{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:59:03Z","timestamp":1788155943682,"version":"build-2803163510"},"reference-count":61,"publisher":"BMJ","issue":"6","funder":[{"name":"Texas Medical Center Digestive Diseases Center","award":["PHS grant P30DK056338"],"award-info":[{"award-number":["PHS grant P30DK056338"]}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["CIN 13-413"],"award-info":[{"award-number":["CIN 13-413"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["Career Development Award: 1 IK2 HX003346-01A2"],"award-info":[{"award-number":["Career Development Award: 1 IK2 HX003346-01A2"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000936","name":"Gordon and Betty Moore Foundation","doi-asserted-by":"publisher","award":["Diagnostic Excellence Award, grant #GBMF11505.01"],"award-info":[{"award-number":["Diagnostic Excellence Award, grant #GBMF11505.01"]}],"id":[{"id":"10.13039\/100000936","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01 HS028595"],"award-info":[{"award-number":["R01 HS028595"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01 HS029318"],"award-info":[{"award-number":["R01 HS029318"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R18 HS029347"],"award-info":[{"award-number":["R18 HS029347"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2025,9,8]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We previously developed a digital quality measure (dQM) of emergency presentations (EPs) in colorectal cancer (CRC) and found it to be associated with worse outcomes. Potentially avoidable EPs were common in this cohort, but identifying them required time-intensive chart reviews. We aimed to enhance the existing dQM to automate the detection of potentially avoidable EPs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We defined potentially avoidable EPs as those preceded by a CRC red flag (iron-deficiency anaemia or haematochezia \u226560 days prior, or positive stool-based screening test \u2265180 days prior). The enhanced dQM was applied to a national cohort of incident CRC cases diagnosed in the Veterans Affairs healthcare system from 2017 to 2021. We examined associations with cancer stage, treatment and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The enhanced dQM had a positive predictive value of 92% (95% CI 85.5% to 95.7%) for identifying potentially avoidable EPs. Among 9096 CRC cases, 28.1% were identified as EPs. Of these, 31.6% were classified as potentially avoidable. These patients were more likely to have advanced-stage disease (adjusted OR 1.50; 95%\u2009CI 1.27 to 1.78), less likely to receive treatment (adjusted OR 0.58; 95%\u2009CI 0.48 to 0.70) and had higher mortality (adjusted HR 1.58; 95%\u2009CI 1.40 to 1.79) compared with other patients with CRC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The enhanced dQM accurately identified potentially avoidable EPs, which were associated with worse outcomes. This measure is unique in its focus on cases of preventable care delays, which can help guide future efforts to improve diagnostic timeliness and reduce EPs among patients with CRC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjqs-2025-019084","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T17:20:18Z","timestamp":1759252818000},"page":"380-392","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Digital quality measure of potentially avoidable emergency presentations among patients with colorectal cancer"],"prefix":"10.1136","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7585-6183","authenticated-orcid":false,"given":"Natalia","family":"Khalaf","sequence":"first","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA"},{"name":"Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basim","family":"Ali","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Zimolzak","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA"},{"name":"Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Liu","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA"},{"name":"Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Wei","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fasiha","family":"Kanwal","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA"},{"name":"Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4419-8974","authenticated-orcid":false,"given":"Hardeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA"},{"name":"Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"2026051802150685000_35.6.380.1","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1515\/dx-2019-0019","article-title":"Serious misdiagnosis-related harms in malpractice claims: The \u201cBig Three\u201d \u2013 vascular events, infections, and cancers","volume":"6","author":"Newman-Toker","year":"2019","journal-title":"Diagnosis (Berl)"},{"key":"2026051802150685000_35.6.380.2","unstructured":"Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine . Improving diagnosis in health care. Washington (DC) National Academies Press (US); 2015. Available: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK338596\/ [accessed 01 Nov 2023]"},{"key":"2026051802150685000_35.6.380.3","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21772"},{"key":"2026051802150685000_35.6.380.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cdp.2008.01.001"},{"key":"2026051802150685000_35.6.380.5","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.324"},{"key":"2026051802150685000_35.6.380.6","doi-asserted-by":"crossref","DOI":"10.1155\/2015\/285096","article-title":"Missed Opportunities for the Diagnosis of Colorectal Cancer","volume":"2015","author":"Siminoff","year":"2015","journal-title":"Biomed Res Int"},{"key":"2026051802150685000_35.6.380.7","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(22)00127-9"},{"key":"2026051802150685000_35.6.380.8","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001080"},{"key":"2026051802150685000_35.6.380.9","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.408"},{"key":"2026051802150685000_35.6.380.10","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2016.155"},{"key":"2026051802150685000_35.6.380.11","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2013.569"},{"key":"2026051802150685000_35.6.380.12","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.2217\/fon.14.80","article-title":"Are emergency diagnoses of cancer avoidable? A proposed taxonomy to motivate study design and support service improvement","volume":"10","author":"Lyratzopoulos","year":"2014","journal-title":"Future Oncol"},{"key":"2026051802150685000_35.6.380.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2008.01613.x"},{"key":"2026051802150685000_35.6.380.14","unstructured":"Centers for Medicare & Medicaid Services . CMS quality measure development plan: supporting the transition to the merit-based incentive payment system (mips) and alternative payment models (apms). 2016. Available: https:\/\/www.cms.gov\/Medicare\/Quality-Initiatives-Patient-Assessment-Instruments\/Value-Based-Programs\/MACRA-MIPS-and-APMs\/Final-MDP.pdf [Accessed 16 Aug 2024]."},{"key":"2026051802150685000_35.6.380.15","unstructured":"Centers for Medicare & Medicaid Services . eCQI Resource Center. Available: https:\/\/ecqi.healthit.gov\/ [Accessed 23 Jul 2025]."},{"key":"2026051802150685000_35.6.380.16","doi-asserted-by":"crossref","first-page":"2506","DOI":"10.1200\/JCO.23.01523","article-title":"Development and Implementation of a Digital Quality Measure of Emergency Cancer Diagnosis","volume":"42","author":"Kapadia","year":"2024","journal-title":"JCO"},{"key":"2026051802150685000_35.6.380.17","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s10620-024-08762-6","article-title":"Prevalence and Outcomes of Emergency Presentations of Colorectal Cancer in Veterans Affairs Health Care System","volume":"70","author":"Khalaf","year":"2025","journal-title":"Dig Dis Sci"},{"key":"2026051802150685000_35.6.380.18","unstructured":"Patel N , Kessler C . VA emergency medicine: using evidence to inform policy and improve access to effective emergency and urgent care for veterans. 2024. Available: https:\/\/www.hsrd.research.va.gov\/publications\/forum\/fall24\/default.cfm?ForumMenu=fall24-1 [Accessed 23 Jul 2025]."},{"key":"2026051802150685000_35.6.380.19","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/acem.14670","article-title":"Continuing the transformation: charting the path for the future delivery of Veteran emergency care","volume":"30","author":"Ward","year":"2023","journal-title":"Acad Emerg Med"},{"key":"2026051802150685000_35.6.380.20","doi-asserted-by":"crossref","first-page":"e1883","DOI":"10.7205\/MILMED-D-16-00371","article-title":"Cancer Incidence Among Patients of the U.S. Veterans Affairs Health Care System: 2010 Update","volume":"182","author":"Zullig","year":"2017","journal-title":"Mil Med"},{"key":"2026051802150685000_35.6.380.21","unstructured":"Culbreath C , Gonsoulin M . VIReC Corporate Data Warehouse (CDW) Domain Descriptions. Hines IL: U.S. Department of Veterans Affairs, Health Services Research & Development Service, VA Information Resource Center, 2019."},{"key":"2026051802150685000_35.6.380.22","unstructured":"Veterans Affairs Informatics and Computing Infrastructure (VINCI) . VINCI data catalog. U.S. Department of Veterans Affairs. Available: https:\/\/vaww.vinci.med.va.gov\/vincicentral\/data_catalog\/ [Accessed 23 Jul 2025]."},{"key":"2026051802150685000_35.6.380.23","unstructured":"U.S. Department of Veterans Affairs . Corporate Data Warehouse (CDW). VA Health Services Research & Development. Available: https:\/\/www.hsrd.research.va.gov\/for_researchers\/cdw.cfm [Accessed 23 Jul 2025]."