{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T03:01:23Z","timestamp":1780282883483,"version":"3.54.0"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.23278.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000}}],"reference-count":50,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns5:p>Background Social anxiety is a heightened fear and discomfort in social situations. Cases of elevated distress and impaired functioning can lead to a clinical diagnosis of social anxiety disorder. Altering cognitive biases associated with social anxiety has been suggested as potentially beneficial; however, little is known about the comparative effectiveness of such interventions. The aim of this living systematic review is to examine the efficacy of cognitive bias modification for reducing social anxiety. Methods We will search multiple electronic databases for randomised controlled trials evaluating the efficacy of cognitive bias modification for people diagnosed with social anxiety and people exposed to a social stressor. The primary outcome will be change in social anxiety related symptoms; secondary outcomes will be changes in social functioning and quality of life and adverse events. Study selection, data extraction and risk of bias assessment will be done by at least two reviewers using pre-defined tools. We will synthesise data from people with social anxiety diagnosis and those subjected to a simulated social stressor separately using random effects meta-analyses. Heterogeneity will be evaluated by investigating characteristics of included studies and we will conduct a network meta-analysis in order to compare the efficacy of subtypes of cognitive bias modification for social anxiety disorder. We will appraise the strength of the evidence for each outcome by reviewing the overall association, internal and external validity, and reporting biases. Where data allows, we will triangulate the evidence from both sources with a multidisciplinary group of experts. We will also descriptively report factors reported to mediate cognitive bias modification, The review will begin in living mode and the database search will be rerun every three months to identify potential new evidence. We will co-produce this review with members of a global lived experience advisory board. This protocol was registered on 15.10.2024 (CRD42024601380)..<\/ns5:p>","DOI":"10.12688\/wellcomeopenres.23278.2","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T10:25:08Z","timestamp":1747995908000},"page":"657","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Cognitive bias modification for social anxiety: protocol for a living systematic review of human studies and meta-analysis"],"prefix":"10.12688","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7312-8676","authenticated-orcid":false,"given":"Jaycee","family":"Kennett","sequence":"first","affiliation":[{"name":"Department of Psychiatry Oxford England University of Oxford"},{"name":"NIHR Oxford Health Biomedical Research Centre Oxford Oxford Precision Psychiatry 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package for network meta-analysis using frequentist methods.","volume":"106","author":"S Balduzzi","year":"2023","journal-title":"J Stat Softw."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"153-160","DOI":"10.1136\/ebmental-2019-300117","article-title":"How to perform a meta-analysis with R: a practical tutorial.","volume":"22","author":"S Balduzzi","year":"2019","journal-title":"Evid Based Ment Health."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"103-119","DOI":"10.1007\/s10608-013-9576-6","article-title":"Change processes during Cognitive Bias Modification for obsessive compulsive beliefs.","volume":"38","author":"J Beadel","year":"2014","journal-title":"Cognitive Ther Res."},{"key":"ref-44","doi-asserted-by":"publisher","first-page":"465-467","DOI":"10.1016\/S2215-0366(20)30170-X","article-title":"Clinical efficacy of Cognitive Bias Modification interventions.","volume":"7","author":"S Blackwell","year":"2020","journal-title":"Lancet Psychiatry."},{"key":"ref-45","doi-asserted-by":"publisher","first-page":"E54","DOI":"10.1017\/sjp.2017.41","article-title":"A question of control? Examining the role of control conditions in experimental psychopathology using the example of Cognitive Bias Modification research.","volume":"20","author":"S Blackwell","year":"2017","journal-title":"Span J Psychol."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"52-78","DOI":"10.1007\/s11065-018-9386-4","article-title":"Cognitive Bias Modification for behavior change in alcohol and smoking addiction: Bayesian meta-analysis of individual participant data.","volume":"29","author":"M Boffo","year":"2019","journal-title":"Neuropsychol Rev."},{"key":"ref-8","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-021-02166-3","article-title":"ROB-MEN: a tool to assess Risk Of Bias due to Missing Evidence in Network meta-analysis.","volume":"19","author":"V Chiocchia","year":"2021","journal-title":"BMC Med."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"932-944","DOI":"10.1002\/sim.3767","article-title":"Checking consistency in mixed treatment comparison meta-analysis.","volume":"29","author":"S Dias","year":"2010","journal-title":"Stat Med."