Insights from Adding Transportation Sector Detail into an Economy-Wide Model: The Case of the ADAGE CGE Model.

Computable general equilibrium (CGE) models provide valuable insights into economy-wide impacts of anticipated future structural changes in the transportation sector, yet few CGE models offer detailed transportation representations. We use an enhanced Applied Dynamic Analysis of the Global Economy (ADAGE) CGE model to incorporate disaggregated transportation modes and technologies in on-road passenger and freight transportation. We assess the impacts of these inclusions on U.S. transportation patterns, energy consumption and greenhouse gas emissions. Simulating illustrative global oil price cases with and without transportation detail, we find subsector mode disaggregation and technology additions in a CGE model significantly alter the impacts of oil prices on global trade and freight patterns, energy consumption, and greenhouse gas (GHG) emissions. We find that: (1) alternative technologies are essential for capturing transportation sector impacts, (2) electrification may reduce emissions with electricity decarbonization, and (3) higher oil prices may hasten electrification.

Land-based measures to mitigate climate change: Potential and feasibility by country.

Land-based climate mitigation measures have gained significant attention and importance in public and private sector climate policies. Building on previous studies, we refine and update the mitigation potentials for 20 land-based measures in >200 countries and five regions, comparing "bottom-up" sectoral estimates with integrated assessment models (IAMs). We also assess implementation feasibility at the country level. Cost-effective (available up to $100/tCO2 eq) land-based mitigation is 8-13.8 GtCO2 eq yr-1 between 2020 and 2050, with the bottom end of this range representing the IAM median and the upper end representing the sectoral estimate. The cost-effective sectoral estimate is about 40% of available technical potential and is in line with achieving a 1.5°C pathway in 2050. Compared to technical potentials, cost-effective estimates represent a more realistic and actionable target for policy. The cost-effective potential is approximately 50% from forests and other ecosystems, 35% from agriculture, and 15% from demand-side measures. The potential varies sixfold across the five regions assessed (0.75-4.8 GtCO2eq yr-1 ) and the top 15 countries account for about 60% of the global potential. Protection of forests and other ecosystems and demand-side measures present particularly high mitigation efficiency, high provision of co-benefits, and relatively lower costs. The feasibility assessment suggests that governance, economic investment, and socio-cultural conditions influence the likelihood that land-based mitigation potentials are realized. A substantial portion of potential (80%) is in developing countries and LDCs, where feasibility barriers are of greatest concern. Assisting countries to overcome barriers may result in significant quantities of near-term, low-cost mitigation while locally achieving important climate adaptation and development benefits. Opportunities among countries vary widely depending on types of land-based measures available, their potential co-benefits and risks, and their feasibility. Enhanced investments and country-specific plans that accommodate this complexity are urgently needed to realize the large global potential from improved land stewardship.

Importance of Cross-Sector Interactions When Projecting Forest Carbon across Alternative Socioeconomic Futures.

In recent decades, the carbon sink provided by the U.S. forest sector has offset a sizable portion of domestic greenhouse gas (GHG) emissions. In the future, the magnitude of this sink has important implications not only for projected U.S. net GHG emissions under a reference case but also for the cost of achieving a given mitigation target. The larger the contribution of the forest sector towards reducing net GHG emissions, the less mitigation is needed from other sectors. Conversely, if the forest sector begins to contribute a smaller sink, or even becomes a net source, mitigation requirements from other sectors may need to become more stringent and costlier to achieve economy wide emissions targets. There is acknowledged uncertainty in estimates of the carbon sink provided by the U.S. forest sector, attributable to large ranges in the projections of, among other things, future economic conditions, population growth, policy implementation, and technological advancement. We examined these drivers in the context of an economic model of the agricultural and forestry sectors, to demonstrate the importance of cross-sector interactions on projections of emissions and carbon sequestration. Using this model, we compared detailed scenarios that differ in their assumptions of demand for agriculture and forestry products, trade, rates of (sub)urbanization, and limits on timber harvest on protected lands. We found that a scenario assuming higher demand and more trade for forest products resulted in increased forest growth and larger net GHG sequestration, while a scenario featuring higher agricultural demand, ceteris paribus led to forest land conversion and increased anthropogenic emissions. Importantly, when high demand scenarios are implemented conjunctively, agricultural sector emissions under a high income-growth world with increased livestock-product demand are fully displaced by substantial GHG sequestration from the forest sector with increased forest product demand. This finding highlights the potential limitations of single-sector modeling approaches that ignore important interaction effects between sectors.

