Long-term cerebral thromboembolic complications of transapical endocardial resynchronization therapy

Purpose: Cardiac resynchronization therapy (CRT) is an established therapeutic option in selected heart failure patients (pts). However, the transvenous left ventricular (LV) lead implantation remains ineffectual in a considerable number of pts. Transapical LV (TALV) lead implantation is an alternative minimally invasive, surgical, endocardial implantation technique. The aim of the present prospective study is to determine the long-term outcome, including the cerebral thromboembolic complications, of pts

Vom Flickenteppich zur echten Kreislaufwirtschaftsstrategie : Impulspapier

Ohne die Transformation unserer Wirtschaft in eine nachhaltige Kreislaufwirtschaft werden wir die planetaren Grenzen weiter überschreiten, die Klimaziele verfehlen und die Ökosysteme schädigen. Deutschlands Politik hat sich in einem Flickenteppich aus Strategien und Gesetzen verfangen, aus dem eine echte Kreislaufwirtschaft nicht in der notwendigen Geschwindigkeit hervorgehen kann. Der Versuch, einer verschwenderischen Wirtschaft allein mit den Mitteln des Abfallrechts beizukommen, kann nicht glücken. Nötig ist vielmehr eine ganzheitliche, übergeordnete deutsche Kreislaufwirtschaftsstrategie mit ambitionierten nationalen Zielen. Das vorliegende Papier will zeigen, was sich konkret verändern muss und welche Hebel es braucht, um die Kreislaufwirtschaft signifikant voranzubringen. Es ist Zeit zu handeln. Innovative Ideen, Konzepte und Forderungen liegen auf dem Tisch. Sie machen es möglich, Deutschland auf eine zirkuläre Zukunft auszurichten, Rohstoffe und Materialien konsequent im Kreislauf zu führen und der Wirtschaft Planungssicherheit zu geben. Kreislaufwirtschaft ist Zukunftswirtschaft. Sie muss Kernthema einer neuen Regierung werden

Report on Non-Technical Barriers to the market placement

The iNSPiRe project addresses the need for energy efficiency measures by focussing on making so called deep renovations using multifunctional, industrialised kits in order to speed up the on-site installation process and reduce costs. Energy renovation investment is a multi-factor decision and many of these factors are not technical, which is why this report analyses the non-technical barriers to this investment decision. The study focusses on the kits developed within the iNSPiRe project, but many of the findings are relevant for other single stage deep renovation projects. Both the planning and implementation phases are considered. The aim was to develop suggestions for overcoming these non-technical barriers so that the iNSPiRe kits can more easily be deployed in the market. The report is based on a study of policy documents, the experiences of European umbrella organisations for architects, property owners and local governments as well as on a large number of in-depth interviews with relevant stakeholders. Many of the 60 participants were made in conjunction with stakeholder workshops that were organised for specific focus groups such as architects, private property owners, public procurers and the stakeholders of the European Housing Forum. The non-technical barriers have been split into economic, political and social barriers, with most interviewed stakeholders emphasising the economic aspects. Subsidies are considered by most as essential for property owners to take the decision to make a deep renovation, but stability of the subsidy programs is essential to have a good impact. Low-interest loans are not as favoured. Other key economic issues are the increase in the asset value of the property after such a renovation and the green value of the resulting low energy building. These are both difficult to quantify, partly due to the fact that such renovated buildings are not as yet so common, and vary in the different property markets. The EU has many policies on energy efficiency that are relevant for renovation of buildings, with the 2010 Energy Performance of Buildings Directive (EPBD recast) and the 2012 Energy Efficiency Directive (EED) being the most important. Many member states were late in implementing these and most have problems with forcing compliance with them. National tenancy laws can also make energy renovations difficult by restricting the possibility of raising rents for. For the iNSPiRe kits, regulations and standards are seen as a barrier in the short term as the kits combine several different functions into one product that are covered by several different regulations and/or standards. The social barriers are mostly concerned with the tenants, while architectural considerations are also important. In buildings with owner-occupied flats, the decision process for renovation is difficult and even more so when deep renovation is to be considered. In rental properties the owners and tenants have different interests and incentives, leading to possible conflicts. All have uncertainties about the use of multifunctional kits and how well they will perform technically as well as about how much they will save economically. The report makes a number of suggestions for overcoming these barriers. Especially important for the iNSPiRe kits is training of relevant installers and planners and use of Life Cycle Cost calculations to show the expected benefits over the lifetime of the products. In each section of the report, in addition to the analysis of the specific barrier, there are sections with specific comments from the interviewed stakeholders.iNSPiR

Report on Non-Technical Barriers to the market placement

The iNSPiRe project addresses the need for energy efficiency measures by focussing on making so called deep renovations using multifunctional, industrialised kits in order to speed up the on-site installation process and reduce costs. Energy renovation investment is a multi-factor decision and many of these factors are not technical, which is why this report analyses the non-technical barriers to this investment decision. The study focusses on the kits developed within the iNSPiRe project, but many of the findings are relevant for other single stage deep renovation projects. Both the planning and implementation phases are considered. The aim was to develop suggestions for overcoming these non-technical barriers so that the iNSPiRe kits can more easily be deployed in the market. The report is based on a study of policy documents, the experiences of European umbrella organisations for architects, property owners and local governments as well as on a large number of in-depth interviews with relevant stakeholders. Many of the 60 participants were made in conjunction with stakeholder workshops that were organised for specific focus groups such as architects, private property owners, public procurers and the stakeholders of the European Housing Forum. The non-technical barriers have been split into economic, political and social barriers, with most interviewed stakeholders emphasising the economic aspects. Subsidies are considered by most as essential for property owners to take the decision to make a deep renovation, but stability of the subsidy programs is essential to have a good impact. Low-interest loans are not as favoured. Other key economic issues are the increase in the asset value of the property after such a renovation and the green value of the resulting low energy building. These are both difficult to quantify, partly due to the fact that such renovated buildings are not as yet so common, and vary in the different property markets. The EU has many policies on energy efficiency that are relevant for renovation of buildings, with the 2010 Energy Performance of Buildings Directive (EPBD recast) and the 2012 Energy Efficiency Directive (EED) being the most important. Many member states were late in implementing these and most have problems with forcing compliance with them. National tenancy laws can also make energy renovations difficult by restricting the possibility of raising rents for. For the iNSPiRe kits, regulations and standards are seen as a barrier in the short term as the kits combine several different functions into one product that are covered by several different regulations and/or standards. The social barriers are mostly concerned with the tenants, while architectural considerations are also important. In buildings with owner-occupied flats, the decision process for renovation is difficult and even more so when deep renovation is to be considered. In rental properties the owners and tenants have different interests and incentives, leading to possible conflicts. All have uncertainties about the use of multifunctional kits and how well they will perform technically as well as about how much they will save economically. The report makes a number of suggestions for overcoming these barriers. Especially important for the iNSPiRe kits is training of relevant installers and planners and use of Life Cycle Cost calculations to show the expected benefits over the lifetime of the products. In each section of the report, in addition to the analysis of the specific barrier, there are sections with specific comments from the interviewed stakeholders.iNSPiR

Intravascular large B-cell lymphoma:remission after rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy

Intravascular lymphoma is an uncommon, very aggressive extranodal non-Hodgkin lymphoma that most frequently involves the skin and central nervous system. Most cases are of B-cell origin; T-cell phenotype is extremely rare. Malignant cells proliferate within the lumens of capillaries, arterioles, venules, and small arteries; vascular occlusion is responsible for the clinical signs and symptoms. The prognosis of this high-grade B-cell lymphoma has improved since the introduction of the anti-CD20 monoclonal antibody, rituximab. We describe a case of B-cell intravascular lymphoma successfully treated with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisolone