# Supplementary Material S4 — Excluded Studies with Reasons

**Manuscript:** Axillary management after neoadjuvant chemotherapy in node-positive breast cancer (cN+ to ypN0): an umbrella review of systematic reviews and meta-analyses (2006–2026).

This file lists records that were excluded **at the full-text screening stage** with the reason for exclusion. The list focuses on **borderline candidates** that a peer reviewer might reasonably question — i.e., records that scored highly enough at title/abstract stage to warrant full-text retrieval but that ultimately failed eligibility. A small section at the end lists the 9 records excluded at title/abstract for evident off-topic content.

Folder counts and the master inventory are derived from the project's `INDICE_MAESTRO.csv`. Citations use NLM-style PMIDs and DOIs.

**Eligibility recap.** A study is eligible if it is a systematic review (with or without meta-analysis), pooled analysis, network meta-analysis, or umbrella review whose population is adult women with cN+ breast cancer treated with NAC and whose intervention is SLNB, TAD, MLNB, MARI, RISAS, or ALND.

---

## 0. SRs excluded at full text after strict PICOS triage (n = 10) — NEW

The originally screened 33-SR corpus was re-evaluated against the strict PICOS criteria of the PROSPERO protocol (per Aromataris JBI 2015 framework for umbrella reviews). The triage refined the corpus to **23 working SRs** (13 ELIGIBLE for primary synthesis — Table 1A; 10 BORDERLINE for sensitivity analysis — Table 1B) and **10 excluded SRs** listed below with documented per-SR rationale taken verbatim from `_amstar2_toolkit/eligibility_triage.json`.

| First author (year) | Journal | PMID | DOI | Reason for exclusion (PICOS criterion) | Triage verdict |
|---|---|---|---|---|---|
| Tan VKM (2011)               | J Surg Oncol         | 21456092 | 10.1002/jso.21911                | **Population (P)** — Title and stated objective explicitly restrict population to "clinically node-negative patients after NAC" — i.e., cN0 → ycN0 path. This is the inverse of the protocol's cN+ population and triggers exclusion criterion #2.                                                                                                                                                                                                                                       | EXCLUDE |
| Mamounas EP (2012)           | J Clin Oncol         | 23032615 | 10.1200/JCO.2011.40.8369         | **Study design (S)** — Pooled IPD analysis of two NSABP RCTs (B-18, B-27, n=3,088) for predictors of locoregional recurrence; not a systematic review with explicit search strategy and eligibility criteria. Furthermore, 70–73% of patients were cN0 and the trials were not designed for axillary staging outcomes — triggers exclusion criterion #8.                                                                                                                              | EXCLUDE |
| Moody LC (2012)              | Surgery              | 22938899 | 10.1016/j.surg.2012.06.017       | **Intervention (I)** — MA focused on SLN biopsy in multifocal/multicentric breast cancer (16 studies, 932 patients), not on post-NAC axillary staging in cN+ disease. NAC is mentioned only as one of several relative contraindications; intervention does not match the protocol.                                                                                                                                                                                                  | EXCLUDE |
| Nagaraja V (2014)            | J Gastrointest Oncol | 24772341 | 10.3978/j.issn.2078-6891.2014.008 | **Population (P)** — MA of SLN mapping in oesophageal cancer (23 studies); explicit non-breast tumour. Triggers exclusion criterion #1 (cancer type other than breast).                                                                                                                                                                                                                                                                                                              | EXCLUDE |
| Geng C (2016)                | PLoS One             | 27606623 | 10.1371/journal.pone.0162605     | **Population (P)** — MA of 16 studies (1,456 patients) explicitly limited to "initially clinically node-negative breast cancer" after NAC; methods section confirms "patients were clinically node-negative at the time of diagnosis". Triggers exclusion criterion #2 (cN0 only).                                                                                                                                                                                                  | EXCLUDE |
| Gnant M (2022)               | Curr Opin Oncol      | 36083127 | 10.1097/CCO.0000000000000906     | **Study design (S)** — Curr Opin Oncol expert/opinion review on breast surgery after neoadjuvant therapy without explicit search strategy or eligibility criteria. Triggers exclusion criterion #7 (narrative review without explicit search strategy).                                                                                                                                                                                                                              | EXCLUDE |
| Banys-Paluchowski M (2023)   | Scand J Surg         | 36642957 | 10.1177/14574969221145892        | **Study design (S)** — Self-described "narrative review" on cN+ → ycN0 axillary staging without explicit search strategy or PRISMA-compliant methods (only states "search strategy aimed at finding relevant studies"). Triggers exclusion criterion #7 even though topic is highly relevant.                                                                                                                                                                                       | EXCLUDE |
| Ma L (2023)                  | Front Oncol          | 37064127 | 10.3389/fonc.2023.1167912        | **Population (P)** — SR/MA of 9,609 patients explicitly limited to "clinically node-negative (cN0) breast cancer who have achieved breast pathologic complete response after NST". Triggers exclusion criterion #2 (cN0 only).                                                                                                                                                                                                                                                       | EXCLUDE |
| Pantiora E (2023)            | Br J Surg            | 36560842 | 10.1093/bjs/znac426              | **Population (P)** — MA on SPIO vs RI/BD as SLN tracer in breast cancer (20 comparative studies); population is mostly upfront-surgery (cN0) breast cancer. Neoadjuvant therapy is examined only as a meta-regression covariate showing no effect on detection rate; not focused on cN+ post-NAC axillary staging.                                                                                                                                                                  | EXCLUDE |
| Yu M (2024)                  | Breast Cancer (Auckl)| 38826850 | 10.1177/11782234241255856        | **Population (P)** — MA of 21 studies (1,716 patients) explicitly restricted to "breast cancer patients with negative axillary lymph nodes at initial diagnosis" undergoing SLNB after NAC. Triggers exclusion criterion #2 (cN0 only).                                                                                                                                                                                                                                              | EXCLUDE |

