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01.
arXiv (CS.AI) 2026-06-25

Adapt Only When It Pays: Budgeted Decision-Loss Priority for Delayed Online Time-Series Adaptation

作者:

arXiv:2606.25068v1 Announce Type: cross Abstract: Online time-series forecasters receive labels only after horizon-dependent delays, while every adaptation step spends limited compute. We study when an online learner should update, not how to adapt at every opportunity, and introduce ADOWIP: a residual-adapter framework with sealed delay queues, exact budget accounting, and auditable update telemetry. Its main scheduler is an observed decision-loss priority gate that updates only after feedback is revealed, when downstream loss, optionally penalized by prediction MSE, exceeds a calibrated empirical quantile and budget remains. We prove hard-budget feasibility, projected-OGD regret for a convex linear accepted-update subproblem, and stability plus conditional finite-sample gate-selection statements. On public ETT capacity-planning tasks, a frozen calibration/evaluation split selects a gate that lowers held-out decision loss against always, fixed-period, and drift-triggered exact-update baselines under matched compute. Secondary threshold/load-index ETT suites are mixed: 33 of 41 selected contrasts clear the stricter cross-artifact Holm family, and the 8 nonpassing rows are explicitly excluded from primary claims. The same protocol improves an external UCI Bike capacity proxy with 20/0 held-out wins, and a fixed gate passes three full-year Capital Bikeshare station-rebalancing contrasts. Probe-based and finance experiments remain negative, delimiting the current scope of decision-prioritized adaptation.

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

Visual-Seeker: Towards Visual-Native Multimodal Agentic Search via Active Visual Reasoning

arXiv:2606.15231v1 Announce Type: new Abstract: Multimodal large language models (MLLMs) have demonstrated impressive capabilities in many visual tasks, but they often struggle with factual grounding when confronted with complex, open-world scenarios. While recent multimodal deep search agents attempt to address this issue by utilizing external tools, the visual-native search paradigm remains underexplored. Existing methods primarily rely on simple images with explicit semantics and text-only evidence trajectories, limiting the agent's ability to perform multi-hop, cross-modal reasoning and search. To address these limitations, we propose Visual-Seeker, a visual-native multimodal deep search agent via active visual reasoning. Rather than treating vision as a static input, our agent actively attends to fine-grained visual details, dynamically harvests visual evidence throughout the search process. To unlock its visual-native potential, we design an active visual reasoning data pipeline and synthesize 5K high-quality multimodal trajectories for model training. Extensive experiments demonstrate the state-of-the-art performance across five challenging multimodal search benchmarks, even surpassing several proprietary models, validating robust visual-native reasoning and search in real-world web environments. The code and data can be accessed at: https://github.com/ZhengboZhang/Visual-Seeker.

04.
medRxiv (Medicine) 2026-06-23

Timing of S. aureus-related mortality in a large randomized clinical trial: Implications for future study design

Background: Longer follow-up periods in clinical trials for S. aureus bacteremia (SAB) may capture unrelated deaths, adding random noise that risks biasing trial results towards the null. Objective: To evaluate the timing and infection-relatedness of deaths within a large SAB clinical trial platform. Design: Blinded duplicate adjudication of trial deaths using a modified 7-point Likert-Scale. A third reviewer settled disagreements. Setting: 37 Canadian hospitals participating in the S. aureus Network Adaptive Platform (SNAP) Trial. Participants: 1515 adult patients recruited to SNAP between February 2022 and May 2026. Measurements: Timing and relatedness of 90-day deaths categorized as at least possibly SAB-related not likely to be SAB-related. Optimal follow-up cut-off was determined using Youden's index and graphically. Results: 247 deaths occurred; 97 (39.3%) were adjudicated as at least possibly SAB-related and 150 (60.7%) as not likely related. For probably/definitely related deaths, interrater agreement was 85.0% (Gwet's AC 0.73, substantial); for at least possibly related, it was 77.3% (Gwet's AC 0.55, moderate). Median survival was significantly shorter for SAB-related deaths (12 vs. 30.5 days; difference: 19 days earlier, 95% CI: 12-26, p

