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

Risk-Aware LLM Agents for Geospatial Data Retrieval: Design and Preliminary Adversarial Evaluation

We present an LLM-driven framework for retrieving remote sensing data from cloud-based geospatial catalogues using natural language queries. The system converts user intent into structured API calls, enabling efficient access to satellite imagery and environmental datasets. The architecture integrates three agents: Guardrail for safety and policy enforcement, General-QA for intent interpretation, and Recommender-Analyst for schema-aware API call generation. This coordinated design ensures reliable, semantically aligned interaction with external data services. The modular framework is portable across platforms through API schema substitution and supports applications in environmental monitoring, disaster response, and climate analysis. It establishes a scalable interface between user intent and geospatial infrastructure, enabling streamlined and automated Earth observation workflows. Preliminary experiments under adversarial multi-turn settings show that prompt-level safety instructions improve robustness, although rare high-impact failures persist in API manipulation scenarios and highlight the need for adaptive, system-level defenses that balance safety, usability, and cost efficiency, which motivates the use of our intercept-level Guardrail agent.

02.
medRxiv (Medicine) 2026-06-17

LLM-Driven Extraction of NI-RADS and Imaging Tumor Characteristics to Enhance Oropharyngeal Cancer Survivorship Surveillance

Abstract Purpose Radiologic surveillance is essential for oropharyngeal cancer (OPC) survivors, guiding recurrence detection and follow-up strategies. The Neck Imaging Reporting and Data System provides a standardized framework for post-treatment risk reporting at both the primary tumor site (pNI-RADs) and cervical lymph nodes (nNI-RADS). Comprehensive surveillance additionally requires assessment of disease status, including the primary tumor, nodal involvement, and distant metastases. These clinical results are often embedded as unstructured data within free-text radiology reports. We hypothesized that a large language model (LLM) can reliably extract NI-RADS score criteria and summarize key imaging features from unstructured radiology text, achieving high concordance with expert review. Methods Previously untreated OPC patients who received definitive cancer therapy were identified. Eligible imaging reports included post-treatment head and neck CT, MRI, or FDG PET/CT scans containing narrative and impression text. Examinations lacking narrative or impression text, containing pre-existing NI-RADS annotations, or involving non-surveillance imaging modalities were excluded. A total of 200 reports were randomly selected from 7,076 eligible examinations for manual abstraction using a three-reviewer consensus framework to establish a reference dataset. Using the Palantir Foundry Pipeline Builder, a GPT-5-based LLM was deployed to extract pNI-RADS and nNI-RADS scores, and key imaging features of disease status from these reports. Performance was evaluated using exact agreement and F1-based metrics. Results Agreement for no evidence of disease (score of 1) was 93.3% (126/135; F1 = 0.94) and 90.3% (130/144; F1 = 0.93) for pNI-RADS and nNI-RADS, respectively. For NI-RADS [≥]2, exact category agreement was 73.1% (38/52; macro-F1 = 0.75) for pNI-RADS and 64.3% (27/42; macro-F1 = 0.56) for nNI-RADS. Quadratic weighted {kappa} was 0.81 and 0.59, respectively. For post-treatment disease surveillance variables, agreement was 94.9% (149/157; F1 = 0.87) for primary tumor presence, 89.1% (164/184; F1 = 0.87) for nodal disease presence, and 94.7% (126/133; F1 = 0.70) for distant metastasis detection. Specificity was high across disease-status variables (0.95-0.99), with negative predictive values of 0.95 for primary tumor, 0.87 for nodal disease, and 0.99 for distant metastasis. Conclusions Our LLM-based information retrieval and classification approach for radiographic treatment response from unstructured, multidimensional imaging reports achieved high performance for disease exclusion and moderate performance for detecting suspected residual and/or new disease. This pipeline supports scalable and standardized surveillance data capture for longitudinal monitoring, clinical analytics, and survivorship research in head and neck oncology.

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

From Argument Components to Graphs: A Multi-Agent Debate with Confidence Gating for Argument Relations

Large Language Models (LLMs) are increasingly assessed and utilized in the field of Argument Mining (AM), thanks to their strong general reasoning capabilities. However, standard training-free models often miss sophisticated details, specifically in contexts where two parts of the text have to be analyzed together. Furthermore, self-correction mechanisms tend to reinforce initial hallucinations in reasoning. Overcoming these limitations typically requires expensive, domain-specific supervised fine-tuning. Recent work has shown that a multi-agent paradigm can address such weaknesses for the component classification task through dialectical refinement with a Proponent-Opponent-Judge architecture, setting a promising direction for training-free approaches in the field. In this paper, we extend and evaluate this framework on the Argument Relation Identification and Classification (ARIC) task, reformulating it as a debate over component pairs. Besides that, we introduce a confidence gating mechanism that enables debating only on the uncertain cases and accepting the initial prediction when confidence is high. On the UKP Argument Annotated Essays v2 corpus, we demonstrate that the selective debate achieves the highest Macro F1 among all training-free methods, while debate over all samples degrades performance below that of one of the baselines. All generative approaches also outperform fine-tuned RoBERTa models on Macro F1, suggesting that the under-representation of the Attack class was more damaging to supervised fine-tuning than to inference-only models. Additionally, our framework produces human-readable debate transcripts, offering interpretability absent from both single-agent and supervised classifiers.

