{"id":"https://openalex.org/W7225407397","doi":"https://doi.org/10.1186/s41077-026-00471-6","title":"Mechanical limitation of compression depth in a common CPR training manikin","display_name":"Mechanical limitation of compression depth in a common CPR training manikin","publication_year":2026,"publication_date":"2026-11-06","ids":{"openalex":"https://openalex.org/W7225407397","doi":"https://doi.org/10.1186/s41077-026-00471-6","pmid":"https://pubmed.ncbi.nlm.nih.gov/42995642","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13744116"},"language":"en","primary_location":{"id":"doi:10.1186/s41077-026-00471-6","doi":"https://doi.org/10.1186/s41077-026-00471-6","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s41077-026-00471-6","pdf_url":"https://link.springer.com/content/pdf/10.1186/s41077-026-00471-6.pdf","source":{"id":"https://openalex.org/S2739124158","display_name":"Advances in Simulation","issn_l":"2059-0628","issn":["2059-0628"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","jufo-1","ki-jl-1","norway-1"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Advances in Simulation","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://link.springer.com/content/pdf/10.1186/s41077-026-00471-6.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5161029481","display_name":"Jonatan Appelt","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I161046081","display_name":"University of Freiburg","ror":"https://ror.org/0245cg223","country_code":"DE","type":"education","lineage":["https://openalex.org/I161046081"]},{"id":"https://openalex.org/I2801240073","display_name":"University Medical Center Freiburg","ror":"https://ror.org/03vzbgh69","country_code":"DE","type":"healthcare","lineage":["https://openalex.org/I2801240073"]}],"countries":["DE"],"is_corresponding":true,"raw_author_name":"Jonatan Appelt","raw_affiliation_strings":["Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany. jonatan.appelt@uniklinik-freiburg.de"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany. jonatan.appelt@uniklinik-freiburg.de","institution_ids":["https://openalex.org/I161046081","https://openalex.org/I2801240073"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161130203","display_name":"Lena Jakob","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I161046081","display_name":"University of Freiburg","ror":"https://ror.org/0245cg223","country_code":"DE","type":"education","lineage":["https://openalex.org/I161046081"]},{"id":"https://openalex.org/I2801240073","display_name":"University Medical Center Freiburg","ror":"https://ror.org/03vzbgh69","country_code":"DE","type":"healthcare","lineage":["https://openalex.org/I2801240073"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"Lena Jakob","raw_affiliation_strings":["Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany","institution_ids":["https://openalex.org/I161046081","https://openalex.org/I2801240073"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161097739","display_name":"Marco Freschi","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I161046081","display_name":"University of Freiburg","ror":"https://ror.org/0245cg223","country_code":"DE","type":"education","lineage":["https://openalex.org/I161046081"]},{"id":"https://openalex.org/I2801240073","display_name":"University Medical Center Freiburg","ror":"https://ror.org/03vzbgh69","country_code":"DE","type":"healthcare","lineage":["https://openalex.org/I2801240073"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"Marco Freschi","raw_affiliation_strings":["Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany","institution_ids":["https://openalex.org/I161046081","https://openalex.org/I2801240073"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5083849324","display_name":"Bernd Flamm","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I161046081","display_name":"University of Freiburg","ror":"https://ror.org/0245cg223","country_code":"DE","type":"education","lineage":["https://openalex.org/I161046081"]},{"id":"https://openalex.org/I2801240073","display_name":"University Medical Center Freiburg","ror":"https://ror.org/03vzbgh69","country_code":"DE","type":"healthcare","lineage":["https://openalex.org/I2801240073"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"Bernd Flamm","raw_affiliation_strings":["Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany","institution_ids":["https://openalex.org/I161046081","https://openalex.org/I2801240073"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161087983","display_name":"Ann-Kathrin Heissel","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I161046081","display_name":"University of Freiburg","ror":"https://ror.org/0245cg223","country_code":"DE","type":"education","lineage":["https://openalex.org/I161046081"]},{"id":"https://openalex.org/I2801240073","display_name":"University Medical Center Freiburg","ror":"https://ror.org/03vzbgh69","country_code":"DE","type":"healthcare","lineage":["https://openalex.org/I2801240073"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"Ann-Kathrin Heissel","raw_affiliation_strings":["Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany","institution_ids":["https://openalex.org/I161046081","https://openalex.org/I2801240073"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5136107850","display_name":"Lukas Fiebelkorn","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I161046081","display_name":"University of Freiburg","ror":"https://ror.org/0245cg223","country_code":"DE","type":"education","lineage":["https://openalex.org/I161046081"]},{"id":"https://openalex.org/I2801240073","display_name":"University Medical Center Freiburg","ror":"https://ror.org/03vzbgh69","country_code":"DE","type":"healthcare","lineage":["https://openalex.org/I2801240073"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"Lukas Fiebelkorn","raw_affiliation_strings":["Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany","institution_ids":["https://openalex.org/I161046081","https://openalex.org/I2801240073"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5047160153","display_name":"Axel Schmutz","orcid":"https://orcid.org/0000-0002-9744-5764","observed_orcids":["https://orcid.org/0000-0002-9744-5764"]},"institutions":[{"id":"https://openalex.org/I161046081","display_name":"University of Freiburg","ror":"https://ror.org/0245cg223","country_code":"DE","type":"education","lineage":["https://openalex.org/I161046081"]},{"id":"https://openalex.org/I2801240073","display_name":"University Medical Center Freiburg","ror":"https://ror.org/03vzbgh69","country_code":"DE","type":"healthcare","lineage":["https://openalex.org/I2801240073"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"Axel Schmutz","raw_affiliation_strings":["Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany","institution_ids":["https://openalex.org/I161046081","https://openalex.org/I2801240073"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5071006002","display_name":"Julian Ganter","orcid":"https://orcid.org/0000-0002-3922-6782","observed_orcids":["https://orcid.org/0000-0002-3922-6782"]},"institutions":[{"id":"https://openalex.org/I161046081","display_name":"University of Freiburg","ror":"https://ror.org/0245cg223","country_code":"DE","type":"education","lineage":["https://openalex.org/I161046081"]},{"id":"https://openalex.org/I2801240073","display_name":"University Medical Center Freiburg","ror":"https://ror.org/03vzbgh69","country_code":"DE","type":"healthcare","lineage":["https://openalex.org/I2801240073"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"Julian Ganter","raw_affiliation_strings":["Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, 79106, Germany","institution_ids":["https://openalex.org/I161046081","https://openalex.org/I2801240073"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5161029481"],"corresponding_institution_ids":["https://openalex.org/I161046081","https://openalex.org/I2801240073"],"apc_list":{"value":2790,"currency":"USD","value_usd":2790},"apc_paid":{"value":2790,"currency":"USD","value_usd":2790},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"11","issue":"1","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10645","display_name":"Cardiac Arrest and Resuscitation","score":0.8374000191688538,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"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/T10645","display_name":"Cardiac Arrest and Resuscitation","score":0.8374000191688538,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"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/T11238","display_name":"Simulation-Based Education in Healthcare","score":0.1542000025510788,"subfield":{"id":"https://openalex.org/subfields/3304","display_name":"Education"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11984","display_name":"Anatomy and Medical Technology","score":0.0008999999845400453,"subfield":{"id":"https://openalex.org/subfields/2204","display_name":"Biomedical Engineering"},"field":{"id":"https://openalex.org/fields/22","display_name":"Engineering"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/cardiopulmonary-resuscitation","display_name":"cardiopulmonary resuscitation","score":0.8949999809265137},{"id":"https://openalex.org/keywords/chest-compression-depth","display_name":"compression depth","score":0.9649999737739563},{"id":"https://openalex.org/keywords/cpr-manikin","display_name":"CPR manikin","score":0.8100000023841858},{"id":"https://openalex.org/keywords/mechanical-design","display_name":"mechanical design","score":0.42800000309944153},{"id":"https://openalex.org/keywords/distance-sensor","display_name":"distance sensor","score":0.6439999938011169},{"id":"https://openalex.org/keywords/cpr-training","display_name":"CPR training","score":0.6169999837875366},{"id":"https://openalex.org/keywords/hospital-training","display_name":"hospital-based training","score":0.675000011920929}],"concepts":[{"id":"https://openalex.org/C180016635","wikidata":"https://www.wikidata.org/wiki/Q2712821","display_name":"Compression (physics)","level":2,"score":0.7168999910354614},{"id":"https://openalex.org/C2777211547","wikidata":"https://www.wikidata.org/wiki/Q17141490","display_name":"Training (meteorology)","level":2,"score":0.6051999926567078},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.5101000070571899},{"id":"https://openalex.org/C165838908","wikidata":"https://www.wikidata.org/wiki/Q736777","display_name":"Calibration","level":2,"score":0.5074999928474426},{"id":"https://openalex.org/C107551265","wikidata":"https://www.wikidata.org/wiki/Q1458245","display_name":"Displacement (psychology)","level":2,"score":0.4268999993801117},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.41499999165534973},{"id":"https://openalex.org/C99508421","wikidata":"https://www.wikidata.org/wiki/Q2678675","display_name":"Physical medicine and rehabilitation","level":1,"score":0.37400001287460327},{"id":"https://openalex.org/C148043351","wikidata":"https://www.wikidata.org/wiki/Q4456944","display_name":"Current (fluid)","level":2,"score":0.3100999891757965},{"id":"https://openalex.org/C44154836","wikidata":"https://www.wikidata.org/wiki/Q45045","display_name":"Simulation","level":1,"score":0.29440000653266907},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.29260000586509705},{"id":"https://openalex.org/C2909361675","wikidata":"https://www.wikidata.org/wiki/Q2712821","display_name":"Mechanical compression","level":2,"score":0.2921000123023987},{"id":"https://openalex.org/C2988634675","wikidata":"https://www.wikidata.org/wiki/Q34508","display_name":"Video recording","level":2,"score":0.2500999867916107}],"mesh":[],"locations_count":5,"locations":[{"id":"doi:10.1186/s41077-026-00471-6","doi":"https://doi.org/10.1186/s41077-026-00471-6","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s41077-026-00471-6","pdf_url":"https://link.springer.com/content/pdf/10.1186/s41077-026-00471-6.pdf","source":{"id":"https://openalex.org/S2739124158","display_name":"Advances in Simulation","issn_l":"2059-0628","issn":["2059-0628"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","jufo-1","ki-jl-1","norway-1"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Advances in Simulation","raw_type":"journal-article"},{"id":"pmid:42995642","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42995642","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":"Advances in simulation (London, England)","raw_type":"Letter"},{"id":"pmh:oai:pubmedcentral.nih.gov:13744116","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13744116/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"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":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Adv Simul (Lond)","raw_type":"Text"},{"id":"pmh:oai:doaj.org/article:bf41b9d0318f4f54bb24107c4f69b405","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/bf41b9d0318f4f54bb24107c4f69b405","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Advances in Simulation, Vol 11, Iss 1 (2026)","raw_type":"article"},{"id":"pmh:oai:freidok.uni-freiburg.de:289139","doi":null,"is_oa":false,"landing_page_url":"https://freidok.uni-freiburg.de/data/289139","pdf_url":null,"source":{"id":"https://openalex.org/S4306401057","display_name":"FreiDok plus (Universit\u00e4tsbibliothek Freiburg)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I161046081","host_organization_name":"University of Freiburg","host_organization_lineage":["https://openalex.org/I161046081"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Advances in Simulation. - 11, 1 (2026) , ISSN: 2059-0628","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1186/s41077-026-00471-6","doi":"https://doi.org/10.1186/s41077-026-00471-6","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s41077-026-00471-6","pdf_url":"https://link.springer.com/content/pdf/10.1186/s41077-026-00471-6.pdf","source":{"id":"https://openalex.org/S2739124158","display_name":"Advances in Simulation","issn_l":"2059-0628","issn":["2059-0628"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","jufo-1","ki-jl-1","norway-1"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Advances in Simulation","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":0.9391000270843506}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225407397.pdf","grobid_xml":"https://content.openalex.org/works/W7225407397.grobid-xml"},"referenced_works_count":7,"referenced_works":["https://openalex.org/W2027834926","https://openalex.org/W2176568680","https://openalex.org/W2751185741","https://openalex.org/W4285040224","https://openalex.org/W4415407845","https://openalex.org/W4415407889","https://openalex.org/W7151482724"],"related_works":["https://openalex.org/W2107702304","https://openalex.org/W2004612154","https://openalex.org/W2087221194","https://openalex.org/W2129765426","https://openalex.org/W2269964085","https://openalex.org/W39539199","https://openalex.org/W3102095720","https://openalex.org/W2156050935","https://openalex.org/W2027834926","https://openalex.org/W1979409294"],"abstract_inverted_index":{"Current":[0],"CPR":[1,95],"guidelines":[2],"recommend":[3],"a":[4,17,40,74],"chest":[5,64],"compression":[6,30],"depth":[7,41],"of":[8,42],"5-6":[9],"cm.":[10],"During":[11],"an":[12],"in-hospital":[13],"training":[14,96],"project":[15],"using":[16],"widely":[18,76],"adopted":[19],"manikin":[20],"(Resusci":[21],"Anne,":[22],"Laerdal":[23],"Medical),":[24],"integrated":[25],"distance":[26],"sensors":[27],"consistently":[28],"recorded":[29],"depths":[31],"below":[32],"this":[33,50],"target":[34],"range.Further":[35],"mechanical":[36,88],"evaluation":[37],"showed":[38],"that":[39],"6":[43],"cm":[44],"is":[45],"not":[46,56],"physically":[47],"achievable":[48],"with":[49,93],"model;":[51],"the":[52,69,82],"maximum":[53],"displacement":[54],"did":[55],"exceed":[57],"5.7":[58],"cm,":[59],"even":[60],"when":[61],"measurements":[62],"included":[63],"components":[65],"as":[66],"recommended":[67],"by":[68],"manufacturer.":[70],"Although":[71],"limited":[72],"to":[73,84,90],"single,":[75],"used":[77],"manikin,":[78],"these":[79],"findings":[80],"highlight":[81],"need":[83],"reassess":[85],"calibration":[86],"and":[87,97],"design":[89],"ensure":[91],"alignment":[92],"guideline-based":[94],"accurate":[98],"performance":[99],"feedback.":[100]},"counts_by_year":[],"updated_date":"2026-11-11T12:16:26.678958","created_date":"2026-11-07T00:00:00"}
