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

Multi-Turn Reasoning When Context Arrives in Pieces: Scalable Sharding and Memory-Augmented RL

When a user reveals task-critical information across several conversation turns, LLM accuracy drops by up to 65% despite full context availability. We show that this Lost in Conversation degradation can be substantially mitigated by training models to maintain a compact rolling memory instead of attending to a growing history. To make such training scalable, we introduce a low-cost sharding pipeline that converts single-turn QA datasets into multi-turn fragmented-information episodes, eliminating the need for hours of manual annotation. Training only on sharded GSM8K, our memory-augmented policy significantly improves multi-turn accuracy and generalises zero-shot to harder math and out-of-domain long-context QA. Moreover, memory-trained models outperform full-history baselines even when given the full history at test time, suggesting that learning to compress induces more robust incremental reasoning than full-context exposure alone.

02.
arXiv (CS.LG) 2026-06-18

Multi-Agent Systems are Mixtures of Experts: Who Becomes an Influencer?

arXiv:2605.25929v2 Announce Type: replace-cross Abstract: The effectiveness of multi-agent LLM deliberation depends not only on the agents' individual predictions, but also on how they communicate and collaborate. We study this mechanism through the lens of Friedkin-Johnsen (FJ) opinion dynamics, a tractable model for analyzing stubbornness, influence, and opinion change in multi-agent systems that captures empirically observed deliberation patterns. We show that the FJ parameters are input-dependent, turning multi-agent deliberation into a mixture of experts. This perspective implies that multi-agent systems can outperform single agents and static ensembles when routing reflects agent competence. Since competence is latent in practice, we analyze how influence is established through observable proxies: agents' self-assessed confidence, their perceived confidence, and initial alignment with other agents' views.

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

ATLAS: Active Theory Learning for Automated Science

arXiv:2606.12386v1 Announce Type: cross Abstract: Advancing scientific understanding through mechanistic modeling requires posing the right experimental questions to yield maximally informative data. To automate this pursuit within cognitive science, we introduce ATLAS (Active Theory Learning for Automated Science), an active learning framework for the data-driven discovery of interpretable behavioral models. ATLAS iterates between generating mechanistic hypotheses–instantiated as a diverse ensemble of sparse neural networks (Disentangled RNNs)–and designing experiments that optimally distinguish between them. We test this approach on the problem of recovering reinforcement learning agents from their behavior in bandit tasks. ATLAS designs varied sequences of qualitatively novel experiments with temporal structure tailored to underlying agent characteristics. The models trained on these experiments are evaluated against a comprehensive set of metrics for mechanistic modeling that capture behavioral, structural, and computational similarity. ATLAS achieves a 5-10x improvement in sample efficiency across all metrics compared to random experimentation, and its performance is further validated against expert-designed experiments derived from literature. These in silico results showcase ATLAS's potential to accelerate human-interpretable insights in cognitive science and other domains where scientific inquiry relies on discovering mechanistic models.

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

An affordable hardware-aware neural architecture search for deploying convolutional neural networks on ultra-low-power computing platforms

arXiv:2606.16290v1 Announce Type: cross Abstract: Hardware-aware neural architecture search (HW-NAS) allows the integration of Convolutional Neural Networks (CNNs) in microcontrollers devices by automatically designing neural architectures that can fit prearranged hardware constraints. However, state-of-the-art HW-NAS target high-performance microcontrollers, whose power consumption does not meet sensing nodes requirements. This work presents a HW-NAS generating tiny CNNs that can run on ultra-low-power microcontrollers, featuring a lightweight search procedure enabling its execution even on embedded devices. Empirical results on three well-known benchmarks for tiny computer vision proved that the proposed HW-NAS was able to generate tiny CNNs while preserving state-of-the-art classification accuracy.

05.
arXiv (CS.CL) 2026-06-19

Disentangling Linguistic Relatedness from Task Alignment in Cross-Lingual Transfer

We study cross-lingual transfer by fine-tuning seven large language models (4B–671B parameters) on Arabic and evaluating zero-shot reading comprehension on Semitic languages and non-Semitic controls. Across dense and Mixture-of-Experts architectures, we find no evidence of Semitic-specific transfer: models with weak baselines improve dramatically across all languages, while strong-baseline models show only marginal gains regardless of language family. A chain-of-thought ablation reinforces this finding – the same models that benefit most from fine-tuning benefit equally from inference-time reasoning, suggesting both mechanisms address task-format alignment rather than cross-lingual knowledge transfer.

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

Benchmarking Large Language Models for Safety Data Extraction

Accurate extraction of structured information from Safety Data Sheets (SDS) remains challenging in industrial safety due to heterogeneous document formats and the limitations of traditional rule-based methods. This study benchmarks state-of-the-art Large Language Models (LLMs) for automated SDS data extraction, comparing text-based and multimodal processing pipelines. We systematically evaluate four models: Gemini 1.5 Pro, GPT-4o, Claude 3.7 Sonnet, and Llama 3.1-70B, across three prompting strategies: zero-shot, few-shot, and chain-of-thought. The evaluation framework assessed accuracy, latency, and cost across more than 50,000 extracted data fields. Results show that text-based extraction consistently outperforms multimodal processing across all metrics. Gemini 1.5 Pro combined with a Chain-of-Thought prompt achieved the highest accuracy (84%), outperforming GPT-4o (81%) and Claude 3.7 Sonnet (79%). However, no model surpassed the 90% accuracy threshold commonly required for reliable real-world deployment. These findings indicate that general-purpose LLMs are not yet robust enough for unsupervised industrial use, though performance suggests strong potential with task-specific fine-tuning. Future research should focus on domain-adapted training, model calibration, and the integration of Human-in-the-Loop verification to ensure safety-critical reliability.

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

Sharp connectivity bounds for the vacant set of random interlacements

arXiv:2504.02777v2 Announce Type: replace Abstract: We consider percolation of the vacant set of random interlacements at intensity $u$ in dimensions three and higher, and derive lower bounds on the truncated two-point function for all values of $u>0$. These bounds are sharp up to principal exponential order for all $u$ in dimension three and all $u \neq u_\ast$ in higher dimensions, where $u_*$ refers to the critical parameter of the model, and they match the upper bounds derived in the article arXiv:2503.14497. In dimension three, our results further imply that the truncated two-point function grows at large distances $x$ at a rate that depends on $x$ only through its Euclidean norm, which offers a glimpse of the expected (Euclidean) invariance of the scaling limit at criticality. The rate function is atypical, it incurs a logarithmic correction and comes with an explicit pre-factor that converges to $0$ as the parameter $u$ approaches the critical point $u_*$ from either side. A particular challenge stems from the combined effects of lack of monotonicity due to the truncation in the super-critical phase, and the precise (rotationally invariant) controls we seek, that measure the effects of a certain "harmonic humpback" function. Among others, their derivation relies on rather fine estimates for hitting probabilities of the random walk in arbitrary direction $e$, which witness this invariance at the discrete level, and preclude straightforward applications of projection arguments.

08.
arXiv (CS.AI) 2026-06-16

Topological Flow Matching

arXiv:2606.15897v1 Announce Type: cross Abstract: Flow matching is a powerful generative modeling framework, valued for its simplicity and strong empirical performance. However, its standard formulation treats signals on structured spaces, such as fMRI data on brain graphs, as points in Euclidean space, overlooking the rich topological features of their domains. To address this, we introduce topological flow matching, a topology-aware generalization of flow matching. We interpret flow matching as a framework for solving a degenerate Schrödinger bridge problem and inject topological information by augmenting the reference process with a Laplacian-derived drift. This principled modification captures the structure of the underlying domain while preserving the desirable properties of flow matching: a stable, simulation-free objective and deterministic sample paths. As a result, our framework serves as a drop-in replacement for standard flow matching. We demonstrate its effectiveness on diverse structured datasets, including brain fMRIs, ocean currents, seismic events, and traffic flows.

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

GPT-Based Fast Simulation of CLAS12 Detector Hits via Conditional Autoregressive Generation

arXiv:2606.16035v1 Announce Type: cross Abstract: Modern particles physics experiments have demonstrated an increasing need for fast, high-fidelity detector simulation as detector components have improved and subsequent computational requirements approach the limits of available resources. Recently, deep generative models have emerged as a promising alternative to traditional Monte-Carlo methods, with recent works drawing inspiration from large language models (LLMs) and self-supervised next-token prediction methods. In this work, we present an application of a GPT-style autoregressive transformer as a fast surrogate model for the calorimeter inside the CLAS12 experiment at the Thomas Jefferson National Accelerator Facility. The model is conditioned on incident momentum and generates realistic detector hits autoregressively across all nine calorimeter layers as sequences of strip, ADC, and TDC tokens. We demonstrate that the model faithfully reproduces hit multiplicity, spatial distributions, energy deposits, and the energy-momentum response of the electromagnetic calorimeter. The generator achieves inference rates exceeding 700 events per second on a single GPU, providing a substantial speedup over traditional Geant4-based simulations while maintaining physics fidelity essential for high-luminosity experimental programs.

10.
medRxiv (Medicine) 2026-06-17

Long-term mortality and cause-specific death after non-cardiac chest pain: a multicentre cohort study of 160,245 patients in China

Abstract Background Non-cardiac chest pain (NCCP) is commonly regarded as a low-risk condition. However, long-term mortality, cause-specific death, and high-risk subgroup characteristics remain poorly defined. Methods In this multicentre registry-linked cohort study, we linked the Chest Pain Center Registry from 101 hospitals in Hunan, China, with the Mortality and Cause of Death Registry. Adults diagnosed with NCCP from Jan 1, 2017, to Dec 31, 2021, were included. We assessed 3-year all-cause, cardiovascular, and non-cardiovascular mortality using Cox, restricted cubic spline, and Fine-Gray models. Findings Among 160,245 patients, 4674 deaths occurred within 3 years (2.9%). Mortality increased sharply after 60.5 years. Age [≥] 60.5 years (adjusted hazard ratio [aHR] 7.49 [95% CI 6.89-8.14]), rural residence (time-varying aHR 1.46 [1.35-1.57] in year 1 and 1.66 [1.46-1.89] in years 1-3), and male sex (aHR 1.47 [1.38-1.57]) independently predicted death. Three-year mortality ranged from 0.3% in younger urban women to 8.4% in older rural men. Cardiovascular diseases accounted for 56.4% of deaths among older patients, whereas other non-cardiovascular causes (22.8%) and malignancy (20.8%) were the largest categories among younger decedents. Interpretation NCCP is not uniformly benign. Age, rural residence, and sex identify patients who could benefit from risk-stratified follow-up, with cardiovascular prevention prioritised for older rural men and broader non-cardiovascular assessment considered for younger patients.

11.
medRxiv (Medicine) 2026-06-18

Factor Analysing Predictive Processing: No Evidence for a General Factor Across Tasks

Background & Hypothesis: Dysfunctional predictive processing (PP), specifically the aberrant weighting of priors, is a frequently-proposed mechanism for psychosis and psychosis-like phenomena (schizotypy). Evidence for this theory mostly originates from single-task studies, which assume that all tasks load onto a single latent construct of PP performance, but the underlying factor structure of PP tasks is unknown. PP deficits in psychosis may be better described by a two-factor, hierarchical model: weakened lower-level (perceptual) priors compensated by higher-level (cognitive) priors. Study Design: This study implements a multi-paradigm approach in healthy participants to investigate latent constructs underlying PP and their relationship to schizotypy. Participants (N = 73) completed 6 tasks measuring reliance on priors across language, memory, visual, and auditory domains. A factor analysis investigated whether performance across tasks is captured by a single or two-factor model. Study Results: Although a two-factor model best described performance, factors reflected within-task correlations rather than a PP hierarchy. Cross-task PP measures were poorly correlated, suggesting that individuals' weighting of priors was task-specific. A full model including all task outcomes (not factors) significantly predicted the severity of schizotypal aberrant beliefs but no other schizotypal measures. Conclusions: These results do not evidence a single factor underpinning PP performance. It is therefore inappropriate to use results from single tasks to propose a generalised PP deficit in psychosis. Variation was also not captured by a two-factor hierarchical model of priors. Further multi-paradigm research is required to evaluate alternative models or additional variables that describe aberrant PP in psychosis.

