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01.
arXiv (CS.CL) 2026-06-18

Rethinking Reward Supervision: Rubric-Conditioned Self-Distillation

Post-training of reasoning language models is commonly driven by supervised distillation and reinforcement learning with verifiable rewards. Distillation often relies on chain-of-thought annotations that are expensive to obtain and may themselves be noisy, incomplete, or partially incorrect; even when the final solution is correct, an imperfect rationale can interfere with learning. Reinforcement learning with verified rewards, on the other hand, typically compresses evaluative feedback into a scalar signal, obscuring which aspects of a response should be improved. We propose Rubric-Conditioned Self-Distillation, a framework that incorporates rubrics as structured, fine-grained feedback for on-policy self-distillation. Our method conditions the teacher model on criterion-level rubrics and uses it to provide token-level guidance on the student's own sampled trajectories. This design avoids treating a single reference rationale as the sole supervision target. Instead, rubrics specify what a strong response should satisfy, enabling more fine-grained credit assignment over the reasoning process than scalar reward optimization. We instantiate this framework with a two-stage pipeline that first learns to generate task-specific rubrics and then trains a rubric-guided reasoner. We evaluate on a diverse suite of science reasoning benchmarks and results show that rubric-conditioned self-distillation effectively converts rubric-level criteria into token-level guidance over the reasoning process, surpassing GRPO by 1.0 points and OPSD by 0.9 points on average.

02.
arXiv (CS.CV) 2026-06-15

Interpretable Alzheimer's Diagnosis via Multimodal Fusion of Regional Brain Experts

Accurate and early diagnosis of Alzheimer's disease (AD) is critical for effective intervention and requires integrating complementary information from multimodal neuroimaging data. However, conventional fusion approaches often rely on simple concatenation of features, which cannot adaptively balance the contributions of biomarkers such as amyloid PET and MRI across brain regions. In this work, we propose MREF-AD, a Multimodal Regional Expert Fusion model for AD diagnosis. It is a Mixture-of-Experts (MoE) framework that models mesoscopic brain regions within each modality as independent experts and employs a gating network to learn subject-specific fusion weights. Utilizing tabular neuroimaging and demographic information from the Alzheimer's Disease Neuroimaging Initiative (ADNI), MREF-AD achieves competitive performance over strong classic and deep baselines while providing interpretable, modality- and region-level insight into how structural and molecular imaging jointly contribute to AD diagnosis. The source code is available at https://github.com/PennShenLab/mref-ad.

03.
arXiv (CS.CV) 2026-06-15

$\mu_0$: A Scalable 3D Interaction-Trace World Model

World models that capture how actions induce physical change enable scalable robot learning without reliance on embodiment-specific action labels. Pixel-space video models provide broad visual priors but expend model capacity on dense appearance reconstruction, while direct action models require embodiment-specific labels that hinder scalability. We present $\mu_0$, a scalable world model based on 3D traces. Rather than predicting dense pixels or directly modeling actions, $\mu_0$ forecasts smooth 3D trajectories for salient interaction points such as objects, tools, hands, and contact regions, yielding a compact, embodiment-agnostic motion interface. To enable training from diverse video sources, our TraceExtract system automatically extracts 3D supervision by selecting keypoints, constructing globally aligned traces, and associating motion segments with hierarchical language captions. This TraceExtract supervision pretrains $\mu_0$ by combining a pretrained vision-language backbone with a modular trace expert, which represents each query via B-spline control points and predicts future traces. Experiments show that $\mu_0$ outperforms baselines in both 2D and 3D trace prediction, including trace prediction models and tokenized VLM methods. Because $\mu_0$ is frozen and reusable, it can be paired with action experts for downstream robot embodiments. Despite action-free pretraining, the resulting trace-conditioned policies achieve performance competitive with VLA models pretrained with action supervision, such as $\pi_0$. These results establish 3D traces as a scalable and transferable representation for cross-embodiment manipulation.

04.
arXiv (CS.CV) 2026-06-18

S3OD: Towards Generalizable Salient Object Detection with Synthetic Data

Salient object detection exemplifies data-bounded tasks where expensive pixel-precise annotations force separate model training for related subtasks like DIS and HR-SOD. We present a method that dramatically improves generalization through large-scale synthetic data generation and ambiguity-aware architecture. We introduce S3OD, a dataset of over 139,000 high-resolution images created through our multi-modal diffusion pipeline that extracts labels from diffusion and DINO-v3 features. The iterative generation framework prioritizes challenging categories based on model performance. We propose a streamlined multi-mask decoder that handles the inherent ambiguity in salient object detection by predicting multiple valid interpretations. Models trained only on synthetic data achieve 20-50% error reduction in cross-dataset generalization, while fine-tuned versions reach state-of-the-art performance across DIS and HR-SOD benchmarks.

05.
arXiv (CS.LG) 2026-06-18

TS-Fault: Benchmarking Time Series Forecasters Against Structural Faults

arXiv:2606.18539v1 Announce Type: new Abstract: Time series forecasting (TSF) underpins consequential decisions in energy, transportation, finance, and healthcare, yet TSF models are almost universally ranked by a single number (e.g., average error) on clean held-out data, under the implicit assumption that it predicts deployed reliability. However, real faults are not i.i.d noise but structured events with temporal shape, broken cross-variable dependencies, regime change coupled with missingness, and causal propagation across a sensing pipeline. Treating TSF robustness as a data-quality problem, we present TS-Fault, a benchmark that evaluates forecasting models under explicit, parameterized fault scenarios with controllable semantic difficulty. TS-Fault organizes recurring failures into four modes along two orthogonal axes (observation- vs mechanism-level; univariate vs multivariate) and injects each fault into the most prediction-critical window via a unified importance score. This design enables robustness to be tested against the structures models actually rely on, rather than reduced to generic noise sensitivity. We evaluate 21 models across 6 datasets, 4 modes, and 5 difficulty levels under a paired clean/corrupt protocol. The results reveal three findings that contradict common leaderboard intuition: (i) clean-data accuracy anti-correlates with robustness; (ii) clean rankings are preserved under observation-level faults but reshuffled under mechanism-level faults; and (iii) all catastrophic failures occur under mechanism-level faults, with foundation models achieving the highest clean-data accuracy yet exhibiting the greatest fragility. The code is publicly available at https://github.com/Ray-zyy/TS-Fault.

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

StereoFactory: A Unified Merging Framework for Robust Stereo Matching

Stereo matching has advanced through foundation models trained on large-scale datasets, yet this paradigm suffers from a scalability bottleneck: incorporating new data requires costly joint retraining. Model merging offers a scalable post-hoc alternative by integrating knowledge from specialized models after source checkpoints are available. However, existing merging methods typically retain all available models or rely on greedy inclusion, which can preserve harmful task-vector interference. We propose StereoFactory, a coarse-to-fine evolutionary framework for adaptive model merging. Stage~1 employs a genetic algorithm to search the combinatorial space of model subsets, determining which models should participate. Stage~2 addresses module-level knowledge specialization (different functional modules exhibit distinct preferences for knowledge sources) through CMA-ES optimization of architecture-adaptive routing over the selected task vectors, with optional module-level scaling. Experiments across two architectures and four benchmarks demonstrate that StereoFactory consistently achieves the best four-benchmark average under the same checkpoint pool, reducing the average error from 3.80 to 3.30 on NMRF and from 2.88 to 2.19 on FoundationStereo relative to the strongest controlled baseline. The post-hoc search requires only 2.7–3.7\% of the corresponding joint-retraining wall-clock time. Analysis reveals that knowledge contributions are inherently module-specific, and selected subsets can transfer across architectures with minimal degradation. Code will be publicly released upon acceptance at: https://github.com/XiandaGuo/StereoFactory.

07.
PLOS Medicine 2026-06-02

Prognostic value of cervical length for spontaneous preterm birth in asymptomatic women with singleton pregnancy: An individual participant data meta-analysis

Authors:

by Kelly Hughes, David Nguyen, Mason Aberoumand, Heather Ford, Erin Clarke, Nuria Banos Lopez, Margaret Dziadosz, Richard Fischer, Renato T. Souza, Jose Guilherme Cecatti, Kelly Orzechowski, Courtney Olson-Chen, Alberto Borges Peixoto, Vorapong Phupong, Joshua Rosenbloom, Moeun Son, Athena Souka, Liu Du, Michael Sean Esplin, Roberta Granese, Simi Gupta, Brenda Kazemier, Lindsay Kindinger, Pihla Kuusela, Jeanine Van der Ven, Omer Weitzner, Evelyn Minis, Alba Farras Llobet, Heather Frey, Rashmi Bagga, Siddhidatri Mishra, Elizabeth Patberg, Philip Bennett, Megan Hall, Andrew Shennan, Shaun Brennecke, Shakila Thangaratinam, Anna Lene Seidler, Ben Willem Mol, Rui Wang Background Spontaneous preterm birth (SPTB) is the leading cause of perinatal and early childhood mortality worldwide. Studies have generally suggested that mid-trimester transvaginal sonographic cervical length

08.
arXiv (CS.CL) 2026-06-16

The Truth Stays in the Family: Enhancing Contextual Grounding via Inherited Truthful Heads in Model Lineages

Recent advances in large language models (LLMs) have produced many specialized multimodal LLMs (MLLMs) that share common foundational LLMs, forming distinct model lineages. It remains unclear whether a fundamental behavioral link exists between the foundational LLMs and downstream variants. We investigate this question by quantifying head-level context-truthfulness scores. Across diverse LLM and MLLM lineages, including Vicuna-, Qwen2.5-, LLaMA2-, and Mistral-based models, we find that Truth Scores are strongly preserved within model families, even after instruction tuning or multimodal adaptation. We further show that this inheritance is consistent with attention-head weight preservation, and that context-truthful heads attend to query-relevant evidence. Building on this finding, we propose TruthProbe, a soft-gating strategy that amplifies context-truthful heads while preserving other head contributions. TruthProbe improves contextual truthfulness on HaluEval and reduces multimodal hallucination on POPE and CHAIR, with base-LLM Truth Scores transferring effectively to their fine-tuned LLM and MLLM descendants. Code is available at https://github.com/miso-choi/TruthProbe.

09.
arXiv (math.PR) 2026-06-16

Quantitative Oppenheim Conjecture for Random Quadratic Forms and Optimal Variance Bounds in Function Fields

arXiv:2606.16699v1 Announce Type: cross Abstract: We prove a quantitative version of Oppenheim's conjecture in the function field setting. In order to do so, we compute the higher moments of the Siegel transform. In particular, we find an optimal bound on the variance of the number of lattice points in a set. Moreover, we compute the exact variance of the number of lattice points in a ball, which is of independent interest.

10.
arXiv (CS.CV) 2026-06-17

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

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.

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

Visual-Redundancy-Controlled Parallel Decoding for Diffusion-Based Multimodal Large Language Models

arXiv:2605.25820v2 Announce Type: replace Abstract: Diffusion-based multimodal large language models (dMLLMs) decode by iteratively predicting tokens at multiple masked positions in parallel. This turns each decoding step into a position-selection problem: the model must choose not only which predictions are reliable in isolation, but also which positions should be committed together as context for later decoding steps. Existing confidence-based decoding ranks masked positions independently and commits the top-K positions, largely ignoring whether the committed tokens provide complementary visual grounding. We identify a step-level limitation of this strategy in multimodal settings: high-confidence tokens selected in the same step can rely on overlapping visual grounding, introducing visual redundancy among the committed tokens and leaving less complementary visual grounding available for later decoding. To quantify this effect, we introduce the Visual Redundancy Index (VRI), which measures visual grounding overlap among tokens committed in parallel. To control this redundancy during decoding, we propose Visual-Redundancy-Controlled Decoding (VRCD), a training-free inference-time decoding method that uses token-to-image attention to prioritize visually complementary positions. Across diverse multimodal benchmarks, VRCD reduces visual redundancy and remaining-position entropy with modest runtime overhead. In longer decoding experiments, it also achieves relative accuracy gains of up to 18.8% on M^3CoT and 6.9% on MMBench over confidence-based decoding. Code is available at https://github.com/infiniteYuanyl/VRCD.

12.
arXiv (CS.CL) 2026-06-16

LLM-Assisted Stance Detection in Scientific Discourse: A Test Case in Bayesian Cognitive Science

Qualitative coding is central to social science, but expert annotation is difficult to scale. LLMs offer a possible extension, yet require careful validation when the target construct is interpretive, theoretically loaded, and only indirectly expressed. We study this problem in a difficult case: detecting whether authors treat Bayesian models as descriptions of mental and neural mechanisms (realism) or as useful mathematical tools (instrumentalism). Our method combines a theory-driven codebook, expert-coded reference annotations, a diagnostic-gated prompt-optimization search yielding a shared zero-shot prompt for three frontier LLMs (GPT-5.1, Claude Sonnet 4.6, Gemini 3 Pro Preview), and multi-rater reliability analysis. The final prompt achieved a held-out combined reliability score of 0.76 (harmonic mean of ICC = 0.79 and $\alpha$ = 0.74), with all diagnostics satisfied. Deployed on 6,858 quotes from 210 articles, the three LLMs reached substantial quote-level agreement (ICC = 0.80; $\alpha$ = 0.76; combined = 0.78) and near-perfect article-level rank stability ($r$ = 0.96-0.97 across rater pairs). The corpus was predominantly weakly realist, but article-level stances were rarely uniform: only 1.4% of articles used a single band, while 59.5% spanned four or more. Low-level perception/motor articles scored 8.8 Realism points higher than high-level cognition articles ($p < .001$, $d = 0.60$), quantifying a long-held qualitative intuition. We present this as an expert-led case study; the framework is intended to generalize to similar theoretically demanding tasks, not to all qualitative analysis.

13.
arXiv (CS.CL) 2026-06-11

ProHiFlo: Hierarchical Flow Matching with Functional Guidance for De Novo Protein Generation

De novo protein generation has transformative potential in therapeutic design, enzyme engineering, and synthetic biology. While diffusion-based and flow matching approaches have achieved progress, they typically operate at single resolution and lack mechanisms for incorporating functional constraints. We introduce ProHiFlo, a hierarchical flow matching framework with three innovations: (1) coarse-to-fine generation that models backbone geometry before refining to all-atom coordinates, reducing computational cost while maintaining accuracy; (2) functional guidance leveraging pretrained predictors to steer generation toward desired properties without retraining; (3) adaptive SE(3)-equivariant architecture for efficient multi-scale processing. Experiments on unconditional generation, motif scaffolding, and functional design demonstrate state-ofthe-art performance while requiring 4 fewer sampling steps. On enzyme active site scaffolding, ProHiFlo achieves 58.9% success rate compared to 41.2% for RFDiffusion.

14.
arXiv (CS.LG) 2026-06-16

David vs. Goliath in Next Activity Prediction: Argmax vs. LSTM, Transformer, and LLM

arXiv:2606.15868v1 Announce Type: new Abstract: Next activity prediction (NAP) is a cornerstone of predictive process monitoring (PPM), enabling organizations to move from retrospective analysis to proactive process steering. The PPM field has progressed from classical machine learning through deep learning architectures such as LSTMs and Transformers to large language models (LLMs). Despite growing model complexity, no benchmark jointly compares LLMs, Transformers, LSTMs, and simple baselines in a direct sequence modeling setting for NAP. In this paper, we fill this gap with a systematic benchmark. We compare vocabulary-adapted LLMs, Transformers trained from scratch, LLM-distilled Transformers, and LSTMs against a simple counting-based argmax baseline across seven real-life event logs. Our results tell a David vs. Goliath story: pretraining confers no consistent improvement over training from scratch, model size shows little effect on performance, and on most datasets the argmax baseline matches or approaches the performance of billion-parameter LLMs.

15.
arXiv (CS.CL) 2026-06-11

ALIGNBEAM : Inference-Time Alignment Transfer via Cross-Vocabulary Logit Mixing

Domain fine-tuning degrades the safety of large language models: fine-tuned specialists readily comply with harmful prompts framed in domain language. Existing inference-time defenses that mix logits from a safe anchor model require both models to share a vocabulary, which rules them out for the cross-family specialists where safety is most degraded. We present ALIGNBEAM, a training-free method that lifts this restriction by translating anchor logits into the target model's vocabulary token-by-token at each decoding step; a small LLM judge then selects the safest among K candidate continuations. No weights are changed, and the safety-utility trade-off can be tuned at deployment without retraining. Across both cross-vocabulary and same-vocabulary evaluation pairs, ALIGNBEAM substantially raises refusal on adversarial benchmarks while keeping task accuracy and inference overhead within practical bounds. The results show that safety alignment can be transferred between model families at inference time, without touching either model's weights.

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

The Voice Behind the Words: Quantifying Intersectional Bias in SpeechLLMs

Speech Large Language Models (SpeechLLMs) process spoken input directly, retaining cues such as accent and perceived gender that were previously removed in cascaded pipelines. This introduces speaker identity dependent variation in responses. We present a large-scale intersectional evaluation of accent and gender bias in three SpeechLLMs using 2,880 controlled interactions across six English accents and two gender presentations, keeping linguistic content constant through voice cloning. Using pointwise LLM-judge ratings, pairwise comparisons, and Best-Worst Scaling with human validation, we detect recurring directional disparities. Eastern European-accented speech receives lower helpfulness scores, particularly for female-presenting voices. Responses remain polite but differ in helpfulness. While LLM judges capture the directional trend of these biases, human evaluators exhibit significantly higher sensitivity, showing stronger accent-level contrasts.

17.
arXiv (CS.CL) 2026-06-15

OdysSim: Building Foundation Models for Human Behavior Simulation

Large language models are increasingly deployed as human simulators for interactive evaluation and social simulation. Yet helpfulness-driven post-training pulls them toward a homogeneous, overly agreeable assistant register, creating a behavioral Sim2Real gap. We present OdysSim, the largest open systematic investigation of behavioral foundation models, i.e., models trained to simulate human behavior at scale. We propose SOUL, a taxonomy of five capability axes (CONV, SS, COG, ROLE, EVAL) that unifies 62 datasets and 23 benchmark tasks under one framework. Specifically, we curate the OdysSim corpus (21.4M interactions, 10B tokens, retrofitted with back-generated social contexts), construct the SOUL-Index benchmark, and develop an end-to-end training recipe combining midtraining, task-specific RL, and expert distillation. The resulting open 8B OSim model ranks first or tied-first on 8 of 23 tasks, outperforming any individual frontier model by this count, with the strongest gains on conversational and social tasks. Its outputs are also more human-like in length, formatting, and word choice, and it transfers zero-shot to out-of-distribution user simulation on $\tau$-bench, nearly matching real users on reaction alignment (93.2 vs. 93.5). We further show that LLM-as-judge RL induces reward-hacking patterns, and that our detectors can mitigate them during post-training. Together, our findings suggest that behavioral foundation models require rethinking the LLM training paradigm. We release all artifacts to support future research.

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

Learning a Sampling-Free Variational DNN Plugin from Tiny Training Sets to Refine OOD Segmentation With Uncertainty Estimation

Deep neural networks (DNNs) frequently fail to generalize to out-of-distribution (OOD) medical images because of variations in scanners and acquisition protocols. Retraining DNN models to address these distribution shifts is often impractical due to the high cost of acquiring and annotating new medical datasets. To address this, we introduce VarDeepPCA, a novel lightweight variational DNN framework designed to restore/refine degraded segmentation maps by leveraging intrinsic geometric priors. Unlike existing approaches that require target-domain data or extensive pre-training, our VarDeepPCA explicitly learns a distribution of valid anatomical geometries using only small in-distribution (ID) datasets. Theoretically, our novel variational learning framework leverages a reinterpretation of the softmax mapping to implicitly perform exact distribution modeling, thereby enabling computationally efficient, sampling-free learning and inference. This also enables VarDeepPCA to provide uncertainty estimates associated with its restored segmentation maps. We empirically validate our framework across 4 distinct clinical applications, using 14 publicly available datasets, involving segmentation of the myocardium, neuroretinal rim, prostate, and fetal head. Comparisons against 15 existing methods demonstrate that VarDeepPCA consistently restores segmentation maps produced by the existing methods on OOD data to (i) significantly improve anatomical plausibility of geometries and clinical utility of the segmentations, and (ii) significantly reduce errors, without needing any more training data than that used by existing methods.

20.
arXiv (quant-ph) 2026-06-16

Decoherence-free algebras in quantum dynamics

arXiv:2403.12926v2 Announce Type: replace Abstract: In this Article we analyze the algebraic properties of the asymptotic dynamics of finite-dimensional open quantum systems in the Heisenberg picture. In particular, a natural product (Choi-Effros product) can be defined in the asymptotic regime. Motivated by this structure, we introduce a new space called the Choi-Effros decoherence-free algebra. Interestingly, this space is both a C*-algebra with respect to the composition product, and a B*-algebra with respect to the Choi-Effros product. Moreover, such space admits a direct-sum decomposition revealing a clear relationship with the attractor subspace of the dynamics. In particular, the equality between the attractor subspace and the Choi-Effros decoherence-free algebra is a necessary and sufficient condition for a faithful dynamics. Finally, we show how all the findings do not rely on complete positivity but on the much weaker Schwarz property.

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

ScholarSum: Student-Teacher Abstractive Summarization via Knowledge Graph Reasoning and Reflective Refinement

Abstractive summarization plays a crucial role in enabling efficient understanding of scientific literature, yet it inherently demands both linguistic fluency and factual faithfulness. Existing approaches often fail to reconcile these two requirements. Extractive methods rely on rigid sentence splicing that disrupts macro-level logical coherence, while large language model (LLM)-based generative approaches, despite mastering linguistic fluency, exhibit limited factual consistency. In this work, we propose ScholarSum, a hierarchical reflective graph-based framework that emulates a student-teacher writing process for fluent and faithful scientific summarization. ScholarSum first organizes the document into a hierarchical knowledge graph by segmenting it into semantically coherent units, whose multi-layered community structure captures global logic and macro-level themes. Guided by this global structure, the student generates an initial draft, which is subsequently refined through fine-grained evidence retrieval. To ensure factual consistency, a teacher-like reviewer then iteratively examines the draft, identifies unsupported content, and prompts targeted re-retrieval and rewriting until the summary meets rigorous quality standards. Extensive experiments demonstrate that ScholarSum significantly outperforms previous baselines in terms of both completeness and faithfulness. Our code is available at https://github.com/Xiaoyu-Tao/ScholarSum.

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

Disagreement-Based Cross-Model Routing for Implicit Video Question Answering

We study multiple-choice video question answering on the ImplicitQA benchmark, where the correct answer is never explicitly shown but must be inferred from off-screen events, line-of-sight cues, causal structure, and cross-shot spatial layout. On this benchmark a single frontier video LLM already operates near its accuracy ceiling, and we observe that conventional self-consistency strategies – majority voting across repeated samples of the same model – can hurt rather than help, because the model's errors on hard questions are correlated. We propose disagreement-based cross-model routing, a pure inference-time procedure that requires no labels and no training. We triple-sample a native-video model (Gemini 3.1 Pro Preview) at temperature zero, exploit the genuine sample-to-sample variance of its video-processing pipeline to identify the roughly 20% subset of questions where the three samples disagree, and route only that subset to a second model from a different family (Claude Opus 4.8) that consumes uniformly sampled frames with adaptive thinking. On the 1001-question validation set with public ground truth – our main evaluation – the method improves AvgAcc by +1.43 over the best single sample of the primary model, with per-category gains concentrated on Motion & Trajectory (+5.49), Inferred Counting (+3.45), and Vertical Spatial Reasoning (+1.82) – the categories most dependent on cross-shot reference resolution. The same pipeline applied to the held-out 172-question CVPR 2026 ImplicitQA challenge test set achieves 82.03 AvgAcc / 79.71 MacroAvgAcc (+1.81 over the best single sample of the primary model), confirming the validation result on an independent split.

23.
medRxiv (Medicine) 2026-06-16

Validating an Early Pregnancy HbA1c as the Screening Test for Gestational Diabetes Mellitus: Findings from PRISMA Pakistan Cohort

Background: Early identification of gestational diabetes mellitus (GDM) is critical to improving maternal and neonatal outcomes, particularly in resource-constrained settings where universal oral glucose tolerance testing (OGTT) is burdensome. We assessed whether early-pregnancy HbA1c alone or combined with common risk factors can predict GDM and reduce the burden of OGTT requirements in a peri-urban cohort in Karachi, Pakistan. Methods: We conducted a secondary analysis of the Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA) Pakistan cohort. Women enrolled before 20 weeks' gestation with available early-pregnancy HbA1c and a 2-hour 75g OGTT at 24 to 28 weeks were included. We externally validated GDM prediction models originally developed in the STRiDE-India cohort. Model performance was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC). We assessed four models: HbA1c alone (Model 1a); age, BMI, and family history of diabetes mellitus (FH DM) (Model 1b); HbA1c combined with age, BMI, and FH DM (Model 2); and an extended model, i.e., Model 2 combined with socioeconomic status, gestational age, parity, systolic and diastolic blood pressure (Model 3). A dual-threshold approach was applied to assess rule-in and rule-out performance. Results: Among 2,489 women, GDM incidence was 7.5% (n=186). Models with a broader set of predictors demonstrated higher AUC values, with Model 2 achieving an AUC of 0.61 (95% CI: 0.57, 0.66). Including additional factors (Model 3) did not further improve predictive ability (AUC: 0.62; 95% CI: 0.58, 0.66). In addition, at predefined thresholds, Model 2 achieved sensitivity of 73.7% (rule-out) and specificity of 83.5% (rule-in), with the potential to reduce OGTT requirements (58.5%). Conclusions: Early-pregnancy risk stratification using HbA1c combined with simple clinical predictors offers a pragmatic approach to streamline GDM screening among high-risk pregnant women. A dual-threshold strategy using Model 2 could reduce reliance on universal OGTT while prioritizing high-risk women for confirmatory testing.

24.
medRxiv (Medicine) 2026-06-15

Quality Improvement Based Implementation and Evaluation of a Decision Aid for Patients with Nephrolithiasis

Introduction Patients with nephrolithiasis face challenges in making a high-quality, preference sensitive decision. Our prior work established feasibility and patient acceptance of a software-based decision aid (DA). The objectives for this study were to identify implementation strategies for the DA in routine care and determine whether DA implementation enhances decisional quality for patients. Methods New nephrolithiasis patients were recruited from the institution Medical Center from June 2018 to April 2024 to receive a software-based pre-visit DA that measured care preferences and used decision analysis to rank treatments. The RE-AIM framework and Plan-Do-Study-Act (PDSA) cycles were used to improve implementation outcomes. Patients completed survey instruments evaluating decisional conflict, shared decision-making, care satisfaction, and treatment choice following their provider visit. These metrics were compared in the DA cohort (n=81) to those in a usual care cohort (n=78) with Wilcoxon rank-sum and Chi-square (or Fishers exact) tests. Results Implementation data revealed sustained reach and progressive improvement in fidelity. The DA cohort reported higher decisional quality relative to controls (p=0.003) and reported greater support/advice to make a choice (p=0.005). The DA cohort more often discussed options with their doctor (87.5% vs 69.2%, p=0.005) and were more likely to be promoters of their provider (p

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

Taming Curvature: Architecture Warm-Up for Stable Transformer Training

arXiv:2606.16768v1 Announce Type: new Abstract: Training billion-parameter Transformers is often brittle, with transient loss spikes and divergence that waste compute. Even though the recently developed Edge of Stability (EoS) theory provides a powerful tool to understand and control the stability of optimization methods via the (preconditioned) curvature, these curvature-controlling methods are not popular in large-scale Transformer training due to the complexity of curvature estimation. To this end, we first introduce a fast online estimator of the largest (preconditioned) Hessian eigenvalue (i.e., curvature) based on a warm-started variant for power iteration with Hessian-vector products. We show theoretically, and verify empirically, that the proposed method makes per-iteration curvature tracking feasible at billion parameter scale while being more accurate. Using this tool, we find that training instabilities coincide with surges in preconditioned curvature and that curvature grows with depth. Motivated by these observations, we propose architecture warm-up: progressively growing network depth to carefully control the preconditioned Hessian and stabilize training. Experiments on large Transformers validate that our approach enables efficient curvature tracking and reduces instabilities compared to existing state-of-the-art stabilization techniques without slowing down convergence.