PEER REVIEW HISTORY ARTICLE DETAILS TITLE (PROVISIONAL)

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1 PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form ( and are provided with free text boxes to elaborate on their assessment. These free text comments are reproduced below. ARTICLE DETAILS TITLE (PROVISIONAL) AUTHORS Climate Change and Human Health: What Are The Research Trends? A scoping review protocol Herlihy, Niamh; Bar-Hen, Avner; Verner, Glenn; Fischer, Helen; Sauerborn, Rainer; Depoux, Anneliese; Flahault, Antoine; Schutte, Stefanie VERSION 1 - REVIEW REVIEWER REVIEW RETURNED Ander Wilson Harvard T.H. Chan School of Public Health 03-Apr-2016 GENERAL COMMENTS The authors propose a systematic review of the literature on the effects on climate change on human health. The review will cover a 25 year period ( ) and will result in a journal article (review paper) and an newly constructed searchable database. This article outlines the plans for conducting such a review. Overall, the authors lay out a nice vision for a review. I would surely read the final review article that they produce and think it is timely. Below are my specific comments and concerns. 1) I have trouble understanding how the authors can identify research gaps without assessing the quality of the publications. Gaps may be not yet researched areas or areas where the existing research is inadequate (for any number of reasons including quality). This appears to me a major limitation of the proposed approach. 2) The table numbering is incorrect. For example, the first table referenced in the text is Table 4 (page 4, 5th line of text). Also, Table 4 (appearing on page 6) does not contain the information that is being referenced in the text. Similarly, Table 1 is referenced on page 5 sections on Search Strategy and appears to describe the information contained in Table 3. These errors appear throughout. In addition, not all tables are referenced in the text. 3) The search terms in Table 3 do not match the search strategy syntax in Table 4. For example, morbidity appears only in Table 4. Please clarify these differences. 4) While I agree that such a review is a good idea, the manuscript would be strengthened if they authors better clarify why this review is needed, particularly in light of the IPCC reports and the other reviews referenced. 5) The authors plan to make a searchable database of the articles they identified. We have Google Scholar, PubMed, Web of Science, and a seemingly overwhelming supply of search tools. What value does this additional database provide? Particularly, when the articles are not curated for quality. Why is this new database better than the existing tools and why is it needed? 6) It would like to know more about the data extraction method. In

2 particularly, it would be helpful to share how R will be used to extract the information and how it will be checked. REVIEWER REVIEW RETURNED Chris Degeling School of Public Health, University of Sydney, Australia 08-Apr-2016 GENERAL COMMENTS I think the protocol is well constructed and should yield some valuable results, especially if the proposed database come into being. Because this is a research protocol rather than a research report I would have expected there to be further discussion about the conceptualization, strengths and limitations of scoping review methodologies, especially how they differ in content and analytic value from other systematic review methods. Consequently the paper presents a compelling case for why such a review is needed - but does little to engage with methodological issues about how the evidence will be produced and how it can and should be interpreted. Arksey and O'Malley is a key paper but other teams such as those lead by Duadt and Pham have dome much to further the discussion around the promise and pit falls of scoping methodologies - I suggest that a paragraph in the introduction on the nature and uses of scoping reviews would be of benefit to the article. I also wonder about the relationship between the proposed review and the previous ones described on page 4 from line 17. Will this be used as resources for search strings and bibliography searches or will the proposed study re-invent the wheel. I also wonder if limiting the MeSH termsto "Communicable disease" for impacts related to infectious diseases to might miss papers that are relevant to the scoping study. There is no description of test searches that assures me that this will not be the case. Otherwise I think this is a valuable contribution that if amended to adresse these issues warrants publication. REVIEWER REVIEW RETURNED Jamie Hosking The University of Auckland New Zealand 26-Apr-2016 GENERAL COMMENTS General comments Overall, I think this protocol forms the basis for a review that will be potentially very valuable. I applaud the authors for publishing a protocol in advance of their review. I wonder, is it possible to register a scoping review? My main concern which the authors may be able to address is about the scope and feasibility of this review. It could be useful to report the initial number of citations identified by their draft search strategies as an indicator of the feasibility of the review as it currently stands. The authors have provided useful tables setting out the data items they will use to categorise the studies. These tables illustrate how broad this area can be. One possible way to conceptualise the topic

3 of health impacts of climate change is as follows: climate change -> intermediary factors -> health. Table 6 provides many examples of intermediary factors such as floods, droughts and air pollution. I wondered whether the authors plan to include only studies that explicitly linked the exposure variable climate change to the outcome variable health. Or, do the authors plan to also include studies of the effect of intermediary factors on health (even if climate change is not an explicit exposure variable)? I suspect such a review which might need to include all studies of the association between air pollution, for example, and health would be too large to be feasible. Alternatively, the authors may have devised a different scope. I think the protocol should be more explicit about this aspect of the scope of the review. Specific comments Abstract, line 9: suggest removing the gender-specific term manmade ; anthropogenic would be an alternative, if desired. Table 1, lines 16-18: this sentence appears to be incomplete Page 3, lines 48-9: I think this sentence should be re-written as it implies that all uncertainty about the health impacts of climate change can potentially be removed Page 3, line 54: does it refer to climate change or information/communication? Page 4, line 8: I did not understand the reference to table 4 Table 4: it would be helpful to format this search strategy hierarchically to make it easier to read Table 5, line 27: I do not think the exclusion criterion about search terms is necessary Table 5, line 28: suggest changing and to and/or Page 8, line 14: I am surprised that the authors propose using the AMSTAR checklist, which is designed for studies that review systematic reviews. I would expect this study to identify mostly papers that are not systematic reviews. I am not aware of a checklist that is ideal for scoping reviews, but I would have thought that PRISMA would be more useful than AMSTAR in this instance. Table 6: this table identifies health outcomes as a data item that will be extracted from included studies. Will the authors only categorise the health outcome that was addressed by the study, or will they also extract information on study results (e.g. effect measures)? The latter may not be feasible (especially given the multiple eligible types of papers), but I think that it should be explicitly stated whether or not study results will be extracted (and if so, how). Page 9, line 48 refers to successful strategies, which could be interpreted to mean that the success of studies will be assessed in this review either way, this statement should be consistent. Contribution statement: I note that two authors state that they wrote the first draft of the paper; perhaps one should say they contributed to the first draft

4 VERSION 1 AUTHOR RESPONSE Reviewer: 1 Reviewer Name Ander Wilson Institution and Country Harvard T.H. Chan School of Public Health Please state any competing interests or state None declared : None declared Please leave your comments for the authors below The authors propose a systematic review of the literature on the effects on climate change on human health. The review will cover a 25 year period ( ) and will result in a journal article (review paper) and a newly constructed searchable database. This article outlines the plans for conducting such a review. Overall, the authors lay out a nice vision for a review. I would surely read the final review article that they produce and think it is timely. Below are my specific comments and concerns. 1) I have trouble understanding how the authors can identify research gaps without assessing the quality of the publications. Gaps may be not yet researched areas or areas where the existing research is inadequate (for any number of reasons including quality). This appears to me a major limitation of the proposed approach. Response: It is true that without analysis of quality it is difficult to provide assessment of definitive research gaps. We have, therefore adjusted our methods slightly to be clearer that our analysis will be based more so around the volume of literature published on certain topics and to highlight those areas where more or less research has been carried out. In the absence of quality data, it is still relevant to see where funding has been directed for research and where there is a lack of funding based on the volume of articles covering a particular topic. It may also be of interest to researchers to explore areas where there is a gap in peer reviewed literature. 2) The table numbering is incorrect. For example, the first table referenced in the text is Table 4 (page 4, 5th line of text). Also, Table 4 (appearing on page 6) does not contain the information that is being referenced in the text. Similarly, Table 1 is referenced on page 5 sections on Search Strategy and appears to describe the information contained in Table 3. These errors appear throughout. In addition, not all tables are referenced in the text. Response: Thank you for pointing out this error. The reference to Table 4 on page 5 has been removed as it was not relevant. We have removed the Table tab from the Strengths and Weaknesses box (as seen in other protocols published in the BMJ Open protocol style) and have renumbered the rest of the tables. We have edited the references to tables in the text to match the content of the renumbered tables and have inserted references to tables that were not previously referenced in the text. 3) The search terms in Table 3 do not match the search strategy syntax in Table 4. For example, morbidity appears only in Table 4. Please clarify these differences. Response: This was an error on the writer s part which we have now corrected. Morbidity and NCD have been added to the health related search terms in Table 3 (now Table 2 following table renumbering) 4) While I agree that such a review is a good idea, the manuscript would be strengthened if they

5 authors better clarify why this review is needed, particularly in light of the IPCC reports and the other reviews referenced. Response: The IPCC reports gather data from the previous 6-7 years prior to each iteration with each report covering a different time period. Other reports also analyses data over a relatively short period of time or are selective in terms of what aspect of health is addressed. Aside from the time period covered, the IPPC and other reports cover analysis of research content. With this review, we aim to present an extensive overview of the trends in scientific literature over a 25 year period but will not explore in detail the research content. We also have very broad criteria for inclusion of the human health impacts on climate change. 5) The authors plan to make a searchable database of the articles they identified. We have Google Scholar, PubMed, Web of Science, and a seemingly overwhelming supply of search tools. What value does this additional database provide? Particularly, when the articles are not curated for quality. Why is this new database better than the existing tools and why is it needed? Response: The database will be screened and articles selected to match the specific topic of Climate Change and Health studies which is not the case for Google Scholar. In the case of PubMed and Web of Science, even with refined search syntax, there are still large numbers of irrelevant articles. The database will save researchers much time they would themselves have to spend screening. It will also be part of a Climate Change and Health Resource that will be available on the Centre Virchow Villermé's website. This study of the academic literature is one axe of a larger overall study on the communication of climate change and health. Other axes include reviews of national legislation and the media to better understand the role of the health argument for Climate Change. The Climate Change and Health Resource will also contain links to MOOCs that have been produced by the CVV on the topic and other related MOOCs produced elsewhere. So overall, the database will serve to compliment the other information resources across different disciplines. 6) I would like to know more about the data extraction method. In particularly, it would be helpful to share how R will be used to extract the information and how it will be checked. Response: PubMed has an API that allows data extraction. Moreover there is a dedicated library in R to extract and manipulate the data which can also be used for articles from the Web of Science database. All programs will be provided to allow for reproducible analysis Reviewer: 2 Reviewer Name Chris Degeling Institution and Country School of Public Health, University of Sydney, Australia Please state any competing interests or state None declared : None declared Please leave your comments for the authors below 1. I think the protocol is well constructed and should yield some valuable results, especially if the proposed database come into being. Because this is a research protocol rather than a research report I would have expected there to be further discussion about the conceptualization, strengths and limitations of scoping review methodologies, especially how they differ in content and analytic value from other systematic review methods. Consequently the paper presents a compelling case for why such a review is needed - but does little to engage with methodological issues about how the

6 evidence will be produced and how it can and should be interpreted. Arksey and O'Malley is a key paper but other teams such as those lead by Duadt and Pham have done much to further the discussion around the promise and pit falls of scoping methodologies - I suggest that a paragraph in the introduction on the nature and uses of scoping reviews would be of benefit to the article. Response: We have reviewed your various points and have added an additional paragraph about the scoping review methodology into the methods section to address the issues you have raised. The inserted section reads as the following: Scoping review methodology Scoping reviews are a relatively recent method to review evidence based research particularly in health but also used in other disciplines (16). There is no single definition of what a scoping review is. A frequently applied definition is that from Arskey and O Malley which states that the aim of a scoping review is to map rapidly the key concepts underpinning a research area and the main sources and types of evidence available (17).This scoping review framework developed by Arskey and O Malley in 2005 will be applied for this study. There have been a number of studies since 2005 which enhance the initial framework and have advanced our understanding of this methodology and how to produce a more efficient and effective study (16, 18, 19) The key strength of the scoping review method as applied to our study is that it allows for the analysis of a broad research question. Climate change and health is a vast area of research and our intention is to map the breadth of the literature on this topic. The quality of the literature will not be assessed which is a limitation of scoping reviews. Systematic reviews, which have more refined research questions and narrower study parameters, generally result in fewer, more homogenous citations which can be more efficiently assessed for quality. The large volume of diverse citations anticipated from our literature search will be compiled into a catalogued database. Reflecting on the experience of others and in the absence of official guidelines for scoping reviews, we will proceed with implementing the initial framework and gleaning insights from the follow up studies to guide us in developing this study. 2. I also wonder about the relationship between the proposed review and the previous ones described on page 4 from line 17. Will this be used as resources for search strings and bibliography searches or will the proposed study re-invent the wheel. Response: The study you refer to described on Page 4 from line 10 by Hoskings et al is a scoping review on the theme of climate change and health which we considered to be the most similar study we identified to our own. In describing briefly this study we wish to recognise what is available in the current literature on this topic and to distinguish our study and its value relevant to that most similar to our own. The database will be screened and articles selected to fit the specific topic of Climate Change and Health studies which is not the case for Google Scholar and even with PubMed and Web of Science with refined search syntax, there are still large numbers of irrelevant articles. The database will save researchers much time they would themselves have to spend screening. It will also be part of a Climate Change and Health Resource that will be available on the Centre Virchow Villermé's website. This study of the academic literature is one axe of a larger overall study on the communication of climate change and health. Other axes include reviews of national legislation and the media to better understand the role of the health argument for Climate Change. The Climate Change and Health Resource will also contain links to MOOCs that have been produced by the CVV on the topic and other related MOOCs produced elsewhere. So overall, the database will serve to compliment the other information resources across different disciplines. 3. I also wonder if limiting the MeSH terms to "Communicable disease" for impacts related to infectious diseases to might miss papers that are relevant to the scoping study. There is no description of test searches that assures me that this will not be the case. Response: We spent much time in choosing and testing search terms in order to have the most