12.
Nature Medicine 2026-06-11

Microglia at a key inflection point in Alzheimer’s disease

作者: 未知作者

We analyzed brains from octogenarians and cognitively resilient centenarians to understand why some individuals with substantial Alzheimer’s disease pathology develop dementia whereas others remain cognitively intact. Spatial transcriptomics revealed gene expression changes in discrete tissue domains surrounding amyloid plaques and tau pathology that distinguish early, clinically silent, disease from later stages associated with cognitive decline.

13.
arXiv (quant-ph) 2026-06-15

Landscape-Similarity-Guided Optimization in Divide-and-Conquer QAOA

arXiv:2602.21689v3 Announce Type: replace Abstract: Divide-and-conquer strategies mitigate hardware constraints for the Quantum Approximate Optimization Algorithm (QAOA) on Noisy Intermediate-Scale Quantum (NISQ) devices by partitioning large interaction graphs into smaller, hardware-compatible sub-problems. However, this approach introduces a severe classical training bottleneck: a decomposition across $m$ boundary nodes generates $2^m$ distinct sub-problems that typically require independent optimization. In this work, we demonstrate that across diverse synthetic and real-world interaction graphs, the variational landscapes of these reduced QAOA instances actually exhibit a robust universality. Adapting the replica-overlap framework of spin-glass physics, we define a landscape-overlap order parameter $q$ to quantify geometric correlations between energy landscapes, revealing a sharp landscape-similarity transition as graph connectivity is tuned. Exploiting this, we introduce Doubly Optimized QAOA (DO-QAOA), an adaptive pipeline that collapses the sub-problems from $2^m$ distinct sub-problems into $K=\mathcal{O}(1)$ effective landscape classes. By performing optimization on a single representative sub-problem and dynamically transferring parameters to remaining sub-problems, DO-QAOA lowers runtime and quantum measurement overhead by orders of magnitude while maintaining a competitive Approximation Ratio Gap (ARG).

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

Large Language Model Agents Are Not Always Faithful Self-Evolvers

Self-evolving large language model (LLM) agents continually improve by accumulating and reusing past experience, yet it remains unclear whether they faithfully rely on that experience to guide their behavior. We present the first systematic investigation of experience faithfulness, the causal dependence of an agent's decisions on the experience it is given, in self-evolving LLM agents. Using controlled causal interventions on both raw and condensed forms of experience, we comprehensively evaluate four representative frameworks across 13 LLM backbones and 9 environments. Our analysis uncovers a striking asymmetry: while agents consistently depend on raw experience, they often disregard or misinterpret condensed experience, even when it is the only experience provided. This gap persists across single- and multi-agent configurations and across backbone scales. We trace its underlying causes to three factors: the semantic limitations of condensed content, internal processing biases that suppress experience, and task regimes where pretrained priors already suffice. These findings challenge prevailing assumptions about self-evolving methods and underscore the need for more faithful and reliable approaches to experience integration.

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

Tungsten Germanide Superconducting Nanowire Single-Photon Detectors with Saturated Internal Detection Efficiency at Wavelengths up to 29 {\mu}m

arXiv:2511.20868v2 Announce Type: replace-cross Abstract: Superconducting nanowire single-photon detectors (SNSPDs) are among the most sensitive single-photon detectors available and have the potential to transform fields ranging from infrared astrophysics to molecular spectroscopy. However, extending their performance into the mid-infrared spectral region - crucial for applications such as exoplanet transit spectroscopy and vibrational fingerprinting of molecules - has remained a major challenge, primarily due to material limitations and scalability constraints. Here, we report on the development of SNSPDs based on tungsten germanide, a novel material system that combines high mid-infrared sensitivity with compatibility for large-scale fabrication. Our detectors exhibit saturated internal detection efficiency at wavelengths up to 29 {\mu}m, while using 2.7x thicker films (8 nm vs 3 nm) and up to 4.5x wider nanowires (360 nm vs 80 nm) compared to mid-infrared-optimized SNSPDs fabricated from tungsten silicide. This advance will enable scalable, high-performance single-photon detection in a spectral region that was previously inaccessible, opening new frontiers in remote sensing, thermal imaging, environmental monitoring, molecular physics, and astronomy.

