bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Genomics Suggests Mechanisms of Genetic Adaptation toward the Catabolism of the Phenylurea Herbicide Linuron in Variovorax
Authors: Öztürk Başak , Werner Johannes , Meier-Kolthoff Jan P , Bunk Boyke , Spröer Cathrin , Springael Dirk
Published: April 2020

Biodegradation of the phenylurea herbicide linuron appears a specialization within a specific clade of the Variovorax genus. The linuron catabolic ability is likely acquired by horizontal gene transfer but the mechanisms involved are not known. The full-genome sequences of six linuron-degrading Variovorax strains isolated from geographically distant locations were analyzed to acquire insight into the mechanisms of genetic adaptation toward linuron metabolism. Whole-genome sequence analysis confirmed the phylogenetic position of the linuron degraders in a separate clade within Variovorax and indicated that they unlikely originate from a common ancestral linuron degrader. The linuron degraders differentiated from Variovorax strains that do not degrade linuron by the presence of multiple plasmids of 20–839 kb, including plasmids of unknown plasmid groups. The linuron catabolic gene clusters showed 1) high conservation and synteny and 2) strain-dependent distribution among the different plasmids. Most of them were bordered by IS1071 elements forming composite transposon structures, often in a multimeric array configuration, appointing IS1071 as a key element in the recruitment of linuron catabolic genes in Variovorax. Most of the strains carried at least one (catabolic) broad host range plasmid that might have been a second instrument for catabolic gene acquisition. We conclude that clade 1 Variovorax strains, despite their different geographical origin, made use of a limited genetic repertoire regarding both catabolic functions and vehicles to acquire linuron biodegradation.
Interactional Effects Between Relational and Cognitive Reserves on Decline in Executive Functioning
Authors: Sauter Julia , Widmer Eric , Baeriswyl Marie , Ballhausen Nicola , Vallet Fanny , Fagot Delphine , Kliegel Matthias , Ihle Andreas
Published: April 2020

Objectives

The present study set out to investigate associations of cognitive reserve (as indicated by education) and relational reserve (as indicated by the family network size and indices of emotional support) to decline in executive functioning over 6 years as measured by changes in Trail Making Test (TMT) completion time in older adults and whether education and network size interacted with age and sex as covariates with respect to this longitudinal association.

Method

We analyzed data from 897 participants tested on TMT parts A and B in two waves 6 years apart. The mean age in the first wave was 74.33 years. Participants reported information on their family networks and their level of education.

Results

Latent change score modeling testing for moderation effects revealed a significant interaction of network size in the first wave of data assessment with education. Specifically, for lower levels of cognitive reserve (−1 SD of education), the longitudinal association between relational reserve in the first wave and subsequent changes in executive functioning was not significant. In contrast, for higher levels of cognitive reserve (+1 SD of education), a higher relational reserve in the first wave significantly predicted a smaller subsequent increase in TMT completion time from the first to the second wave (i.e., a smaller decline in executive functioning).

Discussion

The present longitudinal study provides evidence for the interaction between cognitive and relational reserves. This confirms the hypothesis that reserves from different domains are intertwined and their combined effects contribute to less cognitive decline in old age.
Poor Disgust Suppression Is Associated with Increased Anxiety in Caregivers of People with Neurodegenerative Disease
Authors: Wells Jenna L , Hua Alice Y , Levenson Robert W
Published: April 2020

Objectives

Caregivers of persons with neurodegenerative disease have high rates of mental health problems compared to noncaregiving adults. Emotion regulation may play an important role in preserving caregivers’ mental health. We examined the associations between caregivers’ emotion regulation measured in several ways (ability, habitual use, and self-ratings) and their mental health symptoms.

Method

Ninety-one caregivers of persons with neurodegenerative disease participated in a laboratory-based assessment of emotion regulation. In two series of tasks, caregivers were given different instructions (no instruction, suppress) regarding altering their emotional behavioral responses to disgusting films and acoustic startle stimuli. Caregivers’ emotional behavior was measured via behavioral coding and caregivers rated “how much emotion” they showed during each task. Anxiety, depression, and habitual use of expressive suppression were measured via questionnaires.

Results

Poor emotion regulation in the disgust suppression condition (i.e., greater emotional behavior) was associated with greater anxiety. Associations were not found for the startle suppression condition, depression, or self-report measures of emotion regulation.

Discussion

Findings suggest that caregivers who are unable to suppress emotional behavior in response to disgusting stimuli may be at greater risk for anxiety. Given high levels of anxiety in caregivers, it may be useful to evaluate interventions that improve ability to downregulate emotional behavior.
Implementation of a multilevel, multicomponent intervention for obesity control in Native American communities (OPREVENT2): challenges and lessons learned
Authors: Gittelsohn J , Jock B , Poirier L , Wensel C , Pardilla M , Fleischhacker S , Bleich S , Swartz J , Trude Angela C B
Published: April 2020

OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest. OPREVENT2 worked with worksites, food stores, schools (grades 2–6), through social media and mailings, and with a local community action committee (CAC), in each of the three intervention communities, and was implemented in six phases. We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Implementation of each component was classified as high, medium or low according to set standards, and reported back at the end of each phase, allowing for improvements. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time. The school program had only moderate reach and dose delivered, as did the social media component. The CAC achieved high reach and dose delivered. Overall, study reach and dose delivered reached a high implementation level, whereas fidelity was medium. Great challenges exist in the consistent implementation of MLMC interventions. The detailed process evaluation of the OPREVENT2 trial allowed us to carefully assess the relative strengths and limitations of each intervention component.
Reconstructing the European Court of Human Rights’ Article 8 Jurisprudence in Deportation Cases: The Family’s Right and the Public Interest
Authors: Collinson Jonathan
Published: April 2020

This article rationalises the case law of the European Court of Human Rights under Article 8 of the European Convention on Human Rights in deportation cases involving children. The Court engages in a balancing exercise between the right to family life of the deportee’s family on the one side, and the public interest in deportation on the other. This article expands on existing case law analysis by suggesting that in deportation cases, the Court considers Article 8 as a form of commonly held right, rather than an individual right held by one member of the family. Furthermore, the balance is argued to be constructed as a relationship between two factors on both sides, rather than of a sole factor on either side as being determinative. This article concludes that the best interests of the child (one of the ‘Üner criteria’) is not adequately reflected in the Court’s deportation decision-making practice.
Epidemiological and clinical characteristics of 671 COVID-19 patients in Henan Province, China
Authors: Nie Yifei , Li Jitian , Huang Xueyong , Guo Wanshen , Zhang Xiaobai , Ma Yan , Wang Haifeng , Qi Muge , Tang Xiaoyan , Shen Xiaojing , Dai Xiaofeng
Published: April 2020

Background

Despite many reports on the characteristics of coronavirus disease 2019 (COVID-19) in Wuhan, China, relatively little is known about the transmission features of COVID-19 outside Wuhan, especially at the provincial level.

Methods

We collected epidemiological, demographic, clinical, laboratory, radiological and occupation information, along with contact history, of 671 patients with laboratory-confirmed COVID-19 reported from January 23 to February 5, 2020, in Henan province, China. We described characteristics of these cases, compared the diagnostic accuracy and features of blood testing, computed tomography (CT) scans and X-rays, and analysed SARS-CoV-2 transmission sources and patients’ occupations in Henan province.

Results

The mean age of patients in this case series was 43 years, 56.2% were male and 22.4% had coexisting medical disorders. The death rate was 0.3%. Fourteen patients did not show any symptoms. Lymphocyte percentage was associated with disease severity (χ2 = 6.71, P = 0.035) but had a large variation in each sample group. The mean time from illness onset to diagnosis was 5.6 days. A total of 330 patients had ever lived in or visited Wuhan, 150 had contact with confirmed cases, 323 had been to a hospital and 119 had been to a wet market. There were 33 patients who did not have a traceable transmission source, with 21.2% of these being farmers and 15.2% being workmen.

Conclusions

Lymphocyte percentage was a sign of severe COVID-19 in general but was not a good diagnostic index. Longer time from illness onset to diagnosis was associated with higher COVID-19 severity, older age, higher likelihood of having coexisting cardiovascular diseases including hypertension, and being male. Farming was found to be a high-risk occupation in Henan province, China.
Role of PstS in the Pathogenesis of Acinetobacter baumannii Under Microaerobiosis and Normoxia
Authors: Gil-Marqués María Luisa , Labrador Herrera Gema , Miró Canturri Andrea , Pachón Jerónimo , Smani Younes , Pachón-Ibáñez María Eugenia
Published: April 2020

Acinetobacter baumannii is a successful pathogen responsible for infections with high mortality rate. During the course of infection it can be found in microaerobic environments, which influences virulence factor expression. From a previous transcriptomic analysis of A. baumannii ATCC 17978 under microaerobiosis, we know the gene pstS is overexpressed under microaerobiosis. Here, we studied its role in A. baumannii virulence. pstS loss significantly decreased bacterial adherence and invasion into A549 cells and increased A549 cell viability. pstS loss also reduced motility and biofilm-forming ability of A. baumannii. In a peritoneal sepsis murine model, the minimum lethal dose required by A. baumannii ATCC 17978 ΔpstS was lower compared to the wild type (4.3 vs 3.2 log colony forming units/mL, respectively), and the bacterial burden in tissues and fluids was lower. Thus, the loss of the phosphate sensor PstS produced a decrease in A. baumannii pathogenesis, supporting its role as a virulence factor.
Impacts of Low Temperatures on Wolbachia (Rickettsiales: Rickettsiaceae)-Infected Aedes aegypti (Diptera: Culicidae)
Authors: Lau Meng-Jia , Ross Perran A , Endersby-Harshman Nancy M , Hoffmann Ary A
Published: April 2020

In recent decades, the occurrence and distribution of arboviral diseases transmitted by Aedes aegypti mosquitoes has increased. In a new control strategy, populations of mosquitoes infected with Wolbachia are being released to replace existing populations and suppress arboviral disease transmission. The success of this strategy can be affected by high temperature exposure, but the impact of low temperatures on Wolbachia-infected Ae. aegypti is unclear, even though low temperatures restrict the abundance and distribution of this species. In this study, we considered low temperature cycles relevant to the spring season that are close to the distribution limits of Ae. aegypti, and tested the effects of these temperature cycles on Ae. aegypti, Wolbachia strains wMel and wAlbB, and Wolbachia phage WO. Low temperatures influenced Ae. aegypti life-history traits, including pupation, adult eclosion, and fertility. The Wolbachia-infected mosquitoes, especially wAlbB, performed better than uninfected mosquitoes. Temperature shift experiments revealed that low temperature effects on life history and Wolbachia density depended on the life stage of exposure. Wolbachia density was suppressed at low temperatures but densities recovered with adult age. In wMel Wolbachia there were no low temperature effects specific to Wolbachia phage WO. The findings suggest that Wolbachia-infected Ae. aegypti are not adversely affected by low temperatures, indicating that the Wolbachia replacement strategy is suitable for areas experiencing cool temperatures seasonally.
EP29 An evaluation of the use of baseline pulmonary function tests in the detection of interstitial lung disease in patients newly diagnosed with rheumatoid arthritis
Authors: Haque Ashraful , Kilding Rachael , Smith Ruth , Khalid Sameena , Sandler Robert , Cox Miriam , Hendry Thomas , Flores-Martin Andreas , Lindop Kathleen , Maxwell James
Published: April 2020

Background

Interstitial lung disease (ILD) is a serious extra-articular manifestation of rheumatoid arthritis (RA). Risk factors include smoking, the presence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (CCP). Pulmonary function tests (PFT) show reduced carbon monoxide diffusion capacity (DLCO) early and reduced forced vital capacity (FVC) later in disease. HRCT is the gold standard diagnostic test while chest X-ray (CXR) has low sensitivity. PFT are routinely performed in the majority of RA patients at baseline at our tertiary centre. The aim of this study was to evaluate the frequency of abnormal PFT, specificity for ILD and influence on subsequent decision-making in patients newly diagnosed with RA.

Methods

A retrospective analysis was undertaken of patients with a new diagnosis of RA between January 2016 and December 2017. Patients meeting the ACR (2010) criteria for RA, with baseline PFT data available were included. Clinic letters and the hospital electronic records were used to obtain the data.

Results

139 patients were included in the data analysis (Table 1). 23 patients had DLCO <70% predicted, while 7 patients had an FVC <80% predicted. Patients with abnormal PFT were more likely to be older, female, seropositive and to have smoked. Of the patients with DLCO <70%, CXR was abnormal in 6 patients with changes suggesting ILD in 2 patients. 13 patients had HRCT and 7/13 patients had evidence of ILD and 6/13 patients had significant emphysema on CXR or HRCT. 1 patient with DLCO of 82% had changes of ILD on a CT scan organised for another reason. Methotrexate was commenced in 19/23 patients with DLCO<70% and discontinued in 2 patients for respiratory reasons.

Conclusion

This evaluation suggests baseline PFT are more sensitive than baseline CXR in detecting ILD but that a DLCO <70% is not specific for this diagnosis. The abnormal PFT lead to HRCT being requested in 13/24 patients, of whom 7 had ILD which had not been identified by CXR in 5 patients. Baseline PFT are also useful as a reference point in patients who go on to develop respiratory symptoms at a later point in their illness.

Disclosures

A. Haque None. R. Kilding None. R. Smith None. S. Khalid None. R. Sandler None. M. Cox None. T. Hendry None. A. Flores-martin None. K. Lindop None. J. Maxwell None.
O25 Quantifying and predicting the effect of anti-TNF therapy on axSpA-related fatigue: results from the BSRBR-AS registry and meta-analysis
Authors: Shim Joanna , Dean Linda , Karabayas Maira , Jones Gareth , Macfarlane Gary , Basu Neil
Published: April 2020

Background

Fatigue represents a critical priority among patients with axial spondyloarthritis (axSpA). Its effective management is a major unmet clinical need. Existing studies indicate that anti-TNF therapy may reduce fatigue levels, although any effect has yet to be definitively quantified. Moreover, predictors of any such improvements have not been studied.

Methods

The British Society for Rheumatology Register in Axial Spondyloarthritis (BSRBR-AS) prospectively recruited axSpA patients across 83 centres in the UK. Changes in fatigue levels (measured using the Chalder Fatigue Scale (0-33)) over 1 year were compared between those starting anti-TNF therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results were combined with other studies in a meta-analysis to calculate pooled estimates. Then, among those BSRBR-AS anti-TNF commencers with clinically relevant fatigue, baseline predictors of response were investigated.

Results

Of the 998 BSRBR-AS recruits with complete fatigue outcome data, 310 were anti-TNF commencers and 688 were not. At 1 year follow-up, the former group reported a mean change in fatigue of -2.6 (95% CI -4.1, -1.9) points while the latter reported a mean worsening of fatigue by 0.2 points. Following propensity score adjustment, those commencing anti-TNF therapy reduced fatigue by 3.0 points compared to those not 95% CI (-4.1-1.9). In the meta-analysis, including 1109 subjects across 5 observational studies and trials, treatment with anti-TNF therapy resulted in a significant improvement in fatigue (SMD 0.36, 95% CI 0.15-1.56). Of those BSRBR-AS recruits commencing anti-TNF, n = 205 (66%) reported clinically significant fatigue at baseline of whom n = 139 (68%) experienced a clinically relevant improvement in their fatigue at 1 year. Poor sleep quality at baseline was predictive of fatigue improvement.

