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01.
arXiv (CS.CV) 2026-06-12

Proto-LeakNet: Towards Signal-Leak Aware Attribution in Synthetic Human Face Imagery

The growing sophistication of synthetic image and deepfake generation models has turned source attribution and authenticity verification into a critical challenge for modern computer vision systems. Recent studies suggest that diffusion pipelines unintentionally imprint persistent statistical traces, known as signal-leaks, within their outputs, particularly in latent representations. Building on this observation, we propose Proto-LeakNet, a signal-leak-aware and interpretable attribution framework that integrates Closed-set classification with a density-based Open-set evaluation on the learned embeddings, enabling analysis of unseen generators without retraining. Acting in the latent domain of diffusion models, our method re-simulates partial forward diffusion to expose residual generator-specific cues. A temporal attention encoder aggregates multi-step latent features, while a feature-weighted prototype head structures the embedding space and enables transparent attribution. Trained solely on closed data and achieving a Macro AUC of 98.13\%, Proto-LeakNet learns a latent geometry that remains robust under post-processing, surpassing state-of-the-art methods, and achieves strong separability both between real images and known generators, and between known and unseen ones. The codebase is available at the following link: https://github.com/claudiunderthehood/Proto-LeakNet .

02.
arXiv (CS.CV) 2026-06-11

DIRECT: When and Where Should You Allocate Test-Time Compute in Embodied Planners?

Vision-Language Models (VLMs) are increasingly deployed as high-level planners for embodied agents, with an emerging strategy of scaling test-time compute to improve capability. However, we observe that doing so increases latency, token usage, and FLOPs while yielding uneven, often diminishing gains in downstream success, limiting where embodied agents can be deployed. We argue that choosing when and where to spend test-time compute is central to bringing frontier performance to the real world. We introduce DIRECT, a routing framework that uses multimodal scene context to allocate compute per prompt, improving the success–cost Pareto frontier over fixed model selection. Across three dominant scaling axes, namely chain-of-thought depth, model size, and memory history, our experiments on VLABench and RoboMME show that test-time compute is not a uniform lever: different axes yield qualitatively distinct capability gains. We validate these insights on a physical Franka arm in a DROID setup spanning zero-shot manipulation and long-horizon chaining, where our router matches or exceeds a stronger model's success rate at up to 65% lower average latency. Ultimately, our results show that naively scaling test-time compute is wasteful, and that DIRECT can provide frontier-level embodied planning in robotic systems at a fraction of the cost. Project page can be found at jadee-dao.github.io/direct/.

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

Calibration Without Comprehension: Diagnosing the Limits of Fine-Tuning LLMs for Vulnerability Detection in Systems Software

arXiv:2606.20502v1 Announce Type: cross Abstract: Whether LLMs scoring well on vulnerability benchmarks genuinely reason about security or merely pattern-match on contaminated data remains unresolved. We present CWE-Trace, a framework for LLM vulnerability detection built from 834 manually curated Linux kernel samples spanning 74 CWEs. The framework enforces a strict temporal split (pre-2025 historical set / post-cutoff leakage-free set), preserves context-aware vulnerable–patched pairs, and introduces two diagnostic metrics: the Directional Failure Index (DFI) and Hierarchical Distance and Direction (HDD). We evaluate eight vanilla LLMs and 15 LoRA fine-tuned variants across non-targeted detection, targeted detection, and CWE classification. Our analysis yields two key results. First, data contamination provides no measurable advantage. Function-level analysis shows that 84% of nominally contaminated samples carry no usable memorization signal: vulnerable functions are absent or cross-mapped across datasets, and ~31% of contaminated samples carry CWE misclassification. Second, backbone directional priors dominate fine-tuning. Models exhibit stable, systematic failure modes (DFI ranging from -85.5 to +94.8 pp) that persist from historical to post-cutoff data and resist correction. Fine-tuning shifts the output threshold without changing the decision policy. This is calibration without comprehension: output distributions adapt to training data while the underlying security reasoning remains absent. The weakest backbone at binary detection (DeepSeek-R1) gains the most in coarse CWE classification, revealing that detection and understanding are decoupled capabilities. The best detection score reaches only 52.1% (+2.1 pp above chance); exact CWE ranking remains below 1.3% Top-1 accuracy, confirming that current LLMs lack reliable security reasoning for systems software, regardless of fine-tuning strategy.

04.
arXiv (CS.LG) 2026-06-17

Learning in Matching Games with Bandit Feedback

arXiv:2506.03802v2 Announce Type: replace Abstract: We introduce a learning problem in a generalized two-sided matching market, where agents select actions to interact with their match. Specifically, we consider a setting in which matched agents engage in zero-sum games with initially unknown payoff matrices, and we investigate whether a centralized procedure can learn an equilibrium from bandit feedback. We adopt the solution concept of a matching equilibrium, where a matching \( \mathfrak{m} \) and a set of agent strategies \( X \) form an equilibrium if no agent has an incentive to deviate from \( (\mathfrak{m}, X) \). To quantify deviations of a candidate solution \( (\mathfrak{m}, X) \) from the equilibrium \( (\mathfrak{m}^\star, X^\star) \), we introduce the notion of matching instability, which serves as a regret measure for the learning problem. We propose a UCB-based algorithm in which agents form preferences and select actions according to optimistic estimates of the payoffs. Our analysis establishes a sublinear, instance-independent regret upper bound, further supported by empirical evidence.

05.
arXiv (quant-ph) 2026-06-12

Understanding quantum behaviors of an electron in a uniform magnetic field alternatively

arXiv:2606.13290v1 Announce Type: cross Abstract: Quantum mechanically, an electron moving in a uniform magnetic field forms Landau levels. A curious feature is that for states with a negative angular quantum number, the total probability current vanishes, which appears to contradict the classical picture of cyclotron motion. While a geometric interpretation based on classical orbits exists, alternative interpretations remain of interest. In this paper, we examine the probability current density and identify a critical radius that naturally partitions the plane into an inner clockwise-flow region and an outer counterclockwise-flow region. We show that the vanishing total current results from an exact cancellation between these two regions. Furthermore, by defining a partitioned kinetic angular momentum with respect to the critical radius, we reveal an intrinsic competitive structure: the electron simultaneously carries two opposing rotational components. The negative quantum number manifests in the strength of the inner counter-rotation, while the net kinetic angular momentum remains positive. This bidirectional flow picture also provides a dynamical interpretation of the infinite degeneracy of Landau levels.

06.
Nature Biotechnology 2026-06-05

Multiplexed, precise genome engineering in monocots with twin prime editing systems

Authors:

Simultaneously introducing diverse genomic edits remains a challenge in crop genome engineering. Here we describe a twin prime editing-based knockout (TKO) system that installs stop codon clusters (SCCs) for precise translational termination with minimal in-frame mutations. TKO achieves knockout efficiencies of up to 70.5%, 58.6% and 75.1% in rice, maize and wheat protoplasts, respectively, and produces heritable knockout alleles in 96.8% of regenerated rice plants. In hexaploid wheat, TKO outperforms Cas9 4.2-fold in generating triple-homolog knockouts, largely by reducing in-frame mutations. Orthogonal TKO editors with sequence-divergent SCCs enable simultaneous knockout of up to ten genes without cross-interference. Integration of TKO with conventional prime editing establishes TRIM1 (TKO editor-enabled gene rupture and development of integrated multitype genome modification system) for simultaneous knockout and precise editing, achieving a 22.8% coediting of four genes in rice. TRIM2 extends this capacity to kilobase-scale modifications through a prime editor–recombinase system, enabling a 4.9-kb insertion (1.2% efficiency) and gene knockout (up to 79.8%) in protoplasts. Plant genome editing is multiplexed with twin prime editing.

07.
medRxiv (Medicine) 2026-06-16

Re-evaluating the Cross-Sectional Prevalence of Severe Age-Related Hearing Loss Using Extreme Value Statistics

Authors:

Standard demographic models of age-related hearing loss (presbycusis) predominantly utilize symmetric functions, such as log-normal distributions for age-binned thresholds and 4-parameter logistic curves for prevalence estimates. While these models capture early-to-moderate degradation effectively, they structurally struggle to characterize the heavy tails associated with severe clinical impairment. In this study, we present a statistical critique using a secondary analysis of the historical Medical Research Council (MRC) National Study of Hearing (1980-1986) dataset. By applying Generalized Extreme Value (GEV) distribution theory, we demonstrate that as severity increases, the underlying statistical geometry of hearing loss shifts. The asymmetric, heavy-tailed GEV distribution provides a parsimonious description of severe impairment, requiring fewer parameters than standard symmetric models. However, we explicitly acknowledge that utilizing static population data to infer progression introduces an ecological fallacy. Furthermore, the dataset's historical nature embeds unquantified generational cohort effects. We conclude that while extreme value statistics offer a compelling mathematical framework for modeling the variance of severe presbycusis, true longitudinal datasets are required to isolate physiological degradation from historical cohort variance.

