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A multistate model of frailty progression after severe infections in adults >=65 years in England: a matched-cohort study

Background Evidence on frailty progression following severe infections is limited. We compared rates of transition to greater frailty or death between adults with and without severe infection in England. Methods We conducted a matched-cohort study among adults aged [≥]65 years (1,452,117: median age 76 years, 45% male) in Clinical Practice Research Datalink Aurum (2006-2019). Adults with severe infection (hospitalised primarily due to infection) were matched on calendar time to individuals without severe infection on age, sex, and primary care practice. The admission date was used as index date and same was assigned to matched unexposed adults. We measured frailty using Electronic Frailty Index, a proportion of 36 health deficits in validated categories (Fit 0-0.12, Mild >0.12-0.24, Moderate >0.24-0.36, Severe >0.36). In a time-varying Markov multistate model, we focused on forward transitions from baseline or intermediate frailty states to higher states or death. For each transition, we used Cox regression to estimate cause-specific transition hazard ratios (HR) with 95% confidence intervals (CIs), comparing adults with and without severe infection. We adjusted for baseline frailty score, age, sex, deprivation, harmful alcohol use, smoking, and primary care infection history 5 years before index date. We estimated state occupancy probabilities, and expected length of stay (ELOS) in each state at year five among adults with and without severe infection. We explored effect modification by infection type. Results Across all transitions, severe infection was associated with higher adjusted hazards of transitioning to worsening frailty or death, HR, 95% CI: (fit to: mild[1.56, 1.54-1.58], moderate[2.51, 1.79-3.51], death[4.57, 4.50-4.65]; mild to: moderate[1.52, 1.50-1.53], severe[1.90, 1.43-2.52], death[2.67, 2.64-2.70]; moderate to: severe[1.40, 1.38-1.42], death[1.87, 1.85-1.90]; severe to death[1.48, 1.46-1.50]). Transition hazard ratios were strongest for lower respiratory tract infections, followed by sepsis, urinary tract infections, meningitis/encephalitis, gastroenteritis, and skin and soft tissue infections. At five years, adults with severe infection had higher probabilities of transitioning to greater frailty or death across all transitions and lower ELOS in each frailty state than those without severe infection. Interpretation Severe infections may accelerate frailty deterioration in older age. Prevention through vaccination, early detection, and prompt management may help mitigate this decline.

DeepForestVisionV2: Ecology-Driven Taxonomy Expansion for Camera-Trap Monitoring in African Tropical Forests

Camera-trap monitoring in African tropical forests increasingly extends beyond closed-canopy interiors to riverbanks, clearings, and park edges. Among available open tools for African forest camera-trap classification, DeepForestVision is the only one providing a matched offline workflow for both photographs and videos, and previous work showed that it outperformed other available baselines on a comparable benchmark. However, it was designed for closed-canopy, ground-level forest interiors and uses a 35-class prediction space that becomes too coarse when deployments encounter arboreal primates, birds, semi-aquatic taxa, or human-associated confounders such as livestock. We present DeepForestVisionV2, an ecology-driven expansion from 35 to 64 prediction classes (61 animal classes plus human, vehicle, and blank) designed to address three recurrent deployment gradients: vertical stratification, scene openness, and anthropogenic interfaces. DeepForestVisionV2 retains the same offline workflow and is trained on 1,535,010 photographs and 243,354 videos from multi-country African tropical-forest projects. Evaluation combines a cross-country cropped-photo validation set, used to assess robustness across sites and camera-trap settings, with three held-out Uganda video benchmarks spanning the targeted gradients. On the validation set, DeepForestVisionV2 reaches 0.86 accuracy, 0.82 macro-F1, and 0.81 balanced accuracy. On the deployment benchmarks, it preserves or improves baseline accuracy despite its harder classification task, while increasing the number of identified taxa from 22 to 29 in forest-interior videos and from 4 to 9 at riverbanks. In the park-edge use case, it raises accuracy from 0.62 to 0.86 and reduces false alarms from 11 to 0. These results show that DeepForestVisionV2 materially improves field utility while preserving robustness across sites, habitats, and camera-trap settings.