{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T20:03:57Z","timestamp":1784577837521,"version":"3.55.0"},"reference-count":64,"publisher":"Weston Medical Publishing","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Disaster Med"],"abstract":"<jats:p>Objective: To provide an overview of the literature on disaster preparedness regarding surge capacity with a particular focus on vulnerable populations during a pandemic.Design: The Disaster Preparedness and Response Committee of the American College of Emergency Physicians addressed the topic of vulnerable populations during a pandemic. A workgroup of nine physicians with academic and\/or disaster deployment experience was formed. A literature review focused on individuals with access and functional needs, also referred to as special healthcare needs (SHCN) or vulnerable individuals, was performed. Search terms included pandemic, public health emergency of international concern (PHEIC), disaster, COVID-19, vulnerable population, individuals with access and functional needs, special health care needs (SHCN), surge capacity, and communications, medical care, independence, supervision, and transportation (CMIST). Search strategies included medical sources such as PubMed, Medline, Google Scholar, ScienceDirect, Scopus, and the Cochrane Database of Systematic Reviews. Reviews were performed by a librarian. In addition, relevant articles from the bibliographies of included studies and more recent articles identified by committee members were included. The workgroup evaluated the literature and identified issues regarding surge capacity occurring during a pandemic that particularly impacted the SHCN population. Potential solutions were identified.Results: Vulnerable individuals are at greater risk during a pandemic than the general population, although potential solutions to mitigate the impact of a pandemic on vulnerable individuals are possible. Conclusions: Although pandemics can have significant adverse effects on the general population, vulnerable individuals have the greatest morbidity and mortality and are at the greatest risk. Efforts are warranted to better address the negative impact of a pandemic, not just for the general population but also for individuals with access and functional needs, and to find solutions that can help mitigate the consequences of a pandemic.<\/jats:p>","DOI":"10.5055\/ajdm.0525","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T19:30:54Z","timestamp":1784575854000},"page":"133-148","source":"Crossref","is-referenced-by-count":0,"title":["Disaster preparedness for vulnerable populations during a pandemic: Part 3: Surge capacity and communications in a pandemic"],"prefix":"10.5055","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2011-8407","authenticated-orcid":false,"given":"Sharon E.","family":"Mace","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance J.","family":"Doyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul D.","family":"Biddinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Bradin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Burdash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxanna","family":"Lefort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Noll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell R.","family":"Moriber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Cornelius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3008","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"102290","doi-asserted-by":"crossref","unstructured":"Devereaux A, Yang H, Seda G, et al.: Optimizing scarce resource allocation during COVID-19: Rapid creation of a regional healthcare coalition and triage teams in San Diego County, California. Disaster Med Public Health Prep. 2022; 16(1): 321-327. DOI: 10.1017\/dmp.2020.344.","DOI":"10.1017\/dmp.2020.344"},{"key":"102291","unstructured":"TRACIE: Emergency preparedness information gateway. Crisis Standards of Care Brief: Health Care Providers. Available at https:\/\/files.asprtracie.hhs.gov\/documents\/aspr-tracie-csc-brief-healthcareproviders.pdf. Accessed December 8, 2025."