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01.
bioRxiv (Bioinfo) 2026-06-24

RNabel-A Standalone Software Tool for Annotating Tandem Mass Spectra of Modified Ribonucleic Acids

Authors:
Song↗Du↗Y.-J. N↗Sun↗Dong↗M.-Q↗

Ribonucleic acid (RNA) modifications, with over 170 identified types, play diverse roles in cellular processes. The past decade has witnessed surging demand for accurate identification and localization of RNA modifications in both endogenous and synthetic therapeutic RNAs. With accurate spectral annotation for RNA, tandem mass spectrometry (MS/MS) can meet this demand. Here we present RNabel, a user-friendly software tool for in-depth annotation of MS/MS spectra of RNA oligonucleotides. RNabel considers a full set of backbone-cleavage ions (a, b, c, d, a-B, w, x, y, z) in which the ribonucleotide unit could be A, U, C, G, Y (pseudouridine), or I (Inosine). Additionally, RNabel considers 196 modifications on the base, the phosphoribose linkage, the 5' or the 3' terminus, or detachment of a sub-nucleotide fragment as a neutral or charged group. Users can create new components if needed, including ribonucleotides, modifications, neutral or charged groups that could detach from a ribonucleotide. RNabel efficiently processes large datasets in four acceptable formats including .mgf, .raw, .txt from msConvert, and RNabel batch files. Multiple statistical metrics are provided for quality assessment of spectral annotation. To accelerate RNA modification analysis, RNabel is made freely available for Mac and Windows users at https://github.com/songge1111/RNabel/releases.

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02.
arXiv (CS.AI) 2026-06-11

Resource-Aware LLM Reasoning for Mobile Edge General Intelligence

Authors:
Mingyi Luo↗Ruichen Zhang↗Xiangwang Hou↗Jun Du↗Chunxiao Jiang↗Yong Ren↗Shiwen Mao↗

arXiv:2509.23248v3 Announce Type: replace Abstract: The rapid advancement of large language models (LLMs) has enabled an emergence of agentic artificial intelligence (AI) with powerful reasoning and autonomous decision-making capabilities. This integration with edge computing has led to the development of Mobile Edge General Intelligence (MEGI), which brings real-time, privacy-preserving reasoning to the network edge. However, deploying LLM-based agentic AI reasoning in MEGI environments poses significant challenges due to the high computational demands of reasoning and the limited resources of edge devices. To address these challenges, we propose a joint optimization framework for efficient LLM reasoning deployment in MEGI. First, we systematically review enhancement methods to identify mechanisms suitable for edge adaptation. Subsequently, we present a distributed framework that synergizes reasoning enhancement via adaptive CoT prompting with scalable deployment through a distributed MoE architecture. An important innovation of this approach involves modeling reasoning depth as a dynamic network resource variable, which is optimized jointly with expert activation and transmission power. This mechanism allows the system to dynamically regulate expert networks and reasoning complexity according to task requirements and device capabilities. Experimental evaluations in mobile edge environments demonstrate that the proposed framework effectively balances reasoning quality and resource efficiency. The results show that with less than one second of additional inference time, both accuracy and latency satisfaction rate can reach 90\%, validating the practical viability of deploying sophisticated LLM reasoning in resource-constrained MEGI systems.

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03.
arXiv (CS.AI) 2026-06-16

LiteOdyssey: A Lightweight Reasoning AI Agent for Interpretable Rare-Disease Diagnosis

Authors:
Minh-Ha Nguyen↗Erica Gray↗Chih-Ting Yang↗Rizwan Hamid↗Lingyao Li↗Siyuan Ma↗Thomas A. Cassini↗Cathy Shyr↗

