Energy Demand and Supply Simultaneous Optimization to Design a Nearly Zero-Energy House

The effective design of nearly zero-energy buildings depends on a large set of interdependent variables, which affect both energy demand and supply. Considering them simultaneously is fundamental when searching for optimal design of nearly zero-energy buildings, as encouraged by the EU in the second recast of the Energy Performance of Building Directive (EPBD). This paper presents the application of the new energy demand and supply simultaneous optimization (EDeSSOpt) methodology to optimize the design of a single-family house in the Italian context. Both primary energy optimization and financial optimization are carried out in the context of European regulations. Robustness of the resulting optimal solution is studied through analysis of optimum neighborhoods. The resulting cost-optimized solution relies on a moderately insulated envelope, a highly efficient system, and 34% of coverage from renewables. The energy-optimized solution requires a higher level of insulation and a higher coverage from renewables, demonstrating that there is still a gap between energy and cost optimums. Beyond the results, integrated optimization by means of EDeSSOpt is demonstrated to better minimize cost functions while improving the robustness of results

Competitividad y comercialización de las empresas exportadoras de arándanos al mercado de Estados Unidos periodo 2016 - 2020

El presente estudio planteó como objetivo identificar la relación entre la competitividad y comercialización de las empresas exportadoras de arándanos al mercado de Estados Unidos en el periodo 2016-2020. La investigación se sustentó en el enfoque cuantitativo, siendo el tipo de investigación aplicada, de nivel descriptivo y diseño no experimental de corte longitudinal. La muestra estuvo conformada por los datos seleccionados de las tablas con contenidos procedentes de Siicex Perú, Adex data trade, MINAGRI y Trademap; del periodo 2016 – 2020, utilizando como instrumento la ficha de recolección de datos. Los resultados indican que existe una relación entre la competitividad y la comercialización de las empresas exportadoras de arándanos al mercado de Estados Unidos en el periodo 2016-2020 (Ro= 0.900; p= 0.037), así mismo se evidencio la relación entre productividad y los costos en las empresas exportadoras de arándanos en el periodo 2016-2020 (Ro= 0.900; p= 0,037); la relación entre tecnológica y participación en el mercado de las empresas exportadoras de arándanos en el periodo 2016-2020 (Ro= 0.900; p= 0,037) y la relación entre las bases microeconómicas y macroeconómicas y el precio en las empresas exportadoras de arándanos en el periodo 2016-2020 (Ro= 1.000; p= 0,000). Se concluye que existe una relación entre la competitividad y la comercialización de las empresas exportadoras de arándanos al mercado de Estados Unidos en el periodo 2016- 2020; con una correlación del 90% y un p-valor de 0,037 resaltando la importancia de mejorar la competitividad de las empresas que exportan arándanos, así como su proceso de comercialización que fomente su producción hacia mercados externos como el estadounidense

Prenatal Biochemical and Ultrasound Markers in COVID-19 Pregnant Patients: A Prospective Case-Control Study

This prospective observational study aimed to evaluate whether women with SARS-CoV-2 infection during the first trimester of pregnancy are at higher risk of noninvasive prenatal screening test alterations and/or of congenital fetal anomalies at the second-trimester fetal anatomy scan. Maternal symptoms were secondly investigated. The study was carried out on 12-week pregnant women admitted for noninvasive prenatal testing (16 April and 22 June 2020). The cohort had seromolecular tests for SARS-CoV-2, after which they were divided into a positive case group and a negative control group. Both groups had 20-week ultrasound screening. Seventeen out of the 164 women tested positive for SARS-CoV-2 (10.3%). There were no significant differences in mean nuchal translucency thickness or biochemical markers (pregnancy-associated plasma protein A, alpha-fetoprotein, human chorionic gonadotropin, unconjugated estriol) between cases and controls (p = 0.77, 0.63, 0.30, 0.40, 0.28) or in the fetal incidence of structural anomalies at the second-trimester fetal anatomy scan (p = 0.21). No pneumonia or hospital admission due to COVID-19-related symptoms were observed. Asymptomatic or mildly symptomatic SARS-CoV-2 infection during the first trimester of pregnancy did not predispose affected women to more fetal anomalies than unaffected women. COVID-19 had a favorable maternal course at the beginning of pregnancy in our healthy cohort

Clinical utility of Next Generation Sequencing of plasma cell-free DNA for the molecular profiling of patients with NSCLC at diagnosis and disease progression

Background: The present study evaluates the utility of NGS analysis of circulating free DNA (cfDNA), which incorporates small amounts of tumor DNA (ctDNA), at diagnosis or at disease progression (PD) in NSCLC patients. Methods: Comprehensive genomic profiling on cfDNA by NGS were performed in NSCLC patients at diagnosis (if tissue was unavailable/insufficient) or at PD to investigate potential druggable molecular aberrations. Blood samples were collected as routinary diagnostic procedures, DNA was extracted, and the NextSeq 550 Illumina platform was used to run the Roche Avenio ctDNA Expanded Kit for molecular analyses. Gene variants were classified accordingly to the ESCAT score. Results: A total of 106 patients were included in this study; 44 % of cases were requested because of tissue unavailability at the diagnosis and 56 % were requested at the PD. At least one driver alteration was observed in 62 % of cases at diagnosis. Driver druggable variants classified as ESCAT level I were detected in 34 % of patients, including ALK-EML4, ROS1-CD74, EGFR, BRAF, KRAS p.G12C, PI3KCA. In the PD group, most patients were EGFR-positive, progressing to a first line-therapy. Sixty-three percent of patients had at least one driver alteration detected in blood and 17 % of patients had a known biological mechanism of resistance allowing further therapeutic decisions. Conclusions: The present study confirms the potential of liquid biopsy to detect tumour molecular heterogeneity in NSCLC patients at the diagnosis and at PD, demonstrating that a significant number of druggable mutations and mechanisms of resistance can be detected by NGS analysis on ctDNA

Impact of structural features of very thin stents implanted in unprotected left main or coronary bifurcations on clinical outcomes

Objectives: To evaluate the independent clinical impact of stent structural features in a large cohort of patients undergoing unprotected left main (ULM) or coronary bifurcation percutaneous coronary intervention (PCI) with a range of very thin strut stents. Background: Clinical impact of structural features of contemporary stents remains to be defined. Methods: All consecutive patients enrolled in the veRy thin stents for patients with left mAIn or bifurcatioN in real life (RAIN) registry were included. The following stent structural features were studied: antiproliferative drugs (everolimus vs. sirolimus vs. zotarolimus), strut material (platinum-chromium vs. cobalt-chromium), polymer (bioresorbable vs. durable), number of crowns (<8 vs. ≥8) and number of connectors (<3 vs. ≥3). For small diameter stents (≤2.5 mm), struct thickness (74 vs. 80/81 μm) was also tested. Target lesion failure (TLF), a composite of target lesion revascularization and stent thrombosis, was the primary endpoint. Multivariate analysis was performed with Cox regression models. Results: Out of 2,707 patients, 110 (4.1%) experienced a TLF event after 16 months (12–18). After adjustment for confounders, an increased number of connectors (adjusted hazard ratio [adj-HR] 0.62, 95% confidence interval (CI) 0.39–0.99, p =.04) reduced risk of TLF, driven by stents with ≥2.5 mm diameter (HR 0.54, 95% CI 0.32–0.93, p =.02). This independent relationship was lost for stents with diameter <2.5 mm, where only strut thickness appeared to impact. Conversely, no independent relationship of polymer type, number of crowns, and the specific limus-family eluted drug with outcomes was observed. Conclusions: Among a range of contemporary very thin stent models, an increased number of connectors improved device-related outcomes in this investigated high-risk procedural setting

Daily risk of adverse outcomes in patients undergoing complex lesions revascularization: a subgroup analysis from the RAIN-CARDIOGROUP VII study (veRy thin stents for patients with left mAIn or bifurcatioN in real life)

Introduction: Percutaneous coronary intervention (PCI) for complex lesions, including unprotected left main (ULM) and bifurcations, is gaining a relevant role in treating coronary artery disease with good outcomes, also thanks to new generation stents. The daily risk of adverse cardiovascular events and their temporal distribution after these procedures is not known.Methods: All consecutive patients presenting with a critical lesion of ULM or bifurcation treated with very thin struts stents, enrolled in the RAIN-Cardiogroup VII study, were analyzed. The daily risk of major acute cardiovascular events (MACE), target lesion revascularization (TLR) and stent thrombosis (ST) and their temporal distribution in the first year of follow-up was the primary endpoint. Differences among subgroups (ULM, patient presentation, kind of stent polymer) were the secondary endpoint.Results: 2745 patients were included, mean age 68 ± 11 years, 33.3% diabetics, 54.5% had an acute coronary syndrome (ACS); 88.5% of treated lesions were bifurcations, 27.2% ULM. Average daily risk was 0.022% for MACE, 0.005% for TLR and 0.004% for ST, in the first year. Bimodal distribution of adverse events, especially TLR, with an early peak in the first 50 days and a late one after 150 days, was observed. Patients with ULM presented a significantly higher daily risk of events, and ACS patients presented higher MACE risk. No difference emerged according to the type of stent polymer.Conclusions: The daily risk of adverse events in the first year after complex PCI in our study is acceptably low. PCI on ULM carries a higher risk of complications