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Cancer is the top leading cause of death among Latino people. Lack of health insurance is a significant contributor to inadequate cancer detection and treatment. Despite healthcare policy expansions such as the Affordable Care Act, Latino people persistently maintain the highest uninsured rate among any ethnic and racial group in the US, especially among Latino individuals who are immigrants or part of a mixed immigration status household. Recognizing that immigration status is a critical factor in the ability of Latino community members to seek health insurance and access healthcare services, a few US states and the District of Columbia have implemented policies that have expanded coverage to children and adults regardless of immigration status. Expansion of Medicaid eligibility regardless of immigration status may significantly benefit Latino communities, however the facilitators and barriers to enrolling in these programs need to be evaluated to ensure reach and achieve health equity across the cancer control continuum for all Latinos. [ABSTRACT FROM AUTHOR]

Objective: To describe telemedicine use patterns and understand clinic's approaches to shifting care delivery during the COVID-19 pandemic. Methods: We used electronic health record data from 203 community health centers across 13 states between 01/01/2019 and 6/31/2021 to describe trends in telemedicine visit rates over time. Qualitative data were collected from 13 of those community health centers to understand factors influencing adoption and implementation of telemedicine. Results: Most clinics in our sample were in urban areas (n = 176) and served a majority of uninsured and publicly insured patients (12.8% and 44.4%, respectively) across racial and ethnic minority groups (16.6% Black and 29.3% Hispanic). During our analysis period there was a 791% increase in telemedicine visits from before the pandemic (.06% pre- vs 47.5% during). A latent class growth analysis was used to examine differences in patterns of adoption of telemedicine across the 203 CHCs. The model resulted in 6 clusters representing various levels of telemedicine adoption. A mixed methods approach streamlined these clusters into 4 final groups. Clinics that reported rapid adoption of telemedicine attributed this change to leadership prioritization of telemedicine, robust quality improvement processes (eg, using PDSA processes), and emphasis on training and technology support. Conclusions: In response to the COVID-19 pandemic, telemedicine adoption rates varied across clinics. Our study highlight that organizational factors contributed to the clinic's ability to rapidly uptake and use telemedicine services throughout the pandemic. These approaches could inform future non-pandemic practice change and care delivery. [ABSTRACT FROM AUTHOR]

Simple Summary: Non-small-cell lung cancer is characterized by high morbidity and mortality. Currently, the precision medicine approach in the adenocarcinoma subtype of non-small-cell lung cancer aims to identify genomic alterations that can be targeted in individual patients and offer them appropriate treatment. Several biomarker-guided therapies have been approved, targeting genes frequently altered in adenocarcinoma, such as EGFR, BRAF, MET, ALK, ROS1, RET and NTRK. To overcome the emergence of resistance and increase the efficacy of these targeted therapies, the combination of chemotherapy and targeted therapy has been studied and validated in adenocarcinoma patients with EGFR mutations. This study proposes to examine whether this type of combined approach, which is difficult to study in clinical trials, could be more widely used by targeting other genetic alterations in the MAPK/PI3K pathways or against alterations in the CDNK2A gene in adenocarcinomas but also in squamous-cell carcinomas. The combination of chemotherapy and targeted therapy has been validated in non-small-cell lung cancer (NSCLC) patients with EGFR mutations. We therefore investigated whether this type of combined approach could be more widely used by targeting other genetic alterations present in NSCLC. PDXs were generated from patients with NSCLC adenocarcinomas (ADCs) and squamous-cell carcinomas (SCCs). Targeted NGS analyses identified various molecular abnormalities in the MAPK and PI3K pathways and in the cell cycle process in our PDX panel. The antitumor efficacy of targeted therapies alone or in combination with chemotherapy was then tested in vivo. We observed that trametinib, BKM120, AZD2014 and palbociclib increased the efficacy of each chemotherapy in SCC PDXs, in contrast to a non-insignificant or slight improvement in ADCs. Furthermore, we observed high efficacy of trametinib in KRAS-, HRAS- and NRAS-mutated tumors (ADCs and SCCs), suggesting that the MEK inhibitor may be useful in a wider population of NSCLC patients, not just those with KRAS-mutated ADCs. Our results suggest that the detection of pathogenic variants by NGS should be performed in all NSCLCs, and particularly in SCCs, to offer patients a more effective combination of chemotherapy and targeted therapy. [ABSTRACT FROM AUTHOR]

Introduction: Pain related to injection of propofol during induction of anesthesia decreases from 66.8% without prevention, to 22–31% of cases when lidocaine is associated. Hypnoanalgesia of the hand is currently used for painful procedures in children but has never been evaluated in this indication. The primary aim of this prospective randomized single‐blind study was to evaluate the efficacy of hypnoanalgesia of the hand for the prevention of moderate to severe pain during intravenous injection of propofol alone in comparison to lidocaine admixture. The secondary aim was to compare the global satisfaction of children in both methods. Patients and Methods: One hundred patients aged 7–14 years, ASA 1‐2, admitted for scheduled surgery under general anesthesia were randomized into two groups. Group L received a mixture of 1% propofol (3 mg/kg) and 1% Lidocaine (0.3 mg/kg). Group H received 1% propofol (3 mg/kg) after hypnoanalgesia of the hand realized by a single experimented operator. A video was made in order to evaluate the pain related to propofol injection by a blinded observer using the 4‐point score of Cameron (painful ≥ 2). The global satisfaction of children was evaluated in postanesthesia care unit and documented if visual analog score was <7/10. Results: Ninety‐six patients were analyzed. The rate of painful patients did not differ significantly between groups (8.5% in group H [n = 47] vs 6.1% in group L [n = 49], OR= 0.70; 95% CI [0.13–3.35], p = 0.65), nor did the rate of nonsatisfied patients (10.6 in group H vs. 12.2% in group L, OR = 0.85; 95% CI [0.19–3.65], p = 1). Conclusions: Our results suggest that hypnoanalgesia of the hand alone is effective to prevent the pain related to propofol injection in children. No significant difference was found in comparison with lidocaine admixture nor for pain or satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: Nausea and vomiting complicating chemotherapy (CINV) remain side effects despite preventive and curative treatments. We hypothesize that acupuncture (ACU), auriculotherapy (AUR), and their combination (ACU-AUR), could decrease, compared to usual treatment (UT), the intensity of acute nausea in patients already treated according to the antiemetic guidelines and presenting nausea with or without vomiting in the earlier cycle. Methods: In this multicenter study, patients were treated just before chemotherapy according to randomization. ACU consisted of implanting bilaterally on each forearm, one semi-permanent needle at point P6. AUR consisted of implanting bilaterally on each pavilion of the ear, one semi-permanent needle at point O. All patients received systematic preventive drug treatment according to antiemetic guidelines. Main outcome was intensity of nausea at 24 h after chemotherapy using a numeric scale ranging from 0 (no nausea) to 10 (maximum symptoms). Results: One hundred and fifteen patients were included. Baseline characteristics were similar between groups at inclusion. Intensity of nausea at 24 h after chemotherapy, was statistically different between the groups (covariance intergroup analysis, p = 0.005) and was significantly lower for the all-treatment groups vs UT group (p = 0.007 for AUR, p = 0.008 for ACU, and p = 0.0009 for AUR-ACU). AUR-ACU also decreased intensity of delayed nausea when compared to UT (p = 0.023). AUR, ACU and AUR-ACU had no effect on acute and delayed vomiting episodes. No serious adverse event due to the studied treatments was reported in our study. Conclusion: AUR or ACU reduce intensity of acute and delayed nausea in patients treated by optimal antiemetic treatment. Trial Registration Number. Clinicaltrials.gov identifier NCT02767791, registered on May 10, 2016. [ABSTRACT FROM AUTHOR]

Purpose: Glaucoma is the leading cause of irreversible blindness worldwide. The brain and eye share many characteristics, so the eye may provide an easy‐access window on brain processes. The aim of the study was to evaluate the link between glaucoma as well as intraocular pressure (IOP)‐lowering drops load and all‐cause dementia. Methods: This was a nested case‐control study based on the French national healthcare database from 1 January 2006 to 31 December 2018in individuals aged ≥60 years. We compared cases of incident all‐cause dementia with 1:5 controls matched by date of case diagnosis (index date), age, sex, and income. We set a 5‐year exposure to glaucoma period ending 2 years before the index date (lag‐time period to avoid protopathic bias). The main outcome was glaucoma defined with hospitalization related to POAG and/or dispensations of IOP‐lowering drops. The secondary outcome was the IOP‐lowering drops load. Results: In total, 4810 incident all‐cause dementia and 24 050 matched controls were analysed (median [IQR] age 82 [10] years; 66.6% women). The prevalence of glaucoma was 14.0% in controls and cases. Risk of all‐cause dementia was not associated with glaucoma (crude OR, 1.02; 95% CI [0.93–1.11]; p = 0.7; adjusted OR, 0.99; 95% CI [0.91–1.09]; p = 0.9) or IOP‐lowering drops load (p = 0.2). Conclusion: The present study in general population ≥60 years old in France did not find any association between glaucoma and incident all‐cause dementia. [ABSTRACT FROM AUTHOR]

Diet is the only treatment for celiac disease (CeD), and good adherence to a gluten-free diet (GFD) is the only way to ensure complete remission and to prevent complications. Limited education about the disease and a GFD is an attributing factor to inadequate adherence. Thus, our aim was to assess the current knowledge about a GFD and the clinical monitoring of adherence to the diet among CeD people and HCPs. Specific questionnaires were designed and distributed to assess the knowledge of CeD people (Q1 questionnaire) (n = 2437) and to analyze the follow-up of the disease from the perspective of patients (Q2 questionnaire) (n = 1294) and HCPs (Q3 questionnaire) (n = 346). Two-thirds of HCPs specialized in pediatric care, while one-third did so in adult care. In CeD people, general questions regarding food classification and cross-contamination are well understood. When patients have doubts, 51.4% reported using the Internet and social networks. Thus, it is crucial that resources like social media are reliable and provide valuable information. Q3 revealed the lack of time to follow up the diet after diagnosis (48% of HCPs allocate < 15 min), the interest in further training, and the need for a professional specialized in diets within the healthcare system. In conclusion, it is essential to enhance nutritional education to increase awareness of a GFD. [ABSTRACT FROM AUTHOR]

The linguistic interdependence hypothesis posits the existence of language features common to different languages. This set of characteristics, known as Common Underlying Proficiency (CUP), is a powerful facilitating agent in second language acquisition. Fluid intelligence (Gf), on the other hand, is the construct that encompasses those cognitive resources devoted to general learning, and its involvement in second language acquisition is unproven. The aim of this study is to determine the direct and interactive effect of L1 knowledge and Gf on second language acquisition in language immersion learners across different linguistic domains. The study analyzed the proficiency of 131 Romanian students in Spanish and Catalan, the official languages of Catalonia. Mixed-effects regression models were used to analyze lexical, morphosyntactic, and orthographic aspects. The results were obtained using mixed-effects regression models, revealing a particularly noticeable interdependence effect in lexical, morphosyntactic, and orthographic aspects, with differences between Catalan and Spanish. Furthermore, Gf had an impact on the morphosyntactic component with similar intensity for both languages but did not moderate the interdependence effect. The study discusses the possible causes of these effects, as well as their psycho-pedagogical consequences. [ABSTRACT FROM AUTHOR]

Paramos, unique and biodiverse ecosystems found solely in the high mountain regions of the tropics, are under threat. Despite their crucial role as primary water sources and significant carbon repositories in Colombia, they are deteriorating rapidly and garner less attention than other vulnerable ecosystems like the Amazon rainforest. Their fertile soil and unique climate make them prime locations for agriculture and cattle grazing, often coinciding with economically critical deposits such as coal which has led to a steady decline in paramo area. Anthropic impact was evaluated using multispectral images from Landsat and Sentinel over 37 years, on the Guerrero and Rabanal paramos in central Colombia which have experienced rapid expansion of mining and agriculture. Our analysis revealed that since 1984, the Rabanal and Guerrero paramos have lost 47.96% and 59.96% of their native vegetation respectively, replaced primarily by crops, pastures, and planted forests. We detected alterations in the spectral signatures of native vegetation near coal coking ovens, indicating a deterioration of paramo health and potential impact on ecosystem services. Consequently, human activity is reducing the extent of paramos and their efficiency as water sources and carbon sinks, potentially leading to severe regional and even global consequences. [ABSTRACT FROM AUTHOR]

Contact tracing played a crucial role in minimizing the onward dissemination of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) in the recent pandemic. Previous studies had also shown the effectiveness of preventive measures such as mask-wearing, physical distancing, and exposure duration in reducing SARS-CoV-2 transmission. However, there is still a lack of understanding regarding the impact of various exposure settings on the spread of SARS-CoV-2 within the community, as well as the most effective preventive measures, considering the preventive measures adherence in different daily scenarios. We aimed to evaluate the effect of individual protective measures and exposure settings on the community transmission of SARS-CoV-2. Additionally, we aimed to investigate the interaction between different exposure settings and preventive measures in relation to such SARS-CoV-2 transmission. Routine SARS-CoV-2 contact tracing information was supplemented with additional data on individual measures and exposure settings collected from index patients and their close contacts. We used a case-control study design, where close contacts with a positive test for SARS-CoV-2 were classified as cases, and those with negative results classified as controls. We used the data collected from the case-control study to construct a Bayesian network (BN). BNs enable predictions for new scenarios when hypothetical information is introduced, making them particularly valuable in epidemiological studies. Our results showed that ventilation and time of exposure were the main factors for SARS-CoV-2 transmission. In long time exposure, ventilation was the most effective factor in reducing SARS-CoV-2, while masks and physical distance had on the other hand a minimal effect in this ventilation spaces. However, face masks and physical distance did reduce the risk in enclosed and unventilated spaces. Distance did not reduce the risk of infection when close contacts wore a mask. Home exposure presented a higher risk of SARS-CoV-2 transmission, and any preventive measures posed a similar risk across all exposure settings analyzed. Bayesian network analysis can assist decision-makers in refining public health campaigns, prioritizing resources for individuals at higher risk, and offering personalized guidance on specific protective measures tailored to different settings or environments. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze the relationships between cybervictimization in social networks, problematic smartphone use, aggressive behaviors, and prosocial altruistic tendencies in young adults. The sample consisted of 601 young adults (mean age  =  19.96  years; SD  =  2.27; 69.1% female) who were administered online assessments of experiences of humiliation on networks, problematic smartphone use, prosocial altruistic tendencies, and aggressiveness. Results indicated significant indirect effects of cyber victimization on aggressiveness and prosocial altruistic tendencies through problematic smartphone use. Problematic cell phone use explained the relationships between online humiliation and aggressive and prosocial altruistic behaviors. The results confirmed the positive relationship between cybervictimization and problematic cell phone use, consistent with previous research. However, the negative relationship between cybervictimization and altruistic prosocial tendencies was not corroborated. The findings emphasize the need to promote actions that foster social connectedness and interdependence among young individuals to develop their identity within the community. [ABSTRACT FROM AUTHOR]

Background: The term "post-COVID-19 condition" refers to the symptomatology that appears between four to twelve weeks after Covid-19 infection. These symptoms can persist for weeks or even months, significantly diminishing the quality of life for affected individuals. The primary objective of this study was to assess the effectiveness of pulmonary rehabilitation programs and/or respiratory muscle training on respiratory sequelae in patients with post-COVID condition. Methods: The literature search was conducted in the following databases: PubMed, PEDro, Embase, Cochrane, Scopus, and Web of Science. Randomized clinical trials were included in which participants were aged 18 years or older. Articles were excluded if at least one of the therapies did not involve pulmonary rehabilitation or respiratory muscle training, if the participants were COVID positive, if studies lacked results, and finally, if interventions were conducted without supervision or at home. This review only encompasses supervised non-virtual interventions. This study adheres to the PRISMA statement and has been registered in the PROSPERO database (CRD42023433843). Results: The outcomes obtained in the included studies are assessed across the following variables: Exercise capacity using the 6-minute walk test, Dyspnea, fatigue, Pulmonary function, Maximum inspiratory pressure, and Quality of life. Conclusion: Despite the absence of a specific treatment at present, it was evident from this review that a well-structured pulmonary rehabilitation program that incorporates both aerobic and muscular strength exercises along with techniques and inspiratory muscle exercises was the most effective form of treatment. [ABSTRACT FROM AUTHOR]

Background: A breast cancer diagnosis is a highly stressful experience that affects patients' mental health. The study's main objective was to compare the level of anticipative anxiety and depression in patients prepared for their first dose of chemotherapy for breast cancer with virtual reality vs. a standard psychoeducational intervention. Methods: The study was single-center, comparative, and randomized and included a group that received four sessions with virtual reality and another that received four sessions of regular psychoeducational intervention based on mindfulness. Results: 133 patients with a mean age of 49 SD 11.6; range 30–82) were included. Both groups showed a decrease in anxiety and depression with the Anxiety and Depression Scale, higher in the experimental group with significant differences. At three months, a more notable decrease in the Emotional Discomfort Detection Scale was observed in the experimental group, with significant differences. The fighting spirit and cognitive avoidance increased assessed with the MINI-MAC coping scale, higher in the experimental group, with significant differences in all evaluations. Conclusion: A psychoeducational intervention protocol using virtual reality can improve anticipatory anxiety, depression, and emotional distress in breast cancer patients who must start chemotherapy. [ABSTRACT FROM AUTHOR]

Acute myeloid leukemia (AML) with t(9;22) (q34.1; q11.2)/BCR::ABL1, a distinct entity within the group of AML with defining genetic abnormalities, belong to the adverse-risk group of the 2022 ELN classification. However, there is little data on outcome since the era of tyrosine kinase inhibitors. Among 5819 AML cases included in the DATAML registry, 20 patients with de novo BCR::ABL1+AML (0.3%) were identified. Eighteen patients treated with standard induction chemotherapy were analyzed in this study. Imatinib was added to chemotherapy in 16 patients. The female-to-male ratio was 1.25 and median age was 54 years. The t(9;22) translocation was the sole chromosomal abnormality in 12 patients. Main gene mutations detected by NGS were ASXL1, RUNX1 and NPM1. Compared with patients with myeloid blast phase of chronic myeloid leukemia (CML-BP), de novo BCR::ABL1+AML had higher WBC, fewer additional chromosomal abnormalities, lower CD36 or CD7 expression and no ABL1 mutations. Seventeen patients (94.4%) achieved complete remission (CR) or CR with incomplete hematologic recovery. Twelve patients were allografted in first remission. With a median follow-up of 6.3 years, the median OS was not reached and 2-year OS was 77% (95% CI: 50–91). Four out of five patients who were not transplanted did not relapse. Comparison of BCR::ABL1+AML, CML-BP, 2017 ELN intermediate (n = 643) and adverse-risk patients (n = 863) showed that patients with BCR::ABL1+AML had a significant better outcome than intermediate and adverse-risk patients. BCR::ABL1+AML patients treated with imatinib and intensive chemotherapy should not be included in the adverse-risk group of current AML classifications. [ABSTRACT FROM AUTHOR]

Introduction: Rare copy number variants (CNVs) and polygenic risk for intelligence (PRS-IQ) both confer susceptibility for autism spectrum disorder (ASD) but have opposing effects on cognitive ability. The field has struggled to disentangle the effects of these two classes of genomic variants on cognitive ability from their effects on ASD susceptibility, in part because previous studies did not include controls with cognitive measures. We aim to investigate the impact of these genomic variants on ASD risk while adjusting for their known effects on cognitive ability. Methods: In a cohort of 8,426 subjects with ASD and 169,804 controls with cognitive assessments, we found that rare coding CNVs and PRS-IQ increased ASD risk, even after adjusting for their effects on cognitive ability. Results: Bottom decile PRS-IQ and CNVs both decreased cognitive ability but had opposing effects on ASD risk. Models combining both classes of variants showed that the effects of rare CNVs and PRS-IQ on ASD risk and cognitive ability were largely additive, further suggesting that susceptibility for ASD is conferred independently from its effects on cognitive ability. Despite imparting mostly additive effects on ASD risk, rare CNVs and PRS-IQ showed opposing effects on core and associated features and developmental history among subjects with ASD. Discussion: Our findings suggest that cognitive ability itself may not be the factor driving the underlying liability for ASD conferred by these two classes of genomic variants. In other words, ASD risk and cognitive ability may be two distinct manifestations of CNVs and PRS-IQ. This study also highlights the challenge of understanding how genetic risk for ASD maps onto its dimensional traits. [ABSTRACT FROM AUTHOR]

Decision support systems (DSSs) enable dairy farmers to make informed and timely decisions on herd health management. However, the lack of a disease scoring system by category and severity limits the application of this approach. In this study, we developed an innovative approach to dairy herd health management by establishing a novel scoring system for dairy herd health management aimed at providing a more nuanced understanding of disease impact. For this purpose, we retrieved 5-year data from 2 558 disease diary records of 798 primiparous and multiparous cows housed on a Czech farm and classified 125 production diseases into six categories, namely lameness, mastitis, postpartum diseases, digestive system, reproductive diseases and other diseases. Based on this metric, we developed a data-driven DSS for farm management. Using this DSS, we identified markers of disease categories for efficient veterinary monitoring on dairy farms. This DSS highlighted a decreasing trend of average monthly disease scores, yet the prevalence of postpartum and other diseases increased during the same period, due to changes in reproduction management within the herd. These findings underscore the need for data-driven targeted interventions for promoting the herd health. Therefore, our scoring model not only provides a comprehensive framework for dairy herd health monitoring and improvement but also advances dairy farming by providing a decision support system easily applicable to dairy farms based on available data recorded in disease diaries. [ABSTRACT FROM AUTHOR]

Background: Vertebral infections, including vertebral osteomyelitis, septic physitis, and discospondylitis, are rarely reported in goats, and when reported, have been largely limited to necropsy case reports. Objective: Describe clinical findings and outcome in goats with vertebral infections evaluated by computed tomography (CT). Animals: Five goats with vertebral osteomyelitis, septic physitis, and discospondylitis evaluated by CT. Methods: Retrospective case series. Results: The most common presenting complaints were progressive weakness, paresis and recumbency. Three goats were tetraparetic and 2 goats had pelvic limb paraparesis. Clinicopathologic findings included leukocytosis, mature neutrophilia, and hyperfibrinogenemia. The most common vertebrae affected were C7‐T1. All 5 goats had discospondylitis with or without vertebral osteomyelitis and septic physitis. Computed tomographic evidence of spinal cord compression was present in 4/5 goats. Medical management (antimicrobials, physical therapy, analgesia, supportive care) was attempted in 4 goats, and 1 goat was euthanized at the time of diagnosis. All 4 goats that were treated regained ambulatory ability and survived to hospital discharge. Conclusions and Clinical Importance: Despite severity of CT imaging findings, goats with discospondylitis, septic physitis, and vertebral osteomyelitis can successfully return to ambulatory function. Additional studies are required to determine ideal treatment regimens. [ABSTRACT FROM AUTHOR]

Branched glycerol dialkyl glycerol tetraethers (brGDGTs) are bacterial lipids that have been widely used as environmental proxies in continental paleorecords. Another group of related lipids, branched glycerol monoalkyl glycerol tetraethers (brGMGTs), has recently been proposed as a potential paleotemperature proxy. Nevertheless, the sources and environmental dependencies of both brGDGTs and brGMGTs along the river–sea continuum are still poorly understood, complicating their application as paleoenvironmental proxies in some aquatic settings. In this study, the sources of brGDGTs and brGMGTs and the potential factors controlling their distributions are explored across the Seine River basin (NW France), which encompasses the freshwater-to-seawater continuum. BrGDGTs and brGMGTs were analyzed in soils, suspended particulate matter (SPM), and sediments (n=237) collected along the land–sea continuum of the Seine basin. Both types of compounds (i.e., brGDGTs and brGMGTs) are shown to be produced in situ, in freshwater and saltwater, based on their high concentrations and distinct distributions in aquatic settings (SPM and sediments) vs. soils. Redundancy analysis further shows that both salinity and nitrogen dominantly control the brGDGT distributions. Furthermore, the relative abundance of 6-methyl vs. that of 5-methyl brGDGTs (the IR 6Me ratio), the total nitrogen (TN), the δ15 N, and the chlorophyll a concentration co-vary in a specific geographical zone with low salinity, suggesting that 6-methyl brGDGTs are preferentially produced under low-salinity and high-productivity conditions. In contrast to brGDGTs, the brGMGT distribution appears to be primarily regulated by salinity, with a distinct influence on the individual homologues. Salinity is positively correlated with homologues H1020a and H1020b and negatively correlated with compounds H1020c and H1034b in SPM. This suggests that bacteria living in freshwater preferentially produce compounds H1020c and H1034b, whereas bacteria that primarily grow in saltwater appear to be predominantly responsible for the production of homologues H1020a and H1020b. Based on the abundance ratio of the freshwater-derived compounds (H1020c and H1034b) vs. their saltwater-derived homologues (H1020a and H1020b), a novel proxy, the Riverine IndeX (RIX), is proposed to trace riverine organic matter inputs, with high values (>0.5) indicating a higher riverine contribution. We successfully applied RIX to the Godavari River basin (India) and a paleorecord across the upper Paleocene and lower Eocene from the Arctic Coring Expedition at Lomonosov Ridge, showing its potential applicability to both modern samples and paleorecords. [ABSTRACT FROM AUTHOR]

Owing to advances in medical and surgical fields, patients with single ventricle (SV) have a greatly improved life expectancy. However, progressive functional deterioration is observed over time, with a decrease in cardiopulmonary fitness. This study aimed to identify, in patients with SV, the association between cardiac magnetic resonance imaging (CMR) parameters and change in cardiopulmonary fitness assessed by cardiopulmonary exercise test (CPET), and if certain thresholds could anticipate a decline in aerobic fitness. Patients with an SV physiology were retrospectively screened from 2011 and 2021 in a single-centre observational study. We evaluated (1) the correlation between baseline CMR and CPET parameters, (2) the association between baseline CMR results and change in peak oxygen uptake (peak VO2), and (3) the cut-off values of end-diastolic and end-systolic volume index in patients with an impaired cardiopulmonary fitness (low peak VO2 and/or high VE/VCO2 slope). 32 patients were included in the study. End-systolic volume index (r = 0.37, p = 0.03), end-diastolic volume index (r = 0.45, p = 0.01), and cardiac index (r = 0.46, p = 0.01) correlated with the VE/VCO2 slope. End-systolic ventricular volume (r = − 0.39, p = 0.01), end-diastolic ventricular volume (r = − 0.38, p = 0.01), and cardiac output (r = − 0.45, p < 0.01) inversely correlated with the peak VO2. In multivariate analysis, the cardiac index obtained from baseline CMR was inversely associated with the change in peak VO2 (p < 0.01). An end-diastolic volume index > 101 ml/m2 and an end-systolic volume index > 47 ml/m2 discriminated patients with impaired cardiopulmonary fitness. CMR parameters correlate with cardiopulmonary fitness in patients with SV and can therefore be useful for follow-up and therapeutic management of these patients. [ABSTRACT FROM AUTHOR]

Background: This cross-sectional controlled study aims to assess health-related quality of life (HRQoL) of children and adolescents with a molecular diagnosis of Marfan syndrome (MFS) or related disorders and to evaluate the factors associated with HRQoL in this population. Sixty-three children with MFS and 124 age- and sex-matched healthy children were recruited. HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL™) generic questionnaire. The correlation between HRQoL scores and the different continuous parameters (age, body mass index, disease severity, systemic score, aortic sinus diameter, and aerobic physical capacity) was evaluated using Pearson's or Spearman's coefficient. A multiple linear regression analysis was performed on the two health summary self-reported PedsQL™ scores (physical and psychosocial) to identify the factors associated with HRQoL in the MFS group. Results: Except for emotional functioning, all other domains of HRQoL (psychosocial and physical health, social and school functions) were significantly lower in children with MFS compared to matched healthy children. In the MFS group, the physical health summary score was significantly lower in female than in male patients (self-report: absolute difference [95%CI] = -8.7 [-17.0; -0.47], P = 0.04; proxy-report: absolute difference [95%CI] = -8.6 [-17.3; 0.02], P = 0.05) and also negatively correlated with the systemic score (self-report: R = -0.24, P = 0.06; proxy-report: R = -0.29, P = 0.03) and with the height Z-score (proxy-report: R = -0.29, P = 0.03). There was no significant difference in the physical health summary scores between the different genetic subgroups. In the subgroup of 27 patients who performed a cardiopulmonary exercise test, self- and proxy-reported physical health summary scores were highly correlated with their aerobic physical capacity assessed by peak oxygen consumption (VO2max) and ventilatory anaerobic threshold (VAT). In the multivariate analysis, the most important independent predictors of decreased physical health were increased height, decreased body mass index, decreased VAT and use of prophylactic therapy. Conclusions: This study reports an impaired HRQoL in children and adolescents with MFS or related conditions, in comparison with matched healthy children. Educational and rehabilitation programs must be developed and evaluated to improve exercise capacity and HRQoL in these patients. Trial registration: ClinicalTrials.gov, NCT03236571. Registered 28 July 2017. [ABSTRACT FROM AUTHOR]

Background and Aims Cardiopulmonary fitness in congenital heart disease (CHD) decreases faster than in the general population resulting in impaired health-related quality of life (HRQoL). As the standard of care seems insufficient to encourage and maintain fitness, an early hybrid cardiac rehabilitation programme could improve HRQoL in CHD. Methods The QUALIREHAB multicentre, randomized, controlled trial evaluated and implemented a 12-week centre- and home-based hybrid cardiac rehabilitation programme, including multidisciplinary care and physical activity sessions. Adolescent and young adult CHD patients with impaired cardiopulmonary fitness were randomly assigned to either the intervention (i.e. cardiac rehabilitation) or the standard of care. The primary outcome was the change in HRQoL from baseline to 12-month follow-up in an intention-to-treat analysis. The secondary outcomes were the change in cardiovascular parameters, cardiopulmonary fitness, and mental health. Results The expected number of 142 patients was enroled in the study (mean age 17.4 ± 3.4 years, 52% female). Patients assigned to the intervention had a significant positive change in HRQoL total score [mean difference 3.8; 95% confidence interval (CI) 0.2; 7.3; P =.038; effect size 0.34], body mass index [mean difference −0.7 kg/m2 (95% CI −1.3; −0.1); P =.022; effect size 0.41], level of physical activity [mean difference 2.5 (95% CI 0.1; 5); P =.044; effect size 0.39], and disease knowledge [mean difference 2.7 (95% CI 0.8; 4.6); P =.007; effect size 0.51]. The per-protocol analysis confirmed these results with a higher magnitude of differences. Acceptability, safety, and short-time effect of the intervention were good to excellent. Conclusions This early hybrid cardiac rehabilitation programme improved HRQoL, body mass index, physical activity, and disease knowledge, in youth with CHD, opening up the possibility for the QUALIREHAB programme to be rolled out to the adult population of CHD and non-congenital cardiac disease. [ABSTRACT FROM AUTHOR]

