Rapporto sull'efficienza energetica 2013

Rapporto tecnico sulla gestione energetica nelle grandi strutture del CNR e sui possibili interventi per la riduzione dei consumi (258 pagine, con contributi di 25 autori). Pubblicazione del progetto “Efficienza energetica”, promosso dal Direttore Generale del CNR con lettera prot. CNR n. 0075888 del 7/12/2012

Atti del secondo convegno: Energy management nelle strutture del CNR. Il progetto Energy+ ed altre iniziative per l’efficienza energetica

A tre anni di distanza dal primo convegno “Energy management nelle strutture del CNR”, dedicato al tema della gestione dell’energia nelle strutture dell’Ente, il CNR ha organizzato questa seconda edizione dell’evento allo scopo di presentare alcune recenti iniziative per la promozione dell’efficienza energetica all’interno delle sue strutture. In particolare, due interventi hanno presentato le attività del progetto Energy+, riguardanti la realizzazione di una piattaforma dedicata agli Energy manager dell’Ente, un portale per la promozione delle buone pratiche di risparmio energetico fra i dipendenti CNR, una rete di stazioni meteo di supporto alle attività di miglioramento dell’efficienza energetica. Durante la giornata sono state inoltre illustrate alcune attività in corso nelle Aree della Ricerca di Pisa, Padova e Montelibretti. L’evento ha rappresentato un importante momento d’incontro e di confronto tra i tecnici ed i ricercatori coinvolti a vario titolo nella tematica della gestione energetica, gli energy manager, i responsabili delle Aree della Ricerca e l’Amministrazione centrale. Questa edizione del convegno è stata organizzata dal Gruppo di Lavoro del progetto Energy+, vincitore del Premio Innovazione CNR 2013, e dal Dipartimento Ingegneria, ICT e Tecnologie per l’Energia e i Trasporti, in collaborazione con la rete degli Energy Manager del CNR (Dicembre 2015)

Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

Background: The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Società Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). Methods: A questionnaire consisting of 26 statements was developed, validated by an 18-member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when ≥70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. Results: Two-hundred-forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first-round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). Conclusions: The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable