Innovative BIPV rooftops: development, realization, and monitoring of 2 BIPV field tests in the Netherlands

Building Integrated PV (BIPV) is seen as strategy to realize the EU target of Nearly Zero Energy Buildings (NZEB’s), while at the same time creating an aesthetically acceptable built environment. This in contrast with Building Added PV (BAPV) of which the result is often seen as aesthetically unwelcome additions to new and existing building. BIPV might have some negative aspects considering lifespan and PV output besides the aesthetical positive effect. In this research project two field tests are realized to investigate the negative aspects of different BIPV solutions, focusing on the effect of back-string cooling of PV modules on PV electricity output, relative humidity and lifespan. These aspects are seen as possible bottlenecks for large-scale acceptance of BIPV in society and the design, realization and monitoring of these field tests can contribute to an increased implementation of BIPV through improved BIPV solutions

Comparative performance assessment of four BIPV roof solutions in the Netherlands

A significant amount of global energy consumption takes place in the built environment, with as collateral effect CO2-related climate change. One of the strategies to realize a significant CO2 reduction is by integrating photovoltaic modules in the building envelope (BIPV). Disadvantages of BIPV include a possibly lower energy output and a possibly decreased life span due to the lack of optimal cooling of the PV modules. Currently, cooling of PV modules is usually realized by passive back-string ventilation, which is under strain when integration PV modules in the building envelope. In this study, a comparative field study of BIPV is conducted in the field lab ‘The District of Tomorrow’ to generate insight into BIPV efficiency as a function of back-string ventilation. This paper presents a selection of the monitoring results of the realized system, consisting of 24 PV modules in 4 segments with a total of 6000 Wp output with different amounts of back-string ventilation. The measurements indicate that in a moderate climate BIPV solutions without back-string ventilation result in increased operating temperatures, lower electricity output and condensation between PV modules and rooftop surface. To decrease relative humidity levels and operating temperatures to acceptable values, back-string ventilation is seen as an effective cooling medium in the presented field case

Functional hyperactivity of hepatic glutamate dehydrogenase as a cause of the hyperinsulinism/hyperammonemia syndrome: effect of treatment

OBJECTIVE: The combination of persistent hyperammonemia and hypoketotic hypoglycemia in infancy presents a diagnostic challenge. Investigation of the possible causes and regulators of the ammonia and glucose disposal may result in a true diagnosis and predict an optimum treatment. PATIENT: Since the neonatal period, a white girl had been treated for hyperammonemia and postprandial hypoglycemia with intermittent hyperinsulinism. Her blood level of ammonia varied from 100 to 300 micromol/L and was independent of the protein intake. METHODS: Enzymes of the urea cycle as well as glutamine synthetase and glutamate dehydrogenase (GDH) were assayed in liver tissue and/or lymphocytes. RESULTS: The activity of hepatic GDH was 874 nmol/(min.mg protein) (controls: 472-938). Half-maximum inhibition by guanosine triphosphate was reached at a concentration of 3.9 micromol/L (mean control values:.32). The ratio of plasma glutamine/blood ammonia was unusually low. Oral supplements with N-carbamylglutamate resulted in a moderate decrease of the blood level of ammonia. The hyperinsulinism was successfully treated with diazoxide. CONCLUSION: A continuous conversion of glutamate to 2-oxoglutarate causes a depletion of glutamate needed for the synthesis of N-acetylglutamate, the catalyst of the urea synthesis starting with ammonia. In addition, the shortage of glutamate may lead to an insufficient formation of glutamine by glutamine synthetase. As GDH stimulates the release of insulin, the concomitant hyperinsulinism can be explained. This disorder should be considered in every patient with postprandial hypoglycemia and diet-independent hyperammonemia

Concomitant intraperitoneal and systemic chemotherapy for extensive peritoneal metastases of colorectal origin: protocol of the multicentre, open-label, phase I, dose-escalation INTERACT trial

INTRODUCTION: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has become standard of care for patients with peritoneal metastases of colorectal origin with a low/moderate abdominal disease load. In case of a peritoneal cancer index (PCI) score >20, CRS-HIPEC is not considered to be beneficial. Patients with a PCI >20 are currently offered palliative systemic chemotherapy. Previous studies have shown that systemic chemotherapy is less effective against peritoneal metastases than it is against haematogenous spread of colorectal cancer. It is suggested that patients with peritoneal metastases may benefit from the addition of intraperitoneal chemotherapy to systemic chemotherapy. Aim of this study is to establish the maximum tolerated dose of intraperitoneal irinotecan, added to standard of care systemic therapy for colorectal cancer. Secondary endpoints are to determine the safety and feasibility of this treatment and to establish the pharmacokinetic profile of intraperitoneally administered irinotecan. METHODS AND ANALYSIS: This phase I, '3+3' dose-escalation, study is performed in two Dutch tertiary referral centres. The study population consists of adult pa

