{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:33:56Z","timestamp":1787020436396,"version":"build-2736575974"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T00:00:00Z","timestamp":1628553600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T00:00:00Z","timestamp":1628553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["E0267201"],"award-info":[{"award-number":["E0267201"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010794","name":"Medicinska fakulteten, Ume\u00e5 Universitet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010794","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Umea University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study, undertaken in Rwanda, aimed to investigate health professionals\u2019 experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine hundred and seven health professionals participated: obstetricians\/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-021-06758-w","type":"journal-article","created":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T17:02:34Z","timestamp":1628614954000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Maternal health care professionals\u2019 experiences and views on the use of obstetric ultrasound in Rwanda: A cross-sectional study"],"prefix":"10.1186","volume":"21","author":[{"given":"Ingrid","family":"Mogren","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Ntaganira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Paul Semasaka","family":"Sengoma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Holmlund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhonda","family":"Small","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Pham Thi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussein Lesio","family":"Kidanto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda","family":"Ngarina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Bergstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Edvardsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,10]]},"reference":[{"key":"6758_CR1","volume-title":"recommendations on antenatal care for a positive pregnancy experience","author":"WHO","year":"2016","unstructured":"WHO. recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016."},{"key":"6758_CR2","volume-title":"Clinical practice guidelines: pregnancy care","author":"Department of Health","year":"2018","unstructured":"Department of Health. Clinical practice guidelines: pregnancy care. Canberra: Australian Government Department of Health; 2018."},{"issue":"6","key":"6758_CR3","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1097\/AOG.0000000000001815","volume":"128","author":"Committee on Practice Bulletins","year":"2016","unstructured":"Committee on Practice Bulletins. Obstetrics and the American Institute of Ultrasound in Medicine. Practice Bulletin No. 175: Ultrasound in Pregnancy. Obstet Gynecol. 2016;128(6):241\u201356.","journal-title":"Obstet Gynecol"},{"key":"6758_CR4","volume-title":"Antenatal care for uncomplicated pregnancies: Clinical guideline [CG62]. NICE","author":"National Institute for Health and Care Excellence (NICE)","year":"2020","unstructured":"National Institute for Health and Care Excellence (NICE). Antenatal care for uncomplicated pregnancies: Clinical guideline [CG62]. NICE; 2020."},{"issue":"1","key":"6758_CR5","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1002\/uog.12342","volume":"41","author":"LJ Salomon","year":"2013","unstructured":"Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, et al. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013;41(1):102\u201313. https:\/\/doi.org\/10.1002\/uog.12342.","journal-title":"Ultrasound Obstet Gynecol"},{"key":"6758_CR6","volume":"6","author":"Z Alfirevic","year":"2017","unstructured":"Alfirevic Z, Stampalija T, Dowswell T. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev. 2017;6:CD007529.","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"6758_CR7","doi-asserted-by":"publisher","first-page":"103","DOI":"10.21106\/ijma.294","volume":"9","author":"KA Stewart","year":"2020","unstructured":"Stewart KA, Navarro SM, Kambala S, Tan G, Poondla R, Lederman S, et al. Trends in ultrasound use in low and middle income countries: a systematic review. Int J MCH AIDS. 2020;9(1):103\u201320. https:\/\/doi.org\/10.21106\/ijma.294.","journal-title":"Int J MCH AIDS"},{"issue":"12","key":"6758_CR8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0208387","volume":"13","author":"S Holmlund","year":"2018","unstructured":"Holmlund S, Ntaganira J, Edvardsson K, Lan PT, Semasaka Sengoma JP, Lesio Kidanto H, et al. Health professionals' experiences and views on obstetric ultrasound in Rwanda: a cross-sectional study. PLoS One. 2018;13(12):e0208387. https:\/\/doi.org\/10.1371\/journal.pone.0208387.","journal-title":"PLoS One"},{"issue":"7","key":"6758_CR9","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1111\/tmi.12718","volume":"21","author":"K Edvardsson","year":"2016","unstructured":"Edvardsson K, Ntaganira J, Ahman A, Sengoma JP, Small R, Mogren I. Physicians' experiences and views on the role of obstetric ultrasound in rural and urban Rwanda: a qualitative study. Tropical Med Int Health. 2016;21(7):895\u2013906. https:\/\/doi.org\/10.1111\/tmi.12718.","journal-title":"Tropical Med Int Health"},{"issue":"1","key":"6758_CR10","doi-asserted-by":"publisher","first-page":"1350451","DOI":"10.1080\/16549716.2017.1350451","volume":"10","author":"S Holmlund","year":"2017","unstructured":"Holmlund S, Ntaganira J, Edvardsson K, Lan PT, Semasaka Sengoma JP, Ahman A, et al. Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives' experiences and views of obstetric ultrasound. Glob Health Action. 2017;10(1):1350451. https:\/\/doi.org\/10.1080\/16549716.2017.1350451.","journal-title":"Glob Health Action"},{"issue":"1","key":"6758_CR11","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1186\/s12978-018-0571-y","volume":"15","author":"ET Kim","year":"2018","unstructured":"Kim ET, Singh K, Moran A, Armbruster D, Kozuki N. Obstetric ultrasound use in low and middle income countries: a narrative review. Reprod Health. 2018;15(1):129. https:\/\/doi.org\/10.1186\/s12978-018-0571-y.","journal-title":"Reprod Health"},{"issue":"10","key":"6758_CR12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0078450","volume":"8","author":"AB Ross","year":"2013","unstructured":"Ross AB, DeStigter KK, Rielly M, Souza S, Morey GE, Nelson M, et al. A low-cost ultrasound program leads to increased antenatal clinic visits and attended deliveries at a health care clinic in rural Uganda. PLoS One. 2013;8(10):e78450. https:\/\/doi.org\/10.1371\/journal.pone.0078450.","journal-title":"PLoS One"},{"issue":"1","key":"6758_CR13","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s13690-015-0086-8","volume":"73","author":"S Mbuyita","year":"2015","unstructured":"Mbuyita S, Tillya R, Godfrey R, Kinyonge I, Shaban J, Mbaruku G. Effects of introducing routinely ultrasound scanning during ante Natal Care (ANC) clinics on number of visits of ANC and facility delivery: a cohort study. Arch Public Health. 2015;73(1):36. https:\/\/doi.org\/10.1186\/s13690-015-0086-8.","journal-title":"Arch Public Health"},{"issue":"4","key":"6758_CR14","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1097\/RUQ.0000000000000142","volume":"31","author":"MG Kawooya","year":"2015","unstructured":"Kawooya MG, Nathan RO, Swanson J, Swanson DL, Namulema E, Ankunda R, et al. Impact of introducing routine antenatal ultrasound services on reproductive health indicators in Mpigi District, Central Uganda. Ultrasound Q. 2015;31(4):285\u20139. https:\/\/doi.org\/10.1097\/RUQ.0000000000000142.","journal-title":"Ultrasound Q"},{"issue":"12","key":"6758_CR15","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1111\/1471-0528.15287","volume":"125","author":"RL Goldenberg","year":"2018","unstructured":"Goldenberg RL, Nathan RO, Swanson D, Saleem S, Mirza W, Esamai F, et al. Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial. BJOG. 2018;125(12):1591\u20139. https:\/\/doi.org\/10.1111\/1471-0528.15287.","journal-title":"BJOG."},{"key":"6758_CR16","volume-title":"Trends in maternal mortality: 1990\u20132015","author":"WHO","year":"2015","unstructured":"WHO. Trends in maternal mortality: 1990\u20132015. Geneva: World Health Organization; 2015."},{"key":"6758_CR17","volume-title":"Demographic and Health Survey 2019\/2020. NISR","author":"Rwanda National Institute of Statistics","year":"2020","unstructured":"Rwanda National Institute of Statistics. Demographic and Health Survey 2019\/2020. NISR; 2020."},{"key":"6758_CR18","unstructured":"Rwanda National Institute of Statistics. Rwanda Demographic and Health Survey, 2014\u20132015. https:\/\/www.statistics.gov.rw\/publication\/demographic-and-health-survey-20142015-final-report2016."},{"issue":"1","key":"6758_CR19","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1186\/1471-2393-14-363","volume":"14","author":"K Edvardsson","year":"2014","unstructured":"Edvardsson K, Small R, Persson M, Lalos A, Mogren I. Ultrasound is an invaluable third eye, but it can't see everything': a qualitative study with obstetricians in Australia. BMC Pregnancy Childbirth. 2014;14(1):363. https:\/\/doi.org\/10.1186\/1471-2393-14-363.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"6758_CR20","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1186\/s12884-015-0632-y","volume":"15","author":"K Edvardsson","year":"2015","unstructured":"Edvardsson K, Mogren I, Lalos A, Persson M, Small R. A routine tool with far-reaching influence: Australian midwives' views on the use of ultrasound during pregnancy. BMC Pregnancy Childbirth. 2015;15(1):195. https:\/\/doi.org\/10.1186\/s12884-015-0632-y.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"6758_CR21","doi-asserted-by":"publisher","first-page":"28405","DOI":"10.3402\/gha.v8.28405","volume":"8","author":"K Edvardsson","year":"2015","unstructured":"Edvardsson K, Graner S, Thi LP, Ahman A, Small R, Lalos A, et al. 'Women think pregnancy management means obstetric ultrasound': Vietnamese obstetricians' views on the use of ultrasound during pregnancy. Glob Health Action. 2015;8(1):28405.","journal-title":"Glob Health Action"},{"key":"6758_CR22","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.midw.2016.09.009","volume":"42","author":"K Edvardsson","year":"2016","unstructured":"Edvardsson K, Lalos A, Ahman A, Small R, Graner Md Ph DS, Mogren I. Increasing possibilities - increasing dilemmas: a qualitative study of Swedish midwives' experiences of ultrasound use in pregnancy. Midwifery. 2016;42:46\u201353. https:\/\/doi.org\/10.1016\/j.midw.2016.09.009.","journal-title":"Midwifery"},{"issue":"1","key":"6758_CR23","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1186\/s12884-015-0743-5","volume":"15","author":"A Ahman","year":"2015","unstructured":"Ahman A, Persson M, Edvardsson K, Lalos A, Graner S, Small R, et al. Two sides of the same coin--an interview study of Swedish obstetricians' experiences using ultrasound in pregnancy management. BMC Pregnancy Childbirth. 2015;15(1):304. https:\/\/doi.org\/10.1186\/s12884-015-0743-5.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"6758_CR24","doi-asserted-by":"publisher","first-page":"31062","DOI":"10.3402\/gha.v9.31062","volume":"9","author":"A Ahman","year":"2016","unstructured":"Ahman A, Kidanto HL, Ngarina M, Edvardsson K, Small R, Mogren I. Essential but not always available when needed' - an interview study of physicians' experiences and views regarding use of obstetric ultrasound in Tanzania. Glob Health Action. 2016;9(1):31062. https:\/\/doi.org\/10.3402\/gha.v9.31062.","journal-title":"Glob Health Action"},{"issue":"3","key":"6758_CR25","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1111\/j.1552-6909.2008.00241.x","volume":"37","author":"JL Alhusen","year":"2008","unstructured":"Alhusen JL. A literature update on maternal-fetal attachment. J Obstet Gynecol Neonatal Nurs. 2008;37(3):315\u201328. https:\/\/doi.org\/10.1111\/j.1552-6909.2008.00241.x.","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"issue":"5","key":"6758_CR26","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1177\/0969733009106655","volume":"16","author":"JL Leung","year":"2009","unstructured":"Leung JL, Pang SM. Ethical analysis of non-medical fetal ultrasound. Nurs Ethics. 2009;16(5):637\u201346. https:\/\/doi.org\/10.1177\/0969733009106655.","journal-title":"Nurs Ethics"},{"issue":"5","key":"6758_CR27","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1053\/j.semperi.2013.06.004","volume":"37","author":"JS Abramowicz","year":"2013","unstructured":"Abramowicz JS. Benefits and risks of ultrasound in pregnancy. Semin Perinatol. 2013;37(5):295\u2013300. https:\/\/doi.org\/10.1053\/j.semperi.2013.06.004.","journal-title":"Semin Perinatol"},{"issue":"4","key":"6758_CR28","doi-asserted-by":"publisher","first-page":"541","DOI":"10.7863\/jum.2008.27.4.541","volume":"27","author":"JS Abramowicz","year":"2008","unstructured":"Abramowicz JS, Barnett SB, Duck FA, Edmonds PD, Hynynen KH, Ziskin MC. Fetal thermal effects of diagnostic ultrasound. J Ultrasound Med. 2008;27(4):541\u201359; quiz 60-3. https:\/\/doi.org\/10.7863\/jum.2008.27.4.541.","journal-title":"J Ultrasound Med"},{"issue":"3","key":"6758_CR29","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1002\/uog.9055","volume":"38","author":"KA Salvesen","year":"2011","unstructured":"Salvesen KA. Ultrasound in pregnancy and non-right handedness: meta-analysis of randomized trials. Ultrasound Obstet Gynecol. 2011;38(3):267\u201371. https:\/\/doi.org\/10.1002\/uog.9055.","journal-title":"Ultrasound Obstet Gynecol"},{"key":"6758_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.srhc.2017.12.006","volume":"16","author":"TA Fagerli","year":"2018","unstructured":"Fagerli TA. Mogren I, Adolfsson a, Edva. Midwives' and obstetricians' views on appropriate obstetric sonography in Norway. Sex Reprod Healthc. 2018;16:1\u20135. https:\/\/doi.org\/10.1016\/j.srhc.2017.12.006.","journal-title":"Sex Reprod Healthc"},{"issue":"9","key":"6758_CR31","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-031761","volume":"9","author":"S Holmlund","year":"2019","unstructured":"Holmlund S, Lan PT, Edvardsson K, Phuc HD, Ntaganira J, Small R, et al. Health professionals' experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study. BMJ Open. 2019;9(9):e031761. https:\/\/doi.org\/10.1136\/bmjopen-2019-031761.","journal-title":"BMJ Open"},{"issue":"3","key":"6758_CR32","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1057\/palgrave.sth.8700053","volume":"3","author":"K Ballard","year":"2005","unstructured":"Ballard K, Elston MA. Medicalisation: A Multi-dimensional Concept. Soc Theory Health. 2005;3(3):228\u201341. https:\/\/doi.org\/10.1057\/palgrave.sth.8700053.","journal-title":"Soc Theory Health"},{"key":"6758_CR33","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.socscimed.2013.05.033","volume":"93","author":"RP Hammer","year":"2013","unstructured":"Hammer RP, Burton-Jeangros C. Tensions around risks in pregnancy: a typology of women's experiences of surveillance medicine. Soc Sci Med. 2013;93:55\u201363. https:\/\/doi.org\/10.1016\/j.socscimed.2013.05.033.","journal-title":"Soc Sci Med"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-021-06758-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-021-06758-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-021-06758-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T17:02:52Z","timestamp":1628614972000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-021-06758-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,10]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6758"],"URL":"https:\/\/doi.org\/10.1186\/s12913-021-06758-w","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,10]]},"assertion":[{"value":"1 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 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":"Prior to the start of the data collection, ethical approval was obtained from the University of Rwanda College of Medicine and Health Sciences Institutional Review Board, on behalf of the Rwandan National Ethics Committee (Reference No\/310\/CMHS IRB\/2016). An approval from the Ministry of Health was also granted (Reference No 20\/5779\/DGPHFIS\/MPP\/2016). All methods were performed in accordance with the relevant guidelines and regulations. Participants were provided with verbal and written information about the study, and written informed consent was obtained from all participants. Participation was voluntary and no identifiable information was collected.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consent for publication was granted at participation of the study. Participation was anonymous.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"789"}}