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01.
medRxiv (Medicine) 2026-06-23

THE SILENT STRUGGLE: EXPLORING THE EFFECTS OF COMMUNICATION BREAKDOWNS IN HEALTHCARE DELIVERY IN THE NORTHERN REGION OF GHANA

作者:
Salifu↗Abdulai↗Ibrahim↗

Abstract Effective health communication is central to patient-centred care and improved health outcomes, particularly in culturally diverse healthcare settings. In clinical and assistive practice, communication breakdowns may negatively affect diagnosis, treatment adherence, and preventive care. A qualitative phenomenological design was employed, utilizing Semi-Structured interviews with purposively sampled twenty patients and healthcare professionals from Tamale Teaching Hospital, Yendi Hospital, and Bimbilla Hospital. The researchers adopted Content Analysis as the tool of analysis for the data. The findings of this study revealed that language discrepancies Poor attitudes of healthcare providers hinderer patient openness and the quality treatment. Logistical issues, such as inadequate medicines and medical supplies, resulted in delayed treatment and additional financial burden on patients and their relatives. Cultural and social factors discourage patients from discussing certain health conditions with healthcare providers, leading to delayed treatment. These hurdles adversely impact on treatment and assistive practice, specifically in culturally diverse environment and preventive care. The study recommends training and capacity-building programs for healthcare providers in cultural competence, fostering effective and ethical health communication between patients and healthcare providers, and recruiting professional interpreters to bridge the linguistics gap between patients and providers. Abstract Effective health communication is central to patient-centered care and improved health outcomes, particularly in culturally diverse healthcare settings. In clinical and assistive practice, communication breakdowns may negatively affect diagnosis, treatment adherence, and preventive care. A qualitative phenomenological design was employed, utilizing semi-structured interviews with twenty purposively sampled patients and healthcare professionals from Tamale Teaching Hospital, Yendi Hospital, and Bimbilla Hospital. The researchers adopted content analysis as the tool of analysis for the data. The findings of this study revealed that language discrepancies Poor attitudes of healthcare providers hinder patient openness and quality treatment. Logistical issues, such as inadequate medicines and medical supplies, resulted in delayed treatment and additional financial burden on patients and their relatives. Cultural and social factors discourage patients from discussing certain health conditions with healthcare providers, leading to delayed treatment. These hurdles adversely impact treatment and assistive practice, specifically in culturally diverse environments and preventive care. The study recommends training and capacity-building programs for healthcare providers in cultural competence, fostering effective and ethical health communication between patients and healthcare providers, and recruiting professional interpreters to bridge the linguistics gap between patients and providers.

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02.
medRxiv (Medicine) 2026-06-19

Within-host pathogen population diversity predicts treatment response in tuberculosis

作者:
Kulkarni↗Marin↗Mann↗Rawoot↗Goodwin↗Cesare↗Warren↗Jacobson↗Farhat↗

Background: Tuberculosis (TB) treatment outcomes remain suboptimal, and standard clinical diagnostics cannot reliably identify patients at high risk of treatment failure or relapse at the time of diagnosis. While within-host Mycobacterium tuberculosis genetic diversity is hypothesized to reflect the viable bacterial burden and adaptive capacity of the infection, its clinical prognostic value remains unknown. Methods: We conducted a prospective cohort study of 364 patients with newly diagnosed, rifampicin-susceptible pulmonary TB in South Africa. Patients received standard 6-month therapy and were monitored for up to two years to ascertain composite unfavorable outcomes (treatment failure, death, or relapse). To accurately detect low-frequency (unfixed) genetic variants and eliminate reference bias artifacts, we mapped medium to high depth short-read sequences against matched, patient-specific long-read assemblies. The association between baseline pathogen genetic diversity and clinical outcomes was evaluated using multivariable Cox proportional-hazards models. Results: After bioinformatic filtering, true unfixed variants were relatively rare but significantly enriched in genes mediating pathogen adaptation and drug tolerance, including transporter proteins and two-component regulatory systems. Within-host bacterial genetic diversity (i.e., the total number of unfixed variants) ranged from 0-20, with a median of 1 per patient. In survival analysis adjusting for known clinical risk factors–including HIV status, prior TB, baseline smear positivity, and radiographic lung involvement–baseline within-host genetic diversity emerged as a strong, independent predictor of unfavorable treatment outcomes. For patients with greater than 3 unfixed variants at diagnosis, each increase of 5 unfixed variants was associated with more than double the risk of a composite unfavorable outcome (adjusted Hazard Ratio, 2.36; 95% CI, 1.27 to 4.39; p=0.007). Conclusions: Baseline within-host pathogen genetic diversity is an independent predictor of unfavorable TB treatment outcomes. As sequencing becomes increasingly integrated into routine diagnostics, quantifying unfixed variants is an accessible approach that promises to risk-stratify patients and guide the duration of individualized regimens.

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

Variance Reduction for Non-Log-Concave Sampling with Applications to Inverse Problems

作者:
M. Berk Sahin↗Ahmet Ege Tanriverdi↗Behzad Sharif↗Abolfazl Hashemi↗

arXiv:2606.16257v1 Announce Type: cross Abstract: Sampling from high-dimensional, non-log-concave distributions with unnormalized densities is a fundamental challenge in machine learning, particularly when the exact gradient of the potential is unavailable and must be approximated via stochastic gradients that exhibit high variance under a fixed budget of gradient computations per iteration. Although variance reduction techniques such as SGD with momentum, STORM, and PAGE have demonstrated improved convergence properties in non-convex optimization, their implications for sampling from non-log-concave distributions remain largely unexplored. In this work, we develop the first unified analysis of these estimators for sampling from non-log-concave distributions. We establish improved non-asymptotic convergence rates in $\varepsilon$-relative Fisher information and, under a Poincaré inequality assumption, in squared total variation distance, and further prove weak convergence to the target distribution. We extend our analysis to solving inverse problems with score-based generative priors. We empirically validate our theory and demonstrate that, under a fixed gradient computations per iteration, variance-reduction techniques consistently improve sample quality in two standard imaging applications.

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

Structure-Semantic Co-optimized Latent Diffusion Model for Fast Visual Anagram Synthesis

作者:
Xiang Gao↗Yunpeng Jia↗

Visual anagram is an intriguing form of art creation wherein a single image presents different conceptual interpretations under transformations such as flipping or rotation. Recent work has achieved visual anagram synthesis by leveraging pretrained text-to-image (T2I) diffusion models, yet still suffers from several key limitations including computational inefficiency, suboptimal aesthetic quality, and weak semantic fidelity and expressiveness. This work focuses on generating visual anagrams with substantially improved visual quality at minimal computational cost, thereby advancing intelligent creation of illusionary digital art. To increase image resolution while reducing time overhead, we adapt the cutting-edge parallel denoising algorithm from pixel-based T2I model to the adversarially distilled latent-based one, and accordingly propose a structure-semantic co-optimization (S2CO) framework to counteract the consequent visual degradation. As the core of our approach, S2CO framework comprises three key innovations: (\romannumeral1) null-text structure alignment optimization; (\romannumeral2) semantic enhancement optimization; (\romannumeral3) attention-guided noise fusion. Building upon these components, our method dubbed S2CO-Anagram is able to generate higher-resolution anagram images with noticeably superior visual harmony and semantic faithfulness than related SOTA approaches, all while achieving substantially faster inference speed. Code will be publicly available.

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05.
arXiv (CS.AI) 2026-06-18

Skill-Guided Continuation Distillation for GUI Agents

作者:
Zhimin Fan↗Hongwei Yu↗Yeqing Shen↗Haolong Yan↗Guozhen Peng↗Tianhao Peng↗Yudong Zhang↗Xiaowen Zhang↗Kaijun Tan↗Zheng Ge↗Xiangyu Zhang↗Daxin Jiang↗…

arXiv:2606.18890v1 Announce Type: new Abstract: Improving GUI agents typically relies on behavior cloning on expert trajectories. However, as the current policy deviates from the expert policy, it inevitably encounters policy-induced off-trajectory states during closed-loop execution, i.e., states that fall outside the expert trajectories. Since expert trajectories provide no demonstrations for these unseen states, such states receive no effective supervision, leaving the policy unable to select the correct action. To close this supervision gap, we propose Skill-Guided Continuation Distillation (SGCD), an iterative self-improvement framework. SGCD first runs the plain policy without skill guidance for a few steps to reach realistic off-trajectory states. From these states, a skill-guided policy then completes the task and produces successful continuations, which are mixed with expert trajectories to supply supervision over policy-induced off-trajectory states. The skills are extracted from both successful and failed rollouts, consisting of Continuation Plans, Critical Targets, Failure Traps, and Success Criteria. On OSWorld-Verified, SGCD improves the success rate of three base models from the low-30\% range to over 50\%, demonstrating its effectiveness and generality.

