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- Ovadia, C., et al.
(författare)
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Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis
- 2021
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Ingår i: Lancet Gastroenterology & Hepatology. - : Elsevier BV. - 2468-1253. ; 6:7
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Tidskriftsartikel (refereegranskat)abstract
- Background Ursodeoxycholic acid is commonly used to treat intrahepatic cholestasis of pregnancy, yet its largest trial detected minimal benefit for a composite outcome (stillbirth, preterm birth, and neonatal unit admission). We aimed to examine whether ursodeoxycholic acid affects specific adverse perinatal outcomes. Methods In this systematic review and individual participant data meta-analysis, we searched PubMed, Web of Science, Embase, MEDLINE, CINAHL, Global Health, MIDIRS, and Cochrane without language restrictions for relevant articles published between database inception, and Jan 1, 2020, using search terms referencing intrahepatic cholestasis of pregnancy, ursodeoxycholic acid, and perinatal outcomes. Eligible studies had 30 or more study participants and reported on at least one individual with intrahepatic cholestasis of pregnancy and bile acid concentrations of 40 mu mol/L or more. We also included two unpublished cohort studies. Individual participant data were collected from the authors of selected studies. The primary outcome was the prevalence of stillbirth, for which we anticipated there would be insufficient data to achieve statistical power. Therefore, we included a composite of stillbirth and preterm birth as a main secondary outcome. A mixed-effects meta-analysis was done using multi-level modelling and adjusting for bile acid concentration, parity, and multifetal pregnancy. Individual participant data analyses were done for all studies and in different subgroups, which were produced by limiting analyses to randomised controlled trials only, singleton pregnancies only, or two-arm studies only. This study is registered with PROSPERO, CRD42019131495. Findings The authors of the 85 studies fulfilling our inclusion criteria were contacted. Individual participant data from 6974 women in 34 studies were included in the meta-analysis, of whom 4726 (67.8%) took ursodeoxycholic acid. Stillbirth occurred in 35 (0.7%) of 5097 fetuses among women with intrahepatic cholestasis of pregnancy treated with ursodeoxycholic acid and in 12 (0.6%) of 2038 fetuses among women with intrahepatic cholestasis of pregnancy not treated with ursodeoxycholic acid (adjusted odds ratio [aOR] 1.04, 95% CI 0.35-3.07; p=0.95). Ursodeoxycholic acid treatment also had no effect on the prevalence of stillbirth when considering only randomised controlled trials (aOR 0.29, 95% CI 0.04-2.42; p=0.25). Ursodeoxycholic acid treatment had no effect on the prevalence of the composite outcome in all studies (aOR 1.28, 95% CI 0.86-1.91; p=0.22), but was associated with a reduced composite outcome when considering only randomised controlled trials (0.60, 0.39-0.91; p=0.016). Interpretation Ursodeoxycholic acid treatment had no significant effect on the prevalence of stillbirth in women with intrahepatic cholestasis of pregnancy, but our analysis was probably limited by the low overall event rate. However, when considering only randomised controlled trials, ursodeoxycholic acid was associated with a reduction in stillbirth in combination with preterm birth, providing evidence for the clinical benefit of antenatal ursodeoxycholic acid treatment. Copyright (C) 2021 The Authors(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
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- Aabrekk, S., et al.
(författare)
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Deliverable 2.2 Possible market strategies for one stop shops of renovation of single family house. : Report prepared for Nordic Innovation Centre
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The document describes examples of missions, visions and strategies based on the potentialpiloting models defined in report 3.2. It is based on status of interest amongst thestakeholders, and the information, figures and challenges which were discussed in the reportD 2.1 Stakeholder interests. The different service models will request different missionsdepending on the stakeholder in charge of the model. Also visions and strategies could bedifferent depending on the composition of services (core business) offered within each pilot aswell as the additional services offered by sub suppliers and the network connected to the pilot.In the report D2.1 Stakeholders interests, the following 5 different piloting models aresuggested:Type 1 Joint venture of industry, retailers and contractorsType 2 Joint venture of construction/renovation, industry and architect/engineering companiesType 3 Complementary businesses expand their business into renovationType 4 Joint venture of type house producer, bank and home owner associationType 5 Energy/building consultant, real estate agent and financing institutions, e.g. bankIn this report we have described mission, vision and market strategies for 4 existing orproposed models; The Project Manager by Bolig Enøk, from Norway (type 1), ENRA concept(type 2) and K-Rauta & Rautia (type 3) from Finland, and ProjectLavenergi (type 2) fromDenmark. Cleantech by Dong Energy (type 3) from Denmark is also addressed, but notdescribed in detail. As there is no concrete examples representing two of the models fromD2.1 (types 4 and 5), we have made a theoretical exercise in developing mission, vision andmarket strategies for type 5 model, while type 4 is not handled.It may be concluded that there are commercial actors in different parts of the value chainwhich see an opportunity in developing different approaches of “one stop shops” for energyefficient holistic renovations. The concepts are still in a development phase and differ inrespect to how they are organised (as supply side). We may say that the pilots in the differentcountries also find inspiration from each other through this research project. Due to thecomplexity of a holistic renovation project, it is a prerequisite with good partnerships even inthe development phase. In all identified models there is however one main actor taking thelead and ownership to the business model.Independent of the business model the responsible company needs to make some strategicchoices. The starting point is the SWOT analysis which sums up all major challenges for therespective business model. How the strategies should be developed is described in this report.Although the main target group for this report is companies seeing an interest in developingbusiness models for renovation, we found some important issues identified in the SWOTanalysis which the authorities may influence including lack of interest in the market (need ofmore public attention through holistic campaigns), fragmented solutions (stop subsidisingsingle measures without a holistic plan), serious vs unserious companies (need of certificationsystems to build credibility), cost focus leads to limited renovation (need of subventionschemes for holistic retrofitting including tax deduction measures) and finally lack incompetence within companies (need of support to training and collaboration acrosscompanies).
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- Mahapatra, Krushna, 1974-, et al.
(författare)
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Deliverable 3.1 Report on possible financing schemes for one-stop-shop service for sustainable renovation of single family house : Report prepared for Nordic Innovation Centre
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- There are significant potentials to improve energy efficiency of single-family houses in theNordic countries. Technical solutions exist, but there are market and financial barriers toimplementation of such measures. The aim of the report is to identify financial barriers toimplement energy efficiency measures in Nordic single family houses and to discuss optionsto address those barriers.In the initial phase of a market formation, the targeted potential customers (the “innovators”who are few in numbers) usually have capacity to invest in energy-efficient measures.However, such measures, though cost effective in a life-cycle perspective, often incur highinvestment cost and majority of the consumers tend to stick to the least efficient products.Moreover, a lack of awareness about the possible energy efficiency measures, including theirbenefits, and the uncertainty regarding the level of energy savings due to a lack ofstandardised measurements and verifications protocol may not encourage, both the customersand financiers, to go for energy efficiency investments. Financiers perceive energy efficiencyprojects as risky investments maybe because of their small size, difficulty to control energyuse behaviour of the occupants and the difficulty to predict future energy prices.The options to finance energy efficiency renovations include homeowners’ own resources,mortgage refinancing, flex loan, personal loan, financing by service providers, preferentialloan, subsidies/grants, credit cards, and financing supported by guarantee on energy savings.Each option has its own advantages and disadvantages. It is less likely that the one-stop-shopservice providers in Nordic countries, at present, will give any guarantee on actual savings inenergy use or cost. But, such a concept is emerging in some European countries and could bean option in future.The best option to finance energy efficiency improvements in Nordic countries seems to bethat one-stop-shop service providers collaborate with commercial banks to offer mortgagerefinancing. Such a mechanism is convenient for the homeowners, and banks will have a lessrisky asset in their portfolio. In situations where homeowners cannot avail additionalmortgage financing, e.g. those who recently purchased a house and used the limit to suchloans, banks may consider an energy efficient renovation plan prepared by an entrepreneurand pre-evaluate the post-renovation value of the house. This pre-renovation valuation couldform the basis for the bank to confirm the homeowner and the service provider that certainamount of investment cost would be available from mortgage refinancing. To cover the costthat exceeds the amount available from mortgage financing (or base loan), nationalgovernments may consider to provide soft loans or subsidies.In countries where tax deduction on home renovation is available, amendments should bemade to such programs to incorporate specific requirements regarding energy efficiency ofimplemented measures. Also, higher tax deduction could be offered for energy efficiencyimprovement than for other renovation. Moreover, a simple tool to inform the homeownersabout the cost-efficiency of energy renovation investment would be that banks and utilitiescollaborate to send a joint invoice which contains the monthly cost of mortgage loan and theenergy cost.
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- Mahapatra, Krushna, 1974-, et al.
(författare)
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Deliverable 3.2 Report on business models for one-stop-shop service for sustainable renovation of single family house : Report prepared for Nordic Innovation Centre
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the report is to analyze and develop one-stop-shop business models to offer fullservicerenovation packages in the Nordic countries. The report will contribute to identifypotential models that can be tested in pilot studies and will be an important source of marketinformation for companies planning to develop a one-stop-shop concept.In Nordic countries significant primary energy efficiency potential exists in houses builtbefore 1980. These houses are more than 30 years old and need to be renovated. This providesan opportunity for implementation of energy efficiency measures, but the renovation market isdominated by handicraft-based individual solutions. There is a need for one-stop-shopbusiness models where an overall contractor offers full-service renovation packages includingconsulting, independent energy audit, renovation work, follow-up (independent qualitycontrol and commissioning) and financing. There is a significant business potential for such amodel as the renovation market for single-family houses could be in the order of hundreds ofmillion Euros per year in each Nordic country. Homeowners will get an improved qualityrenovated house with little risk or responsibility which usually is the case with traditionalrenovations, the energy cost will be reduced, market value of the house is likely to increase,mortgage banks will have a safer asset and there are societal benefits in terms of reducedenergy use and greenhouse gas emission. However, there is uncertainty over who will beresponsible for guarantee of the renovation work if the service provider goes bankrupt.Insurance companies could be involved to address this issue.A comparative assessment of models proposed in the Nordic countries shows that differenttype of actors may play the key role in a one-stop-shop for energy efficient renovation ofsingle-family houses. In some models the service provider collaborates with financinginstitutions to provide renovation financing. There are differences on how customers arecontacted, while the similarities are more on how the service is provided. A main challenge ishow to secure independent advising.Even though there is strong business potential for one-stop-shop energy renovation concept,still it has been somewhat difficult to start or run such a business. One of the main reasons isthe uncertainties about the customer base. One way to attract more customers is to offersubsidies for energy efficiency measures. In Denmark, Sweden and Finland there are taxdeductions for labour cost for home renovation and other household work. An amendment tosuch programs to incorporate specific requirements regarding energy efficiency ofimplemented measures could be a way to increase homeowners’ interest in energy efficientrenovation. A guarantee on energy or energy cost saving may encourage energy efficientrenovation of houses as energy cost saving is one of the most important factors in thehomeowners’ decision to implement energy efficiency measures. At present it is less likelythat such guarantee will be given as the full service energy renovation concept is yet to betested and not enough experience exists regarding energy savings potential in the context ofvarying household energy behaviour. Highlighting the energy (e.g. cost reduction) and nonenergybenefits (improved thermal comfort or indoor air quality) of energy efficiencyimprovements may create customer interest in energy efficient renovations. Some of theexisting models include financing by the service providers in collaboration with financinginstitutions. To support the mortgage financing of energy efficiency renovations, governmentcould provide soft loans or subsidies to cover the investment cost beyond the mortgage (base)loan.
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| 10. |
- Vanhoutteghem, L., et al.
(författare)
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Deliverable 1.2 Analysis of promising sustainable renovation concepts : Report prepared for Nordic Innovation Centre
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The report focuses on analyses of the most promising existing sustainable renovationconcepts, i.e. full-service concepts and technical concepts, for single-family houses. As abasis for the analyses a detailed building stock analysis was carried out. Furthermore, ageneral method as proposal for package solutions for sustainable renovation is described. Themethod contains investigation of the house, proposal for sustainable renovation and detailedplanning as well as commissioning after renovation.The building stock analysis shows that detached single-family houses account for large shareof the total number of dwellings in all Nordic countries. Electric heating (and oil heating) ofsingle-family houses is very common in the Nordic countries, except for Denmark whereoil/gas boiler and district heating is mostly used. Natural ventilation is widespread inDenmark while mechanical ventilation is also often used in Norway, Sweden and Finland.Houses in Norway, Sweden and Finland are typically built with wood as a main constructionmaterial, but the insulation and/or finishing materials differ. In Denmark bricks are used as adominant construction material for cavity walls.The typical single-family houses identified to have large primary energy saving potentialalmost descend from the same time period in each Nordic country. The first segment is housesbuilt in large numbers in the 1960 and 1970. The second segment is houses built before 1940pre-war (except for Finland) where a large part of them has been renovated, but energyrenovation of those houses today would still account for a large energy saving. The thirdsegment is houses from the post-war period in Finland, houses that are all individual but builtin the same way, using the same materials.Existing full-service renovation concepts in the Nordic countries have just recently enteredthe market and are not well established and their success is yet to be evaluated. Companiesmay improve concepts by a more integrated approach and application of the full range oftechnical solutions to ensure the homeowner a sustainable renovation to a reasonable price.Energy efficiency calculations for individual measures for each of the typical single-familyhouses in the Nordic countries were made, and also some examples of cost analysis based onthe criterion of cost of conserved energy (CCE) that takes into account the investment andrunning cost and savings during a defined relevant reference period.Different technical renovation scenarios consisting of energy efficiency measures have beentested for the typical single-family houses with large energy saving potential in each of theNordic countries. Energy efficiency measures in connection with renovation of single-familyhouses have the potential for very large energy savings. In general the analyses show thattypical single-family houses can be renovated to the level of energy performance required fornew houses today or in some cases to low-energy level. Reaching passive house level may bechallenging in old houses. Passive house level was not reached in any of the analysed cases.Positive impact on the indoor environment can be expected. Thermal comfort will beimproved by insulation and air-tightness measures that will increase surface temperatures andreduce draught from e.g. badly insulated windows. A ventilation system with heat recoverywill also contribute to a good thermal comfort by draught-free supply of fresh air and assurean excellent air quality. Overheating can effectively be avoided by external movable solarshadings and/or higher venting rate by use of e.g. automatically controlled windows.
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