Inappropriate timing of salt intake increases the risk of heat-related illness: An observational study

Takeyasu Kakamu; Teruna Ito; Shota Endo; Tomoo Hidaka; Yusuke Masuishi; Hideaki Kasuga; Tetsuhito Fukushima

doi:10.1371/journal.pone.0296388

Peer Review History

Original SubmissionFebruary 9, 2023
28 Mar 2023 Decision Letter - William M. Adams, Editor PONE-D-23-02599Inappropriate timing of salt intake increases the risk of heat-related illness: An observational studyPLOS ONE Dear Dr. Kakamu, 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 May 12 2023 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, William M. Adams Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following in the Acknowledgments Section of your manuscript: “We would like to thank Editage (www.editage.com) for English language editing. This work was supported by JSPS KAKENHI (grant number 21K10449).” We note that you have provided funding information that is currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: “This work was supported by JSPS KAKENHI(https://www.jsps.go.jp/english/index.html) grant number 21K10449　(TK). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 3. 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. [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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: 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 ****** 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: Thank you very much for the opportunity to review this very interesting paper. However, I believe that two main points need to be fundamentally modified (1) Sample size The main analysis is a multivariate logistic analysis with 7 covariates, but you have not considered whether the sample size of 28 participants is sufficient for statistical analysis. I apologize if the number of participants is incorrect. However, even in that case, it is difficult to understand the attributes of the participants, and we would appreciate clarification. 2) Attributes of each group in the Salt intake Since the details of each of the groups are not clear, it is not possible to determine whether Salt intake can be considered a significant factor. I am sure there are other points to consider, but if you are going to submit a revised submission, I would appreciate it if you could respond to the above two points as soon as possible and then review it again. Reviewer #2: 1. Specific errors here: 37 line: indiacte 73 line: minimze 84-85 line: salt intake in HRI aims 89 line: emphasizing 102: in accordance with 239: may actually 271: a daily basis 2. Material and Methods / 2.1. Study design and participants. Please include inclusion criteria, heat acclimation criteria. Describe the selected Fukushima Prefectural Fire Department sites, total number of possible participants. Add in the annexes the Informed Consent and the Approval of the Ethics Committee. 2.3 Data Collection. Please add in the annexes the questionnaires before and after the training, also clarify how they took the value during the training. Define the variables contained between lines 111 to 114. Define the parameters under which HRI was defined. How the salt tablets were prepared and how they were administered. Define how weight and height measurements were taken, what equipment was used. What information was taken from the medical history. Add the BDHQ questionnaire, which method was used to calculate alcohol consumption, number of responses not given. Were the dietitians previously trained? Were the weather conditions evaluated with those taken at the site and their relationship with HRI? 3. Results. How did you calculate the concentration of salt in the diet and if you took salt tablets, how and at what time? It would be possible to add more sociodemographic information by site, including gender, to Table 1. What time of day did the training take place? In table 3, can the information be disaggregated by each site? How was the information collected during the training? 4. Conclusion It is suggested to support the conclusions with part of the information placed in the summary. 5. Additional comments for the author. Personally, I consider it to be excellent research whose results will help improve the treatment and prevention of HRI. I believe that the research has much more data to contribute, which were taken during the field work, it is possible that its analysis and a more robust correlation of the variables could increase the conclusions, achieving greater indications for the prevention of this pathology. . ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. 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.0296388.r001
Revision 1
25 Apr 2023 Author Response Response to reviewer Dear Reviewers, We appreciate for your constructive comments on our paper. We have carefully revised the manuscript text based on your comments. The point to point responses are below. Reviewer #1: Thank you very much for the opportunity to review this very interesting paper. However, I believe that two main points need to be fundamentally modified (1) Sample size The main analysis is a multivariate logistic analysis with 7 covariates, but you have not considered whether the sample size of 28 participants is sufficient for statistical analysis. I apologize if the number of participants is incorrect. However, even in that case, it is difficult to understand the attributes of the participants, and we would appreciate clarification. Response: To clarify, there were 28 study participants. In total, they recorded outdoor training for 250 days. The sample size sufficient for statistical analysis was 250 working days. In the Methods section of the revised manuscript, we have mentioned the total sample size. 2) Attributes of each group in the Salt intake Since the details of each of the groups are not clear, it is not possible to determine whether Salt intake can be considered a significant factor. Response: We apologize for this lack of explanation. We have added this detail in the revised manuscript. I am sure there are other points to consider, but if you are going to submit a revised submission, I would appreciate it if you could respond to the above two points as soon as possible and then review it again. Response: Thank you for your comments. We have carefully reviewed your comments and addressed them in the revised manuscript. Reviewer #2: 1. Specific errors here: 37 line: indiacte 73 line: minimze 84-85 line: salt intake in HRI aims 89 line: emphasizing 102: in accordance with 239: may actually 271: a daily basis Response: We apologize for these typographical errors. We have corrected them in the revised manuscript. In addition, we have had the manuscript checked by a native English speaker from a professional editing company to ensure that there are no remaining grammatical or syntax errors. We hope that the revised manuscript is now suitable for publication. 2. Material and Methods / 2.1. Study design and participants. Please include inclusion criteria, heat acclimation criteria. Describe the selected Fukushima Prefectural Fire Department sites, total number of possible participants. Add in the annexes the Informed Consent and the Approval of the Ethics Committee. Response: In the revised manuscript, we have detailed the inclusion criteria, heat acclimation criteria, selected fire department, total number of fire departments, and recruited subjects. We have also submitted the annexes you have mentioned to the editorial office. 2.3 Data Collection. Please add in the annexes the questionnaires before and after the training, also clarify how they took the value during the training. Response: The original version of the questionnaire is written in Japanese. In this resubmission, we have submitted the questionnaire as an annexed file. Participants administered to questionnaire after the training. Define the variables contained between lines 111 to 114. Define the parameters under which HRI was defined. How the salt tablets were prepared and how they were administered. Response: As per your comment, we have clarified the definition of HRI in the Statistical analysis section . Details regarding the salt tablets are described in line 131. Define how weight and height measurements were taken, what equipment was used. Response: Data on height were obtained from health checkup records. Body weight was measured using Body Composition Analyzer BS-230 (Dretech Co., Ltd, Saitama, Japan). We added these details in the revised manuscript (lines 127–128). What information was taken from the medical history. Response: From the medical history, we collected information on the history of hypertension and diabetes mellitus because these diseases increase the risk of HRI. Add the BDHQ questionnaire, which method was used to calculate alcohol consumption, number of responses not given. Response: We cannot provide the BDHQ as it is a copyrighted material. We have instead included a reference paper demonstrating the reliability of the BDHQ in nutritional surveys. Were the dietitians previously trained? Response: Yes, one dietitian (co-author TI) was trained to evaluate the BDHQ. Were the weather conditions evaluated with those taken at the site and their relationship with HRI? Response: Yes, daily maximum WBGT was included as a confounding factor, and it indicated a negative result. 3. Results. How did you calculate the concentration of salt in the diet and if you took salt tablets, how and at what time? Response: The concentration of salt in the diet was estimated from the BDHQ. The BDHQ was administered in the beginning of July. It would be possible to add more sociodemographic information by site, including gender, to Table 1. Response: All firefighters in the study department were men. Since one participant trained at multiple sites, the demographic data for each site could not be described. What time of day did the training take place? Response: The fire department scheduled training time twice daily (morning and afternoon), and all firefighter engaged training once in a day without emergency dispatch. In table 3, can the information be disaggregated by each site? Response: We have added more information in Table 3 and corrected a typographical error. However, this error did not affect the results of logistic regression analysis. How was the information collected during the training? Response: As described in lines 118-119, study participants answered a self-administered questionnaire before and after training. 4. Conclusion It is suggested to support the conclusions with part of the information placed in the summary. Response: Yes, we have revised the conclusions section and unified the content with that in the Abstract. 5. Additional comments for the author. Personally, I consider it to be excellent research whose results will help improve the treatment and prevention of HRI. I believe that the research has much more data to contribute, which were taken during the field work, it is possible that its analysis and a more robust correlation of the variables could increase the conclusions, achieving greater indications for the prevention of this pathology. Response: Thank you for your favorable review of our manuscript. We have carefully revised our paper to sufficiently address all your comments. Attachments Attachment Submitted filename: Response_to_reviewer 20230425.docx https://doi.org/10.1371/journal.pone.0296388.r002
6 Jun 2023 Decision Letter - William M. Adams, Editor PONE-D-23-02599R1Inappropriate timing of salt intake increases the risk of heat-related illness: An observational studyPLOS ONE Dear Dr. Kakamu, 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: Please address the comments and concerns posed by Reviewer #1 ============================== Please submit your revised manuscript by Jul 21 2023 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, William M. Adams 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: Please address the comments and concerns posed by reviewer #1. [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 #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: No Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: 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 #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No 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 description of the statistical analysis is still confusing. Regarding the sample size, which we pointed out in the last issue, the process of calculating the required number of 250 cases is not clear. However, if I were to accept your assertion, then 28 participants would require 250 cases, which would mean multiple data collections from a single patient. From the statement "Table 4. logistic regression analysis of heat-related illness risk.", I assume that a multivariate logistic analysis was performed. However, in principle, in a multivariate logistic analysis, the outcome is measured once per patient. From your description, I can only follow the above inference. From this inference, I cannot say that you have performed the statistical analysis correctly, and I have no choice but to reject your paper. Reviewer #2: All my comments, questions, concerns and recommendations were fully resolved. It is an excellent article. I appreciate the opportunity given for its review and congratulations to the authors. ****** 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 ******** [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.0296388.r003
Revision 2
20 Aug 2023 Author Response We have revised the description related to Table 4 following the results of the recalculations. Attachments Attachment Submitted filename: Response_to_reviewer 0821.docx https://doi.org/10.1371/journal.pone.0296388.r004
6 Nov 2023 Decision Letter - Timothy Omara, Editor PONE-D-23-02599R2Inappropriate timing of salt intake increases the risk of heat-related illness: An observational studyPLOS ONE Dear Dr. Kakamu, 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:Dear Authors,Kindly address the concern of Reviewer 1 on your submission. Specifically, you need to explain why the switch of the regression methods of statistical analysis. I would strongly suggest that you give:1. Some supporting citation(s) for the new statistical approach adopted.2. Limitations of the study, clearly indicating that the results reported should be treated with caution considering the volume of the data generated in the study.3. Directions for future research under CONCLUSIONS. Please submit your revised manuscript by Dec 21 2023 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, Timothy Omara, PhD 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. [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 #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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: No ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I addressed the questions regarding logistic analysis and study design in the previous peer review. I had expected that you would revise the study design, but you have utilized a different statistical technique. There was no response to my comments on what led to the use of this statistical technique. Since I am not a statistician, I cannot judge the validity of the conclusions you have drawn from the results of this analysis without comment. I have assigned a Major Revision for this peer review. If the manuscript is to be resubmitted, it needs to be evaluated by reviewers other than me. ****** 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 ******** [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.0296388.r005
Revision 3
11 Dec 2023 Author Response Response to the reviewer Dear Editor, We appreciate your constructive comments on our paper. We have carefully revised the manuscript text based on your comments. We explained why we selected mixed-effect model in the response for reviewer #1. 1. Some supporting citation(s) for the new statistical approach adopted. Response: Thank you for your suggestion. We added references that support our new statistical method (citation No28 and 29). 2. Limitations of the study, clearly indicating that the results reported should be treated with caution considering the volume of the data generated in the study. Response: We have noted the need for caution regarding the handling of the results in the limitation section. 3. Directions for future research under CONCLUSIONS. Response: We added sentence in conclusions section. Dear Reviewers, We appreciate your constructive comments on our paper. We have carefully revised the manuscript text based on your comments. Our point-to-point responses are below. Reviewer #1: I addressed the questions regarding logistic analysis and study design in the previous peer review. I had expected that you would revise the study design, but you have utilized a different statistical technique. There was no response to my comments on what led to the use of this statistical technique. Since I am not a statistician, I cannot judge the validity of the conclusions you have drawn from the results of this analysis without comment. I have assigned a Major Revision for this peer review. If the manuscript is to be resubmitted, it needs to be evaluated by reviewers other than me. Response: The mixed-effects model is a statistical method used in studies where the same individual is measured repeatedly, such as in the current study. Information that can identify individuals and information that takes the same value for multiple subjects are referred to as fixed effects, while information that varies by measurement is treated as random effects and incorporated as variables. We have added a citation for a paper that utilizes these mixed-effects models. Attachments Attachment Submitted filename: Response_to_reviewer_1211.docx https://doi.org/10.1371/journal.pone.0296388.r006
13 Dec 2023 Decision Letter - Timothy Omara, Editor Inappropriate timing of salt intake increases the risk of heat-related illness: An observational study PONE-D-23-02599R3 Dear Dr. Kakamu, 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, Timothy Omara, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0296388.r007
Formally Accepted
20 Dec 2023 Acceptance Letter - Timothy Omara, Editor PONE-D-23-02599R3 PLOS ONE Dear Dr. Kakamu, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Timothy Omara Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0296388.r008

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .