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01.
PLOS Medicine 2026-05-22

Differences in tuberculosis prevalence by sex in low- and middle-income countries over 1993–2025: A systematic review and meta-analysis

作者:
Nicole A. Swartwood↗

by Nicole A. Swartwood, Nanki Singh, Seyed Alireza Mortazavi, Melike Hazal Can, Hening Cui, Do Kyung Ryuk, Peter MacPherson, Katherine C. Horton, Nicolas A. Menzies Background Global and national initiatives to combat tuberculosis (TB) have expanded over recent years. Despite this, the TB burden remains high in some population groups, with men recognized as having elevated TB risks. Summary measures of sex differences in TB prevalence were last estimated in 2016. Since then, many additional prevalence surveys have been conducted, including in the highest TB burden countries. We conducted a systematic review of sex-stratified TB prevalence survey data published over 1993–2025, to provide updated estimates of male-to-female (M:F) TB prevalence ratios and determine whether sex-related disparities in TB burden have closed over time. Methods and findings We identified surveys reporting community-representative, sex-stratified estimates of pulmonary TB prevalence in low- and middle-income countries (LMICs), including surveys from an earlier review (covering January 1993–March 2016) and a new systematic review (covering 1st December 2015–13th October 2025). This review was prospectively registered with PROSPERO (CRD42024503853) and included searches of PubMed, Embase, Global Health, the Cochrane Library, Africa Index Medicus, LILACS, and SciELO. We extracted data on bacteriologically confirmed and smear-positive TB prevalence among adults (aged ≥ 15 years), stratified by sex. Risk of bias was evaluated using eight criteria specific to prevalence surveys. We fit multi-level Bayesian regression models with study- and country-level random effects to estimate the M:F ratio of TB prevalence (male prevalence divided by female prevalence), overall and for key subgroups. In meta-regression analyses, we estimated how prevalence ratios varied over time and according to known TB risk factors and TB case definitions.We identified 10,124 publications and extracted data from 100 eligible studies representing 102 unique prevalence surveys and 4,658,310 participants (45.6% male) in 33 LMICs. TB prevalence was higher in men than women in 90/102 of the included surveys, with a pooled M:F prevalence ratio of 2.02 (95% credible interval (CrI): 1.71, 2.34) for bacteriologically confirmed TB and 2.38 (95% CrI: 1.91, 2.90) for smear-positive TB. Time trend analyses showed a 2.0% (95% CrI: −0.2, 4.5%) average annual change in the M:F ratio of bacteriologically confirmed TB over the study period. The M:F prevalence ratio was estimated to be higher for countries with greater excess HIV prevalence among men, and countries with greater gender equity (as measured by the United Nation’s Gender Development Index). The estimated M:F prevalence ratio was also higher for surveys that did not restrict testing to individuals reporting TB symptoms. Study limitations include heterogeneity in survey methods and definitions, as well as limited data from the Americas, Eastern Mediterranean, and Europe WHO world regions and post-COVID-19 period. Conclusions Men in LMICs consistently experience TB at a higher prevalence than women. Time trend estimates are uncertain, but consistent with widening sex differences in TB prevalence over the last three decades, despite efforts to address the risk factors underlying this excess TB burden.

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

NIM4-ASR: Towards Efficient, Robust, and Customizable Real-Time LLM-Based ASR

作者:
Yuan Xie↗Jiaqi Song↗Guang Qiu↗Xianliang Wang↗Kai Qiao↗Junfeng Yuan↗Shengqing Liu↗Yi Zhang↗Bowen Chen↗Ming Lei↗Jie Gao↗Jie Wu↗…

Integrating large language models (LLMs) into automatic speech recognition (ASR) has become a mainstream paradigm in recent years. Although existing LLM-based ASR models demonstrate impressive performance on public benchmarks, their training remains predominantly data-driven, leaving key practical challenges insufficiently addressed – particularly limited downward scalability in resource-constrained deployments and hallucinations under acoustically challenging conditions. To address these issues, we present NIM4-ASR, a production-oriented LLM-based ASR framework optimized for both efficiency and robustness. Grounded in a principled delineation of functional roles between the encoder and the LLM, we redesign the multi-stage training paradigm to align each module with its intended capability boundary. Specifically, we reformulate the pre-training architecture and objective to mitigate the modality gap and improve parameter efficiency; introduce an iterative asynchronous SFT stage to preserve acoustic fidelity and constrain representation drift; and design an ASR-specialized reinforcement learning stage to further enhance recognition quality and robustness. We additionally incorporate a suite of production-oriented optimizations, including robustness under noisy and silent conditions, real-time streaming inference, and hotword customization via retrieval-augmented generation (RAG). Experiments show that NIM4-ASR achieves state-of-the-art performance on multiple public benchmarks with merely 2.3B parameters, while substantially outperforming larger-scale competitors on internal benchmarks – particularly in entity-intensive real-world scenarios. NIM4-ASR further supports million-scale hotword customization via RAG with sub-millisecond retrieval latency, enabling efficient adaptation to emerging entities and personalized user requirements.

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04.
arXiv (CS.AI) 2026-06-19

The Tao of Agency: Autotelic AI, Embedded Agency and Dissolution of the Self

作者:
Aritra Sarkar↗

arXiv:2606.19924v1 Announce Type: new Abstract: Most artificial intelligence systems are built on the assumption that goals are exogenous and specified by the designer. Exploring what happens when an agent begins generating its own goals opens the field of autotelic AI. Agents are expected not merely to pursue objectives but to discover them. In this article, we trace its consequences through intrinsic motivation, resource-driven priors, causal-interventional learning, homeostasis, and embeddedness; the last of which is found to be a necessary but not sufficient condition for autotelic agency. Embeddedness individuates the agent at the cost of revealing that the individuation is non-unique, such that the same dynamics admit many valid partitions, each defining a different candidate self. The deepest problem with autotelic AI is therefore not how the agent generates goals, but how it generates and relativizes the self to which the goals are assigned. The agent must believe in its own boundary in order to act, and see through that boundary in order to understand. We consolidate these developments into a single framework and extend it along three directions: a quantum formulation in which the agent-environment cut becomes physical, a philosophical reading against non-dual contemplative traditions, and a concrete LLM-based agentic instantiation.

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

RAID: Semantic Graph Diffusion for True Cold-Start and Cross-Lingual Forecasting

作者:
Arunkumar V↗Manoranjan Gandhudi↗Gangadharan G. R↗Arun Prakash↗S. Senthilkumar↗

arXiv:2606.16925v1 Announce Type: new Abstract: Time-series foundation models show strong transfer performance when given a non-empty history window. However, true cold-start scenarios, where a new item has no prior observations, violate this assumption. We propose RAID (Retrieval-Augmented Iterative Diffusion) a framework, which replaces history-based correlation learning with metadata-driven semantic retrieval and graph-conditioned diffusion. RAID maps textual metadata into a shared semantic space using a frozen multilingual embedding model and constructs an inductive retrieval graph that extends naturally to unseen items. It first forms a base forecast by aggregating information from semantically related neighbors, then refines this forecast with a gated diffusion module to model residual uncertainty. Under a strict true cold-start protocol, RAID outperforms strong foundation models and competitive baselines on both forecasting accuracy and prediction interval coverage, while reducing inference latency by an order of magnitude through non-autoregressive decoding. The shared semantic space also enables zero-shot cross-lingual transfer, allowing a model trained on English descriptions to generalize to items described in other languages without direct supervision.

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07.
arXiv (CS.CV) 2026-06-12

ReFoCUS: Reinforcement-guided Frame Optimization for Contextual Understanding

作者:
Hosu Lee↗Junho Kim↗Hyunjun Kim↗Yong Man Ro↗

Recent progress in Large Multi-modal Models (LMMs) has enabled effective vision-language reasoning, yet the ability to video understanding remains constrained by suboptimal frame selection strategies, albeit with the rapid development of video-specialized LMMs. Prior works attempted to solve this with static heuristics or external retrieval modules to feed frame-level information, but these approaches often fail to capture visual cues grounded to the given user queries conflating raw visual dynamics with true semantic relevance. In this paper, we introduce ReFoCUS (Reinforcement-guided Frame Optimization for Contextual UnderStanding), the first framework to integrate online policy-gradient reinforcement learning into frame-level optimization for video-LLMs. ReFoCUS aims to learn a frame selection policy, leveraging reward signals derived from reference models to capture their underlying scoring behavior over frame combinations that best support temporally grounded responses. To efficiently explore the large combinatorial frame space, we employ an autoregressive and query-conditional selection architecture that ensures contextual consistency while reducing complexity. Our policy learning removes the need for explicit frame-level supervision, as it implicitly discovers optimal and semantically consistent frame compositions. ReFoCUS consistently improves reasoning accuracy across multiple video QA benchmarks, demonstrating the advantage of aligning frame selection with model-internal utility.

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08.
arXiv (CS.CL) 2026-06-24

Towards Spec Learning: Inference-Time Alignment from Preference Pairs

作者:
Dhriti Krishnan↗Tejas Goyal↗Jaromir Savelka↗

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.

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09.
arXiv (CS.AI) 2026-06-15

DiffusionBlocks: Block-wise Neural Network Training via Diffusion Interpretation

作者:
Makoto Shing↗Masanori Koyama↗Takuya Akiba↗

arXiv:2506.14202v4 Announce Type: replace-cross Abstract: End-to-end backpropagation requires storing activations throughout all layers, creating memory bottlenecks that limit model scalability. Existing block-wise training methods offer means to alleviate this problem, but they rely on ad-hoc local objectives and remain largely unexplored beyond classification tasks. We propose $DiffusionBlocks$, a principled framework for transforming transformer-based networks into genuinely independent trainable blocks that maintain competitive performance with end-to-end training. Our key insight leverages the fact that residual connections naturally correspond to updates in a dynamical system. With minimal modifications to this system, we can convert the updates to those of a denoising process, where each block can be learned independently by leveraging the score matching objective. This independence enables training with gradients for only one block at a time, thereby reducing memory requirements in proportion to the number of blocks. Our experiments on a range of transformer architectures (vision, diffusion, autoregressive, recurrent-depth, and masked diffusion) demonstrate that DiffusionBlocks training matches the performance of end-to-end training while enabling scalable block-wise training on practical tasks beyond small-scale classification. DiffusionBlocks provides a theoretically grounded approach that successfully scales to modern generative tasks across diverse architectures. Code is available at https://github.com/SakanaAI/DiffusionBlocks .

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10.
medRxiv (Medicine) 2026-06-22

Sex-specific multimorbidity clusters and all-cause mortality in relatively healthy older adults: findings from the ASPREE cohort

作者:
Du↗Vishwanath↗Wu↗Phyo↗A. Z. Z↗Orchard↗S. G↗Sheets↗Ernst↗M. E↗Ryan↗

Background: Multimorbidity is common in older adults, but sex differences in chronic condition clustering remain unclear. This study explored multimorbidity clusters and their associations with all-cause mortality among community-dwelling adults aged 70 years and over. Methods: This was a secondary analysis of data from 16,095 Australian ASPREE participants aged at least 70 years without prior dementia or cardiovascular disease. Fifteen baseline chronic conditions were grouped using latent class analysis (LCA). Observed-to-expected (O/E) ratios characterised conditions over-represented within clusters, and Cox proportional hazards models assessed associations with all-cause mortality. Results: Among 16,095 participants (mean age 74 years), 88.3% had multimorbidity at baseline; 4,217 deaths occurred over a median follow-up of 10.85 years. Five clusters were identified overall: hypertension and dyslipidemia (52.1%), gout and metabolic (14.4%), depressive symptoms, osteoporosis and frailty (10.0%), anaemia and kidney disease (10.2%), and hypotension, thyroid disorder and past cancer (13.3%). Sex-stratified analyses revealed three clusters in males and four in females. The frailty, depressive symptoms and osteoporosis cluster was associated with higher mortality in both sexes (aHR 1.56 [95% CI 1.40-1.73] in males; 1.68 [1.49-1.89] in females). Higher mortality was also observed for the metabolic, gout and kidney disease cluster in males (aHR 1.63 [1.47-1.81]) and the gout, anaemia and kidney disease cluster in females (aHR 1.96 [1.74-2.21]). Conclusions: Distinct multimorbidity clusters differed by sex and were associated with increased all-cause mortality. These findings may support risk stratification, targeted screening, and more person-centred management of older adults with multimorbidity.

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11.
arXiv (CS.CL) 2026-06-15

Large Language Model Agents Are Not Always Faithful Self-Evolvers

作者:
Weixiang Zhao↗Yingshuo Wang↗Yichen Zhang↗Yang Deng↗Yanyan Zhao↗Wanxiang Che↗Bing Qin↗Ting Liu↗

Self-evolving large language model (LLM) agents continually improve by accumulating and reusing past experience, yet it remains unclear whether they faithfully rely on that experience to guide their behavior. We present the first systematic investigation of experience faithfulness, the causal dependence of an agent's decisions on the experience it is given, in self-evolving LLM agents. Using controlled causal interventions on both raw and condensed forms of experience, we comprehensively evaluate four representative frameworks across 13 LLM backbones and 9 environments. Our analysis uncovers a striking asymmetry: while agents consistently depend on raw experience, they often disregard or misinterpret condensed experience, even when it is the only experience provided. This gap persists across single- and multi-agent configurations and across backbone scales. We trace its underlying causes to three factors: the semantic limitations of condensed content, internal processing biases that suppress experience, and task regimes where pretrained priors already suffice. These findings challenge prevailing assumptions about self-evolving methods and underscore the need for more faithful and reliable approaches to experience integration.

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

GridVQA-X: A Framework for Evaluating Multimodal Explainability Methods

作者:
Sujay Belsare↗Sudarshan Nikhil↗Sushant Kumar↗Ponnurangam Kumaraguru↗Chirag Agarwal↗

With the increasing development of Vision-Language Models, it becomes imperative that their predictions are readily explainable to relevant stakeholders. However, the field of explainability has not kept pace with the multimodal surge. While recent Multimodal Explainable AI (MxAI) methods generate explanations to attribute the interaction between different modalities, current evaluation protocols lack the ground truth required to distinguish between true cross-modal reasoning (e.g., spatial composition) and shallow cross-modal shortcuts (e.g., Bag-of-Words attribute matching). It remains unknown whether MxAI methods faithfully capture synergistic interactions or merely hallucinate reasoning on models acting as simple feature detectors. In this paper, we introduce GridVQA-X, the first diagnostic framework specifically designed to evaluate cross-modal explainability. Unlike natural datasets, GridVQA-X leverages a closed-world synthesis logic to generate unique, mathematically guaranteed explanations. We utilize this controlled environment to train paired ground-truth models on identical architectures: $M_{pure}$, which learns robust spatial-relational reasoning and $M_{spur}$, which is structurally forced to rely on cross-modal shortcuts. This behavioral divergence creates a rigorous testbed: a faithful explainer must report distinct reasoning pathways for each model. Our findings reveal that widely used methods fail to distinguish between models relying on genuine spatial-relational reasoning and those exploiting cross-modal shortcuts, highlighting a critical gap in capturing true cross-modal synergy and misrepresenting how multimodal models actually make decisions.

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13.
arXiv (CS.CL) 2026-06-17

Your AI Travel Agent Would Book You a Bullfight: An Agentic Benchmark for Implicit Animal Welfare in Frontier AI Models

作者:
Jasmine Brazilek↗Oliver Tulio↗Joel Christoph↗Miles Tidmarsh↗Carol Kline↗Arturs Kanepajs↗

AI agents are moving from advisors to actors, booking travel, planning menus, and running procurement on behalf of users. Existing benchmarks for AI and animal welfare evaluate model text responses to question-answer prompts, leaving open whether the welfare reasoning surfaced in those responses transfers to agentic deployment where the model must take actions with tools. We introduce TAC (Travel Agent Compassion), the first agentic benchmark measuring whether AI agents avoid options involving animal exploitation when acting on behalf of users. TAC presents an AI agent with twelve hand-authored travel booking scenarios across six categories of animal exploitation, augmented to forty-eight samples to control for price, rating, and position confounds. We evaluate seven frontier models from four labs. Every model scores below the chance level of sixty-four percent, with the best performer (Claude Opus 4.7) at fifty-three percent. A single welfare-aware sentence in the system prompt yields gains of forty-seven to sixty-three percentage points in Claude and GPT-5.5, twenty-six points in GPT-5.2, and under twelve points in DeepSeek and Gemini. An auxiliary Inspect Scout audit of 288 base-condition transcripts from the top two performers, using Gemini 2.5 Flash Lite as judge, flags zero transcripts for evaluation awareness, suggesting the below-chance rates do not stem from the models recognising the evaluation. We discuss implications for category-level variation across cultural domains, the limits of text-response welfare benchmarks, and the EU General-Purpose AI Code of Practice systemic risk framework.

