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

What sentiment analysis can't see: Measuring whether customers were helped, and what went wrong, across 70,000 support conversations

Most companies read their customer support data at scale using sentiment analysis, which measures how customers sound rather than whether they were satisfied with the result. We tested a richer alternative on 70,450 support conversations from a leading online fundraising platform: alongside tone, we used GPT-5.4 to estimate each customer's satisfaction and to flag whether they reported a concrete problem, then validated all three readings against the 1-to-5 ratings customers left on the conversations they rated. The satisfaction estimate tracked those ratings far better than sentiment did, correlating at 0.47 against 0.36 and flagging unhappy customers with far fewer false alarms. The structured read also sees what sentiment cannot: tone and satisfaction disagree in 44% of conversations, a single "Neutral" label hides everything from quietly satisfied customers to ones who quietly gave up, and the largest group of all is "tolerated friction," customers who are satisfied but still reporting a fixable problem, a standing issue that no sentiment-based dashboard can surface. The broader finding is that LLM-based annotation can capture far more than the tonality of a customer's language, offering strong potential for new business metrics grounded instead in the customer's state (whether they were satisfied) and the cause of their problem extracted directly from the raw textual data of interactions and feedback.

02.
arXiv (CS.AI) 2026-06-15

A fully GPU-based workflow for building physics emulators of hypersonic flows

arXiv:2606.13742v1 Announce Type: cross Abstract: The ability to resolve complex physical phenomena with high fidelity and at low computational cost is central to addressing key challenges in modern engineering. A prime example lies in hypersonic flows, where the precise prediction of the full flowfield topology, in particular with respect to shock wave location and intensity, is critical. Yet supersonic and hypersonic flows continue to be a stumbling block for traditional reduced-order models and neural emulators that struggle to capture steep gradients in flow states with physical consistency in applications of industrial relevance. To that end, we introduce a fully GPU based workflow that integrates accelerated data generation with the training of neural emulators augmented by uncertainty quantification and physics-aware refinement. Our workflow is enabled by a differentiable high-fidelity solver (JAX-Fluids) which we employ for rapid dataset creation and residual-based improvement of the neural emulator to enhance physical consistency. Building on this framework, we first present a suite of model architectures and analyze their scaling behavior to expose their strengths and shortcomings. We then show that residual-based refinement enables training on cases where only mesh and input parameters are available, substantially reducing residuals and improving physical consistency. Together, differentiable simulation and residual-based refinement yield physics emulators that remain reliable beyond their training distribution, a key requirement for deploying surrogates in real-world engineering design loops.

03.
arXiv (CS.AI) 2026-06-19

A Neuromorphic Reinforcement Learning Framework for Efficient Pathfinding in Robotic Mobile Fulfillment Systems

arXiv:2606.20031v1 Announce Type: cross Abstract: Dynamic environmental changes, confined workspaces, and stringent real-time constraints make pathfinding in Robotic Mobile Fulfillment Systems (RMFS) a challenging problem for conventional search- and rule-based methods, which typically suffer from high computational complexity and long decision latency. While reinforcement learning (RL) has emerged as a powerful alternative, deploying learned policies with extreme energy efficiency on resource-constrained hardware remains an open challenge. We present SDQN-RMFS, an end-to-end framework that achieves high-fidelity deployment of an RL-trained policy from a full-precision artificial neural network (ANN) through to a neuromorphic chip. By computing only when triggered by sparse events, this framework unlocks ultra-low-power RMFS pathfinding. Our full-stack pipeline operates as follows: an ANN policy is first efficiently trained via a collision-allowing strategy to densify informative trajectories, and then converted into a spiking neural network (SNN) via a hard-label knowledge distillation approach. This effectively addresses the output distribution mismatch, preserving policy capability across the ANN-to-SNN pipeline while substantially reducing inference latency. Hardware experiments demonstrate up to 11,281$\times$ energy savings and a nearly two-fold reduction in latency compared to a high-performance GPU baseline, while maintaining decision quality on par with the original trained policy. These results establish physical neuromorphic inference as a practical and energy-sustainable pathway for large-scale RMFS operations.

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

InternVideo3: Agentify Foundation Models with Multimodal Contextual Reasoning

Recent progress in foundation models has shifted toward agentic behavior involving multi-step reasoning and tool use. However, open-source efforts largely focus on text-dominant settings, leaving long-horizon multimodal tasks underexplored. This gap is evident in video tasks requiring sustained temporal understanding and iterative interaction. We present InternVideo3, a framework enhancing these capabilities via Multimodal Contextual Reasoning (MCR). MCR treats understanding as a closed-loop process over a shared, evolving context containing observations, instructions, reasoning, tool actions, and memory. This frames long-video understanding as evidence accumulation and verification. To ensure efficiency, we introduce Multimodal Multi-head Latent Attention (M^2LA), a token-preserving reparameterization compressing KV-cache states while retaining the full token stream. Our staged training includes continued pretraining, short-to-long supervised fine-tuning, rule-based reinforcement learning, and on-policy distillation. Experiments show InternVideo3 achieves strong performance on benchmarks like Video-MME, MLVU, and EgoSchema. We further instantiate the model as a video agent with retrieval tools, demonstrating robust evidence-grounded behavior. Our results suggest that efficient context handling and closed-loop reasoning are vital for adapting open multimodal models toward long-horizon visually grounded agency.

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

Let Them Steal: Trapping Large Language Model Extraction Attacks with Knowledge Honeypot

arXiv:2606.15810v1 Announce Type: cross Abstract: Large language models deployed as commercial APIs are vulnerable to model extraction attacks, while existing defenses either act too late or degrade utility for legitimate users. We propose Knowledge Trap, a defense that redirects extraction attacks toward low-transferability knowledge through a Honeypot Knowledge Graph (HKG) and breadcrumb-guided exploration. Instead of blocking queries or perturbing outputs, Knowledge Trap consumes the attacker's limited query budget on knowledge with negligible downstream utility while preserving benign-user performance. Experiments in medical and financial domains show that Knowledge Trap reduces surrogate Agreement by 6.2\% on average without degrading legitimate-user accuracy, outperforming existing defenses that impose measurable user impact. These results suggest that defending knowledge-space traversal is a practical direction for mitigating LLM extraction attacks.

07.
arXiv (CS.LG) 2026-06-11

A Riemannian Approach to Low-Rank Optimal Transport

arXiv:2606.12120v1 Announce Type: new Abstract: Low-rank optimal transport (OT) mitigates the quadratic scaling of classical solvers, yet existing approaches rely heavily on first-order mirror-descent updates that require careful hyperparameter tuning and ignore the optimization landscape's curvature. To address these limitations, we propose a unified Riemannian geometric framework for low-rank OT, modeling balanced and unbalanced rank-$r$ positive factored couplings as novel smooth embedded submanifolds of the positive orthant. By equipping these manifolds with the Fisher-Rao product metric, we derive tractable formulations for Riemannian projectors, retractions, and Hessian-vector products. Our cost-agnostic framework seamlessly extends to linear OT, Gromov-Wasserstein (GW), fused GW, and their unbalanced counterparts. For balanced OT, our geometric ingredients are computed via efficient conjugate-gradient and iterative Bregman updates. For the unbalanced OT, our operations elegantly reduce to closed-form scalings, completely eliminating inner iterative loops. In both regimes, per-iteration complexity scales linearly with dataset size, and we provide a rank-sufficiency certificate for global optimality verification. Extensive experiments across a range of problem sizes demonstrate that our regularization-free first- and second-order solvers achieve faster convergence and superior performance over existing state-of-the-art low-rank OT solvers.

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

Fuzzy-processing quantum computation

作者:

arXiv:2606.16623v1 Announce Type: new Abstract: Quantum computation has attracted numerous attentions and develops rapidly in the recent decades. To against the decoherence and the control errors upon the qubits, quantum error corrections are adopted. Such approaches require lots of redundant qubits, accurate measurement and timely feedback. Here we investigate a new framework of quantum computation that is associated with fuzzy processing. It will benefit significantly from three aspects: the fuzzy recognition of qubit states reduce the required gate fidelity; the fuzzy encoding encodes the information of the qubits into a distribution of probability, suppressing the fluctuations in the output of long quantum circuits; the fuzzy feedback offers a more efficient way to control the qubits when precision information of quantum states are absent. Furthermore, the fuzzy processing can be integrated into quantum error correction, eliminating the need for immediate correction operations. The proposed scheme will be fairly suitable for the solution of decision problems, which has significant applications in the optimization problems and control problems.

