Center Of Core Research Articles

A study to develop workshop programs for consultants in the linked regional core centers for the treatment of liver disease (The continued report): The qualitative analysis relating to the needs of the workshop participants

A study to develop workshop programs for consultants in the linked regional core centers for the treatment of liver disease (The continued report): The qualitative analysis relating to the needs of the workshop participants

Concept of breed and burn reactor with spiral fuel shuffling

A spiral fuel-shuffling scheme was proposed to establish an advantageous neutron-economy breed and burn (B&B) operation mode, in which high-reactivity fuels are placed stably in a region of high neutron importance. To reduce the maximum displacements per atom (dpa) value without a fuel reconditioning process, B&B operation mode with smaller burnup core was also considered as a requirement. In this shuffling scheme, fresh fuel assemblies composed of natural uranium are loaded from the core periphery and moved toward the center along a spiral path, then discharged from the core center. Calculation results found that the core with spiral fuel shuffling achieved an equilibrium state at criticality, and that average burnup of discharged fuel was 115 GWD/t-HM. In this equilibrium state, it was found that high-reactivity fuels were continuously placed in a region of high neutron importance, and maximum dpa value was less than 600 dpa.

Delivering electricity market insights in Northern Italy

This paper assesses the robustness and predictive power of a model comprising a complete set of variables affecting the electricity prices in Northern Italy. The Italian market is based on an implicit auction mechanism via six zonal prices, whose weighted average derives the System Marginal Price, or Prezzo Unico Nazionale (PUN). Given the focus on Northern Italy, as the country’s industrial core and main demand center, this work considers an exhaustive set of exogenous variables affecting a specific market zone, i.e. the North Zone. The import from bordering countries and market zones, the impact of non-programmable renewables, the load factor, the weather data and the prices of underlying commodities have been included. The econometric modelling of an ARMAX process for North Zone prices results in an under performance compared to a standard ARMA, to be fine-tuned, with potential implications regarding the reliance on timely adjustments on market information at trading floor level.

Water Oxidation Reaction Mediated by an Octanuclear Iron‐Oxo Cluster

In the original article1 the compound “[FeCl3(µ-4-tBu-pzH)2]” was erroneously termed “mer-[FeCl3(µ-4-tBu-pzH)2]” both in the text (on page 1) and in Scheme 1. A new Scheme 1 is provided where “mer-[FeCl3(µ-4-tBu-pzH)2]” is now correctly shown as “[FeCl3(µ-4-tBu-pzH)2]”. We also inadvertently omitted to include a citation2 to indicate the source of the sentence in quotation marks in the conclusions of our original article1 (already cited in our original article1 as ref.[10]). We deeply regret our oversight. The sentence in question should read: The question that arises then is “why Nature has ignored such a simple and efficient redox catalyst in favor of its sulfur analogues?”[10] In the Supporting Information of the original article1 we did not include the FTIR spectrum of compound 2 and its 18O-labeled analogue. Also in the Supporting Information in the section “Synthesis of [Fe(µ-4-tBu-pz)4Cl2][FeCl4]/[Fe(µ-4-tBu-pz)2Cl3] (1)”, the compound “Na-4-tBu-pz” was erroneously written. The correct compound is “4-tBu-pzH”. The original Supporting Information has now been updated to include the FTIR spectrum of 2 (Figure S4) in the range 450–1550 cm–1and the correct compound. Following a comment by Professor Raphael Raptis, Florida International University, we looked into the Mössbauer spectra of compound 2 more carefully. We found an error – our analysis of the different Mössbauer spectrum of 2 relative to 3 is incorrect. In fact, 2 and 3 have comparable Mössbauer spectra. We would therefore like to replace Figure 2 in the original article1 with the following new Figure 2, and Table S1 in the Supporting Information has also been updated to reflect the corrected isomer shift (δ)/Quadrupole splitting (ΔEQ) parameters of 2. The corresponding corrected text accompanying Figure 2 (on page 2) (on page 2; caption corrected) is as follows: At zero magnetic field, the Mössbauer spectrum of 2 consists of two quadrupole doublets with isomer shift (δ)/Quadrupole splitting (ΔEQ) parameters of 0.43/0.33 mm s–1 (Figure 2b; blue shaded area) and 0.39/0.70 mm s–1 (orange shaded area). The δ values of both doublets are characteristic of high-spin iron(III) centers; [20] the iron center with lower δ and higher ΔEQ is assigned to the five-coordinate outer Fe(4-tBu-pz)3Cl units (Feo), whereas the one with higher δ and lower ΔEQ corresponds to the octahedral iron center (Fec) of the inner Fe4O4 core. Notably, the δ and ΔEQ values associated with the Fec and Feo centers in 2 are similar to that reported previously for the Fec and Feo centers in [Fe8(µ4-O)4(µ-pz)12Cl4] (3) involving the unsubstituted pz ligand (Table S1).[11] The similar δ and ΔEQ values in 2 and 3 are consistent with the predominance of the Oh (for Fec) and TBP geometries (τ[21] = 0.90 for both Feo centers in 2 and 3) for both complexes. A sentence in the Conclusion is corrected accordingly to remove any reference to the differences in the Mössbauer spectra of compounds 2 and 3. The correct sentence is: Nevertheless, the electronic structure of 2 is significantly different from that of the [Fe8(µ4-O)4(µ-pz)12Cl4] complex 3, as evidenced by an approximately 300 mV shift of redox potentials to more positive values in 2. We sincerely apologize for these mistakes and thank Professor Raptis for bringing these points to our attention. The Authors

Assessing the inner core nucleation paradox with atomic-scale simulations

We investigate the conditions required to freeze liquid iron and iron alloys near the centre of Earth's core. It is usually assumed that inner core growth begins once the ambient core temperature falls below the melting temperature of the iron alloy at Earth's centre; however, additional (under)cooling is required to overcome the energy barrier associated with creating a solid–liquid interface. Predictions based on Classical Nucleation Theory (CNT) have estimated a required undercooling of ∼1000 K, which cannot be reconciled with predicted core cooling rates of ∼100 K Gyr−1. This apparent contradiction has been called the ‘inner core nucleation paradox’. Here we address three major uncertainties in the application of CNT to inner core nucleation using atomic-scale simulations. First, we simulate freezing in Fe and Fe–O liquids at core conditions to self-consistently constrain all parameters required by the CNT equations. Second, we test the basic validity of CNT by directly calculating the waiting time to observe freezing events in Fe and Fe–O liquids. Third, we investigate the influence of wave-like forcings applied to the atomic simulations, which have been suggested as a means to significantly reduce the energy barrier. Our results are consistent with CNT in the computationally accessible parameter regime, though error estimates on the waiting time can reach 50% of the measurement at the largest undercooling temperatures. Using CNT to extrapolate to inner core conditions yields estimated undercooling of 730±20 K for the pure iron system and 675±35 K for the Fe–O system. Forcings corresponding to large pressure variations of O(10) GPa reduce these values by ∼100 K. While our undercooling estimates are significantly lower than previous estimates they are not low enough to resolve the inner core nucleation paradox.

Challenges recruiting to a proof-of-concept pharmaceutical trial for a rare disease: the trigeminal neuralgia experience

BackgroundThis study aimed to describe recruitment challenges encountered during a phase IIa study of vixotrigine, a state and use-dependent Nav1.7 channel blocker, in individuals with trigeminal neuralgia.MethodsThis was an international, multicenter, placebo-controlled, randomized withdrawal study that included a 7-day run-in period, a 21-day open-label phase, and a 28-day double-blind phase in which patients (planned n = 30) were randomized to vixotrigine or placebo. Before recruitment, all antiepileptic drugs had to be stopped, except for gabapentin or pregabalin. After the trial, patients returned to their original medications. Patient recruitment was expanded beyond the original five planned (core) centers in order to meet target enrollment (total recruiting sites N = 25). Core sites contributed data related to patient identification for study participation (prescreening data). Data related to screening failures and study withdrawal were also analyzed using descriptive statistics.ResultsApproximately half (322/636; 50.6%) of the patients who were prescreened at core sites were considered eligible for the study and 56/322 (17.4%) were screened. Of those considered eligible, 26/322 (8.1%) enrolled in the study and 6/322 (1.9%) completed the study. In total, 125 patients were screened across all study sites and 67/125 (53.6%) were enrolled. At prescreening, reasons for noneligibility varied by site and were most commonly diagnosis change (78/314; 24.8%), age > 80 years (75/314; 23.9%), language/distance/mobility (61/314; 19.4%), and noncardiac medical problems (53/314; 16.9%). At screening, frequently cited reasons for noneligibility included failure based on electrocardiogram, insufficient pain, and diagnosis change.ConclusionsFactors contributing to recruitment challenges encountered in this study included diagnosis changes, anxiety over treatment changes, and issues relating to distance, language, and mobility. Wherever possible, future studies should be designed to address these challenges.Trial registrationClinicalTrials.gov, NCT01540630.EudraCT, 2010-023963-16. 07 Aug 2015.

