A case of artificial intelligence-enhanced diagnostics leading to heart transplantation
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arXiv:2606.18209v1 Announce Type: new Abstract: Dataset distillation (DD) has emerged as a prominent approach in data centric machine learning, aiming to synthesize compact training sets for efficient training by compressing the information in large datasets into a small number of synthetic samples. However, DD methods are often evaluated under inconsistent evaluation protocols, ranging from standard ERM to single/multi-teacher supervision, making it difficult to isolate the effectiveness of distilled data from evaluation. Moreover, many prior methods claim that DD outperforms data pruning approaches such as coreset selection (CS), based on the assumption that restricting condensed datasets to subsets of real samples fundamentally limits their expressiveness. In this work, we critically evaluate DD methods through large-scale experiments using standardized datasets and evaluation protocols to assess their intrinsic effectiveness. We benchmark seven state-of-the-art (SOTA) DD methods on ImageNet-1K, ImageNet100, and ImageNette, using three widely adopted training protocols against three CS strategies. Our results show that while some DD methods fail to outperform even simple random subsets, the SOTA DD approaches are comparable to or worse than coresets on large-scale datasets and incur a substantially higher cost for construction. Beyond accuracy, we also evaluate the representativeness, diversity, and quality of condensed sets, and find that coresets consistently achieve better coverage of the original data distribution. These findings highlight the limited practical advantages of current DD methods and show that coresets remain competitive and are often a more computationally efficient alternative for data-centric learning.
Cultural garments pose a unique challenge for visual retrieval systems, as their identity often depends on subtle structural and symbolic details that are poorly captured by standard AI models. We introduce VietFashion, a new benchmark for sketch-text composed image retrieval centered on the Ao Dai, a traditional Vietnamese garment. VietFashion enables designers and researchers to retrieve culturally meaningful outfits using a combination of hand-drawn sketches, which convey garment structure, and textual descriptions, which encode cultural semantics. The dataset is initialized with 650 sketches and expanded using generative models to produce over 21,000 photorealistic images with aligned captions. Textual prompts that describe detailed outfit attributes, which are extracted from fashion magazines to ensure authenticity and diversity. To better reflect the inherent ambiguity of design intent, VietFashion adopts a multi-target retrieval setting, where a single query may correspond to multiple valid results. We establish standardized evaluation protocols and benchmark state-of-the-art composed image retrieval methods. Experimental results reveal significant performance gaps in modeling fine-grained cultural semantics and multi-modal composition, positioning VietFashion as a challenging benchmark for fine-grained fashion retrieval. The dataset is publicly available at: https://hng0303.github.io/VietFashion.
arXiv:2605.30920v2 Announce Type: replace Abstract: Diffusion-based neural solvers have shown strong promise for combinatorial optimization (CO), but existing methods typically rely on supervised training with large collections of near-optimal solutions. In this work, we extend adjoint-based trajectory optimization methods to discrete combinatorial domains. We formulate diffusion-based CO as a stochastic control problem over Continuous-Time Markov Chains and introduce discrete adjoint dynamics for propagating optimization signals through discrete generative trajectories. Building on this formulation, we propose Combinatorial Adjoint Matching (CAM), an unsupervised training framework for discrete diffusion solvers with structured and low-variance trajectory-level optimization signals. Empirically, CAM consistently outperforms existing unsupervised diffusion baselines and achieves performance competitive with strong supervised diffusion solvers and even traditional solvers across diverse combinatorial optimization problems. Our code is available at https://github.com/Shengyu-Feng/CAM.
Speculative decoding (SD) accelerates autoregressive Large Language Models (LLMs) by drafting multiple tokens and verifying them in parallel, but it faces a scaling limitation: increasing the draft budget improves speed only when acceptance remains high and drafting overhead stays low. This ceiling has been difficult to break because prior head-based SD methods face a causality-efficiency dilemma. Autoregressive drafters produce path-conditioned candidates that are effective for tree speculative decoding with higher acceptance length, but their drafting cost grows with tree depth. Bidirectional block-diffusion drafters generate all positions in one pass, but their branch-agnostic marginals can form individually plausible yet mutually inconsistent trees, wasting budget and reducing acceptance. We propose JetFlow, a head-based SD framework that combines one-forward drafting efficiency with branch-wise causal conditioning. JetFlow trains a causal parallel draft head over fused hidden states from the frozen target model, producing candidate trees whose scores align with the target model's autoregressive factorization. This enables JetFlow to convert larger draft budgets into longer accepted prefixes and higher end-to-end speedup. Across math, coding, and chat benchmarks on dense and MoE Qwen3 models, JetFlow consistently outperforms bidirectional-head and tree-based SD baselines. On H100 GPUs, JetFlow achieves up to 9.64x speedup on MATH-500 and 4.58x on open-ended conversational workloads, with further latency gains demonstrated through vLLM integration under realistic serving loads. Our code and models are available at https://github.com/hao-ai-lab/JetFlow.
Navigation foundation models trained on massive web-scale data enable agents to generalize across diverse environments and embodiments. However, these models, which are trained solely on offline data, often lack the capacity to reason about the consequences of their actions or adapt through counterfactual understanding. They thus face significant limitations in real-world urban navigation, where interactive and safe behaviors, such as avoiding obstacles and moving pedestrians, are critical. To tackle these challenges, we introduce the Seeing-to-Experiencing (S2E) learning framework to scale the capability of navigation foundation models with reinforcement learning. S2E combines the strengths of pretraining on offline videos and post-training through reinforcement learning. It maintains the model's generalizability acquired from large-scale real-world videos while enhancing its interactivity through reinforcement learning in simulation environments. Specifically, we introduce two innovations: (1) an Anchor-Guided Distribution Matching strategy for offline pretraining, which stabilizes learning and models diverse motion patterns through anchor-based supervision; and (2) a Residual-Attention Module for reinforcement learning, which obtains reactive behaviors from simulation environments without erasing the model's pretrained knowledge. Moreover, we establish a comprehensive end-to-end evaluation benchmark, NavBench-GS, built on photorealistic 3D Gaussian Splatting reconstructions of real-world scenes that incorporate physical interactions. It can systematically assess the generalizability and safety of navigation foundation models.
arXiv:2505.16120v3 Announce Type: replace Abstract: The emergence of Large Language Models (LLMs) has reshaped agent systems. Unlike traditional rule-based agents with limited task scope, LLM-powered agents offer greater flexibility, cross-domain reasoning, and natural language interaction. Moreover, with the integration of multi-modal LLMs, current agent systems are highly capable of processing diverse data modalities, including text, images, audio, and structured tabular data, enabling richer and more adaptive real-world behavior. This paper comprehensively examines the evolution of agent systems from the pre-LLM era to current LLM-powered architectures. We categorize agent systems into software-based, physical, and adaptive hybrid systems, highlighting applications across customer service, software development, manufacturing automation, personalized education, financial trading, and healthcare. We further discuss the primary challenges posed by LLM-powered agents, including high inference latency, output uncertainty, lack of evaluation metrics, and security vulnerabilities, and propose potential solutions to mitigate these concerns.
AudioLLMs enable speech recognition conditioned on textual prompts such as domain descriptions or entity lists. However, it remains unclear whether these models genuinely utilise such context or rely on parametric knowledge learned during pretraining. Existing benchmarks cannot answer this question because they evaluate transcription under fixed prompting conditions and rarely include explicit contextual inputs. We introduce IndicContextEval, a 56-hour multilingual benchmark of natural speech from 555 speakers across 8 Indian languages and 23 professional domains. We design a 7-level prompting framework that progressively introduces contextual signals, including metadata, natural-language descriptions, entity lists in English and native script, and adversarial prompts with incorrect entities. Evaluating five models reveals substantial differences in context utilisation behaviour, highlighting the need for explicit evaluation of contextual grounding in AudioLLMs.
Mamba-based models have emerged as a promising alternative for salient object detection (SOD), offering significant advantages in modeling long sequences. However, existing models often fail to explore contextual information and the depth of the entire architecture. This paper introduces U$^2$Mamba, a powerful and innovative U-structured network for salient object detection. We propose multiscale Mamba U-blocks (MMUBs) that enhance the model depth to improve local feature extraction capabilities. Our newly developed nested U-structure, incorporating MMUBs, enables the network to integrate various receptive fields from shallow and deep layers, thereby collecting richer contextual information and longer-range data without being constrained by resolution. Instead of using the traditional deep supervision scheme and top-level supervised training, we propose a hierarchical training supervision method where the loss is computed at each level during the training process. Extensive experiments demonstrate that U$^2$Mamba achieves highly competitive performance against state-of-the-art methods. The source code is available at \url{https://github.com/JL021/U2Mamba}.
arXiv:2606.16808v1 Announce Type: new Abstract: While Large Reasoning Models (LRMs) excel at complex tasks, they remain highly vulnerable to sophisticated jailbreaks and direct harmful queries. To address this vulnerability, prior works depend heavily on external manual data annotation for safety alignment. However, we observe that LRMs can inherently identify safety risks when being re-presented with original queries alongside their own reasoning trajectories – a capability we term Latent Safety Awareness. To leverage this safety awareness, we first employ Supervised Fine-Tuning (SFT) to explicitly induce safe tags to trigger safety analysis and guidance following the initial reasoning content for unsafe queries, while preserving standard responses for general queries to ensure adaptive triggering. Subsequently, we apply Direct Preference Optimization (DPO) to further enhance the correctness and stability of the safety analysis and guidance. Notably, responses required for both training stages are entirely generated by models being optimized. With (Safe Trigger) SFT and DPO, experimental results demonstrate significant safety enhancement. For example, the Attack Success Rate (ASR) of DeepSeek-R1-Distill-Llama-8B, on average, drops 24.65% and 36.72% on harmful and jailbreak benchmarks, respectively. Finally, our Safe Trigger method exerts almost no negative impact on general performance or user experience.
arXiv:2606.13692v1 Announce Type: cross Abstract: Data quality assessment is a critical prerequisite for effective data analytics and data-driven decision-making, yet it remains a challenging task due to the inherently context-dependent nature of data quality. Existing approaches often rely on static rules or manual assessment strategies, limiting their adaptability to diverse usage scenarios and constraining automation at scale. Recent advances in artificial intelligence, particularly large language models, offer new opportunities for automating data quality assessment, but raise concerns related to reliability, grounding, and execution safety. In this paper, we propose a unified agentic-retrieval framework for autonomous context-aware data quality assessment. The framework interprets natural-language descriptions of intended data usage, derives context-aware assessment strategies, and generates executable validation logic through a multi-agent workflow. To ensure operational reliability, the framework introduces a feasibility validation stage that evaluates the realism and executability of generated assessment specifications before execution, enabling iterative refinement when necessary. Accepted validation logic is executed deterministically to guarantee reproducible and auditable results. We implement the proposed framework as an end-to-end prototype and evaluate it across multiple usage scenarios applied to the same dataset. The results demonstrate that assessment outcomes adapt meaningfully to different intended uses, while feasibility-gated execution reduces unrealistic or non-executable rule generation. The proposed approach provides a practical foundation for deploying autonomous yet controlled data quality assessment in modern data-driven environments.
Large language models (LLMs) have become an effective tool for synthetic data generation, including for low-resource languages, where generated data can improve downstream task performance. Current best-performing approaches typically rely on few-shot prompting with target-language examples, which increases inference costs and may reduce diversity through lexical anchoring. In this work, we investigate activation steering as an alternative for low-resource synthetic data generation. We study two steering strategies: Language Steering, which targets the linguistic identity of a language, and Quality Steering, which captures well-formedness by contrasting human-written and backtranslated text representations. We evaluate these methods across four open-source LLMs, multiple layers, and 11 typologically diverse languages by generating sentiment and topic classification data and finetuning smaller classifiers. Steering is applied in both zero-shot and few-shot prompting settings and compared against non-steered counterparts. Our results show that steering on early layers consistently improves the diversity of generated data while often yielding stronger downstream model performance, particularly for low-resource languages.
arXiv:2606.12710v1 Announce Type: new Abstract: Diffusion models provide expressive data-driven priors for Bayesian inverse problems, but many diffusion posterior samplers rely on heuristic guidance approximations that can fail for nonlinear operators and multimodal posteriors. In this work, we develop a stabilized path-space framework for diffusion-based posterior sampling. Starting from a base diffusion process whose terminal marginal represents the prior, we define a likelihood-weighted target measure on trajectories and cast posterior sampling as learning a controlled stochastic process whose path measure matches this target. This formulation connects diffusion posterior sampling to stochastic optimal control while preserving the Bayesian structure needed for uncertainty quantification. We introduce a time reparameterization that makes the path-space control problem well posed by removing the bias induced by the unknown initial value function, without auxiliary training. We then learn the control via a trust-region path-space optimization method with log-variance objectives. The path-space perspective also unifies our learned control approach with existing guidance-based samplers, quantifies the sampling error induced by approximate controls, and yields importance sampling corrections for asymptotically exact posterior expectations. We evaluate the proposed framework on a suite of benchmark inverse problems with analytically characterized or high-quality reference posteriors, enabling principled assessment of sampling accuracy and uncertainty quantification. These experiments provide insight into the behavior of diffusion-based posterior samplers and demonstrate improved accuracy and robustness over leading approaches.
arXiv:2606.15702v1 Announce Type: cross Abstract: Modern deep learning optimization features heterogeneous parameter structures, noisy gradients, and highly nonconvex landscapes, posing significant challenges for both algorithm design and theoretical analysis. Motivated by the limitations of SGD and the success of adaptive optimizers, we propose {\it Schattor}, a family of adaptive first-order methods based on Schatten norms. Schattor unifies SGD and the recently proposed matrix-variate adaptive optimizer Muon within a single Schatten-norm-based framework. We establish dimension-free stationarity guarantees for methods in the Schattor family for stochastic matrix optimization problems via a novel matrix martingale moment bound. We also develop multi-block extensions that adaptively balance block-wise optimization progress and prove dimension-free stationarity guarantees in this more general setting.
End-to-end autonomous driving has achieved state-of-the-art performance on benchmarks and real-world deployments. Its standard training recipe, however, is expensive across all stages: collecting and labeling millions of driving frames is costly, and closed-loop RL on images is bottlenecked by the per-step cost of photorealistic rendering plus a forward pass through a large vision backbone. Self-play in vectorized simulators changes the economics: millions of rollout steps per second, and a state distribution naturally rich in collisions, near-misses, and recoveries that no driving log contains. Our approach exploits this asymmetry by decoupling learning to drive from learning to see. We pretrain a single policy by self-play, then align its latent space with a pretrained vision backbone, through the action KL divergence and a batch-relational low-rank structural loss. The action target comes from the self-play policy, so alignment never supervises against a logged trajectory: a paired dataset of (image, scene-state) frames suffices, with no need for the curated expert demonstrations that imitation pretraining is built on. On photorealistic 3D Gaussian splatting closed-loop scenarios, the resulting end-to-end policy matches or exceeds prior end-to-end methods.
Most existing approaches either fix the container in advance or optimize only a single container dimension through an outer search loop, leaving the remaining dimensions as a manual tuning problem. We present a differentiable packing framework that jointly optimizes all 6N object pose parameters and all three container side lengths inside a single gradient-based loop. The formulation combines six physics-inspired, differentiable loss terms computed directly on triangle meshes through axis-aligned bounding-box proxies. An adaptive squeezing mechanism periodically tightens the container whenever the overlap loss falls below a pair-count-scaled threshold, producing a large initial drop in container volume, followed by small refinements. All pairwise computations are written in tensor-broadcasting form, giving a 3.4 to 54 times speedup over a reference loop-based implementation. The pipeline is implemented in Python and PyTorch, with no physics engine, FFT library, or convex decomposition. On multiple object categories, the method produces containers that are 11 to 32 percent smaller than time-matched DBLF and simulated-annealing baselines at N =100, while running in under 4 minutes per instance on a single consumer GPU.
