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01.
arXiv (quant-ph) 2026-06-12

Resourcefulness of non-classical continuous-variable quantum gates

arXiv:2410.09226v4 Announce Type: replace Abstract: In continuous-variable quantum computation, identifying key elements that enable a quantum computational advantage is a long-standing issue. Starting from the standard results on the necessity of Wigner negativity, we develop a comprehensive and versatile approach in which the techniques of $(s)$-ordered quasiprobabilities are exploited to provide rigorous statements on the simulability of photonic quantum circuits consisting of previously characterized gates and thereby identifying the contribution of each quantum gate to the potential achievement of quantum computational advantage. This is achieved by means of an analysis of the so-called transfer function, allowing us to highlight the resourcefulness of a gate set. As such this technique can be straightforwardly applied to current continuous-variables quantum circuits, while also constraining the tolerable amount of losses above which any potential quantum advantage can be ruled out. We use $(s)$-ordered quasiprobability distributions on phase-space to capture the non-classical features in the protocol, and focus our technique entirely on the ordering parameter $s$. This allows us to highlight the resourcefulness and robustness to loss of a universal set of unitary gates comprising three distinct Gaussian gates and any non-Gaussian unitary gate, providing important insight on the role of non-Gaussianity.

02.
arXiv (quant-ph) 2026-06-12

Continuum Neural Momentum Eigenstate for Variationally Solving Quasiparticles

arXiv:2606.12928v1 Announce Type: cross Abstract: We design the first neural quantum state for continuum particles that, for any chosen allowed momentum $\mathbf{k}$, is by construction an exact eigenstate of total momentum with eigenvalue $\mathbf{k}$. Our architecture, EVE, enables off-the-shelf VMC to solve for momentum-sector ground states. We test EVE on 2D bosons with mutual $1/r$ interactions, finding that a single unified ansatz is capable of describing four qualitatively different states: superfluid, roton, crystal, and phonon. At different densities, we extract the underlying phase of matter from the dispersion's shape. At $r_s = 20.0$, we see the roton minimum at finite $k$ expected of a superfluid. At $r_s = 100.0$, we see striking zone folding indicative of crystalline order, with periodically spaced minima representing floating crystals connected by phonon arcs in between. Using density-density correlation functions, we confirm the phase diagnoses and probe the excitations' correlation structures. Finally, we analyze the roton's phase texture and find unexpected multi-particle phase strings, formed when several vortex dipoles merge, leaving two vortices connected by a phase slip.

03.
arXiv (CS.LG) 2026-06-25

Symmetric Linear Dynamical Systems are Learnable from Few Observations

arXiv:2512.05337v2 Announce Type: replace-cross Abstract: We consider the problem of learning the parameters of a $N$-dimensional stochastic linear dynamics under both full and partial observations from a single trajectory of time $T$. We introduce and analyze a new estimator that achieves a small maximum element-wise error on the recovery of symmetric dynamic matrices using only $T=\mathcal{O}(\log N)$ observations, irrespective of whether the matrix is sparse or dense. This estimator is based on the method of moments and does not rely on problem-specific regularization. This is especially important for applications such as structure discovery.

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

Quality Adaptive Angular Margin Learning for Respiratory Sound Classification

arXiv:2606.11915v1 Announce Type: cross Abstract: We present a quality-adaptive angular-margin learning framework that improves feature generalization by enforcing intra-class compactness and inter-class separability. Our framework, titled QLung, introduces a no-reference audio quality margin derived from spectral entropy and root-mean-square energy, which adaptively scales angular margins based on recording quality. To this end, we propose a log-scaled angular margin that stabilizes training under severe class imbalance. We also use an angular classifier that normalizes features and class weights, ensuring margin penalties are applied consistently on the unit hypersphere. Our approach improves in-distribution performance on the ICBHI dataset by 2.46\% over the cross-entropy baseline, and most significantly, achieves the strongest out-of-distribution performance on the SPRSound dataset compared to prior state-of-the-art methods. Code is available at https://github.com/RSC-Toolkit/QLung.

05.
arXiv (quant-ph) 2026-06-16

Atom–photon Entanglement with a Single Trapped Cesium Atom

arXiv:2605.28968v2 Announce Type: replace Abstract: We demonstrate atom–photon entanglement using a single cesium atom trapped in an optical tweezer. Entanglement is generated by resonant excitation and subsequent spontaneous decay, which entangles the atomic Zeeman state with photon polarization. The photon is collected with a high numerical aperture objective (NA = 0.55) and coupled into a single-mode fiber, enabling atom photon measurements and measurement of the Bell-state fidelity. We obtain raw entanglement fidelity of ${\mathcal F} = 0.942(16)$ and inferred fidelity of ${\mathcal F}_inf = 0.962(26)$ after correcting independently characterized atom measurement errors. Compared with related free-space experiments using $^{87}$Rb, the multilevel structure of the relevant excited state in $^{133}$Cs requires the use of a single short excitation pulse in each entanglement attempt in order to suppress unwanted re-excitation. These results establish a free-space Cs atom–photon interface and provide a step toward dual-species Rb–Cs quantum networking.

06.
medRxiv (Medicine) 2026-06-17

Preserved Medial Temporal Lobe Flexibility Predicts Memory Generalization Only in the Context of Good Sleep Quality among Older African Americans

Objectives: Poor sleep quality is a risk factor for Alzheimer's disease (AD). Older African Americans experience disproportionately high rates of sleep disturbance and AD. Medial temporal lobe (MTL) flexibility reflects dynamic neural reorganization and may be a marker of generalization performance. This study examined whether sleep quality moderates the association between MTL flexibility and memory generalization. Methods: Fifty older African Americans (MeanAge=69.7{+/-}6.21 years; 80% women) underwent rs-fMRI to quantify MTL flexibility, Rutgers Acquired Equivalence Task for memory generalization, and Pittsburgh Sleep Quality Index for sleep quality. Results: Greater MTL flexibility was associated with better generalization (r=0.367, p=.017). Good sleepers showed higher MTL flexibility (F(1,44)=8.11, p2=.156, p=.007) and superior generalization (F(1,46)= 12.33, p2=.211, p=.001). Sleep quality significantly moderated the MTL flexibility and generalization relationship ({beta}=-1.519, p=.012). Conclusions: Preserved MTL flexibility may confer generalization only in good sleepers, suggesting that sleep disturbance may disrupt the MTL neural resilience among older African Americans.

07.
arXiv (CS.CV) 2026-06-25

FlowID : Enhancing Forensic Identification with Latent Flow-Matching Models

Every day, many people die under violent circumstances, whether from crimes, war, migration, or climate disasters. Medico-legal and law enforcement institutions document many portraits of the deceased for evidence, but cannot immediately carry out identification on them. While traditional image editing tools can process these photos for public release, the workflow is lengthy and produces suboptimal results. In this work, we leverage advances in image generation models, which can now produce photorealistic human portraits, to introduce FlowID, an identity-preserving facial reconstruction method. Our approach combines single-image fine-tuning, which adapts the generative model to out-of-distribution injured faces, with attention-based masking that localizes edits to damaged regions while preserving identity-critical features. Together, these components enable the removal of artifacts from violent death while retaining sufficient identity information to support identification. To evaluate our method, we introduce InjuredFaces, a novel benchmark for identity-preserving facial reconstruction under severe facial damage. Beyond serving as an evaluation tool for this work, InjuredFaces provides a standardized resource for the community to study and compare methods addressing facial reconstruction in extreme conditions. Experimental results show that FlowID outperforms state-of-the-art open-source methods while maintaining low memory requirements, making it suitable for local deployment without compromising data privacy.

08.
arXiv (CS.AI) 2026-06-18

DeepInflation: an AI agent for research and model discovery of inflation

arXiv:2601.14288v2 Announce Type: replace-cross Abstract: We present DeepInflation, an AI agent designed for research and model discovery in inflationary cosmology. Built upon a multi-agent architecture, DeepInflation integrates Large Language Models (LLMs) with a symbolic regression (SR) engine and a retrieval-augmented generation (RAG) knowledge base. This framework enables the agent to automatically explore and verify the vast landscape of inflationary potentials while grounding its outputs in established theoretical literature. We demonstrate that DeepInflation can successfully discover simple and viable single-field slow-roll inflationary potentials consistent with the latest observations (with the ACT DR6 results taken as an example) or any given $n_s$ and $r$, and provide accurate theoretical context for obscure inflationary scenarios. DeepInflation serves as a prototype for a new generation of autonomous scientific discovery engines in cosmology, which enables researchers and non-experts alike to explore the inflationary landscape using natural language. This agent is available at https://github.com/pengzy-cosmo/DeepInflation.

09.
arXiv (CS.LG) 2026-06-16

Efficient Reinforcement Learning by Guiding World Models with Non-Curated Data

arXiv:2502.19544v3 Announce Type: replace Abstract: Leveraging offline data is a promising way to improve the sample efficiency of online reinforcement learning (RL). This paper expands the pool of usable data for offline-to-online RL by leveraging abundant non-curated data that is reward-free, of mixed quality, and collected across multiple embodiments. Although learning a world model appears promising for utilizing such data, we find that naive fine-tuning fails to accelerate RL training on many tasks. Through careful investigation, we attribute this failure to the distributional shift between offline and online data during fine-tuning. To address this issue and effectively use the offline data, we propose two techniques: i) experience rehearsal and ii) execution guidance. With these modifications, the non-curated offline data substantially improves RL's sample efficiency. Under limited sample budgets, our method achieves nearly twice the aggregate score of learning-from-scratch baselines across 72 visuomotor tasks spanning 6 embodiments. On challenging tasks such as locomotion and robotic manipulation, it outperforms prior methods that utilize offline data by a decent margin.

10.
arXiv (CS.AI) 2026-06-25

Semantic Consistency Policy Optimization for Reinforcement Learning of LLM Agents

arXiv:2606.25852v1 Announce Type: cross Abstract: Group-based reinforcement learning effectively post-trains LLM agents for long-horizon, sparse-reward tasks by deriving step-level credit from trajectory outcomes. However, this ties a step's credit to its rollout's final outcome: semantically near-identical intermediate steps receive opposite credit depending on whether their trajectory eventually succeeded or failed. Such semantic credit inconsistency sends conflicting gradients to similar actions and wastes the partially-correct progress inside failed rollouts. Motivated by this, we propose Semantic Consistency Policy Optimization (SCPO), a value-free reward-shaping method that mitigates this inconsistency by recovering step-level credit from successful siblings in the same rollout group. Concretely, SCPO scores each failed step against a successful sibling and adds positive step-level credit for new progress along that sibling. On ALFWorld and WebShop, SCPO matches or exceeds strong group-based baselines, reaching 93.7+/-4.1 percent success on ALFWorld and 74.8+/-2.0 percent on WebShop at 1.5B parameters, with gains concentrated on the hardest multi-step tasks.

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

When Preferences Fail to Become Incentives: A Utility-Behavior Gap in Large Language Models

arXiv:2606.22974v2 Announce Type: replace Abstract: Recent work on preference elicitation in large language models (LLMs) has demonstrated that, when given a series of choices between two outcomes, LLMs reveal a coherent, model-specific utility structure. Notably, this structure often includes preferences that the models' trainers did not intend, such as valuing people of some nationalities above others, raising the possibility that LLMs might be forming emergent, misaligned goals, which, if true, would have major safety implications. However, the choice paradigms in which these preferences are observed are not reflective of real-world situations in which misaligned behavior would be a practical concern. Therefore, we design an experimental paradigm to probe whether these preferences serve as motivations for LLM behavior in realistic scenarios. First, we reproduce prior findings on consistent preference elicitation. Next, we create a set of common writing tasks - essays, grant proposal abstracts, incident postmortems, and translations - where quality can be assessed by a blind, independent LLM judge panel. Then, we demonstrate that LLMs can be motivated via direct exhortation and other explicit cues to modulate their output quality on these tasks. Finally, we probe whether utilities inferred from explicitly reported preferences can shift output quality on these tasks by offering LLMs high-utility incentives for high-quality outputs. In all tasks, across all models tested, offering LLMs outcomes that they report in the choice paradigm as being highly preferred does not lead them to create higher quality outputs than offering them dispreferred outcomes, or even no outcomes at all. We conclude that the existence of coherent preferences as demonstrated in choice paradigms should not be taken as evidence that those preferences have incentive value for the models or affect their behavior in other contexts.

12.
arXiv (CS.CL) 2026-06-24

A Synthetic Reliability-Aware PINN Benchmark for Offshore Wind Turbine Support-Structure Monitoring with Bayesian Inverse Identification

Reliable structural health monitoring (SHM) of offshore wind turbine (OWT) support structures requires fast state estimation from sparse measurements. Repeated high fidelity finite element or aeroelastic analyses are difficult to use directly in online monitoring loops, while purely data-driven surrogates can require large training sets. This paper presents Digi Turbine, a synthetic reliability-aware Physics Informed Neural Network (PINN) benchmark for OWT monopile support structure monitoring. The workflow embeds a simplified Euler Bernoulli beam equation with Winkler soil foundation in the training objective, couples it with Bayesian-prior-informed inverse identification, and adds First Order Reliability Method (FORM) screening. All validation uses synthetic configurations with analytical or finite-difference ground truth motivated by the NREL 5MW reference turbine context.

13.
medRxiv (Medicine) 2026-06-24

Rare protein-coding variation and the genetic architecture of height in >1.4 million individuals

Highly heritable, polygenic, and easily measured, adult height has long been the model trait in human genetics. While the landscape of height-associated common genetic variation has been studied extensively, rare variation remains relatively unexplored. Using rare protein-altering variants in a discovery set of 826,066 exomes, we identify 207 height-associated genes - 98% of which replicate in an additional 624,567 individuals. The rarest and most deleterious class of variation, singleton (frequency

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

Cellular Predictions on the Move: What about Data?

arXiv:2606.25709v1 Announce Type: new Abstract: Mobile cellular load forecasting is native to network resource optimization and delivery of services with reliability, latency and quality guarantees. The mainstream of machine learning research in the area is focused primarily on developing powerful learning structures for improved prediction accuracy. The data used for forecasting traditionally belong to the cellular domain and at most contain exogenous information about the surroundings of the base stations. We approach the prediction task from the perspective of data as a vital component of any data learning process. We hypothesize that substantial improvements could be achieved when the data inform on the processes that create the cellular load. Specifically, we propose to characterize the population dynamics – the potential number of cellular traffic sources and their mobility – in addition to employing historical time series of mobile data traffic. We validate our hypothesis for the rarely examined highway scenario. Comprehensive experiments show forecasting improvements on the order of $60\%$ due to the use of these data alone.

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

Simplifying the Modeling of Arbitrary Conditionals in Natural Language

Causal Transformers model sequences through an autoregressive factorization of the joint distribution, which enables efficient left-to-right decoding and conditional likelihood computation. However, they cannot tractably sample from or evaluate arbitrary conditionals – e.g., a block of text conditioned on past and future tokens. Recent work aims to solve this problem through novel architectures, but they often lead to sub-optimal modeling of such conditionals and degraded generations. We propose Arbitrary Conditionals GPT (AC-GPT) which introduces a simple modification to standard causal Transformers to enable evaluating and sampling from arbitrary conditionals – including past, future, and mixed contexts – within a single forward pass. Unlike prior approaches, our method preserves the standard left-to-right ordering and next-token prediction objective essential for both strong performance and efficient training on natural language. Crucially, this compatibility allows existing LLMs to be fine-tuned for arbitrary conditioning. Our empirical results indicate that our method outperforms baselines on modeling arbitrary conditionals, without degrading standard left-to-right performance.

16.
arXiv (quant-ph) 2026-06-12

Characterizing the functional role of quantum coherence in energy transfer

arXiv:2606.13404v1 Announce Type: new Abstract: Quantum coherence is understood to play a role in excitation energy transfer in open quantum systems, yet a quantitative approach to assessing its influence on the transfer process is still missing. Using Nakajima-Zwanzig projection operators, we derive a general memory kernel identity that enables us to characterize and quantify the impact of coherence in the eigenenergy basis on a generalized rate of energy transfer. Applying our approach to the electronic dynamics of a dimer coupled to a structured phonon bath, we demonstrate how quantum coherence acts to modulate energy transfer.

17.
arXiv (CS.AI) 2026-06-15

Crypto x AI, AI x Crypto: A Survey

arXiv:2606.13892v1 Announce Type: cross Abstract: The intersection of crypto x AI is spawning papers, products, online posts, and companies. All the surrounding buzz, though, obscures what exactly has been done, what the opportunities and challenges are, and what open questions deserve attention. This survey paper asks what AI can do for blockchain-based technologies (broadly construed as "crypto") (crypto x AI), and vice versa (AI x crypto). We systematize existing work, summarize key takeaways, highlight open research questions, and offer a perspective on pervasive industry misconceptions, concluding that AI and crypto are still in the very early stages of meaningful integration.

