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Connected communities are groups of grid-interactive efficient buildings able to worktogether to address grid challenges and building needs at a community level. They providegreater benefits than building-by-building approaches, optimizing multiple buildings to reducedistribution infrastructure capacity requirements, improve grid utilization of diverse energytechnologies, and create new value streams from buildings. Connected communities have beenidentified as an important part of decarbonizing the grid, particularly in their role to use demandflexibility to support greater degrees of variable renewable energy in the power supply.The DOE Connected Communities program selected 10 projects throughout the U.S. todemonstrate cutting edge connected communities approaches. These projects utilize diverseenergy technologies and include both residential and commercial buildings, retrofit and newconstruction, numbering in the tens to thousands per community. These projects are led bydiverse stakeholders driven by different use cases, including utilities, homebuilders, energyservice providers, universities, research organizations, and more.To enable community-scale benefits, these projects must have control mechanisms forcoordinating the operation of buildings and distributed energy resources such as generation andstorage. Several types of coordinated control architectures have evolved in the ConnectedCommunities program, influenced by the stakeholder use case, existing market conditions, andthe types of building and energy resources integrated. This paper describes these architectures, aswell as their use cases, benefits, and challenges they face during their implementation. Thefindings can support scalability of community-scale coordinated energy systems by clarifyingtradeoffs in their design for utilities, control vendors, and developers.

California is facing three major challenges in electrical grid operation: renewableovergeneration, steep evening ramping, and growing peak demand. The state has identifieddynamic retail price response as a key strategy evidenced by CPUC’s Dynamic Rates proceedingand CEC’s Load Management Standards. Furthermore, the CEC launched a $16M “CaliforniaLoad Flexibility Research and Deployment Hub (CalFlexHub)” administered by Berkeley Lab toaccelerate price-response flexible load technologies in buildings and EV charging.There are more than 16 laboratory and field demonstration projects in CalFlexHub, eachdemonstrating innovative automated price-response technologies. CalFlexHub tests variouspathways through which hourly price signals and triggered control commands are communicatedto load-flexible devices such as smart thermostats, heat pumps, water heaters, and EVs. Weidentified seven unique communication and control pathways, which involve combinations ofthird-party cloud, device OEM’s cloud, building central gateway, and local controller in betweenthe price server and the load-flexible devices.It is important for utilities and policy makers to understand the long-term implications ofeach pathway in designing future programs and creating related policies and mandates for markettransformation. We propose an evaluation framework including the following aspects:● Functionality: connectivity and uptime, resilience, and optimization;● Customer experience: simplicity in setup, troubleshooting support, continuity,customer choice, first cost, and ongoing cost;● Business model and scalability: advance interoperability, holistic solution, bridgeunique gap, customer base, and value streams and pricing structures.In this paper, we identify emerging business models associated with each communicationpathway and discuss their positive features and challenges from the above aspects.

To the urgent call for mitigating climate change, substantial initiatives have beenundertaken to deploy grid-interactive heating, ventilation, and air-conditioning (HVAC) controls,such as model predictive control (MPC) for buildings. These efforts typically aim to curtail peakenergy demand, shift load and enhance overall energy efficiency. With the recent developmentof low-cost MPC technologies that don’t require extensive instrumentation or manual modeling,small and medium commercial buildings (SMCBs), which rarely utilize advanced HVAC controlsystems, have become candidates for grid-interactive efficient buildings (GEBs). However,despite the potential benefits and maturity of the technology itself, several practical challengesremain in real-world implementation. In this paper, we share the practical challenges that wehave encountered in implementing and testing three types of MPC solutions (ON/OFF unit, dualfuel,and VRF systems) on multiple SMCB sites. We describe the MPC deployment process anddiscuss the lessons learned. The site selection, eligibility, and retrofit availability (e.g., utilityprice structure, thermostat communications, etc.) are the main discussion points at the beginningof the project. Also, the modeling automation and the best practices for interacting with endusersand handling erroneous situations are presented for successful operations.

BackgroundThe COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. ObjectiveThe aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. MethodsUltimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. ResultsThe Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient’s spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. ConclusionsThe Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.

BackgroundPatient portals have drawn much attention, as they are considered an important tool for health providers in facilitating patient engagement. However, little is known about whether the intensive use of patient portals contributes to improved management of patients’ health in terms of their confidence in acquiring health information and exercising self-care. There is a lack of randomized trials with these outcomes measured both pre- and postadoption of patient portals. ObjectiveThe aim of this study was to examine the causal relationship between the usage of patient portals and patients’ self-efficacy toward obtaining health information and performing self-care. MethodsThis study was a secondary data analysis that used data from a US national survey, the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 1. Patient portal usage frequency was used to define the treatment. Survey items measuring self-efficacy on a Likert-type scale were selected as the main outcomes, including patients’ confidence in obtaining health information and performing self-care. To establish causality using survey data, we adopted the instrumental variables method. To determine the direction of the causal relationship in the presence of high-dimensional confounders, we further proposed a novel testing framework that employs conditional independence tests in a directed acyclic graph. The average causal effect was measured using the two-stage least squares regression method. ResultsWe showed that frequently using patient portals improves patients’ confidence in obtaining health information. The estimand of the weighted average causal effect was 0.14 (95% CI 0.06-0.23; P

In the transition from fossil fuel to electrified heating, a concerning trend is emerging in certain regions of the US. Owners of buildings with gas-based systems leave them in place after adding heat pumps (HPs). Existing control solutions for these hybrid (dual fuel) systems are rudimentary and fall short of realizing the full carbon reduction potential of these systems. Model predictive control (MPC) is often regarded as the benchmark for achieving optimal control in integrated systems. However, in the case of small-medium commercial buildings (SMCBs), the control and communication infrastructure required to facilitate the implementation of such advanced controls is often lacking. This paper presents a field implementation of easy-to-deploy MPC for a dual fuel heating system consisting of HPs and a gas-fired furnace (GF) for SMCBs. The control system is deployed on an open-source middleware platform and utilizes low-cost sensor devices to be used for real SMCBs without major retrofits. We demonstrated this MPC in a real office building with 5 HPs and 1 GF for 2 months. The test results showed that MPC reduced 27% of cost while completely eliminating GF usage by shifting 23% of the thermal load from occupied-peak time to non-occupied-non-peak times.

* Context.--Clinician feedback is an important source of information for laboratory quality improvement programs. Objective.--To pilot a program for nearly real-time solicitation and analysis of physician feedback regarding clinical laboratory services. Design.--Laboratories distributed either electronic or paper survey forms to physicians. Results were tabulated by College of American Pathologists staff. Free-text comments were shared promptly with the participating laboratories to facilitate follow-up. Results.--Forty-seven clinical laboratories participated in the study and submitted results for 987 physician surveys, including both paper and electronic forms. Of 694 responses submitted electronically within the study period, 460 (66.3%) included at least 1 free-text entry, for a total of 951 free-text comments. Conclusions.--Point-of-service solicitation of physician feedback regarding clinical laboratory services is feasible and can provide a substantial quantity of potentially useful information regarding laboratory performance from the customer perspective. (Arch Pathol Lab Med. 2024;148:694-698; doi: 10.5858/arpa.2023-0064-CP), Many organizations consider customer-centricity, defined as putting the customer at the center of everything an organization does, to be the key to success. (1,2) Organizations that misunderstand and/or fail to [...]

The rapid growth of renewable generation is creating challenges for the California grid in the form of the “duck curve,” with increasingly steep ramping required for conventional generation resources in the morning and evening, and growing curtailment of solar resources in midday periods. Time-varying electricity tariffs have received considerable attention as a tool to address these challenges, with a renewed recent focus on the potential for dynamic tariffs that vary to reflect conditions on the grid in near-real time. Consideration of dynamic tariffs may raise concerns about the financial impact on utility customers, especially for those who have limited flexibility to modify their electricity consumption in response. Specific areas of concern include electricity bills, bill volatility, and equity implications related to cost shifting among customer groups. In this paper we leverage smart meter data for more than 400,000 California utility customers, spanning residential, commercial, industrial, and agricultural customers, to assess potential customer bill impacts arising from a multi-component dynamic tariff . Specifically, we compute impacts on customer bills and bill volatility under the assumption of fully inelastic demand, i.e., where customers do not change their consumption patterns in response to the tariff. We also assess various approaches designing subscription load shapes that customers can pre-purchase as a hedge that may provide a measure of protection against large negative impacts, while still incentivizing the modification of loads on the margin. We compare and contrast the relative impacts on different customer classes and discuss benefits and pitfalls of different dynamic tariff structures and subscription load shapes.