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01.
arXiv (CS.AI) 2026-06-17

C2FL: Clustered Continual Federated Learning under Spatial and Temporal Drift

arXiv:2606.18003v1 Announce Type: cross Abstract: Collective Adaptive Systems (CAS) increasingly rely on machine learning to let each node learn from locally sensed data, aligning its behavior with the surrounding environment. Scaling this intelligence, however, raises fundamental challenges: sensed data is often privacy-sensitive, preventing centralized collection; nodes are mobile, traversing regions where nearby nodes perceive similar phenomena while distant ones observe radically different conditions, creating natural spatial clusters; and these distributions evolve over time due to mobility, introducing temporal drift that makes local models progressively stale. These dynamics arise across domains - vehicular sensing, drone-based monitoring, smartphone crowdsensing - yet the interplay of privacy, spatial heterogeneity, and temporal drift severely undermines conventional learning strategies. Therefore, we propose C2FL, a fully distributed Federated Learning (FL) approach where nodes self-organize into learning groups through spatial clustering, reflecting the geographic structure of the environment. To counteract temporal drift, each node combines experience replay with a dwell-time-aware adaptive averaging step, progressively incorporating the regional consensus as it remains longer within the same area, while preserving previously acquired knowledge under evolving distributions. We evaluate our approach on synthetic experiments that systematically reproduce spatial and temporal shifts, showing that standard federated strategies degrade significantly under these conditions and that our method restores robust collective adaptation.

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

Thermodynamic Measure of Intelligence

arXiv:2606.20231v1 Announce Type: new Abstract: Can intelligence be measured? We propose that intelligence can be defined as the lawful amplification of rare but valid futures: a system increases the probability of outcomes that would be unlikely under passive dynamics but remain admissible under the constraints of the domain. We start with the premise that an intelligent system must model the world and its own place within it. Because the system is part of the world it models, this leads naturally to recursive self-simulation: the system represents futures in which its own actions are part of the trajectory. Our central results give a necessity statement and a conditional near-sufficiency statement connecting this architecture to a precise thermodynamic measure of lawful amplification of rare-valid futures: high rare-valid lift is impossible unless the internal simulation identifies rare-valid futures with high fidelity; conversely, when rare-valid fidelity is high and the simulation contains an effective policy, the achievable lift approaches the actuation-limited optimum. Thus recursive self-simulation is not merely a plausible feature of intelligence but, under the stated assumptions, is necessary and nearly sufficient for high thermodynamic intelligence. The resulting framework makes intelligence measurable on a universal scale, from passive matter and feedback controllers, large language models, and humans as text generators to Maxwell-demon-like information engines.

03.
arXiv (CS.AI) 2026-06-16

Learning Interface Breakup: A Geometry-Conditioned Latent Surrogate for Spray Formation

arXiv:2606.16587v1 Announce Type: cross Abstract: Designing spray nozzles requires predicting how geometry shapes transient two-phase breakup, but high-fidelity volume-of-fluid (VOF) simulations with adaptive mesh refinement (AMR) are too expensive for iterative design exploration. Standard surrogate models are also challenged by this setting because both the liquid–gas interface and the underlying adaptive discretization evolve across time and geometries. We introduce a geometry-conditioned latent surrogate trained on 797 two-phase nozzle simulations that addresses this by encoding the AMR cell-density field, rather than the full multi-channel flow state, as a compact proxy for where the solver concentrates resolution. From this representation, the model reconstructs transient density evolution and nozzle geometry, and a lightweight second stage recovers the remaining flow variables. On held-out simulations, the method accurately captures key interface dynamics while reducing inference time to 0.045 seconds per trajectory, corresponding to a speed-up of more than $6\times10^4$ relative to Basilisk CFD. These results suggest that AMR refinement structure can serve as a compact and learnable representation for geometry-conditioned surrogate modeling of transient two-phase flows.

05.
arXiv (CS.CV) 2026-06-12

DiskChunGS: Large-Scale 3D Gaussian SLAM Through Chunk-Based Memory Management

Recent advances in 3D Gaussian Splatting (3DGS) have demonstrated impressive results for novel view synthesis with real-time rendering capabilities. However, integrating 3DGS with SLAM systems faces a fundamental scalability limitation: methods are constrained by GPU memory capacity, restricting reconstruction to small-scale environments. We present DiskChunGS, a scalable 3DGS SLAM system that overcomes this bottleneck through an out-of-core approach that partitions scenes into spatial chunks and maintains only active regions in GPU memory while storing inactive areas on disk. Our architecture integrates seamlessly with existing SLAM frameworks for pose estimation and loop closure, enabling globally consistent reconstruction at scale. We validate DiskChunGS on indoor scenes (Replica, TUM-RGBD), urban driving scenarios (KITTI), and resource-constrained Nvidia Jetson platforms. Our method uniquely completes all 11 KITTI sequences without memory failures while achieving superior visual quality, demonstrating that algorithmic innovation can overcome the memory constraints that have limited previous 3DGS SLAM methods.

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

Optimizing Health Coverage in Ethiopia: A Learning-augmented Approach and Persistent Proportionality Under an Online Budget

arXiv:2509.00135v2 Announce Type: replace Abstract: As part of nationwide efforts aligned with the United Nations' Sustainable Development Goal 3 on Universal Health Coverage, Ethiopia's Ministry of Health is strengthening health posts to expand access to essential healthcare services. However, only a fraction of this health system strengthening effort can be implemented each year due to limited budgets and other competing priorities, thus the need for an optimization framework to guide prioritization across the regions of Ethiopia. In this paper, we develop a tool, Health Access Resource Planner (HARP), based on a principled decision-support optimization framework for sequential facility planning that aims to maximize population coverage under budget uncertainty while satisfying region-specific proportionality targets at every time step. We then propose two algorithms: (i) a learning-augmented approach that improves upon expert recommendations at any single-step; and (ii) a greedy algorithm for multi-step planning, both with strong worst-case approximation estimation. In collaboration with the Ethiopian Public Health Institute and Ministry of Health, we demonstrated the empirical efficacy of our method on three regions across various planning scenarios.

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

Theoretical Grounding of Out-Of-Distribution Detection With Reinforcement Learning Optimizer

Out-of-distribution (OOD) detection in dynamic open-world environments requires a model to continually adapt to evolving data distributions while generalizing to covariate-shifted inputs and rejecting semantic-shifted OOD examples. Most existing OOD detection methods optimize only the current-step objective and do not explicitly account for how post-deployment environment changes affect future OOD behavior. In this paper, we establish a theoretical grounding for dynamic OOD detection using a reinforcement learning (RL)-guided optimizer that explicitly favors updates that reduce the semantic OOD false positive rate over time. We develop a novel augmented optimizer that uses an RL-guided correction term on top of standard gradient descent (GD) and show its improvement over both future-domain generalization and semantic-OOD rejection. We analyze temporal error decomposition in terms of model-change and environment-change generalization errors and develop a new theoretical framework for comparing the generalization errors under both GD and RL-guided optimizers.

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

Adiabatic preparation of a fractional quantum Hall fluid by coherently pumping atoms from a Bose-Einstein condensate

arXiv:2606.15951v1 Announce Type: cross Abstract: We propose a protocol to adiabatically prepare a many-particle fractional quantum Hall fluid of bosonic ultracold atoms exploiting a time-dependent coherent coupling of a strongly interacting atomic state with a large dilute Bose-Einstein condensate. Starting from an empty cloud, atoms with well-defined angular momentum are coherently pumped into the fluid by Raman beams with a Laguerre-Gauss profile. Compared to number-conserving schemes which rely on finite-size-induced topological gaps, we identify an adiabatic path in the Fock space which avoids crossing topological phase transitions and thus maintains a sizable adiabatic gap open at all times. The efficiency of our preparation protocol is numerically assessed for typical experimental parameters up to particle numbers that largely exceed the experimental state-of-the-art. The crucial advantage of including an anharmonic confinement is finally highlighted.

10.
PLOS Medicine 2026-05-29

Availability, appeal, and addictiveness by design: Tobacco and nicotine industry deliberate targeting of youth

Authors:

by Raglan Maddox, Becky Freeman, Charlotta Pisinger, Emily Banks Contemporary tobacco and nicotine products, particularly e-cigarettes, are deliberately designed, marketed, and distributed to maximize youth appeal, uptake, dependence, and use. Youth uptake is a predictable outcome of systems designed to maximize product availability, appeal, and addictiveness. In recognition of the World No Tobacco Day 2026 theme, "unmasking the appeal", this Perspective by Raglan Maddox and colleagues discusses how tobacco and nicotine products, particularly e-cigarettes, are deliberately designed and marketed to maximize youth appeal, and highlight the need for policies to ensure greater industry accountability and to tackle concerning uptake trends.

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

DLWM: Diverse Latent World Models for Efficient Multimodal Reasoning

Reasoning capabilities of multimodal large language models (MLLMs) have improved considerably in recent years. Existing approaches typically rely on explicit chain-of-thought or continuous latent-space trajectories to enhance multi-step reasoning. However, these methods generally assume that an input admits a single latent interpretation and unfold reasoning along a fixed path or under a uniform computation budget. In real-world multimodal settings, visual observations are often subject to occlusion, blur, viewpoint variation, or semantic ambiguity, giving rise to multiple plausible interpretations. A uniform reasoning strategy not only limits the model's ability to explore multiple hypotheses but also incurs high memory usage and rollout cost. We present DLWM (Diverse Latent World Models), a multimodal reasoning framework that combines latent-space reasoning with reinforcement learning. First, we construct a set of diverse latent world hypotheses in continuous latent space, each capturing a different plausible interpretation of the visual input, and unfold latent reasoning independently on each hypothesis. An orthogonality-based diversity regularizer explicitly prevents hypothesis collapse. Second, we formulate the latent reasoning process as a resource-constrained sequential decision problem and introduce a resource-aware reinforcement learning policy that adaptively allocates computation across hypotheses, dynamically deciding whether to expand, terminate, or merge reasoning paths, thereby substantially reducing memory footprint and improving rollout efficiency. Experiments on multiple multimodal reasoning benchmarks demonstrate that DLWM outperforms existing methods by 2-5 points in accuracy while reducing memory usage by 24%.

13.
arXiv (CS.AI) 2026-06-19

Uncertainty-Aware Reward Modeling for Stable RLHF

arXiv:2606.19818v1 Announce Type: cross Abstract: Reinforcement learning from human feedback (RLHF) aligns large language models by training reward models on preference data and optimizing policies to maximize predicted rewards. However, this pipeline faces two fundamental challenges: (1) reward models cannot signal when their predictions are unreliable, since they usually act as deterministic point estimators; and (2) modern group-based policy optimization can amplify unreliable reward signals, as exemplified by GRPO's uniform treatment of rewards during advantage computation. As policies explore increasingly diverse responses, these two limitations create a critical vulnerability: unreliable reward estimates may be granted disproportionate influence, triggering severe reward hacking. We propose Uncertainty-Aware Reward Modeling (UARM), which equips reward models with calibrated uncertainty via quantile-based conformal prediction and reweights GRPO advantages through heteroscedastic variance decomposition. Experiments across HelpSteer, UltraFeedback, and PKU-SafeRLHF demonstrate that UARM significantly improves reward model calibration, reduces reward hacking, and enhances downstream alignment quality compared to standard GRPO and uncertainty-agnostic baselines.

14.
arXiv (CS.LG) 2026-06-17

Credibility-Weighted Pricing of Autonomous Vehicle Liability Under Operational Design Domain Shift

Authors:

arXiv:2606.17451v1 Announce Type: new Abstract: Automated Driving System deployments create a foundational ratemaking challenge: sparse experience, shifting operational design domains, and non-stationary risk across software releases. We propose a hierarchical Bayesian credibility framework pooling across cities, software versions, and territories via a learned ODD-similarity kernel, nesting Buhlmann-Straub as a limiting case. Demonstrated on 648 verified-engaged Waymo crashes across four U.S. metros from the NHTSA Standing General Order database against 116 million matched miles, city-aggregate credibility weights are moderate (0.12-0.46), partial pooling decisively outperforms no pooling, and a power analysis shows the learned kernel's advantage becomes detectable at approximately twelve deployed cities.

