Examining real time pricing in electricity usage

Demand Side Management (DSM) has been proposed to reduce energy load and provide savings to customers in deregulated markets. Currently, United States residential electric prices are not based on real-time. This paper explores potential customer preferences to Real Time Pricing (RTP), or different prices for electricity based on time of day and weather. A survey of 147 residential customers examined willingness to shift demand to off-peak hours for 11 typical household appliances. Price differentials were then developed to analyze effects. These preliminary results demonstrate potential for residential customers to shift demand if RTP was enacted in the United States

PAK1 Protein Expression in the Auditory Cortex of Schizophrenia Subjects

Deficits in auditory processing are among the best documented endophenotypes in schizophrenia, possibly due to loss of excitatory synaptic connections. Dendritic spines, the principal post-synaptic target of excitatory projections, are reduced in schizophrenia. p21-activated kinase 1 (PAK1) regulates both the actin cytoskeleton and dendritic spine density, and is a downstream effector of both kalirin and CDC42, both of which have altered expression in schizophrenia. This study sought to determine if there is decreased auditory cortex PAK1 protein expression in schizophrenia through the use of quantitative western blots of 25 schizophrenia subjects and matched controls. There was no significant change in PAK1 level detected in the schizophrenia subjects in our cohort. PAK1 protein levels within subject pairs correlated positively with prior measures of total kalirin protein in the same pairs. PAK1 level also correlated with levels of a marker of dendritic spines, spinophilin. These latter two findings suggest that the lack of change in PAK1 level in schizophrenia is not due to limited sensitivity of our assay to detect meaningful differences in PAK1 protein expression. Future studies are needed to evaluate whether alterations in PAK1 phosphorylation states, or alterations in protein expression of other members of the PAK family, are present in schizophrenia

Interventions for hyperhidrosis in secondary care : a systematic review and value-of-information analysis

Background: Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. Objective: To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. Methods: A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. Results and conclusions: Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. Limitations: The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. Future work: Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses

The HANS KAI Project: a community-based approach to improving health and well-being through peer support

Introduction: HANS KAI is a unique health promotion intervention to improve participants’ health by focussing on interrelated chronic disease prevention behaviours through peer support and strengthening of social support networks. The study objective was to determine the effectiveness of HANS KAI in an urban Canadian setting. Methods: We used a mixed methods intervention research design that involved multiple sites from November 2010 to April 2015. Data was obtained from participant surveys as well as in-person interviews at zero, 6, 12 and 24 months. Participants met in groups at least once a month during the research period, to self-monitor health indicators, prepare and share a healthy snack, participate in a physical activity, set a healthy lifestyle goal (optional) and socialize. Results: There were statistically significant mental health improvements from pre- to post-program, and 66% of the participants described specific behaviour changes as a result of HANS KAI participation. Additional positive health impacts included peer support; acquiring specific health knowledge; inspiration, motivation or accountability; the empowering effect of monitoring one’s own health indicators; overcoming social isolation and knowing how to better access services. Conclusion: The need to identify innovative ways to address chronic disease prevention and management has been the driver for implementing and evaluating HANS KAI. While further research will be required to validate the present findings, it appears that HANS KAI may be an effective approach to create environments that empower community members to support each other while promoting healthy lifestyle choices and detecting early changes in health status

Le projet HANS KAÏ : une approche communautaire visant à améliorer la santé et le bien-être grâce au soutien par les pairs

Introduction : Le modèle HANS KAÏ est une intervention de promotion de la santé originale qui vise à améliorer la santé des participants en ciblant les comportements interdépendants de prévention des maladies chroniques grâce au soutien par les pairs et au renforcement des réseaux de soutien social. L'objectif de notre étude était de mesurer l’efficacité du modèle HANS KAÏ en contexte urbain canadien. Méthodologie : Nous avons utilisé un modèle de recherche interventionnelle à méthodes mixtes appliqué à plusieurs sites entre novembre 2010 et avril 2015. Les données ont été recueillies au moyen de sondages auprès des participants et d’entrevues en personne au début de l'étude puis à 6, 12 et 24 mois. Les participants se sont réunis en groupes au moins une fois par mois durant la période de recherche afin de surveiller eux-mêmes leurs indicateurs de santé, de préparer et de partager une collation saine, de participer à une activité physique, d’établir un objectif en matière de mode de vie sain (facultatif) et d'avoir une activité de convivialité. Résultats : Des améliorations statistiquement significatives de la santé mentale ont été constatées avant et après le programme, et 66 % des participants ont fait état de changements de comportement précis résultant de la participation au projet HANS. D’autres effets positifs sur la santé ont été constatés : un soutien par les pairs, l’acquisition de connaissances précises en matière de santé, l’inspiration, la motivation et la prise de responsabilité, l’autonomisation découlant du suivi de ses propres indicateurs de santé, la possibilité de rompre l’isolement social et enfin une meilleure connaissance de la façon d'avoir accès aux services. Conclusion : C'est la nécessité de trouver des moyens innovants pour favoriser la prévention et la gestion des maladies chroniques qui a motivé la mise en oeuvre et l’évaluation du modèle HANS KAÏ. Bien que d’autres recherches soient nécessaires pour valider nos résultats, il semble que le modèle HANS KAÏ puisse être efficace pour créer un contexte permettant à la population locale de s’entraider en favorisant des choix de vie sains et en détectant de façon précoce les changements d’état de santé