{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:58:22Z","timestamp":1765825102060,"version":"3.48.0"},"reference-count":77,"publisher":"BMJ","issue":"8","funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,6,20]]},"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Anxiety, mood and trauma-related disorders are common, affecting up to 20% of adults. Many of these individuals will experience symptoms of more than one disorder as diagnostically defined. However, most psychological treatments focus on individual disorders and are less effective for those who experience comorbid disorders. The Healthy and Resilient Mind Programme: Building Blocks for Mental Wellbeing (HARMONIC) trial introduces a novel transdiagnostic intervention (\n                      <jats:italic>Shaping Healthy Minds (SHM)<\/jats:italic>\n                      ), which synthesises several evidence-based treatment techniques to address the gap in effective interventions for people with complex and comorbid difficulties. This early phase trial aims to estimate the efficacy and feasibility of the transdiagnostic intervention in preparation for a later-phase randomised controlled trial, and to explore mechanisms of change.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\/analysis<\/jats:title>\n                    <jats:p>\n                      We outline a patient-level two-arm randomised controlled trial (HARMONIC) that compares\n                      <jats:italic>SHM<\/jats:italic>\n                      to treatment-as-usual for individuals aged &gt;18 years (n=50) with comorbid mood, anxiety, obsessive-compulsive or trauma\/stressor disorders diagnoses, recruited from outpatient psychological services within the UK National Health Service (NHS). The co-primary outcomes will be 3-month follow-up scores on self-report measures of depressive symptoms, anxiety symptoms, and disability and functional impairment. Secondary outcomes include changes in symptoms linked to individual disorders. We will assess the feasibility and acceptability of\n                      <jats:italic>SHM<\/jats:italic>\n                      , the utility of proposed outcome measures, and refine the treatment manuals in preparation for a later-phase trial.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This trial protocol has been approved by the Health Research Authority of the NHS of the UK (East of England, Reference: 16\/EE\/0095). We anticipate that trial findings will inform future revisions of clinical guidelines for numerous forms of mood, anxiety and stressor-related disorders. Findings will be disseminated broadly via peer-reviewed empirical journal articles, conference presentations, clinical workshops and a trial website.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT03143634\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial pre-results\">NCT03143634<\/jats:ext-link>\n                      ; Pre-results.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-024546","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T18:06:29Z","timestamp":1588874789000},"page":"e024546","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["The HARMONIC trial: study protocol for a randomised controlled feasibility trial of Shaping Healthy Minds\u2014a modular transdiagnostic intervention for mood, stressor-related and anxiety disorders in adults"],"prefix":"10.1136","volume":"8","clinical-trial-number":[{"clinical-trial-number":"nct03143634","registry":"10.18810\/clinical-trials-gov","type":"preResults"},{"clinical-trial-number":"nct03143634","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1450-1140","authenticated-orcid":false,"given":"Melissa","family":"Black","sequence":"first","affiliation":[{"name":"Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK"},{"name":"Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2435-0713","authenticated-orcid":false,"given":"Caitlin","family":"Hitchcock","sequence":"additional","affiliation":[{"name":"Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK"},{"name":"Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Bevan","sequence":"additional","affiliation":[{"name":"Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cliodhna","family":"O