arXiv:2606.18923v1 Announce Type: new Abstract: Programmability is a missing first-class interface in fixed-tensor neural networks: editing a relation, freezing a subgraph, auditing a local function, or changing the execution backend should be an operation on the neural program rather than ad-hoc parameter surgery. GrapNet studies this graph-as-network setting. The graph is the architecture and executable program, not an input data graph. Each compute node owns its next-layer child references and a trainable allocation vector aligned with those references; deleting a relation physically removes both the child reference and the corresponding allocation coordinate. Structural rules and execution policies live outside the node core, so the same child-owned graph can be grown, frozen, structurally edited, grouped into trainable family blocks, routed by attention over active relations, or lowered to dense snapshots after topology stabilizes. GrapNet composes with conventional modules through a vector-valued parent interface: dense layers, CNN encoders, ResNet feature extractors, attention blocks, and transformer representations can all feed one sensory GrapNode per coordinate. The evaluation is organized as a programmability stress suite rather than as a new replay benchmark. In a matched ten-seed Split Fashion-MNIST study, a plastic GrapNet+ER head reaches 63.16 percent seen-class accuracy versus 51.08 percent for a parameter-larger dense MLP+ER under the same seen-class loss and replay memory, with paired delta 12.08 points and p=1.3e-5. On Split CIFAR-10 with a frozen ImageNet ResNet-18 encoder, the same substrate improves the online head over MLP-256 by 3.81 points, with p=0.0026. These results support GrapNet as an editable neural graph substrate whose core value is structural programmability with faithful execution views.
Wastewater genomic surveillance provides an opportunity to detect human and animal influenza A virus (IAV). We aimed to implement an IAV genomic surveillance framework agnostic to subtype, which enables recovery of IAV from multiple hosts and estimation of proportions across subtypes. We conducted IAV genomic surveillance in wastewater during the 2024-2025 flu season at multiple sites in California and compared these data with available human clinical IAV sequences and test positivity. We applied a custom whole-genome, multi-host IAV probe enrichment panel and adapted our custom expectation-maximization (EM) algorithm to deconvolute IAV mixtures in wastewater and infer subtype relative abundances. Absolute IAV concentrations were quantified using RT-PCR-based assays. H5N1 wastewater and clinical sequences were further characterized by constructing a whole-genome maximum-likelihood phylogenetic tree. Finally, we performed variant analysis to examine amino acid substitutions detected in wastewater. Our IAV probe enrichment method and EM algorithm successfully enriched all eight segments of three circulating IAV subtypes and accurately estimated subclade relative abundances for mixed IAV samples. Seasonal human H1N1pdm09 and H3N2 were detected throughout the study period from both wastewater and clinical sequencing data, with H1N1 subclades 6B.1A.5a.2a.1 and 6B.1A.5a.2a co-circulating, and H3N2 dominated by subclade 3C.2a1b.2a.2a.3a.1. Wastewater surveillance consistently detected H5N1 clade 2.3.4.4b across three monitored wastewater sites, while clinical H5N1 detections, from anywhere in CA, were sporadic and rare. Whole-genome phylogenetic analysis revealed that wastewater H5N1 sequences clustered with reference sequences associated with dairy cow and avian infections, while all human clinical H5N1 sequences clustered exclusively with reference sequences associated with dairy cow infections. Amino acid substitutions were identified across viral segments, and no mutations associated with mammalian adaptation were observed from wastewater samples.
arXiv:2606.11679v1 Announce Type: cross Abstract: The position operator plays a central role in condensed-matter observables such as velocity, orbital moment, and electric polarization. In solid-state physics, the evaluation of operators incorporating the position operator has not reached a consensus, as observed in the operator-level discrepancy between the local circulation of Wannier functions and the self-rotation of wave packets. Here, to achieve a consistent evaluation of such operators, we propose three rules for evaluating operators involving the position operator in the Bloch representation. The rules are devised to satisfy physical conditions: independence from the choice of unit cell, preservation of Hermitian conjugacy for the product of operators, and recovery of the correct intraband velocity. We further address the gauge dependence of the position operator and introduce a scheme termed gauge filtration, which systematically removes gauge-dependent contributions from the operators containing the position operator. This methodology ensures that the quantities obtained from the operator evaluation correspond to observable physical phenomena. By applying our framework, we reconcile the results concerning the self-rotation of the wave packet and the local circulation of the Wannier function. We expect our proposal to establish a consistent framework for evaluating operators involving the position operator.
