PONE-D-21-23236Predictors of fall risk among community-dwelling older adults: cross-sectional study from Palestine.PLOS ONE

Dear Dr. Badrasawi,

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.

The manuscript has been evaluated by three reviewers, and their comments are available below.

The reviewers have raised a number of major concerns that need attention. They request additional information on methodological aspects of the study, revisions to the statistical analyses and they question the internal and external validity of the results reported.

Could you please revise the manuscript to carefully address the concerns raised?

Please submit your revised manuscript by Jul 02 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,

Sebastian Shepherd

Staff Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at 

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

We will update your Data Availability statement to reflect the information you provide in your cover letter.

3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. 

In your revised cover letter, please address the following prompts:

a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories.

We will update your Data Availability statement on your behalf to reflect the information you provide.

4. Please upload a new copy of Figure 2 as the detail is not clear. Please follow the link for more information: https://blogs.plos.org/plos/2019/06/looking-good-tips-for-creating-your-plos-figures-graphics/" https://blogs.plos.org/plos/2019/06/looking-good-tips-for-creating-your-plos-figures-graphics/

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

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: No

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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 authors looked into the relationship between fear of falling and several multi-domain parameters in Palestinian older adults. The manuscript is generally well written. The authors are to be commended for that. Though the topic is not novel, it could be potentially interesting for the readers of PLOS ONE. However, some issues are to be addressed before the manuscript can be accepted for publication.

Abstract

1. “Fear of falling is a major health problem....”. This is an exaggeration. FOF has serious implications for health, which can be major health problems, but that’s just an indirect relationship. Please rephrase.

2. Several scientific journals from the field or gerontology and geriatrics either advice again or even prohibit using the word “elderly” in submitted manuscripts, as this is a pejorative term. Please use “older adults” or other terms instead throughout the manuscript.

3. “The Falls Efficacy Scale-International in order to predict falls among Palestinian older adults”: The sentence is incomplete. Please rephrase.

4. At the results section the Timed Up-and-Go test is mentioned, although it wasn’t listed in the methods section. (Note that the TUG test does not fall under the category “ADL or IADL)

Introduction

5. “occasional fall”: Do you mean maybe “accidental fall”?

6. “… a ground of high rates…”: what does this mean? Please rephrase

7. There are plenty of previous studies assessing the relationships between fear of falling and various multidisciplinary factors (partly the exact same with the ones used in this study); many of them even using a more robust design (longitudinal studies)*, which is more appropriate to define an outcome`s predictors. What is the exact research gap the authors try to address with this study? Does it have to do with the ethinicity of this sample? If so, how are Palestinians different from the samples of previous studies? Are different results expected?

*e.g:

Austin, N., Devine, A., Dick, I., Prince, R., & Bruce, D. (2007). Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors. Journal of the American Geriatrics Society, 55(10), 1598-1603.

Rivasi, G., Kenny, R. A., Ungar, A., & Romero-Ortuno, R. (2020). Predictors of incident fear of falling in community-dwelling older adults. Journal of the American Medical Directors Association, 21(5), 615-620.

8. What is the reason for choosing the selected parameters as predictors of FOF in this study?

Methods

9. How can the authors be sure that this was a “representative” sample of Palestinian older adults?

10. Why wasn’t the sample size calculation based on the regression analysis, which was also the main analysis of the study?

11. The last paragraph of the “sample size calculation and sampling method” is a bit confusing (mostly linguistically). Please rephrase.

12. Why were nutritionists selected as an appropriate profession to conduct motor functioning geriatric assessments?

13. There are several typos/language errors throughout the manuscript. Please make a careful check before re-submission.

14. What was the rationale for building two categories of people based on their sleeping duration/problems? What does that have to do with FOF and the overall aims of the study and analysis? And what is the classification based on? Please explain and also provide references.

15. “Many screening instruments are available to assess concerns about falling among elderly people”: I am not familiar with any other besides the FES. Can you please name some?

16. The section “nutritional status” barely contains anything related to nutrition. A title like “Body Composition” seems more appropriate.

17. “Cognitive function was assessed using a validated Arabic version of the short geriatric depression scale (GDS-15) in order to detect depression among older adults”, and “The presence of depressive symptoms was assessed using a validated Arabic version of Montreal cognitive assessment –basic to detect mild cognitive impairment.”: Depression and cognition may be often related but there are completely different constructs. Please explain what you mean.

18. ADL and iADL are highly correlated. Why use both as possible predictors and have you checked for multicollinearity?

Results

19. Figures 1 and 2 are a too simplistic and in my opinion unnecessary. The information presented there can be easily integrated into the text (which was partly already done-in figure 2)).

20. Please discuss the unbalance between the number of men and women in the sample and how this can affect the results.

21. The descriptive results take up most of the results section. I suggest to shorten and focus on the associations.

22. “Table 3 shows the relationship between…..”: This table presents descriptive results (means). In what way can relationships be derived from this table?

Discussion

23. Why was such focus given on nutrition (in the discussion but also throughout the manuscript) when nutrition is just one of the many factors that potentially relate to FOF? Following up on this point, why was nutrition even selected as a factor? Please explain the direct (if it exists) relationship between nutrition and FOF.

Reviewer #2: I have reviewed the manuscript entitled Predictors of fall risk among community-dwelling older adults: cross-sectional study from Palestine. Please see my comments below.

Please use the term older adults instead of elderly

Abstract

Present first the assessment used for fall, as it is the main variable of the study.

Present the % of men, women

Present statistical results to support the findings

Conclusion, does not make the responsibility for healthcare professionals and yes tell about policies and procedures. Because this is a correlational study, conclude using this aspect and not about interventions.

Introduction

The introduction presents important information. Because this could be one of the first study in Palestine (it is not possible to confirm as not all studies are available online and in databases), the authors could explain what the particular relevance of this study for the Palestinian population and healthcare are. Also, do not forget to identify the missing in the literature this study wants to cover and the state the study-question. Do not forget to link the conclusion section with the study question.

Methods (please use Methods and not Methodology)

Report fear of falling first

For the heading of Cognitive function, change for Depressive Symptoms and Cognitive function as you are presenting GDS and MOCA.

Statistical analysis section needs to be expanded, giving more details, in special about the regression analysis. This should be as a receipt, telling step by step, you can refer the Tables and figures in the results.

Results

All the topics about patients’ recruitment should appear in the Methods section and not Results.

Tables need to be formatted.

Reviewer #3: Thank you for inviting me to review this manuscript. This study is about falls risk predictors among community-dwelling older adults in Palestine. Although well-intended, the study has shortcomings that limit my enthusiasm.

A first comment is for the (in)congruence between the title – “Predictors of fall risk…” and the aims of the study - “… to investigate risk for fear of falling among Palestinian older adults….” . Risk of falls and risk for fear of falling are conceptually different. Fear of falling can be a determinant of risk of falls and also a consequence of falls. So, the authors need to be clearer about the differences. In fact, when I read the manuscript, it seems that the authors intended to explore factors related to fear of falling, rather than to risk of falling. In this sense, please elaborate more on the relation about predictors of fear of falling -fear of falling – and risk of falling.

Moreover, predictors of falls or predictors of fear of falling are well established in the literature, thus I cannot see what the novelty of this study is, beside cultural issues, like being conducted among Palestinian older population. If this is the case, the authors should address how cultural issues might have impacted the results in the discussion section.

In the Introduction, the background needs to be updated regarding epidemiological data about the world aging population, as there are recent references about demographic projections besides that of Newgarde et al. 2013. Since FES-I is the instrument used to assess the variable of interest in this study, the authors also need to revise the different constructs of fear associated with falls and revise which construct they really are aiming to assess – Concern about falling. For inspiration read this article:

J Aging Health. 2011 Feb;23(1):3-23. doi: 10.1177/0898264310378039. Epub 2010 Sep 17.

Reconceptualizing the role of fear of falling and balance confidence in fall risk.

Hadjistavropoulos T1, Delbaere K, Fitzgerald TD.

A last comment regarding the background is related to the 4th paragraph. A more clear and sustained relation about the fear of falling and variables such as mobility, functional decline, depression, activity restriction, just to name a few, should be emphasised.

The methods section is not presented in a standard way: Study design, Participants, Data collection; data analysis.

Regarding exclusion criteria, how was “having dementia” assessed? Were participants allowed to use walking aid?

Did participants report a history of falls in the last 3, 6 or 12 months?

Please provide cut-off scores for the IPAQ and interpretations.

Please go into more detail regarding the psychometric properties of the instruments used (e.g., FES-I, MOCA, GDS, TUG, etc.)

GDS does not assess cognitive function but depressive symptoms. Please correct this information for DGS and MOCA

In the results section, there are too many tables and figures that are not easy to follow.

Please provide a table describing the sample’s sociodemographic, without separating women and man. It is not clear why the authors present data for men and women separately without any statistical analysis between them in Table 1. Finally, all the English must be carefully revised.

**********

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: Eleftheria Giannouli

Reviewer #2: Yes: Allan Bregola

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.

PONE-D-21-23236R1Predictors of fear of falling among community-dwelling older adults: cross-sectional study from Palestine.PLOS ONE

Dear Dr. Badrasawi,

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.

==============================

ACADEMIC EDITOR: You did a good job on responding to the previous reviewers comments and suggestions. However, since the previous reviewers were not responsive, we had to send it to other reviewers. Please, revise according to their suggestions and submit it again. 

==============================

Please submit your revised manuscript by Nov 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,

Aqeel M Alenazi

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 Editor Comments:

You did a good job on responding to the previous reviewers comments and suggestions. However, since the previous reviewers were not responsive, we had to send it to other reviewers. Please, revise according to their suggestions and submit it again.

[Note: HTML markup is below. Please do not edit.]

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 #4: All comments have been addressed

Reviewer #5: All comments have been addressed

Reviewer #6: (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 #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

**********

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

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

**********

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 #4: Yes

Reviewer #5: Yes

Reviewer #6: 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 #4: Yes

Reviewer #5: Yes

Reviewer #6: 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 #4: Fear of falling and its predictors among older adults is an important topic. Exploring those factors in specific community would help health care providers detect fear of falling early on and address them before getting serious injuries.

Authors of this manuscript did a great job in investigating several important factors and analyze the results in the appropriate statistics.

Reviewer #5: 1. Under Sample size and sampling techniques: a small country divided into three regions (south, center, and south) need to correct it.

2. Reference: there is differences in the reference style

Reviewer #6: Overall, this is a well-written manuscript of a well-designed study. I am highlighting the areas in which I believe the manuscript could be clarified or improved.

Abstract:

1. For abbreviations and acronyms spell out the full term at its first mention, like ADL, IADL

Introduction:

-Please add appropriate reference in the first paragraph

- I would suggest adding a paragraph talking about falls and fear of falling in the Middle east, and emphasize how serious and prevalent is fear of falling. ( suggested articles DOI: 10.1016/j.archger.2019.04.006, DOI: 10.1111/ajag.12673 , DOI: 10.1016/j.archger.2018.08.001

Methods:

- In the method section, the author should report whether there is any data missing and how missing data is processed. Also, add a flow chart of the participants selection.

- Use “and” instead of using “&”

- History of falls has been consistently reported as a risk factor of fear of falling in previous studies. Have taken it into consideration if not, why?

- In your inclusion criteria of age was 60 years and older, and yet in your sample the age ranges from 65-98. Please explain?

**********

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 #4: Yes: Alia Alghwiri

Reviewer #5: Yes: Bijad Alqahtani

Reviewer #6: 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: PONE.docx

Predictors of fear of falling among community-dwelling older adults: cross-sectional study from Palestine.

PONE-D-21-23236R2

Dear Dr. Badrasawi,

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,

Aqeel M Alenazi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for addressing the comments from all reviewers. We apologize for unexpected delay with your manuscript. You did a great Job in responding to reviewers

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 #5: (No Response)

Reviewer #6: 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 #5: (No Response)

Reviewer #6: Yes

**********

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

Reviewer #5: (No Response)

Reviewer #6: Yes

**********

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 #5: (No Response)

Reviewer #6: 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 #5: (No Response)

Reviewer #6: 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 #5: (No Response)

Reviewer #6: Overall, this is a well-written manuscript of a well-designed study. Thank you for addressing my comments.

**********

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 #5: No

Reviewer #6: No

**********