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Cardiometabolic risk phenogroups from a data-driven classification with expanded risk factors

Background and Aims Current diagnostic criteria for metabolic syndrome (MetS) may inadequately capture underlying metabolic heterogeneity and associated cardiovascular risks. We aimed to use expanded cardiometabolic variables to identify new cardiometabolic phenogroups with relevance to prognosis and risk stratification. Methods Latent class analysis (LCA) was applied to a discovery cohort (RESET; n=1,034), using the six conventional MetS measures and eight additional variables. A decision tree model was constructed using the most important variables to enable practical phenogroup classification and facilitate external validation. External validation was conducted in three independent cohorts, PICMAN (n = 120), UK Biobank (n = 344,817), and CHARLS (n = 12,145), analysing for proteomic signatures and cardiovascular outcomes. Results Five latent phenogroups were identified in the discovery cohort: Metabolically Preserved with and without isolated hypertension (each n=244; 23.6%), Lean-Insulin Resistant (IR) (n=140; 13.5%), Obese-Insulin Sensitive (IS) (n=211; 20.4%), and Obese-IR (n=195; 18.9%). Lean-IR and Obese-IS showed discordant adiposity and insulin/glycemic status, and a low prevalence of MetS (21.4% and 31.3%, respectively), whereas MetS was high (75.9%) only in the Obese-IR group. A decision tree model using four binary indicators (visceral adiposity, IR, elevated SBP, and HbA1c) accurately classified individuals into the five latent phenogroups and was subsequently deployed for external validation. Validation in PICMAN showed significantly higher liver fat (Mean 9.0% [SD 6.3%]) in Lean-IR versus Metabolically Preserved (Mean 2.8% [SD 1.8%], P=0.002). Plasma proteomic analyses further reflected unique metabolic-inflammation signatures across the 5 groups. Validation in the UK Biobank showed significant association between the latent phenogroups with outcomes of myocardial infarction and stroke. Hazard ratios for the composite outcome after adjusting for age and sex were 1.52 (95% CI, 1.43-1.61) for isolated hypertension, 1.86 (1.75-1.98) for Lean-IR, 1.85 (1.75-1.97) for Obese-IS, and 2.75 (2.56-2.95) for Obese-IR, compared with the Metabolically Preserved group. Conclusion Expanded cardiometabolic risk factors reveal metabolic heterogeneity obscured by current MetS criteria. Incorporating visceral adiposity and IR into a novel classification system refines cardiovascular risk stratification for the management of cardiometabolic disease.

ASTRA: A Scalable Next-Generation ATCO Training Simulator with Autonomous Simpilots

arXiv:2606.18319v1 Announce Type: cross Abstract: Air Traffic Control Operators (ATCOs) are vital in ensuring the safe, orderly, and efficient flow of air traffic, yet training capacity is constrained by reliance on specialized human trainers known as simpilots, who must role-play both pilots and ATCOs in a simulated airspace. Existing automated solutions rely on Western-centric speech models that perform poorly in Singaporean operational contexts, with off-the-shelf systems exhibiting Word Error Rates (WER) of up to 107.80% on Singaporean-accented aviation speech. We introduce ASTRA, an end-to-end training simulator that automates these simpilot roles through a pipeline that transcribes ATCO speech, interprets instructions, and generates appropriate pilot and ATCO responses using locally adapted voice models. Our fine-tuned Automatic Speech Recognition (ASR) pipeline reduces WER to 23.45%, substantially outperforming existing approaches in this domain. Beyond traffic simulation, ASTRA incorporates an AI-assisted performance evaluation framework that assesses trainee radiotelephony communications across accuracy, brevity, and completeness, achieving post-optimization scores of 91.7%, 88.2%, and 86.9%, respectively. Built on open-source foundations such as DSPy and Unsloth, this approach enables scalable, standardized ATCO assessment while reducing instructor workload.

Clinically Aligned Geometry Constraints for Robust IVUS Vessel Boundary Segmentation

Intravascular ultrasound (IVUS) lumen and external elastic membrane (EEM) segmentation is important for quantitative coronary plaque burden assessment. Errors in lumen or EEM delineation directly propagate to plaque area, plaque burden and geometric measurements. However, standard methods prioritising overlap scores often suffer from boundary drift and topology errors, leading to inaccurate clinical measurements. We present GeoCat, a geometry-consistent network that processes 5-frame IVUS clips using dual Cartesian-polar encoders with cross-domain attention and temporal fusion. A differentiable geometry consistency loss directly supervises clinically relevant descriptors including diameters, orientations, and cross-sectional areas. The model is trained on 12,242 annotated frames from 146 patients acquired with two commercial IVUS systems. We evaluate performance using both segmentation accuracy and plaque-relevant clinical metrics, including Dice/IoU, boundary measures(95HD (mm), ASSD), topology violation rate, and clinical geometry errors (dmax/dmin, angles, and areas). On our dataset, GeoCat achieves a Dice of 0.93, reduces 95HD to 0.14 mm, and lowers topology violations to 1.0%. Importantly, it significantly improves geometric fidelity, yielding diameter errors of 0.13-0.16 mm and angular errors of ~8 degrees, supporting reliable plaque burden quantification.

Diffusion Transformer World-Action Model for AV Scene Prediction

Action-conditioned world models let an autonomous vehicle predict future camera scenes from its own planned controls, enabling planning and simulation without real-world rollouts, but at compact, trainable scale the futures are ambiguous and the field's standard distortion metrics actively mislead: they reward a blurry regression mean over a realistic prediction. We confront this with a compact latent world model that, given the present front-camera latent and a sequence of ego-actions, predicts future scene latents a frozen decoder renders to $256 \times 256$ frames up to 8 seconds ahead, evaluated on 150 held-out nuScenes scenes. We first benchmark where to predict: across six frozen encoders spanning four representation families, V-JEPA2 with temporal context reduces steering RMSE by 40% over the best single-frame encoder. We then train a latent Diffusion Transformer (DiT) and, through a controlled diagnosis, identify the four ingredients it needs: spatial tokens, the $x_0$ objective, residual anchoring, and sampling matched to target uncertainty. In a Stable-Diffusion-VAE encode-predict-decode pipeline we expose the central tension: distortion metrics (cosine similarity, SSIM) favor the blurry mean, masking that the diffusion model is far closer to the real frame distribution. Inception-based FID and KID reveal a clean perception-distortion frontier: diffusion attains KID 0.078 versus 0.375 for regression ($4.8\times$ better), and a deployable train-derived calibration makes this practical without test-time ground truth. The model is genuinely action-controllable (steering drives scene displacement, Spearman $\rho = 0.81$, vs $-0.18$ for regression). We trace limited single-pass motion to a shared-present anchor and engineer a compact 1.7M-parameter "jump" model that recovers full ground-truth motion magnitude ($1.02\times$ GT), where single-pass models capture less than half.