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OBJECTIVE End-of-life care for patients with cancer is often overly burdensome, and palliative and hospice care are underutilized. The objective of this study was to evaluate whether the mental health diagnoses of anxiety and depression were associated with variation in end-of-life care in metastatic cancer. METHODS This study used electronic health data from 1,333 adults with metastatic cancer who received care at two academic health centers in Louisiana, USA, and died between 1/1/2011-12/31/2017. The study used descriptive statistics to characterize the sample and logistic regression to examine whether anxiety and depression diagnoses in the six months before death were associated with utilization outcomes (chemotherapy, intensive care unit [ICU] visits, emergency department visits, mechanical ventilation, inpatient hospitalization, palliative care encounters, and hospice utilization), while controlling for key demographic and health covariates. RESULTS Patients (56.1% male; 65.6% White, 31.1% Black) commonly experienced depression (23.9%) and anxiety (27.2%) disorders within six months of death. Anxiety was associated with an increased likelihood of chemotherapy (odds ratio [OR] = 1.42, p = 0.016), ICU visits (OR = 1.40, p = 0.013), and inpatient hospitalizations (OR = 1.85, p

Rural communities are among the most underserved and resource-scarce populations in the United States. However, there are limited data on COVID-19 outcomes in rural America. This study aims to compare hospitalization rates and inpatient mortality among SARS-CoV-2-infected persons stratified by residential rurality.This retrospective cohort study from the National COVID Cohort Collaborative (N3C) assesses 1,033,229 patients from 44 US hospital systems diagnosed with SARS-CoV-2 infection between January 2020 and June 2021. Primary outcomes were hospitalization and all-cause inpatient mortality. Secondary outcomes were utilization of supplemental oxygen, invasive mechanical ventilation, vasopressor support, extracorporeal membrane oxygenation, and incidence of major adverse cardiovascular events or hospital readmission. The analytic approach estimates 90-day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient adverse events while controlling for major risk factors using Kaplan-Meier survival estimates and mixed-effects logistic regression.Of 1,033,229 diagnosed COVID-19 patients included, 186,882 required hospitalization. After adjusting for demographic differences and comorbidities, urban-adjacent and nonurban-adjacent rural dwellers with COVID-19 were more likely to be hospitalized (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI], 1.16-1.21 and aOR 1.29, CI 1.24-1.1.34) and to die or be transferred to hospice (aOR 1.36, CI 1.29-1.43 and 1.37, CI 1.26-1.50), respectively. All secondary outcomes were more likely among rural patients.Hospitalization, inpatient mortality, and other adverse outcomes are higher among rural persons with COVID-19, even after adjusting for demographic differences and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.

Objective In response to COVID-19, the informatics community united to aggregate as much clinical data as possible to characterize this new disease and reduce its impact through collaborative analytics. The National COVID Cohort Collaborative (N3C) is now the largest publicly available HIPAA limited dataset in US history with over 6.4 million patients and is a testament to a partnership of over 100 organizations. Materials and Methods We developed a pipeline for ingesting, harmonizing, and centralizing data from 56 contributing data partners using 4 federated Common Data Models. N3C data quality (DQ) review involves both automated and manual procedures. In the process, several DQ heuristics were discovered in our centralized context, both within the pipeline and during downstream project-based analysis. Feedback to the sites led to many local and centralized DQ improvements. Results Beyond well-recognized DQ findings, we discovered 15 heuristics relating to source Common Data Model conformance, demographics, COVID tests, conditions, encounters, measurements, observations, coding completeness, and fitness for use. Of 56 sites, 37 sites (66%) demonstrated issues through these heuristics. These 37 sites demonstrated improvement after receiving feedback. Discussion We encountered site-to-site differences in DQ which would have been challenging to discover using federated checks alone. We have demonstrated that centralized DQ benchmarking reveals unique opportunities for DQ improvement that will support improved research analytics locally and in aggregate. Conclusion By combining rapid, continual assessment of DQ with a large volume of multisite data, it is possible to support more nuanced scientific questions with the scale and rigor that they require.

