Background: SMS text messaging reminders are widely used to reduce missed outpatient appointments; however, evidence remains limited regarding which types of reminder content patients prefer, particularly within East Asian universal health systems. In Taiwan, minimal financial barriers to care and unrestricted access to secondary and tertiary hospitals contribute to high outpatient visit volumes and persistent no-show rates. These contextual features underscore the need for behaviorally informed and demographically tailored reminder strategies rather than uniform messaging approaches. Objective: This study aimed to examine patient preferences for 6 theory-guided SMS appointment reminder types and to identify the predictors of reminder preference related to demographic characteristics and health care utilization, with the goal of informing personalized reminder design for a forthcoming randomized controlled trial. Methods: We conducted a cross-sectional online survey among adults in Taiwan with prior outpatient experience. Six SMS reminder prototypes were developed based on behavioral communication principles and validated by a multidisciplinary expert panel using item-level content validity indices. Participants selected their preferred SMS reminder type and reported sociodemographic characteristics and recent health care utilization. Bivariate associations were examined using chi-square tests and one-way ANOVA, with Benjamini-Hochberg false discovery rate correction applied to control for multiple testing. To identify independent predictors of SMS reminder preference while adjusting for potential confounding, we fitted a multinomial logistic regression model with all covariates entered simultaneously. Results: A total of 1095 respondents completed the survey. General reminders and messages referencing prior missed appointments were most frequently preferred, whereas empathy-based or relationally framed messages were selected less often. In false discovery rate–adjusted univariate analyses, both age and sex were associated with SMS reminder preference. However, in the fully adjusted multinomial logistic regression model, age emerged as the only statistically significant independent predictor. Participants younger than 50 years were significantly more likely to prefer alternative reminder message types compared with the general reminder (adjusted odds ratio 1.64, 95% CI 1.18‐2.28; =.003). Sex did not retain statistical significance after multivariable adjustment. Other sociodemographic characteristics and health care utilization variables, including education level, employment status, residential region, outpatient visit frequency, and recent missed appointments history, were not independently associated with reminder preference. Conclusions: Preferences for outpatient SMS reminder content vary systematically, with age representing the most robust independent predictor. Across the sample, concise and behavior-focused reminders were preferred over empathy-oriented or relational formats. These findings support age-informed tailoring of SMS reminder content and provide content-validated SMS prototypes for use in subsequent interventional research. The results offer formative evidence to guide the design of randomized trials aimed at reducing outpatient no-shows and improving the efficiency of ambulatory care delivery in Taiwan’s universal health care system.

Background: Incomplete clinical details on magnetic resonance imaging (MRI) examination requests (MERs) can lead to suboptimal protocol selection. An institutional secure large language model (sLLM) with access to manually retrieved salient data from the electronic medical record (EMR) may improve request completeness and protocol accuracy across multiple MRI subspecialties. Objective: The objective of this study was to compare clinician MERs with sLLM-augmented MERs for information quality and to evaluate the protocoling accuracy of the sLLM versus board-certified radiologists across body, musculoskeletal, and neuroradiology MRI. Methods: This retrospective study included 608 random outpatient MRI examinations performed between September 2023 and July 2024 (body 206, musculoskeletal 203, neuroradiology 199). The cohort comprised 528 patients (mean 51.2 years, SD 19.2; range 4‐93; n=279, 52.8% women, n=249, 47.2% men). MERs without EMR access were excluded. A privately hosted Anthropic Claude 3.5 model (temperature 0) augmented each MER with manually retrieved salient EMR data and, via rule-based parsing, mapped the extracted elements onto predefined institutional criteria to recommend region or coverage and contrast use. Two experienced radiologists established a consensus reference standard. Two board-certified general radiologists (Rad 3 and Rad 4) and the sLLM were compared with this standard. Clinical information quality was graded using the Reason-for-Exam Imaging Reporting and Data System (RI-RADS). Interrater reliability was quantified with Gwet AC1. Paired accuracies were compared with the McNemar test to determine whether there was a statistically significant difference. Results: Interreader agreement for RI-RADS was almost perfect for sLLM-augmented MERs (AC1 0.97, 95% CI 0.94‐0.99) and moderate for clinician MERs (AC1 0.43, 95% CI 0.34‐0.52). Limited or deficient clinical information (RI-RADS C/D) fell to 0% to 0.7% (0/608 to 4/608) with sLLM augmentation vs 4.1% to 20.4% (25/608 to 124/608) for clinician MERs. Overall protocol accuracy was 93.1% (566/608; 95% CI 89.6‐96.6) for the sLLM, 91.4% (556/608; 95% CI 87.6‐95.3) for Rad 3, and 92.1% (560/608; 95% CI 88.4‐95.8) for Rad 4 (sLLM vs Rad 3 =.23 vs Rad 4 =.40). Region or coverage accuracy was similar (sLLM: 579/608, 95.2%; Rad 3: 585/608, 96.2%; Rad 4: 573/608, 94.2%; =.46 and =.36). Contrast decisions were more accurate using the sLLM at 94.4% (574/608; 95% CI 91.3‐97.5) vs Rad 3 at 92.1% (560/608; 95% CI 88.4‐95.8; =.027) and were not significantly different to Rad 4 at 92.9% (565/608; 95% CI 89.4‐96.4; =.16). Subspecialty analyses showed similar patterns, with the sLLM outperforming Rad 4 for musculoskeletal MRI contrast decisions (96.6% vs 91.1%; =.006) and matching readers elsewhere. Manual review indicated that sLLM improvements arose from EMR details not listed on the MER (infection/inflammation, tumor history, prior surgery). No clinically significant hallucinations were identified in a manual review of discordant cases. Conclusions: Across body, musculoskeletal, and neuroradiology MRI, sLLM-augmented examination requests improved clinical context and enhanced contrast selection while demonstrating accuracy comparable to general radiologists for region or coverage. Integrating sLLMs into routine vetting workflows may reduce manual workload in protocol selection for more efficient, standardized protocoling.

Background: Depression and anxiety can significantly impact workplace productivity, for instance, by increasing absenteeism and presenteeism. This loss of productivity leads to diminished workplace economic outcomes. Internet-based cognitive behavioral therapy (iCBT) has emerged as a cost-effective intervention within workplace settings that improves workplace productivity loss due to depression and anxiety, but more generalizable evidence beyond the workplace, such as in a national health service setting, is lacking. Objective: This naturalistic, repeated-measures, retrospective study investigated the impact of iCBT on work productivity metrics using nationally representative data from patients enrolled in the Irish national health service (ie, the Health Service Executive). Methods: We analyzed repeated measures retrospective data from 7125 employed patients enrolled in iCBT at the Health Service Executive between March 2023 and May 2024. The Work Productivity and Activity Impairment questionnaire was used to measure absenteeism, presenteeism, overall productivity loss, and activity impairment. Secondary outcomes included depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7). Patients were primarily 25 to 64 years old (n=5578, 78%), female (n=4956, 70%), and met clinical scoring criteria on the Patient Health Questionnaire-9 or Generalized Anxiety Disorder-7 (n=4774, 67%). Missing data were handled using multiple imputation. We used mixed-effects models to assess pre-post treatment changes in outcomes and then utilized Irish national salary estimates from 2022 to derive cost savings (in 2022 € values; €1=approximately US $1.05) based on productivity improvement during use of the iCBT program. Results: From baseline to follow-up, absenteeism reduced by 6.85% (

arXiv:2604.04220v1 Announce Type: new Abstract: We introduce TimeSeek, a benchmark for studying how the reliability of agentic LLM forecasters changes over a prediction market's lifecycle. We evaluate 10 frontier models on 150 CFTC-regulated Kalshi binary markets at five temporal checkpoints, with and without web search, for 15,000 forecasts total. Models are most competitive early in a market's life and on high-uncertainty markets, but much less competitive near resolution and on strong-consensus markets. Web search improves pooled Brier Skill Score (BSS) for every model overall, yet hurts in 12% of model-checkpoint pairs, indicating that retrieval is helpful on average but not uniformly so. Simple two-model ensembles reduce error without surpassing the market overall. These descriptive results motivate time-aware evaluation and selective-deference policies rather than a single market snapshot or a uniform tool-use setting.

arXiv:2604.04356v1 Announce Type: new Abstract: Mixture-of-Experts (MoE) large language models (LLMs) are among the top-performing architectures. The largest models, often with hundreds of billions of parameters, pose significant memory challenges for deployment. Traditional approaches to reduce memory requirements include weight pruning and quantization. Motivated by the Router-weighted Expert Activation Pruning (REAP) that prunes experts, we propose a novel method, Router-weighted Expert Activation Merging (REAM). Instead of removing experts, REAM groups them and merges their weights, better preserving original performance. We evaluate REAM against REAP and other baselines across multiple MoE LLMs on diverse multiple-choice (MC) question answering and generative (GEN) benchmarks. Our results reveal a trade-off between MC and GEN performance that depends on the mix of calibration data. By controlling the mix of general, math and coding data, we examine the Pareto frontier of this trade-off and show that REAM often outperforms the baselines and in many cases is comparable to the original uncompressed models.

arXiv:2604.04448v1 Announce Type: new Abstract: Cognitive Behavioral Therapy (CBT) aims to identify and restructure automatic negative thoughts pertaining to involuntary interpretations of events, yet existing counseling agents struggle to identify and address them in dialogue settings. To bridge this gap, we introduce STEP, a dataset that models CBT counseling by explicitly reflecting automatic thoughts alongside dynamic, action-level counseling sequences. Using this dataset, we train STEPPER, a counseling agent that proactively elicits automatic thoughts and executes cognitively grounded interventions. To further enhance both decision accuracy and empathic responsiveness, we refine STEPPER through preference learning based on simulated, synthesized counseling sessions. Extensive CBT-aligned evaluations show that STEPPER delivers more clinically grounded, coherent, and personalized counseling compared to other strong baseline models, and achieves higher counselor competence without inducing emotional disruption.

arXiv:2604.03401v1 Announce Type: cross Abstract: Understanding student engagement usually requires time-consuming manual observation or invasive recording that raises privacy concerns. We present a privacy-preserving pipeline that analyzes classroom videos to extract insights about student attention, without storing any identifiable footage. Our system runs on a single GPU, using OpenPose for skeletal extraction and Gaze-LLE for visual attention estimation. Original video frames are deleted immediately after pose extraction, thus only geometric coordinates (stored as JSON) are retained, ensuring compliance with FERPA. The extracted pose and gaze data is processed by QwQ-32B-Reasoning, which performs zero-shot analysis of student behavior across lecture segments. Instructors access results through a web dashboard featuring attention heatmaps and behavioral summaries. Our preliminary findings suggest that LLMs may show promise for multimodal behavior understanding, although they still struggle with spatial reasoning about classroom layouts. We discuss these limitations and outline directions for improving LLM spatial comprehension in educational analytics contexts.

arXiv:2604.03486v1 Announce Type: cross Abstract: We present VisionClaw, an always-on wearable AI agent that integrates live egocentric perception with agentic task execution. Running on Meta Ray-Ban smart glasses, VisionClaw continuously perceives real-world context and enables in-situ, speech-driven action initiation and delegation via OpenClaw AI agents. Therefore, users can directly execute tasks through the smart glasses, such as adding real-world objects to an Amazon cart, generating notes from physical documents, receiving meeting briefings on the go, creating events from posters, or controlling IoT devices. We evaluate VisionClaw through a controlled laboratory study (N=12) and a longitudinal deployment study (N=5). Results show that integrating perception and execution enables faster task completion and reduces interaction overhead compared to non-always-on and non-agent baselines. Beyond performance gains, deployment findings reveal a shift in interaction: tasks are initiated opportunistically during ongoing activities, and execution is increasingly delegated rather than manually controlled. These results suggest a new paradigm for wearable AI agents, where perception and action are continuously coupled to support situated, hands-free interaction.

