bluuebunny/crossref_metadata_2025_split huggingface dataset:
BT12 Great expectations: implementing artificial intelligence software into a regional skin cancer teledermatology service
Authors: Walker-Smith Philippa , Christie Anne-Marie , Scott Annabel , Chandrakumar Arani 
Published: June 2024

Abstract
Every year 2-week rule (TWR) referrals for skin cancer are increasing, reflected at both national and local level, and they are projected to rise further. The number of substantive staff in dermatology is not increasing and innovative solutions are necessary. We present an evaluation of a south-east UK dual-site teledermatology TWR service 1 year after implementation of the artificial intelligence software DERM, provided by third-party Skin Analytics (SA). Our TWR service successfully initiated a photodermatology service by use of a ‘PhotoHub’ for skin lesions. SA DERM was subsequently implemented to analyse these images and autonomously triage the patients into (i) TWR referral to secondary care dermatology, (ii) benign and for automated discharge, or (iii) ‘other’ diagnosis for general practitioner or community review. Lesions deemed benign by DERM underwent a safety-net review by an SA consultant dermatologist prior to discharge. Patients referred to secondary care dermatology were reviewed on a virtual platform by a trust consultant dermatologist to determine an appropriate pathway. SA DERM aimed to (i) speed up local cancer diagnosis, (ii) reassure patients with benign lesions faster, (iii) support workforce capacity and (iv) be cost-effective. Over a 12-month period (July 2022 to July 2023), 1599 patients seen in the PhotoHub underwent analysis by SA DERM. By the end of the pilot around 30% of the monthly TWR referrals were being analysed. SA DERM had a correct automated discharge rate of 20%. In total, 50% of cases were referred directly to trust dermatologists for further triage via the SA online platform. Overall, 41% of patients analysed by SA DERM avoided urgent face-to-face appointments. SA Derm demonstrated &gt; 95% target sensitivity for melanoma and squamous cell carcinoma and &gt; 90% for basal cell carcinoma and premalignant lesions. Patient and end users reported a 75% positive experience. The hospital skin cancer performance target increased from 36% to 95%. Clinicians have been surveyed on their experience. In conclusion, SA DERM helps manage the continued increase in TWR referrals. It demonstrated an improvement each quarter as the software was established. However, a large proportion of teledermatology images requiring triage remained, with the subsequent administrative burden. Future local challenges include encouraging community referrals via the PhotoHub and addressing the waiting list backlog for ‘routine’ appointments so this pathway can be utilized for lower-grade skin lesions. Clinician concerns remain. Ongoing engagement with AI solutions is likely to be required to develop skin cancer services fit for future demand.
BT28 Analysis of a single practitioner’s teledermatology processing decisions in an established teledermatology service over a 12-month period
Authors: Tuckwell William , Winter Sarah , Motley Richard 
Published: June 2024

Abstract
In our department, teledermatology has been the default referral pathway from general practice since August 2016. In the 12 months to August 2022, 19 995 teledermatology referrals were processed by 10 consultant dermatologists (8 whole-time equivalents). This analysis reviewed the diagnoses and outcomes of 2667 consecutive teledermatology referrals, processed by one of these consultants, with a special interest in skin cancer, over that 12-month period. Data collected from the National Clinical Patient Database included the initial teledermatology referral and response and, where appropriate, details of subsequent clinic attendance and histology reports. Duplicate referrals (n = 64) and referrals redirected to colleagues (n = 82) were excluded from the analysis. In total, 157 (6%) referrals were rejected by the teledermatologist, either because they were submitted without a photograph (n = 41), the photograph was inadequate (n = 78), the incorrect photo was attached (n = 3), the history was insufficient (n = 21) or there were other factors such as request for services not offered or advice had already been provided (n = 14). Overall, 1391 (52%) referrals were returned to the general practitioner with diagnosis and/or management advice, and 973 (36%) patients were accepted onto the dermatology waiting list for subsequent review in clinic. Of these, 155 were accepted to rule out melanoma. During the period of assessment, 632 of the patients who had been accepted onto the waiting list had been reviewed in clinic: 96 (72%) of those with a telediagnosis of basal cell carcinoma (BCC) were confirmed to have BCC, 61 (30%) of those with a telediagnosis of squamous cell carcinoma (SCC) were confirmed to have SCC, 16 (57%) of those with a telediagnosis of melanoma were confirmed to have melanoma, and of those accepted to rule out melanoma, 14 (9%) were confirmed to have melanoma. Teledermatology provides a ‘snapshot’ of a skin disease with limited clinical information and photographs. The teledermatologist must decide whether the information provided is adequate to make a confident diagnosis and management plan. Our analysis showed that most teledermatology referrals were considered adequate for the purpose, and just over one-third needed to be seen in clinic. It also demonstrated the superior diagnostic accuracy of face-to-face consultations over teledermatology. Teledermatology is an excellent tool for dermatology triage, and in this analysis it reduced the need for face-to-face consultations by &gt; 60%.
BT29 Modelling the cost-effectiveness of an artificial intelligence as a medical device
Authors: Zhelev Zhivko , Puttergill David , Kalsi Dilraj , Mullarkey Dan , Hyde Christopher 
Published: June 2024

Abstract
Dermatology services are facing rising demand with limited workforce and resources. Artificial intelligence as a medical device (AIaMD) may offer a way to expand capacity and improve patient outcomes. The aim of this project was to develop a cost–utility health economic model of an AIaMD used for the screening, triage and assessment of lesions suspicious for skin cancer using dermoscopic images. This report focuses on the triage of patients referred by general practitioners on the dermatology urgent suspected cancer pathway. The AIaMD assessment takes place in a photo clinic and the images and medical history are subsequently assessed by a specialist (teledermatology). The aim of the AIaMD triage is to identify patients with noncancerous lesions who could be discharged. Four diagnostic strategies are compared: face-to-face assessment (comparator), teledermatology (comparator), AIaMD, and AIaMD with a dermatologist second read (AIaMD_SR). A decision tree with Markov models at the terminal nodes was constructed to estimate the long-term costs and outcomes in quality adjusted life-years (QALYs) of each intervention. Three diagnostic categories were considered: (i) high-risk cancer (including melanoma, squamous cell carcinoma and rare cancers), (ii) basal cell carcinoma and (iii) noncancerous (benign or precancerous) lesions. The model has a life-time horizon (up to age 100 years), it takes National Health Service and personal social services perspectives, and the costs and benefits are discounted at an annual rate of 3.5%. One-way and probabilistic sensitivity analyses were conducted to quantify any uncertainty in the model. Modelling shows that the AIaMD_SR and AIaMD interventions are more effective and less costly than face-to-face assessment and teledermatology. The cost per QALY threshold set by the National Institute for Health and Care Excellence is £20 000–£30 000. The most cost-effective interventions were DERM_SR at a willingness-to-pay (WTP) threshold of £30 000 and DERM at WTP threshold of £20 000. The results were confirmed by the sensitivity analysis. Cost savings are due to reduced face-to-face appointment and biopsy costs. Savings are calculated as £52 per patient, £259 000 for an average trust or £35 million for NHS England. QALY benefits are due primarily to reduced patient anxiety and biopsies. The relatively small changes to false negatives between the interventions and standards of care do not have a significant an impact. Capacity modelling showed that only the AIaMD intervention is likely to significantly reduce total dermatologist workload compared with face-to-face care, with a reduction of 15%. Some parameter uncertainty exists, reflecting a paucity of baseline data, which will be investigated further with refinement of the model as more data becomes available. This modelling work was funded as part of the NHS AI in Health and Care Award. Three of the five authors are employed by the AI provider.
BT37 Can patients with psoriasis and eczema support their self-management by being involved in care decision making?
Authors: Aldeen Taha 
Published: June 2024

Abstract
Eczema and psoriasis are often associated with psychological and metabolic comorbidities. They usually require long-term medical care. Currently, no intervention is available to regularly assess such patients’ needs and comorbidities and support their involvement in decision making and self-management. The objective of this study was to explore the acceptability and potential of a self-developed questionnaire (study tool) in addressing the needs, comorbidities and feedback of patients with psoriasis and eczema, to support their involvement in decision making and self-management of their chronic conditions. A mixed-methods study was conducted that included a postal survey on adult male and female patients with psoriasis and eczema. The study tool contained the Dermatology Life Quality Index and seven supplementary open-ended questions to capture patients’ views, feedback, comorbidities, coping status and needs. The survey was followed by semistructured face-to-face interviews with a sample of the patients who had participated in the survey. The final study involved sharing the research findings along with a prototype of the proposed online version of the study tool with a group of healthcare professionals. Of the 114 patients who participated in the postal survey, 108 (94.7%) expressed physical, metabolic and psychological comorbidities. Stress was identified as the dominant disease-triggering factor in 72 (63.2%) participants. Thirty-three (28.9%) participants reported that they could not cope with their chronic illness. Eighteen (15.8%) had anxiety, and 12 (10.5%) had depression and suicidal thoughts. Twenty-nine (25.4%) participants addressed their needs for support at home, and 16 (14.0%) of them asked for support at work. In the interviews, all the participants (22, 100%) welcomed the use of the study tool on a regular basis to support their needs and feedback. Nineteen (86%) of them preferred using an online version of the tool (portal system) as a convenient way of remote and interactive communication with the healthcare provider, particularly during the worsening of their skin condition. In the final study, the healthcare experts agreed that the proposed online version of the study tool (portal) would be a convenient platform for such patients to address their unmet needs, comorbidities and feedback. It can be designed to provide access to supportive services including links to patient information on skin diseases, local mental health services, patient forums and other relevant support groups and charities. In conclusion, the study tool has the potential to regularly engage and assess patients’ unmet needs, comorbidities and feedback. All the interviewees welcomed regular use of the study tool. The use of an online version of the tool can have the potential to fill important gaps in patient self-management and in health service improvement.
BT41 Piloting a hospital-based teledermatology and artificial intelligence service for urgent suspected skin cancer alongside an established community-based teledermatology advice and guidance service
Authors: Frow Helen , Brown Alistair , Waqas Muhammad , Skittrall Zachary , Charman Carolyn 
Published: June 2024

Abstract
The aim of this pilot was to assess the value of a hospital-based teledermatology hub for urgent suspected skin cancer referrals in a semirural integrated care system. The hub uses a new medical photography-led teledermoscopy service to assess both teledermatology and artificial intelligence (AI) compared with face-to-face outpatient review in clinic. The deployment and this work were funded as part of the National Health Service AI in Health and Care Award. In parallel, the existing advice and guidance (A&G) service using images taken by general practice teams was promoted for all referrals other than urgent suspected skin cancer, including low-risk basal cell carcinomas and precancerous lesions. Analysis of the first 100 patients through the teledermoscopy–AI service showed that 18% of patients were diagnosed with benign lesions using the AI (and second-read dermatologist), 25% of patients required face-to-face review for diagnosis, 45% were triaged directly for a surgical procedure with a preoperative telephone call, 6% were prescribed topical therapy virtually, and 6% were discharged using images and telephone consultation without requiring treatment. Subsequent expansion of the dermatology medical photography team using both medical photographers and a trained healthcare assistant has supported extension of the teledermoscopy–AI service, with the pilot running to August 2024. Expansion to community hospital teledermoscopy hubs and extension of the urgent skin cancer service to the community diagnostic centre are changes supported by the pilot, to develop more streamlined pathways for patients with urgent suspected skin cancer. Through 2023 the community A&G service also expanded from around 250 requests per month to over 400 requests per month, with maintenance of conversion rates to referral of 30%, and redirection of patients with low-risk basal cell carcinomas to community skin surgery services. Development of the new urgent suspected skin cancer virtual teledermatology–AI pathway has required administrative adaptations within the hospital electronic patient record to support patient tracking, resourcing and job planning for image review. Training of photographers has been supported by online teledermoscopy resources developed by the Institute of Medical Illustrators. Selection of appropriate patients for the teledermoscopy–AI pathway while maintaining patient choice and safety has remained central to the teledermoscopy–AI pilot.
Ageing, Poverty and Agency: Reconceptualising Resistance to Poverty among Older Adults
Authors: Weiss-Dagan Shlomit , Timor-Shlevin Shachar 
Published: June 2024

Abstract
The experiences and daily lives of older adults living in poverty are underexplored topics in the literature. Specifically, the question of agency and how older people cope with poverty and resist it requires further investigation. Ruth Lister’s model is the theoretical foundation of this study, which emphasises individuals’ ability to be active agents in shaping their life stories. Lister’s renowned model of agency in poverty focuses on working-age people and is widely used by scholars. The current qualitative study expands on Lister’s theoretical articulation of agency by presenting the stories of twenty-seven older people living in poverty in Israel. The findings demonstrate how, under the social constraints of ageing, people tend to focus on the personal and local agency of survival because strategic and more political forms of agency are structurally inaccessible. These findings have practical implications. Social workers can play a crucial role in recognising older adults’ agency, standing with them in their struggles, advocating for them by addressing structural barriers and facilitating their access to resources. We also employ these findings to develop an expanded theoretical articulation of agency that incorporates agents and their respective social circles.
On the Morality of Reallocating Life-Sustaining Interventions in Times of Scarcity
Authors: Leever Martin G 
Published: June 2024

Abstract
As coronavirus disease 2019 made its way across the world in 2019, health systems began to develop guidelines to allocate what was expected to be a scarcity of medical resources. Considerable attention was given to triaging intensive care resources such as ventilators. While there was general agreement among bioethicists and policymakers that it may be permissible to withhold life-sustaining interventions from patients with poor prognoses in order to make them available to patients with better prognoses, there was disagreement about the permissibility of withdrawing such interventions for this purpose. Some maintained that the doctrine of double effect (DDE) revealed the intrinsic wrongness of such acts of reallocation. This article argues that so long as there is transparency and effective ongoing communication, the DDE may permit the discontinuation of life-sustaining interventions from patients who may still benefit from them in order to make them available to patients with more favorable prognoses.
Religious Freedom “with Chinese Characteristics”
Authors: Earley Brady 
Published: June 2024

Abstract
China’s approach to religious freedom is unique. Heavy State regulation and the involvement of the Chinese Communist Party often invite external critique of Chinese religious freedom based on legal commitments outside of China. However, China’s rich legal tradition and textual commitments to religious freedom suggest there is more to learn. Analyzing religious freedom in legal texts and in practice from Chairman Mao Zedong to President Xi Jinping, this article offers a dialectic account of religious freedom with Chinese characteristics. Chinese text and practice regarding religious freedom suggest three enduring constitutional commitments: non-discrimination in religious belief, normalization of religious practices, and resistance to foreign religious influence. Each of these textual commitments correspond to the values found in Daoism, Legalism, and Confucianism—the pillars of traditional Chinese culture. With this understanding of China’s religious freedom approach, the article then offers three implications for strengthening China’s commitment to its own theory of religious freedom by (1) separating State and Party policy on religious registration, (2) removing cult designations from criminal law, and (3) accommodating non-traditional religious organizations to help address social issues.
Romosozumab versus parathyroid hormone receptor agonists: which osteoanabolic to choose and when?
Authors: Anastasilakis Athanasios D , Yavropoulou Maria P , Palermo Andrea , Makras Polyzois , Paccou Julien , Tabacco Gaia , Naciu Anda Mihaela , Tsourdi Elena 
Published: June 2024

Abstract
Osteoanabolic agents are used as a first line treatment in patients at high fracture risk. The PTH receptor 1 (PTH1R) agonists teriparatide (TPTD) and abaloparatide (ABL) increase bone formation, bone mineral density (BMD), and bone strength by activating PTH receptors on osteoblasts. Romosozumab (ROMO), a humanized monoclonal antibody against sclerostin, dramatically but transiently stimulates bone formation and persistently reduces bone resorption. Osteoanabolic agents increase BMD and bone strength while being more effective than antiresorptives in reducing fracture risk in postmenopausal women. However, direct comparisons of the antifracture benefits of osteoanabolic therapies are limited. In a direct comparison of TPTD and ABL, the latter resulted in greater BMD increases at the hip. While no differences in vertebral or non-vertebral fracture risk were observed between the two drugs, ABL led to a greater reduction of major osteoporotic fractures. Adverse event profiles were similar between the two agents except for hypercalcemia, which occurred more often with TPTD. No direct comparisons of fracture risk reduction between ROMO and the PTH1R agonists exist. Individual studies have shown greater increases in BMD and bone strength with ROMO compared with TPTD in treatment-naive women and in women previously treated with bisphosphonates. Some safety aspects, such as a history of tumor precluding the use of PTH1R agonists, and a history of major cardiovascular events precluding the use of ROMO, should also be considered when choosing between these agents. Finally, convenience of administration, reimbursement by national health systems and length of clinical experience may influence patient choice.
Contextualizing Individual Attitudes on Economic Statecraft
Authors: Peterson Timothy M , Miller Susan M 
Published: June 2024

Abstract
When do US citizens express greater support for economic intervention abroad in response to violations of international norms? Under what conditions do they express greater support for punitive sanctions or positive inducements? We know little about whether and to what extent citizens offer greater support for sanctions compared to positive inducements and how contextual factors might alter support for each. We design a conjoint survey experiment to gauge support for an intervention—i.e., sanctions or inducements—using comparable counterfactuals. We compare long-enduring bad behavior to recent shocks, differently framed consequences of inaction, as well as varying expertise levels among policy proposal authors. We also consider preexisting attitudes about the target country. In a US sample, we find that policy proposals are supported to a greater extent when they involve sanctions as opposed to inducements, but that preexisting affinity toward the country has a strong conditioning impact.
HLA-DQA1*05 Allele Carriage and Anti-TNF Therapy Persistence in Inflammatory Bowel Disease
Authors: Doherty Jayne , Ryan Anthony W , Quinn Emma , Conroy Judith , Dolan Jackie , Corcoran Roisin , Hara Fintan O , Cullen Garret , Sheridan Juliette , Bailey Yvonne , Dunne Cara , Hartery Karen , McNamara Deirdre , Doherty Glen A , Kevans David 
Published: June 2024

Abstract

Introduction
Carriage of the HLA-DQA1*05 allele is associated with development of antidrug antibodies (ADAs) to antitumor necrosis factor (anti-TNF) therapy in patients with Crohn’s disease. However, ADA is not uniformly associated with treatment failure. We aimed to determine the impact of carriage of HLA-DQA1*05 allele on outcome of biologic therapy evaluated by drug persistence.

Methods
A multicenter, retrospective study of 877 patients with inflammatory bowel disease (IBD) treated with anti-TNF therapy with HLA-DQA1*05 genotypes were generated by imputation from whole genome sequence using the HIBAG package, in R. Primary end point was anti-TNF therapy persistence, (time to therapy failure), segregated by HLA-DQA1*05 allele genotype and development of a risk score to predict anti-TNF therapy failure, incorporating HLA-DQA1*05 allele genotype status (LORisk score).

Results
In all, 877 patients receiving anti-TNF therapy were included in our study; 543 (62%) had no copy, 281 (32%) one copy, and 53 (6%) 2 copies of HLA-DQA1*05 allele. Mean time to anti-TNF therapy failure in patients with 2 copies of HLA-DQA1*05 allele was significantly shorter compared with patients with 0 or 1 copy at 700 days’ follow-up: 418 vs 541 vs 513 days, respectively (P = .012). Factors independently associated with time to anti-TNF therapy failure included carriage of HLA-DQA1*05 allele (hazard ratio [HR], 1.2, P = .02; female gender HR, 1.6, P &lt; .001; UC phenotype HR, 1.4, P = .009; and anti-TNF therapy type [infliximab], HR, 1.5, P = .002). The LORisk score was significantly associated with shorter time to anti-TNF therapy failure (P &lt; .001).

Conclusions
Carriage of 2 HLA-DQA1*05 alleles is associated with less favorable outcomes for patients receiving anti-TNF therapy with shorter time to therapy failure. HLA-DQA1*05 genotype status in conjunction with clinical factors may aid in therapy selection in patients with IBD.