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02.
arXiv (quant-ph) 2026-06-24

Efficient Graph State Purification with Factorized Graph-Preserving Operations across Local Clifford Orbits

arXiv:2606.23809v1 Announce Type: new Abstract: Graph states form a broad class of multipartite entangled states underlying measurement-based quantum computation, quantum networks, and stabilizer codes. However, systematic entanglement distillation for arbitrary graph states remains challenging because the circuit design space grows rapidly with the number of parties. We introduce a group of Clifford operations that we call "factorized graph-preserving". It enables us to efficiently enumerate and optimize graph-state purification circuits at finite size for realistic noisy hardware. These operations map products of graph-basis states to products of graph-basis states, so their action can be represented as permutations of graph-basis labels. Moreover, this useful gate set admits a compact factorized description determined by simple graph-theoretic features. This structure also allows, after some initial cached precomputation, drastically lower computational complexity for simulating a gate. We further organize these operations over local-complementation (LC) orbits using minimum-edge representatives (MERs), which let us design purification circuits that apply to all locally equivalent graph states (up to a basis change). Using this framework, we optimize noisy finite-size multipartite distillation circuits for several graph-state families. Numerical results show that the resulting graph-preserving circuits can outperform standard recurrence-based purification protocols under realistic gate and measurement noise. Our results establish LC-orbit structure and factorized graph-preserving operations as practical tools for scalable, topology-aware and hardware-constrained graph-state distillation protocol design. Our work can also be interpreted as a graph-based heuristic for finding transversal gates.

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

Communication-Efficient Neural Tangent Kernels for Heterogeneous Decentralized Federated Learning

Authors:

arXiv:2512.12737v2 Announce Type: replace Abstract: Decentralized federated learning (DFL) enables collaborative model training without a central server, but converges slowly under statistical heterogeneity. Recent work has shown that neural tangent kernel (NTK) methods achieve faster convergence than gradient-based updates in DFL, while momentum has proven effective for accelerating gradient-based FL. However, applying momentum to NTK updates can destabilize training under heterogeneous data. We propose SPARK, which addresses this instability with a stage-wise annealed soft-label regularizer evaluated on neighborhood-aggregated data, so that momentum can accelerate NTK updates stably. Under high heterogeneity, SPARK converges about 3$\times$ faster than baselines and lowers the total communication to a target accuracy by up to about 70\%, and it attains higher accuracy across heterogeneity levels. We further study random projection as an optional Jacobian-compression strategy for bandwidth-constrained settings. We validate the approach across multiple datasets, network topologies, and heterogeneity levels.

04.
arXiv (CS.CL) 2026-06-16

Spokes: Optimizing for Diverse Pretraining Data Selection

Diversity plays a critical role in data selection, improving performance under fixed data budgets by reducing redundancy and repetition. However, optimizing for diversity is inherently challenging, as it is a set-level property that depends on interactions between data points rather than individual examples. As a result, existing approaches typically rely on proxies or approximations, which often fail to ensure sufficiently diverse subsets. In this work, we directly optimize diversity by introducing a probabilistic diversification framework based on the G-Vendi score, optimized via exponentiated gradient descent. Our method produces subsets that are substantially more diverse than those obtained via random sampling, achieving a +489 increase in G-Vendi score on a 500k-sample subset. We evaluate our approach on FineWeb and DCLM, where it consistently outperforms existing methods. Notably, SPOKES (diversity-only) improves average downstream performance by +0.4 and +0.5 points over random sampling on DCLM and FineWeb, respectively. More importantly, jointly optimizing for both quality and diversity yields the strongest results: SPOKES achieves gains of +1.5 and +1.4 points on DCLM and FineWeb, outperforming all baselines, including semantic deduplication and quality filtering.

