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01.
arXiv (CS.CV) 2026-06-19

GH-ESD: Grounded Hypothesis-Driven Error Slice Discovery for Instance-Level Vision Tasks

Systematic failures of vision models on semantically coherent subsets, known as error slices, reveal limitations in robustness and evaluation. Existing slice discovery approaches largely model slices as clusters in representation space or combinations of predefined attributes. While effective for image-level classification, such formulations are insufficient for instance-level tasks such as object detection and segmentation, where failures often arise from contextual relational and spatially grounded visual patterns. We propose GH-ESD (Grounded Hypothesis-Driven Error Slice Discovery), a generate and verify framework that reformulates slice discovery as grounded hypothesis generation and statistical verification. GH-ESD constructs relational failure hypotheses using LLM priors and grounded visual evidence, discovers hypothesis slices at the instance level via Vision Language Models, and verifies them through statistical trend analysis over instance-level errors. We also introduce GESD (Grounded Error Slice Dataset), a new benchmark for instance-level error slice discovery, providing expert-defined and spatially grounded slices derived from detection and segmentation failures. Extensive experiments demonstrate that GH-ESD consistently outperforms baselines, improving Precision@10 by 0.10 (0.73 vs. 0.63) on the GESD benchmark for detection tasks, while also supporting segmentation scenarios. GH-ESD identifies interpretable slices that facilitate actionable model improvements. The GESD dataset will be made publicly available upon acceptance.

02.
arXiv (quant-ph) 2026-06-11

A post-selected quantum model of cosmic acceleration

arXiv:2606.12297v1 Announce Type: cross Abstract: The origin of cosmic acceleration remains a central problem in cosmology, commonly attributed to a cosmological constant within the $\Lambda$CDM model or to dynamical dark energy. Here, we develop an alternative approach in which acceleration emerges from quantum post-selection, a standard feature of quantum theory that is not usually incorporated into cosmological modelling. While quantum theory admits both pre-selected and post-selected ensembles, quantum cosmological models are almost exclusively formulated in terms of initial conditions. Building on previous work on post-selected quasiclassical dynamics, we construct a minimal predictive cosmological model in which post-selection and coarse-graining generate effective late-time acceleration without introducing a cosmological constant, dark energy, or modifications of general relativity. The resulting expansion history is highly constrained theoretically and depends on at most two parameters beyond standard Friedmann evolution. Confrontation with type Ia supernova and cosmic chronometer data yields statistically competitive fits while naturally avoiding the coincidence problem. The model also reproduces the standard radiation- and matter-dominated behaviour at early times and predicts a present-day jerk parameter significantly different from the $\Lambda$CDM value. These results suggest that cosmic acceleration may arise as a macroscopic quantum cosmological effect rather than from additional cosmological fluids or modified gravitational dynamics.

03.
arXiv (CS.AI) 2026-06-11

Noise-Guided Transport for Imitation Learning

arXiv:2509.26294v2 Announce Type: replace-cross Abstract: We consider imitation learning in the low-data regime, where only a limited number of expert demonstrations are available. In this setting, methods that rely on large-scale pretraining or high-capacity architectures can be difficult to apply, and efficiency with respect to demonstration data becomes critical. We introduce Noise-Guided Transport (NGT), a lightweight off-policy method that casts imitation as an optimal transport problem solved via adversarial training. NGT requires no pretraining or specialized architectures, incorporates uncertainty estimation by design, and is easy to implement and tune. Despite its simplicity, NGT achieves strong performance on challenging continuous control tasks, including high-dimensional Humanoid tasks, under ultra-low data regimes with as few as 20 transitions.

04.
Nature (Science) 2026-06-12

‘Student Geng’ ignites research-integrity scandal in China after calling out senior academics<b> </b>

作者:

Video blogger’s viral accusations of data manipulation in Nature journals have sparked intense debate and speedy institutional investigations. Video blogger’s viral accusations of data manipulation in Nature journals have sparked intense debate and speedy institutional investigations.

05.
arXiv (CS.CV) 2026-06-11

MedCTA: A Benchmark for Clinical Tool Agents

To make clinically grounded decisions, medical AI agents are expected to go beyond simple recognition and be capable of tool retrieval, evidence acquisition, and integration. Existing benchmarks largely evaluate isolated perception or single-turn question answering, and therefore provide limited visibility into failures of planning, tool recruitment, and rollout reliability. We introduce MedCTA, a benchmark for evaluating medical tool agents on clinician-validated, step-implicit tasks grounded in realistic multimodal clinical inputs, including radiology images, pathology slides, and reports. MedCTA comprises 107 real-world clinical tasks with clinician-verified executable trajectories over 5 deployed tools, and supports process-aware evaluation of tool selection, argument validity, execution stability, trajectory fidelity, and outcome quality. We benchmark 18 open- and closed-source multimodal models and find that even frontier systems remain brittle in multi-step clinical tool use: autonomous rollouts are dominated by protocol failures, premature stopping, and incorrect tool recruitment, while gold-standard tool routing yields large but still incomplete gains. These results show that strong backbone perception does not translate into reliable agentic behavior in clinical settings. MedCTA provides a rigorous testbed for auditing, diagnosing, and advancing trustworthy medical AI agents. The dataset and evaluation suite are available at https://ivul-kaust.github.io/MedCTA/

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

TabKD: Tabular Knowledge Distillation through Interaction Diversity of Learned Feature Bins

arXiv:2603.15481v2 Announce Type: replace-cross Abstract: Data-free knowledge distillation enables model compression without original training data, critical for privacy-sensitive tabular domains. However, existing methods does not perform well on tabular data because they do not explicitly address feature interactions, the fundamental way tabular models encode predictive knowledge. We identify interaction diversity, systematic coverage of feature combinations, as an essential requirement for effective tabular distillation. To operationalize this insight, we propose TabKD, which learns adaptive feature bins aligned with teacher decision boundaries, then generates synthetic queries that maximize pairwise interaction coverage. Across 4 benchmark datasets and 4 teacher architectures, TabKD achieves highest student-teacher agreement in 14 out of 16 configurations, outperforming 5 state-of-the-art baselines. We further show that interaction coverage strongly correlates with distillation quality, validating our core hypothesis. Our work establishes interaction-focused exploration as a principled framework for tabular model extraction.

07.
arXiv (CS.CV) 2026-06-17

m2sv: A Scalable Benchmark for Map-to-Street-View Spatial Reasoning

Vision–language models (VLMs) achieve strong performance on many multimodal benchmarks but remain brittle on spatial reasoning tasks that require aligning abstract overhead representations with egocentric views. We introduce m2sv, a scalable benchmark for map-to-street-view spatial reasoning that asks models to infer camera viewing direction by aligning a north-up overhead map with a Street View image captured at the same real-world intersection. We release m2sv-20k, a geographically diverse benchmark with controlled ambiguity, along with m2sv-sft-11k, a curated set of structured reasoning traces for supervised fine-tuning. Despite strong performance on existing multimodal benchmarks, the best evaluated VLM achieves only 65.2% accuracy on m2sv, below human annotators who reach 72.0% on average (and 95% for an expert) with strong inter-annotator agreement ($\kappa$ up to 0.76). While supervised fine-tuning and reinforcement learning yield consistent gains, cross-benchmark evaluations reveal limited transfer. Beyond aggregate accuracy, we systematically analyze difficulty in map-to-street-view reasoning using both structural signals and human effort, and conduct an extensive failure analysis of adapted open models. Our findings highlight persistent gaps in geometric alignment, evidence aggregation, and reasoning consistency, motivating future work on grounded spatial reasoning across viewpoints.

08.
arXiv (CS.LG) 2026-06-18

Hierarchical Attention via Domain Decomposition

arXiv:2606.18525v1 Announce Type: new Abstract: We propose a hierarchical attention mechanism based on two-level overlapping Schwarz domain decomposition. The method is motivated by the observation that two-level Schwarz domain decomposition methods combine local subdomain corrections with a coarse level that communicates global, long-range information. We test its usefulness in the context of finite-dimensional operator learning using a simple, one-dimensional diffusion problem with homogeneous Dirichlet boundary conditions. Although elementary, this problem provides a controlled sequence-to-sequence setting in which the exact nonlocal solution operator is known. After discretization, learning the solution operator amounts to approximating the inverse of a symmetric positive definite matrix. As a baseline, we use a global softmax-free low-rank attention operator of the form $QK^T$. The proposed construction replaces this dense global factorization by a two-level additive structure: local low-rank attention blocks on overlapping subdomains are combined with a coarse attention block. The resulting operator has the form $$M_{\theta}^{-1} = \Phi Q_0 K_0^T \Phi^T + \sum_{i=1}^{N} R_i^T D_i^{1/2} Q_i K_i^T D_i^{1/2} R_i.$$ Here $R_i$ restricts to an overlapping subdomain, $D_i$ is a partition-of-unity weight, and $\Phi$ is a coarse interpolation (or prolongation) matrix. Numerical experiments for synthetic Fourier right-hand sides indicate that the domain-decomposition attention operator is able to train faster and can give more accurate approximations than a global low-rank attention baseline while using significantly fewer parameters.

09.
arXiv (CS.CV) 2026-06-15

Trimodal Glioma Representation Alignment via Volumetric Contrastive Learning

Glioma grading and survival prediction require the integration of heterogeneous information collected at different spatial and biological scales. Histopathology describes tissue morphology, mRNA expression captures molecular activity, and magnetic resonance imaging provides a non-invasive view of tumor extent and radiological heterogeneity. Existing glioma prognosis models often combine only two of these sources, while their alignment objectives remain mostly pairwise. This paper introduces GLORIA, a novel trimodal framework for GLioma Omics - Radiology - hIstopathology Alignment. GLORIA processes whole-slide image regions, gene-expression profiles, and 3D MRI volumes through modality-specific encoders, projects them into a shared latent space, and aligns them with a Gramian contrastive loss that measures the volume spanned by the three modality embeddings. The aligned representations are fused through a cross-modal gating module and optimized jointly for three-class glioma grading and overall survival prediction. We evaluate GLORIA on a matched TCGA-GBM/LGG and BraTS21 cohort, comprising 132 patients with all three modalities. On the shared trimodal test set, GLORIA improves over the bimodal WSI-mRNA baseline in all the metrics considered.

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

Prefill/Decode-Aware Evaluation of LLM Inference on Emerging AI Accelerators

arXiv:2606.17104v1 Announce Type: cross Abstract: As large language models (LLMs) are increasingly deployed in latency- and cost-sensitive settings, inference efficiency has become a central systems challenge. While GPUs dominate current deployments, a growing number of AI accelerators claim advantages for LLM inference, yet it remains unclear under which conditions such accelerators outperform GPUs in practice. Recent inference systems decompose execution into Prefill and Decode phases, which exhibit distinct computational characteristics and latency metrics, commonly captured by time to first token (TTFT) and time per output token (TPOT). This paper presents a phase-aware evaluation of LLM inference performance across GPUs and emerging AI accelerators using a common model, Llama2-7B. By separately measuring Prefill and Decode performance, we reveal that accelerator advantages differ by phase and metric. Our results show that GPUs consistently excel in the compute-intensive Prefill phase, while GroqRack achieves significantly lower TPOT during Decode (batching not currently supported). However, GPUs regain an advantage in Decode throughput as batch size increases. These findings demonstrate that each platform exhibits distinct phase-dependent strengths. We further analyze heterogeneous Prefill/Decode disaggregation across different accelerator platforms, identifying performance gains and the workload and network conditions under which such gains are realized.

