{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:25:02Z","timestamp":1791509102188,"version":"4.3.4"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,2,19]],"date-time":"2022-02-19T00:00:00Z","timestamp":1645228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["Fondos FEDER: CB06-06-036"],"award-info":[{"award-number":["Fondos FEDER: CB06-06-036"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>It remains unknown whether the type of aerosol generating device is affecting efficacy and safety among non-cystic fibrosis bronchiectasis (NCFB) adults. The proposal of this network meta-analysis (NMA) is to evaluate effectiveness and safety of inhaled antibiotics administered via dry powder inhaler (DPI) and via nebulizers (SVN) among adult patients with NCFB. Inclusion criteria were randomized-controlled trials, adults (\u226518 years) with NCFB, and inhaled antibiotics administered via DPI as intervention. Search strategy was performed in PubMed, Web of Science, and Cochrane Library from 2000 to 2019. Sixteen trials (2870 patients) were included. Three trials (all ciprofloxacin) used DPIs and thirteen used SVN (three ciprofloxacin). Both DPI and SVN devices achieved similar safety outcomes (adverse events, antibiotic discontinuation, severe adverse events, and bronchospasm). Administration of ciprofloxacin via DPI significantly improved time to first exacerbation (87 days, 95% CI 34.3\u2013139.7) and quality of life (MD \u22127.52; 95% CI \u221213.06 to \u22121.98) when compared with via SVN. No other significant differences were documented in clinical efficacy (at least one exacerbation, FEV1% predicted) and microbiologic response (bacterial eradication, emergence of new potential pathogens, and emergence of antimicrobial resistance) when comparing devices. Our NMA documented that time to first exacerbation and quality of life, were more favorable for DPIs. Decisions on the choice of devices should incorporate these findings plus other criteria, such as simplicity, costs or maintenance requirements.<\/jats:p>","DOI":"10.3390\/antibiotics11020275","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T08:14:46Z","timestamp":1645431286000},"page":"275","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Safety and Efficacy of Devices Delivering Inhaled Antibiotics among Adults with Non-Cystic Fibrosis Bronchiectasis: A Systematic Review and a Network Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2000-6587","authenticated-orcid":false,"given":"Sofia","family":"Tejada","sequence":"first","affiliation":[{"name":"Clinical Research\/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d\u2019Hebron Institut of Research (VHIR), 08035 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Ram\u00edrez-Estrada","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Cl\u00ednica Corach\u00e1n, 08017 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Forero","sequence":"additional","affiliation":[{"name":"School of Medicine, Universitat Internacional de Catalunya, 08195 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Gallego","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Respiratory Department, Parc Taul\u00ed University Hospital, 08208 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9740-2994","authenticated-orcid":false,"given":"Joan","family":"Soriano","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Hospital Universitario La Princesa, Universidad Aut\u00f3noma de Madrid, 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4459-8919","authenticated-orcid":false,"given":"Pablo","family":"Cardinal-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, HM Group, 28015 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Ehrmann","sequence":"additional","affiliation":[{"name":"CHRU Tours, M\u00e9decine Intensive R\u00e9animation, CIC INSERM 1415, CRICS-TriggerSEP F-CRIN Research Network, 37000 Tours, France"},{"name":"Centre d\u2019\u00e9tude des Pathologies Respiratoires, INSERM U1100, Universit\u00e9 de Tours, 37032 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0676-6210","authenticated-orcid":false,"given":"Jordi","family":"Rello","sequence":"additional","affiliation":[{"name":"Clinical Research\/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d\u2019Hebron Institut of Research (VHIR), 08035 Barcelona, Spain"},{"name":"Clinical Research in the ICU, CHU Nimes, Universite de Nimes-Montpellier, 30900 Nimes, France"},{"name":"Medicine Department, Universitat Internacional de Catalunya (UIC), 08195 Sant Cugat, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jcf.2018.02.006","article-title":"ECFS Best Practice Guidelines: The 2018 Revision","volume":"17","author":"Castellani","year":"2018","journal-title":"J. Cyst. Fibros."},{"key":"ref_2","first-page":"1","article-title":"British Thoracic Society Guideline for Bronchiectasis in Adults","volume":"74","author":"Hill","year":"2019","journal-title":"Thorax"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.arbr.2017.07.014","article-title":"Spanish Guidelines on Treatment of Bronchiectasis in Adults","volume":"54","author":"Olveira","year":"2018","journal-title":"Arch. Bronconeumol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1700629","DOI":"10.1183\/13993003.00629-2017","article-title":"European Respiratory Society Guidelines for the Management of Adult Bronchiectasis","volume":"50","author":"Polverino","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.5694\/mja14.00287","article-title":"Extended voting group Chronic Suppurative Lung Disease and Bronchiectasis in Children and Adults in Australia and New Zealand Thoracic Society of Australia and New Zealand Guidelines","volume":"202","author":"Chang","year":"2015","journal-title":"Med. J. Aust."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ejim.2021.04.009","article-title":"Inhaled Antibiotics for Treatment of Adults with Non-Cystic Fibrosis Bronchiectasis: A Systematic Review and Meta-Analysis","volume":"90","author":"Tejada","year":"2021","journal-title":"Eur. J. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Garc\u00eda, M.\u00c1., Oscullo, G., Barreiro, E., Cuenca, S., Cervera, A., Padilla-Galo, A., de la Rosa, D., Navarro, A., Giron, R., and Carbonero, F. (2020). Inhaled Dry Powder Antibiotics in Patients with Non-Cystic Fibrosis Bronchiectasis: Efficacy and Safety in a Real-Life Study. J. Clin. Med., 9.","DOI":"10.3390\/jcm9072317"},{"key":"ref_8","first-page":"367","article-title":"The Inhalation of Drugs: Advantages and Problems","volume":"50","author":"Rau","year":"2005","journal-title":"Respir Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1378\/chest.127.1.335","article-title":"American College of Asthma, Allergy, and Immunology Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines: American College of Chest Physicians\/American College of Asthma, Allergy, and Immunology","volume":"127","author":"Dolovich","year":"2005","journal-title":"Chest"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.cmi.2017.03.018","article-title":"Key Considerations on Nebulization of Antimicrobial Agents to Mechanically Ventilated Patients","volume":"23","author":"Rello","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/S2213-2600(19)30185-7","article-title":"The Efficacy and Safety of Inhaled Antibiotics for the Treatment of Bronchiectasis in Adults: A Systematic Review and Meta-Analysis","volume":"7","author":"Laska","year":"2019","journal-title":"Lancet Respir. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1753466620936866","DOI":"10.1177\/1753466620936866","article-title":"Inhaled Antibiotics Therapy for Stable Non-Cystic Fibrosis Bronchiectasis: A Meta-Analysis","volume":"14","author":"Xu","year":"2020","journal-title":"Ther. Adv. Respir. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1183\/09031936.00018414","article-title":"Inhaled Antibiotics for Stable Non-Cystic Fibrosis Bronchiectasis: A Systematic Review","volume":"44","author":"Brodt","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1097\/MCP.0000000000000109","article-title":"Dry Powder Inhalers in Cystic Fibrosis: Same Old Drugs but Different Benefits?","volume":"20","author":"Uttley","year":"2014","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_15","first-page":"433","article-title":"What Have We Learned from Network Meta-Analyses Applied to Critical Care?","volume":"85","year":"2019","journal-title":"Minerva Anestesiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1702052","DOI":"10.1183\/13993003.02053-2017","article-title":"RESPIRE 1: A Phase III Placebo-Controlled Randomised Trial of Ciprofloxacin Dry Powder for Inhalation in Non-Cystic Fibrosis Bronchiectasis","volume":"51","author":"Aksamit","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1702053","DOI":"10.1183\/13993003.02053-2017","article-title":"RESPIRE 2: A Phase III Placebo-Controlled Randomised Trial of Ciprofloxacin Dry Powder for Inhalation in Non-Cystic Fibrosis Bronchiectasis","volume":"51","author":"Aksamit","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1183\/09031936.00071312","article-title":"Ciprofloxacin Dry Powder for Inhalation in Non-Cystic Fibrosis Bronchiectasis: A Phase II Randomised Study","volume":"41","author":"Wilson","year":"2013","journal-title":"Eur. Respir. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/S2213-2600(18)30427-2","article-title":"Inhaled Liposomal Ciprofloxacin in Patients with Non-Cystic Fibrosis Bronchiectasis and Chronic Lung Infection with Pseudomonas Aeruginosa (ORBIT-3 and ORBIT-4): Two Phase 3, Randomised Controlled Trials","volume":"7","author":"Haworth","year":"2019","journal-title":"Lancet Respir. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1159\/000486134","article-title":"A Prospective Trial of Nebulized Amikacin in the Treatment of Bronchiectasis Exacerbation","volume":"95","author":"Ailiyaer","year":"2018","journal-title":"Respiration"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/S2213-2600(14)70165-1","article-title":"Aztreonam for Inhalation Solution in Patients with Non-Cystic Fibrosis Bronchiectasis (AIR-BX1 and AIR-BX2): Two Randomised Double-Blind, Placebo-Controlled Phase 3 Trials","volume":"2","author":"Barker","year":"2014","journal-title":"Lancet Respir. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1159\/000438490","article-title":"Eradication Therapy against Pseudomonas Aeruginosa in Non-Cystic Fibrosis Bronchiectasis","volume":"90","author":"Orriols","year":"2015","journal-title":"Respiration"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1164\/rccm.201312-2208OC","article-title":"Inhaled Colistin in Patients with Bronchiectasis and Chronic Pseudomonas Aeruginosa Infection","volume":"189","author":"Haworth","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1136\/thoraxjnl-2013-203207","article-title":"ORBIT-2 investigators Inhaled, Dual Release Liposomal Ciprofloxacin in Non-Cystic Fibrosis Bronchiectasis (ORBIT-2): A Randomised, Double-Blind, Placebo-Controlled Trial","volume":"68","author":"Serisier","year":"2013","journal-title":"Thorax"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1164\/rccm.201005-0756OC","article-title":"A Randomized Controlled Trial of Nebulized Gentamicin in Non-Cystic Fibrosis Bronchiectasis","volume":"183","author":"Murray","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1378\/chest.130.5.1503","article-title":"Addition of Inhaled Tobramycin to Ciprofloxacin for Acute Exacerbations of Pseudomonas Aeruginosa Infection in Adult Bronchiectasis","volume":"130","author":"Bilton","year":"2006","journal-title":"Chest"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1345\/aph.1E099","article-title":"Inhaled Tobramycin in Non-Cystic Fibrosis Patients with Bronchiectasis and Chronic Bronchial Infection with Pseudomonas Aeruginosa","volume":"39","author":"Drobnic","year":"2005","journal-title":"Ann. Pharmacother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"114S","DOI":"10.1378\/chest.120.3_suppl.114S","article-title":"Treatment With Tobramycin Solution for Inhalation in Bronchiectasis Patients with Pseudomonas Aeruginosa","volume":"120","author":"Couch","year":"2001","journal-title":"Chest"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1164\/ajrccm.162.2.9910086","article-title":"Tobramycin Solution for Inhalation Reduces Sputum Pseudomonas Aeruginosa Density in Bronchiectasis","volume":"162","author":"Barker","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_30","unstructured":"Insmed Incorporated (2021, March 08). Safety and Tolerability Study of 2 Dose Level of ArikayceTM in Patients with Bronchiectasis and Chronic Infection Due to Pseudomonas Aeruginosa, Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT00775138."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"190120","DOI":"10.1183\/16000617.0120-2019","article-title":"The Radiological Diagnosis of Bronchiectasis: What\u2019s in a Name?","volume":"29","author":"Tiddens","year":"2020","journal-title":"Eur. Respir. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.jcf.2020.08.001","article-title":"Long-Term Safety Study of Colistimethate Sodium (Colobreathe\u00ae): Findings from the UK Cystic Fibrosis Registry","volume":"20","author":"Kaplan","year":"2021","journal-title":"J. Cyst. Fibros."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jcf.2010.10.003","article-title":"Safety, Efficacy and Convenience of Tobramycin Inhalation Powder in Cystic Fibrosis Patients: The EAGER Trial","volume":"10","author":"Konstan","year":"2011","journal-title":"J. Cyst. Fibros."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1097\/ALN.0000000000001570","article-title":"Nebulization of Antiinfective Agents in Invasively Mechanically Ventilated Adults: A Systematic Review and Meta-Analysis","volume":"126","author":"Rouby","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Boisson, M., Bougl\u00e9, A., Sole-Lleonart, C., Dhanani, J., Arvaniti, K., Rello, J., Rouby, J.-J., and Mimoz, O. (Semin. Respir. Crit. Care Med., 2022). European Investigator Network for Nebulized Antibiotics in Ventilator-Associated Pneumonia (ENAVAP). Nebulized Antibiotics for Healthcare- and Ventilator-Associated Pneumonia, Semin. Respir. Crit. Care Med., [Online ahead of print].","DOI":"10.1055\/s-0041-1740340"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1097\/QCO.0000000000000720","article-title":"European Investigators Network for Nebulized Antibiotics in Ventilator-associated Pneumonia (ENAVAP) Nebulized Antibiotics for Ventilator-Associated Pneumonia: Methodological Framework for Future Multicenter Randomized Controlled Trials","volume":"34","author":"Monsel","year":"2021","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Tejada, S., Ram\u00edrez-Estrada, S., Tejo, A.M., Forero, C.G., Pomares, X., Gallego, M., Soriano, J.B., Chalmers, J.D., and Rello, J. (Eur. J. Intern. Med., 2022). Critical Appraisal of International Adult Bronchiectasis Guidelines Using the AGREE II Tool, Eur. J. Intern. Med., [Online ahead of print].","DOI":"10.1016\/j.ejim.2022.01.023"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.2147\/COPD.S209513","article-title":"Nebulized Colistin And Continuous Cyclic Azithromycin In Severe COPD Patients With Chronic Bronchial Infection Due To Pseudomonas Aeruginosa: A Retrospective Cohort Study","volume":"14","author":"Prina","year":"2019","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e20210198","DOI":"10.36416\/1806-3756\/e20210198","article-title":"New Insights into Pneumonia in Patients on Prolonged Mechanical Ventilation: Need for a New Paradigm Addressing Dysbiosis","volume":"47","author":"Rello","year":"2021","journal-title":"J. Bras. Pneumol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/j.chest.2018.01.044","article-title":"Clinical and Safety Outcomes of Long-Term Azithromycin Therapy in Severe COPD Beyond the First Year of Treatment","volume":"153","author":"Pomares","year":"2018","journal-title":"Chest"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jclinepi.2009.06.006","article-title":"The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration","volume":"62","author":"Liberati","year":"2009","journal-title":"J. Clin. Epidemiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-Analyses of Health Care Interventions: Checklist and Explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2019). Cochrane Handbook for Systematic Reviews of Interventions, John Wiley & Sons.","DOI":"10.1002\/9781119536604"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1016\/S0140-6736(10)60926-9","article-title":"Aerosol Drug Delivery: Developments in Device Design and Clinical Use","volume":"377","author":"Dolovich","year":"2011","journal-title":"Lancet"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the Sample Mean and Standard Deviation from the Sample Size, Median, Range and\/or Interquartile Range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Tonin, F.S., Borba, H.H., Mendes, A.M., Wiens, A., Fernandez-Llimos, F., and Pontarolo, R. (2019). Description of Network Meta-Analysis Geometry: A Metrics Design Study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0212650"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/2\/275\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:23:16Z","timestamp":1760134996000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/2\/275"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,19]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["antibiotics11020275"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics11020275","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,19]]}}}