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01.
arXiv (CS.CV) 2026-06-17

EmbodiTTA: Resource-Efficient Test-Time Adaptation for Embodied Visual Systems

Continual Test-time adaptation (CTTA) continuously adapts the deployed model on every incoming batch of data. While achieving optimal accuracy, existing CTTA approaches present poor real-world applicability on resource-constrained edge devices, due to the substantial memory overhead and energy consumption. In this work, we first introduce a novel paradigm – on-demand TTA – which triggers adaptation only when a significant domain shift is detected. Then, we present OD-TTA, an on-demand TTA framework for accurate and efficient adaptation on edge devices. OD-TTA comprises three innovative techniques: 1) a lightweight domain shift detection mechanism to activate TTA only when it is needed, drastically reducing the overall computation overhead, 2) a source domain selection module that chooses an appropriate source model for adaptation, ensuring high and robust accuracy, 3) a decoupled Batch Normalization (BN) update scheme to enable memory-efficient adaptation with small batch sizes. Extensive experiments show that OD-TTA achieves comparable and even better performance while reducing the energy and computation overhead remarkably, making TTA a practical reality.

03.
arXiv (CS.CL) 2026-06-16

Learning When to Sample: Confidence-Aware Selective Sampling for Efficient Chain-of-Thought Reasoning

Large language models (LLMs) can achieve strong reasoning performance through chain-of-thought (CoT) reasoning, yet they often generate unnecessarily long reasoning paths that incur high inference cost. Self-consistency-based approaches push accuracy higher still, but they require sampling and aggregating multiple reasoning trajectories, leading to substantial computational overhead. In this paper, we introduce a confidence-aware selective sampling framework that, at inference time, analyzes a single reasoning trajectory to adaptively determine whether to rely on that trajectory alone or trigger multi-path sampling. The framework uses trajectory-level numeric features and sentence-level linguistic features extracted from reasoning states to guide selective multi-path reasoning. We train it on MedQA and evaluate it in-domain on MedQA and under calibration-only transfer on MathQA, MedMCQA, and MMLU, without further fine-tuning. Experimental results show that the proposed framework maintains comparable performance to full and efficient multi-path reasoning baselines, with accuracy changes of $-0.41 \pm 0.58$ and $-0.31 \pm 0.58$ percentage points, respectively, while reducing token usage by $71.7 \pm 5.0%$ and $36.6 \pm 9.1%$. These findings demonstrate that reasoning trajectories contain rich signals for uncertainty estimation, enabling a simple, transferable mechanism to balance accuracy and efficiency in LLM reasoning.

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

LLM-based Visual Code Completion for Aerospace Geometric Design

Recent advances in both Large Language Models (LLMs) and Vision Language Models (VLMs) have seen a step change in their ability to perform visual code completion, but the aerospace industry, which prioritizes safety and explainabilty over rapid LLM adoption, currently has no publicly announced LLM-based geometric design copilot systems in commercial use by aerospace Original Equipment Manufacturers (OEMs). This paper presents a LLM-based visual programming copilot application for aerospace engineering design tasks, using a visual programming variant of the ReAct methodology and GPT 5.4. In addition to the copilot, we describe Wingbuilder, a new Grasshopper plugin library with custom components for aerospace-specific geometry abstraction, and an associated Aerospace Visual Programming Dataset (AVPD) with 18 aerospace expert designed tasks at different levels of difficulty alongside ground truth solutions. We evaluate our copilot application with a user trial involving two experienced aerospace engineers from a large aircraft manufacturing company. We find our copilot visual programming ReAct methodology was successful in generating suggestions that participants found helpful, but slow ReAct inference times limit its usefulness to more complex time-consuming tasks where waiting for good copilot solution suggestion was worthwhile. Participants reported they liked the tool and would be willing to use it in the future.

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

Adversarial Attacks Leverage Interference Between Features in Superposition

Why do adversarial examples exist, and why do they transfer between models? Existing explanations appeal to high-dimensional geometry, non-robust patterns in the input, and decision boundary structure, but none provides a representation-level mechanism that explains why specific perturbations succeed and why attacks transfer between models. In this paper, we show that adversarial vulnerability can stem from efficient information encoding in neural networks. Specifically, vulnerability can arise from superposition - the phenomenon where networks represent more concepts than they have dimensions, forcing non-orthogonal representation and thus interference. This interference causes perturbations targeting one representation to affect others, creating vulnerabilities determined by interference patterns. In synthetic settings with precisely controlled superposition, we establish that superposition suffices to create adversarial vulnerability. The resulting attacks are predictable: PGD-discovered perturbations align with theoretically optimal perturbations derived from the interference geometry. Models trained on similar data develop similar interference patterns, explaining attack transferability. We then show that successful attacks on image classifiers exhibit the structure predicted by our proposed mechanism. These findings reveal that adversarial vulnerability can be a byproduct of networks' representational compression, complementing existing explanations based on data properties or architectural factors.

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

Lightweight Distillation of SAM 3 and DINOv3 for Edge-Deployable Individual-Level Livestock Monitoring and Longitudinal Visual Analytics

Foundation-model pipelines for individual-level livestock monitoring – combining open-vocabulary detection, promptable video segmentation, and self-supervised visual embeddings – have raised the accuracy ceiling of precision livestock farming (PLF), but their GPU memory budgets exceed the envelope of commodity edge accelerators. To close this gap, the 446M-parameter Perception Encoder (PE-ViT-L+) backbone of SAM 3 is distilled into a 40.66M-parameter multi-scale student through three mechanisms: a Feature Pyramid Network student encoder built on TinyViT-21M-512, a four-term direction-then-scale distillation loss, and backbone-substitution inference with sliding-window session pruning that bounds streaming GPU memory growth. The DINOv3 family includes a pre-distilled ViT-S/16 variant (21.6M parameters) released alongside a 6716M-parameter ViT-7B teacher; the ViT-S (21M) variant is adopted as the per-individual embedder. On the Edinburgh Pig dataset, the compressed pipeline reaches 92.29% MOTA and 96.15% IDF1 against the SAM 3 teacher (1.68- and 0.84-percentage-point losses), achieves a 7.77-fold reduction in system-level parameters and a 3.01-fold reduction in peak VRAM (19.52GB -> 6.49GB), and reaches 97.34% top-1 accuracy with 91.67% macro-F1 on nine-class pig behaviour classification. The pipeline fits inside an NVIDIA Jetson Orin NX 16GB envelope with 4.9GB of headroom, supporting a proposed – but not yet empirically validated – on-device embedding-pool re-identification mechanism whose per-individual footprint of approximately 94MB per animal per year produces a longitudinal visual record amenable to retrospective association with disease, lameness, reproductive, and growth outcome labels.

07.
arXiv (CS.CL) 2026-06-12

Leveraging Audio-LLMs to Filter Speech-to-Speech Training Data

Large-scale mined corpora provide abundant training data for end-to-end speech-to-speech translation (S2ST) but may contain noise, misalignment, and semantic errors. Filtering noisy data is crucial to maintain robust speech translation performance. We study how to train an audio-language model to make keep/drop decisions on paired speech directly from audio. To obtain reliable supervision without manual labels, we adopt a scalable two-stage Rank-to-Distill strategy. A lightweight ranker generates keep/drop pseudo-labels from noisy speech pairs, then trains an audio large language model to predict keep/drop directly from raw paired speech. The resulting model jointly captures acoustic fidelity and cross-lingual semantic consistency for the selection of speech-conditioned data. Experiments on CVSS-C and SpeechMatrix show consistent improvements over unfiltered training, yielding up to +1.4 ASR-BLEU for end-to-end S2ST.

09.
arXiv (quant-ph) 2026-06-11

Super-Heisenberg Non-Equilibrium Quantum Sensing with Waveguide-Coupled Emitters

arXiv:2606.11975v1 Announce Type: new Abstract: We explore an array of quantum emitters as non-equilibrium probes, coupled to a one-dimensional photonic waveguide, aiming to estimate its properties such as wave number which encodes the waveguide frequency and dispersive characteristics. By considering transient dynamics following initial excitation, we show that the quantum Fisher information (QFI) can be significantly enhanced through careful emitter positioning. For two-emitter probes, optimal spacing stabilizes populations and coherences in the single-excitation subspace, suppressing super radiant decay and extending both the magnitude and longevity of QFI. Randomized emitter configurations also reveal that vanishing waveguide-mediated cross decay maximizes both achievable sensitivity and the temporal duration over which information about the parameter remains accessible. Extending to multipartite probes, we demonstrate that the maximum QFI and its temporal integral scale with system size, exceeding the Heisenberg limit for all positioning strategies. Our results highlight the potential of waveguide-coupled emitter arrays as versatile quantum sensors, where collective radiative dynamics can be harnessed to achieve tunable, long-lived, and enhanced precision.

