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01.
arXiv (CS.AI) 2026-06-24

Skills for the future software profession: beyond agentic AI!

arXiv:2606.21894v2 Announce Type: replace-cross Abstract: As coding agents are rapidly changing software engineering, a natural question is: what are the core skills needed by future software engineers? To identify where software engineering is headed and thus what skills will be needed, we summarize the results of two round-tables with researchers and industrial practitioners, held in 2026 in New York and Singapore. One key finding is that verification and validation is increasing in importance as agents handle implementation, as highlighted by anecdotes from the events. From our observations, we identify the skills developers need in the agentic era of development, with implications for training and educating future software engineers in coming years.

04.
arXiv (quant-ph) 2026-06-16

Non-Gaussian Phase Transition and Cascade of Instabilities in the Dissipative Quantum Rabi Model

arXiv:2507.07092v3 Announce Type: replace Abstract: The open quantum Rabi model describes a two-level system coupled to a harmonic oscillator. A Gaussian phase transition for the nonequilibrium steady states has been predicted when the bosonic mode is soft and subject to damping. We show that oscillator dephasing is a relevant perturbation, which leads to a non-Gaussian phase transition and an intriguing cascade of instabilities for $k$-th order bosonic operators, as well as a jump in the steady-state qubit polarization. For the soft-mode limit, the equations of motion form a closed hierarchy and spectral properties can be efficiently studied. To this purpose, we establish a fruitful connection to non-Hermitian Hamiltonians. The results for the phase diagram, stability boundaries, and relevant observables are based on mean-field analysis, exact diagonalization, perturbation theory, and Keldysh field theory.

05.
arXiv (CS.AI) 2026-06-24

DeepBD: A Grounded Agentic Workflow for Variant Prioritization and Diagnosis of Genetic Birth Defects

arXiv:2606.24779v1 Announce Type: cross Abstract: Birth defects are a major cause of fetal loss, neonatal morbidity and long-term disability. In the subset with suspected genetic etiologies, exome and genome sequencing have moved many cases from variant detection to post-sequencing interpretation: clinicians must rank patient-specific candidate variants under incomplete fetal or infant phenotypes and heterogeneous evidence from population genetics, variant-effect prediction, gene-disease validity, phenotype ontologies, cellular and pathway context, protein structure and clinical literature. We present DeepBD, a grounded agentic workflow for variant prioritization and diagnostic interpretation of genetic birth defects. DeepBD organizes the workflow into LLM-assisted case structuring, a pretrained evidence engine, specialist evidence modules and a grounded diagnostic review layer. The evidence engine learns patient-specific variant scores from structured rule evidence, sequence and variant-effect representations and phenotype-conditioned biological context, whereas specialist modules and the agentic layer provide tool-based refinement, candidate-pool review and diagnosis-oriented synthesis from ranked candidates. Developed using an in-house fetal and infant cohort comprising 18,622 cases, DeepBD achieved Recall@1/3/5/10 of 0.658/0.882/0.912/0.929 on an internal held-out solved-case benchmark, outperforming standalone Exomiser, DeepRare and prompted LLM reranking baselines evaluated on Exomiser-derived top-20 candidate variants. Ablation and overlap analyses show that rule evidence, mechanistic context, and specialist refinement provide complementary signals. These findings support a grounded agentic workflow that separates evidence integration, tool-based refinement, and LLM-assisted diagnostic review for retrospective variant prioritization in genetic birth defects.

06.
Nature (Science) 2026-06-22

Why heritage sites are at risk in a warming world — and how to save them

As rising seas and intensifying disasters threaten historic sites worldwide, new ways to understand, preserve and adapt these places are needed urgently. As rising seas and intensifying disasters threaten historic sites worldwide, new ways to understand, preserve and adapt these places are needed urgently.

07.
medRxiv (Medicine) 2026-06-15

Long-read sequencing enables high-accuracy mitochondrial heteroplasmy detection in Parkinson's disease

Background: Low-frequency heteroplasmic mitochondrial DNA (mtDNA) variants are associated with aging and neurological diseases, including Parkinson's disease (PD). Targeted deep mtDNA sequencing using PacBio HiFi long reads has the potential to resolve heteroplasmy across the full mitochondrial genome with high accuracy. Methods: To validate Vega PacBio sequencing for detecting mtDNA heteroplasmy, we analyzed four predefined mixtures of two mtDNA haplotypes. We generated a single long-range PCR amplicon covering the entire mitochondrial genome. These amplicons were mixed at predefined ratios (minor mixture haplotype component: 5%, 2%, 1%, and 0.1%). Variant calling was performed using Mutserve2, and accuracy was assessed by calculating the F1 score from comparisons between expected and detected variants. Full-length mtDNA PacBio sequencing was applied to investigate heteroplasmy across fibroblast passages derived from five LRRK2 p.Gly2019Ser variant carriers (n=3 affected with PD and n=2 unaffected carriers). Changes in mtDNA heteroplasmy level and variant load were assessed longitudinally using a linear mixed model. Results: The single-amplicon approach enabled full-length haplotype resolution without amplification bias associated with overlapping PCR strategies. The F1 score of the predefined mixtures was 1.0 for heteroplasmy levels between 5% and 1% and remained high (0.91) at 0.1%. We detected n=10/62 variants discordant with the Illumina reference at the 0.1% mixture, but sensitivity remained very high at 1.00 in that mixture. Detected minor variants closely matched expected heteroplasmy levels, with average variant levels of 0.057 (5%), 0.022 (2%), 0.011 (1%), and 0.001 (0.1%). Across twelve fibroblast passages, we observed fewer mtDNA heteroplasmic variants ({beta}=-3.2, p=0.026). Increased heteroplasmic variant load over time was also associated with older age ({beta}=1.50, p=0.001) and PD affection status ({beta}=5.0, p=1.0 x 10-4) in LRRK2 variant carriers. Notably, we observed distinct patterns of heteroplasmic variants that either increased or decreased in heteroplasmy level across passages. Conclusion: PacBio HiFi sequencing, combined with a single-amplicon strategy, enables accurate full-length mtDNA heteroplasmy detection and longitudinal analysis, providing a valuable tool for studying mitochondrial variation and dynamics in disease.

09.
arXiv (CS.LG) 2026-06-16

The Machine Learning Approach to Moment Closure Relations for Plasma: A Review

arXiv:2511.22486v3 Announce Type: replace-cross Abstract: The requirement for large-scale global simulations of plasma is an ongoing challenge in both space and laboratory plasma physics. Any simulation based on a fluid model inherently requires a closure relation for the high order plasma moments. This review compiles and analyses the recent surge of machine learning approaches developing improved plasma closure models capable of capturing kinetic phenomena within plasma fluid models. We survey two methodological families: neural-network surrogates (from multilayer perceptrons to Fourier neural operators, the latter recently reproducing both linear and non-linear Landau damping online within a fluid solver) and equation-discovery methods such as sparse regression; and organise the studies by whether they are tested offline against reference data or online within a time-evolving solver. We outline the challenges associated with machine-learning closures, including off-diagonal pressure-tensor accuracy, generalisation beyond the training distribution, and stable integration into large-scale simulations, and the directions future research might take to address them.

10.
arXiv (CS.LG) 2026-06-17

A Diffusion Approximation for Temporal-Difference Learning with Linear Features under Markovian Noise

arXiv:2606.18183v1 Announce Type: cross Abstract: Temporal difference (TD) learning with linear function approximation is a core method for policy evaluation. Its classical continuous-time description is an ordinary differential equation (ODE), which captures the asymptotic mean dynamics but neglects stochastic fluctuations determining the error floor. We introduce a stochastic differential equation (SDE) approximation for linear TD(0) under Markovian noise. The resulting model distinguishes the contraction dynamics governed by the projected Bellman operator from the influence of Markovian sampling. As a consequence, the model explains the constant-stepsize error floor through the interaction between Markovian long-run covariance and the contraction geometry of the projected Bellman operator.

11.
arXiv (CS.CL) 2026-06-12

AI SciBrief as a Gateway to Research: A Framework for Onboarding Students into New Research Areas

Students at all levels of higher education face a significant barrier in the form of information overload, which often paralyzes the initial stages of the research process and suppresses motivation. In response, this article introduces a pedagogical framework that leverages AI SciBrief, a platform powered by a Large Language Model (LLM) designed to automatically generate digests of scientific trends. We describe how this multidisciplinary tool - with initial coverage in finance, medicine, and education - can be integrated into the curriculum to overcome this "entry barrier." The framework provides concrete methodologies for utilizing these digests to facilitate topic selection for term papers, accelerate literature reviews for dissertations, and enable postgraduate students to continuously monitor emerging trends. We conclude that AI SciBrief functions as a "gateway to research" effectively reducing students' cognitive load and empowering them to transition more rapidly from information searching to knowledge creation.

12.
arXiv (CS.AI) 2026-06-11

Graph2Idea:Retrieval-Augmented Scientific Idea Generation with Graph-Structured Contexts

arXiv:2606.09105v3 Announce Type: replace Abstract: Generating novel, feasible, and high-quality research ideas is an important yet challenging task in scientific discovery. Recent Large Language Model (LLM)-based methods often ground idea generation with retrieved literature, but the retrieved evidence is usually provided as flat text, such as titles, abstracts, or summaries. Such flat contexts may contain redundant or weakly relevant information, while making cross-paper relations among problems, methods, mechanisms, and findings difficult to identify and trace. To address this challenge, we propose Graph2Idea, a knowledge graph-guided framework for retrieval-augmented scientific idea generation.Graph2Idea first retrieves papers according to the input topic, transforms them into structured knowledge triples, and dynamically constructs a target-centered knowledge graph to make literature relations explicit. It then extracts compact graph-derived contexts that retain target-relevant relational evidence while reducing noisy textual input. Based on these contexts, a two-stage generation process first identifies promising research directions and then guides the LLM to synthesize candidate ideas from graph-grounded evidence. Experiments on a scientific idea generation benchmark show that Graph2Idea outperforms representative baselines under the automatic evaluation protocol. Compared with the strongest baseline scores, it improves Novelty from 0.45 to 0.52, Quality from 0.24 to 0.29, and Feasibility from 0.22 to 0.28. These results suggest that graph-structured evidence helps LLMs generate research ideas through more explicit, compact, and traceable recombination of prior scientific knowledge.

13.
arXiv (CS.CV) 2026-06-11

Weakly Supervised Segmentation as Semantic-Based Regularization

Weakly supervised semantic segmentation (WSSS) trains dense pixel-level segmentation models from partial or coarse annotations such as bounding boxes, scribbles, or image-level tags. While recent work leverages foundation models such as the Segment Anything Model (SAM) to generate pseudo-labels, these approaches typically depend on heuristic prompt choices and offer limited ways to incorporate prior knowledge or heterogeneous labels. We address this gap by taking a neurosymbolic perspective: integrating differentiable fuzzy logic with deep segmentation models. Weak annotations and domain-specific priors are unified as continuous logical constraints that fine-tune SAM under weak supervision. The refined foundation model then produces improved pseudo-labels, from which we train a second-stage prompt-free segmentation model. Experiments on Pascal VOC 2012 and the REFUGE2 optic disc/cup segmentation dataset show that our logic-guided fine-tuning yields higher-quality pseudo-labels, leading to state-of-the-art segmentation accuracy that often exceeds densely supervised baselines.

14.
arXiv (CS.CL) 2026-06-19

Med-R2: Perception and Reflection-driven Complex Reasoning for Medical Report Generation

Automated medical report generation (MRG) is increasingly used to reduce the burden of manual reporting and for decision support. Large vision-language models (LVLMs) hold great promise for automated MRG due to their fine-grained image-text alignment and advanced text-generation capabilities. Currently, state-of-the-art MRGs primarily focus on adapting pre-trained LVLMs with direct supervised fine-tuning (SFT), a fine-tuning strategy with medical image-report pairs. However, several factors limit the performance of these LVLMs. Firstly, direct SFT enables LVLMs to generate medical reports directly without an intermediate thinking process of pathological feature perception and diagnostic reasoning. This causes a potential failure to perceive pathological features and thus leads to misdiagnosis. Secondly, direct SFT lacks the incorporation of radiology-specific knowledge guidance, causing LVLMs to misinterpret perceived pathological features and make incorrect diagnoses. To address these gaps, we propose a novel fine-tuning strategy named Med-R2. We introduce a perception-driven long reasoning process that precedes report generation and incorporates radiology-specific knowledge as guidance. Additionally, to alleviate potential perceptual errors in complex reasoning, a reflection mechanism is introduced to refine the perception of pathological features and the generated report. Our experiments demonstrate that Med-R2 effectively enhances the capability of pathological features perception and diagnosis accuracy for MRG via fine-tuned LVLMs.

15.
arXiv (CS.AI) 2026-06-24

Listening makes Vision Clear for VLMs

arXiv:2606.23763v1 Announce Type: cross Abstract: Recent work typically assesses vision–language consistency using attention distributions of answer-side tokens. However, we observe that highest attention regions are not always consistent with the intended semantic token. This probably stems from decoding drift, where language priors from previously generated answer tokens accumulate and mismatch with visual attention. Besides the priors from previous answer tokens, we find that structural tokens, e.g., modality boundary markers, may encompass the entire context and generate high attention to areas unrelated to the target. To avoid these distortions and provide consistency evaluation for large VLMs, we adopt prompt-side semantics and propose Prompt-Vision Token Activation Map (PV-TAM). PV-TAM further incorporates a filter to remove systematic bias induced by modality boundary markers. Unlike traditional methods that evaluate overlap solely through masks while ignoring activation intensity, our metrics leverage the peak distribution of attention to measure the alignment between prompts and visual regions. In experiments, PV-TAM consistently improves both attention-based and IoU-style localization metrics over answer-side baselines on various datasets.

16.
arXiv (quant-ph) 2026-06-11

Measurement incompatibility and quantum steering via linear programming

arXiv:2506.03045v3 Announce Type: replace Abstract: The problem of deciding whether a set of quantum measurements is jointly measurable is known to be equivalent to determining whether a quantum assemblage is unsteerable. This problem can be formulated as a semidefinite program (SDP). However, the number of variables and constraints in such a formulation grows exponentially with the number of measurements, rendering it intractable for large measurement sets. In this work, we circumvent this problem by transforming the SDP into a hierarchy of linear programs that compute upper and lower bounds on the incompatibility robustness with a complexity that grows polynomially in the number of measurements. The hierarchy is guaranteed to converge and it can be applied to arbitrary measurements – including non-projective POVMs (Positive Operator-Valued Measures) – in arbitrary dimensions. While convergence becomes impractical in high dimensions, in the case of qubits our method reliably provides accurate upper and lower bounds for the incompatibility robustness of sets with several hundred measurements in a short time using a standard laptop. We also apply our methods to qutrits, obtaining non-trivial upper and lower bounds in scenarios that are otherwise intractable using the standard SDP approach, although such bounds are significantly looser than the ones obtained in the qubit case. Finally, we show how our methods can be used to construct local hidden state models for states (i.e., to prove that a state cannot lead to steering under any possible local measurements), or conversely, to certify that a given state exhibits steering; for two-qubit quantum states, our approach is comparable to, and in some cases outperforms, the current best methods.

17.
arXiv (quant-ph) 2026-06-15

Quasilinear Equivalence Checking for Detector Error Models

arXiv:2606.14677v1 Announce Type: new Abstract: A Detector Error Model (DEM) is a structured representation of error mechanisms in quantum circuits, which has gained popularity in quantum compilation pipelines for its ability to capture fault-tolerance at a circuit level. It lists error mechanisms as instructions targeting detectors and observables, specifying for each physical fault channel the probability that the fault fires, the detectors it triggers, and the observables it flips. In this paper, we develop an equational theory for DEMs, with its associated categorical semantics. We present a sound, terminating, confluent rewriting system for DEM terms, formulating it as a symmetric monoidal theory (a PROP) over the Giry monad. We prove that every DEM term has a unique normal form, which can be computed efficiently in quasilinear time $O(k|E|\log|E|)$, where $|E|$ is the number of instructions and $k$ bounds the size of a target set. This provides a complete set of invariants (via Tanner graphs) for structural DEM equivalence. We provide the first static decision procedure for DEM equivalence, with rigorous correctness guarantees. It is complete (decides full decoder-equivalence exactly) for non-adaptive quantum error correction (QEC) pipelines, and scales to a sound and applicable decision procedure for partially-adaptive circuits (lattice surgery, distributed QEC, ...) without suffering exponential overhead. We discuss its application to the verification and optimisation of quantum compilers.

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

Towards Physically Realizable Adversarial Attenuation Patch against SAR Object Detection

Deep neural networks have demonstrated excellent performance in SAR target detection tasks but remain susceptible to adversarial attacks. Existing SAR-specific attack methods can effectively deceive detectors; however, they often introduce noticeable perturbations and are largely confined to digital domain, neglecting physical implementation constrains for attacking SAR systems. In this paper, a novel Adversarial Attenuation Patch (AAP) method is proposed that employs energy-constrained optimization strategy coupled with an attenuation-based deployment framework to achieve a seamless balance between attack effectiveness and stealthiness. More importantly, AAP exhibits strong potential for physical realization by aligning with signal-level electronic jamming mechanisms. Experimental results show that AAP effectively degrades detection performance while preserving high imperceptibility, and shows favorable transferability across different models. This study provides a physical grounded perspective for adversarial attacks on SAR target detection systems and facilitates the design of more covert and practically deployable attack strategies. The source code is made available at https://github.com/boremycin/SAAP.

