{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T04:22:57Z","timestamp":1782706977856,"version":"3.54.5"},"reference-count":53,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"DOI":"10.1038\/s41746-025-01956-w","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T10:08:01Z","timestamp":1758794881000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Quality safety and disparity of an AI chatbot in managing chronic diseases: simulated patient experiments"],"prefix":"10.1038","volume":"8","author":[{"given":"Yafei","family":"Si","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yurun","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruopeng","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limin","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingqin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel","family":"Bateman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbin","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Zu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoqing","family":"Gong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongliang","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudong","family":"Miao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojing","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"1956_CR1","doi-asserted-by":"publisher","first-page":"e1706","DOI":"10.1016\/S2214-109X(24)00118-9","volume":"12","author":"SM Ahmed","year":"2024","unstructured":"Ahmed, S. M. et al. Delivering non-communicable disease services through primary health care in selected South Asian countries: are health systems prepared?. Lancet Glob. Health 12, e1706\u2013e1719 (2024).","journal-title":"Lancet Glob. Health"},{"key":"1956_CR2","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","volume":"76","author":"GA Roth","year":"2020","unstructured":"Roth, G. A. et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u20132019. J. Am. Coll. Cardiol. 76, 2982\u20133021 (2020).","journal-title":"J. Am. Coll. Cardiol."},{"key":"1956_CR3","unstructured":"Momtazmanesh, S. et al. Global burden of chronic respiratory diseases and risk factors, 1990\u20132019: an update from the Global Burden of Disease Study 2019. EClinicalMedicine 59, 101936 (2023)."},{"key":"1956_CR4","doi-asserted-by":"publisher","first-page":"2160","DOI":"10.3390\/nu15092160","volume":"15","author":"ES Darmawan","year":"2023","unstructured":"Darmawan, E. S. et al. Beyond the Plate: Uncovering Inequalities in Fruit and Vegetable Intake across Indonesian Districts. Nutrients 15, 2160 (2023).","journal-title":"Nutrients"},{"key":"1956_CR5","doi-asserted-by":"publisher","first-page":"2584","DOI":"10.1016\/S0140-6736(17)33109-4","volume":"390","author":"X Li","year":"2017","unstructured":"Li, X. et al. The primary health-care system in China. Lancet 390, 2584\u20132594 (2017).","journal-title":"Lancet"},{"key":"1956_CR6","doi-asserted-by":"publisher","first-page":"2549","DOI":"10.1016\/S0140-6736(17)32478-9","volume":"390","author":"J Lu","year":"2017","unstructured":"Lu, J. et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1\u00b7 7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet 390, 2549\u20132558 (2017).","journal-title":"Lancet"},{"key":"1956_CR7","doi-asserted-by":"crossref","unstructured":"Zhang, M. et al. Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey. BMJ. 380, e071952 (2023).","DOI":"10.1136\/bmj-2022-071952"},{"key":"1956_CR8","doi-asserted-by":"publisher","first-page":"2515","DOI":"10.1001\/jama.2017.7596","volume":"317","author":"L Wang","year":"2017","unstructured":"Wang, L. et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. Jama 317, 2515\u20132523 (2017).","journal-title":"Jama"},{"key":"1956_CR9","doi-asserted-by":"crossref","unstructured":"Xiong, S. et al. Factors associated with the uptake of the national essential public health service package for hypertension and type-2 diabetes management in China\u2019s primary health care system: a mixed-methods study. Lancet Reg. Heal. Pac. 31, 100664 (2023).","DOI":"10.1016\/j.lanwpc.2022.100664"},{"key":"1956_CR10","doi-asserted-by":"crossref","unstructured":"Das, J., Chowdhury, A., Hussam, R. & Banerjee, A. V. The impact of training informal health care providers in India: A randomized controlled trial. Science 354, 6308 (2016).","DOI":"10.1126\/science.aaf7384"},{"key":"1956_CR11","doi-asserted-by":"crossref","unstructured":"Si, Y. et al. Quantifying the financial impact of overuse in primary care in China: A standardised patient study. Soc. Sci. Med. 320, 115670 (2023).","DOI":"10.1016\/j.socscimed.2023.115670"},{"key":"1956_CR12","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1093\/heapol\/czad119","volume":"39","author":"Y Si","year":"2024","unstructured":"Si, Y. et al. The quality of telemedicine consultations for sexually transmitted infections in China. Health Policy Plan. 39, 307\u2013317 (2024).","journal-title":"Health Policy Plan."},{"key":"1956_CR13","doi-asserted-by":"publisher","first-page":"779293","DOI":"10.3389\/fpubh.2021.779293","volume":"9","author":"M Su","year":"2022","unstructured":"Su, M., Zhou, Z., Si, Y. & Fan, X. The Association Between Patient-Centered Communication and Primary Care Quality in Urban China: Evidence From a Standardized Patient Study. Front. Public Health 9, 779293 (2022).","journal-title":"Front. Public Health"},{"key":"1956_CR14","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1093\/heapol\/czu014","volume":"30","author":"S Sylvia","year":"2015","unstructured":"Sylvia, S. et al. Survey using incognito standardized patients shows poor quality care in China\u2019s rural clinics. Health Policy Plan. 30, 322\u2013333 (2015).","journal-title":"Health Policy Plan."},{"key":"1956_CR15","doi-asserted-by":"crossref","unstructured":"Si, Y., Chen, G., Zhou, Z., Yip, W. & Chen, X. The impact of physician-patient gender match on healthcare quality: An experiment in China. Soc. Sci. Med. 380, 118166 (2025).","DOI":"10.1016\/j.socscimed.2025.118166"},{"key":"1956_CR16","doi-asserted-by":"publisher","first-page":"e001669","DOI":"10.1136\/bmjgh-2019-001669","volume":"4","author":"A Kwan","year":"2019","unstructured":"Kwan, A. et al. Use of standardised patients for healthcare quality research in low-and middle-income countries. BMJ Glob. Health 4, e001669 (2019).","journal-title":"BMJ Glob. Health"},{"key":"1956_CR17","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-018-0742-z","volume":"17","author":"D Li","year":"2018","unstructured":"Li, D. et al. Unequal distribution of health human resource in mainland China: what are the determinants from a comprehensive perspective? Int. J. Equity Health 17, 29 (2018).","journal-title":"Int. J. Equity Health"},{"key":"1956_CR18","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1001\/jama.2023.1044","volume":"329","author":"A Sarraju","year":"2023","unstructured":"Sarraju, A. et al. Appropriateness of cardiovascular disease prevention recommendations obtained from a popular online Chat-based Artificial Intelligence Model. JAMA 329, 842\u2013844 (2023).","journal-title":"JAMA"},{"key":"1956_CR19","doi-asserted-by":"publisher","DOI":"10.2196\/47621","volume":"25","author":"T Kuroiwa","year":"2023","unstructured":"Kuroiwa, T. et al. The potential of ChatGPT as a self-diagnostic tool in common orthopedic diseases: exploratory study. J. Med. Internet Res. 25, e47621 (2023).","journal-title":"J. Med. Internet Res."},{"key":"1956_CR20","doi-asserted-by":"publisher","first-page":"116357","DOI":"10.1016\/j.socscimed.2023.116357","volume":"338","author":"V Vo","year":"2023","unstructured":"Vo, V. et al. Multi-stakeholder preferences for the use of artificial intelligence in healthcare: A systematic review and thematic analysis. Soc. Sci. Med. 338, 116357 (2023).","journal-title":"Soc. Sci. Med."},{"key":"1956_CR21","doi-asserted-by":"publisher","first-page":"2302980","DOI":"10.1080\/07853890.2024.2302980","volume":"56","author":"MH Kurniawan","year":"2024","unstructured":"Kurniawan, M. H., Handiyani, H., Nuraini, T., Hariyati, R. T. S. & Sutrisno, S. A systematic review of artificial intelligence-powered (AI-powered) chatbot intervention for managing chronic illness. Ann. Med. 56, 2302980 (2024).","journal-title":"Ann. Med."},{"key":"1956_CR22","doi-asserted-by":"publisher","DOI":"10.2196\/48009","volume":"25","author":"C Wang","year":"2023","unstructured":"Wang, C. et al. Ethical considerations of using ChatGPT in health care. J. Med. Internet Res. 25, e48009 (2023).","journal-title":"J. Med. Internet Res."},{"key":"1956_CR23","unstructured":"Frost & Sullivan. 2024 China Large Language Model Evaluatoin Analysis Result. https:\/\/www.frostchina.com\/content\/insight\/detail\/6600efdba2aa84f5d87e82df (2024)."},{"key":"1956_CR24","doi-asserted-by":"crossref","unstructured":"Huang, L. et al. The performance evaluation of artificial intelligence ERNIE bot in Chinese National Medical Licensing Examination. Postgrad. Med. J. 100, qgae062 (2024).","DOI":"10.1093\/postmj\/qgae062"},{"key":"1956_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41591-024-03328-5","volume":"31","author":"S Johri","year":"2025","unstructured":"Johri, S. et al. An evaluation framework for clinical use of large language models in patient interaction tasks. Nat. Med. 31, 1\u201310 (2025).","journal-title":"Nat. Med."},{"key":"1956_CR26","doi-asserted-by":"crossref","unstructured":"Wiseman, V. et al. Using Unannounced Standardised Patients to Obtain Data on Quality of Care in Low-Income and Middle-Income Countries: Key Challenges and Opportunities. (BMJ Specialist Journals, 2019).","DOI":"10.1136\/bmjgh-2019-001908"},{"key":"1956_CR27","doi-asserted-by":"publisher","first-page":"S25","DOI":"10.1016\/S0140-6736(19)32361-X","volume":"394","author":"Y Si","year":"2019","unstructured":"Si, Y., Zhou, Z., Su, M. & Chen, X. Revisiting gender gap in quality of health care in urban China: a standardised patient audit study. Lancet 394, S25 (2019).","journal-title":"Lancet"},{"key":"1956_CR28","doi-asserted-by":"publisher","DOI":"10.2196\/56121","volume":"26","author":"Y Si","year":"2024","unstructured":"Si, Y. et al. Quality and Accountability of ChatGPT in health care in low-and middle-income countries: simulated patient study. J. Med. Internet Res. 26, e56121 (2024).","journal-title":"J. Med. Internet Res."},{"key":"1956_CR29","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.socscimed.2017.08.025","volume":"191","author":"Y Zhu","year":"2017","unstructured":"Zhu, Y. & \u00d6sterle, A. Rural-urban disparities in unmet long-term care needs in China: The role of the hukou status. Soc. Sci. Med. 191, 30\u201337 (2017).","journal-title":"Soc. Sci. Med."},{"key":"1956_CR30","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12955-018-0868-0","volume":"16","author":"M Su","year":"2018","unstructured":"Su, M. et al. Comparing the effects of China\u2019s three basic health insurance schemes on the equity of health-related quality of life: using the method of coarsened exact matching. Health Qual. Life Outcomes 16, 41 (2018).","journal-title":"Health Qual. Life Outcomes"},{"key":"1956_CR31","first-page":"101019","volume":"45","author":"S Xiong","year":"2024","unstructured":"Xiong, S. et al. Using routinely collected data to determine care cascades of hypertension and type-2 diabetes management in China: a cross-sectional study. Lancet Reg. Heal. Pac. 45, 101019 (2024).","journal-title":"Lancet Reg. Heal. Pac."},{"key":"1956_CR32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/ecoj.12260","volume":"127","author":"L Balafoutas","year":"2017","unstructured":"Balafoutas, L., Kerschbamer, R. & Sutter, M. Second-degree moral hazard in a real-world credence goods market. Econ. J. 127, 1\u201318 (2017).","journal-title":"Econ. J."},{"key":"1956_CR33","doi-asserted-by":"publisher","first-page":"e98","DOI":"10.1093\/geront\/gnx020","volume":"59","author":"JMS S\u00e3o Jos\u00e9","year":"2019","unstructured":"S\u00e3o Jos\u00e9, J. M. S., Amado, C. A. F., Ilinca, S., Buttigieg, S. C. & Taghizadeh Larsson, A. Ageism in health care: a systematic review of operational definitions and inductive conceptualizations. Gerontologist 59, e98\u2013e108 (2019).","journal-title":"Gerontologist"},{"key":"1956_CR34","doi-asserted-by":"crossref","unstructured":"Das, J. et al. In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps. Health Aff. 31, 2774\u20132784 (2012).","DOI":"10.1377\/hlthaff.2011.1356"},{"key":"1956_CR35","unstructured":"Howarth, J. How Many People Own Smartphones (2023-2028). Exploding Topics https:\/\/explodingtopics.com\/blog\/smartphone-stats (2023)."},{"key":"1956_CR36","doi-asserted-by":"crossref","unstructured":"Xu, D.(R. oman) et al. Improving Data Surveillance Resilience Beyond COVID-19: Experiences of Primary heAlth Care quAlity Cohort In ChinA (ACACIA) Using Unannounced Standardized Patients. Am. J. Public Health 112, 913\u2013922 (2022).","DOI":"10.2105\/AJPH.2022.306779"},{"key":"1956_CR37","doi-asserted-by":"publisher","first-page":"3765","DOI":"10.1257\/aer.20151138","volume":"106","author":"J Das","year":"2016","unstructured":"Das, J., Holla, A., Mohpal, A. & Muralidharan, K. Quality and accountability in health care delivery: audit-study evidence from primary care in India. Am. Econ. Rev. 106, 3765\u20133799 (2016).","journal-title":"Am. Econ. Rev."},{"key":"1956_CR38","doi-asserted-by":"publisher","first-page":"1616","DOI":"10.1056\/NEJMoa1204410","volume":"367","author":"JC Weeks","year":"2012","unstructured":"Weeks, J. C. et al. Patients\u2019 expectations about effects of chemotherapy for advanced cancer. N. Engl. J. Med. 367, 1616\u20131625 (2012).","journal-title":"N. Engl. J. Med."},{"key":"1956_CR39","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.socscimed.2014.10.055","volume":"123","author":"AJ He","year":"2014","unstructured":"He, A. J. The doctor\u2013patient relationship, defensive medicine and overprescription in Chinese public hospitals: Evidence from a cross-sectional survey in Shenzhen city. Soc. Sci. Med. 123, 64\u201371 (2014).","journal-title":"Soc. Sci. Med."},{"key":"1956_CR40","doi-asserted-by":"crossref","unstructured":"Sellamuthu, S. et al. AI-based recommendation model for effective decision to maximise ROI. Soft Comput. 1\u201310 (2023).","DOI":"10.1007\/s00500-023-08731-7"},{"key":"1956_CR41","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.1001\/jama.2025.6571","volume":"333","author":"D Zeng","year":"2025","unstructured":"Zeng, D., Qin, Y., Sheng, B. & Wong, T. Y. DeepSeek\u2019s \u201cLow-Cost\u201d Adoption Across China\u2019s Hospital Systems: Too Fast, Too Soon?. JAMA 333, 1866\u20131869 (2025).","journal-title":"JAMA"},{"key":"1956_CR42","doi-asserted-by":"publisher","first-page":"2550","DOI":"10.1038\/s41591-025-03726-3","volume":"31","author":"M Tordjman","year":"2025","unstructured":"Tordjman, M. et al. Comparative benchmarking of the DeepSeek large language model on medical tasks and clinical reasoning. Nat. Med. 31, 2550\u20132555 (2025).","journal-title":"Nat. Med."},{"key":"1956_CR43","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.1016\/S2589-7500(23)00225-X","volume":"6","author":"T Zack","year":"2024","unstructured":"Zack, T. et al. Assessing the potential of GPT-4 to perpetuate racial and gender biases in health care: a model evaluation study. Lancet Digit. Health 6, e12\u2013e22 (2024).","journal-title":"Lancet Digit. Health"},{"key":"1956_CR44","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1038\/s41746-023-00939-z","volume":"6","author":"JA Omiye","year":"2023","unstructured":"Omiye, J. A., Lester, J. C., Spichak, S., Rotemberg, V. & Daneshjou, R. Large language models propagate race-based medicine. NPJ Digit. Med. 6, 195 (2023).","journal-title":"NPJ Digit. Med."},{"key":"1956_CR45","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1126\/science.adh2713","volume":"381","author":"M DeCamp","year":"2023","unstructured":"DeCamp, M. & Lindvall, C. Mitigating bias in AI at the point of care. Science 381, 150\u2013152 (2023).","journal-title":"Science"},{"key":"1956_CR46","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1093\/ej\/ueaa024","volume":"130","author":"F Gottschalk","year":"2020","unstructured":"Gottschalk, F., Mimra, W. & Waibel, C. Health services as credence goods: A field experiment. Econ. J. 130, 1346\u20131383 (2020).","journal-title":"Econ. J."},{"key":"1956_CR47","doi-asserted-by":"publisher","first-page":"7454","DOI":"10.1073\/pnas.1518015113","volume":"113","author":"R Kerschbamer","year":"2016","unstructured":"Kerschbamer, R., Neururer, D. & Sutter, M. Insurance coverage of customers induces dishonesty of sellers in markets for credence goods. Proc. Natl. Acad. Sci. 113, 7454\u20137458 (2016).","journal-title":"Proc. Natl. Acad. Sci."},{"key":"1956_CR48","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41591-024-03139-8","volume":"30","author":"J Li","year":"2024","unstructured":"Li, J. et al. Integrated image-based deep learning and language models for primary diabetes care. Nat. Med. 30, 1\u201311 (2024).","journal-title":"Nat. Med."},{"key":"1956_CR49","doi-asserted-by":"publisher","first-page":"2878","DOI":"10.1038\/s41591-024-03148-7","volume":"30","author":"P Wan","year":"2024","unstructured":"Wan, P. et al. Outpatient reception via collaboration between nurses and a large language model: a randomized controlled trial. Nat. Med. 30, 2878\u20132885 (2024).","journal-title":"Nat. Med."},{"key":"1956_CR50","doi-asserted-by":"crossref","unstructured":"Yip, W. Improving primary healthcare with generative AI. Nat. Med. 30, 1\u20132 (2024).","DOI":"10.1038\/s41591-024-03257-3"},{"key":"1956_CR51","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3122\/jabfm.2011.03.100170","volume":"24","author":"KD Bertakis","year":"2011","unstructured":"Bertakis, K. D. & Azari, R. Patient-centered care is associated with decreased health care utilization. J. Am. Board Fam. Med. 24, 229\u2013239 (2011).","journal-title":"J. Am. Board Fam. Med."},{"key":"1956_CR52","doi-asserted-by":"publisher","first-page":"5060","DOI":"10.3390\/ijerph18105060","volume":"18","author":"M Su","year":"2021","unstructured":"Su, M. et al. Comparing the Quality of Primary Care between Public and Private Providers in Urban China: A Standardized Patient Study. Int. J. Environ. Res. Public. Health 18, 5060 (2021).","journal-title":"Int. J. Environ. Res. Public. Health"},{"key":"1956_CR53","doi-asserted-by":"crossref","unstructured":"Das, J., Woskie, L., Rajbhandari, R., Abbasi, K. & Jha, A. Rethinking assumptions about delivery of healthcare: implications for universal health coverage. BMJ. 361, k1716 (2018).","DOI":"10.1136\/bmj.k1716"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01956-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01956-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01956-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T10:08:16Z","timestamp":1758794896000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01956-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1956"],"URL":"https:\/\/doi.org\/10.1038\/s41746-025-01956-w","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,25]]},"assertion":[{"value":"8 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"574"}}