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

MemBoost: A Memory-Boosted Framework for Cost-Aware LLM Inference

Large Language Models (LLMs) deliver strong performance but incur high inference cost in real-world services, especially under workloads with repeated or near-duplicate queries across users and sessions. In this work, we propose MemBoost, a memory-boosted LLM serving framework that enables a lightweight model to reuse previously generated answers and retrieve relevant supporting information for cheap inference, while selectively escalating difficult or uncertain queries to a stronger model. Unlike standard retrieval-augmented generation, which primarily grounds a single response, MemBoost is designed for interactive settings by supporting answer reuse, continual memory growth, and cost-aware routing. Experiments across multiple models under simulated workloads show that MemBoost substantially reduces expensive large-model invocations and overall inference cost, while maintaining high answer quality comparable to the strong model baseline.

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

Systematic Study of Dysarthric Speech Recognition: Spectral Features and Acoustic Models

arXiv:2606.19793v1 Announce Type: cross Abstract: The challenge associated with recognizing dysarthric speech primarily arises from pronounced acoustic variability attributed to impaired articulatory precision. Past research has demonstrated improved recognition through the use of hybrid DNN/HMM sequence discriminative training. This paper presents a comprehensive investigation of various combinations of acoustic features tailored to different Acoustic Models, offering suitable feature selections for each. The incorporation of Pitch features notably improved recognition performance, especially for sentence recognition tasks involving dysarthric speech. Through a systematic examination of the TORGO database, we have demonstrated the potential to enhance the performance of the state-of-the-art Factorized Time Delay Neural Network (F-TDNN) model for recognizing dysarthric speech. Our methods, implemented with the F-TDNN model, resulted in a 4.65\% relative improvement in isolated word recognition and a 4.63\% relative improvement in sentence recognition for dysarthric speech, compared to previous research. This improvement effectively compensates for speech variability, attributable to our deliberate selection of the number of overlapping frames between consecutive training example chunks.

12.
arXiv (CS.LG) 2026-06-19

Quantile of Means: A Bonus-Free Ensemble Method for Minimax Optimal Reinforcement Learning

arXiv:2606.20107v1 Announce Type: new Abstract: Optimal Reinforcement Learning (RL) algorithms typically rely on carefully constructed count-based uncertainty estimates to drive exploration. Although theoretically sound, such estimates are hard to compute in practical settings and therefore offer limited insight for designing exploration heuristics. Meanwhile, ensembling has emerged as a practical approach, but remains without theoretical justification. Building on a recent ensemble-based method for Multi-Armed Bandits, we propose a quantile-based ensemble method for finite-horizon Markov Decision Processes (MDPs). Our simple count-free approach achieves optimal variance-dependent regret bounds, providing theoretical grounding for ensemble-based exploration in RL.

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

Floating-Point Networks with Automatic Differentiation Can Represent Almost All Floating-Point Functions and Their Gradients

arXiv:2605.01702v2 Announce Type: replace Abstract: Theoretical studies show that for any differentiable function on a compact domain, there exists a neural network that approximates both the function values and gradients. However, such a result cannot be used in practice since it assumes real parameters and exact internal operations. In contrast, real implementations only use a finite subset of reals and machine operations with round-off errors. In this work, we investigate whether a similar result holds for neural networks under floating-point arithmetic, when the gradient with respect to the input is computed by the automatic differentiation algorithm $D^\mathtt{AD}$. We first show that given a floating-point function $\phi$ (e.g., a loss function), arbitrary function values and gradients can be represented by a floating-point network $f$ and $D^\mathtt{AD}(\phi\circ f)$, respectively. We further extend this result: given $\phi_1,\dots,\phi_n$, $D^\mathtt{AD}(\phi_i\circ f)$ can simultaneously represent arbitrary gradients while $f$ represents the target values, under mild conditions. Our results hold for practical activation functions, e.g., $\mathrm{ReLU}$, $\mathrm{ELU}$, $\mathrm{GeLU}$, $\mathrm{Swish}$, $\mathrm{Sigmoid}$, and $\mathrm{tanh}$.

14.
arXiv (CS.CL) 2026-06-15

EmoMind: Decoding Affective Captions from Human Brain fMRI

Decoding visual experience from brain activity has advanced substantially, but current brain-to-text systems largely recover semantic content while discarding affect. Additionally, language models can generate emotional text when prompted with categorical labels, but such labels collapse rich inter-subject variability into coarse discrete bins. We present EmoMind, the first end-to-end pipeline for decoding affective captions directly from fMRI signals. EmoMind first retrieves a semantically grounded neutral scene description from brain-decoded visual features, then rewrites it using a continuous 34-dimensional emotion vector decoded from the same fMRI recording. To control the balance between content preservation and affective expression, we train the rewriter with classifier-free guidance against an identity-preserving null branch, enabling smooth interpolation between semantic fidelity and affective expressivity. We evaluate affective caption generation with a three-axis validation framework spanning subject-specificity, structural geometry, and causal control. We further augment this framework with a synthetic-brain substitution test that probes robustness to the measurement apparatus, and we benchmark each axis against GPT-4 prompted with brain-decoded top-5 emotion labels as a strong discrete baseline. Across two independent emotion fMRI datasets, EmoMind significantly outperforms label-prompted GPT-4 on all three axes, with the largest gains on metrics that require person-specific affective structure rather than population-level emotion aggregation. These results establish continuous brain-decoded affect as a viable control signal for individualized affective caption generation and open new directions for studying individual affective brain organisation.

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

AnonShield: Scalable On-Premise Pseudonymization for CSIRT Vulnerability Data

arXiv:2606.15650v1 Announce Type: cross Abstract: We present AnonShield, a high-throughput, on-premise pseudonymization system that combines GPU-accelerated NER, streaming processing, caching, and schema-aware configuration. Evaluated on datasets up to 550 MB (70,951 records), AnonShield reduces processing time from over 92 hours to under 10 minutes (up to 738x speedup) while achieving up to 94.2% F1-score and 96.7% recall. Our results show that scalable pseudonymization of vulnerability data is feasible without sacrificing analytical utility, enabling compliant data sharing in operational CSIRT environments.

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

Optimizing resource bounds in direct fidelity estimation

arXiv:2606.16336v1 Announce Type: new Abstract: Direct fidelity estimation provides a way to estimate the fidelity between an experimentally prepared state and a desired pure target state without performing full tomography. Two influential formulations were introduced in 2011 by Flammia and Liu and by da Silva, Landon-Cardinal, and Poulin. In these protocols, the total estimation error is controlled through two distinct probabilistic steps: first, the fidelity is approximated using randomly sampled Pauli observables; second, each sampled expectation value is estimated from finitely many measurement outcomes. In this work we show that additional structural information about the noise can substantially sharpen the corresponding resource bounds. In particular, for some canonical channels the effective number of sampled Pauli settings can be reduced, leading to lower measurement cost both in the general pure-state setting and in the case of a stabilizer state. These results illustrate a broader point: worst-case confidence bounds in direct fidelity estimation can be significantly conservative when experimentally relevant structure is ignored. As a technical ingredient, we also revisit the allocation of the total accuracy and confidence budgets between the two probabilistic steps. Reformulating the analysis in terms of separate error parameters yields a constrained optimization problem whose solution lowers the average number of measurements in the general pure-state setting. Numerical simulations based on quantum circuits implemented in Qiskit illustrate both the improvement obtained under structured-noise assumptions and the conservativeness of the original worst-case bounds.

17.
arXiv (CS.AI) 2026-06-11

CoVar: Confidence-Variance-Guided Pseudo-Label Selection for Semi-Supervised Learning

