{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:09:51Z","timestamp":1773011391165,"version":"3.50.1"},"reference-count":72,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T00:00:00Z","timestamp":1683590400000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Team Simon Foundation for Cystic Fibrosis"},{"name":"Cure4CF Holckner Family Impact Grant"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2023,4,21]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Cystic fibrosis (CF) is a multisystem condition that is complicated by recurrent pulmonary infections requiring aggressive antibiotic treatment. This predisposes the patient to complications such as sensorineural hearing loss, renal impairment, hypersensitivity and the development of antibiotic resistance. <jats:italic>Pseudomonas aeruginosa<\/jats:italic> is one of the more common organisms which cause recurrent infections and result in greater morbidity and mortality in people living with CF. Bacteriophages have been identified as a potential alternative or adjunct to antibiotics. We hypothesise that bacteriophage therapy is a safe and well-tolerated treatment in children with CF infected with <jats:italic>P. aeruginosa<\/jats:italic> infection in their airways.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This single-arm, open-labelled, non-randomised trial will run for a maximum period of 36 months with up to 10 participants. Adolescents (\u226512 years and &lt;18 years of age) who continue to shed <jats:italic>P.aeruginosa<\/jats:italic> (within 3 months of enrolment) despite undergoing eradication therapy previously, will be considered for this trial. Non-genetically modified bacteriophages that have demonstrated obligate lytic activity against each of the study participants\u2019 <jats:italic>P. aeruginosa<\/jats:italic> strains will be selected and prepared according to a combination of established protocols (isolation, purification, sterility testing and packaging) to achieve close to good manufacturing practice recommendations. The selected bacteriophage will be administered endo-bronchially first under direct vision, followed by two times a day nebulisation for 7\u2009days in addition to standard CF treatment (intravenous antibiotics, physiotherapy to be completed as inpatient for 10\u201314 days). Safety and tolerability will be defined as the absence of (1) fever above 38.5\u00b0C occurring within 1\u2009hour of the administration of the nebulised bacteriophage, (2) a 10% decline in spirometry (forced expiratory volume in 1 s %) measured preadministration and postadministration of the first dose of nebulised bacteriophage. Clinical reviews including repeat sputum cultures and spirometry will be performed at 3, 6, 9 and 12 months following bacteriophage treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>Our clinical trial is conducted in accordance with (1) good clinical practice, (2) Australian legislation, (3) National Health and Medical Research Council guidelines for the ethical conduct of research.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>Australia and New Zealand Clinical Trial Registry (ACTRN12622000767707).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjresp-2022-001360","type":"journal-article","created":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T10:52:50Z","timestamp":1683715970000},"page":"e001360","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Single-arm, open-labelled, safety and tolerability of intrabronchial and nebulised bacteriophage treatment in children with cystic fibrosis and <i>Pseudomonas aeruginosa<\/i>"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6162-6483","authenticated-orcid":false,"given":"Jagdev","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, The Children\u2019s Hospital at Westmead, Sydney, New South Wales, Australia"},{"name":"Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominic A","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, The Children\u2019s Hospital at Westmead, Sydney, New South Wales, Australia"},{"name":"Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Jaffe","sequence":"additional","affiliation":[{"name":"School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Hunt","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, The Children\u2019s Hospital at Westmead, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy J","family":"Barr","sequence":"additional","affiliation":[{"name":"Monash University, Clayton, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Iredell","sequence":"additional","affiliation":[{"name":"Westmead Institute for Medical Research, Westmead, New South Wales, Australia"},{"name":"Department of Infectious Diseases, Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiran","family":"Selvadurai","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, The Children\u2019s Hospital at Westmead, Sydney, New South Wales, Australia"},{"name":"Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,9]]},"reference":[{"key":"2025083110343518000_10.1.e001360.1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.10127"},{"key":"2025083110343518000_10.1.e001360.2","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2001.112897"},{"key":"2025083110343518000_10.1.e001360.