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01.
arXiv (CS.CL) 2026-06-24

ErrorLLM: Modeling SQL Errors for Text-to-SQL Refinement

Despite the remarkable performance of large language models (LLMs) in text-to-SQL (SQL generation), correctly producing SQL queries remains challenging during initial generation. The SQL refinement task is subsequently introduced to correct syntactic and semantic errors in generated SQL queries. However, existing paradigms face two major limitations: (i) self-debugging becomes increasingly ineffective as modern LLMs rarely produce explicit execution errors that can trigger debugging signals; (ii) self-correction exhibits low detection precision due to the lack of explicit error modeling grounded in the question and schema, and suffers from severe hallucination that frequently corrupts correct SQLs. In this paper, we propose ErrorLLM, a framework that explicitly models text-to-SQL Errors within a dedicated LLM for text-to-SQL refinement. Specifically, we represent the user question and database schema as structural features, employ static detection to identify execution failures and surface mismatches, and extend ErrorLLM's semantic space with dedicated error tokens that capture categorized implicit semantic error types. Through a well-designed training strategy, we explicitly model these errors with structural representations, enabling the LLM to detect complex implicit errors by predicting dedicated error tokens. Guided by the detected errors, we perform error-guided refinement on the SQL structure by prompting LLMs. Extensive experiments demonstrate that ErrorLLM achieves the most significant improvements over backbone initial generation. Further analysis reveals that detection quality directly determines refinement effectiveness, and ErrorLLM addresses both sides by high detection F1 score while maintain refinement effectiveness.

02.
arXiv (CS.AI) 2026-06-19

MakeupMirror: Improving Facial Attribute Preservation in Diffusion Models for Makeup Transfer

arXiv:2606.20094v1 Announce Type: cross Abstract: Makeup transfer models enable fun augmented reality (AR) experiences as well as virtual try-on (VTO) for online makeup shopping. While recent state-of-the-art diffusion based solutions such as Stable-Makeup dramatically improve the accuracy and realism of makeup transfer, they still face limitations in identity and skin color preservation, making production-level VTO for makeup shopping unrealistic. In this work, we propose MakeupMirror, a diffusion-based approach to makeup transfer that makes significant progress towards preserving facial features and skin tone. We introduce several technical innovations over Stable-Makeup: (1) integration of facial geometry conditioning with ControlNets to maintain facial fidelity; (2) region-specific makeup transfer control to enable precise makeup application across facial regions such as skin, eyes and lips; (3) skin tone-based makeup transfer modulation that prevent skin tone alteration in cross-subject transfer scenarios; and (4) integration of a Levenberg-Marquardt Langevin sampler to speed up inference while maintaining generation quality. Our experiments on CPM-Real, Makeup Wild, and (herein newly collected, more diverse) MakeupSelfies datasets show that MakeupMirror improves relative facial recognition similarity by +60%, reduces relative skin tone difference by -50% over Stable-Makeup, with a latency of 0.7s, while achieving expert acceptance rate of 94% across core facial identity preservation criteria.

03.
medRxiv (Medicine) 2026-06-22

Building accessible resources to empower communities: the case of the Lupus Mexican Registry

Motivation: Although SLE data in Latin America is increasing, clinical datasets remain difficult to access and interpret, highlighting the need for accessible tools that support data-driven precision medicine, citizen science, and public health initiatives. Results: We developed a user-friendly platform that enables us to explore LupusRGMX data through interactive queries, report generation, statistical modeling, and comprehensive insights. This resource supports community-oriented research, improves the visibility of underrepresented populations in lupus research, and provides a useful tool to enhance data accessibility. Availability and implementation: Developed in R using Shiny and bslib for interactive visualization and interface design. Available at https://github.com/NeuroGenomicsMX/Lupus_App_2.0 and https://lupusrgmx.liigh.unam.mx/shiny/lupus/

