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01.
arXiv (CS.CV) 2026-06-12

ReFoCUS: Reinforcement-guided Frame Optimization for Contextual Understanding

Recent progress in Large Multi-modal Models (LMMs) has enabled effective vision-language reasoning, yet the ability to video understanding remains constrained by suboptimal frame selection strategies, albeit with the rapid development of video-specialized LMMs. Prior works attempted to solve this with static heuristics or external retrieval modules to feed frame-level information, but these approaches often fail to capture visual cues grounded to the given user queries conflating raw visual dynamics with true semantic relevance. In this paper, we introduce ReFoCUS (Reinforcement-guided Frame Optimization for Contextual UnderStanding), the first framework to integrate online policy-gradient reinforcement learning into frame-level optimization for video-LLMs. ReFoCUS aims to learn a frame selection policy, leveraging reward signals derived from reference models to capture their underlying scoring behavior over frame combinations that best support temporally grounded responses. To efficiently explore the large combinatorial frame space, we employ an autoregressive and query-conditional selection architecture that ensures contextual consistency while reducing complexity. Our policy learning removes the need for explicit frame-level supervision, as it implicitly discovers optimal and semantically consistent frame compositions. ReFoCUS consistently improves reasoning accuracy across multiple video QA benchmarks, demonstrating the advantage of aligning frame selection with model-internal utility.

02.
arXiv (CS.CV) 2026-06-16

Enabling Real-Time Point-of-Care Ultrasound Segmentation: A GPU-Free Deployment in Resource-Limited Settings

Authors:

Ultrasound imaging is the most widely adopted medical modality globally due to its low cost and portability, yet artificial intelligence (AI) deployment remains constrained by reliance on GPU-accelerated models, creating a structural paradox where the cost of "intelligence" exceeds that of the imaging device itself. Here, we present the systematic adaptation and extensive evaluation of UltraSeg, an ultra-lightweight architecture originally developed for colonoscopic polyp segmentation, now engineered for point-of-care ultrasound (POCUS) across ten public datasets spanning six anatomical sites (breast, thyroid, kidney, carotid, fetal, and small-animal tumor). We systematically validate both variants in ultrasound domains: UltraSeg-130K (0.13M parameters) achieves 89.7 FPS on single-core CPUs and 34.8 FPS on a refurbished mobile device, while UltraSeg-500K (0.5M parameters) delivers 44.6 FPS on CPU and 16.1 FPS on mobile device. UltraSeg-500K matches or exceeds the Dice performance of the 31M-parameter UNet and approaches 105M-parameter TransUNet in average performance, with superior zero-shot cross-dataset generalization on external validation sets (UDIAT, DDTI). By enabling clinical-grade segmentation without GPU dependency, this work brings AI costs in line with ultrasound accessibility, making advanced diagnostics available in resource-limited settings.

03.
arXiv (CS.CL) 2026-06-16

Building Customer Support AI Agents at 100M-User Scale: An Evaluation-Driven Framework

The rapid rise in LLM capabilities has made AI agents increasingly viable across a broad range of tasks. Among the most promising applications is building production-ready customer-facing agents, a challenge that demands coordinated excellence in evaluation methodology, context engineering, training, and online measurement. Yet these critical pillars are typically developed in isolation, creating blind spots that only surface after deployment. In this paper, we present a unified framework that bridges offline development with online impact for customer support AI agents at Nubank, a company with 100M+ users. Our approach integrates several key components: (1) structured context engineering tailored to customer support agents, (2) systematic human-in-the-loop prompt iteration, (3) rigorous LLM judge evaluation with measured inter-rater agreement and GEPA optimization for consistency, and (4) ideation-to-production validation. A central insight is that evaluation-pipeline quality directly determines iteration velocity. We present results from five production deployments spanning distinct domains: card delivery, debt management, credit-limit support, card management, and product explanation. These deployments deliver consistent customer-satisfaction gains while substantially accelerating iteration. In our card-delivery deployment, large-scale A/B testing yields a 37 percentage-point improvement in AI transactional Net Promoter Score and a 29 percentage-point gain in self-service rate over prior agent variants, alongside a strong correlation between offline simulation metrics and online outcomes, demonstrating that eval-driven development reliably predicts production impact. On most use cases, AI satisfaction reaches within a few percentage points of expert human agents.

