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The Total Equivalent Warming Impact (TEWI) index is conventionally used to evaluate emissions from heating, ventilation, air conditioning and refrigeration (HVAC&R) systems. However, a more comprehensive indicator, the Expanded Total Equivalent Warming Impact (ETEWI), has been proposed to overcome the limits of TEWI index and to consider additional environmental impacts such as the effects of urban heat island and the natural gas losses along high-pressure pipelines supplying gaseous fuel to natural gas-fired power plants. In this study, TEWI and ETEWI metrics are applied to an air-to-water electric heat pump (EHP) serving a university building in Benevento (Southern Italy). Real data on EHP electricity consumption have been derived from the entire building's electric load and compared to measured data. ETEWI index has been estimated in two scenarios, one considering the impact of refrigerant charge variation on the performance of the EHP and its environmental impact and the other disregarding it. Additionally, carbon dioxide emission factors for electricity production have been forecasted from 2021 to 2033 to determine the indirect term of ETEWI index. Over the lifetime of the EHP, ETEWI increases by 4.8% compared to TEWI when the variation of refrigerant charge level is not considered. However, this percentage growth is equal to 6.5% when the impact of refrigerant charge change is accounted too. In the latter scenario, the indirect term of ETEWI decreases from 22.7 tCO 2 in 2015 to 12.0 tCO 2 in 2033 when the forecast of the carbon dioxide emission factors for electricity production is taken into account. [ABSTRACT FROM AUTHOR]

In Europe, the recast of Directive 2018/2001 defined Renewable Energy Communities as innovative configurations for renewable energy sharing between different end user types. In this regard, this work aims to assess the benefits following the constitution of a Renewable Energy Community in the industrial area of Benevento (South of Italy), involving a mixed-use building and an industrial wastewater treatment plant. The alternative single end users' configuration has been also examined, and both solutions have been compared with the current state where the users' electric energy requests are fully met by the power grid. The users have been equipped with a 466 kWp photovoltaic plant, modelled in HOMER Pro®, providing in input experimental meteorological data (global solar radiation and air temperature) collected by one of the weather control units in Benevento. Real data about users' electric energy demand have been gathered from their electricity bills, and when unavailable their electric load profiles on an hourly basis have been reconstructed based on the aggregated monthly data. Energy sharing has been proven to increase energy self-consumption and the users' self-sufficiency. Annually, the primary energy demand is reduced by 577 MWh (1.2 MWh/kWp), carbon dioxide emissions by 84 tCO2 and operative costs by 101 kEUR. [ABSTRACT FROM AUTHOR]

Purpose: To compare and analyze the incidence of otitis media with effusion (OME), before and during the COVID-19-related pandemic period, to evaluate the effects of the social changes (lockdown, continuous use of facial masks, social distancing, reduction of social activities) in the OME incidence in children and adults. Methods: The number of diagnosed OME in e five referral centers, between 1 March 2018 and 1 March 2021, has been reviewed and collected. To estimate the reduction of OME incidence in children and adults during the COVID-19 pandemic period the OME incidence in three period of time were evaluated and compared: group 1—patients with OME diagnosis achieved between 1/03/2018 and 01/03/2019 (not pandemic period). Group 2—patients with OME diagnosis achieved between 1/03/2019 and 1/03/2020 (not pandemic period). Group 3—patients with OME diagnosis achieved between 1/03/2020 and 1/03/2021 (COVID-19 pandemic period). Results: In the non-pandemic periods (group 1 and 2), the incidence of OME in the five referral centers considered was similar, with 482 and 555 diagnosed cases, respectively. In contrast, the OME incidence in the same centers, during the pandemic period (group 3) was clearly reduced with a lower total number of 177 cases of OME estimated. Percentage variation in OME incidence between the first non-pandemic year considered (group 1) and the pandemic period (group 3) was—63, 3%, with an absolute value decrease value of—305 cases. Similarly, comparing the second non-pandemic year (group 2) and the pandemic year (group 3) the percentage variation of OME incidence was—68, 1% with an absolute value of—305 cases decreased. Conclusions: Our findings showed a lower incidence of OME during the pandemic period compared with 2 previous non pandemic years. The drastic restrictive anti-contagion measures taken by the Italian government to contain the spread of COVID-19 could have had a positive impact on the lower OME incidence during the last pandemic year. [ABSTRACT FROM AUTHOR]

Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by a reduction (hypopnea) in or a complete cessation (apnea) of airflow in the upper airways at night, in the presence of breathing effort. The gold standard treatment for OSA is ventilation through continuous positive airway pressure (CPAP), although this often shows poor patient compliance. In recent years, transoral robotic surgery (TORS) has been proposed as a valid surgical treatment for patients suffering from OSA in a multilevel surgical setting. The aim of this study is to analyze the effects on QoL and daytime sleepiness of multilevel surgery for OSA (barbed pharyngoplasty + transoral robotic surgery). Furthermore, we compared the impact on QoL and daytime sleepiness of two different treatments for patients with moderate to severe OSA, such as CPAP and TORS. Sixty-seven OSA patients who underwent multilevel robotic surgery and sixty-seven OSA patients treated with CPAP were enrolled, defined as Group 1 and Group 2, respectively. The Glasgow Benefit Inventory (GBI) questionnaire was administrated to evaluate the changes in the QoL. Respiratory outcomes were evaluated and compared. Group 1 showed a GBI total average value of +30.4, whereas Group 2, a value of +33.2 (p = 0.4). General benefit score showed no difference between groups (p = 0.1). Better values of social status benefit (p = 0.0006) emerged in the CPAP Group, whereas greater physical status benefit (p = 0.04) was shown in the TORS Group. Delta-AHI (−23.7 ± 14.3 vs. −31.7 ± 15.6; p = 0.001) and Delta-ODI (−24.5 ± 9.5 vs. −29.4 ± 10.5; p = 0.001) showed better values in the CPAP group. Therapeutic success rate of the Multilevel TORS Group was 73.1% and 91% in the CPAP group (p = 0.01), respectively. Multilevel TORS and CPAP have a positive effect on the quality of life of OSA patients. Greater social support has been reported in the CPAP group and better physical health status in the TORS group. No statistical difference emerged in the reduction in daytime sleepiness between both groups. [ABSTRACT FROM AUTHOR]

Objective Postoperative infection is a potentially dramatic consequence in endoscopic endonasal surgery. The aim of this study was to assess the efficacy of our intraoperative antibiotic prophylaxis by analyzing the risk factors of postoperative meningitis in our series. Methods Each endoscopic endonasal procedure performed since 1998 in patients with no preoperative infections and a follow-up longer than 30 days were included and retrospectively reviewed. Antibiotic protocol consisted in single antibiotic administration of ampicillin/sulbactam 3 g or cefazolin 2 g on induction; no postoperative administrations were performed after 2005. All cases of cerebrospinal fluid (CSF) leak, meningitis, and systemic infection were recorded. Results Two thousand thirty-two procedures matched the inclusion criteria (median age 50 years; range: 1–89 years, male/female ratio: 1:1.12). Intraoperative CSF leak occurred in 32.8% of the cases and postoperative CSF leak in 3.4%. The rate of meningitis was 0.69%; other systemic infections were observed in 0.44% of cases. Meningitis was statistically associated with intra- and postoperative CSF leak ( P < 0.001). Other risk factors were the intradural extension of the tumors and their malignant histology. Extended approaches producing wide osteodural defects were correlated with a greater risk of meningitis ( P < 0.001). Conclusions All surgical maneuvers to prevent, detect, and quickly repair intra- and postoperative CSF leak are crucial to avoid postoperative meningitis. The proposed prophylaxis protocol is comparable in safety to those recommended in literature as assessed by the low rate of meningitis. [ABSTRACT FROM AUTHOR]