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

From Agent Traces to Trust: A Survey of Evidence Tracing and Execution Provenance in LLM Agents

arXiv:2606.04990v2 Announce Type: replace-cross Abstract: Large language model (LLM)-based agents are evolving from passive text generators into autonomous systems capable of planning, tool use, retrieval, memory access, environmental interaction, and multi-agent collaboration. These capabilities expand agent autonomy, but also make agent behavior harder to verify, debug, and audit. Final-answer accuracy alone cannot explain how an output was produced, which evidence supported each claim, whether tool calls were justified, how memory influenced later decisions, or where failures originated. This survey examines evidence tracing and execution provenance as foundations for process-level accountability in trustworthy LLM agents. We define execution provenance as the typed graph of an agent execution and evidence tracing as its projection onto evidence-support relations. This perspective connects retrieval grounding, claim support, tool-use safety, memory lineage, observability, debugging, audit, and recovery within a unified framework. We introduce a taxonomy covering trace sources, evidence and execution units, provenance relations, tracing granularity and timing, representation forms, and trust functions. We then review key methodological directions, including provenance representation, evidence attribution, tool-use provenance, runtime guardrails, provenance-bearing memory, observability, and failure diagnosis. Finally, we discuss benchmarks, datasets, metrics, and open challenges for building provenance-aware, auditable, and recoverable agent systems.

20.
arXiv (CS.AI) 2026-06-16

Synthetic Counteradaptation: A Principle of Human-AI Co-evolution

arXiv:2606.15503v1 Announce Type: new Abstract: In this paper, we introduce the concept of synthetic counteradaptation, a process where human and AI systems co-evolve by adapting to each other's strategies and behaviors. Synthetic counteradaptation occurs when AI systems develop novel strategies or social protocols, prompting humans to extract insights and adapt their own behaviors in response, leading to the emergence of new agent interaction dynamics. To illustrate these dynamics, we analyze examples from various contexts, including the game of Go, mixed-motive social interactions, and geopolitical simulations. By exploring these cases, we demonstrate how synthetic counteradaptation provides a framework for understanding the recursive and co-evolutionary nature of human-AI interactions in multi-agent environments.

21.
arXiv (CS.CV) 2026-06-15

Instruct-Particulate: Scaling Feed-Forward 3D Object Articulation with Kinematic Control

Reconstructing articulated 3D objects is important for animation, gaming, and robotic simulations. Recent neural networks can estimate the articulated structure of 3D objects, but their generalization remains limited by the scarcity of annotated data for this task. To address this gap, we introduce Instruct-Particulate, a model that takes a 3D mesh together with a target kinematic specification, including part descriptions, connectivity, joint types, and optional point prompts, and predicts the corresponding kinematic part segmentation and joint motion parameters. The kinematic specification disambiguates the task and allows the model to target annotations of different granularity, thereby making it possible to use more abundant heterogeneous training data. At test time, the kinematic specification can be obtained automatically from large-scale vision-language models, so the model can be applied to any input mesh. To train our model at scale, we construct a heterogeneous dataset of more than 150,000 articulated 3D objects, extending existing publicly available collections with data obtained by partially labelling other 3D models (monolithic or already decomposed into parts) with kinematic labels by means of vision-language models. Experiments show that our model generalizes better across categories and to AI-generated meshes, enabling articulated asset reconstruction from real-world images via image-to-3D models.

22.
arXiv (CS.AI) 2026-06-15

Dense Coordinate-List Fine-Tuning Induces a Controllable Interference Surface in Vision-Language Models

