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01.
arXiv (CS.AI) 2026-06-17

Learning Red Agent Policy from Observations for Neurosymbolic Autonomous Cyber Agents

arXiv:2606.18223v1 Announce Type: cross Abstract: With sophisticated cyber-attacks becoming increasingly prevalent, modern networks require intelligent autonomous cyber-defense agents trained via Reinforcement Learning (RL). These agents employ neurosymbolic approaches such as behavior trees with learning-enabled components (LECs) to learn, reason, adapt, and implement security rules while maintaining critical operations. However, these autonomous networks are partially observable systems, i.e., the cyber-attacker's (red agent's) actions are not observable, making it difficult for the defender to predict red actions, learn red policies, or assess the attacker's intrusion levels. To address this, we propose a Policy Learning Technique using imitation learning to learn policies for partially observable RL agents with discrete states and discrete actions. We apply this technique in an autonomous cyber environment to predict red agent's actions from network observations and defender actions. Integrated with a neurosymbolic cyber-defense agent, our method effectively handles different red policies and achieves high prediction accuracy across diverse simulated scenarios.

02.
PLOS Medicine 2026-06-12

Placenta accreta spectrum in the 21st century: Challenging dogma and redefining disorder

Authors:

by Eric Jauniaux, Helena C. Bartels, Yalda Afshar Placenta accreta spectrum (PAS) is a serious pregnancy complication caused by abnormal placental attachment to the uterus. In this Perspective, Eric Jauniaux and colleagues discuss emerging evidence that challenges our long-held pathophysiological understanding of PAS, and argue that a critical reassessment of definition, diagnosis, and management is overdue. In this Perspective, Jonathan Evans and colleagues discuss why restricting access to joint replacement surgery based on BMI alone is not supported by evidence, and highlight how such rest rictions risk exacerbating stigma, inequity and avoidable harm to those who would benefit from surgery.

03.
arXiv (CS.CV) 2026-06-19

FUSE: Frequency-domain Unification and Spectral Energy Alignment for Multi-modal Object Re-Identification

Despite significant progress in multi-modal Re-Identification (ReID), existing methods tend to emphasize low-frequency cues. Consequently, they focus on attributes such as color, illumination, and coarse appearance, while overlooking mid and high-frequency structures that encode geometric, textural, and identity-discriminative details. This imbalance leads to incomplete spectral representations and unstable cross-modal alignment. To overcome these limitations, we introduce FUSE, a frequency-domain framework that reformulates multi-modal ReID as a two-stage process of spectral disentanglement and energy alignment. The proposed Spectral Decomposition Module (SDM) adaptively partitions features into low, mid, and high-frequency subspaces, enabling hierarchical spectral modeling. The Cross-Modal Alignment Module (CAM) further enforces energy alignment and subspace complementarity across modalities via frequency-consistency regularization. In addition, FUSE incorporates learnable frequency modulation to enhance robustness under varying illumination and heterogeneous sensor conditions. Extensive experiments on RGBNT201, RGBNT100, and MSVR310 show that FUSE achieves 9.1\% mAP and 9.5\% Rank-1 improvements, establishing an interpretable frequency-domain paradigm for multi-modal representation learning.

04.
medRxiv (Medicine) 2026-06-22

How knowledge shapes community stigma and social support for women seeking abortion in the Democratic Republic of Congo: A cross-sectional study.

Background The Democratic Republic of Congo (DRC) bears one of the highest maternal mortality ratios globally (746 per 100,000 live births), with nearly 11% of deaths attributable to complications of unsafe abortion. Despite ratification of the Maputo Protocol and related national policies, access to safe abortion remains limited, largely due to entrenched stigma. Social support, encompassing emotional, informational, and instrumental assistance, is critical in shaping womens abortion-seeking behaviors and health outcomes. This study examines the influence of community-level knowledge on stigma and social support for women seeking abortion care. Methods A cross-sectional survey was conducted from May 2024 to June 2024 among 1,715 adults in Kinshasa and North Kivu provinces. Analyses focused on a sub-sample of 574 respondents reporting familiarity with women who had undergone abortion. Structural Equation Modeling (SEM) was applied to estimate direct and indirect pathways linking community knowledge, stigma, and social support. Results Two core knowledge indicators, recognition of abortion as a safe medical procedure and awareness of legal conditions for access, were significantly associated with outcomes. A one-unit increase in knowledge corresponded to a 0.39-point increase in social support and a 0.19-point reduction in stigma. Enhanced knowledge promoted empathetic attitudes, reinforced practical support, and mitigated moralizing judgments toward women seeking abortion. Conclusions Strengthening community knowledge emerges as a strategic lever to reduce abortion-related stigma and enhance social support in the DRC. These findings underscore the importance of integrating stigma-reduction and knowledge-enhancement interventions into reproductive health programs to improve womens access to safe and dignified abortion care.

