a promising route to this goal by combining sparse parity checks with finite encoding rate and growing distance, but their construction remains a challenging discrete design problem. Here we introduce structured concept evolution (SCE), a search framework that pairs a large language model with a structured algebraic mutation grammar to discover lifted-product code families, a class of CSS qLDPC codes. Instead of asking the LLM to design codes from first principles, SCE evolves structured concepts consisting of algebraic specifications paired with executable programs that realize them, using hierarchical mutations that modify the group algebra, protograph geometry, or base space. Running SCE, we discover a diverse set of competitive code families, ranging from abelian constructions to families over non-abelian groups beyond those underlying standard designs such as bivariate-bicycle codes, and characterize them under code-capacity depolarizing noise with BP+OSD decoding. These results are obtained with lightweight models (GPT-5.4-mini and GPT-5.4-nano).

16.
arXiv (quant-ph) 2026-06-19

Local controllability of heralded quantum linear optics

arXiv:2606.19470v1 Announce Type: new Abstract: Photonic linear optical networks provide a versatile platform for quantum information processing and quantum state engineering. However, the set of states that can be generated using passive linear optics alone is fundamentally constrained by bosonic symmetries. Heralding, based on conditional measurements on auxiliary modes, is a widely used technique to overcome these limitations and effectively enlarge the set of accessible states. Despite the widespread use of heralding, it is often unclear how specific ancillary resources impact the overall reachability of the target space. In this work, we investigate the local controllability of photonic states in linear optical networks by analyzing the rank of the Jacobian of the output state with respect to the underlying unitary circuit, which provides a quantitative measure of the dimension of the accessible tangent space at a given configuration. Our analysis ranges from passive linear optics to heralded linear optics, where auxiliary resources and conditional measurements are included. Within this framework, we quantify how different resources enlarge the locally accessible state space beyond that of passive linear optics and determine the resources required for the Jacobian rank to reach its maximal value, thereby achieving full local controllability. As maximal local rank is a necessary condition for global reachability, our framework offers a systematic tool to assess and compare the accessible state space of measurement-based photonic architectures, and to establish practical criteria for the resources needed in high-dimensional quantum state engineering.

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

Self-CTRL: Self-Consistency Training with Reinforcement Learning

arXiv:2606.18327v1 Announce Type: cross Abstract: Language models (LMs) that faithfully describe their own behavior can more easily be audited, understood, and trusted by users. This paper describes Self-Consistency Training with Reinforcement Learning (Self-CTRL), a method that optimizes for consistency between a LM's self-explanations and behavior on related inputs by updating explanations to better predict behavior or updating behavior to better match explanations. We apply our method in two domains. First, we study a formal probabilistic reasoning task in which LMs must learn to imitate a family of biased samplers and evaluated on their ability to report the associated biases. We find that consistency training improves the correlation between self-reported and behaviorally-measured latent biases from $R^2=0.24$ to $R^2=0.64$ on a set of held-out distributions, matching the generalization of direct ground-truth supervision. Second, we study a constitutional AI domain in which LMs must describe when they will refuse or comply with user requests. Here, Self-CTRL produces rules that faithfully describe the model's behavior on held-out requests, improving the refusal predictions of a third-party auditor model from $36\%$ to $92\%$. In the other direction, behavior updates improve alignment, reducing HarmBench failure rate from $15.0\%$ to $0.5\%$ without substantially increasing refusal on harmless prompts. By aligning explanations and behavior, our work provides a general recipe for training AI models to be safer, more transparent, and more controllable.

