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01.
arXiv (math.PR) 2026-06-17

Convergence rate of Euler–Maruyama scheme to the invariant probability measure under total variation distance for the SDEs

arXiv:2505.04218v3 Announce Type: replace Abstract: This article shows the geometric decay rate of Euler-Maruyama scheme for one-dimensional stochastic differential equation towards its invariant probability measure under total variation distance. Firstly, the existence and uniqueness of invariant probability measure and the uniform geometric ergodicity of the chain are studied through introduction of non-atomic Markov chains. Secondly, the equivalent conditions for uniform geometric ergodicity of the chain are discovered, by constructing a split Markov chain based on the original Euler-Maruyama scheme.

02.
arXiv (CS.LG) 2026-06-16

Generative Modeling on Metric Graphs via Neural Optimal Transport

arXiv:2606.16273v1 Announce Type: cross Abstract: We introduce, to our knowledge, the first deep generative modeling framework for probability distributions continuously supported on compact metric graphs. Given source and target measures on a metric graph, our method embeds the graph into a smooth ambient space, solves an entropic Kantorovich problem via a neural semidual parameterization, and projects generated samples back onto the original graph. We study two embedded geometries: an extrinsic Euclidean realization and the intrinsic tropical Abel–Jacobi embedding into the Jacobian torus. In both cases, the resulting generator is graph-supported by construction. We prove that, in the joint limit of increasing neural expressivity, the learned generator converges weakly to a valid transport coupling between the original graph measures. Empirically, across a range of geometrically distinct graphs, our method matches or improves upon heuristic transport baselines based on discrete graph OT, while scaling more favorably. Finally, we demonstrate scalability on real-world urban mobility data by training our model on one million Uber pickup locations in Manhattan, New York City.

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

The Measurement Gap in the Automation of EU Law: Benchmarking Doctrinal Legal Reasoning under the EU AI Act

Large language models now produce legal text of at least median quality, yet no existing benchmark can evaluate whether they perform doctrinal legal reasoning, which forms the interpretive core of legal work, rather than the ancillary, paralegal tasks that most current legal-AI evaluations measure. This measurement gap is not only methodological but legal: the EU AI Act makes "appropriate accuracy" a binding requirement for high-risk AI used in the judicial domain, yet that requirement cannot acquire operational content without the very doctrinal-reasoning benchmark the field lacks.

04.
arXiv (CS.CV) 2026-06-17

MaineCoon: Pursuing A Real-Time Audio-Visual Social World Model

As an increasing majority of global video content is consumed on social platforms for interactive social purposes, video generation models built for social worlds are important but largely overlooked by previous studies. In this work, we define the position of social world models and build a prototype model as the first step towards this goal. While previous world models successfully simulate physical environments or gaming world exploration, they remain fundamentally detached from human-centric social dynamics. To bridge this gap as the first step to social world models, we present MaineCoon, the first real-time audio-visual autoregressive model that has 22B parameters and is capable of real-time streaming generation and sub-second interaction, with a record-breaking frame rate of up to 47.5 FPS, on a single GPU. To the best of our knowledge, MaineCoon is also the first real-time audio-visual generation model specifically optimized for social-interactive applications. To enable efficient and stable training, we introduce several novel techniques into MaineCoon, including self-resampling, cross-modal representation alignment, domain-aware preference optimization, and reinforced online-policy distillation (ROPD). We also design the first agentic streaming inference framework that supports thousand-second-scale or even longer generation while mitigating drift with agentic cache management and prompt planing. These innovations significantly accelerate training while optimizing real-time inference performance. We believe this work not only sets a new state-of-the-art (SOTA) performance benchmark for high-quality, low-latency, and long-horizon audio-visual autoregressive models, but also points out the paradigm shift desired for next-generation AI-native social platforms.

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

The Benchmark Illusion: Pruned LLMs Can Pass Multiple Choice but Fail to Answer

Compressing large language models reduces memory use and inference cost, but it can also create failures that standard benchmarks miss. A pruned model may still perform well on multiple-choice evaluations, yet fail to answer the same question in open generation. We ask what pruning changes: does it erase the correct answer, or does it make the answer harder to produce as the top output? We study this question with multilingual question answering, tracking the same questions before and after pruning. We find a benchmark illusion. Under high-sparsity pruning, especially Wanda, models often fail in greedy open generation while still selecting the correct answer under multiple-choice scoring. In these recognition-only errors, the answer is usually not gone, but demoted: it often reappears with beam search, sampling, or one in-context example. Overall, multiple-choice benchmarks can overstate the usability of compressed LLMs, creating an evaluation blind spot. Compressed models should be tested on what they can produce, not only on what they can recognize.

06.
bioRxiv (Bioinfo) 2026-06-11

STITCH links cellular morphology and gene expression in spatial transcriptomics

In situ spatial (ISS) sequencing can uncover co-variation between cellular morphology and gene expression in vivo. However, a principled and interpretable mathematical representation of morphology has not yet been applied in this context. In particular, current deep learning-based representations of cell images confound a cell's shape with its size. We present an interpretable representation of cellular boundary contours, based on tangent principal component analysis (TPCA) in a Kendall shape manifold, that captures size-independent contour shape features. This approach successfully recovers shape-perturbing genes in an RNAi screen than a previous metric geometry-based approach. We build on TPCA to develop STITCH (Shape-TranscriptomIc Correlation and Harmonization), an approach to reveal covariation between cell morphology with gene expression in ISS datasets. In a Xenium dataset, STITCH outperforms a deep learning-based approach in both recovering the layered organization of keratinocytes and a spatial gradient in nuclear eccentricity. Across samples in a melanoma CosMx dataset, STITCH reproducibly associates elongated and triangular fibroblasts with proximity to malignant cells and myofibroblast-like transcriptional program. Finally, STITCH independently recovers a known link between mesenchymal-like malignant cell states and increased cell area in two melanoma cohorts. STITCH can thus yield interpretable morphology-transcriptome relationships across cell types, patients, and spatial transcriptomics platforms.

08.
arXiv (quant-ph) 2026-06-16

Towards Interpretability of Neural Quantum States

arXiv:2508.14152v2 Announce Type: replace Abstract: Neural quantum states (NQS) have emerged as a powerful variational ansatz for representing quantum many-body wave functions. Their internal mechanisms, however, remain poorly understood. We investigate the role of correlations for NQS-like quantum state representation by employing a correlation-based interpretable neural network architecture and then proving our observations using Boolean function theory. The correlator neural network demonstrates that, even for simple product states, up to all system-size correlation orders in the chosen computational basis are required to represent a quantum state faithfully. We explain these observations using Fourier expansion, which reveals the correlator basis as the effective basis of the internal NQS structure, the resulting necessity for high-order correlations that is supported by an entanglement bound that scales with the correlation order, consequences of linear dependencies in constrained Hilbert spaces for correlation requirements, and connections between spin basis rotations and the correlator basis. Furthermore, we analyze how neural networks achieve high correlation orders by increasing the magnitude of the network weights, which can be compensated by increasing the network depth. Lastly, we discuss how activation functions, network architectures, and choice of reference basis influence correlation requirements. Our results provide new insights and a better understanding of the internal structure and requirements of NQS, enabling a more systematic use of NQS in future research.

09.
arXiv (quant-ph) 2026-06-19

Nearest-neighbour gates are all you need: High-rate quantum low-density parity-check codes on a planar grid

arXiv:2606.19482v1 Announce Type: new Abstract: High-performance quantum low-density parity-check codes promise substantial reductions in the overhead of fault-tolerant quantum computation, but most constructions require long-range connectivity or qubit shuttling, both of which are difficult to realise in superconducting architectures. Here we introduce a family of quantum low-density parity-check codes that, for the first time, combines planar open-boundary layouts, finite-size advantages over surface codes, and syndrome extraction using only nearest-neighbour gates on a square grid of qubits. The key idea is to generate check-data connectivity dynamically: nearest-neighbour iSWAP walks both define the stabiliser supports and implement their measurement, avoiding the need for a long-range hardware graph. The resulting circuits achieve optimal constant-depth stabiliser measurement, independent of code size, and naturally remove leakage from the system by exchanging the role of check and data qubits at each syndrome extraction round. We find finite-size instances such as a [[323,14,15]] code, whose code-efficiency ratio is nearly an order of magnitude larger than that of rotated surface-code patches. At around 30 circuit qubits per logical qubit, the best directional tile-code layouts reduce the per-logical per-round logical error rate by up to a factor of 1000 relative to rotated surface-code memories. These results show that the advantages of quantum low-density parity-check codes can survive compilation into strictly planar nearest-neighbour circuits, bringing low-overhead fault-tolerant memories closer to near-term hardware.

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

Are Online Skill and Memory Modules Always Worth Their Tokens? A Budget-Constrained Study of Web Agents

Online web agents often augment a base actor with memory, workflow, or skill modules. These modules can improve performance, but they also consume test-time tokens, a cost rarely reported alongside the actor's inference cost. We study online augmentation, where this overhead is paid on every task, and re-evaluate its benefits under a fixed total inference budget. We compare AWM, ASI, and ReasoningBank with a token-matched vanilla baseline that uses the same budget for additional actor steps. Across three WebArena domains and three models, Gemini 3 Flash, GPT-5.4-mini, and Qwen 3.6-27B, the vanilla baseline matches or surpasses all three augmentation methods in aggregate success rate while often using fewer total tokens. We observe a similar trend on WorkArena-L1 with Qwen 3.6-27B, indicating that the effect extends to enterprise knowledge-work tasks. Our results suggest that skills and workflow memory can be useful in specific domains, but their apparent gains often vanish against a budget-matched actor. We further show that run-to-run variance materially affects outcomes and should be reported as a core evaluation criterion for online web agents.

11.
arXiv (math.PR) 2026-06-12

Exact Fourier dimensions of dyadic Mandelbrot cascades under minimal integrability

arXiv:2606.08683v2 Announce Type: replace Abstract: We determine the Fourier dimension of dyadic Mandelbrot cascades under the minimal Kahane-Peyriere integrability condition. The interval theorem is proved in a vector-valued dyadic cascade model in which sibling weights may have arbitrary dependence. For every balanced energy-admissible vector law, almost surely on non-extinction, dim_F(mu)=dim_E(mu)=dim_2(mu)=D_E(X). In the canonical scalar case, under W>=0, E W=1, E[W log_2^+ W]

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

Freeing the Law with LOCUS: A Local Ordinance Corpus for the United States

Progress in legal AI increasingly depends on access to authoritative legal text at scale. Yet one of the most consequential layers of American law remains largely absent from existing machine-readable corpora: local ordinances. Local codes govern zoning, housing, business licensing, public health, noise, animal control, and many other domains of everyday regulation, but they are fragmented across vendor platforms designed for human browsing rather than bulk research access. We introduce LOCUS - the Local Ordinance Corpus for the United States - a comprehensive corpus and county-harmonized access layer for U.S. municipal and county ordinance codes. The raw corpus, available for release to researchers, represents nearly all publicly available municipal and county ordinance codes. The resulting raw corpus contains codes from 9,239 cities and counties. A smaller county-harmonized LOCUS access layer provides coverage for the largest 2,309 of 3,144 U.S. counties, accounting for a majority of the population. We use OCR to handle the myriad of document formats that have kept the law from being a public resource. We release the corpus with coverage metadata to support reproducibility, downstream legal AI research, and the incremental expansion of machine-readable access to local law. We train a collection of ModernBERT-based classifiers and scorers to facilitate analyzing U.S. local law among several dimensions, such as opacity and paternalism, that have not previously been studied at this scale. LOCUS-v1 and its derivative models are available at: https://huggingface.co/datasets/LocalLaws/LOCUS-v1