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

TW-LegalBench: Measuring Taiwanese Legal Understanding

作者:
Fei-Yueh Chen↗Chun Huang Lin↗Chan Wei Hsu↗Kuan Hsuan Yeh↗Zih-Ching Chen↗Kuan-Ming Chen↗Patrick Chung-Chia Huang↗

Large language models (LLMs) have shown impressive capabilities across diverse tasks, yet their performance on jurisdiction-specific legal reasoning remains underexplored. We present TW-LegalBench that utilizes Taiwanese legal system's rich official corpus open to the public to fill the gap in evaluating LLMs on Taiwanese law, among common-law benchmarks that focus on English sources and civil-law benchmarks focusing on sources of Simplified Chinese. TW-LegalBench comprises three task types: (1) over 16,000 multiple-choice questions (MCQs) across five years of official examinations in 18 professional domains; (2) 117 open-ended essay questions (OEQs) from examinations for legal professionals with official scoring rubrics; and (3) more than 14,000 legal judgment prediction (LJP) instances covering hundreds of crime categories. We evaluate 13 LLMs using accuracy for MCQs, a decomposed LLM-as-Judge framework based on the scoring rubric points for OEQs, and metrics for sentencing accuracy and statute citation for LJP. Our results reveal that top-performing models exceed the passing threshold for qualified lawyers (passing rate: 11%) but fall short of that for judges and prosecutors (passing rate: 1~2%). For LJP, while models demonstrate reasonable verdict type accuracy and sentence prediction capability, they struggle to cite exact legal articles. These findings highlight that reliable legal text generation remains challenging for LLMs, even though their performance on qualification examinations approaches human level.

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

Mix-QVLA: Task-Evidence-Aware Mixed-Precision Quantization of Vision-Language-Action Models

作者:
Navin Ranjan↗Andreas Savakis↗

We propose Mix-QVLA, a task-evidence-aware mixed-precision PTQ framework for VLA models. Mix-QVLA anchors each quantized variant to the full-precision action-token reference decision and evaluates whether quantization preserves task-relevant evidence across key VLA functional boundaries. It computes normalized gradient-weighted task-evidence maps from boundary activations and compares full-precision and quantized maps using evidence-mass and attribution-distribution distortion, capturing changes in both the strength and allocation of decision-supporting evidence. A soft-bottleneck objective aggregates boundary-level degradation into layer-wise sensitivity scores. Mix-QVLA further models sensitivity throughout task execution, capturing phase-dependent shifts in layer importance rather than assuming a fixed sensitivity profile. The resulting evidence- and time-aware scores guide mixed-precision bit allocation under model-size and BitOps budgets. Extensive evaluations on OpenVLA-style policies show that Mix-QVLA improves the accuracy-efficiency trade-off of low-bit VLA deployment. On LIBERO, Mix-QVLA reduces OpenVLA-OFT memory from 15.4 GB to 4.1 GB, retains 96.3 average success compared with 97.1 for the BF16 model, and achieves a 1.52x inference speedup.

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08.
arXiv (CS.CL) 2026-06-17

A Multifaceted Analysis of Social Biases in Large Language Models

作者:
Xulang Zhang↗Rui Mao↗Erik Cambria↗

Large language models (LLMs) have rapidly become indispensable tools for acquiring information and supporting human decision-making. However, ensuring that these models uphold fairness across varied contexts is critical to their safe and responsible deployment. In this study, we undertake a comprehensive examination of four widely adopted LLMs, probing their underlying biases and inclinations across the dimensions of politics, ideology, alliance, language, and gender. Through a series of carefully designed experiments, we investigate their political neutrality using news summarization, ideological biases through news stance classification, tendencies toward specific geopolitical alliances via United Nations voting patterns, language bias in the context of multilingual story completion, and gender-related affinities as revealed by responses to the World Values Survey. Results indicate that while the LLMs are aligned to be neutral and impartial, they still show biases and affinities of different types.

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

CONCORD: Asynchronous Sparse Aggregation for Device-Cloud RAG under Document Isolation

作者:
Xuedong Hu↗Zhiqing Tang↗Zhi Yao↗Tian Wang↗Weijia Jia↗

arXiv:2606.15179v1 Announce Type: new Abstract: Retrieval-augmented generation (RAG) has emerged as a pivotal technique for improving language models by incorporating external knowledge at inference time. As device-cloud collaborative inference makes it feasible to deploy small language models on edge devices, a new setting arises in which private documents remain on the device and public knowledge resides in the cloud. Privacy and policy constraints often forbid raw document exchange, creating a document-isolated dual-end RAG setting. However, existing methods rely on frequent remote synchronization and dense evidence transfer, limiting throughput under realistic latency and bandwidth conditions. To address this issue, we propose CONCORD, an asynchronous sparse aggregation framework for dual-end RAG under document isolation. CONCORD treats the cloud as an asynchronously arriving evidence source rather than a continuously synchronized co-generator. Specifically, we introduce waiting debt control to decide whether each decoding step should continue waiting for remote participation based on the observed return of waiting. We also design a certificate-guided minimal supplementation mechanism that requests only the remote evidence needed to determine the current greedy decision. Steps that consult the cloud preserve the same greedy token as dense dual-end aggregation, while the remaining steps commit locally without remote evidence. Experiments on Natural Questions and WikiText-2 show that CONCORD improves end-to-end throughput over baselines by $1.66\times$ and $2.15\times$, respectively, while reducing per-token communication by over two orders of magnitude and maintaining comparable answer quality and perplexity.

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10.
medRxiv (Medicine) 2026-06-17

Real-World Effectiveness and Safety of Avacopan in ANCA-Associated Vasculitis: A Systematic Literature Review and Meta-analysis

作者:
Ibiloye↗Kathe↗Mirkovic↗Martin↗Tu↗Gamburg↗Kumar↗Solanki↗Wallace↗

Background: The efficacy and safety of avacopan in ANCA-associated vasculitis (AAV) has been established in randomized trials of of avacopan as a glucocorticoid (GC) sparing therapy. However, real world evidence (RWE) has an important role in confirming effectiveness and evaluating safety in more generalizable settings. This study aimed to synthesize RWE on the effectiveness and safety of avacopan in adults with AAV. Methods: A systematic literature review and meta analysis of non interventional real world studies was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Eligible studies included adults with AAV treated with avacopan in routine clinical practice. Pooled estimates of effectiveness and safety outcomes were calculated using random effects meta-analyses. Primary outcomes included remission at 6 and 12 months and sustained remission at 12 months. Secondary outcomes included relapse, GC use and dosing, hepatotoxicity, infections, and treatment discontinuation. Exploratory outcomes included changes in estimated glomerular filtration rate (eGFR) and dialysis related endpoints. Results: A total of 71 studies were included and contributed to quantitative analyses. Pooled remission for patients on avacopan was 87% (95% CI: 75%-94%) at 6 months and 93% (95% CI: 86%-97%) at 12 months, and sustained remission was 86% (95% CI: 74%-93%) at 12 months. Relapse at 12 months was low (7%; 95% CI: 4%-11%). GC use was 36% at both 6 and 12 months. Improvements in eGFR were observed at 6 months (18 mL/min/1.73 m2) and 12 months (18 mL/min/1.73 m2), and dialysis liberation was 66% in a limited subset. Among avacopan patients, 11% experienced any hepatotoxicity, including 7% with serious (defined as directly reported or requiring hospitalization) hepatotoxicity, while 7% experienced serious (defined as directly reported or requiring hospitalization) infection. Conclusions: In real world clinical practice, avacopan is associated with high remission rates, low relapse rates, and a consistent GC sparing effect, with effectiveness comparable to standard of care regimens. Findings support its clinical use with appropriate safety monitoring; however, the observed heterogeneity in hepatotoxicity and the limited comparative effectiveness evidence highlight areas requiring further investigation.

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

Through the PRISM: Preference Representation in Intermediate States of Video Diffusion Models

作者:
Haoxuan Wu↗Lai Man Po↗Mengyang Liu↗Kun Li↗Hongzheng Yang↗Wei Liu↗

Evaluating video generation with clean, pixel-based reward models disconnects evaluation from the noisy diffusion process and incurs massive VAE decoding costs. In this paper, we challenge this paradigm by asking a fundamental question: Can a powerful video generator inherently discriminate preferences directly from noisy latents? To answer this, we introduce PRISM (Preference Representation in Intermediate States of Diffusion Models). PRISM employs a lightweight Query-based Aggregation head with a frozen video diffusion backbone to decode preference signals from noisy latents. Surprisingly, PRISM not only achieves SOTA preference accuracy but also unlocks strong noise-robustness, which enables early-stage Best-of-$N$ sampling. This allows for filtering suboptimal candidates at the very beginning of denoising, drastically reducing computation while boosting video quality. We also reveal a strong positive correlation between a backbone's generative performance and its inherent evaluative power, enabling self-improving video backbones.

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

EHRNote-ChatQA: A Benchmark for Evidence-Grounded Multi-Turn Clinical Question Answering over Longitudinal Discharge Summaries

作者:
Jiyoun Kim↗Muhan Yeo↗Eunhye Jang↗Jeewon Yang↗Hangyul Yoon↗Su Ji Lee↗Hee Jo Han↗Hee-Jae Jung↗Doyun Kwon↗Jun young Lee↗Jaehun Lee↗Jung-Oh Lee↗…

Discharge summaries are crucial clinical documents containing the context of a patient's overall hospital stay, and are routinely reviewed by medical experts for patient readmission, ongoing care, and diagnostic decision-making. When reviewing them, medical experts often must iteratively synthesize information across multiple summaries while verifying the evidence supporting each answer. Although large language models (LLMs) are increasingly explored for clinical question answering, existing benchmarks do not sufficiently reflect this setting: they often evaluate exam-style medical knowledge or focus on single-turn question answering with limited evidence-grounding evaluation. We introduce EHRNote-ChatQA, the first benchmark for evidence-grounded multi-turn clinical question answering over patients' multiple discharge summaries. Built from de-identified MIMIC-IV discharge summaries, EHRNote-ChatQA contains 967 patient-level multi-turn samples spanning one to five notes and 16,072 medical-expert-verified QA pairs (8,036 content questions, each paired with an evidence-grounding question) across eight clinical categories. The benchmark is constructed through an expert-informed pipeline combining discharge-summary structuring schema, expert-curated multi-turn QA templates, and LLM-based generation, followed by review and revision of every single QA sample by 11 medical experts. Benchmarking 22 open- and closed-source LLMs reveals several challenges, including that LLMs struggle more with evidence grounding than content answering, multi-turn errors compound across turns, and single-turn clinical QA performance does not reliably transfer to this setting. These findings establish EHRNote-ChatQA as a rigorous and practical benchmark for evaluating clinical QA systems. The dataset will be made publicly available through PhysioNet credentialed access.

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

CASHEW: Stabilizing Multimodal Reasoning via Iterative Trajectory Aggregation

作者:
Chaoyu Li↗Deeparghya Dutta Barua↗Fei Tao↗Pooyan Fazli↗

Vision-language models achieve strong performance across a wide range of multimodal understanding and reasoning tasks, yet their multi-step reasoning remains unstable. Repeated sampling over the same input often produces divergent reasoning trajectories and inconsistent final predictions. To address this, we introduce two complementary approaches inspired by test-time scaling: (1) CASHEW, an inference-time framework that stabilizes reasoning by iteratively aggregating multiple candidate trajectories into higher-quality reasoning traces, with explicit visual verification filtering hallucinated steps and grounding reasoning in visual evidence, and (2) CASHEW-RL, a learned variant that internalizes this aggregation behavior within a single model. CASHEW-RL is trained using Group Sequence Policy Optimization (GSPO) with a composite reward that encourages correct answers grounded in minimal yet sufficient visual evidence, while adaptively allocating reasoning effort based on task difficulty. This training objective enables robust self-aggregation at inference. Extensive experiments on 13 image understanding, video understanding, and video reasoning benchmarks show significant performance improvements, including gains of up to +26.2 percentage points on ScienceQA and +9.1 percentage points on EgoSchema.

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14.
arXiv (quant-ph) 2026-06-16

Against probability: A quantum state is more than a list of probability distributions

作者:
Ladina Hausmann↗Renato Renner↗

arXiv:2601.18872v2 Announce Type: replace Abstract: The state of a quantum system can be represented by listing the outcome probabilities for a tomographically complete set of measurements. Such representations appear throughout physics, for example, in quantum field theory via correlation functions and in quantum foundations within generalized probabilistic frameworks. In this paper, we show a no-go result: To enable useful statements, the probability representation must be topologically robust$\unicode{x2014}$preserving the notion of closeness between states. Yet, a topologically robust probability representation cannot simultaneously retain other essential structure, such as the subsystem structure.

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

When the Past Matters: FlashBack Memory for Precipitation Nowcasting

作者:
Yuhao Du↗Boxiao Huang↗Chengrong Wu↗Jiankai Zhang↗

Accurate precipitation nowcasting is crucial for disaster mitigation and socio-economic planning, yet existing methods often struggle with false alarms, missed events, and long range dependency modeling at high spatiotemporal resolution. To address these challenges, we propose FlashBack Memory (FB), a module that dynamically retrieves key historical states and integrates them via an adaptive fusion gate, enhancing the spatiotemporal representation capability of recurrent-based models. We incorporate FB into PredRNN, PredRNNpp, MIM, MotionRNN, and PredRNN-V2, and evaluate on CIKM2017, Shanghai2020, and SEVIR datasets. Experimental results demonstrate that FB significantly improves MSE, MAE, SSIM, and CSI metrics, particularly for high-intensity rainfall and long-sequence predictions, while reducing false alarms and missed events and enhancing temporal consistency and spatial localization. The proposed method provides a general and efficient memory enhancement mechanism, improving the overall performance of recurrent-based precipitation nowcasting models.