Large City Social and Spatial Segregation in Youth’s Opinion

The article deals with the problem of the socio-spatial segregation of the city as the isolation of social groups in the urban space. As human civilization advances, cities are transformed into “dominant types of settlements”, which makes it important to study the phenomena of urban life, including urban social segregation. The major research objective is to analyze the youth’ attitudes toward the city as a space of vital activity and to assess the city space segregation of Yekaterinburg. The research methodology combines qualitative and quantitative methods. Methods of collecting primary data were the questionnaire and in-depth interview. 200 young people were questioned at the age of 18 years and older on the basis of the quota sampling in 2015 in the city of Yekaterinburg. Depths interviews with experts (n=15) are applied on purpose to identify main problems of the topic. The investigation has revealed that the city of Yekaterinburg in Russian youth’ opinion is divided into specific local units: the core and the periphery. At the same time, the periphery is divided into two large zones: industrial quarter and commune of residence which are located in different parts of the urban space. Two thirds of the respondents are satisfied with their area of residence and 30% of the respondents would like to move to the center of the city. The research has fixed the key issues which exist in the city periphery. The majority of uncontrolled parking lots near residential buildings and transport lines congestion are the main issues of commune of residence. Insufficient territory’s cleaning, poor streets lighting and the need for green spaces are the key issues of industrial quarters. The survey has shown that the urban space is divided into three zones: the core (center) with modern buildings of executive housing in which high-income people live, the periphery commune of residence where the middle class lives, and industrial quarters of the periphery where people with lower incomes live.

Characteristics, Social Factors, and Trends in HIV and AIDS-Related Lymphoma: A 23-Year Analysis Since the Implementation of c ART, a County Hospital AIDS Malignancy Project (CHAMP) Study

Introduction: Stroger Hospital (CCH) and the Ruth M. Rothstein CORE Center (CC) are the largest health providers for HIV+ patients (pts) in Chicago and one of the largest HIV clinics in the United States. CCH/CC treat approximately 5,000 HIV+ individuals per year and 40 newly diagnosed HIV-associated cancers annually. The CHAMP Study was originally a retrospective database from 1990 to 2010 of all clinical, demographic, cancer characteristics of pts diagnosed with HIV/AIDS. Since then, the study has compiled data prospectively on all pts with hematological malignancies. In this study, we analyzed various characteristics of pts with HIV/AIDS diagnosed with lymphoma as well as changes seen over time including therapy response since the implementation of combined anti-retroviral therapy (cART). In addition, we assessed variables including drug use, psychiatric history (hx) and time of HIV diagnosis (dx) with respect to cancer presentation. While large population studies of HIV and cancer exist, few studies specifically examine the largest growing HIV demographic, the inner-city HIV population.Methods: Patient's HIV and cancer clinical, laboratory, and survival data were compiled from the CHAMP database. Psychiatric hx and social factors including drug use and time of HIV dx were also analyzed by retrospective chart review and compared between racial and gender groups as well as differences and overall survival (OS). Survival data was examined using Kaplan-Meier analysis and Cox Proportional Hazards model. Statistical comparisons between different groups were performed via the Fisher's exact test.Results: Between 1995-2018, 226 lymphoma pts were identified spanning 26 diagnoses. Fifty-nine percent, 28%, and 11% were African American (AA), Hispanic, and Caucasian, respectively. The cohort was 87% male. The median age by disease ranged from 35-45. Categorized by cancer type; 32% were diffuse large B-cell lymphoma (DLBCL; n=72), 22.5% classic Hodgkin lymphoma (cHL; n=32), 13% Burkitt lymphoma (BL; n=29), 6.7% primary CNS lymphoma (PCNSL; n=15), and 5% plasmablastic lymphoma (PBL; n=11). Seventy-eight percent of pts presented with stage III/IV disease. CD4+ T cell count (CD4) at dx varied by disease, with the median CD4 count ranging from 19 for PCNSL to 260 cells/µL in cHL. DLBCL pts treated with DAEPOCHR (n=23) had a 5-year OS of 80% vs. 68% treated with CHOPR (n=35; p=0.4). cHL had a 5-year OS of 76%. PBL and BL had a 10-year OS of 62% and 58%, respectively. Cases of cHL decreased from 48% of all lymphomas in 2012 (n=8) to 9% in 2017 (p<0.01) while the incidence of BL dropped from 38% in 2004 to 0-10% in 2015-2017. PBL was diagnosed only twice before 2013 to on average of 20% of all lymphomas diagnosed from 2014-17. As a whole, 22% of pts were diagnosed with HIV/AIDS at time of lymphoma dx. Moreover, 13/21 (62%) of Hispanics, 9/41 (22%) AA and 3/11 (30%) Caucasians (p<0.007) with DLBCL and 5/6 (83%) Hispanic vs. 3/18 (18%) AA pts with BL were diagnosed with HIV/AIDS at dx (P<0.007). While Hispanics with DLBCL were more likely to be diagnosed with HIV at lymphoma dx, there was no difference in OS at 5 years, 76% vs. 75%, when stratified by those presenting with compared to those without a known hx of HIV infection. Furthermore, 11/43 (26%) AA DLBCL pts had a hx or known psychiatric disorder compared to 0/20 (0%) Hispanic pts (p<0.037). Men 26/59 (44%) vs. 8/10 (80%) women DLBCL pts had hx of known drug use (p=0.036). No difference in OS by drug use, type of drug, alcohol use, or psychiatric hx was identified in the DLBCL cohort.Conclusions: HIV/AIDS-associated lymphoma in the inner-city remains an AA, male dominated disease, a clear disparity compared to the US HIV/cancer population. Dissimilar to national trends, a statistical decrease in cases of cHL and BL has been noticed over time with a concomitant elevation in PBL. Outcomes for DLBCL were improved with DAEPOCHR compared to CHOPR. Wh en analyzed by race, the majority of Hispanics with lymphoma were diagnosed with HIV at the time of dx, statistically significant, over AA and Caucasians. AA also demonstrated a statistically significant increase in psychiatric hx compared to other races. These findings could explain why 78% of our lymphoma cohort present with advanced stage disease. Combining efforts in prevention/screening of HIV and drug use and providing psychological interventions could help improve outcomes for Hispanics and AA beyond that made with improved therapies. DisclosuresNo relevant conflicts of interest to declare.

On the orientation of the fast and slow directions of anisotropy in the deep inner core

Several studies of inner core anisotropy suggest the presence of an innermost inner core (IMIC) of about 300–600 km radius, with distinct anisotropic geometry. There is significant variability between different proposed models for cylindrical anisotropy in the IMIC, but studies based on ballistic travel time measurements of inner-core sensitive PKP waves generally favor an axis of symmetry that is also the fast-axis and is quasi-parallel to the Earth's rotation axis. This debate has been recently reopened following the results of a study based on coda wave interferometry – rather than earthquake data – which suggest that the fast, symmetry axis of anisotropy in the IMIC is oriented in a direction close to the equatorial plane. We have augmented the existing database of ballistic PKP travel times by sampling the deep inner core along equatorial directions. We find that, while the slowest velocity is observed in a direction that changes with depth, the fast, symmetry axis remains quasi-parallel to the Earth's rotation axis at all depths in the inner core, as previously found in most other ballistic studies. The direction of slowest velocity is close to the equator in the shallow inner core but changes to a steeper direction about 300–500 km below the inner core boundary, and is then accompanied by a gradual increase in the amplitude of the velocity minimum with increasing depth, which may indicate increased compaction of iron towards the centre of the inner core. We find that a sharply defined boundary between outermost and innermost inner cores is not required by the data, but that if an IMIC does exist, its preferred radius is ∼750 km.