},{"key":"102292","unstructured":"American Nurses Association (ANA): Crisis standards of care COVID-19 pandemic. Available at final-crisis-standards-of-care\u20131.pdf. Accessed December 8, 2025."},{"key":"102293","unstructured":"Federal Healthcare Resilience Task Force EMS\/Prehospital Team: COVID-19: Considerations, strategies, and resources for emergency medical services crisis standards of care. Available at https:\/\/www.ems.gov\/assets\/COVID-19_Considerations_for_EMS_Crisis_Standards_of_Care.pdf. 2020. Accessed December 8, 2025."},{"key":"102294","doi-asserted-by":"crossref","unstructured":"Hick JL, Hanfling D, Wynia MK, et al.: Crisis standards of care and COVID-19: What did we learn? How do we ensure equity? What should we do? NAM Perspect. 2021. DOI: 10.31478\/202108e.","DOI":"10.31478\/202108e"},{"key":"102295","unstructured":"American College of Emergency Physicians: The care of patients under crisis standards of care. 2021. Available at https:\/\/www.acep.org\/patient-care\/policy-statements\/the-care-of-patients-under-crisisstandards-of-care\/. Accessed December 8, 2025."},{"key":"102296","unstructured":"American Medical Association: Crisis standards. 2020. Available at https:\/\/code-medical-ethics.ama-assn.org\/learning-center\/crisisstandards-care. Accessed December 8, 2025."},{"key":"102297","unstructured":"TRACIE: Emergency preparedness information gateway. Medical Operations Coordination Centers (MOCC)\/Patient Load-Balancing: Summary of Lessons Learned during COVID-19. 2022. Available at https:\/\/asprtracie.hhs.gov\/MOCC. Accessed December 8, 2025."},{"key":"102298","doi-asserted-by":"crossref","unstructured":"Hick JL, Hanfling D, Wynia M: Hospital planning for contingency and crisis conditions: Crisis standards of care lessons from COVID-19. Jt Comm J Qual Patient Saf. 2022; 48: 354-361.","DOI":"10.1016\/j.jcjq.2022.02.003"},{"key":"102299","doi-asserted-by":"crossref","unstructured":"Mace SE, Doyle CJ, Askew K, et al.: Planning considerations for persons with access and functional needs in a disaster\u2014Part 2: Evacuation and sheltering. Am J Disaster Med. 2018; 13(2): 69-83. DOI: 10.5055\/ajdm.2018.0289.","DOI":"10.5055\/ajdm.2018.0289"},{"key":"102300","doi-asserted-by":"crossref","unstructured":"Mace SE, Sharieff G, Bern AI, et al.: Pediatric issues in disaster management, part 2; evacuation centers and family separation\/reunification. Am J Disaster Med. 2010; 5(3): 149-161. DOI: 10:5055\/ajdm.2010.0017.","DOI":"10.5055\/ajdm.2010.0019"},{"key":"102301","unstructured":"Meredith JT: Hurricanes. In Hogan DE, Burstein JL (eds.): Disaster Medicine. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2007: 205-213."},{"key":"102302","doi-asserted-by":"crossref","unstructured":"Goldschmitt D: Disaster capacity framework. In Goldschmitt D, Bonvino R (eds.): Medical Disaster Response\u2014A Survival Guide for Hospitals in Mass Casualty Events. Boca Raton, FL: CRC Press, 2009: 377-393.","DOI":"10.1201\/EBK1420061222-c22"},{"key":"102303","doi-asserted-by":"crossref","unstructured":"Barbisch DF: Surge capacity and scarce resource allocation. In Koenig KL, Schultz CH (eds.): Koenig and Schultz\u2019s Disaster Medicine Comprehensive Principles and Practices. 2nd ed. New York: Cambridge University Press, 2016: 38-51 (Chapter 3).","DOI":"10.1017\/CBO9781139629317.006"},{"key":"102304","unstructured":"Rinnert KJ, Keyes DC, Re S: Hospital preparedness. In Burstein JL, Schwartz RB (eds.): Medical Response to Terrorism Preparedness and Clinical Practice. Philadelphia: Lippincott Williams & Wilkins, 2004: 235."},{"key":"102305","unstructured":"US Army Corps of Engineers: Alternate care sites (ACS). Available at https:\/\/www.usace.army.mil\/Missions\/Emergency-Operations\/Coronavirus\/Alternate-Care-Sites. Accessed December 8, 2025."},{"key":"102306","unstructured":"ASPR. TRACIE: Topic collection: Alternate care sites (including shelter medical care). Available at https:\/\/asprtracie.hhs.gov\/technical-resources\/48\/alternate-care-sites-including-shelter-medicalcare\/47. Accessed December 8, 2025."},{"key":"102307","unstructured":"Mace SE (ed.): Disasters including pandemics\u2013COVID-19. In Observation Medicine: Principles and Protocols. 2nd ed. Cambridge, UK, 2025: 481-510, subsection 5B. Doyle CJ: Observation centers during a disaster. In Mace SE (ed.): Observation medicine: Principles and protocols. 2nd ed. Cambridge, UK, 2025, 471-479, Ch. 75."},{"key":"102308","unstructured":"Mace SE (ed.): Disasters including pandemics\u2014COVID-19. In Observation Medicine: Principles and Protocols. 2nd ed. Cambridge, UK, 2025: 481-510, subsection 5B."},{"key":"102309","doi-asserted-by":"crossref","unstructured":"Mace SE, Doyle CJ, Fuchs S, et al.: Pediatric patients in a disaster: Part of the all-hazard, comprehensive approach to disaster management. Am J Disaster Med. 2012; 7(2): 111-125. DOI: 10.5055\/AJDM.2012.0087.","DOI":"10.5055\/ajdm.2012.0087"},{"key":"102310","doi-asserted-by":"crossref","unstructured":"Mace SE, Doyle CJ: Patients with access and functional needs in a disaster. Southern Med J. 2017; 110(8): 509-515.","DOI":"10.14423\/SMJ.0000000000000679"},{"key":"102311","unstructured":"Federal Emergency Management Agency (FEMA): National Incident Management System. 3rd ed. 2017. Available at https:\/\/www.fema.gov\/sites\/default\/files\/2020-07\/fema_nims_doctrine-2017.pdf. Accessed May 15, 2025."},{"key":"102312","doi-asserted-by":"crossref","unstructured":"Weinstein B, Geiling J, Fosher K, et al.: Mutual aid. In Ciottone GR, Biddenger PD, Darling RG (eds.): Ciottone's Disaster Medicine. 2nd ed. Philadelphia: Elsevier, 2016: 222-232 (Chapter 34).","DOI":"10.1016\/B978-0-323-28665-7.00034-0"},{"key":"102313","unstructured":"Isakov AP: Influenza pandemic. In Partridge Proano L, Marcozzi D (eds.): Oxford American Handbook of Disaster Medicine. New York: Oxford University Press, 2012: 714-722."},{"key":"102314","unstructured":"Centers for Disease Control and Prevention: Influenza (flu) influenza. Available at https:\/\/www.cdc.gov\/flu\/pandemic-resources\/index.htm. Accessed May 15, 2025."},{"key":"102315","doi-asserted-by":"crossref","unstructured":"Smith JE, II, Gebhart ME: Patient surge. In Ciottone GR, Biddenger PD, Darling RG, et al.: Ciottone\u2019s Disaster Medicine. 2nd ed. Philadelphia: Elsevier, 2016: 233-240 (Chapter 35).","DOI":"10.1016\/B978-0-323-28665-7.00035-2"},{"key":"102316","doi-asserted-by":"crossref","unstructured":"Kadri SS, Sun J, Lawandi A, et al.: Association between caseload and COVID-19 survival in 558 US hospitals. Ann In tern Med. 2021; 174: 1240-1251. DOI: 10.7326\/M21-1213.","DOI":"10.7326\/M21-1213"},{"key":"102317","unstructured":"The Orange County Health Care Agency (OCHCA) Emergency Operations Plan (EOP): Annex. OCHCA Medical Surge Plan Annex. COVID-19\/flu surge. 2021. Available at https:\/\/ochealthinfo.com\/sites\/hca\/files\/import\/data\/files\/119215.pdf. Accessed May 15, 2025."},{"key":"102318","doi-asserted-by":"crossref","unstructured":"Mace SE, Doyle CJ, Askew K, et al.: Planning considerations for persons with access and functional needs in a disaster\u2014Part 1: Overview and legal. Am J Disaster Med. 2018; 13(2): 69-83.","DOI":"10.5055\/ajdm.2018.0289"},{"key":"102319","doi-asserted-by":"crossref","unstructured":"Tejada-Vera B, Kramarow EA: COVID-19 mortality in adults aged 65 and over: United States. NCHS Data Brief. 2022: 446. Available at https:\/\/www.cdc.gov\/nchs\/data\/databriefs\/db446.pdf. Accessed May 15, 2025.","DOI":"10.15620\/cdc:121320"},{"key":"102320","doi-asserted-by":"crossref","unstructured":"Sabetello M, Landes SD, McDonald KE: People with disabilities in COVID-19: Fixing out priorities. Am J Bioeth. 2020; 20(7): 187-190.","DOI":"10.1080\/15265161.2020.1779396"},{"key":"102321","unstructured":"Yee S, Breslin ML, Goode TD, et al.: Compounded disparities: Health equity at the intersection of disability, race, and ethnicity. Washington, DC: The National Academies of Sciences, Engineering and Medicine, 2018."},{"key":"102322","doi-asserted-by":"crossref","unstructured":"Power GA, Carson J: The promise of transformed long-term care homes: Evidence from the pandemic. Healthc Manage Forum. 2022; 35(1): 25-28.","DOI":"10.1177\/08404704211037794"},{"key":"102323","unstructured":"Meredith LS, Shugarman LR, Chandra A, et al.: Analysis of Risk Communication Strategies and Approaches with at-Risk Populations to Enhance Emergency Preparedness, Response, and Recovery: Final Report. Santa Monica, CA: RAND Corporation, 2009."},{"key":"102324","unstructured":"WHO: Risk communication and community engagement readiness and response to coronavirus disease (COVID-19): Interim guidance. Available at https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/331513\/WHO-2019-nCoV-RCCE-2020.2-eng.pdf. Accessed May 15, 2025."},{"key":"102325","doi-asserted-by":"crossref","unstructured":"Wieland ML, Asiedu GB, Lantz K, et al.: Leveraging community engaged research partnerships for crisis and emergency risk communication to vulnerable populations in the COVID-19 pandemic. J Clin Trans Sci. 2021; 5: E61.","DOI":"10.1017\/cts.2020.47"},{"key":"102326","unstructured":"Crisis and Emergency Risk Communications: Communications plan implementation for A severe pandemic. Available at https:\/\/www.linksglobal.org\/Pandemic_Influenza\/spanish\/extras\/toolkit\/Tool%2013_CommunicationsPlanImplementationforaSeverePandemic.pdf. Accessed May 15, 2025."},{"key":"102327","doi-asserted-by":"crossref","unstructured":"El-Sadr WM, Vasan A, El-Mohandes A: Facing the new COVID-19 reality. N Engl J Med. 2023; 388(5): 385-387.","DOI":"10.1056\/NEJMp2213920"},{"key":"102328","doi-asserted-by":"crossref","unstructured":"Vaughan E, Tinker T: Effective health risk communication about pandemic influenza for vulnerable populations. Am J Public Health. 2009; 99(Suppl. 2): S324-S332. DOI: 10.2105\/AJPH.2009.162537.","DOI":"10.2105\/AJPH.2009.162537"},{"key":"102329","doi-asserted-by":"crossref","unstructured":"Epstein S, Campanile J, Cerilli C, et al.: New obstacles and widening gaps: A qualitative study of the effects of the COVID-19 pandemic on US adults with disabilities. Disabil Health J. 2021; 14(3): 101103.","DOI":"10.1016\/j.dhjo.2021.101103"},{"key":"102330","doi-asserted-by":"crossref","unstructured":"Embregts P, Frielink N, Taminiau TTT, et al.: Experiences and needs of direct support staff working with people with intellectual disabilities during the COVID-19 pandemic: A thematic analysis. Res Intell Disabil. 2021; 34: 480-490.","DOI":"10.1111\/jar.12812"},{"key":"102331","doi-asserted-by":"crossref","unstructured":"Armitage R, Nellums LB: The COVID-19 response must be disability inclusive. Lancet Public Health. 2020; 5(5): E257.","DOI":"10.1016\/S2468-2667(20)30076-1"},{"key":"102332","doi-asserted-by":"crossref","unstructured":"Ipsen C, Myers A, Sage R: A cross-sectional analysis of trust of information and COVID-19 preventative practices among people with disabilities. Disabil Health J. 2021; 14(2): 101062.","DOI":"10.1016\/j.dhjo.2021.101062"},{"key":"102333","unstructured":"CDC: CERC templates & tools: Special populations assessment. Populations assessment tool. 2018. Available at https:\/\/CERCSpecial. Accessed May 15, 2025."},{"key":"102334","unstructured":"Association of State and Tribal Health Officials (ASTHO): Meeting the needs of at-risk populations during the 2009 H1N1 pandemic response. 2011. Available at https:\/\/www.astho.org\/Infectious-Disease\/At-Risk-Populations\/Meeting-the-Needs-of-At-Risk-Populations-During-the-2009-H1N1-Pandemic-Response. Accessed May 15, 2025."},{"key":"102335","doi-asserted-by":"crossref","unstructured":"Annaswamy TM, Verduzco-Gutierrez M, Frieden L: Telemedicine barriers and challenges for persons with disabilities: COVID-19 and beyond. Disabil Health J. 2020; 13(4): 100973.","DOI":"10.1016\/j.dhjo.2020.100973"},{"key":"102336","doi-asserted-by":"crossref","unstructured":"Bonica GM, Johns RW, Jadvar H: Telehealth and telemedicine. Clin Nucl Med. 2024; 49: 644-647.","DOI":"10.1097\/RLU.0000000000005254"},{"key":"102337","doi-asserted-by":"crossref","unstructured":"Elendu C, Egbunu EO, Opasjhola KA, et al.: The role of telemedicine in improving healthcare outcome: A review. Adv Res. 2023; 24(5): 55-59.","DOI":"10.9734\/air\/2023\/v24i5958"},{"key":"102338","doi-asserted-by":"crossref","unstructured":"Hu S, Song D, Wan S, et al.: Digital health: Current applications, challenges, and future directions for enhancing healthcare quality and safety. Front Public Health. 2025; 13: 1646802.","DOI":"10.3389\/fpubh.2025.1646802"},{"key":"102339","doi-asserted-by":"crossref","unstructured":"Connolly SL, Adusumelli Y, Azario RP, et al.: A qualitative evidence synthesis of patient and provider attitudes toward audio-only telemental health care. Telemed J E-Health 2025; 31(1): 3-17.","DOI":"10.1089\/tmj.2024.0355"},{"key":"102340","unstructured":"Telehealth.hhs.gov: Billing for telehealth. Available at https:\/\/telehealth.hhs.gov\/providers\/billing-and-reimbursement. Accessed December 8, 2025."},{"key":"102341","doi-asserted-by":"crossref","unstructured":"Alnasser Y, Proano A, Loock C, et al.: Telemedicine and pediatric care in rural and remote areas of middle-and-low income countries: Narrative review. J Epidemiol Global Health. 2024; 14: 779-786. DOI: 10.1007\/s44197-024-00214-8.","DOI":"10.1007\/s44197-024-00214-8"},{"key":"102342","doi-asserted-by":"crossref","unstructured":"Shaver J: The state of telehealth before and after the COVID-19 pandemic. Prim Care Clin Office Pract. 2022; 49: 517-530.","DOI":"10.1016\/j.pop.2022.04.002"},{"key":"102343","doi-asserted-by":"crossref","unstructured":"Haimi M: The tragic paradoxical effect of telemedicine on health care disparities\u2014A time for redemption: A narrative review. BMC Inform Decis Mak. 2023; 23: 95. DOI: 10.1186\/s12911-023-02194-4.","DOI":"10.1186\/s12911-023-02194-4"},{"key":"102344","doi-asserted-by":"crossref","unstructured":"Williams C, Shang D: Telehealth usage among the low-income racial and ethnic minority populations during the COVID-19 pandemic: Retrospective observational study. J Med Internet Res. 2023; 25: E43604. DOI: 10.2196\/43604.","DOI":"10.2196\/43604"},{"key":"102345","doi-asserted-by":"crossref","unstructured":"Banskota S, Healy M, Goldberg EM: Smartphone apps for older adults to use while in isolation during the COVID-19 pandemic. West J Emerg Med. 2020; 21(3): 514-525. DOI: 10.5811\/westjem.2020.4.47372.","DOI":"10.5811\/westjem.2020.4.47372"},{"key":"102346","doi-asserted-by":"crossref","unstructured":"Darkins AD: Telemedicine and telehealth: Role in disaster and public health emergencies. In Koenig K, Schultz CH (eds.): Koenig and Schultz\u2019s Disaster Medicine Comprehensive Principles and Practice. 2nd ed. Cambridge University Press: Cambridge, UK, 2016: 415-432 (Chapter 26).","DOI":"10.1017\/CBO9781139629317.029"},{"key":"102347","doi-asserted-by":"crossref","unstructured":"Ezeamii VC, Okobi OE, Wambai-Sani H, et al.: Revolutionizing healthcare: How telemedicine is improving patient outcomes and expanding access to care. Cureus. 2024; 16(7): e63881. DOI: 10.7759\/cureus.63881.","DOI":"10.7759\/cureus.63881"},{"key":"102348","doi-asserted-by":"crossref","unstructured":"Aijaz M, Lewis VA, Murray GF: Advancing equity in challenging times: A qualitative study of telehealth expansion and changing patient\u2013provider relationships in primary care settings during the COVID-19 pandemic. Digital Health. 2024; 10: 20552076241233148.","DOI":"10.1177\/20552076241233148"},{"key":"102349","doi-asserted-by":"crossref","unstructured":"Alter N, Arif H, Wright D-D, et al.: Telehealth utilization in trauma care: The effects on emergency department length of stay and associated outcomes. Am Surg. 2023; 89(11): 4826-4834.","DOI":"10.1177\/00031348231173944"},{"key":"102350","unstructured":"CDC Research Anthology: Telehealth and telemedicine. 2024. Available at https:\/\/www.cdc.gov\/phlp\/php\/publications\/researchanthology-telehealth-and-telemedicine.html. Accessed December 8, 2025."},{"key":"102351","doi-asserted-by":"crossref","unstructured":"Guetterman TC, Buis LR: Examining telehealth through the institute of medicine quality domains: Unanswered questions and research agenda. BMJ Qual Saf. 2024; 33: 552-555. DOI: 10.1136\/bmjqs-2023-016872.","DOI":"10.1136\/bmjqs-2023-016872"},{"key":"102352","doi-asserted-by":"crossref","unstructured":"Hossain MA: Impact of telemedicine on the clinical outcomes among elderly patients: A systematic review. Arch Pharm Pract. 2024; 15(2): 82-92.","DOI":"10.51847\/2tavelw0xJ"},{"key":"102353","doi-asserted-by":"crossref","unstructured":"Litvak M, Miller K, Boyle T, et al.: Telemedicine use in disasters: A scoping review. Disaster Med Public Health Prep. 2022; 16(2): 791-800. DOI: 10.1017\/dmp.2020.473.","DOI":"10.1017\/dmp.2020.473"}],"container-title":["American Journal of Disaster Medicine"],"original-title":[],"link":[{"URL":"https:\/\/wmpllc.org\/ojs\/index.php\/ajdm\/article\/download\/4059\/4339","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wmpllc.org\/ojs\/index.php\/ajdm\/article\/download\/4059\/4339","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T19:31:23Z","timestamp":1784575883000},"score":1,"resource":{"primary":{"URL":"https:\/\/wmpllc.org\/ojs\/index.php\/ajdm\/article\/view\/4059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":64,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,7,20]]}},"URL":"https:\/\/doi.org\/10.5055\/ajdm.0525","relation":{},"ISSN":["1932-149X","1932-149X"],"issn-type":[{"value":"1932-149X","type":"electronic"},{"value":"1932-149X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}