{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:31:11Z","timestamp":1760059871613,"version":"build-2065373602"},"reference-count":66,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007329","name":"Universidad del Valle","doi-asserted-by":"publisher","award":["CI: 21140"],"award-info":[{"award-number":["CI: 21140"]}],"id":[{"id":"10.13039\/501100007329","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Systems"],"abstract":"<jats:p>The development of new diagnostic technologies is accelerating, and budgetary constraints in the health sector necessitate a systematic decision-making process to acquire emerging technologies. Health Technology Assessment methodologies integrate technology, clinical efficacy, patient safety, and organizational and financial factors in this context. However, these methodologies do not include the learning curve, a critical factor in operator-dependent technologies. This study presents an evaluation model incorporating the learning curve, developed from the domains of the AdHopHTA project. Using System Dynamics (SD), the model was validated and calibrated as a case study to evaluate the use of Point-of-Care Ultrasound (POCUS) in identifying dengue. This approach allowed for the analysis of the impact of the learning curve and patient demand on the revenues and costs of the healthcare system and the cost\u2013benefit indicator associated with dengue detection. The model assesses physician competency and how different training strategies and frequencies of use affect POCUS adoption. The findings underscore the importance of integrating the learning curve into decision-making. This study highlights the need for further investigation into the barriers that limit the effective use of POCUS, particularly in resource-limited settings. It proposes a framework to improve the integration of this technology into clinical practice for early dengue detection.<\/jats:p>","DOI":"10.3390\/systems13070591","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T08:24:17Z","timestamp":1752654257000},"page":"591","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Developing a Dynamic Simulation Model for Point-of-Care Ultrasound Assessment and Learning Curve Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1614-1898","authenticated-orcid":false,"given":"Sandra","family":"Usaqu\u00e9n-Perilla","sequence":"first","affiliation":[{"name":"Faculty of Engineering, Universidad del Valle, Cali 760042, Colombia"},{"name":"Biomedical Engineering Program, Universidad Militar Nueva Granada, Cajic\u00e1 250747, Colombia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6452-5269","authenticated-orcid":false,"given":"Laura Valentina","family":"Bocanegra-Villegas","sequence":"additional","affiliation":[{"name":"Industrial Engineering Department, National Technological Institute of Mexico TecNM, Orizaba 94300, Mexico"}]},{"given":"Jose Isidro","family":"Garc\u00eda-Melo","sequence":"additional","affiliation":[{"name":"Faculty of Engineering, Universidad del Valle, Cali 760042, Colombia"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025, March 01). Health Technology Assessment and Health Benefit Package Survey 2020\/2021. Available online: https:\/\/www.who.int\/teams\/health-systems-governance-and-financing\/economic-analysis\/health-technology-assessment-and-benefit-package-design\/survey-homepage."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1810905","DOI":"10.1080\/20016689.2020.1810905","article-title":"Organizational aspect in healthcare decision-making: A literature review","volume":"8","author":"Dubromel","year":"2020","journal-title":"J. Mark. Access Health Policy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jval.2016.12.010","article-title":"The HTA Core Model\u201410 Years of Developing an International Framework to Share Multidimensional Value Assessment","volume":"20","author":"Kristensen","year":"2017","journal-title":"Value Health"},{"key":"ref_4","unstructured":"Sampietro-Colom, L., Lach, K., Cicchetti, A., Kidholm, K., Pasternack, I., Fure, B., Rosenm\u00f6ller, M., Wild, C., Kahveci, R., and Was-serfallen, J.B. (2025, July 05). The AdHopHTA handbook: A handbook of hospital-based Health Technology Assess-ment (HB-HTA); Public deliverable; The AdHopHTA Project (FP7\/2007-13 grant agreement nr 305018); 2015. Available online: http:\/\/www.adhophta.eu\/handbook."},{"key":"ref_5","first-page":"e00352520","article-title":"Sedimentation of health technology assessment in hospitals: A scoping review","volume":"37","author":"Camargo","year":"2021","journal-title":"Cad. Saude Publica"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/hec.3468","article-title":"Key Recommendations from the MedtecHTA Project","volume":"26","author":"Tarricone","year":"2017","journal-title":"Health Econ."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.healthpol.2016.08.010","article-title":"HTA of medical devices: Challenges and ideas for the future from a European perspective","volume":"121","author":"Fuchs","year":"2017","journal-title":"Health Policy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/hec.3469","article-title":"Challenges in the Assessment of Medical Devices: The MedtecHTA Project","volume":"26","author":"Tarricone","year":"2017","journal-title":"Health Econ."