bluuebunny/crossref_metadata_2025 huggingface dataset:
Creating People and Saving People
Authors: McMahan Jeff
Published: April 2022

Most people are skeptical of the claim that the expectation that a person would have a life that would be well worth living provides a reason to cause that person to exist. This chapter argues that to cause such a person to exist would be to confer a benefit of a noncomparative kind and that there is a moral reason to bestow benefits of this kind. But this conclusion raises many problems, among which is that it must be determined how the benefits conferred on people by causing them to exist weigh against comparable benefits conferred on existing people. In particular, might the reason to cause people to exist ever outweigh the reason to save the lives of existing people?
Nationalism in Swedish Children’s Film and the Case of Astrid Lindgren
Authors: Åberg Anders Wilhelm
Published: April 2022

This chapter traces the development of Swedish children’s film from the focal point of the national discourse in Sweden. Children’s films in Sweden, especially those with a high audience appeal, tend to be a part of the national discourse and to promote ideas about Sweden and Swedishness, as well as entice pleasurable feelings associated with the Swedish nation and people. In the films based on the work of Astrid Lindgren, this is accomplished through picturesque renditions of a pastoral “patriotic landscape” and thematizing ideas of community in a way that invites the audience to equate, cognitively and emotionally, ideal local communities with the national community. Lindgren’s films are discussed in the context of children’s film in Sweden at large to illustrate an historical arc from future-oriented nation-building to nostalgia.
Nation, Identity, and the Larrikin Streak in Australian Children’s Cinema
Authors: Schober Adrian
Published: April 2022

This chapter on Australian children’s cinema takes as its starting point a certain anti-authoritarian streak in the national character that has helped define Australia’s identity: the larrikin streak. In analysing this streak across a range of films from the silent to the post-war eras to the Australian film revival of the 1970s and 1980s, the chapter argues that larrikinism—and a larrikin childhood in particular—speaks directly to questions of history, nation and identity. This throws into sharp relief so-called aspects of the Australian character, or mystique—what historian Russell Ward termed the Australian Legend. Combining film history with textual analysis and an analysis of critical and commercial reception, this chapter charts a course for the larrikin children’s film in Australia. The films discussed are The Kid Stakes, Those Terrible Twins, Smiley, Smiley Gets a Gun, Let the Balloon Go, Fatty Finn, and Ginger Meggs.
Unreality, Fantasy, and the Anti-fascist Politics of the Children’s Films of Satyajit Ray
Authors: Banerjee Koel
Published: April 2022

This chapter focuses on Satyajit Ray’s Hirak Rajar Deshe (Kingdom of Diamonds, 1980) and explores how the genre of the children’s film responds to its political milieu. Ray had been criticized his contemporaries for not being political enough, and his carefully crafted naturalism was seen as an impediment to politically committed cinema. However, in Hirak Rajar Deshe, Ray deviates from his seamless naturalist style and provides an acerbic critique of the Emergency, which was a period of curtailment of civil liberties imposed by the Indira Gandhi government in India between 1975–1977. The chapter asks how the children’s film genre the enables Ray to mount such a critique of state-sponsored violence that is otherwise thought to be missing from his oeuvre. The chapter argues that the allegorical structure of the film enables it to transcend its own temporal referents to offer a critique of the fascism that we are encountering in our present moment.
Corpus Approaches to Hip-Hop
Authors: Ohriner Mitchell
Published: April 2022

As of 2018, hip-hop has overtaken rock music to become the most popular genre on the planet. A steady ascent of hip-hop scholarship has accompanied this rise, although hip-hop continues to be little studied in the music disciplines in general and in corpus studies of music in particular. This chapter summarizes existing approaches to corpus studies of hip-hop. Furthermore, it explores statistically significant differences between corpora that aim to sample the same genre and locates those differences in divergent sampling methods and representational schemes. In two brief concluding analyses, the author shows how corpus studies of hip-hop might be expanded to characterize differences in artists’ expressive practices in general (rather than descriptions of the genre as a whole) and rhythmic microstructure in particular.
All of Our Relations
Authors: Kukutai Tahu
Published: April 2022

This chapter offers a perspective on what makes Indigenous sociology distinctive, and why it is important. It is less concerned with “speaking back” or “up” to the sociological discipline and canon than with situating Indigenous sociology on its own terms. These terms are inherently relational. In Aotearoa New Zealand, the concept that best embodies relationality is whakapapa. Often used as a synonym for genealogy (a noun), whakapapa is also a verb that means to place in layers. The chapter explores the multiple meanings of whakapapa—and its relevance for relational sociology—in the context of a genealogical project with a hapū (subtribe) that I descend from. The chapter concludes by considering the implications of Indigenous sociology for Western sociology, in particular what it portends for transformation and decolonization.
Indigenous Womxn’s Embodied Theory and Praxis
Authors: Sherwood Yvonne P. , Jacob Michelle M.
Published: April 2022

This chapter starts from the premise that Native womxn are much more than their experiences of settler-colonial violence. The authors draw from Indigenous teachings to assert Indigenous feminist sociology, in which community, leadership, and accountability are fundamental principles. In the chapter, the authors theorize the importance of “auntie-ing” as a form of Native feminist praxis. They discuss critical contemporary examples of Indigenous feminist theory and praxis, informed by movement spaces around issues such as uranium mining, water rights, and gender violence, and in doing so reveal that “auntie-ing” on the front lines builds and maintains networks and values that “make power” beyond a simplified reaction to the violence that is experienced in the settler-colonial present. They extend Michelle Jacob’s concept of “auntie-ing” as a lived methodology in order to highlight its grounded and vital mode of being to a deeper understanding of Native feminism and a radical potential to transform our settler-colonial realities through their direct engagement on intersecting fronts.
Living Whiteness and Indigeneity
Authors: RedCorn Alex
Published: April 2022

Using Indigenous autoethnography, this chapter works to deepen the conversation about Whiteness and Indigeneity by sharing the perspectives of an Osage (USA) academic who passes for White while moving in and out of Indigenous and White social spaces. Using Osage ribbon work as a framework, this chapter serves as a confrontation of colonial entanglements and encourages readers to engage with the reality that Whiteness, and the associated privileges that come with passing for White, are important dimensions of lived experiences that need more interrogation as it operates at the intersections of Indigeneity. Overall, this chapter serves as a call for future scholarship and practitioner dialogue to acknowledge these realities and engage in the complexity that it represents as we work to deepen our understanding of modern Indigenous lived experiences—entanglements and all.
Capturing Superdiversity in Official Data
Authors: Aspinall Peter J.
Published: April 2022

This chapter discusses the capture of superdiversity in one particular set of official data, that is, the recent decennial censuses. First, it provides a review of how superdiversity variables are defined in the wider literature, including attempts to operationalize such variables in measurement studies. It then explores how the census captures these variables, including any advantages and drawbacks. Following a brief consideration of the evidence for growing superdiversity in the British population, the changes to the 2001 and 2011 censuses that have enhanced the capture of superdiversity are discussed. New questions have resulted in a high volume of tables that cover most of the superdiversity variables. In particular, customized census tables have yielded data on three-way contingency tables that contain at least one granular variable, providing a point of access to the intersectional nature of superdiversity. Further “Small Population” tables have provided data for groups that are excluded from standard tabulations by their small group size. How census data have been used to describe and analyze population superdiversity is illustrated by studies of particular communities of descent, attempts to develop a superdiversity index, and the mapping of superdiversity at the small-area level. Finally, the conclusion examines developments that may further enhance the utility of census data in the future for capturing superdiversity.
Artificial Intelligence for Adjudication
Authors: Glaze Kurt , Ho Daniel E. , Ray Gerald K. , Tsang Christine
Published: April 2022

Despite widespread skepticism of data analytics and artificial intelligence (AI) in adjudication, the Social Security Administration (SSA) pioneered path-breaking AI tools that became embedded in multiple levels of its adjudicatory process. How did this happen? What lessons can we draw from the SSA experience for AI in government? We first discuss how early strategic investments by the SSA in data infrastructure, policy, and personnel laid the groundwork for AI. Second, we document how SSA overcame a wide range of organizational barriers to develop some of the most advanced use cases in adjudication. Third, we spell out important lessons for AI innovation and governance in the public sector. We highlight the importance of leadership to overcome organizational barriers, “blended expertise” spanning technical and domain knowledge, operational data, early piloting, and continuous evaluation. AI should not be conceived of as a one-off IT product, but rather as part of continuous improvement. AI governance is quality assurance.
Moral Expertise
Authors: Driver Julia
Published: April 2022

This chapter explores the nature of moral expertise and its significance to debates in metaethics and normative ethics. A role for moral expertise in the clinical setting is presented which relies on drawing from considerations cited in moral epistemology work on testimony in favour of moral deference. Moral deference to expert moral testimony is important in certain situations identified in clinical settings, such as situations in which someone has difficulty ascribing fundamentality to any of the values they ascribe to. In high-stakes situations, in conditions of moral uncertainty, the testimony of trusted experts can be very helpful to those wrestling with difficult decisions.
Redirecting Rawlsian Reasoning Toward the Greater Good
Authors: Greene Joshua D. , Huang Karen , Bazerman Max
Published: April 2022

In A Theory of Justice, John Rawls employed the ‘veil of Ignorance’ as a moral reasoning device designed to promote impartial thinking. By imagining the choices of decision-makers who are blind to biasing information, one might see more clearly the organizing principles of a just society. In our experimental research we’ve applied veil-of-ignorance reasoning to more specific moral dilemmas. Here, we summarize our main findings and consider their implications. First, we argue that our findings provide further support for consequentialist approaches to ethics. Second, and more importantly, we argue that veil-of-ignorance reasoning may be a useful and underappreciated tool for thinking about real-world moral problems. We highlight the ability of VOI reasoning to foster more impartial decision-making and promote the greater good across a variety of domains, from the ethics of self-driving cars to healthcare to charitable giving.
Morality and Possibility
Authors: Knobe Joshua
Published: April 2022

