{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:18:27Z","timestamp":1791364707007,"version":"4.3.1"},"reference-count":58,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["16\/137\/95"],"award-info":[{"award-number":["16\/137\/95"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the feasibility of delivering a culturally tailored pulmonary rehabilitation (PR) programme and conducting a definitive randomised controlled trial (RCT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A two-arm, randomised feasibility trial with a mixed-methods process evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Secondary care setting in Georgia, Europe.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>People with symptomatic spirometry-confirmed chronic obstructive pulmonary disease recruited from primary and secondary care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Participants were randomised in a 1:1 ratio to a control group or intervention comprising 16 twice-weekly group PR sessions tailored to the Georgian setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary and secondary outcome measures<\/jats:title><jats:p>Feasibility of the intervention<jats:italic>and<\/jats:italic>RCT were assessed according to: study recruitment, consent and follow-up, intervention fidelity, adherence and acceptability, using questionnaires and measurements at baseline, programme end and 6 months, and through qualitative interviews.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study recruited 60 participants (as planned): 54 (90%) were male, 10 (17%) had a forced expiratory volume in 1 second of \u226450% predicted. The mean MRC Dyspnoea Score was 3.3 (SD 0.5), and mean St George\u2019s Respiratory Questionnaire (SGRQ) 50.9 (SD 17.6). The rehabilitation specialists delivered the PR with fidelity. Thirteen (43.0%) participants attended at least 75% of the 16 planned sessions. Participants and rehabilitation specialists in the qualitative interviews reported that the programme was acceptable, but dropout rates were high in participants who lived outside Tbilisi and had to travel large distances. Outcome data were collected on 63.3% participants at 8 weeks and 88.0% participants at 6 months. Mean change in SGRQ total was \u221224.9 (95% CI \u221240.3 to \u20139.6) at programme end and \u22124.4 (95% CI \u221212.3 to 3.4) at 6 months follow-up for the intervention group and \u22120.5 (95% CI \u22128.1 to 7.0) and \u22128.1 (95% CI \u221216.5 to 0.3) for the usual care group at programme end and 6 months, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>It was feasible to deliver the tailored PR intervention. Approaches to improve uptake and adherence warrant further research.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN16184185\">ISRCTN16184185<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-056902","type":"journal-article","created":{"date-parts":[[2022,9,24]],"date-time":"2022-09-24T04:20:56Z","timestamp":1663993256000},"page":"e056902","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Feasibility of a pulmonary rehabilitation programme for patients with symptomatic chronic obstructive pulmonary disease in Georgia: a single-site, randomised controlled trial from the Breathe Well Group"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"isrctn16184185","registry":"10.18810\/isrctn"}],"author":[{"given":"Mariam","family":"Maglakelidze","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ia","family":"Kurua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nino","family":"Maglakelidze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamaz","family":"Maglakelidze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivane","family":"Chkhaidze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketevan","family":"Gogvadze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natia","family":"Chkhaidze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Beadle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Redden-Rowley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peymane","family":"Adab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1798-3854","authenticated-orcid":false,"given":"Rachel","family":"Adams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunhua","family":"Chi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KK","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"Cooper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Correia-de-Sousa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7591-8129","authenticated-orcid":false,"given":"Andrew P","family":"Dickens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Enocson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Farley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola K","family":"Gale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Jowett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Martins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Rai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice J","family":"Sitch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Stavrikj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Stelmach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice M","family":"Turner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sian","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel E","family":"Jordan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Jolly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,23]]},"reference":[{"key":"2022092321201156000_12.9.e056902.1","doi-asserted-by":"publisher","DOI":"10.2500\/aap.2015.36.3812"},{"key":"2022092321201156000_12.9.e056902.2","unstructured":"World Health Organization . Chronic obstructive pulmonary disease (COPD). Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/chronic-obstructive-pulmonary-disease-(copd) [Accessed 22 Nov 2020]."},{"key":"2022092321201156000_12.9.e056902.3","unstructured":"Centers for Disease Control and Prevention . COPD costs 2019. Available: https:\/\/www.cdc.gov\/copd\/infographics\/copd-costs.html [Accessed 22 Nov 2020]."},{"key":"2022092321201156000_12.9.e056902.4","doi-asserted-by":"publisher","DOI":"10.1097\/00063198-200203000-00001"},{"key":"2022092321201156000_12.9.e056902.5","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/S2213-2600(20)30105-3","article-title":"Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the global burden of disease study 2017","volume":"8","year":"2020","journal-title":"Lancet Respir Med"},{"key":"2022092321201156000_12.9.e056902.6","unstructured":"Gamkrelidze AMN , Sturua L , Demetrashvili N . Non-communicable diseases risk-factors STEPS survey, Georgia, 2016. Available: https:\/\/www.who.int\/ncds\/surveillance\/steps\/STEPS_Georgia_2016_ENG_summary_2016_final.pdf [Accessed 1 Jun 2021]."},{"key":"2022092321201156000_12.9.e056902.7","unstructured":"American Cancer Society . The tobacco atlas, Georgia country facts. Available: https:\/\/tobaccoatlas.org\/wp-content\/uploads\/pdf\/georgia-country-facts.pdf [Accessed 22 Nov 2020]."},{"key":"2022092321201156000_12.9.e056902.8","first-page":"116","article-title":"Introduction of universal health program in Georgia: problems and perspectives","volume":"262","author":"Verulava","year":"2017","journal-title":"Georgian Med News"},{"key":"2022092321201156000_12.9.e056902.9","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-016-0238-9"},{"key":"2022092321201156000_12.9.e056902.10","doi-asserted-by":"crossref","unstructured":"McCarthy B , Casey D , Devane D , et al . Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015;2:CD003793.","DOI":"10.1002\/14651858.CD003793.pub3"},{"key":"2022092321201156000_12.9.e056902.11","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-018-0718-1"},{"key":"2022092321201156000_12.9.e056902.12","doi-asserted-by":"crossref","first-page":"e1363","DOI":"10.1016\/S2214-109X(18)30409-1","article-title":"The burden of chronic respiratory diseases and their heterogeneity across the states of India: the global burden of disease study 1990-2016","volume":"6","year":"2018","journal-title":"Lancet Glob Health"},{"key":"2022092321201156000_12.9.e056902.13","doi-asserted-by":"crossref","DOI":"10.1038\/s41533-020-00210-y","article-title":"Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings","volume":"30","author":"Habib","year":"2020","journal-title":"NPJ Prim Care Respir Med"},{"key":"2022092321201156000_12.9.e056902.14","first-page":"971","article-title":"Chronic respiratory diseases in developing countries: the burden and strategies for prevention and management","volume":"79","author":"A\u00eft-Khaled","year":"2001","journal-title":"Bull World Health Organ"},{"key":"2022092321201156000_12.9.e056902.15","doi-asserted-by":"crossref","first-page":"141","DOI":"10.2147\/COPD.S348663","article-title":"Barriers and enablers to pulmonary rehabilitation in low- and middle-income countries: a qualitative study of healthcare professionals","volume":"17","author":"Bickton","year":"2022","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2022092321201156000_12.9.e056902.16","doi-asserted-by":"publisher","DOI":"10.1111\/j..2002.384.doc.x"},{"key":"2022092321201156000_12.9.e056902.17","first-page":"576","article-title":"Discussion on the diagnosis of pulmonary emphysema","volume":"45","author":"Gough","year":"1952","journal-title":"Proc R Soc Med"},{"key":"2022092321201156000_12.9.e056902.18","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00034805"},{"key":"2022092321201156000_12.9.e056902.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2022092321201156000_12.9.e056902.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2022092321201156000_12.9.e056902.21","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-203808"},{"key":"2022092321201156000_12.9.e056902.22","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201510-1966ST"},{"key":"2022092321201156000_12.9.e056902.23","unstructured":"Michie S , Atkins L , West R . The APEASE criteria for designing and evaluating interventions. In: Michie S , Atkins L , West R , eds. The behaviour change wheel: a guide to designing interventions. London: Silverback Publishing, 2014."},{"key":"2022092321201156000_12.9.e056902.24","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2007.081208"},{"key":"2022092321201156000_12.9.e056902.25","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/141.4_Pt_1.909"},{"key":"2022092321201156000_12.9.e056902.26","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/145.6.1321"},{"key":"2022092321201156000_12.9.e056902.27","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00102509"},{"key":"2022092321201156000_12.9.e056902.28","doi-asserted-by":"publisher","DOI":"10.1249\/01.MSS.0000078924.61453.FB"},{"key":"2022092321201156000_12.9.e056902.29","first-page":"256","article-title":"Effect of a self-management program on patients with chronic disease","volume":"4","author":"Lorig","year":"2001","journal-title":"Eff Clin Pract"},{"key":"2022092321201156000_12.9.e056902.30","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2022092321201156000_12.9.e056902.31","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"2022092321201156000_12.9.e056902.32","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-011-9903-x"},{"key":"2022092321201156000_12.9.e056902.33","doi-asserted-by":"crossref","DOI":"10.1177\/1479973119882939","article-title":"Establishing a pulmonary rehabilitation programme in primary care in Greece: a fresh air implementation study","volume":"16","author":"Anastasaki","year":"2019","journal-title":"Chron Respir Dis"},{"key":"2022092321201156000_12.9.e056902.34","unstructured":"Glaser B , Strauss A . Grounded theory: the discovery of grounded theory. New York: de Gruyter, 1967."},{"key":"2022092321201156000_12.9.e056902.35","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1111\/resp.12128","article-title":"Frequency of referral to and attendance at a pulmonary rehabilitation programme amongst patients admitted to a tertiary hospital with chronic obstructive pulmonary disease","volume":"18","author":"Johnston","year":"2013","journal-title":"Respirology"},{"key":"2022092321201156000_12.9.e056902.36","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305276687"},{"key":"2022092321201156000_12.9.e056902.37","doi-asserted-by":"publisher","DOI":"10.1081\/COPD-200050513"},{"key":"2022092321201156000_12.9.e056902.38","first-page":"1","article-title":"How much change is enough? Evidence from a longitudinal study on depression in UK primary care","author":"Kounali","year":"2020","journal-title":"Psychol Med"},{"key":"2022092321201156000_12.9.e056902.39","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2018-212725"},{"key":"2022092321201156000_12.9.e056902.40","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S2213-2600(14)70001-3","article-title":"Minimum clinically important difference for the COPD assessment test: a prospective analysis","volume":"2","author":"Kon","year":"2014","journal-title":"Lancet Respir Med"},{"key":"2022092321201156000_12.9.e056902.41","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S146659"},{"key":"2022092321201156000_12.9.e056902.42","doi-asserted-by":"crossref","unstructured":"Dickens A , Adab P , Cheng K , et al . Using a rapid prioritisation process to identify health research priorities in LMICs. Eur Respiratory Soc 2018.","DOI":"10.1183\/13993003.congress-2018.PA905"},{"key":"2022092321201156000_12.9.e056902.43","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.6.1705"},{"key":"2022092321201156000_12.9.e056902.44","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2011.610393"},{"key":"2022092321201156000_12.9.e056902.45","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.2147\/COPD.S268076","article-title":"A novel case-finding instrument for chronic obstructive pulmonary disease in low- and middle-income country settings","volume":"15","author":"Siddharthan","year":"2020","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2022092321201156000_12.9.e056902.46","doi-asserted-by":"crossref","first-page":"100","DOI":"10.4103\/2229-3485.179438","article-title":"Understanding perception of chronic obstructive pulmonary disease among general practitioners, physicians, and pulmonologists in India: results from a face-to-face survey","volume":"7","author":"Kaur","year":"2016","journal-title":"Perspect Clin Res"},{"key":"2022092321201156000_12.9.e056902.47","first-page":"485","article-title":"Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: a qualitative study","volume":"34","author":"Dennis","year":"2017","journal-title":"Fam Pract"},{"key":"2022092321201156000_12.9.e056902.48","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.2147\/COPD.S84247","article-title":"Case finding for COPD in primary care: a qualitative study of the views of health professionals","volume":"10","author":"Haroon","year":"2015","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2022092321201156000_12.9.e056902.49","doi-asserted-by":"publisher","DOI":"10.1177\/1479972310393756"},{"key":"2022092321201156000_12.9.e056902.50","unstructured":"Steiner M , Holzhauer-Barrie J , Lowe D , et al . Pulmonary rehabilitation: steps to breathe better. pulmonary rehabilitation: an exercise in improvement. National chronic obstructive pulmonary disease (COPD) audit programme: clinical audit of pulmonary rehabilitation services in England and Wales 2017. National COPD audit programme. London: Royal College of physicians 2018, 2018. Available: https:\/\/www.nacap.org.uk\/nacap\/welcome.nsf\/vwFiles\/COPD-PR-2017-Clinical-and-organisational\/$File\/Pulmonary%20Rehabilitation%20-%20An%20exercise%20in%20improvement%20-%20National%20report%20(Web).pdf?openelement [Accessed 6 Jul 2021]."},{"key":"2022092321201156000_12.9.e056902.51","doi-asserted-by":"crossref","DOI":"10.1097\/HCR.0000000000000436","article-title":"Adherence to pulmonary rehabilitation in COPD: a qualitative exploration of patient perspectives on barriers and facilitators","volume":"39","author":"Oates","year":"2019","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2022092321201156000_12.9.e056902.52","unstructured":"Steiner M , Holzhauer-Barrie J , Lowe D , et al . Pulmonary rehabilitation: time to breathe better. National chronic obstructive pulmonary disease (COPD) audit programme: resources and organisation of pulmonary rehabilitation services in England and Wales 2013-18 workstream. National organisational audit report. London: Royal College of physicians, 2015. Available: https:\/\/www.rcplondon.ac.uk\/projects\/outputs\/pulmonary-rehabilitation-time-breathe-better [Accessed 6 Jun 2021]."},{"key":"2022092321201156000_12.9.e056902.53","article-title":"Does pulmonary rehabilitation work in clinical practice? A review on selection and dropout in randomized controlled trials on pulmonary rehabilitation","volume":"2","author":"Bjoernshave","year":"2010","journal-title":"Clin Epidemiol"},{"key":"2022092321201156000_12.9.e056902.54","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01822-2020"},{"key":"2022092321201156000_12.9.e056902.55","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/PHM.0000000000001505","article-title":"Physical medicine and rehabilitation and pulmonary rehabilitation for COVID-19","volume":"99","author":"Wang","year":"2020","journal-title":"Am J Phys Med Rehabil"},{"key":"2022092321201156000_12.9.e056902.56","doi-asserted-by":"crossref","DOI":"10.1177\/0300060520948382","article-title":"Rehabilitation of patients post-COVID-19 infection: a literature review","volume":"48","author":"Demeco","year":"2020","journal-title":"J Int Med Res"},{"key":"2022092321201156000_12.9.e056902.57","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2019-214246"},{"key":"2022092321201156000_12.9.e056902.58","doi-asserted-by":"crossref","DOI":"10.1177\/1479973120952418","article-title":"Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: a rapid review","volume":"17","author":"Holland","year":"2020","journal-title":"Chron Respir Dis"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-056902","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T17:03:24Z","timestamp":1701104604000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-056902"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":58,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,23]]},"published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1136\/bmjopen-2021-056902"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-056902","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9]]}}}