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01.
arXiv (CS.CV) 2026-06-11

Parameter-Efficient Adapter Tuning for Tabular-Image Multimodal Learning

作者:

Tabular-image multimodal learning aims to improve predictive modeling by jointly using structured tabular attributes and visual data. Although pretrained encoders provide strong modality-specific representations, full fine-tuning can be computationally expensive, while keeping encoders frozen may limit task-specific adaptation. We propose the Tabular-Image Adapter (TI-Adapter), a modality-specific adapter-based fine-tuning framework for efficient multimodal adaptation. TI-Adapter freezes the pretrained tabular encoder and learns an adapter after the extracted tabular embedding, while adapting the image branch with embedding-level and bottleneck-level adapters instead of full fine-tuning. Experiments on 20 tabular-image datasets show that TI-Adapter achieves competitive or better predictive performance than full fine-tuning while using substantially fewer trainable parameters. Ablation studies further demonstrate the importance of adapter placement for balancing performance and practical efficiency.

02.
arXiv (CS.AI) 2026-06-15

AI Receptivity or AI Adoption Breadth? A Tool-Specific Reanalysis of the Lower-Literacy/Higher-Usage Link

arXiv:2606.13734v1 Announce Type: new Abstract: Recent evidence reported by Tully, Longoni, and Appel (2025) suggests that lower artificial intelligence (AI) literacy predicts greater receptivity toward AI. We revisit this claim using the public data from Study 3 of that article, which measures past usage of five AI tool categories on a five-point frequency scale. We first reproduce the negative association between AI literacy and aggregate AI usage using OLS on participant-level averages, binary logit, ordered logit, and multinomial logit specifications. We then show that the aggregate relationship masks substantial heterogeneity by tool type. In our demographic-adjusted primary specification, AI literacy does not significantly predict text AI usage (ordered-logit $\beta$ = -0.090, p = .387), whereas it remains a strong predictor of non-text AI adoption ($\beta$ = -0.377, p < .001). The non-text effect is also robust under Tully et al.'s original Study 3 control specification ($\beta$ = -0.502, p < .001). Binary, ordered-logit, and multinomial specifications suggest that the non-text relationship is primarily an adoption/non-adoption pattern rather than evidence of intensive use: the demographic-adjusted odds ratio of ever having used a non-text AI tool is 0.68. Thus, in the study that measures self-reported past usage rather than stated preferences, the evidence does not support a simple claim that lower AI literacy predicts greater receptivity to AI in general. It points instead to a narrower pattern of broader adoption across lower-penetration, non-text AI tools.

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

Understanding, Detecting, and Repairing Real-World In-Context-Learning-Based Text-to-SQL Errors

Large language models (LLMs) have been adopted for text-to-SQL tasks, utilizing their in-context learning (ICL) capability to translate natural language questions into SQL queries. However, such a technique faces correctness problems. In this paper, we conduct the first comprehensive study of text-to-SQL errors of ICL-based techniques. Our study covers four representative ICL-based techniques, five basic repairing methods, two benchmarks, and two LLM settings. We find that text-to-SQL errors are widespread and summarize 27 error types of 7 categories. We also find that existing repairing attempts have limited correctness improvement while having high computational overhead and many mis-repairs. Based on these findings, we propose MapleDoctor, a novel text-to-SQL error detection and repairing framework. The evaluation demonstrates that MapleDoctor outperforms existing solutions by repairing 13.8% more queries with a negligible number of mis-repairs and reducing 67.4% repair latency. The artifact is publicly available at GitHub.

04.
arXiv (CS.CL) 2026-06-17

ZeroSyl: Simple Zero-Resource Syllable Tokenization for Spoken Language Modeling

Pure speech language models aim to learn language directly from raw audio without textual resources. A key challenge is that discrete tokens from self-supervised speech encoders result in excessively long sequences, motivating recent work on syllable-like units. However, methods like Sylber and SyllableLM rely on intricate multi-stage training pipelines. We propose ZeroSyl, a simple training-free method to extract syllable boundaries and embeddings directly from a frozen WavLM model. Using L2 norms of features in WavLM's intermediate layers, ZeroSyl achieves competitive syllable segmentation performance. The resulting segments are mean-pooled, discretized using K-means, and used to train a language model. ZeroSyl outperforms prior syllabic tokenizers across lexical, syntactic, and narrative benchmarks. Scaling experiments show that while finer-grained units are beneficial for lexical tasks, our discovered syllabic units exhibit better scaling behavior for syntactic modeling.

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

LakeFM: Toward a Foundation Model for Aquatic Ecosystems Using Irregular Multivariate Multi-depth Time Series Data

arXiv:2606.11268v1 Announce Type: new Abstract: Understanding and forecasting lake dynamics is critical for monitoring water quality and ecosystem health across lakes and reservoirs. While machine learning methods have been recently applied to ecological time-series data, existing works assume regular sampling in time and depth, and struggle to generalize across lakes with heterogeneous variables, depths, and observation patterns. To address these limitations, we introduce \textsc{LakeFM}, a foundation model for aquatic systems, pre-trained on large-scale ecological datasets comprising both simulated and observed lakes. Through extensive empirical evaluation, we show that \textsc{LakeFM} learns meaningful representations spanning broader lake-level characteristics, and achieves competitive or often superior-forecasting performance compared to existing time-series foundation and non-foundation models, while producing physically plausible predictions consistent with real-world lake dynamics.

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

ResAware: Cross-Environment Website Fingerprinting via Resource-Privileged Distillation

arXiv:2606.17462v1 Announce Type: new Abstract: While Website Fingerprinting (WF) attacks achieve high accuracy in controlled laboratory settings, they often degrade substantially in real-world environments due to spatio-temporal drift, browser heterogeneity, proxy obfuscation and etc. This limitation stems from their sole reliance on low-level traffic features that are noisy and highly sensitive to environmental perturbations. To address this problem, we propose ResAware, a cross-environment resource-aware distillation framework under a training-rich/inference-poor asymmetric setting. Specifically, ResAware trains a teacher model on resource-level features, and then distills the resulting privileged knowledge into a student model through heterogeneous knowledge distillation. At deployment time, the student model performs inference using only encrypted traffic, incurring zero additional cost. We evaluate ResAware on a large-scale dataset collected over five months from six globally distributed vantage points, comprising more than $160{,}000$ paired samples. The results show that ResAware significantly enhances the cross-environment robustness of diverse WF baselines. Under a 150-day temporal drift, for example, ResAware improves the F1-score of Var-CNN from $72.77\%$ to $81.49\%$ and the open-world $TPR@1\%FPR$ from $22.40\%$ to $27.20\%$. Our results demonstrate that resource-level supervision improves WF robustness without expanding online observation capabilities.

07.
arXiv (CS.AI) 2026-06-19

Secure Coding Drift in LLM-Assisted Post-Quantum Cryptography Development: A Gamified Fix

arXiv:2606.19474v1 Announce Type: cross Abstract: The transition to Post Quantum Cryptography (PQC) introduces considerable implementation complexity, requiring strict adherence to constant-time execution, side channel resistance, and precise parametrisation. Simultaneously, large language models (LLMs) are heavily embedded in software development workflows, including cryptographic engineering. While LLMs improve productivity, evidence shows that they frequently generate insecure or suboptimal code, particularly in security critical domains. This paper introduces Secure Coding Drift in PQC, a novel socio technical vulnerability model capturing the gradual degradation of secure coding practices due to sustained reliance on LLM-generated code. Unlike prior work that focuses on static vulnerabilities, we conceptualise security risk as a longitudinal behavioural phenomenon rising from human AI interaction. To mitigate this, we propose a gamified, LLM augmented secure coding framework that embeds adversarial evaluation, behavioural feedback, and security scoring into development workflows. Our approach reframes LLMs from passive assistants into active security co-pilots, contributing toward safer PQC implementation in AI mediated environments.

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

Pretraining A Large Language Model using Distributed GPUs: A Memory-Efficient Decentralized Paradigm

Pretraining large language models (LLMs) typically requires centralized clusters with thousands of high-memory GPUs (e.g., H100/A100). Recent decentralized training methods reduce communication overhead by employing federated optimization; however, they still need to train the entire model on each node, remaining constrained by GPU memory limitations. In this work, we propose SParse Expert Synchronization (SPES), a memory-efficient decentralized framework for pretraining mixture-of-experts (MoE) LLMs. SPES trains only a subset of experts per node, substantially lowering the memory footprint. Each node updates its local experts and periodically synchronizes with other nodes, eliminating full-parameter transmission while ensuring efficient knowledge sharing. To mitigate limited per-expert data utilization under sparse expert updates, we introduce an expert-merging warm-up strategy, where experts exchange knowledge early in training, to rapidly establish foundational capabilities. With SPES, we train a 2B-parameter MoE LLM using 16 standalone 48GB GPUs over internet connections, which achieves competitive performance with centrally trained LLMs under similar computational budgets. We further demonstrate scalability by training a 7B model from scratch and a 9B model upcycled from a dense checkpoint, both of which match prior centralized baselines. Our code is available at https://github.com/zjr2000/SPES.

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

Machine Learning for Biomedical Raman Spectroscopy: From Spectral Acquisition to Clinical Translation

arXiv:2606.14169v1 Announce Type: new Abstract: Raman spectroscopy provides label-free, chemically specific characterization of biological systems and has become an important tool for cancer diagnosis, molecular subtyping, microbiological identification, and intraoperative decision support. Biomedical Raman spectra are, however, high-dimensional, noisy, and affected by fluorescence background, acquisition variability, and biological heterogeneity, making robust computational analysis essential. This review examines the role of machine learning across the biomedical Raman spectroscopy pipeline, from preprocessing and signal correction to unsupervised structure discovery, supervised diagnosis and molecular stratification, representation and transfer learning, explainability, biomarker discovery, and multimodal integration with imaging, pathology, and molecular profiling. Emphasis is placed on the use of machine learning not only for diagnostic classification, but also for biologically interpretable and clinically actionable analysis. We also discuss the main barriers to clinical translation, including limited dataset sizes, inter-instrument variability, inconsistent preprocessing, insufficient external validation, reproducibility concerns, and limited sharing of software, data, and metadata. We argue that progress will require methodological advances together with standardization, robust validation, explainability, and deployment-ready analytical frameworks. By integrating methodological, biomedical, and translational perspectives, this review outlines key directions for developing reliable and clinically deployable Raman-AI systems.

10.
arXiv (CS.LG) 2026-06-11

Finding Multiple Interpretations in Datasets

arXiv:2606.12277v1 Announce Type: new Abstract: In this paper, we propose an approach to finding sets of similar-performing models (in terms of loss/accuracy measurements) with highly different context-aware characteristics. Through experiments on the METABRIC dataset, we show that the proposed method finds multiple models with highly different gene expressions than those found by the control methodology without performance penalties. We argue that the proposed methodology is important whenever one aims to analyze any global characteristic of a model to extract insight into the underlying phenomenon being studied.

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

Trusted Multi-View Deep Learning Classification of Fetal Congenital Heart Disease with Feature-level and Decision-level Fusion

Congenital heart disease (CHD) refers to the abnormal anatomical structure caused by the abnormal development of the heart and great vessels during embryonic development. Traditional diagnostics often fail to achieve high accuracy and efficiency, especially given the complexity of cardiac anatomy. This study presents a specialized multi-view deep learning framework for CHD binary classification using echocardiographic images. A large-scale CHD dataset, including five views, was used to train the model, enabling it to integrate multi-angle image data. The framework utilizes advanced feature extraction and attention mechanisms to improve diagnostic precision and reliability. An uncertainty-based decision-making component is also integrated to handle low-quality images, enhancing diagnostic outcomes. Experimental results show that this method achieves top-tier performance on our dataset and provides a robust tool for early CHD detection, underscoring its potential for clinical use. The dataset and source code will be released upon paper acceptance.

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

Bridging Functional Correctness and Runtime Efficiency Gaps in LLM-Based Code Translation

While large language models (LLMs) have greatly advanced the functional correctness of automated code translation systems, the runtime efficiency of translated programs has received comparatively little attention. With the waning of Moore's law, runtime efficiency has become increasingly important for program quality, alongside functional correctness. Our preliminary study reveals that LLM-translated programs often run slower than human-written ones, and this issue cannot be remedied through prompt engineering alone. Therefore, our work proposes SwiftTrans, a code translation framework comprising two key stages: (1) Multi-Perspective Exploration, where MpTranslator leverages parallel in-context learning (ICL) to generate diverse translation candidates; and (2) Difference-Aware Selection, where DiffSelector identifies the optimal candidate by explicitly comparing differences between translations. We further introduce Hierarchical Guidance for MpTranslator and Ordinal Guidance for DiffSelector, enabling LLMs to better adapt to these two core components. To support the evaluation of runtime efficiency in translated programs, we extend existing benchmarks, CodeNet and F2SBench, and introduce a new benchmark, SwiftBench. Experimental results across all three benchmarks show that SwiftTrans achieves consistent improvements in both correctness and runtime efficiency.

13.
arXiv (CS.AI) 2026-06-15

History of the Muddy Children Puzzle

arXiv:2606.13703v1 Announce Type: new Abstract: The Muddy Children Puzzle is a puzzle about knowledge and ignorance that has been inspiring for the development of epistemic logic. Who came up with it first? This is unclear. We trace the origin of the Muddy Children Puzzle through logical and literary publications over the past two centuries. The puzzle inspired a numerous variations such as involving numbers or coloured hats. We also present a novel hats puzzle involving self-reference.

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

Thinking Outside the [Chat]Box: Bridging Computer Science and Industrial Design for Cognitive-Inclusive Generative AI

arXiv:2606.14306v1 Announce Type: cross Abstract: Current Generative AI (GenAI) interfaces remain largely constrained to chatbox interaction, which can impose high cognitive demands on users and create substantial barriers for people with intellectual disabilities (ID), including prompt formulation difficulties, response overload, and limited mechanisms to assess information reliability. To explore alternative interaction models for cognitive accessibility, we conducted a cross-disciplinary co-design challenge in which two student cohorts (Computer Science and Industrial Design) developed interface concepts from the same set of functional requirements (e.g., prompt scaffolding, structured output, GUI-based refinement, transparency, and personalization). Comparing the resulting proposals reveals both convergence on foundational requirements (notably initial calibration, proactive prompting, and direct manipulation of response fragments) and complementary contributions that outline a multi-layered support system. Computer Science teams primarily produced structural scaffolding, emphasizing predictability, navigability, and trust through mechanisms such as reliability indicators, explicit sources, and context management for long conversations. Industrial Design teams emphasized experiential scaffolding, focusing on pacing, attention guidance, multimodality, and proactive agency, including step-by-step response flows, focus modes, and assistant-like integrations. We synthesize these findings into a dual-layer scaffolding framework that expands the design space for cognitively accessible GenAI interaction beyond chat-centric models and motivates future work on expert refinement, technical feasibility, and empirical validation with users with ID.

15.
arXiv (CS.CL) 2026-06-19

Code-Switching Reveals Language Anchoring in Multilingual LLMs

Multilingual Large Language Models (MLLMs) are increasingly expected to handle Code-Switched (CS) inputs, yet mixing languages frequently degrades performance relative to source- or target-language monolingual counterparts. To understand this degradation, we use grammar-forced CS as a controlled diagnostic setting for locating CS representations relative to their source and target counterparts. We introduce Anchor Bias, a geometric measure that quantifies language anchoring, whether a CS hidden state aligns closer to its source or target language counterpart. Across diverse MLLMs, Anchor Bias reveals a consistent grammar-frame effect: source-framed CS stays source-anchored, whereas target-framed CS shifts target-ward and shows larger Question Answering (QA) degradation. Motivated by this representational pattern, we propose CANVAS (Contextual Anchor-based Neural Vector Alignment Steering), an inference-time intervention that extracts a source-side canvas from the input and softly steers target-language hidden states toward the source anchor during prefill. CANVAS consistently recovers QA F1 across MLLMs and CS conditions, showing that internal anchoring signals provide an actionable target for mitigating CS inference failures.

16.
arXiv (quant-ph) 2026-06-17

Probes of chaos over the Clifford group and approach to Haar values

arXiv:2603.29695v3 Announce Type: replace Abstract: Chaotic behavior of quantum systems can be characterized by the adherence of the expectation values of given probes to moments of the Haar distribution. In this work, we analyze the behavior of several probes of chaos using a technique known as Isospectral Twirling [1]. This consists in fixing the spectrum of the Hamiltonian and picking its eigenvectors at random. Here, we study the transition from stabilizer bases to random bases according to the Haar measure by T-doped random quantum circuits. We then compute the average value of the probes over ensembles of random spectra from Random Matrix Theory, the Gaussian Diagonal Ensemble and the Gaussian Unitary Ensemble, associated with non-chaotic and chaotic behavior respectively. We also study the behavior of such probes over the Toric Code Hamiltonian.