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

A Benchmark for Hallucination Detection in VLMs for Gastrointestinal Endoscopy

arXiv:2606.24115v1 Announce Type: cross Abstract: Vision-language models (VLMs) are prone to hallucination, which remains a major barrier to their safe deployment in clinical practice. To date, most hallucination detection methods have been evaluated on radiology benchmarks such as MIMIC-CXR and VQA-RAD, while gastrointestinal (GI) endoscopy remains largely underexplored. In this paper, we benchmark nine hallucination detection methods on the Gut-VLM dataset, a GI diagnostic Visual Question Answering (VQA) dataset with 4,392 test VQA pairs, across five VLMs (MedGemma-4B, MedGemma-27B, LLaVA-Med-7B, LLaVA-v1.6-7B, and Lingshu-32B). The methods span three categories: black-box methods (RadFlag, SelfCheckGPT-NLI), gray-box methods (AvgProb, AvgEnt, MaxProb, MaxEnt, Semantic Entropy, and VASE), and a white-box method (ReXTrust). Our results show that ReXTrust, a white-box method, achieves the highest AUC across all five models, outperforming the strongest alternative method on each VLM by a statistically significant margin (paired permutation test, p < 0.001 in all cases), reaching a peak AUC of 93.0 on MedGemma-4B. White-box hidden-state access provides a consistent advantage of 19.5 AUC points on average (range: 9.5–33.5), with ReXTrust maintaining strong performance even on LLaVA-v1.6-7B (AUC 79.9), where black-box methods and clustering-based gray-box methods collapse to near-chance performance. Among non-white-box methods, token-level gray-box statistics (MaxEnt, MaxProb) are the strongest alternatives, outperforming both clustering-based gray-box methods (Semantic Entropy, VASE) and black-box approaches on average. We further identify confident confabulation, a failure mode in which models hallucinate with high inter-sample consistency or high token-level probability, as a systemic failure for both consistency and uncertainty-based methods.

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

Stab-QRAM: A Clifford-Only Quantum Oracle for Affine Boolean Data

arXiv:2509.26494v3 Announce Type: replace Abstract: Oracle-based quantum algorithms require coherent evaluation of classical functions on superposed inputs, and in fault-tolerant architectures this cost is dominated by non-Clifford gates: generic lookup constructions incur $T$-counts that grow with the data size. Here we show that affine Boolean functions $f(\mathbf{x})=A\mathbf{x}+\mathbf{b}$ over $\mathbb{F}_2$ – the algebraic core of parity checks, linear feedback shift registers, and cipher linear layers – are exactly the functions admitting computational-basis-preserving Clifford oracles, and we develop this correspondence into Stab-QRAM, a compiler mapping a specification $(A,\mathbf{b})$ to an ancilla-free circuit of CNOT and $X$ gates with zero $T$-count. Via K\"{o}nig's edge-coloring theorem, the compiled schedule provably attains the minimum depth for its gate set. Case studies spanning Simon-type oracles, block-encodings of $X$-type coset operators, and syndrome extraction for CSS codes show one compiler serving the algorithm, primitive, and error-correction layers of the quantum stack.

07.
arXiv (CS.CV) 2026-06-16

Gen-VCoT: Generative Visual Chain-of-Thought Reasoning via Diffusion-Based RGB Intermediate Representations

Multimodal large language models (MLLMs) excel at visual reasoning but rely on text-based chain-of-thought (CoT), lacking interpretable visual intermediates. Existing methods use opaque tokens or external tools, missing key properties. We propose Gen-VCoT, a framework using expert vision models to generate RGB images as reasoning intermediates. It has three stages: visual grounding (SAM segmentation), geometric reasoning (Marigold depth maps), and semantic reasoning (Qwen2-VL integration). An adaptive router selects reasoning depth. Evaluations show Gen-VCoT improves spatial (25% better) and depth (50% better) questions, but may hurt simple factual queries. Text CoT outperforms visual intermediates on CLEVR (91.2% vs 62.5%), showing task-dependent optimal representations. Gen-VCoT establishes a new paradigm for interpretable multimodal reasoning.

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

EurekAgent: Agent Environment Engineering is All You Need For Autonomous Scientific Discovery

LLM-based agents have shown increasing potential in automating scientific discovery. Given an optimizable metric and an execution environment, they can propose, validate, and iterate scientific solutions, and have produced results that outperform human-designed approaches. As model capabilities continue to improve, we argue that the bottleneck for autonomous scientific discovery is shifting from prescribing agent workflows to designing agent environments: the resources, constraints, and interfaces that shape agent behavior. We frame this as environment engineering: building environments that amplify productive behaviors, such as open-ended exploration, systematic artifact management, and inter-agent collaboration, while suppressing harmful behaviors, such as reward hacking and high-friction human oversight. We present EurekAgent, an environment-engineered agent system for metric-driven autonomous scientific discovery. EurekAgent engineers the environment along four dimensions: permissions engineering for bounded agent execution and isolated evaluation; artifact engineering for filesystem and Git-based collaboration; budget engineering for budget-aware exploration; and human-in-the-loop engineering for easy human supervision and intervention. EurekAgent sets new state-of-the-art results on multiple mathematics, kernel engineering, and machine learning tasks, including new state-of-the-art 26-circle packing results discovered with less than $11 in total API cost. We open-source our code and results, and call for environment engineering as a core research direction for developing reliable autonomous research agents.

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

Architectural Wisdom: A Framework for Governing Optimization in AI Systems

arXiv:2606.16319v1 Announce Type: new Abstract: Modern AI systems exhibit structural failures that capability scaling alone does not reliably fix: they optimize under-specified objectives with no architectural mechanism to question whether the objective should be optimized at all. Engagement maximization can amplify harmful pathways; tool-using agents can commit irreversible actions; preference-trained language models can become sycophantic. We argue that this failure is a wisdom problem, not an intelligence problem. We use "wisdom" in a deliberately architectural sense, not as a claim about virtue, consciousness, or moral omniscience. Intelligence accepts a goal and optimizes within it; wisdom interrogates whether the goal should be optimized at all. The two are separable architectural properties. We propose architectural wisdom as a corrigible objective-governance layer above the optimization substrate. The layer makes three structural commitments explicit and nondegenerate before any action: temporal horizon, relational boundary, and irreversibility. It is realized by four components (Structural Utility Transform, Moral Admissibility Interface, Arbitration and Escalation Controller, Value Revision Channel) that compute a six-coordinate wisdom tuple over horizon, relational coverage, irreversibility, admissibility, value revision, and auditability. We motivate the architecture by eight cases drawn from contemporary AI failures, secular wisdom traditions, and hard ethical situations, and defend the distinction against the intelligence-completeness thesis using goal-questioning over goal-taking, Bostrom's orthogonality, structural separation in our exemplar cases, and persistent failure modes despite capability scaling. The framework is the conceptual contract for a larger architecture whose formal specifications and empirical validation are developed in subsequent work.

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

The N-Body Problem: Parallel Execution from Single-Person Egocentric Video

Humans can intuitively parallelise complex activities, but can a model predict this from observing a single person? Given one egocentric video, we introduce the N-Body Problem: predicting how N individuals, can hypothetically perform the same set of tasks. The goal is to maximise speed-up, but naive assignment of video segments to individuals often violates real-world constraints, leading to physically impossible scenarios like two people using the same object or occupying the same space. To quantify this, we formalise the N-Body Problem and propose a suite of metrics to evaluate both performance (speed-up, task coverage) and feasibility (spatial collisions, object conflicts and causal constraints). As a proof of concept, we introduce a structured prompting strategy that guides a Vision-Language Model (VLM) to reason about the 3D environment, object usage, and temporal dependencies, producing a viable parallel execution. On 100 videos from EPIC-Kitchens and HD-EPIC, for $N = 2$, our structured prompt improves action coverage by 45% over a baseline prompt for Gemini 2.5 Pro, while simultaneously slashing collision rates, object and causal conflicts by 51%, 52% and 55% respectively.

11.
arXiv (CS.LG) 2026-06-19

An adaptive framework for the axisymmetric pulsar magnetosphere using physics-informed Kolmogorov-Arnold networks

arXiv:2606.10686v2 Announce Type: replace-cross Abstract: The pulsar magnetosphere has only recently been addressed using Physics-Informed Neural Networks (PINNs), by deploying a domain-decomposition approach and treating the separatrix and equatorial current sheet as infinitesimally thin discontinuities. However, this baseline requires extensive manual hyperparameter tuning, achieves limited final accuracy and demands several hours of training. We refine this framework by introducing domain-specific neural architectures based on Kolmogorov-Arnold networks, an automated adaptive training pipeline and a physics-based convergence criterion that eliminate the need for manual calibration. The proposed methodology delivers self-consistent axisymmetric magnetosphere solutions with mean squared errors of the PDE residuals at O(1e-6) in double precision - an improvement of two orders of magnitude over the baseline - while achieving convergence in under 20 minutes in single precision. Importantly, the method reliably resolves stellar radii reduced by up to 80% compared to the baseline, overcoming the severe spatial scale disparities that also challenge traditional solvers. Furthermore, by varying the flux that opens to infinity, we provide a correction to the equation that connects it to the equatorial T-point's position. The complete framework is released as the open-source library PulsarX.

12.
arXiv (quant-ph) 2026-06-19

Progress on the Kretschmann-Schlingemann-Werner Conjecture

arXiv:2308.15389v4 Announce Type: replace Abstract: Given any pair of quantum channels $\Phi_1,\Phi_2$ such that at least one of them has Kraus rank one, as well as any respective Stinespring isometries $V_1,V_2$, we prove that there exists a unitary $U$ on the environment such that $\|V_1-({\bf1}\otimes U)V_2\|_\infty\leq\sqrt{2\|\Phi_1-\Phi_2\|_\diamond}$. Moreover, we provide a simple example which shows that the factor $\sqrt2$ on the right-hand side is optimal, and we conjecture that this inequality holds for every pair of channels.

13.
arXiv (math.PR) 2026-06-17

Optional Stopping for Superhedging Supermartingales

arXiv:2606.17452v1 Announce Type: new Abstract: Superhedging supermartingales, introduced by the authors in previous work, are non-probabilistic processes defined via subadditive outer integrals that carry a purely financial interpretation in terms of superhedging cost. Building on the Leinert-König theory of non-lattice integration, the present paper establishes several results that are classical in probability theory but whose non-probabilistic proofs require fundamentally new arguments: (i) a tower inequality for the conditional outer integral \overline{\sigma}_j applied at stopping times, reducing to equality when the integrand is conditionally integrable; (ii) three versions of Doob's optional stopping theorem, organised by the class of supermartingale and the range of the stopping times; and (iii) Dubins' upcrossing inequality in both finite- and infinite-time horizons. A key structural result, property (K)-a.e., identifies conditions under which the two superhedging operators \overline{\sigma}_j and \overline{I}_j coincide on non-negative functions, extending the scope of all preceding results to the positive operator \overline{I}_j. None of the proofs invoke classical measure-theoretic tools; in particular, (classical) integrability and measurability are not assumed. The analogues of classical stochastic results acquire a purely financial interpretation and, in this way, gain depth and generality by providing a context that is independent of any a priori probabilistic structure.

14.
arXiv (CS.AI) 2026-06-25

Holographic Memory for Zero-Shot Compositional Reasoning in Knowledge Graphs: A Mechanistic Study of Where and Why It Fails

arXiv:2606.24948v1 Announce Type: cross Abstract: Knowledge graph embedding (KGE) models predict single-hop links well but have no mechanism for zero-shot compositional queries: multi-hop questions whose relation chains never appeared during training. Holographic Reduced Representations (HRR), which bind and unbind symbols via circular convolution, are a theoretically attractive candidate, since binding is approximately invertible and associative. We test whether this promise holds. We study two holographic memory variants, real-valued HRR and phase-only Fourier HRR (FHRR), each with a modern Hopfield cleanup, on FB15k-237 over five seeds. Four findings follow. First, both are competitive single-hop retrievers (filtered MRR 0.358 +/- 0.002 for HRR, 0.350 +/- 0.021 for FHRR). Second, neither composes zero-shot: accuracy stays at chance across all cleanup temperatures. Third, the main contribution, we localise the failure mechanistically. A hop-1 probe shows the memory recovers the correct intermediate entity with high fidelity (MRR 0.896 +/- 0.002 for HRR), yet composition still fails even with a verified-correct intermediate. A second probe shows why: posing the ground-truth second-hop fact as a standalone atomic query, bypassing composition entirely, already recovers it at only 0.26 to 0.48x average atomic accuracy, uniformly across relation fan-out. The bottleneck is not the bind-unbind algebra or the cleanup; it is that facts compositional chains pass through are intrinsically harder for the superposed memory to retrieve, a capacity and interference effect present already at a single hop. Fourth, we prove (Lemma 4.1) that FHRR's softmax cleanup is not phase-equivariant, compounding the primary failure on the minority of chains where hop-1 itself errs. Fixing zero-shot composition requires improving retrieval capacity under superposition, not just redesigning the cleanup.

15.
arXiv (CS.LG) 2026-06-12

Generative Modeling of Bach-Style Symbolic Music: A Comparative Study of Autoregressive, Latent-Variable, and Adversarial Approaches

arXiv:2606.13626v1 Announce Type: cross Abstract: We study generative modeling of Bach-style symbolic piano music using a shared MIDI corpus and three model families: autoregressive LSTMs with attention, latent-variable models including recurrent VAEs and vector-quantized VAEs, and generative adversarial networks. We compare their ability to model polyphonic note sequences, learn useful latent representations, and generate stylistically coherent compositions. Our experiments show that the autoregressive LSTM with attention produces the most musically coherent samples, while vector quantization helps mitigate posterior collapse and yields more structured outputs than conventional recurrent VAEs. The adversarial approach captures local pitch patterns but remains difficult to train and generalizes less reliably to Bach's style. These results highlight the relative strengths and failure modes of autoregressive, latent-variable, and adversarial approaches for symbolic music generation.

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

Agentic Discovery of Non-Canonical Antimicrobial Peptides with AMPGAN v3

arXiv:2606.17127v1 Announce Type: cross Abstract: Antimicrobial resistance causes to over a million deaths annually. Antimicrobial peptides (AMPs) are a promising solution, but generative AMP models are not yet ready to design peptides with non-natural amino acids and/or chemical modifications, which are essential for real-world peptide drugs. We present AMPGAN v3, a multi-objective conditional GAN that expands the generative vocabulary to D-amino acids and N/C-terminus modifications such as amidation. By separating adversarial and activity-aware supervision across two specialized discriminators, AMPGAN v3 substantially improves training stability and outperforms prior generative AMP models on external classifiers. We validated five candidates spanning three structural classes in vitro; two showed activity against Gram-positive strains, with the best candidate reaching MIC 8 {\mu}g/mL against B. subtilis. To support downstream curation, we further present PepCraft, a multi-agent framework for end-to-end AMP discovery in which a Planning Agent orchestrates specialized executors for generation, filtering, and verification. Its prioritization recommendations align with our in vitro outcomes. Together, these contributions let us examine, on a small but real scale, how generative and agentic AI compose in therapeutic peptide discovery. Code: https://github.com/marszzibros/AMPGANv3

17.
arXiv (CS.CL) 2026-06-12

AfriSUD: A Dependency Treebank Collection for Evaluating Models on African Languages

Despite their linguistic diversity and global significance, African languages remain underrepresented in research and resources to support NLP. We aim to bridge this gap by introducing AfriSUD, the first large-scale collection of syntactically annotated treebanks for nine diverse African languages spanning major language families and regions across Sub-Saharan Africa. Using the Surface-Syntactic Universal Dependencies (SUD) framework, our community-led effort provides high-quality, native-speaker verified data that capture typological key features such as agglutination and tone. We evaluate a range of models on AfriSUD for part-of-speech tagging and dependency parsing including non-transformer baselines, multilingual pretrained encoders, and LLMs. Our results reveal a significant syntax gap, where models still show clear limitations across the nine languages, suggesting that existing architectures may not fully capture the structural diversity of African-language syntax.

18.
arXiv (CS.CL) 2026-06-17

The Benchmark Illusion: Pruned LLMs Can Pass Multiple Choice but Fail to Answer

Compressing large language models reduces memory use and inference cost, but it can also create failures that standard benchmarks miss. A pruned model may still perform well on multiple-choice evaluations, yet fail to answer the same question in open generation. We ask what pruning changes: does it erase the correct answer, or does it make the answer harder to produce as the top output? We study this question with multilingual question answering, tracking the same questions before and after pruning. We find a benchmark illusion. Under high-sparsity pruning, especially Wanda, models often fail in greedy open generation while still selecting the correct answer under multiple-choice scoring. In these recognition-only errors, the answer is usually not gone, but demoted: it often reappears with beam search, sampling, or one in-context example. Overall, multiple-choice benchmarks can overstate the usability of compressed LLMs, creating an evaluation blind spot. Compressed models should be tested on what they can produce, not only on what they can recognize.

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

Trustworthy Self-Composable Big-Data-as-a-Service: An LLM-Orchestrated Multi-Agent Framework for Automated Data Engineering, AutoML, MLOps Deployment, and Drift-Aware Lifecycle Optimization

arXiv:2606.17915v1 Announce Type: cross Abstract: Big-Data-as-a-Service (BDaaS) platforms require re liable automation across data ingestion, cleaning, feature engi neering, model development, deployment, and post-deployment monitoring. However, existing LLM-based data science agents and AutoML systems mainly focus on isolated workflow stages, leaving limited support for lifecycle-level orchestration, artifact governance, human oversight, and drift-aware adaptation. This paper proposes a trustworthy self-composable BDaaS frame work based on LLM-orchestrated multi-agent collaboration. The proposed architecture decomposes the BDaaS lifecycle into specialized agents for data ingestion, data cleaning, feature engineering, AutoML training, model evaluation, MLOps de ployment, monitoring, and drift detection. A central LLM or chestration layer coordinates agent execution, validates interme diate outputs, manages workflow context, and enables dynamic workflow composition. The framework also incorporates shared artifact governance, reproducibility support, human-in-the-loop checkpoints, and drift-aware feedback loops. A prototype-based evaluation is conducted using controlled tabular benchmark datasets with missing values, categorical variables, outliers, class imbalance, and simulated covariate drift. Compared with manual ML, AutoML-only, and single-agent LLM baselines, the pro posed multi-agent BDaaS pipeline achieves competitive predictive performance while improving lifecycle-level reliability, including workflow completion, artifact traceability, deployment readiness, reproducibility, and drift recovery. The results suggest that LLM-orchestrated multi-agent systems can extend conventional AutoML toward trustworthy, adaptive, and production-oriented BDaaS lifecycle automation.