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

CMDS-AD: Cross-Modal Dual-Stream Decoupling for Few-Shot Anomaly Detection

Few-shot anomaly detection remains challenging due to limited training data. Multi-modal anomaly detection (MAD) offers a viable solution, leveraging 3D geometric cues to enrich 2D RGB representations and compensate for this scarcity. However, existing MAD methods apply spatially uniform feature processing, conflating stable macroscopic structures with high-frequency localized defect signals, exacerbating cross-modal misalignment and inflating false-positive rates. To overcome this, we present CMDS-AD, a Cross-Modal Dual-Stream Anomaly Detection framework. A LoRA-guided diffusion model generates diverse RGB samples to mitigate extreme data scarcity. For 3D normal augmentation, we employ a pre-trained diffusion model as a normal estimator. Crucially, this estimator inherently acts as a non-linear low-pass filter, directly extracting low-frequency normal representations from RGB inputs. This establishes an auxiliary estimated stream of purely low-frequency information, anchoring robust structural templates and assisting the uncompressed real stream, containing coupled high- and low-frequency components, to precisely isolate micro-defects. A Coordinate-Aware Hierarchical Feature Mapper adaptively aligns cross-modal semantics, while a multiplicative scoring mechanism filters modality-specific noise. Under the extreme 1-shot setting, CMDS-AD achieves absolute performance gains of 5.7% (I-AUROC) and 2.0% (AUPRO) on MVTec 3D-AD, alongside 7.7% and 5.6% improvements on EyeCandies, establishing a new state-of-the-art.

13.
arXiv (math.PR) 2026-06-11

The $K$-th nearest neighbor random walk on a Poisson point process gets trapped

arXiv:2606.11271v1 Announce Type: new Abstract: The $K$-th nearest neighbor random walk $(X_n)_{n \geq 0}$ on a homogeneous Poisson point process $\chi$ on $\R^d$ ($d\geq 1$), starts at the origin and at each step picks its next Poisson point among its closest neighbors according to i.i.d. labels having the same distribution as $K$. Our main result (Theorem 1) states that the number of Poisson points visited by $(X_n)_{n \geq 0}$ admits an exponential decay whenever the random variable $K$ has a bounded support (BS). In particular, the $K$-th nearest neighbor random walk visits finitely many Poisson points if and only if $K$ satisfies Assumption (BS). To prove it, we introduce the key notion of pioneer point which allows us to deal with the region of $\R^d$ already explored by $(X_n)_{n \geq 0}$. Still under Assumption (BS), we also prove an exponential decay for the Euclidean length of the trajectory performed by $(X_n)_{n \geq 0}$ (Theorem 2). Finally, and quite surprisingly, we exhibit an example of label distribution with bounded support for which the $K$-th nearest neighbor random walk discovers new Poisson points after a number of steps whose tail distribution is at least polynomial (Theorem 3).

14.
arXiv (CS.AI) 2026-06-12

Examining the Usage of Generative AI Models in Student Learning Activities for Software Programming

arXiv:2511.13271v2 Announce Type: replace-cross Abstract: The rise of Generative AI (GenAI) tools like ChatGPT has created new opportunities and challenges for computing education. Existing research has primarily focused on GenAI's ability to complete educational tasks and its impact on student performance, often overlooking its effects on knowledge gains. In this study, we investigate how GenAI assistance compares to conventional online resources in supporting knowledge gains across different proficiency levels. We conducted a controlled user experiment with 24 undergraduate students of two different levels of programming experience (beginner, intermediate) to examine how students interact with ChatGPT while solving programming tasks. We analyzed task performance, conceptual understanding, and interaction behaviors. Our findings reveal that generating complete solutions with GenAI significantly improves task performance, especially for beginners, but does not consistently result in knowledge gains. Importantly, usage strategies differ by experience: beginners tend to rely heavily on GenAI toward task completion often without knowledge gain in the process, while intermediates adopt more selective approaches. We find that both over-reliance and minimal use result in weaker knowledge gains overall. Based on our results, we call on students and educators to adopt GenAI as a learning rather than a problem solving tool. Our study highlights the urgent need for guidance when integrating GenAI into programming education to foster deeper understanding.

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

Edit Knowledge, Not Just Facts via Multi-Step Reasoning over Background Stories

arXiv:2602.02028v2 Announce Type: replace Abstract: Enabling artificial intelligence systems, particularly large language models, to update knowledge and flexibly apply it during reasoning remains a central challenge. Existing knowledge editing approaches emphasize atomic facts, improving factual recall but often failing to integrate updated information into a coherent framework usable across contexts. In this work, we argue that knowledge update is fundamentally a reasoning problem rather than a memorization problem. Consequently, a model should be trained in situations where the new information is instrumental to solving a task, combined with pre-existing knowledge, and exercised through multi-step reasoning. Based on this insight, we propose a training strategy based on three principles. First, new knowledge is introduced as a coherent background story that contextualizes novel facts and explains their relation to existing knowledge. Second, models are trained using self-generated multi-hop questions that require multi-step reasoning involving the new information. Third, training is done using knowledge distillation, forcing a student model to internalize the teacher's reasoning behavior without access to the novel information. Experiments show that models trained with this strategy effectively leverage newly acquired knowledge during reasoning and achieve remarkable performance on challenging questions that require combining multiple new facts.

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

Encoding parameters by measurement: Forgetting can be better in quantum metrology

arXiv:2512.10541v2 Announce Type: replace Abstract: We introduce quantum parameter estimation with the encoding being via a quantum measurement. We quantify the precision for estimating parameters characterizing a general two-outcome qubit measurement, considering two cases: when the outcomes of the encoding measurement are recorded and when the same are ignored. We find that in a large variety of such estimation scenarios, forgetting the outcomes yields higher precision. We derive a necessary criterion under which remembering the measurement outcomes provides better precision in comparison to the outcome-forgotten strategy. Furthermore, we establish a necessary and sufficient criterion for the simultaneous estimation of multiple parameters encoded by an arbitrary quantum process, including those involving measurements, using qubit probes, and find when the quantum Cramér$-$Rao bound is valid and achievable. For simultaneous estimation of two parameters characterizing the measurement, we find that the achievable quantum Cramér$-$Rao bound can be a valid precision bound only when the measurement direction depends on the parameters of interest.

17.
arXiv (CS.CL) 2026-06-15

Is ChatGPT Fair for Recommendation? Evaluating Fairness in Large Language Model Recommendation

The remarkable achievements of Large Language Models (LLMs) have led to the emergence of a novel recommendation paradigm – Recommendation via LLM (RecLLM). Nevertheless, it is important to note that LLMs may contain social prejudices, and therefore, the fairness of recommendations made by RecLLM requires further investigation. To avoid the potential risks of RecLLM, it is imperative to evaluate the fairness of RecLLM with respect to various sensitive attributes on the user side. Due to the differences between the RecLLM paradigm and the traditional recommendation paradigm, it is problematic to directly use the fairness benchmark of traditional recommendation. To address the dilemma, we propose a novel benchmark called Fairness of Recommendation via LLM (FaiRLLM). This benchmark comprises carefully crafted metrics and a dataset that accounts for eight sensitive attributes1 in two recommendation scenarios: music and movies. By utilizing our FaiRLLM benchmark, we conducted an evaluation of ChatGPT and discovered that it still exhibits unfairness to some sensitive attributes when generating recommendations. Our code and dataset can be found at https://github.com/jizhi-zhang/FaiRLLM.

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

Measurement Plasticity: Sensor-Level Adaptation for Vision-Language Models

We propose Multi-View Physical-prompt (MVP) for Test-Time Adaptation (TTA), a forward-only framework that moves TTA from tokens to photons by treating the camera exposure triangle (i.e., ISO, shutter speed, and aperture) as physical prompts. At inference, MVP acquires selected multiple physical views using a source-affinity score, evaluates digitally augmented variants of each retained view and filters the lowest-entropy predictions, and aggregates predictions with hard voting. This selection-then-vote design is simple, calibration-friendly, and requires no gradients or model modifications. On ImageNet-ES and ImageNet-ES-Diverse, MVP outperforms digital-only TTA on both Auto-Exposure and a combination with conventional sensor control. MVP remains effective under reduced parameter candidates that lower capture latency, demonstrating its practicality.

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

Toward all-optical unsupervised Hebbian learning in deep photonic neuromorphic networks

arXiv:2601.22300v3 Announce Type: replace-cross Abstract: We propose a deep photonic neuromorphic network (PNN) architecture based on phase-change material (PCM) synapses and local optical feedback for online, unsupervised Hebbian learning. The proposed architecture combines optical vector-matrix multiplication, non-volatile PCM synaptic weighting, and local coincidence-driven synaptic adaptation within a multilayer photonic crossbar framework compatible with photonic integrated circuits. Unlike conventional PNNs that rely on externally computed gradients, repeated optical-electrical-optical conversions, or global backpropagation, the proposed framework employs local Hebbian learning governed directly by correlated pre- and post-synaptic optical activity. To investigate the feasibility of the proposed learning mechanism, we implemented the PNN design using fiber-optic components, programmable variable optical attenuators, and real-time software control that incorporates PCM thermal dynamics. Supervised and unsupervised learning behaviors were experimentally evaluated under both offline and online learning conditions using representative image-recognition tasks. The experimental results demonstrate adaptive synaptic evolution, successful optical inference, and autonomous pattern encoding through local Hebbian learning under realistic fiber-optic hardware conditions. These results establish a pathway toward future integrated photonic neuromorphic systems capable of scalable and energy-efficient online Hebbian learning.

20.
arXiv (quant-ph) 2026-06-16

Information Is Not Physical: Possibility Spaces, Erasure, and the Structure of Unrealized Alternatives

arXiv:2606.15120v1 Announce Type: cross Abstract: The slogan ``information is physical,'' introduced by Rolf Landauer and developed through quantum information theory and black-hole thermodynamics, has achieved near-axiomatic status in modern physics. Yet the ontological status of information remains surprisingly underexamined: most discussions either reduce information to a form of energy or treat it as a purely mathematical object. This paper proposes a third position. I argue that information is neither a physical substance nor a free-floating abstraction, but rather the structure of physically realizable alternatives – a counterfactual structure that a physical system instantiates in virtue of the possibility space available to it. Building on Shannon's combinatorial definition, the Landauer principle, the no-cloning theorem, and the black-hole information paradox, I show that the informational content of any physical event is constituted by the set of outcomes that could have occurred but did not. This counterfactual reading dissolves several persistent confusions: it explains why erasing information dissipates heat without making information ``material,'' why quantum superposition is informationally richer than any classical mixture, and why information loss in black holes is physically significant beyond mere bookkeeping. The proposal sits within a structural-realist framework but departs from standard structural realism by locating the relevant structure in modal, not merely actual, relations. I conclude by sketching implications for the foundations of quantum mechanics, quantum gravity, and scientific ontology more broadly.

21.
Science (Express) 2026-06-18

Indium-free perovskite/silicon tandem solar cells with tin oxide recombination layer and electrodes | Science

作者: 未知作者

Indium-based transparent conductive oxides are widely used as electrodes and recombination layers in perovskite/silicon tandem solar cells, yet their scalability is constrained by indium scarcity and sputtering-induced damage. Here we report high efficiency and stable indium-free perovskite/silicon tandem solar cells enabled by reactive plasma deposited tin oxide (RPD-SnO x ). For RPD-SnO x as the recombination layer, a certified efficiency of 33.6% is achieved. Fully indium-free tandems that used RPD-SnO x as both recombination layer and electrodes delivering a champion PCE of 33.2% (1 cm 2 ) and a mini-module with a certified efficiency of 31.0% (207.9 cm 2 ). Dense and uniform self-assembled monolayer anchoring enabled by RPD-SnO x suppressed non-radiative recombination and reduced halide migration. Indium-free mini-modules exhibited high thermal, damp-heat, and outdoor operational stability and retained 65% of their maximum initial efficiency after 105 days of outdoor operation.

22.
medRxiv (Medicine) 2026-06-22

Starting, stopping and restarting. Patterns of Methylphenidate Use over 14 years in a large public health system

Background Persistence with stimulant medication is poor in children and adolescents with ADHD, and the evidence base is derived predominantly from high-income countries. We describe methylphenidate utilisation patterns and predictors of 12-month retention across 14 years in a large South African public health service. Methods Retrospective cohort study using routine pharmacy data from the Western Cape provincial health service (2011-2024). Children aged 5-18 at first prescription were included. Treatment episodes were defined as continuous prescription sequences with no gap exceeding 90 days and classified as initiations or restarts. Logistic regression modelled 12-month retention against early visit frequency and formulation type as pre-specified exposures. Findings 421,925 prescription events for 23,243 children across 115 facilities generated 65,885 treatment episodes. Median age at first prescription was 10 years (IQR 8-12); 77.6% were male. Kaplan-Meier 12-month survival was 28.2% for initiations and 15.4% for restarts, substantially below high-income country comparators. A quarter of all initiating prescriptions were not followed by a subsequent dispensing event; nearly 40% of patients had three or more treatment episodes. Early visit frequency was the strongest predictor of 12-month retention (high vs low: OR 2.85, 95% CI 2.65-3.06). The sustained-release formulation effect was present but attenuated on multivariable adjustment. Treatment re-initiations showed a marked seasonal pattern consistent with the South African school calendar. Interpretation Twelve-month retention was markedly lower than high-income country rates. Against a backdrop of high attrition, both early visit frequency and sustained-release formulation access predicted persistence; clinical engagement and reducing structural barriers to access are modifiable factors in this setting. Funding None.

