Decentralized energy services delivery in developing countries, Case study; India

In developing countries, access to modern energy services is limited in spite of ambitious efforts of the governments and international development agencies like the World Bank. In this work, the importance of decentralized energy service delivery in developing countries has been investigated using the concepts of Service Engineering and institutional analysis of different delivery models is performed using the process mapping technique from the energy service provider's perspective. Decentralized energy service delivery has the theoretical potential to satisfy energy needs of the rural inhabitants. It supplements and strengthens the current centralized energy services delivery system in urban areas of developing countries. In addition, promotion of decentralized energy service delivery in developing countries will provide the necessary market-pull for renewable energy technologies. Decentralized energy service delivery by the market demonstrates the sustainability and scalability at an institutional level in developing countries. Small and medium scale enterprises play an important role in decentralized energy service delivery due to dispersed nature of potential end-users and needs to be promoted to improve access to modern energy services. Knowledge gap is the main challenge, as is evident from the walkthrough audit of the market delivery models, and this needs to be bridged in order to promote decentralized energy delivery through market approach

Anesthetic management of a large mediastinal mass for tracheal stent placement

AbstractThe anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses

Enhancing Hairfall Prediction: A Comparative Analysis of Individual Algorithms and An Ensemble Method

Hair fall, a prevalent issue affecting many individuals globally, necessitates early detection for preventive measures and hair health maintenance. Machine learning algorithms have gained attention in predicting hair fall by analysing genetic predisposition, lifestyle habits, and environmental factors. However, the performance of individual algorithms can be improved through ensemble models that combine their strengths. This research paper proposes an ensemble machine learning approach tailored for hair fall prediction. Comparative evaluations with individual algorithms reveal the ensemble models consistently outperform in accuracy, precision, and recall. Leveraging diverse algorithms, the ensemble approach captures a wider range of hair fall patterns, enhancing prediction accuracy. The ensemble models also exhibit higher precision and recall rates, correctly identifying both hair fall and non-hair fall instances. The ensemble models' superiority stems from mitigating the limitations of individual algorithms, resulting in a comprehensive and robust prediction framework. Overall, this research showcases the efficacy of ensemble machine learning models in hair fall prediction, enabling early detection and intervention for hair loss prevention. These findings provide valuable insights for researchers, practitioners, and individuals concerned about hair health

Disparities in Antifibrotic Medication Utilization Among Veterans With Idiopathic Pulmonary Fibrosis

BackgroundTwo antifibrotic medications, pirfenidone and nintedanib, are approved for the treatment of idiopathic pulmonary fibrosis (IPF). Little is known about their real-world adoption.Research questionWhat are the real-world antifibrotic utilization rates and factors associated with uptake among a national cohort of veterans with IPF?Study design and methodsThis study identified veterans with IPF who received care either provided by the Veterans Affairs (VA) Healthcare System or non-VA care paid for by the VA. Patients who had filled at least one antifibrotic prescription through the VA pharmacy or Medicare Part D between October 15, 2014, and December 31, 2019, were identified. Hierarchical logistic regression models were used to examine factors associated with antifibrotic uptake, accounting for comorbidities, facility clustering, and follow-up time. Fine-Gray models were used to evaluate antifibrotic use by demographic factors, accounting for the competing risk of death.ResultsAmong 14,792 veterans with IPF, 17% received antifibrotics. There were significant disparities in adoption, with lower uptake associated with female sex (adjusted OR, 0.41; 95% CI, 0.27-0.63; P < .001), Black race (adjusted OR, 0.60; 95% CI, 0.49-0.73; P < .001), and rural residence (adjusted OR, 0.88; 95% CI, 0.80-0.97; P = .012). Veterans who received their index diagnosis of IPF outside the VA were less likely to receive antifibrotic therapy (adjusted OR, 0.15; 95% CI, 0.10-0.22; P < .001).InterpretationThis study is the first to evaluate the real-world adoption of antifibrotic medications among veterans with IPF. Overall uptake was low, and there were significant disparities in use. Interventions to address these issues deserve further investigation

Common Genetic Polymorphisms Influence Blood Biomarker Measurements in COPD

Implementing precision medicine for complex diseases such as chronic obstructive lung disease (COPD) will require extensive use of biomarkers and an in-depth understanding of how genetic, epigenetic, and environmental variations contribute to phenotypic diversity and disease progression. A meta-analysis from two large cohorts of current and former smokers with and without COPD [SPIROMICS (N = 750); COPDGene (N = 590)] was used to identify single nucleotide polymorphisms (SNPs) associated with measurement of 88 blood proteins (protein quantitative trait loci; pQTLs). PQTLs consistently replicated between the two cohorts. Features of pQTLs were compared to previously reported expression QTLs (eQTLs). Inference of causal relations of pQTL genotypes, biomarker measurements, and four clinical COPD phenotypes (airflow obstruction, emphysema, exacerbation history, and chronic bronchitis) were explored using conditional independence tests. We identified 527 highly significant (p 10% of measured variation in 13 protein biomarkers, with a single SNP (rs7041; p = 10−392) explaining 71%-75% of the measured variation in vitamin D binding protein (gene = GC). Some of these pQTLs [e.g., pQTLs for VDBP, sRAGE (gene = AGER), surfactant protein D (gene = SFTPD), and TNFRSF10C] have been previously associated with COPD phenotypes. Most pQTLs were local (cis), but distant (trans) pQTL SNPs in the ABO blood group locus were the top pQTL SNPs for five proteins. The inclusion of pQTL SNPs improved the clinical predictive value for the established association of sRAGE and emphysema, and the explanation of variance (R2) for emphysema improved from 0.3 to 0.4 when the pQTL SNP was included in the model along with clinical covariates. Causal modeling provided insight into specific pQTL-disease relationships for airflow obstruction and emphysema. In conclusion, given the frequency of highly significant local pQTLs, the large amount of variance potentially explained by pQTL, and the differences observed between pQTLs and eQTLs SNPs, we recommend that protein biomarker-disease association studies take into account the potential effect of common local SNPs and that pQTLs be integrated along with eQTLs to uncover disease mechanisms. Large-scale blood biomarker studies would also benefit from close attention to the ABO blood group

Verkosta irrallisen maaseutujen sähköistämisen rajat: Base-of-the--the-Pyramid –markkinoiden realiteetit, riskit ja haasteet

Off-grid systems deployment is essential to achieving Sustainable Development Goals related to energy access (SDG-7). Their deployment presents a market opportunity, given the limitations of public utilities. Given this scenario, policymakers struggle with the wicked problem: if existing sociotechnical solutions can alleviate energy poverty, why is the energy transition slower than expected in rural Base-of-the-Pyramid (BoP) markets despite potential market opportunities? The slow progress is often attributed to market imperfections and other resource constraints in rural BoP markets. Social enterprise can potentially fill this void in rural BoP markets against this backdrop. This dissertation focuses on on-site experiences to examine the relationship between social entrepreneurship, rural BoP market characteristics, and challenges related to deploying off-grid systems in low-income areas. The study employs case studies to theorize on-site experiences concerning off-grid system deployment, specifically Solar Home Systems (SHSs) and mini-grids. This study mainly uses a qualitative method of enquiry. The qualitative method employs an interdisciplinary approach blending multiple theoretical lenses: cases studies to collect data, narrative analysis for analyzing experiences of practitioners, social entrepreneurship to contextualize business operations in rural BoP markets, and Multi-Level Perspective (MLP) for understanding sociotechnical challenges of mini-grids. In addition to presenting the analysis of practitioners' narratives, the study suggests using multi-criteria tools such as stochastic multi-criteria acceptability analysis (SMAA) to overcome the disadvantages of descriptive methods and field pilots. This dissertation presents new insights into on-site experiences and identifies the often overlooked or invisible nuances related to social enterprises' participation in rural BoP markets. First, practitioners and stakeholders must manage rural SHS markets through a risk assessment of three key activities: community engagement, stakeholder management, and organizational capacity building. Additionally, this study enhances the business model framework for off-grid solar by adding risk as a new dimension. Second, the sustainability of a mini-grid business model depends on how sociotechnical aspects are designed, managed and operated. In addition, this study proposes a mini-grid business model framework integrating social and technical aspects employing sociotechnical regimes in the MLP. Finally, the multi-criteria decision support technique enables off-grid systems planners to make informed decisions to avoid untended or unforeseen consequences.Sähköverkosta irrallisten (off-grid) järjestelmien käyttöönotto on välttämätöntä kestävän kehityksen tavoitteiden (SDG-7) saavuttamiseksi. Ottaen huomioon julkisten palveluiden rajoitukset, off-gird -järjestelmät luovat uusia markkinoita. Tämä asettaa päättäjät hankalan ongelman eteen: miksi maaseutujen Base-of-Pyramid (BoP) –markkinoiden kehitys on hidasta vaikka sosio-tekniset ratkaisut ovat olemassa? Usein ajatellaan että hidas kehitys johtuu markkinoiden epätäydellisyydestä ja muista resurssirajoitteista. Yhteiskunnalliset yritykset voivat potentiaalisesti auttaa tämän ongelman ratkaisemisessa. Tässä tutkimuksessa keskitytään yhteiskunnallisen yrittäjyyden, maaseutujen BoP-markkinoiden ja off-grid-järjestelmien välisiin suhteisiin alhaisen tulotason alueilla. Tapaustutkimuksen keinoin teorisoidaan off-grid -järjestelmien käyttöönottoa, erityisesti aurinkosähköön ja miniverkkoihin keskittyen. Lähtökohtana on kvalitatiivinen kyselytutkimus. Analyysissa sovelletaan monitieteistä lähestymistapaa ja eri tarkastelukulmia: narratiivianalyysia, yhteiskunnallista yrittäjyyttä, ja monitasoisen muutoksen mallia. Lisäksi työssä esitetään monikriteerisen päätöksenteon menetelmien soveltamista, kuten stokastinen monikriteerinen arvostusanalyysi (SMAA) täydentämään deskriptiivisten menetelmien rajoitteita. Tutkimuksessa esitetään BoP-yrittäjien kokemuksiin perustuvia uusia näkemyksiä maaseutujen markkinoiden kehittymisestä ja tunnistetaan usein huomioimattomia tai huomaamattomia yksityiskohtia jotka häiritsevät markkinoiden kehittymistä. Ensinnäkin, markkinoilla toimijoiden on hallittava maaseutujen aurinkosähkömarkkinoiden riskit liittyen yhdyskunnan sitoutumiseen, sidosryhmien hallintaan ja organisatoristen valmiuksien kehittämiseen. Tutkimus parantaa off-grid aurinkosähköjärjestelmien liiketoimintamallia lisäämällä toiminnan riskit uutena dimensiona. Toiseksi, miniverkkojen liiketoimintamallin kestävyys riippuu järjestelmän sosio-teknisestä suunnittelusta, hallinnasta ja käytöstä. Tutkimuksessa esitetään liiketoimintamallin laajentamista integroimalla sosiaaliset ja tekniset näkökulmat monitasoisen muutoksen malliin. Lopuksi, monikriteerisen päätöksenteon mallilla autetaan off-grid-järjestelmien suunnittelijoita huomioimaan samanaikaisesti erilaiset vaikutukset ja vältämään ei-toivotut tai ennakoimattomat haitat

Empowerment or employment? Uncovering the paradoxes of social entrepreneurship for women via Husk Power Systems in rural North India

Men continue to dominate the supply-side narratives of energy access projects, leaving an unexplored gap in gendered organizations. To fill this gap, the article utilises interviews with women workers to consider their lived experience working for an energy access-based organisation. Through the use of narrative analysis, this study highlights the importance of socio-cultural contextualisation of social entrepreneurial activities and social missions. It takes a persuasive case-study approach to analysing Husk Power Systems (HPS), which operates primarily in Bihar, India. HPS, a mini grid-based social enterprise, began its operations in Bihar in 2007 with the goal of ameliorating rural Bihar’s energy access problems and secondarily, empowering women through employment opportunities. Drawing on the concepts of women’s empowerment, social inequalities, and intersectionality, this article argues that although HPS provides formal employment opportunities, its presence has not secured long-lasting women’s empowerment in Bihar. As a social enterprise, HPS has limited capacity to reform social inequalities. Although HPS guarantees local job creation, we underscore further exploration of the intersectional dimensions influencing social enterprises’ energy access business operations’ longevity and impact, including those of local systems of power, caste, gender, and class.Peer reviewe

Manejo anestésico de grande massa mediastinal para a colocação de stent traqueal

ResumoO manejo anestésico de pacientes com grandes massas situadas no mediastino pode ser complicado por causa dos efeitos da pressão da massa sobre as vias aéreas ou grandes vasos. Relatamos o manejo anestésico bem‐sucedido de uma paciente de 64 anos com uma grande massa mediastinal que invadiu os grandes vasos e comprimiu a traqueia. Um stent traqueal foi colocado para aliviar a compressão da traqueia, sob anestesia geral. A ventilação espontânea foi mantida durante o período perioperatório com o uso de uma máscara laríngea clássica. Discutimos a utilidade da máscara laríngea para o manejo da colocação de stent traqueal em pacientes com massas situadas no mediastino.AbstractThe anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64‐year‐old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses

Unveiling the Decision-Making Dilemmas in Mini-Grids: The Intricate Case of Smart Meters

Mini-grids need to imitate the transition path of a traditional grid to maintain their position as a sustainable energy access alternative, while aligning with the objectives of the seventh Sustainable Development Goal. One such strategy is implementing smart-metering solutions to improve business viability and remote monitoring of distributed mini-grid assets. However, selecting smart meters presents a significant challenge for mini-grid operators, primarily due to the installation costs involved and the complexities associated with operating mini-grids in rural areas. Against this backdrop, the current case study’ demonstrates the utility of multi-criteria decision aids, such as stochastic multi-criteria acceptability analysis (SMAA), to assist mini-grid operators in making informed decisions concerning smart-meter selection. In addition, practitioners’ narratives elucidate how implementing smart metering can function as part of mini-grid operations in rural areas. Furthermore, narratives highlight the importance of considering context-specific conditions to avoid the under-utilisation of smart meters.Peer reviewe

Touching the invisible : Exploring the nexus of energy access, entrepreneurship, and solar homes systems in India

Off-grid electrification, using Solar Home Systems (SHSs), has become a viable alternative to conventional grid extensions in geographically dispersed rural Bottom of the Pyramid (BoP) markets, which are characterised as high-risk business environments. Using two SHS companies, Boond and Selco, as case studies, this article uses narrative interviews with key employees to identify the often overlooked, or invisible, micro-activities that social enterprises need to sustain themselves in rural BoP markets. This study examines the relationship between social entrepreneurship, rural BoP market characteristics, and challenges related to energy access, by combining the business model frameworks of social entrepreneurship and off-grid solar. Using narrative theory, it identifies three key activities and associated risks: community engagement, stakeholder management, and organizational capacity building. Social enterprises ought to engage in these three activities in order to manage the high-risk environment in the rural BoP markets. Community engagement bolsters social trust and results in customized solutions for the end-user; stakeholder management creates a favourable business environment and is a determinantal risk proposition; and finally, organizational capacity-building enables businesses to deliver reliable services, by increasing overall human resource management efficiency, while building social trust. Through a risk assessment of social entrepreneurial activities, practitioners and stakeholders can navigate the risk-based nature of rural SHS markets.Peer reviewe