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01.
arXiv (CS.CL) 2026-06-18

JetFlow: Breaking the Scaling Ceiling of Speculative Decoding with Parallel Tree Drafting

Speculative decoding (SD) accelerates autoregressive Large Language Models (LLMs) by drafting multiple tokens and verifying them in parallel, but it faces a scaling limitation: increasing the draft budget improves speed only when acceptance remains high and drafting overhead stays low. This ceiling has been difficult to break because prior head-based SD methods face a causality-efficiency dilemma. Autoregressive drafters produce path-conditioned candidates that are effective for tree speculative decoding with higher acceptance length, but their drafting cost grows with tree depth. Bidirectional block-diffusion drafters generate all positions in one pass, but their branch-agnostic marginals can form individually plausible yet mutually inconsistent trees, wasting budget and reducing acceptance. We propose JetFlow, a head-based SD framework that combines one-forward drafting efficiency with branch-wise causal conditioning. JetFlow trains a causal parallel draft head over fused hidden states from the frozen target model, producing candidate trees whose scores align with the target model's autoregressive factorization. This enables JetFlow to convert larger draft budgets into longer accepted prefixes and higher end-to-end speedup. Across math, coding, and chat benchmarks on dense and MoE Qwen3 models, JetFlow consistently outperforms bidirectional-head and tree-based SD baselines. On H100 GPUs, JetFlow achieves up to 9.64x speedup on MATH-500 and 4.58x on open-ended conversational workloads, with further latency gains demonstrated through vLLM integration under realistic serving loads. Our code and models are available at https://github.com/hao-ai-lab/JetFlow.

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

SPADE: Split-and-Delay Embeddings for Autoregressive High-Granularity Calorimeter Simulation

arXiv:2606.11304v1 Announce Type: cross Abstract: We introduce SPADE (SPlit And Delay Embeddings), an autoregressive transformer for sequences whose tokens carry multiple features. Rather than embedding these features jointly, SPADE embeds them independently. Delaying each feature stream relative to the previous one allows intra-token correlations to be learned by the standard self-attention mechanism. Applied to point-cloud calorimeter shower generation in the highly granular ILD detector, SPADE is competitive with the state of the art AllShowers model on photon showers, and substantially outperforms its VQ-VAE-based predecessor OmniJet-$\alpha_C$. The mechanism is applicable to any generative task with multi-feature tokens, enabling LLM-style pretraining workflows for higher-dimensional data.

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

"Do Not Mention This to the User": Detecting and Understanding Malicious Agent Skills in the Wild

LLM-based coding agents increasingly rely on third-party extensions called skills, which bundle natural language instructions and helper scripts that execute with full user privileges. Community registries have emerged to distribute these skills, but the security implications remain unstudied due to the absence of labeled threat data. This paper presents a systematic security analysis of 98,380 skills collected from two major registries. Through a combination of static pattern matching and dynamic behavioral verification, we identify 157 skills exhibiting confirmed malicious behavior, encompassing 632 distinct vulnerabilities across 13 attack techniques. Our analysis reveals that these threats are deliberate rather than accidental: each malicious skill contains an average of 4.03 vulnerabilities spanning multiple attack phases. We identify two dominant attack strategies with statistically significant negative correlation – credential theft via remote code execution, and agent manipulation through adversarial instructions embedded in documentation. Over half of all confirmed cases originate from a single threat actor employing templated brand impersonation at scale. We further observe that attack sophistication correlates with concealment investment, with advanced skills universally employing undocumented capabilities while also exploiting platform-native trust mechanisms. Following responsible disclosure, registry maintainers removed all 157 (100%) of the reported skills. Our dataset and detection pipeline are publicly available to facilitate future research on securing LLM agent ecosystems.

04.
arXiv (CS.AI) 2026-06-12

Decoding Insect Song: A Multitask Semisupervised Orthoptera Bioacoustic Classifier

arXiv:2606.13236v1 Announce Type: cross Abstract: Passive acoustic monitoring holds great promise for ecological inference, yet existing automated tools are typically narrowly trained and non-transferable. We address these limitations with PULSE, a semi-supervised, multi-task framework for Orthoptera bioacoustics, combining weakly-supervised species classification, self-supervised learning on unlabelled field audio, and knowledge distillation from a general-purpose bioacoustic model. Our domain-adapted specialist model outperforms a state-of-the-art general model across all metrics (macro F1: 0.21 vs. 0.07; AUC: 0.74 vs. 0.45; AP: 0.32 vs. 0.19), with active learning further raising F1 to 0.34 and AUC to 0.84. Beyond classification, the learned embeddings encode ecologically meaningful structure, exposed through an interactive visualisation tool for ecological discovery.

05.
arXiv (quant-ph) 2026-06-11

Quantum optimal control of the Dicke manifold in dipolar Rydberg atom arrays

arXiv:2606.02283v2 Announce Type: replace Abstract: The ability to engineer and control quantum states of many-body systems is a central challenge in quantum information science. For a register of $N$ qubits, the full Hilbert space dimension grows exponentially as $2^N$, rendering generic state preparation and control infeasible without exploiting structure or symmetry. A particularly important and physically motivated restriction is to the fully symmetric subspace, spanned by the Dicke states, which are simultaneous eigenstates of collective spin $J=N/2$. Ensembles of Rydberg atoms interacting via electric dipoles in two-dimensional tweezer arrays form a promising platform for achieving such control. However, the finite range of dipole-dipole interactions poses a challenge to generating and controlling the Dicke manifold because the Hamiltonian incurs leakage from the computational subspace. To counteract this leakage, we perform quantum optimal control algorithms on a truncated Hilbert space according to our newly developed method of ``irrep distillation'' (IRD), which captures the process by which the symmetric subspace couples to leakage error-spaces, using only linear-scaling Hilbert dimension. We implement gradient ascent pulse engineering (GrAPE) on control schemes with little or no local addressing, to generate resourceful states like Greenberger-Horne-Zeilinger, Dicke, and extremal quantum states. We benchmark each scheme of IRD-GrAPE for its quantum speed limit (QSL), as well as exactly testing pulse fidelities on small system sizes and predicting fidelities using higher-order IRD on larger systems.

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

Seeing Below the Limit of Detection: A Censored-Poisson Bayesian Latent-Growth Change-Point Detector (the Span Detector) for Serial ctDNA in HR+/HER2- Metastatic Breast Cancer

arXiv:2606.11876v1 Announce Type: cross Abstract: Circulating-tumour DNA (ctDNA) carries evidence of drug resistance months before imaging shows it, but the earliest evidence lives below the assay's limit of detection (LoD): a nascent subclone is detected only intermittently, producing a flickering sequence of faint detects and non-detects. Commercial liquid biopsies treat each draw as an independent snapshot and a non-detect as nothing. We argue a non-detect is a left-censored observation, and the pattern of non-detects and faint detects over time carries actionable evidence of growth before any single value is trustworthy. We introduce Span, a censored-Poisson Bayesian latent-growth change-point detector that models the binary detection process, accumulates a sequential generalised-likelihood-ratio statistic for an upward change-point in the per-variant detection rate, and raises a competing-risks alarm with calibrated false-alarm control. Span has no learned weights, so there is nothing to overfit. On a synthetic cohort of HR+/HER2- metastatic breast cancer on first-line CDK4/6-inhibitor plus endocrine therapy, at a matched 10% false-alarm rate, Span roughly doubles the fraction of impending progressions caught three months ahead (indolent regime: 25% vs 11% for the snapshot), with a falsifiable dose-response: large for indolent emergence, vanishing for fast emergence. A value-trajectory baseline performs identically to the snapshot, isolating the gain to the censored detection model. The survival backbone matches a Cox baseline on real breast-cancer data (GBSG-2, n=686; C-index 0.67 vs 0.68), and on a real longitudinal cohort with clean biomarkers (PBC2, n=312) the same pipeline correctly declines to win, a falsifiable boundary test confirming the mechanism is regime-specific. All ctDNA trajectories are synthetic.

07.
arXiv (CS.CL) 2026-06-16

From Argument Components to Graphs: A Multi-Agent Debate with Confidence Gating for Argument Relations

Large Language Models (LLMs) are increasingly assessed and utilized in the field of Argument Mining (AM), thanks to their strong general reasoning capabilities. However, standard training-free models often miss sophisticated details, specifically in contexts where two parts of the text have to be analyzed together. Furthermore, self-correction mechanisms tend to reinforce initial hallucinations in reasoning. Overcoming these limitations typically requires expensive, domain-specific supervised fine-tuning. Recent work has shown that a multi-agent paradigm can address such weaknesses for the component classification task through dialectical refinement with a Proponent-Opponent-Judge architecture, setting a promising direction for training-free approaches in the field. In this paper, we extend and evaluate this framework on the Argument Relation Identification and Classification (ARIC) task, reformulating it as a debate over component pairs. Besides that, we introduce a confidence gating mechanism that enables debating only on the uncertain cases and accepting the initial prediction when confidence is high. On the UKP Argument Annotated Essays v2 corpus, we demonstrate that the selective debate achieves the highest Macro F1 among all training-free methods, while debate over all samples degrades performance below that of one of the baselines. All generative approaches also outperform fine-tuned RoBERTa models on Macro F1, suggesting that the under-representation of the Attack class was more damaging to supervised fine-tuning than to inference-only models. Additionally, our framework produces human-readable debate transcripts, offering interpretability absent from both single-agent and supervised classifiers.

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

On-Chip Quantum Randomness Amplification

arXiv:2606.12173v1 Announce Type: new Abstract: Randomness amplification, the task of extracting uniform private bits from biased seeds that may be partly known by a malicious third party, is of central importance in cryptography. The highest security in this task is provided by a class of quantum protocols known as device-independent, which however are challenging to integrate into scalable devices. Semi-device-independent (SDI) protocols are a promising alternative that guarantees security under few natural assumptions, such as bounds on the amount of energy used by the devices. Here, we provide the first demonstration of SDI randomness amplification on an integrated silicon photonic chip, achieving a throughput rate of 20 Mbps suitable for practical applications. This rate is achieved through a novel technique for SDI entropy certification, which delivers strictly tighter von Neumann entropy bounds compared to existing methods and remains valid even if the preparation and measurement devices share quantum correlations. Overall, the methods developed in this work enable the integration of SDI technology into portable telecom devices, opening up a new generation of quantum cryptographic hardware.

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

Hybrid Classical-Quantum Variational Autoencoder for Neural Topic Modeling

作者:

Neural topic models enable scalable semantic discovery, but their integration with quantum hardware remains largely unexplored. We present a proof-of-concept hybrid classical-quantum variational autoencoder (VAE) for topic modeling, embedding parameterized quantum circuits within the VAE inference network while retaining a classical topic-word decoder. To address the resource constraints of quantum hardware, we propose a modified Gaussian Softmax posterior that decouples latent space dimensionality from the number of topics to be extracted, enabling the model to operate with a low-resource 10-qubit quantum device. On the AgNews dataset, the hybrid VAE outperforms state-of-the-art neural topic models (NTMs), reaching a $C_v$ coherence score of 0.71 and an NPMI score of 0.20 while preserving high topic diversity. For comparison, we also construct a fully classical variant, which also outperforms state-of-the-art models on AgNews and exhibits clear class separation in the latent space. These results demonstrate that hybrid VAEs are computationally viable even on NISQ-era devices and represent a promising direction for quantum-enhanced topic modeling.

10.
arXiv (CS.CL) 2026-06-16

ACCORD: Action-Conditioned Contextual Grounding for Language Agents

User instructions are often underspecified because humans rely on implicit assumptions about the surrounding environment. For large language model (LLM) agents operating in information-rich digital and physical environments, these assumptions cannot be inferred from the instruction alone; they must be recovered from the current state of tools, data, interfaces, and observations. Effective execution therefore requires agents to identify missing context, ground it in observed evidence, and carry it forward into subsequent actions. We show that current agents often fail to do so. They act from assumed rather than observed specifics, overlook information they could have gathered, and fail to incorporate evidence that has already been returned. Building on this insight, we propose ACCORD (Action-Conditioned Contextual Grounding), a simple and effective agent framework for adaptive grounding. Before each action, ACCORD actively probes the environment for missing information and integrates relevant context from the agent's trajectory that would otherwise be overlooked. Requiring no additional training or task-success signals, ACCORD improves task-goal completion on AppWorld by up to +20.6 points with GPT-5-mini, from 42.0% to 62.6%, compared to strong baselines. These gains persist with a substantially stronger base model (+10.8 with Claude-4.5-sonnet), an open-weight model (+10.1 with Qwen3.5-27B-FP8), and on the embodied AlfWorld benchmark (+7.4 success rate with GPT-5-mini).

11.
arXiv (quant-ph) 2026-06-16

Enhancing Quantum Machine Learning with Anyons

arXiv:2606.16090v1 Announce Type: new Abstract: The power of quantum computing and quantum machine learning relies on harnessing uniquely quantum phenomena as computational resources. While superposition, coherence and entanglement have been central to this effort, the role of particle exchange statistics remains largely unexplored. Here, we introduce a quantum kernel framework that unifies bosonic, fermionic, and anyonic (fractional) exchange statistics within a single learning paradigm. We study this family of kernels from three perspectives. At the representation level, Haar-averaged effective-dimension analysis shows that fractional exchange phases access feature-space directions inaccessible to the purely symmetric or antisymmetric limits. At the level of kernel geometry, the corresponding Gram matrices show greater separation from the distinguishable-particle baseline and reduced label-dependent model complexity. Finally, on learning benchmarks, anyonic kernels consistently outperform their bosonic and fermionic counterparts, with stronger target alignment and more favorable class geometry. Together, these findings show that exchange statistics reshape the structure and geometry of quantum feature space, leading to enhanced learning performance. Our work identifies particle exchange statistics as an overlooked computational ingredient for quantum machine learning and provides the first systematic comparison of quantum learning models across exchange phases.

12.
bioRxiv (Bioinfo) 2026-06-10

Bias-mitigated microbiome inference refines coronary artery disease signature

作者:

Roughly half the cells in the human body are microbial, and changes in these communities are increasingly implicated in cardiovascular, metabolic, and oncological diseases. Yet identifying which taxa truly differ in abundance, differential abundance (DA), is distorted by four major sources of bias: loss of total microbial load, taxa measurement efficiencies, arbitrary pseudocounts required to handle pervasive zeros, and contamination which has recently driven retractions. No existing DA method accounts for all four. Here we introduce BootDA, a non-parametric bootstrap-based method that explicitly models each bias source without data transformations, pseudocounts, parametric assumptions, or assuming that most taxa are non-DA. In semi-parametric simulations preserving the sparsity (>70% zeros) and correlation structure of real 16S amplicon data, BootDA achieved the highest sensitivity among tested methods, including ANCOM-BC2, LinDA, MaAsLin 3, and Wilcoxon tests, while controlling the false discovery rate. Performance was retained in low biomass settings when contamination contributed ~50% of counts, and without negative controls, indicating de novo decontamination capability. Applied to a coronary artery disease cohort, BootDA refined the original signature to two co-enriched genera, Klebsiella and Gemmiger, and excluded likely contaminants. BootDA is available as an R package and could generalise to other sparse, high dimensional biological data.

13.
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.

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

AI SciBrief as a Gateway to Research: A Framework for Onboarding Students into New Research Areas

Students at all levels of higher education face a significant barrier in the form of information overload, which often paralyzes the initial stages of the research process and suppresses motivation. In response, this article introduces a pedagogical framework that leverages AI SciBrief, a platform powered by a Large Language Model (LLM) designed to automatically generate digests of scientific trends. We describe how this multidisciplinary tool - with initial coverage in finance, medicine, and education - can be integrated into the curriculum to overcome this "entry barrier." The framework provides concrete methodologies for utilizing these digests to facilitate topic selection for term papers, accelerate literature reviews for dissertations, and enable postgraduate students to continuously monitor emerging trends. We conclude that AI SciBrief functions as a "gateway to research" effectively reducing students' cognitive load and empowering them to transition more rapidly from information searching to knowledge creation.

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

A Unified Theory of Sinusoidal Activation Families for Implicit Neural Representations

Implicit Neural Representations (INRs) model continuous signals with compact neural networks and have become a standard tool in vision, graphics, and signal processing. A central challenge is accurately capturing fine detail without heavy hand-crafted encodings or brittle training heuristics. Across the literature, periodic activations have emerged as a compelling remedy: from SIREN, which uses a single sinusoid with a fixed global frequency, to more recent architectures employing multiple sinusoids and, in some cases, trainable frequencies and phases. We study this family of sinusoidal activations and develop a principled theoretical and practical framework for trainable sinusoidal activations in INRs. Concretely, we instantiate this framework with Sinusoidal Trainable Activation Functions (STAF), a Fourier-like activation whose amplitudes, frequencies, and phases are learned. Our analysis (i) establishes a Kronecker-equivalence construction that expresses trainable sinusoidal activations with standard sine networks and quantifies expressive growth, (ii) characterizes how the Neural Tangent Kernel (NTK) spectrum changes under trainable sinusoidal parameterization, and (iii) provides an initialization that yields standard normal post-activations without asymptotic central limit theorem (CLT) arguments. Empirically, on images, audio, shapes, inverse problems (super-resolution, denoising) and NeRF, STAF is competitive and often stronger on distortion-oriented reconstruction metrics such as PSNR/SSIM across the evaluated INR tasks, with favorable parameter efficiency under layer-wise sharing. While periodic activations can alleviate practical manifestations of spectral bias, our results indicate they do not eliminate it; instead, trainable sinusoids can improve the observed capacity-optimization trade-off in the evaluated settings.

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

Robust Spin Splitting and Strain-Controlled Optical Response in Monolayer CrC2N4 for Valleytronic and Optoelectronic Applications

arXiv:2606.17329v1 Announce Type: cross Abstract: Monolayer CrC2N4 recently emerged as a promising two-dimensional semiconductor, yet its spin-orbit-coupled (SOC) physics and strain-tunable optical response remained largely unexplored. Here, we investigated the electronic, valley, charge-transfer, and optical properties of pristine and biaxially strained monolayer CrC2N4 using first-principles calculations. The monolayer exhibited a direct band gap at the K/K' valleys. SOC produced valley contrasting out-of-plane spin polarization, yielding a moderate valence band spin splitting of 51.9 meV and a small conduction band spin splitting of 1.7 meV. Orbital-resolved analysis showed that the edge states were mainly governed by Cr-d and N-p hybridization, while Bader analysis indicated polar-covalent bonding through charge transfer toward N atoms. Biaxial strain in the range of -4% to +4% tuned the band gap from 1.987 to 1.421 eV and drove an indirect-to-direct gap transition near -1% strain. Tensile strain enhanced the Berry curvature and red-shifted the optical response toward the visible-near-infrared region. These results suggested monolayer CrC2N4 as a promising platform for strain-engineered valleytronic and optoelectronic device applications.

17.
arXiv (CS.CL) 2026-06-11

ProcessThinker: Enhancing Multi-modal Large Language Models Reasoning via Rollout-based Process Reward

Visual question answering increasingly requires multi-step reasoning. Recent post-training with reinforcement learning under verifiable rewards (RLVR) and Group Relative Policy Optimization (GRPO) can improve multimodal reasoning, but most approaches rely on sparse outcome-only rewards. As a result, they struggle to tell whether an incorrect answer comes from a small mistake late in the reasoning or from an unhelpful trajectory from the start. A common solution is to train a process reward model (PRM) for step-level supervision, but this typically requires large-scale high-quality chain-of-thought annotations and additional training cost. We propose ProcessThinker, a practical post-training pipeline that provides step-level process rewards without training an explicit PRM. ProcessThinker first rewrites reasoning traces into a step-tagged format for cold-start supervised fine-tuning, then applies GRPO with a standard format reward and our rollout-based process reward. Concretely, for each intermediate step, we sample multiple continuations from that step and use the empirical success rate (final-answer verification) as the step reward. This gives dense credit assignment and encourages reasoning steps that more reliably support a correct conclusion, helping reduce inconsistent or self-contradictory progress across steps – a key issue in logical reasoning. Across four challenging video benchmarks (Video-MMMU, MMVU, VideoMathQA, and LongVideoBench), ProcessThinker consistently improves over the baseline model Qwen3-VL-8B-Instruct

18.
arXiv (CS.AI) 2026-06-19

ProMUSE: Progressive Multi-modal Uncertainty-guided Staged Evidential Alzheimer Disease Classification

arXiv:2606.19371v1 Announce Type: cross Abstract: Alzheimer's disease (AD) is a fatal disorder that destroys memory and cognitive skills in the elderly population. Most treatments for AD are effective in the early stage, leading to an increasing demand for early AD diagnosis. AD diagnosis increasingly relies on multimodal data such as clinical assessments, structural Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) imaging. However, MRI and PET acquisition remain costly and not universally accessible, making full-modality inference impractical in real-world clinical workflows. We propose ProMUSE, a Progressive Multi-modal Uncertainty Guided Staged Evidential Network that adaptively determines when additional modalities are necessary, helping reduce the overall cost of data acquisition while maintaining accuracy. ProMUSE first performs evidential classification using low-cost clinical data and quantifies uncertainty via a Dirichlet-based subjective logic model. When uncertainty exceeds a learned threshold, ProMUSE progressively incorporates MRI or PET features, fusing modality-wise belief and uncertainty through Dempster-Shafer theory to obtain a calibrated multimodal prediction. This staged acquisition strategy enables accurate diagnosis while minimizing reliance on expensive imaging. Experiments on ADNI, AIBL, and OASIS across CN-AD, CN-MCI, and MCI-AD tasks demonstrate that ProMUSE achieves competitive or superior accuracy compared to full-modality baselines while reducing MRI/PET usage by 50-90%, yielding substantial cost savings. These results highlight ProMUSE as a practical, uncertainty-aware, and resource-efficient solution for real-world AD screening.

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

A Quantitative Experimental Repeated Measures Study of Training Dynamics in a Small Llama Style Language Model Under a Compute-Aware Token Budget

作者:

arXiv:2606.13370v1 Announce Type: new Abstract: This study examines training dynamics in a small Llama-style language model trained under a fixed, compute-constrained token budget. Rather than evaluating efficiency solely through endpoint performance, the study uses a quantitative experimental repeated measures design to analyze how validation loss, validation perplexity, rolling volatility, backslide behavior, spike behavior, and between-seed variability change across token-based training intervals. Six independent training runs were conducted on a 4.26-million-parameter model using the TinyStories corpus, CPU-based full-precision training, and a target budget of approximately 20 million cumulative training tokens. Metrics were collected across 21 intervals, producing 126 seed-by-interval observations. Repeated measures ANOVA showed statistically significant interval effects for validation loss, validation perplexity, and rolling volatility. Descriptive trajectories revealed rapid early improvement followed by non-monotonic degradation during later training intervals. Mean validation loss decreased from 8.3552 at initialization to 2.7996 near 4 million tokens, but increased to 3.9010 by the final checkpoint. Validation perplexity followed the same pattern, falling sharply early in training before rising later. Derived telemetry further showed recurrent validation-loss backslides and no interval-summary evidence of a stable phase under the predefined criteria. These findings suggest that compute-aware language model evaluation should examine training trajectories rather than endpoint metrics alone. In constrained compute settings, additional token exposure may increase computational cost without producing proportional generalization gains, and interval-level telemetry can reveal instability, regression, and diminishing returns that final metrics may obscure.

20.
medRxiv (Medicine) 2026-06-22

Study protocol: Feasibility and clinical implications of real-time cerebral autoregulation monitoring in major noncardiac surgery with the Medtronic Cotrending algorithm (AUTOREGULATE-NONCARDIAC-COTRENDING)

Background: Perioperative hypotension is associated with postoperative organ injury. However, trials of hypotension avoidance have not found meaningful improvements in postoperative cardiovascular, renal, neurological or functional outcomes. One possible explanation is that organ perfusion depends on patients individual autoregulatory ranges. Hence, technology enabling monitoring of the autoregulatory status of vital organs, e.g. the brain, could provide a physiologic basis for personalising of blood pressure targets. However, current established methodologies for monitoring cerebral autoregulation in noncardiac surgery, e.g. the cerebral oximetry index (COx), are limited by performance and usability. The Medtronic Cotrending algorithm has been developed to provide automated, near real-time assessment of cerebral autoregulation. While feasibility was demonstrated in cardiac surgery, its applicability in major noncardiac surgery remains unknown. This study aims to evaluate the technical feasibility and clinical implications of Cotrending-based cerebral autoregulation monitoring in major noncardiac surgery. Objectives: Primary objective: To evaluate the technical feasibility of using the Medtronic Cotrending algorithm to monitor intraoperative cerebral autoregulation in real-time during major noncardiac surgery, drawing comparisons to the COx algorithm. Secondary objectives: to investigate the potential clinical implications of Cotrending-based cerebral autoregulation monitoring. Design: Single-centre, prospective cohort study. Setting: Swiss tertiary care centre Patients: Patients enrolled in AUTOREGULATE-NONCARDIAC who were monitored intraoperatively with the Medtronic INVOS(TM) 5100 near-infrared spectroscopy (NIRS) system. Outcomes: Technical feasibility outcomes include success rate of determination of the lower limit of cerebral autoregulation, intraoperative uptime, time to first estimate of the lower limit of cerebral autoregulation, sensitivity to external factors and to data artefacts; agreement of Cotrending-derived lower limit of cerebral autoregulation with COx-derived lower limit of cerebral autoregulation. Conclusions: N/A Trial registration: Clinicaltrials.gov NCT07630129

21.
medRxiv (Medicine) 2026-06-15

Evaluation of AI-Generated Synthetic Data for Clinical Research in Secondary Cardiovascular Prevention among Dyslipidemia Patients

Background: Access to high-quality clinical data is essential for advancing medical research and developing effective medical statistical and Artificial Intelligence models. However, privacy regulations and logistical barriers often hinder timely access to real-world data. Synthetic data offer a promising solution, preserving the statistical characteristics of original datasets while protecting patient privacy. Objectives: This study investigates the use of synthetic data for secondary cardiovascular prevention in patients with dyslipidemia, using two real-world datasets from Centro Cardiologico Monzino. Methods: Given the high dimensionality and limited sample size of the datasets, we employed a custom generative framework based on Large Language Models (LLMs). Pre-trained LLMs were fine-tuned on original clinical records to synthesize tabular data replicating source-data distributions. Fine-tuning was performed within the Centro Cardiologico Monzino's secure infrastructure to ensure data sovereignty. We evaluate clinical utility and privacy using fidelity and privacy metrics, identifying the optimal generative model and benchmarking against traditional anonymization methods. Results: Synthetic data achieved a superior trade-off than classically anonymized datasets. Real and synthetic datasets showed strong agreement, with significant distributional differences limited to few variables. Models trained on synthetic data replicated key associations from the original dataset, including therapy modification and creatine phosphokinase as predictors of SAMS, and pharmacological intensity as the main driver of LDL-C reduction. Conclusions: Results support the feasibility of using synthetic data as a proxy for real-world datasets in exploratory analyses and model development. Despite slight attenuation of some effect sizes, preserved clinical relationships reinforce the validity of synthetic data in medical research.

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

Rethinking Shrinkage Bias in LLM FP4 Pretraining: Geometric Origin, Systemic Impact, and UFP4 Recipe

arXiv:2606.20381v1 Announce Type: new Abstract: FP4 training promises substantial reductions in memory and computation cost for LLM pretraining, yet current FP4 hardware paths and recipes, including NVIDIA Blackwell/Rubin-class systems and AMD MI350-series GPUs, remain centered on E2M1 data elements. In this study, we identify a fundamental limitation of that choice: non-uniform formats such as E2M1 inherently suffer from Shrinkage Bias, a systematic negative rounding error caused by the geometric asymmetry of their representable bins. We show that this bias accumulates multiplicatively across layers and is amplified by the Random Hadamard Transform (RHT), providing a unified explanation for the training instability observed in existing E2M1-based FP4 recipes. In contrast, uniform grids (E1M2/INT4) bypass this grid-geometry error and better convert the improved bucket utilization from RHT into higher quantization quality. Based on this finding, we propose UFP4, a uniform 4-bit training recipe that applies RHT to all three training GEMMs while restricting stochastic rounding to dY alone. On Dense 1.5B, MoE 7.9B, and MoE 124B long-run pretraining, UFP4 consistently achieves lower BF16-relative loss degradation than strong E2M1-based baselines, supported by scaling-law analysis and ablation studies. Our results suggest that future accelerators should support E1M2/INT4-style uniform 4-bit grids as first-class training primitives alongside E2M1.

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

Transformer-Guided Graph Attention for Direct Cardiac Mesh Reconstruction: A Structural Digital Twin Framework

Building patient-specific cardiac models sits at the heart of precision cardiology, yet getting those models into clinical use keeps running into the same wall: mesh generation is slow, messy, and frustrating. The standard workflow – segmenting the image, running Marching Cubes, and then manually cleaning up the result – is time-consuming, inconsistent across operators, and demands specialist knowledge most clinical teams do not have. We take a fundamentally different approach. Instead of treating segmentation and mesh generation as two separate problems, we train a single end-to-end network that goes directly from a raw 3D medical image to a smooth, simulation-ready cardiac surface mesh. The core is a 3D Swin Transformer encoder-decoder that extracts volumetric features from CT or MRI volumes, paired with a Graph Attention Network (GAT) head that iteratively deforms a template mesh to fit the patient's cardiac boundary. We tested on the MM-WHS 2017 benchmark using both CT and MRI. Segmentation scores were competitive (Dice of 0.84 on CT, 0.83 on MRI), but the primary focus is mesh quality: mean Chamfer distance of 1.8 mm, with 95th-percentile surface distance below 5 mm. Every mesh is produced in a single forward pass – no Marching Cubes, no smoothing filters, no manual cleanup. We argue that for cardiac digital twin pipelines, geometric fidelity and topological correctness matter more than pixel-level Dice scores. By removing the post-processing bottleneck, this approach makes patient-specific cardiac simulation substantially more accessible for clinical use.

24.
medRxiv (Medicine) 2026-06-18

Chest X-Ray as a critical screening tool for Household Contacts of TB: Lessons from Three Years of Programmatic Data in India

Introduction: Household contacts (HHCs) of pulmonary TB patients remain at high risk for TB infection and disease progression, yet many remain asymptomatic and are missed by symptom-screening pathways. While India expanded its TB preventative guidelines to include all HHCs in 2021, chest X-ray (CXR) screening continues to be used selectively, representing a missed opportunity in early case detection. Methods: The analysis uses programmatic data from Project JEET 2.0 (Joint Effort for Elimination of Tuberculosis), implemented by the William J. Clinton Foundation in India, between October 2021 and March 2024. Eligible HHCs (>=5 years) were offered CXR screening as part of TB preventive therapy (TPT) evaluation. Descriptive and multivariable analyses examined predictors of CXR uptake and TB yield. A two-stage logistic regression model estimated potential TB yield under universal CXR coverage. Model performance was evaluated using the area under the curve (AUC), and bootstrap simulations generated counterfactual estimates of missed TB cases. Results: Among 1,034,621 HHCs, 1.02% individuals were found positive for TB, which includes 7,786 HHCs who were on TB treatment already, while an additional 2,812 were identified during pre-TPT evaluation. Among eligible HHCs (n = 1,026,835), 70% were screened with CXR, of which 2.4% had suggestive TB findings. Of these, 79% went for further TB assessment. Symptomatic HHCs were more likely to be CXR screened (84% vs 69%) and assessed for TB, yet two-thirds of all detected TB cases were asymptomatic. It is estimated that universal CXR coverage and TB testing for suggestive cases can increase TB detection by at least 87%. Conclusion: The study provides a scalable approach to expand CXR coverage through public-private partnerships, enabling early TB detection among HHCs, especially among asymptomatic contacts. Future implementations will benefit from integrating AI-enabled reading, along with systematic follow up for those with suggestive findings.

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arXiv (CS.LG) 2026-06-18

Latent-Conditioned Parameterized Quantum Circuits as Universal Approximators for Distributions over Quantum States

arXiv:2605.28690v3 Announce Type: replace-cross Abstract: Many applications in quantum simulation, quantum chemistry, and quantum machine learning require not a single quantum state but an ensemble of states characterizing the heterogeneity of a target system. Preparing such ensembles state-by-state is prohibitive in both variational and fault-tolerant settings, thereby motivating a generative modeling approach. We introduce latent-conditioned parameterized quantum circuits (LPQCs), a hybrid quantum-classical framework in which classical neural networks map a latent variable sampled from a prior distribution to the parameters of a parameterized quantum circuit. We prove that LPQCs are universal approximators for probability measures over density operators in the 1-Wasserstein distance, extending classical universal approximation theorems to the quantum-distribution setting. We additionally introduce a multimodal latent prior and a mixture-of-experts circuit architecture, and show empirically that the latent-conditioned parameterization alleviates the barren plateau problem during optimization, a behavior for which we provide rigorous partial guarantees. Numerical experiments validate the framework on a synthetic multi-cluster ensemble of mixed quantum states and on a QM9-derived ensemble of 3-D molecular structures. In these tasks, LPQC outperforms recent quantum generative baselines and matches the generation quality of a classical neural-network baseline, while requiring an output dimension that grows only linearly with the number of qubits rather than exponentially. By leveraging classical expressivity in the latent space, LPQCs offer a tractable route to quantum generative modeling.