{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:39:21Z","timestamp":1792809561575,"version":"4.5.0"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,25]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Children with nonsyndromic craniosynostosis (NSC) are at risk for neurodevelopmental delays that often require rehabilitative therapies. Early surgical intervention (before 12 months of age) is believed to support more normal brain development, but prior studies have been constrained by small cohorts and limited follow-up. This study provides the first national, longitudinal analysis of the relationship between age at surgery and subsequent therapy utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors performed a retrospective cohort study using the Merative MarketScan commercial database (2016\u20132022). Children with NSC who underwent cranial surgery were identified and stratified by timing of intervention (\u2264 vs &gt; 12 months). Patients older than 3 years were excluded for surgery, in addition to those with comorbid neurological and genetic conditions. Outcomes included use of speech, occupational, and physical therapy, as well as gross provider payments. A multilevel logistic regression analysis assessed associations between surgical timing, Pediatric Comorbidity Index scores, sex, sociodemographic factors, and therapy utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 1523 patients with a median follow-up of 4 (interquartile range 2\u20138) years, 28.6% received speech therapy, 34.9% occupational therapy, and 30.1% physical therapy; 1301 patients (85.4%) underwent surgery under 1 year of age while 222 patients (14.6%) underwent surgery between 1 and 3 years of age. Patients undergoing later surgery had markedly higher therapy utilization across all domains, i.e., speech (48.2% vs 25.3%), occupational (56.3% vs 31.2%), and physical therapy (51.8% vs 26.4%; all p &lt; 0.001). The median number of sessions and payments were also significantly greater in the late cohort for occupational and physical therapy. On multilevel regression, surgery after 12 months was independently associated with increased odds of therapy use (speech OR 1.72, occupational OR 1.61, and physical OR 1.55; all p &lt; 0.05). Patients undergoing surgery after 12 months also had significantly higher rates of developmental delay, including speech delay (40.1% vs 28.1%), motor delay (20.7% vs 9.1%), and global delay (26.6% vs 7.8%) compared with those treated at \u2264 12 months (all p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Children undergoing surgery for NSC after 12 months of age demonstrated higher rates of documented developmental delay diagnoses and greater use of rehabilitative services. This work supports multidisciplinary rehabilitative therapy in the long-term management of children with craniosynostosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.4.peds2617","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:02:35Z","timestamp":1790121755000},"page":"1-9","source":"Crossref","is-referenced-by-count":0,"title":["The association between greater age at surgery and increased developmental delays and therapy burden in craniosynostosis"],"prefix":"10.3171","author":[{"given":"Andrew","family":"Salib","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Glaeser-Khan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Allam","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Kauke-Navarro","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Moscarelli","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Flores Perez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Alperovich","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Dis Model Mech","first-page":"dmm049390","article-title":"The clinical manifestations, molecular mechanisms and treatment of craniosynostosis","volume":"15","author":"Stanton E","year":"2022","unstructured":"Stanton E, Urata M, Chen JF, Chai Y. The clinical manifestations, molecular mechanisms and treatment of craniosynostosis. Dis Model Mech. 