Clean energy technologies are widely recognized as a part of the solution for a sustainable future. Unfortunately, these technologies often rely on materials that are considered critical because of ...their importance to the technology and their potential for supply disruptions, which often lead to drastic and unexpected price spikes. With many clean energy technologies still struggling to compete economically with incumbent technologies, it is uncertain if such material price changes could have a significant economic impact on overall clean energy technology costs. In this paper, we first estimate material intensity of critical materials for three case study clean energy technologies: proton exchange membrane (PEM) fuel cells in fuel cell electric vehicles (FCEVs), neodymium iron boron (NdFeB) permanent magnets in direct drive wind turbines, and Li-ion batteries in battery electric vehicles (BEVs). Using these data, as well as material price information, we analyze technology-level costs under potential material price spike scenarios. By benchmarking against target costs at which each technology is expected to become economically competitive relative to incumbent energy systems, we evaluate the impact of price spikes on marketplace competitiveness. For the three case studies, technological costs could increase by between 13 and 41% if recent historical price events were to recur at current material intensities. By analyzing the economic impact of material price changes on technology-level costs, we demonstrate the need for stakeholders to push for various supply risk reduction measures, which are also summarized in this paper.
Current concerns about lack of diversity in supply of critical metals have spurred research into utilizing domestic sources, particularly from waste streams. Sustainability strategies like urban ...mining, industrial symbiosis, and the circular economy suggest avenues to realize new supplies of critical metals. In this work we explore the resource and economic potential for extracting rare earth elements (REEs) from industry byproducts (e.g. coal combustion products, red mud) and secondary sources (e.g. waste electronics and light bulbs). Combining materials flow analysis and characterization data, we find that while REE concentrations in waste and byproduct streams are mostly much lower than current REE ores, some secondary sources are richer than ores in high value REEs such as scandium. The quantities of REEs contained in secondary sources could meet current global demand even with low extraction yield rates. Phosphogypsum, coal ash and red mud from aluminum production stand out as promising candidates for recovery due to high concentrations of valuable REEs and sufficient quantities to potentially meet demand. Processes to extract REEs from secondary sources are under development, it is not yet clear which will be profitable at scale and which can be achieved at least environmental impact. This work provides high level guidance on the potential of secondary sources by characterizing quality (concentrations of different rare earths) and quantity (mass of rare earths in global scale wastes and byproducts). This significant first step helps clarify directions for policy and research and development investments.
Introduction:
In 2017, approximately 295,000 women died during and immediately following pregnancy and childbirth worldwide, with 94% of these deaths occurring in low-resource settings. The Dominican ...Republic (DR) exhibits one of the highest maternal mortality ratios in the region of Latin America and the Caribbean despite the fact that 99% of registered births in the country are reportedly attended by a skilled birth attendant. This paradox implies that programs to support healthcare worker knowledge and skills improvement are vital to improving maternal health outcomes in the DR. Helping Mothers Survive (HMS) is a provider training program developed by Jhpiego and global partners. The goal of HMS is to combat maternal mortality by contributing to quality improvement efforts that reinforce maternal health skills of local healthcare workers.
Methods:
An international, multisectoral group of stakeholders collaborated in the implementation of two HMS curricula, Bleeding After Birth (BAB) and pre-eclampsia & eclampsia (PE&E). Demographic information as well as pre- and post-training knowledge scores were recorded for each participant. Knowledge score improvement was assessed in order to support effectiveness of the program on knowledge acquisition of healthcare workers.
Results:
Three hundred and twenty healthcare workers participated in the HMS training workshops between October 2016–August 2020. Of the 320 participants, 132 were trained as master trainers. The majority of participants identified as attending physicians, followed by residents/interns, nurses, students, and “other.” A significant improvement in knowledge scores was observed for both the BAB and PE&E curricula, with a 21.24 and 30.25% change in average score (pre- to post-test), respectively. In response to COVID-19 pandemic restrictions, flexibility of the local team led to a PE&E virtual training pilot workshop in August 2020.