Afforestation on former pastures is widely promoted due to its potential to increase soil organic carbon sequestration while reducing CO2 emission. The establishment of a forest on a former pasture, however, might affect soil microbial community structure due to the alteration in substrate quality and thus impact carbon cycling in soils. To date, it still remains an open question if and how afforestation may alter the soil microbial community structure and related implications for soil organic matter stabilization. In addition, the majority of studies focuses on low altitude regions which results in uncertainties regarding the effects of afforestation on soil microbiology in mountainous regions. In this study, we aimed to investigate the consequences of afforestation of a subalpine pasture with Norway spruce (Picea abies L.) on the soil microbial community structure following 130 years of afforestation. We used a multi-proxy biomarker approach, including phospholipid fatty acids (PLFAs) and glycerol dialkyl glycerol tetraethers (GDGTs), to explore the shift in the microbial community structure following afforestation with increasing forest stand age. We found a significant increase in bacterial communities (Gram- and Gram+ bacteria) with increasing forest stand age compared to the pasture. This trend, however, was reversed with increasing forest age when considering GDGT biomarkers. We thereby conclude that the microbial community in the pasture and forests of different forest stand ages utilize different carbon substrates as food resource, which is a direct consequence of the modification in litter input after the conversion of a pasture to forests. Our data further suggests that an increase in the soil organic matter decomposition results from the alteration in the microbial community structure, which is especially evident in the subsoil of the 130-year-old forest stand ages. [ABSTRACT FROM AUTHOR]

Radon (222 Rn) is a naturally occurring gas that represents a health threat due to its causal relationship with lung cancer. Despite its potential health impacts, several regions have not conducted studies, mainly due to data scarcity and/or economic constraints. This study aims to bridge the baseline information gap by building an interactive dashboard (http://ircmodelingdashboard.eu.pythonanywhere.com/ , last access: 17 April 2024) that uses inferential statistical methods to estimate the spatial distribution of indoor radon concentration (IRC) for a target area. We demonstrate the functionality of the dashboard by modeling IRC in the city of Bogotá, Colombia, using 30 in situ measurements. IRC measured was the highest reported in the country, with a geometric mean of 91±14 Bq m -3 and a maximum concentration of 407 Bq m -3. In 57 % of the residences, RC exceeded the WHO's recommendation of 100 Bq m -3. A prediction map for houses registered in Bogotá's cadaster was built in the dashboard by using a log-linear regression model fitted with the in situ measurements, together with meteorological, geologic and building-specific variables. The model showed a cross-validation root mean squared error of 57 Bq m -3. Furthermore, the model showed that the age of the house presented a statistically significant positive association with RC. According to the model, IRC measured in houses built before 1980 presents a statistically significant increase of 72 % compared to IRC of those built after 1980 (p value = 0.045). The prediction map exhibited higher IRC in older buildings most likely related to cracks in the structure that could enhance gas migration in older houses. This study highlights the importance of expanding 222 Rn studies in countries with a lack of baseline values and provides a cost-effective alternative that could help deal with the scarcity of IRC data and get a better understanding of place-specific variables that affect IRC spatial distribution. [ABSTRACT FROM AUTHOR]

This article examines the relapse rates in chronic myelogenous leukemia (CML) patients after stopping tyrosine kinase inhibitor (TKI) treatment. The study found that relapse occurred faster in patients who had previously received the first-generation TKI imatinib compared to second-generation TKIs dasatinib or nilotinib. The study used standardized definitions of response and resistance and included patients from multiple centers. The findings suggest that the choice of TKI may affect the rate of relapse after treatment discontinuation. However, more research is needed to validate these findings in larger studies and clinical trials. [Extracted from the article]

Aims Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) using very high-power short-duration (vHPSD) radiofrequency (RF) ablation proved to be safe and effective. However, vHPSD applications result in shallower lesions that might not be always transmural. Multidetector computed tomography-derived left atrial wall thickness (LAWT) maps could enable a thickness-guided switching from vHPSD to the standard-power ablation mode. The aim of this randomized trial was to compare the safety, the efficacy, and the efficiency of a LAWT-guided vHPSD PVI approach with those of the CLOSE protocol for PAF ablation (NCT04298177). Methods and results Consecutive patients referred for first-time PAF ablation were randomized on a 1:1 basis. In the QDOT-by-LAWT arm, for LAWT ≤2.5 mm, vHPSD ablation was performed; for points with LAWT > 2.5 mm, standard-power RF ablation titrating ablation index (AI) according to the local LAWT was performed. In the CLOSE arm, LAWT information was not available to the operator; ablation was performed according to the CLOSE study settings: AI ≥400 at the posterior wall and ≥550 at the anterior wall. A total of 162 patients were included. In the QDOT-by-LAWT group, a significant reduction in procedure time (40 vs. 70 min; P < 0.001) and RF time (6.6 vs. 25.7 min; P < 0.001) was observed. No difference was observed between the groups regarding complication rate (P = 0.99) and first-pass isolation (P = 0.99). At 12-month follow-up, no significant differences occurred in atrial arrhythmia-free survival between groups (P = 0.88). Conclusion LAWT-guided PVI combining vHPSD and standard-power ablation is not inferior to the CLOSE protocol in terms of 1-year atrial arrhythmia-free survival and demonstrated a reduction in procedural and RF times. [ABSTRACT FROM AUTHOR]

Shoulder tendinopathies produce pain and reduce functionality. The aim of this randomized clinical trial was to analyze the effects of Percutaneous electrolysis (PE), Percutaneous peripheral Nerve Stimulation (PNS) and eccentric exercise (EE) on pain (NPRS), strength, electromyographic activity, ultrasound characteristics of the tendon (echogenicity, thickness and hypervascularization) and functionality (DASH and SPADI) in individuals with supraspinatus tendinopathy. Participants (n = 50) were divided into two groups; they received 4 treatment sessions, 1 per week, of PE and PNS (n = 25) or 10 treatment sessions of TENS and US (n = 25). Both groups performed the EE program consisting of 3 sets of 10 repetitions of each of the 3 exercises, twice a day, during the 4 weeks. Follow-up was carried out at 4, 12 and 24 weeks after the start of the intervention. There are statistically significant differences in the analysis between groups (p < 0.001) in the post-treatment and follow-up measurements favorable to the PE+PNS+EE treatment on pain (NPRS), strength, supraspinatus electromyographic amplitude, ultrasound characteristics of the tendon (echogenicity, thickness and hypervascularization) and DASH and SPADI questionnaires. The combined treatment with PE, PNS and EE is an effective option in the clinical management of tendinopathies, with positive results in the short and long term on the variables studied. [ABSTRACT FROM AUTHOR]

