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A blood gas parameter–based assessment model for predicting poor prognosis in sepsis: A retrospective analysis of the MIMIC-IV and eICU-CRD
Background Blood gas parameters are associated with sepsis prognosis. This study aimed to develop an assessment model based on blood gas parameters for predicting patient outcomes. Methods Data were retrospectively extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) and electronic Intensive Care Unit Collaborative Research Database (eICU-CRD). A sepsis assessment model was developed using the MIMIC-IV cohort, followed by internal validation in patients with septic shock from the same database and external validation in patients with sepsis from the eICU-CRD. Bioinformatics and machine learning clarified the relationship between the model and the primary outcome of 28-day mortality in patients with sepsis and septic shock. Results The sepsis assessment blood gas 3 (SABG-3), an assessment model incorporating PO 2 , base excess (BE), and lactate, was developed and validated as an independent predictor of 28-day mortality in patients with MIMIC-IV sepsis (odds ratio: 1.559; 95% confidence interval: 1.464–1.659; P < 0.001). Its prognostic performance was internally validated in patients with MIMIC-IV sepsis and externally validated in patients with eICU-CRD sepsis. High-risk patients identified by SABG-3 exhibited greater illness severity than low-risk ones. Sensitivity analyses across five methods confirmed the prognostic value of SABG-3 for intensive care unit patients with sepsis and septic shock. A SABG-3-derived nomogram proved superior to existing scales. Conclusion We developed and validated a novel assessment model and nomogram to evaluate sepsis prognosis rapidly and to identify patients who may benefit from intensified treatment.
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Assessing the appropriateness of helicopter emergency medical services for non-traumatic emergencies in a medically underserved rural area, Japan
Background Helicopter emergency medical services (HEMS) are essential in trauma care, but their role in non-traumatic emergencies remains unclear, particularly in medically underserved rural areas where long total prehospital times and limited specialty care access complicate emergency response. Objectives To evaluate the appropriateness of HEMS dispatches in non-trauma emergencies by assessing undertriage and overtriage based on clinical necessity and total prehospital time in rural western Kochi Prefecture, Japan. Methods We conducted a retrospective cohort study of adult patients (≥18 years) requiring emergency transport for moderate to severe non-traumatic conditions during HEMS operational hours from 2017 to 2021. HEMS necessity was classified as “absolute” (treatment unavailable at local core hospitals) or “relative” (critical condition benefiting from shorter transport). Appropriateness was defined as concordance between actual transport modality and predefined necessity criteria, with undertriage and overtriage determined by comparing the actual primary HEMS dispatch requests against these criteria and regional total prehospital times. Results Of the 2,312 eligible patients, 63 received primary HEMS dispatches and 2,249 ground EMS (GEMS). Among HEMS dispatches, 56 of 63 (88.9%) were overtriaged, while seven (11.1%) were appropriately triaged. Among GEMS transports, 248 of 2,249 (11.0%) retrospectively met HEMS criteria, yielding an 11.0% undertriage rate. Overtriaged cases included patients lacking relative necessity criteria or total prehospital time advantage. Conclusions In medically underserved rural regions, clinical severity alone may be insufficient for determining HEMS necessity in non-traumatic emergencies. Incorporating total prehospital time advantage and regional infrastructure consideration may refine dispatch decision-making and improve HEMS utilization appropriateness.
Keep the Hubble and James Webb Space Telescopes alive — the science is worth the price tag
Bound states in doped charge transfer insulators
Determinants of intention to use generative AI fitness assistants: Integrating the Theory of Planned Behavior, second-order information system quality, and perceived value
As generative artificial intelligence (GAI) becomes embedded in sport and health management, GAI fitness assistants can generate and iteratively refine training plans through conversational interactions; however, their adoption remains shaped by users’ trade-offs between perceived quality and risk. Drawing on the Information Systems Success Model and the Theory of Planned Behavior (TPB), and incorporating perceived value, this study analyzed cross-sectional, self-reported data from 342 valid questionnaires using structural equation modeling to examine the relationships among second-order information system quality, subjective norms, attitude, perceived behavioral control, and category-level behavioral intention to use GAI fitness assistants. The results indicate that information system quality was significantly associated with more favorable attitude (β = 0.623) and perceived behavioral control (β = 0.485), with system quality contributing the greatest weight (0.805). Bootstrapped indirect-effect tests showed that subjective norm was significantly associated with behavioral intention through attitude, perceived behavioral control, perceived value, and the serial attitude-to-value pathway, whereas its direct effect was not significant. Perceived value is the strongest predictor of intention (β = 0.447), and attitude (β = 0.275) and perceived behavioral control (β = 0.163) are also important antecedents. Overall, the model explains 50.9% of the variance in intention to use. These findings suggest theoretical and practical implications for improving the stability of GAI fitness assistants, the reliability of their recommendations, and the communication of user value.
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Rapid quasi-periodic reconfiguration of the accretion column in pulsar 1A 0535+262
A Multitask Learning framework for E‐commerce time series analytics: Operational risk, demand forecasting, and anomaly detection
The study presents MT-PyraRisk, a multi-task learning framework that integrates pyramidal attention mechanisms for cross-border e-commerce risk prediction. The model processes multimodal time-series data through a shared feature extraction layer and task-specific prediction modules, supporting both regression tasks, such as operational risk and demand forecasting, and classification tasks, such as anomaly detection. Experiments were conducted on the Global E-commerce Dataset and the Kaggle Network Traffic Dataset using a sliding-window time-series setting, with the data divided into training, validation, and testing sets at a ratio of 70%, 15%, and 15%, respectively. The model was evaluated using MSE and MAE for regression tasks and Precision, Recall, and F1-score for classification and anomaly detection tasks. Compared with the strong baseline Timesformer, MT-PyraRisk reduced MSE by approximately 4.3% and improved F1-score and Recall by approximately 1.1% and 2.3%, respectively, on the Global E-commerce Dataset. On the Kaggle Network Traffic Dataset, MT-PyraRisk reduced MSE by approximately 5.1% and improved F1-score, Precision, and Recall by approximately 3.3%, 2.2%, and 4.5%, respectively. Ablation results further demonstrate the contribution of the pyramidal attention mechanism, task-specific prediction layers, and joint optimization module, as removing these components led to clear performance degradation. These results indicate that MT-PyraRisk can provide an effective multi-task modeling solution for operational risk forecasting, demand prediction, and anomaly detection in cross-border e-commerce risk management.
Listen to Gen Z when it comes to AI in education
Reversibly Stacked Monolithic 3D Integrated Circuits
Family planning service receipt during facility visits in Ethiopia: Evidence from the 2021–2022 service provision assessment survey
Background Family planning is a central component of reproductive health and contributes to reductions in maternal and child mortality. While most evidence in Ethiopia is derived from household surveys, limited attention has been given to service delivery at the point of care. This study examines determinants of receipt of family planning services during facility visits using nationally sampled Service Provision Assessment (SPA) survey data. Methods A facility-based cross-sectional analysis was conducted using nationally implemented SPA survey data. The survey employed a stratified multistage sampling design, in which health facilities were selected within strata defined by region, managing authority, and facility type, followed by systematic sampling of clients within facilities for exit interviews. The study included 2,588 women aged 15–49 years who attended sampled facilities and completed client exit interviews. The outcome was receipt of any family planning service during the visit, defined as provision of counseling and/or a contraceptive method, reflecting service delivery at the point of care rather than contraceptive use. Multivariable logistic regression was used to assess associations between client characteristics, provider attributes, and facility-level factors. Exploratory interaction analyses were conducted but not retained in the final model due to instability and sparse data structures. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was defined at a two-sided p-value < 0.05. All analyses were conducted using R (version 4.5.3). Results Overall, 64.2% of clients received a family planning service during their visit. After adjustment, clients without prior contact with a provider had higher odds of receiving a service compared with those reporting prior contact (AOR = 2.25; 95% CI: 1.86–2.72; p < 0.001). Married women had lower odds of receiving a service than single women (AOR = 0.69; 95% CI: 0.49–0.98; p = 0.030). Substantial regional variation was observed, with lower odds in Amhara (AOR = 0.29; 95% CI: 0.17–0.49) and Addis Ababa (AOR = 0.41; 95% CI: 0.23–0.73), and higher odds in Benishangul-Gumuz, Gambella, and Dire Dawa. Other covariates were not statistically significant after adjustment, and observed associations should be interpreted as reflecting service delivery processes at the point of care rather than underlying contraceptive demand. Conclusions Family planning service receipt during facility visits in Ethiopia is associated with prior client–provider contact, marital status, and regional context. The persistence of regional differences after adjustment indicates that contextual factors related to health system performance and service delivery environments play a role in shaping service delivery during clinical encounters. The findings indicate heterogeneity in service delivery at the point of care, suggesting the need for context-specific strategies to improve the consistency and quality of family planning services within health facilities.
Decoding cancer circulating transcriptomic signatures with language models
Knowledge, attitude, and practices towards rabies: A community survey in selected areas of KwaZulu-Natal Province, South Africa
Knowledge, attitude, and practices (KAP) studies have been widely used to assess gaps in KAP towards rabies. However, there is no evidence of baseline studies that have assessed KAP towards rabies among selected communities in KwaZulu-Natal Province, South Africa. A cross-sectional, questionnaire-based study design was adopted. Participants (n = 768) were selected using systematic random sampling. Data from respondents (≥18 years of age) were collected using a validated questionnaire and analysed using descriptive and inferential statistics. Overall, 26.95% (207/768) of the respondents could name the cause of rabies, while 53.52% (411/768) indicated that they would adhere to post-exposure prophylaxis (PEP), which can include, depending on the category of the bite wound, wound washing, and receiving a dose of human rabies immune globulin (HRIG) and rabies vaccine at the time of the first medical visit. Most respondents (90.10%, 692/768) would seek medical attention following a dog bite. Most dog owners (82.11%, 459/559) owned a vaccination certificate for their pet. Allowing dogs to roam without supervision was widely reported by the respondents. Dog ownership was the only factor significantly associated (p = 0.0001) with knowledge of rabies. Gaps in some aspects of knowledge about rabies were observed, which require awareness creation among residents of the study area, irrespective of whether they own pets.
Author Correction: A generalizable approach for programming protease-responsive conformationally inhibited artificial transcriptional factors
Performance of four scoring systems in predicting the need for massive transfusion in Iranian trauma patients
Background Post-traumatic hemorrhage is a leading cause of death if not promptly identified and treated. This study aimed to compare the performance of four scoring systems in predicting the need for massive transfusion (MT) in trauma patients. Methods This retrospective cohort study analyzed data from trauma patients admitted to Sina Hospital in Tehran between July 2021 and December 2024. All trauma patients who received at least one unit of packed red blood cells were included in the study. Patients were evaluated for the need for MT, and four scoring systems were compared between those who did and did not receive MT. The discriminative ability of the Shock Index (SI), Assessment of Blood Consumption (ABC), Revised Assessment of Bleeding and Transfusion (RABT), and Trauma-Associated Severe Hemorrhage (TASH) was evaluated using the concordance index (C-index) and logistic regression models. Results A total of 329 trauma patients were included, with a mean age of 49.2 (SD = 20.8) years; 244 (74.2%) were male. MT occurred in 36 patients (10.9%). All four scoring systems were significantly associated with the need for MT (p < 0.001) and showed comparable discriminative performance (C-index range: 0.81–0.84). At predefined cutoff values, sensitivity ranged from 63.9% to 94.4%, specificity from 60.0% to 94.2%, PPV from 22.4% to 59.5%, and NPV from 95.5% to 98.9%. In univariable logistic regression, an ABC score ≥ 2 was significantly associated with MT (OR: 36.9; 95% CI: 15.6–87.3), followed by an RABT score ≥ 2 (OR: 25.5, 95% CI: 11.2–58.1) and a TASH score ≥ 6 (OR: 25.2, 95% CI: 5.9–106.9). Conclusion All four scoring systems showed significant associations with the need for MT. These tools may assist clinicians in the early risk stratification of trauma patients; however, given the moderate positive predictive values in this low-prevalence setting, they should be used as adjuncts to clinical judgment rather than as standalone triggers for massive transfusion activation.
How to avoid dementia — what the science really says
Propagation effects in high harmonic generation media driven by bright squeezed vacuum light
Multi-method, longitudinal study on behavioral, emotional, and developmental factors of children in residential care in Lower Austria: A study protocol
Background In Austria, there is a significant research gap concerning the quality of out-of-home care (OoHC) provisions and their capacity to promote children’s well-being and development. Given the intrusive nature of such interventions, thorough evaluation is essential. This study protocol outlines a multi-method, long-term, and multi-perspective study that investigates: 1) the circumstances leading to full-time residential care placements; 2) the development of behavioral, emotional, and social factors over time; 3) key factors influencing children’s outcomes in residential care 4) the structure and everyday reality of residential care in Lower Austria, a federal state of Austria and 5) that generates knowledge that will inform improvements in child welfare practice and policy. Methods The first three research questions will be addressed through a longitudinal quantitative study involving children and adolescents (aged 11–21 years), their parents, and professionals working in residential care settings. Standardized surveys will be administered at multiple time points to track developmental changes and identify influencing factors. In addition, to gain a deeper understanding of the implicit mechanisms, and everyday practices of residential care, we plan to implement accompanying qualitative methods adapted to the particular circumstances of the field of research. Finally, a communicative validation process will be used to discuss and reflect on preliminary findings with professionals in the field. This step ensures the relevance of the results and supports the development of practice-oriented knowledge for quality improvement and safeguarding in child welfare services. Discussion This first-of-its-kind study in Austria combines quantitative and qualitative methods to generate evidence for child welfare practice and policy. An innovative element is the potential development of a standardized documentation tool to support research and quality assurance. Challenges include the field’s complexity, participant recruitment, and risk of participation fatigue, which require close collaboration with practitioners and flexible survey strategies to ensure relevant results.