2022;15(4):dmm049390. doi:10.1242\/dmm.049390"},{"issue":"6","key":"b2","series-title":"Plast Reconstr Surg","first-page":"1209e","article-title":"Update in management of craniosynostosis","volume":"149","author":"Xue AS","year":"2022","unstructured":"Xue AS, Buchanan EP, Hollier LH. Update in management of craniosynostosis. Plast Reconstr Surg. 2022;149(6):1209e\u20131223e. doi:10.1097\/PRS.0000000000009046"},{"issue":"5","key":"b3","series-title":"Childs Nerv Syst","first-page":"893","article-title":"Neurocognitive outcomes of children with non-syndromic single-suture craniosynostosis","volume":"38","author":"Kalmar CL","year":"2022","unstructured":"Kalmar CL, Lang SS, Heuer GG,  Neurocognitive outcomes of children with non-syndromic single-suture craniosynostosis. Childs Nerv Syst. 2022;38(5):893\u2013901. doi:10.1007\/s00381-022-05448-0"},{"issue":"5","key":"b4","series-title":"Am J Epidemiol","first-page":"918","article-title":"Development and validation of a pediatric comorbidity index","volume":"190","author":"Sun JW","year":"2021","unstructured":"Sun JW, Bourgeois FT, Haneuse S,  Development and validation of a pediatric comorbidity index. Am J Epidemiol. 2021;190(5):918\u2013927. doi:10.1093\/aje\/kwaa244"},{"issue":"1","key":"b5","series-title":"Childs Nerv Syst","first-page":"233","article-title":"Long-term neurocognitive and behavioral outcomes in patients with non-syndromic craniosynostosis","volume":"41","author":"Ihnat J","year":"2025","unstructured":"Ihnat J, Hu KG, Goss J,  Long-term neurocognitive and behavioral outcomes in patients with non-syndromic craniosynostosis. Childs Nerv Syst. 2025;41(1):233. doi:10.1007\/s00381-025-06888-0"},{"issue":"4","key":"b6","series-title":"Plast Reconstr Surg","first-page":"821","article-title":"Surgical timing and neurocognitive development among patients with craniosynostosis: analysis of confounders","volume":"151","author":"Lynn JV","year":"2023","unstructured":"Lynn JV, Buchman LK, Breuler CJ, Buchman SR. Surgical timing and neurocognitive development among patients with craniosynostosis: analysis of confounders. Plast Reconstr Surg. 2023;151(4):821\u2013829. doi:10.1097\/PRS.0000000000010004"},{"issue":"1","key":"b7","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Craniosynostosis surgery practice patterns in the United States: what are we doing and how are we doing it?","volume":"58","author":"Sullivan LE","year":"2025","unstructured":"Sullivan LE, Alving-Trinh A, O\u2019Sick N,  Craniosynostosis surgery practice patterns in the United States: what are we doing and how are we doing it? Neurosurg Focus. 2025;58(1):E2. doi:10.3171\/2024.10.FOCUS24572"},{"issue":"3","key":"b8","series-title":"Pediatrics","first-page":"e2020015511","article-title":"Identifying the misshapen head: craniosynostosis and related disorders","volume":"146","author":"Dias MS","year":"2020","unstructured":"Dias MS, Samson T, Rizk EB, Governale LS, Richtsmeier JT. Identifying the misshapen head: craniosynostosis and related disorders. Pediatrics. 2020;146(3):e2020015511. doi:10.1542\/peds.2020-015511"},{"issue":"4","key":"b9","series-title":"J Neurosurg Pediatr","first-page":"442","article-title":"Impact of surgery timing for craniosynostosis on neurodevelopmental outcomes: a systematic review","volume":"23","author":"Mandela R","year":"2019","unstructured":"Mandela R, Bellew M, Chumas P, Nash H. Impact of surgery timing for craniosynostosis on neurodevelopmental outcomes: a systematic review. J Neurosurg Pediatr. 2019;23(4):442\u2013454. doi:10.3171\/2018.10.PEDS18536"},{"issue":"4","key":"b10","series-title":"Plast Reconstr Surg","first-page":"608e","article-title":"The impact of age at surgery on long-term neuropsychological outcomes in sagittal craniosynostosis","volume":"134","author":"Patel A","year":"2014","unstructured":"Patel A, Yang JF, Hashim PW,  The impact of age at surgery on long-term neuropsychological outcomes in sagittal craniosynostosis. Plast Reconstr Surg. 2014;134(4):608e\u2013617e. doi:10.1097\/PRS.0000000000000511"},{"issue":"4","key":"b11","series-title":"Plast Reconstr Surg","first-page":"824","article-title":"Morphologic severity and age at surgery are associated with school-age neurocognitive outcomes in metopic craniosynostosis","volume":"154","author":"Long AS","year":"2024","unstructured":"Long AS, Hauc SC, Almeida MN,  Morphologic severity and age at surgery are associated with school-age neurocognitive outcomes in metopic craniosynostosis. Plast Reconstr Surg. 2024;154(4):824\u2013835. doi:10.1097\/PRS.0000000000010999"},{"issue":"1","key":"b12","series-title":"Nat Rev Dis Primers","first-page":"24","article-title":"Non-syndromic craniosynostosis","volume":"11","author":"Alperovich M","year":"2025","unstructured":"Alperovich M, Tonello C, Mayes LC, Kahle KT. Non-syndromic craniosynostosis. Nat Rev Dis Primers. 2025;11(1):24. doi:10.1038\/s41572-025-00607-4"},{"issue":"3","key":"b13","series-title":"Plast Reconstr Surg","first-page":"491","article-title":"The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis","volume":"134","author":"Hashim PW","year":"2014","unstructured":"Hashim PW, Patel A, Yang JF,  The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis. Plast Reconstr Surg. 2014;134(3):491\u2013501. doi:10.1097\/PRS.0000000000000420"},{"issue":"2","key":"b14","series-title":"J Neurosurg Pediatr","first-page":"169","article-title":"Sagittal synostosis: does choice of intervention and its timing affect the long-term aesthetic and neurodevelopmental outcome? A single-institution study of 167 children","volume":"31","author":"Chowdhury AM","year":"2022","unstructured":"Chowdhury AM, Patel R, Silva AHD,  Sagittal synostosis: does choice of intervention and its timing affect the long-term aesthetic and neurodevelopmental outcome? A single-institution study of 167 children. J Neurosurg Pediatr. 2022;31(2):169\u2013178. doi:10.3171\/2022.10.PEDS22135"},{"key":"b15","series-title":"J Pediatr","first-page":"142","article-title":"Minimally invasive endoscopic surgery for infantile craniosynostosis: a longitudinal cohort study","volume":"216","author":"Riordan CP","year":"2020","unstructured":"Riordan CP, Zurakowski D, Meier PM,  Minimally invasive endoscopic surgery for infantile craniosynostosis: a longitudinal cohort study. J Pediatr. 2020;216:142\u2013149.e2. doi:10.1016\/j.jpeds.2019.09.037"},{"key":"b16","series-title":"J Craniofac Surg","article-title":"A decade of craniosynostosis surgery in the United States: trends in management, payer mix, and cost","author":"Salib A","year":"2026","unstructured":"Salib A, Kong V, Moscarelli J,  A decade of craniosynostosis surgery in the United States: trends in management, payer mix, and cost. J Craniofac Surg. 2026. Published online January 30, 2026. doi:10.1097\/SCS.0000000000012496"},{"key":"b17","article-title":"Census Bureau Tables","unstructured":"Census Bureau Tables. United States Census Bureau. Accessed January 10, 2026. https:\/\/data.census.gov\/table"},{"issue":"2","key":"b18","series-title":"Dev Neurorehabil","first-page":"115","article-title":"Correlates of therapy use and expenditures in children in the United States","volume":"11","author":"Kuhlthau K","year":"2008","unstructured":"Kuhlthau K, Hill K, Fluet C, Meara E, Yucel RM. Correlates of therapy use and expenditures in children in the United States. Dev Neurorehabil. 2008;11(2):115\u2013123. doi:10.1080\/17518420701605627"},{"issue":"1","key":"b19","series-title":"J Neurosurg Pediatr","first-page":"52","article-title":"Increased utilization of healthcare services in children with craniosynostosis","volume":"30","author":"Ruiz Col\u00f3n GD","year":"2022","unstructured":"Ruiz Col\u00f3n GD, Jin MC, Grant GA, Prolo LM. Increased utilization of healthcare services in children with craniosynostosis. J Neurosurg Pediatr. 