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Nozzle guide vane platforms often employ complex cooling schemes to mitigate ever-increasing thermal loads on endwall. Understanding the impact of advanced cooling schemes amid the highly complex three-dimensional secondary flow is vital to engine efficiency and durability. This study analyzes and describes the effect of coolant to mainstream blowing ratio, momentum ratio and density ratio for a typical axisymmetric converging nozzle guide vane platform with an upstream doublet staggered, steep-injection, cylindrical hole jet purge cooling scheme. Nominal flow conditions were engine representative and as follows: Maexit = 0.85, Reexit/Cax = 1.5 × 106 and an inlet large-scale freestream turbulence intensity of 16%. Two blowing ratios were investigated, each corresponding to upper and lower engine extrema at M = 3.5 and 2.5, respectively. For each blowing ratio, the coolant to mainstream density ratio was varied between DR = 1.2, representing typical experimental neglect of coolant density, and DR = 1.95, representative of typical engine conditions. An optimal coolant momentum ratio between = 6.3 and 10.2 is identified for in-passage film effectiveness and net heat flux reduction, at which the coolant suppresses and overcomes secondary flows but imparts minimal turbulence and remains attached to endwall. Progression beyond this point leads to cooling effectiveness degradation and increased endwall heat flux. Endwall heat transfer does not scale well with one single parameter; increasing with increasing mass flux for the low density case but decreasing with increasing mass flux of high density coolant. From the results gathered, both coolant to mainstream density ratio and blowing ratio should be considered for accurate testing, analysis and prediction of purge jet cooling scheme performance.

Purpose: To evaluate visual and anatomic outcomes following pars plana vitrectomy and intravitreal or subretinal tissue plasminogen activator for submacular hemorrhage in patients with age-related macular degeneration. Methods: This was a retrospective study on patients with a minimum follow-up of 12 months undertaken at a tertiary referral center. Data collected include demographic details, visual and optical coherence tomography changes, surgical details, and complications. Surgical results were compared with patients who were age and lesion size matched and treated with anti-vascular endothelial growth factor injections alone. Results: There were 36 patients in surgical and 18 patients in control group. Patients in surgical arm had pars plana vitrectomy, intravitreal tissue plasminogen activator with air 24 (67%), 6 (16%) with C3F8 gas, 1 (3%) with SF6 gas, 4 (11%) subretinal tissue plasminogen activator with air, and 1 (3%) with C2F6 as post-operative tamponade. Mean LogMAR in tissue plasminogen activator group at baseline was 1.56, and it was improved at all time points 1.06 at 1 month (p Conclusion: Pars plana vitrectomy with intravitreal (or subretinal) tissue plasminogen activator and pneumatic displacement can offer better outcome in comparison to anti-vascular endothelial growth factor alone in patients with submacular hemorrhage secondary to age-related macular degeneration.

e14086 Background: Only about 3% of adult cancer treatment is within a clinical trial (CT). Patient personal factors may impact willingness to participate. We leveraged CTs embedded in Clinical Oncology Pathways (COP) to examine patient barriers to CT participation. Methods: A COP program used in an academic cancer center embeds CTs that are open for accrual at the center. Providers must either select the CT to alert the research team for patient screening for the CT or provide a reason for bypassing the CT before the COP presents standard care options. This study includes patients with solid tumors receiving systemic therapy for whom a CT is presented in the COP and the provider documented that the patient was “not interested in this trial”. Prior to being offered the survey, these patients were asked if they had been interested in participating in a CT and were considered ineligible for the survey if they said “yes”. The survey was comprised of 29 Likert, demographic, multiple choice and open-ended questions. We categorized patients’ reasons for declining to enroll in a CT, and attitudes about CTs. Results: Among 1108 patients with CTs presented to the provider in COPs from May 2018 to June 2019 there were 164 identified by the provider as not interested in a CT. 23 were deceased, and 54 were not able to be contacted. 57 were otherwise ineligible. Of these, 33% did not recall being offered a CT. Of the 30 patients approached, 9 declined and 21 completed the survey (70% participation). Cancer types included gastrointestinal (33%), breast (19%), non-small cell (14%), pancreas (14%) and others (20%). 66% were female and 80% had metastatic cancer. Age ranged from 41 to 69 years (median 66). Race/ethnicity was Caucasian (81%), African American (10%), American Indian/Alaskan Native (5%) and non-specified (5%). When asked, “How do you view being asked to participate in cancer research, 76% saw it as “a positive thing”. Patient primary concerns were desire for more information on study outcomes (42%), concerns about additional appointments or tests (28%) and concerns about receiving a placebo (23%). Conclusions: There is a gap between patients’ positive views of clinical trials and their willingness to participate. This suggests that barriers identified are modifiable. Many who initially decline CTs may be open to joining a clinical trial with further education.Interventions such as the Meropol et al Preparatory Education About Clinical Trials (J Clin Oncol 2015:34:469) should be considered for broad implementation.

