Sustainable delivery models for achieving SDG7 : lessons from an energy services social enterprise in Malawi

Energy services social enterprises are emerging as a sustainable response to the challenges of achieving SDG 7, but detailed case study insight is lacking to inform the sector. Malawi has one of the lowest electricity access rates in the world, with a rural electrification rate of only 4%. This paper highlights lessons from an energy service social enterprise in Malawi, using a case study framework to outline key achievements and challenges faced. The learning is used to form recommendations on increasing the impact, growth and sustainability of energy service social enterprises, both for grassroots practitioners as well as policy and investment decision makers. It has been found that energy service social enterprises need to develop robust strategies for sustainability through fostering cross sectorial linkages, investing in capacity building and awareness raising, collaborating through research partnerships, budgeting and resource planning conservatively, tracking social impact to inform business strategy, seeking innovation in business planning, and utilising smart subsidies. The case study analysis presented is intended to inform other social enterprises offering energy services, and to progress the rural electrification sector to achieve Sustainable Development Goal 7

A market assessment for modern cooking in Malawi

This paper presents the findings from a study which used household surveys and expert interviews to investigate cooking practices and understand the barriers and opportunities to the growth of the modern cooking sector in Malawi. The findings from expert interviews highlight barriers to electric and LPG cooking around the weakness of existing infrastructure, lack of consumer willingness and ability to pay and resistance to the adoption of modern cooking devices. The greatest opportunity for electric cooking is in urban areas and on mini-grids, while LPG is also most viable in urban areas, however knowledge and infrastructure gaps need to be narrowed to facilitate growth. An analysis of household surveys in urban, peri-urban and rural areas, using data from “indicative cooking diaries”, demonstrates the diversity of cooking practices in Malawian households by showing what, how, and with what, dishes are cooked. It is demonstrated that there is a latent demand for modern cooking in Malawi. Targeted research is needed to test modern cooking devices’ ability to cook Malawian dishes in ways which are acceptable to Malawian people, in order to effectively accelerate a transition towards modern cooking in Malawi and address the negative health and environmental impacts of biomass cooking

Impact of new electric cooking appliances on the low voltage distribution network and off-grid solar microgrids

Over three billion people around the world rely on biomass as their primary source of cooking fuel, a practise which is particularly prevalent across countries in Sub-Saharan Africa, Developing Asia, and Latin America. Cooking with biomass has significant negative health impacts, due to the toxic fumes produced which are estimated to cause over four million premature deaths annually. In addition, it negatively impacts the environment, through contributing to deforestation and climate change, which is exacerbated by increasing demand for biomass due to rapid population growth in these regions. Women and girls are disproportionately affected by these impacts as they are often responsible for cooking and the collection of cooking fuels. Increased adoption of electricity as a replacement for biomass as a source of cooking energy is one potential solution to reduce these negative environmental and social impacts. The studies presented in this report identify the main technical challenges associated with accommodating electric cooking on microgrids and low voltage (LV) distribution networks in sub-Saharan Africa. Evidence and experience has shown that the adoption of electric cooking appliances can already be supported by some networks without the need for any upgrades in the system. This is primarily within networks which have been overdesigned relative to existing electrical demand and as a result, sufficient headroom to adopt clean electric cooking appliances exists. Simultaneously, where system designs more closely match baseload (non-cooking) characteristics, limitations may occur when supporting the addition of electric cooking loads. Identifying these limitations has been the subject of investigations in this report. The technical analysis was primarily supported by models developed in OpenDSS. Load flows, voltage profiles and transformer/power inverter requirements were modelled to investigate the performance of representative LV and microgrid network topologies before and after the introduction of loads from different sized electric cooking devices. This research was conducted as a part of the MECS (Modern Energy Cooking Solution) consortium

Global Market Assessment for Electric Cooking

Globally, approximately 2 billion people have access to some form of electricity but do not have access to clean cooking, the majority of which rely on the traditional use of biomass. Cooking with biomass leads to an estimated 3.8 million deaths per year attributed to household air pollution. The widespread practise of cooking with non-renewable wood fuels also contributes to ecosystem degradation and the emission of approximately 1 gigaton of CO2/year (2% of global emissions total). According to the State of Access to Modern Energy Cooking Services report by the World Bank, ESMAP and MECS, not progressing beyond the status quo is costing the world more than US$2 trillion each year; US$ 1.4 trillion from the negative impacts on health, US$0.2 trillion per year from climate impacts and environmental degradation and US$ 0.8 trillion per year from its adverse effects specifically on women. A growing body of evidence is showing that, in many settings, modern energy cooking services such as electric cooking are already cost-effective alternatives. For many countries in the Global South with a strong enabling environment (including having access to affordable, reliable electricity and the presence of a strong, active modern cooking sector) a transition to electric cooking is already taking place, mainly among the consumer class. For other countries where many households have limited or no access to modern energy, a suite of innovative business models and technologies are rapidly expanding opportunities to transition to electric cooking via mini-grid and off-grid systems. To understand where the greatest opportunities and challenges for a scale up of electric cooking in the Global South lie, a Global Market Assessment (GMA) for electric cooking has been conducted by the Modern Energy Cooking Services (MECS) programme which seeks to “to rapidly accelerate the transition from biomass to clean cooking on a global scale”. The GMA has drawn on the experience of a range of stakeholders to identify the key factors which influence the viability of a scale up of electric cooking and represents this as a weighted score constructed from 37 indicators covering 130 countries in the Global South. As electric cooking relies on a electricity which can now be supplied in a variety of different ways, the GMA provides a score for national grid, mini-grid and off-grid (standalone) supported electric cooking

The Role of Computational Fluid Dynamics in the Management of Unruptured Intracranial Aneurysms: A Clinicians' View

Objective. The importance of hemodynamics in the etiopathogenesis of intracranial aneurysms (IAs) is widely accepted. Computational fluid dynamics (CFD) is being used increasingly for hemodynamic predictions. However, alogn with the continuing development and validation of these tools, it is imperative to collect the opinion of the clinicians. Methods. A workshop on CFD was conducted during the European Society of Minimally Invasive Neurological Therapy (ESMINT) Teaching Course, Lisbon, Portugal. 36 delegates, mostly clinicians, performed supervised CFD analysis for an IA, using the @neuFuse software developed within the European project @neurIST. Feedback on the workshop was collected and analyzed. The performance was assessed on a scale of 1 to 4 and, compared with experts' performance. Results. Current dilemmas in the management of unruptured IAs remained the most important motivating factor to attend the workshop and majority of participants showed interest in participating in a multicentric trial. The participants achieved an average score of 2.52 (range 0–4) which was 63% (range 0–100%) of an expert user. Conclusions. Although participants showed a manifest interest in CFD, there was a clear lack of awareness concerning the role of hemodynamics in the etiopathogenesis of IAs and the use of CFD in this context. More efforts therefore are required to enhance understanding of the clinicians in the subject

Theorems on existence and global dynamics for the Einstein equations

This article is a guide to theorems on existence and global dynamics of solutions of the Einstein equations. It draws attention to open questions in the field. The local-in-time Cauchy problem, which is relatively well understood, is surveyed. Global results for solutions with various types of symmetry are discussed. A selection of results from Newtonian theory and special relativity that offer useful comparisons is presented. Treatments of global results in the case of small data and results on constructing spacetimes with prescribed singularity structure or late-time asymptotics are given. A conjectural picture of the asymptotic behaviour of general cosmological solutions of the Einstein equations is built up. Some miscellaneous topics connected with the main theme are collected in a separate section.Comment: Submitted to Living Reviews in Relativity, major update of Living Rev. Rel. 5 (2002)

Prediction of overall survival for patients with metastatic castration-resistant prostate cancer : development of a prognostic model through a crowdsourced challenge with open clinical trial data

Background Improvements to prognostic models in metastatic castration-resistant prostate cancer have the potential to augment clinical trial design and guide treatment strategies. In partnership with Project Data Sphere, a not-for-profit initiative allowing data from cancer clinical trials to be shared broadly with researchers, we designed an open-data, crowdsourced, DREAM (Dialogue for Reverse Engineering Assessments and Methods) challenge to not only identify a better prognostic model for prediction of survival in patients with metastatic castration-resistant prostate cancer but also engage a community of international data scientists to study this disease. Methods Data from the comparator arms of four phase 3 clinical trials in first-line metastatic castration-resistant prostate cancer were obtained from Project Data Sphere, comprising 476 patients treated with docetaxel and prednisone from the ASCENT2 trial, 526 patients treated with docetaxel, prednisone, and placebo in the MAINSAIL trial, 598 patients treated with docetaxel, prednisone or prednisolone, and placebo in the VENICE trial, and 470 patients treated with docetaxel and placebo in the ENTHUSE 33 trial. Datasets consisting of more than 150 clinical variables were curated centrally, including demographics, laboratory values, medical history, lesion sites, and previous treatments. Data from ASCENT2, MAINSAIL, and VENICE were released publicly to be used as training data to predict the outcome of interest-namely, overall survival. Clinical data were also released for ENTHUSE 33, but data for outcome variables (overall survival and event status) were hidden from the challenge participants so that ENTHUSE 33 could be used for independent validation. Methods were evaluated using the integrated time-dependent area under the curve (iAUC). The reference model, based on eight clinical variables and a penalised Cox proportional-hazards model, was used to compare method performance. Further validation was done using data from a fifth trial-ENTHUSE M1-in which 266 patients with metastatic castration-resistant prostate cancer were treated with placebo alone. Findings 50 independent methods were developed to predict overall survival and were evaluated through the DREAM challenge. The top performer was based on an ensemble of penalised Cox regression models (ePCR), which uniquely identified predictive interaction effects with immune biomarkers and markers of hepatic and renal function. Overall, ePCR outperformed all other methods (iAUC 0.791; Bayes factor >5) and surpassed the reference model (iAUC 0.743; Bayes factor >20). Both the ePCR model and reference models stratified patients in the ENTHUSE 33 trial into high-risk and low-risk groups with significantly different overall survival (ePCR: hazard ratio 3.32, 95% CI 2.39-4.62, p Interpretation Novel prognostic factors were delineated, and the assessment of 50 methods developed by independent international teams establishes a benchmark for development of methods in the future. The results of this effort show that data-sharing, when combined with a crowdsourced challenge, is a robust and powerful framework to develop new prognostic models in advanced prostate cancer.Peer reviewe

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe