Search Results (129,438)

Decarbonizing the construction sector requires high-volume replacement of Portland clinker with non-calcined supplementary cementitious materials (SCMs). This study investigates white cement pastes incorporating raw Algerian diatomite—a silica-rich biogenic mineral—at substitution levels from 40% to 95% (5% increments) and a fixed water-to-binder ratio of 0.5. The target application is ultra-lightweight, multifunctional composites for non-structural uses such as decorative panels and partition elements. Increasing diatomite content progressively reduced bulk density from 1.483 g/cm${}^3$ (D40) to 0.557 g/cm${}^3$ (D95) and increased porosity. 28-day compressive strength decreased monotonically from 16 MPa (D40) to 2.4 MPa (D95) as clinker dilution intensified. Ultrasonic pulse velocity dropped from 6205 m/s to 1495 m/s, reflecting progressive pore development and confirming the material’s lightweight potential. Statistically significant strength gains beyond 28 days were recorded ($+25.87\%$ for compression, p-value$<0.05$), evidencing delayed pozzolanic activity. These results confirm that raw, non-calcined diatomite is a viable SCM for eco-efficient, low-density construction systems. To overcome the extrapolation instability of purely data-driven approaches, a Meta-Avrami Hybrid Framework was developed. It anchors Gradient Boosting residual learning to a sigmoidal Avrami hydration kernel. The model achieved high predictive accuracy ($R^2\approx 0.999$, $\mathrm{RMSE}\approx 0.010$) under 10-fold cross-validation. Generalization was well-controlled, with a low overfitting gap ($\Delta R^2=0.0226$) and stable fold-to-fold performance ($\mathrm{Std}=0.0204$). These metrics confirm suitability for unseen mix designs. This is particularly relevant for service-life assessment of partition panels and lightweight façade elements, where long-term performance guarantees are required. The physics-informed architecture ensures asymptotic strength stabilization up to a 10-year horizon (amplification ratios 1.03–1.05). This prevents the non-physical divergence observed in polynomial and power-law hybrids (ratios 1.36–1.70). The framework provides a reliable and interpretable tool for service-life design of sustainable low-carbon cementitious systems. Full article

Background: Herpes simplex virus (HSV), Epstein–Barr virus (EBV), and cytomegalovirus (CMV) establish lifelong latency in sensory neurons, lymphoid tissue, and myeloid–endothelial cells, respectively. A substantial proportion of adults worldwide are infected with all three viruses and may experience concurrent herpesvirus latency, yet they have largely been studied independently. This review examined whether latent and intermittently reactivating herpesviruses share overlapping inflammatory signatures and whether their combined presence contributes to chronic inflammatory burden. Methods: A narrative integrative review was conducted using MEDLINE, Embase, and Google Scholar (inception–October 2025). Evidence from thirty-one cohort studies and mechanistic investigations spanning virology, immunology, neurology, and clinical medicine was synthesized. Results: Herpesvirus reactivation rates ranged from 23% in general Intensive Care Unit (ICU) populations to 85% in severe COVID-19. Concurrent reactivation of multiple viruses occurred in 34–63% of critically ill patients and was associated with worse clinical outcomes. Notably, simultaneous CMV and EBV reactivation independently predicted mortality (adjusted hazard ratio, 3.17; 95% CI, 1.41–7.13). Across infections, overlapping inflammatory biomarkers, including IL-6, TNF-α, CRP, and PGE₂, were consistently elevated, reflecting convergent activation of IFN and NF-κB signaling pathways. Mechanistic studies suggest cross-compartment immune priming, where CMV-driven T-cell exhaustion facilitates EBV reactivation, and viral cytokine signaling enhances HSV-associated neuroinflammation. Conclusions: HSV, EBV, and CMV triple latency may represent an underrecognized contributor to chronic inflammation in immunocompetent hosts. Understanding this multi-virus inflammatory network may inform mechanistic research, biomarker-guided risk stratification, and therapeutic strategies targeting convergent inflammatory pathways. Prospective interventional studies incorporating concurrent multi-virus monitoring are needed to clarify causal relationships. Full article

Introduction: Diabetic gastroparesis increases the risk of aspiration, pneumonia, and sepsis, yet the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on these outcomes is uncertain because of their gastric-emptying effects. Methods: We performed a retrospective cohort study using the TriNetX Global Research Network. Adults (≥18 years) with diabetes mellitus and gastroparesis were identified and divided into two cohorts based on GLP-1 RA exposure. Propensity score matching (1:1) balanced demographics, comorbidities, and antidiabetic medications, yielding 23,371 patients per cohort. Outcomes, assessed from 180 days after index, included pneumonia, pneumonitis, mechanical ventilation, ventilator-associated pneumonia, sepsis, bacteremia, empyema, lung abscess, acute respiratory distress syndrome (ARDS), and need for enteral feeding. Risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. Results: Compared with GLP-1 users, non-GLP-1 patients had higher incidences of pneumonitis (3.6% vs. 2.5%; HR 1.76, 95% CI 1.58–1.95), pneumonia (13.2% vs. 12.2%; HR 1.34, 95% CI 1.27–1.41), mechanical ventilation (4.4% vs. 3.3%; HR 1.63, 95% CI 1.49–1.79), sepsis (12.8% vs. 11.1%; HR 1.44, 95% CI 1.37–1.52), and bacteremia (5.2% vs. 4.4%; HR 1.46, 95% CI 1.35–1.59) (all p < 0.001). Empyema and ARDS were also numerically lower among GLP-1 users, while ventilator-associated pneumonia and lung abscess were rare and similar between groups. No patients required percutaneous endoscopic gastrostomy or nasal enteral feeding. Conclusions: In patients with diabetes and gastroparesis, GLP-1 RA therapy was associated with significantly fewer pulmonary and systemic infectious complications. These data suggest that the systemic benefits of GLP-1 RAs may outweigh concerns regarding delayed gastric emptying in this high-risk population. Full article

Modeling immune cell recruitment within a wound-relevant microenvironment remains challenging. Here, we developed a novel skin-derived extracellular matrix (ECM) hydrogel model to study monocyte (THP-1) entry and phenotypic changes within a dermal fibroblast-populated (NHDF) matrix. The main novelty of this study is that it compares the effects of fibroblast-derived soluble signals and active monocyte infiltration in a 3D biomimetic model. Signaling by fibroblast-secreted soluble factors enhanced a pro-angiogenic secretome (e.g., >3-fold upregulation of VEGFA at day 1) and promoted endothelial tube formation (increasing network junctions to 1.16 ± 0.16 vs. 0.93 ± 0.23 in monoculture). In contrast, this paracrine signaling did not induce the matrix-driven pro-fibrotic response in hydrogels. Crucially, physical immune infiltration restricted monocyte penetration (mean depth of 8.92 ± 2.27 μm vs. 121.1 ± 15.9 μm in monoculture at day 5), reduced hydrogel-induced myofibroblast activation (decreasing α-SMA+ cells from 79.1% to 54.3% upon initial contact), and was associated with slower collagen loss during the early phase. (retaining a high-density collagen ratio of 3.46 ± 0.33 vs. 2.02 ± 0.29 in monoculture at day 1). These observations were accompanied by a shift toward a matrix-stabilizing profile, including increased TIMP expression and reduced pro-fibrotic markers. (ACTA2 and COL1A1). By including active immune infiltration (which was absent in previous tSVF models), we capture the transition from inflammation to the proliferation stage. Although the later stages of extensive ECM remodeling appear suppressed here, they may occur as repair progresses. Overall, our findings highlight that the immune cell is a key regulatory component for coordinating matrix preservation and vascular support. Importantly, this model replicates the early phases of wound healing, a stage where the monocyte–fibroblast secretome supports endothelial network formation. We established this innovative 3D ECM hydrogel system as a practical and physiologically relevant platform to investigate immune–matrix–stromal crosstalk. Full article

Background/Objectives: Cervical drainage has traditionally been used after thyroidectomy to reduce postoperative fluid accumulation and mitigate bleeding-related complications. However, advances in surgical technique, perioperative hemostasis, and postoperative care pathways have led to an increase in the use of short-stay and outpatient thyroidectomy, prompting renewed evaluation of the role of routine drainage. The objective of this systematic review and meta-analysis was to examine the association between postoperative cervical drainage and postoperative outcomes following thyroidectomy. Methods: A systematic literature search was conducted across PubMed/MEDLINE, Google Scholar, Semantic Scholar, and the Cochrane Central Register of Controlled Trials to identify studies comparing thyroidectomy with versus without cervical drainage. Studies published between January 2005 and January 2026 were eligible for inclusion. Randomized controlled trials and non-randomized comparative studies involving adult patients were included. The outcomes of interest were cervical hematoma, surgical site infection (SSI), seroma formation, postoperative bleeding, reoperation, and length of hospital stay. Random-effects meta-analyses were performed using odds ratios for binary outcomes and mean differences for continuous outcomes. Sensitivity and influence analyses were conducted to assess robustness. The results were additionally examined in prespecified sensitivity analyses restricted to randomized trials, and study-design-stratified estimates are presented. Results: Thirty studies comprising 2810 patients were included. Drain use was not statistically significantly associated with postoperative cervical hematoma (OR 1.28, 95% CI 0.93–1.75; p = 0.124). In contrast, drain use was associated with a significantly increased risk of surgical site infection (OR 2.04, 95% CI 1.46–2.85; p = 0.0002) and a significantly longer postoperative length of hospital stay (mean difference 1.96 days, 95% CI 0.42–3.50; p = 0.016). No statistically significant associations were observed between drainage and seroma formation (OR 0.95, 95% CI 0.70–1.30; p = 0.750), postoperative bleeding (OR 1.26, 95% CI 0.85–1.86; p = 0.228), or reoperation (OR 0.89, 95% CI 0.59–1.32; p = 0.525). Sensitivity and influence analyses demonstrated consistent results across analytical approaches and study designs. Conclusions: In thyroidectomy, routine cervical drainage is not associated with a reduction in bleeding-related complications and is associated with adverse recovery-related outcomes, including increased risk of surgical site infection and prolonged hospitalization. Overall, the findings indicate that routine cervical drainage after thyroidectomy offers no clear advantage in preventing postoperative complications and may be associated with adverse postoperative outcomes. Routine cervical drainage after thyroidectomy was not associated with a protective effect on complications and showed associations with less favorable recovery-related outcomes. Full article

Against the backdrop of a low-carbon economy, the control of soot emissions from combustion processes is of paramount importance. In this study, the effects of CO₂ dilution on soot formation in ethylene laminar diffusion flames are investigated through a combination of experimental measurements and numerical simulations. In addition, a virtual species, denoted as F_xCO₂, is introduced to progressively decouple the individual mechanisms by which different effects suppress soot formation. The results indicate that increasing the CO₂/N₂ dilution ratio leads to reductions in both the peak flame temperature and the soot volume fraction, with CO₂ exhibiting a more pronounced inhibitory effect than N₂. The decoupling analysis reveals that the dilution effect and the chemical effect are the dominant contributors to flame temperature reduction. The soot-inhibiting effectiveness of the individual effects follows the order: dilution effect > thermal effect > chemical effect > density effect > transport effect. With respect to their influence on C₂H₂ concentration, the effects are ranked as: dilution effect > chemical effect > transport effect > thermal effect > density effect. The chemical effect suppresses the formation of OH radicals, thereby reducing the flame temperature and H radical concentration. In contrast, the dilution effect enhances soot oxidation by increasing the OH radical concentration, effectively inhibiting soot particle formation. Full article

During CO₂ storage in deep saline aquifers, low-permeability lenticular shale layers alter CO₂ migration and affect dissolution trapping, but their impacts remain unclear. In this study, a two-dimensional radial numerical model coupling gas–brine two-phase flow and mass transfer is developed to simulate CO₂ plume evolution and dissolution beneath discontinuous lenticular shale layers. In the model, lenticular shale interlayers are represented as discontinuous low-permeability barriers, and their geometry is characterized by radial length and vertical thickness. The blocking effect of lenticular shale layers induces bypass flow, promotes lateral plume spreading, and prolongs contact time between CO₂ and brine, which increases dissolution during 250 to 1000 days of injection. When the permeability anisotropy ratio is 0.001, upward migration of CO₂ is suppressed and a high-concentration retention zone forms beneath the lenticular shale layer. As the radial length of the lenticular shale layers increases from 150 to 250 m, the plume expands and the bypass-flow path lengthens, which strengthens lateral CO₂ spreading and redistributes dissolved CO₂ concentration. In contrast, varying the thickness of the lenticular shale layers from 6 to 10 m has a relatively limited influence on the extent of bypass flow and the morphology of the concentration field. Full article

This study aimed to investigate the underlying mechanisms by which replacing soybean meal with different proportions of black soldier fly (BSF) larvae meal affects the antioxidant capacity, immune function, and intestinal health in Xichuan black-bone chickens. After feeding the diets with 0.0%, 3.9%, 7.8%, 11.7%, and 15.6% BSF powder for 56 days, twelve chickens were sampled from each group. The optimal addition group was determined. Compared with the control group, adding 11.7% BSF significantly increased serum T-AOC, SOD, IgA, IgM, IL-4, and IL-10 concentrations, while markedly reducing IL-1β, TNF-α, and IL-6 (p < 0.05) and improving spleen morphology. Adding 11.7% BSF significantly increased the duodenal villus-to-crypt ratio (V/C) and markedly elevated the ileal V/C (p < 0.05), and it significantly increased gene expression levels of duodenal Claudin-1, Occludin, and E-cadherin, jejunal Claudin-1, and ileal Claudin-1, Occludin, and E-cadherin (p < 0.05). Compared with the control group, the 11.7% addition group exhibited significant alterations in caecal microbiota composition (p < 0.05), with 10 distinct bacterial genera identified at the genus level. A total of 424 differentially expressed metabolites were identified. Correlation analyses revealed that adding 11.7% BSF may enhance immune function by regulating intestinal metabolites such as isovaleric acid, inosine, and tazarotenic acid via Akkermansia, Sphaerochaeta, and Blautia in the cecum. It may also improve gut health by modulating inosine through Sphaerochaeta and Blautia. This trial provides feasibility evidence for substituting soybean meal with BSF meal, offering scientific support for sustainable development in animal husbandry. Full article

The need for Structural Health Monitoring is evident in order to ensure the safety of civil infrastructure. The goal of vibration monitoring is to derive the eigenfrequencies, mode shapes and damping of a structure. A change in the eigenfrequency over time can indicate deterioration or damage in a structure. The amplitude can be used to calculate the damping ratio. As the damping ratio is amplitude-dependent, it is important to correctly determine the amplitude values. This study focuses on the amplitude correctness of high-rate Global Navigation Satellite System (GNSS) receiver data. In an experiment with controlled oscillations with a shaker and a Laser Triangulation Sensor (LTS) as a reference, the vibration amplitudes derived by GNSS measurements were analyzed, using time-frequency techniques like Short Time Fourier Transform (STFT) and Wavelet Transform (WT). We demonstrate that vibrations in the millimeter range can be derived from the measurements of satellites orbiting 20,000 km above Earth. However, the amplitudes of the determined frequencies show systematic errors up to 60% when compared to independent reference measurements. We introduce a correction method to reduce this error by applying a frequency-dependent correction function. Full article

The Jiaodong gold-mineralized area is one of the most significant gold districts in China. The newly discovered Moshan gold deposit is hosted in the Late Jurassic Queshan granite, previously considered a prospecting blind zone. In this study, pyrite from the Moshan gold deposit is examined as the primary research subject. To elucidate the ore-forming processes and genetic mechanisms of this deposit, we conducted a comprehensive mineralogical and geochemical study on pyrite, the principal gold-bearing mineral. EPMA and LA-MC-ICP-MS analyses reveal that the pyrite is slightly sulfur-deficient (average S/Fe ratio of 1.976) and exhibits trace element variations (As, Co, and Ni) strongly correlated with distinct metallogenic stages. Gold occurs in various forms, including visible inclusion gold, fracture gold, and invisible nano-particulate gold (Au⁰). The in situ sulfur isotope δ³⁴S values range from 7.11‰ to 9.40‰ (average 8.00‰), displaying high homogeneity and a positive deviation from the troilite in the Canyon Diablo iron meteorite. By integrating pyrite S-Fe relationships, Co-Ni-As systematics, and sulfur isotope characteristics, the study indicates that the Moshan gold deposit originates from a magmatic-hydrothermal source. The ore-forming materials predominantly derive from Mesozoic granite-derived magmatic-hydrothermal fluids, with a minor contribution from crustal basement materials. The depth of mineralization is interpreted as mid-shallow. These findings not only highlight the metallogenic potential of the Queshan granite and clarify the genetic relationship between the Moshan gold deposit and other regional gold deposits but also provide a novel theoretical foundation and technical support for deep gold exploration in the Jiaodong region. Full article