arXiv:2601.11670v3 Announce Type: replace-cross Abstract: Pseudo-label selection in semi-supervised learning is commonly driven by maximum-confidence thresholds, yet confidence alone can be unreliable under model overconfidence and class imbalance. We propose CoVar, a confidence–variance framework that assesses pseudo-label reliability by jointly modeling Maximum Confidence (MC) and Residual-Class Variance (RCV). Starting from entropy minimization, we derive a second-order cross-entropy approximation showing that low-loss pseudo-labels are favored when MC is high and RCV is low, with a confidence-dependent penalty that becomes stronger for near-certain predictions. Based on this criterion, CoVar embeds predictions into a two-dimensional confidence–variance space and uses SVD-based spectral relaxation to separate reliable and unreliable predictions without hand-tuned confidence thresholds. Cluster-wise Gaussian weighting then converts this separation into per-sample training weights. The resulting weights can be integrated into existing semi-supervised segmentation and classification pipelines during training and introduce no inference-time overhead. Experiments on PASCAL VOC 2012, Cityscapes, CIFAR-10, CIFAR-100, SVHN, and STL-10 show clear gains on VOC and Cityscapes under matched backbones, as well as competitive or improved error rates on standard classification benchmarks. These results indicate that residual-class dispersion provides a useful signal complementary to confidence for robust pseudo-label selection.

18.
arXiv (quant-ph) 2026-06-16

The Quantum Transition State

Authors:

arXiv:2606.10266v2 Announce Type: replace Abstract: The transition state – the critical configuration separating reactants from products – is the central organizing concept of chemical reaction rate theory, yet for nearly a century it has been thought to have no exact quantum counterpart: the recrossing-free, one-way flux through a transition state appears to demand simultaneous knowledge of position and momentum, in conflict with the uncertainty principle. We show this obstruction is illusory and construct the quantum transition state directly from the exact quantum flow. Its stable and unstable invariant manifolds intersect in a unique bounded trajectory – the quantum transition-state trajectory – anchoring a moving dividing surface that each reactive characteristic crosses exactly once, yielding a one-way flux of the standard quantum probability current. The geometric framework underlying classical transition-state theory thus survives intact in exact quantum mechanics, in a fundamentally quantum form.

19.
Nature (Science) 2026-06-08

Distributed control circuits across a brain-and-cord connectome

Just as genomes revolutionized molecular genetics, connectomes (maps of neurons and synapses) are transforming neuroscience. To date, the only organisms with complete connectomes are worms1–3, sea squirts4, and comb jellies5 (103–104 synapses). By contrast, the fruit fly is more complex (108 synaptic connections), with a brain that supports learning and spatial memory6,7 and an intricate ventral nerve cord analogous to the vertebrate spinal cord8–12. Here we report the first densely-reconstructed adult fly connectome that unites the brain and ventral nerve cord, and we leverage this resource to investigate principles of neural control. We show that effector neurons (motor neurons, endocrine cells, and efferent neurons targeting the viscera) are primarily influenced by sensory neurons in the same body part, forming local feedback loops. These local loops are linked by long-range circuits involving ascending and descending neurons organized into behavior-centric modules. Single ascending and descending neurons are often positioned to influence the voluntary movements of multiple body parts, together with the endocrine cells or visceral organs that support those movements. Brain regions involved in learning and navigation supervise these circuits. These results reveal an architecture that is distributed, parallelized, and embodied, reminiscent of distributed control architectures in engineered systems13,14.

20.
arXiv (math.PR) 2026-06-16

High-Order Talagrand and Eldan–Gross Inequalities via Besov-Type Variance Functionals

arXiv:2606.14876v1 Announce Type: new Abstract: By introducing high-order Besov-type variance functionals that generalize the canonical variance, we develop a unified framework for proving high-order Talagrand-type inequalities that relate high-order energies to Fourier weights. Applying this machinery, we establish high-order Poincaré-type, $L^p$–$L^q$, isoperimetric-type, Falik–Samorodnitsky and Eldan–Gross inequalities, all with explicit constants, in both the Boolean and Gaussian settings. Fundamentally, our semigroup-based framework relies primarily on hypercontractivity and high-order Bismut-type derivative estimates, and is broadly applicable.

21.
arXiv (CS.CV) 2026-06-12

ComAct: Reframing Professional Software Manipulation via COM-as-Action Paradigm

Existing computer-use agents remain fundamentally limited in professional software manipulation: GUI-based agents suffer from fragile visual grounding and long-horizon error accumulation, while API-basedapproaches struggle with heterogeneous protocols and inaccessible commercial interfaces. In this work,we identify the Component Object Model (COM) as a unified executable abstraction, proposing COM-as-Action: a new paradigm that reframes professional software interaction as deterministic program synthesisrather than sequential visual control. To validate this paradigm in the most demanding environments, weintroduce ComCADBench, the first benchmark for agents operating real industrial CAD software. Ourexperiments reveal a substantial paradigm gap: frontier proprietary models achieve near-zero successunder GUI-based interaction, whereas COM-based execution yields substantial immediate gains. Tobridge the remaining gap between syntactic correctness and geometric accuracy, we develop ComActor, aself-correcting agent trained through a progressive three-stage framework, alongside ComForge, a scalableplatform for large-scale training in Windows containers. Extensive experiments show that ComActorachieves state-of-the-art performance on ComCADBench, with strong resilience in long-horizon taskswhere baselines collapse, and generalizes to external CAD benchmark.

22.
arXiv (CS.CL) 2026-06-18

Dual Dimensionality for Local and Global Attention

Decoder-only Transformers compute attention over the KV cache of preceding tokens. Keys (and Values) are typically represented with the same dimensionality, regardless of its distance from the prediction target. In natural language, however, the next word is most strongly influenced by the immediately preceding tokens. We hypothesize that local and distant tokens impose asymmetric demands on representational capacity: local tokens are more critical for predicting immediate outputs and thus require richer representations, whereas distant tokens primarily serve as long-range memory, for which lower-dimensional representations may suffice. We formalize this idea as Distance-Adaptive Representation (DAR), implemented in a controlled setting that preserves full-dimensional representations within a local context window while assigning reduced-dimensional representations (e.g. 1/4 of the original dimensionality) to tokens beyond that window. Across multiple pretraining scales (70M to 410M parameters), as well as continued supervised fine-tuning on a 1B-scale model, this approach closely matches the performance of full-dimensional baselines. In contrast, uniformly reducing dimensionality across all token positions leads to worse performance. These results challenge the common assumption that key and value dimensionality should be uniform across token positions. Our findings suggest a new direction for designing attention architectures that adaptively allocate representational capacity across sequences, enabling further reductions in KV cache during inference.

23.
arXiv (CS.LG) 2026-06-11

PianoKontext: Expressive Performance Rendering from Deadpan Context

arXiv:2606.12282v1 Announce Type: cross Abstract: Expressive performance rendering (EPR) aims to generate realistic performances constrained on sequences of notes. However, flow matching audio editing models manipulate only synchronized music samples of the same duration, limiting their understanding of expressive timing. We introduce PianoKontext, a flow matching rendering model for classical piano music that generates variable-length performances in the latent space of a pretrained Music2Latent model. We synthesize MIDI scores into deadpan audio and employ Dynamic Time Warping (DTW) in the latent space to construct paired data for training. The aligned embeddings are concatenated in DiT blocks, allowing for a simple and effective learning of the dependencies between the score and performances. Audio samples are available at our demo page: https://realfolkcode.github.io/pianokontext_demo/.

24.
arXiv (CS.CV) 2026-06-17

When LLMs Analyze Scars: From Images to Clinically-Meaningful Features

Medical image classification faces a fundamental dilemma: while deep learning models achieve remarkable performance at scale, real-world clinical scenarios often suffer from severe data scarcity due to annotation costs, privacy constraints, and disease rarity. This challenge is particularly pronounced in pathological scar classification, where differentiating keloids from hypertrophic scars requires subtle expert knowledge and labeled images are extremely limited. We propose a novel paradigm that repositions large language models (LLMs) as knowledge-driven feature engineers rather than end-to-end classifiers. We call this framework ScaFE (Scar Feature Engineering). Our key insight is that LLMs encode rich medical knowledge that can be externalized as executable feature extraction code, enabling the transformation of high-dimensional images into low-dimensional, clinically interpretable representations. Specifically, we prompt an LLM with established scar assessment criteria to generate deterministic Python code that extracts features aligned with clinical scoring systems such as the Vancouver Scar Scale. Our approach offers three key advantages: (1) data efficiency, achieving robust performance with limited training samples by decoupling knowledge acquisition from statistical learning; (2) privacy preservation, as raw images are processed locally without exposure to external LLMs; and (3) interpretability, through explicit features grounded in clinical reasoning. Extensive experiments on scar classification demonstrate that our method consistently outperforms end-to-end deep learning baselines or using LLMs as black-box classifiers under limited data conditions, establishing a promising direction for integrating LLMs into data-efficient and clinically transparent medical AI systems.

25.
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.