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01.
arXiv (CS.LG) 2026-06-25

Solving Markov Decision Processes with Future Information via MPC

arXiv:2606.24991v1 Announce Type: cross Abstract: Model Predictive Control (MPC) is widely used in industrial and robotic systems for enforcing constraints and embedding domain knowledge through finite-horizon optimization-based planning. However, despite these strengths, an MPC scheme typically does not yield optimal policies for sequential decision-making problems formulated as Markov Decision Processes (MDPs). Recent combinations of MPC with Reinforcement Learning (RL) alleviate this issue by treating MPC as a parameterized model of the optimal policy of an MDP and adjusting its parameters using data. While these approaches typically consider classical MDPs, many real-world problems include future information–such as forecasts, prices, or reference trajectories–at decision time, which must be included in the MDP state for optimal decision-making. Current MPC-RL approaches do not directly account for this augmented-state structure, raising the question of how to incorporate future information into MPC to obtain an optimal policy. This work establishes the structural requirements under which a parameterized MPC can exactly represent the optimal value functions and policy of an MDP with future information. We further demonstrate that such a parameterized MPC can serve as a structured function approximator, with its parameters learned using RL. The approach is illustrated on a point-mass racing task with future reference information.

02.
arXiv (CS.CV) 2026-06-17

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

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

03.
medRxiv (Medicine) 2026-06-24

Study partner profile effects on CDR-SB change in anti-amyloid therapy evaluation

INTRODUCTION: The Clinical Dementia Rating Sum of Boxes (CDR-SB), a primary outcome in anti-amyloid therapy (AAT) trials, integrates information from participants and study partners. CDR-SB scores may vary by study partner characteristics, but their impact on 18-month change interpretation remains unclear. METHODS: Using the NACC Uniform Data Set, we fitted linear mixed-effects calibration models in an Alzheimer's disease (AD)-primary early symptomatic cohort and propagated study partner-associated coefficients through Monte Carlo simulations. We estimated components of 18-month CDR-SB change under observed profile changes, simulated follow-up imbalance in a common female living-with profile, and tipping-point scenarios. Analyses were repeated in amyloid-positive and trial-like cohorts. RESULTS: The AD-primary cohort included 15,061 participants and 7,683 baseline-to-18-month pairs. Observed profile changes generated a negligible cohort-level component (mean 0.0014 points, 95% simulation interval 0.0006 to 0.0022). Simulated follow-up imbalance generated differences of 0.014 to 0.071 points across 10% to 50% reassignment. Under the primary calibration model, generating a 0.45-point difference, equal to the reported Clarity AD CDR-SB group difference, required median net imbalance >100% and was feasible in 48% of iterations. Amyloid-positive and trial-like cohorts had lower median tipping points but wider intervals, reflecting coefficient imprecision. DISCUSSION: In the large AD-primary cohort, observed study partner profile changes and simulated follow-up imbalance generated CDR-SB differences that were small relative to the 0.45-point Clarity AD benchmark. Biomarker-confirmed estimates were less stable because of coefficient imprecision. These findings suggest limited impact under typical AD-primary conditions but support systematic study partner profile collection and sensitivity analyses in observational and external-comparator CDR-SB studies for AAT evaluation.

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

Defending against Adaptive Prompt Injection Attacks via Reasoning-enabled Task Alignment

arXiv:2606.15441v1 Announce Type: cross Abstract: Indirect prompt injection attacks hijack LLM-based agents by embedding malicious instructions in third-party data that the agent retrieves during task execution. Existing defenses report near-zero attack success rate on static benchmarks, yet recent adaptive evaluations show that these results collapse once the attacker is allowed to optimize against the deployed defense. In this work, we trace this collapse to two failure modes. First, existing defense methods are confined to recognizing specific attack patterns, rather than assessing whether the intent of every embedded instruction is relevant to the user task. Second, training-based defenses, which otherwise offer the strongest safety-utility trade-off, assemble their adversarial examples from a handful of hand-crafted templates, and the resulting defender fails to generalize outside that narrow strategy distribution. To address these gaps, we propose RETA, a training-based method that grounds defense decisions on the user tasks rather than attacker-controlled data. At each tool-output step, the defender undertakes chain-of-thought reasoning verifying that its actions are consistent with the user task. Leveraging red-teaming, a simulated attacker synthesizes adversarial training data and receives a dictionary-learning diversity reward, achieving broad coverage of injection-reformulation strategies. Together, these allow the defender to be optimized via multi-objective reinforcement learning and achieve better safety-utility trade-off. Across six black-box adaptive attacks, RETA keeps every per-attack ASR below 10%, with average ASR of 2.92% and 3.75% on the two target models, while preserving most utility under attack and on clean inputs.

05.
arXiv (quant-ph) 2026-06-25

Collective rotational cat states of molecules in microwave cavities

arXiv:2606.25815v1 Announce Type: new Abstract: We show theoretically that an ensemble of polar molecules coupled to a microwave cavity supports hybrid rotational-photonic cat states. The cavity couples to a symmetric rotor in the bright manifold of $N$ molecules with $\sqrt{N}$-enhancement. In the dispersive limit of the collective strong coupling regime, virtual multilevel transitions induce an effective Kerr nonlinearity, as confirmed by Wigner tomography and a Schrieffer-Wolff analysis, leading to parity-locked cat structure in the cavity sectors. Collective molecular rotations thus provide a new route to hybrid light-matter cat states.

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

On the Reliability of Cue Conflict and Beyond

Understanding how neural networks rely on visual cues offers a human-interpretable view of their internal decision processes. The cue-conflict benchmark has been influential in probing shape-texture preference and in motivating the insight that stronger, human-like shape bias is often associated with improved in-domain performance. However, we find that the current stylization-based instantiation can yield unstable and ambiguous bias estimates. Specifically, stylization may not reliably instantiate perceptually valid and separable cues nor control their relative informativeness, ratio-based bias can obscure absolute cue sensitivity, and restricting evaluation to preselected classes can distort model predictions by ignoring the full decision space. Together, these factors can confound preference with cue validity, cue balance, and recognizability artifacts. We introduce REFINED-BIAS, an integrated dataset and evaluation framework for reliable and interpretable shape-texture bias diagnosis. REFINED-BIAS constructs balanced, human- and model- recognizable cue pairs using explicit definitions of shape and texture, and measures cue-specific sensitivity over the full label space via a ranking-based metric, enabling fairer cross-model comparisons. Across diverse training regimes and architectures, REFINED-BIAS enables fairer cross-model comparison, more faithful diagnosis of shape and texture biases, and clearer empirical conclusions, resolving inconsistencies that prior cue-conflict evaluations could not reliably disambiguate.

07.
arXiv (quant-ph) 2026-06-16

Reconstruction of detector error model for quantum error correction

arXiv:2606.16288v1 Announce Type: new Abstract: Fault-tolerant quantum computing fundamentally relies on the accurate characterization of circuit-level noise to optimize decoding algorithms. However, extracting complex multi-body error correlations remains challenging. Contemporary greedy inference algorithms can suffer from statistical distortion, discarding true physical mechanisms while introducing many unphysical false positives. Here, we introduce the Correlation-Analysis-based Hypergraph Reconstruction (CAHR) algorithm, a globally consistent framework to invert experimental syndrome statistics directly into discrete physical hypergraphs. By coupling exact algebraic correlation equations with a top-down concurrent-pruning strategy, CAHR recovers the fault topology without false positives for both $d=5$ rotated surface codes and dense 8-body 2D color codes in our benchmark settings. Furthermore, we show that exact continuous parameter extraction in dense codes is limited by a variance cascade, where absolute statistical variance accumulates linearly from high- to low-degree mechanisms. This motivates a two-stage inference paradigm: utilizing CAHR to extract the fault topology, followed by continuous probability optimization. This provides a practical approach for characterizing and decoding highly correlated noise in realistic quantum hardware.

08.
arXiv (quant-ph) 2026-06-25

Detection of patterns in a discrete-outcome sensor network

arXiv:2606.25100v1 Announce Type: new Abstract: A discrete outcome quantum sensor network is one in which we are only interested in which detectors are activated. This can be studied in either the strong or weak interaction regime. If the detectors interact strongly with the environment, it is possible to definitely find which ones were activated. If the interaction is weaker, there is a possibility of making an error, and the object is to minimize the probability of this happening. Here we will be interested in this weaker interaction regime. We will also assume that only certain patterns of detectors will be activated, different patterns being translated versions of a fundamental one. Our object will be to find which pattern has been activated. We will look at both one and two-dimensional detector arrays and make use of techniques from minimum-error state discrimination.

09.
arXiv (quant-ph) 2026-06-25

Self-Modulating Quantum Fast-Weight Programmers for Efficient Adaptive Sequential Learning

arXiv:2606.24933v1 Announce Type: new Abstract: Recent advances in quantum machine learning have motivated efficient models for sequential data processing. In this paper, we propose Self-Modulating Quantum Fast Weight Programmers, or Self-Modulating QFWP, which extends Quantum Fast Weight Programmers by introducing adaptive modulation over both newly generated fast-weight updates and historical fast-weight memory. Numerical results show that the proposed mechanism improves convergence stability and prediction performance across varying model settings, including different numbers of qubits and input sequence lengths. We further provide theoretical arguments explaining how self-modulation balances new information injection with memory retention, thereby enhancing temporal information propagation. These results suggest that Self-Modulating QFWP is a compact and effective framework for quantum machine learning on time-series data.

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

An Integrable Token Mixing Layer from the Generalized Yang Baxter Equation

arXiv:2606.15085v1 Announce Type: new Abstract: The YB Mixer is a sequence token mixing layer derived from free fermion and generalized Yang Baxter structures. It applies a core principle from integrable systems where a local algebraic constraint guarantees global computational stability. By using the Ising exchange algebra the mixer creates a free fermionic structure that acts as an exactly norm preserving orthogonal map. This algebra also produces commuting transfer matrices which allow inference to be order free and adaptable to any variable budget. To ensure the model can generalize to longer sequence lengths it uses a spectral circulant generator. This generator maintains the crucial orthogonal and commuting properties of the system. The result is a highly stable and mathematically grounded architecture for sequence processing.

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

Which Pairs to Compare for LLM Post-Training?

arXiv:2606.19607v1 Announce Type: new Abstract: Preference-based post-training has become a central paradigm for aligning language models. A common data-collection strategy is to generate a small set of completions for each prompt and label the resulting comparison pairs. However, human preference labels are often much more expensive than generating additional completions, suggesting a different use of the same labeling budget: generate a larger pool of completions, but label only the most informative comparison pairs. This paper studies which pairs should be compared in preference-based post-training. We formulate comparison curation as a sampling-design problem and evaluate designs by the quality of the final policy under the preference-based post-training objective. We instantiate this framework for Direct Preference Optimization (DPO), analyzing how the choice of labeled pairs propagates through DPO training to downstream policy performance. Our main results provide matching upper and lower bounds on the post-training optimality gap of the DPO-trained policy. The bounds show that comparison selection affects downstream performance through a single design-dependent information matrix, which links label allocation to parameter estimation error and policy suboptimality. This yields an explicit optimization criterion for budgeted comparison curation and motivates practical sampling designs for selecting informative pairs from large generated completion pools. Experiments on synthetic settings and language-model post-training benchmarks show that the proposed designs consistently improve sample efficiency over common comparison-selection heuristics.

12.
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 $91.8\%$.

13.
arXiv (CS.CV) 2026-06-19

HY-WU (Part I): An Extensible Functional Neural Memory Framework and An Instantiation in Text-Guided Image Editing

Foundation models are transitioning from offline predictors to deployed systems expected to operate over long time horizons. In real deployments, objectives are not fixed: domains drift, user preferences evolve, and new tasks appear after the model has shipped. This elevates continual learning and instant personalization from optional features to core architectural requirements. Yet most adaptation pipelines still follow a static weight paradigm: after training (or after any adaptation step), inference executes a single parameter vector regardless of user intent, domain, or instance-specific constraints. This treats the trained or adapted model as a single point in parameter space. In heterogeneous and continually evolving regimes, distinct objectives can induce separated feasible regions over parameters, forcing any single shared update into compromise, interference, or overspecialization. As a result, continual learning and personalization are often implemented as repeated overwriting of shared weights, risking degradation of previously learned behaviors. We propose HY-WU (Weight Unleashing), a memory-first adaptation framework that shifts adaptation pressure away from overwriting a single shared parameter point. HY-WU implements functional (operator-level) memory as a neural module: a generator that synthesizes weight updates on-the-fly from the instance condition, yielding instance-specific operators without test-time optimization.

14.
arXiv (CS.AI) 2026-06-17

EvolveNav: Proactive Preflection and Self-Evolving Memory for Zero-Shot Object Goal Navigation

arXiv:2606.18235v1 Announce Type: new Abstract: Zero-Shot Object-Goal Navigation (ZS-OGN) requires embodied agents to explore and locate target objects without any prior training. To this end, recent methods leverage foundation models. But they typically rely on static priors and lack adaptation, which leads to repeated errors and costly trial and error. In this paper, we propose a self-evolving ZS-OGN framework that enables continuous test-time improvement. Specifically, we build an agentic rule memory by extracting actionable knowledge from past trajectories. Then, we propose a retrieval strategy based on upper confidence bound, selecting effective rules by balancing semantic relevance and historical success. In addition, we introduce a memory-guided preflection module that forecasts potential outcomes before action, reducing inefficient exploration. Extensive experiments show that our method outperforms existing zero-shot baselines, achieving a 10.1\% improvement in success rate with fewer unnecessary steps.

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

A nonparametric two-sample test using a parametric integral probability metric

arXiv:2606.16941v1 Announce Type: cross Abstract: Detecting distributional differences between two independent samples is a fundamental problem in statistics and machine learning. Nonparametric two-sample testing provides a principled framework for determining whether two samples are drawn from the same underlying distribution, without assuming any specific parametric form for the distribution. In this study, we propose a new two-sample test statistic based on a newly introduced integral probability metric (IPM), using a specially designed parametric discriminator class with a single node of a neural network. We show that the resulting test statistic, called PReLU-IPM, is nonparametric and establish theoretical guarantees for the associated two-sample testing procedure, PReLU-TST, including its consistency and asymptotical equivalence to nonparametric IPM-based tests under regularity conditions. By analyzing multiple simulated and real benchmark datasets, we demonstrate that PReLU-TST achieves higher power across a range of alternatives or performs comparably to its competitors, for finite samples.

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

Sub-Semantic Image Segmentation

Images can be segmented based on visual cues (i.e., texture segmentation) or into objects (i.e., semantic segmentation). We propose a new category of sub-semantic image segmentation that blurs the line between the two. In sub-semantic image segmentation, language is not used to name whole objects. Instead, it is used to partition an image into stable appearance patterns that can be described by language. To do that, we couple a general-purpose vision-language model to SAM 3, a promptable segmentation backbone whose native text pathway can ground rich descriptions into masks. Simple coupling fails for a number of reasons that we identify in the paper, and we overcome them by introducing DETECTURE that resolves three concrete failure modes – language leakage between texture regions, prompt competition inside the segmentation backbone, and semantic distortion at the language-to-mask interface. Since there is no dataset of sub-semantic image segmentation, we introduce one, termed TextureADE. The new dataset is derived from the ADE20K dataset using a system we designed. We compare DETECTURE to a number of baselines and find that it achieves the strongest performance on several datasets using different metrics. Code is available at https://github.com/Scientific-Computing-Lab/TextureDetecture.

17.
arXiv (CS.CV) 2026-06-12

Perceive, Interact, Reason: Building Tool-Augmented Visual Agents for Spatial Reasoning

While recent vision-language models (VLMs) demonstrate strong multimodal understanding, they remain limited in spatial reasoning tasks that require active evidence acquisition and multi-step visual interaction. This limitation suggests that relying solely on implicit visual representations from vision encoders is insufficient for recovering fine-grained spatial evidence. We introduce PERception-Interaction-reason Agent (PERIA), a tool-augmented visual agent for spatial reasoning tasks across map reasoning, visual probing, and vision reconstruction. PERIA uses two lightweight tool families: vision perception tools for exposing textual, symbolic, and spatial evidence, and vision interaction tools for manipulating visual context, tracing paths, and verifying spatial relations. To train PERIA, we develop a unified recipe that combines supervised tool-use trajectory synthesis, composite rewards, and Observation-Relaxed Group-in-Group Policy Optimization (OR-GIGPO) for effective multi-tool behavior. Experiments on 13 benchmarks from 8 datasets show that PERIA-8B improves over the Qwen3-8B backbone by 10.0% on in-distribution benchmarks and 4.4% on out-of-distribution benchmarks, while outperforming previous state-of-the-art baselines of similar size by 7.0%-14.8%. It also achieves performance comparable to much larger models such as Qwen3-VL-235B-A22B-Thinking and GPT-5, demonstrating the effectiveness of PERIA in enhancing spatial reasoning capabilities.

18.
medRxiv (Medicine) 2026-06-19

Hyperleukocytosis and outcomes in pediatric B-cell acute lymphoblastic leukemia: A report from the REDIAL Consortium

Hyperleukocytosis (white blood cell [WBC] count >100 000/uL) at diagnosis is an important prognostic risk factor in pediatric acute lymphoblastic leukemia (ALL), though its significance with contemporary therapy is unclear. We analyzed 1 826 pediatric ALL patients from a multi-institution cohort to determine whether hyperleukocytosis independently predicts outcomes using multivariable Cox proportional hazard modeling. Hyperleukocytosis occurred in 211 patients (12%), with 121 having B-ALL, and showed no prognostic significance in T-ALL patients. In B-ALL, 5-year event-free survival (EFS) was 65% versus 89% for non-hyperleukocytosis patients, and overall survival (OS) was 78% versus 93%. After adjustment for age, cytogenetic risk, central nervous system disease status, and treatment site, hyperleukocytosis remained an independent predictor of end-of-induction minimal residual disease (MRD) positivity (odds ratio 2.53 [95% confidence interval [CI]: 1.71-3.94; p

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

Biophysical EPR Using Superconducting Resonators

arXiv:2606.23952v1 Announce Type: new Abstract: We present innovations that enable the use of superconducting resonators for high sensitivity, high bandwidth pulsed electron paramagnetic resonance (EPR) measurements on biologically relevant samples with enhanced stability and throughput. A custom-built X-band pulsed EPR spectrometer with AWG and digital IF capability generated by an FPGA was used to control a novel patterned thin film planar superconducting microstrip resonator capable of generating Rabi fields sufficient to achieve 6 ns pi/2 Gaussian pulses using a 100 W solid-state HPA. The system allows automated sequential calibration, measurement, and analysis of five 3.5 uL samples contained in a sample cartridge. Performance was validated through measurements of double electron-electron resonance (DEER) distances in a variety of spin-labeled protein samples with biologically relevant concentrations, including measurements below 10 uM. The results enable broadening the scope of applications for both superconducting resonators and the use of EPR in biotechnology.

20.
arXiv (CS.CV) 2026-06-17

High-Fidelity 3D Geometric Reconstruction of Pelvic Organs from MRI: A Hybrid Deep Learning and Iterative Optimization Approach

Patient-specific 3D reconstruction of pelvic organ geometry from MRI is important for pelvic floor modeling and downstream patient-specific analysis. However, while previous studies have focused primarily on either image segmentation or downstream use of 3D models, the reconstruction of high-fidelity, high-quality geometries remains labor-intensive and poorly standardized. The study introduced a hybrid deformable shape modeling framework that integrates deep learning prediction with iterative optimization for the reconstruction of the bladder, uterus, and rectum. The framework consists of three core components: a geometry-aware multi-level deep learning architecture that preserves topological consistency of pelvic organs; a two-stage amortized optimization training strategy that balances global shape capture and local surface refinement; and a holistic synergy mechanism–where iterative optimization provides supervision for deep learning during the training phase, and during inference, deep learning rapidly predicts the global organ morphology, followed by iterative optimization to refine local surfaces and mesh quality. This framework demonstrated marked superiority in geometric fidelity than current mainstream deep learning-based organ reconstruction models. For individual anatomical structures, the reconstructed 3D geometries for the bladder, rectum, and uterus achieved significantly lower Chamfer Distance values and higher Dice Similarity Coefficient scores. In addition, while maintaining high computational efficiency, the proposed architecture yielded superior overall volumetric mesh quality. At the patient level, the framework achieved higher mean values for the 10 worst elements for both minSICN and minSIGE compared to traditional geometric post-processing algorithms.

21.
arXiv (math.PR) 2026-06-11

Patterned matrices with random walk entries

arXiv:2512.04612v3 Announce Type: replace Abstract: It is well known that the weak limit of a suitably scaled continuous-time random walk (CTRW) is the Brownian motion. We investigate the convergence of certain patterned random matrices whose entries are independent CTRWs and their time-changed versions, in a non-commutative probability framework. For the Wigner link function, the limits are free Brownian motion and its time-changed version driven by an inverse stable subordinator. For the symmetric circulant and the circulant with CTRW entries, we use their explicit eigenvalue expressions to define some empirical processes that converge weakly to a Brownian motion and a complex Brownian motion, respectively. For matrices with iid entries, and for elliptic matrices, the algebraic limits are equal in $*$-distribution to processes whose marginals are circular and elliptic variables, respectively. A random time-changed variant of these results is also established.

22.
arXiv (CS.CV) 2026-06-25

Concept Removal for Frontier Image Generative Models

Image generative models are trained on massive, largely uncurated internet-scale datasets that contain undesirable visual concepts. Efficiently removing such concepts from the model generations without degrading the quality of output images remains challenging. We introduce a novel concept removal method for frontier diffusion and image autoregressive models, such as SD3.5, Flux, and Infinity. Our intervention replaces the internal bottleneck layer present in all these modern models with a transcoder that is trained to replicate the original layer while structuring it into distinct activation features. This in-place substitution creates an integrated filter through which concept-specific signals can be selectively disabled while preserving the rest of the model's behavior. Since the intervention modifies the model backbone rather than attaching an external component, it remains persistent under white-box access. Empirically, the approach achieves state-of-the-art concept removal performance across modern diffusion and autoregressive models, maintains visual generation quality, provides robustness against adversarial prompts, and supports sequential removal of diverse concepts. This positions our method as a practical approach for concept removal in frontier image generative models.

23.
medRxiv (Medicine) 2026-06-22

A Plasmodium vivax controlled human infection and transmission model to evaluate interventions across the life cycle

Background Plasmodium vivax is an underappreciated cause of malaria disease burden. No reproducible and standardized full life-cycle controlled human malaria infection (CHMI) model to accelerate development of novel interventions is available. Methods This transmission-CHMI trial was conducted in Nijmegen, Netherlands. Healthy, malaria-naive adults were sequentially enrolled into three cohorts of four and inoculated with the asexual blood-stage isolate PvW1. Primary endpoint was proportion of oocyst-positive laboratory-reared Anopheles stephensi mosquitoes. The sequential design allowed for adaptations between cohorts. At parasitemia >10 parasites/microL or symptom onset, participants received oral gametocyte-sparing treatment (GST): mepacrine (Cohort 1 and 3; 100 mg at 0, 8 16 hours, then once daily for 3 days) or piperaquine (Cohort 3; 480 mg single-dose). Transmission was assessed by direct skin feeding (DSF) and membrane feeding assay (DMFA) with and without enrichment of gametocytes. End-of-study treatment was atovaquone-proguanil (1000/400 mg once daily for 3 days). The trial was registered: NL-OMON57011. Findings Participants were enrolled between September 17, 2024 and March 25, 2025, all (12/12) developed parasitemia and transmitted PvW1 to mosquitoes. No serious adverse events occurred. Most adverse reactions were related to malaria. Mepacrine and piperaquine reduced asexual parasitemia while preserving gametocytemia and transmission. Peak transmission occurred within 3 days after GST and depended on the parasite developmental cycle, with highest gametocyte-infectivity ~48 h post ring-stage. In Cohort 3, mosquito infection reached 100% in all transmission assays. Median peak oocyst counts were 24 (IQR: 14-31) for DSF, 17 (12-19) for DMFA, and 150 (116-199) for enriched DMFA. A two-fold increase in pre-GST maximal parasitemia was associated with 20 additional oocysts (95% CI 8,6-32) in enriched DMFA. Sporozoites were viable in primary human hepatocytes. Interpretation A PvW1 transmission-CHMI is reproducible and safe, enabling P. vivax sporozoite production, relapse models and evaluation of transmission-blocking interventions.

24.
medRxiv (Medicine) 2026-06-18

Avidity of anti-pertussis toxin antibodies is associated with symptomatic Bordetella pertussis infection in a novel controlled human infection model

Background The association between functional antibody responses following Bordetella pertussis infection and symptomatic disease remains unclear. We characterized the maturation of anti-pertussis toxin (PT) IgG avidity after human challenge with B. pertussis and determined its association with symptomatic infection. Methods Healthy adults were intranasally inoculated with live B. pertussis organisms in a controlled human infection model and monitored for development of pertussis symptoms (NCT05136599). Serum samples were collected one day before inoculation and at 14, 28, 56, 180, and 365 days post challenge. Anti PT IgG avidity was tested using a titration of ammonium isothiocyanate (the bond breaking agent) to quantify a wide range of antibody avidities from low to very-high. Associations between covariates and avidity were examined using linear regression models, and high dimensional analyses were used to integrate all data. Findings Anti PT IgG avidity increased in both symptomatic (n=20) and asymptomatic (n=10) participants after the challenge, reached maximum levels at day 56, and then declined through day 365. Symptomatic participants developed significantly higher levels of high- and very high-avidity anti-PT antibodies at 28, 56, 180, and 365 days post-challenge compared with those who remained asymptomatic. In multivariate analyses, symptomatic infection was associated with higher levels of high and very high avidity anti-PT IgG at day180 and365 after challenge. Distinct avidity profiles in symptomatic vs asymptomatic participants emerged at day28 onwards, with the former group having higher levels of antibodies with higher avidities. However, levels of medium-high, high and very high avidity antibodies in symptomatic participants were lower at day 365 after challenge compared to their peak levels. Interpretation Anti-PT IgG avidity was associated with symptomatic B. pertussis infection and thus may serve as a surrogate of clinical disease outcome. These results highlight that antibody avidity provides an additional functional assay besides antibody quantitation to dissect immune responses to pertussis. Further investigation of anti PT IgG avidity should be pursued in natural pertussis outbreaks to determine whether it might be used to differentiate symptomatic from asymptomatic infections for epidemiologic purposes.

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

Pathway-Structured Privileged Distillation for Deployable Computational Pathology

Integrating transcriptomics and histopathology can improve cancer risk modelling, yet practical use is constrained by the limited availability of RNA profiling in routine settings. Here we introduce Mixture of Pathway Experts (MoPE), a knowledge-distillation framework that reframes multimodal learning as privileged distillation for histology-only inference. MoPE is motivated by the partial observability between RNA profiles and whole-slide images: histology can capture morphology-linked consequences of certain molecular programmes, but cannot be expected to reconstruct the full transcriptomic state. MoPE encodes RNA-derived pathways and transfers the molecular supervision to pathway-indexed pathology experts through memory-usage alignment. Across diverse public benchmarks and two independent breast cancer cohorts, MoPE consistently improved WSI-only inference performance relative to baseline methods. Pathway-usage analyses and human-audited visual inspection provide bounded inspection of model behaviour and candidate morphology-linked readouts. These results support pathway-structured privileged distillation as a promising route to using molecular information during training while preserving RNA-free inference.