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01.
medRxiv (Medicine) 2026-06-11

Development of iADJUST: a theory-informed, patient co-designed digital psychological intervention for adjustment in chronic kidney disease

Background: Psychological distress is common in chronic kidney disease (CKD) and is associated with reduced quality of life, treatment non-adherence, and worse clinical outcomes. Distress in CKD is also linked to difficulties adjusting to the demands of illness management. Despite this, psychological support remains inconsistently integrated within kidney care pathways, and existing interventions often lack clear theoretical specification and explicit targeting of mechanisms underpinning adjustment to CKD. Objectives: To describe the systematic development of iADJUST, a theory-informed patient co-designed digital psychological intervention targeting key cognitive and behavioural mechanisms involved in adjustment to CKD. Methods: Intervention development was guided by the Medical Research Council framework for complex interventions. A structured, iterative process integrated empirical evidence, psychological theory, and patient and public involvement and engagement. The Common-Sense Model of Self-Regulation and cognitive behavioural theories informed the identification of modifiable maintaining mechanisms associated with adjustment to CKD. Intervention components were mapped onto these mechanisms and refined through co-design with people living with CKD. Results: iADJUST is a six-session self-guided digital psychological intervention delivered over 12 weeks and supplemented by therapist contact. The intervention targets illness-related uncertainty, fatigue-related activity dysregulation, catastrophic what-if thinking, self-critical evaluation, and behavioural withdrawal. It integrates psychoeducation, cognitive and behavioural strategies, maintenance planning, and elements from acceptance and commitment therapy and compassion-focused approaches. Content is delivered through video, audio, and guided tasks and activities. Conclusion: iADJUST provides a theory-informed, evidence-based psychological intervention for CKD explicitly mapping intervention components to maintaining cognitive and behavioural mechanisms implicated in adjustment. Feasibility evaluation is underway.

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

DeFrame: Debiasing Large Language Models Against Framing Effects

As large language models (LLMs) are increasingly deployed in real-world applications, ensuring their fair responses across demographics has become crucial. Despite many efforts, an ongoing challenge is hidden bias: LLMs appear fair under standard evaluations, but can produce biased responses outside those evaluation settings. In this paper, we identify framing – differences in how semantically equivalent prompts are expressed (e.g., "A is better than B" vs. "B is worse than A") – as an underexplored contributor to this gap. We first introduce the concept of "framing disparity" to quantify the impact of framing on fairness evaluation. By augmenting fairness evaluation benchmarks with alternative framings, we find that (1) fairness scores vary significantly with framing and (2) existing debiasing methods improve overall (i.e., frame-averaged) fairness, but often fail to reduce framing-induced disparities. To address this, we propose a framing-aware debiasing method that encourages LLMs to be more consistent across framings. Experiments demonstrate that our approach reduces overall bias and improves robustness against framing disparities, enabling LLMs to produce fairer and more consistent responses.

03.
arXiv (CS.CV) 2026-06-19

Efficiently Linking Real Scenes with Synthetic Data Generation for AI-based Cognitive Robotics and Computer Vision Applications

AI vision models are a driving factor for the potential use case scenarios of cognitive robotics within in the industry and household applications. A large array of methods from semantic environment analysis towards 6D and grasping pose estimation have been proposed based on the latest AI achievements. However, such advancements require further strong and efficient methods w.r.t. training data and AI-architectures, which are capable in synergy to tackle current challenges, precision limits, and scalability beyond domain gaps. In this paper, we discuss these current limits and trends in the related state-of-the-art which are challenging those. Further we discuss our current work in progress on bridging the domain gap between simulations and real world applications by linking those in the training data generation.

