{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:43:14Z","timestamp":1790826194547,"version":"4.1.0"},"reference-count":59,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T00:00:00Z","timestamp":1631750400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Medically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviors very close to suicides. Personality disorders (PD) are highly prevalent among them, together with affective and substance use disorders. However, few studies have specifically analyzed the role of PD in MSSA. These suicide attempts (SA) are usually followed by longer hospitalization periods and may result in severe physical and psychological consequences. The aim of this study is to compare the profile of MSSA patients with and without PD. MSSA were defined according to Beautrais \u2018criteria, but had to remain hospitalized \u226548 h. Overall, 168 patients from two public hospitals in Barcelona were evaluated during a three-year period. Mean hospital stay was 23.68 (standard deviation (SD) = 41.14) days. Patients with PD (n = 69) were more likely to be younger, female, make the first and the most serious SA at a younger age, reported recent stressful life-events and more frequently had previous suicide attempts compared to those without PD. However, no differences were found with regards to comorbid diagnoses, current clinical status, features of the attempt, or their impulsivity and hopelessness scores. Therefore, focusing on the subjective, qualitative experiences related to MSSA among PD patients may increase understanding of the reasons contributing to these attempts in order to improve prevention strategies in the future.<\/jats:p>","DOI":"10.3390\/jcm10184186","type":"journal-article","created":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T21:38:12Z","timestamp":1631828292000},"page":"4186","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Medically Serious Suicide Attempts in Personality Disorders"],"prefix":"10.3390","volume":"10","author":[{"given":"Marta","family":"Quesada-Franco","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Department of Psychiatry and Legal Medicine, Universitat Aut\u00f2noma de Barcelona, 08193 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8730-7296","authenticated-orcid":false,"given":"Luis","family":"Pintor-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Hospital Clinic, Instituto de Investigaciones Biom\u00e9dicas Augusto Pi I Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constanza","family":"Daigre","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Department of Psychiatry and Legal Medicine, Universitat Aut\u00f2noma de Barcelona, 08193 Barcelona, Spain"},{"name":"Biomedical Network Research Centre on Mental Health (CIBERSAM), 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6963-6555","authenticated-orcid":false,"given":"Enrique","family":"Baca-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Madrid Autonomous University, 28017 Madrid, Spain"},{"name":"CIBERSAM (Centro de Investigacion en Salud Mental), Carlos III Institute of Health, 28040 Madrid, Spain"},{"name":"Department of Psychiatry, Centre Hospitalier Universitaire de N\u00eemes, 30900 N\u00eemes, France"},{"name":"Psychology Department, Universidad Cat\u00f3lica de Maule, Talca 3605, Chile"},{"name":"Department of Psychiatry, University Hospital Jimenez Diaz Foundation, 28020 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1622-0350","authenticated-orcid":false,"given":"Josep Antoni","family":"Ramos-Quiroga","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Department of Psychiatry and Legal Medicine, Universitat Aut\u00f2noma de Barcelona, 08193 Barcelona, Spain"},{"name":"Biomedical Network Research Centre on Mental Health (CIBERSAM), 08035 Barcelona, Spain"},{"name":"Psychiatry, Mental Health and Addictions Research Group, Vall d\u2019Hebron Research Institute, Universitat Aut\u00f2noma de Barcelona, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Dolores","family":"Braquehais","sequence":"additional","affiliation":[{"name":"Biomedical Network Research Centre on Mental Health (CIBERSAM), 08035 Barcelona, Spain"},{"name":"Psychiatry, Mental Health and Addictions Research Group, Vall d\u2019Hebron Research Institute, Universitat Aut\u00f2noma de Barcelona, 08035 Barcelona, Spain"},{"name":"Integral Care Program for Sick Health Professionals, Galatea Clinic, 08017 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,16]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021). Suicide Worldwide in 2019: Global Health Estimates, World Health Organization. Licence: CC BY-NC-SA 3.0 IGO."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1521\/suli.34.1.1.27772","article-title":"Further suicidal behavior among medically serious suicide attempters","volume":"34","author":"Beautrais","year":"2004","journal-title":"Suicide Life Threat Behav."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1111\/sltb.12035","article-title":"Attachment patterns in medically serious suicide attempts: The mediating role of self-disclosure and loneliness","volume":"43","author":"Gvion","year":"2013","journal-title":"Suicide Life Threat Behav."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1017\/S0033291701003889","article-title":"Suicides and serious suicide attempts: Two populations or one?","volume":"31","author":"Beautrais","year":"2001","journal-title":"Psychol. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1192\/bjp.bp.110.077883","article-title":"Psychiatric disorders in male prisoners who made near-lethal suicide attempts: Case-control study","volume":"197","author":"Rivlin","year":"2010","journal-title":"Br. J. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1016\/S0140-6736(09)60372-X","article-title":"Suicide","volume":"373","author":"Hawton","year":"2009","journal-title":"Lancet"},{"key":"ref_7","first-page":"30","article-title":"Identification of nearly fatal suicide attempts: Self-Inflicted Injury Severity Form","volume":"32","author":"Potter","year":"1998","journal-title":"Suicide Life Threat Behav."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1521\/suli.32.1.5.49.24212","article-title":"Charactristics of impulsive suicide attempts and attempters","volume":"32","author":"Simon","year":"2001","journal-title":"Suicide Life Threat Behav."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1037\/0022-006X.72.6.1170","article-title":"Suicide intent and accurate expectations of lethality: Predictors of medical lethality of suicide attempts","volume":"72","author":"Brown","year":"2004","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1521\/suli.33.3.261.23211","article-title":"The LSARS-II: Lethality of Suicide Attempt Rating Scale-updated","volume":"33","author":"Berman","year":"2003","journal-title":"Suicide Life Threat Behav."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/00030651010490010901","article-title":"An empirical study of seriously disturbed suicidal patients","volume":"49","author":"Fowler","year":"2001","journal-title":"J. Am. Psychoanal. Assoc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jad.2008.02.022","article-title":"Mental pain and its communication in medically serious suicide attempts: An impossible situation","volume":"111","author":"Levi","year":"2008","journal-title":"J. Affect. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1080\/13811118.2013.809041","article-title":"Mental pain, communication difficulties, and medically serious suicide attempts: A case-control study","volume":"18","author":"Gvion","year":"2014","journal-title":"Arch. Suicide Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.jad.2011.11.035","article-title":"Medically serious versus non-serious suicide attempts: Relationships of lethality and intent to clinical and interpersonal characteristics","volume":"136","author":"Horesh","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e191","DOI":"10.4088\/JCP.13m08524","article-title":"Violent and serious suicide attempters: One step closer to suicide?","volume":"75","author":"Giner","year":"2014","journal-title":"J. Clin. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.psychres.2005.11.012","article-title":"Gender differences in medically serious suicide attempts: A study from south India","volume":"144","author":"Mohan","year":"2006","journal-title":"Psychiatry Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jad.2005.12.028","article-title":"Characteristics of high intent suicide attempters admitted to a general hospital","volume":"91","author":"Mohan","year":"2006","journal-title":"J. Affect. Disord."},{"key":"ref_18","first-page":"424","article-title":"Psychiatric consultation of all suicide-attempt patients during a one year period in a tertiary hospital","volume":"15","year":"2013","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1176\/ajp.153.8.1009","article-title":"Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: A case-control study","volume":"153","author":"Beautrais","year":"1996","journal-title":"Am. J. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1521\/suli.32.1.1.22184","article-title":"A case control study of suicide and attempted suicide in older adults","volume":"32","author":"Beautrais","year":"2002","journal-title":"Suicide Life Threat Behav."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1046\/j.1440-1614.2003.01236.x","article-title":"Subsequent mortality in medically serious suicide attempts: A five year follow-up","volume":"37","author":"Beautrais","year":"2003","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1176\/appi.ajp.160.6.1093","article-title":"Suicide and serious suicide attempts in youth: A multiple-group comparison study","volume":"160","author":"Beautrais","year":"2003","journal-title":"Am. J. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1027\/0227-5910.26.1.1","article-title":"National strategies for the reduction and prevention of suicide","volume":"26","author":"Beautrais","year":"2005","journal-title":"Crisis"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/j.1943-278X.1999.tb00761.x","article-title":"Personality traits and cognitive styles as risk factors for serious suicide attempts among young people","volume":"29","author":"Beautrais","year":"1999","journal-title":"Suicide Life Threat Behav."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1176\/appi.ajp.161.3.562","article-title":"Completed suicide after a suicide attempt: A 37-year follow-up study","volume":"161","author":"Suominen","year":"2004","journal-title":"Am. J. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1080\/00048670601172749","article-title":"Risk of repetition of suicide attempt, suicide or all deaths after an episode of attempted suicide: A register-based survival analysis","volume":"41","author":"Christiansen","year":"2007","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jad.2016.03.054","article-title":"Predictive value of psychological characteristics and suicide history on medical lethality of suicide attempts: A follow-up study of hospitalized patients","volume":"199","author":"Trakhenbrot","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.jad.2017.11.033","article-title":"Aggression, impulsivity, and their predictive value on medical lethality of suicide attempts: A follow-up study on hospitalized patients","volume":"227","author":"Gvion","year":"2018","journal-title":"J. Affect. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1111\/j.1600-0447.1987.tb05623.x","article-title":"Adolescents who make suicide attempts repeatedly","volume":"76","author":"Kotila","year":"1987","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1521\/suli.2007.37.4.379","article-title":"Repetition of deliberate self-harm: A study of the characteristics and subsequent deaths in patients presenting to a general hospital according to extent of repetition","volume":"37","author":"Haw","year":"2007","journal-title":"Suicide Life Threat Behav."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1027\/0227-5910.27.3.125","article-title":"One-hundred cases of suicide in Budapest: A case-controlled psychological autopsy study","volume":"27","author":"Zonda","year":"2006","journal-title":"Crisis"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Press. [5th ed.]. Text revision.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1192\/bjp.2019.166","article-title":"The prevalence of personality disorders in the community: A global systematic review and meta-analysis","volume":"216","author":"Winsper","year":"2020","journal-title":"Br. J. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1176\/appi.ajp.162.10.1911","article-title":"The prevalence of DSM-IV personality disorders in psychiatric outpatients","volume":"162","author":"Zimmerman","year":"2005","journal-title":"Am. J. Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1176\/appi.ajp.157.4.601","article-title":"Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder. A comparative study","volume":"157","author":"Soloff","year":"2000","journal-title":"Am. J. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1053\/comp.2001.26271","article-title":"A twenty-seven year follow-up of borderline patients","volume":"42","author":"Paris","year":"2001","journal-title":"Compr. Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1001\/archgenpsychiatry.2011.37","article-title":"Ten-year course of Borderline Personality Disorder: Psychopathology and function from the Collaborative Longitudinal Personality Disorders Study","volume":"68","author":"Gunderson","year":"2011","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1176\/appi.ajp.2011.11101550","article-title":"Attainment and stability of sustained symptomatic remission and recovery among borderline patients and Axis II comparison subjects: A 16-year prospective follow-up study","volume":"169","author":"Zanarini","year":"2012","journal-title":"Am. J. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"18m12436","DOI":"10.4088\/JCP.18m12436","article-title":"Deaths by suicide and other causes among patients with borderline personality disorder and personality-disordered comparison subjects over 24 years of prospective follow-up","volume":"80","author":"Temes","year":"2019","journal-title":"J. Clin. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1146\/annurev.psych.56.091103.070320","article-title":"The psychology and neurobiology of suicidal behavior","volume":"56","author":"Joiner","year":"2005","journal-title":"Annu. Rev. Psychol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1111\/j.1600-0447.2005.00702.x","article-title":"Personality traits as correlates of suicidal ideation, suicide attempt, and suicide completions: A systematic review","volume":"113","author":"Brezo","year":"2006","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0165-0327(02)00391-9","article-title":"\u201cNear-fatal\u201d deliberate self-harm: Characteristics, prevention and implications for the prevention of suicide","volume":"79","author":"Douglas","year":"2004","journal-title":"J. Affect. Disord."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1521\/suli.32.1.5.21.24214","article-title":"Factors associated with the medical severity of suicide attempts in youth and young adults","volume":"32","author":"Swahn","year":"2001","journal-title":"Suicide Life Threat Behav."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"11","DOI":"10.4103\/0972-6748.98408","article-title":"Sociodemographic profile, clinical factors, and mode of attempt in suicide attempters in consultation liaison psychiatry in a tertiary care center","volume":"20","author":"Ramdurg","year":"2011","journal-title":"Ind. Psychiatry J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1503\/cmaj.150056","article-title":"Tertiary hospitals must provide general care","volume":"187","author":"Flegel","year":"2015","journal-title":"CMAJ"},{"key":"ref_46","unstructured":"American Psychiatry Association (2000). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Press. [4th ed.]. Text revision."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1080\/13811118.2018.1480983","article-title":"Protective Factors of Suicide and Suicidal Behavior Relevant to Emergency Healthcare Settings: A Systematic Review and Narrative Synthesis of Post-2007 Reviews","volume":"23","author":"McClatchey","year":"2019","journal-title":"Arch. Suicide Res."},{"key":"ref_48","first-page":"69","article-title":"Escala de Desesperanza de Beck: Adaptaci\u00f3n y caracter\u00edsticas psicom\u00e9tricas","volume":"9","year":"2006","journal-title":"Rev. Investig. Psicol."},{"key":"ref_49","first-page":"147","article-title":"Spanish adaptation of the Barratt Impulsiveness Scale (BIS-11)","volume":"15","author":"Oquendo","year":"2001","journal-title":"Eur. J. Psychiatry"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"445","DOI":"10.2466\/pr0.1974.34.2.445","article-title":"Cross-validation of the Suicidal Intent Scale","volume":"34","author":"Beck","year":"1974","journal-title":"Psychol. Rep."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1176\/ajp.140.8.1023","article-title":"History of suicidal behavior in depressed borderline inpatients","volume":"140","author":"Freidman","year":"1983","journal-title":"Am. J. Psychiatry"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1037\/0021-843X.112.3.375","article-title":"Axis I and axis II disorders as predictors of prospective suicide attempts: Findings from the collaborative longitudinal personality disorders study","volume":"112","author":"Yen","year":"2003","journal-title":"J. Abnorm. Psychol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1521\/pedi.1987.1.4.291","article-title":"The PI 500: Long-term follow-up of borderline inpatients meeting DSM-III criteria: I. Global outcome","volume":"1","author":"Stone","year":"1987","journal-title":"J. Personal. Disord."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1521\/suli.32.1.33.22187","article-title":"The trajectory of suicidal behavior over time","volume":"32","author":"Joiner","year":"2002","journal-title":"Suicide Life Threat. Behav."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1037\/0021-843X.111.1.198","article-title":"Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder","volume":"111","author":"Brown","year":"2002","journal-title":"J. Abnorm. Psychol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1037\/a0018697","article-title":"The interpersonal theory of suicide","volume":"117","author":"Witte","year":"2010","journal-title":"Psychol. Rev."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1159\/000438510","article-title":"From the serotonin model of suicide to a mental pain model of suicide","volume":"84","year":"2015","journal-title":"Psychother. Psychosom."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1521\/suli.2010.40.3.234","article-title":"Exploring the phenomenology of suicide","volume":"40","author":"Pompili","year":"2010","journal-title":"Life Threat Behav."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1521\/suli.33.3.219.23219","article-title":"Mental pain: A multidimensional operationalization and definition","volume":"33","author":"Orbach","year":"2003","journal-title":"Suicide Life Threat Behav."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/18\/4186\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:00:51Z","timestamp":1760166051000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/18\/4186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,16]]},"references-count":59,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["jcm10184186"],"URL":"https:\/\/doi.org\/10.3390\/jcm10184186","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,16]]}}}