bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nest-Site Selection and Temporal Patterns in Habitat Use of Roseate and Common Terns
Authors: Burger Joanna , Gochfeld Michael 
Published: September 2019

Abstract
Roseate Terns (Sterna dougallii) nest in a wide variety of habitats. We examined nest-site selection in a mixed-species colony of Roseate and Common (S. hirundo) terns on the interdune area of a barrier beach to determine species differences, to identify which characteristics at nest sites differed from the available habitat, and to compare nest-site preferences of early- and late-nesting Roseate Terns. Both species nested in the same area, but Roseate Terns nested under dense vegetation and Common Terns nested in more open sites. For Roseate Terns, cover within 0.5 m of the nest was greater than that within 1 m; the opposite was true for Common Terns. Cover within 5 m was similar for both species. Roseate and Common terns select different habitat features. Site characteristics of early- and late-nesting Roseate Tern nests differed. Late-nesting terns used sites with greater cover within 0.5 m, less cover within 5 m, taller vegetation, and with less visibility compared with early-nesting terns. Late-nesting Roseate Terns were still able to find sites in dense cover. At this colony, competition between the two species may not be limiting, and abundant sites remain available.
Muscle mass and plasma myostatin after exercise training: a substudy of Renal Exercise (RENEXC)—a randomized controlled trial
Authors: Zhou Yunan , Hellberg Matthias , Hellmark Thomas , Höglund Peter , Clyne Naomi 
Published: September 2019

Abstract

Background
Sarcopenia increases as renal function declines and is associated with higher morbidity and mortality. Myostatin is a negative regulator of muscle growth. Its expression in response to exercise is unclear. In this prespecified substudy of the Renal Exercise (RENEXC) trial, we investigated the effects of 12 months of exercise training on sarcopenia, muscle mass and plasma myostatin and the relationships between physical performance, muscle mass and plasma myostatin.

Methods
A total of 151 non-dialysis-dependent patients (average measured glomerular filtration rate 23 ± 8 mL/min/1.73 m2), irrespective of age or comorbidity, were randomly assigned to either strength or balance in combination with endurance training. Body composition was measured with dual-energy X-ray absorptiometry. Plasma myostatin was analysed using enzyme-linked immunosorbent assay kits.

Results
After 12 months, the prevalence of sarcopenia was unchanged, leg and whole-body lean mass increased significantly in the balance group and was unchanged in the strength group. Whole fat mass decreased significantly in both groups. There were no significant between-group differences in sarcopenia or body composition. Plasma myostatin levels increased significantly in both groups, with a significant difference in favour of the strength group. Plasma myostatin was significantly positively related to muscle mass and physical performance at baseline, but these relationships were attenuated after 12 months.

Conclusions
Exercise training seems to be effective in preventing sarcopenia and maintaining muscle mass in non-dialysis-dependent patients with chronic kidney disease (CKD). However, the role of plasma myostatin on muscle mass and physical performance in patients with CKD warrants further study.
Survival, costs, and health care resource use by line of therapy in US Medicare patients with newly diagnosed glioblastoma: a retrospective observational study
Authors: Aly Abdalla , Singh Prianka , Korytowsky Beata , Ling You-Li , Kale Hrishikesh P , Dastani Homa B , Botteman Marc F , Norden Andrew D 
Published: September 2019

Abstract

Background
Glioblastoma (GBM) is associated with poor prognosis, large morbidity burden, and limited treatment options. This analysis evaluated real-world treatment patterns, overall survival, resource use, and costs among Medicare patients with GBM.

Methods
This retrospective observational study evaluated Medicare patients age 66 years or older with newly diagnosed GBM using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 2007 through 2013. Patients were followed from diagnosis to death or end of follow-up. An algorithm defined treatment patterns as lines of therapy (LOTs). The Kaplan-Meier method was used to estimate overall survival for the full sample as well as by LOT, surgical resection, Charlson Comorbidity Index (CCI), tumor size, and age. Resource use and costs during the follow-up period were reported in terms of total and per-patient-per-month (PPPM) estimates.

Results
A total of 4308 patients with GBM were identified (median age, 74 years; CCI of 0, 52%). The most commonly used first LOT was temozolomide (82%), whereas chemotherapy + bevacizumab was most prevalent for second-line (42%) and third-line (58%) therapy. The median overall survival was 5.9 months for resected patients and 3 months for unresected patients, with considerable heterogeneity depending on patient characteristics. A great proportion of patients had claims for an ICU admission (86.2%), skilled nursing facility (76.9%), and home health (56.0%) in the postdiagnosis period. The cumulative mean cost was $95 377 per patient and $18 053 PPPM, mostly attributed to hospitalizations.

Conclusions
Limited treatment options, poor survival, and economic burden emphasize the need for novel interventions to improve care for Medicare patients with GBM.
Awareness of axial spondyloarthritis among chiropractors and osteopaths: findings from a UK Web-based survey
Authors: Yong Cee Y , Hamilton Jill , Benepal Jatinder , Griffiths Katie , Clark Zoë E , Rush Amanda , Sengupta Raj , Martindale Jane , Gaffney Karl 
Published: September 2019

Abstract

Objective
Chiropractors and osteopaths are important professional partners in the management of axial spondyloarthritis (axSpA). In view of recent advances in diagnosis and treatment, we sought to understand their current knowledge and working practices.

Methods
A Web-based survey was advertised to chiropractors and osteopaths via the Royal College of Chiropractors and the Institute of Osteopathy.

Results
Of 382 completed responses [237 chiropractors (62%) and 145 osteopaths (38%)], all were familiar with AS, but only 63 and 25% were familiar with the terms axSpA and non-radiographic axSpA, respectively. Seventy-seven per cent were confident with inflammatory back pain. Respondents routinely asked about IBD (91%), psoriasis (81%), acute anterior uveitis (49%), peripheral arthritis (71%), genitourinary/gut infection (56%), enthesitis (30%) and dactylitis (20%). Eighty-seven per cent were aware of the association between axSpA and HLA-B27. Only 29% recognized that axSpA was common in women. Forty per cent recommend an X-ray (pelvic in 80%) and, if normal, 27% would recommend MRI of the sacroiliac joints and whole spine. Forty-four per cent were aware of biologic therapies. Forty-three per cent were confident with the process of onward referral to rheumatology via the general practitioner (GP). The principal perceived barrier to onward referral was reluctance by the GP to accept their professional opinion.

Conclusion
Overall knowledge of ankylosing spondylitis is good, but the term axSpA is poorly understood. Specific learning needs include gender preponderance, awareness of acute anterior uveitis and the availability of biological therapies. There is lack of confidence in the onward referral process to rheumatology via the GP.
P49 Two cases of persistent isolated motor mononeuropathy secondary to etanercept in paediatric population
Authors: MacMahon Jayne M , McHugh John , MacDermott Emma J , Killeen Orla G 
Published: September 2019

Abstract

Background
Juvenile idiopathic arthritis (JIA) is the most common form of inflammatory arthritis in children and has an annual incidence of 33 per 100,000. With the introduction of biologic therapies, the goal of disease remission, both on and off treatment, is becoming increasingly achievable. Etanercept, a TNF-α inhibitor, was the first biologic to be used in JIA and is currently recommended as an add-on therapy in patients with inadequate response to methotrexate alone. While it is generally considered to have a good safety profile, a number of adverse events have been documented, including neuropathy.

Methods
We present two cases of etanercept related mononeuropathy, which persisted despite intravenous immunoglobulin (IVIG) therapy.

Results
Case 1: A 12 year-old girl with polyarticular JIA, who had commenced on etanercept 2 years previously, presented with an acute inability to fully flex her right index finger, associated with intermittent paraesthesia over the area. On examination, there was weakness in the deep flexor digit II and she was unable to flex at the distal interphalangeal joint. Deep tendon reflexes and sensation were normal. Nerve conduction studies showed absence of voluntarily recruited motor potentials in the right flexor digitorum profundus median to right digit II. Etanercept was discontinued and following review by a paediatric neurologist, a course of IVIG was commenced. To date, however, there has been no appreciable clinical improvement.
Case 2: A 7 year-old girl with oligoarticular JIA, who had commenced on etanercept 3 years prior, presented with a ten week history of selective weakness in her left hand and absent power in her flexor pollicis longus. On examination, there was an apparent weakness in her flexor pollicis longus with 0/5 power. Sensory and deep tendon reflexes were normal. Etanercept was discontinued. EMG and nerve conduction studies definitively outruled a proximal median neuropathy or any median motor problem outside of the anterior interosseous nerve. EMG did not find incontrovertible evidence of motor conduction block however this remains a possible and indeed plausible mechanism. She was referred to paediatric neurology and a course of IVIG was commenced.