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

ADORE: Iterative Query Expansion with Retrieval-Grounded Relevance Feedback

LLM-based query expansion improves retrieval by enriching the original query with additional context. Yet most methods remain generation-driven, producing plausible pseudo-documents or expansions without checking how the target corpus responds. This can introduce retrieval drift, amplify misleading vocabulary, or miss terms that distinguish relevant from non-relevant documents. We argue that effective expansion requires retrieval-grounded feedback, not just single-pass generation or unverified iteration. We introduce ADORE (ADapt, Observe, Relevance Evaluate), an iterative framework that turns retrieval outcomes into feedback for the next expansion. At each round, an LLM generates pseudo-passages, a retriever exposes the corpus response, and a relevance assessor evaluates retrieved documents against the original query. These judgments identify what to reinforce, what remains undercovered, and what to suppress. Across TREC Deep Learning, BEIR, and BRIGHT, ADORE consistently outperforms strong query expansion baselines with notable improvements across nearly all evaluation settings, improving average nDCG@10 by 24.5% over BM25 and 3.6% over the strongest prior query expansion method on BEIR, and by 122.9% over BM25 and 9.2% over the best query expansion baseline on BRIGHT. Our code and data are publicly available.

05.
medRxiv (Medicine) 2026-06-11

Maternal deaths associated factors in the Conflict-Affected North West Region of Cameroon. Lessons from a cross-sectional survey

Background Maternal mortality is a significant global public health crisis, particularly in sub-Saharan Africa and conflict-affected regions. Cameroon's maternal mortality ratio is high at 406 deaths per 100,000 live births, while the ongoing Anglophone conflict has further exacerbated maternal healthcare delivery in the North West Region (NWR){middle dot} Despite the evidence-based interventions like partographs, obstetric kits, birth preparedness plans, and active management of the third stage of labour, implementation gaps persist across health facilities. Objective The study aimed to assess factors related to preventable maternal deaths in the NWR of Cameroon by exploring maternal health service usage, implementation of obstetric measures, demand-side challenges, accessibility barriers, and health system weaknesses. Methodology The study employed a quantitative descriptive cross-sectional survey design{middle dot} Data was collected with structured questionnaires from postpartum women and healthcare workers in selected health facilities and catchment communities in the NWR{middle dot} Also, a multistage sampling technique was adopted, and Cochran's formula generated a sample size of 109 respondents{middle dot} In addition, data were analysed using SPSS version 27 and Stata version 18, employing descriptive and inferential statistics. Results In this study, while 70{middle dot}64 percent of females attended at least 4 ANC visits, only 38{middle dot}53 percent met WHO ANC adequacy requirements. Facility delivery was 96{middle dot}33 percent, yet only 38{middle dot}46 percent received completed delivery plans. Conflict-related challenges affected access, with 44{middle dot}95 percent reporting insecurity-associated movement difficulties, while 44{middle dot}95 percent reported increased transportation expenses due to the conflict. Near-miss complications were reported among 27.52 percent of participants. Delivery record reviews indicated that obstetric kits were utilised in 81{middle dot}76 percent of deliveries, partographs were accessible in 86{middle dot}49 percent of records but correctly filled in just 60{middle dot}81 percent , while oxytocin administration was 95{middle dot}95 percent. Integrated Health Centres showed poorer adherence with intrapartum interventions compared with District and Regional Hospitals (p

06.
medRxiv (Medicine) 2026-06-11

Long-term Penetrance of Disease Variants in Genes Prioritized for Genomic Newborn Screening: Evidence from Adult Biobanks

Importance: Genomic newborn screening (gNBS) is a potential public health intervention, but its positive predictive value (PPV) remains uncertain. Estimating the prevalence and penetrance of pathogenic and likely pathogenic (P/LP) variants in genes prioritized for screening may clarify the long-term PPV and clinical utility of gNBS. Objective: To compare ICD-based ascertainment, electronic medical record (EMR) review, and clinical assessment of genetic disorders in adults with P/LP variants in 54 genes prioritized for gNBS. Design: Two-cohort observational study with EMR review and clinical assessment in the hospital-based cohort. Setting: The U.K. Biobank (UKB) and Mass General Brigham Biobank (MGBB). Participants: 451,877 adults from the UKB and 53,371 from the MGBB, all with exome sequencing data. Exposures: P/LP variants in 54 genes prioritized through expert consensus for gNBS, in genotypes consistent with each gene's inheritance pattern. Main outcomes and measures: The primary outcome was the absolute difference in the proportion of MGBB participants identified as affected by ICD versus EMR ascertainment. Secondary outcomes included findings from clinical assessments of undiagnosed MGBB participants, corrected UKB penetrance estimates, and extrapolation to U.S.. annual birth cohorts and living adults. Results: P/LP variants were identified in 665 UKB participants (0.15%) and 82 MGBB participants (0.15%), approximately 1 in 650. In MGBB, EMR review revealed that 58/82 individuals (70.7%) were undiagnosed, although 25 of 58 (43.1%) had documented symptoms. Disease-associated ICD codes were found in 39.0% (32/82) of participants, whereas EMR review identified symptoms in 59.8% (49/82, McNemar P

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

Advances in Scientific Machine Learning for Coupled Fluid Flow and Transport

arXiv:2606.19562v1 Announce Type: new Abstract: This chapter reviews recent advances in Scientific Machine Learning (SciML) for modeling coupled fluid flow and transport phenomena governed by the incompressible Navier-Stokes and scalar transport equations. Such systems, found in applications like turbidity currents and thermal convection, feature strong nonlinear coupling and multiscale behavior that make high-fidelity simulations computationally expensive. To address this, the chapter surveys state-of-the-art SciML methods for building efficient surrogate models, including linear reduced-order techniques based on Singular Value Decomposition (such as Dynamic Mode Decomposition) and nonlinear neural network approaches like Physics-Informed Neural Networks (PINNs) and $\beta$-Variational Autoencoders ($\beta$-VAEs). It first covers the authors' work combining these models with High Performance Computing strategies, including Adaptive Mesh Refinement/Coarsening (AMR/C) and scientific floating-point data compression. It then presents two new contributions: surrogate modeling of turbidity currents via PINNs, and the extraction of disentangled nonlinear modes from thermal flows using $\beta$-VAEs. Governing equations and representative benchmarks, including lock-exchange flows and Rayleigh-Bénard convection, illustrate these methodologies. The chapter is intentionally long, covering both the mathematical and physical foundations of coupled fluid flow and the computational aspects of state-of-the-art modeling. Overall, it demonstrates how SciML enables fast, accurate approximations of complex coupled systems within the specific data regimes and modeling assumptions considered, while substantially reducing computational cost relative to full-order simulations. Broader capabilities such as real-time prediction and uncertainty quantification remain active research directions whose feasibility depends strongly on the problem at hand.

08.
Nature (Science) 2026-06-10

Building user-driven climate adaptation products

Climate adaptation products have traditionally been developed using a supply-driven model reliant on available climate information, leading to usability gaps1–4. To better meet user needs, the climate services field has recognized a need to shift towards a demand-driven model emphasizing co-production, that is, user-driven, scientifically informed products created through shared knowledge practices1–5. However, co-production can be challenging, especially for researchers unfamiliar with the approach or for digital and software-based products with complex user needs2,5–8. User-centred design, from the human–computer interaction field, offers a process that could complement co-production approaches to product development, yet its potential remains underexplored2. Here we show how user-centred design can be integrated into, and strengthen, co-production approaches for building user-driven climate adaptation products. Through a systematic review of the co-production and user-centred design literature, we identify key processes, mechanisms and best practices for both approaches. Our findings offer practical guidance for researchers and propose an integrated approach for developing climate adaptation products that are useful, usable and used. A systematic review and analysis shows how user-centred design can be integrated into, and strengthen, co-production approaches for building user-driven climate adaptation products.

09.
medRxiv (Medicine) 2026-06-11

Long-term exposure to PM2.5 components and lipid profiles in WTC Health Program general responders

Fine particulate matter (PM2.5) was found to be associated with elevated blood lipids, but fewer studies have examined the associations with specific constituents of PM2.5. We studied the associations between exposure to annual PM2.5 and its 14 constituents, and repeated blood lipid measurements among general responders enrolled in the World Trade Center Health Program between 2003 and 2019 (n = 44,876). We used generalized additive mixed effect models to investigate the single-pollutant associations with repeated measures of blood total cholesterol (TC), high and low-density lipoprotein (HDL-C and LDL-C) levels. We then used linear generalized weighted quantile sum regression with a random intercept for participant ID to account for the clustering of repeated measures and evaluate the combined associations with the component mixture. A decile increase in the mixture of 14 PM2.5 chemical components was associated with 0.375 mg/dL increase in TC levels (95% confidence Interval (CI): 0.174-0.577) and 0.302 mg/dL increase in LDL-C (95% CI: 0.063, 0.540). Lead, organic carbon, and iron were major drivers of both associations. Component-specific models also show higher TC and LDL levels associated with interquartile range increases in organic carbon (0.472, 95% CI [0.027, 0.918] and 0.648 95% CI [0.136, 1.160]) and iron exposure (1.081, 95% CI [0.630, 1.532] and 0.748, 95% CI [0.318, 1.178]). In conclusion, we found PM2.5 exposure to be associated with elevated lipid levels. The associations differed by PM2.5 composition, highlighting organic carbon, lead, and iron and major drivers. These findings are highly significant for a population exposed to extreme air pollution event and susceptible to lipid alterations that might trigger cardiovascular events.

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

CAF-Gen: A Multi-Agent System for Enriching Argumentation Structures

Formalizing complex reasoning from natural text is one of the central challenges in computational linguistics. It requires systems to understand not just keywords but also the context and complex reasoning embedded in a text. Current Argument Mining (AM) techniques identify basic claims and premises, yet they often struggle to capture the richer structural information required by advanced schemas such as the Carneades Argumentation Framework (CAF), which incorporates features such as premise types, proof standards, and argument schemes. We address this limitation by introducing CAF-Gen, an automated multi-agent framework designed to enrich shallow argument structures into CAF-compliant argument models. By employing an iterative Creator-Reviewer pipeline, a creator agent's output is validated by a critical agent to ensure structural integrity. This multi-agent collaboration is crucial for mitigating the structural instability typical of single-pass generative models. Our experiments demonstrate that the iterative feedback loop improves the quality of the resulting data and achieves strong alignment with the original annotations, while producing structurally richer models. Our findings show that the multi-agent system can overcome the limitations of single-pass generation, providing a robust methodology for the automated modeling of formal argumentation.

11.
arXiv (CS.LG) 2026-06-17

Towards Fast GNN Surrogates for CO2 Migration in Complex Geological Formations

arXiv:2606.17180v1 Announce Type: new Abstract: This chapter discusses how a data-driven machine learning approach can reproduce key aspects of the physical behavior of multiphase flows in complex geological formations. We propose an end-to-end graph neural surrogate tailored to CO$_2$ plume migration forecasting in geological storage. The method is evaluated on the SPE11A benchmark, a well-known industry test case designed to assess CO$_2$ storage scenarios and characterized by sharp gas-water interfaces, strong advective transport, and rapid convective mixing with fingering development. The benchmark is reformulated as a graph in which nodes represent computational cells and edges encode transmissibility-based interactions enriched with geometric attributes. Directional transport arising from grid geometry, permeability contrasts, and geological heterogeneity is captured through an anisotropic message-passing mechanism, where interaction weights are computed via geometry-conditioned edge embeddings, biasing message aggregation toward physically relevant transport directions. Temporal evolution is modeled in latent space using an autoregressive residual formulation trained with multi-step supervision. The proposed model produces competitive forecasts of gas saturation and liquid-phase density, which are key indicators for CO$_2$ storage monitoring, with cumulative errors that remain moderate over extended forecasting horizons.

12.
medRxiv (Medicine) 2026-06-11

Two modes of aversive control in suicidality: joint computational modelling exposes regime-specific clinical signatures invisible to symptom-based stratification

Suicidal thoughts and behaviours (STBs) are heterogeneous in their proximal dynamics, planning, and stress-sensitivity, yet most subtyping efforts remain symptom-driven and rarely validated across independent datasets. Computational mixture modelling offers a principled alternative: by fitting explicit models of learning and action selection and partitioning individuals by their latent parameter profiles, it can identify mechanistically distinct control strategies invisible to cross-sectional symptom measurement. We applied this approach to aversive Go/NoGo performance, jointly clustering two independently collected STB-enriched samples (N = 50 and N = 184) using tasks with the same structure but different duration, reversal timing, and clinical instrumentation. Two recurrent behavioural regimes emerged: a fast/adaptive regime characterised by rapid policy updating and elevated feedback reactivity, and a slow/perseverative regime characterised by slow updating, high choice determinism, and a pronounced cost following contingency reversal. These regimes were stable across initialisations, recovered more parsimoniously in joint than independent solutions, and were largely orthogonal to symptom-based stratification. Critically, stratification by regime exposed clinical-computational coupling structures substantially attenuated in pooled analyses. Pooled, population-level associations were modest and anchored by a broad affective burden axis. Within the slow/perseverative regime, coupling reorganised around learning dynamics and internalizing burden (depression, hopelessness, and active suicidal ideation) with markedly larger effect sizes. Within the fast/adaptive regime, a dissociation between anxious-compulsive and antisocial-disinhibitory profiles emerged along the same computational axis, invisible at the population level. These findings support a view of suicidality heterogeneity in which clinically similar individuals differ in the control strategies they recruit under aversive uncertainty - variation that symptom measurement alone cannot capture.

13.
arXiv (CS.AI) 2026-06-17

Sustainable Metal-Organic Framework Water Harvesters in the Artificial Intelligence Era

arXiv:2605.29179v2 Announce Type: replace-cross Abstract: Metal-organic frameworks (MOFs) are excellent candidates for water harvesting due to their tunable pore environments, which can be precisely engineered to capture and release water in arid conditions. Integrating artificial intelligence (AI) into MOF discovery can further accelerate the design of high-performance sorbents by identifying structural features that enhance atmospheric water harvesting (AWH), stability, and cycling efficiency. In this Perspective, we examine key MOF design principles, including cooperative adsorption, operational relative humidity (RH), uptake capacity, hysteresis, and scalability. We highlight recent design advancements such as multivariate strategies and long-arm linker extension, and examine how these principles tune pore capacity and hydrophilicity, while preserving stability and crystallinity. Furthermore, we discuss how AI, large language models (LLMs), and data mining can accelerate the discovery process through predictive synthesis, inverse design, and elucidating synthesis-structure-property relationships for the next generation of MOF water harvesters.

14.
arXiv (quant-ph) 2026-06-12

Simple analytical flux-tuned iSWAP pulses for leakage suppression

arXiv:2606.13052v1 Announce Type: new Abstract: Fast, high-fidelity two-qubit gates are a key requirement for fault-tolerant quantum computation. Tunable coupler architectures provide a flexible approach for implementing entangling gates through flux control with large on-off ratios, but fast flux modulation can induce diabatic transitions and population leakage to non-computational states, limiting gate performance. Here we present an analytical flux control method enabling derivative removal by adiabatic gate ($\Phi$-DRAG) for suppressing leakage in flux tunable two-qubit gates. We show that $\Phi$-DRAG differs fundamentally from conventional microwave implementations and derive modified flux modulation protocols that suppress leakage below $10^{-4}$ for fast entangling gates. The method remains effective across a range of asymmetry between qubit anharmonicities and different circuit parameters, enabling high-fidelity two-qubit gates within the fifteen nanosecond range.

15.
medRxiv (Medicine) 2026-06-16

Sleep regularity outweighs sleep duration as a predictor of disease

Sleep regularity, the consistency of sleep-wake timing from one day to the next, is more strongly associated with longevity than adequate sleep duration. Whether this relationship persists across common diseases is unknown. We compared sleep regularity vs. sleep duration as risk factors for 199 diseases and disorders, using ten million hours of objective sleep-wake data (N=60,998, age[mean{+/-}SD]=62.8{+/-}7.8, 55% female). Multivariable-adjusted risks of incident diseases/disorders for regular/irregular and short/adequate sleepers were compared across 9.5 years of follow-up. Irregular sleep predicted risks for 131 diseases/disorders, more than double the number predicted by short sleep duration (63). Irregular sleep was a superior predictor than short sleep duration for 90 diseases/disorders, including circulatory, metabolic, digestive, renal, infectious, neurological, and musculoskeletal conditions, and mental disorders, whereas short sleep duration was the superior predictor for only 9 diseases/disorders. For models where short sleep duration explained disease risks, 83% were improved by adding sleep regularity. Sleep regularity was a stronger predictor of diseases/disorders than sleep duration in this cohort and should be considered an essential dimension of sleep health.

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

Securing Multi-Agent GIS Systems: Risk Evaluation and Prompt Hardening Optimization

Agentic systems are increasingly integrated with geographic information systems (GIS), where multi-agent coordination enables complex conversational and spatial analysis but introduces security risks. This work presents a security-oriented framework for risk identification, evaluation, and mitigation in a multi-agent GIS system while maintaining adaptability to broader agentic architectures. We test the agentic system of a commercial geospatial partner while developing a modular state-machine-based orchestration framework that abstracts agent behavior into reusable components. We evaluate robustness using a red-teaming framework with an adaptive attacker LLM and a deterministic judge that produces binary outcomes with supporting rationales across multi-turn attacks. We further improve resilience with a prompt optimization framework that treats prompts as structured signatures and injects adversarial demonstrations, enabling systematic security improvements without degrading task performance.

17.
medRxiv (Medicine) 2026-06-18

Cost-effectiveness of a virtual fracture clinic versus traditional in-person fracture clinic care for adults with acute simple fractures: a protocol for a health economic evaluation within the RECITAL trial

ABSTRACT Introduction Traditional in-person fracture clinics are often overcrowded and inconvenient for patients. Virtual fracture clinics aim to address some of these concerns by improving the efficiency of the orthopaedic service and reducing unnecessary interventions while maintaining safety and quality of care. The RECITAL trial is a non-inferiority randomised controlled trial comparing follow-up care provided at a virtual fracture clinic for people with acute simple fractures to follow-up care provided at an in-person fracture clinic. This study describes the protocol for an economic evaluation of RECITAL where the primary aim is to investigate the cost-effectiveness of a virtual fracture clinic compared with traditional in-person fracture clinic care from a health system perspective. Methods and analysis The RECITAL trial recruited 312 participants with acute simple fractures and randomised them to receive follow-up care provided at a virtual fracture clinic or follow-up care provided at an in-person fracture clinic. We will conduct a within-trial analysis from a health system perspective (primary analysis), as well as a health service, patient and societal perspective. The economic evaluation will estimate the difference in the cost of resource inputs on an intention to treat basis used by participants in the two arms of the trial, allowing comparisons to be made between the in-person and virtual fracture clinics. Data for intervention costs and healthcare utilisation will be collected from trial records, hospital electronic medical records and district performance units. The results of the economic evaluation will be expressed in terms of incremental cost per utility weight gained at 12 weeks and will be plotted on a cost-effectiveness plane. Bootstrapping by resampling will be used to estimate 95% confidence intervals around costs and outcomes, and to calculate the confidence intervals around the incremental cost-effectiveness ratio. A cost-effectiveness acceptability curve (CEAC) will be plotted, which will provide information about the probability that an intervention is cost-effective, given the level of a decision makers willingness to pay for each additional outcome. Ethics and Dissemination The trail was approved by the SLHD Ethics Review Committee (RPAH Zone) (X23-0200 and 2023/ETH01038). The findings will be disseminated through a peer-reviewed journal and conference presentations. Trial registration number The trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ANZCTR; 12623000934640)

18.
arXiv (quant-ph) 2026-06-17

Superconductor-"Metal" Transition of One-dimensional Interacting Bosons with Ohmic Quantum Dissipation

arXiv:2605.30746v2 Announce Type: replace-cross Abstract: The phase diagram of a system of interacting bosons (Cooper pairs) hoping on a one-dimensional (1D) lattice with onsite phase dissipation describing the Josephson tunneling to a nearby diffusive normal-metal electrode is studied. Starting from the system at commensurate lattice filling, it is shown by a combination of analytical techniques that the phase diagram contains two quantum phases: A dissipative Bose-Einstein condensate (D-BEC) or superconductor with long-range phase coherence, and a dissipative Mott insulator (D-Mott) or "metal" with exponentially decaying phase correlations in space and local imaginary-time correlations decaying as the local pairing correlations of the electrode. The D-Mott/metal phase can be described as a 1D array of dissipative boson puddles, weakly coupled by Josephson tunneling. The puddle size roughly corresponds to the length scale beyond which phase slips suppress phase coherence. The dissipative time-dependent Ginsburg-Landau theory phenomenologically used by Sachdev, Werner, and Troyer [Phys. Rev. Lett. {\bf 92} 237003 (2004)] for the superconductor-metal transition in quasi-1D wires is derived from this microscopic puddle picture. Thus, the criticality of the D-Mott/D-BEC transition is shown to belong to the Wilson-Fisher universality class with dynamical exponent $z\approx 2$. At small doping, the D-Mott/metal phase remains stable due to its finite compressibility, which is computed to leading order in a perturbation expansion of the dissipation strength and the inter-puddle Josephson coupling. At larger doping, using a mapping to a pseudospin chain combined with bosonization, the D-BEC/superconductor phase is the ground state for non-vanishing but arbitrarily small dissipation. Similarities and differences with deconfinement transition of an array 1D bosonic Mott insulators in anisotropic optical lattices are also discussed.

19.
medRxiv (Medicine) 2026-06-16

The Target48 Neurodegeneration Panel: A Novel Tool for Profiling Protein Signatures in Neurodegenerative Disorders

Introduction: Novel tools for absolute quantification of established and emerging fluid neuro-biomarkers are required to advance diagnostic studies and improve biological insights. Methods: We conducted an extensive analytical and clinical validation of the Olink Target 48 Neurodegeneration panel (T48 Neuropanel) in 352 paired CSF and plasma samples from cognitively unimpaired controls (CU), Alzheimer dementia (AD), frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB), n=44 per group. Comparisons with benchmark assays were performed. Results: Good detectability (CSF: 31 out of 42 assays; plasma: 38 out of 42 assays) and technical performance was observed. Benchmark assays showed good correlations, supporting method transformation formulas. Next to emerging biomarkers (MMP10, ITGB2), discriminative performance was excellent in AD: CSF pTau217: AUC=1; FTD: plasma NfL: AUC=0.952; and DLB: CSF DDC: AUC=0.901. Discussion: This analytical and clinical validation of the T48 Neuropanel highlights initial cut-offs and emerging biomarkers to aid clinical studies for the diagnosis, prognosis, and monitoring of neurodegenerative diseases. Highlights: The T48 Neuropanel shows robust analytical performance, with high detectability across both plasma and CSF matrices. The T48 Neuropanel validates established (i.e., pTau217, Abeta42, NfL, and GFAP) and emerging biomarkers (i.e., DDC, MMP10, ITGB2, ITGAM, NPTX2, NPTXR, SMOC1, sTREM1, and sTREM2) in CSF and plasma. CSF NfL, GFAP, ITGB2, and ITGAM and plasma GFAP were dysregulated across AD, FTD, and DLB dementias. -The multiplex design of the T48 Neuropanel enables rich biological interpretation by simultaneously quantifying established and emerging neurodegeneration biomarkers. Importantly, the inclusion of absolute quantification facilitates the establishment of cut-offs, supporting its potential for clinical translation.

20.
arXiv (CS.LG) 2026-06-19

On the Redundancy of Timestep Embeddings in Diffusion Models

arXiv:2606.20416v1 Announce Type: new Abstract: Diffusion models rely heavily on explicit timestep embeddings to modulate the denoising process across various noise scales. In this work, we challenge the necessity of these temporal signals by analyzing their impact on U-Net and Diffusion Transformer architectures. Beyond empirical evidence, we provide a theoretical framework demonstrating that, under certain conditions, the global minimizer of the diffusion training objective can be achieved without explicit timestep conditioning. Our findings reveal a surprising robustness when timestep embeddings are completely removed. Extensive ablation studies on the CelebA and CIFAR-10 datasets show that these time-agnostic models can maintain high structural fidelity and even surpass their conditioned counterparts in competitive metrics, including FID, precision, and recall. Our analysis suggests these architectures can implicitly infer noise scales from the corrupted input under specific assumptions, rendering explicit temporal conditioning redundant. This study challenges long-standing temporal conditioning paradigms and paves the way for more efficient and structurally focused generative architectures.

21.
medRxiv (Medicine) 2026-06-17

A multistate model of frailty progression after severe infections in adults >=65 years in England: a matched-cohort study

Background Evidence on frailty progression following severe infections is limited. We compared rates of transition to greater frailty or death between adults with and without severe infection in England. Methods We conducted a matched-cohort study among adults aged [≥]65 years (1,452,117: median age 76 years, 45% male) in Clinical Practice Research Datalink Aurum (2006-2019). Adults with severe infection (hospitalised primarily due to infection) were matched on calendar time to individuals without severe infection on age, sex, and primary care practice. The admission date was used as index date and same was assigned to matched unexposed adults. We measured frailty using Electronic Frailty Index, a proportion of 36 health deficits in validated categories (Fit 0-0.12, Mild >0.12-0.24, Moderate >0.24-0.36, Severe >0.36). In a time-varying Markov multistate model, we focused on forward transitions from baseline or intermediate frailty states to higher states or death. For each transition, we used Cox regression to estimate cause-specific transition hazard ratios (HR) with 95% confidence intervals (CIs), comparing adults with and without severe infection. We adjusted for baseline frailty score, age, sex, deprivation, harmful alcohol use, smoking, and primary care infection history 5 years before index date. We estimated state occupancy probabilities, and expected length of stay (ELOS) in each state at year five among adults with and without severe infection. We explored effect modification by infection type. Results Across all transitions, severe infection was associated with higher adjusted hazards of transitioning to worsening frailty or death, HR, 95% CI: (fit to: mild[1.56, 1.54-1.58], moderate[2.51, 1.79-3.51], death[4.57, 4.50-4.65]; mild to: moderate[1.52, 1.50-1.53], severe[1.90, 1.43-2.52], death[2.67, 2.64-2.70]; moderate to: severe[1.40, 1.38-1.42], death[1.87, 1.85-1.90]; severe to death[1.48, 1.46-1.50]). Transition hazard ratios were strongest for lower respiratory tract infections, followed by sepsis, urinary tract infections, meningitis/encephalitis, gastroenteritis, and skin and soft tissue infections. At five years, adults with severe infection had higher probabilities of transitioning to greater frailty or death across all transitions and lower ELOS in each frailty state than those without severe infection. Interpretation Severe infections may accelerate frailty deterioration in older age. Prevention through vaccination, early detection, and prompt management may help mitigate this decline.

22.
medRxiv (Medicine) 2026-06-17

Trends in Suicide Mortality by Method among US Individuals aged 10-24 Years from 1999 to 2024

Background: Suicide is the second leading cause of death in US adolescents aged 10-24. Method use strongly influences lethality and design of prevention strategies, but recent trends remain unclear. We therefore aimed to investigate trends in suicide mortality rates by method, age group, and sex. Methods: This cross-sectional study used suicide mortality data from the National Center for Health Statistics for a quarter-century period, between 1999 and 2024. All individuals aged 10-24 years at the time of death, with suicide as the underlying cause, were included. We estimated suicide mortality rates (i.e., the number of suicide deaths per 100,000 people) and annual percent change by method (firearm, asphyxiation, poisoning, other), age group (10-14, 15-19, 20-24), and sex. Changing trend time points were determined using Joinpoint regression models Results: From 1999 to 2024, 159,241 suicide deaths occurred among individuals aged 10-24. While suicide rates declined across all age groups between 2017 and 2024, the male-to-female gap narrowed by 18.9%. Among 10-14-year-olds, declining rates among males masked a consistent increase in female suicide rates since 2011. Although asphyxiation-related suicides decreased across all groups since 2018, firearm suicide rates increased for females in the 10-14 and 20-24 age groups. Albeit not as common as firearms or asphyxiation, poisoning suicide rates increased in the 15-19 and 20-24 age groups. Since 1999, suicide rates by other less common methods (e.g., jumping) showed significant increases, for both sexes, especially among individuals aged 20-24. Suicide rates were consistently highest in the 20-24 age group across all study years. Conclusion: The decrease in suicide mortality rates among individuals aged 10-24 was largely driven by declines in males and reductions in asphyxiation-related suicides. However, increasing female suicide rates in the 10-14 age group, as well as increasing rates of death by less common means, warrant close attention. While suicide prevention efforts like structural interventions and means restriction have shown effectiveness among male adolescents, priority should now be given to adapting these approaches for female adolescents, particularly those aged 10-14.

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

LiteOdyssey: A Lightweight Reasoning AI Agent for Interpretable Rare-Disease Diagnosis

arXiv:2606.16149v1 Announce Type: new Abstract: Most medical AI systems improve by scaling additional machinery: more fine-tuning data, more agents, and/or larger retrieval databases. In rare-disease diagnosis, however, such scaling can produce systems that are difficult to deploy, audit, and maintain. We asked whether state-of-the-art diagnostic performance could instead be achieved by extending the reasoning chain of a single AI agent: guiding it with a diagnostic policy, developed through human-AI collaboration and augmenting with freely available biomedical tools. We introduce LiteOdyssey, a lightweight rare-disease diagnostic framework that guides reasoning language model through a clinical genetics workflow. This framework was developed through Policy Iteration with Human Feedback (PIHF) and uses dynamic access to public biomedical tools. On two challenging benchmarks that provide only patient clinical features, LiteOdyssey achieved state-of-the-art performance, with an overall disease Recall@1 of 59.3% over the combined 1,243 cases of LIRICAL (n = 370) and the PhenoPacket Store (n = 873). Both benchmarks have a high proportion of ultra-rare disease (a prevalence below 1 in 1,000,000, with ultra-rare shares of approximately 45% and 52.8%, respectively). On the more difficult PhenoPacket subset, where causal diseases were not mapped to Orphanet in our rarity-mapping pipeline, LiteOdyssey achieved 60.7% Recall@1, compared with 10.7% for the same baseline model (GPT-5.4) without tools. This performance was achieved without fine-tuning, multi-agent ensembles, or a large case-retrieval database. Gains were also observed in the following: on cases never seen during development, on a private cohort of real-world rare disease patients, and on a smaller open-weights model. LiteOdyssey suggests a path toward rare-disease AI systems that are accurate, easier to deploy, and more transparent for physician review.

24.
medRxiv (Medicine) 2026-06-15

The clinical utility of functional testing in fibroblasts to diagnose primary mitochondrial disease

Genome sequencing of the heterogeneous primary mitochondrial disorders (PMD) frequently reveals variants of uncertain significance that require functional tests for diagnosis, and does not identify variants in all patients. We analyzed mitochondrial enzyme assays, blue native polyacrylamide gel electrophoresis (BN-PAGE) with in-gel activity staining, complex I assembly blot, and select protein abundances in fibroblasts of a case series of 204 PMD patients divided into functional classes, in comparison to 51 controls and 53 differential diagnostic conditions. Overall, sensitivity and specificity for respiratory chain enzyme assays were 46% and 93% respectively, for BN-PAGE 40% and 98%, for complex I assembly assay 49% and 99%. The overall sensitivity of all tests was 76%, specificity 93%, with positive predictive value 96% and negative predictive value 67%. Categories with high sensitivity were isolated complex deficiencies, nuclear DNA-encoded mitochondrial protein synthesis defects, co-factor defects, and mitochondrial amino-acyl-tRNA synthetase conditions when aided by protein abundance. Mitochondrial DNA mutations and maintenance disorders showed poor sensitivities. Secondary dysfunctions were rare. A complete battery of functional tests showed strong diagnostic clinical utility in fibroblasts.

25.
medRxiv (Medicine) 2026-06-16

Supplementation with Arabinoxylan Dietary Fiber at Low Doses Produces Behavioral, Metabolic, and Gut Microbial Changes in Healthy, Overweight Adults: A Randomized Placebo-Controlled Trial

Background: Dietary fiber comprises a heterogeneous group of compounds with distinct physicochemical properties and biological effects. As such, functional outcomes observed for one fiber cannot be generalized to others. Some fermentable fibers, such as arabinoxylan, may exert biologically selective effects across multiple physiological domains, highlighting the need to evaluate individual ingredients for their domain-specific activity in controlled human studies. Methods: In this randomized, double-blind, parallel, 3-arm, placebo-controlled trial, healthy, overweight adults were assigned to consume one of two low doses of an arabinoxylan dietary fiber (3.5g or 5g) or placebo over the intervention period. Self-reported appetite sensations were assessed as the primary outcome using validated visual analogue scales. Secondary and exploratory endpoints included lipid parameters, gastrointestinal outcomes, mood-related measures, and gut microbiota composition and fermentation-derived metabolites. Analyses were conducted in the full analysis set and a high-compliance population to assess responses under sustained intake conditions, as per the intended dosing regimen. Results: The primary endpoint of appetite sensations did not differ between either arabinoxylan group and placebo. In contrast, evidence of microbial fermentation and selective microbiota engagement was observed. These responses occurred alongside consistent and favorable changes in lipid parameters under conditions of sustained intake, including reductions in low-density lipoprotein cholesterol and triglycerides. Additional outcomes, including gastrointestinal symptoms and mood, demonstrated domain-specific responses. Conclusion: This study demonstrates that supplementation with low doses of arabinoxylan dietary fiber elicit biologically selective, domain-specific effects across metabolic, microbial, gastrointestinal, and behavioral outcomes, particularly under conditions of sustained intake. These responses occurred independently of changes in appetite sensation, indicating that functional effects were not mediated through appetite-related pathways. Collectively, the findings highlight the ingredient's biological versatility and contextual responsiveness across physiological systems, and suggest its prebiotic potential through alignment with ISAPP's definition of a prebiotic, supporting further investigation of specific mechanistic pathways. Clinical trial registration: https://clinicaltrials.gov/study/NCT06884449, identifier: NCT06884449