Transforming the energy system - the evolution of the German technological system for solar cells

To improve our understanding of processes involved in the formation and growth of new technological systems in the energy sector and to identify the associated key challenges for policy makers managing the transformation process, we examine the development of the German technological system for solar cells over the past twenty-five years. We use a 'technological system' approach in which we will trace the evolution of actors, networks and institutions that have a bearing on the generation and diffusion of solar cells. An initial preparatory stage lasted until about 1989 and was mainly characterised by knowledge build up induced by a Federal RDD programme. This was followed by a second stage characterised by political struggle over the regulatory framework and subsequently the beginning of a virtuous circle for solar cells. In the concluding discussion, we emphasise four key features of the evolution of the technological system: (1) the role of a coalition of system builders which successfully influenced the regulatory framework so that markets could be formed: (2) the considerable length of the learning period and the large number of actors which need to learn; (3) the importance of policies which form early markets (not only early niche markets, but beyond those) as only markets may induce firms to enter and learn, and (4) the need to run market formation policies simultaneous to policies which maintain technological variety.new technology, growth and formation, solar cells, Germany

Cardiovascular co-morbidity in rheumatic diseases

Patients with rheumatic disorders have an increased risk of cardiovascular disease (CVD). This excess co-morbidity is not fully explained by traditional risk factors. Disease severity is a major risk factor for CVD in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Shared disease mechanisms in atherosclerosis and rheumatic disorders include immune dysregulation and inflammatory pathways, which are potential targets for therapy. Lessons from RA and SLE may have implications for future research on the pathogenesis of atherosclerotic vascular disease in general. Recent data indicate that suppression of inflammation reduces the risk of CVD morbidity and mortality in patients with severe RA. The modest, but clinically relevant, efficacy of atorvastatin treatment in RA adds to the evidence for important anti-inflammatory properties for statins. There is increased recognition of the need for structured preventive strategies to reduce the risk of CVD in patients with rheumatic disease. Such strategies should be based on insights into the role of inflammation in CVD, as well as optimal management of life style related risk factors. In this review, the research agenda for understanding and preventing CVD co-morbidity in patients with rheumatic disorders is discussed

Work productivity in a population-based cohort of patients with spondyloarthritis.

Objective. To assess work productivity and associated factors in patients with SpA.Methods. This cross-sectional postal survey included 1773 patients with SpA identified in a regional health care register. Items on presenteeism (reduced productivity at work, 0-100%, 0 = no reduction) were answered by 1447 individuals. Absenteeism was defined as register-based sick leave using data from a national register. Disease duration, disease activity (BASDAI), physical function (BASFI), health-related quality of life (EQ-5D), anxiety (HAD-a), depression (HAD-d), self-efficacy [Arthritis Self-efficacy Scale (ASES) pain and symptom], physical activity and education were also measured.Results. Forty-five per cent reported reduced productivity at work with a mean reduction of 20% (95% CI 18, 21) and women reported a higher mean reduction than men (mean 23% vs 17%, P < 0.001). Worse quality of life, disease activity, physical function and anxiety all correlated with reduced productivity (r = 0.52-0.66, P < 0.001), while sick leave did not. Worse outcomes on the EQ-5D (β-est -9.6, P < 0.001), BASDAI (β-est 7.8, P < 0.001), BASFI (β-est 7.3, P < 0.001), ASES pain (β-est -0.5, P < 0.001) and HAD-d (β-est 3.4, P < 0.001) were associated with reduced productivity at work in patients with SpA regardless of age, gender and disease subgroup. ASES symptoms, HAD-a and education level <12 years were associated with reduced productivity but were not significant in all strata for age, gender and disease subgroup.Conclusion. Work productivity was reduced in patients with SpA and more so in women. Worse quality of life, disease activity, physical function, self-efficacy and depression were all associated with reduced productivity at work in patients with SpA

Changes and sex differences in patient reported outcomes in rheumatoid factor positive RA-results from a community based study.

Patient reported outcomes (PROs) are important measures in rheumatoid arthritis (RA). A register of patients with RA from all rheumatology care providers in Malmö, Sweden, was established in 1997 and has been continually updated. This register includes virtually all the RA patients in the area. The aim of this study was to analyse PROs in surveys of this population conducted between 1997 and 2009, and to assess differences in treatment and outcome in male and female patients

Decrease in the incidence of total hip arthroplasties in patients with rheumatoid arthritis - results from a well defined population in south Sweden

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.INTRODUCTION: One aim of modern pharmacologic treatment in rheumatoid arthritis (RA) is to prevent joint destruction and reduce the need for surgery. Our purpose was to investigate secular trends in the incidence of primary total hip and knee arthroplasties in a well defined sample of patients with RA. METHODS: Prevalent cases with RA in 1997 and incident cases from 1997 to 2007 in a community based register in Malmö, south Sweden, were included. Based on a structured review of the medical records, patients were classified according to the 1987 ACR criteria for RA. This cohort was linked to the Swedish Hip Arthroplasty Register (through December 2006) and the Swedish Knee Arthroplasty Register (through October 2007). Patients with a registered total hip or knee arthroplasty before 1997 or before RA diagnosis were excluded. Incidence rates for the period of introduction of TNF inhibitors (1998 to 2001) were compared to the period when biologics were part of the established treatment for severe RA (2002 to 2006/2007). RESULTS: In the cohort (n = 2,164; 71% women) a primary hip arthroplasty was registered for 115 patients and a primary knee arthroplasty for 82 patients. The incidence of primary total hip arthroplasties decreased from the period 1998 to 2001 (12.6/1,000 person-years (pyr)) to 2002 to 2006 (6.6/1,000 pyr) (rate ratio (RR) 0.52; 95% confidence interval (CI) 0.35 to 0.76). There was a trend towards an increase of primary knee arthroplasties (incidence 4.8/1,000 pyr vs. 6.8/1,000 pyr; RR 1.43; 95% CI 0.89 to 2.31). CONCLUSIONS: Our investigation shows a significant decrease in the incidence of total hip arthroplasties in patients with RA after 2001. Possible explanations include a positive effect on joint damage from more aggressive pharmacological treatment.The Swedish Research Council Lund University Crafoord Foundation Swedish Rheumatism Associatio

Decrease in sick leave among patients with rheumatoid arthritis in the first 12 months after start of treatment with tumour necrosis factor antagonists: a population-based controlled cohort study.

OBJECTIVE: /st> To investigate the effect of tumour necrosis factor (TNF) antagonist treatment of patients with rheumatoid arthritis (RA) on sick leave (SL) and disability pension (DP) in a population-based setting in southern Sweden. METHODS: /st> All patients with RA in the South Swedish Arthritis Treatment Group register living in the county of Skåne (population 1.2 million), who started their first treatment with a TNF antagonist between January 2004 and December 2007 and were 18-58 years at treatment start (n=365), were identified. For each patient with RA, four matched reference subjects from the general population were randomly selected. Data were linked to the Swedish Social Insurance Agency register and the point prevalence of SL and DP as well as days of SL and DP per month were calculated from 360 days before until 360 days after treatment start. RESULTS: /st> At treatment start 38.6% of the patients with RA were registered for SL. During the first 6 months this share dropped to 28.5% (decrease by 26.2%, p There was a marked decline in SL during the first 6 months of TNF antagonist treatment in patients with RA in southern Sweden, maintained throughout the first year, which was not offset by a corresponding increase in DP

Deltagerdriven forskning – växtodlingsgruppen: Resultat och utvärdering av arbetet under 1998 till 2001

De ekologiska lantbrukarna i Sverige har under lång tid utfört olika typer av utvecklingsarbete på gårdsnivå (Wivstad, 1999). I den fortsatta utvecklingen av ekologiskt lantbruk är det viktigt att ta tillvara dessa erfarenheter och kunskaper. Deltagardriven forskning är en förändringsprocess (Ullmark, 1998) där aktiva lantbrukare, rådgivare och forskare arbetar i grupp utifrån gemensamma intresseområden. Syftet är att knyta ihop forskarnas, rådgivarnas och lantbrukarnas teoretiska och praktiska kunskaper och erfarenheter. Alla som medverkar i processen är lika viktiga och alla parter som berörs av resultaten har möjlighet att påverka gruppens arbete och utveckling (Ullmark, 1998). Tillsammans identifierar gruppen problem och använder/utvecklar för lantbrukaren relevanta försöks- och forskningsmetoder som kan bidra till att lösa de praktiska problem som lantbrukaren faktiskt ställs inför. Genom deltagardriven forskning kan lantbrukarna även få möjlighet till att påverka var och hur forskning bedrivs. Forskningsfrågorna kan hämtas från lantbrukssystemets olika delar samt göra gruppen medveten om hur olika delar påverkar helheten (Wivstad, 1999; Eksvärd et al, 2001). I förlängningen kan deltagarna bli informatörer och överföra idéer till andra lantbrukare (Ullmark, 1998). Centrum för uthålligt lantbruk, CUL, placerat vid SLU, har sedan 1998 ansvarat för det tvärvetenskapliga projektet ”Deltagardriven forskning” som ett verktyg för regional utveckling av det ekologiska lantbruket. Det övergripande målet har varit att öka kunskapen om hur man kan åstadkomma uthålliga lantbrukssystem. Projektet startade med sex delgrupper inriktade på följande områden: grönsaker – friland, grönsaker – växthus, höns, växtodling, biogas samt grisproduktion. Därefter har några tillkommit och några avslutats. För aktuell information se hemsidan: www.cul.slu.se. Ytterligare beskrivning kan fås i ”Deltagardriven forskning – forskningsinriktad aktörssamverkan för svenskt lantbruk” (Eksvärd, i tryck)