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01.
medRxiv (Medicine) 2026-06-18

Development and Initial Validation of the Quality of life Evaluation in NF2-related Schwannomatosis Trials (QUEST) Assessment

Authors:
Merker↗V. L↗Carias↗S. C↗Ferner↗R. E↗Golding↗J. F↗Plotkin↗S. R↗Buono↗F. D↗…

Individuals with NF2-related schwannomatosis (NF2-SWN) experience a complex constellation of physical, emotional, and social symptoms that substantially impact quality of life (QoL). Although disease-specific patient-reported outcome measures are increasingly important for evaluating treatment benefit in clinical trials, existing NF2-SWN QoL measures have limitations in content coverage and sensitivity to change. This study describes the development and initial validation a new disease-specific QoL assessment – the Quality of Life Evaluation in NF2-related Schwannomatosis Trials (QUEST). Using a three-phase, mixed-methods approach, items were generated through concept elicitation interviews with individuals with NF2-SWN and clinicians, prioritized via patient survey data, and refined through iterative cognitive debriefing procedures. The resulting 21-item QUEST assesses the extent to which NF2-SWN has negatively impacted a persons daily life over the past seven days. Initial psychometric evaluation was conducted in an international sample of 174 individuals with NF2-SWN aged 15 years and older (117 women (67%), 158 White individuals (89%)). Exploratory factor analysis supported a four-factor structure, and the total score demonstrated excellent internal consistency and strong test-retest reliability. Evidence of construct validity was demonstrated through hypothesized associations with disease-specific, generic, and domain-specific QoL measures, as well as known-groups validity based on self-reported disease severity and number of prior surgeries. Incremental validity analyses indicated that QUEST explained unique variance beyond existing measures. Together, findings support the QUEST as a reliable and valid disease-specific QoL measure with strong content validity and feasibility for use as a clinical trial endpoint in NF2-SWN.

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02.
medRxiv (Medicine) 2026-06-22

Biopsychosocial determinants of HPV vaccine perception in university students of both sexes in Cucuta, Colombia, 2024: a cross-sectional study

Authors:
ARIAS-SANCHEZ↗Florez↗Pereira↗Caceres-Penaloza↗D. Y↗Dallos Rivera↗L. S↗Nunez-Villamizar↗K. G↗Beltran - Arroyave↗

Colombia has been internationally recognised as a paradigmatic case of vaccine confidence crisis since the 2014 Carmen de Bolivar event, and national HPV vaccination coverage remains far below the World Health Organization 2030 target. Most published evidence focuses on female adolescents and on cervical cancer; the perception of the HPV vaccine in university-age populations of both sexes–and across the broader spectrum of HPV-attributable disease–remains comparatively understudied. We aimed to describe the influence of biopsychosocial determinants on HPV vaccine perception among university students of both sexes in Cucuta, Norte de Santander, Colombia. We conducted a cross-sectional study with a mixed quantitative-qualitative approach in 2024 among four universities (Universidad de Santander, Universidad Francisco de Paula Santander, Universidad de Pamplona and Universidad Libre; combined enrolment 21,033 students). Using convenience sampling stratified by institution, 750 actively enrolled undergraduate students of both sexes (18-60 years) completed a structured online questionnaire adapted from previously validated instruments. The instrument captured sociodemographic information, HPV knowledge and HPV vaccine perception. Data were analysed using Students t-test, one-way analysis of variance, Tukey post-hoc tests, effect sizes and 95% confidence intervals, with a 0.05 significance threshold. Of 750 respondents, 54.2% were women, 61.3% were under 20 years of age, and 75.1% attended public universities. HPV knowledge was high in 39.2%, intermediate in 42.4% and low in 18.4%; women and students aged 26 years or older displayed higher knowledge. Although 91.2% had heard of HPV and 82.5% knew that both sexes could acquire it, recognition of clinical manifestations and complications was uneven: cervical cancer 51.7%, penile cancer 30.5%, vaginal warts 45.9% and warts in the penis, larynx, anus or rectum 34.0%. Vaccine-specific knowledge was low in 77.1%, with men disproportionately represented (85.9% versus 69.5% in women). Overall positive perception of HPV vaccination was 66.6%, slightly higher in women (68.8%) than men (63.9%), in students aged 26 years or older (70.1%) and in students from private universities (68.1% versus 65.9%). Inferential analysis identified sex (Cohens d = -0.357), type of university (d = 0.189) and HPV knowledge (partial eta-squared = 0.096) as the only significant determinants. Age, socioeconomic stratum, age at sexual debut and vaccine-specific knowledge did not reach meaningful significance. HPV vaccine perception was predominantly positive but conditioned by three biopsychosocial determinants, with HPV knowledge as the primary driver. The persistent gender gap reflects historical anchoring of HPV messaging in cervical disease and female-targeted campaigns. Public-health strategies should adopt comprehensive, gender-inclusive educational interventions that explicitly visibilise non-cervical HPV-related cancers and address both sexes from a common evidence base.

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03.
medRxiv (Medicine) 2026-06-22

Reliable quantification of renal function from frozen blood samples

Authors:
French↗S. R↗Culwell↗G. C↗Wiskoski↗H. E↗Arias↗J. C↗Zahra↗Escareno↗C. E↗Heitkamp↗…

BACKGROUND: Differences in renal function may affect Alzheimer disease (AD) blood biomarker levels independent of AD pathology. Although renal function was unaccounted for in foundational AD blood biomarker studies, there is potential to address this through quantification of estimated glomerular filtration rate (eGFR) from frozen serum and plasma samples. However, the validity of eGFR evaluation from long-term frozen blood samples is unknown. METHODS: Adults aged 50-85 with at least 2 vascular risk factors were recruited from vascular surgery or cardiology clinics in Tucson, Arizona from 2022-2025. Individuals with creatinine assessments in point-of-care whole blood (POC-WB) and frozen serum and plasma samples using the iSTAT (Abbott) were included. eGFR was calculated using the 2021 CKD-EPI creatinine equation without race. Agreement between POC-WB and frozen blood samples was assessed using Cohen's kappa with linear weights. RESULTS: 134 participants (mean [SD] age: 72.6 [7.5] years, 39.6% female, 23.1% chronic kidney disease) had POC-WB eGFR available. Frozen serum and plasma samples had strong agreement with POC-WB for eGFR (Kw= 0.90-0.95, P

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

Temporally Consistent Graph Q-Networks for Intelligent Network Control

Authors:
Zacharias Veiksaar↗Maxime Bouton↗

arXiv:2606.13848v1 Announce Type: cross Abstract: Mobile networks continue to grow in complexity and next generation networks are expected to support both increasing traffic loads and more diverse services. As network complexity rises, optimizing antenna parameters under dynamic or changing objectives becomes increasingly challenging. We propose a novel multi-agent reinforcement learning (MARL) algorithm for high-level control and orchestration of mobile networks. The Temporally Consistent Graph Q-Network (TC-GQN) algorithm learns a self-predicting representation of the whole network that is task-independent and aggregates information from all base-stations. A graph neural network is trained using a global reward function to assign coordinated local actions based on the learned encoding of the global network state. We evaluate the algorithm in a simulated environment to orchestrate an energy-saving feature across multiple sectors and multiple carriers under different quality of service (QoS) constraints. The proposed algorithm outperforms state-of-the-art graph-based baselines and a competitive rule-based controller by improving hardware sleep time while maintaining QoS. Moreover, the learned representation enables rapid adaptation to changing intents.

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05.
arXiv (CS.CV) 2026-06-16

IGLU: The Integrated Gaussian Linear Unit Activation Function

Authors:
Mingi Kang↗Zai Yang↗Jeova Farias Sales Rocha Neto↗

Activation functions are fundamental to deep neural networks, governing gradient flow, optimization stability, and representational capacity. Within historic deep architectures, while ReLU has been the dominant choice for the activation function, modern transformer-based models increasingly are adopting smoother alternatives such as GELU and other self-gated alternatives. Despite their empirical success, the mathematical relationships among these functions and the principles underlying their effectiveness remains only partially understood. We introduce IGLU, a parametric activation function derived as a scale mixture of GELU gates under a half-normal mixing distribution. This derivation yields a closed-form expression whose gating component is exactly the Cauchy CDF, providing a principled one-parameter family that continuously interpolates between identity-like and ReLU-like behavior via a single sharpness parameter $\sigma$. Unlike GELU's Gaussian gate, IGLU's heavy-tailed Cauchy gate decays polynomially in the negative tail, guaranteeing non-zero gradients for all finite inputs and offering greater robustness to vanishing gradients. We further introduce IGLU-Approx, a computationally efficient rational approximation of IGLU expressed entirely in terms of ReLU operations that eliminates transcendental function evaluation. Through evaluations on CIFAR-10, CIFAR-100, and WikiText-103 across ResNet-20, ViT-Tiny, and GPT-2 Small, IGLU achieves competitive or superior performance on both vision and language datasets against ReLU and GELU baselines, with IGLU-Approx recovering this performance at substantially reduced computational cost. In particular, we show that employing a heavy-tailed gate leads to considerable performance gains in heavily imbalanced classification datasets.

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06.
medRxiv (Medicine) 2026-06-16

A Poisson Process Life Expectancy framework for optimising patient lifetime during chemotherapy

Authors:
Tzamarias↗B. D. E↗Burroughs↗

Cancer therapy balances between two competing objectives - treatment efficacy against the tumour and the risk of treatment related severe adverse events, including patient death. Most existing optimal control theory (OCT) formulations rely on optimising heuristic cost functionals that lack direct clinical interpretability. In clinical practice treatment efficacy and patient tolerability are primarily assessed through survival metrics and adverse event rates. Here we introduce the Continuous Lifetime Payoff (CLP), a novel OCT objective functional that directly links treatment decisions to patient survival. It explicitly incorporates tumour dynamics, tumour eradication, and patient mortality from tumour progression, drug-related toxicity and age. We fit age-related mortality from life tables and infer parameters from simulated survival data. The CLP provides a clinically grounded framework for optimising chemotherapy regimens.

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