{"id":"https://openalex.org/W2913332377","doi":"https://doi.org/10.1093/cid/ciz142","title":"Changes in Otitis Media Episodes and Pressure Equalization Tube Insertions Among Young Children Following Introduction of the 13-Valent Pneumococcal Conjugate Vaccine: A Birth Cohort\u2013based Study","display_name":"Changes in Otitis Media Episodes and Pressure Equalization Tube Insertions Among Young Children Following Introduction of the 13-Valent Pneumococcal Conjugate Vaccine: A Birth Cohort\u2013based Study","publication_year":2019,"publication_date":"2019-02-16","ids":{"openalex":"https://openalex.org/W2913332377","doi":"https://doi.org/10.1093/cid/ciz142","mag":"2913332377","pmid":"https://pubmed.ncbi.nlm.nih.gov/30770533"},"language":"en","primary_location":{"id":"doi:10.1093/cid/ciz142","doi":"https://doi.org/10.1093/cid/ciz142","is_oa":false,"landing_page_url":"https://doi.org/10.1093/cid/ciz142","pdf_url":null,"source":{"id":"https://openalex.org/S72350973","display_name":"Clinical Infectious Diseases","issn_l":"1058-4838","issn":["1058-4838","1537-6591"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical Infectious Diseases","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5044653047","display_name":"Andrew David Wiese","orcid":"https://orcid.org/0000-0002-0699-4224","observed_orcids":["https://orcid.org/0000-0002-0699-4224"]},"institutions":[{"id":"https://openalex.org/I901861585","display_name":"Vanderbilt University Medical Center","ror":"https://ror.org/05dq2gs74","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210162197","https://openalex.org/I901861585"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Andrew D Wiese","raw_affiliation_strings":["Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee"],"raw_orcid":"https://orcid.org/0000-0002-0699-4224","affiliations":[{"raw_affiliation_string":"Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee","institution_ids":["https://openalex.org/I901861585"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5057648011","display_name":"Xiang Huang","orcid":"https://orcid.org/0000-0003-0180-103X","observed_orcids":["https://orcid.org/0000-0003-0180-103X"]},"institutions":[{"id":"https://openalex.org/I901861585","display_name":"Vanderbilt University Medical Center","ror":"https://ror.org/05dq2gs74","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210162197","https://openalex.org/I901861585"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Xiang Huang","raw_affiliation_strings":["Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee","institution_ids":["https://openalex.org/I901861585"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5015191834","display_name":"Chang Yu","orcid":"https://orcid.org/0000-0002-6132-6085","observed_orcids":["https://orcid.org/0000-0002-6132-6085"]},"institutions":[{"id":"https://openalex.org/I901861585","display_name":"Vanderbilt University Medical Center","ror":"https://ror.org/05dq2gs74","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210162197","https://openalex.org/I901861585"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Chang Yu","raw_affiliation_strings":["Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee","institution_ids":["https://openalex.org/I901861585"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5068733379","display_name":"Edward F. Mitchel","orcid":"https://orcid.org/0000-0002-1151-1397","observed_orcids":["https://orcid.org/0000-0002-1151-1397"]},"institutions":[{"id":"https://openalex.org/I901861585","display_name":"Vanderbilt University Medical Center","ror":"https://ror.org/05dq2gs74","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210162197","https://openalex.org/I901861585"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Edward F Mitchel","raw_affiliation_strings":["Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee","institution_ids":["https://openalex.org/I901861585"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5090358214","display_name":"Moe Hein Kyaw","orcid":"https://orcid.org/0000-0002-0258-6645","observed_orcids":["https://orcid.org/0000-0002-0258-6645"]},"institutions":[{"id":"https://openalex.org/I4210111804","display_name":"Sanofi (United States)","ror":"https://ror.org/027vj4x92","country_code":"US","type":"company","lineage":["https://openalex.org/I3018075036","https://openalex.org/I4210111804"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Moe H Kyaw","raw_affiliation_strings":["Sanofi Pasteur, Swiftwater, PA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Sanofi Pasteur, Swiftwater, PA","institution_ids":["https://openalex.org/I4210111804"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5020436097","display_name":"Marie R. Griffin","orcid":"https://orcid.org/0000-0001-7114-7614","observed_orcids":["https://orcid.org/0000-0001-7114-7614"]},"institutions":[{"id":"https://openalex.org/I901861585","display_name":"Vanderbilt University Medical Center","ror":"https://ror.org/05dq2gs74","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210162197","https://openalex.org/I901861585"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Marie R Griffin","raw_affiliation_strings":["Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee","institution_ids":["https://openalex.org/I901861585"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5089308976","display_name":"Carlos Gabriel Grijalva","orcid":"https://orcid.org/0000-0002-2329-7797","observed_orcids":["https://orcid.org/0000-0002-2329-7797"]},"institutions":[{"id":"https://openalex.org/I901861585","display_name":"Vanderbilt University Medical Center","ror":"https://ror.org/05dq2gs74","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210162197","https://openalex.org/I901861585"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Carlos G Grijalva","raw_affiliation_strings":["Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee","institution_ids":["https://openalex.org/I901861585"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5044653047"],"corresponding_institution_ids":["https://openalex.org/I901861585"],"apc_list":{"value":4763,"currency":"USD","value_usd":4763},"apc_paid":null,"fwci":3.5172,"has_fulltext":false,"cited_by_count":27,"citation_normalized_percentile":{"value":0.9336165,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":89,"max":99},"biblio":{"volume":"69","issue":"12","first_page":"2162","last_page":"2169"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10861","display_name":"Ear Surgery and Otitis Media","score":0.8788999915122986,"subfield":{"id":"https://openalex.org/subfields/2733","display_name":"Otorhinolaryngology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10861","display_name":"Ear Surgery and Otitis Media","score":0.8788999915122986,"subfield":{"id":"https://openalex.org/subfields/2733","display_name":"Otorhinolaryngology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10654","display_name":"Pneumonia and Respiratory Infections","score":0.11620000004768372,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10873","display_name":"Bacterial Infections and Vaccines","score":0.0007999999797903001,"subfield":{"id":"https://openalex.org/subfields/2404","display_name":"Microbiology"},"field":{"id":"https://openalex.org/fields/24","display_name":"Immunology and Microbiology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/otitis-media","display_name":"otitis media","score":0.984000027179718},{"id":"https://openalex.org/keywords/13-valent-pneumococcal-conjugate-vaccine","display_name":"13-valent pneumococcal conjugate vaccine","score":0.9549999833106995},{"id":"https://openalex.org/keywords/pcv13","display_name":"PCV13","score":0.8629999756813049},{"id":"https://openalex.org/keywords/pcv7","display_name":"PCV7","score":0.8600000143051147},{"id":"https://openalex.org/keywords/tympanostomy-tubes","display_name":"tympanostomy tubes","score":0.8360000252723694},{"id":"https://openalex.org/keywords/recurrent-otitis-media","display_name":"recurrent otitis media","score":0.8389999866485596},{"id":"https://openalex.org/keywords/vaccine-impact","display_name":"vaccine impact","score":0.6930000185966492},{"id":"https://openalex.org/keywords/young-children","display_name":"young children","score":0.6809999942779541},{"id":"https://openalex.org/keywords/streptococcus-pneumoniae","display_name":"Streptococcus pneumoniae","score":0.8140000104904175}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8358590602874756},{"id":"https://openalex.org/C2778866548","wikidata":"https://www.wikidata.org/wiki/Q7205991","display_name":"Pneumococcal conjugate vaccine","level":4,"score":0.8120641708374023},{"id":"https://openalex.org/C207103383","wikidata":"https://www.wikidata.org/wiki/Q3930246","display_name":"Hazard ratio","level":3,"score":0.6679102182388306},{"id":"https://openalex.org/C2776439223","wikidata":"https://www.wikidata.org/wiki/Q480700","display_name":"Otitis","level":2,"score":0.661630392074585},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.6512755751609802},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.58279949426651},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.5656633377075195},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.4490070939064026},{"id":"https://openalex.org/C2781253189","wikidata":"https://www.wikidata.org/wiki/Q221179","display_name":"Streptococcus pneumoniae","level":3,"score":0.35188376903533936},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.22936508059501648},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.20115604996681213},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.0},{"id":"https://openalex.org/C54355233","wikidata":"https://www.wikidata.org/wiki/Q7162","display_name":"Genetics","level":1,"score":0.0},{"id":"https://openalex.org/C523546767","wikidata":"https://www.wikidata.org/wiki/Q10876","display_name":"Bacteria","level":2,"score":0.0}],"mesh":[{"descriptor_ui":"D002675","descriptor_name":"Child, Preschool","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007223","descriptor_name":"Infant","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007231","descriptor_name":"Infant, Newborn","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008484","descriptor_name":"Medicaid","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010033","descriptor_name":"Otitis Media","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D010033","descriptor_name":"Otitis Media","qualifier_ui":"Q000209","qualifier_name":"etiology","is_major_topic":false},{"descriptor_ui":"D010033","descriptor_name":"Otitis Media","qualifier_ui":"Q000453","qualifier_name":"epidemiology","is_major_topic":true},{"descriptor_ui":"D010033","descriptor_name":"Otitis Media","qualifier_ui":"Q000517","qualifier_name":"prevention & control","is_major_topic":true},{"descriptor_ui":"D011008","descriptor_name":"Pneumococcal Infections","qualifier_ui":"Q000453","qualifier_name":"epidemiology","is_major_topic":false},{"descriptor_ui":"D011008","descriptor_name":"Pneumococcal Infections","qualifier_ui":"Q000517","qualifier_name":"prevention & control","is_major_topic":false},{"descriptor_ui":"D012306","descriptor_name":"Risk","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D014481","descriptor_name":"United States","qualifier_ui":"Q000453","qualifier_name":"epidemiology","is_major_topic":false},{"descriptor_ui":"D016016","descriptor_name":"Proportional Hazards Models","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D018074","descriptor_name":"Vaccines, Conjugate","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D022242","descriptor_name":"Pneumococcal Vaccines","qualifier_ui":"Q000008","qualifier_name":"administration & dosage","is_major_topic":false},{"descriptor_ui":"D022242","descriptor_name":"Pneumococcal Vaccines","qualifier_ui":"Q000276","qualifier_name":"immunology","is_major_topic":true}],"locations_count":2,"locations":[{"id":"doi:10.1093/cid/ciz142","doi":"https://doi.org/10.1093/cid/ciz142","is_oa":false,"landing_page_url":"https://doi.org/10.1093/cid/ciz142","pdf_url":null,"source":{"id":"https://openalex.org/S72350973","display_name":"Clinical Infectious Diseases","issn_l":"1058-4838","issn":["1058-4838","1537-6591"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical Infectious Diseases","raw_type":"journal-article"},{"id":"pmid:30770533","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/30770533","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical infectious diseases : an official publication of the Infectious Diseases Society of America","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.9922999739646912,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[{"id":"https://openalex.org/F4320333684","display_name":"Sanofi Pasteur","ror":null}],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":29,"referenced_works":["https://openalex.org/W1177887580","https://openalex.org/W1845923557","https://openalex.org/W1975514483","https://openalex.org/W1983346334","https://openalex.org/W1991389919","https://openalex.org/W1994578277","https://openalex.org/W2016610797","https://openalex.org/W2038507666","https://openalex.org/W2053322652","https://openalex.org/W2059512533","https://openalex.org/W2099812223","https://openalex.org/W2102920015","https://openalex.org/W2122858334","https://openalex.org/W2148212653","https://openalex.org/W2150500774","https://openalex.org/W2157244039","https://openalex.org/W2169729911","https://openalex.org/W2172489197","https://openalex.org/W2307286688","https://openalex.org/W2411719747","https://openalex.org/W2509946652","https://openalex.org/W2557816182","https://openalex.org/W2563069092","https://openalex.org/W2743818693","https://openalex.org/W2747266492","https://openalex.org/W2772198177","https://openalex.org/W2794833470","https://openalex.org/W2805807825","https://openalex.org/W4300336165"],"related_works":["https://openalex.org/W2969801621","https://openalex.org/W1983346334","https://openalex.org/W1177887580","https://openalex.org/W2909059335","https://openalex.org/W1993298608","https://openalex.org/W4388673255","https://openalex.org/W2157244039","https://openalex.org/W4220932151","https://openalex.org/W2811334096","https://openalex.org/W4200256008"],"abstract_inverted_index":{"BACKGROUND:":[0],"The":[1,221],"impact":[2],"of":[3,13,30,57,128,214,232,246],"13-valent":[4],"pneumococcal":[5,95],"conjugate":[6,96],"vaccine":[7,97],"(PCV13)":[8],"introduction":[9,206],"on":[10],"the":[11,28,45,82,126,171,187,192,212,244,248],"occurrence":[12],"first":[14,112,249],"and":[15,39,100,109,113,124,144,155,165,174,180,201,217,250],"subsequent":[16,114,251],"otitis":[17],"media":[18],"(OM)":[19],"episodes":[20,32,71,132,138,154],"in":[21,133,139,186,211,243],"early":[22],"childhood":[23],"is":[24],"unclear.":[25],"We":[26,51,68,85,149],"compared":[27,125,190],"risk":[29,107,127,213,245],"OM":[31,48,70,92,130,153,164,179,233,252],"among":[33,160,234],"children":[34,60,235],"age":[35,65],"<2":[36,237],"years":[37,173,238],"before":[38],"after":[40,176],"PCV13":[41,177,205,226],"introduction,":[42],"accounting":[43,105],"for":[44,91,106],"dependence":[46,110],"between":[47,111,142],"episodes.":[49,115,253],"METHODS:":[50],"identified":[52,69],"consecutive":[53],"annual":[54],"(July-June)":[55],"cohorts":[56],"Tennessee":[58],"Medicaid-enrolled":[59],"(2006-2014)":[61],"from":[62,223],"birth":[63,103,146],"through":[64],"2":[66],"years.":[67],"using":[72],"coded":[73],"diagnoses":[74,77],"(we":[75],"classified":[76],"<21":[78],"days":[79],"apart":[80],"as":[81],"same":[83],"episode).":[84],"modeled":[86],"adjusted":[87],"hazard":[88],"ratios":[89],"(aHRs)":[90],"comparing":[93],"7-valent":[94],"(PCV7)-era":[98],"(2006-2010)":[99],"PCV13-era":[101,145],"(2011-2014)":[102],"cohorts,":[104],"factors":[108],"Secondary":[116],"analyses":[117],"examined":[118],"pressure":[119],"equalization":[120],"tube":[121],"(PET)":[122],"insertions":[123,159],"recurrent":[129,218],"(\u22653":[131],"6":[134],"months":[135],"or":[136],"\u22654":[137],"12":[140],"months)":[141],"PCV7-":[143],"cohorts.":[147],"RESULTS:":[148],"observed":[150],"618":[151],"968":[152],"24":[156],"875":[157],"PET":[158,166,181],"368":[161],"063":[162],"children.":[163],"insertion":[167,182],"rates":[168],"increased":[169],"during":[170],"PCV7":[172,224],"declined":[175],"introduction.":[178],"risks":[183],"were":[184],"lower":[185],"2013-2014":[188],"cohort":[189,194],"with":[191,209,229],"2009-2010":[193],"(aHRs":[195],"[95%":[196],"confidence":[197],"interval],":[198],"0.92":[199],"[.91-.93]":[200],"0.76":[202],"[.72-.80],":[203],"respectively).":[204],"was":[207,227],"associated":[208,228],"declines":[210],"first,":[215],"subsequent,":[216],"OM.":[219],"CONCLUSIONS:":[220],"transition":[222],"to":[225,240],"a":[230,241],"decline":[231],"aged":[236],"due":[239],"reduction":[242],"both":[247]},"counts_by_year":[{"year":2026,"cited_by_count":2},{"year":2025,"cited_by_count":2},{"year":2024,"cited_by_count":3},{"year":2023,"cited_by_count":3},{"year":2022,"cited_by_count":8},{"year":2021,"cited_by_count":4},{"year":2020,"cited_by_count":4},{"year":2019,"cited_by_count":1}],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2019-02-21T00:00:00"}
