{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T03:41:28Z","timestamp":1789011688193,"version":"build-2803163510"},"reference-count":65,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,31]],"date-time":"2021-08-31T00:00:00Z","timestamp":1630368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Treatment Action Group","award":["No award number"],"award-info":[{"award-number":["No award number"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nThe GeneXpert diagnostic platform from the US based company Cepheid is an automated molecular diagnostic device that performs sample preparation and pathogen detection within a single cartridge-based assay. GeneXpert devices can enable diagnosis at the district level without the need for fully equipped clinical laboratories, are simple to use, and offer rapid results. Due to these characteristics, the platform is now widely used in low- and middle-income countries for diagnosis of diseases such as TB and HIV. Assays for SARS-CoV-2 are also being rolled out. We aimed to quantify public sector investments in the development of the GeneXpert platform and Cepheid\u2019s suite of cartridge-based assays.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nPublic funding data were collected from the proprietor company\u2019s financial filings, grant databases, review of historical literature concerning key laboratories and researchers, and contacting key public sector entities involved in the technology\u2019s development. The value of research and development (R&D) tax credits was estimated based on financial filings.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nTotal public investments in the development of the GeneXpert technology were estimated to be $252 million, including >$11 million in funding for work in public laboratories leading to the first commercial product, $56 million in grants from the National Institutes of Health, $73 million from other U.S. government departments, $67 million in R&D tax credits, $38 million in funding from non-profit and philanthropic organizations, and $9.6 million in small business \u2018springboard\u2019 grants.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nThe public sector has invested over $250 million in the development of both the underlying technologies and the GeneXpert diagnostic platform and assays, and has made additional investments in rolling out the technology in countries with high burdens of TB. The key role played by the public sector in R&D and roll-out stands in contrast to the lack of public sector ability to secure affordable pricing and maintenance agreements.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0256883","type":"journal-article","created":{"date-parts":[[2021,8,31]],"date-time":"2021-08-31T18:01:31Z","timestamp":1630432891000},"page":"e0256883","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":30,"title":["Public investments in the development of GeneXpert molecular diagnostic technology"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0359-1259","authenticated-orcid":true,"given":"Dzintars","family":"Gotham","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4703-0835","authenticated-orcid":true,"given":"Lindsay","family":"McKenna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1501-5355","authenticated-orcid":true,"given":"Stijn","family":"Deborggraeve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suraj","family":"Madoori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5368-9874","authenticated-orcid":true,"given":"David","family":"Branigan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,8,31]]},"reference":[{"key":"pone.0256883.ref001","unstructured":"World Health Organization. Xpert MTB\/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children. 2013.https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/112472\/9789241506335_eng.pdf (accessed 1 Dec 2020)."},{"key":"pone.0256883.ref002","unstructured":"World Health Organization. WHO consolidated guidelines on tuberculosis. Module 3: diagnosis\u2014rapid diagnostics for tuberculosis detection. 2020.https:\/\/www.who.int\/publications\/i\/item\/who-consolidated-guidelines-on-tuberculosis-module-3-diagnosis\u2014rapid-diagnostics-for-tuberculosis-detection"},{"key":"pone.0256883.ref003","unstructured":"World Health Organization. Automated Real-time Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB\/RIF SystemPolicy Statement. 2011.https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/44586\/9789241501545_eng.pdf?sequence=1 (accessed 14 Oct 2020)."},{"key":"pone.0256883.ref004","unstructured":"World Health Organization. WHO meeting report of a technical expert consultation: non-inferiority analysis of Xpert MTB\/RIF Ultra compared to Xpert MTB\/RIF. 2017.https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/254792\/WHOHTM-TB-2017.04-eng.pdf?sequence=1"},{"key":"pone.0256883.ref005","unstructured":"World Health Organization. Update on the use of nucleic acid amplification tests to detect TB and drug-resistant TB: rapid communication. 2021.https:\/\/www.who.int\/publications\/i\/item\/update-on-the-use-of-nucleic-acid-amplification-tests-to-detect-tb-and-drug-resistant-tb-rapid-communication (accessed 17 Feb 2021)."},{"key":"pone.0256883.ref006","unstructured":"World Health Organization. Public notice: Nucleic acid amplification tests to detect TB and DR-TB, WHO headquarters, Geneva, Switzerland 7\u201318 December 2020. https:\/\/cdn.who.int\/media\/docs\/default-source\/hq-tuberculosis\/public-notice-v2.pdf?sfvrsn=68648922_5"},{"key":"pone.0256883.ref007","unstructured":"Cepheid. Tests. https:\/\/www.cepheid.com\/en\/tests (accessed 18 Oct 2020)."},{"key":"pone.0256883.ref008","doi-asserted-by":"crossref","first-page":"35","DOI":"10.12688\/gatesopenres.12842.1","article-title":"Market penetration of Xpert MTB\/RIF in high tuberculosis burden countries: A trend analysis from 2014\u20132016 [version 2; peer review: 4 approved]","volume":"2","author":"D Cazabon","year":"2018","journal-title":"Gates Open Research"},{"key":"pone.0256883.ref009","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1016\/S2214-109X(19)30559-5","article-title":"Point-of-care HPV molecular diagnostics for a test-and-treat model in high-risk HIV populations","volume":"8","author":"S Sayed","year":"2020","journal-title":"The Lancet Global Health"},{"key":"pone.0256883.ref010","doi-asserted-by":"crossref","first-page":"e0173948","DOI":"10.1371\/journal.pone.0173948","article-title":"Diagnostic accuracy of two multiplex real-time polymerase chain reaction assays for the diagnosis of meningitis in children in a resource-limited setting","volume":"12","author":"J Khumalo","year":"2017","journal-title":"PLOS ONE"},{"key":"pone.0256883.ref011","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1111\/liv.14315","article-title":"In-field evaluation of Xpert\u00ae HCV viral load Fingerstick assay in people who inject drugs in Tanzania","volume":"40","author":"Z Mohamed","year":"2020","journal-title":"Liver International"},{"key":"pone.0256883.ref012","unstructured":"United States Public Health Service. United States Public Health Service Technology Transfer Policy Manual. Chapter 300: PHS Licensing Policy. 2010.https:\/\/www.ott.nih.gov\/sites\/default\/files\/documents\/policy\/pdfs\/300-policy.pdf"},{"key":"pone.0256883.ref013","doi-asserted-by":"crossref","first-page":"e0239118","DOI":"10.1371\/journal.pone.0239118","article-title":"Public investments in the clinical development of bedaquiline","volume":"15","author":"D Gotham","year":"2020","journal-title":"PLOS ONE"},{"key":"pone.0256883.ref014","volume-title":"The entrepreneurial state: debunking public vs. private sector myths","author":"M Mazzucato","year":"2018"},{"key":"pone.0256883.ref015","unstructured":"Global Justice Now, STOPAIDS. Pills and profits: How drug companies make a killing out of public research. https:\/\/stopaids.org.uk\/wp\/wp-content\/uploads\/2017\/10\/Pills-and-profits-report-WEB-002.pdf (accessed 18 Oct 2020)."},{"key":"pone.0256883.ref016","doi-asserted-by":"crossref","first-page":"lsz019","DOI":"10.1093\/jlb\/lsz019","article-title":"From discovery to delivery: public sector development of the r VSV-ZEBOV Ebola vaccine","volume":"7","author":"M Herder","year":"2020","journal-title":"Journal of Law and the Biosciences"},{"key":"pone.0256883.ref017","unstructured":"World Bank. Inflation, GDP deflator (annual %). https:\/\/data.worldbank.org\/indicator\/NY.GDP.DEFL.KD.ZG (accessed 11 Dec 2018)."},{"key":"pone.0256883.ref018","unstructured":"Treatment Action Group. TB Research Funding Trends. https:\/\/www.treatmentactiongroup.org\/resources\/tbrd-report\/ (accessed 26 Oct 2020)."},{"key":"pone.0256883.ref019","unstructured":"World Health Organization. Rapid implementation of the Xpert MTB\/RIF diagnostic test: Technical and Operational \u2018How-to\u2019, Practical considerations. 2011.https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/44593\/9789241501569_eng.pdf?sequence=1 (accessed 19 Oct 2020)."},{"key":"pone.0256883.ref020","unstructured":"Public Citizen. GeneXpert Patent Landscape. 2014.https:\/\/www.citizen.org\/article\/genexpert-patent-landscape\/ (accessed 20 Jan 2021)."},{"key":"pone.0256883.ref021","first-page":"924","article-title":"DNA Amplification in a Microfabricated Reaction Chamber","author":"MA Northrup","year":"1993","journal-title":"Transducers"},{"key":"pone.0256883.ref022","unstructured":"MA Northrup, C Gonzalez, D Hadley, et al. A MEMS-Based Miniature DNA Analysis System. https:\/\/www.osti.gov\/servlets\/purl\/71671 (accessed 6 Oct 2020)."},{"key":"pone.0256883.ref023","unstructured":"MA Northrup, RP Mariella Jr, AV Carrano, et al. Silicon-based sleeve devices for chemical reactions."},{"key":"pone.0256883.ref024","unstructured":"US Department of Energy. DOE this Month. 1995: Year of dramatic change. 1996.https:\/\/books.google.co.uk\/books?id=MgDafWleDKMC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false"},{"key":"pone.0256883.ref025","first-page":"22","volume-title":"LLNL Center for Microtechnology: capabilities, customers, case study\u2014HANAA (Handheld Nucleic Acid Analyzer)","author":"RP Mariella","year":"2003"},{"key":"pone.0256883.ref026","unstructured":"Lawrence Livermore National Laboratory. 65 Years of Excellence. https:\/\/www.llnl.gov\/sites\/www\/files\/llnl_65th_anniversary_book.pdf (accessed 6 Oct 2020)."},{"key":"pone.0256883.ref027","unstructured":"Cepheid. Form 10-K. Annual Report Pursuant To Section 13 Or 15(D) Of The Securities Exchange Act Of 1934 For The Fiscal Year Ended December 31, 2000. 2001.https:\/\/www.sec.gov\/Archives\/edgar\/data\/1037760\/000109581101001831\/f70633e10-k405.txt"},{"key":"pone.0256883.ref028","unstructured":"Kurt Petersen. MEMS Start-ups in Silicon Valley. 2018.http:\/\/site.ieee.org\/scv-mems\/files\/2018\/08\/Kurt_Petersen-SFBA-MEMS-Final.pdf (accessed 7 Oct 2020)."},{"key":"pone.0256883.ref029","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1126\/science.294.5545.1266","article-title":"ANTHRAX: Biodefense Hampered by Inadequate Tests","volume":"294","author":"M Enserink","year":"2001","journal-title":"Science"},{"key":"pone.0256883.ref030","unstructured":"Cepheid. Form 10-K. Annual Report Pursuant To Section 13 Or 15(D) Of The Securities Exchange Act Of 1934 For The Fiscal Year Ended December 31, 2006. 2006.https:\/\/www.sec.gov\/Archives\/edgar\/data\/1037760\/000095013407005786\/f28285e10vk.htm"},{"key":"pone.0256883.ref031","unstructured":"Cepheid. Form 10-K. Annual Report Pursuant To Section 13 Or 15(D) Of The Securities Exchange Act Of 1934 For The Fiscal Year Ended December 31, 2007. 2007.https:\/\/www.sec.gov\/Archives\/edgar\/data\/1037760\/000095013408003850\/f38496e10vk.htm"},{"key":"pone.0256883.ref032","unstructured":"GenomeWeb. Danaher Q2 Revenues Spike 19 Percent. 2020.https:\/\/www.genomeweb.com\/business-news\/danaher-q2-revenues-spike-19-percent#.YBoEttNKjUI (accessed 5 Feb 2021)."},{"key":"pone.0256883.ref033","unstructured":"Northrup Consulting Group. Awards and Funding Sources. http:\/\/northrupconsultinggroup.com\/awards.html (accessed 27 Sep 2020)."},{"key":"pone.0256883.ref034","unstructured":"Department of Defense. DoD Grant Awards. https:\/\/dodgrantawards.dtic.mil\/grants\/#\/home (accessed 20 Oct 2020)."},{"key":"pone.0256883.ref035","unstructured":"People\u2019s Health Movement, Medact, Health Action International, et al. D5: Health and global security: reasons for concern. In: Global Health Watch 3. Zed Books Ltd. https:\/\/www.ghwatch.org\/sites\/www.ghwatch.org\/files\/D5_0.pdf (accessed 27 Oct 2020)."},{"key":"pone.0256883.ref036","unstructured":"USAspending.gov. https:\/\/www.usaspending.gov\/ (accessed 21 Jan 2021)."},{"key":"pone.0256883.ref037","doi-asserted-by":"crossref","DOI":"10.1126\/scitranslmed.3008194","article-title":"Neglected Diseases, Delinquent Diagnostics","volume":"6","author":"M Kessel","year":"2014","journal-title":"Science Translational Medicine"},{"key":"pone.0256883.ref038","unstructured":"Policy Cures Research. G-FINDER 2020: Landscape of emerging infectious disease research and development: Preventing the next pandemic. 2020.https:\/\/s3-ap-southeast-2.amazonaws.com\/policy-cures-website-assets\/app\/uploads\/2020\/09\/16021708\/EID20_Report_Web_1_FINAL.pdf (accessed 27 Oct 2020)."},{"key":"pone.0256883.ref039","unstructured":"Cepheid. Cepheid Receives Emergency Use Authorization from FDA for Rapid SARS-CoV-2 Test. 2020.http:\/\/cepheid.mediaroom.com\/2020-03-21-Cepheid-Receives-Emergency-Use-Authorization-from-FDA-for-Rapid-SARS-CoV-2-Test (accessed 27 Oct 2020)."},{"key":"pone.0256883.ref040","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/978-3-642-29526-3_3","volume-title":"Intellectual Property Issues","author":"U Storz","year":"2012"},{"key":"pone.0256883.ref041","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1111\/j.1467-9566.2011.01411.x","article-title":"A molecular monopoly? HPV testing, the Pap smear and the molecularisation of cervical cancer screening in the USA: Molecularisation of cancer screening in the USA","volume":"34","author":"S Hogarth","year":"2012","journal-title":"Sociology of Health & Illness"},{"key":"pone.0256883.ref042","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1126\/science.291.5507.1195","article-title":"A History of the Human Genome Project","volume":"291","year":"2001","journal-title":"Science"},{"key":"pone.0256883.ref043","unstructured":"Shahzad M, Nguyen T-Y, Veras J, et al. Adoption of Global Access Licensing at Universities and Public Research Institutions. Universities Allied for Essential Medicines 2016. http:\/\/www.unsgaccessmeds.org\/inbox\/2016\/2\/29\/universities-allied-for-essential-medicines-uaem"},{"key":"pone.0256883.ref044","unstructured":"Cepheid. Cepheid Xpert MTB\/RIF Communication September 2011. https:\/\/www.tbonline.info\/media\/uploads\/documents\/cepheid_xpert_mtb-rif_communication_september_2011.pdf (accessed 20 Jan 2021)."},{"key":"pone.0256883.ref045","unstructured":"Unitaid. Mid-term evaluation of the TBXpert project. 2015.https:\/\/unitaid.org\/assets\/Mid-term-evaluation-TBXpert-Innovative-diagnostics-for-multi-drug-resistant-tuberculosis-MDR-TB.pdf (accessed 19 Oct 2020)."},{"key":"pone.0256883.ref046","unstructured":"UNITAID end-of-project evaluation: TB GeneXpert\u2013Scaling up access to contemporary diagnostics for TB. 2017.https:\/\/unitaid.org\/assets\/TB-Xpert-Evaluation_Report-_Final.pdf (accessed 26 Nov 2020)."},{"key":"pone.0256883.ref047","unstructured":"Cambridge Consultants, M\u00e9decins Sans Fronti\u00e8res. Cost of goods and manufacturing analysis of GeneXpert cartridges. https:\/\/msfaccess.org\/sites\/default\/files\/2019-12\/2018%20COGS%20analysis%20of%20Xpert%20MTB_RIF%20Ultra%20cartridges.pdf (accessed 8 Feb 2021)."},{"key":"pone.0256883.ref048","doi-asserted-by":"crossref","first-page":"551","DOI":"10.9745\/GHSP-D-19-00244","article-title":"Realizing the \u201c40 by 2022\u201d Commitment From the United Nations High-Level Meeting on the Fight to End Tuberculosis: What Will It Take to Meet Rapid Diagnostic Testing Needs?","volume":"7","author":"AS Piatek","year":"2019","journal-title":"Glob Health Sci Pract"},{"key":"pone.0256883.ref049","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.ijid.2020.03.078","article-title":"Cost-effectiveness analysis of Xpert in detecting Mycobacterium tuberculosis: A systematic review","volume":"95","author":"X Hao","year":"2020","journal-title":"International Journal of Infectious Diseases"},{"key":"pone.0256883.ref050","unstructured":"FIND. Negotiated prices. https:\/\/www.finddx.org\/pricing\/genexpert\/ (accessed 25 Oct 2020)."