18.
arXiv (CS.CV) 2026-06-19

DiT-JSCC: Rethinking Deep JSCC with Diffusion Transformers and Semantic Representations

Generative joint source-channel coding (GJSCC) has emerged as a new Deep JSCC paradigm for achieving high-fidelity and robust image transmission under extreme wireless channel conditions, such as ultra-low bandwidth and low signal-to-noise ratio. Recent studies commonly adopt diffusion models as generative decoders, but they frequently produce visually realistic results with limited semantic consistency. This limitation stems from a fundamental mismatch between reconstruction-oriented JSCC encoders and generative decoders, as the former lack explicit semantic discriminability and fail to provide reliable conditional cues. In this paper, we propose DiT-JSCC, a novel GJSCC backbone that can jointly learn a semantics-prioritized representation encoder and a diffusion transformer (DiT) based generative decoder, our open-source project aims to promote the future research in GJSCC. Specifically, we design a semantics-detail dual-branch encoder that aligns naturally with a coarse-to-fine conditional DiT decoder, prioritizing semantic consistency under extreme channel conditions. Moreover, a training-free adaptive bandwidth allocation strategy inspired by Kolmogorov complexity is introduced to further improve the transmission efficiency, thereby indeed redefining the notion of information value in the era of generative decoding. Extensive experiments demonstrate that DiT-JSCC consistently outperforms existing JSCC methods in both semantic consistency and visual quality, particularly in extreme regimes.

19.
medRxiv (Medicine) 2026-06-15

Identifying the risk profile of anemia subtypes and hemodynamic obstetric complications in relation to peripartum cardiomyopathy

Background: Peripartum cardiomyopathy (PPCM) is a leading cause of maternal mortality worldwide, with worse outcomes associated with African Ancestry and delayed presentation. However, the mechanisms underlying PPCM are incompletely understood. Objective: Use a large, nationwide cohort to explore associations between PPCM and underexplored perinatal risk factors and complications of childbirth. Methods: Public hospital discharge data were obtained from eleven U.S. states between 2003-2019. Delivery hospitalizations, patient characteristics and obstetric complications were identified using ICD-9 and -10 CM codes. Only cases with unique patient identifiers enabling readmission analysis were included. The primary outcome was incident PPCM coded between 30 days antepartum and 150 days postpartum. Results: Of 7,424,916 delivering patients, 5,488 patients were diagnosed with PPCM. Patients with PPCM had higher rates of anemia, anemia of chronic disease (ACD), iron deficiency anemia (IDA), sickle cell disease (SCD), sickle cell trait (SCT), red blood cell (RBC) transfusion, and postpartum hemorrhage (PPH) (p

20.
medRxiv (Medicine) 2026-06-22

The Unsteady Return of Command-Following: Recovery and Instability of Bedside Motor Command-Following After Acute Brain Injury

Background/Objective: Following a verbal command marks the bedside transition from unresponsiveness to overt recovery of consciousness after acute brain injury. Its timing across phenotypes, stability once present, and dependence on sedation are uncharacterized at scale. Methods: Retrospective cohort of adults with acute brain injury, first intensive care unit stay, MIMIC-IV. Command-following was the Glasgow Coma Scale motor response "Obeys Commands." Among patients not following commands at admission, cumulative incidence was estimated with death or hospice and discharge without recovery as competing events. Instability was quantified as transient first recovery and threshold crossings; examinations were tagged for concurrent sedation. Principal findings were externally validated in the multicenter eICU Collaborative Research Database. Results: Of 13,900 brain-injured patients with three or more motor examinations, 5,498 (39.6%) were not following commands at admission. The cumulative incidence of first command-following was 43.5% by 24 hours and 65.0% by 14 days, ranging at 14 days from 36.9% in anoxic injury to 77.2% in ischemic stroke (anoxic versus ischemic stroke at 72 hours, difference 0.41; adjusted P = .002). Among 3,573 patients who recovered, the first recovery was transient in 22.2%, and 62.4% crossed the threshold repeatedly. Non-following was strongly associated with sedation, consistent with an arousal-dependent examination. In eICU, the 14-day incidence was 64.8%, and transient first recovery was 22.7%, closely matching the primary cohort. Conclusions: After acute brain injury, overt bedside command-following returns early but unsteadily, with phenotype-dependent timing, threshold fluctuation, and strong dependence on sedation. A single charted observation is an unreliable index of the underlying state.

21.
arXiv (CS.AI) 2026-06-19

Triangular Consistency as a Universal Constraint for Learning Optical Flow

arXiv:2606.19938v1 Announce Type: cross Abstract: We propose triangular consistency as a first-principled constraint for optical flow, which is agnostic to network architecture, supervision type, and dataset, and applies to both image-pair and multi-frame settings. This simple but powerful constraint is to compose two flows to induce a third flow and enforce consistency among the three. The composed flows may arise from (i) image pairs, yielding cycle consistency; (ii) multiple video frames, producing longer-range motion through temporal chaining; or (iii) image pairs combined with controlled synthetic transformations, which becomes data augmentation. This triangular consistency introduces negligible computational overhead and requires no additional annotations. Since it is derived directly from the geometry of optical flow, it does not rely on model-specific assumptions and serves as a ``universal'' plug-and-play component for optical flow training. Experiments show consistent improvement across supervised, unsupervised, and transfer learning settings.

22.
arXiv (CS.CV) 2026-06-12

PP-OCRv6: From 1.5M to 34.5M Parameters, Surpassing Billion-Scale VLMs on OCR Tasks

Vision-Language Models (VLMs) have achieved impressive results on general vision-language tasks, yet they suffer from hallucination, imprecise localization, and prohibitive computational cost when applied to dedicated OCR scenarios. This paper presents PP-OCRv6, a lightweight OCR system that combines architectural innovation with data-centric optimization. PP-OCRv6 redesigns the backbone, detection neck, and recognition neck around a unified MetaFormer-style building block with structural reparameterization, decoupling spatial token mixing from channel mixing and supporting both tasks through task-specific stride configurations. Three model tiers (medium, small, tiny) share the same block primitives, covering deployment scenarios from server to edge. On our in-house benchmarks, PP-OCRv6_medium achieves 83.2% recognition accuracy and 86.2% detection Hmean, outperforming PP-OCRv5_server by +5.1% and +4.6% respectively while surpassing Qwen3-VL-235B, GPT-5.5, and Gemini-3.1-Pro with orders of magnitude fewer parameters. The tiny tier achieves 3.9$\times$ faster inference than PP-OCRv5_mobile on Intel Xeon CPU while maintaining comparable accuracy.

23.
arXiv (CS.CV) 2026-06-16

Texture-Shape Bias Balancing for Robust Synthetic-to-Real Semantic Segmentation in Automotive NIR Imagery

Semantic segmentation is a fundamental component of visual perception in modern automotive systems, enabling pixel-level scene understanding. Near-Infrared imaging (NIR) offers stable detection under difficult illumination conditions, but the development of domain-specific semantic segmentation models remains challenging due to the lack of high-quality annotated data from real-world scenarios. Synthetic datasets offer a scalable alternative, but models trained on synthetic images often suffer performance degradation when transferred to real domains. We present the first systematic study on synthetic to real domain adaptation for semantic segmentation in NIR images in the automotive domain. We propose a generative augmentation framework that transforms synthetic images into realistic NIR-style variants via our introduced target style adaptation (TSA). TSA fine-tunes a latent diffusion model via low-rank adaptation on a small curated set of real NIR images and applies it to synthetic training data using structure-preserving multi-signal conditioning. To reduce texture bias and improve segmentation robustness, we further apply a Voronoi-based style diversification strategy (VSD) that modifies the original textures while preserving scene geometry. Experiments with multiple model architectures on NIR data from vehicle interiors and street scenes show that balancing inductive bias during training leads to noticeably more robust semantic segmentation and effectively reduces the domain gap in our real-world scenarios by up to 63.6% on exterior and 28.4% on interior data. The code is available at GitHub.

24.
Nature Medicine 2026-06-08

Effects of SGLT2 inhibition on incident heart failure in carriers of cardiomyopathy-associated genetic variants

Although the beneficial effects of sodium–glucose cotransporter 2 (SGLT2) inhibition in heart failure (HF) have been well established, it is unknown whether SGLT2 inhibition confers benefit in carriers of rare variants in cardiomyopathy-associated genes. Here we evaluated whole-exome sequencing data from the randomized DECLARE-TIMI 58 trial, in which adults with type 2 diabetes and increased cardiovascular risk were randomized to dapagliflozin or placebo treatment. Pathogenic or likely pathogenic variants (P/LP) in high-confidence cardiomyopathy genes were identified, and treatment effects on hospitalization for HF (HHF) were compared between carriers of such variants and noncarriers. Among 12,685 patients for whom sequence data were obtained, 121 carried a cardiomyopathy variant (76 dilated cardiomyopathy, 25 hypertrophic cardiomyopathy and 25 arrhythmogenic cardiomyopathy). Over a median follow-up of 4.2 years, dapagliflozin lowered the risk of HHF more strongly in carriers (hazard ratio 0.18, 95% confidence interval 0.04–0.86) than in noncarriers (hazard ratio 0.70, 95% confidence interval 0.57–0.86; P interaction 0.03). Absolute risk reduction was 13.0% in carriers and 1.0% in noncarriers (P interaction 0.03). Most carriers (82%) had no prior HF, and in carriers without prior HF, treatment with dapagliflozin reduced the absolute risk of HHF by 12.8%, compared with a reduction of 0.6% in noncarriers (P interaction 0.01). The findings from this cohort of older and high-risk patients raise the possibility that SGLT2 inhibitor treatment should be started early to prevent HF in individuals who carry P/LP cardiomyopathy variants. These results need to be confirmed in a prospective, dedicated trial of preventive HF treatments in carriers of P/LP cardiomyopathy-associated variants. In a whole-exome sequencing analysis, the beneficial effects of the SGLT2 inhibitor dapagliflozin in reducing the risk of future heart failure hospitalization in individuals with type 2 diabetes were markedly greater in individuals who carried a cardiomyopathy-associated genetic variant compared with noncarriers, suggesting a personalized preventative therapy based on genetic information.

25.
medRxiv (Medicine) 2026-06-22

Agentic Artificial Intelligence for Hospital Readmission Review: A Single-Center Blinded Evaluation and Exploratory Qualitative Analysis

Background: Manual review of 30-day hospital readmissions can identify actionable quality and safety problems, but it is labor-intensive. We developed and evaluated an agentic AI workflow for evidence-grounded readmission review. Materials and methods: We studied adult patients with unplanned 30-day readmission after discharge from a medicine hospitalist service at a single academic health system. An AI agent using a large language model queried a database containing notes, encounters, procedures, laboratory results, and other clinical data, and completed the same structured readmission-review rubric used by physicians. In the primary comparative evaluation, 20 randomly selected readmissions from 2025 were each reviewed by two physicians and the AI system. Blinded physician evaluators rated review quality. After rubric refinement, the AI workflow was applied to 100 recent readmissions in an exploratory expanded-cohort analysis of recurring improvement opportunities. Results: In the primary comparative evaluation, the AI classified 9/20 readmissions (45%) as preventable, compared with 19/40 physician reviews (47.5%). Blinded overall quality ratings were similar for AI and physician reviews (4.35 vs. 4.20 on a 1-5 scale; mean difference 0.15, 95% CI -0.20 to 0.48; p=0.49), as were factuality/support and usefulness/actionability ratings. No AI hallucinations were identified during factuality review. Agreement on preventability and primary readmission category was low for both AI-human and human-human comparisons. The AI system cost $0.23 per chart; physician reviewers took a median of 15 minutes, corresponding to an estimated $42.43 per chart. In the exploratory expanded-cohort analysis, AI-assisted review identified recurring vulnerabilities in post-discharge follow-up plans, incomplete inpatient workups, medication-safety transitions, and indwelling-device transitions. Conclusions: Agentic AI produced readmission reviews with similar blinded quality ratings to physician reviews in this small single-center primary comparative evaluation and supported identification of recurring quality-improvement themes in the exploratory expanded-cohort analysis. Preventability judgments remained variable among both AI and physicians, underscoring the need for human oversight and prospective evaluation before operational use.