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01.
arXiv (CS.LG) 2026-06-11

Phi-Actor-Critic: Steering General-Sum Games to Pareto-Efficient Correlated Equilibria

arXiv:2606.11284v1 Announce Type: cross Abstract: Real-world multi-agent systems, from traffic coordination to resource allocation, are often modeled as general-sum games where individual incentives conflict with collective welfare. In these settings, the central challenge is not merely finding an equilibrium, but selecting socially desirable outcomes among many suboptimal Nash equilibria. Standard deep multi-agent reinforcement learning (MARL) methods struggle with this problem, as value-decomposition approaches are constrained by monotonicity assumptions and policy-gradient methods often converge to stable but socially inefficient equilibria. To address this limitation, we propose $\Phi$-Actor-Critic ($\Phi$-AC), a framework that leverages swap regret minimization to steer learning toward high-welfare correlated equilibria (CE). To make counterfactual regret estimation tractable in deep MARL, $\Phi$-AC employs a centralized attention critic that predicts vector-valued regrets in a single forward pass, avoiding computationally expensive counterfactual simulations. We further introduce a Lagrangian-based equilibrium selection mechanism that optimizes social welfare while enforcing stability through regret constraints. Experiments on matrix games, Multi-Agent Particle Environments (MPE), and the Melting Pot Harvest scenario demonstrate that $\Phi$-AC learns efficient and stable coordination strategies across diverse mixed-motive settings while maintaining high collective return and competitive fairness.

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

HRDX: A Large-Scale Vector HD-Map Dataset

Reliable autonomous driving requires vectorized HD maps that are geometrically accurate, semantically rich, and scalable to long-horizon driving. However, existing public HD map datasets are limited in scale, provide sparse semantic attributes, and lack modalities such as aerial imagery that could enable new research directions. We present HRDX, a large-scale dataset for vector HD-map construction, spanning about 40 hours (1,400 km) of minimally overlapping drives, which is several times larger than prior public HD map datasets. Data is captured using six synchronized surround cameras, a 128-beam LiDAR, and centimeter-level RTK GNSS/IMU, and is further complemented by precisely aligned aerial orthoimagery. Annotations cover 10 vector map classes, complemented with over 20 semantic and topological attributes. To evaluate this richer ontology, we introduce the Composite Score (CS) to jointly assess geometric fidelity and attribute correctness. Benchmark experiments show that HRDX's scale improves online vector-map construction, and that aligned aerial imagery provides a useful structural prior: using aerial imagery at training and/or inference improves geometric map quality, while aerial-augmented teachers can transfer part of this benefit to camera-only students without increasing inference-time sensor requirements. HRDX is intended to support reproducible research on large-scale HD-map learning, multimodal BEV fusion, and training-time privileged information. HRDX dataset and benchmarks are available at https://github.com/honda-research-institute/HRDX

03.
arXiv (CS.CL) 2026-06-15

Detecting Historical Turning Points in Italian Media: A Complex Systems Approach to a Diachronic News Corpus

The increasing availability of large-scale textual corpora has opened new possibilities for data-driven, quantitative approaches to historical analysis using Natural Language Processing (NLP). However, diachronic corpora with historical relevance from the pre-digital era remain scarce and often incomplete. We present a quantitative approach to historical analysis based on the reconstruction and exploration of a diachronic corpus of around 600,000 articles from the Italian newspaper "La Repubblica", covering all the articles published from the 1st of January 1985 to the 31st of December 2000 - a period of major political, social, and geopolitical change in Italy and globally. Using NLP techniques, we analyze the text at both lexical and semantic levels; we then apply tools from complex systems and statistical physics to trace shifts in media discourse over time. This allows us to detect key transition periods, such as the transition from the First Republic to the Second Republic in Italy, or major international conflicts like the Gulf War or the Kosovo War, without relying on prior labeling. The results show how combining computational linguistics with ideas from complex systems can offer new quantitative insight into historical changes, opening up new paths for studying the dynamics of media and society through large-scale textual data.

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

Whole-Brain Connectomic Graph Model Enables Whole-Body Locomotion Control in Fruit Fly

arXiv:2602.17997v3 Announce Type: replace Abstract: Animals perform coordinated whole-body movements under the control of neural systems shaped by brain-wide connectivity. The mapping of the whole-brain neural connections, or the connectomes, provides a natural graph for modeling sensorimotor information flow, yet its potential as a neural controller for embodied agents remains largely unexplored. Here, we introduce the Fly-connectomic Graph Model, which directly instantiates the whole-brain connectome of an adult Drosophila as a graph-structured neural controller for movements of a simulated biomechanical fruit fly via deep reinforcement learning. We achieve stable performance across diverse locomotion tasks, as well as better sample efficiency compared to both graph and non-graph baselines. Our results demonstrate a biologically informed way towards effective control policy design by translating whole-brain wiring principles into actionable architectural priors, while also improving the interpretability through dynamic information flow. This work also highlights the potential to bridge neuromechanics with embodied intelligence by providing a computational platform for investigating the sensorimotor transformation underlying animal behavior and a paradigm to advance the development of more nature-aligned intelligent systems.

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

Reassessing High-Performing LLMs on Polish Medical Exams: True Competence or Bias-Driven Performance?

Large language models (LLMs) in medicine are mainly evaluated using multiple-choice question answering (MCQA), which can overestimate real clinical ability due to guessing strategies and answer biases. To address these limitations, we introduce an expanded and more challenging benchmark based on Polish medical exams, adding over 15,000 questions, two new domains, and four structural modifications that reduce MCQA-specific artifacts and better test reasoning. We evaluate 21 LLMs and show that evaluation design strongly affects results. Under our harder setup, the best model (Qwen3.5-122B) drops by 28.4 and 31 pp on English and Polish exams, respectively. Despite low evidence of data contamination, standard MCQA scores do not reliably reflect true medical competence. To facilitate further research, we make our benchmark publicly available.

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

Automated Mediator for Human Negotiation: Pre-Mediation via a Structured LLM Pipeline

arXiv:2606.11379v1 Announce Type: new Abstract: Pre-mediation, the preparatory phase preceding direct human negotiation, plays a critical role in achieving mutually beneficial agreements, yet is often omitted due to cost, time, and limited access to trained mediators. We introduce an automated mediator for human negotiation, implemented as a structured pipeline of LLM modules, that supports pre-mediation in integrative negotiation settings. The pipeline decomposes preparation into specialized modules for dialogue, preference prediction, response-level critique, and structured summarization, separating inference, generation, and evaluation to address limitations of monolithic single-prompt approaches. We use the term "agent" for each module following common LLM-systems terminology, but the components are not autonomous and do not interact peer-to-peer; outputs are passed forward in a fixed sequence. We evaluate the system in two controlled human-subject experiments comparing AI-based pre-mediation with professional human mediators in a multi-issue negotiation scenario. On short-term self-reported measures, the automated mediator achieves preparation outcomes broadly comparable to human mediators, including trust in the mediator and confidence in reaching mutually beneficial agreements, while achieving substantially lower error on the preference-inference task under our scenario and prompts (36% lower RMSE). A second study shows that targeted prompt refinements reduce excessive affirmation patterns from 36.6% to 16.8%, matching human mediator baselines. Our findings suggest that structured LLM pipelines can provide scalable, low-effort pre-mediation support broadly comparable to human mediators on short-term self-reported preparation outcomes. The pipeline's single-party design mirrors how human mediators run pre-mediation today and enables parallel deployment across all parties to a dispute, supporting scalability.

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

AI Sovereignty as National Learning Capacity: A Human-Centered Learning Mechanics Viewpoint on France, the United States, and China

Authors:

arXiv:2606.00729v2 Announce Type: replace Abstract: Artificial intelligence in France is often discussed through separate dimensions such as investment, compute, regulation, employment, sovereignty, and education. This viewpoint paper proposes a unified interpretation: France can be analyzed as a national AI learning system. Building on Human-Centered Learning Mechanics (HCLM), we use HCLM not as a validated econometric model, but as a conceptual and diagnostic lens for interpreting national AI development as a balance between information injection, absorptive capacity, and institutional dissipation. Information injection includes compute, data, talent, research, capital, industrial deployment, and policy experimentation. Institutional dissipation refers to avoidable frictions such as administrative overload, coordination failures, energy constraints, regulatory uncertainty, talent mobility pressures, and weak industrial absorption. Regulation is not treated as mere friction: adaptive governance, trusted data spaces, and safety-oriented standards may increase long-term learning capacity by improving legitimacy, interoperability, and social trust. The central claim is not that a country follows neural-network equations, but that AI sovereignty depends on how effectively it converts distributed information into absorbed, coordinated, and socially legitimate capability. The paper connects HCLM with neural scaling laws, endogenous growth theory, creative destruction, absorptive capacity, and coordination mechanisms. It offers a formal heuristic, policy indicators, illustrative scenarios, and implications for France. The numerical results are diagnostic scenarios, not econometric estimates or official rankings. The proposed viewpoint reframes AI policy as the governance of an open, strategic, non-equilibrium learning system that should be tested with historical and cross-country data.

09.
arXiv (CS.CV) 2026-06-17

Complex Layout Classification in the Wild: A Low-Resource Approach with Layout-Preserving Augmentations

Many digitized corpora suffer from low resources because annotations may be scarce, page scans are noisy and of poor resolution, or layouts are structurally complex in ways that negatively affect the quality of automatic transcription. Developing robust classification models for low-resource languages is inhibited by the lack of large-scale annotated data and by the frequent semantic complexity of page layouts. To this end, we have curated a complex-layout dataset, manually classified into eight distinct layout types based on their separator regions. To overcome data scarcity, we propose a novel training strategy in the form of a CNN-based classifier that employs strong, domain-aware augmentations to improve generalization. We utilize narrow anisotropic Gaussian masking to suppress incidental textual details while preserving essential separations, compelling the model to learn global geometric arrangements. Additionally, we implement reflection-induced label transformations to enrich the training distribution while maintaining label consistency across asymmetric categories. The results demonstrate that layout-specific augmentations can substantially improve page-level layout classification under severe annotation scarcity.

10.
arXiv (CS.CL) 2026-06-19

CogniFold: Always-On Proactive Memory via Cognitive Folding

Existing agent memory remains predominantly reactive and retrieval-based, lacking the capacity to autonomously organize experience into persistent cognitive structure. Toward genuinely autonomous agents, we introduce CogniFold, a brain-inspired "always-on" agent memory designed for the next generation of proactive assistants. CogniFold continuously folds fragmented event streams into self-emerging cognitive structures, bootstrapping progressively higher-level cognition from incoming events and accumulated knowledge. We ground this by extending Complementary Learning Systems (CLS) theory from two layers (hippocampus, neocortex) to three, adding a prefrontal intent layer. Emulating the prefrontal cortex as the locus of intentional control and decision-making, CogniFold achieves this through graph-topology self-organization: cognitive structures proactively assemble under the stream, merge when semantically similar, decay when stale, relink through associative recall, and surface intents when concept-cluster density crosses a threshold. We evaluate structural formation using CogEval-Bench, demonstrating that CogniFold uniquely produces memory structures that match cognitive expectations and concept emergence. Furthermore, across eight downstream benchmarks – two probing long-term conversational memory (LoCoMo, LongMemEval) and six spanning other cognitive domains – we validate that CogniFold simultaneously performs robustly on conventional memory tasks. Our code is available at https://github.com/OpenNorve/CogniFold.

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

Beyond Static Endpoints: Tool Programs as an Interface for Flexible Agentic Web Services

arXiv:2606.19992v1 Announce Type: cross Abstract: In the agentic web era, LLM-based agents increasingly invoke web services as tools, yet most interfaces remain static endpoints that poorly express long-horizon workflows with loops, conditionals, joins, and retries. We present ToolPro, which represents an agent's tool intent as an executable tool program that compactly encodes multi-step service interactions with explicit effect types. ToolPro combines constraint-guided program construction, effect-aware replay for exactly-once state-modifying calls, and a profile-driven policy that decides when program execution outperforms stepwise calling. We instantiate ToolPro over MCP-style services with WebAssembly sandboxing and evaluate it on diverse workflows of real-world applications. ToolPro reduces end-to-end latency by up to 53.4\% and client-side traffic by up to 96.1\%, with larger gains under higher network latency and workflow complexity.

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

Dual-Granularity Orthogonal Disentanglement for Generalizable Audio Deepfake Detection

arXiv:2606.16532v1 Announce Type: cross Abstract: Audio deepfake detectors often fail to generalize across speakers, as they learn speaker-identity features rather than synthesis artifacts, known as implicit identity leakage. Existing methods address this but incur architectural complexity or training instability. This paper proposes a dual-granularity orthogonal disentanglement framework enforcing feature independence at two levels: sample-level cosine orthogonality captures directional decorrelation, while batch-level cross-covariance regularization eliminates linear correlations across embedding dimensions. A curriculum disentanglement schedule progressively strengthens the orthogonality constraint without auxiliary networks or adversarial dynamics. Experiments on ASVspoof 2019 LA, ASVspoof 2021 DF, and In-the-Wild datasets demonstrate that the proposed method achieves 1.35%, 7.88%, and 21.58% equal error rates (EER), respectively, surpassing gradient reversal disentanglement by 2.60% absolute on cross-dataset transfer.

