To investigate the role of pelvic floor devices  as adjunctive treatments in pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) after radical prostatectomy.A systematic review with meta-analysis. We searched for randomised controlled trials (RCTs) and prospective non-randomised studies investigating the effectiveness of pelvic floor devices as an adjunctive treatment for SUI symptoms assessed with weight pad-test or standardised questionnaires. To assess the risk of bias (RoB) and overall certainty of evidence, the RoB 2.0 or the ROBINS-I, and the GRADE approach were used.2 = 80.0%; I2 = 80.6%). The overall level of certainty was very low.Eleven RCTs met our eligibility criteria. One was at a ‘low’ RoB, one had ‘some concerns’, while nine were at a ‘high’ RoB. Two meta-analyses were conducted to analyse the pooled results of six RCTs included. Specifically, two RCTs reported at week 4 with a 1h pad test a mean difference of 0.64 , and four RCTs reported at week 12 with a 24h pad test a mean difference of -47.75 . The heterogeneity was high in both analyses (IIn line with our results, we cannot conclude whether pelvic floor devices add any value as adjunctive treatment in the management of SUI after radical prostatectomy. Future studies require more comprehensive and standardised approaches to understand whether these devices are effective. Stress urinary incontinence (SUI) is a common complication after radical prostatectomy . SUI is During the early phase of rehabilitation, different types of feedback are adopted to facilitate the pattern of activation of these muscles , 11. FeeThree previous reviews have compared the effect of pelvic floor devices as adjunctive treatments to PFMT in men with urinary incontinence after radical prostatectomy –23. All In light of the above, we performed a systematic review with meta-analysis to investigate the effect of these devices  as an adjunctive treatment in the management of radical post-prostatectomy SUI symptoms.The protocol of this systematic review was registered into the International Prospective Register of Systematic Reviews . The reporting of this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) 2020 . To condThe primary aim of this systematic review is to analyse the effect of pelvic floor devices  and prospective non-randomised studies were taken into account. No limits on language were set. Case series, single-case studies and systematic reviews were excluded from the analysis. No limitations on the publication date were set. Abstracts and reports from meetings were excluded.We considered eligible for this systematic review only studies addressing men (age > 18 years) with radical post-prostatectomy SUI. No follow-up, symptoms duration and symptom severity limits were set. We excluded studies where participants had any type of comorbidity that could interfere with the pelvic floor training results . People with a history of cancer other than recent prostatectomy were excluded as well. Moreover, we also excluded any other UI types, such as urge incontinence.Studies that investigated the use of a pelvic floor device  as an adjunctive therapy in the management of radical post-prostatectomy SUI were considered eligible. Therefore, studies needed to compare the effectiveness of PFMT with and without the combined use of a device. Any permanent implantable or surgical device was not considered eligible. PFMT was considered as any training involving specifically the contraction of pelvic floor muscles, both supervised and not. No limits on duration or frequency were set. Studies that evaluated a pelvic floor device in isolation were excluded.The primary outcome of this study was the severity of UI symptoms measured either through gold standard objective measures  or self-reported tools . No limits on repetitions  were set. The secondary outcome was HRQoL.As suggested by the Cochrane Handbook for Systematic Reviews of Interventions  we choseThe search was conducted by three authors . The search strategy was a combination of Medical Subjects Headings, Boolean operators  and the keywords “urinary incontinence”, “stress”, “prostatectomy”, “male”, “physical and rehabilitation medicine”, “pelvic floor”, “exercise”, “feedback”, “lower urinary tract symptoms”, and “incontinence impact questionnaire”. The research strings for every database are reported in Supplementary Materials .Articles were uploaded onto Rayyan Website after duplicate removal . AfterwaTwo researchers (B.G. and G.L.) independently extracted the following data from each study using standardised Excel templates: authors, year of publication, country, setting, study design, the total number of participants, age, number in each group, type of intervention and control, the timing of administration of intervention and baseline, post-intervention and follow-up (when available) points estimates, measures of variability of main outcomes and authors key conclusion. Results for both primary and secondary outcomes were extracted. To be able to make a comparison between outcomes and to facilitate the eventual meta-analysis, data were divided based on the times of assessment  and the tests adopted . Authors of studies where data were not completely displayed were contacted. In case of disagreement in the data extraction process, a third author (S.B.) was consulted to gain a consensus.The risk of bias and methodological quality of the included studies were independently assessed by two authors (B.G. and G.L.). For randomised controlled trials, we used the Revised Cochrane risk-of-bias tool 2.0 (RoB 2.0), recommended to assess the risk of bias in Cochrane Reviews . This to2 statistic. The overall certainty of the evidence and strength of the recommendations were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach   , 40. TheIn 2 = 80.0%; I2 = 80.6%] with a level of evidence very uncertain, consistent with the following sensitivity analysis. In line with that, we could not conclude whether the adjunctive use of devices may enhance or not improve SUI symptoms following radical prostatectomy. This finding contrasts with the results of the reviews by Sciarra et al., Silva E.B., and Hsu L. et al. The first review summarised the evidence of the biofeedback and electric stimulation for radical post-prostatectomy UI https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, AttachmentManuscript.docxSubmitted filename: Click here for additional data file.AttachmentManuscript Reviewer 1.docxSubmitted filename: Click here for additional data file. 6 Jul 2023RESPONSE LETTER: #PONE-D-22-34371 EMID:553d4bd8f5e8e815To the kind attention of:the Editor-in-Chief, Ana Katherine Goncalves;the Entire review Board of PLOS ONE;the reviewers: Timothy Uzoma Mbaeri & Ricardo Ney Cobucci.On behalf of myself and all the authors of the manuscript, we would like to thank you for the effort, professionalism, and time employed in reviewing our study. Based on your constructive and positive comments we have denoted a great improvement in the quality of the work, hoping that it can be considered for publication in your renowned journal.In the following paragraphs, you will find all the comments highlighted by the reviewers, our answers, and the references to the modification in the text of the revised manuscript. All parts modified or added to the original paper have been highlighted in yellow on the pdf.Reviewer 1 comments:“Please look at the corrections and comments made in the body of the article. I think with minor corrections as outlined or explanations on the queries raised, the work is good for publication. My recommendations are as stated in the body of the article.”Authors’ comments: Thank you for your time and assistance. Based on your feedback we have made some improvements and corrections to the study. In general, we have revised the included studies and decided to implement the studies between January 2022 and June 2023. In this way the review will be more updated. Moreover, based on the suggestion of another reviewer we have run a sensitivity analysis. We hope we have ensured a better quality!