05.
arXiv (CS.AI) 2026-06-19

Improving Code-Switching ASR with Code-Mixing Guided Synthetic Speech

arXiv:2606.19381v1 Announce Type: cross Abstract: Code-switch (CS) Automatic Speech Recognition (ASR) remains challenging due to limited availability of high quality CS text-speech pairs for training. Although synthetic data augmentation via Text-to-speech (TTS) has been explored, existing CS TTS approaches primarily optimise reconstruction fidelity and do not explicitly enforce language-boundary consistency, thereby limiting their effectiveness for CS ASR augmentation. This paper proposes a code-mixing guided preference-learning framework that steers synthetic speech generation toward improved code-switching fidelity using the Code Mixing Index (CMI). Experiments on the SEAME Mandarin-English conversational corpus demonstrate that the proposed method enhances the utility of synthetic data for ASR fine-tuning. Specifically, when fine-tuning Whisper Large, the proposed approach reduces Mixed Error Rate (MER) from 12.1%/17.8% to 8.9%/14.2% on the DevMAN and DevSGE sets, respectively.

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

Sub-Token Routing for KV Cache Compression

Transformer inference often requires a large KV cache, especially for long-context language modeling and multimodal generation. Existing compression methods usually reduce cache cost by selecting, evicting, quantizing, or compressing cached tokens, or by reducing the visual-token sequence before language-model inference. We introduce sub-token routing, a KV-compression method that adds a finer control axis inside retained tokens. It splits each retained value vector into groups and keeps only selected groups, while leaving query and key states unchanged. The method is designed to work after token-level reduction. First, a token-reduction method determines which tokens are retained. Then, sub-token routing compresses the value states inside those retained tokens. Experiments under matched KV budgets show that adding sub-token routing improves token-level reduction performance in both LLM and VLM settings, including Quest on LLaMA-2-7B and Qwen2.5-7B, and FastV/VisionZip across LLaVA and Qwen-VL models. The gains are larger at smaller KV budgets, suggesting that value-group routing is especially useful when further token removal becomes costly. Overall, token-level reduction and sub-token routing provide complementary ways to reduce KV cost.

07.
arXiv (CS.CV) 2026-06-11

ReMoT: Reinforcement Learning with Motion Contrast Triplets

We present ReMoT, a unified training paradigm to systematically address the fundamental shortcomings of VLMs in spatio-temporal consistency – a critical failure point in navigation, robotics, and autonomous driving. ReMoT integrates two core components: (1) A rule-based automatic framework that generates ReMoT-16K, a large-scale (16.5K triplets) motion-contrast dataset derived from video meta-annotations, surpassing costly manual or model-based generation. (2) Group Relative Policy Optimization, which we empirically validate yields optimal performance and data efficiency for learning this contrastive reasoning, far exceeding standard Supervised Fine-Tuning. We also construct the first benchmark for fine-grained motion contrast triplets to measure a VLM's discrimination of subtle motion attributes (e.g., opposing directions). The resulting model achieves state-of-the-art performance on our new benchmark and multiple standard VLM benchmarks, culminating in a remarkable 25.1% performance leap on spatio-temporal reasoning tasks.

08.
arXiv (CS.AI) 2026-06-19

Can In-Context Learning Support Intrinsic Curiosity?

arXiv:2606.19476v1 Announce Type: cross Abstract: Effective machine learning depends not only on how we model data, but also on what data we choose to collect. While large sequence models have revolutionized data modeling, the problem of automated data selection, or "intrinsic curiosity", remains a significant challenge. Classic approaches incentivize exploration by rewarding an agent based on its "learning progress", which measures how much a newly acquired observation improves a world model's predictive ability. However, evaluating these rewards traditionally requires expensive inner loops of gradient descent updates within each trajectory, rendering them computationally impractical at scale. In this work, we investigate whether the emergent in-context learning (ICL) capabilities of sequence models can eliminate this bottleneck by serving as immediate, update-free world models. Specifically, we evaluate whether an exploration policy can be trained to maximize learning progress, using solely the prediction errors and counterfactual context manipulations of an in-context learner. We first prove that in general Markov decision processes, this is in fact impossible in an unbiased way: the resulting intrinsic rewards either suffer from nuisance terms that bias their estimation of true learning progress, or they cannot be implemented using an in-context learner's prediction errors. Conversely, we prove a positive result for a broad subclass of non-temporal settings, encompassing active learning and Bayesian Experimental Design: here, ICL-derived rewards successfully bound and asymptotically converge to the true learning progress. We corroborate our theory with controlled experiments across continuous and symbolic environments, demonstrating that our ICL-driven framework successfully trains curious data-collection policies that explore optimally.

09.
arXiv (CS.AI) 2026-06-19

A Multi-Agent system for Multi-Objective constrained optimization

arXiv:2606.20236v1 Announce Type: new Abstract: Many decision-making problems in computing and networking systems can be naturally formulated as cost-minimization problems under performance constraints. In dynamic environments, reinforcement learning (RL) is often used to solve such problems at runtime by embedding both costs and constraint violations into a single scalar reward through weighted penalty terms, following a Lagrangian-inspired formulation. However, in this context the behavior of the learned policy critically depends on the choice of these weights, which are typically selected manually. This makes it difficult to identify an appropriate trade-off between optimizing the primary objective and effectively avoiding constraint violations, particularly in non-stationary environments where their relative importance may change. This paper presents MAMO (Multi-Agent system for Multi-Objective constrained optimization), an approach to tackle this balancing problem through multi-agent RL. MAMO decouples task execution from objective design by formulating the selection of reward weights as a learning problem, providing a !rst step towards more autonomous and robust RL-based solutions for constrained optimization problems in dynamic environments.

10.
medRxiv (Medicine) 2026-06-17

Targeted Proteomic Profiling of Nasal Fluid from the Brain-Nose Interface

The brain-nose interface is an anatomical junction where olfactory neurons from the olfactory bulb traverse the cribriform plate into the nasal mucosa, providing minimally invasive access to the central nervous system (CNS). We hypothesized that nasal fluid from this region could enable detection of neurology-relevant proteins using targeted multiplex assays. Using nosecollect, a targeted nasal sampling device, nasal fluid proximal to brain-nose interface was collected from cognitively impaired patients, alongside matched cerebrospinal fluid (CSF) and plasma. After nasal sample-specific dilution optimization and intra-assay precision evaluation, all matrices were profiled with the Olink Target 96 Neurology and NUcleic acid Linked Immuno-Sandwich Assay CNS disease 120 (NULISAseq CNS Disease 120) panels. Nasal fluid showed technically repeatable detection (intra-assay coefficient of variation

11.
arXiv (CS.CV) 2026-06-25

Invoice Haystack: Benchmarking Document Retrieval and Visual Question Answering Under Strong Visual Homogeneity

Vision Language Models have achieved near-human performance on single-document Visual Question Answering, yet their effectiveness degrades significantly when retrieving information from large collections of visually homogeneous documents. Existing multi-document benchmarks aggregate diverse document types, creating artificial separation in embedding space that does not reflect enterprise document repositories where thousands of records share identical visual templates. We identify this as embedding collapse and introduce Invoice Haystack, a benchmark with 1,500 anonymized invoice images paired with 200 discriminative question-answer pairs, specifically designed to stress-test retrieval under strong visual homogeneity. Invoice Haystack exhibits a mean pairwise cosine similarity of 0.73, compared to 0.38 (DocHaystack) and 0.31 (InfoHaystack) in existing benchmarks, posing a fundamentally more challenging retrieval problem. Addressing the identified challenge, we propose VL-RAG, a hybrid retrieval-augmented generation framework that jointly leverages text and visual embeddings to harness the complementary strengths of both modalities, followed by a VLM-based verification filter for precise document identification. VL-RAG achieves 60.0\% Recall@1 on Invoice Haystack-500, outperforming existing state-of-the-art method by up to an absolute 13.5 percentage points. It further improves retrieval considerably on DocHaystack-1000 (77.1\% vs.\ 75.2\%) and InfoHaystack-1000 (84.5\% vs.\ 80.0\%), establishing the proposed dual-stream fusion as a consistently superior retrieval strategy across both homogeneous and heterogeneous document collections.

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

Examining the Usage of Generative AI Models in Student Learning Activities for Software Programming

arXiv:2511.13271v2 Announce Type: replace-cross Abstract: The rise of Generative AI (GenAI) tools like ChatGPT has created new opportunities and challenges for computing education. Existing research has primarily focused on GenAI's ability to complete educational tasks and its impact on student performance, often overlooking its effects on knowledge gains. In this study, we investigate how GenAI assistance compares to conventional online resources in supporting knowledge gains across different proficiency levels. We conducted a controlled user experiment with 24 undergraduate students of two different levels of programming experience (beginner, intermediate) to examine how students interact with ChatGPT while solving programming tasks. We analyzed task performance, conceptual understanding, and interaction behaviors. Our findings reveal that generating complete solutions with GenAI significantly improves task performance, especially for beginners, but does not consistently result in knowledge gains. Importantly, usage strategies differ by experience: beginners tend to rely heavily on GenAI toward task completion often without knowledge gain in the process, while intermediates adopt more selective approaches. We find that both over-reliance and minimal use result in weaker knowledge gains overall. Based on our results, we call on students and educators to adopt GenAI as a learning rather than a problem solving tool. Our study highlights the urgent need for guidance when integrating GenAI into programming education to foster deeper understanding.

13.
arXiv (CS.CL) 2026-06-24

Agon: An Autonomous Large-Scale Omnidisciplinary Research System Built on Prompt Economy

Large language models are making research production scalable, shifting the bottleneck from producing artifacts to judging claims. We present \textsc{Agon}, a research orchestrator that validates what can be checked inside the workflow and leaves the remaining judgments to human scientists. \textsc{Agon} is built on six design principles: Prompt Economy, Future-Facing, Minimal Prompts, OmniDisciplinary, Massive Parallelism, and Zero-Code. We ran \textsc{Agon} across domains for 444 iterations of Prompt Economy loops, using only small starting topics and no human-written experimental code. These deployments demonstrate scalability while exposing new classes of failure. We organize these failures into a taxonomy along severity, fixability, visibility, and capability locus. The taxonomy separates failures the loops can see and fix from those that require human judgment. Together, these results show that \textsc{Agon} is pushing research toward a new paradigm: machine scales, human steers.

14.
arXiv (CS.CV) 2026-06-18

Physics in 2-Steps: Locking Motion Priors Before Visual Refinement Erases Them

Image-to-Video diffusion models leverage input images to generate visually stunning content, yet frequently produce motion that violates physical laws. We reveal a surprising finding: a 2-step generation often exhibits better physical consistency than a 50-step output from the same model. Through spectral analysis, we trace this to phase erosion during denoising; the phase degrades significantly (dropping by $\approx 18\%$ from step 2 to step 50), whereas the magnitude remains relatively stable. Building on this insight, we propose PhaseLock, a training-free framework that preserves the valid motion priors from few-step inference throughout the denoising trajectory. Rather than relying on full-step inference for physical consistency, PhaseLock extracts a motion prior from just 2 steps and enforces it onto high-fidelity generation via Latent Delta Guidance. Our approach effectively mitigates phase degradation, improving physical consistency by an average of 6.2 points across diverse models while largely maintaining visual fidelity, with negligible overhead ($1.06\times$ time, $1.02\times$ memory) and reduced reliance on expensive external guidance methods ($\sim5\times$ time). Project Page: https://dnwjddl.github.io/phaselock

15.
arXiv (math.PR) 2026-06-16

Small moments of the sensitivity of polynomial threshold functions

arXiv:2606.16004v1 Announce Type: new Abstract: In the first version of Chang, Slote, Volberg, and Zhang's paper [BSA_of_PTF], the authors modify a nice recursive approach due to Kane in [Correct_exponent_for_AS] where he bounded the average sensitivity of polynomial threshold functions. In [BSA_of_PTF] Kane's argument was adopted to estimate the boolean surface area of polynomial threshold function. The bridge is a combinatorial averaging lemma considering all balanced partitions. The lemma serves as a substitute for an additive property of average sensitivity. With the lemma, one can apply a Kane-type algorithm to derive a recurrence. Solving the recurrence then gives an upper bound of $e^{C_d \sqrt{\log n}}$ for the boolean surface area. In the second version of the same paper, the authors derive a polylog upper bound for BSA of PTFs. The difference is that they use a tail estimate for the sensitivity function. With the help of a polynomial restriction lemma in [poly_restriction] they sharpen the upper bound. It is noteworthy that when applying the polynomial restriction, each coordinate is put into each part independently with equal probability. As a result, a partition does not necessarily have equal-size blocks. In other words, it may not be balanced. In this note, we first investigate the effect of different partitioning. Second, we use the recursive method in the first version to derive a polylog upper bound for $\mathbb E[s(x)^{\eta}]$ where $\eta < 1/2$. It is interesting to note the phase transition that happens at $\eta=1/2$ in both versions of the proof (but in a completely different form). Section [PhaseTr-s] treats that.