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

Allure of Craquelure: A Variational-Generative Approach to Crack Detection in Paintings

Recent advances in imaging technologies, deep learning and numerical performance have enabled non-invasive detailed analysis of artworks, supporting their documentation and conservation. In particular, automated detection of craquelure in digitized paintings is crucial for assessing degradation and guiding restoration, yet remains challenging due to the possibly complex scenery and the visual similarity between cracks and crack-like artistic features such as brush strokes or hair. We propose a hybrid approach that models crack detection as an inverse problem, decomposing an observed image into a crack-free painting and a crack component. A deep generative model is employed as powerful prior for the underlying artwork, while crack structures are captured using a Mumford–Shah-type variational functional together with a crack prior. Joint optimization yields a pixel-level map of crack localizations in the painting.

18.
bioRxiv (Bioinfo) 2026-06-12

A Graph-based QSAR Modeling Pipeline for Predicting In vitro PubChem Assays and In vivo Human Hepatotoxicity: Mechanistic Analysis of Caspase-3/7 Activation

Background: Caspase-3 and -7 are key effector caspases in the apoptotic pathway, a form of programmed cell death, and their activities serve as a well-established biomarker for evaluating environmental chemical toxicity and informing chemical risk assessment. Loss of mitochondrial membrane potential is a key event in the activation of Caspase-3/7 signaling and the subsequent induction of apoptosis. Therefore, simultaneous assessment of mitochondrial membrane potential and Caspase-3/7 activity enables elucidation of the mechanisms and pathways through which apoptosis is initiated. Rapid and accurate assessment of the potential toxicity of environmental chemicals and drugs remains a major challenge. Quantitative Structure Activity Relationship (QSAR) modeling have been widely used for toxicity prediction. Graph-based approaches encode compounds directly as molecular graphs, allowing structure-activity relationships to be learnt from molecular topology without the information loss in binary fingerprints. While advanced graph models such as graph transformers (GTs) have shown outstanding performance in many domains, they have not been fully leveraged in QSAR modeling on Caspase and mitochondrial toxicity. Methods: We propose a QSAR modeling pipeline that encompasses assay data preprocessing, feature representations (fingerprints and molecular graphs), and benchmarking machine learning (ML) models, including classic ML models, graph neural networks (GNNs), GTs, and their consensus ensembles. Based on in vitro Caspase and mitochondrial assays in PubChem, we applied the pipeline to predict Caspase-3/7 activation and mitochondrial membrane potential (MMP). Beyond in vitro assays, we also built in vivo QSAR modeling for FDA Drug-Induced Liver Injury (DILI) gold standard on human hepatotoxicity. Moreover, mechanistic analysis on Caspase-3/7 activation was conducted by comparing with MMP disruption to identify chemical substructures that may be responsible for dual activations. We also investigated cell-line-specific responses by identifying structural motifs that selectively induce Caspase-3/7 activation in individual cell lines.Results:Experimental evaluations show that GTs and GNNs outperformed classic ML models when the number of active compounds is large, such as MMP disruption, while classic ML models and GTs performed good for highly imbalance data with limited active compounds, such as Caspase-3/7 activation. For DILI prediction, the full consensus model achieved the highest AUC 0.69 and Graphormer had the highest F1 score 0.79, both surpassing the previous best model with AUC 0.63 and F1 0.65 with a large margin.Our mechanistic analysis shows that phenolic compounds bearing a para-hydroxyphenyl motif, as well as members of the lipophilic chain family with long alkyl chains can trigger the collapse of MMP, leading to the activation of caspases-3 and -7. Human embryonic kidney (HEK293) was the only cell line with a distinct structural motif: 1,1-dichloroethane and chlorobenzene. Human neuroblastoma (SK-N-SH) is uniquely impacted by an epoxide fragment and rat hepatoma (H-4-II-E) is uniquely impacted by a tetramethylcyclohexene motif and an acetaldehyde fragment.Conclusions:The proposed pipeline for QSAR modeling, including data preprocessing, feature representations, and incorporation of advanced graph ML approaches, is highly effective in predicting not only on Caspase-3/7 activation and membrane potential collapse, but also on FDA DILI human hetatotoxicity. As future research directions, we will leverage extra information, e.g., biological activity and findings in existing toxicity literature, and recent advances in large language models and agentic AI to further improve the predictive performance and enable a sensitive and specific framework for assessing human hepatotoxicity of environmental compounds.

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

TeleMorpher: Toward Robust Simultaneous Motion-Location Editing

arXiv:2606.19676v1 Announce Type: cross Abstract: Diffusion models have achieved remarkable success in image and video generation and editing. While recent studies have extended these efforts toward motion editing, simultaneously transforming both motion and location-despite its practical importance-remains largely unexplored. To better understand robust motion-location editing, we first analyze the fundamental factors that degrade its quality. Based on this analysis, we propose TeleMorpher, one of the first one-shot frameworks to the best of our knowledge, for simultaneous motion-location editing. Our approach leverages motion priors, a target motion-centric video generated from an off-the-shelf model as motion-editing guidance, and the ground truth motion to enable more controllable and precise motion-location editing. Via this, our framework works as follows: (1) we first disentangle the protagonist and the background via pre-trained segmentation and inpainting models. (2) Then, we introduce a training-free pose warping that edits the protagonist's motion with the motion prior as the guidance. (3) The result of warped motion video is directly injected into a baseline motion editor during inference, mitigating the difference between source and target motions while preserving the appearance of the source video. (4) To enhance the reliability of quantitative evaluations, we propose two new LPIPS-based metrics that measure the background consistency before and after the motion editing and the fidelity of motion editing performance via measuring the difference between the extracted protagonist's skeletons from source and target videos. Experiments with in-the-wild videos and the TaiChi dataset demonstrate that TeleMorpher achieves superior performance across both quantitative and qualitative measurements (real-human evaluation), underscoring its effectiveness.

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

Exact Posterior Score Estimation for Solving Linear Inverse Problems

Diffusion and flow-based models learn powerful data priors by training a denoiser to reverse Gaussian corruption. To use this prior to solve a linear inverse problem, one needs to sample from the posterior, but the score that the prior provides is the unconditional score, not the posterior score. Existing methods either steer a fixed pretrained denoiser with approximate measurement-matching corrections, or train a conditional restoration model that abandons the denoising structure of the prior. We derive the exact posterior score in closed form for linear Gaussian inverse problems under general Gaussian interpolants, and show that posterior sampling reduces to a denoising problem at an operator-dependent shifted pivot under an anisotropic noise covariance. We turn this identity into Exact Posterior Score (EPS), a denoising training objective that preserves the input/output structure of standard pretraining and can therefore be trained from scratch or fine-tuned from a pretrained denoiser. At inference, EPS uses the same sampler as the underlying backbone, with no likelihood gradients or projections. We evaluate EPS on five linear inverse problems across FFHQ and ImageNet, where it outperforms training-free and training-based baselines on fidelity, perceptual, and distributional metrics, while using roughly an order of magnitude fewer denoiser evaluations than gradient-based posterior samplers.

21.
arXiv (CS.CV) 2026-06-19

Cinematic Compositing Using Character-Environment-Harmonized Video Generation Models

Cinematic compositing aims to integrate green-screen characters into novel environments while maintaining physical and photometric realism. Previous methods often fail to capture the complex bidirectional interactions between characters and their surroundings, which we characterize as Character-to-Environment (C2E) physical interaction and Environment-to-Character (E2C) lighting harmonization. To address this, we propose an end-to-end video diffusion framework that jointly models C2E and E2C interactions, specifically handling the challenges of interactive props. Our approach introduces a tri-mask-guided architecture with RGB-D joint denoising to ensure physically consistent interactions among the character, props, and environment. We further develop an efficient prior-driven data curation pipeline to construct high-quality relighting pairs without expensive rendering. Finally, a reference-conditioned mechanism enables controllable environment synthesis and precise prop replacement. Extensive experiments demonstrate that our framework significantly outperforms existing methods in cinematic-quality dynamic video compositing.

22.
medRxiv (Medicine) 2026-06-22

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

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.

23.
medRxiv (Medicine) 2026-06-16

MRMU: A New Paradigm for Mendelian Randomization by Accounting for Measured Covariates and Unmeasured Confounders

Mendelian randomization (MR) is a powerful approach for causal inference, however, its reliability is frequently compromised by unadjusted covariates and unmeasured confounders, such as unmeasured pleiotropy and sample structure. To address these challenges, we introduce MRMU, a novel paradigm for the MR framework. Unlike traditional single-variable or multivariable MR methods, MRMU selects instrumental variables only from the exposure of interest and estimates one exposure effect at a time, while jointly accounting for measured covariates and unmeasured confounders. This design improves the reliability of MR analyses. In simulations and real data, MRMU achieved better type I error control, higher statistical power, and more accurate effect estimation than existing MR methods. Applying to coronary artery disease (CAD), MRMU identified robust cardiometabolic risk factors, including LDL-C, APOB, systolic blood pressure, body mass index, and smoking initiation, with consistent evidence across multiple CAD datasets. In contrast, traits such as HDL-C, height, and educational attainment, which were found to be significant by existing MR methods, were no longer supported by MRMU. MRMU further supported blood pressure-related traits, rather than lipid traits, as the more relevant pathway linking urate to CAD. Finally, by integrating large-scale plasma proteomics data, MRMU identified candidate CAD drug targets beyond established HMGCR- and PCSK9-related pathways, highlighting its utility for therapeutic target prioritization.

24.
medRxiv (Medicine) 2026-06-16

Risk beliefs, intensive digital information and demand for a new preventative health product in public clinics: Evidence from an experiment in Zimbabwe.

Demand for preventative health care is weak in low-income settings. In a field experiment in a low-income, high-risk setting, we evaluated whether demand for a new bio-medical preventative health product, offered free at public health clinics, responds to digital feedback-based intensive information on health risks and benefits of prevention along with a clinic referral enabling access to the product. In our sample of women aged 18-24 years, we find a large correction in risk beliefs sustained six months after the intervention. Against a background of very low baseline usage, within six months we find a 5.8 percentage point increase in take up of the prevention method, a level of uptake which is very large relative to the control group. Reassuringly, there is no meaningful difference in up-take amongst baseline high- risk and low-risk individuals.

25.
medRxiv (Medicine) 2026-06-22

A Parent-Generated Framework of Early Connection: Findings from a CBPR Qualitative Study

Background: Early relational health (ERH) constructs are derived fromresearch observations rather than lived experiences. This study foregrounds diverse parent voices to examine how they describeconnectionwith their young children. Methods: Usingcommunity-based participatory research (CBPR),this study was co-designed withparent leadersfromReach Out and Read. A semi-structured interview guidewas co-designed,and parent leaderssubsequentlyconducted and transcribed 18 interviews with parents from their networks.Researchersanalyzed transcripts using Reflexive Thematic Analysis.Member checking sessions with parent leadersinformedthe analytic framework. Results:Sixorganizing principleswereidentified.(1) Parent-child connection begins with an instinctual sense of responsibility.(2)Connectionebbs and flows as parent and child adapt to one another through dailyactivities.(3) Family circumstances, including family structure, cultural expectations, and intergenerational values, directly shape this connection. (4) Parents' own upbringings and past relationships indirectly shape how they connect with their child. (5) Forconnectionto grow, parents must show up physically and emotionally for their children despite competing demands. (6) Parentsgrow through engaged parenting, and that growth feeds back into the connection, creating a self-sustaining cycle of relational health.Conclusions:Our analysis generated twoconstructs underspecified in ERH frameworks.Parents described their sense of responsibility as immediate and instinctual, preceding an emotional bond.Parentsdemonstratedtheir agency in deciding what to carry forward from their relational histories, a pattern this study termsrelational legacy. Integrating parent-generated language into ERH measurementresearchmay shape a more comprehensive picture of ERHreflectinghow families experience connection.