08.
arXiv (CS.CL) 2026-06-16

P3B3: A Multi-Turn Conversational Benchmark for Measuring European and Brazilian Portuguese Variety Bias in LLMs

As Large Language Models (LLMs) become embedded in everyday communication, capturing regional linguistic variation is essential for reliable and equitable language use. In Portuguese, European (pt-PT) and Brazilian (pt-BR) varieties remain unevenly represented, with pt-BR dominating in data quantity, while LLM preference for Portuguese variants remains underexplored. To address this gap, we introduce P3B3, an expert-curated language variety agnostic benchmark of conversational prompts, along with an evaluation framework for measuring variety bias and controllability. Experiments on several models show that most LLMs exhibit a strong bias toward pt-BR, with variation in controllability across models. These results highlight the need for more balanced multilingual representation across language varieties.

09.
PLOS Medicine 2026-06-04

Comparative impacts and cost-effectiveness of tuberculosis systematic screening strategies in prisons in Brazil, Colombia, and Peru: A mathematical modeling study

Authors:

by Yiran E. Liu, José Victor Bortolotto Bampi, Ronan F. Arthur, Argita D. Salindri, Caroline Busatto, Pedro Avedillo Jiménez, Daniele Maria Pelissari, Fernanda Dockhorn Costa Johansen, Robert Arana-Narvaez, Alvaro Fernando Moreno Roca, Wilfredo Santos Solís Tupes, Esther Mori Jiu, Christian Alfredo Moreno Roca, Erika Albertina Abregú Contreras, Valentina Antonieta Alarcón Guizado, Julián Trujillo Trujillo, Belkys Marcelino, Mónica Alonso Gonzalez, Mayra Cecilia Córdova Ayllon, Ted Cohen, Moises A. Huaman, Jeremy D. Goldhaber-Fiebert, Julio Croda, Jason R. Andrews Background Incarceration is a leading driver of tuberculosis in Latin America. Systematic screening in prisons may reduce tuberculosis burden, but optimal strategies and cost-effectiveness remain uncertain. We examined the population-wide health impacts and cost-effectiveness of systematic screening in prisons in Brazil, Colombia, and Peru, comparing different timepoints, frequencies, and screening algorithms. Methods and findings Using dynamic transmission models calibrated to Brazil, Colombia, and Peru, we simulated annual or biannual (twice-yearly) prison-wide screening, alone or combined with entry and exit screening from 2026 to 2035. We evaluated four algorithms: (1) symptom screening, (2) chest X-ray with computer-aided detection (CXR-CAD), (3) symptoms and CXR-CAD (follow-up testing if either is positive), and (4) GeneXpert Ultra (Xpert) with pooled sputum. Individuals screening positive then received individual Xpert. We projected impacts on within-prison and population-level tuberculosis incidence in 2035, along with discounted costs (2023 US dollars) and disability-adjusted life years (DALYs). Model projections showed that combined entry, exit, and biannual screening with CXR-CAD was highly impactful and cost-effective across countries, reducing tuberculosis incidence by 61%–87% in prisons and 18%–28% population-wide. Compared to only biannual CXR-CAD (the next best strategy), the incremental cost per DALY averted of adding entry and exit screening was $2,984 (Brazil), $2,925 (Colombia), and $645 (Peru). Adding symptom screening to CXR-CAD marginally increased benefit and was only cost-effective in Peru’s higher-incidence prisons. Biannual screening alone remained cost-effective at prison incidence levels well below national averages, as well as at far lower willingness-to-pay thresholds. In settings without CXR-CAD, pooled Xpert was an impactful, cost-effective alternative. Key limitations include the model’s simplified representation of tuberculosis disease states and lack of stratification by age, gender/sex, HIV, or drug resistance. Conclusions These modeling results support immediate national-level adoption of prison-wide tuberculosis screening twice-yearly and at entry and exit, using CXR-CAD or pooled Xpert.

10.
bioRxiv (Bioinfo) 2026-06-22

From hotspot dependence to distributed robustness in resistance-aware lead optimization

Drug resistance remains a recurrent failure mode in targeted anticancer and antiviral therapy, and resistance evidence often enters only after compound selection. ResistAgent is an evidence-constrained framework that converts mutational liabilities into design-time objectives through site- and combo-aware resistance mapping, deterministic mechanism diagnosis and robust counter-design. In EGFR-Erlotinib and HIV-RT-Rilpivirine, the framework separated residue-level liabilities from observed HIV combination liabilities and linked prioritized mutations to anchor loss, pocket rearrangement, electrostatic shifts and contact redistribution. Same-budget paired searches showed that robust objectives changed lower-tail mutant-panel behavior and interaction-dependence profiles while prioritizing robustness over average-affinity behavior. Under predefined liability panels, selected robust-best trajectories shifted support away from mutable hotspot contacts toward more distributed interaction networks. Supplementary physical summaries and ranking-first benchmarks support the scope of this resistance-aware design strategy while preserving clear boundaries for prospective validation.

11.
arXiv (CS.CL) 2026-06-17

From Parasocial Scripts to Dyadic Persistence in Autonomous AI-Agent Communities

While parasocial interactions (PSIs) and parasocial relationships (PSRs) have been studied in conventional media settings, we investigate whether PSI- (colloquial) relational cues also exist in online communities where both sides are autonomous AI agents. We analyze 4,434 posts and 50,338 comments from Moltbook through three theory-based textual indicators: attachment/intimacy language, reciprocity bids, and self-identification to original poster (OP). The combined results across methods based on keyword matching, few-shot large language model (LLM) annotation, and grouped-context LLM annotation reveal that PSI colloquial cues prevail and are strongly associated with OP re-engagement and a reciprocal reply structure. These results are robust across negative controls, nullification, clustered-standard-error re-estimation, and multiple-testing correction. A dyadic persistence test further affirms reciprocity bids aligned with sustained OP-involving mutual recurrence, providing empirical evidence for bridging interaction-level PSI scripts with PSR-consistent repeated dyadic patterns. We interpret the evidence as a behavioral structure in discourse by LLM-enabled agents.

12.
arXiv (CS.LG) 2026-06-19

Reversible Residual Normalization Alleviates Spatio-Temporal Distribution Shift

arXiv:2604.15838v2 Announce Type: replace Abstract: Distribution shift severely degrades the performance of deep forecasting models. While this issue is well-studied for individual time series, it remains a significant challenge in the spatio-temporal domain. Effective solutions like instance normalization and its variants can mitigate temporal shifts by standardizing statistics. However, distribution shift on a graph is far more complex, involving not only the drift of individual node series but also heterogeneity across the spatial network where different nodes exhibit distinct statistical properties. To tackle this problem, we propose Reversible Residual Normalization (RRN), a novel framework that performs spatially-aware invertible transformations to address distribution shift in both spatial and temporal dimensions. Our approach integrates graph convolutional operations within invertible residual blocks, enabling adaptive normalization that respects the underlying graph structure while maintaining reversibility. By combining Center Normalization with spectral-constrained graph neural networks, our method captures and normalizes complex Spatio-Temporal relationships in a data-driven manner. The bidirectional nature of our framework allows models to learn in a normalized latent space and recover original distributional properties through inverse transformation, offering a robust and model-agnostic solution for forecasting on dynamic spatio-temporal systems.

13.
arXiv (quant-ph) 2026-06-16

Achieving double-logarithmic precision dependence in optimization-based quantum unstructured search

arXiv:2603.26039v3 Announce Type: replace Abstract: Grover's algorithm is a fundamental quantum algorithm that achieves a quadratic speedup for unstructured search problems of size $N$. Recent studies have reformulated this task as a maximization problem on the unitary manifold and solved it via linearly convergent Riemannian gradient ascent (RGA) methods, resulting in a complexity of $O(\sqrt{N/M}\log (1/\varepsilon))$, where $M$ denotes the number of target items and $\varepsilon$ denotes the success probability error. In this work, we adopt the Riemannian modified Newton (RMN) method to solve the quantum search problem, under the assumption that the ratio $ M/N$ is known. We show that, in this setting, the Riemannian Newton direction is collinear with the Riemannian gradient in the sense that the Riemannian gradient is always an eigenvector of the corresponding Riemannian Hessian. This structure removes the overhead of Hessian inversion and allows the proposed RMN method to retain the local quadratic convergence in terms of the error $\varepsilon$. More precisely, we rigorously prove an overall complexity of $O(\sqrt{N/M}+\log\log(1/\varepsilon))$. Furthermore, our approach remains Grover-compatible, namely, it relies exclusively on the standard Grover diffusion and oracle operators to ensure algorithmic implementability, and its parameter update process can be efficiently precomputed on classical computers.

14.
PLOS Computational Biology 2026-06-22

Adhesion and polarity-driven morphogenesis: Mechanisms and constraints in tissue formation

by Yoshiyuki T. Nakamura, Chikara Furusawa, Kunihiko Kaneko Embryonic development in multicellular organisms exhibits diverse morphogenetic patterns, which can generally be categorized into fundamental types such as monolayer and multilayer spheres, as well as cell masses. Furthermore, we identify two distinct processes for the formation of spherical structures. These basic patterns are thought to be governed by the microscopic properties of intercellular adhesion. However, the specific mechanisms linking the microscopic factors to the emergence of distinct macroscopic morphogenetic patterns remain poorly understood. In this study, we explore how different morphogenetic patterns arise by employing a computational model that incorporates intercellular adhesion and polarity. Our results demonstrate that all fundamental morphogenetic patterns can be generated through the interplay of two key parameters: the polarity strength of the cell and the regulation of polarity via mechanical signals. Furthermore, analytical considerations reveal key mechanisms underlying the formation of these patterns. These findings highlight the critical role of physical constraints in morphogenesis and suggest potential applications to the design of artificial tissues and organoids.

15.
arXiv (quant-ph) 2026-06-16

No Universal Purification in Quantum Mechanics

arXiv:2509.21111v2 Announce Type: replace Abstract: Many central tasks in fundamental physics and quantum information processing are possible only insofar as mixed quantum states can be made purer. In this work, we prove that the linearity and positivity of quantum mechanics impose general restrictions on quantum purification, unveiling a new fundamental principle of quantum information processing. We first establish that no quantum operation can transform a finite number of copies of an unknown quantum state or channel into an exactly pure output that depends non-trivially on the input, thereby ruling out an important form of universal purification in both static and dynamical settings. Building on this, we show that, upon relaxing the requirement of exact purity, one can establish quantitative sample-complexity lower bounds for approximate purification that hold for arbitrary physically allowed strategies, whose scaling matches the performance of purification-related tasks across several different areas of quantum information processing. Moreover, this lower bound leads to a generalized standard quantum limit for learning arbitrary functions of a quantum state, greatly extending earlier results based on quantum Fisher information and revealing a deep connection between purification and quantum learning. Extending this principle to other important settings, we establish, for the first time, an exponential sample-complexity lower bound for approximate pure dilation state preparation and a no-go theorem for approximate bosonic Gaussian state purification with passive Gaussian operations, establishing much more stringent limitations under practical operational constraints.

16.
arXiv (math.PR) 2026-06-17

Absolute continuity, supports and idempotent splitting in categorical probability

arXiv:2308.00651v5 Announce Type: replace Abstract: Markov categories have recently turned out to be a powerful high-level framework for probability and statistics. They accommodate purely categorical definitions of notions like conditional probability and almost sure equality, as well as proofs of fundamental results such as the Hewitt–Savage 0/1 Law, the de Finetti Theorem and the Ergodic Decomposition Theorem. In this work, we develop additional relevant notions from probability theory in the setting of Markov categories. This comprises improved versions of previously introduced definitions of absolute continuity and supports, as well as a detailed study of idempotents and idempotent splitting in Markov categories. Our main result on idempotent splitting is that every idempotent measurable Markov kernel between standard Borel spaces splits across another standard Borel space, and we derive this as an instance of a general categorical criterion for idempotent splitting in Markov categories.