In the United States, black teens overall have higher pregnancy and birth rates than whites, and it is commonly believed that minority race and low income account for this disparity. We examined racial differences in pregnancy and birth rates among teens from low-income households using Medicaid-enrollment as a proxy for low income.This was a retrospective study of Louisiana Medicaid claims data for female teens aged 15-17 years in 2014 (n = 66,069). Pregnancy and pregnancy outcome codes were identified (n = 2,276) and analyzed for differences by black and white race. We conducted validity analyses with different rate definitions and teens' claims status.The cohort was 36% white and 54% black. More black teens than whites lacked any claims data (15.6% vs. 12.6%; p.001). Rates calculated as events per 1,000 person-years of Medicaid coverage showed no difference in live birth rates between white and black teens (24.6 vs. 25.8; relative incidence ratio, 1.05; 95% confidence interval, .93-1.18; p = .43); however, pregnancy rates for whites were higher than those for blacks (42.7 vs. 36.1; relative incidence ratio, .85; 95% confidence interval, .77-.93; p.001).In contrast to national trends, which include teens from diverse racial and socioeconomic backgrounds, Louisiana Medicaid-enrolled teens aged 15-17 years had equal birth rates regardless of black or white race, and whites had higher pregnancy rates. Decreased racial disparities in pregnancy and birth rates among these adolescents highlights socioeconomic influences in sexual health behavior and a need to examine the interplay of risk factors contributing to racial disparities seen among adolescents nationally.

AIM To compare the cardiovascular risks between users and non-users of sodium-glucose co-transporter-2 (SGLT2) inhibitors based on electronic medical record data from a large integrated healthcare system in South Louisiana. MATERIALS AND METHODS Demographic, anthropometric, laboratory and medication prescription information for patients with type 2 diabetes who were new users of SGLT2 inhibitors, either as initial treatments or as add-on treatments, were obtained from electronic health records. Mediation analysis was performed to evaluate the association of use of SGLT2 inhibitors and changes of metabolic risk factors with the risk of incident ischaemic heart disease. RESULTS A total of 5338 new users of SGLT2 inhibitors were matched with 13 821 non-users. During a mean follow-up of 3.26 years, 2302 incident cases of ischaemic heart disease were defined. After adjusting for multiple confounding factors, patients using SGLT2 inhibitors had a lower risk of incident ischaemic heart disease compared to patients not using SGLT2 inhibitors (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.54-0.73). Patients using SGLT2 inhibitors also had a lower risk of incident ischaemic heart disease within 6 months (HR 0.36, 95% CI 0.25-0.44), 12 months (HR 0.40, 95% CI 0.32-0.49), 24 months (HR 0.53, 95% CI 0.43-0.60) and 36 months (HR 0.65, 95% CI 0.54-0.73), respectively. Reductions in systolic blood pressure partly mediated lowering risk of ischaemic heart disease among patients using SGLT2 inhibitors. CONCLUSIONS The real-world data in the present study show the contribution of SGLT2 inhibitors to reducing risk of ischaemic heart disease, and their benefits beyond glucose-lowering.

IMPORTANCERural communities are among the most underserved and resource-scarce populations in the United States (US), yet there are limited data on COVID-19 mortality in rural America. Furthermore, rural data are rarely centralized, precluding comparability across urban and rural regions.OBJECTIVEThe purpose of this study is to assess hospitalization rates and all-cause inpatient mortality among persons with definitive COVID-19 diagnoses residing in rural and urban areas.DESIGN, SETTINGS, AND PARTICIPANTSThis retrospective cohort study from the National COVID Cohort Collaborative (N3C) examines a cohort of 573,018 patients from 27 US hospital systems presenting with SARS-CoV-2 infection between January 2020 and March 2021, of whom 117,897 were hospitalized. A sample of 450,725 hospitalized persons without COVID-19 diagnoses was identified for comparison.EXPOSURESZIP Codes provided by source hospital systems were classified by urban-rural gradient through a crosswalk to the US Department of Agriculture Rural-Urban Commuting Area Codes.MAIN OUTCOMES AND MEASURESPrimary outcomes were hospitalization and all-cause mortality among hospitalized patients. Kaplan-Meier analysis and mixed effects logistic regression were used to estimate 30-day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient mortality while controlling for major risk factors.RESULTSRural patients were more likely to be older, white, have higher body mass index, and diagnosed with SARS-CoV-2 later in the pandemic compared with their urban counterparts. Rural compared with urban inhabitants had higher rates of hospitalization (23% vs. 19%) and all-cause mortality among hospitalized patients (16% vs. 11%). After adjustment for demographic and baseline differences, rural residents (both urban adjacent and non-adjacent) with COVID-19 were more likely to be hospitalized (Adjusted Odds Ratio (AOR) 1.41, 95% Confidence Interval (CI), 1.37-1.45 and AOR 1.42, CI 1.35-1.50) and to die or be transferred to hospice (AOR 1.62, CI 1.30-1.49 and 1.38, CI 1.30-1.49), respectively. Similar differences in mortality were noted for hospitalized patients without SARS-CoV-2 infection.CONCLUSIONSHospitalization and inpatient mortality are higher among rural compared with urban persons with COVID-19, even after adjusting for several factors, including age and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.KEY POINTSQUESTIONDo mortality and hospitalization rates among rural SARS-CoV-2 infected patients in the United States differ from that of their urban counterparts?FINDINGSHospitalization and mortality rates were significantly greater among rural compared with urban patients, even after adjusting for rural-urban differences including age and comorbidities. Similarly, in persons without SARS-CoV-2 infection, mortality rates were also higher among rural patients.MEANINGThese findings demonstrate a pervasive rural-urban discrepancy in all-cause inpatient mortality among rural individuals in the U.S. infected with SARS-COV-2 as well as among those who were uninfected. Further research is needed to understand factors driving health disparities among rural populations.

Patients with diabetes have a 10-fold higher risk of lower-extremity amputation (LEA) than people without diabetes (1). LEA is associated with the greatest reduction in quality of life and the greatest increase in mortality and medical costs in all diabetes complications. Previous studies suggested that the mean hemoglobin A1c (HbA1c) level was associated with an increased LEA risk among patients with type 2 diabetes (2). However, emerging evidence indicates that long-term glycemic variability evaluated by clinical visit-to-visit HbA1c variability may be a better predictor of diabetes complications (3). So far, the definitions of long-term HbA1c variability are inconsistent. In most studies, standard deviation of serial HbA1c measurements (HbA1c SD) and the intrapersonal coefficient of variation of HbA1c (HbA1c CV) are often used to represent HbA1c variability. In the current study, we added a new marker—HbA1c variability score (HVS) (4)—which is more easily applied to clinical practice. We collected data from electronic health records for patients with type 2 diabetes between 2013 and 2019 in the Louisiana Experiment Assessing Diabetes outcomes (LEAD) cohort study (5). We excluded patients who had LEA diagnosis before entry and within 2 years after the first date of diabetes diagnosis, those with incomplete baseline data, those who did not have at least four HbA1c tests within 2 …

Background: Advancement of fluoroscopy-assisted procedures in the field of medicine has led to an increase in the frequency of their use among cardiologists, radiologists and surgeons. The personal health risk involved with radiation exposure is of concern and has come under the limelight in recent times. In addition to other consequences, radiation has been linked to cardiovascular disease, but its significance is not well established. Methods: Self-reported demographic, social, occupational, and medical data was collected from board-certified cardiologists via an electronic survey. Bivariate and multivariable logistic regression analyses were performed. Results: 1478 responses were collected from board-certified cardiologists; 85.4% were males, 79% were Caucasian and 66.1% were ≤65 yrs of age. 35.6% of respondents were interventional cardiologists and 16.4% were electrophysiologists. Of those who performed procedures, 92.2% wore lead apparel during all times of radiation exposure. Exposure hours, stratified by less or more than 20,000, correlated positively with the presence of hypertension, and remained significant when adjusted for common risk factors such as age, sex, race, DM, OSA, and alcohol/tobacco use (OR 1.63 CI 1.16 to 2.29, p = 0.005). Conclusion: This study captures self-reported data of just over 4% of cardiologists in the US, and demonstrates a positive correlation between hypertension and procedural radiation exposure hours even post-adjustment for traditional risk factors. As the use of fluoroscopy-assisted procedures continues to grow, further research is necessary to inform operators of the personal health risks of radiation exposure and drive progress in protective attire and risk mitigation strategies.

Background Rural communities are among the most vulnerable and resource-scarce populations in the United States. Rural data is rarely centralized, precluding comparability across regions, and no significant studies have studied this population at scale. The purpose of this study is to present findings from the National COVID Cohort Collaborative (N3C) to provide insight into future research and highlight the urgent need to address health disparities in rural populations. N3C Patient Distribution This figure shows the geospatial distribution of the N3C COVID-19 positive population. N3C contains data from 55 data contributors from across the United States, 40 of whom include sufficient location information to map by ZIP Code centroid spatially. Of those sites, we selected 27 whose data met our minimum robustness qualifications for inclusion in our study. This bubble map is to scale with larger bubbles representing more patients. A. shows all N3C patients. B. shows only urban N3C distribution. C. shows the urban-adjacent rural patient distribution. D. shows the nonurban-adjacent rural patient distribution, representing the most isolated patients in N3C. Methods This retrospective cohort of 573,018 patients from 27 hospital systems presenting with COVID-19 between January 2020 and March 2021, of whom 117,897 were admitted (see Data Analysis Plan diagram for inclusion/exclusion criteria), analyzes outcomes and 30-day survival for the hospitalized population by the degree of rurality. Multivariate Cox regression analysis and mixed-effects models were used to estimate the association between rurality, hospitalization, and all-cause mortality, controlling for major risk factors associated with rural-urban health discrepancies and differences in health system outcomes. The difference in distribution by rurality is described as well as supplemented by population-level statistics to confirm representativeness. Data Analysis Plan This data analysis plan includes an overview of study inclusion and exclusion criteria, the matrix for data robustness to determine potential sites to include, and our covariate selection, model building, and residual testing strategy. Results This study demonstrates a significant difference between hospital admissions and outcomes in urban versus urban-adjacent rural (UAR) and nonurban-adjacent rural (NAR) lines. Hospital admissions for UAR (OR 1.41, p< 0.001, 95% CI: 1.37 – 1.45) and NAR (OR 1.42, p< 0.001, 95% CI: 1.35 – 1.50) were significantly higher than their urban counterparts. Similar distributions were present for all-cause mortality for UAR (OR 1.39, p< 0.001, 95% CI: 1.30 – 1.49) and NAR (OR 1.38, p< 0.001, 95% CI: 1.22 – 1.55) compared to urban populations. These associations persisted despite adjustments for significant differences in BMI, Charlson Comorbidity index Score, gender, age, and the quarter of diagnosis for COVID-19. Baseline Characteristics Hospitalized COVID-19 Positive Population by Rurality Category, January 2020 – March 2021 Survival Curves in Hospitalized Patients Over 30 Days from Day of Admission This figure shows a survival plot of COVID-19 positive hospitalized patients in N3C by rural category (A), Charlson Comorbidity Index (B), Quarter of Diagnosis (C), and Age Group (D) from hospital admission through day 30. Events were censored at day 30 based on the incidence of death or transfer to hospice care. These four factors had the highest predictive power of the covariates evaluated in this study. Unadjusted and Adjusted Odds Ratios for Hospitalization and All-Cause Mortality by Rural Category, January 2020 – March 2021 This figure shows the adjusted and unadjusted odds ratios for being hospitalized or dying after hospitalization for the COVID-19 positive population in N3C. Risk is similar between adjusted and unadjusted models, suggesting a real impact of rurality on all-cause mortality. A shows the unadjusted odds ratios for admission to the hospital after a positive COVID-19 diagnosis for all N3C patients. B shows the unadjusted odds ratios for all-cause mortality at any point after hospitalization for COVID-19 positive patients. C shows the adjusted odds ratios for being admitted to the hospital after a positive COVID-19 diagnosis for all N3C patients. D shows the adjusted odds ratios for all-cause mortality for all-cause mortality at any point after hospitalization for COVID-19 positive patients. Adjusted models include adjustments for gender, race, ethnicity, BMI, age, Charlson Comorbidity Index (CCI) composite score, rurality, and quarter of diagnosis. The data provider is included as a random effect in all models. Conclusion In N3C, we found that hospitalizations and all-cause mortality were greater among rural populations when compared to urban populations after adjustment for several factors, including age and co-morbidities. This study also identified key demographic and clinical disparities among rural patients that require further investigation. Disclosures Sally L. Hodder, M.D., Gilead (Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Viiv Healthcare (Grant/Research Support, Advisor or Review Panel member)

Introduction: Fluoroscopy assisted procedures have increased occupational radiation exposure among Cardiologists. Radiation has been linked to cardiovascular complications but its effects on cardiac rhythm has not been extensively explored. Hypothesis: We hypothesized that radiation exposure is associated with increased risk of atrial arrhythmias (AA) despite appropriate leaded body coverage. Methods: Demographic, social, occupational, and medical history was collected from board-certified cardiologists via an electronic survey. Bivariate and multivariable logistic regression analyses were performed. Results: We received 1478 responses from cardiologists; 85.4% were males, 79% were White and 66.1% were ≤65 yrs of age. 35.6% of respondents were interventional cardiologists and 16.4% were electrophysiologists, and of those, 92.2% wore lead apparel during all times of radiation exposure. Cardiologists >50 yrs of age, with >10,000 hours of occupational radiation exposure, had a significantly lower prevalence of AA compared to those with ≤10,000 hours of radiation exposure (11.1% vs 16.7%, p =0.019). A multivariate logistic regression was performed and among cardiologists >50 years of age, exposure to >10,000 radiation hours was significantly associated with lower likelihood of AA, after adjusting for age, sex, DM, HTN and OSA (adjusted OR 0.57; 95% CI 0.38 - 0.85, p =0.007). Traditional risk factors such as age, sex, HTN, DM and OSA were more prevalent in those with AA and cataracts, a well-established complication of radiation exposure in cardiologists, was more prevalent in those exposed to >10,000 radiation hours compared to those exposed to ≤10,000 radiation hours, validating the dependent (AA) and independent variables (radiation exposure), respectively. Conclusions: Radiation exposure in Cardiologists with appropriate lead apparel is inversely related to AA. Large scale prospective studies are needed to validate our findings.

Aims: This study compares the cardiovascular benefits between SGLT2 inhibitors and other glucose-lowering drugs (oGLDs) based on electronic medical record data from a large integrated delivery health system in South Louisiana. Materials and Methods: Demographic, anthropometric, laboratory and medication prescription information for patients with type 2 diabetes who were new users of SGLT2 inhibitors either as initial treatments or as add-on treatments were obtained from electronic health records. Mediation analysis was performed in demonstrating the association of use of SGLT2 inhibitors and changes of metabolic risk factors with the risk of incident coronary heart disease. Results: A total of 5,338 new users of SGLT2 inhibitors were matched with 13,821 patients using oGLDs. During a mean follow up of 3.26 years, 2,303 incident cases of coronary heart disease were defined. After adjusting for multiple confounding factors, patients using SGLT2 inhibitors had a lower risk of incident coronary heart disease compared to patients using oGLDs (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.55-0.72). Patients using SGLT2 inhibitors also had a lower risk of incident coronary heart disease within 6 months (HR 0.32; 95% CI 0.23-0.43), 12 months (HR 0.38; 95% CI0.31-0.48), 24 months (HR 0.49; 95% CI 0.41-0.59) and 36 months (HR 0.59; 95% CI 0.51-0.69), respectively. Reductions in systolic blood pressure attributed the lower risk of coronary heart disease among patients using SGLT2 inhibitors. Conclusions: Evidence from real world data indicated the contribution of SGLT2 inhibitors to reducing risk of coronary heart disease, as well as the benefits beyond glucose-lowering. Disclosure Y. Shen: None. J. Zhou: None. L. Shi: None. E. Nauman: None. P.T. Katzmarzyk: None. E.G. Price-Haywood: None. S. Chu: None. S. Yang: None. A.N. Bazzano: None. S. Nigam: None. G. Hu: None.

Context The comfort of patients with cancer near the end of life (EOL) is often undermined by unnecessary and burdensome treatments. There is a need for more research examining racial disparities in EOL care, especially in regions with a history of racial discrimination. Objectives To examine whether black adults received more burdensome EOL care than white adults in a population-based data set of cancer decedents in Louisiana, a state with a history of slavery and long-standing racial disparities. Methods This was a retrospective analysis of EOL care from the Research Action for Health Network (REACHnet), a regional Patient-Centered Outcomes Research Institute-funded database. The sample consisted of 875 white and 415 black patients with metastatic cancer who died in Louisiana from 2011 to 2017. We used logistic regression to examine whether race was associated with five indicators of burdensome care in the last 30 days of life: chemotherapy use, inpatient hospitalization, intensive care unit admission, emergency department (ED) admission, and mechanical ventilation. Results Most patients (85.0%) received at least one indicator of burdensome care: hospitalization (76.5%), intensive care unit admission (44.1%), chemotherapy (29.1%), mechanical ventilation (23.0%), and ED admission (18.3%). Odds ratios (ORs) indicated that black individuals were more likely than white individuals to be hospitalized (OR = 1.66; 95% CI = 1.21–2.28; P = 0.002) or admitted to the ED (OR = 1.57; 95% CI = 1.16–2.13; P = 0.004) during their last month of life. Conclusion Findings have implications for informing health care decision making near the EOL for patients, families, and clinicians, especially in regions with a history of racial discrimination and disparities.

46 Background: Cancer patients’ comfort near the end of life is often undermined by unnecessary aggressive treatments. Furthermore, Black adults receive more aggressive end of life care compared to White adults. We hypothesized that these inequalities would be especially pronounced in Louisiana given regional trends of high cancer mortality coupled with inaccessibility to high quality cancer care. Methods: This was a retrospective analysis of end-of-life care using a Patient-Centered Outcomes Research Institute (PCORI)-funded PCORnet database in the Deep South, called Research Action for Health Network (REACHnet). Of 3,089,092 individuals included, 1,290 met eligibility criteria for the present study: 1) died in Louisiana with a metastatic cancer diagnosis between January 1, 2011 and December 31, 2017, 2) had at least one outpatient clinic visit within six months of death, and 3) self-identified as White or Black. In collaboration with the Louisiana Clinical and Translational Science (LA CaTS) Center, we extracted data on five validated indicators of aggressive care in the final 30 days of life: chemotherapy use, inpatient hospitalizations, ED admissions, ICU admissions, and mechanical ventilation. Hypotheses were analyzed using binary logistic regression to examine whether patient race (White vs. Black) was associated with receipt of each indicator of aggressive end-of-life care, while controlling for sex, age, number of comorbidities, and cancer type. Results: Patients were either White ( n = 875, 67.8%) or Black ( n = 415, 32.2%) adults, and the majority were ≥60 years old (72.4%). Most patients (85.0%) received at least one indicator of aggressive care in the last 30 days of life ( M = 1.91, SD = 1.23), most commonly inpatient hospitalizations (77.0%). Black individuals were more likely than White individuals to be hospitalized ( OR = 1.66, 95% CI: 1.21 to 2.27, p= .002) or admitted to the ED ( OR= 1.57, 95% CI: 1.16 to 2.13, p= .004) during their last month of life, but race was not associated with other indicators. Conclusions: Findings have implications for informing healthcare decision making near the end of life for patients, families, and clinicians in the Deep South.

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer and lacks effective targeted therapies. HPV(-) patients have a 50-60% recurrence rate and could benefit from adjuvant therapy. Although HPV(+) patients have a significantly better survival, 20% have persistent/recurrent disease. Therefore, biomarkers could potentially help identify patients that would benefit from adjuvant targeted agents. Our objective was to evaluate if the mutational and biomarker analysis of tumor samples from OPSCC patients predict recurrence and/ or persistence in patients undergoing definitive therapy with curative intent. 44 advanced stage OPSCC patients that underwent comprehensive genomic profiling by Caris Life Sciences were included in this retrospective study. Next Generation Sequencing (NGS) on genomic DNA from FFPE tumors was performed using the Illumina Nextseq (592-gene, n=17)/MiSeq (44-gene, n=23) platform. Tumors were analyzed for total mutational load (TML), CNV’s and microsatellite instability status. IHC for tumor protein expression of ERCC1, PD-L1, RRM1, TrkA/B/C, TS and TUBB3 was performed using automated platforms. The ASCO/CAP scoring criteria and the cutoff points from published evidence was used in IHC evaluation. Of the 44 patients, 27 were HPV(+) tumors and 11 had HPV(-) disease. Patients with lack of progression free survival data were excluded. Only 4 patients in the entire cohort harbored a pathogenic PIK3CA mutation. Among HPV(+) patients, 22 patients were TP53 WT and 2 patients were found to be TP53 mutant. Although there was no significant change in the TML in smokers compared to nonsmokers (mean 8.77 vs 6.5, respectively; p=0.253), TML was higher in HPV(-) smokers compared to HPV(+) nonsmokers (mean 10.33 vs 6.5, p=0.0661). Our study presented a higher incidence of recurrent/persistent disease in the Caucasians (60%) in comparison to African-Americans (21%). Considering the sample size in the current study, the racial difference in outcomes appears likely to be present regardless of HPV status or disease state. The co-occurrence of multiple deleterious mutations was observed in 70% of the non-responders. Particularly, mutations in CHEK2, PTCH, MUTYH were noted in 50% of the recurrent/persistent patients. CNV mutations in SMAD2, MALT1, NFKBIA in 50% of the recurrent/persistent patients were found. The co-occurrence of multiple mutations were absent in responders in spite of an appreciable sample size in the responder group (n=12). This study also affirmed an improved prognosis in patients with HPV(+), with higher expression of TUBB3, and with positive expression of PD-1 in the tumors. Co-occurrence of multiple deleterious mutations were associated with patients who did not respond to therapy. Therefore, combination rescue therapies that can target multiple pathways to abrogate the mutational effects can aid/enhance therapeutic benefits in HNSCC patients. Citation Format: Alok R. Khandelwal, Kelsey Poorman, Tara Moore-Medlin, Xiaohui Ma, Abhijit Gundale, Ronald Horswell, San Chu, Michelle Winerip, Cherie-Ann O. Nathan. Co-occurring mutations in recurrent/persistent head and neck squamous cell carcinoma (HNSCC) patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4023.

The reserves of Chinese shale gas is very rich, but still haven’t ever formed a mature technology. According to Chinese shale gas reservoir characteristics, the development technology situation and the principle of high energy gas fracturing, the research and exploration of HEGF stimulation integrated technology which is suitable for the development of Chinese shale gas reservoir need to be carried out. Through a series of analysis and study, compositing high energy gas fracturing technology achievements, this paper discusses the research idea and feasibility of the integrated technology, formed by the liquid gunpowder fracturing technology, in-fracture deeply explosive fracturing technology in low permeability oil layers, composite perforating technology, the multi-pulse fracturing technology and the hydraulic fracturing, simultaneous fracturing ,which transforms shale gas reservoir and develops shale gas. Launching field application test is suggested, and studying the way to optimize the theory and design method of integrated technology, so as to promote the development of shale gas.

Currently, most of Chinese oil companies have getting in the later production period, the oil wells are processed frequently and the cost is increasing. In view of the higher problems existed popular in the oil fields such as multiple layers, big interlayer, the technology composited perforation and high energy gas fracturing has to construct with every layer alone, operate long time, cost high. The author puts forward the design research on the composite process of consecutive perforation-strong pulse fracturing for multiple oil layers and thick interlayer This paper introduces the basic design principle and technology method. The design is realized by using the technology of the perforation-symmetrical overpressure fracturing technology, the multi-pulse multistage fracturing, to efficiently guarantee the effect of perforating and pulse fracturing in every layer. The designed multistage detonating device makes the once completed construction technology used in the single well of the multiple oil layers with big interlayer come true. The field test application has gained good effects, greatly reduced the construction cost, and also promoted the application and generalization of the technology composited perforation and high energy gas fracturing.

To the present status and difficulties of complex oilfields, like low-permeability and ultralow-permeability reservoir, abnormally high formation pressure reservoir and formation vulnerability, liquid powder fracturing stimulation technology is tested in low-permeability oilfields. This paper introduced the study of the performance of liquid powder and process optimization, including the performance optimization experiment of liquid powder, formula optimization study of insulating liquid, design of the ignition process and optimization design of construction process. The loading rate of the optimal liquid powder increased significantly so as to meet the fracture of abnormally high-pressure formation. Its active mechanism and characteristics are also analyzed in this paper. In FY block of Daqing Oilfield, the application test of liquid powder fracturing was used in six vertical wells and a horizontal well called CP-2 well (for the first time), and good results have been observed. Combined with the tests, we carried out research and analysis. Field tests show that the liquid powder fracturing stimulation technology can achieve significant stimulation goals for low-permeability oil reservoir and offer a new technological method to low-permeability oil reservoir fracturing and development.

In China, the coal gas formation is characterized as low permeability, low pressure and low water saturation. The coal bed methane (CBM) has strong adsorption and is difficult to develop. Hydraulic fracture is currently the main measure to improve its permeability, drain the liquid and lower the pressure, which promotes desorption of CBM. But it is not efficient. Based on the principle of high energy gas fracturing (HEGF) and the study of new methods, we proposed the test application of the multi-pulse loading fracturing technology for development of shallow CBM. The mechanism of the technology is that it generates high-temperature and high-pressure gas in the target coal bed to produce a long multi-fracture system with effects of multi-pulse loading. It can also produce strong impulse oscillation acting on formation matrix to loose formation pressure, improve the pore connectivity and permeability of coal bed, which promotes pressure drawdown and desorption of CBM. Thus, the goal of increasing the yield of CBM wells is achieved. This paper focuses on the research ideas, mechanism, process design and feasibility. We carried out analysis combined with field test applications. The study provides a new direction to explore new technologies for China’s CBM development.

A series of ferroelectric liquid crystal polymers having banana-shaped side chain mesogens were synthesized through photo-polymerization of epoxide moiety. 2,5-disubstituted-thiophene sub-unit was used in synthesizing the banana-shaped monomers. These liquid crystal compounds were characterized by NMR, differential scanning calorimetry (DSC) and optical polarized microscopy (POM). Mesomorphism was investigated as a function of spacer units. All the synthesized low molar mass banana-shaped compounds exhibit smectic blue phase, but chiral smectic C phase could be observed only on compounds having longer spacer. The clearing temperature of low molar mass compounds fluctuated a little when spacer length varies. All polymers exhibit cholesteric mesophase and an observable glass transition. These liquid crystalline compounds reveal strong photoluminescence at visible region (λmax = 475 nm for M9EPX) and have potential use in polarized organic light emitting diode materials.

We report the characterization of quality (Q)-factor of RF metal-semiconductor-metal (MSM) planar interdigitated varactors fabricated by standard AlGaN/GaN HEMT process. The MSM varactors have wide tuning range and exhibit high quality-factor at both the maximum and minimum capacitance values. The fundamental limitation of the Q-factor in the medium capacitance range is also revealed. The elimination of ohmic contact resistance in the MSM varactor configuration pushed up the peak Q-factor to 92 at 0.5 GHz and 41 at 1.1 GHz. The operation of the MSM varactor is modeled by a physical equivalent circuit, with which the dependence of the Q-factor over the entire tuning voltage range can be explained.

Femtocells, that operating in licensed band, are low power base stations installed indoor to provide user access to 4G systems. The deployment of femtocells is a very promising option for mobile operators to improve user's communications experience in a cost-effective manner. Traditional macrocell only systems using the signal strength as the major criteria for triggering scan and handover are no longer enough for femtocells system. This paper, in addition to the RSSI trigger, we add periodic trigger and consider mobile station speed into our handover algorithm in next generation WiMAX femtocell/macrocell overlay environments. In particular, the proposed handover mechanism consists of all of the handover scenarios, including femtocell-to-femtocell and macrocell-to-femtocell and femtocell-to-macrocell handover. In simulation, we demonstrate that the proposed mechanism forces the macrocell users handover into available femtocells, thus, improves the femtocell usage, offloads the macrocell traffic while avoiding unnecessary handover when user are moving in high speed.

A comparison of postoperative metabolic and nutritional responses to different hypocaloric parenteral nutrition supports was performed in 42 patients with various gastric lesions. Sixteen patients (group A) received 3000 mL of a 5% glucose in water or glucose in saline infusion per day after surgery (approximately 10 kcal/kg per day). Another 14 patients (group B) received 2000 mL of 5% glucose in water or saline plus 1000 mL of 5% amino acid solution per day (approximately 10 kcal/kg per day and 1 g of protein per kilogram per day). The other 12 patients (group C) received 2000 mL of 5% glucose in water or saline plus 500 mL of 5% amino acid solution and 500 mL of 10% fat emulsion (approximately 20 kcal/kg per day and 0.5 g of protein per kilogram per day). After 7 days of study, all three groups were found to have a decrease in body weight, mid-arm circumference, triceps skin-fold, and serum albumin level, and the differences among them were not significant. Groups B and C had significantly less negative mean nitrogen balance than group A (-5.54 +/- 0.63 g/d and -6.07 +/- 0.49 g/d vs -9.20 +/- 0.68 g/d). Group B also had a significantly greater increase of transferrin (from 175.5 +/- 9.9 mg/dL to 185.4 +/- 9.3 mg/dL) than group A and a significantly greater increase in total lymphocyte count (from 956 +/- 113 cells/mm3 to 1196 +/- 176 cells/mm3) than groups A and C.(ABSTRACT TRUNCATED AT 250 WORDS)

A reflective liquid crystal display (R-LCD) has become an important component of a portable information device; however, its inadequate whiteness appearance is a major issue in achieving the potential of “electronic paper”. The factors causing inadequate whiteness were examined using a conventional R-LCD. Furthermore, a novel reflectance-profile-controlled component “random grating light control film” and a non dispersed LC mode with a high-cell-gap tolerance were presented to achieve the paper-white image of reflective LCDs.

Whiteness appearance is an important issue to improve the readability of reflective LCDs. Factors affecting the whiteness appearance, such as metal reflector, liquid crystal dispersion, color filter, oblique incidence, brightness, and uniformity were analyzed in order to achieve a paper-white image for reflective LCDs.

AIM: To understand the role of nutritional status in cirrhotic patients without clinical porto-systemic encephalopathy (PSE). METHODS: Fifty-one non-alcoholic patients with cirrhosis without PSE were studied prospectively and compared with 20 healthy volunteers. The nutritional evaluation included serum prealbumin, albumin, transferrin, body mass index ( BMI ), mid-arm muscle circumference (MAMC), and grip power. The occurrence of subclinical PSE ( SPSE ) was defined when N20-N65 inter-peak latencies of median nerve-stimulated somatosensory evoked potentials were > 2.5 standard deviations of control means. Blood chemistries were tested within 12 h of somatosensory evoked potentials test and nutritional evaluation. RESULTS: Twenty-five, 17 and 9 cirrhotic patients were graded as Child-Pugh class A, B, and C, respectively. Twenty-four (47.1%) patients developed SPSE. Cirrhotic patients with SPSE had lower serum albumin (2.8 mg/L ± 5 mg/L vs 31 mg/L ± 7 mg/L, P < 0.001) levels than those without SPSE. Prealbumin (106mg/L ± 57mg/L vs 125 mg/L ± 58 mg/L), transferrin (1.64 g/L ± 0.46 g/L vs 1.78 g/L ± 0.58 g/L), BMI (23.7 kg/m2 ± 2.7 kg/m2 vs 25.3 kg/m2 ± 3.6 kg/m2), MAMC (22.2 cm ± 2.6 cm vs 22.7 cm ±3.5 cm), and grip power (26.3 kg ± 6.4 kg vs 26.9 kg ± 6.8 kg) were not different between cirrhotic patients with and without SPSE. N20-N65 inter-peak latencies were correlated with serum albumin levels (P = 0.01) but not with prealbumin, transferrin, BMI, MAMC, or grip power. Serum albumin, prealbumin and transferrin levels were different among cirrhotic patients with Child-Pugh classes A, B, and C (P < 0.05). BMI, MAMC, and grip power were not different among Child-Pugh classes A, B and C. CONCLUSION: Our data suggest that serum albumin level is a simple test in the evaluation of nutritional status in patients with cirrhosis.

A novel GaN-based double-channel metal-semiconductor-metal configuration planar inter-digitated varactor, fabricated with a HEMT compatible process, is presented. Our varactors achieved high Q-factor, wide tuning range, and high minimum Q-factor (Q/sub min/). The double-channel heterostructure extends the useful high Q-factor capacitance tuning range of the varactors. The operation of the varactor is explained by a physical equivalent circuit, in which the whole changing trend of extracted Q-factors over bias voltage and extracted resistance can be explained. The measurement results of the novel double-channel varactors are compared with varactors fabricated on a single channel heterostructure in order to show their superior performance.