A nine liters ethanol-fueled CI engine was equipped with aftertreatment devices while different ratios of exhaust gas recirculation (EGR) were tested. The NO\dX emissions were negatively correlated to the EGR-ratio and NO\dX reductions of between 33% and 73% were obtained. Unfortunately, the decrease in NO\dX was followed by increased emissions of carbon monoxide, hydrocarbons, particulate matter and higher fuel consumption. The particle number emission increased approximately 4 times and particle sizes above 200 nm became more frequent when using EGR. The remedy for these emissions was to combine an oxidation catalyst and a diesel particle filter (DPF), while keeping the EGR-ratio low to minimize fuel consumption. Equipped like this, the engine passed the Euro 5 regulation as well as the Enhanced Environmentally Friendly Vehicles standard (EEV).

Background: Many patients with asthma underuse steroids for inhalation. This has been identified as a main cause of therapy failure and of excess health care utilization.Objective: To elucidate the medication persistence of patients using asthma drugs, how patients combine the drugs over time and whether medication persistence was influenced by patients switching to combination products.Methods: Individual patients' drug acquisition data were obtained from a pharmacy record database for the period 2000-2004. A patient was considered to have satisfactory medication possession ratio (MPR) if the medication supplies covered ≥80% of the prescribed treatment. Drug use profiles were constructed as graphs for each patient, showing the date of each refill and the time period covered by the dispensed drugs. From the graphs the combination of drugs, the continuity of the therapy over time and the MPR for each patient could be determined.Results: Of 1812 patients with asthma drugs in the database, 815 fulfilled the inclusion criteria. The percentage of patients with satisfactory MPR was low (11-27%), but significantly higher among patients using combination products than among those using steroids. For patients who switched from adrenergics plus steroids in two inhalers to combination products in one inhaler, the number of patients with satisfactory MPR was significantly increased.Conclusion: Satisfactory MPR was low for all types of asthma drugs. More patients had satisfactory MPR with combination products in one inhaler than with adrenergics and steroids in two separate inhalers. Asthma drug-delivery is important and combination products of the two ingredients could therefore improve asthma therapy.

The aim of this review is to discuss the methodological issues involved in using pharmacy-record databases of drug sales in pharmacoepidemiology and to illustrate the usefulness of such data in estimating disease prevalence, patient adherence and persistence to therapy. Recent studies show that asthma/chronic obstructive pulmonary disease (COPD) prevalence increases with age. The volume of acquired asthma/COPD drugs per patient also increases with age and was approximately 2.5-times higher for patients aged 60-69 years compared with patients aged 20-29 years. Despite this, there is a comparatively low interest in asthma/COPD research involving elderly individuals. Published asthma/COPD-prevalence data and drug-treatment-prevalence data correspond reasonably well. Short- as well as long-term studies on drug acquisition indicate that approximately a third of patients have drugs available to cover at least 80% of the prescribed treatment time. Only approximately a tenth of the patients acquired steroids or steroid combinations, corresponding to one daily defined dose per day over a 5-year treatment period. It is probable that asthma/COPD is undertreated in all age groups.

Only 49% of the patients with T2D in Sweden that medicate with oral antihyperglycaemic drugs (AHGD) had good blood glucose control (HbA1C < 6.0%). The reason can be low medication adherence. The aim of this study was, therefore, to determine the adherence to different oral AHGD. Included were all patients in Sweden, older than 40 years and having at least two expenditures of AHGD between 1 December 2005 and 30 November 2006. After exclusions of inpatients and patients with unspecified daily dosage 171,220 patients (57% men) remained. Medication possession ratio (MPR) was used for estimating adherence and patients were regarded adherent if MPR ≥80%. The overall refill adherence average 90%, with mean MPR (SD) = 107% (30). Eighty-five percent of the patients in their 40s were adherent compared to 91% of the patients in their 80s. About 90.1% of the women were adherent whereas 89.5% of the men were adherent. Patients with an indication for the medicine were more adherent than patients without this information. We conclude that the unsatisfactory blood glucose control showed among many Swedish T2D patients is not the result of non-adherence to prescribed medication.

To explore the possibility of using dispensed volumes asthma/COPD drugs as a proxy for the combined prevalence of asthma plus COPD. METHODS: The proportions of the Swedish population with inhalation drugs for asthma/COPD 2004 were obtained using three different databases. A pharmacy record database gave the volumes of dispensed drugs (defined daily doses, DDDs of R03A + R03B drugs) for each patient, 20 years and older. The X-plain database of Apoteket AB gave drug sales data for Sweden and Swedish population data were obtained from Swedish statistics. RESULTS: The sales volumes of asthma/COPD drugs were much higher for older than for younger people. The volumes increased from 18 DDD/TID for the 20-29 year group up to 124 DDD/TID for patients 70-79 years, or about seven times. The average volumes per patient in the different age groups corresponded to one DDD/day in only three of the age groups (50-79 years). In the youngest group the average drug volume per patient corresponded to one DDD every second day, which may indicate undermedication. The percentages of the Swedish population with asthma/COPD drugs increased from 4.0% for 20-29 years old to 14.5% for 80+ years old, or 3.6 times. When head-to-head comparisons could be made between reported prevalence data of asthma and COPD and our data the two sets of data were in a reasonable agreement. CONCLUSION: The prevalence of drug treatment, i.e. the proportion of the population with dispensed asthma/COPD drugs, could function as a proxy for the disease prevalence of asthma plus COPD.

Arbetsmaskiner förbrukar en mycket stor del av det dieselbränsle som används i landet. En stor del av avgasemissionerna härrör följaktligen från dessa maskiner. Det är därför viktigt att ta fram kunskap om vilka emissioner som avges och på vilka olika sätt emissionerna kan minskas. Som ett led i detta arbete har projektet "Utveckling av relevanta arbetscykler och emissionsfaktorer samt reducering av bränsleförbrukningen för arbetsmaskiner" (EMMA) genomförts. Projektet har finansierats av Kommunikationsforskningsberedningen (numera en del av VINNOVA), Energimyndigheten, Vägverket och LRF. Dessutom har Volvo Wheel Loaders ställt motorer och Valtra Traktor AB traktorer och motorer tillprojektets förfogande. Vidare har JTI disponerat en större traktor från Lantmännens Maskin Import AB.Projektet har genomförts av ett konsortium bestående av:Luleå tekniska universitet (LTU)JTI - Institutet för jordbruks- och miljöteknik (JTI)Institutionen för lantbruksteknik SLU (LT)SkogForsk (Skog)Svensk Maskinprovning AB (SMP)Vägverket Produktion (VägvP)I denna rapport sammanfattar Luleå Tekniska Universitet sina resultat från emissionsmätningarna i EMMA projektet. Mätningarna omfattar fyra arbetsmaskiner som har körts i motorprovbänk enligt en 22- punkters testcykel. Motorerna som testades var en Sisu Diesel 620 DWRE, en Volvo TD63 KDE, en Volvo TD40 GJE samt en Sisu diesel 420 DWRE. Motorerna testades vid Luleå Tekniska Universitets motorlaboratorium samt vid Svensk maskinprovning i Umeå. Både reglerade och icke-reglerade emissioner har uppmätts. De reglerade emissionerna som har mätts är HC, NOX och CO. De icke reglerade komponenterna som analyserats är formaldehyd, acetaldehyd, akrolein, bensaldehyd, etan, eten, propan, propen, propyn, isobutan, acetylen, 1-buten, isobuten, pentan, 1,3-butadien, bensen, toluen, M-xylen och O-xylen.Genom att använda uppmätta tidsprocentvärden från ett antal olika arbetsoperationer, som därefter har fördelats enligt moderna i ISO 8178, har emissionsfaktorer för ett antal olika arbetsoperationer genererats.

Objective To determine medication possession ratio (MPR) of patients with asthma/COPD drugs. Method Individual patient's volumes of asthma/COPD drugs (ATC-code R03) for 2000-2004 were obtained from a pharmacy record database. For each patient the MPR was calculated as the percentage of the treatment time that the patient had drugs available. Main outcome measure Medication possession ratio (MPR). Results A total of 1,812 patients, 20 years and older, with dispensed asthma/COPD drugs were registered in the database, 928 patients (51%) had acquired drugs less than once per year (68% for 20-29 years old) during the 5-year study. Only 13% of the patients had steroids and steroid combinations available to allow continuous treatment. Eight percent of the patients 20-29 years old had MPR >/= 80% of all the included drugs and 5% when only steroids and steroid combinations were considered. About 25% of the patients had acquired 80% of the total volume of asthma/COPD drugs. Conclusion The majority of the patients, and particularly those in the youngest age group used asthma/COPD drugs only sporadically. This may indicate undermedication which is likely to have a negative impact on patient outcome.

There is an ongoing search for better and cheaper ignition improvers to facilitate the introduction of ethanol fuel. Rapeseed methyl ester (RME) was therefore investigated in an ethanol fueled compression-ignited engine by means of different statistical designs. Experiments were accordingly performed at various levels of speed, load and concentration of RME in ethanol while the emissions were measured. The optimization criterions were; satisfactory engine performance and low exhaust emissions. Initial experiments showed that the power outlet and the opacity increased when using the tested ignition improver. A three level full factorial design correctly predicted that the emissions of HC, CO and NOX, should increase when using RME as an ignition improver. Lowest level of exhaust emissions was obtained at 16 % RME in ethanol but a higher concentration should be used to obtain better engine performance. A general conclusion is that RME seems suitable for the investigated task, i.e. ignition improvement, but the opacity increment should be further studied. Careful selection of the conditions used as well as rigorous control of the engine and dynamometer is necessary to obtain good repeatability and accuracy of the experimental conditions.