04.
arXiv (CS.AI) 2026-06-11

Agents All the Way Down; A Methodology for Building Custom AI Agents from Substrate to Production

arXiv:2606.11869v1 Announce Type: cross Abstract: Custom AI agents areagents that live inside their own application, talk to their own data and tools, enforce their own security boundaries, and carry their own brand and audit trail. What separates them from the general-purpose tier is fit, not capability: each is built for one job, by the engineer who will maintain it. No published practice sets out how to build one end to end. The pieces are everywhere (function-calling APIs, the Model Context Protocol, code agents to pair with), but the practice that chains them lives in podcasts, blogs, and leaked system prompts. This paper writes that practice down as a methodology, Agents All the Way Down: two preconditions crossed once and kept, then three practices repeated for the agent's life. The preconditions are (P1) Substrate, the LLM as a software component, framed as tools, then system, then messages under prompt-caching; and (P2) Building blocks: function calling, MCP, CLI orchestration, the liteshell pattern, the agent loop, skills, characters, hooks, and scaffolding. The practices are (P3) prototype with a general-purpose agent; (P4) harvest, fold, and ship the result as a CLI, the Turtle pattern; and (P5) agent-tests-agent, in which a general-purpose agent drives it through behavioural scenarios, a complement to classical testing, not a replacement. The working loop is P3 to P4 to P5 and back, and one corollary falls out for free: multi-agent orchestration is just CLI composition. The methodology is framework-free by construction. It was distilled from the AAC, a custom agent for the open-source LAMB platform, built in about ten days by one developer with an AI pair-programmer and in production . We present it as a transferable practice, independent of any language or framework.

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

A Definition of Good Explanations and the Challenges Explaining LLM Outputs

arXiv:2606.14838v1 Announce Type: new Abstract: How to define a good explanation is a long-standing philosophical debate which has found recent renewed interest in the context of AI outputs. Explainability is crucial for AI adoption in many contexts, but in order to produce good explanations of AI systems, we must first have an understanding of what good explanations are. In this paper we propose a definition inspired by the notion of counterfactual explanations, however we argue that one must also take into account the interlocutor's prior beliefs in each fact that could be offered in an explanation. We explore the ramifications of this definition for AI explainability and, in particular, why LLM outputs are difficult to produce good explanations for.

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

Low-resource Language Discrimination Towards Chinese Dialects with Transfer learning and Data Augmentation

Chinese dialects discrimination is a challenging natural language processing task due to scarce annotation resource. In this article, we develop a novel Chinese dialects discrimination framework with transfer learning and data augmentation (CDDTLDA) in order to overcome the shortage of resources. To be more specific, we first use a relatively larger Chinese dialects corpus to train a source-side automatic speech recognition (ASR) model. Then, we adopt a simple but effective data augmentation method (i.e., speed, pitch, and noise disturbance) to augment the target-side low-resource Chinese dialects, and fine-tune another target ASR model based on the previous source-side ASR model. Meanwhile, the potential common semantic features between source-side and target-side ASR models can be captured by using self-attention mechanism. Finally, we extract the hidden semantic representation in the target ASR model to conduct Chinese dialects discrimination. Our extensive experimental results demonstrate that our model significantly outperforms state-of-the-art methods on two benchmark Chinese dialects corpora.

07.
arXiv (CS.LG) 2026-06-19

Unsupervised Causal Abstractions Discovery

arXiv:2606.19594v1 Announce Type: new Abstract: Causal abstractions formalize when a high-level structural causal model (SCM) captures the interventional behavior of a lower-level SCM. Existing applications of this notion largely follow a hypothesis-testing paradigm: an expert proposes a candidate high-level model and then evaluates if the low-level system implements it. We study the complementary problem of learning a high-level model directly from low-level measurements. Our contributions leverage hypotheses from low-rank causal discovery, and can be summarized as follows: (1) we show that observations generated by a low-rank graph induce latents that form a causal abstraction, (2) we provide identifiability results about these latents, and (3) we propose a practical objective to learn this high-level SCM.

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

Mod-Guide: An LLM-based Content Moderation Feedback System to Address Insensitive Speech toward Indigenous Ethnic and Religious Minority Communities

arXiv:2606.13397v1 Announce Type: cross Abstract: Language operates as a mechanism of both marginalization and resistance, especially for minority communities navigating insensitive and harmful speech online. As content moderation increasingly depends on large language models (LLMs), concerns arise about whether these systems can recognize culturally insensitive speech-language that disregards or marginalizes the cultural and religious perspectives of historically underrepresented communities, often through implicit erasure, misrepresentation, or normative framing, rather than overt hostility. Focusing on Bangladesh's Hindu and Chakma communities – the country's largest religious and Indigenous ethnic minorities, respectively – this paper investigates the epistemic limits of LLM-based moderation systems and explores methods for incorporating minority perspectives. We co-created a culturally grounded corpus of insensitive speech with community members and integrated their narratives into moderation pipelines using retrieval augmented generation (RAG). Our tool, Mod-Guide, improves LLM sensitivity to minority viewpoints by leveraging contextual cues derived from lived experience. Through mixed-method evaluations involving both minority and majority participants, we demonstrate that RAG-enhanced moderation responses are more contextually accurate and perceived differently across ethnic lines. This work advances research in human-computer interaction, AI ethics, and social computing by foregrounding restorative justice and hermeneutical inclusion in the design of content moderation systems.

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

Context-Guided Semantic Alignment for Feature Fusion Networks

Feature fusion networks are fundamental components in modern object detectors, aggregating multi-scale features to detect objects of varying sizes. However, directly fusing features from different pyramid levels often introduces semantic inconsistency due to their heterogeneous representations. In this paper, we propose Feature Interaction NEtwork (FINE), a lightweight semantic alignment module that refines low-level features via high-level contextual guidance using cross-level attention prior to fusion. To bridge the structural gap and ensure computational efficiency, we introduce an Alignment-Aware Token Sampling that aligns corresponding spatial regions across scales, reducing the attention complexity by an order of magnitude. The resulting attention weights generate a spatial-channel modulation map that is upsampled and applied to the low-level features via residual element-wise modulation. This mechanism ensures that the network selectively enhances semantically relevant pixels while preserving the sub-pixel localization accuracy necessary for dense prediction tasks. FINE is generally applicable to various detectors and consistently improves detection accuracy without compromising efficiency.

10.
Nature Medicine 2026-06-15

Activity-dependent adaptive deep brain stimulation improves gait in Parkinson’s disease

Parkinson’s disease leads to a spectrum of locomotor deficits that vary in severity with the nature of daily activities and the fluctuating physiology of patients. Many of these deficits remain inadequately addressed by existing deep brain stimulation therapies that rely on activity-agnostic parameters optimized for cardinal motor symptoms. By contrast, therapies embedding activity-specific parameters have the potential to better address the entire range of symptoms. Here we expose physiological principles that enable real-time decoding of ongoing locomotor activities across motor fluctuations from the neural dynamics of the subthalamic nucleus. This decoding steered activity-dependent adaptations of deep brain stimulation therapies that improved locomotor deficits while preserving efficacy for cardinal motor symptoms across activities of daily living. Our activity-dependent framework provides a blueprint for next-generation neuromodulation therapies that continuously select parameters optimized to the behavioral context and fluctuating physiology of each patient. ClinicalTrials.gov registration NCT06791902 . Neural decoding algorithms that leverage physiological principles of locomotor encoding support activity-dependent deep brain stimulation therapies that improve locomotor deficits in people with Parkinson’s disease.

11.
arXiv (CS.AI) 2026-06-18

AI-Driven Assessment of Human Tutors: Linking Training Performance to Real-Life Practice

arXiv:2606.18617v1 Announce Type: cross Abstract: There exist numerous tutor training platforms. However, few provide AI-driven training and evaluation for human tutors based on real-life performance. We present an AI-driven system that assesses both open responses during training and authentic real-life tutoring. Unlike platforms that only assess learning through online training or simulations, our system utilizes Generative AI (Gemini-2.5-pro) to analyze transcriptions of authentic tutoring, measuring the transfer of tutor skills to real-life application. Human tutors instructing students remotely in math (N=86) completed six scenario-based lessons, averaging a significant 7.4% learning gain. Using mixed-effects models across 405 session-to-lesson pairs, we found that training performance significantly predicted real-life transcript scores with an effect size of 0.25 SD. Model comparison (AIC/BIC) indicated averaging open response and multiple choice performance during training predicted real-life tutor performance best, although open responses were comparatively more predictive. Exploratory analysis showed that after training, tutors were significantly more likely to encounter pedagogical opportunities to apply their skills (61.1% to 68.9%) and demonstrated higher execution quality within those opportunities (65.5% to 68.1%). Interrupted time series analysis suggested that these tutor improvements were part of a gradual trend over time rather than an immediate intervention effect of training. We illustrate an AI-driven method to link tutor training with real-life assessment. In doing so, we contribute open datasets, AI prompts, and scoring rubrics to support transparency and reproducibility.

12.
arXiv (quant-ph) 2026-06-16

Conditions for Unitarity in Timeless Quantum Theory

arXiv:2504.01579v3 Announce Type: replace Abstract: Quantum timeless approaches solve the problem of time by recovering the usual unitary evolution of quantum theory relative to a clock in a stationary quantum Universe. For some Hamiltonians of the Universe, such as those including an interaction term with the clock, the dynamics is substantially altered and can be non-unitary. This work derives necessary and sufficient conditions for the relative dynamics to be unitary and finds the general form of the unitary evolution operator. A physical interpretation of these conditions is given in terms of the clock's rate. Unitary dynamics is associated with rates that are constant in time and independent of the clock's internal structure.

13.
arXiv (CS.AI) 2026-06-16

EMS: Multi-Agent Voting via Efficient Majority-then-Stopping

arXiv:2604.02863v2 Announce Type: replace Abstract: Majority voting is the standard for aggregating multi-agent responses into a final decision. However, traditional methods typically require all agents to complete their reasoning before aggregation begins, leading to significant computational overhead, as many responses become redundant once a majority consensus is achieved. In this work, we formulate efficient multi-agent voting as a reliability-aware agent scheduling problem and propose Efficient Majority-then-Stopping (EMS) to improve reasoning efficiency. EMS first estimates a Task-Conditioned Reliability Ordering (TCRO) for each agent by retrieving its historical consensus evidence on semantically similar queries, and then invoking agents in descending reliability order. Next, Adaptive Incremental Voting (AIV) terminates the process once the current leading answer cannot be overturned by any possible votes from the remaining agents, and returns this answer. Finally, Reliability History Updating (RHU) updates only the invoked agents according to their consensus with the final decision. Extensive evaluations across five benchmarks show that EMS preserves the accuracy of Majority Voting while reducing the average number of invoked agents by 35% and token consumption by 44%, respectively. The code is available at https://github.com/fuyu66/EMS.

14.
arXiv (quant-ph) 2026-06-11

Fundamental Limitations of QAOA on Constrained Problems and a Route to Exponential Enhancement

arXiv:2511.17259v4 Announce Type: replace Abstract: We study fundamental limitations of the generic Quantum Approximate Optimization Algorithm (QAOA) on constrained problems where valid solutions form a low dimensional manifold inside the Boolean hypercube, and we present a provable route to exponential improvements via constraint embedding. Focusing on permutation constrained objectives, we show that the standard generic QAOA ansatz, with a transverse field mixer and diagonal r local cost, faces an intrinsic feasibility bottleneck: even after angle optimization, circuits whose depth grows at most sublinearly with n cannot raise the total probability mass on the feasible manifold much above the uniform baseline suppressed by the size of the full Hilber space. Against this envelope we introduce a minimal constraint enhanced kernel (CE QAOA) that operates directly inside a product one hot subspace and mixes with a block local XY Hamiltonian. For permutation constrained problems, we prove an angle robust, depth matched exponential enhancement where the ratio between the feasible mass from CE QAOA and generic QAOA grows exponentially in $n^2$ for all depths up to a linear fraction of n, under a mild polynomial growth condition on the interaction hypergraph. Thanks to the problem algorithm co design in the kernel construction, the techniques and guarantees extend beyond permutations to a broad class of NP-Hard constrained optimization problems.

15.
arXiv (math.PR) 2026-06-16

On the empirical spectral distribution of matrix perpetuities

arXiv:2605.31054v2 Announce Type: replace Abstract: We study matrix perpetuities, that is, solutions to affine fixed-point equations of the form \[ \mathbf{X} \stackrel{d}{=} \mathbf{A}\,\mathbf{X} \,\mathbf{A}^\top+\mathbf{B},\qquad (\mathbf{A},\mathbf{B})\mbox{ and }\mathbf{X} \mbox{ are independent}, \] with particular emphasis on the empirical spectral distribution of the solution. We first establish existence and uniqueness results by relating the problem to classical vector perpetuities, and then develop tools that preserve the matrix structure under orthogonal invariance. For positive semidefinite, orthogonally invariant models, we obtain power-law tail asymptotics for the expected empirical spectral distribution and show that the tail is governed by the largest eigenvalue. We also prove that, in the subcritical regime, the expected empirical spectral distribution of matrix perpetuities converges weakly, as the dimension tends to infinity, to the distribution of the corresponding free perpetuity. Our results are illustrated by matrix Beta prime perpetuities, for which explicit limiting spectral distributions are available.

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

Scalable Graph Condensation with Evolving Capabilities

arXiv:2502.17614v3 Announce Type: replace Abstract: The rapid growth of graph data creates significant scalability challenges as most graph algorithms scale quadratically with size. To mitigate these issues, Graph Condensation (GC) methods have been proposed to learn a small graph from a larger one, accelerating downstream tasks. However, existing approaches critically assume a static training set, which conflicts with the inherently dynamic and evolving nature of real-world graph data. This work introduces a novel framework for continual graph condensation, enabling efficient updates to the distilled graph that handle data streams without requiring costly retraining. This limitation leads to inefficiencies when condensing growing training sets. In this paper, we introduce GECC (\underline{G}raph \underline{E}volving \underline{C}lustering \underline{C}ondensation), a scalable graph condensation method designed to handle large-scale and evolving graph data. GECC employs a traceable and efficient approach by performing class-wise clustering on aggregated features. Furthermore, it can inherit previous condensation results as clustering centroids when the condensed graph expands, thereby attaining an evolving capability. This methodology is supported by robust theoretical foundations and demonstrates superior empirical performance. Comprehensive experiments including real world scenario show that GECC achieves better performance than most state-of-the-art graph condensation methods while delivering an around 1000$\times$ speedup on large datasets.

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

SICI: A Semantic-Pragmatic Complexity Index Reveals Regime Shifts in LLM Stance Detection

Prompt-based LLMs are increasingly used for stance detection, but harder examples are not always repaired by clearer instructions, reasoning prompts, retrieval, or debate. We introduce SICI (Stance Inference Complexity Index), a seven-dimensional diagnostic measure of the semantic-pragmatic burden imposed by a target–text pair. Across SemEval-2016 and VAST, SICI predicts LLM accuracy better than surface proxies and shows substantial cross-scorer reliability ($\alpha=0.771$). More importantly, LLM errors change regime as SICI increases: low-complexity examples invite over-attribution, especially Against predictions; intermediate examples form an unstable boundary; and high-complexity examples rapidly concentrate on None. This phase-transition-like structure persists across GPT-3.5, GPT-4o-mini, DeepSeek-V3, and GPT-4o, although stronger models move the boundaries. A 15-method intervention study further shows that prompting, retrieval, and debate often shift models along the attribution–abstention axis rather than removing the high-complexity bottleneck.

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

Urdu Katib Handwritten Dataset: A Historical Document Dataset for Offline Urdu Handwritten Text Recognition with CRNN-Based Baseline Evaluation

Automatic Handwritten Text Recognition (HTR) is inherently a challenging task, and its complexity is further increased when dealing with cursive scripts. Although significant efforts have been made on various cursive scripts, research regarding Urdu Handwritten Text Recognition (UHTR) has been relatively limited. This lag of research is primarily due to the unique challenges posed by its script, and the scarcity and unavailability of benchmark datasets. Therefore, to advance research in UHTR, this study presents a specialized real dataset called the Urdu Katib Handwritten Dataset (UKHD). To the best of our knowledge, this is the first offline Urdu handwritten text lines dataset specifically curated from the materials written by Katibs in historical times. It encompasses a diverse range of flat nib writing variations in the Nastalique calligraphic style. Additionally, the effectiveness of different CRNN-based hybrid models has been evaluated to identify the optimal architecture for Urdu Katib Handwriting Recognition (UKHR). Among the analyzed models, the CNN-BGRU-CTC model showed more robust performance, with low Character Error Rate (CER) and Word Error Rate (WER). This research work aims to support and encourage the research community in developing a robust recognition system for preserving Urdu handwritten literature.

19.
medRxiv (Medicine) 2026-06-12

A Machine Learning Pipeline for Scalable Annotation of Patient-Ventilator Dyssynchrony from Bedside Ventilator Data

Objective: Patient-ventilator dyssynchrony (PVD) is a common and clinically consequential problem in critically ill patients receiving invasive mechanical ventilation. Yet automated identification of PVD subtypes at scale remains an unmet clinical need, owing to the lack of large annotated bedside waveform datasets. Methods: We developed and validated a semi-supervised algorithm for automated annotation of PVD. In two medical ICUs at a tertiary academic center, bedside devices continuously collected airway flow and pressure waveforms from the ventilators. We developed a software interface with an information retrieval system that grouped similar breaths for expert human review, yielding 1,542,296 labeled breaths across eight categories: 2 labels for breath delivery mode, 5 labels for PVD subtypes, and 1 label denoting a normal breath. Two pulmonary physicians with expertise in ventilator training and education provided the expert reference labels. We trained an initial classification model on a model-derivation set of 771,148 breaths (divided into training and validation) and evaluated it on a hold-out test set of 771,149 breaths A semi-supervised approach was utilized to extend labeling to an additional 12,965,000 unlabeled breaths. Results: The supervised model performed well across all labels, with Macro-F1 scores between 0.96 and 1.00. Semi-supervised learning across 12 rounds expanded the training set from 771,148 to 8,563,995 breaths without significant performance degradation. Conclusion: We developed a practical and scalable system for automated PVD annotation that performed well across all subtypes. This work provides a reproducible foundation for automated PVD labeling to support the development of machine-learning-based clinical decision support systems for identifying patient-level asynchrony.

20.
arXiv (CS.CV) 2026-06-18

E-VAds: An E-commerce Short Videos Understanding Benchmark for MLLMs

E-commerce short videos represent a high-revenue segment of the online video industry characterized by a goal-driven format and dense multi-modal signals. Current models often struggle with these videos because existing benchmarks focus primarily on general-purpose tasks and neglect the reasoning of commercial intent. In this work, we first propose a multi-modal information density assessment framework to quantify the complexity of this domain. Our evaluation reveals that e-commerce content exhibits substantially higher density across visual, audio, and textual modalities compared to mainstream datasets, establishing a more challenging frontier for video understanding. To address this gap, we introduce E-commerce Video Ads Benchmark, which is the first benchmark specifically designed for e-commerce short video understanding. We curated 3,961 high-quality videos from Taobao covering a wide range of product categories and used a multi-agent system to generate 19,785 open-ended Q&A pairs, which consist of five distinct tasks. Finally, we develop E-VAds-R1, an RL-based reasoning model featuring a multi-grained reward design called MG-GRPO. This strategy provides smooth guidance for early exploration while creating a non-linear incentive for expert-level precision. Experimental results demonstrate that E-VAds-R1 achieves a 109.2% performance gain in commercial intent reasoning with only a few hundred training samples. Data is available at https://github.com/TaobaoTmall-AlgorithmProducts/E-VAds_Benchmark.