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

Detecting Hidden ML Training With Zero-Overhead Telemetry

arXiv:2606.19262v1 Announce Type: new Abstract: Hardware-enabled monitoring of GPU workloads underpins many proposals for AI compute governance, but if developers can defeat monitoring mechanisms, such schemes are unworkable. We evaluate the adversarial robustness of GPU workload classification using only zero-overhead, privacy-preserving NVML telemetry: content-agnostic signals that observe physical effects of computation without accessing model weights, training data, or hyperparameters. Across 5 rounds of monitor-evader iteration, we evaluate 20 evasion strategy families on 9 GPU models spanning 4 architecture generations. We develop a classifier that achieves 98.2% binary accuracy at identifying training workloads across the whole corpus, and 43-87% accuracy against the most challenging unexpected workloads even when they are adversarially disguised.

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

MaxProof: Scaling Mathematical Proof with Generative-Verifier RL and Population-Level Test-Time Scaling

We present MaxProof, a population-level test-time scaling framework for competition-level mathematical proof in the MiniMax-M3 series. M3 first trains three proof-oriented capabilities – proof generation, proof verification, and critique-conditioned proof repair – using a defense-in-depth generative verifier engineered for low false-positive rate. These capabilities are merged into a single released M3 model. At test time, MaxProof treats the model as a generator, verifier, refiner, and ranker, searches over a population of candidate proofs, and returns one final proof through tournament selection. With MaxProof test-time scaling, the M3 model reaches 35/42 on IMO 2025 and 36/42 on USAMO 2026, exceeding the human gold-medal threshold on both.

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

CTS-MoE: Implicit Terrain Adaptation via Mixture-of-Experts for Perceptive Locomotion

arXiv:2606.19633v1 Announce Type: cross Abstract: Perceptive legged locomotion over discontinuous terrain (e.g., stairs, gaps, and obstacles) requires adaptive behavior, as a single conservative gait cannot produce the anticipatory maneuvers needed for abrupt topology changes. Cast as multi-task reinforcement learning, this problem introduces a tension between sharing and separation. Tasks use a common locomotion base but have conflicting rewards, so a policy must share behavior while avoiding value interference. Prior work addresses only one side, with monolithic policies sacrificing specialization and hierarchical sub-policies sacrificing generalization across transitions and unseen terrain. We propose CTS-MoE, which combines a dense mixture-of-experts actor with perception-based gating to compose shared behaviors and a multi-critic with task-specific value heads to prevent interference. The model is trained end-to-end in a single-stage concurrent teacher-student setup that handles partial observability and avoids sequential distillation, with task labels used only during training. At deployment, routing depends solely on perception, allowing terrain adaptation without a high-level selector or terrain classifier. Experiments on a Unitree Go1 in simulation and on hardware across seen and unseen terrains show task-aware specialization, with lower tracking error and higher success rates than monolithic baselines. Project Website: https://cts-moe.github.io/ .

16.
arXiv (CS.CL) 2026-06-17

When Tables Go Crazy: Evaluating Multimodal Models on French Financial Documents

Vision-language models (VLMs) perform well on many document understanding tasks, yet their reliability in specialized, non-English domains remains underexplored. This gap is especially critical in finance, where documents mix dense regulatory text, numerical tables, and visual charts, and where extraction errors can have real-world consequences. We introduce Scribe Finance, the first multimodal benchmark for evaluating French financial document understanding. The dataset contains 1,204 expert-validated questions spanning text extraction, table comprehension, chart interpretation, and multi-turn conversational reasoning, drawn from real investment prospectuses, KIDs, and PRIIPs. We evaluate six open-weight VLMs (8B-124B parameters) using an LLM-as-judge protocol. While models achieve strong performance on text and table tasks (85-90% accuracy), they struggle with chart interpretation (34-62%). Most notably, multi-turn dialogue reveals a sharp failure mode: early mistakes propagate across turns, driving accuracy down to roughly 50% regardless of model size. These results show that current VLMs are effective for well-defined extraction tasks but remain brittle in interactive, multi-step financial analysis. Scribe Finance offers a challenging benchmark to measure and drive progress in this high-stakes setting.

