Provision Of Services Research Articles

Public value in the making of automated and datafied welfare futures

Across Europe, the public sector is expanding its efforts to introduce data-driven decision-support and intelligent systems in the administration of welfare. The growing body of research that highlights the impact and harms these systems have on citizens’ lives, raises questions about the guiding ideas, values, and norms that are at the heart of current transformations in welfare. Research in critical data studies contends a silent marketisation of social protection and governance. It implies an intricate entanglement between the procedures and output of service provision on the one hand and the normative outcomes in terms of the well-being and flourishing of society as a whole on the other hand. Thinking with the capabilities approach and buen vivir as well as with the concept of data justice, our paper asks how to conceptualise this relation. It discusses how (in)justice may become a sociomaterial component in automated welfare and emphasises that welfare outcomes and welfare practices, including their procedural aspects, are rather co-produced than just interdependent. We conclude that whether future infrastructures of welfare will create public value or not, depends on the institutional arrangements, policies, and norms built to distribute the emerging benefits and risks equally in society.

Evaluation of Staff Views of the Rapid Assistance with Frailty Team, It’s Perceived Clinical Effectiveness and Potential Areas for Development

Abstract Background The Rapid Assistance with Frailty Team (RAFT) has been operating within our local hospital since 2021. This novel multidisciplinary service aims to support frail older adults during hospital admission, by conducting focused comprehensive geriatric assessments, and providing bespoke support to their primary team. One method of evaluating the impact of the service has been to seek regular feedback from other staff, to guide continuous quality improvement regarding our approach. Methods This service evaluation was registered with the Quality and Patient Safety department locally in January 2024. An online questionnaire was developed to seek feedback from colleagues who would have experience of the service, with a link distributed via email to relevant staff members. Data collection took place over an eight-week period. Results In total, 69 responses from staff were received, and analysed thematically. They demonstrated high degrees of staff satisfaction, with over 76% either agreeing or strongly agreeing that ‘RAFT is a valuable service’. A further 69% of respondents felt that ‘RAFT is helpful in supporting discharge’. The most common expectations were for the team to assist with frailty assessment; support discharge planning; offer MDT input; provide follow-up care; and conduct education. Staff felt the service could be improved through refining the medical input role; provision of an ED service; increased staffing; expanding the discharge planning role; development of referral pathways; and improved communication. Conclusion Following presentation of these findings at our departmental teaching, a service development plan was agreed. This includes organising a focused internal rapid improvement event, with RAFT staff utilising the feedback from this service evaluation to identify how the service can be improved, as well as identifying key performance indicators to evaluate this progress. We will repeat this service evaluation in 6 months’ time, to assess if these interventions have made a meaningful impact.

The Development and Impact the First Irish Nurse-Led Lumbar Puncture Clinic in a Regional Specialist Memory Clinic

Abstract Background A Regional Specialist Memory service assesses complex cases of cognitive impairment, requiring a comprehensive diagnostic assessment. Lumbar punctures (LP's) are the definitive procedure to identify Alzheimer's Disease. The highest limitation to LP access is shortage and availability of specially trained medical staff. Cognitive centres across Europe have been training nurses (Advanced Nurse Practitioner) to perform LPs since 2006. A nurse led service was established in April 2023 in a large Irish teaching hospital. Methods This analysis data represents a preliminary 5-month audit of an ANP Led LP service (ALLPS) compared to prior service provision (ALLPS n=40, pre-ALLPS n=20). Waiting time for LP prior to ALLPS averaged 25 weeks, which reduced by over 50% (12 weeks). Results CSF results were identified in half the time with ALLPS (3 weeks versus 6 weeks). The initiation of the ALLPS reduced the timeframe to diagnosis from 12 weeks to 5 weeks. This led to an average wait time reduction from date of CSF result to disclosure of diagnosis of 53% (15 weeks pre-ALLPS to 8 weeks). The ALLPS is pioneering the use of a seated upright LP procedural position, reported to be comfortable by this cohort. Analysis of the nurse led LP procedure is comparative with medical LP services. Almost 40% were achieved on 1st attempt, a further 28% on 2nd attempt, with 18% on 3rd attempt. The ANP successfully completed 75% of LPs in this initial cohort with 9 patients requiring supervisor LP performance. One case required x-ray guided LP. Conclusion Appointment of a dedicated ALLPS service has reduced waiting times for diagnostic intervention, leading to early diagnosis, accessing post diagnostic support, meeting best practice guidelines outlined by the National Dementia Office.

The Development of Halal Well-Being Experience Quality: A Conceptual Framework

In recent years, the hospitality and tourism industry has increasingly focused on enhancing the well-being of guests by providing tailored experiences that address their physical, mental, and spiritual health. This shift has spurred the development of Halal well-being experiences, specifically designed to cater to Muslim travelers by aligning services and facilities with Islamic principles. Halal well-being experiences include a range of services such as Halal-certified food, prayer facilities, gender-segregated wellness amenities, and activities promoting spiritual health. These offerings are vital for Muslim travelers who seek destinations and accommodations that respect and cater to their faith-based needs. To address these challenges, a comprehensive framework for Halal well-being experience quality is essential. This framework should include clear guidelines for service provision, training programs for staff, and effective marketing strategies. This research aims to explore the current state of Halal well-being experiences in the hospitality industry, identify the key challenges and opportunities, and propose a framework for enhancing service quality. The study provides insights and recommendations for developing and promoting Halal well-being experiences that cater to the needs of Muslim travelers. The research underscores the importance of seven dimensions of tourism experience quality (TEQ) in influencing tourist well-being: Halal hedonism, Muslim-friendly involvement, local culture friendliness, refreshment experience, meaningfulness experience, knowledge experience, and novelty experience. These dimensions collectively enhance the physical, mental, social, and spiritual well-being of Muslim travelers, promoting a holistic approach to well-being in the tourism sector.

Assess, Diagnose and Intervene: Are Hospital Based Out-patient Frailty Intervention Teams Perfectly Positioned to Prevent the Frailty Crisis?

Abstract Background This Frailty Intervention Team (FIT) is relatively novel in the sense that it is a hospital based multidisciplinary team (MDT) that provides an outpatient service to community based frail adults. Its main source of referral is from General Practitioners (GP)1, with the average Clinical Frailty Score of those assessed being 4.98 (4.91 men, 5.05 women) 1. Indicating that the mean service user is ‘Living with Mild Frailty’2. Our objective was to establish if this model of service provision is identifying any new diagnoses and what interventions it provides. Our overarching aim is to establish ‘what we are adding to the patient journey’. Methods 3 independent researchers came together to develop a database for the service that would record new diagnoses made, medical & non-medical interventions provided and frequency of on-wards referral. Standard definitions and codes were agreed upon, and the information inputted by patients facing staff on a daily basis. A descriptive data analysis of this database was carried out after the first quarter. Results 51 new patients were assessed in 4 months. Of these patients, 37.25% of cases received new diagnoses; Parkinson’s disease (15.68%), Orthostatic Hypotension (11.76%), Cognitive Impairment / Dementia (11.76%) and Idiopathic Normal Pressure Hydrocephalus (iNPH) (5.88%). Subsequently 62.74% had changes made to their medications. 96.08% of new service users received at least 1 non-medical intervention. Onward referral was made for 58.82% of service users, to a total of 22 organizations. The total amount of onward referrals made was 54. 51 new patients were assessed in 4 months. Conclusion A hospital-based frailty intervention team adds value to a patient’s journey as it is perfectly placed to make rapid diagnosis due to their MDT nature and access to diagnostics. Furthermore, it provides immediate intervention and appropriate onwards referral. Is this a model of service provision that should be made more readily available nationally?

