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01.
arXiv (CS.CL) 2026-06-12

MiniPIC: Flexible Position-Independent Caching in <100LOC

Retrieval-augmented and agentic workloads repeatedly prefill recurring predictable structured inputs (which we call "spans") such as documents and code files. Yet, prefix caching in engines such as vLLM cannot reuse their KV entries unless they share identical prefixes with another request, while Position-Independent Caching (PIC) implementations within production-grade inference servers typically either require substantial server code changes or keep KV state outside the server, incurring host-to-device transfer overhead. We present Minimalistic PIC (MiniPIC): a minimal, flexible and fast vLLM design built from two ingredients: positional-encoding-free KV cache and user-controlled cache-reuse primitives. MiniPIC stores unrotated K vectors in the KV cache, applies RoPE to K tiles inside attention using per-request logical positions, and exposes three user-facing and token-level primitives: block-aligned padding, span separator (SSep), and prompt depend (PDep), that modify hashing behavior and effective block-level causal attention structure. With fewer than 100 lines of core-engine changes plus a custom attention backend, these primitives are sufficient to realize multiple PIC methods, including Block-Attention, EPIC, and Prompt Cache, within the same running vLLM instance, while natively integrating with KV cache CPU offload implementations. On 2WikiMultihopQA, MiniPIC with interleaved scheduling improves prefill throughput by 49% over baseline vLLM, reduces cached-span time-to-first-token by up to two orders of magnitude, preserves the linear prefill scaling of uncached spans, and incurs only 5.7% worst-case overhead.

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

Certifiable Safe RLHF: Semantic Grounding and Fixed Penalty Constraint Optimization for Safer LLM Alignment

arXiv:2510.03520v2 Announce Type: replace-cross Abstract: Ensuring safety is a foundational requirement for large language models (LLMs). Achieving an appropriate balance between enhancing the utility of model outputs and mitigating their potential for harm is a complex and persistent challenge. Contemporary approaches frequently formalize this problem within the framework of Constrained Markov Decision Processes (CMDPs) and employ established CMDP optimization techniques. However, these methods exhibit two notable limitations. First, their reliance on reward and cost functions renders performance highly sensitive to the underlying scoring mechanism, which must capture semantic meaning rather than being triggered by superficial keywords. Second, CMDP-based training entails tuning dual-variable, a process that is both computationally expensive and does not provide any provable safety guarantee for a fixed dual variable that can be exploitable through adversarial jailbreaks. To overcome these limitations, we introduce Certifiable Safe-RLHF (CS-RLHF) that introduces a cost model trained on a large-scale corpus to assign semantically grounded safety scores. In contrast to the lagrangian-based approach, CS-RLHF adopts a rectified penalty-based formulation. This design draws on the theory of exact penalty functions in constrained optimization, wherein constraint satisfaction is enforced directly through a suitably chosen penalty term. With an appropriately scaled penalty, feasibility of the safety constraints can be guaranteed at the optimizer, eliminating the need for dual-variable updates. Empirical evaluation demonstrates that CS-RLHF outperforms state-of-the-art LLM model responses rendering at-least 5 times efficient against nominal and jail-breaking prompts

03.
PLOS Medicine 2026-05-08

Climate change and non-communicable diseases: An invisible syndemic

by Gokul Parameswaran, Sadeer Al-Kindi, Sanjay Rajagopalan Climate change accelerates non-communicable diseases (NCDs) through cascading environmental disruptions and is attributed to driving increased NCD-related mortality. Yet this syndemic remains invisible and underfunded. We detail why addressing the climate-NCD intersection is critical for improving health. In this Perspective, Sanjay Rajagopalan and colleagues discusses how climate change accelerates non-communicable diseases (NCDs) and exacerbates NCD-related mortality, and calls for greater visibility and funding to address this syndemic and improve human health.

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

Periodic-MAE: Periodic Video Masked Autoencoder for rPPG Estimation

In this paper, we propose Periodic-MAE, a self-supervised framework for learning generalizable spatio-temporal representations of periodic physiological signals from unlabeled facial videos. The proposed method leverages a masked autoencoder (MAE), which learns high-dimensional facial representations by reconstructing masked video tokens without relying on remote photoplethysmography (rPPG) specific supervision. To explicitly align representation learning with the characteristics of rPPG, we introduce a periodicity-aware frame masking strategy based on video resampling, enabling the encoder to learn representations that capture quasi-periodic temporal patterns relevant to pulse signal estimation. In addition, physiological bandlimit constraints are integrated into the MAE pre-training framework, exploiting the sparsity of pulse signals in the frequency domain to guide the learned representations toward physiologically meaningful patterns. After pre-training, the learned representations are transferred to downstream rPPG estimation, where the encoder serves as a generic feature extractor for recovering pulse-related signals from facial videos. We conduct extensive experiments on four benchmark datasets, including PURE, UBFC-rPPG, MMPD, and V4V. Moreover, we evaluate the proposed approach on a real-world rPPG dataset collected under unconstrained lighting conditions and subject motion. Experimental results demonstrate that Periodic-MAE consistently improves rPPG estimation performance, particularly in challenging cross-dataset and real-world evaluation settings. Our code is available at https://github.com/ziiho08/Periodic-MAE.

05.
arXiv (CS.AI) 2026-06-16

AC-ODM: Actor–Critic Online Data Mixing for Sample-Efficient LLM Pretraining

arXiv:2505.23878v2 Announce Type: replace-cross Abstract: Optimizing pretraining data composition is pivotal for LLM generalization. While dynamic mixing outperforms static strategies by capturing evolving training dynamics, current methods fail to reconcile computational efficiency with sample efficiency and structural flexibility for diverse pipelines.We introduce Actor–Critic Online Data Mixing (AC-ODM), which approaches data mixing from a reinforcement learning perspective with a parameterized policy that we theoretically prove to act as a dynamic linear surrogate maximizing the constructive interference of gradients. To enhance practical flexibility, AC-ODM supports two operational modes: (i) a proxy mode for fixed, pre-prepared corpora, where a policy learned on a small model is transferred to a larger target; and (ii) a non-proxy mode for direct end-to-end training from scratch without priors. Empirically, AC-ODM significantly outperforms prior methods in convergence speed and downstream accuracy across various architectures. On Pythia-1B, it reaches optimal validation perplexity using up to 66% fewer training steps than competitive baselines, delivering a 27.5% relative improvement in MMLU accuracy and a 2.23 x higher pass@1 on HumanEval, all while incurring a virtually negligible (0.4%) per-step wall-clock increase and only 2% additional memory overhead. Code is available at https://github.com/DANG-ai/AC-ODM.

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

Depth-Attention: Cross-Layer Value Mixing for Language Models

Self-attention selects information freely across the sequence, but across depth, Transformers merely add each layer's output to the residual stream, so later layers cannot selectively reuse earlier-layer representations. Recent cross-layer methods improve this flow but operate on hidden states outside attention, adding state beyond the key-value cache at inference–a cost that becomes increasingly salient as modern LLMs compress the cache with grouped-query and multi-head latent attention. We introduce Depth-Attention, which performs this selection inside the attention module itself: before a layer attends over the sequence, its query attends over the keys of earlier layers at the same token position and mixes their values into the value that self-attention then reads. Because Depth-Attention reuses the standard attention queries, keys, and value-cache slots, storing depth-mixed values in place of the original values, it adds no parameters and introduces no persistent inference state beyond the standard key-value cache–the same cache size as a vanilla decoder and less than hidden-state-based cross-layer methods. On Qwen3-style decoders at 1.5B and 3B parameters, Depth-Attention attains the lowest perplexity and the highest average downstream accuracy, improving over the vanilla Transformer by up to 2.3 accuracy points and surpassing strong cross-layer baselines in perplexity and average accuracy, while adding under 0.01% extra arithmetic FLOPs and no additional persistent inference state. The gains hold from 360M to 3B parameters and extend to looped Transformers.

07.
Nature (Science) 2026-06-08

Daily briefing: Human embryo genomes precisely altered

Authors:

The use of ‘base editing’ to precisely tweak human embryos has divided researchers. Plus, the number of lives saved by less-polluting cars in China and how to tip the world towards a sustainable future. The use of ‘base editing’ to precisely tweak human embryos has divided researchers. Plus, the number of lives saved by less-polluting cars in China and how to tip the world towards a sustainable future.

