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01.
arXiv (CS.CL) 2026-06-19

IdealGPT: Iteratively Decomposing Vision and Language Reasoning via Large Language Models

The field of vision-and-language (VL) understanding has made unprecedented progress with end-to-end large pre-trained VL models (VLMs). However, they still fall short in zero-shot reasoning tasks that require multi-step inferencing. To achieve this goal, previous works resort to a divide-and-conquer pipeline. In this paper, we argue that previous efforts have several inherent shortcomings: 1) They rely on domain-specific sub-question decomposing models. 2) They force models to predict the final answer even if the sub-questions or sub-answers provide insufficient information. We address these limitations via IdealGPT, a framework that iteratively decomposes VL reasoning using large language models (LLMs). Specifically, IdealGPT utilizes an LLM to generate sub-questions, a VLM to provide corresponding sub-answers, and another LLM to reason to achieve the final answer. These three modules perform the divide-and-conquer procedure iteratively until the model is confident about the final answer to the main question. We evaluate IdealGPT on multiple challenging VL reasoning tasks under a zero-shot setting. In particular, our IdealGPT outperforms the best existing GPT-4-like models by an absolute 10% on VCR and 15% on SNLI-VE. Code is available at https://github.com/Hxyou/IdealGPT

02.
arXiv (CS.LG) 2026-06-18

Beyond Algorithms: Conceptual Innovation in Medical Imaging AI

arXiv:2606.19270v1 Announce Type: cross Abstract: Artificial intelligence has driven rapid progress in medical imaging research, producing increasingly sophisticated algorithms and steady improvements on benchmark tasks. However, this algorithm-centric trajectory has also revealed a growing imbalance: while computational methods advance rapidly, the conceptual foundations that define imaging tasks, evaluation metrics, and clinical meaning sometimes remain underexamined. In this Perspective, we distinguish algorithmic innovation, which focuses on improving computational implementations and performance within a fixed problem definition, from conceptual innovation, which reframes what problems are posed, how success is measured, and why an approach is clinically relevant. We argue that prevailing incentive structures, training pathways, and publication norms disproportionately reward algorithmic novelty, particularly for early-career researchers, while at times undervaluing conceptual contributions that are essential for scientific maturation and clinical translation. Through representative examples from medical imaging AI, we show how insufficient conceptual grounding can lead to misaligned objectives, fragile generalization, and limited real-world impact. We conclude with actionable recommendations for researchers, mentors, reviewers, and journals to better recognize, support, and integrate conceptual innovation alongside algorithmic advances.

03.
medRxiv (Medicine) 2026-06-22

Repeat expansions in Parkinson's disease and parkinsonism across ancestries: insights from a global genetic cohort

Expanded short tandem repeats contribute to a broad spectrum of neurodegenerative diseases, yet their roles in Parkinson's disease (PD) and parkinsonism remain incompletely characterized, especially across diverse ancestries. We analyzed short-read whole-genome (WGS) and clinical exome sequencing (CES) data from 38,365 individuals (28,861 WGS; 9,504 CES), encompassing 23,242 patients with PD, 4,729 patients with atypical parkinsonism and 10,394 healthy controls from 11 genetic ancestries. To determine carrier frequencies and characterize repeat structures across diverse ancestries, we genotyped 12 established pathogenic loci where normal, intermediate, and pathogenic alleles can be reliably differentiated using short-read sequencing data. Additionally, we conducted threshold-based associations to determine the minimum threshold associated with increased PD risk in 15,995 individuals (8,591 PD, 7,404 controls) of European ancestry. Pathogenic repeat expansions were detected in 62 patients (56 PD and 6 atypical parkinsonism) and 5 controls across seven loci (AR, ATXN1, ATXN2, ATXN3, CACNA1A, HTT and THAP11), spanning seven ancestries. Among these, ATXN2 expansions were the most frequently observed in PD and were present in African, East Asian, European and Middle Eastern ancestries. Additionally, intermediate ATXN2 repeat expansions exhibited a strong, length-dependent association with PD risk in the European population, with individuals with [≥]32 repeats having a more than four-fold increased risk (odds ratio 4.25, 95% confidence interval 1.80-12.05). Overall, >92% of expanded alleles harbor CAA interruptions within the CAG tract. Pathogenic expansions at other loci, such as ATXN3 and THAP11, showed more ancestry-specific distributions. Clinically, individuals with pathogenic ATXN2 and ATXN3 expansions most often presented with typical PD features but frequently showed earlier disease onset and a strong family history of PD. This large-scale, multi-ancestry study comprehensively maps the genetic landscape of pathogenic and intermediate repeat expansions in PD. Our findings confirm a length- and structure-dependent risk association for ATXN2 with PD in the European population, and highlight the pleiotropic effects of repeat expansions across the parkinsonian spectrum.

04.
arXiv (quant-ph) 2026-06-15

Quantum Horizon: An evaluation of quantum computing as a threat to Bitcoin and Ethereum

arXiv:2606.14484v1 Announce Type: new Abstract: Quantum computing poses a real, broad-based, but bounded and substantially mitigable threat to Bitcoin and Ethereum. We separate the two quantum algorithms that public discussion routinely conflates: Shor's algorithm breaks the elliptic-curve signatures (ECDSA over secp256k1, BLS over BLS12-381) that authorize spending, whereas Grover's algorithm does not meaningfully threaten proof-of-work mining, which is protected by a merely quadratic speedup, fault-tolerant per-operation costs, a square-root parallelization wall, and difficulty adjustment. Folding hardware scaling, the falling resource requirement, a fault-tolerance readiness lag, and expert surveys into a single Monte-Carlo forecast yields a wide, bimodal arrival distribution for a cryptographically relevant quantum computer: about a one-in-six chance by 2035, near 30% by 2040, and about 60% by 2050. Exposure is concentrated and mostly migratable: of Bitcoin's roughly six million quantum-exposed coins only about 2.3 million are irreducibly at risk, while 50 to 65% of Ether sits at key-revealed accounts that can adopt post-quantum signatures. A timely migration beats even an optimistic 2035 machine, so the binding constraint is governance, not technology. A survey of the top twenty cryptocurrencies finds none fully post-quantum. Reproducible models accompany every quantitative claim.

05.
arXiv (CS.CV) 2026-06-19

Gaussian Process Prior Variational Autoencoder for Endoscopic Videos

Endoscopic video analysis is essential for gastrointestinal diagnosis and computer-assisted interventions, but video sequences are routinely degraded by specular reflections, motion artifacts, and missing frames. These transient corruptions can distract clinicians, reduce image interpretability, and disrupt downstream tasks such as 3D reconstruction and navigation. Effective restoration therefore requires methods that exploit temporal continuity rather than treating frames in isolation. We introduce a Gaussian Process Prior Variational Autoencoder (GPVAE) framework for endoscopic video restoration that replaces the standard factorized latent prior with a temporal Gaussian process prior, enabling interpolation of missing frames with uncertainty-aware reconstruction. The framework combines endoscopy-specific encoders, including a convolutional EndoVAE backbone and pretrained Vision Transformer encoders from GastroNet-5M, with two scalable GP approximations: Hierarchical Prior Approximation (HPA) and Sparse Precision Approximation (SPA). Specular reflections are handled using a DUCKNet-based masking pipeline that excludes corrupted pixels from the reconstruction objective. On the C3VDv2 colonoscopy dataset, the best GPVAE variants reduced image reconstruction RMSE by 21.9\% on average, and by up to 26.1\%, relative to matched VAE baselines. Downstream trajectory RMSE was reduced by 12.7\% on average across classical visual odometry and a pretrained PoseNet, at an average increase of 27.3\% in training time per epoch. Finally, the GP posterior provides per-frame uncertainty estimates that reflect temporal support and offer a confidence signal for restored frames.

06.
medRxiv (Medicine) 2026-06-22

Toward less intrusive pubertal assessment: longitudinal evaluation of tanner and non-tanner metrics in East African adolescents

Background: Accurate pubertal assessment is essential in pediatric endocrinology and adolescent health research. While Tanner staging remains the gold standard, its subjective nature and invasive genital examination limit feasibility and acceptability, especially in longitudinal studies and culturally sensitive settings. This study evaluated less intrusive pubertal assessment combinations that maintain discriminative accuracy. Methods: We conducted a longitudinal study among 200 uncircumcised, sexually naive males aged 15-17 years in Southwestern Uganda, with quarterly follow-up over three years. Clinicians assessed Tanner staging metrics (pubic hair, testicular volume, penile length, scrotal color), axillary hair, and serum testosterone. Markov transition models estimated Tanner stage progression. Ordinal logistic regression and area under the receiver operating characteristic curve (AUC) analyses quantified discriminative performance of individual and combined metrics. Results: At baseline, participants were distributed across Tanner stages II (6.0%), III (13.5%), IV (55.0%), and V (25.5%). Among individual metrics, pubic hair distribution best predicted overall Tanner stage (AUC=0.867), while penile length was least predictive (AUC=0.833). The full four-metric Tanner model achieved high discrimination (AUC=0.993). However, a less intrusive combination of pubic hair and scrotal color achieved comparable discrimination (AUC=0.942), improving to AUC=0.953 with axillary hair and age. Markov modeling demonstrated frequent bidirectional transitions between Tanner stages IV and V, reflecting variability in longitudinal staging. Conclusions: A minimally intrusive assessment combining pubic hair, scrotal color, axillary hair, and age reliably predicts pubertal stage, offering an acceptable alternative to traditional Tanner staging for research and surveillance contexts where genital manipulation is impractical or unethical.

07.
medRxiv (Medicine) 2026-06-24

Five-Year Breast Cancer Risk Prediction From Screening Breast Ultrasound Using Deep Learning

Objective: To develop and evaluate a deep learning model for five-year breast cancer risk prediction from screening breast ultrasound (BUS) examinations. Methods: This retrospective study included 295,298 breast ultrasound examinations from 122,072 women imaged between 2012 and 2020. Patients were split into training, validation, and test sets; the test set included screening examinations only. BUS-Risk-Net aggregated image features using attention-based multiple instance learning and combined them with age and ultrasound-estimated breast density to predict 2- to 5-year risk. Performance was compared with the full Tyrer-Cuzick model in a matched case-control cohort and with a reduced Tyrer-Cuzick model in the held-out test set. Risk stratification was evaluated within BI-RADS density categories. Results: In the matched case-control cohort (n = 240 women), BUS-Risk-Net achieved a 5-year AUC of 0.632 (95% CI, 0.562-0.702), versus 0.514 for the full Tyrer-Cuzick model (95% CI, 0.440-0.588; p = 0.04). Among 19,548 examinations from 9,015 women eligible for 5-year evaluation in the test set, BUS-Risk-Net achieved an AUC of 0.679 (95% CI, 0.653-0.706), versus 0.594 for the reduced Tyrer-Cuzick model (95% CI, 0.564-0.623; P < .001). Observed 5-year cancer incidence increased across AI-defined risk tiers within each BI-RADS density category, ranging from 0.0% to 5.8% after AI stratification, compared with 2.1% to 3.6% across density categories alone. Discussion: Deep learning models applied to screening breast ultrasound could enable long-term breast cancer risk prediction and stratify risk beyond breast density alone. External and prospective validation is needed before clinical use.

08.
arXiv (quant-ph) 2026-06-12

Vacuum photon emission and mean electromagnetic field in pair-creating external backgrounds

arXiv:2606.12547v1 Announce Type: cross Abstract: We develop a perturbative description of vacuum radiative processes in quantum electrodynamics with a prescribed external electromagnetic background capable of producing electron-positron pairs. Since the initial vacuum is then unstable and the in- and out-vacua are inequivalent, radiative observables require a real-time formulation beyond the ordinary in-out approach of vacuum-stable QED. Using the Keldysh-Schwinger-Fradkin nonequilibrium technique, we derive the mean number density of emitted photons through the second nonvanishing order in the fine-structure constant. The leading term, of order $\alpha$, reproduces the known vertex and tadpole mechanisms, while the complete order-$\alpha^2$ correction contains interference, loop, and induced-current contributions. We also give an independent derivation based on the spectral decomposition of the identity operator in the in-Fock space, where the photon number density is represented as a sum of squared transition amplitudes and vacuum-disconnected terms are canceled by the optical theorem generalized to an unstable vacuum. In addition, we compute the mean electromagnetic field through order $e^3$, including the electromagnetic dressing of the induced vacuum current, and verify it using the corresponding Schwinger-Dyson equations. The final formulas are expressed in terms of exact solutions and propagators of the Dirac equation in the external background and apply to general spacetime-dependent field configurations.

09.
arXiv (quant-ph) 2026-06-24

M{\o}lmer-S{\o}rensen gates in trapped-ions chains in the presence of correlated noise

arXiv:2606.23951v1 Announce Type: new Abstract: We analyze the impact of correlated laser frequency noise on M{\o}lmer-S{\o}rensen gates in qubit registers based on trapped-ion chains. Using perturbation theory, we calculate gate fidelities in the presence of noise with arbitrary power spectral density for different chain lengths and ion positions in the chain. With our approach, we account for simultaneous excitation of multiple phonon modes during gate operation. We find out that the impact of medium-frequency laser noise depends considerably on the positions of the ions in the chain. In contrast, low-frequency noise has similar effect for different chain lengths and ion positions.