},{"key":"ref-46","doi-asserted-by":"publisher","first-page":"1-8","DOI":"10.1016\/j.janxdis.2015.12.003","article-title":"Social anxiety disorder and quality of life: how fears of negative and positive evaluation relate to specific domains of life satisfaction.","volume":"38","author":"M Dryman","year":"2016","journal-title":"J Anxiety Disord."},{"key":"ref-47","doi-asserted-by":"publisher","first-page":"506-514","DOI":"10.1016\/S2215-0366(20)30130-9","article-title":"Efficacy of Cognitive Bias Modification interventions in anxiety and depressive disorders: a systematic review and network meta-analysis.","volume":"7","author":"L Fodor","year":"2020","journal-title":"Lancet Psychiatry."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"5-12","DOI":"10.1037\/ser0000254","article-title":"Barriers to mental health treatment among individuals with social anxiety disorder and generalized 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Psychiatry."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"350-358","DOI":"10.1016\/j.brat.2012.02.015","article-title":"Attention training to reduce attention bias and social stressor reactivity: an attempt to replicate and extend previous findings.","volume":"50","author":"K Julian","year":"2012","journal-title":"Behav Res Ther."},{"key":"ref-70","doi-asserted-by":"publisher","first-page":"890-897","DOI":"10.1080\/09658211.2013.844261","article-title":"Autobiographical memory bias in social anxiety.","volume":"22","author":"J Krans","year":"2014","journal-title":"Memory."},{"key":"ref-19","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1192\/bjp.2018.41","article-title":"Processing confusing procedures in the recent re-analysis of a Cognitive Bias Modification meta-analysis.","volume":"212","author":"A Kruijt","year":"2018","journal-title":"Br J Psychiatry."},{"key":"ref-48","doi-asserted-by":"publisher","first-page":"169-177","DOI":"10.1016\/j.janxdis.2013.09.005","article-title":"A meta-analysis and scoping review of social cognition performance in social phobia, posttraumatic stress disorder and other anxiety disorders.","volume":"28","author":"M Lavoie","year":"2014","journal-title":"J Anxiety Disord."},{"key":"ref-49","doi-asserted-by":"publisher","first-page":"141-73","DOI":"10.1159\/000414022","article-title":"Social phobia.","volume":"22","author":"M Liebowitz","year":"1987","journal-title":"Mod Probl Pharmacopsychiatry."},{"key":"ref-20","doi-asserted-by":"publisher","first-page":"101-115","DOI":"10.1007\/s00429-013-0641-4","article-title":"Multivariate classification of social anxiety disorder using whole brain functional connectivity.","volume":"220","author":"F Liu","year":"2015","journal-title":"Brain Struct Funct."},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"189-217","DOI":"10.1146\/annurev-clinpsy-032511-143052","article-title":"Cognitive Bias Modification approaches to anxiety.","volume":"8","author":"C MacLeod","year":"2012","journal-title":"Annu Rev Clin Psychol."},{"key":"ref-22","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2022.104180","article-title":"Attention and Interpretation cognitive bias change: a systematic review and meta-analysis of bias modification paradigms.","volume":"157","author":"A Martinelli","year":"2022","journal-title":"Behav Res Ther."},{"key":"ref-23","doi-asserted-by":"publisher","first-page":"249-274","DOI":"10.1146\/annurev-clinpsy-050212-185631","article-title":"Social anxiety and social anxiety disorder.","volume":"9","author":"A Morrison","year":"2013","journal-title":"Annu Rev Clin Psychol."},{"key":"ref-24","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2021.102459","article-title":"Disentangling the mediating role of modifying interpretation bias on emotional distress using a novel Cognitive Bias Modification program.","volume":"83","author":"I Nieto","year":"2021","journal-title":"J Anxiety Disord."},{"key":"ref-26","article-title":"NMA: Network Meta-Analysis based on multivariate meta-analysis models","author":"H Noma","year":"2024"},{"key":"ref-27","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.","volume":"372","author":"M Page","year":"2021a","journal-title":"BMJ."},{"key":"ref-28","article-title":"Risk Of Bias due to Missing Evidence (ROB-ME): a new tool for assessing risk of non-reporting biases in evidence syntheses","author":"M Page","year":"2021b"},{"key":"ref-29","doi-asserted-by":"publisher","first-page":"1179-1189","DOI":"10.1080\/14737175.2019.1666713","article-title":"Therapeutic strategies for social anxiety disorder: where are we now?","volume":"19","author":"A Pelissolo","year":"2019","journal-title":"Expert Rev Neurother."},{"key":"ref-55","doi-asserted-by":"publisher","first-page":"991-6","DOI":"10.1016\/j.jclinepi.2007.11.010","article-title":"Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry.","volume":"61","author":"J Peters","year":"2008","journal-title":"J Clin Epidemiol."},{"key":"ref-30","doi-asserted-by":"publisher","first-page":"37-49","DOI":"10.1016\/j.cpr.2016.09.009","article-title":"Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias.","volume":"50","author":"R Price","year":"2016","journal-title":"Clin Psychol Rev."},{"key":"ref-31","doi-asserted-by":"publisher","first-page":"212-218","DOI":"10.1016\/j.jad.2013.09.013","article-title":"Optimizing the ingredients for imagery-based interpretation bias modification for depressed mood: is self-generation more effective than imagination alone?","volume":"152\u2013154","author":"H Rohrbacher","year":"2014","journal-title":"J Affect Disord."},{"key":"ref-32","doi-asserted-by":"publisher","first-page":"80-97","DOI":"10.1002\/jrsm.1037","article-title":"Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool.","volume":"3","author":"G Salanti","year":"2012","journal-title":"Res Synth Methods."},{"key":"ref-33","doi-asserted-by":"publisher","first-page":"163-171","DOI":"10.1016\/j.jclinepi.2010.03.016","article-title":"Graphical methods and numerical summaries for presenting results from Multiple-Treatment Meta-analysis: an overview and tutorial.","volume":"64","author":"G Salanti","year":"2011","journal-title":"J Clin Epidemiol."},{"key":"ref-34","doi-asserted-by":"publisher","first-page":"59-66","DOI":"10.1017\/S1352465809990543","article-title":"How does Cognitive Bias Modification affect anxiety? Mediation analyses and experimental data.","volume":"38","author":"E Salemink","year":"2010","journal-title":"Behav Cogn Psychother."},{"key":"ref-56","doi-asserted-by":"publisher","first-page":"40","DOI":"10.12688\/wellcomeopenres.20701.2","article-title":"Towards an ontology of mental health: protocol for developing an ontology to structure and integrate evidence regarding anxiety, depression and psychosis [version 2; peer review: 1 approved, 3 approved with reservations].","volume":"9","author":"P Schenk","year":"2024","journal-title":"Wellcome Open Res."},{"key":"ref-50","doi-asserted-by":"publisher","first-page":"5-14","DOI":"10.1037\/a0013643","article-title":"Attention training for generalized social anxiety disorder.","volume":"118","author":"N Schmidt","year":"2009","journal-title":"J Abnorm Psychol."},{"key":"ref-57","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s13643-021-01880-6","article-title":"Machine learning reduced workload for the cochrane COVID-19 study register: development and evaluation of the cochrane COVID-19 study classifier.","volume":"11","author":"I Shemilt","year":"2022","journal-title":"Syst Rev."},{"key":"ref-51","doi-asserted-by":"publisher","first-page":"97-129","DOI":"10.1002\/9781119756194.ch6","article-title":"Searching for and selecting studies.","author":"R Spijker","year":"2023"},{"key":"ref-36","doi-asserted-by":"publisher","first-page":"1606-1613","DOI":"10.1176\/appi.ajp.157.10.1606","article-title":"Disability and quality of life in social phobia: epidemiologic findings.","volume":"157","author":"M Stein","year":"2000","journal-title":"Am J Psychiatry."},{"key":"ref-38","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials.","volume":"366","author":"J Sterne","year":"2019","journal-title":"BMJ."},{"key":"ref-37","doi-asserted-by":"publisher","first-page":"48-54","DOI":"10.1080\/16506070902980737","article-title":"Why is the self important in understanding and treating social phobia?","volume":"38","author":"L Stopa","year":"2009","journal-title":"Cogn Behav Ther."},{"key":"ref-39","doi-asserted-by":"publisher","first-page":"2431-2445","DOI":"10.1001\/jama.2022.22744","article-title":"Anxiety disorders: a review.","volume":"328","author":"K Szuhany","year":"2022","journal-title":"JAMA."},{"key":"ref-40","article-title":"EPPI-Reviewer: advanced software for systematic reviews, maps and evidence synthesis.","author":"J Thomas","year":"2020"},{"key":"ref-52","doi-asserted-by":"publisher","first-page":"538-548","DOI":"10.1017\/S1352465814000149","article-title":"A multi-session attribution modification program for children with aggressive behaviour: changes in attributions, emotional reaction estimates, and self-reported aggression.","volume":"43","author":"S Vassilopoulos","year":"2015","journal-title":"Behav Cogn Psychother."},{"key":"ref-41","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2024.104557","article-title":"Towards implementation of Cognitive Bias Modification in mental health care: state of the science, best practices, and ways forward.","volume":"179","author":"J Vrijsen","year":"2024","journal-title":"Behav Res Ther."},{"key":"ref-42","article-title":"ICD-11 Clinical Descriptions and Diagnostic guidelines for mental and behavioural disorders.","year":"2021"},{"key":"ref-43","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-016-0677-2","article-title":"A review of scales to measure social anxiety disorder in clinical and epidemiological studies.","volume":"18","author":"Q Wong","year":"2016","journal-title":"Curr Psychiatry Rep."}],"container-title":["Wellcome Open 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.25657.r110655, David M. Clark, University of Oxford, Oxford, 09 Dec 2024, version 1, 2 approved with reservations","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-657\/v1#referee-response-110655","order":0,"name":"referee-response-110655","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Jaycee Kennett<\/b>; \n<i>Posted: 13 May 2025<\/i>; We thank Professor Clark for his valuable feedback. We present responses and details of revisions below. &nbsp; Cognitive bias modification is a field that is somewhat controversial due to several failures to replicate beneficial effects of various cognitive bias interventions on social anxiety.  A comprehensive meta-analysis could potentially provide clarity. The proposed meta-analysis has many strengths including: 1) looking separately at studies with people who have a diagnosis of social anxiety disorder (SAD) and those who score high on relevant scales without necessarily being diagnosed and 2) breaking down the diverse category of cognitive bias modification into potentially more informative subcategories. It is suggested the study will be a &quot;living review&quot; with new literature searches conducted every three months and analyses being repeated when new studies become available, I could not find any justification for the every three months feature. Is this really a field where so many studies are being conducted that a re-analysis has to be done every three months? Wouldn't a repeat after 12 months be adequate? Also is it feasible to run complex procedures like a network meta-analysis every 3 months? Repeating searches for new studies at this interval is standard practice for the GALENOS project. We are using additional resources such as machine learning and crowdsourcing for screening to aid this. The analysis will only be re-run when there is sufficient data and the review will only be updated when the author team decided that there is sufficient new evidence that is likely to change our findings. We are working with EPPI-Reviewer to automate the process of adding new data into our network meta-analysis, including automated updating of the results in R markdown format. More information has been added to the manuscript: &nbsp; \n<i>\u201cWe will also investigate the use of machine learning (including large language models) for automating some of the study selection (and possibly data extraction, should technology advance sufficiently) tasks once the review is in living mode. We will do this by testing and training prompts to enable a large language model (GPT-4o) to correctly identify relevant and irrelevant studies. We will do this in EPPI-reviewer in a similar way to Shermilt, Noel-Storr, and Thomas et al (2022) and will soon publish a paper on our training of the model on a separate LSR. The code will be open source and the data will be put on the Open Science Framework.&nbsp; Where we can demonstrate that we can save manual effort without compromising the reliability of the review, we will use these new technologies to make our overall workflows more efficient and use a workflow from EPPI-reviewer to our analysis presentation in R markdown to aid this. In addition to this, future iterations may be supported via crowdsourcing the screening of titles and abstracts in a similar way to Noel-Stoor, Dooley, Elliot et al (2021).\u201d<\/i> (p21) There are some other aspects of the design that can be questioned.  1)&nbsp;Cognitive bias interventions will be divided into 7 sub-categories. How are these sub-categories defined and how will the investigators check that they have allocated a study to the correct sub-category? &nbsp;Will they share their category definitions with the authors of included studies and check with the authors that the type of intervention in their study has been correctly identified? This a major current issue with meta-analytic teams are often being criticised for their classification of interventions and a lack of transparency about the process. &nbsp; \n<b>Response:&nbsp;<\/b>The interventions mentioned in table 3 are ones we expect to find, but do not constitute specific pre-defined sub categories. The manuscript has been changed to make this clearer: \n<i>\u201cWe have specified a list of CBM interventions that we expect will form nodes in the NMA based on previous reviews (see table 3).\u201d<\/i> (p17) We will categorise interventions that will form nodes in the NMA with an adjudication meeting with content experts and methodologists after the data has been collected but before data has been analysed. This has also been made clearer in the manuscript. If disagreements persist among the research team this will be highlighted in the final review and sensitivity analyses will be conducted to explore these differences and will be published. &nbsp; \n<i>\u201cWhen important uncertainty or disagreement persist among the research team, we will decide on the primary model, before we conduct the meta-analyses and use the remaining models as sensitivity analyses. Where disagreement persists, we will highlight this in the final review.\u201d <\/i>(p18)  \n<i>2) Selection of outcome measures. There is likely to be considerable variation in the measures of social anxiety used in different studies. I am not convinced that the authors' way of dealing with this is optimal. Instead of the priority list that they propose, one might take an average of &nbsp;standardised scores on all appropriately validated measures of social anxiety.&nbsp;<\/i> &nbsp; \n<b>Response:&nbsp;<\/b>We have proposed utilising a pre-specified hierarchy to avoid selective outcome reporting. Creating a composite of standardised scores presumes a correlation between the scales of at least 0.5, which we believe we cannot confidently assume, demonstrated by the results of Le Blanc et al., (2014). We also believe that the differences in the aspects of social anxiety measured by the various subscales of each measure (as in some cases only subscales may be reported) and the lack of standardisation in the elements each measure seeks to examine would present a conceptual difficulty in creating a composite score. We will clearly report our decisions- the following has been added to the manuscript: \n<i>\u201cFor the primary outcomes (social anxiety symptom severity) we will publish a list of all measures that data was extracted for and rationale for prioritising each measure that will be included in the analyses.\u201d <\/i>(p14)  3) Several important aspects of trial design aren't mentioned and so may not be taken into account. Nowadays it is generally agreed that the design of a trial (including the proposed primary outcome measures and analytic procedures) should be pre-registered. I could not see evidence that this crucial variable will be taken into account.&nbsp; \n<b>Response:&nbsp;<\/b>We have specified that we will use the Risk of Bias 2 (RoB2) tool to assess risk of bias in the included studies. Section 5.1 of RoB2 asks \u201c\n<i>Were the data that produced this result analysed in accordance with a pre-specified analysis plan that was finalized before unblinded outcome data were available for analysis?\u201d <\/i>As such, whether a trial had a pre-registered design will be assessed during the risk of bias appraisal and the results of each risk of bias domain will be included in the final manuscript.  4) Comparison with other active psychological therapies. There are a number of well-validated psychological therapies for SAD that are in widespread use. If the review is to change clinical practice it will need to also look at how various forms of CBM compare with existing properly specified alternatives. This doesn't seem to be included in the scope (lumping all alternatives together as TAU is not acceptable) \n<b>Response:&nbsp;<\/b>The lumping of control treatments in the initial pairwise meta-analysis detailed in the manuscript is an introductory step to establish the effects of CBM for social anxiety per se, following this additional analysis, further differentiation of the effects of CBM subtypes will be undertaken via network meta-analysis. The main focus of the review will be the network meta-analysis which compares the direct and indirect evidence for subtypes of CBM verses other subtypes and specific controls (not lumped together as TAU). This has been made clearer in the manuscript: \u201cThe lumping of control treatments in this initial pairwise meta-analysis detailed is an introductory step to establish the effects of CBM for social anxiety per se. Following this additional analysis, further differentiation of the effects of CBM subtypes will be undertaken via network meta-analysis. The main focus of the review will be the network meta-analysis which compares the direct and indirect evidence for subtypes of CBM verses other subtypes and specific control.\u201d (p16) &nbsp; We have decided to focus on the effects of CBM subtypes on social anxiety compared to other CBM subtypes and exclude other psychological therapies (e.g. CBT) as we are initially seeking to establish whether CBM subtypes have any significant effects on social anxiety and their relative effectiveness. However, in future iterations we plan to expand the scope of the living systematic review to compare CBM verses a greater number of psychological therapies in order to inform clinical practice. This has been made clearer in the manuscript: \n<i>\u201cWhere disagreement persists, we will highlight this in the final review. This iteration of the LSR aims to establish whether CBM subtypes have significant effects on social anxiety and their relative effectiveness. However in future iterations we plan to expand the scope of the living systematic review to compare CBM verses a greater number of psychological therapies in order to inform clinical practice.\u201d <\/i>(p17)","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-657\/v2#referee-comment-6123","order":1,"name":"referee-comment-6123","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.26799.r124066, Kate Clauss, VA Portland Healthcare System, Portland, Oregon, 03 Jun 2025, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-657\/v2#referee-response-124066","order":2,"name":"referee-response-124066","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.26799.r124418, Yujia Peng, Peking University, Beijing, 09 Jun 2025, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-657\/v2#referee-response-124418","order":3,"name":"referee-response-124418","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"We are funded by Wellcome, a global charitable foundation. 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"}]}}