The use of direct current distribution systems in delivering scalable charging infrastructure for battery electric vehicles

The use of low voltage direct current (LVDC) distribution is becoming recognised as a technology enabler that can be used to efficiently network native DC generators with DC loads, offer improved power sharing capabilities, reduce power system material resource requirements and enhance the performance of variable speed machinery. Practical deployment opportunities for LVDC range from small-scale microgrids in the context of energy for development to sophisticated, modern building-level power distribution systems for commercial office spaces, manufacturing applications and industrial processes. However, the incumbent AC distribution system benefits from existing technical product and safety standards, which makes the early adoption of LVDC systems challenging from a risk and cost perspective. Concurrently, the demand for native DC loads such as Battery Electric Transportation Systems is growing. This is especially significant in the area of private electric vehicles (EVs), taxis and buses, but the prospect of electric trucks, ferries and shortrange aircraft are also tangible opportunities. The success of this electric transport revolution depends on several factors, one of which is the availability of battery charging infrastructure that can cost effectively integrate with the existing electrical network, deliver adequate energy transfer rates and adapt to the rapid technical development of this industry. This thesis explores the application of two, novel LVDC distribution systems for the development of scalable EV charging networks; where charging infrastructure has the ability to scale with increasing EV adoption and has a lower risk of becoming a stranded asset in the future. The modelling is supported by real, rapid DC charger utilisation data from the national charging network in Scotland, comprising over 192 chargers and 400,000 charging events. During the work of this thesis, it was found that a combined heat and power (CHP) system can economically support short duration charging scenarios by providing additional power capacity in a congested electrical grid. In this case the highest system efficiency and Net Present Value (NPV) is achieved with a fuel cell directly connected to the DC charging network, compared to other gas reciprocating CHP options. Furthermore, the proposition of a reconfigurable LVDC charging network, interfaced to the public AC distribution network, reduces the capital outlay, offers a higher NPV and improved scalability compared to other charging solutions. For charging system designers and operators, it was found that rapid DC chargers can be classified by specific locations, each possessing a distinct Gaussian arrival pattern and Gamma distribution for charging energy delivered.The use of low voltage direct current (LVDC) distribution is becoming recognised as a technology enabler that can be used to efficiently network native DC generators with DC loads, offer improved power sharing capabilities, reduce power system material resource requirements and enhance the performance of variable speed machinery. Practical deployment opportunities for LVDC range from small-scale microgrids in the context of energy for development to sophisticated, modern building-level power distribution systems for commercial office spaces, manufacturing applications and industrial processes. However, the incumbent AC distribution system benefits from existing technical product and safety standards, which makes the early adoption of LVDC systems challenging from a risk and cost perspective. Concurrently, the demand for native DC loads such as Battery Electric Transportation Systems is growing. This is especially significant in the area of private electric vehicles (EVs), taxis and buses, but the prospect of electric trucks, ferries and shortrange aircraft are also tangible opportunities. The success of this electric transport revolution depends on several factors, one of which is the availability of battery charging infrastructure that can cost effectively integrate with the existing electrical network, deliver adequate energy transfer rates and adapt to the rapid technical development of this industry. This thesis explores the application of two, novel LVDC distribution systems for the development of scalable EV charging networks; where charging infrastructure has the ability to scale with increasing EV adoption and has a lower risk of becoming a stranded asset in the future. The modelling is supported by real, rapid DC charger utilisation data from the national charging network in Scotland, comprising over 192 chargers and 400,000 charging events. During the work of this thesis, it was found that a combined heat and power (CHP) system can economically support short duration charging scenarios by providing additional power capacity in a congested electrical grid. In this case the highest system efficiency and Net Present Value (NPV) is achieved with a fuel cell directly connected to the DC charging network, compared to other gas reciprocating CHP options. Furthermore, the proposition of a reconfigurable LVDC charging network, interfaced to the public AC distribution network, reduces the capital outlay, offers a higher NPV and improved scalability compared to other charging solutions. For charging system designers and operators, it was found that rapid DC chargers can be classified by specific locations, each possessing a distinct Gaussian arrival pattern and Gamma distribution for charging energy delivered

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Helping Patients Engage in Specialty Care

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 4: "Helping Patients Engage in Specialty Care"Specialty care actors are increasingly addressing the social determinants of health with community outreach, patient navigation, and patient support services

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Ensuring High-Quality Specialty Care

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 3: "Ensuring High-Quality Specialty Care"New efforts to mitigate provider implicit bias, establish culturally-competent care, and leverage quality improvement approaches help identify and eliminate disparities in care

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Increasing Specialty Care Availability

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 2: "Increasing Specialty Care Availability"Solutions such as telemedicine, innovative partnerships between specialists and primary care physicians, and centralized local referral networks improve access to specialty care

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Call to Action for a System-wide Focus on Equity

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 5: "Call to Action for a System-wide Focus on Equity"These solutions create value not only for patients, but also for health care providers and public and private payers.  Each of these actors have a role to play in scaling and sustaining the health equity solutions.

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Striving for Equity in Specialty Care

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Part 1: "Striving for Equity in Specialty Care"A complex set of barriers to specialty care create Health inequities for many Americans, but the current healthcare landscape provides an opportune moment to address this challenge

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Striving for Equity in Specialty Care Full Report

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.

Delayed intraventricular metastasis of clival chordoma

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author’s publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml