bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuro-Oncology Practice Clinical Debate: stereotactic radiosurgery or fractionated stereotactic radiotherapy following surgical resection for brain metastasis
Authors: Palmer Joshua D , Greenspoon Jeffrey , Brown Paul D , Johnson Derek R , Roberge David 
Published: October 2019

Abstract
The treatment of resected brain metastasis has shifted away from the historical use of whole-brain radiotherapy (WBRT) toward adjuvant radiosurgery (stereotactic radiosurgery [SRS]) based on a recent prospective clinical trial demonstrating less cognitive decline with the use of SRS alone and equivalent survival as compared with WBRT. Whereas all level 1 evidence to date concerns single-fraction SRS for postoperative brain metastasis, there is emerging evidence that fractionated stereotactic radiotherapy (FSRT) may improve local control at the resected tumor bed. The lack of direct comparative data for SRS vs FSRT results in a diversity in clinical practice. In this article, Greenspoon and Roberge defend the use of SRS as the standard of care for resected brain metastasis, whereas Palmer and Brown argue for FSRT.
Injury narratives in occupational safety and health prevention in Italy
Authors: Fubini L , Pasqualini O , Ferro E , Marino M , Santoro S , Tosco E , Gilardi L 
Published: October 2019

Abstract

Background
Storytelling is an effective information source when coupled with technical-scientific evidence. It can promote a structured relationship between evidence-based knowledge and field experience of workplace safety and prevention services (WSPS) inspectors. This is key to identifying the causes of workplace injuries and to set priorities for prevention strategies.

Aims
The main aim was to describe and report how story collection can be used for deriving validated indications for injury prevention. The specific objectives were to report the results of the creation and dissemination on the web of the story collection and the experience of setting up a community of practice (CoP) to develop preventive recommendations.

Methods
WSPS inspectors from local health boards in Piedmont (northwest Italy) were asked to write injury stories. They identified the key elements of their stories and developed a narrative of witness accounts to explore the critical issues identified during the investigation. In sessions with the CoP, the inspectors validated the indications for prevention elaborated in each story to reduce bias and standardize recommendations.

Results
Between 2012 and 2017, 60 WSPS inspectors wrote 53 injury stories which were collected and published on the institutional website. Twenty-two stories were selected for discussion during peer review sessions in the CoP and the indications for prevention were transformed as preventive solutions.

Conclusions
Occupational safety and health prevention can benefit from a narrative-based approach that provides a more comprehensive look at health and safety by facilitating knowledge improvement and sharing.
Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings
Authors: Paengsai Ninutcha , Jourdain Gonzague , Salvadori Nicolas , Tantraworasin Apichat , Mary Jean Yves , Cressey Tim Roy , Chaiwarith Romanee , Bowonwatanuwong Chureeratana , Bhakeecheep Sorakij , Kosachunhanun Natapong 
Published: October 2019