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16.
arXiv (CS.CL) 2026-06-17

Evidence of Layered Positional and Directional Constraints in the Voynich Manuscript: Implications for Cipher-Like Structure

作者:
Christophe Parisel↗

The Voynich Manuscript (VMS) exhibits a script of uncertain origin whose grapheme sequences have resisted linguistic analysis. We present a systematic analysis of its grapheme sequences, revealing two complementary structural layers: a character-level right-to-left optimization in word-internal sequences and a left-to-right dependency at word boundaries, a directional dissociation not observed in any of our four comparison languages (English, French, Hebrew, Arabic). We further evaluate two classes of structured generator against a four-signature joint criterion: a parametric slot-based generator and a Cardan grille implementing Rugg's (2004) gibberish hypothesis. Across their full tested parameter spaces, neither class reproduces all four signatures simultaneously. While these results do not rule out generator classes we have not tested, they provide the first quantitative benchmarks against which any future generative or cryptanalytic model of the VMS can be evaluated, and they suggest that the VMS exhibits cipher-like structural constraints that are difficult to reproduce from simple positional or frequency-based mechanisms alone.

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17.
arXiv (quant-ph) 2026-06-19

Hybrid VQE-CVQE algorithm using diabatic state preparation

作者:
John P. T. Stenger↗C. Stephen Hellberg↗Daniel Gunlycke↗

arXiv:2512.04801v2 Announce Type: replace Abstract: We propose a hybrid variational quantum algorithm that has variational parameters used by both the quantum circuit and the subsequent classical optimization. Similar to the Variational Quantum Eigensolver (VQE), this algorithm applies a parameterized unitary operator to the qubit register. We generate this operator using diabatic state preparation. The quantum measurement results then inform the classical optimization procedure used by the Cascaded Variational Quantum Eigensolver (CVQE). We demonstrate the algorithm on a system of interacting electrons and show how it can be used on long-term error-corrected as well as short-term intermediate-scale quantum computers. Our simulations performed on IBM Brisbane produced energies well within chemical accuracy.

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

Why Low-Precision Transformer Training Fails: An Analysis on Flash Attention

作者:
Haiquan Qiu↗Quanming Yao↗

arXiv:2510.04212v4 Announce Type: replace-cross Abstract: The pursuit of computational efficiency has driven the adoption of low-precision formats for training transformer models. However, this progress is often hindered by notorious training instabilities. This paper provides the first mechanistic explanation for a long-standing and unresolved failure case where training with flash attention in low-precision settings leads to catastrophic loss explosion. Our in-depth analysis reveals that the failure is not a random artifact but caused by two intertwined phenomena: the emergence of similar low-rank representations within the attention mechanism and the compounding effect of biased rounding errors inherent in low-precision arithmetic. We demonstrate how these factors create a vicious cycle of error accumulation that corrupts weight updates, ultimately derailing the training dynamics. To validate our findings, we introduce a minimal modification to the flash attention that mitigates the bias in rounding errors. This simple change stabilizes the training process, confirming our analysis and offering a practical solution to this persistent problem. Code is available at https://github.com/ucker/why-low-precision-training-fails.

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19.
bioRxiv (Bioinfo) 2026-06-22

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

作者:
Wang↗Xiao↗Kang↗Cui↗Fu↗Li↗Perea↗S. E↗Han↗

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.

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

Domain-Shift Aware Neural Networks for Unbalance Characterization in Rotating Systems

作者:
Bernardo Feij\'o Junqueira↗Claudio Kiyoshi Umezu↗Bruno Bilhar Karaziack↗Tomaz Junior↗Daniel Alves Castello↗

arXiv:2606.18882v1 Announce Type: cross Abstract: This work investigates the application of a domain-shift aware neural network for regression tasks aimed at estimating unbalance masses in rotating shafts under varying operating conditions. Experimental data were collected from a test rig in which a primary shaft, equipped with a flange carrying unbalanced masses, was driven at different rotational speeds, while a secondary shaft could be optionally activated to introduce domain discrepancy. The unbalance masses were positioned at a fixed radial distance, and the dynamic response of the system was recorded using triaxial accelerometers. The inverse problem of mass estimation is formulated within a domain adaptation framework, where the network is trained with a maximum mean discrepancy strategy to align feature representations across source and target distributions. The results demonstrate the effectiveness of explicitly addressing domain shift in improving prediction accuracy, especially when the system's physical behavior and sources of domain discrepancy are not fully known and fall outside the training conditions. These findings highlight the potential of domain-shift aware models for regression tasks in Structural Health Monitoring.

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21.
arXiv (CS.LG) 2026-06-15

Closed-loop discovery of out-of-distribution processing protocols by evolutionary search and uncertainty-aware learning

作者:
Yu Liu↗Stanislav Udovenko↗Ching-Che Lin↗Jaegyu Kim↗Lane W. Martin↗Susan Trolier-McKinstry↗Sergei V. Kalinin↗

arXiv:2606.13859v1 Announce Type: cross Abstract: Many materials and chemical systems exhibit history-dependent responses, where functional outcomes are governed not only by final-state variables but by the time-dependent sequence of fields, temperatures, or chemical potentials applied during operation. Discovering new processing protocols is therefore a high-dimensional search problem in which the control variable is an entire waveform or sample history, and conventional strategies either remain confined to conservative interpolative families or become prohibitively measurement intensive. Here, a closed-loop workflow is introduced that couples evolutionary search over a compact waveform representation with uncertainty-aware deep kernel learning to generate, rank, and experimentally validate candidate protocols. Applied to ferroelectric thin films, with the scanning-probe tip-bias waveform as the protocol and the nonlinear electromechanical response as the reward, the workflow discovers waveform families that enhance nonlinearity by de-aging the film. Spatially resolved before/after measurements show that the best-performing waveforms selectively activate pre-existing, weakly pinned domain-wall segments, whereas the worst drive long-range irreversible switching. This framework reframes protocol tuning as out-of-distribution discovery, generalizable to synthesis and annealing trajectories, battery formation protocols, and other high-dimensional control problems.

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22.
medRxiv (Medicine) 2026-06-18

Can Vision-Language Models See the Vital Signs? Benchmarking and Fine-Tuning for Intraoperative Monitor Reading

作者:
Gao↗Wang↗Zhao↗Yang↗Zhang↗Feng↗He↗

Background Vital-sign deterioration is a leading contributor to preventable perioperative death, yet manual monitor reading is intermittent, error-prone, and subject to alarm fatigue. Automating this perceptual step could enable continuous surveillance, but existing solutions depend on device-specific hardware integration or cloud-hosted vision-language models (VLMs), which raise privacy, cost, and connectivity barriers in resource-limited healthcare facilities. Methods We constructed a benchmark of 200 in-the-wild intraoperative monitor photographs (spanning multiple vendors, angles, and illumination conditions) annotated for eight vital-sign parameters: heart rate, SpO2, ETCO2, respiratory rate, systolic/diastolic/mean blood pressure, and temperature. We evaluated an optical character recognition (OCR)-based pipeline, nine instruction-tuned VLMs (four commercial, five open-weight ranging from [≤]4B to 31B parameters) under two prompting regimes, and a compact open model (Qwen3.5-9B) adapted via low-rank fine-tuning (LoRA, 0.46% of parameters updated). Results Under a domain-aware prompt, frontier VLMs reached 0.98-0.997 exact-match accuracy zero-shot, whereas the OCR pipeline and [≤]4B model scored approximately 0.20 lower, defining a 9B-class usable floor. LoRA fine-tuning Qwen3.5-9B on 80-120 images raised accuracy from 0.953 to 0.994 (statistically indistinguishable from the best commercial model) and reduced the critical-error rate fivefold (0.0313 [->] 0.0063). Ablations showed that performance saturated at 80 training images and rank-8 adapters. Conclusion Monitor reading is a solved perception problem for VLMs above the 9B scale. A lightweight fine-tuned open model achieves frontier accuracy while running entirely on local hardware, preserving data privacy, offline capability, and near-zero marginal cost. Residual errors stem from blood-pressure source ambiguity and are addressable with explicit disambiguation logic.

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23.
medRxiv (Medicine) 2026-06-18

Development and Initial Validation of the Quality of life Evaluation in NF2-related Schwannomatosis Trials (QUEST) Assessment

作者:
Merker↗V. L↗Carias↗S. C↗Ferner↗R. E↗Golding↗J. F↗Plotkin↗S. R↗Buono↗F. D↗…

Individuals with NF2-related schwannomatosis (NF2-SWN) experience a complex constellation of physical, emotional, and social symptoms that substantially impact quality of life (QoL). Although disease-specific patient-reported outcome measures are increasingly important for evaluating treatment benefit in clinical trials, existing NF2-SWN QoL measures have limitations in content coverage and sensitivity to change. This study describes the development and initial validation a new disease-specific QoL assessment – the Quality of Life Evaluation in NF2-related Schwannomatosis Trials (QUEST). Using a three-phase, mixed-methods approach, items were generated through concept elicitation interviews with individuals with NF2-SWN and clinicians, prioritized via patient survey data, and refined through iterative cognitive debriefing procedures. The resulting 21-item QUEST assesses the extent to which NF2-SWN has negatively impacted a persons daily life over the past seven days. Initial psychometric evaluation was conducted in an international sample of 174 individuals with NF2-SWN aged 15 years and older (117 women (67%), 158 White individuals (89%)). Exploratory factor analysis supported a four-factor structure, and the total score demonstrated excellent internal consistency and strong test-retest reliability. Evidence of construct validity was demonstrated through hypothesized associations with disease-specific, generic, and domain-specific QoL measures, as well as known-groups validity based on self-reported disease severity and number of prior surgeries. Incremental validity analyses indicated that QUEST explained unique variance beyond existing measures. Together, findings support the QUEST as a reliable and valid disease-specific QoL measure with strong content validity and feasibility for use as a clinical trial endpoint in NF2-SWN.