05.
bioRxiv (Bioinfo) 2026-06-21

ReSeT: a taxonomy-aware reference genome selection tool

Motivation: Reference genome composition determines which taxa a profiling pipeline can detect and distinguish, and becomes of critical importance for high-resolution profiling where taxonomic boundaries begin to blur. Existing selection tools optimize within-taxon representativeness but disregard discrimination across taxa, leaving open whether explicitly accounting for inter-taxon discrimination during selection improves profiling. Results: Here we present ReSeT, a facility-location-based reference genome selection tool that operates on arbitrary pairwise distance matrices, extended with a tunable inter-taxon discrimination term and per-genome selection cost, and solved by local search. We benchmark ReSeT against established selection methods on three viral datasets spanning varying degrees of taxonomic ambiguity. On the high-ambiguity SARS-CoV-2 datasets, appropriately tuned ReSeT selections matched or exceeded the strongest alternatives in terms of profiling accuracy, whereas on the low ambiguity IAV dataset VSEARCH remained dominant. Interestingly, we find that the novel inter-taxon discrimination term contributed weakly, indicating that ReSeT's facility-location formulation and selection cost drives ReSeT's performance. We further propose a novel taxonomic ambiguity index, computable from ReSeT's inputs, that summarizes the taxonomic ambiguity of reference genomes and aligns with where ReSeT improves over existing selection methods. Availability and implementation: ReSeT is implemented in Python ([≥]3.10) and is freely available under the MIT license. The source code is available on GitHub at https://github.com/JaspervB-tud/ReSeT and ReSeT can also be installed directly from the Python Package Index (PyPI) via pip install reset-bio.

06.
arXiv (math.PR) 2026-06-24

Sparsity-adaptive concentration inequalities for random polynomials

arXiv:2606.24090v1 Announce Type: new Abstract: We prove concentration inequalities for polynomials of independent, sparse $\alpha$-sub-exponential random variables. Specifically, we consider $X_i=\delta_i\xi_i$, where the Bernoulli selectors $\delta_i$ are independent with parameters $p_i$, and the variables $\xi_i$ are independent \(\alpha\)-sub-exponential random variables (not necessarily centered). For any polynomial $f:\mathbb R^n\to\mathbb R $ of degree at most $D$ and any $0

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

CausalMoE: A Billion-Scale Multimodal Foundation Model for Granger Causal Discovery with Pattern-Routed Heterogeneous Experts

arXiv:2606.13024v1 Announce Type: cross Abstract: Granger Causal Discovery (GCD) is fundamental for analyzing temporal dependencies in complex systems. However, existing neural GCD methods predominantly rely on a "one-size-fits-all" paradigm, struggling to capture distribution shifts and dynamic regime changes inherent in real-world time series. This often leads to entangled representations and spurious causal graphs. In this paper, we propose CausalMoE, a billion-scale multimodal Granger causal foundation model that explicitly models patch-level heterogeneity. CausalMoE introduces a Pattern-Routed Mixture of Heterogeneous Experts, which dynamically identifies latent temporal patterns and routes patches to specialized domain experts, effectively decoupling regime-specific mechanisms from shared dynamics. To ensure interpretable graph recovery, we design a Causality-Aware Self-Attention mechanism operating across variables, yielding sparse Granger causal graphs via proximal optimization. Furthermore, CausalMoE is the first to integrate LLMs and VLMs to align numerical signals with textual and visual priors, regularizing causal estimation in complex scenarios. Extensive experiments demonstrate that CausalMoE establishes a new state-of-the-art on fully supervised benchmarks, while effectively generalizing to few-shot settings where traditional methods fail.

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

Automated jailbreak attack targeting multiple defense strategies

arXiv:2606.16751v1 Announce Type: cross Abstract: Large language models (LLMs) have demonstrated remarkable capabilities across a wide range of tasks. However, their safety remains a critical concern due to their susceptibility to adversarial prompt-based attacks. In this paper, we present UNIATTACK, an adversarial testing framework designed from a defense-oriented perspective to systematically construct effective black-box attack prompts. Unlike prior approaches that rely on static templates or iterative model-specific tuning, UNIATTACK extracts minimal but high-impact attack features from diverse existing attacks, optimizes them via a specialized attacker LLM, and composes them into flexible templates through automated refinement process. This feature-centric construction enables one-shot attacks that generalize across multiple models and safety categories, providing a practical tool for assessing LLM robustness. Our evaluation results shows that compared to the baselines, UNIATTACK achieves an average attack success rate (ASR) improvement of 64.63\%-248.82\% on models deployed with multi-layered defense mechanisms and it only takes 0.03\%-4.96\% cost of the baselines. UNIATTACK artifact is available at https://anonymous.4open.science/r/UniAttack-Artifact-30F1.

09.
arXiv (math.PR) 2026-06-15

Mixing Times for the Facilitated Exclusion Process

arXiv:2402.18999v2 Announce Type: replace Abstract: The facilitated simple exclusion process (FEP) is a one-dimensional exclusion process with a dynamical constraint. We establish bounds on the mixing time of the FEP on the segment, with closed boundaries, and the circle. The FEP on these spaces exhibits transient states that, if the macroscopic density of particles is at least $1/2$, the process will eventually exit to reach an ergodic component. If the macroscopic density is less than $1/2$ the process will hit an absorbing state. We show that the symmetric FEP (SFEP) on the segment $\{1,\ldots,N\}$, with $k>N/2$ particles, has mixing time of order $N^{2}\log(N-k)$ and exhibits the pre-cutoff phenomenon. For the asymmetric FEP (AFEP) on the segment, we show that there exists initial conditions for which the hitting time of the ergodic component is exponentially slow in the number of holes $N-k$. In particular, when $N-k$ is large enough, the hitting time of the ergodic component determines the mixing time. For the SFEP on the circle of size $N$, and macroscopic particle density $\rho \in(1/2,1)$, we establish bounds on the mixing time of order $N^{2}\log N$ for the process restricted to its ergodic component. We also give an upper bound on the hitting time of the ergodic component of order $N^{2}\log N$ for a large class of initial conditions. The proofs rely on couplings with exclusion processes (both open and closed boundaries) via a novel lattice path (height function) construction of the FEP.

10.
arXiv (CS.CL) 2026-06-16

SkillsVote: Lifecycle Governance of Agent Skills from Collection, Recommendation to Evolution

Long-horizon LLM agents generate traces that could become reusable experience, but raw trajectories are noisy, local, and hard to govern. Agent Skills offer a structured artifact for combining procedural guidance, executable resources, and applicability boundaries. Yet open skill ecosystems contain redundant, uneven, environment-sensitive artifacts, and indiscriminate updates can pollute future context. We present SkillsVote, a lifecycle-governance framework for Agent Skills across collection, recommendation, attribution, and evolution. SkillsVote profiles a million-scale open source corpus for environment requirements, quality, and verifiability, and synthesizes tasks for verifiable skills. Before execution, it performs agentic library search over structured skill folders to expose instructional context. After execution, it decomposes trajectories into skill-linked subtasks, attributes outcomes to skill-guided execution, agent exploration, environment, and result signals, and admits only successful reusable discoveries to evidence-gated updates. Experiments on Terminal-Bench 2.0 and SWE-Bench Pro show that SkillsVote improves agent performance on challenging agentic coding benchmarks. The gains arise from two complementary pathways: online evolution over task streams at test time and offline transfer via frozen libraries built from either historical trajectories or curated open source skills.

