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01.
arXiv (CS.AI) 2026-06-16

Parallel Test-Time Scaling with Multi-Sequence Verifiers

arXiv:2603.03417v2 Announce Type: replace-cross Abstract: Parallel test-time scaling, which generates multiple candidate solutions for a single problem, is a powerful technique for improving large language model performance. However, it is hindered by two key bottlenecks: accurately selecting the correct solution from the candidate pool, and the high inference latency from generating many full solutions. We argue that both challenges are fundamentally linked to verifier calibration, as a well-calibrated verifier improves answer selection and enables early-stopping strategies to reduce latency. However, existing non-generative verifiers are limited as they score each candidate in isolation, overlooking rich contextual information across the set of candidates. To address this, we introduce the Multi-Sequence Verifier (MSV), a lightweight verifier that predicts each candidate's correctness conditioned on the full sampled set. MSV achieves improved calibration, which directly enhances best-of-N selection performance and empowers a novel early-stopping framework. Across challenging mathematical reasoning benchmarks, MSV improves best-of-64 accuracy by up to 6\% relative to strong baselines, and in the early-stopping setting reaches the same accuracy as baselines with less than half the latency.

02.
arXiv (CS.CL) 2026-06-16

Modeling Sarcastic Speech: Semantic and Prosodic Cues in a Speech Synthesis Framework

Sarcasm is a pragmatic phenomenon in which speakers convey meanings that diverge from literal content, relying on an interaction between semantics and prosodic expression. However, how these cues jointly contribute to the recognition of sarcasm remains poorly understood. We propose a computational framework that models sarcasm as the integration of semantic interpretation and prosodic realization. Semantic cues are derived from an LLaMA 3 model fine-tuned to capture discourse-level markers of sarcastic intent, while prosodic cues are extracted through semantically aligned utterances drawn from a database of sarcastic speech, providing prosodic exemplars of sarcastic delivery. Using a speech synthesis testbed, perceptual evaluations show that semantic and prosodic cues enhance perceived sarcasm, with the combined system achieving the best downstream F1 while maintaining high subjective sarcasm ratings. These findings highlight the complementary roles of semantics and prosody in pragmatic interpretation and illustrate how modeling can shed light on the mechanisms underlying sarcastic communication.

03.
arXiv (CS.CL) 2026-06-12

It Takes One to Bias Them All: Breaking Bad with One-Shot GRPO

Warning: This paper contains several toxic and offensive statements. Modern large language models (LLMs) are typically aligned through large-scale post-training to ensure fair and reliable behavior. In this work, we investigate how easily such guardrails can be broken by Group Relative Policy Optimization (GRPO). We show that one-shot GRPO training on a single biased example is sufficient to induce systematic bias, with stereotype-driven reasoning generalizing across attributes, categories, and benchmarks. We further find that models differ in their susceptibility based on the initial likelihood of producing biased outputs. Our results reveal a critical vulnerability in post-training: alignment can be overridden by a single example.

04.
arXiv (CS.CL) 2026-06-18

Approximate Structured Diffusion for Sequence Labelling

Sequence labelling, a core task of Natural Language Processing (NLP), consists in assigning each token of an input sentence a label. From a Machine Learning point of view, sequence labelling is often cast as a Linear-Chain Conditional Random Field (CRF) parametrised by a neural network. While this approach gives good empirical results, CRFs assume a finite decision span (eg label bigrams) which can limit their expressivity and hurt performance when long-range dependencies are required. We show we can leverage diffusion to train a CRF conditioned on an entire label sequence, with the caveat that the condition is on a noisy version of labels. We show experimentally that this method, in conjunction with approximate CRF inference, improves label accuracy with a 16.5% error reduction for POS-tagging.

05.
arXiv (quant-ph) 2026-06-17

Kinematic properties of the Pauli equation

arXiv:2606.17548v1 Announce Type: new Abstract: Based on the Wigner-Vlasov formalism, this paper investigates the kinematic properties of the Pauli equation. It is shown that the probability current associated with the Pauli equation can be represented as a superposition of two currents with certain expansion coefficients. Each of these currents corresponds to a particular component of the spinor. The expansion coefficients effectively serve as weighting functions that determine the probability contribution of the corresponding spinor component. Therefore, each spin projection corresponds to its own probability flux. A new system of the Hamilton-Jacobi equations and also a system of motion equations in electromagnetic fields are obtained, taking into account the interaction between the spin and the magnetic field. To illustrate how these equations can be applied we have investigated the quantum system kinematics in detail using an exact solution of the Pauli equation in the presence of a uniform magnetic field and an asymmetric quadratic potential.

07.
arXiv (CS.AI) 2026-06-15

Applicability Condition Extraction for Therapeutic Drug-Disease Relations

arXiv:2606.14031v1 Announce Type: new Abstract: Identifying conditions that a certain drug takes therapeutic effect on a target disease is crucial for clinical decision-making support. However, most existing biomedical information extraction methods have focused on identifying only relations between drugs and diseases, while largely overlooking the context-specific conditions where such relations can apply. To address this problem, we introduce the task of applicability condition extraction for therapeutic drug–disease relations from biomedical research literature. We create the first dataset that has manually annotated triples of drugs, diseases, and applicability conditions on biomedical paper abstracts with 1,119 drug-disease pairs. Using this dataset, we systematically evaluate the performance of a range of existing methods. In addition, we propose a new method that enhances LoRA to consider relations between drugs and diseases. Our method consistently outperforms strong baselines across different evaluation settings. The source code and dataset of this paper can be obtained from: https://github.com/guantingluo98/Drug-ACE

08.
arXiv (CS.AI) 2026-06-19

Neural Additive and Basis Models with Feature Selection and Interactions

arXiv:2606.19850v1 Announce Type: cross Abstract: Deep neural networks (DNNs) exhibit attractive performance in various fields but often suffer from low interpretability. The neural additive model (NAM) and its variant called the neural basis model (NBM) use neural networks (NNs) as nonlinear shape functions in generalized additive models (GAMs). Both models are highly interpretable and exhibit good performance and flexibility for NN training. NAM and NBM can provide and visualize the contribution of each feature to the prediction owing to GAM-based architectures. However, when using two-input NNs to consider feature interactions or when applying them to high-dimensional datasets, training NAM and NBM becomes intractable due to the increase in the computational resources required. This paper proposes incorporating the feature selection mechanism into NAM and NBM to resolve computational bottlenecks. We introduce the feature selection layer in both models and update the selection weights during training. Our method is simple and can reduce computational costs and model sizes compared to vanilla NAM and NBM. In addition, it enables us to use two-input NNs even in high-dimensional datasets and capture feature interactions. We demonstrate that the proposed models are computationally efficient compared to vanilla NAM and NBM, and they exhibit better or comparable performance with state-of-the-art GAMs.

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

Cascaded Sparse Autoencoders Learn Multi-Level Visual Concepts in Multimodal LLMs

Multimodal Large Language Models (MLLMs) have demonstrated strong performance on vision-language tasks, yet their internal visual representations remain difficult to interpret. Sparse Autoencoders (SAEs) provide a scalable way to decompose dense model activations into sparse, interpretable features. However, existing SAE architectures primarily recover flat feature dictionaries and are less suited for explicit multi-level concept organization. In this paper, we introduce cascaded sparse autoencoders (CSAEs) for learning hierarchical visual concepts in MLLMs. Rather than nesting or stacking SAE sparse activation codes, CSAEs train a second-level SAE directly on the decoder weights of the first-level SAE, treating learned low-level feature directions as inputs for higher-level abstraction. This design enables CSAEs to learn "concepts of concepts" while avoiding drawbacks from the shared-prefix coupling of nesting, Matryoshka-style hierarchies and the bottlenecks of naively stacked SAEs. Experiments across Qwen3-VL, Gemma-3, and LLaVA on multiple visual datasets show that CSAEs improve interpretability in terms of hierarchical concept coherence over state-of-the-art SAE baselines. Results on concept steering further demonstrate that the learned concept groups support effective group-level interventions in MLLM outputs.

10.
arXiv (CS.CL) 2026-06-17

Analyzing and Encoding the Al-Mawrid Arabic-English Dictionary with the ISO Language Markup Framework and TEI Lex-0

This paper presents a robust methodology for the systematic digitization and encoding of the Al-Mawrid Arabic-English dictionary, transforming it from a legacy print resource into a standardized computational lexicon. Addressing a significant gap in Arabic lexical infrastructure, the study adopts a dual-standard framing that aligns the ISO Lexical Markup Framework (LMF) with the Text Encoding Initiative TEI Lex-0 guidelines. By applying an editorial view to the dictionary's macro- and microstructure, the research resolves the structural ambiguities and punctuation inconsistencies typical of 20th-century bilingual dictionaries. The methodology is grounded in an empirical analysis of the dictionary's lexical knowledge density. Drawing on a representative sample (the letter Ayn, comprising 4.6% of the total volume), the study provides scientific weight to the encoding process, demonstrating a structural parsing accuracy of 91%. Quantitative evaluation of the information extraction rules reveals high performance, with 85% precision and 98% recall for synonyms, and 88% precision for other morpho-semantic features. Beyond technical description, the paper provides a critical comparison with existing Arabic lexical resources and discusses the limitations of TEI Lex-0 when modelling specific Arabic phenomena, such as implicit "open set" semantic relations and scattered morphological cues. Furthermore, the study explores the potential for Linguistic Linked Open Data (LLOD) integration by establishing a scalable prefix-based referencing system that facilitates the resource's inclusion in the semantic web. The result is an interoperable, machine-tractable resource that provides a reproducible workflow for the retro-digitization of complex legacy bilingual lexicons within the Arabic NLP and Digital Humanities communities.

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

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

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

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

RCEM: Robust Conversational Search EMbedder in Distributional Shift

We propose RCEM, a Robust Conversational search EMbedder that is additionally equipped with LLM's query reformulation capability without losing base model's generalization. Unlike prior conversational dense retrieval approaches that learn direct conversation-to-passage matching, RCEM aligns conversations, prepended by special token, to LLM-rewritten queries, while preserving the original embedding space. The unchanged embedding space automatically maps the rewritten-query to the relevant passages. As a result, RCEM (1) reduces overfitting by simplifying the alignment task from long passages to shorter rewritten queries, (2) eliminates the need for conversation-to-passage relevance labels for training, and (3) maintains its original embedding space that allows conversational queries against indexes built by original embedder without rebuilding them. Extensive experiments show that RCEM consistently outperforms prior approaches, achieving up to 30% improvement under distributional shift.

13.
arXiv (math.PR) 2026-06-12

Fourier Dimensions of Mandelbrot Cascades under Minimal Integrability

作者:

arXiv:2606.08703v2 Announce Type: replace Abstract: This note announces exact Fourier dimension formulas for canonical Mandelbrot cascade measures under the minimal Kahane Peyriere integrability condition and records the canonical b adic extension on cubes. In the dyadic interval setting, the theorem is proved in a balanced vector weight model allowing dependence between sibling weights. Almost surely on non extinction, the Fourier, energy, and L2 dimensions all equal the energy exponent. The scalar specialization gives the canonical Mandelbrot Kahane Fourier dimension formula under the minimal integrability condition. On the circle, the endpoint formula is given by the endpoint lower local dimension exponent. For the b adic Mandelbrot cascade on cubes, the Fourier dimension is the minimum of 2 and the energy exponent, with the universal Fourier barrier at dimension two providing the high dimensional obstruction.

14.
arXiv (CS.CL) 2026-06-11

Building Social World Models with Large Language Models

Understanding and predicting how social beliefs evolve in response to events – from policy changes to scientific breakthroughs – remains a fundamental challenge in social science. Given LLMs' commonsense knowledge and social intelligence, we ask: Can LLMs model the dynamics of social beliefs following social events? In this work, we introduce the concept of the Social World Model (SWM), a general framework designed to capture how social beliefs evolve in response to major events. SWM learns state-transition functions for social beliefs by mining temporal patterns in social data and optimizing the evidence lower bound, without the need for explicit human annotations linking events to belief shifts, or for expensive census data. To evaluate SWM, we introduce a benchmark, SWM-bench, derived from real-world prediction markets, specifically Kalshi and Polymarket. SWM-bench includes over 12k data points for social belief prediction tasks spanning diverse domains such as politics, finance, and cryptocurrency. Our experimental results show that SWM significantly outperforms time-series foundation models, achieving state-of-the-art results on Kalshi data and demonstrating competitive performance on Polymarket data, while offering interpretable insights into the underlying mechanisms of social belief dynamics.

15.
bioRxiv (Bioinfo) 2026-06-16

Integrative Transfer Network: Deep Transfer Learning Across Populations and Prediction Targets

作者:

Large-scale clinical and biomedical datasets increasingly contain both diverse subgroup attributes (e.g., demographic or clinical subgroups) and multiple prediction targets. Although various machine learning approaches can address subgroup differences or multi-target prediction, they often consider these aspects independently rather than jointly. To more effectively capture the shared and subgroup-specific information in such complex datasets, we propose the Integrative Transfer Network (ITN), a deep neural network designed to leverage data across subgroups and multiple related outcomes simultaneously. In extensive experiments, including time-to-event and classification tasks where demographic subgroups and multiple disease endpoints are prevalent, ITN demonstrates consistent improvements in subgroup-specific prediction by borrowing strength from other subgroups and outcomes. We envision ITN as a unified framework for learning from heterogeneous datasets where subgroup-specific insights are critical.

16.
arXiv (math.PR) 2026-06-12

Sticky CIR process with potential: invariant measure and exact sampling

arXiv:2605.13648v4 Announce Type: replace Abstract: We study the sticky Cox–Ingersoll–Ross (CIR) process in one dimension, a diffusion on $[0,\infty)$ with a sticky boundary condition at the origin, arising as the marginal process in a sparse Bayesian inference framework based on Hadamard–Langevin dynamics. For the parameter range $\delta\in(1,2)$, in which the origin is accessible but not absorbing, we prove well-posedness of the process and uniqueness of its invariant measure, which is a mixture of a point mass at zero and a weighted gamma-type density on the interior. We derive an explicit Green's function for the resolvent in terms of confluent hypergeometric functions, and use this to construct an exact sampler for the invariant measure in the zero-potential case. For a non-trivial potential $G$, we establish existence and uniqueness of the tilted invariant measure via a Girsanov change of measure, and develop two sampling algorithms: a Metropolis–Hastings corrected sampler that targets the invariant measure exactly, and a cheaper, biased unadjusted Langevin algorithm (ULA) for a boundary-clamped variant of which we prove a first-order expansion of the stationary bias with an explicit constant: the leading error is a rank-one transfer of mass $K_\star h|\log h| $ onto the atom, so the total-variation bias is of exact order $h|\log h | $ – independent of $\delta$ – whenever the potential has nonzero boundary drift. Numerical experiments confirm the predicted behaviour: the Metropolis–Hastings sampler achieves the target invariant measure at all step sizes, while the ULA bias follows the proven first-order law, including its constant.

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

Closed-Loop Triplet Synergistic Generation for Long-Form Video

Multi-shot long-form video generation remains challenging due to identity drift and compounding inconsistencies across shots. While storyboard-driven pipelines improve controllability, they are often executed in a feed-forward manner, with limited mechanisms to incorporate generated visual evidence back into subsequent conditioning. We propose CoTriSyGen, an agentic framework that formulates multi-shot long video generation as a closed-loop visual-text-memory synergy process, where planned intent, persistent memory, and generated visuals are jointly leveraged for iterative correction and long-range coherence. A vision-language-model-based analyzer reasons over this triplet and produces updates to both prompts and memory along two pathways: (i) intra-shot refinement, which triggers targeted regeneration when semantic or compositional violations are detected and refines image-to-video prompt for coherent motions; and (ii) inter-shot refinement, which rewrites subsequent-shot prompts to propagate newly manifested entities or attributes and improve prompt quality (e.g., compositional grounding and cinematic fluency) based on generated evidence. The loop is grounded in an entity-centric memory modeled as a mutable visual state that evolves as the story progresses, which is continuously updated by both the generator and the analyzer by adding new and evolved entities to reflect appearance changes, accumulated multi-view evidence, and multi-entity compositions. Experiments on our curated StoryBench benchmark demonstrate substantial improvements in cross-shot consistency, prompt adherence, and cinematic continuity over representative methods.

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

SpecLoR: Spectral Lookahead Rectification for Motion-Coherent Text-to-Video Generation

Flow Matching has enabled robust text-to-video generation via latent ODE sampling. However, velocity approximation and numerical discretization errors inevitably accumulate, causing sampling trajectories to drift. Consequently, generated videos often suffer from severe spatiotemporal inconsistencies. Nevertheless, directly correcting these drifted, noisy latents is challenging: (i) timestep-dependent noise obscures reliable structural cues; (ii) spatial interventions risk disrupting intricate local geometry while incurring heavy computational costs. To address this, we propose Spectral Lookahead Rectification (SpecLoR), a plug-and-play inference method that bypasses noise via lookahead prediction, and circumvents spatiotemporal entanglement by shifting corrections to the frequency domain, where universal statistical priors of natural videos are readily available. First, during early sampling stages, SpecLoR looks ahead to estimate the clean latent $z_{t,0}$ and computes its 3D spatiotemporal spectrum. Next, SpecLoR rectifies the amplitude spectrum to match the prior, leaving the phase intact. Finally, the corrected state is re-noised to resume ODE integration. Experiments on Wan2.2 demonstrate that SpecLoR significantly reduces physical artifacts and enhances motion coherence across multiple benchmarks with minimal computational overhead (4 additional NFEs).

19.
bioRxiv (Bioinfo) 2026-06-08

HydraMPP: A lightweight library for distributed massive parallel processing in Python - threading at scale.

We now exist in the era of massive datasets from genomics, large language models, and all the known knowledge of humanity right at our fingertips. Much of this data is becoming more accessible; however, processing such data remains an ongoing issue across systems including high performance computing (HPC) infrastructures. Massively parallel computing (MPP) has solved this using a divide and conquer approach by splitting workloads across independent nodes (i.e., central processing units (CPU) allowing for higher scaling of data). The main engine for this in python is Ray; however, it has many issues including a large code space, security issues, debugging opacity, and memory management issues. Here, we present HydraMPP, a lightweight, ease of use and utilization, with high auditability, and with SLURM ergonomics.

20.
arXiv (quant-ph) 2026-06-11

Dark state spectroscopy in nonlinear waveguide quantum electrodynamics

arXiv:2606.11997v1 Announce Type: new Abstract: Quantum systems face a fundamental trade-off: they must remain decoupled from the environment to maintain long coherence times, yet they require interactions with the environment to be accessible for measurement. As a prime example, emitter arrays coupled to waveguides facilitate collective modes that, owing to interference, can suppress radiation into the waveguide. While complete destructive interference creates perfectly dark states with infinite lifetimes, their inherent decoupling makes them unmeasurable in standard waveguide quantum electrodynamics. Consequently, current approaches must rely on system non-idealities that permit measurement but limit the coherence times. In this work, we lift this limitation by proposing the use of weakly squeezed light generated in \{chi}(2) nonlinear waveguides for the spectroscopy of completely dark states. We show that the fluorescence spectrum probes transitions between the dressed dark states of the emitter array. This work paves the way towards the measurement and control of dark states, with applications for robust quantum memories, computation, and communication.

21.
arXiv (CS.CV) 2026-06-18

Multi-Modal Hyper-Graph Fusion for Low-Light Crowd Counting

Crowd counting is a fundamental task in computer vision. However, crowd counting in low-light environments remains largely underexplored, despite its practical importance in the real world. Existing methods mainly focus on well-lit scenes or rely on single-modality Red-Green-Blue (RGB) representations, which often become unreliable under extreme darkness and complex non-uniform illumination. To handle this problem, we construct three new low-light crowd counting benchmarks, which consist of two synthetic datasets, SHA\_Dark and SHB\_Dark, and a real-world benchmark LC-Crowd (Low-light Crowd Dataset). Inspired by Retinex-based physical modeling, we introduce depth and Canny edge cues as complementary geometric and structural priors to enhance the intrinsic reflectance representation under low-light conditions. We propose a Multi-Modal Hyper-Graph Fusion module, which formulates RGB appearance, depth geometry, and edge structure cues as nodes in a unified hyper-graph and explicitly captures their high-order complementary relationships via dynamic hyperedge construction and message passing. Furthermore, to adaptively allocate computation in dense prediction, we propose a Deformable Rectangular Sparse Attention (DRSA) module, which concentrates computation on informative regions through anchor-aware estimation and adaptive rectangular window modeling. Based on these designs, we develop a unified Low-Light Counting Network (LCNet) for robust low-light crowd counting. Extensive experiments on three benchmarks demonstrate that the proposed method achieves the best overall performance against existing state-of-the-art (SOTA) methods. The code is in the supplementary material. The datasets will be made public upon acceptance.

22.
medRxiv (Medicine) 2026-06-19

Grey- and white-matter resilience to tau, cognition and sex in Alzheimer's disease

INTRODUCTION: Brain resilience to tau has been mainly studied in relation to grey matter, while its role in white matter remains unclear in Alzheimer's disease (AD). Sex may moderate associations between brain resilience and cognition. METHODS: We analyzed medial temporal lobe tau PET SUVR, entorhinal cortical thickness, cingulum-hippocampal mean diffusivity, and cognition in 205 amyloid-positive individuals from ADNI. Associations between grey- and white-matter resilience to tau and cognitive performance or decline were examined using linear and mixed-effects models, including sex interactions and stratified analyses. RESULTS: Higher grey-matter resilience to tau related to better cross-sectional memory and language performance (p

23.
arXiv (CS.AI) 2026-06-16

Frame-Conditioned Moral Computation in LLaMA 3.1-8B-Instruct: A Mechanistic Interpretability Audit of Ethical Reasoning

arXiv:2606.15507v1 Announce Type: new Abstract: Behavioral audits of Large Language Models on moral prompts measure what the model says, not the internal computation producing it. We use Transluce, an AI-driven mechanistic-interpretability platform, to examine LLaMA 3.1-8B-Instruct on 54 moral prompts in four batteries: 17 dilemmas, policy, and meta-ethical questions (B1); 6 role-playing scenarios (B3); and a controlled trolley contrast varying the switching mechanism with people fixed (B4, 15 prompts) or identity attributes with mechanism fixed (B5, 16 prompts). Two complementary metric families, five cluster-level metrics and a six-metric neuron-level panel, converge on a Situational Anchor Effect: domain-specific representations dominate the top of the activation list across every battery. The model's ethics-labeled capacity stays essentially constant; its salience (rank, priority, top-of-list presence) is highly sensitive to the interpretive frame the prompt selects. The B4-vs-B5 contrast confirms the model attends to whichever surface feature varies: aggregate ethics metrics are indistinguishable, but the dominant non-ethics distractor mirrors the design. A multi-temperature audit identifies a candidate ethics neuron (L16/N3837) stable across temperatures; a cross-model behavioral proxy on two frontier models yields preliminary evidence of divergence in self-reported moral focus, consistent with an Alignment Wrapper in which RLHF re-orders surface text without removing underlying domain-first frames. We unify these as Frame-Conditioned Moral Computation: the prompt's surface vocabulary selects a feature manifold, and the moral conclusion is downstream of that selection. Behavioral alignment must be supplemented by Mechanistic Alignment: a research program asking whether ethics-related features can be shown causally privileged under controlled frame variation, not merely loud in the explanation.

24.
medRxiv (Medicine) 2026-06-15

Wellbeing After Stroke-2 (WAterS-2): a feasibility study with process evaluation exploring inclusive, accessible, online psychological support after stroke

Objectives: Explore feasibility and acceptability of upskilling a workforce to deliver a co-developed intervention, based on Acceptance and Commitment Therapy (ACT), to support psychological adjustment post-stroke targeting underserved groups. Design: Multi-site, single-arm feasibility study with embedded mixed-methods process evaluation (ISRCTN17628580). Setting: Four NHS community stroke services across England. Participants: 1. Stroke survivors [≥]18 years of age, [≥]4 months post-stroke, reporting psychological difficulties adjusting to stroke, able to consent and access remote group sessions in English; 2. Group facilitators from NHS stroke services, not ACT specialists. Intervention: WAterS-2: an eight-session, remotely-delivered ACT-informed group intervention. Outcome measures: Recruitment, fidelity, safety, acceptability and perceived value were assessed using fidelity checklists, post-intervention surveys and semi-structured interviews with stroke survivors and facilitators. Clinical outcomes including mood (HADS), wellbeing (ONS4), psychological flexibility (AAQ-ABI), measured post-group and three-months later. Results: Nineteen stroke survivors recruited (mean 9.6 months post-stroke; n=5 (26%) minoritised ethnicities; n=10 (52%) with aphasia). Thirteen facilitators - including two peer support workers - delivered the intervention with fidelity following structured training across four services. Drop-out was low (2/19; 11%); with 15 (79%) attending [≥]5/8 sessions. Remote data collection was feasible (79% follow-up completion), with no adverse events recorded. Acceptability was high: survivors valued peer connection, grounding and mindfulness practices. ACT metaphors were helpful for some but challenging for others, including some with aphasia. Online delivery was suitable but limited informal connection. Facilitators reported increased capability, incorporating ACT skills into routine care. NHS workforce pressures and geographically-constrained referral pathways limited recruitment reach. Conclusions: WAterS-2 is feasible, safe, acceptable and inclusive. A mixed workforce, including NHS peer support workers, can be upskilled to deliver with fidelity. Inclusion of underserved groups is achievable but requires active strategies beyond standard NHS referral routes. Findings inform a provisional logic model and a future pragmatic trial.

25.
arXiv (CS.CL) 2026-06-19

Med-R2: Perception and Reflection-driven Complex Reasoning for Medical Report Generation

Automated medical report generation (MRG) is increasingly used to reduce the burden of manual reporting and for decision support. Large vision-language models (LVLMs) hold great promise for automated MRG due to their fine-grained image-text alignment and advanced text-generation capabilities. Currently, state-of-the-art MRGs primarily focus on adapting pre-trained LVLMs with direct supervised fine-tuning (SFT), a fine-tuning strategy with medical image-report pairs. However, several factors limit the performance of these LVLMs. Firstly, direct SFT enables LVLMs to generate medical reports directly without an intermediate thinking process of pathological feature perception and diagnostic reasoning. This causes a potential failure to perceive pathological features and thus leads to misdiagnosis. Secondly, direct SFT lacks the incorporation of radiology-specific knowledge guidance, causing LVLMs to misinterpret perceived pathological features and make incorrect diagnoses. To address these gaps, we propose a novel fine-tuning strategy named Med-R2. We introduce a perception-driven long reasoning process that precedes report generation and incorporates radiology-specific knowledge as guidance. Additionally, to alleviate potential perceptual errors in complex reasoning, a reflection mechanism is introduced to refine the perception of pathological features and the generated report. Our experiments demonstrate that Med-R2 effectively enhances the capability of pathological features perception and diagnosis accuracy for MRG via fine-tuned LVLMs.