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01.
medRxiv (Medicine) 2026-06-16

Care Delivery Gap framework: a proof-of-concept patient-reported measure of guideline-referenced care-process omissions in sickle cell disease

Authors:
Agbalalah↗Rowaiye↗

Abstract Background:Sickle cell disease (SCD) is concentrated in sub-Saharan Africa, where delivery of guideline-referenced care remains challenging. Current evaluation approaches rely largely on access indicators and clinical outcomes, which do not directly measure care delivery. We developed the Care Delivery Gap (CDG) framework, a patient-reported approach for identifying care-process omissions, and conducted a proof-of-concept study to assess feasibility and explore variation across income strata. Methods: We conducted a cross-sectional framework-development study involving a proof-of-concept sample of 52 individuals with SCD or caregivers recruited through clinics and moderated SCD communities across Africa, North America, and Europe between June 2025 and March 2026. The CDG framework assessed patient-reported omissions in specialist involvement, follow-up continuity, cardiovascular screening, and biochemical surveillance. Analyses were descriptive. Results: Substantial multi-domain care-process omissions were identified despite high reported healthcare engagement. Across geographic income strata, cardiovascular screening was reported by 4/35 (11%) LMIC versus 16/17 (94%) HIC participants, and regular follow-up within the preceding 12 months by 14/35 (40%) versus 16/17 (94%), respectively. High CDG scores, representing 1 omissions across three or four domains, occurred in 20/35 (57%) LMIC compared with 1/17 (6%) HIC participants. Similar disparities were observed across specialist review and vitamin B12 surveillance domains. Conclusion: A structured patient-reported framework identified multi-domain omissions in guideline-referenced SCD care, including among individuals reporting healthcare access. The divergence between access indicators and reported care delivery suggests that service contact alone may not reflect care quality. The framework provides a feasible foundation for future process-level quality measurement in high-burden settings.

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02.
arXiv (CS.CV) 2026-06-17

ED3R: Energy-Aware Distributed Disaster Detection Enabled by Cooperative Robotic Agents

Authors:
Lina Magoula↗Nikolaos Koursioumpas↗Nancy Alonistioti↗Ramin Khalili↗

Robotics are expected to support environmental monitoring and natural disaster management, where decisions must be made under uncertainty, resource limitations, and strict operational constraints. In critical missions, such as wildfires, robotic agents must not only identify hazardous events with sufficient confidence, but also manage the energy cost and time until detection. This paper introduces ED3R, an energy-aware distributed framework for wildfire detection under uncertainty. ED3R enables hierarchical cooperative decision-making between a robot and a remote controller. The remote controller decides upon the robot's motion, while the robot senses the environment and decides where to execute the wildfire detection (onboard or remotely) and how. The common goal is to detect wildfires with a required confidence while minimizing the energy consumed by any robot operation. ED3R further integrates mechanisms to avoid nearby obstacles, prevent redundant exploration, enable adaptive early mission completion, and ensure feasibility through a custom penalty function. ED3R also introduces a forward-looking capability, enabled through distributed neural regression models that allow the agents to anticipate the future by evaluating candidate strategies before execution. The framework is evaluated through realistic robotics simulations, ablation studies, and baseline comparisons. Overall, ED3R achieves a mission success rate of up to 97.18%. Especially in the most demanding missions, it reduces energy consumption by up to 36.4% and detects wildfires up to 41% faster than baselines.

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

MuseVLA: An Adaptive Multimodal Sensing Vision-Language-Action Model for Robotic Manipulation

Authors:
Xingyuming Liu↗Ruichun Ma↗Heyu Guo↗Qixiu Li↗Qingwen Yang↗Lin Luo↗Shiqi Jiang↗Chenren Xu↗Jiaolong Yang↗Baining Guo↗

Humans naturally leverage diverse sensing modalities to interact with the physical world, while most Vision-Language-Action (VLA) models for robotics rely solely on RGB observations. This limits their ability to perceive physical properties that are difficult or impossible to infer from RGB cameras, such as temperature, sound, or radar response. We present MuseVLA, an adaptive multimodal sensing VLA model that integrates novel sensors as on-demand tools for robotic manipulation. Given a task instruction and visual context, MuseVLA first generates a sensor token and target description that select the sensing modality to invoke and what to attend to, analogous to a tool call with arguments. It then converts the selected sensor measurement into a grounded sensor image, a unified intermediate representation that encodes heterogeneous readings for multimodal fusion and action generation. This design decouples sensor-specific processing from the VLA backbone, enabling efficient integration of diverse modalities. To reduce the need for expensive multisensory robot datasets, we further introduce a data synthesis pipeline that augments existing RGB video datasets with grounded sensor images, enabling generalization to unseen sensor-guided tasks. We evaluate MuseVLA on a real-world robot across challenging dexterous hand manipulation tasks that require multimodal sensing inputs, including temperature-guided pick-and-place, audio-driven object search, and radar-assisted hidden object retrieval. MuseVLA achieves 80.6% success rate on average, outperforming RGB-only and multisensory VLA baselines significantly, and exhibits strong zero-shot capabilities on unseen tasks.

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

Reinforcement Learning Disrupts Gradient-Based Adversarial Optimization

Authors:
Xinhai Zou↗Chang Zhao↗Alireza Aghabagherloo↗Dave Singel\'ee↗Robin Degraeve↗Bart Preneel↗

arXiv:2606.12251v1 Announce Type: cross Abstract: Gradient-based adversarial attacks remain a dominant threat to deep neural networks (DNNs), as they exploit gradient information to efficiently optimize adversarial perturbations. To address this, we investigate whether reinforcement learning (RL) training can disrupt the gradient structure used by attackers by training image classifiers with policy-gradient objectives and epsilon-greedy exploration. Through systematic experiments across CIFAR-10, CIFAR-100, and ImageNet-100 with multiple architectures, we find that RL-trained classifiers significantly disrupt gradient-based adversarial optimization. To explain this, we conduct a comprehensive mechanism analysis using loss landscape visualization, static and dynamic gradient indicators, and predictive entropy. Our analysis reveals that RL acts as an implicit regularizer, producing models with highly unstable gradient directions and smaller gradient magnitudes. This combination makes each PGD step both unreliable in direction and limited in magnitude, causing gradient-based attacks to fail within practical iteration budgets. We further show that combining RL with adversarial training (RL-adv) provides a dual-layer defense operating at two complementary levels: RL degrades gradient information available to attackers (gradient-level defense), while adversarial training strengthens decision boundaries (boundary-level defense). RL-adv achieves the highest robustness across all major attack types evaluated, including gradient-based (PGD, AutoAttack), transfer-based, and query-based attacks, outperforming SL-adv by a significant margin. These findings identify RL-induced gradient disruption as a complementary robustness mechanism and motivate future research on hybrid SL-RL training schedules that combine SL's efficiency with RL's gradient-regularization properties.

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05.
arXiv (math.PR) 2026-06-18

Multi-Dimensional Cohomological Phenomena in the Lower Multiparametric Model

Authors:
Jon V. Kogan↗

arXiv:2402.02573v4 Announce Type: replace-cross Abstract: In the past two decades, extensive research has been conducted on the (co)homology of various models of random simplicial complexes. So far, it has always been examined merely as a list of groups. This paper expands upon this by describing both the ring structure and the Steenrod-algebra structure of the cohomology of the lower multiparametric model. We prove that the ring structure is always a.a.s trivial, while, for certain parameters, the Steenrod-algebra a.a.s acts non-trivially. This reveals that complex multi-dimensional topological structures appear as subcomplexes of this model.

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

Navigating Distribution Shifts in Medical Image Analysis: A Survey

Authors:
Zixian Su↗Jingwei Guo↗Xi Yang↗Qiufeng Wang↗Frans Coenen↗Amir Hussain↗Kaizhu Huang↗

Medical Image Analysis (MedIA) has become indispensable in modern healthcare, enhancing clinical diagnostics and personalized treatment. Despite the remarkable advancements supported by deep learning (DL) technologies, their practical deployment faces challenges posed by distribution shifts, where models trained on specific datasets underperform on others from varying hospitals, or patient populations. To address this issue, researchers have been actively developing strategies to increase the adaptability of DL models, enabling their effective use in unfamiliar environments. This paper systematically reviews approaches that apply DL techniques to MedIA systems affected by distribution shifts. Rather than organizing existing methods by technical characteristics, we explicitly bridge real-world clinical constraints – such as limited data accessibility, strict privacy requirements, and heterogeneous collaboration protocols – with the technical paradigms able to address them. By establishing this connection between operational constraints and methodological evolution, we categorize existing works into Joint Training, Federated Learning, Fine-tuning, and Domain Generalization, each aligned with specific healthcare scenarios. Beyond this taxonomy, our empirical analysis suggests that, as domain information becomes progressively less accessible across these paradigms, performance improvements become increasingly constrained, and further uncovers a gradual shift in methodological focus from explicit distribution alignment toward uncertainty-aware modeling, ultimately pointing to the need for more deployability-aware design in real-world MedIA.

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07.
Nature (Science) 2026-06-10

SIRT7 regulates dosage compensation and safeguards the female X chromosome

Authors:
Nicolas G. Simonet↗

Sirtuins are deacetylases implicated in stress responses and longevity in mammals1,2. Although their differential impact on disease for the two sexes has been noted3–7, the underlying reasons are unclear. Here, using Sirt7 as a model in mice, we examine the mechanisms leading to sex differences and find that Sirt7−/− female mice have decreased fitness throughout their lifespan. Notably, SIRT7 preferentially localizes to the sex chromosomes. In female individuals, SIRT7 loss affects X-chromosome inactivation, the first arm of dosage compensation that equalizes X-linked gene expression between males and females8–10. Xist is overexpressed and gene silencing becomes more efficient. However, SIRT7 loss has greatest impact on the active X (Xa) chromosome. The Xa chromosome becomes hyperacetylated at Lys36 of histone H3, structurally disorganized, prone to DNA damage and overexpressed. Increased Xa-chromosome expression leads to genome imbalance and augmented X-chromosome upregulation—the second arm of dosage compensation that balances X-chromosome versus autosomal gene expression. These data reveal an essential crosstalk between sirtuins and the sex chromosomes, with SIRT7 safeguarding X-chromosome integrity and dosage balance with autosomes. We propose that the sex bias in SIRT7 biology can be explained in part by unequal effects on the sex chromosomes. SIRT7 safeguards X-chromosome integrity and dosage balance with autosomes.

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08.
arXiv (CS.AI) 2026-06-18

Agentra: A Supervisable Multi-Agent Framework for Enterprise Intrusion Response

Authors:
Raj Patel↗Shaswata Mitra↗Michele Guida↗Stefano Iannucci↗Sudip Mittal↗Shahram Rahimi↗

arXiv:2606.18325v1 Announce Type: cross Abstract: Enterprise intrusion response still depends on static playbooks and analyst-driven triage, creating delay between alert generation and containment. We present Agentra, a supervisable multi-agent Intrusion Response System (IRS) framework that converts alerts from IDS, EDR, and XDR platforms into structured incident response plans grounded in MITRE ATT&CK, MITRE D3FEND, and NIST CSF 2.0. Agentra decomposes response reasoning across role-scoped agents, validates proposed plans through a bounded Planner–Validator review loop, screens retrieved threat intelligence through a Moderator security gateway, gates actions through an Action Catalog and risk score, and records decisions in an append-only audit log. We evaluate Agentra against a static OASIS CACAO v2.0 cyber-playbook baseline on a 120-event corpus drawn from ThreatHunter-Playbook, Splunk BOTSv3, and DARPA OpTC. The strongest configuration improves FP-aware IRS F1 from 0.61 to 0.84 and restores the projected harmful-action rate to the static baseline level of 0.0% after Planner-only configurations introduce unsafe overreaction. These results indicate that multi-agent response planning can improve ontology-grounded IRS coverage while preserving analyst approval and auditability.

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09.
arXiv (CS.LG) 2026-06-11

Attention by Synchronization in Coupled Oscillator Networks

Authors:
Fabio Pasqualetti↗Taosha Guo↗

arXiv:2606.12059v1 Announce Type: new Abstract: We address transformer attention on energy-constrained physical substrates. Softmax attention requires exponentiation and global reduction, operations with high energy cost on von Neumann hardware and no natural physical analog. We show that Kuramoto synchronization dynamics (which arise in electrical, mechanical, superconducting, and charge-density-wave oscillator arrays, among other physical systems) implement a well-defined attention operation without either. The resulting mechanism, fixed-query oscillator attention, replaces softmax's arithmetic with the equilibration of a gradient flow on the sphere: queries are learned anchors fixed on the sphere, and free oscillators evolve under Kuramoto-Lohe dynamics until they settle at positions encoding attention weights via cosine similarity. Because the computation is equilibration, it requires no exponentiation; the only global operation is an affine normalization at readout. The fixed point is provably unique and globally attractive from almost every initial condition, a guarantee that holds across every physical realization. Empirically, at the minimal hardware configuration (oscillator dimension $d_{\mathrm{osc}}$ = 2), oscillator attention outperforms softmax on keyword spotting (+1.00 pp) and on subject-verb agreement (+5.27 pp on hard sentences, with zero training failures versus one in five for softmax). On causal language modeling, where softmax retains an advantage, oscillator attention closes the gap as $d_{\mathrm{osc}}$ grows: from +11.09 PPL at $d_{\mathrm{osc}}$ = 2 to +2.98 PPL at $d_{\mathrm{osc}}$ = 32 on WikiText-2, and from +2.39 PPL at $d_{\mathrm{osc}}$ = 2 to +0.57 PPL at $d_{\mathrm{osc}}$ = 32 on TinyStories. The main objective of this work is not to replace softmax in software but to provide a mathematically grounded blueprint for accurate attention on physical substrates.