arXiv:2606.14507v1 Announce Type: new Abstract: Fine-tuning vision-language models to emit dense coordinate lists improves visual grounding but also changes how models serialize, repeat, and terminate structured outputs. We study this behavior as a generation and control surface. In Gemma 4 12B, high-capacity q/k/v/o LoRA raises class-aware F1@0.3 from 0.007 to 0.448 while inducing repeated-tail pressure (duplicate rate 0.080, max repeat 23). A q/v rank sweep keeps max repeat at 21-22 across ranks 4-64, showing capacity persistence. The target signal is separable: object-level repeat-stop removes exact repeated records (duplicate rate 0.000, max repeat 1) while preserving F1 (0.494 to 0.490) and stricter F1@0.5 (0.381 to 0.385). Structure-axis probes localize the effect to bbox-coordinate object lists; dense non-bbox and spatial/count JSON remain repeat-clean, including under high-capacity adapters. Qwen3-VL-8B reproduces a clean controlled endpoint (F1@0.3 0.318, duplicate rate 0.000), and COCO 2017 reproduces acquisition plus duplicate pressure. Dense coordinate-list adaptation therefore creates a structure-bound, cross-family interference surface that can be measured and controlled.

23.
bioRxiv (Bioinfo) 2026-06-12

Computational Design of Optimal Sequences for Targeted Hypermutagenesis Using Recombination-Coupled Diversity-Generating Retroelements

Diversity-generating retroelements (DGRs) are natural systems that accelerate evolution via targeted hypermutation at adenines. We previously developed DGRec, a system combining DGRs and recombineering for programmable mutagenesis in Escherichia coli. We here address two important issues with DGRec: the dependence of mutagenesis efficiency on the dgrRNA secondary structure and the variability of the reverse-transcription biases with sequence context and position. First, we introduce and validate a method to recode non-functional templates, i.e. with low mutagenesis efficiency, into highly functional ones through synonymous mutations. Second, we develop a Long Short-Term Memory (LSTM) model to predict DGRec mutational profiles for any given template sequence. By integrating this LSTM model with our recoding method, we establish a comprehensive workflow for customized directed evolution, enabling researchers to precisely fine-tune DGRec in vivo mutagenesis to their engineering needs.

24.
bioRxiv (Bioinfo) 2026-06-19

SteerAF: Distogram-based Steering of AlphaFold2 toward Alternative Conformations

End-to-end structure predictors, such as AlphaFold2, typically output only the dominant conformational state of a given protein, which is biased by the training data set. Existing strategies for recovering alternative conformations are often computationally expensive and offer limited biological interpretability. Here, we present SteerAF, an inference-time optimization framework based on AlphaFold2 that leverages information encoded in the distogram derived from deep multiple sequence alignments (MSAs) to predict alternative protein conformations. Across four benchmark datasets, SteerAF matches or surpasses existing methods in predicting alternative conformations for the majority of systems. Sparse MSA-feature modifications generated via block gradient ascent exhibit a strong correlation with experimentally characterized functional residues, recovering them with approximately 50% precision in the tested proteins. Furthermore, SteerAF enables effective decoy selection in the absence of experimental structures, and its predictions can serve as seed structures for molecular dynamics simulations to map conformational landscapes. Thus, SteerAF provides an efficient and interpretable approach for predicting alternative conformations, offering a framework that can be extended to other similar predictors and problems.

25.
Nature (Science) 2026-06-17

Towards autonomous medical artificial intelligence agents

Authors:

Large language models (LLMs) show great potential for clinical decision-making, yet most applications remain narrow, task-specific chat tools rather than systems integrated into clinical workflows1,2. However, building physician copilots will require models that operate within the electronic health record (EHR), with governed access to patient data and the ability to initiate permitted EHR actions within defined safety constraints. Yet it remains unproven whether such a system can manage patient cases with physician-level performance. Here we show that MIRA (Medical Intelligence for Reasoning and Action), an autonomous artificial intelligence agent operating in a sandboxed EHR environment, can navigate a large clinical action space to obtain patient histories; order and interpret laboratory, imaging and microbiology tests; generate differential diagnoses; and formulate treatment plans such as prescribing medications, scheduling surgical procedures and planning admissions. In simulations on real patient cases spanning multiple diagnoses, MIRA outperformed physicians in diagnostic accuracy and made guideline-concordant, medication-safe and appropriate admission decisions. Compared with previous LLM applications that addressed isolated subtasks or provided free-text advice, these results suggest that an EHR-integrated artificial intelligence agent can turn clinical intent into structured, actionable EHR operations, possibly making it a more effective decision-support partner for physicians. Further work is needed to establish generalization, safety and governance through prospective, real-world studies. A large language model artificial intelligence agent operating in a sandboxed electronic health record system can autonomously take patient histories, order tests, interpret findings, diagnose conditions and propose treatments, outperforming experienced clinicians while adhering to safety standards and clinical guidelines.