{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:50:07Z","timestamp":1774659007299,"version":"3.50.1"},"reference-count":47,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T00:00:00Z","timestamp":1691712000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T00:00:00Z","timestamp":1691712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000038","name":"Gouvernement du Canada | Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","award":["RGPIN-2021-03457"],"award-info":[{"award-number":["RGPIN-2021-03457"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000038","name":"Gouvernement du Canada | Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","award":["RGPIN-2021-04268"],"award-info":[{"award-number":["RGPIN-2021-04268"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Wolfond Scholarship in Wireless Information Technology and unrestricted gift from Google"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Past studies on how blood glucose levels vary across the menstrual cycle have largely shown inconsistent results based on limited blood draws. In this study, 49 individuals wore a Dexcom G6 continuous glucose monitor and a Fitbit Sense smartwatch while measuring their menstrual hormones and self-reporting characteristics of their menstrual cycles daily. The average duration of participation was 79.3\u2009\u00b1\u200921.2 days, leading to a total of 149 cycles and 554 phases in our dataset. We use periodic restricted cubic splines to evaluate the relationship between blood glucose and the menstrual cycle, after which we assess phase-based changes in daily median glucose level and associated physiological parameters using mixed-effects models. Results indicate that daily median glucose levels increase and decrease in a biphasic pattern, with maximum levels occurring during the luteal phase and minimum levels occurring during the late-follicular phase. These trends are robust to adjustments for participant characteristics (e.g., age, BMI, weight) and self-reported menstrual experiences (e.g., food cravings, bloating, fatigue). We identify negative associations between each of daily estrogen level, step count, and low degrees of fatigue with higher median glucose levels. Conversely, we find positive associations between higher food cravings and higher median glucose levels. This study suggests that blood glucose could be an important parameter for understanding menstrual health, prompting further investigation into how the menstrual cycle influences glucose fluctuation.<\/jats:p>","DOI":"10.1038\/s41746-023-00884-x","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T11:02:49Z","timestamp":1691751769000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Blood glucose variance measured by continuous glucose monitors across the menstrual cycle"],"prefix":"10.1038","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9993-2718","authenticated-orcid":false,"given":"Georgianna","family":"Lin","sequence":"first","affiliation":[]},{"given":"Rumsha","family":"Siddiqui","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7958-590X","authenticated-orcid":false,"given":"Zixiong","family":"Lin","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7684-3571","authenticated-orcid":false,"given":"Joanna M.","family":"Blodgett","sequence":"additional","affiliation":[]},{"given":"Shwetak N.","family":"Patel","sequence":"additional","affiliation":[]},{"given":"Khai N.","family":"Truong","sequence":"additional","affiliation":[]},{"given":"Alex","family":"Mariakakis","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,8,11]]},"reference":[{"key":"884_CR1","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1177\/0972558X19835371","volume":"19","author":"S Dey","year":"2019","unstructured":"Dey, S., Dasgupta, D. & Roy, S. Blood glucose levels at two different phases of menstrual cycle: A study on a group of bengali-speaking hindu ethnic populations of West Bengal, india. Orient. Anthropol. 19, 55\u201363 (2019).","journal-title":"Orient. Anthropol."},{"key":"884_CR2","doi-asserted-by":"publisher","first-page":"403","DOI":"10.7326\/0003-4819-142-6-200503150-00006","volume":"142","author":"G Boden","year":"2005","unstructured":"Boden, G., Sargrad, K., Homko, C., Mozzoli, M. & Stein, T. P. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2. Diabetes Ann. Intern. Med. 142, 403\u2013411 (2005).","journal-title":"Diabetes Ann. Intern. Med."},{"key":"884_CR3","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1080\/10408398.2013.792772","volume":"56","author":"WR Russell","year":"2016","unstructured":"Russell, W. R. et al. Impact of diet composition on blood glucose regulation. Crit. Rev. Food Sci. Nutr. 56, 541\u2013590 (2016).","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"884_CR4","doi-asserted-by":"publisher","first-page":"2979","DOI":"10.1210\/clinem\/dgab415","volume":"106","author":"KA MacGregor","year":"2021","unstructured":"MacGregor, K. A., Gallagher, I. J. & Moran, C. N. Relationship between insulin sensitivity and menstrual cycle is modified by bmi, fitness, and physical activity in nhanes. J. Clin. Endocrinol. Metab. 106, 2979\u20132990 (2021).","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"884_CR5","doi-asserted-by":"publisher","first-page":"2560","DOI":"10.1056\/NEJMoa0802987","volume":"358","author":"MS Kirkman","year":"2008","unstructured":"Kirkman, M. S., Mahmud, H. & Korytkowski, M. T. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N. Engl. J. Med. 358, 2560\u20132572 (2008).","journal-title":"N. Engl. J. Med."},{"key":"884_CR6","doi-asserted-by":"publisher","first-page":"2215","DOI":"10.1016\/S0140-6736(10)60484-9","volume":"375","author":"Emerging Risk Factors Collaboration.","year":"2010","unstructured":"Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 375, 2215\u20132222 (2010).","journal-title":"Lancet"},{"key":"884_CR7","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.2337\/diab.41.12.1651","volume":"41","author":"A Montelongo","year":"1992","unstructured":"Montelongo, A., Lasunci\u00f3n, M. A., Pallardo, L. F. & Herrera, E. Longitudinal study of plasma lipoproteins and hormones during pregnancy in normal and diabetic women. Diabetes 41, 1651\u20131659 (1992).","journal-title":"Diabetes"},{"key":"884_CR8","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1080\/13697137.2016.1267723","volume":"20","author":"C Stuenkel","year":"2017","unstructured":"Stuenkel, C. Menopause, hormone therapy and diabetes. Climacteric 20, 11\u201321 (2017).","journal-title":"Climacteric"},{"key":"884_CR9","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1093\/ije\/19.1.42","volume":"19","author":"C Bonithon-Kopp","year":"1990","unstructured":"Bonithon-Kopp, C., Scarabin, P.-Y., Darne, B., Malmejac, A. & Guize, L. Menopause-related changes in lipoproteins and some other cardiovascular risk factors. Int. J. Epidemiol. 19, 42\u201348 (1990).","journal-title":"Int. J. Epidemiol."},{"key":"884_CR10","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.physbeh.2017.08.016","volume":"187","author":"F Mauvais-Jarvis","year":"2018","unstructured":"Mauvais-Jarvis, F. Gender differences in glucose homeostasis and diabetes. Physiol. Behav. 187, 20\u201323 (2018).","journal-title":"Physiol. Behav."},{"key":"884_CR11","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1007\/s11883-004-0030-9","volume":"6","author":"J-F Louet","year":"2004","unstructured":"Louet, J.-F., LeMay, C. & Mauvais-Jarvis, F. Antidiabetic actions of estrogen: insight from human and genetic mouse models. Curr. Atherosclerosis Rep. 6, 180\u2013185 (2004).","journal-title":"Curr. Atherosclerosis Rep."},{"key":"884_CR12","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.1113\/jphysiol.2010.199018","volume":"589","author":"BK Gorres","year":"2011","unstructured":"Gorres, B. K., Bomhoff, G. L., Morris, J. K. & Geiger, P. C. In vivo stimulation of oestrogen receptor \u03b1 increases insulin-stimulated skeletal muscle glucose uptake. J. Physiol. 589, 2041\u20132054 (2011).","journal-title":"J. Physiol."},{"key":"884_CR13","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/S0188-0128(98)00008-6","volume":"30","author":"JME Pulido","year":"1999","unstructured":"Pulido, J. M. E. & Salazar, M. A. Changes in insulin sensitivity, secretion and glucose effectiveness during menstrual cycle. Arch. Med. Res. 30, 19\u201322 (1999).","journal-title":"Arch. Med. Res."},{"key":"884_CR14","doi-asserted-by":"publisher","first-page":"5435","DOI":"10.1210\/jc.2010-0702","volume":"95","author":"EH Yeung","year":"2010","unstructured":"Yeung, E. H. et al. Longitudinal study of insulin resistance and sex hormones over the menstrual cycle: the biocycle study. J. Clin. Endocrinol. Metab. 95, 5435\u20135442 (2010).","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"884_CR15","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1055\/s-0028-1082081","volume":"40","author":"C Bingley","year":"2008","unstructured":"Bingley, C., Gitau, R. & Lovegrove, J. Impact of menstrual cycle phase on insulin sensitivity measures and fasting lipids. Horm. Metab. Res. 40, 901\u2013906 (2008).","journal-title":"Horm. Metab. Res."},{"key":"884_CR16","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1172\/JCI107979","volume":"55","author":"BM Sherman","year":"1975","unstructured":"Sherman, B. M. et al. Hormonal characteristics of the human menstrual cycle throughout reproductive life. J. Clin. Investig. 55, 699\u2013706 (1975).","journal-title":"J. Clin. Investig."},{"key":"884_CR17","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1177\/1941738112469930","volume":"5","author":"L Wideman","year":"2013","unstructured":"Wideman, L., Montgomery, M. M., Levine, B. J., Beynnon, B. D. & Shultz, S. J. Accuracy of calendar-based methods for assigning menstrual cycle phase in women. Sports Heal 5, 143\u2013149 (2013).","journal-title":"Sports Heal"},{"key":"884_CR18","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/0031-9384(94)90296-8","volume":"56","author":"WG Johnson","year":"1994","unstructured":"Johnson, W. G., Corrigan, S. A., Lemmon, C. R., Bergeron, K. B. & Crusco, A. H. Energy regulation over the menstrual cycle. Physiol. Behav. 56, 523\u2013527 (1994).","journal-title":"Physiol. Behav."},{"key":"884_CR19","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.maturitas.2011.12.016","volume":"71","author":"AL Hirschberg","year":"2012","unstructured":"Hirschberg, A. L. Sex hormones, appetite and eating behaviour in women. Maturitas 71, 248\u2013256 (2012).","journal-title":"Maturitas"},{"key":"884_CR20","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.2337\/diacare.28.5.1231","volume":"28","author":"DC Klonoff","year":"2005","unstructured":"Klonoff, D. C. Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Diabetes Care 28, 1231\u20131239 (2005).","journal-title":"Diabetes Care"},{"key":"884_CR21","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1089\/15209150050214069","volume":"2","author":"JS Skyler","year":"2000","unstructured":"Skyler, J. S. The economic burden of diabetes and the benefits of improved glycemic control: The potential role of a continuous glucose monitoring system. Diabetes Technol. Ther. 2, 7\u201312 (2000).","journal-title":"Diabetes Technol. Ther."},{"key":"884_CR22","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.2337\/dci17-0049","volume":"40","author":"MC Riddle","year":"2017","unstructured":"Riddle, M. C., Gerstein, H. C. & Cefalu, W. T. Maturation of cgm and glycemic measurements beyond hba1c-a turning point in research and clinical decisions. Diabetes Care 40, 1611\u20131613 (2017).","journal-title":"Diabetes Care"},{"key":"884_CR23","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1007\/s40279-022-01691-2","volume":"52","author":"G Bruinvels","year":"2022","unstructured":"Bruinvels, G., Hackney, A. C. & Pedlar, C. R. Menstrual cycle: The importance of both the phases and the transitions between phases on training and performance. Sports Med. 52, 1457\u20131460 (2022).","journal-title":"Sports Med."},{"key":"884_CR24","doi-asserted-by":"publisher","first-page":"65","DOI":"10.3390\/nu13010065","volume":"13","author":"I Zajac","year":"2020","unstructured":"Zajac, I. et al. Modified fasting compared to true fasting improves blood glucose levels and subjective experiences of hunger, food cravings and mental fatigue, but not cognitive function: results of an acute randomised cross-over trial. Nutrients 13, 65 (2020).","journal-title":"Nutrients"},{"key":"884_CR25","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1093\/sleep\/30.2.219","volume":"30","author":"JR Jennings","year":"2007","unstructured":"Jennings, J. R., Muldoon, M. F., Hall, M., Buysse, D. J. & Manuck, S. B. Self-reported sleep quality is associated with the metabolic syndrome. Sleep 30, 219\u2013223 (2007).","journal-title":"Sleep"},{"key":"884_CR26","doi-asserted-by":"publisher","first-page":"e70","DOI":"10.2337\/dc12-2248","volume":"36","author":"DS Barata","year":"2013","unstructured":"Barata, D. S., Adan, L. F., Netto, E. M. & Ramalho, A. C. The effect of the menstrual cycle on glucose control in women with type 1 diabetes evaluated using a continuous glucose monitoring system. Diabetes Care 36, e70 (2013).","journal-title":"Diabetes Care"},{"key":"884_CR27","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1038\/s41598-017-01433-9","volume":"7","author":"M Shilaih","year":"2017","unstructured":"Shilaih, M., Clerck, V. D., Falco, L., K\u00fcbler, F. & Leeners, B. Pulse rate measurement during sleep using wearable sensors, and its correlation with the menstrual cycle phases, a prospective observational study. Sci. Rep. 7, 1294 (2017).","journal-title":"Sci. Rep."},{"key":"884_CR28","first-page":"290","volume":"30","author":"ML Barron","year":"2005","unstructured":"Barron, M. L. & Fehring, R. J. Basal body temperature assessment: Is it useful to couples seeking pregnancy? MCN 30, 290\u2013296 (2005).","journal-title":"MCN"},{"key":"884_CR29","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/S0010-7824(02)00355-4","volume":"66","author":"RJ Fehring","year":"2002","unstructured":"Fehring, R. J. Accuracy of the peak day of cervical mucus as a biological marker of fertility. Contracept. (Stoneham) 66, 231\u2013235 (2002).","journal-title":"Contracept. (Stoneham)"},{"key":"884_CR30","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1093\/biostatistics\/kxq020","volume":"11","author":"P Bortot","year":"2010","unstructured":"Bortot, P., Masarotto, G. & Scarpa, B. Sequential predictions of menstrual cycle lengths. Biostat. (Oxf., Engl.) 11, 741\u2013755 (2010).","journal-title":"Biostat. (Oxf., Engl.)"},{"key":"884_CR31","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1136\/bmjsrh-2019-200488","volume":"47","author":"S Earle","year":"2021","unstructured":"Earle, S., Marston, H. R., Hadley, R. & Banks, D. Use of menstruation and fertility app trackers: a scoping review of the evidence. BMJ Sex. Reprod. Heal 47, 90\u2013101 (2021).","journal-title":"BMJ Sex. Reprod. Heal"},{"key":"884_CR32","doi-asserted-by":"publisher","first-page":"5589","DOI":"10.3390\/s21165589","volume":"21","author":"V Vijayan","year":"2021","unstructured":"Vijayan, V., Connolly, J. P., Condell, J., McKelvey, N. & Gardiner, P. Review of wearable devices and data collection considerations for connected health. Sens. (Basel, Switz.) 21, 5589 (2021).","journal-title":"Sens. (Basel, Switz.)"},{"key":"884_CR33","doi-asserted-by":"crossref","unstructured":"Li, T. et al. Noninvasive glucose monitoring using polarized light. In Proceedings of the 18th Conference on Embedded Networked Sensor Systems, 544\u2013557 (2020).","DOI":"10.1145\/3384419.3430720"},{"key":"884_CR34","doi-asserted-by":"publisher","first-page":"3273","DOI":"10.1039\/D1AN00283J","volume":"146","author":"A Vaquer","year":"2021","unstructured":"Vaquer, A., Bar\u00f3n, E. & de la Rica, R. Detection of low glucose levels in sweat with colorimetric wearable biosensors. Analyst 146, 3273\u20133279 (2021).","journal-title":"Analyst"},{"key":"884_CR35","unstructured":"Zhang, J. Algorithm effectiveness report of