{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T23:01:52Z","timestamp":1768258912465,"version":"3.49.0"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["R21TW012439"],"award-info":[{"award-number":["R21TW012439"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43 TW009345"],"award-info":[{"award-number":["D43 TW009345"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32AI055433"],"award-info":[{"award-number":["T32AI055433"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000867","name":"Robert Wood Johnson Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100023029","name":"Fulbright Program","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100023029","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Medicine, University of Rochester"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Meningitis affects over 2.5 million people worldwide, primarily within resource-limited regions of the meningitis belt of Africa. In 2017, we implemented a cryptococcal meningitis (CM) diagnosis and treatment program (CM-DTP) designed to improve CM outcomes. In 2021, a meningitis diagnosis and treatment program (MEN-DTP) began to include all etiologies of meningitis to assess the impact of expanded diagnosis and treatment of meningitis. We conducted a retrospective study utilizing clinical records from 1443 adult patients admitted to Lira Regional Referral Hospital (LRRH) over three time periods between 2015\u20132024. Group 1 included 321 patients in a historical control group; Group 2 consisted of 890 patients during the CM-DTP and Group 3 included 232 patients during the MEN-DTP. Group 1 received routine meningitis care, Group 2 received testing and treatment focused on CM, and Group 3 received expanded diagnostic testing, including gram stain, culture, PCR- and antigen-based testing. Meningitis diagnosis and in-hospital mortality outcomes were assessed to evaluate our programs. A confirmed meningitis etiology was found in 13.7% in Group 1, 20.7% in Group 2, and 42.2% in Group 3. In Group 3, confirmed etiologies were identified based on culture (n\u2009=\u200930), Pastorex LA (n\u2009=\u200923), BioFire PCR (n\u2009=\u200956), GeneXpert Ultra (n\u2009=\u200914), and serum or CSF CrAg LFA (n\u2009=\u200953). Overall, more confirmed etiologies of meningitis were identified among people living with HIV (PLWH) (n\u2009=\u2009319) compared to those without HIV (n\u2009=\u200922) in Group 3. Antibiotic use increased with pre-admission antibiotic use doubling from Group 1 to Group 3 (10.6% to 27.2%). Compared to Group 1, mortality improved in Groups 2 and 3. Overall, PLWH had increased mortality compared to those without HIV (32.4% vs. 13.3%). Introduction of molecular diagnostics increased meningitis diagnoses and improved outcomes, particularly in those with CM. MEN-DTP increased confirmed diagnoses, yet half remained undiagnosed, supporting investigation of deep sequencing technologies.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005800","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T18:31:29Z","timestamp":1768242689000},"page":"e0005800","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Meningitis diagnosis, treatment, and outcomes in rural, northern Uganda: 2015\u20132024"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2209-1946","authenticated-orcid":true,"given":"Abigail","family":"Link","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Okwir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betty","family":"Nabongo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred","family":"Okello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jimmy","family":"Alal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8854-0321","authenticated-orcid":true,"given":"David","family":"Meya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul R.","family":"Bohjanen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"pgph.0005800.ref001","author":"Institute for Health Metrics and Evaluation (IHME)","year":"2019"},{"key":"pgph.0005800.ref002","author":"World Health Organisation (WHO)","year":"2023"},{"key":"pgph.0005800.ref003","unstructured":"Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV [Internet]. 2022. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240052178"},{"issue":"6","key":"pgph.0005800.ref004","article-title":"Global etiology of bacterial meningitis: A systematic review and meta-analysis","volume":"13","author":"AM Oordt-Speets","year":"2018","journal-title":"PLoS One"},{"key":"pgph.0005800.ref005","volume-title":"Meningitis outbreak response in sub-Saharan Africa","author":"World Health Organization (WHO)","year":"2014"},{"key":"pgph.0005800.ref006","first-page":"133","volume-title":"Weekly epidemiological record: Control of epidemic meningitis in countries in the African meningitis belt, 2019","author":"World Health Organization (WHO)","year":"2020"},{"key":"pgph.0005800.ref007","volume-title":"Defeating meningitis by 2030: a global road map","author":"World Health Organization (WHO)","year":"2020"},{"issue":"5","key":"pgph.0005800.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000254","article-title":"Impact of a Cryptococcal meningitis diagnosis and treatment program at Lira Regional Referral Hospital in rural, Northern Uganda","volume":"2","author":"A Link","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"pgph.0005800.ref009","unstructured":"Nabongo B. Personal Communication. 25 January 2019."},{"key":"pgph.0005800.ref010","first-page":"4","article-title":"Uganda Populaiton-Based HIV Impact Assessment","author":"Uganda Minstry of Health","year":"2022"},{"key":"pgph.0005800.ref011","author":"Republic of Uganda Ministry of Health, UNICEF, World Health Organization","year":"2017"},{"key":"pgph.0005800.ref012","author":"Uganda Ministry of Health","year":"2023"},{"key":"pgph.0005800.ref013","volume-title":"R: A language and environment for statistical computing. 3.6.3 ed","author":"R Core Team","year":"2020"},{"issue":"9","key":"pgph.0005800.ref014","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1086\/425368","article-title":"Practice guidelines for the management of bacterial meningitis","volume":"39","author":"AR Tunkel","year":"2004","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pgph.0005800.ref015","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1007\/s12281-016-0256-3","article-title":"Evolution of Cryptococcal Antigen Testing: What is new?","volume":"10","author":"E Nalintya","year":"2016","journal-title":"Curr Fungal Infect Rep"},{"issue":"6","key":"pgph.0005800.ref016","doi-asserted-by":"crossref","first-page":"459","DOI":"10.2217\/bmm-2019-0333","article-title":"Methods for rapid diagnosis of meningitis etiology in adults","volume":"14","author":"V Poplin","year":"2020","journal-title":"Biomark Med"},{"issue":"1","key":"pgph.0005800.ref017","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1186\/s12879-023-08645-7","article-title":"Comparison of bacterial culture with BioFire\u00ae FilmArray\u00ae multiplex PCR screening of archived cerebrospinal fluid specimens from children with suspected bacterial meningitis in Nigeria","volume":"23","author":"S Obaro","year":"2023","journal-title":"BMC Infect Dis"},{"issue":"9","key":"pgph.0005800.ref018","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.1128\/JCM.00730-16","article-title":"Multicenter Evaluation of BioFire FilmArray Meningitis\/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens","volume":"54","author":"AL Leber","year":"2016","journal-title":"J Clin Microbiol"},{"issue":"4","key":"pgph.0005800.ref019","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.01927-17","article-title":"Evaluation of a Commercial Multiplex Molecular Panel for Diagnosis of Infectious Meningitis and Encephalitis","volume":"56","author":"RM Liesman","year":"2018","journal-title":"J Clin Microbiol"},{"issue":"4","key":"pgph.0005800.ref020","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/cid\/cir379","article-title":"Evaluation of a newly developed lateral flow immunoassay for the diagnosis of cryptococcosis","volume":"53","author":"MD Lindsley","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pgph.0005800.ref021","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3201\/eid2001.130906","article-title":"Multisite validation of cryptococcal antigen lateral flow assay and quantification by laser thermal contrast","volume":"20","author":"DR Boulware","year":"2014","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"pgph.0005800.ref022","doi-asserted-by":"crossref","first-page":"14","DOI":"10.4103\/ijstd.IJSTD_94_19","article-title":"Evaluation of point of care serum cryptococcal antigen by lateral flow immunoassay for diagnosis of cryptococcosis and cryptococcal meningitis in HIV-positive patients","volume":"42","author":"U Kamble","year":"2021","journal-title":"Indian J Sex Transm Dis AIDS"},{"issue":"3","key":"pgph.0005800.ref023","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3390\/jof5030065","article-title":"Diagnosis and Management of Central Nervous System Cryptococcal Infections in HIV-Infected Adults","volume":"5","author":"C Skipper","year":"2019","journal-title":"J Fungi (Basel)"},{"issue":"5","key":"pgph.0005800.ref024","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/0002-9343(87)90635-8","article-title":"Human immunodeficiency virus-associated meningitis. Clinical course and correlations","volume":"83","author":"H Hollander","year":"1987","journal-title":"Am J Med"},{"issue":"6","key":"pgph.0005800.ref025","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1086\/313810","article-title":"Neurological symptoms during primary human immunodeficiency virus (HIV) infection correlate with high levels of HIV RNA in cerebrospinal fluid","volume":"30","author":"G Tambussi","year":"2000","journal-title":"Clin Infect Dis"},{"issue":"6","key":"pgph.0005800.ref026","doi-asserted-by":"crossref","first-page":"3934","DOI":"10.3892\/etm.2016.3859","article-title":"Staining with two observational methods for the diagnosis of tuberculous meningitis","volume":"12","author":"Y Zou","year":"2016","journal-title":"Exp Ther Med"},{"issue":"6","key":"pgph.0005800.ref027","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.jinf.2018.09.003","article-title":"Improving the microbiological diagnosis of tuberculous meningitis: A prospective, international, multicentre comparison of conventional and modified Ziehl-Neelsen stain, GeneXpert, and culture of cerebrospinal fluid","volume":"77","author":"AD Heemskerk","year":"2018","journal-title":"J Infect"},{"issue":"4","key":"pgph.0005800.ref028","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1164\/rccm.201309-1686OC","article-title":"Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis","volume":"189","author":"G Feng","year":"2014","journal-title":"Am J Respir Crit Care Med"},{"issue":"8","key":"pgph.0005800.ref029","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1093\/cid\/ciaa473","article-title":"Xpert MTB\/RIF Ultra for the Diagnosis of Tuberculous Meningitis: A Small Step Forward","volume":"71","author":"J Donovan","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"3","key":"pgph.0005800.ref030","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/S1473-3099(19)30550-X","article-title":"Xpert MTB\/RIF Ultra for the diagnosis of HIV-associated tuberculous meningitis: a prospective validation study","volume":"20","author":"FV Cresswell","year":"2020","journal-title":"Lancet Infect Dis"},{"issue":"29","key":"pgph.0005800.ref031","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000026778","article-title":"Efficacy of Xpert MTB\/RIF Ultra in diagnosing tuberculosis meningitis: A systematic review and meta-analysis","volume":"100","author":"Y Shen","year":"2021","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"pgph.0005800.ref032","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1186\/s12890-019-0966-8","article-title":"Treatment outcomes of tuberculous meningitis in adults: a systematic review and meta-analysis","volume":"19","author":"M-G Wang","year":"2019","journal-title":"BMC Pulm Med"},{"issue":"9","key":"pgph.0005800.ref033","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0185526","article-title":"HIV and tuberculosis co-infection among migrants in Europe: A systematic review on the prevalence, incidence and mortality","volume":"12","author":"AM Tavares","year":"2017","journal-title":"PLoS One"},{"issue":"9342","key":"pgph.0005800.ref034","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1016\/S0140-6736(02)11318-3","article-title":"Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features","volume":"360","author":"GE Thwaites","year":"2002","journal-title":"Lancet"},{"issue":"11","key":"pgph.0005800.ref035","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/S1473-3099(10)70138-9","article-title":"Tuberculous meningitis: a uniform case definition for use in clinical research","volume":"10","author":"S Marais","year":"2010","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"pgph.0005800.ref036","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s40475-015-0046-y","article-title":"Cryptococcal Meningitis: Diagnosis and Management Update","volume":"2","author":"M Abassi","year":"2015","journal-title":"Curr Trop Med Rep"},{"issue":"1","key":"pgph.0005800.ref037","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25416","article-title":"Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis","volume":"23","author":"MW Tenforde","year":"2020","journal-title":"J Int AIDS Soc"},{"issue":"8","key":"pgph.0005800.ref038","article-title":"Tuberculosis\/cryptococcosis co-infection in China between 1965 and 2016","volume":"6","author":"W Fang","year":"2017","journal-title":"Emerg Microbes Infect"},{"issue":"8","key":"pgph.0005800.ref039","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofy193","article-title":"Cryptococcal Meningitis and Tuberculous Meningitis Co-infection in HIV-Infected Ugandan Adults","volume":"5","author":"J Ellis","year":"2018","journal-title":"Open Forum Infect Dis"},{"issue":"2","key":"pgph.0005800.ref040","doi-asserted-by":"crossref","first-page":"274","DOI":"10.4269\/ajtmh.14-0452","article-title":"Epidemiology of meningitis in an HIV-infected Ugandan cohort","volume":"92","author":"R Rajasingham","year":"2015","journal-title":"Am J Trop Med Hyg"},{"issue":"2","key":"pgph.0005800.ref041","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000002372","article-title":"Etiologies and Management of Aseptic Meningitis in Patients Admitted to an Internal Medicine Department","volume":"95","author":"I Jarrin","year":"2016","journal-title":"Medicine"},{"issue":"7","key":"pgph.0005800.ref042","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/trstmh\/trw046","article-title":"Evaluation of Pastorex meningitis kit performance for the rapid identification of Neisseria meningitidis serogroup C in Nigeria","volume":"110","author":"K Uadiale","year":"2016","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"4","key":"pgph.0005800.ref043","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofz119","article-title":"Cerebrospinal Fluid Analysis With the BioFire FilmArray Meningitis\/Encephalitis Molecular Panel Reduces Length of Hospital Stay in Patients With Suspected Central Nervous System Infections","volume":"6","author":"G DiDiodato","year":"2019","journal-title":"Open Forum Infect Dis"},{"issue":"4","key":"pgph.0005800.ref044","doi-asserted-by":"crossref","DOI":"10.3390\/diseases10040110","article-title":"Analysis of the clinical impact of the BioFire FilmArray meningitis encephalitis panel on antimicrobial use and duration of therapy at an academic medical center","volume":"10","author":"K Markovich","year":"2022","journal-title":"Diseases"},{"issue":"10","key":"pgph.0005800.ref045","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0223887","article-title":"A review of a 13-month period of FilmArray Meningitis\/Encephalitis panel implementation as a first-line diagnosis tool at a university hospital","volume":"14","author":"A Boudet","year":"2019","journal-title":"PLoS One"},{"key":"pgph.0005800.ref046","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.vhri.2021.09.006","article-title":"Cost-Effectiveness Analysis of the Implementation of Cryptococcal Antigen Lateral Flow Assay for the Diagnosis of Cryptococcal Meningitis in Symptomatic People Living With Human Immunodeficiency Virus in Brazil","volume":"29","author":"CMdM Vianna","year":"2022","journal-title":"Value Health Reg Issues"},{"key":"pgph.0005800.ref047","doi-asserted-by":"crossref","first-page":"103274","DOI":"10.1016\/j.ebiom.2021.103274","article-title":"Molecular diagnostic assays for the detection of common bacterial meningitis pathogens: A narrative review","volume":"65","author":"K Diallo","year":"2021","journal-title":"EBioMedicine"},{"issue":"24","key":"pgph.0005800.ref048","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1056\/NEJMoa1803396","article-title":"Clinical Metagenomic Sequencing for Diagnosis of Meningitis and Encephalitis","volume":"380","author":"MR Wilson","year":"2019","journal-title":"N Engl J Med"},{"issue":"10","key":"pgph.0005800.ref049","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1038\/s41582-020-0374-y","article-title":"Metagenomics for neurological infections - expanding our imagination","volume":"16","author":"PS Ramachandran","year":"2020","journal-title":"Nat Rev Neurol"},{"key":"pgph.0005800.ref050","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3389\/fcimb.2020.00088","article-title":"Metagenomic Next-Generation Sequencing for Diagnosis of Infectious Encephalitis and Meningitis: A Large, Prospective Case Series of 213 Patients","volume":"10","author":"X-W Xing","year":"2020","journal-title":"Front Cell Infect Microbiol"},{"issue":"6","key":"pgph.0005800.ref051","doi-asserted-by":"crossref","DOI":"10.1128\/mBio.01888-15","article-title":"Making the Leap from Research Laboratory to Clinic: Challenges and Opportunities for Next-Generation Sequencing in Infectious Disease Diagnostics","volume":"6","author":"B Goldberg","year":"2015","journal-title":"mBio"},{"key":"pgph.0005800.ref052","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.3389\/fmicb.2017.01069","article-title":"Metagenomics: The Next Culture-Independent Game Changer","volume":"8","author":"JD Forbes","year":"2017","journal-title":"Front Microbiol"},{"issue":"1","key":"pgph.0005800.ref053","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s13054-023-04365-1","article-title":"Metagenomic Sequencing in the ICU for Precision Diagnosis of Critical Infectious Illnesses","volume":"27","author":"LPA Neyton","year":"2023","journal-title":"Crit Care"},{"issue":"1","key":"pgph.0005800.ref054","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1186\/s12879-022-07606-w","article-title":"Co-infection with dual Streptococcus pneumoniae serotypes as a cause of pediatric bacterial meningitis in Iran: a multi-center cross-sectional study","volume":"22","author":"SR Tabatabaei","year":"2022","journal-title":"BMC Infect Dis"},{"key":"pgph.0005800.ref055","doi-asserted-by":"crossref","first-page":"664386","DOI":"10.3389\/fmicb.2021.664386","article-title":"Co-infections as Modulators of Disease Outcome: Minor Players or Major Players?","volume":"12","author":"P Devi","year":"2021","journal-title":"Front Microbiol"},{"issue":"2","key":"pgph.0005800.ref056","doi-asserted-by":"crossref","DOI":"10.1371\/journal.ppat.1010212","article-title":"Microbial (co)infections: Powerful immune influencers","volume":"18","author":"A Hassan","year":"2022","journal-title":"PLoS Pathog"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005800","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T18:31:40Z","timestamp":1768242700000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005800"}},"subtitle":[],"editor":[{"given":"Mustafa A.","family":"Barbhuiya","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":56,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005800","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]}}}