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01.
arXiv (CS.LG) 2026-06-19

Insulin4RL: Real-Time Insulin Management in the Intensive Care Unit for Offline Reinforcement Learning

arXiv:2606.19481v1 Announce Type: new Abstract: Offline reinforcement learning (ORL) offers the potential to improve the quality of clinical decision-making using historical electronic health record (EHR) data. Current training and evaluative practices in this field rely heavily on EHR datasets that have been temporally discretised into fixed, regular time intervals. Discretisation creates fictional representations of complex clinical scenarios and compromises the generalisability of retrospective model evaluations. In this paper, we introduce Insulin4RL, a healthcare ORL dataset featuring naturally irregular inputs and actions from real clinical trajectories. Derived from MIMIC-IV, Insulin4RL comprises over 375,000 labelled decisions across 12,209 patients requiring insulin infusion titration in the Intensive Care Unit. The dataset can thus be used for research into ORL model performance under realistic clinical sampling assumptions. We provide a description of the dataset's structure and characteristics, baseline performance metrics using model-free offline reinforcement learning, and a standardised evaluation protocol using fitted Q-evaluation. We conclude with suggested areas for future research that could be addressed using this resource.

02.
arXiv (CS.AI) 2026-06-12

Beyond Runtime Enforcement: Shield Synthesis as Defensibility Analysis for Adversarial Networks

arXiv:2606.13621v1 Announce Type: new Abstract: Shielded reinforcement learning is typically presented as a runtime safety mechanism that compiles temporal-logic specifications into automata restricting an agent's actions. We argue this is the wrong product. The same automata-theoretic machinery – specification compilation, product game construction, attractor computation, and winning-region extraction – is better read as a design-time analytical instrument whose outputs are structural insights about a system rather than runtime constraints on a deployed agent. We instantiate this through a constrained two-player safety game for network defense. The two specifications are enforced asymmetrically: the defender specification defines the unsafe region of the game, whereas the attacker specification restricts the adversary's legal actions during attractor computation. Solving the game yields a defensibility verdict – a formal certificate that a topology-specification pair is or is not defensible – with the associated winning region and shield. Beyond the binary verdict, we derive topology-level metrics from the attractor structure and combine them with post-convergence behavior from shield-constrained adversarial multi-agent reinforcement learning. Together these form a defensibility fingerprint capturing both a network's formal safety properties and its operational behavior under adaptive play. A what-if analysis shows that formal defensibility and operational effectiveness capture distinct aspects of security: small architectural changes can produce large shifts in operational outcomes while leaving formal safety margins nearly unchanged. Shield synthesis is thus most valuable not as a deployment mechanism for safe agents, but as a framework for answering architectural questions about whether, where, and how a system can be defended. The defensibility verdict is the output, not the safe policy.

03.
arXiv (math.PR) 2026-06-15

Upper tails for irregular graphs beyond the mean-field regime

arXiv:2606.14564v1 Announce Type: new Abstract: Let $G_{n,p}$ be the binomial random graph of density $p$ and let $X_H$ be the number of copies of a fixed graph $H$ in $G_{n,p}$. We prove asymptotically tight bounds on the logarithmic upper-tail probability of $X_H$ whenever $H$ is a connected, irregular graph with maximum degree $\Delta \ge 2$ and $p \ge n^{-1/\Delta - \varepsilon_H} (\log n)^{\omega(1)}$ for an explicit $\varepsilon_H >0$. These bounds are expressed in terms of a new variational problem that generalises the combinatorial optimisation problem arising from the naïve mean-field approximation. This new variational problem includes an entropy term that corresponds to the large number of embeddings of certain highly structured graphs in $K_n$. For a certain class of irregular graphs $H$ that we call stable, we show that this description of the upper-tail probability is valid in a range of densities that is optimal up to a poly($\log\log n$) factor. For a further subclass of stable graphs, which includes all irregular complete bipartite graphs, we show that this range of densities is optimal up to a multiplicative constant.

04.
arXiv (quant-ph) 2026-06-11

Magneto-Optical Trapping of a Metal Hydride Molecule

arXiv:2512.22350v2 Announce Type: replace-cross Abstract: We demonstrate a three-dimensional magneto-optical trap (MOT) of a metal hydride molecule, CaH. We are able to scatter $\sim$$10^{4}$ photons with vibrational loss covered up to vibrational quantum number $\nu=2$. This allows us to laser slow the molecular beam near zero velocity with a "white-light" technique and subsequently load it into a radio-frequency MOT. The MOT contains $230(40)$ molecules, limited by beam source characteristics and predissociative loss of CaH. The temperature of the MOT is below one millikelvin. The predissociative loss mechanism could, in turn, facilitate controlled dissociation of the molecule, offering a possible route to optical trapping of hydrogen atoms for precision spectroscopy.

05.
arXiv (CS.CL) 2026-06-17

Zone of Proximal Policy Optimization: Teacher in Prompts, Not Gradients

Knowledge distillation transfers a teacher's competence to a small student but is brittle in the small-student regime: forcing the student to imitate logits from a much larger teacher concentrates it on the teacher's sharpest modes, hurting generalization on benchmark families beyond the training corpus. Reinforcement learning (RL) avoids logit imitation by training on the student's own rollouts. However, on questions where every rollout fails-yielding zero advantage and being silently discarded-injecting a stronger teacher's response into the policy gradient breaks the on-policy assumption and induces drift. We introduce Zone of Proximal Policy Optimization (ZPPO), inspired by Vygotsky's zone of proximal development, which keeps the teacher inside the prompt rather than the policy gradient. On hard questions, ZPPO constructs two reformulated prompts: a Binary Candidate-included Question (BCQ) pairs one correct teacher response with one incorrect student response as anonymized candidates the student must discriminate, and a Negative Candidate-included Question (NCQ) aggregates the student's wrong rollouts into a single prompt to surface their shared failure modes. A prompt replay buffer recirculates each hard question until it either graduates-the student's mean rollout accuracy on it reaches half- or is FIFO-evicted under finite capacity, amplifying BCQ and NCQ inside the student's current zone of proximal development. On the Qwen3.5 family at four student scales (0.8B-9B) with a 27B teacher, post-trained as vision-language models and evaluated on a 31-benchmark suite (16 VLM, 10 LLM, 5 Video), ZPPO outperforms off/on-policy distillation and GRPO, with the largest gains at the smallest scale.

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

MiniPIC: Flexible Position-Independent Caching in <100LOC

Retrieval-augmented and agentic workloads repeatedly prefill recurring predictable structured inputs (which we call "spans") such as documents and code files. Yet, prefix caching in engines such as vLLM cannot reuse their KV entries unless they share identical prefixes with another request, while Position-Independent Caching (PIC) implementations within production-grade inference servers typically either require substantial server code changes or keep KV state outside the server, incurring host-to-device transfer overhead. We present Minimalistic PIC (MiniPIC): a minimal, flexible and fast vLLM design built from two ingredients: positional-encoding-free KV cache and user-controlled cache-reuse primitives. MiniPIC stores unrotated K vectors in the KV cache, applies RoPE to K tiles inside attention using per-request logical positions, and exposes three user-facing and token-level primitives: block-aligned padding, span separator (SSep), and prompt depend (PDep), that modify hashing behavior and effective block-level causal attention structure. With fewer than 100 lines of core-engine changes plus a custom attention backend, these primitives are sufficient to realize multiple PIC methods, including Block-Attention, EPIC, and Prompt Cache, within the same running vLLM instance, while natively integrating with KV cache CPU offload implementations. On 2WikiMultihopQA, MiniPIC with interleaved scheduling improves prefill throughput by 49% over baseline vLLM, reduces cached-span time-to-first-token by up to two orders of magnitude, preserves the linear prefill scaling of uncached spans, and incurs only 5.7% worst-case overhead.

07.
arXiv (CS.AI) 2026-06-17

LLM Consumer Behavior Theory: Foundations of a Novel Research Field

arXiv:2606.18005v1 Announce Type: new Abstract: Large language models (LLMs) are increasingly deployed as autonomous agents that make consumption decisions on behalf of users. This shift raises fundamental questions for consumer theory, which has traditionally modeled humans as the primary decision-makers. In this paper, we introduce LLM Consumer Behavior Theory, a new field of study concerned with analyzing consumer behavior in agentic markets. Drawing on classical and behavioral economics alongside recent advances in Natural Language Processing, we formalize how human preferences are reflected and acted upon by LLM-based agents, and how agent-level decisions aggregate into market demand. We unify previously fragmented literature on LLM decision-making, human behavior simulation, and preference elicitation under a common economic lens, highlighting where assumptions, such as rationality and heterogeneity, may fail in agentic markets. Rather than providing empirical validation, this paper outlines the scope of LLM consumer behavior and identifies open research questions related to alignment, preference representation, and market dynamics.

08.
arXiv (CS.CV) 2026-06-19

DiffMath: Symbol- and Graph-Aware Latent Diffusion Transformer for Handwritten Mathematical Expression Generation

Handwritten Mathematical Expression Generation (HMEG) is challenging due to the complex two-dimensional layouts and long-range structural dependencies of mathematical expressions. Existing methods typically rely on explicit spatial supervision, such as symbol-level bounding boxes, which incurs high annotation costs and limits scalability. In this work, we propose DiffMath, a symbol- and graph-aware latent diffusion framework that leverages the hierarchical structure inherent in LaTeX as a structural prior, eliminating the need for positional supervision. First, we design a Relational Abstract Syntax Tree (RelAST), a generation-oriented representation that distills MathML trees into compact triplet sequences [S, R, D], where each token directly encodes a symbol identity, spatial relation, or nesting depth. Second, we introduce MathVAE, which learns structure-preserving latent representations through symbol-aware and relation-aware perceptual regularization, ensuring that the latent space captures both character semantics and spatial topology. Third, MathDiT performs conditional denoising in this structured latent space, further guided by a global symbol-count prior via Adaptive Layer Normalization (AdaLN) to improve structural coherence. Experiments show that DiffMath produces structurally consistent handwritten expressions, achieves superior performance over existing methods, and improves the accuracy of downstream OCR models through synthetic data augmentation.

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

RL-Index: Reinforcement Learning for Retrieval Index Reasoning

arXiv:2606.16316v1 Announce Type: cross Abstract: Retrieving external knowledge is essential for solving real-world tasks, yet it remains challenging when the relationship between a query and its relevant knowledge involves implicit and complex reasoning beyond surface-level semantic or lexical matching (e.g., mathematical problems relying on the same theorem or coding requiring deep reasoning). Existing approaches primarily rely on query-side reasoning (e.g., query rewriting), which introduces significant online latency and underutilizes the opportunity to perform reasoning over the knowledge corpus itself (i.e., index-side reasoning). In this paper, we propose RL-Index, an agentic indexing framework that formulates retrieval index reasoning as a reinforcement learning problem. Instead of performing reasoning at query time, RL-Index shifts reasoning to the indexing stage by augmenting documents with LLM-generated rationales that explicitly encode the latent query-knowledge relationship. To optimize the quality of these rationales, we employ Group Relative Policy Optimization (GRPO) and use retrieval similarity as a verifiable reward signal, enabling direct optimization of indexing decisions for retrieval effectiveness. Extensive experiments on the BRIGHT benchmark demonstrate that RL-Index consistently improves both retrieval and downstream question-answering performance, while significantly reducing online inference latency. Moreover, the learned rationale augmentation generalizes across diverse retrievers and generators, highlighting its robustness as a plug-and-play indexing strategy across different retrieval systems.

10.
arXiv (CS.CV) 2026-06-15

PMOF: A Dataset and Benchmark for Passenger Monitoring Using Overhead Fisheye Cameras

Autonomous staff-free public transport requires reliable in-vehicle passenger monitoring. However, perception inside moving vehicles is challenged by confined spaces, variable illumination, motion-induced background variation, occlusion, and limited viewpoints. To mitigate these spatial constraints, ceiling-mounted fisheye cameras provide full-scene coverage from a single viewpoint. Yet existing public overhead fisheye datasets are recorded in static environments and do not capture the domain shift introduced by vehicle motion. To fill this gap, we introduce PMOF, Passenger Monitoring using Overhead Fisheye cameras, the first public dataset of top-view fisheye imagery captured inside a moving vehicle, comprising over 19k manually annotated frames. PMOF provides rotated bounding boxes, tracking identifiers, and action labels, supporting object detection, tracking, and action recognition. We benchmark PMOF using YOLO26m-obb models fine-tuned under multiple dataset configurations that combine PMOF with existing overhead fisheye datasets. Cross-domain fine-tuning with custom rotation-aware augmentation achieves 94.8% AP50 on PMOF and 96.5% AP50 on an unseen overhead fisheye dataset from a different domain. Our results highlight the domain gap between static and moving environments and show that incorporating PMOF improves detection performance and advances generalization beyond passenger monitoring to broader fisheye-based person detection tasks. The dataset and code are available at https://swermuth.github.io/pmof/.

11.
medRxiv (Medicine) 2026-06-18

Biomedical Capacity, Governance, and Health Security: A Dominican Republic Research Analysis of Stakeholder Perspectives

The COVID-19 pandemic exposed critical vulnerabilities in globally concentrated biomedical supply chains and accelerated interest in nearshoring and hemispheric health-security strategies. The Dominican Republic, already the third-largest medical device exporter in Latin America, occupies a strategically significant but institutionally constrained position within this realignment. This study evaluates stakeholder perceptions of the principal opportunities and barriers affecting biomedical ecosystem development in the Dominican Republic, with particular attention to governance, workforce capacity, and value-chain upgrading pathways. Methods. A concurrent mixed-methods design was employed, integrating a cross-sectional electronic survey of 142 purposively sampled domain experts (administered September-December 2025) with a qualitative executive consultation with senior government and industry leaders. Survey analyses combined descriptive statistics, one-sample t-tests against the scale neutral midpoint, chi-square goodness-of-fit tests, Friedman non-parametric ranking, Spearman rank correlations, and exploratory linear and logistic multivariable regression. Qualitative responses were analyzed using a framework approach grounded in the Triple Helix model of innovation systems. Results. Perceived government support was significantly below neutral (mean = 2.67, SD = 1.12; p = 0.034). Workforce shortages (83.3%) and weak academia-industry collaboration (71.4%) were the most frequently endorsed barriers ({chi}2(5) = 18.7, p = 0.002). Regulatory modernization (88.1%) and workforce development (85.7%) ranked as the highest-priority policy levers (Friedman p = 0.005). Clinical trials and contract research organization services were the dominant sub-sector priority (76.2%, binomial p < 0.001). In multivariable analysis, perceived government support, talent availability, and confidence in IP protection jointly explained 46% of the variance in sector competitiveness (R2 = 0.46, p < 0.001). Strong majority support existed for a formal public-private biomedical coordination authority (73.8%, p < 0.001).Conclusion. Institutional credibility and advanced human capital–rather than geography or market access–are the perceived binding constraints on the Dominican Republics biomedical trajectory. Regulatory modernization, targeted workforce investment, and the establishment of a national biomedical coordination authority represent the highest-leverage interventions for positioning the country as a hemispheric hub for biomedical manufacturing, clinical research, and health security.

12.
medRxiv (Medicine) 2026-06-11

Computer Vision Scoring of Figure Copy and Recall

Objective. Figure copy and recall tests are sensitive measures of visuoconstruction and visual episodic memory, but their clinical is constrained by labor-intensive manual scoring. We developed and validated an automated, element-level scoring pipeline using Vertex AI object detection for the tablet-based figure copy and recall tasks in the California Cognitive Assessment Battery (CCAB). The automated scoring pipeline duplicated the scoring procedures used by expert manual raters. Methods. A normative sample of 2,011 community-dwelling adults aged 18-90 completed figure copy and delayed recall trials at baseline, with subsamples retested at 1 day and at 6, 18, and 30 months. Participants completed the drawings with their index finger on a tablet computer with finger position digitized to analyze the speed and timing of individual drawing strokes A convolutional object-detection model trained on the Vertex AI AutoML Vision platform identified each of twelve canonical figure elements in rendered drawings. Separate element presence and location scores were computed after homographically warping drawings onto a canonical template to produce trial-level Element, Location, and Total scores. To compare Vertex and human scores, Vertex AI and expert human raters independently scored 1500 randomly selected drawings to evaluate inter-rater agreement, including a common subset of 100 drawings scored by Vertex AI and all raters. Results. Total scores were virtually indistinguishable (r = 0.966) from human-human agreement (mean r = 0.971) as were Element presence scores (mean r = 0.959 vs. r = 0.963). Location-score agreement (r = 0.951) was slightly below the human-human mean (r = 0.972) due to pixel-level analysis by Vertex AI that was impossible for human raters. The Vertex pipeline showed no preferential advantage for the single expert rater who categorized Elements during training. Automated scores showed strong demographic gradients, age effects on Recall (r = -0.32) were approximately twice those in Copy conditions (r = -0.16). A Memory Cost score (Recall - Copy) showed a monotonic age-related decline from +0.40 z in the youngest subjects to -0.54 z in the oldest. Kinetic analysis revealed that drawing speed and efficiency showed significant age-related changes. Overnight test-retest reliability was high (Recall r = 0.72) and the Recall trial showed a large overnight learning effect ({Delta} = +1.18) that continued with repeated tests up to 30 months ({Delta} = +0.75).

13.
arXiv (CS.CL) 2026-06-19

Beyond Global Replanning: Hierarchical Recovery for Cross-Device Agent Systems

Real-world computer-use tasks often span multiple applications and devices, requiring agents to coordinate heterogeneous environments under dynamic runtime failures. Existing multi-device agent systems support task decomposition and cross-device assignment, but recovery remains largely coarse-grained: when execution fails, they typically retry the same strategy, reassign the subtask, or revise the global plan, without systematically modeling the device-local strategy space. This limits their ability to distinguish failures that can be repaired within the current device from those that require cross-device replanning. We propose H-RePlan, a hierarchical replanning framework for multi-device agents with unified API–CLI–GUI execution. H-RePlan equips each device with interchangeable execution strategies and separates device-local strategy recovery from orchestrator-level global replanning through a compact cross-layer failure abstraction. To evaluate this capability, we introduce HeraBench, a fault-injected benchmark that constructs cross-device workflows over Linux and Android devices and injects strategy- and device-level failures. Experiments show that H-RePlan substantially outperforms single-strategy and coarse-grained multi-device baselines, achieving higher completion, instruction adherence, and perfect-pass rates while reducing the token cost required for reliable end-to-end success. These results demonstrate that scope-aware hierarchical recovery is essential for robust multi-device agent execution.

14.
arXiv (CS.AI) 2026-06-16

Proximal Policy Optimization for Amortized Discrete Sampling

arXiv:2606.15793v1 Announce Type: cross Abstract: This paper explores policy gradient algorithms for training stochastic policies to sample from structured discrete probability distributions under the Generative Flow Network (GFlowNet) framework. Building on extensive theoretical connections between GFlowNets and entropy-regularized reinforcement learning, we derive equivalents of standard policy gradient algorithms for training GFlowNets, as well as experimentally explore their various methodological aspects, including baseline training and advantage estimation. Most importantly, our work is the first to derive and successfully apply proximal policy optimization to GFlowNets, showing its improved convergence speed and data efficiency compared to standard GFlowNet training objectives on benchmarks ranging from synthetic energies to molecular graph generation.

15.
medRxiv (Medicine) 2026-06-15

Investigation of Intra-Fraction Stability and Inter-Fraction Reproducibility of Deep Inspiration Breath-Hold Across Two Hypofractionated Radiotherapy Regimens in the HYPORT Adjuvant Study.

Background: Deep Inspiration Breath Hold (DIBH) is a widely used respiratory motion management technique for minimizing cardiac dose in left-sided breast radiotherapy. In the Breast HYPORT Adjuvant study, DIBH was employed for cardiac sparing in patients without nodal irradiation using a standardized institutional protocol with the Varian Real-time Position Management (RPM) system. Both moderate-hypofractionation (control arm - 40Gy in 15 fractions) and one-week hypofractionation (experimental arm - 26 Gy in 5 fractions) regimens were delivered using this protocol. This study aimed to evaluate the robustness of DIBH by analyzing intra-fraction stability and inter-fraction reproducibility of breath-hold amplitude across the two treatment regimens. Methods: Respiratory waveforms acquired during each treatment session were analyzed to determine the median breath-hold amplitude and its standard deviation during beam delivery. Intra-fraction stability was assessed from vari- ations within individual treatment sessions, while inter-fraction reproducibility was evaluated relative to the simula- tion waveform amplitude across all treatment sessions. These parameters were compared between the two HYPORT regimens to examine breath-hold consistency during treatment delivery. Moreover, an additional comparison was made between the one-week hypofractionation regimen and the first five fractions of the moderate-hypofractionation regimen to evaluate the effect of treatment duration . Lung volumes from free-breathing and DIBH CT scans were analyzed to assess the effectiveness of patient breath-hold training. Results: Both arms demonstrated an average 1.7-fold increase of air volume in lung during the breath-hold position, confirming the effective implementation of DIBH during treatment planning and delivery. Structured training resulted in increased breath-hold amplitudes, with gains of 22.87% and 24.16% with respect to the first trial session in the experimental and control arms, respectively. Both regimens receive equivalent doses for approximately the same air volume in lung . Despite the different prescription doses in the two arms (26 Gy vs. 40 Gy), the experimental arm achieved an equivalent mean heart dose of 2.91% (75.6 cGy) compared with 2.95% (118.51 cGy) in the control arm, suggesting a similar cardiac preservation protocol adopted during treatment planning. Intra-fraction stability was similar between the control arm and the experimental arm, with median amplitude variations of 1.006 mm (95% CI: [0.998-1.015]) and 1.079 mm (95% CI: [1.067-1.097]), respectively. In contrast, inter-fraction reproducibility improved in the experimental arm, with lower deviation from simulation amplitude (0.44 {+/-} 0.24 mm vs. 0.66 {+/-} 0.25 mm) for the entire treatment schedule. The stability and reproducibility of experimental arm were further compared with the first five fractions of the control arm. The results were similar to those of the experimental arm. Conclusion: In this study, we compared two treatment regimens in terms of intra-fraction stability and inter-fraction reproducibility during DIBH radiotherapy. Both regimens demonstrated comparable intra-fraction stability, indicating effective motion management irrespective of treatment duration. However, the experimental arm showed better inter- fraction reproducibility, suggesting more consistent breath-hold performance throughout the treatment course. Based on stability and reproducibility, a reasonable narrowing of the DIBH gating window may be implemented with minor changes to the institutional protocol. The observed trend highlights the potential for improved consistency with the experimental approach and supports further investigation to better understand the underlying factors and strengthen these findings in future studies.

