Utility Cost Savings Research Articles

Multi-scale retrofit pathways for improving building performance and energy equity across cities: A UBEM framework

Institutional inequality has created an environment in which our physical surroundings reflect racial and economic biases – causing inequitable thermal comfort and energy consumption across neighborhoods. Just as energy and thermal comfort challenges are unique to each climate and built environment, the solutions to address these issues should be optimized for their context. We introduce a novel integrated data-driven and building energy simulation method that incorporates urban context, satellite imagery, and socioeconomic data to analyze multi-scale retrofit scenarios across disparate communities. We apply this method to case studies in New York City and Los Angeles to analyze energy and thermal comfort inequities across distinct climate zones and urban morphologies. Through parametric analysis, we demonstrate the efficacy of multi-scale retrofits at improving building performance and reducing existing thermal inequities. Our research shows that retrofit effectiveness is influenced by the microclimatic changes induced by the urban context and existing infrastructural inequity. For example, instantaneous building cooling energy demand in a disadvantaged community of Los Angeles is reduced more due to window retrofits (around 30 kWh) than by a greenspace retrofit (around 3 kWh). Greenspace installation dissipates more heat overnight and in the early morning, whereas window retrofits reduce solar heat gain during the day, showing the different heat reduction pathways that retrofits can achieve. Although the window retrofits lead to an order of magnitude higher utility cost savings ($70 savings from windows vs $9 for greenspace and $12 for reduced cars), the district-scale retrofits show promising pathways for reducing the cost burden across all residents. We also analyze pathways for achieving city-specific CO2 reduction targets and find that building-level retrofits are most effective at meeting building performance standards (reducing CO2 by 40%), whereas district-level retrofits should be used to achieve city-scale climate goals because of the sequestered and abated emissions offered by these pathways. This generalizable modeling framework empowers policymakers, urban planners, and building owners around the world to analyze pathways for meeting their climate action plan goals by reducing extreme heat, reducing greenhouse emissions, and reducing energy cost burden while improving environmental justice in their cities.

Sludge dewaterability improvement with microbial fuel cell powered electro-Fenton system (MFCⓅEFs): Performance and mechanisms

Throughout the entire process of sludge treatment and disposal, it is crucial to explore stable and efficient techniques to improve sludge dewaterability, which can facilitate subsequent resource utilization and space and cost savings. Traditional Fenton oxidation has been widely researched to enhance the performance of sludge dewaterability, which was limited by the additional energy input and the instabilities of Fe2+ and H2O2. To reduce the consumption of energy and chemicals and further break the rate-limiting step of the iron cycle, a novel and feasible method that constructed microbial fuel cell powered electro-Fenton systems (MFCⓅEFs) with ferrite and biochar electrode (MgFe2O4@BC/CF) was successfully demonstrated. The MFCⓅEFs with MgFe2O4@BC/CF electrode achieved specific resistance filtration and sludge cake water content of 2.52 × 1012 m/kg and 66.54 %. Cellular structure and extracellular polymeric substances (EPS) were disrupted, releasing partially bound water and destroying hydrophilic structures to facilitate sludge flocs aggregation, which was attributed to the oxidation of hydroxyl radicals. The consistent electron supply supplied by MFCⓅEFs and catalytically active sites on the surface of the multifunctional functional group electrode was responsible for producing more hydroxyl radicals and possessing a better oxidizing ability. The study provided an innovative process for sludge dewaterability improvement with high efficiency and low energy consumption, which presented new insights into the green treatment of sludge.

Energy and cost savings of cool coatings for multifamily buildings in U.S. climate zones

While cool coatings have recently received much attention for building applications, their impact on building energy consumption strongly depends upon climatic conditions. Herein we evaluate the energy, cost, carbon, and interior comfort impact of cool coatings applied to a residential multifamily building across 32 climate zones in the United States by applying advanced cool coating properties to established building energy models. The model not only considers promising cool coating properties based upon recent experiments but also an ideal cool coating. Our calculations show that the ideal cool coating can achieve annual cooling energy savings of up to 6.64 kWh/m2 (Phoenix, AZ), annual net utility cost savings up to $1.16/m2 (Brawley, CA), and net annual carbon emission savings up to 7.7 % (Phoenix, AZ). We also estimate the change in interior temperature for buildings without space cooling systems and show that cool coatings make buildings in the warmest climate zones in the U.S. without space cooling more comfortable by 30 % to 50 % on a cooling degree days basis. Using analysis of variance, we examine the statistical relationships between building performance metrics and climatic parameters. The presented methodology enables evaluation of cool coating application to buildings in various climate zones across the world.

From product to service – strategies for upscaling smart home performance monitoring

ABSTRACT Smart home technologies provide an opportunity to address the housing design or retrofit-performance gap and to improve the building regulations. It is currently used to manage comfort, security, and resource efficiency but, adoption remains piecemeal, and disparate. This study aims to explore how householder perceptions of housing quality, and the cost–benefit of improvements informs the adoption of smart technologies. Further, it bridges the theory-to-practice gap by proposing the product-as-service domains that can be deployed for the upscaled implementation of smart home performance monitoring. The survey method returned 972 nationally representative responses. Factor analysis was then used to establish the housing quality priorities, and home improvement drivers that combine to inform the adoption of smart home performance monitoring. Findings show that householders will adopt technologies in return for a ‘benefit’ if reliable smart systems and data-feedback mechanisms are packaged as: (a) commerce services to support utility efficiencies and cost savings, (b) convenience and control services to improve comfort and wellbeing, (c) information and communication services to inform behaviours and decisions, and (d) entertainment services to satisfy hedonic needs. The paper concludes with practical, scalable implementation strategies for smart home performance monitoring. Thus bridging the gap between theory and practice.

Modernizing Identification of Non-Convulsive Seizures and Status Epilepticus: Neurologists’ Experience at a Level 1 Trauma Center (P9-1.007)

<h3>Objective:</h3> We hypothesized that utilization of the Ceribell Rapid Response EEG (RR-EEG) can reduce time to diagnosis in a level one trauma center in the Department of Defense. A secondary aim was to evaluate utilization practices and cost savings. <h3>Background:</h3> Non-convulsive seizures (NCS) and non-convulsive status epilepticus (NCSE) have been found in up to 27% of patients that are critically ill and often go unrecognized or have delays in recognition. Electroencephalography (EEG) is the gold standard diagnostic tool but is a limited resource, requires trained technicians and specialized neurologists, thereby potentially leading to delays in diagnosis and treatment. <h3>Design/Methods:</h3> We obtained 50 rr-EEG headsets from the manufacturer Ceribell Inc as part of quality improvement effort. From September 2021 through April 2022, Neurology residents triaged consults concerning for NCS or NCSE and based on clinical suspicion performed rr-EEG or ordered conventional EEG. Data was collected to include time of consult, time of initiation, time of interpretation, provider’s clinical impressions, and final diagnosis of seizure or not. <h3>Results:</h3> Average time to initiation of data collection for rr-EEG was 48.94 minutes compared to 128.05 minutes for conventional EEG (<i>p</i>-value &lt;0.001). Average time to interpretation of rr-EEG was 58.59 minutes compared to 246.29 minutes time of interpretation after downloading the conventional EEG. We compared time of interpretation of the rr-EEG (58.59 minutes) to the initiation of the conventional EEG (128.05 minutes) due to delays associated with work-flow and formal reading of the EEGs. This yielded a <i>p</i>-value of &lt;0.001. <h3>Conclusions:</h3> rr-EEG reduced time to initiation and interpretation by over 50% compared to conventional EEG as utilized by neurologists at a busy Level 1 trauma center. rr-EEG also reduced cost per EEG while increasing utilization and availability of EEG technology. <b>Disclosure:</b> Dr. Luster has nothing to disclose. Dr. Tchopev has nothing to disclose. The institution of Dr. Hoffman has received research support from United States Air Force. Dr. Jacobus has nothing to disclose. The institution of Dr. Willis has received research support from Air Force. Dr. Willis has received intellectual property interests from a discovery or technology relating to health care.

Field test of Model Predictive Control in residential buildings for utility cost savings

Air conditioners in residential buildings often rely on local feedback control to regulate the indoor temperature, where the unit is cycled on and off by comparing the actual temperature with the temperature set-point. Model Predictive Control (MPC) is a technique that makes use of building models, disturbance forecasts, and optimization algorithms to enhance building performance. MPC has demonstrated its potential in reducing building energy consumption and operating costs; however, it has seldom been applied in residential buildings because of the high implementation costs, complicated hardware configuration, and insufficient data. In this study, we developed and tested a MPC controller in a real apartment aimed at reducing the operating costs based on the local Time-of-Use (ToU) utility structure. We developed a feasible and easy-to-use hardware configuration as well as a cloud-based software deployment. The MPC controllers were implemented and evaluated through one-month field testing in a bedroom and living room of an apartment in a residential building. The field test showed that the MPC controller saved 22.1% for the bedroom and 26.8% cooling costs for the living room, compared to conventional rule-based control (RBC). We further confirmed the robustness of the MPC controller as the field test showed that the MPC controller is able to outperform the conventional RBC controller, even if the model is not accurate. Our work provides a practical MPC solution that can unlock the load flexibility potential of residential buildings, which creates a win–win solution for the households and the grid: saving utility costs for households and helping the grid to manage the balance between supply and demand.

Impact of a remdesivir formulary restriction by antimicrobial stewardship on drug utilization and cost at a safety-net community hospital during the COVID-19 pandemic

Abstract Deploying novel COVID-19 therapies proved challenging amid rapidly evolving data, drug shortages, and conflicting guidelines. We established a remdesivir formulary restriction remdesivir to promote its evidence-based use. This intervention led to changes in remdesivir utilization patterns and cost savings. Formulary restrictions can play an important role in pandemic preparedness and response.

Optimal predictive control of phase change material-based energy storage in buildings via mixed-integer convex programming

This paper describes a mixed-integer convex programming-based control strategy to optimize the operation of phase change material-based energy storage integrated in building supply ducts. To improve the numerical feasibility, the original nonlinear control problem is pre-conditioned and transformed to a mixed-integer convex program through convexification of the cooling system control model, mixed-integer reformulation of the phase change material dynamics and discretization of the supply airflow. The overall control framework was leveraged toward development of two model predictive control strategies to optimally charge/discharge the phase change material storage, through supply air temperature reset, and the building passive thermal mass, via scheduling of the zone air temperature setpoint. These strategies were tested and compared to two baseline control strategies using a simulation case study over three summer days. Test results show that using the phase change material energy storage alone, energy cost savings of 2.9% and peak demand reduction of 46.7% could be achieved, compared to a conventional fixed-supply air temperature and zone air temperature night setup control strategy; when both the active (phase change material) and passive (building thermal mass) storage capacities are utilized, the savings potentials could increase to 8.4% for the energy cost and 65% for the demand charge. • Integration of PCM energy storage in supply ducts is effective in reducing demand. • Predictive control of PCM storage offers significant utility cost savings potential. • Charging/discharging of PCM thermal storage results in efficiency losses. • Combining active and pass storage can provide the maximum load shifting potential.

Clinical Utility and Potential Cost Savings of Pharmacologic Monitoring of Eculizumab for Complement-Mediated Thrombotic Microangiopathy

One of the treatment options for complement-mediated thrombotic microangiopathy (CM-TMA), also known as atypical hemolytic uremic syndrome, is the administration of the C5 complement inhibitor eculizumab. In vivo studies have reported a complete complement blockade with eculizumab serum concentrations above 50 μg/mL in the case of atypical hemolytic uremic syndrome. The eculizumab trough levels and C5 functional activity were monitored in patients with CM-TMA being treated with eculizumab. For those with eculizumab trough concentrations of more than 100 μg/mL, the frequency of eculizumab 1200-mg doses was decreased. In this article, we describe the pharmacologic monitoring data with the use of C5 functional activity and mass spectrometric assessments of eculizumab to allow for a tailored eculizumab schedule for 10 patients with CM-TMA. In 9 out of 10 (90%) patients with a standard administration schedule, eculizumab trough concentrations were more than 100 μg/mL. At the time of the last eculizumab follow-up (median, 250 days; range, 85-898 days), the interval between eculizumab infusions was extended to every 3-6 weeks for 8 patients; no disease relapse was found with the modified dosing interval. Altering the administration of maintenance eculizumab from every 2-3 weeks to 3-6 weeks yields a savings of $78,185 per patient for a 6-month eculizumab treatment course. Although larger standardized cohorts are necessary to confirm these findings, our data suggest that monitoring eculizumab levels in conjunction with C5 assessment allows for safe modification of eculizumab dosing and results in considerable cost savings.

Reflex single-gene non-invasive prenatal testing is associated with markedly better detection of fetuses affected with single-gene recessive disorders at lower cost

Objective To evaluate the clinical benefits and achievable cost savings associated with the adoption of a carrier screen with reflex single-gene non-invasive prenatal test (sgNIPT) in prenatal care. Method A decision-analytic model was developed to compare carrier screen with reflex sgNIPT (maternal carrier status and fetal risk reported together) as first-line carrier screening to the traditional carrier screening workflow (positive maternal carrier screen followed by paternal screening to evaluate fetal risk). The model compared the clinical outcomes and healthcare costs associated with the two screening methods. These results were used to simulate appropriate pricing for reflex sgNIPT. Results Reflex sgNIPT carrier screening-detected 108 of 110 affected pregnancies per 100,000 births (98.5% sensitivity), whereas traditional carrier screening-detected 46 of 110 affected pregnancies (41.5% sensitivity). The cost to identify one affected pregnancy was reduced by 62% in the reflex sgNIPT scenario compared to the traditional scenario. Adding together the testing cost savings and the savings from earlier clinical intervention made possible by reflex sgNIPT, the total cost savings was $37.6 million per 100,000 pregnancies. Based on these cost savings, we simulated appropriate reflex sgNIPT pricing range: if the cost to identify one affected pregnancy is the unit cost, carrier screening with reflex sgNIPT can be priced up to $1,859 per test (or $7,233 if sgNIPT is billed separately); if the cost per 100,000 pregnancies is the unit cost, carrier screening with sgNIPT can be priced up to $1,070 per test (or $2,336 if sgNIPT is billed separately). Conclusion Using the carrier screen with reflex sgNIPT as first-line screening improves the detection of affected fetuses by 2.4-fold and can save costs for the healthcare system. A real-life experience will be needed to assess the clinical utility and exact cost savings of carrier screen with reflex sgNIPT.

In-duct phase change material-based energy storage to enhance building demand flexibility

This paper presents a novel energy storage solution by incorporating phase change material (PCM) panels in supply ducts to increase a building’s thermal storage capacity and demand flexibility. During off-peak hours, the system runs at a supply air temperature (SAT) below the PCM solidification point to charge the storage unit with “cooling” energy. During on-peak hours, a higher SAT is utilized so that the stored “cooling” energy can be discharged into the supply-air as a means to reduce the peak air-conditioning power usage. To evaluate the potentials of peak demand reduction and utility cost savings, a numerical model for a PCM panel prototype and its heat exchange with the air flow in the duct was developed and calibrated using experimental data. Whole building energy simulations were conducted in a co-simulation environment that has integrated the developed PCM model, EnergyPlus Department of Energy (DOE) prototypical model for a medium office building and a calibrated model for variable-speed direct-expansion cooling systems. The simulations covered five cities in different U.S. climate zones over a three-month cooling season and used actual time-of-use (TOU) rate schedules offered by the local electric utility companies. The simulation results have shown the PCM storage could reduce the on-peak energy consumption by 23–32% and the seasonal cooling electricity cost by up to 16%, with a simple rule-based control strategy. A simple payback analysis resulted in payback periods from 7.5 to 27 cooling months.

Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive Patients

Abstract Purpose The aim of this study was to report the utility of chest radiography following interventional radiology-performed ultrasound-guided thoracentesis. Materials and Methods A total of 3,998 patients underwent thoracentesis between 2003 and 2018 at two institutions. A total of 3,022 (75.6%) patients were older than 18 years old, underwent interventional radiology-performed ultrasound-guided thoracentesis, and had same-day post-procedure chest radiograph evaluation. Patient age (years), laterality of thoracentesis, procedural technical success, volume of fluid removed (mL), method of post-procedure chest imaging, absence or presence of pneumothorax, pneumothorax size (mm), pneumothorax management measures, and clinical outcomes were recorded. Technical success was defined as successful aspiration of pleural fluid. Post-procedure clinical outcomes included new patient-perceived dyspnea and hypoxia (oxygen saturations &lt; 90% on room air). Costs associated with radiographs were estimated using Medicare and Medicaid fee schedules. Results Mean age was 56.7 ± 15.5 years. Interventional radiology-performed ultrasound-guided thoracentesis was performed on the left (n = 1,531; 50.7%), right (n = 1,477; 48.9%), and bilaterally (n = 14; 0.5%) using 5-French catheters. Technical success was 100% (n = 3,022). Mean volume of 940 ± 550 mL of fluid was removed. Post-procedure imaging was performed in the form of posteroanterior (PA) (2.6%; 78/3,022), anteroposterior (AP) (17.0%; 513/3,022), PA and lateral (77.9%; 2,355/3,022), or PA, lateral, and left lateral decubitus (2.5%; 76/3,022) chest radiographs. Post-procedural pneumothorax was identified in 21 (0.69%) patients. Mean pneumothorax size, measured on chest radiograph as the longest distance from the chest wall to the lung, was 18.8 ± 10.2 mm (range: 5.0–35.0 mm). Of the 21 pneumothoraces, 7 (33.3%) were asymptomatic, resolved spontaneously, and had a mean size of 6.4 ± 2.4 mm. Fourteen pneumothoraces, of mean size 25.0 ± 5.8 mm, required management with a pleural drainage catheter (66.6%). The overall incidence of pneumothorax requiring pleural drainage catheter placement following interventional radiology-performed ultrasound-guided thoracentesis was 0.46% (14/3,022). Of the patients requiring drainage catheter placement, 12/14 (85.7%) and 13/14 (92.9%) had dyspnea and hypoxia, respectively. Potential costs to Medicare and Medicaid, for chest radiographs, in this study, were $27,547 and $10,581, respectively. Conclusion The incidence of clinically significant pneumothorax requiring catheter drainage following interventional radiology-operated ultrasound-guided thoracentesis is exceedingly low (0.46%), and routine post-procedure chest radiographs in asymptomatic patients provide little value. Reserving post-procedure chest radiographs for patients with post-procedure dyspnea or hypoxia will result in more efficient resource utilization and health care cost savings.

Utility cost savings helping airports in the pandemic

COVID-19 is impacting health, economics and operations around the world. As airports consider strategies to be resilient from this worldwide event, utility cost-savings projects are still tools to support this effort. Some airports are demonstrating that utility-savings projects work in different settings and locations. In addition to reducing energy and water costs, these projects also support sustainability efforts by reducing emissions and supporting other sustainability and resiliency goals. This paper presents some examples of how some airports are achieving this.

Abstract 15340: Reducing Unnecessary Preoperative Cardiology Referral and Cost in Patients Undergoing Bariatric Surgery

Introduction: Candidates for bariatric surgery are at increased risk for cardiovascular disease, which may increase surgical risk. Currently, there are no society guidelines indicating which patients are appropriate for preoperative cardiovascular evaluation and risk stratification. Hypothesis: We hypothesized that applying a standardized surgical risk calculator with a novel multidisciplinary internal referral algorithm to stratify patients for preoperative cardiovascular evaluation would decrease unnecessary referrals and cost. Methods: All patients undergoing bariatric surgery at our institution between 2014-2018 were identified. After assessing baseline patient characteristics, referral patterns to cardiology, prevalence of cardiac testing ordered, and surgical outcomes were measured. The Revised Cardiac Risk Index (RCRI) score was retrospectively calculated for each patient and grouped as low versus increased risk (RCRI score of 0 versus ≥ 1). Imputing a post hoc referral algorithm requiring an RCRI ≥ 1, age ≥ 65, METS ≤ 4, and/or ever smoking history for cardiology referral, we calculated how referral pattern would be affected and the resultant change in referral costs. Results: A total of 797 patients underwent bariatric surgery during the study period, of which 68% (n=540) were referred to cardiology preoperatively. Those referred had more hypertension, hyperlipidemia, diabetes, smoking history, and were more likely to have BMI &gt;50 kg/m 2 . Of those referred, 81% (n=438), 15% (n=81), 3% (n=17), and 1% (n=4) had RCRI scores of 0, 1, 2, and ≥ 3, respectively. Of those patients with an RCRI score of 0, 53% (n=234) underwent further cardiac testing. Strictly applying our standardized internal referral algorithm, of the 540 patients referred to cardiology, only 45% (n=199) were appropriately referred. Based on Medicare reimbursement for Level 4 outpatient consults, this would have resulted in a savings of approximately $86,000. Conclusions: Among candidates for bariatric surgery, a novel referral algorithm based on RCRI and other cardiovascular risk factors may reduce unnecessary preoperative cardiology referrals, with resultant reduction in resource utilization and overall cost savings.

Techno-Economic Assessment of CHP Systems in Wastewater Treatment Plants

Wastewater treatment plant (WWTP) utilization of combined heat and power (CHP) systems allows for the efficient use of on-site biogas production, as well as increased annual savings in utility costs. In this paper, a review of biogas energy recovery options, CHP prime mover technologies, and the costs associated with biogas cleaning give a broad summary of the current state of CHP technology in WWTPs. Even though there are six different prime mover technologies, the main ones currently being implemented in WWTPs are micro turbines, fuel cells and reciprocating engines. Different prime movers offer varying efficiencies, installation costs, and biogas impurity (H2S, siloxanes, HCl) tolerances. To evaluate the long-term savings capabilities, a techno-economic assessment of a CHP installation at a case study WWTP shows the payback, annual savings, and initial costs associated with the installation of a CHP system. In this case, a study a payback of 5.7 years and a net present value of USD 709,000 can be achieved when the WWTP generates over 2,000,000 m3 of biogas per year and utilizes over 36,000 GJ of natural gas per year.

Review of the first comprehensive outpatient parenteral antimicrobial therapy program in a tertiary care hospital in Japan

ObjectivesThe infectious diseases team at Kameda Medical Center, Japan, implemented a new outpatient parenteral antimicrobial therapy (OPAT) program in July 2012 and expanded the program with the support of home care services. This study reviews the OPAT program after 5.5 years of operation. MethodsWe prospectively collected data about the age, sex, diagnoses, causative organisms, types of OPAT, modes of administration, selected antibiotics, treatment durations, bed days saved, outcomes, readmissions, and estimated cost reductions of all patients who were treated in the OPAT program from July 2012 to December 2017. ResultsOf the 66 patients treated under the OPAT program, 45 (68.2%) were treated using clinic OPAT, and 21 (31.8%) were treated using homecare OPAT. The most commonly targeted organism was methicillin-susceptible Staphylococcus aureus. Continuous infusion with elastomeric pumps was employed in 55 patients (83.3%). Cefazolin was the most frequently used antibiotic (39.4%), followed by penicillin G (24.2%). The median OPAT duration was 13 days (range, 3–51), and the total bed days saved was 923. The estimated medical cost reduction was approximately 87,000 US dollars. ConclusionsOur experience shows that OPAT is a safe and feasible practice not only for efficient bed utilization and medical cost savings but also for better antimicrobial stewardship.

Assessments of demand response potential in small commercial buildings across the United States

Buildings are responsible for more than 73% of the total electricity usage in the United States and have a significant contribution to peak electrical demand of the power grid. Thus, proper building demand management could improve the robustness and efficiency of grid operation and could also result in economic benefits for building owners. Almost half of the building electricity usage occurs in the commercial building sector where 60% of the installed cooling capacity is attributed to small commercial buildings employing packaged air-conditioning systems (e.g., rooftop units). Thus, understanding the demand response potential and economic benefits for the small commercial sector is of great importance. In particular, the effect of climate, building type, and utility structure on demand response potential is valuable information for building managers in identifying the most beneficial demand response strategies and for utilities in developing better utility structure rate incentives to achieve demand reduction. This article presents a simulation-based assessment approach and highlights the key assessment results for three demand response strategies—thermostat, shade, and lighting controls—across a range of building types, vintages, locations, and utility rate structures. The control performance is evaluated in terms of utility cost savings, peak demand reductions, and indoor comfort impacts in comparison to a baseline night setup strategy. The tradeoff between cost savings and comfort is also explicitly investigated. The assessment results show that the demand response controls lead to slightly worse indoor comfort compared to the baseline control, with an increase in the median percentage of people dissatisfied from 5.7% to 8.1%. However, significant demand reductions and cost savings could be achieved across all tested cases with the magnitudes dependent on the weather condition and building type. Annual electricity cost savings of 5 to 25 cents/ft2 (54 to 269 cents/m2) were demonstrated for time-of-use energy rates with demand charges, whereas the savings were relatively small, below 5 cents/ft2 (54 cents/m2) for most cases, when buildings subscribed to flat rates without demand charges.

Shifting Implementation Science Theory to Empower Primary Care Practices.

Observers of the past 10 to 15 years have witnessed the simultaneous growth of dramatic changes in the practice of primary care and the emergence of a new field of dissemination and implementation science (D&I). Most current implementation science research in primary care assumes practices are not meeting externally derived standards and need external support to meet these demands. After a decade of initiatives, many stakeholders now question the return on their investments. Overall improvements in quality metrics, utilization cost savings, and patient experience have been less than anticipated. While recently conducting a research project in primary care practices, we unexpectedly discovered 3 practices that profoundly shifted our thinking about the sources and directionality of practice change and the underlying assumptions of D&I. Inspired by these practices-along with systems thinking, complexity theory, action research, and the collaborative approaches of community-based participatory research-we propose a reimagining of D&I theory to empower practices. We shift the emphasis regarding the source and direction of change from outside-in to inside-out Such a shift has the potential to open a new frontier in the science of dissemination and implementation and inform better health policy.

Tearing down the information barrier: the price impacts of energy efficiency ratings for buildings in the German rental market

Improving the energy efficiency levels of the housing stock is of particular concern in the private rental market where capital costs and utility cost savings are not shared in equal measure by landlords and tenants. This problem is particularly pronounced in the German housing market with its predominance of rented accommodation over owner occupancy. The present study is the largest to date to investigate the effect of energy efficiency ratings on rental values. Using a semiparametric hedonic model and an empirical sample of nearly 760 thousand observations across 403 local markets in Germany with full hedonic characteristics, we find evidence that energy-efficient rental units are rented at a premium. However, this effect is not confirmed for the largest metropolitan housing markets. In a second step, a survival hazard model is estimated to study the impact of the energy ratings on time-on-market. It is found that energy inefficient dwelling have longer marketing periods and are hence less liquid than their more energy efficient counterparts.

Residential PV-BES Systems: Economic and Grid Impact Analysis

The energy industry has seen a revolutionary transformation in the growth of renewables over the past decade. With recent advances in battery storage performance, solar energy is fast becoming the focus of the global energy shift towards a more sustainable future. Photovoltaic (PV) systems integrated with Battery Energy Storage (BES) systems are expected to play an important role in the UK’s future energy industry, aided in part by manufacturing cost reductions. For energy consumers, these systems can deliver considerable savings in utility costs and potentially bring a financial return via a feed-in-tariff (FIT) scheme. Such a system could also help energy suppliers and network operators ease the burden of a huge surge of future energy demand, mitigate network congestion and improve system resilience and autonomy. There is, however, limited literature that utilises simulation to investigate the influence of PV-BES system deployment at urban scale on the grid based on economic and technical analysis. In this work, a household-level model is developed that includes load demand heterogeneities, as well as BES and PV systems. The single household model can be scaled to higher levels, such as streets and community, hence the model can be applied to study the interaction between households, the wider community and the grid, in terms of electricity im/export, BES usage and network injection impact. A comprehensive analysis of both technical and economic perspectives is presented based on several key performance indicators (KPIs), such as self-consumption rate (SCR), self-sufficiency rate (SSR) and reduction in peak charges. The addition of a BES system can significantly increase the self-consumption of a home PV system, by at least 15%, however the expensive upfront cost of the BES system leads to a much longer payback time.