Potential for Electric Vehicle Adoption to Mitigate Extreme Air Quality Events in China.

Electric vehicle (EV) adoption promises potential air pollutant and greenhouse gas (GHG) reduction co-benefits. As such, China has aggressively incentivized EV adoption, however much remains unknown with regard to EVs' mitigation potential, including optimal vehicle type prioritization, power generation contingencies, effects of Clean Air regulations, and the ability of EVs to reduce acute impacts of extreme air quality events. Here, we present a suite of scenarios with a chemistry transport model that assess the potential co-benefits of EVs during an extreme winter air quality event. We find that regardless of power generation source, heavy-duty vehicle (HDV) electrification consistently improves air quality in terms of NO2 and fine particulate matter (PM2.5), potentially avoiding 562 deaths due to acute pollutant exposure during the infamous January 2013 pollution episode (~1% of total premature mortality). However, HDV electrification does not reduce GHG emissions without enhanced emission-free electricity generation. In contrast, due to differing emission profiles, light-duty vehicle (LDV) electrification in China consistently reduces GHG emissions (~2 Mt CO2), but results in fewer air quality and human health improvements (145 avoided deaths). The calculated economic impacts for human health endpoints and CO2 reductions for LDV electrification are nearly double those of HDV electrification in present-day (155M vs. 87M US$), but are within ~25% when enhanced emission-free generation is used to power them. Overall, we find only a modest benefit for EVs to ameliorate severe wintertime pollution events, and that continued emission reductions in the power generation sector will have the greatest human health and economic benefits.

Public Health and Climate Benefits and Trade-Offs of U.S. Vehicle Electrification.

Vehicle electrification is a common climate change mitigation strategy, with policymakers invoking co-beneficial reductions in carbon dioxide (CO2) and air pollutant emissions. However, while previous studies of U.S. electric vehicle (EV) adoption consistently predict CO2 mitigation benefits, air quality outcomes are equivocal and depend on policies assessed and experimental parameters. We analyze climate and health co-benefits and trade-offs of six U.S. EV adoption scenarios: 25% or 75% replacement of conventional internal combustion engine vehicles, each under three different EV-charging energy generation scenarios. We transfer emissions from tailpipe to power generation plant, simulate interactions of atmospheric chemistry and meteorology using the GFDL-AM4 chemistry climate model, and assess health consequences and uncertainties using the U.S. Environmental Protection Agency Benefits Mapping Analysis Program Community Edition (BenMAP-CE). We find that 25% U.S. EV adoption, with added energy demand sourced from the present-day electric grid, annually results in a ~242 M ton reduction in CO2 emissions, 437 deaths avoided due to PM2.5 reductions (95% CI: 295, 578), and 98 deaths avoided due to lesser ozone formation (95% CI: 33, 162). Despite some regions experiencing adverse health outcomes, ~$16.8B in damages avoided are predicted. Peak CO2 reductions and health benefits occur with 75% EV adoption and increased emission-free energy sources (~$70B in damages avoided). When charging-electricity from aggressive EV adoption is combustion-only, adverse health outcomes increase substantially, highlighting the importance of low-to-zero emission power generation for greater realization of health co-benefits. Our results provide a more nuanced understanding of the transportation sector's climate change mitigation-health impact relationship.

Effects of routine pupillary dilation on functional daylight vision.

The visual acuity of 100 patients between the ages of 16 and 66 years, seen for routine ophthalmologic examination, was measured before and after dilation. All patients had a predilation visual acuity of 20/40 or better. Postdilation binocular visual acuity using the patients' usual correction was measured first in the office and then outdoors, both with the patient's back to and the patient facing the sun, with and without the aid of postmydriatic sunglasses. Twelve percent experienced disabling photophobia even with the use of postmydriatic sunglasses, with 3% having significant objective visual loss defined as 20/50 or worse. No objective visual loss was found in 30 controls examined outdoors before dilation, without sunglasses. We recommend that patients who have experienced significant photophobia with dilation in the past, or who have never before undergone dilation, make arrangements for transportation after a dilated examination.

The pigmentary dispersion disorder in USAF aviators.

The pigmentary dispersion syndrome (PDS) can have serious ocular consequences. Visual changes due to glaucoma and the treatment required can threaten the high level of visual function necessary in military aviation. We reviewed the records of 50 aviators with PDS who were evaluated at the Aeromedical Consultation Service (formerly the USAF School of Aerospace Medicine) over the past 10 years. At last evaluation, 48 were still qualified to fly. Only two aviators were permanently removed from flying duties due to glaucoma. Initial intraocular pressures, cup-to-disc ratios, and refractions were not statistically correlated with progression to glaucoma, but sample sizes were small. At final evaluation, 20 of the 34 aviators with follow-up had glaucoma and required medication. Thirteen eyes underwent laser trabeculoplasty. With appropriate management, the majority of aviators with PDS were able to safely continue their flying careers.

Recovery of pupillomotor function after cataract surgery.

To determine the effect of cataract surgery upon pupillomotor function, we studied the pupillary response to light in four subjects who had extracapsular cataract extraction with implantation of an intraocular lens. A video infrared pupillometer was used to record pupillary responses 6-20 weeks after surgery. Non-operated eyes were compared to operated eyes in each subject. Amplitudes and peak velocities of constriction for operated versus non-operated eyes differed over a small range (2-14%). No evidence of dilation lag or segmental palsy was found in the operated eyes. The latency of constriction was not prolonged. We conclude that pupillomotor function can be expected to recover in aviators who require routine cataract surgery, and that visual disability due to a poorly dilating or constricting pupil should not be an overriding concern.

Displacement of the right paraspinous interface: a radiographic sign of acute traumatic rupture of the thoracic aorta.

Displacement of the right paraspinous interface is a moderately sensitive and highly specific sign of acute traumatic rupture of the thoracic aorta. In the appropriate clinical setting, it is an indication for further evaluation and consideration of aortography.

Visual results after cataract surgery by a military resident surgeon.

We compare the visual results of cataract surgery performed by a military resident with those achieved by civilian surgeons. Upon reviewing the first 47 extracapsular cataract extractions performed by one resident military surgeon, we found that 98% of eyes achieved a final visual acuity of 20/40 or better, and 95% were 20/25 or better. The mean surgically induced astigmatism was 0.54 diopters, with 97% less than or equal to 2 D from preoperative values. Eighty-three percent of eyes receiving intraocular lenses were within 2 D of emmetropia. The mean residual refractive error in those eyes was +0.121. Complications were infrequent (17%). These results compare favorably with other reports.

Force necessary to fracture the orbital floor.

Current thought on the pathophysiology of orbital wall fractures postulates either a "hydraulic" or a "buckling" mechanism. Evidence from cadaver, dried skull, and theoretical model studies supports both theories. No in vivo data, human or nonhuman primate, are available that quantitate the force necessary to fracture the orbital floor by either of the two mechanisms. We developed an apparatus that delivers quantifiable force only to the globe, without occluding the orbital opening or striking the orbital rim. We used it on 11 anesthetized Macaca fascicularis monkeys. Following a single bilateral application, the orbits were exenterated, and the orbital walls and orbital contents were examined to determine the extent of injuries. Fractures were described, diagrammed, and photographed. Fracture of the orbital floor was consistently produced at and above a force of 2.08 J. Posterior ruptures of five eyes occurred over the same range. We provide the first accurate measurements of the force required to produce orbital blow-out fractures in a live primate model. We show that orbital floor fractures can occur at low energies with direct ocular trauma only ("pure" hydraulic mechanism). Orbital wall fractures failed to protect the globe from rupture in 23% of cases.

[Isolated aortic isthmus stenosis: operation indications and results]. / Isolierte Aortenisthmusstenose: Operationsindikation und Ergebnisse.

The goal of surgical correction of isolated coarctation of the aorta is normalization of the blood pressure. To assess the optimal age for the intervention with respect to operative morbidity and mortality, residual stenosis and recoarctation rate as well as the postoperative persistence of arterial hypertension without recoarctation, the pre- and postoperative findings of 237 patients (age at surgery: range one week to 17 years) were analyzed. The blood pressure, which was above the 95th percentile of age-matched normal values preoperatively in 93%, showed a clear decrease postoperatively in all age groups. On surgical correction, however, performed as of six years of age, there was a continuously increasing rate of persistent arterial hypertension without recoarctation which ranged from about 10% in those undergoing surgery between the ages of six and eight years to 31% in patients operated at ages between 13 and 17 years. In consideration of the operative results only with respect to the response of the resting blood pressure, insight is enabled only into one aspect of the prognosis, since the latter is equally dependent on the postoperative systemic arterial resistance. The systemic arterial resistance is already slightly elevated at three to five years of age, significantly increased as of six years of age, and at surgery after the age of six, shows a further increasing tendency. Accordingly, patients with postoperative normal or borderline-elevated blood pressure and apparently adequate surgical results, may be at risk of subsequent development of hypertension due to persistence of increased resistance, in particular, if surgery is performed after the age of five years.(ABSTRACT TRUNCATED AT 250 WORDS)