Kostnadsbesparing vid differentierade fjärrvärmeprismodeller

Kostnadsbesparing vid differentierade fjärrvärmeprismodeller Problem Kostnaden för fjärrvärme baseras på priskonstruktioner som varierar bland fjärrvärmeleverantörerna på den svenska marknaden, där förutsättningarna inom varje enskild kommun skiljer sig. Då fjärrvärme är det vanligast förekommande uppvärmningsalternativet för lokaler och flerbostadshus i Sverige finns det anledning att utvärdera hur pass utbredda priskonstruktionernas variationer är, samt hur lönsamheten av en energieffektiviseringsåtgärd påverkas av detta. Syfte Syftet med arbetet är att skapa ett verktyg i Excel för kostnadsberäkning av de differentierade fjärrvärmeprismodellerna. Detta möjliggör en utvärdering av lönsamheten före och efter en energi-effektiviseringsåtgärd, fördelat på kostnaden för de ingående komponenterna: energianvändning, effektuttag, varmvattenflöde samt returvattentemperatur. Genom att tydligt framställa kostnads-fördelningen och besparingspotentialen finns en förhoppning om att stärka relationen mellan fjärrvärmeleverantör och kund. Metod Arbetet med framtagandet av verktyget utgår utifrån en kartläggning av dagens prismodeller samt en litteraturstudie på området. Med hjälp av verktyget utvärderas besparingspotentialen för ett par utvalda fjärrvärmenät, samt att fördelarna med att noggrant beräkna fjärrvärmekostnader utreds. Under arbetsgången sker kontinuerlig återkoppling med representanter från främst fastighetsbranschen. Slutsatser Baserat på beräkningar med det framtagna verktyget PRISMO Fjärrvärme, framkommer det att besparingspotentialen varierar utifrån aktuell prismodell. Den procentuella kostnadsbesparingen kan inte heller förväntas motsvara andelen besparad energi från genomförd effektiviseringsåtgärd, utan är snarare lägre. Det förekommer även variationer av kostnadsfördelningen på de ingående komponenterna, vilket framkommer av verktygets resultat och möjliggör för djupare analyser.Cost saving potential with differentiated pricing models for district heating Problem The cost of district heating is based on pricing models, which varies among the district heating companies on the Swedish market, with different conditions for each municipality. Since district heating is the most common heating option for apartment buildings and commercial real estates in Sweden, there is a need to research the extent of the widespread pricing structures, and evaluate how the cost saving potential is affected by energy efficiency measures in relation to the variance in pricing models. Objective The purpose of this thesis is to create a cost calculation tool in Excel for the differentiated district heating pricing models. This enables a method for evaluating the profitability before and after an energy efficiency measure, divided into the cost of the included price components: energy consumption, required power output, hot water flow and return water temperature. By clarifying the cost allocation and savings potential, there is an expectation to strengthen the relationship between district heating suppliers and customers. Method The development of the tool is based on a survey of the current pricing models and a literature study on the subject. The tool is then used to evaluate the cost saving potential in a few selected district heating networks, and aims to evaluate the benefits of calculating district heating costs in detail. Along the working process, continuous feedback is received, mainly from representatives in the real estate industry. Conclusions Based on calculations from the developed tool PRISMO Fjärrvärme, it appears that the cost saving potential varies based on the current pricing model. The percental amount of energy saved by the implemented efficiency measure, is lower than the relative cost saving potential. There are also variations in the cost distribution of the components, as evidenced by the results from the tool and allow for further in-depth analysis.För åtgärder som minskar energibehovet för uppvärmning är den aktuella prismodellen för fjärrvärme avgörande, främst då driftkostnad för en fastighet kan skilja sig med cirka 50 % mellan svenska kommuner. Den möjliga kostnadsbesparingen är viktig för att en åtgärd ska genomföras. Dock är det svårt att göra en noggrann kostnadsbedömning eftersom det förekommer variationer i prismodellernas uppbyggnad. Prismodellerna för fjärrvärmen i Sverige skiljer sig i uppbyggnad beroende på vad som avgör kostnaden. De vanligaste delarna som påverkar kostnaden är: • energianvändning • effektuttag • varmvattenflöde • returvattentemperatur Utöver variationer i en prismodells uppbyggnad, finns skillnader i prissättning. Vanligtvis är kostnaden för energi indelat efter årstid, där avgifterna blir som störst under vintertid. Den prisgrundande effekten, dvs. det tillfälliga energiuttaget, bestäms utifrån ett medel- eller maxvärde baserat på tidigare användning. För fastighetsägare och konsulter som utför kostnadsberäkningar, innebär de varierande prismodellerna ofta svåra och tidskrävande bedömningar. Inte minst om åtgärderna ska genomföras för fastigheter på flera platser i Sverige där olika prismodeller gäller. För att utreda möjligheten att minska fjärrvärmekostnader med en energi-besparande åtgärd, har verktyget PRISMO Fjärrvärme tagits fram. Baserat på uppmätt eller simulerad energianvändning kan kostnaden före och efter en åtgärd beräknas utifrån användarens val av prismodell. Den beräknade kostnaden delas upp för att visa hur priset påverkas av varje kostnadsdel. Detta kan vara till hjälp vid val av energibesparingsåtgärd. Två fastigheter har analyserats, där olika energibesparande åtgärder har utförts i varje fastighet. Baserat på ett antal utvalda prismodeller som skiljer sig i uppbyggnad och prissättning har sedan besparings-möjligheten beräknats. Vid jämförelse mellan de minskade driftkostnaderna har skillnaden visat sig vara omkring 50 % mellan vissa prismodeller. För en fastighetsägare som överväger att genom-föra en energibesparande åtgärd är det viktigt att veta om den är lönsam eller ej. Utifrån analysen framkom att kostnadsbesparingen skiljer sig beroende på åtgärd och prismodell samt att ett direkt samband saknas mellan energibesparing och minskade driftkostnader. Samma energibesparing ger alltså inte motsvarande kostnadsbesparing, räknat i procent. Det framkom även att en prismodell som tar stor hänsyn till effektuttaget ger lägre kostnadsbesparing för de undersökta åtgärderna. Förhoppningen är att detaljerade beräkningar av fjärrvärmekostnaden ska bidra till att fler energibesparingsåtgärder genomförs, vilket ur ett långsiktigt perspektiv medverkar till att EU:s klimatmål uppnås. Samarbetet mellan fjärrvärmeleverantör och kund kan förbättras när förståelsen ökar kring hur prismodellerna är uppbyggda och hur kostnaden påverkas

Does Dysphagia Indicate Recurrence of Benign Esophageal Strictures?

Esophageal dilatation in dysphagic patients with benign strictures is usually considered successful if the patients' dysphagia is alleviated. However, the relation between dysphagia and the diameter of a stricture is not well understood. Moreover, the dysphagia may also be caused by an underlying esophageal motor disorder. In order to compare symptoms and objective measurements of esophageal stricture, 28 patients were studied with interview and a radiologic esophagram. The latter included swallowing of a solid bolus. All patients underwent successful balloon dilatation at least one month prior to this study. Recurrence of a stricture with a diameter of less than 13 mm was diagnosed by the barium swallow in 21 patients. Recurrence of dysphagia was seen in 15 patients. Thirteen patients denied any swallowing symptoms. Chest pain was present in 9 patients. Of 15 patients with dysphagia 2 (13%) had no narrowing but severe esophageal dysmotility. Of 13 patients without dysphagia 9 (69%) had a stricture with a diameter of 13 mm or less. Of 21 patients with a stricture of 13 mm or less 14 (67%) were symptomatic while 7 (33%) were asymptomatic. Four of 11 patients with retrosternal pain had a stricture of less than 10 mm. Three patients with retrosternal pain and obstruction had severe esophageal dysmotility. Whether or not the patients have dysphagia may be more related to diet and eating habits than to the true diameter of their esophageal narrowing. We conclude that the clinical history is non-reliable for evaluating the results of esophageal stricture dilatation. In order to get an objective measurement of therapeutic outcome, barium swallow including a solid bolus is recommended

Endoscopic Balloon Dilatation of Benign Esophageal Stricture—A Nonhazardous Procedure?

Balloon dilatation of benign esophageal strictures has been widely used since its introduction. We have performed 224 dilatation procedures in 52 patients. Dilatation was done as an outpatient procedure. Strictures were due to reflux esophagitis in 25 patients, anastomatic stenosis in 6, achalasia in 5, complications of sclerotherapy in 5, corrosive lesions in 3, and long-standing nasogastric intubation in 2. The cause was unknown in 6 cases. The intention was to dilate all strictures up to 20 mm. Three major complications occurred, and one of these patients died. The risk of perforation seems to be higher after repeated procedures than during the first one

Grading scale of radiographic findings in the pubic bone and symphysis in athletes.

Purpose: Radiographic abnormalities in the pubic bone and symphysis are often seen in athletes with groin pain. The aim was to create a grading scale of such radiologic changes. Material and Methods: Plain radiography of the pelvic ring including the pubic bone and the symphysis was performed in 20 male athletes, age 19-35, with long-standing uni- or bilateral groin pain. We used two control groups: Control group 1: 20 healthy age-matched men who had undergone radiologic examination of the pelvis due to trauma. Control group 2: 120 adults (66 men and 54 women) in 9 age groups between 15 and 90 years of age. These examinations were also evaluated for interobserver variance. Results and Conclusion: The grading scale was based on the type and the amount of the different changes, which were classified as follows: No bone changes (grade 0), slight bone changes (grade 1), intermediate changes (grade 2), and advanced changes (grade 3). The grading scale is easy to interpret and an otherwise troublesome communication between the radiologist and the physician was avoided. There was a high interobserver agreement with a high kappa value (0.8707). Male athletes with long-standing groin pain had abnormal bone changes in the symphysis significantly more frequently and more severely (p>0.001) than their age-matched references. In asymptomatic individuals such abnormalities increased in frequency with age both in men and women

Objective and quantitative definitions of modified food textures based on sensory and rheological methodology

Introduction: Patients who suffer from chewing and swallowing disorders, i.e. dysphagia, may have difficulties ingesting normal food and liquids. In these patients a texture modified diet may enable that the patient maintain adequate nutrition. However, there is no generally accepted definition of ‘texture’ that includes measurements describing different food textures. Objective: Objectively define and quantify categories of texture-modified food by conducting rheological measurements and sensory analyses. A further objective was to facilitate the communication and recommendations of appropriate food textures for patients with dysphagia. Design: About 15 food samples varying in texture qualities were characterized by descriptive sensory and rheological measurements. Results: Soups were perceived as homogenous; thickened soups were perceived as being easier to swallow, more melting and creamy compared with soups without thickener. Viscosity differed between the two types of soups. Texture descriptors for pâtés were characterized by high chewing resistance, firmness, and having larger particles compared with timbales and jellied products. Jellied products were perceived as wobbly, creamy, and easier to swallow. Concerning the rheological measurements, all solid products were more elastic than viscous (G′>G″), belonging to different G′ intervals: jellied products (low G′) and timbales together with pâtés (higher G′). Conclusion: By combining sensory and rheological measurements, a system of objective, quantitative, and well-defined food textures was developed that characterizes the different texture categories

European Society for Swallowing Disorders: European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies

The oxytocin/vasopressin receptor antagonist atosiban delays the gastric emptying of a semisolid meal compared to saline in human

BACKGROUND: Oxytocin is released in response to a meal. Further, mRNA for oxytocin and its receptor have been found throughout the gastrointestinal (GI) tract. The aim of this study was therefore to examine whether oxytocin, or the receptor antagonist atosiban, influence the gastric emptying. METHODS: Ten healthy volunteers (five men) were examined regarding gastric emptying at three different occasions: once during oxytocin stimulation using a pharmacological dose; once during blockage of the oxytocin receptors (which also blocks the vasopressin receptors) and thereby inhibiting physiological doses of oxytocin; and once during saline infusion. Gastric emptying rate (GER) was assessed and expressed as the percentage reduction in antral cross-sectional area from 15 to 90 min after ingestion of rice pudding. The assessment was performed by real-time ultrasonography. At the same time, the feeling of satiety was registered using visual satiety scores. RESULTS: Inhibition of the binding of endogenous oxytocin by the receptor antagonist delayed the GER by 37 % compared to saline (p = 0.037). In contrast, infusion of oxytocin in a dosage of 40 mU/min did not affect the GER (p = 0.610). Satiation scores areas in healthy subjects after receiving atosiban or oxytocin did not show any significant differences. CONCLUSION: Oxytocin and/or vasopressin seem to be regulators of gastric emptying during physiological conditions, since the receptor antagonist atosiban delayed the GER. However, the actual pharmacological dose of oxytocin in this study had no effect. The effect of oxytocin and vasopressin on GI motility has to be further evaluated

Neue chirurgisch-pathologische Aspekte des Zenker-Divertikels. Diagnostische Bildgebung und Funktionsanalysen

Radiology of the pharyngoesophageal segment in patients with dysphagia relies on evaluation of both morphology and function. Video- or cineradiographic techniques are necessary. Retention of contrast material above the cricopharyngeal muscle can be due to small pseudodiverticula or true diverticula. Both phenomena are due to dysfunction in the pharyngoesophageal segment. To develop into a true diverticulum it is probably necessary to have a congenital defect between the muscle layers in the pharyngoesophageal segment