Document is current

Article History

Received: 16 February 2026

Accepted: 3 May 2026

First Online: 11 May 2026

Declarations

:

: The study was conducted at the University of Toronto (UT) (2006–2008) and Pennsylvania State University (PSU) (2008–2014) with approval from the Research Ethics Board of UT and the Institutional Review Board of PSU. Accordingly, the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

: Not applicable.

: The opinions and assertions expressed herein are those of the author(s) and do not reflect the official policy or position of the Uniformed Services University or the Department of Defense. The Contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions or policies of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.

: All participants provided signed informed consent in accordance with procedures approved by the University of Toronto (UT) (2006–2008) Research Ethics Board and Pennsylvania State University’s (PSU) (2008–2014) Institutional Review Board.

: The authors declare no competing interests.