Severe weather conditions not only damage electric power infrastructure, and energy systems, but also affect millions of users, including residential, commercial or industrial consumers. Moreover, power outages due to weather-related natural disasters have been causing financial losses worth billions of US dollars. In this paper, we analyze the impact of power outages on the revenue of electric power suppliers, particularly due to the top five weather-related natural disasters. For this purpose, reliable and publicly available power outage events data are considered. The data provide the time of the outage event, the geographic region, electricity consumption and tariffs, social and economic indicators, climatological annotation, consumer category distribution, population and land area, and so forth. An exploratory analysis is carried out to reveal the impact of weather-related disasters and the associated electric power revenue risk. The top five catastrophic weather-related natural disaster categories are investigated individually to predict the related revenue loss. The most influencing parameters contributing to efficient prediction are identified and their partial dependence on revenue loss is illustrated. It was found that the electric power revenue associated with weather-related natural disasters is a function of several parameters, including outage duration, number of customers, tariffs and economic indicators. The findings of this research will help electric power suppliers estimate revenue risk, as well as authorities to make risk-informed decisions regarding the energy infrastructure and systems planning.
360 Background: Aromatase inhibitors (AI) are an essential treatment for postmenopausal women with hormone receptor-positive breast cancer in the adjuvant setting. Estrogen deficiency caused by AIs has adverse effects on bone health. Studies reveal that 5 years of treatment with anastrozole led to 6.1% of bone loss at the lumbar spine and 7.2% at the hip. The aim of the project is to identify the current degree of attention to bone health and skeletal-related complications in women with early-stage breast cancer stages I-III that are on AIs at a community cancer center at Einstein Medical Center Montgomery. Methods: This is a retrospective chart review of 63 patients ages 50-85 diagnosed with early-stage I-III breast cancer on an AI in the adjuvant setting. Patients who started on an AI between January 2013 through December 2017 were included. Data on Dual-energy X-ray absorptiometry scans (DEXA) and treatment at baseline, 2-years, and 4-years were analyzed. We followed to see if they had a DEXA scan every 2 years after the baseline DEXA scan for the following 4 years and analyzed information on their bone health. Results: Patients included were on an AI throughout the 4 years. The median age was 60.2 years. 46/63 (73%) had a baseline DEXA scan. Out of these, 12/63 had a normal bone density. 28/63 had osteopenia, of which 16/28 were treated. 6/63 had osteoporosis and only 2/6 were treated. After 2 years, 39/63 (61%) had a 2-year DEXA scan. Of these, 8 had a normal bone density. 26/63 had osteopenia of which 21/26 were treated. 5/63 had osteoporosis and all 5 were treated for this. At 4 years, 40/63 (63%) had baseline DEXA scans. 9/63 had a normal bone density. 21/63 had osteopenia, out of which 17/21 were treated. 10/63 had osteoporosis of which 5/10 were treated. Conclusions: Patients who are being treated with aromatase inhibitors should be evaluated for baseline bone health prior to initiating AIs and every 2 years thereafter. Treatment with bisphosphonates or RANK ligand inhibitors is recommended at an earlier T-score compared to post-menopausal osteoporosis in the absence of breast cancer. In our study, we noticed that the number of patients who did not receive a DEXA scan at the correct time points increased during the period of treatment with the AI. About 53% of patients had osteopenia or osteoporosis at the time of initiation of AIs. The amount of osteoporosis in patients increased from 9.5% at baseline to 15.8% at the 4-year point. This data indicates the need for proper guidelines on DEXA scans and interventions for this patient population. Current interventions planned are patient education Flyers, a patient risk factor checklist in the EMR (Electronic Medical Record) and prompts to review the status of the DEXA report when ordering AIs.
Background In ambulatory settings, primary hyperparathyroidism is the most prevalent cause of hypercalcemia. Approximately 85% of primary hyperparathyroidism cases are caused by a solitary parathyroid adenoma; other causes include diffuse parathyroid hyperplasia, multiple parathyroid adenomas, and parathyroid cancer. Chief cell adenomas are the most prevalent; adenomas can also consist of oxyphil cell adenomas, lipoadenomas, or mixed cell adenomas. Water clear cell adenoma (WCCA) is a rare tumor formed of large clear cells with foamy pink cytoplasm. Fewer than 30 cases have been recorded in the literature. Case A 52-year-old male with polyuria and polydipsia, diagnosed with hypercalcemia was referred to an endocrinologist. His calcium was 10.9 mg/dl, corresponding parathyroid hormone (PTH) 74 pg/ml, 24-hour urine calcium 818 mg/24hr, vitamin D 25–hydroxy 24.2 ng/ml. He was referred to an endocrine surgeon. A 4-dimensional CT scan revealed soft tissue masses posterior to the thyroid and in the tracheoesophageal groove, consistent with potential parathyroid masses. In the operating room, baseline intraoperative PTH (ioPTH) was 371 pg/ml. A large left superior gland was removed from its normal position, and the ioPTH dropped to 104 pg/ml at 10 minutes post-resection, followed by a rise to 525 pg/ml. A large descended (ectopic) right superior gland was then identified and resected, and the ioPTH decreased to 72, 44, and 57 pg/ml at 10, 15 and 20 minutes post-resection. The remaining parathyroid glands were not identified due to adipose tissue in the neck and likely gland suppression in the setting of high PTH. The pathology report of the two excised glands (left superior 3.2×1.7×0.5cm and 3.703g, right superior 3.4×1.3×0.4cm and 1.86g) demonstrated water clear cell tissue. Post-operatively, patient's polyuria and polydipsia resolved. Labs collected 3 months after surgery demonstrated normalization of the calcium and PTH. The patient was advised to continue follow up every six months. Conclusion Water clear cell parathyroid adenomas are extremely rare. Water clear-cell lesions are considered indolent because excised adenomas are markedly larger than conventional adenomas and grow to a considerable size before becoming biochemically active and diagnosed. Clinical presentation of water clear cell parathyroid lesion is like other causes of primary hyperparathyroidism. The only way to diagnose is via histopathological examination. In rare cases, clear cell renal carcinoma can metastasize to the parathyroid gland causing a similar presentation. Additionally, the rate of hypercalcemia recurrence is higher in WCCA as compared to chief cell adenoma. Therefore, closer follow up of these patients is recommended. Reporting additional cases will aid in our understanding of this uncommon entity, elucidating possible causes/associations, natural history, typical appearances, and post-treatment prognosis. Presentation: No date and time listed
The Microfacies analysis of the Cretaceous Mishrif Formation was studied in Nasiriyah oil field in Nasiriyah Governorate, southern of Iraq using integrated borehole data set that included, core samples and well logs in newly drilled well to analyze the microfacies and the Diagenesis Process of the formation, 100 thin sections for selected well. The results show that the formation composed of: (top to base) a fine-grained, limonitic fresh water limestone containing Charophytae. Four facies’ associations were distinguished in the Mishrif Formation. These include: - These include: - Restricted shallow Open Marin environment is represented by Wackstone and Mudstone to Wackstone. The shallow open marine environment is represented by bioclastic wackestone and packestone, as well as rudistid floastone in rare situations. Shoal Environmentis represented by bioclastic packstone to grainstone, as well as rudstone. Deep Marine environment is represented by mudstone to packstone. six diagenetic processes affected on Mishrif Formation: Cementation, Micritization, Recrystallization, Dissolution, Compaction and Pressure Solution (Stylolization), and Dolomitization, found in thin sections.
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