The Haber–Bosch fertilizer production process should be taught through a social-ecological lens
Letter to the Editor
Academic Intelligence · Curated Daily
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Letter to the Editor
arXiv:2606.16364v1 Announce Type: new Abstract: LLM agents mis-call tools, and the natural guess is that the model failed to see the right tool in a crowded harness. We show the opposite through a lens concurrent work sets aside – the model's attention to labeled tool-definition segments. On real BFCL failures, by per-candidate attention argmax the model attends most to the correct tool 80% of the time (vs. 21% chance), and the gold is the under-attended segment on only 10%: it looks at the right tool and still picks wrong. This directly refutes the intuitive "crowded-harness / lost-in-the-middle" explanation: the failure is at the decision readout, not the harness, and we pin it there three ways. (1) Input vs. readout: repairing the prompt (reordering or duplicating the gold tool) recovers
Long-term visual acuity (VA) forecasting after anti-VEGF therapy is important for counseling and follow-up planning in diabetic macular edema (DME), yet remains challenging when only early post-treatment findings are available. While prior OCT-based methods mainly focus on short-term response or single-endpoint prediction, multi-horizon VA forecasting from early longitudinal data remains insufficiently under-explored. In this study, we assembled a real-world cohort of 188 anti-VEGF–treated DME patients with paired baseline and month-1 OCT scans, along with tabular OCT-derived biomarkers and non-imaging clinical variables. Using only these early data, we formulate a multi-horizon VA forecasting problem aimed at predicting visual outcomes at 3, 6, 12, 18, and 24 months, reflecting clinically meaningful follow-up intervals. We propose ReVA, a response-aware multimodal framework that combines baseline and month-1 OCT features with tabular variables to capture disease status and early treatment response. ReVA integrates spatial OCT attention, dependency-aware tabular encoding, and cross-modal fusion to predict patient-specific long-term VA trajectories. The proposed framework achieves MAE=0.1246, RMSE=0.1621, and R^2=0.6064 for 24-month VA prediction, with consistent performance across all forecast horizons. Our findings show that incorporating early treatment-response signals enables clinically meaningful long-term visual acuity forecasting, supporting data-driven decision support for routine anti-VEGF management. Code and pretrained models will be released on https://github.com/nguyenpbui/ReVA.
Large Language Models (LLMs) are increasingly entering specialized, safety-critical engineering workflows governed by strict quantitative standards and immutable physical laws, making rigorous evaluation of their reasoning capabilities imperative. However, existing benchmarks such as MMLU, MATH, and HumanEval assess isolated cognitive skills, failing to capture the physically grounded reasoning central to engineering, where scientific principles, quantitative modeling, and practical constraints must converge. To enable verifiable process supervision in engineering, we introduce EngTrace, a symbolic benchmark built on 90 parameterized templates, each generating unique, contamination-resistant problem instances, spanning three major engineering branches, nine core domains, and 20 distinct areas, yielding 1,350 test cases that stress-test generalization across diverse physical scenarios. Moving beyond outcome matching, we introduce a verifiable two-stage evaluation framework that uses a tiered protocol to validate intermediate reasoning traces alongside final answers through automated procedural checks and a heterogeneous AI Tribunal. Our evaluation of 27 leading LLMs reveals a distinct trade-off between numeric precision and trace fidelity, identifying a complexity cliff where abstract mathematical pre-training fails to translate into the integrative reasoning required for advanced engineering tasks.
LLM-based query expansion improves retrieval by enriching the original query with additional context. Yet most methods remain generation-driven, producing plausible pseudo-documents or expansions without checking how the target corpus responds. This can introduce retrieval drift, amplify misleading vocabulary, or miss terms that distinguish relevant from non-relevant documents. We argue that effective expansion requires retrieval-grounded feedback, not just single-pass generation or unverified iteration. We introduce ADORE (ADapt, Observe, Relevance Evaluate), an iterative framework that turns retrieval outcomes into feedback for the next expansion. At each round, an LLM generates pseudo-passages, a retriever exposes the corpus response, and a relevance assessor evaluates retrieved documents against the original query. These judgments identify what to reinforce, what remains undercovered, and what to suppress. Across TREC Deep Learning, BEIR, and BRIGHT, ADORE consistently outperforms strong query expansion baselines with notable improvements across nearly all evaluation settings, improving average nDCG@10 by 24.5% over BM25 and 3.6% over the strongest prior query expansion method on BEIR, and by 122.9% over BM25 and 9.2% over the best query expansion baseline on BRIGHT. Our code and data are publicly available.
arXiv:2606.20510v1 Announce Type: cross Abstract: Securing AI agents that operate in complex digital environments has become a critical need, and runtime monitoring approaches that formulate and enforce policies expressed in a formal language like Datalog offer a promising solution. However, existing approaches are restricted to deterministic policies. In many practical applications of AI agents, there is a need to enforce security policies in the face of ambiguity, leading to probabilistic predicates or state transitions (for example, a declassifier or Personally Identifiable Information (PII) detector that has some failure probability on each invocation). Furthermore, in many such applications, one cannot easily make the independence assumptions necessary to invoke prior work on probabilistic inference in Datalog. We address this by introducing a sound and efficient framework for such verification based on distributionally robust optimization, computing sound upper bounds on the probability of policy violation regardless of possible correlations between predicates. On standard benchmarks for terminal and tool calling agents, we demonstrate that our approach outperforms prior art and improves the security-utility trade-off while ensuring rigorous bounds on the probability of policy violation.
arXiv:2605.29128v2 Announce Type: replace Abstract: The wide adoption of LLMs has led to their use in great variety of applications and scenarios, such as chatbot assistants and data annotation, creating the need for the models to satisfy certain budget and hardware constraints. This has led to the trend of LLMs being released in batches consisting of similar models of various sizes for the family of models to adhere to as wide of a range of constraints as possible. In this paper, we validate distillation and quantization as a cost-effective way to expand model families to new sizes and hardware formats. Based on the open-recipe Apertus 8B LLM, we produce Apertus-v1.1 - a distilled family of models with up to 4B parameters trained on 1.7T permissive license tokens. We demonstrate cost-efficiency and strong accuracy performance of our approach for covering large ranges of hardware and systems requirements.
arXiv:2606.19047v1 Announce Type: new Abstract: Multi-turn tool-use RL is bottlenecked by the rapid depletion of informative samples in static datasets. We observe that the gradient signal in GRPO concentrates on tasks with the highest rollout reward variance, a consequence of the Popoviciu upper bound. Consequently, samples near the agent's capability boundary – where successes and failures are roughly balanced – contribute disproportionately large policy gradients. As training progresses, this boundary continuously shifts, which gradually depletes the pool of informative samples in a static dataset. We propose RODS (Reward-driven Online Data Synthesis) to resolve this depletion. RODS closes the loop between RL training and data generation by repurposing the progress reward variance as a practical, zero-cost boundary detector that requires no extra inference beyond the rollouts already computed for training. It continuously identifies such boundary samples, synthesizes new multi-turn variants matching their structural complexity (e.g., API topology and dependency depth) via a skill-aligned resampling pipeline, and manages a dynamic replay buffer that co-evolves with the policy. Starting from 400 human seeds and maintaining an active training pool of ~800 samples, RODS achieves comparable performance to a 17K-sample offline pipeline while requiring roughly 20x fewer trajectories, and improves over fixed-data RL and environment augmentation in our controlled setting.
Post-training quantization (PTQ) enables efficient deployment of deep networks using a small set of data. Its application to visual autoregressive models (VAR), however, remains relatively unexplored. We identify two key challenges for applying PTQ to VAR: (i) large reconstruction errors in attention-value products, especially at coarse scales where high attention scores occur more frequently; and (ii) a discrepancy between the sampling frequencies of codebook entries and their predicted probabilities due to limited calibration data. To address these challenges, we propose a PTQ framework tailored for VAR. First, we introduce a shift-and-sum quantization method that reduces reconstruction errors by aggregating quantized results from symmetrically shifted duplicates of value tokens. Second, we present a resampling strategy for calibration data that aligns sampling frequencies of codebook entries with their predicted probabilities. Experiments on class-conditional image generation, inpainting, outpainting, and class-conditional editing show consistent improvements across VAR architectures, establishing a new state of the art in PTQ for VAR.
arXiv:2606.15288v1 Announce Type: cross Abstract: Greenland iceberg discharge exhibits complex nonlinear dynamics with limited observability, challenging traditional predictive models. We present a Hybrid NARX-LLM framework that combines a nonlinear autoregressive model with exogenous inputs (NARX) and a large language model (LLM) for residual correction. We further propose a Physics-Informed Prompt (PIP) method that transforms unstructured physical knowledge into structured prompts for zero-shot in-context reasoning. The primary objective is to explore the corrective potential of this framework for modeling Greenland iceberg discharge, rather than merely optimizing predictive accuracy. The NARX component captures intrinsic temporal dependencies, while the LLM, guided by PIP, encodes glacier dynamics and environmental drivers and perceives key trend patterns to correct systematic prediction errors. This integration allows the model to reason about unmodeled factors and produce interpretable residuals, enhancing overall predictive accuracy. Applied to Greenland iceberg discharge time series, our approach addresses extreme events that are difficult to predict due to rare variations and nonstationary trends, a limitation often overlooked by traditional methods. By fusing structured time-series modeling with knowledge-driven foundation AI, the framework offers a scalable and interpretable pathway to bridge data-limited climate forecasting with physics-informed LLM reasoning. The code is available.
arXiv:2606.18897v1 Announce Type: cross Abstract: Intent-based recommender systems have gained significant attention for improving accuracy and interpretability by modeling the underlying motivations behind user behaviors. Most existing models derive intents directly from user sequences via clustering or prototype learning. However, they are sensitive to sequence quality, require presetting the number of intents, and lack explicit semantic grounding. These issues lead to an incomplete and coarse intent set and limit the effectiveness of recommendation. In this paper, we propose the Sparse Autoencoder for intent-based recommendation (SAERec), a novel recommender that automatically constructs a fine-grained and interpretable intent space from a textual corpus to guide recommendation. Rather than treating texts as side signals, SAERec leverages them as high information density evidence for intent construction. Specifically, we first extract a comprehensive set of fine-grained interpretable intents from the latent space of large language models (LLMs) by using a sparse autoencoder (SAE) to disentangle and interpret text embeddings, which isolates intent-related semantics from textual noise. Then, for each user, we retrieve relevant intents from this set as priors to guide recommendation. It contains personal intents matching a user's current interests and public intents capturing general item patterns shared across users (e.g., quality, price). Finally, to integrate retrieved intents into sequence modeling, we propose a multi-branch attention mechanism that captures temporal dependencies and injects both personal and public intent signals, followed by an adaptive fusion layer to construct the final user representation for recommendation. Extensive experiments on public datasets demonstrate the superiority of SAERec, consistently outperforming state-of-the-art baselines while providing human-understandable explanations.
arXiv:2606.16604v1 Announce Type: new Abstract: This work addresses the critical challenge of excited-state preparation for semiconductor band structure calculations. We introduce a variational adiabatic eigensolver (VAE) protocol that combines adiabatic evolution with variational optimization to prepare high-fidelity eigenstates on noisy intermediate-scale quantum (NISQ) devices. Applying a momentum-space truncation, we accurately compute the electronic band structure of silicon – an idealized infinite periodic system – using only a modest number of qubits. Our approach employs multi-qubit parameterized circuits and a phase-based loss function, overcoming limitations of conventional methods. These limitations include the circuit-construction difficulty in traditional adiabatic approaches and the reduced accuracy of variational quantum eigensolvers for excited states. Through rigorous numerical simulation and experimental implementation on a superconducting quantum processor, we successfully prepare silicon's valence-band and conduction-band eigenstates. Single-shot readout yields state fidelities exceeding 96%, and the measured energy expectations agree with theoretical band energies within 0.5 eV. Further refinement via single-frequency oscillation fitting reduces the energy deviation to below 0.01 eV. This framework provides a robust and practical pathway for precisely determining electronic structures in quantum materials.
arXiv:2606.11640v1 Announce Type: cross Abstract: Few-shot tabular learning provides a cost-effective approach for real-world applications where annotation is costly and collecting sufficient samples for new tasks is difficult. Existing Traditional and LLM-based methods have demonstrated effectiveness in few-shot scenarios. However, traditional methods need additional training on unlabeled or generated data, which incur significant computational overhead. In addition, LLM-based methods that directly feed raw tabular data into LLMs raise privacy and compliance concerns. More importantly, both paradigms largely overlook the semantic relationships between features, which provide structural and semantic prior for constructing a semantic graph. Semantic graph is essential for modeling meaningful feature interactions in few-shot scenarios. In this paper, we propose TAROT, a GNN-based framework that encodes the structural and semantic prior by constructing and refining a task-adaptive semantic graph from this prior, thereby improving predictive performance in few-shot tabular learning. TAROT first encodes heterogeneous tabular data into unified node semantic representations via a Unified Semantic Tabular Node Encoder (USTNE). Then, it prompts LLMs to infer the semantic relationship between features based on the task description and feature names to construct a semantic graph. To mitigate structural noise introduced by the hallucination of LLMs, TAROT introduces Task-adaptive Semantic Graph Refinement that prunes spurious or task-unrelated edges and adds missing task-related ones, aligning the graph structure with the downstream objective. Finally, a GNN performs message passing over the refined graph to capture task-related semantic dependencies for prediction. Extensive experiments on various few-shot tabular learning benchmarks demonstrate the superior performance of TAROT, establishing it as a state-of-the-art approach in this domain.
Sparse-view CT reduces radiation dose and scanning time by acquiring fewer projection views, but angular undersampling makes reconstruction severely ill-posed, causing streak artifacts, structural blurring, and loss of fine details. Existing supervised methods are often tied to specific sampling settings, whereas generative methods may introduce anatomically inconsistent hallucination-like structures under severe undersampling. We propose Lucid, a sparsity-adaptive, consistency-guided reconstruction framework based on a Flow Matching generative prior for sparse-view CT. Lucid is trained only on high-quality CT images to learn a continuous transport between a Gaussian distribution and the high-quality CT image distribution, independent of view sampling. During inference, the sampling sparsity level is explicitly incorporated to adapt the generative trajectory of a single pretrained model. Specifically, Lucid constructs a degradation-matched initial state by sparsity-weighted fusion of the sparse-view FBP image and Gaussian noise, performs sparsity-modulated Flow Matching updates, and applies projection-domain data-consistency correction after each prior update. Experiments under multiple sparse-view settings show that Lucid achieves stable reconstruction performance across different sampling densities, improves image quality and structural fidelity, and reduces the risk of hallucination-like structures in generative sparse-view CT reconstruction.
Understanding student errors in the programming is a cornerstone of programming education, yet obtaining a representative set of student errors for any newly designed task remains slow and costly, since authentic submissions only accumulate after extensive classroom deployment. This paper explores whether large language models (LLMs) can serve as scalable proxies for students by simulating realistic logical errors in code submissions. Using the CodeWorkout dataset of 74,000+ unique student Java submissions across 37 problems, we evaluate five LLMs under three mainstream prompting strategies: Input-Output (IO), Chain-of-Thought (CoT), and iterative Self-Refine. We assess performance along two key dimensions: diversity (the range of distinct error patterns) and alignment (alignment with authentic student mistakes), and examine how these vary by struggling level of programming tasks. Our quantitative findings reveal that while all models generate diverse errors, their alignment to human submissions diverges: Claude Sonnet 4 achieves the most balanced performance. In addition, we conducted a blinded expert annotation study (N = 401) comparing synthetic and authentic errors. This qualitative analysis confirms that the generated errors are functionally indistinguishable from authentic student errors. Moreover, higher-struggling-level problems elicit more diverse but less student-like errors. These results highlight trade-offs in using LLMs to simulate human learners and suggest design considerations for integrating synthetic errors into teachable agents, intelligent tutoring systems, and large-scale learning analytics.
arXiv:2606.19629v1 Announce Type: cross Abstract: Voice attribute editing models modify characteristics such as age and gender while preserving speaker identity. In large-scale speech datasets, however, attribute annotations are often noisy or inconsistent, which can cause conditional generative models to produce unstable edits. In this work, we show that idempotency provides an effective mechanism for improving robustness to noisy labels. An idempotent operator is one for which repeated application does not change the result, i.e., f(f(x)) = f(x). Enforcing this property acts as an implicit regularizer that reduces sensitivity to mislabeled examples. We introduce RIVET, a training framework that incorporates an idempotency objective to improve robustness to label noise. We evaluate RIVET under controlled label noise and on the GLOBE dataset with naturally noisy annotations. RIVET improves editing success and better preserves speaker identity than standard training, showing that idempotency improves robustness in voice editing models.
arXiv:2509.22037v2 Announce Type: replace-cross Abstract: We prove optimal non-commutative analogues of the classical Law of Iterated Logarithm (LIL) for both martingales and sequences of independent (non-commutative) random variables. The classical martingale version was established by Stout [Sto70b] and the independent case by Hartman-Wintner [HW41]. Our approach relies on a key exponential inequality essentially due to Randrianantoanina [Ran24] that improves that from Junge and Zeng [JZ15]. It allows to derive an optimal non-commutative Stout-type LIL just as in [Zen15], from that martingale result we then deduce a non-commutative Hartman-Wintner type LIL for independent sequences of random variables.
This research introduces a framework for incorporating Concept Bottleneck Models (CBMs) into 3D generative architectures to address the inherent 'semantic gap' in deep geometric learning. As deep models become central to 3D content creation, explainability shifts from a peripheral feature to a fundamental requirement for trust and accountability in safety-critical domains such as healthcare and manufacturing. CBMs provide an intrinsic interpretability solution by constraining latent representations to align with human-defined concepts, yet their application to unstructured 3D data remains largely unexplored. We design, implement, and validate a formal 3D-CBM architecture that maps raw geometric inputs, including point clouds and meshes, into a multi-tiered taxonomy of interpretable primitives and functional attributes. The framework further identifies strategic datasets, such as PartNet and ShapeNet, specialized for concept-based supervision. Experimental results from a 3D part-manipulation proof-of-concept experiment demonstrate the framework's efficacy, achieving a concept prediction accuracy of 88.8\% and a Chamfer Distance of 0.0115. Critically, the model enables precise test-time intervention, allowing for the interactive correction of structural errors. This work establishes a foundation for semantically-steerable 3D generation and invites further exploration into collaborative human-in-the-loop design systems.
Introduction: Hantavirus disease is an emerging and potentially severe zoonosis of global distribution. In Uruguay, it is transmitted by rodents inhabiting peridomestic, suburban, and rural areas. Global incidence is estimated at 150,000 to 200,000 cases per year, with up to 300 annual cases in the Americas. Since 1997, Uruguay's Ministry of Public Health (MPH) has monitored Hantavirus cardiopulmonary syndrome (HCPS), the most common clinical presentation in the region. By 2019, a total of 271 cases had been identified in the country, with an estimated mortality rate of nearly 50%. Objectives: To describe the clinical, epidemiological, and occupational characteristics of patients with Hantavirus disease in Uruguay during the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. Methods: A descriptive, cross-sectional, observational study was conducted, including all serologically confirmed cases of Hantavirus infection reported to the MPH between 2018 and 2021. Clinical and demographic data were extracted from the mandatory reporting form for zoonotic diseases. Incidence and case fatality rates were calculated, and factors associated with fatal outcomes were analyzed. Results: A total of 58 confirmed cases were identified between 2018 and 2021. Most patients were male (62%), with a mean age of 36.5 years (SD 16). A decline in incidence was observed during 2020-2021, with no significant change in case fatality. Direct rodent exposure was the most frequently associated risk factor. Montevideo and Canelones were the most affected departments. Renal and pulmonary involvement were significantly associated with mortality. Conclusion: Hantavirus remains a relevant public health concern in Uruguay. Although a decrease in incidence was observed during the COVID-19 pandemic years, case fatality rates remained high. The findings underscore the need for sustained surveillance and early recognition, particularly in urbanizing regions.
arXiv:2606.15032v1 Announce Type: new Abstract: World models have rapidly become one of the central abstractions in modern AI. Yet the term now refers to several different objects: action-conditioned environment models, latent imagination models, future-video predictors, interactive neural simulators, latent predictive representations, and synthetic-data engines. Evaluation has broadened with the term. Recent papers measure video realism, perceptual similarity, instruction following, physical plausibility, policy ranking, executability, planning success, and downstream policy improvement. The result is not only metric diversity but also a recurring problem of claim/evidence mismatch: papers frequently make a stronger claim about what their model is useful for than their evaluation can actually establish. This paper surveys the recent literature and argues that the central question is use-dependent. When a model is presented as a world model for embodied decision-making, a more decisive issue is not whether it generates visually compelling videos, but whether it supports reliable counterfactual reasoning, policy evaluation, planning, and policy optimization under intervention, policy-induced distribution shift, and long-horizon rollout. We organize the literature using an L0–L7 ladder that ranges from visual plausibility to policy optimization utility. In our interpretation, L0–L3 are most naturally read as diagnostics of generated artifacts, L4 is often the first genuinely interventional test, and L5–L7 provide the most direct evidence of decision usefulness. Based on this diagnosis, we propose a decision-making-centric evaluation framework and a benchmark protocol that foreground counterfactual action fidelity, closed-loop rollout validity, reward/value prediction, policy-ranking agreement, optimization lift, model exploitability, and uncertainty calibration.
arXiv:2508.17116v2 Announce Type: replace Abstract: This paper establishes general sufficient conditions for a sequence of controlled branching processes to converge weakly on the Skorokhod space. We focus on a class of control mechanisms that extend previous results by decomposing those random variables into the sum of two independent components: an immigration term, which depends on the current population size, and a size-divisible term, which can be expressed as the sum of random contributions from each individual. This extension allows us to capture a broad range of control functions including Poisson, binomial, and negative binomial distributions, commonly used in the literature. The assumptions are formulated in terms of probability generating functions of the offspring and control laws, distinguishing in this latter between the immigration and the size-divisible parts. The limit process is shown to be a continuous-state branching process with dependent immigration. The proof essentially relies on tightness arguments and the identification of a martingale problem. We also identify the special case in which the limit reduces to a classical Feller branching diffusion with immigration.
arXiv:2606.20162v1 Announce Type: new Abstract: Semantic-aware communication has emerged as a transformative paradigm for next-generation communication systems, shifting the fundamental goal from transmitting bit-level symbols to reliably recovering and understanding the semantic meaning of information. Previous studies have demonstrated that representing the semantic content of source messages as graph-based structures can significantly improve communication efficiency and the accuracy of semantic inference at the receiver. However, existing solutions typically employ graphs that capture only pairwise relationships, thereby neglecting higher-order implicit correlations commonly observed in real-world scenarios, such as group interactions, multi-entity associations, and complex relational contexts. This limitation reduces semantic expressiveness and makes semantic inference susceptible to ambiguity and performance degradation, particularly under noisy or corrupted channel conditions. To address these issues, this paper proposes a novel hypergraph-based implicit semantic reasoning framework, HISR, which leverages hypergraphs to represent complex multi-entity relationships among semantic knowledge entities. In HISR, entities and their associated higher-order relations are mapped into dedicated semantic subspaces tailored to distinct relational contexts. This design not only disentangles diverse semantic interactions to mitigate the over-smoothing effects commonly found in traditional graph embedding methods but also enables robust semantic inference even when partial information loss occurs during transmission. Numerical results show that the proposed HISR achieves up to a 36.6% improvement in implicit semantic interpretation accuracy over the state-of-the-art benchmarks.
The gene-therapy trial aims to treat glaucoma by rejuvenating cells in the optic nerve. Plus, the mystery of how things freeze and encouragement to go out into the sunlight. The gene-therapy trial aims to treat glaucoma by rejuvenating cells in the optic nerve. Plus, the mystery of how things freeze and encouragement to go out into the sunlight.
arXiv:2606.11770v1 Announce Type: new Abstract: Spatial reasoning remains a challenge for Multimodal Large Language Models (MLLMs), as it requires reliable multi-hop inference over both intermediate states and state transitions. Current studies often leave intermediate states unverified and treat state transitions as implicit processes, which limits reliability in multi-hop spatial reasoning. To address this, we propose State-aware Visualization-of-Thought (SVoT), a reinforcement learning framework that generates interleaved, verifiable intermediate states and visualizations. SVoT integrates transition reasoning chains into the generation processes, enabling the model to verify action preconditions and effects through interleaved textual and visual reasoning. We train SVoT via Group Relative Policy Optimization (GRPO), instantiating verification through reward design and evaluating the efficacy of different fine-grained rewards. As existing benchmarks reduce state transitions to single-variable updates, substantially simplifying the problems, we establish five domains by extending classical environments and introducing two novel domains, Pacman and Gather, that require multi-object interactions and numerical reasoning. These domains support systematic evaluation of multi-hop spatial reasoning with quantitative verification of generated intermediate states and transition reasoning. SVoT with transition-aware supervision achieves state-of-the-art performance across the introduced domains, yielding up to a 65% absolute accuracy gain on out-of-distribution test sets.
Background: Cardiovascular disease (CVD), cardiometabolic and neurocognitive conditions share risk factors and frequently co-occur. We evaluated whether four established CVD risk prediction models (QRISK3, PCE, SCORE2, SCORE2-OP) can be repurposed to predict 10-year risk of these conditions and their co-occurrence with CVD. Methods: The models were recalibrated using 20% of the UK Biobank (UKB) and evaluated in the remaining 80%. We performed external validation using data from Clinical Practice Research Datalink (CPRD) Aurum, assessing model discrimination (c-statistics) and calibration (intercept and slope). We used permuted feature importance to determine the influence of each individual predictor in the models. Results: Depending on the model, the c-statistics for incident CVD ranged from 0.71 to 0.74 in the UKB test set (16,137 events). Discrimination was equal to or higher than CVD when evaluated against non-traditional CVD outcomes: 0.74 to 0.77 for heart failure (3,471 events), 0.72 to 0.73 for atrial fibrillation (9,213 events), 0.73 to 0.75 for peripheral arterial disease (1,927 events) and 0.80 to 0.82 for abdominal aortic aneurysm (595 events). For the multimorbidity endpoints, model discrimination ranged from 0.74 for the composite of CVD and T2DM (SCORE2-OP) to 0.83 for the composite of CVD and dementia or Parkinson's disease (QRISK3). When considering the onset of any cardiovascular, cardiometabolic, or neurocognitive outcome discrimination ranged from 0.71 to 0.72. The repurposed models slightly underestimated the predicted risk in the CPRD compared to the UKB: average difference in calibration intercept was at most -0.64. After age and sex, smoking status and systolic blood pressure contributed most to model predictions. Conclusions: Repurposed CVD models can be used to identify 10-year risk of many CVD-related conditions and their multimorbidity. These may be used to support risk-based approaches to prevention and screening. The repurposed models have been made available at: https://repurposed-cvd-risk-models.shinyapps.io/cvd_cmd_dementia_app/ Keywords: Risk prediction; cardiovascular disease; cardiometabolic disease; dementia; disease prevention.