{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:45:58Z","timestamp":1792788358709,"version":"4.5.0"},"update-to":[{"DOI":"10.12688\/f1000research.122351.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000}}],"reference-count":47,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Institute of OM Foundation","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Background The relationship between sexuality, or the libido, and spirituality or religion has long been debated in psychiatry. Recent studies have explored the neurophysiology of both sexual experiences and spiritual practices such as meditation or prayer. In the present study, we report changes in cerebral glucose metabolism in a unique meditation practice augmented by clitoral stimulation called, Orgasmic Meditation, in which a spiritual state is described to be attained by both male and female participants engaged in the practice as a pair. Methods Male (N=20) and female (N=20) subjects had an intravenous catheter connected to a bag of normal saline inserted prior to the practice. During the practice, men stimulated their partner\u2019s clitoris for exactly 15 minutes (he received no sexual stimulation). Midway through the practice, researchers injected 18F-fluorodeoxyglucose so the scan would reflect cerebral metabolism during the practice. Positron emission tomography (PET) imaging was performed approximately 30 minutes later. Results In the female participants, the meditation state showed significant decreases in the left inferior frontal, inferior parietal, insula, middle temporal, and orbitofrontal regions as well as in the right angular gyrus, anterior cingulate and parahippocampus compared to a neutral state (p&lt;0.01). Male subjects had significant decreases in the left middle frontal, paracentral, precentral, and postcentral regions as well as the right middle frontal and paracentral regions during meditation (p&lt;0.01). Men also had significantly increased metabolism in the cerebellum and right postcentral and superior temporal regions (p&lt;0.01). Conclusions These findings represent a distinct pattern of brain activity, for both men and women, that is a hybrid between that of other meditation practices and sexual stimulation. Such findings have potential psychotherapeutic implications and may deepen our understanding of the relationship between spiritual and sexual experience.<\/ns3:p>","DOI":"10.12688\/f1000research.122351.2","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T04:45:09Z","timestamp":1703133909000},"page":"1015","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Alterations in cerebral glucose metabolism measured by FDG PET in subjects performing a meditation practice based on clitoral stimulation"],"prefix":"10.12688","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8230-1752","authenticated-orcid":false,"given":"Andrew B.","family":"Newberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6226-3960","authenticated-orcid":false,"given":"Nancy A.","family":"Wintering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Hriso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faezeh","family":"Vedaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feroze B.","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara E.","family":"Gottfried","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reneita","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2023,12,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"113-122","DOI":"10.1016\/s0925-4927(01)00074-9","article-title":"The measurement of regional cerebral blood flow during the complex cognitive task of meditation: a preliminary SPECT study.","volume":"106","author":"A Newberg","year":"2001","journal-title":"Psychiatry Res."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"517-526","DOI":"10.3233\/JAD-2010-1391","article-title":"Meditation effects on cognitive function and cerebral blood flow in subjects with memory loss: a preliminary study.","volume":"20","author":"A Newberg","year":"2010","journal-title":"J. Alzheimers Dis."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"60-67","DOI":"10.1016\/j.pscychresns.2010.09.011","article-title":"Cerebral blood flow changes associated with different meditation practices and perceived depth of meditation.","volume":"191","author":"D Wang","year":"2011","journal-title":"Psychiatry Res."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"397-407","DOI":"10.1002\/smi.2470","article-title":"Changes in cerebral blood flow and anxiety associated with an 8-week mindfulness programme in women with breast cancer.","volume":"28","author":"D Monti","year":"2012","journal-title":"Stress. Health."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2565-2575","DOI":"10.1002\/pon.3320","article-title":"Psychosocial benefits of a novel mindfulness intervention versus standard support in distressed women with breast cancer.","volume":"22","author":"D Monti","year":"2013","journal-title":"Psychooncology."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"92-115","DOI":"10.2741\/s542","article-title":"Neural correlates of meditation: a review of structural and functional MRI studies.","volume":"12","author":"R Afonso","year":"2020","journal-title":"Front. Biosci. (Schol. Ed.)."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"708973","DOI":"10.3389\/fpsyg.2021.708973","article-title":"Alterations in functional connectivity measured by functional magnetic resonance imaging and the relationship with heart rate variability in subjects after performing Orgasmic Meditation: An exploratory study.","volume":"12","author":"A Newberg","year":"2021","journal-title":"Front. Psychol."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"182-187","DOI":"10.1159\/000119450","article-title":"Changed pattern of regional glucose metabolism during yoga meditative relaxation.","volume":"23","author":"H Herzog","year":"1990-1991","journal-title":"Neuropsychobiology."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"67-71","DOI":"10.1016\/j.pscychresns.2006.07.001","article-title":"The measurement of regional cerebral blood flow during glossolalia: a preliminary SPECT study.","volume":"148","author":"A Newberg","year":"2006","journal-title":"Psychiatry Res."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"496-507","DOI":"10.1093\/scan\/nsv133","article-title":"Neural signatures of experimentally induced flow experiences identified in a typical fMRI block design with BOLD imaging.","volume":"11","author":"M Ulrich","year":"2016","journal-title":"Soc. Cogn. Affect. Neurosci."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"956-961","DOI":"10.1097\/MNM.0b013e32832fa26c","article-title":"Cerebral blood flow changes during chanting meditation.","volume":"30","author":"D Khalsa","year":"2009","journal-title":"Nucl. Med. Commun."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"309-319","DOI":"10.1016\/j.neuron.2010.01.026","article-title":"The spiritual brain: selective cortical lesions modulate human self-transcendence.","volume":"65","author":"C Urgesi","year":"2010","journal-title":"Neuron."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"282-291","DOI":"10.1016\/s0306-9877(03)00175-0","article-title":"The neural basis of the complex mental task of meditation: neurotransmitter and neurochemical considerations.","volume":"61","author":"A Newberg","year":"2003","journal-title":"Med. Hypotheses."},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.20113853.v1","article-title":"Orgasmic Meditation FDG PET Scans.","author":"A Newberg","year":"2022","journal-title":"figshare. [Dataset]."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"571-583","DOI":"10.1038\/jcbfm.1992.81","article-title":"Measurement of radiotracer concentration in brain gray matter using positron emission tomography: MRI-based correction for partial volume effects.","volume":"12","author":"H M\u00fcller-G\u00e4rtner","year":"1992","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref16","first-page":"904-911","article-title":"Correction for partial volume effects in PET: principle and validation.","volume":"39","author":"O Rousset","year":"1998","journal-title":"J. Nucl. Med."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"669-677","DOI":"10.1016\/j.neuroimage.2016.12.077","article-title":"Alzheimer\u2019s Disease Neuroimaging Initiative. PETPVE12: an SPM toolbox for Partial Volume Effects correction in brain PET - Application to amyloid imaging with AV45-PET.","volume":"147","author":"G Gonzalez-Escamilla","year":"2017","journal-title":"NeuroImage."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"339-351","DOI":"10.1007\/s12021-016-9299-4","article-title":"DPABI: Data Processing & Analysis for (Resting-State) Brain Imaging.","volume":"14","author":"C Yan","year":"2016","journal-title":"Neuroinform."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"25914639","DOI":"10.3389\/fninf.2015.00008","article-title":"NeuroVault.org: a web-based repository for collecting and sharing unthresholded statistical maps of the brain.","volume":"9","author":"K Gorgolewski","year":"2015","journal-title":"Front. Neuroinform."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e0246065","DOI":"10.1371\/journal.pone.0246065","article-title":"Partner intimate touch is associated with increased interpersonal closeness, especially in non-romantic partners.","volume":"16","author":"N Prause","year":"2021","journal-title":"PLoS One."},{"key":"ref21","first-page":"314P","article-title":"Cerebral glucose metabolic changes associated with a meditation based relaxation technique.","volume":"47","author":"A Newberg","year":"2006","journal-title":"J. Nucl. Med."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"29-52","DOI":"10.1111\/nyas.12360","article-title":"The default network and self-generated thought: component processes, dynamic control, and clinical relevance.","volume":"1316","author":"J Andrews-Hanna","year":"2014","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1-13","DOI":"10.1002\/hbm.10014","article-title":"Areas of brain activation in males and females during viewing of erotic film excerpts.","volume":"16","author":"S Karama","year":"2002","journal-title":"Hum. Brain Mapp."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"369-385","DOI":"10.1080\/00207450600588980","article-title":"The role of prefrontal systems in sexual behavior.","volume":"117","author":"M Spinella","year":"2007","journal-title":"Int. J. Neurosci."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"3305-3316","DOI":"10.1111\/j.1460-9568.2006.05206.x","article-title":"Regional cerebral blood flow changes associated with clitorally induced orgasm in healthy women.","volume":"24","author":"J Georgiadis","year":"2006","journal-title":"Eur. J. Neurosci."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"9185-9193","DOI":"10.1523\/JNEUROSCI.23-27-09185.2003","article-title":"Brain activation during human male ejaculation.","volume":"23","author":"G Holstege","year":"2003","journal-title":"J. Neurosci."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"208-216","DOI":"10.1016\/j.neuroimage.2009.12.034","article-title":"Dynamic subcortical blood flow during male sexual activity with ecological validity: a perfusion fMRI study.","volume":"50","author":"J Georgiadis","year":"2010","journal-title":"NeuroImage."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1380-1391","DOI":"10.1016\/j.jsxm.2017.08.014","article-title":"Brain activity unique to orgasm in women: An fMRI analysis.","volume":"14","author":"N Wise","year":"2017","journal-title":"J. Sex. Med."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"77-88","DOI":"10.1016\/j.brainres.2004.07.029","article-title":"Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves.","volume":"1024","author":"B Komisaruk","year":"2004","journal-title":"Brain Res."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"241-243","DOI":"10.1016\/0304-3940(94)90328-x","article-title":"Increase in cerebral blood flow of right prefrontal cortex in man during orgasm.","volume":"170","author":"J Tiihonen","year":"1994","journal-title":"Neurosci. Lett."},{"key":"ref32","doi-asserted-by":"crossref","first-page":"62-86","DOI":"10.1080\/10532528.2005.10559829","article-title":"Functional MRI of the brain during orgasm in women.","volume":"16","author":"B Komisaruk","year":"2005","journal-title":"Annu. Rev. Sex Res."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"20254-20259","DOI":"10.1073\/pnas.1112029108","article-title":"Meditation experience is associated with differences in default mode network activity and connectivity.","volume":"108","author":"J Brewer","year":"2011","journal-title":"Proc. Natl. Acad. Sci. U. S. A."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"9968","DOI":"10.1038\/s41598-018-28274-4","article-title":"Open monitoring meditation reduces the involvement of brain regions related to memory function.","volume":"8","author":"M Fujino","year":"2018","journal-title":"Sci. Rep."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"473","DOI":"10.3389\/fnhum.2019.00473","article-title":"Revealing Changes in Brain Functional Networks Caused by Focused-Attention Meditation Using Tucker3 Clustering.","volume":"13","author":"T Miyoshi","year":"2020","journal-title":"Front. Hum. Neurosci."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"419808-419811","DOI":"10.1155\/2015\/419808","article-title":"The Meditative Mind: A Comprehensive Meta-Analysis of MRI Studies.","volume":"2015","author":"M Boccia","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"145-153","DOI":"10.1007\/s11764-017-0653-9","article-title":"Changes in cerebellar functional connectivity and autonomic regulation in cancer patients treated with the Neuro Emotional Technique for traumatic stress symptoms.","volume":"12","author":"D Monti","year":"2018","journal-title":"J. Cancer Surviv."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"112828","DOI":"10.1016\/j.bbr.2020.112828","article-title":"Cortical reorganization processes in meditation na\u00efve participants induced by 7 weeks focused attention meditation training.","volume":"395","author":"L Lenhart","year":"2020","journal-title":"Behav. Brain Res."