Transportation emissions scenarios for New York City under different carbon intensities of electricity and electric vehicle adoption rates.

Like many cities around the world, New York City is establishing policies to reduce CO2 emissions from all energy sectors by 2050. Understanding the impact of varying degrees of electric vehicle adoption and CO2 intensities on emissions reduction in the city is critical. Here, using a technology-rich, bottom-up, energy system optimization model, we analyse the cost and air emissions impacts of New York City's proposed CO2 reduction policies for the transportation sector through a scenario framework. Our analysis reveals that the electrification of light-duty vehicles at earlier periods is essential for deeper reductions in air emissions. When further combined with energy efficiency improvements, these actions contribute to CO2 reductions under the scenarios of more CO2-intense electricity. Substantial reliance on fossil fuels and a need for structural change pose challenges to cost-effective CO2 reductions in the transportation sector. Here we find that uncertainties associated with decarbonization of the electric grid have a minimum influence on the cost-effectiveness of CO2 reduction pathways for the transportation sector.

Understanding Technology, Fuel, Market and Policy Drivers for New York State's Power Sector Transformation.

A thorough understanding of the drivers that affect the emission levels from electricity generation, support sound design and the implementation of further emission reduction goals are presented here. For instance, New York State has already committed a transition to 100% clean energy by 2040. This paper identifies the relationships among driving factors and the changes in emissions levels between 1990 and 2050 using the logarithmic mean divisia index analysis. The analysis relies on historical data and outputs from techno-economic-energy system modeling to elude future power sector pathways. Three scenarios, including a business-as-usual scenario and two policy scenarios, explore the changes in utility structure, efficiency, fuel type, generation, and emission factors, considering the non-fossil-based technology options and air regulations. We present retrospective and prospective analysis of carbon dioxide, sulfur dioxide, nitrogen oxide emissions for the New York State's power sector. Based on our findings, although the intensity varies by period and emission type, in aggregate, fossil fuel mix change can be defined as the main contributor to reduce emissions. Electricity generation level variations and technical efficiency have relatively smaller impacts. We also observe that increased emissions due to nuclear phase-out will be avoided by the onshore and offshore wind with a lower fraction met by solar until 2050.

Incorporating upstream emissions into electric sector nitrogen oxide reduction targets.

Electricity production is a major source of air pollutants in the U.S. Policies to reduce these emissions typically result in the power industry choosing to apply controls or switch to fuels with lower combustion emissions. However, the life-cycle emissions associated with various fuels can differ considerably, potentially impacting the effectiveness of fuel switching. Life-cycle emissions include emissions from extracting, processing, transporting, and distributing fuels, as well as manufacturing and constructing new generating capacity. The field of life-cycle analysis allows quantification of these emissions. While life-cycle emissions are often considered in greenhouse gas mitigation targets, they generally have not been included in air quality policymaking. We demonstrate such an approach, examining a hypothetical electric sector emission reduction target for nitrogen oxides (NOx) using the Global Change Assessment Model with U.S. state-level resolution. When only power plant emissions are considered in setting a NOx emission reduction target, fuel switching leads to an increase in upstream emissions that offsets 5% of the targeted reductions in 2050. When fuel extraction, processing, and transport emissions are included under the reduction target, accounting for 20% of overall NOx reduction goal, the resulting control strategy meets the required reductions and does so at 35% lower cost by 2050. However, manufacturing and construction emissions increase and offset up to 7% of NOx reductions in electric sector, indicating that it may be beneficial to consider these sources as well. Assuming no legal obstacles exist, life-cycle-based approaches could be implemented by allowing industry to earn reduction credits for reducing upstream emissions. We discuss some of the limitations of such an approach, including the difficulty in identifying the location of upstream emissions, which may occur across regulatory authorities or even outside of the U.S.

THE INCIDENCE OF MULTIPLE MYELOMA IN THE DNIPROPETROVSK REGION. / ZAKhVORIuVANIST' NA MNOZhYNNU MIIeLOMU V DNIPROPETROVS'KIY̆ OBLASTI.

OBJECTIVE: To conduct a comparative analysis of the incidence of MM in the population of the Dnipropetrovsk region, taking into account the possible impact of various adverse environmental factors (air, water and soil con- tamination). MATERIALS AND METHODS: Epidemiological indicators of multiple myeloma (MM) morbidity in the 12-year observation period from 2006 to 2017 are analyzed in polluted and conventionally clean areas of the Dnipropetrovsk region. RESULTS: In assessing the dynamics of morbidity in MM for years 2006-2017 there was an increase in the incidence in 2011, 2015 and quite stable indicators for 2006-2010. The analysis of morbidity in the industrial cities of the region showed consistently high rates for the entire period of observation. A marked increase in the incidence rate in the Zhovti Vody (2007, 2012, 2016), Nikopol (2016), Novomoskovsk (2016), Marganets (2008, 2009 and 2017), Pokrov (2016, 2017) from 4.35 to 6.25 was noted. This may indicate a fluctuation in the incidence of MM in sepa- rate large cities of Dnipropetrovsk. The analysis of the dynamics of morbidity in the most polluted cities showed a clear increase in the number of cases in the MM in Zhovti Vody, which is characterized by radiation pollution. According to the average annual morbidity rate among cities of Dnipropetrovsk region, Pokrov takes the first place, the second - Zhovti Vody. CONCLUSIONS: The obtained data testify to the fluctuation in the incidence of MM in the Dnipropetrovsk region during the period 2006-2017 and the negative environmental factors clearly affect the growth of morbidity in large industrialized cities contaminated with radioactive and chemical substances.

Age-Associated Changes in Antioxidants and Redox Proteins of Rat Heart.

Oxidative stress and decline in cellular redox regulation have been hypothesized to play a key role in cardiovascular aging; however, data on antioxidant and redox regulating systems in the aging heart are controversial. The aim of the present study was to examine the effect of aging on critical antioxidant enzymes and two major redox-regulatory systems glutathione (GSH) and thioredoxin (Trx) system in hearts from adult (6-month-old), old (15-month-old), and senescent (26-month-old) rats. Aging was associated with a non-uniform array of changes, including decline in contents of reduced GSH and total mercaptans in the senescent heart. The activities of Mn-superoxide dismutase (SOD2), glutathione peroxidase (GPx), glutathione reductase (GR), and thioredoxin reductase (TrxR) exhibited an age-related decline, whereas catalase was unchanged and Cu,Zn-superoxide dismutase (SOD1) displayed only slight decrease in old heart and was unchanged in the senescent heart. GR, Trx, and peroxiredoxin levels were significantly reduced in old and/or senescent hearts, indicating a diminished expression of these proteins. In contrast, SOD2 level was unchanged in the old heart and was slightly elevated in the senescent heart. Decline in GPx activity was accompanied by a loss of GPx level only in old rats, the level in senescent heart was unchanged. These results indicate age-related posttranslational protein modification of SOD2 and GPx. In summary, our data suggest that changes are more pronounced in senescent than in old rat hearts and support the view that aging is associated with disturbed redox balance that could alter cellular signaling and regulation.

What is the role of distributed energy resources under scenarios of greenhouse gas reductions? A specific focus on combined heat and power systems in the industrial and commercial sectors.

Combined heat and power (CHP) is promoted as an economical, energy-efficient option for reducing air emissions, mitigating carbon emissions and reducing reliance on grid electricity. However, its potential benefits have only been analyzed within the context of the current energy system. To fully examine the viability of CHP as a clean-technology alternative, its growth must be analyzed considering how the energy sector may transform under the influence of various technological and policy drivers that are specifically geared toward limiting greenhouse gas (GHG) emissions. Scenarios were developed through a bottom-up technology model of the U.S. energy system to determine the impacts on CHP development and both system-wide and sectoral GHG and air pollutant emissions. Various scenarios were considered, from CO2 emissions reductions in the electric generating units (EGU) sector to GHG reductions across the whole energy system while considering levels of CHP investment. The largest CHP investments were observed in scenarios that limited CO2 emission from the EGU sector alone. The investments were scaled back in the scenarios that incorporated energy system level GHG reductions. The energy system level reduction scenarios yielded rapid transformation of the EGU sector towards zeroemissions technologies as reliance on electricity increases with the electrification of the many end-use sectors such as buildings, transportation and industrial sectors, reducing investment in CHP. The prime mover and fuel choice heavily influenced the air pollutant emissions resulting in trade-offs among pollutants including GHG emissions. The results suggest that CHP could play a role in a future low-carbon energy system, but that role diminishes as carbon reduction targets increase.

Evolution of the United States Energy System and Related Emissions under Varying Social and Technological Development Paradigms: Plausible Scenarios for Use in Robust Decision Making.

The energy system is the primary source of air pollution. Thus, evolution of the energy system into the future will affect society's ability to maintain air quality. Anticipating this evolution is difficult because of inherent uncertainty in predicting future energy demand, fuel use, and technology adoption. We apply scenario planning to address this uncertainty, developing four very different visions of the future. Stakeholder engagement suggested that technological progress and social attitudes toward the environment are critical and uncertain factors for determining future emissions. Combining transformative and static assumptions about these factors yields a matrix of four scenarios that encompass a wide range of outcomes. We implement these scenarios in the U.S. Environmental Protection Agency MARKet ALlocation (MARKAL) model. Results suggest that both shifting attitudes and technology transformation may lead to emission reductions relative to the present, even without additional policies. Emission caps, such as the Cross-State Air-Pollution Rule, are most effective at protecting against future emission increases. An important outcome of this work is the scenario-implementation approach, which uses technology-specific discount rates to encourage scenario-specific technology and fuel choices. End-use energy demands are modified to approximate societal changes. This implementation allows the model to respond to perturbations in manners consistent with each scenario.

Non-convulsive status epilepticus: mimics and chameleons.

Non-convulsive status epilepticus (NCSE) is an enigmatic condition with protean manifestations. It often goes unrecognised, leading to delays in its diagnosis and treatment. The principal reason for such delay is the failure to consider and request an electroencephalogram (EEG), although occasional presentations have no scalp or surface electroencephalographic correlate. In certain settings with limited EEG availability, particularly out-of-hours, clinicians should consider treating without an EEG. Patients need a careful risk-benefit analysis to assess the risks of neuronal damage and harm versus the risks of adverse effects from various intensities of therapeutic intervention. Specialists in EEG, intensive care or epilepsy are invaluable in the management of patients with possible NCSE.

Clinical utility of EEG in diagnosing and monitoring epilepsy in adults.

Electroencephalography (EEG) remains an essential diagnostic tool for people with epilepsy (PWE). The International Federation of Clinical Neurophysiology produces new guidelines as an educational service for clinicians to address gaps in knowledge in clinical neurophysiology. The current guideline was prepared in response to gaps present in epilepsy-related neurophysiological assessment and is not intended to replace sound clinical judgement in the care of PWE. Furthermore, addressing specific pathophysiological conditions of the brain that produce epilepsy is of primary importance though is beyond the scope of this guideline. Instead, our goal is to summarize the scientific evidence for the utility of EEG when diagnosing and monitoring PWE.

Hidden in plain sight: Non-convulsive status epilepticus-Recognition and management.

Non-convulsive status epilepticus (NCSE) is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity. It can present in a multitude of ways, but classification based on the clinical presentation and electroencephalographic appearances assists in determining prognosis and planning treatment. The aggressiveness of treatment should be based on the likely prognosis and the underlying cause of the NCSE.

Role of natural gas in meeting an electric sector emissions reduction strategy and effects on greenhouse gas emissions.

With advances in natural gas extraction technologies, there is an increase in the availability of domestic natural gas, and natural gas is gaining a larger share of use as a fuel in electricity production. At the power plant, natural gas is a cleaner burning fuel than coal, but uncertainties exist in the amount of methane leakage occurring upstream in the extraction and production of natural gas. At higher leakage levels, the additional methane emissions could offset the carbon dioxide emissions reduction benefit of switching from coal to natural gas. This analysis uses the MARKAL linear optimization model to compare the carbon emissions profiles and system-wide global warming potential of the U.S. energy system over a series of model runs in which the power sector is required to meet a specific carbon dioxide reduction target across a number of scenarios in which the availability of natural gas changes. Scenarios are run with carbon dioxide emissions and a range of upstream methane emission leakage rates from natural gas production along with upstream methane and carbon dioxide emissions associated with production of coal and oil. While the system carbon dioxide emissions are reduced in most scenarios, total carbon dioxide equivalent emissions show an increase in scenarios in which natural gas prices remain low and, simultaneously, methane emissions from natural gas production are higher.

Effect of maturation on the resistance of rat hearts against ischemia. Study of potential molecular mechanisms.

Reduced tolerance to ischemia/reperfusion (IR) injury has been shown in elder human and animal hearts, however, the onset of this unfavorable phenotype and cellular mechanisms behind remain unknown. Moreover, aging may interfere with the mechanisms of innate cardioprotection (preconditioning, PC) and cause defects in protective cell signaling. We studied the changes in myocardial function and response to ischemia, as well as selected proteins involved in "pro-survival" pathways in the hearts from juvenile (1.5 months), younger adult (3 months) and mature adult (6 months) male Wistar rats. In Langendorff-perfused hearts exposed to 30-min ischemia/2-h reperfusion with or without prior PC (one cycle of 5-min ischemia/5-min reperfusion), we measured occurrence of reperfusion-induced arrhythmias, recovery of contractile function (left ventricular developed pressure, LVDP, in % of pre-ischemic values), and size of infarction (IS, in % of area at risk size, TTC staining and computerized planimetry). In parallel groups, LV tissue was sampled for the detection of protein levels (WB) of Akt kinase (an effector of PI3-kinase), phosphorylated (activated) Akt (p-Akt), its target endothelial NO synthase (eNOS) and protein kinase Cepsilon (PKCepsilon) as components of "pro-survival" cascades. Maturation did not affect heart function, however, it impaired cardiac response to lethal IR injury (increased IS) and promoted arrhythmogenesis. PC reduced the occurrence of malignant arrhythmias, IS and improved LVDP recovery in the younger animals, while its efficacy was attenuated in the mature adults. Loss of PC protection was associated with age-dependent reduced Akt phosphorylation and levels of eNOS and PKCepsilon in the hearts of mature animals compared with the younger ones, as well as with a failure of PC to upregulate these proteins. Aging-related alterations in myocardial response to ischemia may be caused by dysfunction of proteins involved in protective cell signaling that may occur already during the process of maturation.

Early predictors of refractory status epilepticus: an international two-center study.

BACKGROUND AND PURPOSE: Status epilepticus (SE) refractory to first- and second-line antiepileptic drugs carries high mortality. Little is known on early prediction of refractory SE (RSE)­an essential tool for planning appropriate therapy. Our aim was to identify and validate independent early RSE predictors in adults. METHODS: Clinical and laboratory data on consecutive intensive care unit patients with SE from two academic care centers (a derivation data set from a Swiss center and a validation data set from a US center) were assessed. Multivariable analysis was performed with the derivation set to identify RSE predictors at SE onset. Their external validity was evaluated with an independent validation set. Measures of calibration and discrimination were assessed. RESULTS: In all, 302 patients were analyzed (138 with and 164 without RSE), 171 in the derivation data set and 131 in the validation data set. Acute SE etiology, coma/stupor and serum albumin <35 g/l at SE onset were independent predictors for RSE in the derivation data set [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.01-4.07; OR 4.83, 95% CI 2.42-9.68; OR 2.45, 95% CI 1.16-5.16]. The prediction model showed good measures of calibration (Hosmer-Lemesow goodness-of-fit test P = 0.99) and discrimination (area under the receiver operating characteristic curve 0.8) on the derivation data set­results that were similar in the validation data set (Hosmer-Lemeshow P = 0.24; area under the receiver operating characteristic curve 0.73). CONCLUSIONS: This study confirms the independent prognostic value of readily available parameters for early RSE prediction. Prospective studies are needed to identify additional robust predictors, which could be added to the proposed model for further optimization towards a reliable prediction scoring system.

Electroencephalographic sleep elements and outcome in acute encephalopathic patients: a 4-year cohort study.

BACKGROUND AND PURPOSE: Acute encephalopathy in hospitalized patients is common and associated with high mortality. Preservation of physiological sleep has been associated with favorable outcomes in acute brain injury. It is hypothesized that electroencephalographic presence of sleep elements is associated with good outcome in encephalopathic adults. METHODS: This observational study was performed at an academic tertiary medical care center. Clinical data, electroencephalogram (EEG) characteristics and outcome of critically ill patients with acute encephalopathy were assessed. EEGs were interpreted regarding the presence of sleep elements (K-complexes, vertex sharp-waves and sleep spindles). Associations between sleep elements and outcome (graded by the Glasgow Outcome Scale, GOS) were analyzed. RESULTS: One hundred and forty-two consecutive patients with a median age of 64.5 years (range 18-98) and mean Glasgow Coma Scale 10.4 (± 3.8) were included. Leading etiologies were infections (47.2%), intracranial hemorrhages (14.1%) and ischaemic strokes (10.6%). All EEGs demonstrated encephalopathy patterns and 38% had ≥ 1 sleep element (27.5% K-complexes, 31.7% vertex sharp-waves and 33.8% sleep spindles). Patients without sleep elements were older (P = 0.010) and septic shock was more common (P = 0.014). Amongst sleep elements, K-complexes were significantly associated with good outcome, even after adjusting for possible confounders (odds ratio for GOS 5 = 2.79, 95% confidence interval 1.16-6.69) and without significant effect modification across subgroups. CONCLUSIONS: Whilst EEG sleep elements were detected more frequently in patients with favorable outcome, only K-complexes were significantly and independently associated with good outcome in intensive care unit patients with acute encephalopathy, findings that need to be confirmed in larger prospective studies.

Uncovering clinical and radiological associations of triphasic waves in acute encephalopathy: a case-control study.

BACKGROUND AND PURPOSE: Triphasic waves (TWs) are archetypal waveforms seen on electroencephalography (EEG) in some forms of encephalopathy. Their particular underlying pathological substrates are largely unexplored. This case-control study was designed to identify and quantify specific clinical and neuroradiological associations underlying TWs and to determine if TWs predicate outcome. METHODS: From 2004 to 2012, adult encephalopathic patients with TWs (cases) were matched 1:1 with encephalopathic patients without TWs (controls) by Glasgow Coma Scale (GCS) and the frequency range of EEG background activity. Clinical characteristics, neuroimaging and outcomes were assessed. RESULTS: The mean age of 190 patients (95 with and 95 without TWs) was 66.6 years (±15.6). In multivariable analyses, patients with TWs had significantly higher odds for liver insufficiency [odds ratio (OR) = 8.10, 95% confidence interval (CI) 1.98-33.08], alcohol abuse (OR = 3.65, 95% CI 1.25-10.63), subcortical brain atrophy (OR = 2.82, 95% CI 1.39-5.71) and respiratory tract infections (OR = 1.28, 95% CI 1.01-4.71). With each additional independent predictor, the odds increased for the occurrence of TWs (1 predictor, OR = 2.40, 95% CI 1.16-5.13; ≥2 predictors, OR = 9.20, 95% CI 3.27-25.62). Mortality was 15% and tended to be higher in patients with TWs (19% with vs. 11% without TWs). CONCLUSIONS: Alcohol abuse, liver insufficiency, infections and subcortical brain atrophy were independently associated with TWs in patients matched for clinical and EEG features of encephalopathy. These associations strengthen the hypothesis that TWs evolve from an interplay of pathological neurostructural, metabolic and toxic conditions. When matched for EEG background activity and GCS, TWs were not associated with death.

Slow pseudoperiodic lateralized epileptiform discharges in nonconvulsive status epilepticus in a patient with cerebral palsy and a large central meningioma.

The presence of cerebral palsy and that of slow growing brain tumors are risk factors for convulsive and nonconvulsive status epilepticus. Nonconvulsive status epilepticus (NCSE) needs electroencephalographic (EEG) monitoring to be confirmed as it may be clinically subtle. Furthermore, it may present with a variety of ictal EEG morphologies. We report a case of a patient with cerebral palsy and a large central meningioma. Electroencephalogram showed a slow pattern of periodic lateralized epileptiform discharges (PLEDs) (a pattern considered as being situated in the ictal-interictal continuum) on an alpha background. The patient was treated for NCSE successfully with benzodiazepines followed by up-titration of his antiepileptic drug doses.