{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T01:28:06Z","timestamp":1774920486526,"version":"3.50.1"},"reference-count":71,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T00:00:00Z","timestamp":1619395200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005068","name":"Jimma University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005068","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>As blood transfusion remains life-saving and is being frequently prescribed, a greater number of its practice is unnecessary or inappropriate. This important clinical intervention is reported as one of the five overused medical treatments, with gross over-ordering and whole blood transfusions as the sole component being common in developing countries. Study of recipient\u2019s demographics, clinical conditions, appropriate blood utilization, and continuous clinical audits for quality assurance and service improvement plan are important factors to this practice. This study was designed to assess the recipient\u2019s characteristics, blood type distributions, appropriateness of blood transfusion, and utilization practice of the big medical center.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>Institution based cross-sectional study was conducted from February 1 to June 30, 2018. Data were collected using a structured data collection format prepared for this study. All transfusion prescriptions were followed from requisition up to completion. Patient\u2019s age, sex, requesting departments, hemodynamics, number and component of units requested and issued, and units transfused were collected. Transfusion appropriateness was assessed by a criterion-based method while blood utilization was calculated.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>A total of 545 units of blood for 425 patients were cross-matched of the 809 units of total blood prescribed. The mean and median age of transfused individuals was found to be 27.47 \u00b115.28 years and 26 years respectively, and 65.4% females most in reproductive age groups. O and A Rhesus-positive blood types were the two major blood groups observed. Overall 82.1% of transfusions were appropriate; while only 27.8% of patients received appropriate components as 96.5% of individuals received a whole blood transfusion. Significant blood utilization was recorded with a C\/T ratio of 1.05, TP% of 100%, and TI of 1.23.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>Much of the transfusion recipients were relatively young aged and females, most in the reproductive age group. Although whole blood was used as a sole component, significant blood transfusion utilization and appropriateness were recorded; while appropriate component transfusion was recorded to be significantly low. Local transfusion guidelines and appropriate component preparation and utilization are required to improve the sub-optimal blood component transfusion practice.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0250623","type":"journal-article","created":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T19:36:23Z","timestamp":1619465783000},"page":"e0250623","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Assessment of recipients\u2019 characteristics, transfusion appropriateness, and utilization pattern of blood and blood products in Jimma Medical Center, Jimma, Ethiopia"],"prefix":"10.1371","volume":"16","author":[{"given":"Tufa","family":"Feyisa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Girum","family":"Tesfaye Kiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1624-3114","authenticated-orcid":true,"given":"Wondimagegn Adissu","family":"Maleko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,4,26]]},"reference":[{"key":"pone.0250623.ref001","volume-title":"Rossi\u2019s Principles of Transfusion Medicine","author":"LS Toby","year":"2016","edition":"5"},{"key":"pone.0250623.ref002","volume-title":"Transfusion Medicine","author":"JM Jeffrey","year":"2012","edition":"3"},{"key":"pone.0250623.ref003","volume-title":"Blood Banking and Transfusion Medicine","author":"CD Hillyer","year":"2007","edition":"2"},{"key":"pone.0250623.ref004","volume-title":"Mollison\u2019s Blood Transfusion in Clinical Medicine","author":"GK Harvey","year":"2008","edition":"11"},{"key":"pone.0250623.ref005","volume-title":"Transfusion Medicine Made Easy for Students of Allied Medical Sciences and Medicine","author":"O