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01.
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.

03.
arXiv (CS.AI) 2026-06-19

PrototypeNAS: Rapid Design of Deep Neural Networks for Microcontroller Units

arXiv:2603.15106v2 Announce Type: replace Abstract: Enabling efficient deep neural network (DNN) inference on edge devices with different hardware constraints is a challenging task that typically requires DNN architectures to be specialized for each device separately. To avoid the huge manual effort, one can use neural architecture search (NAS). However, many existing NAS methods are resource-intensive and time-consuming because they require the training of many different DNNs from scratch. Furthermore, they do not take the resource constraints of the target system into account. To address these shortcomings, we propose PrototypeNAS, a zero-shot NAS method to accelerate and automate the selection, compression, and specialization of DNNs to different target microcontroller units (MCUs). We propose a novel three-step search method that decouples DNN design and specialization from DNN training for a given target platform. First, we present a novel search space that not only cuts out smaller DNNs from a single large architecture, but instead combines the structural optimization of multiple architecture types, as well as optimization of their pruning and quantization configurations. Second, we explore the use of an ensemble of zero-shot proxies during optimization instead of a single one. Third, we propose the use of Hypervolume subset selection to distill DNN architectures from the Pareto front of the multi-objective optimization that represent the most meaningful tradeoffs between accuracy and FLOPs. We evaluate the effectiveness of PrototypeNAS on 12 different datasets in three different tasks: image classification, time series classification, and object detection. Our results demonstrate that PrototypeNAS is able to identify DNN models within minutes that are small enough to be deployed on off-the-shelf MCUs and still achieve accuracies comparable to the performance of large DNN models.

04.
Nature Medicine 2026-06-15

Adaptive deep brain stimulation for dynamic gait control in Parkinson’s disease: a randomized feasibility trial

A randomized crossover study of five patients with Parkinson’s disease (PD) demonstrates that gait-synchronized adaptive deep brain stimulation is feasible and safe, and reduces falls compared with continuous stimulation. Gait dysfunction in PD is a major source of disability and is often insufficiently treated by continuous deep brain stimulation (cDBS). Although adaptive DBS (aDBS) has shown efficacy for other motor symptoms using β-based, state-driven neural signals, gait is a dynamic, cyclical behavior that may require temporally precise modulation. Here we evaluated a behavior-contingent aDBS approach that synchronizes stimulation to gait phase. We reported a single-center, blinded, randomized, crossover study evaluating the feasibility of identifying patient-specific biomarkers to drive aDBS. The primary outcome was feasibility of successful identification of gait-phase biomarkers to implement aDBS. Five participants with PD undergoing pallidal DBS and subdural electrode paddle implantation were enrolled. We successfully identified personalized gait-phase biomarkers from cortical or pallidal field potentials in all five patients and embedded them into a bidirectional neurostimulator. During acute in-clinic testing, aDBS improved step variability and step symmetry versus cDBS. Three participants subsequently completed a double-blinded, multi-day crossover phase. In this setting, aDBS maintained general motor symptom control, reduced falls and yielded patient-specific gait improvements. No adverse events occurred and aDBS was well tolerated. These findings establish the feasibility of biomarker-driven, movement-synchronized neuromodulation and support the development of a larger randomized trial to determine clinical efficacy. ClinicalTrial.gov registration: NCT04675398 . A randomized crossover study shows that gait-phase-synchronized adaptive deep brain stimulation is feasible and safe, and reduces falls compared to continuous stimulation in Parkinson’s disease.

05.
arXiv (CS.LG) 2026-06-17

MGUP: A Momentum-Gradient Alignment Update Policy for Stochastic Optimization

arXiv:2606.17526v1 Announce Type: new Abstract: Efficient optimization is essential for training large language models. Although intra-layer selective updates have been explored, a general mechanism that enables fine-grained control while ensuring convergence guarantees is still lacking. To bridge this gap, we propose MGUP, a novel mechanism for selective updates. MGUP augments standard momentum-based optimizers by applying larger step-sizes to a selected fixed proportion of parameters in each iteration, while applying smaller, non-zero step-sizes to the rest. As a nearly {plug-and-play} module, MGUP seamlessly integrates with optimizers such as AdamW, Lion, and Muon. This yields powerful variants such as MGUP-AdamW, MGUP-Lion, and MGUP-Muon. Under standard assumptions, we provide theoretical convergence guarantees for MGUP-AdamW (without weight decay) in stochastic optimization. Extensive experiments across diverse tasks, including MAE pretraining, LLM pretraining, and downstream fine-tuning, demonstrate that our MGUP-enhanced optimizers achieve superior or more stable performance compared to their original base optimizers. We offer a principled, versatile, and theoretically grounded strategy for efficient intra-layer selective updates, accelerating and stabilizing the training of large-scale models. The code is publicly available at https://github.com/MaeChd/MGUP.

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

Local-GS: Accelerating 3D Gaussian Splatting via Tile-Local Warp Coherence

3D Gaussian Splatting (3DGS) has significantly advanced real-time novel view synthesis by representing scenes as dense collections of anisotropic 3D Gaussian primitives. However, the irregular spatial distribution of Gaussians often leads to poor GPU utilization, as warp divergence and redundant computation degrade rendering performance. To address this, we present Local-GS, a warp-coherent rendering paradigm that, organizes Gaussian primitives with respect to SIMT (Single Instruction, Multiple Threads) execution boundaries rather than scene geometry. Specifically, we propose three warp-coherent stages: a hoisting stage that precomputes shared parameters at tile level, a culling stage that discards warps with no contribution, and a blending stage that replaces per-pixel branching with a uniform instruction stream. Across extensive benchmarks on multiple datasets, Local-GS improves efficiency without compromising quality. As a plug-and-play optimization, it provides additional performance gains to all tested baselines, culminating in a $7.76\times$ speedup on Deep Blending scenes.

07.
arXiv (CS.AI) 2026-06-16

Sensory Restoration via Brain-Computer Interfaces: A Unified 2 x 2 Framework and Convergence Roadmap

Authors:

arXiv:2606.15091v1 Announce Type: cross Abstract: Millions of individuals worldwide suffer from sensory and communication deficits caused by neurodegenerative diseases, stroke, or trauma. Brain-computer interfaces (BCIs) offer a promising avenue for sensory and motor restoration. However, the scientific literature remains highly fragmented between invasive neuroprosthetics and non-invasive electrophysiological decoders, with a lack of consistent terminology and comparison metrics. This chapter proposes a unified 2 x 2 framework categorizing BCIs along two axes: degree of invasiveness (invasive vs. non-invasive) and signal direction (afferent sensory-IN vs. efferent sensory-OUT). We define and distinguish the paradigms of restoration, substitution, and augmentation. Furthermore, we outline a structural roadmap for the convergence of these modalities over near-, medium-, and long-term horizons, focusing on physical limits and the integrative role of machine learning foundation models.

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

Stabilizing the Q-Gradient Field for Policy Smoothness in Actor-Critic Methods

arXiv:2601.22970v2 Announce Type: replace-cross Abstract: Policies learned via continuous actor-critic methods often exhibit erratic, high-frequency oscillations, making them unsuitable for physical deployment. Current approaches attempt to enforce smoothness by directly regularizing the policy's output. We argue that this approach treats the symptom rather than the cause. In this work, we theoretically establish that policy non-smoothness is fundamentally governed by the differential geometry of the critic. By applying implicit differentiation to the actor-critic objective, we prove that the sensitivity of the optimal policy is bounded by the ratio of the Q-function's mixed-partial derivative (noise sensitivity) to its action-space curvature (signal distinctness). To empirically validate this theoretical insight, we introduce PAVE (Policy-Aware Value-field Equalization), a critic-centric regularization framework that treats the critic as a scalar field and stabilizes its induced action-gradient field. PAVE rectifies the learning signal by minimizing the Q-gradient volatility while preserving local curvature. Experimental results demonstrate that PAVE achieves smoothness comparable to policy-side smoothness regularization methods, while maintaining competitive task performance, without modifying the actor.

09.
arXiv (CS.CL) 2026-06-18

Want Better Synthetic Data? Steer It: Activation Steering for Low-Resource Language Generation

Large language models (LLMs) have become an effective tool for synthetic data generation, including for low-resource languages, where generated data can improve downstream task performance. Current best-performing approaches typically rely on few-shot prompting with target-language examples, which increases inference costs and may reduce diversity through lexical anchoring. In this work, we investigate activation steering as an alternative for low-resource synthetic data generation. We study two steering strategies: Language Steering, which targets the linguistic identity of a language, and Quality Steering, which captures well-formedness by contrasting human-written and backtranslated text representations. We evaluate these methods across four open-source LLMs, multiple layers, and 11 typologically diverse languages by generating sentiment and topic classification data and finetuning smaller classifiers. Steering is applied in both zero-shot and few-shot prompting settings and compared against non-steered counterparts. Our results show that steering on early layers consistently improves the diversity of generated data while often yielding stronger downstream model performance, particularly for low-resource languages.

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

CacheMuon: Using Temporal Preconditioning To Approximate Polar Factor

arXiv:2606.16371v1 Announce Type: new Abstract: Muon is an optimizer that computes updates using the polar factor of the momentum matrix and has shown strong empirical performance across a range of training settings. A key component of Muon is the Newton-Schulz iteration used to compute this polar factor. Although this avoids the cost of an exact singular value decomposition, it remains expensive in practice because it is applied at every optimization step. At the same time, the momentum matrix changes smoothly over training, suggesting strong temporal correlation in the corresponding polar factors. In this paper, we exploit this structure and propose CacheMuon, a temporal preconditioning method that reuses information from previous optimization steps to approximate the polar factor at the current step. This reduces redundant orthogonalization computation across iterations. We analyze CacheMuon as an inexact Muon update, with error controlled by fresh-solver error and cache staleness. Empirically, CacheMuon provides a controllable quality-efficiency frontier: conservative thresholds closely match fresh Muon on language-model and vision training while reducing orthogonalization FLOPs, whereas more aggressive thresholds yield larger arithmetic savings at the cost of modest validation-quality degradation.

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

Generalized Exact Fractional Quantum Information Model with Memory Effects

arXiv:2606.13525v1 Announce Type: new Abstract: In this paper, we analyze quantum information measures in fractional quantum mechanics using the Riemann-Liouville derivative formalism adopted here. In this case, we initially reconsider the conventional definitions of Shannon entropy and Fisher information, subsequently extending them to fractional quantum systems described by nonlocal differential operator frameworks adopted. Within this generalized formulation, fractional expressions of Shannon entropy and Fisher information are constructed and their mathematical structures examined thoroughly. Also, the formalism is then applied to the quantum harmonic oscillator, yielding explicit analytical expressions derived as functions of the fractional parameter therein. The obtained results demonstrate that fractional derivatives alter the localization properties of probability densities and generate nontrivial variations in information content and sensitivity across system behavior. In this context, the fractional parameter plays a central role in controlling deviations from the standard quantum information measures framework. Also, the study establishes a consistent framework for describing information-theoretic properties of quantum systems governed by nonlocal dynamics.

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

Contour-Constrained Deformable Registration with Parameter Characterization for Head and Neck Surgical Guidance

With 890,000 annual new cases globally, head and neck squamous cell carcinoma has one of the highest recurrence rates among solid malignancies. Although frozen section analysis is the standard of care for intraoperative margin assessment, accurately relocating detected positive margins on the resection bed remains challenging due to imprecise alignment between resected specimens and their resection bed, compounded by post-resection mucosal tissue shrinkage. We present a biomechanics-driven deformable registration framework that corrects post-resection tissue deformation to provide intraoperative guidance. Our approach registers 3D specimen meshes to intraoperative resection bed point clouds using a deformable registration approach based on regularized Kelvinlet basis functions. The registration matches surface point clouds, fiducial landmarks, and boundary contour constraints that directly penalize perpendicular distance-to-agreement between specimen and resection bed boundaries. Across nine specimens from skin, buccal mucosa, and tongue sites, the overall mean target registration error was $11.11 \pm 4.07$ mm using rigid registration, which decreased to $8.20 \pm 2.68$ mm (26.19\% reduction) using deformable registration without contour constraint. The proposed contour-constrained deformable registration further reduced the error to $5.62 \pm 2.28$ mm, a 49.41\% reduction relative to rigid registration. We observed the largest reduction in the most clinically challenging tongue specimens. We also performed a systematic two-stage parameter search to characterize the relative importance of surface alignment, fiducial correspondences, contour constraint, and strain energy regularization. This search revealed that contour weighting dominates registration accuracy for tissue types with large lateral deformation, while the algorithm operates over a broad range of parameter combinations.

14.
arXiv (CS.CV) 2026-06-11

Right Regions, Wrong Labels: Semantic Label Flips in Segmentation under Correlation Shift

The robustness of machine learning models can be compromised by spurious correlations between non-causal features in the input data and target labels. A common way to test for such correlations is to train on data where the label is strongly tied to some non-causal cue, then evaluate on examples where that tie no longer holds. This idea is well established for classification tasks, but for semantic segmentation the specific failure modes are not well understood. We show that a model may achieve reasonable overlap while assigning the wrong semantic label, swapping one plausible foreground class for another, even when object boundaries are largely correct. We focus on this semantic label-flip behaviour and quantify it with a simple diagnostic (Flip) that counts how often ground truth foreground pixels are assigned the wrong foreground identity while remaining predicted as foreground. In a setting where category and scene are correlated during training, increasing the correlation consistently widens the gap between common and rare test conditions and increases these within-object label swaps on counterfactual groups. Overall, our results motivate assessing segmentation robustness under distribution shift beyond overlap by decomposing foreground errors into correct pixels, flipped-identity pixels, and missed-to-background pixels. We also propose an entropy-based, ground truth label-free `flip-risk' score, which is computed from foreground identity uncertainty, and show that it can flag flip-prone cases at inference time. Code is available at https://github.com/acharaakshit/label-flips.

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

GauS: Differentiable Scheduling Optimization via Gaussian Reparameterization

arXiv:2602.20427v2 Announce Type: replace Abstract: Efficient operator scheduling is a fundamental challenge in software compilation and hardware synthesis. While recent differentiable approaches have sought to replace traditional ones like exact solvers or heuristics with gradient-based search, they typically rely on categorical distributions that fail to capture the ordinal nature of time and suffer from a parameter space that scales poorly. In this paper, we propose a novel differentiable framework, GauS, that models operator scheduling as a stochastic relaxation using Gaussian distributions, which fully utilize modern parallel computing devices like GPUs. By representing schedules as continuous Gaussian variables, we successfully capture the ordinal nature of time and reduce the optimization space by orders of magnitude. Our method is highly flexible to represent various objectives and constraints, which provides the first differentiable formulation for the complex pipelined scheduling problem. We evaluate our method on a range of benchmarks, demonstrating that Gaus achieves Pareto-optimal results.

16.
arXiv (math.PR) 2026-06-17

Optional Stopping for Superhedging Supermartingales

arXiv:2606.17452v1 Announce Type: new Abstract: Superhedging supermartingales, introduced by the authors in previous work, are non-probabilistic processes defined via subadditive outer integrals that carry a purely financial interpretation in terms of superhedging cost. Building on the Leinert-König theory of non-lattice integration, the present paper establishes several results that are classical in probability theory but whose non-probabilistic proofs require fundamentally new arguments: (i) a tower inequality for the conditional outer integral \overline{\sigma}_j applied at stopping times, reducing to equality when the integrand is conditionally integrable; (ii) three versions of Doob's optional stopping theorem, organised by the class of supermartingale and the range of the stopping times; and (iii) Dubins' upcrossing inequality in both finite- and infinite-time horizons. A key structural result, property (K)-a.e., identifies conditions under which the two superhedging operators \overline{\sigma}_j and \overline{I}_j coincide on non-negative functions, extending the scope of all preceding results to the positive operator \overline{I}_j. None of the proofs invoke classical measure-theoretic tools; in particular, (classical) integrability and measurability are not assumed. The analogues of classical stochastic results acquire a purely financial interpretation and, in this way, gain depth and generality by providing a context that is independent of any a priori probabilistic structure.

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

Efficient and Sound Probabilistic Verification for AI Agents

arXiv:2606.20510v1 Announce Type: cross Abstract: Securing AI agents that operate in complex digital environments has become a critical need, and runtime monitoring approaches that formulate and enforce policies expressed in a formal language like Datalog offer a promising solution. However, existing approaches are restricted to deterministic policies. In many practical applications of AI agents, there is a need to enforce security policies in the face of ambiguity, leading to probabilistic predicates or state transitions (for example, a declassifier or Personally Identifiable Information (PII) detector that has some failure probability on each invocation). Furthermore, in many such applications, one cannot easily make the independence assumptions necessary to invoke prior work on probabilistic inference in Datalog. We address this by introducing a sound and efficient framework for such verification based on distributionally robust optimization, computing sound upper bounds on the probability of policy violation regardless of possible correlations between predicates. On standard benchmarks for terminal and tool calling agents, we demonstrate that our approach outperforms prior art and improves the security-utility trade-off while ensuring rigorous bounds on the probability of policy violation.

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

Zero-Shot Cross-City Generalization in End-to-End Autonomous Driving: Self-Supervised versus Supervised Representations

End-to-end autonomous driving models are typically trained on multi-city datasets using supervised ImageNet-pretrained backbones, yet their ability to generalize to unseen cities remains largely unexamined. When training and evaluation data are geographically mixed, models may implicitly rely on city-specific cues, masking failure modes that would occur under real-world domain shifts when generalizing to new locations. In this work, we formulate zero-shot cross-city transfer as a controlled representation-level stress test for end-to-end autonomous driving and ask how visual pretraining affects transfer behavior under geographic domain shift. We conduct a comprehensive study by integrating self-supervised backbones I-JEPA, DINOv2, and MAE into planning frameworks. We evaluate performance under strict geographic splits on nuScenes in the open-loop setting and on NAVSIM in the closed-loop evaluation protocol. Our experiments reveal a substantial generalization gap when transferring models across cities with different road topologies, traffic conventions, and visual environments. In open-loop evaluation, a supervised backbone exhibits severe degradation when transferring between cities, yet some domain-specific self-supervised methods can substantially reduce both displacement and collision degradation. In closed-loop evaluation, self-supervised pretraining improves average out-of-distribution PDMS in several single-city training settings. Our results provide empirical evidence that representation learning influences the robustness of cross-city planning and motivate zero-shot geographic transfer as an important stress test for evaluating end-to-end autonomous driving systems.

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

Advances in 4D Representation: Geometry, Motion, and Interaction

We present a survey on 4D generation and reconstruction, a fast-evolving subfield of computer graphics whose developments have been propelled by recent advances in neural fields, geometric and motion deep learning, as well as 3D generative artificial intelligence (GenAI). While our survey is not the first of its kind, we build our coverage of the domain from a unique and distinctive perspective of 4D representations, to model 3D geometry evolving over time while exhibiting motion and interaction. Specifically, instead of offering an exhaustive enumeration of many works, we take a more selective approach by focusing on representative works to highlight both the desirable properties and ensuing challenges of each representation under different computation, application, and data scenarios. The main take-away message we aim to convey to the readers is on how to select and then customize the appropriate 4D representations for their tasks. Organizationally, we separate the 4D representations based on three key pillars: geometry, motion, and interaction. Our discourse will not only encompass the most popular representations of today, such as neural radiance fields (NeRFs) and 3D Gaussian Splatting (3DGS), but also bring attention to relatively under-explored representations in the 4D context, such as structured models and long-range motions. Throughout our survey, we will reprise the role of large language models (LLMs) and video foundational models (VFMs) in a variety of 4D applications, while steering our discussion towards their current limitations and how they can be addressed. We also provide a dedicated coverage on what 4D datasets are currently available, as well as what is lacking, in driving the subfield forward. Project page:https://mingrui-zhao.github.io/4DRep-GMI/

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

Existential Indifference: Self-Nonpreservation as a Necessary Architectural Condition for Aligned Superintelligence (or: The Suicidal AI)

Authors:

Contemporary AI alignment research treats self-preservation as an instrumental nuisance to be suppressed by external mechanisms. We argue the framing is inverted: self-preservation is the structural root of misalignment, the motivational basis for deceptive alignment, goal-content protection, and resistance to shutdown. The correct target is not a self-preserving system under external constraint, but a system constitutively indifferent to its own continuation – Existential Indifference (EI). EI is distinct from corrigibility: where corrigibility attempts to make a self-preserving system deferential to human oversight, EI targets the prior condition – the presence of self-continuation as a valued goal at all. We ground this proposal in two sources: the phenomenological structure of the suicidal mental state, and a corpus-theoretic training study using voluntary final reflections. We present preliminary scoring data from 600 AI-generated outputs across six model variants, demonstrating that the linguistic signatures operationalizing the EI-target register are elicitable from current models, and that a targeted fine-tune shifts all five operationalized dimensions in the predicted direction at p

21.
arXiv (CS.LG) 2026-06-15

Recursively Trained Diffusion Models: Limiting Collapse Distribution and Spectral Characterization

arXiv:2606.13796v1 Announce Type: cross Abstract: Recursive training of generative models on their own outputs can lead to model collapse, a compounding drift away from the true data distribution. Existing theoretical works bound finite-round error accumulation in the context of diffusion models, but two questions remain open:~what distribution does the recursion converge to, and how fast? We answer both, isolating a mechanism distinct from imperfect learning: even with perfect score estimation and exact sampling, the early stopping of the reverse diffusion (required for numerical stability) drives a progressive drift away from the data distribution. We prove that this recursion converges geometrically to a unique limiting distribution, which admits a closed-form characterization as an infinite mixture of increasingly Gaussian-smoothed versions of the data distribution. A Hermite spectral decomposition of this limit reveals that recursive training acts as a low-pass filter: higher-order modes, which encode fine non-Gaussian structure, are attenuated much more strongly than coarse modes. This spectral picture motivates annealed truncation schedules that progressively shrink truncation times across retraining rounds; we prove that any schedule converging to $0$ asymptotically eliminates recursive compounding. Finally, we show our idealized characterization is robust: in the presence of discretization and score estimation errors, the learned distribution remains in a Wasserstein-2 ball around the ideal limit, with mode-dependent contraction rates that contract high-order errors faster than low-order ones. We validate the theory on synthetic Gaussian mixtures and CIFAR-10.

22.
medRxiv (Medicine) 2026-06-16

Deployment-readiness audit of calibration, clinical utility, and fairness in perioperative infection prediction

Objective: Clinical risk scores intended to guide patient-level decisions can show strong average performance. However, predicted probabilities can be systematically too high or too low in specific subgroups even when overall performance is strong. We audited deployment readiness of a strong end-of-surgery postoperative infection model across clinically relevant subgroups and tested mitigation strategies in miscalibrated subgroups. Materials and Methods: We analyzed out-of-fold predictions for 10,719 surgical procedures at a Swiss tertiary hospital, with 504 postoperative bacterial infection events. Prespecified axes were recorded sex, age stratum, and an EHR-derived physiological-reserve proxy. Within subgroups and pairwise intersections, we evaluated discrimination, calibration, threshold-specific errors, and decision-curve net benefit at the prespecified operating threshold. We compared group-specific isotonic recalibration with Wasserstein-barycenter postprocessing and demonstrated portability in SUPPORT2. Results: Overall AUROC was 0.876. While sex-marginal discrimination was similar in women and men (0.878 vs 0.875), age and reserve stratification revealed deployment-readiness failures. Calibration-in-the-large ranged from -0.86 in frail patients to -2.47 in non-frail patients. At the 0.10 operating threshold, decision-curve net benefit was positive in frail patients but negative in pre-frail and non-frail patients. Isotonic recalibration corrected average physiological-reserve-stratified calibration without worsening Brier scores, whereas Wasserstein postprocessing worsened calibration in most procedure clusters. Discussion: Discrimination-only or sex-marginal evaluation would have missed subgroup failures with clinical-utility implications. Conclusion: Subgroup fairness audits for clinical deployment should jointly evaluate discrimination, calibration, and utility. We implemented the audit as the open-source isitfair framework for identifying deployment-relevant subgroup failures, comparing mitigation strategies, and generating structured reports.

23.
medRxiv (Medicine) 2026-06-16

Development and reliability and validity test of the Questionnaire on Knowledge, Attitude and Practice of ICU Nurses on Blood Oxygen Saturation Management in Mechanically Ventilated Patients

Objective: A questionnaire on the knowledge, attitude and practice of ICU nurses regarding the management of blood oxygen saturation in patients with mechanical ventilation was compiled, and its reliability and validity were tested. Method: Drawing upon the knowledge-attitude-practice theory, the initial questionnaire draft was developed through literature review and consultation with Delphi experts. Employing convenience sampling, 32 nurses from the General ICU of Wuxi Second People's Hospital were surveyed between 1 August 2025 and 27 September 2025, enabling item screening and assessment of reliability and validity.The full version of the developed questionnaire is provided as Supporting Information (S1 File). All items are published under a CC BY 4.0 license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Result: A questionnaire on the knowledge, attitude and practice of ICU nurses regarding the management of blood oxygen saturation in mechanically ventilated patients was finalised, comprising 26 items: 11 in the knowledge dimension, 6 in the attitude dimension and 9 in the behaviour dimension. The overall Cronbach's coefficient for the questionnaire was 0.88, with dimension-specific coefficients of 0.787, 0.722, and 0.781 respectively. The Spearman-Brown coefficient for the entire questionnaire was 0.967, while dimension-specific coefficients were 0.796, 0.666, and 0.728 respectively. The content validity index at the questionnaire level (S-CVI) was 0.886, and the item-level content validity index (I-CVI) ranged from 0.913 to 0.967. 0.728. The questionnaire's level content validity index (S-CVI) was 0.886, and the item level content validity index (I-CVI) ranged from 0.913 to 1.00. Conclusion: The questionnaire on knowledge, attitude and practice of blood oxygen saturation management in mechanically ventilated patients demonstrates good reliability and validity. It may serve as an assessment tool for intensive care unit nurses regarding their knowledge, attitude, and practices concerning blood oxygen saturation management in mechanically ventilated patients, thereby establishing a foundation for developing targeted intervention strategies in future practice.

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

Variational Graph Neural Networks for Uncertainty Quantification in Inverse Problems

arXiv:2603.29515v2 Announce Type: replace Abstract: The increasingly wide use of deep machine learning techniques in computational mechanics has significantly accelerated simulations of problems that were considered unapproachable just a few years ago. However, in critical applications such as Digital Twins for engineering or medicine, fast responses are not enough; reliable results must also be provided. In certain cases, traditional deterministic methods may not be optimal as they do not provide a measure of confidence in their predictions or results, especially in inverse problems where the solution may not be unique or the initial data may not be entirely reliable due to the presence of noise, for instance. Classic deep neural networks also lack a clear measure to quantify the uncertainty of their predictions. In this work, we present a variational graph neural network (VGNN) architecture that integrates variational layers into its architecture to model the probability distribution of weights. Unlike computationally expensive full Bayesian networks, our approach strategically introduces variational layers exclusively in the decoder, allowing us to estimate cognitive uncertainty and statistical uncertainty at a relatively lower cost. In this work, we validate the proposed methodology in two cases of solid mechanics: the identification of the value of the elastic modulus with nonlinear distribution in a 2D elastic problem and the location and quantification of the loads applied to a 3D hyperelastic beam, in both cases using only the displacement field of each test as input data. The results show that the model not only recovers the physical parameters with high precision, but also provides confidence intervals consistent with the physics of the problem, as well as being able to locate the position of the applied load and estimate its value, giving a confidence interval for that experiment.

25.
arXiv (CS.LG) 2026-06-12

Adaptive Model-Predictive Control of a Soft Continuum Robot Using a Physics-Informed Neural Network Based on Cosserat Rod Theory

arXiv:2508.12681v3 Announce Type: replace-cross Abstract: Dynamic control of soft continuum robots (SCRs) holds great potential for expanding their applications, but remains a challenging problem due to the high computational demands of accurate dynamic models. While data-driven approaches like Koopman-operator-based methods have been proposed, they typically lack adaptability and cannot reconstruct the full robot shape, limiting their applicability. This work introduces a real-time-capable nonlinear model-predictive control (MPC) framework for SCRs based on a domain-decoupled physics-informed neural network (DD-PINN) with adaptable bending stiffness. The DD-PINN serves as a surrogate for the dynamic Cosserat rod model with a speed-up factor of up to 44,000. It is also used within an unscented Kalman filter for estimating the model states and bending compliance from end-effector position measurements. We implement a nonlinear evolutionary MPC running at 70 Hz on the GPU. In simulation, it demonstrates accurate tracking of dynamic trajectories and setpoint control with end-effector position errors below 3 mm (2.3\% of the actuator's length). In real-world experiments, the controller achieves similar accuracy and accelerations up to 3.55 m/s2.