10.
medRxiv (Medicine) 2026-06-18

Biomedical Capacity, Governance, and Health Security: A Dominican Republic Research Analysis of Stakeholder Perspectives

The COVID-19 pandemic exposed critical vulnerabilities in globally concentrated biomedical supply chains and accelerated interest in nearshoring and hemispheric health-security strategies. The Dominican Republic, already the third-largest medical device exporter in Latin America, occupies a strategically significant but institutionally constrained position within this realignment. This study evaluates stakeholder perceptions of the principal opportunities and barriers affecting biomedical ecosystem development in the Dominican Republic, with particular attention to governance, workforce capacity, and value-chain upgrading pathways. Methods. A concurrent mixed-methods design was employed, integrating a cross-sectional electronic survey of 142 purposively sampled domain experts (administered September-December 2025) with a qualitative executive consultation with senior government and industry leaders. Survey analyses combined descriptive statistics, one-sample t-tests against the scale neutral midpoint, chi-square goodness-of-fit tests, Friedman non-parametric ranking, Spearman rank correlations, and exploratory linear and logistic multivariable regression. Qualitative responses were analyzed using a framework approach grounded in the Triple Helix model of innovation systems. Results. Perceived government support was significantly below neutral (mean = 2.67, SD = 1.12; p = 0.034). Workforce shortages (83.3%) and weak academia-industry collaboration (71.4%) were the most frequently endorsed barriers ({chi}2(5) = 18.7, p = 0.002). Regulatory modernization (88.1%) and workforce development (85.7%) ranked as the highest-priority policy levers (Friedman p = 0.005). Clinical trials and contract research organization services were the dominant sub-sector priority (76.2%, binomial p < 0.001). In multivariable analysis, perceived government support, talent availability, and confidence in IP protection jointly explained 46% of the variance in sector competitiveness (R2 = 0.46, p < 0.001). Strong majority support existed for a formal public-private biomedical coordination authority (73.8%, p < 0.001).Conclusion. Institutional credibility and advanced human capital–rather than geography or market access–are the perceived binding constraints on the Dominican Republics biomedical trajectory. Regulatory modernization, targeted workforce investment, and the establishment of a national biomedical coordination authority represent the highest-leverage interventions for positioning the country as a hemispheric hub for biomedical manufacturing, clinical research, and health security.

11.
arXiv (CS.AI) 2026-06-15

A fully GPU-based workflow for building physics emulators of hypersonic flows

arXiv:2606.13742v1 Announce Type: cross Abstract: The ability to resolve complex physical phenomena with high fidelity and at low computational cost is central to addressing key challenges in modern engineering. A prime example lies in hypersonic flows, where the precise prediction of the full flowfield topology, in particular with respect to shock wave location and intensity, is critical. Yet supersonic and hypersonic flows continue to be a stumbling block for traditional reduced-order models and neural emulators that struggle to capture steep gradients in flow states with physical consistency in applications of industrial relevance. To that end, we introduce a fully GPU based workflow that integrates accelerated data generation with the training of neural emulators augmented by uncertainty quantification and physics-aware refinement. Our workflow is enabled by a differentiable high-fidelity solver (JAX-Fluids) which we employ for rapid dataset creation and residual-based improvement of the neural emulator to enhance physical consistency. Building on this framework, we first present a suite of model architectures and analyze their scaling behavior to expose their strengths and shortcomings. We then show that residual-based refinement enables training on cases where only mesh and input parameters are available, substantially reducing residuals and improving physical consistency. Together, differentiable simulation and residual-based refinement yield physics emulators that remain reliable beyond their training distribution, a key requirement for deploying surrogates in real-world engineering design loops.

12.
arXiv (quant-ph) 2026-06-16

QALM: Escaping Local Minima via Interleaved Exploration and Exploitation in Quantum Circuit Optimization

arXiv:2606.16221v1 Announce Type: new Abstract: Quantum circuit optimizers face a fundamental limitation in how they tolerate temporary cost increases. At one extreme, greedy rule-based optimizers immediately apply any cost-reducing transformation, achieving high efficiency but quickly becoming trapped in local minima. At the other extreme, search-based optimizers accept cost-increasing moves to explore the circuit space and escape such minima. However, because search-based optimizers cannot determine within a reasonable time budget whether a given point is promising, that is, whether its neighborhood contains a deeper local minimum, they must blindly explore higher-cost regions. As a result, escaping the current basin to reach a promising point takes exponentially many steps. In this work, we show that this limitation can be overcome with a hybrid framework that interleaves the exhaustive exploration capabilities of search algorithms with the efficiency of rule-based optimization. We implement this framework as QALM, a novel optimizer designed to escape local minima without incurring the runtime penalties of pure search. Crucially, our results demonstrate that QALM does not merely strike a balance; it outperforms existing rule-based and search-based optimizers in circuit reduction rates while operating with the computational efficiency of rule-based systems. In a comprehensive evaluation across 248 circuits, QALM matches or exceeds the fidelity of the strongest baseline on 83.9% of these circuits, given the same time budget.

13.
arXiv (quant-ph) 2026-06-25

Self-testing Quantum Supermaps

arXiv:2606.25124v1 Announce Type: new Abstract: By certifying quantum operations from measurement statistics directly, without any assumption on the internal workings of the devices involved, self-testing enables a uniquely reliable identification of quantum objects. While such device-independent characterization has been shown to be possible for states, measurements and channels, it has so far not been extended to quantum supermaps – operations that act on quantum channels themselves and can combine them in either a well-defined causal order or also, remarkably, in an indefinite causal order. Here we show that quantum supermaps can be identified device-independently. Specifically, we obtain two levels of certification, depending on the network structure of the experiment: when each slot of the supermap accepts a single uncharacterized black box, identification up to local embedding combs is obtained; when several black boxes are inserted within each slot, identification up to local extracting and injecting maps is achieved. We illustrate our approach on four examples – the identity comb, a bit-flip error-correcting comb, the comb describing Grover's algorithm, and the quantum switch – providing in particular the first self-test of both a quantum algorithmic comb and a causally indefinite quantum process. Notably, in the latter case, this provides a new way to certify causal indefiniteness in a device-independent manner.

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

Input-Dependent Fisher Information for Local Sensitivity Analysis of Medical Image Classifiers

arXiv:2606.16362v1 Announce Type: cross Abstract: Deep neural networks have achieved strong performance in medical image classification, but often work like black-box. Commonly used post-hoc interpretation methods often provide heuristic visualizations whose relationship to the classifier's predictive distribution is indirect. This work introduces a local sensitivity analysis framework based on the input-dependent Fisher Information Matrix (iFIM) of a trained classifier. The iFIM characterizes how the classifier's predictive distribution changes under infinitesimal perturbations of the input image. By using a Gram-matrix formulation, the nonzero eigenspectrum of the iFIM can be recovered without explicitly forming the full image-dimensional Fisher matrix. The leading iFIM eigenspace is then used to project an input image into a high local-sensitivity component and its orthogonal component. These components provide a model-intrinsic description of local predictive sensitivity, rather than a conventional pixel-wise attribution heatmap or a causal segmentation of task-relevant anatomy. The framework is evaluated on controlled and clinical medical image classification tasks using multiple classifier architectures. Perturbation-based experiments show that high-sensitivity iFIM components are more strongly coupled to changes in predictive confidence and classification performance than lower-sensitivity complementary components. The results support the iFIM framework as a principled tool for analyzing local decision sensitivity and for complementing existing attribution-based interpretability methods in medical imaging.

15.
arXiv (quant-ph) 2026-06-15

Tantalum as a base material for superconducting integrated circuits

arXiv:2606.13750v1 Announce Type: new Abstract: The performance of superconducting integrated circuits for quantum applications is fundamentally limited by material-related losses. Tantalum, as an emerging material for next-generation quantum circuits, has attracted considerable attention in recent years after demonstrating breakthrough performance in both superconducting microwave resonators and qubits. Concurrently, a growing body of work is devoted to the operation of tantalum-based circuits and related fabrication techniques. This interest is further stimulated by tantalum thin films polymorphism resulting in a variety of its crystalline structure, superconducting properties, coherence, etc. Furthermore, tantalum circuits exhibit distinctive features in cryogenic experiments, which have not been observed in aluminum- or niobium-based ones. In this review, we summarize the recent research of tantalum thin films growth and phase selection mechanisms on various substrates, key aspects of fabrication and performance of superconducting circuit, including a material first-principles theoretical study. In conclusion, we address a number of open issues, including the role of \b{eta}-phase impurities, the effect of hydrofluoric acid solutions on chain characteristics, and the anomalous behavior of {\alpha}-tantalum chains at cryogenic temperatures.

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

Arbitrary control over multimode wave propagation for machine learning

arXiv:2402.17750v2 Announce Type: replace-cross Abstract: Controlled multimode wave propagation can enable more space-efficient photonic processors than architectures based on discrete components connected by single-mode waveguides. Instead of defining discrete elements, one can sculpt the continuous substrate of a photonic processor to perform computations through multimode interference in two dimensions. Here we designed and demonstrated a device with a refractive index that can be rapidly reprogrammed across space, allowing arbitrary control of wave propagation. The device, a two-dimensional programmable waveguide, uses parallel electro-optic modulation of the refractive index of a slab waveguide with about $10^4$ programmable spatial degrees of freedom. We implemented neural network inference on benchmark tasks with up to $49$-dimensional vectors in a single pass, without digital pre-processing or post-processing. Theoretical and numerical analyses further indicated that two-dimensional programmable waveguides may offer not only a constant-factor reduction in device area but also a scaling benefit, with the area required growing as $N^{1.5}$ rather than $N^2$.

17.
medRxiv (Medicine) 2026-06-24

Trust as a Hidden Driver of Epidemic Dynamics: A Missing Parameter in Compartmental Disease Transmission Models

Compartmental models of infectious disease transmission make assumptions about human behaviors. Specifically, they parameterize interactions across population groups, assumed to have distinct epidemiologically-relevant behavioral patterns, primarily through contact matrices stratified by demographic variables such as age, gender, or socioeconomic status. Although such demographic characteristics are readily measurable, they may inadequately capture the social and psychological forces that govern protective behaviors. Drawing on 20 waves of a national survey conducted throughout the COVID-19 pandemic in the United States, we show that institutional trust - particularly trust in public health agencies, physicians, and hospitals - is a dominant predictor of protective behavior adoption. For mask wearing during periods of strongest pandemic activity, for example, institutional trust explains more behavioral variance across population groups than age, income, education, and partisan affiliation combined. In unadjusted analyses, the difference in protective behavior adoption between individuals with the highest and lowest trust in the CDC was four- to six-fold larger than the corresponding differences by age, income, or educational attainment, and exceeded the difference between Democratic and Republican respondents. This association was institutionally specific (e.g., the relationship attenuates for trust in banks), and behaviorally specific (e.g., trust in the CDC is associated with protective behaviors but not visiting a doctor). The latter suggests that trust modifies voluntary compliance with public health recommendations rather than access to or use of healthcare. We conclude that compartmental models of disease transmission would be substantially improved by incorporating institutional trust as a stratifying variable. We additionally offer a trust-integrated mathematical modeling framework and recommendations for the data infrastructure needed for its implementation.

18.
medRxiv (Medicine) 2026-06-22

Vaccine introductions in the WHO African Region, 2023-26: a country-level ecological analysis by Gavi eligibility and conflict-affected status

Background. The Immunization Agenda 2030 (IA2030) tracks new and underused vaccine introduction as an access metric, and its mid-term review calls for stronger country ownership, prioritisation, data use and tailored support in conflict-affected and resource-constrained settings; however, national launch status does not measure recurrent financing, implementation, safety or equity. We examined how recent vaccine-introduction activity was distributed across the WHO African Region. Methods. We conducted a descriptive country-level ecological analysis of all 47 Member States from January 2023 to June 2026. The country was the unit of analysis and contributed one cumulative, unweighted count of nationally endorsed vaccine-introduction and programme-change events. Counts were linked to Gavi eligibility, World Bank FY26 conflict-affected status, broader fragile and conflict-affected situation status in sensitivity analysis, and concurrent system-performance indicators, and modelled with Poisson regression using HC1 robust standard errors. Two Expanded Programme on Immunization (EPI) manager survey waves were summarised at country level. Reporting followed STROBE and RECORD. Results. Seventy-two events were recorded across 38 of 47 Member States: 48 new-antigen introductions, 20 dose or schedule expansions and four combination-vaccine introductions; malaria vaccines accounted for 21. Gavi-eligible conflict-affected countries averaged 2.50 events per country versus 1.27 in both comparison groups. Gavi-eligible conflict-affected status was associated with a higher count (incidence rate ratio [IRR] 1.97, 95% confidence interval [CI] 1.38-2.81; p