17.
arXiv (quant-ph) 2026-06-16

Complete Relational Description of Spin in a Quantum Background

arXiv:2606.15873v1 Announce Type: new Abstract: The standard description of the state of a spin in quantum mechanics presupposes externally fixed directions – a classical background. Can a spin be fully described instead in relation to other quantum mechanical systems? Poulin suggested twenty years ago group averaging over rotations the joint state of a fundamental spin and a reference spin with large angular momentum which, however, yields a classical bit in a probabilistic mixture. We revisit this idea and show that when the quantum reference system is augmented to two large spins, the standard quantum mechanical description of a spin is recovered in the limit of large quantum numbers for the reference system.

18.
arXiv (CS.CV) 2026-06-17

Attention Alignment Between Humans and Vision-Language Models

Visual perception depends on top-down goals and bottom-up sensory mechanisms. Vision-language models implement both, allowing us to treat each component as a separable hypothesis about what drives where we look. We compared spatial attention maps from six vision-language models against human fixation heatmaps recorded on 200 images during two tasks (general description and social captioning). The six models spanned a 2$\times$2 factorial of CNN vs.\ ViT encoders crossed with LSTM vs.\ Transformer decoders, plus Molmo 7B-D and Qwen3.5 9B. We found that both decoder and encoder architecture shaped alignment, but decoder choice dominated. LSTM vs.\ Transformer decoders increased alignment by 40–50 percentage points (80–87\% vs.\ 40–59\% of the human noise ceiling). In contrast, CNN vs.\ ViT encoders contributed a secondary 5–20 point advantage depending on decoder family, with CNN-LSTM the most aligned model overall (85–87\%). Despite their alignment advantage, LSTM-decoder attention maps were spatially diffuse and minimally task-differentiated; ViT-Transformer, the weakest in alignment, showed the sharpest spatial concentration and strongest task differentiation. A hemispatial-neglect simulation confirmed that ablating attention impacted LSTM decoders more than Transformer decoders. In an exploratory extension using TRIBE-simulated synthetic neural responses, fixation alignment and neural relevance dissociate: CNN-Transformer attention maps better predicted synthetic brain activity despite lower fixation alignment, with attention maps best predicting early visual cortex. Together, top-down and bottom-up components trade off what they predict in behavioral and synthetic neural data.

19.
arXiv (CS.CV) 2026-06-16

CheXGenBench: A Unified Benchmark For Fidelity, Privacy and Utility of Synthetic Chest Radiographs

Structured benchmarks have advanced text-conditional image generation for real-world imagery, however, no such benchmark exists for synthetic radiograph generation. Despite being a highly active area of research, existing studies continue adopting inconsistent evaluation protocols and lack a unified assessment of the three most critical criteria: generative fidelity, privacy risk, and downstream utility. To address these limitations, we introduce CheXGenBench, the first unified evaluation framework for synthetic chest radiograph generation that simultaneously assesses fidelity, privacy risks, and downstream utility across frontier text-to-image (T2I) generative models. Our evaluation protocol, comprising over 20 quantitative metrics, covers 11 leading T2I architectures with plug-and-play integration for newer models. Through a rigorous and fair evaluation protocol, we establish comprehensive baseline state-of-the-art (SoTA) performances across all dimensions to guide future research. Furthermore, our results uncover several limitations of current generative models, which include first, even SoTA models struggle with long-tailed medical distributions; second, models pose high privacy risks regardless of fidelity quality; and third, while synthetic data already benefits downstream classification, it is of limited utility for downstream multimodal tasks. Drawing from these results, we propose concrete research directions to advance the field. The code is available at https://github.com/Raman1121/CheXGenBench

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

How Far Can Machine Translation Quality Take You? Extrinsic Discourse Evaluation in Goal-Oriented Setups

Existing machine translation (MT) metrics and discourse-focused evaluations primarily assess translation quality intrinsically, without measuring the downstream consequences of translation errors. In this work, we focus on extrinsic discourse evaluation of machine translation under two distinct regimes: static and interactive. Under the static regime, we propose an entity counting task as a probe of referential consistency in discourse. We show that high intrinsic MT quality does not reliably predict downstream discourse success and strong MT systems still produce referential inconsistencies. For the interactive regime, we study the goal-oriented multi-agent Welfare Diplomacy game as a probe of long-horizon communication and coordination. We find that interaction-specific translation failures impact downstream coordination. Our results highlight goal-oriented environments as a viable framework for discourse-sensitive extrinsic MT evaluation.

21.
arXiv (quant-ph) 2026-06-19

Charge-Conjugation Violation and Population Asymmetry in Bipartite Fermionic Lattices

arXiv:2606.06138v2 Announce Type: replace-cross Abstract: Charge conjugation violation (CCV) is a central concept in particle physics and appears also for quasiparticles in quantum many-body systems, which typically relies on an embedded external symmetry breaking to the underlying system. An open question is how an intrinsic CCV mechanism could emerge and what its macroscopic consequences would be. We establish sublattice kinks in bipartite fermionic lattices as a concrete setup showing intrinsic CCV. The intrinsic CCV of the sublattice kink is based on the graph-topological nature of the underlying Hamiltonian, with no explicit symmetry breaking taking place. It leads to a population asymmetry of different configurations and imprints a hidden leaf-like structure in the eigenenergy spectrum. The population asymmetry also leads to an imbalanced sublattice-kink production triggered by the vacuum-instability in the quench dynamics. Our work demonstrates the graph topology as the microscopic origin of intrinsic CCV, with the population asymmetry as the macroscopic consequence, of which the proposed setup is highly amenable to experimental implementation via cold-atom quantum simulators.

22.
arXiv (CS.CV) 2026-06-19

Spectral Query-Key Product Weight Steering for Training-Free VLM Hallucination Mitigation

Vision-language models (VLMs) often generate fluent but visually unsupported descriptions, especially by mentioning objects absent from the image. We propose QK Product Steering, a data-free, training-free, and zero-inference-cost weight edit for reducing object hallucination. The method directly edits the per-head query-key product, the operator that produces pre-softmax attention logits, by suppressing a small number of dominant singular modes in selected middle layers. The edited product is then mapped back to the query weights through a closed-form query-only update while keeping shared key weights fixed, making the edit compatible with grouped-query attention. We further decompose the QK product into symmetric and antisymmetric components to distinguish mutual content-similarity patterns from directional attention patterns. Across three GQA-based VLMs, QK Product Steering achieves an average relative CHAIR$_s$ reduction of $4.0\%$, while matched random-mode controls show negligible change. Interpretability ablations show that the hallucination signal is specific to dominant QK modes and is primarily localized to the symmetric mutual-attention channel. Overall, QK Product Steering offers a simple alternative to decoding-time mitigation, requiring no additional data, fine-tuning, or inference-time overhead while largely preserving general multimodal capability.

23.
medRxiv (Medicine) 2026-06-16

Development of an automated, imaging-based preoperative screening model for early identification of malnutrition in an abdominal surgery cohort

Background: Clinical malnutrition affects one in five abdominal surgery patients and increases postoperative complications and mortality. Current screening occurs after admission, closing the window for preoperative nutritional intervention. No objective, scalable preoperative screening tool exists. Objective: To determine whether automated volumetric CT-based body composition analysis improves preoperative identification of surgical patients at risk for clinical malnutrition compared to clinical variables or single slice imaging alone. Methods: Retrospective cohort study of adults undergoing elective abdominal surgery at a quaternary academic medical center (2018 to 2021) with a preoperative CT scan within 90 days and complete nutrition assessment. Clinical malnutrition was diagnosed by a registered dietitian using ASPEN/AND criteria. Three sex stratified Elastic Net models were compared: (1) base clinical variables; (2) base plus L3 single slice skeletal muscle index and attenuation; and (3) base plus comprehensive 3D volumetric quantification of five muscle groups and two fat depots. Discrimination (AUROC), calibration (Brier score), and clinical utility (decision curve analysis) were assessed via 10-fold cross-validation. Results: Among 1,143 patients (52.4% female; mean age 60.5 years), 231 (20.2%) were diagnosed with malnutrition. Malnourished patients had significantly higher complication rates (36.4% vs. 15.4%, p

24.
medRxiv (Medicine) 2026-06-11

The impact of pre-stroke statin use on baseline corrected infarct volume and collateral perfusion

Stroke is a leading cause of disability and mortality worldwide, with ischaemic stroke the most prevalent type. Statins, used for cholesterol management, have demonstrated benefits in reducing stroke risk and improving outcomes in preclinical studies. However, the impact of pre-stroke statin use on stroke outcomes remain inconsistent. In this study, we aim to evaluate whether pre-stroke statin use is associated with greater volume of salvaged tissue and improved cerebral collateral perfusion. A retrospective analysis was conducted using data from 281 patients presenting with acute ischemic stroke to the John Hunter Hospital between May 2015 and May 2020. Patients were grouped based on pre-stroke statin use, and clinical variables, including infarct volume and collateral perfusion, were assessed. The primary outcome was salvage volume derived from baseline perfusion lesion volume minus infarct volume at follow-up. Collateral perfusion was measured by the hypoperfusion volume defined by delay time (DT)>6 seconds divided by the hypoperfusion volume defined by DT >2 seconds. Patients on statins at admission were significantly older and had more comorbidities. No significant association was found between pre-stroke statin use and salvage volume or collateral perfusion after adjusting for covariates. Larger initial infarct core was a significant predictor of salvage volume due to larger salvageable tissue volume at baseline. These findings indicate that pre-morbid statin use is not associated with larger salvage volume or improved cerebral collateral perfusion.

25.
PLOS Medicine 2026-06-09

Prediction of hospitalisation in young children with pneumonia in Malawi: A machine learning-based approach

by Patrick Staunton, Mohammad Adib Makrooni, Master Chisale, Billy Nyambolo, Joseph Wu, Damien McCarthy, Mark Ledwidge, Yasir Bin Nisar, Chris Watson, Balwani Mbakaya, Cathal Seoighe, Joe Gallagher Background Globally, pneumonia remains the single biggest cause of mortality in children under 5 years of age. This study sought to train and test a prediction model for hospitalisation within 7 days after initial presentation in 2- to 59-month-old Malawian children with WHO-defined pneumonia in primary care and compare its performance to existing risk prediction models. Methods and findings BIOTOPE is a cohort study of children with pneumonia in a primary healthcare setting in Malawi. The training cohort involved nine primary care centres and the testing cohort involved two primary care centres in Northern Malawi. The training cohort was recruited between December 2022 and April 2023 while the testing cohort was recruited in 2016. Participants were consecutive children aged 2–59 months presenting with cough and/or difficulty breathing and who were diagnosed as WHO-defined pneumonia in primary care of any severity. The training cohort was used to train and validate a machine learning model with a prespecified primary outcome defined as hospitalisation and/or death within 7 days as the outcome. This model was then further evaluated in the testing cohort.Median age was 15 months (interquartile range 8−27) in the training and 17 months (interquartile range 9−29) in the external testing cohort (52.1% and 54.4% male, respectively). Hospitalisation occurred in 14.3% (294) of the training cohort and 12.1% (55) of the testing cohort. There was one death in the training cohort only. WHO danger signs were present in 17.6% (360) and 15.9% (70) of children in the training and testing cohorts, respectively. The optimal machine learning model achieved an area under the receiver operating characteristic and precision recall curves of 0.87 and 0.57, respectively, in the testing cohort outperforming existing risk prediction models; furthermore, this model produced an expected calibration error of 0.16 (a logistic regression model using severity status as the response variable and the log odds of the machine learning model’s calibrated probabilities produced an intercept estimate of −0.32 and a slope estimate of 1.13). Key limitations include the use of hospitalisation and/or death as a severity outcome, which may reflect health system factors rather than true disease severity, that mortality-based comparisons were not possible due to low mortality in these primary care cohorts, and that comparator tools were developed for hospital populations rather than primary care populations. Conclusion This machine learning score outperformed traditional pneumonia risk scores in predicting hospitalisation within 7 days in Malawian children presenting to primary care. Traditional pneumonia risk scores diminish in performance when externally applied to new datasets suggesting they may not generalise well beyond their original derivation settings. Mortality-related findings are not applicable as there was only one death in this cohort. Overall these findings support the potential of machine learning to meaningfully improve early identification of children at risk of severe pneumonia in low-resource primary care settings. Further external validation and clinical impact studies are needed to confirm these results.