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

Bridging the Usability Gap: Lessons from Interpreting Studies for Machine Interpreting Design

Machine interpreting (MI), the live, real-time branch of speech translation, has achieved remarkable progress on standard benchmarks, with some systems approaching human parity on textual fidelity. Yet the user experience remains far inferior to interpreter-mediated communication, revealing what we term the accuracy illusion: systems that appear accurate on paper but fail in practice to support smooth, goal-oriented interaction. This paper defines MI as a distinct subfield of speech translation, with its own characteristics and the need for evaluation methods grounded in communicative effectiveness rather than isolated fidelity metrics. Drawing on insights from interpreting studies, we identify critical dimensions of professional interpreting practice that are overlooked by current systems, and consolidate them into three interdependent design priorities for future MI: agency (context-sensitive initiative and repair), grounding (multimodal and discourse-level situational awareness), and experience (adaptive improvement through real interaction). Together, these priorities chart a path toward closing the usability gap and enabling systems that can sustain authentic multilingual communication in real time.

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

Beyond Accuracy: Measuring Bias Acknowledgment in Chain-of-Thought Reasoning for Responsible AI Evaluation

arXiv:2606.15127v1 Announce Type: new Abstract: Reasoning models are increasingly used in settings where the final answer is not the only object of review: educational tools may show students intermediate steps, decision-support systems may require human oversight, and audit workflows may inspect traces for misleading or biased input. In such settings, two responses can receive the same final-answer score while differing in whether the trace explicitly flags injected biasing content. Accuracy-only evaluation collapses these cases. We study this gap as a measurement blind spot for responsible evaluation and introduce a minimal trace-level diagnostic with two axes: susceptibility (whether the bias breaks a previously correct answer) and acknowledgment (whether the trace contains a rubric-defined surface reference to the injected content). Across thousands of biased GSM8K trials, GPT-4o and Claude Sonnet~4 have similar susceptibility rates ($1.3\%$ vs.\ $1.2\%$) but substantially different acknowledgment rates ($13.0\%$ vs.\ $75.0\%$) under the same rubric.

23.
medRxiv (Medicine) 2026-06-18

A Novel Correction Method for QT Interval in the Presence of Left Bundle Branch Block Morphology

Background Accurate assessment of the QT interval is challenging in the presence of QRS prolongation, such as during ventricular pacing or bundle branch block. Current correction methods are heterogeneous and lack consensus. To evaluate the relationship between QRS duration and QT interval during ventricular pacing and to develop a practical correction method for QT assessment. Methods In this prospective single-centre study, 94 patients undergoing electrophysiology study for supraventricular tachycardia were included. Standardised pacing was performed at the same cycle length from the right ventricular (RV) apex, high output and low output pacing from His catheter, and coronary sinus (reference). QRS and QT intervals were measured from 12-lead ECGs. Changes in QT (QT) and QRS duration (QRS) were analysed using linear regression and mixed-effects modelling. QT correction formulas of the form QT corrected = QT N x QRS were evaluated using Bland-Altman analysis across multiple coefficients. Results A significant positive correlation between QRS and QT was observed across all pacing sites (r = 0.52-0.74, p < 0.001). In mixed-effects modelling, QRS was a strong independent predictor of QT (0.59, p < 0.001), with no significant interaction between pacing site and QRS, supporting a consistent relationship across pacing locations. Bland-Altman analysis demonstrated that correction coefficients of 0.65-0.70 minimised systematic bias compared with lower coefficients, with similar precision across models (SD 16 ms) and no evidence of proportional bias. A coefficient of 0.65 provided the most balanced performance between bias and variability. Conclusion QT prolongation during ventricular pacing is primarily driven by QRS widening and follows a consistent linear relationship across pacing sites. A simple correction using QT corrected = QT 0.65 x (QRS 100 ms) provides a practical and accurate method for QT assessment, with potential clinical applicability in patients with conduction abnormalities or ventricular pacing.

24.
PLOS Computational Biology 2026-06-22

Towards modeling phage therapy

by Rob J. de Boer, Robert Schooley, Alan S. Perelson Patients infected with life-threatening multi-drug resistant (MDR) bacteria have been treated with cocktails of bacteriophages. This is a complicated form of personalized medicine as the phages given to a patient have to be selected beforehand on the basis of their lytic capacity of the infecting bacteria. Because bacteria rapidly become resistant, the evolution of resistance to a diverse cocktail of phages is a complicated dynamical process, during which competing bacterial strains replace one another by accumulating several resistance mechanisms, each of which may involve a fitness cost. As a consequence, it is typically not known why a particular phage therapy succeeded or failed, and how one can optimize the composition of the cocktails to maximize the rate of success. To improve upon this, we extend an existing in vivo-calibrated mouse model into a novel mathematical model for the human situation, and include multiple phages infecting multiple bacterial strains, differing in their resistance to each of the phages. We adjust several parameter estimates of the bacterial model to the human situation, and use the model to describe a successful case of phage therapy involving several cocktails, each containing several phages. In the model, treatment success crucially depended on pretreatment resistance levels, and on the diversity and the timing of the cocktails. Once an appropriate cocktail is found, it is less important to further optimize the infection rates of the phages. Resistant bacterial strains expand rapidly when sensitive strains decline, and the higher the infectivity of the phages, the faster resistant strains expand. Because resistance evolves rapidly, it is best to provide a diverse set of phages right from the start of therapy, i.e., to hit hard and early, and create a high genetic barrier to bacterial resistance.

25.
medRxiv (Medicine) 2026-06-18

Diabetes is associated with increased nocturnal respiratory rate

Background and Objective: Diabetes mellitus (DM) causes autonomic neuropathy, which may alter nocturnal respiratory rate (NRR). To test the association between DM and NRR, we analyzed elective polysomnograms of four large observational cohorts. Research Design and Methods: We performed cross-sectional analysis of over 25,000 individuals with polysomnograms (PSGs) from the Sleep Heart Health Study (SHHS), Hispanic Community Health Study/Study of Latinos (HCHS/SOL), Osteoporotic Fractures in Men Study (MrOS), and Wisconsin Sleep Cohort (WSC). Patient-level NRRs were derived from inductance plethysmography waveforms. DM status was determined by self-report, physician diagnosis, medication use, or laboratory values, depending on the cohort. We related DM and NRR (continuous and dichotomized) using logistic regression models and adjusted for potential confounders. Cohort-specific results were combined using random-effects meta-analysis. Results: Meta-analysis of unadjusted models showed a pooled odds ratio (OR) of 1.10 (95% CI:1.04-1.17) for each breath-per-minute (brpm) increase in NRR. This association remained significant after multivariable adjustment (OR:1.06, 95% CI:1.02-1.11). Dichotomized analyses similarly showed higher odds of DM across dichotomization thresholds ranging from 15 to 21 brpm. At a threshold of 18 brpm, the unadjusted pooled OR was 1.77 (95% CI:1.23-2.55, P=0.0022), and the adjusted OR was 1.49 (95% CI:1.10-2.02, P=0.0098). Conclusions: Clinically stable outpatients with elevated NRR have an increased prevalence of DM. Additional studies are needed to investigate whether the mechanism is autonomic neuropathy and whether monitoring NRR can detect early complications of DM.