AbstractObjectiveThe use of some antiretroviral drugs has been associated with a higher risk of diabetes mellitus (DM) in HIV-infected patients, but the risk associated with antiretroviral drug combinations remains unclear. We investigated the association between first-line antiretroviral therapy (ART) regimens, recommended by the World Health Organization (WHO) in 2016, and the risk of DM in adults.MethodWe selected all HIV-infected adults within the Thai National AIDS Program who started a first-line ART regimen consisting the following between October 2006 and September 2013: zidovudine+lamivudine+nevirapine; tenofovir disoproxil fumarate (TDF)+lamivudine+nevirapine; zidovudine+lamivudine+efavirenz; TDF+lamivudine/emtricitabine+efavirenz; zidovudine+lamivudine+ritonavir-boosted lopinavir (LPV/r); or TDF+lamivudine+LPV/r. Diagnosis of DM was defined as having at least 2 of the following characteristics: fasting plasma glucose ≥126 mg/dl, 2010 WHO ICD-10 codes E11-E14, or prescription of antidiabetic drugs. To identify ART regimens associated with DM, we used competing risks regression models that considered mortality without DM as a competing event and adjusted for sex, age, pancreas disease, and stratified by groups defined by a score summarizing the propensity to receive a specific first-line ART regimen.ResultsData from 35 710 adults (49.1% male; median age, 35.0 years; median follow-up, 2.0 years) were included. In the multivariable analysis with zidovudine+lamivudine+nevirapine as the reference group, a higher risk of DM was observed with TDF+lamivudine/emtricitabine+efavirenz (adjusted sub-distribution hazard ratio [aSHR], 1.6; 95% confidence interval [CI], 1.3–1.9), zidovudine+lamivudine+efavirenz (aSHR, 2.0; 95% CI, 1.7–2.3), and TDF+lamivudine+LPV/r (aSHR, 2.7; 95% CI, 1.9–3.9).ConclusionsSeveral of the WHO recommended ART regimens, particularly tenofovir + lamivudine +LPV/r and regimens containing efavirenz, may be associated with an increased risk of DM.
Molecular Evidence of Influenza A Virus Circulation in African Dromedary Camels Imported to Saudi Arabia, 2017–2018
Authors: Alghamdi Abdulaziz , Hassan Ahmed M , Tolah Ahmed M , Alamari Sawsan S , Alzahrani Abdulrahman A , Alsaaidi Ghaleb A , Abujamel Turki S , Azhar Esam I , Hashem Anwar M 
Published: October 2019

Abstract
Little is known about influenza A viruses in dromedaries. Here, we detected influenza A viral RNA in 11 specimens (1.7 %) out of 665 nasal swabs collected from dromedaries between 2017 and 2018 in Saudi Arabia. Positive samples were detected only in imported camels from Sudan and Djibouti but not local ones. Partial genome sequencing indicates a close relationship to 2009–2019 human/swine influenza A H1N1 isolates from different countries, suggesting possible interspecies transmission. Taken together, dromedaries could represent a potentially unrecognized permissive host for these viruses, highlighting the need for enhanced surveillance in animals to aid implementation of one-health strategies.
P25 Magnetic resonance imaging findings in children with Parry Romberg syndrome and en coup de sabre
Authors: Knights Harry , Minas Elizabeth , Khan Faraan , Mankad Kshitij , Shaw Lindsay , Obaidi Muthana Al , Eleftheriou Despina 
Published: October 2019

Poster presentation Tuesday 8 October

Background
En coup de sabre (ECDS) is a form of linear scleroderma characterised by skin induration followed by unilateral pigmentation dysregulation over the frontoparietal region with associated scarring. Parry Romberg syndrome (PRS) is a sporadic neurocutaneous disease characterised by slow and progressive hemifacial atrophy of the skin, muscles, and bony structures. Both conditions are associated with neurological symptoms such as headache and seizures. A wide variety of magnetic resonance findings associated with these conditions have been described. However, to date, attempts to identify predictors of MRI abnormalities have remained unsuccessful. The aim of this study was to: (i) describe the abnormalities seen on MRI in a large group of children with PRS/ECDS; and (ii) identify demographic, clinical, and laboratory predictors of MRI abnormalities.

Methods
This was a single centre (Great Ormond Street Hospital, London) retrospective case series of patients with PRS/ECDS seen from 2001-2018. We identified patients with cutaneous symptoms consistent with the clinical descriptions of PRS/ECDS: lateral forehead scleroderma with/without hemifacial atrophy. Presenting clinical, immunological, and MR brain findings are reported. Results are expressed as medians and ranges or frequencies and percentages. Fisher’s exact test was used to identify clinical associations with MRI abnormalities.

