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01.
medRxiv (Medicine) 2026-06-22

Midlife Measures of General Cognitive Performance in the National Longitudinal Study of Adolescent to Adult Health (Add Health)

Authors:
Aiello↗A. E↗Rob↗F. I↗Gross↗A. L↗Bennett↗D. A↗Manly↗J. J↗Plassman↗B. L↗…

Objective: The Add Health Cognitive Assessment, Physical, and Sensory Function Protocol (Add CAPS) was developed to assess cognitive, physical, and sensory function in early midlife in a nationally representative sample in the United States. Using Add CAPS, we developed two general cognitive performance measures. Methods: The sample included 2,525 participants from Add Health Wave VI who completed an in- home assessment of cognitive performance. Confirmatory factor analysis (CFA) was used to derive two general cognitive performance (GCP) scores: (1) a five-domain score based on originally designed cognitive domains (Add CAPS GCP), and (2) a modified score aligned with the Harmonized Cognitive Assessment Protocol (HCAP) framework (Add CAPS GCP-H). We evaluated model fit using Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Square Residual (SRMR), and Comparative Fit Index (CFI) and tested factor scores for criterion validity. Results: Both models showed good fit (Add CAPS GCP: RMSEA = 0.025, SRMR = 0.031, CFI = 0.968; Add CAPS GCP-H: RMSEA = 0.027, SRMR = 0.033, CFI = 0.962), indicating that they adequately represent the underlying GCP construct. Discussion: The Add CAPS cognitive battery captures a robust, hierarchical structure of GCP across alternative domain specifications. The derived factor scores provide a valuable method for characterizing a person's cognitive baseline during midlife. Importantly, the Add CAPS GCP-H enhances comparability with the HCAP network, supporting cross-cohort analyses of cognitive aging.

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02.
arXiv (CS.LG) 2026-06-17

Adaptable Method for Crystal Design across Diverse Constraints and Objectives with Pretrained Property Predictors

Authors:
Akihiro Fujii↗Yoshitaka Ushiku↗Koji Shimizu↗Anh Khoa Augustin Lu↗Satoshi Watanabe↗

arXiv:2410.08562v5 Announce Type: replace-cross Abstract: Advanced crystal design can accelerate materials discovery across applications from photovoltaics to spintronics. Practical design must satisfy multiple properties and physical constraints, yet existing machine-learning-based approaches to such design often depend on large datasets, retraining, or task-specific generators. Here, we show that direct predictor-guided gradient optimization enables data-efficient, constraint-rich crystal design by combining off-the-shelf predictors with site-wise element masks, template initialization, and task-specific losses. In perovskites, it outperformed generative and Bayesian baselines under three targets – band gap, formation energy, and tolerance factor – and two hard constraints. DFT assessment further showed band-gap targeting competitive with a leading generative model despite using predictors trained on roughly one-tenth of the data. By flexibly combining pretrained predictors with application-oriented masks and custom losses, the same framework supported half-metal design. Such modularity could help researchers and engineers translate diverse application requirements directly into optimized candidate crystals with minimal computational cost.

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03.
arXiv (CS.AI) 2026-06-18

TRIDENT: Breaking the Hybrid-Safety-Physics Coupling for Provably Safe Multi-Agent Reinforcement Learning

Authors:
Zijie Meng↗Ziwei Li↗Yufei Liu↗Zhiyu Li↗Jiyuan Liu↗Wenhua Nie↗Bingcai Wei↗Miao Zhang↗

arXiv:2606.18308v1 Announce Type: cross Abstract: Safe coordination in networked cyber-physical systems forces learning algorithms to simultaneously handle hybrid discrete-continuous actions, hard training-time safety constraints, and physics-governed dynamics. We show that these three features form a directed cycle of biases that defeats any naive composition of off-the-shelf modules, and formalize this as a three-way coupling lemma. We then introduce TRIDENT, the first MARL framework whose three components are co-designed to cancel each leak: a Richardson-Romberg gradient correction reducing Gumbel-Softmax bias from O(tau) to O(tau^2), a Lyapunov-constrained sequential trust-region update enforcing per-iterate feasibility, and a physics-informed residual critic that decomposes value rather than reward. We prove an O~(1/sqrt(K)) convergence rate to a constrained Nash equilibrium and an O(sqrt(K)) cumulative-violation bound. On multi-UAV mobile-edge computing, autonomous intersection management, and a hybrid SMAC variant, TRIDENT cuts training-time violations by 95.5% over MADDPG and 76.3% over MACPO, while improving reward by 13.5% over the strongest unconstrained baseline.

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

Upper Bounds on the Generalization Error of Deep Learning Models via Local Robustness and Stability

Authors:
Abdul-Rauf Nuhu↗Parham M. Kebria↗Vahid Hemmati↗Mahmoud N. Mahmoud↗Edward Tunstel↗Abdollah Homaifar↗

arXiv:2606.16883v1 Announce Type: cross Abstract: Generalization is a critical property of data-driven models, particularly deep learning models deployed in safety-critical applications. Robustness-based generalization bounds have gained attention as a principled way to link robustness properties to generalization performance, often in a data-dependent manner. However, most existing bounds suffer from vacuousness in practical settings, yielding loose upper bounds that greatly exceed the actual error rates and limiting their usefulness for real-world evaluation. While this issue is often attributed to the uncertainty term, a substantial part of the problem originates from the robustness term itself, particularly for the 0-1 loss. Existing approaches typically treat the robustness term as a global measure, ignoring its variation across different sub-regions of the input space. In this work, we propose a generalization bound that addresses this limitation by scaling the robustness term according to the number of stable and unstable samples within each sub-region. Our bounds incorporate both data- and model-dependent factors while maintaining practical relevance (yielding tighter upper bounds on true error). Experiments on models trained on the ImageNet dataset show that our bounds remain consistently non-vacuous and achieve the tightest estimates among existing methods, closely aligning with empirical performance across a range of robust deep neural networks.

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05.
arXiv (math.PR) 2026-06-11

Improved Amenability Bounds for Local Coordination Games

Authors:
Ron Peretz↗Dean Kraizberg↗

arXiv:2606.01963v2 Announce Type: replace-cross Abstract: We study local pure coordination games on finite social networks, continuing the framework of Hutchcroft, Rospuskova, and Tamuz. They showed that low inefficiency in local coordination forces the underlying graph to be amenable, with a square-root loss in the amenability parameter. We improve this loss in the binary unbiased setting. Using Shapley values of a mutual-information game associated with the players' local outputs, we prove that if the average disagreement is at most $\varepsilon$, then the graph is $(O(\varepsilon\log(1/\varepsilon)),r)$-amenable. This gives a sharper quantitative converse between local coordination and graph amenability.

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

ARIADNE: Agnostic Routing for Inference-time Adapter DyNamic sElection

Authors:
Enrico Cassano↗Micha{\l} Brzozowski↗Zuzanna Dubanowska↗Paolo Mandica↗Neo Christopher Chung↗

arXiv:2606.19079v1 Announce Type: new Abstract: The increasing deployment of parameter-efficient fine-tuning (PEFT) has led to model ecosystems in which a single backbone is paired with many task-specialized adapters. In this setting, inference-time queries often arrive without task labels, requiring the system to automatically select the most appropriate adapter from a growing and heterogeneous adapter pool. Existing routing methods either depend on access to adapter internals, such as weight decompositions or gradient-based statistics, or require additional router training, which limits scalability and portability as new adapters are added. We introduce ARIADNE, a training-free, adapter-agnostic routing framework for dynamic adapter selection at inference time. ARIADNE represents each adapter through a set of centroids computed from embeddings of its training set, capturing the data distribution associated with that adapter. Given an unlabeled input, it selects an adapter by measuring proximity to these centroids in latent space. Because routing is performed entirely in the input embedding space, ARIADNE is compatible with arbitrary PEFT methods and requires no modification to the adapters or training procedures. Primarily evaluated with Llama 3.2 1B Instruct on 23 diverse NLP tasks, ARIADNE recovers 97.44% of the upper bound performance. Scaling to 44 tasks, it achieves 89.7% average selection accuracy, without additional training or access to adapter internals.

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07.
medRxiv (Medicine) 2026-06-11

Global population frequencies of NAT2 star alleles observed in three large biobanks

Authors:
Sangkuhl↗Whirl-Carrillo↗Woon↗Venkatesh↗Keat↗Whaley↗Ritchie↗M. D↗Klein↗T. E↗

NAT2 is an important pharmacogene which encodes the N-acetyltransferase 2 enzyme that is involved in the metabolism of multiple medications, and variants in this gene can affect patient response to these medications. CPIC has published a clinical guideline for prescribing hydralazine using NAT2 genotypes. Just prior to the guideline, updated NAT2 star allele numbering and definitions were released, differing somewhat from the historical nomenclature. Clinical pharmacogenomic testing panels often test for the most common star alleles, so knowledge of the most common updated NAT2 star alleles is critical for the implementation of the CPIC NAT2/hydralazine guideline. We first determine NAT2 diplotype frequencies from UK Biobank (UKBB) 200k phased genomes, then analyzed allele, diplotype, and phenotype population frequencies from the All of Us Research program, PennMedicine BioBank (PMBB) and UKBB 500k datasets. We found that analyzing NAT2 diplotypes from phased data provides critical information for algorithms designed to predict diplotypes from unphased data. We observed that NAT2*5, *6, and *4 were the most common star alleles in that order, and the top 11 most frequent NAT2 star alleles were the same across all biobanks. However, differences in star allele frequencies across biogeographical populations were observed. The largest difference led to a higher frequency of NAT2 poor metabolizer phenotypes as compared to rapid and intermediate metabolizer phenotypes in all global populations except in the EAS population, where NAT2 poor metabolizers were in the minority.

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

Training-Free Metrics for Synthetic Object Detection Data: A Proxy for Detector Performance

Authors:
Myeongseok Nam↗Donghoon Yeo↗Seungwook Kim↗

With the recent advent of image generative models, synthetic data are increasingly being used to supplement limited real datasets for training computer vision models. However, not all synthetic datasets improve performance equally, and their effectiveness can only be assessed by training a downstream model, which is computationally expensive and time-consuming. This problem is pronounced in the task of object detection, where the required annotations are much more dense due to bounding boxes. In this paper, we propose a pre-computable metric family, dubbed Conditional-Composition Domain Match (CCDM), which serves as a proxy for the relative utility of candidate synthetic training sets for downstream detection. Experiments on the VisDrone-DET dataset show that the CCDM metric families achieve a Spearman correlation of 1.0 with the downstream performance of YOLOv8, clearly outperforming existing metrics for synthetic image evaluation.

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09.
arXiv (CS.LG) 2026-06-19

Environment-Adaptive Covariate Selection: Learning When to Use Spurious Correlations for Out-of-Distribution Prediction

Authors:
Shuozhi Zuo↗Yixin Wang↗

arXiv:2601.02322v2 Announce Type: replace-cross Abstract: A common approach to out-of-distribution prediction restricts models to causal or invariant covariates to avoid spurious associations that may change across environments. Despite its theoretical appeal, this strategy can underperform empirical risk minimization when only a subset of the causal parents of the outcome is observed. In such settings, non-causal covariates can serve as proxies for unobserved causal parents and improve prediction when the proxy relationship is stable, but they can hurt when shifts disrupt that relationship. Thus, the optimal covariate set can depend on the specific shift encountered. Because different shifts leave signatures in the unlabeled covariate distribution, we propose an environment-adaptive covariate selection algorithm that maps environment-level summaries to environment-specific covariate sets. These summaries may be hand-crafted or learned from multi-environment data, and prior causal knowledge can be incorporated as constraints. Across simulations and applied datasets, the proposed method improves over static causal, invariant, and other non-adaptive rules under diverse shifts.

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10.
arXiv (CS.LG) 2026-06-15

