{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T21:29:04Z","timestamp":1775597344378,"version":"3.50.1"},"reference-count":56,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,6,1]]},"abstract":"<jats:p>Background. A history of loss of consciousness (LOC) is frequently used as an indication for cranial computed tomography (CT) in the emergency department (ED) evaluation of children with blunt head trauma.<\/jats:p><jats:p>Objective. We sought to determine whether an isolated LOC and\/or amnesia is predictive of traumatic brain injury (TBI) in children with blunt head trauma.<\/jats:p><jats:p>Methods. We prospectively enrolled children &amp;lt;18 years old presenting to a level I trauma center ED between July 1998 and September 2001 with blunt head trauma. We evaluated the association of LOC and\/or amnesia with 1) TBI identified on CT and 2) TBI requiring acute intervention. We defined the latter by a neurosurgical procedure, antiepileptic medication for &amp;gt;1 week, persistent neurologic deficits, or hospitalization for \u22652 nights. We then investigated the association of LOC and\/or amnesia with TBI in those patients without other symptoms or signs of TBI (\u201cisolated\u201d LOC and\/or amnesia).<\/jats:p><jats:p>Results. Of eligible children, 2043 (77%) were enrolled, 1271 (62%) of whom underwent CT; 1159 (91%) of these 1271 had their LOC and\/or amnesia status known. A total of 801 (39%) of the 2043 enrolled children had a documented history of LOC and\/or amnesia. Of the 745 with documented LOC and\/or amnesia who underwent CT, 70 (9.4%; 95% confidence interval [CI]: 7.4%, 11.7%) had TBI identified on CT versus 11 of 414 (2.7%; 95% CI: 1.3%, 4.7%) without LOC and\/or amnesia (difference: 6.7%; 95% CI: 4.1%, 9.3%). Of the 801 children known to have had LOC and\/or amnesia (regardless of whether they underwent CT), 77 (9.6%; 95% CI: 7.7%, 11.9%) had TBI requiring acute intervention versus 11 of 1115 (1%; 95% CI: 0.5%, 1.8%) of those without LOC and\/or amnesia (difference: 8.6%; 95% CI: 6.5%, 10.7%). For those with an isolated LOC and\/or amnesia without other signs or symptoms of TBI, however, 0 of 142 (95% CI: 0%, 2.1%) had TBI identified on CT, and 0 of 164 (95% CI: 0%,1.8%) had TBI requiring acute intervention.<\/jats:p><jats:p>Conclusions. Isolated LOC and\/or amnesia, defined by the absence of other clinical findings suggestive of TBI, are not predictive of either TBI on CT or TBI requiring acute intervention. Elimination of an isolated LOC and\/or amnesia as an indication for CT may decrease unnecessary CT use in those patients without an appreciable risk of TBI.<\/jats:p>","DOI":"10.1542\/peds.113.6.e507","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:53:04Z","timestamp":1092444784000},"page":"e507-e513","source":"Crossref","is-referenced-by-count":49,"title":["Does an Isolated History of Loss of Consciousness or Amnesia Predict Brain Injuries in Children After Blunt Head Trauma?"],"prefix":"10.1542","volume":"113","author":[{"given":"Michael J.","family":"Palchak","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Department of Internal Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James F.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Internal Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl W.","family":"Vance","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Internal Medicine"},{"name":"Departments of Pediatrics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca E.","family":"Gelber","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Internal Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bobbie A.","family":"Schauer","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Internal Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathew J.","family":"Harrison","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Internal Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Willis-Shore","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Oregon Health Sciences University, School of Medicine, Portland, Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra L.","family":"Wootton-Gorges","sequence":"additional","affiliation":[{"name":"Radiology, University of California, Davis School of Medicine, Davis, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert W.","family":"Derlet","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Internal Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Kuppermann","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Internal Medicine"},{"name":"Departments of Pediatrics"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2004,6,1]]},"reference":[{"key":"2021121006300982100_R1","unstructured":"Langlois JA. Traumatic Brain Injury in the United States: Assessing Outcomes in Children. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2001:1\u201350"},{"key":"2021121006300982100_R2","unstructured":"National Center for Health Statistics, Centers for Disease Control and Prevention. 2000 National Hospital Ambulatory Medical Care Survey, emergency department file [CD-ROM series 13, no. 33]. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention; 2002"},{"key":"2021121006300982100_R3","unstructured":"National Center for Injury Prevention and Control. Traumatic Brain Injury in the United States: Assessing Outcomes in Children. Atlanta, GA: Centers for Disease Control and Prevention; 2002"},{"key":"2021121006300982100_R4","unstructured":"Hoyert DL, Arias E, Smith B, et al. Final Data for 1999: National Vital Statistics Reports. Vol. 49. Hyattsville, MD: National Center for Health Statistics; 2001"},{"key":"2021121006300982100_R5","unstructured":"National Center for Injury Prevention and Control. Traumatic Brain Injury in the United States: A Report to Congress. Atlanta, GA: Centers for Disease Control and Prevention; 1999"},{"key":"2021121006300982100_R6","doi-asserted-by":"crossref","unstructured":"Palchak MJ, Holmes JF, Vance CW, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med.2003;42:492\u2013506","DOI":"10.1067\/S0196-0644(03)00425-6"},{"key":"2021121006300982100_R7","doi-asserted-by":"crossref","unstructured":"Davis RL, Mullen N, Makela M, Taylor JA, Cohen W, Rivara FP. Cranial computed tomography scans in children after minimal head injury with loss of consciousness. Ann Emerg Med.1994;24:640\u2013645","DOI":"10.1016\/S0196-0644(94)70273-X"},{"key":"2021121006300982100_R8","doi-asserted-by":"crossref","unstructured":"Schunk JE, Rodgerson JD, Woodward GA. The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department. Pediatr Emerg Care.1996;12:160\u2013165","DOI":"10.1097\/00006565-199606000-00004"},{"key":"2021121006300982100_R9","doi-asserted-by":"crossref","unstructured":"Quayle KS, Jaffe DM, Kuppermann N, et al. Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated?Pediatrics.1997;99(5). Available at: www.pediatrics.org\/cgi\/content\/full\/99\/5\/e11","DOI":"10.1542\/peds.99.5.e11"},{"key":"2021121006300982100_R10","doi-asserted-by":"crossref","unstructured":"Greenes DS, Schutzman SA. Clinical indicators of intracranial injury in head-injured infants. Pediatrics.1999;104:861\u2013867","DOI":"10.1542\/peds.104.4.861"},{"key":"2021121006300982100_R11","doi-asserted-by":"crossref","unstructured":"Gruskin KD, Schutzman SA. Head trauma in children younger than 2 years: are there predictors for complications?Arch Pediatr Adolesc Med.1999;153:15\u201320","DOI":"10.1001\/archpedi.153.1.15"},{"key":"2021121006300982100_R12","doi-asserted-by":"crossref","unstructured":"Homer CJ, Kleinman L. Blunt head injury in children. Pediatrics1999;104(6). Available at: www.pediatrics.org\/cgi\/content\/full\/104\/6\/e78","DOI":"10.1542\/peds.104.6.e78"},{"key":"2021121006300982100_R13","doi-asserted-by":"crossref","unstructured":"Ng SM, Toh EM, Sherrington CA. Clinical predictors of abnormal computed tomography scans in paediatric head injury. J Paediatr Child Health.2002;38:388\u2013392","DOI":"10.1046\/j.1440-1754.2002.00012.x"},{"key":"2021121006300982100_R14","doi-asserted-by":"crossref","unstructured":"Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol.2001;176:289\u2013296","DOI":"10.2214\/ajr.176.2.1760289"},{"key":"2021121006300982100_R15","doi-asserted-by":"crossref","unstructured":"Brenner DJ. Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol.2002;32:228\u2013233; discussion 242\u2013244","DOI":"10.1007\/s00247-002-0671-1"},{"key":"2021121006300982100_R16","doi-asserted-by":"crossref","unstructured":"Hall EJ. Lessons we have learned from our children: cancer risks from diagnostic radiology. Peadiatr Radiol.2002;32:700\u2013706","DOI":"10.1007\/s00247-002-0774-8"},{"key":"2021121006300982100_R17","doi-asserted-by":"crossref","unstructured":"Hoffman GM, Nowakowski R, Troshynski TJ, Berens RJ, Weisman SJ. Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics\/American Society of Anesthesiologists process model. Pediatrics.2002;109:236\u2013243","DOI":"10.1542\/peds.109.2.236"},{"key":"2021121006300982100_R18","doi-asserted-by":"crossref","unstructured":"Cote CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics.2000;105:805\u2013814","DOI":"10.1542\/peds.105.4.805"},{"key":"2021121006300982100_R19","doi-asserted-by":"crossref","unstructured":"Rosenberg NM, Walker AR, Bechtel K, Altieri MF. Conscious sedation in the pediatric emergency department. Pediatr Emerg Care.1988;14:436\u2013439","DOI":"10.1097\/00006565-199812000-00017"},{"key":"2021121006300982100_R20","doi-asserted-by":"crossref","unstructured":"Max W, MacKenzie EJ, Rice DP. Head injuries: costs and consequences. J Head Trauma Rehabil.1991;6:76\u201391","DOI":"10.1097\/00001199-199106000-00010"},{"key":"2021121006300982100_R21","doi-asserted-by":"crossref","unstructured":"Stiell IG, Lesiuk H, Wells GA, et al. Canadian CT head rule study for patients with minor head injury: methodology for phase II (validation and economic analysis). Acad Emerg Med.2001;38:317\u2013322","DOI":"10.1067\/mem.2001.116795"},{"key":"2021121006300982100_R22","doi-asserted-by":"crossref","unstructured":"Ramundo ML, McKnight T, Kempf J, Satkowiak L. Clinical predictors of computed tomographic abnormalities following pediatric traumatic brain injury. Pediatr Emerg Care.1995;11:1\u20134","DOI":"10.1097\/00006565-199502000-00001"},{"key":"2021121006300982100_R23","doi-asserted-by":"crossref","unstructured":"Rivara F, Tanaguchi D, Parish RA, Stimac GK, Mueller B. Poor prediction of positive computed tomographic scans by clinical criteria in symptomatic pediatric head trauma. Pediatrics.1987;80:579\u2013584","DOI":"10.1542\/peds.80.4.579"},{"key":"2021121006300982100_R24","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics, Committee on Quality Improvement. The management of minor closed head injury in children. Pediatrics.1999;104:1407\u20131415","DOI":"10.1542\/peds.104.6.1407"},{"key":"2021121006300982100_R25","doi-asserted-by":"crossref","unstructured":"Schutzman SA, Barnes P, Duhaime AC, et al. Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics.2001;107:983\u2013993","DOI":"10.1542\/peds.107.5.983"},{"key":"2021121006300982100_R26","doi-asserted-by":"crossref","unstructured":"Schutzman SA, Greenes DS. Pediatric minor head trauma. Ann Emerg Med.2001;37:65\u201374","DOI":"10.1067\/mem.2001.109440"},{"key":"2021121006300982100_R27","doi-asserted-by":"crossref","unstructured":"Aitken ME, Herrerias CT, Davis R, et al. Minor head injury in children: current management practices of pediatricians, emergency physicians, and family physicians. Arch Pediatr Adolesc Med.1998;152:1176\u20131180","DOI":"10.1001\/archpedi.152.12.1176"},{"key":"2021121006300982100_R28","doi-asserted-by":"crossref","unstructured":"Klassen TP, Reed MH, Stiell IG, et al. Variation in utilization of computed tomography scanning for the investigation of minor head trauma in children: a Canadian experience. Acad Emerg Med.2000;7:739\u2013744","DOI":"10.1111\/j.1553-2712.2000.tb02260.x"},{"key":"2021121006300982100_R29","doi-asserted-by":"crossref","unstructured":"Graham ID, Stiell IG, Laupacis A, O'Connor AM, Wells GA. Emergency physicians' attitudes toward and use of clinical decision rules for radiography. Acad Emerg Med.1998;5:134\u2013140","DOI":"10.1111\/j.1553-2712.1998.tb02598.x"},{"key":"2021121006300982100_R30","unstructured":"Durch JS, Lohr KN. Emergency Medical Services for Children. Washington, DC: National Academy Press; 1993"},{"key":"2021121006300982100_R31","doi-asserted-by":"crossref","unstructured":"Seidel JS, Henderson D, Tittle S, et al. Priorities for research in emergency medical services for children: results of a consensus conference. Ann Emerg Med.1999;33:206\u2013210","DOI":"10.1016\/S0196-0644(99)70395-1"},{"key":"2021121006300982100_R32","doi-asserted-by":"crossref","unstructured":"Dietrich AM, Bowman MJ, Ginn-Pease ME, Kosnik E, King DR. Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography?Ann Emerg Med.1993;22:1535\u20131540","DOI":"10.1016\/S0196-0644(05)81254-5"},{"key":"2021121006300982100_R33","doi-asserted-by":"crossref","unstructured":"Simon B, Letourneau P, Vitorino E, McCall J. Pediatric minor head trauma: indications for computed tomographic scanning revisited. J Trauma.2001;51:231\u2013238","DOI":"10.1097\/00005373-200108000-00004"},{"key":"2021121006300982100_R34","doi-asserted-by":"crossref","unstructured":"Greenes DS, Schutzman SA. Occult intracranial injury in infants. Ann Emerg Med.1998;32:680\u2013686","DOI":"10.1016\/S0196-0644(98)70067-8"},{"key":"2021121006300982100_R35","doi-asserted-by":"crossref","unstructured":"Greenes DS, Schutzman SA. Clinical significance of scalp abnormalities in asymptomatic head-injured infants. Pediatr Emerg Care.2001;17:88\u201392","DOI":"10.1097\/00006565-200104000-00002"},{"key":"2021121006300982100_R36","doi-asserted-by":"crossref","unstructured":"Haydel MJ, Shembekar AD. Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms. Ann Emerg Med.2003;42:507\u2013514","DOI":"10.1067\/S0196-0644(03)00512-2"},{"key":"2021121006300982100_R37","doi-asserted-by":"crossref","unstructured":"Jaeschke R, Guyatt G, Sackett DL. User's guides to the medical literature, III. How to use an article about a diagnostic test. A. Are the results of the study valid?JAMA.1994;271:389\u2013391","DOI":"10.1001\/jama.271.5.389"},{"key":"2021121006300982100_R38","doi-asserted-by":"crossref","unstructured":"Batchelor J, McGiness A. A meta-analysis of GCS 15 head injured patients with loss of consciousness or post-traumatic amnesia. Emerg Med J.2002;19:515\u2013519","DOI":"10.1136\/emj.19.6.515"},{"key":"2021121006300982100_R39","doi-asserted-by":"crossref","unstructured":"Lieh-Lai MW, Theodorou AA, Sarnaik AP, Meert KL, Moylan PM, Canady AI. Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury. J Pediatr.1992;120:195\u2013199","DOI":"10.1016\/S0022-3476(05)80426-3"},{"key":"2021121006300982100_R40","doi-asserted-by":"crossref","unstructured":"Stein SC, Ross SE. Mild head injury: a plea for routine early CT scanning. J Trauma.1992;33:11\u201313","DOI":"10.1097\/00005373-199207000-00003"},{"key":"2021121006300982100_R41","doi-asserted-by":"crossref","unstructured":"James HE. Neurologic evaluation and support in the child with an acute brain insult. Pediatr Ann.1986;15:16\u201322","DOI":"10.3928\/0090-4481-19860101-05"},{"key":"2021121006300982100_R42","doi-asserted-by":"crossref","unstructured":"Kadish HA, Schunk JE. Pediatric basilar skull fracture: do children with normal neurologic findings and no intracranial injury require hospitalization?Ann Emerg Med.1995;26:37\u201341","DOI":"10.1016\/S0196-0644(95)70235-0"},{"key":"2021121006300982100_R43","doi-asserted-by":"crossref","unstructured":"Greenes DS, Schutzman SA. Infants with isolated skull fracture: what are their clinical characteristics, and do they require hospitalization?Ann Emerg Med.1997;30:253\u2013259","DOI":"10.1016\/S0196-0644(97)70158-6"},{"key":"2021121006300982100_R44","doi-asserted-by":"crossref","unstructured":"Abdel-Dayem HM, Abu-Judeh H, Kumar M, et al. SPECT brain perfusion abnormalities in mild or moderate traumatic brain injury. Clin Nucl Med.1998;23:309\u2013317","DOI":"10.1097\/00003072-199805000-00009"},{"key":"2021121006300982100_R45","unstructured":"Mittl RL, Grossman RI, Hiehle JF, et al. Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal CT findings. Am J Neuroradiol.1994;15:1583\u20131589"},{"key":"2021121006300982100_R46","doi-asserted-by":"crossref","unstructured":"Mattioli C, Beretta L, Gerevini S, et al. Traumatic subarachnoid hemorrhage on the computerized tomography scan obtained at admission: a multicenter assessment of the accuracy of diagnosis and the potential impact on patient outcome. J Neurosurg.2003;98:37\u201342","DOI":"10.3171\/jns.2003.98.1.0037"},{"key":"2021121006300982100_R47","doi-asserted-by":"crossref","unstructured":"Svensson E, Starmark JE, Ekholm S, von Essen C, Johansson A. Analysis of interobserver disagreement in the assessment of subarachnoid blood and acute hydrocephalus on CT scans. Neurol Res.1996;18:487\u2013494","DOI":"10.1080\/01616412.1996.11740459"},{"key":"2021121006300982100_R48","doi-asserted-by":"crossref","unstructured":"Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics.1977;33:159\u2013174","DOI":"10.2307\/2529310"},{"key":"2021121006300982100_R49","doi-asserted-by":"crossref","unstructured":"Peduzzi P, Concato J, Feinstein AR, Holford TR. Importance of events per independent variable in proportional hazards regression analysis: II. Accuracy and precision of regression estimates. J Clin Epidemiol.1995;48:1503\u20131510","DOI":"10.1016\/0895-4356(95)00048-8"},{"key":"2021121006300982100_R50","doi-asserted-by":"crossref","unstructured":"Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol.1996;49:1373\u20131379","DOI":"10.1016\/S0895-4356(96)00236-3"},{"key":"2021121006300982100_R51","doi-asserted-by":"crossref","unstructured":"Schutzman SA, Barnes PD, Mantello M, Scott RM. Epidural hematomas in children. Ann Emerg Med.1993;22:535\u2013541","DOI":"10.1016\/S0196-0644(05)81938-9"},{"key":"2021121006300982100_R52","doi-asserted-by":"crossref","unstructured":"Lobato RD, Rivas JJ, Gomez PA, et al. Head injured patients who talk and deteriorate into coma. J Neurosurg.1991;75:256\u2013261","DOI":"10.3171\/jns.1991.75.2.0256"},{"key":"2021121006300982100_R53","doi-asserted-by":"crossref","unstructured":"Teasdale GM, Murray G, Anderson E, et al. Risks of acute traumatic intracranial complications in hematoma in children and adults: implications for managing head injuries. Br Med J.1990;300:363\u2013367","DOI":"10.1136\/bmj.300.6721.363"},{"key":"2021121006300982100_R54","unstructured":"Sharma P, Dahiya RS, Dass B, Dewan Y, Arora AL. How important is history of unconsciousness in head injury patients?J Indian Med Assoc.2001;99:81\u201383"},{"key":"2021121006300982100_R55","doi-asserted-by":"crossref","unstructured":"Bruce DA, Raphaely RC, Goldberg AI, et al. Pathophysiology, treatment and outcome following severe head injury in children. Childs Brain.1979;5:174\u2013191","DOI":"10.1159\/000119817"},{"key":"2021121006300982100_R56","doi-asserted-by":"crossref","unstructured":"Ratan SK, Pandey RM, Ratan J. Association among duration of unconsciousness, Glasgow Coma Scale, and cranial computed tomography abnormalities in head-injured children. Clin Pediatr (Phila).2001;40:375\u2013378","DOI":"10.1177\/000992280104000702"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/113\/6\/e507\/1004335\/zpe0060400e507.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/113\/6\/e507\/1004335\/zpe0060400e507.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:40:13Z","timestamp":1682746813000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/113\/6\/e507\/64307\/Does-an-Isolated-History-of-Loss-of-Consciousness"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,6,1]]},"references-count":56,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2004,6,1]]},"published-print":{"date-parts":[[2004,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.113.6.e507","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,6,1]]}}}