},{"key":"pone.0256883.ref051","unstructured":"Treatment Action Group. Advancing Access through Market Interventions: Lessons Learned from the GeneXpert Tuberculosis Test Buy-down. 2020.https:\/\/www.treatmentactiongroup.org\/wp-content\/uploads\/2020\/09\/tag_geneXpert_lessons_learned_brief_final.pdf (accessed 26 Oct 2020)."},{"key":"pone.0256883.ref052","unstructured":"M\u00e9decins Sans Fronti\u00e8res. Time for $5: GeneXpert diagnostic tests. 2019.https:\/\/msfaccess.org\/time-for-5 (accessed 19 Oct 2020)."},{"key":"pone.0256883.ref053","unstructured":"World Health Organization. Roadmap for rolling out Xpert MTB\/RIF for rapid diagnosis of TB and MDR-TB. 2010.https:\/\/www.who.int\/tb\/laboratory\/roadmap_xpert_mtb-rif.pdf (accessed 19 Oct 2020)."},{"key":"pone.0256883.ref054","unstructured":"Jean de Dieu Iragena. Decade of field experience with TB GeneXpert. 2019.http:\/\/programme.ias2019.org\/PAGMaterial\/PPT\/1822_4690\/Decade%20of%20field%20experience%20with%20TB%20GeneXpert_%20IAS%20Mexico%20by%20JI%2022July2019.pptx (accessed 5 Dec 2020)."},{"key":"pone.0256883.ref055","unstructured":"Cepheid. Form 10-K. Annual Report Pursuant To Section 13 Or 15(D) Of The Securities Exchange Act Of 1934 For The Fiscal Year Ended December 31, 2014. 2014.https:\/\/www.sec.gov\/Archives\/edgar\/data\/1037760\/000119312515065981\/d852874d10k.htm"},{"key":"pone.0256883.ref056","unstructured":"U.S. Department of Defense. Contracts For April 29, 2020. https:\/\/www.defense.gov\/Newsroom\/Contracts\/Contract\/Article\/2170148\/ (accessed 18 Oct 2020)."},{"key":"pone.0256883.ref057","unstructured":"U.S. Department of Defense. Contracts For April 24, 2020. https:\/\/www.defense.gov\/Newsroom\/Contracts\/Contract\/Article\/2164680\/ (accessed 18 Oct 2020)."},{"key":"pone.0256883.ref058","unstructured":"U.S. Department of Defense. Contracts For April 10, 2020. https:\/\/www.defense.gov\/Newsroom\/Contracts\/Contract\/Article\/2146301\/ (accessed 18 Oct 2020)."},{"key":"pone.0256883.ref059","unstructured":"Personal communication with Jeffrey DiVietro, Acting Deputy Director, Technology Partnerships Office, National Institute of Standards and Technology. 2020."},{"key":"pone.0256883.ref060","unstructured":"U.S. Department of Health & Human Services. HHS, DoD collaborate with Cepheid on rapid diagnostics to detect coronavirus infections. https:\/\/medicalcountermeasures.gov\/newsroom\/2020\/cepheid-diagnostic\/ (accessed 22 Oct 2020)."},{"key":"pone.0256883.ref061","unstructured":"World Health Assembly. WHA72.8 Improving the transparency of markets for medicines, vaccines, and other health products. 2019.https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA72\/A72_R8-en.pdf (accessed 24 May 2021)."},{"key":"pone.0256883.ref062","unstructured":"European Alliance for Responsible R&D and Affordable Medicines. Public interest should be at the core of the future European Partnership on Innovative Health, say 43 organisations. 2019.https:\/\/medicinesalliance.eu\/letterhealthpartnership2019\/ (accessed 3 May 2021)."},{"key":"pone.0256883.ref063","unstructured":"Consultative Expert Working Group on Research and Development: Financing and Coordination. Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination. 2012. http:\/\/www.who.int\/phi\/CEWG_Report_5_April_2012.pdf"},{"key":"pone.0256883.ref064","unstructured":"John R Thomas. March-In Rights Under the Bayh-Dole Act. Congressional Research Service. 2016.https:\/\/fas.org\/sgp\/crs\/misc\/R44597.pdf (accessed 4 May 2021)."},{"key":"pone.0256883.ref065","unstructured":"David Lewis, Allison Martell. Donors bet a U.S. firm could transform disease testing in Africa. Then COVID-19 hit. Reuters. 2021.https:\/\/www.reuters.com\/investigates\/special-report\/health-coronavirus-africa-cepheid\/ (accessed 29 May 2021)."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0256883","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,31]],"date-time":"2021-08-31T18:02:47Z","timestamp":1630432967000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0256883"}},"subtitle":[],"editor":[{"given":"Susan","family":"Horton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,8,31]]},"references-count":65,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0256883","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,31]]}}}