Results
A total of 17 patients were identified: 7 males and 10 females; median age 13 years (range 3 – 23). Non-cutaneous manifestations included seizures, headaches, stroke, cranial nerve dysfunction, anxiety, hypertension, hypermobility, Raynaud’s, myositis, and gastro-oesophageal reflux. The positive MR findings included ipsilateral enhanced white matter signalling, mineral deposition, lateral ventricle dilation, leptomeningeal enhancement, cavernomas, generalised atrophy, and loss of cortical gyration. The presence of seizures and the PRS phenotype were significantly associated with an abnormal MRI (p < 0.05) and showed trends towards significance with ipsilateral enhanced white matter signalling (p = 0.09).

Conclusion
The development of seizures and the PRS phenotype predict abnormalities in MR brain imaging in childhood PRS/ECDS. Baseline and regular monitoring MR brain scans should be carried out in all patients with PRS/ECDS to identify abnormalities associated with the development of seizures.

Conflicts of Interest
The authors declare no conflicts of interest.
P38 Never say never: new onset uveitis in adolescence
Authors: Kelly Imogen , Davidson Joyce , Brennan Mary , MacRae Mary , Duncan Julie 
Published: October 2019

Abstract

Background
To highlight the importance of considering new onset uveitis in adolescent patients with longstanding juvenile idiopathic arthritis (JIA).

Methods
We performed a retrospective review of electronic medical records.

Results
A 16 year-old girl was diagnosed in 2004, aged 15 months with extended oligoarticular JIA (ANA positive, >1/640 homogeneous). Her initial treatment included intra-articular steroid injections and approximately eighteen months later methotrexate, which she remained on for four years. During this time she received occasional intra-articular steroid injections. Etanercept was added in 2009 due to persistent active disease and she continued on this treatment regime for the next five years. Methotrexate was discontinued in 2013 due to intolerance. Etanercept was discontinued in 2014 due to disease remission but was restarted after three months when her arthritis flared.
In 2018 biologic treatment was changed due to poor disease control. Etanercept was switched to adalimumab, initially alternate weeks but increasing to weekly together with multiple joint injections. Six months later, her disease control remained poor and drug levels and antibodies were measured. She had a strongly positive anti-drug antibody level>200 AU/ml and her adalimumab level was <0.4mgs/L (normal range 5-10).
At this time our patient now aged 16 presented with a four-week history of intermittent reduced vision in her right eye. Ophthalmology review found bilateral anterior uveitis. This patient had regular eye screening from her JIA diagnosis until her 11th birthday, showing no previous evidence of uveitis.
Following diagnosis of uveitis she was commenced on steroid eye drops and IV methylprednisolone to treat both her uveitis and arthritis. Infliximab, (6mg/kg) was commenced then increased (10mg/kg) for ongoing uveitis and methotrexate was restarted. Despite this treatment she has persistent low grade right uveitis. Her left eye has settled and she has no lens opacities or raised intraocular pressures. She continues with joint discomfort secondary to her hypermobility but her arthritis is currently quiescent.

Conclusion
Type of arthritis and age at onset historically dictated the risk of developing uveitis. However uveitis can present in any age group and in patients with any type of JIA. In our case uveitis developed for the first time almost 15years after diagnosis.
With disease modifying treatments now widely used early in the management of JIA, uveitis may be masked and therefore present late or atypically. It is rare for uveitis to present so long after diagnosis, however this case highlights that rheumatology teams should be aware that it can still develop. Therefore we should never say never!

Conflicts of Interest
The authors declare no conflicts of interest.
P45 Treat the arthritis, not just the chest
Authors: Pilbury Madeline , Clarke Elizabeth , Taylor Julia , Watson Pippa , Jobling Alison 
Published: October 2019

Abstract

Background
Very little literature exists in supporting the assessment and management of cystic fibrosis related arthritis (CFA) particularly in paediatric and adolescent cases.

Methods
A 12 year-old male with cystic fibrosis (CF) was admitted via A&E with severe joint pain that was thought to be associated with a respiratory infection and was treated accordingly. Repeated exacerbations of joint disease occurred every 1-2 months, lasting approximately 1 week with significant joint pain, stiffness, and reduced function.
The patient did not feel his exacerbations of CFA were related to his respiratory symptoms, admitting he under reported arthritis symptoms to avoid being admitted for IV antibiotics. Initial rheumatology review resulted in treatment with IV antibiotics and piroxicam. Flares continued, prompting his CF physiotherapist and multidisciplinary team to seek further specialist review for his now longstanding symptoms. He scored 16 out of 50 on the McGill Pain Questionnaire (MPQ) with a visual analogue score (VAS) of 46 out of 100.
At 16 years old he was seen by an MSK physiotherapy and rheumatology team working within a wider CF team. He had a 4 year history of symmetrical joint pain affecting knees, wrists and hands, on a background of bronchiectasis with previous non-tuberculous mycobacteria infection, cystic fibrosis related diabetes, and poor nutrition.
He reported some episodes being so bad he was unable to get out of bed, and struggling with the stairs at college. He had 6 swollen and 8 tender joints including wrists, MCPs and knees. Ultrasound imaging of the wrists and hands showed confirmed active synovitis with grade 3 greyscale changes and grade 2 power Doppler. Hydroxychloroquine was commenced with naproxen as required, and wrist splints were provided.

Results
At follow-up he reported significant symptomatic improvement with occasional minor stiffness in wrists and knees which responded quickly to naproxen and was no longer limiting his activities. Repeat ultrasound confirmed improvement with no active power Doppler, but some ongoing grade 1 greyscale changes and a small wrist effusion. He has returned to previous function with an MPQ score of 0, and VAS of 10 out of 100. He reported improved quality of life due to reduced pain and fewer, shorter, and more manageable exacerbations.

Conclusion
Specialist review and commencement on disease modifying anti-rheumatic medication helped to manage CFA in this case. All cases of suspected CFA should be referred for specialist rheumatology opinion. CF physiotherapists are in an excellent position to identify cases and empowering the multidisciplinary team has been vital in this case.
Further trials are required to investigate optimal management of CFA, but it seems likely that directly addressing the arthritis with disease modifying therapy may play an important role.

Conflicts of Interest
The authors declare no conflicts of interest.
P63 Evaluation of new patients seen by physiotherapy for obesity
Authors: Pattenden Amy , Hurley Matthew , Deepak Samundeeswari 
Published: October 2019

Abstract

Background
Obesity levels have been increasing rapidly worldwide for the past two decades. The WHO has estimated the UK to be among the most overweight countries in the world, and according to government figures, the UK is now the fattest country in Europe with one in four adults obese. Obesity levels continue to rise within upcoming generations and if current trends continue, the forecast for the future health of today’s children is bleak.

Methods
We aim to evaluate the body mass index (BMI) of children seen at the paediatric physiotherapy team.
All new patients seen by a paediatric physiotherapist during the one month period June 2019 had their heights and weight measured at the first visit. The heights and weights of children were measured for all the children attending one physiotherapist’s clinic. The BMI was calculated for these children using NHS BMI child calculator.

Results
A total of 28 new children attended the physiotherapist clinic. Of these, only 11 children were in the healthy BMI range and 17 were above the 90th centile. Among these 17 children, 12 were on the 98/99th centile. Ankle pain, lower back pain, knee or hip pain appeared to be the most common presenting symptoms of these children.
Among the 28 children seen, 61% were above the 90th centile and 43% were on 98-99th centile. This data reflects only the children seen be one general paediatric physiotherapist. Children known to rheumatology team were seen by the therapists attached to the rheumatology team.

Conclusion
This audit highlights that children who are overweight and obese, experience more mechanical musculoskeletal symptoms. We conclude that further studies are needed to determine the epidemiology of musculoskeletal symptoms in children who are obese and overweight. The limitations of this project are small size and no collection of comorbidity data.
As the trend of obesity is increasing, these issues should be addressed at every opportunity of contact with the health professionals. It is important, linking the weight issues to the conditions we are treating, and raising awareness to patient and carers.