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

FORGE: Foundational Optimization Representations from Graph Embeddings

arXiv:2508.20330v5 Announce Type: replace Abstract: Combinatorial optimization problems are ubiquitous in science and engineering. Still, learning-based approaches to accelerate combinatorial optimization often require solving a large number of difficult instances to collect training data, incurring significant computational cost. Existing learning-based methods require training dedicated models for each problem distribution, for each downstream task, severely limiting their scalability and generalization. We introduce Forge: Foundational Optimization Representations from Graph Embeddings, a framework that pre-trains a vector-quantized graph autoencoder on a large, diverse collection of mixed-integer programming (MIP) instances in an unsupervised manner, without relying on optimization solvers or optimal solutions. Vector quantization produces discrete code assignments that serve as a vocabulary for representing optimization instances. We evaluate Forge in both unsupervised and supervised settings. In the unsupervised setting, Forge embeddings effectively cluster unseen instances across problem domains and sizes. In the supervised setting, we fine-tune Forge embeddings and show that a single pre-trained model helps predicting both the integrality gap for cut-generation and variable hints for search guidance across multiple problem and size distributions. In both tasks, we improve the performance of a commercial optimization solver and outperform state-of-the-art learning-based methods. Finally, we open-source our training code, pre-trained Forge weights, and embeddings for multiple MIP distributions to foster further research in representation learning for optimization problems https://skadio.github.io/forge/

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

Sorries Are Not the Hard Part: An Expert-Review Case Study of a Semi-Autonomous Formalization

arXiv:2606.13925v1 Announce Type: new Abstract: Large language models can often close proof gaps in interactive theorem provers, but a verified theorem is not the same thing as a reusable library contribution. We study this distinction through a detailed case study: a semi-autonomous formalization of Grothendieck's vanishing theorem. The initial version compiles with no sorries, but an expert review found serious problems in definitions, theorem generality, file organization, and the API. We then ran a review-driven refactor and compression process and obtained a second expert review. The before-and-after comparison shows a sharp split: agents adapted well to local, mechanically checkable feedback, but remained weak at choosing definitions and designing APIs. We argue that autoformalization should be evaluated not only by closed sorries, but by whether the resulting formalization survives expert review.

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

Confidence is Not Reliability: Rethinking MC Dropout in Brain Tumour Segmentation

Glioma segmentation in multiparametric MRI is a critical component of treatment planning. A segmentation model that fails silently on treatment-critical sub-regions represents a patient safety risk that overlap-based metrics such as Dice scores cannot expose. We ask whether voxel-level uncertainty estimation via Monte Carlo (MC) Dropout can reliably identify segmentation errors in clinically critical sub-regions, and whether calibration failure modes are detectable from standard reporting metrics alone. In an empirical two-model case study on 126 BraTS21 patients, we evaluate a high-performance pretrained SegResNet and a locally trained UNet with residual units (UNet-Res). MC dropout preserved segmentation accuracy ($|\Delta Dice|$ $

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

A Deep Reinforcement Learning (DRL)-Based Transformer Method for Solving the Open Shop Scheduling Problem

arXiv:2606.13682v1 Announce Type: new Abstract: The open shop scheduling problem (OSSP) arises in many industrial and service settings but remains computationally challenging as the number of jobs and machines increases. While exact methods quickly become intractable, classical dispatching rules and metaheuristics may require substantial tuning to maintain solution quality at large scales. This study develops a Transformer-based scheduling policy for OSSP using an encoder-decoder architecture with multi-head attention. The model is trained on Taillard benchmark instances (4x4, 5x5, 7x7, and 10x10) using only the processing-time matrix as input and produces feasible schedules with makespans typically within 15-30% of best-known values. To evaluate scalability, the trained policy is applied without retraining to randomly generated instances from 40x40 to 100x100 and compared against classical dispatching heuristics, including SPT, LPT, MWKR, and EST. Across these large instances, the Transformer achieved average gaps of 12.89-15.12% relative to a standard lower bound. Compared with EST, the Transformer remained competitive, typically within a modest margin, while substantially outperforming SPT and LPT. These results indicate that a Transformer policy trained on small OSSP instances can generalize to substantially larger problems and provide a feature-light, learning-based alternative to classical dispatching rules.

17.
arXiv (CS.AI) 2026-06-11

Federated continual learning: A comprehensive survey on lifelong and privacy-preserving learning over distributed and non-stationary data

arXiv:2606.11272v1 Announce Type: cross Abstract: Federated Learning (FL) enables collaborative and privacy-preserving model training across distributed clients, but most existing FL systems implicitly assume data stationarity. In real-world settings-such as healthcare, industrial IoT (IIOT), cybersecurity, and smart cities-data streams are inherently non-stationary, leading classical FL methods to suffer from performance degradation, instability, and catastrophic forgetting. Continual Learning (CL) addresses learning under evolving data distributions but has been largely studied in centralized settings, overlooking key constraints of federated systems, including privacy, limited communication, and client heterogeneity. Federated Continual Learning (FCL) emerges at the intersection of FL and CL, aiming to support lifelong, adaptive, and privacy-aware learning over distributed and non-stationary data. This survey provides a comprehensive and systematic overview of FCL. We first present a formal definition of the FCL problem and clarify its distinctive characteristics. We then analyze the limitations of classical FL under non-stationary conditions, highlighting how CL principles support long-term adaptation. To organize the rapidly growing literature, we propose a multi-dimensional taxonomy of FCL approaches. Furthermore, we review representative application domains and data modalities, summarize commonly used evaluation metrics, and discuss experimental perspectives for assessing long-term performance and forgetting. Finally, we highlight key open challenges, including handling extreme heterogeneity under temporal drift, designing scalable and privacy-preserving memory mechanisms, and establishing standardized benchmarks. This survey aims to serve as a reference and a roadmap for advancing FCL toward robust and deployable real-world systems.

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

When Smaller Wins: Dual-Stage Distillation and Pareto-Guided Compression of Liquid Neural Networks for Edge Battery Prognostics

arXiv:2601.06227v3 Announce Type: replace-cross Abstract: Battery management systems increasingly require accurate battery health prognostics under strict on-device constraints. This paper presents DLNet, a practical framework with dual-stage distillation of liquid neural networks that turns a high-capacity model into compact and edge-deployable models for battery health prediction. DLNet first applies Euler discretization to reformulate liquid dynamics for embedded compatibility. It then performs dual-stage knowledge distillation to transfer the teacher model's temporal behavior and recover it after further compression. Pareto-guided selection under joint error-cost objectives retains student models that balance accuracy and efficiency. We evaluate DLNet on a widely used dataset and validate real-device feasibility on an Arduino Nano 33 BLE Sense using int8 deployment. The final deployed student achieves a low error of 0.0066 when predicting battery health over the next 100 cycles, which is 15.4% lower than the teacher model. It reduces the model size from 616 kB to 94 kB with 84.7% reduction and takes 21 ms per inference on the device. These results support a practical smaller wins observation that a small model can match or exceed a large teacher for edge-based prognostics with proper supervision and selection. Beyond batteries, the DLNet framework can extend to other industrial analytics tasks with strict hardware constraints.

19.
arXiv (math.PR) 2026-06-16

The distribution of the de Moivre experiment

arXiv:2606.15178v1 Announce Type: new Abstract: In this paper, we focus on de Moivre random experience which allows us to introduce the $ s- $Bernoulli distribution and the bi$ ^s $nomial distribution. We present some probabilistic properties such as the expectation, the variance, the skewness and kurtosis coefficients, the moments and the generating functions. Then we establish that for $ s\in\mathbb{N} $, the bi$ ^s $nomial distribution converges to a limiting Poisson and normal distributions when $ n\rightarrow\infty. $