20.
arXiv (math.PR) 2026-06-11

Continuous stochastic flows driven by white noise and their duals

作者:

arXiv:2606.12143v1 Announce Type: new Abstract: We study a class of continuous stochastic flows driven by a space-time white noise and characterize their dual flows by explicit stochastic differential equations. A key ingredient of the proof is the convergence of solutions under coefficient approximations. As an application, we derive the dual flows in two illustrative examples, the squared Bessel flow and the Jacobi flow. We also introduce a new model of polynomially self-repelling (PSR) flow and show that it enjoys a self-duality property.

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

LoLA: Low-Rank Linear Attention With Sparse Caching

The per-token cost of transformer inference scales with context length, preventing its application to lifelong in-context learning. Linear attention is an efficient alternative that maintains a constant memory footprint, even on infinite context lengths. While this is a potential candidate for lifelong learning, it falls short in memory capacity. In this paper, we propose LoLA, a training-free augmentation to linear attention that boosts associative recall. LoLA distributes past key-value pairs from context into three memory systems: (i) recent pairs in a local sliding window cache; (ii) difficult-to-memorize pairs in a sparse, global cache; and (iii) generic pairs in the recurrent hidden state of linear attention. We show through ablations that our self-recall error metric is crucial to efficiently manage long-term associative memories. On pass-key retrieval tasks, LoLA improves the base model's performance from 0.6% to 97.4% accuracy. This is achieved with a 4.6x smaller cache than Llama-3.1 8B on 4K context length. LoLA also outperforms other 1B and 8B parameter subquadratic models on zero-shot commonsense reasoning tasks.

22.
medRxiv (Medicine) 2026-06-22

Multisite Real-World Validation of an Electronic Health Record-Integrated Generative Artificial Intelligence Tool for Venous Thromboembolism Risk Stratification

Background: Guiding risk-appropriate inpatient thromboprophylaxis requires venous thromboembolism (VTE) risk stratification; however, reliable risk determination remains inconsistent in routine care. Health systems increasingly pilot artificial intelligence (AI) tools, yet few studies demonstrate rigorous evaluation in the context of a learning health system (LHS). We evaluated the performance of a pilot electronic health record (EHR)-integrated generative AI (GenAI) system, inHealth General Reasoner (iHGR), for VTE risk stratification versus clinician order set classifications and physician-adjudicated chart review. Methods: This multisite retrospective validation study included adult inpatient admissions at Johns Hopkins Medicine between June 21, 2025, and Dec 18, 2025 (checklist-based order set from June 21, 2025 - November 19, 2025, and clinician judgement-based order set from November 29 - December 18, 2025). From 758 eligible admissions, we randomly sampled 500 balanced by site and order set periods. iHGR and clinician-selected order set classifications were compared with the reference standard (RS). Primary outcomes were iHGR sensitivity and specificity. Secondary analyses compared the order sets with the same RS to evaluate workflow comparators and error patterns. Results: iHGR achieved 81.8% sensitivity (95% CI 77.3-85.6) and 70.9% specificity (63.6-77.3). The checklist-based order set had 61.3% sensitivity (53.7-68.5) and 86.2% specificity (77.4-91.9). The clinician judgement-based order set had 78.1% sensitivity (71.3-83.7) and 65.4% specificity (54.3-75.0). False-negative iHGR classifications were associated with missed narrative risk factors. Conclusion: iHGR showed higher sensitivity for VTE risk than checklist-based order sets and clinician judgement without introducing systematic bias. In silico evaluation of pilot AI systems within LHSs can identify clinically important performance trade-offs and implementation targets before operational scale-up. Narrative clinical data abstraction remained a key limitation, supporting the use of GenAI to support rather than supplant clinician judgement.

