{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T21:15:34Z","timestamp":1790284534664,"version":"4.1.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007917","name":"Agricultural Research Service","doi-asserted-by":"publisher","award":["3020-32000-009-00D"],"award-info":[{"award-number":["3020-32000-009-00D"]}],"id":[{"id":"10.13039\/100007917","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007917","name":"Agricultural Research Service","doi-asserted-by":"publisher","award":["3020-32000-018-00D"],"award-info":[{"award-number":["3020-32000-018-00D"]}],"id":[{"id":"10.13039\/100007917","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["HHSN 272201400006C"],"award-info":[{"award-number":["HHSN 272201400006C"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000180","name":"U.S. Department of Homeland Security","doi-asserted-by":"publisher","award":["HSHQDC-16-A-B0006"],"award-info":[{"award-number":["HSHQDC-16-A-B0006"]}],"id":[{"id":"10.13039\/100000180","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Parasites Vectors"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a recently emerged coronavirus that is the causative agent of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 in humans is characterized by a wide range of symptoms that range from asymptomatic to mild or severe illness including death. SARS-CoV-2 is highly contagious and is transmitted via the oral\u2013nasal route through droplets and aerosols, or through contact with contaminated fomites. House flies are known to transmit bacterial, parasitic and viral diseases to humans and animals as mechanical vectors. Previous studies have shown that house flies can mechanically transmit coronaviruses, such as turkey coronavirus; however, the house fly\u2019s role in SARS-CoV-2 transmission has not yet been explored. The goal of this work was to investigate the potential of house flies to mechanically transmit SARS-CoV-2. For this purpose, it was determined whether house flies can acquire SARS-CoV-2, harbor live virus and mechanically transmit the virus to naive substrates and surfaces.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Two independent studies were performed to address the study objectives. In the first study, house flies were tested for infectivity after exposure to SARS-CoV-2-spiked medium or milk. In the second study, environmental samples were tested for infectivity after contact with SARS-CoV-2-exposed flies. During both studies, samples were collected at various time points post-exposure and evaluated by SARS-CoV-2-specific RT-qPCR and virus isolation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>All flies exposed to SARS-CoV-2-spiked media or milk substrates were positive for viral RNA at 4\u00a0h and 24\u00a0h post-exposure. Infectious virus was isolated only from the flies exposed to virus-spiked milk but not from those exposed to virus-spiked medium. Moreover, viral RNA was detected in environmental samples after contact with SARS-CoV-2 exposed flies, although no infectious virus was recovered from these samples.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Under laboratory conditions, house flies acquired and harbored infectious SARS-CoV-2 for up to 24\u00a0h post-exposure. In addition, house flies were able to mechanically transmit SARS-CoV-2 genomic RNA to the surrounding environment up to 24\u00a0h post-exposure. Further studies are warranted to determine if house fly transmission occurs naturally and the potential public health implications of such events.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1186\/s13071-021-04703-8","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T09:03:36Z","timestamp":1618909416000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Mechanical transmission of SARS-CoV-2 by house flies"],"prefix":"10.1186","volume":"14","author":[{"given":"Velmurugan","family":"Balaraman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara S.","family":"Drolet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana N.","family":"Mitzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeana","family":"Owens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha N.","family":"Gaudreault","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Meekins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dashzeveg","family":"Bold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie D.","family":"Trujillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leela E.","family":"Noronha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juergen A.","family":"Richt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9258-6066","authenticated-orcid":false,"given":"Dana","family":"Nayduch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"key":"4703_CR1","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1056\/NEJMoa2001017","volume":"382","author":"N Zhu","year":"2020","unstructured":"Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727\u201333.","journal-title":"N Engl J Med"},{"key":"4703_CR2","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1089\/vbz.2020.2650","volume":"20","author":"T McNamara","year":"2020","unstructured":"McNamara T, Richt JA, Glickman L. A critical needs assessment for research in companion animals and livestock following the pandemic of COVID-19 in humans. Vector Borne Zoonotic Dis. 2020;20:393\u2013405.","journal-title":"Vector Borne Zoonotic Dis"},{"key":"4703_CR3","doi-asserted-by":"publisher","first-page":"2322","DOI":"10.1080\/22221751.2020.1833687","volume":"9","author":"NN Gaudreault","year":"2020","unstructured":"Gaudreault NN, Trujillo JD, Carossino M, Meekins DA, Morozov I, Madden DW, et al. SARS-CoV-2 infection, disease and transmission in domestic cats. Emerg Microbes Infect. 2020;9:2322\u201332.","journal-title":"Emerg Microbes Infect"},{"key":"4703_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/pathogens9070529","volume":"9","author":"AS Abdel-Moneim","year":"2020","unstructured":"Abdel-Moneim AS, Abdelwhab EM. Evidence for SARS-COV-2 infection of animal hosts. Pathogens. 2020;9:1\u201327.","journal-title":"Pathogens"},{"key":"4703_CR5","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1016\/S1473-3099(20)30561-2","volume":"20","author":"E Goldman","year":"2020","unstructured":"Goldman E. Exaggerated risk of transmission of COVID-19 by fomites. Lancet Infect Dis. 2020;20:892\u20133.","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"4703_CR6","doi-asserted-by":"publisher","first-page":"227","DOI":"10.3390\/pathogens10020227","volume":"10","author":"T Kwon","year":"2021","unstructured":"Kwon T, Gaudreault NN, Richt JA. Environmental Stability of SARS-CoV-2 on different types of surfaces under indoor and seasonal climate conditions. Pathogens. 2021;10(2):227. https:\/\/doi.org\/10.3390\/pathogens10020227. PMID: 33670736; PMCID: PMC7922895.","journal-title":"Pathogens."},{"key":"4703_CR7","doi-asserted-by":"crossref","unstructured":"Chamberlain RW. Arboviruses, the arthropod-borne animal viruses. In: Maramorosch K, editor. Insect viruses. Current topics in microbiology and immunology, vol 42. Berlin, Heidelberg: Springer; 1968. p. 38\u201358.","DOI":"10.1007\/978-3-642-46115-6_3"},{"key":"4703_CR8","first-page":"335","volume":"35","author":"H Xia","year":"2020","unstructured":"Xia H, Atoni E, Zhao L, Ren N, Huang D, Pei R, et al. SARS-CoV-2 does not replicate in Aedes mosquito cells nor present in field-caught mosquitoes from Wuhan. Virol Sin. 2020;35:335\u201358.","journal-title":"Virol Sin"},{"key":"4703_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-019-56847-4","volume":"10","author":"YJS Huang","year":"2020","unstructured":"Huang YJS, Vanlandingham DL, Bilyeu AN, Sharp HM, Hettenbach SM, Higgs S. SARS-CoV-2 failure to infect or replicate in mosquitoes: an extreme challenge. Sci Rep. 2020;10:1\u20134.","journal-title":"Sci Rep"},{"key":"4703_CR10","doi-asserted-by":"crossref","unstructured":"Villar M, Fern\u00e1ndez De Mera IG, Artigas-Jer\u00f3nimo S, Contreras M, Gort\u00e1zar C, De La Fuente J. Coronavirus in cat flea: findings and questions regarding COVID-19. Parasites Vectors. 2020;13:1\u20136.","DOI":"10.1186\/s13071-020-04292-y"},{"key":"4703_CR11","doi-asserted-by":"publisher","unstructured":"Balaraman V, Drolet BS, Gaudreault NN, Wilson WC, Owens J, Bold D, Swanson DA, Jasperson DC, Noronha LE, Richt JA, Mitzel DN. Susceptibility of Midge and Mosquito Vectors to SARS-CoV-2. J Med Entomol. 2021 Mar 4:tjab013. https:\/\/doi.org\/10.1093\/jme\/tjab013. Epub ahead of print. PMID: 33686400; PMCID: PMC7989399.","DOI":"10.1093\/jme\/tjab013"},{"key":"4703_CR12","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s13071-021-04578-9","volume":"14","author":"C Fortuna","year":"2021","unstructured":"Fortuna C, Montarsi F, Severini F, Marsili G, Toma L, Amendola A, et al. The common European mosquitoes Culex pipiens and Aedes albopictus are unable to transmit SARS-CoV-2 after a natural-mimicking challenge with infected blood. Parasites Vectors. 2021;14:76.","journal-title":"Parasites Vectors"},{"key":"4703_CR13","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1093\/aesa\/saw083","volume":"110","author":"D Nayduch","year":"2017","unstructured":"Nayduch D, Burrus RG. Flourishing in filth: House fly-microbe interactions across life history. Ann Entomol Soc Am. 2017;110:6\u201318.","journal-title":"Ann Entomol Soc Am"},{"key":"4703_CR14","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.tmaid.2018.02.007","volume":"22","author":"FC Onwugamba","year":"2018","unstructured":"Onwugamba FC, Fitzgerald JR, Rochon K, Guardabassi L, Alabi A, K\u00fchne S, et al. The role of \u201cfilth flies\u201d in the spread of antimicrobial resistance. Travel Med Infect Dis. 2018;22:8\u201317.","journal-title":"Travel Med Infect Dis"},{"key":"4703_CR15","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1637\/0005-2086(2003)047[0149:MTOTCB]2.0.CO;2","volume":"47","author":"D Calibeo-Hayes","year":"2003","unstructured":"Calibeo-Hayes D, Denning SS, Stringham SM, Guy JS, Smith LG, Watson DW. Mechanical transmission of turkey coronavirus by domestic houseflies (Musca domestica Linnaeaus). Avian Dis. 2003;47:149\u201353.","journal-title":"Avian Dis"},{"key":"4703_CR16","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1093\/jmedent\/44.4.666","volume":"44","author":"DW Watson","year":"2007","unstructured":"Watson DW, Ni\u00f1o EL, Rochon K, Denning S, Smith L, Guy JS. Experimental evaluation of Musca domestica (Diptera: Muscidae) as a vector of Newcastle disease virus. J Med Entomol. 2007;44:666\u201371.","journal-title":"J Med Entomol"},{"key":"4703_CR17","first-page":"91","volume":"73","author":"A Pitkin","year":"2009","unstructured":"Pitkin A, Deen J, Otake S, Moon R, Dee S. Further assessment of houseflies (Musca domestica) as vectors for the mechanical transport and transmission of porcine reproductive and respiratory syndrome virus under field conditions. Can J Vet Res. 2009;73:91\u20136.","journal-title":"Can J Vet Res"},{"key":"4703_CR18","first-page":"2078","volume":"44","author":"PM Gough","year":"1983","unstructured":"Gough PM, Jorgenson RD. Identification of porcine transmissible gastroenteritis virus in house flies (Musca domestica Linneaus). Am J Vet Res. 1983;44:2078\u201382.","journal-title":"Am J Vet Res"},{"key":"4703_CR19","doi-asserted-by":"publisher","first-page":"2278","DOI":"10.1080\/22221751.2020.1831405","volume":"9","author":"DA Meekins","year":"2020","unstructured":"Meekins DA, Morozov I, Trujillo JD, Gaudreault NN, Bold D, Carossino M, et al. Susceptibility of swine cells and domestic pigs to SARS-CoV-2. Emerg Microbes Infect. 2020;9:2278\u201388.","journal-title":"Emerg Microbes Infect"},{"key":"4703_CR20","doi-asserted-by":"crossref","unstructured":"Hierholzer JC, Killington RA. Virus isolation and quantitation. In: Mahy BW, Kangro HI, editors. Virology methods manual. London: Academic Press; 1996. p. 25\u201346.","DOI":"10.1016\/B978-012465330-6\/50003-8"},{"key":"4703_CR21","doi-asserted-by":"publisher","first-page":"1920","DOI":"10.3201\/eid2608.200681","volume":"26","author":"F Xiao","year":"2020","unstructured":"Xiao F, Sun J, Xu Y, Li F, Huang X, Li H, et al. Infectious SARS-CoV-2 in feces of patient with severe COVID-19. Emerg Infect Dis. 2020;26:1920\u20132.","journal-title":"Emerg Infect Dis"},{"key":"4703_CR22","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/S2468-1253(20)30083-2","volume":"5","author":"Y Wu","year":"2020","unstructured":"Wu Y, Guo C, Tang L, Hong Z, Zhou J, Dong X, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol. 2020;5:434\u20135.","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"4703_CR23","doi-asserted-by":"publisher","unstructured":"van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, Tamin A, Harcourt JL, Thornburg NJ, Gerber SI, Lloyd-Smith JO, de Wit E, Munster VJ. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020 Apr 16;382(16):1564\u20137. https:\/\/doi.org\/10.1056\/NEJMc2004973. Epub 2020 Mar 17. PMID: 32182409; PMCID: PMC7121658.","DOI":"10.1056\/NEJMc2004973"},{"key":"4703_CR24","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.jhin.2020.10.021","volume":"107","author":"Y Liu","year":"2021","unstructured":"Liu Y, Li T, Deng Y, Liu S, Zhang D, Li H, et al. Stability of SARS-CoV-2 on environmental surfaces and in human excreta. J Hosp Infect. 2021;107:105\u20137.","journal-title":"J Hosp Infect"},{"key":"4703_CR25","doi-asserted-by":"publisher","unstructured":"van Doremalen N, Bushmaker T, Karesh WB, Munster VJ. Stability of Middle East respiratory syndrome coronavirus in milk. Emerg Infect Dis. 2014 Jul;20(7):1263\u20134. https:\/\/doi.org\/10.3201\/eid2007.140500. PMID: 24960335; PMCID: PMC4073862.","DOI":"10.3201\/eid2007.140500"},{"key":"4703_CR26","doi-asserted-by":"publisher","first-page":"522","DOI":"10.4315\/0362-028X-63.4.522","volume":"63","author":"S Bidawid","year":"2000","unstructured":"Bidawid S, Farber JM, Sattar SA, Hayward S. Heat inactivation of hepatitis A virus in dairy foods. J Food Prot. 2000;63:522\u20138.","journal-title":"J Food Prot"},{"key":"4703_CR27","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1038\/s41586-020-2196-x","volume":"581","author":"R W\u00f6lfel","year":"2020","unstructured":"W\u00f6lfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, M\u00fcller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020;581:465\u20139.","journal-title":"Nature"},{"key":"4703_CR28","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1111\/mve.12162","volume":"30","author":"NHV Kumar","year":"2016","unstructured":"Kumar NHV, Nayduch D. Dose-dependent fate of GFP-expressing Escherichia coli in the alimentary canal of adult house flies. Med Vet Entomol. 2016;30:218\u201328.","journal-title":"Med Vet Entomol"},{"key":"4703_CR29","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1093\/jme\/tjx179","volume":"55","author":"R Chifanzwa","year":"2018","unstructured":"Chifanzwa R, Nayduch D. Dose-dependent effects on replication and persistence of Salmonella enterica serovar Typhimurium in house flies (Diptera: Muscidae). J Med Entomol. 2018;55:225\u20139.","journal-title":"J Med Entomol"},{"key":"4703_CR30","first-page":"1264","volume":"55","author":"D Nayduch","year":"2018","unstructured":"Nayduch D, Zurek K, Thomson JL, Yeater KM. Effects of bacterial dose and fly sex on persistence and excretion of Salmonella enterica serovar Typhimurium from adult house flies (Musca domestica L; Diptera: Muscidae). J Med Entomol. 2018;55:1264\u201370.","journal-title":"J Med Entomol"},{"key":"4703_CR31","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1016\/j.pt.2017.06.008","volume":"33","author":"N Pilotte","year":"2017","unstructured":"Pilotte N, Unnasch TR, Williams SA. The current status of molecular xenomonitoring for lymphatic filariasis and onchocerciasis. Trends Parasitol. 2017;33:788\u201398.","journal-title":"Trends Parasitol"},{"key":"4703_CR32","doi-asserted-by":"publisher","first-page":"324","DOI":"10.4269\/ajtmh.17-0063","volume":"97","author":"JR Fauver","year":"2017","unstructured":"Fauver JR, Gendernalik A, Weger-Lucarelli J, Grubaugh ND, Brackney DE, Foy BD, et al. The use of xenosurveillance to detect human bacteria, parasites, and viruses in mosquito bloodmeals. Am J Trop Med Hyg. 2017;97:324\u20139.","journal-title":"Am J Trop Med Hyg"}],"container-title":["Parasites &amp; Vectors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13071-021-04703-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13071-021-04703-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13071-021-04703-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T17:36:19Z","timestamp":1625679379000},"score":1,"resource":{"primary":{"URL":"https:\/\/parasitesandvectors.biomedcentral.com\/articles\/10.1186\/s13071-021-04703-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,20]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["4703"],"URL":"https:\/\/doi.org\/10.1186\/s13071-021-04703-8","relation":{},"ISSN":["1756-3305"],"issn-type":[{"value":"1756-3305","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,20]]},"assertion":[{"value":"15 January 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2021","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"\"Following publication of this article, Additional file 2 and Additional 3\nhave been corrected to remove tracked changes that had been\nerroneously retained in the article.\"","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All the authors declare no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"214"}}