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01.
arXiv (quant-ph) 2026-06-16

Quantum enhancement and Doppler suppression of Kasevich-Chu atom interferometer with motional squeezing states

arXiv:2606.16632v1 Announce Type: new Abstract: Hybridization of internal and external atomic degrees of freedom in a Kasevich-Chu interferometer enables the possibility to enhance the sensitivity significantly even under quantum-standard limit. By introducing motional squeezing state as an input, we systematically derive the computational framework of quantum and classical Fisher information of two measurement protocols for arbitrary strength of Doppler effects. Through maximizing the corresponding classical Fisher information, we obtain the optimal control parameters and the corresponding quantum Fisher information. For population measurement, the largest sensitivity can be as large as four times than the semi-classical limit through enlarging the atom coherence length. For joint measurement of population and position, the competition between quantum enhancement and Doppler suppression induces two three behaviors, in one regime, the quantum enhancement dominates even in presence of strong Doppler broadening effects where the sensitivity is significantly enhanced; while in another regime, an optimal squeezing parameter is observed where the classical Fisher information reaches the maximum. Our results clearly demonstrate the robustness of external quantum enhancement against Doppler suppression. Our proposal can be readily applied to gravimeter of mobile platform where decoherence from noise will damage the many-body entanglement of internal spin squeezing.

02.
arXiv (CS.AI) 2026-06-18

Robust Regularized Policy Iteration under Transition Uncertainty

arXiv:2603.09344v3 Announce Type: replace Abstract: Offline reinforcement learning (RL) enables data-efficient and safe policy learning without online exploration, but its performance often degrades under distribution shift. The learned policy may visit out-of-distribution state-action pairs where value estimates and learned dynamics are unreliable. To address policy-induced extrapolation and transition uncertainty in a unified framework, we formulate offline RL as robust policy optimization, treating the transition kernel as a decision variable within an uncertainty set and optimizing the policy against the worst-case dynamics. We propose Robust Regularized Policy Iteration (RRPI), which replaces the intractable max-min bilevel objective with a tractable KL-regularized surrogate and derives an efficient policy iteration procedure based on a robust regularized Bellman operator. We provide theoretical guarantees by showing that the proposed operator is a $\gamma$-contraction and that iteratively updating the surrogate yields monotonic improvement of the original robust objective with convergence. Experiments on D4RL benchmarks demonstrate that RRPI achieves strong average performance, outperforming recent baselines including percentile-based methods on the majority of environments while remaining competitive on the rest. Moreover, RRPI exhibits robust performance by aligning lower $Q$-values with high epistemic uncertainty, which prevents the policy from executing unreliable out-of-distribution actions.

03.
arXiv (CS.CV) 2026-06-16

BRDFusion: Physics Meets Generation for Urban Scene Inverse Rendering

Inverse rendering of urban scenes from captured videos enables numerous applications, including content creation and autonomous driving simulation. Physically-based rendering methods follow and control lighting physics, but suffer from reconstruction and rendering artifacts. While generative models produce realistic videos, they offer limited consistency and controllability. We present BRDFusion, a unified framework that combines two complementary models for inverse and forward rendering. Specifically, BRDFusion recovers explicit, consistent scene properties with physical modeling and alleviates optimization ambiguity with generative priors. During forward rendering, the physical model provides controllable rendering from the scene configuration, and the generative model denoises and fixes artifacts. Therefore, our method produces high-quality videos while allowing precise control, outperforming baselines in real and synthetic scenes. Moreover, BRDFusion supports novel-view relighting, night simulation, and dynamic object insertion/editing. Project page: https://shigon255.github.io/brdfusion-page/

04.
arXiv (CS.CL) 2026-06-16

DoubtProbe: Black-Box Jailbreak Defense via Structural Verification and Semantic Auditing

As large language models (LLMs) are increasingly deployed in user-facing systems, black-box jailbreak defense has become an important practical problem. Existing defenses often rely on known-attack coverage, prompt-level semantic judgment, or local runtime control, yet these paths can become unstable under evolving prompt packaging, expression rewriting, and structure manipulation. We observe that many black-box jailbreaks do not remove the harmful goal, but reorganize the information needed to express and execute it, thereby evading safety alignment while remaining recoverable during generation. Motivated by this observation, we propose DoubtProbe, a dual-branch inference-time defense framework that combines structural verification with semantic auditing and formulates black-box jailbreak defense as consistency checking under controlled transformation. The structural branch extracts a structured representation from the original request, reconstructs the request under representation constraints, and detects information-preservation failures between the original and reconstructed requests; the semantic branch audits the original prompt directly. We evaluate DoubtProbe against representative black-box defenses on jailbreak and benign-request benchmarks, and further test backbone transfer from Qwen2.5-72B to Llama-3.1-70B. Results show that DoubtProbe achieves a stronger and more stable defense-utility trade-off: on Qwen2.5-72B, it reduces the JBB attack success rate from 0.293 to 0.100 and the CodeAttack attack success rate from 0.152 to 0.001, while maintaining false positive rates of 0.022 and 0.016 on AlpacaEval and OR-Bench; the same pattern remains stable on Llama-3.1-70B. These findings show that structural inconsistency signals provide a practical and generalizable basis for black-box jailbreak defense, especially when combined with semantic auditing.

05.
arXiv (CS.LG) 2026-06-16

False Sense of Safety in Selective Signal Classification: Auditing Bound Tightness and Exchangeability for Risk Control

arXiv:2606.15153v1 Announce Type: new Abstract: Selective prediction with distribution-free risk control promises that, with confidence 1-delta over the calibration draw, the error rate of accepted inputs stays below a user budget alpha. We audit this promise on signal-domain detectors – machine anomalous-sound detection (ASD) and AI-generated-image forensics – for four calibration rules: uncertified empirical thresholding (NAIVE) and certified Hoeffding, Clopper-Pearson (CP), and betting (WSR) upper confidence bounds. We report three findings. (i) NAIVE thresholding, common in practice, exceeds its declared budget in 49-73% of synthetic trials (n=200 calibration points) and in up to 68% of real-data splits: a false sense of safety rather than a broken theorem, since the rule never had a certificate. (ii) Tightness matters: CP and WSR certify substantial coverage where Hoeffding certifies none, with zero observed budget overruns under exchangeable splits. (iii) Under grouped deployment (unseen machine types or generators), certified rules overrun in 9-30% of trials – far above delta – showing the failure lies in the broken exchangeability premise, not in the bounds; a conservative per-group threshold restores validity at a severe coverage cost.

06.
arXiv (CS.AI) 2026-06-18

Enhancing CVRP Solver through LLM-driven Automatic Heuristic Design

arXiv:2602.23092v2 Announce Type: replace Abstract: The Capacitated Vehicle Routing Problem (CVRP), a fundamental combinatorial optimization challenge, focuses on optimizing fleet operations under vehicle capacity constraints. While extensively studied in operational research, the NP-hard nature of CVRP continues to pose significant computational challenges, particularly for large-scale instances. This study presents AILS-AHD (Adaptive Iterated Local Search with Automatic Heuristic Design), a novel approach that leverages Large Language Models (LLMs) to revolutionize CVRP solving. Our methodology integrates an evolutionary search framework with LLMs to dynamically generate and optimize ruin heuristics within the AILS method. Additionally, we introduce an LLM-based acceleration mechanism to enhance computational efficiency. Comprehensive experimental evaluations against state-of-the-art solvers, including AILS-II and HGS, demonstrate the superior performance of AILS-AHD across both moderate and large-scale instances. Notably, our approach establishes new best-known solutions for 8 out of 10 instances in the CVRPLib large-scale benchmark, underscoring the potential of LLM-driven heuristic design in advancing the field of vehicle routing optimization.

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

Structure-Aware Text Recognition for Ancient Greek Critical Editions

Recent advances in visual language models (VLMs) have transformed end-to-end document understanding. However, their ability to interpret the complex layout semantics of historical scholarly texts remains limited. This paper investigates structure-aware text recognition for Ancient Greek critical editions, which have dense reference hierarchies and extensive marginal annotations. We introduce two novel resources: (i) a large-scale synthetic corpus of 185,000 page images generated from TEI/XML sources with controlled typographic and layout variation, and (ii) a curated benchmark of real scanned editions spanning more than a century of editorial and typographic practices. Using these datasets, we evaluate three state-of-the-art VLMs under both zero-shot and fine-tuning regimes. Our experiments reveal substantial limitations in current VLM architectures when confronted with highly structured historical documents. In zero-shot settings, most models significantly underperform compared to established off-the-shelf software. Nevertheless, the Qwen3VL-8B model achieves state-of-the-art performance, reaching a median Character Error Rate of 1.0\% on real scans. These results highlight both the current shortcomings and the future potential of VLMs for structure-aware recognition of complex scholarly documents.

09.
arXiv (CS.LG) 2026-06-19

Learning universal approximations for partial differential equations with Physics-Informed Broad Learning System

arXiv:2606.19754v1 Announce Type: new Abstract: Partial differential equations (PDEs) play a central role in modeling complex physical, biological, and engineering systems. While traditional numerical solvers are robust, they often incur prohibitive computational costs due to mesh dependencies, whereas recent Physics-Informed Neural Networks (PINNs) offer a mesh-free alternative but frequently suffer from slow convergence and optimization instability. To bridge this gap, this article proposes the Physics-Informed Broad Learning System (PIBLS), a novel backpropagation-free framework that reformulates PDE solving as a direct least-squares optimization. We improved an algorithm within this framework to handle nonlinear PDEs efficiently and provide a rigorous mathematical proof establishing the universal approximation property of PIBLS for these equations. Experiments on linear and nonlinear PDEs demonstrate that PIBLS is one to three orders of magnitude faster than conventional PINNs while achieving significantly higher solution accuracy. This framework provides a computationally efficient paradigm for scientific machine learning, offering a practical, high-speed alternative for real-time simulation and design optimization tasks.

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

Learning Instance-Adaptive Low-Rank Orthogonal Subspaces for Clothes-Changing Person Re-Identification

Clothes-changing person re-identification (CC-ReID) aims to recognize individuals despite drastic appearance changes caused by clothing variation. While existing methods rely on adversarial learning to disentangle clothing features, we propose Ortho-ReID, which explicitly models a low-rank clothing subspace from VLM text descriptions and extracts clothing-invariant representations via direct geometric constraints. A critical component is our transformer-based Basis Maker, which refines a shared, low-dimensional clothing prior into an instance-adaptive low-rank subspace through cross-attention with image patches, enabling robust clothing feature extraction even under varying visibility conditions. This instance-adaptive subspace is supervised via alignment with clothing text embeddings, while identity features are extracted via a learnable projection head and geometrically constrained to be strictly orthogonal to it. Extensive experiments demonstrate state-of-the-art performance on PRCC (+5.9% top-1), Celeb-reID-light (+3.5%), and LaST (+5.3%), with competitive results on LTCC.

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

SurgVista: Long-Horizon Surgical World Modeling with Plausible Instrument-Tissue Dynamics

Scaling robot policy learning for autonomous surgery is challenging, as expert demonstrations are expensive and in vivo exploration poses substantial safety risks. Surgical world models address this by generating realistic, action-conditioned future frames from an initial observation, but existing methods exhibit two persistent failure modes: spatial interaction incoherence, where visible instrument contact fails to induce spatially consistent tissue deformation, and temporal fidelity collapse, where prediction errors compound across autoregressive rollouts and progressively corrupt visual quality. We present SurgVista, a surgical world model that mitigates both failures through two training recipes. Deformation Consistency Regularization extracts scene-point trajectories from training videos and enforces cross-frame coherence through latent contrastive learning, strengthening physically consistent instrument-tissue dynamics. Drift Adaptation Training mitigates long-horizon drift by perturbing conditioning frames with online prediction residuals and photometric augmentations calibrated to long-horizon drift statistics, sustaining visual fidelity over extended rollouts. To enable rigorous evaluation, we further introduce SurgWorld-Bench, featuring diverse procedure types, long-range rollouts, and decoupled metrics for instrument-motion accuracy and tissue-response fidelity. Extensive experiments show that SurgVista consistently outperforms state-of-the-art methods across visual quality, temporal consistency, and interaction fidelity, with gains widening as the prediction horizon grows.

12.
medRxiv (Medicine) 2026-06-22

The circulating blood proteome of childhood acute leukemia

The circulating blood proteome provides a systemic readout of disease biology and holds promise for advancing diagnostics and disease monitoring in pediatric leukemia. Here, we profiled 3072 proteins in diagnostic serum from 54 children with acute lymphoblastic leukemia (ALL), 21 with acute myeloid leukemia (AML), and 12 healthy controls using the Olink Proximity Extension Assay. We observed profound alterations in circulating protein levels in leukemia patients compared with controls and identified immunophenotype-specific proteins, including SIGLEC15 in B-cell precursor ALL (BCP-ALL), NOTCH1 in T-ALL, and CEBPA in AML, all which remained high even in patients with low (

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

EverydayGPT: Confidence-Gated Routing for Efficient and Safe Hybrid GPT-RAG Conversational QA

Standard Retrieval-Augmented Generation (RAG) pipelines route every query through retrieval and generation unconditionally, incurring unnecessary computation and propagating low-quality context to the generator. We introduce EverydayGPT, a lightweight conversational QA system built around a Confidence-Gated Routing (CGR) mechanism that formalises the routing decision as a joint policy over retrieval distance and extraction adequacy. The backbone is a 205M-parameter GPT trained from scratch on 10B tokens of FineWeb-Edu. CGR avoids invoking the costly GPT pathway (~5.9s) for 85 percent of queries by resolving them via fast RAG extraction (~45 ms), yielding over 120x latency reduction on the majority of queries while maintaining answer quality. On a 500-question in-domain benchmark, the system achieves F1 = 0.226 +/- 0.004 compared to 0.171 for GPT-only and 0.210 for unconditional RAG. Gains over strong baselines are modest but consistent, while efficiency improvements are substantial (6.3x mean latency reduction). A structured grounding audit finds no unsupported claims in the sampled set, with explicit scope limitations. We position this work as a study of routing strategies under resource constraints rather than a claim of state-of-the-art performance.

14.
medRxiv (Medicine) 2026-06-15

Routine use of oral iron for people with heart failure and iron deficiency in primary care; retrospective cohort study

Aims: Iron deficiency is common among people with heart failure and associated with morbidity and mortality. While intravenous iron improves clinical outcomes, oral iron continues to be prescribed in routine practice despite limited evidence of benefit. Methods: We completed a retrospective primary care cohort study (2016 to 2021) to investigate the proportion of people with an incident diagnosis of heart failure who had iron deficiency identified (defined as ferritin

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

UP-NRPA: User Portrait based Nested Rollout Policy Adaptation for Planning with Large Language Models in Goal-oriented Dialogue Systems

To address the challenge that current dialogue policy planning methods struggle to dynamically adapt to diverse user characteristics, this paper proposes a User Portrait based Nested Rollout Policy Adaptation (UP-NRPA) online framework with Large Language Models. In contrast to conventional approaches dependent on model training and require offline reinforcement learning policy models for user groups, UP-NRPA enables dynamic customization of dialogue strategies through an adaptive mechanism. This is achieved by leveraging real-time user feedback alongside personality, preferences, and objectives mapped from the current user portrait, thereby adapting to user characteristics without offline reinforcement learning. In collaborative and non-collaborative dialogue benchmarks, UP-NRPA demonstrated considerable benefits, achieving an impressive 100% success rate in multiple dialogue tasks. Particularly in negotiation tasks, the sale-to-list ratio (SL) increased by 56.41%. This demonstrates that UP-NRPA can adapt to diverse user needs without requiring a training mechanism, enabling the dialogue system to adapt to user characteristics.

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

PRISM: Perception Reasoning Interleaved for Sequential Decision Making

arXiv:2605.05407v2 Announce Type: replace Abstract: Scaling LLM-based embodied agents from text-only environments to complex multimodal settings remains a major challenge. Recent work identifies a perception-reasoning-decision gap in standalone Vision-Language Models (VLMs), which often overlook task-critical information. In this paper, we introduce PRISM, a framework that tightly couples perception (VLM) and decision (LLM) through a dynamic question-answer (DQA) pipeline. Instead of passively accepting the VLM's description, the LLM critiques it, probes the VLM with goal-oriented questions, and synthesizes a compact image description. This closed-loop interaction yields a sharp, task-driven understanding of the scene. We evaluate PRISM on the ALFWorld and Room-to-Room (R2R) benchmarks. We show that: (1) PRISM significantly outperforms state-of-the-art image-based models, (2) our Interactive goal-oriented perception pipeline yields systematic and substantial gains, and (3) PRISM is fully automatic, eliminating the need for handcrafted questions or answers.

17.
arXiv (CS.AI) 2026-06-15

TRACE: Trajectory-Routed Causal Memory for Delayed-Evidence Visuomotor Imitation

arXiv:2606.14551v1 Announce Type: cross Abstract: Robots under autonomous operation may require decisions based on evidence that is no longer visible. We study delayed-evidence tasks, where an early cue disappears before a later decision point, so visually similar observations can require different actions. In these settings, the current observation is not a sufficient state for control. We introduce TRAjectory-routed Causal Evidence (TRACE), a memory framework for visuomotor imitation policies. TRACE stores task-relevant visual and robot-state evidence, such as object identity, target choice, or route-dependent state, in a fixed-size latent memory that remains bounded over long episodes. Instead of indexing memory by raw time or manually provided task labels, TRACE uses path signatures: compact, order-sensitive features of the executed robot-state trajectory. These signatures do not store the visual cue itself; rather, they provide trajectory-conditioned keys for writing and retrieving the evidence stored when the cue was visible. When the robot later reaches an ambiguous observation, the policy conditions on TRACE memory to recover the missing context and choose the correct branch. TRACE attaches through lightweight adapters to policies, without changing the policy backbone, action head, or imitation objective. Across real-world long-horizon manipulation tasks with visually ambiguous branch points, TRACE improves branch selection and task success over alternative baselines, including short-history and recurrent memory. Project page: https://jeong-zju.github.io/trace

18.
arXiv (CS.LG) 2026-06-12

Self-Guidance: Enhancing Neural Codecs via Decoder Manifold Alignment

arXiv:2606.12940v1 Announce Type: cross Abstract: Neural speech codecs based on Vector-Quantized VAEs (VQ-VAEs) are core audio tokenizers for speech LLMs, yet their reconstruction fidelity is bottlenecked by quantization error. Modifying the quantizer or increasing model capacity are common fixes, but they complicate downstream language modeling. Our core idea is to align the decoder's internal feature manifolds when processing both the quantized tokens and their original continuous embeddings, using a lightweight feature-mapping loss. This requires minimal training overhead and no inference-time changes. Applied to XCodec2, self-guidance improves all reconstruction metrics, achieving state-of-the-art low-bitrate performance. Notably, it enables a 4x codebook reduction without fidelity loss, which downstream TTS experiments show significantly improves LLM-based synthesis by simplifying the token modeling space. Multiple statistical observations and visualizations corroborate the enhanced internal manifold alignment in the decoder. Extensive experiments confirm its generality across various inductive biases. Self-guidance thus establishes an efficient, broadly applicable method for high-fidelity neural audio coding.

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

Reinforcement Twinning for Hybrid Control of Flapping-Wing Drones

arXiv:2505.18201v2 Announce Type: replace-cross Abstract: Controlling flapping-wing drones requires controllers that handle time-varying, nonlinear, underactuated dynamics from incomplete, noisy sensor data. Recent advances in artificial intelligence (AI), particularly reinforcement learning (RL), have opened new perspectives for addressing such complex control problems through data-driven policy optimization from interaction with the environment. Yet purely data-driven methods are sample-inefficient, demanding extensive, sometimes unsafe exploration, especially without guiding physical models. This motivates hybrid AI-physics frameworks. This article proposes a hybrid model-free/model-based flight-control approach using the reinforcement twinning algorithm. The model-based (MB) component uses an adjoint formulation and an adaptive digital twin continuously identified from live trajectories; the model-free (MF) component uses RL. The two agents share knowledge via transfer learning, imitation learning, and shared experience between the real environment and the digital twin, coordinated by a policy referee that selects which agent acts in reality based on digital-twin performance and a real-to-virtual consistency ratio. The framework is evaluated for the longitudinal control of a flapping-wing drone, modelled as a nonlinear time-varying system driven by quasi-steady aerodynamic forces. The hybrid strategy is tested under three adaptive-model initializations: (1) offline identification from existing data, (2) random initialization with fully online identification, and (3) offline pre-training with biased parameters followed by online adaptation. In all cases, the hybrid framework improves performance, robustness, and sample efficiency over purely model-free and purely model-based approaches.

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

Attosecond Path Qubits in High-Harmonic Generation: Classical Dephasing and Trace-Out Decoherence

arXiv:2606.20372v1 Announce Type: cross Abstract: High-harmonic generation (HHG) is governed by interference between electron trajectories. We propose that the dominant short and long trajectories define an experimentally addressable two-level subsystem: an attosecond path qubit (APQ). We formulate a trajectory-resolved density matrix to identify two distinct coherence-loss mechanisms: classical dephasing from ensemble averaging and quantum decoherence arising from the trace-out of unobserved degrees of freedom. By investigating shot-to-shot fluctuations and unresolved transverse momentum, we demonstrate that while dephasing suppresses coherence through averaging, the ``trace-out'' channel produces mixed states even for fixed driving parameters. We explore how these mechanisms modify APQ purity and show that mode selection and conditioning provide operational routes to isolate them. These results establish a reduced-state framework for diagnosing coherence loss in HHG and for engineering trajectory-based quantum states in attosecond interferometry.

21.
medRxiv (Medicine) 2026-06-18

Web-based education on Metabolism and Obesity is associated with improved lifestyle and health behaviours among Brazilian school teachers

Background: Obesity is a major global public health challenge, and teachers play a critical role in school-based health promotion. This study examined the perceived impact of a web-based educational program on metabolism and obesity delivered to Brazilian school teachers. Methods: This analytical cross-sectional study included 217 teachers who responded to the evaluation questionnaire after attending the course between 2017 and 2022. Statistical analyses included logistic regression and chi-square tests. Findings: Course completion rate was 81.98%, substantially exceeding the 5-15% typical of global MOOCs. However, ethnic disparities were observed: White respondents were 4.95 times more likely to complete the course than Black respondents (p=0.00097) and Brown respondents were 3.05 times more likely (p=0.0268) than Black respondents. Among non-completers, lack of time (64.7%) was the primary barrier. Participation was concentrated in Sao Paulo (77%), with no respondents from three northern states. Perceived difficulty showed a non-significant trend (p=0.0893) where by Black respondents had the lowest predicted difficulty; the most challenging course material was Scientific Content/Reading papers (50%). Completion was strongly associated with applying learned activities in teaching (p

22.
arXiv (CS.CL) 2026-06-11

Multi-Agent Reasoning with Adaptive Worker Allocation for Stance Detection

Stance detection requires identifying an author's position toward a target, often from short-form texts where stance is implicit, indirect, or rhetorically framed. Although large language models (LLMs) achieve strong performance on this task, single-pass prompting can be brittle when multiple interpretations are plausible. Existing aggregation strategies, such as majority voting or self-consistency, improve robustness by combining labels, but they discard the intermediate reasoning needed to resolve conflicting interpretations. We introduce a multi-agent reasoning framework with adaptive worker allocation for stance detection that shifts aggregation from label-level voting to reasoning-level synthesis. The framework employs a Manager-Worker architecture in which a Manager adaptively allocates a variable number of Worker agents based on input complexity. Each Worker analyzes the input from a distinct perspective and produces a reasoning-only explanation without emitting a stance label; the Manager then synthesizes these explanations to produce the final prediction. We evaluate the proposed framework on SemEval-2016, P-Stance, and COVID-19 Stance using Llama, Mistral, and Gemini. Results show that the framework yields the largest gains on implicit and context-dependent stance cases, achieving 86.07 Macro-F1 on COVID-19 and 82.90 on SemEval-2016, while remaining competitive on more explicit stance datasets such as P-Stance. These findings suggest that adaptive reasoning-level aggregation is most beneficial when stance cannot be reliably inferred from surface cues alone.

23.
arXiv (CS.CL) 2026-06-12

Small LLMs for Biomedical Claim Verification: Cost-Effective Fine-Tuning, Structural Dataset Shortcuts, and Cross-Domain Generalization

作者:

Large Language Models such as GPT-4o and GPT-5 achieve strong zero-shot performance on biomedical claim verification, but cost and opacity limit scalable use. We fine-tune three small LLMs: Phi-3-mini (3.8B), Qwen2.5-3B, and Mistral-7B, via QLoRA on SciFact and HealthVer, providing the first study of QLoRA models against GPT-4o and fine-tuned BioLinkBERT encoders. Mistral-7B QLoRA surpasses both GPT-4o and GPT-5 (up to 12% F1 gain) at a fractional cost using just 1,008 training examples. We conduct extensive in-domain and cross-domain evaluation: models trained on SciFact tested on HealthVer and vice versa, at matched sizes to isolate dataset structure from data quantity. We identify a previously unreported structural artifact in SciFact that inflates in-domain scores, and show through bidirectional out-of-domain evaluation that training on structurally sound data enables robust cross-domain transfer. We plan to release all code and adapter checkpoints.

24.
medRxiv (Medicine) 2026-06-15

ICD-10 Code Ambiguity Obscures Treatment-Eligible Adults with Spinal Muscular Atrophy: A Single-Center Chart Review and Patient Outreach Study

Background. Three disease-modifying therapies (DMTs) for spinal muscular atrophy (SMA) have been approved since 2016, yet many adults remain untreated. Identifying them depends on ICD-10 codes that capture SMA but do not reliably distinguish it from other related conditions. We examined, in one U.S. health system, both patients' engagement with therapy and the accuracy of the codes used to find them. Methods. We conducted a retrospective chart review of adults in an academic health system identified by SMA-associated ICD-10 codes, with manual adjudication of diagnosis and DMT status. Confirmed SMA-positive, DMT-naive patients were invited to a structured telephone interview on treatment awareness and barriers. Results. Of 60 charts, 22 (36.7%; 95% CI 25.6-49.3%) were appropriately coded for SMA or a related disorder; only 16 (26.7%) had molecularly confirmed SMA. The other 38 (63.3%) were miscoded, spanning spinal and bulbar muscular atrophy, asymptomatic carriers, prenatal screening, and conditions unrelated to SMA. Ten of the 16 confirmed patients (62.5%) were DMT-naive; one was interviewed, one declined, and eight could not be reached. The non-response is itself a finding: the patients least visible to administrative data are the hardest to reach. Conclusions. ICD-10 ambiguity is a barrier to treatment access in adult SMA, as is loss to follow-up. We make two recommendations: continuous documentation-coding alignment that uses natural language processing to verify the genetic precondition, and type-specific SMA codes (subcodes for Types 0-4) anchored on molecular SMN1 confirmation. Together these would support cohort identification, outreach, and evidence generation without adding to clinician burden.

25.
arXiv (CS.CL) 2026-06-12

BLUEmed: Retrieval-Augmented Multi-Agent Debate for Clinical Error Detection

Terminology substitution errors in clinical notes, where one medical term is replaced by a linguistically valid but clinically different term, pose a persistent challenge for automated error detection in healthcare. We introduce BLUEmed, a multi-agent debate framework augmented with hybrid Retrieval-Augmented Generation (RAG) that combines evidence-grounded reasoning with multi-perspective verification for clinical error detection. BLUEmed decomposes each clinical note into focused sub-queries, retrieves source-partitioned evidence through dense, sparse, and online retrieval, and assigns two domain expert agents distinct knowledge bases to produce independent analyses; when the experts disagree, a structured counter-argumentation round and cross-source adjudication resolve the conflict, followed by a cascading safety layer that filters common false-positive patterns. We evaluate BLUEmed on a clinical terminology substitution detection benchmark under both zero-shot and few-shot prompting with multiple backbone models spanning proprietary and open-source families. Experimental results show that BLUEmed achieves the best accuracy (69.13%), ROC-AUC (74.45%), and PR-AUC (72.44%) under few-shot prompting, outperforming both single-agent RAG and debate-only baselines. Further analyses across six backbone models and two prompting strategies confirm that retrieval augmentation and structured debate are complementary, and that the framework benefits most from models with sufficient instruction-following and clinical language understanding.