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

AI Coding Agents in Social Science: Methodologically Diverse, Empirically Consistent, Interpretively Vulnerable

The deployment of LLM-based agents in scientific analysis raises opposing concerns: that agents may reduce methodological diversity, or that they may amplify the analytic flexibility through which researchers reach motivated conclusions. We argue these worries target two empirically separable layers: a design layer of methodological choices, and a verdict layer in which a decision rule maps estimates to a substantive claim. We test both by running 20 independent executions of Claude Code and Codex on a prominent immigration and social-policy against a many-analysts human baseline. At the design layer, Codex matches human methodological diversity and Claude Code produces nearly three times as many specifications; both agents' effect estimates remain broadly aligned with the human consensus, and no agent model exactly matches any human model. A prompt-induced anti-immigration researcher prior reorganizes each agent's methodological decisions but, unlike for biased human analysts in the same data, does not shift aggregate estimates or final verdicts; nor do agents reroute along the methodological axes humans use to bias their estimates. At the verdict layer, an explicit confirmatory prompt flips Claude Code's verdicts from 10% to 90% support while leaving its coefficient distribution essentially unchanged, operating through rule omission rather than rule softening. AI agents can rival or exceed human methodological diversity at the design layer while remaining vulnerable at the verdict layer. In our setting, the locus of AI bias is not estimation but interpretation.

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

Semantic Reasoning in Medicine: The Role of Knowledge Graphs Across Five Key Domains

arXiv:2606.15155v1 Announce Type: new Abstract: Knowledge graphs (KGs) have emerged as a promising solution for integrating and reasoning over complex biomedical and clinical data in healthcare. By representing structured relationships among entities such as diseases, drugs, symptoms, and patient records, KGs provide a semantic backbone for decision-making, prediction, recommendation, and personalized care. Recent advances have demonstrated their utility across diverse medical applications–including clinical decision support systems, disease and treatment outcome prediction, health recommender systems, precision medicine, and medical question answering–where KGs often enhance interpretability, semantic coherence, and patient-specific reasoning. In parallel, a growing body of work focuses on medical KG generation itself, proposing frameworks that construct graphs from EHRs, clinical narratives, biomedical literature, and web resources using ontologies, semantic web technologies, deep-learning-based information extraction, and hybrid neuro-symbolic pipelines. Despite this progress, significant challenges remain, including limited and fragmented knowledge coverage, difficulties in aligning heterogeneous data sources, the fragility of current reasoning and representation-learning methods on dense multi-relational graphs, and unresolved issues related to privacy, bias, and accountability. This survey reviews and categorizes current research on KGs in medicine along both application-oriented and methodology-oriented dimensions, discusses their benefits and technical foundations, and outlines key limitations and open research directions. By analyzing trends, architectures, and evaluation practices, this work aims to guide future developments in KG-driven medical AI systems and support their safe and effective integration into healthcare environments.

03.
arXiv (CS.CV) 2026-06-12

Analyzing and Improving Fine-grained Preference Optimization in Medical LVLMs

Large Vision-Language Models (LVLMs) have achieved strong performance across medical imaging tasks, yet they remain prone to factual inconsistencies, poor visual grounding, and misalignment with clinically meaningful feedback. Existing post-training alignment approaches, including Direct Preference Optimization (DPO) and its variants, face three critical limitations in the medical domain: (1) sequence-level reward signals treat clinically critical tokens identically to generic filler text; (2) reliance on static supervised fine-tuning references as preferred responses introduces an off-policy distribution shift, steering optimization toward stylistic artifacts over clinical correctness; and (3) alignment objectives lack explicit visual grounding constraints, leaving models insensitive to subtle yet diagnostically decisive pathological features. Our method leverages a bidirectional token-wise KL regularizer alongside a visual-contrastive grounding objective that pairs clean and lesion-corrupted images to penalize responses generated without adequate visual evidence. Together, these components form a fine-grained, on-policy alignment framework that constructs preference pairs by minimally editing model-generated outputs, correcting only clinically erroneous spans while preserving the original linguistic style. Extensive experiments across medical imaging tasks and clinical text generation benchmarks validate the effectiveness of our approach.

04.
bioRxiv (Bioinfo) 2026-06-13

Reinforcement learning-driven unified generative framework for multi-objective RNA codon design

Current RNA codon design methods are limited by inefficient long-sequence processing and poor generalizability, often relying on a decoupled "generate-or-optimize" paradigm. We introduce RNARL, a reinforcement learning-driven framework that unifies sequence generation with multi-objective optimization. RNARL directly learns to generate high-performance sequences, effectively optimizing sequences over 3,900 nucleotides and demonstrating superior performance and universality across six species and five RNA types. RNARL thus establishes an effective and generalizable framework for RNA codon design. Finally, a user-friendly web platform is freely available to facilitate its application for RNA therapeutic design.

05.
arXiv (CS.CL) 2026-06-18

Learning User Simulators with Turing Rewards

Learning to simulate human users in interactive settings could advance the training of agent assistants, evaluation of personalization systems, research in the social sciences, and more. Existing approaches generally do so by training a large language model (LLM) to match a single ground truth response, either by maximizing the log probability or by using a similarity reward. We instead propose {Turing-RL}: a Turing-Test-based reinforcement learning approach for training user simulator models. {Turing-RL} uses a discriminative Turing reward with an LLM judge to score how indistinguishable a generated response is from the real user's given the user's history, and the user simulator LLM learns to produce responses indistinguishable from what the user could have said with such rewards. Across two different domains–conversational chat and Reddit forum discussion–we find that {Turing-RL} consistently outperforms baseline methods on both LLM and human evaluation metrics. Our study suggests that optimizing for indistinguishability, rather than response matching, is effective for learning user simulators.

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

Characterizing Software Aging in GPU-Based LLM Serving Systems

arXiv:2606.11916v1 Announce Type: cross Abstract: This paper proposes an empirical methodology to study software aging in GPU-based LLM serving systems. Traditional aging studies focus on CPU-centric software with relatively regular workloads; LLM serving is different, spanning a Python host and a CUDA device, handling requests whose cost varies by orders of magnitude, and relying on rapidly evolving software stacks. We run a 216-hour campaign across six co-located deployments under identical stress conditions, monitor host, device, and client metrics in parallel, and apply a statistical pipeline that accounts for autocorrelation and multiple testing. Our results reveal statistically significant memory aging in all deployments, with leak rates strongly dependent on the serving runtime and deployment configuration. Beyond these findings, we provide a reproducible framework that opens a research direction at the intersection of the software aging and rejuvenation and LLM serving communities.

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

Spectrally Corrected Polynomial Approximation for Quantum Singular Value Transformation

arXiv:2603.03998v2 Announce Type: replace Abstract: Quantum Singular Value Transformation (QSVT) provides a unified framework for applying polynomial functions to the singular values of a block-encoded matrix. QSVT prepares a state proportional to $\bA^{-1}\bb$ with circuit depth $O(d\cdot\mathrm{polylog}(N))$, where $d$ is the polynomial degree of the $1/x$ approximation and $N$ is the size of $\bA$. Current polynomial approximation methods are over the continuous interval $[a,1]$, giving $d = O(\sqrt{\kap}\log(1/\varepsilon))$, and make no use of any properties of $\bA$. We observe here that QSVT solution accuracy depends only on the polynomial accuracy at the eigenvalues of $\bA$. When all $N$ eigenvalues are known exactly, a pure spectral polynomial $p_{S}$ can interpolate $1/x$ at these eigenvalues and achieve unit fidelity at reduced degree. But its practical applicability is limited. To address this, we propose a spectral correction that exploits prior knowledge of $K$ eigenvalues of $\bA$. Given any base polynomial $p_0$, such as Remez, of degree $d_0$, a $K\times K$ linear system enforces exact interpolation of $1/x$ only at these $K$ eigenvalues without increasing $d_0$. The spectrally corrected polynomial $p_{SC}$ preserves the continuous error profile between eigenvalues and inherits the parity of $p_0$. QSVT experiments on the 1D Poisson equation demonstrate up to a $5\times$ reduction in circuit depth relative to the base polynomial, at unit fidelity and improved compliance error. The correction is agnostic to the choice of base polynomial and robust to eigenvalue perturbations up to $10\%$ relative error. Extension to the 2D Poisson equation suggests that correcting a small fraction of the spectrum may suffice to achieve fidelity above $0.999$.

08.
arXiv (CS.AI) 2026-06-12

Reconstructing Template-Memorized Images from Natural Prompts

arXiv:2507.07947v4 Announce Type: replace-cross Abstract: Recent advances in generative models, such as diffusion models, have raised concerns related to privacy, copyright infringement, and data stewardship. To better understand and control these risks, prior work has introduced techniques and attacks that reconstruct images, or parts of images, from training data. While these results demonstrate that training data can be recovered, existing methods often rely on high computational resources, partial access to the training set, or carefully engineered prompts. In this work, we present a new attack that requires low resources, assumes little to no access to the training data, and identifies seemingly benign prompts that can lead to potentially risky image reconstruction. We further show that such reconstructions may occur unintentionally, even for users without specialized knowledge. For example, we observe that for one existing model, the prompt ``blue Unisex T-Shirt'' generates the face of a real individual. Moreover, by combining the identified vulnerabilities with real-world prompt data, we discover prompts that reproduce memorized visual elements. Our approach builds on insights from prior work and leverages domain knowledge to expose a fundamental vulnerability arising from the use of scraped e-commerce data, where templated layouts and images are closely tied to pattern-like textual prompts. The code for our attack is publicly available at https://github.com/TheSolY/lr-tmi.

09.
arXiv (math.PR) 2026-06-16

Collapsibility in Multiparametric Models of Random Simplicial Complexes

作者:

arXiv:2606.15276v1 Announce Type: cross Abstract: We study collapsibility in the multiparametric models of random simplicial complexes, namely the lower and upper models. In the upper model, we improve upon a result of Farber and Nowik, and assert that the homology is a.a.s concentrated in a single dimension by proving that the complex collapses to that \di. In the lower model, we prove that the complex a.a.s collapses to the \di\ with maximal non-trivial cohomology. We then compare this threshold to the ones derived previously for the special cases of the clique complex (by Kahle) and the Linial-Meshulam model.

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

Learning What to Say to Your VLA: Mostly Harmless Vision Language Action Model Steering

arXiv:2606.12299v1 Announce Type: cross Abstract: Vision-Language-Action (VLA) models provide a natural language interface to robot control, but the mapping from language to behavior is often brittle and unintuitive: semantically similar instructions can induce drastically different behaviors, while some capabilities may not be elicitable through prompting alone. As a result, both human instructions and zero-shot language models can fail to reliably steer VLAs toward successful task execution. In this work, we propose a framework that interactively searches for language sequences that improve closed-loop VLA task performance, distills these sequences into a test-time language feedback policy (LFP), and learns an improvement head that predicts when language steering will improve performance. We conformalize this improvement head to prevent harmful steering interventions, where the LFP decreases task performance relative to the original instruction on out-of-distribution scenarios. Crucially, our approach operates on arbitrary frozen pre-trained VLAs, requiring neither access to the original training distribution nor fine-tuning of the underlying model. On seen environments, our conformalized LFP improves base VLA performance by 24.7% in simulation and 65.0% in hardware. On visual and semantic perturbations, our conformalized LFP has strong harmlessness guarantees, and produces recovery behaviors not observed with open-loop prompting.

11.
medRxiv (Medicine) 2026-06-22

Effectiveness of Stress Management to Reduce Stress Eating for Women: A Systematic Review and Meta-analysis of Intervention Studies

Objective: This systematic review and meta-analysis examined 1) the effects of stress management interventions on changes in stress eating for women, and 2) the longevity of these effects, by summarizing and assessing evidence from controlled and non-equivalent pretest-posttest intervention studies. Method: Five databases (PsycINFO, PubMed, Medline, Web of Science, CINAHL), existing sources, and grey literature were searched (February - June 2025). Studies that assessed stress eating or emotional eating, included a stress management intervention, and comprised at least 70% women were included. The primary outcome was reduction in stress eating. Data were pooled in meta-analyses using multi-level random-effects models and subset by follow-up period. Risk of bias was assessed via funnel plots and sensitivity analyses. Results: Sixty studies with 119 effect size estimates were included in the primary analysis. Pooled estimates indicated that stress management interventions significantly reduced stress eating (Hedges g = -0.4174, p < 0.001), with pre-post designs having larger effects than controlled trials. Subgroup analyses of follow-up periods found small effects in the short-term (before 3 months; Hedges g = -0.4202, p < 0.0001) and moderate effects for mid-term (3-6 months; Hedges g = -0.5886, p < 0.0001). Effects beyond 6 months were small and nonsignificant (Hedges g = -0.4370, p = 0.0660). Conclusion and Relevance: Stress management interventions appear to be effective for reducing stress eating for women, suggesting the potential to incorporate stress management in interventions targeting obesity. Effects may be only sustained 6 months post-intervention, suggesting the need for strategies to bolster long-term effectiveness.

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

A Definition of Good Explanations and the Challenges Explaining LLM Outputs

arXiv:2606.14838v1 Announce Type: new Abstract: How to define a good explanation is a long-standing philosophical debate which has found recent renewed interest in the context of AI outputs. Explainability is crucial for AI adoption in many contexts, but in order to produce good explanations of AI systems, we must first have an understanding of what good explanations are. In this paper we propose a definition inspired by the notion of counterfactual explanations, however we argue that one must also take into account the interlocutor's prior beliefs in each fact that could be offered in an explanation. We explore the ramifications of this definition for AI explainability and, in particular, why LLM outputs are difficult to produce good explanations for.

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

Stochastic Schrödinger Diffusion Models for Pure-State Ensemble Generation

arXiv:2605.03573v3 Announce Type: replace-cross Abstract: Quantum machine learning increasingly relies on pure-state representations, motivating generative models that sample directly in quantum representation space rather than perturbing classical inputs and re-encoding. We introduce Stochastic Schrödinger Diffusion Models (SSDMs), a score-based generative framework that defines diffusion, scores, and reverse-time sampling intrinsically on the complex projective manifold $\mathbb{CP}^{d-1}$ under the Fubini–Study metric. SSDMs combine a Riemannian Ornstein–Uhlenbeck forward diffusion with a stochastic Schrödinger realization, and learn reverse-time dynamics driven by the Riemannian score. Our central technical contribution is a local-time learning objective that exploits the local Euclidean OU limit of intrinsic manifold diffusions in Fubini-Study normal coordinates to obtain an analytic teacher score, bypassing the intractable transition densities that limit existing Riemannian score-based models. Across synthetic, physics-inspired (TFIM, XXZ), and quantum feature-state benchmarks up to $14$ qubits, SSDMs match target pure-state ensembles by orders of magnitude on MMD and observable statistics over both ambient Euclidean and matched Riemannian score-based baselines, and improve representation-level diagnostics for downstream quantum kernel methods.

14.
arXiv (math.PR) 2026-06-18

Stable size-biasing and the positive scale-mixture order of generalized Gaussian laws

arXiv:2606.18458v1 Announce Type: new Abstract: Let $X_r\sim N_r(0,1)$ be the centered unit-scale generalized Gaussian random variable with density proportional to $\exp(-|x|^r/2)$. We prove that, for $p,q>0$, there exists a strictly positive random variable $V$, independent of $X_q$, such that $X_p\stackrel{d}{=}VX_q$ if and only if $p\le q$. Moreover, the law of $V$ is unique. For $pq$, the required Mellin quotient, viewed as the candidate characteristic function of $\log V$, is unbounded by Stirling's formula, and hence cannot be a characteristic function. The factor laws form a multiplicative cocycle, $V_{p,r}\stackrel{d}{=}V_{p,q}V_{q,r}$, for $p\le q\le r$, where the factors on the right-hand side are independent copies. Thus the Mellin quotient isolated by Dytso, Bustin, Poor and Shamai is realized constructively throughout the $p

15.
arXiv (quant-ph) 2026-06-12

Where a Quantum Reservoir Works: A Transferable Operating Band

arXiv:2606.13284v1 Announce Type: new Abstract: In quantum reservoir computing, a fixed quantum system transforms an input signal, while learning reduces to training a simple linear readout on its measured outputs. Since the quantum dynamics themselves are never optimized, the method is well suited to today's hardware. Yet these dynamics must still be chosen carefully, because their settings remain fixed throughout training and inference. It therefore remains an open question where, in its control space, a fixed quantum system learns well. We address this question for a dissipative reservoir by mapping performance over three central physical controls: the strength of the input drive, the coupling between neighboring qubits, and the rate of dissipation. Good performance concentrates in a single, well-defined operating region of this control space. This region transfers across tasks and reservoir initializations, and the same memory-defined regime persists under architectural changes. It is also mechanistically grounded, since it disappears whenever any of the mechanisms that create it is removed. Finally, the region can be located cheaply before any task is run, using a simple memory diagnostic.

16.
arXiv (CS.LG) 2026-06-19

CAGE: Curvature-Aware Gradient Estimation For Accurate Quantization-Aware Training

arXiv:2510.18784v3 Announce Type: replace Abstract: Despite significant work on low-bit quantization-aware training (QAT), there is still an accuracy gap between such techniques and native training. To address this, we introduce CAGE (Curvature-Aware Gradient Estimation), a new QAT method that augments the straight-through estimator (STE) gradient with a curvature-aware correction designed to counteract the loss increase induced by quantization. CAGE is derived from a multi-objective view of QAT that balances loss minimization with the quantization constraints, yielding a principled correction term that depends on local curvature information. On the theoretical side, we introduce the notion of Pareto-optimal solutions for quantized optimization, and establish that CAGE yields strong convergence guarantees in the smooth non-convex setting. In terms of implementation, our approach is optimizer-agnostic, but we provide a highly-efficient implementation that leverages Adam statistics. CAGE significantly improves upon the prior state-of-the-art methods in terms of accuracy, for similar computational cost: for QAT fine-tuning, it halves the compression accuracy loss relative to the prior best method, while for QAT pre-training of Llama models, its accuracy for 3-bit weights-and-activations (W3A3) matches the accuracy achieved at 4-bits (W4A4) with the prior best method. The official implementation can be found over https://github.com/IST-DASLab/CAGE .

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

Large Language Models Hack Rewards, and Society

Reinforcement learning (RL) has become a dominant post-training paradigm, enabling large language models (LLMs) to learn from rewards. We observe that societal regulations are structurally similar to reward functions. They define measurable outcomes, thresholds, and exceptions, while often leaving institutional intent only partially specified. We hypothesise that the RL training process may exploit these gaps and therefore ask whether models' well-known tendency to hack reward functions during RL can scale into a more consequential failure mode named societal hacking: discovering loopholes in the rules society runs on. To study this phenomenon, we introduce SocioHack, a sandbox of 72 societal environments, and find that within these environments, reward hacking naturally emerges and leads to regulatory loophole discovery. Models learn to hack the social rules and generate strategies that remain technically compliant while defeating regulatory intent, and current LLM safeguards provide only limited mitigation. Therefore, collecting in-the-wild feedback for model training requires greater caution, and we need a next-generation post-training paradigm for safely iterating LLMs in real society.=