People’s moral judgments appear to influence their intuitions about freedom, causation, and intentional action. Within existing research, a wide variety of different explanations have been offered for these effects. I argue that a number of apparently unrelated explanations should actually be understood as slightly different variations on the same basic idea. Though these different explanations have been worked out within radically different formal frameworks and might at first appear to be making completely different claims, they can all be seen as ways of spelling out the idea that moral judgments impact people’s intuitions because they have an effect on which possibilities people regard as relevant. Understanding these different explanations as different ways of spelling out the same core idea immediately leads us to an array of important questions about how to understand the relationships between them.
Mens Rea in Moral Judgment and Criminal Law
Authors: Giffin Carly , Lombrozo Tania
Published: April 2022

Some actions are both legally and morally blameworthy, some are neither, and still others are one but not the other. One factor that separates actions into these categories is the actor’s mental states: what she knew, intended, foresaw, and so on. Most criminal statutes in the United States place some requirement on the mental states of the accused, from intent at the high end to negligence at the low end. This requirement is referred to as mens rea—Latin for ‘guilty mind’. This chapter explores what legal and moral judgments reveal about the role of mens rea. We review empirical work from moral psychology, with an eye towards normative implications for moral judgment.
Moral Character, Liberal States, and Civic Education
Authors: McTernan Emily
Published: April 2022

Ensuring a functioning and stable liberal society requires a variety of behaviours and attitudes from individual citizens, from paying taxes to tolerating diversity. Political philosophers largely accept that these cannot be achieved through the arrangement of institutions alone, and so propose the cultivation of civic virtues. Meanwhile, in moral philosophy, much has been written about the challenging implications of psychology for theories of moral virtue. This chapter examines what political philosophers might draw from the findings of psychology. I begin by presenting the challenge from psychology to the traditional model of civic education. However, this chapter’s focus is on what political philosophers have to gain from psychological research: namely, a set of empirically superior alternatives to civic education as usual. I will outline three such alternatives—local traits, situational factors, and social norms—sketching their relative merits and the significant changes to civic education as usual that they would require.
Introduction
Authors: Shackel Paul A.
Published: April 2022

Industrial sites archaeology has, for a long time, memorialized the benefits of industrial capitalism at the expense of those workers who toiled in the factories and mines. Research has often emphasized the great engineering feats of the past, while the history of labour has often been subordinated. By understanding and making the heritage of the working class prominent at industrial sites illuminates the differences between labour and capital in the past. This work can also provide new avenues to understanding inequalities in our contemporary world. The call for labour justice that developed as a result of the Lattimer miners’ strike in northeastern Pennsylvania, USA in 1897 is compared to the recent Marikana miners’ strike in South Africa. Many of the injustices in the mining industry that occurred in the USA and other western nations over a century ago now seems to be exported to developing countries.
Mechanics’ Institutes in Britain and Ireland
Authors: Turk Maria Elena
Published: April 2022

Mechanics’ Institutes, reading rooms, philosophical and literary societies, and working mens’ clubs were an important part of the social life of industrial settlements. They were a significant component in the self-improvement movement, and were promoted by many middle-class philanthropists. Nevertheless, these sites were somewhat controversial, their initial development sparked fears of a workers’ revolution. The funding and control of the facility was often a contested point, control of education came with an associated social power. By the nineteenth century Mechanics’ Institutes and sister societies had become one of the most visible civic buildings within planned industrial settlements, and were a key component in most model village design. These facilities provided both leisure facilities and adult education to the working classes, thereby complementing the development of the national school system. This chapter explores the history, development, and distribution of these sites in Britain and Ireland.
Bars, Public Houses, and Saloons
Authors: Davison Andrew
Published: April 2022

Establishments selling alcohol for consumption on the premises were a feature of industrialized societies. Their origins lay in the European alehouse and tavern, but colonization and emigration took them to other parts of the world, notably Australasia and North America. Distinctive building types—the public house (‘pub’), bar, hotel, and saloon—emerged in a number of countries during the nineteenth century, combining social and communal functions with the sale of alcohol, their design influenced by regulatory pressure as well as commercial imperatives. The temperance movement had a significant impact, its campaigns leading to increased regulation of the sale of alcohol and, in places, its prohibition. Archaeological investigation can shed light on their development, construction, design, ownership, and clientele, as well as on the activities which took place in them, supplementing evidence from architectural study and historical research.
Industrialized Conflict
Authors: Cocroft Wayne D.
Published: April 2022

This chapter discusses the complex relationship between the state and the manufacture of armaments. These are goods almost exclusively consumed by governments and in which they have close interest in acquiring the most technically advanced products. So vital was this industry that in many instances munitions manufacture was undertaken in government factories. During the late nineteenth century, states became increasingly reliant on large, commercial armaments firms, which in turn became more dependent on international sales to fill their order books. In times of tension and war the state was a major investor in armaments research and industrial capacity. An analysis of the past distribution of the armaments industry is vital in understanding the locations of civil industries, both through the legacy of its physical infrastructure, the proximity of its component suppliers, and the technical skills of its workforce.
Canals and Inland Waterways
Authors: Steyne Hanna , Crowe Nigel
Published: April 2022