23.
arXiv (CS.CV) 2026-06-17

LiveStarPro: Proactive Streaming Video Understanding with Hierarchical Memory for Long-Horizon Streams

Despite the remarkable progress of Video Large Language Models (Video-LLMs), current online architectures still struggle to simultaneously process continuous video streams, decide autonomously when to respond, and preserve long-horizon contextual memory. These obstacles undermine real-time responsiveness and cause severe forgetting throughout prolonged interactions. In this work, we introduce LiveStarPro, a live streaming assistant that is designed for proactive video understanding over long-horizon streams. The design of LiveStarPro rests on three complementary components. The first component is Streaming Verification Decoding (SVeD), an inference framework that identifies the appropriate response timing through single-pass perplexity verification, thereby eliminating the dependency on explicit silence tokens. The second component is Streaming Causal Attention Masks (SCAM), a training strategy that enforces incremental video-language alignment over variable-length streams. The third component is Tree-Structured Hierarchical Memory (TSHM), a recursive memory architecture that organizes evicted historical information into event chains and consequently enables efficient retrieval from effectively unbounded video streams. To facilitate a comprehensive evaluation under realistic online conditions, we further present OmniStarPro, a large-scale benchmark that spans 15 diverse real-world scenarios and that extends to hour-scale streams for the assessment of long-term recall. Extensive experiments demonstrate that LiveStarPro consistently surpasses existing methods, attaining a 28.9% improvement in semantic correctness and an 18.2% reduction in timing error, while its streaming key-value cache further yields a 1.58x inference speedup over the same model without caching. The model and the code are publicly available at https://github.com/sotayang/LiveStarPro.

24.
arXiv (CS.CL) 2026-06-24

Towards Spec Learning: Inference-Time Alignment from Preference Pairs

Steering a large language model (LLM) toward a desired behavior typically relies on an iterative process of hand-crafting a prompt based on a careful inspection of the model's responses. This is an involved, brittle, and error-prone process. Preference-based fine-tuning is a more rigorous but often prohibitively expensive solution. We propose spec learning, a framework that relies on a brief user instruction and a small set of preference judgments. These are compiled into specifications in the form of natural-language prompts for an LLM. Specifications condition LLMs at inference time, and no parameter updates to the underlying models are required. We show that the responses generated based on the compiled specifications often outperform direct preference optimization (DPO) on datasets from specialized domains whose preference signal is dense. Unlike opaque weight updates, the resulting specifications are human-readable and double as interpretable and transparent written embodiments of the preference signal that produced them.

25.
Nature (Science) 2026-06-17

Towards Conversational AI for Disease Management

While large language models (LLMs) have shown promise in diagnostic dialogue1, their capabilities for effective management reasoning—including disease progression, therapeutic response, and safe medication prescription—remain under-explored. We advance the previously demonstrated diagnostic capabilities of the Articulate Medical Intelligence Explorer (AMIE)1−3 through a new LLM-based agentic system optimized for multi-visit clinical management and dialogue. To ground its reasoning in authoritative clinical knowledge, AMIE leverages Gemini’s long-context capabilities4, combining in-context retrieval with structured reasoning to align its output with up-to-date clinical practice guidelines and drug formularies. In a randomized, blinded virtual Objective Structured Clinical Examination (OSCE) study, AMIE was compared to 21 primary care physicians (PCPs) across 100 multi-visit case scenarios designed to reflect UK NICE Guidance and BMJ Best Practice guidelines. AMIE was non-inferior to PCPs in management reasoning as assessed by specialists and scored better in both preciseness of treatments and investigations, and in its alignment with and grounding in clinical guidelines. To benchmark medication reasoning, we developed RxQA, a multiple-choice question benchmark derived from two national drug formularies (US, UK) and validated by board-certified pharmacists. Though AMIE and PCPs both benefited from the ability to access external drug information, AMIE outperformed PCPs on higher difficulty questions. While further research would be needed before real-world translation, AMIE’s strong performance across evaluations marks a significant step towards conversational AI as a tool in disease management.