Large language models (LLMs) have shown impressive capabilities across diverse tasks, yet their performance on jurisdiction-specific legal reasoning remains underexplored. We present TW-LegalBench that utilizes Taiwanese legal system's rich official corpus open to the public to fill the gap in evaluating LLMs on Taiwanese law, among common-law benchmarks that focus on English sources and civil-law benchmarks focusing on sources of Simplified Chinese. TW-LegalBench comprises three task types: (1) over 16,000 multiple-choice questions (MCQs) across five years of official examinations in 18 professional domains; (2) 117 open-ended essay questions (OEQs) from examinations for legal professionals with official scoring rubrics; and (3) more than 14,000 legal judgment prediction (LJP) instances covering hundreds of crime categories. We evaluate 13 LLMs using accuracy for MCQs, a decomposed LLM-as-Judge framework based on the scoring rubric points for OEQs, and metrics for sentencing accuracy and statute citation for LJP. Our results reveal that top-performing models exceed the passing threshold for qualified lawyers (passing rate: 11%) but fall short of that for judges and prosecutors (passing rate: 1~2%). For LJP, while models demonstrate reasonable verdict type accuracy and sentence prediction capability, they struggle to cite exact legal articles. These findings highlight that reliable legal text generation remains challenging for LLMs, even though their performance on qualification examinations approaches human level.
arXiv:2606.19998v1 Announce Type: cross Abstract: Vision-Language-Action (VLA) models are increasingly deployed across diverse tasks, yet they remain black boxes whose physical interactions can cause irreversible harm, making generalizable and interpretable failure detection essential. We observe that successful and failed rollouts carry systematically different information-theoretic signatures. Building on this, we formalize VLA control as a closed-loop information pipeline and derive the Triple Information-theoretic (Tri-Info) signals that capture whether actions remain diverse, temporally consistent, and coupled to state transitions. Across six VLA models and three benchmark environments, Tri-Info matches the strongest baselines in-domain. Moreover, Tri-Info transfers across architectures, environments, and the sim-to-real gap without retraining, reaching 83\% accuracy on real-world tasks where prior detectors collapse to chance. This establishes Tri-Info as a simple yet powerful method that not only detects failures with strong cross-domain generalization, but also delivers interpretable diagnostics of the underlying failure modes.
arXiv:2505.04289v4 Announce Type: replace Abstract: Benthic algae as a primary producer in riverine ecosystems develop biofilms on the riverbed. Their population dynamics involve growth and decay processes, the former owing to the balance between biological proliferation and mortality, while the latter to mechanical abrasion because of the transport of sediment particles. Contrary to the assumptions of previous studies, the decay has experimentally been found to exhibit long-memory behavior, where the population decreases at an algebraic rate. However, the origin and mathematical theory of this phenomenon remain unresolved. The objective of this study is to introduce a novel mathematical model employing spin processes to describe microscopic biofilm dynamics. A spin process is a continuous-time jump process transitioning between states 0 and 1, and the continuum limit of these processes captures the long-memory decay and generates generic growth. The proposed framework leverages heterogeneous spin rates, achieved by appropriately superposing spin processes with distinct rates, to reproduce the long-memory decay. Computational simulations demonstrate the behavior of the model, particularly emphasizing rate-induced tipping phenomena. This mathematical model provides a computationally tractable interpretation of benthic algae dynamics and their long-term prediction, relevant to river-engineering applications.
Climate-induced permafrost thaw unlocks large stores of organic carbon that are mineralized and emitted as carbon dioxide (CO2) from rivers to the atmosphere1. Concurrently, warming and permafrost thaw can increase mineral weathering rates, thus affecting the release and sequestration of inorganic carbon2–4. Yet how these biological and geological carbon cycles interact and jointly affect CO2 dynamics (emission compared with drawdown) in permafrost rivers remains unknown5. Here we combine CO2 emissions, organic and inorganic solute concentrations, dual carbon isotopes (δ13C–Δ14C) and geochemical modelling to infer how permafrost thaw may affect river biogeochemistry over decades to centuries across the Qinghai–Tibet Plateau. Leveraging a gradient of thermal permafrost degradation, we find that river CO2 emissions decline, whereas solute fluxes from rock weathering increase with decreasing permafrost cover. Across this region, net CO2 drawdown fluxes from rock weathering are about 35% of river CO2 emissions, varying from around 15% in catchments with continuous permafrost to more than 100% in catchments with discontinuous or isolated permafrost. Thus, carbon fluxes from chemical weathering may become increasingly important with ongoing permafrost thaw, potentially even outpacing river CO2 emissions. Our findings disentangle the interplay between biological and geological carbon fluxes that are important for the cryosphere and the global carbon cycle. Permafrost thaw on the Qinghai–Tibet Plateau increases rock-weathering rates while reducing river CO2 emissions, suggesting geological carbon fluxes may eventually outpace thaw-driven emissions.
arXiv:2606.12320v1 Announce Type: new Abstract: Enterprise security was built to govern data boundaries: the protected surface was data at rest and in transit, and the controls – access control, data-loss prevention, perimeter inspection – governed crossings of that boundary. Production AI agents dissolve this assumption. An agent reads context, calls tools, invokes connectors, and modifies systems of record on an enterprise's behalf, so risk moves inside the workflow, into sequences of individually-permitted actions that may transform a business process no one authorized. Existing policy engines do not extend to this regime: they evaluate request-time decisions against atomic principals, where agentic systems require stateful evaluation against composite principals whose authority attenuates through delegation chains. We present a reference architecture for the runtime governance of production agents, built from four composable primitives: a five-plane decomposition (a reasoning plane that adjudicates intent, and four enforcement planes – network, identity, endpoint, data – that realize the decision), stop-anywhere mediation, composite principals with capability attenuation, and audit as a structured evidence substrate. We define a taxonomy of six interruption primitives that generalize allow and deny, state and argue for four correctness invariants, and demonstrate the foreclosure of seven production-agent threats across five concrete workflows. A reference implementation of the policy-engine core supplies measured evidence: attenuation correctness and evidence reconstructability hold on every trial, adjudication runs in single-digit microseconds, and the audit substrate's tamper-evidence behaves exactly as designed. We are explicit about scope: the architecture governs delegated action, not model behavior, and a full-system evaluation against a live agent benchmark is the invited next step.
Background Annually, nearly 2 million hip, knee, and spinal inpatient surgeries are performed in Canada and the US for osteoarthritis (OA), costing over $37 billion in hospital expenditures. However, 15-30% of patients experience limited or no improvement, resulting in poor value for money. This study evaluated the one-year cost-utility of joint and spine procedures for OA by comparing non-responders to responders, considering various responder definitions. Methods Individual micro-costing data were collected for 1,175 elective hip, knee, and spine patients enrolled in the Longitudinal Evaluation in the Arthritis Program - Osteoarthritis (LEAP-OA) between 2014 and 2018. Quality-adjusted life years (QALYs) were derived using the SF-6D utility index. One-year incremental cost-utility ratios (ICURs) were calculated from the hospital perspective. Results Responder rates varied by definition, ranging from 78%-94% for hip replacements, 64%-90% for knee replacements, 60%-64% for spine fusions, and 50%-68% for spine decompressions. Corresponding ICURs were: $45,956-$51,773/QALY for responders versus $108,593-$485,762/QALY for non-responders for hip replacements; $54,831-$71,151/QALY for responders versus $200,486-$1,203,596/QALY for non-responders for knee replacements; $65,980-$74,422/QALY for responders versus $262,039-$729,686/QALY for non-responders for spine fusions; and $29,947-$42,168/QALY for responders versus $63,195-$662,586/QALY for non-responders for spine decompressions. Conclusions While surgical response rates were highly dependent on the responder definition, ICURs for non-responders were significantly higher than those for responders across all definitions. Beyond the negative impact on patients, there is a compelling economic argument for investment in improved pre-operative identification of patients at risk of surgical non-response. Such efforts could enable more personalized, value-based care pathways and reduce the provision of low-value surgical interventions.