<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2 20190208//EN" "http://jats.nlm.nih.gov/publishing/1.2/JATS-journalpublishing1.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="other" dtd-version="1.2" xml:lang="en">
    <front>
        <journal-meta>
            <journal-id journal-id-type="pmc">F1000Research</journal-id>
            <journal-title-group>
                <journal-title>F1000Research</journal-title>
            </journal-title-group>
            <issn pub-type="epub">2046-1402</issn>
            <publisher>
                <publisher-name>F1000 Research Limited</publisher-name>
                <publisher-loc>London, UK</publisher-loc>
            </publisher>
        </journal-meta>
        <article-meta>
            <article-id pub-id-type="doi">10.12688/f1000research.147105.1</article-id>
            <article-categories>
                <subj-group subj-group-type="heading">
                    <subject>Study Protocol</subject>
                </subj-group>
                <subj-group>
                    <subject>Articles</subject>
                </subj-group>
            </article-categories>
            <title-group>
                <article-title>Assessment of dental morbidity in school-going children (6&#x2013;10-year-old): A cross-sectional study</article-title>
                <fn-group content-type="pub-status">
                    <fn>
                        <p>[version 1; peer review: awaiting peer review]</p>
                    </fn>
                </fn-group>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author" corresp="yes">
                    <name>
                        <surname>Shende</surname>
                        <given-names>Vaibhavi</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Formal Analysis</role>
                    <role content-type="http://credit.niso.org/">Visualization</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <uri content-type="orcid">https://orcid.org/0009-0001-0378-4002</uri>
                    <xref ref-type="corresp" rid="c1">a</xref>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Wagh</surname>
                        <given-names>Vasant</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Supervision</role>
                    <role content-type="http://credit.niso.org/">Validation</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <xref ref-type="aff" rid="a2">2</xref>
                </contrib>
                <aff id="a1">
                    <label>1</label>School of Epidemiology and Public Health, Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India</aff>
                <aff id="a2">
                    <label>2</label>Professor of Community Medicine, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India</aff>
            </contrib-group>
            <author-notes>
                <corresp id="c1">
                    <label>a</label>
                    <email xlink:href="mailto:vaibhavishende300@gmail.com">vaibhavishende300@gmail.com</email>
                </corresp>
                <fn fn-type="conflict">
                    <p>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>28</day>
                <month>3</month>
                <year>2024</year>
            </pub-date>
            <pub-date pub-type="collection">
                <year>2024</year>
            </pub-date>
            <volume>13</volume>
            <elocation-id>236</elocation-id>
            <history>
                <date date-type="accepted">
                    <day>21</day>
                    <month>3</month>
                    <year>2024</year>
                </date>
            </history>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2024 Shende V and Wagh V</copyright-statement>
                <copyright-year>2024</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>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.</license-p>
                </license>
            </permissions>
            <self-uri content-type="pdf" xlink:href="https://f1000research.com/articles/13-236/pdf"/>
            <abstract>
                <sec>
                    <title>Background</title>
                    <p>Restricted activity days are prevalent in children with oral health problems. Oral health issues cause over 50 billion hours of education to be lost each year, which has an impact on children&#x2019;s school performance and the potential for success. Mostly it is concluded that dental caries is the most common disease among individuals. In addition, it may create chronic systemic conditions in healthy individuals. In children, it may induce deformities in the growth of the unerupted teeth. This study will help identify the factors and causes of risk factors for morbidities associated with dental problems. It also includes the educational status and socioeconomic condition of their parents, which is conducted in the Wardha district of Maharashtra in the field practice of villages among children.</p>
                </sec>
                <sec>
                    <title>Aim</title>
                    <p>To Assess dental morbidity among schoolchildren in rural areas and their relationship with their socioeconomic status in rural areas of Wardha District.</p>
                </sec>
                <sec>
                    <title>Methodology</title>
                    <p>A questionnaire-based face-to-face interview was conducted in this community-based cross-sectional study to assess dental morbidity in school-going children. The study participants will be children aged 6&#x2013;10 years in the rural areas of the Wardha district. The variables of this study were the sociodemographic profile, habits, and morbidities of the children.</p>
                </sec>
            </abstract>
            <kwd-group kwd-group-type="author">
                <kwd>Oral diseases</kwd>
                <kwd>oral health status</kwd>
                <kwd>oral hygiene</kwd>
                <kwd>school children</kwd>
                <kwd>socioeconomic status.</kwd>
            </kwd-group>
            <funding-group>
                <funding-statement>The author(s) declared that no grants were involved in supporting this work.</funding-statement>
            </funding-group>
        </article-meta>
    </front>
    <body>
        <sec id="sec2" sec-type="intro">
            <title>Introduction</title>
            <p>Dental health in children is a global issue that mainly involves dental caries, early childhood caries, malocclusion, oral diseases, and periodontal diseases. Dental caries and other oral conditions impact an individual&#x2019;s overall well-being as well as their health. Children have the habit of thumb sucking, which may lead to malocclusion. It also negatively affects children&#x2019;s well-being. It is now recognized that an individual&#x2019;s total health and well-being are influenced by both general and oral health.
                <sup>
                    <xref ref-type="bibr" rid="ref1">1</xref>
                </sup> It is important to identify and address issues at an early stage of malocclusion, which highlights their contribution to the formation of dental cavities, periodontitis, and orthodontic problems.
                <sup>
                    <xref ref-type="bibr" rid="ref2">2</xref>
                </sup> To assess the level of oral health among school-age children in Wardha District, a subsequent status assessment was undertaken. Globally, dental issues are the most common chronic condition, and up to 50% of kindergarteners experience tooth decay. Unmet dental needs (UDNs) are not linked to children&#x2019;s developmental health, although there is insufficient research to support this.
                <sup>
                    <xref ref-type="bibr" rid="ref3">3</xref>
                </sup>
            </p>
            <p>The whole condition of a kid&#x2019;s physical, mental, intellectual, community, and emotional well-being is referred to as child health. To reach their full developmental potential, healthy children must live in families, communities, and settings that support this (National Research and Institute of 2004).
                <sup>
                    <xref ref-type="bibr" rid="ref4">4</xref>
                </sup> Maintaining good dental health is crucial for overall well-being and quality of life in both children and adults. Additionally, it plays a role in various aspects of a child&#x2019;s growth and development. Good dental health enhances a child&#x2019;s ability to develop diverse physical and social skills, such as eating, breathing, speech, smiling, and adapting in interpersonal situations.
                <sup>
                    <xref ref-type="bibr" rid="ref5">5</xref>
                </sup>
            </p>
            <p>Many chronic illnesses are known to afflict children, necessitating substantial life management changes and resulting in poor quality of life.
                <sup>
                    <xref ref-type="bibr" rid="ref6">6</xref>
                </sup> Poor oral health strongly affects personal pleasures. Children with gum disease, tooth decay, abscesses, or other dental problems are greatly affected. They may experience difficulties in eating and playing, for example, and they run a higher risk of hospitalization and require expensive treatment. This may hurt their social and emotional wellbeing. The school schedule is also affected.
                <sup>
                    <xref ref-type="bibr" rid="ref7">7</xref>
                </sup> Assessing oral health issues, such as toothache, dental caries, discomfort in the mouth, misaligned teeth, fractured teeth, different types of gum diseases, and abscesses, is therefore necessary. Similar to overall health, dental health is greatly influenced by socioeconomic status.
                <sup>
                    <xref ref-type="bibr" rid="ref8">8</xref>
                </sup> In previous studies, 78.3% of the children had dental caries, 44.8% had gingival bleeding from periodontal disease, and 16.4% had gingivitis. Dental treatment causes stress and anxiety, and the cost of treatment may discourage people from receiving it. It is important to inspire young people and educate them about oral health issues so that they can adopt a positive attitude towards receiving dental care.
