Place or patient as the driver of regional variation in healthcare spending - Discrepancies by category of care.

We study how much regional variation in healthcare spending is driven by place- and patient-specific factors using a random sample of 53,620 regional migrants in Sweden. We find notable differences depending on the category of care, with place-specific factors having a significantly larger impact on specialized outpatient care compared to inpatient and pharmaceutical care. The place effect is estimated to 75% of variation in specialized outpatient care, but 26% or less in variations in inpatient care, and 5% in prescription drug spending. We also find that the empirical estimator has a substantial impact on the estimates of the place-specific effect. The results based on the traditional approach in the literature with two-way fixed effects and event-study models produce much larger estimates of the place-specific effect compared to results based on recently developed heterogeneity-robust models. For total healthcare spending, the traditional two-way fixed effects model estimates a place effect of 78%, while the heterogeneity-robust estimator finds a place effect around 10%. This finding indicates that previous results in this literature, all based on traditional two-way fixed-effects regressions, should be interpreted with care.

Residential relocation to assess impact of changes in the living environment on cardio-respiratory health: A narrative literature review with considerations for exposome research.

Residential relocation studies have become increasingly valuable tools for evaluating the effects of changing living environments on human health, but little is known about their application to multiple aspects of the living environment and the most appropriate methodology. This narrative review explores the utility of residential relocation as a natural experiment for studying the impact of changing urban exposures on cardio-metabolic health in high-income settings. It provides a comprehensive overview of the use of residential relocation studies, evaluates their methodological approaches, and synthesizes findings related to health behaviors and cardio-metabolic outcomes. Our search identified 43 relevant studies published between January 1995 and February 2023, from eight countries, predominantly the USA, Canada, and Australia. The majority of eligible studies were published between 2012 and 2021 and examined changes in various domains of the living environment, such as walkability, the built and social environments, but rarely combinations of exposures. Included studies displayed heterogeneity in design and outcomes, 25 involving only movers and 18 considering both movers and non-movers. To mitigate the issue of residential self-selection bias, most studies employed a "change-in-change" design and adjusted for baseline covariates but only a fraction of them accounted for time-varying confounding. Relocation causes simultaneous changes in various features of the living environment, which presents an opportunity for exposome research to establish causal relationships, using large datasets with increased statistical power and a wide range of health outcomes, behaviors and biomarkers. Residential relocation is not a random process. Thus, studies focusing on living environment characteristics need to carefully select time-varying covariates and reference group. Overall, this review informs future research by guiding choices in study design, data requirements, and statistical methodologies. Ultimately, it contributes to the advancement of the urban exposome field and enhances our understanding of the complex relationship between urban environments and human health.

Effect of residential relocation on environmental exposures in European cohorts: An exposome-wide approach.

Residential relocation is increasingly used as a natural experiment in epidemiological studies to assess the health impact of changes in environmental exposures. Since the likelihood of relocation can be influenced by individual characteristics that also influence health, studies may be biased if the predictors of relocation are not appropriately accounted for. Using data from Swedish and Dutch adults (SDPP, AMIGO), and birth cohorts (BAMSE, PIAMA), we investigated factors associated with relocation and changes in multiple environmental exposures across life stages. We used logistic regression to identify baseline predictors of moving, including sociodemographic and household characteristics, health behaviors and health. We identified exposure clusters reflecting three domains of the urban exposome (air pollution, grey surface, and socioeconomic deprivation) and conducted multinomial logistic regression to identify predictors of exposome trajectories among movers. On average, 7 % of the participants relocated each year. Before relocating, movers were consistently exposed to higher levels of air pollution than non-movers. Predictors of moving differed between the adult and birth cohorts, highlighting the importance of life stages. In the adult cohorts, moving was associated with younger age, smoking, and lower education and was independent of cardio-respiratory health indicators (hypertension, BMI, asthma, COPD). Contrary to adult cohorts, higher parental education and household socioeconomic position were associated with a higher probability of relocation in birth cohorts, alongside being the first child and living in a multi-unit dwelling. Among movers in all cohorts, those with a higher socioeconomic position at baseline were more likely to move towards healthier levels of the urban exposome. We provide new insights into predictors of relocation and subsequent changes in multiple aspects of the urban exposome in four cohorts covering different life stages in Sweden and the Netherlands. These results inform strategies to limit bias due to residential self-selection in epidemiological studies using relocation as a natural experiment.

