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

MA-SBI: Misspecification-Aware Simulation-Based Inference via Side-Channel Guidance

arXiv:2606.16923v1 Announce Type: new Abstract: Simulation-based inference (SBI) of latent parameters is often hindered by simulator misspecification, the mismatch between simulated and real-world observations caused by inherent modeling simplifications. RoPE, the recent state-of-the-art for robust SBI, addresses this through optimal transport between learned representations of real and simulated observations, but requires ground-truth parameter calibration pairs that are typically unavailable in the very settings where SBI is needed. What practitioners do have is unstructured side-information such as regime labels, instruction text, and policy bulletins. We propose Misspecification-Aware Simulation-Based Inference (MA-SBI), a calibration-free framework that turns this side-channel into a posterior correction. A learned corrector maps side-channel text to an observation-space shift applied before any pre-trained amortized posterior, requiring no retraining and no parameter ground-truth. Our main theorem bounds achievable bias reduction by the mutual information between misspecification and side-channel, with a non-vacuous constant that extends to all sub-Gaussian noise via Donsker-Varadhan. On hide-the-calibration benchmarks, MA-SBI with text alone matches the oracle posterior across 10 seeds and two backbones (TOST equivalence), while RoPE given more data does not. The two approaches are complementary: where misspecification is structural and recoverable from parameter pairs, RoPE dominates, as the theory predicts. A stochastic variant improves posterior-predictive log-likelihood on real COVID and OxCGRT epidemiological data, and correctly leaves the posterior unchanged on a well-specified cognitive-science corpus.

02.
arXiv (CS.CL) 2026-06-16

Risk-Aware LLM Agents for Geospatial Data Retrieval: Design and Preliminary Adversarial Evaluation

We present an LLM-driven framework for retrieving remote sensing data from cloud-based geospatial catalogues using natural language queries. The system converts user intent into structured API calls, enabling efficient access to satellite imagery and environmental datasets. The architecture integrates three agents: Guardrail for safety and policy enforcement, General-QA for intent interpretation, and Recommender-Analyst for schema-aware API call generation. This coordinated design ensures reliable, semantically aligned interaction with external data services. The modular framework is portable across platforms through API schema substitution and supports applications in environmental monitoring, disaster response, and climate analysis. It establishes a scalable interface between user intent and geospatial infrastructure, enabling streamlined and automated Earth observation workflows. Preliminary experiments under adversarial multi-turn settings show that prompt-level safety instructions improve robustness, although rare high-impact failures persist in API manipulation scenarios and highlight the need for adaptive, system-level defenses that balance safety, usability, and cost efficiency, which motivates the use of our intercept-level Guardrail agent.

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

LineageMark: Multi-user White-box Watermarking for Contribution Tracing in Model Derivation Chains

arXiv:2606.17123v1 Announce Type: cross Abstract: In open large language model (LLM) ecosystems, models are frequently adapted across multiple domains and applications, forming multi-stage derivation chains. Consequently, tracking and verifying historical contributions is essential for model provenance and intellectual property protection. However, existing watermarking methods are mainly designed for single-user, one-time embeddings, often fail under repeated model derivation and incremental updates. To address this problem, we propose LineageMark, a multi-user white-box watermarking framework for model derivation chains. The framework encodes watermarks in model parameters using a projection-based approach. Stable carriers are first selected to reduce sensitivity to model changes, each watermark bit is then represented as a projection statistic over these carriers. Additional watermark insertions introduce only bounded perturbations in the projection space, and margin constraints are used to maintain signal integrity. We evaluate the effectiveness of LineageMark in multi-stage model derivation chains. Experimental results show that LineageMark preserves contributor watermarks across multi-stage derivation and supports incremental multi-user watermark insertion. Furthermore, it exhibits robustness against perturbations such as re-watermarking, fine-tuning, quantization, and pruning.

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

Trajectory-Level Redirection Attacks on Vision-Language-Action Models

Vision-language-action (VLA) policies bring natural language into closed-loop robot control, enabling robots to execute manipulation tasks directly from text instructions. The same interface gives text a recurring role in control because the prompt is reused at every replanning step, and each prompt-conditioned action changes the future observations on which the policy acts. Existing VLA attacks study adversarial prompts that elicit targeted low-level actions or make such actions persist across changing images. We identify a stronger trajectory-level failure mode: a prompt that still $appears$ to specify the intended task but redirects the final physical outcome. We mathematically formalize this setting as $command-preserving trajectory redirection$, a prompt-only threat model in which the attacker chooses one prompt before the episode, all policy and environment components remain fixed, and the prompt must stay close to the benign instruction while omitting target words and correction language. To find such prompts, we introduce an on-policy prompt search method that uses rollouts to discover perturbations whose closed-loop behavior tracks a target task while satisfying the command-preserving constraints. Experiments in simulation and on hardware show that near-benign prompt perturbations can redirect VLA rollouts to attacker-specified targets. These results expose a trajectory-level vulnerability in VLA instruction grounding: text that appears to preserve the intended command can still give an adversary control over the robot's final physical outcome. Project website: https://vla-redirection-attack.github.io/

07.
arXiv (CS.AI) 2026-06-19

Beyond Static Endpoints: Tool Programs as an Interface for Flexible Agentic Web Services

arXiv:2606.19992v1 Announce Type: cross Abstract: In the agentic web era, LLM-based agents increasingly invoke web services as tools, yet most interfaces remain static endpoints that poorly express long-horizon workflows with loops, conditionals, joins, and retries. We present ToolPro, which represents an agent's tool intent as an executable tool program that compactly encodes multi-step service interactions with explicit effect types. ToolPro combines constraint-guided program construction, effect-aware replay for exactly-once state-modifying calls, and a profile-driven policy that decides when program execution outperforms stepwise calling. We instantiate ToolPro over MCP-style services with WebAssembly sandboxing and evaluate it on diverse workflows of real-world applications. ToolPro reduces end-to-end latency by up to 53.4\% and client-side traffic by up to 96.1\%, with larger gains under higher network latency and workflow complexity.

08.
arXiv (CS.CL) 2026-06-16

Beyond Retrieval: Learning Compact User Representations for Scalable LLM Personalization

Personalizing large language models requires adapting model behavior to individual users while preserving robustness and deployment-scale efficiency. Existing approaches typically personalize LLMs either at the input level, by retrieving user histories or constructing profile prompts, or at the parameter level, by maintaining user-specific parameter-efficient modules. The former makes personalization sensitive to retrieval quality and prompt design, whereas the latter incurs storage and maintenance costs that grow with the user population. To address these limitations, we propose TAP-PER (Temporal Attentive Prefix for PERsonalization), a prefix-based framework that encodes user preferences as learnable representations, eliminating explicit prompt construction and replacing heavy per-user adapters with lightweight user-state prefix embeddings. Inspired by personalized recommendation systems, TAP-PER decomposes user modeling into user-state and query-conditioned components, and incorporates temporal signals to capture the evolving nature of user interests. Experiments on six LaMP tasks show that TAP-PER consistently outperforms prompt-based and model-based baselines across classification, rating, and generation settings. Moreover, TAP-PER uses 130x fewer per-user parameters than OPPU and roughly half the total parameter footprint of PER-PCS at the 1,000-user scale, demonstrating that scalable LLM personalization can be achieved without explicit prompt construction or heavy per-user adapters.

09.
arXiv (CS.AI) 2026-06-18

How Well Do Large Language Models Capture Human Personality?

arXiv:2606.18263v1 Announce Type: cross Abstract: Large language models (LLMs) are increasingly used to simulate human populations via persona prompting, often under the assumptions that richer persona descriptions improve behavioral fidelity, similarly sized attribute combinations are equally simulatable, and persona definitions generalize across tasks. In this work, we formalize these assumptions and systematically evaluate them across multiple architectures, scales, and simulation settings. We identify a fundamental limitation we term persona manifold collapse, where increasingly expressive persona specifications lead to systematic contraction of representational and behavioral diversity. Across models, increasing persona complexity consistently reduces inter-persona separation in latent space and weakens behavioral differentiation in downstream simulation tasks. These effects persist across multiple analyses as richer personas fail to preserve human subgroup disagreement, performance varies across attribute combinations of similar size, and adding descriptive detail often degrades rather than improves simulation fidelity. Surprisingly, simple Age-Gender personas consistently outperform richly specified Ideal Customer Profiles (ICPs) across industries, achieving substantially higher downstream prediction accuracy. We find that collapse is not uniform across attributes. Certain combinations remain behaviorally stable and preserve stronger alignment with human responses, forming localized regions we term alignment bridges. Together, our results provide empirical and conceptual foundations for understanding the limits of persona-conditioned simulation, highlighting the need for representation-aware persona construction rather than increasing persona expressivity alone.

10.
Nature (Science) 2026-06-22

Daily briefing: First-ever ‘nuclear’ clocks put atomic clocks in the shade

Authors:

Two research teams have created a new, long-awaited type of timekeeper. Plus, how backlash has saved an ocean-monitoring network targeted by Trump and how our cultural heritage is put at risk by climate change. Two research teams have created a new, long-awaited type of timekeeper. Plus, how backlash has saved an ocean-monitoring network targeted by Trump and how our cultural heritage is put at risk by climate change.

12.
arXiv (quant-ph) 2026-06-17

Tripartite entanglement of remote atomic qubits

arXiv:2606.17173v1 Announce Type: new Abstract: Distributed entanglement across multi-node quantum networks is essential for a wide range of quantum technologies, including modular quantum computers, distributed sensing and metrology, and multi-party secure communication protocols. Such large-scale quantum networks will require photonic interconnects to generate and sustain entangled states across localized nodes. Previously, three-node distributed Greenberger-Horne-Zeilinger (GHZ) states have been generated between solid-state qubits and atomic ensembles, but not yet in the platform of individual atomic qubits, which can be replicated, detected, and individually controlled with high fidelity. Here we report the first fully-distributed GHZ state of qubits across a three-node quantum network of single atomic memories, using photonic interconnects. We achieve a bounded fidelity of $0.841(17) \leq \mathcal{F} \leq 0.881(17)$ at an entanglement generation rate of 0.095(5)/sec and measure a clear violation of Mermin's inequality while closing the detection loophole for the first time in a fully-distributed multipartite entangled state.

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

Neural network inverse design of nanophotonic scintillators

arXiv:2606.16309v1 Announce Type: cross Abstract: Scintillators are materials converting high-energy radiation into optical light, essential in a range of technologies such as medical imaging systems and security scanners. Scintillator development and optimization have remained limited by the complexity of their underlying physics, involving stochastic cascades of electron-electron, electron-phonon, and electron-photon interactions. Such processes are typically modeled by non-differentiable Monte Carlo simulations, limiting the applicability of machine learning for scintillator development. Here we present a physics-informed neural network that learns the scintillation cascade process from the incident high-energy particle to photon emission, substantially accelerating scintillator design and optimization. Combining this neural network with photonic simulations enables end-to-end differentiable optimization of the scintillator geometry. This allows us to optimize for arbitrary figures of merit, such as specific target emission patterns.. We demonstrate the concept and characterize it relative to previous approaches by inverse design of nanophotonic scintillators for X-ray imaging.

14.
arXiv (quant-ph) 2026-06-17

Asymptotically Optimal Circuit Depth for Diagonal Unitary Synthesis and Compilation on Two-Dimensional Grids

arXiv:2606.17589v1 Announce Type: new Abstract: Diagonal unitaries are a fundamental but resource-intensive class of quantum operations, arising as the phase separators of QAOA and the time-evolution blocks of Hamiltonian simulation. Under all-to-all connectivity their optimal depth is established, but on nearest-neighbor hardware general-purpose compilers fall back on heuristic search, which yields no analyzable cost bound and becomes intractable at the very sizes where depth is the bottleneck. We address synthesis and compilation jointly. On the synthesis side, we develop a Gray-Path Framework (GPF) that realizes any $n$-qubit diagonal unitary in asymptotically optimal $R_z$ and CNOT depth $O(2^n/n)$ without ancillas. Our main result is that compiling GPF onto a two-dimensional nearest-neighbor grid preserves this optimality: routing adds depth $\Theta(2^n/n)$ and gate count $\Theta(2^n)$. Because GPF fixes its entire interaction structure in advance, routing reduces to scheduling a known sequence, with no heuristic search. We give the construction both with and without ancillas: the ancilla-free, cost-optimized layout is a two-row grid, and a $2k$-row layout introduces a space–time tradeoff that cuts depth by $1/k$ while remaining asymptotically optimal for the enlarged register; both are deterministic and analyzed in closed form. The same complexity is also attained on a linear nearest-neighbor chain, so the preservation is topology-independent, holding on any architecture that contains such a chain. All routing bounds are closed-form, giving the concrete resource estimates that heuristic compilers cannot provide at scale.

15.
arXiv (quant-ph) 2026-06-24

A Quantum Non-Gaussianity Criterion Based on Photon Correlations $g^{(2)}$ and $g^{(3)}$

arXiv:2511.08488v2 Announce Type: replace Abstract: Quantum non-Gaussian states, which cannot be written as mixtures of Gaussian states, are necessary to achieve a quantum advantage in continuous variable systems. They represent an important benchmark for the realization of an advanced quantum light source, as they cannot be made by simple means such as displacement and squeezing. We introduce an attenuation-resistant sufficient criterion for quantum non-Gaussian states based on the second- and third-order correlation functions, $g^{(2)}$ and $g^{(3)}$. The general non-linear bound for classical mixtures of Gaussian states is $\sqrt{g^{(3)}} + 3 \sqrt{g^{(2)}} \geq 2$. Any mixture of Gaussian states must fulfill this inequality, thus, the violation of it represents a direct confirmation of quantum non-Gaussianity. We experimentally show the non-Gaussianity of the state produced by a quantum dot single-photon source, where we obtain $\sqrt{g^{(3)}} + 3 \sqrt{g^{(2)}} = 0.174 (13)$, which represents a statistical significance of more than $100$ standard deviations.

16.
medRxiv (Medicine) 2026-06-12

Estimating the effectiveness of syndromic screening at airports for Bundibugyo ebolavirus disease

Authors:

We used a stochastic simulation model to estimate the effectiveness of combined exit and entry airport screening for Bundibugyo ebolavirus disease (BVD), using natural-history parameters from a Bayesian re-analysis of the 2012 Isiro outbreak. For a 12-hour international flight from DRC or Uganda at 86% screening sensitivity, we estimate 65% of infected travellers would arrive undetected (95% CrI: 38 - 76%). The main driver of this outcome is the relative duration of the the incubation period (approximately 7.7 days) and the onset-to-severe-disease interval (approximately 4 days): most infected travellers board before symptom onset and are undetectable by any syndromic screen, whilst those who are symptomatic progress rapidly to illness severe enough to preclude travel. This is compounded during active epidemic growth, when recently exposed (and therefore pre-symptomatic) cases are overrepresented among travellers. Syndromic airport screening offers limited protection against BVD spread via air travel, and should be complemented by outbreak control at source and strengthened clinical surveillance in receiving countries with high travel connectivity to affected areas.

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

Querying an astronomical database using large language models: the ALeRCE text-to-SQL system

arXiv:2606.18108v1 Announce Type: cross Abstract: We develop a text-to-SQL (structured query language) system based on large language models (LLMs) using in-context learning and apply it to the Automatic Learning for the Rapid Classification of Events (ALeRCE) astronomical database. ALeRCE is a community broker for the Zwicky Transient Facility and the Vera C. Rubin Observatory. The system enables users to query the database in natural language (NL) and generates executable SQL queries. To develop and evaluate the system, we constructed a dataset of 110 NL/SQL pairs. We propose a step-by-step generation framework comprising four modules: schema linking, query classification, prompt decomposition, and self-correction. The performance of thirteen LLMs is evaluated using in-context learning and prompt engineering techniques. Text-to-SQL performance is assessed using the perfect-match (PM) rate for row identifiers (e.g., object identifiers) and column identifiers (i.e., column names). The proposed step-by-step framework consistently outperforms a direct-inference baseline, while the self-correction module consistently reduces execution errors. For Claude Opus 4.6, PM performance on row (column) identifiers is high for simple queries, reaching 0.97 (0.94), and decreases with query complexity to 0.44 (0.72) for medium queries and 0.59 (0.49) for hard queries. Among the thirteen evaluated models, the best-performing LLMs for the text-to-SQL task are Claude Opus 4.6, Gemini 2.5 Pro, Gemini 3 Flash, and GPT-5.2-Codex.

18.
arXiv (CS.CV) 2026-06-15

UniversalRAG: Retrieval-Augmented Generation over Corpora of Diverse Modalities and Granularities

Retrieval-Augmented Generation (RAG) has shown substantial promise in improving factual accuracy by grounding model responses with external knowledge relevant to queries. However, most existing approaches are limited to a text-only corpus, and while recent efforts have extended RAG to other modalities such as images and videos, they typically operate over a single modality-specific corpus. In contrast, real-world queries vary widely in the type of knowledge they require, which a single type of knowledge source cannot address. To address this, we introduce UniversalRAG, an any-to-any RAG framework designed to retrieve and integrate knowledge from heterogeneous sources with diverse modalities and granularities. Specifically, motivated by the observation that forcing all modalities into a unified representation space derived from a single aggregated corpus causes a modality gap, where the retrieval tends to favor items from the same modality as the query, we propose modality-aware routing, which dynamically identifies the most appropriate modality-specific corpus and performs targeted retrieval within it, and further justify its effectiveness with a theoretical analysis. Moreover, beyond modality, we organize each modality into multiple granularity levels, enabling fine-tuned retrieval tailored to the complexity and scope of the query. We validate UniversalRAG on 10 benchmarks of multiple modalities, showing its superiority over various modality-specific and unified baselines.

19.
medRxiv (Medicine) 2026-06-16

Prevalence and Correlates of Ideal Cardiovascular Health among Ugandan Adolescents: A Cross-Sectional Study

Introduction: Cardiovascular disease (CVD) risk factors often emerge during adolescence and track into adulthood, yet data on cardiovascular health (CVH) in sub-Saharan Africa remain limited. We assessed the prevalence and correlates of ideal CVH among Ugandan adolescents. Methods: We analysed baseline data of adolescents enrolled in a cluster-randomised controlled trial being conducted in urban (Kampala) and rural (Jinja) districts of Uganda. In this study, Ideal CVH was defined as meeting "ideal" status of 5-7 of the American Heart Association's Life's Simple 7 metrics. Random-effects logistic regression was used to identify factors associated with ideal CVH, accounting for village-level clustering. Results: We recruited 1316 participants with a mean age of 13.2 years, of whom 58.1% were female. Overall, the prevalence of ideal CVH was 66.8% (95% CI: 64.2% - 69.3%). The prevalence was higher in Jinja (74.4%, 95%CI: 70.9% - 77.7%) than Kampala (59.6%, 95%CI: 55.8%-63.2%) and the difference was evident (p

20.
bioRxiv (Bioinfo) 2026-06-20

SAbDab2: The structural antibody database in the age of machine learning

The Structural Antibody Database (SAbDab) is a publicly available repository of experimentally determined antibody structures, first released in 2013. Explicit support for single-domain antibodies was added in 2021, with SAbDab-nano. Recently, increasing interest in antibodies has led to a proliferation of novel antibody formats, while simultaneous advances in machine learning have increased demand for standardised, high-quality structure data. Here, we present SAbDab2, re-engineered for the machine-learning age. It introduces support for a variety of new formats, and makes it easy to retrieve and compare all known structures of a given antibody. In addition, SAbDab2 provides ready access to ML-grade structures of antibody and antibody–antigen-complexes, with standardised, versioned train/test splits. These will be updated every six months going forward, and are available at https://zenodo.org/records/20083995. SAbDab2 itself is updated weekly and is freely available at https://sabdab2.opig.stats.ox.ac.uk.

21.
arXiv (CS.AI) 2026-06-24

DramaDirector: Geometry-Guided Short Drama Generation

arXiv:2606.24107v1 Announce Type: cross Abstract: Short dramas, with their rapid shot rhythms, dialogue-driven focus shifts, and demanding cinematographic grounding, pose challenges that prompt-level or text-only video generation pipelines struggle to meet. We study plot-to-short-drama generation, where a global plot and local context are transformed into visually grounded multi-shot videos. We propose DramaDirector, a geometry-grounded framework that lets the planner borrow cinematographic geometry from a gallery of real short-drama shots indexed by depth and pose. DramaDirector decouples each shot into static visual and dynamic narrative conditions, trains the planner with schema-constrained SFT and GRPO under a learned text-visual alignment reward, and retrieves depth-pose references to guide first-frame generation and image-to-video synthesis. We also introduce DramaBoard, a benchmark built from 35 live-action dramas, 2.8K episodes, and 81K shots, with structured storyboards and multi-dimensional evaluation protocols. Experiments show that DramaDirector improves over representative multi-agent and video generation baselines on faithfulness, consistency, and controllability. Our code is released at: https://github.com/iLearn-Lab/DramaDirector

22.
arXiv (CS.CV) 2026-06-19

DiffMath: Symbol- and Graph-Aware Latent Diffusion Transformer for Handwritten Mathematical Expression Generation

Handwritten Mathematical Expression Generation (HMEG) is challenging due to the complex two-dimensional layouts and long-range structural dependencies of mathematical expressions. Existing methods typically rely on explicit spatial supervision, such as symbol-level bounding boxes, which incurs high annotation costs and limits scalability. In this work, we propose DiffMath, a symbol- and graph-aware latent diffusion framework that leverages the hierarchical structure inherent in LaTeX as a structural prior, eliminating the need for positional supervision. First, we design a Relational Abstract Syntax Tree (RelAST), a generation-oriented representation that distills MathML trees into compact triplet sequences [S, R, D], where each token directly encodes a symbol identity, spatial relation, or nesting depth. Second, we introduce MathVAE, which learns structure-preserving latent representations through symbol-aware and relation-aware perceptual regularization, ensuring that the latent space captures both character semantics and spatial topology. Third, MathDiT performs conditional denoising in this structured latent space, further guided by a global symbol-count prior via Adaptive Layer Normalization (AdaLN) to improve structural coherence. Experiments show that DiffMath produces structurally consistent handwritten expressions, achieves superior performance over existing methods, and improves the accuracy of downstream OCR models through synthetic data augmentation.

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

Candidate overtone shear horizontal SAW resonators in thin-film lithium niobate for intermodal acousto-optic modulation

arXiv:2606.12853v1 Announce Type: cross Abstract: The merits of thin-film surface acoustic wave (SAW) devices are pivotal to develop the high-performance intermodal acousto-optic modulators. In this work, we have proposed shear-horizontal (SH) SAW resonators for anticipated intermodal acousto-optic modulation on the thin-film lithium niobate platform. Through optimization of the cut angle of LN films, the SAW wavelength, and the thickness of interdigital transducer (IDT) electrodes, the calculated acousto-optic overlap factors utilizing SH0 modes are improved by more than an order of magnitude compared with those of Rayleigh modes. Furthermore, we have fabricated and characterized three kinds of proof-of-principle SH0 mode devices without/with grating reflectors. The electromechanical coupling coefficients (keff^2) and quality factors (Q) in the overtone resonators with grating reflectors are systematically evaluated, featuring the highest Q of 843 with the compromised keff^2 of 0.96%-4.72%. The results reveal that the temperature coefficients of frequency (TCF) of Rayleigh modes vary across various overtones, whereas the SH0 modes exhibit TCFs in the range of 32.3-68.9 ppm/C. Our fabricated SH0-mode overtone resonators demonstrate the capability of operating at power levels up to 29 dBm without electrode damage, offering a promising paradigm for robust and high-efficiency intermodal acousto-optic modulators with potential applications in integrated optical signal processing, microwave photonics,and quantum information technologies.

24.
arXiv (CS.CL) 2026-06-19

Proactive Conversational Assistant for a Procedural Manual Task based on Audio and IMU

Real-time conversational assistants for procedural manual tasks often depend on video input, which can be computationally expensive and compromise user privacy. For the first time, we propose a real-time conversational assistant that provides comprehensive guidance for procedural manual tasks using only lightweight privacy-preserving modalities such as audio and IMU inputs from a user's wearable device to understand the context. Using a furniture assembly task and a cooking task, we show how this assistant proactively communicates step-by-step instructions to a user performing a procedural task, and answers user questions. We illustrate the data generation method and the system design to achieve such an assistant. On observing that an off-the-shelf language model is a talkative assistant but is not always able to answer questions correctly, we demonstrate how finetuning the model improves its ability to limit unnecessary dialogues with a 50% increase in the precision, while also improving its ability to answer questions correctly, measured by a 150% increase in the recall of answers. We further describe how such an assistant is implemented on an edge device with no dependence on the cloud.

25.
PLOS Medicine 2026-06-23

Comparisons of core component delivery in cardiac rehabilitation programs by country income classification and decade based on the 2025 Global Audit Update: A survey study

by Gabriela Lima de Melo Ghisi, Rachael P. Carson, Karam Turk Adawi, Rongjing Ding, Warner M. Mampuya, Mariya P. Jiandani, Jimena Martinez, Monserrat Cruz Rivero, Claudia V. Anchique, Dinah L. van Schalkwijk, Jonathan Gallagher, Buket Akinci, Dion Candelaria, Jirapa Champaiboon, Daniel F. Quesada-Chaves, Tone M. Norekvål, Iwona Szadkowska, Borut Jug, Evangelia Kouidi, Marta Supervia, Won-Seok Kim, Chamila Mettananda, Lilian Mbau, Gulsim T. Aimakova, Sherry L. Grace, on behalf of the ICCPR Global Cardiac Rehabilitation Audit Update Investigators Background Cardiovascular disease (CVD) remains a leading global health burden. Cardiac rehabilitation (CR) is essential to reducing morbidity and improving patient outcomes. Since the COVID-19 pandemic, CR delivery worldwide has evolved, yet these changes have not been systematically charactemkjrized. The objective of this study was to characterize globally: (1) the delivery of core CR components, including risk factors assessed, patient education practices, and program resources; (2) differences in these elements by country income classification and relative to the initial 2016 Global CR Audit. Methods and findings A cross-sectional Audit update was conducted. Program-level data were collected from May 1st to September 1st 2025 using a REDCap survey adapted from previous Audits. Eligible respondents were leads of phase II/post-discharge CR programs providing at least an initial assessment, structured aerobic exercise, and ≥1 additional core component. ICCPR associations and local leaders supported program identification. Main outcomes were core components delivered (10 assessed), risk factors assessed (14 assessed), patient education dose (hours/patient/program), and program resources (17 assessed). Generalized linear mixed models (GLMM) tested differences by income classification and (when applicable) changes since 2016. Of 7,025 programs identified globally, 1,505 (62% median country response rate) initiated a survey from 90/113 (80%) countries with CR. The median number of core components offered was 8/program (p25, p75 = 6, 10), with upper-middle income countries offering significantly more components overall (median = 9), and also high-income countries offering more than low-income countries (8 versus 6, p