Conflicts of Interest
The authors declare no conflicts of interest.
The association between the “Plate it Up Kentucky” supermarket intervention and changes in grocery shopping practices among rural residents
Authors: Gustafson Alison , Ng Shu Wen , Jilcott Pitts Stephanie 
Published: October 2019

Abstract
Rural communities experience higher rates of obesity, and residents have a lower intake of fruits and vegetables. Innovative healthy food promotions in supermarkets may improve healthy food access and dietary intake among residents, yet few supermarket interventions have been translated to the rural context. The aim of this project was to determine whether a supermarket-based intervention “Plate it Up Kentucky” was associated with change in fruit, vegetable, and sugar-sweetened beverage (SSB) purchases among rural supermarket customers. Ten Kentucky supermarkets participated in an intervention titled “Plate It Up” to provide in-store promotions, including recipe cards, samples, price reductions for specific fruits and vegetables, and marketing on shopping carts. Six stores in rural Kentucky and North Carolina were controls. Two cross-sectional customer intercept surveys were conducted among grocery store customers in Spring of 2016 (baseline, n = 131 control and n = 181 intervention store customers) and Spring–Summer of 2017 (post-intervention, n = 100 control and n = 83 intervention store customers). Customers were asked to provide store receipts and participate in a survey assessing grocery shopping practices and dietary intake. The primary outcome was purchases in fruit and vegetable (obtained from receipt data). The secondary outcome was dietary intake (captured with the National Cancer Institute's Fruit and Vegetable Screener and BRFSS questionnaire). An adjusted, difference-in-difference model was used to assess the differences between control and intervention store customers at baseline, post-intervention, and then between the two time points. Post-intervention, there was a greater increase in customers stating that they “liked the food” as one main reason for shopping in the store where surveyed among intervention versus control store customers. The adjusted difference-in-difference model indicated that intervention store customers spent on average 8% more on fruits and vegetables from baseline to post-intervention (p = .001) when compared with customers from control stores. Among controls, spending on SSB decreased from $3.61 at baseline to $3.25 at post-intervention, whereas among intervention customers, spending on SSB decreased from $2.75 at baseline to $1.81 at post-intervention (p = .02). In-store promotions that provide recipe cards, samples, price reductions for specific fruits and vegetables, and marketing on shopping carts hold promise as a method to promote healthy food purchases among rural supermarket customers at two time points.
The introduction of new food retail opportunities in lower-income communities and the impact on fruit and vegetable intake: a systematic review
Authors: Hollis-Hansen Kelseanna , Vermont Leah , Zafron Michelle L , Seidman Jennifer , Leone Lucia 
Published: October 2019

Abstract
A lack of access to fresh fruits and vegetables (F&Vs) is associated with consumption of fewer F&Vs and higher risk of obesity, especially for lower-income individuals. It is widely believed that the addition of new food retail opportunities could improve F&V consumption and subsequently reduce the chronic disease burden. Observational studies provide some support for these hypotheses, but contradictions exist. In this study we sought to examine if the introduction of a food retailer affects F&V consumption in lower-income communities. We used a systematic PRISMA approach to conduct this study. We searched PubMed, EMBASE, and ProQuest Dissertations & Theses for academic journal references and gray literature published before August 2018. Included studies were those looking at the effect of the introduction of a new food retailer on F&V consumption. Studies were also categorized based on which dimensions of food access were targeted by the food retailer. We identified 15 studies meeting inclusion criteria: 11 studies reported a positive increase in F&V consumption attributable to the introduction of a new food retailer, of which 6 were statistically significant. The remaining 4 studies, all of which examined the impact of introducing a new retail supermarket, showed no change or a decrease in F&V intake. Results from studies which change the food environment generally support the idea that increased access to healthy food improves diet, but more studies are needed in order to assess the differences between the various types of retailers, and to identify strategies for improving impact. Understanding which types of new food retail programs are most likely to impact diet has implications for policies which incentivize new food retail.