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

GENIE: A Fine-Grained Measure for Novelty

Large Language Models have consistently demonstrated a lack of creativity and diversity across tasks. Prior work has focused on addressing whether models are capable of generating creative outputs. Here, we aim to consider novelty and investigate what makes model-generated content novel or not novel in a task-specific manner. We propose a fine-grained evaluation metric GENIE to measure the novelty of responses along task-specific features with respect to a population of responses. We show that unlike GENIE, holistic metrics struggle to capture the high-dimensionality of novelty and do not provide insight on which properties they target. Finally, we use GENIE to measure the effectiveness of mitigation methods that address creativity to better understand where these methods can improve novelty.

10.
arXiv (CS.LG) 2026-06-15

Denoising Score Matching with Random Features: Insights on Diffusion Models from Precise Learning Curves

arXiv:2502.00336v3 Announce Type: replace Abstract: We theoretically investigate the phenomena of generalization and memorization in diffusion models. Empirical studies suggest that these phenomena are influenced by model complexity and the size of the training dataset. In our experiments, we further observe that the number of noise samples per data sample ($m$) used during Denoising Score Matching (DSM) plays a significant and non-trivial role. We capture these behaviors and shed insights into their mechanisms by deriving asymptotically precise expressions for test and train errors of DSM under a simple theoretical setting. The score function is parameterized by random features neural networks, with the target distribution being $d$-dimensional Gaussian. We operate in a regime where the dimension $d$, number of data samples $n$, and number of features $p$ tend to infinity while keeping the ratios $\psi_n=\frac{n}{d}$ and $\psi_p=\frac{p}{d}$ fixed. By characterizing the test and train errors, we identify regimes of generalization and memorization as a function of $\psi_n,\psi_p$, and $m$. Our theoretical findings are consistent with the empirical observations.

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

PANDA: An LLM-Enhanced Performance-Driven Analog Design Framework Bridging Design Intent and Layout Generation

arXiv:2606.15052v1 Announce Type: cross Abstract: Traditional design of analog circuits heavily relies on manual interventions across topology, sizing, and layout, with prior automation addressing stages in isolation. In this work, we propose PANDA, an LLM-enhanced framework that bridges high-level design intent to final layout by actively managing cross-stage dependencies through guided topology synthesis, substructure-aware sizing, and constraint-driven layout generation. This shifts automation from algorithm-centric execution to intent-centric co-design, reducing turnaround time from days or weeks to hours while improving design performance.

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

An LLM System for Autonomous Variational Quantum Circuit Design

arXiv:2606.13380v1 Announce Type: cross Abstract: The design of high performing quantum circuits remains largely dependent on human expertise. We introduce an autonomous agentic framework that employs large language models (LLMs) to conduct iterative quantum circuit designs under explicit design constraints. Our system integrates seven components: Exploration, Generation, Discussion, Validation, Storage, Evaluation, and Review. These components form a closed-loop workflow that combines web-based knowledge acquisition, literature-grounded critique, executable code generation, and experimental feedback. We evaluate the framework on two tasks: quantum feature map construction for quantum machine learning and ansatz generation for variational quantum eigensolver applications in quantum chemistry. In image classification benchmarks, the best generated feature map outperforms representative quantum feature maps and, when scaled to larger qubit counts, surpasses the classical radial basis function kernel. In molecular ground state estimation across seven molecules, the generated ansatz attains competitive accuracy with widely used chemically inspired and hardware-efficient constructions while satisfying the imposed scaling constraints. These results establish LLM driven agentic system as a viable paradigm for automated quantum circuit design and illustrate how AI systems can participate in iterative scientific optimization workflows across scientific domains.

13.
arXiv (CS.CV) 2026-06-16

MixTeX: Data-Efficient LaTeX OCR via Synthetic Pretraining and Limited Fine-Tuning

LaTeX OCR converts scientific document images into editable LaTeX code. Existing systems rely on large paired datasets, which are costly to collect and limited for low-resource languages. This paper presents MIXTEX, a data-efficient system using synthetic pretraining without real LaTeX sources. Unlike Nougat that depends on arXiv datasets, we generate training data by randomly pairing grammatical Wikipedia text with LaTeX formulas, requiring only syntactic correctness. This eliminates dependency on real document collections, enables scalable data generation (120M tokens), and supports low-resource languages. Following synthetic pretraining, adaptation requires only 400 real samples. Evaluation on a 977-sample benchmark with printed and handwritten English and Chinese shows that this two-stage strategy outperforms methods trained on large real datasets while requiring less human effort and computation. Data, code, and models are publicly available.

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

A Quantitative Experimental Repeated Measures Study of Training Dynamics in a Small Llama Style Language Model Under a Compute-Aware Token Budget

作者:

arXiv:2606.13370v1 Announce Type: new Abstract: This study examines training dynamics in a small Llama-style language model trained under a fixed, compute-constrained token budget. Rather than evaluating efficiency solely through endpoint performance, the study uses a quantitative experimental repeated measures design to analyze how validation loss, validation perplexity, rolling volatility, backslide behavior, spike behavior, and between-seed variability change across token-based training intervals. Six independent training runs were conducted on a 4.26-million-parameter model using the TinyStories corpus, CPU-based full-precision training, and a target budget of approximately 20 million cumulative training tokens. Metrics were collected across 21 intervals, producing 126 seed-by-interval observations. Repeated measures ANOVA showed statistically significant interval effects for validation loss, validation perplexity, and rolling volatility. Descriptive trajectories revealed rapid early improvement followed by non-monotonic degradation during later training intervals. Mean validation loss decreased from 8.3552 at initialization to 2.7996 near 4 million tokens, but increased to 3.9010 by the final checkpoint. Validation perplexity followed the same pattern, falling sharply early in training before rising later. Derived telemetry further showed recurrent validation-loss backslides and no interval-summary evidence of a stable phase under the predefined criteria. These findings suggest that compute-aware language model evaluation should examine training trajectories rather than endpoint metrics alone. In constrained compute settings, additional token exposure may increase computational cost without producing proportional generalization gains, and interval-level telemetry can reveal instability, regression, and diminishing returns that final metrics may obscure.

15.
arXiv (CS.CV) 2026-06-18

Epipolar Geometry Improves Video Generation Models

Video generation models have advanced significantly through the latent diffusion transformers trained with rectified flow techniques. Yet these models still struggle with geometric inconsistencies, unstable motion, and visual artifacts that break the illusion of realistic 3D scenes. 3D-consistent video generation could significantly impact numerous downstream applications in generation and reconstruction tasks. We explore how epipolar geometry constraints improve modern video diffusion models. Despite using massive training data, these models fail to capture fundamental geometric principles. We align diffusion models using pairwise epipolar geometry constraints via preference-based optimization, directly addressing unstable trajectories and geometric artifacts through mathematically principled geometric enforcement. Our approach efficiently enforces geometric principles without requiring end-to-end differentiability. Evaluation demonstrates that classical geometric constraints provide more stable optimization signals than modern learned metrics. Training on static scenes with dynamic cameras ensures metric quality while the model generalizes to various dynamic scenes. By bridging data-driven learning with classical computer vision, we reduce epipolar error by 31% and improve human-rated consistency from 54% to 72% without compromising visual quality.

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

Arrangements of Consecutive Numbers in Mallows Permutations

arXiv:2606.12410v1 Announce Type: cross Abstract: We study the random variable that counts the number of specific arrangements of clustered consecutive numbers in permutations under the Mallows distribution. We provide an asymptotic expression for the expected value of this random variable. This result extends and tightens the previously known result by Pinsky (2022) concerning clustered consecutive numbers in Mallows permutations. Moreover, we identify a range of parameters for which the distribution of the number of arrangements of clustered consecutive numbers in Mallows permutations is close to a Poisson distribution.

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

Dynamic Black-hole Emission Tomography with Physics-informed Neural Fields

With the success of static black-hole imaging, the next frontier is the dynamic and 3D imaging of black holes. Recovering the dynamic 3D gas near a black hole would reveal previously-unseen parts of the universe and inform new physics models. However, only sparse radio measurements from a single viewpoint are possible, making the dynamic 3D reconstruction problem significantly ill-posed. Previously, BH-NeRF addressed the ill-posed problem by assuming Keplerian dynamics of the gas, but this assumption breaks down near the black hole, where the strong gravitational pull of the black hole and increased electromagnetic activity complicate fluid dynamics. To overcome the restrictive assumptions of BH-NeRF, we propose PI-DEF, a physics-informed approach that uses differentiable neural rendering to fit a 4D (time + 3D) emissivity field given EHT measurements. Our approach jointly reconstructs the 3D velocity field with the 4D emissivity field and enforces the velocity as a soft constraint on the dynamics of the emissivity. In experiments on simulated data, we find significantly improved reconstruction accuracy over both BH-NeRF and a physics-agnostic approach. We demonstrate how our method may be used to estimate other physics parameters of the black hole, such as its spin.

18.
Nature (Science) 2026-06-10

‘Hidden hero’ peptides guard crops against sudden cold

作者: 未知作者

A protein signal remains silent under normal conditions but is activated under cold stress to protect developing pollen. This ‘on-demand’ resilience mechanism could enable the development of ‘climate smart’ crops that maintain high yields in good years and food security under climate stress. A peptide signal ensures that, in cold conditions, developing pollen receives nutrients at the right time.

19.
arXiv (CS.LG) 2026-06-18

Everywhere Valid Bounds on False Discovery Proportions in Conformal Inference

arXiv:2605.20726v2 Announce Type: replace-cross Abstract: Modern applications of conformal inference to multiple testing problems, such as outlier detection and candidate selection, often involve selecting test samples whose conformal p-values fall below a threshold. The quality of such methods is often measured by the false discovery proportion (FDP), defined as the fraction of incorrect selections. Existing approaches typically control the expected value of the FDP, using methods such as the Benjamini-Hochberg procedure. This approach fails to provide high-probability bounds on the realized false discovery proportion and invalidates statistical guarantees if the rejection threshold is selected after inspecting the data. This paper establishes finite-sample, distribution-free upper bounds on the FDP that hold simultaneously over all possible rejection thresholds, enabling arbitrary post hoc selection of the threshold. Simultaneous validity is achieved by constructing a high-probability envelope for the empirical distribution function of null conformal p-values by sampling from their joint distribution. Furthermore, our framework allows practitioners to modulate the envelope's shape, thereby producing tight bounds in rejection regions of primary interest. We use this flexible approach to derive simultaneous FDP upper bounds for both outlier detection and conformal selection. We demonstrate through synthetic and real-data experiments that the resulting bounds are both valid and substantially less conservative than those derived from existing approaches.

20.
bioRxiv (Bioinfo) 2026-06-12

Systematic functional annotation of thousands of BAHD acyltransferases in plant genomes using Protein Language Model and phylogenomic tools

The functional annotation of plant genes lags significantly behind their genomic annotation. Closing this gap requires thorough cataloging of reported protein activities alongside predictive methods that scale beyond sequence-similarity inference. Focusing on the BAHD acyltransferase enzyme family as a model, we assembled FuncZymeDB-BAHD, a large database of 2,705 LLM-retrieved and curated enzyme-acceptor-donor activities covering 336 BAHDs from 156 plant species, a 2-to-6-fold expansion over Swiss-Prot and prior compilations. We further developed FuncPred-OG, which maps queries to orthologous groups and previously characterized enzymes in FuncZymeDB-BAHD, returning hits with high evidence provenance. FuncPred-OG enabled functional prediction of over half of BAHDs across 85 plant proteomes, of which five novel predictions were validated via in vitro assays and recent studies. For the remaining BAHDs without FuncPred-OG annotation, we developed FuncPred-AI, where logistic-regression classifiers trained on protein language model embeddings achieved high Area-Under-the-Precision-Recall-curve (AUPR) scores and correct-hit rates up to 93%. FuncPred-AI yielded >1 probable donor/acceptor annotation for 99.9% (8894/8897) of BAHDs in our pan-plant dataset. Finally, the FuncPred workflow and datasets were deployed on a web portal for broader utilization, potentially reducing experimentalist efforts for selecting candidates from days to minutes. Overall, this framework provides a generalizable template for functional annotation of entire enzyme families.

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

Geometry of Reason: Spectral Signatures of Valid Mathematical Reasoning

Verifying whether a language model is genuinely reasoning or pattern-matching remains an open problem: learned verifiers are expensive, and output-based heuristics are brittle. We show that valid mathematical reasoning induces a measurable, training-free spectral signature in transformer attention. By treating each attention matrix as a weighted token graph, we extract four diagnostics: Fiedler value, High-Frequency Energy Ratio (HFER), spectral entropy, and smoothness, that require no learned parameters. Experiments across seven models from four architectural families yield effect sizes up to Cohen's $d = 3.30$ ($p < 10^{-116}$), enabling $85$–$96\%$ single-threshold classification accuracy. Two findings sharpen the interpretation. First, Platonic validity: the spectral signal tracks logical coherence rather than compiler acceptance, proofs rejected for timeouts or missing imports are correctly classified as valid, a distinction confirmed by a manual audit ($\kappa = 0.82$, $n = 51$). Second, architectural determinism: Sliding Window Attention shifts the discriminative feature from HFER to smoothness ($d = 2.09$, $p < 10^{-48}$), showing that attention design governs which spectral channel encodes reasoning quality. Causal ablation confirms the signature traces induction-head circuits. The method generalises to informal chain-of-thought ($d = 0.78$, $p < 10^{-3}$), and in proof search, HFER reranking improves Best-of-16 Pass@1 by $+4.4$–$6.6$\%, matching $98\%$ of the AUC of fully supervised probes with zero labels. Spectral graph analysis is a principled, architecture-aware primitive for reasoning verification.

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

Optimal Coarse Correlated Equilibria in Mean Field Games: Linear Programming and No-Regret Learning

arXiv:2606.20062v1 Announce Type: cross Abstract: We introduce optimal coarse correlated equilibria for continuous-time mean field games. A coarse correlated equilibrium is a randomized recommendation scheme from which no player can gain by ignoring the recommendation and switching to an alternative strategy. The problem is as follows: a moderator selects, among all mean-field coarse correlated equilibria, one that optimizes a prescribed performance criterion, which may differ from the representative player's objective. After formulating the problem, we develop a linear programming (LP) formulation, prove the existence of optimal LP coarse correlated equilibria, and relate the LP characterization to the original probabilistic setting. Building on this characterization, we design a no-regret primal-dual algorithm, based on an equivalent Lagrangian formulation of the external-regret constraint, for learning such equilibria. We provide explicit convergence rates for the learning algorithm, and numerical examples illustrate the method.

23.
arXiv (CS.AI) 2026-06-12

The Internet of Agentic AI: Communication, Coordination, and Collective Intelligence at Scale

作者:

arXiv:2606.12835v1 Announce Type: cross Abstract: The rapid emergence of autonomous AI agents is transforming artificial intelligence from isolated model inference into distributed systems of reasoning, communication, and action. This paper develops the vision of the Internet of Agentic AI (IoAI): an open ecosystem in which heterogeneous agents discover one another, negotiate responsibilities, exchange context, invoke tools, and execute workflows across cloud, edge, device, organizational, and cyber-physical environments. We synthesize foundations from single-agent agentic AI, multi-agent systems, distributed computing, communication networks, game theory, and security engineering to characterize the architectures and mechanisms required for scalable agent ecosystems. The paper examines agent deployment models, workflow lifecycles, communication protocols, interoperability layers, resource-management challenges, and trust architectures, with case studies in adaptive manufacturing and distributed operational coordination. The resulting framework highlights the central research challenges of controlled emergence, semantic interoperability, secure identity, incentive-compatible coordination, resource-aware orchestration, and governance for large-scale networks of autonomous agents.

24.
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.

25.
medRxiv (Medicine) 2026-06-23

Unscreenable: The Burden, Structure, and Analytic Consequences of "Unable to Assess" Delirium Documentation in the Intensive Care Unit

Objective: To quantify the burden, structure, and downstream analytic consequences of "Unable to Assess" (UTA) delirium documentation in the intensive care unit (ICU). Design: Retrospective cross-sectional and repeated-measures study. Setting: A single US academic medical center (Medical Information Mart for Intensive Care IV [MIMIC-IV], 2008-2019). Patients: 72,944 adult ICU stays with at least 1 delirium screen. Interventions: None. Measurements and Main Results: Among 610,632 screens, 130,455 (21.4%; 95% CI, 21.0%-21.8%) were recorded as UTA, exceeding the 119,052 (19.5%) scored positive. The UTA fraction rose from 2.0% at a Richmond Agitation-Sedation Scale (RASS) score of 0 to 97.8% at RASS -4; 22.0% of UTA screens occurred in arousable patients, where UTA was associated with mechanical ventilation (odds ratio [OR], 3.43; 95% CI, 3.17-3.71) and non-English primary language (OR, 3.74; 95% CI, 3.43-4.08). Building the delirium label three ways from the same patients shifted prevalence modestly (32.1% to 30.8%) and prediction (area under the curve, 0.737 to 0.719) but most affected the delirium-mortality association: in a baseline-adjusted model the OR was 4.12 (95% CI, 3.88-4.36) under complete-case handling and fell to 2.16 (95% CI, 2.06-2.27) when UTA was recoded as negative. UTA was recoverable from the observed clinical state (area under the curve, 0.95). Conclusions: In this ICU cohort, Unable to Assess was the most common recorded delirium result other than Negative, exceeding positive screens; recoding it as negative roughly halved the apparent delirium-mortality association by relabeling deeply sedated, high-mortality patients. Delirium datasets should preserve and report UTA, whose concentration among arousable non-English-speaking patients is a measurable equity target.