{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:42:32Z","timestamp":1792806152453,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,7]],"date-time":"2023-04-07T00:00:00Z","timestamp":1680825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Federal Ministry of Education and Research","award":["01KI2003A"],"award-info":[{"award-number":["01KI2003A"]}],"id":[{"id":"https:\/\/ror.org\/04pz7b180","id-type":"ROR","asserted-by":"crossref"}]},{"name":"German Federal Ministry of Education and Research","award":["01KI2003B"],"award-info":[{"award-number":["01KI2003B"]}],"id":[{"id":"https:\/\/ror.org\/04pz7b180","id-type":"ROR","asserted-by":"crossref"}]},{"name":"European Centre for Disease Prevention and Control (ECDC)","award":["01KI2003A"],"award-info":[{"award-number":["01KI2003A"]}],"id":[{"id":"https:\/\/ror.org\/00s9v1h75","id-type":"ROR","asserted-by":"crossref"}]},{"name":"European Centre for Disease Prevention and Control (ECDC)","award":["01KI2003B"],"award-info":[{"award-number":["01KI2003B"]}],"id":[{"id":"https:\/\/ror.org\/00s9v1h75","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>In 2020, a record number of tick-borne encephalitis (TBE) cases was reported in major endemic areas in Germany, i.e., the southern federal states of Baden-Wuerttemberg and Bavaria. Most cases were unvaccinated. Other tick-borne diseases (TBDs), including Lyme borreliosis and tularemia, are rising, too. Thus, strategies are needed to increase TBE vaccination uptake in risk areas and promote education on TBD prevention. Primary care physicians are key providers of both vaccinations and TBD education. The TBD-Prevention (TBD-Prev) study aimed to investigate the knowledge, attitudes and behaviors of primary care physicians in Baden-Wuerttemberg and Bavaria with regard to TBE vaccination and prevention of TBDs and to derive strategies for increasing vaccination rates and improving knowledge about TBE and other TBDs in the population and among primary care physicians. We invited all primary care physicians (N = 14,046) in both states to participate by mail. Using standardized, self-administered questionnaires, available both on paper and online, we asked physicians anonymously about their knowledge, attitudes and behaviors with respect to TBE vaccination and TBD prevention and their need for further information\/educational materials. A total of 2321 physicians participated between May and September 2022 (response rate 17%), of whom 1222 (53%) worked in Baden-Wuerttemberg and 1067 (46%) in Bavaria. Among the participating physicians, 56% were male, 71% were &gt;50 years and 51% worked in an individual practice. Furthermore, 91% were aware of the German national vaccination guidelines, and 98% perceived their knowledge of the risks and benefits of vaccination as adequate. A total of 97% offer TBE vaccinations, 67% provide vaccination counselling during initial consultations with new patients and 64% actively remind patients about due vaccinations. In addition, 24% expressed a need for further information materials, mainly traditional, analogue media such as flyers (82%) and posters (50%), and named timeliness, quality assurance, easy comprehensibility and independence from the pharmaceutical industry as the most important characteristics of such materials. Almost all participating physicians reported offering TBE vaccinations and feeling well-informed about TBE vaccination and TBDs. However, active offering of vaccinations and education could be further improved, and additional, low-threshold information materials are needed. Based on these results, we will develop and provide various materials on TBE vaccination and TBDs, in particular flyers and posters, for use by physicians during consultations.<\/jats:p>","DOI":"10.3390\/microorganisms11040961","type":"journal-article","created":{"date-parts":[[2023,4,7]],"date-time":"2023-04-07T04:08:03Z","timestamp":1680840483000},"page":"961","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Knowledge, Attitudes and Behaviors regarding Tick-Borne Encephalitis Vaccination and Prevention of Tick-Borne Diseases among Primary Care Physicians in Bavaria and Baden-Wuerttemberg, Germany, May\u2013September 2022"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5830-2982","authenticated-orcid":false,"given":"Liza","family":"Coyer","sequence":"first","affiliation":[{"name":"Infectious Disease Epidemiology and Surveillance Unit, Bavarian Health and Food Safety Authority (LGL), 80636 Munich, Germany"},{"name":"ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), 16 973 Solna, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aylin","family":"Sogan-Ekinci","sequence":"additional","affiliation":[{"name":"Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office (LGA), Ministry of Social Affairs, Health and Integration, 70191 