19.
medRxiv (Medicine) 2026-06-11

Association between depressive symptoms and physical function among participants with heart disease in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Background: Depression and heart disease frequently co-occur in the aging population and are associated with functional decline and poor health outcomes. Understanding how depressive symptoms relate to different aspects of physical function among adults with heart disease may help identify high-risk subgroups. Objective: To examine the association of depressive symptoms with self-reported and observed physical function measures among participants with heart disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and assess whether associations differ by sex and race?sex groups. Methods: We conducted a cross-sectional analysis using data from REGARDS study second in-home visit (2013?2016). Depressive symptoms were measured with the 10-item Center for Epidemiologic Studies Depression scale (CES D 10), considering scores ?10 as clinically significant. Physical function measures were instrumental activities of daily living (IADL), activities of daily living (ADL), chair stand time (5 repetitions), and gait speed. Linear regression models estimated associations of depressive symptoms with function, adjusting for sociodemographic, health behavior, antidepressant medications, body mass index, and social support. Effect modification by sex and race?sex group was evaluated. Results: Among 3,055 participants, 11.7% had CES D 10 ?10. Compared to CES-D-10 scores

20.
medRxiv (Medicine) 2026-06-22

Clinical-grade Cuffless Blood Pressure Monitoring via Deep-tissue Diffuse Speckle Pulsatile Flowmetry

Blood pressure (BP) is a vital sign which is measured to diagnose and manage hypertension. However, current methods to measure BP use inflatable cuffs which cause discomfort and limit the frequency at which measurements can be made, or intra-arterial catheters which are invasive and pose infection risks. Here, we propose and evaluate the use of Diffuse Speckle Pulsatile Flowmetry (DSPF) as a cuffless BP measurement method to address these limitations. DSPF is a laser speckle-based technique which simultaneously records blood flow rate and blood volume (i.e. photoplethysmography or PPG) signals from relatively deep vascular tissue. Using information from these signals, we studied DSPFs effectiveness in measuring systolic BP (SBP) and diastolic BP (DBP) through an outpatient study in which 133 patients were recruited, and in measuring beat-to-beat BP waveforms through an inpatient study in which two patients were recruited. In the outpatient study, the DSPF method was able to achieve mean absolute errors (MAEs) of 4.17 mmHg and 2.42 mmHg for SBP and DBP respectively compared to conventional cuff-based methods. It was also able to fulfil the requirements of the AAMI/ESH/ISO 81060-2:2018 standard for BP measurement devices and attain an "A" grade according to the British Hypertension Society grading scheme. For the inpatient study, it produced BP waveforms which had MAEs of 2.35 mmHg and 3.06 mmHg compared to arterial-line measurements for the two patients, respectively. Compared to PPG which has been studied more extensively as a cuffless BP measurement method, we found through ablation studies that DSPF was able to reach significantly lower MAEs and hence better accuracies. DSPF augments the performance of PPG-only methods by leveraging additional information from the blood flow rate signal, and we therefore find it to be a superior cuffless BP measurement method which can potentially be used in outpatient, inpatient, and remote settings.

21.
arXiv (CS.AI) 2026-06-19

Review of Machine Learning Models for Solar Energetic Particle Prediction

arXiv:2606.19539v1 Announce Type: cross Abstract: Solar energetic particle (SEP) events have attracted increasing attention due to their significant radiation hazards for aviation, spacecraft electronics, and human missions beyond Earth's magnetosphere. From a scientific perspective, SEP events are intriguing because they arise from a set of physical processes extending from the solar surface and corona through the heliosphere, offering insight into particle acceleration and transport mechanisms that are widely applicable across astrophysics. Therefore, advancing our ability to understand and predict SEP events is essential both for deepening our knowledge of such mechanisms and for safeguarding space technologies and exploration. Traditionally, researchers have modeled SEPs using physics-based simulations and empirical methods. More recently, machine learning (ML) has emerged as a new tool for understanding and predicting SEP events. The purpose of this manuscript is to review the currently available ML models for SEP prediction, identify the datasets used for training, compare their architectures, inputs, and outputs, and, based on these insights, outline good practices and recommendations for future research.

