• Proposes an integrated ISM-PIS-RABN framework for full-cycle risk assessment of multimodal transportation systems. • Introduces personalized individual semantics to quantify expert heterogeneous, mitigating group decision bias. • Employs rule-augmented Bayesian networks with factor decomposition to overcome the curse of dimensionality. • Validated via a real-world corridor case, providing actionable insights from sensitivity analysis. Multimodal transportation plays a pivotal role in international trade and logistics due to its unparalleled advantages in cost, efficiency, sustainability, and accessibility. However, its complex structure, which is characterized by multiple transfer points, long transit times, and extended routes, makes it more prone to risks than unimodal transport. Conducting scientific risk assessment and identifying critical factors are essential for improving safety. Therefore, this study proposes a risk assessment model integrating Interpretive Structural Modeling (ISM), Personalized Individual Semantics (PIS), and a Rule-Augmented Bayesian Network (RABN), forming a systematic framework covering risk factors identification, correlation analysis, and comprehensive evaluation. Potential risk factors affecting multimodal transport safety are first identified from a 4M1E (Man, Machine, Material, Management, Environment) perspective. ISM is then used to classify these factors hierarchically and construct the Bayesian network structure. By combining PIS, similarity measures, and Inverse Distance Weighting (IDW), the model processes expert judgments to determine root node probabilities. Finally, RABN performs probabilistic inference for risk assessment. The proposed framework is validated through a case study on a route in the New International Land-Sea Trade Corridor. Sensitivity analysis further identifies key risk factors and verifies parameter robustness, offering decision-making support for multimodal transportation risk management.

Adjunctive corticosteroids and mortality in non-HIV patients with Pneumocystis jirovecii pneumonia: A systematic review and meta-analysis.

Prolonged ambulatory EEG findings and risk of seizure recurrence in adults with generalized tonic-clonic seizures alone: A multicentre study.

Intra-abdominal 0.05% Chlorhexidine Gluconate Lavage in Perforated Appendicitis.

Association of social isolation and loneliness with all-cause and cause-specific mortality in individuals with metabolic syndrome: A prospective study.

Remnant cholesterol, serum uric acid, and biological aging: insights from two nationally representative cohorts.

The objectives were to estimate the potential generic production cost of MK-8527, a novel once-monthly oral nucleoside reverse transcriptase translocation inhibitor (NRTTI) in development for HIV preexposure prophylaxis (PrEP), and to assess implications for cost-effectiveness and access in low-income and middle-income countries (LMICs). A cost estimation study using shipment level active pharmaceutical ingredient (API) data and established cost+ modelling methods to project scalable generic production pricing was performed. The Trade Vision LLC database was searched (January 2020 to December 2025) for records of MK-8527 API exports to India. A weighted mean API cost was calculated and combined with annual dosing assumptions (11 mg/month). Standardized cost+ components were applied, including formulation, API loss, packaging, transportation and tariffs, profit margin, and taxation. Sensitivity analyses explored variation in API pricing. Three API shipments were identified, yielding a weighted mean API cost of $9878/kg. Estimated generic production cost for monthly PrEP dosing was $4.49 per person-year (ppy). Sensitivity analyses produced a range of $4.46-$24.91 ppy. These estimates are substantially below published PrEP cost-effectiveness thresholds of approximately $100 ppy in sub-Saharan Africa and up to $200 ppy in high-incidence settings. MK-8527 could be manufactured at extremely low cost, suggesting that intellectual property and licensing arrangements, rather than production feasibility, will determine equitable access in LMICs. Early voluntary licensing agreements could facilitate timely generic entry and affordable global scale-up if clinical efficacy is confirmed.

Pregnancy-associated melanoma has long been debated, with hypotheses that gestational immune tolerance and elevated sex hormones may promote melanocytic transformation; however, large-scale, real-world evidence remains limited and conflicting. Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of pregnant patients with documented first and third trimester encounters versus reproductive-age nonpregnant females with an encounter for contraceptive management and equivalent follow-up. Cohorts were 1:1 propensity-score matched on demographics, comorbidities relevant to immune function and cancer risk, and proxies for sun exposure and dermatologic surveillance. Incident invasive melanoma and melanoma in situ (MIS), stratified by anatomic site, were evaluated over a 21-month observation window corresponding to the duration of pregnancy plus 1 year postpartum. A sensitivity analysis restricted the pregnant cohort to patients with prior estrogen-based therapy exposure. In the primary analysis ( n = 854 193 per cohort), pregnancy was not associated with increased risk of invasive melanoma [hazard ratio: 0.92, 95% confidence interval (CI): 0.78-1.07) or MIS (hazard ratio: 1.01, 95% CI: 0.82-1.24), and no significant differences emerged at head and neck, trunk, or extremity subsites. In the sensitivity analysis ( n = 128 716 per cohort), findings were consistent, with no observed association with invasive melanoma (hazard ratio: 1.06, 95% CI: 0.76-1.49) or MIS (hazard ratio: 1.05, 95% CI: 0.67-1.65). Our results argue against pregnancy as an independent melanoma risk factor and point toward a baseline risk inherent to reproductive-age females.

This study aimed to better estimate the risk of progression of vaginal intraepithelial neoplasia (VaIN) into vaginal cancer. A systematic review was conducted to identify eligible studies that (1) reported at least one event of progression from VaIN to vaginal cancer, (2) provided the VaIN grade, (3) had a follow-up period of at least 6 months, and (4) specified the proportion of treated and untreated patients. The effect size was the risk of progression from VaIN to invasive cancer, calculated as the number of events of progression out of all the observed cases at enrolment. Five thousand seven hundred and sixty-eight references were screened; 30 case series were deemed eligible for qualitative analysis. Twenty case series of treated women, and four case series of untreated women were quantitatively analyzed. Both subgroups included cases of high-grade VaINs (no progressions to vaginal cancer found in low-risk VaINs). A sensitivity analysis on the subgroup of untreated women resulted in the exclusion of a study with excessive influence, with the final data synthesis based on three poor-quality case series. The risk of progression of high-grade VaIN to vaginal cancer in treated women was 7.09% (95% confidence interval [CI]: 6.83-7.36%). The risk of progression of high-grade VaIN to vaginal cancer in untreated women was 29.88% (95% CI: 11.22-58.96%). Progression events primarily occurred within 5 years of follow-up. The risk of progression of high-grade VaIN to vaginal cancer is higher than previously reported and more serious for untreated women (CRD42024618227).

Optimizing facility location and inventory management in food supply chains is essential for reducing costs, prevent spoilage of perishable products, and ensuring equitable food distribution across rural and urban districts. To deal with this issue, this paper proposes a comprehensive model for the integrated optimization of facility location and inventory management within a three-tier hierarchical hub network architecture. The network topology is a complete-star-star structure, with fully interconnected central hub nodes at the highest level. The intermediate and lowest tiers consist of star-shaped subnetworks, where end nodes, including manufacturers, connect to non-central hubs. Given the NP-complete nature of the problem, we propose a hybrid algorithm combining an exact solution with a meta -heuristic genetic algorithm. These algorithms are implemented in GAMS and MATLAB software. Sensitivity analysis is conducted on model’s parameters. The results show that decreasing the costs of establishing the hub by more than 75% increases the number of median hubs. Production quantity and inventory levels remain steady with cost variations up to −50%, but decrease with production cost increases up to 50%, where inventory levels drop to zero

Network analysis of item-level neuroticism in recurrent major depression among Korean women.

Symptoms of anxiety and depression after out-of-hospital cardiac arrest: an exploratory dyadic analysis of survivors and their cohabiting spouses or partners from the BOX trial.

Benchmarking Image-Based Motion-Correction Methods for Ultrasound Localization Microscopy.

This study aimed to define the nonlinear relationship between maternal free thyroxine (FT4) levels in early pregnancy and the risk of preeclampsia. This study used a large-scale retrospective cohort of 46 592 women with singleton pregnancies. Thyroid function parameters and preeclampsia outcomes were collected. A restricted cubic spline model analyzed the nonlinear relationship between FT4 levels and preeclampsia risk. Odds ratios were calculated using multivariable logistic regression, adjusting for confounders. Preeclampsia risk was also assessed based on thyroid disease classifications. Sensitivity analyses validated the robustness of the results. The study found a U-shaped relationship between FT4 levels in early pregnancy and preeclampsia risk. The risk was lowest at 15 pmol/l, with a significant increase as FT4 deviated from this value, especially at lower FT4 levels. A physiological optimal range of 13.9-17.3 pmol/l was identified. Compared to women in this range, low FT4 levels (< 11.7 pmol/l) had a significantly higher risk of preeclampsia (adjusted odds ratio, aOR = 2.23). Even women with FT4 at the lower end of the normal range (11.7-13.9 pmol/l) had increased risk (aOR = 1.26), indicating a latent high-risk group. In traditional thyroid classification, only hypothyroxinemia was a significant independent risk factor. Sensitivity analyses confirmed result stability. This study reveals that low FT4 level is an independent risk factor for preeclampsia, with a dose-dependent effect. These findings support targeted prevention strategies and provide a new approach for precise preeclampsia prevention.

Leveraging contextual confidence for smarter retrieval in large language models.

Deep learning fusion modeling of reference evapotranspiration with multi-source remote sensing data through addressing noise impacts

Selective dorsal rhizotomy (SDR) is used to treat spastic cerebral palsy (CP), but its effectiveness remains debated due to heterogeneous, predominantly non-randomized evidence. This systematic review and single-arm meta-analysis was prospectively registered in PROSPERO (CRD420251132796) and conducted in accordance with PRISMA 2020 and the Cochrane Handbook. PubMed, Embase, and Web of Science were searched for studies evaluating SDR in pediatric CP. Eligible designs included case series, retrospective or prospective cohorts, and randomized trials reporting motor or spasticity outcomes. The primary endpoints were Gross Motor Function Measure-66 (GMFM-66) and Modified Ashworth Scale (MAS). Risk of bias was assessed using the ROBINS-I tool. Mean change values with 95% confidence intervals (CI) were pooled using random-effects models (REML). Statistical heterogeneity was evaluated with the I2 statistic, and sensitivity analyses (including leave-one-out and varying correlation coefficients for missing SDs) were performed. Sixteen studies including 756 children were analyzed. SDR was associated with significant improvements in GMFM-66 at the shortest (mean change 3.29; 95% CI 1.54-5.03; I2=71%) and longest (mean change 3.71; 95% CI 2.00-5.42; I2=72%) available follow-up. Spasticity was significantly reduced, with a pooled mean change in MAS of -1.98 (95% CI -3.26 to -0.70; I2=99%). Sensitivity analyses confirmed the stability of results across assumptions, and leave-one-out analyses did not materially alter effect estimates. All included studies were judged to have a moderate risk of bias. SDR is associated with clinically meaningful and durable improvements in gross motor function and reductions in spasticity in children with spastic CP.

Rent increases and mental health among low-income renters in Australia: A longitudinal analysis.

Exploring the relationship between trauma- and stressor-related disorders and top-down central sensitization: A systematic review and meta-analysis.

Adverse childhood experiences and periodontal diseases and tooth loss in adults: A systematic review and meta-analysis.