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01.
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.

02.
arXiv (CS.LG) 2026-06-19

Quantum ring all-reduce: communication and privacy advantages for distributed learning

arXiv:2606.20344v1 Announce Type: cross Abstract: Machine learning models have scaled to unprecedented sizes, making training across distributed devices the de facto standard in the field. In this work, we explore how quantum communications can make distributed training both more communication-efficient and information-theoretically private, for both classical and quantum learning models. Ring all-reduce is the foundational communication primitive for large-scale distributed training. We present a quantum version that reduces per-link online communication by a provably optimal factor of two using pre-shared entanglement and superdense coding, without requiring the learning model or gradient computation to change. Beyond bandwidth, the primitive enables privacy guarantees that are information-theoretically impossible for any classical protocol, achieving composable {\epsilon}-secure aggregation, via verified entanglement, at a 2x overhead in GHZ copies. Our hybrid quantum-classical communication architecture yields simultaneous communication and security advantages for large scale distributed training, regardless of whether the learning itself is quantum or classical. Finally, we characterise quantum advantages in gradient conflict detection for server-to-client communication under bandwidth constraints, a setting that arises after ring all-reduce is completed, when full gradient broadcast to external clients is infeasible. Two variants of the problem admit different separations. For margin-based alignment testing (\textsc{GapIP}_{\tau}), the quantum advantage is quadratic in the margin parameter: \widetilde{O}({\tau}^{-1}\log P) qubits versus \widetilde{O}(\min(\{\tau}^{-2},P)) bits. For sign-consistency auditing against a private parameter matching (\textsc{TieAudit}_{\epsilon}), the advantage represents an exponential separation in communication complexity: \Omega(\sqrt{P}) bits whereas O({\epsilon}^{-2}\log P) qubits suffice.

03.
Nature Medicine 2026-06-22

<b>PROTEUS trial heralds perioperative therapy for prostate cancer</b>

Perioperative androgen-deprivation therapy plus apalutamide could represent a new treatment option for patients with high-risk, localized prostate cancer. Perioperative androgen-deprivation therapy plus apalutamide could represent a new treatment option for patients with high-risk, localized prostate cancer.

04.
medRxiv (Medicine) 2026-06-11

Neighborhood socioeconomic status associated with post-stroke cognitive impairment: a retrospective cohort study

Background: Late complications after stroke (LCAS), including cognitive symptoms, impact quality of life and recovery. It is not known if neighborhood-level measures of socioeconomic status (SES) influence LCAS. This study assessed associations between SES measures, including neighborhood income inequality (Gini) and area deprivation index (ADI), and cognitive symptoms after acute ischemic stroke (AIS) in a hospital leveraging active surveillance of LCAS. Methods: This retrospective cohort study included 512 patients hospitalized with AIS at Tufts Medical Center with subsequent follow-up (between zero and three months or between three and twelve months) in the Stroke Clinic from 1/1/2018 - 12/31/2022. Using ZIP code data, patients were characterized as low Gini (low inequality) and high ADI (high deprivation) (Gini = 5) by state medians. These variables were combined, indicating patients who were living in both a low Gini and high ADI neighborhood to evaluate the effects of living in a homogeneously deprived area. There were 206 and 281 patients in the low Gini and high ADI groups respectively. 140 patients lived in a low Gini and high ADI neighborhood. The multivariable logistic analysis assessed the likelihood of cognitive symptoms, adjusting for age, race, ethnicity, sex, NIH Stroke Scale (NIHSS), thrombolysis, active LCAS surveillance, poverty, and ADI-Gini combination. Results: There were no associations between high ADI (OR: 1.03, 95% CI: 0.67 ? 1.57) or low Gini (OR: 1.74, 95% CI: 0.98 ? 3.07) alone and cognitive symptoms after AIS. However, the combined variable demonstrated increased likelihood of cognitive symptoms in the high ADI-low Gini group (OR: 1.82, 95% CI: 1.08 ? 3.06). Conclusions: This study suggests that individuals living in homogeneously deprived neighborhoods report higher likelihood of cognitive symptoms after AIS. Further studies with increased power are needed to investigate the underlying causes of these disparities and to develop interventions to reduce these complications.

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

From Paper to Program: Knowledge Externalization for AI-Assisted Quantum Many-Body Code Generation

作者:

arXiv:2604.04089v3 Announce Type: replace-cross Abstract: Large language models can write scientific code, but direct paper-to-program translation remains fragile when correctness depends on tacit conventions in the literature. We identify this bottleneck as knowledge externalization: converting implicit computational assumptions – index conventions, gauge choices, fermionic signs, contraction order, and memory constraints – into an explicit technical specification before implementation. We evaluate a multi-stage, human-in-the-loop workflow that inserts such a specification, with validation and stop gates, between theory extraction and code generation. The workflow is tested on two algorithmically distinct quantum many-body tasks: variational sweep-based Density-Matrix Renormalization Group (DMRG) from a pedagogical review and constructive Pfaffian conversion of Hartree–Fock–Bogoliubov states to matrix product states from the five-page Letter by Jin et al., Phys. Rev. B 105, L081101 (2022), for which no public code is available. For DMRG, all 16 specification-guided model pairings in a $4\times4$ grid satisfy physics-validation criteria, compared with 6/13 direct attempts. A prose-specification ablation indicates that externalized content, not \LaTeX{} formatting, is the essential ingredient. For Pfaffian-MPS, the workflow succeeds in 11/26 archived attempts, whereas direct prompting yields zero audited passes. Cross-specification transfer is asymmetric: non-GPT specifications implemented by GPT~5.5 pass 4/4, while GPT~5.5 specifications implemented by weaker models fail 4/4, indicating a residual implementation-model bottleneck. The resulting Paper-to-Program Many-Body skill provides an auditable protocol for AI-assisted implementation of many-body algorithms and for diagnosing where externalization succeeds or fails.

07.
arXiv (math.PR) 2026-06-16

On stability of outliers from the circular law

arXiv:2606.16609v1 Announce Type: new Abstract: This work investigates the stability of outliers from the circular law, via the convergence of their associated diagonal overlaps between eigenvectors - also known as the squared eigenvalue condition numbers. We consider and compare two paradigmatic cases, namely: 1) the Complex Ginibre Ensemble conditioned on the existence of an outlier, and 2) the outlier induced by a rank-one Hermitian perturbation of a Complex Ginibre matrix. In both cases, we prove almost sure convergence towards a specific constant that only depends on the radius of the outlier and its status - either conditioned or induced. These results can be generalized to other complex integrable ensembles with the same techniques, and complement our understanding of eigenvalue stability in non-Hermitian ensembles.

08.
arXiv (CS.CL) 2026-06-15

Towards Direct Latent-Space Synthesis for Parallel Branches in LLM-Agent Workflows

Large language models increasingly serve as execution engines for agentic systems, yet they still consume context through a sequential text interface. This creates a mismatch with modern structured agent workflows, in which independent branches explore subtasks, retrieve evidence, or generate candidate solutions before a final synthesis step. Existing systems typically merge these branches by concatenating their textual outputs, which discards the parallel structure and incurs redundant prefill computation. In this work, we introduce Parallel-Synthesis, a plug-and-play framework that enables a synthesizer to directly consume the KV caches produced by parallel worker agents. Parallel-Synthesis combines a cache mapper that calibrates independently generated branch caches with a fine-tuned synthesizer adapter that enables generation from this non-sequential cache interface. We train Parallel-Synthesis using data that exposes the synthesizer to parallel cache contexts, teaches aggregation across cached branches, and distills reasoning behavior from standard text-concatenation-based synthesis. Across nine downstream datasets spanning math, science QA, code generation, GAIA, and multi-agent database diagnosis, Parallel-Synthesis matches or outperforms text-based synthesis on seven datasets and remains close on the other two. It also reduces time-to-first-token by 2.5x-11x, suggesting that direct cache-based synthesis is a promising interface for more native and efficient synthesis over parallel agent branches.

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

Controlled Dynamics Attractor Transformer

arXiv:2606.15207v1 Announce Type: cross Abstract: Transformer architectures have dramatically advanced representation learning and inference in deep models through self-attention mechanisms. In parallel,associative memory (AM) frameworks map representations onto energy landscapes, offering interpretable retrieval mechanisms. However, their continuous-time inference dynamics lack the biological plausibility of classical Continuous Attractor Neural Networks (CANNs). To bridge this gap, we propose Controlled Dynamics Attractor Transformer (CDAT), which couples a mixture von Mises-Fisher (Mo-vMF) attention energy with a Hopfield refinement energy, while augmenting energy descent with a CANN-inspired excitation-inhibition modulation. CDAT instantiates a topology-constrained dynamical system whose couplings encode relational structure among tokens, thereby linking attractor-style dynamics to modern energy-based attention. We further provide a constructive dissipation analysis to formally establish their controlled inference dynamics. Benefiting from these robust and structured dynamics, CDAT achieves state-of-the-art performance across multiple benchmarks in graph anomaly detection and graph classification.

10.
bioRxiv (Bioinfo) 2026-06-20

Evaluation of Trypanosoma brucei Phosphofructokinase Allosteric Inhibition: An In-Silico Study

Human African trypanosomiasis, caused by a protozoan parasite Trypanosoma brucei, is a neglected tropical disease for which well-tolerated, conveniently administered, and highly efficacious medicines are still missing. Previously, T. brucei Phosphofructokinase was targeted by small-molecule inhibitor development efforts. This approach has shown promise both in vitro and in vivo. In this study, we have used these wet-lab results, evaluated the compounds already characterised by Molecular Dynamics simulations, found relationships between in silico and wet-lab data and used these observations to evaluate compounds that we selected through several different approaches of virtual screens. We observed that inhibitor-ATP interactions are highly predictive of the inhibitory activity. Several compounds selected through virtual screens have outperformed previously characterised compounds.

11.
arXiv (CS.LG) 2026-06-18

Detecting Hidden ML Training With Zero-Overhead Telemetry

arXiv:2606.19262v1 Announce Type: new Abstract: Hardware-enabled monitoring of GPU workloads underpins many proposals for AI compute governance, but if developers can defeat monitoring mechanisms, such schemes are unworkable. We evaluate the adversarial robustness of GPU workload classification using only zero-overhead, privacy-preserving NVML telemetry: content-agnostic signals that observe physical effects of computation without accessing model weights, training data, or hyperparameters. Across 5 rounds of monitor-evader iteration, we evaluate 20 evasion strategy families on 9 GPU models spanning 4 architecture generations. We develop a classifier that achieves 98.2% binary accuracy at identifying training workloads across the whole corpus, and 43-87% accuracy against the most challenging unexpected workloads even when they are adversarially disguised.

12.
arXiv (CS.LG) 2026-06-15

On Rate-Optimal Partitioning Classification from Observable and from Privatised Data

arXiv:2312.14889v4 Announce Type: replace-cross Abstract: In this paper we revisit the classical method of partitioning classification and prove novel convergence rates under relaxed conditions, both for observable (non-privatised) and for privatised data. We consider the problem of classification in a $d$ dimensional Euclidean space. Previous results on the partitioning classifier worked with the strong density assumption (SDA), which is restrictive, as we demonstrate through simple examples. Here, we study the problem under much milder assumptions. We presuppose that the distribution of the inputs is a mixture of an absolutely continuous and a discrete distribution, such that the absolutely continuous component is concentrated on a $d_a$ dimensional subspace. In addition to the standard Lipschitz and margin conditions, a novel characteristic of the absolutely continuous component is introduced, by which the convergence rate of the classification error probability is computed, both for the binary and for the multi-class cases. This bound can reach the minimax optimal convergence rate achievable using SDA, but under much milder distributional assumptions. Interestingly, this convergence rate depends only on the intrinsic dimension of the continuous inputs, $d_a$, and not on $d$. Under privacy constraints, the data cannot be directly observed, and the constructed classifiers are functions of the randomised outcome of a suitable local differential privacy mechanism. In this paper we add Laplace distributed noises to the discretisations of all possible locations of the feature vector and to its label. Again, tight upper bounds on the convergence rate of the classification error probability can be derived, without using SDA, such that this rate depends on $2d_a$.

13.
arXiv (CS.AI) 2026-06-12

SAIGuard: Communication-State Simulation for Proactive Defense of LLM Multi-Agent Systems

arXiv:2606.12474v1 Announce Type: cross Abstract: LLM-based multi-agent systems (MAS) solve complex tasks through inter-agent collaboration, but their communication-driven nature also allows security risks to spread across agents and trigger system-wide failures. Existing MAS defenses mainly follow a reactive paradigm after execution by detecting and isolating harmful agents, which may cause irreversible damage and degrade collaborative utility. To address this, we propose a proactive defense framework for MAS security, namely a Simulation-aware Interception Guard (SAIGuard). SAIGuard performs communication-state simulation over the MAS interaction graph, estimates the impact of incoming messages on local agent states and the global MAS state, and detects risky messages via reconstruction deviations from benign communication patterns. Instead of isolating agents, SAIGuard sanitizes or regenerates suspicious messages before it propagation into system. Experiments across diverse topologies and attack scenarios show that SAIGuard reduces attack success rates while maintaining MAS utility, outperforming reactive defenses.

14.
bioRxiv (Bioinfo) 2026-06-11

An AI-Powered Trisomy 21 Research Assistant

Down syndrome, caused by trisomy 21, increases the risk of diverse co-occurring conditions. With more than 34,000 related publications indexed in PubMed as of early 2026, keeping pace with this expanding literature is challenging. While general-purpose large language models are widely used for information retrieval, they often rely on broad training data rather than specific evidence. Retrieval-augmented generation (RAG) improves rigor and reliability of responses by linking model outputs to source texts. In research, source texts are peer-reviewed articles. Standard implementations treat all manuscript sections equally, allowing background text to rank as highly as experimental results. To focus model outputs on experimentally supported responses, we developed the T21 Research Assistant, a section-aware RAG system that prioritizes Results sections to ground responses in primary experimental evidence. The system draws exclusively from 1,789 open-access Down syndrome publications from PubMed Central, including 327 NIH INCLUDE-funded studies, and uses a multistage pipeline for query validation, retrieval, reranking, synthesis, and citation verification. Built on NVIDIA Nemotron models, it generates structured, cited responses. Evaluation using expert-curated questions demonstrated strong performance, achieving a BERTScore F1 of 0.712 and recall of 0.758, comparable to or exceeding leading proprietary and open-source models. T21 Research Assistant is available at: https://bioinformatics.cuanschutz.edu/t21-res-assi/

15.
arXiv (quant-ph) 2026-06-17

Induced Resource Theories and Harvesting via Quantum Probes

arXiv:2606.17287v1 Announce Type: new Abstract: We consider scenarios in which a quantum system with a well-defined resource theory is used as a probe to interact with an environment, such as a quantum field, for which a resource-theoretic description is absent or incomplete. We clarify if and how the harvesting of a resource in the probe can tell us about the state of the environment. This is particularly ambiguous when the probe-environment interaction is not a free operation, or the concept of such free operations cannot be defined altogether. We propose a framework and precise conditions under which it becomes possible to interpret resource generation on the probe as evidence of resources in the environment, thereby introducing an effective notion of resources for the latter. Our results clarify in which sense resources can be said to be harvested from the environment and provide a systematic way to analyse such processes beyond fully controlled resource-theoretic settings. More generally, this work may provide a step towards a more general understanding of the interplay of different quantum resources.

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

Experimental realization of the complete seven-phase Anderson-localization landscape

arXiv:2606.14825v1 Announce Type: cross Abstract: Anderson localization has evolved far beyond the conventional dichotomy between extended and localized states. Modern localization theory predicts a complete transport hierarchy comprising extended, critical, and localized phases together with all coexistence phases among them, forming a seven-phase Anderson-localization landscape. Despite its fundamental importance, this hierarchy has never been experimentally realized within a single system. Here we realize the complete seven-phase Anderson-localization landscape in a one-dimensional Floquet photonic lattice. By engineering quasiperiodic hopping profiles containing inhomogeneously distributed hopping zeros, we generate critical states and enable their coexistence with extended and localized sectors. The resulting transport regimes are directly resolved through their distinct spatiotemporal dynamics, including ballistic expansion, confined critical oscillations, and persistent localization. We observe all seven phases, including the elusive triply coexisting extended-critical-localized phase, and experimentally track the phase transitions connecting them. Our results establish the first complete experimental map of the Anderson-localization landscape and provide a unified platform for investigating mobility edges, multifractality, and programmable coherent transport.

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

Learning and Generating Mixed States Prepared by Shallow Channel Circuits

arXiv:2604.01197v4 Announce Type: replace-cross Abstract: Learning quantum states from measurement data is a central problem in quantum information and computational complexity. In this work, we study the problem of learning to generate mixed states on a finite-dimensional lattice. Motivated by recent developments in mixed state phases of matter, we focus on arbitrary states in the trivial phase. A state belongs to the trivial phase if there exists a shallow preparation channel circuit under which local reversibility is preserved throughout the preparation. We prove that any mixed state in this class can be efficiently learned from measurement access alone. Specifically, given copies of an unknown trivial phase mixed state, our algorithm outputs a shallow local channel circuit that approximately generates this state in trace distance. The sample complexity and runtime are polynomial (or quasi-polynomial) in the number of qubits, assuming constant (or polylogarithmic) circuit depth and gate locality. Importantly, the learner is not given the original preparation circuit and relies only on its existence. Our results provide a structural foundation for quantum generative models based on shallow channel circuits. In the classical limit, our framework also inspires an efficient algorithm for classical diffusion models using only a polynomial overhead of training and generation.

18.
arXiv (CS.LG) 2026-06-12

Adaptive Weighted Averaging

arXiv:2606.12763v1 Announce Type: new Abstract: We study the problem of selecting the largest among $n$ unknown values $x_1,\dots,x_n$ given only a single unbiased estimate $y_i$ for each $x_i$. We design strategies that are simultaneously admissible (not uniformly dominated by any other strategy) and also never worse than a given baseline such as uniform random selection. We provide an application to stochastic optimization, where we obtain online-to-batch conversion bounds with a desirable "no-compromise" guarantee: they are never worse than standard random iterate selection, and yet can be significantly better in benign settings.

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

Towards a Bridge Layer Between Bibliographic and Formalized Mathematical Knowledge

作者:

arXiv:2606.11430v1 Announce Type: cross Abstract: Mathematical knowledge is split between bibliographic databases (e.g., MathSciNet, zbMATH Open) and formal proof libraries (e.g., Lean mathlib), preventing unified access between published results and their formalizations. We propose a relational bridge-database that aligns publication metadata with formal artifacts, providing an interoperability layer between mathematical literature and machine-verifiable proofs. We introduce a paper-level formalization score that measures how much of a publication is covered in formal systems. As a feasibility study, we show how such scores can be estimated via cross-document alignment between informal texts and Lean formalizations, enabling large-scale analysis of formalization coverage. This framework is a first step toward integrating bibliographic and formal mathematical ecosystems into scalable, machine-actionable knowledge graphs linking publications to formal proof objects.

20.
arXiv (CS.CV) 2026-06-16

SLU-2K: A Question-Based Benchmark for Semantic Evaluation of Sign Language Translation

