**3. The "Agri-natural-voltaic" technology (ANaV)**

Considering the analysis of the different projects for the photovoltaic system [2], presented above, the ANaV project is compared to other projects with the same technology but with different uses of the soil (called Scenarios).

The comparison is carried out through a comparative table (**Table 2**) to better understand the characteristics of the different photovoltaic projects, which shows the best environmental sustainability of the innovation of the ANaV project.

Preliminary environmental assessments have consequently led to optimize the ANaV photovoltaic technology, which is the most performing, in relation with the reference geographic context (flatlands in the municipality of Cerignola, Foggia Province in Puglia Region – Italy).

The geographic location and the characteristics of the ANaV project are represented in the following images (**Figures 2** and **3**).

The ANaV Project allows a suitable realization of the initiative in the environmental context, safeguarding agricultural production and, simultaneously, positively influencing the botanic, vegetational, and wildlife contexts of the area.

The visual characteristics of the ANaV project are represented in the following representations (**Figure 4**) [3].

1 Complete title: *Progetto per la realizzazione dell'impianto (ANaV) per la produzione di energia elettrica da fonte solare della potenza complessiva di 99,42 MW, sito nel comune di Cerignola, località "San Giovanni in Fonte" e relative opere di connessione nei comuni di Stornarella, Orta e Stornara (FG) Italia*.

*From Photovoltaic to Agri-Natural-Voltaic (ANaV) DOI: http://dx.doi.org/10.5772/intechopen.107063*

**Table 1**

Dual-axis tracker on an

elevated structure

*Comparison between different types of photovoltaic projects.*

#### **Figure 1.**

*Conceptual table: environmental feasibility and its relation with the environmental assessment.*

The ANaV project is made up of modules on "single-axis trackers" for a total capacity of 99.42MWp, suitably elevated from the ground and positioned in such a way as to be best suited to agricultural activity on the same ground surface. (**Figure 5**).

The photovoltaic modules (double-sided with nominal unit power of 605 Wp) are 1.3 2.2 m in size, and 4 cm thick. They are in pairs, mounted horizontally with respect to the main axis of the tracker. Twenty-eight modules will be mounted on each single-axis tracker.

The special structure of photovoltaic panels planned for the ANaV system allows high flexibility in agricultural interventions both for machine accessibility and for the selection of crops and cultivation methods (**Figure 6**).

The panel height from the ground ensures the proper airing in the underlying area, favoring the normal growth of herbaceous vegetation and, contemporarily, preserving the normal indigenous microbial activity of the soil; also, rainwater can flow below without interfering with the normal underground drainage and storage.

In addition, the position of panels in parallel, equidistant rows, enables a rational organization of cultivations and rotations and/or cultivation changes.

The cultivations envisaged by the ANaV project [4] produce a high remuneration per hectare in front of high demands for labor. Their nature of root crops requires

#### **Table 2**

*Comparative table to understand the characteristics of different photovoltaic projects, in green the ANaV project.*

cultivation in rows, that are well suited to the belt structure of the ANaV system. Similarly, the reduced height gain makes it possible to position some rows also in the area occasionally shaded by the tilting photovoltaic panels. Moreover, they do not require bulky machines that could damage the panels.

The agricultural cultivations envisaged by the ANaV project are economically effective in the agro-food district of Cerignola, with a supply chain of propagating material (plants), cold storage, processing rooms, and transport systems.

Crops have been positioned by dividing the full land into four macro-areas, based on the internal roads that actually allow the maneuvering of agricultural vehicles (internal roads are 10 m wide, so maneuvering is easy) [5].

Each macro-area is characterized by cultivation continuity (Artichoke, Asparagus, Cereals/Legumes), with the introduction of a belt of melliferous plants every 8 rows.

The belts cultivated with melliferous plants can also be crossed by vehicles since the species selected to give the ground strong stability and have good crushing resistance. For example, during the hand harvesting of the artichoke or the asparagus on these belts, trainers can be used for carrying the produce (**Figure 7**).

**Figure 2.** *Geographic position of Cerignola site of the ANaV project.*

Considering the planned rotations, at the end of a profitable life of multiannual crops (artichoke and asparagus)—expected to be 5 years—the surface for artichoke cultivations will increase up to 60 hectares total (**Figure 8**).

The surface increase for artichokes rather than cereals/legumes also leads to a high increase in the profitability of the ANaV system thanks to the high remuneration of this horticultural production.

It is emphasized that the high innovation engendered by the ANaV system is due to the maximization of the cultivable surfaces in the installation area.

In fact, the fenced area of the ANaV system, corresponding to 141.28 hectares, is divided as follows:

**Figure 3.** *Detail of the site of the ANaV project.*

**Figure 4.** *Reconstructions of the ANaV environment.*

Therefore, excluding the unproductive parts represented by roads, water storage tanks and different annexes, only 7.6% of the surface cannot be used directly for agricultural cultivations. However, it must be recalled that the hives are located on this area.

**Figure 5.** *Plan view of the ANaV project.*

## **4.  The project has a usable agricultural area of 124.28 ha (89.32%) including the sub-panel belts and the green natural belts. Only 7.6% of the surface cannot be used directly for agricultural cultivations.

The ANaV project is an example of environmental "innovation" that shows it is possible to reconcile agricultural production, the increase of naturality, and photovoltaic power production in a sensitive geographic context. The Project allows a suitable realization of the initiative in the environmental context, safeguarding agricultural production and, simultaneously, positively influencing the botanic, vegetational, and wildlife contexts of the area.

**Figure 6.** *Design dimensions for the ANaV system.*

**Figure 7.** *Plan view of the crop layout in year 0.*

#### **Figure 8.** *Plan view of the crop layout in year 5.*


**Author details**

*Pseudomonas aeruginosa - An Armory Within*

the alginate biosynthesis [110, 112].

tory network is still a puzzle to be resolved.

promise for CF treatment.

**4. Conclusions**

**Figure 6.**

production *in vivo.*

**5. Perspectives**

of glutamine to 2-ketoglutarate, which is dependent on O2 availability [108, 110]. Another positive regulator of AlgD is AlgU [111], but the only negative regulator known is the RpoN, a sigma factor, that regulates nitrogen metabolism. RpoN is increased by disruption of pyrimidine synthesis and decreased by the supplementation with uracil, showing that a high level of RpoN, in the RSCV form, may block

*Regulators of AlgD in alginate production. Negative and positive regulators found up-today.*

Studies on the biosynthetic pathway of biofilms show that chelation of iron by lactoferrin destabilizes the bacterial membrane [113], which combined with xylitol hinders the ability of the bacteria to respond to iron deficiency [101], showing some

*P. aeruginosa* is a relevant pathogen given its widespread prevalence across different organs. The latent menace it poses for inpatients is a liability for institutions. For this, and the negative prognosis that *P. aeruginosa* infections in CF patients has, it is one of the subjects more researched for the last 40 years. The efforts have resulted in understanding the process of invasion, immune response, and bacterial tactics to achieve chronic infection. The complexity of the metabolic changes caused by the contact between the host and the bacteria is so extensive that the selection of variables for in vitro studies is difficult since the production of biofilm by *P. aeruginosa* seems to be regulated by everything, O2, N2, Fe2+, Pi, and NaCl. This multiregula-

Scientists agree that suppression of alginate production is vital to treat CF patients, but in 40 years of research, little has been achieved in suppressing its

The advancement of techniques with high output data like microarrays, proteomes, and mass spectrometry are closing the breach among the different approaches that have been used to tackle *P. aeruginosa* infections. For example, mass-spectrometry has verified through metabolite detection the metabolic pathways studied by molecular biologists and enzymologists. The integration of these studies with the physicians is needed to assess the areas that show more promises to control alginate production and *P. aeruginosa* eradication after it became a chronic

**40**

infection.

Sandra Grumelli Independent Researcher, Centro de Investigaciones en Medicina Respiratoria, Córdoba, Argentina

\*Address all correspondence to<EMAIL_ADDRESS>
© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


**Author details**

Nazish Mazhar Ali\*, Safia Rehman, Syed Abdullah Mazhar, Iram Liaqat and Bushra Mazhar Microbiology Laboratory, Department of Zoology, GCU, Lahore, Pakistan

\*Address all correspondence to<EMAIL_ADDRESS>
© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


**5. Guidelines for reuse of human and animal waste products as organic fertilizers**

The WHO operational monitoring guidelines for the reuse of wastewater, excreta and greywater to fertilize crop strictly advocate certain validation requirements, operation monitoring parameter and technical measures, and verification monitoring are as stated in **Table 7** for safe reuse of waste. WHO guidelines [48] exemplify the die-off efficiency with a temperature of 50°C for at least 1 week before compost or ecohumus is considered safe for reuse. If this temperature is not achieved, a longer composting/storage time has been advo‐ cated by WHO. One to two years of storage is recommended for systems that generate ecohumus for proper removal of bacterial pathogens and appreciable reduction of viral and parasitic protozoa. WHO [48] identified the risk on the exposed groups to the reuse of the excreta and wastewater, and recommended health protective measures. The guidelines also include standards for chemical in fish and vegetables. According to the guideline, ≤1 hel‐ minth's eggs (arithmetic mean number) per litre or per gram total solid applies for excreta to be used on edible products and organic fertilizers to which agriculture workers would be exposed. The guidelines also contain threshold values for bacterial pathogens (based on ≤ 104 – ≤ 105 CFU *E. coli* per 100 mL or g total solid) and for trematode eggs (absent) in aquaculture.

**Table 7.** Validation requirements, operation mornitoring parameter and technical measures, and verification monitoring for reuse in fertilization (adapted from WHO [48]).


**5. VTE in haematological malignancies**

Although the association between malignancy and thrombosis has been well recognized, less is known about the risk of thrombosis in patients with acute leukemia and the impact of VTE on survival. Certainly there is abundant biochemical evidence for thrombin generation and disseminated intravascular coagulation in patients with leukemia (184). The few singlecenter reports of the incidence of venous thrombosis in patients with leukaemia have focused primarily on children with acute lymphoblastic leukaemia. These studies have suggested the cumulative incidence varies between 2% and 10.6% (185-186).

Patients with haematologic malignancies are at high risk of thrombotic or haemorrhagic complications. The incidence of VTE events varies considerably and is influenced by many factors, including the type of disease, chemotherapy used, and whether a central venous device is inserted. As in solid tumors, a number of clinical risk factors have been identified and contribute to the increasing thrombotic rate in haematologic malignancies. Biologic Pathophysiology and Clinical Aspects of 90 Venous Thromboembolism in Neonates, Renal Disease and Cancer Patients

• Gender • Race

• Previous thrombotic episode • Obesity: BMI ≥ 35 kg/m2

• Initial cancer stage

agents

• Surgery

• Radiation

• D-Dimer

Although the association between malignancy and thrombosis has been well recognized, less is known about the risk of thrombosis in patients with acute leukemia and the impact of VTE on survival. Certainly there is abundant biochemical evidence for thrombin generation and disseminated intravascular coagulation in patients with leukemia (184). The few singlecenter reports of the incidence of venous thrombosis in patients with leukaemia have focused primarily on children with acute lymphoblastic leukaemia. These studies have

Patients with haematologic malignancies are at high risk of thrombotic or haemorrhagic complications. The incidence of VTE events varies considerably and is influenced by many factors, including the type of disease, chemotherapy used, and whether a central venous device is inserted. As in solid tumors, a number of clinical risk factors have been identified and contribute to the increasing thrombotic rate in haematologic malignancies. Biologic

Biomarkers • Leukocyte count ≥ 11x109 /L

• Hormonal therapy

• Clotting factor VIII

• Tissue factor (TF) • Soluble P-selectin • C-Reactive protein

• Rate of metastatic spread

• Chronic co-morbid Medical Conditions

• Anti-angiogenic and immunomodulatory

• Biological aggressiveness of cancer

• Use of Hemopoetic growth factors

• Indwelling central venous catheters

• Platelet count ≥ 350 x109 /L

• The prothrombin fragment

**Factor**

Patient Related Factors • Age - > 60 years

Disease Related Factors • Tumors type

Treatment Related Factors • Chemotherapy

Table 1. Summary of the Risk Factors for VTE in Cancer Patients

suggested the cumulative incidence varies between 2% and 10.6% (185-186).

**5. VTE in haematological malignancies**

**CLINICAL RISK FACTORS**

 **BIOMARKERS**

properties of the tumor cells can influence the hypercoagulable state of patients with these malignancies by several mechanisms. Of interest, oncogenes responsible for haematological neoplastic transformation in leukemia also may be involved in haemostatic activation.

#### • **VTE in Central Nervous System Lymphoma**

Patients with brain tumors are at particularly high risk for VTE, and many studies found that the hazard for deep vein thrombosis in patients with malignant glioma may reach 28% (187-188) This high risk is maintained throughout the course of an active disease and during treatment, and not just in the immediate postoperative period (188). Risk factors for VTE in patients with glioma include the presence of paraparesis, a histologic diagnosis of glioblastoma multiforme, age ≥ 60 years, large tumor size, the use of chemotherapy, and length of surgery of > 4 hours. Because of the high incidence of VTE, patients who are treated for brain tumors are usually considered for long term prophylactic anticoagulation as deemed appropriate for a particular patient (189-190).

#### • **VTE in Non-Hodgkin Lymphoma**

The incidence of clinical VTE in patients with malignant lymphoma reportedly ranges between 6.6% and 13.3% (187, 190-194) In one study, 50% of patients had a bulky tumor compressing a vein, 25% of patients had a central catheter at the thrombosed vein, and, in the other patients, thrombosis was attributed to paraneoplasia or to chemotherapy (187)

Conlon SJ et al (194) reported the results of retrospective analysis of patients with a total of 18 653 cases on the NCI Working Formulation: there were 5496 low grade NHL, 12 251 aggressive NHL and 906 high-grade lymphoma cases. The cumulative incidence (CI) of VTE 24 months from diagnosis was 4.0%. The CI of VTE at 24 months were significantly different for the distinct lymphoma groups (p< 0.001, Chi-square and comparisons showed this difference to be significant only between the low grade and other histologies. Of 742 cases that had VTE, 454 died within 2 years (61%). For those without VTE, 7274 of 17911 (41%) died within 2 years. This difference was statistically significant (p < 0.001, Chi-square).

#### • **VTE In Patient with Acute Leukemia**

A population- based cohort study (1993-1999) to determine the incidence and risk factors associated with development of VTE among Californians diagnosed with acute leukemia (1993-1999) was reported in Blood 2009, by Ku GH et al (195). Among 5394 cases of AML, the 2-year cumulative incidence of VTE was 281 (5.2%) and 64% of VTE events occurred within 3 months of AML diagnosis. The authors reported that, in AML patients, female sex, older age, number of co-morbid conditions, presence of CVC were significant predictors for development of VTE within one year following diagnosis of acute leukemia but the event of VTE was not associated with poor survival in AML patients in the studied group. Among 2482 case of ALL, the 2-year incidence of VTE was 4.5% and risk factors in this group were presence of CVC, older age and number of chronic co-morbidities. In this study, development of VTE in ALL patients was associated with a 40% increase of dying within one year.

In the abstract #6595 published in JCO 2011 by Luong NV et al from MD Anderson Cancer Center, USA (196) of a retrospective chart review to determine the prevalence of VTE prior

Venous Thromboembolism in Cancer Patients 93

after a diagnosis of MGUS and MM was 3.3 and 9.2 respectively with excess risk of DVT in the first year of diagnosis. Compared to the background population, patients with multiple myeloma have a 9-fold increased risk of developing DVT especially during the first year of diagnosis while the risk for DVT in MGUS was stable at 3-fold increased risk over time with

Yang X et al (204), in 2009, reported a total of 7764 MDS patient who were prescribed Lenalidomide during the first two years of its commercial use in the USA. VTE was reported in 41 patients (rate of 0.53%) denoting a computed signal that did not exceed the statistical threshold for identification of a significant disproportional signal for VTE in MDS on Lenalidomide without erythropoietin. However, the authors found that a disproportional signal of VTE where erythropoietin was concurrently administered with

Life expectancy of patients with myeloproliferative neoplasms (MPNs) and particularly that of subjects with polycythemia vera (PV) and essential thrombocythemia (ET) has significantly increased over the last three decades, largely due to the use of cytoreductive treatments. Currently, PRV and ET are considered relatively benign diseases in which the main objective of treatment strategy is the prevention of thrombotic events. Widespread use of routine haematologic screening and novel diagnostic tools greatly facilitate disease recognition and treatment. This helps to prevent a significant number of early vascular events that still constitute the first disease manifestation in approximately one-third of patients (205). We can also expect that new therapeutic options and appropriate use of aspirin will result in a further reduction of morbidity and mortality. One of the unmet needs of PRV and ET is validated methods for vascular risk stratification. The evaluation of the thrombotic risk in the individual patients, as reported by Barbui et al. in their paper (206). The pathogenesis of thrombosis in myeloproliferative neoplasms has been extensively investigated by focusing in particular on the possible contribution of disease related haemostatic abnormalities. However, the pathogenesis of thrombosis appears to be multifactorial. Red blood cell, platelet, and leukocyte abnormalities, both qualitative and quantitative, are likely to play a key-role in myeloproliferative neoplasm thrombophilia. High shear stress of the vessel wall, due to blood hyperviscosity, accounts for chronic

Platelets and endothelial cells play a pivotal role in regulating blood flow, both cells might contribute to determine a prothrombotic microenvironment in myeloproliferative neoplasm patients by producing more soluble selectins and less nitric oxide, likely as a consequence of

According to the data of Barbui et al. (208) it is intriguing to consider the possibility that pentraxin 3 response to inflammation in subjects with high JAK2 burden might contribute to lower or enhance the thrombotic risk. More generally the association between JAK2 mutation, inflammation and thrombotic risk deserves scientific attention also for other

no statistical association between DVT in MGUS and risk for progression into MM.

• **VTE in Myelodysplastic Syndrome**

• **VTE in Myeloproliferative Neoplasms**

endothelial dysfunction and platelet and leukocyte activation.

Lenalidomide.

inflammation (207).

speculative and practical purposes.

to treatment and recurrence of VTE. Records of 299 ALL patients and 996 AML patients were included (Nov 1991-May 2005). The authors concluded that acute leukemia patients have a high prevalence of VTE but the occurrence of VTE prior to initiation of chemotherapy was not associated with poor prognosis similar finding to that reported by Ku GH et al.

Blast cells with their procoagulant properties, central venous catheters, chemotherapeutic agents (as discussed earlier in this chapter) concomitant infections, patient-and supportive treatment related factors are major determinants of haemostatic mechanism activation in acute leukemia. The clinical manifestations range from VTE to diffuse life-threatening hemorrhage. Anti-coagulant therapy in this clinical setting is fraud with major difficulties as the patients are at very high risk of haemorrhage because of thrombocytopenia. To date, no guidelines are available for prophylaxis or treatment of VTE in this group of patients (197)