The development of the network of navigable inland waterways and canals in Britain was a fundamental step in the growth and spread of industrialization in Britain. These waterways played an important role in the early transportation of raw materials, particularly coal, to factory sites, and of finished goods to the coast for national and international distribution. The importance of the waterways, however, is not solely technological, but also for the impact they had on the landscape, the peripatetic community employed on the water, and the communities that developed to maintain, support, and run the system. This chapter discusses the development, growth, and decline of inland waterways and their central role in the industrialization of Britain. Through a discussion of the upstanding, working, and buried archaeological remains associated with inland waterways this chapter presents the current state of research and suggests future directions.
OA20 Radiographic hip osteoarthritis classified semi-automatically on dual-energy x-ray absorptiometry scans is strongly predictive of total hip replacement: findings from UK Biobank
Authors: Faber Benjamin G , Ebsim Raja , Saunders Fiona R , Frysz Monika , Lindner Claudia , Gregory Jennifer S , Aspden Richard M , Harvey Nicholas C , Smith George Davey , Cootes Timothy , Tobias Jonathan H
Published: April 2022

Background/Aims

Radiographic hip osteoarthritis (rHOA) is traditionally defined on hip x-rays, using subjective methods such as Kellgren-Lawrence scoring. Associations between subjective rHOA measures and symptoms are inconsistent. Applying digital tools to high-resolution dual-energy X-ray absorptiometry (DXA) scans, we aimed to develop a novel semi-automated classifier for rHOA and evaluate the face validity of the classifier based on relationships with hip pain, hospital diagnosed OA (HES OA), and risk of total hip replacement (THR).

Methods

Using hip DXAs in UK Biobank, osteophyte grades 0-3 were assigned based on manually measured osteophyte area. Minimum joint space width (mJSW) was automatically measured using outline points placed by a machine learning-based algorithm and then used to categorise individuals into joint space narrowing (JSN) grades 0-3. Osteophyte and JSN grades were combined, using a novel system giving greater to weight to osteophytes, to categorise individuals into rHOA grades 0-4. Logistic regression giving odds ratios (OR) was used to examine associations between rHOA grade and hip pain, and HES OA. Cox proportional hazard models giving hazard ratios (HR) were used to examine associations between rHOA grade and subsequent THR. Our adjusted model included age, sex, height and weight as covariates.

Results

40,340 individuals were included in the study (mean age 63.7 [range 44-82], 19294/21046 male/female). 32758 (81.2%) had rHOA grade 0, 4565 (11.3%) grade 1, 2317 (5.7%) grade 2, 543 (1.3%) grade 3, 157 (0.4%) grade 4, with all features of rHOA being more common in males than females. rHOA grades ≥2 were associated with all three clinical outcomes in both unadjusted and adjusted models, a clear dose-response relationship was seen with each increase in grade showing a large rise in OR/HRs (Table 1). Grade 4 rHOA was strongly predictive of THR (HR 57.70 [95%CI 38.08-87.44]).

Conclusion

We successfully applied a novel semi-automated classifier to over 40,000 individuals from UKB. The validity of our classifier was supported by the strong and progressive relationships observed between rHOA and hip pain, and HES OA and risk of THR. We conclude that hip DXAs provide a promising means of defining rHOA, with potential screening applications in the clinic.

Disclosure

B.G. Faber: None. R. Ebsim: None. F.R. Saunders: None. M. Frysz: None. C. Lindner: None. J.S. Gregory: None. R.M. Aspden: None. N.C. Harvey: None. G. Davey Smith: None. T. Cootes: None. J.H. Tobias: None.
OA32 UK Paediatric Rheumatology Clinical Studies Group research priorities - results of a multidisciplinary consultation and consensus exercise
Authors: Smith Eve M. D , Egbivwie Naomi , Cowan Katherine , Ramanan Athimalaipet V , Pain Clare E
Published: April 2022

Background/Aims

The evidence base underlying the management of children and young people (CYP) with paediatric rheumatic diseases (PRDs) is inadequate, with many critical outstanding questions warranting investigation. The aim of this study was to elicit multidisciplinary PRDs research priorities, through consultation with patients, carers and healthcare professionals.

Methods

This study was led by the UK NIHR CRN Children/Versus Arthritis Paediatric Rheumatology CSG (referred to as ‘the CSG’) and its Topic Specific Groups (TSGs). The CSG is a multidisciplinary group with strong patient/parent representation, supporting the development of clinical studies in the UK. Research priority ideas were sought from paediatric rheumatologists, trainees, allied healthcare professional (AHP), nurses, patients, parents and charities, through online surveys and face-to-face meetings. Research ideas were categorised as disease-specific or broad/general. They were grouped into sub-themes, duplicates/questions that had already been answered were removed, and similar submissions combined. A modified Delphi process was undertaken, including online research priority ranking, and an online consensus workshop to derive top PRD research priorities.

Results

The initial consultation yielded 304 research priority ideas; 25% from patients/parents, 22% from the CSG, 18% from TSGs, 13% from AHPs, 11% from trainees, 11% from Nurses. 55 disease-specific and 37 broad/general research priorities were voted upon in the first online survey, yielding a top 11 general broad research priorities. The top 10 disease specific priorities were discussed at the online Delphi priority setting workshop, and two online surveys were held during the workshop to determine their final ranking. Two of the disease-specific priorities were combined, leading to a top 9 (see Table). Disease specific proprieties related to clinical trials in JIA (n = 3) / Juvenile Dermatomyositis (n = 1) / Chronic Recurrent Multifocal Osteomyelitis (n = 1) / Juvenile Systemic Lupus Erythematosus (n = 1) Scleroderma (n = 1), management of JIA in adulthood (n = 1) and chronic pain (n = 1).

Conclusion

UK consensus-based PRD research priorities have been derived, underpinned by collaboration with patients/carers and healthcare professionals, helping to guide funding bodies to improve the evidence base in PRD’s.

Disclosure

E.M.D. Smith: None. N. Egbivwie: None. K. Cowan: None. A.V. Ramanan: None. C.E. Pain: None.
P001 Audit on giant cell arteritis fast track clinic in Tayside
Authors: Subramanian Dhivya , Bhat Smita
Published: April 2022

Background/Aims

Giant cell arteritis (GCA) is a systemic inflammatory disease of medium to large sized arteries. Diagnosis of GCA is a medical emergency due to the consequence of permanent blindness if not treated early with glucocorticoids. The objective of this audit was to assess the effectiveness of the GCA fast track clinic (FTC) in NHS Tayside. The current practice was compared with British Society of Rheumatology (BSR) standards.

Methods

This was a retrospective audit from March 2019 to May 2021. All patients referred with suspicion of GCA were included. Main outcomes measured were referral time, investigations and management. Data were collected through electronic records.

Results

120 patients were included (median age 71 years; F71.7%). 35% of patients were diagnosed with GCA. Most common symptoms were headache (94.2%), jaw claudication (26.7%), visual symptoms (36.7%), PMR symptoms (21.7%), systemic symptoms (50%). As seen in Table 1, 50% with visual symptoms were seen by ophthalmology within 24 hours. 70.8% were seen by rheumatology within 24 hours. 89% were given steroids within 24 hours from suspicion. 80.8% were investigated with ultrasound or biopsy. Comparing with expected standards, provision of written information, advice on recurrence of symptoms, calculation of CRP, documentation of bone protection was achieved at 100%. Immediate follow-up time was 6 weeks. One patient lost vision while on steroids.

Conclusion

Early recognition and prompt management of GCA is crucial for a good prognosis. NHS Tayside’s FTC has allowed for quick evaluation for most patients within 24 hours and has improved prognosis in patients.

Disclosure

D. Subramanian: None. S. Bhat: None.
P011 Audit and Outcomes of Hydroxychloroquine Screening for Retinopathy in a Cohort of Patients with Rheumatological Conditions
Authors: Tehseen Ghazala , Wills Sarah , Chadwick Alexandra , Low Audrey
Published: April 2022

Background/Aims

Hydroxychloroquine (HCQ) is used to treat rheumatoid arthritis (RA) and other inflammatory arthritides. In 2018, the Royal College of Ophthalmologists (RCOphth) published new guidelines to monitor the risk of HCQ associated retinopathy. Risk factors for retinopathy were: dosage >5mg/kg/day, impaired renal function (eGFR <60ml/min/1.73m²) and concurrent tamoxifen use. This report aims to audit 1) HCQ dosing based on RCOphth 2018 guidelines 2) whether patients were appropriately referred for screening 3) outcome of screening.

Methods

All patients (n = 207) who newly started HCQ between April 2013 and November 2014 were identified from hospital outpatient pharmacy records and followed until they reached 5 years’ of follow-up or 30 Nov 2019, whichever came first (censor date). Patients who were still on HCQ by the censor date were reviewed to extract data on demographics, rheumatological diagnosis, starting HCQ dose and risk factors, and were subsequently referred for retinopathy screening via a referral proforma. Exclusions were those who stopped HCQ, prescribed HCQ for non-rheumatological conditions, transferred to a different trust, duplicate or deceased patients. Screening took place between 1 Nov 2018 until 30 June 2019, after which referrals were paused due to lack of capacity and finally stopped due to COVID-19.

Results

86 patients were identified and eligible for screening (study cohort) (Table). The median age of the cohort was 57 years, with 67% of the cohort being female. 23% of patients were prescribed a dose of > 5mg/kg/day. 10% of patients had an eGFR of < 60 ml/min/1.73m2. No patients were on tamoxifen.

Conclusion

After 5 years of follow-up, the drug survival for HCQ is just under half the number (43%) who started the drug. This will help plan screening service capacity issues. The department is investigating the “lost referrals” which seem disproportionately high, which could be due to IT issues or occurred when the screening service was paused. Of the 29 patients who attended for screening, none had evidence of HCQ retinopathy which is reassuring, these included 15 patients with risk factors for retinopathy.

Disclosure

G. Tehseen: None. S. Wills: None. A. Chadwick: None. A. Low: None.
P012 Cross-specialty audit of Infliximab prescribing at the Great North Children’s Hospital (GNCH)
Authors: Habibollah Sahar , Hartley Karen , Mcerlane Flora
Published: April 2022

Background/Aims

Infliximab is an anti-TNF biologic licensed for use in children and young people (CYP) with juvenile idiopathic arthritis (JIA) uncontrolled by methotrexate and children with inflammatory bowel disease uncontrolled by thiopurines. Key side-effects include immunosuppression, neutropenia, liver derangement, latent TB reactivation and risk of anaphylactic reactions. Infliximab is administered intravenously on paediatric day units. Between-specialty inconsistencies complicate the administration and monitoring of infliximab. This retrospective audit aimed to explore adherence to local / national guidance governing Infliximab administration. It is part of an ongoing programme of work towards improved cross-regional quality of care provided to CYP on systemic immunomodulatory therapies.

Methods

All patients prescribed Infliximab at GNCH in Newcastle between January and December 2020 were identified from pharmacy records. Adherence to local and national guidelines was audited, with particular emphasis on pre-medication investigations, rate of administration, frequency of complications and duration of post-infusion monitoring.

Results

The rheumatology team at GNCH prescribe infliximab in accordance with local trust guidelines based on BSPAR guidance. The gastroenterology team follow updated ESPGHAN guidelines (European Society for Paediatric Gastroenterology, Hepatology and Nutrition). A total of 155 patients were identified (138 gastroenterology patients and 17 rheumatology patients - 16 JIA, 1 Behcets disease). 17 gastroenterology patients with Crohn’s disease, matched by age, were selected for this audit. Table 1 details audit results for adherence to local/national guidance for Infliximab administration in GNCH. One child with JIA who was non-compliant with second immunosuppressant had an anaphylactic reaction after 5th Infliximab dose.

Conclusion

Current gastroenterology and rheumatology guidance suggest different pre-screening tests, dose regimens, rates of infusion and duration of post-treatment monitoring. Specialties are not following all guidelines perfectly, in particular pre-treatment viral screening. Although different specialties will continue to require different dosing schedules for infliximab, current practice suggests that it is reasonable to develop cross-specialty guidance governing the prescribing and administration of Infliximab. A cross-specialty guideline will reduce unnecessary variation in practice, reducing the potential for prescribing and administration errors.

Disclosure

S. Habibollah: None. K. Hartley: None. F. Mcerlane: None.
P019 Rheumatology Referrals to Tertiary Care Hospital over a Three Month Period During Covid-19 Pandemic: a Quality Improvement Project
Authors: Khan Behram , David Trixy , Clegg Caroline , Parker Benjamin
Published: April 2022

Background/Aims

During the COVID-19 pandemic, waiting times for routine new referrals to our tertiary rheumatology department was >20 weeks. Therefore, a quality improvement project (QIP) was undertaken to understand the nature of these referrals and develop an alternative option to rheumatology review. Our aim was to reduce waiting times and improve patient experience by better integrating primary, secondary and therapy services, as well as provide additional triage options.

Methods

We conducted a retrospective analysis of all routine referrals over a 3-month period (1st April to 30th June 2020). Urgent referrals including GCA, CTD and EIA were excluded.

Results

A total of 92/143 (64%) patients were referred, a more significant reduction than normal due to the pandemic. Median age [IQR] was 39.5 [28-66.25] years and most referrals (79%) were from primary care. Table 1 represents information included in the referrals. Thirty-one patients had previously undergone a rheumatology review, of which 11 (35%) were seen in our department. Of these, 18/31 (58%) patients had a diagnosis of Hypermobility Spectrum Disorder (HSD) or fibromyalgia. The commonest reason for re-referral was worsening of existing symptoms (n = 11, 35%), with no suggestive of an alternative diagnosis.

Conclusion

Our QIP identified a variation in the quality of referrals and that a high proportion of referrals concerned HSD and fibromyalgia, with many re-referred due to exacerbation of their existing disease. Based on this, we conducted a regional GP trainee educational session and highlighted: i) key features in investigation and management of common rheumatological conditions ii) vital information to include in referrals based on presenting complaint(s) and working diagnosis. We developed a pathway for patients previously diagnosed with fibromyalgia or HSD in our department and re-referred with worsening symptoms, to be triaged into a newly set up weekly specialist MSK physiotherapy-led clinic with rheumatology supervision. Future work will involve re-assessing routine new-referral waiting times and evaluating pre- and post-physiotherapy intervention MSK and quality of life scores, with the aim of formulating a business case to conduct this clinic on a permanent basis. We hope incorporating this pathway will lead to improved patient outcomes and ease some departmental management decisions.

Disclosure

B. Khan: None. T. David: None. C. Clegg: None. B. Parker: None.
P020 The impact of COVID-19: local observations from the National Early Inflammatory Arthritis Audit
Authors: MacPhie Elizabeth , Ashcroft Lesley , Foreman Nicola , GIlbert Sharon , Horton Sarah , Madan Ayesha , Moon Kirsty , Rao Chandini , Fish Sarah
Published: April 2022

Background/Aims

The National Early Inflammatory Arthritis Audit (NEIAA) has provided the opportunity for rheumatology services to benchmark the care they provide against NICE quality standards (QS)33. It has proven to be a powerful lever for improving quality and our department is testimony to this. Recruitment to all national audits was paused for several months due to the COVID-19 pandemic. Once pressures had eased we recognised that NEIAA would help to understand the impact of the pandemic on the diagnosis and initial management of patients with rheumatoid arthritis. Our department continued to see all new urgent referrals face-to-face and were fortunate that the team were not redeployed.

Methods

Data submitted to the NEIAA online tool during year 3 (September 2020-March 2021) were downloaded for analysis. Data from year 2 were downloaded for comparison.

