bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenging native speakerism in a Korean college English course
Authors: Lee Soyoung 
Published: April 2023

Abstract
English is a popular language in South Korea. It has been a part of the official public school curriculum for 10 years and many students pursue more English courses in college. However, there is a general consensus among English instructors in Korean institutions of higher education that students lack confidence as learners and users of English. Students also describe themselves as having ‘English trauma’, which is a popular notion among Korean students. In this article, I explain how damaging native speakerism is for the students’ confidence as language learners and I describe the changes I made to my curriculum to implement a more humanistic curriculum designed to minimize the negative emotional pressure my students felt. In closing, I will discuss my reflections on the process.
Lower-profile stent graft reduces the risk of embolism during thoracic endovascular aortic repair in shaggy aorta
Authors: Seike Yoshimasa , Masada Kenta , Fukuda Tetsuya , Yokawa Koki , Koizumi Shigeki , Kasai Mio , Inoue Yosuke , Sasaki Hiroaki , Matsuda Hitoshi 
Published: April 2023

Abstract

OBJECTIVES
This study aimed to reveal the association between lower-profile stent graft (LPSG) and embolism during thoracic endovascular aortic repair for non-dissecting distal arch and descending thoracic aortic aneurysm.

METHODS
This study reviewed data of 35 patients who underwent thoracic endovascular aortic repair with LPSG (27 males; age: 77 ± 9.2 years) and 312 who underwent thoracic endovascular aortic repair with conventional-sized stent graft (CSSG) (247 males; age: 77 ± 7.4 years) from 2009 to 2021.

RESULTS
The rate of total embolic events was significantly lower in the LPSG group (0/35 [0%]) than the CSSG group (34/312 [11.2%]) (P = 0.035). Shaggy aorta (odds ratio: 5.220; P &lt; 0.001) were identified as positive embolic event predictors. The rate of total embolic events in 68 patients with shaggy aorta (12 in LPSG/56 in CSSG) was significantly lower in the LPSG group (0/12 [0%]) than the CSSG group (19/56 [34%]) (P = 0.015). The rate of total embolic events in 279 patients with the non-shaggy aorta (23 in LPSG/256 in CSSG) reveals no difference between the 2 groups (0 [0%]/16 [6.3%]) (P = 0.377).

CONCLUSIONS
LPSG usage could reduce embolism in thoracic endovascular aortic repair, and the difference was more pronounced in patients with the shaggy aorta. LPSG might be beneficial in preventing embolism in thoracic endovascular aortic repair for patients with a shaggy aorta.
Higher Out-of-pocket Expenses are Associated with Worse Health-related Quality of Life in Burn Survivors: A Northwest Regional Burn Model System Investigation
Authors: Sheckter Clifford C , Holan Cole , Carrougher Gretchen , Orton Caitlin , Gibran Nicole , Stewart Barclay T 
Published: April 2023

Abstract
The care required to recover serious burn injuries is costly. In the United States, these costs are often borne by patients. Examining the relationship between out-of-pocket (OOP) costs and health-related quality of life (HRQL) is important to support burn survivors. Financial data from a regional burn center were merged with data in the Burn Model System (BMS) National Database. HRQL outcomes included VA-Rand 12 (VR-12) physical component summary (PCS) and mental component summary (MCS) scores. Participant surveys were conducted at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, sex, insurance/payer, self-identified race/ethnicity, measures of burn injury severity). 644 participants were included, of which 13% (84) had OOP costs. The percentage of participants with OOP costs was 34% for commercial/private, 22% for Medicare, 8% for other, 4% for self-pay, and 0% for workers’ compensation and Medicaid. For participants with OOP expenses, median payments were $875 with an IQR of $368–1728. In addition to markers of burn injury severity, OOP costs were negatively associated with PCS scores at 6-months (coefficient −0.002, P &lt; .001) and 12-months post-injury (coefficient −0.001, P = .004). There were no significant associations with PCS scores at 24 months post-injury or MCS scores at any interval. Participants with commercial/private or Medicare payer had higher financial liability than other payers. Higher OOP expenses were negatively associated with physical HRQL for at least 12 months after injury. Financial toxicity occurs after burn injury and providers should target resources accordingly.
Cigarette Smoking and Depression Among U.S. Veterans: Longitudinal Associations With Posttraumatic Stress Disorder
Authors: Tran Denise D , Davis Jordan P , Tucker Joan S , Bricker Jonathan B , Lee Daniel S , Fitzke Reagan E , Pedersen Eric R 
Published: April 2023

Abstract

Introduction
Cigarette smoking and depression are associated with morbidity and mortality. Among veterans, approximately 22% are current smokers and 11%–15% have been diagnosed with depression. Although prior research suggests a strong association between smoking and depression among veterans, little research has examined trajectories of smoking and depressive symptoms and their correlates over time in this population.

Aims and Methods
Using parallel process growth curve modeling, we examined the longitudinal relationship between smoking and depression and tested whether posttraumatic stress disorder (PTSD) symptoms predict smoking and depression trajectories over 18 months (February 2020–August 2021). Veterans were recruited for an online, longitudinal study and responded to surveys across five-time points (baseline N = 1230; retention = 79.3%–83.3% across waves).

Results
Associations indicated that more frequent smoking at baseline was associated with steeper increases in depression symptom severity, and greater depression severity at baseline was associated with a less steep decrease in smoking frequency over time. PTSD was associated with less smoking at time 1 but more frequent smoking at times 3–5 as well as greater depression across all time points.

Conclusions
Findings provide support that the growth trajectories of smoking and depression are linked, and PTSD symptoms are associated with these trajectories among veterans. Addressing these factors simultaneously in veteran treatment centers or through tobacco cessation efforts may be beneficial.

Implications
This study offers strong evidence that the growth trajectories of smoking and depression are linked, and PTSD symptoms affect these trajectories among veterans, who represent a largely understudied population despite high rates of substance use and mental health problems. Results of this study strengthen the case for a more integrated treatment approach in which both smoking and mental health concerns are simultaneously addressed, which may yield more beneficial physical health and clinical outcomes for post-9/11 veterans.
OA05 Harnessing high throughput multiplex immunoassays and protein association networks to identify diagnostic protein biomarkers of rheumatoid arthritis-cardiovascular disease (RA-CVD) multimorbid axis
Authors: Shukla Rudresh , Black Nicholas , Plant Darren , Miller Christopher , Plein Sven , Buch Maya H 
Published: April 2023

Abstract

Background/Aims
People with rheumatoid arthritis (RA) have higher mortality rates compared to the general population, primarily due to excess cardiovascular (CV) disease (CVD). The earliest stages of RA are associated with CV abnormalities but biomarkers to identify CVD in early RA are lacking. We aimed to identify focused protein biomarkers that associate with cardiac magnetic resonance imaging (CMR) abnormalities in a treatment-naïve, new-onset RA trial cohort and the predominant inflammatory and metabolic pathways involved in RA-CVD.

Methods
CADERA (Coronary Artery Disease in Early RA) was a bolt-on study to a parent RCT in an early RA inception cohort. 81 treatment-naïve early RA patients underwent CMR at baseline as part of CADERA. Proximity extension immunoassay (OIink) was used to measure normalised protein expression across inflammation, cardiovascular II/III and cardiometabolic panels in CADERA patients. Bayesian mixed effects linear regression was used to identify significant proteins associated with CMR parameters of myocardial oedema/fibrosis and vascular stiffness at baseline. Then, an expanded protein-protein interaction (PPI) network using above proteins was created using an induced network approach (String-DB) and k-means clustering applied to identify protein clusters that were subsequently subjected to Gene ontology (GO) and KEGG enrichment analysis.

Results
Of 340 proteins analysed using Olink, 108 proteins were associated with CMR markers of myocardial fibrosis/oedema (64 proteins) and vascular stiffness (44 proteins) Table 1 highlights the top 5 proteins for each CMR parameter.
K-means clustering of the expanded PPI network identified 4 clusters with roles in vascular endothelial growth factor receptor binding and JAK-STAT signalling pathway (cluster 1); IL27 receptor binding and NF-kappa B signalling pathway (cluster 2); Macrophage CSF receptor binding and ErbB signalling pathway (cluster 3); and IL10 receptor activity and complement and coagulation cascades (cluster 4).

Conclusion
This is the first study to identify protein biomarkers of RA-CVD, an area of unmet clinical need, using a combination of targeted high throughput immunoassays, Bayesian and network analyses. Targeted techniques such as Olink may help identify potential diagnostic biomarkers of RA-CVD. Pathway analysis provides insight into the inter-relationship between inflammation and metabolic mediators of RA-CVD axis.
Disclosure
R. Shukla: None. N. Black: None. D. Plant: None. C. Miller: None. S. Plein: None. M.H. Buch: None.
OA21 Use of the patient activation measure in rheumatology outpatients
Authors: Wood Claire R , Dale James E 
Published: April 2023

Abstract

Background/Aims
Our rheumatology department is considering introducing patient-initiated follow-up (PIFU) for patients with stable inflammatory conditions. This will require patients to be motivated and appropriately seek help when required. The 13-item Patient Activation Measure (PAM-13) is a tool that measures patients' knowledge, skills and confidence in managing their health and is categorised into levels of increasing activation - level 1 (disengaged and overwhelmed), level 2 (becoming aware, still struggling), level 3 (taking action), and level 4 (maintaining behaviours, pushing forwards). Our aim was to describe the distribution of patient activation scores in a cross section of patients attending rheumatology return appointments.

Methods
Clinic patients were asked to complete a form which comprised demographic and disease background information, the PAM-13 and the Arthritis Self Efficacy Score (ASES). All data were anonymised. Demographic details included age, sex, postcode (for Scottish Index of Multiple Deprivation (SIMD) calculation), educational attainment, employment status, living situation, and requirement for assistance with activities of daily living (ADLs). Disease related details were main rheumatological diagnosis, years since diagnosis, patient opinion of disease control, and global health visual analogue score (VAS). Patient Health Questionnaire 2 (PHQ-2) and Generalised Anxiety Disorder 2 (GAD-2) were used to screen for mental ill-health.

Results
A total of 209 responses were collected. Patients fell into the following activation levels: level 1 - 25.4%, level 2 - 32.5%, level 3 - 24.4%, and level 4 - 17.7%. Patients in level 1 were compared to patients in levels 2 - 4 to establish trends.
Those in level 1 less frequently felt that their rheumatic disease was well controlled (52.8% vs 72.4%). Level 1 patients were more likely to live in the most deprived areas (41.5% in SIMD quintile 1 vs 26.9%); had lower rates of full or part time employment (22.7% vs 53.2%) and higher rates of unemployment due to disability (22.6% vs 8.3%); had lower rates of educational attainment (11.3% with university education vs 21.8%); more frequently required assistance with their ADLs (62.3% vs 26.3%) and reported higher levels of depression (58.5% vs 25.6%) and anxiety (41.5% vs 24.4%). Level 1 patients reported lower global VAS (median 50 vs 70) and lower ASES (median 3.8 vs 6).

Conclusion
57.9% of our patients fell into low activation levels 1 and 2. Those in the lowest activation group had the highest proportion of patients from areas with high rates of deprivation, lowest rates of employment and higher educational attainment, and highest rates of requiring assistance with ADLs, depression and anxiety. The converse was true for those in the highest level of activation group. These patients may not be appropriate for new PIFU or may require additional, tailored support for it to be safely implemented.
Disclosure
C.R. Wood: None. J.E. Dale: None.
OA22 Management of haemophagocytic lymphohistiocytosis: service evaluation of a national multi-disciplinary meeting
Authors: Shah Neal S , Hutchinson Matthew , Clark Samuel , Sanchez Emilie , Brown Michael , Stone Neil , Carr Aisling S , Carpenter Ben , Laurence Arian , Gohil Satyen H , Tattersall Rachel S , Manson Jessica J , Jones Alexis 
Published: April 2023

Abstract

Background/Aims
Haemophagocytic lymphohistiocytosis (HLH) is a devastating condition caused by uncontrolled activation of the immune system. If left untreated, the condition leads to multi-organ failure and death. Even with treatment, recent UK data has shown a mortality rate of 50%. In 2019, a group of clinicians from University College London Hospital (UCLH) came together with the aim of improving outcomes for patients with HLH. The UCLH HLH multi-disciplinary meeting (MDM) has been running since that time and includes representation from rheumatology, haematology, infectious diseases, tropical medicine, virology, neurology, and critical care. Clinicians from any UK trust are invited to join and present patients. As part of a service evaluation project, we aimed to assess the scope of this meeting with regards to the number, demographics and primary diagnoses of patients discussed and the geographical location of the referring clinical team.

Methods
This is a retrospective descriptive analysis of all patients discussed at the UCLH HLH MDT from 2nd September 2020 to 20th July 2022. Data were obtained from electronic health records and analysed in Prism version 9.4.1. This work has been registered as a service evaluation project within the Division of Medical Specialities at UCLH.

Results
93 patients were discussed. 38 were female. 55 were male. The median age was 38 years. Triggers for HLH were haematological malignancy (38.0%), infection (29.3%) rheumatological (14.1%) primary HLH (6.5%) and unknown (7.6%). In 4 patients, HLH was not felt to be the underlying diagnosis. 40 patients were managed as inpatients at UCLH, 37 of whom were transferred from other trusts. Geographical data were obtained on 81 patients. Patients were referred from all 9 regions of England: London (34), North East (1), North West (2), Yorkshire (2), East Midlands (1), West Midlands (3) South East (11), East of England (11), South West (11) as well as Wales (2), Scotland (2) and Ireland (1). Haemophagocytosis was confirmed on bone marrow biopsy in 66.7% of patients. Mortality data showed that 32 (34%) patients died following their diagnosis.

Conclusion
A multi-disciplinary approach is essential in the management of HLH. Our data show that patients with HLH are young, have a high mortality and broad range of pathology. The UCLH HLH MDT currently serves a wide geographical area across the UK and UCLH acts as a tertiary referral centre for patients with the condition.
Disclosure
N.S. Shah: None. M. Hutchinson: None. S. Clark: None. E. Sanchez: None. M. Brown: None. N. Stone: None. A.S. Carr: None. B. Carpenter: None. A. Laurence: None. S.H. Gohil: None. R.S. Tattersall: None. J.J. Manson: None. A. Jones: None.
OA33 The incidence of large vessel vasculitis in Norfolk
Authors: Mukhtyar Chetan B , Beadsmoore Clare , Coath Fiona , Ducker Georgina , Sisson Katherine , Watts Richard A 
Published: April 2023

Abstract

Background/Aims
There are no data on the collective incidence of the large vessel vasculitides. The incidence of GCA and Takayasu arteritis in the UK has been based on clinical coding in routine administrative datasets. There are no data on the incidence of these diseases based on clinically verfied diagnoses. We studied the incidence of the large vessel vasculitides in a stable population with a predominant Northern European ancestry.

Methods
Individuals attending a secondary care hospital with a clinically verified diagnosis of primary systemic vasculitis made between 2011-2020, who lived within the NR postcode districts of Norfolk county were included if they met classification criteria for GCA or Takayasu arteritis, or had definite tissue or imaging evidence of large vessel vasculitis. Population above the age of 18 as in the 2011 census, available from the office of national statistics, was accepted as the denominator. If classification criteria for both GCA and TAK were met, physician judgement was accepted as final diagnosis.

Results
272 adults were diagnosed with large vessel vasculitis out of a population of 454,316. The annual incidence of large vessel vasculitis in Norfolk is 59.9/million in the adult population. The annual incidence of GCA is 9.9/100,000 over the age of 50 using the ACR 1990 criteria and 10.6/100,000 using the ACR/EULAR 2022 criteria. The rise in the incidence from 2017 onwards coincides with the establishment of a fast-track pathway (Table 1). The dip in the incidence in 2020 coincides with suspension of services during the SARS-CoV-2 pandemic. The annual incidence peaks at 168.5/100,000 in the 9th decade and is commoner in females (12.3/100,000 vs 7.3/100,000). The annual incidence of Takayasu arteritis is 3.3/million in the adult population using the ACR 1990 criteria and 1.1/million using the ACR/EULAR 2022 criteria.

Conclusion
This is the first study that reports the incidence of all objectively diagnosed large vessel vasculitis in a stable population in Norfolk county. The incidence of GCA rose with the establishment of a fast-track pathway and its peak may have been affected by the SARS-CoV-2 pandemic. GCA is commoner in females and peaks in the 8th and 9th decades.
Disclosure
C.B. Mukhtyar: None. C. Beadsmoore: None. F. Coath: None. G. Ducker: None. K. Sisson: None. R.A. Watts: None.
P011 Rituximab and COVID-19 vaccines; are they fit for purpose?
Authors: Stewart Sarah K , Pendleton Adrian 
Published: April 2023

Abstract

Background/Aims
Since the COVID-19 outbreak the rheumatology community have been concerned about the risk of SARS-CoV-2 infection in patients prescribed immunosuppressing medications. Data suggests that patients receiving Rrtuximab are at increased risk of developing severe outcomes from COVID-19 (1). In our unit all patients receiving rituximab were selected to receive a targeted vaccination and booster programme with all patients receiving at least 2 vaccinations and up to 3 booster vaccinations. We studied the efficacy of the COVID-19 vaccines in rituximab patients, by checking the the Roche Elecsys Anti-SARS-CoV-2-S (Spike) IgG/IgM total antibody levels post vaccination. Our aim was to assess the vaccination response in patients receiving rituximab and to offer advice on continued shielding or alternatively passive immunization with tixagevimab/cilgavimab in those patients who did not mount a response.

Methods
Taking 39 patients currently on rituximab therapy, we measured Anti-SARS-CoV-2-S (Spike) antibody levels post vaccination. We recorded whether the test was positive or negative, and the numerical result. We recorded rituximab dates of administration and dates of vaccines. We also recorded diagnosis, co-prescribed DMARDs, immunoglobulin levels, white cell and lymphocyte counts. We took record of whether or not the patient subsequently contracted COVID-19, required a hospital admission, ICU or died.

Results
Of our 39 patients, 21 had Anti-SARS-CoV-2-S (Spike) antibody levels checked. Of these patients, 7 (33%) had a negative spike protein result. Of the patients with a positive result, 8 (38%) had an antibody level between 0-250U/ML, and only 6 (28.6%) had a level &gt;250U/ML (The manufacturer advises that a level above 0.8U/ML is a positive result). Of patients with a negative result, 1 patient had received 3 vaccines, 5 patients had received 4, and 1 patient had 5. All of the patients had received a vaccine &gt;4 weeks prior to receiving the drug. Two patients were co-prescribed Belimumab, 3 were co-prescribed low-dose methotrexate and 2 were not on additional disease modifying agents. The diagnoses of these patients were, 2 patients with SLE, 4 with SPRA, and 1 MPO Vasculitis. There were no significant findings in lymphocyte count, white cell count or immunoglobulin levels.

Conclusion
These findings suggest that our current COVID-19 vaccination and booster programme may not provide adequate response in patients receiving rituximab therapy. Despite this being a small cohort, these results show that 33% of patients have not mounted a vaccine response and this is concerning. We suggest that vaccine response should be checked in all patients receiving rituximab therapy and those patients who do not mount a vaccine response should be offered passive immunity and advised of possible additional risks regarding COVID-19 exposure.
Disclosure
S.K. Stewart: None. A. Pendleton: None.