High Utilization Rate Research Articles

Analysis of Adaptability and Application Potential of Supercritical Multi-Source Multi-Component Thermal Fluid Technology for Offshore Heavy Oil in China

Supercritical multi-source, multi-component thermal fluid is a heavy oil thermal recovery method independently developed by China National Offshore Oil Co., Ltd (Beijing, China). It uses waste liquid at the production end of the production well as the water source, the injection medium temperature exceeds 374 °C, 22.1 MPa, and all the produced flue gas is re-injected. Compared with steam huff and puff technology, supercritical technology has the advantages of high enthalpy value, high heat utilization rate, good oil displacement effect, and being green and pollution-free. In addition, its oil–water treatment cost is low, it can realize the reuse of organic matter, it has a good cost advantage of water treatment under the background of low carbon, and it is a thermal recovery method with great application potential for offshore heavy oil. Therefore, it is necessary to carry out research on the adaptability and application potential of supercritical multi-source, multi-heat flow thermal recovery technology in the sea. Based on the laboratory one-dimensional displacement experiment, this paper reveals the mechanism of heavy oil supercritical multi-source multi-component thermal fluid displacement and the contribution of supercritical components to the displacement effect, and establishes the supercritical multi-source, multi-component thermal fluid numerical simulation characterization method. Combined with the characteristics of offshore heavy oil reserves, the main control factors affecting supercritical multi-source, multi-component thermal fluid development were established by numerical simulation and orthogonal test methods, and the adaptive screening method of offshore supercritical technology was established. The application potential of 670 million tons of offshore heavy oil reserves was evaluated and sorted, and KL 10-2 oilfield was selected as the pilot test oilfield. The results show that supercritical technology has great advantages in oil displacement and water treatment cost reduction, and the results play an important guiding significance for the development of offshore heavy oil technology system and the iteration of new technology.

Vibration transmission model of buildings based on virtual spring model and energy functional variation principle

In recent years, the “metro depot + over-track buildings” development model has witnessed rapid growth in China, driven by its advantages of high land utilization and investment return rate. However, the issue of vibration and noise caused by trains entering and exiting the depot has become a major impediment to its sustainable development. To predict the vibration of over-track buildings induced by trains, this paper presented a vibration transmission model of buildings based on the virtual spring model and the energy functional variation principle. The model was then applied to an actual engineering project at a metro depot in Guangzhou, China, and its accuracy was validated by comparing the results with finite element analysis and field measurements. Additionally, the vibration transmission characteristics of the over-track building were studied. The results indicated that the vibration transmission model of buildings presented in this paper aligns well with the results obtained through finite element analysis and field measurements. This approach eliminates the need to disassemble structural members, and the introduced virtual spring model effectively simulates non-ideal connections and boundary conditions. Consequently, it offers convenient structural connection and boundary condition settings, as well as high computational efficiency. Due to the edge effects on the top floor of the buildings, vibration waves in the higher floors experience a combination of reflected and incident waves, resulting in slow attenuation and, in some cases, amplification of vibrations as they propagate from the middle floors to the top floor. The vibration of the over-track building is closely related to the natural vibration characteristics of the floor and the frequency spectrum characteristics of the vibration source. When the natural frequency of a building's floor aligns with the main frequency of the vibration source, significant vibration amplification occurs due to local resonance.

Cu/N co-doped biochar activating PMS for selective degrading paracetamol via a non-radical pathway dominated by singlet oxygen and electron transfer

The non-free radical oxidation pathway (PMS-NOPs) of peroxymonosulfate (PMS) holds significant promise for practical wastewater treatment applications, owing to its low oxidation potential, high PMS utilization rate, and robust anti-interference capability in the degradation of pollutants. A novel activator copper nitrogen co-doped porous biochar (Cu-N-BC) with rich defect edges and functional groups was obtained by adding Cu and N to the biochar matrix generated by sodium alginate through pyrolysis in this study. Under the condition of 1 mM PMS, 30 mg/L activator was used to activate PMS and achieve efficient degradation of 10 mg/L paracetamol (PCT) within 15 min, with a high reaction rate constants (kobs) of 0.391 min−1. The activation mechanism of the Cu-N-BC/PMS/PCT system was a non-radical activation pathway with the dominance of singlet oxygen (1O2) and the presence of catalyst-mediated electron transfer. The graphite nitrogen, pyridine nitrogen, and Cu–N coordination introduced by Cu/N co-doping, as well as the carbon skeleton and CO functional group of biochar, were considered active sites that promote the 1O2 generation. The Cu-N-BC/PMS system exhibits strong stability, eco-friendliness, effective mineralization, and interference resistance across diverse pH levels (3–11) and interfering ions, including Cl−, H2PO4−, NO3−, SO42−, and humic acid. Remarkably, it efficiently degrades PCT in tap and lake water, achieving a notable 63.73% TOC mineralization rate, with leached copper ions below 0.02 mg/L. This research introduces a novel method for obtaining metal nitrogen carbon activators and enhances understanding of PMS non-radical activation pathways and active sites.

Microstructure evolution and property of high manganese steel coatings by laser shock assisted laser wire cladding

Field-assisted laser cladding (FALC) overcomes the limitations of laser cladding through the inherent advantages brought about by the use of various auxiliary energy fields (AEFs). Laser wire cladding (LWC) is limited by the common problems of laser cladding but has a promising future due to the extremely high material utilization rate. In this study, a laser shock assisted laser wire cladding (LSALWC) manufacturing process was proposed. In situ laser shock was introduced into the LWC to obtain finer grains structure and improve product performance. LSALWC does not change the composition of the coating, does not require the use of pretreatment and post-treatment, and does not reduce the efficiency of production. Using high manganese steel (HMS) as the model alloy, LSALWC was employed to achieve the expectation of reducing the proportion of columnar grains, refine the microstructure of columnar grains, and transform columnar grains into equiaxed grains. Compared with the sample (LC) manufactured by LWC, the performance of the sample (LSA) manufactured by LSALWC has been improved, the hardness increased from 285 ± 5 HV0.5 to 303 ± 6 HV0.5, the volume wear rate decreased from 2.1 × 10−4 mm3/N·m to 1.7 × 10−4 mm3/N·m, the primary dendrite spacing of the coating was reduced by 11.5%, and the heterogeneity of coating was more obvious. The cladding process under laser shock was studied using a high-speed camera, and the influence of laser shock on the coating was explained. The mechanism of the performance improvement of the LSA sample was explained. This study showed the disturbance of the molten pool was enhanced by laser shock, and the dendrites at the bottom were deflected or even broken. The broken dendrites were dispersed with the liquid flow and became new nucleation sites. Laser shock increased the supercooling during solidification by reducing the temperature gradient in the molten pool, and created an environment conducive to grain nucleation and growth. This process mitigates various issues in the casting process of HMS and provides a novel method for regulating the grain and microstructure of laser cladding. This research delves into the coupling between the AEF and the dynamic behavior of the molten pool, culminating in a model depicting the evolution of laser cladding solidification under the influence of the AEF, which will provide a new perspective for the research of FALC.

Light‐Driven Multi‐Core/Shell Microdroplets as a Targeted Drug Delivery System

AbstractTargeted drug delivery system (DDS) holds exciting prospects in biomedical clinical research and drug development. However, it faces a significant challenge in achieving stable and safe targeted transportation without drug leakage while obtaining precise and controllable drug dosing with a high drug utilization rate and low side effects. Herein, an optical tweezers‐based light‐driven technique is proposed to transport and construct multi‐core/shell microdroplets enveloping drug carriers and target cells as a novel, safe, and efficient targeted DDS. Drug‐loaded microdroplets with core/shell structures are first fabricated by a new and simple injection extrusion method and then it is transported to a target cell by a dynamic optical trap with a low optical power, which ensures no drug leakage, exogenous materials, and biothermal damage are introduced during the drug delivery process. Next, precise drug dosing is realized by pushing the target cell into the drug‐loaded microdroplet under the actions of optical forces, which constructs a multi‐core/shell microdroplet structure with a pure drug environment to improve the drug action efficiency. Moreover, quantitative drug dosing with a high drug utilization rate can also achieved by controlling the sizes/number of drug droplets inside the microdroplets. This light‐driven DDS is of great interest to frontier medical research and disease treatment fields.

Hierarchical porous N-doped carbon fibers enable ultrafast electron and ion transport for Zn-ion storage at high mass loadings

Zinc-ion capacitors (ZICs) are a promising and safe energy storage system for portable electronics but usually limited by relatively low areal capacity and energy density. Although increasing the mass loading has been suggested, thick electrode layers and clogged pores unavoidably lead to sluggish electron transport and ion diffusion as well as “dead volume” of active materials. Herein, a millimeter-scale 3D thick-network electrode, composed of closely intertwined hierarchical porous N-doped and free-standing carbon nanofibers (HPNCFs), was fabricated via carbonization of nanoscale zeolitic imidazolate framework (ZIF-8) particles embedded in electrospun polyacrylonitrile (PAN) nanofibers. With fast electron/ion transport, large ion-accessible surface area and high utilization rate of active materials, the mass loading of the HPNCFs electrode can reach 48.67 mg cm−2 with a thickness of 4.46 mm. Moreover, the HPNCFs-based ZICs can yield a superior areal/gravimetric capacity of 4.13 F cm−2 /280 F g−1, superior rate capability up to 193.7 F g−1 even at 100 A g−1, high energy density of 99.6 Wh kg−1, and long-term stability for 40,000 cycles. The straightforward approach can provide an opportunity to prepare efficient thick electrodes that could be applied in electrocatalysis, energy storage/conversion, and other electrochemical energy-related techniques.

Cable-stranded wire-fed laser cladding of high-aluminum lightweight high-entropy alloys

The wire-fed laser cladding has gained significant attention recently due to its advantages as high material utilization rate and a favorable working environment. However, it's limited by the availability of wires, especially for advanced materials like high entropy alloys which are difficult to shape into wires. Cable-stranded wires offer a potential solution to this problem and can expand the application of wire-fed laser cladding. Nevertheless, issues related to tensile failure and loose strands in skein twisting need addressing. Here, we propose an improved skein twisting process, reengineer and fabricate a wire twisting machine for preparing cable-stranded wires. Specifically, Al50Si6Ti8Fe12Cu12Ni12 and Al50Si6Ti8Cr12Cu12Ni12 - two novel lightweight high-aluminum high-entropy alloys - were designed and stranded into Core-Periphery structured wires while the core wire possesses good high-temperature fluidity to ensure uniformity of the cladding layer. The resulting coatings exhibit no cracks with uniform compositions, and exhibit enhanced hardness and corrosion properties.

Intervention for reducing the overuse of upper endoscopy in patients

Utilisation rates for healthcare services vary widely both within and between nations. Moreover, healthcare providers with insurance-based reimbursement systems observe an effect of social determinants of health on healthcare utilisation...

Bonding performance of reinforced and oil shale residue concrete

Oil shale residue concrete is prepared by utilizing oil shale semi-coke. It has advantages such as low cost and a high solid waste utilization rate. The study of its bonding-slip characteristics with steel bars is a prerequisite for their application in engineering structures. To study the bonding-slip performance of reinforced oil shale residue concrete, 12 half-beam specimens were designed for the bonding performance test. The test parameters included the substitution rate of oil shale residue, bonding length, and cover thickness. The influences of the aforementioned factors and variables on the stress-slip curve and bonding strength were analyzed. The results showed that the anchoring bond length had the greatest impact on the average bonding strengths of the steel bar and concrete. As the bonding length increases from 5d to 10d, the average bonding strength decreased by approximately 18%. The cover thickness had the second-greatest influence on the bonding strength. As the cover thickness increased from 20 to 30 mm, the average bonding strength increased by more than 12%. The substitution rate of the oil shale residue had the least effect on the average bonding strength, and as the substitution rate increased, the bonding strength decrease with a minor magnitude. Through verification, the bonding-slip constitutive model obtained by fitting the experimental data was found to fit the experimental values well.

Inkjet printing for smart electrochromic devices

AbstractElectrochromic technology has recently made many achievements in research and commercialization. Electrochromic devices are being developed based on various coating and printing methods for multipronged applications, and have great potential for next‐generation flexible electronics. Compared to other coating and printing techniques, inkjet printing (IJP) enables non‐contact patterning on a variety of substrates by programming the movement of the printing nozzle. IJP has great advantages in printing smart electrochromic devices because of its low cost, high resolution, high material utilization rate, and applicability to various large‐size substrates. In this review, the principles and process of IJP and the latest progress of IJP in electrochromic devices are summarized in detail. IJP of electrochromic materials, conductive contacts, and blocking layers are discussed. IJP assisted fabrication of smart electrochromic displays, flexible and stretchable electrochromic devices, electrochromic‐energy storage, smart windows, and others are also demonstrated. The problems and challenges faced by IJP electrochromic devices are emphasized, and the future development trends are prospected. This review aims at further promoting the development of IJP for smart electrochromic devices and encouraging future applications of IJP and electrochromic devices in the era of Internet of Things.

