{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:54:22Z","timestamp":1785840862447,"version":"3.56.0"},"reference-count":69,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Environ. Res. Public Health","IJERPH"],"abstract":"<jats:p>(1) Background: Ambulatory services are the main interface between populations and health systems, yet their benefits are unevenly distributed due to structural inequalities\u2014systemic differences rooted in the social, economic, and political organisation of society. Inequities in access and quality are well documented, but patient safety remains the least examined. (2) Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, PubMed\/MEDLINE and Scopus were searched for studies published from 2010 to 2026. In total, 44 studies were included, predominantly from the USA (n = 31), and synthesised narratively. (3) Results: Inequalities operated through geographic maldistribution, financial barriers, exclusionary institutional cultures, and market-driven practices. Access and quality were each addressed by 17 studies, whereas only four examined patient safety directly; the limited safety evidence indicated disproportionate diagnostic errors, medication-safety failures, and care-coordination breakdowns among vulnerable groups. Evidence was concentrated in the USA. (4) Conclusions: Structural inequalities are well documented for access and quality but are markedly under-studied for patient safety\u2014the principal evidence gap identified. Patient safety warrants treatment as an equity outcome, measured with stratification by structural disadvantage and addressed through system-level interventions.<\/jats:p>","DOI":"10.3390\/ijerph23081021","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:38:08Z","timestamp":1785839888000},"page":"1021","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Structural Inequalities in Ambulatory Care: A Scoping Review of Access and Quality and the Neglected Dimension of Patient Safety"],"prefix":"10.3390","volume":"23","author":[{"given":"Andreas","family":"M\u00fcller","sequence":"first","affiliation":[{"name":"Department of Public Health, St. Elizabeth University of Health and Social Work, 811 02 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eitan","family":"Bronschtein","sequence":"additional","affiliation":[{"name":"Department of Public Health, St. Elizabeth University of Health and Social Work, 811 02 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinand","family":"Sasv\u00e1ry","sequence":"additional","affiliation":[{"name":"Department of Public Health, St. Elizabeth University of Health and Social Work, 811 02 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1111\/j.1468-0009.2005.00409.x","article-title":"Contribution of primary care to health systems and health","volume":"83","author":"Starfield","year":"2005","journal-title":"Milbank Q."},{"key":"ref_2","unstructured":"OECD (2023). Health at a Glance 2023: OECD Indicators, OECD Publishing."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1016\/j.puhe.2012.05.014","article-title":"Fair society, healthy lives","volume":"126","author":"Marmot","year":"2010","journal-title":"Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(17)30569-X","article-title":"Structural racism and health inequities in the USA: Evidence and interventions","volume":"389","author":"Bailey","year":"2017","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Williams, D., and Cooper, L. (2019). Reducing racial inequities in health: Using what we already know to take action. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16040606"},{"key":"ref_6","unstructured":"Smedley, B., Stith, A., and Nelson, A. (2026, June 05). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/25032386\/."},{"key":"ref_7","unstructured":"AHRQ (2026, June 05). 2023 National Healthcare Quality and Disparities Report, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK600459\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/S0140-6736(11)61780-7","article-title":"Increasing incidence of serious infectious diseases and inequalities in New Zealand: A national epidemiological study","volume":"379","author":"Baker","year":"2012","journal-title":"Lancet"},{"key":"ref_9","first-page":"498","article-title":"A systems-based framework for integrating health equity and patient safety","volume":"51","author":"Tsuei","year":"2025","journal-title":"Jt. Comm. J. Qual. Patient Saf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s12939-018-0828-7","article-title":"Social disparities in patient safety in primary care: A systematic review","volume":"17","author":"Piccardi","year":"2018","journal-title":"Int. J. Equity Health"},{"key":"ref_11","unstructured":"Auraaen, A., Slawomirski, L., and Klazinga, N. (2018). The Economics of Patient Safety in Primary and Ambulatory Care: Flying Blind (OECD Health Working Papers No. 106), OECD Publishing."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1136\/jech-2020-216061","article-title":"Unequal impact of the COVID-19 crisis on minority ethnic groups: A framework for understanding and addressing inequalities","volume":"75","author":"Katikireddi","year":"2021","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1001\/jama.2020.7858","article-title":"Digital health equity as a necessity in the 21st Century Cures Act era","volume":"323","author":"Rodriguez","year":"2020","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1056\/NEJMra1807873","article-title":"The imperative for climate action to protect health","volume":"380","author":"Haines","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_15","unstructured":"EuroHealthNet (2026, June 04). Improving Health Equity in Europe: Priorities for the 2024\u20132029 Policy Landscape. Available online: https:\/\/eurohealthnet.eu\/improving-health-equity-in-europe-priorities-for-the-2024-2029-policy-landscape\/."},{"key":"ref_16","first-page":"386","article-title":"Racism and health inequity among Americans","volume":"98","author":"Shavers","year":"2006","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1377\/hlthaff.2010.0862","article-title":"How health insurance design affects access to care and costs, by income, in eleven countries","volume":"29","author":"Schoen","year":"2010","journal-title":"Health Aff."},{"key":"ref_18","unstructured":"Solar, O., and Irwin, A. (2010). A Conceptual Framework for Action on the Social Determinants of Health, World Health Organization."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1016\/S0140-6736(08)61690-6","article-title":"Closing the gap in a generation: Health equity through action on the social determinants of health","volume":"372","author":"Marmot","year":"2008","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.11124\/JBIES-20-00167","article-title":"Updated methodological guidance for the conduct of scoping reviews","volume":"18","author":"Peters","year":"2020","journal-title":"JBI Evid. Synth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/1364557032000119616","article-title":"Scoping studies: Towards a methodological framework","volume":"8","author":"Arksey","year":"2005","journal-title":"Int. J. Soc. Res. Methodol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/1748-5908-5-69","article-title":"Scoping studies: Advancing the methodology","volume":"5","author":"Levac","year":"2010","journal-title":"Implement. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12939-024-02156-w","article-title":"Racism against healthcare users in inpatient care: A scoping review","volume":"23","author":"Merz","year":"2024","journal-title":"Int. J. Equity Health"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Agarwal, A., Livingstone, A., Karikios, D.J., Stockler, M.R., Beale, P.J., and Morton, R.L. (2021). Physician\u2013patient communication of costs and financial burden of cancer and its treatment: A systematic review of clinical guidelines. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-08697-5"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1111\/1475-6773.13912","article-title":"Prescribing of low- versus high-cost Part B drugs in Medicare Advantage and traditional Medicare","volume":"57","author":"Anderson","year":"2021","journal-title":"Health Serv. Res."},{"key":"ref_27","unstructured":"Artiga, S., and Hinton, E. (2018). Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity, KFF. Available online: https:\/\/www.kff.org\/racial-equity-and-health-policy\/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity\/."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Bender, J.L., Tong, E., An, E., Liu, Z.A., Shapiro, G.K., Avery, J., Chu, A., Schulz-Quach, C., Hales, S., and Maybee, A. (2025). Collecting data on the social determinants of health to advance health equity in cancer care in Canada: Patient and community perspectives. Curr. Oncol., 32.","DOI":"10.3390\/curroncol32070406"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low health literacy and health outcomes: An updated systematic review","volume":"155","author":"Berkman","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e075244","DOI":"10.1136\/bmj-2023-075244","article-title":"Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: Systematic review","volume":"382","author":"Borsa","year":"2023","journal-title":"BMJ"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.2105\/AJPH.2012.300750","article-title":"The problem with the phrase women and minorities: Intersectionality\u2014An important theoretical framework for public health","volume":"102","author":"Bowleg","year":"2012","journal-title":"Am. J. Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.2105\/AJPH.2016.303212","article-title":"Intersection of living in a rural versus urban area and race\/ethnicity in explaining access to health care in the United States","volume":"106","author":"Caldwell","year":"2016","journal-title":"Am. J. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"105311","DOI":"10.1016\/j.jpubeco.2025.105311","article-title":"Nothing for something: Marketing cancer drugs to physicians increases prescribing without improving mortality","volume":"242","author":"Carey","year":"2025","journal-title":"J. Public Econ."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e37969","DOI":"10.1016\/j.heliyon.2024.e37969","article-title":"Unraveling the drivers of inequality in primary health-care resource distribution: Evidence from Guangzhou, China","volume":"10","author":"Chen","year":"2024","journal-title":"Heliyon"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"FitzGerald, C., and Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Med. Ethics, 18.","DOI":"10.1186\/s12910-017-0179-8"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1017\/S1742058X11000130","article-title":"Structural racism and health inequities","volume":"8","author":"Gee","year":"2011","journal-title":"Du Bois Rev. Soc. Sci. Res. Race"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1377\/hlthaff.2020.01699","article-title":"Fewer pharmacies in Black and Hispanic\/Latino neighborhoods compared with White or diverse neighborhoods, 2007\u20132015","volume":"40","author":"Guadamuz","year":"2021","journal-title":"Health Aff."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1056\/NEJMp1609535","article-title":"Structural racism and supporting Black lives\u2014The role of health professionals","volume":"375","author":"Hardeman","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Hu, J., and Nerenz, D.R. (2025). Outpatient chemotherapy drug costs and expensive chemotherapy drug use in 340B and non-340B hospitals: An observational study. BMC Health Serv. Res., 25.","DOI":"10.1186\/s12913-024-12188-1"},{"key":"ref_40","first-page":"449","article-title":"The association between cost sharing, prior authorization, and specialty drug utilization: A systematic review","volume":"29","author":"Ismail","year":"2023","journal-title":"J. Manag. Care Spec. Pharm."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1672","DOI":"10.1200\/OP.22.00136","article-title":"Trends in medically integrated dispensing among oncology practices","volume":"18","author":"Kanter","year":"2022","journal-title":"JCO Oncol. Pract."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"734","DOI":"10.2340\/1651-226X.2025.42778","article-title":"Comparative study of lung cancer care and survival outcomes across the Nordic countries","volume":"64","author":"Khalife","year":"2025","journal-title":"Acta Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1007\/s11845-024-03672-y","article-title":"Optimising oncology drug expenditure in Ireland","volume":"193","author":"Kieran","year":"2024","journal-title":"Ir. J. Med. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"S198","DOI":"10.2105\/AJPH.2014.302182","article-title":"Persons with disabilities as an unrecognized health disparity population","volume":"105","author":"Krahn","year":"2015","journal-title":"Am. J. Public Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"256","DOI":"10.2105\/AJPH.2015.302955","article-title":"Public health monitoring of privilege and deprivation with the Index of Concentration at the Extremes","volume":"106","author":"Krieger","year":"2016","journal-title":"Am. J. Public Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1146\/annurev-publhealth-040119-094017","article-title":"Measures of racism, sexism, heterosexism, and gender binarism for health equity research: From structural injustice to embodied harm\u2014An ecosocial analysis","volume":"41","author":"Krieger","year":"2020","journal-title":"Annu. Rev. Public Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"441","DOI":"10.7326\/0003-4819-158-6-201303190-00003","article-title":"Access to subspecialty care for patients with mobility impairment","volume":"158","author":"Lagu","year":"2013","journal-title":"Ann. Intern. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1200\/JOP.18.00315","article-title":"Practice patterns for older adult patients with advanced cancer: Physician office versus hospital outpatient setting","volume":"15","author":"Atoria","year":"2019","journal-title":"J. Oncol. Pract."},{"key":"ref_49","first-page":"4525","article-title":"Characterizing and assessing antiemetic underuse in patients initiating highly emetogenic chemotherapy","volume":"27","author":"Mahendraratnam","year":"2019","journal-title":"Support. Care Cancer"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e2234161","DOI":"10.1001\/jamanetworkopen.2022.34161","article-title":"Association of oncologist participation in Medicare\u2019s Oncology Care Model with patient receipt of novel cancer therapies","volume":"5","author":"Manz","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.annepidem.2020.05.003","article-title":"Assessing differential impacts of COVID-19 on Black communities","volume":"47","author":"Millett","year":"2020","journal-title":"Ann. Epidemiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1001\/jamainternmed.2016.8648","article-title":"Association of patient\u2013physician language concordance and glycemic control for limited-English proficiency Latinos with type 2 diabetes","volume":"177","author":"Parker","year":"2017","journal-title":"JAMA Intern. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1038\/s41416-021-01552-1","article-title":"Interactions with the pharmaceutical industry and the practice, knowledge and beliefs of medical oncologists and clinical haematologists: A systematic review","volume":"126","author":"Pokorny","year":"2021","journal-title":"Br. J. Cancer"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1377\/hlthaff.2013.1397","article-title":"\u201cPharmacy deserts\u201d are prevalent in Chicago\u2019s predominantly minority communities, raising medication access concerns","volume":"33","author":"Qato","year":"2014","journal-title":"Health Aff."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1080\/02813432.2025.2451653","article-title":"General practitioners\u2019 clinical decision-making in patients that could have cancer: A vignette study comparing the Baltic states with four Nordic countries","volume":"43","author":"Rosendahl","year":"2025","journal-title":"Scand. J. Prim. Health Care"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Shaltynov, A., Abenova, M., Baibussinova, A., Semenova, Y., Omarov, N., Tanatarova, G., Sepbossynova, A., and Rocha, J. (2025). Inequality in the distribution and utilization of healthcare resources in Kazakhstan (2002\u20132023): A spatiotemporal analysis. Int. J. Environ. Res. Public Health, 22.","DOI":"10.3390\/ijerph22111762"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s11606-018-4785-z","article-title":"The influence of patient race and activation on pain management in advanced lung cancer: A randomized field experiment","volume":"34","author":"Shields","year":"2019","journal-title":"J. Gen. Intern. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1001\/jamainternmed.2013.2777","article-title":"Types and origins of diagnostic errors in primary care settings","volume":"173","author":"Singh","year":"2013","journal-title":"JAMA Intern. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2742","DOI":"10.1038\/s41372-021-01187-3","article-title":"Homelessness in pregnancy: Perinatal outcomes","volume":"41","author":"Spiegel","year":"2021","journal-title":"J. Perinatol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s40259-017-0214-9","article-title":"Impact of guidance on the prescription patterns of G-CSFs for the prevention of febrile neutropenia following anticancer chemotherapy: A population-based utilization study in the Lazio region","volume":"31","author":"Trotta","year":"2017","journal-title":"BioDrugs"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e205165","DOI":"10.1001\/jamanetworkopen.2020.5165","article-title":"Evaluation of practice patterns among oncologists participating in the Oncology Care Model","volume":"3","author":"Walker","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e2024984","DOI":"10.1001\/jamanetworkopen.2020.24984","article-title":"Changes in health services use among commercially insured US populations during the COVID-19 pandemic","volume":"3","author":"Whaley","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1146\/annurev-publhealth-040218-043750","article-title":"Racism and health: Evidence and needed research","volume":"40","author":"Williams","year":"2019","journal-title":"Annu. Rev. Public Health"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e002497","DOI":"10.1136\/bmjph-2024-002497","article-title":"Exploring factors affecting access to non-communicable disease medicines in low- and middle-income countries: A systematic review","volume":"4","author":"Wong","year":"2026","journal-title":"BMJ Public Health"},{"key":"ref_65","unstructured":"Shin, P., Alvarez, C., Sharac, J., Rosenbaum, S., Van Vleet, A., Paradise, J., and Garfield, R. (2013). A Profile of Community Health Center patients: Implications for Policy, KFF. Available online: https:\/\/www.kff.org\/affordable-care-act\/a-profile-of-community-health-center-patients-implications-for-policy\/."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s12961-022-00957-5","article-title":"Quality of care in the context of universal health coverage: A scoping review","volume":"21","author":"Yanful","year":"2023","journal-title":"Health Res. Policy Syst."},{"key":"ref_67","unstructured":"Ng, N., Berger, F., and Rosenberg, K.M. (2023). Inequality in Unmet Healthcare and Social Care Needs in Europe, WHO Centre for Health Development (WHO Kobe Centre)."},{"key":"ref_68","first-page":"492","article-title":"Epidemiology of offences against health in the Republic of Kazakhstan: 2015\u20132019","volume":"28","author":"Tsigengagel","year":"2021","journal-title":"J. Law Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"mzaf006","DOI":"10.1093\/intqhc\/mzaf006","article-title":"Patient safety in low- and middle-income countries: How can we do better?","volume":"37","author":"Pichumani","year":"2025","journal-title":"Int. J. Qual. Health Care"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/8\/1021\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:43:26Z","timestamp":1785840206000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/8\/1021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":69,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["ijerph23081021"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23081021","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}