Leary","sequence":"additional","affiliation":[{"name":"Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK"},{"name":"Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Clarke","sequence":"additional","affiliation":[{"name":"Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Elliott","sequence":"additional","affiliation":[{"name":"Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK"},{"name":"Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Watson","sequence":"additional","affiliation":[{"name":"Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"LaFortune","sequence":"additional","affiliation":[{"name":"Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Rae","sequence":"additional","affiliation":[{"name":"Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Gilbody","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willem","family":"Kuyken","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Johnston","sequence":"additional","affiliation":[{"name":"Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK"},{"name":"Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill M","family":"Newby","sequence":"additional","affiliation":[{"name":"School of Psychology, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Dalgleish","sequence":"additional","affiliation":[{"name":"Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK"},{"name":"Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,8,5]]},"reference":[{"key":"2025121510564188000_8.8.e024546.1","first-page":"e3105","article-title":"The epidemiology of major depressive disorder: results from the National comorbidity survey replication (NCS-R)","volume":"289","author":"Kessler","year":"2003","journal-title":"Journal of the American Medical Association"},{"key":"2025121510564188000_8.8.e024546.2","unstructured":"Medical Research Council,. Review of mental health research: Report of the strategic review group. London: Medical Research Council, 2010."},{"key":"2025121510564188000_8.8.e024546.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d2868"},{"key":"2025121510564188000_8.8.e024546.4","doi-asserted-by":"publisher","DOI":"10.1037\/0021-843X.110.4.585"},{"key":"2025121510564188000_8.8.e024546.5","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.6.593"},{"key":"2025121510564188000_8.8.e024546.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.0963-7214.2006.00425.x"},{"key":"2025121510564188000_8.8.e024546.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2015.02.003"},{"key":"2025121510564188000_8.8.e024546.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2015.08.004"},{"key":"2025121510564188000_8.8.e024546.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.cbpra.2009.06.002"},{"key":"2025121510564188000_8.8.e024546.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2015.06.002"},{"key":"2025121510564188000_8.8.e024546.11","doi-asserted-by":"publisher","DOI":"10.1002\/da.21992"},{"key":"2025121510564188000_8.8.e024546.12","doi-asserted-by":"publisher","DOI":"10.1037\/a0016608"},{"key":"2025121510564188000_8.8.e024546.13","doi-asserted-by":"crossref","unstructured":"Harvey A . G., et al., eds. Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford: Oxford University Press, 2004.","DOI":"10.1093\/med:psych\/9780198528883.001.0001"},{"key":"2025121510564188000_8.8.e024546.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7894(04)80036-4"},{"key":"2025121510564188000_8.8.e024546.15","doi-asserted-by":"publisher","DOI":"10.1002\/da.20045"},{"key":"2025121510564188000_8.8.e024546.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31140-0"},{"key":"2025121510564188000_8.8.e024546.17","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.61.4.611"},{"key":"2025121510564188000_8.8.e024546.18","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.71.4.821"},{"key":"2025121510564188000_8.8.e024546.19","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.74.3.568"},{"key":"2025121510564188000_8.8.e024546.20","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.71.4.706"},{"key":"2025121510564188000_8.8.e024546.21","doi-asserted-by":"publisher","DOI":"10.1037\/a0014565"},{"key":"2025121510564188000_8.8.e024546.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.appsy.2005.05.002"},{"key":"2025121510564188000_8.8.e024546.23","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1001\/jamapsychiatry.2017.2164","article-title":"The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial","volume":"74","author":"Barlow","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"2025121510564188000_8.8.e024546.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2014.08.018"},{"key":"2025121510564188000_8.8.e024546.25","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.janxdis.2016.06.003","article-title":"False Safety Behavior Elimination Therapy: A randomized study of a brief individual transdiagnostic treatment for anxiety disorders","volume":"46","author":"Riccardi","year":"2017","journal-title":"J Anxiety Disord"},{"key":"2025121510564188000_8.8.e024546.26","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(95)00084-4"},{"key":"2025121510564188000_8.8.e024546.27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1655"},{"key":"2025121510564188000_8.8.e024546.28","doi-asserted-by":"publisher","DOI":"10.1080\/16506073.2014.897367"},{"key":"2025121510564188000_8.8.e024546.29","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth ed. Arlington, VA: American Psychiatric Publishing, 2013.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"2025121510564188000_8.8.e024546.30","unstructured":"Arlington, VA: American Psychiatric Association. First MB , et al . Structured Clinical Interview for DSM-5 - research Version (SCID-5 for DSM-5, Research Version, SCID5-RV, Version 1.0.0). 2015."},{"key":"2025121510564188000_8.8.e024546.31","unstructured":"Beck J . Cognitive Behavior Therapy: Basics and Beyond. Second Edition. New York: Guilford Press, 2011."},{"key":"2025121510564188000_8.8.e024546.32","unstructured":"Hayes SC , Strosahl KD , Wilson KG . Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press, 1999."},{"key":"2025121510564188000_8.8.e024546.33","unstructured":"Linehan MM . Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press, 1993."},{"key":"2025121510564188000_8.8.e024546.34","unstructured":"Segal ZV , Williams JMG , Teasdale JD . Mindfulness-based Cognitive Therapy for Depression: A new approach to preventing relapse. New York: Guilford Press, 2002."},{"key":"2025121510564188000_8.8.e024546.35","unstructured":"Martell CR , Dimidjian S , Ruth H-D . Behavioral Acitvation for Depression: A Clinician\u2019s Guide. New York: Guilford Press, 2010."},{"key":"2025121510564188000_8.8.e024546.36","doi-asserted-by":"crossref","unstructured":"Ekers D , et al . Behavioural Activation for Depression; An update of meta-analysis of effectiveness and subgroup analysis. PLoS ONE 2014;6.","DOI":"10.1371\/journal.pone.0100100"},{"key":"2025121510564188000_8.8.e024546.37","unstructured":"Bennett-Levy J , et al . Oxford Guide to Behavioural Experiments in Cognitive Therapy. Oxford University Press: Oxford, 2004."},{"key":"2025121510564188000_8.8.e024546.38","unstructured":"Norton PJ . Group Cognitive-Behavioural Therapy of Anxiety. New York: Guilford Press, 2012."},{"key":"2025121510564188000_8.8.e024546.39","unstructured":"Harris R . ACT Made Simple: A quick start guide to ACT basics and beyond. Oakland, CA: New Harbinger Publications, Inc, 2009."},{"key":"2025121510564188000_8.8.e024546.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2010.08.003"},{"key":"2025121510564188000_8.8.e024546.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2013.05.005"},{"key":"2025121510564188000_8.8.e024546.42","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1016\/j.beth.2016.07.002","article-title":"Considering Meta-Analysis, Meaning, and Metaphor: A Systematic Review and Critical Examination of \"Third Wave\" Cognitive and Behavioral Therapies","volume":"47","author":"Dimidjian","year":"2016","journal-title":"Behav Ther"},{"key":"2025121510564188000_8.8.e024546.43","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20346"},{"key":"2025121510564188000_8.8.e024546.44","unstructured":"Kuyken W , Padesky CA , Dudley R . Collaborative Case Conceptualisation: Working Effectively with Clients in Cognitive-Behavioral Therapy. New York, NY.: The Guilford Press, 2009."},{"key":"2025121510564188000_8.8.e024546.45","doi-asserted-by":"crossref","unstructured":"Blackburn I-M , James IA , Milne DL , et al . THE REVISED COGNITIVE THERAPY SCALE (CTS-R): PSYCHOMETRIC PROPERTIES. Behav Cogn Psychother 2001;29.doi:10.1017\/S1352465801004040","DOI":"10.1017\/S1352465801004040"},{"key":"2025121510564188000_8.8.e024546.46","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2025121510564188000_8.8.e024546.47","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"2025121510564188000_8.8.e024546.48","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.180.5.461"},{"key":"2025121510564188000_8.8.e024546.49","unstructured":"IAPT, D.o.H. The IAPT data handbook version 2.0.1. 2011: Published to DH Website, in electronic PDF format only."},{"key":"2025121510564188000_8.8.e024546.50","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.176.4.379"},{"key":"2025121510564188000_8.8.e024546.51","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(90)90135-6"},{"key":"2025121510564188000_8.8.e024546.52","doi-asserted-by":"publisher","DOI":"10.1037\/\/1040-3590.10.3.206"},{"key":"2025121510564188000_8.8.e024546.53","doi-asserted-by":"crossref","unstructured":"Weiss DS . In: Wilson JP , Tang CS , eds. The Impact of Event Scale: Revised, in Cross-cultural assessment of psychological trauma and PTSD. New York: Springer, 2007:219\u201338.","DOI":"10.1007\/978-0-387-70990-1_10"},{"key":"2025121510564188000_8.8.e024546.54","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(85)90140-8"},{"key":"2025121510564188000_8.8.e024546.55","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(79)90041-X"},{"key":"2025121510564188000_8.8.e024546.56","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.154.11.1571"},{"key":"2025121510564188000_8.8.e024546.57","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291702005822"},{"key":"2025121510564188000_8.8.e024546.58","unstructured":"Sheehan DV . The Anxiety Disease. New York: Charles Scribner and Sons, 1983."},{"key":"2025121510564188000_8.8.e024546.59","doi-asserted-by":"publisher","DOI":"10.1177\/1073191112449857"},{"key":"2025121510564188000_8.8.e024546.60","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1192\/bjpo.bp.116.002907","article-title":"Cost-effectiveness of telehealth for patients with depression: evidence from the Healthlines randomised controlled trial","volume":"2","author":"Dixon","year":"2016","journal-title":"BJPsych Open"},{"key":"2025121510564188000_8.8.e024546.61","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/S2215-0366(16)00083-3","article-title":"Effectiveness of an integrated telehealth service for patients with depression: a pragmatic randomised controlled trial of a complex intervention","volume":"3","author":"Salisbury","year":"2016","journal-title":"Lancet Psychiatry"},{"key":"2025121510564188000_8.8.e024546.62","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"2025121510564188000_8.8.e024546.63","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.27.2(Suppl.).S101"},{"key":"2025121510564188000_8.8.e024546.64","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7916(00)00012-4"},{"key":"2025121510564188000_8.8.e024546.65","doi-asserted-by":"publisher","DOI":"10.1016\/S0191-8869(00)00113-6"},{"key":"2025121510564188000_8.8.e024546.66","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2006.08.003"},{"key":"2025121510564188000_8.8.e024546.67","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.64.5.847"},{"key":"2025121510564188000_8.8.e024546.68","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1037\/pas0000450","article-title":"Development and initial evaluation of a self-report form of the DSM-5 Level of Personality Functioning Scale","volume":"29","author":"Morey","year":"2017","journal-title":"Psychol Assess"},{"key":"2025121510564188000_8.8.e024546.69","doi-asserted-by":"publisher","DOI":"10.1023\/A:1023910315561"},{"key":"2025121510564188000_8.8.e024546.70","doi-asserted-by":"publisher","DOI":"10.1007\/s11031-005-7955-3"},{"key":"2025121510564188000_8.8.e024546.71","doi-asserted-by":"publisher","DOI":"10.1023\/B:JOBA.0000007455.08539.94"},{"key":"2025121510564188000_8.8.e024546.72","doi-asserted-by":"crossref","unstructured":"Weissman AN . The Dysfunctional Attitude Scale: A Validation Study. University of Pennsylvania, 1979.","DOI":"10.1037\/t00091-000"},{"key":"2025121510564188000_8.8.e024546.73","doi-asserted-by":"publisher","DOI":"10.1177\/1073191104268029"},{"key":"2025121510564188000_8.8.e024546.74","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(86)90143-9"},{"key":"2025121510564188000_8.8.e024546.75","doi-asserted-by":"publisher","DOI":"10.1037\/\/1040-3590.11.3.303"},{"key":"2025121510564188000_8.8.e024546.76","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1037\/a0022485","article-title":"Skills of Cognitive Therapy (SoCT): a new measure of patients' comprehension and use","volume":"23","author":"Jarrett","year":"2011","journal-title":"Psychol Assess"},{"key":"2025121510564188000_8.8.e024546.77","doi-asserted-by":"publisher","DOI":"10.1037\/a0023242"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-024546","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:56:50Z","timestamp":1765825010000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-024546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8]]},"references-count":77,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2018,8,5]]},"published-print":{"date-parts":[[2018,8]]}},"alternative-id":["10.1136\/bmjopen-2018-024546"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-024546","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2018,8]]}}}