04.
arXiv (quant-ph) 2026-06-12

Proper and improper mixed states serve as different prior beliefs for quantum state retrodiction

arXiv:2502.10030v2 Announce Type: replace Abstract: A mixed quantum state can be taken as capturing an unspecified form of ignorance; or as describing the lack of knowledge about the true pure state of the system ("proper mixture"); or as arising from entanglement with another system that has been disregarded ("improper mixture"). These different views yield identical density matrices and therefore identical predictions for future measurements. But when used as prior beliefs for inferring the past state from later observations ("retrodiction"), they lead to different updated beliefs. This is a purely quantum feature of Bayesian agency. Based on this observation, we establish a framework for retrodicting on any quantum belief and we prove a necessary and sufficient condition for the equivalence of beliefs. We also illustrate how these differences have operational consequences in quantum state recovery.

05.
arXiv (CS.CV) 2026-06-16

K-Prism: A Knowledge-Guided and Prompt Integrated Universal Medical Image Segmentation Model

Medical image segmentation is fundamental to clinical decision-making, yet existing models remain fragmented. They are usually trained on single knowledge sources and specific to individual tasks, modalities, or organs. This fragmentation contrasts sharply with clinical practice, where experts seamlessly integrate diverse knowledge: anatomical priors from training, exemplar-based reasoning from reference cases, and iterative refinement through real-time interaction. We present $K-Prism$, a unified segmentation framework that mirrors this clinical flexibility by systematically integrating three knowledge paradigms: (i) $semantic priors$ learned from annotated datasets, (ii) $in-context knowledge$ from few-shot reference examples, and (iii) $interactive feedback$ from user inputs like clicks or scribbles. Our key insight is that these heterogeneous knowledge sources can be encoded into a dual-prompt representation: 1-D sparse prompts defining $what$ to segment and 2-D dense prompts indicating $where$ to attend, which are then dynamically routed through a Mixture-of-Experts (MoE) decoder. This design enables flexible switching between paradigms and joint training across diverse tasks without architectural modifications. Comprehensive experiments on 18 public datasets spanning diverse modalities (CT, MRI, X-ray, pathology, ultrasound, etc.) demonstrate that K-Prism achieves state-of-the-art performance across semantic, in-context, and interactive segmentation settings.

06.
arXiv (quant-ph) 2026-06-24

Active interference suppression in frequency-division-multiplexed quantum gates via off-resonant microwave tones

arXiv:2601.14547v3 Announce Type: replace Abstract: The increasing number of control lines connecting quantum processors to external electronics constitutes a major bottleneck in the realization of large-scale quantum computers. Frequency-division multiplexing is expected to enable control of multiple qubits through a single microwave cable; however, interference from off-resonant microwave tones hinders precise qubit control. Here, we propose an active interference suppression method for frequency-division-multiplexed simultaneous gates on microwave-controlled qubits. We demonstrate that the deliberate incorporation of off-resonant microwave tones improves single-qubit gate fidelity. In particular, the gate infidelity scales inversely with the square of the number of microwave tones when off-resonant orthogonal or quasi-orthogonal tones are incorporated. Furthermore, we show that fast oscillations, neglected under the rotating wave approximation, degrade the gate fidelity, and that this degradation can be mitigated through optimized frequency allocation. The proposed approach is simple and effective for improving the performance of frequency-division-multiplexed quantum gates.

07.
arXiv (CS.CL) 2026-06-18

Are LLMs Ready to Assist Physicians? PhysAssistBench for Interactive Doctor-Patient-EHR Assistance

The most plausible near-term role of medical LLMs is to assist rather than replace physicians, yet current evaluations often test isolated capabilities: clinical knowledge, EHR system interaction, or patient communication. Physician assistance instead requires coordinating these capabilities within the same interaction, where physicians issue underspecified requests, patients describe symptoms ambiguously, and EHR systems demand precise tool use. We introduce PhysAssistBench, a benchmark for interactive doctor-patient-EHR assistance. Built from real MIMIC-IV cases, PhysAssistBench uses a scalable pipeline to construct agentic patients: interactive, record-grounded agents that turn static EHR records into multi-turn clinical scenarios while preserving clinical factuality. PhysAssistBench provides a curated bilingual evaluation set of 1,296 manually reviewed and physician-validated turns. Experiments with leading LLMs show that current models remain unreliable in this setting, which exposes a key bottleneck for clinical LLMs: reliable assistance requires coordination across knowledge, communication, and systems, not isolated gains in any of them.

08.
arXiv (CS.CL) 2026-06-19

Disentangling Linguistic Relatedness from Task Alignment in Cross-Lingual Transfer

We study cross-lingual transfer by fine-tuning seven large language models (4B–671B parameters) on Arabic and evaluating zero-shot reading comprehension on Semitic languages and non-Semitic controls. Across dense and Mixture-of-Experts architectures, we find no evidence of Semitic-specific transfer: models with weak baselines improve dramatically across all languages, while strong-baseline models show only marginal gains regardless of language family. A chain-of-thought ablation reinforces this finding – the same models that benefit most from fine-tuning benefit equally from inference-time reasoning, suggesting both mechanisms address task-format alignment rather than cross-lingual knowledge transfer.

09.
arXiv (CS.CV) 2026-06-19

Spectral Query-Key Product Weight Steering for Training-Free VLM Hallucination Mitigation

Vision-language models (VLMs) often generate fluent but visually unsupported descriptions, especially by mentioning objects absent from the image. We propose QK Product Steering, a data-free, training-free, and zero-inference-cost weight edit for reducing object hallucination. The method directly edits the per-head query-key product, the operator that produces pre-softmax attention logits, by suppressing a small number of dominant singular modes in selected middle layers. The edited product is then mapped back to the query weights through a closed-form query-only update while keeping shared key weights fixed, making the edit compatible with grouped-query attention. We further decompose the QK product into symmetric and antisymmetric components to distinguish mutual content-similarity patterns from directional attention patterns. Across three GQA-based VLMs, QK Product Steering achieves an average relative CHAIR$_s$ reduction of $4.0\%$, while matched random-mode controls show negligible change. Interpretability ablations show that the hallucination signal is specific to dominant QK modes and is primarily localized to the symmetric mutual-attention channel. Overall, QK Product Steering offers a simple alternative to decoding-time mitigation, requiring no additional data, fine-tuning, or inference-time overhead while largely preserving general multimodal capability.

10.
arXiv (CS.LG) 2026-06-24

Machine-Learning Emulation of Satellite Greenhouse Gas Retrievals: Stability over Time

arXiv:2606.09313v2 Announce Type: replace Abstract: Retrieval algorithms are used to estimate atmospheric concentrations of greenhouse gases (GHGs), such as carbon dioxide (CO2) and methane (CH4), by solving inverse problems from high-spectral-resolution satellite radiance measurements. However, these algorithms are computationally expensive, which makes real-time estimation at scale difficult. Machine-learning models have therefore been proposed as fast emulators of retrieval algorithms. Most existing studies, however, evaluate them only on test data from the same period as the training data. We study the stability over time of such emulators using data from the Greenhouse Gases Observing SATellite (GOSAT). We show that prediction accuracy generally deteriorates when the test period moves away from the training period. We also show that including time as an input feature substantially improves XCH4 prediction for Lasso and neural-network models. Among the methods considered, a simple Lasso model performs as well as or better than more complex methods such as neural networks, and yields more stable predictions over time. We further validate the results using the Total Carbon Column Observing Network (TCCON), a ground-based observation network. On the TCCON-matched dataset, the time-augmented Lasso achieves errors against TCCON that are comparable to the disagreement between GOSAT and TCCON for both XCO2 and XCH4.

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

CogGuard: Cognitive and Operational Profiling for Proactive Warning in Edge Intelligent Services

arXiv:2606.15199v1 Announce Type: new Abstract: Proactive warning is an important capability for edge intelligent services, where the system predicts whether a subject will successfully complete an incoming task under strict latency and privacy constraints. Such prediction depends on both long-term static attributes and short-term dynamic states derived from historical interaction logs. Recent Large Language Models (LLMs) offer strong long-context reasoning for constructing structured profiles from these logs, but existing solutions face two challenges for edge deployment: (1) profiling methods are typically domain-specific and lack a reusable abstraction across service scenarios, and (2) fine-tuning alignment models on heterogeneous edge clusters incurs high synchronization overhead due to the variance in input sequence lengths. To address these challenges, we propose CogGuard, a proactive-warning framework for edge intelligent services. CogGuard decouples offline LLM-based profile construction from online Small Language Model (SLM)-based score prediction through a shared static-dynamic profile-to-score pipeline, and instantiates it in two representative scenarios: educational performance warning and operational task outcome warning. For efficient profile construction, we design scenario-specific profiling methods with prefix-aligned KV-cache reuse to reduce repeated encoding overhead. For edge-side model alignment, we propose a length-aware distributed fine-tuning strategy with contrastive regularization to mitigate workload imbalance on heterogeneous clusters. Experiments on education and operation datasets show that CogGuard reduces profile construction time by up to 48% and distributed fine-tuning time by 19%, while achieving MAEs of 13.4 and 5.9, respectively, on 100-point-scale warning tasks. In the largest educational setting, CogGuard reduces prediction error by 15.4% compared with the strongest baseline.

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

When Language Representations Interact: Separability and Cross-Lingual Effects in LLMs

arXiv:2606.14347v1 Announce Type: new Abstract: Large language models exhibit strong multilingual capabilities, however, their internal representations are difficult to interpret. Understanding these interactions is important for ensuring reliable behavior in multilingual systems. Recent work has shown that causal-geometric structure can explain how certain concepts are encoded as approximately linear and separable directions, but whether this framework extends to multilingual models, where language identity is correlated and hierarchical, is underexplored. We apply causal-geometric analysis to multilingual LLMs, studying 28 bilingual contrasts across three models, allowing us to analyze when languages behave as approximately independent factors and when structured dependencies persist. We find evidence that language concepts admit stable linear representations that are largely separable under a covariance-adjusted (causal) inner product, with structured deviations reflecting linguistic similarity. Moreover, languages within the same family (such as Germanic or Romance) exhibit a simplex-like geometric structure, suggesting hierarchical organization. These results extend causal-geometric interpretability to multilingual settings and provide insight into how separability and similarity may exist in multilingual LLM representations, motivating interpretability analyses that diagnose when and how structured dependencies between concepts can be anticipated. This has implications for trustworthy deployment, as residual structure between languages may lead to unintended cross-lingual effects when models are monitored or intervened upon.

13.
arXiv (quant-ph) 2026-06-11

Gate-tunable spin-valley transport via carrier velocity in monolayer WSe$_2$

arXiv:2606.12353v1 Announce Type: cross Abstract: We theoretically investigate spin- and valley-resolved quantum transport in monolayer tungsten diselenide (WSe$_2$) described by an effective massive Dirac Hamiltonian. Particular attention is devoted to a finite barrier region characterized by simultaneously modulated Fermi velocity and scalar potential. The barrier velocity $v_2$ is related to the external velocity $v_1$ through a velocity ratio $\xi=v_2/v_1$, motivated by an optical analogy with the Snell-Descartes law. The exact refraction condition depends on the full spin- and valley-resolved dispersion, and the simple ratio $\xi=v_2/v_1$ is recovered only in the massless, symmetric limit. The interplay of intrinsic spin-orbit coupling in the conduction and valence bands, quantified by $\lambda_c$ and $\lambda_v$, with spin- and valley-dependent Zeeman fields, $M_s$ and $M_v$, gives rise to substantial changes in the quasiparticle dispersion, leading to pronounced modifications of the transport characteristics. By solving the Dirac equation and enforcing current-conserving matching conditions at the interfaces, we compute the spin- and valley-dependent transmission probability and conductance. Our results demonstrate that the barrier velocity, scalar potential, incidence angle, incident energy, and barrier width serve as effective control parameters for transport, giving rise to strong anisotropy and resonant tunneling features. Furthermore, we show that both the magnitude and orientation of spin- and valley-polarized currents can be continuously tuned via velocity and potential modulation. These findings establish combined velocity and potential engineering as a powerful theoretical framework for controlling spin-valley physics in two-dimensional transition-metal dichalcogenides.

14.
Nature (Science) 2026-06-22

Will AI spark a scientific renaissance — or a diffuse monoculture?

Authors:

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.

15.
medRxiv (Medicine) 2026-06-15

Supporting people to access social security payments through the Special Rules for End of Life: a qualitative study of the perspectives of patients, carers and health care professionals

Background: People living with terminal illness face a double financial burden from additional costs and loss of earning for themselves and their carers. Social security benefits are intended to help alleviate some of this financial pressure, and in the UK and other countries people are eligible for fast-tracked access to financial support via the Special Rules for End of Life. One in 3 people who are eligible miss out on this support, yet there is limited evidence on the reasons for this take-up deficit. Objectives: The aim of this study is to understand the barriers and facilitators to claiming benefits for terminally ill people from the perspectives of patients, carers, and health care professionals. Methods: This is a qualitative study combining i) focus groups with healthcare professionals recruited via professional networks and social media, and ii) interviews with patients and carers recruited in hospital and hospice settings. We analysed the data using Practical Thematic Analysis Results: Fifty-five multidisciplinary healthcare professionals participated in 11 focus groups, and we interviewed 10 patients and carers. We constructed five descriptive themes to summarise the data: Navigating priorities and uncertainty; positive impacts alongside a sense of shame and stigma; talking about money, difficulties and dividends; everybodys, yet nobodys, responsibility; and sticking points in the system. Conclusion: The themes reveal several challenges that may contribute to people not taking up this financial support. However, discussions about access to benefits were also seen as a core part of holistic care, a positive way to offer support and a gateway to other discussions about end-of-life care preferences and decisions. Recommendations for policy and practice include evaluating the adoption of a diagnostic rather than a prognostic eligibility criteria, integrating discussions about benefits into existing processes such as advance care planning, and improving education and support for clinicians.

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

ERN-Net : Evolving Reason Node-Net for Document Binarization

This paper presents ERN-Net, an Evolving Reason Node-Net for efficient document image binarization. ERN-Net enhances degradation-sensitive regions, such as faint strokes, broken characters, and noisy backgrounds, through evolving reason nodes and multi-scale reasoning. We further compare ResNet-101, ConvNeXt-Tiny, and ConvNeXt-Base, and find that ConvNeXt-Tiny provides the best practical trade-off between accuracy and memory usage. In addition, DIBCO-based pretraining improves binarization performance without increasing model memory consumption, requiring only about 1.5 additional training hours. Experiments on DIBCO-style benchmarks show that ERN-Net is effective under low-data and low-memory settings.

17.
arXiv (CS.AI) 2026-06-24

Does Mixture-of-Experts Actually Help Inference on Consumer and Edge Hardware? An Empirical Study

arXiv:2606.21428v2 Announce Type: replace-cross Abstract: Mixture-of-Experts (MoE) language models are often described as ideal for resource-constrained inference. Each token activates only a small subset of experts, so the per-token compute cost, in floating-point operations (FLOPs), resembles that of a much smaller dense model. Whether that FLOP advantage survives in practice is far less clear. We ask whether MoE models actually run faster and cheaper than comparable dense models on consumer-grade and edge hardware. We benchmark OLMoE-1B-7B (1.3 B active of 6.9 B total) against three dense baselines on an Apple M2 Pro and an NVIDIA Jetson Orin Nano 8 GB through \texttt{llama.cpp}, measuring throughput, memory, and on-device energy. The answer is device-dependent: OLMoE's active-parameter advantage is only partly realised on the laptop (~10% behind the same-active Llama-3.2-1B) and erodes on the edge device (~31% behind, at 2.1$\times$ the energy per token, with peak memory at the 8 GB ceiling). Patching \texttt{llama.cpp} to time the decode graph node-by-node shows routing accounts for under 9% of MoE-block compute on the cleaner edge backend, so the gap reflects total-parameter memory footprint, expert dispatch, and KV-cache pressure rather than routing. The implication is that on bandwidth-bound edge hardware, inference cost tracks total parameters, not active ones, and sparse activation does not buy back what the device is constrained on. These findings are bounded to one MoE model at this parameter scale and two devices, and we release the full measurement harness and per-run data.

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

Neural Posterior Estimation of Terrain Parameters from Radar Sounder Data

arXiv:2605.08179v2 Announce Type: replace-cross Abstract: Radar sounders are electromagnetic instruments that can probe deep into the subsurface of Earth and other planetary bodies by processing the echo of transmitted radar waves. Conventional approaches for analyzing such data rely on approximate assumptions and often produce point estimates that ignore parameter correlations as well as galactic and measurement noise. We propose a simulation-based inference approach to terrain parameter inversion from radar sounder data, where synthetic observations from a GPU-based simulator are used to train a neural network-based density estimator for neural posterior estimation (NPE). By explicitly conditioning on reference surface assumptions, the proposed framework allows systematic evaluation of posterior robustness to reference surface variability. We demonstrate that our NPE model is well calibrated on simulated data and transferable to real Mars radar profiles, where we analyze terrain parameters using literature-informed reference values.

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

Fast LLM-Based Semantic Filtering: From a Unified Framework to an Adaptive Two-Phase Method

arXiv:2606.08090v2 Announce Type: replace-cross Abstract: Evaluating a natural-language yes/no predicate over a document corpus under an accuracy target - the semantic filter - is a cornerstone of LLM-based data processing. Calling the LLM on every document (the oracle) is prohibitive, so cascades pair the oracle with a fast proxy. As deployed today, they leave four limitations on the table. (1) Each cascade family - model-free clustering, prebuilt small-LLM proxies, online-trained proxies - commits to a single representation and pipeline, and wins on only a narrow query regime. (2) The strongest online proxy invests in a custom training scheme on a bi-encoder over dense embeddings, missing the token-level evidence richer predicates require. (3) The proxy is trained against binary yes/no labels, wasting the LLM's per-document confidence at the boundary documents it most needs to learn. (4) Existing calibrations add a uniform safety margin, conflating genuine proxy uncertainty with small-sample noise and inflating cascade cost. We address these by (1) composing families adaptively - model-free clustering first, online proxy only when needed, with oracle calls shared across phases; (2) replacing the cosine bi-encoder with a hybrid of off-the-shelf token-aware models; (3) training the proxy with the oracle's per-document confidence as a soft label; and (4) a calibration that adds the safety margin only where the labeled sample is sparse. We are also the first to use the oracle's per-document confidence for three purposes: a query-level difficulty compass, a lower bound on the minimum oracle calls any proxy-based cascade can make, and the proxy's soft training label. At a 90% accuracy target on three 10K-document corpora, our methods are 1.6-2.0x faster than the best prior method per corpus and meet the target on 95% of queries; the BER-derived lower bound indicates a further ~4-20x of headroom for future work.

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

Semantic Editing with Coupled Stochastic Differential Equations

Editing the content of an image with a pretrained text-to-image model remains challenging. Existing methods often distort fine details or introduce unintended artifacts. We propose using coupled stochastic differential equations (coupled SDEs) to guide the sampling process of any pre-trained generative model that can be sampled by solving an SDE, including diffusion and rectified flow models. By driving both the source image and the edited image with the same correlated noise, our approach steers new samples toward the desired semantics while preserving visual similarity to the source. The method works out-of-the-box, without retraining or auxiliary networks, and achieves high prompt fidelity along with near-pixel-level consistency. These results position coupled SDEs as a simple yet powerful tool for controlled generative AI. Project page: https://z-jianxin.github.io/syncSDE-release/. Code: https://github.com/Z-Jianxin/syncSDE-release.

22.
arXiv (quant-ph) 2026-06-19

Multi-objective design of photon blockade for bright single-photon sources

arXiv:2606.20160v1 Announce Type: new Abstract: High-quality single-photon sources, realized through saturable emitters, photon blockade, or heralded pair generation, are indispensable building blocks for photonic quantum platforms. Although these mechanisms suppress multiphoton emission through distinct principles typically captured by analytical models, their practical implementation is constrained by conflicting requirements for purity, brightness, and indistinguishability, which must be balanced within high-dimensional design landscapes. Here, we propose a computational framework for optimizing competing metrics of single-photon sources. Building on a Liouville-space adjoint formulation that efficiently evaluates multiple objectives in Markovian open quantum systems, we develop a Jacobian-based update, which ensures first-order monotonic reduction of multi-objective costs. By incorporating simulated annealing to escape gradient-vanishing plateaus, our framework achieves a design success rate of nearly 60 % for photon blockade with g2(0) smaller than 0.1 and theoretically bounded brightness across a broad parameter space, without any analytical guidance. This framework provides a general recipe for multi-objective design of open quantum systems.

23.
PLOS Medicine 2026-06-18

Association between initial benzodiazepine prescribing patterns and time to benzodiazepine discontinuation: A population-based retrospective cohort study

by Nikki Bozinoff, Tanya S. Hauck, Robert A. Kleinman, Matthew E. Sloan, Beth A. Sproule, Simone N. Vigod, Jennifer Wyman, Priscila Pequeno, Tara Gomes Background Long-term benzodiazepine use has been associated with increased risk of morbidity and mortality. Preventing long-term use through safer prescribing practices has received little attention to date. We sought to better understand associations between initial prescription characteristics and duration of benzodiazepine use. Methods and findings This was a retrospective population-based cohort study of 1,820,808 adults in Ontario with incident benzodiazepine prescriptions between January 1, 2013 and December 31, 2020, with follow-up to December 31, 2021. The primary exposure was duration of the index prescription (≤7 days—referent group, 8–14 days, 15–30 days, or >30 days). Secondary exposures were: (a) duration of action of index benzodiazepine(s) prescription (short-acting, long-acting or both); (b) number of benzodiazepine dispensed on index (1 or 2+); and (c) mean daily dose of the index prescription in Diazepam Milligram Equivalents (DMEs). The primary outcome was time to benzodiazepine discontinuation in days. Multivariable models were adjusted for age, sex, anxiety, insomnia, and substance use disorders as well as other important comorbidities and socio-demographic characteristics. The median age at index was 53 years (Interquartile Range (IQR) 38–67), and 62.6% were women. The median time to discontinuation in women was 16 days (IQR: 6–29) while the median time to discontinuation in men was 19 days (IQR: 6–29). Lorazepam was the most commonly prescribed benzodiazepine on index (63.9%), followed by clonazepam (17.3%) and diazepam (5.8%). In multivariable Cox Proportional Hazards Models, longer index prescriptions were associated with a lower likelihood of benzodiazepine discontinuation (adjusted Hazard Ratio (aHR) 0.54 (95% Confidence Interval (CI) [0.54,0.54]) for 8–14 days; aHR 0.26 (95% CI [0.25,0.26] for 15–30 days and aHR 0.14 (95% CI [0.14,0.14]) for >30 days, compared to ≤7 days, respectively). Being prescribed two or more benzodiazepines versus 1 was also associated with a reduced likelihood of discontinuation (aHR 0.59 (95% CI [0.57,0.61])), as was being prescribed long-acting benzodiazepines (aHR 0.80 (95% CI [0.80,0.80])) or a combination of short and long acting benzodiazepine (aHR 0.84 (95% CI [0.80,0.88])) versus short-acting benzodiazepines alone. Mean daily doses of >5 to ≤10 DME and >10 to ≤20 DME were associated with an increased likelihood of discontinuation (aHR 1.03 (95% CI [1.03,1.03]); aHR: 1.03 (95% CI [1.03,1.04])), whereas doses >20 DME were associated with a reduced likelihood of discontinuation (aHR 0.98 (95% CI [0.97,0.98])) compared with ≤5 DME. Findings may be subject to bias from unmeasured confounding. Conclusion This large population-based cohort study found that prescribing shorter courses of benzodiazepines, use of a single benzodiazepine, use of a short-acting agent, were associated with reduced likelihood of long-term benzodiazepine use. Findings suggest that simple changes to prescribing practices could reduce prolonged benzodiazepine use and the morbidity and mortality associated with long-term use of these medications.

24.
medRxiv (Medicine) 2026-06-11

Genetic Susceptibility to Incisional Hernia: Evaluation of Hernia Polygenic Risk Scores

Objectives: Incisional hernia (IH) affects 13-30% of people after abdominal surgery, resulting in substantial morbidity and costs. While clinical risk factors have been studied extensively, genomic risk for IH is incompletely understood. We aimed to evaluate the impact of polygenic risk scores (PRS) on IH risk prediction. Methods] We created and evaluated three PRS for abdominal hernia, ventral hernia and latent hernia susceptibility for prediction of IH in an institutional biobank. The primary outcome was defined as the diagnosis or repair of an IH based on ICD-9/10-CM/PCS and CPT codes. Clinical covariates included age, sex, body mass index (BMI), smoking status, index procedure type, and perioperative surgical site infection. A phenome-wide association study (PheWAS) was performed to assess clinical associations with increased PRS. We then tested the ability of the PRS to improve prediction for IH by modeling clinical covariates with and without PRS in patients who underwent abdominal surgery. Model performance was assessed using 10 iterations of 5-fold cross-validation to estimate Brier scores and area under the receiver operating characteristic curve (AUROC), which were compared using cross-model Bayesian analysis of variance. Results: In 55,809 subjects, assessed PRS was significantly associated with incisional, umbilical, and ventral hernia on PheWAS, with 1.19 greater odds of developing IH per 1-SD increase in PRS (95% CI: 1.13-1.25, P < 0.001). Of 9,909 subjects who underwent qualifying abdominal surgery, 706 developed IH. In this cohort, the latent hernia susceptibility PRS was associated with a 16% increased hazard of developing IH per 1-SD increase (HR 1.16; 95% CI: 1.07-1.26; P < 0.001). Compared to a predictive model using clinical covariates (Brier score = 0.047, 95% CI: 0.046-0.048; AUROC = 0.660, 95% CI: 0.653-0.666), addition of the PRS showed similar Brier score and AUROC estimates (Brier score = 0.047, 95% CI: 0.046-0.048; AUROC: 0.667, 95% CI: 0.661-0.673) at five years. Cross-model Bayesian analysis demonstrated >99% probability of practical equivalence when trying to detect a difference of [&ge;] 0.02. Conclusion: All three PRS for hernia were independently associated with IH, suggesting that genomic factors contribute significantly to IH development. However, none of the three PRS meaningfully improved clinical IH risk prediction in patients who underwent abdominal surgery. This suggests that clinical comorbidities and surgical techniques may be equally as important as genomic architecture.

25.
arXiv (CS.CV) 2026-06-18

Conditional Latent Diffusion Model with Fourier-based Motion Modelling for Virtual Population Synthesis

In-silico trials of medical devices require the generation of virtual populations of anatomies. In cardiovascular applications, virtual anatomy is typically represented as a 3D+t mesh sampled from a generative model. However, most existing mesh generators focus on static anatomy, while sequence models often lack explicit periodicity. To this end, we propose 4D F-MeshLDM, a conditional generative framework comprising a convolutional mesh VAE to encode meshes, a structural latent space that parameterises motion using a truncated Fourier series, and a diffusion prior that learns the latent distribution over Fourier coefficient tokens. By conditioning the diffusion process on clinical covariates via affine modulation, we enable controllable synthesis. Sampling tokens and performing inverse Fourier synthesis yield cycle-consistent latent trajectories, which can be decoded into 3D+t cardiac mesh sequences. Experiments on 5,000 UK Biobank subjects demonstrate that 4D F-MeshLDM outperforms state-of-the-art baselines in anatomical fidelity and achieves near-zero cycle closure error. Furthermore, the generated cohorts accurately preserve clinical functional indices, highlighting the potential of our framework for reliable in-silico cardiac trials.