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2008.08.001"},{"key":"2025083110343518000_10.1.e001360.4","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.10135"},{"key":"2025083110343518000_10.1.e001360.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2013.03.005"},{"key":"2025083110343518000_10.1.e001360.6","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/42.1.103"},{"key":"2025083110343518000_10.1.e001360.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2005.09.003"},{"key":"2025083110343518000_10.1.e001360.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1699-0463.1994.tb05219.x"},{"key":"2025083110343518000_10.1.e001360.9","first-page":"277","article-title":"The antibiotic resistance crisis: Part 1: causes and threats","volume":"40","author":"Ventola","year":"2015","journal-title":"P T"},{"key":"2025083110343518000_10.1.e001360.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.chom.2019.01.014"},{"key":"2025083110343518000_10.1.e001360.11","doi-asserted-by":"publisher","DOI":"10.1042\/ETLS20170005"},{"key":"2025083110343518000_10.1.e001360.12","first-page":"S4","article-title":"Bacteriophage therapy for infections in CF","volume":"56 Suppl 1","author":"Chan","year":"2021","journal-title":"Pediatr Pulmonol"},{"key":"2025083110343518000_10.1.e001360.13","doi-asserted-by":"publisher","DOI":"10.1038\/embor.2013.163"},{"key":"2025083110343518000_10.1.e001360.14","doi-asserted-by":"publisher","DOI":"10.1007\/s00005-014-0269-y"},{"key":"2025083110343518000_10.1.e001360.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.addr.2018.08.001"},{"key":"2025083110343518000_10.1.e001360.16","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1146\/annurev-virology-100114-054915","article-title":"Bacteriophage therapy: advances in formulation strategies and human clinical trials","volume":"2","author":"Vandenheuvel","year":"2015","journal-title":"Annu Rev Virol"},{"key":"2025083110343518000_10.1.e001360.17","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.trsl.2018.12.002","article-title":"Safety and efficacy of a bacteriophage cocktail in an in vivo model of Pseudomonas aeruginosa sinusitis","volume":"206","author":"Fong","year":"2019","journal-title":"Transl Res"},{"key":"2025083110343518000_10.1.e001360.18","doi-asserted-by":"publisher","DOI":"10.1080\/07315724.2018.1483783"},{"key":"2025083110343518000_10.1.e001360.19","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/s41564-019-0634-z","article-title":"Safety of bacteriophage therapy in severe Staphylococcus aureus infection","volume":"5","author":"Petrovic Fabijan","year":"2020","journal-title":"Nat Microbiol"},{"key":"2025083110343518000_10.1.e001360.20","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1164\/rccm.201904-0839LE","article-title":"Bacteriophage therapy of ventilator-associated pneumonia and empyema caused by Pseudomonas aeruginosa","volume":"200","author":"Maddocks","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2025083110343518000_10.1.e001360.21","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.029744-0"},{"key":"2025083110343518000_10.1.e001360.22","doi-asserted-by":"publisher","DOI":"10.4161\/bact.1.2.14590"},{"key":"2025083110343518000_10.1.e001360.23","doi-asserted-by":"publisher","DOI":"10.1038\/srep26717"},{"key":"2025083110343518000_10.1.e001360.24","doi-asserted-by":"crossref","first-page":"2990","DOI":"10.1002\/ppul.24945","article-title":"Combining bacteriophages with cefiderocol and meropenem\/vaborbactam to treat a pan-drug resistant Achromobacter species infection in a pediatric cystic fibrosis patient","volume":"55","author":"Gainey","year":"2020","journal-title":"Pediatr Pulmonol"},{"key":"2025083110343518000_10.1.e001360.25","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/pix056"},{"key":"2025083110343518000_10.1.e001360.26","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-016-0001-8"},{"key":"2025083110343518000_10.1.e001360.27","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens8030100","article-title":"Bacteriophages in natural and artificial environments","volume":"8","author":"Batinovic","year":"2019","journal-title":"Pathogens"},{"key":"2025083110343518000_10.1.e001360.28","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2009.18.6.42801"},{"key":"2025083110343518000_10.1.e001360.29","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.addr.2019.01.003","article-title":"Bacteriophage interactions with mammalian tissue: therapeutic applications","volume":"145","author":"Huh","year":"2019","journal-title":"Adv Drug Deliv Rev"},{"key":"2025083110343518000_10.1.e001360.30","doi-asserted-by":"publisher","DOI":"10.2165\/00063030-200216010-00006"},{"key":"2025083110343518000_10.1.e001360.31","doi-asserted-by":"publisher","DOI":"10.1111\/1462-2920.13284"},{"key":"2025083110343518000_10.1.e001360.32","doi-asserted-by":"crossref","DOI":"10.3390\/nu11030666","article-title":"Phage study: effects of supplemental bacteriophage intake on inflammation and gut microbiota in healthy adults","volume":"11","author":"Febvre","year":"2019","journal-title":"Nutrients"},{"key":"2025083110343518000_10.1.e001360.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.virol.2013.05.022"},{"key":"2025083110343518000_10.1.e001360.34","doi-asserted-by":"publisher","DOI":"10.1111\/1462-2920.13574"},{"key":"2025083110343518000_10.1.e001360.35","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiv029"},{"key":"2025083110343518000_10.1.e001360.36","doi-asserted-by":"publisher","DOI":"10.1086\/649227"},{"key":"2025083110343518000_10.1.e001360.37","first-page":"371","article-title":"Animal experiments on mucosal passage and absorption viraemia of T3 phages after oral, trach\u00e9al and rectal administration","volume":"198","author":"Hoffmann","year":"1965","journal-title":"Zentralblatt Fur Bakteriologie, Parasitenkunde, Infektionskrankheiten Und Hygiene"},{"key":"2025083110343518000_10.1.e001360.38","doi-asserted-by":"publisher","DOI":"10.3390\/v7082845"},{"key":"2025083110343518000_10.1.e001360.39","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.virol.2009.03.009","article-title":"T4 phages against Escherichia coli diarrhea: potential and problems","volume":"388","author":"Denou","year":"2009","journal-title":"Virology"},{"key":"2025083110343518000_10.1.e001360.40","doi-asserted-by":"publisher","DOI":"10.1111\/j.1574-695X.2002.tb00555.x"},{"key":"2025083110343518000_10.1.e001360.41","doi-asserted-by":"crossref","DOI":"10.3390\/v13071268","article-title":"The safety and toxicity of phage therapy: a review of animal and clinical studies","volume":"13","author":"Liu","year":"2021","journal-title":"Viruses"},{"key":"2025083110343518000_10.1.e001360.42","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0071036","article-title":"T4 phage and its head surface proteins do not stimulate inflammatory mediator production","volume":"8","author":"Miernikiewicz","year":"2013","journal-title":"PLoS One"},{"key":"2025083110343518000_10.1.e001360.43","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2016.01112","article-title":"T4 phage tail adhesin gp12 counteracts LPS-induced inflammation in vivo","volume":"7","author":"Miernikiewicz","year":"2016","journal-title":"Front Microbiol"},{"key":"2025083110343518000_10.1.e001360.44","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-08336-9"},{"key":"2025083110343518000_10.1.e001360.45","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.mimet.2016.07.027","article-title":"A review of current methods using bacteriophages in live animals, food and animal products intended for human consumption","volume":"130","author":"Cooper","year":"2016","journal-title":"J Microbiol Methods"},{"key":"2025083110343518000_10.1.e001360.46","doi-asserted-by":"crossref","DOI":"10.3390\/v10040205","article-title":"Bacteriophage applications for food production and processing","volume":"10","author":"Moye","year":"2018","journal-title":"Viruses"},{"key":"2025083110343518000_10.1.e001360.47","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.00767-14"},{"key":"2025083110343518000_10.1.e001360.48","doi-asserted-by":"crossref","first-page":"51","DOI":"10.3390\/v13010051","article-title":"Bacteriophage treatment: critical evaluation of its application on world Health organization priority pathogens","volume":"13","author":"AL-Ishaq","year":"2021","journal-title":"Viruses"},{"key":"2025083110343518000_10.1.e001360.49","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpb.2018.01.010"},{"key":"2025083110343518000_10.1.e001360.50","doi-asserted-by":"crossref","first-page":"3829","DOI":"10.1111\/bph.15526","article-title":"Inhaled bacteriophage therapy in a porcine model of pneumonia caused by Pseudomonas aeruginosa during mechanical ventilation","volume":"178","author":"Guillon","year":"2021","journal-title":"Br J Pharmacol"},{"key":"2025083110343518000_10.1.e001360.51","article-title":"The efficacy of phage therapy in a murine model of Pseudomonas aeruginosa pneumonia and sepsis","volume":"12","author":"Yang","year":"2021","journal-title":"Front Microbiol"},{"key":"2025083110343518000_10.1.e001360.52","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1001\/jamaoto.2019.1191","article-title":"Safety and tolerability of bacteriophage therapy for chronic rhinosinusitis due to Staphylococcus aureus","volume":"145","author":"Ooi","year":"2019","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"2025083110343518000_10.1.e001360.53","doi-asserted-by":"publisher","DOI":"10.1016\/S1569-1993(02)00141-8"},{"key":"2025083110343518000_10.1.e001360.54","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201908-1590ST"},{"key":"2025083110343518000_10.1.e001360.55","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.633184"},{"key":"2025083110343518000_10.1.e001360.56","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7039e4"},{"key":"2025083110343518000_10.1.e001360.57","doi-asserted-by":"publisher","DOI":"10.1038\/s41596-020-0346-0"},{"key":"2025083110343518000_10.1.e001360.58","unstructured":"Organisation WH . Test for sterility final text for revision of the International Pharmacopoeia. 2012. Available: https:\/\/www.who.int\/medicines\/publications\/pharmacopoeia\/TestForSterility-RevGenMethod_QAS11-413FINALMarch2012.pdf"},{"key":"2025083110343518000_10.1.e001360.59","unstructured":"Therapeutic Goods Administration A . Tga guidelines for sterility testing of therapeutic goods. 2006. Available: https:\/\/www.tga.gov.au\/sites\/default\/files\/manuf-sterility-testing-guidelines.pdf"},{"key":"2025083110343518000_10.1.e001360.60","unstructured":"FDA . Guidance for industry, container closure systems for packaging human drugs and biologics. n.d. Available: https:\/\/www.fda.gov\/MEDIA\/70788\/DOWNLOAD"},{"key":"2025083110343518000_10.1.e001360.61","unstructured":"FDA . Nasal spray and inhalation solution, suspension, and spray drug products -- chemistry, manufacturing. n.d. Available: https:\/\/www.fda.gov\/REGULATORY-INFORMATION\/SEARCH-FDA-GUIDANCE-DOCUMENTS\/NASAL-SPRAY-AND-INHALATION-SOLUTION-SUSPENSION-AND-SPRAY-DRUG-PRODUCTS-CHEMISTRY-MANUFACTURING-AND"},{"key":"2025083110343518000_10.1.e001360.62","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2010.08.020"},{"key":"2025083110343518000_10.1.e001360.63","first-page":"552","article-title":"Considerations on the treatment of common respiratory diseases by means of bacteriophages","volume":"79","author":"DELACOSTE","year":"1959","journal-title":"Rev Med Suisse Romande"},{"key":"2025083110343518000_10.1.e001360.64","unstructured":"Hoeflmayr J. . Fortschritte der biologischen Aerosol-Forschung in den Jahren 1957\u20131961 [Advances in Biological Aerosols Research in the Years 1957\u20131961]. Stuttgart, Germany: 1962:403\u20139.. Bad Lippspringe, Germany: Schattauer, 1962."},{"key":"2025083110343518000_10.1.e001360.65","first-page":"65","article-title":"Certain methodological aspects of the use of inhalation of a polyvalent bacteriophage in the treatment of pneumonia of young children","volume":"53","author":"Garsevanishvili","year":"1974","journal-title":"Pediatriia"},{"key":"2025083110343518000_10.1.e001360.66","first-page":"63","article-title":"\u041f\u0440\u0438\u043c\u0435\u043d\u0435\u043d\u0438\u0435 \u0431\u0430\u043a\u0442\u0435\u0440\u0438\u043e\u0444\u0430\u0433\u0430 \u0441 \u0430\u043d\u0442\u0438\u0431\u0438\u043e\u0442\u0438\u043a\u0430\u043c\u0438 \u0434\u043b\u044f \u043f\u0440\u043e\u0444\u0438\u043b\u0430\u043a\u0442\u0438\u043a\u0438 \u043e\u0441\u0442\u0440\u044b\u0445 \u043f\u043e\u0441\u0442\u0440\u0435\u0437\u0435\u043a\u0446\u0438\u043e\u043d\u043d\u044b\u0445 \u044d\u043c\u043f\u0438\u0435\u043c \u043f\u043b\u0435\u0432\u0440\u044b \u043f\u0440\u0438 \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u043d\u0430\u0433\u043d\u043e\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f\u0445 \u043b\u0435\u0433\u043a\u0438\u0445","volume":"6","author":"\u0418\u043e\u0441\u0435\u043b\u0438\u0430\u043d\u0438","year":"1980","journal-title":"\u0413\u0440\u0443\u0434\u043d\u0430\u044f \u0425\u0438\u0440\u0443\u0440\u0433\u0438\u044f"},{"key":"2025083110343518000_10.1.e001360.67","first-page":"53","article-title":"Efficacy of staphylococcal bacteriophage in the treatment of purulent lung and pleural diseases","volume":"1982","author":"Meladze","year":"1982","journal-title":"Grudn Khir"},{"key":"2025083110343518000_10.1.e001360.68","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7915.2011.00259.x"},{"key":"2025083110343518000_10.1.e001360.69","doi-asserted-by":"crossref","DOI":"10.1080\/21597081.2015.1020260","article-title":"Phage therapy of pulmonary infections","volume":"5","author":"Abedon","year":"2015","journal-title":"Bacteriophage"},{"key":"2025083110343518000_10.1.e001360.70","doi-asserted-by":"crossref","DOI":"10.3390\/v13010060","article-title":"A case of phage therapy against pandrug-resistant Achromobacter xylosoxidans in a 12-year-old lung-transplanted cystic fibrosis patient","volume":"13","author":"Lebeaux","year":"2021","journal-title":"Viruses"},{"key":"2025083110343518000_10.1.e001360.71","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-019-0437-z"},{"key":"2025083110343518000_10.1.e001360.72","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.resmic.2018.05.001","article-title":"Phage therapy against Achromobacter xylosoxidans lung infection in a patient with cystic fibrosis: a case report","volume":"169","author":"Hoyle","year":"2018","journal-title":"Res Microbiol"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2022-001360","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:34:49Z","timestamp":1756661689000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2022-001360"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":72,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,5,9]]},"published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1136\/bmjresp-2022-001360"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2022-001360","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5]]}}}