                <sup>
                    <xref ref-type="bibr" rid="ref9">9</xref>
                </sup> Early evaluation, diagnosis, treatment, and raising awareness may help avoid complications from dental health issues and their detrimental impact on children&#x2019;s general development.
                <sup>
                    <xref ref-type="bibr" rid="ref10">10</xref>
                </sup> The relationship between oral health and overall health is widely known. Numerous chronic illnesses are known to affect children, necessitating substantial life management changes and resulting in poor quality of life.
                <sup>
                    <xref ref-type="bibr" rid="ref6">6</xref>
                </sup> Children learn about numerous areas of personal cleanliness, sanitation, and social traditions during health education classes at school, which are widely recognized.
                <sup>
                    <xref ref-type="bibr" rid="ref11">11</xref>
                </sup> It has been confirmed that, although oral disorders are not regarded to be life-threatening, they are nevertheless linked to a variety of clinical outcomes in children, including discomfort, pain, and insufficient sleep, as well as a detrimental effect on self-esteem, the capacity to eat, inadequate nourishment, and health.
                <sup>
                    <xref ref-type="bibr" rid="ref12">12</xref>
                </sup> 
                <xref ref-type="table" rid="T1">Table 1</xref> details about key study parameters, their variables, data sources, and data collection method.</p>
            <table-wrap id="T1" orientation="portrait" position="float">
                <label>Table 1. </label>
                <caption>
                    <title>The key study parameters, their variables, data sources, and data collection method.</title>
                </caption>
                <table content-type="article-table" frame="hsides">
                    <thead>
                        <tr>
                            <th align="left" colspan="1" rowspan="1" valign="top">Key parameters</th>
                            <th align="left" colspan="1" rowspan="1" valign="top">Variables</th>
                            <th align="left" colspan="1" rowspan="1" valign="top">Data sources</th>
                            <th align="left" colspan="1" rowspan="1" valign="top">Data collection methods</th>
                        </tr>
                    </thead>
                    <tbody>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">Demographic profile of children in a rural area of Wardha</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">Name
                                <break/>Age
                                <break/>Gender
                                <break/>Standard
                                <break/>Religion
                                <break/>Village name
                                <break/>Employment status of parents
                                <break/>Socioeconomic status
                                <break/>Source of drinking water</td>
                            <td align="left" colspan="1" rowspan="3" valign="top">Children (6-10) age</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">A survey using interview method</td>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">Habits of children</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">Thumb sucking
                                <break/>Tongue thrusting
                                <break/>Nail biting
                                <break/>Mouth breathing</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">A survey using interview method</td>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">Dental morbidities in children</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">Bleeding gums
                                <break/>Sensitivity
                                <break/>Caries
                                <break/>Toothache
                                <break/>Halitosis (Bad breath)
                                <break/>Dental trauma injury
                                <break/>Fluorosis</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">A survey using interview method</td>
                        </tr>
                    </tbody>
                </table>
            </table-wrap>
            <sec id="sec3">
                <title>Rationale</title>
                <p>This study raises awareness and advises us to give children oral health and good dental hygiene with special needs more consideration. This study can help overcome several oral health issues. This may enhance both academic achievement and general well-being. We explicitly conclude that children&#x2019;s physical and mental health will be significantly impacted. This study aimed to determine dental problems in children in the Wardha district. Therefore, this study was designed to assess the gradient in the oral health of children aged 6&#x2013;10 years. The information provided by this study will encourage the government to take action regarding children&#x2019;s oral hygiene. From previous studies, it can be concluded that studies have been conducted on certain dental conditions, and in this study, their relationship with socioeconomic factors as well as the habits of children and lifestyle is enlightened. This study was conducted to examine the frequency of dental diseases in school-going children and to be aware of oral hygiene habits and their habits, such as thumb sucking, mouth breathing, tongue thrusting, and nail-biting. Considering this, the present investigation aimed to analyze morbidity among schoolchildren in a rural field practice region.</p>
            </sec>
            <sec id="sec4">
                <title>Aim</title>
                <p>Assessment of dental morbidity among schoolchildren in rural areas and its relationship with their socioeconomic status.</p>
            </sec>
            <sec id="sec5">
                <title>Objectives</title>
                <p>To assess the sociodemographic variables associated with dental problems among school-going children.</p>
                <p>To assess the prevalence of oral hygiene and dental problems.</p>
                <p>To determine the risk factors linked with dental problems.</p>
                <p>To suggest preventive measures and dental education regarding awareness among school children.</p>
            </sec>
        </sec>
        <sec id="sec6" sec-type="methods">
            <title>Methods</title>
            <sec id="sec7">
                <title>Study design</title>
                <p>This community-based cross-sectional study was conducted to investigate the incidence of dental morbidities.</p>
            </sec>
            <sec id="sec8">
                <title>Study place/setting</title>
                <p>The current study will be conducted in the field practice area of the community department. The study will be conducted in the rural areas of the Wardha district.</p>
            </sec>
            <sec id="sec9">
                <title>Study participants/population</title>
                <p>The present study will include children 6-10 years in the population of male and females in the study.</p>
            </sec>
            <sec id="sec10">
                <title>Inclusion criteria</title>
                <p>The study will include both male and female children ages 6-10 years old.</p>
            </sec>
            <sec id="sec11">
                <title>Exclusion criteria</title>
                <p>Those who were older than 10 years and those under 6 years were excluded from this study.</p>
                <p>Children with autism spectrum disorders, anxiety disorders, or other mood disorders were excluded from the study.</p>
                <p>Children with chronic illnesses, such as respiratory diseases, developmental anomalies, cancer, and renal problems.</p>
            </sec>
            <sec id="sec12">
                <title>Sample size</title>
                <p>
                    <disp-formula id="e1">
                        <mml:math display="block">
                            <mml:mfrac>
                                <mml:mrow>
                                    <mml:msubsup>
                                        <mml:mi mathvariant="normal">Z</mml:mi>
                                        <mml:mrow>
                                            <mml:mn>1</mml:mn>
                                            <mml:mo>&#x2212;</mml:mo>
                                            <mml:mi mathvariant="normal">&#x03b1;</mml:mi>
                                            <mml:mo>/</mml:mo>
                                            <mml:mn>2</mml:mn>
                                        </mml:mrow>
                                        <mml:mn>2</mml:mn>
                                    </mml:msubsup>
                                    <mml:mo>&#x2217;</mml:mo>
                                    <mml:mi mathvariant="normal">p</mml:mi>
                                    <mml:mo>&#x2217;</mml:mo>
                                    <mml:mo>(</mml:mo>
                                    <mml:mrow>
                                        <mml:mn>1</mml:mn>
                                        <mml:mo>&#x2212;</mml:mo>
                                        <mml:mi mathvariant="normal">p</mml:mi>
                                    </mml:mrow>
                                    <mml:mo>)</mml:mo>
                                </mml:mrow>
                                <mml:msup>
                                    <mml:mi mathvariant="normal">d</mml:mi>
                                    <mml:mn>2</mml:mn>
                                </mml:msup>
                            </mml:mfrac>
                        </mml:math>
                    </disp-formula>
                </p>
                <p>Alpha (&#x03b1;) = 0.05</p>
                <p>Estimated proportion (p) = 0.783</p>
                <p>Estimated error (d) = 0.05</p>
                <p>Sample size = 262</p>
                <p>Therefore, the sample size for assessing the prevalence of dental morbidities in school-going children is 262.</p>
            </sec>
            <sec id="sec13">
                <title>Sampling method</title>
                <p>The method used in this study for sampling is a simple random sampling technique.</p>
            </sec>
            <sec id="sec14">
                <title>Variables</title>
                <p>This study aimed to collect information about dental morbidities, and participants will be asked about their name, age, sex, educational status, religion, habits, and lifestyle (bleeding gums, caries, toothache, and sensitivity).</p>
            </sec>
            <sec id="sec15">
                <title>Study/data tools</title>
                <p>An online survey accompanied by a consent form will be the tool being discussed. The Kobo Toolbox was used to build the survey. The semi-structured questionnaire consisted of three sections. The first section contained demographic variables such as name, age, gender, religion, village name, employment status of parents, socioeconomic status, and source of drinking water. In the second section, participants were asked questions regarding their habits. In the last section, morbidity among the children was assessed. The objectives of this study were to identify the dental morbidity occurring in children as dental caries, toothache, bleeding gums, sensitivity, and fluorosis.</p>
            </sec>
            <sec id="sec16">
                <title>Data collection procedure</title>
                <p>The investigation will be conducted online. The study was conducted by visiting people&#x2019;s doors and asking them questions. The participants will have access to the questionnaire. which an interview will be conducted, it will take nearly ten minutes. Parents provided signed informed consent for their children to participate in this study. The online questionnaire was obtained from the Kobo Toolbox with a consent form.</p>
            </sec>
            <sec id="sec17">
                <title>Bias</title>
                <p>The survey could be subject to bias as respondents would find anxiety in answering the questions properly. In addition, there was a lack of cooperation. The survey may have biases due to respondents giving responses that they believe are accepted by others rather than truthful. Furthermore, it is possible that those who answered the questionnaire were re not accurately representative of the study group.</p>
            </sec>
            <sec id="sec18">
                <title>Ethical consideration</title>
                <p>The Datta Meghe Institute of Higher Education and Research (DU) Institutional Ethics Committee approved the study protocol on 19-12-2023 with reference numbers DMIHER (DU)/IEC/2023/39. Before conducting the study, we will obtain informed consent, which will have the objective of determining the factors, current situation, and shift in the stage of dental morbidities. The findings of this study provide confidential information. In addition, we ensured that the study participants would be at ease during the entire process.</p>
            </sec>
            <sec id="sec19">
                <title>Data analysis plan and expected outcome/result</title>
                <p>The data analysis plan will use R statistical software(
                    <ext-link ext-link-type="uri" xlink:href="https://www.r-project.org/">R: The R Project for Statistical Computing (r-project.org)</ext-link>) to analyze the data. It was then converted to an MS Excel spreadsheet. The study will be analyzed using t-tests and chi-squared tests.</p>
            </sec>
            <sec id="sec20">
                <title>Expected outcome</title>
                <p>The conducted study will be further enhanced, and it is expected that there will be a decline in the occurrence of dental morbidity among children. In addition, we will attempt to improve the oral health of children. This would also provide an idea of the risk factors for dental problems.</p>
            </sec>
        </sec>
        <sec id="sec21" sec-type="discussion">
            <title>Discussion</title>
            <p>It has been demonstrated that in Peru, children under the age of 12 years had varying access to oral health care depending on their wealth index, level of education, age, type of health insurance, and natural region of residence. After evaluating these data in the context of Andersen and Col&#x2019;s theoretical model, we concluded that there was unequal availability of oral healthcare in Peru. In addition, this is mostly due to the disjointed and unfair healthcare system.
                <sup>
                    <xref ref-type="bibr" rid="ref13">13</xref>
                </sup>
            </p>
            <p>Children are affected by several chronic illnesses that can lower their quality of life and necessitate major changes in life management. Between 20% and 30% of children and teens in the US are estimated to have chronic health issues according to the National Institutes of Health. Six Childhood obesity, diabetes, and asthma are among the most common diseases, among which is dental caries, which occurs between five and eight times more frequently than respiratory conditions (asthma), which is the next most prevalent illness. This study presents the most recent data on dental care-related absences from schools. also discovered that children who needed such care missed school at a rate of 0.5/year; discomfort or infection accounted for 17% of these absences.