arXiv:2606.16149v1 Announce Type: new Abstract: Most medical AI systems improve by scaling additional machinery: more fine-tuning data, more agents, and/or larger retrieval databases. In rare-disease diagnosis, however, such scaling can produce systems that are difficult to deploy, audit, and maintain. We asked whether state-of-the-art diagnostic performance could instead be achieved by extending the reasoning chain of a single AI agent: guiding it with a diagnostic policy, developed through human-AI collaboration and augmenting with freely available biomedical tools. We introduce LiteOdyssey, a lightweight rare-disease diagnostic framework that guides reasoning language model through a clinical genetics workflow. This framework was developed through Policy Iteration with Human Feedback (PIHF) and uses dynamic access to public biomedical tools. On two challenging benchmarks that provide only patient clinical features, LiteOdyssey achieved state-of-the-art performance, with an overall disease Recall@1 of 59.3% over the combined 1,243 cases of LIRICAL (n = 370) and the PhenoPacket Store (n = 873). Both benchmarks have a high proportion of ultra-rare disease (a prevalence below 1 in 1,000,000, with ultra-rare shares of approximately 45% and 52.8%, respectively). On the more difficult PhenoPacket subset, where causal diseases were not mapped to Orphanet in our rarity-mapping pipeline, LiteOdyssey achieved 60.7% Recall@1, compared with 10.7% for the same baseline model (GPT-5.4) without tools. This performance was achieved without fine-tuning, multi-agent ensembles, or a large case-retrieval database. Gains were also observed in the following: on cases never seen during development, on a private cohort of real-world rare disease patients, and on a smaller open-weights model. LiteOdyssey suggests a path toward rare-disease AI systems that are accurate, easier to deploy, and more transparent for physician review.

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04.
arXiv (CS.AI) 2026-06-11

AI Researchers Must Help Lead Arms Control to Mitigate Military AI Risks

Authors:
Ted Fujimoto↗Jacob Benz↗

arXiv:2606.11533v1 Announce Type: cross Abstract: The advancement of AI capabilities compels researchers and the public to be more aware of its potential worldwide impact. A pressing near-term concern is the regulation of military AI applications. Armament manufacturers and defense contractors are increasingly investing in AI capabilities and forging partnerships with AI companies, creating a burgeoning coalition that demands military leaders, arms control diplomacy experts, and AI researchers collaborate to ensure a safer future. While AI researchers often focus on the long-term implications of superintelligent AI, this approach may not adequately address the immediate challenges posed by AI in military applications. Success requires acknowledging and mitigating the emerging risks of frontier AI models that plan to be integrated into defense applications, like military AI systems. Arms control has reduced past catastrophic risks, so lessons learned from nuclear deterrence can guide AI safety and security research towards innovations in verification and diplomacy. AI researchers, however, must assist in leading the technical research that clearly defines and alleviates instability in military settings. Given these new responsibilities and the lack of sufficiently reliable solutions, we argue that AI researchers must take a leading role in advancing arms control research to minimize risk in military AI applications.

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05.
arXiv (CS.CV) 2026-06-12

ViPER: Vision-based Packing-Aware Encoder for Robust Malware Detection

Authors:
Fatima Qaiser↗Bisma Tahir↗Muhammad Abid Mughal↗Nauman Shamim↗

Visualization-based malware detection maps raw binary bytes to grayscale images and applies learned visual classifiers, providing an evasion-resistant and disassembly-free alternative to conventional analysis pipelines. However, executable packing remains a critical failure mode: packed binaries produce high-entropy images that obscure the structural patterns these models rely on. Because packing is also prevalent in benign software (e.g., for compression or copy protection), packing state alone is not a reliable indicator of maliciousness, and existing approaches do not address this challenge within a unified supervised framework. We present ViPER, a Vision-based Packing-Aware Encoder for Robust malware detection. ViPER builds on a LoRA-adapted ViT-B/14 backbone with a dual-head architecture that jointly learns malware classification and packing detection. A packing-aware gating mechanism conditions malware predictions on the inferred packing state, enabling distinct decision boundaries for packed and unpacked inputs. To address packing label skew during training, we employ frequency-weighted losses with stratified sampling over joint class-packing strata. Evaluated on 200,000 Windows PE byteplot images, ViPER achieves a balanced accuracy of 0.8521, ROC-AUC of 0.9260, and AUPR of 0.9279, outperforming representative state-of-the-art baselines across all primary metrics, while attaining a packing detection AUC of 0.9949.

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

Bitwise Systolic Array Architecture for Runtime-Reconfigurable Multi-precision Quantized Multiplication on Hardware Accelerators

Authors:
Yuhao Liu↗Salim Ullah↗Akash Kumar↗

arXiv:2602.23334v2 Announce Type: replace-cross Abstract: Neural network accelerators have been widely applied to edge devices for complex tasks like object tracking, image recognition, etc. Previous works have explored the quantization technologies in related lightweight accelerator designs to reduce hardware resource consumption. However, low precision leads to high accuracy loss in inference. Therefore, mixed-precision quantization becomes an alternative solution by applying different precision in different layers to trade off resource consumption and accuracy. Because regular designs for multiplication on hardware cannot support the precision reconfiguration for a multi-precision Quantized Neural Network (QNN) model in runtime, we propose a runtime reconfigurable multi-precision multi-channel bitwise systolic array design for QNN accelerators. We have implemented and evaluated our work on the Ultra96 FPGA platform. Results show that our work can achieve 1.3185 to 3.5671 times speedup in inferring mixed-precision models and has less critical path delay, supporting a higher clock frequency (250MHz).

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07.
arXiv (CS.CL) 2026-06-12

PersonaDrive: Human-Style Retrieval-Augmented VLA Agents for Closed-Loop Driving Simulation

Authors:
Mahmoud Srewa↗Praneetsai Iddamsetty↗Mohammad Abdullah Al Faruque↗Salma Elmalaki↗

Closed-loop driving simulators typically populate their environments with non-ego traffic agents that behave largely the same way, produced either by rule-based traffic managers or by learned models trained toward a single behavioral mode. Recent work introduces style variation through post-hoc labels on observational data or LLM-inferred reward weights, but these signals act as proxies for what a style should reward rather than demonstrations of humans explicitly asked to drive in that style. We introduce PersonaDrive, a pipeline that conditions a vision-language-action (VLA) driving agent on retrieved demonstrations from a style-instructed human driving dataset, in which participants drive CARLA leaderboard routes under aggressive, neutral, and conservative instructions on a driver-in-the-loop rig. The pipeline has three stages: (i) offline triplet mining over per-style human driving data using a combined image-text similarity score; (ii) training a lightweight retrieval head that fuses frozen visual features with a small control encoder over per-style databases; and (iii) fine-tuning a single VLA backbone to treat retrieved context points as in-context behavioral demonstrations during waypoint prediction. At inference, the same backbone is conditioned on any style by swapping which per-style database the retrieval head queries, so selecting a style requires no per-style retraining while enabling human-style, style-diverse non-ego agents for closed-loop simulation. On Bench2Drive, PersonaDrive (no style) improves the driving score by 4.6% over SimLingo and 2.5% over HiP-AD, and under style conditioning attains the highest driving score in every style within a roughly 2% band (its weakest style surpassing the strongest baseline, DMW, by 5.4%), while average speed and acceleration rise by 18% and 25% from the conservative to the aggressive instruction.

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08.
arXiv (CS.CV) 2026-06-17

Colab NAS: Obtaining lightweight task-specific convolutional neural networks following Occam's razor

Authors:
Andrea Mattia Garavagno↗Daniele Leonardis↗Antonio Frisoli↗

The current trend of applying transfer learning from convolutional neural networks (CNNs) trained on large datasets can be an overkill when the target application is a custom and delimited problem, with enough data to train a network from scratch. On the other hand, the training of custom and lighter CNNs requires expertise, in the from-scratch case, and or high-end resources, as in the case of hardware-aware neural architecture search (HW NAS), limiting access to the technology by non-habitual NN developers. For this reason, we present ColabNAS, an affordable HW NAS technique for producing lightweight task-specific CNNs. Its novel derivative-free search strategy, inspired by Occam's razor, allows to obtain state-of-the-art results on the Visual Wake Word dataset, a standard TinyML benchmark, in just 3.1 GPU hours using free online GPU services such as Google Colaboratory and Kaggle Kernel.

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09.
arXiv (CS.AI) 2026-06-17

Using Cognitive Models to Improve Language Model Simulation of Human Persuasion Games

Authors:
Zirui Cheng↗Zeyu Shen↗Thomas L. Griffiths↗Peter Henderson↗

arXiv:2606.17657v1 Announce Type: new Abstract: People make decisions differently in strategic interactions. Some update beliefs like a Bayesian; others exhibit biases like motivated reasoning. Although creators of large language models use simulated humans for safety evaluations and training, they often fail to cover this breadth of human behavior. We argue that cognitive science and economics provide a convenient tool for doing so, making use of mathematical models of human decision-making. We propose an approach that we call Equation-to-Behavior Prompting for guiding large language models to match cognitive models, and evaluate this approach on persuasion games based on legal decision-making. We find that large models can approximate equation-based specifications – Bayesian updating, affine distortion, motivated updating, and Grether's $\alpha$-$\beta$ model – using prompting, but small models fail to do so. However, training small models with reinforcement learning to adhere to mathematical rules, Equation-to-Behavior RL, reduces belief error by 26.5% in out-of-distribution parameterizations. We show that these simulations can help create diverse training environments; training small models to consider different kinds of decision-makers improves average belief change by 2.5%–12% over Bayesian-only training, even when persuading GPT-5-mini. Our work could improve human simulations for training and evaluation in increasingly realistic settings, and could also enable novel research into more complicated mathematical models of human decision-making.