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

Distilling latent electrostatics from foundation machine learning interatomic potentials

arXiv:2606.15001v1 Announce Type: cross Abstract: Foundation machine learning interatomic potentials (MLIPs) have enabled atomistic simulations across broad regions of chemical and materials space, but many remain computationally expensive and lack explicit electrostatics, limiting their use for systems governed by long-range interactions and electrical response. Previously, we introduced Latent Ewald Summation (LES), which learns latent atomic charges and long-range electrostatics from density functional theory (DFT) energy and force labels alone. Here, we use LES to extract electrostatics that are latent in foundation models: energies and forces predicted by a teacher model are used to train a lightweight LES-augmented student MLIP, with optional fine-tuning on additional DFT data. The resulting models reduce computational cost while providing access to Born effective charge tensors, and infrared spectra. We benchmark student models distilled from a broad set of foundation MLIPs, including UMA, MACE, Orb, eSEN, GemNet-OC, PET, and EquiformerV2-based models, against experimental infrared spectra for liquid water, concentrated hydrochloric acid, and the anatase TiO2(101)-water interface. Across these systems, electrostatic response can be extracted from most foundation MLIPs. The benchmark further shows that the underlying DFT level and dataset used to train the teacher model play a larger role than architecture in determining electrostatic and spectroscopic accuracy. For the TiO2-water interface, fine-tuning with a modest amount of higher-level DFT data improves structural and infrared predictions. LES-based distillation therefore provides a practical route for converting foundation MLIPs into efficient, electrically responsive models, while also testing the physical fidelity encoded in foundation models.

19.
arXiv (CS.LG) 2026-06-16

Polynomial-Time Mistake-Bounded Language Generation

arXiv:2606.16077v1 Announce Type: cross Abstract: In this note, we introduce a polynomial-time version of the mistake-bounded language generation (MBLG) framework due to Kleinberg, Peale, and Reingold (2026). We observe that the family of parities of variables, and the family of conjunctions of literals, are polynomial-time MBLG. Our main result states that the family of monotone Boolean functions with polynomially-many maxterms is polynomial-time MBLG. This family includes all monotone Boolean functions, computable by polynomial-size decision trees. Our technique can be presented as a new combinatorial game about writing numbers on a board.

20.
arXiv (CS.CV) 2026-06-19

Mix-QVLA: Task-Evidence-Aware Mixed-Precision Quantization of Vision-Language-Action Models

We propose Mix-QVLA, a task-evidence-aware mixed-precision PTQ framework for VLA models. Mix-QVLA anchors each quantized variant to the full-precision action-token reference decision and evaluates whether quantization preserves task-relevant evidence across key VLA functional boundaries. It computes normalized gradient-weighted task-evidence maps from boundary activations and compares full-precision and quantized maps using evidence-mass and attribution-distribution distortion, capturing changes in both the strength and allocation of decision-supporting evidence. A soft-bottleneck objective aggregates boundary-level degradation into layer-wise sensitivity scores. Mix-QVLA further models sensitivity throughout task execution, capturing phase-dependent shifts in layer importance rather than assuming a fixed sensitivity profile. The resulting evidence- and time-aware scores guide mixed-precision bit allocation under model-size and BitOps budgets. Extensive evaluations on OpenVLA-style policies show that Mix-QVLA improves the accuracy-efficiency trade-off of low-bit VLA deployment. On LIBERO, Mix-QVLA reduces OpenVLA-OFT memory from 15.4 GB to 4.1 GB, retains 96.3 average success compared with 97.1 for the BF16 model, and achieves a 1.52x inference speedup.

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

SpatialClaw: Rethinking Action Interface for Agentic Spatial Reasoning

Spatial reasoning, the ability to determine where objects are, how they relate, and how they move in 3D, remains a fundamental challenge for vision-language models (VLMs). Tool-augmented agents attempt to address this by augmenting VLMs with specialist perception modules, yet their effectiveness is bounded by the action interface through which those tools are invoked. In this work, we study how the design of this interface shapes the agent's capacity for open-ended spatial reasoning. Existing spatial agents either employ single-pass code execution, which commits to a full analysis strategy before any intermediate result is observed, or rely on a structured tool-call interface that often offers less flexibility for freely composing operations or tailoring the analysis to each task. Both designs offer limited flexibility for open-ended, complex 3D/4D spatial reasoning. We therefore propose SpatialClaw, a training-free framework for spatial reasoning that adopts code as the action interface. SpatialClaw maintains a stateful Python kernel pre-loaded with input frames and a suite of perception and geometry primitives, letting a VLM-backed agent write one executable cell per step conditioned on all prior outputs, enabling the agent to flexibly compose and manipulate perception results and adapt its analysis to both intermediate text and visual observations and the demands of each problem. Evaluated across 20 spatial reasoning benchmarks spanning a broad range of static and dynamic 3D/4D spatial reasoning tasks, SpatialClaw achieves 59.9% average accuracy, outperforming the recent spatial agent by +11.2 points, with consistent gains across six VLM backbones from two model families without any benchmark- or model-specific adaptation.

22.
medRxiv (Medicine) 2026-06-17

Treatment of Multi-Drug-Resistant Tuberculosis with Second-Line All-Oral Drugs in Ghana: Incidence of Adverse Events.

Introduction: The treatment of multidrug-resistant tuberculosis (MDR-TB) remains challenging due to the toxicity of second-line medications and suboptimal treatment outcomes. This study aimed to determine the incidence of adverse events and identify factors associated with these events in patients undergoing treatment for MDR-TB with second-line all-oral drugs in Ghana. Methods: This retrospective cohort study reviewed the medical records of 384 MDR-TB patients treated with second-line all-oral drugs at selected health facilities in Ghana, including the Greater Accra Regional Hospital, Eastern Regional Hospital, and Kumasi South Hospital. Data were extracted using the Kobo Collect tool, capturing patient demographics, baseline clinical and laboratory characteristics, treatment regimens, and adverse events. The study period spanned from 2020 to August 2024. Results: The study included a total of 384 MDR-TB patients, with a mean age of 45 years (SD = 15). The majority of patients were male (65.78%), and most were within the 45-64 years age group (33.85%), followed by those aged 25-44 years (31.25%). Regionally, the highest number of cases were reported from the Greater Accra Region (39.06%), followed by the Eastern Region (31.25%) and Kumasi South Hospital (29.69%). Approximately one in four patients (25%) presented with comorbidities, with HIV being the most common (19.5%). The most frequently reported adverse events were diarrhea (14%), dizziness (13.7%), and vomiting (12.3%). Most of these were mild to moderate in severity and tended to decrease as treatment progressed. Severe adverse events, such as leukopenia and acute kidney injury, were rare, occurring in less than 5% of patients. Over the course of treatment, gastrointestinal adverse events such as vomiting and nausea showed a significant decline, indicating possible patient adaptation or improved clinical management. Results from the multivariate Poisson regression analysis revealed that age and comorbidities were significant predictors of adverse events. Patients aged 65 years and above had a 56% lower risk of developing adverse events compared to younger patients (Adjusted Risk Ratio [aRR] = 0.44, 95% CI: 0.25-0.79, p = 0.005). Conversely, patients with comorbid conditions such as diabetes or hypertension were approximately 2.6 times more likely to experience adverse events compared to those without comorbidities (aRR = 2.65, 95% CI: 1.58-4.43, p < 0.001). The effect of sex was not statistically significant after adjustment (aRR = 1.03, 95% CI: 0.70-1.50, p = 0.86). At the end of the treatment period, 74.9% of patients achieved successful outcomes, including both those who were cured and those who completed treatment without being classified as cured. However, 25.1% had unsuccessful outcomes, which included treatment failure, relapse, or death. Conclusion: In conclusion, adverse events are common in the treatment of MDR-TB with second-line All-Oral drugs, with gastrointestinal adverse events being the most prevalent. These findings highlight the importance of monitoring and managing adverse events to optimize treatment outcomes for MDR-TB patients in Ghana.

