IQOS and cigarette advertising across regulatory periods and population groups in Israel: a longitudinal analysis

BACKGROUND

Tobacco regulation recently changed in Israel, including a partial advertisement ban. We assessed the impact of regulatory changes on Philip Morris International's (PMI) IQOS and cigarette advertisements.

METHODS

Weekly number of ads and weekly adspend of PMI's IQOS and cigarettes were analysed descriptively and using Quasi-Poisson regressions over time, across regulatory periods and in relation to subpopulations (general public, Arab, Russian and Ultra-Orthodox), from 25 December 2016 to 4 August 2020. Exponentiated coefficients (a value >1 indicates an increase) and 95% CIs are reported.

RESULTS

The average weekly number of ads and the average weekly adspend of IQOS were higher than cigarettes (42.22 vs 26.76 ads/week and 59 409 vs 45 613 new Israeli shekels/week; p<0.001 for both) during the study period, with exclusive IQOS advertisements during market penetration (December 2016 to May 2017). Variation in both outcomes was observed with regard to regulatory decisions. After the advertisement ban, there was a significant decrease in the weekly number of ads (IQOS: ß=0.04, 95% CI 0.002 to 0.20; cigarettes: ß=0.05, 95% CI 0.01 to 0.15) and weekly adspend (IQOS: ß=0.15, 95% CI 0.07 to 0.29; cigarettes: ß=0.31, 95% CI 0.17 to 0.53) for both products. The Ultra-Orthodox had significantly higher average weekly ads compared with the Arab population (IQOS: 0.67 vs 0.07; cigarettes: 2.74 vs 0.13; p=0.02 for both) but lower adspend.

CONCLUSIONS

IQOS and cigarette advertisements varied over time and appeared to have been impacted by regulatory changes. PMI invested more in IQOS advertisements than in cigarettes, with a partial advertisement ban decreasing both products' advertisements. PMI might be targeting the Ultra-Orthodox Jewish population which has a low smoking rate. Further research and surveillance are needed to better understand targeting strategies in order to inform tobacco control policy.

Art Value Creation and Destruction

I present a theory of creative and destructive value state referring to abstract art. Value is a probabilistic state held as a mixture of its expectation and information forces that coexist in a give-and-take relationship. Expectations are driven by the disclosure of novel information about the value state of various events of desire. Each bit of accumulated information contributes to the improvement of perception up to a threshold level, beyond which begin conscious states. The desire to disclose a value state triggers a triadic system of evaluation which uses concepts, observables and approaches. While the triadic valuation mechanisms can be used to assess various commodities, the scope of this work is limited to the case of artworks, in particular abstract paintings. I assume that art value is basically mediated by the interplay between these value state mechanisms of creation and destruction. Expectations in artwork develop attraction by challenging its contemplator to evaluate (predict) its meaning. Once the relevant information, corresponding to its creative expectations, is acquired (and conditioned), emotional states of indifference, disinterest and desensitization develop.

The Effects of the Medicaid Expansion on Hospital Utilization, Employment, and Capital

In recent years, hospitals reacted to changes in demand caused by the Affordable Care Act Medicaid expansions. We conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. We used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. During the period studied, the Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. We find strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. We found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.

The impact of conventional cost-effectiveness analysis on pricing dynamics in the market of new medicines: a proposed countervailing approach

BACKGROUND

Countries using cost effectiveness ratio as a decision tool for price and reimbursement decisions still witness accelerating price increases. The objective of this paper is to propose a change in the application of the incremental cost effectiveness ratio as a criterion for price policy.

RESEARCH DESIGN

We develop a model that sets a price for marginal effectiveness equal to the marginal willingness to pay, but it reimburses average effectiveness according to the size of increased QALY gain.

RESULTS

This new formula also allows to split the economic value of drug between patients and the industry and creates a reward to invest into QALY gains. We show some empirical data of the new prices derived from the application of the new formula, as well as the implications in terms of the consumer and manufacturer´s surplus based on two potential scenarios of the incentives generated by this new formulation.

DISCUSSION

We propose that small increases in life expectancy be priced differently from substantial as a way of containing the price dynamics.

CONCLUSIONS

A change in the application of the ICER threshold will help to reduce the price pressure on public budgets.

Perceived transaction cost and its antecedents associated with fintech users' intention: Evidence from Pakistan

Researches depict a considerable degree of acknowledgment of financial technology improvement in Pakistan. However, the costs blocking clients' intention to utilize financial technology remain dubious. Building upon Transaction Cost Economics and Innovation diffusion theory, this paper hypothesizes that consumers' transaction cost of fintech is affected by nine antecedents: perceived asset specificity, complexity, product uncertainty, behavioral uncertainty, transaction frequency, dependability, limitations, convenience, and economic utility. Transaction cost has a negative relationship with consumers' intentions to use fintech for online buying or availing services. We tested the model using data gathered from the individuals. The results show that factors that are positively related to consumers' perceived transaction cost, among them product uncertainty (β = 0.231) is the greatest of factors, followed by behavior uncertainty (β = 0.209) and asset specificity (β = 0.17), those that are negatively associated are dependability (β = 0.11), and convenience (β = 0.224). The study is limited in scope, focusing primarily on cost factors. Future research may analyze additional cost-related elements and the actual use of financial technology by using samples from different countries.

Hospital Survival In Rural Markets: Closures, Mergers, And Profitability

Financial distress among rural hospitals in the US has increased in recent years. Using national hospital data, we investigated how the decline in profitability has affected hospital survival, either independently or with a merger. The answer has direct implications for access to care and competition in rural markets. We assessed the rate of hospital closures and mergers in predominantly rural markets during the period 2010-18, focusing on hospitals that were unprofitable at baseline. A minority of unprofitable hospitals (7 percent) closed. A larger share (17 percent) merged, most commonly with organizations from outside of their local geographic market. Most unprofitable hospitals (77 percent) continued to operate through 2018 without closure or merger. About half of these hospitals returned to profitability. At the market level, 22 percent of markets served by unprofitable hospitals lost a competitor to closure or within-market merger. Out-of-market mergers affected 33 percent of markets with an unprofitable hospital. Overall, our results suggest that rural markets are experiencing meaningful rates of hospital closures and mergers, yet many hospitals have survived despite poor financial performance. Policies targeting access to care will continue to be important. Similar attention will be needed to address the competitive effects of hospital closures and mergers on prices and quality.

A patent-based analysis of the evolution of basic, mission-oriented, and applied research in European universities

The dynamics of basic and applied research at university and industry have steadily changed since the Eighties, with the private sector reducing its investments in science and universities experiencing significant remodelling in the governance of their funding. While studies have focussed on documenting these changes in industry, less attention has been paid to observe the trajectories of basic and applied research in universities. This work contributes to fill this gap by looking at the evolution of publicly funded research that has been patented by universities between 1978 and 2015. First, we adopt a critical perspective of the basic versus applied dichotomy and identify patents according to three typologies of research: basic, mission-oriented, and applied research. Second, we describe the evolution of these three typologies in universities compared to industry. Our results show that over the years, patents from academic research that was publicly funded have become more oriented towards pure basic research, with mission-oriented basic research and pure applied research decreasing from the late 1990s. These results complement and extend the literature on basic and applied research dynamics in the private sector. By introducing mission-oriented research as a type of basic research with consideration of use, the work problematises the basic and applied research dichotomy and provides insights into the evolution of academic research focus, offering a more complex picture of how university research contributes to industry and broader social value creation.

Technological diversification, technological coupling and invention performance

Purpose

To investigate the relationship between technological diversification and firm performance as a function of varying levels of technological coupling and internal technological change.

Design/methodology/approach

A longitudinal study of US-based bio-pharmaceutical companies.

Findings

Technological diversification improves invention performance. However, high levels of technological coupling reduce this effect.

Practical implications

Firms with highly diversified technological portfolios should strive to keep their technologies at low levels of technological coupling.

Originality/value

This is the first study to show that technological coupling reduces the positive effect of technological diversification on firms' invention performance.

Political endorsement by Nature and trust in scientific expertise during COVID-19

High-profile political endorsements by scientific publications have become common in recent years, raising concerns about backlash against the endorsing organizations and scientific expertise. In a preregistered large-sample controlled experiment, I randomly assigned participants to receive information about the endorsement of Joe Biden by the scientific journal Nature during the COVID-19 pandemic. The endorsement message caused large reductions in stated trust in Nature among Trump supporters. This distrust lowered the demand for COVID-related information provided by Nature, as evidenced by substantially reduced requests for Nature articles on vaccine efficacy when offered. The endorsement also reduced Trump supporters' trust in scientists in general. The estimated effects on Biden supporters' trust in Nature and scientists were positive, small and mostly statistically insignificant. I found little evidence that the endorsement changed views about Biden and Trump. These results suggest that political endorsement by scientific journals can undermine and polarize public confidence in the endorsing journals and the scientific community.

Government R&D and green technology spillovers: the Chernobyl disaster as a natural experiment

Using data on green patents filed at the European Patent Office from 1980 to 1984, this paper investigates the effect of increasing government R&D budget on green technology spillovers. Spillovers are measured with patent forward citations over the period 1981–1988. The level of government R&D budget is instrumented leveraging the unexpected occurrence of the Chernobyl nuclear accident—that exogenously pushed governments to reduce their energy-related R&D budgets—in a difference in differences setting. 2SLS results show that a 10% increase in government R&D increases by some 0.7% the number of citations received by green patents. Although positive and significant, the small magnitude of the estimated elasticity suggests that government R&D takes time to let innovation spillovers from green technologies to materialize with some relevance. Interestingly, increasing government R&D expenditures fosters green technology spillovers across traditional (non-green) fields and enlarges the technological breadth of inventions citing green patents. Overall, I conclude that government R&D fosters green knowledge spillovers, accelerates hybridization processes and favors technological diversification around green technologies. However, these positive effects seem to materialize at a slow pace.

Industry consolidation as a strategy: an acquisition program perspective

Purpose

The purpose of this paper is to enlighten the intriguing process of industry asset consolidation. It is critical for firms to manage their business acquisitions strategically for survival in this industry life cycle process, which develops through multiple company mergers. The companies extensively acquiring industry assets have utilized acquisition programs consisting of both pre-acquisition strategizing and post-acquisition integration; however, the existing literature on acquisition programs focuses on post-acquisition integration activities. This study aims to bridge this gap.

Design/methodology/approach

This study focuses on pre-acquisition strategizing of acquisition programs and proposes a model in which an acquiring company could manage its acquisitions for industry asset consolidation over the industry evolution.

Findings

Empirically, in the multi-case study of telecommunications infrastructure companies, the authors collect an extensive set of archival records accumulated over the whole industry life-cycle, spanning more than 30 years, and they apply a qualitative data analysis to reveal strategic actions within the companies.

Research limitations/implications

The discoveries elaborate on activities comprising the acquisition process model: social legitimacy, strategic alignment, resource fulfillment, consolidation pursuit and merging.

Practical implications

The counterintuitive findings are that the companies strived to ensure legitimacy early in the telecommunication infrastructure markets before they reached strategic alignment with their owners.

Originality/value

The results extend the understanding of industry asset consolidation as an organization-level phenomenon and show how contextual factors connected to industry life-cycle phases, such as regulatory regimes and financial cycles and industry evolution, influence the attributions of an acquisition program.

Beyond Donations: Isomorphism and Revenue Mix in Nonprofit Start-Ups

The literature on nonprofit growth contains a practical ambiguity regarding which types of revenues to cultivate as a start-up nonprofit. The revenue portfolio of a more established organization may be inappropriate (or unattainable) for a new one, but there may be perils in relying too long on sources of nonprofit start-up capital. We posit that nonprofit entrepreneurs choose to mimic larger organizations in their field for growth rather than rely on the revenue mix of their start-up stage. This study uses two different dynamic econometric models to estimate the role of revenue type and other organizational factors in the growth of young and small nonprofits. We find that mimicking the revenue habits of larger organizations is generally (but not universally) advisable, with most conclusions sensitive to subsector.

Effect of the topic-combination novelty on the disruption and impact of scientific articles: Evidence from PubMed

Novelty, disruption and impact are essential concepts for understanding the originality and importance of scientific discoveries. By drawing on a large-scale corpus consisting of nearly 0.9 million PubMed papers published between 1970 and 2009 and their citations before 2018 in the Web of Science, we found that the topic-combination novelty has different effects on the impact and disruption of scientific papers, that is, an inverted U-shaped effect on the impact and a positive effect on disruption. One of our contributions is that we have significantly improved the reliability of topic-combination novelty by applying MeSH terms of PubMed to the measurement of novelty. Another contribution is that we have explained how a novel combination of MeSH terms of an article contributes to citations and citation networks, that is, the middle-level novelty is more likely to achieve large citation counts. In contrast, high topic-combination novelty relates to the discontinuity in the focal paper’s citation network.

Do repeated alliances within patent pools encourage enterprise innovation? Evidence from MPEG LA

Purpose

The purpose of this study is to investigate whether repeated alliances between two members of a patent pool boost enterprise innovation. Furthermore, this paper intends to determine whether the innovation performance becomes higher or lower based on the partnership characteristics.

Design/methodology/approach

In this empirical study, hierarchical regression is used to analyze the longitudinal data obtained from 12 patent pools managed by MPEG LA during a time period ranging from 2006 to 2018. The members of patent pools comprise research institutions, firms and universities. Research analyses are performed based on a sample of 68,400 member pairs who had established repeated alliances. The information regarding such pairs is gathered from public databases.

Findings

Repeated alliances positively correlate with enterprise innovation performance in patent pools; this performance is higher when the two enterprises have exploratory collaborations. Conversely, the performance is lower when the partners have a similar technology base and are engaged in a technological competition (competitive learning and patent litigation). Moreover, the performance is lower when one partner demonstrates higher network centrality and richer structural holes than the other partner.

Originality/value

Patent pools play an instrumental role in eliminating patent-licensing barriers, thereby allowing mutual acquisition of complementary technologies, and cooperatively strengthening technology development. From the perspective of theories of coopetition, knowledge management and social network, this study explores the impact of patent pools on enterprise innovation performance and ascertains the moderating roles of technology coopetition, technology similarity and network position, thereby expanding the scope of innovation effect in the context of patent pools.

Study on effect of collaborative governance participation willingness of online food delivery platform restaurants and consumers from perspective of control theory: Based on moderating effects of perceived risks

The popularization of the Internet and the convenience of e-commerce are driving the online restaurant industry’s rapid development of worldwide. However, serious information asymmetries in online food delivery (OFD) transactions not only aggravate food safety risks, resulting in simultaneous government and market failures, but also intensify consumers’ perceived risks. This paper innovatively constructs a research framework for the governance participation willingness of OFD platform restaurants and consumers under the moderating effects of perceived risks from the perspective of control theory and then develops scales for analyzing the governance willingness of both restaurants and consumers. Using data collected through a survey, this paper explores the effect of control elements on governance participation by restaurants and consumers and analyzes the moderating effects of perceived food safety risks. Results showed that both government regulations and restaurant reputation (formal control elements) and online complaints and restaurant management response (informal control elements) can increase governance participation willingness among both platform restaurants and consumers. The moderating effects of perceived risks are partially significant. When the risks perceived by restaurants and consumers are strong, government regulation and online complaints can more effectively boost the governance participation willingness of restaurants and consumers, respectively. At this moment, consumers’ willingness to pursue problem solving through online complaints is evidently enhanced. Accordingly, the perceived risks and the online complaints jointly motivate restaurants and consumers to participate in governance activities.