Conclusion
While etanercept remains a widely used medication in the setting of JIA, these case studies highlight the potential neurological adverse events that can occur. To our knowledge are the first reports of persistent isolated motor neuropathy secondary to etanercept use in the paediatric population.

Conflicts of Interest
The authors declare no conflicts of interest.
P51 Is it injury or inflammation: teenage boy with back pain
Authors: Deepak Samundeeswari , Dandy Tracey , Isles Rachel 
Published: September 2019

Abstract

Background
A 14 year-old boy was referred by an orthopaedic colleague at the district hospital for evaluation of ankylosing spondylitis. The child was previously fit and well. His symptoms reported at the referral was back pain and also possibility of foot drop on the right ankle. His dad had ankylosing spondylitis and was on biologic treatment. Also, there was significant history of autoimmunity in other family members.

Methods
During the initial consultation, we revisited the history. The boy reported that main symptoms were recurrent popping sensation of his right side shoulder associated with pain and burning sensation on the shoulder which usually settles after an hour. He is sporty boy and plays regular rugby, football and used to throw discus. He denied any history of injury or illnesses preceding his symptoms. There was past history of fracture of right ankle on two occasions managed conservatively. There were no other systemic symptoms.
On examination, the child was afebrile and systemically looked well. There was no lymphadenopathy, mouth ulcers or clubbing. His cardio respiratory examination was normal. Abdomen was soft with no organomegaly. He was noted to have winging of scapula on the right side and weakness of the abductor muscles on the right side shoulder. There was wasting of muscles around the right ankle. He was noticed to have bilateral cavovarus and high arched feet. There was scoliosis at the thoracic and lumbar level. His muscle tone, power and reflexes were all normal.

Results
With his clinical presentation of winging of scapula, long thoracic nerve palsy was considered and he was referred to local physiotherapy. MRI spine done at local hospital was reviewed in the MSK radiology meeting and this showed no evidence of ankylosing spondylitis and confirmed scoliosis. His blood tests showed normal full blood count, liver and kidney function, raised creatinine kinase of 358 and HLA B27 positive. The repeat creatinine kinase was normal (153).The nerve conduction study of both the upper and lower limbs were normal. He was also seen by the neurology team. Further discussion with sport medicine colleagues and advised to continue physiotherapy. On the review 3 months later, his symptoms were much improved.

Conclusion
The presentation of a teenage boy with back pain and family history of ankylosing spondylitis warrants further evaluation. Thorough history, examination and early referral to specialist centre is beneficial for appropriate management of complex situations like this.

Conflicts of Interest
The authors declare no conflicts of interest.
P57 Ensuring safe and efficient prescribing: an audit of external prescription requests from the National Centre of Paediatric Rheumatology, Ireland
Authors: Byrne Dearbhla , MacMahon Jayne M , Deely Derek , Peate Karen , O’Gara Emir , MacDermott Emma J , Killeen Orla G 
Published: September 2019

Abstract

Background
Medication prescribing in paediatric rheumatology is closely monitored, particularly as a large number of medications used are either DMARDs or biologic therapy. Within our centre, we aim to give prescriptions when patients are attending outpatient clinics however due to long waiting lists, some patients require prescriptions before their clinic appointment. Currently, this is arranged by parents phoning in to our secretaries, however they often do not have the medication dose or route and this can delay efficient prescribing. We have also found that as most patients have their blood monitoring done in a primary care setting, we do not have access to their results.
The aim of our audit was to formally assess outpatient prescribing in our centre, with a view to streamlining the process.

Methods
Data was collected over a one month period between 05/03/19 and the 05/04/19. Each prescription request was received by our CNS or secretary and passed to the NCHDs. The date and medication required was documented, along with chart availability, last clinic date, last bloods taken, whether the parents gave the dose and if a prescription was ultimately written. All data was analysed using Microsoft Excel.

Results
In total 36 prescriptions were requested. The majority of prescriptions (28) were routine prescriptions, with an additional 6 for ‘emergency’ prescriptions (e.g. diclofenac, ondansetron, NSAIDs and prednisolone) and 2 prescriptions were for a change in medication. Overall, 17 requests were for biologic agents, 7 for methotrexate and 5 for both biologic and methotrexate. Charts were available for 27 patients. Of those not available, 5 parents had given doses with their requests. If doses and charts were not available the dose from the last clinic letter on the system was used. Only in 10 cases out of 36, did parents leave a dose for medication with their prescription request. In total, 21 patients had recent blood tests recorded on our hospital database in the last 3 months and 27 had had clinic appointments in the preceding 6 months, with 13 of these occurring in the preceding 3 months.

Conclusion
This study highlights the large volume of external prescription requests received, as well as the potential for error in prescribing. We are currently planning on introducing a form that parents will be required to complete with all prescription requests, detailing dose and route of medication along with the results of their most recent blood tests. We hope that this will both streamline the process and allow for safer prescribing and plan to re-audit 3 months after its implementation.

Conflicts of Interest
The authors declare no conflicts of interest.
P64 Connecting the dots: towards patient-centric outcome-based RA management: a patient initiative
Authors: Umaashanker Chitra , Shenoy Padmanabha 
Published: September 2019

Abstract

Background
A chronic illness like RA which can result in crippling, chronic pain and disability, needs a fourfold approach to address the wellbeing of the patient, namely physical medicine, suitable diet, mild to moderate exercise and mental/emotional wellbeing. This need for multipronged approach brings its own challenges in the current ecosystem of medical care in India. Adding to the fact that any treatment aimed at control/cure of RA can last for months and years makes the whole process tedious and frustrating at times.
The organisation Parihaar aims to address this challenge by providing continuous support to the patient in order to equip them to become an active partaker in their treatment, and also aims to bring relevant stakeholders together.

Methods
Parihaar addresses the gaps in current ecosystem in chronic autoimmune illness management with help from technology and the internet.

Results
Parihaar is a project that is underway. It is a patient initiative supported by a rheumatologist.

Conclusion
Parihaar is a small step that is addressing a large issue. It is complementary to the current healthcare ecosystem in India, and its success truly depends on adoption and usage.

Conflicts of Interest
The authors declare no conflicts of interest.
A meta-analysis of biologic therapies on risk of new or recurrent cancer in patients with rheumatoid arthritis and a prior malignancy
Authors: Xie Wenhui , Xiao Shiyu , Huang Yanrong , Sun Xiaoying , Gao Dai , Ji LanLan , Li Guangtao , Zhang Zhuoli 
Published: September 2019

Abstract

Objectives
To explore the risk of new and recurrent cancer in adult RA patients with prior malignancy and subsequently exposed to biologic therapies.

Methods
Separate searches were performed of PubMed, EMBASE and Cochrane Library and conference proceedings for observational studies reporting cancer incidence or recurrence in patients with RA and prior malignancy treated with biologics and conventional synthetic DMARDs (csDMARDs). Mantel-Haenszel fixed-effects method was conducted to calculate relative risk and 95% CI.

Results
A total of 12 studies involving 13 598 patients and 32 473 patient-years of follow-up were included (10, 3 and 1 studies for TNF inhibitors [TNFi], rituximab and anakinra, respectively). The crude incidence of new and recurrent cancer per 1000 patient-years were 34.4 for TNFi, 32.3 for rituximab, 32.3 for anakinra and 31.8 for csDMARDs. In the quantitative meta-analysis, biologics were not associated with an increased risk of new or recurrent cancer compared with csDMARDs in patients with RA and prior cancer (TNFi: relative risk = 0.95, 95% CI = 0.83, 1.09; rituximab: relative risk = 0.89, 95% CI = 0.52, 1.53). Secondary analyses of stratification of cancer types, the interval between initiation of TNFi and prior cancer diagnosis, and duration of TNFi exposure, found similar results.

Conclusion
Compared with csDMARDs, there is no increased risk of developing cancer overall or some specific subtypes in RA patients with a prior cancer receiving biologics. More investigations are warranted to explore the risk of cancer development in individual cancer as well as to determine optimal time to initiate biologic therapy after the diagnosis of cancer or completion of cancer treatment.
Implementation of the Neonatal Sepsis Calculator in Early-Onset Sepsis and Maternal Chorioamnionitis
Authors: Akangire Gangaram , Simpson Elizabeth , Weiner Julie , Noel-MacDonnell Janelle , Petrikin Joshua , Sheehan Michael 
Published: September 2019

Background:
Utilization of the neonatal sepsis calculator published by Kaiser Permanente is rapidly increasing. This freely available online tool can be used in assessment of early-onset sepsis (EOS) in newborns 34 weeks' gestation or more based on maternal risk factors and neonatal examination. However, many hospitals lack standard guidelines for its use, leading to provider discomfort with practice change.

Purpose:
The goal of this project was to study the antibiotic use rate for EOS at a level III neonatal intensive care unit and create standardized guidelines and staff education for using the sepsis calculator. Our ultimate goal was to decrease antibiotic use for EOS in newborns 34 weeks' gestation or more.

Methods:
A standard quality improvement Plan-Do-Study-Act (PDSA) model was utilized with a plan to study the problem, implement the intervention, and test again for improvement. The primary outcome of interest was a decrease in the use of antibiotics for EOS in neonates 34 weeks' gestation or more.

Results:
Over a 4-month period, prior to sepsis calculator implementation, antibiotic use for suspected EOS was 11% and blood culture was done on 14.8% of live births. After implementation of the sepsis calculator and completion of the PDSA cycle, sepsis calculator use was greater than 95%, antibiotic use dropped significantly to 5% (P = .00069), and blood culture use dropped to 7.6% (P = .00046).

Implications for Practice:
Staff education and systematic intervention using a PDSA model can significantly impact patient care, decreasing the administration of antibiotics to infants at risk for sepsis.

Implications for Research:
Future research is needed to decrease antibiotic use in premature infants less than 34 weeks' gestation with similar risk factors and clinical features.

Video Abstract available at
https://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=34&autoPlay=true
National Burden of Hospitalization Due to Cutaneous Melanoma in Adolescents and Young Adults
Authors: Tripathi Raghav , Knusel Konrad D. , Ezaldein Harib H. , Bordeaux Jeremy S. , Scott Jeffrey F. 
Published: September 2019

Objectives:
Although adolescents and young adults (AYA) suffer disproportionately from cutaneous melanoma (CM), little is known regarding the burden of CM leading to hospitalization in AYA. The objective of this study was to elucidate sociodemographic/hospitalization characteristics of AYA CM inpatients, determine which factors lead to the greater length of stay (LOS) and cost of care for AYA CM inpatients, and evaluate trends in the prevalence, LOS, and cost of care for AYA CM hospitalizations.

Materials and Methods:
A retrospective cohort study of nationally representative data from the 2009 to 2015 National Inpatient Sample. Multivariable survey-weighted logistic regression models were used to determine sociodemographic factors associated with AYA CM hospitalization. Multivariable survey-weighted linear regression models were used to determine characteristics associated with the greater cost of care and LOS in AYA CM inpatients.

Results:
A total of 8986 AYA CM inpatients were included in this study. The prevalence of AYA CM hospitalizations is decreasing over time while the cost of care is increasing. On average, AYA CM hospitalizations were 3.3 days long and cost $38,018.40. Controlling for all covariates, male sex, older age, non-Hispanic white race, higher income, private insurance, and elective admissions were associated with AYA hospitalization due to CM (P<0.0001). Male sex was associated with longer LOS (P=0.007) and cost of care (P=0.01) among AYA hospitalized for CM.

Conclusions:
Despite a decreasing prevalence of CM hospitalizations in AYA inpatients, the economic burden of these hospitalizations is increasing. Substantial sex-based differences exist in the inpatient burden of AYA CM. Further research is required to elucidate the causes of these differences and prevent AYA hospitalization due to CM.