{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,15]],"date-time":"2026-11-15T05:22:07Z","timestamp":1794720127085,"version":"4.9.1"},"reference-count":59,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,3]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Due to the documented benefits of peripheral resistance training (RT) and inspiratory resistance training, known as inspiratory muscle training (IMT), in patients with cardiovascular disease, both exercise forms are regularly used in cardiac rehabilitation. However, little is known about the haemodynamic responses to different intensities of dynamic RT, isometric RT, and IMT in patients with coronary artery disease (CAD). This study is designed to evaluate and compare the acute haemodynamic responses elicited by different RT and IMT modalities in patients with CAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This study design is a prospective, single-centre, randomised crossover trial. A total of 20 participants with CAD will be included. All participants will undergo four different exercise training interventions: IMT, isometric wall squat training (IWS), dynamic leg press training (DLP) and isometric handgrip training (IHG). For each intervention, participants will perform two intensity modalities in randomised order: IMT (low vs high), IWS (low vs moderate), DLP (low vs high) and IHG (low vs moderate). The primary outcomes are the acute exercise-induced haemodynamic responses (esp. systolic blood pressure, pulse rate, stroke volume, cardiac output) across the different exercise training interventions, as well as the changes in haemodynamic responses during the recovery phase for each intervention. Secondary outcomes include changes in tissue oxygen saturation, oxygen saturation, and perceived dyspnoea and exertion. The study period is planned for 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study has been approved by the Ethics Committee of the German Sport University Cologne (Ethical Approval Code: 209\/24). The findings will be disseminated through international peer-reviewed publications. This study is supported by the Alexander von Humboldt Foundation via the partnership with the Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior (CAPES)(CAPES-Humboldt Research Fellowship for Experienced Researchers) and by research funding from Edwards Lifesciences LLC (Limited Liability Company).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>German Clinical Trials Register DRKS00035668.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108067","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T13:47:30Z","timestamp":1762264050000},"page":"e108067","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Haemodynamic response to peripheral and inspiratory resistance training in patients with coronary artery disease (HEMODYRET): study protocol of a prospective, single-centre, randomised crossover trial"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0972-194X","authenticated-orcid":false,"given":"Flavia","family":"Mazzoli-Rocha","sequence":"first","affiliation":[{"name":"Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil"},{"name":"Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, NRW, Germany"},{"name":"CAPES-Humboldt Research Fellowship for Experienced Researcher - Call 21, Alexander von Humboldt Foundation, Bonn, NRW, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Riemer","sequence":"additional","affiliation":[{"name":"Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, NRW, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Vikoler","sequence":"additional","affiliation":[{"name":"Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, NRW, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekka","family":"Milewski","sequence":"additional","affiliation":[{"name":"Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, NRW, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Niederegger","sequence":"additional","affiliation":[{"name":"Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, NRW, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Schwan","sequence":"additional","affiliation":[{"name":"German Association for Health Sports and Sports Therapy, H\u00fcrth, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Georg","family":"Predel","sequence":"additional","affiliation":[{"name":"Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, NRW, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birna","family":"Bjarnason-Wehrens","sequence":"additional","affiliation":[{"name":"Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, NRW, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, NRW, Germany"},{"name":"Sch\u00fcchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, NDS, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"2026111421160482000_15.11.e108067.1","unstructured":"World health organization . Cardiovascular diseases. 2021. Available: https:\/\/www.who.int\/newsroom\/fact-sheets\/detail\/cardiovascular-diseases-(cvds)"},{"key":"2026111421160482000_15.11.e108067.2","unstructured":"World health Organization . Ageing and health. 2022. Available: https:\/\/www.who.int\/news-room\/factsheets\/detail\/ageing-and-health"},{"key":"2026111421160482000_15.11.e108067.3","doi-asserted-by":"publisher","DOI":"10.1177\/2047487315604311"},{"key":"2026111421160482000_15.11.e108067.4","doi-asserted-by":"publisher","DOI":"10.1177\/2047487320905719"},{"key":"2026111421160482000_15.11.e108067.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac747"},{"key":"2026111421160482000_15.11.e108067.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.isci.2023.107861","article-title":"The effect of cardiac rehabilitation on cardiopulmonary function after coronary artery bypass grafting: A systematic review and meta-analysis","volume":"26","author":"Miao","year":"2023","journal-title":"iScience"},{"key":"2026111421160482000_15.11.e108067.7","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/2047487320913379","article-title":"Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation","volume":"28","author":"Ambrosetti","year":"2020","journal-title":"Eur J Prev Cardiol"},{"key":"2026111421160482000_15.11.e108067.8","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10102192","article-title":"Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 1","volume":"10","author":"Rauch","year":"2021","journal-title":"J Clin Med"},{"key":"2026111421160482000_15.11.e108067.9","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10143071","article-title":"Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2","volume":"10","author":"Schwaab","year":"2021","journal-title":"J Clin Med"},{"key":"2026111421160482000_15.11.e108067.10","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1093\/eurjpc\/zwab007","article-title":"Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology","volume":"29","author":"Hansen","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"2026111421160482000_15.11.e108067.11","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/HCR.0000000000000730","article-title":"Resistance Training in Patients With Coronary Artery Disease, Heart Failure, and Valvular Heart Disease: A REVIEW WITH SPECIAL EMPHASIS ON OLD AGE, FRAILTY, AND PHYSICAL LIMITATIONS","volume":"42","author":"Bjarnason-Wehrens","year":"2022","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2026111421160482000_15.11.e108067.12","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1177\/2047487318776097","article-title":"The \u2018aerobic\/resistance\/inspiratory muscle training hypothesis in heart failure\u2019","volume":"25","author":"Laoutaris","year":"2018","journal-title":"Eur J Prev Cardiolog"},{"key":"2026111421160482000_15.11.e108067.13","doi-asserted-by":"crossref","DOI":"10.3390\/jcdd9050131","article-title":"Exercise Training and Interventions for Coronary Artery Disease","volume":"9","author":"Fern\u00e1ndez-Rubio","year":"2022","journal-title":"J Cardiovasc Dev Dis"},{"key":"2026111421160482000_15.11.e108067.14","doi-asserted-by":"crossref","first-page":"4488","DOI":"10.15829\/1560-4071-2021-4488","article-title":"2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"26","author":"Pelliccia","year":"2020","journal-title":"Russ J Cardiol"},{"key":"2026111421160482000_15.11.e108067.15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.064296"},{"key":"2026111421160482000_15.11.e108067.16","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1016\/j.hlc.2023.06.854","article-title":"A Clinical Guide for Assessment and Prescription of Exercise and Physical Activity in Cardiac Rehabilitation. A CSANZ Position Statement","volume":"32","author":"Verdicchio","year":"2023","journal-title":"Heart Lung Circ"},{"key":"2026111421160482000_15.11.e108067.17","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1007\/s10741-023-10310-9","article-title":"Practical guidelines for exercise prescription in patients with chronic heart failure","volume":"28","author":"Taylor","year":"2023","journal-title":"Heart Fail Rev"},{"key":"2026111421160482000_15.11.e108067.18","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1177\/2047487319847003","article-title":"Dynamic strength training intensity in cardiovascular rehabilitation: is it time to reconsider clinical practice? A systematic review","volume":"26","author":"Hansen","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"2026111421160482000_15.11.e108067.19","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1177\/204748730501200103","article-title":"The effect of different intensity modalities of resistance training on beat-to-beat blood pressure in cardiac patients","volume":"12","author":"Lamotte","year":"2005","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"key":"2026111421160482000_15.11.e108067.20","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/HJR.0b013e328332efdd","article-title":"Acute cardiovascular response to resistance training during cardiac rehabilitation: effect of repetition speed and rest periods","volume":"17","author":"Lamotte","year":"2010","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"key":"2026111421160482000_15.11.e108067.21","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1249\/MSS.0000000000000811","article-title":"Hemodynamic Responses to Resistance Exercise in Patients with Coronary Artery Disease","volume":"48","author":"Gj\u00f8vaag","year":"2016","journal-title":"Med Sci Sports Exerc"},{"key":"2026111421160482000_15.11.e108067.22","doi-asserted-by":"publisher","DOI":"10.1177\/1741826710393197"},{"key":"2026111421160482000_15.11.e108067.23","doi-asserted-by":"publisher","DOI":"10.1177\/2047487317713329"},{"key":"2026111421160482000_15.11.e108067.