2022;30(1):52\u201359. doi:10.3171\/2022.2.PEDS2253"},{"issue":"3","key":"b20","series-title":"J Craniofac Surg","first-page":"931","article-title":"Longitudinal assessment of neurodevelopment in patients with nonsyndromic single-suture craniosynostosis: a retrospective review of 66 patients","volume":"34","author":"Lynn JV","year":"2023","unstructured":"Lynn JV, Buchman LK, Breuler CJ, Buchman SR. Longitudinal assessment of neurodevelopment in patients with nonsyndromic single-suture craniosynostosis: a retrospective review of 66 patients. J Craniofac Surg. 2023;34(3):931\u2013935. doi:10.1097\/SCS.0000000000009140"},{"issue":"1","key":"b21","series-title":"Plast Reconstr Surg","first-page":"62e","article-title":"Nonsyndromic craniosynostosis and associated abnormal speech and language development","volume":"140","author":"Naran S","year":"2017","unstructured":"Naran S, Miller M, Shakir S,  Nonsyndromic craniosynostosis and associated abnormal speech and language development. Plast Reconstr Surg. 2017;140(1):62e\u201369e. doi:10.1097\/PRS.0000000000003423"},{"issue":"4","key":"b22","series-title":"J Neurosurg Pediatr","first-page":"434","article-title":"Impact of age at surgery on neurodevelopmental outcomes in sagittal synostosis","volume":"23","author":"Bellew M","year":"2019","unstructured":"Bellew M, Mandela RJ, Chumas PD. Impact of age at surgery on neurodevelopmental outcomes in sagittal synostosis. J Neurosurg Pediatr. 2019;23(4):434\u2013441. doi:10.3171\/2018.8.PEDS18186"},{"issue":"5","key":"b23","series-title":"Plast Reconstr Surg","first-page":"979e","article-title":"Risk of attention-deficit\/hyperactivity disorder, autism spectrum disorder, and executive function impairment in metopic craniosynostosis","volume":"154","author":"Almeida MN","year":"2024","unstructured":"Almeida MN, Alper DP, Long AS,  Risk of attention-deficit\/hyperactivity disorder, autism spectrum disorder, and executive function impairment in metopic craniosynostosis. Plast Reconstr Surg. 2024;154(5):979e\u2013992e. doi:10.1097\/PRS.0000000000011249"},{"issue":"2","key":"b24","series-title":"Plast Reconstr Surg","first-page":"400","article-title":"Speech, cognitive, and behavioral outcomes in nonsyndromic craniosynostosis","volume":"116","author":"Becker DB","year":"2005","unstructured":"Becker DB, Petersen JD, Kane AA, Cradock MM, Pilgram TK, Marsh JL. Speech, cognitive, and behavioral outcomes in nonsyndromic craniosynostosis. Plast Reconstr Surg. 2005;116(2):400\u2013407. doi:10.1097\/01.prs.0000172763.71043.b8"},{"issue":"5","key":"b25","series-title":"Cleft Palate Craniofac J","first-page":"374","article-title":"Presurgical and postsurgical mental and psychomotor development of infants with sagittal synostosis","volume":"34","author":"Speltz ML","year":"1997","unstructured":"Speltz ML, Endriga MC, Mouradian WE. Presurgical and postsurgical mental and psychomotor development of infants with sagittal synostosis. Cleft Palate Craniofac J. 1997;34(5):374\u2013379. doi:10.1597\/1545-1569_1997_034_0374_papmap_2.3.co_2"},{"issue":"3","key":"b26","series-title":"Childs Nerv Syst","first-page":"269","article-title":"Neurodevelopment of children with single suture craniosynostosis: a review","volume":"23","author":"Kapp-Simon KA","year":"2007","unstructured":"Kapp-Simon KA, Speltz ML, Cunningham ML, Patel PK, Tomita T. Neurodevelopment of children with single suture craniosynostosis: a review. Childs Nerv Syst. 2007;23(3):269\u2013281. doi:10.1007\/s00381-006-0251-z"},{"issue":"3","key":"b27","series-title":"Pediatrics","first-page":"e615","article-title":"Intellectual and academic functioning of school-age children with single-suture craniosynostosis","volume":"135","author":"Speltz ML","year":"2015","unstructured":"Speltz ML, Collett BR, Wallace ER,  Intellectual and academic functioning of school-age children with single-suture craniosynostosis. Pediatrics. 2015;135(3):e615\u2013e623. doi:10.1542\/peds.2014-1634"},{"issue":"Suppl 1","key":"b28","series-title":"Pediatrics","first-page":"e2025070739M","article-title":"Inequities in operative age for infants with craniosynostosis","volume":"156","author":"Balkin DM","year":"2025","unstructured":"Balkin DM, Ward VL, Meara JG,  Inequities in operative age for infants with craniosynostosis. Pediatrics. 