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

C-QUERI: Congressional Questions, Exchanges, and Responses in Institutions Dataset

Questions in political interviews and hearings serve strategic purposes beyond information gathering including advancing partisan narratives and shaping public perceptions. However, these strategic aspects remain understudied due to the lack of large-scale datasets for studying such discourse. Congressional hearings provide an especially rich and tractable site for studying political questioning: Interactions are structured by formal rules, witnesses are obliged to respond, and members with different political affiliations are guaranteed opportunities to ask questions, enabling comparisons of behaviors across the political spectrum. We develop a pipeline to extract question-answer pairs from unstructured hearing transcripts and construct a novel dataset of committee hearings from the 108th–117th Congress. Our analysis reveals systematic differences in questioning strategies across parties, by showing the party affiliation of questioners can be predicted from their questions alone. Our dataset and methods not only advance the study of congressional politics, but also provide a general framework for analyzing question-answering across interview-like settings.

19.
arXiv (CS.CV) 2026-06-24

Generative Manifold Distillation: Aligning Restoration Trajectories with Natural Image Prior

Pre-trained image restoration models often fail on out-of-distribution (OOD) real-world degradations. Adapting to these domains is challenging as real-world data lacks paired ground truth, and unsupervised methods often require unstable architectural changes. We propose Generative Manifold Distillation (GMD), which reframes domain adaptation as geometric manifold alignment. GMD operates in a strictly unpaired setting, requiring only low-quality (LQ) target observations. By leveraging the flow-matching dynamics of a frozen text-to-image foundation model, GMD projects off-manifold restorations onto the natural image manifold to generate high-quality pseudo-targets. To ensure stability, a quality-gated manifold filter rejects off-manifold samples, while source-anchored trajectory regularization prevents error accumulation. Ultimately, GMD distills a powerful generative prior into an efficient restoration network. Experiments demonstrate that GMD seamlessly adapts to new distributions using only LQ inputs, drastically improving perceptual quality with zero architectural modifications or added inference latency.

20.
arXiv (CS.CL) 2026-06-12

One Token to Fool LLM-as-a-Judge

Large language models (LLMs) are increasingly trusted as automated judges, assisting evaluation and providing reward signals for training other models, particularly in reference-based settings like Reinforcement Learning with Verifiable Rewards (RLVR). However, we uncover a critical vulnerability even in this reference-based paradigm: generative reward models are systematically susceptible to reward hacking. We find that superficial inputs, which we term ''master keys'' such as non-word symbols (e.g., '':'' or ''.'') or generic reasoning openers (e.g., ''Thought process:'' or ''Let's solve this problem step by step.''), can consistently elicit false positive rewards without any substantive reasoning. Our systematic evaluation demonstrates this is a widespread failure affecting a diverse range of models, including leading proprietary systems such as GPT-o1 and Claude-4. These results challenge the assumed robustness of LLM judges and pose a significant threat to their reliability. To address this, we propose a simple yet effective data augmentation strategy using truncated model outputs as adversarial negative examples. The resulting Master Reward Models (Master-RMs) demonstrate state-of-the-art robustness against these ''master key'' attacks while maintaining high performance in standard evaluation settings. We supplement these findings with a comprehensive analysis of the vulnerability across model scales, prompt variations, and common inference-time strategies, offering insights to guide future research on robust LLM evaluation. We release our robust, general-domain reward models and the synthetic training data at https://huggingface.co/sarosavo/Master-RM and https://huggingface.co/datasets/sarosavo/Master-RM.

21.
arXiv (CS.CL) 2026-06-12

LoHoSearch: Benchmarking Long-Horizon Search Agents Beyond the Human Difficulty Ceiling

Search agent benchmarks exemplified by BrowseComp have rapidly saturated over the past year, with the strongest models surpassing 90% accuracy. Since these benchmarks are predominantly human-authored, annotators lack a global perspective on entity statistics and cannot systematically maximize search space size and structural complexity. This creates a difficulty ceiling that is hard to break. To address this, we introduce LoHoSearch (Long-Horizon Search Agents), a challenging benchmark comprising 544 human-verified questions across 11 domains. LoHoSearch is constructed via an automated pipeline built upon a knowledge graph covering over 7 million Wikipedia entities, which selects relations with large search spaces and assembles them into structurally complex questions with KG-verified unique answers. Our evaluation demonstrates that even the strongest model achieves only 34.74% accuracy, and existing context management strategies (best +6.8%) yield far smaller gains than on prior benchmarks. LoHoSearch provides a more demanding standard for evaluating long-horizon reasoning and context management in search agents.

