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This study assesses the impacts of on-road light- to heavy-duty zero emission vehicle (ZEV) adoption and charging protocols on greenhouse gas emissions for the years 2030 and 2045 in California, and on air quality for the year 2045. Two scenarios are addressed: (1) a “business-as-usual” (BAU) scenario with modest ZEV adoption, and (2) a “carbon neutral” scenario that achieves carbon neutrality by 2045 with proactive ZEV adoption. Electricity load for fueling ZEVs is projected, including electricity fuel for battery electric vehicles and electrolytic hydrogen for fuel cell electric vehicles. This electric load was input into an electric grid dispatch model and electric grid and air quality analyses were conducted. The results revealed that although medium- and heavy-duty vehicles (MHDVs) are projected to have lower total electric load associated with fueling, they will require roughly double the electricity for hydrogen production of light-duty vehicles. For the electric grid scenarios examined, ZEV loads increased peak electricity demand by 3% to 6% in 2030 and 22% to 31% in 2045. MHDV time-of-use and smart charging strategies were equally able to shift charging demand to off-peak times. Higher ZEV loads under the carbon neutral scenario increased natural gas use up to 6% in 2030 and energy storage requirements up to 45% in 2045 compared with the BAU scenario. The analyses also found that achieving carbon neutrality through ZEV adoption had the cobenefit of significantly reducing ground-level ozone and PM2.5 concentrations in key regions of California, providing health savings of approximately $28 billion annually in 2045.

Purpose Anesthesia inhalation induction (falling asleep for a surgery using a medical mask) is often stressful for children. When children become anxious about induction, they may resist wearing the anesthesia mask. High anxiety during induction is associated with poorer outcomes after surgery, such as increased emergence delirium, increased pain and negative behavioral changes after discharge. The purpose of this project was to design an optimal anesthesia induction experience for children, with a focus on decreasing patient anxiety during inhalation induction. Design Designing for the perioperative environment requires in-depth knowledge of existing processes, needs of key stakeholders, strengths/shortcomings of existing approaches, and iterative testing of design concepts. We used a human centered design model (design research) to approach this challenge. Methods Hospital staff partnered with a design team at the Live Well Collaborative. Families and staff were consulted during all phases of the design process. The iterative design research process (research, ideation, refinement) was used to develop product and process concepts for optimizing the induction experience. Requirements for an optimal induction experience were defined during the research phase through reviewing the scientific literature, process mapping and benchmarking with other products. Product and process concepts were developed during the ideation phase. Concepts were tested and refined during the refinement phase. Findings The research phase provided insights about the current anesthesia induction process and what interventions help engage children in medical care. Key insights included normalizing the anesthesia mask through medical play, providing patients with an increased sense of control preoperatively and during induction, and engaging multiple senses during the process. The ideation phase led to the development of several design concepts, including an app that is activated by breathing into the anesthesia mask. During the refinement phase, concepts were shared and refined with input from families and clinical staff. This phase led to the development of a novel zoo-themed gaming app. Conclusions The design research process facilitated the creation of a new anxiety reduction tool for the perioperative environment. The breath-controlled induction app simultaneously employs multiple evidence-based anxiety reduction techniques and is designed to seamlessly integrate into the fast-paced perioperative workflow during key stress points. Testing in the clinical setting is needed to determine the effectiveness of the app for preoperative anxiety reduction.

This analysis applies a novel learning-curve methodology with uncertainty through Monte Carlo simulation to forecast market share of competing renewable fuel production technologies from 2025 through 2050. The analysis incorporates uncertainty in technology learning rate within Wright's Law, market rate of growth, and project-specific bidding to develop build-out scenarios for renewable hydrogen production capacity to serve the global market through 2050 with California as a proxy. Two major hydrogen production technologies are included: electrolyzers (with proton exchange membrane electrolytic cells as proxies) and thermochemical devices (with gasifiers as proxies). The method provides a quantitative foundation to forecasting technology shares in emerging sectors, overcomes the weakness of point estimates of relative cost that generally lead to binary behavior, and can support policy development and assessment of community impacts associated with the large-scale facility build-out needed to serve the growing demand for renewable hydrogen in transportation and other applications. Results show that biomass gasifiers are the dominant technology in the early market but the higher learning rate of electrolyzers and long-term trend of price decline for renewable electricity leads to equal shares for new installations by the mid-term and eventually to electrolyzers having the dominant share of new facilities. Electricity, biomass, and initial gasifier technology costs are the three primary factors impacting 2050 renewable hydrogen market composition.

Since 2003, the National Fuel Cell Research Center at the University of California, Irvine (UCI) has operated the first U.S. publicly accessible hydrogen refueling station (HRS). During this period, the UCI HRS supported all manufacturers in the early, pre-commercialization years of the fuel cell electric vehicle (FCEV). This paper describes and analyzes the performance of the UCI HRS during the first five years of FCEV commercialization, over which time the station has dispensed the most hydrogen daily in the California network. The station performance is compared to aggregate data published by NREL for all U.S. HRSs. Using the Hydrogen Delivery Scenario Analysis Model, typical daily refueling profiles are analyzed to determine the effect on HRS design. The results show different daily refueling profiles could substantially affect HRS design and ultimately the cost of hydrogen. While technical issues have been reduced, the compressor, dispenser, and fueling rate are areas for improvement.

Objectives:To examine the strengths and opportunities for improvement of current home care education practices to inform the development of the Home Care for Heart Health intervention, and to develop a web-based intervention for parents and clinicians with complimentary print materials that could provide the right education at the right time to foster a safer transition from hospital to home.Methods:An inter-professional focus group of parents, clinicians, and designers was formed to co-create a home care education intervention for parents of children with congenital heart disease (CHD) and their care team. We used the Integrated New Product Development process model created by Jonathon Cagan and Craig Vogel at Carnegie Mellon University to develop the intervention. This process model is a way of thinking that combines horizontal and inter-disciplinary teams, stakeholder-centric focus, and a system of qualitative discovery and development evolving towards quantitative methods of refinement.Results:Our team developed the Home Care for Heart Health intervention. The evidenced-based intervention includes a quick reference guide for parents of children with CHD, an accompanying app, family-friendly pathways, and clinician education.Conclusion:Using an inter-professional approach, our team of clinicians, parents, and design experts were able to co-create a clinician–parent home care education intervention with broad application and lifelong relevance to the Congenital Heart Disease Community.Practice Implications:Our intervention has the potential to be used as a model for other home care education interventions for parents of children with chronic illnesses.

BackgroundPaediatric surgery is a stressful experience for patients and caregivers. While standardised protocols are the norm, patient-centred approaches are needed to empower patients/caregivers for an optimal perioperative pain experience. To address this gap, we employed a patient-centred approach using design thinking (DT) methodology to develop insights, map processes, identify opportunities and design solutions for individualised empowerment tools.MethodsIn consultation with DT experts, a multidisciplinary team of stakeholders (healthcare providers, patients who underwent pectus excavatum/scoliosis surgery and their caregivers), were invited to participate in surveys, interviews and focus groups. The project was conducted in two sequential stages each over 24 weeks—involving 7 families in stage 1 and 16 patients/17 caregivers in stage 2. Each stage consisted of three phases: design research (focus groups with key stakeholders to review and apply collective learnings, map processes, stressors, identify influencing factors and opportunities), concept ideation (benchmarking and co-creation of new solutions) and concept refinement.ResultsIn stage 1, mapping of stress/anxiety peaks identified target intervention times. We identified positive and negative influencers as well as the need for consistent messaging from the healthcare team in our design research. Current educational tools were benchmarked, parent-child engagement dyads determined and healthcare-based technology-based solutions conceived. The ‘hero’s journey’ concept which has been applied to other illness paradigms for motivation successfully the was adapted to describe surgery as a transformative experience. In stage 2, patient and caregiver expectations, distinct personas and responses to perioperative experience were categorised. Educational tools and an empowerment tool kit based on sensorial, thinking, relaxation and activity themes, tailored to parent/child categories were conceptualised.ConclusionDT methodology provided novel family centred insights, enabling design of tailored empowerment toolkits to optimise perioperative experience. Adapting the hero’s journey call to adventure may motivate and build resilience among children undergoing surgery.

Plug-in fuel cell electric vehicles (PFCEVs) combine features of battery electric vehicles (BEVs) and fuel cell electric vehicles (FCEVs). With a 40-mile battery electric range (BER), the PFCEV provides unusually efficient driving. The BER also affords convenient recharging. The fuel cell and hydrogen fuel facilitate long range and quick refueling, removing range anxiety. With a small battery and fuel cell, the PFCEV maintains weight low and efficiency high. Thereby, PFCEVs are economically competitive with other vehicles and unusually efficient. This paper uses California as a case study of PFCEV deployment due to regulations that make it the first deployment area of alternative vehicle technology. If all vehicles in California today were PFCEVs, the hydrogen required would be significantly less than current hydrogen production for petroleum refining in California, and the electricity used would be 19% of California's current total demand. The BER capability suggests fewer hydrogen fueling stations needed to fuel PFCEVs compared to non-plug-in FCEVs. These results suggest that PFCEVs are an attractive candidate as the principal vehicle owned by the majority of the motoring public in the electric vehicle era.

Supplemental Digital Content is available in the text., Introduction: Greater than 70% of children who die in our institution annually die in an intensive care unit (ICU) setting. Family privacy, visitation policies, and an inability to perform religious rituals in the ICU are barriers to provide children with culturally competent, family-centered care when a child dies. The goal of this project was to profoundly understand family and staff experiences surrounding pediatric death in our institution to identify unique opportunities to design improved, novel delivery models of pediatric end of life (EOL) care. Methods: This project utilized a structured process model based on the Vogel and Cagan’s 4-phase integrated new product development process model. The 4 phases are identifying, understanding, conceptualizing, and realizing. We utilized an adaptation of this process model that relies on human-centered and design thinking methodologies in 3 phases: research, ideation, and refinement of a process or product opportunity. Results: There were 2 primary results of this project: 5 process and opportunity areas to improve the EOL experience across the hospital, and a set of criteria and considerations for a dedicated EOL space. Discussion: Sometimes, the best outcome we can provide for a child and their family is a peaceful, dignified death. This project utilized human-centered design to create improved process outcomes and to design a dedicated EOL space for children who die in the hospital. Offering grieving families quiet, private time with their child in a beautiful, dignified, peaceful location enables the beginning of improved bereavement outcomes for the family and staff.

The evolution of alternative vehicles is leading to an evolution in fuel, from electricity to hydrogen, and the associated fueling infrastructure. Using California as an example and a variety of tools (e.g., vehicle and electric grid simulation, travel surveys, census data, and GIS analyses), fueling supply chain and dispensing scenarios are evaluated and compared for conventional internal combustion vehicles (ICVs), vehicles bridging from conventional to alternative vehicles such as hybrid electric vehicles (HEVs) and plug-in hybrid electric vehicles (PHEVs), and alternative vehicles including battery electric vehicles (BEVs), fuel cell electric vehicles (FCEVs), and plug-in fuel cell electric vehicles (PFCEVs). When assessed for a 2050 timeframe, PFCEVs require less electric infrastructure compared to BEVs, and less hydrogen infrastructure compared to FCEVs. In addition, until 100% zero-emission fuel supply chains are achieved, PFCEVs reduce GHG and CAP emissions to a greater extent than BEVs and FCEVs.

The stress and uncertainty created by a child's cancer diagnosis and treatment can affect parent and child functioning. Health technology provides a potential avenue for intervention delivery. Interviews were conducted with parents of children diagnosed with cancer to discover their needs following diagnosis and design a relevant mobile application. Treatment experience was the overarching theme. Subthemes included the emotional response, use of information, and environmental factors. Technology was used primarily to seek out information and communicate with others. Health technologies are gaining popularity and have the potential to be beneficial for patients and families throughout the treatment experience.