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

The Containment Gap: How Deployed Agentic AI Frameworks Fail Public-Facing Safety Requirements

arXiv:2606.12797v1 Announce Type: new Abstract: Agentic large language model systems that autonomously invoke tools, maintain persistent memory, and execute multi-step plans are increasingly deployed in public-facing domains, including government services, healthcare triage, and financial advising. We ask whether the frameworks used to build these systems provide architectural-level structural safety guarantees. Applying six containment principles derived from a compositional model of agentic architectures, we audit three dominant frameworks (LangChain, AutoGPT, and OpenAI Agents SDK) and find no native compliance in any of them. Memory integrity, a defense against one of the most prevalent vulnerability classes, is not observed in any of the three evaluated frameworks. We validate these findings empirically: in a simulated government benefits agent built on LangChain, a single memory-poisoning write induces persistent targeted corruption across all tested seeds and backends, increasing the wrongful denial rate for targeted applicants to 88.9%. Under a complex five-factor policy, the same attack preserves aggregate accuracy while increasing targeted wrongful denials by 3.5x, rendering the corruption difficult to detect through standard monitoring. We then introduce two lightweight containment mechanisms: a memory integrity validator and a policy gate, which eliminate both attack vectors with sub-millisecond overhead (

18.
arXiv (math.PR) 2026-06-16

Universality in the target arrival statistics of non-conservative search processes

arXiv:2606.16025v1 Announce Type: cross Abstract: Stochastic search processes in which searchers are continuously introduced to and removed from a target search domain are fundamental to a wide class of physical and artificial systems. The theory of such non-conservative search processes is, however, much less developed than for search processes with a fixed number of particles. Here we exploit a natural mapping between non-conservative stochastic search and queueing theory to derive the full time-dependent distribution of target arrivals under minimal assumptions on the underlying search process. Remarkably, we find that the steady-state inter-arrival time distribution is exactly exponential, regardless of the details of the search process, showing a robust universality that emerges directly from the queueing framework. Thus, counterintuitively, the arrival statistics of a non-conservative search process are much simpler than sequential search-and-capture processes involving a fixed number of searchers. This has major implications for target resource accumulation, where the delivery of resources is counter-balanced by their downstream consumption.

19.
arXiv (CS.CV) 2026-06-17

Edit3DGS: Unified Framework for Dynamic Head Editing via 2D Instruction-Guided Diffusion and 3D Gaussian Splatting

We present Edit3DGS, a unified framework for dynamic 3D head editing that integrates 2D instruction-guided diffusion with 3D Gaussian splatting. Unlike prior approaches that separately address frame-based edits or static 3D reconstruction, our method couples semantic controllability in the image domain with photorealistic, temporally consistent 3D representations. Given an input video, editable facial regions are masked and modified using a text-conditioned diffusion model to support fine-grained operations such as expression transformation, attribute modification, and appearance refinement. The edited frames are then aggregated through 3D Gaussian splatting to produce a coherent, high-fidelity avatar that preserves both identity and motion dynamics. To enforce consistency, Edit3DGS incorporates multi-view batch editing and lightweight inpainting strategies that recover lost expressions across timesteps. Experimental results demonstrate that our framework enables controllable, artifact-free head editing with smooth temporal transitions, offering practical applications in virtual avatars, immersive communication, film production, and interactive media.

20.
arXiv (CS.AI) 2026-06-11

EvalStop: Using World Feedback to Detect and Correct Reward Overoptimization in Multi-Tenant RLHF Platforms

arXiv:2606.04145v2 Announce Type: replace-cross Abstract: Cloud LLM fine-tuning platforms increasingly serve RLHF workloads, where a learned reward model is optimized as a proxy for human quality. As Gao et al. (2023) showed, this proxy diverges from world feedback (downstream eval metrics) under sustained optimization pressure, a phenomenon known as reward overoptimization. Existing platform schedulers ignore this divergence: non-clairvoyant schedulers optimize JCT without any quality signal, SLAQ-style quality-aware schedulers use training loss (a weaker proxy that drops monotonically through hacking), and classical per-job early stopping requires human monitoring and does not free shared GPUs. We propose EvalStop, a composable scheduling primitive that terminates jobs on k consecutive eval-score declines, releases GPUs, preserves the best checkpoint, and delegates to any base scheduler. We frame scheduler-level early stopping as a detection problem and evaluate it in a discrete-event simulator whose RLHF workload mixes reward-hacking and structurally healthy runs, with ground-truth labels hidden from schedulers. On RLHF-heavy workloads (80% RLHF, 64 GPUs), EvalStop achieves precision 98% / recall 99% / FPR 1.5% while improving JCT by 9% and cutting wasted compute by 22% over SRTF-Est (p

21.
arXiv (CS.AI) 2026-06-25

FactorLibrary: From Polynomials to Circuits via Recursive Subgoals

arXiv:2606.25394v1 Announce Type: cross Abstract: Finding minimal arithmetic circuits for polynomials over finite fields is a combinatorially hard problem central to algebraic complexity theory. We formulate it as a reinforcement learning problem in two directions, bottom-up and top-down. To address the challenge of a fast-growing combinatorial search space, we introduce FactorLibrary, which stores factorizable subexpressions that serve as reusable subgoals across training episodes. We trained a bottom-up agent with Gumbel-PPO-MCTS and two top-down agents with PPO+MCTS and SAC. The PPO+MCTS top-down agent exhibited the most stable performance, finding certified optimal circuits up to complexity $8$ with a success rate of $91.8\%$.

22.
arXiv (CS.AI) 2026-06-18

HAARES Half-Split Residual Basis Routing for Deep Transformers

Authors:

arXiv:2606.06564v2 Announce Type: replace-cross Abstract: Block-level residual routing makes learned residual aggregation practical by routing over block summaries, but each summary compresses an ordered sequence of attention and MLP updates into one cumulative vector. We propose \method{}, a lightweight residual basis router that keeps the cumulative block source and adds one half-split detail basis, computed as the difference between first-half and second-half residual updates. The detail basis is RMS-matched and updated online, exposing coarse intra-block trajectory information without dense sublayer-level routing. Across OpenWebText, cross-domain character-level benchmarks, and BPE-tokenized OpenWebText, the empirical pattern is depth-dependent: gains are small or mixed at shallow depth and most reliable in 48-layer models. In the 201M 48-layer setting, \method{} improves over Block AttnRes across all three seeds, while a 453M two-seed probe shows the same direction. Ablations rule out source duplication, random signed details, fixed detail-source biases, or block-count changes alone. Cost analysis shows that the method is FLOP-light but not wall-clock-free: it adds memory and routing overhead, yet its relative arithmetic cost is amortized as width grows and earlier convergence can reduce time-to-target.

23.
arXiv (CS.LG) 2026-06-19

Model soups need only one ingredient

arXiv:2602.09689v2 Announce Type: replace Abstract: Fine-tuning large pre-trained models on a target distribution often improves in-distribution (ID) accuracy, but at the cost of out-of-distribution (OOD) robustness as representations specialize to the fine-tuning data. Weight-space ensembling methods, such as Model Soups, mitigate this effect by averaging multiple checkpoints, but they are computationally prohibitive, requiring the training and storage of dozens of fine-tuned models. In this paper, we introduce MonoSoup, a simple, data-free, hyperparameter-free, post-hoc method that achieves a strong ID-OOD balance using only a single checkpoint. Our method applies Singular Value Decomposition (SVD) to each layer's update and decomposes it into high-energy directions that capture task-specific adaptation and low-energy directions that introduce noise but may still encode residual signals useful for robustness. MonoSoup then uses entropy-based effective rank to automatically re-weigh these components with layer-wise coefficients that account for the spectral and geometric structure of the model. Experiments on CLIP models fine-tuned on ImageNet and evaluated under natural distribution shifts, as well as on Qwen language models tested on mathematical reasoning and multiple-choice benchmarks, show that this plug-and-play approach is a practical and effective alternative to multi-checkpoint methods, retaining much of their benefits without their computational overhead.

24.
medRxiv (Medicine) 2026-06-18

Effectiveness and Safety of Bempedoic Acid Across Clinically Relevant Subgroups: Insights from the CLEAR Taiwan Study

Background Despite available lipid-lowering therapies (LLT), many patients fail to achieve low-density lipoprotein cholesterol (LDL-C) targets. This gap persists across clinically relevant subgroups. Bempedoic acid has demonstrated effective LDL-C lowering with a favorable safety profile in the CLEAR Taiwan study; however, its effects across subgroups in Asian populations remains limited. Methods The phase IV CLEAR Taiwan study (NCT06925100) enrolled patients with inadequately controlled hypercholesterolemia who received bempedoic acid for 12 weeks in addition to background LLT. This analysis evaluated changes in lipid parameters, high-sensitivity C-reactive protein (hsCRP), and safety outcomes in clinically relevant subgroups, including cardiovascular risk, diabetes, age, statin tolerance, and sex. Results A total of 180 patients were included. Bempedoic acid achieved significant LDL-C reductions in all subgroups. Numerically greater LDL-C reductions were observed in primary prevention, statin-intolerant, younger (< 65 years), and female patients, while comparable reductions were observed across diabetes status. Reductions in non-high-density lipoprotein cholesterol, total cholesterol, and apolipoprotein B were consistent with LDL-C findings. Significant decreases in hsCRP were observed in all subgroups, with numerically greater reductions in patients aged < 65 years and those without diabetes. Bempedoic acid was well tolerated, with a low incidence of adverse events and no new safety signals identified. Changes in liver enzymes, renal function, and uric acid were minimal within subgroups. Conclusion Subgroup analyses from the CLEAR Taiwan study demonstrate consistent efficacy and safety of bempedoic acid across clinically relevant subgroups and support its use as a flexible option to address residual gaps in lipid management.

25.
medRxiv (Medicine) 2026-06-18

Diabetes is associated with increased nocturnal respiratory rate

Background and Objective: Diabetes mellitus (DM) causes autonomic neuropathy, which may alter nocturnal respiratory rate (NRR). To test the association between DM and NRR, we analyzed elective polysomnograms of four large observational cohorts. Research Design and Methods: We performed cross-sectional analysis of over 25,000 individuals with polysomnograms (PSGs) from the Sleep Heart Health Study (SHHS), Hispanic Community Health Study/Study of Latinos (HCHS/SOL), Osteoporotic Fractures in Men Study (MrOS), and Wisconsin Sleep Cohort (WSC). Patient-level NRRs were derived from inductance plethysmography waveforms. DM status was determined by self-report, physician diagnosis, medication use, or laboratory values, depending on the cohort. We related DM and NRR (continuous and dichotomized) using logistic regression models and adjusted for potential confounders. Cohort-specific results were combined using random-effects meta-analysis. Results: Meta-analysis of unadjusted models showed a pooled odds ratio (OR) of 1.10 (95% CI:1.04-1.17) for each breath-per-minute (brpm) increase in NRR. This association remained significant after multivariable adjustment (OR:1.06, 95% CI:1.02-1.11). Dichotomized analyses similarly showed higher odds of DM across dichotomization thresholds ranging from 15 to 21 brpm. At a threshold of 18 brpm, the unadjusted pooled OR was 1.77 (95% CI:1.23-2.55, P=0.0022), and the adjusted OR was 1.49 (95% CI:1.10-2.02, P=0.0098). Conclusions: Clinically stable outpatients with elevated NRR have an increased prevalence of DM. Additional studies are needed to investigate whether the mechanism is autonomic neuropathy and whether monitoring NRR can detect early complications of DM.