{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T02:02:14Z","timestamp":1772244134203,"version":"3.50.1"},"update-to":[{"DOI":"10.3310\/nihropenres.13384.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T00:00:00Z","timestamp":1707091200000}}],"reference-count":25,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T00:00:00Z","timestamp":1707091200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/open-government-licence\/version\/3\/"}],"funder":[{"DOI":"10.13039\/501100009130","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["NIHR202952"],"award-info":[{"award-number":["NIHR202952"]}],"id":[{"id":"10.13039\/501100009130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["openresearch.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["NIHR Open Res"],"abstract":"<ns3:p>Background Gastrointestinal symptoms in cystic fibrosis (CF) are common and intrusive to daily life. Relieving gastrointestinal symptoms was identified as an important research priority and previously explored in an international survey in 2018. However, following the widespread introduction of cystic fibrosis transmembrane conductance regulator (CFTR) modulators in 2019, the landscape of CF treatment has changed. We repeated an online survey to further describe gastrointestinal symptoms and their effect on quality of life (QoL) in the CFTR modulator era. Methods An electronic survey consisting of closed questions and free text responses was distributed via social media and professional networks for a period of one month between March - April 2022. People with CF (pwCF), their family and friends, and healthcare professionals (HCPs) were invited to take part. Results There were 164 respondents: 88 pwCF (54%), 22 (13%) family, and 54 (33%) healthcare professionals (HCPs). A total of 89\/110 (81%) pwCF or family members reported CFTR modulator treatment. The most commonly reported symptoms were wind \/ gas and rumbling stomach noises (borborygmi) in both the modulator and non-modulator groups in addition to loose motions (modulator group) and bloating (no modulator group). Abdominal pain and bloating had the greatest impact on QoL. For those on a CFTR modulator, the proportion of pwCF reporting \u201cno change\u201d or \u201cworse\u201d for all of the symptoms surveyed was greater than the proportion reporting an improvement. For some symptoms such as stomach pains and reduced appetite, improvements were perceived more commonly in HCPs than what was reported by pwCF. Following modulator introduction, dietary changes to manage GI symptoms were recommended by 28\/35 (80%) of HCPs and reported by 38\/76 (50%) lay respondents. Changes in medication were recommended by 19\/35 (54%) HCPs and reported by 44\/76 (58%) of patients and family members. Conclusion This survey has shown that gastrointestinal symptoms remain prevalent in pwCF in the CFTR modulator era, though the nature of these symptoms may have changed. A better understanding of the underlying pathophysiology of these symptoms is essential. Future clinical studies should focus on improving symptoms and QoL.<\/ns3:p>","DOI":"10.3310\/nihropenres.13384.2","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T07:05:06Z","timestamp":1707116706000},"page":"18","update-policy":"https:\/\/doi.org\/10.3310\/nihropenres.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A grumbling concern: A survey of gastrointestinal symptoms in cystic fibrosis in the modulator era"],"prefix":"10.3310","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3676-2712","authenticated-orcid":false,"given":"Rebecca J","family":"Calthorpe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Goodchild","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vigilius","family":"Gleetus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinishaa","family":"Premakumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bu","family":"Hayee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoe","family":"Elliott","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bethinn","family":"Evans","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1105-3645","authenticated-orcid":false,"given":"Nicola J","family":"Rowbotham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0580-2478","authenticated-orcid":false,"given":"Siobh\u00e1n B","family":"Carr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4388-2563","authenticated-orcid":false,"given":"Helen","family":"Barr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Horsley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Peckham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5494-5438","authenticated-orcid":false,"given":"Alan R","family":"Smyth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2024,2,5]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"1809-19","DOI":"10.1056\/NEJMoa1908639","article-title":"Elexacaftor-Tezacaftor-Ivacaftor for Cystic Fibrosis with a Single Phe508del Allele.","volume":"381","author":"P Middleton","year":"2019","journal-title":"N Engl J Med."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"419-28","DOI":"10.1007\/s40271-019-00361-2","article-title":"Validity and Reliability of a Novel Multimodal Questionnaire for the Assessment of Abdominal Symptoms in People with Cystic Fibrosis (CFAbd-Score).","volume":"12","author":"A Jaudszus","year":"2019","journal-title":"Patient."},{"key":"ref-3","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2020-000614","article-title":"How can we relieve gastrointestinal symptoms in people with cystic fibrosis? 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(Commentary).","volume":"20 Suppl 3","author":"R Calthorpe","year":"2021","journal-title":"J Cyst Fibros."}],"container-title":["NIHR Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T09:25:09Z","timestamp":1715851509000},"score":1,"resource":{"primary":{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,5]]},"references-count":25,"URL":"https:\/\/doi.org\/10.3310\/nihropenres.13384.2","relation":{"has-review":[{"id-type":"doi","id":"10.3310\/nihropenres.14664.r31165","asserted-by":"subject"},{"id-type":"doi","id":"10.3310\/nihropenres.14664.r31165","asserted-by":"object"}]},"ISSN":["2633-4402"],"issn-type":[{"value":"2633-4402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,5]]},"assertion":[{"value":"Indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.3310\/nihropenres.14515.r29317, Dhiren Patel, Saint Louis University, St. Louis, Missouri, 12 Jul 2023, version 1, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v1#referee-response-29317","order":0,"name":"referee-response-29317","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alan Smyth<\/b>; \n<i>Posted: 19 Nov 2023<\/i>; \n<u>General comments: <\/u> Comment. Although it is named as international survey, the majority of responders were from UK. This could have been an issue with the distribution. I certainly have not seen this survey making its way to me in USA and I am part of the DIGEST group in USA. Having said that, this has been done in USA and authors cite that reference in the manuscript. I don't think its a big issue but I would suggest to specify this as a limitation\u201d \u2013  Response. Thank you, this was noted in the results section that the majority of respondents were from the UK. This has been added as a limitation as advised. The word international has also been removed from the text.  \n<u>Abstract: <\/u> Comment. Consider replacing \u201crumbling stomach noises\u201d with borborygmi\u201d  Response. This has been included in brackets for clarification in the abstract and main body of the text.&nbsp;  Comment. \u201cLoose motions (modulator) and bloating (no modulator)&quot; \u2013 does this mean loose motion is the most commonly reported in patients on modulator etc?\u201d  Response. Wind\/ gas and borborygmi were the most commonly reported symptoms in both groups, loose motions were also commonly reported in those on a modulator and bloating in those not receiving modulator therapy. The abstract has been updated to clarify this.  \n<u>Page 3:<\/u> Comment. Correct spelling of \u201clicencing\u201d  Response. This has been updated to licensing  Comment. \u201cprior to the licensing of the newest and most widely used modulator ETI\u201d \u2013 no comma needed.  Response. Thank you, this has been updated.  Comment. Resources in [ ] are great, but seem out of place as just a link here. Perhaps consider keeping them as a reference and then putting together a list of the hyperlinks at the end\u201d &nbsp; Response. Thank you for this comment. The journal referencing style requires weblinks and URLs to be included as hyperlinks in the body of the text rather than at the end of the article as a reference and so these have not been amended in the manuscript.  Comment. \u201c5th paragraph, first sentence, consider condensing this sentence\u201d  Response. This has been addressed and split into two sentences.  Comment. \u201c5th paragraph, last sentence, add a source\u201d  Response. Reference added by Costa et al detailing the eligibility and licencing of the different modulators in the EU and US.  Comment. \u201c6th paragraph: consider changing less well to not as well\u201d  Response. Thank you, this has been updated.  Comment. 7th paragraph: Spell out JLA the first time you use it\u201d  Response. Thank you. This is written out in full when it is first used in paragraph 2 of the introduction.  Comment. Keep references consistent  Response. The journal referencing style requires weblinks and URLs to be included as hyperlinks in the body of the text rather than at the end of the article as a reference and so these have not been amended in the manuscript.  \n<u>Page 4:<\/u> Comment. 1st paragraph: PSP?  Response. This stands for priority settling partnership. This is written out in full the first time it is used in paragraph 2 of the introduction.  Comment. 2nd paragraph: consider changing patient community to CF community  Response. This has now been updated from \u201cpatient\u201d to \u201cCF\u201d community.  Comment. At the end of this paragraph, the reference style is not consistent with other references.  Response. This is in line with the journal requirements for referencing webpages and URLs.  \n<u>Page 5:<\/u> Comment. First paragraph \u2013 your point regarding artificially increasing words is a good point.  Response. Thank you for this feedback.  Comment. Table 1: what does \u201cOther\u201d vs \u201cUnknown\u201d entail?\u201d  Response. Other denotes other healthcare professionals from specific disciplines or researchers. Due to the number of responses being less than 5 we were unable to detail these any further to maintain anonymity. \u201cUnknown\u201d refers to those HCPs who did not record what role or discipline they belonged to.&nbsp;  \n<u>Page 6:<\/u> Comment. Figure 1: clarify what is in other vs none of the above\u201d  Response. This has been clarified in the legend of figure 1.  None of above: pwCF did not have one of the 5 listed gastrointestinal complications in the question (meconium ileus, pancreatic insufficiency, DIOS, CF related liver disease or CF related diabetes).  Other: free text response for other GI related complications not listed in the question.  \n<u>Page 7:<\/u> Comment. Figure 3 \u2013 interesting discrepancy between HCP vs PwCF reports of changes in symptoms\u201d  Response. Thank you for your insight here, this observation has now also been included in the abstract and discussion sections.  \n<u>Page 8:<\/u> Comment. Paragraph 6 \u2013 last line \u2013 what sort of changes to advice did they give  Response. This included promotion of a healthy diet, reducing calories and fats, and promoting exercise. These are detailed in the following paragraph after this sentence.","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v2#referee-comment-3286","order":1,"name":"referee-comment-3286","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.14515.r29764, Mette Frahm Olsen, University of Copenhagen, Copenhagen, 10 Aug 2023, version 1, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v1#referee-response-29764","order":2,"name":"referee-response-29764","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alan Smyth<\/b>; \n<i>Posted: 19 Nov 2023<\/i>; \n<u>General comments:<\/u> Comment. It seems a bit of a stretch to call this \u201can international survey\u201d as it was only in English and mainly promoted on UK platforms. The large majority of respondents (85%) were from the UK and the rest mainly from North America. It leaves about 10 respondents from other European countries. \u201c&lt;5% rest of world\u201d is mentioned but other categories sum to 100%. I would suggest toning down that it was international (from title etc). If it was a main aim, the survey should have been planned differently to better represent the international CF community\u201d \u2013  Response. Thank you for this comment, we have removed international as you suggested given the large representation from the UK.  Comment. No direct comparisons were possible, but data suggest that GI symptoms persist after introduction of CFTRm. However, a main issue with the study is selection bias as people self-select to answer a survey about GI symptoms, i.e. issues are likely to be overrepresented and potential improvement could be overlooked. Selection bias is mentioned in study limitations, but not the risk of not detection improvements, e.g. if those with resolved symptoms are less likely to answer the survey\u201d.  Response. This is a valid comment and this has now been reflected in paragraph 1 of the limitations section in the discussion.  \n<u>Abstract:<\/u> Comment. Changes in dietary intake and medication are reported. It is later mentioned that these are with the intention of managing GI symptoms. Please add this information to the abstract\u201d \u2013  Response. This has been added as requested  \n<u>Introduction:<\/u> Comment. You argue that \u201cThese results will inform the development of a CF-specific gastrointestinal patient reported outcome measure for people with CF that can be used in clinical trials.\u201d But as mentioned just above, several CF-specific tools exist. Please clarify how the new tool will be different from the currently available tools? (e.g. Mainz et al. CFAbd score, Quittner et al. GI symptom tracker) and why there is a need for more PROMs?  