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

Collaborative Multi-Modal Coding for High-Quality 3D Generation

3D content inherently encompasses multi-modal characteristics and can be projected into different modalities (e.g., RGB images, RGBD, and point clouds). Each modality exhibits distinct advantages in 3D asset modeling: RGB images contain vivid 3D textures, whereas point clouds define fine-grained 3D geometries. However, most existing 3D-native generative architectures either operate predominantly within single-modality paradigms-thus overlooking the complementary benefits of multi-modality data-or restrict themselves to 3D structures, thereby limiting the scope of available training datasets. To holistically harness multi-modalities for 3D modeling, we present TriMM, the first feed-forward 3D-native generative model that learns from basic multi-modalities (e.g., RGB, RGBD, and point cloud). Specifically, 1) TriMM first introduces collaborative multi-modal coding, which integrates modality-specific features while preserving their unique representational strengths. 2) Furthermore, auxiliary 2D and 3D supervision are introduced to raise the robustness and performance of multi-modal coding. 3) Based on the embedded multi-modal code, TriMM employs a triplane latent diffusion model to generate 3D assets of superior quality, enhancing both the texture and the geometric detail. Extensive experiments on multiple well-known datasets demonstrate that TriMM, by effectively leveraging multi-modality, achieves competitive performance with models trained on large-scale datasets, despite utilizing a small amount of training data. Furthermore, we conduct additional experiments on recent RGB-D datasets, verifying the feasibility of incorporating other multi-modal datasets into 3D generation.

02.
arXiv (CS.CL) 2026-06-12

Structuring The Future: Diffusion LLM Speculative Decoding via Calibrated Draft Graphs

Diffusion LLMs (dLLMs) have recently emerged as a powerful alternative to autoregressive LLMs (AR-LLMs) with the potential to operate at significantly higher token-generation rates. To unlock this potential, we present Spiffy, a speculative decoding algorithm to accelerate dLLM inference while provably preserving the model's output distribution. This work addresses the unique challenges involved in applying ideas from speculative decoding of AR-LLMs to dLLMs. Spiffy performs auto-speculation to eliminate the overheads of an independent draft model, structuring draft states in the form of a novel directed draft graph to take advantage of the bidirectional, blockwise nature of dLLM generation. These draft graphs are calibrated offline to maximize acceptance rates and are dynamically pruned during inference for improved computational efficiency. We present a detailed formulation of Spiffy and demonstrate its ability to accelerate LLaDA, Dream, and SDAR models in combination with KV caching and threshold-based dynamic unmasking leading to up to $8.6\times$ reduction in model inferences and $6.3\times$ acceleration in token rate.

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

Fusion-E2Pulse: A Multimodal Event-RGB Fusion Network for Non-contact Pulse Wave Reconstruction

Non-contact pulse wave reconstruction hinges on the precise recovery of waveform morphology, including the dicrotic notch. Conventional Red-Green-Blue (RGB)-based methods, which extract physiological signals from recorded facial videos, are constrained by the integral imaging mechanism of standard cameras, where the exposure process induces a smoothing effect that attenuates subtle vascular pulsation details. Conversely, neuromorphic event cameras, while offering exceptional sensitivity to intensity fluctuations, are inherently susceptible to noise and artifacts induced by minor motion. To exploit the synergy between frame-based integration and event-based differential sensing, we propose a novel multimodal network named Fusion-E2Pulse. This framework utilizes filtered RGB signals as structural priors to suppress motion artifacts, while leveraging the high-sensitivity of event streams to recover fine-grained morphological details. Experimental results demonstrate that Fusion-E2Pulse achieves state-of-the-art performance, effectively balancing noise suppression and morphological fidelity, achieving a mean absolute error of 0.78 bpm for heart rate estimation, a waveform correlation of 0.89, and a systolic phase duration error of 16.74 ms, validating its efficacy in reconstructing fine-grained pathological features.

04.
arXiv (CS.LG) 2026-06-15

BigPower: Hierarchical Source-Level Module Power Estimation for CPUs with Large Language Models

arXiv:2606.13747v1 Announce Type: cross Abstract: Accurate power estimation is important for understanding and optimizing CPU power behavior, yet practical workflows often rely on simulation-derived information or post-silicon analysis. In this work, we present BigPower, a hierarchical source-level surrogate model for fine-grained module-level power estimation during CPU design. BigPower leverages large language model-based representations together with architectural hierarchy, module connectivity, configuration parameters, and workload context to estimate module-level power consumption directly from source-level design information, without requiring additional simulation during inference. Experimental results in the open-source XiangShan processor family demonstrate practical fine-grained power estimation across diverse configurations and workloads, offering an efficient alternative to conventional simulation-based workflows.

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

Optimising Temporary Accommodation Placement Across London with AI-Powered SaaS in E-Governance Systems

arXiv:2606.16652v1 Announce Type: cross Abstract: Temporary accommodation has become a major fiscal and administrative pressure for English local authorities, particularly in London, where demand and costs have risen sharply. This paper documents the creation and use of DOMUS, a cloud-based, AI-enabled decision-support system built from scratch at the University of East London and customised for the needs of London Borough of Newham to support statutory Temporary accommodation placement. DOMUS integrates household case records, policy-constrained affordability and suitability rules, and live private-rental listings within a single governance-aligned workflow. The system combines transparent, rule-based filtering with large language model-assisted search to standardise the application of bedroom need, affordability thresholds, geographic preferences, and accessibility requirements, while preserving officer discretion and audibility. Household and property attributes are encoded into policy-consistent representations prior to AI-assisted ranking and explanation. A pilot deployment in Newham's secure environment evaluated operational performance relative to manual workflows. Results indicate substantial reductions in search time, improved adherence to key placement constraints, and high staff satisfaction, while maintaining statutory compliance and role-based accountability. Beyond TA, the paper frames DOMUS as replicable digital public infrastructure: a modular, cloud-native Software-as-a-Service architecture that can be deployed across other UK boroughs and adapted to other public administration tasks characterised by scarcity, rule-bound eligibility, and high stakes. The findings demonstrate the feasibility of scalable, ethically governed AI deployment in local government and contribute to debates on AI-enabled public value creation in e-governance.

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

MetaboNet-Bench: A Multi-modal Benchmark for Glucose Forecasting in Type 1 Diabetes

arXiv:2606.18640v1 Announce Type: new Abstract: Glucose forecasting algorithms are an important aspect of glycemic control management in type 1 diabetes. So far, the research community has developed numerous algorithms and models for forecasting. However, it is well-recognized that the lack of standardized model performance evaluation benchmarks makes fair comparison difficult and hinders further innovation, and thus benchmark standardization is in urgent need. Furthermore, many published glucose forecasting algorithms are limited to CGM data alone, ignoring other multimodal signals such as insulin dosing and carbohydrate intake. Here, we introduce MetaboNet-Bench, a benchmark for multimodal glucose forecasting for patients with type 1 diabetes that provides an extensible open-source evaluation framework for comparison of glucose forecasting algorithms that leverage glucose, insulin, and carbohydrate data. We then demonstrate its utility by benchmarking several recently published glucose forecasting models and a custom multimodal time-series model, representing different model architectures. The results show that the benefit of adding data modalities is conditioned on the complexity of the model and that incorporating more clinical metrics helps identify meaningful gaps to fill for future research.

07.
arXiv (quant-ph) 2026-06-16

Conditions for Unitarity in Timeless Quantum Theory

arXiv:2504.01579v3 Announce Type: replace Abstract: Quantum timeless approaches solve the problem of time by recovering the usual unitary evolution of quantum theory relative to a clock in a stationary quantum Universe. For some Hamiltonians of the Universe, such as those including an interaction term with the clock, the dynamics is substantially altered and can be non-unitary. This work derives necessary and sufficient conditions for the relative dynamics to be unitary and finds the general form of the unitary evolution operator. A physical interpretation of these conditions is given in terms of the clock's rate. Unitary dynamics is associated with rates that are constant in time and independent of the clock's internal structure.

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

SMT-AD: a scalable quantum-inspired anomaly detection approach

arXiv:2604.06265v2 Announce Type: replace Abstract: Quantum-inspired tensor networks algorithms have shown to be effective and efficient models for machine learning tasks, including anomaly detection. Here, we propose a highly parallelizable quantum-inspired approach which we call SMT-AD from Superposition of Multiresolution Tensors for Anomaly Detection. It is based upon the superposition of bond-dimension-1 matrix product operators to transform the input data with Fourier-assisted feature embedding, where the number of learnable parameters grows linearly with feature size, embedding resolutions, and the number of additional components in the matrix product operators structure. We demonstrate successful anomaly detection when applied to standard datasets, including credit card transactions, and find that, even with minimal configurations, it achieves competitive performance against established anomaly detection baselines. Furthermore, it provides a straightforward way to reduce the weight of the model and even improve the performance by highlighting the most relevant input features.

10.
arXiv (CS.CL) 2026-06-19

Learning to Prompt: Improving Student Engagement with Adaptive LLM-based High-School Tutoring

LLMs can personalize education, although current static-prompt tutoring systems struggle to adapt to diverse academic disciplines. We develop and test a system with subject-aware prompting, based on 14 pedagogical features (e.g., tutor scaffolding, student understanding) extracted from raw transcripts. We first train a prompt routing model in a simulation environment, and then deploy it for online adaptation with actual high-school students. The simulation benchmark shows the router outperforming two static baselines ($0.694$ vs. $0.647$ and $0.64$, $p

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

Steering Emotional Dynamics for Art Therapy: Controllable Narrative Script Generation through Hierarchically Guided LLM Agents

arXiv:2606.16481v1 Announce Type: new Abstract: Art therapy plays a vital role in emotional healing, in which narrative creation acts as the primary vehicle for emotional expression. Given the inherently dynamic nature of emotions during healing, narratives with finely controlled emotional fluctuations enable individuals to safely project inner conflicts and achieve emotional catharsis. Recently, with the rapid development of Large Language Models (LLMs), automated narrative generation technology has provided a new pathway to support such artistic designs. However, while existing methods can produce fluent texts, they struggle to generate narratives that adhere to specified affective trajectories, failing to meet the demands of emotion-oriented psychological healing. To address these issues, this paper proposes EC-Script, an LLM agent-based framework that enables hierarchical control of the affective trajectory in narrative generation for emotional healing. To ensure that the generated narratives strictly follow the given emotional patterns, EC-Script establishes overall narrative direction through Emotion-Trajectory Planning, propels scene-level plot development with Character-Driven Scene Generation, and regulates local emotional changes of characters via Emotion-Controlled Script Writing. Ultimately, it outputs scene-by-scene script content that remains highly consistent with the preset affective trajectory. Experimental results demonstrate that EC-Script significantly outperforms baseline methods in affective trajectory adherence, exhibiting excellent and reliable emotional controllability, thereby providing effective technical support for AI-assisted emotional healing scenarios.

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

DuET: Dual Expert Trajectories for Diffusion Image Editing

Recent diffusion editors perform diverse instruction-based edits while conditioning on the source image at every denoising step. Yet persistent source-image conditioning can limit how fully an edit is executed and how natural the result appears, especially when the target scene diverges substantially from the input. We introduce DuET (Dual Expert Trajectories), a training-free inference method that temporarily relaxes source-image conditioning by transitioning through a text-to-image phase before returning to edit mode, allowing the denoising trajectory to move toward the target distribution while retaining the structural benefits of image-conditioned editing. Without modifying model weights or increasing sampling cost, DuET consistently improves instruction relevance, semantic fidelity, and perceptual quality across diverse models and benchmarks. In some cases, these gains come with a modest reduction in source-image preservation, revealing a predictable trade-off between source preservation and edit fidelity.

13.
arXiv (CS.AI) 2026-06-19

Boundary Embedding Shaping with Adaptive Contrastive Learning for Graph Structural Disentanglement

arXiv:2606.20283v1 Announce Type: cross Abstract: Graph neural networks (GNNs) excel at aggregating neighbor information for classification, yet their performance is hindered by graph structural entanglement, where spurious correlations from semantically irrelevant neighbors contaminate node embeddings. This challenge is most acute for nodes near class boundaries in the embedding space, where amplified structural noise blurs decision boundaries and destabilizes predictions. Existing robust GNN methods largely treat all nodes uniformly, ignoring boundary vulnerabilities. In this paper, to improve classification performance, we tackle graph structural disentanglement by identifying boundary-region entanglement as the primary bottleneck and propose Boundary Embedding Shaping (BES), an adaptive contrastive learning GNN plug-in module that selectively suppresses spurious structural noise at decision boundaries with minimal model parameter perturbation. Extensive experiments demonstrate that BES consistently improves boundary discrimination and outperforms existing leading methods. Notably, BES boosts GCN performance by an average of 3.3% in node classification (up to 5.0% on WikiCS) and achieves superior accuracy in link prediction.

14.
arXiv (quant-ph) 2026-06-19

Quantifying Imaginarity in Neutrino Systems

arXiv:2412.01871v2 Announce Type: replace-cross Abstract: It is a fundamental question why quantum mechanics employs complex numbers rather than solely real numbers. In this work, we conduct the first analysis of imaginarity quantification in neutrino flavor and spin-flavor oscillations. As quantum systems in coherent superposition, neutrinos are ideal candidates for quantifying imaginarity within the resource theoretic framework, using measures such as the $\ell_1$-norm and the relative entropy of imaginarity. We show that in the case of two-flavor mixing, these measures of imaginarity are nonzero. The measures of imaginarity reach their extreme values when the probabilistic features of quantum theory are fully maximized, i.e., both the transitional and survival probabilities are approximately equal. Our study reveals that the imaginarity, as a resource, can be harnessed not solely from the presence of a complex phase in the mixing matrix but also from the intrinsic quantum dynamics of time evolution itself. We further extend our analysis to explore the dynamics of three-flavor neutrino mixing, incorporating the effects of a nonzero $CP$ phase.

15.
arXiv (CS.CL) 2026-06-19

Displacement Is Not Direction: Evaluating Fidelity Metrics for Quantized LLM Deployment

Fidelity metrics, such as per-token KL divergence (KLD) against a high-precision reference, are often used in practice as low-cost proxies for benchmark quality. We test this practice on a 28-quant cohort of Qwen3.6-35B-A3B and a 41-quant cohort of Devstral-Small-2-24B, evaluated across a suite of downstream benchmarks. We find that KLD is strongly correlated with benchmark score over the full cohort ($\rho=-0.72$ on Qwen and $\rho=-0.86$ on Devstral, both with $p

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

Beyond Predefined Schemas: TRACE-KG for Context-Enriched Knowledge Graph Generation

arXiv:2604.03496v2 Announce Type: replace Abstract: Knowledge graph generation typically relies either on predefined ontologies or on schema-free extraction. Ontology-driven pipelines enforce consistent typing but require costly schema design and maintenance, whereas schema-free methods often produce fragmented graphs with weak global organization, especially in long technical documents with dense, context-dependent information. We propose TRACE-KG (Text-dRiven schemA for Context-Enriched Knowledge Graphs), a framework that jointly constructs a context-enriched knowledge graph and an induced schema without assuming a predefined ontology. TRACE-KG captures conditional relations through structured qualifiers and organizes entities and relations using a data-driven schema that serves as a reusable semantic scaffold while preserving full traceability to the source evidence. Experiments show that TRACE-KG produces structurally coherent, traceable knowledge graphs and offers a practical alternative to both ontology-driven and schema-free construction pipelines.

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

Stable Menus of Public Goods: AI-Enabled Progress

作者:

arXiv:2606.16989v1 Announce Type: cross Abstract: Using an open problem from the EC 2025 paper "Stable Menus of Public Goods" as a testbed, we conduct experiments to understand the effectiveness of different AI-for-EconCS research workflows. Specifically, we study three questions: Does providing human intuition in the prompt help? Does automated multi-turn interaction help? And, does an LLM outperform a first-year PhD student? Regarding the first two questions, we provide evidence for the following workflow suggestions: (1) prompting with human intuition can encourage the LLM to have better "taste", (2) multi-turn workflows help when the pipeline encourages "ambitious" steps. Regarding the third question, using an unpublished manuscript written by the paper's senior authors prior to collaborating with the first-year PhD student, we compare the effectiveness of the LLM with that of the first-year PhD student, and find that the LLM is slightly less effective.

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

Robust Local Polynomial Regression with Similarity Kernels

arXiv:2501.10729v3 Announce Type: replace-cross Abstract: Local Polynomial Regression (LPR) is a widely used nonparametric method for modeling complex relationships due to its flexibility and simplicity. It estimates a regression function by fitting low-degree polynomials to localized subsets of the data, weighted by proximity. However, traditional LPR is sensitive to outliers and high-leverage points, which can significantly affect estimation accuracy. This paper revisits the kernel function used to compute regression weights and proposes a novel framework that incorporates both predictor and response variables in the weighting mechanism. The focus of this work is a conditional density kernel that robustly estimates weights by mitigating the influence of outliers through localized density estimation. The proposed method is implemented in Python and is publicly available at https://github.com/yaniv-shulman/rsklpr. The population analysis quantifies the bias induced by density-based robust weighting, and the reported experiments show lower empirical bias than iterative robust LOWESS while remaining competitive with standard LOWESS. This advancement provides a promising extension to traditional LPR, opening new possibilities for robust regression applications.

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

Analysis of the asymmetric shelf shuffle

arXiv:2606.18047v1 Announce Type: new Abstract: In an asymmetric shelf shuffle, a deck of $n$ cards is dealt sequentially from the bottom and assigned one of the $m$ shelves uniformly at random. The card is placed at the top of the assigned shelf with probability $p$, and at the bottom of the assigned shelf with probability $(1-p)$. Analysis of the shelf shuffle has gained much attention recently, and the case $p=1/2$ was first treated by Diaconis–Fulman–Holmes [Ann. Appl. Prob. 23 (2013), no. 4, 1692–1720]. In this paper, we extend the analysis of the shelf shuffle to general $p\in (0, 1)$. In particular, we study the distribution of cycles, cycle lengths, number of descents, number of valleys, number of inversions, and the RSK shape of a permutation obtained from an asymmetric shelf shuffle. Our results extend the analysis of Diaconis–Fulman–Holmes to arbitrary $p$. Furthermore, our analysis of the distribution of descents and inversions is new even for $p=1/2$.

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

Tyler: Typed Latent Reasoning for Language Models – When to Think, What to Compute, and How Much to Allocate

Chain-of-thought (CoT) prompting improves reasoning in large language models (LLMs) by externalizing intermediate computation as discrete text tokens, but this textual interface also introduces redundancy and inference overhead. Latent reasoning offers a promising alternative by carrying part of the computation in continuous representations. However, existing methods typically predefine when latent computation is invoked and how it is allocated during decoding, leaving a key problem unresolved: when to invoke latent computation, what type of computation to perform, and how much budget to allocate. We propose Typed Latent Reasoning (Tyler), a typed and budget-aware framework for latent reasoning during autoregressive decoding. Tyler learns a policy that, at each decoding step, chooses between emitting a text token and switching to a latent computation module specialized for a particular reasoning function. Once invoked, an operator maps the current reasoning state into latent tokens that support global planning, local state updates, or reusable procedural abstraction. Across extensive experiments on three backbone LLMs, Tyler improves accuracy by up to 14.49 points over CoT and by up to 4.30 points over the strongest competing baseline. It further generalizes across diverse reasoning domains and achieves the best final-stage performance with the lowest forgetting.

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

GLARE: A Natural Language Interface for Querying Global Explanations

arXiv:2606.19735v1 Announce Type: new Abstract: While global explanations are crucial for understanding vision models across datasets, classes, and decision contexts, their complex and monolithic nature often hinders practical exploration. Because users typically seek targeted answers to specific questions rather than static artifacts, we present an LLM-based interactive interface that provides natural language access to global explanations for black-box image classifiers. The system's core LLM acts as a mediator, translating natural language questions into structured SQL queries over local explanation data. This enables flexible aggregation without exposing users to low-level representations. For each query, the interface outputs statistics-augmented natural language responses, supporting local explanations, and intent-aligned visualizations. We evaluate the system on intent interpretation, query mapping accuracy, generalization to novel queries and datasets, and robustness to linguistic errors. Our results demonstrate that LLM-mediated querying substantially improves the accessibility and usability of global explanations for human-centered XAI.

22.
arXiv (CS.CL) 2026-06-17

RubricsTree: Scalable and Evolving Open-Ended Evaluation of Personal Health Agents across Health Memory and Medical Skills

The LLM-empowered personal health agents with user health (sensor) metrics have offered a promising pathway to alleviate global disparities in healthcare access. However, large-scale clinical deployment remains constrained by an open-ended evaluation bottleneck: physician annotation is reliable but costly and unscalable, while LLM-as-a-judge evaluators are scalable but subjective, inconsistent, and sometimes clinically misaligned. We introduce RubricsTree, a scalable evaluation framework with an expert-aligned hierarchical taxonomy of over 100 atomic, clinically-verifiable Boolean rubrics, evolving from the insights of 4,000 real user queries through an iterative human-in-the-loop curation protocol with an expertise panel led by an experienced physician. A context-aware adaptive router activates only the relevant auto-weighted rubric subset per query, providing the throughput needed for scalable evaluation with expert-aligned quality. Through a systematic meta-evaluation, we show that RubricsTree (i) substantially exceeds a strong large-scale evaluation baseline in expert alignment on challenging open-ended queries; (ii) reliably penalizes contextually degraded responses; and (iii) when used as structured instructions, text feedback, or training rewards for performance optimization, yields up to ~66% relative gains on HealthBench for Gemini, GPT, and Qwen model families. RubricsTree thus provides a scalable, auditable, and evolving evaluation infrastructure required for the continuous optimization of product-level personal healthcare AI.

23.
arXiv (CS.LG) 2026-06-19

A deep learning framework for jointly solving transient Fokker-Planck equations with arbitrary parameters and initial distributions

arXiv:2604.06001v2 Announce Type: replace-cross Abstract: Efficiently solving the Fokker-Planck equation (FPE) is central to analyzing complex parameterized stochastic systems. However, current numerical methods lack parallel computation capabilities across varying conditions, severely limiting comprehensive parameter exploration and transient analysis. This paper introduces a deep learning-based pseudo-analytical probability solution (PAPS) that, via a single training process, simultaneously resolves transient FPE solutions for arbitrary multi-modal initial distributions, system parameters, and time points. The core idea is to unify initial, transient, and stationary distributions via Gaussian mixture distributions (GMDs) and develop a constraint-preserving autoencoder that bijectively maps constrained GMD parameters to unconstrained, low-dimensional latent representations. In this representation space, the panoramic transient dynamics across varying initial conditions and system parameters can be modeled by a single evolution network. Extensive experiments on paradigmatic systems demonstrate that the proposed PAPS maintains high accuracy while achieving inference speeds four orders of magnitude faster than GPU-accelerated Monte Carlo simulations. This efficiency leap enables previously intractable real-time parameter sweeps and systematic investigations of stochastic bifurcations. By decoupling representation learning from physics-informed transient dynamics, our work establishes a scalable paradigm for probabilistic modeling of multi-dimensional, parameterized stochastic systems.

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

Dynamic Link Prediction with Temporally Enhanced Signed Graph Neural Networks

arXiv:2605.26290v2 Announce Type: replace Abstract: Temporal signed networks (TSNs) model the time evolution of cooperative and adversarial relationships that arise in applications such as social media analysis, trust and reputation systems, and financial transaction networks. While graph neural networks (GNNs) perform well for static or unsigned link prediction, effective learning in temporal signed graphs remains challenging due to the interaction of signed relations, evolving structure, and balance-theoretic constraints. To address this gap, we propose a modular temporal enhancement framework for signed GNNs that integrates historical context into otherwise static architectures. The framework introduces a Historical Context Integration Module (HCIM) that combines learnable recency-aware temporal weighting, LSTM-based embedding trajectory modeling, and multi-head temporal attention to capture both short- and long-term signed interaction dynamics. Historical information is fused with current node representations using either global or node-adaptive weighting, allowing the architecture-agnostic framework to accommodate heterogeneous temporal behaviors. We instantiate the approach on the Self-Explainable Signed Graph Transformer (SE-SGformer), preserving interpretability while extending it with temporal awareness. Experiments on real-world and synthetic TSNs, including Bitcoin OTC, Bitcoin Alpha, Reddit, and small-world network models, demonstrate consistent and statistically significant improvements over the static baseline.

25.
medRxiv (Medicine) 2026-06-16

Validating an Early Pregnancy HbA1c as the Screening Test for Gestational Diabetes Mellitus: Findings from PRISMA Pakistan Cohort

Background: Early identification of gestational diabetes mellitus (GDM) is critical to improving maternal and neonatal outcomes, particularly in resource-constrained settings where universal oral glucose tolerance testing (OGTT) is burdensome. We assessed whether early-pregnancy HbA1c alone or combined with common risk factors can predict GDM and reduce the burden of OGTT requirements in a peri-urban cohort in Karachi, Pakistan. Methods: We conducted a secondary analysis of the Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA) Pakistan cohort. Women enrolled before 20 weeks' gestation with available early-pregnancy HbA1c and a 2-hour 75g OGTT at 24 to 28 weeks were included. We externally validated GDM prediction models originally developed in the STRiDE-India cohort. Model performance was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC). We assessed four models: HbA1c alone (Model 1a); age, BMI, and family history of diabetes mellitus (FH DM) (Model 1b); HbA1c combined with age, BMI, and FH DM (Model 2); and an extended model, i.e., Model 2 combined with socioeconomic status, gestational age, parity, systolic and diastolic blood pressure (Model 3). A dual-threshold approach was applied to assess rule-in and rule-out performance. Results: Among 2,489 women, GDM incidence was 7.5% (n=186). Models with a broader set of predictors demonstrated higher AUC values, with Model 2 achieving an AUC of 0.61 (95% CI: 0.57, 0.66). Including additional factors (Model 3) did not further improve predictive ability (AUC: 0.62; 95% CI: 0.58, 0.66). In addition, at predefined thresholds, Model 2 achieved sensitivity of 73.7% (rule-out) and specificity of 83.5% (rule-in), with the potential to reduce OGTT requirements (58.5%). Conclusions: Early-pregnancy risk stratification using HbA1c combined with simple clinical predictors offers a pragmatic approach to streamline GDM screening among high-risk pregnant women. A dual-threshold strategy using Model 2 could reduce reliance on universal OGTT while prioritizing high-risk women for confirmatory testing.