{"id":"https://openalex.org/W4416738844","doi":"https://doi.org/10.1093/jamia/ocaf207","title":"Comparison of clinical outcomes of sepsis patients in two county emergency departments using systemic inflammatory response syndrome versus Epic\u2019s proprietary severe sepsis alert","display_name":"Comparison of clinical outcomes of sepsis patients in two county emergency departments using systemic inflammatory response syndrome versus Epic\u2019s proprietary severe sepsis alert","publication_year":2025,"publication_date":"2025-11-13","ids":{"openalex":"https://openalex.org/W4416738844","doi":"https://doi.org/10.1093/jamia/ocaf207","pmid":"https://pubmed.ncbi.nlm.nih.gov/41293980"},"language":"en","primary_location":{"id":"doi:10.1093/jamia/ocaf207","is_oa":false,"landing_page_url":"https://doi.org/10.1093/jamia/ocaf207","pdf_url":null,"source":{"id":"https://openalex.org/S129839026","display_name":"Journal of the American Medical Informatics Association","issn_l":"1067-5027","issn":["1067-5027","1527-974X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"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":"Journal of the American Medical Informatics Association","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12844591/","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5000993603","display_name":"Daniel G. Ostermayer","orcid":"https://orcid.org/0000-0003-3205-4161"},"institutions":[{"id":"https://openalex.org/I919571938","display_name":"The University of Texas Health Science Center at Houston","ror":"https://ror.org/03gds6c39","country_code":"US","type":"education","lineage":["https://openalex.org/I919571938"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Daniel G Ostermayer","raw_affiliation_strings":["Department of Emergency Medicine, McGovern Medical School, UT Health at the University of Texas Health Science Center at Houston , Houston, TX 77030,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Emergency Medicine, McGovern Medical School, UT Health at the University of Texas Health Science Center at Houston , Houston, TX 77030,","institution_ids":["https://openalex.org/I919571938"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5114667647","display_name":"Benjamin Braunheim","orcid":null},"institutions":[{"id":"https://openalex.org/I2801539370","display_name":"Harris Health System","ror":"https://ror.org/04m8z4n60","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2801539370"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Benjamin Braunheim","raw_affiliation_strings":["Department of Health Informatics and Data Science, Harris Health System , Bellaire, TX 77401,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Health Informatics and Data Science, Harris Health System , Bellaire, TX 77401,","institution_ids":["https://openalex.org/I2801539370"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5028510211","display_name":"Amit Mehta","orcid":"https://orcid.org/0000-0001-5721-9589"},"institutions":[{"id":"https://openalex.org/I919571938","display_name":"The University of Texas Health Science Center at Houston","ror":"https://ror.org/03gds6c39","country_code":"US","type":"education","lineage":["https://openalex.org/I919571938"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Amit Mehta","raw_affiliation_strings":["Department of Emergency Medicine, McGovern Medical School, UT Health at the University of Texas Health Science Center at Houston , Houston, TX 77030,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Emergency Medicine, McGovern Medical School, UT Health at the University of Texas Health Science Center at Houston , Houston, TX 77030,","institution_ids":["https://openalex.org/I919571938"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5007388193","display_name":"Jeremy Ward","orcid":"https://orcid.org/0000-0001-7037-4268"},"institutions":[{"id":"https://openalex.org/I181547552","display_name":"Baylor College of Medicine","ror":"https://ror.org/02pttbw34","country_code":"US","type":"education","lineage":["https://openalex.org/I181547552","https://openalex.org/I2801539370"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jeremy Ward","raw_affiliation_strings":["Department of Trauma and Acute Care Surgery, Baylor College of Medicine , Houston, TX 77030,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Trauma and Acute Care Surgery, Baylor College of Medicine , Houston, TX 77030,","institution_ids":["https://openalex.org/I181547552"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5037085786","display_name":"Sara Andrabi","orcid":"https://orcid.org/0000-0002-9368-6982"},"institutions":[{"id":"https://openalex.org/I181547552","display_name":"Baylor College of Medicine","ror":"https://ror.org/02pttbw34","country_code":"US","type":"education","lineage":["https://openalex.org/I181547552","https://openalex.org/I2801539370"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Sara Andrabi","raw_affiliation_strings":["Department of Emergency Medicine, Baylor College of Medicine , Houston, TX 77030,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Emergency Medicine, Baylor College of Medicine , Houston, TX 77030,","institution_ids":["https://openalex.org/I181547552"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5012292389","display_name":"Anwar Mohammad Sirajuddin","orcid":null},"institutions":[{"id":"https://openalex.org/I2801539370","display_name":"Harris Health System","ror":"https://ror.org/04m8z4n60","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2801539370"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Anwar Mohammad Sirajuddin","raw_affiliation_strings":["Department of Health Informatics and Data Science, Harris Health System , Bellaire, TX 77401,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Health Informatics and Data Science, Harris Health System , Bellaire, TX 77401,","institution_ids":["https://openalex.org/I2801539370"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":6,"corresponding_author_ids":["https://openalex.org/A5000993603"],"corresponding_institution_ids":["https://openalex.org/I919571938"],"apc_list":{"value":3967,"currency":"USD","value_usd":3967},"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.46162797,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"33","issue":"2","first_page":"404","last_page":"408"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10218","display_name":"Sepsis Diagnosis and Treatment","score":0.9490000009536743,"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"}},"topics":[{"id":"https://openalex.org/T10218","display_name":"Sepsis Diagnosis and Treatment","score":0.9490000009536743,"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/T11961","display_name":"Neonatal and Maternal Infections","score":0.023800000548362732,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"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/T13248","display_name":"Healthcare Technology and Patient Monitoring","score":0.005200000014156103,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"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/systemic-inflammatory-response-syndrome","display_name":"Systemic inflammatory response syndrome","score":0.8019999861717224},{"id":"https://openalex.org/keywords/sepsis","display_name":"Sepsis","score":0.7649000287055969},{"id":"https://openalex.org/keywords/emergency-department","display_name":"Emergency department","score":0.5738000273704529},{"id":"https://openalex.org/keywords/inflammatory-response","display_name":"Inflammatory response","score":0.5382999777793884},{"id":"https://openalex.org/keywords/emergency-response","display_name":"Emergency response","score":0.4366999864578247},{"id":"https://openalex.org/keywords/early-warning-score","display_name":"Early warning score","score":0.3652999997138977}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8920999765396118},{"id":"https://openalex.org/C2781090800","wikidata":"https://www.wikidata.org/wiki/Q776030","display_name":"Systemic inflammatory response syndrome","level":3,"score":0.8019999861717224},{"id":"https://openalex.org/C2778384902","wikidata":"https://www.wikidata.org/wiki/Q183134","display_name":"Sepsis","level":2,"score":0.7649000287055969},{"id":"https://openalex.org/C2780724011","wikidata":"https://www.wikidata.org/wiki/Q1295316","display_name":"Emergency department","level":2,"score":0.5738000273704529},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.5514000058174133},{"id":"https://openalex.org/C3020196126","wikidata":"https://www.wikidata.org/wiki/Q101991","display_name":"Inflammatory response","level":3,"score":0.5382999777793884},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.4997999966144562},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.4397999942302704},{"id":"https://openalex.org/C3017997152","wikidata":"https://www.wikidata.org/wiki/Q814610","display_name":"Emergency response","level":2,"score":0.4366999864578247},{"id":"https://openalex.org/C2777671062","wikidata":"https://www.wikidata.org/wiki/Q6889402","display_name":"Early warning score","level":2,"score":0.3652999997138977},{"id":"https://openalex.org/C2994086866","wikidata":"https://www.wikidata.org/wiki/Q183134","display_name":"Severe sepsis","level":4,"score":0.3386000096797943},{"id":"https://openalex.org/C30036603","wikidata":"https://www.wikidata.org/wiki/Q17125150","display_name":"Severity of illness","level":2,"score":0.2827000021934509},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.2816999852657318}],"mesh":[{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000900","descriptor_name":"Anti-Bacterial Agents","qualifier_ui":"Q000627","qualifier_name":"therapeutic use","is_major_topic":false},{"descriptor_ui":"D000900","descriptor_name":"Anti-Bacterial Agents","qualifier_ui":"Q000627","qualifier_name":"therapeutic use","is_major_topic":false},{"descriptor_ui":"D004636","descriptor_name":"Emergency Service, Hospital","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D004636","descriptor_name":"Emergency Service, Hospital","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D005260","descriptor_name":"Female","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":"D006801","descriptor_name":"Humans","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":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008875","descriptor_name":"Middle Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008875","descriptor_name":"Middle Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D012189","descriptor_name":"Retrospective Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D012189","descriptor_name":"Retrospective Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017052","descriptor_name":"Hospital Mortality","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017052","descriptor_name":"Hospital Mortality","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D018746","descriptor_name":"Systemic Inflammatory Response Syndrome","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":true},{"descriptor_ui":"D018746","descriptor_name":"Systemic Inflammatory Response Syndrome","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":true},{"descriptor_ui":"D018805","descriptor_name":"Sepsis","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":true},{"descriptor_ui":"D018805","descriptor_name":"Sepsis","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":true},{"descriptor_ui":"D018805","descriptor_name":"Sepsis","qualifier_ui":"Q000401","qualifier_name":"mortality","is_major_topic":true},{"descriptor_ui":"D018805","descriptor_name":"Sepsis","qualifier_ui":"Q000401","qualifier_name":"mortality","is_major_topic":true},{"descriptor_ui":"D020000","descriptor_name":"Decision Support Systems, Clinical","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D020000","descriptor_name":"Decision Support Systems, Clinical","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D063305","descriptor_name":"Organ Dysfunction Scores","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D063305","descriptor_name":"Organ Dysfunction Scores","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":3,"locations":[{"id":"doi:10.1093/jamia/ocaf207","is_oa":false,"landing_page_url":"https://doi.org/10.1093/jamia/ocaf207","pdf_url":null,"source":{"id":"https://openalex.org/S129839026","display_name":"Journal of the American Medical Informatics Association","issn_l":"1067-5027","issn":["1067-5027","1527-974X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"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":"Journal of the American Medical Informatics Association","raw_type":"journal-article"},{"id":"pmid:41293980","is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41293980","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":"Journal of the American Medical Informatics Association : JAMIA","raw_type":null},{"id":"pmh:oai:pubmedcentral.nih.gov:12844591","is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12844591/","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":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"J Am Med Inform Assoc","raw_type":"Text"}],"best_oa_location":{"id":"pmh:oai:pubmedcentral.nih.gov:12844591","is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12844591/","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":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"J