-----------------------------------------------------------------------------------------------------------------------------------------------“Title: What type of prostatectomy? Please specify.” “Introduction: Specify the prostatectomy you mean. I can guess you are talking about radical prostatectomy. State it clearly”.Authors’ comments: Thank you for specifying that. We refer to ‘radical prostatectomy’, as you have guessed by reading the manuscript. We have therefore clarified that we referred to ‘radical prostatectomy’.Authors’ actions: We have added the word ‘radical’ to ‘post-prostatectomy’ or ‘prostatectomy’ all over the manuscript.-----------------------------------------------------------------------------------------------------------------------------------------------“Objective: I think you should state all the once you actually tested. Remove the etc so the work can be reproducible”.Authors’ comments: We think that you have absolute right here, as it was not clear and reproducible. Therefore, we have removed the ‘etc.’ as you have suggested. Authors’ actions: Pag 4, Lines 85-86: the word ‘etc.’ has been removed.-----------------------------------------------------------------------------------------------------------------------------------------------“Methods, Population: These exclusion criteria were of the studies to make and not you. So, how were you able to determine that the authors did this exclusion if it were not in their exclusion criteria?”Authors’ comments: Thank you for this specification. We could not determine if the authors did this exclusion unless it was declared otherwise. Our intention, in declaring this, was to specify that we would have excluded any study in which these criteria were declared by the authors.Authors’ actions: We have tried to better explain that these criteria were analysed in the investigating studies and only if these characteristics declared by the authors they were excluded. The paragraph has been amended as follows: Page 4, line 96-101: “We considered eligible for this systematic review only studies addressing men (age > 18 years) with radical post-prostatectomy SUI. No follow-up, symptoms duration and symptom severity limits were set. We excluded studies where participants had any type of comorbidity that could interfere with the pelvic floor training results . People with a history of cancer other than recent prostatectomy were excluded as well. Moreover, we also excluded any other UI types, such as urge incontinence.”.-----------------------------------------------------------------------------------------------------------------------------------------------“Methods, Primary Outcomes: Can we have two gold standards in one assessments? Why not stick with the pad test? Pad test is objective while iciq test is subjective. We can only compare studies that used the same outcome measures or validated comparable outcome measures if they are different.”Authors’ comments: We’d like to thank the reviewer for highlight this. Actually, our primary outcome was not the pad test, as this is an outcome measure. Rather, as also reported in the protocol, it was UI symptoms. We have modified the paragraph as reported below. However, we found just one study that used a subjective and validated outcome, but the same study did not report the data. As stated in the paper, we have tried to contact the authors but they did not get back to us. Therefore, the study by Marchiori et al. has been removed, leaving only the studies that adopted the objective pad weight test outcome. Authors’ actions: Paragraph ‘Types of outomes’, Pag 5 lines 112-114 has been amended as follows: “The primary outcome of this study was the severity of UI symptoms measured either through gold standard objective measures  or self-reported tools . No limits on repetitions  were set.”The following lines in ‘Results’ section have been added: Page 7, lines 188-192: “One study that adopted a subjective outcome measure as primary outcome also reached the final screening phase, however data results were not reported in the manuscript. We contacted the authors for raw data, but they did not get back to us (41). Therefore, we have excluded this paper as we did not know whether it really answered our research question (41)”The Marchiori et al. study has been removed from the final included studies.-----------------------------------------------------------------------------------------------------------------------------------------------“Results, Table 1: Marchiori D., Bertaccini A., Manferrari F, Ferri C. and Martorana G did not state what was used and thus should be excluded. If there is no result on the outcome measure, should it be used for the study. It is an incomplete study and should not be used.”Authors’ comments: We agree with your opinion in this case, since there was no declaration on what was used. For this reason, we have agreed to remove this study from the included studies. Authors’ actions: Marchiori et al. study has been removed from the included study.-----------------------------------------------------------------------------------------------------------------------------------------------“Results, Table 2: De Santana 2017 and Marchiori 2010: If there is no result on the outcome measure, should it be used for the study. It is an incompletes studies and should not be used.”Authors’ comments: As reported above, we have removed Marchiori et al. study. We do not agree with the exclusion of De Santana et al. study, though. De Santana et al. did use the pad test; however, they did not report the pad weight data, but a severity classification based on the pad test, that is, in our opinion a serious reporting bias (‘High’ risk of bias), but not for this reason should be excluded. Authors’ actions: Marchiori et al. study has been removed from the included study.-----------------------------------------------------------------------------------------------------------------------------------------------“Results, Page 16: Primary outcome – weight pad test. This result is not congruent with the report table where two works did not give data on their primary outcome measure. Santana and Marchiori. Check and explain please.”Authors’ comments: thank you for this specification. We have tried to better declare what we have found based on the studies’ reported data. Therefore, we have declared that ‘De Santana’ did report an increase in UI symptoms, but that their reported data were changes in symptoms’ classification based on the amount of pad weights. Marchiori, instead, has been completely removed from the included studies, since authors did not report data (as mentioned above).Authors’ actions: the ‘Results’ section in Pag 18, lines 2-8, has been amended as follows:“Regarding the weight pad test, four studies found that the intervention group reduced this outcome compared to the control group . On the other hand, one study, as in the previous studies, found a reduction compared to the control group, but its magnitude was lower (34). Five studies found no difference between the intervention and control groups . Finally, one study (38) reported that the intervention reduced the 1h pad weight compared to control group, but authors did not report the pad weight data in grams, instead they reported a urine severity symptoms classification of participants, based on the amount of pad grams , before and after the treatment.”-----------------------------------------------------------------------------------------------------------------------------------------------“Discussion, Page 18 2nd paragraph: State the heterogeneity you noted and why in your estimation you think the studies are faulted to the extent of the information you got. That is what makes it a discussion.”Authors’ comments: Thank you for this consideration. We have stated the heterogeneity we noted in the ‘Discussion’ section, and we have tried to better explain what might have affected the heterogeneity of our results .Authors’ actions: Pag 21, Line 8, the I2 Index has been added: I2 = 80.0%; I2= 80.6%.Pag 21, Lines 26-29 have been amended as follows: “The coexistence of these results may be linked to the different ways in which PFMT is delivered, contributing to the high heterogeneity of PFMT treatment outcomes and study results. Besides the high risk of bias of studies included, three elements discussed hereafter might have contributed to increasing the heterogeneity of our results: supervision, load, and type of PFMT.”.Pag 22, Lines 58-59 have been amended as follows: “Furthermore, given the general trend of results in favour of the adoption of devices in addition to PFMT, since none of the control groups adopted a sham intervention, it is worth questioning if these results reflected a real efficacy of the devices or a general placebo response (51).”Pag 23, Lines 67-68, the following sentence has been added: “Future studies should adopt sham therapies for control groups to better contain the placebo effect of these devices, but researchers might also give voice to patients to explore the aspects presented above and to understand the perceived usefulness of these treatments. While waiting for future evidence to shed some light on the efficacy of these devices in SUI after prostatectomy, clinicians might opt to choose (or not) these devices based on other factors ”.The following ‘Discussion’ section has been amended as follows: Pag 21, Lines 10-21:“This finding contrasts with the results of the reviews by Sciarra et al., Silva E.B., and Hsu L. et al. The first review summarised the evidence of the biofeedback and electric stimulation for radical post-prostatectomy UI (21). In this review, the authors affirmed that the devices in the management of UI following radical prostatectomy improved the incontinence recovery rate within the first 3 months compared with PFMT alone (21). However, their review was not focused on SUI symptoms and did not provide a level of certainty about the reported results (GRADE approach). The second, instead, investigated the beneficial effects of biofeedback-assisted PFMT, suggesting that biofeedback-assisted PFMT exerts beneficial effects on improving SUI after radical post-prostatectomy (23). However, they did not focus on SUI symptoms and did not provide a level of certainty about the reported results as well. Conversely, in the review of Zaidan P. and Da Silva E.B. (22) they concluded that electric stimulation associated with PFMT did not show additional benefit. However, they did not perform a meta-analysis. Overall, we can conclude that there is a need of more evidence to understand whether or not these devices are effective as an adjunctive therapy to PFMT.”-----------------------------------------------------------------------------------------------------------------------------------------------“Discussion: Revise and cite all references.”Authors’ comments: Thank you for this note. We have revised the references and corrected them where necessary. Authors’ actions: The following references have been added: 1. Pag 21, Line 12, 14, the reference n° 21 has been added.2. Pag 21, Line 19, the references n°22 has been added.3. Pag 21, Line 17, the references n°23 has been added.4. Pag 22, Line 59, the reference n° 51 has been added. Reviewer 2 comments:“The authors in the meta-analysis sought to evaluate the effectiveness of interventions such as biofeedback and electrical stimulation in controlling stress urinary incontinence after prostatectomy. Eleven clinical trials with more than a thousand patients were included, which confers an important value to the study. However, there is a need for some improvements that I highlight by sections:”Authors’ comments: Thank you for your time and assistance. We followed your suggestions and improved the quality of our study. In particular, we have updated our research until June 2023, and we have improved the introduction and discussions sections. However, we did not feel like to perform a publication bias analysis and due to reasons explained below. We hope that our improvements have increased the quality of our study in a relevant way.-----------------------------------------------------------------------------------------------------------------------------------------------https://doi.org/10.1590/1980-5918.029.003.AO21 / http://dx. doi.org/10.1016/j.ijnurstu.2016.03.013.”“Introduction: It could be improved with one more paragraph, in which the authors should highlight what this systematic review adds to the evidence of others previously published: Authors’ comments: Thank you for suggesting adding this paragraph. We agree that a paragraph highlighting the adding value of our review would be relevant. Therefore, we have added a new paragraph that discusses what our study adds compared to previous existing studies. Authors’ actions: The following paragraph has been added to the ‘Introduction’ section, Pag 3, lines 64-72: “Three previous reviews have compared the effect of pelvic floor devices as adjunctive treatments to PFMT in men with urinary incontinence after radical prostatectomy (21–23). All of them concluded that the adoption of pelvic floor devices is beneficial for improving urinary incontinence symptoms; however, some limits need to be disclosed. Zaidan P. and Da Silva E.B. (22) investigated the effectiveness of PFMT with or without electrical stimulation without performing a meta-analysis. Hsu L. et al. (23), in their review with meta-analysis, investigated the beneficial effects of biofeedback-assisted PFMT, but the biofeedback was intended also as verbal feedback and the interventions were sometimes applied before the prostatectomy. Finally, Sciarra et al. (21) performed a review with meta-analysis to investigate the effects of a biofeedback-guided programme or pelvic floor muscle electric stimulation but did not provide a level of certainty of the reported results. Moreover, none of these reviews focused on SUI symptoms.”-----------------------------------------------------------------------------------------------------------------------------------------------“Methodology: First, the search strategy should be updated with articles published in 2023 and there should not be a limitation of including only articles published in English, as today there are tools that allow good translation into any language.”Authors’ comments: We have updated our review screening the articles that we rejected previously due to language. Unfortunately, only was study (south Korean) met our inclusion criteria. Moreover, we also run a new research from January 2022 to June 2023. We thank you for that, because with updating our research we have improved the quality of our study!Authors’ actions: We have included and screened the studies which language was different from English, and we have updated our research until June 2023. The Figure 1 (PRISMA) has been updated. One study has been added into the final included studies. -----------------------------------------------------------------------------------------------------------------------------------------------“Methodology: Sensitivity analysis should be included in the methodology and performed. An example is to perform a sensitivity meta-analysis in the clinical trials of the 24h Pad test subgroup, removing one study at a time and checking for changes in mean difference and heterogeneity.”https://handbook-5-1.cochrane.org/chapter_9/9_7_sensitivity_analyses.htm). Authors’ comments: Thank you for this consideration. Priorly, we did not declare we would have run a sensitivity analysis on our ‘Prospero Protocol’, still, based on your suggestion, we decided to implement it because we thought it would have been interesting. We could not divide the studies based on the risk of level because they were all at ‘high’ risk, therefore we could not use this criterion for the sensitivity analysis. Moreover, we could not change from a random to fixed effect, since we declared in the protocol that we would have adopted a random one as fixed-effect might not be appropriate based on the evidence on this topic. Finally, we choose not to adopt the ‘leave-one-out’ method for different reasons: potential bias results, lack of justification and limited insight into robustness . Authors’ actions: In the ‘methodology’ section, Pag 7 the following lines (175-177) have been added: “A sensitivity analysis was run to evaluate the robustness of our findings. Specifically, we explored the effects of the devices plus PFMT by clustering them based on their type .”The sub-paragraph ‘Sensitivity analysis’ has been added to the ‘Results’ section, Pag 18-19, Lines 30-36: “Based on the used devices, we have divided the studies to run a sensitivity analysis. Among the four studies included in meta-analysis of 24h pad test at week 12, only two adopted the same type of device  . The results of the sensitivity analysis were in line with the previous analysis, with a heterogeneity of I2 = 83.8% and a mean difference of -40.08  . We did not run a sensitivity analysis of 1h pad test at week 4 because only two studies were included in the meta-analysis.”The file ‘Supplementary material 2’ containing the results of the sensitivity analysis of the ‘24h Pad test at week 12’, subdivided by device adopted, has been added to the manuscript files. -----------------------------------------------------------------------------------------------------------------------------------------------“Methodology: It is not correct to state that analysis of publication bias cannot be performed due to the small number of trials in the meta-analysis. I suggest that the authors see how to do the analysis with Egger test.”Authors’ comments: We would like to thank the reviewer for highlighting this. Cochrane Library states that funnel plot asymmetry should be used only when there are at least 10 studies included in the meta-analysis, otherwise the test’s power will be too low. We did include 11 studies in the systematic review, but not in the meta-analyses, which were fewer than 10. In addition, the Cochrane reports that the Egger’s test is potentially misleading for continuous outcomes, which were our cases. Please, have a look at the following references.https://training.cochrane.org/resource/identifying-publication-bias-meta-analyses-continuous-outcomesReferences: https://training.cochrane.org/handbook/current/chapter-13https://www.sciencedirect.com/science/article/pii/S0895435699002048?via%3DihubAuthors’ actions: No actions were taken.-----------------------------------------------------------------------------------------------------------------------------------------------“Results: results after sensitivity analysis will need to be included and whether publication bias exists after applying the Egger test this should also be put in the section.”Authors’ comments: Thank you for specifying this. Based on the adopted methodology for the sensitivity analysis, explained above, we have conducted and commented the results of the analysis. Unfortunately, we could not match many studies based on the device adopted, therefore only two included studies were eligible for the analysis. The results, anyway, were consistent with the synthesis of results. Authors’ actions: The sub-paragraph ‘Sensitivity analysis’ has been added to the ‘Results’ section, Pag 18-19, Lines 30-36: “Based on the used devices, we have divided the studies to run a sensitivity analysis. Among the four studies included in meta-analysis of 24h pad test at week 12, only two adopted the same type of device  . The results of the sensitivity analysis were in line with the previous analysis, with a heterogeneity of I2 = 83.8% and a mean difference of -40.08  . We did not run a sensitivity analysis of 1h pad test at week 4 because only two studies were included in the meta-analysis.”The following sentence has been added to the ‘discussion’ section, Pag 21, lines 6-8: “From the pooled results of the two meta-analyses and the GRADE assessment, we found a high heterogeneity among studies  with a level of evidence very uncertain, consistent with the following sensitivity analysis.”-----------------------------------------------------------------------------------------------------------------------------------------------http://dx.doi.org/10.1016/j.ijnurstu.2016.03.013).“Discussion: It is well-built, but if new clinical trials published between January 2022 and May 2023 are to be included, it should be reformulated. In addition, a comparison of the results of this meta-analysis with the one I suggested including in the introduction can be carried out . In this review, the authors affirmed that the devices in the management of UI following radical prostatectomy improved the incontinence recovery rate within the first 3 months compared with PFMT alone (21). However, their review was not focused on SUI symptoms and did not provide a level of certainty about the reported results (GRADE approach). The second, instead, investigated the beneficial effects of biofeedback-assisted PFMT, suggesting that biofeedback-assisted PFMT exerts beneficial effects on improving SUI after radical post-prostatectomy (23). However, they did not focus on SUI symptoms and did not provide a level of certainty about the reported results as well. Conversely, in the review of Zaidan P. and Da Silva E.B. (22) they concluded that electric stimulation associated with PFMT did not show additional benefit. However, they did not perform a meta-analysis. Overall, we can conclude that there is a need of more evidence to understand whether or not these devices are effective as an adjunctive therapy to PFMT.”-----------------------------------------------------------------------------------------------------------------------------------------------AttachmentResponse to Reviewers.docxSubmitted filename: Click here for additional data file. 24 Jul 2023The added value of devices to pelvic floor muscle training in radical post-prostatectomy stress urinary incontinence: a systematic review with metanalysisPONE-D-22-34371R1Dear Dr. Marco Testa <div style="color: rgb; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; outline: none !important;"> Article type: Research Article </div>  <div style="color: rgb; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; outline: none !important;">   </div> We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.Within one week, you’ll receive an e-mail detailing the required amendments. 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For more information, please contact Kind regards,Ana Katherine Gonçalves, Ph.D.Academic EditorPLOS ONEAdditional Editor Comments :The authors followed of the reviewers' recommendations and the manuscript is appropriate for publication.Reviewers' comments:Reviewer's Responses to Questions <font color="black"> Comments to the Author </font> 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.Reviewer #2: All comments have been addressedReviewer #3: All comments have been addressed********** <font color="black"> 2. Is the manuscript technically sound, and do the data support the conclusions? </font> The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: YesReviewer #3: Yes********** <font color="black"> 3. Has the statistical analysis been performed appropriately and rigorously?  </font> Reviewer #2: YesReviewer #3: Yes********** <font color="black"> 4. Have the authors made all data underlying the findings in their manuscript fully available?PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. </font> The Reviewer #2: YesReviewer #3: Yes********** <font color="black"> 5. Is the manuscript presented in an intelligible fashion and written in standard English? </font> PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.Reviewer #2: YesReviewer #3: Yes********** <font color="black"> 6. Review Comments to the Author </font> Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. Reviewer #2: The authors met most of the reviewers' recommendations and the manuscript is in better shape for publication. Congratulations.Reviewer #3: The authors followed of the reviewers' recommendations and the manuscript is appropriate for publication.********** <font color="black"> 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.If you choose “no”, your identity will remain anonymous but your review may still be made public.Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. </font> Yes: Ricardo Ney CobucciReviewer #2: Reviewer #3: No********** 26 Jul 2023PONE-D-22-34371R1 The added value of devices to pelvic floor muscle training in radical post-prostatectomy stress urinary incontinence: a systematic review with metanalysis Dear Dr. Marco:I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. onepress@plos.org.If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact plosone@plos.org. 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The interaction between smoking and asthma impairs lung function and increases airflow obstruction severity. The identification of smoking patterns in smokers with and without asthma is crucial to provide the best care strategies. The aims of this study are to estimate asthma frequency, describe asthma features, and characterize smoking in smokers attending smoking cessation units.We carried out a cross-sectional study in five smoking cessation units with different geographical distribution to estimate asthma frequency in smokers, characterize asthma features in smokers, as well as smoking in asthmatic smokers.Asthma frequency among smokers was 18.6%. Asthmatic smokers presented high passive exposure, low smoking self-efficacy and will to quit smoking, as well as a high exacerbation frequency, severe symptoms, and frequent use of long-acting beta agonists, inhaled steroids, and short-acting beta agonists.Smokers with asthma constitute a high-risk group with worsened evolution of pulmonary involvement. All smokers should be regularly screened for asthma. Effective smoking cessation strategies should be proposed to smokers with asthma in order to reverse the harmful effects of smoking on the airway, together with a comprehensive and integral approach. Tobacco smoking is the leading cause of preventable premature mortality in the world . Indeed,On the other hand, asthma is a chronic airway disease, affecting around 7.5% of the adult population, characterized by variable airway obstruction, airway hyperresponsiveness, and airway inflammation . It is ie.g., chronic mucus hypersecretion) in the asthmatic airways, explaining the reported accelerated lung function decline and increased airflow obstruction severity Reviewers' comments:Reviewer's Responses to Questions  Comments to the Author1. Is the manuscript technically sound, and do the data support the conclusions?  The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly**********  2. Has the statistical analysis been performed appropriately and rigorously?   Reviewer #1: Yes**********  3. Have the authors made all data underlying the findings in their manuscript fully available?PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.  The Reviewer #1: Yes**********  4. Is the manuscript presented in an intelligible fashion and written in standard English?  PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.Reviewer #1: Yes**********  5. Review Comments to the Author  Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. Reviewer #1: General commentThis is an original paper which assess the frequency and smoking characteristics of asthmatic patients attending 5 different smoking cessation units in Spain.An adequate number of study subjects is analysed. The topic is of interest for respiratory physicians. The reasearch need to be improved, particularly in the analysis of lung function and outcome of smoking cessation.Specific commentsMajor- The title should contain information on the fact that the study subjects are smokers attending smoking cessation units.- Considering that the study subjects are smokers attending smoking cessation units, the study should include a multivariate analysis assessing the variables possibly associated with smoking cessation at least at short-medium term (e.g. 4-12 weeks from the start of the smoking cessation program) for asthmatic/non-asthmatic smokers.- It is unclear if the presented data about the "Smoking cessation interventions" and "Relapse" (Table 4) are related to previous quit attempts or to the actual attempt at the moment of the enrollment in the study.- The frequency of airway obstruction in the study subjects should be reported. Obstruction should be defined as FEV1/FVC < 5th percentile of the predicted value, by applying GLI equations - Discussion section: "We would like to highlight the significantly lower smoking cessation support in asthmatic smokers found in our study." . This affirmation should be further clarified in relation to the presented results.- Discussion section: "However, these patients had significant pulmonary involvement regardless of smoking and did not achieve good smoking cessation rates." . This affirmation should be further clarified in relation to the presented results and to those to be added in a revised version of the manuscript.Minor- The abstract lacks of a clear aim of the study.- "packs per year" should be replaced by: pack-years, throughout the manuscript. In the Material and methods section it should be reported how "packs per year"/pack-years were calcutated.- Material and methods section. The used lung function protocol should be reported.- Material and methods section. Reference and description of the UISPM=Test de la Unidad del Instituto de Salud Pública de Madrid should be reported.- In the title of Table 1, 2, 3 and 4 it should be reported the total number of the study subjects (n=329). Within each table, a note reporting that there were missing data for some indicated variable should be added.- "Table 2" is not quoted in the text of the Results section.- Table 2. It should be clarified that Table 2 refers only to the smokers with diagnosis of asthma.- Title of Table 3: correct "Tabla 3".- Table 3. Those reported in this table are clinical and respiratory function characteristics in addition to demographic characteristics. The title should be corrected accordingly.- Table 3. FEV1, FVC, and PEF lack of units of measurement.- Table 3: numbers and percentages of the obstructed study subjects should be added.- Table 3. Information on cannabis use are lacking.- Table 4. "CO levels " and "HbCo levels" lack of units of measurement.**********  6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.If you choose “no”, your identity will remain anonymous but your review may still be made public.Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.  Yes: Francesco PistelliReviewer #1: **********https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool,  3 Oct 2023PONE-D-23-14534Frequency and Differential Characteristics of Asthma in SmokersDear Editor and reviewers,We would like to thank you for all the constructive comments and suggestions. We really appreciated them and are confident that will clearly contribute to improving the manuscript. See below our responses (in blue) to your comments (in black) and applied changes.Looking forward to your response,Juan Antonio Riesco on behalf of the authors*****************************************************************************REVIEWER #1: General commentThis is an original paper which assess the frequency and smoking characteristics of asthmatic patients attending 5 different smoking cessation units in Spain.An adequate number of study subjects is analysed. The topic is of interest for respiratory physicians. The research needs to be improved, particularly in the analysis of lung function and outcome of smoking cessation.Specific comments. Major- The title should contain information on the fact that the study subjects are smokers attending smoking cessation units.We agree with the reviewer; we have modified the title according to his suggestion. The current title is:Title page: Frequency and characteristics of Asthma in smokers attending smoking cessation units in Spain. ------------------------------------------------------------------------------------------------------------------------------- Considering that the study subjects are smokers attending smoking cessation units, the study should include a multivariate analysis assessing the variables possibly associated with smoking cessation at least at short-medium term (e.g. 4-12 weeks from the start of the smoking cessation program) for asthmatic/non-asthmatic smokers.Thanks for the comment. The analysis of the factors associated with smoking cessation and possible differences in asthmatics vs non-asthmatics can be very interesting. However, these factors are not the focus of the study and, therefore, information on possible determinants or confounding factors of smoking cessation  may be incomplete.------------------------------------------------------------------------------------------------------------------------------- It is unclear if the presented data about the "Smoking cessation interventions" and "Relapse" (Table 4) are related to previous quit attempts or to the actual attempt at the moment of the enrollment in the study.We agree that Table 4, on differential characteristics of smoking between asthmatics and non-asthmatics, is difficult to understand. To make it easier to read, we have modified the table by grouping related variables under the same characteristic (in bold type). Thus, the variables related to any quit attempt are grouped together, as well as those referring to the last attempt, regularity of the habit, reward, dependence, or others. ------------------------------------------------------------------------------------------------------------------------------- The frequency of airway obstruction in the study subjects should be reported. Obstruction should be defined as FEV1/FVC < 5th percentile of the predicted value, by applying GLI equations The spirometer software has the GLI equations implemented, so the results are already expressed as adjusted. However, we agree on the importance of adding some additional information. In this sense, we have calculated the FEV1/FVC ratio and the percentage of patients with chronic airflow limitation, defined by an FEV1/FVC ratio <0.70. (Page 11). ------------------------------------------------------------------------------------------------------------------------------- Discussion section: "We would like to highlight the significantly lower smoking cessation support in asthmatic smokers found in our study." . This affirmation should be further clarified in relation to the presented results.Thanks for the comment. This sentence is based in results shown in table 4, with a lower proportion of support to quit smoking in asthmatics versus no-asthmatics (60% vs. 77%). On the other hand, we have added some bibliographic reference in the discussion to support this result (page 16).------------------------------------------------------------------------------------------------------------------------------- Discussion section: "However, these patients had significant pulmonary involvement regardless of smoking and did not achieve good smoking cessation rates." . This affirmation should be further clarified in relation to the presented results and to those to be added in a revised version of the manuscript. The reviewer is right. The sentence is confusing. The idea is to emphasize that the absence of differences in quit rates between asthmatics and no asthmatics probably points to the need to use more intensive intervention strategies in asthmatic smokers because of the impact of smoking on the asthmatic patient's lung function. We have added a short explanation in this regard, as well as bibliography that supports our results (page 16).Minor- The abstract lacks a clear aim of the study.The reviewer is right, thank you very much for the comment. We have added a sentence with the main purposes of the study (page 2). ------------------------------------------------------------------------------------------------------------------------------- "packs per year" should be replaced by: pack-years, throughout the manuscript. In the Material and methods section, it should be reported how "packs per year"/pack-years were calcutated.Thank you very much for the comment. We have added a sentence on how to calculate the number of pack-years in the methods section . In addition, we have changed the expression “packs per year” by “pack-years” throughout the text, as suggested by the reviewer. ------------------------------------------------------------------------------------------------------------------------------- Material and methods section. The used lung function protocol should be reported.The reviewer is right. Thank you for your comment. We have added the requested information and referenced it in the relevant section (page 7). ------------------------------------------------------------------------------------------------------------------------------- Material and methods section. Reference and description of the UISPM=Test de la Unidad del Instituto de Salud Pública de Madrid should be reported.Indeed, we agree that the information on this test is scarce in the article. Consequently, we have added a short explanation of this tool as well as the corresponding bibliography in Methods section (page 8). ------------------------------------------------------------------------------------------------------------------------------ In the title of Table 1, 2, 3 and 4 it should be reported the total number of the study subjects (n=329). Within each table, a note reporting that there were missing data for some indicated variable should be added.Certainly, the n changes in different variables due to missing values (that is why the n of each variable was placed in each row). In order to lighten the table, the partial n's have been suppressed and a sentence about the existence of missing values has been added.------------------------------------------------------------------------------------------------------------------------------- "Table 2" is not quoted in the text of the Results section.Explanation of table 2 has been quoted in the text (page 10).------------------------------------------------------------------------------------------------------------------------------- Table 2. It should be clarified that Table 2 refers only to the smokers with diagnosis of asthma.Thanks for the comment. An explanatory sentence has been added before describing table 2 (page 10).------------------------------------------------------------------------------------------------------------------------------- Table 3: • Title correct "Tabla 3". The spelling error has been corrected (page 12) • Those reported in this table are clinical and respiratory function characteristics in addition to demographic characteristics. The title should be corrected accordingly. Title has been modified according to the reviewer’s suggestion (page 11).• FEV1, FVC, and PEF lack of units of measurement. Corresponding units have been added to respective parameters in table 3. ------------------------------------------------------------------------------------------------------------------------------Numbers and percentages of the obstructed study subjects should be added. The chronic air flow limitation, defined by a FEV1/FVC ratio <0.70, has been calculated and added to lung function parameters in table 3. ------------------------------------------------------------------------------------------------------------------------------Information on cannabis use is lacking.No specific information on cannabis use was collected.------------------------------------------------------------------------------------------------------------------------------- Table 4. "CO levels " and "HbCo levels" lack of units of measurement. The corresponding units have been added to the table (ppm for CO levels and % for HbCO levels) (page 14).AttachmentPNE-D-23-14534_R1-Response to reviewers.docxSubmitted filename: Click here for additional data file. 6 Nov 2023Frequency and characteristics of Asthma in smokers attending smoking cessation units in SpainPONE-D-23-14534R1Dear Dr. Riesco,We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at onepress@plos.org.If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact Kind regards,Manlio MilaneseAcademic EditorPLOS ONEAdditional Editor Comments :Reviewers' comments:Reviewer's Responses to Questions  Comments to the Author  1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.Reviewer #1: All comments have been addressed**********  2. Is the manuscript technically sound, and do the data support the conclusions?  The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes**********  3. Has the statistical analysis been performed appropriately and rigorously?   Reviewer #1: Yes**********  4. Have the authors made all data underlying the findings in their manuscript fully available?PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.  The Reviewer #1: Yes**********  5. Is the manuscript presented in an intelligible fashion and written in standard English?  PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.Reviewer #1: Yes**********  6. Review Comments to the Author  Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. Reviewer #1: The authors have adequately addressed the comments raised by this reviewer and the manuscript is now improved.**********  7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.If you choose “no”, your identity will remain anonymous but your review may still be made public.Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.  Reviewer #1: No********** 27 Nov 2023PONE-D-23-14534R1 Frequency and characteristics of Asthma in smokers attending smoking cessation units in Spain Dear Dr. Riesco:I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. onepress@plos.org.If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact customercare@plos.org.If we can help with anything else, please email us at Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staffon behalf ofDr. Manlio Milanese Academic EditorPLOS ONE


Every country has seen multiple waves of this disease, placing a considerable strain on healthcare resources. Across the world, the pandemic has motivated diligent data collection, with an enormous amount of data being available in the public domain. In this manuscript, we collate COVID-19 case data from around the world  website), and provide various definitions for waves. Using these definitions to define labels, we create a labelled dataset, which can be used while building supervised learning classifiers. We also use a simple eXtreme Gradient Boosting (XGBoost) model to provide a minimum standard for future classifiers trained on this dataset and demonstrate the utility of our dataset for the prediction of (future) waves. This dataset will be a valuable resource for epidemiologists and others interested in the early prediction of future waves. The datasets are available from  The COVID-19 pandemic has been a significant threat to global public health, and has continued to spread throughout the world, wreaking havoc on the healthcare infrastructure . DespiteR0) forms a key challenge in nearly all of these methods. However, for all these models, the evaluation typically requires labelled data. Machine Learning classifiers can also be used to predict waves, without having to estimate the various parameters of the SIR model.Multiple approaches have been attempted when trying to predict COVID-19 waves. The pandemic has been notoriously difficult to predict accurately . VariousIn this manuscript, we provide a cleaned labelled dataset, ‘COWAVE’. Our dataset contains labels on whether each day was part of a “wave” or not, along with multiple helpful features extracted from the data. We also provide a baseline supervised classifier that can be helpful when comparing the performance of any classifier trained on COWAVE. We believethat scientists would find COWAVEhelpful, for building models that learn the dynamics of various kinds of COVID-19 outbreaks, and use it to predict new waves of the pandemic, quickly and reliably. The rest of this manuscript is organised as follows: we first present the data source and methods for smoothing the data and defining waves for labelling the dataset. We then present the datasets generated in this study. We then go on to discuss example classifiers and their predictions, along with possibilities for feature generation and selection.https://github.com/RamanLab/COWAVE/). The codes were all written in Python 3, and the analyses were performed on the cloud, using Google Colaboratory (https://colab.research.google.com/).In this section, we describe the source of our data, various smoothing algorithms and our approach to defining waves. All codes used in this study, and the datasets generated, are available from GitHub . The columns of the dataset provide the Date Reported, the Country Name and Code, and the WHO Region, along with the new and cumulative cases and death counts. No preprocessing was performed. Two things must be noted. The first is that the new case count suddenly becomes 0 or very low for certain dates. This is likely due to no testing being done on those days/improper testing. A moving average can be used to interpolate these points, but we do not do so since smoothing will be done later.All data were obtained from the World Health Organization (WHO) website  is fitted locally to each subset. Points closer to the point whose response is estimated are given higher weights.Locally Weighted Scatter-plot Smoothing (LOWESS) is a common method used for the smoothing of scatter-plot data. It is a method equivalent to the Savitzky-Golay filter and was rediscovered by Cleveland . Based oThe only problem with LOWESS is that it does not provide the polynomials used to approximate the dataset. In a way, it is a black box. However, this is not a problem here since we are only interested in smoothing the data.yx is the data point at t = x and α is a smoothing parameter (0 ≤ α ≤ 1).The simplest of the exponential smoothing methods is called Simple Exponential Smoothing (SES). This method is suitable for forecasting data with no clear trend or seasonal pattern . This alThe literature does not offer a universal definition of a “wave”. While waves are characterized by rising and falling parts, which when put together form the wave, this definition is very vague for obvious reasons.For example, in The notion of a wave in the context of creating a dataset for a classifier is even more ill-defined , 19. Notet al. Reviewers' comments:Reviewer's Responses to Questions  Comments to the Author1. Is the manuscript technically sound, and do the data support the conclusions?  The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: YesReviewer #2: Partly**********  2. Has the statistical analysis been performed appropriately and rigorously?   Reviewer #1: YesReviewer #2: N/A**********  3. Have the authors made all data underlying the findings in their manuscript fully available?PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.  The Reviewer #1: YesReviewer #2: No**********  4. Is the manuscript presented in an intelligible fashion and written in standard English?  PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.Reviewer #1: NoReviewer #2: Yes**********  5. Review Comments to the Author  Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. Reviewer #1: The manuscript is interesting; however, the following comment should be addressed:1: All the sections and subsections must be included in the text, Such as :.2: The abstract needs to be improved to do justice to the main contributions of the paper, also it contains some abbreviations that need to be explained.3: The contribution is not stated also add it at the end of the introduction section.4: Please add future work to the conclusion section and discuss it briefly.5: This study suffers from a fresh literature review. It is recommended to boost the literature review of this study.6: Please add the system specifications used for the evaluation as well as the programming language.7: There are some typos and grammatical errors that should be corrected.Reviewer #2: Summary:In this work, COVID-19 case data have been collected from around the world. The regions of waves are labelled. Also, XGBoost model is used to provide a minimum standard for future classifiers trained on this dataset. In addition, the utility of the dataset for the prediction of (future) waves.The manuscript is interesting; however, the following comment should be addressed :Abstract :- - - - - - - - - - -1 – Some facts about the collected dataset need to be included in the abstract.Introduction Section :- - - - - - - - - - - - - - - - - - - - - -2 – The introduction need to be extended because it is very short.3 – The contribution should be included as a list at the end of the introduction section .Data and Methods Section :- - - - - - - - - - - - - - - - - - - - - - - -4 – This section is fine. No comments.The Datasets Section :- - - - - - - - - - - - - - - - - - - - - -5 – More details about the dataset should be included .6 – Visual analysis should be discussed thoroughly .Results Section :- - - - - - - - - - - - - - - - - - - - - -7 – The author mentioned that supervised classifier can be used. Thus , the author need to refer to other types of feature extraction tools. For example: a) 10.1109/ACCESS.2022.3170893, b) 10.1002/cpe.7311, and c) 10.3390/sym14040715 .Conclusion Section :- - - - - - - - - - - - - - - - - - - - - -8 – This section is fine. No comments .General Comments:- - - - - - - - - - - - - - - - -9 - There are some grammatical errors that should be corrected . It is highly recommended to be proofed the manuscript carefully .- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -**********  6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.If you choose “no”, your identity will remain anonymous but your review may still be made public.Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.  Reviewer #1: NoReviewer #2: No**********https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool,  10 Jan 2023Response to Reviewer 11. All the sections and subsections must be included in the text, Such as :.We have added all sections and subsections. Further, we have now (slightly) reorganized the sections and subsections for better readability.2. The abstract needs to be improved to do justice to the main contributions of the paper, also it contains some abbreviations that need to be explained.We have improved the abstract, with more details regarding the contributions made, the nature of the dataset created, and the baseline classifiers. All abbreviations used in the abstract, have also been explained.3. The contribution is not stated also add it at the end of the introduction section.We have added the contributions in the Introduction section (lines xx-yy).4. This study suffers from a fresh literature review. It is recommended to boost the literature review of this study.We have now included an additional paragraph in the “Introduction” section to boost the literature review, as per the reviewer’s suggestion (lines 8-13).5. Please add the system specifications used for the evaluation as well as the programming language.Since we are not reporting any runtimes, we have not reported system specifications. We have now clearly indicated the programming language, and that the codes were run on Google Colaboratory, at the beginning of the Data and Methods section (lines 28-32).6. This study suffers from a fresh literature review. It is recommended to boost the literature review of this study.We have now extended the Introduction section, with some methods of predicting COVID waves (lines 8-16).7. There are some typos and grammatical errors that should be corrected.We have carefully proofread the document again, and corrected all typos and grammatical errors that were found.Response to Reviewer 2:1. Some facts about the collected dataset need to be included in the abstract.We have added the source of the initially collected dataset, in the abstract.2. The introduction needs to be extended because it is very short.We have now extended the Introduction section, with some methods of predicting COVID waves.3. The contribution should be included as a list at the end of the introduction section.We have included the contribution at the end of the introduction (lines 18-21).4. This section is fine. No comments.We thank the reviewer for their appreciation.5. More details about the dataset should be included.We have now included more details about the dataset used to build the COWAVE datasets.6. Visual analysis should be discussed thoroughly.We have improved the discussion of the visual analysis.7. The author mentioned that a supervised classifier can be used. Thus, the author needs to refer to other types of feature extraction tools. For example: a) 10.1109/ACCESS.2022.3170893, b) 10.1002/cpe.7311, and c) 10.3390/sym14040715.We have now cited other possible feature selection techniques (lines 223-224).8. This section is fine. No comments.We thank the reviewer for their appreciation.9. There are some grammatical errors that should be corrected. It is highly recommended to be proofed the manuscript carefully.We have carefully proofread the document again and corrected all typos and grammatical errors that were found. 24 Mar 2023COWAVE: A Labelled COVID-19 Wave Dataset for BuildingPredictive ModelsPONE-D-22-27577R1Dear Dr. Raman,We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at onepress@plos.org.If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact Kind regards,Hilal TayaraAcademic EditorPLOS ONEAdditional Editor Comments :Please address all comments raised by reviewr 4.Reviewers' comments:Reviewer's Responses to Questions  Comments to the Author  1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.Reviewer #2: All comments have been addressedReviewer #3: All comments have been addressedReviewer #4: (No Response)Reviewer #5: All comments have been addressedReviewer #6: All comments have been addressed**********  2. Is the manuscript technically sound, and do the data support the conclusions?  The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: YesReviewer #3: YesReviewer #4: (No Response)Reviewer #5: YesReviewer #6: Yes**********  3. Has the statistical analysis been performed appropriately and rigorously?   Reviewer #2: YesReviewer #3: YesReviewer #4: (No Response)Reviewer #5: YesReviewer #6: Yes**********  4. Have the authors made all data underlying the findings in their manuscript fully available?PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.  The Reviewer #2: YesReviewer #3: YesReviewer #4: (No Response)Reviewer #5: YesReviewer #6: Yes**********  5. Is the manuscript presented in an intelligible fashion and written in standard English?  PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.Reviewer #2: YesReviewer #3: YesReviewer #4: (No Response)Reviewer #5: YesReviewer #6: Yes**********  6. Review Comments to the Author  Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. Reviewer #2: Summary:In this work, COVID-19 case data have been collected from around the world. The regions of waves are labelled. Also, XGBoost model is used to provide a minimum standard for future classifiers trained on this dataset. In addition, the utility of the dataset for the prediction of (future) waves.The authors have addressed the raised comments.Comments :Abstract :- - - - - - - - - - -1 – The abstract is fine. No further comments .Introduction Section :- - - - - - - - - - - - - - - - - - - - - -2 – This section is fine. No further comments .Data and Methods Section :- - - - - - - - - - - - - - - - - - - - - - - -3 – This section is fine. No further comments .Results Section :- - - - - - - - - - - - - - - - - - - - - -4 – This section is fine. No further comments .Conclusion Section :- - - - - - - - - - - - - - - - - - - - - -5 – This section is fine. No further comments .- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Reviewer #3: This version of the manuscript is well improved. The authors have addressed all reviewer comments. The manuscript can be accepted for publication.Reviewer #4: - The abstract is long and NOT satisfactory. It should contain the following parts:i. The importance of or motivation for the research.ii. The issue/argument of the research.iii. The methodology.iv. The result/findings.v. The implications of the result/findings.-where is keyword list.Authors should add keyword list contain of 5 to 8 keywords.-The motivation and contribution need to be improve in introduction.Author should also add seprate paragaraph of orgnization at the end of introducation.-Was the dataset balanced? if the dataset is unbalanced and may affect the results significantly. The authorsshould solve the problem of the unbalanced dataset.-Clearly highlight the mathematical terms used in the paper and explain them in the text.-Author should discuss more recent reference in introducation*COVID-19 detection by dogs: From physiology to field application-a review article*Combination of Angiotensin (1-7) Agonists and Convalescent Plasma as a New Strategy to Overcome Angiotensin Converting Enzyme 2 (ACE2) Inhibition for the Treatment of COVID-19*Derivatization and combination therapy of current COVID-19 therapeutic agents: a review of mechanistic pathways, adverse effects, and binding sites*The next frontier in vaccine safety and VAERS: Lessons from COVID-19 and ten recommendations for action- Conclusion to be made more systematic and future scope to be elaborated more on technical featuresthat are planned to be added in the proposed system in the near future.- The use of English language is fine, however, it is recommended to be checked once again.Reviewer #5: The authors have addressed all the comments. The manuscript is well structured. Abstract is okay. data collection, Methodology, results and discussion are okay. Relevant articles were cited and properly referenced.Reviewer #6: (No Response)**********  7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.If you choose “no”, your identity will remain anonymous but your review may still be made public.Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.  Reviewer #2: NoReviewer #3: NoReviewer #4: NoYes: Boluwaji Ade AkinnuwesiReviewer #5: Reviewer #6: No********** 3 Apr 2023PONE-D-22-27577R1 COWAVE: A Labelled COVID-19 Wave Dataset for Building Predictive Models Dear Dr. Raman:I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! 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