16.
arXiv (CS.AI) 2026-06-11

Precomputing Multi-Agent Path Replanning Using Temporal Flexibility

arXiv:2601.04884v3 Announce Type: replace Abstract: Executing a multi-agent plan can be challenging when an agent is delayed, because this typically creates conflicts with other agents. So, we need to quickly find a new safe plan. Replanning only the delayed agent often does not yield an efficient plan, and sometimes cannot even yield a feasible one. On the other hand, replanning other agents may lead to a cascade of changes and delays, and it is computationally expensive. We show how to efficiently replan a single delayed agent by tracking and using the temporal flexibility of other agents while avoiding cascading delays. This flexibility is the maximum delay that the agent can take without changing the order with agents other than the initially delayed agent, or further delaying other agents. Our algorithm, FlexSIPP, precomputes all possible plans for the delayed agent and returns the changes to the other agents within the given scenario. We demonstrate our method in a real-world case study of replanning trains in the densely-used Dutch railway network and in the MovingAI MAPF benchmark set. Our experiments show that FlexSIPP provides effective solutions relevant to real-world adjustments, and within a reasonable timeframe.

17.
medRxiv (Medicine) 2026-06-22

Cumulative Metabolic Exposure to Hyperglycemia and Risk of Cardiovascular and Limb Events in Peripheral Artery Disease

Background: Although diabetes is a potent risk factor for the development of peripheral artery disease (PAD), the effect of cumulative metabolic exposure to hyperglycemia on risk of cardiovascular or limb events in patients with PAD remains unclear. Methods: The Peripheral Artery Disease: Long-term Survival (PEARLS) is a longitudinal registry of Veterans with newly diagnosed PAD identified using a natural language processing approach. Included patients had ankle brachial index [&le;]0.9 or toe brachial index [&le;]0.7, and no history of lower extremity revascularization or major amputation. Among patients with diabetes in this cohort, we assessed cumulative exposure to hyperglycema based on a 24-month rolling average of hemoglobin (Hgb) A1c values, categorized as [&le;]7%, >7% to [&le;]8%, and >8%. Multivariable Cox regression models evaluated the association between categories of HgbA1c, modeled as a time-varying exposure, and risk of cardiovascular (CV: myocardial infarction or stroke) and limb (chronic limb threatening ischemia [CLTI] or major amputation) events. Results: Among 45,109 patients with new diagnosis of PAD and pre-existing diabetes, the mean HgbA1c at baseline was 7.5%, with nearly one-third (30.4%) having HgbA1c >8%. The mean age was 70.4 years, 19.8% were Black and 4% were Hispanic. Patients with baseline HgbA1c >8% were younger and compared to those with HgbA1c [&le;]7%, more likely to have coronary disease, kidney disease, and obesity. Over a median follow up of 4.2 years, 8,306 (18.4%) patients experienced a CV event, and 8,199 (18.2%) experienced a limb event. The adjusted association between HgbA1c and hazard of CV events was 12% higher in patients exposed to HgbA1c >7% to [&le;]8% (HR 1.12; 95%CI: 1.05-1.18) and 38% higher in those exposed to HgbA1c >8% (HR 1.38; 95%CI: 1.30-1.46), compared to HgbA1c 7% to [&le;]8% (HR 1.20; 95%CI: 1.13-1.28) and HgbA1c >8% (HR 1.60; 95%CI: 1.51-1.70), respectively when compared to HgbA1c [&le;]7%. These findings were consistent in subgroups based on age and severity of PAD. Conclusions: Among diabetic patients with PAD, cumulatiave metabolic exposure to hyperglycemia is associated with a markedly increased risk of clinical events, especially limb events.

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

We Need Explanation Cards to Connect Explanation Algorithms to the Real World

arXiv:2606.16786v1 Announce Type: new Abstract: Algorithmic explanations are intended to help stakeholders understand opaque algorithmic decisions, but in practice, they often fall short. First, the meaning of algorithmic explanations is often not what one might intuitively expect, so expert knowledge is required to interpret them correctly. Second, recent work has shown that popular explanation algorithms are uninformative about the behavior of complex decision functions. Together, these issues create a gap between what explanations appear to convey and what they actually provide. In this work, we propose Explanation Cards for Explanation Algorithms, which augment standard explanations with complementary information about robustness and validity, as well as clear instructions for interpretation. The complementary information can render otherwise uninformative explanations practically useful, while also helping to detect cases where they are not. Importantly, the interpretation instructions in explanation cards shift responsibility from users to providers: Rather than expecting users to recognize what can and cannot be concluded from an explanation, providers must make this explicit upfront. Using counterfactual explanations and SHAP as examples, we demonstrate how providers can construct explanation cards and that these cards provide users with the guidance needed for sound interpretation. We further argue that explanation cards offer a practical means of operationalising the explainability provisions of the EU AI Act. Overall, explanation cards are a significant step toward making explanation algorithms fit for real-world use cases.