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

Rewrite to Translate, Translate to Reward: Reinforcement Learning for Source Rewriting in Machine Translation

Rewriting source text with large language models (LLMs) before translation has been shown to improve machine translation (MT) quality. However, we find that prompt-based rewriting can degrade translation quality rather than improve it, particularly when smaller LLMs, such as 4B-parameter models, are used. We argue that this limitation stems from the difficulty of controlling rewriting behavior through natural-language prompts alone: a rewrite is useful only if it improves downstream translation, yet existing prompt-based methods do not explicitly optimize for this signal. To address this issue, we propose RLSR (Reinforcement Learning for Source Rewriting), a reinforcement learning framework that trains the rewriting model with a reward based on the downstream translation-quality improvement produced by each rewrite. Experiments across six MT systems and 16 language pairs show that our 4B RLSR-trained rewriting models significantly outperform both the no-rewriting baseline and prompt-based rewriting baselines at the same model scale, while remaining competitive with baselines that use a 235B LLM.

23.
arXiv (quant-ph) 2026-06-17

Impact of Network Constraints on Fault-Tolerant Distributed Quantum Computing

arXiv:2606.17495v1 Announce Type: new Abstract: As we move towards scalable and modular quantum computing, quantum data centres become imperative. Existing analyses typically treat network constraints in isolation or through simplified models, leaving the interplay between error correction operations and communication resources underexplored. In this work, we present an end-to-end simulation framework that jointly models surface-code operations, internal QPU connectivity, and realistic network constraints including finite entanglement generation rates, limited communication qubits, and bandwidth contention, producing execution latency, from which logical error rate estimates are obtained. The framework is modular by design, allowing individual components such as routing heuristics, scheduling policies, and network topologies to be independently replaced. Numerical evaluation reveals distinct operating regimes in which the optimal resource allocation and code distance selection shift depending on the network characteristics. These results point to tradeoffs in the design of distributed quantum computing architectures that are not visible when computation and communication are modeled separately.

24.
PLOS Medicine 2026-05-13

Contribution of nosocomial transmission to <i>Klebsiella pneumoniae</i> neonatal sepsis in Africa and South Asia: An observational study of infection clusters inferred from pathogen genomics and temporal data

by Erkison Ewomazino Odih, Jabir A. Abdulahi, Anne V. Amulele, Matthew Bates, Eva Heinz, Weiming Hu, Kajal Jain, Rindidzani Magobo, Courtney P. Olwagen, John M. Tembo, Tolbert Sonda, Jonathan Strysko, Caroline C. Tigoi, Kyle Bittinger, Jennifer Cornick, Ebenezer Foster-Nyarko, Wilson Gumbi, Steven M. Jones, Chileshe L. Musyani, Carolyn M. McGann, Ahmed M. Moustafa, Patrick Musicha, James C. L. Mwansa, Moreka L. Ndumba, Thomas D. Stanton, Donwilliams O. Omuoyo, Oliver Pearse, Laura T. Phillips, Paul J. Planet, Charlene M. C. Rodrigues, Fatou Secka, Kirsty Sands, Erin Theiller, Allan M. Zuza, Sulagna Basu, Grace J. Chan, Kenneth C. Iregbu, Jean-Baptiste Mazarati, Semaria Solomon Alemayehu, Timothy R. Walsh, Rabaab Zahra, Angela Dramowski, Sombo Fwoloshi, Appiah-Korang Labi, Lola Madrid, Noah Obeng-Nkrumah, David Ojok, Boaz D. Wadugu, Andrew C. Whitelaw, Anudita Bhargava, Atul Jindal, Ramesh K. Agarwal, Alexander M. Aiken, James A. Berkley, Susan E. Coffin, Nicholas A. Feasey, Nelesh P. Govender, Davidson H. Hamer, Shabir A. Madhi, Mari Jeeva Sankar, Kelly L. Wyres, Kathryn E. Holt Background Klebsiella pneumoniae is the leading cause of sepsis among neonates in low- and middle-income countries (LMICs) in Africa and Asia, contributing substantially to the overall burden of antimicrobial-resistant infections and mortality among neonates globally. Pathogen sequencing has been used to investigate case clusters and confirm nosocomial transmission in a small number of neonatal units. Here we utilise pathogen sequence data to estimate the fraction of K. pneumoniae neonatal sepsis attributable to nosocomial transmission in African and South Asian countries. Methods and findings We estimated the proportion of invasive K. pneumoniae disease involved in nosocomial transmission clusters in a given neonatal unit, using single-linkage clustering based on pairwise temporal and genetic distances estimated from bacterial whole-genome sequences aggregated from 10 contributing studies. Analysing 1,523 K. pneumoniae isolates from 27 units in 13 countries in Africa and South Asia between 2013 and 2023, we inferred 156 nosocomial transmission clusters, ranging from 2 to 188 neonates each (83 of the clusters comprised ≥3 cases). Overall, we estimated that 1,035 neonatal infections (68.0%) were part of nosocomial transmission clusters. Excluding the first infection in each cluster as a potential index case, we estimate at least 879 (57.7%) infections were acquired via nosocomial transmission. Sensitivity analyses showed that results were robust to the choice of genetic distance estimation methods and thresholds used to define clusters, and cluster estimates were stable over temporal distance thresholds ranging from 2 to 8 weeks. Isolates were mostly extended-spectrum beta-lactamase (ESBL) producers (90.9%) and included 172 multi-locus sequence types (STs). Fourteen STs, including several globally recognised multidrug-resistant lineages, were associated with transmission clusters at multiple units, and these were collectively responsible for two-thirds of all infections. Carriage of carbapenemase genes (adjusted odds ratio, aOR = 2.08 [95% confidence interval, CI: 1.04, 4.14]; p = 0.04) and ESBL genes (aOR = 2.48 [95% CI: 1.26, 4.90]; p = 0.006) were significantly positively associated with transmission in a logistic regression model with site as a covariate. Limitations of this study include the lack of sufficient clinical data to allow high-resolution investigation of transmission dynamics and lack of facility-level data to investigate contributors to the observed differences in transmission burden across sites. Conclusions Nosocomial transmission contributes to a substantial proportion of K. pneumoniae sepsis in neonatal care units in Africa and South Asia. Reducing transmission within these settings through improved infection prevention and control and other measures could substantially reduce the neonatal sepsis burden. A high burden of transmission clusters is associated with the same drug-resistant lineages that are recognised as high-risk clones associated with hospital outbreaks in high-income countries, indicating global connectivity of the antimicrobial-resistant pathogen population.

25.
arXiv (CS.AI) 2026-06-19

CareTransition-Audit: A Benchmark to Audit Discharge Summaries for Efficient Care Transitions

arXiv:2604.05435v2 Announce Type: replace Abstract: Incomplete or inconsistent discharge documentation drives care fragmentation and avoidable readmissions. Despite its critical role in patient safety, auditing discharge summaries relies on manual review and does not scale. We propose an automated framework for auditing discharge summaries using large language models (LLMs). Our approach operationalizes the DISCHARGED framework into a checklist of 46 questions. Using 50 summaries from the MIMIC-IV database, with clinician ground-truth labels, we benchmark 11 LLMs. Model-assessed mean documentation completeness ranges from 54.9% to 74.2%, and the best-performing models achieve a Cohen's kappa values around 0.5 against clinician labels, indicating moderate agreement. All models struggle to identify ambiguous documentation (Unclear), highlighting a key gap in current automated auditing. This work provides a clinician-validated benchmark and zero-shot baselines for systematic quality improvement in clinical documentation.