Microstructure and mechanical properties of thin-walled ODS ferritic steel tubes fabricated by a near-net forming method

This research successfully applied a new near-net forming process for producing thin-walled ODS ferritic steel tubes. The process involves hot isostatic pressing (HIP), hot extrusion (HE), and Pilger-rolling (PR). The tubes produced have a length of 2800 mm and a thickness of ∼1 mm. The microstructural analysis shows that the thin-walled tubes have partially elongated grains and a γ-fiber {111} texture. The precipitated nano-oxide particles in the thin-walled tubes are Y4Zr3O12 and Y2(Zr0.6Ti0.4)2O7, with an average size of 7.21 nm and a number density of 4.3 × 1023 m−3. The tubes have an ultimate tensile strength (UTS) of 908.3 MPa at ambient temperature and 186.2 MPa at 800 °C along the hoop direction. These values are comparable to those reported for ODS steel tubes produced by conventional methods, including powder hot extrusion, drilling machining, and Pilger-rolling. Based on the results, this near-net forming method effectively produces high-performance thin-walled ODS steel tubes. In addition, compared to conventional methods, the manufacturing process has a high material utilization rate of over 90%, which is a significant improvement.

Synergistic effects of CoS-decorated Ni-MOF with hierarchical structures for high-performance supercapacitor electrode materials

To further improve the electrochemical performance of supercapacitor, the construction of composite based electrode material was proved to be an effective strategy. Herein, CoS-decorated Ni-MOF composites with hierarchical structures and obvious synergistic effects were synthesized by one-step hydrothermal and subsequent electrodeposition route. Benefitting from the increased surface roughness with more exposed active sites, the hierarchical structure with high space utilization rate for rapid ion transport as well as the improved conductivity and entire robustness, the optimal composites exhibited an excellent specific capacitance (2167.5 F g−1 at 1 A g−1), outstanding rate performance (up to 70.1% even at 5 A g−1) and the good cycle stability (80.12% capacity retention after 3500 cycles). The corresponding assembled asymmetric supercapacitors could reach an energy density 92.18 Wh kg−1 when the power density of was 1626.71 W kg−1, which overwhelmed most other reported works. What is more, the capacity retention could maintain 73.34% even after 7000 cycles, indicating the excellent cycle stability. Overall, to our knowledge, this is the first report on a synergistic effect of a combination of Ni-MOF and CoS. The constructed composites exhibited great potential as promising candidates for high-performance energy storage devices.

Backside Coating for Stable Zn Anode with High Utilization Rate.

Stable Zn anodes with high utilization rate are urgently required to promote the specific and volumetric energy densities of Zn-ion batteries for practical applications. Herein, contrary to the widely utilized surface coating on Zn anodes, this work shows that a zinc foil with a backside coated layer delivers much enhanced cycling stability even under high depth of discharge. The backside coating significantly reduces stress concentration, accelerates heat diffusion, and facilitates electron transfer, thus effectively preventing dendrite growth and structural damage at high Zn utilization. As a result, the developed anode can be stably cycled for 334h at 85.5%Zn utilization, which outperforms bare Zn and previously reported results on surface-coated Zn foils. An NVO-based full cell also shows stable performance with high Zn utilization rate(69.4%), low negative-positive electrodes ratio (1.44), and high specific/volumetric energy densities (155.8Wh kg-1/178Wh L-1), which accelerates the progress toward practical zinc-ion batteries.

Spatiotemporal Absorption Features of Yellow Willow Water Usage on the Southern Edge of the Semi-Arid Hunshandak Sandland in China

The improvement of water usage efficiency and productivity, as well as the development of effective water management plans, necessitates a comprehensive understanding of how water utilization patterns in different soil layers within arid and semi-arid climates impact the capacity of plant roots to absorb water. However, there is currently no knowledge regarding the water use strategies employed by artificial yellow willow. So, we conducted a study on the hydrogen and oxygen isotopic composition of rainfall in yellow willow (Salix gordejevii) from the semi-arid region located at the southern edge of the Hunshandak Sandland in China. This study utilized measured data on xylem water, groundwater, soil moisture, and rainfall. By employing a combination of the direct comparison method and the MixSIAR model, we investigated the water uptake strategies employed by yellow willow throughout its growing season. The findings revealed that the mean δ D was highest in precipitation and lowest in groundwater, whereas the mean δ18O was highest in stem water and lowest in groundwater. The δ D and δ18O fluctuated significantly in precipitation but were steady in groundwater. Because precipitation was significantly less than evaporation, the slope and intercept were lower for the local than global atmospheric precipitation line. Water availability steadily declined with increasing depth. Lower δ18O values were caused by precipitation diluting the soil water. The MixSIAR results indicated that the primary source in May, September, and October was utilized at 19%, 18%, and 18%, respectively. In contrast, the utilization rate of each source varied considerably in June, July, and August (the primary source was utilized at 19%, 18%, and 18%, respectively). Comparatively high rates of water absorption and utilization were observed in June (19% of the total water source), July (18%), and August (23%). Therefore, the vertical distribution of the root system and variations in the soil water content regulate water usage for the yellow willow. To prevent excessive water usage and promote ecosystem restoration with artificial yellow willow plantations in water-limited desert settings, policy makers should consider the patterns of plant water use and soil water availability. By selecting drought-adapted plant species and optimizing irrigation management, it is possible to reduce water wastage and ensure that water is used efficiently for revegetation and ecosystem restoration, avoiding overuse of water and maintaining the sustainability of revegetation in water-stressed desert areas.

Elucidating uptake and metabolic fate of dipeptides in CHO cell cultures using 13C labeling experiments and kinetic modeling

The rapidly growing market of biologics including monoclonal antibodies has stimulated the need to improve biomanufacturing processes including mammalian host systems such as Chinese Hamster Ovary (CHO) cells. Cell culture media formulations continue to be enhanced to enable intensified cell culture processes and optimize cell culture performance. Amino acids, major components of cell culture media, are consumed in large amounts by CHO cells. Due to their low solubility and poor stability, certain amino acids including tyrosine, leucine, and phenylalanine can pose major challenges leading to suboptimal bioprocess performance. Dipeptides have the potential to replace amino acids in culture media. However, very little is known about the cleavage, uptake, and utilization kinetics of dipeptides in CHO cell cultures. In this study, replacing amino acids, including leucine and tyrosine by their respective dipeptides including but not limited to Ala-Leu and Gly-Tyr, supported similar cell growth, antibody production, and lactate profiles. Using 13C labeling techniques and spent media studies, dipeptides were shown to undergo both intracellular and extracellular cleavage in cultures. Extracellular cleavage increased with the culture duration, indicating cleavage by host cell proteins that are likely secreted and accumulate in cell culture over time. A kinetic model was built and for the first time, integrated with 13C labeling experiments to estimate dipeptide utilization rates, in CHO cell cultures. Dipeptides with alanine at the N-terminus had a higher utilization rate than dipeptides with alanine at the C-terminus and dipeptides with glycine instead of alanine at N-terminus. Simultaneous supplementation of more than one dipeptide in culture led to reduction in individual dipeptide utilization rates indicating that dipeptides compete for the same cleavage enzymes, transporters, or both. Dipeptide utilization rates in culture and cleavage rates in cell-free experiments appeared to follow Michaelis-Menten kinetics, reaching a maximum at higher dipeptide concentrations. Dipeptide utilization behavior was found to be similar in cell-free and cell culture environments, paving the way for future testing approaches for dipeptides in cell-free environments prior to use in large-scale bioreactors. Thus, this study provides a deeper understanding of the fate of dipeptides in CHO cell cultures through an integration of cell culture, 13C labeling, and kinetic modeling approaches providing insights in how to best use dipeptides in media formulations for robust and optimal mammalian cell culture performance.

Healthcare Burden and Resource Utilization After Pediatric Acute Respiratory Distress Syndrome: A Secondary Analysis of the Collaborative Pediatric Critical Care Research Network Acute Respiratory Distress Syndrome Study.

To describe family healthcare burden and health resource utilization in pediatric survivors of acute respiratory distress syndrome (ARDS) at 3 and 9 months. Secondary analysis of a prospective multisite cohort study. Eight academic PICUs in the United States (2019-2020). Critically ill children with ARDS and follow-up survey data collected at 3 and/or 9 months after the event. None. We evaluated family healthcare burden, a measure of healthcare provided by families at home, and child health resource use including medication use and emergency department (ED) and hospital readmissions during the initial 3- and 9-month post-ARDS using proxy-report. Using multivariable logistic regression, we evaluated patient characteristics associated with family healthcare burden at 3 months. Of 109 eligible patients, 74 (68%) and 63 patients (58%) had follow-up at 3- and 9-month post-ARDS. At 3 months, 46 families (62%) reported healthcare burden including (22%) with unmet care coordination needs. At 9 months, 33 families (52%) reported healthcare burden including 10 families (16%) with unmet care coordination needs. At month 3, 61 patients (82%) required prescription medications, 13 patients (18%) had ED visits and 16 patients (22%) required hospital readmission. At month 9, 41 patients (65%) required prescription medications, 19 patients (30%) had ED visits, and 16 (25%) required hospital readmission were reported. Medication use was associated with family healthcare burden at both 3 and 9 months. In a multivariable analysis, preillness functional status and chronic conditions were associated with healthcare burden at month 3 but illness characteristics were not. Pediatric ARDS survivors report high rates of healthcare burden and health resource utilization at 3- and 9-month post-ARDS. Future studies should assess the impact of improved care coordination to simplify care (e.g., medication management) and improve family burden.

Design, optimization and verification of a conical guiding origami mechanism for underwater docking station

Underwater docking station requires a conical guiding device with a large tolerance capacity and smaller volume to recover unmanned underwater vehicles (UUVs). Here, this paper innovatively introduces a conical guiding origami mechanism designed by an array and rotation approach based on a rigid origami mechanism. The Jacobian matrix method systematically calculates the degree of freedom (DOF) of the device. The variation function of dihedral angle in the folding process of the origami mechanism is derived, and the kinematics model is established within the Cartesian coordinate system. Based on this model, we established a mathematical model for optimizing the origami mechanism by considering number of units and unit volume as the design variables, subject to minimizing the underwater flow area and length. The sequential quadratic programming algorithm is employed to identify the optimum design variables. Subsequently, based on optimized results, collision simulation is carried out, and a conical guiding device tailored for an underwater docking station is successfully designed. The proposed device can be used as an underwater docking station to recover UUVs for ocean exploration. The proposed device has a large tolerance capacity, minimal shrinkage state cross-sectional area and length, excellent hydrodynamic performance, and a high spatial utilization rate.

Bottom Deposition Enables Stable All-Solid-State Batteries with Ultrathin Lithium Metal Anode.

Modern strides in energy storage underscore the significance of all-solid-state batteries (ASSBs) predicated on solid electrolytes and lithium (Li) metal anodes in response to the demand for safer batteries. Nonetheless, ASSBs are often beleaguered by non-uniform Li deposition during cycling, leading to compromised cell performance from internal short circuits and hindered charge transfer. In this study, the concept of "bottom deposition" is introduced to stabilize metal deposition based on the lithiophilic current collector and a protective layer composed of a polymeric binder and carbon black. The bottom deposition, wherein Li plating ensues between the protective layer and the current collector, circumvents internal short circuits and facilitates uniform volumetric changes of Li. The prepared functional binder for the protective layer presents outstanding mechanical robustness and adhesive properties, which can withstand the volume expansion caused by metal growth. Furthermore, its excellent ion transfer properties promote uniform Li bottom deposition even under a current density of 6 mA·cm-2. Also, scanning electron microscopy analysis reveals a consistent plating/stripping morphology of Li after cycling. Consequently, the proposed system exhibits enhanced electrochemical performance when assessed within the ASSB framework, operating under a configuration marked by a high Li utilization rate reliant on an ultrathin Li.

Treatment Pattern, Healthcare Resource Utilization and Symptom Burden Among Patients with Triple Class Exposed Multiple Myeloma: A Population-Based Cohort Study

PurposeThis study aims to describe the treatment patterns, outcomes, health care utilization and symptom burden of triple class exposed (TCE) relapsed/refractory patents with multiple myeloma (MM) receiving a subsequent line of treatment (LOT). MethodsThis is a retrospective observational cohort study using administrative databases in Ontario, Canada. Outcomes were captured for TCE patients receiving a subsequent LOT and included: treatment regimen details, time to next treatment (TTNT), overall survival (OS), health care utilization, palliative care referral, and patient reported symptoms. ResultsOf the 16,777 patients diagnosed with MM between 2007-2021 in Ontario, 1358 (8%) patients were classified as TCE. Among the TCE MM patients, 489 (36%) received a subsequent LOT. The two most commonly administered therapies post TCE were carfilzomib/dexamethasone (n = 111, 22%) and pomalidomide/dexamethasone(n = 95, 19%). Median TTNT was 1.7 months (95%CI 1.2-2.4 months) and median OS 12.8 months (95%CI 10.8-16.5). Healthcare utilization was high with 276 (56%) of patients evaluated in an emergency department (ED) or admitted to hospital. There was high symptom burden as reported by patients with moderate-severe impairment in well-being, fatigue, pain and drowsiness noted in greater than 25% of the cohort. Palliative care referrals rates were low with only 10% (n = 48) patients referred to palliative care. Among the patients that died during study follow up, the majority died in hospital (n = 147,44%). ConclusionOur study reports one of the largest series of real-world TCE patients published and demonstrates the poor outcomes of TCE patients receiving a subsequent LOT.

(161) Usage Patterns of Erectile Dysfunction Medications in Young Adult Men

Abstract Introduction There has been a significant increase in the accessibility of pharmacologic erectile dysfunction (ED) treatments through direct-to-consumer platforms. However, the impact of this broad accessibility on usage in young adult men has not been studied. Objective We sought to assess demographic, socioeconomic, and health factors associated with erectile dysfunction medication use among men aged 18-40 years. Methods We created a survey assessing prior phosphodiesterase-5 inhibitor (PDE-5) use, means of acquisition, and receipt of counseling prior to use. The survey was disseminated with the modified International Index of Erectile Function (IIEF-5) questionnaire to a convenience sample of men ages 18-40 via Research Match, an NIH-funded database of research participants. Demographic data including age, race, ethnicity, education level, insurance status, sexual orientation, and relationship status were collected. Descriptive statistics were performed using t-test, chi-squared test, and univariable and multivariable logistic regression with significance defined as p<0.05. Results Among 210 respondents, 82 (39.0%) indicated prior use of ED medication. Men identifying as Black or African American (OR = 3.54, 95% CI: 1.82-6.88, p<0.001) and Hispanic or Latino (3.32, 95% CI: 1.45-7.62, p=0.01) were more likely to have reported prior use. Higher rates of utilization were similarly observed among men insured by Medicare or Medicaid (OR = 6.07, 95% CI: 3.10-11.87, p<0.001). Income >$200,000 per year was associated with decreased utilization (OR 0.23, 95% CI: 0.06-0.92, p=0.04). Mild, mild to moderate, and severe erectile dysfunction per the modified IIEF scale were associated with increased utilization (OR = 3.09, 13.70, 20.25 and p-values = 0.01, <0.001, <0.001, respectively). There were no statistically significant differences among usage patterns with respect to age, education level, relationship status, or sexual orientation. Medicare or Medicaid coverage (p<0.001) and IIEF symptom severity were significant independent predictors on multivariable regression. Performance anxiety with a partner (56.6%), difficulty maintaining erections (46.9%), and providing confidence during intercourse (39.5%) were the most frequently cited reasons behind use. Primary care providers were the most frequent source of initial procurement (30.9%), followed by friends, family members, or partners (25.9%) and direct-to-consumer online platforms (18.5%). The most important factors considered in procuring medications were privacy (61.7%) and cost (54.3%). Despite 72.8% of men reporting counseling on proper use and risks, only 28.0% were able to correctly identify four key features surrounding proper use (including medication timing, dosage interval, prolonged erections, and sexual stimulation requirement). Conclusions We found high use of ED medication among young adult men, particularly among those identifying as Black or African American and Hispanic or Latino, as well as those insured by Medicare or Medicaid. The emphasis on privacy over cost and convenience in obtaining medications likely demonstrates continued stigma surrounding men’s health and sexual health issues. Despite most men reporting counseling on proper use, a stark knowledge gap exists as only a minority of men can correctly identify proper use. This underscores the need for healthcare professionals to provide thorough patient education and guidance to ensure safe and effective use of these medications in young men. Disclosure No.