Background/Objectives: Early prognostication in critically ill patients with low burden of organ dysfunction (BOD) remains challenging. Progranulin (PGRN), a hypoxia inducible and anti-inflammatory protein, may offer prognostic value. We investigated whether PGRN levels predict mortality in ICU patients stratified by their BOD. Methods: In this secondary analysis of a prospectively recruited ICU cohort (n = 99), patients were categorized into low (Sequential Organ Failure Assessment Score (SOFA) ≤ 8) and high (SOFA > 8) BOD groups. Plasma PGRN concentrations were measured every 8 h for up to 5 days. Initial values and kinetic parameters (maximum, mean, and normalized area score (NAS)) were evaluated. Associations with in-hospital mortality were analyzed by univariate logistic regression and area under the receiver operating characteristic curve (AUROC) comparisons. Results: In patients with low BOD (n = 53), the PGRN kinetics were significantly associated with in-hospital mortality, with odds ratios of 1.086 (95% CI 1.027–1.148), 1.102 (95% CI 1.025–1.184), and 1.093 (95% CI 1.021–1.170) for maximum, mean, and NAS values, respectively. The respective AUROC values were 0.815 (p = 0.001), 0.753 (p = 0.010), and 0.738 (p = 0.016). By contrast, none of the PGRN metrics predicted mortality in patients with high BOD (n = 46; all AUROC values < 0.61, p > 0.25). The respective SOFA and CRP metrics were not predictive in low BOD patients. Maximum PGRN levels predicted death at least 32 h in advance. Conclusions: Serial PGRN measurements offer prognostic information, particularly in ICU patients with low BOD, a group whose deterioration is often difficult to anticipate and may be underestimated by conventional scoring systems such as SOFA. These findings support further investigation of PGRN as a tool for early risk stratification in critical illness. Full article

Healthcare fraud poses significant risks to insurance systems, undermining both financial sustainability and equitable access to care. Accurate detection of fraudulent claims is therefore critical to ensuring the integrity of healthcare insurance operations. However, the increasing sophistication of fraud techniques and limited data availability have undermined the performance of traditional detection approaches. To address these challenges, this paper proposes WCGAN-GA-RF, an integrated fraud detection framework that synergistically combines Wasserstein Conditional Generative Adversarial Network with gradient penalty (WCGAN-GP) for synthetic data generation, genetic algorithm-based feature selection (GA-RF) for dimensionality reduction, and Random Forest (RF) for classification. The proposed framework was empirically validated on a real-world dataset of 16,000 healthcare insurance claims from a Chinese healthcare technology firm, characterized by a 16:1 class imbalance ratio ($5.9\%$ fraudulent samples) and 118 original features. Using a stratified $80/20$ train–test split with results averaged over five independent runs, the WCGAN-GA-RF framework achieved a precision of $96.47\pm 0.5\%$, a recall of $97.05\pm 0.4\%$, and an F1-score of $96.26\pm 0.4\%$. Notably, the GA-RF component achieved a $65\%$ feature reduction (from 80 to 28 features) while maintaining competitive detection accuracy. Comparative experiments demonstrate that the proposed approach outperforms conventional oversampling methods, including Random Oversampling (ROS), Synthetic Minority Oversampling Technique (SMOTE), and Adaptive Synthetic Sampling (ADASYN), particularly in handling high-dimensional, severely imbalanced healthcare fraud data. Full article

Basalt fiber-reinforced concrete (BFRC) exhibits superior mechanical performance, durability, and environmental benefits, making it a promising material for promoting green and low-carbon construction. This study develops a novel multi-objective mix design optimization method for BFRC under cost and carbon emission constraints, presents a framework that considers tensile strength (f_t) as a core design objective, and establishes high-precision strength prediction models via gene expression programming (GEP). Material cost and carbon emission functions were formulated based on market data, while compressive strength (f_c) and tensile strength (f_t) prediction models were established using using GEP implemented in MATLAB 2018b with seven mix design variables, including cement dosage, aggregate parameters, and basalt fiber (BF) characteristics (diameter, length, and dosage). Multiple constraints covering material quantities, mix ratios, workability, and density were incorporated into the optimization model, which was solved via the non-dominated sorting genetic algorithm II (NSGA-II). The method identifies the optimal cement dosage, aggregate proportions, and BF dosage to maximize tensile strength (f_t) while minimizing cost and carbon emissions. Computational results suggest that within the target strength range of 30–60 MPa, the proposed design yields reductions of 10–20% in carbon emissions and 12–18% in costs compared to conventional methods, offering potential advantages for sustainable construction. Unlike existing multi-objective studies, which focus on compressive strength, this work addresses critical factors of tensile strength (f_t) and prediction inaccuracy, proposing a systematic low-carbon design framework for potential BFRC applications. Full article

The joint design of unimodular waveforms and receive filters is a pivotal technology in Multiple-Input Multiple-Output (MIMO) radar systems. However, most existing methods primarily focus on point target detection or ignore the impact of active jamming in extended target scenarios. To bridge this gap, this paper proposes an optimization framework for the joint design of unimodular waveforms and receive filters specifically for MIMO radar extended target detection in the presence of suppressive jamming. The problem is formulated to maximize the Signal-to-Interference-plus-Noise Ratio (SINR) while strictly satisfying the unimodular constraint and mitigating suppressive jamming. Due to the non-convexity of the unimodular constraint and the quadratic fractional nature of the SINR objective function, the optimization problem is highly challenging. Unlike conventional methods that rely on convex relaxation—which often leads to performance degradation—we exploit the geometric structure of the constraint set. Specifically, the unimodular constraints are modeled using complex circle manifolds, and the suppressive jamming suppression requirements are integrated into the objective function via a smooth penalty metric. Building on these characteristics, a Product Complex Circle Euclidean Manifold (PCCEM) method is developed. This approach transforms the constrained problem into an unconstrained optimization task on a product manifold, which is then efficiently solved using the limited-memory Broyden–Fletcher–Goldfarb–Shanno (L-BFGS) algorithm. Simulation results demonstrate that the proposed PCCEM method outperforms baseline algorithms in terms of computational efficiency, output SINR, and the depth of the formed jamming notches. Full article

Respiratory support requirement among children hospitalized with pneumonia is a key marker of disease severity and resource needs, yet scalable risk stratification tools for routine hospital settings in Southern Vietnam remain limited. Background: This study aimed to develop and evaluate clinical and laboratory-based multivariable models to predict respiratory support requirement in children under five hospitalized with pneumonia, using a routine care dataset. Methods: We conducted a retrospective cohort study conducted at a tertiary pediatric hospital in Southern Vietnam (July 2024–November 2025), children aged 2–59 months hospitalized with pneumonia were included after predefined exclusions. The outcome was the maximum (worst) level of respiratory support required during hospitalization (oxygen therapy, CPAP, or invasive mechanical ventilation), analyzed as a binary endpoint (any support vs. none) for model development. Candidate predictors included bedside clinical variables (age < 12 months, malnutrition, recurrent pneumonia, cyanosis, tachypnea, chest indrawing) and complete blood count-derived inflammatory indices. Univariable logistic regression was used for crude associations. Two multivariable logistic regression models were built: Model 1 (clinical-only) and Model 2 (clinical + neutrophil-to-lymphocyte ratio [NLR]; primary). Discrimination was assessed using area under the ROC curve (AUC), and calibration was evaluated using the Hosmer–Lemeshow test and observed-to-expected (O:E) ratio. Results: A total of 1797 children were included; 154 (8.6%) required respiratory support. In the primary model, independent predictors were age < 12 months (aOR 2.57, 95% CI 1.69–3.92), malnutrition (aOR 4.33, 2.56–7.33), recurrent pneumonia (aOR 1.82, 1.18–2.81), cyanosis (aOR 24.02, 7.41–77.87), chest indrawing (aOR 4.19, 2.73–6.43), and higher NLR (per 1 unit: aOR 1.49, 1.38–1.60), while tachypnea was not independently associated after adjustment. Discrimination improved from Model 1 (AUC 0.754) to Model 2 (AUC 0.840; 95% CI 0.806–0.874). At the optimal probability cut-off (0.122), Model 2 achieved sensitivity 66.2%, specificity 86.2%, PPV 31.1%, NPV 96.5%, and accuracy 84.5%. Calibration was acceptable (Hosmer–Lemeshow p = 0.662; O:E = 1.00). Conclusions: A simple clinical model strengthened by NLR provided good discrimination and calibration for predicting respiratory support requirement among children under-five hospitalized with pneumonia in Southern Vietnam. This approach may support early triage, prioritization of monitoring intensity, and escalation readiness in resource-constrained settings, although external validation is warranted. Full article