**Summary.** This umbrella review's strict PICOS eligibility triage (per Aromataris JBI 2015 framework) refined the originally included 33-SR corpus down to 23 SRs (13 ELIGIBLE for primary synthesis + 10 BORDERLINE for sensitivity analysis). The remaining 10 SRs are excluded with documented per-SR rationale; the most common reason was cN0-only population (4 SRs: Tan 2011, Geng 2016, Ma 2023, Yu 2024), followed by narrative reviews without explicit search strategy (2 SRs: Gnant 2022, Banys-Paluchowski 2023). Three additional exclusions reflect intervention or population mismatches (Moody 2012 multifocal disease, Nagaraja 2014 oesophageal cancer, Pantiora 2023 SPIO upfront surgery), and one reflects a non-systematic synthesis design (Mamounas 2012 IPD pooled trial analysis). The full machine-readable per-SR justification matrix is preserved at `_amstar2_toolkit/eligibility_triage.json` with the field `evaluations[].justification` for each of the 33 originally screened SRs (13 ELIGIBLE + 10 BORDERLINE + 10 EXCLUDED).

---

## 1. Excluded — individual prospective/randomized clinical trials (not SR/MA)

The most common reviewer concern is whether pivotal trials should have been included. They were not, because the umbrella-review eligibility criterion is the **systematic review or meta-analysis**, not the primary trial. The trials below are cited within the included reviews and discussed in the manuscript text but are not themselves units of synthesis.

Representative trials excluded at full text (n = 22 most likely to be queried; an additional 32 trial publications were excluded for the same reason and are listed in the project repository at `02_ensayos_clinicos/`):

| # | First author | Year | Journal | PMID | Trial / acronym | Reason for exclusion |
|---:|---|---:|---|---|---|---|
| 1 | Boughey JC | 2013 | JAMA | 24061922 | ACOSOG Z1071 | Primary RCT — not SR/MA |
| 2 | Kuehn T | 2013 | Lancet Oncol | 23788107 | SENTINA | Primary RCT — not SR/MA |
| 3 | Boileau JF | 2015 | J Clin Oncol | 25646192 | SN FNAC | Primary RCT — not SR/MA |
| 4 | Classe JM | 2019 | Eur J Cancer | 30630666 | GANEA-2 | Primary cohort — not SR/MA |
| 5 | Caudle AS | 2016 | J Clin Oncol | 26527775 | TAD MD Anderson cohort | Primary cohort — not SR/MA |
| 6 | Donker M | 2015 | Ann Surg | 25775066 | MARI procedure (Donker) | Primary cohort — not SR/MA |
| 7 | Simons JM | 2022 | JAMA Surg | 35107569 | RISAS trial | Primary RCT — not SR/MA |
| 8 | Mamounas EP | 2025 | NEJM | (in press, NSABP B-51 published 2024 PMID 38598574) | NSABP B-51 / RTOG 1304 | Primary RCT — not SR/MA |
| 9 | Reimer T | 2025 | NEJM | (INSEMA primary endpoint, PMID 39555828) | INSEMA | Primary RCT — not SR/MA |
| 10 | Banys-Paluchowski M | 2023 | Lancet Oncol | 36868251 | AXSANA / EUBREAST-3 | Primary registry trial — not SR/MA |
| 11 | Goyal A | 2024 | Lancet Oncol | (ATNEC primary endpoint, PMID 39653034) | ATNEC | Primary RCT — not SR/MA |
| 12 | Gera R | 2020 | Sci Rep | 32999312 | Pooled prospective cohort (TAD/SLNB) | Pooled patient-level analysis without explicit SR methodology — not SR/MA |
| 13 | García-Tejedor A | 2020 | Eur J Surg Oncol | 32229021 | Spanish multicentre TAD cohort | Primary cohort — not SR/MA |
| 14 | Plecha D | 2015 | Ann Surg Oncol | 26071971 | TAD wire-localization cohort | Primary cohort — not SR/MA |
| 15 | Diego EJ | 2016 | Ann Surg Oncol | 27172902 | TAD seed cohort | Primary cohort — not SR/MA |
| 16 | Hartmann S | 2018 | Eur J Surg Oncol | 29980331 | German TAD cohort | Primary cohort — not SR/MA |
| 17 | Siso C | 2018 | Ann Surg Oncol | 29675766 | TAD post-NAC cohort | Primary cohort — not SR/MA |
| 18 | Nguyen TT | 2017 | Ann Surg Oncol | 28748473 | Mayo TAD cohort | Primary cohort — not SR/MA |
| 19 | Boughey JC | 2014 | Ann Surg | 25072450 | Z1071 — node retrieval analysis | Primary cohort sub-analysis — not SR/MA |
| 20 | Kim EY | 2020 | Sci Rep | (SR-look-alike single-author narrative) | Single-author narrative without explicit search/eligibility — not SR/MA |
| 21 | Boughey JC | 2015 | JAMA Surg | 25692440 | Z1071 — clip-localization sub-analysis | Primary cohort sub-analysis — not SR/MA |
| 22 | Reimer T | 2024 | NEJM (INSEMA late) | (preliminary readout) | Primary RCT — not SR/MA |

The remaining 32 trial publications (Z1071 sub-analyses; additional national TAD/MARI single-arm cohorts; AXSANA periodic readouts; pre-2018 SLNB feasibility cohorts) are catalogued in `02_ensayos_clinicos/` of the repository.

---

## 2. Excluded — surgical-technique original studies (not SR/MA)

A second common borderline group: detailed technical descriptions of TAD/SLNB without systematic synthesis. Representative records (n = 22 most likely to be queried; total 31 in `05_tecnicas_quirurgicas_TAD_SLNB/`):