Graph Diffusion Residuals for Control-Function Instrumental Variables

Authors:
Rui Wu↗Zongyuan Chen↗Hong Xie↗Defu Lian↗Enhong Chen↗

arXiv:2606.14636v1 Announce Type: new Abstract: Control-function instrumental variable estimators need a first-stage residual, not merely a first-stage prediction. High-capacity first stages can interpolate treatment and leave too little residual information for the outcome equation. We study Adaptive Anisotropic Instrumental Heat Flow (A-IHF), a deterministic graph-diffusion residual extractor for flexible control functions. A-IHF treats treatment as a signal on a graph of first-stage features, uses pilot diffusion to detect large treatment jumps, attenuates conductance across those jumps, and computes the generated control with a sparse graph resolvent. Its observational selection rule uses only $(Z,X)$, combining graph generalized cross-validation, roughness, residualized-treatment relevance, and graph-admissibility filtering. The analysis decomposes error into structural leakage, residual attenuation, and residualized treatment variation, yielding finite-sample bounds, graph-admissibility rates under latent piecewise-smooth geometry, and finite-path selection calibration. Across 54 synthetic benchmark cells with tuned graph, kernel, tree, boosting, series, and neural control-function baselines, guarded observational A-IHF has the lowest average structural-response MSE; the A-IHF family beats the best non-A-IHF baseline in 32 cells. Performance is strongest when the graph captures piecewise-smooth first-stage structure.

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

CREST: Deployment-Realistic Hardware-in-the-Loop NAS for Embedded Sensing Systems

Authors:
Joseph Q. Zales↗Pragya Sharma↗Mani Srivastava↗

arXiv:2606.15004v1 Announce Type: cross Abstract: Deploying neural networks on low-power microcontrollers (MCUs) requires selecting model architectures under tight memory, latency, and energy constraints. Existing workflows often simplify this process along one or more axes: static proxy costs such as FLOPs or parameters, treating one MCU as representative, and continuous-inference tests instead of deployed sensing schedules. These assumptions can mis-rank Pareto-front candidates, miss infeasible deployments, and obscure schedule-dependent energy. We present CREST (Cross-platform Runtime Evaluation and Search Tool), a deployment-realistic hardware-in-the-loop (HIL) neural architecture search (NAS) framework for MCU sensing systems. CREST keeps the optimizer, HIL measurement boundary, logging, and replay workflow fixed while exposing workload, model family, target backend, schedule, quantization, and scoring policy as configurable axes. This makes deployment effects experimentally separable within one reusable workflow. We evaluate CREST on inertial odometry and audio classification across three Arm Cortex-M targets. For inertial odometry, measured-energy HIL search reduces median per-inference energy by 41.7% versus FLOPs-based selection and 40.8% versus memory-traffic-based selection at similar error. FLOPs-based selection also chooses infeasible deployments on memory-constrained targets. On the STM32 N657 target, continuous-inference and duty-cycled searches produce different Pareto frontiers. For audio classification, the same application-level policy selects different DS-CNN architectures on different boards, and cross-board replay changes deployment cost substantially. Overall, CREST shows that deployment-realistic MCU NAS must jointly optimize model architecture, target platform, runtime schedule, and deployment policy rather than relying only on static proxy costs or continuous-inference measurements.

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

Starter-Iterator Neural Operator: A Unified Architecture for High-Fidelity Forward and Inverse PDE Problems

Authors:
Kuilin Qin↗Lianfang Wang↗Xu Sun↗Jiwei Jia↗Yu Wang↗Yong Wang↗Yuping Duan↗

arXiv:2606.18305v1 Announce Type: cross Abstract: Operator learning is an emerging interdisciplinary field that integrates machine learning with scientific computing. By mapping infinite-dimensional function spaces, this approach provides an efficient surrogate modeling framework for high-dimensional partial differential equations (PDEs). Compared to traditional numerical solvers, it achieves a superior trade-off between computational complexity and approximation accuracy, demonstrating significant advantages in many-query tasks such as real-time prediction and parameter sweeps. Given the stringent accuracy requirements of both forward simulation and inverse inference, as well as the precision bottlenecks of existing operator learning methods in handling complex boundaries or long-term evolution, we propose the Starter-Iterator Neural Operator (SINO). Our framework reinterprets the initialization strategies and iterative formats of traditional iterative methods through neural networks, establishing an efficient approach for spectral-spatiotemporal collaborative modeling. Specifically, the frequency-domain initialization module captures globally stable low-frequency features, while the time-domain learning module focuses on optimizing local solution residuals, thereby effectively overcoming the inherent limitations of conventional single-domain modeling approaches. Extensive experiments on typical dynamical systems such as the Navier-Stokes equations and acoustic wave equations, as well as practical applications including super-resolution imaging and weather forecasting, demonstrate that SINO achieves outstanding performance in numerical accuracy, generalization capability, and robustness.

