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01.
arXiv (CS.LG) 2026-06-11

Mitigating Disparate Impact of Differentially Private Learning through Bounded Adaptive Clipping

arXiv:2506.01396v2 Announce Type: replace Abstract: Differential privacy (DP) has become an essential framework for privacy-preserving machine learning. Existing DP learning methods, however, often have disparate impacts on model predictions, e.g., for minority groups. Gradient clipping, which is often used in DP learning, can suppress larger gradients from challenging samples. We show that this problem is amplified by adaptive clipping, which will often shrink the clipping bound to tiny values to match a well-fitting majority, while significantly reducing the accuracy for others. We propose bounded adaptive clipping, which introduces a tunable lower bound to prevent excessive gradient suppression. Our method improves worst-class accuracy by over 10 percentage points on Skewed and Fashion MNIST compared to unbounded adaptive clipping, 7 points compared to Automatic clipping, and 5 points compared to constant clipping. The code is available at https://github.com/TrustworthyMLHelsinki/adaptive-clipping-fairness.

02.
arXiv (CS.AI) 2026-06-24

The Geometry Behind Diffusion and Flow Matching: Gradient Flows and Geodesics in Wasserstein Space

arXiv:2606.24157v1 Announce Type: new Abstract: The space $\mathcal{P}_2(\mathbb{R}^d$) of probability measures with finite second moment carries a natural geometry: the quadratic Wasserstein distance W_2 makes it a complete metric space and, following Otto, a (formal) Riemannian manifold whose geodesics are the optimal-transport interpolations. On this manifold, the gradient flow of the free energy F(rho) = KL(rho || \pi) is exactly the Fokker-Planck equation, and its implicit-Euler discretization is the JKO scheme. This is the geometry underlying diffusion models: the forward process descends the free energy, and each denoising step realizes one JKO step, which recovers DDPM, DDIM, NCSN/SMLD, and Energy Matching; this is one scheme, not separate theories. The same manifold supports a second variational principle. Its geodesics - the minimum-action curves of the Benamou-Brenier formula - are precisely the optimal-transport paths that Flow Matching learns. Fixing both endpoints and following the geodesic, generation becomes a deterministic ODE along a straight line, hence far fewer sampling steps. Placing both families of models on one manifold makes their relationship exact: diffusion follows a free-energy gradient flow, an initial-value problem; optimal-transport Flow Matching follows a Wasserstein geodesic, a boundary-value problem. The two reach the same endpoints along different paths.

03.
arXiv (quant-ph) 2026-06-24

Electrical-Circuit Simulation of the Uhlmann Phase

arXiv:2606.24559v1 Announce Type: new Abstract: The Uhlmann phase extends the concept of geometric phases to mixed quantum states through a parallel-transport condition on purification amplitudes, but its experimental realization has so far required sophisticated quantum platforms with carefully engineered auxiliary degrees of freedom. In this work, we reformulate the Uhlmann parallel-transport condition as a linear matrix differential equation and vectorize it to obtain an effective dynamical generator. This generator can be directly mapped onto the admittance matrix of a classical RC circuit, thereby translating the Uhlmann dynamics into the evolution of circuit node voltages. We illustrate the mapping using the equatorial-loop model and, via a rotating-frame transformation followed by a real decomposition, derive a time-independent, real-valued dynamical system suitable for analog implementation. LTspice simulations of the resulting active RC network faithfully reproduce the Uhlmann geometric phase and its topological transition at the critical purity, demonstrating that classical electrical circuits offer a simple and accessible platform for probing mixed-state geometric phases.

04.
arXiv (math.PR) 2026-06-17

Limit theorems for descents and inversions of shelf-shuffles

arXiv:2510.00343v2 Announce Type: replace Abstract: We prove central limit theorems for the number of descents and inversions of permutations produced by shelf-shuffles. These are a model for casino card shuffling machines. We show the asymptotic normality of the number of descents in two limiting regimes depending on the ratio of cards to shelves. On the other hand, we study the inversions by employing a modification of the techniques from Islak's analysis of the statistics of riffle shuffles. In particular, we obtain a bound for the rate of convergence for inversions that is independent of the number of shelves.

05.
arXiv (CS.CV) 2026-06-19

One-Shot Novel View and Pose Human Image Synthesis via 3D Prior Guided Diffusion Model

This paper addresses the challenge of one-shot novel view and pose human image synthesis. The existing methods transfer the reference human image to a target pose using a set of 2D pose keypoints or synthesize human images based on generalizable human NeRF which uses human model priors to extract point-wise features. However, pose transfer based methods can not handle complex human pose using ambiguous 2D pose as the condition, while generalizable human NeRFs may be inaccurate to recover occluded/invisiable human parts without extracted reliable features. To solve these problems, we propose a novel approach for novel view and pose synthesis from a singe human image via conditional denoising diffusion model. Our diffusion model divides the novel view and pose synthesis problem into a sequence of conditional denoising steps. Specifically, to generate humans with complex and arbitrary poses, we introduce 3D human priors, i.e., 3D normal map and color prompt, as geometry and color conditions into the generation process. By transferring the reference human into the target human with a series of diffusion steps, our diffusion model enables high-quality synthesis including the occluded/invisible parts. Further, we propose a self-reconstruction based customized refinement to enhance fine details when tested on novel persons.Experimental results on different public datasets demonstrate that our approach significantly outperforms previous methods and also shows better generalization ability across datasets. The code will be made publicly available at https://github.com/Yankeegsj/3DPGDM.

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

PU-UNet: Stable Multiplicative Interactions for Medical Image Segmentation

arXiv:2606.20035v1 Announce Type: cross Abstract: Many dense prediction networks rely on additive feature transformations and model higher-order feature interactions only implicitly. Product units provide an explicit mechanism for multiplicative feature modeling, but their logarithmic–exponential formulation can cause numerical instability, which has limited their use in deep dense prediction networks. In this work, we propose Product-Unit U-Net (PU-UNet), a residual U-Net that integrates stable product-unit residual blocks into rich low-resolution stages for medical image segmentation. The proposed formulation combines smooth positivity mapping with log-domain clipping, enabling stable multiplicative feature learning with negligible computational overhead. On ISIC 2018, Kvasir-SEG, and BUSI, PU-UNet achieves Dice scores of 0.942, 0.959, and up to 0.925, respectively. Compared with a matched Residual U-Net baseline, PU-UNet consistently improves Dice and IoU while keeping parameters, FLOPs, and inference latency nearly unchanged, and reduces the image-level false-positive rate on normal BUSI cases from 0.077 to zero. Ablation studies suggest that the gains are associated with product-unit interactions, are strongest under low-resolution placement, and benefit from the proposed stabilization design. These results suggest that stable product-unit residual learning can be an effective way to enhance U-Net-style segmentation networks with explicit multiplicative interactions.

07.
arXiv (quant-ph) 2026-06-15

Quantum sensing through bosonic-fermionic Bell-state transitions in two-photon interference

arXiv:2606.14408v1 Announce Type: new Abstract: Hong-Ou-Mandel (HOM) interference has become a central resource for quantum sensing and metrology owing to its sensitivity to temporal delay and photon indistinguishability. However, existing HOM-based sensing schemes generally rely on inserting a sample into one arm of the interferometer, making the measurement vulnerable to optical loss, alignment instability, and bandwidth-dependent distortion of the interference profile. Here, we demonstrate a symmetry-controlled quantum sensing scheme based on continuous transitions between symmetric (bosonic-like) and antisymmetric (fermionic-like) Bell states in two-photon interference. By imprinting a geometric phase onto the classical pump beam and transferring it to polarization-entangled photons generated via spontaneous parametric down-conversion, we coherently tune the exchange symmetry of the entangled state without altering the temporal or spectral indistinguishability of the photons. The HOM response evolves continuously from bunching to antibunching with a sine square phase dependence, producing a coincidence modulation of approximately 10 * 10^4 counts s^-1 counts/s. In contrast to conventional HOM sensing, the phase-modulation linewidth remains fixed at pi/2, independent of photon bandwidth. Using a birefringent crystal placed directly in the pump beam, we measure thermo-dispersive birefringence with a resolution of the order of 10^{-6} over a broad temperature range. Our results establish exchange symmetry as a controllable resource for robust quantum sensing and symmetry-engineered photonic quantum information processing.

08.
arXiv (CS.AI) 2026-06-16

MASCOT-Android: A Curated Dataset and Automated Collection Pipeline for Android Malware Source Code Specimens

arXiv:2606.16072v1 Announce Type: cross Abstract: Compared with binaries and decompiled code, malware source code more directly reflects the attackers' original intent. However, the scarcity of source code and the high cost of manual review make such datasets difficult to build and maintain. We propose MASCOT-Android, a curated dataset of Android malware source code and an automated collection framework for scalable malware source code discovery on GitHub. A key finding of our work is that repository-level documentation alone provides a strong signal for malware source code collection. Our model extracts character-level TF-IDF features from 8,772 malware and 25,747 benign README documents and trains a LinearSVC classifier to distinguish malware repositories. This README-only model achieves an accuracy of 96.28\% and an FPR of 1.06\% in local evaluation. In addition, the model outputs confidence scores, allowing users to adjust the decision threshold to balance FPR and coverage, which is practical in real-world malware source code collection.

09.
arXiv (CS.LG) 2026-06-18

Measurement noise limits the advantage of nonlinear models over linear models in biomedical prediction

arXiv:2606.18420v1 Announce Type: new Abstract: On biomedical tabular data, flexible models such as deep networks, gradient-boosted trees, and kernel methods are repeatedly matched or beaten by linear and logistic regression given the same features. The usual reaction is to treat this as a model-side shortfall, to be fixed with more data, a better architecture, or tuning, on the assumption that the nonlinear structure is there and the model has failed to capture it. We argue that these fixes cannot help when the binding limit is the measurement rather than the model, as it frequently is in biomedicine. Additive noise blurs the population-optimal predictor, and because blurring removes a function's fine, rapidly varying detail before its broad shape, it erases nonlinear structure faster than linear structure. A degree-$k$ interaction is attenuated by the $k$-th power of feature reliability, while the linear part is attenuated only once. At the reliabilities typical of biomedical measurement, the nonlinear advantage can vanish even when the underlying biology is strongly nonlinear, and what the noise removes cannot be recovered by a larger cohort or a more flexible model, only by better measurement. The nonlinearity is hidden, not absent, and a tie between linear and flexible models is not by itself a verdict on the biology. These pieces are classical, drawn from measurement-error statistics, psychometrics, and Gaussian analysis, and we assemble them into an exact excess-risk identity. Measurement reliability is one of three conditions, alongside sample size and feature representation, that must align for a flexible model to help, and together they leave only a narrow window that most biomedical tasks fall outside. Across 140 UK Biobank tasks, the gap between flexible and linear models, where it exists, carries the predicted noise signature, and the three conditions can be separated by intervention but not by a benchmark alone.

10.
arXiv (CS.CV) 2026-06-17

Visuals Lie, Consistency Speaks: Disentangling Spatial Attention from Reliability in Vision-Language Models

Multimodal Foundation Models are increasingly used as reasoning agents, making reliability, knowing when a model may hallucinate, critical. A common intuition, which we call the Attention-Confidence Assumption, holds that reliability follows from "structural" visual perception: tight attention on relevant regions should signal a trustworthy answer, while scattered attention signals confusion. We challenge this through the VLM Reliability Probe (VRP), a systematic cross-family study of reliability signals in contemporary Vision-Language Models (VLMs). We introduce structural-attention metrics, cluster counts (C_k) and spatial entropy (H_s), to quantify the visual encoder's gaze, and track its evolution (Delta H_s) across layers. This reveals a "Symbolic Detachment": models often "Early Lock" visual features only to diffuse attention later, severing early perception from final generation. Contrary to the grounding hypothesis, we find a "Cluster Failure": spatial attention has near-zero correlation (R approx 0.001) with accuracy. Instead, reliability is a phenomenon of generation dynamics and internal-state distributions. Self-Consistency, the agreement rate across sampled reasoning paths, is the dominant predictor of truth (R = 0.429). Scaling causal interventions exposes a sharp architectural divergence: LLaVA locks its prediction in a fragile late-stage bottleneck, whereas PaliGemma and Qwen2-VL distribute reliability globally, staying resilient even when ~50% or more of their most predictive layer is destroyed. For current VLMs, reliability signals are detached from visual grounding maps and are best inferred from generation-time dynamics and hidden-state probes.

11.
arXiv (CS.AI) 2026-06-12

Beyond Problem Solving: UOJ-Bench for Evaluating Code Generation, Hacking, and Repair in Competitive Programming

arXiv:2606.12864v1 Announce Type: cross Abstract: Despite strong performance in competitive programming, the role of Large Language Models (LLMs) in supporting human learning in the same setting remains largely unexplored. In this work, we introduce UOJ-Bench, a benchmark designed to evaluate not only the problem-solving ability of LLMs, but also their ability to identify errors in human-written code – a crucial educational activity traditionally supported by running test cases over online judge systems. UOJ-Bench consists of three distinct tasks: code generation, code hacking, and code repair, all constructed from real-world code submissions on the Universal Online Judge (UOJ) and evaluated through UOJ's native judging infrastructure. Our results show that under one-shot evaluation, even the strongest models fail to identify errors in more than 50% of a set of submissions that have been found to be incorrect by UOJ users. While test-time scaling improves success rates to above 90%, the substantial computational costs incurred from model inference limit its practicality for large-scale deployment. Despite these limitations, we find that the best-performing models under test-time scaling can uncover errors in over 5% of full-score submissions across roughly 30 problems, suggesting that frontier LLMs can already provide complementary signals beyond standard judging systems.

12.
arXiv (CS.CL) 2026-06-18

TurnGuide: Enhancing Meaningful Full Duplex Spoken Interactions via Dynamic Turn-Level Text-Speech Interleaving

Full-Duplex Speech Language Models (FD-SLMs) are specialized foundation models designed to enable natural, real-time spoken interactions by modeling complex conversational turn-taking such as interruptions, backchannels, and overlapping speech. End-to-end (e2e) FD-SLMs leverage real-world double-channel conversational data to capture nuanced two-speaker dialogue patterns for human-like interactions, but their conversational abilities often degrade compared to pure-text conversation due to prolonged speech sequences and limited high-quality spoken dialogue data. Although interleaved text-speech generation could mitigate this degradation, integrating discrete text tokens into continuous double-channel audio streams could disrupt the precise time alignment required for fluid interaction. To address this, we propose TurnGuide, a novel text-speech interleaved generation approach for e2e FD-SLMs that dynamically segments assistant speech into dialogue turns and interleaves turn-level text and speech generation. This approach allows FD-SLMs to integrate the semantic intelligence of LLMs without compromising the natural acoustic flow. Extensive experiments show that TurnGuide not only significantly improves e2e FD-SLMs to produce semantically meaningful, coherent speech but also achieves state-of-the-art performance on various turn-taking events. Demos are available at https://dreamtheater123.github.io/TurnGuide-Demo/. Code is available at https://github.com/dreamtheater123/TurnGuide.

13.
arXiv (CS.LG) 2026-06-18

Strategic Feature Selection

arXiv:2606.18867v1 Announce Type: new Abstract: When algorithmic predictors inform resource allocation in high-stakes domains such as healthcare, these predictors must account for strategic manipulation of input features. The typical solution is to redesign the predictor itself to explicitly account for strategic interactions. In practice, however, decision makers are often constrained to adjusting coarser levers within existing prediction pipelines. For example, healthcare organizations often select which features to exclude based on perceived manipulability, while using standard regularization procedures to shrink the coefficients of retained features. In this work, we initiate a formal study of strategic classification through feature selection and its interaction with ridge regularization. Our main finding is that excluding individual features based on their manipulability alone is generally suboptimal. We provide a fine-grained characterization of the performance of a feature subset under optimal regularization, yielding new insights for policy design. Motivated by this characterization, we develop a practical algorithm for jointly choosing the feature set and the level of ridge regularization. Through a real-world case study on a healthcare payments benchmark, we illustrate how our algorithm can guide the design of coarse policy levers in practice. Our results provide a principled, practical framework for mitigating the effects of strategic behavior in algorithmic decision-making systems.

