{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:29:24Z","timestamp":1791934164798,"version":"4.3.4"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The clinical incidence of antimicrobial-resistant fungal infections has dramatically increased in recent years. Certain fungal pathogens colonize various body cavities, leading to life-threatening bloodstream infections. However, the identification and characterization of fungal isolates in laboratories remain a significant diagnostic challenge in medicine and public health. Whole-genome sequencing provides an unbiased and uniform identification pipeline for fungal pathogens but most bioinformatic analysis pipelines focus on prokaryotic species. To this end, TheiaEuk_Illumina_PE_PHB (TheiaEuk) was designed to focus on genomic analysis specialized to fungal pathogens.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>TheiaEuk was designed using containerized components and written in the workflow description language (WDL) to facilitate deployment on the cloud-based open bioinformatics platform Terra. This species-agnostic workflow enables the analysis of fungal genomes without requiring coding, thereby reducing the entry barrier for laboratory scientists. To demonstrate the usefulness of this pipeline, an ongoing outbreak of <jats:italic>C. auris<\/jats:italic> in southern Nevada was investigated. We performed whole-genome sequence analysis of 752 new <jats:italic>C. auris<\/jats:italic> isolates from this outbreak. Furthermore, TheiaEuk was utilized to observe the accumulation of mutations in the FKS1 gene over the course of the outbreak, highlighting the utility of TheiaEuk as a monitor of emerging public health threats when combined with whole-genome sequencing surveillance of fungal pathogens.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A primary result of this work is a curated fungal database containing 5,667 unique genomes representing 245 species. TheiaEuk also incorporates taxon-specific submodules for specific species, including clade-typing for <jats:italic>Candida auris (C. auris)<\/jats:italic>. In addition, for several fungal species, it performs dynamic reference genome selection and variant calling, reporting mutations found in genes currently associated with antifungal resistance (<jats:italic>FKS1<\/jats:italic>, <jats:italic>ERG11<\/jats:italic>, <jats:italic>FUR1<\/jats:italic>). Using genome assemblies from the ATCC Mycology collection, the taxonomic identification module used by TheiaEuk correctly assigned genomes to the species level in 126\/135 (93.3%) instances and to the genus level in 131\/135 (97%) of instances, and provided zero false calls. Application of TheiaEuk to actual specimens obtained in the course of work at a local public health laboratory resulted in 13\/15 (86.7%) correct calls at the species level, with 2\/15 called at the genus level. It made zero incorrect calls. TheiaEuk accurately assessed clade type of <jats:italic>Candida auris<\/jats:italic> in 297\/302 (98.3%) of instances.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>TheiaEuk demonstrated effectiveness in identifying fungal species from whole genome sequence. It further showed accuracy in both clade-typing of <jats:italic>C. auris<\/jats:italic> and in the identification of mutations known to associate with drug resistance in that organism.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1198213","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T14:59:13Z","timestamp":1690901953000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["TheiaEuk: a species-agnostic bioinformatics workflow for fungal genomic characterization"],"prefix":"10.3389","volume":"11","author":[{"suffix":"III","given":"Frank J.","family":"Ambrosio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle R.","family":"Scribner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sage M.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R.","family":"Otieno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma L.","family":"Doughty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Gorzalski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle Denise","family":"Siao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Killian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi","family":"Hua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vici","family":"Varghese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin G.","family":"Libuit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Pandori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel R.","family":"Sevinsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hess","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"57","DOI":"10.3390\/jof3040057","article-title":"Global and multi-national prevalence of fungal diseases-estimate precision","volume":"3","author":"Bongomin","year":"2017","journal-title":"J Fungi"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"ofab593","DOI":"10.1093\/ofid\/ofab593","article-title":"Prevalence and healthcare burden of fungal infections in the United States, 2018. Open