Re-Searching for Hidden Costs: Evidence from the Adoption of Fuel-Saving Technologies in Light-Duty Vehicles.

A variety of fuel-saving technologies have been implemented in light-duty vehicles since 2012 under the U.S. Environmental Protection Agency's (EPA) and Department of Transportation (DOT)'s light-duty vehicle greenhouse gas emissions and fuel economy standards. Questions have arisen whether there are hidden costs that have not been included in the net benefit calculations as a result of adoption of the new technologies. In this paper, we replicate and expand results from Helfand et al. (2016). We define hidden costs of the new technologies as problems with operational characteristics such as acceleration, handling, ride comfort, noise, braking feel, and vibration, not all of which are easily measured by objective criteria. We overcome the empirical challenge by using data coded from online professional auto reviews that qualitatively evaluate fuel-saving technologies and operational characteristics for model years 2014 and 2015 vehicles. We estimate relationships of fuel-saving technologies and operational characteristics, including an overall vehicle assessment, and find little correlation of hidden costs with the technologies themselves. Variable quality of implementation of technologies across automakers may better explain negatively evaluated operational characteristics. The results imply that automakers have typically been able to implement fuel-saving technologies without harm to vehicle operational characteristics.

Consumer Willingness to Pay for Vehicle Attributes: What Do We Know?

As standards for vehicle greenhouse gas emissions and fuel economy have become more stringent, concerns have arisen that the incorporation of fuel-saving technologies may entail tradeoffs with other vehicle attributes important to consumers such as acceleration performance. Assessing the effects of these tradeoffs on consumer welfare requires estimates of both the degree of the tradeoffs, and consumer willingness to pay (WTP) for the foregone benefits. This paper has two objectives. The first is to review recent literature that presents, or can be used to calculate, marginal WTP (MWTP) for vehicle attributes to describe the attributes that have been studied and the estimated MWTP values. We found 52 U.S.-focused papers with sufficient data to calculate WTP values for 142 different vehicle attributes, which we organized into 15 general groups of comfort, fuel availability, fuel costs, fuel type, incentives, model availability, non-fuel operating costs, performance, pollution, prestige, range, reliability, safety, size, and vehicle type. Measures of dispersion around central MWTP values typically show large variation in MWTP values for attributes. We explore factors that may contribute to this large variation via analysis of variance (ANOVA) and find that, although most have statistically significant effects, they account for only about one third of the observed variation. Case studies of papers that provide estimates from a variety of model formulations and estimation methods suggest that decisions made by researchers can strongly influence MWTP estimates. The paper's second objective is to seek consensus estimates for WTP for fuel cost reduction and increased acceleration performance. Meta-analysis of MWTP for reduced fuel cost indicates that estimates based on revealed vs. stated preference data differ, as do estimates from models that account for endogeneity and those that do not. We find greater consistency in estimates of MWTP for acceleration despite substantial uncertainty about the overall mean. We conclude with recommendations for improving the understanding of consumers' MWTP for vehicle attributes.

Visual field defects after radiosurgery for mesial temporal lobe epilepsy.

PURPOSE: Gamma knife radiosurgery (RS) may be an alternative to open surgery for mesial temporal lobe epilepsy (MTLE), but morbidities and the anticonvulsant mechanisms of RS are unclear. Examination of visual field defects (VFDs) after RS may provide evidence of the extent of a postoperative fixed lesion. VFDs occur in 52-100% of patients following open surgery for MTLE. METHODS: This multicenter prospective trial of RS enrolled patients with unilateral hippocampal sclerosis and concordant video-electroencephalography (EEG) findings. Patients were randomized to low (20 Gy) or high (24 Gy) doses delivered to the amygdala, hippocampal head, and parahippocampal gyrus. Postoperative perimetry were obtained at 24 months after RS. Visual field defect ratios (VFDRs) were calculated to quantify the degree of VFDs. Results were contrasted with age, RS dose and 50% isodose volume, peak volume of radiation-induced change at the surgical target, quality of life measurements, and seizure remission. KEY FINDINGS: No patients reported visual changes and no patients had abnormal bedside visual field examinations. Fifteen (62.5%) of 24 patients had postoperative VFDs, all homonymous superior quadrantanopsias. None of the VFDs were consistent with injury to the optic nerve or chiasm. Clinical diagnosis of VFDs correlated significantly with VFDRs (p = 0.0005). Patients with seizure remission had smaller (more severe) VFDRs (p = 0.04). No other variables had significant correlations. SIGNIFICANCE: VFDs appeared after RS in proportions similar to historical comparisons from open surgery for MTLE. The nature of VFDs was consistent with lesions of the optic radiations. The findings support the hypothesis that the mechanism of RS involves some degree of tissue damage and is not confined entirely to functional changes in neuromodulation.