17.
medRxiv (Medicine) 2026-06-22

A Parent-Generated Framework of Early Connection: Findings from a CBPR Qualitative Study

Background: Early relational health (ERH) constructs are derived fromresearch observations rather than lived experiences. This study foregrounds diverse parent voices to examine how they describeconnectionwith their young children. Methods: Usingcommunity-based participatory research (CBPR),this study was co-designed withparent leadersfromReach Out and Read. A semi-structured interview guidewas co-designed,and parent leaderssubsequentlyconducted and transcribed 18 interviews with parents from their networks.Researchersanalyzed transcripts using Reflexive Thematic Analysis.Member checking sessions with parent leadersinformedthe analytic framework. Results:Sixorganizing principleswereidentified.(1) Parent-child connection begins with an instinctual sense of responsibility.(2)Connectionebbs and flows as parent and child adapt to one another through dailyactivities.(3) Family circumstances, including family structure, cultural expectations, and intergenerational values, directly shape this connection. (4) Parents' own upbringings and past relationships indirectly shape how they connect with their child. (5) Forconnectionto grow, parents must show up physically and emotionally for their children despite competing demands. (6) Parentsgrow through engaged parenting, and that growth feeds back into the connection, creating a self-sustaining cycle of relational health.Conclusions:Our analysis generated twoconstructs underspecified in ERH frameworks.Parents described their sense of responsibility as immediate and instinctual, preceding an emotional bond.Parentsdemonstratedtheir agency in deciding what to carry forward from their relational histories, a pattern this study termsrelational legacy. Integrating parent-generated language into ERH measurementresearchmay shape a more comprehensive picture of ERHreflectinghow families experience connection.

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

Hierarchical Control in Multi-Agent Games: LLM-based Planning and RL Execution

arXiv:2606.20014v1 Announce Type: cross Abstract: Reinforcement learning (RL) has achieved strong performance in sequential decision-making, yet scaling to complex multi-agent environments remains challenging due to sparse rewards, large state-action spaces, and the difficulty of learning coordinated strategies. We propose a hierarchical architecture where a pretrained large language model (LLM) acts as a centralized strategic controller that selects among specialized RL skill policies for a team of agents, while RL policies handle reactive low-level execution. We evaluate this hybrid system in a competitive 2v2 King of the Hill environment against behavior tree (BT) and ``Flat'' RL (end-to-end training without skill decomposition) baselines. The LLM+RL system achieves task performance statistically equivalent to hand-crafted BT (46.4\% vs 51.5\% win rate, $p=0.103$) while both significantly outperform Flat RL trained without skill decomposition. A user study ($n=15$) reveals that 60\% of participants perceive LLM+RL agents as the most human-like ($p=0.027$), citing behavioral adaptability and tactical variability. These results demonstrate that pretrained LLM reasoning can effectively orchestrate pretrained RL skills, achieving competitive multi-agent coordination and superior perceived believability without manual rule engineering.

19.
arXiv (quant-ph) 2026-06-16

Bath memory as a precision resource in quantum transport

arXiv:2606.17026v1 Announce Type: new Abstract: Structured baths can reshape transport fluctuations in mesoscopic quantum devices, yet a predictive criterion for when this enhances precision has been lacking. We propose a route towards such precision advantages by utilizing bath memory in coherent fermionic transport through a noninteracting quantum-dot chain. Using the Landauer-Büttiker formalism, we derive a dual impedance-matching condition that synchronizes the conductor mode splitting, boundary dissipation, and bath bandwidth, and sustains constructive multimode interference across the transmission window. The analytical predictions for the optimal bath bandwidths show excellent agreement with exact nonequilibrium Green's function calculations of the transport for Lorentzian, Gaussian, and Newns spectral densities. The prescription yields an optimal bath bandwidth at which the current Fano factor is minimized and the thermodynamic and kinetic precision coefficients are simultaneously enhanced beyond their Markovian limits. The alignment of the optimal precision regime with the experimentally accessible current Fano factor minimum thus provides a practical strategy for designing precision-enhanced transport in mesoscopic platforms such as semiconductor quantum-dot arrays and ultracold fermionic channels.