7 relevant results. The term "infectious disease" was one of our tested terms which did not affect the results. It is not a MeSH term in PubMed. However for the purpose of clarification, we have compared the current search syntax and one which includes "infectious disease" [All Fields] in PubMed. The current syntax results in 5280 results (01/06/2016) and the insertion of the infectious disease term also produced 5280 results. The same comparison was carried out in Web of Science. Current search syntax 3436 (01/06/2016) and adding the term "infectious disease" does not change the result. It seems that the term does not affect the results. Having completed one full screening with the second screening underway we are confident with the high volume of articles addressing infectious diseases (dengue, malaria etc) that the search terms have captured the relevant articles for both infectious and communicable diseases. We have however noted an error in the syntax for PubMed. Lifestyle and Communicable are not MeSh terms. This was corrected in developing the search but the older incorrect syntax was copied into the text of the article. The result remains the same as before. A large number of test searches took place and are not documented in the article as it would take quite a lot of the word count. We are also following a structure in the article similar to that of other scoping review protocols which do not describe test searches either. Total number of articles from our final search terms was over 7269 (duplicates removed) which we think should be sufficient to provide robust results. 4. Otherwise I think this is a valuable contribution that if amended to address these issues warrants publication. We thank the reviewer for this positive and encouraging estimation. Reviewer: 3 Herlihy et al 2016 review 26 Apr 2016 Reviewer: Jamie Hosking General comments 1. Overall, I think this protocol forms the basis for a review that will be potentially very valuable. I applaud the authors for publishing a protocol in advance of their review. I wonder, is it possible to register a scoping review? Response: Thank you for your positive words. We are unsure what you mean by "register" a scoping review. If by "register" you mean publish, the answer is yes. The BMJ Open are welcoming the submission of study protocols, and it is a very constructive method to receive feedback prior to submitting the completed study for publication. There are a significant number of scoping reviews published and some scoping review protocols which we have studied and learned from. 2. My main concern which the authors may be able to address is about the scope and feasibility of this review. It could be useful to report the initial number of citations identified by their draft search strategies as an indicator of the feasibility of the review as it currently stands. Response: The search has resulted in 7292 citations following the removal of duplicates. One full screening of these articles has been completed and resulted in 3750 included articles. The second screening is being undertaken currently so we do not wish to present preliminary results as this may change when the second screening is complete. We will however, insert a flow chart of results in the final article when the screening has been complete. Following the large number of articles identified in

8 the first screening we have removed Table 5 as we do not think that it will be feasible to address all indicators given the volume of articles. We will however present and adjusted table for the final article. 3. The authors have provided useful tables setting out the data items they will use to categorise the studies. These tables illustrate how broad this area can be. One possible way to conceptualise the topic of health impacts of climate change is as follows: climate change -> intermediary factors -> health. Response: This is a helpful comment thank you. We will consider this point for the later full article with the completed research when all the screening is complete, and when we have a better understanding of the literature. However, for the moment we do not consider this a critical aspect to outline the protocol for this scoping review. 4. Table 6 provides many examples of intermediary factors such as floods, droughts and air pollution. I wondered whether the authors plan to include only studies that explicitly linked the exposure variable climate change to the outcome variable health. Or, do the authors plan to also include studies of the effect of intermediary factors on health (even if climate change is not an explicit exposure variable)? I suspect such a review which might need to include all studies of the association between air pollution, for example, and health would be too large to be feasible. Alternatively, the authors may have devised a different scope. I think the protocol should be more explicit about this aspect of the scope of the review. Response: We plan to explicitly screen the title and abstract of articles which capture climate change (represented by one of the selected climate terms) exposure and its effect on human health (represented by the selected health terms) as the outcome variable. Specific comments 5. Abstract, line 9: suggest removing the gender-specific term man-made ; anthropogenic would be an alternative, if desired. Response: We agree and have changed it in the text. For 28 years, the Intergovernmental Panel on Climate Change (IPCC) has been assessing the potential risks associated with anthropogenic climate change. 6. Table 1, lines 16-18: this sentence appears to be incomplete Response: Thank you yes, they were incomplete and have been edited to complete the phrases Study strengths and limitations - The review will cover a comprehensive time frame of 25 years. - Publications not restricted to any particular study type, geographical region or human health issue. - Findings will be systematically categorized and input into a searchable database. - The review will cover two data bases focusing on English language results. - Grey literature will not be included in the literature search but will include comments or opinion views published in peer-reviewed journal. - The quality of publications captured will not be assessed. 7. Page 3, lines 48-9: I think this sentence should be re-written as it implies that all uncertainty about the health impacts of climate change can potentially be removed Response: You are correct, thank you. The wording has been rephrased to address this issue. Clear information and communication about the health consequences are a critical factor to remove some of this uncertainty. This may also assist in elevating the importance of climate change to ensure that it is a high priority which receives sufficient commitment both financially and politically. 8. Page 3, line 54: does it refer to climate change or information/communication? Response: "It" refers to climate change. The text was altered to ensure clarity.

9 Climate change presents an enormous governance challenge, with a need for greater new integrated governance structures at national and international levels. 9. Page 4, line 8: I did not understand the reference to table 4 Response: We have removed this reference as it was incorrectly placed. The 2014 IPCC report outlines the direct impact from extreme weather and indirect impacts through ecosystem mediated effects and human system mediated effects. 10. Table 4: it would be helpful to format this search strategy hierarchically to make it easier to read Response: Thank you for this insight. We have based this presentation style on our learnings from other scoping review protocols which do not tend to present search terms in hierarchical format. We consider that the table of key terms above the presented search syntax is sufficient for this protocol. For some studies we have observed the search syntax is presented in an Annex with only the key terms being presented in a table in the text or embedded within the text. 11. Table 5, line 27: I do not think the exclusion criterion about search terms is necessary Response: We agree and have removed it from the text. Inclusion Criteria Peer-reviewed articles (including original quantitative and qualitative studies, systematic reviews, editorials, viewpoints) Indexed in PubMed and/or Web of Science Databases Published between 1990 and 2015 Focus on climate change and human health Publications in English only No restriction to country or population Exclusion Criteria Book chapters and grey literature (dissertations, conference proceedings, reports etc.) 12. Table 5, line 28: suggest changing and to and/or Response: This is a useful suggestion, thank you. The text has been edited accordingly. 13. Page 8, line 14: I am surprised that the authors propose using the AMSTAR checklist, which is designed for studies that review systematic reviews. I would expect this study to identify mostly papers that are not systematic reviews. I am not aware of a checklist that is ideal for scoping reviews, but I would have thought that PRISMA would be more useful than AMSTAR in this instance. Response: We have reflected on this useful observation and made contact with BMJ open to ask if they have guidelines for Scoping Reviews as they have for other types of research articles. They are in the process of developing such guidelines. As you correctly point out the majority of papers will not be systematic reviews and at this point we do not plan to assess neither the quality nor presence of bias in the articles, so we have removed the explicit reference both the AMSTAR and PRISMA assessment methods from the article as neither are matching the study methods. We will present a flow chart similar to that of a PRISMA flow for the selection of articles in the final article once analysis has been complete. 14. Table 6: this table identifies health outcomes as a data item that will be extracted from included studies. Will the authors only categorise the health outcome that was addressed by the study, or will they also extract information on study results (e.g. effect measures)? The latter may not be feasible (especially given the multiple eligible types of papers), but I think that it should be explicitly stated whether or not study results will be extracted (and if so, how). Response: We will only categorise the health outcomes addressed in the study, not those in the study results. As you correctly point it would not be feasible to categorise based on study results and we have adjusted the text to clarify this point.

10 15. Page 9, line 48 refers to successful strategies, which could be interpreted to mean that the success of studies will be assessed in this review either way, this statement should be consistent. Response: Agreed, this statement is misleading, and we have removed it from the text. We will provide a summary of the research that has been done up to 2015 which can be useful to avoid repetition of failed climate mitigation or adaptation strategies relating to human health. 16. Contribution statement: I note that two authors state that they wrote the first draft of the paper; perhaps one should say they contributed to the first draft Response: We agree and changed the wording in the text accordingly. SS designed the study design, initiated data collection and contributed to the first draft of the paper. VERSION 2 REVIEW REVIEWER REVIEW RETURNED Chris Degeling Centre for Values, Ethics and the Law in Medicine, School of Public health, University of Sydney, Australia 17-Jul-2016 GENERAL COMMENTS The authors have addressed my concerns and I am happy for the paper to proceed to publication. REVIEWER REVIEW RETURNED Jamie Hosking The University of Auckland, New Zealand 27-Jul-2016 GENERAL COMMENTS Thank you for the opportunity to review this revised paper. Overall, I think the authors have appropriately responded to reviewer comments and the paper should be accepted for publication once a few minor issues have been clarified. I have commented on some minor issues below. Systematic review protocols can be registered with PROSPERO ( to improve review quality and avoid duplication. Is it possible to register this review? p14, line 19: The author s name is misspelt p16, line 11, homogenous : This should more properly be homogeneous. p16, line 14, we will proceed with implementing the initial framework and gleaning insights from follow up studies : I didn t understand this phrase. What is the initial framework? Which follow-up studies? Please clarify. p20, line 27, compliment : This should be complement.

11 VERSION 2 AUTHOR RESPONSE Reviewer: 2 Reviewer Name Chris Degeling Institution and Country Centre for Values, Ethics and the Law in Medicine, School of Public health, University of Sydney, Australia Please state any competing interests or state None declared : None declared Please leave your comments for the authors below The authors have addressed my concerns and I am happy for the paper to proceed to publication. Response: Thank you for taking the time to review the paper and for your positive support for publication. Reviewer: 3 Reviewer Name Jamie Hosking Institution and Country The University of Auckland, New Zealand Please state any competing interests or state None declared : None declared Please leave your comments for the authors below Thank you for the opportunity to review this revised paper. Overall, I think the authors have appropriately responded to reviewer comments and the paper should be accepted for publication once a few minor issues have been clarified. I have commented on some minor issues below. Response: Thank you for taking the time to review the paper and for your positive support for publication. Systematic review protocols can be registered with PROSPERO ( to improve review quality and avoid duplication. Is it possible to register this review? Response: Thank you for clarifying this from your previous comment. I have looked up the PROSPERO registration but as indicated on the web site Scoping reviews and literature reviews are not eligible for inclusion in PROSPERO. It is only for systematic reviews it seems for now. Below is the link to the webpage where this information can be found. p14, line 19: The author s name is misspelt Response: Thank you. This has been edited in the text with track changes to the correct spelling -

12 Hosking p16, line 11, homogenous : This should more properly be homogeneous. Response: Thank you. This has been corrected in the text with track changes to homogeneous p16, line 14, we will proceed with implementing the initial framework and gleaning insights from follow up studies : I didn t understand this phrase. What is the initial framework? Which follow-up studies? Please clarify. Response: In order to clarify the uncertainty in the text it has been rephrased to read: Reflecting on the experience of others and in the absence of official guidelines for scoping reviews, we will proceed with implementing the initial framework by Arskey and O Malley and glean insights from the proceeding studies aimed at enhancing this methodology to guide us in developing this study. p20, line 27, compliment : This should be complement. Response: Thank you. This has been corrected in text with track changes to complement Thank you to all reviewers and the editorial team for your time.