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Early identification of patients with carbapenemase-producing Enterobacterales (CPE) colonization is crucial for infection control; however, microbiological testing may delay detection and be costly. Machine learning may enhance predictive analytics for timely identification of at-risk patients.
Methods:
Four machine learning models: Decision Tree, Random Forest, Gradient Boosting, and XGBoost, were used to predict CPE colonization within 48 hours of admission using microbiological and demographic data. Model performance was assessed through sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Uniform Manifold Approximation and Projection (UMAP) evaluated topological separability of CPE-positive cases and CPE-negative controls.
Results:
From January 1, 2015 to December 31, 2024, 453,372 fecal specimens were submitted for CPE screening, with 194,917 (43.0%) collected within 48 hours of admission, comprising 3,328 CPE-positive cases (1.7%) and 191,589 CPE-negative controls. The Gradient Boosting classifier showed the best performance, achieving an AUROC of 0.598, sensitivity of 54.4%, and specificity of 59.1%. Demographic factors (age ≥ 75 and male sex), history of hospitalization, and known CPE colonization in the past year, and admission specialty (general medicine and general surgery) were consistently included in all models as top predictors. UMAP revealed significant overlap between CPE-positive and CPE-negative patients, indicating challenges in differentiating the risk profiles.
Conclusions:
This study highlights the complexities of using machine learning to predict CPE colonization within 48 hours of admission. The low AUROC values suggest that the models may not effectively predict CPE colonization at the patient level, potentially due to inherent rarity of events and overlapping risk profiles.
The potential of obesity medications to serve as viable alternatives to bariatric surgery to treat obesity remains an open question. This review examines whether contemporary anti-obesity pharmacotherapy can replace metabolic and bariatric surgery in the management of obesity, by critically comparing their mechanisms of action, weight loss outcomes, durability, safety profiles, and roles in long-term disease control. While metabolic/bariatric surgery has been the gold standard for substantial and sustained weight loss, advancements in pharmacotherapy are producing weight loss approaching surgical outcomes without associated risks, complications, and recovery time. New drug therapies demonstrate previously unattainable efficacy and long-term control of obesity. Surgery, however, induces superior short- and long-term weight loss via profound hormonal, neurological, and metabolic shifts, resulting in durable outcomes without ongoing intervention, though it remains difficult to scale. Pharmacotherapy is scalable and increasingly effective but requires sustained adherence, with loss of treatment-mediated control and weight regain upon cessation. It also does not have as extensive established research on safety as surgery. While obesity medications cannot fully replicate the multifactorial physiological impacts of metabolic/bariatric surgery, they offer a scalable, less invasive treatment path that broadens patient options. So far, pharmacotherapy will not replace surgery, as there are patients who will respond better to it, while others to medication only. However, combining both surgical and pharmacological options can increase the penetrance of treatments to manage the chronic complexities of obesity.
The ethically reflective assessment of life reveals a paradox. On the one hand, many people regard life as one of the highest values and celebrate each new life. On the other hand, every sentient life is inevitably exposed to suffering. Why, then, do we usually consider sentient life worth starting, despite the fact that, apart from a relatively small group of antinatalists, this judgment is rarely questioned? In this article, I argue that sentience is not an advantage but a disadvantage because its central negative consequence is unavoidable suffering for every sentient being. I further argue that bioethics and healthcare ethics should take antinatalist intuitions more seriously in order to challenge pronatalist assumptions that normalize procreation and, in doing so, magnify eradicable suffering.
We define the concept of slenderness for arbitrary semigroups containing at least one idempotent element, and give necessary and sufficient conditions for semigroups to be slender. We describe the semigroup of all homomorphisms of the direct product of a nonempty family of groups into a slender rectangular abelian group.
The exiles in the so-called ‘Themistocles Decree’ from Troezen are universally identified with the ostracized who, according to the Athenaion Politeia, were recalled due to Xerxes’ invasion. This identification should be questioned. If the document is a forgery (as is now widely believed), it need not correspond with all available information. The decree’s language suggests instead that, in its author’s mind, the exiles had collectively been in exile for ten years when he thought they returned. Some speculation is offered about their possible identification within the context of fourth-century historiography.
