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arXiv:2603.08558v3 Announce Type: replace Abstract: Learning compact state representations in Markov Decision Processes (MDPs) has proven crucial for addressing the curse of dimensionality in large-scale reinforcement learning (RL) problems. Existing principled approaches leverage structural priors on the MDP by constructing state representations as linear combinations of the state-graph Laplacian eigenvectors. When the transition graph is unknown or the state space is prohibitively large, the graph spectral features can be estimated directly via sample trajectories. In this work, we prove an upper bound on the approximation error of linear value function approximation under the learned spectral features. We show how this error scales with the algebraic connectivity of the state-graph, grounding the approximation quality in the topological structure of the MDP. We further bound the error introduced by the eigenvector estimation itself, leading to an end-to-end error decomposition across the representation learning pipeline. Additionally, our expression of the Laplacian operator for the RL setting, although equivalent to existing ones, prevents some common misunderstandings, of which we show some examples from the literature. Our results hold for general (non-uniform) policies without any assumptions on the symmetry of the induced transition kernel. We validate our theoretical findings with numerical simulations on gridworld environments.
arXiv:2606.17073v1 Announce Type: cross Abstract: While commonsense knowledge may suffice for virtual agents, embodied robots interacting with humans require grounded and semantically rich representations of both their environment and their own physical embodiment. In cognitive robotics, ontologies are effective for integrating such heterogeneous knowledge to enable explainable reasoning, even during continuous knowledge updates. Yet, their manual construction remains a bottleneck. We present a preliminary approach for the automatic generation of robot semantic abstractions by transforming Unified Robot Description Format (URDF) models into populated ontologies. Although URDF files provide structural and kinematic descriptions, their identifiers often require commonsense interpretation to recover meaningful semantics, a task at which Large Language Models (LLMs) excel. Our pipeline leverages LLMs to infer semantic relationships by prompting them with concepts from an existing ontology, ensuring the final classification remains aligned with the formal model. To improve reliability, the pipeline combines majority voting across multiple LLM queries along with syntactic and schema-level validation to ensure that generated outputs conform to the expected representation format and ontology constraints. We evaluate the approach on multiple robot descriptions and discuss the generated abstractions. Initial results indicate that the proposed method can effectively bridge the gap between low-level robot descriptions and the structured, grounded knowledge representations required for human-robot interaction.
arXiv:2606.18308v1 Announce Type: cross Abstract: Safe coordination in networked cyber-physical systems forces learning algorithms to simultaneously handle hybrid discrete-continuous actions, hard training-time safety constraints, and physics-governed dynamics. We show that these three features form a directed cycle of biases that defeats any naive composition of off-the-shelf modules, and formalize this as a three-way coupling lemma. We then introduce TRIDENT, the first MARL framework whose three components are co-designed to cancel each leak: a Richardson-Romberg gradient correction reducing Gumbel-Softmax bias from O(tau) to O(tau^2), a Lyapunov-constrained sequential trust-region update enforcing per-iterate feasibility, and a physics-informed residual critic that decomposes value rather than reward. We prove an O~(1/sqrt(K)) convergence rate to a constrained Nash equilibrium and an O(sqrt(K)) cumulative-violation bound. On multi-UAV mobile-edge computing, autonomous intersection management, and a hybrid SMAC variant, TRIDENT cuts training-time violations by 95.5% over MADDPG and 76.3% over MACPO, while improving reward by 13.5% over the strongest unconstrained baseline.
We propose a lightweight real-time method for reconstructing strand-based hair G-Buffers from severely undersampled rasterized inputs. Our pipeline first applies neural spatial reconstruction and temporal accumulation to recover hair coverage, i.e., fractional hair visibility within a pixel, and tangent. It then uses a tangent-guided reconstruction step to complete the position, which is subsequently used for physically based deferred hair shading. We evaluate our method across a diverse set of hairstyles, including straight, wavy, afro, and ponytail styles, under both static and dynamic scenarios. Our method achieves higher hair reconstruction quality than existing hair-specific denoising techniques and general industrial neural reconstruction solutions such as DLSS and FSR.