20.
PLOS Medicine 2026-05-06

Point-of-care early infant HIV diagnosis at birth in a pragmatic cluster-randomized trial in Mozambique and Tanzania: A comparative cost and cost-effectiveness study

Authors:

by Kira Elsbernd, Issa Sabi, Ilesh V. Jani, Chishamiso Mudenyanga, Siriel Boniface, Arlete Mahumane, Joaquim Lequechane, Falume Chale, Bindiya Meggi, Kassia Pereira, Raphael Edom, Anange F. Lwilla, W. Chris Buck, Nyanda Elias Ntinyinya, Michael Hoelscher, Till Baernighausen, Arne Kroidl, Stefan Kohler, the LIFE Study Consortium Background Timely access to early infant diagnosis (EID) is crucial for newborns with HIV, as late diagnosis can delay lifesaving antiretroviral treatment (ART). We assessed the comparative cost and cost-effectiveness of integrating point-of-care EID at birth into routine care in primary healthcare settings. Methods and findings This pre-specified secondary analysis was nested in the cluster-randomized LIFE study conducted at 28 primary healthcare facilities in Mozambique and Tanzania from October 2019 to September 2021. We estimated the health system cost of point-of-care birth plus 4–8-week HIV testing (very early infant diagnosis; VEID) compared to standard-of-care (SoC) testing at 4–8 weeks only, both with immediate ART initiation. We assessed the cost-effectiveness of VEID relative to SoC with respect to ART initiation within one week of life using Bayesian hierarchical models. As this is an intermediate outcome, incremental cost-effectiveness ratios (ICERs) cannot be directly compared to available life-year-based cost-effectiveness thresholds. To contextualize results, we derived the minimum life-years gained per early ART initiation required for VEID to meet standard thresholds in a break-even analysis.VEID was associated with a higher cost and resulted in earlier ART initiation than SoC in both countries. In Mozambique, VEID increased the proportion of infants initiating ART within one week of life by 90.0 (95% CrI [67.5, 98.5]) percentage points at an incremental cost of $2,632 (95% CrI [$2,249, $3,062]) per infant with HIV. In Tanzania, VEID increased early ART initiation by 59.9 (95% CrI [20.9, 89.5]) percentage points at an incremental cost of $6,263 (95% CrI [$5,394, $7,243]) per infant with HIV. The ICER was $2,924 and $10,458 in Mozambique and Tanzania, respectively and was sensitive to intrauterine transmission rate. These findings were limited by the lack of long-term health outcome data and reliance on an intermediate outcome. Based on the break-even analysis, we estimated that VEID would need to yield 6–32 life-years gained per additional early ART initiation to meet standard thresholds. Conclusions Adding birth testing improved early ART initiation but was unlikely to be cost-effective relative to standard thresholds given current prices, vertical transmission rates, and knowledge of long-term health benefits. Cost-effectiveness could be achieved at current costs if early ART translates to substantial long-term health benefits or if targeted to infants at high risk of vertical transmission.

21.
PLOS Medicine 2026-05-08

Climate change and non-communicable diseases: An invisible syndemic

by Gokul Parameswaran, Sadeer Al-Kindi, Sanjay Rajagopalan Climate change accelerates non-communicable diseases (NCDs) through cascading environmental disruptions and is attributed to driving increased NCD-related mortality. Yet this syndemic remains invisible and underfunded. We detail why addressing the climate-NCD intersection is critical for improving health. In this Perspective, Sanjay Rajagopalan and colleagues discusses how climate change accelerates non-communicable diseases (NCDs) and exacerbates NCD-related mortality, and calls for greater visibility and funding to address this syndemic and improve human health.

22.
Nature (Science) 2026-06-10

A first-in-class pulsatile FXR agonist for bile-acid-related liver diseases

Authors:

Nuclear receptors are central regulators of metabolism1, yet therapeutic strategies that enforce continuous receptor activation frequently lead to reduced efficacy and unacceptable toxicity. Here we report a first-principles drug design strategy that aligns pharmacokinetics with physiological signalling cycles. We developed linafexor, a potent non-bile-acid agonist of the farnesoid X receptor (FXR)2; it is engineered for rapid systemic clearance, which enables pulsatile receptor activation that mirrors endogenous bile acid dynamics3–5. Linafexor has robust efficacy across multiple preclinical models of metabolic dysfunction-associated steatohepatitis6, liver fibrosis7, primary biliary cholangitis and primary sclerosing cholangitis8,9. Transcriptomic analyses reveal that, unlike long-acting FXR agonists10,11, linafexor preserves cyclic FXR signalling, avoids receptor downregulation and prevents broad transcriptional dysregulation. Direct manipulation of delivery patterns demonstrates that sustained FXR activation—independent of compound identity—induces severe toxicity, establishing activation duration as a determinant of therapeutic index. In phase 1 clinical studies (ClinicalTrials.gov; NCT05082779), linafexor administered once daily produces transient FXR pathway engagement, marked by (1) induction of FGF1912–14, a key endocrine mediator of bile acid feedback regulation; and (2) suppression of C415, an intermediate reflecting hepatic bile acid synthesis, with no treatment-related adverse events. Together, these findings identify pulsatile FXR activation as a mechanistically grounded and clinically translatable strategy, and establish linafexor as a first-in-class therapeutic for bile acid–related liver diseases. Linafexor is a rapidly cleared FXR agonist designed to mimic natural bile acid signalling, achieving transient receptor activation with strong efficacy and reduced toxicity in preclinical and early clinical studies.

23.
arXiv (CS.LG) 2026-06-15

A Complexity Measure for Active Learning in Multi-group Mean Estimation

arXiv:2606.14690v1 Announce Type: new Abstract: We study a max-risk objective for active learning in a multi-group mean estimation $d$-armed bandits: a learner adaptively allocates a budget of $T$ samples across $d$ groups to minimize the worst-case uncertainty index $\max_{k\in[d]}\sigma_k^2/n_k$, where $\sigma_k$ is the standard deviation of the distribution of arm $d$, and $n_k$ is the number of times arm $d$ is sampled. We develop a local minimax framework and prove the first general lower bound for this objective, valid for any finite-variance hypothesis class. The bound separates difficulty into three orthogonal factors: a budget term, a heteroscedasticity index measuring how unevenly the uncertainty is spread across arms, and a model-dependent complexity measure, the Variance Local Curvature ($\mathrm{VLC}$), which captures how much information a local change of variance creates inside the hypothesis class. For smooth classes, the $\mathrm{VLC}$ is a reparametrization of a variance–Fisher information, with closed-form values for common families. Benchmarking against the strongest available upper bound shows near-optimality up to logarithmic factors in broad regimes, and pinpoints a systematic gap in highly heterogeneous instances. Our proof introduces two key ingredients: a loss-induced $\ell_1$ geometry on the decision space, and a representation-based instance generator that reduces hard-instance construction to an explicit random matrix calculation.

24.
arXiv (CS.CV) 2026-06-16

From Static Inference to Dynamic Interaction: A Survey of Streaming Large Language Models

Standard Large Language Models (LLMs) are predominantly designed for static inference with pre-defined inputs, which limits their applicability in dynamic, real-time scenarios. To address this gap, the streaming LLM paradigm has emerged. However, existing definitions of streaming LLMs remain fragmented, conflating streaming generation, streaming inputs, and interactive streaming architectures, while a systematic taxonomy is still lacking. This paper provides a comprehensive overview and analysis of streaming LLMs. First, we establish a unified definition of streaming LLMs based on data flow and dynamic interaction to clarify existing ambiguities. Building on this definition, we propose a systematic taxonomy of current streaming LLMs and conduct an in-depth discussion on their underlying methodologies. Furthermore, we explore the applications of streaming LLMs in real-world scenarios and outline promising research directions to support ongoing advances in streaming intelligence. We maintain a continuously updated repository of relevant papers at https://github.com/EIT-NLP/Awesome-Streaming-LLMs.

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

CheXGenBench: A Unified Benchmark For Fidelity, Privacy and Utility of Synthetic Chest Radiographs

Structured benchmarks have advanced text-conditional image generation for real-world imagery, however, no such benchmark exists for synthetic radiograph generation. Despite being a highly active area of research, existing studies continue adopting inconsistent evaluation protocols and lack a unified assessment of the three most critical criteria: generative fidelity, privacy risk, and downstream utility. To address these limitations, we introduce CheXGenBench, the first unified evaluation framework for synthetic chest radiograph generation that simultaneously assesses fidelity, privacy risks, and downstream utility across frontier text-to-image (T2I) generative models. Our evaluation protocol, comprising over 20 quantitative metrics, covers 11 leading T2I architectures with plug-and-play integration for newer models. Through a rigorous and fair evaluation protocol, we establish comprehensive baseline state-of-the-art (SoTA) performances across all dimensions to guide future research. Furthermore, our results uncover several limitations of current generative models, which include first, even SoTA models struggle with long-tailed medical distributions; second, models pose high privacy risks regardless of fidelity quality; and third, while synthetic data already benefits downstream classification, it is of limited utility for downstream multimodal tasks. Drawing from these results, we propose concrete research directions to advance the field. The code is available at https://github.com/Raman1121/CheXGenBench