| 1. |
- Alzuhairi, Karam Sadoon, et al.
(author)
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Sub-acute cardiac magnetic resonance to predict irreversible reduction in left ventricular ejection fraction after ST-segment elevation myocardial infarction : A DANAMI-3 sub-study
- 2020
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 301, s. 215-219
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Journal article (peer-reviewed)abstract
- Aims: To predict irreversible reduction in left ventricular ejection fraction (LVEF) during admission for ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) in addition to classical clinical parameters. Irreversible reduction in LVEF is an important prognostic factor after STEMI which necessitates medical therapy and implantation of prophylactic implantable cardioverter defibrillator (ICD). Methods and results: A post-hoc analysis of DANAMI-3 trial program (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) which recruited 649 patients who had CMR performed during index hospitalization and after 3 months. Patients were divided into two groups according to CMR-LVEF at 3 months: Group 1 with LVEF≤35% and Group 2 with LVEF>35%. Group 1 included 15 patients (2.3%) while Group 2 included 634 patients (97.7%). A multivariate analysis showed that: Killip class >1 (OR 7.39; CI:1.47–36.21, P = 0.01), symptom onset-to-wire ≥6 h (OR 7.19; CI 1.07–50.91, P = 0.04), LVEF≤35% using index echocardiography (OR 7.11; CI: 1.27–47.43, P = 0.03), and infarct size ≥40% of LV on index CMR (OR 42.62; CI:7.83–328.29, P < 0.001) independently correlated with a final LVEF≤35%. Clinical models consisted of these parameters could identify 7 out of 15 patients in Group 1 with 100% positive predictive value. Conclusion: Together with other clinical measurements, the assessment of infarct size using late Gadolinium enhancement by CMR during hospitalization is a strong predictor of irreversible reduction in CMR_LVEF ≤35. That could potentially, after validation with future research, aids the selection and treatment of high-risk patients after STEMI, including implantation of prophylactic ICD during index hospitalization.
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| 2. |
- Bertelsen, Niels Haldor, et al.
(author)
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CREDIT Performance Indicator Framework - A proposal based on studies of building cases, regulations, standards and research in seven Nordic and Baltic countries. CREDIT Report 3.
- 2010
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Reports (other academic/artistic)abstract
- This CREDIT Report 3 'CREDIT Performance Indicator Framework' presents a framework of building costs, performance and impact indicators. The framework is an endeavor to map and communicate many and differing approaches and perspectives on building and real estate in one model. The general and specific objectives of the research on the performance indicator framework were to: – Improve transparent value creation in both construction and real estate. – Develop an international performance classification framework focusing on the first step needed by the Nordic and Baltic countries. – Provide recommendations for international key indicators for buildings. – Focus on performance demands and requirements to buildings to satisfy the end-user needs and functions of the building rather than to follow a prescriptive approach. – Distinguish between the demand and the supply perspective in the construction and facility management process. – Secure that the needed performance information is available throughout the life cycle of the building. The performance indicator framework developed in CREDIT is a 'gross' inventory of indicators relevant in relation to building and real estate in the seven Nordic and Baltic countries: Denmark, Finland, Iceland, Norway, Sweden, Estonia and Lithuania. The content of the report is based on CREDIT Report 1, State of the Art, the findings in 28 CREDIT case studies as well as on input from national building regulations and standards on selected research topics. The performance indicator framework was developed concurrently with the case studies and experience with assessment tools, enterprises, buildings and international benchmarking reported in CREDIT Reports 2, 4 and 5. Performance indicators in seven independent facets A simple and understandable structure of indicators in seven independent facets was developed in CREDIT. They range from hard-core measurable indicators to soft, qualitative and hardly measurable indicators. The first facet included costs and price through the life cycle of the building. The five next facets addressed performance of location, building, building parts, facility management and process. They all included objective measurable performance indicators and indicators that addressed less measurable properties as well as the users' experience and feelings. The final facet focused on the impact of the building on the external environment, social life and economy. 1 Costs, price and life cycle economy (LCE) 2 Location, plot, region and country 3 Building performance and indoor environment 4 Building part and product performance 5 Facility performance in operation and use 6 Process performance in design and construction 7 Impact environmentally, socially and economically These 7 facets were divided into sub-facets, which in turn were divided into sub-facets covering a total of 187 indicators.The performance indicator framework encompassed two different ways of looking at the building, depending on which relation you have to it: – The building viewed from within as the occupier or owner of the building – The building viewed from without as the surrounding society Because of its inclusive character, the CREDIT performance indicator framework could work as a tool to improve the performance of buildings as well as the cooperation between the parties in the construction and real estate sectors. Product and process performance indicators User's experience and feelings are important and therefore they were included in five of the seven facets: location, building performance, building parts performance, facility management, and process performance. This was done with the intent to focus on values as well as end-user needs rather than prices, costs and standard of execution and equipment. In the study it was also important to get a better understanding of how the built environment could create value for the users and thereby increase the outcome of activities housed in the building. One focus was therefore the assessing of indicators that were directly linked to the building or the perception of it. It turned out to be the main topic in the performance indicator framework presented in the report. A second focus was the assessing of indicators and how we link the productivity of the enterprises involved and the different processes in construction and real estate. The report presents process indicators to support the primary focus in the building sector today. The third focus of the study was to change the focus from the building as an expense to how it could be a social and economic advantage for the business and the activities in the building in use. It appears in the CREDIT performance indicator framework as a new approach in several facets and levels, and it might be a new positive way to push the development forwards in the future. Performance indicators and the phases of the buildings life cycle The CREDIT Indicators have three different purposes depending on where and when in the building process they are addressed. In the initial phases they serve as specifications or requirements in the briefing and programming phases. During design and construction phase they serve as guidelines for the design and how to compare qualities and properties of building and component in order to comply with the requirements. After completion, they serve as tools to assess the performance, quality or economic potential of the finished building as a delivery to facility management and the users of the building. It is important that these three purposes in the practical application of the CREDIT performance indicator framework are carefully interlinked and information is reused to improve the process performance. Key performance indicators The CREDIT case studies showed that a few indicators turned up in all cases or in relation to all building types and therefore could be common key performance indicators in CREDIT. These few common key indicators were of a basic character namely: location, building type, size/area and price/- costs. Otherwise the indicators varied primarily depending on the purpose of the assessment and on the user or recipient of the assessment. There did not seem to be a strong linkage between particular indicators and specific building types. Therefore CREDIT recommended that several sets of key performance indicators should be defined, reflecting the needs of specific user/recipients (end-user, client, authorities, contractors, consultants) of the assessments as well as sets that reflect the needs linked to particular phases in the life cycle of the building. With the interests and needs of the building owner/client in mind, CREDIT proposes a set of 10 key indicators with indicators from all facets of the classification framework and on various levels of facets. Other proposals could be prepared in the future as alternatives. Readiness of the performance indicators The various indicators described in the report were at very different stages concerning their readiness for inclusion in national or cross- boarder benchmarking. Some of the indicators were already being applied in national benchmarking, international certification schemes in many or all the countries in CREDIT and they were covered by international standards. This included many but not all the indicators on indoor climate, energy efficiency, environmental impact and facility management. To use these indicators in cross-boarder benchmarking, would require translation and harmonisation. Other groups of indicator were not quite as readily applicable in benchmarking let alone in cross boarder benchmarking. This included areas like process performance and life cycle costing, both of which were covered by international standards. In these areas the barrier was the differences in the charts of accounts, making up of amounts and sizes both on national as well as international level. A third group consisted of indicators that were possible to distinguish only in two classes, compliance with building regulations or not. This group included such areas as accessibility, construction safety and fire safety. The reason why they were not applicable right now differs. A fourth group consisted of indicators of a relative character. This included indicators addressing usability, architectural or aesthetic quality and cultural heritage. Some of these indicators were included in international standards, but were not defined in acknowledgement of the relative character of these issues that either depends on building function or on cultural or national values.
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| 3. |
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| 4. |
- Bertelsen, Niels Haldor, et al.
(author)
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National and International Benchmarking - CREDIT Report 6
- 2010
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Reports (other academic/artistic)abstract
- This report summarises the work undertaken in the CREDIT project and proposals for how to implement the CREDIT framework. It is the final part of the Nordic/Baltic project CREDIT: Construction and Real Estate – Developing Indicators for Transparency. The report presents the objectives and the research model for CREDIT followed by a summary of the results of CREDIT Reports 2, 3, 4 and 5. The conclusive part of the report presents national recommendations of how to implement the CREDIT framework in the Nordic/Baltic countries Denmark, Finland, Norway, Sweden, Iceland, Estonia and Lithuania.
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| 5. |
- Engstrøm, Thomas, et al.