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

TerraMind: Large-Scale Generative Multimodality for Earth Observation

arXiv:2504.11171v5 Announce Type: replace-cross Abstract: We present TerraMind, the first any-to-any generative, multimodal foundation model for Earth observation (EO). Unlike other multimodal models, TerraMind is pretrained on dual-scale representations combining both token-level and pixel-level data across modalities. On a token level, TerraMind encodes high-level contextual information to learn cross-modal relationships, while on a pixel level, TerraMind leverages fine-grained representations to capture critical spatial nuances. We pretrained TerraMind on nine geospatial modalities of a global, large-scale dataset. In this paper, we demonstrate that (i) TerraMind's dual-scale early fusion approach unlocks a range of zero-shot and few-shot applications for Earth observation, (ii) TerraMind introduces "Thinking-in-Modalities" (TiM) – the capability of generating additional artificial data during finetuning and inference to improve the model output – and (iii) TerraMind achieves beyond state-of-the-art performance in community-standard benchmarks for EO like PANGAEA. The pretraining dataset, the model weights, and our code are open-sourced under a permissive license.

12.
arXiv (quant-ph) 2026-06-11

Planted-Solution Pauli Hamiltonians as a Quantum Benchmarking Primitive

arXiv:2606.11455v1 Announce Type: new Abstract: We introduce a construction of Pauli Hamiltonians with exactly known ground-state energies, intended as reference instances for ground-state energy estimation algorithms. The construction embeds a planted block-product state as the simultaneous ground state of a sum of frustration-free local clauses on overlapping supports, exposes the resulting model only as a polynomial-size linear combination of Pauli operators, and admits optional Clifford conjugation that preserves the spectrum. The framework subsumes classical planted constraint-satisfaction problems as a diagonal special case, providing a direct embedding channel through which classical hardness properties can be inherited. Open-source software, certification keys, and example instances are made publicly available.

13.
arXiv (CS.LG) 2026-06-25

A Flow-rate-conserving CNN-based Domain Decomposition Method for Blood Flow Simulations

arXiv:2509.15900v2 Announce Type: replace-cross Abstract: This work aims to predict blood flow with non-Newtonian viscosity in stenosed arteries using convolutional neural network (CNN) surrogate models. An alternating Schwarz domain decomposition method is proposed which uses CNN-based subdomain solvers. A universal subdomain solver (USDS) is trained on a single, fixed geometry and then applied for each subdomain solve in the Schwarz method. Results for two-dimensional stenotic arteries of varying shape and length for different inflow conditions are presented and statistically evaluated. One key finding, when using a limited amount of training data, is that incorporating a physics-aware constraint, as, in our case, flow rate conservation, into the USDS improves the prediction accuracy and convergence behavior of the Schwarz method compared to a purely data-driven USDS. As the USDS is a data-driven, inexact subdomain solver, admissible parameter ranges for the geometry and inflow configurations must be defined and tested.

14.
arXiv (CS.CV) 2026-06-24

GeoT2V-Bench: Benchmarking 3D Consistency in Text-to-Video Models via 3D Reconstruction

Camera-prompted text-to-video (T2V) models are increasingly used to synthesize virtual camera captures, such as orbiting objects or moving through static scenes. For these outputs, visual plausibility is insufficient: the generated frames should also provide coherent multi-view evidence for a single static 3D scene. We introduce GeoT2V-Bench, a reconstruction-based diagnostic benchmark for evaluating whether camera-prompted T2V clips can support explicit rigid 3D reconstruction. Our pipeline estimates per-frame camera intrinsics and poses with VGGT-style geometry estimation, fits DeformableGS, derives a static MedianGS proxy by temporal-median aggregation, and renders this proxy along the estimated camera path. Instead of producing a pass/fail label or a single scalar score, GeoT2V-Bench reports a continuous reconstruction profile covering apparent image motion, estimated trajectory behavior, MedianGS static rendering error, static-render flow agreement, and the gap between flexible and static fits. On a fair-format four-seed evaluation with 3,840 completed reconstructions from 12 open-weight model configurations and 80 GeCo-Eval static-scene prompts, we find that visible motion, static rendering error, flow agreement, and flexible-vs-static behavior often disagree. GeoT2V-Bench therefore captures complementary failure modes that emerge when generated videos are tested as global static-scene acquisitions.

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

Statistical Foundations of LLM-based A/B Testing: A Surrogacy Framework for Human Causal Inference

arXiv:2606.17165v1 Announce Type: cross Abstract: Organizations and researchers show increasing interest in using large language models (LLMs) in place of human participants in A/B tests, in the hope of experimenting faster and at lower cost. We study when a treatment effect estimated on LLM outcomes recovers the effect that would have been measured on the human population of interest. Distributional equivalence between LLM and human outcomes would make any standard estimator valid but is unrealistic. We therefore develop a statistical framework that adapts surrogate endpoint theory to LLMs. The framework shows that calibrating LLM outcomes to human outcomes identifies the average treatment effect under surrogacy and comparability conditions that are jointly weaker than distributional equivalence. When these conditions fail, the effect of interest is only partially identified, and we provide diagnostics that can falsify surrogacy on historical experiments together with a bound on the worst-case bias from limited overlap. We further show that the stochasticity inherent to LLMs introduces both bias and variance, but using an average of multiple draws as the surrogate mitigates both. We illustrate the methods and theory in simulations and an application to A/B tests on Upworthy headlines. A central takeaway from our work is that the validity of LLM outcomes as surrogates can only be falsified for past treatments and never verified for new ones, so human experiments remain indispensable for novel interventions. We discuss the role of LLM choice, prompting, and temperature as design variables, and how to size human experiments for validation.

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

Diffusion Offline Reinforcement Learning for Fair and Energy-Efficient UAV-Assisted Wireless Networks

arXiv:2606.16331v1 Announce Type: new Abstract: The integration of generative artificial intelligence with wireless communication and signal processing systems has opened new avenues for intelligent, data-driven decision-making in future 6G networks. This work proposes a diffusion soft actor-critic (Diffusion-SAC) approach that leverages offline reinforcement learning (RL) enhanced by denoising diffusion probabilistic models (DDPMs) to optimize trajectory and scheduling control in unmanned aerial vehicle (UAV) networks. While offline RL methods, such as conservative Q-learning (CQL), can learn from static datasets, they often struggle to generalize in low-data or dynamic conditions. To address this, we combine the robustness of CQL with the generative power of diffusion models, enabling expressive and signal-aware policy learning that generalizes beyond behavior policies. Applied to a UAV-assisted wireless network, the proposed framework minimizes transmission energy and improves fairness among devices. Simulations show that Diffusion-SAC outperforms standard offline RL baselines, achieving more stable convergence and higher rewards even with limited datasets. The method enhances data efficiency, reduces energy consumption, and increases throughput by more than 35 % compared to existing algorithms, demonstrating its potential for robust policy learning in next-generation wireless control systems.

17.
arXiv (CS.AI) 2026-06-25

CausalRAG2: Hierarchical Causal Knowledge Graph Design for RAG

arXiv:2602.05143v2 Announce Type: replace Abstract: Retrieval augmented generation (RAG) has enhanced large language models by enabling access to external knowledge, with graph-based RAG emerging as a powerful paradigm for structured retrieval and reasoning. However, existing graph-based methods often over-rely on entity-centric node matching and lack explicit causal modeling, leading to unfaithful or spurious answers. Prior attempts to incorporate causality are typically limited to local or single-document contexts and also suffer from information isolation that arises from modular graph structures, which hinders scalability and cross-module causal reasoning. To address these challenges, we propose CausalRAG2, a framework that rethinks knowledge organization for graph-based RAG through causal gating across hierarchical modules. CausalRAG2 explicitly models causal relationships to suppress spurious correlations while enabling scalable reasoning over large-scale knowledge graphs. We also introduce HolisQA, a benchmark for holistic comprehension beyond entity-centric matching. Extensive experiments demonstrate that CausalRAG2 consistently outperforms competitive graph-based RAG baselines across multiple datasets and evaluation metrics. Our work establishes a principled foundation for structured, scalable, and causally grounded RAG systems. Our code and HolisQA benchmark are available at https://github.com/Pwnb/CausalRAG2.

18.
arXiv (CS.CV) 2026-06-17

Reasoning Text-to-Video Retrieval for Operating Room Clips via Action-Driven Digital Twins

Text-to-video retrieval in operating rooms (OR) is an enabling technology for OR safety, as it allows stakeholders to retrieve and inspect recordings of specific events. However, because the most safety-critical events may not follow the common structure, to unlock its full potential text-to-video retrieval must be able to handle implicit queries that require reasoning to identify the right video (e.g., the step right before clipping). However, existing methods rely on global embeddings that cannot reason over such queries. We propose OR3, a text-to-video retrieval method that converts clips into action-driven digital twins (ActDTs), grouping concurrent subject-action-object triplets under non-overlapping temporal intervals. Moreover, rather than cross-modal matching through paired encoders, OR3 performs imagination-based retrieval where an LLM generates hypothetical ActDTs from queries. This enables intra-modal matching via a single encoder trained with ActDT-tailored hard negatives. Finally, evidence-grounded refinement revises imagined ActDTs based on discrepancies with top candidates to capture procedure-specific patterns. We construct a benchmark from MM-OR with 276 implicit queries across four reasoning categories over 386 clips from robotic knee procedures. OR3 achieves 57.6 R@1 and 77.3 R@5, outperforming the strongest baseline. These results demonstrate that OR3 enables fine-grained discrimination between visually similar OR video clips through temporal action reasoning.

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

Why Tree-Style Branching Matters for Thought Advantage Estimation in GRPO

Group Relative Policy Optimization (GRPO) trains Chain-of-Thought reasoning with verifiable rewards, but estimating thought-level advantages without value functions often suffers from high variance. Although tree-style branching is used in practice to reduce variance, it lacks a theoretical explanation of why it works and whether it is important or potentially necessary. We study thought-level advantage estimation in GRPO from a variance perspective under a minimal tree-style setting where multiple continuations are sampled for each thought. Using the multivariate delta method, we reveal a sampling-dimension asymmetry. Increasing sampled thoughts ($K$) leaves a strictly positive estimation-variance floor, whereas increasing continuations per thought ($M$) drives the leading-order estimation variance to zero at rate $1/M$. This implies that, within the fixed-temperature GRPO-style estimator without value models studied here, accurate thought-level advantage estimation cannot be achieved by scaling thought sampling alone, making continuation-level branching a principled and potentially necessary mechanism rather than a heuristic. Experiments further provide empirical evidence for its effectiveness and potential necessity, demonstrating improved optimization stability, training efficiency, and final performance not only in math but also across vision domains and under different model architectures and sizes.

20.
arXiv (CS.LG) 2026-06-15

Closed-loop discovery of out-of-distribution processing protocols by evolutionary search and uncertainty-aware learning

arXiv:2606.13859v1 Announce Type: cross Abstract: Many materials and chemical systems exhibit history-dependent responses, where functional outcomes are governed not only by final-state variables but by the time-dependent sequence of fields, temperatures, or chemical potentials applied during operation. Discovering new processing protocols is therefore a high-dimensional search problem in which the control variable is an entire waveform or sample history, and conventional strategies either remain confined to conservative interpolative families or become prohibitively measurement intensive. Here, a closed-loop workflow is introduced that couples evolutionary search over a compact waveform representation with uncertainty-aware deep kernel learning to generate, rank, and experimentally validate candidate protocols. Applied to ferroelectric thin films, with the scanning-probe tip-bias waveform as the protocol and the nonlinear electromechanical response as the reward, the workflow discovers waveform families that enhance nonlinearity by de-aging the film. Spatially resolved before/after measurements show that the best-performing waveforms selectively activate pre-existing, weakly pinned domain-wall segments, whereas the worst drive long-range irreversible switching. This framework reframes protocol tuning as out-of-distribution discovery, generalizable to synthesis and annealing trajectories, battery formation protocols, and other high-dimensional control problems.

21.
medRxiv (Medicine) 2026-06-16

Comparative Effectiveness and Safety of Prophylactic Vasopressors for Preventing Post-induction Hypotension in the Elderly: A Systematic Review and Network Meta-analysis

Background: Post-induction hypotension is a predictable haemodynamic hazard in older adults undergoing general anaesthesia. Prevention remains divided among volume optimisation, anaesthetic dose reduction, rescue treatment after hypotension occurs and proactive vasoactive support. Methods: We searched PubMed, Embase, Web of Science, CENTRAL, CNKI, Wanfang and VIP from inception to 30 March 2026. Eligible studies were randomised trials of prophylactic vasoactive drugs given before, during or immediately after induction in older adults. The primary outcome was post-induction hypotension. Secondary outcomes were post-induction mean arterial pressure (MAP), systolic arterial pressure (SBP), heart rate (HR) and reported haemodynamic adverse events. Random-effects network meta-analysis was used, and confidence in network estimates was assessed using CINeMA principles. Results: Thirty-one trials including 2,821 participants were included in the revised network. Compared with placebo/control, all active agents favoured lower post-induction hypotension. The most favourable point estimates were observed for phenylephrine (odds ratio [OR] 0.17, 95% confidence interval [CI] 0.01 to 2.16) and metaraminol (OR 0.19, 95% CI 0.02 to 1.53), although both were imprecise. More precise reductions were observed for methoxamine (OR 0.23, 95% CI 0.13 to 0.43), norepinephrine (OR 0.25, 95% CI 0.13 to 0.47) and ephedrine (OR 0.34, 95% CI 0.19 to 0.63). Phenylephrine ranked highest for MAP support, norepinephrine ranked highest for SBP support, and ephedrine ranked highest for HR preservation. Global inconsistency was detected for SBP but not for hypotension incidence, MAP or HR, supporting cautious profile-based interpretation. Conclusions: Prophylactic vasopressor choice during induction should be guided by haemodynamic phenotype rather than ranking alone. In the revised network, active prophylaxis consistently favoured lower hypotension, but sparse nodes produced uncertainty. Norepinephrine retained a comparatively balanced profile when vasodilatory post-induction hypotension is anticipated, phenylephrine and related alpha-agonists provided stronger pressure support when HR and cardiac-output reserve are preserved, and ephedrine was most relevant when chronotropic support is desired. Keywords: general anaesthesia; induction; hypotension; norepinephrine; phenylephrine; ephedrine; network meta-analysis; older adults.

22.
medRxiv (Medicine) 2026-06-15

Repurposing cardiovascular disease risk models to predict incident and co-occurring cardiovascular, cardiometabolic and neurocognitive outcomes.

Background: Cardiovascular disease (CVD), cardiometabolic and neurocognitive conditions share risk factors and frequently co-occur. We evaluated whether four established CVD risk prediction models (QRISK3, PCE, SCORE2, SCORE2-OP) can be repurposed to predict 10-year risk of these conditions and their co-occurrence with CVD. Methods: The models were recalibrated using 20% of the UK Biobank (UKB) and evaluated in the remaining 80%. We performed external validation using data from Clinical Practice Research Datalink (CPRD) Aurum, assessing model discrimination (c-statistics) and calibration (intercept and slope). We used permuted feature importance to determine the influence of each individual predictor in the models. Results: Depending on the model, the c-statistics for incident CVD ranged from 0.71 to 0.74 in the UKB test set (16,137 events). Discrimination was equal to or higher than CVD when evaluated against non-traditional CVD outcomes: 0.74 to 0.77 for heart failure (3,471 events), 0.72 to 0.73 for atrial fibrillation (9,213 events), 0.73 to 0.75 for peripheral arterial disease (1,927 events) and 0.80 to 0.82 for abdominal aortic aneurysm (595 events). For the multimorbidity endpoints, model discrimination ranged from 0.74 for the composite of CVD and T2DM (SCORE2-OP) to 0.83 for the composite of CVD and dementia or Parkinson's disease (QRISK3). When considering the onset of any cardiovascular, cardiometabolic, or neurocognitive outcome discrimination ranged from 0.71 to 0.72. The repurposed models slightly underestimated the predicted risk in the CPRD compared to the UKB: average difference in calibration intercept was at most -0.64. After age and sex, smoking status and systolic blood pressure contributed most to model predictions. Conclusions: Repurposed CVD models can be used to identify 10-year risk of many CVD-related conditions and their multimorbidity. These may be used to support risk-based approaches to prevention and screening. The repurposed models have been made available at: https://repurposed-cvd-risk-models.shinyapps.io/cvd_cmd_dementia_app/ Keywords: Risk prediction; cardiovascular disease; cardiometabolic disease; dementia; disease prevention.

23.
PLOS Medicine 2026-06-23

Comparisons of core component delivery in cardiac rehabilitation programs by country income classification and decade based on the 2025 Global Audit Update: A survey study

by Gabriela Lima de Melo Ghisi, Rachael P. Carson, Karam Turk Adawi, Rongjing Ding, Warner M. Mampuya, Mariya P. Jiandani, Jimena Martinez, Monserrat Cruz Rivero, Claudia V. Anchique, Dinah L. van Schalkwijk, Jonathan Gallagher, Buket Akinci, Dion Candelaria, Jirapa Champaiboon, Daniel F. Quesada-Chaves, Tone M. Norekvål, Iwona Szadkowska, Borut Jug, Evangelia Kouidi, Marta Supervia, Won-Seok Kim, Chamila Mettananda, Lilian Mbau, Gulsim T. Aimakova, Sherry L. Grace, on behalf of the ICCPR Global Cardiac Rehabilitation Audit Update Investigators Background Cardiovascular disease (CVD) remains a leading global health burden. Cardiac rehabilitation (CR) is essential to reducing morbidity and improving patient outcomes. Since the COVID-19 pandemic, CR delivery worldwide has evolved, yet these changes have not been systematically charactemkjrized. The objective of this study was to characterize globally: (1) the delivery of core CR components, including risk factors assessed, patient education practices, and program resources; (2) differences in these elements by country income classification and relative to the initial 2016 Global CR Audit. Methods and findings A cross-sectional Audit update was conducted. Program-level data were collected from May 1st to September 1st 2025 using a REDCap survey adapted from previous Audits. Eligible respondents were leads of phase II/post-discharge CR programs providing at least an initial assessment, structured aerobic exercise, and ≥1 additional core component. ICCPR associations and local leaders supported program identification. Main outcomes were core components delivered (10 assessed), risk factors assessed (14 assessed), patient education dose (hours/patient/program), and program resources (17 assessed). Generalized linear mixed models (GLMM) tested differences by income classification and (when applicable) changes since 2016. Of 7,025 programs identified globally, 1,505 (62% median country response rate) initiated a survey from 90/113 (80%) countries with CR. The median number of core components offered was 8/program (p25, p75 = 6, 10), with upper-middle income countries offering significantly more components overall (median = 9), and also high-income countries offering more than low-income countries (8 versus 6, p 

24.
arXiv (quant-ph) 2026-06-19

Mapping molecular polariton transport via pump-probe microscopy

arXiv:2504.15501v4 Announce Type: replace Abstract: We demonstrate how the transport properties of molecular polaritons in optical cavities can be extracted from a microscopic modeling of pump-probe spectroscopy. Our approach combines a mean-field treatment of the light-matter Hamiltonian with a perturbative expansion of both light and matter components, along with spatial coarse-graining. This approach extends semiclassical cavity spectroscopy to multimode light-matter interactions, providing full access to spatially resolved transient spectra. By simulating a microscopy experiment with counter-propagating pump and probe pulses, we compute the differential transmission and show how molecular dephasing and persistent dark exciton populations drive sub-group-velocity transport of the root-mean-square displacement. We analyze transport across the polariton dispersion, showing how velocity renormalization correlates with excitonic weight, consistent with experimental observations, and further its dependence on the rate of molecular dephasing. Our results highlight the need to consider measured spectroscopic observables when characterizing transport in polaritonic systems.

25.
medRxiv (Medicine) 2026-06-15

Evaluation of AI-Generated Synthetic Data for Clinical Research in Secondary Cardiovascular Prevention among Dyslipidemia Patients

Background: Access to high-quality clinical data is essential for advancing medical research and developing effective medical statistical and Artificial Intelligence models. However, privacy regulations and logistical barriers often hinder timely access to real-world data. Synthetic data offer a promising solution, preserving the statistical characteristics of original datasets while protecting patient privacy. Objectives: This study investigates the use of synthetic data for secondary cardiovascular prevention in patients with dyslipidemia, using two real-world datasets from Centro Cardiologico Monzino. Methods: Given the high dimensionality and limited sample size of the datasets, we employed a custom generative framework based on Large Language Models (LLMs). Pre-trained LLMs were fine-tuned on original clinical records to synthesize tabular data replicating source-data distributions. Fine-tuning was performed within the Centro Cardiologico Monzino's secure infrastructure to ensure data sovereignty. We evaluate clinical utility and privacy using fidelity and privacy metrics, identifying the optimal generative model and benchmarking against traditional anonymization methods. Results: Synthetic data achieved a superior trade-off than classically anonymized datasets. Real and synthetic datasets showed strong agreement, with significant distributional differences limited to few variables. Models trained on synthetic data replicated key associations from the original dataset, including therapy modification and creatine phosphokinase as predictors of SAMS, and pharmacological intensity as the main driver of LDL-C reduction. Conclusions: Results support the feasibility of using synthetic data as a proxy for real-world datasets in exploratory analyses and model development. Despite slight attenuation of some effect sizes, preserved clinical relationships reinforce the validity of synthetic data in medical research.