bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanics’ Institutes in Britain and Ireland
Authors: Turk Maria Elena 
Published: April 2022

Abstract
Mechanics’ Institutes, reading rooms, philosophical and literary societies, and working mens’ clubs were an important part of the social life of industrial settlements. They were a significant component in the self-improvement movement, and were promoted by many middle-class philanthropists. Nevertheless, these sites were somewhat controversial, their initial development sparked fears of a workers’ revolution. The funding and control of the facility was often a contested point, control of education came with an associated social power. By the nineteenth century Mechanics’ Institutes and sister societies had become one of the most visible civic buildings within planned industrial settlements, and were a key component in most model village design. These facilities provided both leisure facilities and adult education to the working classes, thereby complementing the development of the national school system. This chapter explores the history, development, and distribution of these sites in Britain and Ireland.
Bars, Public Houses, and Saloons
Authors: Davison Andrew 
Published: April 2022

Abstract
Establishments selling alcohol for consumption on the premises were a feature of industrialized societies. Their origins lay in the European alehouse and tavern, but colonization and emigration took them to other parts of the world, notably Australasia and North America. Distinctive building types—the public house (‘pub’), bar, hotel, and saloon—emerged in a number of countries during the nineteenth century, combining social and communal functions with the sale of alcohol, their design influenced by regulatory pressure as well as commercial imperatives. The temperance movement had a significant impact, its campaigns leading to increased regulation of the sale of alcohol and, in places, its prohibition. Archaeological investigation can shed light on their development, construction, design, ownership, and clientele, as well as on the activities which took place in them, supplementing evidence from architectural study and historical research.
Industrialized Conflict
Authors: Cocroft Wayne D. 
Published: April 2022

Abstract
This chapter discusses the complex relationship between the state and the manufacture of armaments. These are goods almost exclusively consumed by governments and in which they have close interest in acquiring the most technically advanced products. So vital was this industry that in many instances munitions manufacture was undertaken in government factories. During the late nineteenth century, states became increasingly reliant on large, commercial armaments firms, which in turn became more dependent on international sales to fill their order books. In times of tension and war the state was a major investor in armaments research and industrial capacity. An analysis of the past distribution of the armaments industry is vital in understanding the locations of civil industries, both through the legacy of its physical infrastructure, the proximity of its component suppliers, and the technical skills of its workforce.
Canals and Inland Waterways
Authors: Steyne Hanna , Crowe Nigel 
Published: April 2022

Abstract
The development of the network of navigable inland waterways and canals in Britain was a fundamental step in the growth and spread of industrialization in Britain. These waterways played an important role in the early transportation of raw materials, particularly coal, to factory sites, and of finished goods to the coast for national and international distribution. The importance of the waterways, however, is not solely technological, but also for the impact they had on the landscape, the peripatetic community employed on the water, and the communities that developed to maintain, support, and run the system. This chapter discusses the development, growth, and decline of inland waterways and their central role in the industrialization of Britain. Through a discussion of the upstanding, working, and buried archaeological remains associated with inland waterways this chapter presents the current state of research and suggests future directions.
OA20 Radiographic hip osteoarthritis classified semi-automatically on dual-energy x-ray absorptiometry scans is strongly predictive of total hip replacement: findings from UK Biobank
Authors: Faber Benjamin G , Ebsim Raja , Saunders Fiona R , Frysz Monika , Lindner Claudia , Gregory Jennifer S , Aspden Richard M , Harvey Nicholas C , Smith George Davey , Cootes Timothy , Tobias Jonathan H 
Published: April 2022

Abstract

Background/Aims
Radiographic hip osteoarthritis (rHOA) is traditionally defined on hip x-rays, using subjective methods such as Kellgren-Lawrence scoring. Associations between subjective rHOA measures and symptoms are inconsistent. Applying digital tools to high-resolution dual-energy X-ray absorptiometry (DXA) scans, we aimed to develop a novel semi-automated classifier for rHOA and evaluate the face validity of the classifier based on relationships with hip pain, hospital diagnosed OA (HES OA), and risk of total hip replacement (THR).

