{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:11:13Z","timestamp":1792789873713,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecn\u00f3logico","doi-asserted-by":"publisher","award":["#401633\/2023-3"],"award-info":[{"award-number":["#401633\/2023-3"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"award":["#401633\/2023-3"],"award-info":[{"award-number":["#401633\/2023-3"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004586","name":"Funda\u00e7\u00e3o Carlos Chagas Filho de Amparo \u00e0 Pesquisa do Estado do Rio de Janeiro","doi-asserted-by":"publisher","award":["#E-26\/200.037\/2026"],"award-info":[{"award-number":["#E-26\/200.037\/2026"]}],"id":[{"id":"10.13039\/501100004586","id-type":"DOI","asserted-by":"publisher"}]},{"award":["#E-26\/200.037\/2026"],"award-info":[{"award-number":["#E-26\/200.037\/2026"]}],"id":[{"id":"https:\/\/ror.org\/03kk0s825","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","award":["Finance Code 001"],"award-info":[{"award-number":["Finance Code 001"]}],"id":[{"id":"https:\/\/ror.org\/00x0ma614","id-type":"ROR","asserted-by":"crossref"}]},{"award":["Finance Code 001"],"award-info":[{"award-number":["Finance Code 001"]}],"id":[{"id":"https:\/\/ror.org\/00x0ma614","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Muscles"],"abstract":"<jats:p>Background: Because falls can lead to loss of autonomy in individuals with post-tuberculosis lung disease (iwPTLD), assessing fall risk is crucial for reducing the likelihood of fractures and preventing the decline of physical function. This cross-sectional study aimed to evaluate balance control (BC) in iwPTLD and correlate it with functional capacity during exertion (FCE), pulmonary function, muscle strength, and fatigue. Methods: This cross-sectional study assessed BC in iwPTLD using the Berg Balance Scale (BBS), the Tinetti Balance Scale (TBS), and the Timed \u201cUp and Go\u201d Test (TUGT). Participants also underwent assessments of pulmonary function, respiratory muscle strength, handgrip strength (HGS), quadricep strength (QMS), general fatigue, and functional capacity during exertion (FCE) using the six-minute step test (6MST). Results: Of the 50 individuals with iwPTLD, 66%, 38%, and 46% had a BBS, TBS, and TUGT, respectively, indicating a moderate\/high risk of falls. The degree of agreement between BC classifications was weak to poor (Kappa between 0.15 and 0.35). The BBS and TBS exhibited weak-to-moderate correlations with the QMS and 6MST. The TUGT, however, showed strong correlations with the QMS, the 6MST, and residual volume\/total lung capacity ratio. Conclusions: Impaired BC appears to be common in iwPTLD, with alterations observed in up to two-thirds of cases. For these individuals, there are significant correlations of BC with peripheral muscle strength, FCE, and static pulmonary hyperinflation, especially when the TUGT is used to assess BC. Thus, the TUGT may be a tool with potential clinical applications for identifying balance impairment in patients with PTLD. However, it requires prospective validation. The BBS and TBS should be reserved for comprehensive assessments of patients with abnormal TUGT results.<\/jats:p>","DOI":"10.3390\/muscles5030064","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:58:59Z","timestamp":1789545539000},"page":"64","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Balance Control and Its Correlation with Functional Capacity in People with Post-Tuberculosis Lung Disease"],"prefix":"10.3390","volume":"5","author":[{"given":"Pedro Henrique Perpetuo","family":"de Lima Silva","sequence":"first","affiliation":[{"name":"Rehabilitation Sciences Post-Graduation Program, Centro Universit\u00e1rio Augusto Motta (UNISUAM), Rua Dona Isabel, 94, Bonsucesso, Rio de Janeiro 21032-060, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4055-4991","authenticated-orcid":false,"given":"Isabelle","family":"da Nobrega Ferreira","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Avenida Professor Manoel de Abreu, 444, 2\u00b0 Andar, Vila Isabel, Rio de Janeiro 20550-170, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Alessandro","family":"dos Santos Beserra","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Avenida Professor Manoel de Abreu, 444, 2\u00b0 Andar, Vila Isabel, Rio de Janeiro 20550-170, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Nielza Moreira","family":"de Souza","sequence":"additional","affiliation":[{"name":"Rehabilitation Sciences Post-Graduation Program, Centro Universit\u00e1rio Augusto Motta (UNISUAM), Rua Dona Isabel, 94, Bonsucesso, Rio de Janeiro 21032-060, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Estephane Ramos","family":"de Souza Penna","sequence":"additional","affiliation":[{"name":"Faculty of Physiotherapy, Centro Universit\u00e1rio Augusto Motta (UNISUAM), Avenida, Paris, 84, Bonsucesso, Rio de Janeiro 21041-020, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Al\u00edcia Sales","family":"Carneiro","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Avenida Professor Manoel de Abreu, 444, 2\u00b0 Andar, Vila Isabel, Rio de Janeiro 20550-170, Brazil"},{"name":"Department of Pulmonology, Hospital Universit\u00e1rio Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro 20551-030, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Walter","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Hospital Universit\u00e1rio Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro 20551-030, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0255-1696","authenticated-orcid":false,"given":"Bruna Cuoco","family":"Provenzano","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Hospital Universit\u00e1rio Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro 20551-030, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Ana Paula","family":"Santos","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Avenida Professor Manoel de Abreu, 444, 2\u00b0 Andar, Vila Isabel, Rio de Janeiro 20550-170, Brazil"},{"name":"Department of Pulmonology, Hospital Universit\u00e1rio Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro 20551-030, Brazil"},{"name":"Medical School and Institute of Thorax Diseases, Universidade Federal do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255, Sala 01D 58\/60, Cidade Universit\u00e1ria, Rio de Janeiro 21941-913, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8598-4878","authenticated-orcid":false,"given":"Agnaldo Jos\u00e9","family":"Lopes","sequence":"additional","affiliation":[{"name":"Rehabilitation Sciences Post-Graduation Program, Centro Universit\u00e1rio Augusto Motta (UNISUAM), Rua Dona Isabel, 94, Bonsucesso, Rio de Janeiro 21032-060, Brazil"},{"name":"Postgraduate Program in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Avenida Professor Manoel de Abreu, 444, 2\u00b0 Andar, Vila Isabel, Rio de Janeiro 20550-170, Brazil"},{"name":"Department of Pulmonology, Hospital Universit\u00e1rio Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro 20551-030, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1016\/S1473-3099(20)30919-1","article-title":"Quantifying the global number of tuberculosis survivors: A modelling study","volume":"21","author":"Dodd","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1679","DOI":"10.1016\/S2214-109X(21)00367-3","article-title":"Lifetime burden of disease due to incident tuberculosis: A global reappraisal including post-tuberculosis sequelae","volume":"9","author":"Menzies","year":"2021","journal-title":"Lancet Glob. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e315","DOI":"10.1016\/S1473-3099(25)00548-1","article-title":"Post-tuberculosis lung disease: A case definition for use in research studies","volume":"26","author":"Bisson","year":"2026","journal-title":"Lancet Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e1020","DOI":"10.1016\/S2214-109X(25)00105-6","article-title":"Post-pulmonary tuberculosis lung function: A systematic review and meta-analysis","volume":"13","author":"Ratnakumar","year":"2025","journal-title":"Lancet Glob. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.arbres.2025.09.017","article-title":"Charting the course in post-tuberculosis lung disease: From inflammation to intervention","volume":"61","author":"Thu","year":"2025","journal-title":"Arch. Bronconeumol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.4102\/sajp.v75i1.1319","article-title":"Post-tuberculosis health-related quality of life, lung function and exercise capacity in a cured pulmonary tuberculosis population in the Breede Valley District, South Africa","volume":"75","author":"Daniels","year":"2019","journal-title":"S. Afr. J. Physiother."},{"key":"ref_7","first-page":"503","article-title":"Evaluation of functional capacity, quality of life and quality of sleep in people with chronic obstructive pulmonary disease","volume":"23","author":"Silva","year":"2019","journal-title":"Rev. Bras. Ci\u00eanc. Sa\u00fade"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e70115","DOI":"10.1002\/pri.70115","article-title":"Peripheral muscle strength and pulmonary function negatively impact functional capacity in patients with post-tuberculosis lung disease: A cross-sectional study","volume":"30","author":"Ferreira","year":"2025","journal-title":"Physiother. Res. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/978-3-319-47313-0_6","article-title":"The relationship between postural and movement stability","volume":"957","author":"Feldman","year":"2016","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_10","first-page":"00164","article-title":"Clinical assessment of balance and functional impairments in people with stable chronic obstructive pulmonary disease: A systematic review and meta-analysis","volume":"8","year":"2022","journal-title":"ERJ Open Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100574","DOI":"10.1016\/j.jctube.2025.100574","article-title":"Central nervous system tuberculosis: Characteristics, risks, and outcomes in California adults, 2010-2022","volume":"42","author":"Parchinski","year":"2025","journal-title":"J. Clin. Tuberc. Other Mycobact. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Garg, R.K., Pandey, S., Mahdi, R.A., and Singhal, S. (2025). Movement disorders in central nervous system tuberculosis: A systematic review. Can. J. Neurol. Sci., in press.","DOI":"10.1017\/cjn.2025.10436"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e43609","DOI":"10.1097\/MD.0000000000043609","article-title":"Balance, gait, and postural control impairment and fall risk in patients with chronic obstructive pulmonary disease and breathing pattern disorder: A case-control study","volume":"104","author":"Ahmad","year":"2025","journal-title":"Medicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"820","DOI":"10.5588\/ijtld.20.0067","article-title":"Post-tuberculosis lung health: Perspectives from the First International Symposium","volume":"24","author":"Allwood","year":"2020","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e1967","DOI":"10.1002\/pri.1967","article-title":"Postural balance and its association with functionality and quality of life in non-hospitalized patients with post-acute COVID-19 syndrome","volume":"27","author":"Gardel","year":"2022","journal-title":"Physiother. Res. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.1532-5415.1986.tb05480.x","article-title":"Performance-oriented assessment of mobility problems in elderly patients","volume":"34","author":"Tinetti","year":"1986","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_17","first-page":"109","article-title":"The Timed Get-up-and-Go test revisited: Measurement of the component tasks","volume":"37","author":"Wall","year":"2000","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.2147\/COPD.S106151","article-title":"A simple and rapid test of physical performance in chronic obstructive pulmonary disease","volume":"11","author":"Albarrati","year":"2016","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"390","DOI":"10.21037\/atm-20-4576","article-title":"Pulmonary tuberculosis as a risk factor for chronic obstructive pulmonary disease: A systematic review and meta-analysis","volume":"9","author":"Fan","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1590\/S1806-37132007000400008","article-title":"New reference values for forced spirometry in white adults in Brazil","volume":"33","author":"Pereira","year":"2007","journal-title":"J. Bras. Pneumol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1590\/S0100-879X1999000600006","article-title":"Reference values for lung function tests. I. Static volumes","volume":"32","author":"Neder","year":"1999","journal-title":"Braz. J. Med. Biol. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1590\/S0100-879X1999000600008","article-title":"Reference values for lung function tests. III. Carbon monoxide diffusing capacity (transfer factor)","volume":"32","author":"Neder","year":"1999","journal-title":"Braz. J. Med. Biol. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1590\/S0100-879X1999000600007","article-title":"Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation","volume":"32","author":"Neder","year":"1999","journal-title":"Braz. J. Med. Biol. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1164\/rccm.201501-0082LE","article-title":"Functionally relevant cut point for isometric quadriceps muscle strength in chronic respiratory disease","volume":"192","author":"Canavan","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_26","first-page":"246","article-title":"Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: Proposal for use as a screening tool","volume":"13","author":"Paridaens","year":"2005","journal-title":"Support. Care Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e20210511","DOI":"10.36416\/1806-3756\/e20210511","article-title":"Normative values and reference equation for the six-minute step test to evaluate functional exercise capacity: A multicenter study","volume":"48","author":"Albuquerque","year":"2022","journal-title":"J. Bras. Pneumol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"37","DOI":"10.22158\/wjssr.v3n1p37","article-title":"Sample size guideline for correlation analysis","volume":"3","author":"Bujang","year":"2016","journal-title":"World J. Soc. Sci. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"99","DOI":"10.4103\/picr.picr_38_24","article-title":"Handling missing data in research","volume":"15","author":"Ranganathan","year":"2024","journal-title":"Perspect. Clin. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1136\/thoraxjnl-2019-213608","article-title":"Balance impairment in individuals with COPD: A systematic review with meta-analysis","volume":"75","author":"Loughran","year":"2020","journal-title":"Thorax"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1016\/j.apmr.2020.01.016","article-title":"Balance impairment and effectiveness of exercise intervention in chronic obstructive pulmonary disease-a systematic review","volume":"101","author":"Chuatrakoon","year":"2020","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40520-017-0749-0","article-title":"Tools for assessing fall risk in the elderly: A systematic review and meta-analysis","volume":"30","author":"Park","year":"2018","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1002\/mdc3.70099","article-title":"Tuberculosis related movement disorders: A systematic scoping review highlighting geographic disparities, phenotypic patterns, treatment responses, and knowledge gaps in global reporting","volume":"12","author":"Desai","year":"2025","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.14336\/AD.2018.1226","article-title":"Handgrip strength and pulmonary disease in the elderly: What is the link?","volume":"10","author":"Lima","year":"2019","journal-title":"Aging Dis."},{"key":"ref_36","first-page":"887","article-title":"Evaluation of post-treatment health-related quality of life (HRQoL) among tuberculosis patients","volume":"11","author":"Muniyandi","year":"2007","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3649","DOI":"10.1038\/s41598-024-54338-9","article-title":"The six-minute step test can predict COPD exacerbations: A 36-month follow-up study","volume":"14","author":"Marinho","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1590\/S1806-37132012000500007","article-title":"Responsiveness of the six-minute step test to a physical training program in patients with COPD","volume":"38","author":"Marrara","year":"2012","journal-title":"J. Bras. Pneumol."}],"container-title":["Muscles"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2813-0413\/5\/3\/64\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:13:05Z","timestamp":1789704785000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2813-0413\/5\/3\/64"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["muscles5030064"],"URL":"https:\/\/doi.org\/10.3390\/muscles5030064","relation":{},"ISSN":["2813-0413"],"issn-type":[{"value":"2813-0413","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}