The oil and gas industry, like many others is constantly looking at ways to keep costs of well completion down based on cost effective solutions that do not compromise safety. This combined with the desire to develop new oil and gas fields that are very challenging in terms of operating pressures, temperatures, and corrosivity of the environment may result in the need to utilize materials closer to their mechanical loading limit in a corrosive environment. Modern alloys of high strength and corrosion resistance are often more susceptible to cracking. With a move toward higher production pressures, and temperature, production tubing for downhole use may become a limiting factor for exploration of future oil and gas wells. Typically, materials and corrosion test samples are usually set up to examine material behavior under single mode loading (e.g., tensile sample) and not combined loads experienced by a production tubing in a well completion. A novel test set‐up was developed to simulate stresses in a production tubing string with the potential to define combined load conditions in a corrosive environment once mechanical load limit is determined. In small scale tests cold worked super duplex stainless steel mini pipes were subjected to combined load, that is, axial stress simulating weight of the tubing string and internal pressure (from the reservoir). The mechanical load limit (failure envelope) was determined in the absence of a corrosive environment thereafter the mini pipes were subjected to load conditions below mechanical limit in a corrosive environment to determine load and environment conditions that would not lead to crack initiation. The potential pipe load limit when in the corrosive environment is below the corrosion test load condition to avoid crack initiation and failure.

IntroductionWorcestershire Acute Hospitals NHS Trust has an Alcohol Liaison Nurse Service (ALNS) across two hospital sites, with two full-time ALNs providing screening, case management support, brief interventions (BI) and referrals into community treatment services. We performed a retrospective cohort study to assess the impact of the ALNS on emergency departement (ED) re-attendance over a 3 year period and estimated the cost saving using the 2012/3 reference costs.MethodsAll patients who had attended the ED, surgical or medical assessment units and received a BI delivered by the ALNS over a 3 month period, between January to March 2012, was identified via hospital records (Patient First ED computer system and OASIS). Patient attendances to ED for the preceding 12 month period were compared with the 12 month periods after the BI over the following 3 years. Patients were excluded if they lived outside the trust catchment area or were imprisoned or died during the study period. Costs of attendances to ED over the period were estimated as £114 per visit. Statistical analysis was by paired t-test.Results192 patients (123 males & 69 females) identified as having a BI were included in the cohort. 36 were excluded due to death within the study period and 4 due to incarceration. The median age of the cohort was 44 years (range 17–87 years). The most common reason for presentation related to mental health issues including deliberate self harm and overdose. During the 12 month period before ALNS intervention there were 464 qualifying ED attendances with an average of 2.42 attendances per patient. In the first 12 months following BI, the ED attendance rate fell to 327 (1.7 attendances/patient), and then to 255 in the second 12 months (1.33 attendances/patient), and finally 225 in the third 12 months following BI (1.17 attendances/patient).The reduction in attendance was statistically significant 12 months after intervention compared with the preceding year (p < 0.005) and was sustained at 36 months post intervention (p < 0.005). Attendance for the third 12 month period post-intervention was statistically significantly lower compared with the first (p = 0.0181).For this 3 month cohort of 192 patients, the cost of ED attendance in the year before BI was estimated at £52, 896. By the end of the study period this had been reduced by 51.5% (twelve monthly cost estimates £37,278, £29,070 and £25,650).ConclusionThis pragmatic study suggests that an ALNS may have a sustained effect upon the number and cost of ED attendances.Reference1 Disclosure of InterestNone Declared

IntroductionPatients attending for routine review at a primary care diabetes clinic were screened for advanced fibrosis using a NAFLD fibrosis score calculator.MethodsThe NAFLD Fibrosis Score online calculator () has been developed to identify patients that are at significant risk of having advanced fibrosis using body mass index, serum ALT, AST, platelet count, diagnosis of diabetes and age as parameters.1 We prospectively screened consecutive patients attending for routine review at a primary care diabetes clinic between June and December 2015. Advanced fibrosis was predicted using high cut-off score (>0.676; with previously validated Positive Predictive Value 90%) or excluded for low cut-off score (<−1.455; Negative Predictive Value 93%). Patients with Type 1 and Type 2 diabetes were included. Statistical analysis was performed with Pearson’s and Chi Squared test.Results208 patients were screened, 126 males and 82 females, with a median age of 66 years (range 22–93 years). 21% of patients (29 male and 17 female) with a median age of 76, had a NAFLD Fibrosis score predicting a significant risk of advanced fibrosis and identifying them as appropriate for referral to secondary care. A NAFLD score predicting a significant risk of advanced fibrosis increased with age: 5.6% (1/ 18) of patients aged less than 50, 9.5% (4/42) of patients aged 50–59 years, 12.5% (7/56) of patients aged 60–69, 35.1% (20/57) aged 70–79 and 56% (14/25) of patients aged 80 years and older. Advanced fibrosis was predicted for 23% male (29/126) and 21% females (17/82) patients. Advanced fibrosis was excluded in 13.5% patients (28/208). As expected, there was a moderate positive correlation between NAFLD score and age (r = 0.56). There was no significant difference in the proportion of male or female patients with advanced fibrosis (p = 0.7).ConclusionIt is practical to routinely screen patients for liver fibrosis secondary to NAFLD within a primary care diabetes clinic using the NAFLD fibrosis score calculator and identify a significant proportion of patients at significant risk of advanced fibrosis.Reference1 Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007;45(4):846-854Disclosure of InterestNone Declared