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This work aims to study the effect of milk powder incorporation on the nutritional and sensory quality of our traditional indigenous food, bhakka. Different samples were prepared replacing the rice flour by milk powder at different ratios (2.5:97.5, 5:95, 7.5:92.5, 10:90). Bhakka prepared from 100% rice flour was considered as control. Sensory-related results showed that 7.5% milk powder and 92.5% rice flour can be mixed to prepare an acceptable quality. The proximate analysis showed protein content of 5.18% in rice flour bhakka and 6.7% in milk-powder-incorporated bhakka. The milk-powder-incorporated bhakka had a fat content of 1.51%, crude fibre content of 0.18%, crude protein content of 6.70%, total ash content of 0.44%, and carbohydrate content of 62.3%, which was higher than that of rice flour bhakka. The product prepared can help in combating protein–energy malnutrition, adds a new taste as well as value to our traditional indigenous food.

The public release of ChatGPT in November 2022 brought excitement and concerns regarding students' use of language models in higher education. However, little research has empirically investigated students' intention to adopt ChatGPT. This study developed a theoretical model based on the Unified Theory of Acceptance and Use of Technology (UTAUT) with an additional construct- anxiety, to investigate university students' adoption intention of ChatGPT in two higher education contexts-- the UK and Nepal. 239 and 226 questionnaires were deemed sufficient for data analysis for Nepal and the UK, respectively. We utilised the structural equation modelling technique to test the hypotheses. Our results reveal that performance expectancy, effort expectancy and social influence significantly impacted the adoption intention of ChatGPT for both countries. However, anxiety's impact varied between Nepal and the UK. Integrating UTAUT with a cross-country comparative approach provides insights into how ChatGPT's reception diverges between different higher education contexts. Our results also have implications for technology companies aiming to expand language models' availability worldwide.

Animal studies show aging varies between individuals as well as between organs within an individual1-4, but whether this is true in humans and its effect on age-related diseases is unknown. We utilized levels of human blood plasma proteins originating from specific organs to measure organ-specific aging differences in living individuals. Using machine learning models, we analysed aging in 11 major organs and estimated organ age reproducibly in five independent cohorts encompassing 5,676 adults across the human lifespan. We discovered nearly 20% of the population show strongly accelerated age in one organ and 1.7% are multi-organ agers. Accelerated organ aging confers 20-50% higher mortality risk, and organ-specific diseases relate to faster aging of those organs. We find individuals with accelerated heart aging have a 250% increased heart failure risk and accelerated brain and vascular aging predict Alzheimers disease (AD) progression independently from and as strongly as plasma pTau-181 (ref. 5), the current best blood-based biomarker for AD. Our models link vascular calcification, extracellular matrix alterations and synaptic protein shedding to early cognitive decline. We introduce a simple and interpretable method to study organ aging using plasma proteomics data, predicting diseases and aging effects.

River restoration projects can be designed to cultivate a diversity of human interactions with the riverscape, alongside the fulfillment of traditional biophysical objectives. The Salinas River is a major river in an agricultural valley in California, where restoration projects could address annual concerns of winter flooding while facilitating more human interactions throughout the riverscape. We conducted a study to investigate (i) who currently interacts with the river, (ii) where the sites of these interactions are, and (iii) how we can restore them for ecological and socio-cultural benefits. We combined site visits and evaluations, informal interviews, and GIS analyses to answer our questions. We find the Salinas River largely disconnected from public life, out of view and physical access. Nonetheless, there is a desire to connect with the water and riverfronts. Among the five sites we evaluated, Arroyo Seco is a well-frequented public area with amenities and ease of access to the banks and streams. The other sites require illicit passage through private property, but vary with regards to visual and physical accessibility, and site conditions, such as quantity of trash. Nonetheless, all sites inspire visions for restoration projects. such as floodable parks and linear riverfront parks, to yield biophysical and socio-cultural benefits .

Background and Purpose: Social anxiety disorder (SAD) which is characterized by persistent fear of social situations is increasingly relevant, particularly among students in today’s competitive society. This study assesses the prevalence of SAD and identifies associated factors among health care students. Materials and Methods: A web-based cross-sectional study was conducted from March to May 2023 and included 325 participants from five colleges in Kathmandu City, Nepal. The sample size was calculated using the formula Z²pq/d². The participants were selected via the purposive sampling method. SAD was assessed using the 17-item social phobia inventory instrument. Logistic regression analysis identified significant predictors (P

This paper attempts to reflect on how international education has come to be imagined as a quest for 'greener pastures' by many young Nepalese who are on the move in what is increasingly described as a 'globalized world'. Networking and engaging deeply in social, cultural and sporting rituals with the Nepalese students in Copenhagen, first as an Erasmus Mundus fellow from 2006 to 2008 and then as a doctoral student from 2011 to 2015 accompanied by a fieldwork in Nepal, this paper examines how international education has come to serve this diasporic desire for many young Nepalese.

Wound trajectory and outcomes research has applications in different aspects of wound healing: forecasting wound healing time, access and utilization of wound care services, factors associated with disparities in wound care services, and its quality and outcomes. Wound care research benefits from a well-maintained record management system. In this article, we demonstrate the customization of the District Health Information Software (DHIS2) platform to integrate wound care clinical data with social determinants of health from several Comprehensive Wound Centers (CWC) in Indiana. We describe the modules and features of our platform, such as tracker capture, visualization, and maps. DHIS2 is used in more than 60 countries to monitor and evaluate health programs. However, to the best of our knowledge, this is the first attempt to use DHIS2 as a wound care data warehouse, a platform to perform wound care research for academic researchers and clinical practitioners. Clinicians can use the platform as one of the key tools to make an informed decision in determining the treatment for favorable healing trajectory and wound outcomes. We conducted a usability and acceptance survey among researchers at the Indiana Center for Regenerative Medicine and Engineering and found that DHIS2 can be a suitable infrastructure to manage metadata to import and analyze combined data from disparate sources, including Electronic Medical Records, WoundExpert, and clinical trials management software like REDCap.

Objective: Enhanced Recovery After Surgery protocols are relatively new in cardiac surgery. Enhanced Recovery After Surgery addresses perioperative analgesia by implementing multimodal pain control regimens that include both opioid and nonopioid components. We investigated the effects of an Enhanced Recovery After Surgery protocol at our institution on postoperative outcomes with particular focus on analgesia. Methods: Single-center retrospective study comparing perioperative opioid use before and after implementation of an Enhanced Recovery After Surgery protocol at our institution. Subjects were divided into 2 cohorts: Enhanced Recovery After Surgery (study group from year 2020) and pre–Enhanced Recovery After Surgery (control group from year 2018). Baseline and perioperative variables including total opioid use from the day of surgery to postoperative day 5 were collected. Opioid use was calculated as morphine milligram equivalents and compared between the 2 cohorts. Results: A total of 466 patients were included: 250 in the Enhanced Recovery After Surgery group and 216 in the pre–Enhanced Recovery After Surgery group. Both groups had similar baseline characteristics, but the Enhanced Recovery After Surgery group had significantly more subjects with intravenous drug use history (P

We fit an SARS-CoV-2 model to US data of COVID-19 cases and deaths. We conclude that the model is not structurally identifiable. We make the model identifiable by prefixing some of the parameters from external information. Practical identifiability of the model through Monte Carlo simulations reveals that two of the parameters may not be practically identifiable. With thus identified parameters, we set up an optimal control problem with social distancing and isolation as control variables. We investigate two scenarios: the controls are applied for the entire duration and the controls are applied only for the period of time. Our results show that if the controls are applied early in the epidemic, the reduction in the infected classes is at least an order of magnitude higher compared to when controls are applied with 2-week delay. Further, removing the controls before the pandemic ends leads to rebound of the infected classes.

While crop diversification has many benefits and is a stated government objective across the Eastern Gangetic Plains (EGP) of South Asia, the complexity of assessment has led to a rather limited understanding on the progress towards, and status of, smallholder crop diversification. Most studies focus on specific commodities or report as part of a singular index, use outdated secondary data, or implement highly localized studies, leading to broad generalisations and a lack of regional comparison. We collected representative primary data with more than 5000 households in 55 communities in Eastern Nepal, West Bengal (India) and Northwest Bangladesh to explore seasonally based diversification experiences and applied novel metrics to understand the nuanced status of farm diversification. While 66 crops were commercially grown across the region, only five crops and three crop families were widely grown (Poaceae, Malvaceae, and Brassicaceae). Non-cereal diversification across the region was limited (1.5 crops per household), though regional differentiation were evident particularly relating to livestock and off-farm activities, highlighting the importance of cross border studies. In terms of farmer's largest commercial plots, 20% of systems contained only rice, and 57% contained only rice/wheat/maize, with substantial regional diversity present. This raises concerns regarding the extent of commercially oriented high value and non-cereal diversification, alongside opportunities for diversification in the under-diversified pre-monsoon and monsoon seasons. Future promotional efforts may need to focus particularly on legumes to ensure the future sustainability and viability of farming systems.

IntroductionOver the last 5 years, the American Association for the Surgery of Trauma has developed grading scales for emergency general surgery (EGS) diseases. In a previous validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay, and mortality in skin and soft-tissue infections (STIs).MethodsThis multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics, and outcomes such as mortality, overall complications, and hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability.Results1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher Laboratory Risk Indicator for Necrotizing Fasciitis scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status, and hospital-level volume. Grade V disease was significantly associated with mortality as well.ConclusionThis validation effort demonstrates that grade IV and V STI are significantly predictive of complications, hospital length of stay, and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes.Level of evidencePrognostic/Epidemiologic retrospective multicenter trial, level III.

Climate Smart Agriculture (CSA) is an integrated approach that transforms the agri-food system and mitigates climate change. They connect the use of farming techniques in order to increase food productivity, Climate resilient practice, and decrease greenhouse gases. The main aim of this review is to demonstrate the typical interrelationship between climate and agriculture and get knowledge regarding this. In addition, focus on traditional agriculture along with its mitigating measures for climate agriculture. They approach collective development practices through the efforts of individuals in order to manage agriculture and the food system under climate change. Therefore, there is an increasing need for a strategic plan to balance agriculture and the food system.

Abstract Direct-seeded rice (DSR) seeds are often exposed to multiple environmental stresses in the field, leading to poor emergence, growth and productivity. Appropriate seed priming agents may help to overcome these challenges by ensuring uniform seed germination, and better seedling stand establishment. To examine the effectiveness of sodium selenite (Na-selenite), sodium selenate (Na-selenate), zinc oxide nanoparticles (ZnO-NPs), and their combinations as priming agents for DSR seeds, a controlled pot experiment followed by a field experiment over two consecutive years was conducted on a sandy clay loam soil (Inceptisol) in West Bengal, India. Priming with combinations of all priming agents had advantages over the hydro-priming treatment (control). All the combinations of the three priming agents resulted in the early emergence of seedlings with improved vigour. In the field experiment, all the combinations increased the plant chlorophyll, phenol and protein contents, leaf area index and duration, crop growth rate, uptake of nutrients (N, P, K, B, Zn and Si), and yield of DSR over the control. Our findings suggest that seed priming with the combination of ZnO-NPs, Na-selenite, and Na-selenate could be a viable option for the risk mitigation in DSR.

Abstract The objective of this study is to examine the association between neighborhood socioeconomic status (nSES) and baseline allostatic load (AL) and clinical trial endpoints in patients enrolled in the E1A11 therapeutic trial in multiple myeloma (MM). Study endpoints were symptom burden (pain, fatigue, and bother) at baseline and 5.5 months, non-completion of induction therapy, overall survival (OS) and progression-free survival (PFS). Multivariable logistic and Cox regression examined associations between nSES, AL and patient outcomes. A 1-unit increase in baseline AL was associated with greater odds of high fatigue at baseline (adjusted OR [95% CI] = 1.21 [1.08–1.36]) and a worse OS (adjusted hazard ratio, [95% CI] = 1.21 [1.06–1.37]). High nSES was associated with worse baseline bother (middle OR = 4.22 [1.11–16.09] and high 4.49 [1.16–17.43]) compared to low nSES. There was no association between AL or nSES and symptom burden at 5.5 months, non-completion of induction therapy or PFS. Additionally, there was no association between nSES and OS. AL may have utility as a predictive marker for OS among patients with MM and may allow individualization of treatment. Future studies should standardize and validate AL patients with MM.

The main aim of this study was to determine the best formulation of biscuit using roasted gram flour and roasted peanut flour with wheat flour. Bengal gram flour, peanut flour, and wheat flour were blended in the following ratios: sample A; 2.5:2.5:95, sample B; 5:5:90, sample C; 7.5:7.5:85, sample D; 10:10:80. Initial analysis showed that 7.5% roasted gram flour, 7.5% roasted peanut flour and 85% wheat flour can be blended to prepare quality biscuit. The protein content of biscuit ranged from 6.78% in wheat flour biscuit to 13.67% in composite flour biscuit. Fat (16.63%), crude fiber (1.96%), protein (13.67%), and ash content (2.805%) of composite flour biscuit was higher than that of wheat flour biscuit. The shelf life of the composite flour biscuit was studied for 90 days at 15-day interval. The initial and final values of acid value, peroxide value, and moisture were found to be 0.13 mg KOH/gm, 0.265 mg KOH/gm, 0.86 meq peroxide/kg fat, 1.904 meq peroxide/kg fat, and 4%, 5.1%, respectively.

Harnessing the potential yields of evergreen perennial crops like tea (Camellia sinensis L.) essentially requires the application of optimum doses of nutrients based on the soil test reports. In the present study, the soil pH, organic carbon (OC), available potassium as K2O (AK), and available sulphur (AS) of 7300 soil samples from 115 tea estates spread over the Dooars ranging from 88°52’E to 89°86’E longitude and 26°45’N to 27°00’N latitude of West Bengal, India have been documented. About 54% of soil samples were found within the optimum range of soil pH (4.50-5.50) for tea cultivation. The overall range of OC was found from 0.28% to 6.00% of which, 94% of the analyzed samples were within the range of satisfactory to excellent level of OC i.e. (>0.80% to 6.00%). Around 36.3% of soil samples were found to have high AK (>100 mg kg-1) but 37.1% of soils were found to have high AS content (>40 mg kg-1). The nutrient index status of soil pH was low in Dam Dim, Chulsa, Nagrakata, Binnaguri, and Jainti sub-districts. Soils from five sub-districts had a high nutrient index (2.47 to 2.83) for soil organic carbon. However, it existed in the medium index (1.69 and 2.22) for Dalgaon and Kalchini sub-districts. Only Nagrakata sub-district soil samples were in the high nutrient index (2.65) for AK. All analyzed samples showed a medium nutrient index (1.97 to 2.27) for AS. The result indicated that soil pH was significantly negatively correlated with soil OC (-0.336) and AK (-0.174). However, the soil OC was significantly positive correlated with AK (0.258) and AS (0.100). It could be concluded that a balanced fertilizer application would be needed as a part of the soil improvement program through soil chemical tests for sustainable tea cultivation.

Pest infestation causes heavy loss to farmers; both in fields and in stores. This study evaluated the efficacy of biopesticides in management of potato tuber moths (PTM) under storage condition. The potato cultivars Khumal Seto-1, Janak Dev and MS-42.3 and biopesticides Bacillus thuringiensis, Acorus calamus, Azadirachta indica, Artemisia vulgaris were used at the rate of 5 g l−1, 2 g kg−1, 4 g kg−1 and 20 g kg−1 of potato tubers respectively; also, a control was set to compare the treatment effects. Tubers were coated with solution for Bacillus thuringiensis while for the remaining biopesticidial powder was dusted on tubers. The cv. Janak Dev had the lowest infestation points per tuber (8.13), emergence of PTM adults (19.77%), physiological loss in weight (26.03%), decay loss (17.89%) and tuber damage score (2.74). The biopesticide Acorus calamus had the least infestation points per tuber (2.56), infested eyes per tuber (0.17), emergence of PTM adults (1%), tuber damage index (2.24), physiological loss in weight (12.11%), decay loss (4%) and tuber damage score (1.36). Acorus calamus had reduced larval mining by 88% and eventually had reduced decay loss by 93% as compared to control. The parameters relating to damage indicated that the cv. Janak Dev was least susceptible among the tested cultivars and Acorus calamus provided the best protection against damage caused by potato tuber moth.

Objective: The goal of this study was to partner with community organizations to understand the research experiences of communities who speak languages other than English (LOE). Methods: We conducted semi-structured qualitative interviews in Spanish, Nepali, Mandarin, French, or Kizigua with LOE community members and community leaders who completed recruitment and data collection. Audio-recordings of the interviews were transcribed and translated. We conducted qualitative coding using a mixed deductive-inductive analysis approach and thematic analyses using three rounds of affinity clustering. This study occurred in partnership with an established community-academic collaboration. Results: Thirty community members and six community leaders were interviewed. 83% of LOE participants were born outside of the US and most participants (63%) had never participated in a prior research study. Six themes emerged from this work. Many participants did not understand the concept of research, but those that did thought that inclusion of LOE communities is critical for equity. Even when research was understood as a concept, it was often inaccessible to LOE individuals, particularly because of the lack of language services. When LOE participants engaged in research, they did not always understand their participation. Participants thought that improving research trust was essential and recommended partnering with community organizations and disseminating research results to the community. Conclusion: This study's results can serve as an important foundation for researchers seeking to include LOE communities in future research to be more inclusive and scientifically rigorous. [ABSTRACT FROM AUTHOR]

Large cardamom is one of the most important spices that can significantly contribute to the economical farming in the country of Nepal. It is grown in Nepal and north-eastern states of India which provide suitable agroclimatic growing conditions of high humidity, ambient temperature and high rainfall. Meeting the demand for high quality plants and yield of cardamom is challenging with traditional methods of propagation. The present study has used the plant tissue culture technique to produce high quality plants. In this regard, MS media with three different hormonal combinations were used for the development protocol for 8 weeks. Shoot length, root length, shoot number and root number were assessed at intervals. The best protocol for growth was MS media with 1 mg/L BAP + 0.5 mg/L IBA for the Ramsey variety, with no significant difference for Golsai, Dambarsai, or Sikkimae varieties. Similarly, the acclimatization and field transfer study was done. The use of any substrate composition in ratio of coco peat: soil 1:2; moss: coco peat 1:2 and sawdust: coco peat 1:2 enables transfer of healthy plants to the field. The results indicate that the varieties respond differently to the micropropagation process and to hormone concentrations indicated by differing root and shoot production. The protocol of 1mg/L BAP and 0.5mg/L IBA could be used for the Ramsai while optimal shoot production for Golsai and Sikkimae should be at 0.5mg/L and 5mg/L for shoot production. All varieties showed optimal root production at 0mg/L BAP and 0.5mg/L IBA. This study sheds light on the different responsiveness of varieties to tissue culture and hormone concentrations for both root and shoot development in micropropagation.

While numerous studies have documented the benefits of conservation agriculture (CA) in South Asia, most focus on favorable environments where farmers have reliable access to energy supporting irrigation and inputs. The performance of CA in South Asia’s under-developed coastal environments is comparatively understudied. In these environments, farmers are increasingly interested in growing a second crop to meet food security and income generation objectives in rotation following the predominant monsoon season rice crop, though labor, energy costs, and investment constraints limit their ability to do so. We hypothesized that rotating rice (Oryza sativa) with maize (Zea mays) using conservation agriculture, or CA (i.e., strip-tilled maize followed by unpuddled transplanted rice), or seasonally alternating tillage (SAT, i.e., strip-tilled maize followed by fully-tilled, puddled rice with residues retained across rotations) would reduce costs and energy use, increase energy-use efficiency, and reduce yield-scaled CO2-eq emissions (YSE) and total global warming potential (GWP), compared to farmers’ own practices (FP) and conventional full-tillage (CT) under the same rotation in Bangladesh’s coastal region. Starting with winter maize followed by summer rice, we evaluated four tillage and crop establishment treatments in farmer-managed experiments in partially irrigated and rainfed environments over three years in 35 farmer’s fields across Bangladesh’s coastal districts. Treatments included FP, CT, complete CA, and SAT under a rice-maize rotation. Across years, the full suite of CA practices and SAT were significantly more energy-efficient and energy-productive than FP or CT. The order of YSE in rice was CA< CT or FP < SAT while in maize, it was CA or SAT < FP < CT. Across environments, CA and SAT resulted in 15-18% higher yield at the cropping systems level (maize and rice yields combined) and 26-40% less manual labor than CT or FP. CA and SAT also reduced by 1-12% and 33-35% total production costs respective to CT and FP. This was associated with 13-17% greater grain energy output in CA and SAT, and 2-18% lower YSE, compared to CT or FP. While our data suggest that both CA and SAT can result in a range of positive agronomic, economic, and environmental outcomes compared to FP or CT, post-trial surveys and discussions with farmers revealed a strong practical aversion to use of the full suite of CA practices and preference for adapted practices due to logistical constraints in negotiating the hire of laborers for unpuddled manual transplanting.

Abstract Purpose Pericardiectomy has traditionally carried relatively high perioperative mortality and morbidity, with few published reports of intermediate- and long- term outcomes. We investigated our 15-year experience performing pericardiectomy at our institution. Methods Retrospective study of all patients who underwent pericardiectomy at our institution between 2005 and 2019. Baseline demographics, intraoperative details, and postoperative outcomes including long-term survival were analyzed. Results Sixty-three patients were included in the study. 66.7% of subjects underwent isolated pericardiectomy while 33.3% underwent pericardiectomy concomitantly with another cardiac surgical procedure. The most common indications for pericardiectomy were constrictive (79.4%) and hemorrhagic (9.5%) pericarditis. Preoperatively, 76.2% of patients were New York Heart Association class II and III, while postoperatively, 71.4% were class I and II. One-, three-, five-, and ten- year overall mortality was 9.5, 14.3, 20.6, and 25.4%, respectively. Overall pericarditis recurrence rate was 4.8%. Conclusion Pericardiectomy carries relatively high overall mortality rates, which likely reflects underlying disease etiology and comorbidities. Patients with prior cardiac intervention, history of dialysis, and immunocompromised state are associated with worse outcomes.

Abstract There is a paucity of data describing the effect of time interval between diagnosis and surgery for Acute Type A Aortic Dissection. We describe our 8-year experience and investigate the impact of time interval between symptom onset, diagnosis and surgery on outcomes. Retrospective single-center study utilizing our Society of Thoracic Surgeons registry and patient records. Subjects were grouped by time interval between radiographic diagnosis and surgical treatment: Group A (0–4 h), Group B (4.1–8 h), Group C (8.1–12 h), and Group D (12.1 + h). Data were analyzed to identify factors associated with mortality and outcomes. 164 patients were included. Overall mortality was 21.3%. Group C had the greatest intervals between symptom onset to diagnosis to surgery, and also the highest mortality (66.7%). Preoperative tamponade, cardiac arrest, malperfusion, elevated creatinine, cardiopulmonary bypass time, and blood transfusions were associated with increased mortality, while distance of referring hospital was not. Time intervals between symptom onset, diagnosis and surgery have a significant effect on mortality. Surgery performed 8–12 h after diagnosis carries the highest mortality, which may be exacerbated by longer interval since symptom onset. Time-dependent effects should be considered when determining optimal strategy especially if inter-facility transfer is necessary.

Abstract Early admission to the neurosciences intensive care unit (NSICU) is associated with improved patient outcomes. Natural language processing offers new possibilities for mining free text in electronic health record data. We sought to develop a machine learning model using both tabular and free text data to identify patients requiring NSICU admission shortly after arrival to the emergency department (ED). We conducted a single-center, retrospective cohort study of adult patients at the Mount Sinai Hospital, an academic medical center in New York City. All patients presenting to our institutional ED between January 2014 and December 2018 were included. Structured (tabular) demographic, clinical, bed movement record data, and free text data from triage notes were extracted from our institutional data warehouse. A machine learning model was trained to predict likelihood of NSICU admission at 30 min from arrival to the ED. We identified 412,858 patients presenting to the ED over the study period, of whom 1900 (0.5%) were admitted to the NSICU. The daily median number of ED presentations was 231 (IQR 200–256) and the median time from ED presentation to the decision for NSICU admission was 169 min (IQR 80–324). A model trained only with text data had an area under the receiver-operating curve (AUC) of 0.90 (95% confidence interval (CI) 0.87–0.91). A structured data-only model had an AUC of 0.92 (95% CI 0.91–0.94). A combined model trained on structured and text data had an AUC of 0.93 (95% CI 0.92–0.95). At a false positive rate of 1:100 (99% specificity), the combined model was 58% sensitive for identifying NSICU admission. A machine learning model using structured and free text data can predict NSICU admission soon after ED arrival. This may potentially improve ED and NSICU resource allocation. Further studies should validate our findings.