Effects of a demand-led evidence briefing service on the uptake and use of research evidence by commissioners of health services: protocol for a controlled before and after study

Background: Clinical Commissioning Groups (CCGs) are mandated to use research evidence effectively to ensure optimum use of resources by the National Health Service (NHS), both in accelerating innovation and in stopping the use of less effective practices and models of service delivery. We intend to evaluate whether access to a demand-led evidence service improves uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. 

Methods/design: This is a controlled before and after study involving CCGs in the North of England. Participating CCGs will receive one of three interventions to support the use of research evidence in their decision-making:1) consulting plus responsive push of tailored evidence; 2) consulting plus an unsolicited push of non-tailored evidence; or 3) standard service unsolicited push of non-tailored evidence. Our primary outcome will be changed at 12 months from baseline of a CCGs ability to acquire, assess, adapt and apply research evidence to support decision-making. Secondary outcomes will measure individual clinical leads and managers’ intentions to use research evidence in decision making. Documentary evidence of the use of the outputs of the service will be sought. A process evaluation will evaluate the nature and success of the interactions both within the sites and between commissioners and researchers delivering the service. 

Discussion: The proposed research will generate new knowledge of direct relevance and value to the NHS. The findings will help to clarify which elements of the service are of value in promoting the use of research evidence.Those involved in NHS commissioning will be able to use the results to inform how best to build the infrastructure they need to acquire, assess, adapt and apply research evidence to support decision-making and to fulfil their statutory duties under the Health and Social Care Act.

Wind generation and electricity demand during the severe winter of 2009/10 in Ireland

Throughout the world the share of wind power in the generation mix is increasing. In the All Island Grid, of the Republic of Ireland and Northern Ireland there is now over 1.5 GW of installed wind power. As the penetration of these variable, non-dispatchable generators increases, power systems are becoming more sensitive to weather events on the supply side as well as on the demand side. In the temperate climate of Ireland, sensitivity of supply to weather is mainly due to wind variability while demand sensitivity is driven by space heating or cooling loads. The interplay of these two weather-driven effects is of particular concern if demand spikes driven by low temperatures coincide with periods of low winds. In December 2009 and January 2010 Ireland experienced a prolonged spell of unusually cold conditions. During much of this time, wind generation output was low due to low wind speeds. The impacts of this event are presented as a case study of the effects of weather extremes on power systems with high penetrations of variable renewable generation.

Hierarchical Demand Response for Peak Reduction using Dantzig‐Wolfe Decomposition

Demand Response (DR) algorithms manipulate the energy consumption schedules of controllable loads so as to satisfy grid objectives. Implementation of DR algorithms using a centralised agent can be problematic for scalability reasons, and there are issues related to the privacy of data and robustness to communication failures. Thus it is desirable to use a scalable decentralised algorithm for the implementation of DR. In this paper, a hierarchical DR scheme is proposed for Peak Minimisation (PM) based on Dantzig-Wolfe Decomposition (DWD). In addition, a Time Weighted Maximisation option is included in the cost function which improves the Quality of Service for devices seeking to receive their desired energy sooner rather than later. The paper also demonstrates how the DWD algorithm can be implemented more efficiently through the calculation of the upper and lower cost bounds after each DWD iteration.

Demand response to improved walking infrastructure: A study into the economics of walking and health behaviour change

Walking is the most common form of moderate‐intensity physical activity among adults, is widely accessible and especially appealing to obese people. Most often policy makers are interested in valuing the effect on walking of changes in some characteristics of a neighbourhood, the demand response for walking, of infrastructure changes. A positive demand response to improvements in the walking environment could help meet the public health target of 150 minutes of at least moderate‐intensity physical activity per week. We model walking in an individual’s local neighbourhood as a ‘weak complement’ to the characteristics of the neighbourhood itself. Walking is affected by neighbourhood
characteristics, substitutes, and individual’s characteristics, including their opportunity cost of time.  Using compensating variation, we assess the economic benefits of walking and how walking behaviour is affected by improvements to the neighbourhood.  Using a sample of 1,209 respondents surveyed over a 12 month period (Feb 2010‐Jan 2011) in East Belfast, United Kingdom, we find that a policy that increased walkability and people’s perception of access to shops and facilities  would lead to an increase in walking of about 36 minutes/person/week, valued at £13.65/person/week. When focusing on inactive residents, a policy that improved the walkability of the area would lead to guidelines for physical activity being reached by only 12.8% of the population who are currently inactive. Additional interventions would therefore be needed to encourage inactive residents to
achieve the recommended levels of physical activity, as it appears that interventions that improve the walkability of an area are particularly effective in increasing walking among already active citizens, and, among the inactive ones, the best response is found among healthier, younger and wealthier citizens.

Demand-side characterisation of the smart city for energy modelling.

This paper presents a new methodology for characterising the energy performance of buildings suitable for city-scale, top-down energy modelling. Building properties that have the greatest impact on simulated energy performance were identified via a review of sensitivity analysis studies. The methodology greatly simplifies the description of a building to decrease labour and simulation processing overheads. The methodology will be used in the EU FP7 INDICATE project which aims to create a master-planning tool that uses dynamic simulation to facilitate the design of sustainable, energy efficient smart cities.

A Scheme Design of Cloud + End Technology in Demand Side Management

Demand Side Management (DSM) plays an important role in Smart Grid. It has large scale access points, massive users, heterogeneous infrastructure and dispersive participants. Moreover, cloud computing which is a service model is characterized by resource on-demand, high reliability and large scale integration and so on and the game theory is a useful tool to the dynamic economic phenomena. In this study, a scheme design of cloud + end technology is proposed to solve technical and economic problems of the DSM. The architecture of cloud + end is designed to solve technical problems in the DSM. In particular, a construct model of cloud + end is presented to solve economic problems in the DSM based on game theories. The proposed method is tested on a DSM cloud + end public service system construction in a city of southern China. The results demonstrate the feasibility of these integrated solutions which can provide a reference for the popularization and application of the DSM in china.

Hydrogel-forming microneedle arrays made from light-responsive materials for on-demand transdermal drug delivery

We describe, for the first time, stimuli-responsive hydrogel-forming microneedle (MN) arrays that enable delivery of a clinically-relevant model drug (ibuprofen) upon application of light. MN arrays were prepared using a polymer prepared from 2-hydroxyethyl methacrylate (HEMA) and ethylene glycol dimethacrylate (EGDMA) by micromolding. The obtained MN arrays showed good mechanical properties. The system was loaded with up to 5% (w/w) ibuprofen included in a light-responsive 3,5-dimethoxybenzoin conjugate. Raman spectroscopy confirmed the presence of the conjugate inside the polymeric MN matrix. In vitro, this system was able to deliver up to three doses of 50 mg of ibuprofen upon application of an optical trigger over a prolonged period of time (up to 160 hours). This makes the system appealing as a controlled release device for prolonged periods of time. We believe that this technology has potential for use in ?on-demand? delivery of a wide range of drugs in a variety of applications relevant to enhanced patient care.

Immigration and the demand for life insurance: evidence from Canada, 1911

This article analyses the determinants of the demand for life insurance using sample data from the 1911 Census of Canada. We find that immigrants' demand for life insurance was on average around 13 percentage points lower than that of native-born Canadians, with the effect varying by province of settlement. We interpret these findings as evidence suggesting a greater appetite for risk among self-selecting immigrants relative to native-born Canadians. We also uncover evidence of a slow assimilation of immigrants in terms of life insurance holdings, slower indeed than the process of assimilation in terms of earnings.

Hierarchical Demand Response for Peak Minimization Using Dantzig-Wolfe Decomposition

Demand response (DR) algorithms manipulate the energy consumption schedules of controllable loads so as to satisfy grid objectives. Implementation of DR algorithms using a centralized agent can be problematic for scalability reasons, and there are issues related to the privacy of data and robustness to communication failures. Thus, it is desirable to use a scalable decentralized algorithm for the implementation of DR. In this paper, a hierarchical DR scheme is proposed for peak minimization based on Dantzig-Wolfe decomposition (DWD). In addition, a time weighted maximization option is included in the cost function, which improves the quality of service for devices seeking to receive their desired energy sooner rather than later. This paper also demonstrates how the DWD algorithm can be implemented more efficiently through the calculation of the upper and lower cost bounds after each DWD iteration.

Local Storage Meets Local Demand: A Technical Solution to Future Power Distribution System

Future power systems are expected to integrate large-scale stochastic and intermittent generation and load due to reduced use of fossil fuel resources, including renewable energy sources (RES) and electric vehicles (EV). Inclusion of such resources poses challenges for the dynamic stability of synchronous transmission and distribution networks, not least in terms of generation where system inertia may not be wholly governed by large-scale generation but displaced by small-scale and localised generation. Energy storage systems (ESS) can limit the impact of dispersed and distributed generation by offering supporting reserve while accommodating large-scale EV connection; the latter (load) also participating in storage provision. In this paper, a local energy storage system (LESS) is proposed. The structure, requirement and optimal sizing of the LESS are discussed. Three operating modes are detailed, including: 1) storage pack management; 2) normal operation; and 3) contingency operation. The proposed LESS scheme is evaluated using simulation studies based on data obtained from the Northern Ireland regional and residential network.

An Electric Vehicle Dispatch Module for Demand-Side Energy Participation

The penetration of the electric vehicle (EV) has increased rapidly in recent years mainly as a consequence of advances in transport technology and power electronics and in response to global pressure to reduce carbon emissions and limit fossil fuel consumption. It is widely acknowledged that inappropriate provision and dispatch of EV charging can lead to negative impacts on power system infrastructure. This paper considers EV requirements and proposes a module which uses owner participation, through mobile phone apps and on-board diagnostics II (OBD-II), for scheduled vehicle charging. A multi-EV reference and single-EV real-time response (MRS2R) online algorithm is proposed to calculate the maximum and minimum adjustable limits of necessary capacity, which forms part of decision-making support in power system dispatch. The proposed EV dispatch module is evaluated in a case study and the influence of the mobile app, EV dispatch trending and commercial impact is explored.

Stimuli-Responsive Microneedle Arrays For On-Demand Drug Delivery

Pulsatile, or “on-demand”, delivery systems have the capability to deliver a therapeutic molecule at the right time/site of action and in the right amount (1). Pulsatile delivery systems present multiple benefits over conventional dosage forms and provide higher patient compliance. The combination of stimuli-responsive materials with the drug delivery capabilities of hydrogel-forming MN arrays (2) opens an interesting area of research. In the present work we describe, a stimuli-responsive hydrogel-forming microneedle (MN) array that enable delivery of a clinically-relevant model drug (ibuprofen) upon application of UV radiation (Figure 1A). MN arrays were prepared using a micromolding technique using a polymer prepared from 2-hydroxyethyl methacrylate (HEMA) and ethylene glycol dimethacrylate (EGDMA) (Figure 1B). The arrays were loaded with up to 5% (w/w) ibuprofen included in a light-responsible conjugate (3,5-dimethoxybenzoin conjugate) (2). The presence of the conjugate inside the MN arrays was confirmed by Raman spectroscopy measurements. MN arrays were tested in vitro showing that they were able to deliver up to three doses of 50 mg of ibuprofen after application of an optical trigger (wavelength of 365 nm) over a long period of time (up to 160 hours) (Figure 1C and 1D). The work presented here is a probe of concept and a modified version of the system should be used as UV radiation is shown to be the major etiologic agent in the development of skin cancers. Consequently, for future applications of this technology an alternative design should be developed. Based on the previous research dealing with hydrogel forming MN arrays a suitable strategy will be to use hydrogel-forming MN arrays containing a backing layer made with the material described in this work as the drug reservoir (2). Finally, a porous layer of a material that blocks UV radiation should be included between the MN array and the drug reservoir. Therefore radiation can be applied to the system without reaching the skin surface. Therefore after modification, the system described here interesting properties as “on-demand” release system for prolonged periods of time. This technology has potential for use in “on-demand” delivery of a wide range of drugs in a variety of applications relevant to enhanced patient care.