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.12.076"},{"key":"2026111421160482000_15.11.e108067.25","unstructured":"Schnalke A , Schmidt T . Krafttraining in den ambulanten Herzgruppen - Can we do better? Eine Querschnittsuntersuchung der Trainingsintensit\u00e4ten. Herzmedizin 2025;55\u20136."},{"key":"2026111421160482000_15.11.e108067.26","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1152\/jappl.1985.58.3.785","article-title":"Arterial blood pressure response to heavy resistance exercise","volume":"58","author":"MacDougall","year":"1985","journal-title":"J Appl Physiol"},{"key":"2026111421160482000_15.11.e108067.27","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-009-1025-6"},{"key":"2026111421160482000_15.11.e108067.28","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1080\/02640414.2013.809471","article-title":"The effects of isometric wall squat exercise on heart rate and blood pressure in a normotensive population","volume":"32","author":"Goldring","year":"2014","journal-title":"J Sports Sci"},{"key":"2026111421160482000_15.11.e108067.29","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-016-3501-0"},{"key":"2026111421160482000_15.11.e108067.30","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-106503"},{"key":"2026111421160482000_15.11.e108067.31","doi-asserted-by":"crossref","DOI":"10.3389\/fbioe.2024.1444598","article-title":"Effects of the intensity, duration and muscle mass factors of isometric exercise on acute local muscle hemodynamic responses and systematic blood pressure regulation","volume":"12","author":"Lin","year":"2024","journal-title":"Front Bioeng Biotechnol"},{"key":"2026111421160482000_15.11.e108067.32","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1111\/j.1600-0838.2011.01435.x","article-title":"Isometric handgrip training lowers blood pressure and increases heart rate complexity in medicated hypertensive patients","volume":"23","author":"Millar","year":"2013","journal-title":"Scand J Med Sci Sports"},{"key":"2026111421160482000_15.11.e108067.33","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.112.004473","article-title":"Exercise training for blood pressure: a systematic review and meta-analysis","volume":"2","author":"Cornelissen","year":"2013","journal-title":"J Am Heart Assoc"},{"key":"2026111421160482000_15.11.e108067.34","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s00421-023-05269-2","article-title":"The implementation of a home-based isometric wall squat intervention using ratings of perceived exertion to select and control exercise intensity: a pilot study in normotensive and pre-hypertensive adults","volume":"124","author":"Lea","year":"2024","journal-title":"Eur J Appl Physiol"},{"key":"2026111421160482000_15.11.e108067.35","doi-asserted-by":"publisher","DOI":"10.3109\/14017431.2011.595820"},{"key":"2026111421160482000_15.11.e108067.36","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ijcard.2018.12.013","article-title":"Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial","volume":"279","author":"Dos Santos","year":"2019","journal-title":"Int J Cardiol"},{"key":"2026111421160482000_15.11.e108067.37","doi-asserted-by":"crossref","first-page":"4074","DOI":"10.1080\/09638288.2022.2146767","article-title":"The results of inspiratory muscle training on cardiac, respiratory, musculoskeletal, and psychological status in patients with stable angina: a randomized controlled trial","volume":"45","author":"Huzmeli","year":"2023","journal-title":"Disabil Rehabil"},{"key":"2026111421160482000_15.11.e108067.38","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1177\/2047487318798917","article-title":"Inspiratory muscle training - an inspiration for more effective cardiac rehabilitation in heart failure patients?","volume":"25","author":"Bjarnason-Wehrens","year":"2018","journal-title":"Eur J Prev Cardiol"},{"key":"2026111421160482000_15.11.e108067.39","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1177\/2047487318792315","article-title":"Best mode of inspiratory muscle training in heart failure patients: a systematic review and meta-analysis","volume":"25","author":"Sadek","year":"2018","journal-title":"Eur J Prev Cardiol"},{"key":"2026111421160482000_15.11.e108067.40","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1097\/HCR.0000000000000794","article-title":"Hemodynamic Tolerance of New Resistance Training Methods in Patients With Heart Failure and Coronary Artery Disease: A randomized crossover study","volume":"43","author":"Gillet","year":"2023","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2026111421160482000_15.11.e108067.41","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053"},{"key":"2026111421160482000_15.11.e108067.42","unstructured":"Emea EMA . Guideline for Good Clinical Practice E6(R2). 2016;1\u201368."},{"key":"2026111421160482000_15.11.e108067.43","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.c332","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials","volume":"340","author":"Schulz","year":"2010","journal-title":"BMJ"},{"key":"2026111421160482000_15.11.e108067.44","unstructured":"German-speaking part of Europe Germany A, Switzerland . S3LL KardReha D-A-CH - Guideline for Cardiac Rehabilitation. 2020;1\u2013414."},{"key":"2026111421160482000_15.11.e108067.45","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"2026111421160482000_15.11.e108067.46","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00150314"},{"key":"2026111421160482000_15.11.e108067.47","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(84)80146-X"},{"key":"2026111421160482000_15.11.e108067.48","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.166.4.518"},{"key":"2026111421160482000_15.11.e108067.49","doi-asserted-by":"crossref","first-page":"225","DOI":"10.2478\/bhk-2023-0026","article-title":"POWERbreathe\u00ae S-Index Test \u2013 guidelines and recommendations for practitioners","volume":"15","author":"Kowalski","year":"2023","journal-title":"Biomedical Human Kinetics"},{"key":"2026111421160482000_15.11.e108067.50","doi-asserted-by":"crossref","first-page":"55","DOI":"10.5271\/sjweh.1815","article-title":"Psychophysical scaling with applications in physical work and the perception of exertion","volume":"16 Suppl 1","author":"Borg","year":"1990","journal-title":"Scand J Work Environ Health"},{"key":"2026111421160482000_15.11.e108067.51","first-page":"38","article-title":"Finger arterial pressure measurement with Finapres","volume":"85 Suppl 3","author":"Wesseling","year":"1996","journal-title":"Z Kardiol"},{"key":"2026111421160482000_15.11.e108067.52","first-page":"232","article-title":"The accuracy of noninvasive cardiac output and pressure measurements with finger cuff: a concise review","volume":"21","author":"Ameloot","year":"2015","journal-title":"Curr Opin Crit Care"},{"key":"2026111421160482000_15.11.e108067.53","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1097\/EJA.0000000000000690","article-title":"The impact of continuous non-invasive arterial blood pressure monitoring on blood pressure stability during general anaesthesia in orthopaedic patients: A randomised trial","volume":"34","author":"Meidert","year":"2017","journal-title":"Eur J Anaesthesiol"},{"key":"2026111421160482000_15.11.e108067.54","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-017-0015-1"},{"key":"2026111421160482000_15.11.e108067.55","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000010105","article-title":"The safety of isometric exercise: Rethinking the exercise prescription paradigm for those with stage 1 hypertension","volume":"97","author":"Wiles","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"2026111421160482000_15.11.e108067.56","unstructured":"Medicine ACoS . ACSM\u2019s guidelines for exercise testing and prescription. 2018."},{"key":"2026111421160482000_15.11.e108067.57","doi-asserted-by":"crossref","DOI":"10.3390\/jcdd9090287","article-title":"Effect of Lower- versus Higher-Intensity Isometric Handgrip Training in Adults with Hypertension: A Randomized Controlled Trial","volume":"9","author":"Javidi","year":"2022","journal-title":"J Cardiovasc Dev Dis"},{"key":"2026111421160482000_15.11.e108067.58","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2010.09.091"},{"key":"2026111421160482000_15.11.e108067.59","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.1007\/s00421-019-04207-5","article-title":"Autonomic cardiovascular control changes in recent heart transplant recipients lead to physiological limitations in response to orthostatic challenge and isometric exercise","volume":"119","author":"Nygaard","year":"2019","journal-title":"Eur J Appl Physiol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-108067","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,15]],"date-time":"2026-11-15T05:17:25Z","timestamp":1794719845000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-108067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":59,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,4]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjopen-2025-108067"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-108067","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2025-108067.supp1","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}