This article describes recent co-simulation advances for the simultaneous modeling of detailed building electrical distribution systems and whole-building energy performance. The co-simulation architecture combines the EnergyPlus® engine for whole-building energy modeling with a new Modelica library for building an electrical distribution system model that is based on harmonic power flow. This new library allows for a higher-fidelity modeling of electrical power flows and losses within buildings than is available with current building electrical modeling software. We demonstrate the feasibility of the architecture by modeling a simple, two-zone thermal chamber with internal power electronics converters and resistive loads, and we validate the model using experimental data. The proposed co-simulation capability significantly expands the capabilities of building electrical distribution system models in the context of whole-building energy modeling, thus enabling more complex analyses than would have been possible with individual building performance simulation tools that are used to date.

Acute myeloid leukemia (AML) is the most common diagnosed leukemia. In older adults, AML confers an adverse outcome^1,2. AML originates from a dominant mutation, then acquires collaborative transformative mutations leading to myeloid transformation and clinical/biological heterogeneity. Currently, AML treatment is initiated rapidly, precluding the ability to consider the mutational profile of a patient's leukemia for treatment decisions. Untreated patients with AML ≥ 60 years were prospectively enrolled on the ongoing Beat AML trial (ClinicalTrials.gov NCT03013998 ), which aims to provide cytogenetic and mutational data within 7 days (d) from sample receipt and before treatment selection, followed by treatment assignment to a sub-study based on the dominant clone. A total of 487 patients with suspected AML were enrolled; 395 were eligible. Median age was 72 years (range 60-92 years; 38% ≥75 years); 374 patients (94.7%) had genetic and cytogenetic analysis completed within 7 d and were centrally assigned to a Beat AML sub-study; 224 (56.7%) were enrolled on a Beat AML sub-study. The remaining 171 patients elected standard of care (SOC) (103), investigational therapy (28) or palliative care (40); 9 died before treatment assignment. Demographic, laboratory and molecular characteristics were not significantly different between patients on the Beat AML sub-studies and those receiving SOC (induction with cytarabine + daunorubicin (7 + 3 or equivalent) or hypomethylation agent). Thirty-day mortality was less frequent and overall survival was significantly longer for patients enrolled on the Beat AML sub-studies versus those who elected SOC. A precision medicine therapy strategy in AML is feasible within 7 d, allowing patients and physicians to rapidly incorporate genomic data into treatment decisions without increasing early death or adversely impacting overall survival.