Adverse selection and health insurance decisions of young migrant workers: An empirical study in China

Using data from the China Migrants Dynamic Survey (CMDS) in 2017, this study assessed adverse selection and the impact of mobility factors on adverse selection by analyzing two samples of young migrant workers. The results of the sample analysis showed that young migrant workers with higher health risks were more inclined to enroll in health insurance, indicating the presence of adverse selection. Mobility distance and settle intention have a heterogeneous effect on adverse selection, with young workers who migrate inter-provincially and intend to settle down being more susceptible. The analysis of the insured samples showed that the phenomenon of adverse selection was also evident in the choice of health insurance, with individuals with higher risks preferring Urban Employee Basic Medical Insurance (UEBMI), which has better financial coverage and benefits compared to Rural Residents' Basic Medical Insurance (URRBMI). The heterogeneity test confirmed that mobility distance plays a role in determining the likelihood of adverse selection, with inter-city and inter-province young migrant workers being more likely to show adverse selection.

A prediction model of users' attention transfer in the context of multitopic competition

Purpose

Multiple topics often exist on social media platforms that compete for users' attention. To explore how users’ attention transfers in the context of multitopic competition can help us understand the development pattern of the public attention.

Design/methodology/approach

This study proposes the prediction model for the attention transfer behavior of social media users in the context of multitopic competition and reveals the important influencing factors of users' attention transfer. Microblogging features are selected from the dimensions of users, time, topics and competitiveness. The microblogging posts on eight topic categories from Sina Weibo, the most popular microblogging platform in China, are used for empirical analysis. A novel indicator named transfer tendency of a feature value is proposed to identify the important factors for attention transfer.

Findings

The accuracy of the prediction model based on Light GBM reaches 91%. It is found that user features are the most important for the attention transfer of microblogging users among all the features. The conditions of attention transfer in all aspects are also revealed.

Originality/value

The findings can help governments and enterprises understand the competition mechanism among multiple topics and improve their ability to cope with public opinions in the complex environment.

Does prospective payment influence quality of care? A systematic review of the literature

In the light of rising health expenditures, the cost-efficient provision of high-quality inpatient care is on the agenda of policy-makers worldwide. In the last decades, prospective payment systems (PPS) for inpatient care were used as an instrument to contain costs and increase transparency of provided services. It is well documented in the literature that prospective payment has an impact on structure and processes of inpatient care. However, less is known about its effect on key outcome indicators of quality of care. In this systematic review, we synthesize evidence from studies investigating how financial incentives induced by PPS affect indicators of outcome quality domains of care, i.e. health status and user evaluation outcomes. We conduct a review of evidence published in English, German, French, Portuguese and Spanish language produced since 1983 and synthesize results of the studies narratively by comparing direction of effects and statistical significance of different PPS interventions. We included 64 studies, where 10 are of high, 18 of moderate and 36 of low quality. The most commonly observed PPS intervention is the introduction of per-case payment with prospectively set reimbursement rates. Abstracting evidence on mortality, readmission, complications, discharge disposition and discharge destination, we find the evidence to be inconclusive. Thus, claims that PPS either cause great harm or significantly improve the quality of care are not supported by our findings. Further, the results suggest that reductions of length of stay and shifting treatment to post-acute care facilities may occur in the course of PPS implementations. Accordingly, decision-makers should avoid low capacity in this area.

Financial incentives and antibiotic prescribing patterns: Evidence from dispensing physicians in a public healthcare system

To ensure sufficient access to healthcare in remote areas, some countries allow physicians to directly dispense prescribed drugs through on-site pharmacies. Depending on the medication prescribed, this may pose a significant financial incentive for physicians to over-prescribe. This study, therefore, explored the effect of on-site pharmacies on antibiotic dispensing in a social health insurance system. Investigating physicians' prescribing behavior is especially relevant in the case of antibiotics, as over-utilization expedites antimicrobial resistance, leading to the development of untreatable bacterial infections. The empirical analysis was based on comprehensive administrative data on 13,741 antibiotic prescriptions issued by all 4044 public general practitioners (GPs) in Austria between 2016 and 2019. Switches from dispensing to non-dispensing status (and vice versa) were exploited in a difference-in-difference framework to mitigate a potential selection bias. GPs with the right to dispense over the entire observed period were used as the control group, and those who had either lost or gained the right to dispense as the treatment group. The results from a log-linear mixed model show that not currently operating an on-site pharmacy is associated with a 9.2% lower dispensing rate (i.e., antibiotics per 1000 yearly consultations). The results are robust to potential differences between GPs who switch from dispensing to non-dispensing and those who switch from non-dispensing to dispensing, to potential patient sorting, and to different functional forms. A prescribing effect interpretation (i.e., financial incentives give rise to more prescriptions for antibiotics) explains the observed volume effect provided that the share of unfilled antibiotic prescriptions issued by non-dispensing physicians does not exceed 4%.

How does social network in patent provide changes in the Chinese manufacturing firm market value?

Patent thickets create external resource constraints that reduce the market value of enterprises. In the process of technological innovation, it is no longer possible to obtain competitive advantage by relying on individual resource endowment alone. Patent cooperation is considered an important institutional element in social network relations, through which enterprises can integrate external innovation resources to counteract their shortcomings and obtain competitive advantages. In this study, 419 electronic equipment manufacturing enterprises in China between 2009 and 2019 are used as the research objects, and panel data include the financial data of enterprises, the number of patent citations, and the number of patents jointly applied for by enterprises. Based on the patent fragmentation index, social network analysis is used to construct a patent cooperation network. Using UCINET and Gephi tools, the structure of corporate patent thicket networks and their evolutionary characteristics can be obtained. A panel regression model is used to empirically test the social network effect and the effect of patent thickets on the market value of firms in the context of patent cooperation. The findings show that patent thickets can discount the market value of enterprises. However, if a firm is at the center of patent cooperation, it can obtain more innovation resources. If it is at the intermediary of cooperation, it can absorb external knowledge and technology and occupy a richer structural hole, which can positively regulate the negative effect of the patent thicket. In addition, the negative effects of patent thickets are weaker for firms with more than five years of patent maintenance compared to those with less. Our study has important implications for improving the efficiency of patent cooperation and helping governments and firms to effectively cope with patent thickets.

A Conceptual Framework for Optimizing the Equity of Hospital-Based Emergency Care: The Structure of Hospital Transfer Networks

Policy Points Current pay-for-performance and other payment policies ignore hospital transfers for emergency conditions, which may exacerbate disparities. No conceptual framework currently exists that offers a patient-centered, population-based perspective for the structure of hospital transfer networks. The hospital transfer network equity-quality framework highlights the external and internal factors that determine the structure of hospital transfer networks, including structural inequity and racism.

CONTEXT

Emergency care includes two key components: initial stabilization and transfer to a higher level of care. Significant work has focused on ensuring that local facilities can stabilize patients. However, less is understood about transfers for definitive care. To better understand how transfer network structure impacts population health and equity in emergency care, we proposea conceptual framework, the hospital transfer network equity-quality model (NET-EQUITY). NET-EQUITY can help optimize population outcomes, decrease disparities, and enhance planning by supporting a framework for understanding emergency department transfers.

METHODS

To develop the NET-EQUITY framework, we synthesized work on health systems and quality of health care (Donabedian, the Institute of Medicine, Ferlie, and Shortell) and the research framework of the National Institute on Minority Health and Health Disparities with legal and empirical research.

FINDINGS

The central thesis of our framework is that the structure of hospital transfer networks influences patient outcomes, as defined by the Institute of Medicine, which includes equity. The structure of hospital transfer networks is shaped by internal and external factors. The four main external factors are the regulatory, economic environment, provider, and sociocultural and physical/built environment. These environments all implicate issues of equity that are important to understand to foster an equitable population-based system of emergency care. The framework highlights external and internal factors that determine the structure of hospital transfer networks, including structural racism and inequity.

CONCLUSIONS

The NET-EQUITY framework provides a patient-centered, equity-focused framework for understanding the health of populations and how the structure of hospital transfer networks can influence the quality of care that patients receive.

Review: Patent Bibliometrics in Cranial Neurosurgery: The First Bibliometric Analysis of Neurosurgery's Technological Literature

BACKGROUND

Bibliometric analyses of the scientific literature have grown increasingly popular in the past few decades. However, patent bibliometric studies, evaluation of technological literature, have not yet been applied in neurosurgery.

OBJECTIVE

To perform a pilot patent bibliometric analysis of the top 100 most cited patents in cranial neurosurgery.

METHODS

The Lens was used to query multiple databases, to select the top 100 cranial neurosurgical patents based upon forward patent citations. These were organized into 9 categories based on technological descriptors and were evaluated based on the earliest priority date, year issued, and expiration status, among others.

RESULTS

The top 100 most cited patents included technology underlying 3D navigation (n = 31), pharmacology and implants (n = 20), vascular occlusion (n = 5), craniotomy closure (n = 9), focal lesioning and tissue resection (n = 8), brain and systemic cooling (n = 5), neuroendoscopy (n = 8), neuromonitoring and stimulation (6), and technologies improving surgeon performance (n = 8). Ninety-six patents were filed in the United States, 72 were expired, 19 are still active, and 9 were listed as inactive. The highest number of patents was applied for from the mid-1990s to the mid-2000s. Demonstrated trends showed no meaningful correlation between patent rank and earliest priority date (linear trendline y = 0.7107 x -1367.5; R² = 0.0671), while a very strong correlation was found between patent rank and citations per year (power trendline y = 127.93 x -1.094; R² = 0.8579).

CONCLUSIONS

Patent bibliometrics allow evaluation of neurosurgical advancements from the past and enable subsequent development of cutting-edge technology in the future. The described method is a reproducible and reliable technique for evaluating our field's patent literature.

Tax on sugary drinks and trends in daily soda consumption by family affluence: an international repeated cross-sectional survey among European adolescents

BACKGROUND

The WHO recommends soda taxes to reduce sugar consumption, but the effect across socioeconomic groups is unclear.

OBJECTIVES

We assessed 16-y trends in daily soda consumption among adolescents in 4 European countries with a soda tax and 5 comparison countries, by family affluence.

METHODS

Five rounds of the international "Health Behaviour in School-Aged Children" school-based survey were used (school years 2001/2002 to 2017/2018, repeated cross-sectional design). Finland, France, Belgium, and Portugal introduced or updated a soda tax during this period. For comparison, we selected 5 neighboring countries without such a tax. Nationally representative samples of adolescents aged 13 and 15 y (n = 165,521; 51.2% girls) completed a standardized questionnaire, including a question on soda consumption frequency. Using the family affluence scale (FAS), we categorized adolescents into lower-, middle- or higher-affluent groups. Changes in daily soda consumption were assessed in each country independently.

RESULTS

Before taxation, daily soda consumption was more likely among lower-affluent adolescents in France and Belgium (P < 0.001, socioeconomic inequalities) and was similar across FAS groups in Finland and Portugal (no inequalities). After the tax, daily soda consumption was reduced across all FAS groups in Finland, Belgium, and Portugal (P_interactions ≥ 0.33). In France, a posttax decrease was observed only among lower-affluent adolescents (OR_lower, 0.76; 95% CI: 0.60, 0.96; reduced inequalities). During the same periods, socioeconomic patterns remained stable in 3 comparison countries (P_interactions ≥ 0.38), and larger reductions in daily soda consumption were observed among middle- or higher-affluent adolescents compared with lower-affluent adolescents in the remaining 2 comparison countries (P_interactions ≤ 0.08, increased inequalities).

CONCLUSIONS

Socioeconomic patterns did not change after the tax implementation in 3 out of 4 countries, and socioeconomic inequalities were reduced in France. Taxing sodas might be an effective measure to attenuate, or at least not exacerbate, socioeconomic inequalities in adolescent daily soda consumption. Am J Clin Nutr 20XX;xx:xx-xx.

Regulatory Environment and Approvals in Cell and Gene Therapy Products Between Japan, the USA, and the EU

BACKGROUND

This study aimed to demonstrate the differences in the way cell and gene therapy (CGT) products have been developed and reviewed for approval in Japan, the USA, and the EU by comparing regulations and successfully launched products in each region, and to examine the background to such differences.

METHODS

Information on relevant regulations and approved CGT products were collected from the public source and compared by region.

RESULTS

While regulations on CGT products are largely consistent among these regions, some differences could have a substantial impact on the practices defining CGT products, the timing of responses required to comply with the regulations for handling gene-modified organisms, and the acceptable validation processes under good manufacturing practice regulations. Although CGT products are given some preferential status in all regions, the preferential treatment given to CGT products varies across regions. The CGT products launched in each region also differ significantly in type, indications, the nature of the developers, and the clinical evidence submitted. While all the cellular products launched in Japan were approved based on small uncontrolled trials, most cellular products in the USA and EU were approved based on controlled studies. A trend was observed for companies to enter their home markets.

CONCLUSION

Our study showed differences of regulations on CGT products and of features in approved products as well as the trend of their home market entries, which may have been driven by a different context than that of traditional pharmaceuticals.

Voluntary private health insurance demand by Portuguese seniors before the COVID-19 pandemic

AIMS

The Portuguese health system is mainly described as a National Health Service (NHS), but it also has some Bismarckian features. On top of these two layers of health insurance coverage, there is a market for voluntary private health insurance (VPHI). Usually, seniors are not eligible for this type of health insurance and this may serve as a complement or supplement to the NHS. The purpose of this work is to identify the main factors associated with holding a VPHI policy among seniors before the COVID-19 pandemic.

MATERIAL AND METHODS

We use data collected by the National Health Survey of 2019/20 and estimate a multivariate logistic regression.

RESULTS

The main findings show that VPHI may be bought by seniors as a facilitator to access health care, either specialised or dental care. While oral health is not covered by the NHS, specialist care is only available after referral by a gatekeeper and requires a long waiting time to be scheduled. Results show that people who had an appointment with a dentist or a specialist in the last 12 months are more likely to have a VPHI policy. Additionally, it was found that people benefiting from occupation-based insurance schemes are less likely to buy private health insurance.

CONCLUSION

The current Portuguese health system organization based on different layers of health protection raises some issues concerning equity to health care access by seniors.

Cognitive bias and how to improve sustainable decision making

The rapid advances of science and technology have provided a large part of the world with all conceivable needs and comfort. However, this welfare comes with serious threats to the planet and many of its inhabitants. An enormous amount of scientific evidence points at global warming, mass destruction of bio-diversity, scarce resources, health risks, and pollution all over the world. These facts are generally acknowledged nowadays, not only by scientists, but also by the majority of politicians and citizens. Nevertheless, this understanding has caused insufficient changes in our decision making and behavior to preserve our natural resources and to prevent upcoming (natural) disasters. In the present study, we try to explain how systematic tendencies or distortions in human judgment and decision-making, known as “cognitive biases,” contribute to this situation. A large body of literature shows how cognitive biases affect the outcome of our deliberations. In natural and primordial situations, they may lead to quick, practical, and satisfying decisions, but these decisions may be poor and risky in a broad range of modern, complex, and long-term challenges, like climate change or pandemic prevention. We first briefly present the social-psychological characteristics that are inherent to (or typical for) most sustainability issues. These are: experiential vagueness, long-term effects, complexity and uncertainty, threat of the status quo, threat of social status, personal vs. community interest, and group pressure. For each of these characteristics, we describe how this relates to cognitive biases, from a neuro-evolutionary point of view, and how these evolved biases may affect sustainable choices or behaviors of people. Finally, based on this knowledge, we describe influence techniques (interventions, nudges, incentives) to mitigate or capitalize on these biases in order to foster more sustainable choices and behaviors.