{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:35Z","timestamp":1780736495555,"version":"3.54.1"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Incidental durotomy during degenerative lumbar spine surgeries poses a complex medical challenge. Despite its relatively common occurrence, consensus on its management remains elusive due to the absence of robust, high-level evidence, resulting in significant variations in practice across medical institutions. The aim of this survey was to assess the current practices in Germany regarding early mobilization versus bed rest in the postoperative management of incidental durotomy during lumbar surgery to estimate the need for a randomized clinical trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A digital survey titled \"Postoperative management of incidental durotomy in lumbar spine surgery\" was conducted among 119 neurosurgical departments in Germany. Key questions included the use of bed rest postsurgery, timing of mobilization, and whether the practice depended on the complexity of the surgery or the quality of the dural tear repair. The survey also explored the role of lumbar drains in management and respondents\u2019 potential participation in a multicenter study on the benefits of bed rest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Invitations were sent in November 2023, and responses were collected during November and December 2023. A total of 89 (75%) departments completed the survey. Among them, 75% reported using bed rest in the postoperative management of incidental durotomy. For 57%, this practice depends on the complexity of the surgical procedure or the quality of the surgical repair of the dural tear, while 18% apply it independently. Twenty-nine of the 89 departments (33%) answered that mobilization is allowed 24 hours after surgery, 13 departments (15%) allow mobilization after 48 hours, and 19 departments (21%) allow it after 72 hours. Additionally, 34% reported using a lumbar drain in cases of persistent postoperative CSF leakage, 36% use it for secondary surgical revision, and 30% do not use it in either case. Furthermore, 55 departments (62%) expressed potential interest in participating in a multicenter randomized trial addressing the postoperative management of incidental durotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The postoperative management of incidental durotomy during lumbar surgery exhibits significant variation across neurosurgical departments in Germany. Postoperative bed rest remains a common practice. To evaluate the true benefits of bed rest, a randomized multicenter study is recommended. A summary proposal for such a study is presented to address this need.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.11.focus24586","type":"journal-article","created":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T06:53:28Z","timestamp":1738392808000},"page":"E14","source":"Crossref","is-referenced-by-count":0,"title":["Results of a German national survey to assess early mobilization versus bed rest in the postoperative management of incidental durotomy during lumbar surgery and the need for a randomized clinical trial"],"prefix":"10.3171","volume":"58","author":[{"given":"Tammam","family":"Abboud","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Asendorf","sequence":"additional","affiliation":[{"name":"Medical Statistics, University Medical Center G\u00f6ttingen, Lower Saxony; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros","family":"Evangelou","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Younes","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothee","family":"Mielke","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Department of Neurosurgery, University Hospital Augsburg, Bavaria, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veit","family":"Rohde","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Acta Neurochir (Wien)","first-page":"525","article-title":"The intra- and postoperative management of accidental durotomy in lumbar spine surgery: results of a German survey","volume":"157","author":"Clajus C","year":"2015","unstructured":"Clajus C, Stockhammer F, Rohde V. The intra- and postoperative management of accidental durotomy in lumbar spine surgery: results of a German survey. Acta Neurochir (Wien). 2015;157(3):525\u2013530."},{"issue":"389","key":"b2","series-title":"Clin Orthop Relat Res","first-page":"238","article-title":"Evaluation and treatment of dural tears in lumbar spine surgery: a review","author":"Bosacco SJ","year":"2001","unstructured":"Bosacco SJ, Gardner MJ, Guille JT. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res. 2001;(389):238-247."},{"issue":"4","key":"b3","series-title":"Eur Spine J","first-page":"904","article-title":"Dural tears in primary decompressive lumbar surgery. Is primary repair necessary for a good outcome?","volume":"23","author":"Grannum S","year":"2014","unstructured":"Grannum S, Patel MS, Attar F, Newey M. Dural tears in primary decompressive lumbar surgery. Is primary repair necessary for a good outcome? Eur Spine J. 2014;23(4):904\u2013908."},{"key":"b4","series-title":"ScientificWorldJournal","first-page":"532628","article-title":"Accidental durotomy in minimally invasive transforaminal lumbar interbody fusion: frequency, risk factors, and management","volume":"2015","author":"Klingler JH","year":"2015","unstructured":"Klingler JH, Volz F, Kr\u00fcger MT,  Accidental durotomy in minimally invasive transforaminal lumbar interbody fusion: frequency, risk factors, and management. ScientificWorldJournal. 2015;2015:532628."},{"issue":"23 suppl 1","key":"b5","series-title":"Circulation","first-page":"I9","article-title":"Risk factors for venous thromboembolism","volume":"107","author":"Anderson FA Jr","year":"2003","unstructured":"Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 suppl 1):I9-I16."},{"issue":"6","key":"b6","series-title":"Br J Neurosurg","first-page":"800","article-title":"Pilot study of perioperative accidental durotomy: does the period of postoperative bed rest reduce the incidence of complication?","volume":"27","author":"Low JC","year":"2013","unstructured":"Low JC, von Niederh\u00e4usern B, Rutherford SA, King AT. Pilot study of perioperative accidental durotomy: does the period of postoperative bed rest reduce the incidence of complication? Br J Neurosurg. 2013;27(6):800\u2013802."},{"issue":"17","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"E1042","article-title":"Cost analysis of incidental durotomy in spine surgery","volume":"39","author":"Nandyala SV","year":"2014","unstructured":"Nandyala SV, Elboghdady IM, Marquez-Lara A, Noureldin MN, Sankaranarayanan S, Singh K. Cost analysis of incidental durotomy in spine surgery. Spine (Phila Pa 1976). 2014;39(17):E1042\u2013E1051."},{"issue":"18","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"1444","article-title":"The incidence of durotomy and its clinical and economic impact in primary, short-segment lumbar fusion: an analysis of 17,232 cases","volume":"40","author":"Buck JS","year":"2015","unstructured":"Buck JS, Yoon ST. The incidence of durotomy and its clinical and economic impact in primary, short-segment lumbar fusion: an analysis of 17,232 cases. Spine (Phila Pa 1976). 2015;40(18):1444\u20131450."},{"issue":"9","key":"b9","series-title":"Eur Spine J","first-page":"2065","article-title":"Health care costs of incidental durotomies and postoperative cerebrospinal fluid leaks after elective spinal surgery","volume":"24","author":"Weber C","year":"2015","unstructured":"Weber C, Piek J, Gunawan D. Health care costs of incidental durotomies and postoperative cerebrospinal fluid leaks after elective spinal surgery. Eur Spine J. 2015;24(9):2065\u20132068."},{"issue":"20","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"2298","article-title":"The long-term clinical sequelae of incidental durotomy in lumbar disc surgery","volume":"30","author":"Saxler G","year":"2005","unstructured":"Saxler G, Kr\u00e4mer J, Barden B, Kurt A, Pf\u00f6rtner J, Bernsmann K. The long-term clinical sequelae of incidental durotomy in lumbar disc surgery. 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A retrospective review of 20 cases. Spine (Phila Pa 1976). 1999;24(19):2062\u20132064."},{"issue":"3","key":"b13","series-title":"J Neurosurg Spine","first-page":"460","article-title":"Early mobilization versus bed rest for incidental durotomy: an institutional cohort study","volume":"37","author":"Verma K","year":"2022","unstructured":"Verma K, Freelin AH, Atkinson KA, Graham RS, Broaddus WC. Early mobilization versus bed rest for incidental durotomy: an institutional cohort study. J Neurosurg Spine. 2022;37(3):460\u2013465."},{"issue":"11","key":"b14","series-title":"PLoS One","first-page":"e0188038","article-title":"Risk factors for incidental durotomy during posterior open spine surgery for degenerative diseases in adults: a multicenter observational study","volume":"12","author":"Ishikura H","year":"2017","unstructured":"Ishikura H, Ogihara S, Oka H,  Risk factors for incidental durotomy during posterior open spine surgery for degenerative diseases in adults: a multicenter observational study. PLoS One. 2017;12(11):e0188038."},{"issue":"1","key":"b15","series-title":"BMC Surg","first-page":"30","article-title":"Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery","volume":"22","author":"Tang J","year":"2022","unstructured":"Tang J, Lu Q, Li Y,  Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery. BMC Surg. 2022;22(1):30."},{"issue":"3","key":"b16","series-title":"Eur Spine J","first-page":"778","article-title":"Complications after early versus late mobilization after an incidental durotomy: a systematic review and meta-analysis","volume":"32","author":"Najjar E","year":"2023","unstructured":"Najjar E, Hassanin MA, Komaitis S, Karouni F, Quraishi N. Complications after early versus late mobilization after an incidental durotomy: a systematic review and meta-analysis. Eur Spine J. 2023;32(3):778\u2013786."},{"issue":"3","key":"b17","series-title":"Int J Spine Surg","first-page":"536","article-title":"Risk factors for accidental dural tears in spinal surgery","volume":"15","author":"Alshameeri ZAF","year":"2021","unstructured":"Alshameeri ZAF, Jasani V. Risk factors for accidental dural tears in spinal surgery. Int J Spine Surg. 2021;15(3):536\u2013548."},{"issue":"1","key":"b18","series-title":"Eur Spine J","first-page":"141","article-title":"No benefit of early versus late ambulation after incidental durotomy in lumbar spine surgery: a randomized controlled trial","volume":"29","author":"Farshad M","year":"2020","unstructured":"Farshad M, Aichmair A, Wanivenhaus F, Betz M, Spirig J, Bauer DE. No benefit of early versus late ambulation after incidental durotomy in lumbar spine surgery: a randomized controlled trial. Eur Spine J. 2020;29(1):141\u2013146."},{"issue":"3","key":"b19","series-title":"Med Forum","first-page":"105","article-title":"To compare the frequency of unintended durotomy in open discectomy versus endoscopic discectomy","volume":"30","author":"Ahmed M","year":"2019","unstructured":"Ahmed M, Nawaz MF, Ullah H, Sameja MS. To compare the frequency of unintended durotomy in open discectomy versus endoscopic discectomy. Med Forum. 2019;30(3):105\u2013108."},{"issue":"6","key":"b20","series-title":"Neurocirugia (Astur: Engl Ed)","first-page":"293","article-title":"Investigating acetazolamide effectiveness on CSF leak in adult patients after spinal surgery","volume":"33","author":"Kankam SB","year":"2022","unstructured":"Kankam SB, Amini E, Khoshnevisan K, Khoshnevisan A. Investigating acetazolamide effectiveness on CSF leak in adult patients after spinal surgery. Neurocirugia (Astur: Engl Ed). 2022;33(6):293\u2013299."},{"issue":"12","key":"b21","series-title":"Eur Spine J","first-page":"3560","article-title":"Cerebrospinal fluid (CSF) leak after elective lumbar spinal fusion: who is at risk?","volume":"31","author":"Hanna G","year":"2022","unstructured":"Hanna G, Pando A, Saela S, Emami AP. Cerebrospinal fluid (CSF) leak after elective lumbar spinal fusion: who is at risk? Eur Spine J. 2022;31(12):3560\u20133565."},{"issue":"3","key":"b1","series-title":"Acta Neurochir (Wien)","first-page":"525","article-title":"The intra- and postoperative management of accidental durotomy in lumbar spine surgery: results of a German survey","volume":"157","author":"Clajus C","year":"2015","unstructured":"Clajus C, Stockhammer F, Rohde V. The intra- and postoperative management of accidental durotomy in lumbar spine surgery: results of a German survey. Acta Neurochir (Wien). 2015;157(3):525\u2013530."},{"issue":"389","key":"b2","series-title":"Clin Orthop Relat Res","first-page":"238","article-title":"Evaluation and treatment of dural tears in lumbar spine surgery: a review","author":"Bosacco SJ","year":"2001","unstructured":"Bosacco SJ, Gardner MJ, Guille JT. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res. 2001;(389):238-247."},{"issue":"4","key":"b3","series-title":"Eur Spine J","first-page":"904","article-title":"Dural tears in primary decompressive lumbar surgery. Is primary repair necessary for a good outcome?","volume":"23","author":"Grannum S","year":"2014","unstructured":"Grannum S, Patel MS, Attar F, Newey M. Dural tears in primary decompressive lumbar surgery. Is primary repair necessary for a good outcome? Eur Spine J. 2014;23(4):904\u2013908."},{"key":"b4","series-title":"ScientificWorldJournal","first-page":"532628","article-title":"Accidental durotomy in minimally invasive transforaminal lumbar interbody fusion: frequency, risk factors, and management","volume":"2015","author":"Klingler JH","year":"2015","unstructured":"Klingler JH, Volz F, Kr\u00fcger MT,  Accidental durotomy in minimally invasive transforaminal lumbar interbody fusion: frequency, risk factors, and management. ScientificWorldJournal. 2015;2015:532628."},{"issue":"23 suppl 1","key":"b5","series-title":"Circulation","first-page":"I9","article-title":"Risk factors for venous thromboembolism","volume":"107","author":"Anderson FA Jr","year":"2003","unstructured":"Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 suppl 1):I9-I16."},{"issue":"6","key":"b6","series-title":"Br J Neurosurg","first-page":"800","article-title":"Pilot study of perioperative accidental durotomy: does the period of postoperative bed rest reduce the incidence of complication?","volume":"27","author":"Low JC","year":"2013","unstructured":"Low JC, von Niederh\u00e4usern B, Rutherford SA, King AT. Pilot study of perioperative accidental durotomy: does the period of postoperative bed rest reduce the incidence of complication? Br J Neurosurg. 2013;27(6):800\u2013802."},{"issue":"17","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"E1042","article-title":"Cost analysis of incidental durotomy in spine surgery","volume":"39","author":"Nandyala SV","year":"2014","unstructured":"Nandyala SV, Elboghdady IM, Marquez-Lara A, Noureldin MN, Sankaranarayanan S, Singh K. Cost analysis of incidental durotomy in spine surgery. Spine (Phila Pa 1976). 2014;39(17):E1042\u2013E1051."},{"issue":"18","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"1444","article-title":"The incidence of durotomy and its clinical and economic impact in primary, short-segment lumbar fusion: an analysis of 17,232 cases","volume":"40","author":"Buck JS","year":"2015","unstructured":"Buck JS, Yoon ST. The incidence of durotomy and its clinical and economic impact in primary, short-segment lumbar fusion: an analysis of 17,232 cases. Spine (Phila Pa 1976). 2015;40(18):1444\u20131450."},{"issue":"9","key":"b9","series-title":"Eur Spine J","first-page":"2065","article-title":"Health care costs of incidental durotomies and postoperative cerebrospinal fluid leaks after elective spinal surgery","volume":"24","author":"Weber C","year":"2015","unstructured":"Weber C, Piek J, Gunawan D. Health care costs of incidental durotomies and postoperative cerebrospinal fluid leaks after elective spinal surgery. Eur Spine J. 2015;24(9):2065\u20132068."},{"issue":"20","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"2298","article-title":"The long-term clinical sequelae of incidental durotomy in lumbar disc surgery","volume":"30","author":"Saxler G","year":"2005","unstructured":"Saxler G, Kr\u00e4mer J, Barden B, Kurt A, Pf\u00f6rtner J, Bernsmann K. The long-term clinical sequelae of incidental durotomy in lumbar disc surgery. Spine (Phila Pa 1976). 2005;30(20):2298\u20132302."},{"issue":"22","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"2609","article-title":"Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases","volume":"31","author":"Khan MH","year":"2006","unstructured":"Khan MH, Rihn J, Steele G,  Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976). 2006;31(22):2609\u20132613."},{"issue":"19","key":"b12","series-title":"Spine (Phila Pa 1976)","first-page":"2062","article-title":"Management of incidental durotomy without mandatory bed rest. A retrospective review of 20 cases","volume":"24","author":"Hodges SD","year":"1999","unstructured":"Hodges SD, Humphreys SC, Eck JC, Covington LA. Management of incidental durotomy without mandatory bed rest. A retrospective review of 20 cases. Spine (Phila Pa 1976). 1999;24(19):2062\u20132064."