Applications of teledentistry in a French inmate population: A one-year observational study

Camille Inquimbert; Ioan Balacianu; Nicolas Huyghe; Joao Pasdeloup; Paul Tramini; Fadi Meroueh; Sylvie Montal; Sompop Bencharit; Nicolas Giraudeau

doi:10.1371/journal.pone.0247778

Peer Review History

Original SubmissionNovember 23, 2020
29 Dec 2020 Decision Letter - Abhishek Makkar, Editor PONE-D-20-36871 Applications of Teledentistry in a French Inmate Population: A one-year observational study PLOS ONE Dear Dr. Bencharit, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please address concerns raised by both reviewers. Please submit your revised manuscript by Feb 12 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Abhishek Makkar, M.D. Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2.In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. 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Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. 3. Please ensure that you refer to Figure 2 in your text as, if accepted, production will need this reference to link the reader to the figure. 4. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 5, 8, 9, 10 and 11 in your text; if accepted, production will need this reference to link the reader to the Table. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: No ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Applications of Teledentistry in a French Inmate Population: A one-year observational Study Objectives The main objective was to analyze the implementation of oral telemedicine in the VLM Health Unit during the 2018 year. The secondary objectives were to evaluate the caries experience and the urgency level, and to collect information about the patients’ practitioners. Materials and Methods • DMFT Score - The DMFT score was then obtained- Please describe what the DMFT score is as all the results were focused on this and there is no mention of the description of the score for a reader. • Please explain the caregiver role in methods – is he/she a person with previous dental provider experience or a novice person who was taught how to perform oral examinations with telemedicine equipment Results Overall, the results section is incomplete and vague. Please summarize all the results in 1-2 paragraphs with corresponding references to the tables. There were lot of tables and figures with no legends. Multiple tables were used, which could be summarized into fewer tables. • Conditions making the assessment difficult or impossible such severe gag reflect – sentence not clear • Table 4 Reported last time seeing a dentist -Please label the columns, it’s not clear especially what the data in third column meant • Table 5 DMFT distribution It would be ideal to mention the abnormalities to get a clear picture, Example below Abnormalities n (%) at least one decayed teeth 493 (87.88%) at least one decayed filled teeth 138 (34.40%) • Table 7 Distribution of treatment after teledentistry Table 7 top 4 rows replicates the data which was already presented in table 2, please redo this table to minimize duplication • Tables 8 through 11 and Figure 2 - All these tables basically compare NO PRACTITIONER AND REGULAR PRACTITIONER group differences. These all could be summarized in a single table rather than 4 different tables and figure 2. This allows the reader to better understand the message being conveyed. -The number in NO PRACTITiONER and REGULAR PRACTITIONER groups was different in table 8 and Table 9 through 11 Discussion: • There is duplication of results within the discussion section. Please avoid the duplication if possible. • It would be ideal if the authors can summarize their key findings from the study at the beginning of the discussion section to set forth further discussion. • Some of the the key findings from the study seem to be o Observational study of oral health of large number of prison inmates o Teledentistry used as an innovative effective screening tool for oral health of prison inmates o Telemedicine allowed to screen and identify the oral conditions needing urgent interventions • Once the key results are summarized, the authors can then discuss each key finding with supported literature in a concise manner • The authors did not highlight any limitations of the study Reviewer #2: Thank you for the valuable study, it is a great addition to the literature and provides insights about potential valuable use of Telehealth in both preventive and diagnostic dentistry. It would be great to reorganize the paper. Some suggestions in the comment section. Thank you ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. 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Revision 1
20 Jan 2021 Author Response RESPONSES TO EDITOR AND REVIEWERS The authors are grateful for the kind comments and thorough reviews from the editor and reviewers. The following list includes all comments, responses, and text modifications. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf RESPONSE: The manuscript has been revised per PLOS ONE’s style requirements. 2.In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. RESPONSE: The de-identified data sheet in an excel format was added as supplementary information. 3. Please ensure that you refer to Figure 2 in your text as, if accepted, production will need this reference to link the reader to the figure. RESPONSE: Figure 2 demonstrated redundant data that are displayed already in the Tables. We remove Figure 2 per Reviewer #1’s request. 4. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 5, 8, 9, 10 and 11 in your text; if accepted, production will need this reference to link the reader to the Table. RESPONSE: Tables are now revised, consolidated and cited. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: Applications of Teledentistry in a French Inmate Population: A one-year observational Study Objectives The main objective was to analyze the implementation of oral telemedicine in the VLM Health Unit during the 2018 year. The secondary objectives were to evaluate the caries experience and the urgency level, and to collect information about the patients’ practitioners. Materials and Methods • DMFT Score - The DMFT score was then obtained- Please describe what the DMFT score is as all the results were focused on this and there is no mention of the description of the score for a reader. RESPONSE: We appreciate the comment. TEXT CHANGE: DMFT definition as Decay, Missing, and Filled Tooth was added. • Please explain the caregiver role in methods – is he/she a person with previous dental provider experience or a novice person who was taught how to perform oral examinations with telemedicine equipment RESPONSE: We appreciate the comment. The caregiver role/training was added in the Methods. TEXT CHANGE: “The caregiver was trained by the prison’s dentist to do a virtual oral examination using Soprocare®, an intraoral camera along with a video camera, and a computer. The caregiver was also trained in simple oral diagnosis with a virtual consulted dentist.” Results Overall, the results section is incomplete and vague. Please summarize all the results in 1-2 paragraphs with corresponding references to the tables. There were lot of tables and figures with no legends. Multiple tables were used, which could be summarized into fewer tables. RESPONSE: We appreciated the comments very much. The results section has been rewritten per your suggestion. The Tables are consolidated. Figure 2 was removed (redundant data). Legends are added. TEXT CHANGE: Please see detailed changes below. “The primary outcomes of this work were the teledentistry implementation in the new inmates, while the secondary outcomes were oral health baseline data of the inmates once arrived at the prison, including past dental care, DMFT, and urgent care scoring. In 2018, 1,051 men entered VLM's remand center. Over 60% of them, 619 (58.90%), agreed to have an oral examination by teledentistry. The oral health data recording was done primarily by a caregiver with a remote dentist’s as needed consultations. Through teledentistry, the remote dentist, which was the dentist responsible for the entire prison, could continue to treat patients all day with non interruptions for new consultation. The record data per inmate was done on average of 14 minutes and with additional 8 minutes on average of analysis time. It is important to note the main reasons for inmates to refuse oral examination by teledentistry. This included refusal of all or part of the entry medical examination, having limited mouth opening or severe gag reflect that cannot tolerate the intraoral device, conditions making the assessment difficult or impossible such severe gag reflect, refusal of benefit from dental care, refusal of teledentistry, and finally fear of dentists. In terms of oral health status of new inmates, out of the examined 619 people, 52 were edentulous and had removable complete denture prostheses and therefore no telemedicine assessment was performed. The remaining 567 (58.9%) inmates received an oral examination through teledentistry. The percentages of oral telemedicine oral examination range from the lowest 50% in April to the highest 80% in August (Table 3). The average age of new inmates is 31.65+/-10.69 years with the youngest of 16 and the oldest of 76 years old. Out of the 567 patients who underwent the telemedicine examination, 561 of them had sufficient accuracy oral teledentistry for further analysis for DMFT. Within this 561 inmates, we examined if having a primary care dentist and the last dental visit were factors influencing their oral health status. When asking a question: "Do you have a primary care dentist?”, about half (51.68%) of the new inmates reported that they did not have a primary care dentist (Table 4). In terms of last dental visit, on average the inmate (out of 567 inmates) had seen a dentist 30.87+/- 36.78 months ago or just about two and a half years ago (Table 5). The distribution of the DMFT score in this population of detainees is shown in Figure 2 and Table 6, with a mean value of 7.76 (+/- 5.31) and 9.27% caries-free. The mean components of DMFT were also assessed: D = 5.78 (+/- 4.64), M = 0.29 (+/- 0.82), F = 1.68 (+/- 2.93). The mean number of cavitated lesions per inmate was 2.93 (3.11), and the mean number of enamel lesions was 0.87 (1.49). The mean number filled teeth with cavitated lesions was 0.74 (1.39). It is important to note that almost 90% of inmates have at least one tooth that needed to be treated (Table 6). The oral health status was generally very poor among prisoners. We identified only 9.27% (52) with a DMFT equal to 0 and only 12.12% (68) did not present any decay. Over 30% (34.40% or 193 inmates) showed a treated tooth with recovery of decay and only 46.17% (259) had at least one treated tooth. In terms of treatment urgency (Table 7), the average urgency score is less than 3 (referred to advanced urgency). However, over 40% of the inmates had an urgency score of 4 (high urgency) which required immediate treatment. About 12-31% of new inmates who received a teledentistry oral exam, subsequently had a dental appointment (Table 8). To further examine if having a primary care dentist is a factor influencing the urgency score, DMFT, last dental visit, and extraction needed. Mann-Whitney U test was used to examine the differences between the inmate with and without a primary care dentist (Table 9). The mean urgency score was not significantly different when individuals had a regular primary care dentist or not (Table 9). New inmates with a primary care dentist had a higher DMFT score, reflective of better dental care, compared to the new inmates without a primary care dentist (Table 9). The mean last appointment time was significantly different when individuals had a primary care dentist or not. New inmates with no primary care dentist also had not seen a dentist for a longer period of time compared to the ones with a primary care dentist (Table 9). However, the mean extraction needed was not significantly different when individuals had a primary care dentist or not (Table 9).” • Conditions making the assessment difficult or impossible such severe gag reflect – sentence not clear RESPONSE: We agree. TEXT CHANGE: The sentence is now read: “Having limited mouth opening or severe gag reflect that cannot tolerate the intraoral device” • Table 4 Reported last time seeing a dentist -Please label the columns, it’s not clear especially what the data in third column meant RESPONSE: We appreciate the comment. TEXT CHANGE: Each column is now labelled. • Table 5 DMFT distribution It would be ideal to mention the abnormalities to get a clear picture, Example below Abnormalities n (%) at least one decayed teeth 493 (87.88%) at least one decayed filled teeth 138 (34.40%) RESPONSE: We appreciate the comment. TEXT CHANGE: Diseased tooth conditions are now represented in bold with a footnote labelled. • Table 7 Distribution of treatment after teledentistry Table 7 top 4 rows replicates the data which was already presented in table 2, please redo this table to minimize duplication RESPONSE: We appreciate the comment. TEXT CHANGE: The top 5 rows were removed. • Tables 8 through 11 and Figure 2 - All these tables basically compare NO PRACTITIONER AND REGULAR PRACTITIONER group differences. These all could be summarized in a single table rather than 4 different tables and figure 2. This allows the reader to better understand the message being conveyed. -The number in NO PRACTITiONER and REGULAR PRACTITIONER groups was different in table 8 and Table 9 through 11 RESPONSE: We thank the reviewer for this insight. TEXT CHANGE: Table 8 through Table 11 are consolidated into one table. Figure 2 was removed. The numbers in Table 8 were corrected. Discussion: • There is duplication of results within the discussion section. Please avoid the duplication if possible. RESPONSE: We really appreciate the input. TEXT CHANGE: All redundant results were removed from the Discussion to avoid duplication. • It would be ideal if the authors can summarize their key findings from the study at the beginning of the discussion section to set forth further discussion. • Some of the the key findings from the study seem to be o Observational study of oral health of large number of prison inmates o Teledentistry used as an innovative effective screening tool for oral health of prison inmates o Telemedicine allowed to screen and identify the oral conditions needing urgent interventions RESPONSE: We really appreciate this suggestion TEXT CHANGE: The key finding paragraph was added at the beginning of the Discussion. • Once the key results are summarized, the authors can then discuss each key finding with supported literature in a concise manner RESPONSE: We appreciate this suggestion TEXT CHANGE: The supportive literature was now discussed following the key finding paragraph. • The authors did not highlight any limitations of the study RESPONSE: We appreciate this suggestion TEXT CHANGE: A limitation paragraph was added at the end of the Discussion section. Reviewer #2: Thank you for the valuable study, it is a great addition to the literature and provides insights about potential valuable use of Telehealth in both preventive and diagnostic dentistry. It would be great to reorganize the paper. Some suggestions in the comment section. RESPONSE: The authors truly appreciate the guidance from the reviewer. We also thank the reviewer for the time and effort spending on reviewing the manuscript. We included all corrections and suggestions in the revised manuscript. Please see the manuscript with track changes. Attachments Attachment Submitted filename: Response to reviewers_PLoSONE_01172021.docx https://doi.org/10.1371/journal.pone.0247778.r002
5 Feb 2021 Decision Letter - Abhishek Makkar, Editor PONE-D-20-36871R1 Applications of Teledentistry in a French Inmate Population: A one-year observational study PLOS ONE Dear Dr. Bencharit, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Thanks for taking time to address most of reviewer comments. Please address following before we can consider your manuscript for publication. Introduction: Last line of Introduction should be revised to say Patient's Primary care dentist instead of Patient's Practioner to be consistent with terminology used in other sections of manuscript. Results: Please rephrase Line 10 of results, it is hard to read and needs grammatical correction. Sentence starting. This included refusal of ………….fear of dentists. Tables: Please check formatting on table 3,6 and 8 so two or 3 digit numbers displayed are in one line. Please complete missing column lables in Tables 5 and 7. ( Currently missing n and % label) References: Please translate references 1,2,4,5,7,11 to English. Reference 10 is incomplete, please submit complete reference with online access date if its a webpage. Please submit your revised manuscript by Mar 22 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Abhishek Makkar, M.D. Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0247778.r003
Revision 2
9 Feb 2021 Author Response RESPONSES TO COMMENTS FROM EDITOR/REVIEWERS Introduction: Last line of Introduction should be revised to say Patient's Primary care dentist instead of Patient's Practitioner to be consistent with terminology used in other sections of manuscript. RESPONSE: Appreciate the comment. TEXT CHANGE: The sentence is now read: “... patient’s primary care dentist.’ Results: Please rephrase Line 10 of results, it is hard to read and needs grammatical correction. Sentence starting. This included refusal of ………….fear of dentists. RESPONSE: We appreciate the comment. TEXT CHANGE: The sentence is now read: “This included refusal of any medical exam, refusal of dental care or teledentistry, limited mouth opening or gag reflex, and fear of dentists.” Tables: Please check formatting on table 3,6 and 8 so two or 3 digit numbers displayed are in one line. RESPONSE: We appreciate the comment. TEXT CHANGE: Changes have been made. Please complete missing column lables in Tables 5 and 7. ( Currently missing n and % label) RESPONSE: We appreciate the comment. TEXT CHANGE: Changes have been made. References: Please translate references 1,2,4,5,7,11 to English. RESPONSE: We appreciate the comment. TEXT CHANGE: Changes have been made. Reference 10 is incomplete, please submit complete reference with online access date if its a webpage. RESPONSE: We appreciate the comment. TEXT CHANGE: Changes have been made. Attachments Attachment Submitted filename: Responses_to_Review_R2_02082021.docx https://doi.org/10.1371/journal.pone.0247778.r004
16 Feb 2021 Decision Letter - Abhishek Makkar, Editor Applications of Teledentistry in a French Inmate Population: A one-year observational study PONE-D-20-36871R2 Dear Dr. Bencharit, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Abhishek Makkar, M.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0247778.r005
Formally Accepted
29 Mar 2021 Acceptance Letter - Abhishek Makkar, Editor PONE-D-20-36871R2 Applications of Teledentistry in a French Inmate Population: A one-year observational study Dear Dr. Bencharit: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Abhishek Makkar Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0247778.r006

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