A Comprehensive Energy Model for an Optimal Design of a Hybrid Refrigerated Van

The path towards decarbonization requires a progressive adaptation of all refrigeration systems, but only stationary ones have been intensely studied to improve their environmental performance. However, refrigerated transport is vital in the cold chain and must be considered in the green transition. In this paper, we propose a model for a hybrid refrigerated van that includes photovoltaic panels and electric batteries to decrease total greenhouse gas emissions from the engine. Thermal, electrical, and battery sub-models are considered and integrated into the comprehensive hybrid solar-powered refrigerated van model. Different technologies are compared, including lithium and lead-acid batteries and three different types of photovoltaic panels. The model was validated regarding van fuel consumption, showing a 4% deviation. Single and multiple delivery scenarios are considered to assess the energy, economic, and environmental benefits. Monthly CO2,e emissions could be reduced by 20% compared to a standard refrigerated van. Despite the environmental benefits provided by this sustainable solution, the payback period is still too long (above 20 years) because of the necessary investment to adapt the vehicle and considering fuel and electricity prices currently

Expanded Total Equivalent Warming Impact analysis on experimental standalone fresh-food refrigerator

The stand-alone refrigerators for fresh food storage represent a large part of supermarket refrigeration equip-ment. In these devices, the usage of refrigerants with low Global Warming Potential allows the mitigation of the direct emissions due to refrigerant leakages. In contrast, the indirect emissions in these components are highly dependent on the refrigerant charge, leakage, and equivalent emission factors related to the electricity pro-duction mix. The most used index to evaluate the environmental impact of refrigerators is the Total Equivalent Warming Impact. Despite that this index presents limits on the fixed evaluation of many parameters such as refrigerant charge, electricity consumption and, electricity emission factor. Otherwise in this study, an accurate evaluation of refrigerators emissions has been realised by using the innovative Expanded Total Equivalent Warming Impact method to an experimental stand-alone refrigerator by using a dynamic approach to evaluate direct and indirect contributions. The environmental analysis considers four different refrigerants and four different countries of location. The results show that the indirect emissions due to electricity consumption cover the highest share of emissions. In addition, the operating years affected by low refrigerant charges are respon-sible for emissions by greater than 25% compared to other ones. The hourly equivalent emissions due to elec-tricity consumption in countries characterized by an electricity generation mix mainly based on renewable and/ or nuclear plants show an indirect environmental impact up to 5 times lower than countries with a natural gas -based electricity production mix. The study also defines new strategies to reduce the environmental impact of the stand-alone refrigerator such as the use of photovoltaic systems combined with this technology or earlier maintenance processes that could determine an equivalent emission saving of up to 38%

Organocatalytic Stereoselective α-Formylation of Ketones

We have described the first organocatalytic stereoselective formylation of ketones accomplished by the use of N-methybenzothiazolylium iodide. The benzothiazolium salt, generally used as a masked formyl group or as precursor of carbenes,[31] is quite electrophilic and react with enamines formed in situ. Both moderate yield and high stereoselectivity were obtained with different ketones

The "Crossed Leg Sign" in the Emergency Department (or Tilli's Sign): A New Semiotic Sign for the Early Evaluation of Patients Accessing the Emergency Setting.

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Hepatic follicular lymphoma in an old patient with Crohn’s disease: a rare case and review of the literature

OBJECTIVE: Crohn’s Disease (CD) has been associated with non-Hodgkin lymphoma. Follicular Lymphoma (FL) limited to the liver is extremely rare, accounting for 1% to 4.4% of all Primary Hepatic Lymphoma (PHL). CASE PRESENTATION: In 2018, an 85-years old male patient with post-operative recurrence of ileal CD referred rare episodes of fever and mild diffuse abdominal pain. Since cholecystectomy in 2001, clinical history was characterized by recurrent episodes of cholangitis and common bile duct stones. In 2018, ultrasonography and MRI showed a solid focal hepatic lesion (FHL)(4.5 cm x 2.5 cm) in the IV hepatic segment. The radiographic aspect of the lesion was unusual. Initially, focal nodular hyperplasia was suspected. Clinical history of cholangitis and radiological findings subsequently suggested a diagnosis of Hepatic Abscess (HA). A progressive enlargement of the FHL (7.3 cm x 5.8 cm) despite antibiotic treatments, led to perform a liver biopsy. Histological and immunophenotypi-cal analysis of the FHL (7.5 cm x 5.4 cm) enabled a final diagnosis of FL. The “in situ” hybridization for Epstein-Barr virus (EBER) was negative. No additional lesions related to FL were initially detected, thus suggesting a very rare case of PHL in an old patient with CD never treated with thiopurines. CONCLUSIONS: This case report highlights the need to consider a rare diagnosis of FL of the liver in patients showing a challenging focal hepatic lesion of unknown origin

13C urea breath test to identify Helicobacter pylori Infection in patients with upper gastrointestinal bleeding admitted to the Emergency Department

OBJECTIVE: Upper gastrointestinal bleeding (UGIB) is a cause of Emergency Department (ED) visits. Peptic ulcer secondary to H. pylori (HP) infection and/or to the use of NSAIDs is the most frequent cause. The aim of the study is to evaluate directly in the ED the prevalence of HP infection through Urea Breath test (UBT) in patients admitted to the ED for UGIB. PATIENTS AND METHODS: We enrolled 87 patients (58M/29F) with a mean age of 63.8 + 11.7 yrs with an active UGIB who performed EGDS and UBT. RESULTS: 34.4% of patients performing EGDS and UBT resulted positive to HP. Peptic ulcer was present in 20/30 (66.7%) of HP+ compared to 20/57 (35.1%) of HP- (p<0.001), and also gastritis and/or duodenitis were mostly present in HP+ (23.3% vs. 15.8%) (p<0.05). A biopsy was performed in only 31% of patients with a positive rate of 33.3%. In 78% we obtained a correspondence between UBT and biopsy results. Compared to biopsy result, we obtained for UBT a positive predictive value (PPV) of 71% and a negative predictive value (NPV) of 80%. Taking the UBT as a gold standard, we obtained for biopsies a PPV of 69% and a NPV of 85%. CONCLUSIONS: Our study confirms that the use of UBT directly in ED in patients with UGIB allows for a rapid, reliable and non-invasive diagnosis of HP infection as a causative agent for bleeding, thus permitting a right etiological treatment

Twenty Years of Hepatitis C in the Treviso District (Local Health Unit 2): Treatments, Clinical Management and Cost Analysis

Chronic hepatitis C virus (HCV) infection is a global health problem, and about 10-30% of patients develop cirrhosis or hepatocellular carcinoma several years after being infected. In past decades, treatment of HCV infection was based on peginterferon and ribavirin, which lead to a sustained virologic response (SVR) in only 50-60% of patients. Since 2014, direct acting antiviral (DAA) agents have been available. Patients administered DAA agents usually reach SVR in 12 weeks. The aim of this study was to estimate the cost analysis of these innovative drugs while also taking into account the total health expenditure for managing HCV infection. The pharmaceutical and hospitalisation databases of the Local Health Unit (ULSS2) of Treviso were retrospectively analysed between 1997 and 2016 for each HCV patient. During this twenty-year period, people affected by HCV totalled 2,949; 277 of these patients were treated with DAA and, of these, only 2% did not reach SVR. The HCV genotype 1b was the most common, accounting for 58% of the total patients. The treatment for HCV genotype 3 was associated with higher costs. The expenses for the new treatments were found to be significantly higher compared to those for the old ones (i.e., peginterferon and ribavirin). The average costs for a cycle of therapy were €8,000 and €24,000 for interferon and DAA therapy, respectively. Total health care costs associated with HCV (excluding DAA treatments) for an individual HCV infection patient were estimated to be €32,000. Our results confirm the high efficacy of DAA therapy. Furthermore, these agents improve the clinical conditions and reduce both the treatment cost and health care in patients with HCV infection

Einstein, Planck and Vera Rubin: Relevant Encounters Between the Cosmological and the Quantum Worlds

In Cosmology and in Fundamental Physics there is a crucial question like: where the elusive substance that we call Dark Matter is hidden in the Universe and what is it made of? that, even after 40 years from the Vera Rubin seminal discovery [1] does not have a proper answer. Actually, the more we have investigated, the more this issue has become strongly entangled with aspects that go beyond the established Quantum Physics, the Standard Model of Elementary particles and the General Relativity and related to processes like the Inflation, the accelerated expansion of the Universe and High Energy Phenomena around compact objects. Even Quantum Gravity and very exotic Dark Matter particle candidates may play a role in framing the Dark Matter mystery that seems to be accomplice of new unknown Physics. Observations and experiments have clearly indicated that the above phenomenon cannot be considered as already theoretically framed, as hoped for decades. The Special Topic to which this review belongs wants to penetrate this newly realized mystery from different angles, including that of a contamination of different fields of Physics apparently unrelated. We show with the works of this ST that this contamination is able to guide us into the required new Physics. This review wants to provide a good number of these \u201cpaths or contamination\u201d beyond/among the three worlds above; in most of the cases, the results presented here open a direct link with the multi-scale dark matter phenomenon, enlightening some of its important aspects. Also in the remaining cases, possible interesting contacts emerges. Finally, a very complete and accurate bibliography is provided to help the reader in navigating all these issues

Safety of treatments for inflammatory bowel disease: Clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD)

Inflammatory bowel diseases are chronic conditions of unknown etiology, showing a growing incidence and prevalence in several countries, including Italy. Although the etiology of Crohn's disease and ulcerative colitis is unknown, due to the current knowledge regarding their pathogenesis, effective treatment strategies have been developed. Several guidelines are available regarding the efficacy and safety of available drug treatments for inflammatory bowel diseases. Nevertheless, national guidelines provide additional information adapted to local feasibility, costs and legal issues related to the use of the same drugs. These observations prompted the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) to establish Italian guidelines on the safety of currently available treatments for Crohn's disease and ulcerative colitis. These guidelines discuss the use of aminosalicylates, systemic and low bioavailability corticosteroids, antibiotics (metronidazole, ciprofloxacin, rifaximin), thiopurines, methotrexate, cyclosporine A, TNFα antagonists, vedolizumab, and combination therapies. These guidelines are based on current knowledge derived from evidence-based medicine coupled with clinical experience of a national working group