Asymmetry between the left and right hemisphere is a key feature of brain organization. Hemispheric functional specialization underlies some of the most advanced human-defining cognitive operations, such as articulated language, perspective taking, or rapid detection of facial cues. Yet, genetic investigations into brain asymmetry have mostly relied on common variants, which typically exert small effects on brain-related phenotypes. Here, we leverage rare genomic deletions and duplications to study how genetic alterations reverberate in human brain and behavior. We designed a pattern-learning approach to dissect the impact of eight high-effect-size copy number variations (CNVs) on brain asymmetry in a multi-site cohort of 552 CNV carriers and 290 non-carriers. Isolated multivariate brain asymmetry patterns spotlighted regions typically thought to subserve lateralized functions, including language, hearing, as well as visual, face and word recognition. Planum temporale asymmetry emerged as especially susceptible to deletions and duplications of specific gene sets. Targeted analysis of common variants through genome-wide association study (GWAS) consolidated partly diverging genetic influences on the right versus left planum temporale structure. In conclusion, our gene-brain-behavior data fusion highlights the consequences of genetically controlled brain lateralization on uniquely human cognitive capacities. Asymmetry is a key organising principle of the brain. Here the authors leveraged rare genetic mutations to revisit structural brain asymmetry showing the planum temporale is susceptible to deletions & duplications of specific gene sets. [ABSTRACT FROM AUTHOR]

Previous literature has analyzed the effect of internet disclosure on NPO donations, specifically, through website disclosure, showing a positive relation between internet disclosure and NPO income. Nonetheless, there is a lack of studies examining the association between sentiment on social media and NPO donations. Therefore, the aim of this study is to examine the effect that sentiment in Twitter messages has on the donations received by NPOs. Using a sample of NPOs listed on the Non-Profit Times 100, we examine whether the sentiment transmitted by the NPOs through Twitter affects their donations. The results show that the sentiment associated with certain specific categories of messages (community messages and information messages about matters not directly related to the NPO) has a significant effect on the amount of donations received. [ABSTRACT FROM AUTHOR]

Fibromyalgia is a chronic condition characterized by musculoskeletal pain. The aim of this study was to synthesize scientific evidence on the effects of aquatic exercise programs on pain and quality of life in individuals with fibromyalgia. This review was carried out using the following databases in January 2024: Cochrane Library, PEDro, PubMed, SCOPUS, and Web of Science. Four clinical trials focusing on aquatic exercise as a treatment for patients with fibromyalgia were selected. These trials were published in English between 2019 and 2024. Pain recorded using the Visual Analog Scale (VAS) and quality of life with the Short Form-36 Health Survey (SF-36) or Fibromyalgia Impact on Quality of Life (FIQ) were the most commonly analyzed variables. This review was carried out according to the PRISMA statement and was registered in PROSPERO (CRD42024510219). The results in terms of pain and quality of life were positive. In conclusion, these findings support the incorporation of aquatic exercise into fibromyalgia physical therapy treatment. However, the benefits could be equivalent to those of other exercise modalities, underscoring the need for individualized adaptation to each patient's needs. [ABSTRACT FROM AUTHOR]

Interdisciplinary STEM and STEAM education gives us the opportunity for training students to achieve all educational objectives in a sustainable development framework. Land in a rural area is a scenario with a range of educational resources for the development of STEM and STEAM projects to train students to interact with the rural environment. The possibilities of the land in order to prepare students for the needs of today's world are linked and sensitized to the environment. In this article, we will offer contemporary examples of STEM and STEAM projects that have been carried out in Latin America. These projects are being developed in which young people establish links with their environment, territory, and the local environment surrounding them. We must look carefully at projects and works in which students' ties to their land and environment are valued through the STEM and STEAM education necessary today. In this scenario, a comparison has been made between the projects in Latin American countries and Spain. [ABSTRACT FROM AUTHOR]

Objectives: Shapiro's syndrome (SS) is a rare condition characterized by spontaneous periodic hypothermia. The underlying pathophysiological mechanisms and etiology of this syndrome remain controversial, and fewer than 100 cases have been reported to date. The objective of this case report is to present a unique iatrogenic case of SS and contribute additional insights into the underlying etiology of this rare disorder. Methods: We conducted an analysis of existing medical literature and described a clinical case of SS secondary to a neurosurgical procedure. Results: To our knowledge, we present the first iatrogenic case of SS in a 53-year-old woman who underwent a partial right parieto-occipital lobectomy in 2003 as a treatment for refractory epilepsy. Several years after the surgical procedure, she began experiencing recurrent episodes of hypothermia. Brain magnetic resonance imaging (MRI) revealed the absence of the splenium of the corpus callosum (CC) and pituitary hyperplasia. After ruling out other potential causes of hypothermia, a diagnosis of SS was made. Discussion: The most plausible mechanism to explain the recurrent hypothermia associated with SS in our patient is a probable disruption of the pathways involved in thermoregulation through the CC as a consequence of the surgical procedure. This case report provides further insights into the etiology of this rare disorder. [ABSTRACT FROM AUTHOR]

Pythium insidiosum is an aquatic oomycete that causes granulomatous infection in dogs, most commonly cutaneous and gastrointestinal. Ultrasonographic characteristics of gastrointestinal pythiosis have been described; occasionally, CT is utilized in the clinical setting, and CT features of pythiosis have not been published. The purpose of this retrospective, multicenter, descriptive study is to describe CT characteristics of noncutaneous canine pythiosis. The following CT parameters were recorded: lesion anatomic location, number, shape, margination, size, attenuation pre‐ and postcontrast, enhancement pattern, lymph nodes affected, other lesions identified, and presence of peritoneal effusion or steatitis. Descriptive statistics demonstrating the frequency of lesion appearances were performed. Twenty‐five dogs with noncutaneous pythiosis lesions that underwent CT were included; 19 had primarily gastrointestinal infections, four primarily arterial infections, one intrathoracic and intra‐abdominal infection, and one primary pulmonary infection. In dogs with primary gastrointestinal infection, lesions were most common at the ileocolic junction and were most frequently focal, well‐defined, moderate to marked circumferential wall thickening that was homogeneous and smoothly marginated precontrast, with moderate heterogeneous contrast enhancement. Most dogs had involvement of multiple gastrointestinal regions. Of four dogs with primary arterial involvement, three had large aneurysmal dilatations of the cranial mesenteric artery with severe mural thickening. All dogs had regional lymphadenopathy, which was variable but generally mild. Nine dogs had peritoneal effusion; six dogs had steatitis. CT features of pythiosis can overlap with neoplasia, but pythiosis should be considered as a differential, especially in young dogs. Findings supported using CT as an adjunct imaging test for increasing clinical suspicion of noncutaneous pythiosis. [ABSTRACT FROM AUTHOR]

