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02.
arXiv (math.PR) 2026-06-16

Risk-averse mean field games: exploitability and non-asymptotic analysis

arXiv:2301.06930v5 Announce Type: replace-cross Abstract: In this paper, we use mean field games (MFGs) to investigate approximations of $N$-player games ($N$pGs) with uniformly symmetrically continuous heterogeneous closed-loop actions. To incorporate agents' risk aversion (beyond the classical expected utility of total costs), we use an abstract evaluation functional for their performance criteria. Centered around the notion of exploitability, we conduct non-asymptotic analysis on the approximation capability of MFGs from the perspective of state-action distributions without requiring the uniqueness of equilibria. Under suitable assumptions, we first show that scenarios in the $N$pGs with large $N$ and small average exploitabilities can be well approximated by approximate solutions of MFGs with relatively small exploitabilities. We then show that $\delta$-mean field equilibria can be used to construct $\varepsilon$-equilibria in $N$pGs. Furthermore, in this general setting, we prove the existence of mean field equilibria. This proof reveals a possible avenue for incorporating penalization for randomized action into MFGs.

03.
PLOS Computational Biology 2026-06-12

Stage-dependent role of NEK7 in the inactive-to-active conformational transition of NLRP3 monomer

Authors:

by Jin Peng, Wenjian Li, Hao Wang, Xiaohui Chen, Manjie Zhang, Bin Sun The NLRP3 inflammasome is a multiprotein complex that primes cytokine production in the innate immune system. The inflammasome activation involves the cage-to-disk transition of NLRP3 oligomers, facilitated by the co-factor NEK7 protein. While NEK7’s role in promoting cage disassembly has been reported, its involvement in the large conformational changes of the NLRP3 monomer during activation remains elusive. Here, by using multi-scale simulations, we uncovered a stage-dependent role of NEK7 in the inactive-to-active transition. In the early stage, NEK7 reshapes the dynamics of the highly unstable inactive NLRP3 monomer to resemble active state, priming the conformational transition. In the middle stage, NEK7 impedes progression by populating an intermediate state farther from the active conformation than the NEK7-free counterpart, and structures in this state exhibit reduced allosteric potential toward activation. In the late stage, NEK7 has negligible impact, as the active conformation remains inherently isolated by a high energy barrier regardless of NEK7 presence. This highlights the critical role of oligomeric assembly in enabling monomeric NLRP3 to complete its conformational transition, in agreement with experiment observations. Our work suggests a multilayered activation mechanism where oligomer-level assembly and monomeric conformational changes are coupled, providing new mechanistic insights into this physiologically essential macromolecular process.

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

On Local Population-Risk Certificates

Authors:

arXiv:2606.19147v1 Announce Type: cross Abstract: This paper develops local certificates for population-risk increments around a current model. For a local candidate set \(\mathcal D\), the certificate is a two-sided confidence band for \(P({\ell_{\theta+v}-\ell_\theta})\) over \(v\in\mathcal D\). As an application, the upper endpoint of this band yields a risk-controlled update rule: an update is accepted only when its certified upper endpoint is nonpositive; otherwise the current model is retained.

07.
arXiv (quant-ph) 2026-06-19

Locally Gentle State Certification for High Dimensional Quantum Systems

arXiv:2602.04550v3 Announce Type: replace Abstract: Standard approaches to quantum statistical inference rely on measurements that induce a collapse of the wave function, effectively consuming the quantum state to extract information. In this work, we investigate the fundamental limits of locally-gentle quantum state certification, where the learning algorithm is constrained to perturb the state by at most $\alpha$ in trace norm, thereby allowing for the reuse of samples. We analyze the hypothesis testing problem of distinguishing whether an unknown state $\rho$ is equal to a reference $\rho_0$ or $\epsilon$-far from it. We derive the minimax sample complexity for this problem, quantifying the information-theoretic price of non-destructive measurements. Specifically, by constructing explicit measurement operators, we show that the constraint of $\alpha$-gentleness imposes a sample size penalty of $\frac{d}{\alpha^2}$, yielding a total sample complexity of $n = \Theta(\frac{d^3}{\epsilon^2 \alpha^2})$. Our results clarify the trade-off between information extraction and state disturbance, and highlight deep connections between physical measurement constraints and privacy mechanisms in quantum learning. Crucially, we find that the sample size penalty incurred by enforcing $\alpha$-gentleness scales linearly with the Hilbert-space dimension $d$ rather than the number of parameters $d^2-1$ typical for high-dimensional private estimation.

08.
PLOS Computational Biology 2026-06-08

Statistics of cortical representational drift can enable robust readout

Authors:

by Charles Micou, Timothy O’Leary Representational drift of fixed stimuli, learned tasks and familiar environments is observed in many brain areas, leading to reconfiguration of population codes over days to weeks. This raises the question of whether downstream brain regions employ mechanisms to track changes in population activity and thus preserve the fidelity of the information they extract. We show that the statistical properties of drift have a significant impact on such mechanisms. Over an extended period, a net change in population tuning due to drift can arise from an accumulation of small changes distributed across the population, or via abrupt jumps that affect smaller subsets of cells at each time point. We demonstrate that an adaptive readout can exploit the heavy-tailed statistics of abrupt jumps to maintain a more stable readout using a simple inference mechanism. Using experimental data, we investigate the extent to which heavy-tailed drift statistics are observed during representational drift in the posterior parietal cortex and visual cortex. We find that experimentally measured drift does not conform to a Gaussian random walk. Instead, we find sudden jumps in neural tuning that would be advantageous for a downstream observer adapting to changes in representation. These observations motivate future study to determine whether adaptive decoding mechanisms exist in the brain and to determine the physiological mechanisms that shape the statistics of representational drift.

09.
arXiv (CS.AI) 2026-06-16

How to Detect and Measure the AI Dangers to Democracy

arXiv:2606.16054v1 Announce Type: cross Abstract: Research on artificial intelligence and democracy has grown quickly over the last decade. A shared conclusion in this literature is that AI does not create new democratic problems so much as it makes old ones worse. We now see this across information ecosystems, in elections, and in public administration. However, despite growing evidence, we lack a clear way to prioritize risks in this area, compare them across domains, and identify where democratic control is most likely to break down. So, our problem is: How can we systematize the problems that AI systems pose to democratic processes? This paper argues that principal agent theory may fit the task. In many phases of democratic systems, principals delegate key functions to AI systems and their providers without really being able to monitor how these systems operate or the outputs they produce. Treating AI as a delegation problem helps identify accountability gaps and other governance failures. Most importantly, as we shall illustrate, it provides metrics for empirical assessments of AI impact on democracy. As a second analytical element, we draw on the NIST AI Risk Management Framework and its seven characteristics of trustworthy AI, which supply substantive criteria for evaluating delegated tasks. Operationalized across the three domains through measurable indicators and domain specific trustworthiness criteria, we propose an analytical framework that centers on institutional assessability as the central condition for democratic control over AI. However, we stress that how severe a harm is, and how much risk is acceptable, are evaluative judgments that current methodologies neither acknowledge nor operationalize. This becomes acute when such evaluative judgments are (silently) delegated to private vendors. We identify this as a strong limitation left for future work.

10.
arXiv (CS.LG) 2026-06-18

How fast can you find a good hypothesis?

arXiv:2509.03734v3 Announce Type: replace-cross Abstract: In the hypothesis selection problem, we are given sample and query access to finite set of candidate distributions (hypotheses), $\mathcal{H} = \{H_1, \ldots, H_n\}$, and samples from an unknown distribution $P$, both over a domain $\mathcal{X}$. The goal is to output a distribution $Q$ whose distance to $P$ is comparable to that of the nearest hypothesis in $\mathcal{H}$. Specifically, if the minimum distance is $\mathsf{OPT}$, we aim to output $Q$ such that, with probability at least $1-\delta$, its total variation distance to $P$ is at most $C \cdot \mathsf{OPT} + \varepsilon$. The optimal approximation for proper algorithms (where $Q \in \mathcal{H}$) is $C=3$ using $\Theta(\log(n/\delta)/\varepsilon^2)$ samples from $P$ and for improper algorithms (where $Q$ is not necessarily in $\mathcal{H}$) is $C=2$ using $\tilde{\Theta}(\log(n/\delta)/\varepsilon^2)$ samples from $P$. In the improper setting, the algorithm achieving $C=2$ [Bousquet, Braverman, Kol, Efremenko, Moran, FOCS 2021] runs in time which grows polynomially with $|\mathcal{X}|$ – it does not run in finite time for real-valued distributions. A promising path towards improved runtime is to consider improper algorithms which output a mixture $Q$ of the hypotheses as such a distribution can be represented in $n$ words of memory. We show (1) a lower bound that no algorithm which outputs a mixture can achieve approximation better than $C = 3-2/n$ unless the number of samples is polynomial in $|\mathcal{X}|$, as well as (2) an algorithm which runs in time $poly(n)$ and achieves the same approximation guarantee. In the proper setting, [Aliakbarpour, Bun, Smith, NeurIPS 2024] provided an algorithm with $C=3$ running in $\tilde{O}(n/(\delta^3\varepsilon^3))$ time. We improve this time complexity to $\tilde{O}(n/(\delta \varepsilon^2))$, significantly reducing the dependence on the confidence and error parameters.

