Do patients’ characteristics influence their healthcare concerns?—A hospital care survey

George G. A. Pujalte; Isaac I. Effiong; Tais G. O. Bertasi; Raphael A. O. Bertasi; Susannah S. Rothstein; Ryan Cudahy; Lorenzo O. Hernandez; Timothy M. Davlantes

doi:10.1371/journal.pone.0258618

Peer Review History

Original SubmissionAugust 4, 2020
8 Mar 2021 Decision Letter - Sharon Mary Brownie, Editor PONE-D-20-24334 Do Patients’ Characteristics Influence Their Healthcare Concerns? – A Hospital Care Survey PLOS ONE Dear Dr.Tais Garcia de Oliveira Bertasi, 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 10 April. 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, Sharon Mary Brownie 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 Additional Editor Comments Reviewers have offered a significant number of recommendations to strengthen your paper. Please respond in full to each suggestion offered 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: Yes Reviewer #2: Partly Reviewer #3: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #3: Yes ****** 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: No Reviewer #3: No ****** 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: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 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: 1. if a linelist of the potential samples were made to select study samples at random. 2. could all the tables and figures have a title on the top of each. 3. could there be chance of recall bias particularly for aged respondents while the interview was done 50 or more days after discharge from the hospital. 4. The demographic information table (table 1) could contain information of distribution of respondents by gender and age group. Reviewer #2: It is not possible to interpret the findings in the absence of information on the randomization process and the response rate to the survey, both overall and in terms of key characteristics of the repondents Reviewer #3: This is an interesting study, but there are some concerns that need to be addressed. After reading the introduction, I was unsure whether the authors disagree with using the CAHPS for reporting hospital quality or not. Although the CAHPS/CMS aggregates measures for hospital reporting (e.g., hospital compare), researchers could request the data to understand more granular level information and patterns (e.g., patient characteristics). Link: https://hcahpsonline.org/globalassets/hcahps/survey-instruments/mail/qag-v16.0-materials/2021_survey-instruments_english_mail.pdf I would encourage the authors to review sections of the introduction. For example: “Some factors that affect patient survey scores may not be directly related to hospital performance. [5] Characteristics of different patient populations may make certain parts of the survey more relevant than others. Hospitals may have very little control on the education level and age of patients who present for care. It is known that more educated and younger patients tend to evaluate health care less positively.” I would hope that hospitals “want” to treat everyone equally. Surveys are designed to get a range of responses that would be representative of the overall population. The authors mentioned “A survey developed via literature review and specialist recommendations was applied in different departments of our tertiary care center during the year of 2016.” More information about how the survey questions were developed is needed. What article(s) or literature was used to develop the questions? It is unclear to me why the patients needed to be recently admitted to the hospital or admitted more than 50 days before the survey was being applied. Explaining this range may be important. In addition, what does it mean to be recently admitted? More details are needed about “The investigators randomly approached the patients in different hospital departments to solicit their participation.” Are these the authors in the paper, RAs, others? How many investigators were conducting the surveys? Why were participants approached randomly? I would assume that the investigators were hoping for some representation. How many people declined to participate? In the discussion, the authors mentioned that “‘Acquiring an infection while receiving health care is also known as “health care-associated Infections” (HAI) [11]’” They may need to expand about how common these infections are and provide some explanations as to why they believe this was the top concern. The authors also mentioned that “physicians conducted the surveys, which may have influenced the responses.” How do the authors believe that this may have influenced the responses? Finally, these data are somewhat dated. The authors may need to include a paragraph in the discussion about how the current epidemic may have changed/influences or make these survey more relevant. ****** 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: Yes:** Dr. Md. Ziaur Rahman Reviewer #2: No 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. https://doi.org/10.1371/journal.pone.0258618.r001
Revision 1
28 Jul 2021 Author Response Reviewer's Responses to Questions 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: Yes Reviewer #2: Partly Reviewer #3: Partly 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #3: Yes 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: No Reviewer #3: No 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: Yes Reviewer #2: Yes Reviewer #3: Yes The authors appreciate the reviewers’ availability and great suggestions. We made several edits to the manuscript and included Appendix 2 with the raw data collected with the survey answers. Reviewer's Comments to the Author REVIEWER 1: 1. If a linelist of the potential samples were made to select study samples at random. The authors appreciate your comment. The randomization process was included in the Methods section and is described below in the answer for the 1st comment from Reviewer 2. 2. Could all the tables and figures have a title on the top of each. Thank you for your suggestion. We included a title on the top of the figures and table. 3. Could there be chance of recall bias particularly for aged respondents while the interview was done 50 or more days after discharge from the hospital. The authors appreciate your comment. We have indicated this possibility in the limitations section. 4. The demographic information table (table 1) could contain information of distribution of respondents by gender and age group. Thank you for your suggestion. We added the age and sex information on Table 1. REVIEWER 2: 1. It is not possible to interpret the findings in the absence of information on the randomization process and the response rate to the survey, both overall and in terms of key characteristics of the respondents The authors appreciate your comment. The randomization process was included in the Methods section. The authors of the study were the investigators who approached patients in waiting rooms in all the Mayo buildings, in hospital rooms, and patient rooms, depending on the setting they are in, at various days of the study period. They asked if patients were recently hospitalized if they were in the waiting room or patient room. A total of 142 patients declined participating in the study, with a response rate of 64.8%. Consent was obtained for those interested and study survey was given. Participants were approached randomly to maximize experience breadth. For example, if only patients in one building were approached, only patients admitted into specific services (e.g. Family Medicine, Internal Medicine, Rehabilitation Medicine) would be surveyed. The authors wanted to cover all experiences from admission into all services offered in the hospital, as much as possible and hoped that by spreading out in this manner, there would be good representation of all types of patient admission. REVIEWER 3: This is an interesting study, but there are some concerns that need to be addressed. 1. After reading the introduction, I was unsure whether the authors disagree with using the CAHPS for reporting hospital quality or not. Although the CAHPS/CMS aggregates measures for hospital reporting (e.g., hospital compare), researchers could request the data to understand more granular level information and patterns (e.g., patient characteristics). Link: https://hcahpsonline.org/globalassets/hcahps/survey-instruments/mail/qag-v16.0-materials/2021_survey-instruments_english_mail.pdf Thank you for your comment and for the link. The authors agree that it was not clear whether we disagree with using the CAHPS for reporting hospital quality. Therefore, we included some sentences at the end of the Introduction section to make it clearer and to explain that the aim of our study is to understand in more detailed the patients’ concerns behind each response to those surveys. 2. I would encourage the authors to review sections of the introduction. For example: “Some factors that affect patient survey scores may not be directly related to hospital performance. [5] Characteristics of different patient populations may make certain parts of the survey more relevant than others. Hospitals may have very little control on the education level and age of patients who present for care. It is known that more educated and younger patients tend to evaluate health care less positively.” I would hope that hospitals “want” to treat everyone equally. Surveys are designed to get a range of responses that would be representative of the overall population. The authors appreciate your comment. We have changed the introduction to make our message clearer. 3. The authors mentioned “A survey developed via literature review and specialist recommendations was applied in different departments of our tertiary care center during the year of 2016.” More information about how the survey questions were developed is needed. What article(s) or literature was used to develop the questions? Thank you for your suggestion. We included the references of the literature used to develop the survey. 4. It is unclear to me why the patients needed to be recently admitted to the hospital or admitted more than 50 days before the survey was being applied. Explaining this range may be important. In addition, what does it mean to be recently admitted? Thank you for your comment. Recently admitted means admitted within 1-2 weeks. The survey from Mayo Clinic usually arrives more than 50 days after patients are admitted. The reason for this is unclear but may be because surveyors want to determine what remains in patients’ recollections after such a period of time has elapsed. 5. More details are needed about “The investigators randomly approached the patients in different hospital departments to solicit their participation.” Are these the authors in the paper, RAs, others? How many investigators were conducting the surveys? Why were participants approached randomly? I would assume that the investigators were hoping for some representation. How many people declined to participate? The authors of the study were the investigators who approached patients in waiting rooms in all the Mayo buildings, in hospital rooms, and patient rooms, depending on the setting they are in, at various days of the study period. They asked if patients were recently hospitalized if they were in the waiting room or patient room. Consent was obtained for those interested and study survey was given. Participants were approached randomly to maximize experience breadth. For example, if only patients in one building were approached, only patients admitted into specific services (e.g. Family Medicine, Internal Medicine, Rehabilitation Medicine) would be surveyed. The authors wanted to cover all experiences from admission into all services offered in the hospital, as much as possible and hoped that by spreading out in this manner, there would be good representation of all types of patient admission. A sentence was included in the Methods section to make it clearer. A total of 142 patients declined participating in the study (the response rate was included in the Results section) 6. In the discussion, the authors mentioned that “‘Acquiring an infection while receiving health care is also known as “health care-associated Infections” (HAI) [11]’” They may need to expand about how common these infections are and provide some explanations as to why they believe this was the top concern. Thank you for your suggestion. The authors included a few sentences in the Discussion section about the frequency of HAIs and why we believe this was a top concern for the patients. 7. The authors also mentioned that “physicians conducted the surveys, which may have influenced the responses.” How do the authors believe that this may have influenced the responses? The authors believe that having physicians conducting the surveys may have influenced who they gave surveys to. For example, physicians may not want to give the surveys to patients they took care of. However, the authors/investigators tried not to be affected by this factor when giving out the surveys. 8. Finally, these data are somewhat dated. The authors may need to include a paragraph in the discussion about how the current epidemic may have changed/influences or make this survey more relevant. The authors appreciate this interesting comment. We included a comment about this in the discussion section. Attachments Attachment Submitted filename: Response to Reviewers.doc https://doi.org/10.1371/journal.pone.0258618.r002
18 Aug 2021 Decision Letter - Sharon Mary Brownie, Editor PONE-D-20-24334R1 Do Patients’ Characteristics Influence Their Healthcare Concerns? – A Hospital Care Survey PLOS ONE Dear Dr.Tais Garcia de Oliveira Bertasi, 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 September 20. 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, Sharon Mary Brownie 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. Editor Comments Reviewers have requested some additional information and improvements in your methods section. Please pay careful attention to what is requested and respond appropriately. 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 #2: (No Response) ******** 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 #2: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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 #2: No ****** 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 #2: Yes ****** 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 respondent selection criteria regarding hospital admission as mentioned."recently admitted or admitted more the 50 days before the survey was applied" is not clear. If data was collected from patients admitted a week before or 90 days before data collection. Should it not be a range e.g. admitted 10 - 50 days before data collection. Reviewer #2: This version does not address my previous comments. Simply stating that patients were approached randomly does not adequately describe the randomisation process. Further, the response rate according to key characteristics is not provided. It could be that the response rate varied significantly by race, education, age gender etc, so introducing potential biases. This information is required for a determination of the validity of the findings ****** 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: Dr. Md. Ziaur Rahman, Epidemiologist and Public Health Specialist Reviewer #2: Yes:** Prof Ian Ring [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.0258618.r003
Revision 2
23 Sep 2021 Author Response REVIEWER #1: The respondent selection criteria regarding hospital admission as mentioned, "recently admitted or admitted more the 50 days before the survey was applied" is not clear. If data was collected from patients admitted a week before or 90 days before data collection, should it not be a range (e.g. admitted 10 - 50 days before data collection)? The authors agree with your comment. The methodology section was rewritten in agreement with your recommendation. REVIEWER #2: This version does not address my previous comments. Simply stating that patients were approached randomly does not adequately describe the randomisation process. Further, the response rate according to key characteristics is not provided. It could be that the response rate varied significantly by race, education, age gender, etc., so introducing potential biases. This information is required for a determination of the validity of the findings. The authors appreciate your comment. The methodology section was rewritten to address the previous comment. Regarding the response rate, as it is possible to see on the appendix showing all data, the maximum of missing answers for each of the nine questionnaire questions were from two participants; this fortunately would not make a statistically significant difference when accounting for race, education, age, and gender. However, the reviewer made a great point, and the potential bias is now included in the limitations section. Attachments Attachment Submitted filename: Response to Reviewers.doc https://doi.org/10.1371/journal.pone.0258618.r004
4 Oct 2021 Decision Letter - Sharon Mary Brownie, Editor Do Patients’ Characteristics Influence Their Healthcare Concerns? – A Hospital Care Survey PONE-D-20-24334R2 Dear Dr. Tais Garcia de Oliveira Bertasi, 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, Sharon Mary Brownie Academic Editor PLOS ONE Editor Comments Reviewer comments have been fully addressed. Reviewers' comments: https://doi.org/10.1371/journal.pone.0258618.r005
Formally Accepted
7 Oct 2021 Acceptance Letter - Sharon Mary Brownie, Editor PONE-D-20-24334R2 Do Patients’ Characteristics Influence Their Healthcare Concerns? – A Hospital Care Survey Dear Dr. Bertasi: 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 Professor Sharon Mary Brownie Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0258618.r006

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