ABSTRACT
Electricity system decarbonization is key for environmental sustainability. From a consumption-production perspective, much attention has been paid to changes in how electricity is generated and used, but electricity systems also rely on a grid infrastructure that connects and integrates production and consumption, and which will also need to transform. At the same time, new technologies in the electricity system, including the grid, offer the potential for more socially sustainable ways of producing and consuming energy. However, in practice, change has been slow, uneven, and often dysfunctional. A socio-technical transitions approach offers insights into why this is so, seeing electricity system change not simply in technical and economic terms, but also as the outcomes of interactions between technology and social and political processes. The approach draws attention to the particular challenges of achieving rapid transitions in complex critical infrastructures like electricity with strong institutional logics of security. This article applies this approach to the case of Great Britain, where despite strong commitments to sustainability in the form of high-level climate policy, the electricity grid has often been a constraint on the pace of change. The nature of the British transition is explained partly by weak links between these high-level goals on the one hand and the detailed rules and practices in the electricity system on the other. It is also explained by patterns of ownership and grid regulation in the British case that protect incumbents and make it difficult for new actors to develop the system in more socially sustainable directions.
ABSTRACT
Institutions can affect coordination, consensus, and strategy.
ABSTRACT
Bisphosphonates are commonly used in patients with metastatic bone disease to prevent skeletal related events. Atypical femur fracture is a known complication of long-term bisphosphonate use but the incidence in cancer patients and pathogenesis are not well known. Several mechanisms of pathogenesis have been proposed including altered angiogenesis, altered bone mechanical properties, micro damage and bone remodeling suppression. Atypical femur fractures are atraumatic or minimally traumatic fractures in the sub trochanteric region or the femoral shaft. Awareness of atypical femur fractures is critical to diagnose and treat them in a timely manner. There is a paucity of data regarding the management of atypical femur fracture in patients with malignancy. Management options of atypical femur fractures include stopping bisphosphonates, initiating calcium/vitamin D supplementation and either surgery with internal fixation or conservative management. In the future, it will be important to explore the effect of continuous vs. intermittent exposure, cumulative dose and length of exposure on the incidence of this complication. Herein, we review the epidemiology, risk factors, management options and proposed mechanisms of pathogenesis of atypical femur fractures.
ABSTRACT
In immunocompromised patients, Fusarium species cause infections that lead to high mortality. Our case report describes a case of disseminated fusariosis in a neutropenic patient with AML after myelosuppressive chemotherapy, and a neutropenic multiple myeloma patient with Fusarium fungemia awaiting stem cell collection. Both cases highlight the fact that Fusarium can grow as yeast-like structures in the blood causing a delay in diagnosis, and that Fusarium has a tendency to be a resistant organism. Fusarium was only susceptible to amphotericin B in both cases, but we chose to continue treatment with voriconazole in the first case with disseminated infection, despite culture results, in view of his good clinical response. Despite high mortality rates in disseminated infection, our two patients had good outcomes.