Conclusion

Anti TNF therapy results in a significant but modest reduction in fatigue amongst axSpA patients, with those reporting poor sleep quality most likely to report improvement. Effective management will likely require additional, possibly non-pharmacological, approaches.

Disclosures

J. Shim None. L. Dean None. M. Karabayas None. G. Jones None. G. Macfarlane None. N. Basu None.
P27 A challenging case of multi-site avascular necrosis
Authors: Haque Ashraful , Coote Annabel
Published: April 2020

Background

A 32 year old gentleman was assessed in the rheumatology department in August 2018 having been referred for investigation into the cause of multi-site avascular necrosis (AVN).

Methods

He had mild Raynaud's symptoms in his hands and recurrent oral ulceration. He was previously fit and well without any history of thrombotic events or family history. He smoked 2 cigarettes a day and denied any alcohol intake.

Results

In February 2011 he was diagnosed with T-cell lymphoma while in the Navy. He underwent chemotherapy in a medical oncology department at a tertiary care centre. His chemotherapy regime involved 2 cycles of cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) and 4 cycles of cyclophosphamide, cytarabine, vincristine, doxorubicin, methotrexate, ifosfamide, etoposide, cytarabine (CODOX-M IVAC) which finished in September 2011. He developed severe bilateral hip pain 6 months after completing his chemotherapy. X-rays revealed bilateral avascular necrosis (AVN). He was discharged from the Navy on medical grounds and underwent bilateral total hip replacements in 2013. In March 2014 he developed pain involving both shoulders. An MRI scan revealed extensive bilateral humeral head AVN. He was seen by an orthopaedic surgeon at a tertiary centre and underwent re-surfacing surgery on both shoulders. Meanwhile he was reviewed by the pain team and a palliative care consultant in June- July 2014 for ongoing widespread pain in his elbows, wrists, knees and ankles. He also suffered from depression, poor sleep and expressed frustration regarding his general health and inability to work. Multiple analgesic agents used included amitriptyline, dothiepin, pregabalin, oxycodone, oxynorm and clonazepam. He also tried cognitive behavioural therapy (CBT). He developed a headache and saw a neurologist who investigated this and concluded the patient had an analgesia overuse headache. In December 2017 he developed more pain in his knees and ankles and X-rays revealed AVN of both knees. He underwent a right total knee replacement in June 2018. An MRI scan of his ankles revealed signs of bilateral AVN with bone infarction of the distal tibia and a small area of the talus bilaterally. When he was assessed in the rheumatology clinic in August 2018, he had a number of investigations which revealed normal blood counts, haemoglobin electrophoresis and clotting screen. An autoimmune screen was negative including ANA, ENA and antiphospholipid antibodies. An infection screen including HIV was also negative. A lipid screen revealed a triglyceride level of 10.9, cholesterol 8.1 and HDL ratio of 9.3.

Conclusion

This challenging case involves a young patient with AVN in 8 sites which is rare. The AVN is likely related to chemotherapy, steroids and untreated hyperlipidaemia. There have been devastating painful and psychological consequences to his daily functioning. Ongoing issues include widespread pain and further sites of AVN.

Disclosures

A. Haque None. A. Coote None.
P28 Marfan syndrome? Think again!
Authors: Madenidou Anastasia- Vasiliki , Choida Varvara , Reddy Venkat , Kazkaz Hanadi
Published: April 2020

Background

A 21 year old male was referred to the adult hypermobility clinic from the local rheumatologist with a suspected diagnosis of Marfan syndrome, based on his body habitus although he had presented to his GP with painful toes.

Methods

He had a background of autism,learning difficulties and was wearing glasses due to amblyopia. He had a history of dental crowding with two previous teeth extractions. There was no family history of note. On examination, his arm span was not greater than his height, there was no arachnodactyly, his palate was normal, but he had gum hypertrophy. His skin texture was normal, with no abnormal scarring or bruising, but there was presence of striae. His Beighton score was 4/9 and he had flat feet. There was reduced muscle mass and hypotonia, which was felt to be the cause of his hypermobility, rather than increased ligamentous laxity. There was evidence of gynaecomastia and lack of facial hair. The working diagnosis was Klinefelter syndrome due to his tall stature, gynaecomastia and absence of secondary male characteristics. Subsequently, the patient was referred to endocrinology and for genetic testing.

Results

The endocrinology team recognised the clinical features of male hypogonadism with small phallus (Tanner stage 2/3) and small testes, confirmed also by ultrasound. The patient reported absence of early morning erections. Blood tests confirmed hypergonadotropic hypogonadism (high luteinizing hormone, low testosterone) and the patient was commenced on testosterone therapy. His bone mineral density values lied within the expected range for age. Karyotype analysis confirmed the presence of 48,XXYY which is a chromosomal condition characterized by the presence of an extra X and Y chromosome in males. In terms of management, he attended our Outpatient Hypermobility Exercise Programme and was given advice on footwear. He was provided with extensive written information about this condition by the Rare Chromosome Disorder Support Group, Unique.

