{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:24:33Z","timestamp":1772119473916,"version":"3.50.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T00:00:00Z","timestamp":1709683200000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Auton Res"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Orthostasis increases the variability of continuously recorded blood pressure (BP). Low-frequency (LF) BP oscillations (Mayer waves) in this setting are related to the vascular-sympathetic baroreflex. Mechanisms of increased high-frequency (HF) BP oscillations at the periodicity of respiration during orthostasis have received less research attention. A previously reported patient with post-neurosurgical orthostatic hypotension (OH) and vascular-sympathetic baroreflex failure had large tilt-evoked, breathing-driven BP oscillations, suggesting that such oscillations can occur independently of vascular-sympathetic baroreflex modulation. In the present study we assessed effects of orthostasis on BP variability in the frequency domain in patient cohorts with or without OH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Power spectral analysis of systolic BP variability was conducted on recordings from 73 research participants, 42 with neurogenic OH [13 pure autonomic failure, 14 Parkinson\u2019s disease (PD) with OH, 12 parkinsonian multiple system atrophy, and 3 status post-brainstem neurosurgery] and 31 without OH (control group of 16 healthy volunteers and 15 patients with PD lacking  OH), before, during, and after 5\u2032 of head-up tilt at 90\u00a0degrees from horizontal. The data were log transformed for statistical testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across all subjects, head-up tilting increased HF power of systolic BP variability (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), without a difference between the neurogenic OH and control groups. LF power during orthostasis was higher in the control than in the OH groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this observational cohort study confirm those based on our case report and lead us to propose that even in the setting of vascular-sympathetic baroreflex failure orthostasis increases HF power of BP variability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10286-024-01022-7","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T05:02:26Z","timestamp":1709701346000},"page":"125-135","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tilt-evoked, breathing-driven blood pressure oscillations: Independence from baroreflex-sympathoneural function"],"prefix":"10.1007","volume":"34","author":[{"given":"Edward","family":"Grabov","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patti","family":"Sullivan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siqi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5709-9940","authenticated-orcid":false,"given":"David S.","family":"Goldstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,3,6]]},"reference":[{"issue":"129","key":"1022_CR1","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1152\/japplphysiol.00452.2020","volume":"19","author":"WH Barnett","year":"2020","unstructured":"Barnett WH, Latash EM, Capps RA, Dick TE, Wehrwein EA, Molkov YI (2020) Traube-Hering waves are formed by interaction of respiratory sinus arrhythmia and pulse pressure modulation in healthy men. J Appl Physiol (1985) 19(129):1193\u20131202","journal-title":"J Appl Physiol (1985)"},{"key":"1022_CR2","doi-asserted-by":"publisher","first-page":"H1193","DOI":"10.1152\/ajpheart.00645.2006","volume":"292","author":"RJ Brychta","year":"2007","unstructured":"Brychta RJ, Shiavi R, Robertson D, Biaggioni I, Diedrich A (2007) A simplified two-component model of blood pressure fluctuation. Am J Physiol Heart Circ Physiol 292:H1193-1203","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"1022_CR3","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s10286-019-00598-9","volume":"29","author":"WP Cheshire Jr","year":"2019","unstructured":"Cheshire WP Jr, Goldstein DS (2019) Autonomic uprising: the tilt table test in autonomic medicine. Clin Auton Res 29:215\u2013230","journal-title":"Clin Auton Res"},{"issue":"Pt 2","key":"1022_CR4","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1111\/j.1469-7793.1999.0617t.x","volume":"517","author":"WH Cooke","year":"1999","unstructured":"Cooke WH, Hoag JB, Crossman AA, Kuusela TA, Tahvanainen KU, Eckberg DL (1999) Human responses to upright tilt: a window on central autonomic integration. J Physiol 517(Pt 2):617\u2013628","journal-title":"J Physiol"},{"key":"1022_CR5","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.1097\/00004872-200309000-00017","volume":"21","author":"A Diedrich","year":"2003","unstructured":"Diedrich A, Jordan J, Tank J, Shannon JR, Robertson R, Luft FC, Robertson D, Biaggioni I (2003) The sympathetic nervous system in hypertension: assessment by blood pressure variability and ganglionic blockade. J Hypertens 21:1677\u20131686","journal-title":"J Hypertens"},{"key":"1022_CR6","doi-asserted-by":"publisher","first-page":"341","DOI":"10.3109\/07853890008995937","volume":"32","author":"DL Eckberg","year":"2000","unstructured":"Eckberg DL (2000) Physiological basis for human autonomic rhythms. Ann Med 32:341\u2013349","journal-title":"Ann Med"},{"key":"1022_CR7","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s10286-011-0119-5","volume":"21","author":"R Freeman","year":"2011","unstructured":"Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, Cheshire WP, Chelimsky T, Cortelli P, Gibbons CH, Goldstein DS, Hainsworth R, Hilz MJ, Jacob G, Kaufmann H, Jordan J, Lipsitz LA, Levine BD, Low PA, Mathias C, Raj SR, Robertson D, Sandroni P, Schatz I, Schondorff R, Stewart JM, van Dijk JG (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 21:69\u201372","journal-title":"Clin Auton Res"},{"key":"1022_CR8","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/0165-1838(94)00135-7","volume":"51","author":"R Furlan","year":"1995","unstructured":"Furlan R, Piazza S, Bevilacqua M, Turiel M, Norbiato G, Lombardi F, Malliani A (1995) Pure autonomic failure: complex abnormalities in the neural mechanisms regulating the cardiovascular system. J Auton Nerv Syst 51:223\u2013235","journal-title":"J Auton Nerv Syst"},{"key":"1022_CR9","doi-asserted-by":"publisher","first-page":"395","DOI":"10.3389\/fnins.2020.00395","volume":"14","author":"MGZ Ghali","year":"2020","unstructured":"Ghali MGZ, Ghali GZ (2020) Mechanisms contributing to the generation of Mayer waves. Front Neurosci 14:395","journal-title":"Front Neurosci"},{"key":"1022_CR10","doi-asserted-by":"publisher","first-page":"521","DOI":"10.31083\/j.jin.2020.03.0196","volume":"19","author":"MGZ Ghali","year":"2020","unstructured":"Ghali MGZ, Ghali GZ, Lima A, McDermott M, Glover E, Voglis S, Humphrey J, Konig MSS, Brem H, Uhlen P, Spetzler RF, Yasargil MG (2020) Mechanisms underlying the generation of autonomorespiratory coupling amongst the respiratory central pattern generator, sympathetic oscillators, and cardiovagal premotoneurons. J Integr Neurosci 19:521\u2013560","journal-title":"J Integr Neurosci"},{"key":"1022_CR11","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1007\/BF02309628","volume":"8","author":"S Gilman","year":"1998","unstructured":"Gilman S, Low P, Quinn N, Albanese A, Ben-Shlomo Y, Fowler C, Kaufmann H, Kockgether T, Lang A, Lantos P, Litvan I, Mathias C, Oliver E, Robertson D, Schatz I, Wenning G (1998) Consensus statement on the diagnosis of multiple system atrophy. Clin Auton Res 8:359\u2013362","journal-title":"Clin Auton Res"},{"key":"1022_CR12","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s10286-017-0474-y","volume":"27","author":"DS Goldstein","year":"2017","unstructured":"Goldstein DS, Cheshire WP Jr (2017) Beat-to-beat blood pressure and heart rate responses to the Valsalva maneuver. Clin Auton Res 27:361\u2013367","journal-title":"Clin Auton Res"},{"key":"1022_CR13","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s10286-023-00935-z","volume":"33","author":"DS Goldstein","year":"2023","unstructured":"Goldstein DS, Dill S, Sullivan P, Grabov E, Chittiboina P (2023) Baroreflex-sympathoneural without baroreflex-cardiovagal failure in neurogenic orthostatic hypotension. Clin Auton Res 33:205\u2013208","journal-title":"Clin Auton Res"},{"key":"1022_CR14","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1172\/JCI113298","volume":"81","author":"DS Goldstein","year":"1988","unstructured":"Goldstein DS, Eisenhofer G, Stull R, Folio CJ, Keiser HR, Kopin IJ (1988) Plasma dihydroxyphenylglycol and the intraneuronal disposition of norepinephrine in humans. J Clin Invest 81:213\u2013220","journal-title":"J Clin Invest"},{"key":"1022_CR15","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1161\/01.CIR.0000155613.20376.CA","volume":"111","author":"DS Goldstein","year":"2005","unstructured":"Goldstein DS, Eldadah B, Holmes C, Pechnik S, Moak J, Sharabi Y (2005) Neurocirculatory abnormalities in chronic orthostatic intolerance. Circulation 111:839\u2013845","journal-title":"Circulation"},{"key":"1022_CR16","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1016\/j.parkreldis.2008.01.010","volume":"14","author":"DS Goldstein","year":"2008","unstructured":"Goldstein DS, Holmes C, Bentho O, Sato T, Moak J, Sharabi Y, Imrich R, Conant S, Eldadah BA (2008) Biomarkers to detect central dopamine deficiency and distinguish Parkinson disease from multiple system atrophy. Parkinsonism Relat Disord 14:600\u2013607","journal-title":"Parkinsonism Relat Disord"},{"key":"1022_CR17","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1007\/s10286-002-0020-3","volume":"12","author":"DS Goldstein","year":"2002","unstructured":"Goldstein DS, Holmes C, Dendi R, Li ST, Brentzel S, Vernino S (2002) Pandysautonomia associated with impaired ganglionic neurotransmission and circulating antibody to the neuronal nicotinic receptor. Clin Auton Res 12:281\u2013285","journal-title":"Clin Auton Res"},{"key":"1022_CR18","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/s10286-008-0457-0","volume":"18","author":"DS Goldstein","year":"2008","unstructured":"Goldstein DS, Holmes C, Sato T, Bernson M, Mizrahi N, Imrich R, Carmona G, Sharabi Y, Vortmeyer AO (2008) Central dopamine deficiency in pure autonomic failure. Clin Auton Res 18:58\u201365","journal-title":"Clin Auton Res"},{"key":"1022_CR19","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1212\/01.WNL.0000058766.46428.F3","volume":"60","author":"DS Goldstein","year":"2003","unstructured":"Goldstein DS, Holmes C, Sharabi Y, Brentzel S, Eisenhofer G (2003) Plasma levels of catechols and metanephrines in neurogenic orthostatic hypotension. Neurology 60:1327\u20131332","journal-title":"Neurology"},{"key":"1022_CR20","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s10286-016-0388-0","volume":"27","author":"DS Goldstein","year":"2017","unstructured":"Goldstein DS, Holmes C, Sullivan P, Donadio V, Isonaka R, Zhong E, Pourier B, Vernino S, Kopin IJ, Sharabi Y (2017) Autoimmunity-associated autonomic failure with sympathetic denervation. Clin Auton Res 27:57\u201362","journal-title":"Clin Auton Res"},{"key":"1022_CR21","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1161\/01.CIR.66.2.432","volume":"66","author":"DS Goldstein","year":"1982","unstructured":"Goldstein DS, Horwitz D, Keiser HR (1982) Comparison of techniques for measuring baroreflex sensitivity in man. Circulation 66:432\u2013439","journal-title":"Circulation"},{"key":"1022_CR22","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1161\/CIRCULATIONAHA.108.805887","volume":"119","author":"DS Goldstein","year":"2009","unstructured":"Goldstein DS, Sharabi Y (2009) Neurogenic orthostatic hypotension: a pathophysiological approach. Circulation 119:139\u2013146","journal-title":"Circulation"},{"key":"1022_CR23","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/BF02281111","volume":"10","author":"DS Goldstein","year":"2000","unstructured":"Goldstein DS, Tack C (2000) Non-invasive detection of sympathetic neurocirculatory failure. Clin Auton Res 10:285\u2013291","journal-title":"Clin Auton Res"},{"key":"1022_CR24","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/0378-4347(93)E0430-X","volume":"653","author":"C Holmes","year":"1994","unstructured":"Holmes C, Eisenhofer G, Goldstein DS (1994) Improved assay for plasma dihydroxyphenylacetic acid and other catechols using high-performance liquid chromatography with electrochemical detection. J Chromatogr B Biomed Appl 653:131\u2013138","journal-title":"J Chromatogr B Biomed Appl"},{"key":"1022_CR25","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.cardiores.2005.11.008","volume":"70","author":"C Julien","year":"2006","unstructured":"Julien C (2006) The enigma of Mayer waves: facts and models. Cardiovasc Res 70:12\u201321","journal-title":"Cardiovasc Res"},{"key":"1022_CR26","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1111\/j.1440-1681.2008.04907.x","volume":"35","author":"C Julien","year":"2008","unstructured":"Julien C (2008) Baroreflex control of sympathetic nerve activity and blood pressure variability. Clin Exp Pharmacol Physiol 35:512\u2013515","journal-title":"Clin Exp Pharmacol Physiol"},{"key":"1022_CR27","doi-asserted-by":"publisher","first-page":"e210","DOI":"10.1093\/cvr\/cvz327","volume":"116","author":"C Julien","year":"2020","unstructured":"Julien C (2020) An update on the enigma of Mayer waves. Cardiovasc Res 116:e210\u2013e211","journal-title":"Cardiovasc Res"},{"key":"1022_CR28","doi-asserted-by":"publisher","first-page":"R834","DOI":"10.1152\/ajpregu.00102.2003","volume":"285","author":"C Julien","year":"2003","unstructured":"Julien C, Chapuis B, Cheng Y, Barres C (2003) Dynamic interactions between arterial pressure and sympathetic nerve activity: role of arterial baroreceptors. Am J Physiol Regul Integr Comp Physiol 285:R834-841","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"1022_CR29","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/BF02291236","volume":"6","author":"H Kaufmann","year":"1996","unstructured":"Kaufmann H (1996) Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clin Auton Res 6:125\u2013126","journal-title":"Clin Auton Res"},{"key":"1022_CR30","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1007\/s10286-020-00693-2","volume":"31","author":"BE Legg Ditterline","year":"2021","unstructured":"Legg Ditterline BE, Aslan SC, Wang S, Ugiliweneza B, Hirsch GA, Wecht JM, Harkema S (2021) Restoration of autonomic cardiovascular regulation in spinal cord injury with epidural stimulation: a case series. Clin Auton Res 31:317\u2013320","journal-title":"Clin Auton Res"},{"key":"1022_CR31","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1002\/mdc3.13190","volume":"8","author":"A Lenka","year":"2021","unstructured":"Lenka A, Lamotte G, Goldstein DS (2021) Cardiac (18)F-dopamine PET distinguishes PD with orthostatic hypotension from Parkinsonian MSA. Mov Disord Clin Pract 8:582\u2013586","journal-title":"Mov Disord Clin Pract"},{"key":"1022_CR32","doi-asserted-by":"publisher","first-page":"H1486","DOI":"10.1152\/ajpheart.00740.2003","volume":"286","author":"JV Meck","year":"2004","unstructured":"Meck JV, Waters WW, Ziegler MG, deBlock HF, Mills PJ, Robertson D, Huang PL (2004) Mechanisms of postspaceflight orthostatic hypotension: low alpha1-adrenergic receptor responses before flight and central autonomic dysregulation postflight. Am J Physiol Heart Circ Physiol 286:H1486-1495","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"1022_CR33","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1161\/01.RES.40.1.72","volume":"40","author":"MA Nathan","year":"1977","unstructured":"Nathan MA, Reis DJ (1977) Chronic labile hypertension produced by lesions of the nucleus tractus solitarii in the cat. Circ Res 40:72\u201381","journal-title":"Circ Res"},{"key":"1022_CR34","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s10286-014-0234-1","volume":"24","author":"F Rahman","year":"2014","unstructured":"Rahman F, Goldstein DS (2014) Quantitative indices of baroreflex-sympathoneural function. Clin Auton Res 24:103\u2013110","journal-title":"Clin Auton Res"},{"key":"1022_CR35","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1161\/01.HYP.0000077441.45309.08","volume":"42","author":"Y Sharabi","year":"2003","unstructured":"Sharabi Y, Dendi R, Holmes C, Goldstein DS (2003) Baroreflex failure as a late sequela of neck irradiation. Hypertension 42:110\u2013116","journal-title":"Hypertension"},{"key":"1022_CR36","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1152\/jappl.1995.78.2.638","volume":"78","author":"BH Taha","year":"1995","unstructured":"Taha BH, Simon PM, Dempsey JA, Skatrud JB, Iber C (1995) Respiratory sinus arrhythmia in humans: an obligatory role for vagal feedback from the lungs. J Appl Physiol (1985) 78:638\u2013645","journal-title":"J Appl Physiol (1985)"},{"key":"1022_CR37","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1016\/j.parkreldis.2011.04.016","volume":"17","author":"DC Velseboer","year":"2011","unstructured":"Velseboer DC, de Haan RJ, Wieling W, Goldstein DS, de Bie RM (2011) Prevalence of orthostatic hypotension in Parkinson\u2019s disease: a systematic review and meta-analysis. Parkinsonism Relat Disord 17:724\u2013729","journal-title":"Parkinsonism Relat Disord"},{"key":"1022_CR38","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1113\/jphysiol.2001.013398","volume":"543","author":"R Zhang","year":"2002","unstructured":"Zhang R, Iwasaki K, Zuckerman JH, Behbehani K, Crandall CG, Levine BD (2002) Mechanism of blood pressure and R-R variability: insights from ganglion blockade in humans. J Physiol 543:337\u2013348","journal-title":"J Physiol"}],"container-title":["Clinical Autonomic Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10286-024-01022-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10286-024-01022-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10286-024-01022-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T12:05:10Z","timestamp":1725278710000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10286-024-01022-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["1022"],"URL":"https:\/\/doi.org\/10.1007\/s10286-024-01022-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3126167\/v1","asserted-by":"object"}]},"ISSN":["0959-9851","1619-1560"],"issn-type":[{"value":"0959-9851","type":"print"},{"value":"1619-1560","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2]]},"assertion":[{"value":"29 June 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 March 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 have no conflicts of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}