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01.
arXiv (CS.LG) 2026-06-11

My Chemical Harness: Evolutionary Molecular Design over Synthetic Pathways with Large Language Model Agents

arXiv:2606.11256v1 Announce Type: cross Abstract: Designing molecules with target properties is most useful when candidate structures are accompanied by feasible synthetic routes. We introduce My Chemical Harness, a route-native evolutionary framework for goal-directed molecular design in which the search population consists of executable synthetic pathways rather than isolated molecular graphs. Each route is built from purchasable building blocks and reaction templates, executed by deterministic chemistry tools, and scored through task-specific molecular oracles. Large language models (LLMs) are used only as strategy controllers that select high-level preferences over route length, move type, reaction families, motifs, and exploration pressure, while local code performs route construction, validation, deduplication, scoring, selection, and memory updates. This separation lets the LLM guide exploration without allowing it to introduce hallucinated products or unsupported reaction steps. On a soluble epoxide hydrolase proxy task, our LLM agent improves over single pass LLM and deterministic controllers, reaching state-of-the-art performance across the sEH score, synthetic accessibility score, and AiZynthFinder success rate metrics. These results suggest that constrained LLM agents can play a significant role in molecular discovery without requiring training, fine-tuning, or dedicated generative models.

02.
arXiv (CS.AI) 2026-06-17

KFTD: Koopman-Fourier Time-Differentiable Network for Continuous Ocean Spatiotemporal Forecasting

arXiv:2606.17070v1 Announce Type: cross Abstract: Accurate oceanic forecasting is critical for climate monitoring and disaster early warning. However, ocean spatiotemporal forecasting encounters the double challenges of modeling complex dynamical systems and ensuring computational efficiency. We present Koopman Fourier Time-Differentiable (KFTD) Network, a time continuous twostage paradigm that decouples interpolation from prediction to achieve efficient and scalable spatiotemporal modeling. We map complex nonlinear dynamics into the Koopman linear space and exploit Fourier analysis to enable continuous time interpolation at arbitrary sub-steps. A lightweight residual network consumes the high fidelity intermediate states to yield the final forecast. Unlike diffusion models, KFTD eliminates multi step noise sampling and directly evolves the system in continuous time, yielding a 4 computational speedup. We further introduce a DPP Loss that supports arbitrary PDE constraints in an endtoend manner, breaking the physical consistency bottleneck of pure data-driven approaches. Empirical results on four ocean datasets confirm that our continuous time framework reduces MSE by an average of 5.6% (up to 12.7% for SST) and improves efficiency over MCVD by 76.25%.

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

HK-LegiCoST: Leveraging Non-Verbatim Transcripts for Speech Translation

We introduce HK-LegiCoST, a new three-way parallel corpus of Cantonese-English translations, containing 600+ hours of Cantonese audio, its standard traditional Chinese transcript, and English translation, segmented and aligned at the sentence level. We describe the notable challenges in corpus preparation: segmentation, alignment of long audio recordings, and sentence-level alignment with non-verbatim transcripts. Such transcripts make the corpus suitable for speech translation research when there are significant differences between the spoken and written forms of the source language. Due to its large size, we are able to demonstrate competitive speech translation baselines on HK-LegiCoST and extend them to promising cross-corpus results on the FLEURS Cantonese subset. These results deliver insights into speech recognition and translation research in languages for which non-verbatim or ``noisy'' transcription is common due to various factors, including vernacular and dialectal speech.

04.
arXiv (CS.AI) 2026-06-15

CARE: Controlling LLM-Generated Policies through Auditable Review of Evidence in Scientific Experimentation

arXiv:2606.14581v1 Announce Type: cross Abstract: Granting LLMs direct control over costly, irreversible scientific experiments leads to unsafe exploration and unstable performance, but discarding LLM creativity entirely sacrifices significant optimization potential. We introduce CARE (Controlling LLM-Generated Policies through Auditable Review of Evidence in Scientific Experimentation), an auditable controller for high-throughput experimentation (HTE) optimization that keeps a non-LLM incumbent optimizer as the default action path while using LLMs to revise challenger ranking policies. Before each outcome is revealed, a public-evidence intervention gate compares the challenger with the incumbent. It authorizes the challenger's selection only when the evidence available before selection supports the change, with the decision recorded in the audit log. CARE outperforms all other evaluated methods on Minerva/Olympus and ChemLex benchmarks, with final-best improving from 80.0 to 88.5 on Minerva/Olympus and from 83.9 to 92.1 on ChemLex, relative to the public incumbent. Our experiments indicate that LLM self-evolution is more reliable when it expands the proposal space under an auditable controller, rather than directly choosing experiments.

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

Can LLM Agents Infer World Models? Evidence from Agentic Automata Learning

We propose agentic automata learning to evaluate the extent to which tool-calling LLM agents can uncover hidden environments through interaction. In our setup, an agent should uncover a hidden deterministic finite automaton (DFA) by interacting with an oracle through (1) membership queries ("Does this string belong to the target language?") and (2) equivalence queries ("Is this the target DFA?"). This yields a scalable testbed with controlled task complexity, measurable interaction efficiency, and strong baselines (classic automata-learning algorithms). Evaluating state-of-the-art LLMs, we find that performance drops sharply as DFA size increases. Reasoning models are markedly stronger than non-reasoning models, yet trajectory analyses reveal recurring failures in query planning, evidence integration, and hypothesis construction. Overall, our results show that current LLM agents can sometimes perform non-trivial interactive discovery, but remain far less robust and efficient than classic algorithms for the task.

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

PERRY: Policy Evaluation with Confidence Intervals using Auxiliary Data

arXiv:2507.20068v2 Announce Type: replace Abstract: Off-policy evaluation (OPE) methods estimate the value of a new reinforcement learning (RL) policy prior to deployment. Recent advances have shown that leveraging auxiliary datasets, such as those synthesized by generative models, can improve the accuracy of OPE methods. Unfortunately, such auxiliary datasets may also be biased, and existing methods for using data augmentation within OPE lack principled uncertainty quantification. In high stakes domains like healthcare, reliable uncertainty estimates are important for ensuring safe and informed deployment of RL policies. In this work, we propose two methods to construct valid confidence intervals for OPE with data augmentation. The first provides a confidence interval over $V^{\pi}(s)$, the policy value conditioned on an initial state $s$. To do so we introduce a new conformal prediction method suitable for Markov Decision Processes (MDPs) with continuous state spaces, extending prior work to higher-dimensional settings. Second, we consider the more common task of estimating the average policy performance over all initial states, $V^{\pi}$; we introduce a method that draws on ideas from doubly robust estimation and prediction powered inference. Across simulators spanning inventory management, robotics, healthcare, and a real healthcare dataset from MIMIC-IV, we find that our methods can effectively leverage auxiliary data and consistently produce confidence intervals that cover the ground truth policy values, unlike previously proposed methods. Our work enables a future in which OPE can provide rigorous uncertainty estimates for high-stakes domains.

07.
arXiv (CS.LG) 2026-06-16

Send a SCOUT First: Pre-hoc Reasoning for Adaptive Detector Allocation in Prompt-Injection Defense

arXiv:2605.30837v2 Announce Type: replace-cross Abstract: Prompt-injection detectors are heterogeneous: each is strong on a different slice of attacks, and none is always reliable. Yet existing systems still treat detection as a fixed single-detector pipeline, committing every request to one detector's blind spots. We reframe defense as detector allocation: given a heterogeneous pool, decide per request which detectors to run and whether to escalate to an LLM judge. Our framework SCOUT (Scalable and Controllable Outcome-prediction for Uncertainty-aware Triage) makes this decision dynamic by predicting each detector's per-sample reliability and latency from how it behaved on similar past inputs, and exposes a single safety-utility threshold to the operator (where utility bundles benign-pass rate and wall-clock). To evaluate this setting, we build SCOUT-450, a benchmark that captures the structurally complex, agent-facing injections that older prompt-injection sets under-represent. On SCOUT-450, a safety-oriented operating point reduces attack-success rate by 46% and total wall-clock by 40% relative to an always-on GPT-4o judge, at a 5.1-point benign-utility drop. SCOUT also transfers to three external benchmarks (BIPIA, IPI, and IHEval), improving the safety-utility frontier.

08.
medRxiv (Medicine) 2026-06-16

Usability testing with a prototype user interface of an Artificial Intelligence driven air-Safety Tool (AISaT)

Involving end-users in the development of an AI tool is an important facilitator to its implementation. Usability testing was therefore conducted with a prototype user interface of an Artificial Intelligence driven air-Safety Tool (AISaT) to capture the perspectives and user experiences of AISaT from 10 staff members across two hospitals working within estates, infection prevention and control, and clinical areas, to inform the development of next iterations of AISaT. The perspectives shared could be grouped under improvements to the understand-ability; content; navigation; visibility; usability; workflow; ownership; and frequency of use of the tool. There were key areas that can and will be easily improved within AISaT, however there were areas that required a deeper level of critical reflection, such as incorporating data on more existing variables in a room (i.e., existing ventilation) and whether all patients should be assumed as infectious and breathing heavily. The research team must consider if the target audience of end users and recommended frequency of AISaT use will be pre-defined by the tool developers, or whether this level of detail should be left to each individual hospital to decide.

09.
arXiv (CS.CL) 2026-06-11

Energy-Efficient On-Device RAG on a Mobile NPU: System Design and Benchmark on Snapdragon X Elite

Retrieval-Augmented Generation (RAG) pipelines are compute-intensive, combining embedding, retrieval, reranking, and large language model (LLM) generation. Running them entirely on-device benefits privacy, latency, and offline use, but the energy cost of CPU inference is a major barrier. We present what is, to our knowledge, the first end-to-end RAG pipeline that runs all neural stages – embedding, reranking, and LLM generation – on the Qualcomm Hexagon NPU of the Snapdragon X Elite. Profiling on a Dell XPS 13 laptop, we compare NPU-accelerated RAG against CPU and OpenCL/Adreno GPU baselines on indexing and query workloads. On indexing, the NPU achieves 9.1x higher embedding throughput and 12.3x less system energy. On a 120-query Wikipedia-passage benchmark, it delivers 18.1x faster LLM prefilling, 4.0x lower end-to-end query latency, and 4.0x less system energy than the CPU baseline; the same workload on the integrated GPU is 1.7x slower than CPU and uses 6.5x more energy than the NPU. A GPT-4.1 LLM-as-judge evaluation finds NPU answer quality on par with CPU and GPU within evaluator noise (mean 9.32 vs. 8.95 vs. 9.03 on a 1-10 rubric), with 86.7% of queries scoring identically across all three backends. On the Snapdragon X Elite / Hexagon class of laptop SoC, the NPU thus enables practical, energy-efficient on-device RAG without quality regression – a sustainable path toward green edge intelligence that we expect to generalize to comparable mobile NPUs (Apple Neural Engine, Intel NPU, MediaTek APU) as their software stacks mature.

10.
arXiv (CS.AI) 2026-06-16

Bayesian Inference and Decision Audits for Public Archives of Frontier AI Evaluations

Authors:

arXiv:2606.17005v1 Announce Type: new Abstract: Public AI evaluations are often read as terminal leaderboards, yet the underlying evidence is a selective time series shaped by reporting rules, benchmark revisions, and missingness. Repeated public archives for LiveBench and Open LLM Leaderboard v2 serve as the primary longitudinal record; LMArena provides a preference stress test; and GAIA and tau-bench contribute limited agentic pilots. Together, these archives instantiate a Bayesian inference problem: under a fixed reporting convention, one constructed terminal-only example over $1{,}000$ systems is compatible with two pre-terminal histories, yielding times of $23.03$ or $75.13$ to reach within $0.05$ of the ceiling under the same terminal-tail model. In synthetic posterior comparisons, action-facing diagnostics differ across observation regimes. The candidate selection-aware frontier model fails synthetic recovery, objective-archive prediction, preference transfer, and uncertainty calibration; correspondingly, fixed audit gates reject its stronger claims. An archive-and-adjudication protocol reconstructs public evaluation histories, isolates a verified timing boundary, and falsifies unsupported frontier claims.

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

Nonslop: A Gamified Experiment in Human-AI Collaborative Writing

arXiv:2606.12350v1 Announce Type: new Abstract: The rapid proliferation of large language models (LLMs) raises critical questions about human creativity and individual expression in an era of AI-assisted creation. When do humans adopt AI suggestions, and what are the implications for individual voice? This study examines these questions through a gamified writing exercise where 74 participants (214 responses) replied to prompts while AI-generated word suggestions were available as they wrote. The game simulates a dystopian future in which an AI is attempting to learn from what remains of human individuality, and disincentivizes AI-like writing. In doing so, it attempts to create conditions that reveal authentic user preferences rather than default behaviors, such as accepting a readily available AI-generated suggestion. Note that this is a deliberate inversion of the "helpful assistant" design pattern; the system is explicitly forbidding you from accepting AI suggestions. We analyze user behavior patterns across different task types, user behaviors, and response characteristics to understand the factors influencing human-AI interaction in creative tasks. The study focuses on when users choose to maintain creative autonomy versus violating the rules of the game and accepting AI assistance. It also explores how these choices relate to response patterns, task characteristics, and user behavior. This gamified approach offers both a framework for studying authentic human-AI interaction and a provocative lens for understanding the tension between efficiency and authenticity in AI-augmented creativity.

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

MeshFlow: Efficient Artistic Mesh Generation via MeshVAE and Flow-based Diffusion Transformer

We present MeshFlow, a new method for generating artist-like 3D meshes. Current mesh generators often adopt Auto-Regressive (AR) next-token prediction, a natural choice given the discrete nature of mesh topology. However, AR methods scale poorly because the inference cost is quadratic in mesh size. They also require discretizing the vertex coordinates, which introduces quantization errors. To address these challenges, we introduce a Variational Autoencoder (VAE) that, supervised with a contrastive loss, represents both continuous vertex positions and discrete connectivity in a continuous latent space. This latent space is significantly more compact than prior token-based mesh representations. We then build a 3D generator based on a Rectified Flow transformer, generating all mesh vertices and edges in parallel. Our model generates meshes 18x faster than the fastest AR generator while also achieving excellent accuracy across standard mesh-generation metrics. Homepage: https://mesh-flow.github.io/, Code: https://github.com/facebookresearch/meshflow

13.
medRxiv (Medicine) 2026-06-15

Population-scale genomics reveals divergent pathogenicity of variant classes across paralogous collagen IV genes

Monoallelic pathogenic or likely pathogenic variants in COL4A3 and COL4A4 occur in approximately 1 in 106 individuals, yet whether these paralogous genes confer equivalent pathogenicity for the same variant classes has not been tested at population scale. Using whole-genome sequencing data from the UK Biobank (UKB; n = 500,000), with replication in the All of Us Research Program (n = 414,000), we performed per-variant association testing, gene-based collapsing analyses and phenome-wide association studies (PheWAS) across haematuria, proteinuria and chronic kidney disease. We identified 64 COL4A3 and 92 COL4A4 rare variants significantly associated with haematuria or proteinuria, generating a quantitative allelic series for clinical variant interpretation. Glycine substitutions within collagenous domains conferred similar risks in both genes. In contrast, truncating and non-collagenous domain (NC1) missense variants were strongly associated with haematuria and proteinuria in COL4A4 carriers but showed substantially attenuated or absent associations in COL4A3 carriers despite comparable carrier frequencies and predicted pathogenicity scores. These findings were independently replicated in All of Us. Genome-wide association analysis identified the COL4A3/COL4A4 locus as the dominant genetic determinant of haematuria, with the signal attributable to the aggregate effects of rare coding variants and no evidence of independent common variant or trans-acting modifier effects. These findings demonstrate substantial gene-specific differences in tolerance to truncating and NC1 variants between COL4A3 and COL4A4, challenging assumptions of equivalent pathogenicity across paralogous collagen IV genes. Gene identity and not variant class alone, should inform risk stratification, variant interpretation and genetic counselling in individuals carrying collagen IV risk genotypes.

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

AgenticRec: A Recommendation-Oriented Agentic Framework with Progressive Tool-Integrated Reasoning Optimization

arXiv:2603.21613v2 Announce Type: replace-cross Abstract: Recommender agents built on Large Language Models offer a promising paradigm for personalized recommendation. However, existing agents typically suffer from a misalignment between their tool-integrated reasoning trajectories and recommendation feedback, limiting their ability to distinguish fine-grained user preferences. To address these challenges, we propose AgenticRec, an agentic recommendation framework that formulates recommendation as a tool-integrated reasoning process over a recommendation-oriented tool suite. Built upon this framework, we further develop a dedicated two-stage training paradigm tailored for recommender agents. In the first stage, we introduce Recommendation-Oriented Trajectory Activation, optimize the agentic recommendation ability under implicit feedback. In the second stage, Progressive Preference Refinement further refines the agent through bidirectional preference reasoning over self-bootstrapped hard pairs, progressively sharpening preference boundaries. Theoretical analysis and extensive experiments demonstrate the effectiveness of AgenticRec. Our code is available at https://anonymous.4open.science/r/AgenticRec-FB16.

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

WeaveLA: Event Driven Cross-Subtask Latent Memory Weaving for Repetitive Robot Manipulation

Vision-Language-Action (VLA) policies have achieved remarkable single-step manipulation, yet they remain brittle precisely where each stage depends on what was just completed. The core issue is structural: short-window VLAs lack an explicit channel for rouxting information across sub-task boundaries, and existing memory-augmented variants either write at every frame, retrieve from demonstration-time stages, or fire at sub-goal events without performing an explicit sub-task-to-sub-task hand-off into the action expert. We identify the sub-goal completion event as the natural temporal unit for cross-subtask memory hand-off, and present WeaveLA (Weave Latent memory for Vision-Language-Action policies), a cross-subtask memory interface that, on top of a frozen VLA backbone, compresses each completed segment into latent tokens via query-driven attention pooling and routes them directly into the action-generation path of the next sub-task. This event-triggered, action-side design preserves the base policy's short-window interface while adding a lightweight cross-subtask channel. Through stratified evaluation on RoboMME with a $\pi_{0.5}$ backbone, WeaveLA's gains land exactly where the channel is needed: on the hardest repetition slice (SwingXtimes, $N{=}3$), success rises from $0\%$ to $47.8\%$, while single-execution episodes remain unchanged. Per-episode paired analysis confirms the gains are confined to tasks whose causal structure requires cross-subtask information.

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

Hidden Degradation Costs in Energy-Cost-Only HEMS Optimisation: Study on Battery and PV Sensitivity

arXiv:2606.16051v1 Announce Type: cross Abstract: Residential battery energy storage systems (BESS) are increasingly deployed alongside photovoltaic (PV) generation to reduce household energy costs under volatile time-of-use (TOU) tariffs. Model predictive control (MPC) is a widely adopted optimisation strategy for home energy management systems (HEMS), typically formulated to minimise net energy cost, subject to physical and operational constraints. However, battery degradation is rarely embedded in the optimisation objective, meaning its cost is unquantified and aggressive; high-cycle-count strategies could incur significant losses once deployed to physical systems. This paper presents a receding-horizon mixed-integer linear programming (MILP) baseline for a UK residential HEMS, using demand data from the REFIT dataset. A 3 by 3 sensitivity study is conducted across three battery sizes and three PV array sizes, with post-hoc degradation cost estimated using the Naumann stress model and rainflow cycle counting. Results show that degradation remains constant for each battery size and can exceed energy cost savings by up to 1,060 %. These results demonstrate that energy-cost-only optimisation systematically underestimates the true system cost, motivating a degradation-aware control formulation.

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

ACC: Compiling Agent Trajectories for Long-Context Training

Recent development of agents has renewed demand for long-context reasoning capacity of LLMs. However, training LLMs for this capacity requires costly long-document curation or heuristic context synthesis. We observe that agents produce massive trajectories when solving problems, invoking tools and receiving environment observations across many turns. The evidence needed to answer the original question is thus scattered throughout these turns, requiring integration of distant context segments. Nevertheless, standard agent SFT masks tool responses and only trains turn-level tool selection, creating a supervision blind spot where these scattered signals go unused. We propose Agent Context Compilation (ACC), which converts trajectories from search, software engineering, and database querying agents into long-context QA pairs that combine the original question with tool responses and environment observations gathered across multiple turns, training the model to answer directly without tool use. This makes the dependencies between the question and the evidence explicit, enabling direct supervision of long-context reasoning over distant segments without additional annotation. ACC is a simple but effective approach that can be combined with any existing long-context extension or training method, providing scalable supervised fine-tuning data. We validate ACC on long-range dependency modeling tasks through MRCR and GraphWalks, challenging benchmarks requiring cross-turn coreference resolution and graph traversal over extended contexts. Training Qwen3-30B-A3B with ACC achieves 68.3 on MRCR (+18.1) and 77.5 on GraphWalks (+7.6), results comparable to Qwen3-235B-A22B, while preserving general capabilities on GPQA, MMLU-Pro, AIME, and IFEval. Further mechanism analysis reveals that the ACC-trained model exhibits task-adaptive attention restructuring and expert specialization.

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

RefGC-SR$^2$: Reference-guided Generated Content Super-Resolution and Refinement

Reference-guided generation (e.g., object compositing, customization) has progressed rapidly, yet current pipelines share a fundamental limitation: the object-centric high-resolution reference image (HRRI) provided by users is downsampled to a fixed low-resolution (LR) before being fed into the model, so the fine-grained details are discarded before the output is even produced. In addition, the generation step then introduces its own artifacts (e.g., identity distortion) on top of this loss. Existing reference-guided generated content refinement (RefGCR) methods can correct some of these artifacts but still operate in the LR domain; reference-guided super-resolution (RefSR) methods recover resolution but assume natural-image degradations and ignore the artifact distribution of generative pipelines. To address both gaps in a single formulation, we introduce a new task: reference-guided generated content super-resolution-refinement (RefGC-SR$^2$), where the original HRRI is reused at the post-processing stage to recover lost details, refine generative artifacts, and upscale the output simultaneously. We construct the first real-world triplet data generation pipeline for this RefGC-SR$^2$ task, training a diptych-conditioned generator to synthesize paired low-quality anchors that public pretrained models cannot provide. We further present a frequency-aware diffusion transformer model for RefGC-SR$^2$ that selectively injects fine details from the HRRI while removing generative artifacts. Extensive experiments demonstrate that our RefGC-SR$^2$ model successfully (i) refines the object identity faithfully with respect to the reference, and (ii) recovers high-resolution details, so that the final result is significantly higher quality and practically more usable compared to existing RefGCR and RefSR baselines.

19.
arXiv (CS.CV) 2026-06-15

WAM4D: Fast 4D World Action Model via Spatial Register Tokens

World action models (WAMs) have recently shown promise in jointly modeling future observations and executable robot actions. However, most existing WAMs still operate in 2D video or latent spaces, where visually plausible rollouts miss the 3D spatial constraints and occluded contact geometry required for precise manipulation. While geometric foundation models offer strong priors for recovering dense 3D structure and motion from visual observations, forcing WAMs to predict the dense 4D representation introduces costly geometric decoding and slows down causal action generation. To address the trade-off, we present WAM4D, a fast 4D world action model that uses lightweight spatial register tokens as training-time future-depth readouts to transfer pretrained geometric priors into a causal video-action transformer, then removes the register branch for lightweight action inference. To prevent non-causal shortcuts, we further design causal mixture attention for the Mixture-of-Transformers (MoT) WAM backbone, defining modality-specific visibility among video, action, and geometry tokens. Comprehensive experiments on RoboTwin 2.0 and challenging real-world manipulation tasks show that WAM4D improves spatial consistency and achieves competitive action prediction while maintaining efficient inference.

20.
PLOS Medicine 2026-05-20

Prescribed hormonal contraceptive use trends in the Estonian Biobank: A longitudinal observational study

by Jelisaveta Džigurski, Märt Möls, Kristi Läll, Hannah Currant, Mall Eltermaa, Estonian Biobank Research Team , Reedik Mägi, Lili Milani, Triin Laisk Background Hormonal contraceptives (HCs) are widely used and have well-documented population-level statistics. Previous studies with short follow-ups have focussed on individual HC use and side effects. However, the same aspects over longer periods, HC formulation switching, and the impact of genetic factors on HC side effects remain understudied due to the limited availability of suitable datasets. We investigated whether the Estonian Biobank (EstBB) is suitable for studying genetic risk for HC side effects. Methods and findings This is a longitudinal descriptive study combining prescribed HC purchase data collected from 2004 to 2022 with genetic and health data from 73,071 female EstBB HC users aged 15–55 at the time of purchase. HC usage was defined by the Anatomical Therapeutic Chemical (ATC) codes G02B, G03A, and G03HB01. Methods included calculating age-stratified annual user prevalence, inferring usage periods from purchases, assessing formulation switching, identifying the International Classification of Diseases, Tenth Revision (ICD-10)-based side effect-related diagnoses and thromboembolism risk factors, and assessing carrier status for Factor V Leiden (FVL, rs6025) and prothrombin G20210A (PTM, rs1799963) genetic variants as proof-of-concept. Over 19 years, 20 HC formulations with five administration routes (oral pills, transdermal patches, vaginal rings, subdermal implants, intrauterine devices) were used. In the EstBB, combined HCs were the most commonly used among users aged 15–29, while progestin-only HC use increased with age and over time, comparable to the Estonian population. Overall, 64.2% (n = 46,920) of users switched formulations at least once, with 17.7% (n = 12,929) being rapid switchers. Side effect-related diagnoses were observed in 23.1% (n = 2,982) of rapid switchers, with excessive/irregular menstrual bleeding being the most common. Genetic analysis revealed that 5.3% (n = 3,886) of users carried at least one variant previously associated with increased thrombosis risk (3.5% (n = 2,556) carried FVL only, 1.8% (n = 1,276) PTM only, and 0.07% (n = 54) both). Carriers of thrombosis-associated variants had a significantly higher percentage of thrombosis (6.5%) than non-carriers (4.2%; OR = 1.61, 95% CI [1.40, 1.84], p 

21.
medRxiv (Medicine) 2026-06-12

Microbial etiology, antibiotic susceptibility profiles, and multidrug resistance of urinary tract infections at a secondary healthcare facility in Ghana

Background: Rising antibiotic resistance challenges empirical therapies for urinary tract infections (UTIs). This study evaluated the microbial etiology, susceptibility profiles, and multidrug resistance (MDR) patterns of uropathogens among outpatients at the Berekum Holy Family Hospital, Ghana. Methods: This cross-sectional study (February to August 2021) screened 263 symptomatic outpatients. Mid-stream urine samples underwent quantitative culture, biochemical identification, and antimicrobial susceptibility testing via the Kirby-Bauer disc diffusion method following the 2021 CLSI guidelines. Results: Significant bacteriuria prevalence was 22.8% (60/263). UTIs predominated in females (78.3%, 47/60; p = 0.1501) and individuals [≥]45 years (33.3%, 20/60). Gram-negative rods accounted for 90.0% of isolates, primarily Escherichia coli (26.7%), Citrobacter spp. (25.0%), and Enterobacter spp. (21.7%); Staphylococcus aureus (10.0%) was the only Gram-positive pathogen. Extreme phenotypic resistance was observed against piperacillin/tazobactam (98.3%), cefotaxime (93.3%), tetracycline (88.3%), and cefoperazone (85.0%). Conversely, highest therapeutic susceptibilities were retained by amikacin (78.3%), levofloxacin (61.7%), and gentamicin (58.3%). Conclusion: The high prevalence of MDR uropathogens against advanced beta-lactamase inhibitor combinations and cephalosporins necessitates an immediate re-evaluation of regional empirical protocols. Amikacin, levofloxacin, and gentamicin remain viable options prior to culture confirmation. These findings establish a crucial phenotypic baseline to guide localized prescribing policies and regional antimicrobial resistance tracking strategies.

23.
medRxiv (Medicine) 2026-06-23

Timing of S. aureus-related mortality in a large randomized clinical trial: Implications for future study design

Background: Longer follow-up periods in clinical trials for S. aureus bacteremia (SAB) may capture unrelated deaths, adding random noise that risks biasing trial results towards the null. Objective: To evaluate the timing and infection-relatedness of deaths within a large SAB clinical trial platform. Design: Blinded duplicate adjudication of trial deaths using a modified 7-point Likert-Scale. A third reviewer settled disagreements. Setting: 37 Canadian hospitals participating in the S. aureus Network Adaptive Platform (SNAP) Trial. Participants: 1515 adult patients recruited to SNAP between February 2022 and May 2026. Measurements: Timing and relatedness of 90-day deaths categorized as at least possibly SAB-related not likely to be SAB-related. Optimal follow-up cut-off was determined using Youden's index and graphically. Results: 247 deaths occurred; 97 (39.3%) were adjudicated as at least possibly SAB-related and 150 (60.7%) as not likely related. For probably/definitely related deaths, interrater agreement was 85.0% (Gwet's AC 0.73, substantial); for at least possibly related, it was 77.3% (Gwet's AC 0.55, moderate). Median survival was significantly shorter for SAB-related deaths (12 vs. 30.5 days; difference: 19 days earlier, 95% CI: 12-26, p

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

Thinking with Visual Grounding

arXiv:2606.16122v1 Announce Type: new Abstract: Visual thinking should not only sound right; it should show its evidence. While recent vision-language models (VLMs) can produce natural-language reasoning traces, these traces often leave the supporting image regions implicit, making them hard to verify and difficult to supervise. We introduce visually grounded thinking, a reasoning process in which models interleave natural-language thoughts with explicit point or box groundings of the visual evidence used at each step. This lets the model express intermediate reasoning in language while grounding key objects in the image regions they refer to. To train this behavior, we construct a scalable synthesis pipeline that distills correct visual reasoning traces, extracts the visual objects required by the traces, grounds them with a SAM3-based agent, and derives aligned point and box supervision from the resulting masks. We further propose grounding-aware reinforcement learning, which combines answer correctness rewards with dense grounding rewards that score whether generated object references match the correct image evidence. Across two counting benchmarks and four spatial reasoning benchmarks, adding visually grounded thinking to Gemma3-4B-IT consistently improves performance over the original model and the non-grounded thinking baseline. On spatial reasoning, the visually grounded thinking 4B models match, and in some cases surpass, Gemma3-27B-IT from the same model family. Our analysis shows that point grounding is well suited to counting, while box grounding benefits most from explicit grounding rewards on spatial tasks. Overall, our results show that VLMs think better when their intermediate thoughts are tied to the image regions that make them true.

25.
medRxiv (Medicine) 2026-06-10

Impact of Early Treatment on Symptom Improvement and Procedural Events among Men with BPH and Bothersome Lower Urinary Tract Symptoms: A Contemporary Analysis of the American Urological Association Quality (AQUA) Registry

PURPOSE: As the armamentarium of BPH therapies continues to expand, it remains imperative to maximize patient satisfaction and minimize decisional regret. We sought to determine the impact of time from BPH diagnosis to index treatment on symptom improvement and subsequent procedural events. MATERIALS AND METHODS: We queried the American Urological Association Quality Registry for men [&ge;] 40 years old with BPH, available IPSS data, and no receipt of prior BPH treatment. Index treatment included medication, surgery, or minimally invasive surgical therapy (MIST). Outcomes included IPSS over 3 years of follow-up, change in percentage of mild lower urinary tract symptoms (LUTS) by 3 months, and time to procedural event. Patients were stratified by time from index diagnosis to treatment by 3 years. Outcomes were compared across time-to-treatment cohorts with appropriate statistical tests with p < 0.05 as significant. RESULTS: 43,919 patients met criteria with 19,642 pursuing treatments. Patients pursued treatment at comparably lower baseline IPSS compared to prior prospective series. Patients undergoing surgery and MIST had significantly higher baseline IPSS, while medical comorbidities were significantly more common among men initiating pharmacotherapy. Early surgery and MIST were associated with significant improvement in IPSS within 6-12 months and an increase in mild LUTS by 3 months. All forms of early treatment were associated with delayed time to procedural events, including catheterization and fulguration. CONCLUSIONS: Early procedural intervention for BPH is associated with early symptom improvement and delayed time to procedural events among real-world, contemporary practice.