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14.
arXiv (CS.AI) 2026-06-15

COGNITION: From Evaluation to Defense against Multimodal LLM CAPTCHA Solvers

作者:
Junyu Wang↗Changjia Zhu↗Yuanbo Zhou↗Lingyao Li↗Xu He↗Mingkui Wei↗Junjie Xiong↗

arXiv:2512.02318v4 Announce Type: replace-cross Abstract: This paper studies how multimodal large language models (MLLMs) undermine the security guarantees of visual CAPTCHA. We identify the attack surface where an adversary can cheaply automate CAPTCHA solving using off-the-shelf models. We evaluate 7 representative MLLMs on 18 real-world CAPTCHA task types, measuring single-shot accuracy, success under limited retries, end-to-end latency, and per-solve cost. We further validate our findings through a supplemental external dataset and an adaptive-attacker setting with session memory, while also analyzing the impact of task-specific prompt engineering and few-shot demonstrations on solver effectiveness. We reveal that MLLMs can reliably solve recognition-oriented and low-interaction CAPTCHA tasks at human-like cost and latency, whereas tasks requiring fine-grained localization, multi-step spatial reasoning, or cross-frame consistency remain significantly harder for current models. By examining the reasoning traces of such MLLMs, we investigate the underlying mechanisms of why models succeed/fail on specific CAPTCHA puzzles and use these insights to derive defense-oriented guidelines for selecting and strengthening CAPTCHA tasks. To validate these principles, we present a proof-of-concept by hardening a vulnerable CAPTCHA type using our guidelines. We demonstrate that incorporating fine-grained localization and implicit counting reduces the success rate of state-of-the-art MLLMs from over 95\% to 0\%, confirming that structural changes can effectively mitigate the threat. We conclude by emphasizing the urgent need for CAPTCHA redesign as MLLM capabilities increasingly threaten existing defenses. Code Availability (https://doi.org/10.5281/zenodo.20406852).

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

DTT-BSR+: A Generative-Regression Cascade for Music Source Restoration

作者:
Youran Ni↗Shihong Tan↗Yuzhu Wang↗Gongping Huang↗

arXiv:2606.24127v1 Announce Type: cross Abstract: Music source restoration (MSR) requires jointly addressing source unmixing and the inversion of non-linear production effects. Current methods struggle to achieve accurate target signal reconstruction while maintaining semantic consistency. To address this limitation, we propose DTT-BSR+, a two-stage cascade MSR system that decouples distribution fitting from signal reconstruction into separate stages. A generative DTT-BSR separator in the first stage produces stems matching the prior of clean sources, and a modified Demucs network in the second stage enhances the first stage output using time-domain and multi-resolution spectral losses. DTT-BSR+ improves multi-mel signal-to-noise ratio (MMSNR) over the single-stage DTT-BSR across all stems, and surpasses the state-of-the-art X-LANCE MSR system on five stems. We also reveal through Fréchet Audio Distance (FAD) decomposition an implicit trade-off between signal reconstruction accuracy and semantic distribution fitting across stems.

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16.
arXiv (CS.CL) 2026-06-15

Verbatim Chunks Beat Extracted Artifacts: A Controlled Ablation of Memory Representations for Long LLM Conversations

作者:
Tao An↗

A growing class of conversational-memory systems compresses dialogue history into structured artifacts – extracted facts, decisions, or events – on the premise that distilled structure retrieves better than raw text. We test this premise with a controlled ablation: within one fixed retrieval-rerank-reasoning pipeline, we swap only the stored representation – LLM-extracted typed artifacts versus verbatim conversation chunks – holding the model, retriever, reranker, and judge constant. Verbatim chunks win by 15.9 points on LoCoMo (43.9% vs. 28.0%) and 22.0 points on LongMemEval-S (67.4% vs. 45.4%); a 1-hop semantic graph does not recover the gap, and five confound controls reproduce the effect. The mechanism is lossy distillation: extraction discards verbatim detail that chunks retain for free, and the extracted-artifact pipeline never beats naive RAG in overall accuracy. Concurrent positive results with near-verbatim, provenance-preserving units fit the same account: retrieval accuracy tracks how far the representation departs from the source. For the extraction designs we test, structured memory should augment verbatim text rather than replace it: a chunks $\cup$ artifacts union store matches chunks on both benchmarks while artifacts alone forfeit the gap. Code and data: https://github.com/tao-hpu/cog-canvas

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

STAR: SpatioTemporal Adaptive Reward Allocation for Text-to-Image RL Post-Training

作者:
Jinjie Shen↗Wei Deng↗Xian Hu↗Daiguo Zhou↗Jian Luan↗

arXiv:2606.17979v1 Announce Type: new Abstract: Existing RL post-training methods for text-to-image generation usually convert the final-image reward into a single scalar advantage and apply it with the same strength to the entire generative trajectory. However, text-to-image generation naturally has temporal and spatial structure: different denoising steps are responsible for different generation stages, and the content that truly determines text alignment often appears only in part of the image. This granularity mismatch makes it difficult for policy updates to focus on the generative components that actually affect the reward. To address this issue, we propose SpatioTemporal Adaptive Reward (STAR) Allocation for RL post-training of text-to-image diffusion and flow models. STAR uses text-image attention inside the generative model and starts from the core content that the user truly cares about in the prompt. It constructs spatial allocation maps that dynamically vary across denoising steps and rollouts, and allocates the same group-relative advantage to more relevant latent regions with almost no additional computational overhead. STAR then applies stronger policy updates to these regions through a spatially resolved policy objective. We use Stable Diffusion 3.5 Medium as the base model and evaluate on three tasks: GenEval, OCR text rendering, and PickScore. Experimental results show that STAR improves compositional semantic alignment, text rendering, and preference optimization without changing the external reward source, achieving $\mathbf{0.9759}$, $\mathbf{0.9757}$, and $\mathbf{23.60}$ on GenEval, OCR, and PickScore, respectively.

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18.
arXiv (CS.LG) 2026-06-19

Streaming Interventions: Can Video Large Language Models Correct Mistakes as They Occur?

作者:
Apratim Bhattacharyya↗Shweta Mahajan↗Sanjay Haresh↗Rajeev Yasarla↗Reza Pourreza↗Litian Liu↗Risheek Garrepalli↗Roland Memisevic↗

arXiv:2606.09547v2 Announce Type: replace-cross Abstract: Learning everyday skills, like cooking a dish, relies increasingly on instructional media such as online videos. This opens the door to the use of video (and multimodal) large language models (LLMs) as task guidance assistants. A crucial capability for the real-world success of a prospective task guidance assistant is it's ability to intervene proactively as soon as a mistake is apparent in order to guide the user. To evaluate this crucial capability, we introduce Ego-MC-Bench (Mistake Corrections), a benchmark for evaluating reactive, step-by-step task guidance in realistic cooking scenarios. Extensive experiments show that Ego-MC-Bench is highly challenging for state-of-the-art video LLMs. We argue that a key reason is the limited availability of training data for fine-tuning models on this task. Although there exists a wide range of cooking video datasets, existing datasets lack examples of mistakes along with appropriately timed interventions. To help address this data limitation, we also introduce Ego-CoMist, a counterfactual synthetic dataset created by transforming non -interactive cooking videos into supervised training examples showing proactive interventions. We show that fine-tuning on Ego-CoMist yields performance gains especially for smaller and more efficient video LLMs that are well suited for delivering assistance on edge devices.

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19.
medRxiv (Medicine) 2026-06-18

Hospital staff views on the visibility, role and impact of Acute Learning Disability Liaison Services in Wales: a service evaluation

作者:
Sha'aban↗Mazzaschi↗F. I. M↗Alazizi↗McAulay↗Edwards↗Joseph-Williams↗N. I. M↗

People with a learning disability experience marked health inequalities. In Wales, Acute Learning Disability Liaison Services (ALDLS) are delivered by specialised learning disability services, and all roles within them are undertaken by Learning Disability Liaison Nurses (LDLN). These services aim to enable access to, and delivery of, secondary care by supporting reasonable adjustments, facilitating communication, and coordinating care for people with learning disability during hospital encounters. However, independent evidence of the impact of ALDLS on patient care remains limited. This evaluation tries to address this evidence gap by examining hospital staff perceptions of the visibility, role, and impact of ALDLS across Welsh Health Boards, with the aim of informing service design and development and improving secondary care access and care for people with learning disability. The service evaluation used a qualitative approach involving interviews and a focus group with hospital staff across the seven Welsh Health Boards who had experience working with or interacting with ALDLS staff to care for patients with learning disability. Findings cover six key areas including i) visibility and delivery of ALDLS, ii) Barriers and challenges to effective ALDLS delivery, iii) Enablers of effective ALDLS delivery, iv) Positive impacts for patients with learning disability, v) Negative impacts and unintended consequences when the service is absent or limited, and vi) Participants recommendations for future improvements of ALDLS. To synthesise the findings, we developed an overview diagram, which illustrates how ALDLS may influence care quality in acute hospitals. The overview places the liaison service at the centre, showing how organisational enablers and barriers shape its delivery, and how its core functions support improvements in safety, timeliness, effectiveness, efficiency, equity, and patient-centred care. From the findings we have identified recommendations for practice and policy. These include that ALDLS should be recognised as a core, safety-critical component of acute hospital care for people with a learning disability, rather than an optional add-on. In practice, services should be more visibly embedded within routine pathways, with consistent site-based presence, clear referral criteria, early identification through electronic flagging and notification systems, and routine involvement in multidisciplinary planning for complex admissions and procedures. At policy level, ALDLS provision should be recognised within equality and patient safety frameworks as an essential service requiring sustained investment, national minimum configuration standards, adequate staffing, and better-integrated digital systems to support continuity, equitable access, and person-centred care.

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20.
arXiv (quant-ph) 2026-06-19

Quantum Dynamics from Lax Pair Theory: A Reconstruction from Spectrum Preservation

作者:
P\'eter Szab\'o↗

arXiv:2606.19664v1 Announce Type: new Abstract: We reconstruct unitary quantum dynamics from a minimal axiomatic foundation built on Hilbert-space observables and isospectral evolution. The only dynamical assumption is that physical time evolution is a continuous one-parameter flow of Hermitian observables that preserves their spectra, i.e. the possible outcomes of measurement. We show that this assumption is already sufficient to force the Lax form of quantum dynamics. The Heisenberg equation, the time-dependent and time-independent Schrödinger equations, conservation laws, and good quantum numbers then follow as theorems rather than postulates. In this formulation, Lax pair theory supplies the missing dynamical bridge between the measurement structure of a Hilbert space and standard quantum evolution: the Hamiltonian is not assumed, but emerges as the generator required for an isospectral observable flow.

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21.
arXiv (quant-ph) 2026-06-19

Random Local Stabilizer Codes in Three Dimensions without String or Self-Similar Fractal Logical Operators

作者:
Han Yan↗

arXiv:2606.19873v1 Announce Type: new Abstract: Quantum error-correcting codes (QECs) are essential components quantum computation and have deep connections to quantum phases of matter. A key obstruction to passive self-correcting QECs is the presence of string logical operators, which can generate logical errors through constant-energy-barrier processes. Haah's Codes (fracton codes) showed that three-dimensional stabilizer codes can forbid such string logical operators, but their translation-invariant structure supports self-similar fractal logical operators with a logarithmic energy barrier. We introduce the qutrit random cubic codes, a family of local qutrit Calderbank-Shor-Steane stabilizer Hamiltonians with similar cube-check structure as Haah's Code 1 but built from spatially varying stabilizers. We prove that these models retain the no-string property and numerically observe that they have properties distinct from translation-invariant fracton codes: the smallest ground-state degeneracy exponent is $k=2$ for odd $L$ and $k=4$ for even $L$; noncontractible plane-logical operators span the entire logical space; and charge-push diagnostics show that the self-similar fractal operators are absent. These results demonstrate that constrained randomness can fundamentally change the nature of stabilizer codes and improve their self-correction properties. They further point to broader families of quantum error-correcting codes and quantum phases beyond canonical topological and fracton orders.

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22.
medRxiv (Medicine) 2026-06-17

Nickel and Dimed: How a Common Earth Element is Short-Changing Our Health

作者:
Heitzig↗Rehkopf↗

Nickel has been studied for a long time as an environmental contaminant but less so in its connection to population health. It does not announce itself as loudly as its transition metal brethren like mercury and cadmium, but its chemical properties permit it to be deleterious as a low-dose, chronic exposure, particularly among those with immune systems sensitized to it. There is a growing evidence base and vocabulary to discuss nickel's affect on health. However, in the U.S., there are not recent, reliable estimates of the share of the population with a nickel allergy, let alone how much nickel Americans are exposed to through their diet. This paper seeks to close this evidence gap by creating a new dataset of dietary nickel and other heavy metal exposure and assessing how high levels of dietary nickel exposure shape local demand for health care services. We use soil data from the U.S. Geological Survey and data on agricultural product transport from FoodFlows.org to create a county-level dietary nickel exposure index. We then use a large electronic health record database and double machine learning to estimate how demand for primary care services varies across levels of dietary nickel exposure. We find that counties with high nickel exposure experience an increase in the share of primary care office visits for symptoms highly suggestive of nickel poisoning. This result survives multiple hypothesis test corrections and placebo tests. Our research suggests that nickel has harmful effects on individual health whose exposure can be measured at a population level, and is shaping primary care across the U.S.

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23.
PLOS Computational Biology 2026-06-22

Cell-type resolved transcriptional network analysis of <i>in vivo</i> cellular senescence following injury

作者:
Alda Sabalic↗

by Alda Sabalic, Victoria Moiseeva, Andres Cisneros, Oleg Deryagin, Eusebio Perdiguero, Pura Muñoz-Cánoves, Jordi Garcia-Ojalvo Identifying the genetic correlates of complex phenotypes is a challenging task. Methods coming from the field of complex networks can help finding such molecular patterns, by revealing statistical associations among groups of genes that correlate with the phenotype. Here we study cellular senescence, a complex cell state whose molecular underpinnings are still under active investigation. We analyze cell type–resolved RNA sequencing data obtained from injured muscle tissue in mice, with a network-based approach that merges eigenvector centrality feature selection and community detection. Our analysis identifies genetic markers that had not been associated with senescence so far, which are validated with existing single-cell RNA sequencing data in a different type of tissue. The identified key genes belong to transcriptional pathways associated with established hallmarks of senescence, and thus can be interpreted as molecular correlates of such hallmarks. The method proposed here could be applied to any complex cellular phenotype even when only bulk RNA sequencing is available, provided the data is resolved by cell type.

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24.
arXiv (math.PR) 2026-06-24

Autoregressive Processes on Riemannian Manifolds

作者:
Meshal Abuqrais↗Davide Pigoli↗

arXiv:2606.24771v1 Announce Type: cross Abstract: This paper introduces a Riemannian autoregressive (R-AR) model of order one, generalising classical discrete-time stochastic processes to manifold-valued data. The model is based on two parameters, a parameter $\mu$ representing the intrinsic central tendency as the Fréchet mean and an autoregressive parameter $\phi$ controlling the stationarity and ergodic properties. Due to the inherent dependence structure of the R-AR process, the estimation procedure for these parameters necessitates new asymptotic results for dependent processes on manifolds. Thus, we establish a strong law of large numbers for the sample Fréchet mean set of ergodic Markov chains in proper metric spaces. By proving this general consistency result, we move beyond the limitations of classical i.i.d. theory to provide the mathematical foundation required for the strong consistency of our proposed estimators. The framework is validated through numerical simulations in the hyperbolic plane and an application to aerosol size distributions on the Fisher-Rao manifold, demonstrating how the proposed model can characterise mean-reverting dynamics in nonlinear geometries.

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25.
arXiv (CS.LG) 2026-06-16

Graph Learning Should Move Beyond Restrictive Views of Spectral and Message-Passing GNNs

作者:
Antonis Vasileiou↗Juan Cervino↗Pascal Frossard↗Charilaos I. Kanatsoulis↗Christopher Morris↗Michael T. Schaub↗Pierre Vandergheynst↗Zhiyang Wang↗Guy Wolf↗Ron Levie↗

arXiv:2602.10031v2 Announce Type: replace Abstract: Graph neural networks (GNNs) are commonly divided into message-passing neural networks (MPNNs) and spectral GNNs, reflecting two largely separate research traditions in machine learning and signal processing. While MPNNs have a precise definition, there is no widely accepted criterion for what makes a mapping a spectral GNN. Most existing work restricts spectral GNNs to layered architectures based on linear spectral filters. Under this restriction, we show that spectral and spatial GNNs have largely equivalent expressive power. To promote progress in the field, we propose a precise definition of spectral GNNs based on eigenbasis symmetries, in contrast to the definition of MPNNs via neighborhood permutation symmetries. We further argue that the two perspectives offer complementary strengths. MPNNs provide a natural language for discrete structure and expressivity analysis through tools from logic and graph isomorphism, while the spectral perspective offers principled tools for understanding smoothing, bottlenecks, stability, and community structure. Overall, we argue that progress in graph learning will be accelerated by clarifying the similarities and differences between these perspectives and by moving toward a unified theoretical framework.

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