                <sup>
                    <xref ref-type="bibr" rid="ref6">6</xref>
                </sup>
            </p>
            <p>Halitosis is a widespread, unpleasant ailment that affects people of all ages and can lead to significant social and psychological obstacles, also children are affected by this unpleasant condition. A villa, A Zollanvari, G Alterovitz, MG Cagetti, L Strohmenger, and S Abati (2013) concluded that 64 percent of subjects had nasal breath. In more than 25% of the dental surfaces analyzed, dental plaque was present in approximately 12% of the children included in this analysis. These results indicate that approximately 40% of children have halitosis.
                <sup>
                    <xref ref-type="bibr" rid="ref14">14</xref>
                </sup>
            </p>
            <p>The study included school-aged participants in the 5-8 and 9-12 age groups. 45.3 Of the children aged 5-8 years, 45.3% were female and 54.7% were male. 50.3 Of the children aged 9&#x2013;12 years, 50.3% were female and 45.3% were men. When the two age groups were compared, it was found that the 5&#x2013;8-year-old group had far better dental hygiene than the 9&#x2013;12-year-old group. Between the two age groups, the 5-8 year old group showed noticeably higher gingival bleeding than the 9&#x2013;12 year old group.
                <sup>
                    <xref ref-type="bibr" rid="ref1">1</xref>
                </sup>
            </p>
            <p>This study demonstrated a relationship between preschoolers&#x2019; OHRQoL (oral health-related quality of life), clinical status, and socioeconomic position. Piovesan et al. proposed a low-income household as a contributing factor to poor OHRQoL in children. Furthermore, poorer OHQoL in children has been linked to lower educational levels of both the mother and father.
                <sup>
                    <xref ref-type="bibr" rid="ref15">15</xref>
                </sup>
            </p>
            <sec id="sec22">
                <title>Implications of the study</title>
                <p>This study will help to determine the current health and factors associated with dental morbidities and their socioeconomic status. This study provides information for future research. It also identifies the factors that may lead to dental morbidity. This study will aid in inhibiting and improving oral hygiene among children in rural communities.</p>
            </sec>
            <sec id="sec23">
                <title>Limitations</title>
                <p>Dental-related problems in school-going children have some limitations, such as the absence of a child at home while collecting data. It does not include less than 6-year-old children. However, there is still a need to decrease the prevalence of dental morbidities and oral diseases. However, there is a lack of information and awareness. Accessibility aids that are useful for maintaining oral hygiene may not be available nearby.</p>
                <p>Dental caries seem to be a serious public health concern among children in India, as evidenced by the low use of dental services and inadequate oral hygiene habits. Children with various diseases have been shown to have a significant degree of oral health issues; nevertheless, treatment indices were generally lower in these groups of patients than in the healthy population. To deal with this public health issue at an early stage and to increase the consumption of dental treatment, it is necessary to implement quick oral health promotion methods.</p>
            </sec>
            <sec id="sec24">
                <title>Dissemination</title>
                <p>The study protocol will be featured in a recognized journal index and showcased at seminars and conferences.</p>
            </sec>
            <sec id="sec26">
                <title>Study status</title>
                <p>The study has not commenced yet.</p>
            </sec>
        </sec>
    </body>
    <back>
        <sec id="sec28" sec-type="data-availability">
            <title>Data availability</title>
            <p>No data are associated with this article.</p>
            <sec id="sec29">
                <title>Extended data</title>
                <p>Repository Name: Figshare</p>
                <p>File Name: STROBE checklist for &#x201c;Assessment of dental morbidity in school-going children (6&#x2013;10-year-old): A cross-sectional study&#x201d;.</p>
                <p>DOI: 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.6084/m9.figshare.25389397">10.6084/m9.figshare.25389397</ext-link>
                </p>
                <p>Licence: 
                    <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/legalcode">CC BY 4.0</ext-link>
                </p>
            </sec>
        </sec>
        <ref-list>
            <title>References</title>
            <ref id="ref1">
                <label>1</label>
                <mixed-citation publication-type="journal">
                    <person-group person-group-type="author">

                        <name name-style="western">
                            <surname>Sharma</surname>
                            <given-names>A</given-names>
                        </name>

                        <name name-style="western">
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