bluuebunny/crossref_metadata_2025_split huggingface dataset:
P296 Giant cell arteritis/large vessel vasculitis with normal inflammatory markers: a case series of 15 patients in south Manchester
Authors: Chua Ezolene P 
Published: April 2022

Abstract

Background/Aims
An elevated ESR is a criterion for giant cell arteritis (GCA) in the 1990 ACR classification. An international case series of GCA with normal inflammatory markers has been described. We describe characteristics and estimate the incidence of patients with GCA/large vessel vasculitis (LVV) with normal or minimally elevated inflammatory markers in south Manchester.

Methods
Temporal-axillary artery ultrasound (TAUS) has been the first line investigation modality in the local GCA fast track pathway (FTP) since 2019. TAUS, performed between April 2019 and May 2021, were reviewed. Clinical notes were reviewed if patients had scan findings positive for hypoechoic halos. Basic demographics and clinical details were further collected for cases with ESR &lt;50mm/hr or CRP &lt;20mg/dL to characterise their clinical profile.

Results
15 patients had positive TAUS with ESR &lt;50mm/hr or CRP &lt;20mg/dL. 10 patients were male (66.7%) and 5 were female (33.3%). 14 (93.3%) patients were of Caucasian race, while 1 was of African Black origin (6.7%). Median age at presentation was 66 years (63-74). Median BMI was overweight at 29kg/m2. Headache was the most common symptom in 13 patients (86.7%), followed by jaw and ocular complaints in 7 patients each (46.7%), and polymyalgia rheumatica in 3 patients (20%). Fevers and weight loss were each noted in 1 patient (6.7%). Median duration of symptoms before referral to our centre was 21 days (7-51). Formal ophthalmology assessment did not identify any patient with ocular damage. Median ESR was 17mm/hr (10- 21) and CRP 3.5g/dL (2-4.8). Median duration of steroids before TAUS was 0 days. In 1 patient, diagnosis of LVV was further confirmed by PET scan, while in another, it was further confirmed by MR and CT aortogram. 2 cases (13.3%) were relapses of GCA - 1 of which was previously confirmed on histology. All patients indicated symptom response to corticosteroids. Repeated TAUS in 8 patients noted 3 resolution, 3 improvement, 1 unchanged and 1 slight worsening. 6 (40%) patients required DMARDs (2 tocilizumab and 4 methotrexate).

Conclusion
TAUS facilitates early diagnosis of atypical GCA/LVV in patients who present with relatively normal inflammatory markers - our time-to-scan from steroid treatment was a median of 0 days. Early definitive treatment may explain the absence of ophthalmic morbidity amongst our patients. With an estimated population of 137,000 in south Manchester, these 15 cases suggest an incidence of atypical GCA/LVV to be 5.5 per 100,000 people. The elevated median BMI of our patients challenges the traditional notion that baseline ESR should be adjusted in patients with increased body mass. Relatively prolonged symptom duration (median 21 days) before referral to our FTP also challenges the notion that normal inflammatory markers in GCA/LVV reflects the window period of early presentation before disease evolution with subsequent inflammatory rise.

Disclosure
E.P. Chua: None.
P302 Trends in hospital admissions in patients with ANCA-associated vasculitis before and during the COVID-19 pandemic
Authors: Odingo Myron , Rutter Megan , Lanyon Peter , Grainge Matthew , Groves David , Bythell Mary , Aston Jeanette , Stevens Sarah , Pearce Fiona 
Published: April 2022

Abstract

Background/Aims
People with ANCA-associated vasculitis (AAV) have high rates of hospital admissions. They may have emergency admissions at the time of diagnosis, or day case admissions to receive immunosuppressive treatment. We describe the trends in emergency and day case admissions over the past 9 years, and the effect of the COVID-19 pandemic.

Methods
We extracted hospital episode statistics available publicly from NHS Digital for 2012/13 to 2019/20 and added provisional data from the National Congenital Anomaly and Rare Disease Registration Service for 2020/21 under their legal permissions (CAG 10-02(d)/2015) because the publicly available data had not yet been released. We extracted all emergency and day-case admission rates with ICD codes for each AAV subtype (M301, M313 and M317, in the primary position denoting main admission diagnosis). We used England population estimates from the Office for National Statistics as the denominator for rates. We calculated Poisson confidence intervals to quantify the difference in rates between 2019/20 and 2020/21 financial years.

Results
Rates of day case admissions per 1,000,000 for AAV increased from 49.1 (47.2 - 50.9) in 2012/13 to 63.3 (61.2 - 65.4) in 2019/20, then decreased by 26.4% to 48.6 (46.7 - 50.4) in 2020/21 (Table). The trends in emergency admissions were relatively unchanged between 2012/13 and 2019/20 (mean 6.7 per 1,000,000), and there was no significant decrease in emergency admissions during the COVID-19 pandemic.

Conclusion
Day case admission rates increased between 2012/13 and 2019/20 but decreased during the COVID-19 pandemic. Emergency admission rates for patients with AAV remained relatively unchanged, despite the context of the significant disruption and reconfiguration of healthcare services. Further work on patient-level data is needed to establish whether the day case reduction is due to fewer new patients or relapsing patients being diagnosed (and therefore fewer remission induction infusions) during this period or altered clinical practice leading to postponement of planned remission maintenance treatment that would have usually been given. Alternatively, this change may reflect a change in clinical practice to preferentially use oral rather than IV agents. All of this may have future consequences both for clinical practice and individual patient care and outcomes post-pandemic.

Disclosure
M. Odingo: None. M. Rutter: None. P. Lanyon: Grants/research support; Grants/research support; PCL has received funding for research from Vifor Pharma. M. Grainge: None. D. Groves: None. M. Bythell: None. J. Aston: None. S. Stevens: None. F. Pearce: Grants/research support; Grants/research support; FAP has received funding for research from Vifor Pharma.
P305 Validating diagnostic GCA ultrasonography skills against an expert sonographer
Authors: Coath Fiona L , Mukhtyar Chetan 
Published: April 2022

Abstract

Background/Aims
Ultrasonography has become the recommended first line investigation for suspected giant cell arteritis (GCA). However, it is still not yet widely available in the UK due to a paucity of skilled rheumatologists. Effective training programmes have been developed, but subsequent hands-on practice is needed to become truly proficient. There is no consensus on the logistics of gaining the ‘appropriate’ level of skill. This project demonstrates a potential mechanism for validation against an expert sonographer.

Methods
Over a 6-month period, 12 scans of patients referred with suspected GCA were sequentially performed by first a trainee (FC) and then an expert sonographer (CM) on the same day. FC had theoretical knowledge and supervised practical experience but had not scanned independently prior to this project. CM has performed &gt;1000 scans. 6 vascular territories considered to be the core GCA US data set (common, frontal and parietal branches of the superficial temporal artery, and the 1st, 2nd and 3rd part of the axillary artery) were marked as either ‘normal’ or ‘halo’. CM was blinded to FC’s results. Inter-observer reliability was calculated for all vascular territories using Cohen’s kappa.

Results
A total of 144 vascular territories were scanned in 12 patients. Table 1 details the inter-observer variation, with a near perfect level of agreement demonstrated, kappa=0.90 (95% CI 0.83 - 0.98).

Conclusion
This is the first study that demonstrates a mechanism for validation of ultrasonography skills which will allow GCA US to become a feasible reality in clinical practice. This project demonstrates that after acquiring supervised training, near perfect levels of agreement can be arrived between a trainee and expert.

Disclosure
F.L. Coath: None. C. Mukhtyar: None.
A Standardized Technique for Gummy Smile Treatment Using Repeated Botulinum Toxins: A 1-year Follow-up Study
Authors: Adel Noury 
Published: April 2022

Summary:
The present study was performed to evaluate the effect of repeated botulinum toxin injections and their long-term effects, using a customized injection point and dosage technique in the treatment of excessive gingival display. Twenty women who had gummy smile due to hypermobility of the upper lip or gingival display, ranging from 4 to 6 mm‚ were included in the study. All patients were injected with Botox injections at different injection points according to the type of smile. Pre- and postoperative measurements were taken by measuring digitally the gingival display at smiling, using Adobe Photoshop software via standardized digital photographs. Patients were followed up at 14 days, 4 months, 8 months, and 12 months. Postoperative measurements showed marked improvement at 14-day follow-up, with a significant reduction in the amount of gingival display. Relapse, however, occurred at 4 months and later. For excessive gingival display, Botox is an effective treatment that lasts for 2–3 months, with almost complete relapse at 4 months. We concluded from the results of our study that, despite repeated Botox injections at two follow-up intervals (4 and 8 months), the theory that repeated Botox injections may offer a permanent effect is still questionable.
Implementation of an At-home Blood Pressure Measurement Protocol in a Hypertension Management Clinical Trial During the COVID-19 Pandemic
Authors: Miller Hailey N. , Berger Miriam B. , Askew Sandy , Trefney Elizabeth , Tyson Crystal , Svetkey Laura , Bennett Gary G. , Steinberg Dori M. 
Published: April 2022

Background
The Dietary Approaches to Stop Hypertension eating plan is an evidence-based treatment of hypertension; however, adherence to the Dietary Approaches to Stop Hypertension is low. To improve adherence to the Dietary Approaches to Stop Hypertension among adults with hypertension, we designed Nourish, a 2-arm, 12-month randomized controlled trial. The COVID-19 pandemic necessitated a change from in-person to remotely delivered visits, requiring substantial protocol modifications to measure blood pressure accurately and safely for secondary outcome data.

Purpose
The purpose of this article is to describe the implementation of an at-home blood pressure measurement protocol for the Nourish trial.

Conclusion
Our investigator team and study staff developed and implemented a robust and feasible blood pressure measurement protocol to be executed within an at-home format.

Clinical Implications
The described blood pressure measurement protocol provides a framework for use in future clinical trials and clinical settings in which a remote visit is preferred or required.
Comfort Level of Occupational and Physical Therapist Students in Addressing Sexual Issues With Patients
Authors: Dockter Mary , Parker Michael , Gebeke Lauren , Scheresky Kara , Tulintseff Alexandra , Truscinski Madison , Ver Burg Kyle , Abraham Karen , Reisch Rebecca 
Published: April 2022

Introduction.
Addressing a patient's sexuality and sexual health is an important component of holistic health care, but there are several challenges affecting students' comfort levels. Studies have indicated that patients want to talk about sexual issues, but there is a lack of conversation initiation from the health care providers. Although there is research to indicate that occupational therapists (OTs) are more comfortable than physical therapists (PTs) in discussing sexual issues, both professions report a lack of content within their respective programs. The purpose of this study was to determine comfort levels of OT and PT students when discussing and addressing sexual issues, as well as demographic factors that might influence comfort level and perceived barriers.

Methods.
A survey was sent to OT and PT students from 3 different universities inquiring as to the respondent's demographics, academic and clinical training, comfort level with various patient scenarios, and perceived barriers to addressing sexual issues. Mann -Whitney U and Kruskal -Wallis statistical tests were used to analyze the differences in comfort levels between groups of students, and open ended questions were coded into themes based on similarity and frequency of responses.

Results.
A total of 128 students completed the survey. Third-year students, regardless of professional program, were more comfortable addressing sexual issues compared with first-year students. The most common barriers to addressing sexual issues with patients included lack of experience and lack of knowledge.

Discussion and Conclusion.
Overall, the comfort level was affected by age, academic year, personal demographics, and perceived confidence. Neither geographical location nor religious background had a significant influence on student comfort level.
Acuity-Based Staffing in Labor and Delivery Using Electronic Health Record Data
Authors: Jones Lynn W. , Hall Valerie L. 
Published: April 2022

Abstract

Background:
Planning safe and effective nurse staffing can be challenging for nurse leaders of labor and delivery units due to the dynamic nature of birth and unpredictable fluctuations in census and acuity. The electronic health record (EHR) has a vast source of patient data that can be used to retrospectively review patient needs and nurse staffing gaps that can serve as a basis for prospective planning for nurse staffing.

Purpose:
This quality improvement project was initiated with the goal of developing real-time and longitudinal reports to quantify hourly nurse staffing needs based on patient census, acuity, and required clinical interventions from data that are contained with the EHR. The plan was to determine trends and nurse staffing needs for each 24-hour period every day of the week and identify ongoing staffing patterns to meet the Association of Women's Health, Obstetric, and Neonatal Nurses' (AWHONN) staffing guidelines.

Methods:
The obstetric nursing leadership team worked with the information technology specialists and developed an algorithm that identifies patient acuity level, indicated clinical interventions, and outlines necessary staffing requirements to provide safe high-quality care. Various reports were built in the EHR to inform the nursing leadership team about nurse staffing on a real-time and historical basis.

Results:
The reports provided quantitative data that supported a budgetary increase in nurse staffing and a more flexible nurse staffing scheduling system to meet the needs of the patients. The project was successfully implemented in all four of the hospital system maternity units.

Clinical Implications:
Use of EHR in labor and delivery units is nearly universal. Working with the information technology specialists to integrate nurse staffing data into the EHR is one way to align nurse staffing with the AWHONN nurse staffing standards in real-time and for projections of nurse staffing needs based on unit historical patient data.
Effects of the T337M and G391V disease-related variants on human phosphoglucomutase 1: structural disruptions large and small
Authors: Stiers Kyle M. , Owuocha Luckio F. , Beamer Lesa J. 
Published: April 2022

Phosphoglucomutase 1 (PGM1) plays a central role in glucose homeostasis in human cells. Missense variants of this enzyme cause an inborn error of metabolism, which is categorized as a congenital disorder of glycosylation. Here, two disease-related variants of PGM1, T337M and G391V, which are both located in domain 3 of the four-domain protein, were characterized via X-ray crystallography and biochemical assays. The studies show multiple impacts resulting from these dysfunctional variants, including both short- and long-range structural perturbations. In the T337M variant these are limited to a small shift in an active-site loop, consistent with reduced enzyme activity. In contrast, the G391V variant produces a cascade of structural perturbations, including displacement of both the catalytic phosphoserine and metal-binding loops. This work reinforces several themes that were found in prior studies of dysfunctional PGM1 variants, including increased structural flexibility and the outsized impacts of mutations affecting interdomain interfaces. The molecular mechanisms of PGM1 variants have implications for newly described inherited disorders of related enzymes.
Maximising profit by waste reduction in postharvest Supply Chain of tomato
Authors: Karthick K. , Boris Ajit A. , Subramanaian V. , Anbuudayasankar S.P. , Narassima M.S. , Hariharan D. 
Published: April 2022

PurposeThe paper aims to analyse the postharvest Supply Chain (SC) of tomatoes to maximise profit by restructuring the modes of operation.Design/methodology/approachSystem Dynamics-based simulation of four scenarios depicting different operational modes of postharvest food SC was employed. Real-time of Tamil Nadu state, India was used to enact the scenarios using Vensim.FindingsResults indicated that cold storage improved the profit of wholesalers by prolonging the shelf-life of commodities. Retailers and farmers gained more profit in the absence of wholesalers. Though the absence of middlemen reduces the transit time and prevents deterioration, the role of wholesalers, i.e. transporting the commodities to farther customers’ needs to be shouldered by other agents effectively to minimise losses.Research limitations/implicationsThe accuracy of the results depend on the exactness of the data collected. The simulation findings, on the other hand, could be helpful in decision-making as these models portray the actual operational modes of postharvest SC. The suitability of each network structure depends on the capabilities of the agents, market scenario and demography. Implications based on discussions with stakeholders and in terms of establishing dedicated societies (cooperatives) have been provided.Originality/valuePostharvest losses incurred for horticultural crops like tomatoes are significantly high. It is of much importance to India as agriculture contributes to 17% of the Gross Domestic Product (GDP) and India is the second-largest producer of tomatoes globally. The study would shed light on restructuring the network appropriately.
Factors affecting public perception of scientific information about organic foods
Authors: Koswatta Taniya Jayani , Wingenbach Gary , Leggette Holli R. , Murphrey Theresa Pesl 
Published: April 2022

PurposePublic perception of health benefits derived from organic foods is often misaligned with scientific evidence. This study aims to examine the factors affecting public perception of scientific information about organic foods.Design/methodology/approachThe authors conducted multinominal and multiple linear regression analyses to examine associations between public perception of scientific information about organic foods and 19 factors using data from a descriptive survey (N = 763).FindingsPerceived benefits of organic foods, trust in scientists, communicator credibility, preexisting beliefs and events related to science (e.g. COVID-19) were significant predictors of public perception of scientific information about organic foods.Theoretical implicationsCognitive dissonance and recreancy theoretical frameworks help describe relationships between beliefs, science, trust and risk. These theories intersect when purchasing credence goods (i.e. organic foods) whose qualities cannot be observed during or after purchase. Hence, public trust of scientific information about perceived health benefits of organic foods may conflict with strongly held beliefs that contradict scientific findings.Practical implicationsScientists can more effectively share research findings after trust is established through the listening, asking and sharing values process. Therefore, by following the path of listening, asking and sharing the endogenous/exogenous factors in this study, scientists and the public can have meaningful conversations about perceived health benefits and nutritional values of organically and conventionally grown foods.Originality/valueCurrent research on perception factors about organic foods often examined consumers' perceptions and purchase intentions but rarely considered perceptions of scientific information about organic foods. This study examined relationships between public perception of scientific information about organic foods and endogenous/exogenous factors.
A multi-stage method to determine organizational constraint structure and its application in a steel plant in India
Authors: Singh Saroj Kumar , Raj Alok , Kumar J. Ajith , Foropon Cyril 
Published: April 2022

PurposeThe purpose of this paper is to identify potential constraints and determine the constraint structure in a steel manufacturing plant. “Potential constraint” is defined as a factor that is either a constraint at present or can become one in the future and “constraint structure” is used to denote the network of influences between the potential constraints in an organization.Design/methodology/approachA three-step methodology was followed. First, potential constraints in a steel manufacturing plant were identified with a literature review and expert inputs. Then, the fuzzy decision-making trial and evaluation laboratory (fuzzy DEMATEL) technique was applied to uncover the structure and finally, an ex-post validation and refinement of the results was done with help from other experts.FindingsA total of 10 key potential constraints to steel manufacturing were identified. The two outputs of fuzzy DEMATEL – the influence scatter plot (ISP) and the influence network diagram (IND) – together reveal the constraint structure. The 10 potential constraints could be classified into three types – influencers, mediators and influenced – respectively. Of these “Top management commitment (TMC)” and “Clear vision and long-term planning (CLP)” influence other factors the most, and are themselves influenced the least; while “Customer Relationship Management (CRM)” is most influenced by other factors, while influencing other factors the least.Practical implicationsPotential constraints and the constraint structure can help decision makers in a steel manufacturing plant to identify which organizational factors to address and achieving the plant's goals.Originality/valueThis is the first study that analyzed organizational level constraints in a steel manufacturing context.
The impact of enterprise niche on dual innovation performance: moderating role of innovation openness
Authors: Zhang Hui , Xiong Huanhuan , Wang Qian , Gu Yongjie 
Published: April 2022

PurposeThis paper aims to explore the impact of enterprise niche on dual innovation performance and the moderating role of innovation openness on the relationship between enterprise niche and dual innovation performance.Design/methodology/approachThis study uses the panel data of the enterprise technology patents of China's Top 100 Electronic Information Enterprises from 2009 to 2018. Multiple regression analyses were used to test the hypotheses.FindingsNiche width has a significant positive impact on exploitative and exploratory innovation performance. Niche overlap has an inverted U-shaped effect on exploitative innovation performance and significantly positively affects exploratory innovation performance. Innovation openness negatively moderates the impact of niche width on exploitative innovation performance and positively moderates the impact of niche overlap on exploitative innovation performance.Originality/valueThis study provides new insights into the effects of enterprise niche on dual innovation performance by showing the moderating role of innovation openness. The study finds a strategic logic of moderate niche overlap, clarifies the innovative effect of different innovation openness modes and reveals the construction and management mechanisms of enterprise niche and innovation openness strategy.