Sign Language Translation (SLT) is typically evaluated with surface-form metrics such as BLEU and ROUGE, which reward lexical overlap but do not directly measure whether a translation preserves the meaning of the source sign sequence. This is in contrast with the final objective of integrating SLT in assistive technology. In this work, we shift the focus from Sign Language Translation (SLT) to Sign Language Understanding (SLU), with particular emphasis on semantic understanding. Specifically, we evaluate systems based on their ability to correctly recover, from the input video, key semantic aspects of the original sentence, such as actions taking place and facts about people and objects. To enable this evaluation systematically, we propose SLU-2K, a dataset of 2,350 closed-ended video question-answer pairs based on the popular PHOENIX-2014T and CSL-Daily datasets. To obtain SLU-2K, we propose and extensively evaluate an automated data generation pipeline which produces questions across 7 categories, namely actions, locations, numbers, objects, people, time, and weather conditions. We show the potential of SLU-2K by evaluating popular Multimodal Large Language Models (MLLMs) and two representative state-of-the-art systems, MMSTL and SpaMo. Our results show that MLLMs reach near-random performance, highlighting the need for a more systematic integration of SLU in current AI systems. Furthermore, state-of-the-art translation systems carefully fine-tuned on in-domain data still exhibit a substantial semantic gap, with results ranging from 56.7% to 75.2%. These findings suggest that current SLT evaluation protocols overestimate true understanding and that future progress should be measured not only by fluency and n-gram overlap, but also by semantic correctness. Code, prompts, and benchmark files are available at https://github.com/ZenoTsT/SLU-2K

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

Rotation-Invariant Spherical Watermarking via Third-Order SO(3) Representation Coupling

Reliable watermarking of panoramic imagery is fundamentally challenged by arbitrary 3D rotations. As panoramas are defined on the sphere, they naturally transform under the action of $SO(3)$, rendering conventional planar representations and augmentation-based robustness strategies inadequate and devoid of theoretical guarantees. To address this, we formulate panoramas as spherical signals and leverage $SO(3)$ representation theory to derive provably rotation-invariant descriptors. While spherical harmonic coefficients transform equivariantly under rotations, the natural invariant constructions are typically limited to zeroth-order statistics which eliminate directional information and severely constrain embedding capacity. In this work, we introduce a principled third-order invariant construction by coupling higher-order $SO(3)$ irreducible representations via tensor products and projecting onto the trivial representation. This yields a spherical invariant bispectrum that preserves phase information while remaining strictly rotation-invariant. Leveraging this property, we embed watermarks into higher-order spherical harmonic coefficients and recover them from invariant bispectral scalars, enabling reliable extraction under arbitrary 3D rotations. We provide a theoretical proof of $SO(3)$ invariance for it and demonstrate experimentally its near-perfect robustness to continuous rotations while maintaining high visual fidelity.

22.
arXiv (CS.CV) 2026-06-17

Flux-Guard: Facial Identity Protection using diffusion models

The widespread deployment of face recognition (FR) systems exposes personal images shared on social media and public platforms to identity linkage and privacy risks. Existing adversarial privacy protection methods can degrade unauthorized FR performance but are not compatible with generative face editing. Artificial intelligence-driven face editing tools are gaining popularity, which has significantly increased user demand for personalized portrait generation and social sharing. However, current editing methods often preserve identity features, making the edited images still susceptible to tracking by malicious FR systems. Thus, this paper proposes Flux-Guard, a privacy-preserving face editing framework based on adversarial attacks, which integrates face editing and privacy protection within a unified generative process. Specifically, we design a flow trajectory control method to align semantic manipulations with the generative process and introduce latent-space adversarial optimization with an adaptive perceptual-loss-driven weighting strategy, dynamically adjusting adversarial strength to maximize attack effectiveness while preserving visual quality. Extensive experiments demonstrate that Flux-Guard supports face editing while significantly improving attack success rates against cross-domain face recognition models on the CelebA-HQ and LADN datasets. Furthermore, evaluation results for commercial APIs have confirmed its effectiveness in real-world applications. The code is released at https://github.com/JLMWang/Flux-Guard.

23.
PLOS Medicine 2026-05-06

Pathways of emergency care for severely ill children in Nigerian and Ugandan hospitals: A process mapping study

作者:

by Rami Subhi, Abiodun Sogbesan, Dan Muramuzi, Mikael Burhin, Ayobami A. Bakare, Adegoke G. Falade, Freddy E. Kitutu, Freddie Ssengooba, Carina King, Sumit Kane, Belinda Dawson-McClaren, Hamish R. Graham, the MOXY-Implementation Research Collaboration Background Child mortality remains high in countries with weak emergency care systems. Facility organisation for paediatric emergency care is heterogeneous and under-described. We examined how hospitals in Uganda and Nigeria are organised to deliver emergency care for neonates and children. Methods and findings We conducted a qualitative, multi-method study in 26 purposively selected secondary and tertiary facilities in Uganda and Nigeria from October 2023 to December 2024. Embedded researchers documented patient pathways, resources for care, and care processes for severely ill children (

24.
medRxiv (Medicine) 2026-06-16

Ranking-optimized survival models can underperform fixed-horizon clinical prediction: a SUPPORT2 reanalysis of machine learning, attending-physician judgment, and the original SUPPORT model at 60- and 180-day mortality

Machine-learning survival models are increasingly proposed for intensive-care mortality prediction and are almost always selected and reported using the concordance index, a ranking metric averaged over follow-up. Yet most bedside decisions hinge on a probability at a specific time, such as 60- or 180-day mortality. We asked whether ranking-optimized models remain competitive at fixed clinical horizons against two reference points clinicians actually rely on: unaided attending-physician judgment and the original 1995 SUPPORT logistic model. Reanalyzing the SUPPORT2 cohort (9,105 critically ill adults from five United States centers, 1989-1994) under a stratified 70/15/15 split, we compared a gradient-boosted survival model, the physician's recorded prognosis, and the 1995 model at 60 and 180 days, alongside several alternative learners. The survival model achieved competitive ranking concordance (0.705) yet underperformed both comparators at fixed horizons: at 60 days its area under the ROC curve was 0.750, against 0.808 for physicians on the matched sample and 0.827 for the 1995 model, a gap that held across eight independent data splits and remained statistically reliable after multiplicity correction. The shortfall was not miscalibration, since post-hoc recalibration left discrimination unchanged, nor limited capacity, since neural networks, a deep ranking model, and two timepoint-aware discrete-time models also failed to close it; replacing the ranking objective with timepoint-matched binary training recovered roughly half the gap, pointing to an objective-horizon mismatch. Discrimination was equitable across sex, race, and age, but leave-one-disease-out validation exposed severe failure for disease groups absent from training, and the physician advantage was conditional on a physician electing to provide an estimate. We recommend reporting timepoint-specific discrimination alongside concordance, timepoint-matched training when fixed-horizon predictions drive care, leave-one-subgroup validation, and distribution-free prediction intervals to support selective deployment.

25.
Nature (Science) 2026-06-10

A thalamus–brainstem attractor network drives history-biased decisions

作者:

Natural environments often change gradually, making it adaptive to bias decisions on the basis of the recent past — a phenomenon known as serial dependence1–3. Large-scale recordings during behaviour have identified that serial dependence is a common motif for decision-making, with neural representations of past experiences found throughout the brain4–11. However, it remains unclear whether this bias arises from dedicated neural circuits with history-specific computations. Using whole-brain, cellular-resolution imaging in zebrafish performing memory-guided evasive manoeuvres12–14, we identified a hierarchical circuit that maintains past information and biases future choices. Discrete attractors in the dorsal thalamus encoded the position of the most recent obstacle, maintaining a categorical memory via persistent activity lasting 10–20 s. Optogenetic manipulation of the dorsal thalamus abolished or imposed serial bias. A downstream hindbrain integrator received input from the thalamus and combined it with current sensory cues to produce graded responses reflecting multi-trial history. Leveraging a comprehensive brain atlas in zebrafish15, we constructed a whole-brain computational model that recapitulated behaviour and also predicted a key role for heterogeneous inhibitory subtypes in enabling flexible state transitions. This attractor–integrator architecture reveals a hierarchical and modular computation that unifies robust memory retention with flexible sensory integration, providing a general principle for history-biased decisions. Whole-brain, cellular-resolution imaging reveals a hierarchical thalamus–brainstem attractor network that encodes recent history and shapes behavioural bias in zebrafish.