22.
arXiv (CS.LG) 2026-06-16

Not all Jensen-Shannon Divergence Estimators are Equal

arXiv:2606.16411v1 Announce Type: new Abstract: The Jensen-Shannon divergence is widely reported as a scalar measure of fidelity for synthetic tabular data. Yet, in practice, it is estimated from finite samples using protocols that are often underspecified. This creates a measurement problem. Although the population divergence is well defined, the empirical value depends on the estimator family, sampling protocol, calibration, dimensionality, and class balance. We show that different protocols can yield non-comparable values: marginal-based estimators ignore dependencies in the joint distribution and can severely underestimate divergence, while classifier-based estimators capture joint structure but exhibit strong estimator dependence. We systematically study this behavior across controlled settings with reference divergences and real-world synthetic tabular benchmarks. Our analysis reveals dependence blindness in marginal estimators, prior-shift bias under class imbalance, and estimator sensitivity in high dimensions. To address prior shift, we derive a closed-form posterior correction for classifier-based Jensen-Shannon estimation. Our results show that empirical Jensen-Shannon divergence values are inherently protocol-dependent, making explicit specification of the estimation procedure necessary for meaningful comparison. We provide practical guidelines and an open-source tool for estimator-aware Jensen-Shannon evaluation.

23.
arXiv (CS.CV) 2026-06-15

Pix2Pix-Hybrid: Structure-Guided Conditional Synthesis of Hajj Crowd Images with Multi-Channel Conditioning and Weak Attribute Supervision

Developing accurate crowd-counting models for Hajj pilgrimage scenes remains challenging because domain-specific annotated images are scarce and data collection during large gatherings raises privacy concerns. To address these limitations, this paper proposes Pix2Pix-Hybrid (P2P-H), a hybrid conditional GAN for structure-guided Hajj crowd-image synthesis and data augmentation. P2P-H builds on Pix2Pix and employs a U-Net generator conditioned on eight input channels that jointly encode structural cues (edges and grayscale) and contextual attributes (crowd density and time of day). To capture detailed textures in dense scenes, the framework integrates two multi-scale PatchGAN discriminators operating at different resolutions. The training procedure combines adversarial, perceptual, and feature-matching objectives with adaptive data augmentation and stabilization strategies. The model was trained on 993 real Hajj frames collected from 60 publicly available video sources, with conditioning attributes derived automatically to reduce manual labeling effort. Using this framework, we constructed CrowdH, a synthetic dataset of 10,000 high-resolution Hajj crowd images. Experimental results show that P2P-H improves structure-preserving conditional synthesis quality compared with Pix2Pix and StyleGAN2-ADA baselines and shows favorable transfer to other crowd datasets. To assess downstream utility, we further constructed CrowdH-Mix-469, an annotated mixed real-synthetic dataset comprising 384 real Hajj images and 85 selected synthetic images,and evaluated five crowd-counting models under real-only and real-plus-synthetic training. The selected synthetic data reduced MAE across all five models, with the strongest gain observed for CSRNet.

24.
medRxiv (Medicine) 2026-06-11

Malaria Risk among Internally Mobile Individuals and Heterogeneous Mobility Patterns in Two Hypoendemic Communities: Implications for Malaria Elimination in the Peruvian Amazon.

Background: Human mobility is increasingly recognized as a key factor influencing malaria transmission dynamics, particularly in low-transmission settings approaching elimination. This study aimed to assess mobility patterns and their association with malaria risk in two hypoendemic communities in the Peruvian Amazon. Method: A longitudinal study was conducted in the communities of Libertad and Urcomirano (Mazan River basin). Monthly population screenings were combined with weekly active and passive case detection. A total of 678 individuals were enrolled. Mobility patterns were assessed through structured questionnaires, and social network analysis was used to characterize travel connections. Log-binomial regression analysis was applied to identify risk factors associated with malaria infection. Result: Internally, mobile individuals in Libertad showed a higher malaria incidence (>32.47 cases per 1,000 person-months) than those in Urcomirano (

25.
medRxiv (Medicine) 2026-06-10

Exploratory Assessment of Pulsed-Wave Doppler Representations of Lung Sounds Using Deep Learning: An In-Vitro Phantom Study

The increasing availability of portable ultrasound systems motivates exploration of novel approaches to respiratory signal assessment. In this in-vitro study, we investigate whether pulsed-wave (PW) Doppler ultrasound can capture structured spectral patterns from replayed lung sound recordings. Digitized respiratory sounds were replayed through a tissue-mimicking ultrasound phantom, generating 1,478 PW Doppler spectral images from recordings associated with healthy subjects and several externally labeled disease categories. Exploratory classification experiments using a ResNet-18 architecture demonstrated that these Doppler representations contain learnable differences under controlled conditions. These findings motivate further investigation into PW Doppler as a potential representation of respiratory acoustics.