Long Term Performance Of Passive House Buildings

Long term experience with Passive House buildings is illustrated with two early large scale projects, a school and an office building located in Germany. Those were monitored in lump energy performance (school, commissioned 2004) and great detail (office, commissioned 2002) respectively. Moreover, they give an indication of the characteristics of such buildings subject to changes in usage intensity. Both buildings generally performed as expected with the school facing occasional overheating in the summer due to inflexible shading controls. Following an extension in schooling hours the addition of a canteen was required and the ventilation system was adapted to the changed usage. Nevertheless the building’s user comfort and energy performance remain high,despite exceeding the Passive House primary energy target slightly due to increased electricity consumption. The office likewise meets the calculated efficiency in operation. The ground coupled cooling worked well despite greatly increased internal heat gains due to unexpected usage. This extra heat input did not, however, exhaust the geothermal (passive) cooling capacity for the future. Thermal comfort proved near optimal at all times, despite a very simple control regime of the one-circuit concrete core activation system for heating and cooling. In the last section air tightness design and measurement experience in the UK and particularly the question of long-term stability of the airtight building envelope is assessed. It was found that measurement results are not only repeatable in relatively short intervals such as a few months. The data available suggests stability of the airtight envelope over many years. Attention is required as regards the leakage of party walls of terraced buildings which need to be integrated in the overall airtightness concept. A high permeability of party walls in terraced buildings with a common airtight envelope presents a challenge for measuring air tightness. Long-term series of airtightness measurements exist for the Kranichstein House in Darmstadt/Germany and prove the stability of the chosen airtightness concept. Moreover, results for 17 early Passive House buildings in Germany in eight locations and various construction types revisited in 2001 (1.4 to 10 years after the initial airtightness test) suggest stability of air tightness values over time. Great advances have since been made in materials and methods available and the general understanding in the industry. This is supported by a large sample of 2934 Passive House projects of varied construction materials, locations, sizes and usages that yielded an average air tightness test result as low as n50 = 0.41 h-1

The value of the pragmatic-explanatory continuum indicator summary wheel in an ongoing study: the bullous pemphigoid steroids and tetracyclines study

BACKGROUND: The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) tool is intended to be used in the design phase of trials to help investigative teams design trials in-line with their purpose. Our team applied this tool to an ongoing trial (BLISTER) to determine whether the initial suggestion among some team members that the trial could be described as largely pragmatic was the consensus. METHODS: Each of the six members of the BLISTER trial team was sent a blank PRECIS wheel to independently complete. The results obtained were averaged and plotted on a single PRECIS wheel to illustrate the degree of pragmatism of the trial. RESULTS: The trial team found that the design of the trial was closest to the pragmatic end of the pragmatic-explanatory continuum. The strongest consensus was found on the 'flexibility of the comparison intervention' and 'practitioner adherence' domains (SD = 13). The trial team appeared to disagree most on the 'eligibility criteria' (SD = 35) and 'participant compliance' (SD = 31) domains, although the large standard deviations were a result of a single outlier in the two domains. CONCLUSION: The PRECIS tool can be used to retrospectively determine the pragmatism of a trial provided enough expertise and information on the trial is available. Illustrating the design of a trial on the PRECIS wheel can help research users more easily identify studies of interest. We hope our recommendations for applying this useful tool will encourage others to consider using it when designing, conducting and reporting studies. TRIAL REGISTRATION: Current Controlled Trials http://www.controlled-trials.com/ISRCTN13704604

Bullous pemphigoid and comorbidities: a case-control study in Portuguese patients