15.
arXiv (math.PR) 2026-06-19

Towards practical PDMP sampling: Metropolis adjustments, locally adaptive step-sizes, and NUTS-based time lengths

arXiv:2503.11479v2 Announce Type: replace-cross Abstract: Piecewise-Deterministic Markov Processes (PDMPs) hold significant promise for sampling from complex probability distributions. However, their practical implementation is hindered by the need to compute model-specific bounds. Conversely, while Hamiltonian Monte Carlo (HMC) offers a generally efficient approach to sampling, its inability to adaptively tune step sizes impedes its performance when sampling complex distributions like funnels. To address these limitations, we introduce three innovative concepts: (a) a Metropolis-adjusted approximation for PDMP simulation that eliminates the need for explicit bounds without compromising the invariant measure, (b) an adaptive step size mechanism compatible with the Metropolis correction, and (c) a No U-Turn Sampler (NUTS)-inspired scheme for dynamically selecting path lengths in PDMPs. These three ideas can be seamlessly integrated into a single, `doubly-adaptive' PDMP sampler with favourable robustness and efficiency properties.

16.
arXiv (quant-ph) 2026-06-17

Time-spectral control of accidental coincidences in daylight entanglement-based free-space QKD

arXiv:2606.17365v1 Announce Type: new Abstract: Daylight entanglement-based free-space quantum key distribution (QKD) is limited by accidental coincidences from receiver-admitted background light. We develop and experimentally validate a receiver-level framework linking receiver bandwidth, accepted temporal width, and background-noise density to Bob singles, sifted-key rate, error rate, and quantum bit error rate (QBER) in telecom-wavelength BBM92 QKD. Indoor sweeps show that useful sifted counts saturate near the source-matched bandwidth, whereas broader bandwidth or higher background mainly increases accidental contamination. Increasing the accepted temporal width leaves Bob singles nearly unchanged but directly raises QBER by enlarging the random-overlap probability. A two-dimensional design map shows that the temporal-window margin contracts rapidly with increasing background-to-signal ratio, while the bandwidth margin remains comparatively broad near source-matched filtering. A 10 m rooftop daylight experiment demonstrates operation in the predicted low-accidental regime, yielding a mean sifted-key rate of 2,811 cps and a mean QBER of 4.43%.

17.
PLOS Computational Biology 2026-06-22

CoDaLoMic: An R package for modeling microbiome compositional and longitudinal data

by Irene Creus-Martí, Andrés Moya, Francisco J. Santonja In this paper we present CoDaLoMic, an R package for analyzing longitudinal and compositional microbiome datasets. The CoDaLoMic package implements three models specifically designed for the analysis of microbiome data that are both compositional and longitudinal. Unlike many existing methods that focus solely on pairwise interactions, CoDaLoMic also captures interactions among groups of bacteria, providing a more robust methodological framework for studying microbial relationships at the community level. In addition, the package facilitates the analysis of microbiome variability in relation to host health status and allows for the identification of groups of taxa that exhibit similar temporal dynamics. Working with time series data makes it possible to understand not only the current state of a microbial community but also its dynamics over time, which is essential for identifying patterns of ecological succession, detecting events of dysbiosis or recovery, and inferring potential causal relationships between taxa. On the other hand, focusing on interactions among groups of bacteria, rather than analyzing only pairwise relationships, enables a more integrated and functionally meaningful view of the microbiome. Many key ecological functions are the result of the collective behavior of functionally related groups of taxa. Two datasets have been considered in CoDaLoMic, one real and one simulated. The real dataset contains the information of the genera present in the microbiome of the Blatella germanica cockroach at 105 time points. The simulated dataset is defined taking Lotka-Volterra structure into account. CoDaLoMic is available at CRAN.

