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01.
arXiv (CS.CV) 2026-06-16

CoIRL-AD: Collaborative-Competitive Imitation-Reinforcement Learning in Latent World Models for Autonomous Driving

End-to-end autonomous driving models trained with imitation learning (IL) often generalize poorly, particularly in long-tail scenarios where expert demonstrations are sparse. Reinforcement learning (RL) can provide complementary task-level supervision, but applying RL to real-world autonomous driving is challenging in offline settings without interactive simulators, where datasets are dominated by expert actions and provide limited behavioral diversity. We propose CoIRL-AD, a competitive dual-policy framework that integrates IL and RL under a unified offline training regime. CoIRL-AD decouples imitation and reward optimization into separate actors to alleviate objective conflicts, uses imagined future rollouts for long-horizon reward estimation, and introduces a competition mechanism that selectively transfers beneficial behaviors while keeping RL anchored to expert-like driving. Experiments on the nuScenes benchmark show that CoIRL-AD consistently improves robustness over strong IL-based baselines, with especially large gains in cross-city generalization and long-tail scenarios. Code is available at: https://github.com/SEU-zxj/CoIRL-AD.

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

ZipSplat: Fewer Gaussians, Better Splats

Feed-forward 3D Gaussian Splatting methods reconstruct a scene from posed or pose-free images in a single forward pass, yet current approaches predict one Gaussian per input pixel, tying the representation budget to camera resolution rather than scene complexity. A flat wall and a richly textured object thus produce equally many Gaussians despite very different geometric needs. We propose ZipSplat, a token-based feed-forward model that decouples Gaussian placement from the pixel grid. A multi-view backbone extracts dense visual tokens, and k-means clustering compresses them into a compact set of scene tokens. Cross- and self-attention refine these tokens, and a lightweight MLP decodes each into a group of Gaussians with unconstrained 3D positions. Because clustering is applied at inference, a single trained model spans the quality-efficiency curve without retraining. ZipSplat operates without ground-truth poses or intrinsics, yet sets a new state of the art on DL3DV and RealEstate10K with ${\sim}6{\times}$ fewer Gaussians than pixel-aligned methods, surpassing the best pose-free baseline by 2.1dB and 1.2dB PSNR, respectively. It further generalizes zero-shot to Mip-NeRF360 and ScanNet++, outperforming all comparable baselines. Our project page is at https://veichta.com/zipsplat.

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

Separable Neural Architectures as Physical World Models: from Mathematical Theory to Applications

arXiv:2606.14934v1 Announce Type: cross Abstract: This work introduces the Separable Neural Architecture (SNA), a function representational class combining neural approximation with tensor decomposition. The SNA decouples localized coordinate functions (atoms) from global interactions governed by a sparse, low-rank interaction object. This architecture possesses a compact and smooth inductive bias well-suited for solving partial differential equations (PDEs). When viewed as a Galerkin trial space under the variational SNA (VSNA) framework, the formulation satisfies classical variational guarantees under Lax-Milgram: well-posedness, quasi-optimality, convergence, and stability. In high-dimensional spatiotemporal–parametric PDEs, the VSNA mitigates the curse of dimensionality by scaling algebraically rather than exponentially. Exploiting an entirely factorized, tensor-native alternating least squares (ALS) optimization framework reduces this cost to linear in dimension. The VSNA is validated across elliptic, hyperbolic, and parabolic systems, demonstrating close alignment with predicted algebraic and spectral scaling rates. We showcase the SNA as a "solve once, query anywhere" physical world model via two engineering case studies: a 7D parametric manufacturing simulation and an experimental thermal-to-property inversion pipeline for Inconel 718. The VSNA executes a 1,000,000-query Monte Carlo sweep in 102s on a standard laptop CPU, yielding a 150,000x speedup over a full-grid finite element baseline hosted on an NVIDIA A100 GPU. It further enables real-time generative inverse-mode reconstructions under 100ms. These results demonstrate that the SNA serves as a compact mathematical substrate for continuous parameter manifolds to enable real-time inversion, optimization loops, and rapid uncertainty propagation.

04.
arXiv (quant-ph) 2026-06-16

Exactly Solvable Quantum Model with Spin-Dependent Coulomb Interaction

arXiv:2501.05103v5 Announce Type: replace Abstract: In this work, we report an exactly solvable quantum model featuring a spin-dependent Coulomb interaction, described by the spin vector potential \(\vec{\mathcal{A}} = k (\vec{r} \times \vec{S}) / r^2\) together with a Coulomb-type scalar potential \(\varphi = \kappa / r\) . The model is governed by the Schrödinger-type Hamiltonian \(\mathcal{H}_S = \vec{\Pi}^2 / (2M) + q \varphi\) in nonrelativistic quantum mechanics and by the Dirac-type Hamiltonian \(\mathcal{H}_D = c \vec{\alpha} \cdot \vec{\Pi} + \beta M c^2 + q \varphi\) in relativistic quantum mechanics, where \(\vec{\Pi} = \vec{p} - (q/c)\vec{\mathcal{A}}\) is the canonical momentum. We demonstrate two main results: (i) Just as the Coulomb-type scalar potential \(\mathcal{S}_Maxwell = \{\vec{\mathcal{A}} = 0,\ \varphi = \kappa / r\}\) is a local exact solution of Maxwell's equations on $r\neq0$, the gauge potential \(\mathcal{S}_YM = \{\vec{\mathcal{A}} = k (\vec{r} \times \vec{S}) / r^2,\ \varphi = \kappa / r\}\) constitutes a local exact solution of the Yang–Mills equations on the punctured region $r\neq0$. (ii) Both Hamiltonians \(\mathcal{H}_S\) and \(\mathcal{H}_D\) can be solved exactly in the presence of this spin-dependent Coulomb interaction. The resulting energy spectra are derived, and they naturally reduce to those of the ordinary hydrogen atom when the spin-dependent terms are neglected. Finally, we clarify the quantization conditions and the fixed-background interpretation of the model.

05.
arXiv (CS.AI) 2026-06-17

SP-GCRL: Influence Maximization on Incomplete Social Graphs

arXiv:2605.12513v2 Announce Type: replace-cross Abstract: Influence maximization (IM) in real platforms is challenged by incomplete, noisy social graphs and non-stationary diffusion dynamics. We propose SP-GCRL, a social-propagation-aware graph contrastive reinforcement learning framework that learns end-to-end seed selection under partial observability.We first introduce a social-propagation-aware nonlinear diffusion function to model reinforcement/diminishing effects and probability drift under repeated exposure; we then construct dual structural views and perform contrastive learning to obtain node representations robust to missing edges and weak ties, while replacing expensive strategy metrics with a GAT-based regression surrogate to improve efficiency and scalability; finally, we use DDQN to learn an end-to-end seed selection policy on top of these representations. Experiments on multiple real-world networks show that SP-GCRL achieves significant gains over heuristic and learning-based baselines across budgets and topologies, while maintaining strong large-scale scalability.

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

MapDream: Task-Driven Map Learning for Vision-Language Navigation

Vision-Language Navigation (VLN) requires agents to follow natural language instructions in partially observed 3D environments, motivating map representations that aggregate spatial context beyond local perception. However, most existing approaches rely on hand-crafted maps constructed independently of the navigation policy. We argue that maps should instead be learned representations shaped directly by navigation objectives rather than exhaustive reconstructions. Based on this insight, we propose MapDream, a map-in-the-loop framework that formulates map construction as autoregressive bird's-eye-view (BEV) image synthesis. The framework jointly learns map generation and action prediction, distilling environmental context into a compact three-channel BEV map that preserves only navigation-critical affordances. Supervised pre-training bootstraps a reliable mapping-to-control interface, while the autoregressive design enables end-to-end joint optimization through reinforcement fine-tuning. Experiments on R2R-CE and RxR-CE achieve state-of-the-art monocular performance, validating task-driven generative map learning.

07.
arXiv (CS.LG) 2026-06-15

PCR-CA: Parallel Codebook Representations with Contrastive Alignment for Multiple-Category App Recommendation

arXiv:2508.18166v5 Announce Type: replace-cross Abstract: Modern app store recommender systems struggle with multiple-category apps, as traditional taxonomies fail to capture overlapping semantics, leading to suboptimal personalization. We propose PCR-CA (Parallel Codebook Representations with Contrastive Alignment), an end-to-end framework for improved CTR prediction. PCR-CA first extracts compact multimodal embeddings from app text, then introduces a Parallel Codebook VQ-AE module that learns discrete semantic representations across multiple codebooks in parallel – unlike hierarchical residual quantization (RQ-VAE). This design enables independent encoding of diverse aspects (e.g., gameplay, art style), better modeling multiple-category semantics. To bridge semantic and collaborative signals, we employ a contrastive alignment loss at both the user and item levels, enhancing representation learning for long-tail items. Additionally, a dual-attention fusion mechanism combines ID-based and semantic features to capture user interests, especially for long-tail apps. Experiments on a large-scale dataset show PCR-CA achieves a +0.76% AUC improvement over strong baselines, with +2.15% AUC gains for long-tail apps. Online A/B testing further validates our approach, showing a +10.52% lift in CTR and a +16.30% improvement in CVR, demonstrating PCR-CA's effectiveness in real-world deployment. The new framework has now been fully deployed on the Microsoft Store.

08.
arXiv (CS.LG) 2026-06-19

Low-Burden Data Augmentation for Dysarthric ASR via Zero-Shot Voice Cloning

arXiv:2606.19823v1 Announce Type: cross Abstract: Automatic speech recognition remains unreliable for dysarthric speech due to data scarcity and high inter-speaker variability. While synthetic data can address these gaps, traditional methods often require extensive speaker-specific data, reintroducing the collection bottleneck. We investigate zero-shot voice cloning as a low-burden augmentation strategy, using Higgs Audio V2 to clone speakers in the TORGO dataset. We fine-tune (FT) Whisper-medium on cloned, real, and hybrid data and evaluate on held-out real speech. Compared to the zero-shot (31.62%), Clone FT achieved a competitive 26.00% WER, nearly matching the 24.44% and 25.12% seen with Real and Hybrid FT, respectively. Notably, Clone and Hybrid FT outperform Real FT for moderate-severe speakers. Clone FT achieves the best results (11.45% relative) in cross-corpus evaluation on the SAP-1102. These results suggest that zero-shot cloning provides scalable training data that circumvents the costly data collection bottleneck.

09.
arXiv (CS.AI) 2026-06-16

Adaptive $k$NN graph model

arXiv:2601.16509v2 Announce Type: replace-cross Abstract: The $k$-nearest neighbors ($k$NN) algorithm is a cornerstone of non-parametric classification in artificial intelligence, yet its deployment in large-scale applications is persistently constrained by the computational trade-off between inference speed and accuracy. Existing approximate nearest neighbor solutions accelerate retrieval but often degrade classification precision and lack adaptability in selecting the optimal neighborhood size ($k$). Here, we present an adaptive graph model that decouples inference latency from computational complexity. By integrating a Hierarchical Navigable Small World (HNSW) graph with a pre-computed voting mechanism, our framework completely transfers the computational burden of neighbor selection and weighting to the training phase. Within this topological structure, higher graph layers enable rapid navigation, while lower layers encode precise, node-specific decision boundaries with adaptive neighbor counts. Benchmarking against eight state-of-the-art baselines across six diverse datasets, we demonstrate that this architecture significantly accelerates inference speeds, achieving real-time performance, without compromising classification accuracy. These findings offer a scalable, robust solution to the inherent inference bottleneck of $k$NN, laying an adaptive structural foundation for graph-based nonparametric learning.

10.
medRxiv (Medicine) 2026-06-16

Risk beliefs, intensive digital information and demand for a new preventative health product in public clinics: Evidence from an experiment in Zimbabwe.

Demand for preventative health care is weak in low-income settings. In a field experiment in a low-income, high-risk setting, we evaluated whether demand for a new bio-medical preventative health product, offered free at public health clinics, responds to digital feedback-based intensive information on health risks and benefits of prevention along with a clinic referral enabling access to the product. In our sample of women aged 18-24 years, we find a large correction in risk beliefs sustained six months after the intervention. Against a background of very low baseline usage, within six months we find a 5.8 percentage point increase in take up of the prevention method, a level of uptake which is very large relative to the control group. Reassuringly, there is no meaningful difference in up-take amongst baseline high- risk and low-risk individuals.

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

Data-Centric Benchmarking of Exploit Generation in LLMs: Understanding the Impact of Fine-Tuning

arXiv:2606.15123v1 Announce Type: cross Abstract: We study the task of CVE-conditioned exploit generation, where a model drafts proof-of-concept (PoC) exploits given software vulnerability context. We adopt a data-centric approach, constructing a high-quality dataset via multi-stage preprocessing and introducing a scalable evaluation framework with LLM-as-judge and fine-grained rubrics. Under this unified setup, we benchmark 17 large language models across 8 evaluation criteria, providing systematic insights into their zero-shot capabilities. We further show that a compact 8B open-weight model, when fine-tuned on curated data, achieves over 42.5% improvement in exploit quality and rivals some proprietary models when combined with simple test-time rejection strategies. Our results highlight the importance of data quality, structured supervision, and evaluation design for reliable exploit generation, suggesting that these factors can be as critical as model scale in adapting LLMs to cybersecurity tasks.

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

Floating-Point Networks with Automatic Differentiation Can Represent Almost All Floating-Point Functions and Their Gradients

arXiv:2605.01702v2 Announce Type: replace Abstract: Theoretical studies show that for any differentiable function on a compact domain, there exists a neural network that approximates both the function values and gradients. However, such a result cannot be used in practice since it assumes real parameters and exact internal operations. In contrast, real implementations only use a finite subset of reals and machine operations with round-off errors. In this work, we investigate whether a similar result holds for neural networks under floating-point arithmetic, when the gradient with respect to the input is computed by the automatic differentiation algorithm $D^\mathtt{AD}$. We first show that given a floating-point function $\phi$ (e.g., a loss function), arbitrary function values and gradients can be represented by a floating-point network $f$ and $D^\mathtt{AD}(\phi\circ f)$, respectively. We further extend this result: given $\phi_1,\dots,\phi_n$, $D^\mathtt{AD}(\phi_i\circ f)$ can simultaneously represent arbitrary gradients while $f$ represents the target values, under mild conditions. Our results hold for practical activation functions, e.g., $\mathrm{ReLU}$, $\mathrm{ELU}$, $\mathrm{GeLU}$, $\mathrm{Swish}$, $\mathrm{Sigmoid}$, and $\mathrm{tanh}$.

13.
arXiv (CS.CV) 2026-06-18

SAMA: Semantic Anchor-aligned Augmentation for Unified Low-Resource Multimodal Information Extraction

Multimodal Information Extraction (MIE)-covering tasks such as Multimodal Named Entity Recognition (MNER), Relation Extraction (MRE), and Event Extraction (MEE)-is essential for understanding multimedia content but remains constrained by severe data scarcity. Although data augmentation is a promising remedy, existing approaches are impeded by coarse cross-modal alignment and fragmented, task-specific designs that fail to exploit shared semantic knowledge. To overcome these limitations, we introduce Semantic Anchor-aligned Multimodal Augmentation (SAMA), a unified framework for generating high-fidelity, task-aware synthetic data. SAMA constructs structured semantic anchors from ground-truth labels to guide a Collaborative Multi-Experts Multimodal Large Language Model (CME-MLLM), which integrates a Universal Adapter for shared semantics with Task-Specific Adapters to produce diverse yet constraint-compliant textual samples. For image synthesis, SAMA employs an Anchor-Preserving Diffusion mechanism that uses anchor-weighted prompts and latent conditioning to maintain critical semantic anchors while diversifying visual contexts. To eliminate the need for manual verification, SAMA further introduces a Dual-Constraint Filtering module that selects synthetic samples based on both cross-modal consistency and anchor fidelity. Extensive experiments across benchmark datasets for MNER, MRE, and MEE demonstrate that SAMA consistently outperforms state-of-the-art augmentation baselines under both fully supervised and low-resource settings, underscoring its versatility, robustness, and effectiveness.

14.
arXiv (CS.AI) 2026-06-16

Large Language Models as Optimizers: A Survey of Direct vs. Tool-Augmented Approaches and Their Performance Frontiers

arXiv:2606.15577v1 Announce Type: new Abstract: Large Language Models (LLMs) are increasingly involved in complex mathematical optimization, even if the pragmatic user who triggers them is unaware of it. After all, many real-world problems reduce to the search for better or the best solutions. The field of LLM-as-optimizer has three paradigms: direct optimization, tool-augmented optimization, and tool-creating optimization. Direct optimization uses iterative prompting and heuristic generation to navigate solution spaces. Tool-augmented optimization translates natural language problems into formal specifications and orchestrates external solvers. Tool-creating optimization goes further, using LLMs to discover reusable algorithms or heuristics that can be deployed at zero marginal LLM cost. We describe current performance frontiers based on the benchmarks from the literature. We identify the critical reasoning gap in current architectures and argue for trade-offs between the future potential of direct optimization and the auditability of tool-augmented optimization. Even future, more powerful models might opt for tool-making to improve operational efficiency for repetitive families of problems.

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

SENTINEL: Failure-Driven Reinforcement Learning for Training Tool-Using Language Model Agents

Language model agents are increasingly effective in solving realistic tasks through multi-turn tool use. However, training reliable tool-using agents remains challenging in practice. While reinforcement learning provides an on-policy paradigm for improving agents from their own environment interactions, its effectiveness depends heavily on the training task distribution. When tasks are fixed before training, the task distribution can become increasingly mismatched with the policy's evolving capabilities, causing many rollouts to be spent on uninformative tasks. We propose SENTINEL, a failure-driven reinforcement learning framework that turns the Solver's rollout failures into targeted training tasks. SENTINEL follows a Controller–Proposer–Solver loop: the Controller analyzes failed trajectories and summarizes recurring error patterns, the Proposer generates executable tasks that stress these weaknesses, and the Solver is trained on the targeted tasks. On Tau2-Bench Retail with Qwen3-4B-Thinking-2507, SENTINEL improves Pass\^{}1 from 66.4 to 74.9 and outperforms RL on general synthetic tasks across Pass\^{}k metrics. These results demonstrate that model failures provide an effective and scalable source of targeted training signal for improving tool-using language model agents.

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

Out-of-Distribution (OOD) Detectors for Open-Set RF Fingerprinting

arXiv:2606.12718v1 Announce Type: new Abstract: Radio-frequency (RF) fingerprinting systems must operate in open-world environments where signals from unknown transmitters and temporal drift introduce distribution shift at test time. Out-of-distribution (OOD) detection provides a natural framework for this problem, yet its application to RF fingerprinting (RFF) remains limited. A key barrier to their adoption is that most OOD detectors require auxiliary OOD data for parameter tuning, an assumption that is difficult to satisfy in RF environments where representative OOD data is impractical to collect. In this work, we introduce a promising set of OOD detection methods from the machine learning literature to open-set RFF domain. We present these methods within a unified mathematical framework based on information theory, which is a natural framework for communication systems. Our framework allows for the systematic analysis of methods and development of new methods. We further demonstrate the applicability of recent work on tuning OOD detectors without given OOD tuning data for open-set RFF. We evaluate on the POWDER RF fingerprinting dataset, showing that detectors tuned without any given OOD data achieve performance comparable to baselines with access to true OOD tuning data and greatly out-perform baseline approaches without access to true OOD tuning data, showcasing the practical viability for the RFF problem.

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

EvolveNav: Proactive Preflection and Self-Evolving Memory for Zero-Shot Object Goal Navigation

arXiv:2606.18235v1 Announce Type: new Abstract: Zero-Shot Object-Goal Navigation (ZS-OGN) requires embodied agents to explore and locate target objects without any prior training. To this end, recent methods leverage foundation models. But they typically rely on static priors and lack adaptation, which leads to repeated errors and costly trial and error. In this paper, we propose a self-evolving ZS-OGN framework that enables continuous test-time improvement. Specifically, we build an agentic rule memory by extracting actionable knowledge from past trajectories. Then, we propose a retrieval strategy based on upper confidence bound, selecting effective rules by balancing semantic relevance and historical success. In addition, we introduce a memory-guided preflection module that forecasts potential outcomes before action, reducing inefficient exploration. Extensive experiments show that our method outperforms existing zero-shot baselines, achieving a 10.1\% improvement in success rate with fewer unnecessary steps.

18.
arXiv (quant-ph) 2026-06-11

Large Fluctuations in Open Quantum Systems

arXiv:2606.11822v1 Announce Type: new Abstract: We study statistics of atypical measurement outcomes in the steady states of driven open quantum systems. In equilibrium, the probability distribution over the phase space, as encoded in, e.g., the Wigner function, is analytic in the phase-space coordinates. We show that this property is generically lost in driven dissipative systems: their {\it large-deviation function} develops lines and surfaces across which its derivatives are discontinuous. As an illustrative example, we consider a parametrically driven Kerr oscillator coupled linearly and/or nonlinearly to a dissipative bath. Rare fluctuations in the amplitude and phase of the induced oscillations are governed by semiclassical instanton trajectories of the corresponding Keldysh-Lindblad action. We demonstrate that a given fluctuation can be realized through multiple distinct instanton trajectories. The competition between these trajectories leads to abrupt switching of the dominant instanton and, consequently, to non-analytic features in the large-deviation function.

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

Nemotron 3 Ultra: Open, Efficient Mixture-of-Experts Hybrid Mamba-Transformer Model for Agentic Reasoning

We introduce Nemotron 3 Ultra, a 550 billion total and 55 billion active parameter Mixture-of-Experts Hybrid Mamba-Attention language model. We pre-trained Nemotron 3 Ultra on 20 trillion text tokens, then extended the context length to 1M tokens, and post-trained using Supervised Fine Tuning (SFT), Reinforcement Learning (RL), and Multi-teacher On-Policy Distillation (MOPD). Nemotron 3 Ultra is our most capable model yet, employing multiple key technologies - LatentMoE, Multi Token Prediction (MTP), NVFP4 pre-training, multi-environment RLVR, MOPD, and reasoning budget control. Nemotron 3 Ultra achieves up to ~6x higher inference throughput as compared to state-of-the-art publicly available LLMs while attaining on-par accuracy. The state-of-the-art accuracy, high inference throughput, and 1M token context length make Nemotron 3 Ultra ideal for long-running autonomous agentic tasks. We open-source the base, post-trained, and quantized checkpoints, along with the training data and recipe on HuggingFace.

20.
arXiv (CS.CV) 2026-06-11

Real-Time Neural Hair Denoising

We propose a lightweight real-time method for reconstructing strand-based hair G-Buffers from severely undersampled rasterized inputs. Our pipeline first applies neural spatial reconstruction and temporal accumulation to recover hair coverage, i.e., fractional hair visibility within a pixel, and tangent. It then uses a tangent-guided reconstruction step to complete the position, which is subsequently used for physically based deferred hair shading. We evaluate our method across a diverse set of hairstyles, including straight, wavy, afro, and ponytail styles, under both static and dynamic scenarios. Our method achieves higher hair reconstruction quality than existing hair-specific denoising techniques and general industrial neural reconstruction solutions such as DLSS and FSR.

21.
arXiv (CS.CL) 2026-06-12

One Token to Fool LLM-as-a-Judge

Large language models (LLMs) are increasingly trusted as automated judges, assisting evaluation and providing reward signals for training other models, particularly in reference-based settings like Reinforcement Learning with Verifiable Rewards (RLVR). However, we uncover a critical vulnerability even in this reference-based paradigm: generative reward models are systematically susceptible to reward hacking. We find that superficial inputs, which we term ''master keys'' such as non-word symbols (e.g., '':'' or ''.'') or generic reasoning openers (e.g., ''Thought process:'' or ''Let's solve this problem step by step.''), can consistently elicit false positive rewards without any substantive reasoning. Our systematic evaluation demonstrates this is a widespread failure affecting a diverse range of models, including leading proprietary systems such as GPT-o1 and Claude-4. These results challenge the assumed robustness of LLM judges and pose a significant threat to their reliability. To address this, we propose a simple yet effective data augmentation strategy using truncated model outputs as adversarial negative examples. The resulting Master Reward Models (Master-RMs) demonstrate state-of-the-art robustness against these ''master key'' attacks while maintaining high performance in standard evaluation settings. We supplement these findings with a comprehensive analysis of the vulnerability across model scales, prompt variations, and common inference-time strategies, offering insights to guide future research on robust LLM evaluation. We release our robust, general-domain reward models and the synthetic training data at https://huggingface.co/sarosavo/Master-RM and https://huggingface.co/datasets/sarosavo/Master-RM.

22.
medRxiv (Medicine) 2026-06-22

Characteristics and Outcomes of Gene-Elusive Dilated Cardiomyopathy

Background and Aims Genetic testing in dilated cardiomyopathy (DCM) guides risk stratification and family screening. Likely pathogenic or pathogenic (LP/P) variants are identified in approximately one-third of patients, leaving many without a genetic diagnosis. Cohort studies suggest that "gene-elusive" patients have a lower risk of adverse events. This study aims to better characterise this group and identify factors associated with adverse outcomes. Methods Consecutive and unrelated DCM patients undergoing genetic testing and returning no LP/P variants were retrospectively recruited and compared to two control cohorts of DCM patients carrying LP/P variants in LMNA and TTN for a primary composite endpoint of end-stage heart failure (ESHF) or malignant ventricular arrhythmia (MVA). Results Among patients without prior MVA, the composite endpoint occurred in 36/423 (8.5%) gene-elusive, 14/39 (35.9%) LMNA and 11/100 (11%) TTN cardiomyopathy patients (log-rank p

23.
medRxiv (Medicine) 2026-06-11

A continental-scale scenario modelling framework for evaluating infant RSV immunisation strategies across Europe

Background. The recent approval of long-acting monoclonal antibodies (la-mAbs) and a maternal vaccine (MV) in the EU enables universal RSV prevention in infants. Modelling studies are widely used to quantify the population-level impact of alternative immunisation strategies. However, existing assessments of new RSV immunisation products focus on national or sub-national settings. Methods. We developed an age-stratified, stochastic compartmental model of RSV transmission for 28 EU/EEA countries. It combines literature-based parameters on RSV natural history and product efficacy with country-specific demographic and contact patterns. After model calibration against age- and country-specific RSV hospitalisation rates, we designed scenarios for both la-mAbs and MV at four coverage levels, with and without catch-up immunisation for infants under six months at season onset. We then evaluated each scenario against a no-immunisation baseline. Results. At 95% coverage, the cross-country median reduction in RSV hospitalisations over one season in infants under 12 months is 29.9% for la-mAbs (country median range: 27.7-33.9%) and 22.4% for MV (20.0-25.6%), scaling linearly with coverage. Out of all averted hospitalisations, 78.3% (90% CI: [67.3, 92.7]%) are concentrated in infants aged 0-2 months for la-mAbs and 72.7% (90% CI: [61.4, 88.6]%) for MV. A catch-up campaign nearly doubles the overall reduction in RSV hospitalisations. Conclusions. Despite country-specific heterogeneities, impact of la-mAbs and MV is comparable across settings and herd-immunity effects are largely negligible. This supports harmonised European guidelines on coverage targets. Seasonal catch-up campaigns emerge as an effective lever to maximise the impact of immunisation programmes.

24.
medRxiv (Medicine) 2026-06-19

Cardiometabolic multimorbidity and care experiences in primary healthcare among Brazilian adults aged 50 and over (ELSI-Brazil)

Background: Population aging and the rising burden of non-communicable diseases have increased the prevalence of cardiometabolic multimorbidity (CM-MM) among older adults. Patient-reported experience measures (PREMs) are recognized as essential components of healthcare quality assessment, yet evidence on primary care experiences among individuals with CM-MM remains scarce. Objective: To analyze primary care experiences according to the presence of cardiometabolic multimorbidity among Brazilians aged 50 years and older. Methods: Cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021; n = 9,949). CM-MM was defined as the self-reported coexistence of two or more of the following conditions: hypertension, diabetes mellitus, dyslipidemia, acute myocardial infarction, and stroke. Primary care experiences were assessed using a validated 12-item instrument organized into four domains: first-contact access, longitudinality, communication, and care coordination. Associations were estimated using Poisson regression adjusted for sociodemographic, health conditions, and healthcare utilization variables, with stratified analysis by Family Health Strategy (FHS) coverage. Results: CM-MM prevalence was 25.5%, with a progressive increase by age and an inverse gradient by education. Individuals with CM-MM reported significantly more positive experiences in longitudinality (mean index 2.53 vs. 2.34; adjusted PR = 1.22; 95%CI 1.12-1.33; p < 0.001) and, to a lesser extent, in communication (mean index 2.68 vs. 2.58; adjusted PR = 1.10; 95%CI 1.00-1.20; p = 0.041). No statistically significant differences were found in first-contact access or care coordination. After stratified by FHS coverage, the observed differences in longitudinality and communication were no longer statistically significant. Conclusions: CM-MM was associated with more positive primary care experiences in longitudinality and communication. The absence of differentiated experiences in first-contact access and coordination highlights structural gaps in primary care responsiveness to individuals with greater clinical complexity. Keywords: Multimorbidity; Cardiometabolic diseases; Primary Care; Patient-reported experience measures; Older adults; ELSI-Brazil.

25.
medRxiv (Medicine) 2026-06-11

Ferritin across long-term conditions in England: cross-sectional primary care study

Background Iron deficiency (ID) is a readily treatable condition once identified. Ferritin is the primary diagnostic marker, but cut-offs vary and inflammation complicates interpretation in patients with long-term conditions (LTCs). Aim To describe ferritin distribution and the prevalence of threshold-defined low ferritin in adults with and without LTCs in primary care. Design and setting Cross-sectional observational study using routinely collected electronic health records from a national primary care database in England (1st January 2015 to 31st December 2021). Method Adults with >1 ferritin test in Clinical Practice Research Datalink (CPRD) Aurum were included. LTCs were identified using validated primary-care code lists. Outcomes included ferritin distribution and threshold-defined ID prevalence using World Health Organization (WHO) (