BACKGROUND: Although rare, bullous pemphigoid (BP) is the most common autoimmune blistering disease. Recent studies have shown that patients with bullous pemphigoid are more likely to have neurological and psychiatric diseases, particularly prior to the diagnosis of bullous pemphigoid. OBJECTIVE: The aims were: (i) to evaluate the demographic and clinical features of bullous pemphigoid from a database of patients at a Portuguese university hospital and (ii) to compare the prevalence of comorbid conditions before the diagnosis of bullous pemphigoid with a control group. METHODS: Seventy-seven patients with bullous pemphigoid were enrolled in the study. They were compared with 176 age- and gender-matched controls, which also had the same inpatient to outpatient ratio, but no history of bullous or cutaneous malignant disease. Univariate and multivariate analyses were used to calculate odds ratios for specific comorbid diseases. RESULTS: At least one neurologic diagnosis was present in 55.8% of BP patients compared with 20.5% controls (p<0.001). Comparing cases to controls, stroke was seen in 35.1 vs. 6.8%, OR 8.10 (3.80-17.25); dementia in 37.7 vs. 11.9%, OR 5.25 (2.71-10.16); and Parkinson's disease in 5.2 vs. 1.1%, OR 4.91 (0.88-27.44). Using multivariate analysis, all diseases except Parkinson's retained their association with BP. Patients under systemic treatment were eight times more likely to have complications than those treated with topical steroids (p< 0.017). CONCLUSIONS: The results of this study substantiate the association between BP and neurological diseases. In addition, they highlight the potential complications associated with the treatment of BP

Doxycycline compared to prednisolone therapy for patients with bullous pemphigoid: cost-effectiveness analysis of the BLISTER trial

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomised controlled trial (RCT). OBJECTIVES: To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP. METHODS: a multicentre, parallel-group, investigator-blinded RCT. Within-trial analysis used bivariate regression of costs and QALYs, with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective RESULTS: In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline-initiated therapy with prednisolone-initiated therapy (net cost: £959, 95% CI -£24 to £1941; net QALYs: -0.024, 95% CI -0.088 to 0.041). However, findings varied by baseline blister severity. For patients with mild or moderate blistering (≤30) net costs and outcomes were similar. For patients with severe blistering (>30) net costs were higher (£2558, 95% CI -£82 to £5198) and quality of life poorer (-0.090 QALYs, 95% CI-0.222 to 0.042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1.5% at a willingness to pay of £20,000/QALY. CONCLUSIONS: Consistent with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering

アトガキ

Background: Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomised controlled trial (RCT). Objectives: To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP. Methods: a multicentre, parallel-group, investigator-blinded RCT. Within-trial analysis used bivariate regression of costs and QALYs, with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective Results: In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline-initiated therapy with prednisolone-initiated therapy (net cost: £959, 95% CI –£24 to £1941; net QALYs: –0.024, 95% CI –0.088 to 0.041). However, findings varied by baseline blister severity. For patients with mild or moderate blistering (≤30) net costs and outcomes were similar. For patients with severe blistering (>30) net costs were higher (£2558, 95% CI –£82 to £5198) and quality of life poorer (–0.090 QALYs, 95% CI–0.222 to 0.042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1.5% at a willingness to pay of £20,000/QALY. Conclusions: Consistent with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering

Twelve-week Treatment of Lentigo Maligna with Imiquimod Results in a High and Sustained Clearance Rate

Dermatology-oncolog

Treatment of Lentigo Maligna with Imiquimod Cream: A Long-Term Follow-Up Study of 10 Patients

BACKGROUND The first choice of treatment for lentigo maligna (LM) is excision. Initial studies of treatment with imiquimod 5% cream have shown promising results with excellent cosmetic outcome, but the follow-up duration in these studies was short. OBJECTIVES To evaluate the results of treatment of patients with LM with imiquimod in routine clinical practice with long-term follow-up. METHODS We prospectively followed 10 patients with LM who were treated with imiquimod 5% cream between 2004 and 2007 with a median follow-up of 31 months (range 11-56 months). Histological clearance was assessed in all patients using post-treatment biopsies. RESULTS Complete clinical clearance was achieved in nine of 10 patients after treatment with imiquimod. During follow-up, three clinical and histological recurrences were observed at 9, 10, and 27 months after treatment cessation. In a fourth patient, histological recurrence without clinical signs was demonstrated 17 months after treatment. Five of 10 patients are in sustained clinical remission. CONCLUSIONS Imiquimod appears to be an effective treatment for a subset of patients with LM. We recommend long-term follow-up and taking multiple post-treatment biopsies, even in the absence of a clinical recurrence. This case series emphasizes the need for finding an optimal treatment regimen.Dermatology-oncolog