PONE-D-21-39587Measurement of Stress Appraisal (SAM) of German Dentists Examining Children and Adolescents with Autism Spectrum DisordersPLOS ONE

Dear Dr. Reis,

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.

Having intensively double checked your re-submitted draft, two of our external reviewers have forwarded strongly contrasting recommendations. Consequently, I also have inspected your submission (see R #1), to come to a more balanced decision. Please note that your manuscript would not seem satisfying, and is not considered ready to proceed. Indeed, some most critical aspects would seem in need of a thorough discussion. With your re-revision, you should follow the reviewers' comments added below, to finalize your paper convincingly, and to meet both Plos One's quality standards and our readership's expectations.

In order to expedite the processing of the revised manuscript, please make sure to address each of the criticized aspects and incorporate all your carefully elaborated responses within the manuscript. Your rebuttal letter should include point-by-point responses to the reviewer comments, even if you happen to disagree with them, or feel not being able to incorporate all the suggested feedback. Thus, I would like to encourage you to provide a thorough (in terms of language, reviewers' constructive criticism, content, generalizable outcome, and/or Authors' Guidelines) revision in order to avoid an iterative and lengthy review process and facilitate a smooth publication process. Please remember that Plos One will not provide an in-depth copy-editing service, and this requires flawless manuscripts to proceed.

Please submit your revised manuscript by Apr 23 2022 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:

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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Andrej M Kielbassa, Prof. Dr. med. dent. Dr. h. c.

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

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2. Please amend your current ethics statement to address the following concerns:

a) Did participants provide their written or verbal informed consent to participate in this study?

b) If consent was verbal, please explain i) why written consent was not obtained, ii) how you documented participant consent, and iii) whether the ethics committees/IRB approved this consent procedure.

3. Thank you for stating the following financial disclosure:

 “The authors declare that the study was funded by the Department of Special Care Dentistry at Witten/Herdecke University and the Department of Child and Adolescent Psychiatry, Psychotherapy and Neurology of Childhood and Adolescence at the Gemeinschaftskrankenhaus

Herdecke as part of a collaborative project between the two departments. This scientific project is financially supported by the Software-AG-Foundation based in Darmstadt/Hesse, Germany.”

Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

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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: No

Reviewer #2: No

Reviewer #3: Yes

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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

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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: Yes

Reviewer #2: No

Reviewer #3: Yes

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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: Abstract

- "(...) sent to members of the German Society of Paediatric Dentistry (DGKiZ) via a link to participate." Please add number of members having been invited to participate.

- "92 participants (11 male, 81 female) fully completed the questionnaire." Must read "Ninety-two participants (...)", please re-edit. Indeed, 92 would seem a poor number only. Why do you think that this would result in some kind of representative outcome?

- "(...) and in some cases there were high intercorrelations between the scales, (...)." Please provide exact results, give r and p values. Phrases like "some cases" or "high intercorrelations" would not seem acceptable. Please remember that future readers will decide switching to your full text AFTER having read your Abstract section.

- "This could be reasoned in the circumstance that the participants in the present study were generally very experienced in treating children, including children e.g. with underlying diseases." This would not seem astonishing. Do you see any news from your study, not only confirmative ones?

- "In future, dentists who rarely treat children could also be surveyed in a further, larger study." Do not stick to meaningless phrases here. With your Conclusions, please stick exclusively to your revised aims (see comments given below). Do not simply repeat your results (or even speculate) here. Instead, provide a reasonable and generalizable extension of your outcome.

Intro

- This study has been finished, right? "The purpose of the present study is to check (...)" must read "The purpose of the present study was to check (...)".

- Same with "(...) is examined."

- Both aims and objectives elaborated here would seem convincing. However, "SAM’s utility" aspects should be mentioned with your Abstract section, too. Please revise/adapt carefully.

Meths

- Do not use legal terms like GmbH, ®, and so on.

- With ALL materials and methodologies (including statistical software), please use general names with your text, followed by (brand name; manufacturer, city, ST [if US], country) in parentheses. Stick to semicolon. Revise thoroughly.

- "Before the start of the study, a positive vote for carrying out the survey was obtained from the board of the DGKiZ." What about the positive vote of an Ethical Committee? Please provide vote number and date of approval.

- "Since the data collection was planned in accordance with the European General Data Protection Regulation and represents an expert survey, a formal ethics application to the responsible ethics committee of the Witten/Herdecke University was not performed before the start of the project." This would seem astonishing. An "expert survey" does not need an ethical approval? Please provide a sound and reliable reference.

- "(...) successfully sent to 1.725 e-mail addresses (...)." Please see comments given above. With 92 respondents, some 5% have participated only, and this would not seem a reliable database, don't you think so?

- "(...) This measures cognitive processing mechanisms and perceived stressfulness in the event of acute stress [26]. Peacock and Wong see the transactional stress model as the basis of their questionnaire [34,35]. According to this model, stress arises from (...)." This does not seem to refer to your methodology, but might be discussed later. Please revise carefully, and focus on the methodology here.

- Reduce repeated mentioning of Author names, please (see, for example, "Peacock and Wong", but this also refers to other names). Instead, please focus on your main thoughts, to ensure readability (Authos' previous work will be acknowledged with your References section).

- Legend Fig 1: Please do not repeat the full reference here, see comments given above. [Number] will be sufficient.

- Same with legend of Table 2 and Table 4.

Results

- Revise carefully for any typos. See, for example, Table 1, "(e.g. students. persioner)".

- "The Kaiser-Meyer-Olkin coefficient as a measure of sample suitability was .80. Since this value was above the lower limit of .50, a factor analysis could be carried out [37]." Please provide more information on the "suitability". Again, see comments given above, and remember that 92 respondents would not seem convincing.

- Please double check, and revise for correct inter punctuation. See "(β = .64. R2 = .41 p <.01)".

- Again, several aspects should be explained and discussed in the Discussion section. Here, please focus on the results.

Disc

- "To our best knowledge, there is no study that specifically deals with the psychological and physical stress on dentists from Germany when treating children and adolescents with ASD." It would seem unclear why "dentistry from Germany" have been considered important for the Authors. What would predispose "German dentists" from other nations? What about the transferability of your outcome to other dentists from other countries?

- "This study now offers this information for the first time." And now? Again, why do you think that his would be important?

- Again, please revise for minor shortcomings, see "Since the majority of our study participants already had of professional experience of (...)."

Concl

- Remember that this section is not a second summary. Again, with your Conclusions, please stick exclusively to your revised aims. Do not simply repeat your results (or even speculate) here. Instead, provide a reasonable and generalizable extension of your outcome, which must be based on your results.

- The current version of this section would seem right, but major aspects must be provided with the Discussion section, since these are not considered conclusions from your study.

Refs

- Please stick to the Journal guidelines, and consults some recently published Plos One papers.

- Style would be "Tanagawa M, Yoshida K, Matsumoto S, Yamada T, Atsuta M. Inhibitory effect of antibacterial resin composite against Streptococcus mutans. Caries Res. 1999; 33(5): 366–371. https://doi.org/10.1159/ 000016535 PMID: 10460960" Revise thoroughly.

In total, this submitted draft would seem interesting, is considered easily intelligible, and should be worth following after a thorough revision, following the aspects given above. Additionally, the manuscript is ready for external review.

Reviewer #2: Many thanks for asking me to review this paper.

Overall summary

While I acknowledge there is little data available on this topic in Germany, overall I do not feel this paper merits publication in a prestigious journal like PLOS ONE. The questionnaire response rate of 5% is inadequate and liable to survey error and a high degree of reporting bias.

It may have been more prudent for the investigators to find new ways of engaging with the survey population to yield an improved response rate to the survey, rather than attempt to publish a questionnaire survey with such a poor response rate. As almost 95% of the survey population did not respond, I do not feel any credible conclusions can be drawn on the views of German paediatric dentists towards treating children and adolescents with autism spectrum disorders.

I have some further more specific comments to share below that may help to improve the paper, should attempts be made to improve its methodological rigour:

The title of the paper could be revised to represent the fact that it is a questionnaire study and restricted to paediatric dentists.

The paper is difficult to follow and would benefit from a technical restructure to provide a clearer rationale for the research question, clearer explanation of background context and greater clarity over terms used to define the population of interest and why this particular methodology was chosen. There may be more appropriate methodologies for investigating this topic and it doesn’t feel like this approach has elucidated the views of German paediatric dentists in a complete and comprehensive way. The methodology appears overly complex for such predictable results, which leads me to think why this research was necessary.

I fully appreciate the authors are using a second language, but in places it is not clear what is meant, in particular in the background are references being made specifically in regard to autism spectrum disorders or disability/mental disorders more generally?

In terms of the methods there are insufficient details of the questionnaire development (piloting and refinement of the tool), administration (for example how were duplicate entries managed, or ineligible individuals accounted for), anonymity, storage and management of the data, and there is no reference to efforts to maximise the response rate. A recruitment diagram would aid reader understanding of the process and response and completion rates. Particularly as the response rate is only referred to in the conclusion section. In addition, a copy of the questionnaire should be provided as an online appendix to accompany the paper.

The rigour of the results and corresponding conclusions can only be appraised based on a more robust response rate, which is not observed in this work.

Reviewer #3: Summary

The manuscript is well written and particularly scientifically sound as the results of the study are given in elaborate detail. The data analysis is very extensive and the regression analysis is discussed in great depth. The study clearly highlights the novel element of using the SAM as a survey tool for measuring stress perceptions and stress appraisal.