This article discusses the localised provision of basic services (health, education, livelihood support) during the COVID-19 pandemic in Indonesia, by taking the case of SONJO, a digital mutual aid community in Yogyakarta, Indonesia. Through a Foucauldian governmentality analytical lens, we argue that SONJO showcases contradictory ways in which a locally and digitally self-governed community supports citizens’ welfare and well-being during a crisis. On the one hand, the community facilitates redistribution of resources by its leaders and members, ensuring the delivery of social services to those most in need. On the other hand, the community’s activation of localised practices of sambatan—rural Javanese practices of mobilising common resources in time of need—normalises the neoliberal transfer of state responsibilities and decision-making for basic services to citizens. The case study helps unpack the intertwining of neoliberal ideas—which champion individuals as self-reliant actors—and Javanese principles of harmony that emphasise social togetherness, communality, and empathy. Together, they render acceptable the unpaid labour of community members in managing services for fellow citizens within a local context marked by pervasive precarious work, underdeveloped welfare support, and recurrent natural disasters that disrupt livelihoods.
Archaeologists have long interpreted Arizona and Sonora’s Upper Santa Cruz valley as a precolonial “contact zone” or “frontier” between the Trincheras and Hohokam traditions. These models are heavily influenced by the contemporary US-Mexico border and outdated core/periphery models. Furthermore, although plain ware represents most pottery from this region, it has never been used to understand the populations who inhabited the region or to reconstruct local communities of practice. This article provides the first systematic study of plain ware from 23 sites across the Upper Santa Cruz. We incorporate Bhabha’s (2004) “Third Space” theory to suggest that local potter communities actively responded to changing interactions with neighboring populations for more than five centuries. By focusing our attention on local ceramic production, and critically evaluating cultural boundaries, we reposition the Upper Santa Cruz as neither a periphery nor frontier but an area rich in its own dynamic cultural expressions and regional agency.
While the social and political contributions of Iranian Shii émigré scholars to the early modern Deccan have attracted some scholarly attention, the actual contents of their intellectual production remain understudied. An important reason for this is the broader neglect of the corpus of commentaries and translations in the early modern Islamicate world. To address this gap, this article analyses the ways in which Ibn Khātūn al-ʿĀmilī (d. 1059/1649) combines the genres of translation and gloss in his Persian rendition of a hadith collection by Bahāʾ al-Dīn al-ʿĀmilī (d. 1030/1621). After providing an overview of translation projects of Shii texts in the Deccan and a biographical sketch of Ibn Khātūn, I examine the latter’s translation and commentarial strategies. I show how, by merging elements of translation and gloss into his text, the author addresses the needs of an intellectual milieu characterised by a high level of pedagogical engagement in the transmission of Shii knowledge.
Recently, Harrington et al. [‘Every arithmetic progression contains infinitely many b-Niven numbers’, Bull. Aust. Math. Soc.109(3) (2024), 409–413] proved that every arithmetic progression contains infinitely many base-b Niven numbers for any fixed $b\ge 2$. We use a sparse repunit construction to treat a structured two-base version of the same problem, showing that every arithmetic progression with common difference relatively prime to b contains infinitely many integers that are simultaneously b-Niven and $b^k$-Niven (indeed, we can obtain simultaneous $b^\ell $-Niven-ness for $\ell =1,\ldots , k$).
Schistocephalus spp. are widely distributed Holarctic cestodes that comprise key model species for host-parasite studies. S. solidus and S. pungitii, the most extensively studied species, exhibit narrow host specificity. Another species, S. cotti, is known from the European bullhead (Cottus gobio); however, information on its host range, geographical distribution, and molecular data remain poorly characterized. In Siberia, plerocercoids of Schistocephalus found in sculpins were previously recorded from endemic cottid fishes of Lake Baikal and were identified as S. solidus, which is inconsistent with the known host specificity of this species. The present study aims to clarify the species identity of Schistocephalus from Siberian cottid fishes using morphological and molecular data, and to test the hypothesis of conspecificity of Schistocephalus plerocercoids from sculpin hosts across Eurasia and North America. Morphologically, Siberian plerocercoids correspond to the description of S. cotti, supporting their assignment to this species. The phylogenetic analysis confirmed the identity of the plerocercoids as S. cotti and demonstrated the existence of two distinct Schistocephalus lineages in North America and Siberia. These findings indicate that at least two different Schistocephalus species infect sculpins in the Old and New Worlds.
Non-spherical wrist manipulators are widely used in industrial settings, yet they lack effective inverse kinematics solutions. Current methods primarily rely on numerical iteration, which suffers from limitations such as sensitivity to initial values and convergence issues. Meanwhile, algebraic elimination methods require complex elimination techniques to obtain analytical solutions, restricting their practical engineering application. To address the limitations of these existing approaches, this paper innovatively proposes a novel analytical method based on conformal geometric algebra theory. The core of this method lies in utilizing the geometric characteristics of the manipulator to establish a polynomial equation for one of the joint variables, after which the remaining joint angles are solved according to the joint angle solution methodology. The correctness of the proposed method was verified using three sets of joint angles. Additionally, a comparative analysis with the Dixon elimination method was conducted using 100 sets of arbitrary initial joint angles. Example validation demonstrates that the proposed method exhibits significant advantages in computation time, solution completeness, and numerical accuracy, thereby providing a new theoretical tool and practical framework for the inverse kinematics analysis of robotic manipulators.
Surgical site infection (SSI) surveillance can be time consuming and resource intensive. This study investigates the potential of generative artificial intelligence (GenAI) to augment the detection and classification of SSIs.
Methods:
A case control study of patients with SSI following spine surgery at one US hospital. SSIs were classified into superficial, deep, and organ space. All SSIs were confirmed by infection prevention (IP) experts as they occurred from October, 2023 to September, 2025 and matched 1:1 by year to surgeries deemed non-SSI. A secure GenAI was used to determine if patients had an SSI based on standardized prompts and clinical data. IP nurses used GenAI output to review cases with the ability to ask GenAI questions within the data provided or independently open the medical record. We compared GenAI determinations to initial IP nurses’ determinations.
Results:
A total of 555 patients had spine surgeries. All 16 SSIs were matched by year to 16 non-SSI. All SSIs were correctly identified by GenAI (sensitivity 100%, 16/16) and only 1 non-SSI was incorrectly identified as SSI (specificity 93.7%, 15/16). Although GenAI accurately identified all SSI cases, it was discordant with original review at classifying the level of infection in 37.5% (6/16) of cases. Upon final IP physician review, GenAI was correct in 66.7% (4/6) of discordant cases (often determining “organ space infections” rather than “deep”). Median time to complete GenAI assisted SSI reviews was 9 minutes (IQR 7–21).
Conclusion:
GenAI is a promising tool to assist in SSI surveillance following spinal surgery that could improve efficiency.
We show that both temporal and spatial symmetry breaking in canonical K-type boundary layer transition arise as organised structures with quantifiable energetic pathways rather than unstructured noise. Before the skin-friction maximum, the flow is described by a periodic, spanwise-symmetric fundamental harmonic response (FHR) to the Tollmien–Schlichting wave. The FHR is spatially compact, produces hairpin packets and remains fully harmonic despite a turbulence-like appearance, thereby delimiting the deterministic regime. Past this point, a distinct regime change occurs: a hierarchy of quasi-periodic and aperiodic structures emerges, followed shortly by anti-symmetric structures that develop similarly despite no anti-symmetric inputs. We identify these structures as symmetry-decomposed spectral and space–time proper orthogonal modes that resolve the progression from deterministic harmonics to broadband dynamics. We introduce inter-modal and inter-symmetry energy budgets derived from symmetry-decomposed Navier–Stokes equations. They reveal a directed energy transfer from the FHR into the leading temporal and spatial symmetry breaking modes and, subsequently, into broadband residual fluctuations, showing that broadband dynamics grow only once inter-modal transfer is active, while inter-symmetry transfer also strongly amplifies broadband anti-symmetric fluctuations once asymmetry is present. These key insights support a view of laminar–turbulent transition as a sequence of symmetry breaking events, energetically driven by dominant space–time modes that route energy from harmonic flow to broadband turbulence.