System-driven design and integration of low-carbon domestic heating technologies

This research explores various combinations of electric heat pumps (EHPs), hydrogen boilers (HBs), electric boilers (EBs), hydrogen absorption heat pumps (AHPs) and thermal energy storage (TES) to assess their potential for delivering cost-efficient low-carbon heat supply. The proposed technology-to-systems approach is based on comprehensive thermodynamic and component-costing models of various heating technologies, which are integrated into a whole-energy system optimisation model to determine cost-effective configurations of heating systems that minimise the overall cost for both the system and the end-user. Case studies presented in the study focus on two archetypal systems: (i) the North system, which is characterised by colder climate conditions and abundant wind resource; and (ii) the South system, which is characterised by a milder climate and higher solar energy potential. The results indicate a preference for a portfolio of low-carbon heating technologies including EHPs, EBs and HBs, coupled with a sizable amount of TES, while AHPs are not chosen, since, for the investigated conditions, their efficiency does not outweigh the high investment cost. Capacities of heat technologies are found to vary significantly depending on system properties such as the volume and diversity of heat demand and the availability profiles of renewable generation. The bulk of heat (83–97%) is delivered through EHPs, while the remainder is supplied by a mix of EBs and HBs. The results also suggest a strong impact of heat demand diversity on the cost-efficient mix of heating technologies, with higher diversity penalizing EHP relatively more than other, less capital-intensive heating options

System-driven design and integration of low-carbon domestic heating technologies

Data availability: Data will be made available on request.A shorter version of this work has been presented during the 17th Conference on Sustainable Development of Energy, Water and Environment Systems (SDEWES) held in Paphos, Cyprus, 6–10 November 2022.Copyright © 2023 The Authors. This research explores various combinations of electric heat pumps (EHPs), hydrogen boilers (HBs), electric boilers (EBs), hydrogen absorption heat pumps (AHPs) and thermal energy storage (TES) to assess their potential for delivering cost-efficient low-carbon heat supply. The proposed technology-to-systems approach is based on comprehensive thermodynamic and component-costing models of various heating technologies, which are integrated into a whole-energy system optimisation model to determine cost-effective configurations of heating systems that minimise the overall cost for both the system and the end-user. Case studies presented in the study focus on two archetypal systems: (i) the North system, which is characterised by colder climate conditions and abundant wind resource; and (ii) the South system, which is characterised by a milder climate and higher solar energy potential. The results indicate a preference for a portfolio of low-carbon heating technologies including EHPs, EBs and HBs, coupled with a sizable amount of TES, while AHPs are not chosen, since, for the investigated conditions, their efficiency does not outweigh the high investment cost. Capacities of heat technologies are found to vary significantly depending on system properties such as the volume and diversity of heat demand and the availability profiles of renewable generation. The bulk of heat (83–97%) is delivered through EHPs, while the remainder is supplied by a mix of EBs and HBs. The results also suggest a strong impact of heat demand diversity on the cost-efficient mix of heating technologies, with higher diversity penalizing EHP relatively more than other, less capital-intensive heating options.UK Engineering and Physical Sciences Research Council (EPSRC) grant number EP/R045518/1 (IDLES Programme)

System-driven design of hybrid electricity- and hydrogen-based systems for domestic heat decarbonisation

For the purpose of Open Access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.This paper explores various combinations of electric heat pumps (EHPs), hydrogen boilers (HBs), electric boilers (EBs), hydrogen absorption heat pumps (AHPs) and thermal energy storage (TES) to assess their potential for delivering cost-efficient low-carbon heat supply. A technology-to-systems approach is adopted in the paper based on comprehensive thermodynamic and component-costing models of various heating technologies, which are integrated into a whole-energy system optimisation model to determine cost-effective configurations of heating systems that minimise the overall cost for both the system and the end-user. Case studies presented in the paper focus on two archetypal systems that differ in terms of heat demand and availability profiles of renewables (North and South). Modelling results indicate a preference for a portfolio of low-carbon heating technologies including EHPs, EBs, HBs and TES, while AHPs are not chosen for investment due to their high investment cost. Capacities of the four heating technologies are found to vary significantly depending on system properties such as the volume and diversity of heat demand and the availability profiles of renewable generation. The bulk of heat (83-97%) is delivered through EHPs, while the remainder is supplied by a mix of EBs, HBs and TES. The results also suggest a strong impact of heat demand diversity on the cost-efficient mix of heating technologies, with higher diversity (i.e. lower coincidence factor) favouring less EHP and more of the other, less capital-intensive heating options. Finally, if only a subset of heating technologies is available for investment, the modelling suggests that coupling EHPs with TES is the second best solution in the North system, while in the South it was the combination of EHPs and EBs.UK Engineering and Physical Sciences Research Council (EPSRC) grant number EP/R045518/1 (IDLES Programme)

Translation, Adaptation and Validation of the Coronary Revascularization Outcome Questionnaire (CROQ) into Greek

Date of Acceptance: 31/05/2015Evaluating the impact of coronary revascularization on patients’ health related quality of life with a patient-based and disease-specific tool is important for drawing conclusions about treatment and outcomes. This study reports on the translation, adaptation and psychometric evaluation of a Greek version of the Coronary Revascularization Outcome Questionnaire (CROQ-Gr)Peer reviewe

Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

Background and purpose: Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF). Methods: In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Results: The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19). Conclusions: Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death. Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013

Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation. the GLORIA-AF registry

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.