17.
arXiv (CS.CL) 2026-06-19

Generative Engine Optimization at Scale: Measuring Brand Visibility Across AI Search Engines

People increasingly get answers straight from AI search engines like ChatGPT, Claude, Perplexity, and Gemini rather than scrolling search results. Brands that once focused on search engine optimization (SEO) must now optimize for how these engines represent, cite, and recommend them – a shift variously called Generative Engine Optimization (GEO), Answer Engine Optimization (AEO), and AI Search Visibility. We treat AEO and AI Visibility as part of GEO, and study how to measure brand visibility across AI engines: what they value when they cite a brand, which sources they rely on, and what content large language models surface. The hard case is everyone outside the already-authoritative top brands – SMEs, D2C brands, creators, and early-stage startups. We analyze 100K+ prompt responses across 100+ brands tracked on Ranqo between March and May 2026. First visibility runs form a clear three-tier brand-stature ladder: global household names (e.g., Stripe, Nike) appear in 73% of relevant AI answers on their first run; established mid-market and regional brands (e.g., Olipop, Klaviyo) in 44%; niche and small brands in just 11% – about 30 percentage points per step. When engines cite sources, about 78% go to corporate websites; among non-corporate sources YouTube leads, ahead of Reddit, editorial media, and Wikipedia. The highest-leverage page is the ranked "best-of" listicle, the most-cited content format at about 21% of all citations. Sentiment is the unstable signal: whether a brand is framed positively or negatively flips about 6.7 times more often than whether it is mentioned at all. These findings provide a first large-scale baseline for measuring GEO: AI brand visibility can be measured, differs by platform, and varies strongly by brand maturity. We close by proposing seven v1.1 protocols to test whether specific recommendations can causally improve AI visibility.

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

AthDGC: An Open Diachronic Greek Treebank with Indo-European Parallels

AthDGC ("Athens-PROIEL") is an open, end-to-end workflow and dataset. It is, to the best of our knowledge, the first openly licensed dependency-parsed treebank of Greek that spans eight diachronic periods, namely Archaic, Classical, Koine, Late Antique, Byzantine, Late Byzantine, Early Modern, and Modern Greek, under a single PROIEL XML 2.0 schema, with verse-level cross-alignment of the New Testament to Latin (Vulgate), Gothic (Wulfila), Old Church Slavonic (Marianus), and Classical Armenian. AthDGC builds on the PROIEL Treebank Family (Haug and Johndal 2008; Eckhoff et al. 2018), which established the schema and the Koine-Greek reference set for the project. Annotation uses the Stanford Stanza PROIEL-trained workflow; sentence-level alignment uses LaBSE, a multilingual sentence-embedding model; word-level alignment uses multilingual-BERT attention through the AwesomeAlign procedure. The v0.4 release provides curated samples and the open-source toolkit; the full annotated corpus partitions remain under v0.5 audit on the Greek national HPC. Quantitative scale, per-witness verse counts, and per-period annotated-row counts are reported in the v0.5 release notes, after the audit pass completes. Concept DOI: 10.5281/zenodo.20439182.

19.
arXiv (CS.CV) 2026-06-17

Remote sensing data imputation using deep learning for multispectral imagery

Remote sensing techniques have been increasingly utilised in aquatic applications in recent years. A common challenge in using optical satellite data is the presence of missing observations due to cloud cover. These data gaps can lead to missed detection of critical events, such as algal blooms, in lakes of high interest to water authorities. As a result, enhancing the completeness of optical satellite datasets is crucial for improving the monitoring and prediction of algal blooms. In this study, we compared a traditional data imputation method (i.e., linear interpolation) with deep learning models for reconstructing missing spectral bands across four lakes with historical records of algal blooms. The deep learning models adopted include CNN-based architectures (i.e., CNN, Inception Resnet, and Autoencoder) and CNN-LSTM-based architectures (i.e., CNN-LSTM, Resnet-LSTM, and Autoencoder-LSTM). Our results demonstrated that deep learning models substantially outperformed the baseline linear interpolation method in imputing spectral band values within artificially masked regions. Among these models, CNN delivered the best performance across most lakes. Furthermore, we evaluated the performance of algal bloom indices (i.e., Green/Red and NDCI) derived from the imputed imagery by comparing them with the observed data. Our results demonstrate that deep learning models are effective for imputing missing data in PlanetScope SuperDove imagery, enabling more reliable applications in water monitoring.

20.
arXiv (quant-ph) 2026-06-19

General circuit mapping algorithm for neutral atom quantum computers

arXiv:2606.20503v1 Announce Type: new Abstract: Neutral atom quantum computers (NAQC) are emerging as a promising, scalable quantum computing platform because of their long qubit coherence, flexible qubit arrangement, and multiqubit gate capabilities. However, circuit execution often requires physically moving qubits, making compilation a critical optimization challenge. We propose a circuit independent mathematical framework built on graph-theoretic combinatorial optimization that determines the minimal number of required qubit transfers. This model captures spatial constraints specific to NAQC platforms with zone-limited gate operations and multi-qubit gates. From this framework, we encode the qubit mapping problem as a nonlinear integer program and solve it using a genetic algorithm, enabling trade-offs between minimizing the total traveled distance and the number of parallel transfer operations. Compared to the state-of-the-art scalable compiler for zoned architectures, our approach consistently finds fewer transfers. Depending on the optimization focus, our method produces shorter traveled distances or fewer parallel transfer operations. This work provides both theoretical guaranties and a practical tool for efficient, architecture-aware quantum circuit compilation. As a result, practitioners can generate hardware-aware mappings that reduce movement-induced errors and better exploit atom transfer parallelism, directly improving execution efficiency on NAQC devices.

21.
arXiv (CS.CL) 2026-06-17

Do We Still Need Humans in the Loop? Comparing Human and LLM Annotation in Active Learning for Hostility Detection

Instruction-tuned LLMs can annotate thousands of instances at low cost. This raises two questions for active learning (AL): can LLM labels replace human labels within the AL loop, and does AL remain necessary when entire corpora can be cheaply labeled? We investigate both on a new dataset of 277,902 German political TikTok comments (25,974 LLM-labeled, 5,000 human-annotated), comparing LLM and human annotation across seven conditions, four encoders, and 10 random seeds. Under a two-question interface that mirrors the human annotation task, LLM annotation at scale outperforms human-supervised classifiers at roughly one-tenth the cost (\$28 for GPT-5.2 Batch API vs. \$316 for Prolific). The advantage holds for both a closed-source (GPT-5.2) and an open-weight (Qwen3.5-122B-10B) LLM, is robust under soft-label evaluation, and is unlocked specifically by the two-question decomposition; a holistic single-prompt baseline only ties with human supervision. AL provides no reliable advantage over random sampling under either LLM annotator. However, error structure varies sharply: only GPT-5.2 under the two-question interface produces classifiers with near-human FP/FN balance, while other LLM variants over-flag border-control and economic competition discourse. We release the dataset and code.

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

SAM3 Self-Distillation for Fine-Grained GOOSE 2D Semantic Segmentation

Authors:

We describe our 4th-place entry to the ICRA 2026 GOOSE 2D Fine-Grained Semantic Segmentation Challenge, which reached a composite mean Intersection-over-Union (mIoU) of 69.73% on the official 1,815-image test set. Our model adapts the image encoder of a recent visual foundation model, Segment Anything Model 3 (SAM3), with a lightweight decoder. Beyond this, we contribute two techniques and one empirical finding: (i) a self-distillation scheme that re-uses SAM3 itself, prompted with ground-truth boxes, as a teacher on the classes where it outperforms our own model; (ii) an image-level multi-scale test-time augmentation scheme that restores multi-scale inference for a fixed-input-size model by rescaling the image rather than the model input; and (iii) the finding that an aggressive photometric distortion from a winning 2025 GOOSE 2D entry, transplanted onto our pipeline, is its single largest source of improvement.

23.
medRxiv (Medicine) 2026-06-22

The direct economic impact of surgical non-response in orthopaedic hip, knee, and spine surgery for osteoarthritis: a cost-utility analysis

Background Annually, nearly 2 million hip, knee, and spinal inpatient surgeries are performed in Canada and the US for osteoarthritis (OA), costing over $37 billion in hospital expenditures. However, 15-30% of patients experience limited or no improvement, resulting in poor value for money. This study evaluated the one-year cost-utility of joint and spine procedures for OA by comparing non-responders to responders, considering various responder definitions. Methods Individual micro-costing data were collected for 1,175 elective hip, knee, and spine patients enrolled in the Longitudinal Evaluation in the Arthritis Program - Osteoarthritis (LEAP-OA) between 2014 and 2018. Quality-adjusted life years (QALYs) were derived using the SF-6D utility index. One-year incremental cost-utility ratios (ICURs) were calculated from the hospital perspective. Results Responder rates varied by definition, ranging from 78%-94% for hip replacements, 64%-90% for knee replacements, 60%-64% for spine fusions, and 50%-68% for spine decompressions. Corresponding ICURs were: $45,956-$51,773/QALY for responders versus $108,593-$485,762/QALY for non-responders for hip replacements; $54,831-$71,151/QALY for responders versus $200,486-$1,203,596/QALY for non-responders for knee replacements; $65,980-$74,422/QALY for responders versus $262,039-$729,686/QALY for non-responders for spine fusions; and $29,947-$42,168/QALY for responders versus $63,195-$662,586/QALY for non-responders for spine decompressions. Conclusions While surgical response rates were highly dependent on the responder definition, ICURs for non-responders were significantly higher than those for responders across all definitions. Beyond the negative impact on patients, there is a compelling economic argument for investment in improved pre-operative identification of patients at risk of surgical non-response. Such efforts could enable more personalized, value-based care pathways and reduce the provision of low-value surgical interventions.

24.
medRxiv (Medicine) 2026-06-15

Non-invasive intracranial pressure waveform reconstruction with deep learning

Purpose: Continuous intracranial pressure (ICP) monitoring requires invasive instrumentation, reaching only a narrow subset of critically ill patients. We tested whether deep learning models trained on routinely acquired extracranial signals can reconstruct continuous ICP waveforms at clinically relevant accuracy in an independent external cohort. Methods: In adults admitted to the ICU at a single quaternary health system, five deep learning architectures were trained on high-frequency arterial blood pressure (ABP), photoplethysmography (PPG), and electrocardiography (ECG) waveforms, using invasive (intraparenchymal) ICP as ground truth. Two fusion strategies (early and late) and three training objectives (waveform-morphology, baseline robust regression, and weighted robust regression) were evaluated. Models were externally validated on the held-out MIMIC-III Waveform Database. Performance was assessed by mean absolute error (MAE) and waveform similarity by Pearson correlation (r). Results: We analyzed data from 158 critically ill adults (~5,322 hours) across two quaternary health systems (Johns Hopkins Hospital, Baltimore; Beth Israel Deaconess Medical Center, Boston). Validation MAE ranged from 4.276 mmHg [95% CI 4.269, 4.283] (gated recurrent, late fusion) to 4.946 mmHg [95% CI 4.938, 4.956] (attention-based, early fusion), with Pearson r ranging from 0.599 [95% CI 0.599, 0.600] to 0.722 [95% CI 0.722, 0.723]. The multiscale encoder-decoder model demonstrated the most favorable MAE-correlation tradeoff. Conclusion: This is the first demonstration that continuous ICP waveform reconstruction from bedside signals generalizes across institutions at clinically relevant accuracy, establishing a foundation for non-invasive ICP monitoring and motivating validation across broader populations and ICP ranges.

25.
Nature Medicine 2026-06-12

General-purpose large language models outperform specialized clinical AI tools on medical benchmarks

Specialized clinical artificial intelligence (AI) tools are entering medical practice despite scarce independent evaluation. We quantitatively evaluate two clinical AI tools, OpenEvidence and UpToDate Expert AI, built on large language models (LLMs) against three frontier LLMs: GPT-5.2, Gemini 3.1 Pro and Claude Opus 4.6. Our evaluation has three stages: (1) 500 MedQA questions testing medical knowledge, (2) 500 HealthBench items measuring alignment with clinicians and (3) the real clinical queries (RCQ) benchmark, built from 100 de-identified queries from physicians to a general-purpose language model in a live clinical environment. For the RCQ benchmark, 12 US clinicians performed randomized, blinded review of model outputs, producing 1,800 model–question annotations. Frontier LLMs outperformed clinical AI tools in all three evaluations. Clinical AI tools performed comparably to auto-enabled Google Search AI Overview on the RCQ. These findings highlight the need for independent, real-world evaluation of AI tools before they enter clinical settings. In an independent evaluation, frontier large language models outperformed specialized clinical artificial intelligence tools on medical knowledge, clinician alignment and real-world clinical queries.