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01.
bioRxiv (Bioinfo) 2026-06-14

Somatic variant detection in normal tissues from single-cell sequencing data

A crucial advantage of single-cell sequencing (SCS) is its ability to identify somatic variants in individual cells, enabling phylogenetic analysis of cellular populations within bulk tissues. While identifying somatic variants in tumor tissues via SCS has become a common practice, doing so in normal tissues remains challenging due to the rarity of somatic variants in normal cells. To evaluate the feasibility of somatic variant calling from widely available single-nucleus RNA-seq (snRNA-seq) and single-nucleus ATAC-seq (snATAC-seq) data, we profiled a Cell-line mix of six HapMap samples prepared by the SMaHT consortium using 10x Genomics 5' snRNA-seq (12k cells with 36k mean reads per cell) and snATAC-seq (11k cells with 14k median high-quality fragments per cell) for variant calling. PacBio long-read whole genome sequencing (WGS) data (109x) generated from individual cell lines were used as ground truth. Two computational tools, Monopogen and SComatic, were used for somatic variant calling from the SCS data. Monopogen achieved single nucleotide variant (SNV) detection accuracies of 93.30% in the snRNA-seq and 99.64% in the snATAC-seq data, both of which outperformed SComatic (74.35% and 94.29%, respectively). Monopogen also consistently detected somatic SNVs at cellular fractions as low as 0.5% (2.54% in snRNA and 0.81% in snATAC) in individual samples. Notably, snATAC-seq exhibited higher genomic coverage breadth and larger number of variants detected than snRNA-seq. While the SCS data have lower overall genome coverage than that of the bulk WGS, the single-cell level variant resolution allows Monopogen to assign variants to their cells of origin with over 80% accuracy in both RNA and ATAC modalities, thereby facilitating studies of clonal evolution and cell-type-specific mutagenesis. Other benchmarking methods were also evaluated (DeepVariant, Cellsnp-lite and Mutect2) for comparison. In conclusion, our study demonstrated the feasibility of performing reliable single-cell somatic mutation calling in a cell-line mixture and discussed the strengths and limitations of current computational methods when applied to normal tissues.

02.
arXiv (CS.LG) 2026-06-11

Renewable Lasso without Batch-Number Constraints: A Gradient-Enhanced Approach

arXiv:2606.11738v1 Announce Type: cross Abstract: We study online estimation for high-dimensional generalized linear models with streaming data. First, for the non-distributed setting, we propose a gradient-enhanced surrogate loss that approximates the cumulative loss using only historical summaries, which modifies and improves upon the existing renewable estimation approach for the same model in the high-dimensional setting, and removes the batch-number constraint in previous studies. We then extend the method to distributed streaming data under the master-client architecture, where batches are partitioned across sites and only summaries (gradient vectors) are exchanged. Instead of directing applying the popular method of Jordan et al. (2019) to the surrogate quadratic loss, our adjusted approach does not require the clients to compute the full surrogate loss. We derive non-asymptotic error bounds under the high-dimensional scaling, without the stringent constraint on the number of batches in the previous studies. Simulation results under linear and logistic models, together with a real-data application, show improved accuracy over existing renewable estimators.

03.
arXiv (CS.LG) 2026-06-17

Softmax as Linear Attention in the Large-Prompt Regime: a Measure-based Perspective

arXiv:2512.11784v2 Announce Type: replace Abstract: Softmax attention is a central component of transformer architectures, yet its nonlinear structure poses significant challenges for theoretical analysis. We develop a unified, measure-based framework for studying single-layer softmax attention under both finite and infinite prompts. For i.i.d. Gaussian inputs, we lean on the fact that the softmax operator converges in the infinite-prompt limit to a linear operator acting on the underlying input-token measure. Building on this insight, we establish non-asymptotic concentration bounds for the output and gradient of softmax attention, quantifying how rapidly the finite-prompt model approaches its infinite-prompt counterpart, and prove that this concentration remains stable along the entire training trajectory in general in-context learning settings with sub-Gaussian tokens. In the case of in-context linear regression, we use the tractable infinite-prompt dynamics to analyze training at finite prompt length. Our results allow optimization analyses developed for linear attention to transfer directly to softmax attention when prompts are sufficiently long, showing that large-prompt softmax attention inherits the analytical structure of its linear counterpart. This, in turn, provides a principled and broadly applicable toolkit for studying the training dynamics and statistical behavior of softmax attention layers in large prompt regimes.

04.
arXiv (CS.AI) 2026-06-11

Towards Responsibly Non-Compliant Machines

arXiv:2606.12147v1 Announce Type: new Abstract: We consider the problem of engineering autonomous intelligent agents that are capable to responsibly not comply with user requests. We argue that machine non-compliance comes in many different forms, and sketch the issues we should pursue on the road of accomplishing responsibly non-compliant intelligent machines. We anchor responsible non-compliance in justifications for task refusal, pathways to override the non-compliance, as well as careful tracking of security risks and liability transfers.

05.
medRxiv (Medicine) 2026-06-22

Use of the Pharmacy First service in England in the first 12 months: geographic variation and health system context

Objectives: The Pharmacy First (PF) service was introduced across England from 31 January 2024 to expand the clinical role of community pharmacies and improve access to primary care. This paper describes use of PF in its first 12 months, in terms of uptake, access routes, consultation outcomes, geographic variations, service costs and antimicrobial supply. Methods: A descriptive analysis of all PF consultations submitted for payment to NHS Business Services Authority in England between 31 January 2024 and 31 January 2025. Pharmacy-level consultation data were linked to national data on population, location and pharmacy characteristics. PF use was examined using population-standardised consultation rates and consultations per pharmacy. Results: During the first year of implementation, 2,205,731 PF consultations were recorded as delivered across 11,349 pharmacies, with payment of GBP123 million to pharmacies. Uptake increased steadily over time. Most consultations were for acute sore throat (33%) and uncomplicated urinary tract infection (27%), with corresponding antibiotics, phenoxymethylpenicillin and nitrofurantoin being the most supplied. Most people self-referred (74%) into the service, with 95% of consultations managed without onward referral. Substantial geographic variation was observed. Northern regions had higher use based on the eligible population. The South East and Midlands had higher activity per pharmacy. London showed a distinct pattern, with higher self-referral into the service, lower medication supply and higher referral to other healthcare services. Higher consultation volume was weakly associated with pharmacy characteristics, including opening hours, pharmacy type and retail setting, and local context, in terms of socio-economic and geographic factors. Conclusions: PF had immediate uptake and is operating primarily as a direct-access model for common acute conditions. Findings suggest that PF is contributing to improved access to care and may shift demand away from general practice. However, the service uptake appears to be shaped by geographic location, proximity to other healthcare services and pharmacy characteristics.

06.
bioRxiv (Bioinfo) 2026-06-16

Phylogenetic tree inference using generative models

Accurate inference of phylogenetic trees is fundamental to evolutionary biology, yet existing methods rely on complex pipelines involving multiple sequence alignment, explicit evolutionary models, and computationally intensive tree search procedures. Here, we present BetaInfer, a generative framework that reformulates phylogenetic tree inference as a sequence transduction problem. BetaInfer leverages hybrid transformer-based architectures to directly map sets of unaligned sequences to phylogenetic trees represented in Newick format. Trained on large-scale simulated evolutionary data with known ground truth, BetaInfer learns to capture complex evolutionary signals directly from sequence data. Ensemble-based generation of multiple candidate trees further improves robustness, reducing reconstruction error by over 30% relative to single predictions. Across extensive evaluations on both simulated and empirical datasets, BetaInfer achieves competitive performance relative to state-of-the-art phylogenetic pipelines, matching, and in some cases exceeding, the accuracy of established likelihood-based and distance-based methods under a wide range of conditions. Interpretability analyses reveal that BetaInfer leverages internal pairwise-distance computations to synthesize evolutionary relationships into an integrated, global representation that supports direct tree generation. Together, these results demonstrate that generative models can serve as a viable and scalable alternative to standard phylogenetic pipelines.

07.
arXiv (CS.AI) 2026-06-18

Searching for Synergy in Shared Workspace Human-AI Collaboration

arXiv:2606.18413v1 Announce Type: new Abstract: Automated AI agents are increasingly capable, yet many scientific and professional tasks require human judgment and contextual expertise. We study shared-workspace human-AI teams, where AI agents and human collaborators must coordinate responsibilities before submitting a final answer. Using the Collaborative Gym environment with DiscoveryBench tasks, we examine when adding simulated human collaborators improves performance and when process loss turns additional collaborators into coordination overhead. Across 1,482 sessions, adding relevant collaborators can lower performance when teams lack structure to coordinate their contributions. We then evaluate scaffolding that combines shared group memory with simulated human-in-the-loop (HITL) gates, where selected actions require approval from a designated simulated participant. This scaffolding yields higher mean performance, most clearly in three-person teams, with clearer responsibility signals and stronger routing of expertise to team actions. Overall, how human-AI teams coordinate and integrate expertise matters as much as the capability available to them.

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

How Linear Is a Transformer Feed-Forward Block? Per-Block Linear Recoverability Is Learned, Not Architectural

作者:

Transformer feed-forward networks (FFNs) are often treated as nonlinear stores of computation, yet how nonlinear a trained FFN block actually is has rarely been measured. We treat each FFN as a position-wise input-to-output map and split it into the exact least-squares linear approximation plus a residual. The held-out variance the closed-form linear map explains defines a block's linear recoverability (R^2_lin), an optimiser-free measure of its linearity. Across all twelve blocks of GPT-2, Pythia-160m, and llama-160m, R^2_lin is highly heterogeneous and non-monotone with depth, ranging from near-linear (>0.99) to strongly nonlinear (

09.
arXiv (CS.CL) 2026-06-25

Continual Knowledge Updating in LLM Systems: Learning Through Multi-Timescale Memory Dynamics

LLMs are trained once, then deployed into a world that never stops changing. External memory compensates for this, but most systems manage it explicitly rather than letting it adapt on its own. Biological memory works differently: coupled multi-timescale dynamics make new associations immediately usable, strengthen what repetition confirms, and let the rest fade. We argue that external memory should follow a similar principle. In Memini, this view takes the form of an associative memory that organizes knowledge as a directed graph. Each edge carries two coupled internal variables, one fast and one slow, following the Benna-Fusi model of synaptic consolidation. From this coupling, episodic sensitivity, gradual consolidation, and selective forgetting are expected to emerge as facets of a single mechanism, reframing external memory as a learning substrate that reorganizes through its own dynamics. This workshop article describes an early-stage conceptual design without experimental evaluation.

10.
PLOS Computational Biology 2026-06-10

Interpreting higher-order dependence in multimorbidity using cohort data: A partial information decomposition approach

by Cillian Hourican, Geeske Peeters, René J. F. Melis, Almar Kok, Natasja M. van Schoor, Sandra Wezeman, Mike Lees, Marcel G. M. Olde Rikkert, Rick Quax In the context of multimorbidity, clinical features seldom act in isolation: symptoms, signs and behaviours form interdependent systems in which joint effects on function can be demonstrated only when features are considered together. We introduce an open, reusable workflow that detects and interprets these “together-only” interactions using bivariate Partial Information Decomposition (PID; two sources to one target), linking synergy-based dependence to the broader network of clinical variables rather than to a single target. The workflow estimates synergy with small-sample bias correction and summarises each pair in a Breadth–Uniformity–Synergy–Total (BUST) map: breadth of synergy across target variables (broad “generalist” vs narrow “specialist” patterns), cross-stratum uniformity across age, sex and multimorbidity (uniform vs subgroup-specific), synergy strength, and total shared information. Simple diagnostics contrast observed targets with additive expectations, revealing the specific joint configurations through which non-additive effects arise. Applied to data from the Longitudinal Ageing Study Amsterdam, we treated all health-related variables—covering symptoms, clinical signs, behaviours, lifestyle factors, and self-rated health indicators—as both sources and targets in the PID framework. This symmetric design permits synergy to be quantified for every pair of variables with respect to every other variable. The workflow identifies synergistic constellations that additive models miss. Multidomain cliques involving subjective health, pain, cognition and grip strength showed multiple non-additive configurations, whereas pairs such as alcohol use with grip strength exhibited focused, narrow but uniform synergy. Notably, the pairs with the strongest synergistic contributions were largely distinct from those with the highest total mutual information, indicating that synergy captures dependency structure overlooked by conventional association measures. Rather than a new measure, this work provides a bias-aware workflow that makes higher-order dependence visible and transferable. Our results support synergy-aware mapping as a practical complement to conventional multimorbidity analyses: it highlights specific combinations of routinely assessed features whose joint states may be especially informative across multiple health targets and therefore candidates for prioritised joint assessment and future multi-domain intervention studies.

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

Power-Flexible AI Data Centers: A New Paradigm for Grid-Responsive Compute

arXiv:2606.25098v1 Announce Type: cross Abstract: The rapid expansion of artificial intelligence (AI) infrastructure is driving unprecedented growth in electricity demand from data centers. Traditional power-system planning treats large computing facilities as inflexible peak loads, leading to costly infrastructure upgrades and long delays in grid interconnection. Recent work has shown that AI clusters can reduce electricity consumption during peak demand through software-based workload orchestration. This article explores how modern GPU-based AI data centers can operate as grid-interactive assets that respond dynamically to power system conditions. We describe an architecture integrating grid signals, workload scheduling, and power telemetry for fine-grained cluster power control. Experimental results from a real-world deployment on a 130 kW GPU cluster demonstrate multiple forms of flexibility, including rapid load reduction, sustained curtailment, and carbon-aware operation while preserving service levels for priority jobs. We further demonstrate performance-aware load shifting across geographically distributed clusters, enabling workloads to migrate toward regions with lower grid stress. Together, these capabilities transform AI infrastructure from static electricity consumers into flexible resources that support grid reliability, accelerate interconnection, and improve computing sustainability.

13.
arXiv (CS.AI) 2026-06-16

Integrating Reasoning and Generalization in Text-to-SQL via Self-Enhanced Fine-Tuning

arXiv:2606.15598v1 Announce Type: new Abstract: Text-to-SQL aims to translate natural language questions into executable SQL queries over structured databases, enabling non-expert users to access data intuitively. While recent advances in large language models (LLMs) have shown promise in this task, existing LLM-based approaches often struggle to strike a balance between strong reasoning capabilities and robust generalization. To address these limitations, we propose CoTE-SQL to enhance the LLM-based text-to-SQL generation with three key innovations: (i) self-enhanced reasoning traces distilled from LLMs without human annotation, (ii) structured chain-of-thought (CoT) prompting with modular decomposition and examples retrieval, and (iii) error-aware revision based on SQL execution feedback. Extensive experiments on the Spider and Bird benchmarks demonstrate that CoTE-SQL achieves new state-of-the-art performance among methods built on open-source LLMs with comparable model sizes on Bird (53.39% EX / 59.02 VES) and strong results on Spider (79.60% EX / 77.19 VES), with especially significant gains on complex queries. Results highlight the effectiveness of combining self-enhancement, structured reasoning, and execution-time feedback within an LLM-based framework for text-to-SQL design.

14.
arXiv (CS.LG) 2026-06-25

The Urysohn Ladder: Recursive Metric Contraction for Scalable Continual Learning

作者:

arXiv:2512.18471v2 Announce Type: replace Abstract: Continual learning systems face a fundamental geometric obstacle: as experience accumulates on a fixed-capacity manifold, covering numbers grow linearly with time, eventually forcing representational overlap and catastrophic interference. Prevailing approaches attack this problem by expansion - projecting into higher-dimensional spaces via kernels, overparameterization, or replay. We argue the solution is the opposite: contraction. We formalize abstraction as the Urysohn Ladder, a hierarchy of quotient maps that recursively collapse validated metric neighborhoods into compact tokens, converting unbounded ambient-space search into bounded navigation on a low-dimensional intrinsic scaffold. Geometrically, each collapsed token acts as a shortcut - a region of extreme metric contraction that bridges distant experiences, much like a wormhole in the representational manifold. We establish four results that collectively guarantee separability (metric contraction renders nonlinearly entangled structure linearly separable at each quotient level, and this separability propagates faithfully through the entire hierarchy), bounded capacity (covering numbers remain $O(1)$ per quotient level, independent of stream length), stability (parity-partitioned flow/scaffold subspaces enable unbounded plasticity without catastrophic interference), and scalability (inference cost scales with quotient distance, not ambient distance). We validate each claim empirically with pretrained models and real-world datasets. Moreover, we demonstrate the potential of Urysohn Ladder for scalable continual learning via scaffold amortization.

