{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T17:19:40Z","timestamp":1779297580726,"version":"3.51.4"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T00:00:00Z","timestamp":1746835200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T00:00:00Z","timestamp":1746835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Umea University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Global demographics show a steady increase in the number of octogenarians. Consequently, the number of degenerative spine procedures in the elderly has significantly increased. This study aims to describe patient satisfaction, the patient-reported health-related quality-of-life, and complications, following posterior cervical laminectomy for degenerative cervical myelopathy (DCM) in octogenarians based on the national Swedish experience.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>The national Swedish spine registry, Swespine was reviewed between January 2006 and December 2020 for patients who underwent laminectomy for DCM. Complication rates, patient satisfaction, and Patient-Reported Outcome Measures (PROMs) one year after surgery, were analyzed and compared between propensity score matched octogenarian (\u2265\u200980) and younger adult cohorts (&lt;\u200980 years).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 1,382 patients, 162 octogenarians, and 1,220 younger patients were identified. At one-year after surgery there were no significant difference in patient satisfaction rate or in any of the other PROMS (Eq.\u00a05D, NRS neck pain, NRS arm pain, EQ-VAS, Neck Disability Index (NDI), the European Myelopathy Score (EMS). Complication rates were also comparable, 8.0% in octogenarians (<jats:italic>n<\/jats:italic>\u2009=\u200913) and 11% in younger adults (<jats:italic>n<\/jats:italic>\u2009=\u200951), respectively. The length of hospital stay was significantly longer in the octogenarian group, with a mean hospitalization of 5.08 days (SD\u2009\u00b1\u20094.86) compared to 3.76 days (SD\u2009\u00b1\u20093.93) in the younger adult cohort (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Octogenarians undergoing cervical spine surgery for DCM experience outcomes comparable to younger adults in terms of satisfaction, pain relief, and quality of life, indicating that age alone should not hinder surgical treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of evidence<\/jats:title>\n            <jats:p>IV, Retrospective observational cohort study.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00586-025-08890-1","type":"journal-article","created":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T02:48:58Z","timestamp":1746845338000},"page":"3003-3011","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Patient-reported outcome measures and satisfaction after laminectomy for degenerative cervical myelopathy in octogenarians: an observational study from the national Swedish spine registry"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9479-761X","authenticated-orcid":false,"given":"Victor Gabriel","family":"El-Hajj","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1039-2098","authenticated-orcid":false,"given":"Victor E.","family":"Staartjes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5228-738X","authenticated-orcid":false,"given":"Anastasios","family":"Charalampidis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5464-8609","authenticated-orcid":false,"given":"Gunnar","family":"Nilsson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8061-7163","authenticated-orcid":false,"given":"Paul","family":"Gerdhem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8781-1169","authenticated-orcid":false,"given":"Erik","family":"Edstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3776-6136","authenticated-orcid":false,"given":"Adrian","family":"Elmi-Terander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5920-293X","authenticated-orcid":false,"given":"Josefin","family":"\u00c5kerstedt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,10]]},"reference":[{"key":"8890_CR1","unstructured":"Murthi M, World Bank Group (2016) In Europe, Life Gets Shorter for Some. https:\/\/www.worldbank.org\/en\/news\/opinion\/2015\/04\/22\/in-europe-life-gets-shorter-for-some (accessed August 30, 2023)"},{"key":"8890_CR2","unstructured":"United Nations (2019) World Population Ageing 2019 Highlights United Nations"},{"key":"8890_CR3","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1007\/s10143-010-0301-6","volume":"34","author":"S Chibbaro","year":"2010","unstructured":"Chibbaro S, Di Rocco F, Makiese O, Mirone G, Marsella M, Lukaszewicz AC, Vicaut E, Turner B, Hamdi S, Spiriev T, Di Emidio P, Pirracchio R, Payen D, George B, Bresson D (2010) Neurosurgery and elderly: analysis through the years. Neurosurg Rev 34:229\u2013234","journal-title":"Neurosurg Rev"},{"key":"8890_CR4","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1016\/j.wneu.2015.10.099","volume":"87","author":"KJ Whitehouse","year":"2016","unstructured":"Whitehouse KJ, Jeyaretna DS, Wright A, Whitfield PC (2016) Neurosurgical care in the elderly: increasing demands necessitate future healthcare planning. World Neurosurg 87:446\u2013454","journal-title":"World Neurosurg"},{"key":"8890_CR5","doi-asserted-by":"publisher","first-page":"2469","DOI":"10.1007\/s00415-020-09854-9","volume":"267","author":"E Edlmann","year":"2020","unstructured":"Edlmann E, Whitfield PC (2020) The changing face of neurosurgery for the older person. J Neurol 267:2469\u20132474","journal-title":"J Neurol"},{"key":"8890_CR6","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.2106\/JBJS.M.01126","volume":"96","author":"H Yoshihara","year":"2014","unstructured":"Yoshihara H, Yoneoka D (2014) Trends in the incidence and In-Hospital outcomes of elective major orthopaedic surgery in patients Eighty years of age and older in the united States from 2000 to 2009. J Bone Joint Surg Am 96:1185\u20131191","journal-title":"J Bone Joint Surg Am"},{"key":"8890_CR7","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1001\/jama.2010.338","volume":"303","author":"RA Deyo","year":"2010","unstructured":"Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259\u20131265","journal-title":"JAMA"},{"key":"8890_CR8","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1097\/01.brs.0000152381.20719.50","volume":"30","author":"K Galiano","year":"2005","unstructured":"Galiano K, Obwegeser AA, Gabl MV, Bauer R, Twerdy K (2005) Long-term outcome of laminectomy for spinal stenosis in octogenarians. Spine 30:332\u2013335","journal-title":"Spine"},{"key":"8890_CR9","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.3171\/2020.2.JNS193460","volume":"134","author":"RT Sch\u00e4r","year":"2020","unstructured":"Sch\u00e4r RT, Tashi S, Branca M, S\u00f6ll N, Cipriani D, Schwarz C, Pollo C, Schucht P, Ulrich CT, Beck J, Z\u2019Graggen WJ, Raabe A (2020) How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases. J Neurosurg 134:1113\u20131121","journal-title":"J Neurosurg"},{"key":"8890_CR10","doi-asserted-by":"publisher","first-page":"764","DOI":"10.14245\/ns.1836336.168","volume":"16","author":"JY-W Tan","year":"2019","unstructured":"Tan JY-W, Kaliya-Perumal A-K, Oh JY-L (2019) Is spinal surgery safe for elderly patients aged 80 and above?? Predictors of mortality and morbidity in an Asian population. Neurospine 16:764\u2013769","journal-title":"Neurospine"},{"key":"8890_CR11","doi-asserted-by":"publisher","first-page":"e16","DOI":"10.1016\/j.wneu.2017.09.021","volume":"109","author":"J Steinberger","year":"2018","unstructured":"Steinberger J, Bronheim RS, Vempati P, Oermann EK, Ladner TR, Lee NJ, Kothari P, Caridi JM, Shrivastava RK (2018) Morbidity and mortality of meningioma resection increases in octogenarians. World Neurosurg 109:e16\u2013e23","journal-title":"World Neurosurg"},{"key":"8890_CR12","doi-asserted-by":"publisher","first-page":"611","DOI":"10.3109\/02688697.2014.889809","volume":"28","author":"MG Stovell","year":"2014","unstructured":"Stovell MG, Jenkinson MD (2014) Neurosurgery in octogenarians. Br J Neurosurg 28:611\u2013615","journal-title":"Br J Neurosurg"},{"key":"8890_CR13","doi-asserted-by":"publisher","first-page":"e185","DOI":"10.1016\/j.wneu.2019.08.219","volume":"132","author":"DG Eichberg","year":"2019","unstructured":"Eichberg DG, Di L, Shah AH, Luther E, Richardson AM, Sarkiss CA, Ivan ME, Komotar RJ (2019) Brain tumor surgery is safe in octogenarians and nonagenarians: A Single-Surgeon 741 patient series. World Neurosurg 132:e185\u2013e192","journal-title":"World Neurosurg"},{"key":"8890_CR14","doi-asserted-by":"publisher","first-page":"e425","DOI":"10.1016\/j.wneu.2021.12.060","volume":"159","author":"N Ahmed","year":"2022","unstructured":"Ahmed N, Kuo Y, Shin S (2022) Octogenarian survival after neurosurgical procedures to treat severe head trauma. World Neurosurg 159:e425\u2013e430","journal-title":"World Neurosurg"},{"key":"8890_CR15","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-024-08312-8","author":"VG El-Hajj","year":"2024","unstructured":"El-Hajj VG, Singh A, Fletcher-Sandersj\u00f6\u00f6 A, Buwaider A, Gharios M, Habashy KJ, Blixt S, Stenimahitis V, Nilsson G, Gerdhem P, Edstr\u00f6m E, Elmi-Terander A (2024) Long-term outcomes after surgery for subaxial cervical spine injuries in octogenarians, a matched population-based cohort study. Eur Spine J. https:\/\/doi.org\/10.1007\/s00586-024-08312-8","journal-title":"Eur Spine J"},{"key":"8890_CR16","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1016\/j.wneu.2020.04.060","volume":"140","author":"M Zileli","year":"2020","unstructured":"Zileli M, Dursun E (2020) How to improve outcomes of spine surgery in geriatric patients. World Neurosurg 140:519\u2013526","journal-title":"World Neurosurg"},{"key":"8890_CR17","doi-asserted-by":"publisher","first-page":"188","DOI":"10.4103\/2152-7806.91408","volume":"2","author":"NE Epstein","year":"2011","unstructured":"Epstein NE (2011) Spine surgery in geriatric patients: sometimes unnecessary, too much, or too little. Surg Neurol Int 2:188","journal-title":"Surg Neurol Int"},{"key":"8890_CR18","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1007\/s00586-013-2758-9","volume":"22","author":"B Str\u00f6mqvist","year":"2013","unstructured":"Str\u00f6mqvist B, Fritzell P, H\u00e4gg O, J\u00f6nsson B, Sand\u00e9n B (2013) Swedish society of spinal surgeons, swespine: the Swedish spine register: the 2012 report. Eur Spine J 22:953\u2013974","journal-title":"Eur Spine J"},{"key":"8890_CR19","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1007\/s00701-024-05991-6","volume":"166","author":"A Singh","year":"2024","unstructured":"Singh A, von Vogelsang A-C, Tatter C, El-Hajj VG, Fletcher-Sandersj\u00f6\u00f6 A, Cewe P, Nilsson G, Blixt S, Gerdhem P, Edstr\u00f6m E, Elmi-Terander A (2024) Dysphagia, health-related quality of life, and return to work after occipitocervical fixation. Acta Neurochir (Wien) 166:90","journal-title":"Acta Neurochir (Wien)"},{"key":"8890_CR20","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2024.10.010","author":"A Buwaider","year":"2024","unstructured":"Buwaider A, El-Hajj VG, MacDowall A, Gerdhem P, Staartjes VE, Edstr\u00f6m E, Elmi-Terander A (2024) Machine learning models for predicting dysphonia following anterior cervical discectomy and fusion: a Swedish registry study. Spine J. https:\/\/doi.org\/10.1016\/j.spinee.2024.10.010","journal-title":"Spine J"},{"key":"8890_CR21","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1016\/j.apmr.2024.01.021","volume":"105","author":"VG El-Hajj","year":"2024","unstructured":"El-Hajj VG, Stenimahitis V, Singh A, Blixt S, Edstr\u00f6m E, Elmi-Terander A, Gerdhem P (2024) The effect of concomitant spinal cord injury on postoperative health-related quality of life after traumatic subaxial cervical spine injuries: A nationwide registry study. Arch Phys Med Rehabil 105:1069\u20131075","journal-title":"Arch Phys Med Rehabil"},{"key":"8890_CR22","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1016\/j.spinee.2023.04.014","volume":"23","author":"VG El-Hajj","year":"2023","unstructured":"El-Hajj VG, Singh A, Blixt S, Edstr\u00f6m E, Elmi-Terander A, Gerdhem P (2023) Evolution of patient-reported outcome measures, 1, 2, and 5 years after surgery for subaxial cervical spine fractures, a nation-wide registry study. Spine J 23:1182\u20131188","journal-title":"Spine J"},{"key":"8890_CR23","doi-asserted-by":"publisher","first-page":"337","DOI":"10.3109\/07853890109002087","volume":"33","author":"R Rabin","year":"2001","unstructured":"Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol group. Ann Med 33:337\u2013343","journal-title":"Ann Med"},{"key":"8890_CR24","doi-asserted-by":"publisher","DOI":"10.1037\/t35122-000","author":"H Vernon","year":"2018","unstructured":"Vernon H (2018) S. Mior Neck disability index. PsycTESTS Dataset https:\/\/doi.org\/10.1037\/t35122-000","journal-title":"PsycTESTS Dataset"},{"key":"8890_CR25","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1007\/978-3-642-78801-7_43","volume-title":"Cerebellar infarct. Midline tumors. Minimally invasive endoscopic neurosurgery (MIEN)","author":"J Herdmann","year":"1994","unstructured":"Herdmann J, Linzbach M, Krzan M, Dvor\u00e1k J, Bock WJ (1994) The European myelopathy score. Cerebellar infarct. Midline tumors. Minimally invasive endoscopic neurosurgery (MIEN). Springer Berlin Heidelberg, Berlin, Heidelberg, pp 266\u2013268"},{"key":"8890_CR26","doi-asserted-by":"crossref","unstructured":"Zakieh O, Jawid MY, Bowers MF, Young MW, Zuckerman SL, Lugo-Pico JG, Gardocki RJ, Abtahi AM, Stephens BF (1976) Should we operate on octogenarians with cervical myelopathy or radiculopathy? SpinePhila. Pa. 50 (2025) E122\u2013E127","DOI":"10.1097\/BRS.0000000000005232"},{"key":"8890_CR27","doi-asserted-by":"publisher","first-page":"2317","DOI":"10.1007\/s00701-022-05282-y","volume":"164","author":"TO Johansen","year":"2022","unstructured":"Johansen TO, Vangen-L\u00f8nne V, Holmberg ST, Salvesen \u00d8O, Solberg TK, Gulati AM, Nygaard \u00d8P, Gulati S (2022) Surgery for degenerative cervical myelopathy in the elderly: a nationwide registry-based observational study with patient-reported outcomes. Acta Neurochir (Wien) 164:2317\u20132326","journal-title":"Acta Neurochir (Wien)"},{"key":"8890_CR28","doi-asserted-by":"publisher","first-page":"E13","DOI":"10.3171\/2016.3.FOCUS1657","volume":"40","author":"K Madhavan","year":"2016","unstructured":"Madhavan K, Chieng LO, Foong H, Wang MY (2016) Surgical outcomes of elderly patients with cervical spondylotic myelopathy: a meta-analysis of studies reporting on 2868 patients. Neurosurg Focus 40:E13","journal-title":"Neurosurg Focus"},{"key":"8890_CR29","doi-asserted-by":"publisher","first-page":"824047","DOI":"10.3389\/fmed.2022.824047","volume":"9","author":"E Shabo","year":"2022","unstructured":"Shabo E, Brandecker S, Rana S, Bara G, Scorzin JE, Eichhorn L, Vatter H, Banat M (2022) Safety evaluation of cervical dorsal instrumentation in geriatric patients: experience at a level 1 center for spinal surgery-A single center cohort study. Front Med (Lausanne) 9:824047","journal-title":"Front Med (Lausanne)"},{"key":"8890_CR30","doi-asserted-by":"publisher","first-page":"470","DOI":"10.3171\/2010.12.SPINE10486","volume":"14","author":"K-MG Fu","year":"2011","unstructured":"Fu K-MG, Smith JS, Polly DW, Ames CP, Berven SH, Perra JH, McCarthy RE, Knapp DR, Shaffrey CI (2011) Correlation of higher preoperative American society of anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery. J Neurosurg Spine 14:470\u2013474","journal-title":"J Neurosurg Spine"},{"key":"8890_CR31","first-page":"100829","volume":"32","author":"SH Lee","year":"2020","unstructured":"Lee SH, Prasad N, Jain A (2020) Cervical fixation in the elderly, Semin. Spine Surg 32:100829","journal-title":"Spine Surg"},{"key":"8890_CR32","doi-asserted-by":"publisher","first-page":"1652","DOI":"10.1097\/BRS.0b013e31820110b4","volume":"36","author":"M Yagi","year":"2011","unstructured":"Yagi M, King AB, Boachie-Adjei O (2011) Characterization of osteopenia\/osteoporosis in adult scoliosis: does bone density affect surgical outcome? Spine (Phila Pa 1976) 36:1652\u20131657","journal-title":"Spine (Phila Pa 1976)"},{"key":"8890_CR33","doi-asserted-by":"publisher","first-page":"2714","DOI":"10.2106\/JBJS.F.00186","volume":"88","author":"S Okuda","year":"2006","unstructured":"Okuda S, Oda T, Miyauchi A, Haku T, Yamamoto T, Iwasaki M (2006) Surgical outcomes of posterior lumbar interbody fusion in elderly patients. J Bone Joint Surg Am 88:2714\u20132720","journal-title":"J Bone Joint Surg Am"},{"key":"8890_CR34","doi-asserted-by":"crossref","unstructured":"Guzman JZ, Feldman ZM, McAnany S, Hecht AC, Qureshi SA, Cho SK (2016) Osteoporosis in cervical spine surgery. Spine (Phila Pa 1976) 41:662\u2013668","DOI":"10.1097\/BRS.0000000000001347"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-025-08890-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-025-08890-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-025-08890-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T13:41:52Z","timestamp":1757166112000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-025-08890-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,10]]},"references-count":34,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["8890"],"URL":"https:\/\/doi.org\/10.1007\/s00586-025-08890-1","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,10]]},"assertion":[{"value":"19 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 April 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 April 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 May 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Like most Swedish quality registers, the Swespine Registry employs an opt-out method for patient participation. This means that data can be collected and automatically used from the registry unless a patient actively dissents. Answering the patient-reported outcome questionnaires is voluntary. The study complied with the ethical considerations of the Helsinki Declaration and was approved by the Regional Ethical Review Board in Stockholm; 2012\/206\/31\u2009\u2212\u20091, 2018\/2746-32, 2020\/00193, and 2021\/04773.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}