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01.
medRxiv (Medicine) 2026-06-17

Cardio Heart Connect: Protocol for a Randomized Trial of a Commercially Available mHealth Fitness Intervention for Cardiac Rehabilitation After Transcatheter Aortic Valve Replacement

Authors:
Rosen↗Butala↗N. M↗Kramer↗D. B↗Helmkamp↗L. J↗Gama↗Goldberg↗Marzec↗Peterson↗P. N↗…

Background: Despite ample evidence of the benefits of cardiac rehabilitation (CR), few transcatheter aortic valve replacement (TAVR) patients participate. Commercially available mobile health offers an opportunity to deliver activity-promotion content to populations that are challenged to participate in CR. This study aims to test the efficacy of clinically controlled, commercially available fitness programming for improving physical activity and cardiovascular health outcomes designed to be initiated while patients are on waitlists for traditional CR. Methods: The Cardio Heart Connect study is a hybrid type I effectiveness-implementation trial aiming to enroll N=200 patients who have been placed on a cardiac rehab waitlist following a TAVR procedure from the University of Colorado Hospital Heart and Vascular Center. Participants will be randomized 1:1 to the Cardio Heart Connect intervention with commercially available fitness or attention control, designed to control for technology access. At baseline, post-intervention (8 weeks), and follow-up (12 months), we will assess the primary outcome of participants? daily steps as measured by smartwatch accelerometer and secondary outcomes of interest including functional capacity (Duke Activity Status Index; VO2max), quality of life (Kansas City Cardiomyopathy Questionnaire), and cardiovascular health status (Life Essential 8). In addition, we will use mixed methodologies to evaluate the implementation of intervention using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. Conclusions: Commercially available fitness programs have the potential to provide more accessible opportunities for patients recovering from TAVR to engage in physical activity and may be preferred due to their customizability, convenience, and ease of scheduling. Overall, this study will provide insight into the use of commercial mHealth to promote activity following TAVR.

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02.
medRxiv (Medicine) 2026-06-19

Hyperleukocytosis and outcomes in pediatric B-cell acute lymphoblastic leukemia: A report from the REDIAL Consortium

Authors:
Kim↗J. J↗Brown↗A. L↗Gramatges↗Hoang↗Sok↗Garcia-Morales↗Taylor↗O. A↗Huynh↗Ludwig↗…

Hyperleukocytosis (white blood cell [WBC] count >100 000/uL) at diagnosis is an important prognostic risk factor in pediatric acute lymphoblastic leukemia (ALL), though its significance with contemporary therapy is unclear. We analyzed 1 826 pediatric ALL patients from a multi-institution cohort to determine whether hyperleukocytosis independently predicts outcomes using multivariable Cox proportional hazard modeling. Hyperleukocytosis occurred in 211 patients (12%), with 121 having B-ALL, and showed no prognostic significance in T-ALL patients. In B-ALL, 5-year event-free survival (EFS) was 65% versus 89% for non-hyperleukocytosis patients, and overall survival (OS) was 78% versus 93%. After adjustment for age, cytogenetic risk, central nervous system disease status, and treatment site, hyperleukocytosis remained an independent predictor of end-of-induction minimal residual disease (MRD) positivity (odds ratio 2.53 [95% confidence interval [CI]: 1.71-3.94; p

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03.
medRxiv (Medicine) 2026-06-18

Predicting Motor Recovery After Stroke: Utility and Limits of Corticospinal Tract Biomarkers

Authors:
Rickers↗E. S↗Paul↗Esser↗Hensel↗Rizor↗Binder↗Rehme↗A. K↗Ringmaier↗Schoenberger↗Tscherpel↗…

Background: Corticospinal tract (CST) damage is a major cause of post-stroke motor deficits. However, it remains unclear which estimates of CST damage best predict motor recovery, especially regarding different aspects of motor control. While conventional CST-lesion metrics offer superior feasibility, data-driven machine learning (ML) approaches may better capture patients propensity for task-specific recovery with important implication for their use as future clinical biomarkers. Methods: Providing the first direct longitudinal comparison of these approaches based exclusively on CST-lesion patterns, we evaluated six conventional CST-lesion metrics and a voxel-wise ML approach using clinical MRI data from 127 acute ischemic stroke patients. Acute impairment and outcome (>3 months post-stroke) were assessed for basal and complex motor functions. Conventional CST-lesion metrics and ML were used to predict task-specific motor impairment and outcome. Results: All conventional CST-lesion metrics correlated significantly with both acute impairment and motor outcome across motor domains, with metrics weighted for CST narrowing and tract probability performing best. However, predictive performance for unseen patients was low. ML outperformed conventional markers in predicting acute impairment across motor domains and basal motor outcome, but failed to predict complex motor outcome. Topographically, predictive voxels clustered within and above the posterior limb of the internal capsule, with distinct CST subregions associated with basal versus complex motor impairment, consistent with a task-specific somatotopic organization. Conclusions: The predictive utility of CST biomarkers was task- and timepoint-dependent. While ML may improve predictive performance, complex motor outcome remained difficult to predict, likely reflecting greater reliance on distributed cortical reorganization beyond the CST. By revealing task-specific CST subregions, voxel-wise ML provides an anatomically informed foundation for future predictive models. Such future models should combine CST biomarkers with measures of broader motor network integrity to enable individualized prognosis tailored to specific motor domains and recovery stages.

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04.
medRxiv (Medicine) 2026-06-18

Factor Analysing Predictive Processing: No Evidence for a General Factor Across Tasks

Authors:
Miller-Silva↗Knolle↗Greve↗de Beer↗Mujirishvili↗MacGregor↗L. J↗Corlett↗P. R↗Haarsma↗Powers↗A. R↗…

Background & Hypothesis: Dysfunctional predictive processing (PP), specifically the aberrant weighting of priors, is a frequently-proposed mechanism for psychosis and psychosis-like phenomena (schizotypy). Evidence for this theory mostly originates from single-task studies, which assume that all tasks load onto a single latent construct of PP performance, but the underlying factor structure of PP tasks is unknown. PP deficits in psychosis may be better described by a two-factor, hierarchical model: weakened lower-level (perceptual) priors compensated by higher-level (cognitive) priors. Study Design: This study implements a multi-paradigm approach in healthy participants to investigate latent constructs underlying PP and their relationship to schizotypy. Participants (N = 73) completed 6 tasks measuring reliance on priors across language, memory, visual, and auditory domains. A factor analysis investigated whether performance across tasks is captured by a single or two-factor model. Study Results: Although a two-factor model best described performance, factors reflected within-task correlations rather than a PP hierarchy. Cross-task PP measures were poorly correlated, suggesting that individuals' weighting of priors was task-specific. A full model including all task outcomes (not factors) significantly predicted the severity of schizotypal aberrant beliefs but no other schizotypal measures. Conclusions: These results do not evidence a single factor underpinning PP performance. It is therefore inappropriate to use results from single tasks to propose a generalised PP deficit in psychosis. Variation was also not captured by a two-factor hierarchical model of priors. Further multi-paradigm research is required to evaluate alternative models or additional variables that describe aberrant PP in psychosis.

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05.
medRxiv (Medicine) 2026-06-15

Fanconi Anemia as a Window into Premalignant Field Cancerization of the Oral Mucosa

Authors:
Berger↗Donovan↗F. X↗Lin↗Y.-C↗Soma↗May↗Bhadresha↗Krieg↗Giri↗McReynolds↗L. J↗…

Head and neck squamous cell carcinoma (HNSCC) evolves through stepwise clonal expansion within genetically altered mucosa fields, yet actionable biomarkers remain undefined. Leveraging Fanconi anemia (FA), a cancer predisposition syndrome with extreme HNSCC risk due to defective DNA interstrand crosslink repair, we profiled premalignant changes in the oral cavity using noninvasive brush biopsies. Consistent with our prior demonstration of genomic instability in FA-associated SCCs, we detected pathogenic TP53 variants in 26% and copy number alterations in 60.5% in clinically normal-appearing oral mucosa of individuals with FA. These subclinical clonal expansions define candidate biomarkers of early clonal evolution amenable to serial sampling for risk stratification and prevention studies. Since FA-associated SCCs share genomic features with sporadic HNSCC, these findings may extend to the broader population. We also identify somatic reversion of a pathogenic FANCB variant, providing evidence of genomic self-correction and suggesting a potential avenue for gene-based cancer prevention in FA.

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06.
arXiv (quant-ph) 2026-06-19

On the significance of Wigner's Friend in contexts beyond quantum foundations

Authors:
Caroline L. Jones↗Markus P. Mueller↗

arXiv:2402.08727v3 Announce Type: replace Abstract: There has been a surge of recent interest in the Wigner's Friend paradox, sparking several novel thought experiments and no-go theorems. The main narrative has been that Wigner's Friend highlights a counterintuitive feature that is unique to quantum theory, and which is closely related to the quantum measurement problem. Here, we challenge this view. We argue that the gist of the Wigner's Friend paradox can be reproduced without assuming quantum physics, and that it underlies a much broader class of enigmas in the foundations of physics and philosophy. To show this, we first consider several recently proposed Extended Wigner's Friend scenarios, and demonstrate that some of their implications for the absoluteness of observations can be reproduced by classical thought experiments that involve the duplication of agents. Crucially, some of these classical scenarios are technologically much easier to implement than their quantum counterparts. Then, we argue that the essential structural ingredient of all these scenarios is a feature that we call "Restriction A": that a physical theory cannot give us a probabilistic description of the observations of all agents. Finally, we argue that this difficulty is at the core of other puzzles in the foundations of physics and philosophy, and demonstrate this explicitly for cosmology's Boltzmann brain problem. Our analysis suggests that Wigner's Friend should be studied in a larger context, addressing a frontier of human knowledge beyond quantum foundations: to obtain reliable predictions for experiments in which these predictions can be privately but not intersubjectively verified.

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