Erhabor","year":"2012"},{"key":"pone.0250623.ref006","volume-title":"Blood Transfusion: a Basic Text. Alexandria","author":"AFH Britten","year":"1994"},{"key":"pone.0250623.ref007","volume-title":"The History of Blood Transfusion in Sub-Saharan Africa","author":"WH Schneider","year":"2013","edition":"1"},{"key":"pone.0250623.ref008","volume-title":"Transfusion Handbook","author":"D Norfolk","year":"2013","edition":"5"},{"key":"pone.0250623.ref009","doi-asserted-by":"crossref","DOI":"10.1002\/9781118520093","volume-title":"Practical Transfusion Medicine","author":"MF Murphy","year":"2013","edition":"4"},{"key":"pone.0250623.ref010","volume-title":"Handbook of Blood Banking and Transfusion Medicine","author":"G HR Rao","year":"2006"},{"issue":"9880","key":"pone.0250623.ref011","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1016\/S0140-6736(13)60673-X","article-title":"Blood management: Transfusion medicine comes of age","volume":"381","author":"LT Goodnough","year":"2013","journal-title":"Lancet Lond Engl"},{"issue":"1","key":"pone.0250623.ref012","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1182\/asheducation-2013.1.638","article-title":"Transfusion guidelines: when to transfuse","volume":"2013","author":"ZM Szczepiorkowski","year":"2013","journal-title":"Hematology"},{"issue":"9","key":"pone.0250623.ref013","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1111\/trf.13718","article-title":"Relative impact of a patient blood management program on utilization of all three major blood components","volume":"56","author":"RN Thakkar","year":"2016","journal-title":"Transfusion"},{"key":"pone.0250623.ref014","first-page":"4","article-title":"Evaluation of Cross Match to Transfusion Ratio in Pre-Operative Blood Ordering for Elective Surgery","volume":"2","author":"MF Mahfouz","year":"2019","journal-title":"Gen Surg"},{"issue":"1","key":"pone.0250623.ref015","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.transci.2018.11.002","article-title":"Assessment of the knowledge of usage of blood and blood products amongst medical doctors in the Department of Medicine at the Faculty of Health Sciences, University of the Witwatersrand affiliated academic hospitals","volume":"58","author":"M Laher","year":"2019","journal-title":"Transfus Apher Sci"},{"issue":"5","key":"pone.0250623.ref016","doi-asserted-by":"crossref","first-page":"538","DOI":"10.4103\/0019-5049.144648","article-title":"Indications for blood and blood product transfusion","volume":"58","author":"S Yaddanapudi","year":"2014","journal-title":"Indian J Anaesth"},{"issue":"2","key":"pone.0250623.ref017","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.tmrv.2003.12.005","article-title":"The role of hospital transfusion committees in blood product conservation","volume":"18","author":"SL Haynes","year":"2004","journal-title":"Transfus Med Rev"},{"issue":"2","key":"pone.0250623.ref018","doi-asserted-by":"crossref","first-page":"109","DOI":"10.4103\/GJTM.GJTM_36_17","article-title":"Audit of clinical use of red blood cells in a tertiary care setting: An algorithmic approach!","volume":"2","author":"AK Tiwari","year":"2017","journal-title":"Glob J Transfus Med India"},{"issue":"9","key":"pone.0250623.ref019","doi-asserted-by":"crossref","first-page":"473","DOI":"10.5694\/j.1326-5377.1997.tb126674.x","article-title":"Reduction of inappropriate use of blood products by prospective monitoring of transfusion request forms","volume":"167","author":"A Tuckfield","year":"1997","journal-title":"Med J Aust"},{"issue":"5","key":"pone.0250623.ref020","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.tracli.2011.06.001","article-title":"From whole blood to component therapy: The economic, supply\/demand need for implementation of component therapy in sub-Saharan Africa","volume":"18","author":"O Erhabor","year":"2011","journal-title":"Transfus Clin Biol"},{"key":"pone.0250623.ref021","volume-title":"ABC of Transfusion","author":"M Contreras","year":"2009"},{"key":"pone.0250623.ref022","volume-title":"The Clinical Use of Blood: Handbook","author":"World Health Organization","year":"2001"},{"issue":"16","key":"pone.0250623.ref023","article-title":"Demographic characteristics of blood and blood components transfusion recipients and pattern of blood utilization in a tertiary health institution in southern Nigeria","volume":"18","author":"HU Okoroiwu","year":"2018","journal-title":"BMC Hematol"},{"issue":"10","key":"pone.0250623.ref024","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1136\/jcp.2006.043505","article-title":"Transfusion in sub-Saharan Africa: Does a Western model fit?","volume":"60","author":"SP Field","year":"2007","journal-title":"J Clin Pathol"},{"issue":"3","key":"pone.0250623.ref025","article-title":"An audit of appropriate use of blood components in tertiary care hospital","volume":"2","author":"S Richa","year":"2015","journal-title":"Int J Med Sci Educ"},{"issue":"4","key":"pone.0250623.ref026","first-page":"186","article-title":"Clinical appropriateness of blood component transfusion: regulatory requirements and standards set by the Scientific Society in Italy","volume":"6","author":"G Grazzini","year":"2008","journal-title":"Blood Transfus"},{"issue":"3","key":"pone.0250623.ref027","first-page":"199","article-title":"Appropriate use of red blood cell transfusion in emergency departments: A study in five emergency departments","volume":"15","author":"MQ D\u00edaz","year":"2017","journal-title":"Blood Transfus"},{"issue":"3","key":"pone.0250623.ref028","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.transci.2013.04.037","article-title":"The utilization of red cell concentrates at Kimberley Hospital Complex, Northern Cape Province, South Africa","volume":"49","author":"S Joubert","year":"2013","journal-title":"Transfus Apher Sci"},{"issue":"4","key":"pone.0250623.ref029","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1046\/j.1537-2995.1976.16476247063.x","article-title":"The maximum surgical blood order schedule and surgical blood use in the United States","volume":"16","author":"BA Friedman","year":"1976","journal-title":"Transfusion"},{"issue":"7","key":"pone.0250623.ref030","first-page":"251","article-title":"An audit of blood cross-match ordering practices at the Aga Khan University Hospital: First step towards a Maximum Surgical Blood Ordering Schedule","volume":"51","author":"T Chawla","year":"2001","journal-title":"JPMA J Pak Med Assoc"},{"issue":"7","key":"pone.0250623.ref031","article-title":"Blood conservation in South Africa. A vital need. Bloodless Medicine and Surgery","volume":"43","author":"K Efraim","year":"2001","journal-title":"Bloodless Med Surg"},{"issue":"1","key":"pone.0250623.ref032","first-page":"13","article-title":"Blood utilization in elective general surgery cases: Requirements, ordering and transfusion practices","volume":"46","author":"M Vibhute","year":"2000","journal-title":"J Postgrad Med"},{"issue":"2","key":"pone.0250623.ref033","article-title":"A Study of blood Requisition and transfusion Practice in Surgery at Bir Hospital","volume":"9","author":"SV RB","year":"2009","journal-title":"Post-Grad Med J NAMS"},{"key":"pone.0250623.ref034","doi-asserted-by":"crossref","first-page":"758910","DOI":"10.1155\/2013\/758910","article-title":"Blood requisition and utilization practice in surgical patients at University of Gondar hospital, northwest Ethiopia","volume":"2013","author":"T Belayneh","year":"2013","journal-title":"J Blood Transfus"},{"issue":"1","key":"pone.0250623.ref035","doi-asserted-by":"crossref","first-page":"15","DOI":"10.4314\/tjhc.v13i1.36702","article-title":"Blood utilization in elective surgical procedures in Ilorin","volume":"13","author":"HO Olawumi","year":"2006","journal-title":"Trop J Health Sci"},{"key":"pone.0250623.ref036","first-page":"16","article-title":"Transfusion in trauma. African Journal of Trauma","volume":"2","author":"PO Olatunji","year":"2004","journal-title":"Afr J Trauma"},{"issue":"1","key":"pone.0250623.ref037","first-page":"75","article-title":"A Survey of Blood Request Versus Blood Utilization at a University Hospital in Iran","volume":"4","author":"AP Yazdi","year":"2016","journal-title":"Arch Bone Jt Surg"},{"key":"pone.0250623.ref038","unstructured":"World Health Organization. Safe Blood and Blood Products: Introductory Module: Guidelines and Principles for Safe Blood Transfusion Practice; 2009."},{"issue":"4","key":"pone.0250623.ref039","first-page":"307","article-title":"Red blood cell transfusion policy: A critical literature review","volume":"15","author":"M Franchini","year":"2017","journal-title":"Blood Transfus"},{"key":"pone.0250623.ref040","unstructured":"World Health Organization. Aide-m\u00e9moire: Clinical Transfusion Process and Patient Safety;2010."},{"issue":"1","key":"pone.0250623.ref041","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/trf.14949","article-title":"Blood transfusion safety in sub-Saharan Africa: A literature review of changes and challenges in the 21st century","volume":"59","author":"A Weimer","year":"2019","journal-title":"Transfusion"},{"key":"pone.0250623.ref042","unstructured":"World Health Organization. The appropriate Clinical use of blood and blood products: information sheet for clinicians [Internet]. Geneva: World Health Organization, Blood Transfusion Safety; 2000. Available from: https:\/\/www.who.int\/bloodsafety\/clinical_use\/ClinicalUseBInfoSheetEn.pdf?ua=1"},{"key":"pone.0250623.ref043","unstructured":"Tapko JB, Mainuka P, Diarra-Nama AJ. Status of Blood Safety in the WHO African Region: Report of the 2006 Survey. WHO Regional Office for Africa; 2009."},{"key":"pone.0250623.ref044","unstructured":"Tapko JB, Toure B, Sambo LG. Status of Blood Safety in the WHO African Region: Report of the 2010 Survey. WHO Regional Office for Africa; 2014."},{"key":"pone.0250623.ref045","unstructured":"Federal Ministry of Health. National Blood Transfusion Service Strategy. FDRE MoH, Ethiopia; 2005."},{"key":"pone.0250623.ref046","unstructured":"Federal Ministry of Health. National Blood Bank Service: Quality manual. 1st ed. Vol. POL QAS-01. FDRE MoH, Ethiopia"},{"key":"pone.0250623.ref047","unstructured":"World Health Organization. Global database on blood safety: Summary Report 2011 [Internet]. World Health Organization; 2011. Available from: https:\/\/www.who.int\/bloodsafety\/global_database\/GDBS_Summary_Report_2011.pdf?ua=1"},{"key":"pone.0250623.ref048","unstructured":"World Health Organization. Blood safety and availability [Internet]. 2020 [cited 2020 Sep 8]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/blood-safety-and-availability"},{"issue":"3","key":"pone.0250623.ref049","doi-asserted-by":"crossref","first-page":"303","DOI":"10.4103\/1119-3077.86773","article-title":"Knowledge and behavior towards voluntary blood donation among students of a tertiary institution in Nigeria","volume":"14","author":"AG Salaudeen","year":"2011","journal-title":"Niger J Clin Pract"},{"key":"pone.0250623.ref050","unstructured":"Federal Ministry of Health. National Guideline for Appropriate use of blood. FDRE MoH; 2016."},{"key":"pone.0250623.ref051","volume-title":"Technical Manual","author":"MK Fung","year":"2005","edition":"15"},{"key":"pone.0250623.ref052","volume-title":"Technical manual","author":"MK Fung","year":"2014","edition":"18"},{"issue":"1","key":"pone.0250623.ref053","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1186\/s12913-019-4584-1","article-title":"Efficiency of blood utilization in elective surgical patients","volume":"19","author":"K Zewdie","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"pone.0250623.ref054","unstructured":"World Health Organization. Hemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. WHO, 2011 Geneva. (WHO\/NMH\/NHD\/MNM\/11.1) [Internet] [Cited 2021 Jan 26]. Available from: http:\/\/www.who.int\/vmnis\/indicators\/haemoglobin.pdf"},{"issue":"3","key":"pone.0250623.ref055","doi-asserted-by":"crossref","DOI":"10.1016\/j.tmrv.2011.02.001","article-title":"Appropriateness of Allogeneic Red Blood Cell Transfusion: The International Consensus Conference on Transfusion Outcomes","volume":"25","author":"A Shander","year":"2011","journal-title":"Transfus Med Rev"},{"issue":"4","key":"pone.0250623.ref056","first-page":"600","article-title":"Profiles of blood and blood component transfusion recipients in Zimbabwe","volume":"13","author":"N Mafirakureva","year":"2015","journal-title":"Blood Transfus"},{"issue":"3","key":"pone.0250623.ref057","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/j.1365-3148.2010.00992.x","article-title":"Assessment of the clinical transfusion practice at a regional referral hospital in Uganda","volume":"20","author":"B Natukunda","year":"2010","journal-title":"Transfus Med"},{"issue":"1","key":"pone.0250623.ref058","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/j.1423-0410.2012.01628.x","article-title":"A study of blood transfusion services at a district hospital in Malawi","volume":"104","author":"HF Bugge","year":"2013","journal-title":"Vox Sang"},{"issue":"5","key":"pone.0250623.ref059","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1111\/trf.13010","article-title":"Blood utilization at a national referral hospital in sub-Saharan Africa","volume":"55","author":"EK Butler","year":"2015","journal-title":"Transfusion"},{"issue":"1","key":"pone.0250623.ref060","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4236\/ojbd.2019.91004","article-title":"Demographic and clinical profiles of blood transfusion recipients at a teaching and Referral Hospital in Kenya","volume":"9","author":"JC Kipkulei","year":"2019","journal-title":"Open Journal of Blood Diseases"},{"issue":"3","key":"pone.0250623.ref061","doi-asserted-by":"crossref","DOI":"10.4172\/2380-5439.1000177","article-title":"Pattern of ABO and Rhesus blood groups distribution of five years survey in Jimma Town Blood Bank, South West Ethiopia","volume":"4","author":"T Zerihun","year":"2016","journal-title":"Journal of Health Education Research & Development"},{"issue":"1","key":"pone.0250623.ref062","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ejmhg.2014.09.002","article-title":"Frequency distribution of ABO and Rh (D) blood group alleles in Silte Zone, Ethiopia","volume":"16","author":"K Tesfaye","year":"2015","journal-title":"Egyptian Journal of Medical Human Genetics"},{"key":"pone.0250623.ref063","first-page":"8043768","article-title":"Assessing ABO\/Rh Blood Group Frequency and Association with Asymptomatic Malaria among Blood Donors Attending Arba Minch Blood Bank, south Ethiopia","volume":"2016","author":"G Alemu","year":"2016","journal-title":"Malar Res Treat"},{"issue":"1","key":"pone.0250623.ref064","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1186\/s13104-017-2644-3","article-title":"High rhesus (Rh(D)) negative frequency and ethnic-group based ABO blood group distribution in Ethiopia","volume":"10","author":"L Golassa","year":"2017","journal-title":"BMC Res Notes"},{"issue":"1","key":"pone.0250623.ref065","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/tmi.13173","article-title":"Packed red cells versus whole blood transfusion for severe paediatric anaemia, pregnancy-related anaemia and obstetric bleeding: an analysis of clinical practice guidelines from sub-Saharan Africa and evidence underpinning recommendations","volume":"24","author":"N Kohli","year":"2019","journal-title":"Trop Med Int Health TM IH"},{"key":"pone.0250623.ref066","unstructured":"World Health Organization. Global status report on blood safety and availability, 2016. [Internet]. 2017 [cited 2020 Sep 9]. Available from: http:\/\/apps.who.int\/iris\/bitstream\/10665\/254987\/1\/9789241565431-eng.pdf"},{"issue":"6","key":"pone.0250623.ref067","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1002\/ajh.20644","article-title":"Use of breath carbon monoxide measurements to assess erythrocyte survival in subjects with chronic diseases","volume":"81","author":"BL Mitlyng","year":"2006","journal-title":"Am J Hematol"},{"issue":"6","key":"pone.0250623.ref068","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.3390\/nu12061784","article-title":"Anemia of Chronic Diseases: Wider Diagnostics\u2014Better Treatment?","volume":"12","author":"M Wici\u0144ski","year":"2020","journal-title":"Nutrients"},{"issue":"50","key":"pone.0250623.ref069","article-title":"A systematic review and meta-analysis of the clinical appropriateness of blood transfusion in China","volume":"94","author":"C Zhu","year":"2015","journal-title":"Medicine"},{"issue":"2","key":"pone.0250623.ref070","doi-asserted-by":"crossref","first-page":"42","DOI":"10.15406\/htij.2020.08.00221","article-title":"Blood requisition and transfusion practices for elective surgical procedures at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia, 2017","volume":"8","author":"GA Tegu","year":"2020","journal-title":"Hematol Transfus Int J"},{"issue":"2","key":"pone.0250623.ref071","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4103\/GJTM.GJTM_30_17","article-title":"Evaluation of blood requisition and utilization practices at a tertiary care hospital blood bank in Islamabad, Pakistan","volume":"2","author":"U Waheed","year":"2017","journal-title":"Global Journal of Transfusion Medicine"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250623","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,25]],"date-time":"2022-12-25T13:31:38Z","timestamp":1671975098000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250623"}},"subtitle":[],"editor":[{"given":"Wisit","family":"Cheungpasitporn","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,26]]},"references-count":71,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0250623","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,26]]}}}