{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:45:37Z","timestamp":1792079137805,"version":"4.4.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Dysphagia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Flexible endoscopic evaluation of swallowing (FEES) is a cornerstone of instrumental dysphagia assessment, yet substantial practice variation has been documented across clinical settings. This study aimed to characterize variation in FEES protocols and examine associations between clinician and professional characteristics, practice patterns, and confidence in interpreting clinical findings. An online survey was completed by 109 professionals with FEES experience. The final analytic sample included 97 participants. The survey assessed demographic and professional background, protocol components, examination duration, and self-rated confidence in clinical judgements. Substantial heterogeneity was found across FEES protocol components, including inconsistent incorporation of sensory testing, variable dye use, and diverse rating scale adoption. The Penetration-Aspiration Scale was used by 98.9% of respondents, while other scales showed lower adoption rates. Confidence was highest for judging aspiration presence and lowest for aspiration depth. Greater FEES-specific experience was associated with shorter examination duration (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03), but neither years of experience nor education level significantly predicted overall confidence in judgment. Physician status and higher education were significantly associated with performing formal sensory testing. FEES is implemented with considerable variability in clinical practice. Confidence in judgment appears to be influenced by the complexity of the clinical finding and the availability of structured rating tools rather than by experience or education alone. These findings support the need for clearer definition of core protocol components, development of standardized tools for complex swallowing parameters, and systematic evaluation of training models.\n                  <\/jats:p>","DOI":"10.1007\/s00455-026-11012-8","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:17:35Z","timestamp":1792066655000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Practice Variation in Flexible Endoscopic Evaluation of Swallowing (FEES): An International Survey"],"prefix":"10.1007","author":[{"given":"Yuval","family":"Nachalon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M","family":"Evangelista","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan S","family":"Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doron","family":"Zaliat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1511-5321","authenticated-orcid":false,"given":"Nogah","family":"Nativ-Zeltzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"7","key":"11012_CR1","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/j.jamda.2017.02.015","volume":"18","author":"O Ortega","year":"2017","unstructured":"Ortega O, Mart\u00edn A, Clav\u00e9 P. Diagnosis and Management of Oropharyngeal Dysphagia Among Older Persons, State of the Art. J Am Med Dir Assoc. 2017;18(7):576\u201382. https:\/\/doi.org\/10.1016\/j.jamda.2017.02.015.","journal-title":"J Am Med Dir Assoc"},{"key":"11012_CR2","doi-asserted-by":"publisher","first-page":"818979","DOI":"10.1155\/2011\/818979","volume":"2011","author":"L Rofes","year":"2011","unstructured":"Rofes L, Arreola V, Almirall J, et al. Diagnosis and management of oropharyngeal Dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterol Res Pract. 2011;2011:818979. https:\/\/doi.org\/10.1155\/2011\/818979.","journal-title":"Gastroenterol Res Pract"},{"issue":"4","key":"11012_CR3","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1007\/BF02414429","volume":"2","author":"SE Langmore","year":"1988","unstructured":"Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2(4):216\u20139.","journal-title":"Dysphagia"},{"issue":"6","key":"11012_CR4","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1016\/j.otc.2013.08.004","volume":"46","author":"R Speyer","year":"2013","unstructured":"Speyer R. Oropharyngeal dysphagia: screening and assessment. Otolaryngol Clin North Am. 2013;46(6):989\u20131008. https:\/\/doi.org\/10.1016\/j.otc.2013.08.004.","journal-title":"Otolaryngol Clin North Am"},{"key":"11012_CR5","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s42466-019-0021-5","volume":"1","author":"R Dziewas","year":"2019","unstructured":"Dziewas R, Auf dem Brinke M, Birkmann U, et al. Safety and clinical impact of FEES - results of the FEES-registry. Neurol Res Pract. 2019;1:16. https:\/\/doi.org\/10.1186\/s42466-019-0021-5.","journal-title":"Neurol Res Pract"},{"issue":"1","key":"11012_CR6","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s00455-016-9775-x","volume":"32","author":"SE Langmore","year":"2017","unstructured":"Langmore SE. History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years. Dysphagia. 2017;32(1):27\u201338. https:\/\/doi.org\/10.1007\/s00455-016-9775-x.","journal-title":"Dysphagia"},{"issue":"6","key":"11012_CR7","doi-asserted-by":"publisher","first-page":"2727","DOI":"10.1007\/s00405-021-07161-1","volume":"279","author":"A Schindler","year":"2022","unstructured":"Schindler A, Baijens LWJ, Geneid A, Pizzorni N. Phoniatricians and otorhinolaryngologists approaching oropharyngeal dysphagia: an update on FEES. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol -. Head Neck Surg. 2022;279(6):2727\u201342. https:\/\/doi.org\/10.1007\/s00405-021-07161-1.","journal-title":"Head Neck Surg"},{"issue":"1","key":"11012_CR8","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1044\/2022_AJSLP-22-00057","volume":"32","author":"CK Miller","year":"2023","unstructured":"AB-SSD Task Force-Pediatric Group, Miller CK, Reynolds J, et al. Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Pediatric Populations: Part 2. Am J Speech Lang Pathol. 2023;32(1):55\u201382. https:\/\/doi.org\/10.1044\/2022_AJSLP-22-00057.","journal-title":"Am J Speech Lang Pathol"},{"issue":"2","key":"11012_CR9","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/BF00417897","volume":"11","author":"JC Rosenbek","year":"1996","unstructured":"Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93\u20138. https:\/\/doi.org\/10.1007\/BF00417897.","journal-title":"Dysphagia"},{"issue":"5","key":"11012_CR10","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1007\/s00455-015-9631-4","volume":"30","author":"PD Neubauer","year":"2015","unstructured":"Neubauer PD, Rademaker AW, Leder SB. The Yale Pharyngeal Residue Severity Rating Scale: An Anatomically Defined and Image-Based Tool. Dysphagia. 2015;30(5):521\u20138. https:\/\/doi.org\/10.1007\/s00455-015-9631-4.","journal-title":"Dysphagia"},{"issue":"6","key":"11012_CR11","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.1044\/2021_JSLHR-21-00014","volume":"64","author":"HM Starmer","year":"2021","unstructured":"Starmer HM, Arrese L, Langmore S, et al. Adaptation and Validation of the Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing: DIGEST-FEES. J Speech Lang Hear Res. 2021;64(6):1802\u201310. https:\/\/doi.org\/10.1044\/2021_JSLHR-21-00014.","journal-title":"J Speech Lang Hear Res"},{"issue":"2","key":"11012_CR12","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s00455-021-10293-5","volume":"37","author":"JA Curtis","year":"2022","unstructured":"Curtis JA, Borders JC, Perry SE, Dakin AE, Seikaly ZN, Troche MS. Visual Analysis of Swallowing Efficiency and Safety (VASES): A Standardized Approach to Rating Pharyngeal Residue, Penetration, and Aspiration During FEES. Dysphagia. 2022;37(2):417\u201335. https:\/\/doi.org\/10.1007\/s00455-021-10293-5.","journal-title":"Dysphagia"},{"issue":"1","key":"11012_CR13","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1044\/2021_AJSLP-20-00348","volume":"31","author":"SE Langmore","year":"2022","unstructured":"Langmore SE, Scarborough DR, Kelchner LN, et al. Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Adult Populations: Part 1. Am J Speech Lang Pathol. 2022;31(1):163\u201387. https:\/\/doi.org\/10.1044\/2021_AJSLP-20-00348.","journal-title":"Am J Speech Lang Pathol"},{"issue":"3","key":"11012_CR14","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/j.bjorl.2021.03.002","volume":"88","author":"A Prikladnicki","year":"2021","unstructured":"Prikladnicki A, Santana MG, Cardoso MC. Protocols and assessment procedures in fiberoptic endoscopic evaluation of swallowing: an updated systematic review. Braz J Otorhinolaryngol. 2021;88(3):445\u201370. https:\/\/doi.org\/10.1016\/j.bjorl.2021.03.002.","journal-title":"Braz J Otorhinolaryngol"},{"issue":"6","key":"11012_CR15","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1159\/000503132","volume":"72","author":"M Cimoli","year":"2020","unstructured":"Cimoli M, Oates J, McLaughlin E, Langmore SE. Exploring Consistency and Variation in Fibreoptic Endoscopic Evaluation of Swallowing Practice in Australia. Folia Phoniatr Logop Off Organ Int Assoc Logop Phoniatr. 2020;72(6):429\u201341. https:\/\/doi.org\/10.1159\/000503132.","journal-title":"Folia Phoniatr Logop Off Organ Int Assoc Logop Phoniatr"},{"issue":"3","key":"11012_CR16","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/j.bjorl.2021.03.002","volume":"88","author":"A Prikladnicki","year":"2022","unstructured":"Prikladnicki A, Santana MG, Cardoso MC. Protocols and assessment procedures in fiberoptic endoscopic evaluation of swallowing: an updated systematic review. Braz J Otorhinolaryngol. 2022;88(3):445\u201370. https:\/\/doi.org\/10.1016\/j.bjorl.2021.03.002.","journal-title":"Braz J Otorhinolaryngol"},{"issue":"3","key":"11012_CR17","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1007\/s00455-016-9700-3","volume":"31","author":"JM Pisegna","year":"2016","unstructured":"Pisegna JM, Langmore SE. Parameters of Instrumental Swallowing Evaluations: Describing a Diagnostic Dilemma. Dysphagia. 2016;31(3):462\u201372. https:\/\/doi.org\/10.1007\/s00455-016-9700-3.","journal-title":"Dysphagia"},{"key":"11012_CR18","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s12909-016-0587-3","volume":"16","author":"R Dziewas","year":"2016","unstructured":"Dziewas R, Glahn J, Helfer C, et al. Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society. BMC Med Educ. 2016;16:70. https:\/\/doi.org\/10.1186\/s12909-016-0587-3.","journal-title":"BMC Med Educ"},{"issue":"8","key":"11012_CR19","doi-asserted-by":"publisher","first-page":"1897","DOI":"10.3390\/diagnostics12081897","volume":"12","author":"S Rocca","year":"2022","unstructured":"Rocca S, Pizzorni N, Valenza N, Negri L, Schindler A. Reliability and Construct Validity of the Yale Pharyngeal Residue Severity Rating Scale: Performance on Videos and Effect of Bolus Consistency. Diagnostics. 2022;12(8):1897. https:\/\/doi.org\/10.3390\/diagnostics12081897.","journal-title":"Diagnostics"},{"issue":"2","key":"11012_CR20","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1007\/s00455-023-10614-w","volume":"39","author":"BOI Costa","year":"2024","unstructured":"Costa BOI, Machado LS, Augusto MM, Magalh\u00e3es DDD, Alves TC, Pernambuco L. Training to Analyze Functional Parameters with Fiberoptic Endoscopic Evaluation of Swallowing: A Scoping Review. Dysphagia. 2024;39(2):198\u2013207. https:\/\/doi.org\/10.1007\/s00455-023-10614-w.","journal-title":"Dysphagia"},{"issue":"2","key":"11012_CR21","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1080\/17549507.2025.2457401","volume":"28","author":"C Stanley","year":"2026","unstructured":"Stanley C, Miles A, Phyland D. Is there a doctor in the house? Roles and practices in videofluoroscopic swallowing assessment of structural abnormalities. Int J Speech Lang Pathol. 2026;28(2):171\u201382. https:\/\/doi.org\/10.1080\/17549507.2025.2457401.","journal-title":"Int J Speech Lang Pathol"},{"issue":"3","key":"11012_CR22","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1044\/2022_AJSLP-22-00022","volume":"32","author":"S Watts","year":"2023","unstructured":"Watts S, Gaziano J, Kumar A, Richter J. The Modified Barium Swallow Study and Esophageal Screening: A Survey of Clinical Practice Patterns. Am J Speech Lang Pathol. 2023;32(3):1065\u201382. https:\/\/doi.org\/10.1044\/2022_AJSLP-22-00022.","journal-title":"Am J Speech Lang Pathol"},{"key":"11012_CR23","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.clinimag.2021.12.016","volume":"83","author":"L Hermann","year":"2022","unstructured":"Hermann L, Donaker M, Salmon K, Mervak B. Understanding differences in practices and preferences during videofluoroscopic swallow studies: A survey of radiologists and speech language pathologists in the United States. Clin Imaging. 2022;83:144\u201351. https:\/\/doi.org\/10.1016\/j.clinimag.2021.12.016.","journal-title":"Clin Imaging"},{"issue":"2","key":"11012_CR24","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1080\/17549507.2025.2482865","volume":"28","author":"A Miles","year":"2026","unstructured":"Miles A, Wallace S. Management of adults with a tracheostomy: An international survey of speech-language pathologists\u2019 practice. Int J Speech Lang Pathol. 2026;28(2):183\u201396. https:\/\/doi.org\/10.1080\/17549507.2025.2482865.","journal-title":"Int J Speech Lang Pathol"},{"issue":"5","key":"11012_CR25","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1111\/1460-6984.12873","volume":"58","author":"F Sparks","year":"2023","unstructured":"Sparks F, Dipper L, Coffey M, Hilari K. Approaches to tracheoesophageal voice rehabilitation: a survey of the UK and Irish speech and language therapists\u2019 current practice and beliefs. Int J Lang Commun Disord. 2023;58(5):1481\u201395. https:\/\/doi.org\/10.1111\/1460-6984.12873.","journal-title":"Int J Lang Commun Disord"},{"key":"11012_CR26","unstructured":"IDDSI, Complete IDDSI, Framework. 2019. https:\/\/ftp.iddsi.org\/Documents\/Complete_IDDSI_Framework_Final_31July2019.pdf"},{"issue":"5 Pt 1","key":"11012_CR27","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1177\/000348949810700503","volume":"107","author":"JE Aviv","year":"1998","unstructured":"Aviv JE, Kim T, Sacco RL, et al. FEESST: a new bedside endoscopic test of the motor and sensory components of swallowing. Ann Otol Rhinol Laryngol. 1998;107(5 Pt 1):378\u201387. https:\/\/doi.org\/10.1177\/000348949810700503.","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"3","key":"11012_CR28","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1177\/0003489414550241","volume":"124","author":"A Kaneoka","year":"2015","unstructured":"Kaneoka A, Krisciunas GP, Walsh K, Raade AS, Langmore SE. A comparison of 2 methods of endoscopic laryngeal sensory testing: a preliminary study. Ann Otol Rhinol Laryngol. 2015;124(3):187\u201393. https:\/\/doi.org\/10.1177\/0003489414550241.","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"6","key":"11012_CR29","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1177\/0003489419901145","volume":"129","author":"JC Borders","year":"2020","unstructured":"Borders JC, O\u2019Dea MB, McNally E, et al. Inter- and Intra-Rater Reliability of Laryngeal Sensation Testing with the Touch Method During Flexible Endoscopic Evaluations of Swallowing. Ann Otol Rhinol Laryngol. 2020;129(6):565\u201371. https:\/\/doi.org\/10.1177\/0003489419901145.","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"11","key":"11012_CR30","doi-asserted-by":"publisher","first-page":"e13690","DOI":"10.1111\/nmo.13690","volume":"31","author":"B Labeit","year":"2019","unstructured":"Labeit B, Muhle P, Ogawa M, et al. FEES-based assessment of pharyngeal hypesthesia\u2014Proposal and validation of a new test procedure. Neurogastroenterol Motil. 2019;31(11):e13690. https:\/\/doi.org\/10.1111\/nmo.13690.","journal-title":"Neurogastroenterol Motil"},{"issue":"4","key":"11012_CR31","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1007\/s00455-024-10789-w","volume":"40","author":"N Regio","year":"2025","unstructured":"Regio N, Hutton R, Wallace ES. Upper Airway Sensory Testing in Dysphagia - Implications for Clinical Practice and Future Research Directions. Dysphagia. 2025;40(4):920\u201330. https:\/\/doi.org\/10.1007\/s00455-024-10789-w.","journal-title":"Dysphagia"},{"issue":"3","key":"11012_CR32","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1037\/0033-295X.100.3.363","volume":"100","author":"KA Ericsson","year":"1993","unstructured":"Ericsson KA, Krampe RT, Tesch-R\u00f6mer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev. 1993;100(3):363\u2013406. https:\/\/doi.org\/10.1037\/0033-295X.100.3.363.","journal-title":"Psychol Rev"},{"issue":"11","key":"11012_CR33","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1111\/j.1553-2712.2008.00227.x","volume":"15","author":"KA Ericsson","year":"2008","unstructured":"Ericsson KA. Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med Off J Soc Acad Emerg Med. 2008;15(11):988\u201394. https:\/\/doi.org\/10.1111\/j.1553-2712.2008.00227.x.","journal-title":"Acad Emerg Med Off J Soc Acad Emerg Med"},{"issue":"1","key":"11012_CR34","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1097\/ACM.0000000000001421","volume":"92","author":"GR Norman","year":"2017","unstructured":"Norman GR, Monteiro SD, Sherbino J, Ilgen JS, Schmidt HG, Mamede S. The Causes of Errors in Clinical Reasoning: Cognitive Biases, Knowledge Deficits, and Dual Process Thinking. Acad Med J Assoc Am Med Coll. 2017;92(1):23\u201330. https:\/\/doi.org\/10.1097\/ACM.0000000000001421.","journal-title":"Acad Med J Assoc Am Med Coll"},{"issue":"10","key":"11012_CR35","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1097\/MLG.0b013e318123ee6a","volume":"117","author":"AM Kelly","year":"2007","unstructured":"Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007;117(10):1723\u20137. https:\/\/doi.org\/10.1097\/MLG.0b013e318123ee6a.","journal-title":"Laryngoscope"}],"container-title":["Dysphagia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00455-026-11012-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00455-026-11012-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00455-026-11012-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:03:21Z","timestamp":1792076601000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00455-026-11012-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":35,"alternative-id":["11012"],"URL":"https:\/\/doi.org\/10.1007\/s00455-026-11012-8","relation":{},"ISSN":["0179-051X","1432-0460"],"issn-type":[{"value":"0179-051X","type":"print"},{"value":"1432-0460","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"19 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 September 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflict of interests.","order":1,"name":"Ethics","label":"<b>Conflict of interests<\/b>","group":{"name":"EthicsHeading","label":"Declarations"}}]}}