08.
arXiv (quant-ph) 2026-06-11

Classical representation of the dynamics of quantum spin chains

Authors:

arXiv:2502.10502v3 Announce Type: replace-cross Abstract: Since the advent of quantum mechanics, classical probability interpretations have faced significant challenges. A notable issue arises with the emergence of negative probabilities when attempting to define the joint probability of non-commutative observables. In this work, we propose a resolution to this dilemma for quantum spin chains, by introducing an exact representation of their dynamics in terms of classical continuous-time Markov chains (CTMCs). These CTMCs effectively model the creation, annihilation, and propagation of pairs of classical particles and antiparticles. The quantum dynamics then emerges by averaging over various realizations of this classical process.

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

UniT: Unified Multimodal Chain-of-Thought Test-time Scaling

Unified models can handle both multimodal understanding and generation within a single architecture, yet they typically operate in a single pass without iteratively refining their outputs. Many multimodal tasks, especially those involving complex spatial compositions, multiple interacting objects, or evolving instructions, require decomposing instructions, verifying intermediate results, and making iterative corrections. While test-time scaling (TTS) has demonstrated that allocating additional inference compute for iterative reasoning substantially improves language model performance, extending this paradigm to unified multimodal models remains an open challenge. We introduce UniT, a framework for multimodal chain-of-thought test-time scaling that enables a single unified model to reason, verify, and refine across multiple rounds. UniT combines agentic data synthesis, unified model training, and flexible test-time inference to elicit cognitive behaviors including verification, subgoal decomposition, and content memory. Our key findings are: (1) unified models trained on short reasoning trajectories generalize to longer inference chains at test time; (2) sequential chain-of-thought reasoning provides a more scalable and compute-efficient TTS strategy than parallel sampling; (3) training on generation and editing trajectories improves out-of-distribution visual reasoning. These results establish multimodal test-time scaling as an effective paradigm for advancing both generation and understanding in unified models.

10.
arXiv (CS.AI) 2026-06-17

C2FL: Clustered Continual Federated Learning under Spatial and Temporal Drift

arXiv:2606.18003v1 Announce Type: cross Abstract: Collective Adaptive Systems (CAS) increasingly rely on machine learning to let each node learn from locally sensed data, aligning its behavior with the surrounding environment. Scaling this intelligence, however, raises fundamental challenges: sensed data is often privacy-sensitive, preventing centralized collection; nodes are mobile, traversing regions where nearby nodes perceive similar phenomena while distant ones observe radically different conditions, creating natural spatial clusters; and these distributions evolve over time due to mobility, introducing temporal drift that makes local models progressively stale. These dynamics arise across domains - vehicular sensing, drone-based monitoring, smartphone crowdsensing - yet the interplay of privacy, spatial heterogeneity, and temporal drift severely undermines conventional learning strategies. Therefore, we propose C2FL, a fully distributed Federated Learning (FL) approach where nodes self-organize into learning groups through spatial clustering, reflecting the geographic structure of the environment. To counteract temporal drift, each node combines experience replay with a dwell-time-aware adaptive averaging step, progressively incorporating the regional consensus as it remains longer within the same area, while preserving previously acquired knowledge under evolving distributions. We evaluate our approach on synthetic experiments that systematically reproduce spatial and temporal shifts, showing that standard federated strategies degrade significantly under these conditions and that our method restores robust collective adaptation.

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

Off-Policy Evaluation for Missingness-Aware Policies in MDPs with Rewards Missing Not at Random

arXiv:2606.20206v1 Announce Type: cross Abstract: In offline Reinforcement Learning, immediate rewards in logged batch data are often unobserved due to sparse or irregular record-keeping, or censored beyond certain reward values. This issue arises in practical settings, including health care and marketing. We investigate off-policy evaluation (OPE) in finite-horizon Markov decision processes when rewards are missing not at random (MNAR), which breaks ignorability and induces selection bias even after conditioning on states and actions. To address this, we formalize a reward-dependent propensity model and use future states as shadow variables to identify the full-data conditional mean reward. We further introduce a bridge function that recovers the conditional mean reward without explicitly modeling the MNAR mechanism, and estimate it via a min-max procedure to avoid double sampling. Building upon these identification results, we propose an Fitted-Q-Evaluation-style estimator that propagates the recovered rewards while allowing target policies to depend on past missingness indicators. Finally, we establish consistency and finite-sample error bounds for our OPE estimator, and show through experiments the strong performance of our method compared to existing methods on simulated and MIMIC-III Sepsis data.

12.
arXiv (CS.LG) 2026-06-11

Restless bandits with imperfect binary feedback: PCL-indexability analysis and computation

arXiv:2606.11192v1 Announce Type: new Abstract: We study restless bandits with binary latent states and imperfect binary feedback, motivated by opportunistic spectrum access with sensing errors. For the associated belief-state model, we develop a partial conservation laws (PCL)-based analytical and computational framework for establishing indexability and evaluating the Whittle index, building on a verification theorem for real-state discounted restless bandits. The framework analyzes the stochastic dynamics via an associated deterministic skeleton, renewal decompositions, and combinatorics on words. It yields tractable expressions for discounted reward and resource metrics in several threshold regimes, enabling full verification of the PCL-indexability conditions there. For the remaining regime, where a complete analytic verification is not achieved in this paper, we derive efficient numerical schemes for computing the relevant marginal metrics and the marginal productivity (MP) index, which equals the Whittle index when those conditions hold. Extensive computational experiments provide strong evidence that these conditions also hold in that regime across broad parameter ranges and without the stringent parameter restrictions imposed in prior work. The experiments further show that theMP index policy typically outperforms standard benchmark policies, often by a substantial margin.

13.
arXiv (CS.CV) 2026-06-17

Bounding Box Label Propagation for Re-Annotation of Document Layout Analysis Datasets

Datasets in practical document processing scenarios typically grow over time, and their class annotations undergo continuous refinement. This creates significant re-annotation efforts, which are time-consuming and costly. A promising remedy is to re-annotate only a small subset of available documents manually and apply semi-supervised learning techniques that leverage both labelled and unlabelled data. Although there are numerous approaches to tackle this problem for classification, there exists no adaptation for the problem of re-classifying object detection instances, e.g. for document layout analysis. To this end, we propose Bounding Box Label Propagation (BBLP), a pseudo-labelling framework for object detection. An object encoder integrates visual, textual, and positional embeddings from object detection samples to come up with a joint embedding that can be used for Label Propagation on partially annotated datasets in a plug-and-play fashion. Evaluation results indicate that the proposed approach produces high-quality class annotations of bounding boxes. In the D4LA layout analysis dataset, it achieves a mAP of 54.0%, corresponding to 81.6% of fully supervised performance, while using only 10% labelled data. Our work demonstrates the potential of Label Propagation for object detection and lays the groundwork for reducing manual annotation efforts in real-world document processing applications.

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

World Model Self-Distillation: Training World Models to Solve General Tasks

Pretrained video generators are promising visual world models that exhibit emergent task-solving abilities; however, their reliance on detailed textual descriptions limits their direct use for planning and decision-making. Existing approaches either outsource this reasoning to language or vision-language models, or rely on supervised fine-tuning with paired task-execution videos, which are costly to collect and difficult to scale. We propose a scalable framework that elicits task-solving ability in such models by combining self-distillation with reinforcement learning. Given an unlabeled scene image, a vision-language model generates a candidate task and a detailed step-by-step solution. The solution conditions a pretrained video diffusion model, the Demonstrator; we distill its behavior into an Executor conditioned only on the image and a short task prompt. This transfers execution knowledge from caption-guided generation to instruction-conditioned task solving without curated task-video supervision. We further improve the Executor with reinforcement learning from VLM feedback, exploiting the asymmetry between judging whether a sampled video satisfies a task and generating the solution. Experiments on our proposed WorldTasks-Benchmark and the DreamGen robotics benchmark show that the Executor surpasses the Demonstrator under our VLM-based evaluation protocol and transfers competitively to robotic tasks.

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

Distribution-Agnostic Robust Trajectory Optimization via Chance-Constrained Reinforcement Learning

arXiv:2606.13605v1 Announce Type: cross Abstract: This paper presents a distribution-agnostic robust trajectory-optimization framework based on chance-constrained reinforcement learning. The uncertainty is represented here through initial conditions and process noise, with the only requirement being that it can be sampled. A deterministic nominal trajectory is first computed offline, and reinforcement learning is then used only to robustify that baseline through a structured affine closed-loop correction law comprising a feedforward control adjustment and time-varying feedback gains. Probabilistic feasibility is enforced empirically through rollout-based upper-tail quantiles, while terminal dispersion is regulated through covariance-feasibility penalties. The framework is assessed on two materially different trajectory design problems. The flagship case study is a three-dimensional multi-impulse Earth-Mars transfer, where the learned policy is benchmarked against a recent robust trajectory-optimization reference under Gaussian uncertainty and then evaluated under bounded uniform uncertainty and under process disturbances not seen during training. The second case study is a stochastic atmospheric pinpoint rocket landing problem, used to assess portability to a short-horizon continuous-thrust setting with drag, mass depletion, and glide-slope constraints. The results show that the proposed framework can remain competitive in upper-tail fuel cost while preserving probabilistic feasibility, and that the same robustification scaffold can be carried across heterogeneous spacecraft trajectory planning problems without redesign of its core stochastic-control structure.

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

Zero-Shot Active Feature Acquisition via LLM-Elicitation

arXiv:2606.18933v1 Announce Type: new Abstract: Active feature acquisition (AFA) sequentially selects which features to observe to reach a classification or ranking decision. Its central limitation is reliance on large amount of labeled data to fit probabilistic models guiding acquisition. Large language models (LLMs) supply unsupervised domain knowledge, but are poor sequential planners. Asking one to both know and decide conflates capabilities best kept separate. Here, we develop a framework for zero-shot AFA through disciplined elicitation: asking the LLM only for what it can be trusted to return, the unary deviations and pairwise co-variations that are the sufficient statistics of a Markov random field (MRF). We apply our framework to two settings: binary classification and top-$k$ identification. In practice, the LLM reliably returns only discriminative statistics, what distinguishes the classes rather than each class in isolation, which precludes classical AFA. We apply a maximum-entropy closure that resolves this gauge ambiguity. We evaluate on a cohort of Inflammatory Bowel Disease (IBD) patients, an active clinical setting where diagnostic ambiguity and patient heterogeneity obstruct stable treatment strategies. Our framework outperforms the LLM both on real labels and on its own extracted beliefs. Where it matters most, on the hardest patients, our top-$k$ acquisition policy markedly outperforms all existing methods.

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

JSCGC: Joint Source-Channel-Generation Coding for Wireless Generative Communications

Conventional communication systems, including both separation-based coding and learning-based joint source-channel coding (JSCC), are typically designed under Shannon's rate-distortion theory. However, relying on generic distortion metrics fails to capture complex human visual perception, often resulting in blurred or unrealistic reconstructions. In this paper, we propose Joint Source-Channel-Generation Coding (JSCGC), a generative communication paradigm that replaces the conventional decoder with a generative model at the receiver. The received signal is treated as a condition that controls the sampling process into the learned conditional distribution, reformulating communication from deterministic reconstruction for distortion minimization to controlled generation for mutual information maximization under perceptual constraints. Based on this formulation, we develop a unified joint training and efficient stochastic sampling framework, and provide theoretical analysis of its effectiveness in both learning and inference stages. Extensive experiments on latent-space image transmission demonstrate that the JSCGC consistently improves feature-based, semantic-level, and distributional quality across diverse channel conditions, while exhibiting a distinct error behavior characterized by semantic inconsistency rather than distortion.