Minor Revision

However there are few points that still need further elaboration:

1. It would be helpful for the reader if the authors added a few lines explaining the terms used for the seven subscales (threat, centrality, controllable-by-self, controllable-by-others, uncontrollable, challenge and stressfulness) and what they denote in light of the study.

2. There is a very detailed representation of data in Table 1 regarding the demographic aspects of the study but no mention of these results in the discussion. It would be interesting to see how age, gender and the working arrangement of the dentists relate to the psychological and physical stress experienced by them when treating children with ASD. There is a clear majority of females in the study and its relation to the results must be highlighted in the discussion.

3. More references of studies done in other parts of the world can strengthen the discussion especially those studies where dentists having less experience are questioned for the study.

4. Line 65, the word should be ‘based’

5. Line 113, what is the meaning of ‘resp’ or is it a typo?

6. Line 338, a in place ‘of’

7. Line 393, ‘states’ instead of ‘statements’.

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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

Reviewer #3: Yes: Dr Fatima Suhaib

[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.

PONE-D-21-39587R1Is examining children and adolescents with autism spectrum disorders a challenge? - Measurement of Stress Appraisal (SAM) in German dentists with key expertise in paediatric dentistryPLOS ONE

Dear Dr. Reis,

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.

I have read your re-submitted version, to double check your revisions prior to forwarding your paper to the reviewers (see R #1). Having intensively reviewed your revised draft, our external reviewers differed considerably with their final recommendations. Please note that your current version still would benefit from thorough re-edits, please see the comments of one of external reviewers below. Thus, I would like to encourage you to provide a thorough (in terms of language, reviewers' constructive criticism, content, generalizable outcome, and/or Authors' Guidelines) revision in order to avoid an iterative and lengthy review process and facilitate a smooth publication process. Please note that a further non-conning version of your draft must lead to outright reject. Comments from external reviewer:While I acknowledge the authors have made significant attempts to address my points and there are improvements to the manuscript, I am still of the opinion that the study lacks meaningful results due to coverage issues which have limited impact. 

Although the response rate to the survey is mentioned more explicitly as a key limitation in the study, and it is now mentioned appropriately in the abstract, reference to it is still missing from the results section. An overall response rate should be presented in the first line of the results section to ensure readers understand the context to the results and how many respondents they relate to, this is a key expectation in cross sectional studies. I am aware that many journals will not publish a cross sectional survey with such a low response rate and I am not convinced the authors responses adequately address the issue of quality in their approach. 

The results of the study are not particularly remarkable, as one would expect dentists with an interest in paediatric dentistry to experience less stress when treating children and adolescents with ASD. Again, this for me is a design flaw and the study might have applied an alternative design to elucidate the views of different type of dentists, which might of provided some greater insight into the issue. Indeed, the conclusion of the paper appears to recommend 

“special training sessions in special needs dentistry for dentists involved in the treatment of children and adolescents with ASD” 

but I am not sure the results of this study substantiate this point and it is not clear if the paper is recommending more training for paediatric dentists or the general dental population. I suspect it is the latter but that cannot be made based on the results of this study. This study provides only data on the utility of SAM in measuring stress response and the perceived levels of stress in a small sample of pediatric dentists.

Please submit your revised manuscript by Jul 10 2022 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: https://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,

Andrej M Kielbassa

Academic Editor

PLOS ONE

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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 #2: All comments have been addressed

Reviewer #3: (No Response)

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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 #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: I Don't Know

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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 #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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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 #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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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 #1: With the help of the reviewers, this revised and re-submitted draft has been considerably improved, and is considered ready for external review.

Reviewer #2: (No Response)

Reviewer #3: While the authors have made some improvemnets in the article however I still feel that there should be mention of similar studies done in other parts of the world as it gives a bigger picture of the challenges faced in dealing with children with Autism.

If the the authors can highlight this point then it is acceptable for publication.

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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: No

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.

Is examining children and adolescents with autism spectrum disorders a challenge? - Measurement of Stress Appraisal (SAM) in German dentists with key expertise in paediatric dentistry

PONE-D-21-39587R2

Dear Dr. Reis,

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.

Congratulations, and stay healthy, please...

Prof. Dr. med. dent. Dr. h. c. Andrej M. Kielbassa

Academic Editor

----------------------------------------- 

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,

Andrej M Kielbassa

Academic Editor

PLOS ONE

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: All comments have been addressed

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 #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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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 #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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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 #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

**********

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: This revised and re-submitted draft is considered ready for external review.

------------------------------------------------------------------------------------

Reviewer #2: (No Response)

Reviewer #3: (No Response)

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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: No

Reviewer #2: No

Reviewer #3: No

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