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01.
PLOS Medicine 2026-06-01

The NIH 2025 Public Access Policy: Immediate access, unequal costs

by Caitlin R. Ryus, Caroline Raymond King, Edward R. Melnick The NIH 2025 Public Access Policy eliminates embargo periods for federally funded research, expanding who can read science. Yet without addressing article processing charges and market concentration, the policy risks creating new barriers to who can afford to perform and publish their science. In this Perspective, Caitlin Ryus and colleagues discuss the NIH 2025 Public Access Policy, highlighting that while expanding who can read science, the policy risks creating new barriers to who can afford to perform and publish their science.

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

Cluster LOCO: Feature Importance For Interpreting Clusters

arXiv:2606.14592v1 Announce Type: cross Abstract: Clustering is widely used for exploratory analysis and scientific discovery, driving insights from market segmentation to biological data analysis, but its outputs can be difficult to interpret, audit, and reproduce as modern datasets become increasingly large and complex. Reliable use of clustering requires understanding which features drive the discovered structure, yet feature-level explanations for clustering remain scarce compared with methods in supervised learning. Furthermore, existing clustering feature importance scores are often tied to specific algorithms and data assumptions. To address these challenges, we propose Cluster LOCO (Leave-One-Covariate-Out), a family of model-agnostic feature importance scores for clustering. Cluster LOCO is built on feature occlusion and clustering generalizability, defined as whether cluster labels learned on one subset of the data can be accurately predicted on held-out samples. For any chosen clustering algorithm, Cluster LOCO quantifies a feature's importance by measuring how much its removal degrades generalizability. We first introduce Cluster LOCO-Split, which relies on data splitting, and then extend it to Cluster LOCO-MP, a minipatch ensemble-based version designed for large-scale data. Across synthetic simulations and an application to cell-type discovery in single-cell transcriptomics, we show that Cluster LOCO more reliably recovers informative features than existing clustering feature importance methods.

03.
arXiv (CS.AI) 2026-06-19

FlowFake: Liquid Networks for Audio Deepfake Detection

arXiv:2606.19579v1 Announce Type: cross Abstract: Audio deepfakes generated by neural text-to-speech and voice-cloning systems threaten speaker verification and public discourse at scale. The core challenge is cross-dataset generalization: detectors trained on one synthesis pipeline collapse on unseen forgeries. We argue that this failure is primarily because of structural synthetic speech artifacts which are multi-timescale trajectory anomalies. Though every existing detector aggregates a fixed-window frame statistics, this misaligns the architecture with the signal. We propose FlowFake, a Liquid Time-Constant (LTC) architecture whose hidden state evolves via a learned ODE, with per-neuron adaptive time constants simultaneously resolving spectral (10ms) and prosodic (2s) cues. At only 34K parameters FlowFake achieves formal BIBO stability and O(dt^4) integration error. On a four-dataset cross domain benchmark (ASVspoof2019-LA, FakeOrReal, InTheWild, MLAAD), FlowFake reaches 75.29% on ASVspoof2019 trained only on FakeOrReal and 79.97% trained only on MLAAD. It outperforms RawGAT-ST and Whisper-DF on every evaluated pair and matching SSL Wav2vec2 (300x larger) at 0.01% of its parameter count. The source code is available on : https://github.com/GhostRider2023/FlowFake

04.
medRxiv (Medicine) 2026-06-15

Epileptogenicity alters intrahippocampal ripple propagation

Objective: Tracing the propagation of high-frequency oscillations (HFOs) aids in localizing epileptogenic regions and improving surgical outcomes. We examined how hippocampal epileptogenicity influences the propagation properties of the HFOs it generates. Methods: We analyzed non-REM sleep stereo-EEG from 49 patients (68 hemispheres) with verified hippocampal contacts. Hippocampi were stratified by excitability: 28 seizure onset zone (SOZ), 22 more-irritative non-SOZ (>6 interictal epileptiform discharges [IED]/min), and 18 less-irritative non-SOZ (

05.
arXiv (CS.CL) 2026-06-16

AdaPLD: Adaptive Retrieval and Reuse for Efficient Model-Free Speculative Decoding

Speculative decoding accelerates generation by verifying multiple drafted tokens in a single target-model forward pass, reducing sequential decoding iterations. Model-free variants avoid auxiliary draft models by reusing text and model states already available during generation, but their speedup depends on the reliability of the constructed drafts. We identify two limitations of existing reuse-based methods: lexically anchored retrieval has limited recall under surface-form variation, and deterministic span copying can be brittle when the retrieved context does not uniquely determine the continuation. We propose AdaPLD, a training-free method that adaptively improves both retrieval and draft construction. AdaPLD preserves high-precision lexical reuse while using semantic similarity to recover additional reuse opportunities when lexical matching fails. It further constructs branched reuse hypotheses to account for continuation uncertainty, rather than relying on a single copied span. Across diverse benchmarks, AdaPLD reduces target-model forward passes and achieves up to $3.10\times$ decoding speedup.

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

HorusEye: Language as Dynamic Attention for Emergency Visual Analysis

Authors:

We introduce HorusEye, Language as Dynamic Attention for Emergency Visual Analysis. Our investigation followed five stages. The first one is benchmarking RefCOCO-Degraded, a dataset of 15,244 images (3,811 base images x 4 conditions: Clean, Fog, Smoke and Thermal) with systematic visual degradation. Through four research questions, we evaluate multiple VLMs (Gemini, Qwen2-VL, BLIP-2, LLaVA, Kosmos-2) across visual grounding the second stage, language feedback recovery the third one, health VQA tasks the fourth, and hallucination analysis the final stage. Our key finding is that language feedback effectiveness is model-dependent: Gemini achieves +47.3% improvement in thermal conditions through iterative language feedback, while Qwen2-VL shows -5.1% degradation under the same protocol. We also identify the 'Thermal Paradox' where cropping strategies that improve RGB performance catastrophically fail in thermal imagery. Furthermore, BLIP-2 uniquely hallucinates more under degradation, making it unsuitable for emergency deployment

07.
PLOS Computational Biology 2026-06-12

Stage-dependent role of NEK7 in the inactive-to-active conformational transition of NLRP3 monomer

Authors:

by Jin Peng, Wenjian Li, Hao Wang, Xiaohui Chen, Manjie Zhang, Bin Sun The NLRP3 inflammasome is a multiprotein complex that primes cytokine production in the innate immune system. The inflammasome activation involves the cage-to-disk transition of NLRP3 oligomers, facilitated by the co-factor NEK7 protein. While NEK7’s role in promoting cage disassembly has been reported, its involvement in the large conformational changes of the NLRP3 monomer during activation remains elusive. Here, by using multi-scale simulations, we uncovered a stage-dependent role of NEK7 in the inactive-to-active transition. In the early stage, NEK7 reshapes the dynamics of the highly unstable inactive NLRP3 monomer to resemble active state, priming the conformational transition. In the middle stage, NEK7 impedes progression by populating an intermediate state farther from the active conformation than the NEK7-free counterpart, and structures in this state exhibit reduced allosteric potential toward activation. In the late stage, NEK7 has negligible impact, as the active conformation remains inherently isolated by a high energy barrier regardless of NEK7 presence. This highlights the critical role of oligomeric assembly in enabling monomeric NLRP3 to complete its conformational transition, in agreement with experiment observations. Our work suggests a multilayered activation mechanism where oligomer-level assembly and monomeric conformational changes are coupled, providing new mechanistic insights into this physiologically essential macromolecular process.

08.
arXiv (CS.CL) 2026-06-12

Uncertainty-Aware Hybrid Retrieval for Long-Document RAG

Retrieval augmented generation (RAG) depends critically on the quality and granularity of retrieved evidence. Large retrieval units preserve context but often introduce irrelevant content, which can dilute answer bearing evidence and worsen long context utilization. Fine-grained units are more compact, but they may be difficult to retrieve reliably because short chunks can lack semantic, lexical, or bridging cues needed to match the query. We propose Uncertainty-aware Multi-Granularity RAG (UMG-RAG), a training-free hybrid retrieval framework that treats chunk granularity as query-specific reliability estimation. Instead of training a new retriever or modifying the generator, UMG-RAG uses existing dense and sparse retrievers as complementary experts across multiple chunk granularities. For each query, it converts each expert-granularity score list into an evidence distribution, estimates reliability from distribution entropy, and fuses candidates according to query-specific semantic, lexical, and granularity confidence. We further introduce UMGP-RAG, a parent promotion variant that uses fine-grained hits to locate relevant evidence while returning broader non-redundant parent chunks for local coherence. Experiments on question answering benchmarks show that uncertainty-aware fusion and parent promotion improve generation quality while maintaining a lightweight, plug-and-play retrieval pipeline.

09.
arXiv (CS.CV) 2026-06-11

Making Foresight Actionable: Repurposing Representation Alignment in World Action Models

World Action Models (WAMs) offer a promising route for robot manipulation by using video generation models to model future scene evolution before producing control actions. However, our empirical observations reveal a phenomenon: generating plausible visual futures does not always guarantee the extraction of accurate actions. To diagnose this failure, we conduct action-head attention analysis and causal interventions. We find that the action decoder fails to focus on task-relevant interaction regions and remains sensitive to perturbations in task-irrelevant areas. This reveals a representation mismatch: hidden states optimized for visual reconstruction are not inherently organized in a form useful for low-level action control. In this paper, we propose AGRA, an Action-Grounded Representation Alignment objective that regularizes the world-action interface by aligning intermediate video diffusion features with spatially coherent semantic representations from a foundation visual encoder. We evaluate AGRA on real-world manipulation tasks. Experiments show that AGRA makes world model representations more action-grounded: by focusing the action decoder on the correct interaction regions, it improves object localization accuracy and affordance understanding, and makes the policy more robust to perturbations in task-irrelevant regions. As a result, AGRA consistently improves both in-distribution performance and out-of-distribution generalization over the baseline world action model.

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

Findings of the MAGMaR 2026 Shared Task

This overview paper presents the results of the shared task for the second workshop on Multimodal Augmented Generation via Multimodal Retrieval (MAGMaR). In this shared task participants submitted systems focused on either (i) video retrieval or (ii) grounded generation of articles given retrieved videos. Teams could submit to either task. For the retrieval task, we had 2 participating teams that submitted a total of 17 systems – all of which beat a baseline derived from the winner of last year's shared task. On the generation side, we had 4 teams submit 16 systems. All teams had at least one generated report that was labeled the best by a human annotator.

11.
arXiv (CS.CL) 2026-06-18

Dual Dimensionality for Local and Global Attention

Decoder-only Transformers compute attention over the KV cache of preceding tokens. Keys (and Values) are typically represented with the same dimensionality, regardless of its distance from the prediction target. In natural language, however, the next word is most strongly influenced by the immediately preceding tokens. We hypothesize that local and distant tokens impose asymmetric demands on representational capacity: local tokens are more critical for predicting immediate outputs and thus require richer representations, whereas distant tokens primarily serve as long-range memory, for which lower-dimensional representations may suffice. We formalize this idea as Distance-Adaptive Representation (DAR), implemented in a controlled setting that preserves full-dimensional representations within a local context window while assigning reduced-dimensional representations (e.g. 1/4 of the original dimensionality) to tokens beyond that window. Across multiple pretraining scales (70M to 410M parameters), as well as continued supervised fine-tuning on a 1B-scale model, this approach closely matches the performance of full-dimensional baselines. In contrast, uniformly reducing dimensionality across all token positions leads to worse performance. These results challenge the common assumption that key and value dimensionality should be uniform across token positions. Our findings suggest a new direction for designing attention architectures that adaptively allocate representational capacity across sequences, enabling further reductions in KV cache during inference.

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

Bounded Context Management for Tabular Foundation Models on Stream Learning

arXiv:2606.18677v1 Announce Type: cross Abstract: Tabular stream learning requires predictions on sequentially arriving examples under distribution shift. While standard methods adapt by updating model states, tabular foundation models (TFMs) make predictions conditioned on a labeled context in an in-context manner, making them a natural alternative for stream learning. This shifts the challenge from how to update the model to how to manage the context. We propose a future information view that yields three practical requirements for context management: preserve recent examples, retain uncertain examples, and remove redundant examples. We instantiate these requirements as CURE (Context management via Uncertainty-aware admission and Redundancy aware Eviction), a context-managing policy with entropy-gated admission and redundancy-aware eviction. Across seven streams, CURE shows up to 27.0% relative improvement over classical stream learners, remains robust across multiple TFM backbones, and ranks first among other policy variants. Code and datasets are available at https://github.com/morcellinus/CURE-ICML-FMSD.

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

SceneMiner: Identity-Preserving Multi-Task Fine-Tuning for Unified BEV Scene Mining

Mining hard, safety-critical scenes from driving logs is bottlenecked by the absence of difficulty labels, and no single proxy, collision risk, trajectory ambiguity, or semantic rarity suffices to find such scenes on its own. We present SceneMiner, a unified, camera-only bird's-eye-view pipeline that emits complementary mining signals from a frozen vision-language backbone in a single forward pass, with no LiDAR or radar: a retrieval embedding for text-prompted scenario search, a multi-label scene-tag distribution, and a continuous physics-based risk score (a motion forecast is a byproduct, not a contribution). Building such a multi-head model exposes our central finding, a failure mode we term cross-task interference: adding or upgrading one head shifts a shared activation stream and degrades weight-frozen sibling heads, so freezing parameters alone is insufficient. Our contribution, identity-preserving multi-task fine-tuning, removes this interference by zero-initializing every new sub-module and freezing every parameter that feeds the shared stream. The mining heads are thereby preserved bit-identically while training only ~102k parameters. The tagging head reaches mAP 0.4614 (micro-F1 0.5557) on 20 scene tags by pooling each scene into 32 visual tokens, and the embedding head supports text-prompted retrieval, validated qualitatively. Code is available at: https://anonymous.4open.science/r/sceneminer_anonymous-64E5

14.
arXiv (CS.CL) 2026-06-11

BaltiVoice: A Speech Corpus and Fine-tuned Whisper ASR System for the Balti Language

Authors:

We present BaltiVoice, a 16.8-hour read-speech corpus for Balti (ISO 639-3: bft), a Tibetic language spoken in Gilgit-Baltistan, Pakistan, with no prior publicly available ASR resources. The corpus contains 10,060 validated utterances in native Nastaliq script, derived from Mozilla Common Voice recordings. Fine-tuning OpenAI Whisper-small yields a Word Error Rate (WER) of 26.74% and a Character Error Rate (CER) of 8.67% on a 538-utterance speaker-disjoint validation set, down from a zero-shot baseline of 159.19% WER and 152.52% CER. A Whisper-base fine-tuned on the same data achieves 44.54% WER and 15.61% CER, confirming that model capacity matters for this low-resource setting. The dataset, fine-tuned model, and a live transcription demo are publicly available on HuggingFace.

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

How Post-Training Shapes Biological Reasoning Models

arXiv:2606.16517v1 Announce Type: new Abstract: Scientific reasoning models for biology combine language models with foundation models trained on multimodal biological data, including DNA, RNA, and proteins. These models are built through post-training, yet how each stage shapes reasoning and generalization remains poorly understood. We study when post-training improves performance and when it induces over-specialization. Across genomics, transcriptomics, and proteins, we train and evaluate more than 100 biological reasoning models under controlled variation in backbone, continued pre-training (CPT), supervised fine-tuning (SFT), and reinforcement learning (RL), measuring both in-domain (ID) and out-of-domain (OOD) performance. We find that each post-training stage reshapes generalization in a distinct way rather than contributing uniform gains. CPT improves downstream performance by aligning models with biological language. SFT consistently increases ID performance but causes OOD performance to peak early and decline as models fit the training distribution. RL, when applied to strong SFT checkpoints with aligned rewards, improves OOD performance and partially recovers generalization. These results show that biological reasoning does not improve monotonically with additional supervision or compute. Instead, performance depends on how training stages are composed. Under fixed post-training budgets, the strongest ID-OOD trade-off comes from brief SFT, larger RL allocations, and asymmetric adaptation capacity across stages.

16.
arXiv (CS.CV) 2026-06-18

Performance Gap Analysis between Latin and Arabic Scripts HTR

Recent studies have shown that handwritten text recognition (HTR) systems perform worse on Arabic-script datasets than on Latin-script data. However, the reasons for this gap are still not well understood due to the lack of controlled comparisons. In this work, we present a comprehensive study of Arabic and Latin scripts HTR using a unified CRNN model for line-level HTR across nine datasets (including KHATT (Arabic), Muharaf (Arabic), NUST-UHWR (Urdu), PHTD (Persian), IAM (English), READ-2016 (German), and others) and di ferent training sizes (K in {100, 500, 1000, 2000, ..., Kfull}). Our results show the performance gap remains: it is large in low-resource settings, decreases with more data, but remains even at full scale, with a consistent difference of 5-7 CER points. We show that annotation quality matters, as many datasets contain labeling errors. Cleaning reduces error rates and narrows the gap, but does not eliminate it. In addition, we find that a fixed number of training samples provides less effective coverage in Arabic due to higher visual variability, requiring more data to learn similar representations. We compare recognition across datasets in terms of the number of text lines and the number of characters, showing an equivalence trade-off. We compare character frequency distributions across scripts and show that Arabic is significantly more heavy-tailed than Latin. Our error analysis reveals that around 30 percent of substitution errors in Arabic datasets (e.g., KHATT) are caused by confusion between visually similar characters, compared to about 15 percent in Latin-script datasets such as IAM.

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

GarmentSketch: Large-scale Sketch-to-Fashion Benchmark

Fashion sketching is a cornerstone of design workflows, allowing rapid visualization of creative concepts prior to physical prototyping. Yet, progress in sketch-based fashion image synthesis has been hindered by the absence of large-scale, high-quality paired resources. To bridge this gap, we present GarmentSketch, a novel dataset comprising 26,249 fashion sketches across 21 garment categories, each paired with detailed textual descriptions. Captions were produced through a multi-stage pipeline that integrates multiple multimodal large language models (MLLMs) with human-in-the-loop refinement, ensuring both semantic accuracy and descriptive richness. We benchmark GarmentSketch on state-of-the-art generative models, providing baseline performance for sketch-guided text-to-image generation. Our experiments reveal both the promise and the current limitations of existing methods. By offering a comprehensive and richly annotated resource, GarmentSketch establishes a foundation for advancing sketch understanding, fine-grained fashion image generation, and creative human-AI collaboration in design. The dataset will be available at: https://khangbdd.github.io/garmentsketch.

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

BrainWorld: A Structural-Prior-Conditioned Generative Model for Whole-Brain 4D fMRI Dynamics

Whole-brain 4D fMRI generation is valuable for modeling functional brain dynamics, yet existing fMRI foundation models mainly target representation learning and downstream prediction rather than conditional predictive generation. We introduce BrainWorld, a structural-prior-conditioned generative model for whole-brain 4D fMRI dynamics. BrainWorld uses sMRI as subject-level anatomical context to guide future fMRI generation, integrating structural information into the denoising process rather than treating it as a parallel modality. Evaluated on 22 datasets spanning diverse cohorts and brain states, BrainWorld generates stable 4D fMRI trajectories up to 400 frames, improves downstream performance through generated-example augmentation, and learns transferable multimodal representations that outperform baselines. Together, these results establish BrainWorld as a condition-aware generative framework for long-horizon brain dynamics modeling and multimodal representation learning.

19.
arXiv (math.PR) 2026-06-17

Decay of correlations and zeros for the hard-core model

arXiv:2603.17858v2 Announce Type: replace Abstract: In a recent paper the last author proved that absence of complex zeros of the partition function of the hard-core model near a parameter $\lambda>0$ implies a form of correlation decay called strong spacial mixing. In this paper we investigate the reverse implication. We introduce a strengthening of strong spatial mixing that we call very strong spatial mixing (VSSM). Our main result is that if VSSM holds at a parameter $\lambda>0$ for a family of graphs, this implies that the partition function has no zeros near that parameter for each graph in the family. We also demonstrate that a closely related variant of very strong spatial mixing does not imply zero-freeness. As a consequence of our main result, we moreover obtain that VSSM implies spectral independence. Our proof relies on transforming the problem to the analysis of an induced non-autonomous dynamical system given by Möbius transformations.

20.
arXiv (CS.AI) 2026-06-12

CAPED: Context-Aware Privacy Exposure Defense for Mobile GUI Agents

arXiv:2606.12666v1 Announce Type: cross Abstract: Screenshot-based mobile GUI agents can operate ordinary smartphone apps through the same visual interface as a human user, but this capability also turns every screen observation into a privacy boundary. During normal task execution, screenshots may expose contacts, messages, photos, files, recommendations, health cues, and other sensitive context that is unrelated to the user's request. We call this problem incidental visual privacy exposure. It is difficult to address with existing defenses: text anonymization misses many visual and inferential cues, while generic privacy masking can remove the evidence and controls that a GUI agent needs to complete the task. This paper presents CAPED, a context-aware pre-upload exposure control layer for mobile GUI agents. CAPED is designed as a phone-side protection layer: before screenshots are released to a remote multimodal agent, it extracts task requirements, uses screen context as a privacy prior, parses visible UI elements, and selectively exposes only content needed for the current task while masking incidental private content. We evaluate CAPED on AndroidWorld for broad task utility and with a controlled 28-task seeded privacy evaluation used as a measurement instrument for trajectory-level incidental leakage. In this seeded evaluation, Full CAPED reduces success-conditioned weighted seeded leakage from 0.766 under raw screenshots to 0.268 while preserving high task utility. A broader AndroidWorld run shows a remaining prototype-level utility cost, but the results support the central claim that screenshot upload should be treated as an explicit device–cloud boundary decision, governed by task-driven selective exposure rather than all-or-nothing screen sharing.

21.
arXiv (math.PR) 2026-06-17

Moments in Rough Bergomi and Boundary Attainment in Rough Heston

arXiv:2606.07482v2 Announce Type: replace Abstract: We address two open questions in the rough volatility literature. First, we prove finite positive moments for the rough Bergomi price process, and for a wider class of Gaussian Volterra Bergomi models, in the whole subcritical range under negative correlation. More precisely, if \(\rho\in[-1,0)\), then \(\E[S_T^p]

22.
arXiv (quant-ph) 2026-06-17

Engineering entanglement and transport in interacting quantum walks with tailored potentials

arXiv:2606.17825v1 Announce Type: new Abstract: Controlling the interplay between particle propagation and quantum correlation generation is a central challenge in quantum transport. Here, we investigate two distinguishable continuous-time quantum walkers evolving on parallel one-dimensional lattices, interacting via distance-dependent potentials. While on-site interactions reproduce the typical bosonic behaviour, extending the interaction to a linear potential over multiple neighbors introduces controlled Bloch-like oscillations and shifts the bound-pair regime to stronger couplings. More generally, we explore a Coulomb-like interaction parameterized by strength, spatial scaling, and decay rate. This reveals a rich phase diagram including four distinct dynamical regimes: (i) a high-entropy, oscillatory regime akin to a linear potential; (ii) a strongly localized, bound-pair regime; (iii) a novel intermediate regime combining near-ballistic spreading with strong correlations; and (iv) a weakly interacting, free-propagation regime. Notably, regime (iii) achieves concurrent optimization of transport efficiency and entanglement, offering a sweet spot for correlated quantum dynamics. Our results provide a tool for designing interaction-engineered quantum walks with potential applications in quantum information processing and simulations.

23.
arXiv (math.PR) 2026-06-15

On a stochastic phase-field model of cell motility with singular diffusion

arXiv:2601.05881v2 Announce Type: replace Abstract: We study existence of solutions in the variational sense for a class of stochastic phase-field models describing moving boundary problems. The models consist of stochastic reaction-diffusion equations with singular diffusion forced by a phase-field. We investigate both the case of an independently evolving phase-field and of coupled phase-field evolution driven by a viscous Hamilton-Jacobi equation. Such systems are used in the modelling of single-cell chemotaxis, where the contour of the cell shape corresponds to a level set of the phase-field. The technical challenge lies in the singularities at zero level sets of the phase-field. For large classes of initial data, we establish global existence of probabilistically weak solutions in $L^2$-spaces with weights which compensate for the singularities.

24.
medRxiv (Medicine) 2026-06-11

Development of iADJUST: a theory-informed, patient co-designed digital psychological intervention for adjustment in chronic kidney disease

Background: Psychological distress is common in chronic kidney disease (CKD) and is associated with reduced quality of life, treatment non-adherence, and worse clinical outcomes. Distress in CKD is also linked to difficulties adjusting to the demands of illness management. Despite this, psychological support remains inconsistently integrated within kidney care pathways, and existing interventions often lack clear theoretical specification and explicit targeting of mechanisms underpinning adjustment to CKD. Objectives: To describe the systematic development of iADJUST, a theory-informed patient co-designed digital psychological intervention targeting key cognitive and behavioural mechanisms involved in adjustment to CKD. Methods: Intervention development was guided by the Medical Research Council framework for complex interventions. A structured, iterative process integrated empirical evidence, psychological theory, and patient and public involvement and engagement. The Common-Sense Model of Self-Regulation and cognitive behavioural theories informed the identification of modifiable maintaining mechanisms associated with adjustment to CKD. Intervention components were mapped onto these mechanisms and refined through co-design with people living with CKD. Results: iADJUST is a six-session self-guided digital psychological intervention delivered over 12 weeks and supplemented by therapist contact. The intervention targets illness-related uncertainty, fatigue-related activity dysregulation, catastrophic what-if thinking, self-critical evaluation, and behavioural withdrawal. It integrates psychoeducation, cognitive and behavioural strategies, maintenance planning, and elements from acceptance and commitment therapy and compassion-focused approaches. Content is delivered through video, audio, and guided tasks and activities. Conclusion: iADJUST provides a theory-informed, evidence-based psychological intervention for CKD explicitly mapping intervention components to maintaining cognitive and behavioural mechanisms implicated in adjustment. Feasibility evaluation is underway.

25.
medRxiv (Medicine) 2026-06-17

Cross-Device Adaptation of Mirai for Mammography-Based Breast Cancer Risk Prediction

Fine-tuning can adapt pretrained medical imaging models to new clinical datasets, but device-specific domain shifts may limit generalizability. We evaluated Mirai, a mammography-based deep learning model for breast cancer risk prediction, in a large screening cohort containing Hologic and General Electric (GE) full-field digital mammography systems, including GE Premium View (GE PV) and Tissue Equalization (GE TE) post-processing software. Native Mirai showed lower performance on TE images than on Hologic or PV images. Fine-tuning on TE images improved TE performance, particularly for short-term risk prediction, but substantially reduced performance on Hologic images, consistent with catastrophic forgetting. To mitigate this effect, we developed a device-invariant model using interleaved multi-device sampling and conditional adversarial training. This approach largely restored Hologic performance while maintaining improved TE performance, providing better robustness across heterogeneous imaging platforms. Comparison of cumulative and annual risk AUCs over a five-year time horizon further showed that performance gains were driven mainly by short- and intermediate-term predictions. These findings highlight both the value and dangers of device-specific fine-tuning and support balanced domain-adaptation strategies for deploying mammography-based risk models across diverse clinical imaging environments.