Conclusion

Our case report illustrates the importance of considering 48,XXYY syndrome in patients with typical body habitus and joint hypermobility. Marfanoid habitus is associated with connective tissue diseases, like hypermobile Ehlers-Danlos syndrome and Marfan syndrome, but also described in homocystinuria and Klinefelter syndrome. 48,XXYY was considered previously as a variant of Klinefelter syndrome, but now it is regarded as a separate syndrome with overlapping features with the Klinefelter syndrome. As in our case, the classical phenotypic characteristicsinclude gynaecomastia, small testes and tall stature. Most affected individuals are infertile. This syndrome is also associated with behavioural problems, learning difficulties, congenital heart defects, bone abnormalities, tremor, obesity, type 2 diabetes and/orrespiratory problems. Patients have an essentially normal life expectancy but require regular medical follow-up.

Disclosures

A. Madenidou None. V. Choida None. V. Reddy None. H. Kazkaz None.
P42 Use of trametinib, a MEK1 inhibitor, to treat Erdheim Chester disease (ECD)
Authors: Alkoky Hoda , Munir Talha , Borg Frances
Published: April 2020

Background

Erdheim Chester disease (non-Langerhan’s cell histocytosis) is a poorly recognised rare multisystem disorder. Alfa interferon (αINF) is recommended as initial therapy. BRAFV600E and MAP2K1 mutations have been identified in this condition, for which targeted biologic therapy is now available. We present a clinically challenging case of ECD, including both small and large vessel vasculitis, intolerant of αINF, who has now responded well to MAP2KI inhibition.

Methods

A 49-year-old gentleman was referred to the rheumatology clinic in 2013 with a multisystem inflammatory condition, initially characterised by weight loss, systemic upset, cranial diabetes insipidus and hypogonadism, testicular masses, lymphadenopathy and knee arthritis. Initial PET scan demonstrated uptake in these areas, together with the typical long bone pattern of uptake of ECD with complete enhancement of the pituitary on MRI. Non-Langerhan’s cell histocytosis was confirmed histologically from synovial biopsy, with presence of the MAP2K1 mutation. He was initially treated with αINF, which he was unable to tolerate, and he was then maintained on a combination of subcutaneous methotrexate and prednisolone. In 2017, he developed transient weakness and dysarthria, and episcleritis with DSA-MRI consistent with small vessel cerebral vasculitis. This was treated with cyclophosphamide. 6 months later, he experienced amaurosis fugax. He was found to have critically stenotic carotid arteries, despite these being normal when imaged 6 months previously. Carotid artery biopsy confirmed non-giant cell vasculitic changes, and PET confirmed large vessel uptake from carotids to aortic arch.

Results

Funding for targeted biologic therapy was turned down by NHSE. Trametib, a MEK1 inhibitor was obtained on compassionate grounds. Following commencement of this, PET uptake in all areas, including the vasculature normalised, with symptomatic resolution and CRP falling from 148 to 4. At the 6-month point, he remains in remission symptomatically, radiographically and in laboratory markers.

Conclusion

ECD is a rare multi-system disorder characterised by tissue infiltration of foamy histiocytes. There are approximately 550 cases described in the literature. It is classified as an inflammatory myeloid neoplasm, with variable phenotype and prognosis. Median survival is 162 months. CNS involvement and lack of response to α-INF are both independent predictors of a poor prognosis. Two genetic mutations have been identified in these patients: BRAFV600E in over 60% and MAP2K1 in 20%. Both mutations now have targeted biologic inhibition. ECD may present in the rheumatology clinic due to its inflammatory and multisystem involvement. We hope to promote recognition of this condition through this case. Although targeted therapies exist, better avenues of funding need to be available for patients with rare conditions to access them.

Disclosures

H. Alkoky None. T. Munir None. F. Borg None.
P59 Social care use in people with chronic pain
Authors: Humphreys Jenny H , Dempsey Katy , Phelan Ollie , Boothman Laura , Cook Louise , Dixon William G
Published: April 2020

Background

Chronic pain is a common and disabling health problem and those affected may need support with their activities of daily living (ADLs). However currently there are no data quantifying how much social care support people with chronic pain need.

Methods

Between June-July 2019, previous participants of the Cloudy with a Chance of Pain study were invited to take part in an online survey, adapted from a validated Personal Social Services Research Unit interview survey. It collected data on whether participants with chronic pain needed help with ADLs, how frequently help was needed and who provided it (formal/informal social care). Additional data was collected on demographics, employment status, pain diagnosis, and comorbidities. Descriptive statistics described the burden of social care need and multivariable logistic regression identified factors associated with social care need.

Results

There were 981 respondents; 791 (81%) were female, median age 59 years (Table 1). In the last month 527 (61%) respondents reported needing help with ADLs. Over three-quarters of help was provided informally by family and friends (408 (77%)). For 309 (59%) respondents, help was needed at least daily. In the multivariable logistic regression model, needing help was lower with older age, (OR (95% CI) 0.96 (0.94-0.98), but higher in female gender (OR (95% CI) 1.96(1.27-3.01), fibromyalgia (OR (95% CI) 2.75 (2.53-5.54)), osteoarthritis (OR (95% CI) 1.56 (1.11-2.19)) and multi-morbidity OR (95% CI) 2.13 (1.51-3.01)). Compared to full-time work, respondents who were retired or unable to work were also significantly more likely to need help with ADLs, respective OR (95% CI) 2.16 (1.21-3.84) and 6.98 (3.72-13.08).

Conclusion

A high proportion of people with chronic pain needed support with ADLs; for more than half, on a daily or more frequent basis. Interestingly, younger patients were more likely to need help which may reflect responder bias. Most support was provided informally, and this could be for a number of reasons. For example, lack of awareness/not meeting eligibility/unable to afford formal social care, or preference to be cared for by familiar persons. This should be explored in future research. These results demonstrate the burden of social care may be significantly greater than government and social care organisations are aware, with important implications for policy and planning.

Disclosures

J.H. Humphreys None. K. Dempsey None. O. Phelan None. L. Boothman None. L. Cook None. W.G. Dixon None.
P66 Risk factors for chronic widespread pain among older workers: findings from the Health and Employment After Fifty (HEAF) study
Authors: Ntani Georgia , D'Angelo Stefania , Harris Clare , Linaker Cathy , Walker-Bone Karen
Published: April 2020

Background

Incident chronic widespread pain (CWP) is associated with demographic and personal risk factors such as low mood and somatisation. More recently, there has been increased focus on the role of workplace factors on CWP. However, evidence from studies exploring the interaction of demographic, personal risk factors, job activities and psychosocial aspects of work on pain in older workers is limited. We assessed several potential determinants of the onset of CWP among participants in the HEAF study, a prospective UK cohort.

Methods

A cohort of participants aged 50-64 years were recruited from 24 English general practices in 2013-14 and have been followed-up annually by postal questionnaire. At baseline, information was collected about demographic and employment circumstances, physical workload, psychosocial aspects of work and their general health, mood and well-being. At three years of follow-up, information about pain was also obtained by reporting painful sites on a body mannikin, and CWP was defined according to the ACR criteria. Associations between potential risk factors and the onset of new CWP were explored using logistic regression modelling. Effect estimates were summarised by odds ratios (OR) and 95% confidence intervals (CIs).

Results

HEAF recruited a total of 8,134 people aged 50-64 years at baseline. Among the N = 3,909 still at work at three years’ follow-up, N = 3,873 did not report CWP in the first two years of follow-up. The incidence of CWP at three years follow-up was 7.4% (males: 5.7%; females: 8.9%). Multivariate analyses showed that the strongest predictors of the onset of new CWP were: female sex (OR(95% CI): 1.7(1.2-2.3)), reporting that they have low expectations of coping with physical demands of the job (OR (95%CI): 2.1 (1.5-3.0)); somatisation (OR(95%CI): 2.1(1.3-3.2)) and poor self-rated health (OR(95%CI): 2.3(1.7-3.2)). Physical workload and other psychosocial aspects of work were also significantly associated with onset of CWP but with relatively smaller effect sizes (physical workload OR(95%CI): 1.2(1.1-1.3)); lack of appreciation OR (95% CI): 1.6(1.1-2.5))

Conclusion

Our results complement previous findings that physical loading at work independently predicts the onset of CWP. However, personal risk factors like self-rated health and work-related expectations demonstrated stronger effects. These findings can inform future interventions for prevention of CWP.

Disclosures

G. Ntani None. S. D'Angelo None. C. Harris None. C. Linaker None. K. Walker-Bone None.
P89 Can we manage osteoporosis without patients ever seeing a consultant?
Authors: Fourmy Joanne , Begum Julie , Nisar Muhammad K
Published: April 2020

Background

Specialist services are heavily reliant on a consultant reviewing a patient and discussing management options. We designed an innovative proof-of-concept osteoporosis service with patients only consulting a metabolic bone CNS and a consultant providing remote oversight. The aim of the project was to improve the efficiency of the service by eliminating consultant appointments and reducing unnecessary hospital visits whilst continuing to deliver a high-quality and safe service.

Methods

All stakeholders involved in the management of osteoporosis at our unit were engaged. Following extensive discussions, a new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged post menopausal women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation and assess the suitability of parenteral treatment. Relevant investigations were requested during the telephone clinic and treatment related information was despatched to help with shared decision making. All patients were then reviewed in a consultant-CNS virtual MDT. Appropriate parenteral treatment option was agreed and confirmed to everyone. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. If all checks were satisfactory, the treatment was commenced, and individuals advised to contact the advice line for any concerns. There was no face-to-face appointment in the service unless explicitly requested by the users.

Results

In the proof-of-concept phase, 38 patients were triaged into the new service. It was a combination of sixteen new referrals and 22 patients pulled from the consultants’ waiting list. Mean age of participants was 77.2 years (65-92). Referral to virtual triage took median 20 days (0-62). Median time for triage to new patient CNS telephone consultation was 18 days (6-87). Time to virtual MDT for treatment authorisation was median zero days (0-76 days). 17 patients had anabolic therapy commenced via home care. Remaining had anti resorptive therapy. No patient requested face-to-face review. Only one patient fed back that they would’ve preferred to see the consultant once. 38 new patient consultant appointments were saved and median delay in treatment commencement was reduced from 84 to 38 days.

Conclusion

To our knowledge, this is the first successful example of an innovative service wholly provided by CNSs for commencing parenteral anti-osteoporotic therapy with only remote consultant supervision. Our service redesign has significantly improved the efficiency of the parenteral osteoporosis pathway with reduction in treatment delay and a more streamlined patient journey. A nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution to thinly stretched health care needs of people with chronic conditions.

Disclosures

J. Fourmy None. J. Begum None. M.K. Nisar None.
P111 Should standing consultations be offered throughout the NHS? An investigation into patient attitude towards standing consultations in a rheumatological department
Authors: Oliver Andrew , Raftery Graham , Coady David
Published: April 2020

Background

Britain is becoming an increasingly sedentary society; public health statistics tell us our health is being affected by our everyday lifestyle choices with reduced levels of physical activity and increasing levels of obesity contributing to increased demands on health and social care systems. On average, the UK workforce spends 9 hours sitting down per day. This is particularly prominent amongst GPs and certain senior physician roles in hospital, where clinics contribute to a large amount of the workload. Standing has been shown to put less stress on the lower back and other joints, burn more energy than sitting down and increase productivity and energy levels. Thus, evidence shows it is healthier to stand more during the day, but is it feasible in a healthcare setting? The aim of this study was to investigate whether patients would prefer to sit or stand for their consultations and the reasoning behind their choices.

Methods

A consultation room within the rheumatology outpatient department in Sunderland Royal Hospital was fitted with an adjustable standing desk. During clinics, patients were offered a standing consultation on entry to the room. A focused questionnaire was created and given to patients, consisting of 6 questions on the demographics of the patients, whether they wanted a standing consultation or not and what their reasoning was for their decision. This was an opportunistic study that included 39 patients over a 3-week period.

Results

In total, 39 questionnaires were given out, with each patient being offered a standing consultation. The results found that 13 patients opted for a standing consultation and 23 patients preferred to sit down. Not wanting to stand due to an MSK problem was the most prevalent answer with 16 patients using that as their reasoning.

Conclusion

In an increasingly sedentary population, the introduction of standing desks could help to reduce this behaviour in healthcare professionals and contribute positively to health. This study also highlights the question of positive modelling of patient behaviours, by healthcare professionals demonstrating the benefits of standing, it could encourage patients to begin to integrate it into their own lives. If we remove the 16 patients that did not want to stand due to an MSK problem, then the results show that 13/23 (56%) of patients wanted a standing consultation, so why not offer the choice? Increasing the sample size and trialling the desk in another department, where MSK problems are less prevalent, is the logical next step to develop this research. Following further investigation, the implementation of standing desks throughout more healthcare departments could help to reduce sedentary behaviour, increase productivity, lessen sick days amongst staff and demonstrate healthy living to patients.

Disclosures

A. Oliver None. G. Raftery None. D. Coady None.
P126 An analysis of the quality and readability of online information for osteoarthritis
Authors: Murray Kieran , Murray Timothy , Low Candice , O'Rourke Anna , Veale Douglas J
Published: April 2020

Background

Osteoarthritis is the most common cause of disability in people over 65 years old. The readability of of online osteoarthritis information has never been assessed. A 2003 study found the quality of online osteoarthritis information to be poor. This study reviews the quality of online information regarding osteoarthritis in 2018 using three validated scoring systems. Readability is reviewed for the first time, again using three validated tools.

Methods

The term osteoarthritis was searched across the three most popular English language search engines. The first 25 pages from each search engine were analysed. Duplicate pages, websites featuring paid advertisements, inaccessible pages (behind a pay wall, not available for geographical reasons) and non-text pages were excluded. Readability was measured using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) and Gunning-Fog Index (GFI). Website quality was scored using the the Journal of the American Medical Association (JAMA) benchmark criteria and DISCERN criteria. Presence or absence of HONcode certification, age of content, content producer and author characteristics were noted.

Results

37 unique websites were suitable for analysis. Readability varied by assessment tool from 8th to 12th grade level. This compares with the recommended 7- 8th grade level. One (2.7%) website met all four JAMA Criteria. Mean DISCERN quality of information for OA websites was “fair”, comparing favourably with the “poor” grading of a 2003 study. HONCode endorsed websites (43.2%) were of a statistically significantly higher quality.

Conclusion

Quality of online health information for OA is “fair”. 2.7% of websites met JAMA benchmark criteria for quality. Readability was equal to or more difficult than recommendations. HONcode certification was indicative of higher quality, but not readability.

Disclosures

K. Murray None. T. Murray None. C. Low None. A. O'Rourke None. D.J. Veale None.
P142 Factors associated with change in health-related quality of life in people living with gout: a three-year prospective cohort study in primary care
Authors: Watson Lorraine , Belcher John , Nicholls Elaine , Chandratre Priyanka , Blagojevic-Bucknall Milisa , Hider Samantha , Lawton Sarah A , Mallen Christian D , Muller Sara , Rome Keith , Roddy Edward
Published: April 2020

Background

Gout affects 2.5% of adults in the UK but is often poorly managed. It can impair health-related quality of life (HRQOL), yet little is known about which people with gout are at risk of worse outcomes. We investigated factors associated with change in HRQOL over a three-year period in people living with gout in primary care.

Methods

People with gout registered with 20 general practices in the West Midlands completed the Gout Impact Scale (GIS), Short-Form-36 Physical Function subscale (PF10) and health assessment questionnaire disability index (HAQ-DI) at five time-points (baseline & 6, 12, 24 and 36 months) via postal questionnaire. Linear mixed modelling (LMM) with multivariate adjustment for baseline and time-varying covariates was used to investigate gout-specific, comorbid and socio-demographic factors associated with change in the Concern Overall (GIS-CO), PF10 and HAQ-DI over three years. Higher scores are worse for GIS-CO and HAQ-DI, but better for PF10.

Results

Of 1,184 baseline respondents, 818 (80%), 721 (73%), 696 (75%), 605 (68%) responded at 6, 12, 24 and 36 months respectively. Mean age (SD) at baseline was 65.6 (12.5) years. 990 (84%) were male, 494 (42%) reported >2 gout flares in the previous year, 624 (54%) were taking allopurinol and 318 (27%) had an eGFR<60mL/min/1.73m2. Factors identified as being associated with a deterioration in HRQOL over three years (table), were gout flare frequency (GIS-CO, PF10), history of oligo/polyarticular flares (GIS-CO, HAQ-DI), having a flare currently (GIS-CO), allopurinol use (PF10), having body pain (GIS-CO, PF10, HAQ-DI), higher pain severity (GIS-CO, PF10, HAQ-DI), number of comorbidities (PF10), eGFR <60mL/min/1.73m2 (PF10, HAQ-DI), anxiety (GIS-CO), depression (PF10, HAQ-DI), and older age (PF10, HAQ-DI). Factors associated with an improvement in HRQOL were longer gout duration (GIS-CO), older age (GIS-CO), lower socioeconomic deprivation (PF10, HAQ-DI) and more frequent alcohol consumption (PF10, HAQ-DI).

Conclusion

Gout-specific, comorbid and socio-demographic factors associated with change in HRQOL over a three-year period in people living with gout in primary care were identified, highlighting people at risk of worse outcomes over three years and at greatest need of urate-lowering therapy and other targeted interventions.

Disclosures

L. Watson None. J. Belcher None. E. Nicholls None. P. Chandratre None. M. Blagojevic-Bucknall None. S. Hider None. S.A. Lawton None. C.D. Mallen None. S. Muller None. K. Rome None. E. Roddy None.
P151 Forced vital capacity in patients with systemic sclerosis associated pulmonary fibrosis: predictors of meaningful decline
Authors: Nihtyanova Svetlana I , Derrett-Smith Emma C , Fonseca Carmen , Ong Voon H , Denton Christopher P
Published: April 2020

Background

Pulmonary fibrosis (PF) is common in systemic sclerosis (SSc) and serial pulmonary function tests (PFTs) are used for routine PF monitoring. Forced vital capacity (FVC) decline reflects progression in PF and FVC is frequently used as an endpoint in clinical trials. We explore the changes in FVC over time in patients with SSc-PF, receiving standard management, including immunosuppression.

Methods

Only SSc patients with CT-confirmed PF were included. FVC changes over the first 10 years from onset and their associations were assessed using linear mixed effects models. Predictors of time from first PFT to development of threshold FVC (FVC<70% and FVC<50%) were analysed using Cox regression.

Results

We identified 505 SSc-PF subjects, 21.6% were male, average age at onset was 47 years and 49.3% had diffuse cutaneous subset (dcSSc). The most common autoantibody was anti-Scl70 in 40.4%, followed by anti-RNA polymerase (ARA) in 11.7% and anti-centromere (ACA) in 7.1%. In 16.4% of the patients, ANA was positive, but no ENAs were identified (ANA+ENA-). Average FVC at 12 months from onset was 80.1% (SD 19.3) and this declined by 0.32% per year (p = 0.007) at a group level. There was no significant correlation between baseline FVC and subsequent change (correlation coefficient -0.13; 95%CI -0.26, 0.01). For every year older age at onset, average FVC increased by 0.32%, p < 0.001. Males had 3.3% lower FVC at 1 year from onset (p < 0.001) and 0.6% faster decline per year (p = 0.034) compared to females. DcSSc subjects had 5.6% lower FVC compared to limited disease (p = 0.003). Average FVC at 1 year from onset in ARA+ subjects were higher than any other antibody (15.1% v. ANA+ENA-, p < 0.001; 14.6% v. ATA, p < 0.001 and 12.5% v. ACA, p = 0.010). Nevertheless, ARA+ subjects had FVC decline rates similar to ATA+ and ANA+ENA- subjects, while ACA+ patients had a small but significant increase in FVC over time. Factors that increased the risk for FVC drop below the thresholds were male sex, ATA and low baseline FVC (Table 1).

Conclusion

This study provides insight into long-term patterns of FVC change and develops a model that may help predict those most at risk of significant decline.

Disclosures

S.I. Nihtyanova None. E.C. Derrett-Smith None. C. Fonseca None. V.H. Ong None. C.P. Denton None.