Methods
Using hip DXAs in UK Biobank, osteophyte grades 0-3 were assigned based on manually measured osteophyte area. Minimum joint space width (mJSW) was automatically measured using outline points placed by a machine learning-based algorithm and then used to categorise individuals into joint space narrowing (JSN) grades 0-3. Osteophyte and JSN grades were combined, using a novel system giving greater to weight to osteophytes, to categorise individuals into rHOA grades 0-4. Logistic regression giving odds ratios (OR) was used to examine associations between rHOA grade and hip pain, and HES OA. Cox proportional hazard models giving hazard ratios (HR) were used to examine associations between rHOA grade and subsequent THR. Our adjusted model included age, sex, height and weight as covariates.

Results
40,340 individuals were included in the study (mean age 63.7 [range 44-82], 19294/21046 male/female). 32758 (81.2%) had rHOA grade 0, 4565 (11.3%) grade 1, 2317 (5.7%) grade 2, 543 (1.3%) grade 3, 157 (0.4%) grade 4, with all features of rHOA being more common in males than females. rHOA grades ≥2 were associated with all three clinical outcomes in both unadjusted and adjusted models, a clear dose-response relationship was seen with each increase in grade showing a large rise in OR/HRs (Table 1). Grade 4 rHOA was strongly predictive of THR (HR 57.70 [95%CI 38.08-87.44]).

Conclusion
We successfully applied a novel semi-automated classifier to over 40,000 individuals from UKB. The validity of our classifier was supported by the strong and progressive relationships observed between rHOA and hip pain, and HES OA and risk of THR. We conclude that hip DXAs provide a promising means of defining rHOA, with potential screening applications in the clinic.

Disclosure
B.G. Faber: None. R. Ebsim: None. F.R. Saunders: None. M. Frysz: None. C. Lindner: None. J.S. Gregory: None. R.M. Aspden: None. N.C. Harvey: None. G. Davey Smith: None. T. Cootes: None. J.H. Tobias: None.
OA32 UK Paediatric Rheumatology Clinical Studies Group research priorities - results of a multidisciplinary consultation and consensus exercise
Authors: Smith Eve M. D , Egbivwie Naomi , Cowan Katherine , Ramanan Athimalaipet V , Pain Clare E 
Published: April 2022

Abstract

Background/Aims
The evidence base underlying the management of children and young people (CYP) with paediatric rheumatic diseases (PRDs) is inadequate, with many critical outstanding questions warranting investigation. The aim of this study was to elicit multidisciplinary PRDs research priorities, through consultation with patients, carers and healthcare professionals.

Methods
This study was led by the UK NIHR CRN Children/Versus Arthritis Paediatric Rheumatology CSG (referred to as ‘the CSG’) and its Topic Specific Groups (TSGs). The CSG is a multidisciplinary group with strong patient/parent representation, supporting the development of clinical studies in the UK. Research priority ideas were sought from paediatric rheumatologists, trainees, allied healthcare professional (AHP), nurses, patients, parents and charities, through online surveys and face-to-face meetings. Research ideas were categorised as disease-specific or broad/general. They were grouped into sub-themes, duplicates/questions that had already been answered were removed, and similar submissions combined. A modified Delphi process was undertaken, including online research priority ranking, and an online consensus workshop to derive top PRD research priorities.

Results
The initial consultation yielded 304 research priority ideas; 25% from patients/parents, 22% from the CSG, 18% from TSGs, 13% from AHPs, 11% from trainees, 11% from Nurses. 55 disease-specific and 37 broad/general research priorities were voted upon in the first online survey, yielding a top 11 general broad research priorities. The top 10 disease specific priorities were discussed at the online Delphi priority setting workshop, and two online surveys were held during the workshop to determine their final ranking. Two of the disease-specific priorities were combined, leading to a top 9 (see Table). Disease specific proprieties related to clinical trials in JIA (n = 3) / Juvenile Dermatomyositis (n = 1) / Chronic Recurrent Multifocal Osteomyelitis (n = 1) / Juvenile Systemic Lupus Erythematosus (n = 1) Scleroderma (n = 1), management of JIA in adulthood (n = 1) and chronic pain (n = 1).

Conclusion
UK consensus-based PRD research priorities have been derived, underpinned by collaboration with patients/carers and healthcare professionals, helping to guide funding bodies to improve the evidence base in PRD’s.

Disclosure
E.M.D. Smith: None. N. Egbivwie: None. K. Cowan: None. A.V. Ramanan: None. C.E. Pain: None.
P001 Audit on giant cell arteritis fast track clinic in Tayside
Authors: Subramanian Dhivya , Bhat Smita 
Published: April 2022

Abstract

Background/Aims
Giant cell arteritis (GCA) is a systemic inflammatory disease of medium to large sized arteries. Diagnosis of GCA is a medical emergency due to the consequence of permanent blindness if not treated early with glucocorticoids. The objective of this audit was to assess the effectiveness of the GCA fast track clinic (FTC) in NHS Tayside. The current practice was compared with British Society of Rheumatology (BSR) standards.

Methods
This was a retrospective audit from March 2019 to May 2021. All patients referred with suspicion of GCA were included. Main outcomes measured were referral time, investigations and management. Data were collected through electronic records.

Results
120 patients were included (median age 71 years; F71.7%). 35% of patients were diagnosed with GCA. Most common symptoms were headache (94.2%), jaw claudication (26.7%), visual symptoms (36.7%), PMR symptoms (21.7%), systemic symptoms (50%). As seen in Table 1, 50% with visual symptoms were seen by ophthalmology within 24 hours. 70.8% were seen by rheumatology within 24 hours. 89% were given steroids within 24 hours from suspicion. 80.8% were investigated with ultrasound or biopsy. Comparing with expected standards, provision of written information, advice on recurrence of symptoms, calculation of CRP, documentation of bone protection was achieved at 100%. Immediate follow-up time was 6 weeks. One patient lost vision while on steroids.

Conclusion
Early recognition and prompt management of GCA is crucial for a good prognosis. NHS Tayside’s FTC has allowed for quick evaluation for most patients within 24 hours and has improved prognosis in patients.

Disclosure
D. Subramanian: None. S. Bhat: None.
P011 Audit and Outcomes of Hydroxychloroquine Screening for Retinopathy in a Cohort of Patients with Rheumatological Conditions
Authors: Tehseen Ghazala , Wills Sarah , Chadwick Alexandra , Low Audrey 
Published: April 2022

Abstract

Background/Aims
Hydroxychloroquine (HCQ) is used to treat rheumatoid arthritis (RA) and other inflammatory arthritides. In 2018, the Royal College of Ophthalmologists (RCOphth) published new guidelines to monitor the risk of HCQ associated retinopathy. Risk factors for retinopathy were: dosage &gt;5mg/kg/day, impaired renal function (eGFR &lt;60ml/min/1.73m²) and concurrent tamoxifen use. This report aims to audit 1) HCQ dosing based on RCOphth 2018 guidelines 2) whether patients were appropriately referred for screening 3) outcome of screening.

Methods
All patients (n = 207) who newly started HCQ between April 2013 and November 2014 were identified from hospital outpatient pharmacy records and followed until they reached 5 years’ of follow-up or 30 Nov 2019, whichever came first (censor date). Patients who were still on HCQ by the censor date were reviewed to extract data on demographics, rheumatological diagnosis, starting HCQ dose and risk factors, and were subsequently referred for retinopathy screening via a referral proforma. Exclusions were those who stopped HCQ, prescribed HCQ for non-rheumatological conditions, transferred to a different trust, duplicate or deceased patients. Screening took place between 1 Nov 2018 until 30 June 2019, after which referrals were paused due to lack of capacity and finally stopped due to COVID-19.

Results
86 patients were identified and eligible for screening (study cohort) (Table). The median age of the cohort was 57 years, with 67% of the cohort being female. 23% of patients were prescribed a dose of &gt; 5mg/kg/day. 10% of patients had an eGFR of &lt; 60 ml/min/1.73m2. No patients were on tamoxifen.

Conclusion
After 5 years of follow-up, the drug survival for HCQ is just under half the number (43%) who started the drug. This will help plan screening service capacity issues. The department is investigating the “lost referrals” which seem disproportionately high, which could be due to IT issues or occurred when the screening service was paused. Of the 29 patients who attended for screening, none had evidence of HCQ retinopathy which is reassuring, these included 15 patients with risk factors for retinopathy.

Disclosure
G. Tehseen: None. S. Wills: None. A. Chadwick: None. A. Low: None.
P012 Cross-specialty audit of Infliximab prescribing at the Great North Children’s Hospital (GNCH)
Authors: Habibollah Sahar , Hartley Karen , Mcerlane Flora 
Published: April 2022

Abstract

Background/Aims
Infliximab is an anti-TNF biologic licensed for use in children and young people (CYP) with juvenile idiopathic arthritis (JIA) uncontrolled by methotrexate and children with inflammatory bowel disease uncontrolled by thiopurines. Key side-effects include immunosuppression, neutropenia, liver derangement, latent TB reactivation and risk of anaphylactic reactions. Infliximab is administered intravenously on paediatric day units. Between-specialty inconsistencies complicate the administration and monitoring of infliximab. This retrospective audit aimed to explore adherence to local / national guidance governing Infliximab administration. It is part of an ongoing programme of work towards improved cross-regional quality of care provided to CYP on systemic immunomodulatory therapies.

Methods
All patients prescribed Infliximab at GNCH in Newcastle between January and December 2020 were identified from pharmacy records. Adherence to local and national guidelines was audited, with particular emphasis on pre-medication investigations, rate of administration, frequency of complications and duration of post-infusion monitoring.

Results
The rheumatology team at GNCH prescribe infliximab in accordance with local trust guidelines based on BSPAR guidance. The gastroenterology team follow updated ESPGHAN guidelines (European Society for Paediatric Gastroenterology, Hepatology and Nutrition). A total of 155 patients were identified (138 gastroenterology patients and 17 rheumatology patients - 16 JIA, 1 Behcets disease). 17 gastroenterology patients with Crohn’s disease, matched by age, were selected for this audit. Table 1 details audit results for adherence to local/national guidance for Infliximab administration in GNCH. One child with JIA who was non-compliant with second immunosuppressant had an anaphylactic reaction after 5th Infliximab dose.

Conclusion
Current gastroenterology and rheumatology guidance suggest different pre-screening tests, dose regimens, rates of infusion and duration of post-treatment monitoring. Specialties are not following all guidelines perfectly, in particular pre-treatment viral screening. Although different specialties will continue to require different dosing schedules for infliximab, current practice suggests that it is reasonable to develop cross-specialty guidance governing the prescribing and administration of Infliximab. A cross-specialty guideline will reduce unnecessary variation in practice, reducing the potential for prescribing and administration errors.

Disclosure
S. Habibollah: None. K. Hartley: None. F. Mcerlane: None.
P019 Rheumatology Referrals to Tertiary Care Hospital over a Three Month Period During Covid-19 Pandemic: a Quality Improvement Project
Authors: Khan Behram , David Trixy , Clegg Caroline , Parker Benjamin 
Published: April 2022

Abstract

Background/Aims
During the COVID-19 pandemic, waiting times for routine new referrals to our tertiary rheumatology department was &gt;20 weeks. Therefore, a quality improvement project (QIP) was undertaken to understand the nature of these referrals and develop an alternative option to rheumatology review. Our aim was to reduce waiting times and improve patient experience by better integrating primary, secondary and therapy services, as well as provide additional triage options.

Methods
We conducted a retrospective analysis of all routine referrals over a 3-month period (1st April to 30th June 2020). Urgent referrals including GCA, CTD and EIA were excluded.

Results
A total of 92/143 (64%) patients were referred, a more significant reduction than normal due to the pandemic. Median age [IQR] was 39.5 [28-66.25] years and most referrals (79%) were from primary care. Table 1 represents information included in the referrals. Thirty-one patients had previously undergone a rheumatology review, of which 11 (35%) were seen in our department. Of these, 18/31 (58%) patients had a diagnosis of Hypermobility Spectrum Disorder (HSD) or fibromyalgia. The commonest reason for re-referral was worsening of existing symptoms (n = 11, 35%), with no suggestive of an alternative diagnosis.

Conclusion
Our QIP identified a variation in the quality of referrals and that a high proportion of referrals concerned HSD and fibromyalgia, with many re-referred due to exacerbation of their existing disease. Based on this, we conducted a regional GP trainee educational session and highlighted: i) key features in investigation and management of common rheumatological conditions ii) vital information to include in referrals based on presenting complaint(s) and working diagnosis. We developed a pathway for patients previously diagnosed with fibromyalgia or HSD in our department and re-referred with worsening symptoms, to be triaged into a newly set up weekly specialist MSK physiotherapy-led clinic with rheumatology supervision. Future work will involve re-assessing routine new-referral waiting times and evaluating pre- and post-physiotherapy intervention MSK and quality of life scores, with the aim of formulating a business case to conduct this clinic on a permanent basis. We hope incorporating this pathway will lead to improved patient outcomes and ease some departmental management decisions.

Disclosure
B. Khan: None. T. David: None. C. Clegg: None. B. Parker: None.
P020 The impact of COVID-19: local observations from the National Early Inflammatory Arthritis Audit
Authors: MacPhie Elizabeth , Ashcroft Lesley , Foreman Nicola , GIlbert Sharon , Horton Sarah , Madan Ayesha , Moon Kirsty , Rao Chandini , Fish Sarah 
Published: April 2022

Abstract

Background/Aims
The National Early Inflammatory Arthritis Audit (NEIAA) has provided the opportunity for rheumatology services to benchmark the care they provide against NICE quality standards (QS)33. It has proven to be a powerful lever for improving quality and our department is testimony to this. Recruitment to all national audits was paused for several months due to the COVID-19 pandemic. Once pressures had eased we recognised that NEIAA would help to understand the impact of the pandemic on the diagnosis and initial management of patients with rheumatoid arthritis. Our department continued to see all new urgent referrals face-to-face and were fortunate that the team were not redeployed.

Methods
Data submitted to the NEIAA online tool during year 3 (September 2020-March 2021) were downloaded for analysis. Data from year 2 were downloaded for comparison.

Results
In year 3, 154 patients were recruited to the audit compared to 268 in year 2. 36 (23%) had rheumatoid arthritis and were included in the follow-up cohort compared to 73 (27%) in year 2. All patients had a baseline and a 3-month follow up form completed, however 17 patients in year 3 had a telephone appointment at 3 months and there was no available DAS28. Patient demographics were similar. The case mix of patients recruited was also; in year 3, 41% were diagnosed with autoimmune inflammatory arthritis compared to 47% in year 2 and 42% with a non-inflammatory condition compared to 39% in year 2. In year 3, 41% of all patients were seen within 3 weeks of being referred and 58% of patients with RA started DMARD therapy within 6 weeks of referral. This compared to 54% and 56%, respectively, in year 2. In year 3, symptom duration prior to referral appeared longer: 31% had symptoms for less than 3 months, 31% for 3-6 months, 22% for 6-12 months and 16% for more than 12 months compared to 67%, 18%, 12% and 3%, respectively, in year 2. DAS28 at baseline was higher in year 3 with 47% high, 47% moderate and 6% low disease activity or in remission compared to 27%, 61% and 12%, respectively, in year 2. DAS28 at 3-months was also higher in year 3 with 16% high, 37% moderate and 27% low disease activity or remission compared to 6%, 25% and 69% respectively in year 2.

Conclusion
Despite the impact of the pandemic we have maintained our performance against QS2 and 3. However, patients seemed to have longer duration of symptoms prior to referral, higher disease activity at baseline and at 3 months. We await the 12-month data to determine 1-year outcomes, including escalation to high cost drug therapies.

Disclosure
E. MacPhie: Other; EM is the secretary of the North West Rheumatology Club, meetings have been supported by UCB, MSD, Abbvie and Lilly. L. Ashcroft: None. N. Foreman: None. S. GIlbert: None. S. Horton: None. A. Madan: None. K. Moon: None. C. Rao: None. S. Fish: None.