{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:33:41Z","timestamp":1783690421203,"version":"3.55.0"},"reference-count":62,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Patient-based health related quality of life (HRQoL) measurements are associated with an improvement in quality of care and outcomes. For a complex disease such as sarcoma, there is no disease-specific questionnaire available which covers all clinically relevant dimensions. Herein, we report on the development of an electronically implemented, sarcoma-specific instrument to assess health-related outcomes, which encompasses a combination of generic questionnaires tailored to the respective disease and treatment status covering the entire longitudinal care cycle. An interoperable digital platform was designed to provide a node between patients and physicians and to integrate the sarcoma-specific HRQoL instrument with patient and physician-based quality indicators to allow longitudinal structured real-world-time data evidence analytics. This approach enables the prediction modeling of disease, and by attributing cost tags to quality indicators, treatment effectiveness for a given disease will be directly correlated with financial expenses, which may ultimately lead to a more sustainable healthcare system.<\/jats:p>","DOI":"10.3390\/diagnostics13061206","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T09:10:04Z","timestamp":1679476204000},"page":"1206","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Sarcoma-Specific Instrument to Longitudinally Assess Health-Related Outcomes of the Routine Care Cycle"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4530-7554","authenticated-orcid":false,"given":"Nasian","family":"Mosku","sequence":"first","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, University of Grenoble, 38000 Grenoble, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5090-4935","authenticated-orcid":false,"given":"Philip","family":"Heesen","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3831-4350","authenticated-orcid":false,"given":"Salome","family":"Christen","sequence":"additional","affiliation":[{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6453-3947","authenticated-orcid":false,"given":"Mario F.","family":"Scaglioni","sequence":"additional","affiliation":[{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland"},{"name":"University Teaching Hospital LUKS Lucerne Sarcoma Surgery, University of Lucerne, 6000 Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Bode","sequence":"additional","affiliation":[{"name":"Patho Enge, University of Zurich, 8000 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Studer","sequence":"additional","affiliation":[{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland"},{"name":"University Teaching Hospital LUKS Lucerne Sarcoma Surgery, University of Lucerne, 6000 Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland"},{"name":"University Teaching Hospital LUKS Lucerne Sarcoma Surgery, University of Lucerne, 6000 Lucerne, Switzerland"},{"name":"Kantonsspital Winterthur (KSW), 8400 Winterthur, Switzerland"},{"name":"University Hospital Zurich (USZ), 8000 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1056\/NEJMp2006099","article-title":"Do We Spend Too Much on Health Care?","volume":"383","author":"Baicker","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.ejso.2020.06.010","article-title":"The value of patient centred care in oncology","volume":"47","author":"Ramello","year":"2020","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1097\/SLA.0b013e31818a43af","article-title":"Value-based health care delivery","volume":"248","author":"Porter","year":"2008","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1038\/s41591-021-01662-6","article-title":"Cancer treatments should benefit patients: A common-sense revolution in oncology","volume":"28","author":"Gyawali","year":"2022","journal-title":"Nat. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1001\/jama.2016.11698","article-title":"From Volume to Value in Health Care: The Work Begins","volume":"316","author":"Porter","year":"2016","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6537","DOI":"10.1245\/s10434-022-11534-z","article-title":"What is \u201cValue\u201d? Results of a Survey of Cancer Patients and Providers","volume":"29","author":"Allen","year":"2022","journal-title":"Ann. Surg. Oncol."},{"key":"ref_7","first-page":"1","article-title":"Health Care 2030: The coming transformation","volume":"1","author":"Zilchman","year":"2021","journal-title":"NEJM Catalyst"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kaplan, R.S., Jehi, L., Ko, C.Y., Pusic, A., and Witkowski, M. (2021). Health Care Measurements that Improve Patient Outcomes. NEJM Catal., 2.","DOI":"10.1056\/CAT.20.0527"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/j.annonc.2022.04.007","article-title":"The role of patient-reported outcome measures in the continuum of cancer clinical care: ESMO Clinical Practice Guideline","volume":"33","author":"Basch","year":"2022","journal-title":"Ann. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"MacLean, C.H., Antao, V.C., Fontana, M.A., Sandhu, H.S., and McLawhorn, A.S. (2021). PROMs: Opportunities, Challenges, and Unfinished Business. NEJM Catal., 2.","DOI":"10.1056\/CAT.21.0280"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1038\/s41591-022-01781-8","article-title":"Patient reported outcome assessment must be inclusive and equitable","volume":"28","author":"Calvert","year":"2022","journal-title":"Nat. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1038\/s41591-021-01648-4","article-title":"The value of patient-reported outcomes in early-phase clinical trials","volume":"28","author":"Retzer","year":"2022","journal-title":"Nat. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.annonc.2021.12.010","article-title":"The use of patient-reported outcomes (PROs) in cancer care: A realistic strategy","volume":"33","author":"Minvielle","year":"2022","journal-title":"Ann. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1056\/NEJMp1511701","article-title":"Standardizing Patient Outcomes Measurement","volume":"374","author":"Porter","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100433","DOI":"10.1016\/j.jbo.2022.100433","article-title":"Quantitative Preoperative Patient Assessments Are Related to Survival and Procedure Outcome for Osseous Metastases","volume":"34","author":"Bartelstein","year":"2022","journal-title":"J. Bone Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.jclinepi.2006.10.006","article-title":"Patient-reported outcomes helped predict survival in multiple myeloma using partial least squares analysis","volume":"60","author":"Viala","year":"2007","journal-title":"J. Clin. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/(SICI)1097-0142(19990115)85:2<333::AID-CNCR10>3.0.CO;2-Q","article-title":"Is quality of life predictive of the survival of patients with advanced nonsmall cell lung carcinoma?","volume":"85","author":"Herndon","year":"1999","journal-title":"Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s10549-010-1236-x","article-title":"Improvement in self-reported physical health predicts longer survival among women with a history of breast cancer","volume":"127","author":"Patterson","year":"2011","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"k5267","DOI":"10.1136\/bmj.k5267","article-title":"Maximising the impact of patient reported outcome assessment for patients and society","volume":"364","author":"Calvert","year":"2019","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1002\/cncr.30511","article-title":"The utility of abbreviated patient-reported outcomes for predicting survival in early stage colorectal cancer","volume":"123","author":"Hsu","year":"2017","journal-title":"Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Khurana, D., Leung, G., Sasaninia, B., Tran, D., Khan, M., and Firek, A. (2022). The Whole PERSON Health Score: A Patient-Focused Tool to Measure Nonmedical Determinants of Health. NEJM Catalyst, 3.","DOI":"10.1056\/CAT.22.0096"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1001\/jama.2020.1637","article-title":"The Role of Physicians in Addressing Social Determinants of Health","volume":"323","author":"Maani","year":"2020","journal-title":"JAMA"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/ACM.0000000000002491","article-title":"Social Determinants of Health Training in U.S. Primary Care Residency Programs: A Scoping Review","volume":"94","author":"Gard","year":"2019","journal-title":"Acad. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/00333549141291S206","article-title":"The social determinants of health: It\u2019s time to consider the causes of the causes","volume":"129","author":"Braveman","year":"2014","journal-title":"Public Health Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1111\/1475-6773.12351","article-title":"County Health Rankings and the Cult of the Imperfect","volume":"50","author":"Remington","year":"2015","journal-title":"Health Serv. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"4178","DOI":"10.1158\/1078-0432.CCR-22-2588","article-title":"AACR Cancer Progress Report 2022: Decoding Cancer Complexity, Integrating Science, and Transforming Patient Outcomes","volume":"28","author":"Williams","year":"2022","journal-title":"Clin. Cancer Res."