PONE-D-20-33739

Perceptions, awareness on snakebite envenomation among the tribal community and health care providers of Dahanu block, Palghar district in Maharashtra, India

PLOS ONE

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Kind regards,

Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE

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Reviewers' comments:

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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

Reviewer #3: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: I Don't Know

**********

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: No

Reviewer #2: No

Reviewer #3: Yes

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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: Yes

Reviewer #3: 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: The research question is definitely of interest to readers in India and other countries in the tropics where snakebite is well and truly a occupational hazard. To the best of my knowledge a study along similar lines has not been carried out in India and the results of the study would help policy makers in bringing in changes to plug the gaps and deficiencies identified.

The research question interesting and the methodology fairly well charted.

The deficiency really is in the presentation of the findings and results.

- The abstract and introduction need to be written better and be representative of the actual research question. The introduction seems scattered and not to the point, going from numbers of snakebite to chronic sequelae which also includes death, venom constituents and effect to ASV. Restructuring the introduction and giving it a form should help make it read better. Would suggest adding some details on the tribal community and geography as well. The research question here is perceptions and awareness on snakebite envenomation, of the 202 respondents in the community it has not been explicitly stated whether all were tribals. The researchers could also specify whether the different tribes had different occupations vis a vis hunter, gatherer, farmer etc and their educational status.

62 higher than what, as only 13 states were assessed as a part of the million death study

82 unidentified- unknown

Lines 84,85 - it would be interpreted that death is a long term complication

Lines 94,95- Relevance of skin hypersensitivity in the context of the article

103-108 against the flow

Line 125 drinking water (potable water), would also imply sleeping is an activity?

Lines 139-141 – 4.5 % CFR included non venomous too (76% venomous and 24% non venomous)

Line 165 qualitative study, qualitative cannot be considered a study design, the study is cross sectional

Line 185 convenience sampling ? how representative would it be of the population studied

Line 207 it could be that they are unaware of their age

Line 345/443 peripheral health care workers, would be best sticking to frontline health workers

Line 395 how were the 18 out of 65 SC decided upon, what criteria was used to pick the same

Line 457 / 58 not clear what he intends to say is it that non venomous do not bite multiple times

The training for medical personnel seems not to have made much of a difference in improving knowledge of treating doctors

Was there an incentive given to the community responders, was it a convenience sampling and if so would it bias the results and could the result be considered as representative of the study population

The most important part of the result would be the perception and understanding of the subject of venomous snakebite among the community members presumably tribals, this for me, the qualitative study results are not clear. Themes and sub themes have been mentioned but only a few have been represented. If a table giving percentages of themes and subthemes were displayed the qualitative aspect would be much clearer. The qualitative analysis needs better representation both by way of themes and subthemes and its relevance to the community studied.

I take this opportunity to wish the researchers the best and hope they continue their research in this much neglected field.

Reviewer #2: Abstract

• Line 35 – In-depth-interviews are to be conducted using interview guide, not using pre-tested questionnaire.

Methodology & Results

• As the study is of qualitative nature, authors need to refer to COREQ checklist (http://cdn.elsevier.com/promis_misc/ISSM_COREQ_Checklist.pdf) and report the data analysis and study results.

Reviewer #3: 1. The area of this research is important for India where more than 50% of global snakebite deaths are happening there. A recent study published in E-life by Million Death Study collaborates finds 58k deaths and 1.1 to 1.7 million bites annually in India and one million deaths were in last 20 years. I learnt from a snakebite advocacy group meeting at ICMR, a substantial amount of expired unused anti venom vials throwing into trash without use in every year while many thousands die without treatments. This is a problem of either people not aware of (or trust) anti venom treatment in hospitals or physicians were not trained/confident enough in clinical management of snakebite cases or both.

2. According to the authors, the objective of this study is to test the awareness about prevention strategies, knowledge of first aids and treatment options among community; Snakebite patient management among snake handlers, healers, healthcare workers and medical personnel. Another set objective is to train the healthcare workers, a significant part of the manuscript allocated for that purpose. I am not sure the latter is a research?

3. I have some doubt of technical aspect of the methods. As describe in the manuscript this study is a qualitative research based on focus group discussions. At the same time, they use pretested questionnaires for data collection. To my knowledge, data were collected using recorded narratives in qualitative research instead use questionnaires. Information of these data are analyzed using standard software like Nvivo. It is difficult for me to comment anything about the method because this method is a mix of quantitative survey methods and qualitative research, which I am not familiar.

4. Commenting of statistical analysis and presentation, tables and in figures are very poorly presented. In particularly figures are powerful tools to exhibit study outcomes. It is difficult to grasp the messages going to reflect from figures and they should need significant improvements to bring into the journal standard.

5. Full of many unwanted stories, inclusion of unrelated stuffs, repeating the same information in many places, confusing non-standard English wordings and confusing sentences etc. are in everywhere of this manuscript and very hard to follow for me to read and understand about 60 pages of the manuscript.

6. Research reporting also seen some professional bias. Researchers as the allopathic medical personnel ask the traditional healers to disclose their treatments at focus group meetings in front of others. Researchers complaining they rejected to explain their treatment methods to them. I think it is not relevant for this study and these researchers don’t have a common sense about other professions.

7. I am sorry all my comments are negative here. It does not mean this manuscript does not have anything good. I didn’t spend my time to go too much deep commenting for improving the manuscript because so many technical flaws are already there.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Comments to the authors.docx

PONE-D-20-33739R1

Perceptions, awareness on snakebite envenomation among the tribal community and health care providers of Dahanu block, Palghar district in Maharashtra, India

PLOS ONE

Dear Dr. Gajbhiye,

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 submit your revised manuscript by 07-April-2021. 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. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Academic Editor Comments:

- Few errors of English grammar and use persist in the revised manuscript. Copy-edit the manuscript before proceeding with the next submission.

- Avoid abuse of capital letters throughout the manuscript (examples: line 58 - replace ''Health care workers'' with ''health care workers''; line 50: replace ''Medical Officers'' with ''medical officers'')

- Abstract: ASHA? ANM? MPW?

- Line 113-Introduction: ASV - Provide the full form in the first place of use of the abbreviation in the main text.

-Line 146-Introduction: HCW - Provide the full form in the first place of use of the abbreviation in the main text. I am aware that the abbreviation/full-form is already being considered in the 'abstract' section.

- Line 152- Methods: ICU & OPD - Provide the full forms.

- Line 170 - Methods: PHC?

- Line 171 - Methods: MSW?

- Methods-Recruitment, Sampling & Data Collection: The use of the abbreviation DA in the text apparently seems to be confusing for a term rather than the initials of a co-author. Rewrite to avoid confusion as there are other abbreviations like FGD and HCW used in the same paragraph.

- Line 280 - Results: Would you prefer to substitute ''circulating snakes'' with a better phrase?

- Lines 306-312: The scientific name of Indian cobra is mentioned, but not that of the common krait, Russell's viper and saw scaled viper. All scientific names are mentioned along side the corresponding common names in Table 1. Therefore, for the sake of uniformity, avoid using the term Naja naja in this paragraph.

- Let the ''conclusions'' drawn be based on the data/observations/results of the present study. Provide separate paragraphs on ''recommendations/future directions'' and ''implications of the present study''.

- Address the minor revisions recommended by the reviewer(s).

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

**********

2. 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: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: I Don't Know

**********

4. 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 #3: Yes

**********

5. 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: Yes

Reviewer #3: No

**********

6. 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: The comments of the three reviewers have been taken into account by the authors and necessary revisions made. The manuscript makes for a much better read now and would be of interest to readers. The scientific / generic names of the snakes to be written correctly separating genus / species. Mention to be made of which echis species- carinatus or sochureki.

Wish the authors the best and I would recommend the article for publication, which I am sure would be of interest to a lot of readers.

Thanks for having given me the opportunity to review the manuscript.

regards

Jaideep

Dr Jaideep C Menon

Cardiologist, Amrita Institute of Medical Sciences

Kochi, Kerala

Reviewer #3: See attachment.

1. The area of this research is important for India where more than 50% of global snakebite

deaths are happening there. A recent study published in E-life by Million Death Study

collaborates finds 58k deaths and 1.1 to 1.7 million bites annually in India and one million deaths

were in last 20 years. I learnt from a snakebite advocacy group meeting at ICMR, a substantial

amount of expired unused anti venom vials throwing into trash without use in every year while

many thousands die without treatments. This is a problem of either people not aware of (or trust)

anti-venom treatment in hospitals or physicians were not trained/confident enough in clinical

management of snakebite cases or both.

Response: We thank the reviewer for acknowledging the importance of snakebite research for

India.

# Thanks.

2. According to the authors, the objective of this study is to test the awareness about prevention

strategies, knowledge of first aids and treatment options among community; Snakebite patient

management among snake handlers, healers, healthcare workers and medical personnel. Another

set objective is to train the healthcare workers, a significant part of the manuscript allocated for

that purpose. I am not sure the latter is a research?

Response: As recommended, we have deleted the major text related to training of healthcare

workers.

# Glad to see many improvements in the Introduction text. I like the new text from line 184 to 208 and is appropriate.

3. I have some doubt of technical aspect of the methods. As describe in the manuscript this study

is a qualitative research based on focus group discussions. At the same time, they use pretested

questionnaires for data collection. To my knowledge, data were collected using recorded

narratives in qualitative research instead use questionnaires. Information of these data are

analyzed using standard software like Nvivo. It is difficult for me to comment anything about the

method because this method is a mix of quantitative survey methods and qualitative research,

which I am not familiar.

Response: We apologize for not clearly presenting the qualitative results. As recommended by

reviewer, the methodology and results are revised and reported as per COREQ checklist (Page

no. 7, Line no 158). We did not use the software Nvivo and manual coding was done.

# Thanks for improvements in research method. It is now somewhat more comprehensible to me. Since my knowledge in qualitative research is limited, I leave it to other reviewers and the editor to take care.

4. Commenting of statistical analysis and presentation, tables and in figures are very poorly

presented. In particularly figures are powerful tools to exhibit study outcomes. It is difficult to

grasp the messages going to reflect from figures and they should need significant improvements

to bring into the journal standard.

Response: As recommended we have substantially edited the manuscript, tables, and figures for

improved presentation as per the journal standard.

# I am OK with the revision

5. Full of many unwanted stories, inclusion of unrelated stuffs, repeating the same information in

many places, confusing non-standard English wordings and confusing sentences etc. are in

everywhere of this manuscript and very hard to follow for me to read and understand about 60

pages of the manuscript.

Response: We apologize for the inconvenience caused to the reviewer. As recommended, we

have revised the manuscript in light of the reviewer’s comments.

# A good progress can be seen in revised manuscript. I think remaining repeating information and consistency of the text in the manuscript can take care by the editor with the help of the authors at the editorial process.

6. Research reporting also seen some professional bias. Researchers as the allopathic medical

personnel ask the traditional healers to disclose their treatments at focus group meetings in front

of others. Researchers complaining they rejected to explain their treatment methods to them. I

think it is not relevant for this study and these researchers don’t have a common sense about

other professions.

Response: We did not conduct the FGD with traditional healers. We conducted interview of

traditional healers individually and not in group. The reasons for not disclosing the treatment

given by Traditional healers was explained in the manuscript.

# I am OK with the revision of the text.

7. I am sorry all my comments are negative here. It does not mean this manuscript does not have

anything good. I didn’t spend my time to go too much deep commenting for improving the

manuscript because so many technical flaws are already there.

Response: We sincerely thank the reviewer for accepting the fact that our manuscript has merit.

As per the recommendations, we have revised the manuscript substantially incorporating the

suggestions of all the reviewers and editor.

# Thanks.

# Additional comments:

Throughout this manuscript uses the words ‘envenomation’ and ‘envenoming’ interchangeably. It looks authors have not given much attention to the difference between these 2 words. I think if the bite is an accident, then the best word would be the envenoming that WHO uses https://www.who.int/snakebites/disease/en/. Also I see another word “anti-snake venom”. The correct word should be the “anti-venom”. Refer same WHO and recent leading research articles on Snakebites.

**********

7. 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: Yes: Jaideep C Menon

Reviewer #3: 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/. 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.

Attachments

Attachment

Submitted filename: To.docx

Attachment

Submitted filename: Revewer report WS (post response).docx

PONE-D-20-33739R2

Perceptions, awareness on snakebite envenoming among the tribal community and health care providers of Dahanu block, Palghar district in Maharashtra, India

PLOS ONE

Dear Dr. Gajbhiye,

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 submit your revised manuscript by 30-May-2021. 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. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

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2. 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 #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

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4. 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 #3: Yes

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5. 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 #3: No

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6. 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 #3: I am glad to see a reasonable progress in revised manuscript. Thanks, authors have well responded to my initial comments and no any technical issues from me.

Even tough I said no issues from me, manuscript needs a significant language improvement, condense the long descriptions squeeze into shorter, and eliminate all remaining repetitions and unrelated texts before publishing.

It is a serious challenge for editor and authors but would not be a big issue if you work seriously. Good luck

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Reviewer #3: Yes: Wilson Suraweera

[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.

Perceptions, awareness on snakebite envenoming among the tribal community and health care providers of Dahanu block, Palghar district in Maharashtra, India

PONE-D-20-33739R3

Dear Dr. Gajbhiye,

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.

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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,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE