Suchergebnisse

PURPOSE: This study was designed to evaluate the timeline of recurrence of pilonidal sinus disease after primary vs. multiple surgery. Data of medical military service in Germany were reviewed. METHODS: Telephone interview of 205 patients after pilonidal sinus disease surgery after median interval of 14.8 (standard deviation +/-3.9) years was conducted. A total of 345 patient charts with pilonidal sinus disease recurrence and fully documented previous surgery history were analyzed. RESULTS: Pilonidal sinus disease recurred in 41 of 205 patients (20 percent; actuarial survival 22 percent) after first surgery. Median recurrence-free-interval was 1.8 (range, 0.1-16.5) years. Twenty-nine of 41 of all recurrences (71 percent) were observed within four years after primary surgery. Fifteen of 50 patients (30 percent) treated by primary closure had recurrent disease after a median recurrence-free interval of 2.7 (range, 0.2-13.5) years compared with 24 of 144 patients (17 percent), who experienced recurrence after rhomboid excision and open wound treatment after a median of 1.8 (range 0.1-16.5) years (P = 0.081, long-rank-test). Analysis of 345 recurrent disease charts revealed that recurrence time decreased for multiple recurrences compared with first recurrence (R1 vs. R2: P = 0.07; R2 vs. R3: P = 0.03, Mann-Whitney U test). CONCLUSIONS: Long-term recurrence rate was 22 percent and thus higher than previously reported. This may be attributed to the long follow-up interval. Recurrences up to 20 years after surgery were seen. Our data provide evidence that follow-up after first to the third pilonidal sinus surgery should complete or exceed five years, because the majority of recurrences occur during this postoperative interval. Nevertheless, even a five-year follow-up will still miss 25 percent of recurrences.

Non-steady-state (NSS) chamber techniques have been used for decades to measure nitrous oxide (N₂O) fluxes from agricultural soils. These techniques are widely used because they are relatively inexpensive, easy to adopt, versatile, and adaptable to varying conditions. Much of our current understanding of the drivers of N₂O emissions is based on studies using NSS chambers. These chamber techniques require decisions regarding multiple methodological aspects (e.g., chamber materials and geometry, deployment, sample analysis, and data and statistical analysis), each of which may significantly affect the results. Variation in methodological details can lead to challenges in comparing results between studies and assessment of reliability and uncertainty. Therefore, the New Zealand Government, in support of the objectives of the Livestock Research Group of the Global Research Alliance on Agricultural Greenhouse Gases (GRA), funded two international projects to, first, develop standardized guidelines on the use of NSS chamber techniques and, second, refine them based on the most up to date knowledge and methods. This introductory paper summarizes a collection of papers that represent the revised guidelines. Each article summarizes existing knowledge and provides guidance and minimum requirements on chamber design, deployment, sample collection, storage and analysis, automated chambers, flux calculations, statistical analysis, emission factor estimation and data reporting, modeling, and "gap-filling" approaches. The minimum requirements are not meant to be highly prescriptive but instead provide researchers with clear direction on best practices and factors that need to be considered. Health and safety considerations of NSS chamber techniques are also provided with this introductory paper.

A broad variety of instruments like standards, taxes, subsidies and informational campaigns is used in Europe to influence the energy consumption for residential space heating. Within the project EPISODE the existing instruments in countries in the northern and moderate climatic zones have been analysed with a focus on The Netherlands, France, Denmark, Sweden and Germany have been analysed. In these countries space heating accounts for about 70% of the residential energy consumption. The effectiveness of the applied instruments has been analysed by an international empirical analysis based on survey data. Additionally the results of the empirical analysis have been compared with the results of a building simulation model in order to confirm or negate the empirical results. The analysed instruments lead to a decrease in energy consumption per square meter dwelling area. Especially standards have shown a strong influence on the energy reduction in the past. The analysis has also shown that the influence of taxes is very small in the short-term. A comparison of the energy consumption for space heating between the participating countries has also shown that there is still a considerable potential for energy savings. Future policies in the field should combine a bundle of instruments to achieve substantial emission reductions at low costs. Emission taxes as economically efficient instrument play thereby an important role, but also flexible standards are important for new dwellings. Subsidies and informational measures are particular important to activate energy efficiency potentials in the existing building stock. ; In den nördlichen und moderaten Klimazonen wird für die Erzeugung von Raumwärme der größte Anteil des Energieverbrauchs der Haushalte genutzt. In diesem Feld wurden große Potentiale für Energieeinsparung und Emissionsminderung identifiziert. Dementsprechend haben die Mitgliedsstaaten der Europäischen Union eine Vielzahl von Instrumenten zur Realisierung dieser Potentiale implementiert - Standards, Steuern, Förderprogramme. Ohne Zweifel hat dies zu einem fallenden Energieverbrauch und verringerten Emissionen pro Quadratmeter Wohnfläche geführt. Allerdings ist eine weitere Intensivierung dieser Maßnahmen angezeigt, um die neuen umweltbezogenen Ziele zu erreichen, insbesondere die Reduktionsverpflichtungen für Emissionen, die von der Europäischen Union bei der Kyoto Konferenz eingegangen wurden. Bis heute ist der tatsächliche Effekt von Standards, Förderprogrammen und Steuern oftmals nicht bekannt oder wurde nur ungefähr abgeschätzt. Zudem bildet die Vielfalt der eingesetzten politischen Instrumenten eine Beeinträchtigung des europäischen Binnenmarktes, da die Produzenten von Gütern zur Verbesserung der Energieeffizienz (Isolierungen, Heizungsanlagen), Baufirmen und Architekten unterschiedliche Gesetzgebungen in den Mitgliedsstaaten berücksichtigen müssen. Daraus ergibt sich die Aufgabe einer zukünftigen Harmonisierung. Darüber hinaus gibt es ernsthafte Zweifel an der Wirksamkeit der existierenden Instrumente. Aus diesen Gründen/ hat das Projekt eine detaillierte Analyse der Bestimmungsfaktoren für die Energieeffizienz von Wohnungen zum Ziel, im Hinblick auf die Entwicklung verbesserter und harmonisierter Regulierungen. Der Forschungsansatz basiert auf einer empirischen Analyse der Effekte existierender Politikmaßnahmen in verschiedenen Mitgliedsstaaten, wie z. B. Standards, Steuern und Förderprogramme für Isolierungs- und Heizungstechnologien. Dies wird durch die Analyse von Mikrodaten aus verschiedenen, nationalen Quellen untersucht.