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01.
arXiv (quant-ph) 2026-06-16

Forbidden transitions in superconducting artificial atoms

arXiv:2606.06069v2 Announce Type: replace Abstract: Artificial atoms built from Josephson junctions have become a powerful tool to explore the limits of quantum optics due to their strong coupling to electromagnetic fields and their sensitivity to changes at the single-photon level. This sensitivity to quantum fluctuations complements their metrological and computational use, which are based on the precise oscillating frequency of the underlying supercurrents. We present here a theory for Josephson junctions immersed in electromagnetic fields where focus is shifted from temporal correlations and towards spatial ones. Unlike the commonly used circuit and black-box descriptions, our work is based on a microscopic model that enables systematically accounting for the effect of the spatial and vectorial profile of an electromagnetic field over a junction. As an example of the interactions that emerge in such a setup, we investigate the possibility of driving a junction via a quadrupole transition, using typical experimental parameters in existing devices. With the transition being dependent on the gradient of the electric field – rather than its intensity – the junction can be excited in a region where the electric field vanishes.

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

Direct Fisher Score Estimation for Likelihood Maximization

arXiv:2506.06542v2 Announce Type: replace-cross Abstract: We study the problem of likelihood maximization when the likelihood function is intractable but model simulations are readily available. We propose a sequential, gradient-based optimization method that directly models the Fisher score based on a local score matching technique which uses simulations from a localized region around each parameter iterate. By employing a linear parameterization to the surrogate score model, our technique admits a closed-form, least-squares solution. This approach yields a fast, flexible, and efficient approximation to the Fisher score, effectively smoothing the likelihood objective and mitigating the challenges posed by complex likelihood landscapes. We provide theoretical guarantees for our score estimator, including bounds on the bias introduced by the smoothing. Empirical results on a range of synthetic and real-world problems demonstrate the superior performance of our method compared to existing benchmarks.

03.
arXiv (CS.CV) 2026-06-17

Contactless Respiratory Monitoring on Heterogeneous Mobile Robots: A Multimodal Edge-Computing Framework

Respiratory-rate (RR) monitoring is a critical component of remote triage and victim assessment in emergency response, disaster recovery, and infectious-disease scenarios, where minimizing physical contact can reduce responder risk and improve operational safety. However, field deployment of contactless RR monitoring remains challenging due to variable illumination, posture changes, platform heterogeneity, and the impracticality of wearable sensors in hazardous environments. In this paper, we present a modality-adaptive contactless RR monitoring framework for heterogeneous mobile robots with onboard edge computing. The proposed system combines brightness-adaptive sensor selection across RGB, thermal, near-infrared (NIR), and low-light cameras, keypoint-guided chest ROI extraction for posture-robust monitoring, and a signal-quality-index (SQI)-based filtering mechanism for reliable respiratory estimation. We implement and evaluate the framework on three robotic platforms spanning quadruped and wheeled locomotion and multiple edge-computing architectures. Experiments conducted across diverse lighting conditions, subject poses, and robot-to-subject distances demonstrate that the framework generalizes across platforms without per-platform algorithmic retuning, while revealing modality-specific operational boundaries. RGB provides the broadest coverage up to 8m, NIR remains effective up to 6m, thermal is reliable only at short range, and low-light sensing supports monitoring in complete darkness up to 8m. Overall, the results demonstrate the feasibility of multimodal contactless RR monitoring on mobile robots and support its use as a foundation for autonomous triage and victim assessment in hazardous search-and-rescue settings.

04.
arXiv (math.PR) 2026-06-16

A uniform-in-time weakly convergent explicit numerical method for the underdamped Langevin equation with polynomial potentials

Authors:

arXiv:2606.15175v1 Announce Type: cross Abstract: The underdamped Langevin equation is a fundamental model in statistical mechanics for sampling Gibbs measures and simulating molecular dynamics, for which numerical methods with uniform-in-time weak convergence are essential for accurately reproducing long-time statistical observables and invariant measures of the underlying dynamics. Currently, such uniform-in-time weak convergence is established for implicit schemes, but remains unknown for explicit ones under polynomially growing potentials. To improve efficiency in long-time simulations, we propose the first explicit numerical method for the underdamped Langevin equation with polynomially growing potentials that is proven to achieve uniform-in-time weak convergence. The explicit numerical method is constructed by introducing a dissipativity on the scalar auxiliary variable (SAV), which we call the DSAV method. The proposed DSAV method enables the approximation of the invariant measure for the underdamped Langevin equation with a precision of $\varepsilon$ at a significantly reduced computational cost of $\mathcal{O}(\varepsilon^{-1} \log(\varepsilon^{-1}))$. In addition, we establish the existence and positivity of the density function of the numerical solution without using the Malliavin calculus. Numerical experiments are performed to verify the theoretical findings and demonstrate the long-time stability of the proposed numerical method.

05.
arXiv (CS.LG) 2026-06-17

Resource-Efficient Variational Quantum Classifier

arXiv:2511.09204v3 Announce Type: replace-cross Abstract: We introduce the unambiguous quantum classifier based on Hamming distance measurements combined with classical post-processing. The proposed approach improves classification performance through a more effective use of ansatz expressivity, while requiring significantly fewer circuit evaluations. Moreover, the method demonstrates enhanced robustness to noise, which is crucial for near-term quantum devices. We evaluate the proposed method on a breast cancer classification dataset. The unambiguous classifier achieves an average accuracy of 90%, corresponding to an improvement of 6.9 percentage points over the baseline, while requiring eight times fewer circuit executions per prediction. In the presence of noise, the improvement is reduced to approximately 3.1 percentage points, with the same reduction in execution cost. We substantiate our experimental results with theoretical evidence supporting the practical performance of the approach.

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

Bioacoustic Geolocation: Species Sounds as Geographic Signals

arXiv:2505.18726v3 Announce Type: replace-cross Abstract: Can we determine someone's geographic location solely from the sounds they hear? Are acoustic signals enough to localize within a country, state, or even city? In this work, we tackle the challenge of global-scale audio geolocation, with a particular focus on wildlife and natural sounds. We posit that bioacoustic signals contain informative geolocation cues because of well-defined geographic ranges of species. To test this hypothesis, we benchmark image geolocation and soundscape mapping methods, design oracles and species-centric baselines, and propose a hybrid approach that combines species range prediction with retrieval-based geolocation. We further ask whether geolocation improves with species-diverse recordings and spatiotemporal aggregation across neighboring samples. Finally, we extend our study to multimodal geolocation with case studies from movies that combine both audio and visual content. Our results highlight the potential of incorporating bioacoustic signals into geospatial tasks, motivating future work on species recognition and audio geolocation.

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 (CS.AI) 2026-06-16

Attribute Inference from Interactive Targeted Ads

Authors:

arXiv:2606.15209v1 Announce Type: new Abstract: Targeted advertising systems can pair audiences selected by advertisers with ad units that expose visible user actions. When an interaction remains linked to the campaign that elicited it, the advertiser may receive an observation tied to a user rather than only an aggregate report. We model that channel as a noisy oracle for attribute inference. The model separates targeting predicates, exposure, interaction, and disclosure. These boundaries capture the gap between eligibility and delivery, and the gap between interaction and advertiser visibility. We build a reproducible benchmark using synthetic populations calibrated with public data, each with known sensitive labels. A generated campaign semantics layer provides topic variants and response priors. The simulator generates the ground truth, event traces, disclosed observations, and metrics. The evaluation compares Bayesian, supervised, positive and unlabeled, and adaptive attacks under common campaign and disclosure definitions. The final evaluation uses four topic variants, seven simulator seeds, and two interaction settings. Repeated campaigns with identity exposure produce measurable but bounded inference signal. At $160$ campaigns, Bayesian and supervised attacks reach about $0.64$ AUC in the main setting and about $0.65$ AUC in the higher interaction setting. Disclosure policy is the strongest control. Aggregate reporting removes the evaluated oracle input tied to users. Type filtering and randomized disclosure reduce the released signal. The result is a model, artifact, and defense evaluation method for privacy in interactive targeted advertising. The code is available at https://github.com/P-HOW/Interactive-Ad-Oracle.

09.
bioRxiv (Bioinfo) 2026-06-13

Testing the reliability of AI-generated protein structures

Authors:

Although AlphaFold2 and its competitors have demonstrated remarkable abilities to predict protein structure, more work is needed to explore the limitations of these methods. Here we investigated the reliability of AlphaFold2 and ColabFold by creating a set of realistic but false protein sequences, using ColabFold to predict their structure, and then asking how often the program produces a high-scoring structure for a sequence that does not represent a protein. We determined that AlphaFold2 has a very small but non-zero false positive rate, estimated here at approximately 1 in 435 if one uses a threshold pLDDT score of 70 to define positive predictions. We also discovered, serendipitously, that some high-scoring sequences in the human genome were not false positives, but instead were previously unknown and un-annotated pseudogenes. These latter findings indicate that some well-established human annotations of protein-coding genes may have incorrectly extended the 5-prime untranslated regions too far. They also suggest that the false positive rate of AlphaFold2 is low enough that almost any high-scoring structure, even in a noncoding region, is worthy of further investigation.

10.
arXiv (CS.CL) 2026-06-16

ROMPAR: Morphological Completion and Demographic Unlearning for Romanian-Accented Speech Recognition

Automated transcription of parliamentary proceedings faces significant hurdles due to demographic bias, dialectal variation, and technical artifacts such as utterance truncation during segmentation. This paper introduces the ROManian PARliamentary Speech Corpus (ROMPAR) dataset, a 17.80-hour corpus of Romanian and Moldavian parliamentary speech, featuring double-annotated ground truth and explicit labels for reconstructed word fragments. To build a robust ASR system, we propose a multi-task adversarial training framework that enforces demographic invariance across age, gender, and dialect. We address the inherent instability of adversarial objectives in generative architectures by introducing an exponential decay mechanism for the adversarial coefficients. Furthermore, we implement an LLM-guided decoding strategy with position-dependent weighting to facilitate morphological completion of truncated terminal words. Our results demonstrate that the proposed framework significantly reduces WER and achieves an F1-score of 96.6% in morphological reconstruction.

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

PromptShift-CRC: Drift-Aware Conformal Risk Control for Foundation Models Under Prompt and Domain Shift

arXiv:2606.15964v1 Announce Type: cross Abstract: Foundation models are now used in settings where the prompts they receive can change quickly. Users change, topics change, policies change, and the model may suddenly face a kind of request that was rare in the calibration data. This makes fixed calibration risky. Conformal prediction and conformal risk control give model-agnostic ways to control error, but they work best when the calibration data still look like the future data. This paper develops PromptShift CRC, a drift-aware conformal risk control method for foundation-model outputs under prompt and domain shift. The method embeds prompts and responses, measures how far the current prompt stream has moved from the calibration pool, gives more weight to relevant or recent calibration examples, and updates the risk level online after observed violations. It reports three practical diagnostics: realized risk error, prompt drift, and effective calibration size. We give conditions under which the method controls risk up to terms for distribution mismatch and weighted quantile uncertainty. In a synthetic prompt-shift benchmark, static conformal risk control fails sharply after drift, while PromptShift-CRC gives the best coverage among the adaptive baselines considered. We then evaluate the same calibration layer on public benchmark derived streams for question answering, toxicity, summarization factuality, and long-context hallucination risk

13.
arXiv (CS.AI) 2026-06-12

Multiagent Protocols with Aggregated Confidence Signals

arXiv:2606.13591v1 Announce Type: new Abstract: Confidence is used for reliability, oversight, and a range of downstream decision tasks in Natural Language Processing (NLP), yet no existing method produces or evaluates a confidence for the output of a multiagent system. Prior work uses confidence within multiagent debate (MAD) to weight messages, trigger debate, or calibrate individual agents, but it never aggregates these into a single confidence for the system itself. We introduce three protocols that produce a final answer along with a single aggregated confidence by first transforming raw confidence signals to make them comparable across models, then combining them via soft voting or a probability fusion we call Bayesian fusion. This aggregated confidence is substantially more discriminative (AUARC) than that of the best single agent or the standard debate baselines, while correctness (F1-score) stays stable and recovers the losses MAD incurs on more ambiguous tasks. Analyzing two estimators, sequence probability and self-report, alongside parametric and non-parametric calibrators, we find that calibration improves F1 for both estimators while AUARC is less reliant on it. We evaluate six homogeneous and heterogeneous debating pairs per benchmark, across five benchmarks and four task types, spanning a range of model capabilities and sizes.

14.
arXiv (CS.AI) 2026-06-15

Listening with Attention: Entropy-Guided Explainability for Transformer-Based Audio Models

arXiv:2606.14647v1 Announce Type: cross Abstract: Transformer-based automatic speech recognition (ASR) models such as Whisper are highly accurate, but their predictions remain difficult to interpret. Existing explainable AI (XAI) methods often lack faithfulness and precise temporal grounding. We propose Listening with Entropy-guided Attention for Faithful explainability (LEAF-X), a model-intrinsic XAI framework for transformer-based ASR. LEAF-X combines entropy-guided attention weighting, multi-layer attention rollout, and optional causal ablations to identify low-entropy, high-impact heads and layers, producing sparse token-to-frame attributions. Unlike perturbation-based explainers or raw attention maps, LEAF-X exploits the internal structure of encoder-decoder and speech-augmented decoder-only models to generate explanations that better reflect model computation. Results show 32% improved faithfulness, 35-39% stronger locality/sparsity, and the most stable attributions, supporting more transparent and auditable ASR.

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

Ride, Track, and Recover: Pilot Randomized Trial of a Wearable Digital Self-Management Intervention During a Veteran Endurance-Cycling Program

arXiv:2606.13529v1 Announce Type: cross Abstract: Post-traumatic stress disorder (PTSD) in veterans is characterized by persistent hyperarousal and comorbid anxiety and depressive symptoms that are difficult to monitor and manage outside clinical settings. Thirteen veterans participating in a Project Hero cycling event in Texas were randomized by computer-generated sequence in a naturalistic setting to two arms: (1) digital intervention plus physical activity, or (2) physical activity only, plus a third at-home monitoring control cohort consisting of 7 veterans selected from the broader Project Hero veteran community. Continuous smartwatch sensing combined heart rate and accelerometer features to detect hyperarousal events, which were confirmed in real time by participants. Weekly self-report measures of anxiety, depression, and PTSD severity were collected. Generalized additive mixed models characterized nonlinear trajectories over time. Baseline-normalized hyperarousal trajectories differed significantly across conditions, with the digital intervention group (n=7) showing structured stabilization compared to late-study escalation in the physical-only group (n=3). Both cycling groups exhibited acute symptom improvements during the endurance event; however, the digital intervention group demonstrated a higher overall maintenance of gains. The at-home control group (n=4) showed gradual symptom declines. Perceived precision of ML detections varied substantially across individuals and was positively associated with symptom severity, with higher-severity participants confirming a greater proportion of detected events. These results suggest that coupling wearable detection with digital self-management tools may support stabilization of hyperarousal and symptom improvement while emphasizing the importance of personalization and human-centered design in wearable mental health systems.

16.
arXiv (CS.CL) 2026-06-15

OLaPh: Optimal Language Phonemizer

Phonemization is a critical component in text-to-speech synthesis. Traditional approaches rely on deterministic transformations and lexica, while neural methods offer potential for higher generalization on out-of-vocabulary (OOV) terms. We introduce OLaPh (Optimal Language Phonemizer), a hybrid framework that integrates extensive multilingual lexica with advanced NLP techniques and a statistical subword segmentation function. Evaluations on the WikiPron benchmark show OLaPh significantly outperforms established baselines in overall accuracy and maintains robustness on OOV data through advanced fallback mechanisms. To further explore neural generalization, we utilize the framework to synthesize a high-consistency training corpus for an instruction-tuned Large Language Model (LLM). While the deterministic framework remains more accurate overall, the LLM demonstrates strong generalization, matching or partly exceeding the framework's performance. This suggests that the LLM successfully internalized phonetic intuitions from the synthetic data that transcend the framework's capabilities. Together, these tools provide a comprehensive, open-source resource for multilingual grapheme-to-phoneme conversion (G2P) research.

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

Rotational Symmetry based Object Pose Estimation from Point Clouds in the Absence of Known 3D Models

Object pose estimation is crucial to many industrial applications, with one example being automated spray painting using a robot. However, confidentiality concerns often limit access to high-quality 3D models, posing a significant challenge for point-cloud-based pose estimation. In such scenarios, rotational symmetry, a readily accessible characteristic of many industrial objects, can provide valuable prior information to facilitate pose estimation.In this paper, we propose a method that leverages the rotational symmetry commonly found in industrial objects to address the challenge caused by the absence of 3D models. The object pose is jointly estimated with point cloud refinement through an iterative optimization process. This optimization relies on a rotational symmetry constraint loss. To construct this loss, each 3D point is rotated according to the currently estimated pose, and multiple correspondences are identified using nearest-neighbor search by exploiting the rotational symmetry property. These correspondences are then used to compute the rotational symmetry constraint loss, which iteratively refines both the pose and the point cloud.By explicitly incorporating rotational symmetry into the optimization process, the proposed method achieves robust pose estimation and generalizes well across diverse object types. The proposed method is evaluated on a dataset specifically created for point clouds without known 3D models, consisting of four categories of synthetic objects and one real wheel hub collected from a production line. Experimental results demonstrate that the proposed method achieves performance comparable to methods that rely on known 3D models.

19.
arXiv (CS.LG) 2026-06-16

Near-Optimal Stochastic Linear Bandits with Delay

arXiv:2606.16656v1 Announce Type: new Abstract: We study stochastic linear bandits with delayed feedback under several delay models and establish near-optimal regret guarantees. Our results identify when delayed linear bandits exhibit the same qualitative behavior as multi-armed bandits (MAB), and when the linear structure creates fundamentally new challenges. Specifically, (1) for loss-independent delays, where the delay does not depend on the realized loss (but potentially depends on the arm), we show that delays incur only an additive regret penalty. Under stochastic delays, this penalty scales with the expected delay, while under adversarial delays, it scales with the maximum number of outstanding observations. Notably, both delay penalties are dimension-free, improving upon the state-of-the-art results; (2) for loss-dependent delays, we show that linear bandits are substantially harder than MAB: unlike in MAB, we prove matching (up to log factors) upper and lower bounds in linear bandits, whose delay penalty depends on the square root of the dimension. (3) for the delay-as-payoff model, a special case of loss-dependent delay, we show that the optimal MAB guarantee, which depends only on the delay of the optimal arm, is also unattainable in linear bandits. Together, these results provide a sharp characterization of how delayed feedback interacts with linear generalization.

20.
arXiv (CS.LG) 2026-06-19

Indexed Bellman Information Complexity

Authors:

arXiv:2606.11171v2 Announce Type: replace Abstract: We develop indexed Bellman information complexity, a representation-level theory of interactive decision making centered on information indices and reference histories. The representation strips away problem-specific syntax and retains only the ingredients needed for dynamic programming and information accounting, thereby unifying the earlier framework of indexed algorithmic information ratios (AIR). On the upper-bound side, regret is controlled by Bellman supersolutions or potential identities whose gradient bracket is paid for by indexed information. Upper-confidence-bound (UCB), estimation-to-decision/decision-estimation-coefficient (E2D/DEC), and adaptive-minimax-sampling or exploration-by-optimization (AMS/EBO) methods appear as three relaxations of this same identity. On the lower-bound side, the posterior-reference trajectory supplies both the information telescope and the ghost quantile of small-regret trajectories. The resulting critical radius in the lower bound is an effective-dimension-scale quantity, as in Fano and local-prior-mass lower bounds, rather than the constant radius of a two-point Le Cam argument. The examples show that DEC is best viewed as a one-step relaxation of indexed Bellman information complexity, not as a universally tight conversion mechanism. We illustrate the framework through several applications, with particular emphasis on kernel bandits. In this setting, the active action marginal provides a concrete basis for comparing UCB, E2D, and AMS/EBO.

21.
arXiv (CS.CV) 2026-06-12

Improving Pre-trained Adult Glioma Segmentation Models Using only Post-processing Techniques

Gliomas are the most common malignant brain tumors in adults and are among the most lethal. Despite aggressive treatment, the median survival rate is less than 15 months. Accurate multiparametric MRI (mpMRI) tumor segmentation is critical for surgical planning, radiotherapy, and disease monitoring. While deep learning models have improved the accuracy of automated segmentation, large-scale pre-trained models generalize poorly and often underperform, producing systematic errors such as false positives, label swaps, and slice discontinuities in slices. These limitations are further compounded by unequal access to GPU resources and the growing environmental cost of large-scale model training. In this work, we propose adaptive post-processing techniques to refine the quality of glioma segmentations produced by large-scale pretrained models developed for various types of tumors. We demonstrated the techniques in multiple BraTS 2025 segmentation challenge tasks, with the ranking metric improving by 14.9 % for the sub-Saharan Africa challenge and 0.9% for the adult glioma challenge. This approach promotes a shift in brain tumor segmentation research from increasingly complex model architectures to efficient, clinically aligned post-processing strategies that are precise, computationally fair, and sustainable.

22.
arXiv (quant-ph) 2026-06-12

Quantum Reference Fields Transformations in Linearized Quantum Gravity

arXiv:2606.09344v1 Announce Type: cross Abstract: Diffeomorphism invariance is a central feature of general relativity. Without external reference structures, matter and geometry must be specified relationally, with respect to internal subsystems serving as reference frames. In quantum gravity, these reference systems must themselves be treated as quantum, motivating the use of quantum reference frames. In this work, we address how such a relational description could be formulated within linearized quantum gravity. To this purpose, we introduce quantum reference fields, i.e. sets of four dynamical scalar fields whose stress-energy tensors enter the gravitational constraints. These fields extend the notion of quantum reference frames to local field-theoretic reference systems, allowing matter and gravitational degrees of freedom to be described relationally with respect to physical quantum systems. By generalizing the perspective-neutral construction of quantum reference frames, we show that relational, gauge invariant observables admit reduced descriptions in the perspective of each quantum reference field, and we derive the unitary transformations relating them. The resulting unitary maps implement local quantum coordinate changes between different internal perspectives, and act on the linearized gravitational field with an analogous structure to a linearized diffeomorphism, but with the classical gauge parameter replaced by a physical quantum field. Finally, we construct a relational von Neumann-type measurement scheme, showing how the corresponding reduced observables can be accessed operationally from the perspective of a quantum reference field.

23.
medRxiv (Medicine) 2026-06-19

Specific epigenetic age acceleration measures are associated with oral health outcomes in U.S. adults

Objectives: Oral health conditions impact a significant proportion of the global population. Chronological age is a known risk factor; however, characterization of epigenetic age remains limited and is expected to provide additional insight into biological mechanisms. Materials and Methods: The National Health and Nutrition Examination Survey (NHANES) was used to analyze the effect of epigenetic age measures of DunedinPoAm, and epigenetic age acceleration (EAA) of Horvath, Hannum, Weidner, Lin, VidalBralo, PhenoAge, GrimAge, and GrimAge2, on various oral health outcomes from survey and examination results. Univariable and multivariable logistic regression were performed, adjusting for sex, race-ethnicity, education, poverty income ratio categories, and dental insurance coverage status. Results: DunedinPoAm was associated with the last dental appointment being for an existing issue (p=0.0093), poor general oral condition (p=0.0226), limiting food due to teeth problems (p=0.0031), and recommendation to see a dentist within the next two weeks (p=0.0171). EAAs for PhenoAge, GrimAge, and GrimAge2, were associated with a smaller number of oral health outcomes, whereas EAAs for Horvath, Hannum, Weidner, Lin, and Vidal-Bralo showed no associations. Conclusions: In a representative U.S. population, DunedinPoAm was most consistently positively associated with different adverse oral health outcomes compared with other epigenetic aging measures. Tracking specific epigenetic ages such as DunedinPoAm, EAA GrimAge, EAA GrimAge2, and PhenoAge, may aid in additional monitoring of oral health outcomes. Understanding specific aging-related CpGs associated with oral health may aid in elucidating underlying molecular mechanisms.

24.
medRxiv (Medicine) 2026-06-17

Diagnostic Concordance of Immediate Versus 1-Hour Technetium-99m Hydroxydiphosphonate Scintigraphy in Suspected Transthyretin Amyloid Cardiomyopathy

Background Bone-avid tracer myocardial scintigraphy for the diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) has traditionally employed imaging at one or 3-hour intervals. Technetium-99m hydroxydiphosphonate (99mTc-HDP) has unique characteristics that may enable earlier imaging. We investigated the diagnostic concordance of immediate versus 1-hour acquisitions. Methods Consecutive patients with suspected ATTR-CM underwent planar imaging and SPECT/CT immediately and at 1-hour following the administration of 99mTc-HDP. Perugini grades and heart to contralateral lung (H/CL) ratios were assessed. Target-to-background ratios (TBRs) were calculated on the SPECT/CT acquisitions using the left ventricular (LV) septum and three background regions: aorta, LV blood-pool, and vertebrae. We assessed diagnostic concordance using Cohen's Kappa ({kappa}), temporal stability using paired t-tests, and correlation between timepoints using Pearson's coefficient (r). The 1-hour SPECT/CT interpretation served as the protocol reference standard. Results Forty-eight patients (83% male; median age, 80 [73-85] years) were evaluated. One-hour SPECT/CT identified 19 positive and 29 negative cases. Immediate SPECT/CT demonstrated 100% diagnostic concordance with the 1-hour reference standard ({kappa} = 1.000; 95% CI: 1.00 to 1.00; p < 0.001). The LV septum/LV Blood-Pool TBR showed the highest correlation (r = 0.956; 95% CI: 0.922 to 0.975; p < 0.001). The LV Septum/Aorta TBR demonstrated high correlation (r = 0.918; 95% CI: 0.857 to 0.953; p < 0.001) and remained stable in the ATTR-negative cohort (-0.02; 95% CI: -0.08 to 0.04; p = 0.54). Significant decrease in the LV Septum/Vertebrae TBR in the ATTR-negative (-0.55; 95% CI: -0.64 to -0.47; p < 0.001) and ATTR-positive cohorts (-1.14; 95% CI: -1.39 to -0.89; p < 0.001) was observed. Conclusions Immediate 99mTc-HDP SPECT/CT is diagnostically concordant with standard 1-hour protocols. By leveraging SPECT/CT and the favorable kinetics of 99mTc-HDP, immediate-phase imaging can accurately reproduce 1-hour acquisitions in cases of suspected ATTR-CM. This expedited approach may improve nuclear laboratory throughput and patient satisfaction.

25.
medRxiv (Medicine) 2026-06-15

Artificial Intelligence-Based Detection of Airway Mucus Plugs on CT and Associations With Clinical Outcomes in COPDGene

RATIONALE: Airway mucus plugging is a clinically relevant manifestation of airway pathology in chronic obstructive pulmonary disease (COPD) and is associated with increased mortality even in early disease; however, visual computed tomography (CT) assessment is subjective and labor intensive. OBJECTIVES: To develop an AI-based quantitative CT method for automated detection of airway mucus plugging and evaluate associations with physiologic impairment and clinical outcomes. METHODS: Inspiratory CT scans from 8,971 COPDGene Phase 1 (GOLD 0-4 and PRISm) participants were analyzed. An AI-based framework combining 3D airway segmentation discontinuities and convolutional neural network classification identified mucus plug obstructions, yielding mucus plug burden (total plug count). Associations with outcomes were evaluated using covariate-adjusted models. MEASUREMENTS AND MAIN RESULTS : Higher mucus plug burden was associated with lower post-bronchodilator FEV % predicted ({rho} = -0.41; P < 0.001), greater air trapping (LAA < -856 HU; {rho} = 0.33; P < 0.001), worse health status (SGRQ; {rho} = 0.31; P < 0.001), and shorter 6-minute walk distance ({rho} = -0.26; P < 0.001). Among GOLD 1-4 participants, mucus plug presence was independently associated with increased all-cause mortality (adjusted hazard ratio, 1.28; P < 0.005) and exacerbation frequency (adjusted incidence rate ratio, 1.32; P < 0.005). Plug presence was also associated with increased respiratory mortality across GOLD categories and cardiovascular mortality in GOLD 1-2. CONCLUSIONS: AI-based quantitative CT assessment of airway mucus plugging provides a scalable, reproducible measure associated with physiologic impairment and adverse outcomes in COPD, supporting its role in risk stratification and future therapeutic studies.