{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T02:34:55Z","timestamp":1791513295933,"version":"4.3.4"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"3-4","license":[{"start":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T00:00:00Z","timestamp":1630972800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T00:00:00Z","timestamp":1630972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000055","name":"National Institute on Deafness and Other Communication Disorders","doi-asserted-by":"publisher","award":["DC018583"],"award-info":[{"award-number":["DC018583"]}],"id":[{"id":"10.13039\/100000055","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017649","name":"Claire Giannini Fund","doi-asserted-by":"crossref","award":["Children's Communication Center"],"award-info":[{"award-number":["Children's Communication Center"]}],"id":[{"id":"10.13039\/100017649","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hum Genet"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Racial\/ethnic disparities in the diagnostic efficacy of genetic testing for hearing loss have been described. These disparities may relate to differences in variant classification between different racial\/ethnic groups, which may, in turn, derive from disparate representation of these groups in the published literature. We sought to quantify racial\/ethnic disparities in the published literature on the human genetics of hearing loss. We conducted a search of PubMed for articles describing single-gene, multiple-gene, or whole-exome sequencing for individuals with sensorineural hearing loss. Data on the included subjects, including race\/ethnicity and\/or region of origin, a number of subjects tested, and method of testing, were extracted. 1355 populations representing 311,092 subjects from 1165 studies were included. Overall, subjects of European and Asian ancestry were equivalently represented, but those of Latino American, African, and indigenous North American ancestry were significantly underrepresented; over 96% of all subjects in the published literature were European or Asian. Within populations, the majority of subjects derived from a small subset of countries. The observed disparity was greater for multiple-gene and whole-exome sequencing than for single-gene sequencing. These findings illustrate the large disparity in the published literature on the genetics of hearing loss, and demonstrate the need for increased representation of Latino American, African, and indigenous North American populations.<\/jats:p>","DOI":"10.1007\/s00439-021-02335-7","type":"journal-article","created":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T14:09:59Z","timestamp":1631023799000},"page":"485-494","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Racial and ethnic disparities in genetic testing for hearing loss: a systematic review and synthesis"],"prefix":"10.1007","volume":"141","author":[{"given":"Stephanie L.","family":"Rouse","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle M.","family":"Florentine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Taketa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0836-3730","authenticated-orcid":false,"given":"Dylan K.","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,7]]},"reference":[{"issue":"6","key":"2335_CR1","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1016\/j.ajhg.2016.03.024","volume":"98","author":"LM Amendola","year":"2016","unstructured":"Amendola LM, Jarvik GP, Leo MC et al (2016) Performance of ACMG-AMP variant-interpretation guidelines among nine laboratories in the clinical sequencing exploratory research consortium. Am J Hum Genet 98(6):1067\u20131076. https:\/\/doi.org\/10.1016\/j.ajhg.2016.03.024","journal-title":"Am J Hum Genet"},{"issue":"4","key":"2335_CR2","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/1479-7364-5-4-220","volume":"5","author":"TM Baye","year":"2011","unstructured":"Baye TM (2011) Inter-chromosomal