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

MatchLM2Lite: A Scalable MLLM-to-Lite Framework for Reproduced Content Identification

Content moderation is critical for online video platforms to ensure content safety, protect creators, and sustain positive user experiences. Beyond filtering harmful content, platforms must guarantee content authenticity at scale so that users are exposed to diverse, original videos rather than low-value reproductions. We present MatchLM2Lite, a real-time, production-grade reproduced content identification (RCI) system that leverages the powerful understanding of a multimodal large language model (MLLM) distilled into a small and fast-inference model. Our system jointly models video, audio, and text signals, operating on pairs of videos to produce fine-grained reproduction scores. The system comprises two modules, MatchLM and MatchLite, and a two-stage training recipe. First, our high-capacity MLLM, MatchLM, serves as a teacher model to define the upper bound of RCI performance. Its capabilities are then distilled into a compact student model, MatchLite. This design allows MatchLite to deliver low-latency, high-throughput inference on video pairs while preserving much of MatchLM's accuracy, making it suitable for integration into real-time recommendation systems. MatchLM achieves an F1-score improvement of +8.57 compared to our previous production model. After knowledge distillation, MatchLite retains a +6.55 gain in F1-score while reducing computational cost by 35x. Deployed at scale, MatchLM2Lite enables efficient, pairwise multimodal RCI, stably serving online traffic at high queries per second (QPS) with an end-to-end latency below 30 seconds. This system has reduced the reproduced video view rate on our platform by 2.5% without degrading user engagement, demonstrating its effectiveness in a large-scale production environment.

02.
arXiv (CS.AI) 2026-06-19

The Algorithmic-Human Manager: AI, Apps, and Workers in the Indian Gig Economy

arXiv:2606.19975v1 Announce Type: cross Abstract: This paper examines the impact of artificial intelligence and digital technologies on the blue-collar gig economy in India, focusing on algorithmic management. This paper examines the impact of artificial intelligence and digital technologies on the blue collar gig economy in India, focusing on algorithmic management he use of automated systems to allocate, monitor, and evaluate work in location-based services such as ride sharing and delivery. Using a social justice framework and a mixed-methods approach comprising interviews with 16 gig workers and 21 key stakeholders, the study uncovers a dual reality: while AI-powered systems expand access to work and generate operational efficiencies, they simultaneously introduce significant challenges related to fairness, transparency, and worker dignity. Key findings reveal that algorithmic systems are opaque by design, produce inequitable outcomes, and are not structured to reward additional labour with proportionate pay. The study advocates for a pragmatic hybrid governance model an Algorithmic Human Manager framework in which technological efficiency and human accountability operate together rather than in opposition. The findings carry implications for policymakers, platform companies, and civil society organizations working to design equitable AI governance frameworks for the gig economy in India and across the Global South.

03.
arXiv (math.PR) 2026-06-15

Boltzmann-Like Occupation of Nonequilibrium Steady States on Dense Networks

arXiv:2606.14542v1 Announce Type: cross Abstract: A central problem in statistical physics is to extend the Boltzmann distribution to nonequilibrium steady states (NESS). We prove that NESS on large dense networks have Boltzmann-like occupation despite extensive entropy production. We further show that the active-matter heuristic of "low rattling" is asymptotically exact. Intuitively, these NESS spend a greater fraction of their time in states they leave more slowly. This explanation extends to the broader class of "equiaccessible" steady states, which play a role in our analysis akin to that of equilibrium in linear response.

04.
arXiv (CS.CL) 2026-06-11

SoftMatcha 2: A Fast and Soft Pattern Matcher for Trillion-Scale Corpora

We present SoftMatcha 2, an ultra-fast and flexible search algorithm that enables search over trillion-scale natural language corpora in under 0.3 seconds while allowing semantic variations in the form of substitution, insertion, and deletion. Our approach employs string matching based on suffix arrays that scales well with corpus size, and represents words as vectors, which underpin its semantic flexibility. To mitigate the combinatorial explosion induced by the semantic relaxation of queries, our method is built on two key algorithmic ideas: dynamic corpus-aware pruning and fast exact lookup enabled by a disk-aware design. We theoretically analyze the efficiency of the proposed method, indicating that it can mitigate exponential growth in the search space. Empirically, on FineWeb-Edu (Lozhkov et al., 2024) (1.4T tokens), it attains substantially lower search latency than existing methods: infini-gram (Liu et al., 2024), infini-gram mini (Xu et al., 2025), and SoftMatcha (Deguchi et al., 2025). As a practical application, our method uncovers benchmark contamination in training corpora that existing approaches miss, and it also benefits information retrieval and paraphrase detection. We also provide an online demo of fast, soft search across corpora in seven languages.

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

Scaling Learning-based AEB with Massive Unlabeled Data

arXiv:2606.18864v1 Announce Type: cross Abstract: This paper studies how to scale learning-based automatic emergency braking (AEB) with massive unlabeled fleet data under production constraints. Our approach is based on meta-feedback semi-supervised learning (MF-SSL), where a teacher generates pseudo labels for unlabeled driving data and is updated using a small labeled anchor set as safety-critical feedback. In production, anchor ambiguity and labeled-unlabeled mismatch can amplify systematic pseudo-label errors, leading to spurious triggers. We propose a stabilized MF-SSL framework with (i) Noise-Aware Decoupling, which removes ambiguity-prone anchors from the teacher's supervised update path, and (ii) kinematics-gated pseudo-labeling with a teacher conflict penalty to suppress mismatch-induced risk hallucinations on unlabeled data while maintaining broad coverage. Extensive experiments show consistent gains as unlabeled data scale from 1M to 1B windows, improving safety while keeping comfort stable. The 1B-trained student model is deployed to hundreds of thousands of vehicles and validated over \$10^9$ km of driving, achieving a positive-to-false activation ratio exceeding 100:1 and a 35% improvement in accident-free driving mileage over a production rule-only baseline.

06.
Nature Medicine 2026-06-16

<b>Engineered heart muscle passes early clinical milestone</b>

Engineered heart muscle allografts derived from induced pluripotent stem cells show promising early outcomes in patients with treatment-refractory advanced heart failure with reduced left ventricular ejection fraction, in support of further clinical investigation. Engineered heart muscle allografts derived from induced pluripotent stem cells show promising early outcomes in patients with treatment-refractory advanced heart failure with reduced left ventricular ejection fraction, in support of further clinical investigation.

07.
arXiv (CS.AI) 2026-06-18

A Knowledge Theory of Capital:The Value of Natural and Artificial Intelligence

arXiv:2606.18288v1 Announce Type: cross Abstract: This volume develops a knowledge theory of capital for economies in which productive capacity increasingly resides in software, data, models, routines, expertise, platforms, organizations, commons, and public epistemic infrastructure. Beginning from Adam Smith's theory of labour, stock, specialization, and market extent, it asks what changes when knowledge becomes stock-like, mobile across forms, scalable, governable, recombinable, and imperfectly visible in accounting. The book introduces knowledge-bearing stock as the central object and analyses how it is generated, converted into governable form, deployed, improved through feedback, enclosed or shared, measured, impaired, and used as input to future production. It distinguishes embodied, disembodied, institutionalized, commons, and public knowledge forms and develops concepts such as first conversion, cognitive enclosure, feedback capture, dark capital, and expected knowledge loss. The argument is conditional and testable: modern wealth depends not only on capital accumulation, but on how productive knowledge is governed.

08.
arXiv (CS.LG) 2026-06-18

Zero-Shot Active Feature Acquisition via LLM-Elicitation

arXiv:2606.18933v1 Announce Type: new Abstract: Active feature acquisition (AFA) sequentially selects which features to observe to reach a classification or ranking decision. Its central limitation is reliance on large amount of labeled data to fit probabilistic models guiding acquisition. Large language models (LLMs) supply unsupervised domain knowledge, but are poor sequential planners. Asking one to both know and decide conflates capabilities best kept separate. Here, we develop a framework for zero-shot AFA through disciplined elicitation: asking the LLM only for what it can be trusted to return, the unary deviations and pairwise co-variations that are the sufficient statistics of a Markov random field (MRF). We apply our framework to two settings: binary classification and top-$k$ identification. In practice, the LLM reliably returns only discriminative statistics, what distinguishes the classes rather than each class in isolation, which precludes classical AFA. We apply a maximum-entropy closure that resolves this gauge ambiguity. We evaluate on a cohort of Inflammatory Bowel Disease (IBD) patients, an active clinical setting where diagnostic ambiguity and patient heterogeneity obstruct stable treatment strategies. Our framework outperforms the LLM both on real labels and on its own extracted beliefs. Where it matters most, on the hardest patients, our top-$k$ acquisition policy markedly outperforms all existing methods.

09.
medRxiv (Medicine) 2026-06-18

A Novel Correction Method for QT Interval in the Presence of Left Bundle Branch Block Morphology

Background Accurate assessment of the QT interval is challenging in the presence of QRS prolongation, such as during ventricular pacing or bundle branch block. Current correction methods are heterogeneous and lack consensus. To evaluate the relationship between QRS duration and QT interval during ventricular pacing and to develop a practical correction method for QT assessment. Methods In this prospective single-centre study, 94 patients undergoing electrophysiology study for supraventricular tachycardia were included. Standardised pacing was performed at the same cycle length from the right ventricular (RV) apex, high output and low output pacing from His catheter, and coronary sinus (reference). QRS and QT intervals were measured from 12-lead ECGs. Changes in QT (QT) and QRS duration (QRS) were analysed using linear regression and mixed-effects modelling. QT correction formulas of the form QT corrected = QT N x QRS were evaluated using Bland-Altman analysis across multiple coefficients. Results A significant positive correlation between QRS and QT was observed across all pacing sites (r = 0.52-0.74, p < 0.001). In mixed-effects modelling, QRS was a strong independent predictor of QT (0.59, p < 0.001), with no significant interaction between pacing site and QRS, supporting a consistent relationship across pacing locations. Bland-Altman analysis demonstrated that correction coefficients of 0.65-0.70 minimised systematic bias compared with lower coefficients, with similar precision across models (SD 16 ms) and no evidence of proportional bias. A coefficient of 0.65 provided the most balanced performance between bias and variability. Conclusion QT prolongation during ventricular pacing is primarily driven by QRS widening and follows a consistent linear relationship across pacing sites. A simple correction using QT corrected = QT 0.65 x (QRS 100 ms) provides a practical and accurate method for QT assessment, with potential clinical applicability in patients with conduction abnormalities or ventricular pacing.

10.
arXiv (CS.LG) 2026-06-18

Kernel of Partition Paths: A Unified Representation for Tree Ensembles

arXiv:2606.18853v1 Announce Type: cross Abstract: A recent line of work has reframed individual decision trees as linear models on engineered features associated with their splits, opening routes for oracle inequalities and feature-importance reinterpretation, but leaving open the question of what unified geometric object a forest induces when one indexes its feature map by nodes rather than by splits. The present paper studies that object. KPP indexes the feature map by the nodes of the forest, weighted by a path metric that turns each coordinate into a component of a squared-Euclidean path-isometric embedding. KPP unifies four pillars under a single non-diagonal Gram that carries a metric: prediction, exact additive attribution, deterministic Lipschitz robust radius in the KPP metric, and uniform Rademacher risk bounds for regression and classification under fixed, honest, or cross-fit conditioning. All probabilistic guarantees are conditional on the representation and are stated under three explicit conditioning regimes; the robust-radius guarantee is deterministic in the KPP metric rather than in a norm on the raw input. Conjectured fast-rate refinements for both regression and classification are stated as open problems and are not claimed as theorems.

11.
arXiv (CS.AI) 2026-06-12

A Minimal Model of Bounded Trade-Off Screening in Multi-Attribute Choice

arXiv:2606.13201v1 Announce Type: new Abstract: Human decision-making often involves choosing between multi-attribute alternatives, yet classical models assume fully compensatory utility aggregation despite evidence that people reject options with poor performance on critical attributes. We propose a bounded trade-off reasoning framework in which decisions are governed by a screening process that evaluates the balance between gains and losses across attributes. The model introduces a trade-off tolerance parameter that controls acceptable imbalance and can vary across contexts. Through simulation, we show that this mechanism produces preference patterns that differ from standard utility-based models and captures context-dependent variation in trade-off behavior. These results establish bounded trade-off screening as a plausible computational mechanism for multi-attribute choice and generate testable predictions for future behavioral studies.

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

LoRDO: Distributed Low-Rank Optimization with Infrequent Communication

arXiv:2602.04396v2 Announce Type: replace-cross Abstract: Distributed training of foundation models via $\texttt{DDP}$ is limited by interconnect bandwidth. While infrequent communication strategies reduce synchronization frequency, they remain bottlenecked by the memory and communication requirements of optimizer states. Low-rank optimizers can alleviate these constraints; however, in the local-update regime, workers lack access to the full-batch gradients required to compute low-rank projections, which degrades performance. We propose $\texttt{LoRDO}$, a principled framework unifying low-rank optimization with infrequent synchronization. We first demonstrate that, while global projections based on pseudo-gradients are theoretically superior, they permanently restrict the optimization trajectory to a low-rank subspace. To restore subspace exploration, we introduce a full-rank quasi-hyperbolic update. $\texttt{LoRDO}$ achieves near-parity with low-rank $\texttt{DDP}$ in language modeling and downstream tasks at model scales of $125$M–$720$M, while reducing communication by $\approx 10 \times$. Finally, we show that $\texttt{LoRDO}$ improves performance even more in very low-memory settings with small rank/batch size.

13.
arXiv (quant-ph) 2026-06-16

A complexity theory for non-local quantum computation

arXiv:2505.23893v2 Announce Type: replace Abstract: Non-local quantum computation (NLQC) replaces a local interaction between two systems with a single round of communication and shared entanglement. Despite many partial results, it is known that a characterization of entanglement cost in at least certain NLQC tasks would imply significant breakthroughs in complexity theory. Here, we avoid these obstructions and take an indirect approach to understanding resource requirements in NLQC, which mimics the approach used by complexity theorists: we study the relative hardness of different NLQC tasks by identifying resource efficient reductions between them. Most significantly, we prove that $f$-measure and $f$-route, the two best studied NLQC tasks, are in fact equivalent under $O(1)$ overhead reductions. This result simplifies many existing proofs in the literature and extends several new properties to $f$-measure. For instance, we obtain sub-exponential upper bounds on $f$-measure for all functions, and efficient protocols for functions in the complexity class $\mathsf{Mod}_k\mathsf{L}$. Beyond this, we study a number of other examples of NLQC tasks and their relationships.

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

Polynomial-Time Mistake-Bounded Language Generation

arXiv:2606.16077v1 Announce Type: cross Abstract: In this note, we introduce a polynomial-time version of the mistake-bounded language generation (MBLG) framework due to Kleinberg, Peale, and Reingold (2026). We observe that the family of parities of variables, and the family of conjunctions of literals, are polynomial-time MBLG. Our main result states that the family of monotone Boolean functions with polynomially-many maxterms is polynomial-time MBLG. This family includes all monotone Boolean functions, computable by polynomial-size decision trees. Our technique can be presented as a new combinatorial game about writing numbers on a board.

15.
arXiv (quant-ph) 2026-06-16

Preparation of Fractional Quantum Hall States on Quantum Computers

arXiv:2606.16548v1 Announce Type: new Abstract: The realization of fractional quantum Hall (FQH) states, characterized by fractional charge and intrinsic topological order, on quantum computers represents a central challenge at the interface of condensed matter physics and quantum information science. Current methods are grouped into two types: methods based on (quasi-)adiabatic evolution of complex parent Hamiltonians to yield target states, and circuit-based approaches for direct state preparation, which are confined to effectively one-dimensional systems near the thin cylinder or torus limit. We introduce a complementary scheme relying on direct quantum circuit construction, which works for arbitrary geometries. Specifically, we present a method to precisely prepare the $\nu=1/3$ Laughlin state on the sphere geometry and demonstrate that it significantly reduces the required number of two-qubit gates and circuit depth, compared to variational quantum circuit approaches. In addition, we employ optimal control techniques to design control pulses for both superconducting and Rydberg atom platforms, identifying experimentally feasible protocols for state preparation. Our results provide an efficient and hardware-relevant pathway for realizing generic FQH states on both noisy intermediate-scale and fault-tolerant quantum devices.

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

Generative-Model Predictive Planning for Navigation in Partially Observable Environments

arXiv:2606.18888v1 Announce Type: new Abstract: Navigation in partially observable environments presents a significant challenge for autonomous agents, requiring effective decision-making with limited sensory information in unknown environments. Belief-based methods, particularly those using neural networks to approximate the belief space, often fail to capture the inherent multimodality of belief spaces, especially in high-dimensional cases with perceptual aliasing. While generative models present a compelling alternative, they typically require substantial data or expert demonstrations and lack explicit mechanisms for long-term planning. In this paper, we introduce BeliefDiffusion, a novel framework that combines the benefits of both generation and planning. BeliefDiffusion leverages diffusion models to explicitly characterize multimodal belief distributions and utilizes Model Predictive Control (MPC) to simultaneously plan ahead. It consists of two steps: (1) Imagining plausible environment configurations based on observation history and (2) Planning efficient navigation strategies across an aggregated configurations. Through extensive experiments in synthetic map environments, we demonstrate that BeliefDiffusion significantly outperforms both model-free reinforcement learning baselines and other generative approaches in navigation success rate and path efficiency. Our results validate that explicitly incorporating multimodal belief representations into planning enables more robust navigation in partially observable settings.

17.
arXiv (quant-ph) 2026-06-11

Random Grover Search

arXiv:2606.11759v1 Announce Type: new Abstract: Grover's algorithm achieves a quadratic speedup for unstructured search given a global oracle for the target set. In many applications, however, the target set is specified as the intersection of multiple constraint sets. Constructing a global oracle for the intersection can be costly, whereas the individual constraint oracles are often much simpler to implement. We study a randomized Grover search algorithm that directly uses these constraint oracles. At each iteration, one of the corresponding Grover operators is selected at random. For the two-operator case with uniform sampling, we prove that the success probability approaches one after \[ \Theta \left(\frac\pi4\sqrt{\frac{N}{r}}\right) \] iterations, where $r$ is the size of the intersection. Thus, the algorithm achieves the same asymptotic query complexity as standard Grover search but without requiring a global oracle. We then generalize the analysis to arbitrary sampling distributions and an arbitrary number of Grover operators through an auxiliary operator that approximates the expected Grover evolution, while retaining the same asymptotic complexity. We further show that highly biased sampling distributions can still achieve near-unit success probability, enabling cheaper Grover operators to be used more frequently. Finally, we prove asymptotic optimality and support the theoretical results with numerical simulations.

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

OmniOPSD: Rationale-Privileged On-Policy Self-Distillation for Affective Computing

Reinforcement learning for multimodal large language models (MLLMs) is often hindered by severe reward sparsity in complex reasoning tasks. This challenge is particularly pronounced in human-centered scenarios involving states, emotions, intentions, and behaviors, where heterogeneous multimodal signals and subjective human factors make high-quality chain-of-thought (CoT) annotations expensive and difficult to obtain. Although many multimodal datasets provide expert-annotated ground-truth labels, directly using these labels for supervised fine-tuning may encourage shortcut learning in multimodal perception and provides limited transparency for safety-critical human–AI interaction. To address these limitations, we propose OmniOPSD, a Rationale-Privileged On-Policy Self-Distillation framework that uses frontier-generated rationales as teacher-side privileged evidence rather than student imitation targets. OmniOPSD uses frontier-generated evidence-aware rationales only as training-time privileged evidence context for a local teacher. The student samples its own rollout from the original multimodal input, while the rationale-privileged teacher scores the same tokens and provides dense token-level supervision. Thus, the student learns on its own trajectory distribution without directly imitating frontier-model completions, and inference requires no labels, rationales, CoT annotations, or closed-source model access. Experiments on MER-UniBench show that OmniOPSD achieves state-of-the-art performance with an average score of $84.19$, and ablations further support the value of rationale-privileged teacher guidance.

19.
arXiv (CS.AI) 2026-06-17

Towards Leveraging AutoML for Sustainable Deep Learning: A Multi-Objective HPO Approach on Deep Shift Neural Networks

arXiv:2404.01965v3 Announce Type: replace-cross Abstract: Deep Learning (DL) has advanced various fields by extracting complex patterns from large datasets. However, the computational demands of DL models pose environmental and resource challenges. Deep shift neural networks (DSNNs) offer a solution by leveraging shift operations to reduce computational complexity at inference. Following the insights from standard DNNs, we are interested in leveraging the full potential of DSNNs by means of AutoML techniques. We study the impact of hyperparameter optimization (HPO) to maximize DSNN performance while minimizing resource consumption. Since this combines multi-objective (MO) optimization with accuracy and energy consumption as potentially complementary objectives, we propose to combine state-of-the-art multi-fidelity (MF) HPO with multi-objective optimization. Experimental results demonstrate the effectiveness of our approach, resulting in models with over 80\% in accuracy and low computational cost. Overall, our method accelerates efficient model development while enabling sustainable AI applications.

20.
arXiv (quant-ph) 2026-06-16

Quantum learning with a single-atom sensor

arXiv:2606.15071v1 Announce Type: new Abstract: The ability to gather information and to act upon it is at the core of every learning agent. But what is the impact of quantum mechanics on an agent's ability to sense external inputs and to translate them into actions? Here we address the question for a prototype task of learning agency at the quantum scale: rotating a single spin based on information gathered by a single atom. We determine the ultimate performance limit for this task, revealing a fundamental tradeoff between entanglement at the sensing stage and coherence at the action stage: if the single-atom sensor is not entangled with the quantum system serving as the agent's internal memory, then the best learning strategy requires a coherent transfer of quantum information from the sensor to the system that controls the agent's actions. In contrast, if the sensor is initially entangled with the agent's memory, then the transfer of quantum information is no longer necessary. Our results indicate that the quantum properties of the sensor radically affect the optimal way to convert external stimuli into actions, revealing a link between quantum sensing and the behavior of quantum agents.

21.
arXiv (CS.LG) 2026-06-19

Environment-Adaptive Covariate Selection: Learning When to Use Spurious Correlations for Out-of-Distribution Prediction

arXiv:2601.02322v2 Announce Type: replace-cross Abstract: A common approach to out-of-distribution prediction restricts models to causal or invariant covariates to avoid spurious associations that may change across environments. Despite its theoretical appeal, this strategy can underperform empirical risk minimization when only a subset of the causal parents of the outcome is observed. In such settings, non-causal covariates can serve as proxies for unobserved causal parents and improve prediction when the proxy relationship is stable, but they can hurt when shifts disrupt that relationship. Thus, the optimal covariate set can depend on the specific shift encountered. Because different shifts leave signatures in the unlabeled covariate distribution, we propose an environment-adaptive covariate selection algorithm that maps environment-level summaries to environment-specific covariate sets. These summaries may be hand-crafted or learned from multi-environment data, and prior causal knowledge can be incorporated as constraints. Across simulations and applied datasets, the proposed method improves over static causal, invariant, and other non-adaptive rules under diverse shifts.

22.
arXiv (CS.CV) 2026-06-15

Improving Lunar Topography with Deep Learning Schrödinger Bridges

Increasing the resolution of planetary topography models can enable a better understanding of surface processes and geomorphology; however, existing analytical super-resolution methods are expensive and difficult to apply at large scales. Generative models provide the tools to learn complex relationships within data and can be applied at scale due to hardware accelerators and parallelization. We present a diffusion-based Schrödinger Bridge (SB) generative modeling approach for lunar topography super-resolution, connecting the distribution of low-resolution topography to that of high-resolution topography, incorporating physically-constraining optical imagery. Our approach is inspired by existing Shape-from-Shading methods, which improve a priori low-resolution topography by using optical images at the target resolution. We train SBs on a novel dataset of rendered lunar topography, emulating optical imagery from the Lunar Reconnaissance Orbiter Narrow Angle Camera. The result is a flexible approach for topography super-resolution which can provide pixel-level uncertainties in the reconstruction.

23.
arXiv (quant-ph) 2026-06-12

Entanglement Detection by Approximate Entanglement Witnesses

arXiv:2402.14755v2 Announce Type: replace Abstract: The problem of determining whether a given quantum state is separable is known to be computationally difficult. We develop an approach to this problem based on approximations of convex polytopes in high dimensions. By showing that a convex polytope constructed from a finite number of hyperplanes approximates the Euclidean ball arbitrarily well in high dimensions, we find evidence that a finite set of approximate entanglement witnesses is potentially sufficient to determine the entanglement of a state with high probability.

24.
medRxiv (Medicine) 2026-06-15

Sociodemographic Disparities in Tafamidis Initiation and Clinical Outcomes in ATTR-CM Across the United States

BACKGROUND Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, life-threatening disease. Sociodemographic factors may influence time to treatment initiation and resulting clinical outcomes, yet these relationships are poorly characterized. OBJECTIVE Assess the effects of sex and race on tafamidis initiation and subsequent outcomes and their interaction with factors such as ATTR-CM type and social deprivation measures. METHODS A retrospective cohort analysis was conducted using the US Komodo Healthcare Map (01/2016-06/2024) among patients with amyloidosis, identified by ICD-10-CM diagnosis codes. Cumulative incidence of treatment initiation and survival probabilities for cardiovascular-related hospitalization (CVH) or death were estimated by Kaplan-Meier, stratified by sex and race. Cox proportional hazards models were fitted for both endpoints to estimate hazard ratios, adjusting for demographics and clinical characteristics. RESULTS Of 11,311 patients identified, White and Black patients (n=9,223) were included in subsequent analyses. Within 12 months of diagnosis, White women had the lowest cumulative incidence of tafamidis initiation (11.4%), followed by Black women (22.0%), Black men (26.7%), and White men (31.0%). Event-free survival at 12 months was lowest in Black women (42.9%), followed by Black men (46.8%), White women (48.6%), and White men (54.4%). Median (95% CI) time to CVH or death was shortest for Black women (8.0 months [6.8-10.0]) followed by Black men (9.9 months [8.8-12.0]), White women (11.0 months [9.6-13.0]), and White men (15.0 months [14.0-16.0]). CONCLUSIONS In this large, real-world cohort of US patients with ATTR-CM, sex and race contributed to disparities in tafamidis initiation and survival, underscoring compounded disparities in both access and outcomes.

25.
medRxiv (Medicine) 2026-06-15

Quality Improvement Based Implementation and Evaluation of a Decision Aid for Patients with Nephrolithiasis

Introduction Patients with nephrolithiasis face challenges in making a high-quality, preference sensitive decision. Our prior work established feasibility and patient acceptance of a software-based decision aid (DA). The objectives for this study were to identify implementation strategies for the DA in routine care and determine whether DA implementation enhances decisional quality for patients. Methods New nephrolithiasis patients were recruited from the institution Medical Center from June 2018 to April 2024 to receive a software-based pre-visit DA that measured care preferences and used decision analysis to rank treatments. The RE-AIM framework and Plan-Do-Study-Act (PDSA) cycles were used to improve implementation outcomes. Patients completed survey instruments evaluating decisional conflict, shared decision-making, care satisfaction, and treatment choice following their provider visit. These metrics were compared in the DA cohort (n=81) to those in a usual care cohort (n=78) with Wilcoxon rank-sum and Chi-square (or Fishers exact) tests. Results Implementation data revealed sustained reach and progressive improvement in fidelity. The DA cohort reported higher decisional quality relative to controls (p=0.003) and reported greater support/advice to make a choice (p=0.005). The DA cohort more often discussed options with their doctor (87.5% vs 69.2%, p=0.005) and were more likely to be promoters of their provider (p