2252. Predictors of Cardiovascular Outcomes in Older HIV-Infected Patients: CORE50 Cohort 10-Year Follow-up

BackgroundCardiovascular (CV) disease is increasingly recognized in HIV+ patients. Currently there are limited data on older HIV+ patients in regards to CV outcomes. The CORE50 study was a cross-sectional study of 121 HIV+ patients ≥ 50 years (83% African American) recruited 2005–2006 at the CORE Center. The goal of this study was to identify predictors of CV outcomes and the impact of the Framingham cardiac risk at baseline on CV outcomes and mortality >10 years later.MethodsRetrospective chart review was conducted in 2018 to evaluate HAART therapy, CD4, viral suppression, HCV coinfection or treatment history, comorbid conditions, BMI, renal function and current medications. Patients were evaluated for CV events (defined as myocardial infarction, cerebrovascular events, transient ischemic attacks and peripheral artery disease).ResultsAt follow-up, 60 (49%) patients with a mean age of 65 years remained in care at CORE. Mean CD4 count was 529 cells/mm3 and 82% had undetectable HIVRNA. 22 patients had died (18%), 10(8%) had transferred care and 29(24%) lost to follow-up. The mean age at death was 61 years. The causes of death were CV (18.2%), cancer (36.4%), infection (18.5%) and other (27.2%; organ failure/overdose/unknown). On Univariate analysis, Framingham cardiac risk (FCR) of >10% at baseline (2005/2006) was associated with increased CV events (P = 0.05). FCR >20% was associated with increased death (P = 0.01). Smoking at baseline and follow-up were associated with increased CV events (P = 0.05 and P = 0.035, respectively). Evaluation of medication regimen showed history of protease inhibitor use or current use of integrase inhibitor was associated with increased CV events (P = 0.01 and P = 0.011, respectively). History of depression was associated with increased CV events (P = 0.035). Aspirin use at initial assessment was associated with decreased death (P < 0.000).ConclusionThis retrospective study shows that FCR, history of depression and smoking are associated with adverse outcomes in HIV patients. It suggests that the FCR is useful for risk stratification of cardiovascular disease in HIV patients. It is extremely important to identify and manage cardiac risk factors in older HIV patients to reduce cardiovascular morbidity and mortality.Disclosures All authors: No reported disclosures.

603. Multi-morbidity and Impaired CD4/CD8 Ratios in Older Adults with Well-Controlled HIV

BackgroundOlder age has been associated with impaired CD4 recovery and a low CD4:CD8 ratio is an independent predictor of non-AIDS morbidity/mortality. In this study we describe the overall comorbidity burden and assess factors associated with CD4:CD8 <1 among HIV+ older adults 60 years+ seen at CORE Center, Cook County Health and Hospital System; a safety-net health system.MethodsWe evaluated demographic, clinical, and lab variables in all HIV+> 60 years who had at least 1 primary care visit from January 1, 2016 to May 31, 2017 at the RMR CORE center. Since HIV viremia is associated with CD4 recovery, analysis on CD4:CD8 ratios was restricted to the patients with viral suppression.ResultsThere were 809 patients with a median age of 63 (range: 60–89) years. Seventy-five percent were male, 74% black, 17% Hispanic and 8% white. Mean CD4 was 538 (+307) cells/mm; 107 (13%) had CD4 < 200 and 675 (84%) had undetectable HIVRNA (<40 copies/mL). 38% were HCV Ab+. Common comorbidities were hypertension 62%, COPD 23%, diabetes 22%, depression 17%, osteoarthritis 15%, neuropathy, chronic kidney disease (CKD) and coronary artery disease (CAD) 13% each. 50% had 1–2 comorbidities and 31% had >3 co-morbidities. Of the 675 patients with suppressed viremia, 470 patient (70%) had CD4:CD8 <1 and 245 (36%) had CD4:CD8 <0.5. Compared with patients with CD4:CD8 >1, patient with CD4:CD8 <1 had lower CD4 counts (451 vs. 739 cells/mm3; P < 0.001), were less likely to have CD4 > 500 (35% vs. 75%; P <0.001), more likely to have CD4 <200 (13% vs. 1%; P <0.001), be male (82% vs. 60%; P < 0.001), HCVab+ (39% vs. 32%; P 0.05). They also trended to have more CAD 7% vs. 4% (P = 0.1) and more CKD 15% vs. 11% (P = 0.2).ConclusionThere was a high rate of multi-morbidity among older, predominantly ethnic minorities HIV-infected adults with 56% having >2 comorbidities. In the setting of viral suppression, 70% still had a CD4:CD8 ratio <1 which likely reflects the effects of older age, and lower CD4 nadir. This impaired immune restoration and co-morbidity burden portend a higher risk of non-AIDS morbidity and mortality in these patients and highlights the need for comprehensive care in HIV clinic settings.Disclosures All authors: No reported disclosures.

578. Virtual vs. True: Identifying Out-of-Care HIV Patients at Lower Risk for Poor Health Outcomes

BackgroundEngagement-in-care is a key component of the HIV care cascade. The CDC reports an engagement-in-care rate for people living with HIV (PLWH) of only 58%. Given the resource intense nature of care re-engagement efforts, it may be useful to identify sub-groups of lost-to-care (LTC) patients at lower risk for poor outcomes. We report on a group of patients whom have had no medical visit, but whom have had lab monitoring in the last year, and who may not require as intense re-engagement interventions.MethodsAt the Ruth M. Rothstein CORE Center, a large, Chicago-area, safety-net HIV clinic which cares for nearly 5,000 PLHW, between April 1, , 2017 and February 1, 2018 we identified patients who had no medical visit within the prior 12 months, but at least one visit in the prior 36 months. Such LTC patients that had no lab monitoring at outside clinics, as determined via collaboration with Chicago Department of Public Health, are included in our analysis. We defined LTC patients as either “true”, if they had no visits or lab monitoring city-wide or “virtual” if they had lab monitoring at the CORE Center, but no medical visits. We report on clinical and demographic differences for these “true” vs. “virtual” LTC patients, and perform logistic regression, assessing for correlation with whether patients subsequently returned to care.ResultsFive hundred patients met our LTC definition; 55 “virtual” and 445 “true.” “Virtual” vs. “true” LTC patients more likely had private insurance (18% vs. 9%) or coverage by the state’s ADAP program (13% vs. 2%; P < 0.001 for insurance differences); “true” vs. “virtual” LTC patients more often received Ryan White case management services (69% vs. 15%, P < 0.001). More “virtual” vs. “true” LTC patients have subsequently returned to care (47% vs. 33%, P = 0.03). Active insurance most strongly associated with subsequent return to care on logistic regression.ConclusionWe found that LTC patients whom had ongoing lab monitoring during their gap in medical visits were more likely to have private insurance or ADAP coverage, while being less likely to have received Ryan White case management services. Prospectively identifying LTC patients more likely to have favorable outcomes may free up re-engagement resources for use with higher need patients.Disclosures R. Lubelchek, Viiv: Scientific Advisor, Salary.

576. Continuing Disparities in Virologic Control for People Living with HIV (PLWH) Receiving Care at a Large, Urban, Safety-Net Clinic

BackgroundThe National HIV/AIDS Strategy highlights reduction of HIV-related disparities as a key goal. Despite universal access to therapy in the United States, the CDC estimates that only 58% of PLWH have achieved virologic suppression. We carried out a recent analysis of virologic suppression, examining for associated factors for PLWH receiving care at one of the nation’s largest, urban, safety-net clinics in order to identify ongoing outcome disparities.MethodsRuth M. Rothstein CORE Center, Cook County Health and Hospital System’s large, urban, safety-net HIV clinic cares for nearly 5,000 PLHW in the Chicago area. We report rates of virologic suppression for PLWH who attended at least one primary care visit between March 31, 2017 and April 1, 2018. We assessed for associations between key demographic characteristics, inclusive of zip code of residence, and virologic suppression (VL < 200 copies/mL3).ResultsA total of 4,660 patients attended at least one visit primary care visit at CORE between March 31, 2017 and April 1, 2018, of whom 84% were virologically suppressed. Sixty-six percent of our patients were African-American (AA), and 25% identified as Hispanic; 74% were male; patients’ median age was 49. On multivariate analysis, AA race (OR 1.54, P = 0.006) correlated with ongoing viremia (VL > 200 copies/mL3), while older age (age group 30 – 49, OR 0.62, P < 0.001; age group > 50 OR 0.27, P < 0.001) and identification as Hispanic (OR 0.63, P = 0.011) associated with virologic suppression. Other HIV transmission categories and demographic characteristics, inclusive of a health literacy measure, did not associate with virologic control. Of the Top 10 most populated zip codes of residence for our patients, three had a significantly higher proportion of viremic patients; while one had significantly more suppressed patients.ConclusionDisparities in virologic suppression persist in younger and African-American PLWH who attended care at Chicago’s largest, safety-net HIV clinic, with our data highlighting particular geographic areas of need. Structural interventions and quality improvement initiatives, at the health system and regional level, must continue to focus on improving outcomes for PLWH who fall into these demographic categories.Disclosures R. Lubelchek, Viiv: Scientific Advisor, Salary.

2235. A Collaborative Drug Therapy Management Model for the Treatment of Hepatitis C Virus (HCV) in an Urban Clinic

BackgroundDirect-acting antivirals (DAAs) have changed the paradigm of HCV treatment due to high-sustained virologic response (SVR) rates and minimal adverse events. Prior authorizations, complex treatment criteria, and inadequate clinic staffing to meet demands of screening efforts may prevent access to treatment. Recent literature suggests that pharmacist involvement in HCV treatment can optimize care. We present a clinic protocol with collaborative drug therapy management to alleviate HCV treatment burdens.MethodsA retrospective review of patients referred and evaluated for HCV treatment between February 2014 and April 2018 at the Ruth M. Rothstein CORE Center. Exclusion was no SVR12 data. Demographic data along with HCV RNA at Week 4, end of treatment, and 12 weeks thereafter were collected.ResultsOf 682 treatment referrals, 76 patients were denied or ineligible, two referred to study, and six not treated (lost to care, incarceration, or death). Of the 598 patients treated, complete data were available for 430. Of the remaining 168 patients, 72% have upcoming appts, 26% lost to follow-up, and 2% died. Mean age was 57.6 years (range 22–82), 70.5% male, 67% black, 17.2% Hispanic, 12.8% White; 203 were (47.2%) HCV/HIV co-infected. Majority were treatment naïve (86.3%) and cirrhotic (42.1%) with a median Fibro Scan of 13 (range 3.4–75). Most patients received ledipasvir/sofosbuvir (70%). Overall SVR rate was 93.5% (402/430); HIV co-infected patients 94.6% (192/203) and mono-infected patients 92.5% (210/227).ConclusionA collaborative approach in HCV treatment allows us to overcome adherence barriers such as health literacy, medication acquisition issues, and drug interactions, as well as increase clinic productivity. A retrospective study may not capture all pharmacist interventions that prevent lapses in therapy such as frequent pharmacy calls and insurance resolution. However, this study shows that with an established clinic protocol and support of a multi-disciplinary team, high SVR rates are maintained, even in the large proportion of cirrhotic patients in our cohort. As clinic referrals continue to grow, additional staff may further support organizational work flow. Disclosures G. Huhn, Gilead: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; ViiV Healthcare: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Janssen: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Theratechnologies: Scientific Advisor, Consulting fee; Proteus: Grant Investigator, Grant recipient.

Inversion Triggered by Protonation—A Rubyrin with Embedded α,β′‐Pyridine Moieties

AbstractIncorporation of α,β′‐pyridine into a [26]hexaphyrin(1.1.0.1.1.0) frame resulted in formation of 29,33‐diaza‐A,D‐di‐p‐benzi[26]hexaphyrin (A,D‐di‐p‐pyrirubyrin), which acquires a strictly planar conformation with two nitrogen pyridine atoms directed to the center of the macrocyclic core. The mode of α,β′‐pyridine incorporation results in efficient 26‐electron π‐conjugation, as shown by the clear spectroscopic and structural aromatic features. The formation of the trication and tetracation through protonation is accompanied by a conformational flip of one or two pyridinium moieties to result in N‐confused or doubly N‐confused conformers of the original macrocyclic frame.

Inversion Triggered by Protonation-A Rubyrin with Embedded α,β'-Pyridine Moieties.

Incorporation of α,β'-pyridine into a [26]hexaphyrin(1.1.0.1.1.0) frame resulted in formation of 29,33-diaza-A,D-di-p-benzi[26]hexaphyrin (A,D-di-p-pyrirubyrin), which acquires a strictly planar conformation with two nitrogen pyridine atoms directed to the center of the macrocyclic core. The mode of α,β'-pyridine incorporation results in efficient 26-electron π-conjugation, as shown by the clear spectroscopic and structural aromatic features. The formation of the trication and tetracation through protonation is accompanied by a conformational flip of one or two pyridinium moieties to result in N-confused or doubly N-confused conformers of the original macrocyclic frame.

Hyperbranched Polyamidoamine Surfactants: Synthesis, Characterization and Evaluation as Biocides

AbstractDifferent generations of cationic hyperbranched quaternary ammonium polyamidoamine dendrimers (PAMAM) with methyl ester end group (G-0.5, G 0.5, G1.5 and G 2.5) were synthesized. Preparation of these dendrimers was carried out via alternative steps of an aza Michael addition reaction (of piperazine as core center molecule) and amidation reaction by ethylene diamine. Each aza Michael addition step was followed by a quaternization step using alkyl bromide with different chain length (4, 8 or 12) carbon atoms. The chemical structures of the prepared dendrimers were confirmed using FTIR, 1H-NMR spectra and elemental analysis for two generations as representative compounds. Also their surface activity has been studied and their surface parameters including surface and interfacial tension, emulsification power, critical micelle concentration, effectiveness, efficiency, maximum surface excess and minimum surface area were determined. The prepared quaternized dendrimers were tested as antimicrobial agents against different strains of bacteria, yeast and fungi. The results showed a significant antimicrobial efficacy of the synthesized surfactants.

Equiaxed Solidification of 430 Ferritic Stainless Steel Nucleating on Core-Containing Ti

AbstractThe solidification structure of ferritic stainless steel can be refined by controlling the contents of Ti, O, and N in the liquid steel through the thermodynamic analysis and high-temperature experiment. It is found by the scanning electron microscopy technology, in which the composite core of Ti nitride-enwrapping Ti oxide can be formed in the solidification front, which promotes the nucleation of δ iron and refines the solidification structure. Meanwhile, the structure analysis of the composite core by the transmission electron microscope technology proves that the Ti oxide that exists in the centre of the composite core is Ti2O3 and the Ti nitride that exists in the outer layer of the composite core is TiN.

Delayed gamma determination at the JSI TRIGA reactor by synchronous measurements with fission and ionization chambers

Well characterized neutron and gamma fields inside a nuclear reactor are of key importance for its safe operation and for successful utilization of various research reactor irradiation facilities. In case of high-flux research reactors such as BR2 in Belgium, Maria in Poland and the future Jules Horowitz Reactor in France, the gamma energy deposition rate in reactor structural components and irradiated samples reaches values well over 10W/g. To assure safe reactor operation, the gamma field and associated heating must therefore be thoroughly characterized in order to provide adequate component and sample cooling.The gamma field can be divided into two contributions: prompt gamma rays are emitted almost instantly after neutron interaction with nuclei, while the delayed gamma rays are emitted from nuclei, which become radioactive by neutron absorption, generated from fission and other processes. Most modern Monte-Carlo particle transport codes enable the transport of prompt gamma rays; a few support delayed gamma ray generation and transport as well. The latter have mostly been applied to fusion devices, where detailed shutdown dose-rate measurements have been performed. Although the delayed gamma field can also be simulated in fission devices, significant inaccuracy in the result is to be expected due to the computational complexity arising from the large number of radioactive fission products and incompleteness of nuclear data. Furthermore, the unavailability of experimental delayed gamma measurements in fission systems presents an important challenge for the validation of the experimental results.Previous measurements in several research reactors show that the delayed gamma flux amounts to around 30% of the total gamma flux. However, these evaluations were performed with measurement data obtained during rapid reactor shutdowns (SCRAMs), using a single measurement point per SCRAM.In this paper we propose a new technique to accurately determine the magnitude of the delayed gamma component and its time evolution, based on synchronous acquisition of fission and ionization chamber signals. The measurements were performed at the JSI TRIGA reactor, using fission and ionization chambers placed in several in-core measurement positions. Their signal was acquired synchronously and at the highest possible acquisition rate in order to distinguish between measurement noise and reactor transients. Using the novel delayed gamma extraction technique we were able to estimate the magnitude of the delayed gamma contribution to be: 18.9% ± 2.0% at the reactor core periphery, linearly increasing towards the reactor core center to 31.4% ± 2.8% of the total measured gamma flux signal after 10min of reactor operation.

Response of inner flow and spray characteristics of a pressure swirl injector to pressure oscillation in supply system

The present work focused on the response of the two phase flow of a pressure swirl injector to pressure oscillation in supply system. A mechanical pulsator was used to generate pressure oscillation in supply system. The inner flow of the injector and spray were captured by backlit shadowgraph technique and the droplet size was recorded by laser diffraction technique. In addition, image processing and proper orthogonal decomposition were used to analyze the data. The results indicate that the inner flow, spray and droplet size oscillate along with pressure oscillation mainly at the driving frequency. The oscillation of air core was used to characterize the inner flow. The dynamics of air core center and air core diameter was analyzed and the modes of the inner flow were obtained. Then, the way the oscillation propagated inside the nozzle was identified as a long wave manner. When the liquid was emanated from the nozzle, thick film resulted from pressure peak was faster when compared with thin film resulted from the trough of pressure oscillation. This characteristic was found to be responsible for the sudden shrink of the spray, and changed the spray pattern from a hollow cone to a pagoda. Finally, the thick and fast film produced a dense spray and large droplets. The whole paper discussed the response of inner flow and spray characteristics of a pressure swirl injector to pressure oscillation, and revealed the way the pressure oscillation propagated from supply system to spray field.