15.
arXiv (CS.CL) 2026-06-24

L3Cube-MahaPOS: A Marathi Part-of-Speech Tagging Dataset and BERT Models

Part-of-Speech (POS) tagging is a foundational NLP task underpinning machine translation, information extraction, and syntactic parsing. Despite Marathi being spoken by over 83 million people and ranking among the top twenty most spoken languages worldwide, it remains severely under-resourced in annotated corpora and standardised evaluation benchmarks. Marathi presents unique challenges for computational modelling owing to its rich morphology, relatively free word order, lack of capitalisation conventions, and pervasive code-mixing with Hindi and English. We introduce L3Cube-MahaPOS, a gold-standard POS tagging dataset for Marathi comprising 32,354 manually annotated sentences drawn from news text. Annotation was performed entirely manually by a team of Marathi-proficient annotators following a 16-tag Universal Dependencies-aligned scheme. A structured preprocessing pipeline covering Unicode normalisation, Devanagari-aware tokenisation, and noise filtering ensures label consistency across all splits. We benchmark the dataset across six model families spanning HMM, CRF, BiLSTM, BiLSTM+CharCNN, MuRIL, and the Marathi-specific transformer MahaBERT-v2. The best system achieves 88.67\% token-level accuracy and a macro-F1 of 81.67% over 15 evaluated tag classes. We release the dataset, annotation guidelines, and trained model checkpoints to foster further research in Marathi NLP.

16.
arXiv (CS.CV) 2026-06-11

ViT-FREE: Efficient Face Recognition via Early Exiting and Synthetic Adaptation

Vision Transformers (ViTs) have gained significant attention in computer vision and shown strong potential for face recognition (FR). However, their high computational cost makes deployment on resource-constrained devices challenging, motivating the need for methods that balance efficiency and accuracy. In this work, we investigate early exiting in pretrained ViTs as a simple yet effective training-free strategy for efficient FR inference. Leveraging the uniform feature dimensionality across transformer encoder blocks, we introduce ViT-FREE, a multi-exit framework that enables face verification directly from intermediate representations without modifying or retraining the backbone model, and thus, reducing inference cost. Empirically, we show that patch embeddings and attention maps evolve progressively across depth, exhibiting high similarity between consecutive ViT blocks and increasing alignment with the final representation. This indicates gradual feature refinement and attention convergence, suggesting that intermediate layers already provide stable and discriminative representations suitable for early exiting. Through extensive experiments on multiple FR benchmarks, we systematically analyze the accuracy-efficiency trade-off across exit depths. Our results demonstrate that later exits achieve a highly favorable balance, with exiting at layer 10 yielding up to a 20% speedup while incurring only a 1.5 drop in verification performance on benchmarks such as IJB-C. Also, we propose ViT-FREE_FT, a lightweight exit-specific fine-tuning strategy that adapts only the projection layers using a small synthetic dataset while keeping the transformer backbone frozen. This approach improves the performance of shallow exits while preserving the efficiency benefits and leaving deeper exits largely unaffected.

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

Does AI Reviewer See the Full Picture? Attacking and Defending Multimodal Peer Review

The integration of Large Language Models (LLMs) and Multimodal LLMs (MLLMs) into scientific peer-review workflows introduces novel and significant risks for adversarial manipulation, especially given the multimodal nature of scientific papers where figures, not just text, convey core evidence. This creates a significant gap: current robustness studies on AI peer-review are overwhelmingly text-only. Moreover, the problem is distinct from standard jailbreaking, as a peer-review attack seeks to induce a domain-specific, targeted failure (e.g., "inflate this score") rather than a general safety policy violation, for which no practical defenses exist. To address this, we introduce PaperGuard, the first comprehensive benchmark designed to systematically evaluate and defend AI-generated peer-review against these domain-specific, cross-modal attacks. Our framework is built on three pillars: (1) a new multimodal peer-review dataset spanning multiple scientific domains; (2) a unified suite of attacks, including black-box prompt injections and white-box perturbations, specifically designed to target both text (GCG) and figures (PGD); and (3) a practical defense, motivated by the long-context challenge of academic papers, that uses chunk-based embedding search to efficiently localize and mitigate harmful instructions. Our extensive experiments, conducted across state-of-the-art models, confirm that AI reviewers are pervasively vulnerable. PaperGuard establishes the foundational benchmark, protocols, and actionable defense necessary to pioneer trustworthy, attack-resilient AI-assisted scholarly reviewing.

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

Self-Questioning Vision-Language Models: Reinforcement Learning for Compositional Visual Reasoning

Vision-Language Models (VLMs) are AI systems that process both images and text, yet they often struggle with compositional visual reasoning questions that require chaining multiple steps together, such as identifying objects, counting them, and comparing the results. Existing approaches improve this reasoning by training models on human-written step-by-step explanations, but creating these annotations is expensive and difficult to scale. We propose a self-questioning framework that trains a VLM to break visual questions into smaller sub-questions and answer each one before producing a final response, using a reinforcement learning algorithm called Group Relative Policy Optimization (GRPO). The model is never shown examples of how to decompose questions, it discovers this behavior on its own, guided by a reward signal that scores whether the output contains sub-questions and whether the final answer is correct. We apply this framework to a 3-billion-parameter model, training on both synthetic scenes of geometric shapes (CLEVR) and real-world photographs (A-OKVQA). On A-OKVQA, both self-questioning and standard reinforcement learning substantially improve accuracy over the untrained model (52.2% and 51.6% vs. 46.8%). We introduce the first self-questioning VLM by rewarding not only the final answer like standard RL but additionally for generating intermediate sub-questions, enabling it to discover compositional decomposition strategies. These results suggest that teaching AI systems to ask themselves intermediate questions is a promising strategy for complex visual reasoning, particularly when the difficulty of a question warrants explicit step-by-step decomposition.

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

CASHEW: Stabilizing Multimodal Reasoning via Iterative Trajectory Aggregation

Vision-language models achieve strong performance across a wide range of multimodal understanding and reasoning tasks, yet their multi-step reasoning remains unstable. Repeated sampling over the same input often produces divergent reasoning trajectories and inconsistent final predictions. To address this, we introduce two complementary approaches inspired by test-time scaling: (1) CASHEW, an inference-time framework that stabilizes reasoning by iteratively aggregating multiple candidate trajectories into higher-quality reasoning traces, with explicit visual verification filtering hallucinated steps and grounding reasoning in visual evidence, and (2) CASHEW-RL, a learned variant that internalizes this aggregation behavior within a single model. CASHEW-RL is trained using Group Sequence Policy Optimization (GSPO) with a composite reward that encourages correct answers grounded in minimal yet sufficient visual evidence, while adaptively allocating reasoning effort based on task difficulty. This training objective enables robust self-aggregation at inference. Extensive experiments on 13 image understanding, video understanding, and video reasoning benchmarks show significant performance improvements, including gains of up to +26.2 percentage points on ScienceQA and +9.1 percentage points on EgoSchema.

20.
medRxiv (Medicine) 2026-06-22

The direct economic impact of surgical non-response in orthopaedic hip, knee, and spine surgery for osteoarthritis: a cost-utility analysis

Background Annually, nearly 2 million hip, knee, and spinal inpatient surgeries are performed in Canada and the US for osteoarthritis (OA), costing over $37 billion in hospital expenditures. However, 15-30% of patients experience limited or no improvement, resulting in poor value for money. This study evaluated the one-year cost-utility of joint and spine procedures for OA by comparing non-responders to responders, considering various responder definitions. Methods Individual micro-costing data were collected for 1,175 elective hip, knee, and spine patients enrolled in the Longitudinal Evaluation in the Arthritis Program - Osteoarthritis (LEAP-OA) between 2014 and 2018. Quality-adjusted life years (QALYs) were derived using the SF-6D utility index. One-year incremental cost-utility ratios (ICURs) were calculated from the hospital perspective. Results Responder rates varied by definition, ranging from 78%-94% for hip replacements, 64%-90% for knee replacements, 60%-64% for spine fusions, and 50%-68% for spine decompressions. Corresponding ICURs were: $45,956-$51,773/QALY for responders versus $108,593-$485,762/QALY for non-responders for hip replacements; $54,831-$71,151/QALY for responders versus $200,486-$1,203,596/QALY for non-responders for knee replacements; $65,980-$74,422/QALY for responders versus $262,039-$729,686/QALY for non-responders for spine fusions; and $29,947-$42,168/QALY for responders versus $63,195-$662,586/QALY for non-responders for spine decompressions. Conclusions While surgical response rates were highly dependent on the responder definition, ICURs for non-responders were significantly higher than those for responders across all definitions. Beyond the negative impact on patients, there is a compelling economic argument for investment in improved pre-operative identification of patients at risk of surgical non-response. Such efforts could enable more personalized, value-based care pathways and reduce the provision of low-value surgical interventions.

21.
medRxiv (Medicine) 2026-06-11

Large-scale proteomics and timing of hypertensive disorders of pregnancy

Background: Hypertensive disorders of pregnancy (HDP) may first be diagnosed antepartum, during labor, or postpartum. We utilized untargeted large-scale proteomics to identify pathways associated with HDP based on timing of onset. Methods: We performed a nested case-control study comparing differential protein expression, from the SomaScan 7K platform, based on timing of onset of HDP versus controls (referent) using first-trimester samples from the NuMoM2b-Heart Health Study, a multi-site cohort that followed nulliparous individuals from the first trimester. Associations of proteins with timing of onset of HDP, adjusted for co-variates, were assessed using logistic regression q value-based false discovery rates and pathway enrichment and differential expression analysis were conducted. Results: Of 1628 individuals included, 678 had HDP, of which 67% manifested antepartum (AP), 29% intrapartum (IP), and 3% postpartum (PP). After adjusting for co-variates, compared to controls, 698 proteins, 39 proteins, and 144 proteins were differentially expressed in those with HDP according to AP, IP, PP onset, respectively. There was little overlap in individual protein expression based on timing of HDP. Pathway enrichment and graphical summary analyses suggested distinct processes. Specifically, there was downregulation of angiogenic proteins in AP HDP, downregulation of immune-related proteins in IP HDP, and upregulation of complement activation promoting fibrotic changes leading to cardiac dysfunction in PP HDP. Conclusion: There are differences in first-trimester protein expression based on whether HDP first manifests AP, IP or PP. This raises the possibility that there may be distinct mechanistic phenotypes that could uniquely inform diagnostic and therapeutic targets for HDP.

22.
medRxiv (Medicine) 2026-06-11

Development of iADJUST: a theory-informed, patient co-designed digital psychological intervention for adjustment in chronic kidney disease

Background: Psychological distress is common in chronic kidney disease (CKD) and is associated with reduced quality of life, treatment non-adherence, and worse clinical outcomes. Distress in CKD is also linked to difficulties adjusting to the demands of illness management. Despite this, psychological support remains inconsistently integrated within kidney care pathways, and existing interventions often lack clear theoretical specification and explicit targeting of mechanisms underpinning adjustment to CKD. Objectives: To describe the systematic development of iADJUST, a theory-informed patient co-designed digital psychological intervention targeting key cognitive and behavioural mechanisms involved in adjustment to CKD. Methods: Intervention development was guided by the Medical Research Council framework for complex interventions. A structured, iterative process integrated empirical evidence, psychological theory, and patient and public involvement and engagement. The Common-Sense Model of Self-Regulation and cognitive behavioural theories informed the identification of modifiable maintaining mechanisms associated with adjustment to CKD. Intervention components were mapped onto these mechanisms and refined through co-design with people living with CKD. Results: iADJUST is a six-session self-guided digital psychological intervention delivered over 12 weeks and supplemented by therapist contact. The intervention targets illness-related uncertainty, fatigue-related activity dysregulation, catastrophic what-if thinking, self-critical evaluation, and behavioural withdrawal. It integrates psychoeducation, cognitive and behavioural strategies, maintenance planning, and elements from acceptance and commitment therapy and compassion-focused approaches. Content is delivered through video, audio, and guided tasks and activities. Conclusion: iADJUST provides a theory-informed, evidence-based psychological intervention for CKD explicitly mapping intervention components to maintaining cognitive and behavioural mechanisms implicated in adjustment. Feasibility evaluation is underway.

