The I3a Framework – Enhancing Off-grid Photovoltaic Energy Service Delivery in Indonesia

This paper describes an interdisciplinary research project to investigate the sustainability of off-grid Photovoltaic Energy Service (PVES) delivery in Indonesia. The paper describes results from the preliminary fieldwork undertaken in late 2002 and early 2003, more substantive fieldwork was carried out in 2005. The general objective of this research project is to understand how PVES can contribute to improving the life of rural Indonesian communities having no access to the electricity grid. It adopts an interdisciplinary approach that combines social and engineering perspectives to address sustainability issues. The I3A (Implementation, Accessibility, Availability, Acceptability) Sustainable PVES Delivery framework was developed to assess sustainability and was used to assess three off-grid PVES case studies in Lampung, West Java and Nusa Tenggara Timur (NTT) provinces. The overall objectives of the I3A framework are to acknowledge the interests of stakeholders, maximize equity, assure PVES continuity and institutionalize PVES by utilizing and enhancing pre-existing community resources to leave host communities with the capacity to meet evolving needs. A key conclusion is that, to be sustainable and equitable, off-grid PVES projects should be implemented in an institutional framework that provides sound project management and addresses PVES accessibility (financial, institutional and technological), availability (technical quality and continuity) and acceptability (social and ecological)

Clinical use of Whole Genome Sequencing for Mycobacterium tuberculosis

Drug resistant tuberculosis (TB) remains a major challenge to global health and to healthcare in the UK. In 2014, England recorded 6520 cases of TB of which 1.4% were multi-drug resistant (MDR-TB). Extensively drug resistant TB (XDR-TB) occurs at a much lower rate, but the impact on the patient and hospital is severe. Current diagnostic methods such as drug susceptibility testing and targeted molecular tests are slow to return or examine only a limited number of target regions respectively. Faster, more comprehensive diagnostics will enable earlier use of the most appropriate drug regimen thus improving patient outcome and reducing overall healthcare costs. Whole genome sequencing has been shown to provide a rapid and comprehensive view of the genotype of the organism and thus enable reliable prediction of the drug susceptibility phenotype within a clinically relevant time frame. In addition it provides the highest resolution when investigating transmission events in possible outbreak scenarios. However, robust software and database tools need to be developed for the full potential to be realized in this specialized area of medicine

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Generation portfolio analysis for a carbon constrained and uncertain future

Paper presented at the International Conference on Future Power Systems, 16-18 November 2005, AmsterdamMany modern electricity systems are faced with the challenge of reducing green house gas emissions and dealing with increasing and more volatile fuel prices. Adequately dealing with these issues requires the evolution of suitable generation portfolios. However, doubts remain if the liberalized marketplace will deliver such portfolios. Analysis is undertaken to try and determine how the generation portfolio on the all-Ireland system may evolve by 2020. Resulting portfolios are examined with respect to the impact of carbon costs on the development of the portfolio and in particular wind energy. An assessment is made of the exposure of the portfolios to fuel price volatility and how portfolios may wish to diversify to avoid this. The analysis endeavours to gain insight into the future generation portfolios with the aim of informing how policy instruments may be tailored to address these issues.Science Foundation IrelandCharles Parsons Energy Research Award

Generation portfolio analysis for a carbon constrained and uncertain future

Paper presented at the International Conference on Future Power Systems, 16-18 November 2005, AmsterdamMany modern electricity systems are faced with the challenge of reducing green house gas emissions and dealing with increasing and more volatile fuel prices. Adequately dealing with these issues requires the evolution of suitable generation portfolios. However, doubts remain if the liberalized marketplace will deliver such portfolios. Analysis is undertaken to try and determine how the generation portfolio on the all-Ireland system may evolve by 2020. Resulting portfolios are examined with respect to the impact of carbon costs on the development of the portfolio and in particular wind energy. An assessment is made of the exposure of the portfolios to fuel price volatility and how portfolios may wish to diversify to avoid this. The analysis endeavours to gain insight into the future generation portfolios with the aim of informing how policy instruments may be tailored to address these issues.Science Foundation IrelandCharles Parsons Energy Research Award