20.
arXiv (CS.LG) 2026-06-15

AcceRL: A Distributed Asynchronous Reinforcement Learning and World Model Framework for Vision-Language-Action Models

arXiv:2603.18464v3 Announce Type: replace Abstract: Reinforcement learning (RL) for large-scale Vision-Language-Action (VLA) models is severely bottlenecked by synchronization barriers and the high cost of environment data acquisition. To overcome these challenges, we propose AcceRL, a distributed asynchronous RL framework that physically isolates environment rollouts, model inference, and gradient updates. By eliminating the cascading long-tail idle bubbles inherent in synchronous systems, AcceRL maximizes hardware utilization and ensures scalable throughput. Furthermore, AcceRL features a modular design that supports the integration of diverse, plug-and-play world models into its distributed pipeline. Extensive experiments demonstrate that the base framework achieves highly competitive performance across all four LIBERO[liu2023libero] task suites. Systematically, the asynchronous architecture delivers a $2.4\times$ throughput speedup over leading synchronous baselines. Algorithmically, by leveraging a world model pre-trained on 1,000 offline trajectories, AcceRL achieves up to a $200\times$ improvement in online sample efficiency on LIBERO-Spatial, establishing a robust framework that is both sample-efficient and time-efficient for embodied AI. Code is included in the supplementary material. Code is available at https://github.com/distanceLu/AcceRL.

21.
arXiv (CS.LG) 2026-06-18

CODEBLOCK: Learning to Supervise Code at the Right Granularity

arXiv:2606.18286v1 Announce Type: new Abstract: Supervised fine-tuning of code LLMs typically applies uniform cross-entropy loss to all response tokens, implicitly assuming that every token provides equally useful learning signal. Recent token-level selection methods challenge this assumption in natural-language SFT by supervising only high-value tokens. However, directly transferring token-level masking to code can break syntactically and semantically coherent program units, because code depends on structural completeness and definition-use relations. We therefore propose CodeBlock, a structure-aware sparse supervision framework that selects structure-complete code evidence rather than isolated tokens. CodeBlock first selects high-quality instruction-response pairs, then partitions code responses into syntactically coherent coding items, estimates their utility by aggregating generalized cross-entropy over core logic tokens, and reranks them with data-flow reach and bridge signals to prioritize blocks that propagate or connect important program dependencies. During training, the full response remains available as context, while loss is applied only to selected code items and informative natural-language tokens. Experiments on six code-generation benchmarks show that CodeBlock achieves stronger average pass@1 than full-token SFT and competitive selection baselines, while using only 1.9% of supervised response tokens.

22.
arXiv (CS.CL) 2026-06-16

When the Same Musical Knowledge Forgets Differently: A Clean Probe of Pathway-Dependent Forgetting

A model can learn that the piano piece Für Elise is calm and reflective by listening to the audio or by reading a text description, but does it matter which route that knowledge took when it is later at risk of being forgotten? Forgetting research in multimodal models measures what knowledge is lost under adaptation, yet has not asked whether acquisition route affects how easily that knowledge is forgotten. We call this untested premise the Pathway-Invariant Assumption. Music understanding enables a clean test because a music clip and a canonical text description can be aligned to the same perceptual content, allowing the same knowledge unit to enter a model through listening or reading while the target remains fixed. Across multiple architecturally distinct audio-language models, we observe a consistent asymmetry: text-pathway knowledge is forgotten more than matched audio-pathway knowledge under identical adaptation pressure. To attribute this effect to route rather than confounds, we introduce the Paired Pathway Controlled Protocol (PPCP), a three-phase design that establishes matched pathway baselines, activates both pathways under symmetric supervision on the same knowledge pool, and applies identical forgetting pressure to both pathways. The gap is stable across models and gain-controlled analyses, persists when contradictory overwrite is replaced by correct-label cross-domain learning, remains under single-modality pressure, and is not removed by lightweight replay. Two independent routing-depth controls confirm that the effect is not explained by architectural depth, pointing to input representation as the dominant factor. Under PPCP, our results demonstrate that forgetting is highly route-dependent, establishing acquisition route as a new analytical dimension for forgetting research and multimodal system design.

23.
arXiv (CS.AI) 2026-06-15

The Journal of Prompt-Engineered (Moral) Philosophy Or: Why AI-Assisted Ethics Research Requires Process Transparency

Authors:

arXiv:2511.08639v4 Announce Type: replace-cross Abstract: Existing AI disclosure mandates in scholarship require that AI assistance be reported but leave transparency philosophically unspecified: they fix the duty without explaining what the duty serves. We argue that ethical inquiry is essentially contested at two independent levels – about what it is, and about what it demands of the inquirer – defeating output-only evaluation and welfare-economic dismissal of the transparency question, and, by extension, reproducibility framings imported from the empirical sciences. The transparency duty is grounded instead in agent-integrity: the legibility, before a community of inquiry, of the identity-constituting commitments that the author's mode of philosophising expresses. Because the standards for evaluating such work are not communally settled, the achievable goal for transparency is not evaluation against agreed criteria but tracking – accumulating the evidentiary record that lets each tradition assess the work on its own terms and makes future normative judgments possible. We develop a documentation-adequacy framework that operationalises Meaningful Human Control through five transparency elements – declaration, navigation, documentation account, process documentation, and development records – demonstrated by the paper itself, whose full documentation record is archived at a persistent identifier. The framework is a first iteration subject to revision, not a settled standard.

24.
medRxiv (Medicine) 2026-06-15

ICD-10 Code Ambiguity Obscures Treatment-Eligible Adults with Spinal Muscular Atrophy: A Single-Center Chart Review and Patient Outreach Study

Background. Three disease-modifying therapies (DMTs) for spinal muscular atrophy (SMA) have been approved since 2016, yet many adults remain untreated. Identifying them depends on ICD-10 codes that capture SMA but do not reliably distinguish it from other related conditions. We examined, in one U.S. health system, both patients' engagement with therapy and the accuracy of the codes used to find them. Methods. We conducted a retrospective chart review of adults in an academic health system identified by SMA-associated ICD-10 codes, with manual adjudication of diagnosis and DMT status. Confirmed SMA-positive, DMT-naive patients were invited to a structured telephone interview on treatment awareness and barriers. Results. Of 60 charts, 22 (36.7%; 95% CI 25.6-49.3%) were appropriately coded for SMA or a related disorder; only 16 (26.7%) had molecularly confirmed SMA. The other 38 (63.3%) were miscoded, spanning spinal and bulbar muscular atrophy, asymptomatic carriers, prenatal screening, and conditions unrelated to SMA. Ten of the 16 confirmed patients (62.5%) were DMT-naive; one was interviewed, one declined, and eight could not be reached. The non-response is itself a finding: the patients least visible to administrative data are the hardest to reach. Conclusions. ICD-10 ambiguity is a barrier to treatment access in adult SMA, as is loss to follow-up. We make two recommendations: continuous documentation-coding alignment that uses natural language processing to verify the genetic precondition, and type-specific SMA codes (subcodes for Types 0-4) anchored on molecular SMN1 confirmation. Together these would support cohort identification, outreach, and evidence generation without adding to clinician burden.

25.
medRxiv (Medicine) 2026-06-15

Multidimensional nutritional assessment in Crohns disease: cross-sectional comparison of active disease and remission

Malnutrition is common in Crohns disease (CD), and its assessment requires multiple tools. Comprehensive evaluation of nutritional status in a population with CD, predominantly characterized by metabolic phenotype, was inadequately reported. This study evaluated the nutritional status of CD patients using anthropometric, clinical, and biochemical measures and compared patients with active disease with those in remission. This cross-sectional study included 127 adults with CD: 63 with active disease and 64 in remission. Disease activity was classified using the Crohns Disease Activity Index, the Simple Endoscopic Score for Crohns Disease, and magnetic resonance enterography. Nutritional assessment included body mass index (BMI), mid-upper arm circumference, calf circumference, triceps skinfold thickness, mid-arm muscle circumference, Mini Nutritional Assessment-Short Form (MNA-SF), and biochemical markers including hemoglobin, serum iron, folate, vitamin B12, albumin, and zinc. Malnutrition was defined using the Global Leadership Initiative on Malnutrition criteria. Overall, 47.2% of participants were malnourished. Malnutrition was significantly more frequent in active disease than in remission (81.0% vs. 14.1%, P