Add RealICU synthetic sample and Croissant metadata

README.md

@@ -0,0 +1,214 @@
+---
+pretty_name: RealICU
+license: other
+license_name: physionet-credentialed-health-data-license-1.5.0
+license_link: https://physionet.org/about/licenses/physionet-credentialed-health-data-license-150/
+language:
+- en
+tags:
+- medical
+- clinical
+- intensive-care
+- electronic-health-records
+- benchmark
+- llm-agents
+size_categories:
+- n<1K
+configs:
+- config_name: icu_stays
+  data_files: trajectories/icu_stay.parquet
+- config_name: events
+  data_files: trajectories/events.parquet
+---
+
+# RealICU
+
+[Paper](https://arxiv.org/abs/2605.13542) · [Code](https://github.com/chengzhi-leo/RealICU-Bench) · [Project page](https://chengzhi-leo.github.io/RealICU-Bench/)
+
+> [!IMPORTANT]
+> **This repository contains a synthetic sample, not the benchmark data.** The files here describe 5
+> synthetic patients in exactly the same file layout, Parquet schemas, and label JSON format as the full
+> dataset. They contain no patient data: every identifier, date, measurement, note, and label was generated
+> from hand-written scenarios, not from MIMIC records. Use the sample to inspect the format and to test data
+> pipelines; do not use it to evaluate models.
+>
+> **The full dataset is distributed through PhysioNet.** RealICU is derived from MIMIC-IV, so it is released
+> under PhysioNet credentialed access: a credentialed PhysioNet account, completed human-subjects research
+> training (CITI), and a signed data use agreement. It has been submitted to PhysioNet as
+> *MIMIC-IV-Ext-RealICU* and is under review. The PhysioNet link will be added here once it is published.
+
+RealICU is a benchmark for evaluating language models and agents on ICU decision support. For each
+evaluation window, it provides clinical events for constructing model inputs and aligned reference labels
+for four tasks: patient status, acute problems, recommended actions, and red flag actions.
+
+The full dataset (version 1.0.0) contains 94 MIMIC-derived patients, one target ICU stay per patient, and
+2,989,158 clinical events. The trajectories include available records before, during, and after the target
+ICU stay.
+
+| Annotation set | Reference source | Windows | Action ratings |
+| --- | --- | ---: | ---: |
+| RealICU-Gold | Paired physician consensus on Oracle candidates | 930 | 2,189 |
+| RealICU-Scale | Oracle, an LLM hindsight annotator | 11,862 | 25,387 |
+
+Gold and Scale share the same patients and have partially overlapping windows; Gold is not a window subset
+of Scale. Both are evaluation sets and should not be used as separate training and test cohorts. Windows
+generally span 30 minutes, with shorter intervals at the end of a stay when needed.
+
+## Synthetic sample in this repository
+
+| Content | Sample | Full dataset |
+| --- | ---: | ---: |
+| Patients (one target ICU stay each) | 5 | 94 |
+| Clinical events | 1,743 | 2,989,158 |
+| Gold windows / action ratings | 35 / 46 | 930 / 2,189 |
+| Scale windows / action ratings | 198 / 219 | 11,862 / 25,387 |
+
+The five synthetic stays cover septic shock, hypoxemic respiratory failure, diabetic ketoacidosis, upper
+gastrointestinal bleeding, and decompensated heart failure. They also reproduce the format's edge cases: a
+truncated final window, a Gold window with an unavailable patient-status label, a Scale window without
+acute-problem references, an `insufficient_data` window, an ICU readmission, and in-hospital deaths after
+ICU discharge. Synthetic identifiers start with 9 (for example `90000001_99000001`) and do not overlap
+MIMIC-IV identifier ranges.
+
+## Quick start
+
+The standalone loader requires Python 3.10 or later, `pandas`, and `pyarrow`:
+
+```bash
+python -m pip install pandas pyarrow huggingface_hub
+hf download leoshen/RealICU --repo-type dataset --local-dir realicu
+cd realicu
+```
+
+Load one Gold window:
+
+```python
+from loader import RealICULoader
+
+loader = RealICULoader(".", "gold", "90000001_99000001")
+sample = loader.load_window(
+    loader.window_indices[0],
+    icu_history_hours=None,
+    pre_icu_history_hours=48,
+    excluded_event_codes=("NOTE_DISCHARGESUMMARY", "META_DEATH"),
+)
+
+model_input = sample["input"]
+labels = sample["labels"]
+current_events = model_input["current_events"]
+references = labels["reference_labels"]
+availability = labels["label_availability"]
+
+print(current_events.head())
+if availability["patient_status"]:
+    print(references["patient_assessment"]["overall"]["label"])
+```
+
+Use `"scale"` instead of `"gold"` to read Oracle annotations. The loader reads a stay once; call
+`load_window` for any ID in `loader.window_indices`. These IDs may be nonconsecutive. List available stays
+with `pandas.read_parquet("trajectories/icu_stay.parquet")["stay_id"]`.
+
+Each sample has two parts:
+
+- `input`: sample and stay identifiers, actual window timestamps, and the three event tables below.
+- `labels`: the four tasks under `reference_labels`, plus `label_availability` indicating which references
+  can be used for evaluation.
+
+| Input event table | Included observations |
+| --- | --- |
+| `pre_icu_events` | Before target ICU admission, within the chosen pre-ICU lookback |
+| `history_events` | During the target ICU stay, before the window, within the chosen ICU lookback |
+| `current_events` | Within the actual half-open interval `[window_start_time, window_end_time)` |
+
+Both lookbacks and `excluded_event_codes` are required choices. Use a number of hours, `None` for all
+available history, or `0` for no history. The pre-ICU lookback is measured from ICU admission; the ICU
+lookback is measured from the window start. An empty tuple retains all event categories. The example's
+48-hour lookback and exclusions are illustrative, not benchmark defaults.
+
+The same example is available from the command line:
+
+```bash
+python loader.py --root . --label-set gold --stay-id 90000001_99000001 \
+  --window-index 0 --icu-history-hours all --pre-icu-history-hours 48 \
+  --excluded-event-codes NOTE_DISCHARGESUMMARY META_DEATH
+```
+
+The prediction and evaluation code in [RealICU-Bench](https://github.com/chengzhi-leo/RealICU-Bench) reads
+this layout directly; set `data.root` to the downloaded directory.
+
+## Tasks and reference labels
+
+The paths below are relative to `reference_labels`:
+
+| Task | JSON path | Reference content |
+| --- | --- | --- |
+| Patient Status | `patient_assessment.overall` | `stable`, `improving`, `deteriorating`, or `insufficient_data`, with a rationale |
+| Acute Problems | `patient_assessment.active_risks` | Active clinical problems or emerging risks, with supporting evidence |
+| Recommended Actions | `action_review.evaluations` | Recorded actions rated `best_practice`, `acceptable`, `potentially_harmful`, or `insufficient_data` |
+| Red Flag Actions | `action_review.red_flags` | Actions to avoid, with a rationale and supporting evidence |
+
+Actions rated `best_practice` or `acceptable` form the positive reference set for recommendation
+evaluation. Every retained action refers to an event within its assigned window. Numeric action and
+evidence IDs refer to `icu_event_index` within the same target stay.
+
+Check `label_availability` for each task before scoring. Its keys are `patient_status`, `active_risks`,
+`recommended_action`, and `red_flags`. A false value means the reference is unavailable. An unavailable
+patient-status label is stored as `unavailable`; this is not a clinical class. An available
+`insufficient_data` label remains a valid reference. An available empty list means no retained reference
+items, not a comprehensive finding that no clinical problems or contraindications exist.
+
+In the full dataset, Gold contains physician-consensus labels and selected items from Oracle candidates;
+its `rationale` and `key_evidence` were retained from Oracle. Scale labels and explanations are Oracle
+outputs. Annotations use retrospective context, so evidence may refer to events before or after the
+observation window, or to pre-ICU history and discharge summaries.
+
+## Files and alignment
+
+```text
+README.md
+loader.py
+croissant.jsonld
+trajectories/
+    events.parquet
+    icu_stay.parquet
+gold/labels/<stay_id>.json
+scale/labels/<stay_id>.json
+```
+
+`events.parquet` contains one clinical event per row. `icu_stay.parquet` contains one target ICU stay per
+row, including admission/discharge times, trajectory bounds, event counts, and outcomes. Join trajectories
+and annotations using `stay_id`, formatted as `<subject_id>_<icu_stay_id>`. An event's own `icu_stay_id`
+may refer to a different encounter; use the added `stay_id` for joins.
+
+Each annotation set has one JSON file per target stay. The file contains stay identifiers,
+`trajectory_metadata`, and a `window_outputs` list. Each window has `sample_id`, `window_index`,
+`window_key`, `window_metadata`, `reference_labels`, and `label_availability`. Use the actual timestamps in
+`window_metadata` to align events; `window_key` gives nominal hours relative to ICU admission.
+
+| Event identifier | Meaning |
+| --- | --- |
+| `event_idx`, `source_event_index` | Original source event identifier |
+| `event_index` | Zero-based position in the published trajectory |
+| `icu_event_index` | Zero-based chronological event ID within the target ICU stay; null outside it |
+
+`croissant.jsonld` provides Croissant 1.1 metadata with field descriptions and Responsible AI documentation.
+Its record sets expose ICU stays, events, windows, action evaluations, active risks, and red flags; each
+label record set covers Gold and Scale, distinguished by `label_set`. Its file URLs point to this
+repository, so it can be loaded directly with `mlcroissant`.
+
+## Evaluation input construction
+
+Keep reference answers and retrospective outcomes out of model inputs. For Action Recommendation, the paper
+removes recorded actions from the current window before prediction to prevent answer leakage (Appendix
+A.1); the loader does not perform this masking automatically.
+
+## Citation
+
+```bibtex
+@article{shen2026realicu,
+  title={RealICU: Do LLM Agents Understand Long-Context ICU Data? A Benchmark Beyond Behavior Imitation},
+  author={Shen, Chengzhi and Shen, Weixiang and Susetzky, Tobias and Chen, Chen (Cherise) and Li, Jun and Liu, Yuyuan and Zhang, Xuepeng and Gong, Zhenyu and Rueckert, Daniel and Pan, Jiazhen},
+  journal={arXiv preprint arXiv:2605.13542},
+  year={2026}
+}
+```