arXiv:2604.03641v1 Announce Type: cross Abstract: Reinforcement learning in real-world systems is often accompanied by delayed feedback, which breaks the Markov assumption and impedes both learning and control. Canonical state augmentation approaches cause the state-space explosion, which introduces a severe sample-complexity burden. Despite recent progress, the state-of-the-art augmentation-based baselines remain incomplete: they either predominantly reduce the burden on the critic or adopt non-unified treatments for the actor and critic. To provide a structured and sample-efficient solution, we propose delayed homomorphic reinforcement learning (DHRL), a framework grounded in MDP homomorphisms that collapses belief-equivalent augmented states and enables efficient policy learning on the resulting abstract MDP without loss of optimality. We provide theoretical analyses of state-space compression bounds and sample complexity, and introduce a practical algorithm. Experiments on continuous control tasks in MuJoCo benchmark confirm that our algorithm outperforms strong augmentation-based baselines, particularly under long delays.

arXiv:2604.04138v1 Announce Type: cross Abstract: Dexterous manipulation requires planning a grasp configuration suited to the object and task, which is then executed through coordinated multi-finger control. However, specifying grasp plans with dense pose or contact targets for every object and task is impractical. Meanwhile, end-to-end reinforcement learning from task rewards alone lacks controllability, making it difficult for users to intervene when failures occur. To this end, we present GRIT, a two-stage framework that learns dexterous control from sparse taxonomy guidance. GRIT first predicts a taxonomy-based grasp specification from the scene and task context. Conditioned on this sparse command, a policy generates continuous finger motions that accomplish the task while preserving the intended grasp structure. Our result shows that certain grasp taxonomies are more effective for specific object geometries. By leveraging this relationship, GRIT improves generalization to novel objects over baselines and achieves an overall success rate of 87.9%. Moreover, real-world experiments demonstrate controllability, enabling grasp strategies to be adjusted through high-level taxonomy selection based on object geometry and task intent.

arXiv:2604.04353v1 Announce Type: cross Abstract: Although HCI research papers offer valuable design insights, designers often struggle to apply them in design workflows due to difficulties in finding relevant literature, understanding technical jargon, the lack of contextualization, and limited actionability. To address these challenges, we present ReFinE, a Figma plugin that supports real-time design iteration by surfacing contextualized insights from research papers. ReFinE identifies and synthesizes design implications from HCI literature relevant to the mockup's design context, and tailors this research evidence to a specific design mockup by providing actionable visual guidance on how to update the mockup. To assess the system's effectiveness, we conducted a technical evaluation and a user study. Results show that ReFinE effectively synthesizes and contextualizes design implications, reducing cognitive load and improving designers' ability to integrate research evidence into UI mockups. This work contributes to bridging the gap between research and design practice by presenting a tool for embedding scholarly insights into the UI design process.

arXiv:2604.04384v1 Announce Type: cross Abstract: Across every attention head in five transformer language models (124M--7B parameters, four architecture families), the logit energy field $\tilde{E}$ reaches 90\% of its variance in 2--11 singular components. The \emph{learned} interaction matrix $W_Q^\mathrm{T} W_K$ needs 38--75 components for the same threshold out of $d_h \in \{64, 128\}$. The spectral gap is $5$--$25\times$ in effective rank. The attention mechanism allocates capacity uniformly across all $d_h$ dimensions, but language concentrates the actual interaction into a few. The compressibility of softmax-attended language is a property of the data, not the frame that analyzes it.

arXiv:2604.04420v1 Announce Type: cross Abstract: Task-free online continual learning has recently emerged as a realistic paradigm for addressing continual learning in dynamic, real-world environments, where data arrive in a non-stationary stream without clear task boundaries and can only be observed once. To consider such challenging scenarios, many recent approaches have employed prompt selection, an adaptive strategy that selects prompts from a pool based on input signals. However, we observe that such selection strategies often fail to select appropriate prompts, yielding suboptimal results despite additional training of key parameters. Motivated by this observation, we propose a simple yet effective SinglePrompt that eliminates the need for prompt selection and focuses on classifier optimization. Specifically, we simply (i) inject a single prompt into each self-attention block, (ii) employ a cosine similarity-based logit design to alleviate the forgetting effect inherent in the classifier weights, and (iii) mask logits for unexposed classes in the current minibatch. With this simple task-free design, our framework achieves state-of-the-art performance across various online continual learning benchmarks. Source code is available at https://github.com/efficient-learning-lab/SinglePrompt.

arXiv:2604.04701v1 Announce Type: cross Abstract: Large language models (LLMs) have achieved outstanding performance across a wide range of natural language processing tasks, but their enormous parameter counts impose ubstantial memory and computational overheads. This challenge is particularly critical in NPU-based on-device environments, where FP16/FP32 computation is inefficient and integer (INT) quantization is therefore essential. However, existing methods, including ZeroQuant, LLM.int8(), and SmoothQuant, do not fully address input-activation outliers and the associated hardware inefficiencies. To overcome these limitations, we propose MUXQ (Mixed-to-Uniform Quantization). MUXQ detects outlier channels in input activations and introduces a small auxiliary matrix that redistributes outlier magnitudes across channels, thereby alleviating the outlier problem. This enables even activation outliers to be quantized at low-precision INT levels while preserving a hardware-friendly computation structure. Experiments on GPT-2 models at three scales (0.1B, 0.3B, and 0.7B parameters) using the WikiText-2 dataset show that MUXQ consistently achieves lower perplexity than naive quantization. In particular, under per-tensor quantization, MUXQ quantizes both activations and weights to INT8 while maintaining accuracy close to that of FP16. With only modest computational overhead, MUXQ enables stable low-precision inference and can be readily combined with other quantization techniques. These results suggest that MUXQ provides a promising direction for efficient and accurate LLM inference on edge devices.

arXiv:2410.14826v3 Announce Type: replace-cross Abstract: Large Language Models (LLMs) have shown impressive capabilities in many scenarios, but their performance depends, in part, on the choice of prompt. Past research has focused on optimizing prompts specific to a task. However, much less attention has been given to optimizing the general instructions included in a prompt, known as a system prompt. To address this gap, we propose SPRIG, an edit-based genetic algorithm that iteratively constructs prompts from prespecified components to maximize the model's performance in general scenarios. We evaluate the performance of system prompts on a collection of 47 different types of tasks to ensure generalizability. Our study finds that a single optimized system prompt performs on par with task prompts optimized for each individual task. Moreover, combining system and task-level optimizations leads to further improvement, which showcases their complementary nature. Experiments also reveal that the optimized system prompts generalize effectively across model families, parameter sizes, and languages. This study provides insights into the role of system-level instructions in maximizing LLM potential.

arXiv:2503.11572v4 Announce Type: replace-cross Abstract: Implicit biases refer to automatic mental processes that shape perceptions, judgments, and behaviors. Previous research on "implicit bias" in LLMs focused primarily on outputs rather than the processes underlying the outputs. We present the Reasoning Model Implicit Association Test (RM-IAT) to study implicit bias-like processing in reasoning models, LLMs that use step-by-step reasoning to solve complex tasks. Using RM-IAT, we find that reasoning models like o3-mini, DeepSeek-R1, gpt-oss-20b, and Qwen-3 8B consistently expend more reasoning tokens on association-incompatible tasks than association-compatible tasks, suggesting greater computational effort when processing counter-stereotypical information. Conversely, Claude 3.7 Sonnet exhibited reversed patterns, which thematic analysis associated with its unique internal focus on reasoning about bias and stereotypes. These findings demonstrate that reasoning models exhibit distinct implicit bias-like patterns and that these patterns vary significantly depending on the models' internal reasoning content.

arXiv:2508.05012v2 Announce Type: replace-cross Abstract: Modern LLM pipelines increasingly resemble complex data-centric applications: they retrieve data, correct errors, call external tools, and coordinate interactions between agents. Yet, the central element controlling this entire process -- the prompt -- remains a brittle, opaque string that is entirely disconnected from the surrounding program logic. This disconnect fundamentally limits opportunities for reuse, optimization, and runtime adaptivity. In this paper, we describe our vision and an initial design of SPEAR (Structured Prompt Execution and Adaptive Refinement), a new approach to prompt management that treats prompts as first-class citizens in the execution model. Specifically, SPEAR enables: (1) structured prompt management, with prompts organized into versioned views to support introspection and reasoning about provenance; (2) adaptive prompt refinement, whereby prompts can evolve dynamically during execution based on runtime feedback; and (3) policy-driven control, a mechanism for the specification of automatic prompt refinement logic as when-then rules. By tackling the problem of runtime prompt refinement, SPEAR plays a complementary role in the vast ecosystem of existing prompt optimization frameworks and semantic query processing engines. We describe a number of related optimization opportunities unlocked by the SPEAR model, and our preliminary results demonstrate the strong potential of this approach.

arXiv:2602.16813v2 Announce Type: replace-cross Abstract: Language models based on discrete diffusion have attracted widespread interest for their potential to provide faster generation than autoregressive models. Despite their promise, these models typically produce samples whose quality sharply degrades in the few-step regime, preventing a dramatic speedup in practice. Here, we show that language models based on continuous flows over one-hot token embeddings can outperform discrete diffusion in both quality and speed. Importantly, our continuous formulation defines a unique flow map that can be learned directly for efficient few-step inference, a structure we show is unavailable to discrete methods. In this setting, we show that both the flow and its associated flow map can be learned with simple cross-entropy objectives that respect the simplex geometry of the data, and we identify three distinct choices for flow map distillation whose performance we compare in practice. Using these insights, we build a flow language model (FLM), a continuous flow that matches state-of-the-art discrete diffusion baselines on the One Billion Words (LM1B) and OpenWebText (OWT) datasets. We then distill FLM into a flow map language model (FMLM), whose one-step generation exceeds the 8-step quality of recent few-step discrete diffusion language models. Our work challenges the widely-held hypothesis that discrete noising processes are necessary for generative modeling over discrete modalities and paves the way toward accelerated language modeling at scale. Code is available at https://github.com/david3684/flm.

arXiv:2603.02050v4 Announce Type: replace-cross Abstract: As agents move into shared workspaces and their execution becomes visible, human-agent collaboration faces a fundamental shift from sequential delegation to concurrent co-creation. This raises a new coordination problem: what interaction patterns emerge, and what agent capabilities are required to support them? Study 1 (N=10) revealed that process visibility naturally prompted concurrent intervention, but exposed a critical capability gap: agents lacked the collaborative context awareness needed to distinguish user feedback from independent parallel work. This motivated CLEO, a design probe that embodies this capability, interpreting concurrent user actions as feedback or independent work and adapting execution accordingly. Study 2 (N=10) analyzed 214 turn-level interactions, identifying a taxonomy of five action patterns and ten codes, along with six triggers and four enabling factors explaining when and why users shift between collaboration modes. Concurrent interaction appeared in 31.8% of turns. We present a decision model, design implications, and an annotated dataset, positioning concurrent interaction as what makes delegation work better.

Nature Medicine, Published online: 07 April 2026; doi:10.1038/s41591-026-04307-8

In a phase 1 basket trial, the small interfering RNA zodasiran, targeting ANGPTL3, lowered triglycerides in patients with severe hypertriglyceridemia and lowered both triglycerides and low-density lipoprotein cholesterol in patients with heterozygous familial hypercholesterolemia.