The Value of Vehicle-to-Grid Systems in the Clean Energy Transition: Policy and Regulatory Issues

As the United States transitions to clean energy, advances in technology are making such a transition possible by enabling utility-scale renewable energy generation (primarily wind and solar) and transportation electrification. However, the growth in renewable energy generation and electric vehicles (EVs) has created new reliability issues for the electric grid due to the intermittent nature of solar and wind power and increased load on the grid from EV charging. New methods and tools are needed to balance energy supply and demand. One such tool is the vehicle-to-grid (V2G) system, which uses EV batteries to help balance the grid, providing additional value beyond transportation and contributing to the clean energy transition. This article advocates for the use of V2G at scale and surveys the policy, technology, and regulatory issues involved in making it successful. Part I argues that V2G should be used as part of the clean energy transition to address renewable generation reliability issues, reduce the grid strain caused by increased EV charging, and expand storage resources for the electric grid. Part II explains how several technology and infrastructure barriers to V2G viability have been reduced or eliminated and discusses issues that still require resolution. Part III makes policy and regulatory recommendations for integrating V2G into grids operating in vertically integrated, monopoly markets or in restructured markets and for resolving two issues central to V2G grid integration: ownership and compensation

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Object Lessons: The Victorians and the Material Text

This volume offers a series of ‘object lessons’ on Victorian publications from broadsides to Bibles, asking what the material forms of these texts teach us about their significance in Victorian culture. Some of our contributors direct their attention to the neglected material forms of the Victorian period—the blank journal, the almanac, the broadside temperance ballad, the thumb Bible, the Illustrated London News’s special issue printed at the Great Exhibition of 1851, and magazines for blind readers. Others consider the under-studied original material forms of now-canonical texts, including the serial and first edition of Sketches by Boz (1836), the first ‘whole book’ written by Dickens as he emerged from his early journalistic career; the first edition of Alice’s Adventures in Wonderland (1865), whose page layout constructs an active child reader; and the neglected serial edition of Henry James’s The Turn of the Screw (1898), written as a marketable commodity by a writer who scorned—but could not afford to ignore—the commodity market. Spanning a temporal range from the 1820s to 1912, all contributions focus attention on the physical ‘book-object’ as nineteenth- and twentieth-century readers encountered it—in all its insistent physicality. Ce volume offre une série de « leçons de choses » sur les publications victoriennes allant des imprimés placardés jusqu’aux Bibles miniatures, interrogeant ce que les formes matérielles de ces textes nous apprennent quant à leur importance dans la culture victorienne. Certains des auteurs portent leurs regards sur des formes matérielles négligées de la période victorienne – le journal, l’almanach, la ballade placardée à visée anti-alcoolique, la Bible miniature, l’édition spéciale de l’Illustrated London News imprimée lors de l’Exposition Universelle de 1851, ainsi que les magazines pour aveugles. D’autres étudient les formes matérielles originales sous-étudiées de textes aujourd’hui canoniques, comme la première édition en séries de Esquisses de Boz (1836), le premier « livre entier » écrit par Dickens lorsqu’il quittait sa carrière journalistique des débuts; la première édition d’Alice au pays des merveilles (1865), dont la mise en page encourage l’enfant lecteur à faire une lecture active; ainsi que l’édition sérielle négligée du Tour d’écrou de Henry James (1898), écrit en tant que produit commercialisable par un écrivain qui méprisait mais ne pouvait toutefois se passer du marché. Couvrant un éventail temporel des années 1820 à 1912, toutes les contributions se concentrent sur l’aspect physique de l’objet-livre tel que les lecteurs des dix-neuvième et vingtième siècles l’ont découvert, dans toute son inévitable matérialité. Nous adressons tous nos remerciements à Laurence Petit qui a effectué la traduction française des résumés et notes biographiques

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

International audienceLife-threatening ‘breakthrough’ cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS-CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals (age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto-Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-α2 and IFN-ω, while two neutralized IFN-ω only. No patient neutralized IFN-β. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

Risk of COVID-19 after natural infection or vaccinationResearch in context

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health