A Novel Viewpoint on the Anticipatory Postural Adjustments During Gait Initiation.

Anticipatory postural adjustments (APAs) are the coordinated muscular activities that precede the voluntary movements to counteract the associated postural perturbations. Many studies about gait initiation call APAs those activities that precede the heel-off of the leading foot, thus taking heel-off as the onset of voluntary movement. In particular, leg muscles drive the center of pressure (CoP) both laterally, to shift the body weight over the trailing foot and backward, to create a disequilibrium torque pushing forward the center of mass (CoM). However, since subjects want to propel their body rather than lift their foot, the onset of gait should be the CoM displacement, which starts with the backward CoP shift. If so, the leg muscles driving such a shift are the prime movers. Moreover, since the disequilibrium torque is mechanically equivalent to a forward force acting at the pelvis level, APAs should be required to link the body segments to the pelvis: distributing such concentrated force throughout the body would make all segments move homogeneously. In the aim of testing this hypothesis, we analyzed gait initiation in 15 right-footed healthy subjects, searching for activities in trunk muscles that precede the onset of the backward CoP shift. Subjects stood on a force plate for about 10 s and then started walking at their natural speed. A minimum of 10 trials were collected. A force plate measured the CoP position while wireless probes recorded the electromyographic activities. Recordings ascertained that at gait onset APAs develop in trunk muscles. On the right side, Rectus Abdominis and Obliquus Abdominis were activated in 11 and 13 subjects, respectively, starting on average 33 and 54 ms before the CoP shift; Erector Spinae (ES) at L2 and T3 levels was instead inhibited (9 and 7 subjects, 104 and 120 ms). On the contralateral side, the same muscles showed excitatory APAs (abdominals in 11 and 12 subjects, 27 and 82 ms; ES in 10 and 7 subjects, 75 and 32 ms). The results of this study provide a novel framework for distinguishing postural from voluntary actions, which may be relevant for the diagnosis and rehabilitation of gait disorders.

Causes of regional variation in Dutch healthcare expenditures: Evidence from movers.

We assess the relative importance of demand and supply factors as determinants of regional variation in healthcare expenditures in the Netherlands. Our empirical approach follows individuals who migrate between regions. We use individual data on annual healthcare expenditures for the entire Dutch population between the years 2006 and 2013. Regional variation in healthcare expenditures is mostly driven by demand factors, with an estimated share of around 70%. The relative importance of different causes varies with the groups of regions being compared.

First operation of the SASE1 undulator system of the European X-ray Free-Electron Laser.

The European XFEL comprises three undulator systems. All of the systems use standardized mechanical, magnetic and control components. The key elements such as undulators, phase shifters and quadrupole movers as well as their controls are described, with special emphasis on the SASE1 undulator system, which was the first to become operational and has been lasing since May 2017. The role of these systems for the commissioning is outlined with special emphasis on beam-based alignment, which was important to achieve first lasing. Radiation damage was observed. The exposure doses were measured with the online radiation dosimetry system. Countermeasures and latest results are reported, which are important for a high-duty-cycle machine such as the European XFEL.

EMDUniFrac: exact linear time computation of the UniFrac metric and identification of differentially abundant organisms.

Both the weighted and unweighted UniFrac distances have been very successfully employed to assess if two communities differ, but do not give any information about how two communities differ. We take advantage of recent observations that the UniFrac metric is equivalent to the so-called earth mover's distance (also known as the Kantorovich-Rubinstein metric) to develop an algorithm that not only computes the UniFrac distance in linear time and space, but also simultaneously finds which operational taxonomic units are responsible for the observed differences between samples. This allows the algorithm, called EMDUniFrac, to determine why given samples are different, not just if they are different, and with no added computational burden. EMDUniFrac can be utilized on any distribution on a tree, and so is particularly suitable to analyzing both operational taxonomic units derived from amplicon sequencing, as well as community profiles resulting from classifying whole genome shotgun metagenomes. The EMDUniFrac source code (written in python) is freely available at: https://github.com/dkoslicki/EMDUniFrac .