19.
medRxiv (Medicine) 2026-06-17

Postoperative Cognitive Decline in Older Patients with Cardiovascular Disease and Preoperative Mild Cognitive Impairment

Objective. Older adults undergoing cardiac surgery may be vulnerable to postoperative cognitive decline. However, no studies have examined postoperative cognitive outcomes in older patients with cardiovascular disease (CVD) according to preoperative mild cognitive impairment (MCI). This study examined 12-month postoperative cognitive outcomes in older CVD patients according to preoperative MCI diagnosis and explored predictors of postoperative cognitive decline. Method. Twenty-two older CVD patients ([&ge;]65 years) and twenty-five controls were included. Neuropsychological assessment was conducted at baseline in both groups and repeated 12 months after surgery in the CVD group. MCI was diagnosed using current clinical criteria. Postoperative cognitive change was examined across preoperative MCI groups. Results. Fifty percent of patients met criteria for postoperative MCI, showing high diagnostic stability relative to preoperative frequency (45.5%). The preoperative CVD-MCI group showed a decline in working memory, executive functions, visual memory, and naming, whereas CVD-nMCI group declined only in verbal memory. Furthermore, CVD-MCI showed more heterogeneous postoperative cognitive trajectories of change than CVD-nMCI, who showed stability. Estimated IQ, APACHE-II score, and postoperative frailty were important variables in predicting the postoperative pattern. Conclusions. MCI frequency remained high and stable in older CVD patients across the preoperative and one-year postoperative period. However, this apparent diagnostic stability masks subclinical cognitive decline, particularly among patients with preoperative MCI, who showed greater susceptibility to further impairment. Estimated IQ, APACHE-II score, and postoperative frailty may be considered relevant predictors of outcome. These results highlight the value of preoperative neuropsychological assessment for characterizing postoperative cognitive risk in older CVD patients.

20.
arXiv (math.PR) 2026-06-15

Ergodicity for stochastic 2D Boussinesq equations with a highly degenerate pure jump Levy noise

arXiv:2503.18045v2 Announce Type: replace Abstract: This study aims to analyze the ergodicity for stochastic 2D Boussinesq equations and explore the impact of a highly degenerate pure jump L\'{e}vy noise acting only in the temperature equation, where this noise could appear on only a few Fourier modes. By leveraging the equi-continuity of the semigroup established through Malliavin calculus and an analysis of stochastic calculus, together with the weak irreducibility of the solution process, we prove the existence and uniqueness of the invariant measure. Moreover, we overcome the main challenge of establishing time asymptotic smoothing properties of the Markovian dynamics corresponding to this system by conducting spectral analysis of the Malliavin covariance matrix.

21.
arXiv (CS.AI) 2026-06-19

GDGU: A Gradient Difference-based Graph Unlearning Method for Cyberattack Localization in Electric Vehicle Charging Networks

arXiv:2606.19566v1 Announce Type: cross Abstract: Electric vehicle charging stations (EVCSs) can expose distribution feeders to cyberattacks. While machine learning methods, including graph neural networks, can localize which bus is compromised, significant challenges remain in data sharing and model training. For example, privacy regulations grant EVCS owners the right to delete their training data from a deployed model, yet retraining from scratch on every request is computationally prohibitive. To address this, we study graph unlearning (GU) for EVCS cyberattack localization, formulated as a feature-level unlearning problem on a graph-level multi-label classification task. Specifically, we propose gradient difference-based graph unlearning (GDGU), which removes the influence of the requested deletion data through a first-order parameter correction. The correction is computed from the gradient difference between the original training data and a modified dataset in which only the charging power features at the requested EVCS buses are unlearned. Then, a batch-normalization recalibration and a brief recovery fine-tuning step are applied to restore localization utility. We benchmark GDGU against two second-order GU baselines on the IEEE 34-bus, 123-bus, and 8500-node distribution networks across three graph neural network backbones and cumulative unlearning scenarios. GDGU matches the strongest baseline on localization utility and reaches forgetting fidelity close to full-retraining, while unlearning 10 to 12 times faster than retraining from scratch and using far less memory than the second-order GU baselines.

22.
arXiv (CS.AI) 2026-06-16

RetailBench: Benchmarking long horizon reasoning and coherent decision making of LLM agents in realistic retail environments

arXiv:2606.15862v1 Announce Type: new Abstract: Large language model (LLM) agents have made rapid progress on short-horizon, well-scoped tasks, yet their ability to sustain coherent decisions in dynamic long-horizon environments remains uncertain. We introduce RetailBench, a data-grounded simulation benchmark for evaluating tool-using LLM agents in single-store supermarket operation. RetailBench models retail management as a partially observable decision process and is designed to support thousand-day-scale simulations. In this environment, agents must manage pricing, replenishment, supplier selection, shelf assortment, inventory aging, customer feedback, external events, and cash-flow constraints. We evaluate seven contemporary LLMs under representative agent frameworks over a 180-day evaluation horizon and compare them with a privileged oracle policy. Results show substantial variation across models: only a small subset survives the full evaluation horizon, and even the strongest LLM runs remain substantially behind the oracle policy in final net worth and sales outcomes. Behavioral analysis attributes these gaps to incomplete evidence acquisition, surface-level decision making, and the lack of a consistent long-horizon policy. RetailBench provides a controlled testbed for studying reliable autonomy in economically grounded long-horizon decision-making.

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

Guidelines for the Annotation and Visualization of Legal Argumentation Structures in Chinese Judicial Decisions

This Guideline presents a systematic and operationalizable annotation framework for representing legal argumentation structures in judicial decisions. Grounded in theories of legal reasoning and argumentation, the framework aims to reveal the logical organization of judicial reasoning and provide a reliable foundation for computational analysis. At the element level, the Guideline distinguishes between the non-propositional layer and the propositional layer. The non-propositional layer consists of two elements: Issue and Non-argumentative Component. At the propositional level, the Guideline defines four proposition types: General Normative Judgment, Particular Normative Judgment, General Factual Judgment, and Particular Factual Judgment. At the relational level, five relation types are defined to represent argumentative structures: Support, Attack, Joint, Match, and Identity. These relations capture positive and negative argumentative connections, conjunctive reasoning structures, correspondences between legal norms and case facts, and identity or semantic equivalence between propositions. The Guideline further specifies formal representation rules and visualization conventions for both basic and nested structures, enabling consistent visualization of complex argumentation patterns. In addition, it establishes a standardized annotation workflow and consistency control mechanisms to ensure the reproducibility and reliability of annotated data. By providing a clear conceptual model, formal representation rules, and practical annotation procedures, this Guideline supports large-scale analysis of judicial reasoning and future research in legal argument mining, computational modeling of legal reasoning, and AI-assisted legal analysis.

24.
arXiv (CS.CV) 2026-06-11

From 2D Grids to 1D Tokens: Reforming Shared Representations for Multimodal Image Fusion

Multimodal image fusion aims to integrate complementary information from different modalities into a fused image that preserves rich local details while maintaining globally consistent appearance. Existing approaches build shared representations on 2D feature grids, which excel at modeling local structures but offer limited leverage over image-level global appearance factors. To balance these objectives, we introduce a compact 1D token interface based on a frozen pretrained image tokenizer for modeling non-local appearance/base factors. Rather than using the tokenizer as a reconstruction backbone, our design uses the 1D token space as a global carrier while retaining the 2D spatial pathway for local structure restoration. Specifically, we introduce Selective Token Editing (STE), which sparsely updates/replaces a small set of critical tokens, providing a lightweight mechanism to steer global appearance coherence while keeping the fusion backbone unchanged and avoiding extra losses. Experiments on four commonly used benchmarks show that our method achieves the best overall performance, with consistent, multi-metric improvements in both global coherence and local fidelity. Project page: https://zju-xyc.github.io/1D-Fusion-Project-Page/

25.
arXiv (CS.AI) 2026-06-11

Lung-SRAD: Spectral-Aware Regularized Audio DASS with Dual-Axis Patch-Mix Contrastive Learning for Respiratory Sound Classification

arXiv:2606.11922v1 Announce Type: cross Abstract: Recent respiratory sound classification (RSC) studies largely rely on CLS-token driven self-attention architectures such as the Audio Spectrogram Transformer (AST). While effective at modeling global context, recent analyses suggest a low-pass filtering behavior that may reduce sensitivity to localized abnormal patterns. In this work, we investigate State Space Models (SSMs) as an alternative backbone for RSC. Using the Distilled Audio State Space model, we analyze intermediate representations through spectral response curves and observe stronger preservation of mid-to-high spatial-frequency components. Based on these observations, we introduce spectral-aware layer regularization using Gaussian convolution applied to selected layers. We further propose Dual-Axis Patch-Mix contrastive learning tailored to SSM-based audio models for robust representation learning. Experiments on the ICBHI benchmark show that our approach achieves 64.48% score, outperforming the AST baseline by 5%. Code is available at https://github.com/RSC-Toolkit/Lung-SRAD.