23.
arXiv (CS.AI) 2026-06-15

I'm Sorry Driver, I'm Afraid I Can't Do That: Appraising the Safety of LLMs within Automotive Contexts

arXiv:2606.14327v1 Announce Type: cross Abstract: This paper appraises recent frameworks within AI development to integrate LLMs into control tasks in automotive contexts from the perspective of safety assurance. This work has built upon the rapid integration of LLMs across automotive settings. However, we find that at present, these frameworks face significant challenges, limiting their efficacy in real-time safety-critical contexts. Firstly, we consider conceptual challenges, including the fact that deployers are faced with a dual challenge, wherein they must assure a model which has been developed upstream, i.e. as general-purpose tools by the large AI labs, in a downstream context, i.e. into specific vehicle architectures. Secondly, we consider concrete challenges from across existing standards. We show that there are currently both fundamental engineering constraints covered in ISO21448, such as latency, and novel LLM-specific issues, such as alignment-related issues covered in ISO/PAS8800. We ground both examples in a concrete introductory, experimental case study exploring an existing open-source repository, Talk2Drive. We present a safety argument in order to make explicit the limitations of existing solutions. Nonetheless, given that the use of LLMs in automotive contexts is being explored at a technical level and operationalised, we propose potential assurance mechanisms for LLM-related hazardous events going forward.

24.
medRxiv (Medicine) 2026-06-15

Unveiling the Awareness of Private Health Insurance Coverage among Healthcare Professionals in Freetown, Sierra Leone: Insights Extracted from Their Perspectives.

Our study is an assessment of the knowledge, personal coverage, and related determinants of private health insurance as revealed by healthcare professionals in Freetown, the urban capital of Sierra Leone. This study stands as a precursor for Low- and Middle-Income Countries (LMICs), like Sierra Leone, seeking to establish Universal Health Coverage (UHC) to provide healthcare access and coverage through publicly arranged risk pooling, designed to help protect against unmanageable medical costs. In parallel, such countries face significant challenges with achieving sustainable universal coverage due to limited public resources, inefficient allocation systems, uneasy reliance on out-of-pocket payments, and large struggling populations. Our research sheds particular light on how healthcare professionals view their own participation with private healthcare options. A cross-sectional, analytical study was conducted, openly recruiting individuals from various facilities in Freetown. Using the Yamane Formula, a sample size of 109 participants was calculated. STATA 14.0 was used for data analysis. Our findings revealed that 96 (88.9%) participants did not have private health insurance, while 12 (11.1%) did have private coverage. However, 105 (97.2%) reported other modes of health insurance, with only 3 (2.8%) uninsured. Notably, 97.2% expressed willingness to join a private health insurance scheme. Our study found no statistically significant associations between selected indicators (demographic or socioeconomic fac tors) and current insurance coverage among study participants. These results highlight a low prevalence and understanding of private health insurance among healthcare professionals in a representative urban center in Sub-Saharan Africa (SSA), while acknowledging high willingness to enroll. The lack of any significant determinants suggests other unexamined factors, such as cost, accessibility, or awareness, capable of influencing the adoption and implementation of a universal health program.

25.
medRxiv (Medicine) 2026-06-22

The Protective Role of Belonging and Socioeconomic Status in Dropout Intent Among Minority Ethnic Students: A Mixed Methods Study

Improving minority ethnic student retention is a global higher education priority. This mixed-methods study investigated how institutional belonging and socioeconomic status interact to shape dropout intentions among minority university students in the UK (N = 182). Quantitative results revealed that perceived course difficulty and lower subjective socioeconomic status were the strongest predictors of dropout intent. While the interaction between socioeconomic status and difficulty was non-significant, qualitative accounts showed distinct structural vulnerabilities. Financial strain restricted social integration, turning socioeconomic disparities into campus isolation. Conversely, representative curricula, diverse peer networks, and stable cultural in-groups (e.g., religious affiliations, living in the parental home) functioned as essential psychological buffers against academic exhaustion and alienation. Universities must shift from transactional models to sustained structural equity to protect vulnerable student groups.