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

A Systematic Evaluation of Large Language Models for PTSD Severity Estimation: The Role of Contextual Knowledge and Modeling Strategies

Large language models (LLMs) are increasingly being used in a zero-shot (generative) fashion to assess mental health conditions, yet we have limited knowledge on what factors affect their accuracy. In this study, we use a clinical dataset of natural language narratives and self-reported PTSD severity scores from 1,437 individuals to comprehensively evaluate the performance of 11 state-of-the-art LLMs. To understand the factors affecting model's assessment accuracy, we systematically varied (i) contextual knowledge prompted to the models like subscale definitions, distribution summary, and interview questions, and (ii) modeling strategies including zero-shot vs few shot, amount of reasoning effort, model sizes, structured subscales vs direct scalar prediction, output rescaling and nine ensemble methods. Our findings indicate that (a) LLMs are most accurate when provided with detailed construct definitions and context of the narrative, even exceeding human raters agreement with self-reported scores; (b) increased reasoning effort leads to better estimation accuracy; (c) performance of open-weight models (Llama, DeepSeek) plateaus beyond 70B parameters while closed-weight (gpt-o3-mini, gpt-5) alternatives improve with newer generations; and (d) best performance is achieved when ensembling a supervised model with the zero-shot LLMs. Beyond agreement with self-reports, LLMs' estimates discriminated PTSD severity from depression, anxiety, and alcohol use, and prospectively predicted future mental healthcare expenditure. Together, these results suggest that contextual knowledge and modeling strategies meaningfully affect accuracy and clinical utility of LLM-based assessments of PTSD severity.

19.
medRxiv (Medicine) 2026-06-17

Low-Density Lipoprotein Cholesterol and Dementia Risk: Integrating Mendelian Randomization and Target Trial Emulation Within the Heart-Brain Axis

Background: The heart-brain axis links cardiovascular and neurodegenerative disease through shared vascular and inflammatory mechanisms. Although low-density lipoprotein cholesterol (LDL-C) is an established causal factor in atherosclerotic cardiovascular disease (ASCVD), its relationship with dementia remains uncertain, with midlife elevations associated with increased risk but late-life associations often appearing null or inverse. To address this cholesterol paradox, we integrated mendelian randomization (MR) with an active-comparator new-user target trial emulation. Methods: We applied a triangulated causal inference framework integrating two-sample MR with observational target trial emulation. Genetic variants associated with LDL-C were used as instrumental variables to evaluate Alzheimer disease (AD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and any dementia (AnyDem), with causal estimates derived using inverse-variance weighted models and sensitivity analyses for heterogeneity and pleiotropy. In parallel, an active-comparator new-user design compared statin versus ezetimibe initiation among adults aged 60 years or older using propensity score (PS) overlap weighting and Cox proportional hazards models to evaluate cardiovascular and dementia outcomes. Results: Genetically predicted LDL-C was associated with increased risk of DLB (OR 1.65, 95% CI 1.30-2.10; p

20.
medRxiv (Medicine) 2026-06-22

National trends and operational drivers of vaccine wastage in Uganda, 2020-2025: a descriptive analysis of four tracer antigens

Background Vaccine wastage reduces immunisation efficiency, increases costs, and complicates supply forecasting. Uganda routinely monitors vaccine use, but national evidence comparing observed wastage with World Health Organization (WHO) and Uganda-specific planning thresholds has been limited. We described national and sub-national trends for four tracer antigens to inform supply-chain planning and forecasting. Methods We conducted a retrospective descriptive analysis of routinely reported immunisation data from Ugandas District Health Information Software 2, 2020-2025. We analysed Bacille Calmette-Guerin (BCG), measles-rubella (MR), oral polio vaccine (OPV), and diphtheria-tetanus-pertussis-containing vaccine (DPT). Vaccine wastage was calculated as the proportion of issued doses not administered. Annual wastage rates were summarised using medians, and temporal trends were assessed using the Mann-Kendall test. Observed wastage was compared with WHO thresholds: BCG[≤]50%, MR[≤]25%, OPV[≤]10%, DPT[≤]15%, and Ugandas planning thresholds: BCG[≤]70%, MR[≤]40%, OPV[≤]15%, DPT[≤]10%. Effective Vaccine Management reports were reviewed to summarise reported reasons for wastage. Results During 2020-2025, median national wastage was 40.6% for BCG, 25.9% for MR, 10.0% for OPV, and 9.2% for DPT. OPV wastage declined from 12.8% in 2020 to 8.0% in 2025, with a significant downward trend ({tau}b=-1.00; p=0.008). OPV and DPT wastage remained largely within their respective Uganda in-country thresholds ([≤]15% and [≤]10%) for most of the study period, while BCG generally remained below the WHO threshold ([≤]50%) and MR frequently exceeded the WHO threshold ([≤]25%) but remained within Uganda's planning threshold ([≤]40%) in most years. The proportion of districts exceeding both WHO and Uganda thresholds declined for OPV from 36.3% to 5.5% (p=0.024) and for DPT from 22.6% to 1.4% (p=0.013). Wastage was consistently higher in lower-level (Health Centre II and III) facilities, compared to hospitals. Among 50 service delivery points, reported reasons included low session attendance (66%), multi-dose vial policy non-compliance (28%), and vaccine expiry (12%). Conclusion Uganda achieved reductions in OPV wastage and district-level improvements in DPT wastage, while BCG and MR remained more variable and frequently had higher wastage. Strengthening adherence to the multi-dose vial policy and improving session planning at lower-level facilities could strengthen vaccine utilisation and forecasting.

21.
arXiv (CS.AI) 2026-06-16

Beyond Weights and Gradients: A Taxonomy of Federated Learning Messages

arXiv:2606.16891v1 Announce Type: cross Abstract: Federated Learning is rapidly evolving beyond the exchange of traditional model weights and gradients, yet existing definitions fail to capture the full scope of modern payloads like synthetic data and federated analytics. This paper addresses the gap by proposing a formal mathematical definition of a federated message that accounts for both utility and privacy. We introduce a taxonomy that organizes these exchanges into three categories: model structures, statistical summaries, and data-conditioned representations. By evaluating these groups based on computational demands, communication costs, and privacy risks, we provide a clearer understanding of the trade-offs involved in decentralized training. Our review of 202 recent publications highlights a significant shift since 2021 toward diverse messaging paradigms, signaling a move away from standard deep learning updates toward more specialized information sharing. This framework provides a structured path for future research to optimize federated systems for varying hardware and security requirements.

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

Orcheo: A Modular Full-Stack Platform for Conversational Search

arXiv:2602.14710v2 Announce Type: replace-cross Abstract: Conversational search (CS) requires a complex software engineering pipeline that integrates query reformulation, ranking, and response generation. CS researchers currently face two barriers: the lack of a unified framework for efficiently sharing contributions with the community, and the difficulty of deploying end-to-end prototypes needed for user evaluation. We introduce Orcheo, an open-source platform designed to bridge this gap. Orcheo offers three key advantages: (i) A modular architecture promotes component reuse through single-file node modules, facilitating sharing and reproducibility in CS research; (ii) Production-ready infrastructure bridges the prototype-to-system gap via dual execution modes, secure credential management, and execution telemetry, with built-in AI coding support that lowers the learning curve; (iii) Starter-kit assets include 45+ off-the-shelf components for query understanding, ranking, and response generation, enabling the rapid bootstrapping of complete CS pipelines. We describe the framework architecture and validate Orcheo's utility through case studies that highlight modularity and ease of use. Orcheo is released as open source under the MIT License at https://github.com/AI-Colleagues/orcheo.

23.
medRxiv (Medicine) 2026-06-22

Use of the Pharmacy First service in England in the first 12 months: geographic variation and health system context

Objectives: The Pharmacy First (PF) service was introduced across England from 31 January 2024 to expand the clinical role of community pharmacies and improve access to primary care. This paper describes use of PF in its first 12 months, in terms of uptake, access routes, consultation outcomes, geographic variations, service costs and antimicrobial supply. Methods: A descriptive analysis of all PF consultations submitted for payment to NHS Business Services Authority in England between 31 January 2024 and 31 January 2025. Pharmacy-level consultation data were linked to national data on population, location and pharmacy characteristics. PF use was examined using population-standardised consultation rates and consultations per pharmacy. Results: During the first year of implementation, 2,205,731 PF consultations were recorded as delivered across 11,349 pharmacies, with payment of GBP123 million to pharmacies. Uptake increased steadily over time. Most consultations were for acute sore throat (33%) and uncomplicated urinary tract infection (27%), with corresponding antibiotics, phenoxymethylpenicillin and nitrofurantoin being the most supplied. Most people self-referred (74%) into the service, with 95% of consultations managed without onward referral. Substantial geographic variation was observed. Northern regions had higher use based on the eligible population. The South East and Midlands had higher activity per pharmacy. London showed a distinct pattern, with higher self-referral into the service, lower medication supply and higher referral to other healthcare services. Higher consultation volume was weakly associated with pharmacy characteristics, including opening hours, pharmacy type and retail setting, and local context, in terms of socio-economic and geographic factors. Conclusions: PF had immediate uptake and is operating primarily as a direct-access model for common acute conditions. Findings suggest that PF is contributing to improved access to care and may shift demand away from general practice. However, the service uptake appears to be shaped by geographic location, proximity to other healthcare services and pharmacy characteristics.

24.
medRxiv (Medicine) 2026-06-19

Within-host pathogen population diversity predicts treatment response in tuberculosis

Background: Tuberculosis (TB) treatment outcomes remain suboptimal, and standard clinical diagnostics cannot reliably identify patients at high risk of treatment failure or relapse at the time of diagnosis. While within-host Mycobacterium tuberculosis genetic diversity is hypothesized to reflect the viable bacterial burden and adaptive capacity of the infection, its clinical prognostic value remains unknown. Methods: We conducted a prospective cohort study of 364 patients with newly diagnosed, rifampicin-susceptible pulmonary TB in South Africa. Patients received standard 6-month therapy and were monitored for up to two years to ascertain composite unfavorable outcomes (treatment failure, death, or relapse). To accurately detect low-frequency (unfixed) genetic variants and eliminate reference bias artifacts, we mapped medium to high depth short-read sequences against matched, patient-specific long-read assemblies. The association between baseline pathogen genetic diversity and clinical outcomes was evaluated using multivariable Cox proportional-hazards models. Results: After bioinformatic filtering, true unfixed variants were relatively rare but significantly enriched in genes mediating pathogen adaptation and drug tolerance, including transporter proteins and two-component regulatory systems. Within-host bacterial genetic diversity (i.e., the total number of unfixed variants) ranged from 0-20, with a median of 1 per patient. In survival analysis adjusting for known clinical risk factors–including HIV status, prior TB, baseline smear positivity, and radiographic lung involvement–baseline within-host genetic diversity emerged as a strong, independent predictor of unfavorable treatment outcomes. For patients with greater than 3 unfixed variants at diagnosis, each increase of 5 unfixed variants was associated with more than double the risk of a composite unfavorable outcome (adjusted Hazard Ratio, 2.36; 95% CI, 1.27 to 4.39; p=0.007). Conclusions: Baseline within-host pathogen genetic diversity is an independent predictor of unfavorable TB treatment outcomes. As sequencing becomes increasingly integrated into routine diagnostics, quantifying unfixed variants is an accessible approach that promises to risk-stratify patients and guide the duration of individualized regimens.

25.
arXiv (CS.CV) 2026-06-18

E-VAds: An E-commerce Short Videos Understanding Benchmark for MLLMs

E-commerce short videos represent a high-revenue segment of the online video industry characterized by a goal-driven format and dense multi-modal signals. Current models often struggle with these videos because existing benchmarks focus primarily on general-purpose tasks and neglect the reasoning of commercial intent. In this work, we first propose a multi-modal information density assessment framework to quantify the complexity of this domain. Our evaluation reveals that e-commerce content exhibits substantially higher density across visual, audio, and textual modalities compared to mainstream datasets, establishing a more challenging frontier for video understanding. To address this gap, we introduce E-commerce Video Ads Benchmark, which is the first benchmark specifically designed for e-commerce short video understanding. We curated 3,961 high-quality videos from Taobao covering a wide range of product categories and used a multi-agent system to generate 19,785 open-ended Q&A pairs, which consist of five distinct tasks. Finally, we develop E-VAds-R1, an RL-based reasoning model featuring a multi-grained reward design called MG-GRPO. This strategy provides smooth guidance for early exploration while creating a non-linear incentive for expert-level precision. Experimental results demonstrate that E-VAds-R1 achieves a 109.2% performance gain in commercial intent reasoning with only a few hundred training samples. Data is available at https://github.com/TaobaoTmall-AlgorithmProducts/E-VAds_Benchmark.