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10.
arXiv (CS.LG) 2026-06-12

Rubric-Guided Self-Distillation: Post-Training Without Rubric Verifiers

Authors:
MohammadHossein Rezaei↗Anas Mahmoud↗Zihao Wang↗Utkarsh Tyagi↗Advait Gosai↗Razvan-Gabriel Dumitru↗Aakash Sabharwal↗Bing Liu↗Yunzhong He↗

arXiv:2606.12507v1 Announce Type: new Abstract: Rubrics have emerged as an alternative to RLVR in open-ended domains where a single ground-truth final answer is not available. Existing rubric-based training methods rely on an LLM verifier that scores each rollout against rubrics. This introduces substantial training-time overhead, exposes optimization to verifier-specific biases, and reduces rubric feedback to a sparse end-of-trajectory signal. We propose Rubric-Guided Self-Distillation (RGSD), a verifier-free training method in which the base policy, conditioned on the rubric, serves as the teacher for the unconditioned student. RGSD distills the rubric-conditioned teacher distribution into the student token-by-token, replacing sparse trajectory-level rewards with dense per-token learning signals and removing the LLM judge from the training loop entirely. Across Qwen-2.5 (3B, 7B) and Qwen3-Thinking (4B, 8B) models on medical and science domains, RGSD achieves rubric satisfaction comparable to judge-based GRPO while using one on-policy rollout per prompt and no training-time verifier calls. Ablations show that raw rubrics provide a stronger teacher enrichment signal than self-generated reference responses, while a stronger GRPO judge can outperform RGSD in some settings, positioning RGSD as a complementary verifier-free alternative when verifier cost or reliability is the bottleneck.

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11.
medRxiv (Medicine) 2026-06-15

Two Blood-based Endotypes Reveal Divergent Clinical Outcomes of Fibrotic Hypersensitivity Pneumonitis

Authors:
Huang↗Ma↗S.-F↗Kim↗J. S↗Strickland↗Receveur↗B. A↗Bonham↗C. S↗Paul↗T. K↗…

Rationale: Fibrotic hypersensitivity pneumonitis (fHP) is an antigen-driven, life-threatening interstitial lung disease characterized by heterogeneous radiologic features, clinical outcomes, and treatment responses. Objectives: To identify blood-based fHP endotypes that inform mechanism, prognosis and therapeutic response. Methods: We performed integrative analyses of multi-compartment transcriptomic data derived from whole blood, peripheral blood mononuclear cells, bronchoalveolar lavage, and surgical lung biopsies, alongside circulating plasma proteomics. Multiple clustering algorithms were cross-compared to ensure robustness and reproducibility of endotypes identification. Immune cell composition was inferred using bulk RNA-seq deconvolution and annotated with BAL single-cell RNA-seq. Pathway activities were characterized using Gene Set Enrichment Analysis. Transplant-free survival (TFS) was evaluated for endotype and corticosteroid exposure by Kaplan-Meier methods, with hazard ratios analyzed using multivariable Cox proportional hazards models. Results: Two molecular endotypes, lymphocytic-associated (L-fHP) and non-lymphocytic-associated (N-fHP), were identified and validated. L-fHP showed enrichment of adaptive immune signaling and lymphocyte predominance, whereas N-fHP demonstrated myeloid-cell activation with neutrophil and macrophage predominance. Corticosteroid exposure was associated with worse TFS in L-fHP but not in N-fHP after adjusting for age, sex, and baseline pulmonary function. Compared to L-fHP, N-fHP had poorer baseline pulmonary function, faster 12-month FVC decline, and shorter TFS. N-fHP also exhibited elevated neutrophil-associated markers, including matrix metalloproteinase-9, across paired transcriptomic and proteomic datasets, supporting a neutrophil-driven, cross-compartment disease process. Conclusion: Multi-omic, multi-compartment analysis identifies two reproducible fHP endotypes with distinct clinical outcomes and corticosteroid responses, supporting a precision medicine approach beyond current clinical and radiologic classification.

