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01.
arXiv (CS.LG) 2026-06-19

Full-Self Diagnostics (FSD): Physics-Grounded Visual Biomarker Inference from Smartphone Video via Inverse Problems and Operator Learning

arXiv:2606.19372v1 Announce Type: cross Abstract: We present Full-Self Diagnostics (FSD), a unified mathematical framework for recovering latent physiological states from unconstrained 9-second facial videos captured by consumer smartphones. The approach integrates five mutually reinforcing components: (1) a physics-based forward model derived from the radiative transfer equation and chromophore absorption that maps camera observables to biomarker concentrations; (2) an information-theoretic observability theory proving that multi-channel visual signals (spectral, pulse, respiratory, micro-expression, and oculomotor) contain strictly increasing mutual information with physiological state; (3) a stable, Tikhonov-regularized inverse problem with domain-uniform identifiability guarantees; (4) an operator-learning formulation that enables generalization across devices, resolutions, and populations; and (5) a supervised learning procedure, interpretable as stochastic variational inference, that continuously refines the model from paired biosensor ground truth with performance improving proportionally to one over the square root of the number of paired observations. Empirical validation on 38812 real-world paired scans across 59 subjects demonstrates practical performance. Self-collected data from the lead author (glucose range 35-550 mg/dL) yields MARD of 29.86 percent with 97.57 percent of predictions in Clarke Error Grid Zones A+B and only 0.27 percent in the dangerous Zone E. A well-managed diabetic participant achieves MARD of 17 percent in the narrower 70-180 mg/dL band. These results confirm that consumer-grade facial video encodes sufficient structured information for clinically relevant, non-invasive biomarker inference under fully unconstrained conditions, with performance scaling predictably as more paired data becomes available.

02.
arXiv (CS.AI) 2026-06-17

A Machine-Learned Comorbidity Index

arXiv:2606.17450v1 Announce Type: new Abstract: Traditional comorbidity scores (e.g., Charlson and Elixhauser) are widely used for risk adjustment and patient stratification, but they have two key limitations: (i) they are largely mortality-centric and do not align well with other clinical outcomes, and (ii) their linear, rule-based structure cannot capture nonlinear, outcome-specific risk relationships. We propose a Machine-Learned Comorbidity Index (MLCI) that maps diagnosis codes to a single scalar by maximizing the normalized Hilbert-Schmidt Independence Criterion (nHSIC) between the learned score and multiple clinical outcomes. MLCI captures nonlinear risk-outcome dependence and is supported by a theory that characterizes when a unified, informative admission-level ordering can be achieved across outcomes. Empirical results on multiple benchmark electronic health record (EHR) datasets show that MLCI outperforms strong baselines across multiple evaluation metrics.

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

LLM4RTL: Tool-Assisted LLM for RTL Generation

arXiv:2606.15500v1 Announce Type: cross Abstract: Large language models (LLMs) have facilitated impressive progress in software engineering, code generation, tooling, and systems. Concurrently, a significant body of research has developed which explores a growing variety of methods and systems for applying LLMs to hardware and chip design (e.g., systems for RTL code generation based on functional description). However, when it comes to open Verilog/RTL code-generation, we need high-quality training samples to build specialized and more effective LLM systems through fine-tuning or low-rank adaptation. Here, we propose a ``judge-renew-check-renew-check'' (JRCRC) pipeline which updates a current public dataset using a hierarchy of state-of-the-art commercial LLM models differing in their costs and capabilities in RTL code generation. This approach achieves a cost-effective mechanism for filtering and refining code-generation samples into a higher-quality training dataset. Our experiments also identify some common weaknesses of LLMs in rule-based reasoning and logic, and consequently, in RTL code-generation. Having identified these weaknesses, we develop an architecture for incorporating pre-processing tools to dynamically assist the LLMs in inferring logical relationships from tabular data formats. With our tools-assisted architecture for RTL code generation, we achieve significant overall performance gains in the VerilogEval benchmark and outperform many state-of-the-art methods. Our LLM4RTL system achieves performance comparable to that of GPT-4O using a significantly much smaller LLM.

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

ThinkJEPA: Empowering Latent World Models with Large Vision-Language Reasoning Model

Recent progress in latent world models (e.g., V-JEPA2) has shown promising capability in forecasting future world states from video observations. Nevertheless, dense prediction from a short observation window limits temporal context and can bias predictors toward local, low-level extrapolation, making it difficult to capture long-horizon semantics and reducing downstream utility. Vision–language models (VLMs), in contrast, provide strong semantic grounding and general knowledge by reasoning over uniformly sampled frames, but they are not ideal as standalone dense predictors due to compute-driven sparse sampling, a language-output bottleneck that compresses fine-grained interaction states into text-oriented representations, and a data-regime mismatch when adapting to small action-conditioned datasets. We propose a VLM-guided JEPA-style latent world modeling framework that combines dense-frame dynamics modeling with long-horizon semantic guidance via a dual-temporal pathway: a dense JEPA branch for fine-grained motion and interaction cues, and a uniformly sampled VLM thinker branch with a larger temporal stride for knowledge-rich guidance. To transfer the VLM's progressive reasoning signals effectively, we introduce a hierarchical pyramid representation extraction module that aggregates multi-layer VLM representations into guidance features compatible with latent prediction. Experiments on hand-manipulation trajectory prediction show that our method outperforms both a strong VLM-only baseline and a JEPA-predictor baseline, and yields more robust long-horizon rollout behavior.

05.
arXiv (CS.AI) 2026-06-18

Enhancing Fatigue Detection through Heterogeneous Multi-Source Data Integration and Cross-Domain Modality Imputation

arXiv:2507.16859v5 Announce Type: replace-cross Abstract: Fatigue detection for human operators is important in safety-related applications such as aviation, mining, and long-haul transport. Reliable estimation of operator fatigue can support timely warnings, adaptive task scheduling, takeover reminders, and other safety-management decisions in human-machine systems. However, the effectiveness of these functions depends on whether fatigue-related signals can be reliably captured in the deployment environment. While many studies have shown the value of high-fidelity sensors in controlled laboratory environments, their performance often degrades when used in real-world settings because of noise, lighting conditions, and field-of-view constraints, thereby limiting their practical use. This paper formalizes a deployment-oriented setting for real-world fatigue detection, where high-quality sensors are often unavailable in practical applications. To address this issue, we use knowledge from heterogeneous source domains, including high-fidelity sensors that are difficult to deploy in the field but commonly used in controlled environments, to assist fatigue detection in the real-world target domain. Based on this idea, we design a heterogeneous and multi-source fatigue-detection framework that uses the available modalities in the target domain while leveraging diverse configurations in the source domains through cross-domain modality imputation based on shared modalities.

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

Quantum geometrical description of hole spin qubits far away from the $\Gamma$-point

arXiv:2606.14683v1 Announce Type: cross Abstract: Hole spin qubits provide one of the leading platforms for spin-based quantum computing due to their large intrinsic spin-orbit interaction (SOI), which enables fast electrical manipulation. The SOI of planar quantum dots has mostly been investigated in theoretical studies by examining the SOI already present in the two-dimensional hole gas (2DHG). Here, we study the SOI created by the in-plane confinement by deriving non-perturbative effective Hamiltonians numerically for hole spin qubits. We find that the quantum geometry of the 2DHG naturally emerges, leading to a meaningful non-perturbative definition of pseudospin valid far away from the $\Gamma$-point. The SOI of the 2DHG and of the in-plane confinement have different forms; therefore, they cannot be turned off simultaneously, ruining the perfect spin-orbit switch functionality of spin qubits. We construct effective Hamiltonians using the symmetry approach for various low-dimensional hole systems: (i) a heavy-hole confined in a SiGe/Ge/SiGe heterostructure, (ii) a light-hole confined in SnGe/Ge, (iii) a gate-defined nanowire in SiGe/Ge/SiGe, and (iv) a hole confined in a Ge/Si core/shell nanowire. The non-perturbative effective Hamiltonians provide results with excellent agreement with the full Hamiltonians.

07.
arXiv (quant-ph) 2026-06-17

Average entropy of Bogoliubov-Kubo-Mori random state ensemble

arXiv:2606.17960v1 Announce Type: cross Abstract: Random states play a foundational role in different branches of modern quantum science. In this work, we study a recently proposed random state ensemble induced from von Neumann entropy through the Bogoliubov-Kubo-Mori (BKM) metric. In particular, we derive an exact yet explicit formula of average entanglement entropy over BKM ensemble. In obtaining the formula, we only make use of properties of normalization constant of the ensemble in the absence of its correlation kernel, contrary to average entropy computation of other ensembles. This new framework paves the way for calculating higher-order cumulants of BKM ensemble beyond the average.

08.
arXiv (CS.CL) 2026-06-17

PromptMN: Pseudo Prompting Language

Prompting has become the primary interface between humans and generative AI, yet many natural language prompts remain fragile: roles, goals, constraints, and expected outputs are often buried in prose or left implicit. In agentic and software development workflows, a misread at the first handoff can propagate through every step, since a significant portion of agent failures stem from context ambiguities rather than model limitations. This paper introduces PromptMN, a pseudo-prompting domain-specific language that annotates natural language with compact, %-prefixed typed directives covering roles, goals, requirements, priorities, constraints, plans, inputs, and outputs. Semantic resolution lets authors write in any order while the model interprets directives by function. PromptMN sits between informal prompting and programming-style pseudocode: structured enough to be inspectable and reusable, yet lightweight enough for analysts, managers, developers, and stakeholders across the software development lifecycle (SDLC). PromptMN also pairs with reverse prompt engineering. Asking a model to restate a desired outcome as PromptMN lets users inspect the inferred roles, goals, constraints, and missing assumptions before acting, reducing repair cycles and yielding a reusable artifact for aligning people and AI tools. PromptMN's feasibility is evaluated across several frontier models, including Claude Fable 5, Claude Opus 4.8, Gemini 3.1 Pro, and GPT-5.5. The models correctly resolved PromptMN instructions, including complex structures such as repetition, conditionals, methods, and a prime-checking task, without fine-tuning. The same vocabulary applies across new codebases, maintenance, and redesign in the SDLC scenarios presented. While large-scale validation remains future work, these early results suggest PromptMN is a practical step toward clearer, more reviewable human-to-AI interaction.

09.
arXiv (CS.CL) 2026-06-12

NOVA: NOise-aware Verbal Confidence CAlibration for Robust Large Language Models in RAG Systems

Accurately assessing model confidence is essential for deploying large language models (LLMs) in mission-critical factual domains. While retrieval-augmented generation (RAG) is widely adopted to improve grounding, confidence calibration in RAG settings remains poorly understood. We conduct a systematic study across four benchmarks, revealing that LLMs exhibit poor calibration performance especially when noisy contexts are retrieved. Specifically, contradictory or irrelevant evidence tends to exacerbate the model's overconfidence issue. To address this, we propose NOVA Rules (NOise-Aware Verbal Confidence CAlibration Rules) to provide a principled foundation for resolving overconfidence under noise. We further design NOVA, a noise-aware calibration framework that synthesizes supervision from ~2K HotpotQA examples guided by these rules. By performing supervised fine-tuning (SFT) with this data, NOVA equips models with intrinsic noise awareness without relying on stronger teacher models. Empirical results show that NOVA yields substantial gains, improving ECE scores by 10.9% in-domain and 8.0% out-of-domain. By bridging the gap between retrieval noise and verbal calibration, NOVA paves the way for both accurate and epistemically reliable LLMs.

10.
arXiv (quant-ph) 2026-06-11

Non-Hermitian Delocalization Realizes Random Dirac Criticality in One Dimension

arXiv:2606.12089v1 Announce Type: cross Abstract: Non-Hermitian systems can evade Anderson localization and exhibit delocalized states even in one dimension. Here, we show that such non-Hermitian delocalized states under periodic boundary conditions (PBC) are intrinsically critical, realizing the universality class of one-dimensional random Dirac fermions. By linking spectral winding to topological Anderson transitions via Hermitization, we demonstrate that the delocalized PBC states exhibit a Dirac-type criticality with universal algebraic correlations. In contrast to Hermitian systems, where this criticality occurs only at fine-tuned transition points, it emerges generically in non-Hermitian systems as a consequence of spectral topology. These results identify a universal mechanism by which non-Hermiticity promotes criticality, providing a unified description of non-Hermitian delocalization in one dimension.

11.
arXiv (CS.CL) 2026-06-15

Verbatim Chunks Beat Extracted Artifacts: A Controlled Ablation of Memory Representations for Long LLM Conversations

作者:

A growing class of conversational-memory systems compresses dialogue history into structured artifacts – extracted facts, decisions, or events – on the premise that distilled structure retrieves better than raw text. We test this premise with a controlled ablation: within one fixed retrieval-rerank-reasoning pipeline, we swap only the stored representation – LLM-extracted typed artifacts versus verbatim conversation chunks – holding the model, retriever, reranker, and judge constant. Verbatim chunks win by 15.9 points on LoCoMo (43.9% vs. 28.0%) and 22.0 points on LongMemEval-S (67.4% vs. 45.4%); a 1-hop semantic graph does not recover the gap, and five confound controls reproduce the effect. The mechanism is lossy distillation: extraction discards verbatim detail that chunks retain for free, and the extracted-artifact pipeline never beats naive RAG in overall accuracy. Concurrent positive results with near-verbatim, provenance-preserving units fit the same account: retrieval accuracy tracks how far the representation departs from the source. For the extraction designs we test, structured memory should augment verbatim text rather than replace it: a chunks $\cup$ artifacts union store matches chunks on both benchmarks while artifacts alone forfeit the gap. Code and data: https://github.com/tao-hpu/cog-canvas

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

Prediction-Powered Causal Inference by Automatic Debiased Machine Learning and Semi-Supervised Riesz Regression

arXiv:2606.12892v1 Announce Type: cross Abstract: This study investigates semiparametric efficient estimation of causal and structural parameters in a semi-supervised setting. In our setting, unlabeled auxiliary regressors are available in addition to labeled observations consisting of outcomes and regressors. Our goal is to construct estimators of causal and structural parameters whose asymptotic variances are smaller than those of estimators constructed using only labeled data. We refer to this framework as prediction-powered causal inference (PPCI). We first derive the efficient influence function and the efficiency bound, which imply that the use of auxiliary regressors can attain a smaller asymptotic variance than the efficiency bound attainable from labeled observations alone. Then, by combining the efficient influence function with the debiased machine learning (DML) framework, we propose methods that we call DML-PPCI. If we construct an estimating-equation estimator, we refer to the method as EE-DML-PPCI; if we construct a targeted-learning estimator, we refer to the method as TMLE-DML-PPCI. The asymptotic variances of both estimators match our derived efficiency bound. In the construction of the estimators, estimation of the efficient influence function plays an important role. In our study, the efficient influence function is also a Neyman orthogonal score, which depends on the Riesz representer and the regression function. For Riesz representer estimation, we develop semi-supervised generalized Riesz regression with convergence rate guarantees.

15.
arXiv (CS.CV) 2026-06-11

Exploring Adaptive Masked Reconstruction for Self-Supervised Skeleton-Based Action Recognition

Recently, masked skeleton reconstruction models have emerged as strong action representation learners, driving significant progress in self-supervised skeleton-based action recognition. However, existing state-of-the-art methods must predict an exceedingly large number of spatiotemporal patches, significantly prolonging training time. Besides, by treating all spatiotemporal regions equally during reconstruction, these models are distracted from learning the critical motion patterns that underlie action semantics. To address these challenges, we propose Adaptive Masked Reconstruction (AMR), a faster and stronger pre-training framework. We first decouple the decoder from the encoder, enabling flexible prediction of larger spatiotemporal patches and dramatically reducing reconstruction complexity. Given that larger patches contain more complex information, which is challenging to predict and consequently degrades performance, we accordingly introduce an adaptive guidance module. This module identifies regions of high motion informativeness, guiding the model to focus on the most discriminative parts of each patch and alleviating reconstruction difficulty. Experiments on NTU RGB+D 60, NTU RGB+D 120, and PKU-MMD datasets demonstrate that AMR not only accelerates pre-training substantially but also improves downstream recognition accuracy, surpassing current state-of-the-art approaches.

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

Retrocausal capacity of a quantum channel: Communicating through noisy closed timelike curves

arXiv:2509.08965v3 Announce Type: replace Abstract: We study the capacity of a quantum channel for retrocausal communication, where messages are transmitted backward in time, from a sender in the future to a receiver in the past, through a noisy postselected closed timelike curve mathematically represented by the channel. We completely characterize the one-shot retrocausal quantum and classical capacities, and we show that the corresponding asymptotic capacities are equal to the average and sum, respectively, of the channel's max-information and its regularized Doeblin information. This endows these information measures with a novel operational interpretation. Furthermore, our characterization can be generalized beyond quantum channels to all completely positive maps. This imposes information-theoretic limits on transmitting messages via postselected-teleportation-like mechanisms with arbitrary initial- and final-state boundary conditions, including those considered in various black-hole final-state models.

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

Mechanisms of Introspective Awareness

arXiv:2603.21396v5 Announce Type: replace Abstract: Recent work has shown that LLMs can sometimes detect when steering vectors are injected into their residual stream and identify the injected concept – a phenomenon termed "introspective awareness." We investigate the mechanisms underlying this capability in open-weights models. First, we find that it is behaviorally robust: models detect injected steering vectors at moderate rates with 0% false positives across diverse prompts and dialogue formats. Notably, this capability emerges specifically from post-training; we show that preference optimization algorithms like DPO can elicit it, but standard supervised finetuning does not. We provide evidence that detection cannot be explained by simple linear association between certain steering vectors and directions promoting affirmative responses. We trace the detection mechanism to a two-stage circuit in which "evidence carrier" features in early post-injection layers detect perturbations monotonically along diverse directions, suppressing downstream "gate" features that implement a default negative response. This circuit is absent in base models and robust to refusal ablation. Identification of injected concepts relies on largely distinct later-layer mechanisms that only weakly overlap with those involved in detection. Finally, we show that introspective capability is substantially underelicited: ablating refusal directions improves detection by +53%, and a trained bias vector improves it by +75% on held-out concepts, both without meaningfully increasing false positives. Our results suggest that this introspective awareness of injected concepts is robust and mechanistically nontrivial, and could be substantially amplified in future models. Code: https://github.com/safety-research/introspection-mechanisms.

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

Do You Really Need a GPU to Guard Your LLM? CPU-Class Classifiers and Multi-Stage Pipelines for Safety Enforcement at Scale

Safety classifiers that screen LLM inputs for jailbreak attempts have become standard deployment components, yet almost all production systems rely on GPU-based models: fine-tuned transformers and LLM-as-a-judge pipelines. These approaches impose significant per-query latency and infrastructure cost. Very little research has asked whether CPU-based classifiers, such as support vector machines and gradient-boosted trees trained on TF-IDF features, can match their accuracy across the conditions that production deployments encounter. We evaluate five CPU classifier families, Mamba-130M as an SSM-based GPU classifier, and transformer-based GPU models (DeBERTa-v3 and Gemma-2B with LoRA) across nine jailbreak sources and three regimes: in-distribution (D1), out-of-distribution (D2), and adversarially obfuscated (D3). On D1, the best CPU classifier matches the best transformer GPU model at roughly one-fifth the deployment cost. On D2, CPU classifiers fail via confident miscalibration, producing high-confidence false negatives that bypass escalation entirely. On D3, CPU classifiers outperform transformer GPU models by more than 26 percentage points in F1. Based on these complementary failure modes, we design GuardChain, a three-stage safety pipeline (Regex -> CPU -> GPU) that routes each prompt to the cheapest stage capable of a confident decision. The CPU stage alone resolves 80\% of in-distribution prompts at near-peak accuracy, and the GPU stage recovers the out-of-distribution failures. For practitioners deploying LLM safety at scale, this work provides evidence that GPU-class infrastructure is unnecessary for the majority of traffic.

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

TAB-PO: Preference Optimization with a Token-Level Adaptive Barrier for Token-Critical Structured Generation

Direct Preference Optimization (DPO) is an effective and widely adopted approach for offline alignment but is poorly matched to ontology-driven structured prediction, where preferred and rejected JSON objects often differ in only a few schema-defining tokens. In this low-edit-distance regime, sequence-level DPO spreads gradient mass across non-critical serialization tokens (gradient dilution) and can reduce likelihood on rare, under-confident preferred schema tokens (token erosion). To address these limitations, we first develop a confusion-aware preference-construction strategy that augments expert-curated ambiguity patterns with empirical structured-error modes estimated from validation-set SFT predictions, synthesizing minimally perturbed, schema-valid negatives that focus preference learning on realistic ontology-level decision errors. We then introduce Token-Adaptive Barrier Preference Optimization (TAB-PO), a post-SFT objective for token-critical structured generation. TAB-PO adds a confidence-gated token-level barrier that applies supervised anchoring to under-confident schema tokens. On the public SciERC scientific information extraction task, evaluated with Llama/Qwen models from 1.5B to 70B, TAB-PO improves ontology-critical semantic-label and relational-linking metrics over SFT by 11.59% on average, wins 100% of comparisons against the strongest token-level and sequence-level DPO variants on these metrics, and surpasses leading frontier models by 14.71%, while delivering strong gains in textual grounding.

20.
arXiv (CS.CL) 2026-06-18

ScholaWrite: A Dataset of End-to-End Scholarly Writing Process

Writing is a cognitively demanding activity that requires constant decision-making, heavy reliance on working memory, and frequent shifts between tasks of different goals. To build writing assistants that truly align with writers' cognition, we must capture and decode the complete thought process behind how writers transform ideas into final texts. We present ScholaWrite, the first dataset of end-to-end scholarly writing, tracing the multi-month journey from initial drafts to final manuscripts. We contribute three key advances: (1) a Chrome extension that unobtrusively records keystrokes on Overleaf, enabling the collection of realistic, in-situ writing data; (2) a novel corpus of full scholarly manuscripts, enriched with fine-grained annotations of cognitive writing intentions. The dataset includes \LaTeX-based edits from five computer science preprints, capturing nearly 62K text changes over four months; and (3) analyses and insights into the micro-dynamics of scholarly writing, highlighting gaps between human writing processes and the current capabilities of large language models (LLMs) in providing meaningful assistance. ScholaWrite underscores the value of capturing end-to-end writing data to develop future writing assistants that support, not replace, the cognitive work of scientists.

21.
arXiv (CS.CL) 2026-06-17

Analyzing and Encoding the Al-Mawrid Arabic-English Dictionary with the ISO Language Markup Framework and TEI Lex-0

This paper presents a robust methodology for the systematic digitization and encoding of the Al-Mawrid Arabic-English dictionary, transforming it from a legacy print resource into a standardized computational lexicon. Addressing a significant gap in Arabic lexical infrastructure, the study adopts a dual-standard framing that aligns the ISO Lexical Markup Framework (LMF) with the Text Encoding Initiative TEI Lex-0 guidelines. By applying an editorial view to the dictionary's macro- and microstructure, the research resolves the structural ambiguities and punctuation inconsistencies typical of 20th-century bilingual dictionaries. The methodology is grounded in an empirical analysis of the dictionary's lexical knowledge density. Drawing on a representative sample (the letter Ayn, comprising 4.6% of the total volume), the study provides scientific weight to the encoding process, demonstrating a structural parsing accuracy of 91%. Quantitative evaluation of the information extraction rules reveals high performance, with 85% precision and 98% recall for synonyms, and 88% precision for other morpho-semantic features. Beyond technical description, the paper provides a critical comparison with existing Arabic lexical resources and discusses the limitations of TEI Lex-0 when modelling specific Arabic phenomena, such as implicit "open set" semantic relations and scattered morphological cues. Furthermore, the study explores the potential for Linguistic Linked Open Data (LLOD) integration by establishing a scalable prefix-based referencing system that facilitates the resource's inclusion in the semantic web. The result is an interoperable, machine-tractable resource that provides a reproducible workflow for the retro-digitization of complex legacy bilingual lexicons within the Arabic NLP and Digital Humanities communities.

22.
medRxiv (Medicine) 2026-06-17

Cardio Heart Connect: Protocol for a Randomized Trial of a Commercially Available mHealth Fitness Intervention for Cardiac Rehabilitation After Transcatheter Aortic Valve Replacement

Background: Despite ample evidence of the benefits of cardiac rehabilitation (CR), few transcatheter aortic valve replacement (TAVR) patients participate. Commercially available mobile health offers an opportunity to deliver activity-promotion content to populations that are challenged to participate in CR. This study aims to test the efficacy of clinically controlled, commercially available fitness programming for improving physical activity and cardiovascular health outcomes designed to be initiated while patients are on waitlists for traditional CR. Methods: The Cardio Heart Connect study is a hybrid type I effectiveness-implementation trial aiming to enroll N=200 patients who have been placed on a cardiac rehab waitlist following a TAVR procedure from the University of Colorado Hospital Heart and Vascular Center. Participants will be randomized 1:1 to the Cardio Heart Connect intervention with commercially available fitness or attention control, designed to control for technology access. At baseline, post-intervention (8 weeks), and follow-up (12 months), we will assess the primary outcome of participants? daily steps as measured by smartwatch accelerometer and secondary outcomes of interest including functional capacity (Duke Activity Status Index; VO2max), quality of life (Kansas City Cardiomyopathy Questionnaire), and cardiovascular health status (Life Essential 8). In addition, we will use mixed methodologies to evaluate the implementation of intervention using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. Conclusions: Commercially available fitness programs have the potential to provide more accessible opportunities for patients recovering from TAVR to engage in physical activity and may be preferred due to their customizability, convenience, and ease of scheduling. Overall, this study will provide insight into the use of commercial mHealth to promote activity following TAVR.

23.
medRxiv (Medicine) 2026-06-22

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

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

24.
medRxiv (Medicine) 2026-06-10

Impact of Early Treatment on Symptom Improvement and Procedural Events among Men with BPH and Bothersome Lower Urinary Tract Symptoms: A Contemporary Analysis of the American Urological Association Quality (AQUA) Registry

PURPOSE: As the armamentarium of BPH therapies continues to expand, it remains imperative to maximize patient satisfaction and minimize decisional regret. We sought to determine the impact of time from BPH diagnosis to index treatment on symptom improvement and subsequent procedural events. MATERIALS AND METHODS: We queried the American Urological Association Quality Registry for men [&ge;] 40 years old with BPH, available IPSS data, and no receipt of prior BPH treatment. Index treatment included medication, surgery, or minimally invasive surgical therapy (MIST). Outcomes included IPSS over 3 years of follow-up, change in percentage of mild lower urinary tract symptoms (LUTS) by 3 months, and time to procedural event. Patients were stratified by time from index diagnosis to treatment by 3 years. Outcomes were compared across time-to-treatment cohorts with appropriate statistical tests with p < 0.05 as significant. RESULTS: 43,919 patients met criteria with 19,642 pursuing treatments. Patients pursued treatment at comparably lower baseline IPSS compared to prior prospective series. Patients undergoing surgery and MIST had significantly higher baseline IPSS, while medical comorbidities were significantly more common among men initiating pharmacotherapy. Early surgery and MIST were associated with significant improvement in IPSS within 6-12 months and an increase in mild LUTS by 3 months. All forms of early treatment were associated with delayed time to procedural events, including catheterization and fulguration. CONCLUSIONS: Early procedural intervention for BPH is associated with early symptom improvement and delayed time to procedural events among real-world, contemporary practice.

25.
medRxiv (Medicine) 2026-06-15

Using wastewater surveillance to explore community-level dietary intake in sewered and non-sewered sanitation systems in Malawi, Africa

Wastewater can be used to measure biomarkers that reflect population-level dietary intake and diversity; however, how this approach may apply in a low-income country remains a knowledge gap. This study aims to evaluate whether select dietary-related metabolites can be detected in wastewater and environmental surveillance (WES) samples from both sewered and non-sewered sanitation systems in Malawi, Africa. Fourteen WES samples were collected and analyzed from two university campuses in Mzuzu and Thyolo, Malawi. Four targets were analyzed: N-methyl-2-pyridone-5-carboxamide (2PY; a biomarker of vitamin B3), 4-pyridoxic acid (4-PA; a biomarker of vitamin B6), as well as enterodiol and enterolactone (biomarkers of dietary fiber and polyphenol consumption). An 18-question survey, paired spatiotemporally with the WES measurements, assessed self-reported daily dietary intake, food insecurity, and nutrient deficiency symptoms among 500 respondents. Among the 14 WES samples, 2PY, 4-PA, and enterolactone were detected, while enterodiol was not detected above the method limit (