23.
medRxiv (Medicine) 2026-06-22

Population-Scale, Genotype-First Characterization of Monogenic Diabetes in 374,973 Multi-Ancestry Individuals from the All of Us Research Program

OBJECTIVE To characterize the prevalence and penetrance of maturity-onset diabetes of the young (MODY) in a multi-ancestry population using a genotype-first design. RESEARCH DESIGN AND METHODS We analyzed whole-genome sequencing and clinical data from 374,973 unrelated All of Us participants (42.0% non-European ancestry). We identified pathogenic or likely pathogenic (P/LP) variants in 10 established MODY genes and assessed carrier prevalence, diabetes penetrance, and glycemic profiles. We evaluated age-dependent diabetes risk by comparing carriers with non-carriers stratified by type 2 diabetes polygenic risk score (T2D PRS). RESULTS We identified 370 carriers of P/LP MODY gene variants (0.099%; 1 in 1,013), with similar carrier prevalence among European- and African-ancestry participants (0.105% in both groups). Diabetes penetrance was incomplete (13.4% by age 40; 43.5% by age 60) and varied by etiology: highest for GCK (56.0% by age 60), intermediate for HNF genes (HNF1A/HNF1B/HNF4A; 45.4%), and lowest for non-GCK/HNF genes (ABCC8/INS/KCNJ11/NEUROD1/PDX1/RFX6; 29.0%). In multivariable Cox models using non-carriers in the middle 80% of the T2D PRS as the reference, non-GCK/HNF gene variant carriers had modestly increased diabetes risk (HR, 1.57), similar to non-carriers in the top 10% of T2D PRS (HR, 1.64). These associations were observed in both European- and non-European-ancestry individuals. HbA1c profiles differed by etiology, with stable mild hyperglycemia in GCK variant carriers and greater variability among HNF and non-GCK/HNF gene variant carriers. CONCLUSIONS MODY gene variants showed incomplete, etiology-dependent penetrance across ancestries. Carriers of P/LP variants in lower-penetrance genes had diabetes risk comparable to that of non-carriers with high polygenic susceptibility.

24.
medRxiv (Medicine) 2026-06-11

A global cross-sectional survey of health professionals' interest-confidence gaps in value-based health care implementation: a learning needs assessment

Abstract Objectives Value-Based Health Care (VBHC) increasingly guides health system redesign internationally. Despite the increasing availability of VBHC education, gaps remain between health professionals' conceptual understanding of VBHC and their confidence to implement it in practice. This study assessed perceived learning needs and preferences of healthcare professionals across foundational topics essential to VBHC implementation. Design Cross-sectional online survey study Setting and participants The survey was distributed to the global VBHC community and yielded 518 responses. Most respondents were based in the UK and Ireland (51%) and 65% had more than 10 years of experience in the health sector. Participants represented a variety of professional backgrounds, including clinicians (34%), operational or executive managers and leaders (22%), and life sciences or procurement professionals (13%). Primary and secondary outcome measures Primary outcome measures included self-reported interest and confidence across 15 VBHC domains and the magnitude of the gap between them. Secondary outcomes included perceived implementation challenges and preferred VBHC learning approaches, including prior engagement with VBHC-related learning. Results Respondents identified substantial VBHC implementation challenges, including implementing outcome measurement (62.4%), conflicting priorities (57.7%), and resistance to change (56.8%). Interest in all VBHC domains was high (median >= 80/10), while confidence to implement remained substantially lower across most domains (median