2025;156(Suppl 1):e2025070739M. doi:10.1542\/peds.2025-070739M"},{"issue":"1","key":"b29","series-title":"Cleft Palate Craniofac J","first-page":"87","article-title":"Sociodemographic disparities in craniosynostosis: a systematic review","volume":"62","author":"Blum JD","year":"2025","unstructured":"Blum JD, Ng JJ, Craig J,  Sociodemographic disparities in craniosynostosis: a systematic review. Cleft Palate Craniofac J. 2025;62(1):87\u201396. doi:10.1177\/10556656231199832"},{"issue":"5","key":"b30","series-title":"Cleft Palate Craniofac J","first-page":"649","article-title":"Age at time of craniosynostosis repair predicts increased complication rate","volume":"55","author":"Bruce WJ","year":"2018","unstructured":"Bruce WJ, Chang V, Joyce CJ, Cobb AN, Maduekwe UI, Patel PA. Age at time of craniosynostosis repair predicts increased complication rate. Cleft Palate Craniofac J. 2018;55(5):649\u2013654. doi:10.1177\/1055665617725215"},{"issue":"1","key":"b31","series-title":"Childs Nerv Syst","first-page":"248","article-title":"Comparison of behavioral outcomes following cranial vault remodeling versus strip craniectomy for non-syndromic sagittal craniosynostosis","volume":"41","author":"Parikh N","year":"2025","unstructured":"Parikh N, Hu KG, Lewis K,  Comparison of behavioral outcomes following cranial vault remodeling versus strip craniectomy for non-syndromic sagittal craniosynostosis. Childs Nerv Syst. 2025;41(1):248. doi:10.1007\/s00381-025-06900-7"},{"issue":"4","key":"b32","series-title":"JAMA Netw Open","first-page":"e248762","article-title":"Cognitive outcomes of children with sagittal craniosynostosis treated with either endoscopic or open calvarial vault surgery","volume":"7","author":"Magge SN","year":"2024","unstructured":"Magge SN, Fotouhi AR, Allhusen V,  Cognitive outcomes of children with sagittal craniosynostosis treated with either endoscopic or open calvarial vault surgery. JAMA Netw Open. 2024;7(4):e248762. doi:10.1001\/jamanetworkopen.2024.8762"},{"issue":"4","key":"b33","series-title":"J Craniofac Surg","first-page":"1127","article-title":"Isolated sagittal craniosynostosis and open or endoscopic cranial vault remodeling: an evaluation of developmental outcomes","volume":"36","author":"Paliwoda ED","year":"2025","unstructured":"Paliwoda ED, Horne MJ, Patel I,  Isolated sagittal craniosynostosis and open or endoscopic cranial vault remodeling: an evaluation of developmental outcomes. J Craniofac Surg. 2025;36(4):1127\u20131130. doi:10.1097\/SCS.0000000000010983"},{"key":"b34","series-title":"World Neurosurg X","first-page":"100526","article-title":"A comparative analysis of suturectomy versus remodeling in non-syndromic craniosynostosis: a systematic review and meta-analysis","volume":"28","author":"Natakusuma TISD","year":"2025","unstructured":"Natakusuma TISD, de Liyis BG, Wiyanjana KDF, Maliawan S, Mahadewa TGB. A comparative analysis of suturectomy versus remodeling in non-syndromic craniosynostosis: a systematic review and meta-analysis. World Neurosurg X. 2025;28:100526. doi:10.1016\/j.wnsx.2025.100526"},{"issue":"7","key":"b35","series-title":"Childs Nerv Syst","first-page":"1921","article-title":"Long-term neurocognitive outcomes in 204 single-suture craniosynostosis patients","volume":"39","author":"Junn AH","year":"2023","unstructured":"Junn AH, Long AS, Hauc SC,  Long-term neurocognitive outcomes in 204 single-suture craniosynostosis patients. Childs Nerv Syst. 2023;39(7):1921\u20131928. doi:10.1007\/s00381-023-05908-1"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/aop\/article-10.3171-2026.4.PEDS2617\/article-10.3171-2026.4.PEDS2617.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/aop\/article-10.3171-2026.4.PEDS2617\/article-10.3171-2026.4.PEDS2617.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:14:16Z","timestamp":1792808056000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/aop\/article-10.3171-2026.4.PEDS2617\/article-10.3171-2026.4.PEDS2617.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":35,"URL":"https:\/\/doi.org\/10.3171\/2026.4.peds2617","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]}}}