bluuebunny/crossref_metadata_2025_split huggingface dataset:
The First- and Second-Nature Geographic Correlates of Federal Budget Transfers and Fiscal Dependence—Evidence from Russia and the United States
Authors: White Allison C , Kim Youngsung 
Published: April 2023

Abstract
This study examines fiscal federalism by interrogating the relationship between first- and second-nature geographic features—most notably distance as well as various economic/infrastructural indicators—and intergovernmental transfers and subnational fiscal dependence in Russia and the United States from 2003 to 2015. Our findings reveal stark differences in the role that geographic factors play in these two federations. While first- and second-nature factors influenced both transfers and reliance in Russia, only second-nature indicators had an effect in the U.S. case. Economic development and infrastructural improvements do not cause the influence of first-nature indicators to evaporate altogether, but they do attenuate the effects of those considerations.
OA01 No difference in risk of myocardial infarction among patients receiving either IL6 or TNF inhibitors for rheumatoid arthritis
Authors: Tian Zixing , Kearsley-Fleet Lianne , Lauper Kim , Haughton Sally , Watson Kath , Lunt Mark , Mclaughlin John , Verma Arpana , Hyrich Kimme L 
Published: April 2023

Abstract

Background/Aims
Interleukin 6 inhibitors (IL-6i) can increase LDL cholesterol levels, which raises concerns about the risk of myocardial infarction (MI) in patients with rheumatoid arthritis (RA) receiving this therapy. This study aims to compare the risk of MI between people with RA in the UK clinical setting receiving IL-6i or tumour necrosis factor inhibitors (TNFi) overall or by line of therapy (LoT).

Methods
Patients with RA registered between 01/10/2001 and 27/05/2022 with BSRBR-RA starting IL-6i or TNFi treatments were included. Occurrence of MI was identified from clinical follow-up forms and through cause of death reported by the national UK death register. Only those MIs occurring whilst the patient was actively receiving drug were included. The risk of MI in patients receiving IL6i compared to TNFi was compared using Cox regression, adjusted for baseline co-variates using propensity scores (PS, see Table 1). Follow-up commenced at the start of the drug of interest and patients were censored at occurrence of MI, death, discontinuation of therapy or last follow-up visit, whichever came first. Multiple imputation was used for missing data. To account for known differences in LoT use of TNFi and IL6i (with IL6i more likely as a later line bDMARD), overall analyses adjusted for LoT in PS and secondary analyses by LoT were conducted. Direct switches between originator to biosimilars were considered the same treatment.

Results
A total of 29,596 IL6i or TNFi treatments in 20,725 patients were included (3,098 IL-6i; 26,498 TNFi), representing 153,913 person-years of exposure. Compared to patients receiving TNFi, patients starting IL-6i treatment were older, had longer disease duration, less likely to use methotrexate and steroids, and had more comorbidities. During follow-up, 372 MIs occurred, 27 on IL-6i and 345 on TNFi, with an overall lower crude rate of MI in patients receiving IL6i compared to TNFi. After PS adjustment, the risk of MI was not significantly different between the two treatment overall (HR 0.77, 95% CI 0.48-1.24) or when stratified by LoT (Table 1).

Conclusion
This study could not identify any difference in risk of MI between IL-6i and TNFi treatment after patient characteristics and LoT were considered.
Disclosure
Z. Tian: None. L. Kearsley-Fleet: None. K. Lauper: Honoraria; Celltrion, Pfizer, Viatris, Galapagos. S. Haughton: None. K. Watson: None. M. Lunt: None. J. Mclaughlin: None. A. Verma: None. K.L. Hyrich: Honoraria; Abbvie. Grants/research support; Pfizer, BMS.
P007 Automating blood monitoring and handover for patients with rheumatic diseases commencing disease-modifying anti-rheumatic drugs (DMARDs)
Authors: Mirza Maria , Lang David , Escudero Alexa , Soni Anushka , Shine Brian , Paddon Kevin , Luqmani Raashid 
Published: April 2023

Abstract

Background/Aims
Approximately 100 patients a month are commenced on DMARD therapy and until recently required manual monitoring and handover to primary care. We aimed to improve this process using a system implementing automated algorithms.

Methods
We designed a system to automate analysis using algorithms based on BSR guidance. Clinician endorsement was required for individual missing and abnormal results. Group endorsement was enabled for normal and mildly abnormal results. Handover to primary care was facilitated by patients completing a Microsoft form providing details of efficacy, side-effects, and compliance. All reports are imported into our bespoke system to generate automatic reports which constituted as a handover letter to primary care

Results
We have analysed 5,483 blood tests using the new system. All normal results can be endorsed at once without scrutiny. Missing records occurred chiefly due to the laboratory providing blood results in sections. The new system has been tested against the manual method for blood monitoring highlighting improved accuracy and efficiency of the new system. To date, 69% of patients have been handed over to the GP successfully without a need for further out-patient appointment.

Conclusion
We have introduced an efficient method for semi-automating DMARD monitoring and handover in 5,483 sets equivalent to assessing 200-250 records per 4-hour session and could efficiently oversee handover in 69% of cases without necessitating direct clinical review. The efficiency is almost 80% reduction in workforce required.
Disclosure
M. Mirza: None. D. Lang: None. A. Escudero: None. A. Soni: Grants/research support; Oxford ucb grant. B. Shine: None. K. Paddon: None. R. Luqmani: Grants/research support; Pfizer global grant.
P039 The association between gout and psychological co-morbidity: a five-year prospective cohort study
Authors: Higgs Jordan J R , Clarson Lorna , Bajpai Ram , Muller Sara , Roddy Edward 
Published: April 2023

Abstract

Background/Aims
Gout is associated with physical co-morbidities and a reduction in physical health-related quality of life. However, the association between gout and psychological comorbidity (depression and anxiety) has received less attention. A secondary analysis of data from a five-year prospective cohort study was performed to determine the prevalence and incidence of anxiety and depression in people with gout, and gout characteristics associated with psychological co-morbidity.

Methods
Adults aged ≥18 years with gout were identified via Read codes or allopurinol prescriptions from 20 general practices across the West Midlands. Questionnaires were mailed at baseline and at 12-, 36- and 60-months. Questionnaire data included socio-demographics, gout-related characteristics (flare frequency, oligo- or poly-articular gout, gout duration and allopurinol use) and validated anxiety (GAD-7) and depression (PHQ-9) questionnaires. Current anxiety and depression were defined as scores&gt;10 on the GAD-7 and PHQ-9 respectively. The prevalence and incidence of new-onset anxiety or depression were described at 12, 36 and 60 months in those without anxiety and depression at baseline. Binary logistic regression used to determine baseline gout characteristics associated with developing new-onset anxiety or depression at each time point (odds ratios (OR), 95% confidence intervals (CI), adjusted for age, gender and deprivation).

Results
Of 1184 baseline responders, 721, 605 and 411 responded at 12-, 36- and 60-months, respectively. The peak prevalence of both depression and anxiety was at baseline at 12.6% and 10.0%, respectively. Responders with anxiety (GAD-7 ≥10) or depression (PHQ-9 ≥10) at baseline were excluded from new-onset analysis. Over five years, one in thirteen (7.5%) developed new-onset anxiety, and one in eleven (9.2%) developed new-onset depression at any future time point. Developing anxiety was associated with a history of oligo- or poly-articular gout flares at baseline (OR 2.31, 95% CI:1.26 to 4.23) but not flare frequency, gout duration, or allopurinol use. New-onset depression was associated with allopurinol use at baseline (OR 1.93, 95% CI: 1.01 to 3.69) but not flare frequency, gout duration, or oligo- or poly-articular gout flares.

Conclusion
Psychological co-morbidity is common in people living with gout; clinicians should be aware of this when assessing and treating people with gout.
Disclosure
J.J.R. Higgs: None. L. Clarson: None. R. Bajpai: None. S. Muller: None. E. Roddy: None.
P055 Giant Cell Arteritis Diagnosis: Metadiagnosis by robust Bayesian estimate of strength of belief
Authors: Clearkin Louis 
Published: April 2023

Abstract

Background/Aims
Metadiagnosis expresses diagnostic belief as: (i) a numeric probability, (ii) degree of confidence in the probability estimate and (iii) defines the derived information as decision thresholds. We use this approach to stratify suspected GCA patients, by disease probability, into three classes. (a) Likely to have GCA, (b) Unlikely to have GCA, and (c) Uncertain GCA status.

Methods
We developed a Bayesian algorithm that computes a patient’s disease probability based on their signs, symptoms and reference-standard tests. This algorithm forms the computational engine of the first iteration of an online APP. The computational engine incorporated statistical weights (likelihood ratios) from a meta-analysis of 68 unique studies (14 037 unique patients with suspected GCA). The algorithm requires the specification of a disease prevalence. This is the “prior” probability any patient has GCA. We then update this probability incrementally with each additional item of information elicited from the questionnaire proforma (e.g. female? headache? visual abnormality? …) by incremental evidence aggregation. Finally, the outcome of the patient's reference standard test is incorporated (e.g. positive, negative, indeterminate) and a final posterior GCA probability is computed for each patient.

Results
Quantitative GCA risk estimate for each individual patient, and how that was altered by the result of reference standard test, produces three distinct groups: a) Low probability group - estimated risk of GCA is significantly lower than the prevalence in the cohort. The reference standard test in this group was uniformly negative.b) intermediate probability group - estimated risk of GCA is around the same as the prevalence in the cohort. The reference standard test (TAB) is almost always negative in this group, but not exclusively.c) high probability group - estimated risk of GCA far exceeds the base or population risk level, and the reference standard test (TAB) is typically confirmatory in this group.

Conclusion
Applying Bayesian algorithmic metadiagnosis, based on established values of how indicators of disease impact on diagnosis, allows numerical disease prediction and non-mathematically communicating the precision of diagnosis may enhance informed patient choice leading to personalised, targeted intervention. An inbuilt artificial neural network (a deep learning method feedback-loop) trains the algorithm to identify the value of all relevant indicators and so improves predictive accuracy. We plan further studies to establish how this approach could impact on patient well-being and resource utilisation.
Disclosure
L. Clearkin: None.
P059 A review of intra-articular corticosteroid injection safety and clinical effectiveness during COVID-19
Authors: McCall Gary J 
Published: April 2023

Abstract

Background/Aims
Intraarticular corticosteroid injections (CSI) are used as a short-term treatment for inflammatory arthritis and osteoarthritis. At the outset of the COVID-19 pandemic there was concern regarding the immunosuppressive effect of steroids and the potential risk of COVID-19 infection in patients treated with CSI. There is no universal evidence-based consensus on the optimum dosing of CSI.
Nationally there was a mixed response to CSI use during the COVID-19 pandemic. Early during the pandemic, our Trust advised using only the lowest BNF indicated steroid dose to minimize any potential side effects. Large joints (knees and shoulders) were injected with 40mg of Kenalog compared to 80mg pre pandemic.
No previous survey has reported the incidence of covid infection post CSI. The primary aim of this project was to address this gap. A secondary aim was to review the clinical effectiveness of a ‘larger’ versus ‘smaller’ steroid dose in CSI.

Methods
Retrospective data collection was carried out for 107 patients who received CSI during the pandemic. All patients who received CSI within the Trust rheumatology department were followed up with a six-week phone call. During this consultation the effectiveness of the CSI was considered by asking them to score the effectiveness of the CSI out of 10 (10 being maximum improvement). The incidence of COVID-19 infection was also recorded.
This data was compared to the same data from a group of patients injected with a larger dose of CSI pre-pandemic (n = 114).

Results
The patient reported incidence of COVID-19 infection within 6 weeks of CSI was 1.87%.
Patient reported outcomes showed a mean improvement in joint symptoms of 6.97 using 80mg of kenalog, versus 5.02 improvement using the smaller 40mg dose at six week follow up.
Interestingly 56% of people injected with a larger dose reported a minimum 8/10 improvement compared to 22% of patients injected with a smaller dose.

Conclusion
The low incidence of COVID-19 infections following CSI indicates that there is no significant correlation with increased in risk of contracting COVID-19. This study did not collect any data on outcomes of infection but at the time of the phone calls no patients had been hospitalized or died.
The incidence of COVID-19 infection was below the national average. Some of the Rheumatology patients injected may have been advised to shield which may have contributed to the lower-than-expected figure.
The significantly increased benefit consistently reported by patients supports the use of a higher dose steroid (Kenalog 80mg) versus lower dose (40mg) when injecting large joints in patients with arthritis. It is important to weight up the risks and benefits of CSI but this suggests that we should use the higher dose in clinical practice.
Disclosure
G.J. McCall: None.
P075 Mendelian randomization studies of lifestyle-related risk factors for osteoarthritis: a PRISMA review and meta-analysis
Authors: Ho Justin , Mak Christopher 
Published: April 2023

Abstract

Background/Aims
Risk factors for osteoarthritis (OA) often exert effects over protracted time-courses. Mendelian randomization (MR) studies therefore have an advantage over conventional observational studies when studying the causal effect of long-term lifestyle-related risk factors on OA. However, given the heterogeneous design of existing MR studies on OA, the reported causal estimates of these effects remain inconsistent, thus obscuring the true extent of the biological effects of OA lifestyle-risk factors.

Methods
We conducted a PRISMA systematic review and specifically included MR studies that investigated the causal effect between lifestyle-related risk factors and OA, where causal estimates for various lifestyle factors were pooled for meta-analysis. Quality of studies was assessed according to STROBE-MR guidelines.

Results
A total of 1576 studies were evaluated and 23 were included. Overall, the studies included were of high quality and had a low risk of bias. Our meta-analysis demonstrates the positive causal effect of BMI (ORIVW-random effects 1.49 [1.23-1.80]) and negative causal effects of serum calcium (ORIVW-random effects 0.69 [0.57-0.83]) and LDL levels (ORIVW-random effects 0.93 [0.90-0.96]) on OA.

Conclusion
Despite the heterogeneous designs and estimates of causal effects provided by various MR studies, our meta-analysis suggests that lifestyle-related risk factors in the form of BMI, serum calcium, and LDL have true biological effects on the development of OA.
Disclosure
J. Ho: None. C. Mak: None.
P077 Bone mineral density predicts fractures when measured in more than one area: results from a large observational cohort
Authors: Nadeem Ummaz , Bukhari Marwan , Sultan Zain 
Published: April 2023

Abstract

Background/Aims
Osteoporosis is characterised by a reduction in bone mineral density (BMD). Low BMD is correlated with increased fracture risk. It is unclear whether a BMD value at a specific site is superior for predicting fracture. The Fracture Risk Assessment (FRAX™) tool is used to evaluate fracture risk, using the BMD at the non-dominant hip; focussing on the neck mean and neck total. This is despite a T score of -2.5 or below in the lumbar spine defining a patient as osteoporotic. This study aimed to determine whether the other measures of BMD that are noted are as predictive of fracture.

Methods
Patients referred for routine dual-energy x-ray absorptiometry (DEXA) scans at the Royal Lancaster Infirmary from 2004 to 2019 were studied. BMD data from lumbar vertebrae (L1-L4) and anatomical regions of the left and right femur were collected from DEXA images. A logistic regression model was fitted using fracture as a dependent variable and BMD values from the lumbar vertebrae, right and left femur as predictors, adjusted for age at scan and sex. Goodness of fit was assessed using a receiver operating characteristic (ROC) curve.

Results
A total of 31,546 patients were included in the analysis (82.9% female), of whom 37.6% had sustained a fracture, and the mean age of the cohort was 64.9 (standard deviation 12.9). Table 1 shows the results of the logistic models. Areas under the receiver operating characteristic curve (AUC) demonstrated the positive predictive ability of a reduction in BMD in the lumbar vertebrae and regions of the femur and fracture risk. BMD data from the four lumbar vertebrae were just as predictive of fracture as the right and left femur.

Conclusion
The study findings demonstrate that low BMD in all areas measured were equally predictive of fracture. When the non-dominant hip is not measurable, using other areas from a DEXA scan could be used to predict fracture risk. Research evaluating change in BMD over time could alter this observation.
Disclosure
U. Nadeem: None. M. Bukhari: None. Z. Sultan: None.
P079 Use of an electronic text messaging service to improve efficiency in initial Fracture Liaison Service Patient Assessment
Authors: Reid Rosie , Lever Elliott , Davis Diana 
Published: April 2023

Abstract

Background/Aims
Fracture Liaison Service (FLS) is labour intensive. It aims to identify all patients aged over 50 years presenting with a new fragility fracture and assess for treatment, in order to prevent future fractures and associated morbidity and mortality. According to the Royal Osteoporosis Society published Standards (2015), patients should have a comprehensive bone assessment within 3 months of the incident fracture. However, such assessments are time consuming, typically taking up to 40 minutes of an FLS practitioner's time. Understaffing led to designing an approach to gather information and streamline the Fracture Liaison service.

Methods
We approached an electronics communication company who generated a secure form containing the information required for FLS initial assessment. As a trial, all patients identified by the FLS as having a new fragility fracture between 15th November 2021 and 15th December 2021 were sent a text link to this questionnaire. A follow-up message was sent 1 day and 1 week later (3 messages in total). The questionnaires were then exported to the patient's electronic clinical record. Data collected included information allowing prediction of risk for future fractures. Following assessment of this data, action letters could be sent to the GP advising on a treatment plan, for example, to start an oral bisphosphonate or referral for parenteral treatment. We analysed the results and performed cost analysis based on comparison to normal practice where the initial assessment would have been undertaken as a clinic appointment.

Results
43 out of 103 patients (42%) responded to the questionnaire. Of these 43 patients, 32 (74%) were female and the majority aged 60 to 79 years. Our cost analysis showed that allowing for a 30-minute face to face appointment for each of 43 patients would have taken 22.5 hours. By comparison, virtual assessment of the data from each questionnaire took only 8 minutes ie a total of 5.7 hours. This saved 16.8 hours of the FLS practitioner's time with a calculated cost saving of £352, based on professional time cost of £21 per hour. Face to face attendances would have cost £120 per patient ie £5160 for 43 patients. The total amount saved using the electronic questionnaire for 43 patients was £5512.

Conclusion
We were able to capture the initial FLS bone assessment data using an electronic questionnaire in 43 out of 103 patents. This resulted in a significant cost saving from outpatient clinics of £5512 over a 1-month period. Downstream processing of the data was much shorter. Further action will be to modify the text messages to increase yield of patients. Electronic fracture liaison is effective at reducing demands on the service and coordinating activity. We have demonstrated a significant cost saving on a small number of patients.
Disclosure
R. Reid: None. E. Lever: None. D. Davis: None.
P085 First ever Juvenile Idiopathic Arthritis Awareness Week
Authors: Wilson Debbie 
Published: April 2023

Abstract

Background/Aims
During conversations with parents, children and adults living with JIA, a common theme kept coming up which is ‘why can’t people understand that JIA is a fluctuating condition?’ It can be very frustrating to keep explaining this. Some days, those living with JIA are able to do most things e.g. play football, cook, go for a run. However other days it can be a struggle to even get out of bed or climb the stairs at school/work. Due to the lack of understanding of this disease some children have had people asking them if they are faking it. They have said, ‘We need to help teachers to understand how diverse and fluctuating the disease is from day to day, I’m not lying about my symptoms, they change’. Therefore, following the success of NRAS’s RA awareness weeks, it was decided we would run the first ever JIA Awareness Week on the theme that no two days are the same living with JIA, and the hashtag #SameJIADifferentDay was created.

Methods
NRAS does not have the resources to do major TV adverts, so we decided to make this a social media campaign. We wanted to have films/photos and content to educate and inform people of what it is like to live with JIA and how no two days are the same. Six films were created, three were from a teenager and three from an adult, both living with JIA. This helps to highlight that adults can be living with JIA as well; it is does not become RA when you are an adult. We launched a different film each day that week (https://jia.org.uk/youtube) Throughout the week, events took place, including: JoinTogether JIA Parent/Carer online group meeting, a Facebook Live Session in which Chloe Umpleby and Ellie Farr from NRAS’s Young Voices Panel shared their experiences of what a good day and bad day looks like for them. Pam Duncan-Glancy MSP living with JIA, put in a motion to the Scottish Government and she helped raise awareness throughout the week.

Results
On average, NRAS’s social media platforms’ engagements went up by 189%. The highest was Facebook which had a 386.5% increase in profile visits. Some of the feedback we received included: “This is important recognition that a condition diagnosed in early childhood can continue to impact on your life as an adult.” “Simple video that speaks volumes.” “I’m loving the social media post for #SameJIADifferentDay, that is exactly what my child is like.”

Conclusion
This was a successful campaign, not only in terms of post engagement and website visits but, as seen in the feedback above, in using video as a powerful tool to get across common misconceptions about JIA.
Disclosure
D. Wilson: None.