Author Correction: Quantification and transcriptome profiling reveal abundant, dynamic and translatable dephospho-CoA-capped RNAs
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arXiv:2606.20402v1 Announce Type: new Abstract: Quantum kernels admit Fourier representations whose frequencies are determined by the data-encoding gates of the underlying feature map. We show that entangling tensor kernels are matrix product operator factorizations of the corresponding Fourier coefficient tensors, thereby identifying quantum kernels as spectral tensor networks. By grouping gate-level frequency configurations that yield the same feature-wise frequency, we obtain a grouped Fourier form that induces a more compact spectral tensor network representation of the kernel. We further show that kernel target alignment serves as a bridge between the Fourier and tensor network views. On a grid that resolves the accessible Fourier modes, it becomes the Frobenius cosine similarity between Fourier coefficient tensors. Our numerical experiments show that layered quantum kernels admit accurate representations with small bond dimension, revealing a compressibility governed by correlations between Fourier modes. This compressibility provides a diagnostic of classical representability and of whether kernel evaluation is likely to remain classically tractable.
by Jitendra Maharana, Aritra Bej, Debasish Biswal, Debashis Panda, Arjun Sharma NOD1 and NOD2, founding members of the NOD-like receptor (NLR) family, play a crucial role in host defense against bacterial infections. Recognition of peptidoglycan-derived ligands triggers ATP-dependent oligomerization of the NACHT domain, exposing the CARD domains that recruit the adaptor protein RIP2 via CARD–CARD interactions to activate the NF-κB signaling cascade. Although NOD1/2-RIP2 interactions and RIP2CARD filament assembly are established, the precise interfaces that stabilize hetero–CARD filaments remain poorly defined. Here, we integrate in silico structural modeling with molecular dynamics (MD) simulations to elucidate structurally compatible arrangements of NOD1–RIP2 and NOD2–RIP2 hetero–CARD filaments. Our results reveal that NOD1CARD subunits form a structurally compatible homomeric scaffold via canonical (type-I–III) interfaces, accommodating multiple tiers of RIP2CARD rings at both filament termini. Meanwhile, the NOD2 tandem CARDs adopt multiple discrete conformations, reflecting a more intricate structural mechanism. In stable filament conformations, tandem CARDs converge at the type-II interface, with RIP2CARD rings stacking onto CARDa (top-down) and CARDb (bottom-up) interfaces, highlighting the structural role of NOD2CARDb in RIP2-mediated CARD–CARD interaction. In silico mutagenesis, involving charge-reversal and alanine scanning of key interfacial residues, disrupts NOD1–RIP2 and NOD2–RIP2 interactions at both top-down and bottom-up interfaces, leading to rapid interface destabilization within 0.1–0.4 μs of simulation. Together, these results reveal conserved and receptor-specific mechanisms governing NOD1/2–RIP2 CARD–CARD interactions and provide deeper structural and dynamic insights into the complex structural mechanisms for NLR-mediated inflammatory signaling.
arXiv:2606.17396v1 Announce Type: cross Abstract: Stimulated transitions are among the most fundamental processes in light-matter interaction, underlying resonant absorption and emission in atomic systems. Here we show that uniform acceleration can convert this familiar response into a frequency-selective absence of response. Specifically, when an incident photon has a nonzero momentum component transverse to the acceleration, the stimulated transition probability vanishes at a discrete set of frequencies fixed by the acceleration, the atomic transition frequency, and the photon propagation angle. At these spectral blind spots, both ordinary stimulated absorption and acceleration-induced excitation are simultaneously suppressed, rendering the atom effectively unresponsive to the incident radiation. The effect arises from the nontrivial response of accelerated atoms to quantum vacuum fluctuations and provides a distinctive signature of the Unruh effect through the absence, rather than the enhancement, of stimulated transitions. We further provide an order-of-magnitude estimate showing that an electron-based implementation with spin splitting in combined electric and magnetic fields could access the required parameter regime. These results reveal an unexplored form of acceleration-modified light-matter interaction and identify spectral blind spots as a new manifestation of the Unruh effect.
Full-duplex spoken language models (FD-SLMs) enable seamless speech interaction by allowing models to listen and speak simultaneously, yet the internal mechanism by which they coordinate listening and speaking remains underexplored. We analyze the predictive behavior encoded in FD-SLM hidden representations and find that they exhibit stream-specific predictive patterns: during listening, they preferentially predict the incoming user stream, whereas during speaking, they preferentially predict the model output stream. Building on this observation, we show that FD-SLMs dynamically modulate their internal predictive focus between two states: a generative state aligned with model output generation and a perceptive state aligned with incoming user input. However, this modulation can lag behind abrupt changes in conversational context. During user interruptions, the model remains transiently biased toward the generative state before transitioning into the perceptive state, causing it to miss the beginning of the incoming input. We term this delayed internal transition state inertia. To quantify its downstream impact, we introduce the Zero-Buffer Benchmark (ZBB), a diagnostic benchmark for evaluating immediate interruption comprehension when user speech begins abruptly. We evaluate this setting using response correctness and initial-word occurrence rate (IWOR). Finally, we mitigate state inertia through activation steering with a perception vector, a training-free intervention with little additional computational overhead. Across multiple state-of-the-art FD-SLMs, activation steering substantially improves interruption handling; for example, on PersonaPlex, it improves correctness from 28% to 45% and IWOR from 40% to 72% without any fine-tuning.
arXiv:2606.15672v1 Announce Type: new Abstract: Highly-localized light-matter interactions are necessary for scaling trapped-ion architectures. In hyperfine qubits, counterpropagating beams generate entangling gates by coupling with motion, but this effect is undesirable during single-qubit operations. For that reason, single-qubit gates are traditionally implemented with copropagating beams, and the coexistence of two beam geometries adds hardware and computational overhead. In an effort towards collective performance improvement with minimal overhead, we design and implement pulse-amplitude and dephasing robust dynamically corrected gates using Space Curve Quantum Control (SCQC) and compare them against the constant-amplitude gate implementation. We perform gate set tomography on a four-qubit trapped-ion register, and we discover more than 50% error reduction when robust pulses are used. We find that counterpropagating robust gates often outperform their copropagating counterparts and reach error rates as low as $(3.59 \pm 1.25)\cdot 10^{-3}$, using diamond distance as a metric. This value establishes a laser-driven-gate error reference and is merely an order of magnitude higher than the best reported $microwave$ gate on a $single$ ion. Additional experiments reveal that robust pulses can effectively suppress non-Markovian errors that grow during runtime. Our work challenges the widely accepted belief that copropagating gates should be preferred for their weak motional coupling and invites the adoption of high-performance robust pulses that suppress multiple noise sources of the trapped-ion error budget.
Lifelong interactive agents are expected to assist users over months or years, which requires continually writing long term memories while retrieving the right evidence for each new query under fixed context and latency budgets. Existing memory systems often degrade as histories grow, yielding redundant, outdated, or noisy retrieved contexts. We present All-Mem, an online/offline lifelong memory framework that maintains a topology structured memory bank via explicit, non destructive consolidation, avoiding the irreversible information loss typical of summarization based compression. In online operation, it anchors retrieval on a bounded visible surface to keep coarse search cost bounded. Periodically offline, an LLM diagnoser proposes confidence scored topology edits executed with gating using three operators: Split, Merge, and Update, while preserving immutable evidence for traceability. At query time, typed links enable hop bounded, budgeted expansion from active anchors to archived evidence when needed. Experiments on LoCoMo and LongMemEval-s show improved retrieval and QA over representative baselines. The code is available at https://github.com/LvCan926/All-Mem.
arXiv:2511.19162v3 Announce Type: replace-cross Abstract: Bioart brings living material into artistic practice, where a single work can be at once an aesthetic object, a scientific instrument, and an ethical provocation. Traditional categories sort such works along one axis at a time, which flattens the very hybridity that defines the field and leaves curators no way to compare works across many dimensions together. I introduce BioArtlas, a computational atlas that represents each bioartwork along many curated dimensions at once and organizes the field by conceptual similarity rather than by medium or chronology. My method embeds the keywords of all 81 works on each of thirteen interpretive axes, groups related concepts into a shared codebook that tames inconsistent terminology, and then searches systematically for a clustering that is both statistically clean and interpretable. Among the methods that place every work on the map, agglomerative clustering separates the field far more cleanly than the usual k-means baseline (silhouette 0.664 versus 0.483), whereas density-based methods reach higher scores only by discarding most of the corpus as noise. By separating rigorous analysis from public storytelling, BioArtlas turns the tangled complexity of bioart into a navigable landscape, openly available as an interactive interface (https://www.bioartlas.com) and dataset (https://github.com/joonhyungbae/BioArtlas).
arXiv:2606.19533v1 Announce Type: cross Abstract: This work presents a tool for the synthesis and simulation of probabilistic architectures for solving combinatorial optimization problems by mapping them to the Ising model. The proposed approach automatically constructs the Ising Hamiltonian and determines the number of probabilistic elements (p-bits) based on problem characteristics such as size and topology. Furthermore, the tool introduces an adaptive strategy for selecting the most suitable update algorithm among Gibbs Sampling, Simulated Annealing (SA), Simulated Quantum Annealing (SQA), and cluster-based methods. Experimental results using benchmark problems demonstrate improved convergence behavior and flexibility compared to fixed approaches. The proposed framework enables systematic evaluation of probabilistic computing strategies and supports the development of future hardware implementations based on MTJs and p-bits.
arXiv:2606.12418v1 Announce Type: cross Abstract: The rapid proliferation of large language models (LLMs) has produced a striking cultural practice: using conversational AI for divination. This paper offers one of the first systematic studies of LLM-mediated divination in the context of Xuanxue, an internet-native umbrella term for mystical and spiritual practices on Chinese social media. Using a mixed-methods design, we analyze 23000+ posts and comments from Xiaohongshu and conduct 32 semi-structured interviews with users and professional diviners. Users primarily consult LLMs about pragmatic concerns - romantic relationships, careers, exams, and in-game gacha draws - via two intersecting pathways: trend-driven curiosity enabled by viral visibility and zero-cost access, and event-driven anxiety under conditions of uncertainty. A defining feature is collaborative prompt refinement, which turns users into active prompt engineers. Among commenters expressing a clear stance, perceived efficacy skews positive, with "accuracy" often justified through biographical fit and retrospective confirmation, consistent with Barnum and confirmation bias. Users also develop verification practices such as repeated trials and cross-model comparison. Professional diviners, by contrast, portray LLMs as lacking the "spiritual power" required for genuine divination, reflecting both ontological commitments and economic boundary-work. We also show how participants navigate tensions between scientific and metaphysical frames when interpreting AI-generated readings. Situating these findings in anthropological and cognitive-evolutionary theories of divination, we argue that LLM divination preserves core functions of traditional practice while introducing scalability, repeatability, and prompt-driven co-production that reshape how divinatory authority is constructed and evaluated.
Objective: To determine whether and to what extent hospitals across the United States vary in their use of late-preterm steroids using a novel data set in which the timing of steroid administration relative to delivery can be observed. Methods: This was a retrospective cohort study of singleton births with known gestational ages identified in the Premier Healthcare Database from 2015 to 2022. The primary variable of interest was hospital-level adoption of antenatal corticosteroids for late-preterm singleton deliveries, calculated as the proportion of late-preterm singleton births (34-36 completed weeks of gestation) with any betamethasone exposure during the same late-preterm period. Hospital adoption was defined as the weighted average rate of ALPS administration among late-preterm infants across the entire post-period. Hospitals were ranked by their late-preterm steroid adoption rates and categorized by quartile based on the empirical distribution. Temporal trends were assessed using annual hospital-level adoption rates and visualized using time-series plots and distributional plots. A logistic regression model was constructed to determine hospital characteristics associated with being a highest-quartile adopting hospital. Results: The analysis cohort included 728 hospitals and 5,452,791 births, of which 361,006 (6.6%) were singleton late preterm births. Hospital steroid exposure rates ranged from 0 to 82% and were categorized into quartiles based on overall exposure rate, with cutoffs at 20.6%, 29.8%, and 40.1%. Median exposure rates increased progressively across quartiles from 14.1% (IQR 9.3-17.4%) in the lowest adopting hospitals (Q1) to 47.6% (IQR 43.7-53.2%) in the highest adopting hospitals (Q4), with substantial within-quartile variation. In the multivariable model, urban location was a strong predictor of high adoption after adjustment (aOR 2.05; 95% CI 1.11-3.83, p=0.02). Compared to Midwest hospitals, Southern hospitals had significantly lower odds of being high adopters (aOR 0.37; 95% CI 0.20-0.69, p
Artificial intelligence’s ability to enrich science will depend not only on model capability, but also on whether researchers, reviewers and funders reward originality over speed. Artificial intelligence’s ability to enrich science will depend not only on model capability, but also on whether researchers, reviewers and funders reward originality over speed.
by Yoshiyuki T. Nakamura, Chikara Furusawa, Kunihiko Kaneko Embryonic development in multicellular organisms exhibits diverse morphogenetic patterns, which can generally be categorized into fundamental types such as monolayer and multilayer spheres, as well as cell masses. Furthermore, we identify two distinct processes for the formation of spherical structures. These basic patterns are thought to be governed by the microscopic properties of intercellular adhesion. However, the specific mechanisms linking the microscopic factors to the emergence of distinct macroscopic morphogenetic patterns remain poorly understood. In this study, we explore how different morphogenetic patterns arise by employing a computational model that incorporates intercellular adhesion and polarity. Our results demonstrate that all fundamental morphogenetic patterns can be generated through the interplay of two key parameters: the polarity strength of the cell and the regulation of polarity via mechanical signals. Furthermore, analytical considerations reveal key mechanisms underlying the formation of these patterns. These findings highlight the critical role of physical constraints in morphogenesis and suggest potential applications to the design of artificial tissues and organoids.
arXiv:2606.13405v1 Announce Type: new Abstract: LLM-based agents are entering regulated industries where they automate judgment intensive quality management processes. We argue that symbolic structures already embedded in these domains, including regulations, typed process models, and compliance constraints, should be treated not merely as external monitoring mechanisms but as core architectural components that shape the agent's decision-making and behavior. We propose compliance-by-construction as a complementary paradigm to guardrail-based monitoring: a structural foundation that prevents control-flow violations, while guardrails remain essential for catching semantic errors. We identify a structured set of neuro-symbolic research challenges on foundational and capability level and show that addressing them jointly enables compliance-by-construction. We call on the neuro-symbolic community to engage with regulated process automation as a high impact research domain.
arXiv:2606.12442v1 Announce Type: cross Abstract: At present, loss of control risks have gained much prominence in public discussion, particularly in relation to AI, with extensive discourse present among academics, frontier labs, and even governments. However, in the existing literature, the concept seems to rest on surprisingly weak foundations, where even those that discuss loss of control extensively do not first establish what control is and what exactly is being lost. Our paper aims to address these gaps. We establish a working definition of control by anchoring it to the "setting and getting of goals". Then, we discuss various aspects of control, built on foundational concepts from related fields like cybernetics, management control, and control theory. This includes who (or what) can be in control, and the things they require to be in control, such as the ability to set goals, having a functional control loop, having requisite variety, and having sufficient goal alignment. Once a framework for control is established, we then discuss how control can be lost, how AIs can contribute to such loss of control, and offer relevant recommendations for how one can maintain control. One interesting consequence of our work is that humanity, as individuals and as groups, can lose varying degrees of control as a result of AI behaviour that is far below the level of superintelligence; the potential for loss of control scenarios (as we define them) already exist, and have existed for a long time.
Property Graphs are rapidly being adopted as database frameworks for representing heterogeneous data sources. To enable precise access to the information contained in them we need conversational interfaces based on Text-To-Cypher (Text2Cypher) parsers. This paper presents an automatic synthetic data generation method that can be leveraged to fine-tune small LLMs for this task. We conduct experiments on all the major Text-To-Cypher benchmarks, demonstrating that with our synthetic data generation approach we can significantly increase the performance of small LLMs, allowing them to compete with much larger proprietary models. This means that in settings in which models must be locally deployed we can ensure data-sovereignty without sacrificing accuracy and without costly annotation campaigns.
Background Cervical cancer remains a significant global public health challenge, ranking as the fourth most common cancer among women worldwide. According to The World Health Organization (WHO) 604,000 women were diagnosed with cervical cancer globally in 2020, with over 342,000 deaths amongst this group [1]. Despite its high mortality, cervical cancer is largely preventable through early detection and vaccination against human papillomavirus (HPV), which causes nearly all cases of cervical cancer [1,2] In Nigeria, it is the second most common cancer among women in Nigeria and a leading cause of cancer-related deaths, with low screening rates exacerbating late diagnoses and poor outcomes [1]. Despite global commitments to elimination with Pap smear screening and HPV vaccination, less than 10% of women in Nigeria have undergone screening due to misconceptions, stigma, and limited awareness. Educational interventions may improve awareness and promote screening behaviors. This global health quality improvement (QI) project aimed to enhance cervical cancer awareness and increase Pap smear uptake at the Central Bank of Nigeria (CBN) Clinic in Abuja, Nigeria. Methods In November 2024, we conducted a health education intervention at the Central Bank of Nigeria (CBN) through a structured educational session for male and female CBN staff members. The session focused on cervical cancer prevention, risk factors, and screening guidelines. Additionally, cervical cancer awareness was raised via email, social media, and electronic bulletin board. Participants completed pre and post-interventions surveys assessing cervical cancer knowledge across 10 key items and demographic characteristics. Pap smear uptake was assessed using the CBN clinic records for three months before and after the intervention. Institutional approval was obtained from CBN and external institutional review board approval was not required. Results 188 participants attended the health education session with 124 survey responses (70 pre-event, 54 post-event). Participants were mostly women aged 30-39. Post-intervention, eight of ten survey questions showed improved knowledge, with five demonstrating statistically significant gains: understanding Pap smear frequency (p
arXiv:2606.06525v2 Announce Type: replace-cross Abstract: Large language models (LLMs) have emerged as powerful foundation models with strong reasoning capabilities across domains. Beyond reactive text generation, agentic LLMs enable autonomous workflow execution through modular task decomposition and coordinated tool use. In structural engineering, recent efforts have developed agentic LLMs for automated analysis of plane frames. However, their extension to 3D frames remains underexplored due to challenges in irregular geometric representation, topological consistency, and long-horizon reasoning. This paper proposes an agentic LLM framework for automated structural analysis of 3D frames from natural language inputs. Irregular 3D frames are represented by projection onto a 2D plan, where orthogonal gridlines define spatial coordinates and a matrix of number of stories encodes vertical extrusion of each grid cell. Building on this representation, the framework establishes a multi-agent pipeline: a problem analysis agent parses input into structured JSON; a floor decomposition agent derives the spatial layout of each floor; the 3D geometry is assembled by node, girder, slab, and column agents; support and load agents assign boundary and loading conditions, and code translation agents generate executable SAP2000 script. Evaluated on ten representative 3D frames, the proposed framework achieves an average accuracy of 90% across repeated trials, demonstrating consistent and reliable performance.
arXiv:2606.13146v1 Announce Type: cross Abstract: We propose a robust feature-weighted jump model for time-dependent clustering. A penalty is used to encourage smoothness of transitions over time, while robustness is achieved through the use of a Tukey's biweight loss function. An additional parameter controls the variability of feature weights across states, allowing the model to assign state-specific relevance to each feature. We illustrate in simulation how the method accurately recovers the true cluster sequence and reliably identifies relevant features, outperforming competing approaches, particularly in the presence of outliers. We conclude with two empirical applications, one on the number of conflict-related homicides in Kosovo in the period 1998-2000, and another on macroeconomic performance of twelve European countries in the period 1949-2024.
arXiv:2606.03108v2 Announce Type: replace Abstract: Autonomous LLM training is often framed as recipe search, which leaves the training harness largely static. This limitation sharpens in agentic RL, where shifting bottlenecks and scalar rewards mask diverse failure modes. We introduce EvoTrainer, an autonomous training framework that co-evolves LLM policies and training-side harnesses through empirical feedback: it diagnoses rollout-level evidence, revises diagnostics, backtests interventions, and accumulates reusable skills. Evaluated on mathematical reasoning, competitive-programming code generation, and repository-level software engineering, EvoTrainer matches or exceeds the human-engineered RL references under the same data, codebase, and evaluation protocol, with the largest gain on long-horizon agentic SWE. Trajectory analyses show that retained strategies diverge across domains, evolving diagnostics prevent invalid high-scoring branches from being promoted, and reusable skills shape later search. Autonomous LLM RL should move beyond recipe search toward joint evolution of policies and the training harnesses that interpret them.
Domain Generalization (DG) seeks to develop a versatile model capable of performing effectively on unseen target domains. Notably, recent advances in pre-trained Visual Foundation Models (VFMs), such as CLIP, have demonstrated considerable potential in enhancing the generalization capabilities of deep learning models. Despite the increasing attention toward VFM-based domain prompt tuning within DG, the effective design of prompts capable of disentangling invariant features across diverse domains remains a critical challenge. In this paper, we propose addressing this challenge by leveraging the controllable and flexible language prompt of the VFM. Noting that the text modality of VFMs is naturally easier to disentangle, we introduce a novel framework for text feature-guided visual prompt tuning. This framework first automatically disentangles the text prompt using a large language model (LLM) and then learns domain-invariant visual representation guided by the disentangled text feature. However, relying solely on language to guide visual feature disentanglement has limitations, as visual features can sometimes be too complex or nuanced to be fully captured by descriptive text. To address this, we introduce Worst Explicit Representation Alignment (WERA), which extends text-guided visual prompts by incorporating an additional set of abstract prompts. These prompts enhance source domain diversity through stylized image augmentations, while alignment constraints ensure that visual representations remain consistent across both the original and augmented distributions. Experiments conducted on major DG datasets, including PACS, VLCS, OfficeHome, DomainNet, and TerraInc, demonstrate that our proposed method outperforms state-of-the-art DG methods.
arXiv:2508.14847v3 Announce Type: replace Abstract: We study discrete time-crystalline (DTC) phases in one-dimensional spin-1/2 chains with power-law-graded Ising interactions under periodic Floquet driving. By generalizing Stark localization to power-law-graded Ising interaction profiles, we identify robust period-doubled dynamics across a wide range of interaction exponents, stabilized by the interplay between coherent driving and spatially varying coupling. Within the DTC phase, the energy stored in the system, interpreted as a quantum battery, increases superlinearly with system size, although no scaling advantage persists in normalized power. Beyond energy storage, we demonstrate that the DTC phase supports enhanced quantum sensing. The quantum Fisher information associated with estimating timing deviations in the drive scales superextensively with system size, surpassing the Heisenberg limit. The degree of quantum advantage can be tuned by varying the interaction exponent, though DTC behavior remains robust throughout. Our results position power-law-graded Ising interacting Floquet systems as robust platforms for storing quantum energy and achieving metrological enhancement.
The Zygomaticomaxillary Suture is a key circummaxillary structure that connects the zygomatic bone and the maxilla, which serves as a primary site of resistance during maxillary advancement, and its maturation status directly influences the timing and efficacy of orthopedic interventions. However, accurate staging of ZMS maturation remains challenging due to subtle high-frequency transitions in suture lines and the global semantic ambiguity between adjacent stages. To address this, we present the first public ZMS dataset, comprising 3,790 ZMS images covering the entire age range from 4 to 24 years. Based on this dataset, we propose SKMamba, a Structure-aware and Knowledge-guided Mamba-based multi-modal framework for automated ZMS maturation assessment. SKMamba adopts a decoupled dual-path architecture that mimics the hierarchical diagnostic process used by experienced orthodontists. We first introduce an Implicit Edge Extractor (IEE), which leverages structural pre-training to reduce trabecular noise and accentuate sutural boundaries. Complementarily, a Cross-Modal Semantic Alignment (CSA) module is designed to incorporate anatomical descriptions from a large language model (LLM). This module helps align local morphological cues with global semantic descriptions while ensuring that objective morphological evidence remains the primary basis for decisions. Extensive experiments on our ZMS dataset demonstrate that SKMamba achieves state-of-the-art performance compared to existing methods. Code is available at https://github.com/galaxygxq1116/SKMamba.
BACKGROUND Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, life-threatening disease. Sociodemographic factors may influence time to treatment initiation and resulting clinical outcomes, yet these relationships are poorly characterized. OBJECTIVE Assess the effects of sex and race on tafamidis initiation and subsequent outcomes and their interaction with factors such as ATTR-CM type and social deprivation measures. METHODS A retrospective cohort analysis was conducted using the US Komodo Healthcare Map (01/2016-06/2024) among patients with amyloidosis, identified by ICD-10-CM diagnosis codes. Cumulative incidence of treatment initiation and survival probabilities for cardiovascular-related hospitalization (CVH) or death were estimated by Kaplan-Meier, stratified by sex and race. Cox proportional hazards models were fitted for both endpoints to estimate hazard ratios, adjusting for demographics and clinical characteristics. RESULTS Of 11,311 patients identified, White and Black patients (n=9,223) were included in subsequent analyses. Within 12 months of diagnosis, White women had the lowest cumulative incidence of tafamidis initiation (11.4%), followed by Black women (22.0%), Black men (26.7%), and White men (31.0%). Event-free survival at 12 months was lowest in Black women (42.9%), followed by Black men (46.8%), White women (48.6%), and White men (54.4%). Median (95% CI) time to CVH or death was shortest for Black women (8.0 months [6.8-10.0]) followed by Black men (9.9 months [8.8-12.0]), White women (11.0 months [9.6-13.0]), and White men (15.0 months [14.0-16.0]). CONCLUSIONS In this large, real-world cohort of US patients with ATTR-CM, sex and race contributed to disparities in tafamidis initiation and survival, underscoring compounded disparities in both access and outcomes.