{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T20:24:46Z","timestamp":1781036686313,"version":"3.54.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Shanghai Science and Technology Innovation Action Plan","award":["22Y11912500"],"award-info":[{"award-number":["22Y11912500"]}]},{"name":"Shanghai Shenkang Development Center Research Physician Innovation and Transformation; Capability Training Program","award":["SHDC2023CRD015"],"award-info":[{"award-number":["SHDC2023CRD015"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Femoral neck fractures in nongeriatric patients pose a significant clinical challenge due to the high clinical failure rate. To address this, Alpha fixation and the Femoral Neck System (FNS) were developed but seldom been compared head-to-head. The purpose of this study was to compare the clinical prognosis of these two methods with traditional parallel screws.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study included 341 patients aged 18\u201365 years, treated between June 2020 and June 2023. Patients were grouped by fixation strategies: (1) parallel screws (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009206), (2) Alpha fixation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200973), and (3) FNS (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200962). Fixation failure (nonunion, severe femoral neck shortening, varus collapse) was compared as primary clinical outcome using univariate and multivariate analyses. Secondary outcomes included avascular necrosis and reoperation rates. Analyses were stratified by Pauwels classification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fixation failure rates were highest with parallel screws (21.4%), intermediate with FNS (12.9%), and lowest with Alpha fixation (9.6%). Multivariate analysis showed significantly lower fixation failure with Alpha fixation compared to parallel screws (adjusted OR\u2009=\u20090.29, 95% CI: 0.10\u20130.73,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014). Alpha fixation significantly reduced femoral neck shortening (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017), whereas FNS significantly reduced varus collapse (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013). In Pauwels type III fractures, Alpha fixation and FNS both significantly reduced fixation failure rates compared to parallel screws; no difference was found in Pauwels types I\u2013II.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Alpha fixation and FNS significantly outperformed parallel screws in reducing fixation failure in vertical femoral neck fractures among nongeriatric patients. Alpha fixation showed advantages in limiting femoral neck shortening, whereas FNS more effectively prevented varus collapse. For stable fractures, conventional parallel screws remain a reasonable choice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00264-025-06671-5","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T08:30:15Z","timestamp":1761035415000},"page":"2829-2836","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical outcomes of femoral neck fractures in nongeriatric patients: a comparative analysis of parallel screws, alpha fixation and femoral neck system"],"prefix":"10.1007","volume":"49","author":[{"given":"Dajun","family":"Jiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqing","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhui","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuquan","family":"Bian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shizan","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weitao","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"6671_CR1","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1007\/s00402-018-3011-0","volume":"138","author":"T Haider","year":"2018","unstructured":"Haider T, Schnabel J, Hochp\u00f6chler J, Wozasek GE (2018) Femoral shortening does not impair functional outcome after internal fixation of femoral neck fractures in non-geriatric patients. Arch Orthop Trauma Surg 138:1511\u20131517. https:\/\/doi.org\/10.1007\/s00402-018-3011-0","journal-title":"Arch Orthop Trauma Surg"},{"key":"6671_CR2","doi-asserted-by":"publisher","first-page":"204","DOI":"10.5312\/wjo.v5.i3.204","volume":"5","author":"T Pauyo","year":"2014","unstructured":"Pauyo T, Drager J, Albers A, Harvey EJ (2014) Management of femoral neck fractures in the young patient: A critical analysis review. World J Orthop 5:204\u2013217. https:\/\/doi.org\/10.5312\/wjo.v5.i3.204","journal-title":"World J Orthop"},{"key":"6671_CR3","doi-asserted-by":"publisher","first-page":"2011","DOI":"10.1007\/s11999-017-5318-5","volume":"475","author":"D Zhao","year":"2017","unstructured":"Zhao D, Qiu X, Wang B, Wang Z, Wang W, Ouyang J, Silva RM, Shi X, Kang K, Xu D, Li C, Zhong S, Zhang Y, Pinkerton KE (2017) Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res 475:2011\u20132023. https:\/\/doi.org\/10.1007\/s11999-017-5318-5","journal-title":"Clin Orthop Relat Res"},{"key":"6671_CR4","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1016\/j.injury.2018.06.028","volume":"49","author":"C Rogmark","year":"2018","unstructured":"Rogmark C, Kristensen MT, Viberg B, R\u00f6nnquist SS, Overgaard S, Palm H (2018) Hip fractures in the non-elderly-Who, why and whither? Injury 49:1445\u20131450. https:\/\/doi.org\/10.1016\/j.injury.2018.06.028","journal-title":"Injury"},{"key":"6671_CR5","doi-asserted-by":"publisher","unstructured":"Jiang D, Zhu H, Cao J, Cai Q, Wu F, Li X, Wang K, Jia W (2024) Contralateral neck-shaft angle lower than 130\u00b0 is associated with clinical failure in nongeriatric individuals: analysis of the National femoral neck fracture database of 1066 patients. Clinical orthopaedics and related researchhttps:\/\/doi.org\/10.1097\/corr.0000000000003071","DOI":"10.1097\/corr.0000000000003071"},{"key":"6671_CR6","doi-asserted-by":"publisher","first-page":"61","DOI":"10.2106\/jbjs.K.01081","volume":"95","author":"JJ Yang","year":"2013","unstructured":"Yang JJ, Lin LC, Chao KH, Chuang SY, Wu CC, Yeh TT, Lian YT (2013) Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg Am 95:61\u201369. https:\/\/doi.org\/10.2106\/jbjs.K.01081","journal-title":"J Bone Joint Surg Am"},{"key":"6671_CR7","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.injury.2014.10.010","volume":"46","author":"GP Slobogean","year":"2015","unstructured":"Slobogean GP, Sprague SA, Scott T, Bhandari M (2015) Complications following young femoral neck fractures. Injury 46:484\u2013491. https:\/\/doi.org\/10.1016\/j.injury.2014.10.010","journal-title":"Injury"},{"key":"6671_CR8","doi-asserted-by":"publisher","first-page":"3051","DOI":"10.1016\/j.injury.2021.02.030","volume":"52","author":"GP Slobogean","year":"2021","unstructured":"Slobogean GP, Sprague S, Bzovsky S, Scott T, Thabane L, Heels-Ansdell D, O\u2019Toole RV, Howe A, Gaski GE, Hill LC, Brown KM, Viskontas D, Zomar M, Della Rocca GJ, O\u2019Hara NN, Bhandari M (2021) Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Exploratory Health-Related Quality of Life and Patient-Reported Functional Outcomes of a Multi-Centre 2 \u00d7 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients. Injury 52:3051\u20133059. https:\/\/doi.org\/10.1016\/j.injury.2021.02.030","journal-title":"Injury"},{"key":"6671_CR9","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1097\/bot.0000000000002355","volume":"36","author":"CA Collinge","year":"2022","unstructured":"Collinge CA, Finlay A, Rodriguez-Buitrago A, Beltran MJ, Mitchell PM, Mir HR, Gardner MJ, Archdeacon MT, Tornetta P 3rd (2022) Treatment failure in femoral neck fractures in adults less than 50 years of age: analysis of 492 patients repaired at 26 North American trauma centers. J Orthop Trauma 36:271\u2013279. https:\/\/doi.org\/10.1097\/bot.0000000000002355","journal-title":"J Orthop Trauma"},{"key":"6671_CR10","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1186\/s13018-021-02619-8","volume":"16","author":"D Jiang","year":"2021","unstructured":"Jiang D, Zhan S, Cai Q, Hu H, Jia W (2021) Enhanced interfragmentary stability and improved clinical prognosis with use of the off-axis screw technique to treat vertical femoral neck fractures in nongeriatric patients. J Orthop Surg Res 16:473. https:\/\/doi.org\/10.1186\/s13018-021-02619-8","journal-title":"J Orthop Surg Res"},{"key":"6671_CR11","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.injury.2014.12.008","volume":"46","author":"CM Hoshino","year":"2015","unstructured":"Hoshino CM, O\u2019Toole RV (2015) Fixed angle devices versus multiple cancellous screws: what does the evidence tell us? Injury 46:474\u2013477. https:\/\/doi.org\/10.1016\/j.injury.2014.12.008","journal-title":"Injury"},{"key":"6671_CR12","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1097\/bot.0000000000000739","volume":"31","author":"K Stoffel","year":"2017","unstructured":"Stoffel K, Zderic I, Gras F, Sommer C, Eberli U, Mueller D, Oswald M, Gueorguiev B (2017) Biomechanical evaluation of the femoral neck system in unstable Pauwels III femoral neck fractures: A comparison with the dynamic hip screw and cannulated screws. J Orthop Trauma 31:131\u2013137. https:\/\/doi.org\/10.1097\/bot.0000000000000739","journal-title":"J Orthop Trauma"},{"key":"6671_CR13","doi-asserted-by":"publisher","first-page":"110842","DOI":"10.1016\/j.injury.2023.110842","volume":"54","author":"D Jiang","year":"2023","unstructured":"Jiang D, Zhan S, Hai H, Wang L, Zhao J, Zhu Z, Wang T, Jia W (2023) What makes vertical femoral neck fracture with posterior inferior comminution different? An analysis of Biomechanical features and optimal internal fixation strategy. Injury 54:110842. https:\/\/doi.org\/10.1016\/j.injury.2023.110842","journal-title":"Injury"},{"key":"6671_CR14","doi-asserted-by":"publisher","unstructured":"(2017) Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet 389:1519\u20131527. https:\/\/doi.org\/10.1016\/s0140-6736(17)30066-1","DOI":"10.1016\/s0140-6736(17)30066-1"},{"key":"6671_CR15","doi-asserted-by":"publisher","first-page":"3408","DOI":"10.1016\/j.injury.2021.07.014","volume":"52","author":"D Jiang","year":"2021","unstructured":"Jiang D, Zhan S, Cai Q, Hu H, Jia W (2021) Long-term differences in clinical prognosis between crossed- and parallel-cannulated screw fixation in vertical femoral neck fractures of non-geriatric patients. Injury 52:3408\u20133414. https:\/\/doi.org\/10.1016\/j.injury.2021.07.014","journal-title":"Injury"},{"key":"6671_CR16","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.1002\/jor.24881","volume":"39","author":"D Jiang","year":"2021","unstructured":"Jiang D, Zhan S, Wang L, Shi LL, Ling M, Hu H, Jia W (2021) Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res 39:1669\u20131680. https:\/\/doi.org\/10.1002\/jor.24881","journal-title":"J Orthop Res"},{"key":"6671_CR17","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1186\/s12891-023-06378-x","volume":"24","author":"J Jiang","year":"2023","unstructured":"Jiang J, Chen J, Xing F, Liu H, Xiang Z (2023) Comparison of femoral neck system versus cannulated screws for treatment of femoral neck fractures: a systematic review and meta-analysis. BMC Musculoskelet Disord 24:285. https:\/\/doi.org\/10.1186\/s12891-023-06378-x","journal-title":"BMC Musculoskelet Disord"},{"key":"6671_CR18","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1186\/s13018-021-02517-z","volume":"16","author":"H Hu","year":"2021","unstructured":"Hu H, Cheng J, Feng M, Gao Z, Wu J, Lu S (2021) Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients. J Orthop Surg Res 16:370. https:\/\/doi.org\/10.1186\/s13018-021-02517-z","journal-title":"J Orthop Surg Res"},{"key":"6671_CR19","doi-asserted-by":"publisher","first-page":"e209072","DOI":"10.1001\/jamanetworkopen.2020.9072","volume":"3","author":"ER Gritz","year":"2020","unstructured":"Gritz ER, Talluri R, Fokom Domgue J, Tami-Maury I, Shete S (2020) Smoking behaviors in survivors of Smoking-Related and Non-Smoking-Related cancers. JAMA Netw Open 3:e209072. https:\/\/doi.org\/10.1001\/jamanetworkopen.2020.9072","journal-title":"JAMA Netw Open"},{"key":"6671_CR20","volume-title":"Der Schenkelhalsbruch. Ein Mechanisches problem","author":"F Pauwels","year":"1935","unstructured":"Pauwels F (1935) Der Schenkelhalsbruch. Ein Mechanisches problem. F Enke, Stuttgart, Germany"},{"key":"6671_CR21","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.injury.2020.10.028","volume":"52","author":"YC Park","year":"2021","unstructured":"Park YC, Um KS, Kim DJ, Byun J, Yang KH (2021) Comparison of femoral neck shortening and outcomes between in situ fixation and fixation after reduction for severe valgus-impacted femoral neck fractures. Injury 52:569\u2013574. https:\/\/doi.org\/10.1016\/j.injury.2020.10.028","journal-title":"Injury"},{"key":"6671_CR22","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1302\/0301-620x.90b11.20582","volume":"90","author":"M Zlowodzki","year":"2008","unstructured":"Zlowodzki M, Brink O, Switzer J, Wingerter S, Woodall J Jr., Petrisor BA, Kregor PJ, Bruinsma DR, Bhandari M (2008) The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Joint Surg Br 90:1487\u20131494. https:\/\/doi.org\/10.1302\/0301-620x.90b11.20582","journal-title":"J Bone Joint Surg Br"},{"key":"6671_CR23","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/978-1-4471-5451-8_29","volume-title":"Classic papers in orthopaedics","author":"PA Banaszkiewicz","year":"2014","unstructured":"Banaszkiewicz PA (2014) Idiopathic bone necrosis of the femoral Head. Early diagnosis and treatment. In: Banaszkiewicz PA, Kader DF (eds) Classic papers in orthopaedics. Springer London, London, pp 121\u2013123"},{"key":"6671_CR24","doi-asserted-by":"publisher","first-page":"782001","DOI":"10.3389\/fbioe.2021.782001","volume":"9","author":"D Jiang","year":"2021","unstructured":"Jiang D, Zhan S, Hu H, Zhu H, Zhang C, Jia W (2021) The effect of vertical and oblique inclinations on fracture stability and reoperation risks in Femoral-Neck fractures of nongeriatric patient. Front Bioeng Biotechnol 9:782001. https:\/\/doi.org\/10.3389\/fbioe.2021.782001","journal-title":"Front Bioeng Biotechnol"},{"key":"6671_CR25","doi-asserted-by":"publisher","first-page":"1654","DOI":"10.2106\/jbjs.G.01353","volume":"90","author":"F Liporace","year":"2008","unstructured":"Liporace F, Gaines R, Collinge C, Haidukewych GJ (2008) Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am 90:1654\u20131659. https:\/\/doi.org\/10.2106\/jbjs.G.01353","journal-title":"J Bone Joint Surg Am"},{"key":"6671_CR26","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s12938-022-01006-6","volume":"21","author":"Z Wang","year":"2022","unstructured":"Wang Z, Yang Y, Feng G, Guo H, Chen Z, Chen Y, Jin Q (2022) Biomechanical comparison of the femoral neck system versus intertan nail and three cannulated screws for unstable Pauwels type III femoral neck fracture. Biomed Eng Online 21:34. https:\/\/doi.org\/10.1186\/s12938-022-01006-6","journal-title":"Biomed Eng Online"},{"key":"6671_CR27","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1016\/j.injury.2023.01.009","volume":"54","author":"TH Chao","year":"2023","unstructured":"Chao TH, Zheng ZH (2023) How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis- letter to editor. Injury 54:1012. https:\/\/doi.org\/10.1016\/j.injury.2023.01.009","journal-title":"Injury"},{"key":"6671_CR28","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1186\/s12891-023-06959-w","volume":"24","author":"M Su","year":"2023","unstructured":"Su M, He Z, Huang N, Lin X, Fang K, Dai Z (2023) Superior short-term outcomes of FNS in combination with a cannulated screw in treating femoral neck fractures. BMC Musculoskelet Disord 24:823. https:\/\/doi.org\/10.1186\/s12891-023-06959-w","journal-title":"BMC Musculoskelet Disord"},{"key":"6671_CR29","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.injury.2019.12.003","volume":"51","author":"MIB Koldaas","year":"2020","unstructured":"Koldaas MIB, Pedersen JN, H\u00f8jsager FD, Palm H, Viberg B (2020) Implant positioning (IMPO) in undisplaced femoral neck fractures: association to reoperation and development of an IMPO scoring system. Injury 51:372\u2013379. https:\/\/doi.org\/10.1016\/j.injury.2019.12.003","journal-title":"Injury"},{"key":"6671_CR30","doi-asserted-by":"publisher","first-page":"3155","DOI":"10.1007\/s00402-022-04551-w","volume":"143","author":"K Schuetze","year":"2023","unstructured":"Schuetze K, Burkhardt J, Pankratz C, Eickhoff A, Boehringer A, Degenhart C, Gebhard F, Cintean R (2023) Is new always better: comparison of the femoral neck system and the dynamic hip screw in the treatment of femoral neck fractures. Arch Orthop Trauma Surg 143:3155\u20133161. https:\/\/doi.org\/10.1007\/s00402-022-04551-w","journal-title":"Arch Orthop Trauma Surg"}],"container-title":["International Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-025-06671-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00264-025-06671-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-025-06671-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T13:07:32Z","timestamp":1764335252000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00264-025-06671-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":30,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["6671"],"URL":"https:\/\/doi.org\/10.1007\/s00264-025-06671-5","relation":{},"ISSN":["0341-2695","1432-5195"],"issn-type":[{"value":"0341-2695","type":"print"},{"value":"1432-5195","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,21]]},"assertion":[{"value":"22 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the local institutional ethics review boards at Shanghai Sixth People\u2019s Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (No. 2022-KY-059[K]). The study was conducted in accordance with the principles outlined in the World Medical Association Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Verbal or written informed consent was obtained from all participants.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}