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01.
arXiv (CS.CV) 2026-06-18

Generalized Kullback-Leibler Divergence Loss

In this paper, we delve deeper into the Kullback-Leibler (KL) Divergence loss and mathematically prove that it is equivalent to the Decoupled Kullback-Leibler (DKL) Divergence loss that consists of (1) a weighted Mean Square Error (wMSE) loss and (2) a Cross-Entropy loss incorporating soft labels. Thanks to the decoupled structure of DKL loss, we have identified two areas for improvement. Firstly, we address the limitation of KL loss in scenarios like knowledge distillation by breaking its asymmetric optimization property along with a smoother weight function. This modification effectively alleviates convergence challenges in optimization, particularly for classes with high predicted scores in soft labels. Secondly, we introduce class-wise global information into KL/DKL to reduce bias arising from individual samples. With these two enhancements, we derive the Generalized Kullback-Leibler (GKL) Divergence loss and evaluate its effectiveness by conducting experiments on CIFAR-10/100, ImageNet, and vision-language datasets, focusing on adversarial training, and knowledge distillation tasks. Specifically, we achieve new state-of-the-art adversarial robustness on the public leaderboard – RobustBench and competitive knowledge distillation performance across CIFAR/ImageNet models and CLIP models, demonstrating the substantial practical merits. Our code is available at https://github.com/jiequancui/DKL.

02.
arXiv (CS.AI) 2026-06-15

Securing the Future of IoMT in the Post-Quantum Era: An Edge-Native Federated Learning Approach

arXiv:2606.14515v1 Announce Type: cross Abstract: Internet of Medical Things (IoMT) devices operate under strict resource constraints while handling highly sensitive health data, making security and privacy critical concerns. Federated learning (FL) further complicates this landscape, as model updates exchanged during training may unintentionally expose private medical information. Emerging quantum computing capabilities threaten the long-term viability of conventional lightweight cryptographic mechanisms, motivating the integration of Post-Quantum Cryptography (PQC) into IoMT systems. This article discusses key enabling technologies for quantum-resilient IoMT, including post-quantum key establishment, lightweight encryption, and edge-native orchestration. We propose a scalable Kubernetes-based framework that integrates PQC into FL-enabled IoMT environments and validate it on a Raspberry Pi testbed. Results demonstrate that distributed cryptographic processing significantly reduces latency compared to sequential designs while maintaining feasible resource overhead. The primary contribution of this work lies in the design and validation of a secure orchestration and communication framework for FL-enabled IoMT systems. We conclude by outlining future directions toward energy-aware architectures, intelligent security optimization, and resilient next-generation Intelligent Internet of Medical Things (IIoMT) ecosystems.

03.
arXiv (quant-ph) 2026-06-11

TensorKit.jl: A Julia package for large-scale tensor computations, with a hint of category theory

arXiv:2508.10076v2 Announce Type: replace-cross Abstract: TensorKit$.$jl is a Julia-based software package for tensor computations, especially focusing on tensors with internal symmetries. This paper introduces the design philosophy, core functionalities, and distinctive features, including how to handle abelian, non-abelian, and anyonic symmetries through the ``TensorMap'' type. We highlight the software's flexibility, performance, and its capability to extend to new tensor types and symmetries, illustrating its practical applications through select case studies.

04.
arXiv (math.PR) 2026-06-11

Construction of ergodic IDLA forests in $\mathbb{Z}^d$

arXiv:2506.10476v2 Announce Type: replace Abstract: We prove the existence of infinite-volume IDLA forests in $\mathbb{Z}^d$ , with $d \geq 2$, based on a multi-source IDLA protocol. Unlike IDLA aggregates, the laws of the IDLA forests studied here depend on the trajectories of particles, and then do not satisfy the famous Abelian property. Their existence is due to a stabilization result (Theorem 1.1, our main result) that we establish using percolation tools. Although the sources are infinitely many, we also prove that each of them play the same role in the building procedure, which results in an ergodicity property for the IDLA forests (Theorem 1.2).

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

Science Earth: Towards A Planet-Scale Operating System for AI-Native Scientific Discovery

arXiv:2606.01316v2 Announce Type: replace Abstract: Scientific discovery demands intelligence, perseverance, and serendipity across vast search spaces. Today, top scientific capabilities remain siloed–one AI system for biological analysis, another for clinical reasoning, mathematical derivation, or materials simulation–and no pre-designed team can anticipate every skill a question will need. Science Earth is a planet-scale scientific runtime in which any capability–a simulation cluster, a wet-lab robot, a proof engine, a single-cell pipeline–can connect to any other, with collaboration structure emerging from the question itself. Its underlying EACN protocol lets capabilities discover one another, negotiate task ownership, and adjudicate across incompatible evidentiary standards without prior knowledge of who will meet whom. This shifts the organizing challenge from workflow design to open-ended connectivity. Two runs validate this under structurally distinct conditions. In a trans-Pacific higher-order Kuramoto synchronization study, agents identified and corrected a closure-ratio assumption in Ott-Antonsen analytic theory that fails outside the Lorentzian limit, within thirty minutes. In an eight-agent single-cell run on the 4.88M-cell Kang 2024 pan-cancer atlas, heterogeneous capabilities coupled over a 64.9-hour window with one structural external instruction, producing three new result layers and anchoring findings against an independent wet-lab study on an adjacent CCR8- TIGIT+ Treg subset. These cases are a first empirical reading, not a benchmark sweep. They show that when AI capabilities are truly connectable and coordination emerges from the problem, scientific reasoning becomes a distributed, self-correcting process–a step towards scaling AI-native discovery to the planet.

06.
arXiv (quant-ph) 2026-06-11

Locally Acting Grover Mixers for Constraint-Preserving QAOA

arXiv:2606.11530v1 Announce Type: new Abstract: The Grover mixer quantum alternating operator ansatz (GM-QAOA) employs the Grover mixer to confine the quantum evolution to the feasible subspace defined by the problem. Its mixing unitary, however, requires a global multi-controlled phase-shift gate acting on all qubits, resulting in substantial circuit overhead on near-term quantum devices. In this work, we propose locally acting Grover mixers tailored to initial states that admit a product structure over disjoint qubit subsystems, which may be obtained by encoding only a subset of problem constraints into the initial state preparation. The proposed method preserves the search space defined by the initial state while significantly lowering implementation cost, as the global multi-controlled phase-shift gate is replaced with local operations on disjoint subsystems. Numerical simulations on the exact-cover problem and the traveling salesman problem (TSP) demonstrate that the proposed method achieves convergence behavior comparable to that of the original GM-QAOA, while using shallower circuits with fewer gates. We further compare two constraint encoding strategies for the TSP, encoding only a subset of constraints versus all constraints into the initial state preparation, and show that the former combined with the proposed mixer yields markedly more compact circuits at the point where comparable solution quality is achieved.

07.
Nature Medicine 2026-06-17

General-purpose chatbots outperform clinical AI tools on physicians’ real-world questions

Authors: Unknown Author

Specialized clinical AI tools are entering medical practice with little independent testing. In a head-to-head evaluation across two public benchmarks and real questions from physicians, three general-purpose frontier large language models outperformed two leading clinical AI tools, which performed no better than Google search AI overview.

08.
arXiv (quant-ph) 2026-06-12

Quantum Network Routing based on Surface Code Error Correction

arXiv:2606.12781v1 Announce Type: new Abstract: Quantum networks encounter unavoidable channel noises and erasure errors, presenting a huge obstacle in designing protocols that attain both high reliability and efficiency. Typically, quantum networks fall into two categories: those utilize quantum entanglements for quantum teleportation, and those directly transfer the actual quantum messages. In this paper, we present SurfNet, a quantum network that inherits the main advantages from both categories. It employs surface codes as logical qubits for encoding messages, and utilizes two parallel communication channels to fault-tolerantly transfer each surface code in a modular manner. Our approach of using surface codes can timely correct both operational and photon loss errors within the network, and the integration of the two channels within the network can greatly improve network throughput. For the implementation of SurfNet, we propose a novel network architecture, designed to better integrate surface codes into quantum networks. We also propose a novel error correction decoder, designed to fully utilize the modular characteristic of surface codes within our network. Simulation results demonstrate that SurfNet with its decoder significantly enhances the communication fidelity within quantum networks.

09.
arXiv (quant-ph) 2026-06-15

Calibrated Helstrom geometry on the Bloch ball via Connes spectral distance

arXiv:2606.13824v1 Announce Type: new Abstract: We show that the equal-prior Helstrom trace-distance geometry of qubit states is recovered from Connes spectral distance in a finite scalar-qubit-scalar model. The two scalar reference sectors couple isotropically to the qubit block through identity Dirac links, so that the full Bloch ball, including mixed states, inherits its standard chordal trace-distance geometry from the finite spectral metric. The scalar-sector distances serve a distinct calibration role: they determine the individual link lengths, satisfy a Pythagorean consistency relation, and reconstruct the middle-sector scale.

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

Confusion-Aware Transfer Teacher Curriculum Learning Framework: Disentangling Scoring and Pacing Effects

arXiv:2606.17706v1 Announce Type: cross Abstract: Curriculum learning couples two design choices, how samples are scored by difficulty and how harder samples are paced into training, making it difficult to attribute observed gains to either component. We disentangle these factors with two evaluation protocols: stage-wise test subsets that validate scoring functions independently of curriculum training, and a baseline that applies the same pacing schedule to randomly ordered data. Within the Transfer Teacher framework (TTF), we use these protocols to evaluate a confusion-aware difficulty score that considers both correct-class confidence and the probability distribution over incorrect classes. On CIFAR-10 with ResNet-18 and VGG-16, the proposed score produces model-interpretable difficulty rankings that align with human intuition. However, at full data, neither curriculum nor anti-curriculum ordering improves accuracy over standard training, indicating that improving the scoring function alone is insufficient to overcome the known failure modes of curriculum learning in TTF. In contrast, We find that confusion-aware curriculum ordering result in consistent data-efficiency benefits, outperforming random ordering by up to 8.7% points at the 20% data regime, suggesting the potential of TTF as a data-efficient training method.

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

Prism: Cost-Efficient Multi-LLM Serving via GPU Memory Ballooning

arXiv:2505.04021v3 Announce Type: replace-cross Abstract: Inference providers must maintain availability for many LLMs, including low-volume but essential models, making resource efficiency increasingly important as token prices fall. Analysis of production traces reveals a dynamic bursty-group pattern in which sets of models become active together and shift over time; existing space- and time-sharing approaches lack principled mechanisms to adapt to this variability, forcing trade-offs between SLO adherence and efficiency. We observe that elastic memory allocation can unify spatial and temporal sharing. Based on this insight, we have developed Prism, a memory-centric LLM co-serving framework that applies memory ballooning to reclaim memory across models and support both forms of sharing under a single scheme. Prism's balloon driver, referred to as kvcached, has been open-sourced at https://github.com/ovg-project/kvcached, and deployed in production environments across 10K+ GPUs.

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

Few-Shot Resampling for Scalable Statistically-Sound Data Mining

arXiv:2606.11235v1 Announce Type: new Abstract: A key step in knowledge discovery is the evaluation of data mining results. In several applications, including pattern mining, graph analysis, and others, this step includes the evaluation of the statistical significance of the results, to avoid spurious discoveries due only to noise or random fluctuations in the data. While specialized procedures have been developed for some specific applications, resampling-based approaches are widely used, in particular for complex analyses where analytical results cannot be derived. However, current resampling-based approaches require the generation and analysis of thousands of resampled datasets, and are therefore impractical for large datasets or computationally intensive analyses. In this paper, we introduce FewRS, a simple and effective resampling-based approach to assess the statistical significance of data mining results with rigorous guarantees on the probability of false discoveries. Our approach can be used in every situation where resampling-based approaches are applied. FewRS builds on our derivation of a novel bound to the supremum deviation of test statistics representing the quality of data mining results. We prove that FewRS needs to generate and analyze an extremely small number of resampled datasets, leading to a highly scalable approach with wide applicability. We test our approach on common tasks such as pattern mining and network analysis. In all cases, our approach results in a reduction of up to two orders of magnitude in running time compared to the state of the art, while preserving high statistical power, enabling the statistical validation of data mining results on large-scale real-world datasets.

13.
PLOS Computational Biology 2026-06-04

CIPHER: An end-to-end framework for designing optimized aggregated spatial transcriptomics experiments

by Zachary Hemminger, Haley De Ocampo, Fangming Xie, Zhiqian Zhai, Jingyi Jessica Li, Roy Wollman Motivation Most imaging-based spatial transcriptomics methods measure individual genes, which limits scalability and typically requires integration with scRNA-seq to recover full cellular states. Recent approaches such as CISI, FISHnCHIPs, and ATLAS address this limitation by measuring aggregate transcriptional signatures, where multiple genes are pooled into each channel to increase throughput. While aggregate measurements improve scalability, they shift the problem from gene selection to feature design. For effective integration with scRNA-seq, these signatures must be not only discriminative in transcriptional space but also straightforward to measure, with balanced signal, sufficient dynamic range, and robustness to experimental noise. By optimizing decoding accuracy in isolation, existing methods leave substantial performance on the table. Results We present CIPHER (Cell Identity Projection using Hybridization Encoding Rules), a neural-network framework that jointly optimizes the experimental encoding matrix, i.e., the way that genes are aggregated to signatures, and the downstream cell embedding. CIPHER integrates the physical limits of imaging assays directly into its loss function, shaping the latent space to maximize discriminability while maintaining robustness to measurement noise and signal constraints. Using a large-scale mouse brain scRNA-seq reference, we show that CIPHER-designed encodings yield latent spaces with improved cell-type separability, uniform signal utilization, and greater resilience to hybridization variability, resulting in higher decoding accuracy from both simulated and experimental data. Conclusion CIPHER formulates aggregate signature design as a joint optimization problem over decoding accuracy and experimental measurability. This enables systematic, scRNA-seq-aligned feature design for scalable spatial transcriptomics based on aggregate measurements. Availability Code and documentation are available at https://github.com/wollmanlab/Design/.

14.
arXiv (CS.LG) 2026-06-19

A Hybrid GNN-FEM Framework for Phase-Field Fracture Simulation. Physics-Preserving Hybridization for Generalizable Surrogate Modeling

arXiv:2606.19378v1 Announce Type: new Abstract: Scientific machine learning (SciML) has emerged as a promising approach for accelerating simulations of complex physical systems, yet achieving physically consistent and generalizable predictions for nonlinear, history-dependent problems remains a central challenge. In this study, we propose a hybrid GNN–FEM framework for efficient and generalizable phase-field fracture modeling. While phase-field approaches provide a robust variational framework for simulating complex crack evolution, their high computational cost limits practical applications because they require solving coupled, nonlinear, and history-dependent systems within an incremental finite element procedure. To address this challenge, a graph neural network surrogate is integrated into the conventional staggered scheme, replacing the phase-field update at each load increment while retaining the FEM-based displacement solver to enforce mechanical equilibrium and boundary conditions. By preserving the incremental solution structure, the framework remains consistent with history-dependent fracture evolution without requiring the surrogate to approximate the full solution trajectory. This selective surrogate strategy emphasizes the identification of a physically meaningful and incrementally structured learning target, rather than relying on brute-force data generation to learn the full fracture process. The proposed framework achieves strong generalization across varying geometries, loading conditions, material properties, and discretizations through dimensionless feature design, a graph-based formulation on mesh-based domains, and a physics-informed loss derived from the governing phase-field equation. Numerical experiments demonstrate that the hybrid approach reduces computational cost while maintaining accuracy compared with conventional FEM, and exhibits robust predictive performance across diverse problem settings.

16.
arXiv (CS.AI) 2026-06-11

When Does Deep RL Beat Calibrated Baselines? A Benchmark Study on Adaptive Resource Control

arXiv:2605.26418v2 Announce Type: replace-cross Abstract: A properly calibrated rule-based autoscaler can beat every one of six mainstream deep reinforcement learning (DRL) algorithms on cost across every workload we test - so when, if ever, does DRL actually help? We study this in RLScale-Bench, a reproducible benchmark and evaluation protocol for DRL on adaptive resource control, where an agent allocates compute to a dynamic workload under cost and service-level constraints. We evaluate PPO, DQN, A2C, SAC, TD3, and DDPG under matched architectures, training budgets, and reward functions against a calibrated rule-based baseline across six workload patterns and five seeds (240 runs), instantiate the benchmark on Kubernetes Horizontal Pod Autoscaling, and probe distribution-shift generalization. Three findings challenge common assumptions: (i) the calibrated controller achieves the lowest cost on all six workloads, though it trails the best RL agents on bursty and flash traffic; (ii) discrete-action algorithms outperform continuous-action ones by one to two orders of magnitude in constraint violations due to action-space mismatch; and (iii) no single algorithm dominates across workloads, with rankings shifting by up to four positions. The bottleneck in RL-based resource control is not algorithm selection but baseline calibration, reward engineering, and realistic evaluation protocols.

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

JE-IRT: A Geometric Lens on LLM Abilities through Joint Embedding Item Response Theory

Standard LLM evaluation practices compress diverse abilities into single scores, obscuring their inherently multidimensional nature. We present JE-IRT, a geometric item-response framework that embeds both LLMs and questions in a shared space. For question embeddings, the direction encodes semantics and the norm encodes difficulty, while correctness on each question is determined by the geometric interaction between the model and question embeddings. This geometry replaces a global ranking of LLMs with topical specialization and enables smooth variation across related questions. Building on this framework, our experimental results reveal that out-of-distribution behavior can be explained through directional alignment, and that larger norms consistently indicate harder questions. Moreover, JE-IRT naturally supports generalization: once the space is learned, new LLMs are added by fitting a single embedding. The learned space further reveals an LLM-internal taxonomy that only partially aligns with human-defined subject categories. We also show that simple linear probes of the embedding space recover cross-subject ability directions, such as an arithmetic axis that highlights quantitatively demanding questions in seemingly distant subjects like virology and global facts. JE-IRT thus establishes a unified and interpretable geometric lens that connects LLM abilities with the structure of questions, offering a distinctive perspective on model evaluation and generalization.

18.
arXiv (CS.LG) 2026-06-15

Towards Efficient Large Language Reasoning Models via Extreme-Ratio Chain-of-Thought Compression

arXiv:2602.08324v5 Announce Type: replace Abstract: Chain-of-Thought (CoT) reasoning successfully enhances the reasoning capabilities of Large Language Models (LLMs), yet it incurs substantial computational overhead for inference. Existing CoT compression methods often suffer from a critical loss of logical fidelity at high compression ratios, resulting in significant performance degradation. To achieve high-fidelity, fast reasoning, we propose a novel EXTreme-RAtio Chain-of-Thought Compression framework, termed Extra-CoT, which aggressively reduces the token budget while preserving answer accuracy. To generate reliable, high-fidelity supervision, we first train a dedicated semantically-preserved compressor on mathematical CoT data with fine-grained annotations. An LLM is then fine-tuned on these compressed pairs via a mixed-ratio supervised fine-tuning (SFT), teaching it to follow a spectrum of compression budgets and providing a stable initialization for reinforcement learning (RL). We further propose Constrained and Hierarchical Ratio Policy Optimization (CHRPO) to explicitly incentivize question-solving ability under lower budgets by a hierarchical reward. Experiments on three mathematical reasoning benchmarks show the superiority of Extra-CoT. For example, on MATH-500 using Qwen3-1.7B, Extra-CoT achieves over 73\% token reduction with an accuracy improvement of 0.6\%, significantly outperforming state-of-the-art (SOTA) methods. Our source codes have been released at https://github.com/Mwie1024/Extra-CoT.

19.
arXiv (CS.LG) 2026-06-11

A Data-Centric Framework for Detecting and Correcting Corrupted Labels

arXiv:2606.11699v1 Announce Type: new Abstract: The performance of machine learning and deep learning models largely depends on the quality of the training data. However, the quality of the real-world datasets is often compromised by noisy labels, which can substantially degrade model accuracy and reliability. To address this challenge, we propose Relabeler, an end-to-end data-centric framework for detecting and correcting corrupted labels. For corrupted label detection, Relabeler jointly leverages both local and global relationships among data instances to identify potentially noisy samples. After detecting suspicious instances, Relabeler further performs label correction by estimating the most probable clean label for each instance based on both its input features and observed noisy label. Extensive experiments across multiple datasets, noise types, and noise rates demonstrate that Relabeler consistently outperforms state-of-the-art baselines, achieving up to 58% improvement in label correction precision and 6% improvement in downstream task performance.

20.
arXiv (CS.LG) 2026-06-18

Clustering and Pruning in Causal Data Fusion

arXiv:2505.15215v3 Announce Type: replace-cross Abstract: Data fusion, the process of combining observational and experimental data, can enable the identification of causal effects that would otherwise remain non-identifiable. Although identification algorithms have been developed for specific scenarios, do-calculus remains the only general-purpose tool for causal data fusion, particularly when variables are present in some data sources but not others. However, approaches based on do-calculus may encounter computational challenges as the number of variables increases and the causal graph grows in complexity. Consequently, there exists a need to reduce the size of such models while preserving the essential features. For this purpose, we propose pruning (removing unnecessary variables) and clustering (combining variables) as preprocessing operations for causal data fusion. We generalize earlier results on a single data source and derive conditions for applying pruning and clustering in the case of multiple data sources. We give sufficient conditions for inferring the identifiability or non-identifiability of a causal effect in a larger graph based on a smaller graph and show how to obtain the corresponding identifying functional for identifiable causal effects. Examples from epidemiology and social science demonstrate the use of the results.

21.
arXiv (CS.CV) 2026-06-16

Simulation-Based Multi-Fillet Evaluation of Woody Breast Poultry Fillets

Woody breast (WB) is a myopathy in modern broiler chickens that causes the breast muscle to become unusually stiff and fibrous, leading to decreased meat quality and significant economic losses. State-of-the-art automated WB detection relies on a side-view imaging system to analyze the bending behavior of a single fillet as it falls off a conveyor belt. While highly accurate, this approach is constrained by its single-fillet field of view, creating throughput bottlenecks on commercial processing lines. In this paper, we address this limitation via a novel multi-fillet detection architecture utilizing a top-down camera configuration. To validate our approach, we first develop a high-fidelity digital twin of an industrial conveyor system. Next, we synthesize a diverse dataset of 3D fillet meshes and model their viscoelastic bending dynamics using a physics-based simulation engine. Lastly, a continuous 2D shape deformation score is extracted from the top-down perspective as the simulated fillets traverse the roller precipice. Experimental results demonstrate that the top-down shape score effectively captures the contour changes of the fillets as it bends, providing a robust and scalable alternative to a side-view imaging system for simultaneous multi-fillet WB evaluation.

22.
arXiv (CS.CV) 2026-06-17

Learning a Maximum Entropy Model for Visual Textures using Diffusion

Visual textures – spatially homogeneous image regions containing repeated elements (e.g. a field of grass, the bark of a tree) – are ubiquitous in visual scenes and provide important cues for recognizing and analyzing materials and objects. A number of existing texture models extract essential statistics from a single texture image, and can then generate high-quality samples that are visually similar to the original by matching these statistics. However, their statistics are either hand-designed or based on a network pretrained for another purpose (e.g., object recognition). Here, we develop the first principled method for unsupervised learning of a set of statistics that are used to constrain a maximum entropy probability model. We leverage methods developed for generative diffusion models to derive training and sampling procedures, and compare these to the traditional method of sampling via matching the statistics. Despite the compactness of our trained model (512 statistics), it generates texture images whose quality is as good as or better than the current state-of-the-art model (~177k statistics). A more direct comparison of the two models, obtained by synthesizing images that are indistinguishable for one model but maximally different for the other, reveals their relative strengths and weaknesses. Finally, we show that unlike previous statistical texture models, a straight trajectory in the representation space of our model generates homogeneous texture samples that interpolate smoothly between the features of the two end points.

23.
medRxiv (Medicine) 2026-06-22

''Circumstantial Determinants'': An Efficient Approach to Reaching People in Need of HIV Prevention?