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

How LLMs Fail and Generalize in RTL Coding for Hardware Design?

Translating sequential programming priors into the parallel temporal logic of hardware design remains a crucial bottleneck for large language models(LLM). To investigate this, we introduce a new error taxonomy grounded in problem solvability, inspired by cognitive theory. Our taxonomy categorizes failures into syntactic, semantic, solvable functional, and unsolvable functional types. Evaluations reveal a strict empirical ceiling on the VerilogEval benchmark, as frontier models plateau at a 90.8% initial pass rate. These plateaus are defined by unsolvable functional errors, exposing persistent knowledge gaps immune to test time compute scaling. Furthermore, we expose a striking surface convergence gap: optimization readily eliminates syntax errors but concurrently exacerbates deeper functional failures. Our findings demonstrate that alignment techniques merely teach models to compile. While repeated sampling strategies can patch solvable errors, register-transfer level(RTL) coding capacity remains strictly bounded by pretraining knowledge. Addressing challenges in the current LLM based hardware generation pipeline requires more studies in model reasoning rather than alignment interventions.

24.
arXiv (CS.CL) 2026-06-11

RedAct: Redacting Agent Capability Traces for Procedural Skill Protection

Users rely on execution traces to observe agent behavior, diagnose failures, and ensure accountability. These traces contain rich procedural detail, including tool invocations, intermediate decisions, and error-recovery logic. Yet this detail can expose private procedural skills, allowing downstream methods to recover key formulas, thresholds, and strategies without access to model weights or skill files. To quantify this risk and evaluate protection, we construct \textsc{CapTraceBench}, a benchmark of 75 specialized long-horizon tasks and 154 curated skills across seven domains. We also introduce \textsc{RedAct} https://github.com/XuShuwenn/RedAct, a protected trace release framework that localizes protected key information, rewrites traces while preserving verifier-critical evidence, and embeds behavioral watermarks for downstream provenance analysis. Across representative trace reuse methods, \textsc{RedAct} reduces normalized skill transfer (NST) from 44.7–67.1\% on raw traces to below the no-skill baseline, while preserving audit evidence. Its standalone behavioral watermarks reach 93.6–100.0\% true detection with a false alarm rate of at most 1.9\%. These results frame public agent traces as security interfaces and show that selective redaction can reduce procedural capability leakage without removing audit evidence.

25.
medRxiv (Medicine) 2026-06-11

Decoding the Genetic Architecture of Autistic Traits in the Aging Population

Autism research has mostly focused on diagnostic frameworks in childhood. However, autistic traits including social skills, communication, attention switching, attention to detail, and imagination may also vary in many undiagnosed individuals beyond childhood, and the genetic architecture of autistic traits in undiagnosed aging adults remains poorly understood. Here, we performed an exome-wide association study of autistic traits in adults aged >=40 from the UK Biobank (n = 161,269) and independently validated key findings in the SPARK cohort (n = 142,357). We identified exome-wide significance at 17q21.31, represented by a lead variant associated with social skills (rs199533, beta = 0.081, P = 2.04e-11). In addition, we identified an independent signal for communication (rs12632110, beta = 0.042, P = 3.07e-12) and two independent signals for attention switching (rs690733, beta = 0.046, P = 4.26e-12; rs2164272, beta = -0.047, P = 1.73e-12). Gene-based analyses further implicated loss-of-function variation in ZSCAN2 (beta = 1.00, P = 2.44e-6), which was associated with communication differences. Enrichment analyses revealed preferential expression of implicated genes in the cerebral cortex, while phenotypic and neuroimaging analyses linked those variants to cortical brain structure and regional volume. Taken together, these findings delineate the genetic architecture of autistic traits in the aging population and link genetic variation to downstream molecular and neuroanatomical mechanisms.