{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:40:33Z","timestamp":1781005233426,"version":"3.54.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008626","name":"Cochlear","doi-asserted-by":"publisher","award":["Cochlear"],"award-info":[{"award-number":["Cochlear"]}],"id":[{"id":"10.13039\/100008626","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>This study assessed whether the Fazekas score could account for the variability in cochlear implantation (CI) outcomes among individuals with DFNA9 and evaluated signal loss in the semicircular canals (SCCs) on magnetic resonance imaging (MRI) among individuals with DFNA9.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Method<\/jats:title>\n            <jats:p>This retrospective cross-sectional study included CI recipients with DFNA9. Pre-implantation MRI-scans were reviewed to determine the Fazekas score, localizing and grading cerebral white matter lesions (WML), and identify abnormalities in the SCCs. CI performance was assessed by evaluating phoneme scores one year post-implantation. The function of the SCCs was evaluated using rotatory chair testing with electronystagmography (ENG) and the video Head Impulse Test (vHIT).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Forty-five subjects (49 ears) were enrolled. The phoneme scores significantly improved from 35% (IQR 11\u201350) pre-implantation to 84% (IQR 76\u201390) one year post-implantation. No correlation was observed between the Fazekas score and the one-year post-implantation phoneme score (r<jats:sub>sp<\/jats:sub>=0.003, <jats:italic>p<\/jats:italic>\u2009=\u20090.986). Signal loss in at least one SCCs was detected in 97.7% of subjects and 77.8% of ears. There was no correlation between vestibular test results and fluid signal loss in the SCCs on MRI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Most individuals with DFNA9 show improved speech recognition with CI. The observed variability in CI outcomes was not linked to the Fazekas score. Additionally, our study confirms a high prevalence of focal sclerosis in DFNA9. Recognizing the limitations of this study, further research is needed to explore the predictive role of the Fazekas score on CI outcomes and its relationship with vestibular function.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00405-024-08933-1","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T21:02:30Z","timestamp":1726261350000},"page":"183-191","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluating cochlear implant outcomes in DFNA9 subjects: a comprehensive study on cerebral white matter lesions and vestibular abnormalities"],"prefix":"10.1007","volume":"282","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6995-668X","authenticated-orcid":false,"given":"M.L.A.","family":"Fehrmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5921-639X","authenticated-orcid":false,"given":"F.J.A.","family":"Meijer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7933-9995","authenticated-orcid":false,"given":"E.A.M.","family":"Mylanus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5517-9683","authenticated-orcid":false,"given":"R.J.E.","family":"Pennings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9397-7766","authenticated-orcid":false,"given":"C.P.","family":"Lanting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3479-4657","authenticated-orcid":false,"given":"W.J.","family":"Huinck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"key":"8933_CR1","doi-asserted-by":"crossref","unstructured":"Robijn SMM, Smits JJ, Sezer K, Huygen PLM, Beynon AJ, van Wijk E et al (2022) Genotype-phenotype correlations of pathogenic COCH variants in DFNA9: a HuGE systematic review and audiometric Meta-analysis. Biomolecules. ;12(2)","DOI":"10.3390\/biom12020220"},{"issue":"1","key":"8933_CR2","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1097\/01.mao.0000187240.33712.01","volume":"27","author":"K Vermeire","year":"2006","unstructured":"Vermeire K, Brokx JP, Wuyts FL, Cochet E, Hofkens A, De Bodt M, Van de Heyning PH (2006) Good speech recognition and quality-of-life scores after cochlear implantation in patients with DFNA9. Otol Neurotol 27(1):44\u201349","journal-title":"Otol Neurotol"},{"issue":"Suppl 1","key":"8933_CR3","first-page":"S8","volume":"12","author":"H Rask-Andersen","year":"2011","unstructured":"Rask-Andersen H, Erixon E, Kinnefors A, L\u00f6wenheim H, Schrott-Fischer A, Liu W (2011) Anatomy of the human cochlea\u2013implications for cochlear implantation. Cochlear Implants Int 12(Suppl 1):S8\u201313","journal-title":"Cochlear Implants Int"},{"issue":"1","key":"8933_CR4","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1159\/000343189","volume":"18","author":"P Blamey","year":"2013","unstructured":"Blamey P, Artieres F, Ba\u015fkent D, Bergeron F, Beynon A, Burke E et al (2013) Factors affecting auditory performance of postlinguistically deaf adults using cochlear implants: an update with 2251 patients. Audiol Neurootol 18(1):36\u201347","journal-title":"Audiol Neurootol"},{"issue":"11","key":"8933_CR5","doi-asserted-by":"publisher","first-page":"e48739","DOI":"10.1371\/journal.pone.0048739","volume":"7","author":"DS Lazard","year":"2012","unstructured":"Lazard DS, Vincent C, Venail F, Van de Heyning P, Truy E, Sterkers O et al (2012) Pre-, per- and postoperative factors affecting performance of postlinguistically deaf adults using cochlear implants: a new conceptual model over time. PLoS ONE 7(11):e48739","journal-title":"PLoS ONE"},{"key":"8933_CR6","doi-asserted-by":"crossref","unstructured":"Knopke S, Bauknecht HC, Gr\u00e4bel S, H\u00e4u\u00dfler SM, Szczepek AJ, Olze H (2021) White Matter Lesions as possible predictors of Audiological performance in adults after Cochlear Implantation. Brain Sci. ;11(5)","DOI":"10.3390\/brainsci11050600"},{"issue":"4","key":"8933_CR7","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1159\/000101473","volume":"12","author":"G Heydebrand","year":"2007","unstructured":"Heydebrand G, Hale S, Potts L, Gotter B, Skinner M (2007) Cognitive predictors of improvements in adults\u2019 spoken word recognition six months after cochlear implant activation. Audiol Neurootol 12(4):254\u2013264","journal-title":"Audiol Neurootol"},{"issue":"4","key":"8933_CR8","doi-asserted-by":"publisher","first-page":"3443","DOI":"10.1016\/j.neuroimage.2009.11.013","volume":"49","author":"DS Lazard","year":"2010","unstructured":"Lazard DS, Lee HJ, Gaebler M, Kell CA, Truy E, Giraud AL (2010) Phonological processing in post-lingual deafness and cochlear implant outcome. NeuroImage 49(4):3443\u20133451","journal-title":"NeuroImage"},{"issue":"5","key":"8933_CR9","doi-asserted-by":"publisher","first-page":"324","DOI":"10.3766\/jaaa.18106","volume":"31","author":"TN Tamati","year":"2020","unstructured":"Tamati TN, Ray C, Vasil KJ, Pisoni DB, Moberly AC (2020) High- and low-performing adult Cochlear Implant users on high-variability sentence recognition: differences in Auditory Spectral Resolution and Neurocognitive Functioning. J Am Acad Audiol 31(5):324\u2013335","journal-title":"J Am Acad Audiol"},{"issue":"1","key":"8933_CR10","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1038\/s41598-022-07175-7","volume":"12","author":"A Walia","year":"2022","unstructured":"Walia A, Shew MA, Kallogjeri D, Wick CC, Durakovic N, Lefler SM et al (2022) Electrocochleography and cognition are important predictors of speech perception outcomes in noise for cochlear implant recipients. Sci Rep 12(1):3083","journal-title":"Sci Rep"},{"issue":"5","key":"8933_CR11","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1152\/jn.00221.2016","volume":"116","author":"CM Filley","year":"2016","unstructured":"Filley CM, Fields RD (2016) White matter and cognition: making the connection. J Neurophysiol 116(5):2093\u20132104","journal-title":"J Neurophysiol"},{"issue":"1077","key":"8933_CR12","first-page":"317","volume":"295","author":"WD Marslen-Wilson","year":"1981","unstructured":"Marslen-Wilson WD, Tyler LK, Le Page RB (1981) Central processes in Speech understanding [and discussion]. Philosophical Trans Royal Soc Lond Ser B Biol Sci 295(1077):317\u2013332","journal-title":"Philosophical Trans Royal Soc Lond Ser B Biol Sci"},{"issue":"42","key":"8933_CR13","doi-asserted-by":"publisher","first-page":"21318","DOI":"10.1073\/pnas.1903402116","volume":"116","author":"B Lyu","year":"2019","unstructured":"Lyu B, Choi HS, Marslen-Wilson WD, Clarke A, Randall B, Tyler LK (2019) Neural dynamics of semantic composition. Proc Natl Acad Sci U S A 116(42):21318\u201321327","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"8","key":"8933_CR14","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.1007\/s10072-019-03875-7","volume":"40","author":"M Branco","year":"2019","unstructured":"Branco M, Ruano L, Portaccio E, Goretti B, Niccolai C, Patti F et al (2019) Aging with multiple sclerosis: prevalence and profile of cognitive impairment. Neurol Sci 40(8):1651\u20131657","journal-title":"Neurol Sci"},{"issue":"4","key":"8933_CR15","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1159\/000493722","volume":"23","author":"A Di Stadio","year":"2018","unstructured":"Di Stadio A, Dipietro L, Toffano R, Burgio F, De Lucia A, Ippolito V et al (2018) Working memory function in children with single side deafness using a bone-anchored hearing Implant: a case-control study. Audiol Neurotology 23(4):238\u2013244","journal-title":"Audiol Neurotology"},{"key":"8933_CR16","doi-asserted-by":"publisher","first-page":"111575","DOI":"10.1016\/j.mad.2021.111575","volume":"200","author":"Y Blinkouskaya","year":"2021","unstructured":"Blinkouskaya Y, Ca\u00e7oilo A, Gollamudi T, Jalalian S, Weickenmeier J (2021) Brain aging mechanisms with mechanical manifestations. Mech Ageing Dev 200:111575","journal-title":"Mech Ageing Dev"},{"issue":"9","key":"8933_CR17","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1212\/WNL.43.9.1683","volume":"43","author":"F Fazekas","year":"1993","unstructured":"Fazekas F, Kleinert R, Offenbacher H, Schmidt R, Kleinert G, Payer F et al (1993) Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 43(9):1683\u20131689","journal-title":"Neurology"},{"issue":"6","key":"8933_CR18","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1097\/AUD.0000000000001070","volume":"42","author":"SPF JanssensdeVarebeke","year":"2021","unstructured":"JanssensdeVarebeke SPF, Moyaert J, Fransen E, Bulen B, Neesen C, Devroye K et al (2021) Genotype-phenotype correlation study in a large series of patients carrying the p.Pro51Ser (p.P51S) variant in COCH (DFNA9) part II: a prospective cross-sectional study of the vestibular phenotype in 111 carriers. Ear Hear 42(6):1525\u20131543","journal-title":"Ear Hear"},{"key":"8933_CR19","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.3389\/fneur.2019.01341","volume":"10","author":"B Ihtijarevic","year":"2019","unstructured":"Ihtijarevic B, Janssens de Varebeke S, Mertens G, Dekeyzer S, Van de Heyning P, Van Rompaey V (2019) Correlations between vestibular function and imaging of the semicircular canals in DFNA9 patients. Front Neurol 10:1341","journal-title":"Front Neurol"},{"issue":"9","key":"8933_CR20","doi-asserted-by":"publisher","first-page":"e969","DOI":"10.1097\/MAO.0000000000003640","volume":"43","author":"A Beerten","year":"2022","unstructured":"Beerten A, Bosmans H, Lauwers M, Vermeulen H, Janssens de Varebeke SP (2022) Radiologic features in Cochlear Implant candidates: a prospective study comparing candidates carrying the p.Pro51Ser mutation in Coagulation factor C homology with noncarriers. Otol Neurotol 43(9):e969\u2013e75","journal-title":"Otol Neurotol"},{"issue":"2","key":"8933_CR21","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1159\/000443822","volume":"21","author":"BJ Burgess","year":"2016","unstructured":"Burgess BJ, O\u2019Malley JT, Kamakura T, Kristiansen K, Robertson NG, Morton CC, Nadol JB (2016) Jr. Histopathology of the human inner ear in the p.L114P COCH Mutation (DFNA9). Audiol Neurootol 21(2):88\u201397","journal-title":"Audiol Neurootol"},{"issue":"5","key":"8933_CR22","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1177\/0284185117727567","volume":"59","author":"R Nylander","year":"2018","unstructured":"Nylander R, Fahlstr\u00f6m M, Rostrup E, Kullberg J, Damangir S, Ahlstr\u00f6m H et al (2018) Quantitative and qualitative MRI evaluation of cerebral small vessel disease in an elderly population: a longitudinal study. Acta Radiol 59(5):612\u2013618","journal-title":"Acta Radiol"},{"issue":"2","key":"8933_CR23","doi-asserted-by":"publisher","first-page":"111","DOI":"10.4103\/0019-5049.79879","volume":"55","author":"M Daabiss","year":"2011","unstructured":"Daabiss M (2011) American Society of Anaesthesiologists physical status classification. Indian J Anaesth 55(2):111\u2013115","journal-title":"Indian J Anaesth"},{"issue":"1","key":"8933_CR24","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1038\/jcbfm.2015.72","volume":"36","author":"R Schmidt","year":"2016","unstructured":"Schmidt R, Seiler S, Loitfelder M (2016) Longitudinal change of small-vessel disease-related brain abnormalities. J Cereb Blood Flow Metab 36(1):26\u201339","journal-title":"J Cereb Blood Flow Metab"},{"issue":"3","key":"8933_CR25","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1097\/AUD.0b013e3182741aa7","volume":"34","author":"LK Holden","year":"2013","unstructured":"Holden LK, Finley CC, Firszt JB, Holden TA, Brenner C, Potts LG et al (2013) Factors affecting open-set word recognition in adults with cochlear implants. Ear Hear 34(3):342\u2013360","journal-title":"Ear Hear"},{"key":"8933_CR26","doi-asserted-by":"crossref","unstructured":"Tropitzsch A, Schade-Mann T, Gamerdinger P, Dofek S, Schulte B, Schulze M et al (2023) Variability in Cochlear Implantation outcomes in a large German cohort with a genetic etiology of hearing loss. Ear Hear","DOI":"10.1097\/AUD.0000000000001386"},{"issue":"8","key":"8933_CR27","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1097\/MAO.0000000000003628","volume":"43","author":"A Walia","year":"2022","unstructured":"Walia A, Shew MA, Lee DS, Lefler SM, Kallogjeri D, Wick CC et al (2022) Promontory Electrocochleography recordings to Predict Speech-Perception performance in Cochlear Implant recipients. Otol Neurotol 43(8):915\u2013923","journal-title":"Otol Neurotol"},{"issue":"3","key":"8933_CR28","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1007\/s00415-020-10208-8","volume":"268","author":"PH Croll","year":"2021","unstructured":"Croll PH, Vinke EJ, Armstrong NM, Licher S, Vernooij MW, Baatenburg de Jong RJ et al (2021) Hearing loss and cognitive decline in the general population: a prospective cohort study. J Neurol 268(3):860\u2013871","journal-title":"J Neurol"},{"issue":"2","key":"8933_CR29","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1097\/WNN.0000000000000092","volume":"29","author":"SJ Lee","year":"2016","unstructured":"Lee SJ, Park KW, Kim L-S, Kim H (2016) Effects of noise level and cognitive function on Speech Perception in Normal Elderly and Elderly with Amnestic mild cognitive impairment. Cogn Behav Neurol 29(2):68\u201377","journal-title":"Cogn Behav Neurol"},{"issue":"1\u20132","key":"8933_CR30","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.jns.2004.09.004","volume":"226","author":"MS Fernando","year":"2004","unstructured":"Fernando MS, Ince PG (2004) Vascular pathologies and cognition in a population-based cohort of elderly people. J Neurol Sci 226(1\u20132):13\u201317","journal-title":"J Neurol Sci"},{"issue":"1","key":"8933_CR31","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1136\/jnnp.70.1.9","volume":"70","author":"FE de Leeuw","year":"2001","unstructured":"de Leeuw FE, de Groot JC, Achten E, Oudkerk M, Ramos LM, Heijboer R et al (2001) Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam scan study. J Neurol Neurosurg Psychiatry 70(1):9\u201314","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"3","key":"8933_CR32","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1159\/000116401","volume":"29","author":"F Fazekas","year":"1989","unstructured":"Fazekas F (1989) Magnetic resonance signal abnormalities in asymptomatic individuals: their incidence and functional correlates. Eur Neurol 29(3):164\u2013168","journal-title":"Eur Neurol"},{"key":"8933_CR33","doi-asserted-by":"crossref","unstructured":"Walia A, Shew MA, Varghese J, Ioerger P, Lefler SM, Ortmann AJ et al (2023) Improved Cochlear Implant Performance Estimation using Tonotopic-based Electrocochleography. JAMA Otolaryngol Head Neck Surg","DOI":"10.1001\/jamaoto.2023.2988"},{"issue":"1","key":"8933_CR34","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1097\/MAO.0000000000003385","volume":"43","author":"MA Shew","year":"2022","unstructured":"Shew MA, Herzog JA, Kallogjeri D, Chen S, Wick C, Durakovic N et al (2022) The impact of age on noise sensitivity in Cochlear Implant recipients. Otology Neurotology 43(1):72\u201379","journal-title":"Otology Neurotology"},{"issue":"4","key":"8933_CR35","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1001\/jamaoto.2022.4825","volume":"149","author":"MJ Raymond","year":"2023","unstructured":"Raymond MJ, Ma C, Schvartz-Leyzac KC, Camposeo EL, Nguyen SA, Meyer TA, McRackan TR (2023) Association of Cognitive Impairment Screening Scores with Improvements in Speech Recognition and Quality of Life after Cochlear Implantation. JAMA Otolaryngology\u2013Head Neck Surg 149(4):344\u2013351","journal-title":"JAMA Otolaryngology\u2013Head Neck Surg"},{"key":"8933_CR36","doi-asserted-by":"crossref","unstructured":"Beerten A, Bosmans H, Lauwers M, Vermeulen H, Janssens de Varebeke SP (2022) Radiologic features in Cochlear Implant candidates: a prospective study comparing candidates carrying the p.Pro51Ser mutation in Coagulation factor C homology with noncarriers. Otology Neurotology. ;43(9)","DOI":"10.1097\/MAO.0000000000003640"},{"key":"8933_CR37","unstructured":"sebastien PF JanssensdeVarebeke VVR Genotype-phenotype Correlation Study of Presymptomatic and Symptomatic DFNA9 Patients. Identifier NCT03716908 2018 [https:\/\/clinicaltrials.gov\/study\/NCT03716908"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-024-08933-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-024-08933-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-024-08933-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T19:54:15Z","timestamp":1736970855000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00405-024-08933-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,13]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["8933"],"URL":"https:\/\/doi.org\/10.1007\/s00405-024-08933-1","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,13]]},"assertion":[{"value":"10 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 September 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors report there are no competing interests to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}