bluuebunny/crossref_metadata_2025_split huggingface dataset:
PA07 (P65) Vitamin D deficiency is associated with atopic dermatitis severity in a Bangladeshi population living in the UK
Authors: McCarthy Rebecca L , Thomas Bjorn R , Tawfik Soha S , Atkar Ravinder , McDonald Bryan , Dhoat Sasha , Hughes Aaron , O’Toole Edel 
Published: June 2023

Abstract
Atopic eczema is a common chronic inflammatory skin condition with considerable heterogeneity. South Asian people living in the UK frequently have low vitamin D levels, and those with atopic disease can present with severe eczema. The association between vitamin D insufficiency and eczema severity, and the role of vitamin D supplementation in atopic eczema is inconsistent, and it is under-researched in people with Asian ancestry living in low-ultraviolet (UV) areas. This cross-sectional study investigates the association between serum 25-hydroxy vitamin D3 [25(OH)D3] and eczema severity in a cohort of South Asian children and young adults living in the UK. Eligible participants were Bangladeshi children and young adults aged 0–30 years with eczema, participating in the THEA study. Data for the study were collected via parent/patient self-reporting, clinical history and examination, and hospital databases. Levels of 25(OH)D3 were documented retrospectively, if available, from hospital databases. Eczema severity was classified by an Eczema Area and Severity Index (EASI) score less than or greater than 10. Multivariate logistic regression was used to adjust for confounding factors. In total, 682 patients were recruited between May 2018 and December 2021. The EASI score was available for 681 participants [mean (SD) 7.9 (9.1)], and 25(OH)D3 results were available for 49.7% (n = 339). Eighty-four per cent were deficient (&lt; 25 nmol L−1) or insufficient (&lt; 50 nmol L−1) in 25(OH)D3. Vitamin D3 levels were inversely correlated with EASI score (Spearman’s rank R2 = –0.22; P &lt; 0.001). After adjustment, there was a significant association between eczema severity (EASI &gt; 10) and lowest 25(OH)D3 [odds ratio (OR) 0.973, 95% confidence interval (CI) 0.956–0.988; P &lt; 0.001], working class (OR 0.542, 95% CI 0.295–0.991; P = 0.047), previous immunosuppression/biologic therapy (OR 2.432, 95% CI 1.189–5.077; P = 0.016), mild-to-moderate potency topical steroid use on the face and neck (OR 3.566, 95% CI 1.730–7.696; P &lt; 0.001) and topical calcineurin inhibitor use on the face and neck (OR 3.421, 95% CI 1.140–10.288; P = 0.027). These findings demonstrate an inverse correlation between 25(OH)D3 level and eczema severity in a cohort of exclusively South Asian children and young adults living in a low-UV region. Vitamin D plays a role in the modulation of proteins required for skin barrier function and regulation of the innate immune system, suggesting that vitamin D deficiency in this population may contribute to inflammation in the skin. Further research on the role of vitamin D supplementation in atopic eczema, particularly in people with skin of colour, is required.
PA09 (P79) A multidisciplinary expert consensus on the assessment of and support for mental health in children and young people living with skin conditions
Authors: Moledina Zahra , McPherson Tess , Ravenscroft Jane , Ali Rukhsana , Baron Susannah 
Published: June 2023

Abstract
Psychological and mental health concerns are common in children and young people (CYP) living with skin conditions, and can have a profound impact on wellbeing. However, there is limited guidance on how best to assess and support the mental health of this population, who are at risk of poor health outcomes. The British Society for Paediatric and Adolescent Dermatology formed a working group to address the mental health needs of CYP with skin conditions, including hair and nails. A systematic review, appraisal of literature and a national survey were carried out, and a multidisciplinary consensus guideline group was convened, comprising dermatologists with expertise in paediatric dermatology and psychodermatology, psychologists, psychiatrists, general practitioners, paediatricians and specialist nurses. Two multidisciplinary virtual panel meetings took place: (i) an initial meeting to discuss the scope, review the current evidence and identify areas for development; and (ii) a second meeting to agree the content and wording of the recommendations. The primary objective was to provide consensus-based guidance on the assessment and monitoring of, and support for, mental health in CYP with skin conditions. Secondary objectives were to address important practical clinical questions relating to primary guidance objectives, and provide audit and research recommendations. The expert panel achieved consensus on 11 recommendations for health workers managing CYP with skin conditions. A new patient-completed history-taking aid called ‘You and Your Skin’ was developed and is being piloted. The recommendations focus on improved mental health assessments for CYP presenting with a skin condition, with clinical guidance and suggested screening measures included. Information regarding accessing psychological support for CYP when required is given, and recommendations were provided for training in mental health and neurodiversity for staff. The methodology and recommendations will be presented in full. Embedding a psychosocial approach within services treating CYP with skin disease should ensure that CYP with psychological needs are able to be identified, listened to, supported and treated. This is likely to improve health outcomes.
PD04 Real-life experience of Scottish patients with idiopathic solar urticaria
Authors: McMullan Alexandra , Lesar Andrea , Ibbotson Sally 
Published: June 2023

Abstract
We conducted a retrospective study to characterize our most recent cohort of patients with idiopathic solar urticaria (SU), to compare with our previous findings (Beattie PE, Dawe RS, Ibbotson SH, Ferguson J. Characteristics and prognosis of idiopathic solar urticaria: a cohort of 87 cases. Arch Dermatol 2003; 139:1149–54). We analysed data derived from our in-house database and paper and electronic records of patients with SU seen through the Scottish Photobiology Service between 2003 and 2022. Eighty-four patients with SU were seen in this period, 57 (68%) women and 27 (32%) men. Twenty-nine (35%) had a single consultation/phototesting and 55 (65%) had follow-up assessments. The average age of onset was 37 years, with the average age of diagnosis being 41 years, with delays from symptom onset to diagnosis ranging from 6 months to 24 years. Importantly, 20 (24%) patients self-reported systemic symptoms, most commonly fatigue, dizziness and nausea. Of 61 patients using antihistamines before diagnosis, 31 (51%) reported benefit. Of patients who tried sunscreens, 31 of 65 (48%) reported benefit. On monochromator phototesting, sensitivity predominantly involved the ultraviolet (UV)A waveband (335–400 + 27 nm in 55%), extending into the visible spectrum (&gt; 430 + 27 nm) in 44% and UVB waveband (305 + 5 nm) in 1%, consistent with previous reports of predominant UVA/visible light dependency in SU. On review of follow-up data, we analysed the fold benefit in minimal urticaria dose (MUD) from testing on H1 antihistamines alone, H1 and H2 antihistamines combined and the addition of montelukast. Most (65%) responded with a more than twofold improvement in MUD after a single dose of H1 antihistamine, with only 35% not responding. Increasing the dose of H1 antihistamine did not provide notable additional benefit. There was a suggestion of improved responses by the addition of an H2 antagonist (in 76% vs. 66% with H1 antagonist alone), but this was not statistically significant (P &gt; 0.05). No additional improvement in threshold sensitivity (MUD) was observed by the addition of montelukast. Small numbers of patients used other treatments such as photo(chemo)therapies and systemic immunosuppressants, and these were found to be of limited benefit. Since 2011, we have used omalizumab for patients with treatment-resistant SU. Of the current cohort, 13 received omalizumab, with 62% reporting a good clinical response and a further 15% a partial clinical response. Phototesting in these patients showed complete abolition of photosensitivity or excellent responses (more than fivefold increase in MUD) in 73%, demonstrating the efficacy of omalizumab in recalcitrant SU. Given the systemic features reported by some patients with SU, this supports a management approach, which includes systemic immunomodulation as a potentially effective option.
PD09 A prospective study of outcomes of narrowband ultraviolet B for the treatment of paediatric atopic dermatitis, with additional breakdown by ethnicity/skin type
Authors: Sambi Pavan , Warburton Katharine , Montgomery Rachel , Majeethia Parisha , Thompson Mia , Clark Sheila 
Published: June 2023

Abstract
Narrowband UVB (NBUVB) phototherapy is regarded as a second-line treatment for atopic dermatitis (AD) when response to first-line treatment is ineffective. We undertook a prospective study evaluating response to NBUVB treatment in paediatric AD to assess changes to pretreatment Eczema Area and Severity Index (EASI) score immediately postphototherapy and 12 months later. We subanalysed response in different skin types. All patients had NBUVB treatment three times weekly up to a maximum of 40 exposures. Follow-up was every 3 months for 1 year postphototherapy. In total, 58 patients were recruited for NBUVB phototherapy treatment [37 (64%) men, 21 (36%) women, mean age 10.6 years (range 4.1–16.9 years)]. Skin types/ethnicity were as follows: White, n = 22 (38%); South Asian (Pakistani/Indian/Bangladeshi), n = 17 (29%); Black African/Caribbean, n = 9 (16%); other, n = 10 (17%). The immediate post-treatment mean EASI reductions vs. pretreatment baseline scores were 10.0 (entire cohort), 12.4 (White), 8.6 (South Asian), 2.5 (Black African/Caribbean) and 7.5 (other). A ≥ 75% increase in EASI (EASI 75) was achieved in the 49% of the entire cohort, in 48% of White people, in 50% of South Asians, in 44% of Black African/Caribbean people and in 56% of others. A ≥ 90% increase in EASI (EASI 90) was achieved in 15% of the whole group, 14% of White people, 13% of South Asians, 22% of Black African/Caribbean people and 11% of others. At 12 months post-treatment, mean EASI reduction vs. pretreatment baseline score was 7.6 in the whole cohort, 9.0 in White people, 8.6 in South Asians, −2.1 (i.e. worsening) in Black African/Caribbean people and 8.0 in others. At 12 months post-treatment, EASI 75 was achieved in 28% of the whole group, 33% of White people, 40% of South Asians, 14% of Black African/Caribbean people and 13% of others. For those who responded, there were a similar proportion of those achieving EASI 75 across the different skin types. However, there was more variation in the reduction in EASI score in those with skin colour. We acknowledge that existing scoring systems may lead to underscoring of the severity of erythema and therefore overall EASI score in darker skin types. Although the mean EASI reduction was highest in the group of White patients, there was a higher proportion of Black/Caribbean patients achieving EASI 90 at the end of the NBUVB treatment; however, the overall number of patients in this group was small. Our study showed that White and South Asian paediatric patients had a more sustained response to NBUVB phototherapy up to 1 year after stopping treatment. Black African/Caribbean patients had a greater risk of relapse.
BT20 Straight to biopsy vs. face-to-face consultation for skin lesions referred on a 2-week wait pathway: a review of outcomes
Authors: Brindley Luke , Hunjan Manrup , Walker Koharu , Higgins Kelly , Gazzani Paul 
Published: June 2023

Abstract
Teledermatology has become an essential tool in the triage and management of skin cancer referral pathways. The implementation of the process varies between dermatology departments. At a large multihospital trust, a retrospective service evaluation was conducted looking at the outcomes between two dermatology sites within the trust. Both use the same teledermatology platform to review all referrals made via a 2-week wait suspected cancer pathway for skin lesions. The main comparator was that one of the sites employs a straight to biopsy (STB) outcome as a potential pathway for referred lesions. The other site conducts face-to-face (F2F) review of suspicious lesions warranting biopsy first. Data were collected for all referrals made to both sites over a week in July 2021. A total of 506 lesions were referred across the two sites. Following teledermatology review at the site where STB was adopted, 32.2% (n = 96/298) of patients had a STB outcome and 33.9% (n = 101/298) had a F2F outcome. In comparison, 48.6% (n = 101/208) had a F2F outcome at the other site. Where STB was employed, biopsies were carried out for 13 intermediate lesions (actinic keratosis, superficial basal cell carcinoma, Bowen disease) vs. seven following F2F review at the other site. Rates of definitive surgery, for example wide local excision, were comparable between sites: 13.4% (STB) vs. 15.5%. Curettage and cautery was performed exclusively for lesions reviewed at the STB site, whereas at the other site, intermediate lesions were seen F2F and likely discharged following management with cryotherapy, topical treatments or conservative measures. The STB model can be appealing as it eliminates the need for a F2F review for lesions that require histological confirmation for diagnosis and management, saving valuable time and resources. However, the multiple stages involved in processing biopsies are costly and resource intensive when considering that many intermediate lesions can be treated from a clinical diagnosis alone. Biopsies are associated with increased morbidity and risk, unnecessary extra steps in patient care. With the Montgomery ruling, the process of consent must be robust and consider the individual values of each patient. Biopsies in more complex anatomical sites may pose additional difficulty when obtaining valid consent. The STB can have a role in the management of skin lesions and can streamline patient pathways. However, it does not replace good clinical acumen and, to remain cost-effective, needs to be employed in an appropriate manner.
BT23 Outcomes of skin lesion referrals assessed via teledermoscopy
Authors: Hamid Iman , Vandormael Isabelle , Mills Caroline , Atwan Ausama 
Published: June 2023

Abstract
Skin lesion referrals from primary care comprise a significant proportion of the dermatology workload. Urgent suspected cancer (USC) referrals are prioritized, which adds strain to outpatient capacity and impacts on waiting lists for less urgent and routine referrals. Our department provides a teledermoscopy diagnostic service to allow for timely diagnosis of skin lesions. This results in fast detection of USC and a reduction in unnecessary hospital visits for patients with benign lesions. The aim of this study was to review the outcomes of USC and routine referrals received from primary care and assessed via our teledermoscopy service. We randomly selected 381 skin lesion referrals triaged for teledermoscopy between January and March 2022. In total, 189 (49.6%) of these were referred as routine and 192 (50.4%) were urgent/USC. High-resolution clinical and dermoscopic photographs of all skin lesions were taken by qualified clinical photographers and stored in the patients’ electronic records. Two separate consultant dermatologists reviewed the images along with the information provided in the referrals for diagnosis. A total of 47 diagnoses were observed in both cohorts. Only 16% of patients referred as urgent/USC had suspected high-risk cancer, including squamous cell carcinoma (SCC; 8.8%), melanoma (5.7%) and lentigo maligna (1.5%). The remainder of urgent/USC referrals were identified as nonurgent or benign, with an overwhelmingly low risk of basal cell carcinoma (23.9%), seborrhoeic keratoses (20.8%) and benign naevi (9.3%). For routine referrals, 11 patients (5.8%) were suspected to have USC. Of these, five had histological confirmation of melanoma (n = 3), SCC (n = 1) and melanoma in situ (n = 1). Of all referrals, 44.6% were reassured and discharged; 20.8% required clinic review for a diagnostic biopsy or treatment; 20.7% were booked directly for minor surgery; 8.3% were referred to the community local enhanced services for the treatment of low-risk lesions on the torso and limbs; 1.3% were referred to other specialties; and 4.1% required digital monitoring by repeating photographs 3–6 months later. An ever-increasing prevalence of skin cancer, together with suboptimal dermatology training for primary care healthcare professionals, anxiety over misdiagnosing malignancy and pressure from anxious patients all contribute to the pressure on dermatology services. We have shown that a teledermoscopy service is a useful tool for triaging skin cancer referrals to maximize the utilization of outpatient capacity and ensure timely treatment for patients with USCs.
Who’s at the table: an exploration of community-based food security initiatives and structures in a north-central Canadian context
Authors: Healy Theresa , Callihoo Christine , Booth Annie L 
Published: June 2023

Abstract
This article examines food security initiatives and actors specific to a rural, remote and northern Canadian community, a context found throughout the world. Using a ‘snowball technique’ to identify experts and practitioners in local food security, we employed qualitative engagement methods to map initiatives, actors and gaps in regional food security. We identified concerns around the ability of the region to be food secure; we also found a lack of cross-sector communication and planning, challenges with a small group of committed actors facing isolation and burnout and a need to more broadly engage the community and political entities with limited awareness of rural and remote cultures and concerns. Facilitating better collaborations across multiple food security-related activities while honouring current and supporting current initiatives could enable those who know their communities, to address food insecurity collectively and collaboratively in a rural, remote and northern context.
Cardiorenal interactions in heart failure: insights from recent therapeutic advances
Authors: Damman Kevin , Testani Jeffrey 
Published: June 2023

Abstract
Heart failure is a syndrome that may develop when cardiovascular disease progresses or is insufficiently treated and associated with a poor quality of life, high mortality rates, and increased healthcare expenditures. Prevention and treatment of heart failure are therefore of utmost importance. New therapies in patients with cardiovascular disease have recently been shown to be effective in the prevention and sometimes treatment of heart failure, and additional research is underway. Specifically, in high-risk patients with either (a combination of) diabetes, chronic kidney disease, and/or heart failure, three specific drug classes [sodium–glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide 1 receptor agonists (GLP-1-RAs), and non-steroidal mineralocorticoid receptor antagonists (MRAs)] have taken centre stage in therapeutic approach for these high cardiovascular risk patients. The commonality of these drugs is the finding that they improve cardiovascular and renal endpoints across the cardiorenal continuum and SGTL2i have already proved effective in all subtypes of heart failure, while we await data on non-steroidal MRA therapy in heart failure. The story may be different for GLP-1-RA in patients with established heart failure, but these drugs are effective in reducing cardiovascular events in patients with diabetes. Taken together, these new therapies advance the treatment and improve the associated outcomes of patients with cardiorenal disease and diabetes, with similar characteristics and effectiveness in different conditions.
Microbial roles in the terrestrial and aquatic nitrogen cycle—implications in climate change
Authors: Mattoo Rohini , B M Suman 
Published: June 2023

Abstract
Nitrogen, as an essential component for living organisms, is the primary limiting nutrient on Earth. The availability and effective utilization of nitrogenous compounds for metabolic and other essential biochemical reactions are dependent on the myriad and phylogenetically diverse microbial communities. The microorganisms harmoniously interact and participate in every reaction of the nitrogen cycle to continuously transform nitrogen into its various bio-available forms. Research on the nitrogen cycle continues to disclose that there are many reactions that remain unknown. In this review, we summarize the recent discoveries that have contributed to advancing our understanding of the microbial involvement in reactions of the nitrogen cycle in soil and aquatic systems that influence climate change. Additionally, the mini-review highlights, which anthropogenic activities cause disturbances in the nitrogen cycle and proposes how beneficial microbes may be harnessed to replenish nitrogen in agricultural ecosystems.
Species-specific protein–protein interactions govern the humanization of the 20S proteasome in yeast
Authors: Sultana Sarmin , Abdullah Mudabir , Li Jianhui , Hochstrasser Mark , Kachroo Aashiq H 
Published: June 2023

Abstract
Yeast and humans share thousands of genes despite a billion years of evolutionary divergence. While many human genes can functionally replace their yeast counterparts, nearly half of the tested shared genes cannot. For example, most yeast proteasome subunits are “humanizable,” except subunits comprising the β-ring core, including β2c (HsPSMB7, a constitutive proteasome subunit). We developed a high-throughput pipeline to humanize yeast proteasomes by generating a large library of Hsβ2c mutants and screening them for complementation of a yeast β2 (ScPup1) knockout. Variants capable of replacing ScPup1 included (1) those impacting local protein–protein interactions (PPIs), with most affecting interactions between the β2c C-terminal tail and the adjacent β3 subunit, and (2) those affecting β2c proteolytic activity. Exchanging the full-length tail of human β2c with that of ScPup1 enabled complementation. Moreover, wild-type human β2c could replace yeast β2 if human β3 was also provided. Unexpectedly, yeast proteasomes bearing a catalytically inactive HsPSMB7-T44A variant that blocked precursor autoprocessing were viable, suggesting an intact propeptide stabilizes late assembly intermediates. In contrast, similar modifications in human β2i (HsPSMB10), an immunoproteasome subunit and the co-ortholog of yeast β2, do not enable complementation in yeast, suggesting distinct interactions are involved in human immunoproteasome core assembly. Broadly, our data reveal roles for specific PPIs governing functional replaceability across vast evolutionary distances.