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13.
arXiv (quant-ph) 2026-06-16

Learning ground state observables from quantum computing experiments

Authors:
Ben Jaderberg↗Freya Shah↗Minjun Jeon↗M. Emre Sahin↗Christa Zoufal↗Kunal Sharma↗

arXiv:2606.15983v1 Announce Type: new Abstract: Recent theoretical progress has established conditions under which machine learning models can efficiently predict ground-state properties of gapped local Hamiltonians when trained on quantum-generated data. Previous experimental demonstrations in this paradigm, however, have largely been limited to small systems or highly structured states, due to the difficulty of preparing many-body ground states on quantum processors. In this work, we demonstrate learning from experimental quantum data generated from approximate ground states of the two-dimensional Heisenberg XXZ model with system sizes up to 115 qubits. We construct a dataset of single-site expectation values, two-point correlations, and 12-body loop correlations across the antiferromagnetic phase. We then train neural networks on this data and show that they can accurately predict spatially resolved observables for previously unseen Hamiltonian parameters, both within the training distribution and in an out-of-distribution regime approaching the phase boundary. Our results demonstrate the practical realization of learning from quantum data for an interacting two-dimensional many-body system at scale, motivating a path toward regimes where quantum processors could provide training data beyond the reach of classical approximation methods.

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14.
medRxiv (Medicine) 2026-06-15

Modelling the public-health impact of indoor air quality interventions on respiratory virus transmission

Authors:
Howes↗Jeyapragasan↗Williamson↗Carel↗Koos↗Swett↗J. L↗Montavon↗Belenky↗Lietar↗Fitzjohn↗Charles↗…

Respiratory virus transmission occurs in indoor settings where ventilation, occupancy, and dwell time determine exposure levels. Improving indoor air quality (IAQ) therefore could help reduce disease burden associated with respiratory viruses, yet its population-level impact remains poorly quantified. Here, we develop an individual-based transmission modelling framework that links within-location airborne dynamics to individual infection risk and population-level spread, whilst explicitly incorporating heterogeneity in ventilation and baseline indoor air quality across locations. We use this modelling approach to evaluate IAQ-improving interventions (air-quality interventions or AQIs), using hypothetical endemic and pandemic pathogen archetypes with properties similar to SARS-CoV-2 and influenza, and evaluate how effects on key epidemiological metrics (such as annualized incidence and epidemic final size) depend on AQI coverage, efficacy and allocation strategy. At 20% AQI intervention coverage and 80% efficacy, annualized incidence was reduced by approximately 7.2% for an endemic 'SARS-CoV-2-like' respiratory virus, and 17.0% for an endemic 'influenza-like' virus; at 60% coverage (80% efficacy) the reductions were 26.3% and 56.4%, respectively. Targeting AQI installation to the highest-risk locations outperformed random allocation: for SARS-CoV-2-like transmission, 20% coverage at 80% efficacy cut absolute incidence by 10.8% when targeted versus 7.2% when random; for influenza-like transmission, this comparison was 28.9% versus 17.0%. In epidemic scenarios, random installation at 40% coverage and 60% efficacy reduced final size by 23.7% (influenza-like) versus 6.3% (SARS-CoV-2-like). These results support treating clean indoor air as core public-health infrastructure and prioritising risk-based deployment of IAQ-improving interventions to maximise population-level benefit within budgetary and operational constraints.

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15.
medRxiv (Medicine) 2026-06-17

Characterisation of disease progression in hantavirus haemorrhagic fever with renal syndrome

Authors:
Armstrong↗Rus↗Knap↗Drousiotis↗Eyers↗Buchan↗I. E↗Avsic-Zupanc↗Hiscox↗J. A↗Korva↗

Hantaviruses can cause haemorrhagic fever with renal syndrome (HFRS). This is a clinically variable disease in which severe outcomes are hypothesized to arise from dysregulated host responses. To characterise this, longitudinal, label-free plasma proteomics was used to compare disease progression in a unique well-defined cohort of patients infected with either Dobrava virus (DOBV) or Puumala virus (PUUV) hantaviruses. Patients were stratified by clinical severity. The average viral load in the first available sample from hospitalized patients was higher in those who went on to have severe infection, and higher in patients infected with DOBV. There was marked separation of infected patients from controls across early, mid and late disease, including after viral RNA clearance, suggesting a sustained systemic host-response signature. Proteomic signatures were consistent with a strong acute-phase response in both mild and severe disease. There was evidence of activation of the adaptive humoral response at later stages. Hierarchical clustering identified severity-associated pathways linked to endothelial dysfunction, thrombocytopenia, vascular leakage and renal injury. These findings define a durable plasma proteomic signature of hantavirus disease and support a model in which severe HFRS is driven by persistent inflammatory, complement and platelet/coagulation pathway activation rather than viral burden alone.

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16.
medRxiv (Medicine) 2026-06-15

Quality Improvement Based Implementation and Evaluation of a Decision Aid for Patients with Nephrolithiasis

Authors:
Lee↗Kazemi↗Wilson↗Thaker↗Kwan↗Cabri↗Li↗Dunn↗Yaghoubian↗Elkhoury↗Scotland↗Saigal↗…

Introduction Patients with nephrolithiasis face challenges in making a high-quality, preference sensitive decision. Our prior work established feasibility and patient acceptance of a software-based decision aid (DA). The objectives for this study were to identify implementation strategies for the DA in routine care and determine whether DA implementation enhances decisional quality for patients. Methods New nephrolithiasis patients were recruited from the institution Medical Center from June 2018 to April 2024 to receive a software-based pre-visit DA that measured care preferences and used decision analysis to rank treatments. The RE-AIM framework and Plan-Do-Study-Act (PDSA) cycles were used to improve implementation outcomes. Patients completed survey instruments evaluating decisional conflict, shared decision-making, care satisfaction, and treatment choice following their provider visit. These metrics were compared in the DA cohort (n=81) to those in a usual care cohort (n=78) with Wilcoxon rank-sum and Chi-square (or Fishers exact) tests. Results Implementation data revealed sustained reach and progressive improvement in fidelity. The DA cohort reported higher decisional quality relative to controls (p=0.003) and reported greater support/advice to make a choice (p=0.005). The DA cohort more often discussed options with their doctor (87.5% vs 69.2%, p=0.005) and were more likely to be promoters of their provider (p

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17.
arXiv (CS.AI) 2026-06-16

Communication-Efficient Verifiable Attention for LLM Inference

Authors:
Ziqun Chen↗Ming Wu↗Michael Heinrich↗Jason Zeng↗Huiying Lan↗Tianwei Zhang↗Rui Tan↗

arXiv:2606.16352v1 Announce Type: cross Abstract: Computation integrity of remote large language model (LLM) serving can be questionable. For conventional deep neural networks (DNNs), the existing TEE-shielded DNN partitioning (TSDP) approach uses Trusted Execution Environment (TEE) to compute non-linear components and verify the integrity of linear components offloaded to an untrusted GPU. However, directly applying TSDP to Transformer-based LLMs incurs significant TEE computation and TEE-GPU communication overhead. This paper presents Communication-efficient TEE-GPU Attention (\textsc{VeriAttn}) for accelerating verifiable LLM inference. \textsc{VeriAttn} offloads both linear and non-linear computations of attention to the GPU, while TEE performs verification. Moreover, for prefill, \textsc{VeriAttn} uses a two-level pipeline to overlap data movement, TEE pre-/post-processing, and GPU computation. For decoding, when the key-value cache exceeds available GPU memory, \textsc{VeriAttn} partitions attention across TEE and GPU to reduce repeated key-value transfers. Evaluation on an Intel TDX platform shows that \textsc{VeriAttn} achieves 2.60-3.38$\times$ and 3.86-5.42$\times$ acceleration over TSDP for 6k-token prompts and 10k-token outputs during prefill and decoding, respectively.

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19.
medRxiv (Medicine) 2026-06-22

Cumulative Metabolic Exposure to Hyperglycemia and Risk of Cardiovascular and Limb Events in Peripheral Artery Disease

Authors:
James↗Li↗Somisetty↗Nguyen↗Vaughan-Sarrazin↗M. S↗Lund↗Tsai↗Smolderen↗K. G↗Hoffman↗R. M↗…

