{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:08:23Z","timestamp":1786975703015,"version":"build-2736575974"},"reference-count":52,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Clinical data on hepatitis C virus (HCV) treatment rates in the United States are sparse.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate HCV treatment rates in the era of direct-acting antivirals (DAAs).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study used data from the deidentified Optum Cliniformatics Data Mart Database (2014-2021) on patients with HCV in the DAA and COVID-19 eras. The database includes patients with private health insurance in the US.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The treatment rate and changes over time were assessed with adjusted log-binomial regression, and factors associated with treatment were examined using multivariable logistic regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 133\u202f348 patients with HCV (79\u202f567 [59.7%] men; mean [SD] age, 59.7 [12.3] years; 4448 [3.3%] Asian, 24\u202f662 [18.5%] Black, and 74\u202f750 [56.1%] White individuals) were included; 38\u202f180 (26.8%) had HCV RNA data, and of those, 20\u202f277 (53.1%) had positive HCV RNA. Overall, 13\u202f214 patients with positive HCV RNA tests (65.2%) received DAA treatment; 6456 of 6634 patients treated with DAAs (97.3%) achieved sustained virologic response. After adjusting for age, sex, and race and ethnicity, the treatment rate in 2018 was 0.5 times greater than the rate in 2014 (adjusted prevalence ratio, 1.50; 95% CI, 1.42-1.59) but declined after 2018, decreasing from 64.8% to 61.2%, and especially after 2019, when it decreased to less than 60% (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). The number of patients with viremic HCV identified in between April 2020 and March 2021 also decreased to 496 from 2761 and 3258 in the preceding 2 years. Receiving care from a gastroenterologist or infectious disease specialist with advanced care practitioner (ie, nurse practitioner, physician assistant, or clinical nurse specialist) was independently associated with greater odds of DAA treatment (adjusted odds ratio [aOR], 1.64; 95% CI, 1.07-1.50). Patients with decompensated cirrhosis and\/or hepatocellular carcinoma (HCC) were 31% less likely to receive treatment compared with those without (aOR, 0.69; 95% CI, 0.54-0.90).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, less than two-thirds of insured patients with viremic HCV received DAA treatment, with declines in both the treatment rate and the number of viremic HCV diagnoses since 2019 and especially during the COVID-19 pandemic. Further efforts are needed to increase HCV diagnosis and treatment, especially for those with cirrhosis and HCC. An urgent call for nationwide actions to improve access to DAA treatment, community outreach programs, and specialists through referral pipelines is needed in the United States to stay on track to meet the World Health Organization goal of reducing the burden of viral hepatitis with the eventual goal to eliminate viral hepatitis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.45424","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T11:01:49Z","timestamp":1670410909000},"page":"e2245424","source":"Crossref","is-referenced-by-count":55,"title":["Characteristics and Treatment Rate of Patients With Hepatitis C Virus Infection in the Direct-Acting Antiviral Era and During the COVID-19 Pandemic in the United States"],"prefix":"10.1001","volume":"5","author":[{"given":"Vy H.","family":"Nguyen","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Kam","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yee Hui","family":"Yeo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"},{"name":"Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Q.","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Henry","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramsey","family":"Cheung","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"},{"name":"Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindie H.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"},{"name":"Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2022,12,7]]},"reference":[{"key":"zoi221282r2","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1111\/ajt.2018.18.issue-S1","article-title":"OPTN\/SRTR 2016 annual data report: liver.","volume":"18","author":"Kim","year":"2018","journal-title":"Am J Transplant"},{"issue":"3","key":"zoi221282r3","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1002\/hep.v69.3","article-title":"Estimating prevalence of hepatitis C virus infection in the United States, 2013-2016.","volume":"69","author":"Hofmeister","year":"2019","journal-title":"Hepatology"},{"issue":"7","key":"zoi221282r4","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.cgh.2011.03.027","article-title":"Factors that affect risk for hepatocellular carcinoma and effects of surveillance.","volume":"9","author":"Yang","year":"2011","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"9","key":"zoi221282r5","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1200\/JCO.2008.20.7753","article-title":"Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005.","volume":"27","author":"Altekruse","year":"2009","journal-title":"J Clin Oncol"},{"issue":"5","key":"zoi221282r6","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1053\/j.gastro.2004.07.020","article-title":"Hepatitis C infection and the increasing incidence of hepatocellular carcinoma: a population-based study.","volume":"127","author":"Davila","year":"2004","journal-title":"Gastroenterology"},{"issue":"1","key":"zoi221282r7","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1002\/hep.27388","article-title":"Emerging trends in hepatocellular carcinoma incidence and mortality.","volume":"61","author":"Njei","year":"2015","journal-title":"Hepatology"},{"issue":"4","key":"zoi221282r8","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1053\/j.gastro.2016.11.020","article-title":"Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through 2012.","volume":"152","author":"White","year":"2017","journal-title":"Gastroenterology"},{"issue":"7","key":"zoi221282r9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0101554","article-title":"The treatment cascade for chronic hepatitis C virus infection in the United States: a systematic review and meta-analysis.","volume":"9","author":"Yehia","year":"2014","journal-title":"PLoS One"},{"issue":"1","key":"zoi221282r10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2017-000181","article-title":"Barriers to care for chronic hepatitis C in the direct-acting antiviral era: a single-centre experience.","volume":"4","author":"Nguyen","year":"2017","journal-title":"BMJ Open Gastroenterol"},{"issue":"22","key":"zoi221282r11","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000003719","article-title":"Racial disparities in treatment rates for chronic hepatitis C: analysis of a population-based cohort of 73,665 patients in the United States.","volume":"95","author":"Vutien","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"20","key":"zoi221282r12","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1056\/NEJMoa1402454","article-title":"Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection.","volume":"370","author":"Afdhal","year":"2014","journal-title":"N Engl J Med"},{"issue":"21","key":"zoi221282r13","doi-asserted-by":"publisher","first-page":"1983","DOI":"10.1056\/NEJMoa1402338","article-title":"ABT-450\/r-ombitasvir and dasabuvir with or without ribavirin for HCV.","volume":"370","author":"Ferenci","year":"2014","journal-title":"N Engl J Med"},{"issue":"21","key":"zoi221282r14","doi-asserted-by":"publisher","first-page":"1973","DOI":"10.1056\/NEJMoa1402869","article-title":"ABT-450\/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis.","volume":"370","author":"Poordad","year":"2014","journal-title":"N Engl J Med"},{"issue":"17","key":"zoi221282r15","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1056\/NEJMoa1315722","article-title":"Treatment of HCV with ABT-450\/r-ombitasvir and dasabuvir with ribavirin.","volume":"370","author":"Feld","year":"2014","journal-title":"N Engl J Med"},{"issue":"4","key":"zoi221282r16","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1056\/NEJMoa1702417","article-title":"Glecaprevir-pibrentasvir for 8 or 12 weeks in HCV genotype 1 or 3 infection.","volume":"378","author":"Zeuzem","year":"2018","journal-title":"N Engl J Med"},{"issue":"27","key":"zoi221282r17","doi-asserted-by":"publisher","first-page":"2618","DOI":"10.1056\/NEJMoa1512614","article-title":"Sofosbuvir and velpatasvir for HCV in patients with decompensated cirrhosis.","volume":"373","author":"Curry","year":"2015","journal-title":"N Engl J Med"},{"issue":"6","key":"zoi221282r18","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1016\/j.jhep.2016.07.050","article-title":"Efficacy and safety of elbasvir\/grazoprevir and sofosbuvir\/pegylated interferon\/ribavirin: a phase III randomized controlled trial.","volume":"65","author":"Sperl","year":"2016","journal-title":"J Hepatol"},{"issue":"2","key":"zoi221282r19","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1089\/pop.2019.0237","article-title":"Hepatitis C screening rates and care cascade in a large US Insured population, 2010-2016: gaps to elimination.","volume":"24","author":"Tran","year":"2021","journal-title":"Popul Health Manag"},{"key":"zoi221282r20","doi-asserted-by":"publisher","DOI":"10.1177\/2150132719884298","article-title":"Room for improvement: rates of birth cohort hepatitis C screening in primary care practices\u2014a WWAMI Region Practice and Research Network study.","volume":"10","author":"Cole","year":"2019","journal-title":"J Prim Care Community Health"},{"key":"zoi221282r21","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.drugalcdep.2019.02.008","article-title":"Treatment cascade for hepatitis C virus in young adult people who inject drugs in San Francisco: low number treated.","volume":"198","author":"Morris","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"zoi221282r22","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1111\/apt.2019.50.issue-1","article-title":"The impact of direct-acting anti-virals on the hepatitis C care cascade: identifying progress and gaps towards hepatitis C elimination in the United States.","volume":"50","author":"Chhatwal","year":"2019","journal-title":"Aliment Pharmacol Ther"},{"issue":"5","key":"zoi221282r23","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1111\/jvh.2019.26.issue-5","article-title":"Awareness of chronic viral hepatitis in the United States: an update from the National Health and Nutrition Examination Survey.","volume":"26","author":"Kim","year":"2019","journal-title":"J Viral Hepat"},{"issue":"2","key":"zoi221282r24","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.aohep.2018.06.001","article-title":"Barriers to treatment of chronic hepatitis C with direct acting antivirals in an urban clinic.","volume":"18","author":"Malespin","year":"2019","journal-title":"Ann Hepatol"},{"issue":"12","key":"zoi221282r25","doi-asserted-by":"publisher","first-page":"1825","DOI":"10.1093\/cid\/civ677","article-title":"Access to costly new hepatitis C drugs: medicine, money, and advocacy.","volume":"61","author":"Trooskin","year":"2015","journal-title":"Clin Infect Dis"},{"issue":"6","key":"zoi221282r26","doi-asserted-by":"publisher","first-page":"893","DOI":"10.2105\/AJPH.2017.303748","article-title":"Restrictions of hepatitis C treatment for substance-using Medicaid patients: cost versus ethics.","volume":"107","author":"Liao","year":"2017","journal-title":"Am J Public Health"},{"issue":"3","key":"zoi221282r27","doi-asserted-by":"publisher","first-page":"215","DOI":"10.7326\/M15-0406","article-title":"Restrictions for Medicaid reimbursement of sofosbuvir for the treatment of hepatitis C virus infection in the United States.","volume":"163","author":"Barua","year":"2015","journal-title":"Ann Intern Med"},{"key":"zoi221282r28","doi-asserted-by":"publisher","first-page":"S773","DOI":"10.1093\/infdis\/jiaa574","article-title":"We must do better: addressing HCV treatment barriers in persons who inject drugs in the United States.","volume":"222","author":"Trooskin","year":"2020","journal-title":"J Infect Dis"},{"issue":"3","key":"zoi221282r30","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2022.100685","article-title":"The impact of COVID-19 on the cascade of care of HCV in the US and China.","volume":"27","author":"Yeo","year":"2022","journal-title":"Ann Hepatol"},{"issue":"6","key":"zoi221282r31","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1093\/cid\/ciac139","article-title":"Characteristics of persons treated for hepatitis C using national pharmacy claims data, United States, 2014-2020.","volume":"75","author":"Teshale","year":"2022","journal-title":"Clin Infect Dis"},{"issue":"2","key":"zoi221282r32","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1002\/hep4.v5.2","article-title":"Direct-acting antiviral treatment use remains low among Florida Medicaid beneficiaries with chronic hepatitis C.","volume":"5","author":"Park","year":"2020","journal-title":"Hepatol Commun"},{"issue":"5","key":"zoi221282r35","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"1","key":"zoi221282r36","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1186\/s12913-019-4349-x","article-title":"Adoption of direct-acting antiviral medications for hepatitis C: a retrospective observational study.","volume":"19","author":"Zullig","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"zoi221282r37","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1097\/PHH.0000000000000829","article-title":"Strategies for improving hepatitis C treatment access in the United States: state officials address high drug prices, stigma, and building treatment capacity.","volume":"25","author":"Kapadia","year":"2019","journal-title":"J Public Health Manag Pract"},{"issue":"17","key":"zoi221282r39","first-page":"453","article-title":"Increases in hepatitis C virus infection related to injection drug use among persons aged =30 years\u2014Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012.","volume":"64","author":"Zibbell","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"zoi221282r40","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.jhep.2020.07.042","article-title":"Impact of COVID-19 on global HCV elimination efforts.","volume":"74","author":"Blach","year":"2021","journal-title":"J Hepatol"},{"issue":"6","key":"zoi221282r41","doi-asserted-by":"publisher","first-page":"1910","DOI":"10.1002\/hep.v71.6","article-title":"Cure with interferon-free direct-acting antiviral is associated with increased survival in patients with hepatitis C virus\u2013related hepatocellular carcinoma from both East and West.","volume":"71","author":"Dang","year":"2020","journal-title":"Hepatology"},{"issue":"6","key":"zoi221282r42","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1111\/jvh.12534","article-title":"Treat chronic hepatitis C virus infection in decompensated cirrhosis: pre- or post-liver transplantation? the ironic conundrum in the era of effective and well-tolerated therapy.","volume":"23","author":"Bunchorntavakul","year":"2016","journal-title":"J Viral Hepat"},{"issue":"3","key":"zoi221282r43","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1136\/gutjnl-2020-323663","article-title":"Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis.","volume":"71","author":"Sapena","year":"2022","journal-title":"Gut"},{"issue":"5","key":"zoi221282r44","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1053\/j.gastro.2019.07.040","article-title":"Direct-acting antiviral therapy for hepatitis C virus infection is associated with increased survival in patients with a history of hepatocellular carcinoma.","volume":"157","author":"Singal","year":"2019","journal-title":"Gastroenterology"},{"issue":"4","key":"zoi221282r45","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1016\/j.cgh.2019.07.042","article-title":"Provider attitudes and practice patterns for direct-acting antiviral therapy for patients with hepatocellular carcinoma.","volume":"18","author":"Rich","year":"2020","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"6","key":"zoi221282r46","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1007\/s12072-020-10105-2","article-title":"HCC risk post-SVR with DAAs in East Asians: findings from the REAL-C cohort.","volume":"14","author":"Tanaka","year":"2020","journal-title":"Hepatol Int"},{"issue":"11","key":"zoi221282r47","doi-asserted-by":"publisher","first-page":"2840","DOI":"10.1093\/cid\/ciz1160","article-title":"Hepatitis C virus cure rates are reduced in patients with active but not inactive hepatocellular carcinoma: a practice implication.","volume":"71","author":"Ogawa","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"3","key":"zoi221282r48","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.jhep.2019.04.017","article-title":"Sustained virologic response to direct-acting antiviral therapy in patients with chronic hepatitis C and hepatocellular carcinoma: a systematic review and meta-analysis.","volume":"71","author":"Ji","year":"2019","journal-title":"J Hepatol"},{"key":"zoi221282r49","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s13027-017-0158-1","article-title":"Outcomes after sofosbuvir-containing regimens for hepatitis C virus in patients with decompensated cirrhosis: a real-world study.","volume":"12","author":"Ji","year":"2017","journal-title":"Infect Agent Cancer"},{"issue":"11","key":"zoi221282r50","doi-asserted-by":"publisher","first-page":"6247","DOI":"10.1002\/jmv.v93.11","article-title":"Real-world clinical outcomes of sofosbuvir and velpatasvir treatment in HCV genotype 1- and 2-infected patients with decompensated cirrhosis: a nationwide multicenter study by the Japanese Red Cross Liver Study Group.","volume":"93","author":"Tada","year":"2021","journal-title":"J Med Virol"},{"key":"zoi221282r1","unstructured":"World Health Organization. Hepatitis C. Updated July 27, 2021. Accessed January 13, 2022. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-c"},{"key":"zoi221282r29","unstructured":"US Centers for Disease Control and Prevention. New estimates reveal declines in hepatitis C treatment in the US between 2015 and 2020. November 8, 2021. Accessed October 31, 2022. https:\/\/www.cdc.gov\/nchhstp\/newsroom\/2021\/2014-2020-hepatitis-c-treatment-estimates.html"},{"key":"zoi221282r33","unstructured":"Stanford University. Stanford Center for Population Health Sciences. Accessed November 14, 2022. https:\/\/redivis.com\/StanfordPHS"},{"key":"zoi221282r34","unstructured":"US Census Bureau. 2010 Census regions and divisions of the united states. Accessed November 3, 2022. census.gov\/geographies\/reference-maps\/2010\/geo\/2010-census-regions-and-divisions-of-the-united-states.html"},{"key":"zoi221282r38","unstructured":"US Centers for Disease Control and Prevention. Increase in hepatitis C infections linked to worsening opioid crisis. December 21, 2017. Accessed January 29, 2022. https:\/\/www.cdc.gov\/nchhstp\/newsroom\/2017\/hepatitis-c-and-opioid-injection-press-release.html"},{"key":"zoi221282r51","unstructured":"US Department of Labor. Minimum wage. Accessed October 15, 2022. https:\/\/www.dol.gov\/general\/topic\/wages\/minimumwage"},{"key":"zoi221282r52","unstructured":"Grunebaum? D. Four in 10 fear prescription drug spiral into bankruptcy, debt: survey. October 4, 2022. Accessed October 31, 2022. https:\/\/www.healthcare.com\/prescription-drug-survey-2022-493197"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2799265\/nguyen_2022_oi_221282_1669818316.66126.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T11:01:57Z","timestamp":1670410917000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2799265"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,7]]},"references-count":52,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.45424","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,7]]}}}