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Study protocol: Feasibility and clinical implications of real-time cerebral autoregulation monitoring in major noncardiac surgery with the Medtronic Cotrending algorithm (AUTOREGULATE-NONCARDIAC-COTRENDING)

Background: Perioperative hypotension is associated with postoperative organ injury. However, trials of hypotension avoidance have not found meaningful improvements in postoperative cardiovascular, renal, neurological or functional outcomes. One possible explanation is that organ perfusion depends on patients individual autoregulatory ranges. Hence, technology enabling monitoring of the autoregulatory status of vital organs, e.g. the brain, could provide a physiologic basis for personalising of blood pressure targets. However, current established methodologies for monitoring cerebral autoregulation in noncardiac surgery, e.g. the cerebral oximetry index (COx), are limited by performance and usability. The Medtronic Cotrending algorithm has been developed to provide automated, near real-time assessment of cerebral autoregulation. While feasibility was demonstrated in cardiac surgery, its applicability in major noncardiac surgery remains unknown. This study aims to evaluate the technical feasibility and clinical implications of Cotrending-based cerebral autoregulation monitoring in major noncardiac surgery. Objectives: Primary objective: To evaluate the technical feasibility of using the Medtronic Cotrending algorithm to monitor intraoperative cerebral autoregulation in real-time during major noncardiac surgery, drawing comparisons to the COx algorithm. Secondary objectives: to investigate the potential clinical implications of Cotrending-based cerebral autoregulation monitoring. Design: Single-centre, prospective cohort study. Setting: Swiss tertiary care centre Patients: Patients enrolled in AUTOREGULATE-NONCARDIAC who were monitored intraoperatively with the Medtronic INVOS(TM) 5100 near-infrared spectroscopy (NIRS) system. Outcomes: Technical feasibility outcomes include success rate of determination of the lower limit of cerebral autoregulation, intraoperative uptime, time to first estimate of the lower limit of cerebral autoregulation, sensitivity to external factors and to data artefacts; agreement of Cotrending-derived lower limit of cerebral autoregulation with COx-derived lower limit of cerebral autoregulation. Conclusions: N/A Trial registration: Clinicaltrials.gov NCT07630129

Quantum-HPC Software Stacks and the openQSE Reference Architecture: A Survey

arXiv:2604.20912v2 Announce Type: replace Abstract: Quantum resources are increasingly integrated into high-performance computing (HPC) and cloud environments, but quantum high-performance computing (QHPC) software stacks remain isolated, often proprietary, full-stack solutions lacking common interfaces across runtime, resource management, orchestration, and execution layers. This paper analyzes nine production QHPC stacks and identifies common design patterns and emerging requirements, covering deployment models, application interaction patterns, SDK support, and readiness for fault-tolerant operation. The survey exposes consistent needs in runtime abstraction, resource management, interconnect semantics, and observability. Based on these findings, we propose the open quantum-HPC software ecosystem ( openQSE) reference architecture as a first step toward unifying the state-of-the-practice. openQSE defines a set of layer boundaries that allow different implementations to interoperate while preserving deployment flexibility, and is structured to support both current noisy intermediate-scale quantum (NISQ) workloads and future fault-tolerant quantum computing (FTQC) systems without changes to upper-layer application interfaces.

SPARC: Separating Perception And Reasoning Circuits for Test-time Scaling of VLMs

Despite recent successes, test-time scaling – i.e., dynamically expanding the token budget during inference as needed – remains brittle for vision-language models (VLMs). Unstructured visual reasoning chains entangle perception and reasoning, leading to long, disorganized contexts where small perceptual mistakes may cascade into completely wrong answers. Reasoning also requires expensive reinforcement learning with hand-crafted rewards. Here, we introduce SPARC (Separating Perception And Reasoning Circuits), a modular framework that explicitly decouples visual perception from reasoning. Inspired by sequential sensory-to-cognitive processing in the brain, SPARC implements a two-stage pipeline where the model first performs explicit visual search to localize question-relevant regions, then conditions its reasoning on those regions to produce the final answer. This separation enables independent test-time scaling with asymmetric compute allocation (e.g., prioritizing perceptual processing under distribution shift), and supports selective optimization (e.g., improving the perceptual stage alone when it is the bottleneck for end-to-end performance). It also accommodates compressed contexts by running global search at lower image resolutions and allocating high-resolution processing only to selected regions, thereby reducing visual token count and compute. SPARC outperforms monolithic baselines and strong visual-grounding approaches across challenging visual reasoning tasks, such as improving Qwen3VL 4B on the $V^*$ VQA benchmark by 6.7 points and surpassing "thinking with images" by 4.6 points in an OOD setting with a $200\times$ lower token budget.