{"id":"https://openalex.org/W7154706780","doi":"https://doi.org/10.1038/s41746-026-02616-3","title":"Referral uptake after diabetic retinopathy screening with artificial intelligence-assisted care pathways: a systematic review and meta-analysis","display_name":"Referral uptake after diabetic retinopathy screening with artificial intelligence-assisted care pathways: a systematic review and meta-analysis","publication_year":2026,"publication_date":"2026-04-17","ids":{"openalex":"https://openalex.org/W7154706780","doi":"https://doi.org/10.1038/s41746-026-02616-3","pmid":"https://pubmed.ncbi.nlm.nih.gov/41998218"},"language":"en","primary_location":{"id":"doi:10.1038/s41746-026-02616-3","is_oa":true,"landing_page_url":"https://doi.org/10.1038/s41746-026-02616-3","pdf_url":"https://www.nature.com/articles/s41746-026-02616-3_reference.pdf","source":{"id":"https://openalex.org/S4210195431","display_name":"npj Digital Medicine","issn_l":"2398-6352","issn":["2398-6352"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319908","host_organization_name":"Nature Portfolio","host_organization_lineage":["https://openalex.org/P4310319908","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Nature Portfolio","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":"npj Digital Medicine","raw_type":"journal-article"},"type":"review","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.nature.com/articles/s41746-026-02616-3_reference.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5076150347","display_name":"James A. Leigh","orcid":"https://orcid.org/0000-0002-0307-2814"},"institutions":[{"id":"https://openalex.org/I104628220","display_name":"Lions Eye Institute","ror":"https://ror.org/006vyay97","country_code":"AU","type":"nonprofit","lineage":["https://openalex.org/I104628220"]},{"id":"https://openalex.org/I177877127","display_name":"The University of Western Australia","ror":"https://ror.org/047272k79","country_code":"AU","type":"education","lineage":["https://openalex.org/I177877127"]},{"id":"https://openalex.org/I40120149","display_name":"University of Oxford","ror":"https://ror.org/052gg0110","country_code":"GB","type":"education","lineage":["https://openalex.org/I40120149"]}],"countries":["AU","GB"],"is_corresponding":true,"raw_author_name":"James A. Leigh","raw_affiliation_strings":["Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, WA, Australia. james.leigh@phc.ox.ac.uk","Lions Eye Institute, Lions Outback Vision, Nedlands, WA, Australia. james.leigh@phc.ox.ac.uk","Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. james.leigh@phc.ox.ac.uk"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, WA, Australia. james.leigh@phc.ox.ac.uk","institution_ids":["https://openalex.org/I177877127"]},{"raw_affiliation_string":"Lions Eye Institute, Lions Outback Vision, Nedlands, WA, Australia. james.leigh@phc.ox.ac.uk","institution_ids":["https://openalex.org/I104628220"]},{"raw_affiliation_string":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. james.leigh@phc.ox.ac.uk","institution_ids":["https://openalex.org/I40120149"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5133865510","display_name":"Alex Sherrington","orcid":null},"institutions":[{"id":"https://openalex.org/I104628220","display_name":"Lions Eye Institute","ror":"https://ror.org/006vyay97","country_code":"AU","type":"nonprofit","lineage":["https://openalex.org/I104628220"]},{"id":"https://openalex.org/I177877127","display_name":"The University of Western Australia","ror":"https://ror.org/047272k79","country_code":"AU","type":"education","lineage":["https://openalex.org/I177877127"]}],"countries":["AU"],"is_corresponding":false,"raw_author_name":"Alex Sherrington","raw_affiliation_strings":["Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, WA, Australia","Lions Eye Institute, Lions Outback Vision, Nedlands, WA, Australia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, WA, Australia","institution_ids":["https://openalex.org/I177877127"]},{"raw_affiliation_string":"Lions Eye Institute, Lions Outback Vision, Nedlands, WA, Australia","institution_ids":["https://openalex.org/I104628220"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5022427750","display_name":"Angus R.J. Barber","orcid":"https://orcid.org/0000-0001-6760-9361"},"institutions":[{"id":"https://openalex.org/I177877127","display_name":"The University of Western Australia","ror":"https://ror.org/047272k79","country_code":"AU","type":"education","lineage":["https://openalex.org/I177877127"]}],"countries":["AU"],"is_corresponding":false,"raw_author_name":"Angus R. J. Barber","raw_affiliation_strings":["School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia","institution_ids":["https://openalex.org/I177877127"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5133865355","display_name":"Angus W. Turner","orcid":null},"institutions":[{"id":"https://openalex.org/I104628220","display_name":"Lions Eye Institute","ror":"https://ror.org/006vyay97","country_code":"AU","type":"nonprofit","lineage":["https://openalex.org/I104628220"]},{"id":"https://openalex.org/I177877127","display_name":"The University of Western Australia","ror":"https://ror.org/047272k79","country_code":"AU","type":"education","lineage":["https://openalex.org/I177877127"]}],"countries":["AU"],"is_corresponding":false,"raw_author_name":"Angus W. Turner","raw_affiliation_strings":["Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, WA, Australia","Lions Eye Institute, Lions Outback Vision, Nedlands, WA, Australia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, WA, Australia","institution_ids":["https://openalex.org/I177877127"]},{"raw_affiliation_string":"Lions Eye Institute, Lions Outback Vision, Nedlands, WA, Australia","institution_ids":["https://openalex.org/I104628220"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5071767868","display_name":"Michael Kidd","orcid":"https://orcid.org/0000-0002-5264-9712"},"institutions":[{"id":"https://openalex.org/I31746571","display_name":"UNSW Sydney","ror":"https://ror.org/03r8z3t63","country_code":"AU","type":"education","lineage":["https://openalex.org/I31746571"]},{"id":"https://openalex.org/I40120149","display_name":"University of Oxford","ror":"https://ror.org/052gg0110","country_code":"GB","type":"education","lineage":["https://openalex.org/I40120149"]}],"countries":["AU","GB"],"is_corresponding":false,"raw_author_name":"Michael Kidd","raw_affiliation_strings":["International Centre for Future Health Systems, University of New South Wales, Kensington, NSW, Australia","Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"International Centre for Future Health Systems, University of New South Wales, Kensington, NSW, Australia","institution_ids":["https://openalex.org/I31746571"]},{"raw_affiliation_string":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK","institution_ids":["https://openalex.org/I40120149"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5011932191","display_name":"John Powell","orcid":"https://orcid.org/0000-0001-6124-439X"},"institutions":[{"id":"https://openalex.org/I40120149","display_name":"University of Oxford","ror":"https://ror.org/052gg0110","country_code":"GB","type":"education","lineage":["https://openalex.org/I40120149"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"John Powell","raw_affiliation_strings":["Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK","institution_ids":["https://openalex.org/I40120149"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5133915098","display_name":"Catherine Pope","orcid":null},"institutions":[{"id":"https://openalex.org/I40120149","display_name":"University of Oxford","ror":"https://ror.org/052gg0110","country_code":"GB","type":"education","lineage":["https://openalex.org/I40120149"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Catherine Pope","raw_affiliation_strings":["Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK","institution_ids":["https://openalex.org/I40120149"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":4,"corresponding_author_ids":["https://openalex.org/A5076150347"],"corresponding_institution_ids":["https://openalex.org/I104628220","https://openalex.org/I177877127","https://openalex.org/I40120149"],"apc_list":{"value":3060,"currency":"USD","value_usd":3060},"apc_paid":{"value":3060,"currency":"USD","value_usd":3060},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.35879945,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"9","issue":"1","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11438","display_name":"Retinal Imaging and Analysis","score":0.5546000003814697,"subfield":{"id":"https://openalex.org/subfields/2741","display_name":"Radiology, Nuclear Medicine and Imaging"},"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/T11438","display_name":"Retinal Imaging and Analysis","score":0.5546000003814697,"subfield":{"id":"https://openalex.org/subfields/2741","display_name":"Radiology, Nuclear Medicine and Imaging"},"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/T10170","display_name":"Retinal Diseases and Treatments","score":0.17149999737739563,"subfield":{"id":"https://openalex.org/subfields/2731","display_name":"Ophthalmology"},"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/T12599","display_name":"Retinal and Optic Conditions","score":0.07050000131130219,"subfield":{"id":"https://openalex.org/subfields/2731","display_name":"Ophthalmology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/referral","display_name":"Referral","score":0.8938000202178955},{"id":"https://openalex.org/keywords/diabetic-retinopathy","display_name":"Diabetic retinopathy","score":0.5953999757766724},{"id":"https://openalex.org/keywords/psychological-intervention","display_name":"Psychological intervention","score":0.5609999895095825},{"id":"https://openalex.org/keywords/health-care","display_name":"Health care","score":0.4142000079154968},{"id":"https://openalex.org/keywords/medline","display_name":"MEDLINE","score":0.4074999988079071},{"id":"https://openalex.org/keywords/blindness","display_name":"Blindness","score":0.4036000072956085},{"id":"https://openalex.org/keywords/primary-care","display_name":"Primary care","score":0.3885999917984009}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8950999975204468},{"id":"https://openalex.org/C2776135927","wikidata":"https://www.wikidata.org/wiki/Q5242559","display_name":"Referral","level":2,"score":0.8938000202178955},{"id":"https://openalex.org/C2779829184","wikidata":"https://www.wikidata.org/wiki/Q631361","display_name":"Diabetic retinopathy","level":3,"score":0.5953999757766724},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.5609999895095825},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.4142000079154968},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.4074999988079071},{"id":"https://openalex.org/C2780929884","wikidata":"https://www.wikidata.org/wiki/Q737460","display_name":"Blindness","level":2,"score":0.4036000072956085},{"id":"https://openalex.org/C2984752397","wikidata":"https://www.wikidata.org/wiki/Q3259956","display_name":"Primary care","level":2,"score":0.3885999917984009},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.3871000111103058},{"id":"https://openalex.org/C2994302464","wikidata":"https://www.wikidata.org/wiki/Q1774706","display_name":"Care pathway","level":3,"score":0.37940001487731934},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.35899999737739563},{"id":"https://openalex.org/C95190672","wikidata":"https://www.wikidata.org/wiki/Q815382","display_name":"Meta-analysis","level":2,"score":0.3517000079154968},{"id":"https://openalex.org/C2776478404","wikidata":"https://www.wikidata.org/wiki/Q1105187","display_name":"Cochrane Library","level":3,"score":0.3034000098705292},{"id":"https://openalex.org/C555293320","wikidata":"https://www.wikidata.org/wiki/Q12206","display_name":"Diabetes mellitus","level":2,"score":0.2953999936580658},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.28040000796318054},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.27950000762939453},{"id":"https://openalex.org/C189708586","wikidata":"https://www.wikidata.org/wiki/Q1504425","display_name":"Systematic review","level":3,"score":0.2752000093460083},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.26809999346733093},{"id":"https://openalex.org/C12174686","wikidata":"https://www.wikidata.org/wiki/Q1058438","display_name":"Risk assessment","level":2,"score":0.25839999318122864},{"id":"https://openalex.org/C2778313320","wikidata":"https://www.wikidata.org/wiki/Q550455","display_name":"Retinopathy","level":3,"score":0.25540000200271606}],"mesh":[],"locations_count":4,"locations":[{"id":"doi:10.1038/s41746-026-02616-3","is_oa":true,"landing_page_url":"https://doi.org/10.1038/s41746-026-02616-3","pdf_url":"https://www.nature.com/articles/s41746-026-02616-3_reference.pdf","source":{"id":"https://openalex.org/S4210195431","display_name":"npj Digital Medicine","issn_l":"2398-6352","issn":["2398-6352"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319908","host_organization_name":"Nature Portfolio","host_organization_lineage":["https://openalex.org/P4310319908","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Nature Portfolio","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":"npj Digital Medicine","raw_type":"journal-article"},{"id":"pmid:41998218","is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41998218","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,"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":"NPJ digital medicine","raw_type":null},{"id":"pmh:oai:doaj.org/article:eb1d97a2e1b7447980d81036c7a4cffe","is_oa":false,"landing_page_url":"https://doaj.org/article/eb1d97a2e1b7447980d81036c7a4cffe","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,"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":"npj Digital Medicine, Vol 9, Iss 1 (2026)","raw_type":"article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13272687","is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13272687/","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,"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":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"NPJ Digit Med","raw_type":"Text"}],"best_oa_location":{"id":"doi:10.1038/s41746-026-02616-3","is_oa":true,"landing_page_url":"https://doi.org/10.1038/s41746-026-02616-3","pdf_url":"https://www.nature.com/articles/s41746-026-02616-3_reference.pdf","source":{"id":"https://openalex.org/S4210195431","display_name":"npj Digital Medicine","issn_l":"2398-6352","issn":["2398-6352"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319908","host_organization_name":"Nature Portfolio","host_organization_lineage":["https://openalex.org/P4310319908","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Nature Portfolio","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":"npj Digital Medicine","raw_type":"journal-article"},"sustainable_development_goals":[],"awards":[],"funders":[{"id":"https://openalex.org/F4320320290","display_name":"University of Oxford","ror":"https://ror.org/052gg0110"},{"id":"https://openalex.org/F4320330690","display_name":"Avant Foundation","ror":null},{"id":"https://openalex.org/F4320336183","display_name":"Clarendon Fund","ror":null}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7154706780.pdf","grobid_xml":"https://content.openalex.org/works/W7154706780.grobid-xml"},"referenced_works_count":23,"referenced_works":["https://openalex.org/W2138480916","https://openalex.org/W2531269403","https://openalex.org/W2765304416","https://openalex.org/W2768095311","https://openalex.org/W2963963432","https://openalex.org/W3036347230","https://openalex.org/W3036885589","https://openalex.org/W3118615836","https://openalex.org/W3130938027","https://openalex.org/W4220926288","https://openalex.org/W4225161532","https://openalex.org/W4385575330","https://openalex.org/W4388153243","https://openalex.org/W4400831181","https://openalex.org/W4401275084","https://openalex.org/W4404311881","https://openalex.org/W4405519411","https://openalex.org/W4406095736","https://openalex.org/W4406233479","https://openalex.org/W4409139359","https://openalex.org/W4410886022","https://openalex.org/W4415834977","https://openalex.org/W7125529244"],"related_works":[],"abstract_inverted_index":{"Abstract":[0],"Artificial":[1],"intelligence":[2],"(AI)":[3],"is":[4,27,147],"an":[5],"accurate":[6],"screening":[7,58,83,146],"tool":[8],"for":[9,72,110],"diabetic":[10],"retinopathy":[11],"(DR),":[12],"the":[13,86,113,142],"leading":[14],"cause":[15],"of":[16,35,61,77,133,144],"blindness":[17],"among":[18],"working-aged":[19],"adults.":[20],"However,":[21],"its":[22],"impact":[23],"on":[24],"referral":[25,53,79,102,171],"uptake":[26,54,80],"uncertain.":[28],"We":[29],"searched":[30],"Embase,":[31],"MEDLINE,":[32],"Scopus,":[33],"Web":[34],"Science":[36],"and":[37,49,69,165],"Cochrane":[38],"Library":[39],"databases":[40],"from":[41,105,151,155],"year":[42],"2000":[43],"to":[44,107,135],"February":[45],"17,":[46],"2025.":[47],"Randomised":[48],"non-randomised":[50],"studies":[51,122],"comparing":[52],"after":[55],"AI-assisted":[56,82],"DR":[57,78,111,145],"versus":[59],"standard":[60],"care":[62,157],"were":[63,67],"included.":[64],"2644":[65],"articles":[66],"identified,":[68],"six":[70],"included":[71],"analysis.":[73],"The":[74],"relative":[75],"risk":[76],"with":[81,85],"compared":[84],"status":[87],"quo":[88],"was":[89],"1.89":[90],"(95%":[91],"CI,":[92],"1.18,":[93],"3.03,":[94],"I":[95],"2":[96],"=":[97,120],"91.9%).":[98],"Settings":[99],"which":[100,169],"underwent":[101],"pathway":[103,158],"transformation":[104,164],"routine":[106],"targeted":[108],"referrals":[109],"demonstrated":[112],"greatest":[114],"effect":[115],"size.":[116],"Most":[117],"(":[118],"n":[119],"4)":[121],"also":[123],"utilised":[124],"behavioural":[125],"change":[126],"interventions":[127,168],"enabled":[128],"by":[129],"immediate":[130],"results":[131],"acquisition":[132],"AI":[134],"enhance":[136],"health-seeking":[137],"behaviour.":[138],"Our":[139],"findings":[140],"suggest":[141],"effectiveness":[143],"derived":[148],"not":[149],"only":[150],"diagnostic":[152],"technology,":[153],"but":[154],"AI-enabled":[156],"redesign":[159],"encompassing":[160],"both":[161],"health":[162],"system":[163],"coordinated":[166],"patient-facing":[167],"improve":[170],"uptake.":[172]},"counts_by_year":[],"updated_date":"2026-07-14T23:27:15.235271","created_date":"2026-04-18T00:00:00"}