Nevin Manimala

Brief Bioinform. 2026 May 4;27(4):bbag406. doi: 10.1093/bib/bbag406.

ABSTRACT

The European Union (EU) enforces strict regulations on the traceability and labeling of genetically modified organisms (GMOs), including genome-edited (GE) lines produced through new genomic techniques (NGTs). Identifying GE organisms created by single nucleotide variations (SNVs) is however challenging, as a single SNV alone cannot unambiguously define a GE line. Recently, we introduced the concept of generating a genetic fingerprint to distinguish a specific GE rice line. This proof-of-concept approach integrated whole-genome sequencing (WGS)-based characterization with the Illumina technology, the public 3 K Rice Genomes (3KRG) database, and statistical feature-selection tools, to select and combine key genetic elements, including GE on-target site(s) and cultivar-specific 2-SNV barcodes, into a unique genetic fingerprint. In the present study, we expand this concept into a generalized data-driven framework allowing identification of multiple rice lines. Supported by newly developed bioinformatics and statistical feature-selection-based pipelines, this optimized strategy enables the generation of genetic fingerprints irrespective of a rice cultivar’s inclusion in publicly available databases like 3KRG. In addition, this refined strategy can leverage WGS data generated from both Illumina and Oxford Nanopore Technologies (ONT) platforms for fingerprint generation and GE line identification. Using two distinct in-house GE rice lines from different cultivars, along with various publicly available WGS datasets, we demonstrated the robustness, scalability, and specificity of this approach for reliable GE rice line identification. Our findings provide a methodological foundation for data-driven traceability of GE rice lines, reinforcing regulatory compliance, supporting intellectual property (IP) protection, and contributing to the responsible implementation of EU GMO/NGT legislation.

PMID:42537001 | DOI:10.1093/bib/bbag406

Ultrasound Obstet Gynecol. 2026 Jul 31. doi: 10.1002/uog.70289. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate, using transvaginal ultrasound imaging, the overlap between polycystic ovarian morphology (PCOM) and endometriosis, and to explore demographic and clinical factors associated with their coexistence across endometriosis phenotypes.

METHODS: This was a retrospective cohort study of consecutive patients undergoing advanced transvaginal ultrasound examination for suspected or previously diagnosed endometriosis at a tertiary gynecological ultrasound clinic between February 2023 and June 2023. Ultrasound was performed following the International Deep Endometriosis Analysis consensus and the International Ovarian Tumor Analysis framework guided lesion characterization, with PCOM defined as per the 2018 and the modified 2023 International Polycystic Ovary Syndrome Guideline (≥ 20 follicles measuring 2-9 mm in diameter and/or ovarian volume > 10 mL in the absence of a dominant follicle, cyst or corpus luteum). Endometriosis phenotypes were classified sonographically as superficial (SE), ovarian (OE) or deep (DE) endometriosis. Demographic and clinical variables were compared between participants with endometriosis alone and those with concurrent endometriosis and PCOM. Logistic regression analysis was performed within the endometriosis-positive subgroup using PCOM as the dependent variable in a univariable model including age and a multivariable model including age and body mass index (BMI). An age-restricted (25-35 years) sensitivity analysis compared the frequencies of any endometriosis and of individual endometriosis phenotypes between participants with and those without PCOM. A secondary analysis within this subgroup compared clinical and demographic characteristics between endometriosis participants with and those without concurrent PCOM.

RESULTS: Among 165 included patients, 62.4% (n = 103) were diagnosed with endometriosis, 37.0% (n = 61) demonstrated PCOM and 35.0% (36/103) of those with endometriosis had concurrent PCOM. In the whole cohort, the frequency of any endometriosis did not differ significantly between participants with and those without PCOM. DE was less frequent among those with PCOM, whereas differences in the frequency of OE and SE between participants with and those without PCOM were not statistically significant. Compared to individuals with endometriosis alone, those with concurrent PCOM were significantly younger and had lower body weight. The proportions of nulligravidae and of nulliparae were also higher. In age-restricted analyses limited to participants aged 25-35 years, no significant differences were observed between those with and those without PCOM for the presence of any endometriosis or for any individual endometriosis phenotype. However, among endometriosis-positive participants, increasing age was associated with lower odds of concurrent PCOM in both the univariable model including age (odds ratio (OR), 0.83 (95% CI, 0.77-0.90) per 1-year increase; P < 0.001) and the multivariable model including age and BMI (OR, 0.84 (95% CI, 0.77-0.92) per 1-year increase; P < 0.001), whereas BMI was not independently associated with PCOM (OR, 0.99 (95% CI, 0.91-1.09) per 1 kg/m² increase; P = 0.874). In the sensitivity analysis restricted to participants aged 25-35 years, the differences observed previously in age, weight, gravidity and parity were no longer statistically significant.

CONCLUSIONS: Endometriosis and PCOM can coexist on ultrasound in a tertiary referral cohort. However, the observed between-group differences were strongly influenced by age, and our findings should be interpreted as exploratory and hypothesis-generating rather than confirmatory. Prospective studies incorporating endocrine characterization, standardized cycle-phase assessment and side-specific ovarian assessment are needed to clarify the clinical and biological significance of this coexistence.

PMID:42536999 | DOI:10.1002/uog.70289

JMIR Med Inform. 2026 Jul 31;14:e84260. doi: 10.2196/84260.

ABSTRACT

BACKGROUND: Postoperative nausea and vomiting are common complications after anesthesia. However, vomiting represents a clinically distinct and objectively measurable endpoint.

OBJECTIVE: This study aimed to develop and internally validate predictive models for postoperative vomiting within 24 hours using structured perioperative data and unstructured clinical text, while introducing a structured framework that separates feature construction from interpretability using large language models (LLMs).

METHODS: We analyzed 33,460 anesthesia records from a single center (2019-2022). Two temporally defined prediction tasks were constructed to reflect real-world clinical decision-making and prevent information leakage: a preoperative model using variables available before anesthesia induction, and a perioperative model using variables available up to the end of surgery. Structured data were modeled using machine learning algorithms (logistic regression, Extreme Gradient Boosting, Light Gradient Boosting Machine [LightGBM]). Unstructured clinical text was incorporated through a deterministic, concept-driven preprocessing pipeline, where LLMs were used solely for normalization (temperature=0) without feature generation, followed by rule-based concept mapping and feature encoding. Post hoc interpretability was further supported using an LLM-based Question Answering Chain module. Model performance was evaluated using receiver operating characteristic-area under the curve (AUC), precision-recall AUC, calibration metrics, and threshold-based operating characteristics. Classification thresholds were selected using the Youden J statistic, and all metrics were reported with 95% CIs derived from bootstrap resampling. Decision curve analysis was performed to assess clinical utility.

RESULTS: A total of 33,460 surgical procedures were included, of which 3607 (10.8%) experienced postoperative vomiting within 24 hours. In the preoperative task, LightGBM achieved an AUC of 0.729 (95% CI 0.706-0.749), compared with 0.610 (95% CI 0.588-0.632) for the Apfel score. In the end-of-surgery task, LightGBM achieved an AUC of 0.735 (95% CI 0.714-0.757). At the Youden-optimal threshold, the negative predictive value exceeded 0.95 across all models. Decision curve analysis demonstrated positive net benefit across clinically relevant threshold probabilities. Incorporating text-derived features provided modest improvements, while LLM-based explanation modules generated structured, natural-language explanations intended to enhance interpretability without substantially improving predictive performance.

CONCLUSIONS: Machine learning models can effectively predict postoperative vomiting within 24 hours using perioperative data. The proposed framework demonstrates that LLMs can be integrated in a controlled and reproducible manner-restricted to deterministic normalization and post hoc reasoning-to generate natural-language explanations intended to enhance the interpretability of model predictions, without introducing information leakage or altering predictive modeling. As no formal clinician-based evaluation was conducted, this interpretability benefit cannot yet be objectively confirmed, and the generated explanations should be regarded as a useful interpretability aid to be validated in future clinician-centered studies. External, multicenter validation is required before broader clinical applicability can be assumed.

PMID:42536998 | DOI:10.2196/84260

J Occup Health. 2026 Jul 31:uiag044. doi: 10.1093/joccuh/uiag044. Online ahead of print.

ABSTRACT

OBJECTIVES: Unpredictable work schedule changes have emerged as a distinct occupational health concern, yet their association with chronic sleep disorders remains understudied. Given the contrasting institutional contexts of Korea and Europe, we hypothesized that the association would differ in magnitude between the two regions and examined this using a dose-response framework based on advance notice timing.

METHODS: This cross-sectional study analyzed data from the 2017 Korean Working Conditions Survey and the 2015 European Working Conditions Survey. Habitual work schedule unpredictability, reflecting structural instability in working time arrangements, was assessed by advance notice timing. Sleep disorders were assessed using the validated Minimal Insomnia Symptom Scale. Stratified and sensitivity analyses were performed.

RESULTS: Unpredictable schedule changes were associated with higher odds of sleep disorders in Korea (adjusted OR = 2.544, 95% CI: 2.195-2.948) and Europe (adjusted OR = 1.787, 95% CI: 1.543-2.070), with a formally confirmed regional difference (p for interaction < 0.0001). Risk increased progressively as advance notice shortened, demonstrating a clear dose-response relationship. Among subgroups, a statistically significant interaction was identified for long working hours in Korea, with stronger associations observed among those without overtime.

CONCLUSION: Habitual work schedule unpredictability is a distinct occupational risk factor for sleep disorders. The observed dose-response pattern suggests that greater advance notice may be associated with lower risk, highlighting schedule predictability as a potential occupational health priority warranting regulatory and organizational attention.

PMID:42536410 | DOI:10.1093/joccuh/uiag044

JAMA Health Forum. 2026 Jul 2;7(7):e262492. doi: 10.1001/jamahealthforum.2026.2492.

ABSTRACT

IMPORTANCE: US nursing home closures, whether planned or unexpected, can disrupt continuity of care, place additional burdens on remaining facilities, and disproportionately affect vulnerable populations. It is important to understand the trends and factors associated with these closures, as such knowledge can inform policy decisions, guide resource allocation, and help develop strategies to mitigate negative effects on both residents and the broader health care system.

OBJECTIVE: To examine nursing home operational dynamics in the US and to identify how facilities transition through openings, closures, and changes of ownership (CHOW).

DESIGN, SETTING, AND PARTICIPANTS: A longitudinal cohort study used 40 years of data from the Centers for Medicare & Medicaid Services Provider of Services File, covering the period from 1985 through June 2025. Facility trajectories were examined using physical location identifiers rather than facility names or provider identifiers.

MAIN OUTCOMES AND MEASURES: Facility lifecycle status (active, closed, or reopened), CHOW events, net changes in certified bed capacity, facility size, availability of specialized beds for patients with dementia, Medicare and Medicaid participation, and staffing intensity were assessed. Descriptive statistics and multivariate logistic regression were used to analyze trends and differences between closed and active facilities.

RESULTS: A total of 39 449 records were analyzed, representing 33 110 unique physical locations and 80 257 event records. Nearly half of all entities followed an entry-exit trajectory without any CHOW, accounting for 46.29% (n = 15 328). A substantial proportion of entities remained active while experiencing at least 1 CHOW (20.48% [n = 6780]). CHOW events accounted for 13 053 occurrences (16.26%) of lifecycle activity, and capacity changes were increasingly concentrated in recent years in select states. Overall, organizational restructuring and within-facility capacity adjustment became more prominent over time than entry or exit.

CONCLUSIONS AND RELEVANCE: This study found that nursing home markets were characterized by continuous organizational change, with ownership transitions and capacity reconfiguration increasingly substituting for entry and exit. Examining the location-based life cycle of the facility shows that closure often reflects restructuring within evolving ownership structures rather than a single terminal event. These findings suggest that nursing home policy and oversight should attend to ownership transitions and capacity reconfiguration, alongside measures of facility entry and exit.

PMID:42536385 | DOI:10.1001/jamahealthforum.2026.2492

J Vis. 2026 Jul 1;26(7):18. doi: 10.1167/jov.26.7.18.

ABSTRACT

The spatial suppression of a high-probability distractor location (HPDL) acquired through statistical learning critically reduces its attentional priority. The present study conducted four experiments to systematically investigate the mechanisms underlying how this learned suppression generalizes to novel tasks. Specifically, we focused on how generalization is influenced by the priority-enhancing attentional capture of a salient target and the competing demands of a newly introduced suppression process. Following training, Experiments 1 and 2 employed a salient color singleton target to test attentional capture. Experiment 1 reused training stimuli, whereas Experiment 2 introduced novel shapes to determine if the capture effect of novel stimuli would completely override the learned suppression. Experiment 3 introduced a new suppression process to evaluate the impact of competing suppression demands. Finally, Experiment 4 utilized a feature search paradigm as a test task devoid of color singletons to eliminate these interfering factors. The results revealed that the intense capture effect of novel stimuli in Experiment 2 completely masked the generalization. Furthermore, sliding window analyses in Experiments 1 and 3 uncovered a dynamic process where generalization only manifested during the middle of the test phase, indicating a competition between these newly introduced factors and the previously acquired suppression. Conversely, eliminating all interference in Experiment 4 yielded a highly stable and persistent generalization of the HPDL suppression. These findings demonstrate that novel interfering factors drive a dynamic adjustment of the HPDL weight within the priority map, revealing the highly flexible and adaptive nature of human attentional control.

PMID:42536381 | DOI:10.1167/jov.26.7.18

JAMA Netw Open. 2026 Jul 1;9(7):e2625985. doi: 10.1001/jamanetworkopen.2026.25985.

ABSTRACT

IMPORTANCE: Prior research found differences in the perceived safety benefits from firearm exposure among diverse gun owners. More women have bought firearms in recent years, resulting in a growing proportion of women who own guns.

OBJECTIVE: To examine differences in perceptions of safety among US women, including women who personally own firearms.

DESIGN, SETTING, AND PARTICIPANTS: This descriptive survey study used data from the nationally representative National Survey of Gun Policy, fielded January 6 to 24, 2025. Participants included members of the AmeriSpeak panel who were invited to, and completed, the survey (survey completion rate, 69.8%; N = 2977) online or by telephone in English or Spanish. This study focused specifically on women respondents.

EXPOSURES: Women respondents were stratified by whether they personally owned a gun, lived in a home with a gun that did not belong to them, or had no guns in the home.

MAIN OUTCOMES AND MEASURES: The main outcome was differences in respondents affirming whether “personally owning a gun will make me safer” and “I would feel safer if more people were allowed to legally carry guns.” These perceptions were also examined across racial and ethnic subgroups of gun-owning women and by whether protection in or out of the home were important reasons for ownership. Differences were assessed using survey-weighted logistic regression models.

RESULTS: A total of 1411 women completed the survey. The mean (SE) age of women respondents was 48.4 (0.6) years; 12.8% self-identified as non-Hispanic Black, 17.4% as Hispanic, 60.3% as non-Hispanic White, and 9.5% as non-Hispanic other race. Overall, 41.1% (95% CI, 37.7%-44.4%) of women affirmed that personally owning a gun would make them safer, and 21.3% (95% CI, 18.5%-24.0%) agreed they would feel safer if more people were allowed to legally carry guns. Affirmations were significantly higher among gun-owning women (69.7% [95% CI, 63.0%-76.3%] and 35.3% [95% CI, 28.6%-42.0%], respectively), compared with those living in homes with guns (48.9% [95% CI, 40.6%-57.1%] and 22.2% [95% CI, 15.1%-29.3%]) and gun-free homes (26.0% [95% CI, 22.5%-29.6%] and 14.8% [95% CI, 11.9%-17.8%]). Among gun owners, agreement with perceived safety gains from ownership ranged from 63.2% (95% CI, 36.7%-89.8%) among non-Hispanic other to 72.6% (95% CI, 56.1%-89.1%) among Hispanic respondents, and perceived safety from others carrying from 20.1% (95% CI, 9.4%-30.9%) among Black to 40.5% (95% CI, 13.4%-67.6%) among non-Hispanic other respondents, with no significant differences by racial and ethnic groups. There were no significant differences when comparing those who did vs did not report that protection in the home or out of the home were important reasons for ownership.

CONCLUSIONS AND RELEVANCE: In this survey study of US women, more than half of overall respondents perceived they would not feel safer with greater exposure to firearms, although results varied by personal gun ownership. As gun ownership diversifies, these findings highlight the importance of attending to perceptions of safety in discussions of interventions to reduce gun violence.

PMID:42536373 | DOI:10.1001/jamanetworkopen.2026.25985

JAMA Netw Open. 2026 Jul 1;9(7):e2626522. doi: 10.1001/jamanetworkopen.2026.26522.

ABSTRACT

IMPORTANCE: Remote patient monitoring (RPM), including self-measured blood pressure monitoring with clinician review and telehealth-supported feedback, can support hypertension management. However, RPM use and related care continuity after switching from Medicare fee-for-service (FFS) to Medicare Advantage (MA) remain unclear.

OBJECTIVE: To compare RPM adoption, clinician continuity, and hypertension-related acute care utilization among beneficiaries who remained in Medicare FFS vs switched to MA plans, categorized as value-based contract (VBC) proxy or non-VBC.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study with an observational difference-in-differences design with propensity score matching used data from 2016 to 2022 Medicare enrollment, FFS claims, and MA encounter data. Beneficiaries were aged 65 years or older with prevalent diagnosed hypertension in 2018 and continuous enrollment in Parts A and B in 2018. Treated groups switched from FFS to MA in January 2019 and remained enrolled through 2022; comparators remained in FFS. Follow-up extended from January 1, 2019, through December 31, 2022. Data analysis was conducted from April to July 2025.

EXPOSURE: Switching from Medicare FFS to MA-VBC proxy or MA non-VBC in 2019.

MAIN OUTCOMES AND MEASURES: The primary outcome was annual RPM adoption during hypertension-related visits; secondary outcomes included clinician loss without replacement, clinician switching or substitution, and hypertension-related emergency department (ED) visits and hospitalizations.

RESULTS: Matched samples included 281 620 beneficiaries, with 46 833 MA-VBC proxy plan switchers and 46 833 FFS comparators (27 920 [59.6%] aged 71 years or older and 27 685 female [59.1%] in each group) and 93 977 MA non-VBC switchers and 93 977 FFS comparators (67 188 [71.5%] aged 71 years or older; 53 122 female [56.5%] in each group). Common comorbidities included diabetes, chronic kidney disease, and heart failure. Switching to MA was associated with lower RPM adoption in 2022 (MA-VBC proxy: odds ratio [OR], 0.55; 95% CI, 0.42-0.72; -0.63 percentage points; non-VBC: OR, 0.73; 95% CI, 0.54-0.99; -0.52 percentage points), greater clinician loss without replacement (MA-VBC proxy: OR, 1.27; 95% CI, 1.23-1.32; 3.41 percentage points; MA non-VBC: OR, 1.09; 95% CI, 1.06-1.12; 0.83 percentage points), and higher hypertension-related hospitalizations (MA-VBC proxy: OR, 1.75; 95% CI, 1.48-2.06; MA non-VBC: OR, 1.94; 95% CI 1.71-2.19; 1.56 percentage points in both comparisons). Event-study analyses showed postswitch divergence through 2022.

CONCLUSIONS AND RELEVANCE: In this cohort study of older Medicare beneficiaries with hypertension, switching from FFS to MA was associated with lower RPM adoption, greater clinician discontinuity, and higher hypertension-related acute care use. These findings suggest that continuity safeguards and clearer payment or quality incentives during MA transitions may support remote monitoring and clinician follow-up for hypertension.

PMID:42536372 | DOI:10.1001/jamanetworkopen.2026.26522

JAMA Netw Open. 2026 Jul 1;9(7):e2626538. doi: 10.1001/jamanetworkopen.2026.26538.

ABSTRACT

IMPORTANCE: Perspectives of families from historically marginalized groups regarding pediatric oncology clinical trial participation are not well-represented in the literature.

OBJECTIVE: To describe clinician- and parent-perceived facilitators and barriers to clinical trial participation.

DESIGN, SETTING, AND PARTICIPANTS: This single-center cross-sectional study with an explanatory sequential mixed-methods design enrolled parents of Black and Hispanic children with cancer as well as pediatric oncology clinicians from a large pediatric cancer center in Boston, Massachusetts. Parent participants completed single-time point surveys, and a subset, purposively sampled based on self-identified race and ethnicity, language, and household material hardship (HMH; ie, food, housing, transportation, or utility insecurity), completed semistructured interviews from September to December 2021. Clinicians completed semistructured interviews from February to March 2022. Data were analyzed from April 2022 to October 2025.

MAIN OUTCOMES AND MEASURES: Key factors influencing clinical trial participation in pediatric oncology among parents from historically marginalized groups. Quantitative data were summarized descriptively. Interview transcripts were analyzed using thematic analysis and integrated along key domains.

RESULTS: A total of 60 parents completed the questionnaire; self-identified race and ethnicity included 5 Hispanic Black (8%), 10 Hispanic White (17%), 21 Hispanic other (35%), 21 non-Hispanic Black (35%), and 3 non-Hispanic White (5%) parents; most were mothers (51 [85%]). Twenty parents participated in interviews. Fifteen clinicians (10 [67%] female participants; 10 [67%] with ≥10 years caring for children with cancer) were interviewed, including 12 (80%) attendings and 3 (20%) advanced practice practitioners; most identified as non-Hispanic White (14 [93%]). Most families experienced HMH (44 [73%]) and reported high trust in their oncology team (mean [SD] score, 4.63 [0.65] of 5.00). Qualitatively, parents and clinicians aligned in identifying altruism and trustworthiness as facilitators to trial participation, while the informed consent discussion, non-English language preference, trial materials, and study requirements were participation barriers. Unlike clinicians, parents did not identify HMH or the experimental nature of trials as significant barriers to participation. Parents identified the desire for representation as a facilitator to participation, and clinicians identified gatekeeping as a barrier.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of pediatric oncology families from historically marginalized groups and clinicians, clinician- and parent-perceived barriers identified opportunities to increase equitable trial participation. Next steps include standardization of trial eligibility screening and systematic HMH screening and support to reduce gatekeeping.

PMID:42536371 | DOI:10.1001/jamanetworkopen.2026.26538

JAMA Netw Open. 2026 Jul 1;9(7):e2626547. doi: 10.1001/jamanetworkopen.2026.26547.

ABSTRACT

IMPORTANCE: Endotracheal aspirate culture (EAC) practices for evaluation of ventilator-associated infections (VAI) vary widely across pediatric hospitals, and overuse can contribute to overdiagnosis and overtreatment for VAI. Diagnostic stewardship strategies to optimize EAC testing practices may reduce overtesting and unnecessary antibiotic treatment.

OBJECTIVE: To evaluate the association of diagnostic stewardship of EACs using clinical decision support with culture rates, antibiotic use, and patient outcomes across a multicenter collaborative of pediatric intensive care units (PICUs).

DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter cohort study with a pre-post study design among the BrighT STAR (Testing Stewardship for Antibiotic Reduction) Quality Improvement (QI) Collaborative involving PICUs across the US between 2019 and 2023. Data were collected from the participating sites and from the Children’s Hospital Association Pediatric Health Information System and were analyzed from August to December 2025.

EXPOSURE: Participating PICUs conducted local QI programs focused on optimizing EAC practices, facilitated by the BrighT STAR collaborative.

MAIN OUTCOMES AND MEASURES: The primary outcome was the monthly rate of EACs per 100 ventilator-days. Secondary outcomes included rates of antibiotic initiations and antibiotic days of therapy, bronchoalveolar lavage cultures, readmissions, length of stay, ventilation duration, ventilation-free days, sepsis, and septic shock. Analysis included adjustment for seasonality.

RESULTS: Across 15 sites (median [IQR] unit size, 30 [25-38] beds), the study captured 106 967 ventilator-days preimplementation and 92 167 ventilator-days postimplementation. Comparing 24 months in the preimplementation period with the 18 months in the postimplementation period, the mean monthly EAC rate declined by 16% from a preimplementation to postimplementation rate of 7.80 to 6.55 cultures per 100 ventilator-days (relative rate [RR], 0.84; 95% CI, 0.78-0.90). The rate of antibiotic initiations remained stable (RR, 0.98; 95% CI, 0.89-1.08), as well as the antibiotic days of therapy rate (RR, 1.03; 95% CI, 0.95-1.11). There were no significant changes in the rates of bronchoalveolar lavage cultures, PICU length of stay, PICU or hospital readmissions, sepsis, septic shock, ventilation duration, or ventilator-free days.

CONCLUSIONS AND RELEVANCE: In this multicenter cohort study, diagnostic stewardship of EACs using clinical decision support led by multidisciplinary teams was associated with reduced EAC use in the PICU without safety concerns. Future work will determine optimal implementation strategies, assess sustainability and the cost impact of EAC stewardship.

PMID:42536370 | DOI:10.1001/jamanetworkopen.2026.26547