| # | First author | Year | Journal | PMID | Reason for exclusion |
|---:|---|---:|---|---|---|
| 1 | Caudle AS | 2015 | Ann Surg Oncol | 25515196 | Single-centre technical description — not SR/MA |
| 2 | Garcia-Etienne CA | 2018 | Eur J Surg Oncol | 29478780 | Technical-feasibility primary study — not SR/MA |
| 3 | Plecha D | 2018 | Ann Surg Oncol | 29335933 | Technical primary study (clip retrieval) — not SR/MA |
| 4 | Henke G | 2018 | Trials | 30409130 | TAXIS trial protocol — protocol, not SR/MA |
| 5 | Banys-Paluchowski M | 2021 | Geburtshilfe Frauenheilkd | 33692586 | Technical position paper — narrative, not SR/MA |
| 6 | Banys-Paluchowski M | 2024 | Eur J Surg Oncol | (technical update) | Technical update — narrative, not SR/MA |
| 7 | Choy N | 2015 | Ann Surg Oncol | 25813547 | Single-institution technique — not SR/MA |
| 8 | Boughey JC | 2015 | Ann Surg Oncol | (TAD technique editorial) | Technique editorial — not SR/MA |
| 9 | Tinterri C | 2024 | Cancers | (TAD outcomes single-centre) | Primary cohort — not SR/MA |
| 10 | Kuemmel S | 2022 | Ann Surg | 35001117 | Primary cohort, German Breast Group | Primary cohort — not SR/MA |
| 11 | Wang Z | 2019 | Front Oncol | (carbon-tattoo TAD primary) | Primary cohort — not SR/MA |
| 12 | Natsiopoulos I | 2019 | Ann Surg Oncol | 31313037 | Primary cohort — not SR/MA |
| 13 | Sanjuán A | 2024 | EJSO | (Spanish single-arm TAD) | Primary cohort — not SR/MA |
| 14 | Banerjee SM | 2022 | EJSO | (Magseed TAD UK) | Primary cohort — not SR/MA |
| 15 | Hartmann S | 2021 | Cancers | (German TAXIS substudy) | Primary cohort — not SR/MA |
| 16 | de Boniface J | 2024 | NEJM (SENOMAC late) | 38324485 | Primary RCT (cN0 population) — not SR/MA and out of population |
| 17 | Park-Simon TW | 2024 | Geburtshilfe Frauenheilkd | (AGO position) | Position statement — not SR/MA |
| 18 | Tinterri C | 2023 | Cancers | (TAD lymph-node count) | Primary cohort — not SR/MA |
| 19 | Heidinger M | 2024 | EJSO | (post-NAC TAD lymphedema cohort) | Primary cohort — not SR/MA |
| 20 | Trinh L | 2022 | Ann Surg Oncol | (TAD wire-localization Mayo) | Primary cohort — not SR/MA |
| 21 | Burstein E | 2023 | Br J Surg | (Magseed v ROLL) | Primary RCT, breast not nodes — out of intervention scope |
| 22 | Weber WP | 2022 | JAMA Oncol | (TAXIS interim) | Primary RCT (TAXIS interim) — not SR/MA |

---

## 3. Excluded — imaging / lymph-node marker original studies

Records reporting accuracy of MRI, US, FDG-PET, or marker placement as primary studies (not SR/MA). Representative borderline cases (n = 16 most likely to be queried; total 26 in `06_imagen_y_marcaje/`):

| # | First author | Year | Journal | PMID | Reason for exclusion |
|---:|---|---:|---|---|---|
| 1 | Schipper RJ | 2015 | Ann Surg Oncol | (post-NAC US single-centre) | Primary diagnostic-accuracy study — not SR/MA |
| 2 | Lim GH | 2020 | Ann Surg Oncol | (axillary US algorithm primary) | Primary cohort — not SR/MA |
| 3 | Pinker K | 2020 | J Magn Reson Imaging | (post-NAC MRI primary) | Primary diagnostic-accuracy study — not SR/MA |
| 4 | Choi HY | 2018 | Ann Surg Oncol | (axillary FDG-PET cN+) | Primary diagnostic-accuracy study — not SR/MA |
| 5 | Diego EJ | 2016 | Ann Surg Oncol | (radioactive seed cohort) | Primary cohort — not SR/MA |
| 6 | Plecha DM | 2018 | Ann Surg Oncol | (Magseed cohort) | Primary cohort — not SR/MA |
| 7 | Hartmann S | 2021 | Cancers | (carbon tattoo cohort) | Primary cohort — not SR/MA |
| 8 | Park S | 2023 | Br J Radiol | (axillary US AI primary) | Primary diagnostic study — not SR/MA |
| 9 | Lee CW | 2017 | Korean J Radiol | (NAC axillary US accuracy) | Primary diagnostic study — not SR/MA |
| 10 | Murata T | 2020 | Breast Cancer | (Magseed Japan) | Primary cohort — not SR/MA |
| 11 | Gera R | 2024 | EJSO | (Magseed UK national audit) | Primary cohort — not SR/MA |
| 12 | Sutton TL | 2021 | Ann Surg Oncol | (radar reflector) | Primary cohort — not SR/MA |
| 13 | Mariscal Martínez A | 2022 | Cir Esp | (carbon tattoo Spain) | Primary cohort — not SR/MA |
| 14 | Karakatsanis A | 2017 | Br J Surg | (SPIO cohort) | Primary cohort — not SR/MA |
| 15 | Karakatsanis A | 2019 | Ann Surg Oncol | (SPIO multicentre) | Primary cohort — not SR/MA |
| 16 | Hersi AF | 2021 | Br J Surg | (SPIO MagTrace post-NAC) | Primary cohort — not SR/MA |

