Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript addresses an important and very practical topic: strategies for standardising nursing handovers in paediatric hospitalisation. The focus on paediatric nursing is highly relevant and the manuscript will be of interest to clinicians and managers seeking to improve patient safety and communication. The overall structure is clear, and the use of a protocol, PRISMA-ScR and formal quality appraisal tools is commendable. At the same time, several aspects of the methodology, reporting and language could be strengthened to improve clarity, transparency and impact.

Major comments

The manuscript and the Supplement use the terms “integrative review” and “scoping review” somewhat interchangeably. In the Abstract and Conclusions, the study is referred to as an “integrative review”, whereas the Methods clearly state that a scoping review following PRISMA‑ScR was conducted, and the Supplement consists of a PRISMA‑ScR checklist.

• Please clearly decide whether this is an integrative review, a scoping review, or a hybrid approach and use one term consistently throughout the title, abstract, methods and discussion.
• If you wish to retain the scoping review framework (which appears most coherent with your methods and the PRISMA‑ScR supplement), the Abstract and Conclusions should be aligned accordingly and the rationale for choosing a scoping approach emphasised in the Introduction.

The description of the study selection and quality appraisal process would benefit from clarification and closer alignment between text, flow diagram and Table 3. For example, you state that 25 studies were “accepted” and then later indicate that 24% (n = 6) “did not obtain the acceptable score” and were excluded, leaving 19 included studies. However, the wording (“accepted studies” vs. excluded) is confusing.

• Please revise the Results section and Figure 1 so that the numbers at each step (records identified, screened, excluded, full texts assessed, studies included, and studies excluded after quality appraisal) are fully consistent and transparently described.
• It would be helpful to explain more explicitly how the ≥7/10 threshold for methodological quality was chosen, and to justify the use of CASPe, MMAT and STROBE in a scoping review context.
• You also apply Sackett’s levels of evidence and a modified GRADE system to the included studies. This is unusual but not necessarily inappropriate in a scoping review; however, the rationale for this choice and how it informs your synthesis (beyond Table 3) should be explained more clearly. At present, the risk‑of‑bias and LOE/GR assessments are reported but not strongly integrated into the narrative (e.g., by indicating which conclusions rest on higher‑ vs lower‑quality/level evidence).

The stated objective is to identify evidence on standardisation strategies for nursing handovers in paediatric hospitalisation. Yet a considerable portion of the evidence base stems from adult or mixed populations, and from multiprofessional handovers (e.g., residents, multidisciplinary handoffs). You acknowledge this in the Limitations, but it would be valuable to sharpen this aspect throughout the manuscript.

• In the Results and Discussion, please distinguish more systematically between:
  (a) evidence derived specifically from paediatric nursing settings,
  (b) paediatric but primarily medical/multiprofessional handovers, and
  (c) adult or generic handover evidence extrapolated to paediatrics.
• Consider structuring Tables 3 and 4 and/or the text such that the reader can immediately see which tools have been evaluated in paediatric nursing handovers versus those adapted from adult or physician‑centred contexts.
• In the Discussion and Conclusions, the strength of recommendations for particular tools (e.g., SBAR, I‑PASS, NBSR) should be explicitly linked to the underlying paediatric nursing evidence rather than to the broader (often adult and medical) literature.

There is occasional conceptual blurring between “standardisation” (use of structured protocols, checklists, mnemonics, electronic tools) and “structuring” of communication (e.g., message content and sequence), and between “handover of paediatric nursing patients” and general handovers.

• It would be helpful to provide a concise conceptual clarification early in the Introduction (e.g., a short paragraph distinguishing standardisation vs structuring, and clarifying that the focus is on nurse‑to‑nurse shift‑to‑shift handovers in paediatric inpatient units).
• In the Discussion, please ensure that statements about “tools for standardising patient handover” clearly refer to tools evaluated (or at least applied) in paediatric nursing settings, and that generalisations from adult or multidisciplinary contexts are marked as such.

The Conclusions and Applicability sections use rather strong language (e.g., “it has been shown that there is a need to focus on the continuous improvement…”, “implementation of these tools will improve the quality of patient handoff, nurses’ satisfaction, and reduce communication errors”). Given the heterogeneity and mostly non‑randomised or indirect evidence, these claims should be somewhat tempered.

• Consider reframing such statements to emphasise that the available evidence suggests or is consistent with improvements in information transfer, perceived communication quality, and possibly patient outcomes, while also highlighting that robust paediatric nursing‑specific outcome data remain limited.
• Similarly, where you refer to tools as “best practice” or “fundamental pillars”, it may be preferable to speak of “promising approaches supported by moderate‑ to low‑quality evidence” to maintain alignment with your own risk‑of‑bias assessment.

The narrative synthesis is generally clear, but some sections are quite dense and could be more reader‑friendly.

• You may consider condensing overlapping descriptions of tools (e.g. SBAR variants, I‑PASS, NBSR, SAFETIPS) in the text and placing the full descriptive detail in Table 4. The main text could then focus on key differentiating features and paediatric nursing applicability.
• The section on tools for assessing handover quality is very useful; however, it would benefit from a short integrative paragraph explicitly advising readers which tools are currently most appropriate for paediatric nursing settings, and under what conditions (e.g., HES, Handoff CEX, Yáñez‑Corral instrument), rather than leaving them as a list.
• Consider adding, if feasible, a simple figure or matrix mapping (i) structuring/standardisation tools and (ii) evaluation tools against setting (paediatric vs adult; nursing vs multiprofessional) and type of outcome (process vs clinical).

Minor comments

In Table 2, the phrasing of some criteria is potentially confusing. For example, “Studies developed in economically developing countries” is listed under Inclusion criteria, which might not reflect your intended scope (many reviews restrict to high‑income or include all income levels). Please verify that each criterion is correctly placed (Inclusion vs Exclusion) and that the wording aligns with what was actually applied in the database filters and screening.

Ensure consistent use of key terms such as “handoff” vs “handover” (both appear), “hospitalisation” vs “hospitalization”, and “paediatric” vs “pediatric” depending on the journal’s preferred style.

Abbreviations like SBAR, ISBAR, I‑PASS, NBSR, SAFETIPS, HES, etc., should be spelled out in full at first use in the main text (even if they appear in the Abstract or Tables).

In Table 3, consider briefly indicating the population and setting (e.g. paediatric nursing, paediatric residents, adult ICU, mixed) for each study, to help readers quickly appreciate external validity.

The reference list appears generally appropriate; however, please check for duplicated entries and ensure that all citations mentioned in the text are present and formatted according to the journal’s style.

 

Comments on the Quality of English Language

The English is generally understandable but would benefit from professional editing to improve fluency, reduce redu

Long and complex sentences in the Introduction and Discussion that could be split for clarity.

Slightly awkward phrasing (e.g. “In light of the findings obtained from our integrative review of standardisation strategies…”; “The quality of patient handover is primarily related to communication, which depends on the following factors”) where more concise formulations would strengthen readability.

Author Response

We sincerely thank the reviewer for the thorough, insightful, and constructive evaluation of our manuscript. We greatly appreciate the time and expertise dedicated to providing such detailed and thoughtful comments. The observations and suggestions have been invaluable in helping us strengthen the methodological clarity, conceptual precision, and overall quality of the manuscript. We have carefully considered each point raised and have revised the manuscript accordingly to improve transparency, coherence, and scientific rigor.

Comment 1: The manuscript and the Supplement use the terms “integrative review” and “scoping review” somewhat interchangeably…

Response 1: We thank the reviewer for this important observation. We have clarified the study design and now consistently use the term “scoping review” throughout the title, abstract, methods, discussion, and conclusions to align with the PRISMA-ScR framework followed in the Methods and Supplementary Materials. The rationale for adopting a scoping review approach has also been emphasised in the Introduction.

Comment 2: The description of the study selection and quality appraisal process would benefit from clarification…

Response 2: We appreciate this valuable suggestion. The Results section and Figure 1 have been revised to ensure full consistency between the text, flow diagram, and Table 3. We have clarified the distinction between full-text articles assessed for eligibility (n = 25) and studies included after methodological quality appraisal (n = 19). The wording has been standardised to avoid ambiguity regarding “accepted” versus “included” studies.

Comment 3: It would be helpful to explain more explicitly how the ≥7/10 threshold was chosen…

Response 3: Thank you for this insightful comment. We have added a clarification in the Methods section explaining that the ≥7/10 threshold was determined by author consensus to ensure minimum methodological robustness and reporting quality. Although scoping reviews do not routinely exclude studies based on quality, we incorporated this threshold to enhance transparency and avoid drawing conclusions from critically low-quality studies. We have also clarified the rationale for using CASPe, MMAT, and STROBE as appropriate tools for the different study designs included.

Comment 4: You also apply Sackett’s levels of evidence and a modified GRADE system…

Response 4: We agree that this approach is less common in scoping reviews. We have clarified that Sackett’s levels of evidence and the modified GRADE system were applied descriptively to contextualise the strength of the evidence rather than to determine inclusion. We have also strengthened the Discussion to more explicitly link conclusions to the level and quality of the underlying evidence.

Comment 5: The stated objective is to identify evidence on standardisation strategies… yet much evidence stems from adult or mixed populations…

Response 5: We thank the reviewer for highlighting this important issue. We have systematically differentiated the included studies according to population and professional scope. A new subsection (Context of Evidence by Population and Professional Scope) has been added to the Results, specifying that 4 studies were conducted specifically in paediatric nurse-to-nurse inpatient settings, 5 in paediatric but primarily medical or multidisciplinary contexts, and 10 in adult or mixed populations. Table 3 have been revised to include population and setting information to improve transparency regarding applicability.

Comment 6: In the Discussion and Conclusions, the strength of recommendations should be explicitly linked to paediatric nursing evidence…

Response 6: We have revised the Discussion and Conclusions to explicitly differentiate between findings derived from paediatric nursing contexts and those extrapolated from medical or adult populations. Statements regarding tools such as SBAR, I-PASS, and NBSR have been moderated and directly linked to the type and strength of the supporting evidence.

Comment 7: There is occasional conceptual blurring between “standardisation” and “structuring”…

Response 7: We appreciate this suggestion. A concise conceptual clarification has been added to the Introduction distinguishing “standardisation” (formalised tools, protocols, checklists, electronic systems) from “structuring” (organisation and sequencing of message content). We have also clarified that the primary focus of the review is nurse-to-nurse shift-to-shift handovers in paediatric inpatient units.

Comment 8: In the Discussion, ensure that statements about tools clearly refer to paediatric nursing settings…

Response 8: The Discussion has been revised to clearly indicate when tools were evaluated in paediatric nursing contexts and when findings derive from adult or multidisciplinary settings. Generalisations have been carefully qualified to reflect the scope of the underlying evidence.

Comment 9: The Conclusions and Applicability sections use rather strong language…

Response 9: We have moderated the language in both sections to better reflect the heterogeneity and predominantly non-randomised nature of the evidence. Expressions such as “it has been shown” and “fundamental pillar” have been replaced with more cautious formulations (e.g., “the available evidence suggests,” “may contribute to”). We have emphasised that paediatric nursing-specific outcome data remain limited.

Comment 10: The narrative synthesis is clear but dense…

Response 10: We thank the reviewer for this helpful suggestion. In revising the manuscript, we aimed to condense overlapping descriptions of tools in the main text and refer readers to Table 4 for detailed structural components, thereby improving readability and flow. At the same time, we ensured that all abbreviations (e.g., SBAR, ISBAR, I-PASS, NBSR, SAFETIPS, HES) are spelled out in full at first mention in the main text, in accordance with the journal’s requirements.

If the reviewer considers that additional descriptive detail should remain in the main body for clarity, we are fully willing to reinstate the expanded descriptions and retain the detailed structural elements exclusively in Table 4.

Comment 11: The section on tools for assessing handover quality would benefit from an integrative paragraph…

Response 11: An integrative paragraph has been added to the assessment section summarising which tools (e.g., HES, Handoff CEX, Yáñez-Corral instrument) appear most appropriate for paediatric nursing contexts and under what circumstances, thereby providing clearer guidance to readers.

Comment 12: Consider adding a simple figure or matrix mapping tools against setting and outcomes…

Response 12: We have incorporated a structured classification in Tables 3 that maps tools according to population (paediatric nursing, paediatric medical, adult/mixed). This provides readers with a clear overview of applicability and outcome type without substantially increasing manuscript length.

Comment 13: In Table 2, the phrasing of some criteria is potentially confusing…

Response 13: Table 2 has been revised to ensure that inclusion and exclusion criteria are correctly positioned and clearly worded. Ambiguous phrasing has been clarified to reflect the criteria actually applied during screening.

Comment 14: Ensure consistent use of key terms…

Response 14: The manuscript has been carefully reviewed to ensure consistent terminology throughout (e.g., “handover,” “hospitalisation,” “paediatric”) in accordance with journal style.

Comment 15: Abbreviations should be spelled out at first use…

Response 15: All abbreviations (e.g., SBAR, ISBAR, I-PASS, NBSR, SAFETIPS, HES) are now spelled out in full at first mention in the main text.

Comment 16: In Table 3, consider indicating the population and setting…

Response 16: A new column specifying population and setting has been added to Table 3 to improve transparency regarding external validity and applicability to paediatric nursing practice.

Comment 17: Please check for duplicated references and formatting consistency…

Response 17: The reference list has been carefully reviewed. Duplicated entries have been removed, inconsistencies corrected, and all citations cross-checked to ensure that in-text references correspond to the reference list and comply with the journal’s formatting requirements.

Comment 18: The English is generally understandable but would benefit from professional editing to improve fluency, reduce redu

Response 18: We thank the reviewer for this observation. The manuscript has undergone professional language editing by a certified scientific translator and native English editor to improve fluency, clarity, and overall readability. Redundant expressions, long or complex sentences, and minor grammatical inconsistencies have been revised throughout the text. We believe these changes have substantially enhanced the linguistic quality of the manuscript.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The analysis of the article reveals a relevant, timely, and well-documented piece of work; however, it also identifies a set of conceptual, methodological, and editorial weaknesses, particularly at the level of the abstract, introduction, and methods, which should be addressed to ensure scientific coherence, methodological alignment, and greater academic robustness.

With regard to the abstract, the main issue lies in a relevant methodological inconsistency: the study is described as an integrative review, whereas throughout the manuscript it is clearly presented as a scoping review conducted in accordance with the PRISMA-ScR guidelines. This inconsistency is not merely terminological but conceptual, as these are distinct review designs with different objectives and methodological assumptions. This situation may generate confusion among readers and reviewers and should be corrected by aligning the abstract with the review design actually employed. In addition, the abstract includes an excessive level of methodological detail, such as the enumeration of methodological quality assessment tools (CASPe, MMAT, STROBE), levels of evidence, and recommendation systems—elements that are neither central nor expected in a scoping review abstract. This level of detail diverts attention from the core message and may raise concerns regarding the methodological appropriateness of the study. The results are presented in an overly descriptive manner, listing study types and tools without providing a clear synthesis of the main trends identified or the gaps in the existing evidence. The conclusion, in turn, is vague and insufficiently specific, referring generically to positive results without clarifying the contexts, target professionals, or limitations. It is therefore recommended that the abstract be reformulated to clearly reflect that the study is a scoping review, simplify the methodological description, present the results in a more interpretative manner, and conclude with a clear message regarding the limitations of the evidence specific to paediatric nursing and the need for tool adaptation and validation.

Regarding the introduction, although it is well grounded and supported by relevant literature, it is excessively long and descriptive, adopting an overly general progressive approach to patient safety and communication that delays a specific focus on paediatric hospital nursing. This imbalance compromises the flow of the text and dilutes the rationale for the review. The specificity of the paediatric context and the role of nursing emerge late in the section, when they should constitute a central axis from the opening paragraphs. Furthermore, although the problem of information transfer is extensively described, the scientific gap justifying the review is not articulated clearly or directly. There is a lack of an unequivocal statement identifying what remains unknown, what is fragmented in the literature, and why a scoping review specifically focused on nursing in paediatric contexts is necessary. Additionally, the research question is framed as an effectiveness question (“Does the implementation… improve…”), which is more appropriate for intervention-focused systematic reviews than for a scoping review, whose purpose is to map evidence, identify key concepts, and highlight gaps. A reformulation of the introduction is therefore recommended to make it more concise, more clearly oriented toward paediatric nursing, and more explicit regarding the scientific gap. The research question should also be revised to reflect an exploratory and mapping objective aligned with scoping review methodology.

With respect to the methods, although they are generally well described, relevant methodological inconsistencies are identified. The most significant relates to the inclusion of a formal methodological quality assessment, levels of evidence, and grades of recommendation—procedures that are neither mandatory nor routinely recommended in scoping reviews. While not prohibited, their use should be clearly justified, which is not sufficiently achieved in the manuscript. This methodological choice may raise concerns, as it runs counter to the primary aim of a scoping review, which is not to hierarchise evidence or exclude studies based on quality, but rather to map existing knowledge. The inclusion and exclusion criteria, although comprehensive, show some redundancy and overlap, mixing study designs, clinical contexts, professional groups, and document types, which may introduce ambiguity into the selection process. The search strategy, while appropriate, would benefit from a clearer justification of database selection, particularly given the exclusion of relevant databases such as Embase or Web of Science. The study selection process could also be described more transparently, clarifying how disagreements between reviewers were resolved and whether a formal consensus mechanism was used. A revision of the methods section is therefore recommended to reinforce coherence with PRISMA-ScR methodology, clarify and streamline eligibility criteria, justify or reconsider methodological quality appraisal, and align the entire process with the exploratory objectives of the review.

The Results section provides a detailed description of the included studies, the identified tools, and their main characteristics, demonstrating a clear effort to organise and systematise the available evidence. The use of extensive tables and categorisation by tool type and methodology enhances clarity. However, the results tend to be overly descriptive, resembling an inventory of studies rather than a true analytical synthesis, even within the scope of a scoping review. In several instances, information presented in the results is later repeated in the discussion, generating redundancy and weakening the manuscript’s interpretative strength.

Some inconsistency is also observed between the total number of studies initially identified, those excluded based on methodological criteria, and those ultimately included in the final synthesis, which may confuse readers despite the presence of the PRISMA flow diagram. The decision to exclude studies based on methodological quality assessment, although described, raises conceptual concerns, as this practice is not central to scoping review methodology and may bias the overall mapping of available evidence. Moreover, the presentation of results does not sufficiently distinguish between tools that have been specifically applied or validated in paediatric nursing and those derived from adult or medical contexts—an essential distinction given the stated objective of the study. It is therefore recommended that the results be reformulated to strengthen thematic synthesis, clarify the applicability of tools to paediatric nursing contexts, and reduce repetition of content more appropriately addressed in the discussion.

Regarding the Discussion, this section demonstrates good command of the literature and a consistent integration of the included studies, articulating different tools for handover standardisation and assessment. The discussion appropriately highlights that instruments such as SBAR, I-PASS, and Flex 11 show documented benefits in improving communication and patient safety. However, the section tends to adopt an overly affirmative tone regarding the effectiveness of these tools, which is not always sufficiently problematised in light of the methodological limitations of the included studies. In several instances, the discussion approaches causal conclusions or implementation recommendations that exceed the level of evidence mapped, which is particularly sensitive in the context of a scoping review.

Additionally, the discussion would benefit from a more critical analysis of the suitability of these tools for the specific context of paediatric nursing, given that most were developed for medical professionals or adult settings. Although this limitation is acknowledged, its practical implications are not explored in depth. The distinction between handover structuring tools and quality assessment instruments, while introduced, is not consistently maintained throughout the discussion, potentially leading to conceptual ambiguity. There is also some repetition of content already presented in the results, whereas the discussion should prioritise interpretation, comparison across studies, identification of patterns, and critical reflection on gaps and inconsistencies in the evidence. The limitations subsection, integrated into the discussion, is appropriate and transparent, recognising important weaknesses such as the low methodological quality of the available evidence, contextual limitations, and study heterogeneity. However, these limitations could be more explicitly linked to the conclusions drawn, reinforcing interpretative caution and avoiding overgeneralisation. A reformulation of the discussion is therefore recommended to strengthen its critical and reflective character, balance reported benefits with evidence limitations, and more closely align interpretations with the exploratory aims of the review.

With regard to the Conclusion, it provides a synthesis consistent with the results and discussion, underscoring the importance of handover standardisation in improving patient safety and the quality of paediatric nursing care. Nevertheless, the tone is at times overly normative and assertive, suggesting a robustness of evidence that is not fully supported by the body of included studies. While the conclusion reiterates the need to implement standardised tools, it would benefit from greater caution in framing recommendations, more explicitly emphasising that the existing evidence is limited, heterogeneous, and frequently derived from non-paediatric nursing contexts.

On the other hand, the conclusion appropriately outlines future research directions, highlighting the need for adaptation, cultural validation, and contextualisation of existing tools, as well as the development of new instruments based on consensus and current evidence. These proposals are well aligned with the review findings and represent one of the manuscript’s strengths. Nevertheless, it would be desirable for the conclusion to more explicitly reinforce the specific contribution of the scoping review, namely as a map of existing evidence and an identifier of knowledge gaps, rather than presenting itself as a synthesis of effectiveness.

It is suggested that the bibliographic references be updated, as most of the cited references are more than five years old.

Author Response

Comment 1: The analysis of the article reveals a relevant, timely... weaknesses at the level of the abstract, introduction, and methods…

Revision 1: We thank the reviewer for this thorough and constructive evaluation. We have carefully revised the abstract, introduction, and methods sections to reinforce methodological coherence, align the design clearly with PRISMA-ScR guidance, and improve conceptual clarity and robustness.

Comment 2: With regard to the abstract… described as integrative review… excessive methodological detail… results overly descriptive… conclusion vague…

Revision 2: We thank the reviewer for this important observation. The abstract has been revised to consistently reflect the scoping review design, simplify methodological detail, reduce emphasis on appraisal tools, and present findings in a more interpretative manner. The conclusion now explicitly highlights the limited paediatric nursing-specific evidence and the need for adaptation and validation.

Comment 3: Regarding the introduction… excessively long… paediatric focus emerges late… gap not clearly articulated… research question framed as effectiveness question…

Revision 3: We appreciate this observation. The Introduction has been streamlined to prioritise the paediatric nursing context from the outset and to clearly articulate the scientific gap. The research question has been reformulated to reflect an exploratory mapping objective aligned with scoping review methodology.

Comment 4: With respect to the methods… inclusion of methodological quality assessment, levels of evidence, grades of recommendation… not sufficiently justified… inclusion/exclusion criteria redundant… search strategy lacks justification… reviewer disagreement resolution unclear…

Revision 4: We thank the reviewer for this methodological reflection. We have revised the Methods to clarify the descriptive role of quality appraisal and removed hierarchical grading elements not aligned with scoping review methodology. Eligibility criteria have been streamlined, database selection justified, and the reviewer consensus process described more transparently.

Comment 5: The Results section… overly descriptive… inconsistency in numbers… exclusion based on methodological quality raises concerns… insufficient distinction paediatric vs adult tools…

Revision 5: We thank the reviewer. The Results section has been revised to strengthen thematic synthesis, clarify numerical consistency across the PRISMA diagram and text, and explicitly differentiate tools evaluated in paediatric nursing settings from those derived from adult or medical contexts. While methodological appraisal is not mandatory in scoping reviews, we retained it to enhance transparency and interpretative rigour, in response to reviewer feedback. We clarified that the appraisal was used to contextualise evidence strength and guide synthesis, rather than to establish effectiveness hierarchies. The exploratory mapping objective of the review remains unchanged.

Comment 6: Regarding the Discussion… overly affirmative tone… causal conclusions… insufficient critical analysis of suitability for paediatric nursing… repetition from results…

Revision 6: We appreciate this comment. The Discussion has been revised to adopt a more critical tone, explicitly contextualise evidence derived from adult or medical settings, and reduce causal language. Repetitive descriptive elements have been removed to prioritise interpretation and identification of knowledge gaps.

Comment 7: With regard to the Conclusion… overly normative tone… should emphasise mapping function rather than effectiveness synthesis…

Revision 7: We thank the reviewer. The Conclusion has been reformulated to emphasise the exploratory and mapping nature of the scoping review and to explicitly acknowledge the heterogeneity and contextual limitations of the evidence base.

Comment 8: It is suggested that the bibliographic references be updated, as most of the cited references are more than five years old.

Revision 8: We thank the reviewer for this suggestion. While foundational methodological and conceptual studies have been retained for relevance, we have reviewed the reference list and incorporated more recent publications where appropriate to ensure currency of the evidence base.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for reworking your manuscript. I endorse publication.

Reviewer 2 Report

Comments and Suggestions for Authors

I consider that the changes made to the article by the authors make it suitable for publication.