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12.
medRxiv (Medicine) 2026-06-12

The Clinical Characteristics and mortality outcomes of Atrial fibrillation complicating Heart failure with reduced ejection fraction: A prospective study from South Africa

Authors:
Mboweni↗N. N↗Maseko↗Tsabedze↗N. I↗Toman↗Nel↗Kagodora↗B. S↗

Background: A growing burden of cardiovascular risk factors has raised cardiovascular disease-related mortality in Sub-Saharan Africa (SSA), driving higher prevalence of heart failure with reduced ejection fraction (HFrEF) and its complication with atrial fibrillation (AF). No prospective study has examined AF's clinical impact on HFrEF in SSA. Aim: To determine AF prevalence in HFrEF, describe HFrEF-AF clinical characteristics, and determine AF's impact on mortality. Methods: In this prospective observational study at a tertiary hospital in Johannesburg, 136 HFrEF patients were enrolled and categorised as HFrEF- SR (sinus rhythm) or HFrEF-AF. Baseline clinical characteristics and biochemistry were recorded. Comprehensive echocardiography including left atrial strain by 2D speckle-tracking was performed. Median follow-up was 30.6 months. Results: AF was present in 28 patients (21%). The mean age was 58.7 {+/-} 14.9 years (52.9% male) and differed between groups (p < 0.001). Hypertensive heart disease was the leading cause of HFrEF (36%). Compared with SR, HFrEF-AF patients had poorer health status (KCCQ 27 [16-43] vs 45 [32-60], p < 0.001) and lower left atrial strain (26.2 {+/-} 11.3%, p < 0.001). Guideline-directed medical therapy was suboptimal in the AF group: anticoagulation use was higher than SR (60% vs 9.5%, p < 0.001) but overall inadequate; HFrEF-AF patients received lower median doses of carvedilol (15.6 mg vs 25 mg, p = 0.002) and enalapril (10 mg vs 20 mg, p = 0.004), and fewer received spironolactone (50% vs 75.3%, p = 0.013). Survival was significantly lower in HFrEF-AF (0.41 [0.22-0.61]) versus SR (0.73 [0.61-0.82], p < 0.001). Independent predictors of mortality included prior stroke, lower TAPSE and KCCQ, and higher E/e' and heart rate. Conclusion: AF is common among HFrEF patients in this SSA cohort (though lower than in high-income countries) and associates with worse clinical status, suboptimal therapy, and higher mortality.

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13.
arXiv (CS.CL) 2026-06-16

Few-Shot Biomedical Relation Extraction with Large Language Models: A Viable Alternative to Supervised Learning?

Authors:
Jakob Mraz↗Toma\v{z} Curk↗Bla\v{z} Zupan↗

Biomedical relation extraction (BioRE) is a key step in transforming biomedical literature into structured knowledge. However, most existing approaches rely on supervised models trained on costly annotated datasets, limiting their scalability and adaptability across relation types and domains. We investigate few-shot BioRE using prompt-based learning with large language models (LLMs) and compare two task formulations: pairwise classification, which predicts relations for individual entity pairs, and joint generation, which extracts multiple relations in a single model call. Experiments on the BioREDirect dataset reveal a clear precision-recall trade-off. Pairwise classification achieves higher recall, whereas joint generation is more precise and computationally efficient. The best-performing model achieves a micro-F1 score of 0.44, substantially outperforming previous few-shot results (0.34) while remaining below the supervised baseline (0.56). Much of this gap is attributable to a single ambiguously defined relation type. When evaluated using macro-F1, which better captures performance across relation types in an imbalanced setting, prompt-based approaches outperform the supervised baseline (0.45 vs. 0.38), particularly on rare relation types. These findings highlight the potential of LLMs for BioRE in low-resource settings and underscore the importance of well-defined relation schemas.

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14.
arXiv (quant-ph) 2026-06-19

Emergency hub placement with a neutral-atom quantum computer

Authors:
Sara Tarquini↗Matteo Vandelli↗Francesco Ferrari↗Daniele Dragoni↗Francesco Tudisco↗

arXiv:2606.19589v1 Announce Type: new Abstract: We study the problem of emergency operation center placement in disaster response, where a minimal number of hubs must be selected to ensure timely coverage of all affected locations. This task can be formulated as a minimum dominating set problem on a graph encoding reachability within a target response time. We propose a hybrid quantum-classical approximation framework that leverages neutral-atom quantum computers as independent set samplers. Candidate dominating sets are constructed from both small maximal independent sets and complements of large independent sets, and are subsequently refined via a lightweight classical procedure. We benchmark the approach on synthetic instances and realistic case studies, and implement it on the Fresnel quantum processor by Pasqal, solving instances of up to 100 nodes. Our results show that quantum-generated samples, despite hardware noise, enable near-optimal solutions of the placement problem. Overall, our results demonstrate that neutral-atom devices operating in analog mode can already be used to tackle graph optimization problems for real-world applications.

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15.
arXiv (CS.CL) 2026-06-19

Detecting Hallucinations for Large Language Model-based Knowledge Graph Reasoning

Authors:
Xinyan Zhu↗Yaoqi Liu↗Yue Gao↗Huadong Ma↗Cheng Yang↗Chuan Shi↗

Knowledge graph (KG) reasoning infers new knowledge from existing facts and is widely applied in question answering, recommendation, and decision support. With the rapid development of large language models (LLMs), LLM-based KG reasoning frameworks have become increasingly popular by leveraging retrieved KG information. However, hallucinations in LLMs remain a critical issue. Even when relevant KG knowledge is incorporated, models may still generate incorrect outputs, leading to misinformation and unreliable decisions. Existing hallucination detection methods either focus on LLM internal states or verify consistency with retrieved contexts, but both overlook the structural information in KGs, resulting in suboptimal performance. To address this gap, we propose LUCID, the first halLUcination deteCtIon method for LLM-based knowleDge graph reasoning frameworks. LUCID jointly leverages LLM attention scores, KG semantics, and structural information. Specifically, it extracts node and edge features from attention scores and semantic similarities, and integrates them with KG structure using a graph neural network. We also construct manually annotated benchmark datasets for evaluation. Experiments on nine datasets show that LUCID achieves state of the art performance compared to 15 baselines.

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

ArtBoost: Synthetic Articulatory Data Augmentation for Acoustic-to-Articulatory Inversion

Authors:
Hyung Kyu Kim↗Byungchan Hwang↗Hak Gu Kim↗

arXiv:2606.16327v1 Announce Type: cross Abstract: Recent acoustic-to-articulatory inversion (AAI) models rely on electromagnetic articulography (EMA) data, which are costly and limited in scale. To address this limitation, we propose ArtBoost, a novel data augmentation strategy that leverages large-scale speech–mesh datasets originally developed for speech-driven 3D facial animation to improve AAI under limited EMA supervision. ArtBoost extracts pseudo articulatory trajectories from visible facial anchors and uses them for pre-training before fine-tuning on real EMA data. Experiments show consistent improvements in PCC and RMSE. Trajectory analyses confirm that the pseudo articulatory signals reflect physically meaningful visible articulatory dynamics. Additional evaluations across different AAI architectures demonstrate stable performance gains, indicating that ArtBoost can be integrated into diverse AAI models. These results suggest that speech–mesh data provide an effective and scalable source of articulatory supervision for AAI. Project page: https://cau-irislab.github.io/Interspeech26-ArtBoost/

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17.
medRxiv (Medicine) 2026-06-15

Beyond the Apnea-Hypopnea Index: Physiological and Demographic Predictors of Excessive Daytime Sleepiness in Obstructive Sleep Apnea

Authors:
Tan↗Parekh↗Wickramaratne↗S. D↗

Excessive daytime sleepiness (EDS) is a common but inconsistently predicted symptom of obstructive sleep apnea (OSA). OSA is typically diagnosed with polysomnography (PSG), and the current standard for severity assessment is the apnea-hypopnea index (AHI). AHI has many limitations, including its inability to explain physiological mechanisms or reflect variability in patient symptoms, such as EDS. This retrospective study aims to find physiological and demographic parameters that better predict EDS in patients with OSA and to evaluate whether these parameters outperform AHI using PSG data from the Mount Sinai Integrative Sleep Center. Clinical variables used to predict EDS included arousal index (AI), average oxygen desaturation during sleep, average heart rate during sleep, and AHI, along with demographic variables including age, sex, and BMI. Hypothesis tests, logistic regression models, and decision tree classifier models were performed on the data to discriminate sleepy from nonsleepy patients as determined by an Epworth Sleepiness Scale (ESS) score [&ge;] 10. AI and oxygen desaturation were found to be the most predictive physiological variables, and sex and BMI were found to be the most predictive demographic variables. The final decision tree model with these four variables outperformed the AHI in predicting EDS. These findings suggest that daytime sleepiness in OSA can be better explained by measures of apnea burden, oxygenation impairment, and patient demographics than by AHI alone, although these remain only modestly predictive. Future studies should focus on investigating more comprehensive physiological markers, multi-night sleep data, and more objective assessments of sleepiness.