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Greut\u00e9laers","sequence":"additional","affiliation":[{"name":"Infectious Disease Epidemiology and Surveillance Unit, Bavarian Health and Food Safety Authority (LGL), 80636 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office (LGA), Ministry of Social Affairs, Health and Integration, 70191 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska S.","family":"Saller","sequence":"additional","affiliation":[{"name":"Infectious Disease Epidemiology and Surveillance Unit, Bavarian Health and Food Safety Authority (LGL), 80636 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Hailer","sequence":"additional","affiliation":[{"name":"District Health Office Reutlingen, 72764 Reutlingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5807-8092","authenticated-orcid":false,"given":"Stefanie","family":"B\u00f6hm","sequence":"additional","affiliation":[{"name":"Infectious Disease Epidemiology and Surveillance Unit, Bavarian Health and Food Safety Authority (LGL), 80636 Munich, Germany"},{"name":"Faculty of Medicine, Ludwig-Maximilians-University of Munich, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Brosch","sequence":"additional","affiliation":[{"name":"Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office (LGA), Ministry of Social Affairs, Health and Integration, 70191 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Wagner-Wiening","sequence":"additional","affiliation":[{"name":"Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office (LGA), Ministry of Social Affairs, Health and Integration, 70191 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2672-7481","authenticated-orcid":false,"given":"Merle M.","family":"B\u00f6hmer","sequence":"additional","affiliation":[{"name":"Infectious Disease Epidemiology and Surveillance Unit, Bavarian Health and Food Safety Authority (LGL), 80636 Munich, Germany"},{"name":"Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S191","DOI":"10.1017\/S0031182003004694","article-title":"Lyme borreliosis in Europe and North America","volume":"129","author":"Piesman","year":"2004","journal-title":"Parasitology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"14976","DOI":"10.1038\/s41598-018-33136-0","article-title":"Incidence of notified Lyme borreliosis in Germany, 2013\u20132017","volume":"8","author":"Enkelmann","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"B\u00f6hmer, M.M., B\u00f6hm, S., Heinzinger, S., and Fingerle, V. (2021). Epidemiological Surveillance of Lyme Borreliosis in Bavaria, Germany, 2013\u20132020. Microorganisms, 3.","DOI":"10.3390\/microorganisms9091872"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/femsre\/fux047","article-title":"Lyme borreliosis\u2013from tick bite to diagnosis and treatment","volume":"42","author":"Stanek","year":"2018","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1086\/515195","article-title":"Tick-Borne Encephalitis","volume":"28","author":"Dumpis","year":"1999","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1016\/S0140-6736(08)60800-4","article-title":"Tick-borne encephalitis","volume":"371","author":"Lindquist","year":"2008","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/BF00145300","article-title":"Family outbreak of alimentary tick-borne encephalitis in Slovakia associated with a natural focus of infection","volume":"12","author":"Kohl","year":"1996","journal-title":"Eur. J. Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S36","DOI":"10.1016\/S0264-410X(02)00819-8","article-title":"Diagnosis of tick-borne encephalitis","volume":"21","author":"Holzmann","year":"2003","journal-title":"Vaccine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1093\/brain\/122.11.2067","article-title":"The clinical and epidemiological profile of tick-borne encephalitis in southern Germany 1994-98: A prospective study of 656 patients","volume":"122","author":"Kaiser","year":"1999","journal-title":"Brain"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1086\/342059","article-title":"Tickborne encephalitis in an area of high endemicity in lithuania: Disease severity and long-term prognosis","volume":"35","author":"Mickiene","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","unstructured":"Robert Koch Institute (2023, February 09). SurvStat@RKI 2.0. Web-Basierte Abfrage der Meldedaten gem\u00e4\u00df Infektionsschutzgesetz (IfSG) 2023 (updated 15 January 2023). Available online: https:\/\/survstat.rki.de\/."},{"key":"ref_12","unstructured":"Robert Koch Institute (2023, January 26). Meldepflichtige Krankheiten und Krankheitserreger (updated 16 November 2020). Available online: https:\/\/www.rki.de\/DE\/Content\/Infekt\/IfSG\/Meldepflichtige_Krankheiten\/Meldepflichtige_Krankheiten_node.html."},{"key":"ref_13","unstructured":"Robert Koch Institute (RKI) (2023). FSME: Risikogebiete in Deutschland (Stand: Januar 2023). Epidemiologisches Bulletin, 9, 3\u201322."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hellenbrand, W., Kreusch, T., B\u00f6hmer, M.M., Wagner-Wiening, C., Dobler, G., Wichmann, O., and Altmann, D. (2019). Epidemiology of Tick-Borne Encephalitis (TBE) in Germany, 2001\u20132018. Pathogens, 8.","DOI":"10.3390\/pathogens8020042"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Borde, J.P., Kaier, K., Hehn, P., B\u00f6hmer, M.M., Kreusch, T.M., and Dobler, G. (2019). Tick-borne encephalitis virus infections in Germany. Seasonality and in-year patterns. A retrospective analysis from 2001\u20132018. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0224044"},{"key":"ref_16","unstructured":"Robert Koch Institute (2023, March 16). SurvStat@RKI 2.0. Web-Basierte Abfrage der Meldedaten gem\u00e4\u00df Infektionsschutzgesetz (IfSG) 2023 (updated 16 March 2023). Available online: https:\/\/survstat.rki.de\/."},{"key":"ref_17","unstructured":"World Health Organization (2023, April 03). WHO Guidelines on Tularaemia. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/43793."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3201\/eid1901.120458","article-title":"Vaccination and tick-borne encephalitis, central Europe","volume":"19","author":"Heinz","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_19","first-page":"Cd000977","article-title":"Vaccines for preventing tick-borne encephalitis","volume":"2009","author":"Demicheli","year":"2009","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11706","DOI":"10.1038\/s41598-022-15447-5","article-title":"Tick-borne encephalitis vaccine effectiveness and barriers to vaccination in Germany","volume":"12","author":"Nygren","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_21","unstructured":"Robert Koch Institute (2021). Epidemiologisches Bulletin. Empfehlungen der St\u00e4ndigen Impfkommission beim Robert Koch-Institut, 2021, Robert Koch Institute."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.vaccine.2020.12.047","article-title":"Vaccination rate and adherence of tick-borne encephalitis vaccination in Germany","volume":"39","author":"Schley","year":"2021","journal-title":"Vaccine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.4161\/hv.7.12.18130","article-title":"Determinants of tetanus and seasonal influenza vaccine uptake in adults living in Germany","volume":"7","author":"Walter","year":"2011","journal-title":"Hum. Vaccin."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.4161\/hv.25823","article-title":"Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines","volume":"9","author":"Gargano","year":"2013","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Hagemann, C., Streng, A., Kraemer, A., and Liese, J.G. (2017). Heterogeneity in coverage for measles and varicella vaccination in toddlers\u2014Analysis of factors influencing parental acceptance. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4725-6"},{"key":"ref_26","unstructured":"(2023, February 14). LamaPoll. Available online: https:\/\/www.lamapoll.de\/."},{"key":"ref_27","unstructured":"(2023, April 04). NUTS\u2014Nomenclature of Territorial Units for Statistics. Available online: https:\/\/ec.europa.eu\/eurostat\/web\/nuts\/background."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1080\/21645515.2015.1057362","article-title":"Apps for immunization: Leveraging mobile devices to place the individual at the center of care","volume":"11","author":"Wilson","year":"2015","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1080\/21645515.2016.1263779","article-title":"ReadyVax: A new mobile vaccine information app","volume":"13","author":"Bednarczyk","year":"2017","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_30","unstructured":"Centers for Disease Control and Prevention (2023, April 04). CDC Vaccine Schedules App for Healthcare Providers, Available online: https:\/\/www.cdc.gov\/vaccines\/schedules\/hcp\/schedule-app.html."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ricco, M., Gualerzi, G., Ranzieri, S., Ferraro, P., and Bragazzi, N.L. (2020). Knowledge, Attitudes, Practices (KAP) of Italian Occupational Physicians towards Tick Borne Encephalitis. Trop. Med. Infect. Dis., 5.","DOI":"10.3390\/tropicalmed5030117"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Vasi\u0107, A., Bjeki\u0107, J., Veinovi\u0107, G., Mihaljica, D., Sukara, R., Poluga, J., Filipovi\u0107, S.R., and Tomanovi\u0107, S. (2022). Knowledge, Attitudes, and Practices on Tick-Borne Encephalitis Virus and Tick-Borne Diseases within Professionally Tick-Exposed Persons, Health Care Workers, and General Population in Serbia: A Questionnaire-Based Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19020867"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.medmal.2017.03.007","article-title":"Primary care physician management of tick bites in the Franche-Comt\u00e9 region (Eastern France, 2013)","volume":"47","author":"Vandererven","year":"2017","journal-title":"M\u00e9decine Mal. Infect."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101774","DOI":"10.1016\/j.ttbdis.2021.101774","article-title":"Knowledge and vaccination practices among family physicians in northeastern France regarding tick-borne encephalitis virus","volume":"12","author":"Dollat","year":"2021","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"102059","DOI":"10.1016\/j.ttbdis.2022.102059","article-title":"Vaccine uptake in 20 countries in Europe 2020: Focus on tick-borne encephalitis (TBE)","volume":"14","author":"Pilz","year":"2023","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_36","unstructured":"(2023, February 09). ImpfDocNE: Evidenzbasiertes Impf management f\u00fcr die Praxis. Available online: https:\/\/www.impfdocne.de\/."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Kunze, M., Banovi\u0107, P., Bogovi\u010d, P., Briciu, V., \u010civljak, R., Dobler, G., Hristea, A., Kerlik, J., Kuivanen, S., and Kyn\u010dl, J. (2022). Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe. Microorganisms, 10.","DOI":"10.3390\/microorganisms10071283"},{"key":"ref_38","unstructured":"Schuler, U. (2016). Vergleichende Studie \u00fcber Steigende Quoten der Influenza-und Pneumokokken-Impfung unter Patienten mit chronischen Erkrankungen und Patienten ab 60 Jahren nach Einf\u00fchrung der Praxissoftware Impf-doc, Ludwig-Maximilians-Universit\u00e4t."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/MOP.0000000000000843","article-title":"Evidence-based strategies to increase vaccination uptake: A review","volume":"32","author":"Cataldi","year":"2020","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2417","DOI":"10.1016\/j.vaccine.2018.03.050","article-title":"Poor knowledge of vaccination recommendations and negative attitudes towards vaccinations are independently associated with poor vaccination uptake among adults\u2014Findings of a population-based panel study in Lower Saxony, Germany","volume":"36","author":"Akmatov","year":"2018","journal-title":"Vaccine"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Slunge, D. (2015). The Willingness to Pay for Vaccination against Tick-Borne Encephalitis and Implications for Public Health Policy: Evidence from Sweden. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0143875"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1007\/s00103-019-02900-6","article-title":"Psychological antecedents of vaccination: Definitions, measurement, and interventions","volume":"62","author":"Betsch","year":"2019","journal-title":"Bundesgesundheitsblatt Gesundh. Gesundh."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/j.ttbdis.2018.02.007","article-title":"Self-reported tick-borne encephalitis (TBE) vaccination coverage in Europe: Results from a cross-sectional study","volume":"9","author":"Erber","year":"2018","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_44","unstructured":"Dobler, G., Erber, W., Br\u00f6ker, M., and Schmitt, H.J. (2021). The TBE Book, Global Health Press Pte Ltd.. [4th ed.]."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"40","DOI":"10.3389\/fcimb.2018.00040","article-title":"Tularemia in Germany-A Re-emerging Zoonosis","volume":"8","author":"Faber","year":"2018","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_46","first-page":"44","article-title":"Saisonale und pandemische Influenzaimpfung: Impfquoten und Einstellung niedergelassener \u00c4rzte in Deutschland","volume":"76","author":"Walter","year":"2014","journal-title":"Das Gesundh."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.vaccine.2022.11.054","article-title":"What impact does the attitude toward COVID-19 vaccination have on physicians as vaccine providers? A cross-sectional study from the German outpatient sector","volume":"41","author":"Hoffmann","year":"2023","journal-title":"Vaccine"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"100236","DOI":"10.1016\/j.jvacx.2022.100236","article-title":"Knowledge and perception regarding effectiveness in influenza vaccines among General Practitioners in Germany: A national survey","volume":"12","author":"Hadigal","year":"2022","journal-title":"Vaccine X"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s44266-022-00001-3","article-title":"Haus\u00e4rtzliche Versorgung ukrainischer Gefl\u00fcchteter","volume":"99","author":"Tillmann","year":"2023","journal-title":"Z. F\u00fcr Allg."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/4\/961\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:11:47Z","timestamp":1760123507000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/4\/961"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,7]]},"references-count":49,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["microorganisms11040961"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms11040961","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,7]]}}}