11.
medRxiv (Medicine) 2026-06-15

Identifying the risk profile of anemia subtypes and hemodynamic obstetric complications in relation to peripartum cardiomyopathy

Background: Peripartum cardiomyopathy (PPCM) is a leading cause of maternal mortality worldwide, with worse outcomes associated with African Ancestry and delayed presentation. However, the mechanisms underlying PPCM are incompletely understood. Objective: Use a large, nationwide cohort to explore associations between PPCM and underexplored perinatal risk factors and complications of childbirth. Methods: Public hospital discharge data were obtained from eleven U.S. states between 2003-2019. Delivery hospitalizations, patient characteristics and obstetric complications were identified using ICD-9 and -10 CM codes. Only cases with unique patient identifiers enabling readmission analysis were included. The primary outcome was incident PPCM coded between 30 days antepartum and 150 days postpartum. Results: Of 7,424,916 delivering patients, 5,488 patients were diagnosed with PPCM. Patients with PPCM had higher rates of anemia, anemia of chronic disease (ACD), iron deficiency anemia (IDA), sickle cell disease (SCD), sickle cell trait (SCT), red blood cell (RBC) transfusion, and postpartum hemorrhage (PPH) (p

12.
medRxiv (Medicine) 2026-06-16

Fidelity-Derived Quantum Dissimilarity-Enhanced k-Nearest Neighbor Algorithm for Arterial Hypertension Prediction

We present a quantum-enhanced version of the classic k-Nearest Neighbors (kNN) classification algorithm, applied to the prediction of arterial hypertension. The traditional Euclidean distance metric of the kNN algorithm is replaced with a Fidelity-derived quantum dissimilarity measure to evaluate the similarity between data samples. We map classical real-world clinical and ECG-derived data features into quantum states via the Dense-Angle Encoding, which efficiently utilizes parameterized rotation gates to pack multiple features into minimal qubits while maintaining pure states. We evaluate the performance of the dissimilarity measure using both the noiseless state vector Simulator and the IBM Qiskit Estimator primitives. The quantum circuit demonstrates robust predictive capabilities comparable to the classical model. While it does not claim computational supremacy over the classical baseline, the framework proves that fidelity-based similarity is a physically meaningful and efficient approach for hybrid quantum classical classification.

13.
medRxiv (Medicine) 2026-06-15

Mucosal and Systemic Antibodies Associated with Clinical Protection in a Pertussis Controlled Human Infection Model

Background The engagement of mucosal and systemic immunity in preventing Bordetella pertussis colonization and infection in humans, the impact of prior vaccination on host immunity and protective outcomes, and the dynamics of the host response following exposure remain poorly understood. Methods Healthy adults were challenged with increasing colony-forming units (CFUs) doses, 106-108, of B. pertussis D420 intranasally (NCT05136599). Shedding (PCR and culturing) and symptom development were monitored up to 21 days post-challenge. Serum and nasal wash IgA and IgG were measured before challenge (baseline) and up to 6 months post-challenge. Findings Antibodies increased post-challenge only in infected individuals, primarily nasal IgA. Participants who remained uninfected had higher baseline levels of filamentous hemagglutinin (FHA)- specific mucosal IgA and IgG, and higher serum IgA against fimbriae 2/3 (FIM). FHA was negatively associated with bacterial load and was a key discriminator between shedders and non-shedders, up to one week post-challenge. By day 14 post-challenge, pertussis toxin (PT) IgG and FIM IgA in both serum and mucosal samples were negatively associated with bacterial colonization. The majority (96.7%) of acellular pertussis (aP) vaccine recipients (n=23, median age 2.0 years) became infected, compared to 69.4% of those who received whole-cell pertussis vaccine (n=36; median age 32.0 years), and their antibody responses remained distinct following infection. Interpretation Nasal FHA antibodies emerged as early predictors of protection against pertussis infection, while PT IgG and FIM IgA antibodies may reflect clearance after infection. aP-primed individuals were more susceptible to infection, despite their younger age and more recent vaccination. Funding CDC Contract #75D30122C15467 and CDC IPA Agreement #24IPA2417512 Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, US Department of Health and Human Services.

14.
bioRxiv (Bioinfo) 2026-06-14

Somatic variant detection in normal tissues from single-cell sequencing data

A crucial advantage of single-cell sequencing (SCS) is its ability to identify somatic variants in individual cells, enabling phylogenetic analysis of cellular populations within bulk tissues. While identifying somatic variants in tumor tissues via SCS has become a common practice, doing so in normal tissues remains challenging due to the rarity of somatic variants in normal cells. To evaluate the feasibility of somatic variant calling from widely available single-nucleus RNA-seq (snRNA-seq) and single-nucleus ATAC-seq (snATAC-seq) data, we profiled a Cell-line mix of six HapMap samples prepared by the SMaHT consortium using 10x Genomics 5' snRNA-seq (12k cells with 36k mean reads per cell) and snATAC-seq (11k cells with 14k median high-quality fragments per cell) for variant calling. PacBio long-read whole genome sequencing (WGS) data (109x) generated from individual cell lines were used as ground truth. Two computational tools, Monopogen and SComatic, were used for somatic variant calling from the SCS data. Monopogen achieved single nucleotide variant (SNV) detection accuracies of 93.30% in the snRNA-seq and 99.64% in the snATAC-seq data, both of which outperformed SComatic (74.35% and 94.29%, respectively). Monopogen also consistently detected somatic SNVs at cellular fractions as low as 0.5% (2.54% in snRNA and 0.81% in snATAC) in individual samples. Notably, snATAC-seq exhibited higher genomic coverage breadth and larger number of variants detected than snRNA-seq. While the SCS data have lower overall genome coverage than that of the bulk WGS, the single-cell level variant resolution allows Monopogen to assign variants to their cells of origin with over 80% accuracy in both RNA and ATAC modalities, thereby facilitating studies of clonal evolution and cell-type-specific mutagenesis. Other benchmarking methods were also evaluated (DeepVariant, Cellsnp-lite and Mutect2) for comparison. In conclusion, our study demonstrated the feasibility of performing reliable single-cell somatic mutation calling in a cell-line mixture and discussed the strengths and limitations of current computational methods when applied to normal tissues.

15.
arXiv (CS.CL) 2026-06-16

ROMPAR: Morphological Completion and Demographic Unlearning for Romanian-Accented Speech Recognition

Automated transcription of parliamentary proceedings faces significant hurdles due to demographic bias, dialectal variation, and technical artifacts such as utterance truncation during segmentation. This paper introduces the ROManian PARliamentary Speech Corpus (ROMPAR) dataset, a 17.80-hour corpus of Romanian and Moldavian parliamentary speech, featuring double-annotated ground truth and explicit labels for reconstructed word fragments. To build a robust ASR system, we propose a multi-task adversarial training framework that enforces demographic invariance across age, gender, and dialect. We address the inherent instability of adversarial objectives in generative architectures by introducing an exponential decay mechanism for the adversarial coefficients. Furthermore, we implement an LLM-guided decoding strategy with position-dependent weighting to facilitate morphological completion of truncated terminal words. Our results demonstrate that the proposed framework significantly reduces WER and achieves an F1-score of 96.6% in morphological reconstruction.

16.
arXiv (CS.AI) 2026-06-15

Tackling GNARLy Problems: Graph Neural Algorithmic Reasoning Reimagined through Reinforcement Learning

arXiv:2509.18930v3 Announce Type: replace-cross Abstract: Neural algorithmic reasoning (NAR) is a paradigm that trains neural networks to execute classic algorithms by supervised learning. Despite its successes, important limitations remain: inability to construct valid solutions without post-processing and to reason about multiple correct ones, poor performance on combinatorial NP-hard problems, and inapplicability to problems for which strong algorithms are not yet known. To address these limitations, we reframe the problem of learning algorithm trajectories as a Markov decision process, which imposes structure on the solution construction procedure and unlocks the powerful tools of imitation and reinforcement learning (RL). We propose the GNARL framework, encompassing the methodology to translate problem formulations from NAR to RL and a learning architecture suitable for a wide range of graph-based problems. We achieve very high graph accuracy results on several CLRS-30 problems, performance matching or exceeding much narrower NAR approaches for NP-hard problems and, remarkably, applicability even when lacking an expert algorithm.

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

Low-Burden LLM-Based Preference Learning: Personalizing Assistive Robots from Natural Language Feedback for Users with Paralysis

arXiv:2604.01463v2 Announce Type: replace-cross Abstract: Physically Assistive Robots require personalized behaviors to ensure user safety and comfort. However, traditional preference learning methods, like exhaustive pairwise comparisons, cause substantial physical and cognitive fatigue for users with severe motor impairments. To solve this, we propose a low-burden, offline framework that translates unstructured natural language feedback directly into deterministic robotic control policies. To safely bridge the gap between ambiguous human speech and robotic code, our pipeline uses Large Language Models (LLMs) grounded in the Occupational Therapy Practice Framework. This clinical reasoning decodes subjective user reactions into explicit physical and psychological needs, which are then mapped into transparent decision trees. Before deployment, an automated "LLM-as-a-Judge" verifies the code's structural safety. We validated this system in a simulated meal preparation study with 10 adults with paralysis. Results show our natural language approach significantly reduces user workload compared to traditional baselines. Additionally, occupational therapists confirmed the generated policies are safe and accurately reflect user preferences.

18.
arXiv (CS.CL) 2026-06-16

FinBalance: A Multi-Document Accounting Reconciliation Benchmark

Existing financial-NLP benchmarks mostly evaluate prepared artifacts such as filings, tables, or extracted values. Real accounting begins earlier: source documents must be reconciled into cited journal entries, aggregated into a balance sheet, and checked for contradictions. We introduce FinBalance, a multi-document accounting reconciliation benchmark built from source-document bundles across eight industries, three period types, and five difficulty levels. Human-authored business scenarios, accounting policies, tax/FX treatments, document schemas, distractors, and inconsistency templates are composed by a deterministic generator whose ledger produces journal entries,balance sheets, and 23 inconsistency-code labels. On a 710-record evaluation split, six contemporary LLMs reach at most 46% exact final-balance-sheet accuracy. Four models show a 26-41 pp gap between BS_exact, the model's reported balance sheet, and BS_recon, the balance sheet obtained by replaying its entries through our ledger. Models often recover numerically plausible entries but fail to bind them to supporting documents and aggregate them consistently. Citation-pressure prompting barely changes document-linking errors, while ledger-feedback ablations substantially improve reported balance sheets and expose inconsistency-detection trade-offs. Expert finance reviewers validate the benchmark design and labels.

19.
arXiv (CS.CV) 2026-06-11

BiWM: Advancing Open-Source Interactive Video World Models with Bidirectional Autoregression

Transitioning bidirectional video diffusion models into an autoregressive paradigm improves the interactivity of video world models, but existing causal pipelines need many stages (control fine-tuning, autoregressive training, causal initialization, few-step distillation) and still trail bidirectional models in quality due to error accumulation. Recent world models such as Yume-1.5 and Matrix-Game-3.0 instead adopt a bidirectional autoregressive approach, gaining fidelity and stable long-horizon rollout from self-correcting error propagation, yet open-source frameworks (e.g., minWM) support only causal models. We present BiWM, the first full-stack framework for interactive video world models under the bidirectional autoregressive paradigm, jointly optimizing generation quality and inference speed. From a pretrained video backbone, BiWM injects camera control by fine-tuning, then runs a few-step Distribution Matching Distillation (DMD) stage that turns the backbone into an action/camera-controllable world model: just two training stages instead of four in minWM, converging in a few hundred steps on 8xH200 GPUs. A single recipe spans Wan2.1-1.3B, Wan2.2-5B, HunyuanVideo-1.5-8B, and LTX-2.3-22B, and also supports secondary fine-tuning of existing bidirectional models. BiWM enables real-world camera control where minWM loses controllability, integrates pluggable history compression (FramePack-style and PackForcing-style) for long rollouts, and offers an optional NVFP4 4-bit training/inference pipeline. To counter DMD's mode-seeking degradation, we add GAN and mass-covering forward-KL objectives that preserve scene dynamics. We open-source BiWM for resource-constrained research and high-fidelity environment simulation.

21.
arXiv (math.PR) 2026-06-18

Phase transitions for contact processes on sparse random graphs via metastability and local limits

arXiv:2505.22471v2 Announce Type: replace Abstract: We propose a new perspective on the asymptotic regimes of fast and slow extinction in the contact process on locally converging sequences of sparse finite graphs. We characterise the phase boundary by the existence of a metastable density, which makes the study of the phase transition particularly amenable to local-convergence techniques. We use this approach to derive general conditions for the coincidence of the critical threshold with the survival/extinction threshold in the local limit. We further argue that the correct time scale to separate fast extinction from slow extinction in sparse graphs is, in general, the exponential scale, by showing that fast extinction may occur on stretched exponential time scales in sparse scale-free spatial networks. Together with {the results of} Nam, Nguyen and Sly (Trans.\ Am.\ Math.\ Soc.\ 375, 2022), our methods can be applied to deduce that the fast/slow threshold in sparse configuration models coincides with the survival/extinction threshold on the limiting Galton-Watson tree.

22.
arXiv (CS.AI) 2026-06-15

Discovery under Hypothesis Redundancy: A Geometric Theory of Discovery Bottlenecks

arXiv:2606.14386v1 Announce Type: cross Abstract: Scientific discovery saturates when new hypotheses cease to provide independent information, even if the nominal hypothesis space remains large. We study hybrid discovery systems that combine structured local search with LLM-generated non-local proposals and pose the Search Compression Hypothesis: non-local exploration helps only when three geometric conditions co-occur: spectral compression, orthogonal escape from the explored span, and residual signal alignment with the target. We formalize these conditions, derive necessary conditions for hybrid advantage, and test the mechanism in controlled synthetic environments, large-scale A-share factor discovery, and symbolic-regression benchmarks; a public tabular operational sanity check tests the associated budget-allocation implication. Signal-planting and directed-versus-random experiments show that novelty alone is insufficient: random orthogonal jumps expand coverage but do not improve yield without predictive alignment. Across compression sweeps, real factor archives, and LLM-SRBench tasks, hybrid gains concentrate in weakly represented but target-bearing directions and vanish as the hypothesis space approaches full rank. The framework turns LLM-guided discovery from generic novelty search into a diagnostic procedure for deciding when directed non-local exploration is warranted.

23.
arXiv (CS.CL) 2026-06-17

Translating the Untranslatable: An Operationalizable Ontology for Untranslatability

Untranslatability, cases where meaning cannot be directly preserved across languages, is well-studied in linguistics but underexplored in NLP. As machine translation (MT) systems improve on standard benchmarks, their limitations increasingly concentrate in such cases, where translation cannot be reduced to one-to-one equivalence. We introduce a structured ontology of untranslatability along with a taxonomy of compensation strategies, which are specific techniques to convey meaning under these untranslatable circumstances. We operationalize this framework into a multilingual dataset of untranslatable sentences paired with strategy-based translations, enabling controlled analysis of translation behavior. Initial human preference studies suggest that translation quality depends on the strategy used, with consistent preferences for outputs that include explanatory context, known as the Annotation compensation strategy. Our framework and dataset provide a foundation for studying and modeling strategy-informed machine translation.

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

Symplectic Transversality and Endpoint Green Estimates for Finite-Horizon Pontryagin Systems

arXiv:2606.17762v1 Announce Type: cross Abstract: We study horizon-uniform local branches of finite-horizon discrete-time Pontryagin boundary value systems after smooth control elimination. The central input is a two-point endpoint inverse for the linearization. We verify this inverse from scaled stable–unstable boundary transversality, prove the associated endpoint-corrected Green estimate, and combine it with weighted contractions to obtain existence, uniqueness, Lipschitz dependence, and first-order expansions with constants independent of the horizon. The framework covers smooth nonlinear endpoint maps, including the original Pontryagin rows that fix the initial state and couple the terminal costate to the terminal state. Symplectic and Riccati criteria verify the inverse hypothesis at the level of the matrix data; in particular, every stabilizable linear-quadratic system with invertible dynamics and definite weights is covered, including noncommuting coupled data. A numerical section illustrates the certificates and the horizon-uniform first-order expansion.

25.
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

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.