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This article introduces a new web-based decision support system created for early-stage feasibility assessments of renewable energy technologies in England, UK. The article includes a review of energy policy and regulation in England and a critical evaluation of literature on similar decision support systems. Overall, it shows a novel solution for a repeatable, scalable digital evidence base for the policy compliant deployment of renewable energy technologies. Data4Sustain is a spatial decision support system developed to quickly identify the feasibility of seven renewable energy technologies across large areas including wind, solar, hydro, shallow and geothermal. A multi-actor approach was used to identify the key factors that influence the technical feasibility of these technologies to generate electricity or heat for local consumption or regional distribution. The research demonstrates opportunities to improve the links between policy and regulation with deployment of renewable energy technologies using novel approaches to digital planning. Deployed, resilient, cost-effective and societally accepted renewable energy generation infrastructure has a role to play in ensuring universal access to affordable, reliableand modern energy supply. This is central to supporting a concerted transition to a low-carbon future in order to address climate change. The selection and siting of renewable energy technology is driven by natural resource availability and physical and regulatory constraints. These factors inform early-stage feasibility of renewables, helping to focus investment of time and money. Understanding their relative importance and identifying the most suitable technologies is a highly complex task due to the disparate and often unconnected sources of data and information needed. Data4Sustain help to overcome these challenges.

The kinetic theory of plasmas is governed by the Boltzmann equation, which describes the evolution of the distributions of electrons and ion species within six-dimensional phase space. When equipped with an appropriate model for the various binary collision events that can occur, this equation can be used to simulate a wide variety of plasma physics problems. Numerical solutions of the Boltzmann equation can be generated by either directly discretizing the six-dimensional phase space or by utilizing particle-based techniques, such as the Particle-in-Cell (PIC) method, to describe the statistical evolution of the distribution functions. However, both methods are inherently computationally expensive, and solutions in complex three-dimensional spatial domains remain intractable. For highly collisional plasmas in which the velocity distributions are nearly isotropic, a spherical harmonic expansion can be used to reduce the dimensionality of the phase space. Recent work at the Naval Research Laboratory 1 has re-examined this classical analytical approach in the context of low-temperature collisional plasmas. The authors derived a multi-term expansion that reduces the six-dimensional Boltzmann equation to a set as four-dimensional fluid-like equations. In this work, we describe the development of a general, high-order numerical solution method for this set of equations based on the discontinuous Galerkin (DG) finite element method. The electron velocity distribution function is discretized directly on the 4D phase-space mesh. Self-consistent electric and magnetic fields are simulated by solving Maxwell’s equations on a sub-dimensional manifold within the higher-dimensional phase-space mesh. A description of the numerical methodology will be presented along with a series of test problems that provide a demonstration of the algorithm and an initial examination of the benefits associated with using high-order phase-space discretizations.

NRL is embarking on a program to study the connection between plasma instabilities and fast ion acceleration for neutron production on a Dense Plasma Focus (DPF). The experiments will be performed on the HAWK generator (665 kA, 1.5 micro-sec), which has a high inductance (619 nH). There is a conjecture that the neutron yield on a DPF may be enhanced on a high impedance generator since the assembly on axis will not significantly reduce the current drive. Furthermore, to prevent upstream breakdown during the implosion there are plans to inject the gas load as a plasma far from the insulator stack. As a propaedeutic study, we performed MHD simulations using the Athena code. Athena is an Eulerian 3D, unsplit finite volume MHD code that includes shock capturing with Riemann solvers and resistive diffusion for the magnetic field components. The simulations are coupled to an equivalent circuit model for HAWK. This initial report will examine the dynamics and implosion time as a function of the initial injected plasma distribution and study the implications of non-ideal effects.