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18.
medRxiv (Medicine) 2026-06-15

CDH13 is associated with cellular viability after exposure to ionizing radiation using genome-wide screening

Authors:
Schmidt↗H.-L↗Ohlei↗Herwest↗Salewsky↗Bertram↗Demuth↗

Background: It is well known that genetic variants contribute to cellular sensitivity to chemotherapeutic agents and ionizing radiation (IR). The aim of this study was to identify single nucleotide polymorphisms (SNPs) and genes associated with the spectrum of normal cellular sensitivity of lymphoblastoid cell lines (LCLs) towards ionizing radiation and mitomycin C (MMC). Methods: In a first step, we determined the viability of LCLs established from male participants of the Berlin Aging Study II (BASE-II) aged >=62 years following treatments with increasing doses of IR (n=137 cell lines) or MMC (n=140 cell lines) using the alamarBlue assay. Results from intra-experimental triplicates and three independent experiments for each cell line and treatment were used to calculate the area under the curves (AUCs) representing the specific sensitivity to IR and MMC of each LCL. The data from these experiments were subsequently used as outcomes in genome-wide association studies (GWASs). In addition, we calculated polygenic risk scores (PGS) from UK Biobank GWAS results for four cancer-related phenotypes and assessed the extent to which the variance in the IR and MMC sensitivity is explained by these PGS. Results: The GWAS analyses revealed one variant, rs74728080, located in CDH13 on chromosome 16, to show genome-wide significant (p < 5 x 10-8, beta = 2.81) association with cellular viability after treatment with IR. In the GWAS on MMC sensitivity the most interesting signal was elicited by SNP rs113978558 in an intron of the PLD5 gene on chromosome 1 (p = 9.232 x 10-8; beta = 1.44). Several other SNPs with statistically suggestive (i.e., p < 1 x 10-5) evidence of association with IR or MMC sensitivity were identified. PGSs calculations from GWAS of four cancer-related traits in UKB explained ~5% and ~3% of phenotypic variance in IR- and MMC-induced cell viability, respectively. Conclusion: The genome-wide significant association of rs74728080 with IR sensitivity and the location of this variant in CDH13 is interesting and functionally highly plausible given its known involvement in oxidative-stress response and function as tumor suppressor. Taken together, our novel data suggest that CDH13 may be genuinely involved in regulating cellular IR sensitivity.

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

GeoStream: Toward Precise Camera Controlled Streaming Video Generation

Authors:
Yizhou Zhao↗Yifan Wang↗Xiaoyuan Wang↗Yushu Wu↗Hao Zhang↗Moayed Haji-Ali↗Rameen Abdal↗Ashkan Mirzaei↗Yanyu Li↗Willi Menapace↗Laszlo Jeni↗Sergey Tulyakov↗…

Accurate interactive camera control is essential for video-based world models, but most existing approaches learn camera motion implicitly, leading to inaccurate control under out-of-distribution trajectories. Explicit geometric conditioning improves controllability, but existing methods are non-autoregressive and rely on a static 3D cache built from an initial frame, which becomes ineffective once the viewpoint moves beyond the original frustum. We propose GeoStream, a framework that enables precise metric-scale camera control in autoregressive streaming video generation. Our method maintains a self-refreshing 3D cache that is periodically updated online from the model's own outputs: we estimate depth from the most recently generated frame, unproject to 3D, and reproject into the target view to produce point reprojections as geometric conditioning for subsequent synthesis. By the same principle, the conditioning seen during training is also rendered from the student's own generated frames, yielding a fully on-policy distillation that naturally aligns the train and inference conditioning distributions. Unlike prior work that uses off-policy condition noising, our approach trains the model against the exact error distribution it encounters at inference, mitigating both standard autoregressive drift and the second-order geometric feedback loop that arises when the cache itself is derived from generated outputs. Quantitative and qualitative results show that our approach substantially improves camera controllability.

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20.
arXiv (math.PR) 2026-06-12

Stochastic dominations for FK percolation and sharp thinning thresholds for the Ising energy field

Authors:
Paul Cahen↗Avelio Sep\'ulveda↗

arXiv:2606.13648v1 Announce Type: new Abstract: At first glance, one would imagine that the energy field of the Ising model, the set of edges whose endpoints share the same spin, is stochastically monotone as a function of the coupling constants. However, this is not generally the case. In this paper, we introduce two weaker notions of stochastic domination that make this result true: $p$–weak and $p$–weak$^\dagger$ domination. Both of these notions depend on a parameter $p$ and we find the optimal values $p$ and $p^\dagger$ so that these dominations hold. One of the key ingredient to obtain some of the results is a new stochastic domination relating FK percolations with different parameters $q,\tilde{q}\geq 1$ that is of independent interest.

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

Structured Nonparametric Variational Inference for Dependent Latent Modeling

Authors:
Yuda Shao↗Zhiling Gu↗Shan Yu↗

arXiv:2606.15458v1 Announce Type: cross Abstract: Variational inference (VI) is a core engine of modern AI, enabling scalable approximate Bayesian learning and uncertainty-aware training of large probabilistic and generative models. In this paper, we propose Structured Nonparametric Variational Inference (SN-VI), a novel framework for modeling complex dependencies among latent variables in posterior approximation, leveraging multivariate spline techniques. Unlike traditional methods that rely on the mean-field assumption, SN-VI preserves intricate latent variable dependencies, providing a flexible and accurate approximation of posteriors with arbitrary shapes. We establish rigorous theoretical guarantees, including the derivation of the lower bound for the variational objective and proof of asymptotic consistency in posterior estimation. To facilitate practical implementation, we develop an algorithm that automatically identifies dependent latent variables and their underlying dependence structure, without requiring manual specification. Simulation studies validate the effectiveness of SN-VI in approximating posterior distributions with bounded support and complex dependencies. The proposed method has been successfully applied to high-dimensional structured data, including computer vision datasets and spatial transcriptomics. In these applications, SN-VI demonstrates improved generative model performance and effectively uncovers coupled biological signals through the learned dependency structure.

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22.
arXiv (math.PR) 2026-06-19

An alternative approach to well-posedness of McKean-Vlasov equations arising in Consensus-Based Optimization

Authors:
Alessandro Baldi↗

arXiv:2512.19446v4 Announce Type: replace-cross Abstract: In this work we study the mean-field description of Consensus-Based Optimization (CBO), a derivative-free particle optimization method. Such a description is provided by a non-local SDE of McKean-Vlasov type, whose fields lack of global Lipschitz continuity. We propose a novel approach to prove the well-posedness of the mean-field CBO equation based on a truncation argument. The latter is performed through the introduction of a cut-off function, defined on the space of probability measures, acting on the fields. This procedure allows us to study the well-posedness problem in the classical framework of Sznitman. Through this argument, we recover the established result on the existence of strong solutions, and we extend the class of solutions for which pathwise uniqueness holds.

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23.
arXiv (CS.CL) 2026-06-16

ACCORD: Action-Conditioned Contextual Grounding for Language Agents

Authors:
Lai Jiang↗Cheng Qian↗Zhenhailong Wang↗Pan Lu↗Heng Ji↗Hao Peng↗

User instructions are often underspecified because humans rely on implicit assumptions about the surrounding environment. For large language model (LLM) agents operating in information-rich digital and physical environments, these assumptions cannot be inferred from the instruction alone; they must be recovered from the current state of tools, data, interfaces, and observations. Effective execution therefore requires agents to identify missing context, ground it in observed evidence, and carry it forward into subsequent actions. We show that current agents often fail to do so. They act from assumed rather than observed specifics, overlook information they could have gathered, and fail to incorporate evidence that has already been returned. Building on this insight, we propose ACCORD (Action-Conditioned Contextual Grounding), a simple and effective agent framework for adaptive grounding. Before each action, ACCORD actively probes the environment for missing information and integrates relevant context from the agent's trajectory that would otherwise be overlooked. Requiring no additional training or task-success signals, ACCORD improves task-goal completion on AppWorld by up to +20.6 points with GPT-5-mini, from 42.0% to 62.6%, compared to strong baselines. These gains persist with a substantially stronger base model (+10.8 with Claude-4.5-sonnet), an open-weight model (+10.1 with Qwen3.5-27B-FP8), and on the embodied AlfWorld benchmark (+7.4 success rate with GPT-5-mini).

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25.
arXiv (CS.CV) 2026-06-16

BRITE: A Benchmark for Reliable and Interpretable T2V Evaluation on Implausible Scenarios

Authors:
Advait Tilak↗Jiwon Choi↗Nazifa Mouli↗Wei Le↗

The rapid advancement of photorealistic Text-to-Video (T2V) generation brings in an urgent need for up-to-date evaluation methods. Existing benchmarks largely overlooked implausible scenarios and do not measure audio-visual alignment. We introduce BRITE, the first framework that unifies (1) implausible prompting, (2) fine-grained assessment of audio-visual consistency, and (3) QA-based interpretable evaluation into a comprehensive T2V benchmark. Unlike fully automated Multimodal LLM-based pipelines, which are prone to hallucination and prompt ambiguity, BRITE guarantees reliability through a rigorous human-in-the-loop protocol for benchmark creation. Evaluating five state-of-the-art models (Sora 2, Veo 3.1, Runway Gen4.5, Pixverse V5.5, and Qwen3Max), we reveal a critical performance gap: while models excel at static object composition, they exhibit significant degradation in object-action binding and audio-visual synchronization. Our framework offers the community a reliable, interpretable benchmark and evaluation framework that can detect and locate limitations in the next generation of T2V models, especially for off-manifold prompts

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