Response. Thank you for this comment. The CF-specific gastrointestinal PROM, which we are developing (CFTummyTracker), is designed for daily use, with an emphasis on the burden caused by GI symptoms. It would compliment the findings of the GI symptom tracker and CFAbd Score which have a longer recall period of one and two weeks respectively.  \n<u>Results:<\/u> Comment. The results are partly based on qualitative data from free-text fields in survey. Please indicate how much data this is based on, e.g. how many respondents used this option and how much text did they provide?  Response. There were multiple free text comments available within the survey asking people to expand on their answers to the quantitative data if they would like to, which were not mandatory. Each free text comment gave a varying number of responses as well as length of the free text comments. For example, questions which a respondent selected \u201cother, please specify\u201d were &lt;5 responses, whereas free text asking the year in which a modulator was started had 84 free text responses. Therefore, we have chosen to include the following sentence explaining this rather than provide individual number of responses per question.&nbsp; \u201cSimilarly, the number of free text responses and the amount of detail provided varied greatly between respondents.\u201d This has been added to paragraph 1 of the results section.  Comment. There are 167 participants in the study, but the denominator is much lower for many variables. Was modulator treatment only known for 110? And only 103 provided responses for GI symptoms? Please clarify and mention in study limitations if this is the case.  Response. Thank you for this comment. All questions were optional for a participant to complete and so not every participant completed every question available to them and therefore the denominator for each question is included in the results. This has been clarified in the first paragraph of the results section and has been added as a limitation as suggested.  Comment. Fig 2. Symptoms by modulator status. Based on 2022 data? Or also 2018 data? Not clear. If only 2022, no modulator data is based on 20 participants? Number of participants should be included in the figure or figure legend\u201d  Response. Thank you for this comment. The denominators have been added to figure 2a and 2c and the legend for figure 2b for clarification.  Comment. Fig 3. HCP seem to overestimate the effects of modulators on GI symptoms. But this could be due to selection bias among CF patients &gt; HCP.\u201d  Response. A paragraph has been added to the discussion section (paragraph 3) to reflect this. &nbsp; \n<u>Discussion:<\/u> Comment. It is not the same respondents or questions in the 2018 vs 2022 surveys, which makes a comparison difficult. Authors do mention this limitation, but I think it would be reasonable to add that longitudinal studies are needed to assess prevalence and changes in GI symptoms in CF.  Response. This has now been addressed in paragraph two of the discussion.","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v2#referee-comment-3287","order":3,"name":"referee-comment-3287","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.14664.r31165, Drucy Borowitz, University at Buffalo, Buffalo, New York, 01 Mar 2024, version 2, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v2#referee-response-31165","order":4,"name":"referee-response-31165","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.14515.r29758, Dana Albon, UVA, Virginia, 10 Aug 2023, version 1, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v1#referee-response-29758","order":5,"name":"referee-response-29758","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alan Smyth<\/b>; \n<i>Posted: 19 Nov 2023<\/i>; I recommend minor revisions to the manuscript.  Comment. Under results, I recommend for the authors to review the numbers again; they do not add and from line to line they differ. Example: for PwCF 89\/110 were prescribed a modulator, however the ETI was reported in 73\/84. If 89 were prescribed a modulator, the reported ETI use would need to be 73\/89 and not 84. There are several discrepancies like this. Please also review the demographics table; same discrepancies are seen in the table; PwCF are listed at 88 and not 89. Similar discrepancies exist throughout the results.  