(author)
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Danegaptide for primary percutaneous coronary intervention in acute myocardial infarction patients : A phase 2 randomised clinical trial
- 2018
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In: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 104:19, s. 1593-1599
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Journal article (peer-reviewed)abstract
- Objectives: Reperfusion immediately after reopening of the infarct-related artery in ST-segment elevation myocardial infarction (STEMI) may cause myocardial damage in addition to the ischaemic insult (reperfusion injury). The gap junction modulating peptide danegaptide has in animal models reduced this injury. We evaluated the effect of danegaptide on myocardial salvage in patients with STEMI. Methods: In addition to primary percutaneous coronary intervention in STEMI patients with thrombolysis in myocardial infarction flow 0-1, single vessel disease and ischaemia time less than 6 hours, we tested, in a clinical proof-of-concept study, the therapeutic potential of danegaptide at two-dose levels. Primary outcome was myocardial salvage evaluated by cardiac MRI after 3 months. Results: From November 2013 to August 2015, a total of 585 patients were randomly enrolled in the trial. Imaging criteria were fulfilled for 79 (high dose), 80 (low dose) and 84 (placebo) patients eligible for the per-protocol analysis. Danegaptide did not affect the myocardial salvage index (danegaptide high (63.9±14.9), danegaptide low (65.6±15.6) and control (66.7±11.7), P=0.40), final infarct size (danegaptide high (19.6±11.4 g), danegaptide low (18.6±9.6 g) and control (21.4±15.0 g), P=0.88) or left ventricular ejection fraction (danegaptide high (53.9%±9.5%), danegaptide low (52.7%±10.3%) and control (52.1%±10.9%), P=0.64). There was no difference between groups with regard to clinical outcome. Conclusions: Administration of danegaptide to patients with STEMI did not improve myocardial salvage. Trial registration number: NCT01977755; Pre-results.
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| 6. |
- Hansson, Bengt, et al.
(author)
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Project Assessments in Construction and Real Estate - Analysing management of end-user needs and ensuring performance in the building life cycle. CREDIT Report 4
- 2010
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Reports (other academic/artistic)abstract
- In this report a generic model for the capture and assessment of end-user requirements and needs, the CREDIT carpenter model, has been developed. The main determinants of the model is the need for the project organisation (including the facilities management organisation) to ensure a thorough understanding of the end-user requirements and needs as well as an assessment through out the project process. The end-users and the project organisation are often working in two different value chains. This, among other things, means that they may not share a common understanding of the process. Apart from just assessing to what extent the requirements and needs has been achieved it is important to assess the process of accomplishing the desired result. This way it is possible to learn from what has worked well and what has not. There is some variation in what and how it is being assessed depending on what type of building it is. Assessments on housing are more inclined to focus on softer aspects, for example perception etc. In the other cases there are, generally, a more technical perspective. It may be an affect of how knowledgeable the users are. In regard to housing the users have possible less experience of construction and communicating their needs than in the case of offices etc. There is also a notable difference between approaches and interest on what to assess in the different countries. Sweden has a much more soft approach and an ambition of getting as many as possible to understand what is being assessed and for what reasons while Finland has a much more technical and measurable approach. The clients, naturally, play a large part in the construction process, also when it come to capturing and transferring the requirements and needs of the end-users. It is mainly the clients that initiate it. Maybe more surprisingly, they do perform a lot of the work themselves as well. Designers play an important role as do known end-users as well. During the project it is mainly the client that initiates the assessments, but the actors of the project process, designers and producers that perform it. Evaluating the degree of fulfilling the requirements and needs as well as assessing the process to enable learning is again mainly a client action both initiating and performing, the rest of the actors do not engage to any larger degree. The processes from begin of the brief to the end of construction have well developed routines as a part of the project management system. These routines are good enough to successfully fulfil the studied project and the control of the process in order to get internal efficiency in the short run perspective. But there is almost no case that shows any assessment tool that support feedback, the knowledge development and the innovation process which is important in the long-run perspective. The missing feedback is marked in the carpenter model. Found in the study there are two examples of tools that together may to some extent overrun this issue. Building Information Models have the potential of acting as an information carrier within a project, storing all types of information needed for assessing a number of different aspects. The main issue is to get the right information and presenting it in a way suitable for the target group. This is done in the case of Falk in Skanska (in Norway). It is a system gathering and presenting a multitude of KPIs, from a number of different systems, in an easy to understand layout.
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| 7. |
- Huovila, Pekka, et al.
(author)
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National and International Benchmarking - CREDIT Report 5.
- 2010
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Reports (other academic/artistic)abstract
- This report summarizes findings and recommendations from 24 case studies from seven participating countries addressing performance indicator benchmarking at a sectoral, national or international scale. Their distribution in scope is: – benchmarking systems and indicators (4 case studies) – offices (7 case studies) – housing (6 case studies) – school and nursery (4 case studies) – shopping centres (3 case studies). In addition, actual performance benchmarking was done between six Finnish and Norwegian office buildings using CREDIT Key Performance Indicators and a web-based benchmarking tool, developed in CREDIT for that purpose. Some good benchmarking practices exist already at a national and international level. They focus on process issues, investment aspects and environmental properties. These existing schemes contribute to the CREDIT framework, but don't cover well the performance dimension. There isn't yet any commonly agreed European Key Performance Indicator system, or building and real estate performance indicator standard. CREDIT made a contribution to their development from the Nordic/Baltic perspective. It also provided valuable input from the performance and social sustainability point of view to existing economic and environmental oriented schemes that are continuously updated and amended. CREDIT made progress in performance indicator framework and actual performance indicators and tools, some of which were already tested in the case studies. Understanding on existing benchmarking schemes is also improved. The results of CREDIT WP6 performance indicator benchmarking at a sectoral, national or international scale can be exploited in number of ways, such as – the front runner companies adopt the core performance indicators in their practices and influence in forming their use a sector based practice – further development of standardization, tool development (IFCs), benchmarking schemes and rating systems makes use of the results.
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| 8. |
- Kaiser, Brooks A., et al.
(author)
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Spatial issues in Arctic marine resource governance workshop summary and comment
- 2015
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In: Marine Policy. - : Elsevier BV. - 0308-597X .- 1872-9460. ; 58, s. 1-5
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Journal article (peer-reviewed)abstract
- The rapidly changing Arctic marine ecosystems face new challenges and opportunities that are increasing and shifting governance needs in the region. A group of economists, ecologists, biologists, political scientists and resource managers met in Stockholm, SE, Sept 4-6, 2014 to discuss the governance of Arctic marine resources in a spatial context. We report on the findings here.
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| 9. |
- Karud, Ole Jørgen, et al.
(author)
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State-of-the-Art of Benchmarking in Construction and Real Estate. CREDIT Report 1.
- 2010
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Reports (other academic/artistic)abstract
- This State-of-the-art report in the CREDIT project has identified and examined a number of existing sets of performance indicators, methods and tools for understanding user needs, requirement management, databases and mandatory reporting. The report has also focused on approaches to better benchmarking schemes in the Nordic and Baltic countries that can compare end-user and client needs, and performance requirement on building parts as well as performance measures on real estate in use. The report covers a range of different subjects as well as practices. The participating countries have chosen different, but complimentary themes, which also have a special local interest and focus in each country. The national and international experiences are studied as a background and as part of the recommendations to the following work packages in the CREDIT project.
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| 10. |
- Kyhl, Kasper, et al.
(author)
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Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease : A DANAMI-3–PRIMULTI Cardiac Magnetic Resonance Substudy
- 2019
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In: JACC: Cardiovascular Interventions. - : Elsevier BV. - 1936-8798. ; 12:8, s. 721-730
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Journal article (peer-reviewed)abstract
- Objectives: The aim of this study was to evaluate the effect of fractional flow reserve (FFR)–guided revascularization compared with culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) on infarct size, left ventricular (LV), function, LV remodeling, and the presence of nonculprit infarctions. Background: Patients with STEMI with multivessel disease might have improved clinical outcomes after complete revascularization compared with PCI of the infarct-related artery only, but the impact on infarct size, LV function, and remodeling as well as the risk for periprocedural infarction are unknown. Methods: In this substudy of the DANAMI-3 (Third Danish Trial in Acute Myocardial Infarction)–PRIMULTI (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization) randomized trial, patients with STEMI with multivessel disease were randomized to receive either complete FFR-guided revascularization or PCI of the culprit vessel only. The patients underwent cardiac magnetic resonance imaging during index admission and at 3-month follow-up. Results: A total of 280 patients (136 patients with infarct-related and 144 with complete FFR-guided revascularization) were included. There were no differences in final infarct size (median 12% [interquartile range: 5% to 19%] vs. 11% [interquartile range: 4% to 18%]; p = 0.62), myocardial salvage index (median 0.71 [interquartile range: 0.54 to 0.89] vs. 0.66 [interquartile range: 0.55 to 0.87]; p = 0.49), LV ejection fraction (mean 58 ± 9% vs. 59 ± 9%; p = 0.39), and LV end-systolic volume remodeling (mean 7 ± 22 ml vs. 7 ± 19 ml; p = 0.63). New nonculprit infarction occurring after the nonculprit intervention was numerically more frequent among patients treated with complete revascularization (6 [4.5%] vs. 1 [0.8%]; p = 0.12). Conclusions: Complete FFR-guided revascularization in patients with STEMI and multivessel disease did not affect final infarct size, LV function, or remodeling compared with culprit-only PCI.
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