forum","volume":"9","author":"Rayens","year":"2022","journal-title":"Infect Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"165rv13","DOI":"10.1126\/scitranslmed.3004404","article-title":"Hidden killers: human fungal infections","volume":"4","author":"Brown","year":"2012","journal-title":"Sci Transl Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"20150468","DOI":"10.1098\/rstb.2015.0468","article-title":"Minimizing fungal disease deaths will allow the UNAIDS target of reducing annual AIDS deaths below 500 000 by 2020 to be realized","volume":"371","author":"Denning","year":"2016","journal-title":"Philos Trans R Soc Lond Ser B Biol Sci"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.tim.2014.01.001","article-title":"A neglected epidemic: fungal infections in HIV\/AIDS","volume":"22","author":"Armstrong-James","year":"2014","journal-title":"Trends Microbiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1111\/j.1469-0691.2009.03015.x","article-title":"Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome","volume":"16","author":"Guinea","year":"2010","journal-title":"Clin Microbiol Infect"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e334","DOI":"10.1016\/S1473-3099(17)30303-1","article-title":"Fungal infections in HIV\/AIDS","volume":"17","author":"Limper","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"4358","DOI":"10.1182\/blood-2002-05-1496","article-title":"Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors","volume":"100","author":"Marr","year":"2002","journal-title":"Blood"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1038\/s41579-022-00720-1","article-title":"Tackling the emerging threat of antifungal resistance to human health","volume":"20","author":"Fisher","year":"2022","journal-title":"Nat Rev Microbiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/mmy\/myy054","article-title":"Candida auris: the recent emergence of a multidrug-resistant fungal pathogen","volume":"57","author":"Forsberg","year":"2019","journal-title":"Med Mycol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1007\/s11908-019-0702-9","article-title":"Antifungal resistance: a concerning trend for the present and future","volume":"21","author":"Hendrickson","year":"2019","journal-title":"Curr Infect Dis Rep"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1186\/s12879-020-05543-0","article-title":"Is the superbug fungus really so scary? A systematic review and meta-analysis of global epidemiology and mortality of Candida auris","volume":"20","author":"Chen","year":"2020","journal-title":"BMC Infect Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1093\/cid\/ciw691","article-title":"Simultaneous emergence of multidrug-resistant Candida auris on 3 continents confirmed by whole-genome sequencing and epidemiological analyses","volume":"64","author":"Lockhart","year":"2017","journal-title":"Clin Infect Dis"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1111\/j.1348-0421.2008.00083.x","article-title":"Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital","volume":"53","author":"Satoh","year":"2009","journal-title":"Microbiol Immunol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1093\/jac\/dkx480","article-title":"A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009\u201317) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance","volume":"73","author":"Chowdhary","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.3389\/fmicb.2017.01024","article-title":"Azole resistance in Aspergillus fumigatus: a consequence of antifungal use in agriculture?","volume":"8","author":"Berger","year":"2017","journal-title":"Front Microbiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3389\/fmicb.2017.00036","article-title":"Antifungal therapy: new advances in the understanding and treatment of mycosis","volume":"8","author":"Scorzoni","year":"2017","journal-title":"Front Microbiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"651","DOI":"10.3389\/fimmu.2018.00651","article-title":"Immunology of cryptococcal infections: developing a rational approach to patient therapy","volume":"9","author":"Elsegeiny","year":"2018","journal-title":"Front Immunol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.mib.2019.11.001","article-title":"A titanic drug resistance threat in Cryptococcus neoformans","volume":"52","author":"Zafar","year":"2019","journal-title":"Curr Opin Microbiol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.3390\/jof8111126","article-title":"Candida auris: a mini review on epidemiology in healthcare facilities in Asia","volume":"8","author":"Thatchanamoorthy","year":"2022","journal-title":"J Fungi"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"3390","DOI":"10.1021\/acs.chemrev.0c00199","article-title":"Antifungal drug resistance: molecular mechanisms in Candida albicans and beyond","volume":"121","author":"Lee","year":"2021","journal-title":"Chem Rev"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"197","DOI":"10.3390\/jof7030197","article-title":"Molecular markers of antifungal resistance: potential uses in routine practice and future perspectives","volume":"7","author":"Garcia-Effron","year":"2021","journal-title":"J Fungi"},{"key":"ref23","year":""},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.7490\/f1000research.1114631.1","article-title":"Full-stack genomics pipelining with GATK4 + WDL + Cromwell","author":"Voss","year":"2017","journal-title":"F1000Res"},{"key":"ref25","year":""},{"key":"ref26","year":""},{"key":"ref27","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/978-1-0716-2417-3_17","article-title":"MycoSNP: a portable workflow for performing whole-genome sequencing analysis of Candida auris","volume-title":"Candida auris","author":"Bagal","year":"2022"},{"key":"ref28","author":"Seemann","year":""},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1198189","article-title":"The use of whole-genome sequencing and development of bioinformatics to monitor overlapping outbreaks of C. auris in southern Nevada","author":"Gorzalski","year":"","journal-title":"Front Public Health"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1186\/s13059-016-0997-x","article-title":"Mash: fast genome and metagenome distance estimation using MinHash","volume":"17","author":"Ondov","year":"2016","journal-title":"Genome Biol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3941","DOI":"10.21105\/joss.03941","article-title":"Rasusa: randomly subsample sequencing reads to a specified coverage","volume":"7","author":"Hall","year":"2022","journal-title":"J Open Source Softw"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2114","DOI":"10.1093\/bioinformatics\/btu170","article-title":"Trimmomatic: a flexible trimmer for Illumina sequence data","volume":"30","author":"Bolger","year":"2014","journal-title":"Bioinformatics"},{"key":"ref33","year":"2022"},{"key":"ref34","author":"Seemann","year":""},{"key":"ref35","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1089\/cmb.2012.0021","article-title":"SPAdes: a new genome assembly algorithm and its applications to single-cell sequencing","volume":"19","author":"Bankevich","year":"2012","journal-title":"J Comput Biol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1186\/s13059-018-1540-z","article-title":"SKESA: strategic k-mer extension for scrupulous assemblies","volume":"19","author":"Souvorov","year":"2018","journal-title":"Genome Biol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1093\/bioinformatics\/btt086","article-title":"QUAST: quality assessment tool for genome assemblies","volume":"29","author":"Gurevich","year":"2013","journal-title":"Bioinformatics"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"3210","DOI":"10.1093\/bioinformatics\/btv351","article-title":"BUSCO: assessing genome assembly and annotation completeness with single-copy orthologs","volume":"31","author":"Sim\u00e3o","year":"2015","journal-title":"Bioinformatics"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e0277575","DOI":"10.1371\/journal.pone.0277575","article-title":"GAMBIT (Genomic Approximation Method for Bacterial Identification and Tracking): a methodology to rapidly leverage whole genome sequencing of bacterial isolates for clinical identification","volume":"18","author":"Lumpe","year":"2023","journal-title":"PLoS One"},{"key":"ref40","author":"Seemann","year":""},{"key":"ref41","doi-asserted-by":"publisher","first-page":"742062","DOI":"10.3389\/fcimb.2021.742062","article-title":"Application of machine learning classifier to Candida auris drug resistance analysis","volume":"11","author":"Li","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"D733","DOI":"10.1093\/nar\/gkv1189","article-title":"Reference sequence (RefSeq) database at NCBI: current status, taxonomic expansion, and functional annotation","volume":"44","author":"O\u2019Leary","year":"2016","journal-title":"Nucleic Acids Res"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"5114","DOI":"10.1038\/s41467-018-07641-9","article-title":"High throughput ANI analysis of 90K prokaryotic genomes reveals clear species boundaries","volume":"9","author":"Jain","year":"2018","journal-title":"Nat Commun"},{"key":"ref44","author":"Lumpe","year":""},{"key":"ref45","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1109\/MCSE.2007.55","article-title":"Matplotlib: a 2D graphics environment","volume":"9","author":"Hunter","year":"2007","journal-title":"Comput Sci Eng"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e0007722","DOI":"10.1128\/msphere.00077-22","article-title":"Comparative analysis and data provenance for 1,113 bacterial genome assemblies","volume":"7","author":"Yarmosh","year":"2022","journal-title":"mSphere"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e0081821","DOI":"10.1128\/MRA.00818-21","article-title":"The ATCC genome portal: microbial genome reference standards with data provenance","volume":"10","author":"Benton","year":"2021","journal-title":"Microbiol Resour Announc"},{"key":"ref48","year":""},{"key":"ref49","doi-asserted-by":"publisher","first-page":"e03364","DOI":"10.1128\/mBio.03364-19","article-title":"Tracing the evolutionary history and global expansion of Candida auris using population genomic analyses","volume":"11","author":"Chow","year":"2020","journal-title":"mBio"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"192","DOI":"10.3201\/eid2501.181321","article-title":"Candida auris sternal osteomyelitis in a man from Kenya visiting Australia, 2015","volume":"25","author":"Heath","year":"2019","journal-title":"Emerg Infect Dis"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1093\/cid\/ciy411","article-title":"Molecular epidemiology of Candida auris in Colombia reveals a highly related, countrywide colonization with regional patterns in amphotericin B resistance","volume":"68","author":"Escand\u00f3n","year":"2019","journal-title":"Clin Infect Dis"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.3201\/eid2509.190262","article-title":"Candida auris in Germany and previous exposure to foreign healthcare","volume":"25","author":"Hamprecht","year":"2019","journal-title":"Emerg Infect Dis"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1038\/s41426-018-0045-x","article-title":"Genomic epidemiology of the UK outbreak of the emerging human fungal pathogen Candida auris","volume":"7","author":"Rhodes","year":"2018","journal-title":"Emerg Microbes Infect"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.3201\/eid2509.190686","article-title":"Potential fifth clade of Candida auris, Iran, 2018","volume":"25","author":"Chow","year":"2019","journal-title":"Emerg Infect Dis"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"e03333","DOI":"10.1128\/mBio.03333-20","article-title":"Genome-wide analysis of experimentally evolved Candida auris reveals multiple novel mechanisms of multidrug resistance","volume":"12","author":"Carolus","year":"2021","journal-title":"mBio"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1080\/22221751.2021.1934557","article-title":"Genomic epidemiology of Candida auris in a general hospital in Shenyang, China: a three-year surveillance study","volume":"10","author":"Tian","year":"2021","journal-title":"Emerg Microbes Infect"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"e0084222","DOI":"10.1128\/mbio.00842-22","article-title":"Genomic diversity across Candida auris clinical isolates shapes rapid development of antifungal resistance in vitro and in vivo","volume":"13","author":"Burrack","year":"2022","journal-title":"mBio"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.21105\/joss.01686","article-title":"Welcome to the tidyverse","volume":"4","author":"Wickham","year":"2019","journal-title":"J Open Source Softw"},{"key":"ref59","year":""},{"key":"ref60","volume-title":"RStudio: integrated development for R RStudio, PBC","year":"2020"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"e0158521","DOI":"10.1128\/Spectrum.01585-21","article-title":"Delineation of the direct contribution of Candida auris ERG11 mutations to clinical triazole resistance","volume":"9","author":"Rybak","year":"2021","journal-title":"Microbiol Spectr"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"e255","DOI":"10.1093\/cid\/ciac489","article-title":"Increased deaths from fungal infections during the coronavirus disease 2019 pandemic-National Vital Statistics System, United States, January 2020-December 2021","volume":"76","author":"Gold","year":"2023","journal-title":"Clin Infect Dis"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"e0024122","DOI":"10.1128\/jcm.00241-22","article-title":"Personnel standards and workforce subcommittee, American Society for Microbiology. The hidden crisis in the times of COVID-19: critical shortages of medical laboratory professionals in clinical microbiology","volume":"60","author":"Leber","year":"2022","journal-title":"J Clin Microbiol"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"2877","DOI":"10.1093\/bioinformatics\/btv271","article-title":"kSNP3.0: SNP detection and phylogenetic analysis of genomes without genome alignment or reference genome","volume":"31","author":"Gardner","year":"2015","journal-title":"Bioinformatics"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"10.21105\/joss.01762","DOI":"10.21105\/joss.01762","article-title":"Mashtree: a rapid comparison of whole genome sequence files","volume":"4","author":"Katz","year":"2019","journal-title":"J Open Source Softw"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"001318","DOI":"10.1099\/jmm.0.001318","article-title":"On the emergence, spread and resistance of Candida auris: host, pathogen and environmental tipping points","volume":"70","author":"Chakrabarti","year":"2021","journal-title":"J Med Microbiol"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1038\/s41591-020-0935-z","article-title":"Ten recommendations for supporting open pathogen genomic analysis in public health","volume":"26","author":"Black","year":"2020","journal-title":"Nat Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1198213\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T14:59:19Z","timestamp":1690901959000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1198213\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,1]]},"references-count":67,"alternative-id":["10.3389\/fpubh.2023.1198213"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1198213","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,1]]},"article-number":"1198213"}}