Background: Although diabetes is a potent risk factor for the development of peripheral artery disease (PAD), the effect of cumulative metabolic exposure to hyperglycemia on risk of cardiovascular or limb events in patients with PAD remains unclear. Methods: The Peripheral Artery Disease: Long-term Survival (PEARLS) is a longitudinal registry of Veterans with newly diagnosed PAD identified using a natural language processing approach. Included patients had ankle brachial index [≤]0.9 or toe brachial index [≤]0.7, and no history of lower extremity revascularization or major amputation. Among patients with diabetes in this cohort, we assessed cumulative exposure to hyperglycema based on a 24-month rolling average of hemoglobin (Hgb) A1c values, categorized as [≤]7%, >7% to [≤]8%, and >8%. Multivariable Cox regression models evaluated the association between categories of HgbA1c, modeled as a time-varying exposure, and risk of cardiovascular (CV: myocardial infarction or stroke) and limb (chronic limb threatening ischemia [CLTI] or major amputation) events. Results: Among 45,109 patients with new diagnosis of PAD and pre-existing diabetes, the mean HgbA1c at baseline was 7.5%, with nearly one-third (30.4%) having HgbA1c >8%. The mean age was 70.4 years, 19.8% were Black and 4% were Hispanic. Patients with baseline HgbA1c >8% were younger and compared to those with HgbA1c [≤]7%, more likely to have coronary disease, kidney disease, and obesity. Over a median follow up of 4.2 years, 8,306 (18.4%) patients experienced a CV event, and 8,199 (18.2%) experienced a limb event. The adjusted association between HgbA1c and hazard of CV events was 12% higher in patients exposed to HgbA1c >7% to [≤]8% (HR 1.12; 95%CI: 1.05-1.18) and 38% higher in those exposed to HgbA1c >8% (HR 1.38; 95%CI: 1.30-1.46), compared to HgbA1c 7% to [≤]8% (HR 1.20; 95%CI: 1.13-1.28) and HgbA1c >8% (HR 1.60; 95%CI: 1.51-1.70), respectively when compared to HgbA1c [≤]7%. These findings were consistent in subgroups based on age and severity of PAD. Conclusions: Among diabetic patients with PAD, cumulatiave metabolic exposure to hyperglycemia is associated with a markedly increased risk of clinical events, especially limb events.

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

MAF: Multimodal Adaptive Few-shot Prompting for Sentiment Analysis with MLLMs

Authors:
Hangling Xie↗

Multimodal large language models (MLLMs) have demonstrated remarkable capabilities in understanding complex multimodal content. However, their performance in sentiment analysis exhibits acute sensitivity to prompt design, rendering static, uniformly applied prompts inherently suboptimal for capturing the nuanced multimodal cues that vary across inputs. To address this limitation, we propose a Multimodal Adaptive Few-Shot Prompting (MAF) framework, which dynamically retrieves and integrates query-relevant demonstrations to elicit the sentiment reasoning capabilities of MLLMs in a context-sensitive manner. MAF constructs a demonstration retrieval module that holistically encodes facial expressions, scene context, and textual semantics, with a lip movement amplitude detection mechanism introduced for accurate speaker identification in multi-person scenarios. Departing from conventional fixed-weight fusion, a lightweight coefficient generation network is trained to output query-conditioned fusion weights in real time, enabling weighted aggregation of multimodal similarity scores to retrieve the top-K most informative demonstrations. Prediction stability is further enhanced through majority voting over multiple candidate outputs generated by the MLLM. Extensive experiments on public benchmark datasets demonstrate that MAF achieves substantial and consistent performance improvements over the corresponding backbone variants and remains competitive with strong multimodal sentiment-analysis baselines.

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21.
arXiv (CS.CL) 2026-06-17

LVLMs and Humans Ground Differently in Referential Communication

Authors:
Peter Zeng↗Weiling Li↗Amie Paige↗Zhengxiang Wang↗Panagiotis Kaliosis↗Dimitris Samaras↗Gregory Zelinsky↗Susan Brennan↗Owen Rambow↗

For generative AI agents to partner effectively with human users, the ability to accurately predict human intent is critical. But this ability to collaborate remains limited by a critical deficit: an inability to model common ground. We present a referential communication experiment with a factorial design involving director-matcher pairs (human-human, human-AI, AI-human, and AI-AI) that interact with multiple turns in repeated rounds to match pictures of objects not associated with any obvious lexicalized labels. We show that LVLMs cannot interactively generate and resolve referring expressions in a way that enables smooth communication, a crucial skill that underlies human language use. We release our corpus of 356 dialogues (89 pairs over 4 rounds each) along with the online pipeline for data collection and the tools for analyzing accuracy, efficiency, and lexical overlap.

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22.
arXiv (CS.CV) 2026-06-16

Pixel-TTS: Image based Text Rendering for Robust Text-to-Speech

Authors:
Adarsh Arigala↗Arjun Gangwar↗S Umesh↗Yova Kementchedjhieva↗

Recent advances in pixel-based text modeling show that representing text as images enables models to exploit visual cues for language understanding. Grounding text in its visual form allows structurally similar characters with different Unicode encodings to produce similar embeddings, benefiting cross-lingual and zero-shot scenarios. Conventional text-based approaches treat each character independently, limiting generalization to unseen characters and requiring embedding expansion during cross-lingual adaptation. We propose Pixel-TTS, the first framework for visually grounded speech synthesis. It renders text as images and projects them through a 2D convolutional layer to generate embeddings. This design eliminates embedding matrix expansion during fine-tuning while improving robustness to unseen characters and orthographic variations. Extensive experiments show Pixel-TTS achieves competitive performance with strong baselines, faster convergence and robust zero-shot generalization.

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23.
arXiv (CS.CL) 2026-06-12

Low-Latency Real-Time Audio Game Commentary System via LLM-Based Parallel Text Generation

Authors:
Ryota Kawamatsu↗Anum Afzal↗Yuki Saito↗Shinnosuke Takamichi↗Graham Neubig↗Katsuhito Sudoh↗Hiroya Takamura↗Tatsuya Ishigaki↗

We present a low-latency real-time audio game commentary system that generates spoken commentary directly from live gameplay video. In this end-to-end setting, a key bottleneck is accumulated waiting time; conventional pipelines capture frames, generate text, and synthesize speech sequentially for each utterance, and do not request the next generation until speech playback has completed. This strict sequentiality causes long and unnatural silence between utterances. To address this latency bottleneck, our system runs text generation in parallel with speech playback and buffers multiple candidate utterances ahead of time, enabling immediate synthesis at playback boundaries. Experiments on fast-paced game videos show that our parallel design reduces the mean inter-utterance silence from 9.6 seconds to 0.3 seconds compared to sequential baselines. It also improves similarity to professional speaking–silence timing patterns by over 40 %, and a user study with 120 experienced game players confirms significantly improved perceived speaking rhythm. Our demo video is available at: https://youtu.be/pmrRUlvav8M.

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24.
medRxiv (Medicine) 2026-06-15

The clinical utility of functional testing in fibroblasts to diagnose primary mitochondrial disease

Authors:
Van Hove↗J. L. K↗Friederich↗M. W↗R. A↗Lee↗J. C↗Knight↗K. M↗Donovan↗T. E↗Silveira↗…

Genome sequencing of the heterogeneous primary mitochondrial disorders (PMD) frequently reveals variants of uncertain significance that require functional tests for diagnosis, and does not identify variants in all patients. We analyzed mitochondrial enzyme assays, blue native polyacrylamide gel electrophoresis (BN-PAGE) with in-gel activity staining, complex I assembly blot, and select protein abundances in fibroblasts of a case series of 204 PMD patients divided into functional classes, in comparison to 51 controls and 53 differential diagnostic conditions. Overall, sensitivity and specificity for respiratory chain enzyme assays were 46% and 93% respectively, for BN-PAGE 40% and 98%, for complex I assembly assay 49% and 99%. The overall sensitivity of all tests was 76%, specificity 93%, with positive predictive value 96% and negative predictive value 67%. Categories with high sensitivity were isolated complex deficiencies, nuclear DNA-encoded mitochondrial protein synthesis defects, co-factor defects, and mitochondrial amino-acyl-tRNA synthetase conditions when aided by protein abundance. Mitochondrial DNA mutations and maintenance disorders showed poor sensitivities. Secondary dysfunctions were rare. A complete battery of functional tests showed strong diagnostic clinical utility in fibroblasts.

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25.
arXiv (CS.LG) 2026-06-18

Detecting Hidden ML Training With Zero-Overhead Telemetry

Authors:
Robi Rahman↗Sabiha Tajdari↗

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.

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