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10.
medRxiv (Medicine) 2026-06-11

Malaria Risk among Internally Mobile Individuals and Heterogeneous Mobility Patterns in Two Hypoendemic Communities: Implications for Malaria Elimination in the Peruvian Amazon.

Authors:
Ramirez Saavedra↗Acosta↗Rodriguez↗Cabrera-Sosa↗Escalente↗A. A↗Vinetz↗J. M↗Torres↗Gamboa↗

Background: Human mobility is increasingly recognized as a key factor influencing malaria transmission dynamics, particularly in low-transmission settings approaching elimination. This study aimed to assess mobility patterns and their association with malaria risk in two hypoendemic communities in the Peruvian Amazon. Method: A longitudinal study was conducted in the communities of Libertad and Urcomirano (Mazan River basin). Monthly population screenings were combined with weekly active and passive case detection. A total of 678 individuals were enrolled. Mobility patterns were assessed through structured questionnaires, and social network analysis was used to characterize travel connections. Log-binomial regression analysis was applied to identify risk factors associated with malaria infection. Result: Internally, mobile individuals in Libertad showed a higher malaria incidence (>32.47 cases per 1,000 person-months) than those in Urcomirano (

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13.
Science (Express) 2026-06-11

Laser phase plate improves structure determination of small proteins by cryo-EM | Science

Authors: Unknown Author

Phase plates can in principle overcome the poor image contrast in electron cryo–microscopy (cryo-EM) and the resulting limits on the structural reconstruction of small proteins. However, previous designs have been unstable and compromised the high-resolution signal. They have thus been unable to surpass results achieved by standard cryo-EM. Here, we show that the laser phase plate (LPP), installed in a custom, modern Titan Krios microscope, enhances the resolution in single-particle reconstruction of small proteins by improving specimen-motion correction, recovery of information from the early frames, as well as particle visualization, 3D classification, and alignment. These advances use standard defocus ranges and reconstruction procedures, but open the door to LPP-tailored protocols offering further improvements by leveraging the LPP demonstrated here.

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14.
arXiv (CS.AI) 2026-06-18

Closing the Loop: PID Feedback Control for Interpretable Activation Steering in Symbolic Music Generation

Authors:
Ioannis Prokopiou↗Pantelis Vikatos↗Maximos Kaliakatsos-Papakostas↗Theodoros Giannakopoulos↗Themos Stafylakis↗

arXiv:2606.18790v1 Announce Type: cross Abstract: Transformer-based architectures have significantly advanced the generation of complex symbolic sequences, yet a significant gap remains in achieving fine-grained, interpretable control over discrete signal attributes. This paper investigates the mechanistic interpretability of the Multitrack Music Transformer (MMT) and proposes a framework for deterministic attribute modulation without retraining to bridge this gap via inference-time activation steering. Utilizing the Difference-in-Means (DiffMean) methodology, we isolate latent directions for signal attributes, specifically Pitch and Duration, within the residual stream. We validate the Linear Representation Hypothesis in this domain, achieving high correlation between steering magnitude and attribute shift. To address the inherent feature entanglement in multi-attribute steering, we introduce a Dual Steering framework utilizing Gram-Schmidt Orthogonalization. Experimental results demonstrate that this geometric decoupling reduces conceptual interference and signal degradation compared to naive vector addition, enabling independent deterministic control even against strong autoregressive conditioning.

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

Neural ARFIMA model for forecasting BRIC exchange rates with long memory

Authors:
Donia Besher↗Madhurima Panja↗Shovon Sengupta↗Tanujit Chakraborty↗

arXiv:2509.06697v3 Announce Type: replace-cross Abstract: Exchange rate forecasting remains a challenging problem, particularly for emerging economies, where the observed time series exhibit pronounced long-memory dependence, nonlinear dynamics, and sensitivity to macro-financial drivers. Classical models such as ARFIMA capture long-range persistence but fail to adequately represent nonlinear relationships, while modern machine learning approaches often neglect the underlying long-memory structure in macroeconomic series. To address this gap, we propose a Neural AutoRegressive Fractionally Integrated Moving Average (NARFIMA) model that integrates ARFIMA-based long-memory modeling with neural networks for nonlinear function approximation, while incorporating exogenous macroeconomic and uncertainty indicators. The framework provides a unified approach for capturing persistence, nonlinear dynamics, and external shocks. We establish asymptotic stationarity of the NARFIMA process and develop conformal prediction intervals for distribution-free uncertainty quantification. Empirical results for BRIC exchange rates show that NARFIMA consistently outperforms a broad range of forecasting benchmarks across multiple horizons, underscoring the importance of explicitly modeling long-memory dependence in exchange rate dynamics. The `narfima' R package provides an implementation of our approach.

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16.
medRxiv (Medicine) 2026-06-19

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

Authors:
Tang↗A. L↗Tsurumi↗

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.

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17.
arXiv (CS.LG) 2026-06-19

CAGE: Curvature-Aware Gradient Estimation For Accurate Quantization-Aware Training

Authors:
Soroush Tabesh↗Mher Safaryan↗Andrei Panferov↗Alexandra Volkova↗Dan Alistarh↗

arXiv:2510.18784v3 Announce Type: replace Abstract: Despite significant work on low-bit quantization-aware training (QAT), there is still an accuracy gap between such techniques and native training. To address this, we introduce CAGE (Curvature-Aware Gradient Estimation), a new QAT method that augments the straight-through estimator (STE) gradient with a curvature-aware correction designed to counteract the loss increase induced by quantization. CAGE is derived from a multi-objective view of QAT that balances loss minimization with the quantization constraints, yielding a principled correction term that depends on local curvature information. On the theoretical side, we introduce the notion of Pareto-optimal solutions for quantized optimization, and establish that CAGE yields strong convergence guarantees in the smooth non-convex setting. In terms of implementation, our approach is optimizer-agnostic, but we provide a highly-efficient implementation that leverages Adam statistics. CAGE significantly improves upon the prior state-of-the-art methods in terms of accuracy, for similar computational cost: for QAT fine-tuning, it halves the compression accuracy loss relative to the prior best method, while for QAT pre-training of Llama models, its accuracy for 3-bit weights-and-activations (W3A3) matches the accuracy achieved at 4-bits (W4A4) with the prior best method. The official implementation can be found over https://github.com/IST-DASLab/CAGE .

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

Aspect-Based Sentiment Evolution and its Correlation with Review Rounds in Multi-Round Peer Reviews: A Deep Learning Approach

Authors:
Ruxue Hana↗Haomin Zhoua↗Jiangtao Zhong↗Chengzhi Zhang↗

Mining sentiment information from the textual content of peer review comments offers valuable insights into the scientific evaluation process. However, previous studies are often constrained by coarse-grained analysis and the lack of differentiation across review rounds. Notably, the dynamic shifts in reviewers' focus and sentiment tendencies throughout multiple review stages remain underexplored. To address this gap, the present study investigates the distribution and evolution of aspect-level sentiments and examines their correlation with the number of review rounds. We begin by segmenting the multi-round review comments of 11,063 accepted papers from Nature Communications and identifying fine-grained review aspect clusters. A manually annotated corpus of approximately 5,000 review sentences is then constructed. Using this dataset, we train a series of deep learning-based aspect sentiment classification models. Among them, the LCF-BERT-CDM model achieves the best performance, with a Macro-F1 score of 82.65%. Subsequent statistical analysis reveals a consistent trend: as the number of review rounds increases, the proportion of positive sentiments rises, while negative sentiments decline. Correlation analysis further indicates that aspect sentiment scores are negatively associated with the total number of review rounds. Key aspects exhibiting stronger correlations include "experiments", "research significance" and "result analysis".

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19.
medRxiv (Medicine) 2026-06-22

Spatial Analysis and Multilevel Determinants of Hypertension in Zambia: Analysis of the 2017 WHO STEPS Survey

Authors:
Mutasha↗Simukoko↗Nkandu↗

Background: Hypertension is the leading modifiable cardiovascular risk factor globally, with the fastest-growing burden in low- and middle-income countries. This study aimed to estimate national hypertension prevalence, map provincial patterns, assess spatial clustering, and identify individual and community-level determinants among Zambian adults using the 2017 WHO STEPS survey. Methods: This cross-sectional study used data from the 2017 WHO STEPS survey, a nationally representative sample of 4,301 adults aged 18-69 years. Hypertension was defined as systolic BP [&ge;]140 mmHg, diastolic BP [&ge;]90 mmHg, or current antihypertensive use. Spatial autocorrelation was assessed via Moran's I and LISA. Four nested generalised linear mixed models with PSU-level random intercepts identified individual and community-level determinants. Results: Overall weighted hypertension prevalence was 24.0%. Lusaka recorded the highest prevalence (30.2%), followed by Southern (29.9%) and Muchinga (28.3%) provinces; Western Province had the lowest (12.4%). Spatial clustering was statistically significant but modest (Moran's I = 0.0247, p < 0.001). Between-cluster variation reduced from ICC = 5.9% to 1.8% in the full model, indicating geographic differences were largely explained by individual characteristics. Age was the strongest predictor; adults aged 60-69 had nearly sevenfold higher odds than those aged 18-29 (AOR 6.92, 95% CI: 4.95-9.66). Women had lower odds than men (AOR 0.64, 95% CI: 0.52-0.79). Obesity (AOR 2.34), overweight (AOR 1.65), high cholesterol (AOR 1.40), diabetes (AOR 1.35), and single marital status (AOR 1.34) were independently significant. Western Province showed consistently lower odds than Central Province (AOR 0.48). Conclusion: Hypertension affects one in four Zambian adults, driven primarily by age, sex, obesity, dyslipidaemia, and diabetes. Geographically prioritised interventions, including community health worker-led screening programmes in Lusaka and Southern Province, would maximise population-level impact. Population-level salt reduction and alcohol policies represent cost-effective complementary strategies. Longitudinal studies with finer spatial resolution are needed to clarify causal pathways underlying observed geographic clustering and inform SDG Target 3.4 progress.

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20.
medRxiv (Medicine) 2026-06-24

Cardiologists perspectives on sociocultural and structural factors shaping cardiovascular genetic testing

Authors:
Ramey↗H. M↗Gabriel↗Morales↗Romagnoli↗Williams↗M. S↗

Introduction: Genetic testing is increasingly central to the diagnosis and management of cardiovascular genetic conditions. However, use and follow-through vary across patient populations. Examining clinician perspectives on sociocultural and structural factors influencing testing is important for understanding these differences and informing public health genomics research and implementation efforts. Methods: We conducted semi-structured interviews with 15 cardiologists from health systems across the United States who have integrated cardiogenetics in their practice. Interviews explored experiences diagnosing cardiovascular genetic conditions among patients from underrepresented backgrounds, as well as approaches to incorporating social and contextual information into care. Data were coded thematically and analyzed using a framework analysis guided by the Health Equity Implementation Framework and Social Determinants of Health domains. Results: Clinicians described multi-level factors shaping genetic testing practices, including patient-provider interactions, clinical workflows, health system infrastructure, and broader policy contexts. Key themes included challenges communicating complex genetic information across language and literacy differences; patient trust shaped by prior healthcare experiences; fragmented insurance coverage separating genetic testing from genetic counseling; and challenges interpreting variants of uncertain significance, particularly for populations underrepresented in genomic reference databases. Clinicians also described adaptive strategies, such as interdisciplinary collaboration, telehealth, and patient assistance programs, that supported testing in some settings but were often inconsistent or resource-dependent. Conclusion: Among cardiologists using genetic testing, system-level and sociocultural factors shape the feasibility and downstream use of cardiovascular genetic testing. Findings highlight considerations for public health-informed genomic infrastructure that accounts for social context, supports communication, and reduces reliance on individual clinician workarounds, with implications for clinical decision support and related public health genomics initiatives.

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21.
medRxiv (Medicine) 2026-06-15

Anti-Platelet Factor 4 Antibody Clonal Heterogeneity and MGUS Status in HIT

Authors:
Kanack↗Mauch↗Kohlhagen↗Coker↗Murray↗Padmanabhan↗

Background Monoclonal gammopathy of thrombotic significance (MGTS) is a recently described chronic prothrombotic condition characterized by monoclonal anti-PF4 antibodies that are detected above the polyclonal antibody background in patient sera (i.e. present as monoclonal gammopathy of undetermined significance, MGUS). Due to conflicting data in the published literature on antibody clonality in heparin-induced thrombocytopenia (HIT), we evaluated clonality and abundance of anti-PF4 antibodies in HIT, including investigating whether an MGUS, if present in HIT, represents the causative anti-PF4 antibody. Methods Blood samples from 15 patients with HIT were subject to Platelet Factor 4-dependent antigen-based and functional tests. The unmanipulated serum antibody repertoire and isolated anti-PF4 antibodies were subjected to mass spectrometric evaluation. Results Two of the 15 HIT patients had an IgG MGUS. Notably, anti-PF4 antibodies were not synonymous with the MGUS antibody in either of the two patients. Eight of the 15 patients demonstrated monoclonal anti-PF4 antibodies, however, none of the anti-PF4 antibodies were detectable as an MGUS upon evaluation of the entire serum antibody repertoire, reflecting their low abundance. In the seven patients with multiple anti-PF4 antibodies, non-monoclonality was confirmed by analysis of deglycosylated antibody heavy chains. Conclusions Anti-PF4 HIT antibodies are monoclonal in approximately 50% of HIT patients, however, antibody abundance is low such that they are not detectable over the polyclonal IgG background (i.e. are MGUS-negative), differentiating HIT from MGTS. This observation helps explain the transient nature of HIT relative to the persistent prothrombotic state seen in MGTS.

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22.
Nature (Science) 2026-06-10

A first-in-class pulsatile FXR agonist for bile-acid-related liver diseases

Authors:
Yi Zang↗

Nuclear receptors are central regulators of metabolism1, yet therapeutic strategies that enforce continuous receptor activation frequently lead to reduced efficacy and unacceptable toxicity. Here we report a first-principles drug design strategy that aligns pharmacokinetics with physiological signalling cycles. We developed linafexor, a potent non-bile-acid agonist of the farnesoid X receptor (FXR)2; it is engineered for rapid systemic clearance, which enables pulsatile receptor activation that mirrors endogenous bile acid dynamics3–5. Linafexor has robust efficacy across multiple preclinical models of metabolic dysfunction-associated steatohepatitis6, liver fibrosis7, primary biliary cholangitis and primary sclerosing cholangitis8,9. Transcriptomic analyses reveal that, unlike long-acting FXR agonists10,11, linafexor preserves cyclic FXR signalling, avoids receptor downregulation and prevents broad transcriptional dysregulation. Direct manipulation of delivery patterns demonstrates that sustained FXR activation—independent of compound identity—induces severe toxicity, establishing activation duration as a determinant of therapeutic index. In phase 1 clinical studies (ClinicalTrials.gov; NCT05082779), linafexor administered once daily produces transient FXR pathway engagement, marked by (1) induction of FGF1912–14, a key endocrine mediator of bile acid feedback regulation; and (2) suppression of C415, an intermediate reflecting hepatic bile acid synthesis, with no treatment-related adverse events. Together, these findings identify pulsatile FXR activation as a mechanistically grounded and clinically translatable strategy, and establish linafexor as a first-in-class therapeutic for bile acid–related liver diseases. Linafexor is a rapidly cleared FXR agonist designed to mimic natural bile acid signalling, achieving transient receptor activation with strong efficacy and reduced toxicity in preclinical and early clinical studies.

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23.
medRxiv (Medicine) 2026-06-24

Pembrolizumab, Temozolomide and HSPPC-96 Vaccine in Newly Diagnosed Glioblastoma Post-Chemoradiation: Results from a Multi-institutional, Phase 2, Randomized, Placebo-Controlled Trial

Authors:
Ozer↗B. H↗Lindhorst↗S. M↗Merrell↗R. T↗Trevino↗C. R↗Rudnick↗J. D↗Avgeropoulos↗N. G↗…

Background: GBM is one of the most common and most aggressive brain tumors in adults, and upfront standard of care treatment has limited efficacy. Immune checkpoint inhibitor strategies have significantly improved outcomes in various solid tumors but have not proven effective in GBM, suggesting other strategies may be needed to realize their full potential. Methods: GBM patients were treated with upfront standard of care chemoradiation with temozolomide and pembrolizumab, followed by adjuvant temozolomide and pembrolizumab for six nine-week cycles. Depending on production of sufficient vaccine, patients were randomized into HSPPC-96 vaccine or placebo group (q4 weeks) while those with failed vaccine production continued on study unblinded as an ancillary group. The primary objective was overall survival at one year, and secondary endpoints were progression-free survival at six months, overall and progression-free survival, radiographic response, and tolerability by patient-reported outcomes and adverse event documentation. Results: 90 patients were screened, 32 were treated (8 vaccine, 9 placebo, 15 ancillary), and 26 were evaluable for radiographic responses prior to accrual termination. The study did not meet its primary endpoint of overall survival at one year (65.5% in vaccine group, 75% in placebo). Progression-free endpoints were mildly improved in the vaccine group but were not significant, and response rates were not significantly different. The regimen was well-tolerated and safe. Conclusions: Though limited by early discontinuation, these findings do not support the combination of pembrolizumab and HSPPC-96 vaccine with standard of care therapy. Trials Registration: ClinicalTrials.gov identifier: NCT03018288

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24.
arXiv (CS.AI) 2026-06-16

Trust Without Trusting: A Recomputable Trust Protocol for Autonomous Agents

Authors:
Lars Kersten Kroehl↗

arXiv:2605.06738v2 Announce Type: replace-cross Abstract: Autonomous AI agents already transact at production scale – 69,000 bots, 165 million transactions, $50 million in volume on a single marketplace – and any party can verify a signed credential without a central service. In an open agent world that covers most of what trust requires: there are no universal borders, and each party chooses for itself whom to deal with. Borders appear only where a closed space draws one – a marketplace, a platform, or a consortium sets house rules. Whoever draws the border holds the authority to apply it, and may apply it as they choose, behind closed doors. This paper addresses the gap that opens there: when you rely on someone else's border, how do you check that they applied their own published rules – taking no one's word for it, and handing the check to no new trusted party? Our answer is the Combined Evidence Protocol (CEP): a five-condition predicate any party recomputes from anchored data, turning "did the boundary-owner follow its own admission rules" into a fact anyone verifies rather than a claim anyone believes. The move that secures optimistic rollups secures this – correctness rests on recomputation, so the measurement belongs to everyone and the oracle problem dissolves. Its load-bearing setting is a consortium of co-equal, mutually distrusting peers under a shared charter, each able to verify, independently, that the rules they jointly agreed are the rules being applied. CEP belongs to the family of trustless systems – optimistic and zero-knowledge rollups, verifiable ML, self-sovereign-identity predicates. The infrastructure beneath it is live: a W3C VC + DID trust layer running since March 2026, anchored on Base L2, continuing arXiv:2605.06738 and standing on its own.

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25.
medRxiv (Medicine) 2026-06-23

Sex-Specific TMPRSS2 Response and Reduced Peripheral RNA Concentration Following AstraZeneca COVID-19 Vaccination in Nigeria.

Authors:
Ekprikpo↗E. S↗Ken-Ezihuo↗S. U↗Echonwere-Uwikor↗B. E↗Jeremiah↗Z. A↗

Background: ChAdOx1 nCoV-19 remains a cornerstone COVID-19 vaccine in sub-Saharan Africa, yet population-specific molecular responses are understudied. We examined peripheral blood ACE2 and TMPRSS2 expression, total RNA concentration, and coagulation indices in Nigerians >=6 months post-vaccination. Methods: In a case-control study in Port Harcourt, Nigeria, 51 ChAdOx1-vaccinated adults and 51 age/sex-matched unvaccinated controls provided venous blood for RNA extraction, qRT-PCR, and coagulation assays. Multivariable linear models assessed effects of vaccination, sex, and age on molecular parameters. Results: Vaccinated participants had 37% lower total RNA concentration than controls (4.02 +/- 0.09 vs 6.38 +/- 0.14 ng/uL, p=6 months post-ChAdOx1, Nigerians show reduced peripheral blood RNA without sustained ACE2/TMPRSS2 upregulation. The sex-specific TMPRSS2 pattern suggests hormone and vaccine interactions previously unreported in African cohorts and highlights the need for sex-disaggregated molecular surveillance. Region-specific reference gene validation is recommended for Nigerian transcriptomic studies.

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