Biomarkers of extracellular matrix metabolism (MMP-9 and TIMP-1) and risk of stroke, myocardial infarction and cause-specific mortality : cohort study

Objective: Turnover of the extracellular matrix in all solid organs is governed mainly by a balance between the degrading matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). An altered extracellular matrix metabolism has been implicated in a variety of diseases. We investigated relations of serum levels of MMP-9 and TIMP-1 to mortality risk from an etiological perspective. Design: The prospective Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, followed from 1991–1995 for up to 18.1 years. A random population-based sample of 1,082 71-year-old men, no loss to follow-up. Endpoints were all-cause (n = 628), cardiovascular (n = 230), non-cardiovascular (n = 398) and cancer mortality (n = 178), and fatal or non-fatal myocardial infarction (n = 138) or stroke (n = 163). Results: Serum MMP-9 and TIMP-1 levels were associated with risk of all-cause mortality (Cox proportional hazard ratio [HR] per standard deviation 1.10, 95% confidence interval [CI] 1.03–1.19; and 1.11, 1.02–1.20; respectively). TIMP-1 levels were mainly related to risks of cardiovascular mortality and stroke (HR per standard deviation 1.22, 95% CI 1.09–1.37; and 1.18, 1.04–1.35; respectively). All relations except those of TIMP-1 to stroke risk were attenuated by adjustment for cardiovascular disease risk factors. Relations in a subsample without cardiovascular disease or cancer were similar to those in the total sample. Conclusion: In this community-based cohort of elderly men, serum MMP-9 and TIMP-1 levels were related to mortality risk. An altered extracellular matrix metabolism may be involved in several detrimental pathways, and circulating MMP-9 or TIMP-1 levels may be relevant markers thereof.

A systematic review of triage-related interventions to improve patient flow in emergency departments

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

Effektiviseringspotential för värmesystem med sol och pellets : Parameterstudier, emissionsfaktoreroch simuleringsresultat

Syftet med denna studie är att hitta driftsbetingelser som sänker pelletsförbrukning och utsläpp och därmed även de totala kostnaderna för ett värmesystem. Värmesystemet har två huvudsakliga energikällor; sol och pellets. En elpatron används också, för att täcka upp med värme när solen lyser med sin frånvaro och pelletsystemet inte har hunnit börja leverera värme,till exempel i samband med start av brännaren. Lasten utgör värme till ett småhus av dagens standard och tappvarmvattenbehov.

Extended local labor markets due to high speed trains : Visualization of estimations in the Swedish national travel demand forecasting tool, SAMPERS

Wider economic benefits resulting from extended geographical mobility is one argument for investments in high-speed rail. More specifically, the argument for high-speed trains in Sweden has been that they can help to further spatially extend labor market regions which in turn has a positive effect on growth and development. In this paper the aim is to cartographically visualize the potential size of the labor markets in areas that could be affected by possible future high-speed trains. The visualization is based on the forecasts of labor mobility with public transport made by the Swedish national mobility transport forecasting tool, SAMPERS, for two alternative high-speed rail scenarios. The analysis, not surprisingly, suggests that the largest impact of high-speed trains results in the area where the future high speed rail tracks are planned to be built. This expected effect on local labor market regions of high-speed trains could mean that possible regional economic development effects also are to be expected in this area. However, the results, in general, from the SAMPERS forecasts indicaterelatively small increases in local labor market potentials.

How does employment density influence individuals’ wages? : A micro data approach.

We estimate the effect of employment density on wages in Sweden in a large geocoded data set on individuals and workplaces. Employment density is measured in four circular zones around each individual’s place of living. The data contains a rich set of control variables that we use in an instrumental variables framework. Results show a relatively strong but rather local positive effect of employment density on wages. Beyond 5 kilometers the effect becomes negative. This might indicate that the effect of agglomeration economies falls faster with distance than the effects of congestion.

Socioekonomisk omvandling i Borlänge 1990-2008 med fokus på bostadsområdet Jakobsgårdarna : Hur påverka omflyttningen befolkningsstrukturen i ett bostadsområde?

Syftet med denna rapport är att undersöka hur individers flyttningsmönster mellan olika bostads-områden påverkar olika segregationsprocesser i Borlänge stad.  Studien visar att Borlänge ligger i mittskiktet om man jämför andelen befolkning med utländskbakgrund i Sveriges alla kommuner. Trots att Borlänge har en förhållandevis låg andel befolkning med utländsk bakgrund har den etniska och socioekonomiska segregationen mellan olika bostadsområden i Borlänge ökat mellan åren 1990-2008. Runt år 2000 har det skett en förändring inom gruppen med utländsk bakgrund där de osynliga minoriteterna (Europa, USA, Kanada, Australien) har minskat och de synliga minoriteterna (utanför Europa undantaget USA, Kanada och Australien) har ökat. Jakobsgårdarna tillsammans med Tjärna ängar och Bullermyren kan karakteriseras som särskilt utsatt områden med en hög andel befolkning med utländsk bakgrund och invånarna är också socioekonomiskt svagare än invånare i andra områden i Borlänge. Den dominerande boend-eformen i Jakobsgårdarna (samt i Tjärna ängar och Bullermyren) är hyreslägenheter ägda av allmännyttan. Det blir därför naturligt att området har en befolkning som är i starten på sin boende-, utbildnings- och yrkeskarriär. Det visar sig i materialet då befolkningen i området är relativt ung dvs. det finns inte så många andra områden som man kan flytta till om man ska flytta hemifrån, då de flesta andra bostadsområden i Borlänge består av privatägda egnahem. Detta får betydelse för befolkningen med utländsk bakgrund, eftersom de av olika skäl har svårare att hitta arbete, få en inkomst etc. blir de kvar i området eller roterar mellan bostadsområdena Jakobs-gårdarna, Tjärna ängar och Bullermyren eftersom det inte finns några andra alternativa boenden. Då utbudet av hyreslägenheter är relativt liten i Borlänge är det troligtvis de sk institutions-genererade flyttningarna som är en grundläggande orsak till den etniska segregationen i Borlänge. Runt år 2002 accelererar utflyttningen av svenskfödda i Jakobsgårdarna och andelen synliga minoriteter ökar i området, det tyder på att det finns ett mönster av sk segregationsgenererande flyttningar från området, dvs. de som har möjlighet flyttar ut ur bostadsområdet gör det. De individer som flyttar från Jakobsgårdarna har en starkare socioekonomiskt ställning än de som flyttar in i området, därför reproduceras den socioekonomiska segregationen och blir ihållande. Denna process gör att området i framtiden, om ingenting görs, troligtvis kommer att förbli ett socioekonomiskt svagt område. Tillsamman med de institutions -och segregationsgenererande flyttningarna riskerar Jakobsgårdarna att bli ännu mer etniskt och socioekonomiskt segregerat från övriga områden i Borlänge.

Strategic alliances in a town centre : Stakeholder’s perceptions of property owner’s role

In order for town centres to manage increased competition in retailing, co-operation between stakeholders in a strategic alliance has become more important. A typical set of stakeholders in a strategic alliance for strengthening retailingare retailers, local authorities and property owners. The roles of retailer’sand local authorities’ are well researched. However, the role of property owners is not. The aim of this paper seeks to unfold the role of property owners in a strategic alliance. This is a case study of a medium-sized town in which semi-structured interviews with different stakeholders were conducted. In the chosen town there is a TCM alliance co-operation at work. The above mentioned stakeholders are possible members in an alliance. The case studied shows a fragmented property owner market with no dominant property owner, as it is in many medium-sized towns. Our study shows that many stakeholders look at the role of property owners as crucial for town centre development. However, property owners do not see that they can significantly contribute to or benefit from the development.The main reasons for this opinion are that they consider themselves as not having enough resources or the capability to influence the town development.

Out-of-town shopping and its induced CO2-emissions

Planning policies in several European countries have aimed at hindering the expansion of out-of-town shopping centers. One argument for this is concern for the increase in transport and a resulting increase in environmental externalities such as CO2-emissions. This concern is weakly founded in science as few studies have attempted to measure CO2-emissions of shopping trips as a function of the location of the shopping centers. In this paper we conduct a counter-factual analysis comparing downtown, edge-of-town and out-of-town shopping. In this comparison we use GPS to track 250 consumers over a time-span of two months in a Swedish region. The GPS-data enters the Oguchi’s formula to obtain shopping trip-specific CO2-emissions. We find that consumers’ out-of-town shopping would generate an excess of 60 per cent CO2-emissions whereas downtown and edge-of-town shopping centers are comparable.

Trips and their CO2 emissions induced by a shopping center

Most previous studies have focused on entire trips in a geographic region, while a few of them addressed trips induced by a city landmark. Therefore paper explores trips and their CO2 emissions induced by a shopping center from a time-space perspective and their usage in relocation planning. This is conducted by the means of a case study in the city of Borlänge in mid-Sweden where trips to the city’s largest shopping mall in its center are examined. We use GPS tracking data of car trips that end and start at the shopping center. Thereafter, (1) we analyze the traffic emission patterns from a time-space perspective where temporal patterns reveal an hourly-based traffic emission dynamics and where spatial patterns uncover a heterogeneous distribution of traffic emissions in spatial areas and individual street segments. Further, (2) this study reports that most of the observed trips follow an optimal route in terms of CO2 emissions. In this respect, (3) we evaluate how well placed the current shopping center is through a comparison with two competing locations. We conclude that the two suggested locations, which are close to the current shopping center, do not show a significant improvement in term of CO2 emissions.

Short Communication: A compelling argument for the gravity p-median model

The p-median model is used to locate P facilities to serve a geographically distributed population. Conventionally, it is assumed that the population always travels to the nearest facility. Drezner and Drezner (2006, 2007) provide three arguments on why this assumption might be incorrect, and they introduce the extended the gravity p-median model to relax the assumption. We favour the gravity p-median model, but we note that in an applied setting, Drezner and Drezner’s arguments are incomplete. In this communication, we point at the existence of a fourth compelling argument for the gravity p-median model.

Methodological issues in applying Location Models to Rural areas

Location Models are usedfor planning the location of multiple service centers in order to serve a geographicallydistributed population. A cornerstone of such models is the measure of distancebetween the service center and a set of demand points, viz, the location of thepopulation (customers, pupils, patients and so on). Theoretical as well asempirical evidence support the current practice of using the Euclidian distancein metropolitan areas. In this paper, we argue and provide empirical evidencethat such a measure is misleading once the Location Models are applied to ruralareas with heterogeneous transport networks. This paper stems from the problemof finding an optimal allocation of a pre-specified number of hospitals in alarge Swedish region with a low population density. We conclude that the Euclidianand the network distances based on a homogenous network (equal travel costs inthe whole network) give approximately the same optimums. However networkdistances calculated from a heterogeneous network (different travel costs indifferent parts of the network) give widely different optimums when the numberof hospitals increases.  In terms ofaccessibility we find that the recent closure of hospitals and the in-optimallocation of the remaining ones has increased the average travel distance by 75%for the population. Finally, aggregation the population misplaces the hospitalsby on average 10 km.

Optimal retail location and CO2 emissions

In this paper, the p-median model is used to find the location of retail stores that minimizes CO2 emissions from consumer travel. The optimal location is then compared with the existing retail location,and the excess CO2 emissions compared with the optimal solution is calculated. The results show that by using the environmentally optimal location, CO2 emissions from consumer travel could be reduced by approximately 25percent. 

How do different densities in a network affect the optimal location of service centers?

The p-median problem is often used to locate p service centers by minimizing their distances to a geographically distributed demand (n). The optimal locations are sensitive to geographical context such as road network and demand points especially when they are asymmetrically distributed in the plane. Most studies focus on evaluating performances of the p-median model when p and n vary. To our knowledge this is not a very well-studied problem when the road network is alternated especially when it is applied in a real world context. The aim in this study is to analyze how the optimal location solutions vary, using the p-median model, when the density in the road network is alternated. The investigation is conducted by the means of a case study in a region in Sweden with an asymmetrically distributed population (15,000 weighted demand points), Dalecarlia. To locate 5 to 50 service centers we use the national transport administrations official road network (NVDB). The road network consists of 1.5 million nodes. To find the optimal location we start with 500 candidate nodes in the network and increase the number of candidate nodes in steps up to 67,000. To find the optimal solution we use a simulated annealing algorithm with adaptive tuning of the temperature. The results show that there is a limited improvement in the optimal solutions when nodes in the road network increase and p is low. When p is high the improvements are larger. The results also show that choice of the best network depends on p. The larger p the larger density of the network is needed. 

How do neighbouring populations affect local population change over time?

This study covers a period when society changed from a pre-industrial agricultural society to a post-industrial service-producing society. Parallel with this social transformation, major population changes took place. In this study, we analyse how local population changes are affected by neighbouring populations. To do so we use the last 200 years of local population change that redistributed population in Sweden. We use literature to identify several different processes and spatial dependencies in the redistribution between a parish and its surrounding parishes. The analysis is based on a unique unchanged historical parish division, and we use an index of local spatial correlation to describe different kinds of spatial dependencies that have influenced the redistribution of the population. To control inherent time dependencies, we introduce a non-separable spatial temporal correlation model into the analysis of population redistribution. Hereby, several different spatial dependencies can be observed simultaneously over time. The main conclusions are that while local population changes have been highly dependent on the neighbouring populations in the 19th century, this spatial dependence have become insignificant already when two parishes is separated by 5 kilometres in the late 20th century. Another conclusion is that the time dependency in the population change is higher when the population redistribution is weak, as it currently is and as it was during the 19th century until the start of industrial revolution.