Microcap pharmaceutical firms: linking drug pipelines to market value.

This article examines predictors of the future market value of microcap pharmaceutical companies. This is problematic since the large majority of these firms seldom report positive net income. Their value comes from the potential of a liquidity event such as occurs when a key drug is approved by the FDA. The typical scenario is one in which the company is either acquired by a larger pharmaceutical firm or enters into a joint venture with another pharmaceutical firm. Binary logistic regression is used to determine the impact of the firm's drug treatment pipeline and its investment in research and development on the firm's market cap. Using annual financial data from 2007 through 2010, this study finds that the status of the firm's drug treatment pipeline and its research and development expenses are significant predictors of the firm's future stock value relative to other microcap pharmaceutical firms.

Effective options for addressing air quality- related environmental public health burdens in Saudi Arabia.

Air pollution poses major disease burdens globally and accounts for approximately 10% of deaths annually through its contribution to a variety of respiratory, cardiovascular, and other diseases. The burden of disease is particularly acute in Saudi Arabia, where a mix of anthropogenic and natural sources of air pollution threatens public health. Addressing these burdens requires careful study of the costs and effectiveness of available technologies and policies for reducing emissions (mitigation) and avoiding exposure (adaptation). To help evaluate these options, we conduct a semi-systematic literature review of over 3,000 articles published since 2010 that were identified by searches of literature focused on pollution mitigation and pollution adaptation. We identify a wide variety of effective mitigation and adaptation technologies and find that cost-effectiveness information for policy design is highly variable in the case of mitigation, both within and across pollution source categories; or scarce, in the case of adaptation. While pollution control costs are well studied, policy costs differ; these may vary more by location because of factors such as technology operating conditions and behavioral responses to adaptation initiatives, limiting the generalizability of cost-effectiveness information. Moreover, potential cost advantages of multipollutant control policies are likely to depend on the existing mix of pollution sources and controls. While the policy literature generally favors more flexible compliance mechanisms that increase the cost of polluting to reflect its costs to society, important policy design factors include policy co-benefits, distributional concerns, and inter-regional harmonization. In addition to these key themes, we find that further study is needed both to improve the availability of cost information for adaptation interventions and to localize technology and policy cost estimates to the Saudi context.

Global cost estimates of reducing carbon emissions through avoided deforestation.

Tropical deforestation is estimated to cause about one-quarter of anthropogenic carbon emissions, loss of biodiversity, and other environmental services. United Nations Framework Convention for Climate Change talks are now considering mechanisms for avoiding deforestation (AD), but the economic potential of AD has yet to be addressed. We use three economic models of global land use and management to analyze the potential contribution of AD activities to reduced greenhouse gas emissions. AD activities are found to be a competitive, low-cost abatement option. A program providing a 10% reduction in deforestation from 2005 to 2030 could provide 0.3-0.6 Gt (1 Gt = 1 x 10(5) g) CO(2).yr(-1) in emission reductions and would require $0.4 billion to $1.7 billion.yr(-1) for 30 years. A 50% reduction in deforestation from 2005 to 2030 could provide 1.5-2.7 Gt CO(2).yr(-1) in emission reductions and would require $17.2 billion to $28.0 billion.yr(-1). Finally, some caveats to the analysis that could increase costs of AD programs are described.

Disability-adjusted life years due to chronic and hidden hunger under food system evolution with climate change and adaptation to 2050.

BACKGROUND: Climate change presents an increasing challenge for food-nutrition security. Nutrition metrics calculated from quantitative food system projections can help focus policy actions. OBJECTIVES: To estimate future chronic and hidden hunger disability-adjusted life years (DALYs)-due to protein-energy undernutrition and micronutrient deficiencies, respectively-using food systems projections to evaluate the potential impact of climate change and agricultural sector investment for adaptation. METHODS: We use a novel combination of a chronic and hidden hunger DALY estimation procedure and food system projections from quantitative foresight modeling to assess DALYs under alternative agricultural sector scenarios to midcentury. RESULTS: Total chronic and hidden hunger DALYs are projected to increase globally out to 2050-by over 30 million compared with 2010-even without climate change. Climate change increases total DALY change between 2010 and 2050 by nearly 10% compared with no climate change. Agricultural sector investments show promise for offsetting these impacts. With investments, DALY incidence due to chronic and hidden hunger is projected to decrease globally in 2050 by 0.24 and 0.56 per 1000 capita, respectively. Total global DALYs will still rise because projected population growth will outpace the rate reduction, especially in Africa south of the Sahara. However, projections also show important regional reductions in total DALYs due to chronic (13.9 million in South Asia, 4.3 million in East Asia and the Pacific) and hidden hunger (7.5 million in East Asia and the Pacific) with investments. CONCLUSIONS: Food system projections to 2050 show a decreasing DALY incidence from both chronic and hidden hunger. Population growth is projected to outpace these improvements and lead to increasing total chronic and hidden hunger DALYs globally, concentrated in Africa south of the Sahara. Climate change increases per-capita chronic and hidden hunger DALY incidence compared with no climate change. Agricultural sector investments show the potential to offset the climate impact on DALYs.

A multicenter, prospective pilot study of gamma knife radiosurgery for mesial temporal lobe epilepsy: seizure response, adverse events, and verbal memory.

OBJECTIVE: The safety, efficacy, and morbidity of radiosurgery (RS) must be established before it can be offered as an alternative to open surgery for unilateral mesial temporal lobe epilepsy. We report the 3-year outcomes of a multicenter, prospective pilot study of RS. METHODS: RS was randomized to 20 or 24Gy targeting the amygdala, hippocampus, and parahippocampal gyrus. Seizure diaries evaluated the final seizure remission between months 24 and 36. Verbal memory was evaluated at baseline and 24m with the Wechsler Memory Scale-Revised (WMS-R) and California Verbal Learning Test (CVLT). Patients were classified as having "significant improvement," "no change," and "significant impairment" based on relative change indices. RESULTS: Thirteen high-dose and 17 low-dose patients were treated. Both groups showed significant reductions in seizures by 1 year after treatment. At the 36-month follow-up evaluation, 67% of patients were free of seizures for the prior 12 months (high dose: 10/13, 76.9%; low dose: 10/17, 58.8%). Use of steroids, headaches, and visual field defects did not differ by dose or seizure remission. The prevalence of verbal memory impairment was 15% (4/26 patients); none declined on more than one measure. The prevalence of significant verbal memory improvements was 12% (3/26). INTERPRETATION: RS for unilateral mesial temporal lobe epilepsy offers seizure remission rates comparable with those reported previously for open surgery. There were no major safety concerns with high-dose RS compared with low-dose RS. Additional research is required to determine whether RS may be a treatment option for some patients with mesial temporal lobe epilepsy.

Combining the effects of increased atmospheric carbon dioxide on protein, iron, and zinc availability and projected climate change on global diets: a modelling study.

BACKGROUND: Increasing atmospheric concentrations of carbon dioxide (CO2) affect global nutrition via effects on agricultural productivity and nutrient content of food crops. We combined these effects with economic projections to estimate net changes in nutrient availability between 2010 and 2050. METHODS: In this modelling study, we used the International Model for Policy Analysis of Agricultural Commodities and Trade to project per capita availability of protein, iron, and zinc in 2050. We used estimated changes in productivity of individual agricultural commodities to model effects on production, trade, prices, and consumption under moderate and high greenhouse gas emission scenarios. Two independent sources of data, which used different methodologies to determine the effect of increased atmospheric CO2 on different key crops, were combined with the modelled food supply results to estimate future nutrient availability. FINDINGS: Although technological change, market responses, and the effects of CO2 fertilisation on yield are projected to increase global availability of dietary protein, iron, and zinc, these increases are moderated by negative effects of climate change affecting productivity and carbon penalties on nutrient content. The carbon nutrient penalty results in decreases in the global availability of dietary protein of 4·1%, iron of 2·8%, and zinc of 2·5% as calculated using one dataset, and decreases in global availability of dietary protein of 2·9%, iron of 3·9%, and zinc of 3·4% using the other dataset. The combined effects of projected increases in atmospheric CO2 (ie, carbon nutrient penalty, CO2 fertilisation, and climate effects on productivity) will decrease growth in the global availability of nutrients by 19·5% for protein, 14·4% for iron, and 14·6% for zinc relative to expected technology and market gains by 2050. The many countries that currently have high levels of nutrient deficiency would continue to be disproportionately affected. INTERPRETATION: This approach is an improvement in estimating future global food security by simultaneously projecting climate change effects on crop productivity and changes in nutrient content under increased concentrations of CO2, which accounts for a much larger effect on nutrient availability than CO2 fertilisation. Regardless of the scenario used to project future consumption patterns, the net effect of increasing concentrations of atmospheric CO2 will slow progress in decreasing global nutrient deficiencies. FUNDING: US Environmental Protection Agency, Consultative Group on International Agricultural Research (CIGAR) Research Program on Policies, Institutions and Markets (PIM), and the CGIAR Research Program on Climate Change and Food Security (CCAFS).