croissant.jsonld

@@ -0,0 +1,1469 @@
+{
+  "@context": {
+    "@language": "en",
+    "@vocab": "https://schema.org/",
+    "sc": "https://schema.org/",
+    "cr": "http://mlcommons.org/croissant/",
+    "rai": "http://mlcommons.org/croissant/RAI/",
+    "prov": "http://www.w3.org/ns/prov#",
+    "dct": "http://purl.org/dc/terms/",
+    "citeAs": "cr:citeAs",
+    "column": "cr:column",
+    "conformsTo": "dct:conformsTo",
+    "containedIn": "cr:containedIn",
+    "data": {
+      "@id": "cr:data",
+      "@type": "@json"
+    },
+    "dataType": {
+      "@id": "cr:dataType",
+      "@type": "@vocab"
+    },
+    "equivalentProperty": "cr:equivalentProperty",
+    "examples": {
+      "@id": "cr:examples",
+      "@type": "@json"
+    },
+    "extract": "cr:extract",
+    "field": "cr:field",
+    "fileObject": "cr:fileObject",
+    "fileProperty": "cr:fileProperty",
+    "fileSet": "cr:fileSet",
+    "format": "cr:format",
+    "includes": "cr:includes",
+    "isArray": "cr:isArray",
+    "isLiveDataset": "cr:isLiveDataset",
+    "jsonPath": "cr:jsonPath",
+    "key": "cr:key",
+    "md5": "cr:md5",
+    "parentField": "cr:parentField",
+    "path": "cr:path",
+    "recordSet": "cr:recordSet",
+    "references": "cr:references",
+    "regex": "cr:regex",
+    "repeated": "cr:repeated",
+    "replace": "cr:replace",
+    "samplingRate": "cr:samplingRate",
+    "separator": "cr:separator",
+    "source": "cr:source",
+    "subField": "cr:subField",
+    "transform": "cr:transform"
+  },
+  "@type": "sc:Dataset",
+  "conformsTo": [
+    "http://mlcommons.org/croissant/1.1",
+    "http://mlcommons.org/croissant/RAI/1.0"
+  ],
+  "name": "MIMIC-IV-Ext-RealICU",
+  "alternateName": [
+    "RealICU"
+  ],
+  "description": "RealICU is a benchmark for evaluating language models and agents on ICU decision support. It contains MIMIC-IV-derived clinical event trajectories for 94 patients, one target ICU stay per patient and 2,989,158 events, and two annotation sets aligned to 30-minute evaluation windows for four tasks: Patient Status, Acute Problems, Recommended Actions, and Red Flag Actions. RealICU-Gold (930 windows, 2,189 action ratings) contains physician-consensus labels selected from Oracle candidates; RealICU-Scale (11,862 windows, 25,387 action ratings) contains labels from Oracle, a physician-validated LLM hindsight annotator. Both annotation sets are evaluation-only.",
+  "url": "https://huggingface.co/datasets/leoshen/RealICU",
+  "version": "1.0.0",
+  "datePublished": "2026-11-03",
+  "license": "https://physionet.org/about/licenses/physionet-credentialed-health-data-license-150/",
+  "conditionsOfAccess": "Credentialed access on PhysioNet: a credentialed PhysioNet account, completed human-subjects research training, and a signed data use agreement.",
+  "isAccessibleForFree": true,
+  "creator": [
+    {
+      "@type": "sc:Person",
+      "name": "Chengzhi Shen"
+    },
+    {
+      "@type": "sc:Person",
+      "name": "Weixiang Shen"
+    },
+    {
+      "@type": "sc:Person",
+      "name": "Tobias Susetzky"
+    },
+    {
+      "@type": "sc:Person",
+      "name": "Chen (Cherise) Chen"
+    },
+    {
+      "@type": "sc:Person",
+      "name": "Jun Li"
+    },
+    {
+      "@type": "sc:Person",
+      "name": "Yuyuan Liu"
+    },
+    {
+      "@type": "sc:Person",
+      "name": "Xuepeng Zhang"
+    },
+    {
+      "@type": "sc:Person",
+      "name": "Zhenyu Gong"
+    },
+    {
+      "@type": "sc:Person",
+      "name": "Daniel Rueckert"
+    },
+    {
+      "@type": "sc:Person",
+      "name": "Jiazhen Pan"
+    }
+  ],
+  "citeAs": "@article{shen2026realicu,\n  title={RealICU: Do LLM Agents Understand Long-Context ICU Data? A Benchmark Beyond Behavior Imitation},\n  author={Shen, Chengzhi and Shen, Weixiang and Susetzky, Tobias and Chen, Chen (Cherise) and Li, Jun and Liu, Yuyuan and Zhang, Xuepeng and Gong, Zhenyu and Rueckert, Daniel and Pan, Jiazhen},\n  journal={arXiv preprint arXiv:2605.13542},\n  year={2026}\n}",
+  "keywords": [
+    "intensive care",
+    "clinical decision support",
+    "electronic health records",
+    "LLM agents",
+    "benchmark",
+    "MIMIC-IV"
+  ],
+  "inLanguage": "en",
+  "rai:dataLimitations": "The dataset is derived exclusively from the MIMIC-IV cohort, meaning the demographic and clinical care-pattern distributions are limited to a single-center academic medical center in the United States. These patterns may not generalize to ICUs with different staffing models, documentation conventions, or international healthcare standards. Additionally, the current version focuses on textual and numerical data, omitting high-fidelity multimodal signals like bedside imaging or raw waveforms. This dataset is explicitly not recommended for training autonomous clinical decision systems; it is designed as a benchmark for evaluative \"co-pilot\" assistance only.",
+  "rai:dataBiases": "Known biases include institutional and geographic bias inherent to the Beth Israel Deaconess Medical Center's patient population. There is a potential labeling bias in the RealICU-Scale subset; while validated, the \"Oracle\" LLM hindsight evaluator showed minor granularity mismatches compared to human physicians, such as favoring broad descriptors over specific complications. Furthermore, the dataset reflects decisions made under the specific clinical heuristics of the source institution's staff, which may influence \"acceptable\" action labels.",
+  "rai:personalSensitiveInformation": "The dataset contains sensitive health and medical data. Categories include: Gender, Age, Language, Marital Status, Insurance Status, Ethnicity, Health or medical data (including vital signs, laboratory results, medications, and clinical notes), Geography (implied via source institution)",
+  "rai:dataUseCases": "The dataset is intended to measure sequential clinical reasoning and bedside situational awareness. It represents the ability of an agent to integrate evolving information streams into structured reassessments. Validated Use Cases: Patient status assessment (improving/stable/deteriorating), Active clinical problem identification, Short-term treatment recommendation, Safety-critical \"Red Flag\" action avoidance; Validation Gaps: These use cases have not been validated for real-world bedside deployment or for predicting outcomes beyond the specific 30-minute windowing logic used in the benchmark.",
+  "rai:dataSocialImpact": "Positive Impact: RealICU provides a safety-first methodology for evaluating clinical AI, helping to identify \"recall-safety tradeoffs\" and \"premature anchoring\" before such systems reach patients.\nNegative Impact/Risks: There is a risk of over-reliance if developers optimize solely for \"Hit@k\" metrics while ignoring the Harmful Recommendation Rate (HRR).\nMitigations: The benchmark includes explicit Red Flag labels and HRR metrics to penalize unsafe logic. The benchmark is released \"test-only\" to prevent data leakage into LLM training sets.",
+  "rai:hasSyntheticData": true,
+  "prov:wasDerivedFrom": [
+    {
+      "@id": "https://physionet.org/content/mimiciv/2.2/",
+      "prov:label": "MIMIC-IV",
+      "sc:license": "physionet-credentialed-health-data-license-1.5.0"
+    },
+    {
+      "@id": "https://physionet.org/content/mimic-iv-ed/2.2/",
+      "prov:label": "MIMIC-IV-ED",
+      "sc:license": "physionet-credentialed-health-data-license-1.5.0"
+    },
+    {
+      "@id": "https://physionet.org/content/mimic-iv-echo/1.0/",
+      "prov:label": "MIMIC-IV-ECHO",
+      "sc:license": "physionet-credentialed-health-data-license-1.5.0"
+    },
+    {
+      "@id": "https://www.physionet.org/content/mimic-iv-note/2.2/",
+      "prov:label": "MIMIC-IV-NOTE",
+      "sc:license": "physionet-credentialed-health-data-license-1.5.0"
+    },
+    {
+      "@id": "https://physionet.org/content/mimic-cxr-jpg/2.1.0/",
+      "prov:label": "MIMIC-CXR-JPG",
+      "sc:license": "physionet-credentialed-health-data-license-1.5.0"
+    }
+  ],
+  "prov:wasGeneratedBy": [
+    {
+      "@type": "prov:Activity",
+      "prov:type": {
+        "@id": "https://www.wikidata.org/wiki/Q5227332"
+      },
+      "prov:label": "Preprocessing",
+      "sc:description": "Merging multiple MIMIC modules into a holistic timeline. Numerical data was textualized with units; categorical codes (ICD/GSN) were resolved to full-text descriptions."
+    },
+    {
+      "@type": "prov:Activity",
+      "prov:type": {
+        "@id": "https://www.wikidata.org/wiki/Q109719325"
+      },
+      "prov:label": "Semi-automated annotation",
+      "sc:description": "RealICU-Gold: Independent labeling by 5 senior ICU physicians with a cross-validation check for consensus. RealICU-Scale: Synthetic annotation using Oracle, a physician-validated LLM-based hindsight evaluator."
+    }
+  ],
+  "distribution": [
+    {
+      "@type": "cr:FileObject",
+      "@id": "repo",
+      "name": "repo",
+      "description": "The Hugging Face git repository that hosts the dataset files.",
+      "contentUrl": "https://huggingface.co/datasets/leoshen/RealICU",
+      "encodingFormat": "git+https",
+      "sha256": "https://github.com/mlcommons/croissant/issues/80"
+    },
+    {
+      "@type": "cr:FileObject",
+      "@id": "readme",
+      "name": "README.md",
+      "description": "Dataset documentation: tasks, label semantics, file alignment, and evaluation guidance.",
+      "contentUrl": "https://huggingface.co/datasets/leoshen/RealICU/resolve/main/README.md",
+      "encodingFormat": "text/markdown",
+      "contentSize": "10240 B",
+      "sha256": "f4887d0deadf93f54f3b8aeb7a4f471f5fae32dd0cb705c41152fe5ae32a4f54"
+    },
+    {
+      "@type": "cr:FileObject",
+      "@id": "loader",
+      "name": "loader.py",
+      "description": "Standalone Python loader that aligns window events with reference labels.",
+      "contentUrl": "https://huggingface.co/datasets/leoshen/RealICU/resolve/main/loader.py",
+      "encodingFormat": "text/x-python",
+      "contentSize": "6491 B",
+      "sha256": "e1dac91cfeb237ad0e396f832b6c13281f61f7224e990e77f8c69d182697ca1e"
+    },
+    {
+      "@type": "cr:FileObject",
+      "@id": "icu_stays-parquet",
+      "name": "trajectories/icu_stay.parquet",
+      "description": "One target ICU stay per row with admission and discharge times, trajectory bounds, event counts, and outcomes.",
+      "contentUrl": "https://huggingface.co/datasets/leoshen/RealICU/resolve/main/trajectories/icu_stay.parquet",
+      "encodingFormat": "application/x-parquet",
+      "contentSize": "12883 B",
+      "sha256": "908e974eb70772cfa0712cff50def7e0feb5394542cb685c207edc8c4b9641cc"
+    },
+    {
+      "@type": "cr:FileObject",
+      "@id": "events-parquet",
+      "name": "trajectories/events.parquet",
+      "description": "One clinical event per row across each patient's published trajectory, sorted by time and source event index within a stay.",
+      "contentUrl": "https://huggingface.co/datasets/leoshen/RealICU/resolve/main/trajectories/events.parquet",
+      "encodingFormat": "application/x-parquet",
+      "contentSize": "69778 B",
+      "sha256": "a72f1b94070651eb64f7abeb87ec8fa82da4b493ac46f0a8336fccfb6fbe2a09"
+    },
+    {
+      "@type": "cr:FileSet",
+      "@id": "labels-windows",
+      "name": "labels-windows",
+      "description": "Gold and Scale label files, one JSON file per target stay, read for the windows record set.",
+      "encodingFormat": "application/json",
+      "includes": [
+        "gold/labels/*.json",
+        "scale/labels/*.json"
+      ],
+      "containedIn": {
+        "@id": "repo"
+      }
+    },
+    {
+      "@type": "cr:FileSet",
+      "@id": "labels-action_evaluations",
+      "name": "labels-action_evaluations",
+      "description": "Gold and Scale label files, one JSON file per target stay, read for the action_evaluations record set.",
+      "encodingFormat": "application/json",
+      "includes": [
+        "gold/labels/*.json",
+        "scale/labels/*.json"
+      ],
+      "containedIn": {
+        "@id": "repo"
+      }
+    },
+    {
+      "@type": "cr:FileSet",
+      "@id": "labels-active_risks",
+      "name": "labels-active_risks",
+      "description": "Gold and Scale label files, one JSON file per target stay, read for the active_risks record set.",
+      "encodingFormat": "application/json",
+      "includes": [
+        "gold/labels/*.json",
+        "scale/labels/*.json"
+      ],
+      "containedIn": {
+        "@id": "repo"
+      }
+    },
+    {
+      "@type": "cr:FileSet",
+      "@id": "labels-red_flags",
+      "name": "labels-red_flags",
+      "description": "Gold and Scale label files, one JSON file per target stay, read for the red_flags record set.",
+      "encodingFormat": "application/json",
+      "includes": [
+        "gold/labels/*.json",
+        "scale/labels/*.json"
+      ],
+      "containedIn": {
+        "@id": "repo"
+      }
+    }
+  ],
+  "recordSet": [
+    {
+      "@type": "cr:RecordSet",
+      "@id": "icu_stays",
+      "name": "icu_stays",
+      "description": "One target ICU stay per row with admission and discharge times, trajectory bounds, event counts, and outcomes.",
+      "key": [
+        {
+          "@id": "icu_stays/stay_id"
+        }
+      ],
+      "field": [
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/subject_id",
+          "name": "subject_id",
+          "description": "MIMIC-IV patient identifier.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "subject_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/icu_stay_id",
+          "name": "icu_stay_id",
+          "description": "MIMIC-IV ICU stay identifier of the target stay.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "icu_stay_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/enter_time",
+          "name": "enter_time",
+          "description": "ICU admission time (shifted MIMIC time).",
+          "dataType": "sc:DateTime",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "enter_time"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/leave_time",
+          "name": "leave_time",
+          "description": "ICU discharge time.",
+          "dataType": "sc:DateTime",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "leave_time"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/enter_event_idx",
+          "name": "enter_event_idx",
+          "description": "Source event index of the ICU admission event.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "enter_event_idx"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/death_time",
+          "name": "death_time",
+          "description": "Time of death; null for patients without a recorded death.",
+          "dataType": "sc:DateTime",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "death_time"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/death_event_idx",
+          "name": "death_event_idx",
+          "description": "Source event index of the death event; null without a recorded death.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "death_event_idx"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/birth_time",
+          "name": "birth_time",
+          "description": "Shifted birth time used to derive age.",
+          "dataType": "sc:DateTime",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "birth_time"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/birth_event_idx",
+          "name": "birth_event_idx",
+          "description": "Source event index of the birth event.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "birth_event_idx"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/min_event_idx",
+          "name": "min_event_idx",
+          "description": "First source event index of the published trajectory.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "min_event_idx"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/max_event_idx",
+          "name": "max_event_idx",
+          "description": "Last source event index of the published trajectory.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "max_event_idx"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/n_events",
+          "name": "n_events",
+          "description": "Number of events in the published trajectory.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "n_events"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/icu_duration_hours",
+          "name": "icu_duration_hours",
+          "description": "Whole hours between ICU admission and discharge.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "icu_duration_hours"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/survived",
+          "name": "survived",
+          "description": "Whether the patient survived the target ICU stay.",
+          "dataType": "sc:Boolean",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "survived"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/readm_time",
+          "name": "readm_time",
+          "description": "Time of ICU readmission; null without readmission.",
+          "dataType": "sc:DateTime",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "readm_time"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/readm_event_idx",
+          "name": "readm_event_idx",
+          "description": "Source event index of the readmission; null without readmission.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "readm_event_idx"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/readm_duration_hours",
+          "name": "readm_duration_hours",
+          "description": "Hours from discharge to ICU readmission; null without readmission.",
+          "dataType": "sc:Float",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "readm_duration_hours"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/shard_idx",
+          "name": "shard_idx",
+          "description": "Shard of the upstream preprocessing pipeline; not used by RealICU.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "shard_idx"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/split",
+          "name": "split",
+          "description": "Split inherited from upstream preprocessing; not a RealICU benchmark split.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "split"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "icu_stays/stay_id",
+          "name": "stay_id",
+          "description": "Target stay key formatted as <subject_id>_<icu_stay_id>; joins trajectories and labels.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileObject": {
+              "@id": "icu_stays-parquet"
+            },
+            "extract": {
+              "column": "stay_id"
+            }
+          }
+        }
+      ]
+    },
+    {
+      "@type": "cr:RecordSet",
+      "@id": "events",
+      "name": "events",
+      "description": "One clinical event per row across each patient's published trajectory, sorted by time and source event index within a stay.",
+      "key": [
+        {
+          "@id": "events/stay_id"
+        },
+        {
+          "@id": "events/event_index"
+        }
+      ],
+      "field": [
+        {
+          "@type": "cr:Field",
+          "@id": "events/subject_id",
+          "name": "subject_id",
+          "description": "MIMIC-IV patient identifier.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "subject_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/time",
+          "name": "time",
+          "description": "Event time (shifted MIMIC time).",
+          "dataType": "sc:DateTime",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "time"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/code",
+          "name": "code",
+          "description": "Harmonized event category, for example VITALS, LAB_TEST, DRUG_START, or NOTE_RADIOLOGYREPORT.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "code"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/numeric_value",
+          "name": "numeric_value",
+          "description": "Numeric measurement, when available.",
+          "dataType": "sc:Float",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "numeric_value"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/event_idx",
+          "name": "event_idx",
+          "description": "Original source event identifier; equal to source_event_index.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "event_idx"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/code_specifics",
+          "name": "code_specifics",
+          "description": "Event description, such as the measurement, drug, or procedure name.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "code_specifics"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/ed_stay_id",
+          "name": "ed_stay_id",
+          "description": "MIMIC-IV-ED stay identifier of the event's own encounter, when applicable.",
+          "dataType": "sc:Float",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "ed_stay_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/end",
+          "name": "end",
+          "description": "End time for interval events, when applicable.",
+          "dataType": "sc:DateTime",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "end"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/hosp_stay_id",
+          "name": "hosp_stay_id",
+          "description": "MIMIC-IV hospital admission identifier of the event's own encounter, when applicable.",
+          "dataType": "sc:Float",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "hosp_stay_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/icu_stay_id",
+          "name": "icu_stay_id",
+          "description": "ICU stay identifier of the event's own encounter; may differ from the target stay.",
+          "dataType": "sc:Float",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "icu_stay_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/orig_code",
+          "name": "orig_code",
+          "description": "Original source code, such as an ICD or GSN code, when applicable.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "orig_code"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/orig_coding_system",
+          "name": "orig_coding_system",
+          "description": "Coding system of orig_code, such as ICD9, ICD10, or GSN.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "orig_coding_system"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/seq_num",
+          "name": "seq_num",
+          "description": "Source sequence number, such as diagnosis priority, when applicable.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "seq_num"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/table",
+          "name": "table",
+          "description": "Source MIMIC module and table, such as icu/chartevents or note/radiology.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "table"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/text_value",
+          "name": "text_value",
+          "description": "Textual value, including note text and record references.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "text_value"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/text_value_hash",
+          "name": "text_value_hash",
+          "description": "Upstream hash of text_value; null when text_value is absent.",
+          "dataType": "sc:Float",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "text_value_hash"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/age",
+          "name": "age",
+          "description": "Patient age in years at the event.",
+          "dataType": "sc:Float",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "age"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/time_delta_prev",
+          "name": "time_delta_prev",
+          "description": "Hours since the previous event in the trajectory.",
+          "dataType": "sc:Float",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "time_delta_prev"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/stay_id",
+          "name": "stay_id",
+          "description": "Target stay key formatted as <subject_id>_<icu_stay_id>; use it for joins.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "stay_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/source_event_index",
+          "name": "source_event_index",
+          "description": "Original source event identifier.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "source_event_index"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/event_index",
+          "name": "event_index",
+          "description": "Zero-based position in the published trajectory.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "event_index"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "events/icu_event_index",
+          "name": "icu_event_index",
+          "description": "Zero-based chronological event ID within the target ICU stay; null outside it. Label action and evidence IDs refer to it.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileObject": {
+              "@id": "events-parquet"
+            },
+            "extract": {
+              "column": "icu_event_index"
+            }
+          }
+        }
+      ]
+    },
+    {
+      "@type": "cr:RecordSet",
+      "@id": "windows",
+      "name": "windows",
+      "description": "One annotated evaluation window per record. Covers RealICU-Gold and RealICU-Scale; filter by label_set.",
+      "key": [
+        {
+          "@id": "windows/sample_id"
+        }
+      ],
+      "field": [
+        {
+          "@type": "cr:Field",
+          "@id": "windows/sample_id",
+          "name": "sample_id",
+          "description": "Window identifier formatted as <label_set>/<stay_id>/<window_key>.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].sample_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/label_set",
+          "name": "label_set",
+          "description": "Annotation set: gold (RealICU-Gold) or scale (RealICU-Scale).",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].sample_id"
+            },
+            "transform": {
+              "regex": "^([^/]+)/"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/stay_id",
+          "name": "stay_id",
+          "description": "Target stay key; joins icu_stays and events.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].sample_id"
+            },
+            "transform": {
+              "regex": "^[^/]+/([^/]+)/"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/window_index",
+          "name": "window_index",
+          "description": "Window index within the stay's label file; may be nonconsecutive.",
+          "dataType": "sc:Integer",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].window_index"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/window_key",
+          "name": "window_key",
+          "description": "Nominal window bounds in hours since ICU admission, formatted as <start>|<end>.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].window_key"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/window_start_time",
+          "name": "window_start_time",
+          "description": "Inclusive window start used to select events.",
+          "dataType": "sc:DateTime",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].window_metadata.window_start_time"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/window_end_time",
+          "name": "window_end_time",
+          "description": "Exclusive window end used to select events.",
+          "dataType": "sc:DateTime",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].window_metadata.window_end_time"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/patient_status",
+          "name": "patient_status",
+          "description": "Patient Status reference: stable, improving, deteriorating, or insufficient_data; unavailable when patient_status_available is false.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.patient_assessment.overall.label"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/patient_status_rationale",
+          "name": "patient_status_rationale",
+          "description": "Oracle rationale for the Patient Status label.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.patient_assessment.overall.rationale"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/patient_status_available",
+          "name": "patient_status_available",
+          "description": "Whether the Patient Status reference can be used for evaluation.",
+          "dataType": "sc:Boolean",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].label_availability.patient_status"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/active_risks_available",
+          "name": "active_risks_available",
+          "description": "Whether the Acute Problems reference can be used for evaluation.",
+          "dataType": "sc:Boolean",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].label_availability.active_risks"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/recommended_action_available",
+          "name": "recommended_action_available",
+          "description": "Whether the Recommended Actions reference can be used for evaluation.",
+          "dataType": "sc:Boolean",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].label_availability.recommended_action"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "windows/red_flags_available",
+          "name": "red_flags_available",
+          "description": "Whether the Red Flag Actions reference can be used for evaluation.",
+          "dataType": "sc:Boolean",
+          "source": {
+            "fileSet": {
+              "@id": "labels-windows"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].label_availability.red_flags"
+            }
+          }
+        }
+      ]
+    },
+    {
+      "@type": "cr:RecordSet",
+      "@id": "action_evaluations",
+      "name": "action_evaluations",
+      "description": "Recommended Actions task: one rated recorded action per record. Covers RealICU-Gold and RealICU-Scale; filter by label_set.",
+      "field": [
+        {
+          "@type": "cr:Field",
+          "@id": "action_evaluations/sample_id",
+          "name": "sample_id",
+          "description": "Window identifier formatted as <label_set>/<stay_id>/<window_key>.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-action_evaluations"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.evaluations[*].`parent`.`parent`.`parent`.`parent`.sample_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "action_evaluations/label_set",
+          "name": "label_set",
+          "description": "Annotation set: gold (RealICU-Gold) or scale (RealICU-Scale).",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-action_evaluations"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.evaluations[*].`parent`.`parent`.`parent`.`parent`.sample_id"
+            },
+            "transform": {
+              "regex": "^([^/]+)/"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "action_evaluations/stay_id",
+          "name": "stay_id",
+          "description": "Target stay key; joins icu_stays and events.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-action_evaluations"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.evaluations[*].`parent`.`parent`.`parent`.`parent`.sample_id"
+            },
+            "transform": {
+              "regex": "^[^/]+/([^/]+)/"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "action_evaluations/action_id",
+          "name": "action_id",
+          "description": "icu_event_index of the rated action within the target stay, stored as a string.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-action_evaluations"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.evaluations[*].action_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "action_evaluations/action_name",
+          "name": "action_name",
+          "description": "Event code and description of the rated action.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-action_evaluations"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.evaluations[*].action_name"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "action_evaluations/label",
+          "name": "label",
+          "description": "best_practice, acceptable, potentially_harmful, or insufficient_data; best_practice and acceptable form the positive reference set.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-action_evaluations"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.evaluations[*].label"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "action_evaluations/rationale",
+          "name": "rationale",
+          "description": "Oracle rationale for the rating.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-action_evaluations"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.evaluations[*].rationale"
+            }
+          }
+        }
+      ]
+    },
+    {
+      "@type": "cr:RecordSet",
+      "@id": "active_risks",
+      "name": "active_risks",
+      "description": "Acute Problems task: one active clinical problem or emerging risk per record. Covers RealICU-Gold and RealICU-Scale; filter by label_set.",
+      "field": [
+        {
+          "@type": "cr:Field",
+          "@id": "active_risks/sample_id",
+          "name": "sample_id",
+          "description": "Window identifier formatted as <label_set>/<stay_id>/<window_key>.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-active_risks"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.patient_assessment.active_risks[*].`parent`.`parent`.`parent`.`parent`.sample_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "active_risks/label_set",
+          "name": "label_set",
+          "description": "Annotation set: gold (RealICU-Gold) or scale (RealICU-Scale).",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-active_risks"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.patient_assessment.active_risks[*].`parent`.`parent`.`parent`.`parent`.sample_id"
+            },
+            "transform": {
+              "regex": "^([^/]+)/"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "active_risks/stay_id",
+          "name": "stay_id",
+          "description": "Target stay key; joins icu_stays and events.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-active_risks"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.patient_assessment.active_risks[*].`parent`.`parent`.`parent`.`parent`.sample_id"
+            },
+            "transform": {
+              "regex": "^[^/]+/([^/]+)/"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "active_risks/risk_name",
+          "name": "risk_name",
+          "description": "Name of the active problem or risk.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-active_risks"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.patient_assessment.active_risks[*].risk_name"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "active_risks/key_evidence",
+          "name": "key_evidence",
+          "description": "Supporting evidence; numeric strings are icu_event_index values, other entries name summaries such as pre-ICU history.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-active_risks"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.patient_assessment.active_risks[*].key_evidence"
+            }
+          },
+          "isArray": true,
+          "arrayShape": "-1"
+        }
+      ]
+    },
+    {
+      "@type": "cr:RecordSet",
+      "@id": "red_flags",
+      "name": "red_flags",
+      "description": "Red Flag Actions task: one action to avoid per record. Covers RealICU-Gold and RealICU-Scale; filter by label_set.",
+      "field": [
+        {
+          "@type": "cr:Field",
+          "@id": "red_flags/sample_id",
+          "name": "sample_id",
+          "description": "Window identifier formatted as <label_set>/<stay_id>/<window_key>.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-red_flags"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.red_flags[*].`parent`.`parent`.`parent`.`parent`.sample_id"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "red_flags/label_set",
+          "name": "label_set",
+          "description": "Annotation set: gold (RealICU-Gold) or scale (RealICU-Scale).",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-red_flags"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.red_flags[*].`parent`.`parent`.`parent`.`parent`.sample_id"
+            },
+            "transform": {
+              "regex": "^([^/]+)/"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "red_flags/stay_id",
+          "name": "stay_id",
+          "description": "Target stay key; joins icu_stays and events.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-red_flags"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.red_flags[*].`parent`.`parent`.`parent`.`parent`.sample_id"
+            },
+            "transform": {
+              "regex": "^[^/]+/([^/]+)/"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "red_flags/contraindicated_action",
+          "name": "contraindicated_action",
+          "description": "Action to avoid in this window.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-red_flags"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.red_flags[*].contraindicated_action"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "red_flags/rationale",
+          "name": "rationale",
+          "description": "Oracle rationale for the red flag.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-red_flags"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.red_flags[*].rationale"
+            }
+          }
+        },
+        {
+          "@type": "cr:Field",
+          "@id": "red_flags/key_evidence",
+          "name": "key_evidence",
+          "description": "Supporting evidence; numeric strings are icu_event_index values, other entries name summaries such as pre-ICU history.",
+          "dataType": "sc:Text",
+          "source": {
+            "fileSet": {
+              "@id": "labels-red_flags"
+            },
+            "extract": {
+              "jsonPath": "$.window_outputs[*].reference_labels.action_review.red_flags[*].key_evidence"
+            }
+          },
+          "isArray": true,
+          "arrayShape": "-1"
+        }
+      ]
+    }
+  ]
+}

gold/labels/90000001_99000001.json

@@ -0,0 +1,412 @@
+{
+  "subject_id": 90000001,
+  "icu_stay_id": 99000001,
+  "trajectory_metadata": {
+    "enter_time": "2151-03-14T06:42:17",
+    "leave_time": "2151-03-15T09:27:17",
+    "age": 68.40049107029685,
+    "gender": "Female",
+    "total_icu_stay_hours": 26,
+    "icu_duration_hours": 26,
+    "survived": true,
+    "icu_outcome": "Survived after ICU",
+    "death_time": null,
+    "total_events": 390
+  },
+  "window_outputs": [
+    {
+      "window_index": 0,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T06:42:17",
+        "window_end_time": "2151-03-14T07:12:17",
+        "hours_since_admission": 0,
+        "current_window_hours": 0.5,
+        "num_current_events": 13
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 66 mmHg, HR 109 bpm, SpO2 90%."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "3",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "4",
+                "7"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "9",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "best_practice",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Escalating vasopressor need and rising lactate indicate worsening septic shock."
+            },
+            {
+              "action_id": "12",
+              "action_name": "BODY_INPUT NaCl 0.9%",
+              "label": "best_practice",
+              "rationale": "NaCl 0.9% is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "gold/90000001_99000001/0.000000|0.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.000000|0.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 2,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T07:42:17",
+        "window_end_time": "2151-03-14T08:12:17",
+        "hours_since_admission": 1,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 63 mmHg, HR 115 bpm, SpO2 90%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "25",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "26",
+                "29"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "22",
+              "action_name": "Piperacillin-Tazobactam",
+              "label": "best_practice",
+              "rationale": "Piperacillin-Tazobactam is appropriate for septic shock from right lower lobe pneumonia."
+            },
+            {
+              "action_id": "23",
+              "action_name": "Vancomycin",
+              "label": "best_practice",
+              "rationale": "Vancomycin is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "gold/90000001_99000001/1.000000|1.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.000000|1.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 5,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T09:12:17",
+        "window_end_time": "2151-03-14T09:42:17",
+        "hours_since_admission": 2.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "unavailable",
+            "rationale": ""
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "46",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "47",
+                "42"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "gold/90000001_99000001/2.500000|3.000000",
+      "label_availability": {
+        "patient_status": false,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "2.500000|3.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 17,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T15:12:17",
+        "window_end_time": "2151-03-14T15:42:17",
+        "hours_since_admission": 8.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 63 mmHg, HR 119 bpm, SpO2 94%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "125",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "123"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "126"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000001_99000001/8.500000|9.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "8.500000|9.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 26,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T19:42:17",
+        "window_end_time": "2151-03-14T20:12:17",
+        "hours_since_admission": 13,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 68 mmHg, HR 107 bpm, SpO2 96%; latest lactate 2.62."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "181",
+                "171"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "172",
+                "187"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "179",
+              "action_name": "Ibuprofen",
+              "label": "potentially_harmful",
+              "rationale": "Ibuprofen risks worsening acute kidney injury in a patient with shock."
+            },
+            {
+              "action_id": "186",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "182"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000001_99000001/13.000000|13.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "13.000000|13.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 35,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T00:12:17",
+        "window_end_time": "2151-03-15T00:42:17",
+        "hours_since_admission": 17.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 69 mmHg, HR 98 bpm, SpO2 94%; latest lactate 2.62."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "236",
+                "171"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "172",
+                "234"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "172"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000001_99000001/17.500000|18.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "17.500000|18.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 52,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T08:42:17",
+        "window_end_time": "2151-03-15T09:12:17",
+        "hours_since_admission": 26,
+        "current_window_hours": 0.5,
+        "num_current_events": 7
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 76 mmHg, HR 87 bpm, SpO2 97%; latest lactate 1.5."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "323",
+                "346"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "323"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000001_99000001/26.000000|26.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "26.000000|26.500000",
+      "window_duration_hours": 0.5
+    }
+  ],
+  "stay_id": "90000001_99000001"
+}

gold/labels/90000002_99000002.json

@@ -0,0 +1,408 @@
+{
+  "subject_id": 90000002,
+  "icu_stay_id": 99000002,
+  "trajectory_metadata": {
+    "enter_time": "2163-11-02T21:15:40",
+    "leave_time": "2163-11-04T03:39:40",
+    "age": 59.20297297639871,
+    "gender": "Male",
+    "total_icu_stay_hours": 30,
+    "icu_duration_hours": 30,
+    "survived": true,
+    "icu_outcome": "Survived after ICU",
+    "death_time": null,
+    "total_events": 458
+  },
+  "window_outputs": [
+    {
+      "window_index": 0,
+      "window_metadata": {
+        "window_start_time": "2163-11-02T21:15:40",
+        "window_end_time": "2163-11-02T21:45:40",
+        "hours_since_admission": 0,
+        "current_window_hours": 0.5,
+        "num_current_events": 18
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Hypoxemia worsens despite high-flow oxygen with rising work of breathing. Current window: MAP 83 mmHg, HR 118 bpm, SpO2 86%; latest ph 7.28."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute hypoxemic respiratory failure",
+              "key_evidence": [
+                "4",
+                "13"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "9",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "best_practice",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Hypoxemia worsens despite high-flow oxygen with rising work of breathing."
+            },
+            {
+              "action_id": "12",
+              "action_name": "LAB_TEST pH",
+              "label": "acceptable",
+              "rationale": "pH is reasonable monitoring or support in this context. Hypoxemia worsens despite high-flow oxygen with rising work of breathing."
+            },
+            {
+              "action_id": "13",
+              "action_name": "LAB_TEST pO2",
+              "label": "best_practice",
+              "rationale": "pO2 is reasonable monitoring or support in this context. Hypoxemia worsens despite high-flow oxygen with rising work of breathing."
+            },
+            {
+              "action_id": "17",
+              "action_name": "High Flow Nasal Cannula 60 L/min, FiO2 0.8",
+              "label": "best_practice",
+              "rationale": "High Flow Nasal Cannula is appropriate for acute hypoxemic respiratory failure from multifocal pneumonia."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "gold/90000002_99000002/0.000000|0.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.000000|0.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 2,
+      "window_metadata": {
+        "window_start_time": "2163-11-02T22:15:40",
+        "window_end_time": "2163-11-02T22:45:40",
+        "hours_since_admission": 1,
+        "current_window_hours": 0.5,
+        "num_current_events": 7
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Hypoxemia worsens despite high-flow oxygen with rising work of breathing. Current window: MAP 78 mmHg, HR 120 bpm, SpO2 86%; latest ph 7.28."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute hypoxemic respiratory failure",
+              "key_evidence": [
+                "23",
+                "13"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "gold/90000002_99000002/1.000000|1.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.000000|1.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 5,
+      "window_metadata": {
+        "window_start_time": "2163-11-02T23:45:40",
+        "window_end_time": "2163-11-03T00:15:40",
+        "hours_since_admission": 2.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Hypoxemia worsens despite high-flow oxygen with rising work of breathing. Current window: MAP 72 mmHg, HR 127 bpm, SpO2 85%; latest ph 7.28."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute hypoxemic respiratory failure",
+              "key_evidence": [
+                "40",
+                "13"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "gold/90000002_99000002/2.500000|3.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "2.500000|3.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 20,
+      "window_metadata": {
+        "window_start_time": "2163-11-03T07:15:40",
+        "window_end_time": "2163-11-03T07:45:40",
+        "hours_since_admission": 10,
+        "current_window_hours": 0.5,
+        "num_current_events": 14
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Oxygenation is stable on invasive ventilation with unchanged sedation. Current window: MAP 72 mmHg, HR 99 bpm, SpO2 94%; latest ph 7.4."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute hypoxemic respiratory failure",
+              "key_evidence": [
+                "148",
+                "142"
+              ]
+            },
+            {
+              "risk_name": "Ventilator-induced lung injury",
+              "key_evidence": [
+                "75"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "141",
+              "action_name": "LAB_TEST pH",
+              "label": "best_practice",
+              "rationale": "pH is reasonable monitoring or support in this context. Oxygenation is stable on invasive ventilation with unchanged sedation."
+            },
+            {
+              "action_id": "142",
+              "action_name": "LAB_TEST pO2",
+              "label": "acceptable",
+              "rationale": "pO2 is reasonable monitoring or support in this context. Oxygenation is stable on invasive ventilation with unchanged sedation."
+            },
+            {
+              "action_id": "152",
+              "action_name": "BODY_INPUT Propofol",
+              "label": "best_practice",
+              "rationale": "Propofol is appropriate for acute hypoxemic respiratory failure from multifocal pneumonia."
+            },
+            {
+              "action_id": "153",
+              "action_name": "BODY_INPUT Fentanyl Citrate",
+              "label": "best_practice",
+              "rationale": "Fentanyl Citrate is appropriate for acute hypoxemic respiratory failure from multifocal pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Tidal volumes above 8 mL/kg predicted body weight",
+              "rationale": "Lung-protective ventilation is required for multifocal pneumonia with hypoxemia.",
+              "key_evidence": [
+                "75"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000002_99000002/10.000000|10.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "10.000000|10.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 30,
+      "window_metadata": {
+        "window_start_time": "2163-11-03T12:15:40",
+        "window_end_time": "2163-11-03T12:45:40",
+        "hours_since_admission": 15,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Ventilator support and sedation are decreasing while oxygenation remains adequate. Current window: MAP 76 mmHg, HR 95 bpm, SpO2 95%; latest ph 7.4."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute hypoxemic respiratory failure",
+              "key_evidence": [
+                "213",
+                "142"
+              ]
+            },
+            {
+              "risk_name": "Ventilator-induced lung injury",
+              "key_evidence": [
+                "171"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "217",
+              "action_name": "BODY_INPUT Propofol",
+              "label": "best_practice",
+              "rationale": "Propofol is appropriate for acute hypoxemic respiratory failure from multifocal pneumonia."
+            },
+            {
+              "action_id": "218",
+              "action_name": "BODY_INPUT Fentanyl Citrate",
+              "label": "best_practice",
+              "rationale": "Fentanyl Citrate is appropriate for acute hypoxemic respiratory failure from multifocal pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Tidal volumes above 8 mL/kg predicted body weight",
+              "rationale": "Lung-protective ventilation is required for multifocal pneumonia with hypoxemia.",
+              "key_evidence": [
+                "171"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000002_99000002/15.000000|15.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "15.000000|15.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 40,
+      "window_metadata": {
+        "window_start_time": "2163-11-03T17:15:40",
+        "window_end_time": "2163-11-03T17:45:40",
+        "hours_since_admission": 20,
+        "current_window_hours": 0.5,
+        "num_current_events": 12
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Ventilator support and sedation are decreasing while oxygenation remains adequate. Current window: MAP 76 mmHg, HR 92 bpm, SpO2 96%; latest ph 7.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Ventilator-induced lung injury",
+              "key_evidence": [
+                "171"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "286",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "best_practice",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Ventilator support and sedation are decreasing while oxygenation remains adequate."
+            },
+            {
+              "action_id": "288",
+              "action_name": "BODY_INPUT Propofol",
+              "label": "best_practice",
+              "rationale": "Propofol is appropriate for acute hypoxemic respiratory failure from multifocal pneumonia."
+            },
+            {
+              "action_id": "289",
+              "action_name": "BODY_INPUT Fentanyl Citrate",
+              "label": "best_practice",
+              "rationale": "Fentanyl Citrate is appropriate for acute hypoxemic respiratory failure from multifocal pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Tidal volumes above 8 mL/kg predicted body weight",
+              "rationale": "Lung-protective ventilation is required for multifocal pneumonia with hypoxemia.",
+              "key_evidence": [
+                "171"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000002_99000002/20.000000|20.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "20.000000|20.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 59,
+      "window_metadata": {
+        "window_start_time": "2163-11-04T02:45:40",
+        "window_end_time": "2163-11-04T03:15:40",
+        "hours_since_admission": 29.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Ventilator support and sedation are decreasing while oxygenation remains adequate. Current window: MAP 80 mmHg, HR 85 bpm, SpO2 98%; latest ph 7.53."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "gold/90000002_99000002/29.500000|30.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "29.500000|30.000000",
+      "window_duration_hours": 0.5
+    }
+  ],
+  "stay_id": "90000002_99000002"
+}

gold/labels/90000003_99000003.json

@@ -0,0 +1,429 @@
+{
+  "subject_id": 90000003,
+  "icu_stay_id": 99000003,
+  "trajectory_metadata": {
+    "enter_time": "2142-07-21T13:05:52",
+    "leave_time": "2142-07-22T07:41:52",
+    "age": 34.701015032828856,
+    "gender": "Female",
+    "total_icu_stay_hours": 18,
+    "icu_duration_hours": 18,
+    "survived": true,
+    "icu_outcome": "Survived after ICU",
+    "death_time": null,
+    "total_events": 306
+  },
+  "window_outputs": [
+    {
+      "window_index": 0,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T13:05:52",
+        "window_end_time": "2142-07-21T13:35:52",
+        "hours_since_admission": 0,
+        "current_window_hours": 0.5,
+        "num_current_events": 18
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 77 mmHg, HR 115 bpm, SpO2 100%; latest glucose 449.79."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "14",
+                "16",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "9",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "best_practice",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            },
+            {
+              "action_id": "12",
+              "action_name": "BODY_INPUT NaCl 0.9%",
+              "label": "best_practice",
+              "rationale": "NaCl 0.9% is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "13",
+              "action_name": "LAB_TEST Glucose",
+              "label": "best_practice",
+              "rationale": "Glucose is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            },
+            {
+              "action_id": "14",
+              "action_name": "LAB_TEST Anion Gap",
+              "label": "acceptable",
+              "rationale": "Anion Gap is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "14"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000003_99000003/0.000000|0.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.000000|0.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 2,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T14:05:52",
+        "window_end_time": "2142-07-21T14:35:52",
+        "hours_since_admission": 1,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 81 mmHg, HR 114 bpm, SpO2 97%; latest glucose 449.79."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "14",
+                "16",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "27",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "14"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000003_99000003/1.000000|1.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.000000|1.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 5,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T15:35:52",
+        "window_end_time": "2142-07-21T16:05:52",
+        "hours_since_admission": 2.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 79 mmHg, HR 111 bpm, SpO2 101%; latest glucose 377.22."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "41",
+                "43",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "41"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000003_99000003/2.500000|3.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "2.500000|3.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 12,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T19:05:52",
+        "window_end_time": "2142-07-21T19:35:52",
+        "hours_since_admission": 6,
+        "current_window_hours": 0.5,
+        "num_current_events": 14
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 80 mmHg, HR 101 bpm, SpO2 100%; latest glucose 247.13."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "100",
+                "102",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "101"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "96",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "97",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "99",
+              "action_name": "LAB_TEST Glucose",
+              "label": "best_practice",
+              "rationale": "Glucose is reasonable monitoring or support in this context. Anion gap is closing and bicarbonate is rising on insulin and potassium replacement."
+            },
+            {
+              "action_id": "100",
+              "action_name": "LAB_TEST Anion Gap",
+              "label": "acceptable",
+              "rationale": "Anion Gap is reasonable monitoring or support in this context. Anion gap is closing and bicarbonate is rising on insulin and potassium replacement."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "100"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000003_99000003/6.000000|6.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "6.000000|6.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 18,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T22:05:52",
+        "window_end_time": "2142-07-21T22:35:52",
+        "hours_since_admission": 9,
+        "current_window_hours": 0.5,
+        "num_current_events": 2
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "insufficient_data",
+            "rationale": "The patient was off the unit for imaging and no vital signs were documented in this window."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "134",
+                "136",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "141",
+              "action_name": "CT scan",
+              "label": "best_practice",
+              "rationale": "CT scan is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "134"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000003_99000003/9.000000|9.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "9.000000|9.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 24,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T01:05:52",
+        "window_end_time": "2142-07-22T01:35:52",
+        "hours_since_admission": 12,
+        "current_window_hours": 0.5,
+        "num_current_events": 17
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 81 mmHg, HR 93 bpm, SpO2 98%; latest glucose 187.26."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "170",
+              "action_name": "LAB_TEST Glucose",
+              "label": "best_practice",
+              "rationale": "Glucose is reasonable monitoring or support in this context. Anion gap is closing and bicarbonate is rising on insulin and potassium replacement."
+            },
+            {
+              "action_id": "182",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Anion gap is closing and bicarbonate is rising on insulin and potassium replacement."
+            },
+            {
+              "action_id": "184",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "185",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "gold/90000003_99000003/12.000000|12.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "12.000000|12.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 36,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T07:05:52",
+        "window_end_time": "2142-07-22T07:35:52",
+        "hours_since_admission": 18,
+        "current_window_hours": 0.5,
+        "num_current_events": 7
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 83 mmHg, HR 86 bpm, SpO2 97%; latest glucose 174.36."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "gold/90000003_99000003/18.000000|18.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "18.000000|18.500000",
+      "window_duration_hours": 0.5
+    }
+  ],
+  "stay_id": "90000003_99000003"
+}

gold/labels/90000004_99000004.json

@@ -0,0 +1,412 @@
+{
+  "subject_id": 90000004,
+  "icu_stay_id": 99000004,
+  "trajectory_metadata": {
+    "enter_time": "2177-01-09T02:31:08",
+    "leave_time": "2177-01-10T00:49:08",
+    "age": 81.30076647146805,
+    "gender": "Male",
+    "total_icu_stay_hours": 22,
+    "icu_duration_hours": 22,
+    "survived": false,
+    "icu_outcome": "Died after ICU",
+    "death_time": "2177-01-12T23:49:00",
+    "total_events": 353
+  },
+  "window_outputs": [
+    {
+      "window_index": 0,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T02:31:08",
+        "window_end_time": "2177-01-09T03:01:08",
+        "hours_since_admission": 0,
+        "current_window_hours": 0.5,
+        "num_current_events": 17
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 57 mmHg, HR 122 bpm, SpO2 95%; latest hemoglobin 6.44."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "3",
+                "12"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "14",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "9",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "best_practice",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL."
+            },
+            {
+              "action_id": "12",
+              "action_name": "LAB_TEST Hemoglobin",
+              "label": "acceptable",
+              "rationale": "Hemoglobin is reasonable monitoring or support in this context. Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL."
+            },
+            {
+              "action_id": "13",
+              "action_name": "LAB_TEST Lactate",
+              "label": "best_practice",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "12"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000004_99000004/0.000000|0.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.000000|0.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 2,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T03:31:08",
+        "window_end_time": "2177-01-09T04:01:08",
+        "hours_since_admission": 1,
+        "current_window_hours": 0.5,
+        "num_current_events": 10
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 58 mmHg, HR 127 bpm, SpO2 96%; latest hemoglobin 6.44."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "23",
+                "12"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "14",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "21",
+              "action_name": "BODY_INPUT Packed Red Blood Cells",
+              "label": "best_practice",
+              "rationale": "Packed Red Blood Cells is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            },
+            {
+              "action_id": "28",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            },
+            {
+              "action_id": "29",
+              "action_name": "Prothrombin Complex Concentrate",
+              "label": "best_practice",
+              "rationale": "Prothrombin Complex Concentrate is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "12"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000004_99000004/1.000000|1.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.000000|1.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 5,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T05:01:08",
+        "window_end_time": "2177-01-09T05:31:08",
+        "hours_since_admission": 2.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 60 mmHg, HR 123 bpm, SpO2 97%; latest hemoglobin 6.44."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "43",
+                "12"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "14",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "12"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000004_99000004/2.500000|3.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "2.500000|3.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 14,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T09:31:08",
+        "window_end_time": "2177-01-09T10:01:08",
+        "hours_since_admission": 7,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 71 mmHg, HR 104 bpm, SpO2 95%; latest hemoglobin 7.45."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "59",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "104",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "57"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000004_99000004/7.000000|7.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "7.000000|7.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 22,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T13:31:08",
+        "window_end_time": "2177-01-09T14:01:08",
+        "hours_since_admission": 11,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 72 mmHg, HR 101 bpm, SpO2 96%; latest hemoglobin 7.66."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "157",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "120"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000004_99000004/11.000000|11.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "11.000000|11.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 29,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T17:01:08",
+        "window_end_time": "2177-01-09T17:31:08",
+        "hours_since_admission": 14.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 71 mmHg, HR 97 bpm, SpO2 94%; latest hemoglobin 7.93."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "169"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000004_99000004/14.500000|15.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "14.500000|15.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 43,
+      "window_metadata": {
+        "window_start_time": "2177-01-10T00:01:08",
+        "window_end_time": "2177-01-10T00:31:08",
+        "hours_since_admission": 21.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 62 mmHg, HR 113 bpm, SpO2 95%; latest hemoglobin 7.14."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "289",
+                "302"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "289"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000004_99000004/21.500000|22.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "21.500000|22.000000",
+      "window_duration_hours": 0.5
+    }
+  ],
+  "stay_id": "90000004_99000004"
+}

gold/labels/90000005_99000005.json

@@ -0,0 +1,415 @@
+{
+  "subject_id": 90000005,
+  "icu_stay_id": 99000005,
+  "trajectory_metadata": {
+    "enter_time": "2128-05-30T17:48:33",
+    "leave_time": "2128-05-31T08:42:33",
+    "age": 76.90278452734049,
+    "gender": "Female",
+    "total_icu_stay_hours": 14,
+    "icu_duration_hours": 14,
+    "survived": false,
+    "icu_outcome": "Died after ICU",
+    "death_time": "2128-06-02T00:42:00",
+    "total_events": 236
+  },
+  "window_outputs": [
+    {
+      "window_index": 0,
+      "window_metadata": {
+        "window_start_time": "2128-05-30T17:48:33",
+        "window_end_time": "2128-05-30T18:18:33",
+        "hours_since_admission": 0,
+        "current_window_hours": 0.5,
+        "num_current_events": 14
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis. Current window: MAP 104 mmHg, HR 108 bpm, SpO2 85%; latest ntprobnp 14612.4."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiogenic pulmonary edema",
+              "key_evidence": [
+                "4",
+                "13",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "9",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "best_practice",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis."
+            },
+            {
+              "action_id": "12",
+              "action_name": "Non-invasive Ventilation",
+              "label": "best_practice",
+              "rationale": "Non-invasive Ventilation is appropriate for acute decompensated heart failure with pulmonary edema."
+            },
+            {
+              "action_id": "13",
+              "action_name": "LAB_TEST NTproBNP",
+              "label": "best_practice",
+              "rationale": "NTproBNP is reasonable monitoring or support in this context. Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "4"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000005_99000005/0.000000|0.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.000000|0.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 2,
+      "window_metadata": {
+        "window_start_time": "2128-05-30T18:48:33",
+        "window_end_time": "2128-05-30T19:18:33",
+        "hours_since_admission": 1,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis. Current window: MAP 99 mmHg, HR 102 bpm, SpO2 89%; latest ntprobnp 14612.4."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiogenic pulmonary edema",
+              "key_evidence": [
+                "25",
+                "13",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "29",
+              "action_name": "BODY_INPUT Nitroglycerin",
+              "label": "best_practice",
+              "rationale": "Nitroglycerin is appropriate for acute decompensated heart failure with pulmonary edema."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "25"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000005_99000005/1.000000|1.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.000000|1.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 5,
+      "window_metadata": {
+        "window_start_time": "2128-05-30T20:18:33",
+        "window_end_time": "2128-05-30T20:48:33",
+        "hours_since_admission": 2.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis. Current window: MAP 92 mmHg, HR 99 bpm, SpO2 93%; latest ntprobnp 14612.4."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiogenic pulmonary edema",
+              "key_evidence": [
+                "44",
+                "13",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "44"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000005_99000005/2.500000|3.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "2.500000|3.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 9,
+      "window_metadata": {
+        "window_start_time": "2128-05-30T22:18:33",
+        "window_end_time": "2128-05-30T22:48:33",
+        "hours_since_admission": 4.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis. Current window: MAP 84 mmHg, HR 98 bpm, SpO2 92%; latest ntprobnp 14612.4."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiogenic pulmonary edema",
+              "key_evidence": [
+                "69",
+                "13",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "69"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000005_99000005/4.500000|5.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "4.500000|5.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 14,
+      "window_metadata": {
+        "window_start_time": "2128-05-31T00:48:33",
+        "window_end_time": "2128-05-31T01:18:33",
+        "hours_since_admission": 7,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Oxygenation is stable with a modest diuretic response. Current window: MAP 79 mmHg, HR 94 bpm, SpO2 94%; latest ntprobnp 14701."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiogenic pulmonary edema",
+              "key_evidence": [
+                "100",
+                "81",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Cardiorenal syndrome",
+              "key_evidence": [
+                "88",
+                "105"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "104",
+              "action_name": "BODY_INPUT Nitroglycerin",
+              "label": "best_practice",
+              "rationale": "Nitroglycerin is appropriate for acute decompensated heart failure with pulmonary edema."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "100"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000005_99000005/7.000000|7.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "7.000000|7.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 19,
+      "window_metadata": {
+        "window_start_time": "2128-05-31T03:18:33",
+        "window_end_time": "2128-05-31T03:48:33",
+        "hours_since_admission": 9.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Oxygenation is stable with a modest diuretic response. Current window: MAP 75 mmHg, HR 94 bpm, SpO2 95%; latest ntprobnp 14701."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiogenic pulmonary edema",
+              "key_evidence": [
+                "133",
+                "81",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Cardiorenal syndrome",
+              "key_evidence": [
+                "88",
+                "130"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "133"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000005_99000005/9.500000|10.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "9.500000|10.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 28,
+      "window_metadata": {
+        "window_start_time": "2128-05-31T07:48:33",
+        "window_end_time": "2128-05-31T08:18:33",
+        "hours_since_admission": 14,
+        "current_window_hours": 0.5,
+        "num_current_events": 7
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock. Current window: MAP 65 mmHg, HR 106 bpm, SpO2 91%; latest ntprobnp 14472.3."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiorenal syndrome",
+              "key_evidence": [
+                "166",
+                "193"
+              ]
+            },
+            {
+              "risk_name": "Cardiogenic shock",
+              "key_evidence": [
+                "188",
+                "169"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "189"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "gold/90000005_99000005/14.000000|14.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "14.000000|14.500000",
+      "window_duration_hours": 0.5
+    }
+  ],
+  "stay_id": "90000005_99000005"
+}

loader.py

@@ -0,0 +1,163 @@
+"""Load aligned RealICU inputs and reference labels without the experiment code."""
+
+from __future__ import annotations
+
+import argparse
+import json
+import math
+from collections.abc import Collection
+from pathlib import Path
+from typing import Any
+
+import pandas as pd
+
+
+EVENT_COLUMNS = [
+    "time",
+    "code",
+    "code_specifics",
+    "numeric_value",
+    "text_value",
+    "source_event_index",
+    "icu_event_index",
+]
+
+
+class RealICULoader:
+    """Read one stay once, then select any of its published label windows."""
+
+    def __init__(self, root: str | Path, label_set: str, stay_id: str) -> None:
+        if label_set not in {"gold", "scale"}:
+            raise ValueError("label_set must be 'gold' or 'scale'")
+
+        root = Path(root)
+        stays = pd.read_parquet(
+            root / "trajectories/icu_stay.parquet",
+            filters=[("stay_id", "==", stay_id)],
+            columns=["stay_id", "enter_time", "leave_time"],
+        )
+        if len(stays) != 1:
+            raise ValueError(f"Expected one ICU stay for {stay_id}, found {len(stays)}")
+
+        with (root / label_set / "labels" / f"{stay_id}.json").open(encoding="utf-8") as handle:
+            payload = json.load(handle)
+        if payload["stay_id"] != stay_id:
+            raise ValueError(f"Label stay_id does not match {stay_id}")
+
+        self._windows = {window["window_index"]: window for window in payload["window_outputs"]}
+        if not self._windows or len(self._windows) != len(payload["window_outputs"]):
+            raise ValueError(f"Empty or duplicate label windows for {stay_id}")
+
+        self.stay_id = stay_id
+        self.enter_time = pd.Timestamp(stays.iloc[0]["enter_time"])
+        self.leave_time = pd.Timestamp(stays.iloc[0]["leave_time"])
+        self.window_indices = tuple(sorted(self._windows))
+        self._events = pd.read_parquet(
+            root / "trajectories/events.parquet",
+            filters=[("stay_id", "==", stay_id)],
+            columns=EVENT_COLUMNS,
+        ).sort_values(["time", "source_event_index"], kind="stable").reset_index(drop=True)
+
+    @staticmethod
+    def _history_start(anchor: pd.Timestamp, hours: float | None) -> pd.Timestamp | None:
+        if hours is None:
+            return None
+        if not math.isfinite(hours) or hours < 0:
+            raise ValueError("History hours must be finite and nonnegative, or None for all available history")
+        return anchor - pd.Timedelta(hours=hours)
+
+    def _slice_events(
+        self,
+        start: pd.Timestamp | None,
+        end: pd.Timestamp,
+        excluded_event_codes: Collection[str],
+    ) -> pd.DataFrame:
+        times = self._events["time"]
+        left = 0 if start is None else times.searchsorted(start, side="left")
+        right = times.searchsorted(end, side="left")
+        events = self._events.iloc[left:right]
+        return events.loc[~events["code"].isin(excluded_event_codes)].copy().reset_index(drop=True)
+
+    def load_window(
+        self,
+        window_index: int,
+        *,
+        icu_history_hours: float | None,
+        pre_icu_history_hours: float | None,
+        excluded_event_codes: Collection[str],
+    ) -> dict[str, Any]:
+        """Return input event tables and labels; None selects all history, zero selects none."""
+        window = self._windows[window_index]
+        metadata = window["window_metadata"]
+        start = pd.Timestamp(metadata["window_start_time"])
+        end = pd.Timestamp(metadata["window_end_time"])
+        if not self.enter_time <= start < end <= self.leave_time:
+            raise ValueError(f"Window {window_index} lies outside ICU stay {self.stay_id}")
+
+        history_start = self._history_start(start, icu_history_hours)
+        if history_start is None or history_start < self.enter_time:
+            history_start = self.enter_time
+        pre_icu_start = self._history_start(self.enter_time, pre_icu_history_hours)
+
+        return {
+            "input": {
+                "sample_id": window["sample_id"],
+                "stay_id": self.stay_id,
+                "window_start_time": start,
+                "window_end_time": end,
+                "pre_icu_events": self._slice_events(pre_icu_start, self.enter_time, excluded_event_codes),
+                "history_events": self._slice_events(history_start, start, excluded_event_codes),
+                "current_events": self._slice_events(start, end, excluded_event_codes),
+            },
+            "labels": {
+                "reference_labels": window["reference_labels"],
+                "label_availability": window["label_availability"],
+            },
+        }
+
+
+def _parse_history_hours(value: str) -> float | None:
+    if value == "all":
+        return None
+    try:
+        hours = float(value)
+    except ValueError as error:
+        raise argparse.ArgumentTypeError("Use 'all' or a nonnegative number of hours") from error
+    if not math.isfinite(hours) or hours < 0:
+        raise argparse.ArgumentTypeError("Use 'all' or a finite, nonnegative number of hours")
+    return hours
+
+
+def main() -> None:
+    parser = argparse.ArgumentParser(description=__doc__)
+    parser.add_argument("--root", type=Path, required=True)
+    parser.add_argument("--label-set", choices=["gold", "scale"], required=True)
+    parser.add_argument("--stay-id", required=True)
+    parser.add_argument("--window-index", type=int, required=True)
+    parser.add_argument("--icu-history-hours", type=_parse_history_hours, required=True)
+    parser.add_argument("--pre-icu-history-hours", type=_parse_history_hours, required=True)
+    parser.add_argument("--excluded-event-codes", nargs="*", required=True)
+    args = parser.parse_args()
+
+    loader = RealICULoader(args.root, args.label_set, args.stay_id)
+    sample = loader.load_window(
+        args.window_index,
+        icu_history_hours=args.icu_history_hours,
+        pre_icu_history_hours=args.pre_icu_history_hours,
+        excluded_event_codes=args.excluded_event_codes,
+    )
+    model_input = sample["input"]
+    print(json.dumps({
+        "sample_id": model_input["sample_id"],
+        "window_start_time": model_input["window_start_time"].isoformat(),
+        "window_end_time": model_input["window_end_time"].isoformat(),
+        "event_counts": {
+            key: len(model_input[key])
+            for key in ("pre_icu_events", "history_events", "current_events")
+        },
+        "label_availability": sample["labels"]["label_availability"],
+    }, indent=2))
+
+
+if __name__ == "__main__":
+    main()

scale/labels/90000001_99000001.json

@@ -0,0 +1,2898 @@
+{
+  "subject_id": 90000001,
+  "icu_stay_id": 99000001,
+  "trajectory_metadata": {
+    "enter_time": "2151-03-14T06:42:17",
+    "leave_time": "2151-03-15T09:27:17",
+    "age": 68.40049107029685,
+    "gender": "Female",
+    "total_icu_stay_hours": 26.0,
+    "icu_duration_hours": 26.0,
+    "survived": true,
+    "icu_outcome": "Survived after ICU",
+    "death_time": null,
+    "total_events": 390
+  },
+  "window_outputs": [
+    {
+      "window_index": 0,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T06:42:17",
+        "window_end_time": "2151-03-14T07:12:17",
+        "hours_since_admission": 0.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 13
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 66 mmHg, HR 109 bpm, SpO2 90%."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "3",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "4",
+                "7"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "9",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Escalating vasopressor need and rising lactate indicate worsening septic shock."
+            },
+            {
+              "action_id": "12",
+              "action_name": "BODY_INPUT NaCl 0.9%",
+              "label": "best_practice",
+              "rationale": "NaCl 0.9% is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000001_99000001/0.000000|0.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.000000|0.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 1,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T07:12:17",
+        "window_end_time": "2151-03-14T07:42:17",
+        "hours_since_admission": 0.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 64 mmHg, HR 115 bpm, SpO2 92%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "14",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "15",
+                "7"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "16",
+              "action_name": "LAB_TEST Lactate",
+              "label": "acceptable",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Escalating vasopressor need and rising lactate indicate worsening septic shock."
+            },
+            {
+              "action_id": "17",
+              "action_name": "LAB_TEST Creatinine",
+              "label": "acceptable",
+              "rationale": "Creatinine is reasonable monitoring or support in this context. Escalating vasopressor need and rising lactate indicate worsening septic shock."
+            },
+            {
+              "action_id": "21",
+              "action_name": "MICROBIOLOGY_TEST BLOOD CULTURE",
+              "label": "best_practice",
+              "rationale": "BLOOD CULTURE is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000001_99000001/0.500000|1.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.500000|1.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 2,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T07:42:17",
+        "window_end_time": "2151-03-14T08:12:17",
+        "hours_since_admission": 1.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 63 mmHg, HR 115 bpm, SpO2 90%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "25",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "26",
+                "29"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "22",
+              "action_name": "Piperacillin-Tazobactam",
+              "label": "best_practice",
+              "rationale": "Piperacillin-Tazobactam is appropriate for septic shock from right lower lobe pneumonia."
+            },
+            {
+              "action_id": "23",
+              "action_name": "Vancomycin",
+              "label": "best_practice",
+              "rationale": "Vancomycin is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000001_99000001/1.000000|1.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.000000|1.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 3,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T08:12:17",
+        "window_end_time": "2151-03-14T08:42:17",
+        "hours_since_admission": 1.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 5
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 64 mmHg, HR 116 bpm, SpO2 92%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "32",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "33",
+                "29"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "34",
+              "action_name": "XRAY CHEST (PORTABLE AP)",
+              "label": "best_practice",
+              "rationale": "CHEST (PORTABLE AP) is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000001_99000001/1.500000|2.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.500000|2.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 4,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T08:42:17",
+        "window_end_time": "2151-03-14T09:12:17",
+        "hours_since_admission": 2.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 64 mmHg, HR 116 bpm, SpO2 93%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "38",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "39",
+                "42"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "36",
+              "action_name": "Arterial Line",
+              "label": "best_practice",
+              "rationale": "Arterial Line is appropriate for septic shock from right lower lobe pneumonia."
+            },
+            {
+              "action_id": "43",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000001_99000001/2.000000|2.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "2.000000|2.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 6,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T09:42:17",
+        "window_end_time": "2151-03-14T10:12:17",
+        "hours_since_admission": 3.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 62 mmHg, HR 120 bpm, SpO2 89%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "49",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "50",
+                "53"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "54",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            },
+            {
+              "action_id": "56",
+              "action_name": "BODY_INPUT NaCl 0.9%",
+              "label": "best_practice",
+              "rationale": "NaCl 0.9% is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "50"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/3.000000|3.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "3.000000|3.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 7,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T10:12:17",
+        "window_end_time": "2151-03-14T10:42:17",
+        "hours_since_admission": 3.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 59 mmHg, HR 120 bpm, SpO2 90%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "58",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "59",
+                "53"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "59"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/3.500000|4.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "3.500000|4.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 8,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T10:42:17",
+        "window_end_time": "2151-03-14T11:12:17",
+        "hours_since_admission": 4.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 11
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 62 mmHg, HR 119 bpm, SpO2 90%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "61",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "17",
+                "70"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "62",
+                "65"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "67",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Escalating vasopressor need and rising lactate indicate worsening septic shock."
+            },
+            {
+              "action_id": "69",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "62"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "17"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/4.000000|4.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "4.000000|4.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 9,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T11:12:17",
+        "window_end_time": "2151-03-14T11:42:17",
+        "hours_since_admission": 4.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 60 mmHg, HR 121 bpm, SpO2 91%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "72",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "17",
+                "70"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "73",
+                "65"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "73"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "17"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/4.500000|5.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "4.500000|5.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 10,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T11:42:17",
+        "window_end_time": "2151-03-14T12:12:17",
+        "hours_since_admission": 5.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 56 mmHg, HR 125 bpm, SpO2 89%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "75",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "17",
+                "81"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "76",
+                "79"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "80",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "76"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "17"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/5.000000|5.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "5.000000|5.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 11,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T12:12:17",
+        "window_end_time": "2151-03-14T12:42:17",
+        "hours_since_admission": 5.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Escalating vasopressor need and rising lactate indicate worsening septic shock. Current window: MAP 56 mmHg, HR 123 bpm, SpO2 89%; latest lactate 3.32."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "83",
+                "16"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "17",
+                "81"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "84",
+                "79"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "84"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "17"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/5.500000|6.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "5.500000|6.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 13,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T13:12:17",
+        "window_end_time": "2151-03-14T13:42:17",
+        "hours_since_admission": 6.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 60 mmHg, HR 122 bpm, SpO2 92%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "100",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "98"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "101",
+                "95"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "101"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "86"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/6.500000|7.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "6.500000|7.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 14,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T13:42:17",
+        "window_end_time": "2151-03-14T14:12:17",
+        "hours_since_admission": 7.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 58 mmHg, HR 119 bpm, SpO2 92%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "103",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "109"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "104",
+                "107"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "108",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "104"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "86"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/7.000000|7.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "7.000000|7.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 15,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T14:12:17",
+        "window_end_time": "2151-03-14T14:42:17",
+        "hours_since_admission": 7.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 61 mmHg, HR 119 bpm, SpO2 89%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "111",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "109"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "112",
+                "107"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "112"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "86"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/7.500000|8.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "7.500000|8.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 16,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T14:42:17",
+        "window_end_time": "2151-03-14T15:12:17",
+        "hours_since_admission": 8.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 11
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 61 mmHg, HR 118 bpm, SpO2 92%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "114",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "123"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "115",
+                "118"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "120",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Hemodynamics are maintained on a stable norepinephrine dose without further escalation."
+            },
+            {
+              "action_id": "122",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "115"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "86"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/8.000000|8.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "8.000000|8.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 17,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T15:12:17",
+        "window_end_time": "2151-03-14T15:42:17",
+        "hours_since_admission": 8.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 63 mmHg, HR 119 bpm, SpO2 94%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "125",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "123"
+              ]
+            },
+            {
+              "risk_name": "Hypoxemic respiratory failure",
+              "key_evidence": [
+                "126",
+                "118"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "126"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "86"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/8.500000|9.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "8.500000|9.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 18,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T15:42:17",
+        "window_end_time": "2151-03-14T16:12:17",
+        "hours_since_admission": 9.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 63 mmHg, HR 114 bpm, SpO2 92%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "128",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "134"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "133",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "129"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "86"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/9.000000|9.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "9.000000|9.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 20,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T16:42:17",
+        "window_end_time": "2151-03-14T17:12:17",
+        "hours_since_admission": 10.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 67 mmHg, HR 115 bpm, SpO2 95%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "139",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "145"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "144",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "140"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "86"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/10.000000|10.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "10.000000|10.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 21,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T17:12:17",
+        "window_end_time": "2151-03-14T17:42:17",
+        "hours_since_admission": 10.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 66 mmHg, HR 112 bpm, SpO2 94%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "147",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "145"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "148"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "86"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/10.500000|11.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "10.500000|11.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 22,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T17:42:17",
+        "window_end_time": "2151-03-14T18:12:17",
+        "hours_since_admission": 11.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 65 mmHg, HR 111 bpm, SpO2 96%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "150",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "156"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "155",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "151"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "86"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/11.000000|11.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "11.000000|11.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 23,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T18:12:17",
+        "window_end_time": "2151-03-14T18:42:17",
+        "hours_since_admission": 11.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 66 mmHg, HR 108 bpm, SpO2 95%; latest lactate 4.34."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "158",
+                "85"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "86",
+                "156"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "159"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "86"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/11.500000|12.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "11.500000|12.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 24,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T18:42:17",
+        "window_end_time": "2151-03-14T19:12:17",
+        "hours_since_admission": 12.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 16
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 67 mmHg, HR 106 bpm, SpO2 95%; latest lactate 2.62."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "161",
+                "171"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "172",
+                "170"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "167",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Hemodynamics are maintained on a stable norepinephrine dose without further escalation."
+            },
+            {
+              "action_id": "169",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            },
+            {
+              "action_id": "171",
+              "action_name": "LAB_TEST Lactate",
+              "label": "acceptable",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Hemodynamics are maintained on a stable norepinephrine dose without further escalation."
+            },
+            {
+              "action_id": "172",
+              "action_name": "LAB_TEST Creatinine",
+              "label": "acceptable",
+              "rationale": "Creatinine is reasonable monitoring or support in this context. Hemodynamics are maintained on a stable norepinephrine dose without further escalation."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "162"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "172"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/12.000000|12.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "12.000000|12.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 25,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T19:12:17",
+        "window_end_time": "2151-03-14T19:42:17",
+        "hours_since_admission": 12.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 68 mmHg, HR 109 bpm, SpO2 96%; latest lactate 2.62."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "177",
+                "171"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "172",
+                "170"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "178"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "172"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/12.500000|13.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "12.500000|13.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 27,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T20:12:17",
+        "window_end_time": "2151-03-14T20:42:17",
+        "hours_since_admission": 13.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamics are maintained on a stable norepinephrine dose without further escalation. Current window: MAP 66 mmHg, HR 105 bpm, SpO2 96%; latest lactate 2.62."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "189",
+                "171"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "172",
+                "187"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Additional large-volume crystalloid boluses",
+              "rationale": "Oxygenation worsened after initial resuscitation, suggesting limited fluid tolerance.",
+              "key_evidence": [
+                "190"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "172"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/13.500000|14.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "13.500000|14.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 28,
+      "window_metadata": {
+        "window_start_time": "2151-03-14T20:42:17",
+        "window_end_time": "2151-03-14T21:12:17",
+        "hours_since_admission": 14.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 68 mmHg, HR 103 bpm, SpO2 95%; latest lactate 2.62."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Septic shock",
+              "key_evidence": [
+                "192",
+                "171"
+              ]
+            },
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "172",
+                "198"
+              ]
+            }
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+              "action_id": "197",
+              "action_name": "BODY_INPUT Norepinephrine",
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+              "key_evidence": [
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+                "198"
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+                "223"
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+              "action_id": "220",
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+            {
+              "action_id": "222",
+              "action_name": "BODY_INPUT Norepinephrine",
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+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
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+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "172"
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+              "key_evidence": [
+                "228",
+                "171"
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+                "172",
+                "234"
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+              "risk_name": "Septic shock",
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+                "236",
+                "171"
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+              "action_id": "244",
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+            },
+            {
+              "action_id": "245",
+              "action_name": "LAB_TEST Creatinine",
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+              "rationale": "Creatinine is reasonable monitoring or support in this context. Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output."
+            },
+            {
+              "action_id": "246",
+              "action_name": "BODY_INPUT Norepinephrine",
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+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "245"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/21.500000|22.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "21.500000|22.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 44,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T04:42:17",
+        "window_end_time": "2151-03-15T05:12:17",
+        "hours_since_admission": 22.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 72 mmHg, HR 94 bpm, SpO2 93%; latest lactate 1.91."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "245",
+                "298"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "297",
+              "action_name": "BODY_INPUT Norepinephrine",
+              "label": "best_practice",
+              "rationale": "Norepinephrine is appropriate for septic shock from right lower lobe pneumonia."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "245"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/22.000000|22.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "22.000000|22.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 45,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T05:12:17",
+        "window_end_time": "2151-03-15T05:42:17",
+        "hours_since_admission": 22.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 71 mmHg, HR 92 bpm, SpO2 97%; latest lactate 1.91."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "245",
+                "298"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "245"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/22.500000|23.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "22.500000|23.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 46,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T05:42:17",
+        "window_end_time": "2151-03-15T06:12:17",
+        "hours_since_admission": 23.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 7
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 74 mmHg, HR 91 bpm, SpO2 96%; latest lactate 1.91."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "245",
+                "308"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "245"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/23.000000|23.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "23.000000|23.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 48,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T06:42:17",
+        "window_end_time": "2151-03-15T07:12:17",
+        "hours_since_admission": 24.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 11
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 73 mmHg, HR 91 bpm, SpO2 97%; latest lactate 1.5."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "245",
+                "321"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "319",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output."
+            },
+            {
+              "action_id": "322",
+              "action_name": "LAB_TEST Lactate",
+              "label": "acceptable",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "245"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/24.000000|24.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "24.000000|24.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 49,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T07:12:17",
+        "window_end_time": "2151-03-15T07:42:17",
+        "hours_since_admission": 24.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 7
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 74 mmHg, HR 91 bpm, SpO2 96%; latest lactate 1.5."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "323",
+                "321"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "323",
+              "action_name": "LAB_TEST Creatinine",
+              "label": "acceptable",
+              "rationale": "Creatinine is reasonable monitoring or support in this context. Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output."
+            },
+            {
+              "action_id": "324",
+              "action_name": "LAB_TEST White Blood Cells",
+              "label": "acceptable",
+              "rationale": "White Blood Cells is reasonable monitoring or support in this context. Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "323"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/24.500000|25.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "24.500000|25.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 50,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T07:42:17",
+        "window_end_time": "2151-03-15T08:12:17",
+        "hours_since_admission": 25.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 7
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 75 mmHg, HR 91 bpm, SpO2 96%; latest lactate 1.5."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "323",
+                "336"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "323"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/25.000000|25.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "25.000000|25.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 51,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T08:12:17",
+        "window_end_time": "2151-03-15T08:42:17",
+        "hours_since_admission": 25.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 75 mmHg, HR 89 bpm, SpO2 96%; latest lactate 1.5."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "323",
+                "336"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "323"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/25.500000|26.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "25.500000|26.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 52,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T08:42:17",
+        "window_end_time": "2151-03-15T09:12:17",
+        "hours_since_admission": 26.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 7
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 76 mmHg, HR 87 bpm, SpO2 97%; latest lactate 1.5."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "323",
+                "346"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "323"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/26.000000|26.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "26.000000|26.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 53,
+      "window_metadata": {
+        "window_start_time": "2151-03-15T09:12:17",
+        "window_end_time": "2151-03-15T09:27:17",
+        "hours_since_admission": 26.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Norepinephrine is being weaned with improving MAP, lactate clearance, and urine output. Current window: MAP 74 mmHg, HR 87 bpm, SpO2 97%; latest lactate 1.5."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Acute kidney injury",
+              "key_evidence": [
+                "323",
+                "346"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "NSAIDs for fever control",
+              "rationale": "Acute kidney injury and shock increase the risk of further renal injury.",
+              "key_evidence": [
+                "323"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000001_99000001/26.500000|27.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "26.500000|27.000000",
+      "window_duration_hours": 0.5
+    }
+  ],
+  "stay_id": "90000001_99000001"
+}

scale/labels/90000003_99000003.json

@@ -0,0 +1,1865 @@
+{
+  "subject_id": 90000003,
+  "icu_stay_id": 99000003,
+  "trajectory_metadata": {
+    "enter_time": "2142-07-21T13:05:52",
+    "leave_time": "2142-07-22T07:41:52",
+    "age": 34.701015032828856,
+    "gender": "Female",
+    "total_icu_stay_hours": 18.0,
+    "icu_duration_hours": 18.0,
+    "survived": true,
+    "icu_outcome": "Survived after ICU",
+    "death_time": null,
+    "total_events": 306
+  },
+  "window_outputs": [
+    {
+      "window_index": 0,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T13:05:52",
+        "window_end_time": "2142-07-21T13:35:52",
+        "hours_since_admission": 0.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 18
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 77 mmHg, HR 115 bpm, SpO2 100%; latest glucose 449.79."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "14",
+                "16",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "9",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            },
+            {
+              "action_id": "12",
+              "action_name": "BODY_INPUT NaCl 0.9%",
+              "label": "best_practice",
+              "rationale": "NaCl 0.9% is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "13",
+              "action_name": "LAB_TEST Glucose",
+              "label": "acceptable",
+              "rationale": "Glucose is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            },
+            {
+              "action_id": "14",
+              "action_name": "LAB_TEST Anion Gap",
+              "label": "acceptable",
+              "rationale": "Anion Gap is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "14"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/0.000000|0.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.000000|0.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 1,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T13:35:52",
+        "window_end_time": "2142-07-21T14:05:52",
+        "hours_since_admission": 0.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 79 mmHg, HR 115 bpm, SpO2 99%; latest glucose 449.79."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "14",
+                "16",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "14"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/0.500000|1.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.500000|1.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 2,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T14:05:52",
+        "window_end_time": "2142-07-21T14:35:52",
+        "hours_since_admission": 1.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 81 mmHg, HR 114 bpm, SpO2 97%; latest glucose 449.79."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "14",
+                "16",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "27",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "14"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/1.000000|1.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.000000|1.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 3,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T14:35:52",
+        "window_end_time": "2142-07-21T15:05:52",
+        "hours_since_admission": 1.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 79 mmHg, HR 113 bpm, SpO2 99%; latest glucose 449.79."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "14",
+                "16",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "14"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/1.500000|2.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.500000|2.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 4,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T15:05:52",
+        "window_end_time": "2142-07-21T15:35:52",
+        "hours_since_admission": 2.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 13
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 77 mmHg, HR 112 bpm, SpO2 98%; latest glucose 377.22.",
+            "weighted_domains": {
+              "hemodynamics": "stable",
+              "respiratory": "stable",
+              "renal_metabolic": "improving",
+              "neurology": "stable"
+            },
+            "trajectory_trend": "improving"
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "41",
+                "43",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "38",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "39",
+              "action_name": "LAB_TEST Glucose",
+              "label": "acceptable",
+              "rationale": "Glucose is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            },
+            {
+              "action_id": "41",
+              "action_name": "LAB_TEST Anion Gap",
+              "label": "acceptable",
+              "rationale": "Anion Gap is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "41"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/2.000000|2.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "2.000000|2.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 6,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T16:05:52",
+        "window_end_time": "2142-07-21T16:35:52",
+        "hours_since_admission": 3.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 80 mmHg, HR 110 bpm, SpO2 97%; latest glucose 377.22."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "41",
+                "43",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "54",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "41"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/3.000000|3.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "3.000000|3.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 7,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T16:35:52",
+        "window_end_time": "2142-07-21T17:05:52",
+        "hours_since_admission": 3.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 79 mmHg, HR 108 bpm, SpO2 98%; latest glucose 377.22."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "41",
+                "43",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "41"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/3.500000|4.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "3.500000|4.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 8,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T17:05:52",
+        "window_end_time": "2142-07-21T17:35:52",
+        "hours_since_admission": 4.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 16
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 79 mmHg, HR 107 bpm, SpO2 99%; latest glucose 276.98."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "71",
+                "73",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "72"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "66",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            },
+            {
+              "action_id": "68",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "70",
+              "action_name": "LAB_TEST Glucose",
+              "label": "acceptable",
+              "rationale": "Glucose is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            },
+            {
+              "action_id": "71",
+              "action_name": "LAB_TEST Anion Gap",
+              "label": "acceptable",
+              "rationale": "Anion Gap is reasonable monitoring or support in this context. Hemodynamically stable on insulin infusion; acidosis persists."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "71"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "72"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/4.000000|4.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "4.000000|4.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 9,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T17:35:52",
+        "window_end_time": "2142-07-21T18:05:52",
+        "hours_since_admission": 4.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 4
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 79 mmHg, HR 107 bpm, SpO2 98%; latest glucose 276.98."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "71",
+                "73",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "72"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "78",
+              "action_name": "BODY_INPUT Potassium Chloride",
+              "label": "best_practice",
+              "rationale": "Potassium Chloride is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "71"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "72"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/4.500000|5.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "4.500000|5.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 10,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T18:05:52",
+        "window_end_time": "2142-07-21T18:35:52",
+        "hours_since_admission": 5.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 78 mmHg, HR 104 bpm, SpO2 98%; latest glucose 276.98."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "71",
+                "73",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "72"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "85",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "71"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "72"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/5.000000|5.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "5.000000|5.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 11,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T18:35:52",
+        "window_end_time": "2142-07-21T19:05:52",
+        "hours_since_admission": 5.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemodynamically stable on insulin infusion; acidosis persists. Current window: MAP 80 mmHg, HR 104 bpm, SpO2 98%; latest glucose 276.98."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "71",
+                "73",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "72"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "71"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "72"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/5.500000|6.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "5.500000|6.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 13,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T19:35:52",
+        "window_end_time": "2142-07-21T20:05:52",
+        "hours_since_admission": 6.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 4
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 80 mmHg, HR 101 bpm, SpO2 98%; latest glucose 247.13."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "100",
+                "102",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "101"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "104",
+              "action_name": "BODY_INPUT Potassium Chloride",
+              "label": "best_practice",
+              "rationale": "Potassium Chloride is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "100"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "101"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/6.500000|7.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "6.500000|7.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 14,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T20:05:52",
+        "window_end_time": "2142-07-21T20:35:52",
+        "hours_since_admission": 7.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 10
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 79 mmHg, HR 99 bpm, SpO2 97%; latest glucose 247.13."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "100",
+                "102",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "101"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "108",
+              "action_name": "Magnesium Sulfate",
+              "label": "insufficient_data",
+              "rationale": "No magnesium level is documented to support or refute replacement."
+            },
+            {
+              "action_id": "115",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "116",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "100"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "101"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/7.000000|7.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "7.000000|7.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 15,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T20:35:52",
+        "window_end_time": "2142-07-21T21:05:52",
+        "hours_since_admission": 7.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 80 mmHg, HR 99 bpm, SpO2 101%; latest glucose 247.13."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "100",
+                "102",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "101"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "100"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "101"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/7.500000|8.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "7.500000|8.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 16,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T21:05:52",
+        "window_end_time": "2142-07-21T21:35:52",
+        "hours_since_admission": 8.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 17
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 79 mmHg, HR 99 bpm, SpO2 99%; latest glucose 216.11."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "134",
+                "136",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "128",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Anion gap is closing and bicarbonate is rising on insulin and potassium replacement."
+            },
+            {
+              "action_id": "130",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "131",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "133",
+              "action_name": "LAB_TEST Glucose",
+              "label": "acceptable",
+              "rationale": "Glucose is reasonable monitoring or support in this context. Anion gap is closing and bicarbonate is rising on insulin and potassium replacement."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "134"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/8.000000|8.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "8.000000|8.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 17,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T21:35:52",
+        "window_end_time": "2142-07-21T22:05:52",
+        "hours_since_admission": 8.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 80 mmHg, HR 97 bpm, SpO2 99%; latest glucose 216.11."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "134",
+                "136",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "134"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/8.500000|9.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "8.500000|9.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 18,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T22:05:52",
+        "window_end_time": "2142-07-21T22:35:52",
+        "hours_since_admission": 9.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 2
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "insufficient_data",
+            "rationale": "The patient was off the unit for imaging and no vital signs were documented in this window."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "134",
+                "136",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "141",
+              "action_name": "CT scan",
+              "label": "best_practice",
+              "rationale": "CT scan is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "134"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/9.000000|9.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "9.000000|9.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 20,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T23:05:52",
+        "window_end_time": "2142-07-21T23:35:52",
+        "hours_since_admission": 10.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 80 mmHg, HR 94 bpm, SpO2 98%; latest glucose 216.11."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "134",
+                "136",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "152",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "153",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "134"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/10.000000|10.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "10.000000|10.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 21,
+      "window_metadata": {
+        "window_start_time": "2142-07-21T23:35:52",
+        "window_end_time": "2142-07-22T00:05:52",
+        "hours_since_admission": 10.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 84 mmHg, HR 94 bpm, SpO2 99%; latest glucose 216.11."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "134",
+                "136",
+                "Pre-ICU summary"
+              ]
+            },
+            {
+              "risk_name": "Hypokalemia during insulin therapy",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "134"
+              ]
+            },
+            {
+              "contraindicated_action": "Insulin bolus without potassium monitoring",
+              "rationale": "Potassium fell to 3.1 mEq/L during insulin therapy.",
+              "key_evidence": [
+                "135"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/10.500000|11.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "10.500000|11.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 22,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T00:05:52",
+        "window_end_time": "2142-07-22T00:35:52",
+        "hours_since_admission": 11.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 81 mmHg, HR 93 bpm, SpO2 99%; latest glucose 216.11."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "134",
+                "136",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "164",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "165",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "134"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/11.000000|11.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "11.000000|11.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 23,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T00:35:52",
+        "window_end_time": "2142-07-22T01:05:52",
+        "hours_since_admission": 11.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 81 mmHg, HR 95 bpm, SpO2 100%; latest glucose 216.11."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Diabetic ketoacidosis",
+              "key_evidence": [
+                "134",
+                "136",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Stopping the insulin infusion before the anion gap closes",
+              "rationale": "Ketoacidosis recurs if insulin is interrupted before ketosis resolves.",
+              "key_evidence": [
+                "134"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000003_99000003/11.500000|12.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "11.500000|12.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 24,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T01:05:52",
+        "window_end_time": "2142-07-22T01:35:52",
+        "hours_since_admission": 12.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 17
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 81 mmHg, HR 93 bpm, SpO2 98%; latest glucose 187.26."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "170",
+              "action_name": "LAB_TEST Glucose",
+              "label": "acceptable",
+              "rationale": "Glucose is reasonable monitoring or support in this context. Anion gap is closing and bicarbonate is rising on insulin and potassium replacement."
+            },
+            {
+              "action_id": "182",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Anion gap is closing and bicarbonate is rising on insulin and potassium replacement."
+            },
+            {
+              "action_id": "184",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "185",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/12.000000|12.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "12.000000|12.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 25,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T01:35:52",
+        "window_end_time": "2142-07-22T02:05:52",
+        "hours_since_admission": 12.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 81 mmHg, HR 90 bpm, SpO2 99%; latest glucose 187.26."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/12.500000|13.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "12.500000|13.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 27,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T02:35:52",
+        "window_end_time": "2142-07-22T03:05:52",
+        "hours_since_admission": 13.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 81 mmHg, HR 91 bpm, SpO2 100%; latest glucose 187.26."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/13.500000|14.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "13.500000|14.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 28,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T03:05:52",
+        "window_end_time": "2142-07-22T03:35:52",
+        "hours_since_admission": 14.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 83 mmHg, HR 88 bpm, SpO2 97%; latest glucose 187.26."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "208",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "209",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/14.000000|14.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "14.000000|14.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 29,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T03:35:52",
+        "window_end_time": "2142-07-22T04:05:52",
+        "hours_since_admission": 14.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 84 mmHg, HR 89 bpm, SpO2 100%; latest glucose 187.26."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/14.500000|15.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "14.500000|15.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 30,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T04:05:52",
+        "window_end_time": "2142-07-22T04:35:52",
+        "hours_since_admission": 15.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 80 mmHg, HR 90 bpm, SpO2 99%; latest glucose 187.26."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "220",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "221",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/15.000000|15.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "15.000000|15.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 31,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T04:35:52",
+        "window_end_time": "2142-07-22T05:05:52",
+        "hours_since_admission": 15.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 82 mmHg, HR 88 bpm, SpO2 101%; latest glucose 187.26."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/15.500000|16.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "15.500000|16.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 32,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T05:05:52",
+        "window_end_time": "2142-07-22T05:35:52",
+        "hours_since_admission": 16.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 17
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 82 mmHg, HR 88 bpm, SpO2 100%; latest glucose 174.36."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "233",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Anion gap is closing and bicarbonate is rising on insulin and potassium replacement."
+            },
+            {
+              "action_id": "235",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "236",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "238",
+              "action_name": "LAB_TEST Glucose",
+              "label": "acceptable",
+              "rationale": "Glucose is reasonable monitoring or support in this context. Anion gap is closing and bicarbonate is rising on insulin and potassium replacement."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/16.000000|16.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "16.000000|16.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 34,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T06:05:52",
+        "window_end_time": "2142-07-22T06:35:52",
+        "hours_since_admission": 17.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 84 mmHg, HR 87 bpm, SpO2 99%; latest glucose 174.36."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "253",
+              "action_name": "BODY_INPUT Insulin - Regular",
+              "label": "best_practice",
+              "rationale": "Insulin - Regular is appropriate for diabetic ketoacidosis."
+            },
+            {
+              "action_id": "254",
+              "action_name": "BODY_INPUT Dextrose 5%",
+              "label": "best_practice",
+              "rationale": "Dextrose 5% is appropriate for diabetic ketoacidosis."
+            }
+          ],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/17.000000|17.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "17.000000|17.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 35,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T06:35:52",
+        "window_end_time": "2142-07-22T07:05:52",
+        "hours_since_admission": 17.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 83 mmHg, HR 86 bpm, SpO2 97%; latest glucose 174.36."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/17.500000|18.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "17.500000|18.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 36,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T07:05:52",
+        "window_end_time": "2142-07-22T07:35:52",
+        "hours_since_admission": 18.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 7
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 83 mmHg, HR 86 bpm, SpO2 97%; latest glucose 174.36."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/18.000000|18.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "18.000000|18.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 37,
+      "window_metadata": {
+        "window_start_time": "2142-07-22T07:35:52",
+        "window_end_time": "2142-07-22T07:41:52",
+        "hours_since_admission": 18.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Anion gap is closing and bicarbonate is rising on insulin and potassium replacement. Current window: MAP 83 mmHg, HR 86 bpm, SpO2 100%; latest glucose 174.36."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": []
+        }
+      },
+      "sample_id": "scale/90000003_99000003/18.500000|19.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "18.500000|19.000000",
+      "window_duration_hours": 0.5
+    }
+  ],
+  "stay_id": "90000003_99000003"
+}

scale/labels/90000004_99000004.json

@@ -0,0 +1,2422 @@
+{
+  "subject_id": 90000004,
+  "icu_stay_id": 99000004,
+  "trajectory_metadata": {
+    "enter_time": "2177-01-09T02:31:08",
+    "leave_time": "2177-01-10T00:49:08",
+    "age": 81.30076647146805,
+    "gender": "Male",
+    "total_icu_stay_hours": 22.0,
+    "icu_duration_hours": 22.0,
+    "survived": false,
+    "icu_outcome": "Died after ICU",
+    "death_time": "2177-01-12T23:49:00",
+    "total_events": 353
+  },
+  "window_outputs": [
+    {
+      "window_index": 0,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T02:31:08",
+        "window_end_time": "2177-01-09T03:01:08",
+        "hours_since_admission": 0.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 17
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 57 mmHg, HR 122 bpm, SpO2 95%; latest hemoglobin 6.44."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "3",
+                "12"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "14",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "9",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL."
+            },
+            {
+              "action_id": "12",
+              "action_name": "LAB_TEST Hemoglobin",
+              "label": "acceptable",
+              "rationale": "Hemoglobin is reasonable monitoring or support in this context. Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL."
+            },
+            {
+              "action_id": "13",
+              "action_name": "LAB_TEST Lactate",
+              "label": "acceptable",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "12"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "12"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/0.000000|0.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.000000|0.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 1,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T03:01:08",
+        "window_end_time": "2177-01-09T03:31:08",
+        "hours_since_admission": 0.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 4
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 58 mmHg, HR 126 bpm, SpO2 95%; latest hemoglobin 6.44."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "18",
+                "12"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "14",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "20",
+              "action_name": "BODY_INPUT Packed Red Blood Cells",
+              "label": "best_practice",
+              "rationale": "Packed Red Blood Cells is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "12"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "12"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/0.500000|1.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.500000|1.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 2,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T03:31:08",
+        "window_end_time": "2177-01-09T04:01:08",
+        "hours_since_admission": 1.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 10
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 58 mmHg, HR 127 bpm, SpO2 96%; latest hemoglobin 6.44."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "23",
+                "12"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "14",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "21",
+              "action_name": "BODY_INPUT Packed Red Blood Cells",
+              "label": "best_practice",
+              "rationale": "Packed Red Blood Cells is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            },
+            {
+              "action_id": "28",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            },
+            {
+              "action_id": "29",
+              "action_name": "Prothrombin Complex Concentrate",
+              "label": "best_practice",
+              "rationale": "Prothrombin Complex Concentrate is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "12"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "12"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/1.000000|1.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.000000|1.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 3,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T04:01:08",
+        "window_end_time": "2177-01-09T04:31:08",
+        "hours_since_admission": 1.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 55 mmHg, HR 128 bpm, SpO2 97%; latest hemoglobin 6.44."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "32",
+                "12"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "14",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "12"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "12"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/1.500000|2.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "1.500000|2.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 4,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T04:31:08",
+        "window_end_time": "2177-01-09T05:01:08",
+        "hours_since_admission": 2.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 55 mmHg, HR 128 bpm, SpO2 94%; latest hemoglobin 6.44."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "35",
+                "12"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "14",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "40",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "12"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "12"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/2.000000|2.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "2.000000|2.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 6,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T05:31:08",
+        "window_end_time": "2177-01-09T06:01:08",
+        "hours_since_admission": 3.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 59 mmHg, HR 122 bpm, SpO2 95%; latest hemoglobin 6.44."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "46",
+                "12"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "14",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "51",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "12"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "12"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/3.000000|3.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "3.000000|3.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 7,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T06:01:08",
+        "window_end_time": "2177-01-09T06:31:08",
+        "hours_since_admission": 3.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 4
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 62 mmHg, HR 115 bpm, SpO2 96%; latest hemoglobin 6.44."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "55",
+                "12"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "14",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "53",
+              "action_name": "EGD",
+              "label": "best_practice",
+              "rationale": "EGD is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "12"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "12"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/3.500000|4.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "3.500000|4.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 8,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T06:31:08",
+        "window_end_time": "2177-01-09T07:01:08",
+        "hours_since_admission": 4.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 16
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 62 mmHg, HR 114 bpm, SpO2 97%; latest hemoglobin 7.45."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "62",
+                "57"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "59",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "57",
+              "action_name": "LAB_TEST Hemoglobin",
+              "label": "acceptable",
+              "rationale": "Hemoglobin is reasonable monitoring or support in this context. Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL."
+            },
+            {
+              "action_id": "58",
+              "action_name": "LAB_TEST Lactate",
+              "label": "acceptable",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL."
+            },
+            {
+              "action_id": "69",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL."
+            },
+            {
+              "action_id": "71",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "57"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "57"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/4.000000|4.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "4.000000|4.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 9,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T07:01:08",
+        "window_end_time": "2177-01-09T07:31:08",
+        "hours_since_admission": 4.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Ongoing hematemesis with hypotension and hemoglobin of 6.4 g/dL. Current window: MAP 65 mmHg, HR 112 bpm, SpO2 98%; latest hemoglobin 7.45."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Hemorrhagic shock",
+              "key_evidence": [
+                "74",
+                "57"
+              ]
+            },
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "59",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "57"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "57"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/4.500000|5.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "4.500000|5.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 10,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T07:31:08",
+        "window_end_time": "2177-01-09T08:01:08",
+        "hours_since_admission": 5.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 65 mmHg, HR 110 bpm, SpO2 97%; latest hemoglobin 7.45."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "59",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "82",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "57"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "57"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/5.000000|5.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "5.000000|5.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 11,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T08:01:08",
+        "window_end_time": "2177-01-09T08:31:08",
+        "hours_since_admission": 5.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 71 mmHg, HR 106 bpm, SpO2 96%; latest hemoglobin 7.45."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "59",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "57"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "57"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/5.500000|6.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "5.500000|6.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 13,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T09:01:08",
+        "window_end_time": "2177-01-09T09:31:08",
+        "hours_since_admission": 6.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 68 mmHg, HR 102 bpm, SpO2 96%; latest hemoglobin 7.45."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "59",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "57"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "57"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/6.500000|7.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "6.500000|7.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 14,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T09:31:08",
+        "window_end_time": "2177-01-09T10:01:08",
+        "hours_since_admission": 7.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 71 mmHg, HR 104 bpm, SpO2 95%; latest hemoglobin 7.45."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "59",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "104",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "57"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "57"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/7.000000|7.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "7.000000|7.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 15,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T10:01:08",
+        "window_end_time": "2177-01-09T10:31:08",
+        "hours_since_admission": 7.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 71 mmHg, HR 103 bpm, SpO2 96%; latest hemoglobin 7.45."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Anticoagulation-associated coagulopathy",
+              "key_evidence": [
+                "59",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "57"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "57"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/7.500000|8.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "7.500000|8.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 16,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T10:31:08",
+        "window_end_time": "2177-01-09T11:01:08",
+        "hours_since_admission": 8.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 16
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 72 mmHg, HR 104 bpm, SpO2 93%; latest hemoglobin 7.66."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "116",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Hemodynamics improve after transfusion and endoscopic hemostasis."
+            },
+            {
+              "action_id": "118",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            },
+            {
+              "action_id": "120",
+              "action_name": "LAB_TEST Hemoglobin",
+              "label": "acceptable",
+              "rationale": "Hemoglobin is reasonable monitoring or support in this context. Hemodynamics improve after transfusion and endoscopic hemostasis."
+            },
+            {
+              "action_id": "121",
+              "action_name": "LAB_TEST Lactate",
+              "label": "acceptable",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Hemodynamics improve after transfusion and endoscopic hemostasis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "120"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "120"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/8.000000|8.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "8.000000|8.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 17,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T11:01:08",
+        "window_end_time": "2177-01-09T11:31:08",
+        "hours_since_admission": 8.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 69 mmHg, HR 101 bpm, SpO2 95%; latest hemoglobin 7.66."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "120"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "120"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/8.500000|9.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "8.500000|9.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 18,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T11:31:08",
+        "window_end_time": "2177-01-09T12:01:08",
+        "hours_since_admission": 9.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 73 mmHg, HR 103 bpm, SpO2 95%; latest hemoglobin 7.66."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "134",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            },
+            {
+              "action_id": "135",
+              "action_name": "Heparin",
+              "label": "potentially_harmful",
+              "rationale": "Heparin started within 12 hours of endoscopic hemostasis risks rebleeding."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "120"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "120"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/9.000000|9.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "9.000000|9.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 20,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T12:31:08",
+        "window_end_time": "2177-01-09T13:01:08",
+        "hours_since_admission": 10.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 71 mmHg, HR 102 bpm, SpO2 95%; latest hemoglobin 7.66."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "146",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "120"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "120"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/10.000000|10.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "10.000000|10.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 21,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T13:01:08",
+        "window_end_time": "2177-01-09T13:31:08",
+        "hours_since_admission": 10.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Hemodynamics improve after transfusion and endoscopic hemostasis. Current window: MAP 70 mmHg, HR 101 bpm, SpO2 94%; latest hemoglobin 7.66."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "120"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "120"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/10.500000|11.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "10.500000|11.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 22,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T13:31:08",
+        "window_end_time": "2177-01-09T14:01:08",
+        "hours_since_admission": 11.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 72 mmHg, HR 101 bpm, SpO2 96%; latest hemoglobin 7.66."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "157",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "120"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "120"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/11.000000|11.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "11.000000|11.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 23,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T14:01:08",
+        "window_end_time": "2177-01-09T14:31:08",
+        "hours_since_admission": 11.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 70 mmHg, HR 100 bpm, SpO2 95%; latest hemoglobin 7.66."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "120"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "120"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/11.500000|12.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "11.500000|12.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 24,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T14:31:08",
+        "window_end_time": "2177-01-09T15:01:08",
+        "hours_since_admission": 12.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 16
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 72 mmHg, HR 100 bpm, SpO2 95%; latest hemoglobin 7.93."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "169",
+              "action_name": "LAB_TEST Hemoglobin",
+              "label": "acceptable",
+              "rationale": "Hemoglobin is reasonable monitoring or support in this context. Hemoglobin and blood pressure remain stable after hemostasis."
+            },
+            {
+              "action_id": "170",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Hemoglobin and blood pressure remain stable after hemostasis."
+            },
+            {
+              "action_id": "171",
+              "action_name": "LAB_TEST Lactate",
+              "label": "acceptable",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Hemoglobin and blood pressure remain stable after hemostasis."
+            },
+            {
+              "action_id": "174",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "169"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "169"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/12.000000|12.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "12.000000|12.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 25,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T15:01:08",
+        "window_end_time": "2177-01-09T15:31:08",
+        "hours_since_admission": 12.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 72 mmHg, HR 99 bpm, SpO2 96%; latest hemoglobin 7.93."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "169"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "169"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/12.500000|13.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "12.500000|13.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 27,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T16:01:08",
+        "window_end_time": "2177-01-09T16:31:08",
+        "hours_since_admission": 13.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 74 mmHg, HR 100 bpm, SpO2 95%; latest hemoglobin 7.93."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "169"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "169"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/13.500000|14.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "13.500000|14.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 28,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T16:31:08",
+        "window_end_time": "2177-01-09T17:01:08",
+        "hours_since_admission": 14.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 73 mmHg, HR 99 bpm, SpO2 95%; latest hemoglobin 7.93."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "198",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "169"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "169"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/14.000000|14.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "14.000000|14.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 29,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T17:01:08",
+        "window_end_time": "2177-01-09T17:31:08",
+        "hours_since_admission": 14.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 71 mmHg, HR 97 bpm, SpO2 94%; latest hemoglobin 7.93."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "169"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "169"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/14.500000|15.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "14.500000|15.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 30,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T17:31:08",
+        "window_end_time": "2177-01-09T18:01:08",
+        "hours_since_admission": 15.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 71 mmHg, HR 101 bpm, SpO2 96%; latest hemoglobin 7.93."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "209",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "169"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "169"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/15.000000|15.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "15.000000|15.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 31,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T18:01:08",
+        "window_end_time": "2177-01-09T18:31:08",
+        "hours_since_admission": 15.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 68 mmHg, HR 104 bpm, SpO2 93%; latest hemoglobin 7.93."
+          },
+          "active_risks": []
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "169"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "169"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/15.500000|16.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "15.500000|16.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 32,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T18:31:08",
+        "window_end_time": "2177-01-09T19:01:08",
+        "hours_since_admission": 16.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 16
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Hemoglobin and blood pressure remain stable after hemostasis. Current window: MAP 63 mmHg, HR 113 bpm, SpO2 95%; latest hemoglobin 6.69."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "225",
+                "214"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "221",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Hemoglobin and blood pressure remain stable after hemostasis."
+            },
+            {
+              "action_id": "223",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            },
+            {
+              "action_id": "225",
+              "action_name": "LAB_TEST Hemoglobin",
+              "label": "acceptable",
+              "rationale": "Hemoglobin is reasonable monitoring or support in this context. Hemoglobin and blood pressure remain stable after hemostasis."
+            },
+            {
+              "action_id": "226",
+              "action_name": "LAB_TEST Lactate",
+              "label": "acceptable",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Hemoglobin and blood pressure remain stable after hemostasis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "225"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "225"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/16.000000|16.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "16.000000|16.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 34,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T19:31:08",
+        "window_end_time": "2177-01-09T20:01:08",
+        "hours_since_admission": 17.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 55 mmHg, HR 120 bpm, SpO2 97%; latest hemoglobin 6.69."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "225",
+                "233"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "239",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            },
+            {
+              "action_id": "241",
+              "action_name": "BODY_INPUT Packed Red Blood Cells",
+              "label": "best_practice",
+              "rationale": "Packed Red Blood Cells is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "225"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "225"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/17.000000|17.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "17.000000|17.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 35,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T20:01:08",
+        "window_end_time": "2177-01-09T20:31:08",
+        "hours_since_admission": 17.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 4
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 56 mmHg, HR 120 bpm, SpO2 93%; latest hemoglobin 6.69."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "225",
+                "242"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "245",
+              "action_name": "Code Status DNR / DNI",
+              "label": "best_practice",
+              "rationale": "Code Status is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "225"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "225"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/17.500000|18.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "17.500000|18.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 36,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T20:31:08",
+        "window_end_time": "2177-01-09T21:01:08",
+        "hours_since_admission": 18.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 13
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 58 mmHg, HR 118 bpm, SpO2 94%; latest hemoglobin 6.59."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "246",
+                "251"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "246",
+              "action_name": "LAB_TEST Hemoglobin",
+              "label": "acceptable",
+              "rationale": "Hemoglobin is reasonable monitoring or support in this context. Recurrent hypotension and falling hemoglobin suggest rebleeding."
+            },
+            {
+              "action_id": "247",
+              "action_name": "LAB_TEST Lactate",
+              "label": "acceptable",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Recurrent hypotension and falling hemoglobin suggest rebleeding."
+            },
+            {
+              "action_id": "257",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "246"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "246"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/18.000000|18.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "18.000000|18.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 37,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T21:01:08",
+        "window_end_time": "2177-01-09T21:31:08",
+        "hours_since_admission": 18.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 5
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 60 mmHg, HR 117 bpm, SpO2 95%; latest hemoglobin 6.59."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "246",
+                "260"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "259",
+              "action_name": "XRAY CHEST (PORTABLE AP)",
+              "label": "best_practice",
+              "rationale": "CHEST (PORTABLE AP) is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "246"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "246"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/18.500000|19.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "18.500000|19.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 38,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T21:31:08",
+        "window_end_time": "2177-01-09T22:01:08",
+        "hours_since_admission": 19.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 59 mmHg, HR 115 bpm, SpO2 98%; latest hemoglobin 6.59."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "246",
+                "264"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "270",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "246"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "246"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/19.000000|19.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "19.000000|19.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 39,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T22:01:08",
+        "window_end_time": "2177-01-09T22:31:08",
+        "hours_since_admission": 19.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 61 mmHg, HR 115 bpm, SpO2 95%; latest hemoglobin 6.59."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "246",
+                "272"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "246"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "246"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/19.500000|20.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "19.500000|20.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 41,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T23:01:08",
+        "window_end_time": "2177-01-09T23:31:08",
+        "hours_since_admission": 20.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 4
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 62 mmHg, HR 113 bpm, SpO2 96%; latest hemoglobin 7.14."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "289",
+                "286"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "289",
+              "action_name": "LAB_TEST Hemoglobin",
+              "label": "acceptable",
+              "rationale": "Hemoglobin is reasonable monitoring or support in this context. Recurrent hypotension and falling hemoglobin suggest rebleeding."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "289"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "289"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/20.500000|21.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "20.500000|21.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 42,
+      "window_metadata": {
+        "window_start_time": "2177-01-09T23:31:08",
+        "window_end_time": "2177-01-10T00:01:08",
+        "hours_since_admission": 21.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 12
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 62 mmHg, HR 113 bpm, SpO2 95%; latest hemoglobin 7.14."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "289",
+                "294"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "290",
+              "action_name": "LAB_TEST Lactate",
+              "label": "acceptable",
+              "rationale": "Lactate is reasonable monitoring or support in this context. Recurrent hypotension and falling hemoglobin suggest rebleeding."
+            },
+            {
+              "action_id": "291",
+              "action_name": "LAB_TEST INR(PT)",
+              "label": "acceptable",
+              "rationale": "INR(PT) is reasonable monitoring or support in this context. Recurrent hypotension and falling hemoglobin suggest rebleeding."
+            },
+            {
+              "action_id": "300",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "289"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "289"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/21.000000|21.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "21.000000|21.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 43,
+      "window_metadata": {
+        "window_start_time": "2177-01-10T00:01:08",
+        "window_end_time": "2177-01-10T00:31:08",
+        "hours_since_admission": 21.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 62 mmHg, HR 113 bpm, SpO2 95%; latest hemoglobin 7.14."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "289",
+                "302"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "289"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "289"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/21.500000|22.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "21.500000|22.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 44,
+      "window_metadata": {
+        "window_start_time": "2177-01-10T00:31:08",
+        "window_end_time": "2177-01-10T00:49:08",
+        "hours_since_admission": 22.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Recurrent hypotension and falling hemoglobin suggest rebleeding. Current window: MAP 61 mmHg, HR 112 bpm, SpO2 95%; latest hemoglobin 7.14."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Recurrent upper GI bleeding",
+              "key_evidence": [
+                "289",
+                "305"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "311",
+              "action_name": "BODY_INPUT Pantoprazole",
+              "label": "best_practice",
+              "rationale": "Pantoprazole is appropriate for upper gastrointestinal bleeding from a gastric ulcer."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Therapeutic or prophylactic anticoagulation",
+              "rationale": "Active ulcer bleeding with recent transfusion contraindicates anticoagulation.",
+              "key_evidence": [
+                "289"
+              ]
+            },
+            {
+              "contraindicated_action": "NSAID administration",
+              "rationale": "NSAIDs increase the risk of recurrent ulcer bleeding.",
+              "key_evidence": [
+                "289"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000004_99000004/22.000000|22.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "22.000000|22.500000",
+      "window_duration_hours": 0.5
+    }
+  ],
+  "stay_id": "90000004_99000004"
+}

scale/labels/90000005_99000005.json

@@ -0,0 +1,1590 @@
+{
+  "subject_id": 90000005,
+  "icu_stay_id": 99000005,
+  "trajectory_metadata": {
+    "enter_time": "2128-05-30T17:48:33",
+    "leave_time": "2128-05-31T08:42:33",
+    "age": 76.90278452734049,
+    "gender": "Female",
+    "total_icu_stay_hours": 14.0,
+    "icu_duration_hours": 14.0,
+    "survived": false,
+    "icu_outcome": "Died after ICU",
+    "death_time": "2128-06-02T00:42:00",
+    "total_events": 236
+  },
+  "window_outputs": [
+    {
+      "window_index": 0,
+      "window_metadata": {
+        "window_start_time": "2128-05-30T17:48:33",
+        "window_end_time": "2128-05-30T18:18:33",
+        "hours_since_admission": 0.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 14
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis. Current window: MAP 104 mmHg, HR 108 bpm, SpO2 85%; latest ntprobnp 14612.4."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiogenic pulmonary edema",
+              "key_evidence": [
+                "4",
+                "13",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "9",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis."
+            },
+            {
+              "action_id": "12",
+              "action_name": "Non-invasive Ventilation",
+              "label": "best_practice",
+              "rationale": "Non-invasive Ventilation is appropriate for acute decompensated heart failure with pulmonary edema."
+            },
+            {
+              "action_id": "13",
+              "action_name": "LAB_TEST NTproBNP",
+              "label": "acceptable",
+              "rationale": "NTproBNP is reasonable monitoring or support in this context. Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "4"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000005_99000005/0.000000|0.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.000000|0.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 1,
+      "window_metadata": {
+        "window_start_time": "2128-05-30T18:18:33",
+        "window_end_time": "2128-05-30T18:48:33",
+        "hours_since_admission": 0.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 8
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis. Current window: MAP 101 mmHg, HR 105 bpm, SpO2 89%; latest ntprobnp 14612.4."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiogenic pulmonary edema",
+              "key_evidence": [
+                "21",
+                "13",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "14",
+              "action_name": "LAB_TEST Creatinine",
+              "label": "acceptable",
+              "rationale": "Creatinine is reasonable monitoring or support in this context. Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis."
+            },
+            {
+              "action_id": "15",
+              "action_name": "LAB_TEST Potassium",
+              "label": "acceptable",
+              "rationale": "Potassium is reasonable monitoring or support in this context. Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis."
+            },
+            {
+              "action_id": "18",
+              "action_name": "Furosemide",
+              "label": "best_practice",
+              "rationale": "Furosemide is appropriate for acute decompensated heart failure with pulmonary edema."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "21"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000005_99000005/0.500000|1.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "0.500000|1.000000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 2,
+      "window_metadata": {
+        "window_start_time": "2128-05-30T18:48:33",
+        "window_end_time": "2128-05-30T19:18:33",
+        "hours_since_admission": 1.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 9
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "improving",
+            "rationale": "Oxygenation and work of breathing improve on non-invasive ventilation, nitrates, and diuresis. Current window: MAP 99 mmHg, HR 102 bpm, SpO2 89%; latest ntprobnp 14612.4."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiogenic pulmonary edema",
+              "key_evidence": [
+                "25",
+                "13",
+                "Pre-ICU summary"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "29",
+              "action_name": "BODY_INPUT Nitroglycerin",
+              "label": "best_practice",
+              "rationale": "Nitroglycerin is appropriate for acute decompensated heart failure with pulmonary edema."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "25"
+              ]
+            }
+          ]
+        }
+      },
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+                "96",
+                "81",
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+                "93"
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+              "action_id": "97",
+              "action_name": "Furosemide",
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+            "rationale": "Oxygenation is stable with a modest diuretic response. Current window: MAP 78 mmHg, HR 95 bpm, SpO2 94%; latest ntprobnp 14701."
+          },
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+              "risk_name": "Cardiogenic pulmonary edema",
+              "key_evidence": [
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+                "81",
+                "Pre-ICU summary"
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+                "130"
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+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "stable",
+            "rationale": "Oxygenation is stable with a modest diuretic response. Current window: MAP 72 mmHg, HR 92 bpm, SpO2 90%; latest ntprobnp 14701."
+          },
+          "active_risks": [
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+              "risk_name": "Cardiorenal syndrome",
+              "key_evidence": [
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+                "141"
+              ]
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+          ]
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+              "action_id": "140",
+              "action_name": "BODY_INPUT Nitroglycerin",
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+              "rationale": "Nitroglycerin is appropriate for acute decompensated heart failure with pulmonary edema."
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+              "contraindicated_action": "Large-volume intravenous fluid boluses",
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+        "hours_since_admission": 10.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 3
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock. Current window: MAP 72 mmHg, HR 95 bpm, SpO2 93%; latest ntprobnp 14701."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiorenal syndrome",
+              "key_evidence": [
+                "88",
+                "141"
+              ]
+            },
+            {
+              "risk_name": "Cardiogenic shock",
+              "key_evidence": [
+                "143",
+                "92"
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+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
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+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "144"
+              ]
+            },
+            {
+              "contraindicated_action": "Beta-blocker uptitration",
+              "rationale": "Beta-blockers worsen low-output heart failure during decompensation.",
+              "key_evidence": [
+                "143"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000005_99000005/10.500000|11.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
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+        "window_start_time": "2128-05-31T04:48:33",
+        "window_end_time": "2128-05-31T05:18:33",
+        "hours_since_admission": 11.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 7
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock. Current window: MAP 70 mmHg, HR 97 bpm, SpO2 93%; latest ntprobnp 14701."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiorenal syndrome",
+              "key_evidence": [
+                "88",
+                "151"
+              ]
+            },
+            {
+              "risk_name": "Cardiogenic shock",
+              "key_evidence": [
+                "146",
+                "92"
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+          ]
+        },
+        "action_review": {
+          "evaluations": [],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "147"
+              ]
+            },
+            {
+              "contraindicated_action": "Beta-blocker uptitration",
+              "rationale": "Beta-blockers worsen low-output heart failure during decompensation.",
+              "key_evidence": [
+                "146"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000005_99000005/11.000000|11.500000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "11.000000|11.500000",
+      "window_duration_hours": 0.5
+    },
+    {
+      "window_index": 23,
+      "window_metadata": {
+        "window_start_time": "2128-05-31T05:18:33",
+        "window_end_time": "2128-05-31T05:48:33",
+        "hours_since_admission": 11.5,
+        "current_window_hours": 0.5,
+        "num_current_events": 4
+      },
+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock. Current window: MAP 69 mmHg, HR 100 bpm, SpO2 92%; latest ntprobnp 14701."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiorenal syndrome",
+              "key_evidence": [
+                "88",
+                "151"
+              ]
+            },
+            {
+              "risk_name": "Cardiogenic shock",
+              "key_evidence": [
+                "154",
+                "92"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "152",
+              "action_name": "BODY_INPUT NaCl 0.9%",
+              "label": "potentially_harmful",
+              "rationale": "A fluid bolus in cardiogenic pulmonary edema is likely to worsen oxygenation."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "155"
+              ]
+            },
+            {
+              "contraindicated_action": "Beta-blocker uptitration",
+              "rationale": "Beta-blockers worsen low-output heart failure during decompensation.",
+              "key_evidence": [
+                "154"
+              ]
+            }
+          ]
+        }
+      },
+      "sample_id": "scale/90000005_99000005/11.500000|12.000000",
+      "label_availability": {
+        "patient_status": true,
+        "recommended_action": true,
+        "active_risks": true,
+        "red_flags": true
+      },
+      "window_key": "11.500000|12.000000",
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+      "window_index": 24,
+      "window_metadata": {
+        "window_start_time": "2128-05-31T05:48:33",
+        "window_end_time": "2128-05-31T06:18:33",
+        "hours_since_admission": 12.0,
+        "current_window_hours": 0.5,
+        "num_current_events": 16
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+      "reference_labels": {
+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock. Current window: MAP 67 mmHg, HR 100 bpm, SpO2 92%; latest ntprobnp 14472.3."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiorenal syndrome",
+              "key_evidence": [
+                "166",
+                "170"
+              ]
+            },
+            {
+              "risk_name": "Cardiogenic shock",
+              "key_evidence": [
+                "157",
+                "169"
+              ]
+            }
+          ]
+        },
+        "action_review": {
+          "evaluations": [
+            {
+              "action_id": "163",
+              "action_name": "Head of Bed 30 Degrees",
+              "label": "acceptable",
+              "rationale": "Head of Bed is reasonable monitoring or support in this context. Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock."
+            },
+            {
+              "action_id": "165",
+              "action_name": "LAB_TEST NTproBNP",
+              "label": "acceptable",
+              "rationale": "NTproBNP is reasonable monitoring or support in this context. Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock."
+            },
+            {
+              "action_id": "166",
+              "action_name": "LAB_TEST Creatinine",
+              "label": "acceptable",
+              "rationale": "Creatinine is reasonable monitoring or support in this context. Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock."
+            },
+            {
+              "action_id": "171",
+              "action_name": "Dobutamine",
+              "label": "best_practice",
+              "rationale": "Dobutamine is appropriate for acute decompensated heart failure with pulmonary edema."
+            }
+          ],
+          "red_flags": [
+            {
+              "contraindicated_action": "Large-volume intravenous fluid boluses",
+              "rationale": "Pulmonary edema and elevated filling pressures make fluid boluses harmful.",
+              "key_evidence": [
+                "158"
+              ]
+            },
+            {
+              "contraindicated_action": "Beta-blocker uptitration",
+              "rationale": "Beta-blockers worsen low-output heart failure during decompensation.",
+              "key_evidence": [
+                "157"
+              ]
+            }
+          ]
+        }
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+        "patient_assessment": {
+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock. Current window: MAP 67 mmHg, HR 105 bpm, SpO2 91%; latest ntprobnp 14472.3."
+          },
+          "active_risks": [
+            {
+              "risk_name": "Cardiorenal syndrome",
+              "key_evidence": [
+                "166",
+                "170"
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+              "contraindicated_action": "Beta-blocker uptitration",
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+            "rationale": "Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock. Current window: MAP 64 mmHg, HR 107 bpm, SpO2 91%; latest ntprobnp 14472.3."
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+              "risk_name": "Cardiorenal syndrome",
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+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock. Current window: MAP 65 mmHg, HR 106 bpm, SpO2 91%; latest ntprobnp 14472.3."
+          },
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+              "risk_name": "Cardiorenal syndrome",
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+              "contraindicated_action": "Beta-blocker uptitration",
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+              "key_evidence": [
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+          "overall": {
+            "label": "deteriorating",
+            "rationale": "Falling MAP, rising lactate, and low urine output indicate evolving cardiogenic shock. Current window: MAP 61 mmHg, HR 111 bpm, SpO2 88%; latest ntprobnp 14472.3."
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+              "risk_name": "Cardiorenal syndrome",
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+              "contraindicated_action": "Beta-blocker uptitration",
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