Discussion/Conclusions:
Simulation-based training improved the knowledge levels of healthcare workers for both HMS curricula. These results suggest that simulation-based workshops have an impact on knowledge acquisition and skills of healthcare workers immediately following training. For the PE&E curriculum, no significant difference in knowledge acquisition was observed between in-person and virtual training sessions. The ongoing pandemic poses challenges to program implementation; however, these preliminary results provide evidence that conducting virtual workshops may be a viable alternative to in-person training.
A 2009 community needs assessment highlighted the health care gap facing Hispanic residents in Hampton, Virginia, one of the major cities served by Eastern Virginia Medical School (EVMS). Survey ...respondents indicated the following as health care barriers: language, lack of knowledge, and lack of a community health center. EVMS students worked to bridge the health care gap between existing needs and services by establishing and maintaining the Clínica Comunitaria Esperanza, a culturally and linguistically competent student-run free clinic serving uninsured Hispanics in the Hampton Roads area. This article provides a model for engaging effectively with a priority population through partnerships that facilitate understanding of the community concerns, values, culture, and existing local resources that serve as determinants of health. This article further illustrates how the integration of two preexisting EVMS programs, the HOPES (Health Outreach Partnership of EVMS Students) Clinic and the Medical Spanish program, has supported the development and sustainability of Clínica Comunitaria Esperanza. The HOPES Clinic is a student-run free clinic that provides both general and specialty care to uninsured patients. EVMS’ Medical Spanish program is a longitudinal service learning initiative composed of medical students, faculty, and staff dedicated to providing inclusive health care to meet the needs of the local Spanish-speaking community.
Current concerns about lack of diversity in supply of critical metals have spurred research into utilizing domestic sources, particularly from waste streams. Sustainability strategies like urban ...mining, industrial symbiosis, and the circular economy suggest avenues to realize new supplies of critical metals. In this work we explore the resource and economic potential for extracting rare earth elements (REEs) from industry byproducts (e.g. coal combustion products, red mud) and secondary sources (e.g. waste electronics and light bulbs). Combining materials flow analysis and characterization data, we find that while REE concentrations in waste and byproduct streams are mostly much lower than current REE ores, some secondary sources are richer than ores in high value REEs such as scandium. The quantities of REEs contained in secondary sources could meet current global demand even with low extraction yield rates. Phosphogypsum, coal ash and red mud from aluminum production stand out as promising candidates for recovery due to high concentrations of valuable REEs and sufficient quantities to potentially meet demand. Processes to extract REEs from secondary sources are under development, it is not clear yet which will be profitable at scale and which can be achieved at least environmental impact. This work provides high level guidance on the potential of secondary sources by characterizing quality (concentrations of different rare earths) and quantity (mass of rare earths in global scale wastes and byproducts). This significant first step helps clarify directions for policy and research and development investments.
Abstract Introduction Effective communication is critical to crisis situations. Crisis resource management (CRM) has been an established part of the anesthesiology curriculum for close to 20 years ...and in emergency departments for the better part of the decade. However, it has yet to find a place in pediatrics training. Pediatric crises occur less often than in other specialties and are different from adult crises, and they are uniquely stressful. Because of their rare occurrence, students and residents are often ill-prepared when they arise. In response to this, we designed a 90-minute simulation module to introduce third-year medical students to the principles of CRM on a high-fidelity simulator during their pediatric clerkship. Methods This module has been written with a focus on discussing improvements that could have been made during each simulation activity. A debriefing session directly follows each simulation activity at which time the observers provide feedback to the participating student. Included in this submission are a guide to the module, a synopsis of both respiratory-to-cardiac-arrest simulation cases, CRM lecture slides, a bag-valve-mask skills workshop, and a student evaluation. Results One hundred thirty-eight medical students participated in our module during their pediatric clerkship. A subjective assessment showed statistically significant improvement in attitudes and confidence of medical students immediately after participating in the simulation session. Specifically, students reported that they felt more comfortable in a pediatric resuscitation (p < .001, 35% change in those who agreed) after participating in this module. They also reported feeling better able to communicate well in a pediatric resuscitation (p < .001, 41% change in those who agreed) and better at understanding what their role was during a pediatric resuscitation (p < .001, 62% change in those who agreed). Discussion Although this module may be completed in a 60-minute time slot, we recommend at least 90 minutes if including the manual bag-valve mask skills component, in order to have time for a more thorough debriefing. We limited our evaluations to manual bag-valve mask skills and CRM skills. Similar modules may be used several times during a student's pediatric rotation in order to focus on additional manual and communication skills. In the future, we hope to implement a multi-institutional study using these materials as the basis of future research.