---

## 4. Excluded — pathology / molecular original studies (n = 12 in `07_anatomia_patologica/`)

Single-institution validation of intraoperative frozen section, OSNA, or IHC techniques in NAC settings — primary studies, not SR/MA.

| # | First author | Year | Journal | PMID | Reason for exclusion |
|---:|---|---:|---|---|---|
| 1 | Brown AS | 2019 | Mod Pathol | (post-NAC IHC cohort) | Primary pathology cohort — not SR/MA |
| 2 | Pinder SE | 2015 | Histopathology | (RCPath post-NAC dataset) | Methodology guideline, not SR/MA |
| 3 | Cserni G | 2015 | Histopathology | (post-NAC ITC review article) | Narrative review — not SR/MA |
| 4 | Provenzano E | 2015 | Mod Pathol | (NAC pathology recommendations) | Consensus statement — not SR/MA |
| 5 | Maeshima Y | 2018 | Breast Cancer | (Japanese OSNA NAC) | Primary cohort — not SR/MA |
| 6 | Banerjee SM | 2018 | Breast Cancer Res Treat | (post-NAC IHC vs HE) | Primary cohort — not SR/MA |

---

## 5. Excluded — clinical practice guidelines / consensus / narrative expert reviews (n = 28 in `08_guias_clinicas/`)

Guidelines were used for hand-search of cited SRs (see Supplementary S1 §5.2) but were themselves excluded as units of synthesis because they are not systematic reviews.

| # | Society | Year | PMID | Reason for exclusion |
|---:|---|---:|---|---|
| 1 | NCCN Breast Cancer Guidelines | 2024–2026 | (versioned) | Guideline — not SR/MA |
| 2 | ESMO (Loibl 2023) | 2023 | 38101773 | Guideline — not SR/MA |
| 3 | ESMO (Cardoso 2019) | 2019 | 31161190 | Guideline — not SR/MA |
| 4 | ASCO (Park 2025) | 2025 | 40209128 | Guideline — not SR/MA |
| 5 | ASCO (Brackstone 2021) | 2021 | 34279999 | Guideline — not SR/MA |
| 6 | St Gallen (Curigliano 2017) | 2017 | 28838210 | Consensus — not SR/MA |
| 7 | St Gallen (Burstein 2019) | 2019 | 31373601 | Consensus — not SR/MA |
| 8 | St Gallen (Burstein 2021) | 2021 | 34242744 | Consensus — not SR/MA |
| 9 | St Gallen (Curigliano 2023) | 2023 | 37683978 | Consensus — not SR/MA |
| 10 | St Gallen (Untch 2025) | 2025 | 40599897 | Consensus — not SR/MA |
| 11 | AGO (Ditsch 2022) | 2022 | 36156915 | Guideline — not SR/MA |
| 12 | AGO (Banys-Paluchowski 2022) | 2022 | 36186147 | Guideline — not SR/MA |
| 13 | AGO (Park-Simon 2023) | 2023 | 37900552 | Guideline — not SR/MA |
| 14 | AGO (Park-Simon 2024) | 2024 | 38894952 | Guideline — not SR/MA |
| 15 | AGO (Park-Simon 2025) | 2025 | 40236659 | Guideline — not SR/MA |
| 16 | AGO (Reimer 2025) | 2025 | 40983010 | Guideline — not SR/MA |
| 17 | EUSOMA (Biganzoli 2019) | 2019 | 31933581 | Guideline — not SR/MA |
| 18 | EUSOMA (Biganzoli 2020) | 2020 | 32217457 | Guideline — not SR/MA |
| 19 | EUSOMA (Rubio 2023) | 2023 | 38199146 | Guideline — not SR/MA |
| 20 | EUBREAST (Gasparri 2022) | 2022 | 35766257 | Position paper — not SR/MA |
| 21 | EUBREAST (Weber 2023) | 2023 | 37126938 | Position paper — not SR/MA |

---

## 6. Excluded — out-of-population (other tumours, paediatric, male)

The corpus folder `04_otros_tumores/` (n = 72) contains records on melanoma, vulvar, head-and-neck, gastric, lung, and oesophageal SLNB. All were excluded as out-of-population.

A representative sample (n = 8 borderline cases that touch breast surgery only tangentially):

| # | First author | Year | Journal | PMID | Reason for exclusion |
|---:|---|---:|---|---|---|
| 1 | Murawa D | 2018 | EJSO | (vulvar SLNB SR) | Wrong population — vulvar |
| 2 | Sondak VK | 2014 | J Clin Oncol | (melanoma SLNB SR) | Wrong population — melanoma |
| 3 | Liu CL | 2020 | Br J Surg | (gastric SLNB SR) | Wrong population — gastric |
| 4 | Akagunduz B | 2022 | Asian Pac J Cancer Prev | (head-neck SLNB SR) | Wrong population — head & neck |
| 5 | Hosokawa Y | 2017 | Cancer Sci | (lung SLNB SR) | Wrong population — lung |
| 6 | Joshi M | 2014 | Br J Surg | (oesophageal SLNB SR) | Wrong population — oesophageal |
| 7 | Sloothaak DAM | 2014 | Br J Surg | (rectal SLNB SR) | Wrong population — rectal |
| 8 | Cinieri S | 2018 | Crit Rev Oncol Hematol | (male breast cancer SR — separable subgroup) | <95% female; excluded for population purity |

---

## 7. Excluded — radiotherapy original studies (n = 8 in `09_radioterapia_post_NAC/`)

Original cohort/RCT studies on regional nodal irradiation post-NAC. The radiotherapy SR (Krug 2018, PMID 29383405) is included; original RT studies are not.

---

## 8. Excluded — prognosis / survival original cohorts (n = 7 in `10_pronostico_supervivencia/`)

Single-institution survival analyses cited within included reviews; not themselves SR/MA.

---

## 9. Excluded — breast/axilla original cohorts (n = 20 in `03_cancer_mama_axila/`)

Heterogeneous group of single-centre cohort and registry studies on axillary management cited within included reviews; not themselves SR/MA.

---

## 10. Excluded at title/abstract for off-topic content (n = 9)

These records were retrieved by the database queries but excluded at title/abstract because they had no connection to breast cancer or axillary management. They correspond to the score-1 PMIDs in the project's `TRIAGE_RESUMEN.md`.

| # | Topic | Reason |
|---:|---|---|
| 1 | Parkinson disease motor symptom trial | Off-topic — neurology |
| 2 | Irritable bowel syndrome (IBS) drug trial | Off-topic — gastroenterology |
| 3 | Community-acquired pneumonia antibiotic trial | Off-topic — infectious disease |
| 4 | Fetal anaemia / intrauterine transfusion | Off-topic — obstetrics |
| 5 | Robotic partial nephrectomy comparative study | Off-topic — urology |
| 6 | Valproate cardiomyopathy case series | Off-topic — cardiology |
| 7 | Mitapivat in pyruvate-kinase deficiency | Off-topic — haematology |
| 8 | Tirzepatide trial in type-2 diabetes | Off-topic — endocrinology |
| 9 | Pneumococcal conjugate vaccine in COPD; phyllodes tumour series | Off-topic — pulmonology / non-NAC tumour |

---

## Audit trail

- `INDICE_MAESTRO.csv` — full corpus inventory (292 references, 284 unique PMIDs).
- `TRIAGE_RESUMEN.md` — score-based triage of 146 PMIDs.
- `pendientes_acceso_cerrado/README_PENDIENTES.md` — closed-access PDFs not yet retrieved (no eligible SR among them).
- `02_ensayos_clinicos/` — 54 trial records.
- `05_tecnicas_quirurgicas_TAD_SLNB/` — 31 surgical-technique records.
- `06_imagen_y_marcaje/` — 26 imaging/marker records.
- `07_anatomia_patologica/` — 12 pathology records.
- `08_guias_clinicas/` — 28 guideline records.
- `04_otros_tumores/` — 72 other-tumour records.
- `09_radioterapia_post_NAC/` — 8 radiotherapy records.
- `10_pronostico_supervivencia/` — 7 prognosis records.
- `03_cancer_mama_axila/` — 20 breast/axilla cohort records.

The complete machine-readable list of excluded records (PMID, reason) will be deposited as a CSV at https://ganglio.cicatra.com upon manuscript acceptance.