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"750-760","DOI":"10.1016\/j.neuroimage.2011.07.008","article-title":"Mind wandering and attention during focused meditation: a fine-grained temporal analysis of fluctuating cognitive states.","volume":"59","author":"W Hasenkamp","year":"2012","journal-title":"NeuroImage."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.3390\/brainsci11101263","article-title":"The Longitudinal Effect of Meditation on Resting-State Functional Connectivity Using Dynamic Arterial Spin Labeling: A Feasibility Study.","volume":"11","author":"Z Zhang","year":"2021","journal-title":"Brain Sci."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"659403","DOI":"10.3389\/fpsyg.2021.659403","article-title":"There Is More to Mindfulness Than Emotion Regulation: A Study on Brain Structural Networks.","volume":"12","author":"S Baltruschat","year":"2021","journal-title":"Front. Psychol."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1203-1216","DOI":"10.1093\/scan\/nsaa137","article-title":"Studying the precuneus reveals structure-function-affect correlation in long-term meditators.","volume":"15","author":"A Berkovich-Ohana","year":"2020","journal-title":"Soc. Cogn. Affect. Neurosci."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"214-220","DOI":"10.1016\/j.jphysparis.2015.08.001","article-title":"A case series study of the neurophysiological effects of altered states of mind during intense Islamic prayer.","volume":"109","author":"A Newberg","year":"2015","journal-title":"J. Physiol. Paris."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"676-682","DOI":"10.1073\/pnas.98.2.676","article-title":"A default mode of brain function.","volume":"98","author":"M Raichle","year":"2001","journal-title":"Proc. Natl. Acad. Sci. USA."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"712-720","DOI":"10.3758\/s13415-015-0358-3","article-title":"Meditation leads to reduced default mode network activity beyond an active task.","volume":"15","author":"K Garrison","year":"2015","journal-title":"Cogn. Affect. Behav. Neurosci."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"46-56","DOI":"10.1016\/j.brainresbull.2010.03.001","article-title":"Neural correlates of focused attention and cognitive monitoring in meditation.","volume":"82","author":"A Manna","year":"2010","journal-title":"Brain Res. Bull."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"104583","DOI":"10.1016\/j.neubiorev.2022.104583","article-title":"Resting-state fMRI functional connectivity and mindfulness in clinical and non-clinical contexts: A review and synthesis.","volume":"135","author":"I Sezer","year":"2022","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"265-278","DOI":"10.1080\/2153599X.2016.1267035","article-title":"Effect of a one-week spiritual retreat on dopamine and serotonin transporter binding: a preliminary study.","volume":"8","author":"A Newberg","year":"2018","journal-title":"Relig. Brain Behav."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/11-1015\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/11-1015\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/11-1015\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T04:40:17Z","timestamp":1735015217000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/11-1015\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,21]]},"references-count":47,"URL":"https:\/\/doi.org\/10.12688\/f1000research.122351.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.122351.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.160302.r346500","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.160302.r232106","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.160302.r232106","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.160302.r346500","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,21]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/11-1015\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.134329.r217436, Michael Winterdahl, Translational Neuropsychiatry Unit, Aarhus University, Aarhus, 15 Nov 2023, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/11-1015\/v1#referee-response-217436","order":0,"name":"referee-response-217436","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Andrew Newberg<\/b>; \n<i>Posted: 16 Dec 2023<\/i>; We greatly appreciate the reviewer's comments which we feel have helped to substantially improve the article. Below is a point-by-point response. Corresponding changes are made in the manuscript in track changes mode.  Firstly, I would like to extend my congratulations to the authors. Securing funding and institutional approval for studies of this nature is a significant challenge, one with which I am personally familiar. The ability to conduct a sound and relatively well-powered PET imaging study under these circumstances is indeed impressive and commendable. \n<b>Thank you for these kind words. It is certainly a challenge performing such studies and we appreciate your comments about this difficulty.<\/b>  Regarding the manuscript, I have a few concerns:  The structure of the manuscript diverges significantly from the conventional format of introduction, methods, results, and discussion. Specifically, the introduction is overly lengthy, while the discussion is notably brief. It would benefit the reader if the introduction were condensed to provide only the necessary background and references to previous work and literature. Furthermore, in the discussion, the results should be contextualized within existing literature, including a thorough examination of the study's limitations. A balanced presentation of the study's strengths and weaknesses is essential (most have been mentioned in the introduction). Finally, the manuscript would be enhanced by suggestions for future research directions. \n<b>Thank you for these suggestions. We have modified the manuscript by shortening the Introduction and adding substantially to the Discussion section. We have also expanded a discussion of limitations and suggested future research directions. <\/b> &nbsp; In a previous paper, the authors published their findings from the same experiment using fMRI. However, they missed the opportunity to compare the fMRI findings with those from FDG PET, a very different imaging modality. The comparison of results between the two techniques could be a major strength of the present manuscript. It would have been beneficial to explore whether these findings correlate and whether the same regions are &quot;activated&quot;. \n<b>We agree and have expanded our discussion regarding the connection of the current reported PET results with those from the MRI analysis and discussed its implications.<\/b> &nbsp; Since the subjects are not being stimulated in the PET scanner, is the argument for using FDG PET imaging really to avoid motion artefacts? Or does the main advantage lie in the biochemical information obtained? Can the authors discuss this further to clarify the details? \n<b>Thank you for this question. There were several factors that the PET imaging provided an advantage including the ability to perform the entire practice outside the scanner while still being able to assess metabolic changes in the brain during the practice. This includes accommodating the subjects to be able to be positioned and touching in the prescribed manner of the practice, reduction of motion artifact, and the ability to assess specific metabolic effects in the brain. We have clarified and expanded this in the manuscript.<\/b> &nbsp; Is the dopamine system involved in meditation? What would, e.g. Raclaprice PET have shown? Could other tracers have contributed with important knowledge - Can the authors discuss this further to clarify the details?&nbsp; \n<b>This is an important question. There is only one study we are aware of that used raclopride to assess a meditation state, but it would be quite interesting to observe changes in various neurotransmitter systems more specifically. We will include this in the Discussion section and also in future directions.<\/b> &nbsp; In a few instances, the participants or volunteers were mistakenly referred to as patients. \n<b>Thank you for pointing this out. They should be referred to as participants or subjects and we will correct this throughout the manuscript.<\/b> &nbsp; Test values are typically denoted with a lowercase &quot;t&quot; (represented using a colour scale in figures). \n<b>We agree and have modified this in the figure.<\/b> &nbsp; Although the population has been described previously, a small recap on the demographics could help the reader. \n<b>We agree and have expanded this discussion in the paper.<\/b>","URL":"https:\/\/f1000research.com\/articles\/11-1015\/v2#referee-comment-10782","order":1,"name":"referee-comment-10782","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.160302.r232106, Helen Lavretsky, Department of Psychiatry, Semel Institute for Neuroscience and Behavior, University of California Los Angeles, Los Angeles, CA, 06 May 2024, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/11-1015\/v2#referee-response-232106","order":2,"name":"referee-response-232106","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.160302.r346500, Abass Alavi, Hospital of the University of Pennsylvania, Philadelphia, 24 Dec 2024, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/11-1015\/v2#referee-response-346500","order":3,"name":"referee-response-346500","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by a gift from the Institute of OM Foundation, IOMF, with Dr. Andrew Newberg as the Principal Investigator. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}