{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T02:45:31Z","timestamp":1780713931334,"version":"3.54.1"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"funder":[{"DOI":"10.13039\/501100005187","name":"National and Kapodistrian University of Athens","doi-asserted-by":"publisher","award":["12085"],"award-info":[{"award-number":["12085"]}],"id":[{"id":"10.13039\/501100005187","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Rheumatol Int"],"published-print":{"date-parts":[[2022,6]]},"DOI":"10.1007\/s00296-022-05126-z","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T12:03:14Z","timestamp":1650283394000},"page":"1035-1041","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Patient characteristics, treatment patterns and disease outcomes in patients with psoriatic arthritis followed in a combined Dermatology\u2013Rheumatology clinic: a retrospective real-world study"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1267-1106","authenticated-orcid":false,"given":"Kalliopi","family":"Klavdianou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0792-1203","authenticated-orcid":false,"given":"Maria","family":"Stavropoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pantelis","family":"Panagakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2422-0994","authenticated-orcid":false,"given":"Marina","family":"Papoutsaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3612-9394","authenticated-orcid":false,"given":"Alexandros","family":"Panagiotopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6621-6918","authenticated-orcid":false,"given":"Christos","family":"Koutsianas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Stratigos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4841-7484","authenticated-orcid":false,"given":"Dimitrios","family":"Rigopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2288-3863","authenticated-orcid":false,"given":"Dimitrios","family":"Vassilopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,18]]},"reference":[{"key":"5126_CR1","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.rdc.2015.07.001","volume":"41","author":"A Ogdie","year":"2015","unstructured":"Ogdie A, Weiss P (2015) The epidemiology of psoriatic arthritis. Rheum Dis Clin North Am 41:545\u2013568. https:\/\/doi.org\/10.1016\/j.rdc.2015.07.001","journal-title":"Rheum Dis Clin North Am"},{"key":"5126_CR2","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1111\/jdv.13700","volume":"30","author":"E Papadavid","year":"2016","unstructured":"Papadavid E, Katsimbri P, Kapniari I et al (2016) Prevalence of psoriatic arthritis and its correlates among patients with psoriasis in Greece: results from a large retrospective study. J Eur Acad Dermatol Venereol 30:1749\u20131752. https:\/\/doi.org\/10.1111\/jdv.13700","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"5126_CR3","first-page":"127","volume":"62","author":"DD Gladman","year":"1987","unstructured":"Gladman DD, Shuckett R, Russell ML et al (1987) Psoriatic arthritis (PSA)\u2013an analysis of 220 patients. Q J Med 62:127\u2013141","journal-title":"Q J Med"},{"key":"5126_CR4","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1038\/s41584-019-0175-0","volume":"15","author":"JU Scher","year":"2019","unstructured":"Scher JU, Ogdie A, Merola JF, Ritchlin C (2019) Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol 15:153\u2013166. https:\/\/doi.org\/10.1038\/s41584-019-0175-0","journal-title":"Nat Rev Rheumatol"},{"key":"5126_CR5","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1056\/NEJMra1909094","volume":"385","author":"G Schett","year":"2021","unstructured":"Schett G, McInnes IB, Neurath MF (2021) Reframing immune-mediated inflammatory diseases through signature cytokine hubs. N Engl J Med 385:628\u2013639. https:\/\/doi.org\/10.1056\/NEJMra1909094","journal-title":"N Engl J Med"},{"key":"5126_CR6","doi-asserted-by":"publisher","first-page":"2152","DOI":"10.1136\/ard.2011.150938","volume":"70","author":"DD Gladman","year":"2011","unstructured":"Gladman DD, Thavaneswaran A, Chandran V, Cook RJ (2011) Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease? Ann Rheum Dis 70:2152\u20132154. https:\/\/doi.org\/10.1136\/ard.2011.150938","journal-title":"Ann Rheum Dis"},{"key":"5126_CR7","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1136\/annrheumdis-2012-202608","volume":"72","author":"W Tillett","year":"2013","unstructured":"Tillett W, Jadon D, Shaddick G et al (2013) Smoking and delay to diagnosis are associated with poorer functional outcome in psoriatic arthritis. Ann Rheum Dis 72:1358\u20131361. https:\/\/doi.org\/10.1136\/annrheumdis-2012-202608","journal-title":"Ann Rheum Dis"},{"key":"5126_CR8","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1136\/annrheumdis-2013-204858","volume":"74","author":"M Haroon","year":"2015","unstructured":"Haroon M, Gallagher P, FitzGerald O (2015) Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis 74:1045\u20131050. https:\/\/doi.org\/10.1136\/annrheumdis-2013-204858","journal-title":"Ann Rheum Dis"},{"key":"5126_CR9","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1016\/j.jaad.2018.11.058","volume":"80","author":"CA Elmets","year":"2019","unstructured":"Elmets CA, Leonardi CL, Davis DMR et al (2019) Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 80:1073\u20131113. https:\/\/doi.org\/10.1016\/j.jaad.2018.11.058","journal-title":"J Am Acad Dermatol"},{"key":"5126_CR10","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s00403-011-1172-6","volume":"304","author":"NF Velez","year":"2012","unstructured":"Velez NF, Wei-Passanese EX, Husni ME et al (2012) Management of psoriasis and psoriatic arthritis in a combined dermatology and rheumatology clinic. Arch Dermatol Res 304:7\u201313. https:\/\/doi.org\/10.1007\/s00403-011-1172-6","journal-title":"Arch Dermatol Res"},{"key":"5126_CR11","doi-asserted-by":"publisher","first-page":"2741","DOI":"10.1007\/s10067-018-4238-4","volume":"37","author":"MM Luchetti","year":"2018","unstructured":"Luchetti MM, Benfaremo D, Campanati A et al (2018) Clinical outcomes and feasibility of the multidisciplinary management of patients with psoriatic arthritis: two-year clinical experience of a dermo-rheumatologic clinic. Clin Rheumatol 37:2741\u20132749. https:\/\/doi.org\/10.1007\/s10067-018-4238-4","journal-title":"Clin Rheumatol"},{"key":"5126_CR12","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1111\/ced.14390","volume":"46","author":"Y Argobi","year":"2021","unstructured":"Argobi Y, Smith GP (2021) Analysis of the first 5 years of an interdisciplinary rheumatology-dermatology clinic. Clin Exp Dermatol 46:270\u2013275. https:\/\/doi.org\/10.1111\/ced.14390","journal-title":"Clin Exp Dermatol"},{"key":"5126_CR13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-041871","volume":"11","author":"KF Hjuler","year":"2021","unstructured":"Hjuler KF, Dige A, Agnholt J et al (2021) Effectiveness of interdisciplinary combined dermatology-gastroenterology-rheumatology clinical care compared to usual care in patients with immune-mediated inflammatory diseases: a parallel group, non-blinded, pragmatic randomised trial. BMJ Open 11:e041871. https:\/\/doi.org\/10.1136\/bmjopen-2020-041871","journal-title":"BMJ Open"},{"key":"5126_CR14","doi-asserted-by":"publisher","first-page":"693","DOI":"10.3899\/jrheum.170148","volume":"44","author":"JP Okhovat","year":"2017","unstructured":"Okhovat JP, Ogdie A, Reddy SM et al (2017) Psoriasis and psoriatic arthritis clinics multicenter advancement network consortium (PPACMAN) survey: benefits and challenges of combined rheumatology-dermatology clinics. J Rheumatol 44:693\u2013694. https:\/\/doi.org\/10.3899\/jrheum.170148","journal-title":"J Rheumatol"},{"key":"5126_CR15","doi-asserted-by":"publisher","first-page":"2665","DOI":"10.1002\/art.21972","volume":"54","author":"W Taylor","year":"2006","unstructured":"Taylor W, Gladman D, Helliwell P et al (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665\u20132673","journal-title":"Arthritis Rheum"},{"key":"5126_CR16","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1186\/s13075-021-02628-2","volume":"23","author":"A Ogdie","year":"2021","unstructured":"Ogdie A, Rozycki M, Arndt T et al (2021) Longitudinal analysis of the patient pathways to diagnosis of psoriatic arthritis. Arthritis Res Ther 23:252. https:\/\/doi.org\/10.1186\/s13075-021-02628-2","journal-title":"Arthritis Res Ther"},{"key":"5126_CR17","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1016\/j.jaad.2014.05.010","volume":"71","author":"PJ Mease","year":"2014","unstructured":"Mease PJ, Gladman DD, Helliwell P et al (2014) Comparative performance of psoriatic arthritis screening tools in patients with psoriasis in European\/North American dermatology clinics. J Am Acad Dermatol 71:649\u2013655. https:\/\/doi.org\/10.1016\/j.jaad.2014.05.010","journal-title":"J Am Acad Dermatol"},{"key":"5126_CR18","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1007\/s00296-021-05029-5","volume":"42","author":"H Al Rayes","year":"2022","unstructured":"Al Rayes H, Alazmi M, Attar S et al (2022) Consensus-based recommendations on the diagnosis, referral and clinical management of patients with psoriatic arthritis. Rheumatol Int 42:391\u2013401. https:\/\/doi.org\/10.1007\/s00296-021-05029-5","journal-title":"Rheumatol Int"},{"key":"5126_CR19","doi-asserted-by":"publisher","first-page":"2150","DOI":"10.1007\/s12325-016-0429-z","volume":"33","author":"J Gratacos-Masmitja","year":"2017","unstructured":"Gratacos-Masmitja J, Luelmo-Aguilar J, Zarco-Montejo P et al (2017) Points to consider in the foundation of multidisciplinary units for psoriatic arthritis: a delphi study and a systematic review of the literature. Adv Ther 33:2150\u20132159. https:\/\/doi.org\/10.1007\/s12325-016-0429-z","journal-title":"Adv Ther"},{"key":"5126_CR20","doi-asserted-by":"publisher","first-page":"S85","DOI":"10.1016\/j.jaad.2005.10.052","volume":"54","author":"KB Gordon","year":"2006","unstructured":"Gordon KB, Ruderman EM (2006) The treatment of psoriasis and psoriatic arthritis: an interdisciplinary approach. J Am Acad Dermatol 54:S85-91. https:\/\/doi.org\/10.1016\/j.jaad.2005.10.052","journal-title":"J Am Acad Dermatol"},{"key":"5126_CR21","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1111\/j.1365-2133.2007.08139.x","volume":"157","author":"E Mody","year":"2007","unstructured":"Mody E, Husni ME, Schur P, Qureshi AA (2007) Multidisciplinary evaluation of patients with psoriasis presenting with musculoskeletal pain: a dermatology: rheumatology clinic experience. Br J Dermatol 157:1050\u20131051. https:\/\/doi.org\/10.1111\/j.1365-2133.2007.08139.x","journal-title":"Br J Dermatol"},{"key":"5126_CR22","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.semarthrit.2016.06.004","volume":"46","author":"C Salvarani","year":"2016","unstructured":"Salvarani C, Girolomoni G, Di Lernia V et al (2016) Impact of training on concordance among rheumatologists and dermatologists in the assessment of patients with psoriasis and psoriatic arthritis. Semin Arthritis Rheum 46:305\u2013311. https:\/\/doi.org\/10.1016\/j.semarthrit.2016.06.004","journal-title":"Semin Arthritis Rheum"},{"key":"5126_CR23","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1111\/j.1468-3083.2009.03159.x","volume":"23","author":"MA Radtke","year":"2009","unstructured":"Radtke MA, Reich K, Blome C et al (2009) Prevalence and clinical features of psoriatic arthritis and joint complaints in 2009 patients with psoriasis: results of a German national survey. J Eur Acad Dermatol Venereol 23:683\u2013691. https:\/\/doi.org\/10.1111\/j.1468-3083.2009.03159.x","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"5126_CR24","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.3899\/jrheum.201199","volume":"48","author":"P Karmacharya","year":"2021","unstructured":"Karmacharya P, Wright K, Achenbach SJ et al (2021) Diagnostic delay in psoriatic arthritis: a population-based study. J Rheumatol 48:1410\u20131416. https:\/\/doi.org\/10.3899\/jrheum.201199","journal-title":"J Rheumatol"},{"key":"5126_CR25","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1016\/j.reumae.2020.05.004","volume":"17","author":"CA Guillen Astete","year":"2021","unstructured":"Guillen Astete CA, Gaite Gonzalez I, Zurita Prada PA, Urrego Laurin C (2021) Delay and diagnostic pathway of patients with psoriatic arthritis in Spain. Reumatol Clin (Engl Ed) 17:525\u2013529. https:\/\/doi.org\/10.1016\/j.reumae.2020.05.004","journal-title":"Reumatol Clin (Engl Ed)"},{"key":"5126_CR26","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s41927-019-0102-7","volume":"4","author":"A Ogdie","year":"2020","unstructured":"Ogdie A, Nowell WB, Applegate E et al (2020) Patient perspectives on the pathway to psoriatic arthritis diagnosis: results from a web-based survey of patients in the United States. BMC Rheumatol 4:2. https:\/\/doi.org\/10.1186\/s41927-019-0102-7","journal-title":"BMC Rheumatol"},{"key":"5126_CR27","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1001\/jamadermatol.2013.5264","volume":"149","author":"AW Armstrong","year":"2013","unstructured":"Armstrong AW, Robertson AD, Wu J et al (2013) Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003\u20132011. JAMA Dermatol 149:1180\u20131185. https:\/\/doi.org\/10.1001\/jamadermatol.2013.5264","journal-title":"JAMA Dermatol"},{"key":"5126_CR28","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s13555-016-0153-2","volume":"7","author":"AW Armstrong","year":"2017","unstructured":"Armstrong AW, Koning JW, Rowse S et al (2017) Under-treatment of patients with moderate to severe psoriasis in the united states: analysis of medication usage with health plan data. Dermatol Ther (Heidelb) 7:97\u2013109. https:\/\/doi.org\/10.1007\/s13555-016-0153-2","journal-title":"Dermatol Ther (Heidelb)"},{"key":"5126_CR29","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1080\/09546634.2016.1255304","volume":"28","author":"J Lambert","year":"2017","unstructured":"Lambert J, Ghislain PD, Lambert J et al (2017) Treatment patterns in moderate-to-severe plaque psoriasis: results from a Belgian cross-sectional study (DISCOVER). J Dermatolog Treat 28:394\u2013400. https:\/\/doi.org\/10.1080\/09546634.2016.1255304","journal-title":"J Dermatolog Treat"},{"key":"5126_CR30","doi-asserted-by":"publisher","first-page":"3431","DOI":"10.3390\/jcm10153431","volume":"10","author":"Y Ingrasciotta","year":"2021","unstructured":"Ingrasciotta Y, Isgro V, Ientile V et al (2021) Are Patients with psoriasis and psoriatic arthritis undertreated? A population-based study from Southern Italy. J Clin Med 10:3431. https:\/\/doi.org\/10.3390\/jcm10153431","journal-title":"J Clin Med"},{"key":"5126_CR31","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1016\/j.jaad.2013.07.023","volume":"69","author":"PJ Mease","year":"2013","unstructured":"Mease PJ, Gladman DD, Papp KA et al (2013) Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European\/North American dermatology clinics. J Am Acad Dermatol 69:729\u2013735. https:\/\/doi.org\/10.1016\/j.jaad.2013.07.023","journal-title":"J Am Acad Dermatol"},{"key":"5126_CR32","doi-asserted-by":"publisher","first-page":"2035","DOI":"10.1111\/jdv.16251","volume":"34","author":"WH Boehncke","year":"2020","unstructured":"Boehncke WH, Horvath R, Dalkilic E et al (2020) Association between clinical specialty setting and disease management in patients with psoriatic arthritis: results from LOOP, a cross-sectional, multi-country, observational study. J Eur Acad Dermatol Venereol 34:2035\u20132043. https:\/\/doi.org\/10.1111\/jdv.16251","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"5126_CR33","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1016\/j.semarthrit.2020.02.001","volume":"50","author":"EZ Zusman","year":"2020","unstructured":"Zusman EZ, Howren AM, Park JYE et al (2020) Epidemiology of depression and anxiety in patients with psoriatic arthritis: a systematic review and meta-analysis. Semin Arthritis Rheum 50:1481\u20131488. https:\/\/doi.org\/10.1016\/j.semarthrit.2020.02.001","journal-title":"Semin Arthritis Rheum"},{"key":"5126_CR34","doi-asserted-by":"publisher","unstructured":"Karmacharya P, Ogdie A, Eder L (2021) Psoriatic arthritis and the association with cardiometabolic disease: a narrative review. Ther Adv Musculoskelet Dis 13:1759720X21998279. https:\/\/doi.org\/10.1177\/1759720X21998279","DOI":"10.1177\/1759720X21998279"},{"key":"5126_CR35","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s41927-021-00217-z","volume":"5","author":"J Ziob","year":"2021","unstructured":"Ziob J, Behning C, Brossart P et al (2021) Specialized dermatological-rheumatological patient management improves diagnostic outcome and patient journey in psoriasis and psoriatic arthritis: a four-year analysis. BMC Rheumatol 5:45. https:\/\/doi.org\/10.1186\/s41927-021-00217-z","journal-title":"BMC Rheumatol"},{"key":"5126_CR36","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.3899\/jrheum.121500","volume":"40","author":"JA Husted","year":"2013","unstructured":"Husted JA, Thavaneswaran A, Chandran V, Gladman DD (2013) Incremental effects of comorbidity on quality of life in patients with psoriatic arthritis. J Rheumatol 40:1349\u20131356. https:\/\/doi.org\/10.3899\/jrheum.121500","journal-title":"J Rheumatol"}],"container-title":["Rheumatology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00296-022-05126-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00296-022-05126-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00296-022-05126-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,22]],"date-time":"2022-05-22T07:04:04Z","timestamp":1653203044000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00296-022-05126-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,18]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["5126"],"URL":"https:\/\/doi.org\/10.1007\/s00296-022-05126-z","relation":{},"ISSN":["1437-160X"],"issn-type":[{"value":"1437-160X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,18]]},"assertion":[{"value":"25 February 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors declare that they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}