mira. https:\/\/www.miracare.com\/assets\/algorithm-effectiveness.pdf. [Online; accessed 14-February-2023]. (2022)"},{"key":"884_CR36","unstructured":"Li, N. Precision performance of the mira confirm test and comparison with the semi-quantitatively product. https:\/\/www.miracare.com\/assets\/precision-performance-of-the-mira-confirm-test-and-comparison-with-the-semi-quantitatively-product.pdf. [Online; accessed 14-February-2023]. (2022)"},{"key":"884_CR37","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1080\/14737159.2021.2000393","volume":"21","author":"TP Bouchard","year":"2021","unstructured":"Bouchard, T. P., Fehring, R. J. & Mu, Q. Quantitative versus qualitative estrogen and luteinizing hormone testing for personal fertility monitoring. Expert. Rev. Mol. diagnostics 21, 1349\u20131360 (2021).","journal-title":"Expert. Rev. Mol. diagnostics"},{"key":"884_CR38","doi-asserted-by":"crossref","unstructured":"Cordeiro, F. et al. Barriers and negative nudges: Exploring challenges in food journaling. In Proceedings of the 33rd annual ACM conference on human factors in computing systems, 1159\u20131162 (2015).","DOI":"10.1145\/2702123.2702155"},{"key":"884_CR39","unstructured":"Dexcom Inc. Dexcom g6 cgm system: No fingersticks, no scanning. https:\/\/www.dexcom.com\/g6-cgm-system. [Online; accessed 14-February-2023]. (2022)"},{"key":"884_CR40","unstructured":"Fitbit. Advanced health smartwatch | fitbit sense. https:\/\/www.fitbit.com\/global\/us\/products\/smartwatches\/sense. [Online; accessed 14-February-2023]. (2020)"},{"key":"884_CR41","unstructured":"Mira. Mira fertility us. https:\/\/usd.miracare.com\/products\/fertility-plus-starter-kit. [Online; accessed 14-February2023]. (2023)"},{"key":"884_CR42","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1001\/jama.1968.03140060001001","volume":"203","author":"L Chiazze","year":"1968","unstructured":"Chiazze, L., Brayer, F. T., Macisco, J. J., Parker, M. P. & Duffy, B. J. The length and variability of the human menstrual cycle. Jama 203, 377\u2013380 (1968).","journal-title":"Jama"},{"key":"884_CR43","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.tree.2018.03.006","volume":"33","author":"A Alvergne","year":"2018","unstructured":"Alvergne, A. & Tabor, V. H. Is female health cyclical? evolutionary perspectives on menstruation. Trends Ecol. Evol. 33, 399\u2013414 (2018).","journal-title":"Trends Ecol. Evol."},{"key":"884_CR44","doi-asserted-by":"crossref","unstructured":"Bates, D., M\u00e4chler, M., Bolker, B. & Walker, S. Fitting linear mixed-effects models using lme4. arXiv preprint arXiv:1406.5823 (2014).","DOI":"10.18637\/jss.v067.i01"},{"key":"884_CR45","doi-asserted-by":"publisher","first-page":"e0241364","DOI":"10.1371\/journal.pone.0241364","volume":"15","author":"L Lusa","year":"2020","unstructured":"Lusa, L. & Ahlin, C. Restricted cubic splines for modelling periodic data.\u02c7. PLoS One 15, e0241364 (2020).","journal-title":"PLoS One"},{"key":"884_CR46","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.21105\/joss.01686","volume":"4","author":"H Wickham","year":"2019","unstructured":"Wickham, H. et al. Welcome to the tidyverse. J. open source Softw. 4, 1686 (2019).","journal-title":"J. open source Softw."},{"key":"884_CR47","unstructured":"L\u00fcdecke, D. & L\u00fcdecke, M. D. Package \u2018sjplot\u2019. R package version 1 (2015)."}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-023-00884-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-023-00884-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-023-00884-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T14:21:42Z","timestamp":1700230902000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-023-00884-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,11]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["884"],"URL":"https:\/\/doi.org\/10.1038\/s41746-023-00884-x","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,11]]},"assertion":[{"value":"28 February 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"140"}}