18.
arXiv (quant-ph) 2026-06-19

Unleashing Emergent Fermions with Rydberg Atom Simulators

arXiv:2606.19444v1 Announce Type: cross Abstract: Rydberg atom simulators, in both analog and digital modes, have attracted significant recent interest due to their versatile geometric reconfigurability. In this work, leveraging this feature, we propose two complementary approaches, one for each mode, to characterize emergent fermions in critical quantum many-body systems. In the analog mode, we assemble the Rydberg atoms in a "developable" (namely, preserving local couplings) Möbius band geometry to realize antiperiodic boundary conditions, where fermionic states reside. Spectroscopic measurement in this sector then reveals universal energy ratios of the bosonic and fermionic states. In the digital mode, we carry out a fermionic version of Kibble-Zurek ramping with a quantum circuit, directly addressing the fermionic scaling form. Reconfigurability allows an exponential speed-up of this task, with an $O(\log L\log\log L)$ circuit-depth overhead. Our work establishes the Rydberg atom simulator as a uniquely powerful platform to attack the notoriously difficult issue of experimentally probing emergent fermions that are nonlocally defined in a bosonic system.

19.
medRxiv (Medicine) 2026-06-18

Hospital-Level Variation in Antenatal Corticosteroids for Late Preterm Births

Objective: To determine whether and to what extent hospitals across the United States vary in their use of late-preterm steroids using a novel data set in which the timing of steroid administration relative to delivery can be observed. Methods: This was a retrospective cohort study of singleton births with known gestational ages identified in the Premier Healthcare Database from 2015 to 2022. The primary variable of interest was hospital-level adoption of antenatal corticosteroids for late-preterm singleton deliveries, calculated as the proportion of late-preterm singleton births (34-36 completed weeks of gestation) with any betamethasone exposure during the same late-preterm period. Hospital adoption was defined as the weighted average rate of ALPS administration among late-preterm infants across the entire post-period. Hospitals were ranked by their late-preterm steroid adoption rates and categorized by quartile based on the empirical distribution. Temporal trends were assessed using annual hospital-level adoption rates and visualized using time-series plots and distributional plots. A logistic regression model was constructed to determine hospital characteristics associated with being a highest-quartile adopting hospital. Results: The analysis cohort included 728 hospitals and 5,452,791 births, of which 361,006 (6.6%) were singleton late preterm births. Hospital steroid exposure rates ranged from 0 to 82% and were categorized into quartiles based on overall exposure rate, with cutoffs at 20.6%, 29.8%, and 40.1%. Median exposure rates increased progressively across quartiles from 14.1% (IQR 9.3-17.4%) in the lowest adopting hospitals (Q1) to 47.6% (IQR 43.7-53.2%) in the highest adopting hospitals (Q4), with substantial within-quartile variation. In the multivariable model, urban location was a strong predictor of high adoption after adjustment (aOR 2.05; 95% CI 1.11-3.83, p=0.02). Compared to Midwest hospitals, Southern hospitals had significantly lower odds of being high adopters (aOR 0.37; 95% CI 0.20-0.69, p

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

ClawEnvKit: Automatic Environment Generation for Claw-Like Agents

Constructing environments for training and evaluating claw-like agents remains a manual, human-intensive process that does not scale. We argue that what is needed is not just a dataset, but an automated pipeline capable of generating diverse, verified environments on demand. To this end, we introduce ClawEnvKit, an autonomous generation pipeline that instantiates this formalism from natural language descriptions. The pipeline comprises three modules: (1) a parser that extracts structured generation parameters from natural language input; (2) a generator that produces the task specification, tool interface, and scoring configuration; and (3) a validator that enforces feasibility, diversity, structural validity, and internal consistency across the generated environments. Using ClawEnvKit, we construct Auto-ClawEval, the first large-scale benchmark for claw-like agents, comprising 1,040 environments across 24 categories. Empirically, Auto-ClawEval matches or exceeds human-curated environments on coherence and clarity at 13,800x lower cost. Evaluated across 4 model families and 8 agent harness frameworks, we find that harness engineering boosts performance by up to 15.7 percentage points over a bare ReAct baseline, completion remains the primary axis of variation with no model saturating the benchmark, and automated generation enables evaluation at a scale previously infeasible. Beyond static benchmarking, ClawEnvKit enables live evaluation: users describe a desired capability in natural language and obtain a verified environment on demand, turning evaluation into a continuous, user-driven process. The same mechanism serves as an on-demand training environment generator, producing task distributions that adapt to an agent's current weaknesses rather than being bounded by existing user logs.