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Daubner-Bendes, R., Kov\u00e1cs, S., Niewada, M., Huic, M., Drummond, M., Ciani, O., Blankart, C.R., Mandrik, O., Torbica, A., and Yfantopoulos, J. (2021). Quo Vadis HTA for Medical Devices in Central and Eastern Europe? Recommendations to Address Methodological Challenges. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.612410"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1017\/S0266462312000487","article-title":"Development and Test of a Decision Support Tool for Hospital Health Technology Assessment","volume":"28","author":"Gallo","year":"2012","journal-title":"Int. J. Technol. Assess. Health Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"729","DOI":"10.3233\/THC-140847","article-title":"Development of sustainable models for technology evaluation in hospital","volume":"22","author":"Miniati","year":"2014","journal-title":"Technol. Health Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.jval.2015.02.002","article-title":"Decision-oriented health technology assessment: One step forward in supporting the decision-making process in hospitals","volume":"18","author":"Ritrovato","year":"2015","journal-title":"Value Health"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Miniati, R., Frosini, F., Cecconi, G., Dori, F., and Gentili, G.B. (2014, January 26\u201330). Hospital-based expert model for health technology procurement planning in hospitals. Proceedings of the 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Chicago, IL, USA.","DOI":"10.1109\/EMBC.2014.6944378"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"873","DOI":"10.3233\/THC-161236","article-title":"Integrated HTA-FMEA\/FMECA methodology for the evaluation of robotic system in urology and general surgery","volume":"24","author":"Frosini","year":"2016","journal-title":"Technol. Health Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.ejor.2015.05.075","article-title":"Multi-criteria decision analysis for supporting the selection of medical devices under uncertainty","volume":"247","author":"Ivlev","year":"2015","journal-title":"Eur. J. Oper. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jbi.2015.12.002","article-title":"Combining multi-criteria decision analysis and mini-health technology assessment: A funding decision-support tool for medical devices in a university hospital setting","volume":"59","author":"Martelli","year":"2016","journal-title":"J. Biomed. Inform."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1017\/S0266462317000393","article-title":"Harmonizing health technology assessment practices in university hospitals: To what extent is the mini-hta model suitable in the French context?","volume":"33","author":"Martelli","year":"2017","journal-title":"Int. J. Technol. Assess. Health Care"},{"key":"ref_18","unstructured":"Mu\u00f1oz Tiznado, P.D.L.\u00c1. (2016). Adquisici\u00f3n de Equipo M\u00e9dicos Basada en AHP-Caso de Estudio de Servicio de Salud Maule (SSM). [Ph.D. Thesis, Universidad de Concepci\u00f3n\u2013CHILE]."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Margotti, A.E., Ferreira, F.B., Santos, F.A., Garcia, R., and Member, S. (2013, January 3\u20137). Health Technology Assessment to Improve the Medical Equipment Life Cycle Management. Proceedings of the 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Osaka, Japan.","DOI":"10.1109\/EMBC.2013.6609510"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.socscimed.2016.07.042","article-title":"\u201cWhether something cool is good enough\u201d: The role of evidence, sales representatives and nurses\u2019 expertise in hospital purchasing decisions","volume":"165","author":"Grundy","year":"2016","journal-title":"Soc. Sci. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1472-6947-13-2","article-title":"User needs elicitation via analytic hierarchy process","volume":"13","author":"Pecchia","year":"2013","journal-title":"BMC Med. Inform. Decis. Mak."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100171","DOI":"10.1016\/j.orhc.2018.08.002","article-title":"Multi-criteria decision analysis for the assessment of non-clinical hospital services: Methodology and case study","volume":"23","author":"Lasorsa","year":"2019","journal-title":"Oper. Res. Health Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jval.2019.10.005","article-title":"Formal Implementation of Cost-Effectiveness Evaluations in Japan: A Unique Health Technology Assessment System","volume":"23","author":"Hasegawa","year":"2020","journal-title":"Value Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1017\/S0266462320000288","article-title":"Development of a health technology assessment module for evaluating mobile medical applications","volume":"36","author":"Moshi","year":"2020","journal-title":"Int. J. Technol. Assess. Health Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.radonc.2019.11.021","article-title":"Clinical evaluation of a full-image deep segmentation algorithm for the male pelvis on cone-beam CT and CT","volume":"145","author":"Schreier","year":"2020","journal-title":"Radiother. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s40572-021-00322-8","article-title":"A Review of Dengue\u2019s Historical and Future Health Risk from a Changing Climate","volume":"8","author":"Soneja","year":"2021","journal-title":"Curr. Environ. Health Rep."},{"key":"ref_27","unstructured":"Organizaci\u00f3n Mundial de la Salud [OMS] (2025, March 01). Dengue. OMS. Available online: https:\/\/www.who.int\/es\/news-room\/fact-sheets\/detail\/dengue-and-severe-dengue."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.cegh.2018.10.006","article-title":"Prediction of plasma leakage phase of dengue in resource limited settings","volume":"7","author":"Herath","year":"2019","journal-title":"Clin. Epidemiol. Glob. Health"},{"key":"ref_29","first-page":"826","article-title":"Ultrasound in Dengue: A Scoping Review","volume":"104","author":"Dewan","year":"2021","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_30","first-page":"8","article-title":"Point-of-Care Ultrasound Assessment of Tropical Infectious Diseases\u2014A Review of Applications and Perspectives","volume":"94","author":"Joekes","year":"2015","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s11908-015-0512-7","article-title":"Application of Ultrasonography in the Diagnosis of Infectious Diseases in Resource-Limited Settings","volume":"18","author":"Brunetti","year":"2016","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.cpem.2019.06.003","article-title":"Perspectives on Point-of-Care Ultrasound Use in Pediatric Tropical Infectious Disease","volume":"20","author":"Kaminstein","year":"2019","journal-title":"Clin. Pediatr. Emerg. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1056\/NEJMra1916062","article-title":"Point-of-Care Ultrasonography","volume":"385","author":"Mayo","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1002\/bjs.6056","article-title":"Quantitative and individualized assessment of the learning curve using LC-CUSUM","volume":"95","author":"Biau","year":"2008","journal-title":"Br. J. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1002\/sim.8847","article-title":"An overview and critique of the use of cumulative sum methods with surgical learning curve data","volume":"40","author":"Woodall","year":"2020","journal-title":"Stat. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"100729","DOI":"10.1016\/j.hlpt.2023.100729","article-title":"Sociotechnical factors of sustainable digital health systems: A system dynamics model","volume":"12","author":"Fanta","year":"2023","journal-title":"Health Policy Technol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"101138","DOI":"10.1016\/j.jth.2021.101138","article-title":"A review of transport-health system dynamics models","volume":"22","author":"Harrison","year":"2021","journal-title":"J. Transp. Health"},{"key":"ref_38","first-page":"121210","article-title":"A dynamic expert system to increase patient satisfaction with an integrated approach of system dynamics, ISM, and ANP methods","volume":"234","author":"Haseli","year":"2023","journal-title":"Expert Syst. Appl."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"104265","DOI":"10.1016\/j.cities.2023.104265","article-title":"Urban resilience under the COVID-19 pandemic: A quantitative assessment framework based on system dynamics","volume":"136","author":"Zhang","year":"2023","journal-title":"Cities"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"101682","DOI":"10.1016\/j.techsoc.2021.101682","article-title":"Policy innovation and emergence of innovative health technology: The system dynamics modelling of early COVID-19 handling in Indonesia","volume":"66","author":"Aminullah","year":"2021","journal-title":"Technol. Soc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.protcy.2013.12.175","article-title":"System Dynamics in E-health Policy Making and the \u201cGlocal\u201d Concept","volume":"11","author":"Ghazvini","year":"2013","journal-title":"Procedia Technol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.envint.2016.08.003","article-title":"A role for low-order system dynamics models in urban health policy making","volume":"95","author":"Newell","year":"2016","journal-title":"Environ. Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"115295","DOI":"10.1016\/j.envres.2023.115295","article-title":"Making the invisible visible: Using a qualitative system dynamics model to map disparities in cumulative environmental stressors and children\u2019s neurodevelopment","volume":"221","author":"Ballard","year":"2023","journal-title":"Environ. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"110565","DOI":"10.1016\/j.ecolmodel.2023.110565","article-title":"Modeling urban growth effects on carrying capacity in arid and semi-arid regions using system dynamics","volume":"487","author":"Manshadi","year":"2024","journal-title":"Ecol. Modell."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"138105","DOI":"10.1016\/j.jclepro.2023.138105","article-title":"A system dynamics approach for large-scale water treatment plant sludge management: A case study in Brazil","volume":"419","author":"Urban","year":"2023","journal-title":"J. Clean. Prod."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"109398","DOI":"10.1016\/j.buildenv.2022.109398","article-title":"The impact of inspection policies on reducing disease prevalence in public buildings: A systems dynamics approach","volume":"223","author":"Nahavandi","year":"2022","journal-title":"Build. Environ."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jss.2019.10.015","article-title":"A System Dynamics Model of Violent Trauma and the Role of Violence Intervention Programs","volume":"247","author":"Cirone","year":"2020","journal-title":"J. Surg. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.ejor.2015.05.043","article-title":"A system dynamics view of the acute bed blockage problem in the Irish healthcare system","volume":"247","author":"Rashwan","year":"2015","journal-title":"Eur. J. Oper. Res."},{"key":"ref_49","unstructured":"Lane, J.D., and Sterman, D.C. (2011). Profiles in Operations Research, Springer."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"114227","DOI":"10.1016\/j.socscimed.2021.114277","article-title":"Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach","volume":"285","author":"Cassidy","year":"2021","journal-title":"Soc. Sci. Med."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Davahli, M.R., Karwowski, W., and Taiar, R. (2020). A system dynamics simulation applied to healthcare: A systematic review. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17165741"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1002\/(SICI)1099-1727(199623)12:3<183::AID-SDR103>3.0.CO;2-4","article-title":"Formal aspects of model validity and validation in system dynamics","volume":"12","author":"Barlas","year":"1996","journal-title":"Syst. Dyn. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/j.jval.2023.06.005","article-title":"Evolving Use of Health Technology Assessment in Medical Device Procurement\u2014Global Systematic Review: An ISPOR Special Interest Group Report","volume":"26","author":"Cangelosi","year":"2023","journal-title":"Value Health"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1002\/sim.3947","article-title":"A method for monitoring a process from an out of control to an in control state: Application to the learning curve","volume":"29","author":"Biau","year":"2010","journal-title":"Stat. Med."},{"key":"ref_55","first-page":"1","article-title":"Control charts to establish and monitor proficiency in the detection of pulmonary B-lines with Point of Care Ultrasound","volume":"27","author":"Kirsch","year":"2023","journal-title":"Ing. y Univ."},{"key":"ref_56","unstructured":"Meadows, D.H., and Wright, D. (2008). Thinking in Systems: A Primer, Taylor & Francis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1097\/ACM.0000000000000681","article-title":"Learning Curves in Health Professions Education","volume":"90","author":"Pusic","year":"2015","journal-title":"Acad. Med."},{"key":"ref_58","unstructured":"American College of Emergency Physicians (2018). Emergency Ultrasound Standard Reporting Guidelines, ACEP."},{"key":"ref_59","first-page":"334","article-title":"A reappraisal of the criteria to diagnose plasma leakage in dengue hemorrhagic fever","volume":"43","author":"Balasubramanian","year":"2006","journal-title":"Indian Pediatr."},{"key":"ref_60","first-page":"1","article-title":"Assessing the learning curve effect in health technologies. Lessons from the nonclinical literature","volume":"18","author":"Ramsay","year":"2002","journal-title":"Int. J. Technol. Assess. Health Care"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Tolsgaard, M.G., Todsen, T., Sorensen, J.L., Ringsted, C., Lorentzen, T., Ottesen, B., and Tabor, A. (2013). International Multispecialty Consensus on How to Evaluate Ultrasound Competence: A Delphi Consensus Survey. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0057687"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1093\/cid\/ciae285","article-title":"Point-of-care ultrasound in infectious diseases: Current insights and future perspectives","volume":"79","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_63","unstructured":"The Royal College of Radiologists RCR (2017). Ultrasound Training Recommendations for Medical and Surgical Specialties Third Edition Board of the Faculty of Clinical Radiology, BMUS."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13089-024-00392-3","article-title":"Comparison of 6 handheld ultrasound devices by point-of-care ultrasound experts: A cross-sectional study","volume":"16","author":"Johnson","year":"2024","journal-title":"Ultrasound J."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Andersen, C.A., Brodersen, J., Rudb\u00e6k, T.R., and Jensen, M.B. (2021). Patients\u2019 experiences of the use of point-of-care ultrasound in general practice\u2013a cross-sectional study. BMC Fam. Pract., 22.","DOI":"10.1186\/s12875-021-01459-z"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Balmuth, E.A., Luan, D., Jannat-Khah, D., Evans, A., Wong, T., and Scales, D.A. (2024). Point-of-care ultrasound (POCUS): Assessing patient satisfaction and socioemotional benefits in the hospital setting. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0298665"}],"container-title":["Systems"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-8954\/13\/7\/591\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:10:23Z","timestamp":1760033423000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-8954\/13\/7\/591"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,16]]},"references-count":66,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["systems13070591"],"URL":"https:\/\/doi.org\/10.3390\/systems13070591","relation":{},"ISSN":["2079-8954"],"issn-type":[{"type":"electronic","value":"2079-8954"}],"subject":[],"published":{"date-parts":[[2025,7,16]]}}}