14.
arXiv (CS.AI) 2026-06-16

Thinking with Visual Grounding

arXiv:2606.16122v1 Announce Type: new Abstract: Visual thinking should not only sound right; it should show its evidence. While recent vision-language models (VLMs) can produce natural-language reasoning traces, these traces often leave the supporting image regions implicit, making them hard to verify and difficult to supervise. We introduce visually grounded thinking, a reasoning process in which models interleave natural-language thoughts with explicit point or box groundings of the visual evidence used at each step. This lets the model express intermediate reasoning in language while grounding key objects in the image regions they refer to. To train this behavior, we construct a scalable synthesis pipeline that distills correct visual reasoning traces, extracts the visual objects required by the traces, grounds them with a SAM3-based agent, and derives aligned point and box supervision from the resulting masks. We further propose grounding-aware reinforcement learning, which combines answer correctness rewards with dense grounding rewards that score whether generated object references match the correct image evidence. Across two counting benchmarks and four spatial reasoning benchmarks, adding visually grounded thinking to Gemma3-4B-IT consistently improves performance over the original model and the non-grounded thinking baseline. On spatial reasoning, the visually grounded thinking 4B models match, and in some cases surpass, Gemma3-27B-IT from the same model family. Our analysis shows that point grounding is well suited to counting, while box grounding benefits most from explicit grounding rewards on spatial tasks. Overall, our results show that VLMs think better when their intermediate thoughts are tied to the image regions that make them true.

15.
arXiv (CS.CV) 2026-06-12

Comparing Commercial Depth Sensor Accuracy for Medical Applications

Depth estimation has numerous medical and surgical applications. We benchmark four depth sensors on a porcine bone specimen, a porcine belly specimen, and a silicone kidney phantom using stylus-sampled references. These objects contain several real-world challenges, including homogeneous surfaces, specular surfaces, and subsurface scattering. The comparison includes stereo, structured-light, and time-of-flight sensors at a distance of approximately 50 cm. Specifically, the Intel RealSense D405 (Intel RealSense, United States), PMD Flexx2 (pmdtechnologies, Germany), Stereolabs ZED 2i (Stereolabs, France), and Zivid 2M+ 60 (Zivid, Norway) are compared. The Zivid 2M+ 60 performed best across all objects and metrics considered in this work. The ZED ranked second for real tissue, but last on the phantom.

16.
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

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

Identification and Inference for Algorithmic Frontiers with Selective Labels

arXiv:2606.14977v1 Announce Type: cross Abstract: This paper provides identification results to characterize a fairness-accuracy (FA) frontier, and statistical inference tools to test hypotheses and build a confidence set for the FA-frontier, when outcomes are observed only for selected individuals. When the selection process is unrestricted but loss is measured in specific ways, we provide a characterization of the sharp identification region of the FA-frontier. Under an assumption of unconfoundedness conditional on observables (and unrestricted loss functions), we obtain point identification and propose a debiased machine learning estimator, derive its asymptotic distribution, and show how this can be used to carry out inference for the FA-frontier. In work in progress, we extend the partial identification results to a broader class of loss functions.

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

Cumulant expansion approach to the decay dynamics of interacting Mössbauer nuclei after strong impulsive excitation

arXiv:2510.00970v2 Announce Type: replace Abstract: Recent progress in accelerator-based x-ray sources brings higher excitation of ensembles of Mössbauer nuclei closer to experimental feasibility. Yet, a theoretical modeling of the decay dynamics of the interacting nuclear ensemble after the impulsive excitation is still an open challenge. Here, we derive a set of nonlinear equations which is capable of efficiently modeling large nuclear ensembles for arbitrary degrees of excitation. As key signature for higher excitation, we identify a non-linear time-evolution of the nuclear dipole phase, which can be tuned via the scattering geometry, and interferometrically be measured. Furthermore, we identify interesting finite-size effects in the nuclear dynamics of small ensembles. Our results provide important guidance for future experiments aiming at the non-linear excitation of nuclei. We further envision the exploration of finite size-effects in Mössbauer spectroscopy with highest spatial resolution, i.e., small sample volumes.

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

Pseudo-Formalization for Automatic Proof Verification

arXiv:2605.20531v2 Announce Type: replace-cross Abstract: Reliable verification of proofs remains a bottleneck for training and evaluating AI systems on hard mathematical reasoning. Fully formal proofs, in languages like Lean, are easy to verify because they are unambiguous and modular. Most proofs, particularly those written by AI systems, have neither property, and translating them into formal languages remains challenging in many frontier math settings. We propose Pseudo-Formalization (PF), a proof format that captures the modularity and precision of formal proofs while retaining the flexibility of natural language. A Pseudo-Formal proof is decomposed into self-contained modules, each stating its premises, conclusion, and proof in natural language. To verify the correctness of a regular natural language proof, an LLM translates it to Pseudo-Formal and then verifies each module independently, an algorithm we call Block Verification (BV). We evaluate PF+BV on two benchmarks spanning olympiad and research-level mathematics, where it pareto-dominates LLM-as-judge baselines on error-finding precision and recall. To support future work, we release our research-level proof verification benchmark ArxivMathGradingBench.

20.
arXiv (CS.CV) 2026-06-16

Projection and Quantisation: A Unifying View of Learning to Hash, from Random Projections to the RAG Era

Authors:

Approximate nearest-neighbour search underpins large-scale retrieval and retrieval-augmented generation, yet its methods are studied in communities that seldom read one another. We argue that they form one field with three design choices. We develop the projection-quantisation-organisation lens: every method places its projections, places its quantisation thresholds, and organises the resulting codes for search. We test the lens with a reproducible measurement, released as the open BitBudget benchmark, and report three findings. First, the quantisation axis delivers the largest memory savings: a one-bit code with full-precision re-ranking matches uncompressed quality for six of seven embedders, the scanned code one thirty-second of the float's size. Second, the orderings the lens anticipates, including a learned-embedding regime where binary codes overtake an inverted-file product quantiser at a matched byte budget, recur as the embedding is enlarged. Third, given class labels, an eight-byte supervised code more than doubles the retrieval quality of the two-kilobyte task-agnostic float it replaces. We also recast the semantic identifiers of generative retrieval as quantisation codes. The main contribution is a single, tested account of compact-code search, from random projections to the retrieval-augmented era.

21.
medRxiv (Medicine) 2026-06-17

Postoperative Cognitive Decline in Older Patients with Cardiovascular Disease and Preoperative Mild Cognitive Impairment

Objective. Older adults undergoing cardiac surgery may be vulnerable to postoperative cognitive decline. However, no studies have examined postoperative cognitive outcomes in older patients with cardiovascular disease (CVD) according to preoperative mild cognitive impairment (MCI). This study examined 12-month postoperative cognitive outcomes in older CVD patients according to preoperative MCI diagnosis and explored predictors of postoperative cognitive decline. Method. Twenty-two older CVD patients ([≥]65 years) and twenty-five controls were included. Neuropsychological assessment was conducted at baseline in both groups and repeated 12 months after surgery in the CVD group. MCI was diagnosed using current clinical criteria. Postoperative cognitive change was examined across preoperative MCI groups. Results. Fifty percent of patients met criteria for postoperative MCI, showing high diagnostic stability relative to preoperative frequency (45.5%). The preoperative CVD-MCI group showed a decline in working memory, executive functions, visual memory, and naming, whereas CVD-nMCI group declined only in verbal memory. Furthermore, CVD-MCI showed more heterogeneous postoperative cognitive trajectories of change than CVD-nMCI, who showed stability. Estimated IQ, APACHE-II score, and postoperative frailty were important variables in predicting the postoperative pattern. Conclusions. MCI frequency remained high and stable in older CVD patients across the preoperative and one-year postoperative period. However, this apparent diagnostic stability masks subclinical cognitive decline, particularly among patients with preoperative MCI, who showed greater susceptibility to further impairment. Estimated IQ, APACHE-II score, and postoperative frailty may be considered relevant predictors of outcome. These results highlight the value of preoperative neuropsychological assessment for characterizing postoperative cognitive risk in older CVD patients.

23.
medRxiv (Medicine) 2026-06-23

Innate immunity associates with protection from pneumococcal colonisation, but colonisation does not confer capsule-independent protection

Nasopharyngeal colonisation with Streptococcus pneumoniae is a prerequisite for transmission and disease and represents an important immunising event. While colonisation induces serotype-specific immunity, the mechanisms underlying heterologous protection remain unclear. We developed a controlled human infection model using pneumococcal serotype 15B and investigated colonisation dynamics, immunogenicity, and cross-protection against subsequent heterologous challenge with serotype 6B. Fifty-four healthy adults were intranasally inoculated with 15B at escalating doses. Colonisation rates peaked at 31.4% with 8 x 10 CFU per naris, lower than those historically observed with 6B and 3 strains. Density was also lower than previously observed with other strains. In vitro assays demonstrated that 15B adhered more readily to epithelial cells than 6B, but was less efficiently internalised, potentially reducing attack rates and colonisation density. Colonisation with 15B induced capsular polysaccharide-specific serum IgG, but baseline humoral immune measures did not predict protection from acquisition. Prior colonisation with 15B did not reduce acquisition of 6B upon re-challenge. Analysis of nasal microbiopsy samples revealed distinct innate activation signatures. Resistance to colonisation was associated with elevated baseline MIP-1 and MIP-1{beta} responses upon in vitro stimulation, whereas carriage was associated with enhanced chemokine and IL-6 responses. Local innate immune activation, rather than circulating antibody responses alone, may therefore contribute to colonisation control. We demonstrate that experimental colonisation with 15B does not confer heterologous protection against 6B and highlight the importance of mucosal innate immune conditioning in serotype-independent defence. Strategies enhancing nasal innate immune recruitment and activation may be required for broader protection against pneumococcal colonisation.

24.
arXiv (CS.CV) 2026-06-18

APT: Atomic Physical Transitions for Causal Video-Language Understanding

Physical events are not understood by their names alone, but by the causal state changes that compose them. A clip-level label such as "bounce" can be correct while hiding the process that makes the event physically valid, from support loss and contact onset to rebound and settling. To make this hidden process explicit, we introduce Atomic Physical Transitions (APTs): minimal, temporally localized state changes that bind a visible cue to an active physical mechanism and before/after dynamical regimes. An APT chain represents a video as an ordered causal transition sequence rather than a single aggregate event label: event labels tell what happened; APT chains explain why it happened. To make APTs learnable by VLMs, we construct mixed-source APT data from human annotations and simulator ground truth, covering 14 transition types across contact, gravity, friction, and rotation/stability, with 27,303 timed instances over 1,246 trials. Using this data, we find that current VLMs miss transition-level physics, with zero-shot recall at most 14% and errors dominated by missed transitions. Direct fine-tuning on APT chains improves transition detection but causes event-level forgetting, indicating that the model learns a specialized answer format rather than a reusable physical representation. We therefore propose APT-Tune, a parameter-efficient recipe that teaches VLMs to use causal transitions without forgetting how to answer video questions. It combines image-pad-aware supervision, format-conditional co-training, and mechanism-conditioned domain-to-type decoding to make APT learning format-robust and physically grounded. With only 11 M LoRA parameters on Qwen3-VL-2B, APT-Tune substantially improves APT recall while also improving event-level video transfer. These results show that APTs are not a new answer format, but a human-aligned causal supervision signal for physical video understanding.

25.
medRxiv (Medicine) 2026-06-22

Accounting for uncertainty in the expected treatment effect substantially increases the sample size required for randomised trials: implications for the feasibility of clinical trials in anaesthesia and critical care

Background Multicentre trials in anaesthesia and critical care report low rates of statistically significant differences. This finding may partly reflect conventional sample size methods, which assume a fixed treatment effect. Assurance methods use a design prior to represent uncertainty in the expected treatment effect, which may provide a more realistic way of estimating sample sizes. Methods We calculated power curves across a range of effect sizes, design priors, and sample sizes using frequentist and Bayesian assurance methods and compared the sample sizes required to achieve 80% and 90% power to the conventional method. We standardised the design priors across effect sizes using the coefficient of variation. We derived a theoretical limit for achievable power. We validated a normal approximation to the Bayesian posterior distribution. Results Frequentist and Bayesian assurance methods produced similar power curves across all scenarios. At a coefficient of variation of 0.5 - reflecting realistic prior uncertainty in the expected effect size - both methods required sample sizes that were approximately 1.5 to 3.5 times larger than the conventional method. The theoretical power limit depends only on the coefficient of variation of the design prior and holds true across all effect sizes. The normal approximation to the Bayesian posterior distribution matched the results obtained from Markov chain Monte Carlo sampling. Conclusions Incorporating clinical uncertainty in the expected effect size substantially increases the sample size required to achieve adequate power, which has important implications for the feasibility of randomised trials in anaesthesia and critical care.