21.
medRxiv (Medicine) 2026-06-12

High coverage, persistent gaps: quality of Antenatal Care and its determinants in Zambia based on the 2024 Demographic and Health Survey.

Abstract Background Evaluating antenatal care (ANC) quality is critical to reducing maternal and neonatal mortality. In Zambia, despite high basic ANC attendance, comprehensive national evidence on the clinical content and quality of services remains limited. This study assessed the coverage of WHO-recommended ANC interventions and identified factors associated with care quality using the latest national data. Methods A cross-sectional analysis was conducted using data from the 2024 Zambia Demographic and Health Survey. The final analytic sample comprised 4,829 women aged 15-49 with a live birth in the preceding 5 years. A composite index of 15 selected, equally weighted WHO-recommended components evaluated clinical assessment, counseling/screening, preventive interventions, and utilization. Survey-weighted Poisson regression estimated adjusted incidence rate ratios (aIRRs) for the count of ANC components received. Results The mean ANC quality score was 12.5 out of 15 (95% CI: 12.4-12.6), and 78.5% (95% CI: 77.0-80.0) of women achieved adequate ANC ([&ge;] 12/15 components). While individual clinical and counseling coverage generally exceeded 90%, only 47.2% (95% CI: 45.3-49.0) of women initiated care during the first trimester, and just 4.8% (95% CI: 4.1-5.6) achieved [&ge;] 8 ANC contacts. Maternal education was the strongest and most stable predictor of quality across all models. Compared to no education, higher education was associated with an 8.0% higher expected quality score (aIRR = 1.080, 95% CI: 1.051-1.110). Lower ANC quality was significantly associated with unwanted pregnancies (aIRR = 0.970, 95% CI: 0.956-0.993) and with residence in Western (aIRR = 0.923, 95% CI: 0.897-0.951) and North Western (aIRR = 0.966, 95% CI: 0.937-0.996) provinces. Absence of distance barriers and residence in Eastern, Luapula, and Copperbelt provinces were associated with higher quality scores. Conclusion While average ANC component coverage in Zambia is high, critical gaps persist in early initiation and total contact frequency. Care adequacy is strongly influenced by maternal education, relationship status, pregnancy intention, and regional inequities. These findings underscore the need for interventions targeted at uneducated women, preventing unintended pregnancies, and underserved regions such as Western and North Western Provinces. Keywords: Antenatal care quality, ANC content, Zambia, maternal education.

22.
medRxiv (Medicine) 2026-06-23

Attention and memory in Parkinson's disease: a discriminant analysis approach

Background. Cognitive impairment in Parkinson's disease (PD) is highly prevalent and heterogeneous. Assessing multiple cognitive domains is challenging and risks redundancy. This study evaluated whether a discriminant analysis approach could optimize the selection of specific tasks and measures for identifying attention and memory deficits in PD. Methods. Thirty PD patients and 25 cognitively unimpaired (CU) controls completed four experimental tasks: two assessing attention (flanker and spatial Stroop), one for recognition memory, one for working memory (n-back). Following group-level difference analyses, a discriminant analysis was performed to identify which tasks, and performance metrics possessed the highest sensitivity for distinguishing PD patients from CU individuals. Results. At the group level, PD patients exhibited significantly worse conflict costs in both attention tasks and lower sensitivity scores (d') in the recognition memory task compared to CU controls. The discriminant analysis revealed that time-based measures from the spatial Stroop task and the sensitivity score from the recognition memory task provided the highest discriminating power to differentiate between the two groups. Conclusion. These findings suggest that cognitive deficits in PD can be identified with high diagnostic accuracy using a targeted subset of metrics, eliminating the need for extensive and redundant neuropsychological testing batteries for attention and memory, without needing an extensive number of cognitive tasks for attention and memory.

23.
medRxiv (Medicine) 2026-06-16

AI-assisted continuous-time modelling of metastatic breast cancer reveals subtype-specific spatiotemporal organ interactions

Metastatic breast cancer is one of the leading causes of premature mortality among women worldwide. A major barrier to optimal care is the marked heterogeneity in both the temporal dynamics of metastatic spread and the organ-specific spatial distribution of metastases. Existing analyses do not adequately capture this complexity, as they either neglect temporal dependencies or assume independence between metastasic sites. As a result, it remains unclear how established metastases influence subsequent organ-specific dissemination. We address this question using patient-level longitudinal trajectories from a large multicentre real-world metastatic breast cancer registry, combined with an AI-assisted disease-progression modelling framework based on continuous-time Markov chains that represent combinations of metastatic sites and the non-uniform and practice-driven timing of radiologic response assessments, as encountered in routine clinical care. We present a stochastic model determined by progression rates, which are parameterised to capture baseline organ-specific transition risks, patient-level covariates, and pairwise inter-organ interaction effects. High-dimensional treatment information is incorporated using an large language model based encoding. We find that metastatic spread follows non-independent, subtype-specific spatiotemporal patterns, with subtype-specific inter-organ interaction patterns that shape progression. Visceral metastases, particularly lung and liver metastasis, are associated with an increased hazard of subsequent brain metastasis, with effects varying across hormone receptor-positive, HER2-positive, and triple-negative subtypes. Together, these findings define a clinically relevant spatiotemporal architecture of metastatic progression in breast cancer. This framework enables refined mechanism-informed risk stratification and provides a data-driven rationale for targeted and risk-adapted – rather than symptom-triggered – surveillance strategies.

24.
arXiv (CS.AI) 2026-06-19

Leveraging systems' non-linearity to tackle the scarcity of data in the design of Intelligent Fault Diagnosis Systems

arXiv:2606.20323v1 Announce Type: new Abstract: Deep Transfer Learning (DTL) allows for the efficient building of Intelligent Fault Diagnosis Systems (IFDS). On the other hand, DTL methods still heavily rely on large amounts of labelled data. Obtaining such an amount of data can be challenging when dealing with machines or structures faults. This document proposes a novel approach to the design of vibration-based IFDS using DTL in condition of strong data scarcity. A periodic multi-excitation level procedure leveraging intrinsic non-linearities of real-world systems is used to produce images that can be conveniently analysed by pre-trained Convolutional Neural Networks (CNNs) to diagnose faults. A new data visualization method and its augmentation technique are proposed in this paper to tackle the typical lack of data encountered during the design of IFDS. Experimental validation on a railway pantograph structure provides effective support for the proposed method.

25.
Nature Medicine 2026-06-08

Post-adjuvant chemotherapy in ctDNA-positive patients with resected colorectal cancer: a randomized phase 3 trial

Authors:

Tumor-informed circulating tumor DNA (ctDNA) enables detection of molecular residual disease (MRD) after curative resection of colorectal cancer (CRC), but whether early intervention improves outcomes remains uncertain. ALTAIR was a randomized, double-blind, phase 3 trial embedded in the CIRCULATE-Japan platform evaluating a post-adjuvant ctDNA surveillance strategy with treatment initiation upon molecular recurrence. Patients with resected stage 0–IV CRC who became ctDNA positive after completion of standard-of-care therapy and had no radiological evidence of disease were randomly assigned (1:1) to receive trifluridine/tipiracil (FTD/TPI) or placebo for 6 months. The primary endpoint was investigator-assessed disease-free survival (DFS). Between July 2020 and June 2023, 243 patients were randomized to FTD/TPI (n = 122) or placebo (n = 121). Median DFS was 9.30 months with FTD/TPI and 5.55 months with placebo (hazard ratio = 0.79, 95% confidence interval: 0.60–1.05, P = 0.107), and the primary endpoint was not met. FTD/TPI increased grade 3 or higher hematologic adverse events (73.0% versus 3.3%) without new safety signals. These findings indicate that post-adjuvant intervention with FTD/TPI did not significantly improve DFS in ctDNA-positive patients without radiological disease. ClinicalTrials.gov identifier: NCT04457297 . In the randomized, double-blind phase 3 ALTAIR trial, patients with resected colorectal cancer who became positive for circulating tumor DNA during post-adjuvant surveillance received trifluridine/tipiracil hydrochloride therapy, which did not significantly prolong disease-free survival compared with placebo.