Magnetic Flux Distribution of Linear Machines with Novel Three-Dimensional Hybrid Magnet Arrays.

The objective of this paper is to propose a novel tubular linear machine with hybrid permanent magnet arrays and multiple movers, which could be employed for either actuation or sensing technology. The hybrid magnet array produces flux distribution on both sides of windings, and thus helps to increase the signal strength in the windings. The multiple movers are important for airspace technology, because they can improve the system's redundancy and reliability. The proposed design concept is presented, and the governing equations are obtained based on source free property and Maxwell equations. The magnetic field distribution in the linear machine is thus analytically formulated by using Bessel functions and harmonic expansion of magnetization vector. Numerical simulation is then conducted to validate the analytical solutions of the magnetic flux field. It is proved that the analytical model agrees with the numerical results well. Therefore, it can be utilized for the formulation of signal or force output subsequently, depending on its particular implementation.

Difference in differences for stayers with a time-varying qualification: health expenditure elasticity of the elderly.

In difference in differences, a treatment is applied only to a qualified group at some time point. The qualification may be time-constant as in gender, or time-varying as in residential location. When the qualification is time-varying, there appear four groups: the newly qualified (in-movers), the already qualified (in-stayers), the newly disqualified (out-movers), and the already disqualified (out-stayers). A change in qualification may affect the response variable of interest even when the treatment effect is zero, which is an 'untreated moving effect'. Also, when the treatment effect is not zero, it may be different across the four groups. The conventional difference in differences fails to remove untreated moving effects and ignores the possible treatment effect heterogeneity across the groups. This paper shows how to account for untreated moving effects and proposes 'the effect on in-stayers' as the main effect of interest. Our proposal can be implemented with least squares estimator for panel models or with nonparametric methods. An empirical analysis is provided using Korean data for the effects of the basic elder pension on health-care expenditure.

Estratégias competitivas e de desenvolvimento de produtos lácteos funcionais: estudos de caso em empresas agroindustriais da região Sul do Brasil / Competitive and product development strategies in functional dairy products: case studies in food processing industries from south Brazil

Esta pesquisa buscou compreender o motivo e o modo como as empresas agroindustriais brasileiras desenvolvem novos produtos e se orientam para o mercado no segmento de alimentos lácteos funcionais. Ela também examina o papel do sistema regulatório nesse processo. Foi utilizada a abordagem de estudos de caso para esclarecer as inter-relações sistêmicas e trade-offs entre os fatores relacionados à inovação. Foi escolhido um desenho de pesquisa com uma unidade de análise (empresas agroindustriais que, recentemente, lançaram novos produtos no mercado de lácteos funcionais) e estudos de caso múltiplos (três empresas agroindustriais da região Sul). Os resultados revelam que as empresas agroindustriais adotam estratégias seguidoras em relação às concorrentes multinacionais. Tradicionalmente, essa é uma estratégia considerada mais segura e exige menores investimentos em P&D e marketing. Contudo, ela corrói a imagem de marca e limita os retornos financeiros das inovações. O comportamento seguidor é resultado de um baixo grau de orientação para mercado e restrita cooperação com parceiros externos. Esse "ciclo vicioso" é reforçado pelas barreiras estabelecidas pelo sistema regulatório.

This multi-case study searched to understand why and how food processing industries develop new products and market orientates to compete in the Brazilian functional dairy market. It also examines the regulatory framework role in this process. We use case studies as an approach to give evidence of the systemic relations and the existent trade-offs among factors related to innovation. We chose a research design with one unity of analysis (food processors that recently launched new products in the functional dairy market) and multiple case studies (three Brazilian dairies of the southern region). The results reveal that the enterprises adopt a second-mover strategy vis-à-vis the multinational competitors. Traditionally, this strategy is considered safer and requires lower R&D and marketing investments. However, it erodes branding and also limits financial returns from innovations. The second-mover behavior is consequence of poor market orientation and restricted cooperation with external partners. This "vicious circle" is also enhanced by barriers established by the regulatory framework.