variation in the pattern of human population genetic structure. Hum Genom 5(4):220. https:\/\/doi.org\/10.1186\/1479-7364-5-4-220","journal-title":"Hum Genom"},{"key":"2335_CR3","doi-asserted-by":"publisher","DOI":"10.17077\/etd.h3om-klhg","volume-title":"Unraveling the genotypic and phenotypic complexities of genetic hearing loss","author":"KT Booth","year":"2018","unstructured":"Booth KT (2018) Unraveling the genotypic and phenotypic complexities of genetic hearing loss. University of Iowa, Iowa. https:\/\/doi.org\/10.17077\/etd.h3om-klhg"},{"key":"2335_CR4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMms2029562","author":"LN Borrell","year":"2021","unstructured":"Borrell LN, Elhawary JR, Fuentes-Afflick E et al (2021) Race and genetic ancestry in medicine a time for reckoning with racism. N Engl J Med. https:\/\/doi.org\/10.1056\/NEJMms2029562","journal-title":"N Engl J Med"},{"key":"2335_CR5","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29193","author":"KD Brodie","year":"2020","unstructured":"Brodie KD, Moore AT, Slavotinek AM et al (2020) Genetic testing leading to early identification of childhood ocular manifestations of usher syndrome. Laryngoscope. https:\/\/doi.org\/10.1002\/lary.29193","journal-title":"Laryngoscope"},{"issue":"12","key":"2335_CR6","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1056\/NEJMsb025007","volume":"348","author":"EG Burchard","year":"2003","unstructured":"Burchard EG, Ziv E, Coyle N et al (2003) The importance of race and ethnic background in biomedical research and clinical practice. N Engl J Med 348(12):1170\u20131175. https:\/\/doi.org\/10.1056\/NEJMsb025007","journal-title":"N Engl J Med"},{"issue":"5","key":"2335_CR7","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1097\/MOO.0000000000000388","volume":"25","author":"ML Bush","year":"2017","unstructured":"Bush ML, Kaufman MR, McNulty BN (2017) Disparities in access to pediatric hearing healthcare. Curr Opin Otolaryngol Head Neck Surg 25(5):359\u2013364. https:\/\/doi.org\/10.1097\/MOO.0000000000000388","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"issue":"1","key":"2335_CR8","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1002\/ajmg.a.20291","volume":"130A","author":"DB Carmeli","year":"2004","unstructured":"Carmeli DB (2004) Prevalence of Jews as subjects in genetic research: figures, explanation, and potential implications. Am J Med Genet A 130A(1):76\u201383. https:\/\/doi.org\/10.1002\/ajmg.a.20291","journal-title":"Am J Med Genet A"},{"issue":"2","key":"2335_CR9","doi-asserted-by":"publisher","first-page":"E34","DOI":"10.1002\/lary.24332","volume":"124","author":"DK Chan","year":"2014","unstructured":"Chan DK, Chang KW (2014) GJB2-associated hearing loss: systematic review of worldwide prevalence, genotype, and auditory phenotype. Laryngoscope 124(2):E34-53. https:\/\/doi.org\/10.1002\/lary.24332","journal-title":"Laryngoscope"},{"key":"2335_CR10","unstructured":"Cochrane Handbook for Systematic Reviews of Interventions (2021). https:\/\/training.cochrane.org\/handbook\/current. Accessed 28 Apr 2021"},{"issue":"12","key":"2335_CR11","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1056\/NEJMsb022863","volume":"348","author":"RS Cooper","year":"2003","unstructured":"Cooper RS, Kaufman JS, Ward R (2003) Race and genomics. N Engl J Med 348(12):1166\u20131170. https:\/\/doi.org\/10.1056\/NEJMsb022863","journal-title":"N Engl J Med"},{"key":"2335_CR12","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2020.579924","author":"CS D\u2019Angelo","year":"2020","unstructured":"D\u2019Angelo CS, Hermes A, McMaster CR et al (2020) Barriers and considerations for diagnosing rare diseases in indigenous populations. Front Pediatr. https:\/\/doi.org\/10.3389\/fped.2020.579924","journal-title":"Front Pediatr"},{"key":"2335_CR13","doi-asserted-by":"publisher","unstructured":"Florentine MM, Rouse SL, Stephans J, Conrad D, Czechowicz J, Matthews IR, Meyer AM, Nadaraja GS, Parikh R, Virbalas J, Weinstein JE, Chan DK (2021) Racial and ethnic disparities in diagnostic efficacy of comprehensive genetic testing for sensorineural hearing loss. https:\/\/doi.org\/10.1007\/s00439-021-02338-4","DOI":"10.1007\/s00439-021-02338-4"},{"issue":"7312","key":"2335_CR14","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1136\/bmj.323.7312.536","volume":"323","author":"HM Fortnum","year":"2001","unstructured":"Fortnum HM, Summerfield AQ, Marshall DH, Davis AC, Bamford JM (2001) Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study. BMJ 323(7312):536","journal-title":"BMJ"},{"issue":"4","key":"2335_CR15","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1001\/jamacardio.2017.5345","volume":"3","author":"GS Gerhard","year":"2018","unstructured":"Gerhard GS, Fisher SG, Feldman AM (2018) Genetic testing for inherited cardiac diseases in underserved populations of non-european ancestry: double disparity. JAMA Cardiol 3(4):273. https:\/\/doi.org\/10.1001\/jamacardio.2017.5345","journal-title":"JAMA Cardiol"},{"issue":"12","key":"2335_CR16","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.2105\/AJPH.2005.068668","volume":"95","author":"E Gonz\u00e1lez Burchard","year":"2005","unstructured":"Gonz\u00e1lez Burchard E, Borrell LN, Choudhry S et al (2005) Latino populations: a unique opportunity for the study of race, genetics, and social environment in epidemiological research. Am J Public Health 95(12):2161\u20132168. https:\/\/doi.org\/10.2105\/AJPH.2005.068668","journal-title":"Am J Public Health"},{"key":"2335_CR17","doi-asserted-by":"publisher","first-page":"8161","DOI":"10.1002\/0471142905.hg0816s89","volume":"89","author":"SM Harrison","year":"2016","unstructured":"Harrison SM, Riggs ER, Maglott DR et al (2016) Using ClinVar as a resource to support variant interpretations. Curr Protoc Hum Genet 89:8161\u201381623. https:\/\/doi.org\/10.1002\/0471142905.hg0816s89","journal-title":"Curr Protoc Hum Genet"},{"issue":"5","key":"2335_CR18","doi-asserted-by":"publisher","first-page":"546","DOI":"10.2174\/156652409788488775","volume":"9","author":"N Hilgert","year":"2009","unstructured":"Hilgert N, Smith RJH, Van Camp G (2009) Function and expression pattern of nonsyndromic deafness genes. Curr Mol Med 9(5):546\u2013564. https:\/\/doi.org\/10.2174\/156652409788488775","journal-title":"Curr Mol Med"},{"issue":"14","key":"2335_CR19","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1161\/CIRCULATIONAHA.117.033200","volume":"138","author":"CY Ho","year":"2018","unstructured":"Ho CY, Day SM, Ashley EA et al (2018) Genotype and lifetime burden of disease in hypertrophic cardiomyopathy. Circulation 138(14):1387\u20131398. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.117.033200","journal-title":"Circulation"},{"key":"2335_CR20","unstructured":"IGSR (2021) Populations. https:\/\/www.internationalgenome.org\/data-portal\/population. Accessed 29 June 2021"},{"issue":"6","key":"2335_CR21","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1038\/ng.388","volume":"41","author":"M Jallow","year":"2009","unstructured":"Jallow M, Teo YY, Small KS et al (2009) Genome-wide and fine-resolution association analysis of malaria in West Africa. Nat Genet 41(6):657\u2013665. https:\/\/doi.org\/10.1038\/ng.388","journal-title":"Nat Genet"},{"issue":"2","key":"2335_CR22","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1038\/84773","volume":"27","author":"H Kaessmann","year":"2001","unstructured":"Kaessmann H, Wiebe V, Weiss G, P\u00e4\u00e4bo S (2001) Great ape DNA sequences reveal a reduced diversity and an expansion in humans. Nat Genet 27(2):155\u2013156. https:\/\/doi.org\/10.1038\/84773","journal-title":"Nat Genet"},{"issue":"8","key":"2335_CR23","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1097\/GIM.0b013e3181e5afb8","volume":"12","author":"WJ Kimberling","year":"2010","unstructured":"Kimberling WJ, Hildebrand MS, Shearer AE et al (2010) Frequency of usher syndrome in two pediatric populations: implications for genetic screening of deaf and hard of hearing children. Genet Med 12(8):512\u2013516. https:\/\/doi.org\/10.1097\/GIM.0b013e3181e5afb8","journal-title":"Genet Med"},{"key":"2335_CR24","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2015.20.383.5230","author":"K Lebeko","year":"2015","unstructured":"Lebeko K, Bosch J, Noubiap JJN, Dandara C, Wonkam A (2015) Genetics of hearing loss in Africans: use of next generation sequencing is the best way forward. Pan Afr Med J. https:\/\/doi.org\/10.11604\/pamj.2015.20.383.5230","journal-title":"Pan Afr Med J"},{"key":"2335_CR25","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1007\/978-1-4684-9063-3_14","volume-title":"Evolutionary biology","author":"RC Lewontin","year":"1972","unstructured":"Lewontin RC (1972) The apportionment of human diversity. In: Dobzhansky T, Hecht MK, Steere WC (eds) Evolutionary biology. Springer, Berlin, pp 381\u2013398. https:\/\/doi.org\/10.1007\/978-1-4684-9063-3_14"},{"issue":"7","key":"2335_CR26","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1056\/NEJMsa1507092","volume":"375","author":"AK Manrai","year":"2016","unstructured":"Manrai AK, Funke BH, Rehm HL et al (2016) Genetic misdiagnoses and the potential for health disparities. N Engl J Med 375(7):655\u2013665. https:\/\/doi.org\/10.1056\/NEJMsa1507092","journal-title":"N Engl J Med"},{"issue":"4","key":"2335_CR27","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1038\/s41588-019-0379-x","volume":"51","author":"AR Martin","year":"2019","unstructured":"Martin AR, Kanai M, Kamatani Y, Okada Y, Neale BM, Daly MJ (2019) Clinical use of current polygenic risk scores may exacerbate health disparities. Nat Genet 51(4):584\u2013591. https:\/\/doi.org\/10.1038\/s41588-019-0379-x","journal-title":"Nat Genet"},{"issue":"1","key":"2335_CR28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40246-014-0023-x","volume":"9","author":"TB Mersha","year":"2015","unstructured":"Mersha TB, Abebe T (2015) Self-reported race\/ethnicity in the age of genomic research: its potential impact on understanding health disparities. Hum Genom 9(1):1. https:\/\/doi.org\/10.1186\/s40246-014-0023-x","journal-title":"Hum Genom"},{"issue":"10","key":"2335_CR29","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1016\/j.jclinepi.2009.06.005","volume":"62","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006\u20131012. https:\/\/doi.org\/10.1016\/j.jclinepi.2009.06.005","journal-title":"J Clin Epidemiol"},{"issue":"20","key":"2335_CR30","doi-asserted-by":"publisher","first-page":"2151","DOI":"10.1056\/NEJMra050700","volume":"354","author":"CC Morton","year":"2006","unstructured":"Morton CC, Nance WE (2006) Newborn hearing screening: a silent revolution. N Engl J Med 354(20):2151\u20132164. https:\/\/doi.org\/10.1056\/NEJMra050700","journal-title":"N Engl J Med"},{"issue":"6","key":"2335_CR31","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1002\/mgg3.260","volume":"4","author":"A Pandya","year":"2016","unstructured":"Pandya A (2016) Genetic hearing loss: the journey of discovery to destination \u2013 how close are we to therapy? Mol Genet Genom Med 4(6):583\u2013587. https:\/\/doi.org\/10.1002\/mgg3.260","journal-title":"Mol Genet Genom Med"},{"key":"2335_CR32","doi-asserted-by":"publisher","DOI":"10.1186\/s13059-016-1016-y","author":"S Petrovski","year":"2016","unstructured":"Petrovski S, Goldstein DB (2016) Unequal representation of genetic variation across ancestry groups creates healthcare inequality\u00a0in the application of precision medicine. Genome Biol. https:\/\/doi.org\/10.1186\/s13059-016-1016-y","journal-title":"Genome Biol"},{"issue":"7624","key":"2335_CR33","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1038\/538161a","volume":"538","author":"AB Popejoy","year":"2016","unstructured":"Popejoy AB, Fullerton SM (2016) Genomics is failing on diversity. Nat News 538(7624):161. https:\/\/doi.org\/10.1038\/538161a","journal-title":"Nat News"},{"issue":"11","key":"2335_CR34","doi-asserted-by":"publisher","first-page":"2614","DOI":"10.1038\/s41436-019-0563-5","volume":"21","author":"AE Shearer","year":"2019","unstructured":"Shearer AE, Shen J, Amr S, Morton CC, Smith RJ (2019) A proposal for comprehensive newborn hearing screening to improve identification of deaf and hard-of-hearing children. Genet Med 21(11):2614\u20132630. https:\/\/doi.org\/10.1038\/s41436-019-0563-5","journal-title":"Genet Med"},{"key":"2335_CR35","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1007\/s00439-016-1648-8","volume":"135","author":"CM Sloan-Heggen","year":"2016","unstructured":"Sloan-Heggen CM, Bierer AO, Shearer AE et al (2016) Comprehensive genetic testing in the clinical evaluation of 1119 patients with hearing loss. Hum Genet 135:441\u2013450. https:\/\/doi.org\/10.1007\/s00439-016-1648-8","journal-title":"Hum Genet"},{"issue":"Suppl 3","key":"2335_CR36","doi-asserted-by":"publisher","first-page":"S371","DOI":"10.2105\/AJPH.2014.302267","volume":"105","author":"S Srinivasan","year":"2015","unstructured":"Srinivasan S, Moser RP, Willis G et al (2015) Small is essential: importance of subpopulation research in cancer control. Am J Public Health 105(Suppl 3):S371-373. https:\/\/doi.org\/10.2105\/AJPH.2014.302267","journal-title":"Am J Public Health"},{"issue":"9","key":"2335_CR37","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1097\/GIM.0b013e3181ab22aa","volume":"11","author":"S Suther","year":"2009","unstructured":"Suther S, Kiros G-E (2009) Barriers to the use of genetic testing: a study of racial and ethnic disparities. Genet Med 11(9):655\u2013662. https:\/\/doi.org\/10.1097\/GIM.0b013e3181ab22aa","journal-title":"Genet Med"},{"issue":"1","key":"2335_CR38","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s13073-019-0616-z","volume":"11","author":"R Walsh","year":"2019","unstructured":"Walsh R, Mazzarotto F, Whiffin N et al (2019) Quantitative approaches to variant classification increase the yield and precision of genetic testing in Mendelian diseases: the case of hypertrophic cardiomyopathy. Genome Med 11(1):5. https:\/\/doi.org\/10.1186\/s13073-019-0616-z","journal-title":"Genome Med"},{"issue":"8","key":"2335_CR39","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1007\/s00439-016-1697-z","volume":"135","author":"D Yan","year":"2016","unstructured":"Yan D, Tekin D, Bademci G et al (2016) Spectrum of DNA variants for nonsyndromic deafness in a large cohort from multiple continents. Hum Genet 135(8):953\u2013961. https:\/\/doi.org\/10.1007\/s00439-016-1697-z","journal-title":"Hum Genet"}],"container-title":["Human Genetics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00439-021-02335-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00439-021-02335-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00439-021-02335-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,23]],"date-time":"2022-04-23T03:07:56Z","timestamp":1650683276000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00439-021-02335-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,7]]},"references-count":39,"journal-issue":{"issue":"3-4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["2335"],"URL":"https:\/\/doi.org\/10.1007\/s00439-021-02335-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-484764\/v1","asserted-by":"object"}]},"ISSN":["0340-6717","1432-1203"],"issn-type":[{"value":"0340-6717","type":"print"},{"value":"1432-1203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,7]]},"assertion":[{"value":"30 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 September 2021","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 declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was exempt from IRB review, as it is a systematic review of existing published literature and therefore does not constitute human subjects research.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}