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24.
medRxiv (Medicine) 2026-06-22

Evidence-guided AI regularization for suicidal ideation prediction in pediatric bipolar disorder

作者:
Jabbar Abdl Sattar Hamoudi↗Wu↗M.-J↗Sanches↗Zunta-Soares↗G. B↗Soutullo↗C. A↗Soares↗J. C↗Mwangi↗

Background: Suicide prediction models in psychiatry often rely on purely data-driven feature selection, which can produce unstable and clinically opaque predictor sets in modest-sized samples. We developed Evidence-Based AI LASSO (EBAL), an evidence-guided regularization framework that incorporates curated clinical evidence into feature-specific penalty factors for interpretable prediction. Methods: Baseline data from 136 youth with confirmed bipolar spectrum disorder in the Greater Houston Area Bipolar Registry were analyzed using 20 candidate clinical predictors. Forty higher-level evidence documents on suicidality and related predictor domains were curated through a structured evidence synthesis workflow and indexed as an auditable evidence corpus. An open-weight large language model assigned feature-specific penalty factors using a prespecified scoring rubric, and these penalties were used to fit a weighted LASSO model. EBAL was compared with a standard evidence-agnostic LASSO using nested leave-one-out cross-validation. Results: For suicidal ideation, EBAL achieved an AUROC of 0.768, balanced accuracy of 0.757, sensitivity of 0.758, and specificity of 0.757. The standard LASSO achieved an AUROC of 0.760 and balanced accuracy of 0.715. EBAL improved balanced accuracy (+0.042, p=0.010) and Matthews correlation coefficient (+0.079, p=0.010), while retaining fewer stable predictors than standard LASSO (11/20 vs 18/20). The strongest positive predictors were current depressed mood, duration of mood disorder illness, and comorbid generalized anxiety disorder. For suicidal behavior, both models performed near chance and retained all candidate predictors. Limitations: The study was cross-sectional, single-site, and modest in sample size, with no external validation cohort. Conclusions: EBAL produced a sparser and more clinically coherent model for suicidal ideation in pediatric bipolar disorder, but did not improve prediction of suicidal behavior. These findings support evidence-guided regularization as a transparent strategy for aligning psychiatric prediction models with prior clinical knowledge while preserving interpretability.

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

Teach-and-Repeat: Accurately Extracting Operational Knowledge from Mobile Screen Demonstrations to Empower GUI Agents

作者:
Yudong Zhang↗Lei Hu↗Daoyang Liu↗Jiawei Liu↗Yangfan Luo↗Xingyu Liu↗Zuojian Wang↗Zhilin Gao↗

arXiv:2606.12817v1 Announce Type: new Abstract: Understanding the digital world on mobile devices is shifting from static UI perception to dynamic action comprehension. This capability enables models to convert visual state transitions into operational knowledge, defined as short natural-language sentences that describe action types, target UI elements, textual arguments, and execution orders. However, due to the highly diverse and heterogeneous UI designs across applications, existing vision-language models (VLMs) struggle to accurately infer these underlying operations. To bridge this gap, we introduce Teach VLM, a core model designed to translate mobile screen trajectories into step-wise operational knowledge by extracting and analyzing operation-related keyframes from demonstration videos. To address the scarcity of aligned training data, we develop a systematic data flywheel for scalable data acquisition. We further introduce a novel Chinese Mobile Screen Teach Benchmark for fine-grained evaluation. Building upon Teach VLM, we propose the Teach-and-Repeat paradigm, where the generated operational knowledge serves as an interpretable procedural reference to guide downstream screen-based execution agents. Extensive evaluations demonstrate that Teach VLM significantly outperforms strong VLM baselines, achieving state-of-the-art performance in operation semantics prediction. Furthermore, experiments in Android World show that our paradigm yields consistent Task Success Rate improvements for downstream agents. Together, Teach VLM and the Teach-and-Repeat paradigm offer a practical pathway from raw demonstrations to reusable task automation.

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