Am Med Inform Assoc","raw_type":"Text"},"sustainable_development_goals":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":25,"referenced_works":["https://openalex.org/W1807259383","https://openalex.org/W1898928487","https://openalex.org/W1969760843","https://openalex.org/W1973857166","https://openalex.org/W2034769820","https://openalex.org/W2055905393","https://openalex.org/W2140410010","https://openalex.org/W2160691650","https://openalex.org/W2168803832","https://openalex.org/W2519501974","https://openalex.org/W2749576742","https://openalex.org/W2891105177","https://openalex.org/W2892557935","https://openalex.org/W2910910290","https://openalex.org/W2911758278","https://openalex.org/W2921640653","https://openalex.org/W2968919852","https://openalex.org/W2978693933","https://openalex.org/W2990895485","https://openalex.org/W3048268578","https://openalex.org/W3081264922","https://openalex.org/W3174786846","https://openalex.org/W3177107382","https://openalex.org/W4312211804","https://openalex.org/W4404432540"],"related_works":[],"abstract_inverted_index":{"OBJECTIVES:":[0],"To":[1],"compare":[2],"the":[3,18,30,50,94,102,106,117,156,164,265],"clinical":[4,51,290],"outcomes":[5,52],"of":[6,53,59,108,141,160,184,192,199,206,213,219],"sepsis":[7,20,72,109],"patients":[8,58,63,125],"when":[9,139,276],"an":[10,305],"augmented":[11],"systemic":[12],"inflammatory":[13],"response":[14],"syndrome":[15],"(SIRS+)":[16],"and":[17,86,134,170,174,194,215,301],"Epic":[19,157],"predictive":[21,211,217],"model":[22],"version":[23],"1":[24],"(ESPMv1)":[25],"alert":[26],"were":[27,64,74,253,295],"active":[28],"in":[29,124,227,260,304],"emergency":[31,56,307],"department":[32,57,308],"at":[33,129,155],"two":[34,112,266],"county":[35],"hospitals.":[36],"MATERIALS":[37],"AND":[38,285],"METHODS:":[39],"This":[40],"retrospective":[41],"study":[42],"from":[43,87],"January":[44,47,67,91],"2018":[45,68],"to":[46,69,76,90,101,166,229,236,246],"2024,":[48],"evaluated":[49,163],"881":[54],"201":[55],"which":[60],"29":[61],"852":[62],"septic.":[65],"From":[66],"June":[70],"2022":[71,89],"notices":[73],"presented":[75],"physicians":[77,127],"based":[78,299],"on":[79,116],"a":[80,182,204,258],"SIRS":[81],"plus":[82,146],"organ":[83,148],"dysfunction":[84,149],"criteria":[85,143],"December":[88],"2024":[92],"using":[93],"ESPMv1":[95,152,202,302],"alert.":[96],"Sepsis":[97],"was":[98,144],"defined":[99,110],"according":[100],"Sepsis-3":[103],"definition":[104],"with":[105],"onset":[107],"as":[111],"or":[113,244,292],"more":[114],"points":[115],"Sequential":[118],"Organ":[119],"Function":[120],"Assessment":[121],"(SOFA)":[122],"score":[123],"where":[126],"ordered":[128],"least":[130],"one":[131,147],"blood":[132,167,237],"culture":[133,238],"antibiotic.":[135],"SIRS+":[136,179,298],"alerting":[137,153,300,311],"occurred":[138,154],"2":[140],"4":[142],"reached":[145],"measurement.":[150],"The":[151,201],"recommended":[158],"threshold":[159],"six.":[161],"We":[162,255],"times":[165],"cultures,":[168],"antibiotics":[169,230],"ICU":[171,247],"admission":[172,248],"requests,":[173],"in-hospital":[175],"death":[176,262],"rates.":[177],"RESULTS:":[178],"alerts":[180,303],"had":[181,203,313],"sensitivity":[183,205],"14.25%,":[185],"specificity":[186,208],"96.1%,":[187],"positive":[188,210],"predicative":[189],"value":[190,197,212,218],"(PPV)":[191],"7.8%":[193],"negative":[195,216],"predative":[196],"(NPV)":[198],"98%.":[200],"15.6%,":[207],"95.4%,":[209],"8.1%,":[214],"98%":[220],"for":[221,278],"diagnosing":[222],"sepsis.":[223],"No":[224,287],"statistical":[225,274],"differences":[226,291],"time":[228,235,245,267],"(5.1":[231],"vs":[232,241,250,270],"5.9":[233],"h),":[234],"draws":[239],"(3.6":[240],"3.5":[242],"h)":[243,252],"(10.4":[249],"9.6":[251],"observed.":[254],"did":[256],"observe":[257],"difference":[259,275],"hospital":[261],"rates":[263],"between":[264,297],"periods":[268],"(11%":[269],"8%)":[271],"but":[272],"no":[273],"adjusting":[277],"unvaccinated":[279],"covid-19":[280],"(OR":[281],"0.95":[282],"[0.87-1.03]).":[283],"DISCUSSION":[284],"CONCLUSION:":[286],"statistically":[288],"significant":[289],"performance":[293],"metrics":[294],"observed":[296],"undifferentiated":[306],"population.":[309],"Both":[310],"systems":[312],"similarly":[314],"poor":[315],"diagnostic":[316],"characteristics.":[317]},"counts_by_year":[],"updated_date":"2026-04-28T14:05:53.105641","created_date":"2025-11-27T00:00:00"}