Background: Uninsured patients (8.6% of the United States population) are more likely to have poorly controlled diabetes and hypertension, which can lead to altered vision or even blindness. Checking ...vital signs regularly is important in monitoring chronic diseases to prevent poorer health outcomes, especially in populations with limited access to care. HOPES (Health Outreach Partnership of Eastern Virginia Medical School Students) and CCE (Clínica Comunitaria Esperanza) are student-run free clinics that serve the uninsured population of Hampton Roads, Virginia. This study describes the services offered and examines trends in measuring vital signs at HOPES and CCE Ophthalmology Clinics to evaluate clinical operations and areas for improvement.
Methods: A retrospective chart review of 347 HOPES and CCE Ophthalmology appointments from January 2015 to June 2021 explored patient demographics, vital sign measurement, reason for visit, diagnoses, and services provided. Chi-square tests were utilized to compare the measurement of vital signs between the two clinics.
Results: 179 appointments met inclusion criteria. Of the 39 different reasons for visit, the most common were blurry vision, diabetic eye exams, floaters, and systemic hypertension. Of the 63 distinct diagnoses made, the most common were cataracts, diabetes with or without retinopathy, and presbyopia. A total of 175 services were provided, including 61 custom frames and glasses, 48 prescriptions for glasses, 54 medications, and 26 referrals to other providers. Vital signs were obtained during 113 appointments (63.10%) and the frequency of vital sign measurement differed significantly between the two clinics (68.80% at HOPES and 50.00% at CCE), p = 0.02.
Conclusion: Vital signs were not consistently obtained at the HOPES and CCE Ophthalmology clinics despite diabetes and hypertension, diseases with known ophthalmologic sequelae, representing primary reasons for visit. Findings are a call to action for quality improvement measures in clinics to enforce vital sign measurement during every encounter.
The uninsured Hispanic pediatric population in the United States faces significant challenges in accessing medical care due to language barriers, citizenship status, and limited access to health ...insurance. Clínica Comunitaria Esperanza Pediátrica (CCE-P) is a bilingual student-run free clinic created to provide healthcare to the underserved population in southeastern Virginia. This study further details the creation, implementation, and early outcomes of CCE-P as well as barriers encountered throughout the process. It describes four critical steps in establishing CCE-P, including leveraging existing institutional partnerships, ensuring high standards of care, prioritizing community outreach, and implementing a quality improvement program. Study outcomes include a demographic characterization of the 46 pediatric patients served by CCE-P, a description of clinic services, and an analysis of gaps in care and strategies to provide more comprehensive health services. This publication serves as an outline to an adaptable model that other organizations may use to establish similar clinics in their own communities.
Within the response and recovery phases of the disaster management cycle, debris clean-up is a well-researched topic, around which numerous policies have been developed. However, the subcategory of ...electronic waste is an issue that is overlooked by existing studies. A theoretical case study of a flood of the Rhine river in Bonn, Germany is used to demonstrate that while electronic waste may be a small portion of the debris generated during a disaster (by volume), it can have disproportionately large health, economic, and environmental consequences if not effectively planned for and handled. A spatial analysis of a flooding disaster scenario in Bonn was conducted to estimate the quantity of electronic waste that could be generated from residential buildings. Further modeling was done to calculate the greenhouse gas savings, energy savings, and economic impacts that can be realized through proper recovery and recycling of the electronic waste created by the flood. One key finding is that while implementation may be difficult, ensuring that effective policy is in place prior to a disaster can enable this waste stream to be managed in a manner that mitigates negative impacts on the environment and human health and keeps valuable materials in circulation.
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