Tobacco farmers and tobacco manufacturers: implications for tobacco control in tobacco-growing developing countries.

Assisting tobacco farmers to transition to non-tobacco alternatives is a key element of comprehensive tobacco control's end-game strategy and specifically required by the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC). We examine the historical relationship between tobacco manufacturers and tobacco farmers in the United States, where the duration of the relationship has been longest and use information obtained to inform possible end-game strategies for tobacco control advocates working with tobacco farmers in developing countries. Tobacco Documents obtained under the Master Settlement Agreement (MSA) provide evidence of conflicts between tobacco manufacturers and tobacco farmers. Findings support WHO FCTC articles aimed at helping developing country tobacco farmers adversely affected by tobacco control efforts and highlight difficulties in discouraging tobacco cultivation as long as it remains relatively profitable. We conclude that successful end-game strategies should take a long-term approach aimed at building alliances with tobacco farmers and at creating mechanisms for tobacco farmer investment in local infrastructure.

Avoided deforestation as a greenhouse gas mitigation tool: economic issues.

Tropical deforestation is a significant contributor to accumulation of greenhouse gases (GHGs) in the atmosphere. GHG emissions from deforestation in the tropics were in the range of 1 to 2 Pg C yr(-1) for the 1990s, which is equivalent to as much as 25% of global anthropogenic GHG emissions. While there is growing interest in providing incentives to avoid deforestation and consequently reduce net carbon emissions, there is limited information available on the potential costs of these activities. This paper uses a global forestry and land use model to analyze the potential marginal costs of reducing net carbon emissions by avoiding deforestation in tropical countries. Our estimates suggest that about 0.1 Pg C yr(-1) of emissions reductions could be obtained over the next 30 to 50 yr for $5 per Mg C, and about 1.6 Pg C yr(-1) could be obtained over the same time frame for $100 per Mg C. In addition, the effects of carbon incentives on land use could be substantial. Relative to projected baseline conditions, we find that there would be around 3 million additional hectares (ha) of forestland in 2055 at $5 per Mg C and 422 million ha at $100 per Mg C. Estimates of reductions in area deforested, GHG mitigation potential, and annual land rental payments required are presented, all of which vary by region, carbon price paid, and time frame of mitigation.

Structural change as a key component for agricultural non-CO2 mitigation efforts.

Agriculture is the single largest source of anthropogenic non-carbon dioxide (non-CO2) emissions. Reaching the climate target of the Paris Agreement will require significant emission reductions across sectors by 2030 and continued efforts thereafter. Here we show that the economic potential of non-CO2 emissions reductions from agriculture is up to four times as high as previously estimated. In fact, we find that agriculture could achieve already at a carbon price of 25 $/tCO2eq non-CO2 reductions of around 1 GtCO2eq/year by 2030 mainly through the adoption of technical and structural mitigation options. At 100 $/tCO2eq agriculture could even provide non-CO2 reductions of 2.6 GtCO2eq/year in 2050 including demand side efforts. Immediate action to favor the widespread adoption of technical options in developed countries together with productivity increases through structural changes in developing countries is needed to move agriculture on track with a 2 °C climate stabilization pathway.

Evaluating the effects of climate change on US agricultural systems: sensitivity to regional impact and trade expansion scenarios.

Agriculture is one of the sectors that is expected to be most significantly impacted by climate change. There has been considerable interest in assessing these impacts and many recent studies investigating agricultural impacts for individual countries and regions using an array of models. However, the great majority of existing studies explore impacts on a country or region of interest without explicitly accounting for impacts on the rest of the world. This approach can bias the results of impact assessments for agriculture given the importance of global trade in this sector. Due to potential impacts on relative competitiveness, international trade, global supply, and prices, the net impacts of climate change on the agricultural sector in each region depend not only on productivity impacts within that region, but on how climate change impacts agricultural productivity throughout the world. In this study, we apply a global model of agriculture and forestry to evaluate climate change impacts on US agriculture with and without accounting for climate change impacts in the rest of the world. In addition, we examine scenarios where trade is expanded to explore the implications for regional allocation of production, trade volumes, and prices. To our knowledge, this is one of the only attempts to explicitly quantify the relative importance of accounting for global climate change when conducting regional assessments of climate change impacts. The results of our analyses reveal substantial differences in estimated impacts on the US agricultural sector when accounting for global impacts vs. US-only impacts, particularly for commodities where the United States has a smaller share of global production. In addition, we find that freer trade can play an important role in helping to buffer regional productivity shocks.

Funding of North Carolina tobacco control programs through the Master Settlement Agreement.

Changing political and economic forces in 1 tobacco-dependent state, North Carolina, demonstrate how the interplay between these forces and public health priorities has shaped current allocation of Master Settlement Agreement funds. Allocation patterns demonstrate lawmakers' changing priorities in response to changes in the economic climate; some of the agreement's funds targeted to tobacco farmers appear to reflect objectives favored by tobacco manufacturers. Funds earmarked for health have underfunded youth tobacco prevention and tobacco control initiatives, and spending for tobacco farmers in North Carolina has not lived up to the rhetoric that accompanied the original agreement. We discuss the implications of these findings for future partnerships between public health advocates and workers as well as tobacco control strategies.

Bile Cast Nephropathy in Cirrhotic Patients: Effects of Chronic Hyperbilirubinemia.

OBJECTIVES: The aim of this study was to determine the prevalence of bile cast nephropathy (BCN) in autopsied cirrhotic patients and to correlate BCN with clinical and laboratory data to direct attention to this underrecognized renal complication of liver failure. METHODS: We assessed 114 autopsy cases of cirrhosis for the presence of renal intratubular bile casts using Hall stain for bile. Presence of bile casts was correlated with etiology of cirrhosis, clinical and laboratory data, and histologic findings. RESULTS: Bile casts were identified in 55% of cases. The most common etiology of cirrhosis was hepatitis C virus (HCV) infection (52%), and serum creatinine ( P = .02) and serum urea nitrogen ( P = .01) were significantly higher in the Hall-positive group. Conjugated bilirubin was below 20 mg/dL in 90%, and levels below 10 mg/dL were noted in 80% of cases. CONCLUSIONS: To our knowledge, this is the largest study of BCN in human subjects and a first report describing the association of BCN with HCV-related cirrhosis. We demonstrated that in the face of protracted chronic hyperbilirubinemia, bile casts are formed at much lower bilirubin levels than previously thought. Furthermore, we proposed an algorithm to assist in better identification of bile casts.

Levamisole-Adulterated Cocaine Nephrotoxicity: Ultrastructural Features.

OBJECTIVES: The issue of levamisole-adulterated cocaine is emerging as a rapidly growing public health concern due to an increasing number of reports describing its role in cutaneous vasculitis and agranulocytosis. Of note, levamisole is recognized as a contaminant in 69% of the cocaine used within the United States. METHODS: We describe a patient who was a chronic cocaine user and developed systemic vasculitis characterized by polyarthralgia, bullous skin lesions, agranulocytosis, and antineutrophil cytoplasmic antibody-positive rapidly progressive glomerulonephritis. RESULTS: The skin biopsy specimen demonstrated leukocytoclastic vasculitis. The renal biopsy specimen revealed pauci-immune necrotizing and crescentic glomerulonephritis and unusual deposits with medium electron density composed of granules, microspherules, and rare single fibrils on electron microscopy. CONCLUSIONS: The electron microscopic features of levamisole-adulterated cocaine toxicity are novel findings that are presented for the first time, to our knowledge, in this report.