Audio language models (ALMs) are increasingly used for speech-based understanding, yet their ability to perform semantic reasoning beyond transcription, Text-to-Audio Retrieval, Captioning, and Question-Answering accuracy remains insufficiently benchmarked. In particular, the effects of accent variation, domain shift, and semantic over-inference on audio reasoning are poorly understood. We evaluate audio language models across five semantic and paralinguistic reasoning tasks: entailment, consistency, plausibility, accent drift, and accent restraint. Collectively, these tasks assess a model's ability to reason over spoken audio as the primary evidence source, including whether a textual hypothesis can be inferred, contradicted, or left undetermined by the audio, whether statements align or conflict with spoken content, whether claims are plausible given the discourse, and whether model predictions remain stable or appropriately constrained across accent variation. These findings highlight critical limitations in current audio reasoning evaluations and hope to provide guidance for more robust and equitable ALM design and assessment
Hirschsprung disease (HSCR) is a congenital neurodevelopmental disorder characterized by segmental aganglionosis due to impaired developmental processes of enteric neural crest cells (NCCs). Despite being the leading genetic cause of functional intestinal obstruction in early childhood, HSCR represents a paradigmatic challenge in precision medicine: its multifactorial etiology, complex gene-environment interactions and limited resolution of single-modality analyses have long hindered mechanistic understanding and therapeutic translation. Here, we applied an integrative multi-omics approach combining genetic, phenotypic, epigenomic and transcriptomic analyses of matched ganglionic and aganglionic formalin-fixed paraffin-embedded (FFPE) patient tissues, complemented by patient-specific in vitro models. Beyond established genetic contributors, our integrative approach reveals novel regulatory pathways predominantly affecting enteric NCC differentiation, with convergent evidence pointing to epigenetic dysregulation as a primary disease mechanism. Notably, we identified over 1,300 differentially methylated positions between ganglionic and aganglionic FFPE samples, with HAND2 emerging as a key candidate due to multiple hypermethylated sites and consistently reduced expression levels in aganglionic tissues and in vitro models, suggesting a potential role in HSCR pathophysiology. We propose that our multi-omics approach offers a powerful and comprehensive framework for dissecting disease mechanisms. Beyond advancing biological understanding, this strategy holds promise for paving the way for molecularly informed patient stratification and supporting the development of personalized treatment and postoperative management strategies.
arXiv:2606.14202v1 Announce Type: cross Abstract: Large Language Models (LLMs) have advanced Automatic Heuristic Design (AHD) by enabling heuristic generation through reasoning and code synthesis. Existing LLM-based AHD architectures mainly follow two paradigms: Natural Evolution, which uses crossover and mutation to explore heuristic programs, and Metacognitive Evolution, which refines reasoning through reflection. However, Natural Evolution discards reasoning traces, weakening knowledge inheritance and exploitation, while Metacognitive Evolution lacks population-level recombination, limiting exploration and increasing the risk of premature convergence. These limitations reduce search efficiency, stability, and solution quality on complex problems. To address this gap, we propose MeEvo, a dual-layer AHD framework that cyclically couples Natural Evolution and Metacognitive Evolution. Natural Evolution explores heuristic code while recording reasoning traces, fitness values, and errors into a shared history; Metacognitive Evolution then reflects on this history to generate improved heuristics that re-enter the parent pool for the next cycle. This design enables population-driven exploration and reflection-driven refinement to reinforce each other. Experiments on five optimization problems with two LLM backbones show that MeEvo achieves stronger and more stable performance than existing LLM-based AHD architectures, especially on complex constrained tasks.
arXiv:2606.15009v1 Announce Type: new Abstract: Optical quantum memories operating directly at telecom wavelengths are a key enabling technology for long-distance quantum networks, yet on-demand storage onto long-lived ground-state spins in this spectral region has remained elusive due to the challenge of coherently transferring optical excitations to hyperfine spin states. Here we demonstrate spin-wave storage in $^{167}$Er$^{3+}$:Y$_2$SiO$_5$ at 0.8 K and 1.1 T, establishing the core operational primitive required for on-demand telecom quantum memories. Using classical optical control pulses, we coherently transfer collective optical excitations to erbium hyperfine states with transfer efficiency exceeding 12%, enabling on-demand retrieval. We measure a hyperfine population lifetime of 25 s and demonstrate spin-wave storage for up to 25 $\mu$s. By identifying hyperfine inhomogeneous broadening as the dominant present limitation, our measurements define a clear pathway toward second-scale storage through improved spectral tailoring and dynamical decoupling. The results highlight the application of erbium-based solid-state memories for scalable fiber-compatible quantum repeater architectures.
arXiv:2606.15155v1 Announce Type: new Abstract: Knowledge graphs (KGs) have emerged as a promising solution for integrating and reasoning over complex biomedical and clinical data in healthcare. By representing structured relationships among entities such as diseases, drugs, symptoms, and patient records, KGs provide a semantic backbone for decision-making, prediction, recommendation, and personalized care. Recent advances have demonstrated their utility across diverse medical applications–including clinical decision support systems, disease and treatment outcome prediction, health recommender systems, precision medicine, and medical question answering–where KGs often enhance interpretability, semantic coherence, and patient-specific reasoning. In parallel, a growing body of work focuses on medical KG generation itself, proposing frameworks that construct graphs from EHRs, clinical narratives, biomedical literature, and web resources using ontologies, semantic web technologies, deep-learning-based information extraction, and hybrid neuro-symbolic pipelines. Despite this progress, significant challenges remain, including limited and fragmented knowledge coverage, difficulties in aligning heterogeneous data sources, the fragility of current reasoning and representation-learning methods on dense multi-relational graphs, and unresolved issues related to privacy, bias, and accountability. This survey reviews and categorizes current research on KGs in medicine along both application-oriented and methodology-oriented dimensions, discusses their benefits and technical foundations, and outlines key limitations and open research directions. By analyzing trends, architectures, and evaluation practices, this work aims to guide future developments in KG-driven medical AI systems and support their safe and effective integration into healthcare environments.
arXiv:2601.19612v3 Announce Type: replace-cross Abstract: Safe exploration is a key requirement for reinforcement learning (RL) agents to learn and adapt online, beyond controlled (e.g. simulated) environments. In this work, we tackle this challenge by utilizing suboptimal yet conservative policies (e.g., obtained from offline data or simulators) as priors. Our approach, SOOPER, uses probabilistic dynamics models to optimistically explore, yet pessimistically fall back to the conservative policy prior if needed. We prove that SOOPER guarantees safety throughout learning, and establish convergence to an optimal policy by bounding its cumulative regret. Extensive experiments on key safe RL benchmarks and real-world hardware demonstrate that SOOPER is scalable, outperforms the state-of-the-art and validate our theoretical guarantees in practice.
arXiv:2606.19943v1 Announce Type: cross Abstract: Hyperspectral infrared observations are an important data source for numerical weather prediction (NWP) because they provide rich information on the vertical structure of atmospheric temperature and humidity. However, most existing deep learning methods mainly focus on one-way retrieval from radiances to atmospheric profiles, while the reverse radiance simulation process and the consistency between atmospheric state space and radiance observation space are insufficiently considered. In this study, we propose SIMBA, a unified bidirectional retrieval-forward simulation framework for FY-4A GIIRS hyperspectral infrared radiance modeling toward NWP applications. The framework jointly performs atmospheric profile retrieval and radiance reconstruction, introduces a cycle-consistency constraint to strengthen the coupling between the two processes, and employs a bidirectional Mamba state-space module to capture long-range dependencies along pressure levels. Using collocated FY-4A GIIRS observations and ERA5 reanalysis data, the proposed method is evaluated for temperature retrieval, specific humidity retrieval, long-wave radiance reconstruction, and medium-wave radiance reconstruction. Experimental results show that SIMBA outperforms several representative deep learning baselines across both retrieval and reconstruction tasks, while ablation experiments confirm the contribution of the bidirectional design and cycle-consistency mechanism. These results demonstrate that the proposed framework is effective for joint atmospheric profile retrieval and hyperspectral infrared radiance modeling, and suggest potential for future Jacobian-related analysis and NWP-oriented extensions.
AI evaluations are widely used for testing and understanding progress. However, the diverse evaluators bring with them inconsistencies that challenge analysis and comparison. First, results are saved in incompatible formats, scattered across leaderboards, papers, blog posts, evaluation harness logs, and custom repositories. Second, results are created by different evaluation frameworks, which produce divergent scores for nominally identical evaluations and record metadata inconsistently, hindering comparison, cross-community evaluation science, cost reduction, and reuse. We introduce Every Eval Ever, the first shared schema and community-crowdsourced repository for AI evaluation results. The schema standardizes how evaluations are represented in a unified, single JSON document. It is source-agnostic by design, ingesting results from evaluation harnesses and papers alike, and optionally stores per-instance outputs for fine-grained analysis. We contribute: (i) a community-governed metadata schema with a companion instance-level schema, the first standardization effort of its kind; (ii) automatic converters from popular formats, evaluation harnesses, and leaderboards to the unified schema; and (iii) a crowdsourced community database hosted on Hugging Face, currently spanning to date 22,235 models, 2,273 unique benchmarks, and 31 evaluation formats.
arXiv:2509.04827v3 Announce Type: replace-cross Abstract: The energy cost of Large Language Model (LLM) inference is rapidly becoming a barrier to sustainable and scalable deployment. Although modern serving architectures expose distinct prefill and decode behaviors, existing systems fail to exploit these phase differences for energy-efficient serving under strict latency SLOs. This paper introduces VoltanaLLM, the first system that explicitly targets and reduces the energy bloat in modern prefill-decode (P/D) disaggregated LLM serving. Guided by a control-theory perspective, VoltanaLLM separates two levers: per-instance operating-point selection (GPU frequency per iteration) and system-level state-space routing of requests. We empirically observe that LLM inference exhibits a U-shaped energy-frequency curve creating "sweet spots" that depend on phase behavior and load. VoltanaLLM exploits this by combining phase-specific, iteration-level frequency selection driven by a lightweight, online-adaptive latency predictor, with a decode state-space guided router that avoids architectural granularity-induced inefficiencies, all while meeting desired SLOs. We implement VoltanaLLM using SGLang and evaluate it across multiple models and real-world workloads. Our results show VoltanaLLM reduces end-to-end energy by up to 36.3% versus a static max-frequency baseline while maintaining high SLO attainment, and generalizes to newer GPUs. These results point to sustainable LLM serving via phase-aware, iteration-level frequency selection coupled with architecture-aware routing. Source code is available in https://github.com/Supercomputing-System-AI-Lab/VoltanaLLM.
Researchers are interested in learning about Mars so that it may eventually become habitable for humans. To achieve this, there is a need for comprehensive knowledge of the planet's atmosphere, hydrology, surface chemistry, radiation environment, and spatial features through the scientific literature. These contain valuable information and meaningful quantitative constraints that can be used in other models and studies, such as habitability assessment and future terraforming studies. We present TerraMARS, an end-to-end information extraction pipeline that combines a domain-adapted Small Language Model to answer Mars terraforming-related questions and convert unstructured Mars science text into machine-readable structured outputs in JavaScript Object Notation (JSON) format. A corpus of open-access papers is collected and processed using a multistage retrieval and chunking framework. Google Gemma 3 1B was adapted to the domain using Quantized Low-Rank Adaptation (QLoRA) fine-tuning on Mars-specific question-answering and information extraction datasets. The resulting pipeline generates both types of output and provides a foundation for integrating knowledge from scientific literature into downstream applications like digital twins and habitability modeling for Mars. The output from this pipeline looks promising, but further improvements are needed to increase extraction accuracy and factual consistency.
arXiv:2603.18104v5 Announce Type: replace Abstract: Prevailing AI training assumes reverse-mode automatic differentiation over IEEE-754 arithmetic. The memory overhead of training relative to inference, optimizer complexity, and structural degradation of geometric properties through training are consequences of this arithmetic substrate. This paper develops an alternative training architecture grounded in three prior results: the Dimensional Type System and Deterministic Memory Management framework (Haynes 2026), which establishes stack-eligible gradient allocation and exact quire accumulation as design-time verifiable properties; the Program Hypergraph (Haynes 2026), which establishes grade preservation through geometric algebra computations as a type-level invariant; and the b-posit bounded-regime design (Jonnalagadda et al. 2025), which makes posit arithmetic tractable across hardware targets conventionally considered inference-only. Their composition enables depth-independent training memory bounded to approximately twice the inference footprint, grade-preserving weight updates, and exact gradient accumulation, applicable uniformly to loss-function-optimized and spike-timing-dependent neuromorphic models. We introduce *Bayesian distillation*, a mechanism by which the latent prior structure of a general-purpose model is extracted through the ADM training regime, resolving the data-scarcity bootstrapping problem for domain-specific training. For deployment, we introduce *warm rotation*, an operational pattern in which an updated model transitions into an active inference pathway without service interruption, with correctness formalized through PHG certificates and signed version records. The result is a class of domain-specific AI systems that are smaller and more precise than general-purpose models, continuously adaptive, verifiably correct with respect to the physical structure of their domains, and initializable from existing models.
Scientific papers advance $claims$ that later work supports, extends, or sometimes refutes. Yet existing methods for citation and claim analysis capture only fragments of this dialogue. In this work, we make these interactions explicit at the level of individual scientific claims. We introduce $\texttt{ClaimFlow}$, a claim-centric view of the NLP literature, built from $1{,}617$ ACL Anthology papers $(1979 - 2025)$ that are manually annotated with $5{,}689$ claims and $4{,}871$ cross-paper claim relations, indicating whether a citing paper $\texttt{supports}$, $\texttt{extends}$, $\texttt{qualifies}$, $\texttt{refutes}$, or references a cited claim as $\texttt{background}$. Building on $\texttt{ClaimFlow}$, we define a new task – $Claim Relation Classification$ – which requires models to infer the scientific stance toward a cited claim from the text and citation context. Evaluating neural models and large language models on this task, we report baseline performance of $0.81$ macro-F1, suggesting that the task is tractable while leaving room for improvement. We then scale this framework to $\sim$$13k$ NLP papers to study claim evolution across decades of NLP research. We show that $63.5\%$ claims are never reused; only $11.1\%$ are ever challenged. Widely propagated claims are more often $reshaped$ through qualification and extension than supported or refuted. Overall, $\texttt{ClaimFlow}$ offers a lens for examining how ideas shift and mature within NLP.
Recent advances in tool-integrated language agents have significantly improved their ability to solve complex reasoning tasks. However, existing alignment methods predominantly focus on maximizing task accuracy, while overlooking auxiliary objectives such as tool-use efficiency, which are essential for practical deployment. To address this gap, we introduce ParetoPO, a two-stage multi-objective optimization framework for aligning tool-using large language models (LLMs) under competing objectives. In the first stage, ParetoPO leverages hypervolume-guided dynamic scalarization to adapt reward weights based on global Pareto frontier progress. In the second stage, it replaces scalarized learning signals with Pareto-ranking-based advantage computation, promoting nondominated trajectories through dominance-aware credit assignment. This design enables fine-grained, action-level optimization across multiple conflicting objectives. Experimental results on mathematic reasoning and multi-hop QA tasks show that ParetoPO consistently discovers policies with superior accuracy-efficiency trade-offs compared to static and heuristic baselines.
Graphical user interface (GUI) agents powered by multimodal large language models (MLLMs) have shown greater promise for human-interaction. However, due to the high fine-tuning cost, users often rely on open-source GUI agents or APIs offered by AI providers, which introduces a critical but underexplored supply chain threat: backdoor attacks. In this work, we first unveil that MLLM-powered GUI agents naturally expose multiple interaction-level triggers, such as historical steps, environment states, and task progress. Based on this observation, we introduce AgentGhost, an effective and stealthy framework for red-teaming backdoor attacks. Specifically, we first construct composite triggers by combining goal and interaction levels, allowing GUI agents to unintentionally activate backdoors while ensuring task utility. Then, we formulate backdoor injection as a Min-Max optimization problem that uses supervised contrastive learning to maximize the feature difference across sample classes at the representation space, improving flexibility of the backdoor. Meanwhile, it adopts supervised fine-tuning to minimize the discrepancy between backdoor and clean behavior generation, enhancing effectiveness and utility. Extensive evaluations of various agent models in two established mobile benchmarks show that AgentGhost is effective and generic, with attack accuracy that reaches 99.7\% on three attack objectives, and shows stealthiness with only 1\% utility degradation. Furthermore, we tailor a defense method against AgentGhost that reduces the attack accuracy to 22.1\%. Our code is available at \texttt{anonymous}.
arXiv:2606.12670v1 Announce Type: new Abstract: We introduce a censored version of the stochastic six-vertex model. We show that for parameters $b_1 < b_2$, this model started from the initial condition ${1}_{x>0}$ is stochastically dominated at any time by the blocking measure. This is a partial analog of the censoring inequality for monotone spin systems. In particular, this result allows us to control the behavior of second-class particles. The proof uses parabolic Kazhdan–Lusztig $R$-polynomials, whose appearance is explained using a connection between the stochastic six-vertex model and the Iwahori–Hecke algebras of symmetric groups. Furthermore, we find an intertwining relation for this process using normalized parabolic Kazhdan–Lusztig $R$-polynomials as an intertwining kernel.
Generating complete 3D scenes from a single image requires inferring globally consistent geometry, object relationships, and environmental context from inherently ambiguous visual evidence. Despite recent progress in joint layout-and-mesh generation, existing methods often rely on holistic or weakly decomposed pipelines that entangle many factors at once and demand extensive scene-level supervision, limiting their generalization to complex real-world environments. We propose a multi-agent orchestration framework that decomposes single-image 3D scene generation into three structured stages: scene initialization, environment construction, and multi-agent refinement. The initialization stage extracts image-derived object masks, builds object-level 3D representations, and predicts an initial spatial layout to form a coarse 3D scene. The environment-construction stage then leverages this initialization together with point-map geometry to build an environmental scaffold of supporting surfaces, room boundaries, materials, and illumination. Finally, in the refinement stage, a planner agent identifies structural and visual inconsistencies, applies simple corrections directly, and dispatches specialist agents for complex localized revisions that are reintegrated into the global scene. To provide reliable structural initialization while reducing reliance on scene-level annotations, we further introduce a geometry-aware layout predictor supervised by sparse geometric priors derived from point maps. Unlike fully supervised layout generators, the predictor can be trained from segmentation-level data and generalizes robustly to diverse real-world scenes. Extensive experiments on benchmark datasets show that our method consistently outperforms prior approaches in geometric accuracy, spatial consistency, and perceptual realism.
Fillets of raw fish are irregular in shape and floppy in texture, but a robot with three arms has learnt how to manipulate a salmon loin. Fillets of raw fish are irregular in shape and floppy in texture, but a robot with three arms has learnt how to manipulate a salmon loin.
arXiv:2606.16652v1 Announce Type: cross Abstract: Temporary accommodation has become a major fiscal and administrative pressure for English local authorities, particularly in London, where demand and costs have risen sharply. This paper documents the creation and use of DOMUS, a cloud-based, AI-enabled decision-support system built from scratch at the University of East London and customised for the needs of London Borough of Newham to support statutory Temporary accommodation placement. DOMUS integrates household case records, policy-constrained affordability and suitability rules, and live private-rental listings within a single governance-aligned workflow. The system combines transparent, rule-based filtering with large language model-assisted search to standardise the application of bedroom need, affordability thresholds, geographic preferences, and accessibility requirements, while preserving officer discretion and audibility. Household and property attributes are encoded into policy-consistent representations prior to AI-assisted ranking and explanation. A pilot deployment in Newham's secure environment evaluated operational performance relative to manual workflows. Results indicate substantial reductions in search time, improved adherence to key placement constraints, and high staff satisfaction, while maintaining statutory compliance and role-based accountability. Beyond TA, the paper frames DOMUS as replicable digital public infrastructure: a modular, cloud-native Software-as-a-Service architecture that can be deployed across other UK boroughs and adapted to other public administration tasks characterised by scarcity, rule-bound eligibility, and high stakes. The findings demonstrate the feasibility of scalable, ethically governed AI deployment in local government and contribute to debates on AI-enabled public value creation in e-governance.
Background. Three disease-modifying therapies (DMTs) for spinal muscular atrophy (SMA) have been approved since 2016, yet many adults remain untreated. Identifying them depends on ICD-10 codes that capture SMA but do not reliably distinguish it from other related conditions. We examined, in one U.S. health system, both patients' engagement with therapy and the accuracy of the codes used to find them. Methods. We conducted a retrospective chart review of adults in an academic health system identified by SMA-associated ICD-10 codes, with manual adjudication of diagnosis and DMT status. Confirmed SMA-positive, DMT-naive patients were invited to a structured telephone interview on treatment awareness and barriers. Results. Of 60 charts, 22 (36.7%; 95% CI 25.6-49.3%) were appropriately coded for SMA or a related disorder; only 16 (26.7%) had molecularly confirmed SMA. The other 38 (63.3%) were miscoded, spanning spinal and bulbar muscular atrophy, asymptomatic carriers, prenatal screening, and conditions unrelated to SMA. Ten of the 16 confirmed patients (62.5%) were DMT-naive; one was interviewed, one declined, and eight could not be reached. The non-response is itself a finding: the patients least visible to administrative data are the hardest to reach. Conclusions. ICD-10 ambiguity is a barrier to treatment access in adult SMA, as is loss to follow-up. We make two recommendations: continuous documentation-coding alignment that uses natural language processing to verify the genetic precondition, and type-specific SMA codes (subcodes for Types 0-4) anchored on molecular SMN1 confirmation. Together these would support cohort identification, outreach, and evidence generation without adding to clinician burden.
Andrew Kythreotis re-evaluated his personal and professional priorities after a mid-career opportunity to move abroad fell through. Andrew Kythreotis re-evaluated his personal and professional priorities after a mid-career opportunity to move abroad fell through.