Abstract-Distributed energy resources (DERs), like electric vehicles (EVs), can offer valuable services to power systems, such as enabling renewable energy to the electricity producer and providing ancillary services to the system operator. However, these new DERs may challenge the distribution grid due to insufficient capacity in peak hours. This paper aims to coordinate the valuable services and operation constraints of three actors: the EV owner, the Fleet operator (FO) and the Distribution system operator (DSO), considering the individual EV owner's driving requirement, the charging cost of EV and thermal limits of cables and transformers in the proposed market framework. Firstly, a theoretical market framework is described. Within this framework, FOs who represent their customer's (EV owners) interests will centrally guarantee the EV owners' driving requirements and procure the energy for their vehicles with lower cost. The congestion problem will be solved by a coordination between DSO and FOs through a distribution grid capacity market scheme. Then, a mathematical formulation of the market scheme is presented. Further, some case studies are shown to illustrate the effectiveness of the proposed solutions.

Background Video-based health care can help address access gaps for patients and is rapidly being offered by health care organizations. However, patients who lack access to technology may be left behind in these initiatives. In 2016, the US Department of Veterans Affairs (VA) began distributing video-enabled tablets to provide video visits to veterans with health care access barriers. Objective This study aimed to evaluate veterans’ experiences with VA-issued tablets and identify patient characteristics associated with preferences for video visits vs in-person care. Methods A baseline survey was sent to the tablet recipients, and a follow-up survey was sent to the respondents 3 to 6 months later. Multivariate logistic regression was used to identify patient characteristics associated with preferences for care, and we examined qualitative themes around care preferences using standard content analysis methods for coding the data collected in the open-ended questions. Results Patient-reported access barriers centered around transportation and health-related challenges, outside commitments, and feeling uncomfortable or uneasy at the VA. Satisfaction with the tablet program was high, and in the follow-up survey, approximately two-thirds of tablet recipients preferred care via a tablet (194/604, 32.1%) or expressed that video-based and in-person care were “about the same” (216/604, 35.7%), whereas one-third (192/604, 31.7%) indicated a preference for in-person care. Patients were significantly more likely to report a preference for video visits (vs a preference for in-person visits or rating them “about the same”) if they felt uncomfortable in a VA setting, reported a collaborative communication style with their doctor, had a substance use disorder diagnosis, or lived in a place with better broadband coverage. Patients were less likely to report a preference for video visits if they had more chronic conditions. Qualitative analyses identified four themes related to preferences for video-based care: perceived improvements in access to care, perceived differential quality of care, feasibility of obtaining necessary care, and technology-related challenges. Conclusions Many recipients of VA-issued tablets report that video care is equivalent to or preferred to in-person care. Results may inform efforts to identify good candidates for virtual care and interventions to support individuals who experience technical challenges.

Purpose Overuse and misuse of antibiotics are the primary risk factors for antibiotics resistance. Inadequate professional competence of primary care physicians might exacerbate these problems in China. This retrospective study aims to document the clinical pattern of antibiotics use and its overuse and misuse rates in rural primary care institutions and to evaluate the association between antibiotics use and characteristics of physicians and their patients. Methods Medical records from 16 primary care hospitals in rural areas of Guizhou province, China were obtained from the Health Information System in 2018. Classification of unnecessary use, incorrect spectrum of antibiotic, escalated use of extended spectrum and combined antibiotics use was based on the Guiding Principle of Clinical Use of Antibiotics (2015, China) and guidelines from the US Centers for Disease Control and Prevention. Generalized Estimating Equations were employed to determine predictive factors for inappropriate antibiotics use. Results A total of 74,648 antibiotics prescriptions were retrieved. Uncomplicated respiratory infection was the most common disease accounting for 58.6% of all prescriptions. The main antibiotic group used was penicillins (51.5%) followed by cephalosporins and macrolides (14% each). Of 57,009 patient visits, only 8.7% of the antibiotic prescriptions were appropriate. Combined use, escalated use of extended spectrum antibiotics, incorrect spectrum and unnecessary antibiotics use was found in 7.8%, 1.9%, 4.3% and 77.3% of patient visits, respectively, of which 28.7% were given intravenously. Antibiotics misuse was significantly more likely among newly employed physicians with lower levels of professional education. Adult patients and those who had public insurance had a higher risk of being prescribed unnecessary antibiotics. Conclusion Overuse of antibiotics for uncomplicated respiratory infection and use of cephalosporins, macrolides and injection antibiotics in primary care are the major problems of clinical practice in rural areas of Guizhou.

Abstract-This paper develops a network-constrained trans-

The future renewable-based power system will have an increased need for balancing power. Prosumers, having both generation and consumption capabilities, are expected to provide balancing power to the grid, if their flexibility can be appropriately managed. Meanwhile, undesirable line congestions and voltage violations may arise in the distribution network, when flexible resources respond to external control or price signals on a large scale. Hence, the development of an effective framework to coordinate flexibility at the distribution system level is of utmost importance. Such a framework should allow for an optimal provision of prosumer balancing power services within the boundaries of local network security constraints. In this study, a balancing market participation framework is proposed, adopting the concept of network-constrained transactive energy, to facilitate the interactions between the transmission system operator and aggregators who manage prosumer energy profiles. This framework retains user privacy and complies with the current market setup, where flexible energy is traded on the spot and balancing markets; however, it is ensured that the resulting energy profiles do not cause problems in the distribution network.

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