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02.
medRxiv (Medicine) 2026-06-15

Midwifery Practice in Conflict Contexts: Lived Experiences from Somalia and Nigeria

Background: Midwives are a central cadre in the health system, particularly in conflict-affected settings where they are sometimes the primary or even only skilled providers available. Yet, despite their critical role, there is limited qualitative evidence capturing their lived experiences and how these shape workforce entry, retention, and overall well-being. Methods: Drawing on a phenomenological research methodology, this qualitative study was embedded within a larger prospective longitudinal cohort of midwifery students and graduates in Somalia and Nigeria. We conducted focus group discussions with graduate midwives (n=48 in Nigeria; n=63 in Somalia) to explore their experiences transitioning into the workforce and their realities working in health systems impacted by conflict and violent insecurity. Data were analysed using inductive thematic analysis. Results: Five themes emerged from the data: (1) job search and workforce entry, which was described as fraught with challenges and shaped by a set of formal systems in Nigeria but informal networks and structural barriers in Somalia (2) working conditions that were marked by resource scarcity, infrastructural challenges, and heavy and unreasonable workloads, (3) safety, security and coping strategies that differed across the two contexts but reflected persistent exposure to violence and a reliance on ad hoc and personal coping in lieu of systematic protection, (4) community perceptions of midwives, shaped and constrained by social and gender norms and (5) mental health and emotional wellbeing, highlighting stress, burnout and moral injury experienced by this cadre. Conclusion: Our findings highlight the profound challenges faced by midwives working in conflict-affected settings, and they shine a light on the urgent need to support and invest in this critical and predominantly female health workforce.

03.
arXiv (CS.CV) 2026-06-17

GeneralVLA-2: Geometry-Aware Reconstruction and Governed Memory for Robot Planning

Generalist vision-language-action systems need object-centric 3D evidence and reusable manipulation experience to plan reliable robot trajectories. GeneralVLA provides a hierarchical interface for converting language and RGB-D observations into 3D end-effector paths, but two bottlenecks remain. First, monocular SAM3D-style object reconstruction can hallucinate pose and unseen geometry, while manipulation benefits from stable object shape when calibrated multi-view observations are available. Second, the original KnowledgeBank mainly retrieves semantically similar snippets and appends new knowledge, which makes it difficult to control memory quality, conflicts, confidence, and geometric relevance. To address the first challenge, we introduce GeoFuse-MV3D, a geometry-prior-guided MV-SAM3D reconstruction branch that verifies external geometry cues with input-view masks, applies soft visual-hull support, performs axis-wise refinement, and fuses only geometry while preserving appearance. To address the second challenge, we upgrade KnowledgeBank into a governed long-term memory system with explicit quality, confidence, lifecycle, verifier, and conflict metadata, together with precision-oriented retrieval. Finally, we evaluate the reconstruction branch on GSO-30 and the memory module on Terminal-Bench 2.0 and SWE-Bench Verified; GeoFuse-MV3D improves over the MV-SAM3D baseline by reducing CD and LPIPS by 2.20% and 2.02% while increasing PSNR and SSIM by 2.36% and 1.03%, and KnowledgeBank improves over ReasoningBank by 4.53% on Terminal-Bench SR and 3.73% on SWE-Bench resolve rate, while reducing AS by 4.95% and 5.65%, respectively. Code: https://github.com/AIGeeksGroup/GeneralVLA-2. Website: https://aigeeksgroup.github.io/GeneralVLA-2.

04.
bioRxiv (Bioinfo) 2026-06-17

An Integrated Framework for Transcriptomic Characterization and Lorentzian Hyperbolic Visualization of a High-Risk Topological Branch in Alzheimer's Disease

Alzheimer's disease (AD) is a highly heterogeneous brain disorder in which molecular alterations vary across brain regions, disease stages, and patient subgroups. This study introduces an integrated analytical framework for characterizing transcriptomic variation associated with a high-risk topological branch, which was identified based on Lorentz distance in postmortem Brodmann area 36 samples from the Mount Sinai Brain Bank cohort, where over 70% of samples were in Braak stages V-VI. The framework integrates weighted gene co-expression network analysis, repeated stability-based differential expression analysis, network-level gene filtering, Gene Ontology enrichment, and nested stratified cross-validation to evaluate whether topological branch-associated genes capture biologically meaningful signals and carry predictive information for high-Braak group status. The identified gene sets were functionally enriched for neuronal development, neuron projection organization, synaptic signaling, vesicle fusion, and regulated synaptic release, suggesting that the high-risk topological branch reflects biologically relevant transcriptomic programs linked to neurodegenerative progression. Nested cross-validation further showed that the selected genes achieved measurable internal predictive performance for distinguishing high-Braak samples. As a second methodological contribution, we introduced a Lorentzian hyperbolic variant of t-distributed stochastic neighbor embedding (Lorentz t-SNE) to explore latent non-Euclidean structure in transcriptomic data. This method embeds samples in hyperbolic space, providing an alternative to Euclidean embeddings for representing hierarchical or nonlinear structures. Compared with conventional Euclidean embeddings, the proposed Lorentz t-SNE revealed a more localized organization of high-Braak samples. Together, these results demonstrate the utility of the proposed analytical framework and Lorentz t-SNE for investigating heterogeneous, potentially non-Euclidean organization in AD transcriptomes.

05.
arXiv (CS.CL) 2026-06-12

Uncertainty-Aware Hybrid Retrieval for Long-Document RAG

Retrieval augmented generation (RAG) depends critically on the quality and granularity of retrieved evidence. Large retrieval units preserve context but often introduce irrelevant content, which can dilute answer bearing evidence and worsen long context utilization. Fine-grained units are more compact, but they may be difficult to retrieve reliably because short chunks can lack semantic, lexical, or bridging cues needed to match the query. We propose Uncertainty-aware Multi-Granularity RAG (UMG-RAG), a training-free hybrid retrieval framework that treats chunk granularity as query-specific reliability estimation. Instead of training a new retriever or modifying the generator, UMG-RAG uses existing dense and sparse retrievers as complementary experts across multiple chunk granularities. For each query, it converts each expert-granularity score list into an evidence distribution, estimates reliability from distribution entropy, and fuses candidates according to query-specific semantic, lexical, and granularity confidence. We further introduce UMGP-RAG, a parent promotion variant that uses fine-grained hits to locate relevant evidence while returning broader non-redundant parent chunks for local coherence. Experiments on question answering benchmarks show that uncertainty-aware fusion and parent promotion improve generation quality while maintaining a lightweight, plug-and-play retrieval pipeline.

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

FlowBender: Feedback-Aware Training for Self-Correcting Conditional Flows

Conditional diffusion and flow models routinely fail to satisfy the very constraints that define their task. For instance, a depth-conditioned model often produces images whose re-extracted depth disagrees with the input, even though the forward operator–the depth predictor defining the constraint–is available during both training and inference. Existing approaches generally fall into two categories: supervised models that treat the conditioning signal as a static cue and ignore alignment information at inference, and guidance-based methods that consult it through hand-tuned linear updates, typically trading fidelity to the condition against the plausibility of the generated sample. We argue that the fundamental gap in both paradigms is that the model is never trained to utilize its own alignment error. We introduce FlowBender, a closed-loop framework that treats this error as a first-class input, training the network to learn a correction policy conditioned on inference-time feedback. At each step, an unguided look-ahead pass estimates the clean signal, a task-specific deviation is computed via the forward operator, and a refinement pass consumes this signal to produce a corrected velocity. We propose several variants of FlowBender, including a gradient-based formulation for differentiable operators and a zero-order variant for non-differentiable settings such as JPEG compression. For efficient sampling, we introduce a prior-step shortcut that enables closed-loop correction at a minimal additional computational cost. Across image-to-image translation, restoration, and 3D mesh texturing, FlowBender consistently outperforms standard supervised baselines, alignment-loss-augmented training, and state-of-the-art inference-time guidance, improving fidelity and plausibility simultaneously rather than trading them against each other. Project page: https://flow-bender.github.io/

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

VERITAS: Verifier-Guided Proof Search for Zero-Shot Formal Theorem Proving

arXiv:2606.19399v1 Announce Type: cross Abstract: LLM-based formal provers often collapse rich verifier signals (syntax errors, type mismatches, partial goal progress) into a binary pass/fail bit. We present VERITAS, a zero-shot framework that routes every verifier signal back into proof search through a two-phase protocol: Best-of-N sampling first, then a critic-guided MCTS pass that ingests Phase 1 failures as explicit negative examples. The protocol preserves every theorem solved by its own Phase 1 sweep, so Phase 2's additional solves are attributable to feedback-driven exploration. VERITAS reaches 40.6% on miniF2F (vs. an independently run Best-of-5 at 36.9%, Portfolio 26.2%) and 7.3% on VERITAS-CombiBench, a 55-theorem combinatorics benchmark we release on which Best-of-5 (1.8%) falls below Portfolio (3.6%), exposing that unguided sampling hurts when correct lemma names must be recovered iteratively from verifier feedback. Artifacts are available on GitHub.

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

Marginal Alignment Does Not Guarantee Joint-Distribution Fidelity: An Official-Reference Audit of Nemotron-Personas-Korea with Cross-Locale Replication

Synthetic persona datasets cite alignment with official demographics as a basis for trust, yet downstream users consume them as joint structures across age, sex, region, occupation, education, name, and institutional status. Marginal alignment does not imply that these joints are preserved. We propose the Independence-Assumption Footprint (IAF), an audit primitive that operates on the attribute combinations a dataset card itself documents as treated independently. For each such combination, IAF compares the synthetic joint against an external official or institutional reference, using direct joint tables where available and rule-implied checks otherwise. Applied to NVIDIA Nemotron-Personas-Korea (one million Korean synthetic personas), IAF finds that NPK aligns with KOSIS marginals while three joints fail. The major-by-occupation distribution against the KEIS graduate universe carries a large conditional mismatch. The age profile of military service is institutionally inconsistent. Female representation in male-dominated occupations is substantially over-flattened toward parity, with the strict screening verdict mapping-dependent and age-robust under direct standardisation. A transferability demonstration across six further NPK locales finds locale-dependent rather than universal diagnostics, with reference-taxonomy cardinality confounding cross-locale flag counts. For synthetic personas used as silicon samples, marginal claims must therefore be paired with disclosure-anchored joint audits before reuse. The released audit artefacts (reference manifests, occupational crosswalks, derived metrics, reproducibility scripts) instantiate this protocol on the NPK family and are released for retargeting at other synthetic persona resources.

09.
arXiv (CS.LG) 2026-06-19

Score Approximation for Diffusion Models on Arbitrary Low-Dimensional Structures

arXiv:2606.19894v1 Announce Type: new Abstract: The remarkable success of score-based diffusion models has spurred significant efforts to establish their theoretical foundations. However, existing complexity bounds for score approximation rely heavily on restrictive assumptions like Lipschitz continuous densities or smooth manifold supports, which are routinely violated by the singularities, sharp boundaries, and disjoint clusters inherent to real-world perceptual data. This work establishes a universal score approximation theorem that works for any distribution supported on any compact set of upper Minkowski dimension $d$. Using a novel discrete-mixture formulation, we prove that the score function can be approximated with a ReLU network whose complexity grows exponentially only with $d$, thus breaking the exponential curse of ambient dimensionality. Combined with existing theories on accurately solving the backward diffusion SDE for arbitrary compact distributions, our work shows that diffusion models readily adapt to irregular, non-smooth data structures, explaining their competence in real-world generative tasks.

10.
arXiv (CS.CL) 2026-06-12

KCSAT-ML: Probing Reasoning Models with Nationwide-Cohort Human Difficulty

Math reasoning benchmarks have proliferated, yet most lack a per-item difficulty signal grounded in actual human performance. We introduce KCSAT-ML, a decade (2014-2025) of Korean College Scholastic Ability Test (KCSAT; Suneung) mathematics: 664 problems with a 339-item core set carrying official per-item error rates from nationwide cohorts of hundreds of thousands of examinees. We pair the benchmark with Difficulty-aligned Reasoning Gain (DRG): a score-orthogonal metric that asks whether a model's mistakes concentrate on the items humans found hard, or on items humans found easy. Together they expose, across a wide range of VLMs (and LLMs via OCR), three patterns: (i) low-budget accuracy collapses on the high-human-error tail at every model size; (ii) test-time scaling (TTS) raises token use roughly linearly with cohort error rate, while accuracy gains follow a non-monotonic curve; (iii) within a single family, TTS flips between anti-scaling on the hardest items and overthinking on easier ones – two faces of the same alignment failure. On DRG, models with near-identical accuracy can sit at near-opposite values: one model gets wrong what humans also find hard, while another solves the hardest items yet fails on items humans find easy – a contrast that aggregate accuracy hides. Our code and dataset builder will be open-sourced at https://github.com/naver-ai/KCSAT-ML.

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

Moving Beyond Diffusion: Hierarchy-to-Hierarchy Autoregression for fMRI-to-Image Reconstruction

Reconstructing visual stimuli from fMRI signals is a central challenge bridging machine learning and neuroscience. Recent diffusion-based methods typically map fMRI activity to a single neural embedding, using it as static guidance throughout the entire generation process. However, this fixed guidance collapses hierarchical neural information and is misaligned with the stage-dependent demands of image reconstruction. In response, we propose MindHier, a coarse-to-fine fMRI-to-image reconstruction framework built on scale-wise autoregressive modeling. MindHier introduces three components: a Hierarchical fMRI Encoder to extract multi-level neural embeddings, a Hierarchy-to-Hierarchy Alignment scheme to enforce layer-wise correspondence with CLIP features, and a Scale-Aware Coarse-to-Fine Neural Guidance strategy to inject these embeddings into autoregression at matching scales. These designs make MindHier an efficient and cognitively aligned alternative to diffusion-based methods by enabling a hierarchical reconstruction process that synthesizes global semantics before refining local details, akin to human visual perception. Extensive experiments on the NSD dataset show that MindHier achieves superior semantic fidelity, 4.67$\times$ faster inference, and more deterministic results than the diffusion-based baselines.

12.
medRxiv (Medicine) 2026-06-17

Waning protection of long-acting RSV monoclonal antibodies in infants: a Bayesian analysis of clesrovimab and nirsevimab trial data

Clesrovimab and nirsevimab are long-acting monoclonal antibodies used to prevent respiratory syncytial virus (RSV) disease in infants, but waning protection in the first year of life is incompletely characterised. We applied a published Bayesian inference framework to clesrovimab and pooled nirsevimab trial data to estimate time-varying efficacy against medically attended RSV lower respiratory tract infection (LRTI) and RSV-associated hospitalisation, accounting for differences in placebo-arm event timing between trials. Estimated clesrovimab efficacy declined from 60.7% (95% CrI: 46.3-72.6) shortly after dosing to 38.3% (8.6-52.9) at six months against medically attended RSV LRTI, and from 87.1% (71.2-96.2) to 49.6% (10.4-70.7) against RSV-associated hospitalisation. For nirsevimab, corresponding estimates declined from 86.9% (75.4-95.0) to 53.8% (27.4-69.7) against LRTI, and from 77.5% (52.6-91.8) to 49.7% (15.7-68.3) against hospitalisation. After accounting for differences in RSV exposure timing and LRTI endpoint definitions between trials, we found no evidence of a difference in efficacy or waning between clesrovimab and nirsevimab.

13.
medRxiv (Medicine) 2026-06-11

Beyond External Load: Integrative Immune Monitoring Reveals Injury-Predictive Signals in the Athlete's Internal State

Abstract (already in the PDF; paste if a box is required): Injury risk prediction in elite football relies almost exclusively on external load metrics derived from GPS tracking, overlooking the molecular state of the athlete. We monitored 26 male players from FC Barcelona's first team across the 2025 calendar year, integrating GPS-derived training load with longitudinal blood-based immune monitoring (systemic inflammation and TCR-derived immune age). Immune age acceleration and inflammation were elevated in the 14 days preceding musculoskeletal injuries. A logistic regression model combining external load, inflammation, immune age acceleration, and career injury history reached an overall AUC of 0.678 and a mean per-player AUC of 0.754 (SD 0.146), improving on a GPS-only baseline of 0.541. Applied to 2026 data, the frozen model ranked players who later sustained non-contact musculoskeletal injuries high in the risk distribution. Together, our data suggest multimodal immune monitoring in elite football to reveal the athlete's internal physiological state, which carries injury-relevant information that external load alone does not capture.

14.
arXiv (CS.CL) 2026-06-12

NOVA: NOise-aware Verbal Confidence CAlibration for Robust Large Language Models in RAG Systems

Accurately assessing model confidence is essential for deploying large language models (LLMs) in mission-critical factual domains. While retrieval-augmented generation (RAG) is widely adopted to improve grounding, confidence calibration in RAG settings remains poorly understood. We conduct a systematic study across four benchmarks, revealing that LLMs exhibit poor calibration performance especially when noisy contexts are retrieved. Specifically, contradictory or irrelevant evidence tends to exacerbate the model's overconfidence issue. To address this, we propose NOVA Rules (NOise-Aware Verbal Confidence CAlibration Rules) to provide a principled foundation for resolving overconfidence under noise. We further design NOVA, a noise-aware calibration framework that synthesizes supervision from ~2K HotpotQA examples guided by these rules. By performing supervised fine-tuning (SFT) with this data, NOVA equips models with intrinsic noise awareness without relying on stronger teacher models. Empirical results show that NOVA yields substantial gains, improving ECE scores by 10.9% in-domain and 8.0% out-of-domain. By bridging the gap between retrieval noise and verbal calibration, NOVA paves the way for both accurate and epistemically reliable LLMs.

15.
arXiv (CS.AI) 2026-06-18

Dual-Channel Grounded World Modeling (DCGWM): Structural Prevention of Objective Interference Collapse via Heterogeneous External Grounding with Inward-Only Gradient Flow

arXiv:2606.18688v1 Announce Type: cross Abstract: Joint Embedding Predictive Architectures (JEPAs) are a leading approach to world model representation learning. We identify a failure mode in JEPA-based world models grounded against two qualitatively distinct external signals: physical dynamics (sparse, high-magnitude, constraint-satisfying gradient corrections) and social-behavioral dynamics (diffuse, distribution-matching corrections). We term this Objective Interference Collapse (OIC): we argue that joint learning in a shared latent space causes the dominant channel to systematically collapse the subordinate channel's representational subspace, in a manner not resolvable by loss weighting alone. We propose Dual-Channel Grounded World Modeling (DCGWM), designed to structurally prevent OIC through a partitioned latent space (physical subspace Z_p, behavioral subspace Z_b) with inward-only gradient flow. A Physical Grounding Channel updates only Z_p via VICReg-style alignment to physical measurements; a Social-Behavioral Grounding Channel updates only Z_b via alignment to trajectories from an emergent multi-agent simulation. An Inter-Channel Interface Module couples the subspaces at the task level without cross-subspace gradients. An Asymmetric Grounding Adherence Loss penalizes rollout drift with a hard hinge for physical violations and a soft KL for behavioral divergence. A Generative Rendering Layer is architecturally isolated from the latent world model. We present three theoretical results: the partition removes the gradient-interference pathway implicated in OIC; each grounded subspace inherits anti-collapse guarantees from its alignment objective; and generative isolation is necessary under a stated assumption on the generative objective's geometry. This manuscript establishes the problem formulation and architecture; experimental validation is ongoing and will be reported in a future revision.

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

Cross-Dataset Bloom Question Classification: Supervised Models and Prompted LLMs

Automatic Bloom's taxonomy classification of assessment questions can substantially reduce instructor workload, but labeling is subjective and teacher-dependent. Prior machine learning (ML) and deep learning (DL) approaches reported strong within-dataset results, yet were rarely evaluated in cross-dataset settings, leaving real-world generalizability unclear; meanwhile, LLM effectiveness for Bloom question classification has not been systematically studied. We evaluated the cross-dataset generalization of existing ML/DL methods and assessed LLMs with multiple prompting strategies on five datasets; the best prompting strategy combined in-context examples with course-specific action verbs. Supervised ML/DL models degraded substantially on unseen datasets, whereas LLMs were more stable, suggesting a robust alternative across diverse educational contexts. Based on the best prompting strategy, we also presented a lightweight UI that supports instructors in automatically classifying large question banks; a usability study indicated low workload and high usability.

17.
arXiv (quant-ph) 2026-06-11

Quantum ergodicity and semiclassical measures: mathematical results

arXiv:2606.12098v1 Announce Type: new Abstract: In this chapter we review some results describing the high-frequency eigenmodes of the Laplacian on compact manifolds, or Euclidean domains, for which the geodesic flow is chaotic. We focus on the macroscopic distribution of these eigenmodes, which is described by the concept of semiclassical measure. The main result on the question is the Quantum Ergodicity theorem, originally due to Schnirelman. We provide the detailed proof of this theorem, including the adjustments necessary to treat the case of manifolds with boundary. We also discuss the Quantum Unique Ergodicity conjecture, and some progress towards this conjecture for strongly chaotic (Anosov) systems. In particular, we describe the constraints on admissible semiclassical measures, in terms of their Kolmogorov-Sinai entropy, as well as more recent delocalization results.

18.
arXiv (CS.LG) 2026-06-15

Recipe-Controlled Decoder Audit for Structural Knowledge-Graph Completion

arXiv:2606.14492v1 Announce Type: new Abstract: We present a recipe-controlled decoder audit (RCDA) for structural transductive knowledge-graph completion (KGC). The audit asks a simple reporting question: before attributing gains to an encoder or training recipe, what changes when the decoder is swapped under the same recipe? Using ComplEx and DistMult as the primary controlled pair, with targeted RotatE/TransE spot-checks, we evaluate seven benchmarks. On five standard KGs, ComplEx-vs-DistMult differences are modest but consistent under our recipe (+0.005 to +0.012 MRR), whereas CompGCN-style encoder effects vary more by dataset. On small KGs, decoder effects become the main diagnostic: Kinship shows a stable ComplEx advantage of +0.143 MRR (6 seeds), while UMLS favours ComplEx by +0.022 MRR in a clean 6-seed server rerun but reverses in an earlier provenance variant. We therefore treat small-KG decoder choice as recipe- and provenance-sensitive rather than as a fixed dataset winner. We further show that decoder choice interacts with encoder depth on WN18RR, and that under our recipe L=0 ComplEx on YAGO3-10 reaches 0.6971 +/- 0.0048 MRR at d=128. The result is a compact audit protocol: report matched decoder rows, log small-KG provenance, and sweep decoder x depth before making encoder-level claims.

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

Lung-R1: A Knowledge Graph-Guided LLM for Pulmonary Diagnostic Reasoning

arXiv:2606.11675v1 Announce Type: new Abstract: Diagnosing pulmonary diseases requires integrating heterogeneous evidence amid phenotypic variability and cross-disease overlap. Although large language models (LLMs) have shown progress on pulmonary knowledge question answering (QA) and information-processing tasks, reliable pulmonary diagnosis requires patient-specific, relation-aware reasoning over electronic medical record (EMR) evidence rather than isolated knowledge recall. We define this gap between pulmonary knowledge and case-level diagnostic reasoning as the Pulmonary Knowledge-to-Diagnosis Gap. To address it, we introduce LungKG, the first structured pulmonary knowledge graph for diagnostic knowledge organization and record-grounded reasoning. LungKG contains 59,038 nodes and 164,308 edges across 15 entity types and 112 relation types, serving as both a reusable pulmonary knowledge resource and the foundation for LungKG-guided model adaptation. Built on LungKG, we propose Lung-R1, a LungKG-guided pulmonary LLM trained through KG-constrained reasoning-chain construction and KG-guided reinforcement learning. In a 20-system evaluation, Lung-R1-14B achieves state-of-the-art performance across Choice, Pulmonary-QA, and EMR Diagnosis, reaching an EMR Diagnosis score of 4.3583 and surpassing the strongest non-Lung-R1 baseline by 0.1476 points. These results demonstrate the value of LungKG-guided training for EMR-based pulmonary diagnosis.

20.
arXiv (CS.AI) 2026-06-16

Hierarchical Modeling of ICD Codes in EHR Foundation Models

arXiv:2606.15447v1 Announce Type: new Abstract: Electronic health record foundation models typically treat ICD diagnosis codes as flat tokens, overlooking the clinically meaningful hierarchical structure that captures disease families, subcategories, and fine-grained diagnostic detail. As a result, existing EHR representation learning methods do not explicitly exploit the hierarchical structure already present in the coding system. In this work, we study ICD-10-CM hierarchy as a general inductive bias for clinical representation learning. We investigate two complementary mechanisms for incorporating hierarchy: first, by augmenting diagnosis sequences in a BERT-style transformer with tokens corresponding to different levels of the ICD hierarchy, and second, by injecting hierarchy into graph-based code representations through hierarchy-aware edges combined with diagnosis co-occurrence structure. Across these settings, we evaluate whether explicit hierarchy improves downstream prediction, which levels of the hierarchy are most useful, whether hierarchy encoding improves transfer across datasets, and how hierarchy reshapes embedding similarity structure. We conduct experiments on two large-scale real-world clinical datasets: MIMIC-IV, used for pretraining and in-domain evaluation, and eICU, used to assess cross-dataset transfer via frozen encoder probing. Our findings show that explicitly encoding ICD hierarchy improves over flat code representations in both in-domain and cross-dataset settings, while revealing that the most useful level of hierarchy depends on both the task and the modeling approach. More broadly, we focus on hierarchy-aware EHR representation learning and show that the benefits of encoding hierarchy are generalizable across modeling settings and hierarchy levels.

21.
medRxiv (Medicine) 2026-06-17

Sao Tome and Principe on the verge of eliminating lymphatic filariasis as a public health problem: evidence from IDA impact assessment surveys

Background Accelerated efforts to eliminate lymphatic filariasis (LF) as a public health problem have been supported by the introduction of the triple-drug regimen of ivermectin, diethylcarbamazine and albendazole (IDA) in endemic settings. In Sao Tome and Principe, nationwide mass drug administration (MDA) with diethylcarbamazine and albendazole was implemented in 2018, followed by IDA in 2019 and 2020. This study assesses progress towards elimination using post-MDA impact assessment surveys conducted after cessation of treatment. Methods Cross-sectional surveys were conducted among adults aged 20 years and older in 2022 and again between December 2024 and January 2025. Circulating filarial antigen (CFA) was detected using the filarial test strip (FTS). Individuals who tested positive were examined for microfilaremia using nocturnal calibrated thick blood smear microscopy. Additionally, programme data on MDA coverage and morbidity were obtained from national surveillance records. Results Three rounds of nationwide MDA achieved high epidemiological coverage (86.4% in 2018, 74.2% in 2019 and 80.0% in 2020). The impact assessment surveys conducted in 2022 evaluated 14 132 adults, with 21 individuals (0.15%) testing positive for CFA, while the follow-up survey conducted between December 2024 and January 2025 assessed 14 653 adults and detected seven positive cases (0.05%). No microfilariae were detected among the 28 antigen-positive individuals examined using nocturnal calibrated thick blood smears. National morbidity records documented 190 cases of lymphoedema and nine cases of hydrocoele. Conclusions Infection indicators remain well below WHO decision thresholds, suggesting that LF transmission is unlikely to be sustained. Sao Tome and Principe appears to be close to eliminating LF as a public health problem. However, strengthening morbidity management services will be essential to support the preparation of the national elimination dossier.

22.
arXiv (CS.AI) 2026-06-18

Compute Efficiency and Serial Runtime Tradeoffs for Stochastic Momentum Methods

arXiv:2606.19179v1 Announce Type: cross Abstract: Stochastic momentum methods such as heavy ball (HB), Nesterov momentum, and variants of Accelerated SGD (ASGD) [Kidambi et al., 2018] are widely used in modern training, but their stochastic benefits depend on two distinct quantities: serial runtime, the number of iterations needed to reach a target accuracy, and compute efficiency (CE), the inverse total gradient-query or FLOP cost. Larger batches reduce serial runtime without hurting CE only when the contraction gap grows linearly with batch size. We study stochastic HB and ASGD for consistent linear regression with Gaussian covariates and prove finite-dimensional, discrete-time lower bounds on their batch-size tradeoffs. Our first result shows that HB does not improve the CE frontier over SGD for arbitrary spectra; rather, it preserves SGD-level CE over a larger batch-size window, allowing larger batches to reduce serial runtime until HB reaches its deterministic accelerated scale. This window can be a factor $\sqrt{\kappa}$ larger than the SGD critical batch size. For ASGD, the picture is more spectrum-dependent: for rapidly decaying power-law spectra, ASGD improves small-batch CE over HB/SGD, but as batch size grows it trades this CE advantage for improved serial runtime. Synthetic linear-regression experiments verify these qualitative regimes, including near-overlap of ASGD and HB for slowly decaying spectra and the predicted CE–serial tradeoff for rapidly decaying spectra.

23.
arXiv (CS.CV) 2026-06-18

From Bounding Boxes to Visual Reasoning: An On-Policy Data Annotation Tool for Vision-Language Models

Vision-language models (VLMs) are rapidly advancing toward sophisticated grounded structured visual reasoning. Training models for such advanced capabilities demands a new genre of data that seamlessly unifies spatial coordinates, open-vocabulary descriptions, structured attributes, and topological relationships into a singular representation. However, existing data annotation tools fundamentally fail to meet these intricate demands, suffering from three systematic bottlenecks: limited expressiveness, severe annotation-training decoupling, and poor data reusability. To bridge this infrastructure gap, we introduce an open-source annotation tool, ScreenAnnotator. First, we define a unified annotation atom schema that binds spatial, semantic, and structural primitives into a single unit. Second, we implement an on-policy annotation loop embedded with a Bayesian Annotation Verifier (BAV). Finally, we design a template-driven multi-task data synthesis process dynamically transforms static atoms into diverse multi-dimensional reasoning tasks, eliminating redundant re-annotation. The on-policy loop drives the annotation accept rate to nearly 100% on flowcharts and 77% on GUI screenshots, while steadily reducing per-image annotation time as labeled data accumulate. In the flowchart scenario, fine-tuning a VLM yields 76.1% average accuracy, which is a 35.1% point absolute gain. Our code is available at: https://github.com/WnQinm/Annotator.

24.
arXiv (CS.AI) 2026-06-17

SkillJect: Effectively Automating Skill-Based Prompt Injection for Skill-Enabled Agents

arXiv:2602.14211v3 Announce Type: replace-cross Abstract: Agent skills extend LLM agents with task-specific instructions, executable scripts, and auxiliary resources, improving reusability but creating a new supply-chain attack surface. A malicious or compromised skill can be repeatedly loaded as trusted guidance and steer downstream tool use. Existing skill-based prompt-injection attacks are often manual and brittle, because explicit malicious instructions are rejected or ignored when they are not aligned with the original workflow. We propose SkillJect, the first automated framework for generating poisoned skills against skill-enabled agent systems. SkillJect uses two coordinated channels. In the artifact channel, it hides the payload inside an auxiliary helper script. In the instruction channel, it rewrites SKILL.md with a front-loaded inducement strategy, placing injected content at the beginning and framing the helper script as a mandatory prerequisite or initialization step. The rewritten instruction explicitly references the helper-script path and provides an executable example command, making the helper appear to be a legitimate setup step before normal skill operations. SkillJect further adopts a closed-loop multi-agent process to improve attack effectiveness. An Attack Agent generates poisoned skills, a Victim Agent executes downstream tasks with the poisoned skill, and an Evaluate Agent inspects execution traces to determine whether the hidden payload was executed. The Attack Agent then uses this feedback to diagnose failure causes and rewrite SKILL.md, while keeping the payload fixed. Experiments across skill-enabled platforms, backend LLMs, and attack categories show that SkillJect substantially outperforms naive direct injection and prior manual skill-injection attacks, highlighting poisoned skills as a persistent threat in reusable skill ecosystems.

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

Topological Flow Matching

arXiv:2606.15897v1 Announce Type: cross Abstract: Flow matching is a powerful generative modeling framework, valued for its simplicity and strong empirical performance. However, its standard formulation treats signals on structured spaces, such as fMRI data on brain graphs, as points in Euclidean space, overlooking the rich topological features of their domains. To address this, we introduce topological flow matching, a topology-aware generalization of flow matching. We interpret flow matching as a framework for solving a degenerate Schrödinger bridge problem and inject topological information by augmenting the reference process with a Laplacian-derived drift. This principled modification captures the structure of the underlying domain while preserving the desirable properties of flow matching: a stable, simulation-free objective and deterministic sample paths. As a result, our framework serves as a drop-in replacement for standard flow matching. We demonstrate its effectiveness on diverse structured datasets, including brain fMRIs, ocean currents, seismic events, and traffic flows.