Three major suites of silicate inclusions in sublithospheric diamonds show evidence of formation at depths > 250 km, and for each suite there is evidence of their formation from subducted material. Two of these are the well known basic (majoritic garnet) and ultrabasic (MgSi-perovskite + ferropericlase) suites. The third, the recently recognised Ca-rich suite, is characterised by carbonate, Ca–Si–Ti minerals and some aluminous material. Carbon isotope ratios in the host diamonds and geochemical–petrological features of the inclusions themselves provide evidence for their derivation from subducted lithosphere materials. The diamonds hosting the basic and ultrabasic suites are suggested to form in fluids/melts resulting from the release of water caused by dehydration reactions affecting both the crustal and mantle portions of a subducting slab of ocean lithosphere. Conversely, the diamonds containing the Ca-rich suite are linked with the formation of carbonatitic melts. In the Juina kimberlite province of Brazil, all three suites have been found in close proximity. A model is presented whereby the formation of the suites occurs progressively during the subduction and stagnation of a single lithospheric slab, with all three suites being transported to the lithosphere by a plume with which the carbonatitic melts of the Ca-rich suite are associated. Nd–Sr isotopic data are presented for the Juina majoritic-garnet inclusions, which supports their formation from oceanic crust of Mesozoic age. In conjunction with published age data for a Ca–Si–Ti inclusion, the Juina (Brazil) sublithospheric inclusions document a series of events involving diamond formation during and following the emplacement of a subducted slab between ca 190 and 90 Ma beneath west Gondwanaland. This slab and related subducted slabs dating from the Palaeozoic at the Gondwanan margin may be the source of the widespread DUPAL geochemical anomaly in the South Atlantic and Indian Oceans. The kimberlites bringing the diamonds to the Earth's surface may have arisen from a superplume, developed from a graveyard of former Gondwanan stagnant slabs, at the Core–Mantle-Boundary.

OBJECTIVE The receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL), and osteoprotegerin (OPG) signaling pathway (RANKL/RANK/OPG signaling) is implicated in the osteolysis associated with diabetic Charcot neuroarthropathy (CN); however, the links with medial arterial calcification (MAC) seen in people with CN are unclear. This study aimed to investigate the role of RANKL/OPG in MAC in patients with CN. RESEARCH DESIGN AND METHODS Enzyme-linked immunosorbent assay and Bio-plex multiarray technology were used to quantify a range of cytokines, including RANKL and OPG in sera from 10 patients with diabetes, 12 patients with CN, and 5 healthy volunteers. Human tibial artery segments were immunohistochemically stained with Alizarin red and human RANKL antibody. Human vascular smooth muscle cells (VSMCs) were also explanted from arterial segments for in vitro studies. RESULTS We demonstrate colocalization and upregulation of RANKL expression in areas displaying MAC. Systemic levels of RANKL, OPG, and inflammatory cytokines (interleukin-8, granulocyte colony–stimulating factor) were elevated in those with CN compared with diabetic patients and healthy control subjects. Human VSMCs cultured in CN serum showed accelerated osteoblastic differentiation (alkaline phosphatase activity) and mineralization (alizarin red staining) compared with cells treated with diabetic or control serum (P < 0.05). Coincubation with OPG, the decoy receptor for RANKL, attenuated osteogenic differentiation of VSMCs and was independent of a high calcium-phosphate milieu. The accelerated mineralization induced by RANKL and CN serum correlated with nuclear translocation of nuclear factor-κB, a process abrogated by OPG. CONCLUSIONS Our data provide direct evidence that RANKL/RANK/OPG signaling is modulated in patients with CN and plays a role in vascular calcification. This study highlights this pathway as a potential target for intervention.

Designing automotive catalysts for effective control of NOx, HC and CO emissions under both lean and stoichiometric engine operation is a challenging task. The present work assesses the performance efficiency of a three-zone prototype catalytic convertor in reducing exhaust emissions from a gasoline engine, operating in Homogeneous Charge Compression Ignition (HCCI) and Spark Ignition (SI) mode under lean and stoichiometric conditions. The performance of the convertor for HC oxidation follows the order: lean HCCI > stoichiometric SI > stoichiometric HCCI. The study mainly focused on the quantitative analysis of C1–C7 hydrocarbon compounds before and after the catalytic convertor. The results show that monocyclic aromatic hydrocarbons such as toluene are present at higher concentrations in the exhaust under HCCI operation than in the SI case. On the other hand, benzene concentrations are higher in the SI exhaust. The most common exhaust products of the two engine operating modes are methane, ethylene, propylene, benzene, and toluene. The prototype catalytic convertor eliminates most of the hydrocarbon species in the exhaust under both combustion modes, especially with a lean mixture. Conversion efficiencies for the different hydrocarbon species over the catalyst were in the order of alkenes > alkanes > aromatics. Hydrogen was added upstream of the catalyst primarily to assess its ability to promote NOx reduction, however it was also found to influence the oxidation characteristics of the catalyst. During H2 addition, the methane concentration was higher downstream of the catalyst.

A major effort has been made to surmount the current obstacles to expanding the operating window of homogeneous charge compression ignition (HCCI) engines. The research involves extensive experimental studies on single-cylinder and multi-cylinder engines and the work is devoted to the development of on-board fuel-reforming technology and to the application of supercharging combined with trapping of residual gases in the cylinder. Fuel reforming yields significant quantities of hydrogen and is used to extend the lower load boundary while supercharging and internal exhaust gas recirculation (EGR) trapping are used to increase the upper load limit of HCCI engines. The present paper highlights the main findings of the research to date; in particular it reveals that using a combination of technical elements for effective control of auto-ignition in a typical passenger car engine configuration is possible and promising.

One of the most widely used methods to enable Homogeneous Charge Compression Ignition (HCCI) combustion is using negative valve overlapping to trap a sufficient quantity of hot residual gas. The characteristics of air motion with specially designed valve events having reduced valve lift and durations associated with HCCI engines and their effect on subsequent combustion are not yet fully understood. In addition, the ignition process and combustion development in such engines are very different from those in conventional spark-ignition or diesel compression ignition engines. Very little data has been reported concerning optical diagnostics of the flow and combustion in the engine using negative valve overlapping. This paper presents an experimental investigation into the in-cylinder flow characteristics and combustion development in an optical engine operating in HCCI combustion mode. PIV measurements have been taken under motored engine conditions to provide a quantitative flow characterisation of negative valve overlap in-cylinder flows. The ignition and combustion process was imaged using a high resolution charge coupled device (CCD) camera and the combustion imaging data was supplemented by simultaneously recorded in-cylinder pressure data which assisted the analysis of the images. It is found that the flow characteristics with negative valve overlapping are less stable and more valve event driven than typical spark ignition in-cylinder flows, while the combustion initiation locations are not uniformly distributed. © 2006 IOP Publishing Ltd.

Unlike graft-resident donor-derived hemopoietic APCs, which decrease in number over time after transplantation, vascular endothelial cells are lifelong residents of a vascularized allograft. Endothelial cells are potent APCs for allogeneic CD8+ T lymphocytes but are unable to induce proliferation of allogeneic CD4+ T lymphocytes. Although the reason for this differential response has been poorly understood, here we report that alloantigen presentation by vascular endothelium to CD4+ T lymphocytes activates and induces CD4+25+Foxp3+ regulatory T cells, which can inhibit proliferation of alloreactive T cells both in vitro and in vivo. This process occurs independently of B7.1 costimulation but is dependent on programmed death ligand 1 (B7-H1). This finding may have important implications for tolerance induction in transplantation.

Three samples of gouge from a U-mineralised fault, and two model samples, montmorillonite and muscovite, spiked with U, were heat-treated at a range of temperatures up to 1100 °C. Mineralogical changes were followed by thermal analysis, powder XRD and electron microscopy, and U extractability was measured by extraction with NH4+. Changes in U speciation in the montmorillonite sample were followed using EXAFS spectroscopy. On heating, the minerals progressively dehydrate, dehydroxylate and eventually decompose to form new phases in a glassy matrix. In the case of montmorillonite (90% of U extractable from unheated material), U extractability increased slightly on heating to temperatures around 400 °C. Almost 50% of U was extracted from unheated muscovite, and this increased slightly by 450 °C. Above 500–600 °C, U extractability from both montmorillonite and muscovite declined to very low levels, reflecting dehydration of the uranyl ion and trapping in the new phases and glassy matrix. Uranium extractability from the natural samples was much lower in all cases (0.25–5% of the total before heating). In 2 samples, a significant increase in U extraction was associated with dehydroxylation at around 600 °C, followed by a decrease to very low levels at higher temperatures. Uranium extraction from the third natural sample, which contained X-ray amorphous U minerals, decreased steadily on heating. The results show that changes in U extraction can be related to structural and morphological changes in sheet silicate minerals. Heat treatment has potential to fix U but only if temperatures above 800 °C are reached. If only lower temperatures, in the range 400–600 °C, are used, then U extraction may increase.

The desire to minimise fuel consumption and corresponding vehicle CO 2 emissions for future powertrain applications drives the need for advanced charging systems. Worldwide legislative requirements and customer desires for improved efficiency whilst maintaining vehicle drivability and performance are challenging automotive manufacturers to investigate innovative concepts for air charge delivery.

The paper discusses Ultra Boost for Economy, a collaborative project part-funded by the Technology Strategy Board, the UK’s innovation agency. ‘Ultraboost’ combines industry- and academia-wide expertise to demonstrate that it is possible to reduce engine capacity by 60% and still achieve the torque curve of a large naturally-aspirated engine, while encompassing the attributes necessary to employ such a concept in premium vehicles. In addition to achieving the torque curve of the Jaguar Land Rover 5.0 litre V8 engine, the main project target was to show that such a downsized engine could in itself provide a viable route to a 35% reduction in vehicle tailpipe CO2, with the target drive cycle being the New European Drive Cycle. In order to do this vehicle modelling was employed to set part load operating points representative of a target vehicle and to provide weighting factors for these points. The engine was sized by using the fuel consumption improvement targets while a series of specification steps, designed to ensure that the required full-load performance and driveability could be achieved, was followed. The intake port in particular was the subject of much effort, and data is presented showing its performance versus a current state-of-the-art production design. The use of a test-cell-based charging system, while the engine-mounted charging system was being developed and characterized in parallel, is discussed. This approach allowed development of the base engine and combustion system without the complicating effects of the charging system performance coming into play. Finally, data is presented comparing the performance of the engine in this guise with that when the engine-driven turbocharger was used, showing that the peak torque and power targets have already been met.

The effect of pH (2–10) and humic acid (HA) concentration on the adsorption of HA onto a range of pure-phase inorganic colloids (δ-alumina, haematite, manganese dioxide, amorphous silica and titanium dioxide) has been studied, and the influence of HA on the colloidal zeta-potential has been investigated. The results showed a decrease in the adsorption of HA with increasing pH, due to both electrostatic effects and specific site interactions. Adsorption was influenced by colloid surface area, HA concentration and the nature of the mineral surface, with acidic surfaces exhibiting a lower affinity for adsorption than more basic surfaces. The HA was shown to confer a more negative surface charge on the colloids with the exception of silica. Natural organic matter (NOM) is ubiquitous in the aquatic environment, which would indicate that natural inorganic colloids are likely to possess NOM coatings and be predominantly negatively charged. The presence of HA was shown to strongly influence the adsorption of 152Eu (1 × 10−9 mol l−1) onto the inorganic colloids over the pH range investigated, except in the manganese dioxide system. 152Eu adsorption onto the bare colloids was shown to be highly pH dependent, adsorption increasing with pH. The mechanism appeared not to be purely electrostatic, but due to metal speciation and the nature of the surface sites, i.e. specific site binding. In the presence of HA, Eu adsorption generally showed an increase at low pH due to adsorption of EuHA complexes onto the colloid surface. At high and intermediate pH, adsorption was generally reduced owing to desorption of EuHA complexes from the colloid surface, and because inorganic Eu species were being prevented from adsorbing onto the colloid surface, a possible cause being a blocking mechanism by the HA. It can be concluded that if inorganic colloids are to be included in metal speciation and transport codes, a thorough understanding of the ternary interactions of NOM with toxic metals and inorganic colloids must be gained.

This paper provides an introduction to the technical challenges and countermeasures required to enable extreme gasoline engine downsizing. Jaguar Land Rover (JLR) is the lead partner in a collaborative project called ‘ULTRABOOST’ which is supported with funding from the UK Technology Strategy Board (TSB). The project aim is to develop an innovative engine concept capable of a 35% CO 2 tailpipe reduction over the NEDC drive cycle relative to a current production V8 engine in a Sports Utility Vehicle, whilst maintaining key vehicle attributes such as performance and transient response. The project consortium is made up of eight technical partners including Jaguar Land Rover, Lotus Engineering, Shell Fuels, GE Precision Engineering, CD-adapco, University of Bath, University of Leeds and Imperial College London. Starting in September 2010 and running for three years the project will utilise the partners expertise and collective skills in engineering, design, combustion modelling, pressure charging and fuels to develop a highly pressure charged downsized engine concept. In this paper the technology required to enable extreme levels of engine downsizing and CO 2 reductions are described, together with accompanying simulation data collected from the initial concept engine development.

Extending the proximal landing zone to facilitate endovascular repair of aortic aneurysms with short proximal necks using the chimney, top-fenestration, or snorkel technique has been previously reported. In addition, extending the distal landing zone using the periscope technique has also been recently described. In this study, we used an extended chimney technique, the “telescoping technique,” to successfully treat a ruptured Crawford type III thoracoabdominal aortic aneurysm in a patient with pre-existing renal failure and an occluded superior mesenteric artery.

Unlike graft-resident donor-derived hemopoietic APCs, which decrease in number over time after transplantation, vascular endothelial cells are lifelong residents of a vascularized allograft. Endothelial cells are potent APCs for allogeneic CD8+ T lymphocytes but are unable to induce proliferation of allogeneic CD4+ T lymphocytes. Although the reason for this differential response has been poorly understood, here we report that alloantigen presentation by vascular endothelium to CD4+ T lymphocytes activates and induces CD4+25+Foxp3+ regulatory T cells, which can inhibit proliferation of alloreactive T cells both in vitro and in vivo. This process occurs independently of B7.1 costimulation but is dependent on programmed death ligand 1 (B7-H1). This finding may have important implications for tolerance induction in transplantation.

While Homogeneous Charge Compression Ignition (HCCI) is a promising combustion mode with significant advantages in fuel economy improvement and emission reductions for vehicle engines, it is subject to a number of limitations, for example, hardware and control complexity, or NOx and NVH deterioration near its operating upper load boundary, diminishing its advantages. Conventional spark-ignition combustion mode is required for higher loads and speeds, thus the operating conditions near the HCCI boundaries and their corresponding alternatives in Sl mode must be studied carefully in order to identify practical strategies to minimise the impact of the combustion mode transition on the performance of the engine. This paper presents the results of an investigation of the combustion mode transitions between Sl and HCCI, using a combination of an engine cycle simulation code with a chemical kinetics based HCCI combustion code. It investigates and discusses the key issues concerning the combustion mode transition and its control. A new approach has been adopted in the modelling of the HCCI engine gas exchange and combustion, which allowed a parametric study of the transient process in the transition on a cycle-by-cycle basis and provided guidelines in the design of the engine hardware and its control strategies.

A single zone combustion model based on a chemical kinetic solver has been combined with a one-dimension thermo/gas dynamic engine simulation code to study the operating characteristics of a V6 engine In which Homogeneous Charge Compression Ignition (HCCI) operation (also referred to as 'Controlled Auto-ignition" CAI) is enabled by a cam profile switching (CPS) system with negative valve overlap. An operational window within which HCCI combustion is possible has been identified and the limit of HCCI operating region for varied valve lift possibilities is explored. The mechanisms and potential fuel economy improvements within the HCCI envelope are studied and modelled results compared against data from similar engines. It is shown that for the best fuel economy the valve timing strategy needs to be selected very carefully, despite the engine's capability to operate at a range of valve timing combinations. The heating effect of the exhaust gases is dominant when using less than approximately 55% residual gases. For higher EGR rates, the diluting effect coupled with reducing exhaust gas temperatures makes the ignition timing retarded. It is demonstrated that for HCCI operation the selection of valve lift for the CPS system is limited between the constraints of the breathing capacity with the lower valve lift and misfires with the higher one.

Federal agencies' annual performance reports should give Congress and the public accurate, timely information documenting the tangible public benefits the agencies produce. The Bush administration has indicated that it will begin using agency performance information later this year when making budget decisions for fiscal year 2003.

Abstract Oryx Energy Company and CNG Producing Company have recently completed the installation of the World's First Spar to be used as a base for well production operations. This Deepwater development is located in Viosca Knoll Block 826 in the Gulf of Mexico, in a water depth of 1930 feet, and is called the "NEPTUNE PROJECT." This paper will provide an overview of the physical characteristics of the Neptune Project. It will also discuss Project Management philosophies that were applied in the execution of the project. The use of a small management team by the owners, integrated with keyteam members from the Contractors' organizations and Classification Society, resulted in completion of the projectwithin original schedule requirements. Unique to the project was the use of the Internet for domestic and international communications. This reduced drawing review and documentation turnaround cycles, helping to support the aggressive project schedule. The strategies applied can be utilized to more effectively manage the execution of largeand small projects, while containing cost and achieving on time completion. Introduction Oryx Energy Company and CNG Producing Company have recently installed facilities in Viosca Knoll Block 826 (VI(826) and have begun production of the reserves located in thearea. Exploration drilling in the area began in 1983 by other operators, and Oryx's exploration efforts began in 1984 with the acquisition of the VK 826 Block. Concurrent with this exploration activity, Ed Horton, President of Deep Oil Technology, Inc.(DOT), patented (Ref. 1) a Spar for use as a floating production platform. This development was sponsored by a Joint Industry Project, in which Oryx participated, beginning in 1986. In 1993, representatives of Oryx and DOT began to focus on theapplication of Spar technology to develop these reserves. The complex geology of the area has been a particular challenge to the selection of the proper development methodology, as discussed below. Oryx drilled its first exploration well in 1989, and initial results were encouraging. Subsequent wells confirmed the presence of approximately 50-75 million equivalent barrels of oil of recoverable hydrocarbons. Several development options were evaluated by Oryx and the other working interest partners. During 1993, CNG became interested in participation in the project and in 1994 formally bought the interest of another major operator. The successful development of the reserves in VK. 826 Unit, is a tribute to the tenacity of a team of geologists, geophysicists, reservoir engineers, facility and operations engineers and scientists who have remained committed to developing a system that would prove the application of this technology for the economic recovery of the oil in place. Location The Viosca Knoll Block 826 Field Unit occupies four blocks, Viosca Knoll 825, 826, 869 and 870. The project is located in federal waters, Offshore Alabama, approximately 60 miles east of the main pass of the Mississippi river, 135 miles southeast of New Orleans, Louisiana and 90 miles south of Mobile, Alabama (Fig. 1) The water depth ranges from 1175 feet in the northwest comer of Block 825 to 3225 feet in the southeast comer of Block 870.

The standard vulnerability assessment model, COVART, can only be used in conjunction with input data files that describe the interactions between thousands of shotlines and the components making up the target. Creating these files is extremely timeand resource-intensive, severely limiting the analyst's ability to produce high-fidelity COVART analyses during the critical early stages of design evolution. McDonnell Douglas, in conjunction with Fortesque Corporation, has developed an alternative methodology that produces COVART shotline input data files directly from CAD design drawing databases, thus providing quick-turnaround vulnerability assessment capability that enables the vulnerability analyst to become a full player in Integrated Product Teams for new designs.

High-speed cine photography has been applied to an optically-accessed version of a modern 4-valve, pent-roof, SI engine in order to observe the behavior of fuel under cold starting and warm-up conditions. A wall film was formed on the combustion chamber surface in the vicinity of the valves when fuel was supplied by pintle and disk-type injectors. This wall film survived combustion but was drawn into the exhaust system when the exhaust valves opened. The use of an air-blast atomizer avoided the formation of this wall film, but some wetting of the piston was apparent, as it was with the other types of injector.

6098 Background: CareFirst BlueCross BlueShield (CFBCBS) insurance network partnered with Cardinal Health Specialty Solutions (CHSS) to develop a cancer care pathway for network physicians in 2008. The program included a recommendation for molecular diagnostic testing with the Oncotype DX assay for pts with early-stage estrogen receptor-positive breast cancer. Based on NCCN guidelines, the pathway suggested adjuvant chemotherapy for all pts with Oncotype DX Recurrence Scores (RS) in the high-risk category. We aimed to determine the RS risk distribution among pts who received Oncotype DX testing and assess the patterns of care that followed. Methods: Using data from CFBCBS, CHSS proprietary claims software, and Genomic Health, we retrospectively identified a cohort of women with breast cancer who were treated on the CFBCBS clinical care pathways program from 8/2008 to 6/2011 and received Oncotype DX testing. We determined the number of pts with a RS value in the low- (RS

569 Background: Cardinal Health Specialty Solutions (CHSS) partners with payers to manage clinical care pathways in oncology and rheumatology. Observations from one such pathway with CareFirst BlueCross BlueShield revealed that pts with estrogen receptor-positive ESBC who underwent Oncotype DX testing and were found to have high-risk Recurrence Scores (RS) received less chemotherapy than expected. To better understand physician behavior as it relates to Oncotype DX testing, CHSS examined patterns of Oncotype DX use in a large private practice oncology group with a robust electronic medical record (EMR), Georgia Cancer Specialists (GCS). We aimed to determine the RS risk distribution among pts who received Oncotype DX testing and assess the patterns of care that followed. Methods: Using GCS EMR data from 2009 to 2011, the number of pts who were eligible to undergo Oncotype DX testing was compared to the number of pts who underwent testing. Pts were considered eligible for testing if they had node-negative, estrogen receptor-positive, HER2-negative ESBC. We determined the number of pts with a RS value in the low- (RS

571 Background: Cardinal Health Specialty Solutions (CHSS) partners with payers to manage clinical care pathways in oncology and rheumatology. Observations from one such pathway with CareFirst BlueCross Blue Shield revealed lower than expected use of CT in patients (pts) with estrogen receptor-positive early-stage breast cancer (ESBC) at high-risk for recurrence by ODX RS. To better understand physician behavior, CHSS examined patterns of care in a large private practice oncology group with a robust EMR, Georgia Cancer Specialists (GCS). Pt characteristics and physician-prescribing patterns were analyzed to determine variables that most impacted the physician’s decision to treat high-risk pts with CT. Methods: Using the GCS EMR from 2009 to 2011, we retrospectively identified pts with ESBC (stage I-II, node-negative, estrogen receptor-positive, HER2-negative) who underwent ODX testing. We determined the number of pts with a RS value in the low- (RS 66 y. CT use in high-risk pts was 82% and 86% in pts with tumor sizes 60% of the time. There were no significant differences in patterns of CT use. Conclusions: The less than expected use of CT in high-risk patients appears to be related to physician preference and pt age. Tumor size and grade did not appear to influence choice of therapy.

e11002 Background: Cardinal Health Specialty Solutions (CHSS) partners with payers to manage clinical care pathways in oncology and rheumatology. Observations from one such pathway with CareFirst BlueCross Blue Shield revealed that in patients with estrogen receptor-positive early-stage breast cancer (ESBC), there was an underuse of Oncotype DX testing. To better understand physician behavior as it relates to Oncotype DX testing, CHSS examined patterns of Oncotype DX use in a large private practice oncology group with a robust electronic medical record (EMR), Georgia Cancer Specialists (GCS). We aimed to determine the variables that most impacted the use of Oncotype DX testing. Methods: Using the GCS EMR from 2009 to 2011, we retrospectively identified patients diagnosed with ESBC who were eligible for Oncotype DX testing (stage I-II, node-negative, estrogen receptor-positive, HER2-negative). The use of Oncotype DX testing was analyzed by patient age, tumor size, tumor grade, and physician prescribing patterns. Results: Of the 1908 patients identified with ESBC, 788 were eligible for Oncotype DX testing and 288 (37%) underwent testing. In an analysis by age, Oncotype DX was utilized in 34% of patients ≤ 45 years, 49% in patients 46-55 years, 37% in patients 56-65 years, 34% in patients 66-75 years, and 13% in patients > 75 years old. Oncotype DX use was 37% and 36% in patients with tumor sizes 60% of the time. There were no significant differences in patterns of chemotherapy use. Conclusions: Based on this analysis, eligible patients with ESBC between 46-55 years of age, with small and intermediate sized tumors (