},{"issue":"3","key":"b13","series-title":"J Neurosurg Spine","first-page":"460","article-title":"Early mobilization versus bed rest for incidental durotomy: an institutional cohort study","volume":"37","author":"Verma K","year":"2022","unstructured":"Verma K, Freelin AH, Atkinson KA, Graham RS, Broaddus WC. Early mobilization versus bed rest for incidental durotomy: an institutional cohort study. J Neurosurg Spine. 2022;37(3):460\u2013465."},{"issue":"11","key":"b14","series-title":"PLoS One","first-page":"e0188038","article-title":"Risk factors for incidental durotomy during posterior open spine surgery for degenerative diseases in adults: a multicenter observational study","volume":"12","author":"Ishikura H","year":"2017","unstructured":"Ishikura H, Ogihara S, Oka H,  Risk factors for incidental durotomy during posterior open spine surgery for degenerative diseases in adults: a multicenter observational study. PLoS One. 2017;12(11):e0188038."},{"issue":"1","key":"b15","series-title":"BMC Surg","first-page":"30","article-title":"Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery","volume":"22","author":"Tang J","year":"2022","unstructured":"Tang J, Lu Q, Li Y,  Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery. BMC Surg. 2022;22(1):30."},{"issue":"3","key":"b16","series-title":"Eur Spine J","first-page":"778","article-title":"Complications after early versus late mobilization after an incidental durotomy: a systematic review and meta-analysis","volume":"32","author":"Najjar E","year":"2023","unstructured":"Najjar E, Hassanin MA, Komaitis S, Karouni F, Quraishi N. Complications after early versus late mobilization after an incidental durotomy: a systematic review and meta-analysis. Eur Spine J. 2023;32(3):778\u2013786."},{"issue":"3","key":"b17","series-title":"Int J Spine Surg","first-page":"536","article-title":"Risk factors for accidental dural tears in spinal surgery","volume":"15","author":"Alshameeri ZAF","year":"2021","unstructured":"Alshameeri ZAF, Jasani V. Risk factors for accidental dural tears in spinal surgery. Int J Spine Surg. 2021;15(3):536\u2013548."},{"issue":"1","key":"b18","series-title":"Eur Spine J","first-page":"141","article-title":"No benefit of early versus late ambulation after incidental durotomy in lumbar spine surgery: a randomized controlled trial","volume":"29","author":"Farshad M","year":"2020","unstructured":"Farshad M, Aichmair A, Wanivenhaus F, Betz M, Spirig J, Bauer DE. No benefit of early versus late ambulation after incidental durotomy in lumbar spine surgery: a randomized controlled trial. Eur Spine J. 2020;29(1):141\u2013146."},{"issue":"3","key":"b19","series-title":"Med Forum","first-page":"105","article-title":"To compare the frequency of unintended durotomy in open discectomy versus endoscopic discectomy","volume":"30","author":"Ahmed M","year":"2019","unstructured":"Ahmed M, Nawaz MF, Ullah H, Sameja MS. To compare the frequency of unintended durotomy in open discectomy versus endoscopic discectomy. Med Forum. 2019;30(3):105\u2013108."},{"issue":"6","key":"b20","series-title":"Neurocirugia (Astur: Engl Ed)","first-page":"293","article-title":"Investigating acetazolamide effectiveness on CSF leak in adult patients after spinal surgery","volume":"33","author":"Kankam SB","year":"2022","unstructured":"Kankam SB, Amini E, Khoshnevisan K, Khoshnevisan A. Investigating acetazolamide effectiveness on CSF leak in adult patients after spinal surgery. Neurocirugia (Astur: Engl Ed). 2022;33(6):293\u2013299."},{"issue":"12","key":"b21","series-title":"Eur Spine J","first-page":"3560","article-title":"Cerebrospinal fluid (CSF) leak after elective lumbar spinal fusion: who is at risk?","volume":"31","author":"Hanna G","year":"2022","unstructured":"Hanna G, Pando A, Saela S, Emami AP. Cerebrospinal fluid (CSF) leak after elective lumbar spinal fusion: who is at risk? Eur Spine J. 2022;31(12):3560\u20133565."}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/58\/2\/article-pE14.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/58\/2\/article-pE14.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/58\/2\/article-pE14.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:23:47Z","timestamp":1780734227000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/58\/2\/article-pE14.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,1]]},"references-count":42,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2024.11.focus24586","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,1]]}}}