Model for Determining Geographical Distribution of Heat Saving Potentials in Danish Building Stock

Since the global oil crisis in the 1970s, Denmark has followed a path towards energy independency by continuously improving its energy efficiency and energy conservation. Energy efficiency was mainly tackled by introducing a high number of combined heat and power plants in the system, while energy conservation was predominantly approached by implementing heat saving measures. Today, with the goal of 100% renewable energy within the power and heat sector by the year 2035, reductions in energy demand for space heating and the preparation of domestic hot water remain at the top of the agenda in Denmark. A highly detailed model for determining heat demand, possible heat savings and associated costs in the Danish building stock is presented. Both scheduled and energy-saving renovations until year 2030 have been analyzed. The highly detailed GIS-based heat atlas for Denmark is used as a container for storing data about physical properties for 2.5 million buildings in Denmark. Consequently, the results of the analysis can be represented on a single building level. Under the assumption that buildings with the most profitable heat savings are renovated first, the consequences of heat savings for the economy and energy system have been quantified and geographically referenced. The possibilities for further improvements of the model and the application to other geographical regions have been discussed

Arterial input function and gray matter cerebral blood volume measurements in children

Purpose To investigate how arterial input functions (AIFs) vary with age in children and compare the use of individual and population AIFs for calculating gray matter CBV values. Quantitative measures of cerebral blood volume (CBV) using dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) require measurement of an AIF. AIFs are affected by numerous factors including patient age. Few data presenting AIFs in the pediatric population exists. Materials and Methods Twenty‐two previously treated pediatric brain tumor patients (mean age, 6.3 years; range, 2.0–15.3 years) underwent DSC‐MRI scans on a 3T MRI scanner over 36 visits. AIFs were measured in the middle cerebral artery. A functional form of an adult population AIF was fitted to each AIF to obtain parameters reflecting AIF shape. The relationship between parameters and age was assessed. Correlations between gray matter CBV values calculated using the resulting population and individual patient AIFs were explored. Results There was a large variation in individual patient AIFs but correlations between AIF shape and age were observed. The center (r = 0.596, P < 0.001) and width of the first‐pass peak (r = 0.441, P = 0.007) were found to correlate significantly with age. Intrapatient coefficients of variation were significantly lower than interpatient values for all parameters (P < 0.001). Differences in CBV values calculated with an overall population and age‐specific population AIF compared to those calculated with individual AIFs were 31.3% and 31.0%, respectively. Conclusion Parameters describing AIF shape correlate with patient age in line with expected changes in cardiac output. In pediatric DSC‐MRI studies individual patient AIFs are recommended

Pneumococcal Serotypes and Mortality following Invasive Pneumococcal Disease: A Population-Based Cohort Study

Analyzing population-based data collected over 30 years in more than 18,000 patients with invasive pneumococcal infection, Zitta Harboe and colleagues find specific pneumococcal serotypes to be associated with increased mortality

A qualitative national focus group study of the experience of living with lymphoedema and accessing local multiprofessional lymphoedema clinics

Aim. The aim of this study was to explore people’s experiences of living withlymphoedema and to assess the impact of access to local lymphoedema clinics ontheir condition and thus their lives.Background. A chronic condition caused by reduced lymphatic function,lymphoedema leads to swelling, pain and mobility problems and can adverselyaffect quality-of-life. It is of international concern as its prevalence is rising. Yetlymphoedema awareness is limited, diagnostic delay common and access tospecialist treatment restricted. The concept of local lymphoedema clinics isgaining support and in 2011 the All Wales Lymphoedema Service was founded.However, empirical investigation of local lymphoedema services remains limited.Design. A qualitative exploratory study consisting of focus group interviews inevery Welsh lymphoedema clinic (n=8).Methods. A convenience sample of adults living with lymphoedema in Wales wasrecruited. Data were collected in digitally recorded focus groups during July andAugust 2013. Interviews were fully transcribed and analysed using a qualitativecontent approach.Findings. Fifty-nine people participated in eight focus groups. Analysis revealedthree themes: Living with lymphoedema is a battle; delays in obtaining a correctdiagnosis and the positive impact of lymphoedema clinics on participants’ lives.Locally accessible clinics made meaningful differences to peoples’ lymphoedema,engendered positive outcomes and improved engagement with and adherence tolymphoedema self-management.Conclusions. Local specialist lymphoedema clinics can make a positive difference.They may be cost-effective and further investigation, including economicevaluation is necessary

Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4–6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52–1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03–4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [&lt;1%], adjusted OR 5·58 [1·22–25·50]; p=0·024). Interpretation: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. Funding: None