Systemic corticosteroid therapy for acute sinusitis

Item does not contain fulltextCLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibiotics may be associated with modest benefit for short-term relief of symptoms in adults with severe symptoms of acute sinusitis compared with antibiotics alone. Oral corticosteroids as monotherapy are not associated with improved clinical outcomes in adults with clinically diagnosed acute sinusitis

Attributable mortality of ventilator-associated pneumonia - Authors' reply

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Making the assessment right, or making the right assessment?

While its design has significant impact on the sustainability of a building, assessment methods to measure sustainability in design phases are not widely used. If assessment methods are applied, it is debateable whether they can generate the insight that is needed to realize a truly sustainable built environment. In this paper the assessment of two important aspects in relation to building sustainability, energy and materials, is investigated. The paper consists of a comparison of these aspects with regard to different assessment strategies. Finally, an alternative indicator offering another perspective on assessing sustainability in relation to architecture is introduced

Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies.

Item does not contain fulltextOBJECTIVE: : To assess the attributable mortality of ventilator-associated pneumonia using results from randomized controlled trials on ventilator-associated pneumonia prevention. DATA SOURCES: : A systematic search was performed in PubMed, Embase, Web of Science, and Cochrane Library from their inception until July 2010. In addition, a reference and related article search was performed. STUDY SELECTION: : Randomized ventilator-associated pneumonia prevention studies in which all patients were mechanically ventilated and from which ventilator-associated pneumonia and mortality rates of intervention and control group could be extracted were included. DATA EXTRACTION/SYNTHESIS: : Fifty-three papers were identified describing 58 comparisons. Statistical significant reductions in ventilator-associated pneumonia incidences were reported in 20 of the 58 comparisons, whereas none of these trials reported a significant reduction of mortality. Pooled estimates of the relative risk reductions of both ventilator-associated pneumonia and mortality were calculated and the attributable mortality was estimated as the ratio between the relative risk reductions of mortality and ventilator-associated pneumonia. Effects of study quality, diagnostic methods used, and effectiveness of preventing ventilator-associated pneumonia on the mortality rate of ventilator-associated pneumonia were assessed in subgroup analyses. The overall attributable mortality of ventilator-associated pneumonia was estimated as 9%. In subgroup analyses, the attributable mortality varied between 3% and 17%. CONCLUSION: : Based on the results of 58 randomized studies on ventilator-associated pneumonia prevention, the attributable mortality rate of ventilator-associated pneumonia was estimated to be 9% and ranged between 3% and 17% in subgroup analyses. Together with the results of other recent studies, there is cumulative evidence that the attributable mortality resulting from ventilator-associated pneumonia is approximately 10%.1 december 201

The Cost-utility of bilateral cochlear implantation: A Systematic Review.

OBJECTIVES/HYPOTHESIS: The (cost-)effectiveness and the subsequent reimbursement of bilateral cochlear implantation has been vigorously debated. Throughout the world healthcare commissioners are still struggling with the decision to reimburse bilateral implantation. Given this debate, this study's objective was to review the literature on the cost-utility of bilateral cochlear implantation in both children and adults, and study the impact of the used cost and quality-of-life estimates. STUDY DESIGN: Systematic review. METHODS: Electronic databases were systematically searched for relevant studies published up to December 2010. All studies reporting on cost-utility and bilateral cochlear implantation were included. RESULTS: Five studies fulfilled the inclusion criteria. The methodological quality of the studies, assessed with Drummond's checklist of cost-effectiveness studies, varied from poor to good. The assumptions regarding gain in quality-adjusted life years (QALYs) and direct costs varied among studies, resulting in a varying gain in QALY (0.38-1.93). The incremental cost-effectiveness ratios for bilateral cochlear implantation differed widely across studies for both children and adults (children: $30,973-$94,340; adults: $38,189-$132,160) and were inversely related to the gain in QALY, cost reductions due to simultaneous implantation, and discounts offered on the second implant. CONCLUSIONS: The incremental cost-effectiveness ratios for bilateral cochlear implantation vary widely and appear to depend on the gain in QALY due to the second implant. The results of this review confirm that more empirical data are required to estimate the cost-effectiveness of bilateral implantation. Laryngoscope, 121:2604-2609, 2011