This paper aims to develop a sustainable energy chain that by means of a solar-driven electrolysis system produces renewable hydrogen used as fuel in fuel-cell-powered bicycles. The novel hydrogen ...bicycle model is the core of the bike-sharing program that is proposed in a Southern Italy tourist place. The sustainable energy chain development has required: i) the definition of the bike-sharing program based on some assumptions such as number of bicycles, number of routes, maximum number of trips per bike per day, mean driver weight, average cycling speed, etc.; ii) the analysis of the hydrogen bike performance; iii) the design of each involved energy sub-section such as the photovoltaic power plant, the hydrogen production system, the hydrogen storage unit and the hydrogen transportation and distribution section. The study has been conducted by implementing a design-sizing methodology. Results have highlighted that, according to the bike sharing program assumptions, the proposed sustainable energy chain consists of a 103 kWp PV power plant that, generating 129 MWh of electric energy, allows to produce 2190 kg of hydrogen by using an alkaline electrolyzer (16 kW). The bike sharing program, with 3772 km travelled in the selected area, contributes to reduce the greenhouse gas emission.
•An energy chain for implementing the sustainable hydrogen mobility is presented.•A solar-driven electrolysis system is used to produce renewable hydrogen.•A novel hydrogen bicycle is the core of the proposed bike sharing system.•A sizing methodology that aims to maximize the solar energy utilization is proposed.
The optimal duration of treatment with vitamin K antagonists (VKA) after venous thromboembolism (VTE) in patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) is uncertain. To ...tackle this issue, we retrospectively studied 206 patients with MPN-related VTE (deep venous thrombosis of the legs and/or pulmonary embolism). After this index event, we recorded over 695 pt-years 45 recurrences, venous in 36 cases, with an incidence rate (IR) of 6.5 per 100 pt-years (95% confidence interval (CI): 4.9-8.6). One hundred fifty-five patients received VKA; the IR of recurrent thrombosis per 100 pt-years was 4.7 (95% CI: 2.8-7.3) on VKA and 8.9 (95% CI: 5.7-13.2) off VKA (P=0.03). In patients receiving VKA, the IR of recurrent thrombosis per 100 pt-years was 5.3 (95% CI: 3.2-8.4) among 108 patients on long-term VKA and 12.8 (95% CI: 7.3-20.7) after discontinuation among the 47 who ceased treatment (P=0.008), with a doubled risk of recurrence after stopping VKA (hazard ratio: 2.21, 95% CI: 1.19-5.30). The IR of major bleeding per 100 pt-years was 2.4 (95%: CI: 1.1-4.5) on VKA and 0.7 (95% CI: 0.08-2.5) off VKA (P=0.08). In conclusion, in MPN patients with VTE recurrent thrombosis is significantly reduced by VKA and caution should be adopted in discontinuation; however, the incidence of recurrence on treatment remains high, calling for clinical trials aimed to improve prophylaxis in this setting.
We retrospectively studied 181 patients with polycythaemia vera (n=67), essential thrombocythaemia (n=67) or primary myelofibrosis (n=47), who presented a first episode of splanchnic vein thrombosis ...(SVT). Budd-Chiari syndrome (BCS) and portal vein thrombosis were diagnosed in 31 (17.1%) and 109 (60.3%) patients, respectively; isolated thrombosis of the mesenteric or splenic veins was detected in 18 and 23 cases, respectively. After this index event, the patients were followed for 735 patient years (pt-years) and experienced 31 recurrences corresponding to an incidence rate of 4.2 per 100 pt-years. Factors associated with a significantly higher risk of recurrence were BCS (hazard ratio (HR): 3.03), history of previous thrombosis (HR: 3.62), splenomegaly (HR: 2.66) and leukocytosis (HR: 2.8). Vitamin K-antagonists (VKA) were prescribed in 85% of patients and the recurrence rate was 3.9 per 100 pt-years, whereas in the small fraction (15%) not receiving VKA more recurrences (7.2 per 100 pt-years) were reported. Intracranial and extracranial major bleeding was recorded mainly in patients on VKA and the corresponding rate was 2.0 per 100 pt-years. In conclusion, despite anticoagulation treatment, the recurrence rate after SVT in myeloproliferative neoplasms is high and suggests the exploration of new avenues of secondary prophylaxis with new antithrombotic drugs and JAK-2 inhibitors.
Hematopoietic stem cell transplantation (HSCT) from human leukocyte antigen (HLA) haploidentical family donors is a promising therapeutic option for high-risk hematologic malignancies. Here we ...explored in 121 patients, mostly with advanced stage diseases, a sirolimus-based, calcineurin-inhibitor-free prophylaxis of graft-versus-host disease (GvHD) to allow the infusion of unmanipulated peripheral blood stem cell (PBSC) grafts from partially HLA-matched family donors (TrRaMM study, Eudract 2007-5477-54). Conditioning regimen was based on treosulfan and fludarabine, and GvHD prophylaxis on antithymocyte globulin Fresenius (ATG-F), rituximab and oral administration of sirolimus and mycophenolate. Neutrophil and platelet engraftment occurred in median at 17 and 19 days after HSCT, respectively, and full donor chimerism was documented in patients' bone marrow since the first post-transplant evaluation. T-cell immune reconstitution was rapid, and high frequencies of circulating functional T-regulatory cells (Treg) were documented during sirolimus prophylaxis. Incidence of acute GvHD grade II-IV was 35%, and occurrence and severity correlated negatively with Treg frequency. Chronic GvHD incidence was 47%. At 3 years after HSCT, transpant-related mortality was 31%, relapse incidence 48% and overall survival 25%. In conclusion, GvHD prophylaxis with sirolimus-mycophenolate-ATG-F-rituximab promotes a rapid immune reconstitution skewed toward Tregs, allowing the infusion of unmanipulated haploidentical PBSC grafts.
The two main algorithms that have been considered for fitting constrained marginal models to discrete data, one based on Lagrange multipliers and the other on a regression model, are studied in ...detail. It is shown that the updates produced by the two methods are identical, but that the Lagrangian method is more efficient in the case of identically distributed observations. A generalization is given of the regression algorithm for modelling the effect of exogenous individual-level covariates, a context in which the use of the Lagrangian algorithm would be infeasible for even moderate sample sizes. An extension of the method to likelihood-based estimation under L1-penalties is also considered.
The success of a mission, in general terms of functionality of a complex system, is based on the probability that failure events do not happen during the mission. Therefore, a preliminary reliability ...analysis and consequently the definition of the reliability target are required. The reliability target of the whole system can be an input or output data of the reliability study; consequently, the reliability values of components are respectively output or input data. If we start from the definition of the target of the system (input data), considering similar ones (if available, especially for innovative ones!), we can allocate the reliability of each component (output data). The choice of the most suitable allocation technique is not a simple task, advantages and disadvantages are discussed in literature. Instead, if we start from the characteristics of the units available (input data), studying the structure (links in series and parallel), it is possible to calculate the reliability target of the whole system. However, these values could be not completely available (innovative systems) or refer to units with not comparable levels in terms of technology, complexity, safety and so on. In the manuscript, a new method is proposed to define the reliability target: Integrated Factors Method 2.0 (IFM 2.0). The purpose will be to combine the advantages of both above approaches. IFM 2.0 is an upgrade of IFM that was developed in 2002 by Falcone et al. The new methodology combines the old IFM method with new maintenance factors. Thanks to IFM 2.0, it is possible to estimate the reliability target of a system in a more confident way: “IFM Target 2.0.” The proposed method has been validated and applied to two complex systems. The obtained results show the effectiveness of the new method and its capability to overcome the problems of other previous methods.
Carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) infections are an emerging cause of death after hematopoietic stem cell transplantation (HSCT). In allogeneic transplants, mortality rate may ...rise up to 60%. We retrospectively evaluated 540 patients receiving a transplant from an auto- or an allogeneic source between January 2011 and October 2015. After an Institutional increase in the prevalence of KPC-Kp bloodstream infections (BSI) in June 2012, from July 2012, 366 consecutive patients received the following preventive measures: (i) weekly rectal swabs for surveillance; (ii) contact precautions in carriers (iii) early-targeted therapy in neutropenic febrile carriers. Molecular typing identified KPC-Kp clone ST512 as the main clone responsible for colonization, BSI and outbreaks. After the introduction of these preventive measures, the cumulative incidence of KPC-Kp BSI (P=0.01) and septic shocks (P=0.01) at 1 year after HSCT was significantly reduced. KPC-Kp infection-mortality dropped from 62.5% (pre-intervention) to 16.6% (post-intervention). Day 100 transplant-related mortality and KPC-Kp infection-related mortality after allogeneic HSCT were reduced from 22% to 10% (P=0.001) and from 4% to 1% (P=0.04), respectively. None of the pre-HSCT carriers was excluded from transplant. These results suggest that active surveillance, contact precautions and early-targeted therapies, may efficiently control KPC-Kp spread and related mortality even after allogeneic HSCT.
Hydrogen refueling infrastructures with on-site production from renewable sources are an interesting solution for assuring green hydrogen with zero CO2 emissions. The main problem of these stations ...development is the hydrogen cost that depends on both the plant size (hydrogen production capacity) and on the renewable source.
In this study, a techno-economic assessment of on-site hydrogen refueling stations (HRS), based on grid-connected PV plants integrated with electrolysis units, has been performed. Different plant configurations, in terms of hydrogen production capacity (50 kg/day, 100 kg/day, 200 kg/day) and the electricity mix (different sharing of electricity supply between the grid and the PV plant), have been analyzed in terms of electric energy demands and costs.
The study has been performed by considering the Italian scenario in terms of economic streams (i.e. electricity prices) and solar irradiation conditions.
The levelized cost of hydrogen (LCOH), that is the more important indicator among the economic evaluation indexes, has been calculated for all configurations by estimating the investment costs, the operational and maintenance costs and the replacement costs.
Results highlighted that the investment costs increase proportionally as the electricity mix changes from Full Grid operation (100% Grid) to Low Grid supply (25% Grid) and as the hydrogen production capacity grows, because of the increasing in the sizes of the PV plant and the HRS units. The operational and maintenance costs are the main contributor to the LCOH due to the annual cost of the electricity purchased from the grid.
The calculated LCOH values range from 9.29 €/kg (200 kg/day, 50% Grid) to 12.48 €/kg (50 kg/day, 100% Grid).
•A techno-economic analysis of on-site hydrogen refueling station is proposed.•An electrolysis unit integrated with a grid-connected PV plant is investigated.•Different electric supply management scenarios and H2 plant capacities are studied.•The plant configurations are analyzed in terms of energy demands and costs.•The levelized cost of hydrogen is calculated in all the proposed scenarios.
The clinical outcome of allogeneic hematopoietic stem cell transplantation (HSCT) is strongly influenced from the potential complications arising during the delicate phase of post-transplant immune ...restoration. The quantitative aspects of immune-cell repopulation after HSCT and the qualitative features their functional restitution have been extensively reported. Nevertheless, measurable immune biomarkers predicting the clinical outcome of HSCT await formal validation. The aim of this review is an appraisal of most studies published so far on the predictive value of different T and NK-cell biomarkers after HSCT with emphasis on defined thresholds endorsed by multivariate analysis.
Data for time trends in the prevalence of occupational asthma (OA) and rhinitis (OR) are not known. To investigate the prevalence and incidence of OA and OR over time. We chose to review studies on ...the prevalence and incidence of OA and OR due to laboratory animals (LA) as a marker of changing OA and OR patterns over time and analysed 15 cross-sectional and 4 longitudinal studies published from 1980 to 2006. The estimated prevalence of OA, defined as work-related chest symptoms (WRCS), declined from 8.2% in 1976 to 4.2% in 2001 (P < 0.005). When defined by WRCS and positive skin prick test (SPT) to LA, the estimated prevalence of OA was 6.7% in 1977 and 2.9% in 1999 (P < 0.02). The prevalence of OR, defined by WRNS or WRNS and SPT to LA, was not related to study date but was inversely associated with mean exposure duration. In four longitudinal studies no clear trend emerged over time. This review suggests a trend toward a progressive decline in the prevalence of occupational asthma due to laboratory animals, which may be due to the reduction of exposure since the early 1980s. A further reduction of exposure is needed to prevent the onset of occupational rhinitis.
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