{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:29:06Z","timestamp":1786422546046,"version":"build-2736575974"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006196","name":"University of Oulu","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    This study aims to compare intranasal dexmedetomidine with inhaled nitrous oxide for procedural pain relief and sedation during intra-articular injections in a pediatric rheumatology outpatient clinic. Patients from 1 to 18\u00a0years-of-age requiring 1\u20135 intra-articular injections were randomized to receive 2\u00a0\u00b5g\/kg intranasal dexmedetomidine or inhaled nitrous oxide in the first visit. When the patient required subsequent treatment visit, the other sedative was administered. The primary outcome was patient-reported pain immediately after recovery from sedation. Hemodynamic and respiratory parameters, level of sedation and patient\u2019s pain assessed by the parent, rheumatologist, and nurse were secondary outcomes. Out of 119 eligible patients, 68 were included, and 43 received both medications at two separate visits. Overall pain experience was mild and did not differ between dexmedetomidine and nitrous oxide in patient-reported pain immediately after the procedure (difference, 0.2; 95% CI\u2009\u2212\u20090.7 to 1.2,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.65) but the patients recalled milder pain after nitrous oxide in the follow-up survey (difference,\u2009\u2212\u20091.3; 95% CI\u2009\u2212\u20092.3 to\u2009\u2212\u20090.3;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.01). Milder pain was reported during the second visit compared to the first visit regardless of the sedative used (difference,\u2009\u2212\u20091.2; 95% CI\u2009\u2212\u20092.1 to\u2009\u2212\u20090.2;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02). In the follow-up survey, majority (69%) of patients would prefer nitrous oxide to dexmedetomidine for sedation in future.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    :\u00a0Both intranasal dexmedetomidine and inhaled nitrous oxide offered effective analgosedation for intra-articular injections in children. Nitrous oxide resulted in better patient experience and became their preference for future sedation.\u00a0\n                  <\/jats:p>\n                  <jats:p>\n                    Trial registration: ClinicalTrials.gov TRN: NCT03069638.\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03069638\" ext-link-type=\"uri\">https:\/\/clinicaltrials.gov\/study\/NCT03069638<\/jats:ext-link>\n                    . The date of registration 2016\u201312-20.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Children suffering juvenile idiopathic arthritis often require repeated intra-articular injections.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Procedural sedation is being used during these procedures.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>When intranasal dexmedetomidine and nitrous oxide was compared in a crossover design both agents provided effective analgosedation without difference in patient-reported pain immediately after the procedure.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Despite this, most patients favored nitrous oxide for future sedation.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07259-w","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T12:40:33Z","timestamp":1784637633000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intranasal dexmedetomidine vs. nitrous oxide for procedural sedation in juvenile idiopathic arthritis (INDEXJIA): a randomized crossover clinical trial"],"prefix":"10.1007","volume":"185","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8109-8684","authenticated-orcid":false,"given":"Miikka","family":"Tervonen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Outi","family":"Peltoniemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"V\u00e4h\u00e4salo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Keskitalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirja","family":"Sard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tytti","family":"Pokka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merja","family":"Kallio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"7259_CR1","doi-asserted-by":"publisher","first-page":"2138","DOI":"10.1016\/S0140-6736(11)60244-4","volume":"377","author":"B Prakken","year":"2011","unstructured":"Prakken B, Albani S, Martini A (2011) Juvenile idiopathic arthritis. Lancet 377:2138\u20132149. https:\/\/doi.org\/10.1016\/S0140-6736(11)60244-4","journal-title":"Lancet"},{"key":"7259_CR2","doi-asserted-by":"publisher","DOI":"10.3389\/FPED.2022.822009","author":"S Li","year":"2022","unstructured":"Li S, Zhang W, Lin Y (2022) Application of intra-articular corticosteroid injection in juvenile idiopathic arthritis. Front Pediatr. https:\/\/doi.org\/10.3389\/FPED.2022.822009","journal-title":"Front Pediatr"},{"key":"7259_CR3","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1002\/ACR.24853","volume":"74","author":"KB Onel","year":"2022","unstructured":"Onel KB, Horton DB, Lovell DJ et al (2022) 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for oligoarthritis, temporomandibular joint arthritis, and systemic juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 74:521\u2013537. https:\/\/doi.org\/10.1002\/ACR.24853","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"7259_CR4","doi-asserted-by":"publisher","DOI":"10.1016\/J.CLIM.2022.109143","author":"PT Oommen","year":"2022","unstructured":"Oommen PT, Strauss T, Baltruschat K et al (2022) Update of evidence- and consensus-based guidelines for the treatment of juvenile idiopathic arthritis (JIA) by the German Society of Pediatric and Juvenile Rheumatic Diseases (GKJR): new perspectives on interdisciplinary care. Clin Immunol. https:\/\/doi.org\/10.1016\/J.CLIM.2022.109143","journal-title":"Clin Immunol"},{"key":"7259_CR5","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.1007\/S00431-013-2052-1","volume":"172","author":"R Casado","year":"2013","unstructured":"Casado R, Lumbreras J, De Inocencio J et al (2013) Sedation for intra-articular corticosteroid injections in juvenile idiopathic arthritis: the views of patients and their parents. Eur J Pediatr 172:1411\u20131413. https:\/\/doi.org\/10.1007\/S00431-013-2052-1","journal-title":"Eur J Pediatr"},{"key":"7259_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.reumae.2018.07.003","author":"JC Nieto-Gonz\u00e1lez","year":"2019","unstructured":"Nieto-Gonz\u00e1lez JC, Monteagudo I (2019) Intra-articular joint injections in juvenile idiopathic arthritis: state of the art. Reumatolog\u00eda Cl\u00ednica (English Edition). https:\/\/doi.org\/10.1016\/j.reumae.2018.07.003","journal-title":"Reumatolog\u00eda Cl\u00ednica (English Edition)"},{"key":"7259_CR7","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1007\/S00431-013-2246-6","volume":"173","author":"S Pastore","year":"2014","unstructured":"Pastore S, Gortani G, Taddio A, Barbi E (2014) Procedural sedation for intra-articular corticosteroid injections in juvenile idiopathic arthritis (JIA) should be a standard of care. Eur J Pediatr 173:831. https:\/\/doi.org\/10.1007\/S00431-013-2246-6","journal-title":"Eur J Pediatr"},{"key":"7259_CR8","doi-asserted-by":"publisher","DOI":"10.1186\/s12969-019-0312-y","author":"R Elitsur","year":"2019","unstructured":"Elitsur R, Hollenbeck A, Tasan L et al (2019) Efficacy and cost savings with the use of a minimal sedation \/ anxiolysis protocol for intra-articular corticosteroid injections in children with juvenile idiopathic arthritis: a retrospective review of prospectively collected data. Pediatr Rheumatol. https:\/\/doi.org\/10.1186\/s12969-019-0312-y","journal-title":"Pediatr Rheumatol"},{"key":"7259_CR9","doi-asserted-by":"publisher","DOI":"10.1186\/s12969-015-0021-0","author":"A Oren-Ziv","year":"2015","unstructured":"Oren-Ziv A, Hoppenstein D, Shles A, Uziel Y (2015) Sedation methods for intra-articular corticosteroid injections in juvenile idiopathic arthritis: a review. Pediatr Rheumatol. https:\/\/doi.org\/10.1186\/s12969-015-0021-0","journal-title":"Pediatr Rheumatol"},{"key":"7259_CR10","unstructured":"Weintraub Y, Rabinowicz N, Hanuka P et al (2014) Medical clowns facilitate nitrous oxide sedation during intra-articular corticosteroid injection for juvenile idiopathic arthritis. Israel Med Assoc J 16(12):771-3"},{"key":"7259_CR11","doi-asserted-by":"publisher","DOI":"10.1186\/1546-0096-6-1","author":"Y Uziel","year":"2008","unstructured":"Uziel Y, Chapnick G, Rothschild M et al (2008) Nitrous oxide sedation for intra-articular injection in juvenile idiopathic arthritis. Pediatr Rheumatol Online J. https:\/\/doi.org\/10.1186\/1546-0096-6-1","journal-title":"Pediatr Rheumatol Online J"},{"key":"7259_CR12","doi-asserted-by":"publisher","DOI":"10.1136\/adc.86.6.416","author":"AG Cleary","year":"2002","unstructured":"Cleary AG, Ramanan AV, Baildam E et al (2002) Nitrous oxide analgesia during intra-articular injection for juvenile idiopathic arthritis. Arch Dis Child. https:\/\/doi.org\/10.1136\/adc.86.6.416","journal-title":"Arch Dis Child"},{"key":"7259_CR13","doi-asserted-by":"publisher","first-page":"93","DOI":"10.5409\/WJCP.V11.I2.93","volume":"11","author":"N Gupta","year":"2022","unstructured":"Gupta N, Gupta A, Narayanan VMR (2022) Current status of nitrous oxide use in pediatric patients. World J Clin Pediatr 11:93. https:\/\/doi.org\/10.5409\/WJCP.V11.I2.93","journal-title":"World J Clin Pediatr"},{"key":"7259_CR14","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/S40262-017-0507-7","volume":"56","author":"MAS Weerink","year":"2017","unstructured":"Weerink MAS, Struys MMRF, Hannivoort LN et al (2017) Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet 56:893\u2013913. https:\/\/doi.org\/10.1007\/S40262-017-0507-7","journal-title":"Clin Pharmacokinet"},{"key":"7259_CR15","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1007\/S40272-015-0145-1","volume":"17","author":"A Tug","year":"2015","unstructured":"Tug A, Hanci A, Turk HS et al (2015) Comparison of two different intranasal doses of dexmedetomidine in children for magnetic resonance imaging sedation. Paediatr Drugs 17:479\u2013485. https:\/\/doi.org\/10.1007\/S40272-015-0145-1","journal-title":"Paediatr Drugs"},{"key":"7259_CR16","doi-asserted-by":"publisher","first-page":"245","DOI":"10.4103\/JPN.JPN_107_19","volume":"15","author":"R Azizkhani","year":"2020","unstructured":"Azizkhani R, Heydari F, Ghazavi M et al (2020) Comparing sedative effect of dexmedetomidine versus midazolam for sedation of children while undergoing computerized tomography imaging. J Pediatr Neurosci 15:245. https:\/\/doi.org\/10.4103\/JPN.JPN_107_19","journal-title":"J Pediatr Neurosci"},{"key":"7259_CR17","doi-asserted-by":"publisher","DOI":"10.1186\/S13049-024-01190-5","author":"A Nikula","year":"2024","unstructured":"Nikula A, Lundeberg S, Ryd Rinder M et al (2024) A randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children. Scand J Trauma Resusc Emerg Med. https:\/\/doi.org\/10.1186\/S13049-024-01190-5","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"7259_CR18","doi-asserted-by":"publisher","DOI":"10.1186\/S13049-024-01292-0","volume":"32","author":"A Nikula","year":"2024","unstructured":"Nikula A, Rinder MR, Lundeberg S et al (2024) A randomized clinical trial of intranasal dexmedetomidine versus inhaled nitrous oxide for procedural sedation and analgesia in children. Scand J Trauma Resusc Emerg Med 32. https:\/\/doi.org\/10.1186\/S13049-024-01292-0","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"7259_CR19","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1213\/ANE.0000000000005988","volume":"136","author":"C Grogan","year":"2023","unstructured":"Grogan C, Thibault C, Moorthy G et al (2023) Dose escalation pharmacokinetic study of intranasal atomized dexmedetomidine in pediatric patients with congenital heart disease. Anesth Analg 136:152\u2013162. https:\/\/doi.org\/10.1213\/ANE.0000000000005988","journal-title":"Anesth Analg"},{"key":"7259_CR20","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1111\/J.1460-9592.2008.02655.X","volume":"18","author":"S Nilsson","year":"2008","unstructured":"Nilsson S, Finnstr\u00f6m B, Kokinsky E (2008) The FLACC behavioral scale for procedural pain assessment in children aged 5\u201316 years. Paediatr Anaesth 18:767\u2013774. https:\/\/doi.org\/10.1111\/J.1460-9592.2008.02655.X","journal-title":"Paediatr Anaesth"},{"key":"7259_CR21","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1055\/s-0039-1678730","volume":"8","author":"K Saelim","year":"2019","unstructured":"Saelim K, Chavananon S, Ruangnapa K et al (2019) Effectiveness of protocolized sedation utilizing the COMFORT-B scale in mechanically ventilated children in a pediatric intensive care unit. J Pediatr Intensive Care 8:156\u2013163. https:\/\/doi.org\/10.1055\/s-0039-1678730","journal-title":"J Pediatr Intensive Care"},{"key":"7259_CR22","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1016\/J.AJEM.2017.03.021","volume":"35","author":"Z Xie","year":"2017","unstructured":"Xie Z, Shen W, Lin J et al (2017) Sedation effects of intranasal dexmedetomidine delivered as sprays versus drops on pediatric response to venous cannulation. Am J Emerg Med 35:1126\u20131130. https:\/\/doi.org\/10.1016\/J.AJEM.2017.03.021","journal-title":"Am J Emerg Med"},{"key":"7259_CR23","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/S1526-5900(03)00716-8","volume":"4","author":"MP Jensen","year":"2003","unstructured":"Jensen MP, Chen C, Brugger AM (2003) Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 4:407\u2013414. https:\/\/doi.org\/10.1016\/S1526-5900(03)00716-8","journal-title":"J Pain"},{"key":"7259_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/J.ANNEMERGMED.2008.09.030","author":"M Bhatt","year":"2009","unstructured":"Bhatt M, Kennedy RM, Osmond MH et al (2009) Consensus-based recommendations for standardizing terminology and reporting adverse events for emergency department procedural sedation and analgesia in children. Ann Emerg Med. https:\/\/doi.org\/10.1016\/J.ANNEMERGMED.2008.09.030","journal-title":"Ann Emerg Med"},{"key":"7259_CR25","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1097\/00000542-200302000-00024","volume":"98","author":"LE Nelson","year":"2003","unstructured":"Nelson LE, Lu J, Guo T et al (2003) The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology 98:428\u2013436. https:\/\/doi.org\/10.1097\/00000542-200302000-00024","journal-title":"Anesthesiology"},{"key":"7259_CR26","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1097\/00006565-199912000-00004","volume":"15","author":"JD Luhmann","year":"1999","unstructured":"Luhmann JD, Kennedy RM, Jaffe DM, McAllister JD (1999) Continuous-flow delivery of nitrous oxide and oxygen: a safe and cost-effective technique for inhalation analgesia and sedation of pediatric patients. Pediatr Emerg Care 15:388\u2013392. https:\/\/doi.org\/10.1097\/00006565-199912000-00004","journal-title":"Pediatr Emerg Care"},{"key":"7259_CR27","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bdj.2008.414","author":"J Versloot","year":"2008","unstructured":"Versloot J, Veerkamp JSJ, Hoogstraten J (2008) Pain behaviour and distress in children during two sequential dental visits: comparing a computerised anaesthesia delivery system and a traditional syringe. Br Dent J. https:\/\/doi.org\/10.1038\/sj.bdj.2008.414","journal-title":"Br Dent J"},{"key":"7259_CR28","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1155\/2009\/535941","volume":"14","author":"EM Rocha","year":"2009","unstructured":"Rocha EM, Marche TA, Von Baeyer CL (2009) Anxiety influences children\u2019s memory for procedural pain. Pain Res Manag 14:233\u2013237. https:\/\/doi.org\/10.1155\/2009\/535941","journal-title":"Pain Res Manag"},{"key":"7259_CR29","doi-asserted-by":"publisher","DOI":"10.3389\/FPED.2023.1132413","author":"J Zhuge","year":"2023","unstructured":"Zhuge J, Zheng D, Li X et al (2023) Parental preferences for the procedural sedation of children in dentistry: a discrete choice experiment. Front Pediatr. https:\/\/doi.org\/10.3389\/FPED.2023.1132413","journal-title":"Front Pediatr"},{"key":"7259_CR30","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/6655628","author":"P Janiani","year":"2023","unstructured":"Janiani P, Gurunathan D, Nuvvula S (2023) Influence of temperament on the acceptance of two conscious sedation techniques in toddlers undergoing dental treatment: a randomised cross over trial. Pain Res Manag. https:\/\/doi.org\/10.1155\/2023\/6655628","journal-title":"Pain Res Manag"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07259-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-07259-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07259-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T03:50:08Z","timestamp":1786420208000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-07259-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["7259"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-07259-w","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"assertion":[{"value":"14 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 July 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The trial was conducted in accordance with the principles of Good Clinical Practice guidelines and the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline. The study protocol was approved by National Committee on Medical Research Ethics (Tukija) on May 20, 2016 (ID: 87\/06.00.00\/2016), the ethical committee of the Northern Ostrobothnia Health care district on October 19, 2016 (ID: 82\/2016) and The Finnish Medicines Agency (Fimea) on November 7, 2016 (ID: 2016\u2013002065-66).","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Parents or legal guardians gave their written informed consent before participation. Patients aged 6 to 18\u00a0years gave their own written consent in addition to parental consent.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"596"}}