Evaluation of the Impacts of On-Demand Bus Services Using Traffic Simulation

This paper uses smart card data from Melbourne’s public transport network to model and evaluate the impacts of a flexible on-demand transport system. On-demand transport is an emerging mode of urban passenger transport that relies on meeting passenger demand for travel using dynamic and flexible scheduling using shared vehicles. Initially, a simulation model was developed to replicate existing fixed-schedule bus performance and was then extended to incorporate on-demand transport services within the same network. The simulation results were used to undertake a comparative analysis which included reliability, service quality, operational efficiency, network-wide effectiveness, and environmental impacts. The results showed that on-demand buses reduced average passenger trip time by 30%, increased vehicle occupancy rates from 8% to over 50%, and reduced emissions per passenger by over 70% on an average weekday compared to fixed-schedule buses. This study also offers insights for successful on-demand transport implementation, promoting urban sustainability. It also outlines future research directions, particularly the need for accurate short-term passenger demand prediction to improve service provision and passenger experience.

Malnutrition Risk Screening and Dietitian Intervention within an Integrated Care Team for Older Persons

Abstract Background Malnutrition in older adults increases the risk of frailty. Nutritional interventions can improve frailty. A Senior Dietitian joined our Integrated Care for Older Persons Community Specialist Team (ICPOP-CST) in 2022. Our Complete Geriatric Assessment (CGA) form was redesigned in early 2023 which included the Malnutrition Screening Tool (MST). We commenced measuring handgrip strength (HGS) in late 2023. We measured the prevalence of malnutrition risk among our patients, audited MST use and explored dietetic service provision. Methods Data from the first 101 patients with a completed (new) CGA form were obtained from the service’s electronic patient database. Patients with a MST score of 0 or 1 were considered to be at low risk of malnutrition and those with a MST score of 2 or more were considered to be at risk of malnutrition. Results The mean age was 84.8±5.3 years and 65% were female. Malnutrition risk was identified in 39 (38.6%) patients. The MST was completed for 96 (95%) patients and completed correctly in 67 (69.8%). The total score was not summed in 26 out of 29 incorrectly completed screening tools (89.7%). Half (51, 50.5%) of the group of older adults received dietetic assessment and intervention. High protein, high calorie advice was provided for 38 (74.5%) of those seen by the ICPOP dietitian and for 29 (93.5 %) of those at risk of malnutrition. Onward referral to primary care dietitians was made for 14 (27.5%) of those seen by the ICPOP dietitian. HGS measurement was performed in 20 patients - 15 (75.0%) were identified to have probable sarcopenia – 11 (73.3%) of these were at risk of malnutrition. All received dietetic intervention in relation to protein and sarcopenia. Conclusion Malnutrition risk and probable sarcopenia are common among older adults referred to our ICPOP-CST team. The MST screening tool is practical and identifies those requiring dietetic intervention.

Deep learning for automated encrustation detection in sewer inspection

Rapid urbanization and population growth in recent decades have placed significant pressure on urban cities to rely heavily on underground infrastructure, such as sewers and tunnels, to maintain the provision of essential services. These sewers, typically having a limited lifespan of 50 to 100 years, are prone to various forms of defects. While prior research has primarily addressed common sewer defect like crack, root intrusion, and infiltration among others, the challenge of encrustation—the formation of hard deposits within sewer systems—has received less attention. This study presents a pioneering deep-learning approach to detect encrustation in sewers by leveraging survey videos from 14 different sewers in the United Kingdom. Our work marks the first effort to develop models specifically for detecting encrustation using deep learning techniques, as previous studies have focused on other types of deposits such as settled and attached deposits. By converting the videos into sequential image frames, we subjected them to thorough analysis and several image pre-processing techniques. Our contributions include the development and comparison of different classification models using backbone CNN networks such as AlexNet, VGG16, EfficientNet, and VGG19 to classify encrustation. Notably, this study provides the first metric-based comparison of these backbone networks to identify the most effective model for encrustation detection. The results demonstrate an impressive 96 % accuracy using the deep architecture of VGG19. Beyond accuracy, this research explores the impact of data augmentation and network dropout on reducing overfitting and enhancing model performance. Additionally, we analyze the time complexities associated with training models with and without data augmentation, providing valuable insights into the efficiency of our approach.

Registered Nurses' Digital Client Work and Associating Factors: A Cross-Sectional Study.

To describe the frequency of digital client work among Finnish registered nurses, including video consultations, secured messaging and digital promotion of care without direct contact with the client. In addition, the study examines the association between various factors related to nurses' characteristics and work environment with digital client work and its frequency. A cross-sectional survey study. A total of 2970 nurses responded to a nationwide survey in spring 2023. Descriptive statistics were used to characterise the frequency of different types of digital client work. Binary logistic regression analyses were used to examine the associations. One-third of the respondents reported digital client work during the last 6 months. The majority had worked digitally with their clients daily or weekly. Secured messaging was the most frequently used type of digital client work, whereas video consultations were less frequent. Nurses working in acute care, home-based care or other environments worked more frequently digitally with their clients than those working in inpatient care. Nurses with higher digital dedication and collegial support had greater odds of digital client work than those with lower dedication. Among those who reported frequent digital client work, lower skills in information security were observed. Given the significant variation in the frequency of digital client work among nurses across different environments, assessing broader digitalisation adoption opportunities is essential. Organisations must ensure that nurses have sufficient skills for secure handling of client data, and efforts should be made in creating motivational and supportive work environments to facilitate digital client work. By understanding the factors influencing nurses' digital client work, organisations can create stronger structures to support their work. Enhancing digital service availability across different healthcare settings would offer clients more care options, thereby potentially improving their access to healthcare. This research addresses a knowledge gap regarding the current extent of nurses' digital client work in various healthcare environments and explores potential influencing factors. As governments aim to significantly expand the provision of digital healthcare services, understanding the variation in nurses' digital client work is crucial. This information can guide targeted interventions, such as continuous education, and organisational and collegial support, facilitating dedication to use digital technologies and ensuring secure and impactful advancements in digital healthcare. Our research will benefit healthcare organisations, decision-makers, nursing professionals and educational institutions. Our study adheres to the relevant EQUATOR guidelines and follows the STROBE checklist for cross-sectional studies. No patient or public contribution.

Strengthening plant health systems in South Sudan: addressing challenges and enhancing system efficiency and sustainability

Climate change-induced invasive pests remain a major bottleneck to agricultural productivity and food security in South Sudan. Strengthening the plant health system has the potential to contribute to reducing crop losses caused by pests. A situational analysis was conducted to assess the current state and effectiveness of plant health functions in three counties in South Sudan. Descriptive findings of data collected from 960 farmers in Juba, Yambio, and Yei indicated low access to plant health services, including advisory and extension, training, and information. There was a high dependence on NGOs and UN agencies to provide plant health services, indicating a gap in government-led initiatives. The findings demonstrate a complex relationship between plant health services and on-farm practices and regional variations in access to plant health services and resources. The findings have crucial implications for the plant health system in South Sudan, requiring the need for service accessibility, government involvement in plant health systems, strengthening of the policy and regulatory frameworks, and inclusivity in service provision.

REGULATORY AND METHODOLOGICAL PRINCIPLES OF TEACHING STANDARDISATION OF MEDICINES TO FUTURE MASTERS OF PHARMACY IN THE CONTEXT OF DIGITALISATION OF EDUCATION IN UKRAINE

The article substantiates that the strategic vector for ensuring the quality of educational services chosen in Ukraine under martial law has increased the need to update state and local regulations of the educational process, as well as to find effective methodological approaches to teaching higher education students, including the transformation of all teaching and learning materials into digital format and the creation of publicly available knowledge bases on their basis. Based on the analysis of national educational legislation, strategic priorities for the development of the healthcare sector, the article features the regulatory and methodological aspects of the implementation of educational initiatives aimed at improving the level of digital literacy of masters of pharmacy, the practical use of digital technologies in their educational and future professional activities, as well as amendments to educational standards and educational programs in terms of the list of general and special (professional, subject) competencies of the above-mentioned specialties. Generalisation of the content of local acts, websites of higher medical/pharmaceutical education institutions of Ukraine made it possible to identify the main innovations in the organisation of training of future masters of pharmacy, to illustrate these with examples of the introduction of digital technologies in the training of future masters of pharmacy, in particular the discipline «Standardisation of Medicines» at the Bogomolets National Medical University. The leading direction for improving the effectiveness of teaching standardisation of medicines to future masters of pharmacy in the context of digitalisation of higher education in Ukraine is identified, which is to harmonize the regulatory and methodological foundations of this process in accordance with the current and future (post-war reconstruction of the educational sphere) challenges of socio-political life of society, compliance with the security system, the provision of quality educational services in the context of the dynamic deployment of the electronic healthcare system, as well as the desire of government institutions and stakeholders to integrate with the European pharmaceutical market.

Group Guidance with Problem-Solving Techniques to Prevent Suicidal Ideation

Aim: determine the differences in the level of suicidal ideation before and after the implementation of group guidance on students at Muhammadiyah Middle School, Palangkaraya, (2) determine the effectiveness of group guidance in preventing suicidal ideation in students at Muhammadiyah Middle School, Palangkaraya. Method: The population in this study were all students of class VIII of SMP Muhammadiyah Palangka Raya, Central Kalimantan, totaling 71 students. The sample of this study consisted of 9 students out of 21 students of class VIII-C. Sampling was determined by the purposive sampling technique. Result and Discussions: The results of the study showed that: (1) before being given group guidance services, most of the students in class VIII-C, namely 9 students, experienced suicidal ideation with a moderate category. After being given group guidance services with the Problem Solving technique, most of the students, namely 5 students with a low category, and 4 students with a moderate category. The total Pre-test score was 587 and the Post-test score was 437, the total score difference was 150. This means that many changes occurred after the provision of group guidance services by the researcher; (2) the results of the hypothesis test calculation using SPSS 25 software on the paired sample T-Test method showed that the significance value obtained was 0.001. This shows that the Sig value <0.05, which means that there is an influence of Problem-Solving to prevent suicidal ideation in class VIII.C students of SMP Muhammadiyah Palangka Raya.

Investigating the impact of the internet on managing green financial innovation and improving agricultural conditions in water-scarce Asian regions using ANN modeling

This research focuses on the importance of management strategies, green innovation, and sustainable practices in the agricultural sector. These factors are crucial for job creation, food security, and environmental conservation. Particularly in water-scarce regions, effective management is necessary to overcome natural resource constraints and encourage a shift towards digital agriculture (AGRI). The study aims to identify and analyze the challenges and issues related to agricultural research and technology in Asian countries. The collected data were analyzed using exploratory factor analysis in the SPSS software. The analysis revealed a range of issues and challenges for agricultural development, including those related to the structure and policy framework, the availability and quality of resources and infrastructures, and the provision of effective support services, all of which encompassed factors such as research and technology investment, research management, productivity, research culture, networking, and the integration of higher education and agricultural research. To estimate the efficiency of technology development, agricultural development, and support services for AGRI, an artificial neural network (ANN) was utilized. The ANN was trained by incorporating changes in management strategies, green innovation, and sustainability across a broader range of experimental scenarios. The evaluation of the ANN's predictions showed that improvements in management strategies and the adoption of green innovation and sustainability significantly impacted the productivity of technology development, agricultural development, and support services for AGRI. The accuracy of the ANN's predictions was further assessed using linear regression. The results indicated an acceptable level of error when compared to the target results obtained from experimental tests. Overall, this study emphasizes the importance of effective management, green innovation, and sustainable practices in driving advancements in technology and agricultural development.

Factors Affecting Application of Modern Agrochemicals and Observance of Pre-Harvest Interval in Khat, Catha edulis (Miraa) Crops in Igembe South Sub County

In Kenya, agriculture plays a crucial role in the economic development as well as alleviating poverty in the households. Strengthening the agricultural sector will call for provision of requisite extension services and ensuring necessary agricultural inputs readily available to the farmers. Evidently, agrochemicals have boosted agricultural productivity over time. Categorized broadly as fertilizers and pesticides, agrochemicals were introduced to enhance crop yields and minimize crop losses due to soil infertility, pests, and diseases. However, use of agrochemicals has been associated with various issues including effects on the environment and specifically, problems related to human health, biodiversity, and the entire ecosystem. Thus, this study investigated factors affecting application of modern agrochemicals and the observance of Pre-Harvest Interval (PHI) in Khat (Miraa) crops protection in Igembe south sub county. The specific objectives that guided the study were to investigate the effect of environmental factors on application of agrochemicals in Khat (Miraa) crops protection and whether farmers observed recommended Pre-Harvest Interval in application of agrochemicals in Khat (Miraa) crops protection in Igembe south sub county. A descriptive research design was utilized with a target population comprising Khat (Miraa) farmers in Igembe south sub county. Purposive sampling technique was adopted in selecting the sample. Stratified sampling was adopted in selecting individual respondents from the various wards to with the strata being the ward. Yamane (1967) formula was utilized to estimate the sample size of 399 respondents. Primary data was collected using a structured questionnaire with a response rate of 79.4%. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 20 and presented in figures and tables. From the analysis, the correlation between environmental factors in the application of modern agrochemicals and the protection of Khat (Miraa) crops was positive and statistically significant (?=0.546, P=0.000). The regression coefficient of environmental factors in the model was positive (r=.221) and statistically significant (P=0.000). Based on the calculated averages and PHI risk factors, majority of the farmers are categorized as high risk or very high-risk users of agrochemicals. Further statistical analysis indicated that the coefficient of the risk factor is positive (r=0.572) and statistically significant (P=0.000). Therefore, the risk factor in observance of the PHI has a significant effect on the number of farmers using specific agrochemicals. The study concluded that environmental factors and non-observance of recommended PHI, positively and significantly affects the protection of Khat (Miraa) crops. The study recommends targeted extension to sensitize Khat (Miraa) growers on importance of observing recommended PHI. Finally, the study recommends that the national and county governments ought to formulate policy guidelines that identify agrochemicals suitable in Miraa crops protection, the recommended application rates, and Pre-Harvest Intervals.

Time Trends, Regional Variation and Associations of Low-Allergy Formula Prescribing in England.

Cow's milk allergy (CMA) overdiagnosis appears to be increasing and is associated with excessive low-allergy formula prescription. We evaluated recent trends and regional variation in low-allergy formula prescribing for CMA in England, and assessed potential risk factors for higher prescribing rates. Data on national and regional prescribing of low-allergy formulas were extracted from England's electronic prescription database using R. Region-level factors were evaluated for potential associations with regional low-allergy formula prescription rates using multivariate linear regression. Analysis of national prescribing trends covered 2007-2023, analysis of regional variation and region-level factors examined 2017-2019, prior to a re-organisation of the regional healthcare structure in England. Low-allergy formula prescribing increased from 6.1 to 23.3 L per birth nationally, between 2007 and 2023. Regional prescribing rate varied from 0.8 to 47.6 L per birth in 2017-2019. We found significant associations between regional low-allergy formula prescribing rate and regional prescribing rates for milk feed thickeners Gaviscon Infant and Carobel Instant (β = 0.10, p < 0.01), and for other anti-reflux medications used in young children (β = 0.89 p < 0.01). Inconsistent associations were seen with prescribing junior adrenaline auto-injectors and oral antibiotics. A model including these four variables accounted for 37% of regional variation in low-allergy formula prescribing rate. Region-level socio-economic deprivation, CMA guideline recommendations and paediatric allergy service provision were not associated with low-allergy formula prescribing. Low-allergy formula prescribing in England is increasing, varies significantly by region and is consistently associated with prescribing rates for milk feed thickeners and other anti-reflux medication for young children. Community prescribing behaviours may be important determinants of CMA overdiagnosis.

The role of the third sector in public health service provision: evidence from 25,338 heterogeneous procurement datasets

The role of the third sector in public health service provision: evidence from 25,338 heterogeneous procurement datasets

A qualitative study exploring the acceptability of a telehealth intervention for family members of people experiencing a first episode psychosis: PERCEPTION.

Family members of people experiencing a first-episode psychosis (FEP) can experience high levels of carer burden, stigma, emotional challenges, and uncertainty. This indicates the need for support and psychoeducation. To address these needs during the COVID-19 pandemic, we developed a multidisciplinary, blended, telehealth intervention, incorporating psychoeducation and peer support, for family members of FEP service users: PERCEPTION (PsychoEducation for Relatives of people Currently Experiencing Psychosis using Telehealth, an In-person meeting, and ONline peer support). The aim of the study was to explore the acceptability of PERCEPTION for family members of people who have experienced an FEP. Ten semi-structured interviews were conducted online via Zoom and audio recorded. Maximum variation sampling was used to recruit a sample balanced across age, gender, relatives' prior mental health service use experience, and participants' relationship with the family member experiencing psychosis. Data were analysed by hand using reflexive thematic analysis. Four themes were produced: 'Developing confidence in understanding and responding to psychosis'; 'Navigating the small challenges of a broadly acceptable and desirable intervention'; 'Timely support enriches the intervention's meaning'; and 'Dealing with the realities of carer burden'. Broadly speaking, PERCEPTION was experienced as acceptable, with the convenient, safe, and supportive environment, and challenges in engagement being highlighted by participants. Data point to a gap in service provision for long-term self-care support for relatives to reduce carer burden. Providing both in-person and online interventions, depending on individuals' preference and needs, may help remove barriers for family members accessing help.

A blockchain-based architecture for tracking and remunerating fast frequency response

The increasing penetration of renewable sources introduces new challenges for power systems’ stability, especially for isolated systems characterized by low inertia and powered through a single diesel power plant, such as it happens in small islands. For this reason, research projects, such as the BLORIN project, have focused on the provision of energy services involving electric vehicles owners residential users to mitigate possible issues on the power system due to unpredictable generation from renewable sources. The residential users were part of a blockchain-based platform, which also the Distributors/Aggregators were accessing. This paper describes the integrated framework that was set up to verify the feasibility and effectiveness of some of the methodologies developed in the BLORIN project for fast frequency response in isolated systems characterized by low rotational inertia. The validation of the proposed methodologies for fast frequency response using Vehicle-to-Grid or Demand Response programs was indeed carried out by emulating the dynamic behavior of different power resources in a Power Hardware-in-the-Loop environment using the equipment installed at the LabZERO laboratory of Politecnico di Bari, Italy. The laboratory, hosting a physical microgrid as well as Power Hardware-in-the-Loop facilities, was integrated within the BLORIN blockchain platform. The tests were conducted by assuming renewable generation development scenarios (mainly photovoltaic) and simulating the system under the worst-case scenarios caused by reduced rotational inertia. The experiments allowed to fully simulate users’ interaction with the energy system and blockchain network reproducing realistic conditions of tracking and remuneration of users’ services. The results obtained show the effectiveness of the BLORIN platform for the provision, tracking and remuneration of grid services by electric vehicles and end users, and the benefits that are achieved in terms of reducing the number of diesel generating units that need to be powered on just to provide operational reserve due to the penetration of renewable sources, resulting in fuel savings and reduced emissions.

Integrating ecosystem services trade-off, drivers and zoning into watershed water environment management in Nansihu Lake Basin, China

A series of ecosystem services (ESs) have a significant impact on water environment. How these ESs can be integrated into water environment management in the lens of coupled human and natural system (CHANS) is still lack exploration. This study proposes an integrating framework that connects the ESs with water environment management to facilitate the watershed sustainable development. We employ the InVEST model to evaluate typical ESs in the Nansihu Lake Basin (largest freshwater lake in Shandong, China), and analyze the spatiotemporal characteristics and trade-off of multiple ESs indicators. By revealing the interaction mechanism and key drivers of ESs and conducting ecological functional zoning, we investigate how ESs can facilitate water environment management in the Nansihu Lake Basin. The results indicated that: (1) The high-value areas of agricultural supply service are mainly distributed in the western plain area of the basin, while high-value areas of water provision, water purification and soil conservation services are in the mountainous and hilly areas in the eastern part of the basin. (2) There is a significant trade-off between crop supply service and water purification services. Crop and livestock supply services have a greater effect on water purification services (TN) than other services. (3) Crop area sown, total power of agricultural machinery and fertilizer application are the main drivers of water purification services (TN). (4) The basin can be divided into three ecological function zones, the agricultural production zone, the ecological regulation zone and the ecological redline zone. These findings imply that water environment management should be integrated with ESs by strengthening intersectoral collaboration, conducting zoning management in watershed planning and applying differentiated control measures in each zone. This includes optimizing the scale and structure of agriculture, and implementing circular economy and clean production practices. This study explored a comprehensive framework of integrating ESs into water environment management to facilitate the sustainable development of watershed.

The Safety and Outcomes of Elective Endovascular Aneurysm Repair in the Elderly: A Systemic Review and Meta-Analysis.

Prevalence of abdominal aortic aneurysms (AAAs) increases with age. Previous trials confirm that elective endovascular aneurysm repair (EVAR) is an effective intervention for AAA. However, few elderly patients were recruited into randomized trials, whereas in contemporary clinical practice, elective repair is commonly performed on octogenarians. We evaluated the safety and outcome of elective EVAR in elderly patients to inform clinical practice and vascular service provision. A systematic review and meta-analysis of studies reporting risk of complications and death in patients undergoing elective EVAR was performed (PROSPERO CRD: 42022308423). Observational studies and interventional arms of randomized trials were included if the outcome rates or raw data were provided. Primary outcome was 30-day mortality. Secondary outcomes were longer-term mortality, 30-day major adverse events, and aneurysm-related mortality. Primary and secondary outcomes were compared between octogenarians and non-octogenarians. Exclusion criteria were emergency procedures, non-infrarenal aneurysms, and lack of octogenarian data. A total of 41 studies were eligible from 10 099 citations, including 10 national and 5 international registries, 26 retrospective studies, and our own prospective cohort. The analysis included 208 997 non-octogenarians (mean age=70.19 [SD=0.62]) and 106 188 octogenarians (mean age=83.75 [SD=0.35]). The 30-day mortality post-elective EVAR was higher in octogenarians (1.08% in non-octogenarians, 2.31% in octogenarians, odds ratio [OR]=2.27 [2.08-2.47], p<0.0001). Linear regression demonstrated a 0.83% increase in 30-day mortality for every 10-year age increase above 60 years old. Mortality for octogenarians increased significantly during follow-up: 11.35% (OR=1.87 [1.65-2.13], p<0.001), 22.80% (OR=1.89 [1.52-2.35], p<0.001), 32.00% (OR=1.98 [1.66-2.37], p<0.001), 47.53%, and 51.08% (OR=2.40 [1.90-3.03], p<0.001) at 1-through-5-year follow-up, respectively. The 30-day major adverse events after elective EVAR were higher in octogenarians (OR=1.75-2.83, p<0.001). Octogenarians experience higher but acceptable peri-operative morbidity and mortality compared with younger patients. However, 3-year to 5-year survival is very low among octogenarians. Our findings challenge the notion of routine intervention in elderly patients and support very careful selection for elective EVAR. Many octogenarians with peri-threshold (<6 cm) AAAs may derive no benefit from EVAR due to limited 3-year to 5-year overall survival and low risk of aneurysm rupture with conservative management. An adjusted threshold for intervention in octogenarians may be warranted. Octogenarians with infra-renal AAA are increasingly managed with elective EVAR. Previous studies have demonstrated that EVAR is safer than open repair for octogenarians, with lower peri-operative mortality and major adverse events. However, randomised trials, on which much of contemporary evidence is based, recruited a relatively younger population of participants. This systematic review and meta-analysis provides a contemporary synthesis of the literature comparing outcomes in octogenarians to younger patients. The results of this analysis, together with low rupture rates amongst octogenarians in existing literature, question the benefit of routine elective intervention for peri-threshold aneurysms and an adjusted threshold for intervention in octogenarians may be warranted.