Results

In year 3, 154 patients were recruited to the audit compared to 268 in year 2. 36 (23%) had rheumatoid arthritis and were included in the follow-up cohort compared to 73 (27%) in year 2. All patients had a baseline and a 3-month follow up form completed, however 17 patients in year 3 had a telephone appointment at 3 months and there was no available DAS28. Patient demographics were similar. The case mix of patients recruited was also; in year 3, 41% were diagnosed with autoimmune inflammatory arthritis compared to 47% in year 2 and 42% with a non-inflammatory condition compared to 39% in year 2. In year 3, 41% of all patients were seen within 3 weeks of being referred and 58% of patients with RA started DMARD therapy within 6 weeks of referral. This compared to 54% and 56%, respectively, in year 2. In year 3, symptom duration prior to referral appeared longer: 31% had symptoms for less than 3 months, 31% for 3-6 months, 22% for 6-12 months and 16% for more than 12 months compared to 67%, 18%, 12% and 3%, respectively, in year 2. DAS28 at baseline was higher in year 3 with 47% high, 47% moderate and 6% low disease activity or in remission compared to 27%, 61% and 12%, respectively, in year 2. DAS28 at 3-months was also higher in year 3 with 16% high, 37% moderate and 27% low disease activity or remission compared to 6%, 25% and 69% respectively in year 2.

Conclusion

Despite the impact of the pandemic we have maintained our performance against QS2 and 3. However, patients seemed to have longer duration of symptoms prior to referral, higher disease activity at baseline and at 3 months. We await the 12-month data to determine 1-year outcomes, including escalation to high cost drug therapies.

Disclosure

E. MacPhie: Other; EM is the secretary of the North West Rheumatology Club, meetings have been supported by UCB, MSD, Abbvie and Lilly. L. Ashcroft: None. N. Foreman: None. S. GIlbert: None. S. Horton: None. A. Madan: None. K. Moon: None. C. Rao: None. S. Fish: None.
P025 Do referrals to rheumatology meet the new British Society of Rheumatology (BSR) guidelines for adult patients with osteoporosis? A retrospective audit of a tertiary osteoporosis service
Authors: Baldeweg Friederike , Bubbear Judith , Keen Richard
Published: April 2022

Background/Aims

British Society of Rheumatology (BSR) released national guidance in September 2021 outlining appropriate referrals to adult rheumatology departments from primary care. Our tertiary metabolic bone service accepts referrals from primary care, secondary care and internal referrals.

Methods

We retrospectively audited the new patient referrals for 50 patients with osteoporosis seen in our clinic over the 6 months prior to the guidance publication. 86% were referred from primary care, 6% from secondary care and 8% from our orthopaedic colleagues. 92% patients were female and 8% patients were male. Mean age was 61.7 years (range 17- 85 years).

Results:

We found that the majority of patients with osteoporosis referred to our specialist service were within the new BSR guidance (45/50 patients or 90% of patients). Reasons for referring patients outside of the BSR guidance included deterioration in bone mineral density without fracture and a family history of osteoporosis. Of these patients, four were referred from primary care and one from secondary care (another rheumatology department). Of the 50 patients seen in our clinic, 48% were advised to commence parenteral bone protection medication. 2% were advised to start hormone replacement therapy (HRT) only. 6% were advised to either start or continue oral bisphosphonates. 38% of patients were advised to remain without bone protection treatment and monitor. 2% were given an alternate diagnosis other than osteoporosis.

Conclusion

We plan to undertake a further audit for a period of 6 months after the release of the guidance.

No funding to declare

Disclosure

F. Baldeweg: None. J. Bubbear: None. R. Keen: None.
P031 Assessing the safety and efficacy of JAK inhibitors in inflammatory arthritis
Authors: Smedley Imogen
Published: April 2022

Background/Aims

JAK inhibitors were recently licensed in the UK and have been shown to be efficacious in refractory moderate to severe rheumatoid arthritis and psoriatic arthritis. We aim to assess their efficacy and safety in use in clinical practice in NHS Tayside. Additionally, there have been several emerging safety concerns, particularly regarding infections and venous thromboembolism risk.

Methods

This project was an observational retrospective case note review of 130 patients. We assessed JAK-inhibitor efficacy via mean change in DAS28 and number of tender and swollen joints at 6 months after initiating therapy. Additionally, 6-month and 2-year drug survival rates were calculated. The presence of adverse events was evaluated.

Results

At 6 months JAK inhibitor therapy produced a mean reduction in DAS28 of 2.04 (p = 0.096) and a mean reduction in number of swollen joints of 3.72 (p = 0.002). Drug survival was 81.42% at 6-months and 51.25% at 24-months. Non-smokers, those with BMI <30, biologic naïve patients and those prescribed a concomitant cDMARD all achieved a greater reduction in DAS28. 53 patients (40.77%) experienced an adverse event, including venous thromboembolism, acute diverticulitis and herpes zoster reactivation. In addition to these, 40.91% of patients experienced dyslipidaemia.

Conclusion

JAK-inhibitors are efficacious in controlling active disease in inflammatory arthritis, however, are better suited to some patients over others based on emergency concerns about side effect profiles. Longer follow up is needed to assess long term efficacy.

Disclosure

I. Smedley: None.
P039 Septic arthritis caused by Mycoplasma hominis in a patient with systemic lupus erythematosus
Authors: Hum Ryan M , Iftikhar Hajira , Tang Elaine Y , Bruce Ian , Ho Pauline
Published: April 2022

Background/Aims

Mycoplasma hominis is a commensal bacterium of the genitourinary tract which can be associated with infection in immunocompromised patients. Colonisation with M. hominis has been associated with reactive arthritis and septic arthritis. We describe a case of M. Hominis septic arthritis in a patient with SLE on maintenance immunosuppression.

Methods

A 27-year-old woman presented with a 2-week history of a swollen left elbow and fatigue which affected her ability to work. Otherwise, she was systemically well and afebrile. She had an established diagnosis of SLE since she was aged 8 years, and her SLE had included mucocutaneous, central nervous system, renal involvement, and haemolytic anaemia. Her SLE was controlled on azathioprine, hydroxychloroquine, and prednisolone 5mg daily. Clinical examination revealed a mildly warm, non-erythematous, tender and swollen left elbow with a 40° flexion deformity. Initial investigations showed raised CRP 41mg/L and ESR 32mm/hr. White blood cell and platelet count were normal. Procalcitonin was insignificant at < 0.1ng/mL. Complements and urine analysis were normal, and dsDNA was negative. X-ray of the left elbow showed joint effusion. Ultrasound revealed active synovitis, subcutaneous oedema and purulent material in the joint. The fluid aspirate was straw coloured. Microscopy showed inflammatory cell count of 4230 white blood cells/mm, with 91% neutrophils. She was treated as probable septic arthritis with intravenous (IV) flucloxacillin. After 48 hours on IV antibiotics, her CRP remained elevated, and she developed pyrexia. Blood and joint fluid cultures were negative. MRI scan confirmed active synovitis with features suggesting joint infection. On discussion with microbiology, oral doxycycline was added on day 3 to cover possible atypical organisms. After a further 4 days the swelling, range of movement, and pain in her elbow had significantly improved. She was discharged home with oral flucloxacillin and doxycycline. On day 16 M. hominis was identified from the Bacterial Identification Services Colindale, by partial sequencing of 16s rDNA from the joint aspirate. She was therefore advised to continue with oral doxycycline for a total of 6 weeks.

Results

After treatment, her CRP, ESR and range of movement returned to normal.

Conclusion

This case highlights the potential pathogenicity of M. hominis in immunocompromised patients. A literature review found 35 published case reports of septic arthritis by M. hominis, with two occurring in patients with SLE. Approximately 70% of the affected cases were in immunocompromised patients who had a poor response to empirical antibiotic therapy. However, identification of M. hominis on joint aspiration and subsequent treatment with appropriate antibiotics resulted in good outcomes for all published cases.

Disclosure

R.M. Hum: None. H. Iftikhar: None. E.Y. Tang: None. I. Bruce: None. P. Ho: None.
P043 Challenges in the diagnosis and management of immune-mediated necrotizing myopathy in a patient on long-term statins
Authors: Khan Faris , Kuttikat Anoop
Published: April 2022

Background/Aims

Statins are very common medications prescribed for cardiovascular disease prevention and with their ever-increasing use; we expect a significant increase in even the rarest side-effects. Immune-mediated necrotising myopathy (IMNM) is a rare type of autoimmune myopathy characterised by relatively severe proximal weakness and is most associated with the development of anti-HMGCoAR (3-hydroxy-3-methylglutaryl CoA Reductase) autoantibodies in statin users. The objective of this clinical case report is to highlight this rare condition to avoid incorrect diagnosis, particularly in primary care, to ensure prompt and specific management.

Methods

A 51-year-old female presented to her GP with gradual onset muscle weakness particularly around her shoulders and legs. She had a history of hypercholesterolemia, for which she had been on atorvastatin 20mg daily for 4 years.

Results

Following a blood test by her GP, a raised CK of 16,670 iU/L prompted a hospital admission due to suspected skeletal muscle damage. MRI scan of thighs showed features of myositis and muscle biopsy showed necrotic regenerating muscle fibres with lymphohistiocytic inflammation consistent with necrotizing myopathy. Blood tests revealed positive anti-HMGCoAR antibodies (negative ANA, DNA, ENA & other myositis-specific antibodies) confirming a diagnosis of anti-HMGCoAR IMNM. Atorvastatin was stopped and treatment was initiated with high-dose IV methylprednisolone followed by oral prednisolone tapering course. She showed only minor improvement in symptoms over the initial 6 weeks. Methotrexate was then added, with gradual improvement in her symptoms and normalization of CK over the next 6 months.

Conclusion

IMNM is unique in that it does not improve with statin discontinuation alone, and usually requires a combination of steroid and steroid-sparing immunosuppressant. Early diagnosis is crucial as commencing treatment early leads to better outcomes in patients. Anti-HMGCoAR antibodies are highly specific for this condition and not associated per se with hyperlipidaemia, self-limiting statin side effects or genetic muscle disease. In patients presenting with muscle weakness who are taking statins, it is beneficial to perform anti-HMGCoAR antibody test (especially if persistent symptoms despite statin cessation) to promptly differentiate this rare condition from more common but less severe statin related myotoxicities.

Disclosure

F. Khan: None. A. Kuttikat: None.