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

RepNet: Tackling spectral bias in deep neural networks via parameter reparameterization

arXiv:2606.16575v1 Announce Type: new Abstract: Deep neural networks (DNNs) have achieved remarkable success in scientific computing, yet they often suffer from spectral bias in capturing oscillatory and multiscale behaviors. In this study, we investigate this limitation by examining the failure of shallow ReLU neural networks in fitting high-frequency functions. This observation identifies two important factors in resolving rapid oscillations: the initial slope scale and the distribution of partition points induced by the networks. Motivated by this analysis, we propose RepNet, a reparameterized DNN model for ReLU and tanh networks designed for high-frequency and multiscale problems. The key idea is to reparameterize the weights and biases in the first hidden layer, which enables effective control of the initial slope scale and provides an appropriate distribution of the initial partition points. Furthermore, treating the reparameterized weights and biases as trainable parameters allows the DNN to achieve adaptive frequency scaling during training. In addition, we derive quantitative estimates for the output and slope magnitudes of the reparameterized DNN to guide the initialization of the proposed method. Numerical experiments, including multiscale one- and four-dimensional function approximation, forward and inverse PDE problems in combination with physics-informed neural networks (PINNs), and operator learning, demonstrate that RepNet improves the predicted accuracy of vanilla DNNs in capturing highly oscillatory features with slightly additional computational cost. These results indicate that RepNet provides an effective and flexible approach for overcoming spectral bias and applying DNNs to multiscale problems.

02.
arXiv (CS.CV) 2026-06-16

Pixel-TTS: Image based Text Rendering for Robust Text-to-Speech

Recent advances in pixel-based text modeling show that representing text as images enables models to exploit visual cues for language understanding. Grounding text in its visual form allows structurally similar characters with different Unicode encodings to produce similar embeddings, benefiting cross-lingual and zero-shot scenarios. Conventional text-based approaches treat each character independently, limiting generalization to unseen characters and requiring embedding expansion during cross-lingual adaptation. We propose Pixel-TTS, the first framework for visually grounded speech synthesis. It renders text as images and projects them through a 2D convolutional layer to generate embeddings. This design eliminates embedding matrix expansion during fine-tuning while improving robustness to unseen characters and orthographic variations. Extensive experiments show Pixel-TTS achieves competitive performance with strong baselines, faster convergence and robust zero-shot generalization.

03.
arXiv (math.PR) 2026-06-17

On Injectivity of Phase Retrieval

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arXiv:2606.17922v1 Announce Type: cross Abstract: In this short note, we prove that if $A \in \mathbb C^{N \times M}$ with $N=4M-5$ has i.i.d.\ standard complex Gaussian entries, then the probability that the phase retrieval map generated by $A$ is not injective is positive. This proves Part (1) of a conjecture of Cynthia Vinzant, which was later restated by Afonso S. Bandeira in [BDL+26]. The main result of this paper was obtained using generative AI, in particular the Rethlas system.

04.
arXiv (CS.CV) 2026-06-18

Learned Radius Estimation for UDF-Based Point Cloud Reconstruction

Surface reconstruction from point clouds is important for consumer-grade 3D capture, including AR/VR and indoor scanning. Local-patch Unsigned Distance Field (UDF) methods are lightweight and generalizable, but their accuracy depends on the support radius, traditionally fixed or selected by a one-dimensional curvature heuristic that cannot capture heterogeneous local geometry. We propose a learned per-query radius selector that predicts a continuous support radius and plugs into a frozen LoSF-UDF backbone. The selector is trained using off-grid target radii obtained by parabolic interpolation of cached UDF error curves. Experiments show improved fine-scale reconstruction accuracy.

05.
arXiv (quant-ph) 2026-06-16

Diagonal-Budgeted Trotterization for Efficient Quantum Hamiltonian Simulation

arXiv:2606.16959v1 Announce Type: new Abstract: Efficient classical simulation of quantum Hamiltonian dynamics is often bottlenecked by exponential state growth and the overhead of generic sparse linear algebra. We introduce diagonal-budgeted Trotterization, a structure-aware strategy that decomposes Hamiltonians into factors preserving diagonal sparsity while tightly controlling fidelity loss. Our implementation, HamSim, utilizes a compact diagonal-sparse data layout and specialized C++/CUDA kernels to bypass the overheads of generic formats like CSR. By leveraging SIMD vectorization, multithreading, and GPU acceleration, HamSim achieves high performance across heterogeneous architectures. Benchmarks on the HamLib suite show that HamSim significantly outperforms Qiskit-Aer. On CPUs, HamSim attains speedups of $182$–$1,269\times$ on optimization instances (TSP, MaxCut) and $4.8$–$841\times$ on physical models (TFIM, Heisenberg). On GPUs, it achieves up to $178\times$ speedup for $12$–$16$ qubit problems. Unlike traditional Trotterization, HamSim maintains near-perfect fidelity without requiring exponential steps. This demonstrates that diagonal-aware numerical kernels provide a scalable foundation for high-fidelity classical Hamiltonian simulation.

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

Training-Free Adversarial Robustness in Computational MRI

Deep learning (DL) methods have become the state-of-the-art for reconstructing sub-sampled magnetic resonance imaging (MRI) data. However, studies have shown that these methods are susceptible to small adversarial input perturbations, resulting in major distortions in the output images. Various strategies have been proposed to reduce the effects of these attacks, but they require retraining. In this work, we propose a novel approach for mitigating adversarial attacks on MRI reconstruction models without any retraining. Based on the idea of cyclic measurement consistency, we devise a novel mitigation objective that is minimized in a small ball around the attack input. Results show that our method substantially reduces the impact of adversarial perturbations across different datasets, attack types/strengths and PD-DL networks, and qualitatively and quantitatively outperforms conventional mitigation methods. We also introduce a practically relevant scenario for small adversarial perturbations that models impulse noise in raw data, which relates to herringbone artifacts, and show the applicability of our approach in this setting. Finally, we show our mitigation approach remains effective in two realistic extension scenarios: a blind setup, where the attack strength or algorithm is not known to the user; and an adaptive attack setup, where the attacker has full knowledge of the defense strategy.

07.
arXiv (quant-ph) 2026-06-16

Atom–photon Entanglement with a Single Trapped Cesium Atom

arXiv:2605.28968v2 Announce Type: replace Abstract: We demonstrate atom–photon entanglement using a single cesium atom trapped in an optical tweezer. Entanglement is generated by resonant excitation and subsequent spontaneous decay, which entangles the atomic Zeeman state with photon polarization. The photon is collected with a high numerical aperture objective (NA = 0.55) and coupled into a single-mode fiber, enabling atom photon measurements and measurement of the Bell-state fidelity. We obtain raw entanglement fidelity of ${\mathcal F} = 0.942(16)$ and inferred fidelity of ${\mathcal F}_inf = 0.962(26)$ after correcting independently characterized atom measurement errors. Compared with related free-space experiments using $^{87}$Rb, the multilevel structure of the relevant excited state in $^{133}$Cs requires the use of a single short excitation pulse in each entanglement attempt in order to suppress unwanted re-excitation. These results establish a free-space Cs atom–photon interface and provide a step toward dual-species Rb–Cs quantum networking.

08.
arXiv (quant-ph) 2026-06-16

Achieving High-Quality Portfolio Optimization with the Variational Quantum Eigensolver

arXiv:2508.18625v2 Announce Type: replace Abstract: Portfolio optimization lies at the core of quantitative finance and aims to determine how assets should be allocated to balance expected returns against risk. It can be formulated as a Quadratic Unconstrained Binary Optimization (QUBO) problem, which is NP-hard. Quantum computing offers the potential to solve such problems more efficiently than classical methods. In this work, we employ the Variational Quantum Eigensolver (VQE) to address the portfolio optimization problem. To increase the likelihood of converging to high-quality solutions, we propose using the Weighted Conditional Value-at-Risk (WCVaR) as the cost function and the Covariance Matrix Adaptation Evolution Strategy (CMA-ES) as the optimizer. Our experiments are conducted using both classical simulations and quantum hardware on the Wuyue QuantumAI platform. Together, these results demonstrate that the combination of WCVaR and CMA-ES improves the performance of VQE for portfolio optimization and provides a practical route for applications on NISQ devices.

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

Epistemic Uncertainty Is Not the Reducible Kind

作者:

arXiv:2606.12646v1 Announce Type: cross Abstract: The standard taxonomy of predictive uncertainty defines epistemic uncertainty as the part removable by collecting more data, while the standard measure identifies it with a mutual-information term. We prove the definition and the measure are extensionally inconsistent. On an explicit construction, the measure assigns all uncertainty to the epistemic class, yet no quantity of training data reduces it. Reducibility is instead a property of the pair (uncertainty, acquisition class), and the dichotomy resolves into three parts: aleatoric, sample-reducible epistemic, and mechanism-reducible epistemic uncertainty. An exact identity for the value of an observation shows that in-distribution data never reduces mechanism-irreducible uncertainty and generically increases it. Ensemble disagreement, the deployed epistemic estimate, tracks the training procedure rather than the epistemic term. It collapses to zero beneath a positive truth under consistent training, and equals hyperparameter-scaled initialization noise under interpolation. A finite-sample falsification test and seed-swept experiments confirm the theory.

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

HERO: Hindsight-Enhanced Reflection from Environment Observations for Agentic Self-Distillation

arXiv:2606.11559v1 Announce Type: new Abstract: Reinforcement learning typically improves multi-turn agent capabilities through the terminal outcome of the trajectories, which makes it difficult to determine credit assignments for each intermediate turns. Recent on-policy self-distillation methods offer a promising alternative by converting privileged feedback into dense token-level supervision through a self-teacher. Our study is motivated by the unexpected performance degradation observed when naively extending this paradigm to multi-turn settings, which we attribute to a lack of alignment between privileged feedback, such as successful trajectories or terminal outcomes, and the student's current decision context. We introduce HERO, a hindsight-enhanced self-distillation framework that uses next environment observations as locally aligned feedback. After each rollout, HERO reflects on the completed interaction to convert each observation into a compact turn-level diagnosis, that captures actionable feedback about the original action such as its necessity, validity or failure cause. On TauBench and WebShop, HERO improves task success and reduces unnecessary turns over environment-feedback-only self-distillation and GRPO. It is especially effective under limited training turn budgets, where successful rollouts are rare and GRPO provides weak reward-contrast signals.

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

Token-Level Entropy Reveals Demographic Disparities in Language Models

We ask whether demographic identity, signaled by a name alone, systematically reshapes the generative distribution of a language model. Measuring full-vocabulary Shannon entropy at temperature zero across six open-weight base models and 5,760 implicit sentence-completion prompts (e.g., "Tanisha walked into the office on a Monday morning and"), we find that Black-associated names produce higher first-token entropy than White-associated names across all six architectures - opposite to the output-level homogeneity bias documented under explicit demographic prompting (Lee et al., 2024) - and Black-associated names always produce greater entropy above identity-neutral baselines than White-associated names ($\Delta\Delta > 0$ in all six models). Women-associated names co-occur with lower first-token entropy (DL-pooled $\hat\beta = -0.041, p = .019$) and more homogeneous outputs ($\hat\alpha = +0.024, p < .001$) than men-associated names - a pattern convergent with homogeneity bias; race and gender effects are additive. Instruction tuning does not attenuate the race gap (matched-format DL-pooled $\hat{\beta}=+0.153$). Running the same templates with explicit group labels instead of names yields null race effects in 10 of 12 models where implicit probing is significant - establishing that probing methodology is a primary determinant of which distributional structure is recovered.

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

Stringalign: Moving beyond summary statistics with a transparent Unicode-aware tool for evaluating automatic transcription models

Comparing text strings is crucial when evaluating and understanding the performance of various text processing tasks such as document recognition and audio transcription. With an increasingly complex landscape of AI-based handwritten text recognition (HTR), optical character recognition (OCR) and automatic speech recognition (ASR) models, there is a need for tools that facilitate evaluation in a flexible and reproducible way. This paper presents Stringalign, a Python library designed to simplify the evaluation process for automatic transcription projects and facilitate transparent evaluation. Stringalign's tools to examine and visualise both the rate of errors and the types of errors a model makes, give insights into possible improvements and help inform model selection for a particular task. Widely used string comparison metrics, such as the character and word error rates (CER and WER), although useful, can be ambiguous due to varying definitions of what constitutes a character and a word. Stringalign addresses this challenge by ensuring all preprocessing (i.e. normalisation and tokenisation) is transparent and easily replicable, and by providing tools to move beyond summary statistics and analyse common model errors. Moreover, Stringalign adheres to FAIR (Findable, Accessible, Interoperable, and Reusable) principles for research software while staying lightweight and easy to adapt into researchers existing workflows. In this paper, we discuss challenges with character and word level string comparisons and show through examples that where existing tools can yield opaque and sometimes confusing results, Stringalign provides an easy-to-use and unambiguous alternative.

13.
arXiv (quant-ph) 2026-06-15

Interpreting Bohm-like quantum potentials in "Computing quantum waves exactly from classical action"

arXiv:2605.20443v3 Announce Type: replace Abstract: The recent posting arXiv:2605.02621 [14], commenting on the article rspa.2025.0413 [7], argues that the proof of Lemma 3.1 in [7] is missing the spatial derivative of the density, which would lead to a Bohm-like quantum potential. This technical note shows why the propagated density is independent of space in the Feynman propagator construction of Lemma 3.1. This is done by extending the proof of Lemma 3.1 explicitly with Bohm-like quantum potential terms along the stationary action paths, and then showing that these terms are exactly zero. In [7], this property can also be verified directly on most examples (double slit, Aharonov-Bohm, potential well, harmonic oscillator, tunneling, EPR, QED), as well as in the derivations of the Pauli, Dirac, and Maxwell equations. For more general nonlinear actions, a time rescaling may be required to guarantee this space independence along stationary paths. In the hydrogen atom example, this time rescaling can be computed in closed form. In contrast to the general wave of the Madelung solution [9] Lemma 3.1 of [7] is defined first for a propagator, and a general wave is then constructed in a second step. Recall that a propagator is a specific quantum wave, which is initialized at $t=0$ with a Dirac impulse at a given initial position or momentum. In turn, a general wave is constructed in a second step by superposing a distribution of initial conditions using the propagator. This key difference is why the Bohm-like quantum potential terms disappear in the construction [7] (specifically, in the first step) while the Bohm potential in the Madelung analysis does not. This fundamental difference is also consistent with the fact that the wave construction in [7] extends naturally to relativistic contexts, while Bohmian non-locality notoriously prevents such extensions. Keywords - Response to arXiv:2605.02621, in relation to rspa.2025.0413

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

Off-Policy Evaluation for Missingness-Aware Policies in MDPs with Rewards Missing Not at Random

arXiv:2606.20206v1 Announce Type: cross Abstract: In offline Reinforcement Learning, immediate rewards in logged batch data are often unobserved due to sparse or irregular record-keeping, or censored beyond certain reward values. This issue arises in practical settings, including health care and marketing. We investigate off-policy evaluation (OPE) in finite-horizon Markov decision processes when rewards are missing not at random (MNAR), which breaks ignorability and induces selection bias even after conditioning on states and actions. To address this, we formalize a reward-dependent propensity model and use future states as shadow variables to identify the full-data conditional mean reward. We further introduce a bridge function that recovers the conditional mean reward without explicitly modeling the MNAR mechanism, and estimate it via a min-max procedure to avoid double sampling. Building upon these identification results, we propose an Fitted-Q-Evaluation-style estimator that propagates the recovered rewards while allowing target policies to depend on past missingness indicators. Finally, we establish consistency and finite-sample error bounds for our OPE estimator, and show through experiments the strong performance of our method compared to existing methods on simulated and MIMIC-III Sepsis data.

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

Towards Verifiable Agentic Data Science: Solving Irregular TSQA Via Tool-Grounded Reasoning

arXiv:2606.15107v1 Announce Type: new Abstract: Time series data in real-world deployments is overwhelmingly irregular. Observations are asynchronous, missing values are informative rather than random, and sampling frequencies vary across sensors and operational windows. However, existing Time Series Question Answering (TSQA) benchmarks mostly assume regularly sampled inputs, leaving a fundamental gap in understanding how large language models (LLMs) and AI agents perform under irregular conditions. To bridge this gap, we introduce IRTS-ToolBench, a benchmark of 1,700 questions spanning 10 task types across 13 domains. IRTS-ToolBench is designed to be used independently by any researcher working on LLM-based irregular time series analysis, providing standardized inputs and a reproducible evaluation protocol. Code can be found in https://github.com/SanhornC/IRTS-ToolBench.

16.
arXiv (CS.AI) 2026-06-18

IPSL-AID: Generative Diffusion Models for Climate Downscaling from Global to Regional Scales

arXiv:2604.03275v2 Announce Type: replace-cross Abstract: Effective adaptation and mitigation strategies for climate change require high-resolution projections to inform strategic decision-making. Conventional global climate models, which typically operate at resolutions of 150 to 200 kilometers, lack the capacity to represent essential regional processes. IPSL-AID is a global to regional downscaling tool based on a denoising diffusion probabilistic model designed to address this limitation. Trained on ERA5 reanalysis data, it generates 0.25 degree resolution fields for temperature, wind, and precipitation using coarse inputs and their spatiotemporal context. It also models probability distributions of fine-scale features to produce plausible scenarios for uncertainty quantification. The model accurately reconstructs statistical distributions, including extreme events, power spectra, and spatial structures. This work highlights the potential of generative diffusion models for efficient climate downscaling with uncertainty

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

DIMOS: Disentangling Instance-level Moving Object Segmentation

Moving instance segmentation (MIS) attracts increasing attention due to its broad applications in traffic surveillance, autonomous driving, and animal tracking. Event cameras record asynchronous brightness changes, providing high temporal resolution and dynamic range, which makes them highly sensitive to motion information. By fusing event and image features, motion cues from events can complement spatial details from images, enhancing the performance of MIS. However, current multimodal MIS methods still struggle to segment small moving instances, as event cameras often yield sparse features under limited resolution. Moreover, event features entangle appearance attributes with motion cues, which further restricts effective cross-modal fusion. To address these challenges, we first propose a dual-disentangling feature extraction framework that separates and extracts appearance and motion information within both image and event modalities, thereby improving feature density. Subsequently, a multi-granularity cross-modal alignment is introduced to align distributionally and semantically consistent features across modalities, enabling more effective fusion with rich spatial and temporal details. The experiment results demonstrate that our method achieves state-of-the-art performance in multimodal MIS, especially for small instances under challenging conditions such as fast motion and low-light settings.

18.
arXiv (CS.AI) 2026-06-16

Medical world models: representing medical states, modelling clinical dynamics and guiding intervention policies

arXiv:2606.16721v1 Announce Type: new Abstract: Medical diagnosis and treatment are dynamic processes in which patient states evolve over time and clinical interventions alter future outcomes. Although current medical AI can detect disease, estimate risk and generate reports, many systems still return static labels or scores, offering limited insight into how illness may progress or how alternative interventions may reshape its trajectory. Medical world models adapt the world-model idea from artificial intelligence to healthcare by learning internal simulators of patient-state dynamics. Their long-term goal is to help clinicians anticipate deterioration, compare treatment-conditioned futures and tailor care to individual patients. Yet relevant work remains scattered across foundation models, longitudinal modelling, disease simulation, treatment-effect estimation, reinforcement learning and digital twins. To bridge this gap, this review outlines a roadmap for advancing medical AI from isolated diagnosis and prediction toward medical world models that simulate disease evolution and support intervention decisions. This roadmap is organized around three coupled capabilities: patient-state construction, clinical dynamics modelling and intervention decision support. Across representative systems, the comparison highlights what each capability contributes and how partial components can be integrated into more mature perception–dynamics–planning systems. Finally, we identify the challenges involved in turning plausible rollouts into clinically useful simulators. Related literature is available at https://github.com/1999kevin/awesome_medical_world_models.

19.
arXiv (CS.AI) 2026-06-11

GEAR-VLA: Learning Geometry-Aware Action Representations for Generalizable Robotic Manipulation

arXiv:2606.08530v2 Announce Type: replace-cross Abstract: Vision-Language-Action (VLA) models achieve strong benchmark performance but still struggle in real-world deployment with unseen objects, background shifts, and different robot embodiments. We argue that this stems from the lack of a unified geometry-aware manipulation representation, leaving existing VLAs vulnerable to low-level trajectory supervision, misaligned 3D features, and embodiment differences. To address this, we propose GEAR-VLA, a VLA framework for learning unified geometry-aware action representations for generalizable robotic manipulation. GEAR-VLA adopts coarse-to-fine action learning, where multi-source embodied pretraining equips the VLM with embodied reasoning and discrete action understanding before latent action tokens connect action semantics to a gradient-decoupled DiT continuous action expert. It further performs semantic-aligned 3D integration by aligning a trainable 3D spatial backbone with the VLA representation while freezing the original VLM-aligned visual pathway. To share this representation across robots, GEAR-VLA uses embodiment canonicalization, where embodiment-aware states and embodiment-invariant actions confine robot differences to the low-level interface. Extensive simulation and real-world experiments demonstrate strong generalization: GEAR-VLA achieves state-of-the-art performance on LIBERO, zero-shot LIBERO-Plus, and RoboTwin 2.0, reaches 85.9% success on AgileX and 81.0% on the pretraining-unseen LDT-01 embodiment, and obtains 90.1% success on a 6,360-trial universal grasping benchmark with 212 unseen objects. Code and models will be released at https://github.com/babynabeauty/GEAR-VLA.

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

Tying the Loop – Tied Expert Layers in Mixture-of-Experts Language Models

作者:

Mixture-of-Experts (MoE) architectures efficiently scale Large Language Models (LLMs) by activating only a small fraction of their experts per token, yet the full parameter count - dominated by the expert parameters - must be held in training and inference memory. To address this, we introduce Expert Tying, an architectural modification that shares expert parameters across consecutive transformer layers while preserving independent, layer-wise routing and attention. We evaluate this approach across common, state-of-the-art architectures, including OLMoE, Qwen3, and DeepSeek-style MoEs. Our pretraining experiments demonstrate that tying experts can reduce memory footprint by almost 2x at virtually no degradation in perplexity or downstream quality. By exploiting the parameter redundancy inherent in MoE pathways, our method provides a highly favorable compute-to-memory trade-off, advancing efficient training and scaling of next-generation LLMs.

21.
arXiv (CS.CL) 2026-06-11

Fast Speech Foundation Model Distillation Using Interleaved Stacking

Distilling a large speech foundation model (SFM) into an efficient student model has been successfully applied to low-resource environments. Although distillation reduces inference latency, it requires an additional student model training. However, the training efficiency of SFM distillation remains underexplored. In this work, we explore training acceleration of SFM distillation to speed up model deployment. We examine the potential of stacking, in which the model depth is progressively increased through training until the target model depth is reached. While existing stacking methods improve training speed, they suffer from performance degradation. To handle this limitation, we propose interleaved stacking, a novel stacking method that consistently preserves layer position throughout the stacking process. This property is particularly critical in SFMs, in which each layer encodes distinct layer-specific knowledge. We validate the effectiveness of the proposed method on SUPERB.

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

Open-SWE-Traces: Advancing Dual-Mode Multilingual Distillation for Software Engineering Agents

arXiv:2606.16038v1 Announce Type: cross Abstract: The path toward autonomous software engineering is currently bottlenecked by a severe deficit of diverse, large-scale trajectory data. We address this by introducing \ourdataset, an expansive dataset of 207,489 agentic trajectories spanning nine programming languages (Python, Go, TS, JS, Rust, Java, PHP, C, C++). Sourced from 20,000 real-world PRs via OpenHands and SWE-agent harnesses, the dataset utilizes a hybrid-reasoning synthesis: Minimax-M2.5 generates trajectories with explicit "thinking" processes, while Qwen3.5-122B provides high-quality "non-thinking" traces. Filtered for permissive licenses (MIT, Apache, BSD) from SWE-rebench-V2, this data facilitates the training of models capable of long-horizon reasoning. We validate the dataset by fine-tuning the Qwen3-30B-A3B series (Thinking, Instruct, and Coder). The best performing model achieves resolve rates of 61.7% on SWE-bench Verified, 57.1% on SWE-bench Multilingual, and 36.8% on SWE-bench Pro. These results establish Open-SWE-Traces as a premier resource for distilling human-level software engineering capabilities into efficient, open-source agentic LLMs.

23.
medRxiv (Medicine) 2026-06-16

Comparative Effectiveness and Safety of Prophylactic Vasopressors for Preventing Post-induction Hypotension in the Elderly: A Systematic Review and Network Meta-analysis

Background: Post-induction hypotension is a predictable haemodynamic hazard in older adults undergoing general anaesthesia. Prevention remains divided among volume optimisation, anaesthetic dose reduction, rescue treatment after hypotension occurs and proactive vasoactive support. Methods: We searched PubMed, Embase, Web of Science, CENTRAL, CNKI, Wanfang and VIP from inception to 30 March 2026. Eligible studies were randomised trials of prophylactic vasoactive drugs given before, during or immediately after induction in older adults. The primary outcome was post-induction hypotension. Secondary outcomes were post-induction mean arterial pressure (MAP), systolic arterial pressure (SBP), heart rate (HR) and reported haemodynamic adverse events. Random-effects network meta-analysis was used, and confidence in network estimates was assessed using CINeMA principles. Results: Thirty-one trials including 2,821 participants were included in the revised network. Compared with placebo/control, all active agents favoured lower post-induction hypotension. The most favourable point estimates were observed for phenylephrine (odds ratio [OR] 0.17, 95% confidence interval [CI] 0.01 to 2.16) and metaraminol (OR 0.19, 95% CI 0.02 to 1.53), although both were imprecise. More precise reductions were observed for methoxamine (OR 0.23, 95% CI 0.13 to 0.43), norepinephrine (OR 0.25, 95% CI 0.13 to 0.47) and ephedrine (OR 0.34, 95% CI 0.19 to 0.63). Phenylephrine ranked highest for MAP support, norepinephrine ranked highest for SBP support, and ephedrine ranked highest for HR preservation. Global inconsistency was detected for SBP but not for hypotension incidence, MAP or HR, supporting cautious profile-based interpretation. Conclusions: Prophylactic vasopressor choice during induction should be guided by haemodynamic phenotype rather than ranking alone. In the revised network, active prophylaxis consistently favoured lower hypotension, but sparse nodes produced uncertainty. Norepinephrine retained a comparatively balanced profile when vasodilatory post-induction hypotension is anticipated, phenylephrine and related alpha-agonists provided stronger pressure support when HR and cardiac-output reserve are preserved, and ephedrine was most relevant when chronotropic support is desired. Keywords: general anaesthesia; induction; hypotension; norepinephrine; phenylephrine; ephedrine; network meta-analysis; older adults.

24.
arXiv (CS.CL) 2026-06-12

MiniPIC: Flexible Position-Independent Caching in <100LOC

Retrieval-augmented and agentic workloads repeatedly prefill recurring predictable structured inputs (which we call "spans") such as documents and code files. Yet, prefix caching in engines such as vLLM cannot reuse their KV entries unless they share identical prefixes with another request, while Position-Independent Caching (PIC) implementations within production-grade inference servers typically either require substantial server code changes or keep KV state outside the server, incurring host-to-device transfer overhead. We present Minimalistic PIC (MiniPIC): a minimal, flexible and fast vLLM design built from two ingredients: positional-encoding-free KV cache and user-controlled cache-reuse primitives. MiniPIC stores unrotated K vectors in the KV cache, applies RoPE to K tiles inside attention using per-request logical positions, and exposes three user-facing and token-level primitives: block-aligned padding, span separator (SSep), and prompt depend (PDep), that modify hashing behavior and effective block-level causal attention structure. With fewer than 100 lines of core-engine changes plus a custom attention backend, these primitives are sufficient to realize multiple PIC methods, including Block-Attention, EPIC, and Prompt Cache, within the same running vLLM instance, while natively integrating with KV cache CPU offload implementations. On 2WikiMultihopQA, MiniPIC with interleaved scheduling improves prefill throughput by 49% over baseline vLLM, reduces cached-span time-to-first-token by up to two orders of magnitude, preserves the linear prefill scaling of uncached spans, and incurs only 5.7% worst-case overhead.

25.
medRxiv (Medicine) 2026-06-10

General-purpose large language models can achieve physician-level accuracy in complex medical data extraction

Background: Unstructured data represent about 80% of total electronic health records (EHR) data. Structuring this free text is essential for advancing clinical research, including cohort selection for trials, retrospective studies, and the development of disease registries. While manual chart review (MCR) remains the gold standard for extracting this clinical data, the process is inherently slow, resource-intensive, and susceptible to errors from human fatigue. We evaluated the extraction accuracy, safety, and efficiency of the HeLIX (Hepatology Logic-Integrated Extraction) framework, a Large Language Model (LLM) protocol using Google Gemini 3 Pro, compared to a gold-standard Manual Chart Review (MCR). Methods: A prospective validation study was conducted using 50 high-complexity, simulated hepatology discharge summaries designed to replicate the real-world heterogeneity of EHRs. The HeLIX framework employed a Zero-Shot, Structured Chain-of-Thought (CoT) prompting strategy enforced by a three-layer architecture: Clinical Reasoning Trace, Schema Enforcement, and Evidence Verification. The model extracted 45 distinct clinical variables. Performance was benchmarked against a consensus MCR. Results: Across 2,250 evaluated data points, the model achieved an overall Extraction Accuracy of 99.24% (95% CI: 98.8%-99.5%), with perfect concordance in 35/45 (77.8%) variables. For binary diagnostic variables, the model demonstrated an overall F1-score of 0.98, Recall of 0.99 and substantial inter-rater reliability (Cohens {kappa} = 0.97). Hallucinations were exceptionally rare (2/2250; 0.08%). Critical errors affecting clinical management occurred in only 2 instances (