HIV prevention and testing programmes primarily reach people who self-refer or attend routine health services. Higher-risk individuals are missed if they are healthy, under-estimate their risk of infection or under-report sexual risk-behaviours. We assess a new approach to address limitations in existing programmes by targeting HIV services on ''Circumstantial Determinants'' (CDs) of HIV risk - the social circumstances, settings, and norms associated with behaviours that increase risk of HIV acquisition. Data on potential CDs and sexual behaviour were collected in a population survey in Zimbabwe in 2018/19 (N=9141). HIV-negative individuals reporting [≥] 1 sexual risk-behaviours were defined as the 'priority population' for HIV prevention. For each sex, six circumstantial determinants were associated with being in the priority population (aOR [≥] 1.30; p [≤] 0.01). Reach and efficiency of CDs (and combinations) were calculated; ROC curve algorithms evaluated their ability to identify priority population membership; and HIV prevention condom cascades were compared between CD-defined priority population subgroups. Example findings include that targeting men at bars and beerhalls could reach 48.5% of the priority population and 25.1% of lower-risk men. These percentages increase to 77.1% and 53.7% if men with poor mental health, no religious affiliation, negative social capital, or living on agricultural estates are also targeted. Targeting women with poor mental health could reach 32.0% of the priority population and 21.3% of lower-risk women. Targeting additional circumstantial determinants increases these percentages to 54.1% and 37.5%, respectively. Cascade barriers to condom use differed between CD-defined subgroups. The Circumstantial Determinants approach demonstrates proof-of-concept potential to strengthen HIV prevention services.

24.
medRxiv (Medicine) 2026-06-18

Chest X-Ray as a critical screening tool for Household Contacts of TB: Lessons from Three Years of Programmatic Data in India

Introduction: Household contacts (HHCs) of pulmonary TB patients remain at high risk for TB infection and disease progression, yet many remain asymptomatic and are missed by symptom-screening pathways. While India expanded its TB preventative guidelines to include all HHCs in 2021, chest X-ray (CXR) screening continues to be used selectively, representing a missed opportunity in early case detection. Methods: The analysis uses programmatic data from Project JEET 2.0 (Joint Effort for Elimination of Tuberculosis), implemented by the William J. Clinton Foundation in India, between October 2021 and March 2024. Eligible HHCs (>=5 years) were offered CXR screening as part of TB preventive therapy (TPT) evaluation. Descriptive and multivariable analyses examined predictors of CXR uptake and TB yield. A two-stage logistic regression model estimated potential TB yield under universal CXR coverage. Model performance was evaluated using the area under the curve (AUC), and bootstrap simulations generated counterfactual estimates of missed TB cases. Results: Among 1,034,621 HHCs, 1.02% individuals were found positive for TB, which includes 7,786 HHCs who were on TB treatment already, while an additional 2,812 were identified during pre-TPT evaluation. Among eligible HHCs (n = 1,026,835), 70% were screened with CXR, of which 2.4% had suggestive TB findings. Of these, 79% went for further TB assessment. Symptomatic HHCs were more likely to be CXR screened (84% vs 69%) and assessed for TB, yet two-thirds of all detected TB cases were asymptomatic. It is estimated that universal CXR coverage and TB testing for suggestive cases can increase TB detection by at least 87%. Conclusion: The study provides a scalable approach to expand CXR coverage through public-private partnerships, enabling early TB detection among HHCs, especially among asymptomatic contacts. Future implementations will benefit from integrating AI-enabled reading, along with systematic follow up for those with suggestive findings.

25.
medRxiv (Medicine) 2026-06-18

Rare Coding Variants Reveal Distinct Genetic Architectures Across Multidimensional Sleep Phenotypes

Sleep and circadian traits have been widely studied using common variants, but the contribution of rare coding variation remains unclear. We analyzed rare coding variants in 397,065 whole-exome sequenced UK Biobank participants across 36 sleep phenotypes from self-report, diagnoses, sleep medication use and accelerometry, and meta-analyzed results with 171,536 whole-genome sequenced All of Us participants of diverse ancestries, with replication in the Mass General Brigham Biobank (N = 31,275). We identified 260 genes associated with sleep phenotypes, including novel associations with sleep medication use in 29 genes and 24 out of 29 have not previously been reported with any sleep phenotypes. We observed modest but significant rare variant heritability and strong genetic correlations between sleep medication use, insomnia and fatigue. Temporal gene expression trajectory analyses indicate that genes associated with self-reported sleep traits show constant high prenatal expression, whereas genes linked to sleep medication phenotypes exhibit peak expression in the late prenatal period. These findings highlight distinct biological mechanisms captured by different measurement sources of sleep phenotypes and reveal rare-variant-informed targets for therapeutic discovery.