2046 Background: Barriers to clinical trial (CT) enrollment continue to be a national challenge, with only about 3% of adult cancer patients treated within a CT. A key recommendation from the 2013 NCI-ASCO Cancer Trial Accrual Symposium was to use information technology to enhance identification of potentially eligible patients for CTs. We assessed if the implementation of a Clinical Oncology Pathways System (COP) with integrated CT information increased enrollment of CT’s, and categorized physician-identified reasons for non-enrollment. Methods: In 2018, Roswell Park Comprehensive Cancer Center (RP) implemented ClinicalPath pathways (formerly Via Oncology) for medical oncology. The COP software embeds interventional CTs that are open to accrual at RP in the pathway specific to a patient’s disease type, stage and biomarkers. The provider is presented with relevant CTs and must select screening for the trial or provide a reason for bypassing the CT from a drop-down list prior to being presented standard care options. CT screening requests from the COP system from 6/1/18-5/31/19 were reviewed. Screening requests and actual enrollment data were matched. The accrual-to-study ratio (ASR), defined as the number of consented accruals divided by the number of CTs open to accrual at RP at any time during the period, was calculated for the study period and the baseline from 6/1/14-6/1/18. The reasons physicians did not elect to screen for CTs were summarized. Results: There can be multiple trials presented for each pathway decision.There were 1,606 decision points with at least one embedded trial. Of these, 1,289 decision points matched 2,242 CTs that were not selected for screening. 317 trials were selected for screening. The most common reasons for not screening were patient ineligibility (41%), provider bypassing the CT by selecting treatment “off pathway” (28%), patient not interested (12%), patient already on CT (8%) and “other” (9%). Audits confirmed that the majority of ineligible patients had co-morbidities such as organ dysfunction or brain metastasis that precluded them from the CT. Among the 317 trials selected for CT screening, 108 (34%) patients enrolled in CTs. The ASR increased from the four-year historical average baseline of 4.08 to 4.33 one year post-implementation. Conclusions: The use of COP with embedded CT was associated with a modest increase in ASR. Stringent eligibility criteria was the primary barrier to enrollment. Adopting a broader set of clinical trial eligibility criteria could increase enrollment to CT.

OBJECTIVE: To test the hypotheses that noncompliance with prescribed drug treatment was related to patient perception of physician competence, pharmacy access, and physical layout. DESIGN: Telephone and mail survey. SETTING: FHP-owned facilities in Southern California. PARTICIPANTS: 158 members who did not claim a prescription and 112 patients chosen as a control group. INTERVENTIONS: Corrective actions were implemented to improve communication about prescriptions. MEASUREMENTS: Satisfaction with competence of physicians, communication with physicians, wait times in pharmacy, the condition of the facility, and co-payment costs. RESULTS: The subject group was significantly more satisfied than the control group with many factors, including competence of physicians, communication with physicians, wait times in pharmacy, the condition of the facility, and co-payment costs. CONCLUSION: Miscommunication about the existence of prescriptions may have caused a significant number of the abandoned prescriptions, rei...

Like any new relationship, the one between a payer and a specialty pharmacy requires patience, understanding, and cooperation. There are other considerations, too - like how to gain physicians’ approval.

Purpose Intravenous drug use (IVDU) is a known risk factor for endogenous endophthalmitis. Endogenous fungal endophthalmitis (EFE) is emerging as a common problem among this community. We describe the management and visual outcomes of acute IVDU-associated EFE. Methods A prospective consecutive case series of 19 patients presenting with presumed acute IVDU-associated EFE from 2001 to 2007 to the Royal Victorian Eye and Ear Hospital was included. All data were collected in a standardized manner. Outcome measures included visual acuity, microbial profiles, and vitrectomy rate. Results Nineteen cases of IVDU-associated EFE were identified. Eight of these (42%) were men, and the mean age was 32.7 years (SD ± 8.0 years). Presenting visual acuity ranged from 6/6 to perception of light, with 58% having a visual acuity of 6/48 or less at presentation. Thirteen (68.4%) were culture positive with all cultures identifying Candida species, and 52.7% underwent vitrectomy. Fifty percent of subjects overall achieved a final visual acuity of 6/18 or better. Men demonstrated improved visual acuity when compared with women (P = 0.04). Age had no effect on final acuity. Conclusion Intravenous drug use is a significant risk factor for developing EFE. Good visual outcomes can be achieved with early treatment, often with intravitreal therapy alone.