04.
arXiv (quant-ph) 2026-06-15

A Collective-Spin Derivation of the Uniform Magnon Hamiltonian in Cavity Magnonics

arXiv:2606.13830v1 Announce Type: cross Abstract: We present a direct collective-spin derivation of the effective uniform-mode Hamiltonian used in cavity magnonics. Starting from a nearest-neighbor Heisenberg ferromagnet coupled to long-wavelength magnetic fields, we show that the relevant dynamics can be restricted to the fully symmetric spin sector, where the exchange interaction contributes only a constant energy shift and the ferromagnet behaves as a macrospin of length $Ns$. Applying the Holstein–Primakoff transformation directly to this total spin yields the usual uniform magnon mode and its leading nonlinear corrections without first introducing site-resolved bosonic operators. This collective formulation makes explicit the interpretation of the ferromagnet as a synthetic large-spin atom and provides a compact route to the effective Hamiltonians used in driven and Floquet cavity magnonics. As a physical consequence, the leading nonlinear correction produces an occupation-dependent reduction of the effective magnon–photon coupling, providing a simple signature of finite-spin saturation under strong uniform-mode driving.

05.
arXiv (CS.LG) 2026-06-11

Learning Object Manipulation from Scratch via Contrastive Interaction

arXiv:2606.11525v1 Announce Type: cross Abstract: Contrastive Reinforcement Learning (CRL) has seen recent success in a wide variety of goal-conditioned robotics tasks by learning structured representations of the dynamics. However, despite its success in locomotion and simpler control domains, CRL often struggles in interaction-rich manipulation. We argue that a key source of this difficulty is object-centric interaction, such as contact or grasping, that induces distinct changes in the underlying dynamic modes. In this work, we formulate manipulation dynamics as a piecewise-smooth Markov process and show that interaction-induced mode changes create piecewise nonlinear reachability structures that are difficult for standard CRL energy functions to represent and plan over. Based on this analysis, we introduce Interaction-weighted Resampling (IWR). IWR performs interaction-aware resampling around phases before, during, and after interactions, encouraging the learned representation to preserve the mode boundaries that determine future reachability to capture multi-modal and piecewise nonlinear reachability. Across interaction-centric environments, including 2D dynamic control, robotic manipulation, and robot air hockey, IWR improves both sample efficiency and overall performance over prior CRL methods, with 19.8% average improvement in simulation. Finally, using a sim-to-real pipeline with policies trained by IWR, we demonstrate the first real-world goal-conditioned robot air hockey agent capable of hitting goals, improving success from 25% to 60%. Project Page: IWR-arxiv.github.io.

07.
arXiv (CS.AI) 2026-06-19

FlowMaps: Modeling Long-Term Multimodal Object Dynamics with Flow Matching

arXiv:2606.20209v1 Announce Type: cross Abstract: Joint spatial and temporal understanding of 3D scenes is a crucial requirement for robots deployed in everyday household environments. Such agents must not only comprehend and navigate spatial layouts, but also reason about how these spaces evolve over time. In particular, humans interact with objects daily, causing them to change position throughout the environment and making it difficult for robots to reliably associate current observations with previously seen objects. However, these interactions are not random: human habits and routines induce spatio-temporally consistent patterns in object locations, which robotic agents can potentially learn and then exploit for downstream tasks such as navigation. To this end, we introduce FlowMaps, a latent flow matching model for estimating multimodal distributions over the future locations of dynamic objects in a continuous 3D space. By learning the implicit dependencies among objects and their temporal evolution, FlowMaps predicts likely changes in object locations conditioned on past human interactions, while supporting generalization across previously unseen environments that share similar object routines. To demonstrate the utility of this method, we deploy FlowMaps in a downstream dynamic Object Navigation task in both simulated and real-world environments. Across more than 600 episodes, FlowMaps outperforms state-of-the-art approaches, showing that modeling object dynamics through continuous, multimodal spatio-temporal distributions improves robotic search and navigation in changing household environments. Code and additional material is available at https://fra-tsuna.github.io/flowmaps/.

08.
arXiv (CS.AI) 2026-06-11

CCKS: Consensus-based Communication and Knowledge Sharing

arXiv:2606.12281v1 Announce Type: cross Abstract: In Decentralized Training and Decentralized Execution (DTDE) for cooperative Multi-Agent Reinforcement Learning (MARL), action-advising-based knowledge sharing promotes interpretable and scalable cooperation among agents. However, current action advising approaches often adhere too much to the teacher's guidance without evaluating teacher-student compatibility, which causes excessive advising, suboptimal stability, and degraded performance. To overcome these challenges, this paper presents a Consensus-based Communication and Knowledge Sharing (CCKS) framework, which allows agents to adopt recommendations based on consensus-derived constraints and to follow the teacher's instructions more smartly. This mechanism enables agents to balance exploration and learning from experienced teachers, improving overall performance. The key is the consensus model construction, for which we propose to employ contrastive learning to construct consensus models based on local observations in the agents' training phase. In action selection, agents score and choose actions based on consensus and shared knowledge. Designed as a plug-and-play solution, CCKS integrates seamlessly with existing DTDE algorithms. Experiments conducted in the Google Research Football environment and the complex StarCraft II Multi-Agent Challenge demonstrate that the integration with CCKS significantly improves cooperation efficiency, learning speed, and overall performance compared with current DTDE baselines. The code is available at https://github.com/yuanxpy/CCKS.

09.
arXiv (CS.CV) 2026-06-15

ForceForget: Reinforcement Concept Removal for Enhancing Safety in Text-to-Image Models

With the advance of generative AI, the text-to-image (T2I) model has the ability to generate various contents. However, T2I models still can generate unsafe contents. To alleviate this issue, various concept erasing methods are proposed. However, existing methods tend to excessively erase unsafe concepts and suppress benign concepts contained in harmful prompts, which can negatively affect model utility. In this paper, we focus on eliminating unsafe content while maintaining model capability in safe semantic meaning interpretation by optimizing the concept erasing reward (CER) with reinforcement learning. To avoid overly content erasure, we introduce the Safe Adapter to project partial text embedding for efficient concept regulation in cross-attention layers. Extensive experiments conducted on different datasets demonstrate the effectiveness of the proposed method in alleviating unsafe content generation while preserving the high fidelity of benign images compared with existing state-of-the-art (SOTA) concept erasing methods. In terms of robustness, our method outperforms counterparts against red-teaming tools. Moreover, we showcase the proposed approach is more effective in emerging image-to-image (I2I) scenarios compared with others. Lastly, we extend our method to erase general concepts, such as artistic styles and objects. Disclaimer: This paper includes discussions of sexually explicit content that may be offensive to certain readers. All images used in this work are synthesized or from public datasets.

10.
Nature (Science) 2026-06-22

Cancer cells adopt unprecedented strategies to produce a molecule that protects them from iron-dependent death

The finding that spermine molecules in cells bind to iron to prevent it unleashing ferroptosis, a type of cell death, opens up strategies for treating tissue damage and cancer. The finding that spermine molecules in cells bind to iron to prevent it unleashing ferroptosis, a type of cell death, opens up strategies for treating tissue damage and cancer.

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

Continual Learning with Support Boundary Experience Blending

Continual learning (CL) seeks to mitigate catastrophic forgetting when models are trained with sequential tasks. A common approach, experience replay (ER), stores past exemplars but only sparsely approximates the data distribution, yielding fragile and oversimplified decision boundaries. We address this limitation by introducing Support Boundary Data (SBD), generated via differential-privacy-inspired noise into latent features to create boundary-adjacent representations that implicitly regularize decision boundaries. Building on this idea, we propose Experience Blending (EB), a framework that jointly trains on exemplars and SBD through a dual-model aggregation strategy. EB has two components: (1) latent-space noise injection to generate support boundary data, and (2) end-to-end training that jointly leverages exemplars and SBD. Unlike standard experience replay, SBD enriches the feature space near decision boundaries, leading to more stable and robust continual learning. Extensive experiments on CIFAR-10, CIFAR-100, Tiny ImageNet, and ImageNet1K demonstrate consistent accuracy improvements of 10%, 6%, 13%, 2%, respectively.

12.
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.

13.
medRxiv (Medicine) 2026-06-19

A soluble bi-specific fusion protein for the improved expansion of human CD8+ CAR-T cells

The success of Chimeric Antigen Receptor (CAR) T cell therapy is heavily dependent on the quality of the final cellular product. Current expansion protocols often rely on reagents that require removal from cell culture media, posing logistical challenges in manufacturing, and can also lead to terminal differentiation. Here, we evaluate the use of a soluble, bead-free T cell activator, T cell expansion protein (T-CEP), as a streamlined alternative for generating potent CAR-T cells. Human T cells were activated with T-CEP or known T cell activators (Dynabeads and TransAct) and transduced with either CD19 or interleukin-13 (IL-13) mutein (tetravariant-13; TV-13)-based CAR lentiviral vectors. Our results demonstrate that T-CEP supports robust CAR-T cell expansion and achieves transduction efficiencies comparable to commercial reagents for both types of CAR-T cells. Notably, T-CEP significantly favored the expansion of CD8+ T cells, yielding an enhanced CD27+ phenotype and a lower CD4:CD8 ratio compared to TransAct. Cytotoxicity assays confirmed that T-CEP-expanded CAR-T cells possess cytolytic function equivalent to commercial reagents for both CARs, while exhibiting lower levels of inflammatory cytokine secretion. In summary, T-CEP represents a competitive alternative to existing expansion agents, as it does not require its removal during CAR-T manufacturing and generates a CD8+ dominant, less-differentiated phenotype without compromising efficacy.

14.
arXiv (quant-ph) 2026-06-16

Complete entanglement detection using polynomial invariants

arXiv:2606.16712v1 Announce Type: new Abstract: Existing methods for deciding whether a bipartite quantum state is separable or entangled typically fall into one of two categories: they are either complete but require access to an explicit density matrix followed by numerical optimization, or they can be evaluated directly by measuring the quantum system but are incomplete, in the sense that they cannot detect all forms of entanglement. In this work, we overcome both limitations in a unified framework. First, we bypass numerical optimization by deriving separability criteria in the form of universal bounds on tensor powers of separable states. We prove that these bounds are complete: every entangled state violates them for sufficiently large tensor powers. Second, we explicitly construct a corresponding complete family of nonlinear entanglement witnesses, which can detect all forms of entanglement without requiring an explicit density matrix. The witnesses we construct are moreover basis-independent, in the sense that they are invariant under conjugation by local unitaries. Altogether, our results expand the toolbox for entanglement detection in arbitrary local dimensions in a manifestly invariant way.

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

Energy-Conserved Neural Pipelines: Attenuating Error Propagation in Modular Neural Networks via Physical Conservation Constraints

arXiv:2606.11341v1 Announce Type: new Abstract: Modular neural network pipelines suffer from error compounding: noise at any module boundary propagates and potentially amplifies through subsequent modules. We introduce energy conservation as a hard physical constraint on inter-module information flow. Activation energy (the squared L2 norm of feature vectors) is enforced to be exactly preserved at every module boundary. Unlike soft energy penalties, conservation is an inviolable law: the network may redistribute energy across neurons but cannot create or destroy it. Four experiments on CIFAR-10 demonstrate: (1) conservation retains 77.4% of clean accuracy at noise sigma=0.2, versus 35.1% for baselines and 30.9% for energy-penalized models (p

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

QUIVER: Cost-Aware Adaptive Preference Querying in Surrogate-Assisted Evolutionary Multi-Objective Optimization

arXiv:2605.04267v2 Announce Type: replace Abstract: Interactive multi-objective optimization systems face a budget allocation dilemma: one can spend resources on expensive objective evaluations or on eliciting decision-maker preferences that identify the relevant region of the Pareto set. Moreover, preference elicitation itself spans modalities with different information content and cognitive burden, ranging from cheap, noisy pairwise preference statements (PS) to richer but costlier indifference adjustments (IA). We study cost-aware optimization under an unknown scalarization and introduce QUIVER (Query-Informed Value Estimation for Regret), a surrogate-assisted evolutionary multi-objective optimizer that adaptively chooses between objective evaluations and heterogeneous preference queries. At each step, QUIVER selects the next action by maximizing the expected decision-quality improvement per unit total cost. Across DTLZ and WFG benchmarks under synthetic decision-maker models, QUIVER achieves the lowest final utility regret on challenging WFG problems (utility regret of 2.14 on WFG4, 2.82 on WFG9: a 25% improvement over baselines), outperforming all single-modality baselines. We analyze how the optimal mix of PS and IA adapts to problem difficulty: on easy problems (DTLZ2), QUIVER selects 80\% PS queries; on hard problems (WFG9), it shifts to 35% IA queries. This adaptive modality selection demonstrates cost-aware preference learning in action.

17.
arXiv (CS.CL) 2026-06-11

Neuron-based Personality Trait Induction in Large Language Models

Large language models (LLMs) have become increasingly proficient at simulating various personality traits, an important capability for supporting related applications (e.g., role-playing). To further improve this capacity, in this paper, we present a neuron-based approach for personality trait induction in LLMs, with three major technical contributions. First, we construct PersonalityBench, a large-scale dataset for identifying and evaluating personality traits in LLMs. This dataset is grounded in the Big Five personality traits from psychology and is designed to assess the generative capabilities of LLMs towards specific personality traits. Second, by leveraging PersonalityBench, we propose an efficient method for identifying personality-related neurons within LLMs by examining the opposite aspects of a given trait. Third, we develop a simple yet effective induction method that manipulates the values of these identified personality-related neurons. This method enables fine-grained control over the traits exhibited by LLMs without training and modifying model parameters. Extensive experiments validate the efficacy of our neuron identification and trait induction methods. Notably, our approach achieves comparable performance as fine-tuned models, offering a more efficient and flexible solution for personality trait induction in LLMs. We provide access to all the mentioned resources at https://github.com/RUCAIBox/NPTI.

18.
bioRxiv (Bioinfo) 2026-06-14

Transposable elements as evolutionary substrates of proteindisorder in the human proteome

Intrinsically disordered regions (IDRs) are central contributors to protein function, evolution and human disease, yet the evolutionary routes that seed new disordered segments within pre-existing proteins are still poorly understood. Sequence insertions provide a powerful mechanism for disorder expansion, but the genomic donors of inserted IDR and its long-term conformational fate remain largely unknown. Transposable elements (TEs), abundant mobile genetic elements with distinctive compositional biases, represent compelling candidates for generating disorder within proteins. Here, we systematically mapped TE-derived segments across human proteins and isoforms, and we found that these insertions are strongly enriched in intrinsic disorder. The structural consequences of their insertion are shaped by TE class and family, reflecting the sequence biases of the elements from which they originate. Recent, Primate specific insertions preferentially generate disordered segments, whereas older insertions more frequently occupy ordered structural contexts, revealing an age-dependent transition in the conformational state of TE-derived sequences. TE-containing isoforms are expressed at lower levels than TE-free isoforms, particularly when insertions are young and disorder-rich, suggesting that intrinsic disorder may constrain the cellular tolerance of newly exonized sequences. These findings identify TEs as a major evolutionary mechanism linking genome mobility to the emergence of new disordered conformational ensembles in the human proteome.

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

AgenticRec: A Recommendation-Oriented Agentic Framework with Progressive Tool-Integrated Reasoning Optimization

arXiv:2603.21613v2 Announce Type: replace-cross Abstract: Recommender agents built on Large Language Models offer a promising paradigm for personalized recommendation. However, existing agents typically suffer from a misalignment between their tool-integrated reasoning trajectories and recommendation feedback, limiting their ability to distinguish fine-grained user preferences. To address these challenges, we propose AgenticRec, an agentic recommendation framework that formulates recommendation as a tool-integrated reasoning process over a recommendation-oriented tool suite. Built upon this framework, we further develop a dedicated two-stage training paradigm tailored for recommender agents. In the first stage, we introduce Recommendation-Oriented Trajectory Activation, optimize the agentic recommendation ability under implicit feedback. In the second stage, Progressive Preference Refinement further refines the agent through bidirectional preference reasoning over self-bootstrapped hard pairs, progressively sharpening preference boundaries. Theoretical analysis and extensive experiments demonstrate the effectiveness of AgenticRec. Our code is available at https://anonymous.4open.science/r/AgenticRec-FB16.

20.
arXiv (CS.AI) 2026-06-12

ARROW: Augmented Replay for RObust World models

arXiv:2603.11395v3 Announce Type: replace-cross Abstract: Continual reinforcement learning challenges agents to acquire new skills while retaining previously learned ones with the goal of improving performance in both past and future tasks. Most existing approaches rely on model-free methods with replay buffers to mitigate catastrophic forgetting; however, these solutions often face significant scalability challenges due to large memory demands. Drawing inspiration from neuroscience, where the brain replays experiences to a predictive World Model rather than directly to the policy, we present ARROW (Augmented Replay for RObust World models), a model-based continual RL algorithm that extends DreamerV3 with a memory-efficient, distribution-matching replay buffer. Unlike standard fixed-size FIFO buffers, ARROW maintains two complementary buffers: a short-term buffer for recent experiences and a long-term buffer that preserves task diversity through intelligent sampling. We evaluate ARROW on two challenging continual RL settings: Tasks without shared structure (Atari), and tasks with shared structure, where knowledge transfer is possible (Procgen CoinRun variants). Compared to model-free and model-based baselines with replay buffers of the same-size, ARROW demonstrates substantially less forgetting on tasks without shared structure, while maintaining comparable forward transfer. Our findings highlight the potential of model-based RL and bio-inspired approaches for continual reinforcement learning, warranting further research.

21.
PLOS Computational Biology 2026-06-05

Heuristic multi-site optimization for protein sequence design using Masked Protein Language Models

Authors:

by Lijuan Wang, Yuze Wang, Chen Qiu, Liwei Xiao, Xianliang Liu, Junjie Chen Protein sequence design for tailored functional properties is a fundamental task in protein engineering, with critical applications in drug discovery and therapeutic development. Efficient navigation of the combinatorial vastness of protein sequence space to identify functional variants remains a formidable challenge. Conventional approaches, which predominantly rely on template-based local search or single-residue mutagenesis, are constrained by their susceptibility to local optima and their potential risk of destabilizing native structural stability. In this study, we introduce ProtHMSO, a heuristic multi-site optimization framework leveraging masked protein language models (ProtLMs) for context-aware sequence exploration. ProtHMSO mimics natural evolutionary mechanisms by employing ProtLM-derived substitution probabilities to guide heuristic searches for synergistic mutations, thereby constraining combinatorial search spaces through evolutionary and biophysical priors. ProtHMSO is further applied to replace the exploration strategies in genetic algorithms (GAs) and Monte Carlo tree search (MCTS) for improving their convergence efficiency. Benchmark experiments demonstrate that protein sequences generated by ProtHMSO exhibit superior functional performance and closer alignment with natural sequence distribution, compared with state-of-the-art methods. These advancements highlight that ProtHMSO has strong potential and compatibility to accelerate functional protein discovery, offering a robust framework for efficient and context-aware exploration of protein sequence space.

22.
medRxiv (Medicine) 2026-06-15

Iron deficiency testing among people with incident heart failure in primary care

Background: Given around 50% of people with heart failure have a degree of iron deficiency, guidelines recommend screening. It is uncertain to what extent this is done in primary care and whether testing is equitable. Aim: To report the proportion of people with incident heart failure who undergo a ferritin test within 12 months. Design and setting: Retrospective primary care cohort study using Clinical Practice Research Datalink Aurum data, between 2016 and 2021. Methods: We report the proportion of adults with an incident diagnosis of heart failure who received a ferritin test within 12 months. Multivariable logistic regression was used to examine the odds of testing based on key demographic covariates and co-morbidities. Results: Among 105,749 individuals with an incident diagnosis of heart failure (mean age 71.6 years, SD 14.3), only 35,688 (33.7%) received a ferritin test within the subsequent year. Increasing age (odds ratio 1.25 per 10-year increase, 95% CI: 1.24-1.27), female sex (male sex OR 0.86, 0.84-0.89) and Asian ethnicity (OR 1.70, 1.59-1.80) were all associated with increased odds of testing as were diagnoses of coeliac disease (OR 1.86, 1.58-2.21), type 1 diabetes (OR 1.82, 1.51-2.19) and cirrhosis (OR 1.64, 1.43-1.87). There was geographic variation in testing, even in adjusted analyses. Conclusion: In a large primary care dataset, two thirds of people with incident heart failure did not receive a ferritin test for iron deficiency within a year of diagnosis demonstrating a gap in current practice and an opportunity for improvements in service delivery.

