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01.
bioRxiv (Bioinfo) 2026-06-20

SAbDab2: The structural antibody database in the age of machine learning

The Structural Antibody Database (SAbDab) is a publicly available repository of experimentally determined antibody structures, first released in 2013. Explicit support for single-domain antibodies was added in 2021, with SAbDab-nano. Recently, increasing interest in antibodies has led to a proliferation of novel antibody formats, while simultaneous advances in machine learning have increased demand for standardised, high-quality structure data. Here, we present SAbDab2, re-engineered for the machine-learning age. It introduces support for a variety of new formats, and makes it easy to retrieve and compare all known structures of a given antibody. In addition, SAbDab2 provides ready access to ML-grade structures of antibody and antibody–antigen-complexes, with standardised, versioned train/test splits. These will be updated every six months going forward, and are available at https://zenodo.org/records/20083995. SAbDab2 itself is updated weekly and is freely available at https://sabdab2.opig.stats.ox.ac.uk.

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

Anti-causal domain generalization: Leveraging unlabeled data

arXiv:2602.17187v2 Announce Type: replace-cross Abstract: The problem of domain generalization concerns learning predictive models that are robust to distribution shifts when deployed in new, previously unseen environments. Existing methods typically require labeled data from multiple training environments, limiting their applicability when labeled data are scarce. In this work, we study domain generalization in an anti-causal setting, where the outcome causes the observed covariates. Under this structure, environment perturbations that affect the covariates do not propagate to the outcome, which motivates regularizing the model's sensitivity to these perturbations. Crucially, estimating these perturbation directions does not require labels, enabling us to leverage unlabeled data from multiple environments. We propose two methods that penalize the model's sensitivity to variations in the mean and covariance of the covariates across environments, respectively, and prove that these methods have worst-case optimality guarantees under certain classes of environments. Finally, we demonstrate the empirical performance of our approach on a controlled physical system and a physiological signal dataset.

03.
medRxiv (Medicine) 2026-06-12

Effect of tenofovir on the outcomes of COVID-19 in persons with chronic hepatitis B: a nationwide cohort study in Sweden.

Background: Patients with chronic hepatitis B (CHB) may have an increased risk of severe COVID-19. Tenofovir has been hypothesized to confer protection against severe disease, but evidence is inconclusive. We evaluated the risk of severe COVID-19 among CHB patients treated with tenofovir compared with other nucleos(t)ide analogues (NAs). Methods and findings: In this nationwide, registry-based cohort study, we included all adults with CHB and laboratory-confirmed COVID-19 in Sweden between February 2020 and July 2022. Data from national health and socioeconomic registers were linked using unique personal identification numbers (PINs). Patients with HIV, hepatitis C, or hepatitis D coinfection were excluded. Exposure was defined as tenofovir versus other NA therapy. The primary outcome was severe COVID-19, defined as hospitalization >2 days or death within 30 days of diagnosis. Logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI), controlling for age, sex, comorbidities, vaccination, socioeconomic status, and region of birth. Among 5,877 CHB patients with COVID-19, 672 were receiving NA therapy (437 tenofovir, 235 other NAs). Severe COVID-19 occurred in 8.0% of tenofovir-treated patients and 14.5% of those receiving other NAs (unadjusted OR 0.52; 95% CI, 0.31-0.85). After adjustment, the association was attenuated and no longer significant (aOR 0.72; 95% CI, 0.39-1.31). Older age, comorbidities, and unvaccinated status were strongly associated with severe disease. Conclusions: The apparent protective effect of tenofovir against severe COVID-19 in unadjusted analyses was largely explained by confounding factors. The risk of severe disease was primarily driven by age, comorbidities, and vaccination status. Prevention of severe COVID-19 in patients with CHB should instead focus on vaccination and management of comorbidities.

04.
arXiv (CS.CL) 2026-06-18

Evaluating Prompting-Based Defenses Against Domain-Camouflaged Injection Attacks

作者:

Domain-camouflaged injection attacks embed malicious instructions in retrieved content using domain-appropriate vocabulary, evading standard detectors that rely on syntactic injection markers. When detection fails, practitioners need to know which defense architectures reduce attack success. We evaluate five prompting-based defenses (spotlighting, paraphrasing, prompt sandwiching, and two combinations) against domain-camouflaged injection across three model families (Claude Haiku, Llama 3.1 8B, Gemini 2.0 Flash) and three deployment domains (financial, legal, general) using 3,510 trials. Paraphrasing retrieved content before agent processing is the most consistently effective defense in this benchmark, reducing camouflage attack success rate by 55-84\% depending on model, and achieves lower attack success rates than our Llama Guard 4 configuration on every model tested. Defense effectiveness is strongly model-dependent: spotlighting halves attack success on Claude Haiku but provides no benefit on Llama 3.1 8B. Financial domain deployments face the highest residual risk at 26-33\% baseline attack success rate, with no prompting-based defense fully eliminating the threat on weaker models. These results provide the first systematic evaluation of prompting-based defenses specifically against camouflage-class injection attacks and establish benchmark-based recommendations for practitioners. All tasks use synthetically constructed professional documents; whether these benchmark rankings generalize to real enterprise documents remains an open question.

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

Rolling Stock Planning Using the Quantum Approximate Optimization Algorithm

arXiv:2606.11383v1 Announce Type: new Abstract: Rolling stock planning is a complex optimization problem in railway management that involves assigning physical trains to scheduled trips while minimizing operational costs. In this work, we address a specific instance of this problem featuring 190 trips over two days, subject to constraints such as mandatory maintenance stops. We reformulate the problem as a Maximum-Weight Independent Set (MWIS) problem on a graph where nodes represent feasible train cycles. To handle the computational complexity of the large search space, we propose a hybrid divide-and-conquer algorithm. This approach iteratively selects subgraphs and solves the MWIS problem using various solvers, including exact classical methods and the Quantum Approximate Optimization Algorithm (QAOA). We evaluate the algorithm's performance by comparing these methods and analyzing the scaling with respect to subgraph size, with QAOA assessed through both classical simulation and execution on a quantum device (IQM Emerald). Our results indicate that increasing the subgraph size generally improves solution quality, demonstrating that the hybrid framework can effectively bridge the gap between polynomial-time approximate solvers and exponential-time exact methods.

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

Self-Questioning Vision-Language Models: Reinforcement Learning for Compositional Visual Reasoning

Vision-Language Models (VLMs) are AI systems that process both images and text, yet they often struggle with compositional visual reasoning questions that require chaining multiple steps together, such as identifying objects, counting them, and comparing the results. Existing approaches improve this reasoning by training models on human-written step-by-step explanations, but creating these annotations is expensive and difficult to scale. We propose a self-questioning framework that trains a VLM to break visual questions into smaller sub-questions and answer each one before producing a final response, using a reinforcement learning algorithm called Group Relative Policy Optimization (GRPO). The model is never shown examples of how to decompose questions, it discovers this behavior on its own, guided by a reward signal that scores whether the output contains sub-questions and whether the final answer is correct. We apply this framework to a 3-billion-parameter model, training on both synthetic scenes of geometric shapes (CLEVR) and real-world photographs (A-OKVQA). On A-OKVQA, both self-questioning and standard reinforcement learning substantially improve accuracy over the untrained model (52.2% and 51.6% vs. 46.8%). We introduce the first self-questioning VLM by rewarding not only the final answer like standard RL but additionally for generating intermediate sub-questions, enabling it to discover compositional decomposition strategies. These results suggest that teaching AI systems to ask themselves intermediate questions is a promising strategy for complex visual reasoning, particularly when the difficulty of a question warrants explicit step-by-step decomposition.

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

Editorial Alignment: A Participatory Approach to Engaging Editorial Expertise in LLM-mediated Knowledge Dissemination

arXiv:2606.20258v1 Announce Type: cross Abstract: The emergence of LLM-driven information services is reshaping the conditions under which public knowledge institutions operate, threatening to absorb the editorial function these institutions exist to exercise. While LLMs offer powerful new affordances for knowledge dissemination, editorial authority is challenged by pretrained LLMs that arrive already aligned with the values and dissemination strategies of their commercial developers. This paper investigates editor participation in re-aligning LLM interfaces to editorial standards through design workshops, in a case study where we design and implement an LLM-enabled encyclopedia interface with a Nordic public knowledge institution. We introduce editorial alignment as a design practice within Participatory AI, framing AI alignment as a design process and positioning the editorial standard as a design artefact that translates editorial practice and values into alignment objectives for technical implementation. Last, we discuss how editorial alignment can create space for ongoing participation and give editors agency in LLM-mediated knowledge dissemination.

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

Fun with Graph States: Nonlocal Bell Pairs and the Arf Invariant

arXiv:2606.06582v2 Announce Type: replace Abstract: We study inner products and partial amplitudes of graph states–a commonly employed class of quantum states, which are specified by graphs. We find that the magnitudes of these quantities are simply related to the rank of the adjacency matrix of the graph over F_2 while the phase is determined by the Arf invariant of its quadratic refinement. These facts motivate a nonlocal tensor factorization of the Hilbert space, with respect to which all graph states are products of Bell pairs with unentangled ancillae. These results may illuminate the quantum advantage in the framework of Measurement-Based Quantum Computation and suggest that graph states can be usefully visualized in the language of algebraic topology. In addition, we develop a specialized technique for computing expectation values of qubit-wise permutations in graph states, which is useful for calculating multi-invariants.

09.
arXiv (quant-ph) 2026-06-15

Scaling native entanglement generation in layered semiconductors with quasi-phase matching

arXiv:2606.14553v1 Announce Type: new Abstract: Efficient generation of entangled photons typically relies on spontaneous parametric down-conversion (SPDC) in phase-matched macroscopic nonlinear media. However, generating entanglement under phase-matching constraints requires additional bulk optics or interferometers. In contrast, ultrathin van der Waals semiconductors - such as transition metal dichalcogenides (TMDs) - exhibit strong enough optical nonlinearities for SPDC to be observed from subwavelength-thick media, thereby bypassing conventional phase-matching constraints. In this microscopic domain, the intrinsic crystal symmetry governs the nonlinear optical response, enabling the native generation of polarization-entangled photon pairs. However, generating these states efficiently has been fundamentally restricted by the material's coherence length ($L_c$), which limits the attainable conversion efficiency. Here, we investigate periodically-poled TMDs (PPTMDs) designed to scale up this interaction via quasi-phase matching. We demonstrate that mechanically flipping the sign of the nonlinearity at precise intervals of $L_c$ introduces quasi-phase matching, that scales the pair-production rate while preserving the pristine, symmetry-generated polarization entanglement, with fidelities exceeding 99%. Backed by a rigorous theoretical model, our work clarifies the interplay between crystal symmetry and propagation effects in thin nonlinear media, providing a new avenue for engineering quantum light in nanophotonic systems.

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

Compatibility-Aware Dynamic Fine-Tuning for Large Language Models

Supervised Fine-Tuning (SFT) is the predominant paradigm for aligning large language models (LLMs), yet it suffers from optimization instability and limited generalization. Recent work attributes this issue to pathological gradient scaling and proposes Dynamic Fine-Tuning (DFT) to correct it at the token level. However, DFT assumes all demonstrations are equally suitable learning targets, an assumption violated by the strong heterogeneity of large-scale instruction data, where demonstration-policy mismatch induces high-variance updates at the sample level. We introduce Compatibility-Aware Dynamic Fine-Tuning (CADFT), a principled extension of DFT that controls sample-level optimization variance. CADFT derives a dynamic, policy-dependent compatibility signal from model likelihoods to modulate supervised updates, suppressing high-variance gradients from incompatible demonstrations. We further propose a delayed, low-frequency compatibility-guided rewriting strategy to transform persistently incompatible demonstrations into learnable targets. We show that CADFT can be interpreted as a variance-controlled estimator that generalizes token-level stabilization in DFT to the sample level. Extensive experiments demonstrate improved stability, generalization, and cold-start reinforcement learning initialization, while remaining fully supervised and independent of explicit reward modeling.

11.
arXiv (CS.AI) 2026-06-19

PrefSQA: Pairwise Preference Prediction for Speech Quality Assessment and the Critical Role of High Quality Datasets

arXiv:2606.19597v1 Announce Type: cross Abstract: Mean opinion scores (MOS) are widely used for speech quality assessment, yet scalar labels are sensitive to rater variability and listening test differences. This introduces labeling noise, which limits the reliability of MOS prediction. Preference prediction reduces this variability as listeners compare signals directly, producing cleaner labels. We study MOS-free preference prediction and propose PrefSQA, which incorporates uncertainty-aware logits, an impairment attention head, and a module based on non-matching-reference comparisons. We use and refine five datasets, including MOS-derived and low-noise simulated sets with matching and non-matching content, experiment with human preference sets, and test on unseen data. Experiments show small improvements on MOS-derived data, while other sets reveal clear improvement over the baselines, highlighting the value of high-quality preference data and demonstrating the effectiveness of the proposed method.

12.
arXiv (CS.CV) 2026-06-16

DLWM: Diverse Latent World Models for Efficient Multimodal Reasoning

Reasoning capabilities of multimodal large language models (MLLMs) have improved considerably in recent years. Existing approaches typically rely on explicit chain-of-thought or continuous latent-space trajectories to enhance multi-step reasoning. However, these methods generally assume that an input admits a single latent interpretation and unfold reasoning along a fixed path or under a uniform computation budget. In real-world multimodal settings, visual observations are often subject to occlusion, blur, viewpoint variation, or semantic ambiguity, giving rise to multiple plausible interpretations. A uniform reasoning strategy not only limits the model's ability to explore multiple hypotheses but also incurs high memory usage and rollout cost. We present DLWM (Diverse Latent World Models), a multimodal reasoning framework that combines latent-space reasoning with reinforcement learning. First, we construct a set of diverse latent world hypotheses in continuous latent space, each capturing a different plausible interpretation of the visual input, and unfold latent reasoning independently on each hypothesis. An orthogonality-based diversity regularizer explicitly prevents hypothesis collapse. Second, we formulate the latent reasoning process as a resource-constrained sequential decision problem and introduce a resource-aware reinforcement learning policy that adaptively allocates computation across hypotheses, dynamically deciding whether to expand, terminate, or merge reasoning paths, thereby substantially reducing memory footprint and improving rollout efficiency. Experiments on multiple multimodal reasoning benchmarks demonstrate that DLWM outperforms existing methods by 2-5 points in accuracy while reducing memory usage by 24%.

13.
arXiv (CS.CL) 2026-06-11

Soft-Prompt Tuning for Fair and Efficient LLM Benchmark Evaluation

Benchmark scores often misrepresent a large language model's (LLM's) knowledge, because they rely, e.g., on the model's ability to follow specific formatting requirements. This especially penalizes base models that may know the correct answers but lack the ability – typically introduced in post-training – to structure them as instructed. To overcome this, we propose soft-prompt tuning, an efficient, fair, and architecture-agnostic model evaluation. By optimizing only 10 soft-prompt vectors (roughly 0.0006% parameters for a 7B model) over a short tuning period, we adapt models to specific benchmark formats, closing gaps in format-following and ensuring that underlying knowledge is accurately reflected in benchmark scores. This allows one to fairly compare different base models – trained with various pre-training recipes – on benchmarks without the need for full post-training. We evaluated soft-prompt tuning across 7 models and 7 datasets. The results show that (a) soft-prompt tuning saturates format-following within 80 steps (~640 samples) making it highly efficient, (b) soft-prompt tuning significantly outperforms zero- and few-shot prompting, surfacing base model knowledge that standard prompting misses, that (c) even post-trained models can benefit from soft-prompts to maximize format compliance, and that (d) soft-prompted base model performance predicts post-trained model rankings more reliably than zero- and few-shot baselines, offering a low-cost proxy for downstream model quality. Our contributions include (1) metrics which disentangle format-following and knowledge accuracy, (2) a fairer benchmarking protocol of LLM knowledge, and (3) a cost- and memory-effective recipe to identify optimal pre-training strategies early in LLM development.

14.
arXiv (CS.CV) 2026-06-19

InfantFace: Detecting infant faces in neonatal clinical environments

Reliable localisation of the neonatal face is the first step for several video-camera based non-contact assessments such as pain and distress related facial expression analysis, pain scoring, cardiorespiratory signal extraction and cessation of breathing alerts. However, major challenges persist in neonatal clinical environments. Cluttered backgrounds, illumination changes and poor lighting conditions can reduce the accuracy of face detection models. Clinical interventions, monitoring equipment and, in some cases, medical devices can obstruct the face, making visual assessment difficult. We propose a one-stage YOLOv11m-based model tailored for face detection of infants in neonatal clinical environments. We combined multiple publicly available datasets (VGGFace2, CelebA, FDDB, WIDER FACE) to train and evaluate our proposed model. We then fine-tuned our model on a neonatal research dataset involving 228 videos from 114 recording sessions of 113 independent infants. Before fine-tuning, our model achieved an AP50 of 0.87, surpassing the performance of three state-of-the-art general face detectors. Performance improved further to an AP50 of 0.96 after clinical-domain adaptation. Evaluating face detection performance across different datasets remains a challenge due to the lack of publicly available neonatal datasets. Prioritising the creation of such datasets, while upholding appropriate privacy safeguards and ethical standards in their creation and use, would greatly support further progress in this field.

15.
arXiv (CS.CL) 2026-06-12

Influcoder: Distilling Decoders' Gradient Influence Rankings into an Encoder for Data Attribution

With the growth of LLMs' (Large Language Models) capabilities, there has been an increasing push to curate high quality datasets by filtering samples in the training data. In general, Data Attribution (DA) methods aim to estimate how individual samples in a training dataset can precondition a model to generate certain outputs. As an example, one might be interested in which samples in the data could be the source of toxic behavior after training the LLM. Many methods quantify this conditioning through the paradigm of influence functions. While methods of this family are effective in its function, they lack the necessary processing speed and storage compactness to be practically implemented on large datasets. We propose a method, Influcoder, as a quick and cost-effective approach to influence-based Data Attribution at scale.

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

Counterfactual Optimization of Baseball Pitch Sequences and Estimation of Its Impact on Season-Level Statistics

arXiv:2606.17345v1 Announce Type: cross Abstract: Although pitch sequencing is a central topic in baseball analytics, previous studies have primarily focused on optimizing the final pitch within a single plate appearance, leaving the role of preceding setup pitches and their impact on long-term season-level performance insufficiently examined. To address these issues, this study conducted counterfactual analyses using MLB Statcast data. A Transformer-based machine-learning model was trained to predict whether a target pitch would result in an in-play outcome or swing-out. Counterfactual pitch sequences were then generated by replacing either the final pitch or the preceding setup pitch with alternative pitch types and locations while keeping the surrounding contextual information fixed. Optimal counterfactual selections were defined as those that minimized the predicted in-play probability, and their expected effects on pitchers' seasonal statistics were estimated using regression models linking model outputs to season statistics. The results suggest that the optimization of both final and setup pitches may substantially influence season-level performance, including improvements of more than 1.0 in K/9. The analyses also provided several practical insights, including velocity-band-specific effective locations, the importance of pitch commands, and the expansion of pitch-selection options through middle-velocity pitches. These findings quantitatively support the strategic importance of pitch sequencing in baseball.

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

An Empirical Study on Learning Latent Representations for Emotional Speech Synthesis

For the last couple of years, the field of speech synthesis has improved dramatically thanks to deep learning. There are more and more deep learning-based TTS systems developed to make it possible to produce voices with high intelligibility and naturalness. Meanwhile, controlling the expressiveness is yet a big deal, generating speech in different styles or manners has received a lot of attention from community recently. This paper aims to give our solutions to deal with the task emotional speech synthesis (ESS) at VLSP 2022 which allows to generate humanlike natural-sounding voice from a given input text with desired emotional expression. By integrating speaker embedding, prosody bottleneck into FastSpeech 2, our systems can promisingly generate emotional speech of a single speaker (Sub-task 1), transfer speaking styles from another speaker to the target speaker with neutral non-expressive data while retaining the target speaker's identity (Sub-task 2).

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

Geometry-Preserving Encoder/Decoder in Latent Generative Models

arXiv:2501.09876v4 Announce Type: replace-cross Abstract: Generative modeling aims to generate new data samples that resemble a given dataset. When using diffusion models for this task, one of the main challenges is solving the problem in the input space, which tends to be very high-dimensional. To address this, recent approaches solve diffusion models in the latent space through an encoder that maps from the data space to a lower-dimensional latent space, improving training efficiency and achieving state-of-the-art results. The variational autoencoder (VAE) is the most commonly used encoder/decoder framework in this domain, known for its ability to learn latent representations and generate data samples. In this paper, we introduce a novel encoder/decoder framework with theoretical properties distinct from those of the VAE, specifically designed to preserve the geometric structure of the data distribution. We demonstrate the significant advantages of this geometry-preserving encoder in the training process of both the encoder and decoder. Additionally, we provide theoretical results proving convergence of the training process, including convergence guarantees for encoder training, and results showing faster convergence of decoder training when using the geometry-preserving encoder.

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

From Agent Traces to Trust: A Survey of Evidence Tracing and Execution Provenance in LLM Agents

arXiv:2606.04990v2 Announce Type: replace-cross Abstract: Large language model (LLM)-based agents are evolving from passive text generators into autonomous systems capable of planning, tool use, retrieval, memory access, environmental interaction, and multi-agent collaboration. These capabilities expand agent autonomy, but also make agent behavior harder to verify, debug, and audit. Final-answer accuracy alone cannot explain how an output was produced, which evidence supported each claim, whether tool calls were justified, how memory influenced later decisions, or where failures originated. This survey examines evidence tracing and execution provenance as foundations for process-level accountability in trustworthy LLM agents. We define execution provenance as the typed graph of an agent execution and evidence tracing as its projection onto evidence-support relations. This perspective connects retrieval grounding, claim support, tool-use safety, memory lineage, observability, debugging, audit, and recovery within a unified framework. We introduce a taxonomy covering trace sources, evidence and execution units, provenance relations, tracing granularity and timing, representation forms, and trust functions. We then review key methodological directions, including provenance representation, evidence attribution, tool-use provenance, runtime guardrails, provenance-bearing memory, observability, and failure diagnosis. Finally, we discuss benchmarks, datasets, metrics, and open challenges for building provenance-aware, auditable, and recoverable agent systems.

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

Model Stealing Through the Lens of Model Multiplicity

arXiv:2606.15493v1 Announce Type: new Abstract: Model stealing attacks, where adversaries create high-fidelity surrogate models, are a significant threat to the intellectual property of machine learning services. Conventional wisdom suggests these surrogates could provide adversaries with economic leverage comparable to the original service providers. This paper challenges this assumption by evaluating model stealing attacks beyond mere fidelity to the target model. Because query-based extraction provides only partial supervision of the target's input-output behavior, the surrogate is not uniquely identified: many near-optimal surrogates can achieve comparable fidelity while differing in deployment-relevant properties. Instead of performing a classic learning-based model stealing attack, we compute the Rashomon Set (i.e., the set of almost-equally-accurate models) of surrogate models, and evaluate its diversity using multiplicity metrics (ambiguity, discrepancy, and Rashomon Capacity) and group fairness metrics. Across tabular, medical imaging, and NLP tasks, our experiments on real-world datasets reveal that despite exhibiting similar fidelity to the target model, surrogate models can display significant variances in other critical performance metrics. These findings cast doubt on the presumed equivalence between high-fidelity surrogates and the target model in practical deployment scenarios.

21.
medRxiv (Medicine) 2026-06-15

Quantitative Gait Categorization in Parkinson's Disease with and without Freezing of Gait

Background: Freezing of gait (FOG) is a disabling and often underrecognized feature of Parkinsons disease (PD). Objective gait analysis may improve characterization of this motor symptom. Objective: To compare quantitative 3D gait parameters in PD with FOG (PDF) and PD without FOG (PDNF) in a routine clinical cohort. Methods: We retrospectively analyzed a sequential sample of 180 patients with PD referred for motion analysis between 2020 and 2024. All patients underwent 3D motion capture in the off-medication state. Eighteen gait outcomes spanning pace, rhythm, postural control, variability, and asymmetry domains were derived from steady-state walking tasks. FOG status was determined using physician documentation and Movement Disorder Society Unified Parkinsons Disease Rating Scale (MDS-UPDRS) items. Group differences between PDF (n=99) and PDNF (n=81) were evaluated using independent samples t-tests, with outcomes adjusted for disease duration and corrected for multiple comparisons. A secondary analysis among PDF compared those in Hoehn and Yahr (H&Y) stage [≥]III to those in H&Y [≤]II. Results: PDF had longer disease duration, higher OFF MDS-UPDRS III scores, and higher Hoehn and Yahr stage than PDNF but were similar in age and sex. After adjusting for disease duration and multiplicity, PDF demonstrated reduced step length, stride length, and forward velocity, and greater cadence variability, while most postural control, and asymmetry measures were comparable between groups. Among PDF, advanced H&Y stage was associated with impaired pace and rhythm, similar to previous reports among PD in general. Conclusion: In this large, sequential, clinically referred cohort, FOG was associated with more advanced PD and specific impairments in pace and gait variability. These findings support comprehensive 3D gait analysis as an objective tool to better delineate FOG-related gait abnormalities and identify features that may predict FOG, informing targeted interventions.

22.
medRxiv (Medicine) 2026-06-11

Wealth-Related Inequalities in Cesarean Section Utilization Among Facility-Based Births in Bangladesh: Evidence from Public and Private Healthcare Facilities

作者:

Background Bangladesh has experienced a rapid increase in cesarean section (CS) utilization over the past two decades. While previous studies have documented socioeconomic disparities in CS use, evidence on how wealth-related inequalities differ between public and private healthcare facilities remains limited. This study assessed the magnitude and drivers of socioeconomic inequality in CS utilization among facility-based births in Bangladesh. Methods We analyzed data from 3,008 facility-based births reported in the 2022 Bangladesh Demographic and Health Survey (BDHS). Survey-weighted multivariable logistic regression was used to identify factors associated with CS utilization. Wealth-related inequality was assessed using concentration curves and the Erreygers-corrected concentration index (ECCI). Regression-based decomposition of the standard concentration index was performed to quantify the contribution of socioeconomic, demographic, and healthcare-related factors to observed inequalities overall and separately for public and private facilities. Results Overall, 71.2% of facility-based births were delivered by CS, with substantially higher prevalence in private facilities (84.2%) than in public facilities (35.9%). Women delivering in private facilities had markedly higher odds of CS than those delivering in public facilities (adjusted odds ratio [AOR]: 9.07; 95% confidence interval [CI]: 7.17-11.47). Significant pro-rich inequality was observed overall (ECCI: 0.154; 95% CI: 0.117-0.191), with inequality substantially greater in public facilities (ECCI: 0.189; 95% CI: 0.114-0.264) than in private facilities (ECCI: 0.049; 95% CI: 0.014-0.084). Decomposition analysis showed that household wealth was the dominant contributor to inequality, particularly the richest wealth quintile, accounting for 81.5% of overall inequality, 63.8% in public facilities, and 109.7% in private facilities. Conclusions Wealth-related inequalities in CS utilization remain substantial in Bangladesh despite widespread use of the procedure. Although pro-rich inequality exists across both sectors, inequality is considerably greater in public facilities and is driven by different mechanisms across facility types. Policies should simultaneously improve equitable access to medically necessary CS and reduce unnecessary procedures, particularly within the private sector.

23.
medRxiv (Medicine) 2026-06-22

Artificial Intelligence-Enabled Cardiac Function Estimation from Phone Videos of Echocardiograms

Importance: Mobile phone-recorded echocardiogram videos are commonly used in point of care, telemedicine, and resource-limited workflows, but artificial intelligence models for left ventricular ejection fraction (LVEF) estimation have primarily been evaluated on native Digital Imaging and Communications in Medicine (DICOM) videos. Objective: To evaluate whether previously described artificial intelligence models for LVEF estimation retain performance when applied to mobile phone-recorded echocardiographic videos. Design: Multicenter model validation study comparing model-estimated LVEF with clinician reported LVEF. Setting: Three medical centers: Kaiser Permanente Northern California, Beth Israel Deaconess Medical Center through MIMIC-IV-ECHO, and Cedars-Sinai Medical Center. Participants: Source studies with clinician reported LVEF and apical 4-chamber or apical 2-chamber views, yielding 6209 phone-recorded videos from 2648 studies and 2611 patients. Exposures: Mobile phone recording of native echocardiographic videos and fine-tuning of pretrained models using mobile phone-recorded videos from the Kaiser Permanente Northern California training cohort. Main Outcomes and Measures: Mean absolute error in ejection fraction percentage points, R^2 for continuous estimation, and area under the receiver operating characteristic curve for identifying ejection fraction greater than 50%. Results: The study included 6209 mobile phone recorded echocardiographic videos from 2648 studies and 2611 patients; the weighted mean age was 68.4 years, and 1031 patients were male (39.5%). Without phone-video fine-tuning, the primary model achieved a mean absolute error of 7.00 percentage points, coefficient of determination of 0.49, and area under the receiver operating characteristic curve of 0.91 on phone-recorded videos; corresponding native DICOM performance was 6.08 percentage points, 0.60, and 0.93, respectively. On the 2396-video fine-tuning evaluation cohort, fine-tuning improved primary model performance to a mean absolute error of 6.96 percentage points, coefficient of determination of 0.61, and area under the receiver operating characteristic curve of 0.93. Fine-tuning the public EchoNet-Dynamic model improved performance from 9.36 percentage points, 0.37, and 0.84 to 7.86 percentage points, 0.50, and 0.89, respectively. Progressive central zoom preprocessing degraded model performance. Conclusions and Relevance: These findings suggest that artificial intelligence assisted left ventricular ejection fraction estimation from mobile phone-recorded echocardiograms may be feasible when native image export is unavailable, although prospective evaluation is needed before clinical deployment.

24.
arXiv (CS.AI) 2026-06-16

PO-PDDL: Learning Symbolic POMDPs from Visual Demonstrations for Robot Planning Under Uncertainty

arXiv:2606.15654v1 Announce Type: cross Abstract: Real-world robot task planning must operate under both stochastic action execution and partial observability, yet constructing Partially Observable Markov Decision Process (POMDP) models for real robotics domains remains difficult and labor-intensive. We introduce PO-PDDL, a symbolic formulation of POMDPs that preserves the relational structure and LLM-friendly syntax of the Planning Domain Definition Language (PDDL), while explicitly modeling partial observability, stochasticity, and beliefs. Building on this formulation, we propose a demonstration-driven pipeline for learning PO-PDDL models. The proposed method reconstructs latent symbolic state trajectories from real-robot execution videos, identifies partial observability via inconsistencies between inferred states and visual observations, and learns stochastic transition and observation models accordingly. The resulting PO-PDDL domains are reusable across tasks and enable online belief-space planning under both perception and execution uncertainty. Experiments on real-world long-horizon manipulation tasks show that our method consistently outperforms existing PDDL and POMDP model-learning approaches, achieving robust task planning under uncertainty with significantly lower planning cost.

25.
medRxiv (Medicine) 2026-06-11

Plasma protein prioritisation in rheumatoid arthritis reveals druggable targets and shared biology with cardiovascular diseases

Abstract Background Rheumatoid arthritis (RA) is an autoimmune inflammatory disease with complex and incompletely understood molecular mechanisms. Understanding circulating proteins associated with RA may improve understanding of disease biology and clarify its pathological links with cardiometabolic comorbidities. Methods A proteome-wide two-sample Mendelian randomisation (MR) drug target analysis was conducted using plasma proteins measured in 54,219 participants from the UK Biobank Pharma Proteomics Project as exposures and RA and cardiometabolic diseases as the outcomes. Summary statistics for RA included 53,663 cases and 1,070,200 controls. Colocalisation analysis was performed to confirm shared single causal variants and prioritise RA proteins supported by both MR and colocalisation. The prioritised proteins were then evaluated in the Accelerating Medicines Partnership RA Phase II synovial single-cell dataset for cell-type expression patterns. Druggability was then assessed followed by analysis of genetic overlap between RA-associated proteins and cardiometabolic diseases. Results 37 plasma proteins had a causal effect on RA risk, supported by combined evidence from MR and conditional colocalisation. In synovial tissue, TPPP3, RARRES2, AKAP12, and GGT5 were predominantly expressed in stromal and endothelial cell clusters. Druggability assessment identified IFNGR2, IL6R, CD40, and FCGR2B as Tier 1 targets. However, several biologically relevant proteins, including RARRES2, AKAP12, TPPP3, and SNX2, had limited available druggability data. Genetic overlap analysis demonstrated shared protein signals between RA and cardiovascular diseases, including overlap of RARRES2 and TPPP3 with coronary artery disease (CAD) and FCGR2B with atrial fibrillation (AF). To approximate the therapeutic effect of target inhibition, the direction of effect estimates for proteins showing overlap between RA-CAD and RA-AF was reversed. Conclusion This study identified circulating proteins involved in RA pathogenesis and reveals shared mechanisms between RA and cardiovascular diseases. While some proteins showed clear translational potential targets, several prioritised proteins had limited available druggability information and could not be confidently classified. Addressing these gaps may help identify new targets relevant to RA management. Future work should also use phenome-wide MR studies to evaluate potential on-target adverse effects of protein inhibition across RA-CAD and RA-AF.