},{"key":"2026051802150685000_35.6.380.24","doi-asserted-by":"crossref","DOI":"10.1186\/1478-7954-4-2","article-title":"Accuracy and completeness of mortality data in the Department of Veterans Affairs","volume":"4","author":"Sohn","year":"2006","journal-title":"Popul Health Metr"},{"key":"2026051802150685000_35.6.380.25","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.6636"},{"key":"2026051802150685000_35.6.380.26","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.61.1301"},{"key":"2026051802150685000_35.6.380.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.08.007"},{"key":"2026051802150685000_35.6.380.28","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1053\/j.gastro.2020.06.046","article-title":"AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia","volume":"159","author":"Ko","year":"2020","journal-title":"Gastroenterology"},{"key":"2026051802150685000_35.6.380.29","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2021-325210"},{"key":"2026051802150685000_35.6.380.30","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2018-317807"},{"key":"2026051802150685000_35.6.380.31","first-page":"284","article-title":"Management of Acute Lower GI Bleeding: Guidelines From the American College of Gastroenterology","volume":"109","author":"Hawks","year":"2024","journal-title":"Am Fam Physician"},{"key":"2026051802150685000_35.6.380.32","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.3634"},{"key":"2026051802150685000_35.6.380.33","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1016\/j.cgh.2020.09.048","article-title":"Association Between Time to Colonoscopy After Positive Fecal Testing and Colorectal Cancer Outcomes: A Systematic Review","volume":"19","author":"Forbes","year":"2021","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2026051802150685000_35.6.380.34","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1053\/j.gastro.2021.01.219","article-title":"Time to Colonoscopy After Abnormal Stool-Based Screening and Risk for Colorectal Cancer Incidence and Mortality","volume":"160","author":"San Miguel","year":"2021","journal-title":"Gastroenterology"},{"key":"2026051802150685000_35.6.380.35","unstructured":"Department of Veterans Affairs . Implementation of programmatic mailed fecal immunochemical testing (FIT) for colorectal cancer screening [memorandum]. Assistant Under Secretary for Health for Clinical Services\/Chief Medical Officer; 2022."},{"key":"2026051802150685000_35.6.380.36","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1093\/jamia\/ocad089","article-title":"Developing electronic clinical quality measures to assess the cancer diagnostic process","volume":"30","author":"Murphy","year":"2023","journal-title":"J Am Med Inform Assoc"},{"key":"2026051802150685000_35.6.380.37","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2018-008086"},{"key":"2026051802150685000_35.6.380.38","unstructured":"Paying for Senior Care . Department of veterans\u2019 affairs table of priority groups. 2024. Available: https:\/\/www.payingforseniorcare.com\/veterans\/veterans_priority_groups [Accessed 19 Sep 2025]."},{"key":"2026051802150685000_35.6.380.39","unstructured":"Washington DL , ed. National veteran health equity report 2021. focus on veterans health administration patient experience and health care quality. Washington, DC VHA Office of Health Equity; 2022."},{"key":"2026051802150685000_35.6.380.40","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.24345","article-title":"Evaluation of Changes in Veterans Affairs Medical Centers\u2019 Mortality Rates After Risk Adjustment for Socioeconomic Status","volume":"3","author":"Trivedi","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2026051802150685000_35.6.380.41","first-page":"21","article-title":"Summary of Veterans Health Administration Cancer Data Sources","volume":"51","author":"Zullig","year":"2024","journal-title":"J Regist Manag"},{"key":"2026051802150685000_35.6.380.42","unstructured":"U.S. Department of Veterans Affairs . OncoTraX: cancer registry user manual (version 2.2) [pdf]. office of information and technology, enterprise program management office. 2022. Available: https:\/\/www.va.gov\/vdl\/documents\/Clinical\/Reg-Oncology\/ONC_2_2_P14_UM.pdf"},{"key":"2026051802150685000_35.6.380.43","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/jvh.12533","article-title":"Epidemiology and outcomes of hepatitis C infection in elderly US Veterans","volume":"23","author":"El-Serag","year":"2016","journal-title":"J Viral Hepat"},{"key":"2026051802150685000_35.6.380.44","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1002\/hep.31157","article-title":"Risk of Cirrhosis and Hepatocellular Cancer in Patients With NAFLD and Normal Liver Enzymes","volume":"72","author":"Natarajan","year":"2020","journal-title":"Hepatology"},{"key":"2026051802150685000_35.6.380.45","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1097\/MPA.0000000000002272","article-title":"The Impact of Race on Pancreatic Cancer Treatment and Survival in the Nationwide Veterans Affairs Healthcare System","volume":"53","author":"Khalaf","year":"2024","journal-title":"Pancreas"},{"key":"2026051802150685000_35.6.380.46","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X690869"},{"key":"2026051802150685000_35.6.380.47","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.canep.2019.04.011","article-title":"Diagnostic route is associated with care satisfaction independently of tumour stage: Evidence from linked English Cancer Patient Experience Survey and cancer registration data","volume":"61","author":"Pham","year":"2019","journal-title":"Cancer Epidemiol"},{"key":"2026051802150685000_35.6.380.48","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2016.250"},{"key":"2026051802150685000_35.6.380.49","unstructured":"U.S. Department of Veterans Affairs . Colorectal cancer doesn\u2019t have to kill you. VA News; 2025. Available: https:\/\/news.va.gov\/138947\/colorectal-cancer-doesnt-have-to-kill-you [Accessed 23 Jul 2025]."},{"key":"2026051802150685000_35.6.380.50","unstructured":"U.S. Department of Veterans Affairs . A lauded by national colorectal cancer roundtable for screening rates. VA News; 2016. Available: https:\/\/news.va.gov\/press-room\/va-lauded-by-national-colorectal-cancer-roundtable-for-screening-rates [Accessed 23 Jul 2025]."},{"key":"2026051802150685000_35.6.380.51","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djp436"},{"key":"2026051802150685000_35.6.380.52","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.0087","article-title":"Medical Home Implementation and Follow-Up of Cancer-Related Abnormal Test Results in the Veterans Health Administration","volume":"7","author":"Rajan","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026051802150685000_35.6.380.53","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2013-001874"},{"key":"2026051802150685000_35.6.380.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2017.10.001"},{"key":"2026051802150685000_35.6.380.55","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.chest.2016.05.001","article-title":"Computerized Triggers of Big Data to Detect Delays in Follow-up of Chest Imaging Results","volume":"150","author":"Murphy","year":"2016","journal-title":"Chest"},{"key":"2026051802150685000_35.6.380.56","first-page":"279","article-title":"Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer","volume":"8","author":"Murphy","year":"2017","journal-title":"Appl Clin Inform"},{"key":"2026051802150685000_35.6.380.57","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6602714"},{"key":"2026051802150685000_35.6.380.58","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1038\/s41416-019-0385-x","article-title":"Predictive values of colorectal cancer alarm symptoms in the general population: a nationwide cohort study","volume":"120","author":"Rasmussen","year":"2019","journal-title":"Br J Cancer"},{"key":"2026051802150685000_35.6.380.59","doi-asserted-by":"crossref","DOI":"10.1186\/1741-7015-7-17","article-title":"The risk of colorectal cancer with symptoms at different ages and between the sexes: a case-control study","volume":"7","author":"Hamilton","year":"2009","journal-title":"BMC Med"},{"key":"2026051802150685000_35.6.380.60","unstructured":"NICE . Evidence | suspected cancer: recognition and referral | guidance. Updated in 2025. Available: https:\/\/www.nice.org.uk\/guidance\/ng12\/evidence [Accessed 20 Sep 2025]."},{"key":"2026051802150685000_35.6.380.61","unstructured":"Department of Health . Improving outcomes: a strategy for cancer. 2011. Available: https:\/\/assets.publishing.service.gov.uk\/media\/5a7c5d0240f0b626628ab882\/dh_123394.pdf [accessed 1 Aug 2024]"}],"container-title":["BMJ Quality &amp; Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjqs-2025-019084","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T09:16:52Z","timestamp":1779095812000},"score":1,"resource":{"primary":{"URL":"https:\/\/qualitysafety.bmj.com\/lookup\/doi\/10.1136\/bmjqs-2025-019084"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":61,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,5,18]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bmjqs-2025-019084"],"URL":"https:\/\/doi.org\/10.1136\/bmjqs-2025-019084","relation":{},"ISSN":["2044-5415","2044-5423"],"issn-type":[{"value":"2044-5415","type":"print"},{"value":"2044-5423","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}