23.
medRxiv (Medicine) 2026-06-17

Real-World Effectiveness and Safety of Avacopan in ANCA-Associated Vasculitis: A Systematic Literature Review and Meta-analysis

Background: The efficacy and safety of avacopan in ANCA-associated vasculitis (AAV) has been established in randomized trials of of avacopan as a glucocorticoid (GC) sparing therapy. However, real world evidence (RWE) has an important role in confirming effectiveness and evaluating safety in more generalizable settings. This study aimed to synthesize RWE on the effectiveness and safety of avacopan in adults with AAV. Methods: A systematic literature review and meta analysis of non interventional real world studies was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Eligible studies included adults with AAV treated with avacopan in routine clinical practice. Pooled estimates of effectiveness and safety outcomes were calculated using random effects meta-analyses. Primary outcomes included remission at 6 and 12 months and sustained remission at 12 months. Secondary outcomes included relapse, GC use and dosing, hepatotoxicity, infections, and treatment discontinuation. Exploratory outcomes included changes in estimated glomerular filtration rate (eGFR) and dialysis related endpoints. Results: A total of 71 studies were included and contributed to quantitative analyses. Pooled remission for patients on avacopan was 87% (95% CI: 75%-94%) at 6 months and 93% (95% CI: 86%-97%) at 12 months, and sustained remission was 86% (95% CI: 74%-93%) at 12 months. Relapse at 12 months was low (7%; 95% CI: 4%-11%). GC use was 36% at both 6 and 12 months. Improvements in eGFR were observed at 6 months (18 mL/min/1.73 m2) and 12 months (18 mL/min/1.73 m2), and dialysis liberation was 66% in a limited subset. Among avacopan patients, 11% experienced any hepatotoxicity, including 7% with serious (defined as directly reported or requiring hospitalization) hepatotoxicity, while 7% experienced serious (defined as directly reported or requiring hospitalization) infection. Conclusions: In real world clinical practice, avacopan is associated with high remission rates, low relapse rates, and a consistent GC sparing effect, with effectiveness comparable to standard of care regimens. Findings support its clinical use with appropriate safety monitoring; however, the observed heterogeneity in hepatotoxicity and the limited comparative effectiveness evidence highlight areas requiring further investigation.

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

Million-scale multimodal pollen microscopy with expert-guided foundation models

Automated pollen identification from microscopy remains a bottleneck in aerobiology, palaeoecology and biodiversity monitoring, because scalable systems must generalise across specimen preparation, scanner settings and geographic origins while retaining palynological interpretability. To address this gap, we present a million-scale multimodal pollen microscopy resource, Pollen AI Atlas, assembled from pure-species whole-slide bright-field images spanning four geographic origins, four scanner settings and 46 taxon labels across 31 botanical families. Seeded by one manually selected exemplar per source slide, token-level mining and filtering produced 1,511,390 released grain detections with 99.6\% proposal precision in expert-curated test regions. Each detection was paired with machine-generated grain-level morphological captions from five open-weight vision-language models, guided by expert-verified palynological anchors, yielding structured descriptions of aperture systems, wall ornamentation, shape and size. Among the evaluated models, Gemma4 provided the most controlled primary caption set, combining tight length control, no leakage and the strongest text-retrieval performance. Baseline benchmarks with frozen visual features reached 88.16\% top-1 accuracy, while cross-regional retrieval showed that caption-derived text embeddings remained robust when image similarity degraded (mAP@20 0.811 versus 0.262). Released data, annotations, captions, splits, code, and weights provide a benchmark for pollen recognition, cross-regional domain adaptation and domain-specific multimodal microscopy learning.

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

A Multi-Center Benchmark for Abdominal Disease Diagnosis and Report Generation from Non-Contrast CT

Multiphasic contrast-enhanced CT (CECT) is widely used for abdominal lesion characterization, yet it carries inherent risks of contrast-induced nephropathy, escalates acquisition burden, and heavily contributes to radiologist workload. To address these challenges, we introduce a novel multi-center benchmark for multi-organ abdominal disease diagnosis and automated radiology report generation, which learns to synthesize contrast-enhanced findings from single-phase non-contrast CT (NCCT). To support this, we curated a large-scale dataset of paired NCCT-CECT studies and their corresponding contrast-enhanced radiology reports from two centers, partitioned into internal sets and an external validation cohort. Under a unified evaluation protocol, we benchmarked five contemporary deep learning architectures encompassing chest-specific, abdomen-specific, and general-purpose multimodal domains. Extensive experiments demonstrate that NCCT retains diagnostic signals, achieving an average multi-organ AUC of 69.1% on the internal cohort and 63.1% on the external cohort, respectively. By releasing this dataset and standardized benchmark publicly, this study aims to catalyze future research into safer, resource-efficient, and globally accessible contrast-free abdominal imaging workflows. Code is available at: https://github.com/xmed-lab/TriALS-Report.