Background: The assessment of deep brain stimulation (DBS) as a therapeutic alternative for treating Alzheimer disease (AD) is ongoing. We aimed to determine the effects of intracranial self-stimulation at the medial forebrain bundle (MFB-ICSS) on spatial memory, neurodegeneration, and serum expression of microRNAs (miRNAs) in a rat model of sporadic AD created by injection of streptozotocin. We hypothesized that MFB-ICSS would reverse the behavioural effects of streptozotocin and modulate hippocampal neuronal density and serum levels of the miRNAs. Methods: We performed Morris water maze and light–dark transition tests. Levels of various proteins, specifically amyloid-β precurser protein (APP), phosphorylated tau protein (pTAU), and sirtuin 1 (SIRT1), and neurodegeneration were analyzed by Western blot and Nissl staining, respectively. Serum miRNA expression was measured by reverse transcription polymerase chain reaction. Results: Male rats that received streptozotocin had increased hippocampal levels of pTAU S202/T205, APP, and SIRT1 proteins; increased neurodegeneration in the CA1, dentate gyrus (DG), and dorsal tenia tecta; and worse performance in the Morris water maze task. No differences were observed in miRNAs, except for miR-181c and miR-let-7b. After MFB-ICSS, neuronal density in the CA1 and DG regions and levels of miR-181c in streptozotocin-treated and control rats were similar. Rats that received streptozotocin and underwent MFB-ICSS also showed lower levels of miR-let-7b and better spatial learning than rats that received streptozotocin without MFB-ICSS. Limitations: The reversal by MFB-ICSS of deficits induced by streptozotocin was fairly modest. Conclusion: Spatial memory performance, hippocampal neurodegeneration, and serum levels of miR-let-7b and miR-181c were affected by MFB-ICSS under AD-like conditions. Our results validate the MFB as a potential target for DBS and lend support to the use of specific miRNAs as promising biomarkers of the effectiveness of DBS in combatting AD-associated cognitive deficits. [ABSTRACT FROM AUTHOR]

Background: Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that contributes in part to irreversible bowel damage and long-term complications, reduced quality of life, invalidity, and economic burden. Suboptimal control of IBD is associated with higher healthcare resource utilization (HCRU), impaired quality of life (QoL), and reduced work productivity. Aims: The IBD-PODCAST study aimed to assess the proportion of IBD patients with suboptimal control and its associated impact. Methods: IBD-PODCAST is a cross-sectional, multicenter study that aimed to characterize the CD and UC population with optimal or suboptimal control according to the STRIDE-II criteria and patient- and physician-reported measures. Here we present the results of the Spanish cohort (n = 396). Results: A total of 104/196 (53.1%) CD and 83/200 (41.5%) UC patients were found to have suboptimal disease control. Long-term treatment targets according to STRIDE-II were applied in 172 (87.8%) CD and 181 (90.5%) UC patients. 125 of 172 (72.7%) CD and 74 of 181 (40.9%) UC patients were currently treated with targeted immunomodulators. Patients with CD and UC and suboptimal disease control showed impaired QoL, higher HCRU and direct costs, and also loss of work productivity compared to those with optimal control. Conclusion: Despite a high rate of targeted immunomodulator therapy, a substantial proportion of IBD patients show suboptimal disease control according to the STRIDE II criteria. Those patients with suboptimal disease control exhibit impaired QoL, less work productivity, and higher HCRU, suggesting that there is considerable need for better treatment approaches in IBD. [ABSTRACT FROM AUTHOR]

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) has a global mean prevalence of 5%. Cognitive Training (CT) and Mindfulness-Based Interventions (MBIs) have shown promising results in managing ADHD symptoms, but they are not its Treatment-As-Usual (TAU). The NeuroMind Study aims to evaluate the preliminary effectiveness and feasibility of three interventions: Mindfulness for Health (M4H), CT using the NeuronUP® platform (CT), and a combination of both, Mindfulness Cognitive Training (MCT). There is empirical evidence supporting the effectiveness of the M4H and NeuronUP® platform; however, this study explores for the first time the effectiveness of MCT and CT, as well as the integration of M4H into TAU. The objectives of this 5-month Randomized Controlled Trial (RCT) are: (1) To analyze the preliminary effectiveness and feasibility of M4H, CT or a combination of both (MCT) added to TAU for children with ADHD; (2) To evaluate the role of psychological process variables (mindfulness and emotional regulation) as mediators of 5-month follow-up clinical outcomes; (3) To preliminarily explore whether specific sociodemographic and clinical characteristics can predict the short-and medium-term clinical response to the specific treatments. Methods and analysis: Participants will be 120 children (7 to 12 years) with ADHD recruited at Child and Adolescent Mental Health Service (CAMHS) Sant Joan de Déu Terres de Lleida (Spain) randomly allocated to one of the four study arms: TAU vs. TAU + CT vs. TAU + M4H vs. TAU + MCT. An assessment to collect ADHD symptoms, Executive Functions (EF), comorbid symptoms and global functioning will be conducted pre-intervention, post-intervention (2 months after baseline) and at the 5-month follow-up. Linear mixed models and mediational models will be computed. Discussion: If the preliminary effectiveness and feasibility of the MCT are demonstrated, this study could be a preliminary basis to do a full RCT with a larger sample to definitively validate the intervention. The MCT could be applied in clinical practice if it is definitively validated. [ABSTRACT FROM AUTHOR]

In most developed countries, patients have been encouraged to elect their preferred choice of health care provider. However, this is different for specialized care, where the patient's referral could be defined as a two-stage decision process and their options are pre-selected by their general practitioner (GP). In this study, we estimate patient preferences while controlling for the pre-selection procedure, and we investigate whether patients are actively choosing their provider for cancer care. The French national hospital discharge database (Programme de Médicalisation des Systèmes d'Information, PMSI – MCO 2017) has been used for investigation. We estimated a multinomial choice model when choice sets are in fact unobserved, which is assumed to identify patient preferences, in a revealed preferences framework. Our findings provide evidence that patients consider factors other than distance to select their provider. The patient – hospital distance as well as the specialization profile of providers appears to be internalized in the pre-selection process, while patients rather consider waiting times, hospital quality, and other provider attributes to make their final choice. We also found that patients would be treated in higher-quality hospitals if they had the opportunity to choose among all available providers. [ABSTRACT FROM AUTHOR]