},{"key":"ref_27","first-page":"16","article-title":"Wie entwickelt sich die Sarkomchirurgie?","volume":"1","author":"Fuchs","year":"2021","journal-title":"Lead. Opin. Ortho\u00e4die Traumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2852","DOI":"10.1093\/annonc\/mdx484","article-title":"Improved survival using specialized multidisciplinary board in sarcoma patients","volume":"28","author":"Blay","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1093\/annonc\/mdz124","article-title":"Surgery in reference centers improves survival of sarcoma patients: A nationwide study","volume":"30","author":"Blay","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1093\/annonc\/mdz408","article-title":"Criteria for reference centers for sarcomas: Volume but also long-term multidisciplinary organisation","volume":"30","author":"Blay","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Fayet, Y., Tetreau, R., Honore, C., Le Nail, L.R., Dalban, C., Gouin, F., Causeret, S., Piperno-Neumann, S., Mathoulin-Pelissier, S., and Karanian, M. (2021). Determinants of the access to remote specialised services provided by national sarcoma reference centres. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-08393-4"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.annonc.2022.02.221","article-title":"Improving at a nationwide level the management of patients with sarcomas with an expert network","volume":"33","author":"Blay","year":"2022","journal-title":"Ann. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"101897","DOI":"10.1016\/j.ejon.2021.101897","article-title":"Patient-Reported Outcomes in Sarcoma: A scoping review","volume":"50","author":"Almeida","year":"2021","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.1007\/s11136-020-02481-x","article-title":"Development of a patient-reported experience questionnaire for patients with sarcoma: The Sarcoma Assessment Measure (SAM)","volume":"29","author":"Martins","year":"2020","journal-title":"Qual. Life Res."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Schut, A.-R.W., Timbergen, M.J.M., Lidington, E., Gr\u00fcnhagen, D.J., van der Graaf, W.T.A., Sleijfer, S., van Houdt, W.J., Bonenkamp, J.J., Younger, E., and Dunlop, A. (2021). The Evaluation of Health-Related Quality of Life Issues Experienced by Patients with Desmoid-Type Fibromatosis (The QUALIFIED Study)\u2014A Protocol for an International Cohort Study. Cancers, 13.","DOI":"10.3390\/cancers13133068"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e000914","DOI":"10.1136\/esmoopen-2020-000914","article-title":"Unravelling the heterogeneity of soft tissue and bone sarcoma patients\u2019 health-related quality of life: A systematic literature review with focus on tumour location","volume":"5","author":"Fiore","year":"2020","journal-title":"ESMO Open"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"den Hollander, D., Fiore, M., Martin-Broto, J., Kasper, B., Casado Herraez, A., Kulis, D., Nixon, I., Sodergren, S.C., Eichler, M., and van Houdt, W.J. (2020). Incorporating the Patient Voice in Sarcoma Research: How Can We Assess Health-Related Quality of Life in This Heterogeneous Group of Patients? A Study Protocol. Cancers, 13.","DOI":"10.3390\/cancers13010001"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e2226252","DOI":"10.1001\/jamanetworkopen.2022.26252","article-title":"Association of Anticancer Immune Checkpoint Inhibitors With Patient-Reported Outcomes Assessed in Randomized Clinical Trials: A Systematic Review and Meta-analysis","volume":"5","author":"Pala","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Saebye, C., Amidi, A., Keller, J., Andersen, H., and Baad-Hansen, T. (2020). Changes in Functional Outcome and Quality of Life in Soft Tissue Sarcoma Patients within the First Year after Surgery: A Prospective Observational Study. Cancers, 12.","DOI":"10.3390\/cancers12020463"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Eichler, M., Hentschel, L., Richter, S., Hohenberger, P., Kasper, B., Andreou, D., Pink, D., Jakob, J., Singer, S., and Grutzmann, R. (2020). The Health-Related Quality of Life of Sarcoma Patients and Survivors in Germany-Cross-Sectional Results of a Nationwide Observational Study (PROSa). Cancers, 12.","DOI":"10.3390\/cancers12123590"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1007\/s11136-020-02561-y","article-title":"The complexity of assessing health-related quality of life among sarcoma patients","volume":"29","author":"Husson","year":"2020","journal-title":"Qual. Life Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.ejca.2020.06.022","article-title":"Active surveillance in desmoid-type fibromatosis: A systematic literature review","volume":"137","author":"Timbergen","year":"2020","journal-title":"Eur. J. Cancer"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1097\/01.mlr.0000258615.42478.55","article-title":"The Patient-Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap cooperative group during its first two years","volume":"45","author":"Cella","year":"2007","journal-title":"Med. Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/j.jval.2021.02.003","article-title":"Measurement Properties of the EQ VAS Around the Globe: A Systematic Review and Meta-Regression Analysis","volume":"24","author":"Cheng","year":"2021","journal-title":"Value Health"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Szende, A., Janssen, B., and Cabases, J. (2014). Self-Reported Population Health: An International Perspective based on EQ-5D, Springer.","DOI":"10.1007\/978-94-007-7596-1"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Derogatis, L. (2000). BSI 18: Brief Symptom Inventory 18. Administration, Scoring, and Procedures Manual, NCS Pearson.","DOI":"10.1037\/t07502-000"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1177\/1403494817702759","article-title":"Predictive validity of the Work Ability Index and its individual items in the general population","volume":"45","author":"Lundin","year":"2017","journal-title":"Scand. J. Public Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1007\/BF00540024","article-title":"Development of a measure of physical function for patients with bone and soft tissue sarcoma","volume":"5","author":"Davis","year":"1996","journal-title":"Qual. Life Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/00003086-199301000-00035","article-title":"A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system","volume":"286","author":"Enneking","year":"1993","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/BF00434800","article-title":"The European Organization for Research and Treatment of Cancer. Approach to quality of life assessment: Guidelines for developing questionnaire modules. EORTC Study Group on Quality of Life","volume":"2","author":"Sprangers","year":"1993","journal-title":"Qual. Life Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e722","DOI":"10.1634\/theoncologist.2019-0348","article-title":"The EORTC QLQ-C30 Summary Score as Prognostic Factor for Survival of Patients with Cancer in the \"Real-World\": Results from the Population-Based PROFILES Registry","volume":"25","author":"Husson","year":"2020","journal-title":"Oncologist"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1245\/s10434-020-08240-z","article-title":"Designing a Rational Follow-Up Schedule for Patients with Extremity Soft Tissue Sarcoma","volume":"27","author":"Wilson","year":"2020","journal-title":"Ann. Surg. Oncol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1038\/s41568-022-00502-0","article-title":"Big data in basic and translational cancer research","volume":"22","author":"Jiang","year":"2022","journal-title":"Nat. Rev. Cancer"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1200\/JCO.20.03375","article-title":"Benefits of Digital Symptom Monitoring With Patient-Reported Outcomes During Adjuvant Cancer Treatment","volume":"39","author":"Basch","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1001\/jama.2017.7156","article-title":"Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment","volume":"318","author":"Basch","year":"2017","journal-title":"JAMA"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2632","DOI":"10.1200\/JCO.21.00482","article-title":"How Can We Evaluate the Electronic Patient-Reported Outcome Appropriately?","volume":"39","author":"Shojima","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1056\/NEJMp2200089","article-title":"Real-World Evidence\u2014Where Are We Now?","volume":"386","author":"Concato","year":"2022","journal-title":"N. Engl. J. Med. (NEJM)"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"287","DOI":"10.3322\/caac.21714","article-title":"An overview of real-world data sources for oncology and considerations for research","volume":"72","author":"Penberthy","year":"2021","journal-title":"CA A Cancer J. Clin."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.2106\/JBJS.21.00030","article-title":"A Call for a Standardized Approach to Reporting Patient-Reported Outcome Measures: Clinical Relevance Ratio","volume":"103","author":"Orr","year":"2021","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e003097","DOI":"10.1136\/bmjgh-2020-003097","article-title":"Infection and mortality of healthcare workers worldwide from COVID-19: A systematic review","volume":"5","author":"Bandyopadhyay","year":"2020","journal-title":"BMJ Glob. Health"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"3770","DOI":"10.1200\/JCO.21.02163","article-title":"Pathway to Precision Patient-Reported Outcomes","volume":"39","author":"Kaufmann","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Pranata, S., Wu, S.V., Alizargar, J., Liu, J.H., Liang, S.Y., and Lu, Y.Y. (2021). Precision Health Care Elements, Definitions, and Strategies for Patients with Diabetes: A Literature Review. Int. J. Environ. Res. 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