Response. Thank you for this comment. The data have been reviewed as advised. The discrepancies above were related to the questions not being mandatory and so not all participants answered every available question to them. We have opted to include the denominator as those who answered a particular question, as described in paragraph 1 of the results section, in line with our previous published research. The text in the results section has also been improved to clarify the discrepancies in the number of pwCF, for example 110 people related to the number of lay people (pwCF or a parent\/relative) who answered this question, as some parents completed this survey on behalf of their child.","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v2#referee-comment-3289","order":6,"name":"referee-comment-3289","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.14515.r29560, Barbara Ruaro, University Hospital of Cattinara, Trieste, 01 Sep 2023, version 1, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v1#referee-response-29560","order":7,"name":"referee-response-29560","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alan Smyth<\/b>; \n<i>Posted: 19 Nov 2023<\/i>; This is an interesting paper. The manuscript is quite well written. I have few suggestion:  \n<u>Introduction:<\/u>  Comment.  \u201cCystic fibrosis (CF) is an autosomal recessive, life-limiting condition affecting approximately 100,000 people worldwide, caused by mutations to the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein1&quot;  Please improve this paragraph and some references. Please, add some information regarding the different aspects of Cystic fibrosis. I suggest: Combined use of rheology and portable low-field NMR in cystic fibrosis patients. Respir Med. 2021;189:106623. doi:10.1016\/j.rmed.2021.106623 &nbsp; Prevalence and Impact of Rheumatologic Pain in Cystic Fibrosis Adult Patients. Front Med (Lausanne). 2022;8:804892. Published 2022 Feb 8. doi:10.3389\/fmed.2021.804892  Response.  Thank you for suggesting these references. The first suggested reference describes the use of low-field NMR to measure the physical properties of respiratory tract secretions in CF. As such, it is not relevant to the current paper which reports the perception of gut symptoms by people with CF. The second proposed citation is a paper on rheumatological pain \u2013 again this is not relevant to a paper on gut symptoms. We have not added these citations.  Comment.  \n<u>Statistical analyses: <\/u> Please, add some information regarding the statistical analyses. The Authors need to add some information on statistical tests used to analysed the data and better clarify the value of the results.  Response.  The results section includes descriptive statistics only. The methods used are described in the section on \u201cData analysis\u201d.  \n<u>Discussion:<\/u>  Comment.  This survey confirms that pwCF frequently experience gastrointestinal symptoms with the most common symptoms being similar to those described in our 2018 survey3. These symptoms can affect quality of life for pwCF through disrupting school, work and social events and lead to feelings of embarrassment or self-consciousness. Although for some people gastrointestinal symptoms have improved, most noticeably for symptoms of pain, bloating and loose motions, overall, the proportion of respondents reporting \u201cno change\u201d or \u201cworse\u201d symptoms in each category of this survey, was greater than the proportion reporting an improvement after starting modulators.&quot;  Improve the summary of the most important study results. Please, add some information regarding the most important statistically significant&nbsp; study results  Response.  As notes above this paper presents descriptive statistics only and statistical tests of significance have not been applied.  Conclusion:  Comment.  &quot;This survey highlights that gastrointestinal symptoms still remain prevalent in the CFTR modulator era in pwCF. A better understanding of the underlying pathophysiology of these symptoms is essential in order to improve gastrointestinal symptoms for pwCF. Future clinical studies into gastrointestinal symptoms should focus on understanding and improving both the symptomatology and quality of life for pwCF.&quot;  Underline the novelty of the study and the possible clinical implications.  Response.  Thank you for this suggestion. We believe the conclusion makes an appropriate comparison with the findings of our previously published survey. The implications are primarily for research rather than clinical practice.","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/3-18\/v2#referee-comment-3290","order":8,"name":"referee-comment-3290","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This project is funded by the National Institute for Health and Care Research (NIHR) under its Programme Development Grant (Grant Reference Number: NIHR202952). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":9,"name":"grant-information","label":"Grant Information"},{"value":"This open access work is licensed under the Open Government Licence v3.0.","order":0,"name":"copyright-info","label":"Copyright"}]}}